Polycystic Ovarian Syndrome Research Paper

Polycystic Ovarian Syndrome Research Paper
Polycystic Ovarian Syndrome Women, ever wonder what all you inherited from your parents? One
condition that women can inherit is polycystic ovarian syndrome. Polycystic ovarian syndrome is a
complex genetic condition common among women, especially those in reproductive ages.
Polycystic ovary syndrome is defined as ovarian dysfunction with polycystic ovaries (Goodarzi et
al., 2011). I was diagnosed with polycystic ovarian syndrome (PCOS) at the age of twelve. It was
hard for me to understand at that age what was truly going on with my body, so I just listened to the
doctors and did what they said. So, I did this research to learn more about PCOS and learn how I can
prevent long term consequences from occurring. This research includes what PCOS is and the
symptoms seen with it, causes, how to diagnose it, prevention, treatment and long–term
consequences if not treated. The biggest ... Show more content on Helpwriting.net ...
One study done on one hundred patients with PCOS showed that administration of metformin and
pioglitazone shows 50 percent effectiveness in helping menstrual cycle irregularities by the end of
six–months of treatment. Both medications also showed a decrease in LDL and an increase in HDL
overall, but this was seen more in the pioglitazone group. This study showed that 64% of women
with PCOS also had hyperinsulinism. HOMA–IR, used to assess insulin resistance, was shown to
have a 15% decrease with metformin and a 50% decrease in patients who used pioglitazone. Thus,
for protection from diabetes pioglitazone may be the better treatment. Ovulation was shown to be
restored in up to 56% of patients on metformin and pioglitazone. This study showed that
pioglitazone may be a new and better option for treatment of PCOS since it can delay onset of type
II diabetes, help with signs of hyperandrogenism, and regulate menstrual cycles (sangeeta,
... Get more on HelpWriting.net ...

Polycystic Ovary Syndrome: PCOS Analysis
Introduction
Polycystic ovary syndrome (PCOS) is a condition that is estimated to effect between 6% and 10% of
reproductive age women (Andreou, Barber, Dimitriadis, & Franks, 2016). In this paper we will
define PCOS, examine the pathogenesis, identify ways to assess for the condition and review the
treatment options on a mock patient.
PCOS Defined
There is still not a consensus among everyone on the medical community on the exact diagnosis
criteria for PCOS, especially since criteria vary based on genetics and ethnicity. Since 2003 the
Rotterdam European Society for Human Reproduction and Embryology and the American Society
of Reproductive Medicine have agreed that PCOS can be diagnosed based on the following criteria:
1) All other conditions ... Show more content on Helpwriting.net ...
Nearly all of the recent research points out that there is a high comorbidity with PCOS, insulin
resistance, and obesity. Obese women with insulin resistance are at the highest risk for developing
PCOS. A 2015 research paper found that if conception is achieved (typically with the assistance of
ovulation–inducing agents as we discussed) while the patient is diagnosed with PCOS the only
notable increased health risk is GDM (Hayata, et al., 2015). However, a 2013 meta–analysis of 21
studies involving a combined 4,841 women with PCOS, and 1,196,705 control woman without
PCOS found "women with PCOS demonstrated significantly elevated risk of gestational diabetes
mellitus (3.5x), pregnancy–induced hypertension (3.4x), preeclampsia (2.2x), premature delivery
(1.9x), caesarean section rate (1.7x), (and) admission to an NICU pregnancy (2.3x)" (Chen, et al.,
2013) This research is supported by a recent article "Pregnancy Complications In Women With
Polycystic Ovary Syndrome" which looked at this same meta–analysis as well as two other previous
meta–analysis which came to similar conclusions. It is worth noting that in my research all of these
complications with the exception of GDM, and pregnancy–induced hypertension can also be
attributed to side effects of the fertility drug clomiphene citrate, especially if multiple eggs are
fertilized. This statement is summed up well in the Pregnancy Complications article just mentioned:
"infertility treatments are considered to be potential confounders in the evaluation of pregnancy
complications" (Battista LaSala, et al., 2015). GDM is clearly the most common side effect that can
be directly linked to PCOS therefore screening should be performed during the first trimester to
allow for adequate insulin control which can typically be easily achieved with dietary modifications
or insulin therapy such as

Potential Therapeutics For Treating Type 2 Diabetes Mellitus
Bromophenols have been identified as potential therapeutics for treating type 2 diabetes mellitus
(T2DM) due to their suspected tyrosine phosphatase 1B (PTP1B) inhibitory activity. A new series of
bromophenol analogues will be synthesised and their PTP1B inhibitory activity will be tested in in
vitro enzymatic assays to elucidate their mechanism of action as PTP1B inhibitors.
Background and Introduction
Type 2 diabetes mellitus (T2DM) is a metabolic disease that is caused by insulin resistance of the
peripheral tissues and impaired insulin secretion of the pancreatic β cells.1 Both conditions result in
reduced glycemic control, which can lead to hyperglycemia. Despite the availability of a wide range
of anti–diabetic drugs to treat T2DM, ... Show more content on Helpwriting.net ...
Bromophenols have attracted much attention as potential PTP1B inhibitors due to their suspected
anti–diabetic activity.4 Bromophenols occur naturally in marine organisms such as algae, mollusks
and jellyfish. (±)–Polysiphenol (1, figure 1) is an example of a bromophenol that can be extracted
from the marine algae Polisiphonia Ferulecea.5 After the Braddock group successfully achieved the
first total synthesis of (±)–polysiphenol and the separation of its enantiomers, they collaborated with
the Woscholski group to test their inhibitory activity in PTP1B enzymatic assays.6,7 Both
enantiomers of polysiphenol were essentially found to be identical in PTP1B inhibitory activity.
Thus polysiphenol, as single enantiomers, cannot be responsible for the observed inhibition. This
implicates a chemical change of polysiphenol into a non–chiral form is likely to take place under the
conditions of the assay. One possibility is the formation of a para–quinone methide species (4, figure
1), which in turn can tautomerise into an ortho–quinone methide species (5, figure 1). Thus there are
various possible reactive species that might be responsible for the observed inhibition of PTP1B.
The formation of quinones highlights a red flag in drug discovery due to their highly reactive nature.
Quinones are Michael acceptors that are known to cause toxicity in vivo by covalently binding to
nucleophilic sites on proteins and DNA.8 Consequently, quinones

A Brief Note On Diabetes And Pregnancy Among First Nations...
1. When reviewing "Diabetes in pregnancy among First Nations women" by Oster, Mayan, and Toth
(2014) for its relevance to nursing/healthcare, the purpose of the study, research questions, and
significance were made very clear. The purpose of the study was to acquire a deeper understanding
of the perspectives held by First Nations women with the intention of discovering more culturally
appropriate interventions to prevent and treat diabetes in pregnancy among this group (Oster,
Mayan, & Toth, 2014). The study is relevant to nursing in that its questions focus on the Aboriginal
woman's lived experience of diabetes in pregnancy and what she believes contributes to a healthy
pregnancy (Oster et al., 2014). At the core of nursing care is ... Show more content on
Helpwriting.net ...
By implementing a person–centered approach to care, healthcare providers such as nurses can work
with First Nations women who are pregnant to help them acquire the knowledge necessary to
manage their diabetes and to connect traditional and mainstream health practices that will support
these women to make positive lifestyle changes in attempt to control their diabetes throughout
pregnancy (Oster et al., 2014).
2. After examining the literature review within Oster et al. (2014), both strengths and weaknesses
were observed. Quantitative research was used to explain the inherent difference in health status
among First Nations and non–First Nations populations. A measured decrease in the age of diabetes
diagnosis and higher fertility rates among First Nations individuals (Oster et al., 2014) alluded to the
urgency of exploring effective care options for pregnant Aboriginal women with diabetes in order to
mitigate the growing "epidemic" (p. 1469). The qualitative studies used were also significant as they
identified a disconnect between traditional and Western views to be explored and bridged in attempt
to deliver effective Type two diabetes health care to First Nations people (Oster et al, 2014).
Referencing quantitative and qualitative studies to demonstrate the importance of identifying
culturally appropriate Type two diabetes care for First Nations women who are pregnant could be
seen as a major strength of the

Polycystic Ovarian Syndrome : Etiology- Environmental And...
Polycystic Ovarian Syndrome: Etiology– Environmental and Genetic Factors
Literature in NFS Seminar 4601
Fall 2015
Ashley Anger
Date of Submission: 11/25/15
Introduction:
The condition Polycystic ovary syndrome(PCOS) is the most common of endocrine disruptions
within women of reproductive ages. The disorder does affect as much as 10% of women within this
reproductive lifecycle. The clinical and biochemical features of the condition are diverse and are as
follows: fertility disruption, overweight/obesity, irregularities in menstruation (frequent, absent,
sporadic) insulin resistance/type 2 diabetes, and increased risk of cardiovascular disease (Jeanes
&Hart &Smith & Barr, 2009). The exact aetiology of Polycystic ovary syndrome (PCOS) is
unknown but does involve both environmental influencers and genetic factors. In summery
Polycystic ovary syndrome (PCOS) is a common endocrine condition associated with metabolic
dysfunction, infertility, and hyperandrogenism. Treatment for PCOS includes diet and lifestyle
changes in order to promote a healthy body mass index (BMI) and further reduce hyperinsulinaemia
(a symptom of the condition). Medications such as metformin/Glucophage might be utilized for
management of the presenting symptoms. PCOS symptoms at present–day can only be managed and
no cure for Polycystic ovary syndrome available. (Jeanes &Hart &Smith & Barr, 2009).
Diet:
Proper diet/nutrition and weight loss can help sufferers of PCOS and aid in

Journal Club : Empagliflozin, Cardiovascular Outcomes, And...
JOURNAL CLUB: Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes:
EMPAG–REG OUTCOME
Danny R. Pate
5/17/16
GENERAL STUDY OVERVIEW
Title/Citation Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J
Med 2015;373:2117–28.
Journal Reputability High level of Reliability
Funding Boehringer Ingelheim (BI) and Eli Lilly, manufacturers of empagliflozin (Jardiance) and
empagliflozin/metformin (Synjardy)were the primary sources of funding for the study
BI paid for medical writing and analyzed the study data, and the study 's steering committee
included employees of BI
All researchers were paid by either BI or Eli Lilly for either consulting or data monitoring
BACKGROUND– THE STUDY QUESTIONS
Introduction Type 2 diabetes is a major risk factor for cardiovascular disease.
There is growing concern that intense glucose lowering or the use of certain agents may be
associated with adverse cardiovascular outcomes.
Empagliflozin was compared with placebo and analyzed for effects on morbidity and mortality in
patients with T2D at high risk for CV events who were receiving standard of care.
Why this study? Empagliflozin has been shown to result in weight loss, reduce blood pressure
without increasing heart rate, favorable effects on markers of arterial stiffness and vascular
resistance and visceral adiposity. Empagliflozin has also been associated with an increase in both
LDL and HDL cholesterol. These surrogate markers

The Pathophysiology Behind Pcos : Inflammation
The Pathophysiology Behind PCOS: Inflammation A Literature Review Alexandra Bailin Abstract,
REFS Purpose of review Recent findings Summary Introduction Polycystic ovary syndrome
(PCOS) is the most common endocrine disorder among reproductive aged women, with a
prevalence of 16.6–18% according to the 2003 Rotterdam criteria (1–3). Though PCOS is extremely
common, up to 70% of women with the syndrome are undiagnosed (3). The PCOS diagnosis is one
of ovarian dysfunction and hyperandrogenism, and as such has important implications for
reproductive health (see Table 1; NIH, 2012). However, in addition to these reproductive criteria –
which tend to manifest as hirsutism, infertility, and pregnancy complications – PCOS is marked by
... Show more content on Helpwriting.net ...
One of the first studies to explore the association between PCOS and cardiovascular disease found
that of 143 women having cardiac catheterization for assessment of chest pain or valvular disease,
42% had polycystic ovaries on ultrasound; those women also presented with more extensive
coronary artery disease than women with normal ovaries (11). A recent meta–analysis reported a 2–
fold risk for arterial disease in patients with PCOS as compared to women without PCOS; BMI
adjustment did not affect this finding (12). Though there is still controversy surrounding this
association (13, 14, 15), most research corroborates the negative impact PCOS has on
cardiovascular health (9, 10)Randeva et al., 2012; Loucks, 2013). A diagnosis of PCOS yields
mental consequences as well as physical. The most common clinical manifestations of PCOS,
namely acne, excess body and facial hair, infertility, and obesity, can present challenges to female
identity and body image. Women with PCOS report decreased psychological well–being,
specifically increased levels of depression and anxiety, an increased response to stress, negative
body image, and low self–esteem (16–18). These women also report negative psychosexual and
social implications of PCOS (18, Benetti–Pinto et al., 2015). In fact, when compared to those with
asthma, epilepsy, diabetes, back pain, arthritis and coronary heart disease, women with PCOS have
been found to have the same or better physical

Medical Causes of Obesity Essay
Close your eyes and picture this, you are outside of a favorite cafe looking for a table. You are just
about to sit on the patio to enjoy a steaming hot cup of coffee, when you look to over and see the
most disgusting sight ever. He looks absolutely mountainous; there are rolls upon rolls suffocating
his body. Food is flying everywhere, lettuce is being launched through the air, and there are pieces
of meat all over the table and floor. You are astounded to see that he is trying to snag his third
burger. You then walk away utterly shocked that someone can let their dog get that fat. That is right
what I was describing was about a canine, not a human being, which is what I bet you thought while
reading the description. Society and the ... Show more content on Helpwriting.net ...
When these glands get damaged which can happen in numerous ways like, for example the gland
getting inflamed or through an autoimmune disease, it can cause hypothyroidism
("Hypothyroidism," 2010). Hypothyroidism is a medical condition where the thyroid gland does not
produce enough thyroid hormones. When this happens it affects your metabolism by slowing the
process down, and when you metabolism is slow you are extremely likely to gain weight (Pick,
2005). Unlike Hypothyroidism, the next disease causes obesity in a completely different way. The
next condition that contributes to obesity is Cushing's disease. While this disease may not be quite
as common as hypothyroidism, it still manages to affect around fifteen–million people each year.
Cushing's disease is a condition where the body is exposed to a high amount of cortisol. This
syndrome can be caused in two ways. The first way this is that the body itself produces too much
cortisol ("Cushing's Syndrome," n.d). The second way is when a person takes a corticosteroid
medication (Mayo Clinic Staff, 2010). During both ways, the excessive cortisol causes the body to
"shift energy in the form of fat" ("Cushing's Segment," 2010). The disease causes weight gain in the
upper body, especially in the face and abdomen regions. There will also tend to be a lot of fat
deposits in the cheeks, which causes people to have the appearance

Class V : Kmt 4 Inhibitors
CLASS V: DPP 4 INHIBITORS
The DPP 4 inhibitors come in the class of incretin based therapies for type 2 diabetes. The incretin
effect is generally blunted in type 2 diabetes patients.16 The two main incretin hormones
responsible for blood glucose regulation are GLP–1 (glucagon like peptide–1) and GIP ( glucose
dependent insulinotropic peptide). These two hormones are secreted when carbohydrates and fats
are consumed and they result in increased glucose dependent insulin secretion or postprandial
insulin release and decreased glucagon secretion. Both of these hormones tend to be rapidly
metabolized in the circulation by the enzyme DPP 4 (dipeptidyl peptidase). Type 2 diabetes mellitus
is characterized by decreased insulin sensitivity and progressive loss of pancreatic beta cell insulin
secretion .The DPP 4 inhibitors block the breakdown of naturally occurring GLP 1 by competitively
inhibiting the binding of GLP 1 to DPP .The DPP 4 inhibitors decrease the acitivity of the enzyme
dipeptidyl peptidase by greater than 80% for up to 24 hours, thereby augmenting the meal related
circulating concentrations of both GLP–1 and GIP.19The duration of effect of GLP 1 is thereby
increased, thus resulting in a reduction in hepatic glucose output and increase in insulin production.
DPP 4 inhibitors currently approved in the US:
Generic name Trade name Dosage Combinations
Sitagliptin Januvia 25 to 100 mg once daily Janumet( Sitagliptin+Metformin)
Saxagliptin Onglyza 2.5 to 5 mg once daily

Metformin Benefits
How can one effectively manage type 2 diabetes during pregnancy? If you are planning to become
pregnant and diabetic it's advisable to visit a doctor to prescribe Metformin to achieve normal blood
sugar levels for six months before getting pregnant and to maintain the levels for the nine months of
the pregnancy. If you have been keen on keeping diabetes under control, continue with the routine
since there will be two on board. For an individual to enjoy benefits brought by Metformin, diet and
exercise are vital.
Additional benefits of Metformin
Health benefits of taking Metformin are not only limited to regulating blood sugar levels and
preventing risks associated with diabetes only. The drug can be prescribed because of additional
gains

Metformin Hydrochloride Research Paper
Metformin hydrochloride is available as immediate–release, extended–release oral tablet and oral
solution. There are different brands available such as Glumetza, Fortamet, Glucophage (U.S.
brands), Diabex, Diaformin and Terry White Chemists Metformin (Australian brands).
Glucophage ER tablet uses the Gel Shield Diffusion System and it entails a dual hydrophilic
polymer matrix system. The external of the tablet is made up of a polymer that incorporates
metformin hydrochloride combined with a drug release controlling polymer in discrete particles
form. As the tablet is consumed, polymers of the tablet will hydrate and swell as the fluids from GI
tract enters the tablet. The drug is released at a controlled rate through diffusion in gel matrix that is
essentially pH–independent. The peak concentration of this drug usually ranges from 4–8 hours and
it is recommended to be taken with ... Show more content on Helpwriting.net ...
It comprises an osmotically active core formulation that is surrounded by a semi–permeable
membrane. Two laser–drilled holes exists on either side of the tablet. When it is ingested, the
osmotic pressure forces drug out of the holes at a desired rate as water enters the tablet. The drug is
delivered at a constant rate and it is dependent upon the maintenance of a constant osmotic gradient
across the membrane (7).
Information in regards to the gastro–retentive technology of Australian brands' metformin
hydrochloride such as Diabex, Diaformin, Terry White Chemists Metformin could not be found on
the internet. However, according to the PBS Australia website, Diabex is generally more expensive
(AUD 24.32) as compared to other metformin drugs (AUD 19.37). This is due to the inclusion of
brand premium price for Diabex (22). This price difference could affect patient's preference when it
comes to purchasing metformin medication as patients would most likely to buy medication that is
cheaper but has the same

Metformin Hypothesis
Objective: More evidence has come to light revealing that the drug Metformin, (a medication
commonly used for type 2 diabetes mellitus) has a chance to protect against Cancer. Inspired by
these new studies we asked the following questions:
1) Can metformin in fact prevent ovarian cancer growth by modifying metabolism?
&
2) Will Metformin increase the susceptibility to chemotherapy?
Study Design:
Two different mouse models were used to test (in vitro) the effects of the drug. Cell lines [in vitro,
n=6] were given either the metformin drug, or phosphate–buffered saline solution and cellular
proliferation and metabolic alterations (adenosine monophosphate–activated protein kinase activity,
glycolysis, and lipid synthesis)]. Each of which

Essay On Metformin
Oral medications along with healthy eating and exercise is prescribed to patients who suffer from
this disease. According to the National Institute of Diabetes and Digestive and Kidney Diseases
(2017) most people start their treatment with metformin pills, which come in as a liquid form tablet.
Metformin is an oral medication that helps decrease the amount of glucose a person absorbs after
eating and it also helps decrease the amount of glucose the liver produces (MedlinePlus, 2017). It is
vital to decrease the amount of glucose in the body so that the patient will not develop
hyperglycemia. In addition, metformin increases the body's response to insulin meaning that cell
receptors can use insulin and control the amount of glucose in the body (MedlinePlus, 2017).
Another medication that is prescribe is SGLT–2, which blocks glucose reabsorption in the kidneys
(Diabetes.co.uk, 2017). Therefore, this can help the kidney ... Show more content on
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However, there is a limit and the pancreas stop secreting insulin. Consequently, patients might be
prescribed insulin, which is apply in a variety of ways. Insulin can be taken on a needle and syringe,
which can be injective in the patients belly, thighs, or upper arm (NIDDK, 2017). Another way to
obtain insulin is through an insulin pen that has a needle at its point and its filled with insulin
(NIDDK, 2017). Furthermore, a patient can take insulin by inhaling powdered from an inhaler,
which is place in the mouth. The insulin inhale goes directly into the lungs and moves into the blood
(NIDDK, 2017). All these methods can help the body obtain insulin and reduce the blood glucose in
the bloodstream. Moreover, if a person suffers from both obesity and type 2 diabetes they can
undergo bariatric surgery. This surgery helps the person lose a large amount of weight and maintain
glucose levels under control (NIDDK,

The New Class Of Anti Diabetic Drugs
Abstract
Glitazones are the new class of anti–diabetic drugs that are the first to be able to manage glycaemia
goals. Troglitazone was first approved for the market in 1997, but it was withdrawn from the market
by 2000. After the withdrawal of troglitazone, rosiglitazone and pioglitazone were introduced in
1999 as potentially safer alternatives. However, currently rosiglitazone is under black box warning
for increased risk of cardiovascular disease and pioglitazone is in a nutshell as the drug required
more investigation. In this review, the potential ability to predict the adverse drug reactions (ADRs)
are examined. If it is possible to predict ADRs, should it be done in the future.
Introduction
Millions of people worldwide are affected due to diabetes, 90% of them having type 2 diabetes
mellitus (non–insulin dependent). Since 1921, drug therapy has been improved minutely and in
1950s the antidiabetic sulphonamides and biguanides has been introduced. Therefore, the arrival of
"glitazone" or thiazolidinediones is an important event (14).
Thiazolidinediones are being developed for the treatment of type 2 diabetes mellitus and insulin
resistance. Thiazolidinediones binds and activate the peroxisome proliferator–activated receptor γ
(PPAR), a nuclear receptor that regulates the several genes which are involved in metabolism. The
PPAR γ controls lipid storage, insulin sensitization and adipocyte differentiation. Besides the
metabolic activities, thiazolidinediones also have

Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) is an endocrine system disorder, also a hormonal condition in
which the ovaries are enlarged with very small cysts on the outer edges. The hormonal imbalance
creates problems in the ovaries. The ovaries make the egg that is released each month as part of a
healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released
during ovulation as it should be. The enlarged ovaries may be filled with small collections of fluid
called follicles that can be detected through a thorough ultrasound. PCOS causes a woman's
hormones to be out of balance. It can also cause problems with a woman's monthly period and it can
even contribute to the difficulty for a woman to get pregnant. Knowing ... Show more content on
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All of these can worsen with obesity. Every woman with PCOS may be affected a little differently.
To be diagnosed with PCOS a woman's doctor looks for at least two of the following conditions;
irregular periods, excess androgen, or polycystic ovaries. Polycystic ovary syndrome signs and
symptoms often start soon after a woman first begins having periods. In some cases, PCOS develops
later during the reproductive years. Symptoms of PCOS start gradually over time. Symptoms can
include several menstrual problems. These can include few or no menstrual periods or heavy,
irregular bleeding. Hair loss from the scalp and hair growth on the face, chest, back, stomach,
thumbs, or toes. Acne and oily skin. Fertility problems, such as not releasing an egg or repeat
miscarriages. Insulin resistance and too much insulin, which can cause things like upper body
obesity and skin tags. Depression or mood swings. Breathing problems while sleeping. Polycystic
ovary syndrome treatment focuses on management of woman's main concerns such as infertility,
hirsutism, acne or obesity. Most treatments are medicines prescribed by a woman's doctor. To
regulate a menstrual cycle, a doctor may recommend combination birth control pills, pills that
contain both estrogen and progestin. These birth control pills decrease androgen production and give
your body a break from the effects of continuous estrogen, lowering your risk of endometrial

Pathophysiology Of Polycystic Ovary Syndrome
Question 1:
Zhao Li is a 20 year old woman; obese; non–insulin dependent diabetes, not managed appropriately;
recent diagnosis past few months of Polycystic Ovary Syndrome (PCOS).
For this patient research to understand the pathophysiology for PCOS research has been conducted
to see what the ovaries are, what is an ovarian cyst, lastly the surgical treatment options for the
patient who has presented with a ruptured ovarian cyst.
What are the Ovaries?
The ovaries are a pair of organs in the female reproductive system located on the lateral walls of the
female pelvic cavity. Martini, Nath & Bartholomew,(2014)
What is an Ovarian Cyst?
Ovarian cysts are fluid filled sacs on the ovary and can occur at any time from puberty to
menopause. Intact ovarian cysts are asymptomatic however should it rupture as it has in the case
study the immediate surgery is necessary the repair the haemorrhage. (Bullock & Hales, 2013)
Pathophysiology of Polycystic ovary syndrome (PCOS).
Polycystic ovarian syndrome (PCOS) is a heterogeneous collection of signs and symptoms that
together for a spectrum disorder with a mild presentation in some but a severe in others. The
pathophysiology of PCOS appears to be multifactorial and polygenic. (Fox, 2011)
Bullock & Hales, (2013) state that the main pathophysiological mechanisms underlying PCOS are
alterations in the functions of the hypothalamic–pituitary–ovary and the hypothalamic–pituitary–
adrenal axes as well as the onset of insulin resistance.
What are

Polycystic Ovary Syndrome Essay
Polycystic ovary syndrome (PCOS) is one of the most common conditions of hyperandrogenic
disorders in reproductive–age of women. It comes with mentrual irregularity, ovary disfunction and
hyperandrogenism such as amenorrhea, menorrhagia, anovulation, infertility, ovarian cysts, acne,
hirsutism, etc.1,2 Additionally, patients with PCOS also experience with serious cardiovascular
problems, and metabolic disorders such as hypertension, dyslipidemia, obesity and type 2 diabetes
mellitus (T2DM).1 Especially, patients with PCOS have higher risks to develop T2DM more than
general population, because of experiencing metabolic disorders.3 Therefore, metformin is used as
the first line agent for insulin–resistance and weight loss in obese and T2DM ... Show more content
on Helpwriting.net ...
In COMBO group, patients received metformin (initiated at 500 mg by mouth once daily and
increased to 1000 mg twice daily) and liraglutide (started at 0.6 mg inject subcutaneous once daily
and increased to 1.2 mg once daily). On the other hand, in LIRA3 group, liraglutide was started at
0.6 mg injected subcutaneous once daily and increased up to 3 mg daily. Therefore, the primary
outcome was focused on the mean change in anthropometric measures (heights, weight, and waist
circumference) of obesity. Besides, the secondary outcomes were based on metabolic and hormonal
changes.6
For safety clinical assessment, patients were screened at the beginning and week 4, 8 and 12 during
the study; overall results were analyzed after twelve weeks. From pre– and post–treatment resutls,
there was a significant decrease (p < 0.01) in weight and BMI in both groups, and a significant
decrease (p = 0.003) in waist circumference in LIRA3. Hence, there was a clinically significant of
each group in reducing weight (35.7% in COMBO and 57.1% in LIRA3) with OR = 0.42, 95% CI =
0.09 – 1.9; however, it was not statistically significant between two groups. Moreover, to compare
the differences between COMBO and LIRA3, BMI and waist circumference showed statistically
significant. For BMI results, LIRA3 had the average decrease was

Diabetes mellitus type 2 is an endocrine disorder that...
Diabetes mellitus type 2 is an endocrine disorder that causes impaired use of carbohydrates while
enhancing the use of proteins and lipids. This is called insulin resistance, in which the pancreas
cannot make enough insulin to keep blood glucose levels normal, or the body is unable to use what
is produced. The impairment causes blood glucose level to rise higher than normal. There is no cure
for type 2 diabetes mellitus and it is life threatening when left untreated. Signs and symptoms of this
disorder include vision changes, increased thirst, increased hunger, increased frequency of urination,
stomach pain, nausea and vomiting, erectile dysfunction, and absences of mentruation. These can
occur abruptly, or over a long period of time. ... Show more content on Helpwriting.net ...
Iodine agents administered intravascularly may lead to renal failure. Ace inhibitors can decrease
glucose levels and dose adjustments should be made during the administration of this medication.
Adverse reactions include nutritional disorders, lactic acidosis, taste disorders, nausea, vomiting and
diarrhea, and liver disorders. The implications metformin has on physical therapy treatment include
the risk of lactic acidosis. Signs and symptoms that should be monitored for during physical therapy
are muscular cramping along with gastrointestinal pain, shortness of breath, hypothermia, and coma.
Glyburide is another generic medication used in the management of diabetes mellitus type 2. Two
trade names of this drug are DiaBeta and Glynase. The chemical name is 1–[ [p–[2–(5–chloro–o–
anisamido) ethyl]phenyl]–sulfonyl]–3–cyclohexylurea. Doses up to 0.75–12 mg/day can be given as
a single dose or divided doses. The circulation of the glyburide is that protein binding is extensive
and half–life is 10 hours. It is excreted through the renal and biliary system. Glyburide acts as an
oral blood glucose lowering drug. The drugs uses include binding and activating the sulfonylurea
receptor 1, which causes depolarization. This results in an increase in intracellular calcium in the
cells and stimulation of insulin release. Major drug interactions are noted between glyburide and

Symptoms And Treatment Of Polycystic Ovary Syndrome
Imagine a syndrome that can cause you, or a woman you know, to be infertile, depressed, anxious,
obese, or hirsute, along with many others. Polycystic ovary syndrome can cause all of these issues in
a woman who is affected by the condition. If it is not treated properly or on time, it could lead to
other serious medical issues that could even be life threatening. Polycystic ovary syndrome,
otherwise known as PCOS, is not a commonly known syndrome and many women affected by it are
not diagnosed or treated for it. PCOS is a major medical problem that is affecting five to ten percent
of the female population in the U.S. and many more across the globe (American Diabetes
Association, 2014). This syndrome must become better known in the near future so that women with
PCOS can take better control and care of their own body.
DEFINITION: Polycystic Ovary Syndrome is a common endocrine disorder that can affect many
women. It is also "an incurable disorder that affects 1 in 10 women and over 50% do not know they
have it" (PCOS Awareness Association, 2014). An ultrasound exam can reveal that women with
PCOS have a collection of follicles on enlarged ovaries. The particular cause of polycystic ovary
syndrome is unknown. It could be connected to long–term complications; therefore, doctors
recommend weight loss to reduce this risk. Also, early diagnosis and treatment can have an impact
on deciphering if a woman will have long–term complications. Such complications include type 2

Differences On Body And Tissue Weights
Results and Discussion
Body and Tissue Weights
The initial body weight of rats was similar (p–value=0.19). At the end of the experimental period,
the HFFr+S rats had a near doubling of visceral fat weight, compared to the control group (6.9±1.1 g
vs. 3.4±0.4 g, p–value=0.009), while it was slightly and non–significantly lower in the other groups,
especially in the rats gavaged with the high dose of metformin (200 mg/kg/day). After 60 days, no
significant differences were found between the groups regarding the final body weight and
liver/body weight percentage (Table 2). This suggests that the excess energy intake of HFFr rats
have led to a greater adiposity, but not to a higher body weight.
Serum Biochemistry
Compared to the control rats, ... Show more content on Helpwriting.net ...
In this line, Linden et al.35,36 reported that metformin (300 mg/kg/day) lowered adiposity,
hemoglobin A1c levels, hepatic triglycerides and markers of hepatic de novo lipogenesis in diabetic
Otsuka Long–Evans Tokushima Fatty (OLETF) rats. These were not accompanied by any
improvement in fasting and post–challenge glycemic control, and either in the increased serum
levels of triglyceride and free fatty acids. Indeed, there are some other studies, showing no effect
exerted by either dietary calcium and/or vitamin D3 on glucose intolerance37–41.
In this study, HFFr diet, calcium–vitamin D3 supplementation and oral gavage administration of
metformin did not alter the serum concentrations of triglycerides, total cholesterol and Non–HDL–C
(p–value>0.05). The rats in the CaD+S group exhibited clearly higher levels of serum HDL–C,
compared to the groups receiving recommended levels of calcium and vitamin D3. Moreover, the
levels of serum CTRP3 (also known as cartonectin, cartducin, CORS–26) was significantly higher
in the +Met200 group, compared to the other groups (except the +CaD+Met200 group). There was
no effect of HFFr diet and no additive effect of metformin and CaD on serum HDL–C and CTRP3
(Table 3).
CTRP3 is a novel adipokine and a member of CTRP superfamily, which has been shown to reduce
glucose levels, hepatic steatosis and gluconeogenesis, by its regulatory

The Development And Evaluation Of Januvia Essay
The development and evaluation of Januvia® (Sitagliptin Phosphate) are illustrative of the activities
that are needed to assess the efficacy, safety and effectiveness of a new product for treating type 2
diabetes milieus. It is the first drug of dipeptidyl peptidase–4 (DPP–4) inhibitors class that is
approved as an adjunct to diet and exercise to improve the glycemic control.1 Januvia was
developed by Merck Research Laboratories and received the FDA approval on 16 October 2006.2
Preclinical/Animal study: The animal study of MK–0431, the code name for Sitagliptin in early
development phase, was done in mice, rat, and dog. Maximum recommended daily adult human
dose (MRHD) of Sitagliptin was found 100mg/day and NOAEL 50mg/kg based on dog study.3 Two
years of carcinogenic study was conducted on mice and rat. In rat, liver adenoma/carcinoma has
been seen at 60 times of MHRD. This is probably due to chronic hepatotoxicity of the drug. No
tumor incidence was observed in case of mice up to 70 times of MHRD. Both in vitro assay and in
vivo mice assay was not suggestive of mutagenic and clastogenic nature of MK–0431. Fertility
adverse effect was also not at 12 times of MHRD)3 and Sitagliptin was labeled as pregnancy
category B.4 Based on these preclinical studies on animal, Merck submitted their Investigational
New Drug (IND 65, 495) application to FDA was on August 2002.4 Phase I: Phase I of Sitagliptin
study was done on 33 volunteer humans. Following 100mg of Sitagliptin oral

Orlistat: Type 2 Diabetes
Most common misused drugs used for weight loss in Egypt are medicines enhancing the metabolism
(42.7 percent), tracked by drugs inhibiting fat absorption (24.3 per cent), appetite depressants.(Ezzat
2012)
I. Gastrointestinal lipase inhibition
 Orlistat
Orlistat Is a pancreatic lipase inhibitor, when administered three times daily during or up to 1 hour
after meals, it decreases the absorption of around 30% of dietary fat. It is existing as a prescription
drug (120mg) and over–the–counter drug (60mg). Orlistat 120mg is approved from FDA for adults
and adolescents aging from 12 to 16 years. The use of orlistat 120mg TID for 12 months produces
modest weight reduction: among adults contributing in behavioral weight control programs and
prescribed ... Show more content on Helpwriting.net ...
It has been used from the end of 1950s and has since caused an unrated as an antidiabetic drug
which is relaxed to handle and remains first line therapy for type 2 diabetes. metformin is designated
only for diabetes control and not for weight control in candidates with or without diabetes.(Group
2012)
Metformin has been detected as a reason of weight loss in type 2 diabetes patients. Non–diabetic
patients obesity seem to be due to insulin resistance (Hoeger, Davidson et al. 2008). Improving
insulin sensitivity might therefore be a reason for weight reduction under metformin therapy, though
the exact underlying patho–mechanisms persist to be interpreted and explained. (Seifarth, Schehler
et al. 2013)
Metformin might also contain other effects on weight loss, as it decreases glucose production by
liver, fat cell lipogenesis inhibition, increases sensitivity of peripheral insulin and may decrease the
intake of food (Hoeger, Davidson et al. 2008). Studies seem to show that metformin have been
associated with moderate BMI reduction in non–diabetic and obese

Metformin Research Paper
It's important to visit a healthcare facility once an individual encounters signs of polycystic ovary
syndrome and the physician may prescribe Metformin to treat PCOS.
Metformin for PCOS isn't a cure for the ailment. So, what does Metformin do for PCOS? Before
tackling the question, let's learn more about the Metformin. It's an oral prescription drug used
mainly to treat type II diabetes. If belongs to a category of medications known as biguanides. It also
has some off–label uses which haven't been approved by the FDA for example to treat infertility, aid
in weight loss, treat or manage PCOS and it has gained popularity as an anti–aging drug. It's a
highly effective medication and has helped many people (both men and women) deal with the
ailments the medication is prescribed for. What is important is to take the drug as instructed; don't
take an overdose nor an under dose.
How does Metformin work for PCOS? ... Show more content on Helpwriting.net ...
The drug works in a number of ways for a woman with the condition. The therapy controls the
symptoms and manages the condition to hinder complications. As earlier mentioned, PCOS is a
cause of anovulation and infertility; a patient doesn't ovulate regularly, thus irregular periods. It's
obvious without ovulation a woman can't conceive. Thus, treating PCOS with Metformin regulates
the menstrual cycle and this is an advantage if you are trying to conceive. The medicine induces
ovulation and a pregnancy may occur. Hormonal imbalance is thought to be one cause of PCOS.
Hormones are substances produced by the glands and absorbed into the bloodstream. They are
ferried to different body tissues and aid in body functions. There are numerous types of hormones;
the following are the hormones mainly affected by

Oral Anti Diabetic Agents Are Used As Pharmacotherapy Options
Introduction:
Oral anti diabetic agents are used as pharmacotherapy options mainly for type 2 diabetes patients or
as an adjuvant therapy for type 1 diabetes patients, who need an oral agent along with insulin/insulin
analogues for better glycemic control. There are a wide variety of oral anti diabetic drug classes that
are available. The choice of pharmacotherapy is patient specific and usually a stepped therapy
approach is applied and titrated as per individual patient requirements. The article here is a detailed
overview of the different classes of these oral agents, their pharmacology, comparative efficacy,
efficacy results from clinical trials, general recommendations etc.
The different classes of oral anti diabetics starting from traditional therapy to the latest
developments are as follows :
 BIGUANIDES [METFORMIN]
 SULFONYLUREAS
a. FIRST GENERATION SULFONYLUREAS.
b. SECOND GENERATION SULFONYLUREAS.
 MEGLITINIDES
 THIAZOLIDINEDIONES
 DPP–4 INHIBITORS
 ALPHA–GLUCOSIDASE INHIBITORS
 SGL2 INHIBITORS (NEWEST CLASS OF DRUGS) CLASS I: BIGUANIDES [METFORMIN]
According to the ADA (American Diabetes Association) 2013 guidelines, metformin is considered
as first line therapy for initiation of treatment in a type 2 diabetes patient when lifestyle
modifications, diet and exercise fail to achieve glycemic control.
Mechanism of action: Metformin decreases hepatic glucose production thereby decreasing intestinal
absorption of

Pcos

Polycystic Ovary Syndrome
Dr. Sqouras
Christal Alfonso
Burhan Sadiq
In this research paper I will attempt to discuss the causes, symptoms and signs of Polycystic Ovarian
Syndrome, as well as how it is diagnosed and treated. As someone who is suffering from this
disease, I found my research to be very informative and educational, raising awareness for my own
understanding, and it is my intention to ensure that this same awareness is translated in my research
paper.
What is Polycystic Ovarian Syndrome Polycystic Ovarian Syndrome also known as Stein–Leventhal
Syndrome, occurs in 5% to 10% of women and is one of the causes of infertility. PCOS is observed
by ultrasound as a number of small cysts on a woman's ovary, and it's ... Show more content on
Helpwriting.net ...
If the pancreas can manage with your body's high demand for insulin your blood sugar levels will
remain normal and you would not become a diabetic. Because diabetes and PCOS is closely related
it is monitored closely. It is shown that women with PCOS is in much greater risk in developing
diabetes. Research has shown that once the pancreatic islet cells have become exhausted and
depleted in the over production of insulin to satisfy the body requirements, your pancreas stop
making insulin and your blood sugar becomes elevated. When that happens the patient becomes
diabetic. Besides diabetes a woman with PCOS is more likely to develop uterine cancer and heart
disease. Patients are also advised not to smoke while diagnosed with PCOS because it increases the
risk for heart disease.
Diagnosis of PCOS If a patient complains with the signs and symptoms previously described along
with abdominal pain, amenorrhea, or difficulty to conceive, a physician will take these necessary
measures to diagnosing PCOS. During a physical examination, lab work will be ordered such as a
fasting lipid profile, a glucose test, hormone levels, and an insulin test. The results will give detail
information on hormone levels such as prolactin and thyroid levels, FSH to LH ratio and androgen
levels. A transvaginal ultrasound will also be recommended and administered to indicate a pearl–
necklace pattern of cysts

Pcos Syndrome
"According to Mayo Clinic Polycystic ovary syndrome (PCOS) is an endocrine system disorder that
affects women of reproductive age. Women who have PCOS may have enlarged ovaries that contain
small collections of fluid located in each ovary that can be seen during an ultrasound exam"
(Polycystic ovary syndrome (PCOS)). PCOS is characterized by a few symptoms including but not
limited to a fluctuating menstrual cycle, acne and excessive weight just to name a few. Many women
who are diagnosed with this disorder often find out in their adolescent years, which is when the
fluctuating menstruation cycles usually start. Right now, there is no known reason of how PCOS
develops or what causes it. The best way to control PCOS and keep symptoms minimal ... Show
more content on Helpwriting.net ...
I also learned that 5% 10% of women are effected by PCOS, as well as that up to 70% of those
affected by it have insulin resistance PCOS. I am going to use this information in my paper to build
off of and answer other questions like other ways to prevent the development of metabolic syndrome
and how many other types of PCOS there are. I will also use the information from this article to
support my claims that I don't think that metformin should be used to treat all women with PCOS
because it is only effective in some

Metformin Synthesis
Metformin is a synthetic pharmaceutical drug. Its subclass and class of drugs is biguanides. The
drugs superclass is organonitrogen compounds. Metformin is an oral medication used in the
treatment of non–insulin dependent Type 2 diabetes or diabetes mellitus patients. It is being
prescribed by doctors to at least 120 million patients around the globe for people who can't control
their blood sugar by diet modification.
The main purpose of the drug is to improves the body's glucose levels in blood by decreasing the
overall production of glucose in liver. It also decreases intestinal absorption of glucose, as well as
increasing insulin–mediated glucose uptake. According to Lond (2016), it also" decrease in hepatic
energy status activates the AMP–activated protein kinase (AMPK)." ... Show more content on
Helpwriting.net ...
This protein kinase is a liver enzyme. This enzyme plays a significant role in how the body signals
the production of insulation and energy balance. By taking the drug patients may see an
improvement in insulin binding to its receptors. The molecular formula for Metformin is

The Role Of Polycystic Ovary Syndrome ( Pcos )
EPIDEMIOLOGY
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects 4% to 12% of
women of childbearing age.1 The proportion of individuals in a population with PCOS depends on
the diagnostic criteria.2 According to the criteria implemented by the European Society for Human
Reproduction and Embryology/American Society for Reproductive Medicine, PCOS is as great as
15% to 20%.2 As stated in The National Institute of Health Office of Disease Prevention Report,
PCOS impacts about 5 million females of reproductive age in United States.3 The identification and
management of the disease is estimated to cost $4 billion annually to the US health care system.3 As
such, PCOS presents a major economic burden.
This heterogeneous ... Show more content on Helpwriting.net ...
COS may suffer include anxiety, depression, body dissatisfaction and a lower quality of life.6,7
ETIOLOGY AND PATHOPHYSIOLOGY
PCOS is an oligogenic disorder that has a heritable factor of approximately 70%.3 Both genetic and
environmental factors contribute to the phenotype of the disease.4 The pathophysiology of PCOS
consists of defects in the hypothalamic–pituitary axis, secretion of insulin and the function of the
ovary.3 Although, the cause of PCOS is an on going topic of research, it has been linked to insulin
resistance and elevated androgen levels that contribute to hormonal imbalance.4 It is estimated that
60%–80% of women with PCOS, show insulin resistance and this percentage increases to 95% of
women who are obese.8 Insulin resistance is a cause as well as an exacerbating factor for the
development of PCOS.3 Insulin resistance contributes to metabolic disturbances, obesity and type 2
diabetes, as well as increased androgens, cardiovascular risks and anovulation.1
Insulin aids in regulation of ovarian function and overproduction of insulin causes the ovaries to
produce high amounts of androgens.9 High levels of gonadotropin releasing hormone (GnRH)
stimulate the ovarian thecal cells to produce a greater amount of androgens such as 17–
hydroprogesterone, testosterone and progesterone.9 Furthermore, thecal cells contain a higher level
of cytochrome P450 11A, CYP17 and 3–HSD2 genes.9 Increased androgens stimulate visceral
adipose tissue to produce free fatty

The Uses Of Metformin
Biguanide (Metformin) is usually the first diabetes medication prescribed if a healthy diet and
physical activity alone has not sufficiently helped to control the blood glucose levels. Metformin
works in two ways: It helps to stop the liver producing new glucose and to overcome insulin
resistance by making insulin carry glucose into muscle cells more effectively. It is available in
different forms – tablets for immediate release (up to three times per day) or prolonged release
(usually once per day), and oral solution and powder for oral solution for immediate release. It is
often used for people who are overweight because it generally does not encourage weight gain and
can reduce the risk of cardiovascular complications like heart ... Show more content on
Helpwriting.net ...
Incretin mimetics: incretin hormones help the body to produce more insulin when needed and
reduce the amount of glucose production when it's not needed. The hormone also reduces the rate at
which the stomach digests food and empties. This medication increases the level of incretins in the
body.
DPP–4 inhibitors (gliptins): works by blocking the action of DPP–4, an enzyme that destroys the
hormone, incretin.
SGLT2 inhibitors: This medication reduces the amount of glucose absorbed by the kidneys and your
blood.
Type 2 diabetics tend to become less responsive to insulin as they age. This can be offset if
necessary by injecting insulin.
Most diabetics with Type 1 diabetes treated with insulin injection as the insulin cannot be taken
orally because, being a protein, it would be digested in the alimentary canal. There are two types of
insulin (Diabetes UK, 2017):
Basal insulin: the role of basal insulin is to keep blood glucose levels at consistent levels during
periods of fasting. When fasting, the body steadily releases glucose into the blood to our cells
supplied with energy. Basal insulin is therefore needed to keep blood glucose levels under control,
and to allow the cells to take in glucose for energy. Basal insulin is usually taken once or twice a day
depending on the insulin. Basal insulin need to act over a relatively long period of time and
therefore basal insulin will either be long acting insulin or intermediate insulin.
Bolus insulin: a

Analysis Of Drug Metformin : A Disorder Of The Endocrine...
Analysis of drug Metformin
"Diabetes Mellitus (DM) is a disorder of the endocrine system"(Ciccone, 2016), which caused an
increase in blood glucose. In the United States, there are approximately 24 million people diagnosed
with DM. (Ciccone, 2016). Diabetes is also considered as a global health problem that seems to
increase every day. It is estimated that people diagnosed with DM will increase up to 366 million in
the year 2030 (Ali et al., 2015). DM causes a serious problem and is known to be the primary cause
of blindness in the adults. Also, it is said that a significant number of patients who were diagnosed
with diabetes will suffer from an end–stage renal disease (Ciccone, 2016). According to Mishra,
Swaroop and Kandpa (2016), complications of diabetes are seen gradually, especially if the glucose
level is not controlled (p. 55). Also, Li, Zheng, Buruku and De Kimpe (2004), explains that people
with diabetes has difficulty or not able to produce insulin that controls the blood glucose.
There are 2 types of diabetes, Type 1 or the insulin dependent diabetes and Type 2, non–insulin
dependent diabetes. Type two diabetes accounts for 90–95% of diabetes. This is the most common
type of diabetes. Diabetes, in general, has a high morbidity and mortality rates (Li et. al., 2004). The
available drugs for diabetes are insulin and oral hypoglycemic medication. It is known that
antidiabetic drugs have minimal side effects.
In 1957, metformin was first written in the scientific

Trade and Generic Name, Drug Classification and Mechanism...
Trade and Generic Name, Drug Classification and Mechanism of Action Metoformin is a
medication used to treat Type 2 diabetes. Metformin is classified as a biguanide and antidiabetic
medication. Its therapeutic classification is an antihyperglycemic. Metformin, which is the drug's
generic name, is also known under its trade names: Fortamet, Glucophage, Glucophage XR,
Glumetza and Riomet. Metformin is an oral hypoglycemic medication and has three main actions:
Metofrmin increases the binding of insulin to insulin receptors in skeletal muscles and fat, which
works to improve tissue sensitivity to insulin. Through this action, glucose is able to be transported
into skeletal muscles and fat and the body is able to use glucose to function properly. Metformin
also suppresses gluconeogenesis, which is the production of glucose from non–carbohydrate sources
such as fat and protein. Metformin also prevents the liver from converting stored glycogen into
glucose. All these actions work together to lower the level of blood sugar and also lower the
Hemoglobin A1C value, ensuring diabetics have better control of their blood sugar.
Indication for Use and Contraindications Metformin is used to treat patients with Type 2 diabetes in
addition with proper diet and exercise. Metformin is contraindicated in patients with
hypersensitivity to metformin, hepatic or cardiopulmonary insufficiency, alcoholics, patients with
multiple infections, acute myocardial infarction,

International Conference On Harmonization Guidelines
1– Introduction
This protocol is designed for trying a research study on human subjects. Based on this protocol, the
trial will be conducted in Canada and on Canadian residents or citizens. All aspects of this study is
designed according to Good Clinical Practice part of the International Conference on Harmonization
guidelines (ICH/ GCP E6) and Health Canada Regulations (Part C, Division 5) that is mandatory to
conduct all the human clinical research in Canada. Metformin is available in Canada as Apo–
Metformin but Vildagliptin (Glavus) is not available in this country and is needed some shipping
process from United State of America under the Health Canada Regulations (Part c, Division 5).
1.1 Background
Diabetes Mellitus is a common disease in the world and Canada. The number of diabetic patients
has been starting to increase in most of the world countries. It is anticipated that the incidence of this
disease will be increased dramatically in the next decade. The main reasons of this event are: a)
obesity, b) increasing the mean age of the world population and c) reducing the physical activities
especially in industrialized areas. CCDSS has reported that in adult people who are over 20 years
old, the prevalence of Diabetes Mellitus was 8.7% (95%CI: 8.72–8.74%), indicating one diabetic
patients in 11 healthy Canadians.[1–2]
The common sort of diabetes disease is Type 2 Diabetes Mellitus (T2DM) that includes 90% of all
diabetic cases. In Canada 90–95% of diabetic patients

Metformin Versus Placebo
Metformin versus Placebo in Obese Pregnant Women without Diabetes Mellitus
Objectives: The objective of the research article was to test the use of metformin verses a placebo as
a potential solution to reducing insulin resistance in order to reduce the incidence of obesity–related
complications in women during pregnancy such as gestational diabetes mellitus and excessive
gestational weight gain.
Hypothesis: Researchers on the Metformin in Obese non–diabetic Pregnant Women trial
hypothesized that Metformin, as compared with a placebo, would be associated with a lower median
neonatal birth–weight z score when administered to pregnant women without diabetes who had a
body–mass index of more than 35.
Methods: The methods used in this article was a double–blind, placebo–controlled trial. From a
group of 450 pregnant women without diabetes and with a BMI greater than 35, half of the group
was randomly given a dose of 3.0 g of metformin per day, and the other half was randomly given a
placebo per day. The metformin and placebo were given from 12 to 18 weeks gestation with a
singleton fetus until the delivery. At the start of the study at 12 or 18 weeks of gestation, the BMI of
each participant was measured by dividing the weight in kilograms by the square of the height in
meters, BMI = weight (kg)/ height2 (m2). Randomization was achieved by using a computer to
generate random numbers. ... Show more content on Helpwriting.net ...
The neonatal birth weight was compared to previously collected singleton pregnancies (72,013),
which had a median birth weight of 3381 ± 563 g. The median of the birth weight taken from the
metformin group was 3516g, and the median from the placebo group was 3351g. The metformin
group also received a higher incidence of side effects than the placebo

The Association Of Psychosocial Aspect
Abstract Diabetes has been addressed by the medical community in terms of biological interventions
and treatments. Fewer studies have been conducted about psychological and social determinants that
may be related with this disease. This study aims to analyze the association of psychosocial aspect
specifically stress, which is caused due to financial burdens for paying rent or mortgage and diabetes
prevalence. How strongly can this form of stress be correlated with diabetes prevalence? To evaluate
this association, the study will use the BRFSS data. Keywords: diabetes prevalence, stress, money,
rent/ mortgage.
Introduction Diabetes is one of the serious diseases in the United States. The Centers for Disease
Control and ... Show more content on Helpwriting.net ...
The risk factors for type 2 diabetes include weight, inactivity, family history, race, age, gestational
diabetes, polycystic ovary syndrome, high blood pressure, and abnormal cholesterol and triglyceride
levels. ("Diabetes Risk factors – Mayo Clinic," n.d.) A research study was conducted to understand
patient psychological insulin resistance (PIR), in other words, to discern psychological opposition
towards insulin use in both people with diabetes and their prescribers and its overall impact on
diabetes management (Brod, Kongsø, Lessard, & Christensen, 2009). Another research study was
conducted to estimate the risk of co–morbid depression on all–cause mortality over time among
individuals with diabetes. The study concluded that depression significantly increased the risk of
mortality among individuals with diabetes and discussed that early detection and treatment of
depression may improve health outcomes in this population (Park, Katon, & Wolf, 2013). In both
the studies to obtain data of the subjects for the study, the researchers used a literature search for
journal articles via databases such as the MEDLINE, PubMed, Google searches, Cochrane Library,
Embase and Science Direct databases. Although the search was extensive and thorough, there could
have been a few biases such as selection biases already made in the earlier articles which the
researchers referred and actively employed in their

Metformin Research Paper
Glorest Hall APII MW 9:25 Metformin a diabetic drug used to lower increased blood sugar level,
however it could possibly lower the risk for glaucoma, which is caused by too much fluid buildup in
the eye, when fluid does not drain properly, or when the blood vessels in the optic nerve are
damaged. Glaucoma is one of the leading cause of blindness all around the world, and classic open–
angle glaucoma develops in late middle age or old age. Metformin was linked to a lower the risk of
developing glaucoma in a study. The study showed individuals who used the drug metformin in the
10 – year study period showed a 25 percent reduced risk of glaucoma compared with people not
taking the drug. All were 40 and over at the start

Content for Glimepiride + Metformin
Content for Glimepiride + Metformin
Background:
The worldwide prevalence of diabetes mellitus (DM) has increased dramatically in the past 20
years. Insulin resistance occurs early in type 2 disease. This leads to progressive beta cell failure and
overt diabetes. Though monotherapy can slow down this process, it does not prevent the progression
of the disease. To address, both insulin resistance and beta cell dysfunction, combination therapy is
required.
Clinical evidence suggests that combination therapy using oral antidiabetic agents with
complementary mechanisms of action such as a sulfonylurea/metformin may be highly effective in
achieving and maintaining target blood glucose levels . Two most commonly used sulphonylureas in
... Show more content on Helpwriting.net ...
Glimepiride 1–mg + metformin 500–mg vs, glimepiride 2–mg + metformin 500–mg
Coadministration of glimepiride and metformin has been used to achieve glucose control. This
combination might be a suitable alternative for patients with whom compliance with a multiple
medication regimen is difficult. An earlier study found that fixed dose combination of glimepiride &
metformin is effective and safe in patients with type 2 DM. Recently one more strength of
combination tablet, glimepiride 2 mg + metformin 500 mg was developed.
This study was conducted to compare the pharmacokinetics of test and reference formulations of
glimepiride + metformin fixed–dose combination tablets under fasting conditions. 2
Methods:
This was a single–dose, randomized, open–label, 2–period, 2–way crossover study conducted study.
Patients were randomized to 1 of 2 dosing sequences: a single oral administration of a fixed–dose
glimepiride 1–mg + metformin 500–mg combination tablet (test) followed by single oral
administration of a fixed–dose glimepiride 2 mg + metformin 500 mg combination tablet
(reference), separated by a 1–week washout period between doses; or a single oral administration of
a fixed–dose glimepiride 2–mg + metformin 500–mg combination tablet followed by single oral
administration of a fixed–dose glimepiride 1 mg + metformin 500–mg combination tablet, separated
by a 1–week washout period

Essay On Glimepiride
Fixed dose glimepiride/metformin was available in normal and sustained release tablet. A
multicenter randomized study reported similar efficacy, hypoglycemic events and compliance
between these two formulations. Mean HbA1c reduced by
0.59% and 0.61% in sustained release group and normal group respectively. Besides, fixed dose
glimepiride/metformin was as effective as glibenclamide/metformin in reducing HbA1c but more
patients achieved HbA1c<7% at 12–month of treatment with glimiperide/metformin (44.6%
versus26.8%).
................................g56
A different study by Roberts et al (2005) evaluated the efficacy and tolerability of glimepiride in
patients with type
2 diabetes mellitus that were inadequately controlled with a combination of immediate– or ... Show
more content on Helpwriting.net ...
This study showed that in these patients with type 2 diabetes not adequately controlled by dual
combination therapy with metformin and a thiazolidinedione, the addition of glimepiride improved
glycemic control compared with placebo with an acceptable tolerability profile. Although there were
signifi – cantly more episodes of hypoglycemia with triple therapy than with dual therapy and
placebo, the risk for severe hypoglycemia was low. This study again supports the use of glimepiride
in conjunction with TZD combination therapies.
...........................................g69
The central event in these diseases is the conversion of a host encoded cellular prion protein (PrPC)
into abnormally folded,disease–associated isoforms (PrPSc) in the brains of infected animals. In this
study we report that treatment with glimepiride reduced the amount of PrPC expressed at the surface
of primary cortical neurones, neuronal cells and prion–infected neuronal cells. Subsequently,
glimepiride treatment significantly reduced the amount of PrPSc within 3 prion–infected neuronal
cell lines (ScGT1, SMB and ScN2a cells) and glimepiride treated cortical neurones showed
increased resistance to the toxic effects of PrP82–146. The protective effect of glimepiride was
accompanied by reduced binding of PrP82–146 to neurones, reduced activation of cPLA2 and PGE2
production. These effects of glimepiride were observed at physiological concentrations, however
they were not shared by 2

There are many chronic health conditions, which affect my...
There are many chronic health conditions, which affect my family. I believe that mother may have
Polycystic Ovary Syndrome, but there is little evidence to support this syndrome is genetic.
However, I choose to research Polycystic Ovary Syndrome, because I have many of the symptoms
listed. I also felt that it was necessary to further researcher this condition, because it affects both my
health and personal life. My own personal relationship to this syndrome is that it affects me as a
woman. As a woman, I am expected to have children, but with PCOS a common problem is
infertility. Also, PCOs affects my overall health. There are many other different health conditions
that are associated with PCOs. The medical definition of polycystic ovarian ... Show more content
on Helpwriting.net ...
The researchers study is important, because it shows women may feel different, because of their
condition and there needs to be an increase of support for women living with PCOS. Researchers,
Pastor, Patrie, Morris, Dalal, and Bray (2011), examined how depression and body dissatisfaction
maybe common among women living with PCOS. Pastore et al. (2011) conducted their study on
another study to see if they could get the same results. The purpose of the current study is to see if it
was possible to duplicate the past study. The past study, tested if that lower body satisfaction and
education were independent predictors of depression in women with PCOS. In 2011, Pastore et al.
study used different instruments and added androgen levels to the model. The methods of the current
research were questionnaires and serum androgens from a community cohort. In the current study,
researchers measured the subject's body satisfaction, by having them answering a 35 questionnaire.
Furthermore the researchers gave the participants another 35 questionnaire to fill out based on their
depression symptoms. Pastore et al. (2011), found that women with PCOS were more likely to show
depressive symptoms. Also, women with PCOS and who are obese are less satisfied with their body
and more likely to be depressed. The next article discusses, the association between women's
psychological symptoms and PCOS, which is important because living with a medical condition
may

The Effect Of Eating On Eating And Exercise ( Qol Ed )
Abstract
Aim: We compared the quality of life related to eating and exercise (QOL ED) in women seeking
fertility treatment with and without PCOS controlling for age and BMI Body Mass Index (BMI).
Method: Twenty–one women with and 132 women without PCOS attending IVF clinics completed a
questionnaire containing the QOL ED global score consisting of five eating disorder subscores.
Results: Women with PCOS had a poorer QOL ED and were almost three times more likely to
obtain a score suggestive of the presence of an eating disorder (47.6%) than women without PCOS
(16.7%, p<0.005). Women with PCOS had poorer QOL ED global scores (p<0.005), generally
poorer eating disorder subscores, and increased anxiety and preoccupation with ... Show more
content on Helpwriting.net ...
Women with PCOS are at increased risk of metabolic problems (impaired insulin resistance,
impaired glucose tolerance, type 2 diabetes mellitus and cardiovascular disease),3 reproductive
abnormalities (infertility, hyperandrogenism and hirsutism)4 and psychiatric illness (anxiety,
depression and poorer quality of life)5,6. It is postulated that decreased fertility in women with
PCOS results from ovarian hyperandrogenism, hyperinsulinemia secondary to insulin resistance and
altered intraovarian paracrine signalling, which disrupt the growth of ovarian follicles. Arrested
follicular development results in menstrual irregularity, polycystic ovaries, further
hyperinsulinaemia and excess androgen production2,7. Anovulation is the predominant cause of
infertility in PCOS8, with fewer women experiencing impaired oocyte development resulting in
miscarriages9.
The optimal treatment for infertile women with PCOS is not well established. In 2011 a team of
specialists developed evidence based guidelines for the assessment and management of PCOS based
on current literature10. The guidelines suggest preconceptional counselling, lifestyle modifications
including weight reduction and exercise, cessation of smoking, and a reduction in alcohol
consumption10. After these modifications, ovulation induction with anti–estrogen clomiphenes
citrate, metformin or a combination of both may be trialled10.
Approximately 50

Polycystic Ovarian Syndrome Research Paper

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Polycystic Ovarian Syndrome Research Paper