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.
As the process of estimate for model and variable selection significant is a crucial process in the semi-parametric modeling At the beginning of the modeling process often At there are many explanatory variables to Avoid the loss of any explanatory elements may be important as a result , the selection of significant variables become necessary , so the process of variable selection is not intended to simplifying model complexity explanation , and also predicting. In this research was to use some of the semi-parametric methods (LASSO-MAVE , MAVE and The proposal method (Adaptive LASSO-MAVE) for variable selection and estimate semi-parametric single index model (SSIM) at the same time .
... Show MoreThis research deals with the most important indicators used to measure the phenomenon of financial depth, beyond the traditional indicators, which are called quantitative indicators, which is shown to be inadequate to show the facts accurately, but it may come in the results of a counterfactual, although reliable in econometric studies done in this regard.
Therefore, this research has sought to put forward alternative indicators, is the structural indicators, and financial prices, and availability of financial instruments, and cost of transactions concluded, in order to measure the phenomenon of financial depth.
After using and analyzing data collected from countries the research
... Show Morehe study aims to build a model that revolves around the main question of the role of strategic agility (SA) in enhancing organizational excellence (OE). For the purpose of achieving OE and to determine the extent of interest and knowledge of managers at the Midwest Refineries Company (MRC) on the theoretical and practical implications, and on the performance foundations of these two vital variables with the aim of continuous improvement. A questionnaire was used and distributed to a random sample of 54 managers in this important energy production company. The study followed the descriptive analytical approach to answer the questions raised. The study model and dimensions were built according to reference models, most notably the models (Al-
... Show MoreThat the essential contribution of this research is a description of how complex systems analysis service of the properties of the queue in Baghdad Teaching Hospital using a technique network is techniques method (Q - GERT) an acronym of the words:
Queuing theory _ Graphical Evaluation and Review Technique
Any method of assessment and review chart where you will be see the movement flow of patients within the system and after using this portal will be represented system in the form of planned network probabilistic analysis and knowledge of statistical distributions appropriate for times of arrival and departure were using the program ready (Win QSB) and simulatio
... Show MoreImportance of study :
The interesting of industrial sector and developing it after corner stone. It is important to build economic balanced and get behind and front linkage for transformative industrials, and this is important to get balanced.
The value of transformative industry sector is more important than other sectors in economy, and this is reflect the capital in industrial sector .Industry sector is larger than other sectors ,so it regards the motive which moving the economic wheel .
The problem :
The research treats reduction and retreat the ind
... Show MoreObjective: Dental caries is a chronic infectious disease that is prevalent worldwide in all age groups. Numerous attempts have been made to develop conservative approaches to halt caries progression and restore enamel defects. This study aimed to investigate the effect of applying grape seed extract and chicken eggshell extract on the microhardness of demineralized enamel in permanent teeth. Methods: Forty-eight sound upper first premolars were used. Following demineralization with the demineralizing solution for 96 hours, they were distributed into four groups consistent with the treatment agent used: group A was treated with casein phosphopeptide amorphous calcium phosphate (as a control group), group B was treated with grape se
... Show More