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.
ABSTRACTBackground: cochlear implants are electronic devices that convert sound energy into electrical signals to stimulate ganglion cells and cochlear nerve fibers. These devices are indicated for patients with severe to profound sensorineural hearing losses who receive little or no benefit from hearing aids. The implant basically takes over the function of the cochlear hair cells. The implant consists of external components (microphone, speech processor and transmitting coil) and internal components (receiver stimulator and electrode array). The implant is inserted via a trans mastoid facial recess approach to the round window and scala tympani.Objectives: to determine the effectiveness and safety of non fixation method in cochlear imp
... Show MoreRecent decades have witnessed tremendous economic development that has led to the spread of international companies (multinational companies) and its activity has expanded to cover many countries of the world, with intense competition among countries to attract more international investments, which has led to the emergence of some controversial accounting issues in many Relevant areas, including accounting for transactions in foreign currencies, translation of financial statements for companies and foreign branches, as this issue is an important and sensitive topic because many of its aspects are controversial and not yet resolved, especially with regard to the variation in standards and Relevant accounting practices from one country to
... Show MoreThe achievements of the art that we know today are questioned in motives that differ from what art knew before, including dramatic artistic transformations, which he called modern art.
In view of the enormity of such a topic, its ramifications and its complexity, it was necessary to confine its subject to the origin of the motives of the transformations of its first pioneers, and then to stand on what resulted from that of the data of vision in composition and drawing exclusively, and through exploration in that, we got to know the vitality of change from the art of its time.
And by examining the ruling contemporary philosophical concepts and their new standards and their epistemological role in contemporary life, since they includ
Refuse derived fuel (RDF) is considered one of the most important types of low cost thermal energy which can be tapped in the industry, especially the cement industry in particular being the need of high thermal energy during the production processes, and in this paper we have implemented the use of a derivative of the fuel RDF as a substitute for gasoline , to reduce production costs and thereby achieve production efficiency, and the methodology used in this research statistical analysis as well as the use of the cost of kaizen target for the purpose of reducing costs and achieve production efficiency, and this has reduced the cost total cement production by which led to reduce total costs of cement production by 8.4% and an incre
... Show Moreesearch Summary
Holidays and occasions in Islamic societies have a legal character and origin. Some of them are proven by the words and actions of the legislator, and some are within the scope of custom that is regulated by the honorable Sharia, and others are approved by scholars and people because of their connection, piety and charity. It has a kind of good.
One of the purposes of the noble Sharia is to glorify the honorable times associated with the blessed events, so that lessons and lessons may be recalled in them, and to activate the legitimate gifts in those events that develop in the individual, the family and the community the meanings of goodness and honor and all that is good and good. Accord
... Show MoreInfertilityis oneuof the most problemsathatufacingaadvancedunations. In the general, about halfof allacasesaof the infertility are causedby factors thaturelated toathe male partner. Propos educausesvofumalev infertility include evgeneticuand environmental factors. Blood samples from 64 infertileumen allawere living in urban its al-Fallujah city (30 azospermeiauand 34 oligospermeia) and 32 fertile men (asuthe control group) were collected. Heavy metal concentrations inusera of infertile and fertile groupswereumeasured by using Atomic Absorption Spectrophotometer. Y- chromosomemicrodeletions were detected by using PCR techniques. Significantdifferences (P?0.05)uin the concentration ofucopper (0.0267±0.0147 and 0.0278±0.0273, for infertileua
... Show Moreتتبلور فكرة البحث حول التوصل لنوع العلاقة التي تربط التعليم الالكتروني خلال جائحة كورونا برفع المهارات التكنولوجية للأساتذة والطلاب، وتبرز أهمية البحث في ان نجاح الوصول لهذه العلاقة يمكن الإفادة منها في تغيير منهجية تطوير المهارات التكنولوجية مستقبلا وذلك باعتماد الجوانب التطبيقية الفعلية بدلا من الدورات وورش العمل والتي قد لا تضاهي الطريقة العملية في رفع مستوى المهارات المختلفة سواء التدريسية او التكنو
... Show MoreGlobal warming has had considerable effects on vital ecosystems, which has also been caused by increased temperatures and CO2 that follow changes in different abiotic factors, which poses threats to mangrove forests environment. This research was conducted to examine the physiological and morphological characteristics of the Rhizophora apiculata mangrove regarding higher air temperature for the variety of tree species that respond to climate change. Seedlings were cultivated for three months in regulated growth chambers with three varying temperatures of 38°C, 21°C under CO2 at 450 ppm, and ambient CO2 concentration i.e., 450 ± 20 ppm under average temperature at 28°C as the control condition
... Show MoreThe picture has taken a place that sometimes enables it to take precedence over media analysis، psychology، and political communication.
The image has the ability to influence to obtain persuasion، not only emotionally or
dramatically، but also on the level of commercial and political persuasion. In every
image، the intention of that persuasion is hidden.
It can be identified by a set of underlying dimensions such as vitality، social dominance، and confidence، for which a group of specific suggestions or movements، such
as a smile، the movement of hands، or the nature and way of looking with the eyes، is
established. The visual image often precedes its verbal counterpart in the proce