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.
Shear lag is the phenomenon that occurs when a supported slender member undergoes deformation from lateral loading, causing in-plane non-uniform distribution of stresses that results in reducing the member’s minimum strength capacity. This paper investigates the behaviour of shear distribution in steel I-section and box girders when subjected to both static and impact loadings. Three-dimensional finite element analysis models were prepared in Strand7 and validated against experimental results providing a basis for further comparison research into shear lagging effects. A parametric study was conducted comparing the effects of impact loading through certain specified velocities at the midspan of restrained ends. It provided new ins
... Show MoreBackground: Medical-surgical nurses are responsible of providing competent care to clients with a wide-array of acute and chronic health problems. This challenging task requires arming nurses with advanced competencies of health literacy to effectively educate their clients. However, evidence about medical-surgical nurse’s health literacy-related knowledge and experience is limited. Purposes: This study aimed to determine the level of the health literacy-related knowledge and experience among medical-surgical nurses.Design: A descriptive-cross-sectional study was conducted among a total sample of 177 nurses who were practicing in medical-surgical wards in teaching hospitals in Iraq. A convenience sampling method was used to sele
... Show MoreA rapid, sensitive and without extraction spectrophotometric method for determination of clonazepam (CLO) in pure and pharmaceutical dosage forms has been described. The proposed method was simply depended on charge transfer reaction between reduced CLO (n-donor) and metol (N-methyl-p-aminophenol sulfate) as a chromogenic reagent (π- acceptor). The reduced drug, with zinc and concentrated hydrochloric acid, produced a purple colored soluble charge-transfer complex with metol in the presence of sodium metaperiodate in neutral medium, which has been measured at λmax 532 nm. All the variables which affected the developed and the stability of the colored product such as concentration of reagent and oxidant, temperature and time of rea
... Show MoreObjective: The aim of this study was to formulate and in vitro evaluate fast dissolving oral film of practically insoluble bromocriptine mesylate to enhance its solubility and to improve its oral bioavailability by avoiding first pass effect as well as to produce an immediate release action of the drug from the film for an efficient management of diabetes mellitus type II in addition to an improvement of the patient compliance to this patient- friendly dosage form. Methods: The films were prepared by the solvent casting method using hydroxypropyl methylcellulose of grades (E3, E5, E15), polyvinyl alcohol (PVA), pectin and gelatin as film-forming polymers in addition to polyethene glycol 400 (PEG400), propylene glycol (PG) and glycerin were
... Show MoreNatural fractures provide an important reservoir space and migration channels for oil and gas reservoirs and control the reservoir potential. Therefore, it is essential to understand the methods for identifying accurate reservoir permeability and characterizing reservoir fractures. In particular, using conventional measurements to identify permeability and characterize fractures is very expensive. While using conventional logging data is very challenging, and an efficient characterization correlation method is urgently needed. In this paper, we have evaluated reservoir potential based on the sensitivity of sonic scanner tools to fluid mobility, maximum stress direction, and fractures presence. This tool provides a continuous estimat
... Show MoreThe high bounce activity according to the fosbery way is regarded as of the difficult sports concerning its way of training and perfection due to hard technique of its performance on one hand and because it depends on the player’s ability to overcome body weight resistance against the gravity. In addition to the strong ability to control the body posture when leaving the land and flying over the barrier. This activity needs to high plosion power at the moment of bouncing and this plosion depends on the period of bouncing, so the two researchers aimed to use a mechanical bouncing platform and an electronic one through several training by one foot and both feet in different directions and positions in order to reduce the time of bouncing an
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