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.
Nanomaterials enhance the performance of both asphalt binders and asphalt mixtures. They also improve asphalt durability, which reduces resource consumption and environmental impact in the long term associated with the production and transportation of asphalt materials. Thus, this paper studies the effectiveness of Nano Calcium Carbonate (Nano CaCO3) and Nano Hydrated Lime (NHL) as modifiers and examines their impact on ranges from 0% to 10% through comprehensive laboratory tests. Softening point, penetration, storage stability, viscosity, and mass loss due to short-term aging using the Rolling Thin Film Oven Test (RTFO) were performed on asphalt binders. Results indicated a significant improvement in binder stiffness, particularly
... Show MoreNon-steroidal anti-inflammatory drugs (NSAIDs) contain free –COOH which thought to be responsible for the GI irritation associated with all traditional NSAIDs. The esterification of this group is one of an approach to ultimate aim for reduce the gastric irritation; so in this study we synthesized and preliminarily evaluated new ester compounds as new analogues with expected selectivity toward COX-2 enzyme. Synthetic procedures have been successfully developed for the generation of the target compounds (III a and b). The synthetic approach involved multi-steps procedures which include: Synthesis of 4-hydroxy benzene sulphonamide ( I b ), synthesis of Naproxen and Ibuprofen acyl chloride and then reacting them with 4-hydroxy benzene sulphon
... Show MoreSystemic lupus erythematosus (SLE) is one of the autoimmune disorders, generated by a production of specific autoantibodies against self-antigens before the occurrence of clinical symptoms. The etiology of disease is still unknown, although there have been several infectious agents that have been associated with SLE development, especially in genetically predisposed individuals. Herpes simplex virus-I and -II (HSV-I and -II) and Toxoplasma gondiiare two infectious agents that have been suggested to be involved in SLE etiology. Accordingly, the present study assessed anti- HSV-I and -II and anti-T. gondii IgG and IgM antibodies by enzyme linked immunosorbent assay in sera of 64 SLE female patients and 32 healthy control women. The patients w
... Show MoreBACKGROUND: Enteric fever caused by Salmonella Typhi is an endemic disease in Iraq. Variations in presentations make it a diagnostic challenge. If untreated or treated inappropriately then it is a serious disease with potentially life-threatening complications. The recent emergence of drug resistant strains of S. Typhi is a rising public health problem and a clinical concern to the physician. AIM: The objectives of the study were to assess and describe the patterns of antimicrobial resistance, clinical characteristics, epidemiological distribution, and complications of typhoid fever. PATIENTS AND METHODS: Fifty cases of typhoid fever (culture proven) were collected during the period from February 2019 to November 2019 in the me
... Show MoreBackground: Diabetic mellitus (DM) is a collection of metabolic disorder identified by hyperglycemia. The heterogeneous etiology includes defects either in insulin secretion, or in insulin action, or the both. In addition to the distraction in carbohydrate, fat and protein metabolism. Inflammatory reaction that caused by many pro-inflammatory cytokines play a central role in the pathogenicity of T2DM, these cytokines can enhance insulin resistance which led to impaired glucose homeostasis. Subjects: The study included 75 patients (38 males and 37 females) suffering from T2DM with age mean ± SE 52.30 ± 1.60, and 70 individuals as healthy controls (35 males and 35 females) with age mean ± SE 48.88 ± 0.64. Evaluation of immunological marke
... Show MoreIntroduction: Inadequate pain assessment and management is a problem in hospitalized patients that impairs their wellbeing. Intensive care unit nurses’ pain practices are affected by several barriers and enablers. Objectives: The objectives of this study were to determine the level of nurses’ practices and perceived barriers related to pain assessment in critically ill patients. Methodology: A cross-sectional design study was used. Purposive sampling technique was employed, including 100 nurses recruited from 8 intensive care units in Baghdad city, Iraq. The study was conducted from September 1st to October 20th, 2022. The pain assessment and management for critically ill patients survey was used to collect data. Descriptive sta
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