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 aim of this research is to measure and analyze the gap between the actual reality and the requirements of the environmental management system in the middle refineries company/refinery cycle according to ISO14001: 2015, as well as to measure the availability of a clean production strategy and test the relationship and impact between the availability of the requirements of the standard and a clean production strategy for the actual reality in the company.
The research problem was determined by the extent to which the requirements of the environmental management system are applied according to ISO14001: 2015 in the middle refineries company? To what extent are the required clean production strategies ava
... Show MoreThe study aims to identify the impact of competency-based training in its dimensions (skills, cognitive abilities, attitudes, and attitudes) in improving the performance of employees (achievement, strategic thinking and problem solving) in Jordanian university hospitals.
The study based on analytical descriptive method. The study population consisted of the Jordanian University Hospitals, the University Hospital of Jordan and the King Abdullah Hospital, as applied study case. The sample of the study consists of all upper and middle administrative employees of these hospitals; questionnaire distributed all of them and the number of valid questionnaires for analysis were 182 questionnaire.
... Show MoreThis paper assesses the impact of changes and fluctuations in bank deposits on the money supply in Iraq. Employing the research constructs an Error Correction Model (ECM) using monthly time series data from 2010 to 2015. The analysis begins with the Phillips-Perron unit root test to ascertain the stationarity of the time series and the Engle and Granger cointegration test to examine the existence of a long-term relationship. Nonparametric regression functions are estimated using two methods: Smoothing Spline and M-smoothing. The results indicate that the M-smoothing approach is the most effective, achieving the shortest adjustment period and the highest adjustment ratio for short-term disturbances, thereby facilitating a return
... Show MoreThe current research presents a study of the sculptural body in the space of the theatrical show through reviewing most of the ideas, propositions and workings presented by philosophers and directors within the space of the show, that there were various experiences of employing those spatial formations through the mediator (the space) based on sculpturing the body in achieving those formations, which contributed in building a symbolic picture of various structural connotations. That was formulated through the research chapters, which include the first chapter (the methodological framework) which consists of two sections. The first section (the duality of space formation and imaginations). The second section (sculptural body sequences in
... Show MoreThe technology and modern social communication medias have contributed to changing many of our concepts about education to a large extent; these technological advancements have created new challenges for the Instructor of course, but on the other hand it did provided him with expressive media, models and strategies that the old methods cannot fulfill, including the flipped classroom strategy, which is one of the modern technical solutions and in it's optimal use it can correct the weakness of the traditional education and can develop the communication skills as a whole among the students, in order to create a positive, active and interactive student.
The current research contained - four chapters: the first one included the methodolog
Many reasons combined behind the Standing of U.S. against Britain in its aggression against Egypt in 1956; the consensus of world opinion on the need to stop the aggression and the fear of the Soviet military intervention which mean a new world war.
United States desired to weaken British influences in the region in general to get new oil gains in the Arabian Gulf and Egypt at the expense of Britain. The exiting of Britain from the area served U.S. strategic interests in the Middle East in general and Egypt in particular to keep the flow of oil for U.S advantage.
The United States wanted to keep its image in the region to apply its future political projects including Eisenhower Project, which intended to take the position of Britis
Abstract
Abstract has many advantages as has historically been one of the regions leading cultural centers . for centuries , it has been a center of commertial and financial operations in Iraq. it is also rich in archeological sites and natural resources, but because of its wars and implementation of urban development strategies are effective and sustainable , so contracted the secretariat of Baghdad with the company (khatib and scirntiffic) for the preparation of the comprehensive development plan for the city of Baghdad in 2030 and funded by the world bank and the fact that the plan was approved ( three stages of it ) and only one phase remains the fourth stage, which is under discussion the aim of the
... Show MoreThe research aims to study the marketing costs in its various items, which are important costs as it specializes in tunnels on the marketing side through which the company's services are introduced to ensure that these services reach as many segments of society as possible, which serves the company's objectives and expand its business and increase its market share. As well as the definition of profitability and its relation to marketing costs in the portfolios of the national insurance company. The research hypothesis was formulated to study and analyze the relationship and impact between the marketing costs and profitability of the research sample company. The research sample was determined by the National General Insurance Comp
... Show MoreAbstract:
The research seeks to explain the role of the international auditing standard (3402) in the auditor's procedures, where the importance of the research stems from the adoption of international auditing standards in the Iraqi environment, including the standard (3402) of assurance engagements that the external auditor performs by submitting reports on the design of control tools and their operational effectiveness in a service facility that provides the beneficiaries with a service. To provide useful information for service organizations The control tools are of great benefit in rationalizing decisions, and many recommen