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.
A pure posteriorly posterior communicating artery (PCoA) aneurysm represents a surgical challenge. This is mainly when there is a need for good exposure of the aneurysmal neck, sac, PCoA, and anterior choroidal arteries. Ruptured pure posteriorly directed PCoA aneurysm imposes significantly extra challenge as the surgeon undergoes dissection through a tight brain. Even with measures commonly used to attain brain relaxation like the lumbar drain and cisternal fenestration. Here, we describe a technique for posterior temporal pole mobilization (TPM) as an integrated part of microsurgical clipping of ruptured pure posteriorly directed PCoA aneurysms. This technique is implicated in twenty-three successive cases of ruptured PCoA aneurys
... Show MoreA mathematical model has been introduced to investigate the effect of nuclear reaction constant ( A ), probability of the BEC ground state occupation Ω i, nD is the number density of deuteron (d) and the overall number of nuclei ND on the total nuclear d-d fusion rate (R). Under steady-state of the condensates of Bose-Einstein, the postulate of quantum theory and Bose-Einstein theory were applied to evaluate the total nuclear (d-d) fusion rate trapping in Nickel-metal The total nuclear fusion rate trapping predicts a strong relationship between astrophysical S-factor and masses of Nickel. The reaction rate trapping model was tested on three reaction d(d,p)T, d(d, n)3He and d(d, 4He)Q = 23.8MeV respectively. The reaction rate has described
... Show MoreCompanies need to educate people about the facts that characterize the business. This is the mission of promotion, it is an important marketing activity, promotion communicates with others and seeks to provide customers with a new business process experience.
Advertising is the most important methods of promotion and the best way to reach an audience. Once the organization advertises its products and services, it can operate in a competitive environment. Marketing competition requires knowledge of humanity that must be affected and convinced. Advertising should create Desires and need for satisfaction. This research comes in the study of visual representations of this psychological incident and how to use it communicatively to create
This study aimed at comparing the performance of vertical, horizontal and hybrid subsurface flow systems in secondary treatment for the effluent wastewater from the primary basins at Al-Rustumia wastewater treatment plant, Baghdad, Iraq. The treatments were monitored for six weeks while the testsduration were from 4 to 12 September 2018 under continuous wastewater feeding for chemical oxygen demand (COD), total suspended solid (TSS),ammonia-nitrogen(NH4-N) and phosphate (PO4-P) in comparison with FAO and USEPA standards for effluent discharge to evaluate the suitability of treated water for irrigation purposes. Among the systems planted with Phragmites Australia, the hybrid subsurface flow system which cons
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This paper analyses the relationship between selected macroeconomic variables and gross domestic product (GDP) in Saudi Arabia for the period 1993-2019. Specifically, it measures the effects of interest rate, oil price, inflation rate, budget deficit and money supply on the GDP of Saudi Arabia. The method employs in this paper is based on a descriptive analysis approach and ARDL model through the Bounds testing approach to cointegration. The results of the research reveal that the budget deficit, oil price and money supply have positive significant effects on GDP, while other variables have no effects on GDP and turned out to be insignificant. The findings suggest that both fiscal and monetary policies should be fo
... Show MoreSynthesis of PEG 200-Di- Acetate ant Its Influence on the Viscosity of PEG 4000 in Different Organic Solvents
The study seeks the relationship between the mathematical-procedural Knowledge and the logical-mathematical intelligence among students at the third stage in mathematics department. To this end, three questions were arisen: what is the level of mathematical-procedural Knowledge among the third stage students in mathematics department regarding their gender? Do male or female students have more logical-mathematical intelligence and are there significant differences base on their gender? What kind of correlation is between the level of mathematical-procedural Knowledge and the logical-mathematical intelligence of male and female students in the third stage in the mathematics department? A sample of (75) male and female students at the thir
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