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 study aims at diagnosing the importance of environmental analysis (external, industrial and internal) in the organization's strategy for the development of public organizations. The theoretical problem derived from the existence of a knowledge gap for studies and research that dealt with the variables of the study. Three public organizations were selected as the study society (the Civil Defense Directorate, the Directorate of Nationality, Passports and Residency, the General Traffic Directorate). The sample of the study was a sample of (215) managers (managers, department managers, Analysis of the data and hypothesis testing using the appropriate statistical tools, Pearson, the simple and multiple regression coefficient to te
... Show MoreColonialism as a movement was very popular in Europe more than two centuries before. It aimed at controlling and exploiting several countries in Africa and Asia in addition to imposing their power and control on uninhabited islands. It received adherence and criticism as well. There also appeared activists and nations who stood against it and its practices. English novels discussed this notion greatly by pointing out the bad practices of the colonizers and how the colonized received them. This paper explores two narrative fictions that tackle the different aspects of the term. While Defoe, in Robinson Crusoe (1719), shows a colonial European figure who expresses his superiority, Wells, in “The Country of the Blind” (1904), deconstructs
... Show MoreBackground: The problem of difficult gallbladder is not clearly defined and associated with real missing of therapeutic approaches that decreased morbidity. Moreover, the difficult gallbladder was reported as a contributing risk factor for biliary injury due to raised difficulty in surgical dissection within Calot’s triangle. The aim of this study is to determine the surgical outcomes of the open fundus-first cholecystectomy in lowering the rate of lethal intraoperative risks.
Subjects and Methods: Our prospective study conducted during the period of January 2019 to December 2022 at Ibn Sina specialized hospital, Khartoum, Sudan, for two hundred and fifty-three patients underw
... Show MoreThe aim of the research is to identify the adequacy of accounting disclosure in granting bank financing in explaining the role of accounting disclosure in granting bank financing by linking the concepts of full, comprehensive and adequate disclosure to bank financing. The impact of full accounting disclosure on granting bank financing, the existence of an impact of comprehensive accounting disclosure on granting bank financing, the existence of an impact of adequate accounting disclosure on granting bank financing, and the research relied on the descriptive approach, the deductive and inductive approach, the inferential analytical approach, a
... Show MoreEvaluation of “Holy Quran & Islamic Education” Curriculum for Second Intermediate Stage from Perspectives of Teachers & Supervisors of material A Field Study conducted in the Directorates-General of Education in Baghdad Governorate. It goes without saying that educational curricula for students of all stages of schooling are in bad need of reviewing, evaluation and revision. The Islamic education curriculum is no exception, since it is a basic subject that plays a role in developing the individual’s moral and conscientious aspects, promotes his/her inner discipline and helps establish coherence with the values system of the community to which he/she belongs.
Based on the foregoing, the evaluation process of
... Show MoreSatire is genre of the literary arts that has always been the source of human interest. Because it is difficult to accept direct criticism, Satire appears as a literary tool in which vices, follies, abuses and shortcomings are held up to ridicule, with the intent of shaming individuals, corporations, government, or society itself into improvement. A satirical critic usually employs irony to attain this goal. Although satire is usually meant to be humorous, its greater purpose is often profitable social criticism, using wit to draw at
... Show MoreThis research aims to know the reality of implementation of Knowledge Management in Saudi Universities Applied in Shaqra University and to study the difficults whish encountered in applying the Knowledge Management approach.
The study investigated the university staff in Shaqra, Thadig, and Huraymila branches, using a questionnaire designed by the researcher to collect the data, sample of (260) members was used, applying the descriptive analytical approach to test the hypothesis by using (SPSS) program.
The study revealed that the first four zero hypothesis are rejected because there is medium approval of the university members on the fo
... Show MoreThe relationship between respiratory diseases and natural geographical variables relative to temperature, relative humidity, wind and solar radiation is a strong one.
The environmental factors have impact on increasing the proportion of people with respiratory diseases in the province of Najaf, especially industrial pollution and working conditions as well as the economic level.
Ah-Mishkhab was in the first rank in terms of the number of people infected with respiratory diseases reached 135177 and 41%, followed by Najaf governorate which reached its numbers to 77801 and 23%. The district of Kufa ranked third with 42051 and 13%, and the other administrative units at fourth and fifth rank respectively.
When comparing diseases and
Medium Access Control (MAC) spoofing attacks relate to an attacker altering the manufacturer assigned MAC address to any other value. MAC spoofing attacks in Wireless Fidelity (WiFi) network are simple because of the ease of access to the tools of the MAC fraud on the Internet like MAC Makeup, and in addition to that the MAC address can be changed manually without software. MAC spoofing attacks are considered one of the most intensive attacks in the WiFi network; as result for that, many MAC spoofing detection systems were built, each of which comes with its strength and weak points. This paper logically identifies and recognizes the weak points
and masquerading paths that penetrate the up-to-date existing detection systems. Then the
A sentence is a key part of Spanish grammar and serves as the fundamental unit in constructing discourse. However, foreign language learners, particularly Arabic speakers, may face complex aspects that hinder their understanding and correct use of sentences. Additionally, there are at least two linguistic approaches that describe the use of compound sentences: one considers the sentence as the basic unit for discourse analysis, while other studies, starting with Van Dijk (2003), emphasize the importance of understanding both the partial and holistic structure of discourse. Therefore, we consider the significance of reviewing the linguistic differences between the native language and Spanish as a potential cause of misunderstanding a
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