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.
The graphic privacy feature is one of the most important specifications for the existence of any type of design achievements alike, which is one of the graphic products with its multiple data, and from here the current research investigates the graphic privacy of vector graphics design with all its technical descriptions and concepts associated with it and the possibility of achieving it to the best that it should be from Where its formal structure in children's publications, where the structural structure of the current research came from the first chapter, which contained the research problem, which came according to the following question: What is the graphic privacy in the design of vector graphics in children's publ
... Show MoreThe fouling depositions of crude oil stream were studied theoretically in a shell and tube heat exchanger to investigate the effect of depositions on the heat transfer process. The employed heat exchanger was with steam flowing in the inner tubes and crude oil in the shell at different velocities and bulk temperatures. It is assumed that fouling occurs only on the heated stream side (crude oil). The analysis was carried out for turbulent flow heat transfer conditions with wide range of Reynolds number, bulk temperature and time. Many previously proposed models for fouling resistance were employed to estimate a new model for fouling rate. It is found that the fouling rate and consequently the heat transfer coefficient were affected by Rey
... Show MoreClass consciousness represents its highest stage in the contemporary Marxist thought of Rosa Luxemburg and Antonio Gramsci, not just a reflection of reality, but rather a dialectical form through the reflection of consciousness on reality and its reproduction. The superiority over the infrastructure (historical materialism) promised the revolutionary class consciousness to be achieved spontaneously, and the seeds of a breakthrough are mass strikes, denying the role of the party to organize this awareness, limiting its role to the interconnection between classes, emphasizing the role of socialist democracy as a conscious vanguard for organizing spontaneity, struggle, and developing awareness during the revolutionary process and the leader
... Show MoreBackground: This study is to evaluate the necessity of prescribing prophylactic antibiotics for nasal packing in spontaneous epistaxis. There are few published papers of infective complications in such patients.
Methods: This prospective study analysed 149 consecutive patients admitted to AL-Kindy teaching hospital with spontaneous, epistaxis, who underwent nasal packing over 2 years period . in the first year, 78 patients received prophylactic antibiotics , In the second year 71 patients were not given prophylatic antibiotics. Exclusion criteria included antibiotics prescribed for unrelated pathology and post-operative epistaxis. Signs and symptoms of acute otitis m
... Show MoreThe cities are not yet a temporal status in the process of the human and civilization development. The cities consider as a life pattern, this mean that people cannot live without cities, which surround us. Several phenomena like globalization, revolution of information, technical development, increased of consumption, do not confirmed without the living in cities. The urbanization – in its simple meaning – means transferring from rural community to city community. In other word, it means that socioeconomic changes happened subject to the patterns and conditions of the urban life. Each government depend a certain policy, this policy contains set of plans and programs, that targeting to affect the population factors and the st
... Show MoreThe specialist researcher fined the relations between economic ideas with economic facts in his theory which called humanity building it is appeared clearly ( in Ibn Khalduons’ Muqaddimah) in a clothe of economic social phenomenon's as a systematical analysis in all fifty chapters of al Muqaddimah ,therefore this paper deal with Ibn Khalduon economic thoughts as important says which describe the society building in its economic subjective and examine the relationship between The dissert and the city within economic says which are cover the social analysis ,and determinate the analysis objects which clearly in this dualism model ,between the state and economic bas
... Show MoreThe inner wasteland can be observed in Samuel Beckett’s early and later plays. His characters suffer from loss of identity, emotions, and sense of time. They lead a life of failure, repetition, inaction, loneliness, doubt, suffering, and nothingness. The inner wasteland includes many aspects, such as the multi and split identity, the habitual repetitive element of life, the dark sorrowful life the characters lead, lack of communication and relations among them, their unfree, inactive condition, their foggy terrible recollections, loneliness, dryness of love, and uncertainty. The analysis and the illustration of each aspect will show how the inner wasteland is intensified in the selected later plays of Beckett.