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 environmental references represented by the intellectual, social, economic, political and religious pressures are considered fundamental factors for the artistic achievement whose importance comes from their multiplicity and branching into natural and psychological pressures that affect the multiplicity, diversity and variability of the artistic and performative methods. Thus they determine the artist's orientations and the creative artistic visions are summoned through symbols and semantic signs of the visual surface, because the societal thought in art in general and the fine art in specific occupies an influential position
... Show MoreConstruction is a hazardous industry with a high number of injuries. Prior research found that many industry injuries can be prevented by implementing an effective safety plan if prepared and maintained by qualified safety personnel. However, there are no specific guidelines on how to select qualified construction safety personnel and what criteria should be used to select an individual for a safety position in the United States (US) construction industry. To fill this gap in knowledge, the study goal was to identify the desired qualifications of safety personnel in the US construction industry. To achieve the study goal, the Delphi technique was used as the main methodology for determining the desired qualifications for constructio
... Show MoreTHE ACTUAL SOCIETY MODEL
Our society model has been showing signs of exhaustion since the end of the XX century. The recent appearance of the Covid-19 virus is another consequence of humanity's distance from Nature and the environment it inhabits. Also, climate change, environmental deterioration, loss of biodiversity, overexploitation of natural resources, and social inequality are some of the consequences derived from this separation between society and Nature. We must change our operating habits. Inevitably from a society based on the market, hyper consumption, fossil energy and individual enrichment at all costs, we will have to change to another
... Show MoreAbstract.The goal of this article is to find the CEO of Iraqi companies that use strategic planning and determine if they are capable of diagnosing the traits of strategic planning systems that improve these companies' capacity to successfully address crisis-related needs. The capacity of the company to successfully react to crisis needs and demands is enhanced by the use of strategic planning, according to a review of data from 64 enterprises utilizing statistical analysis. Furthermore, top and division or unit managers must be involved and committed for strategic planning to be successful. It also has to be planned with an external orientation and get more than just lip service from top and unit or division level managers. In other words,
... Show MoreSKF Dr. Abbas S. Alwan, Dhurgham I. Khudher, INTERNATIONAL JOURNAL OF ENGINEERING SCIENCES & RESEARCH TECHNOLOGY, 2015
The study of these selected traces shows that what Imam Mardini did on Imam al-Zayla'i and enabled him to graduate the hadiths of the book (guidance and conclusions) as well as in choosing the novel closest to Murad the work and not as described by al-Zayla'i .... never deserves descriptions.
This aims tackles the importance of the organizational energy of the hotel organizations that search the success in the business field to penetrate in the whole tourist markets, and to draw the policies and firm rules which must be framed with the administrative strategies that contributed in creativity and achievement the targets besides provide a future vision due to its position among the competitive henceforth achieving the activity. This is what the chapters tackle in the theoretical side. Also many general questions have been arisen to determinate the importance of the research and many other special questions that express the problem of the study. To limit the levels of study alter
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