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.
Osteoporosis (OP) is a systemic skeletal disorder that is characterized by reduced bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. The most frequent osteoporotic fractures are fractures of the hip, wrist, and spine. The exact causes of OP are still unknown; several factors contribute to the disorder. Subjects and Methods: This study consists of patient groups, this group (Group A) was composed of 80 postmenopausal women with OP and osteopenia and the patient group was subdivided into two group; First group (GroupA1) was composed of 50 postmenopausal women with OP and the second group (Group A2) composed of (30) Postmenopausal Women with oste
... Show MoreModified unsaturated polyester (MUPE) was blended with Cellulose (Cls) and with ethyl cellulose (ECls) at ambient conditions in the presence of ethyl methyl ketone peroxide (EMKP) as hardener. The blends containing different weight percentages (5-25 %) of Cls or ECls. Mechanical properties (impact strength, hardness, and bending) and dielectric constant were determined. The results observed that Cls increases the impact strength, hardness, and dielectric constant and decreases the bending of the MUPS, while ECls causes an increase in the three mechanical behaviours and a decrease in the dielectric constant of the MU-PS.
The impact of the auditor's personal judgment starts from the beginning of the audit process to the formation of the final opinion and the issuance of the report, and because of the possibility of bias in the auditor's judgment for various reasons that may relate to the auditor himself or the circumstances surrounding it, which requires assessing the current reality of the auditor's personal judgments In the local environment and determining their determinations. To clarify the concept and determinants of the auditor's personal judgments when implementing the audit work, prepare the report and determine the role of the international auditing standards in rationalizing the auditor's personal judgment when conducti
... Show MoreABSTRACT:
Objectives: The study aims to know the effectiveness of the educational program in the patient’s adherence to medication and diet and to know the relationship between the effectiveness of the education program and their demographic data related to the patient’s age, gender, marital status, education level, occupation, monthly income and residence.
Methodology: A quasi -experimental design study was performed on patient who attended to Gastroenterology and Hepatology Teaching Hospital, from March 2021 to September 2021. The non-probability sampling including 50 patients for case study and 30 patients for control group. The questionnaire consists of 3 parts, part one the socio
... Show MoreIf the State attaches great importance to its foreign relations and intends to strengthen them in order to ensure the achievement of the highest national goals and interests. External relations between countries are one of the most prominent features of foreign policy, which depends on a combination of internal and external factors, the modern relations between Tunisia and Tunisia, which goes back to the pre-independence of Tunisia, when Iraq was a supporter of Tunisia's independence from France in the 1940s, Although these relations did not cause any disturbance by the two countries, but they remained weak relations did not develop in all areas except the sports and cultural field, which we will determine the reasons and the pos
... Show MoreRelationship between thyroid dysfunction and periodontal disease has been mediated through an immune response. Cytokines are implicated in the initiation, consequences of immune response and a crucial role in the pathogenesis of thyroid disease, directly target thyroid follicular cells; and in the development and progression of periodontitis. This study aimed to detect cytokines levels which known to be associated with periodontitis in serum and saliva, to test the hypothesis that hypothyroidism influences the levels of biomarkers of periodontitis. Samples were collected from sixty patients with hypothyroid age ranged (20-64) years, thirty of patients were without periodontitis (group I) and 30 with periodontal disease (II); moreover, 30 su
... Show MoreQuality of e-service is one of the critical factors that decide the success or failure of organizations. It may increase competitive advantages as well as enhance the relationships with the customers. Achieving high e-service quality and user satisfaction are challenging since they depend fundamentally on user perception and expectation which can be tricky at times. To date, there is no agreement as to what service quality is, and how it should be measured, whether it is a function of statistical measures of quality including physical defects or managerial judgment, or it is a function of customer perception about the services. This paper deep-dived the quality of e-services offered b