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.
Death is undoubtedly the theme of Don DeLillo’s White Noise. Murray Siskind, a College-on-the-Hill professor who is obsessed with the exploration and reinterpretation of American popular culture, talks about the Tibetan Book of the Dead, and the German mentor of Jack Gladney has been using the Egyptian Book of the Dead, translated into German. The core episode of the story is the Airborne Toxic Event, the associate of Heinrich (Jack’s teenage son), Orestes Mercator, dreams of becoming one of the great figures in the Guinness Book by challenging and confronting death by enclosing himself in a glass pen jam-packed with poisonous snakes, and Heinrich challenges an imprisoned mass murderer in a chess game. The scholarly expertise of Jack c
... Show MoreBackground: Gray-scale sonography is generally
considered as a first-line diagnostic tool for patient with
suspected acute cholecystitis. It is suggested by gallstones,
Murphy's sign, thickening of the gallbladder wall and bile
sludging, but the specificity of these sonographic findings
are not as high as their sensitivity. Blood flow of the
gallbladder wall is increased in acute inflammation.
Objective: To evaluate the sensitivity and specificity of
power Doppler sonography and compared with conventional
color Doppler and gray-scale sonography in diagnosing
patients with acute cholecystitis.
Type of the study: This was a cross sectional study.
Patients and methods: The study was conducted t
The villa was incredible, summer was hot, and the Mediterranean Sea was so near.
Scil lived happily with her father as they needed no one else. But the visit of a calm and intelligent women caused huge shift in this delightful mess. So, how can this threat be stopped?
This novel displays to the reader a rich study of human soul to implicitly while being supported by short sentences and characterised by persons living in a horrible way and described in very short sentences.Thus, Françoise Sagan’s imagination was enflamed, and so he shaped ethical imagery in the moste wonderful way in the novel Hi, Sadness.
Rés
... Show MoreThe reason for my choice of the topic (what Imam Al-Tirmidhi mentioned in his book Al-Sunan regarding the provisions of sales) is that he mentioned many topics that affect people's lives, which are represented by commercial transactions and the exchange of benefits between them, so it became clear to them what is forbidden and what is not, aiming not to fall into the prohibited, and to achieve their interests, and relieve them of embarrassment. What we will see in the research.
In this study, the water treatment plants located on the Tigris River within Baghdad city were subjected to qualitative and quantitative assessments. Based on location, the plants from upstream to downstream are Al-Karkh, East Tigris, Al-Karamah, Al-Wathbah, Al-Wehdah, Al-Kadiseyah, Al-Dora, and Al-Rashid. Data from 2009 to 2020 on the turbidity, total dissolved solids, Alkalinity, hardness, chloride, calcium, and temperature were used in the qualitative assessment while data on the treated water production and population served were used in the quantitative assessment. The above Data was acquired from the Municipality of Baghdad. The turbidity was mainly used as a fair gauge to assess the performance of the water treatment plants in Baghda
... Show MoreThis study present, the density of alum chrom in water and in aqueous solution of poly (ethylene glycol) (1500) at different temperature (288.15, 293.15, 298.15) k. Experimental values of density was used to calculate the apparent molar volume (Vθ), limiting apparent molar volume Vθ˚, experimental slope (Sv) and the partial molar volume at infinite dilution of transfer of solute Δνθ˚. These results have been interpreted the molecular interaction in term of ion- solvent, ion– ion interaction. The structure making /breaking capacities have been inferred from the sign of the second derivative of limiting partial molar volume with respect temperature at constant pressure. Alum has been formed to act as structure breaker in water and aq
... Show MoreStudents' passive listening to their teacher's reading is one of main
reasons behindtheir weakness in the reading skill which in its turn may
hinderachieving the in desired objectives.
When exploiting critical thinking, which will lead to deeper
understanding of the intellectual content, in learning and accurate and
correct students' outcomes.
Active listening allows paying attention to the speaker, asking him,
arguing with him, judging what he says, and making decision on what
he says. For this reason, the researcher felt the need for preforming a
study to identify the effect of critical listening on developing students'
critical thinking at reading in the Kurdish language department.
The researcher has