Clopidogrel is a prodrug that must be transformed into an active metabolite by hepatic cytochrome P450 (CYP) isoenzymes to prevent platelet clotting. Polymorphisms of the CYP2C19 gene can cause a reduction or complete loss of CYP2C19 enzyme activity resulting in inhibiting clopidogrel metabolism, effectiveness and increase stroke recurrence risk in ischemic stroke patients. This study aims to investigate the correlation between genetic polymorphisms in CYP2C19*2 and*3 and recurrent risk in patients with ischemic stroke taking clopidogrel 75mg in Kurdistan region –Iraq. This retrospective case-control study was carried out at Kurdistan, Erbil, Medicina medical center, and Rizgary general hospital from January 2021 to August 2021. The blood sample was taken from the participants and tested for genotyping. The collection of data was taken from patients' medical charts in the hospital and patients’ electronic medical records from the neurology clinic. Sixty patients participated, (34) were male and (26) were female, with age range (38-96) years, diagnosed from not more than two years with ischemic stroke and taking 75 mg clopidogrel maintenance dose. Genotyping analysis showed 61.7 % were homozygotes for wild allele *1, the heterozygotes divided into 26.7% (*1/*2) and 6.7 % (*1/*3) genotype, while the homozygotes for mutant alleles CYP2C19*2,*3 distributed in 3.3 %(*2/*2) and 1.7 %(*3/*3). The (*2/*3) was not detected in the study population. A significant relation was found between risk of stroke recurrence with carrying the variant allele CYP2C19 *2, reduced CYP2C19 enzyme metabolic activity, and ACEIs/ARBs usage (P = 0.024, P = 0.039, P=0.24 respectively). On the other hand, there was no significant relationship between the risk of stroke recurrence and carrying the variant allele CYP2C19 *3 (P = 1.000). Ischemic stroke patients treated with clopidogrel and carrying a CYP2C19*2 allele had a higher risk of recurrent stroke as it is associated with reduced the metabolic activity of CYP2C19 enzyme leading to reduction of clopidogrel effect.
Role of public relations (PR) and from one community to another, depending on the different cultures of these societies in General, and different ethical values established by their practitioners in these communities organizations , public relations in developed societies, and in some developing countries have taken great strides to contribute to the strategic planning and decision-making, in the framework of their commitment to the values and ethical standards for practitioners, In contrast, we find that applied in Iraq still skips phase coordinate with different communication means with the aim of advertising and publicity for the organization. As a result of the limited recognition of the strategic and vital
... Show MoreThis work aims to show the nature of the relationship between management by walking around (the independent variable) and strategic renewal (the dependent variable), as well as it shows the effect of the independent variable on the dependent variable. Questionnaire items were considered the main tool for data collection by three basic aspects. The first involved the personal data of the respondents, while the second included items related to management by walking in five dimensions, and the third is strategic renewal items by addressing four dimensions. The tourism sector, while the community has six Excellent grade hotels was taken into account in this wor
... Show MoreThe current research aims to know the method and strategy of rainstorming for students to open the door towards innovation and creativity in the field of teaching the subject of geography and the importance of brainstorming method and the studies that touched on it. The study also dealt with the steps of teaching the method of brainstorming and the most important (traditional and modern), and the difficulties of using the method of brainstorming in the teaching process, as well as explained the guidance to improve teaching using the method of brainstorming in the teaching p
... Show MoreBackground The escalating global concern over increased body weight in adolescents, coupled with the rising rates of adolescent pregnancy worldwide, presents a significant challenge to healthcare systems. We plan to identify the maternal and neonatal consequences associated with pre-pregnancy overweight in adolescent women. Methods Throughout five years, all singleton adolescent pregnant women with pre-pregnancy self-reported body mass index (BMI) of 18.5– ≤ 29.9 were involved during the first-trimester visit. Two groups were generated: overweight and appropriate-weight (BMI 25–29.9 and 18.5–24.9, respectively). Obstetric and neonatal outcomes were observed prospectively and statistically adjusted for the confounding factors.
... Show MoreThis research is a pragmatic study of political blame in British and Iraqi Parliaments. It aims to unfold the similarities and/or differences in terms of the pragmatic and pragma-rhetorical strategies used by British and Iraqi politicians when they exchange blame in both offensive and defensive situations. A statistical analysis is conducted to quantitatively support the findings of the pragmatic analysis. The analyses conducted have yielded different results among blame is a process composed of two stages. Each stage is distinct for its pragmatic components and pragma-rhetorical strategies. British and Iraqi MPs at the blame stage tend to utilize impoliteness as their main strategy. However, British and Iraqi MPs perform differently at the
... Show MoreIn this paper, mesoscale modeling is performed to simulate and understand fracture behavior of two concrete composites: cement and asphalt concrete using disk-shaped compact tension (DCT) tests. Mesoscale models are used as alternative to macroscale models to obtain better realistic behavior of composite and heterogeneous materials such as cement and asphalt concrete. In mesoscale models, aggregate and matrix are represented as distinct materials and each material has its characteristic properties. Disk-shaped compact tension test is used to obtain tensile strength and fracture energy of materials. This test can be used as a better alternative to other tests such as three points bending tests because it is more convenient for both field and
... Show MoreNew, easy, simple, and fast spectral method for estimation of sulfamethoxazole (SMZ) in pure and pharmaceutical forms. The proposed method is based on the azotization of the drug compound by sodium nitrite in an acidic medium and then coupling with 2,3dimethyl phenol reagent (DMP) in a basic medium to yield an orange-coloured dye which shows λmax at 402 nm. Different affection of the optimization reaction has been completed, following the classical univariate sequence. The concentration of sulfamethoxazole about (1-15) μg. mL-1 with molar absorptivity of (14943.461) L.mol1 .cm-1 that obeyed Beer’s law. The detection and quantification limits were (0.852, 2.583) μg. mL-1 respectively, while the value of Sandell’s sensitivity (
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