A STUDY · Web view“Polycystic ovary syndrome (PCOS): Arguably the most common endocrinopathy is...
Transcript of A STUDY · Web view“Polycystic ovary syndrome (PCOS): Arguably the most common endocrinopathy is...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. NAME OF THE CANDIDATE AND ADDRESS
Ms. LAISOM ROSY
M.Sc. NURSING 1ST YEAR
Noor College of Nursing,
Bhoopasandra, Bangalore
2. NAME OF THE INSTITUTION
NOOR COLLEGE OF NURSING
Noor College of Nursing,
Bhoopasandra, Bangalore 3. COURSE OF THE STUDY
AND SUBJECTM.Sc, NURSING Ist YEAR
OBSTETRICS AND GYNECOLOGY
NURSING
4. DATE OF ADMISSION TO COURSE 01/06/2009
5. TITLE OF THE TOPIC “A STUDY TO ASSESS THE
EFFECTIVENESS OF
STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE AND
ATTITUDE REGARDING PREVENTION
OF POLYCYSTIC OVARIAN DISEASE
AMONG COLLEGE GIRLS IN SELECTED
COLLEGES AT BANGALORE”.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
Gynecological problems of adolescents occupy a special space in the spectrum of
gynecological disorders of all ages. This is because of the physical nature of the
problems which are so unique, special, and specific for the age group, and also because
of the associated and psychological factors which are very important in the growth and
psychological remodeling of someone in the transition between childhood and
womanhood. 1.
Gynecological diseases are fairly common but most of us women ignore
the symptoms or we are unaware, till the time the problem really worsens. One of
them, now days faced by girls, is POLYCYSTIC OVARIAN DISEASE. (Stein
leventhal Syndrome). This is the commonest course of Amenorrhea in young girls.
The Amenorrhea with polycystic ovaries was first described in 1935 by Stein and
Leventhal. 2
PCOS, also known as Polycystic Ovarian Syndrome, is reported to be a
growing problem with adolescent girls. It can be very difficult to diagnose PCOS in
teenage girls as they often experience irregular or absent menses and acne. 3
A population study revealed that overt and occult PCOD accounted for 90% of
patients with oligomenorrhea and 37% with amenorrhea, or 73% with oligo- or
amenorrhea. Oligo- or amenorrhea accounted for 21% of couples with infertility and
the annual incidence was 247 patients per million of the general population. The
annual incidence of infertility due to PCOD per million was 41 with overt PCOD and
139 with occult PCOD (total 180). Of those, 140 appeared to respond well to
clomiphene (78%) but 40 (22%) failed, requiring alternative therapy.4
Polycystic ovarian disease is also known as Stein Leventhal Syndrome (PCOD),
about 6 to 10% of girls gets affected by this disease and are even not aware of their
presence. In a prospective study of 400 women of reproductive age, 4% to 4.7% of white
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women and 3.4% of African American women had PCOS. 2 A similar rate of 4% to 6%
has been found in other populations.5
Polycystic ovarian disease prevalence is fast increasing among college girls in
urban Mumbai about 30% of young college girls were detected with the POCD.
A study on teen girls and college girls in several colleges around India was found
to show a higher percentage of college girls with PCOD and there was around 36 % of
increase in cases of PCOD compared from a period of 2007-08, showing a severe fast
increase of cases of PCOD among college girls in an alarming rate
Polycystic Ovarian Disease is not curable but treatment is available to alleviate
the symptoms. This disease is so dread able that such girls are unable to conceive and its
pathology of spreading to other organ is far greater than that of infertility. 6
Polycystic Ovarian Disease is very common among girls the main symptoms are
irregular or no menstruation, multiple small cysts in the ovaries which is a common
finding, high blood pressure, excessive pimples and rise in level of insulin are the
common findings.7
Present day lifestyle, food habits, environmental exposure to toxins along with
hereditary predisposition for metabolic syndrome (obesity, hyperlipidemia, diabetes and
hypertension) and stress has contributed to the common problem faced by today’s female
population which is PCOD. 8
Children as young as 16 years are diagnosed with polycystic ovarian disease
which occurs due to the imbalances or abnormalities in the hormones. Hormonal
abnormalities can make the ovaries produce more eggs. These eggs turn into cysts and
the ovaries become large and studded with numerous cysts. It begins as early as in
teenagers and mostly effects adult girls of childbearing age. 9
6.2 NEED FOR THE STUDY:
“Education is given for the sake of individual with a view to save from
destruction”
2
Thompson
Polycystic Ovarian Disease is a common problem among teen girls and young
girls. In fact, almost 1 out of 10 girls have Polycystic Ovarian Disease. A study
findings shows that Adolescent Girls with Polycystic Ovary Syndrome Have an
Increased Risk of the Metabolic Syndrome Associated with Increasing Androgen
Levels Independent of Obesity and Insulin Resistance.14
A study done by U.S. Scientists reported that the prevalence of Polycystic
Ovarian Syndrome may be as high as 11.2% in girls of reproductive years. Among this
group, adolescent girls make up a large part, perhaps as high as 50% of young girls
suffer with polycystic ovarian disease (PCOD).10
A study done on college girls regarding prevalence and risk factors of PCOD
shows that high increase of 30% to 40% within a period of month was noted who
followed sedentary dietary practices. 11
Polycystic ovarian disease or syndrome (PCOS) is a common problem which
may start in the adolescence and affect the girls till her old age. In this condition the
ovary develops many small cysts. This results in an abnormality of the hormones, with
the male hormone dominating. As a result, the girls with this syndrome show features
such as acne, excessive facial hair growth (hirsutism), weight gain and irregular or
scanty menses. 12
A study findings shows that obese girls with polycystic ovary morphology
(PCOM) had a greater risk of developing of Polycystic Ovarian Disease (95%) than
non obese girls with Polycystic ovary morphology. Obese girls with Polycystic ovary
morphology had a higher incidence oligomenorrhea and biochemical
hyperandrogenemia than non obese adolescent girls with PCOM. Obese subjects with
PCOD had a higher risk of developing oligomenorrhea and biochemical
hyperandrogenemia than non obese girls with PCOD. Moreover, obese girls with
PCOD had significantly higher serum total T levels and more prolonged menstrual
intervals than non obese women with Polycystic ovarian disease.13
3
In a study, at the University of Pennsylvania and colleagues identified high rates
of depression (35 percent) among girls with Polycystic ovarian disease, 15
A study conducted in school girls shows that Thirty-seven percent of adolescent
girls with polycystic ovarian disease had metabolic syndrome (MBS) compared with
5% of NHANES III girls (Third National Health and Nutrition Examination Survey).
None of the girls of normal body mass index (BMI) had MBS, whereas 11% of
overweight and 63% of obese girls with PCOS had MBS compared with 0 and 32% of
NHANES III girls, respectively. Girls with polycystic ovarian disease were 4.5 times
more likely to have MBS than age-matched NHANES III girls after adjusting for BMI.
The odds of having the MBS were 3.8 times higher for every quartile increase in
bioavailability testosterone in girls with polycystic ovarian disease after adjusting for
BMI and insulin resistance.16
Polycystic ovary syndrome (PCOS) is the most commonly encountered
endocrinopathy in girls of reproductive age. It has significant reproductive and non
reproductive consequences. Girls of any ethnic background can present with PCOS. In
a prospective study of 400 adult girls of reproductive age, 4% to 4.7% of white girls
and 3.4% of African American girls had Polycystic ovary syndrome. A similar rate of
4% to 6% has been found in other populations.17
Hyperinsulinemia is noted in 50% to 70% of PCOS patients. It is defined as
impaired action of insulin on glucose transport and antilipolysis in adipocytes in the
presence of normal insulin binding.18
Patients with polycystic ovarian disease can present with a bundle of complaints
such as menstrual disturbances, infertility, hirsutism, and acne, their point of entry into
the medical system may be by way of a primary care physician, gynecologist, nurse,
endocrinologist, or dermatologist. Thus, all these disciplines need to be familiar with
this syndrome and its long-term consequences.19
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Overall, 60-85% of patients with polycystic ovarian disease demonstrate overt
menstrual dysfunction primarily oligomenorrhoea although 5% may demonstrate
polymenorrhoea. Chronic anovulation leads to endometrial hyperplasia due to chronic
estrogenic stimulation. Rao found 2.8 % of the causes of puberty menorrhagia were
due to polycystic ovarian disease. The present study shows that 3.07% of puberty
menorrhagia was due to polycystic ovarian disease. 20
The best treatment of the polycystic ovarian disease is life style modification and
weight loss. Even a 5% reduction in weight can help. Hence proper diet and some
exercise regimen to control body weight are of utmost importance. 21
The only quantitative study performed in adolescent girls regarding polycystic
ovarian disease which uses a well-validated instrument shows that health related
quality of life was worse in those with polycystic ovarian disease specially in the areas
of general health perceptions, behavior, physical functioning and family activity.
However, qualitative psychological studies have demonstrated higher levels of
depression, psychological and psychosexual morbidity and an increased response to
stress in girls with polycystic ovarian disease compared with control group. Low self-
esteem, decreased social activity and less romantic contentment were reported in girls
with polycystic ovarian disease. 22
Life style modification in polycystic ovarian disease is very important because
sedentary lifestyles and lack of exercises and fast food consumption by the ladies are
leading to the rise in cases of polycystic ovarian disease especially among urban
college girls.23
Lack of knowledge and the negative lifestyle attitude towards polycystic ovarian
disease among college girls and not taking any measures to improve their lifestyles is
felt by the investigator that these college girls can be helped by assessing their
knowledge and with a view to change their lifestyles by providing necessary
information, so as to help them to get aware about the polycystic ovarian disease. 24
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6.3 REVIEW OF LITERATURE:
“Review of literature is an essential activity of scientific research project;
“Literature review involves system identification, location securing and
summary of written material that information on research problem”
[Polit – 1978]
Polycystic ovarian disease is well recognized inherited disorder. Its genetic basis
has been postulated on the basis of evidences from familiar clustering and reports of
concordance in monozygotic twins. However, factors involved in its genetic
predisposition and the mode of inheritance are still not clear.25
Polycystic ovarian syndrome is the most common endocrine disorder in girls of
reproductive age group, affecting 5 to 10% of girls exhibiting, the full blown syndrome
of hyperandrogenism, chronic anovulation and polycystic ovaries. We now know that
approximately 75% of anovulatary ladies of any cause have polycystic ovaries and 20
to 25% of women with normal ovulation demonstrate ultrasound findings typical of
polycystic ovaries. Chronic anovulation accompanied by hyperandrogenism and
clinical manifestations including, hirsutism, acne, elevated testosterone and
androstenedione, and frequently but not always obesity is seen in PCOD.26
A study on knowledge and attitude of college girls regarding dietary factors and
life style modifications causing PCOD shows that college girls had very poor
knowledge 10% on dietary factors effecting PCOD. Colleges girls also had lack of
knowledge regarding various factors effecting PCOD . 27
A teaching progamme on management of PCOD was conducted among college
girls on prevention of PCOD and was found to be very effective in increasing a
knowledge of 40%. 28
Negative Attitude of college girls regarding PCOD was very much the hindrance
in improving the knowledge among college girls with PCOD and there was a need to
improve there attitude. 29
PCOD is not a new condition, but despite the fact that it was first identified in
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1935 (and was originally known as Stein-Leventhal syndrome after the doctors who
discovered it), there has been no real agreement as to its cause. As recently as five
years ago, according to Dr. Ronald Feinberg, Polycystic Ovaries, and Insulin
Imbalance many specialists still believed it to be primarily a result of dysfunctional or
diseased ovaries, which was Stein's and Leventhal's original supposition.30
Cysts in the ovary are not a disease but a symptom of some metabolic
derangement in the cellular level present in each one of the cells in the body and not
just among the ovarian cells. The core pathology lies in the insulin receptor and
signaling pathways in cellular metabolism which leads to glucose intolerance. The
excess insulin will derange the LH: FSH ratio (hormones secreted in the brain). LH
along with insulin will make the ovarian wall (theca cell) hypertrophied and prevents
the follicle from ovulating. This finally leads to cyst formation.31
As many as 1 out of every 15 assessed was found to be suffering with PCOD in
Wellington college and there knowledge was very poor regarding the subject. College
girls were afraid to talk about there disease to the parents .32
A study reveals that the urban college girls shows that there was a considerable
increase on obesity causing polycystic ovarian disease and their attitude was found to
be very low related to dietary pattern and sedentary lifestyle leading to polycystic
ovarian disease and parent’s attitude was found to be negative and very low among
their daughter suffering polycystic ovarian disease.
Video teaching conducted among college girl in Ukraine was found to increase
the knowledge 55% related to polycystic ovarian disease and its side effect on health
was found to be very effective when compare to the previous knowledge without
implementing video teaching.
6.4 STATEMENT OF THE PROBLEM:
“A study to assess the effectiveness of Structured Teaching Programme on knowledge and attitude regarding prevention of Polycystic Ovarian Disease among college girls in selected colleges at Bangalore”.
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6.5 OBJECTIVE OF THE STUDY:
To assess the level of knowledge regarding prevention of Polycystic
Ovarian Disease among college girls.
To assess the level of attitude regarding prevention of Polycystic Ovarian
Disease among college girls.
To determine the effectiveness of Structured Teaching Program regarding
prevention of Polycystic Ovarian Disease in terms of knowledge and attitude
score of college girls.
To find relationship between knowledge and attitude of college girls
regarding prevention of Polycystic Ovarian Disease.
To find the association of post test level of knowledge and attitude of
college girls with the selected demographic variables.
6.6 OPERATIONAL DEFINITION:
Assess: It is operationalised as the statistical measurements of the knowledge and
attitude scores of the college girls regarding prevention of polycystic ovarian
disease.
Knowledge: The term knowledge refers to the response of college girls regarding
prevention of polycystic ovarian disease by questionnaire in terms
of knowledge scores.
Attitude: The term attitude refers to the written expressive feelings regarding
prevention of Polycystic Ovarian Disease.
Structured teaching programmed: It refers to a well planned instructional
module through lecture cum discussion methods on selected aspects regarding
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prevention of Polycystic Ovarian Disease.
Effectiveness: The term effectiveness refers to the knowledge and attitude
scores after administration of structured teaching program regarding prevention of
Polycystic Ovarian Disease among college girls.
Prevention: The term prevention refers to systematically developed instruction
designed to provide knowledge and attitude of college girls regarding prevention
of Polycystic Ovarian Disease.
Polycystic Ovarian disease : It refers to the hormonal imbalance
which causes irregular menstrual periods, obesity, unwanted or excess hair
growth and acne.
College Girls : Girls with age group of 17 to 21 years and studying in selected
colleges.
6.7 HYPOTHESIS :
H1: There will be significant difference in the level of knowledge regarding
prevention of polycystic ovarian disease between pre-test and post-test scores.
H2: There will be significant difference in the level of attitude regarding
prevention of polycystic ovarian disease between pre-test and post-test scores.
H3: There will be significant relation between knowledge and attitude scores of
polycystic ovarian disease
H4 : The level of knowledge and attitude of college girl regarding prevention of
polycystic ovarian disease will be significantly associated with the selected with
the demography variable.
6.8 ASSUMPTION:
1. College girls possess some knowledge and attitude regarding prevention of
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Polycystic Ovarian Disease
2. College girls will be free to answer the question.
3. Having proper knowledge and attitude regarding prevention regarding of
polycystic ovarian disease reduces the risk of getting Polycystic Ovarian disease
among college girls
6.9 DELIMITATION:
Assessment of attitude related to prevention of polycystic ovarian disease among
college girl is limited to eliciting through attitude checklist only.
7 MATERIALS AND METHODS:
7.1
7.1.1
7.1.2
7.1.3
SOURCES OF DATA
PRIMARY SOURCE College girls studying in different colleges at Bangalore.
RESEARCH APPROACH: An evaluative research approach.
RESEARCH DESIGN: Pre-experimental 1 group pre and post test research design.
7.2 METHODS OF COLLECTION OF DATA:
7.2.1 SAMPLE CRITERIA:
Inclusion criteria
Exclusion Criteria
1. College girls studying in selected
colleges.
2. College girls of age group 17-21years.
3. College girls who can communicate in
Kannada or English.
4. College girl available during period of
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study.
1. College girls of age groups more than 21
years.
2. College girls who are not willing to
participate in the study.
3. College girls who are not available at the
time of study.
7.2.2 POPULATION College girls who are in age group 17 -21 years studying in selected college in Bangalore.
7.2.3VARIABLES UNDER
STUDY:
Independent variable
Dependent Variable
Attribute Variable
Structured teaching program regarding prevention of
Polycystic Ovarian Disease
Knowledge and attitude of college girls.
Age, socioeconomic status, year of education, place of
residence etc.
7.2.4 SETTING OF STUDY: This study will be conducted in selected Colleges at
Bangalore
7.2.5 SAMPLE College girl those who are all fulfilling inclusion
criteria.
7.2.5 SAMPLE TECHNIQUE: Non probability convenient sampling.
7.2.6 SAMPLE SIZE: 60 college girls who are in17 – 21years studying in
selected colleges at Bangalore.
7.2.7 TOOLS OF RESEARCH As per objective of the study a tool is prepared as
1. Structured questionnaires related to socio
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demographic variables of college girls.
2. Structured questionnaires related to knowledge
aspect on prevention of Polycystic Ovarian
Disease among college girls.
3. Checklist to assess the attitude of college girl
regarding prevention of Polycystic Ovarian
Disease.
4. STP regarding prevention of Polycystic Ovarian
Disease.
7.2.8 METHOD OF DATA COLLECTION :
A prior formal permission will be obtained from the
concerned authority. The purpose of the study will be
explained and consent will be obtained from the
subjects. The investigator will select samples as per
inclusion criteria. Structured questionnaires and
checklist will be use to assess the level of knowledge
and attitude as pre test. STP will be administered after
one week of pre test. Reassess the knowledge and
attitude of college girl regarding polycystic ovarian
disease during 6 weeks.
7.2.9 METHOD OF DATA ANALYSIS AND INTERPRETATION:
DESCRIPTIVE STATISTICS:
The researcher will use appropriate descriptive and
inferential statistics for data analysis and present in the
form of tables, graphs and diagrams. with the help of
structured questionnaires to collect the data and
knowledge and attitude.
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INFERENTIAL STATISTICS :
1. Frequency and percentage distribution will be used
to analyze the demographic data of college girls.
2. Mean, median range and standard deviation will be
used to assess the level of knowledge and attitude
scores regarding prevention of Polycystic Ovarian
Disease among college girls.
1. To assess effectiveness of Structured
teaching program on knowledge and attitude of
prevention of Polycystic Ovarian Disease among
college girls.
2. Knowledge and attitude score of college
girl regarding prevention of Polycystic Ovarian
Disease.
3. Co-relation co-effectiveness to find the
relationship between knowledge and attitude of
prevention of Polycystic Ovarian Disease.
4. 2 test to determine the association between
knowledge and attitude scores regarding college
girl prevention on Polycystic Ovarian Disease with
the selected demographic variables.
7.4 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVIEWS TO BE CONDUCTED ON THE PATIENTS OR OTHER HUMAN BEINGS OR ANIMALS?
YES, STP will be conducted and knowledge level will be assess.
No other investigation or interviewer will be conducted on subject.
7.5 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOU
INSTITUTION?
Yes, informed consent will be obtained from the institution authorities and
subjects. Privacy, confidentiality and anonymity will be guarded. Scientific objectivity
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of the study will be maintained with honesty and impartiality.
8 BIBLIOGRAPHIC OF REFERENCES:
1. Ashman. R; “Polycystic ovarian disease” 1 edition Jaypee brothers. 1999; p.
190 - 192
2. Roberts Feldman. “Understanding PCOD”. VI edition. New Delhi. Grew
Hill Publishers. 2004. p. 274-285.
3. Bat show Mol. “Diagnostic and statistical manual of PCOD”. 11 editions.
American Obstetrics association 2000. Washington.
P. 20-25.
4. Ntswane AM, et all mar: 30(1) 40-42 (2007) http:/ pubmed.com
5. The Nursing Journal of India. Nursing service. Vol XLVIII, No. 9. Sept.
2006.p.199-200.
6. Ntswane AM et. Al. Midwifery Mar 2007, 30(1). 85-96.
7. Community living of Minnesota. Minneapolis USA Jan. 2005. d17 (1) : 41-
50.
8. http://google.com
9. Chakrabarti k et.al. “Study on ethological factors on PCOD”. International
journal of General Medicine (2003) 5(1):7-25.
10. Roeleveld Net. Al medical Jan 1992. 21 (1) :110-9 htt://pumbmed.com.
11. Csabi get a; Young Girls with PCOD. “The prevalence of informative
morphogenetic variants”. International Journal of Midwifery Pharmacology
14
(2007) 9 (4): d197-200.
12. Feldman M.A, Obstetrics jul: (1994): 15 (4): 299-332
Http: // google.com.
13. Sparks B, et.al “International journal of women health” sep-oct 1993;
14(15):387-408.
14. Backken J, et.al “Teaching parents with mental retardation. Knowledge
versus skills”. American Journal of mental Retardation (1993) 97 (4): 17-405.
15. Narayan J et.al “Factors influencing the expectation of parents for their
mentally retarded children.” Indian Journal of Intellect Disable (1993) (pt 2) 8-
161.
16. Rycle-Bran dt.B “Anxiety and depression in young girls with PCOD.”
International Journal of obstetrics (1990) 156:21-118.
17. Mavrin- cavorl, “A comparison of the attitude of young girls of non PCOD
and of PCOD girls towards their lifestyles and treatment regimen.” International
Journal of obstetrics (1986) (4):24-315.
18. Margalit M, “Ethnic differences in expressions of shame feeling by women
with PCOD.” International journal of soc – obstetrics (1979) 25(2):79-81.
19. Roskan I et. Al “A qualitative analysis of mother’s childrearing behavior
towards their ovarian cysts.” Indian Journal of Mental Health (2007) 28 (2): 44-
130.
20. Najman JM, et.al “Bias influencing maternal reports of child behavior and
emotional status.” In soc-Psychiatric Epidemiology (2001) 36 (4): 94-186.
15
21. Wild RA. “Long-term health consequences of PCOS.” Hum Reprod
Update. 8: 2002; 231-241.
22. Clark AM, Thornley B,Tomlinson L. “Weight loss in obese infertile women
results in improvement in reproductive outcome for all forms of fertility
treatment”. Hum Reproductive. 13: 1998; 1502-1505.
23. Carmina E, Lobo RA. “Polycystic ovary syndrome (PCOS): Arguably the
most common endocrinopathy is associated with significant morbidity in
women” Journal Clinical Endocrinology Metabolism. 84: 1999; 1897-1899.
24. Polson DW, Wadsworth J, Adams J. “Polycystic ovaries: A common
finding in normal women”. Lancet. 1: 1988; 870-872.
25. Waldstreicher J, Santoro NF, Hall HE. “Hyperfunction of the hypothalamic
pituitary axis in women with polycystic ovarian disease: Indirect evidence for
partial gonadotroph desensitization.” Journal Clinical Endocrinology
Metabolism. 66: 1988; 165-172.
26. Sagle M, Bishop K, Ridley N. “Recurrent early miscarriage and polycystic
ovaries”. BMJ. 297: 1988; 1027-1028.
27. Hoeger K., “Obesity and weight loss in polycystic ovary syndrome”.
Obstetrics Gynecology Clinical North Am. 28: 2001; 85-97.
28. Harborne L, Fleming R, Lyall H. “Descriptive review of the evidence for
the use of metformin in polycystic ovary syndrome.” Lancet. 361: 2003; 1894-
1901.
29. Akhi. R; “Polycystic ovarian disease” 1 edition Jaypee brothers. 1999; p.
190 - 192
30. Daniel DW, Wadsworth J, Adams J. “Polycystic ovaries: A common
finding in normal women”. Lancet. 1: 1988; 870-872.
31. Janet RA. “Long-term health consequences of PCOS.” Hum Reprod
Update. 8: 2002; 231-241.
32. http://google.com
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9 Signature of the Candidate
10 Remarks of the Guide
11 NAME AND DESIGNATION
11.1 Guide
11.2 Signature
11.3 Co – Guide
11.4 Signature
11.5 Head of the Department
11.6 Signature
12 12.1Remarks of the Chairman and
Principal
12.2 Signature
17