Understanding polycystic ovary syndrome: etiology, clinical manifestations, and treatment approaches

1. INTRODUCTION

Polycystic Ovary Syndrome (PCOS) is a common hormonal condition that impacts women in their reproductive years and has substantial consequences for their reproductive, metabolic, and psychological well-being. PCOS is defined by a combination of symptoms, such as irregular menstrual cycles, excessive male hormone levels, and the presence of many cysts on the ovaries. Anovulatory infertility is a prominent factor in causing infertility, and it is frequently linked to metabolic disruptions such insulin resistance, obesity, and a heightened susceptibility to type 2 diabetes and cardiovascular disease. The precise cause of PCOS is still unknown, which is due to the intricate and diverse nature of the illness. The occurrence of PCOS varies significantly, mostly because of the diverse diagnostic criteria employed in different research [1], [2], [3]. PCOS, as per the Rotterdam criteria, has a prevalence of around 6-10% among women worldwide, making it the most commonly used diagnostic standard. These criteria necessitate the existence of a minimum of two out of three characteristics: oligo/anovulation, clinical or biochemical indications of hyperandrogenism, and polycystic ovaries that are observable through ultrasound. Additional diagnostic criteria include the National Institutes of Health (NIH) criteria and the Androgen Excess and PCOS Society (AE-PCOS) criteria, with each criteria focusing on various features of the disease.

The pathophysiology of PCOS is characterised by a combination of genetic, hormonal, and environmental variables, which interact in a complicated manner. Genetic predisposition is a major factor, since studies indicate a high level of familial clustering of the condition. PCOS development has been linked to various potential genes associated with steroidogenesis, insulin signalling, and inflammation [3], [4], [5].

The development of PCOS is mostly caused by hormonal abnormalities, including hyperandrogenism and insulin resistance. Hyperandrogenism is a condition when there are high amounts of androgens, such as testosterone, in the body. This condition causes the appearance of hirsutism (excessive hair growth), acne, and alopecia (hair loss). Insulin resistance, which is frequently observed in women with PCOS, worsens hyperandrogenism by boosting the production of androgens in the ovaries and adrenal glands. Environmental factors, like as lifestyle and nutritional choices, furthermore have a role in the formation and advancement of PCOS.

PCOS and obesity have a mutually influential association. Obesity can worsen insulin resistance and hyperandrogenism in women with PCOS. Additionally, metabolic dysregulation increases the likelihood of weight gain in these women. This establishes a pernicious loop that exacerbates the administration of the condition. The development of PCOS is believed to be influenced by both stress and exposure to endocrine-disrupting substances. However, the specific contributions of these factors are not yet fully understood [5], [6].

From a clinical perspective, Polycystic Ovary Syndrome (PCOS) manifests with a diverse array of symptoms that can greatly differ among those affected. Menstrual irregularities, such as infrequent or absent periods, are frequently the initial indication of the syndrome. Hyperandrogenic symptoms, such as excessive hair growth, acne, and male-pattern baldness, are frequently observed and can have a substantial negative effect on a woman's overall well-being. Women with PCOS are more prone to metabolic diseases, in addition to experiencing reproductive and dermatological symptoms. Insulin resistance is common in 50-70% of women with PCOS, which increases their chances of developing type 2 diabetes. Dyslipidemia, a condition marked by increased levels of triglycerides and low-density lipoprotein (LDL) cholesterol, as well as reduced high-density lipoprotein (HDL) cholesterol, is also prevalent [6], [7], [8]. In addition, PCOS is linked to a higher likelihood of developing cardiovascular illness, non- alcoholic fatty liver disease (NAFLD), and obstructive sleep apnea.

The psychosocial ramifications of Polycystic Ovary Syndrome (PCOS) should not be undervalued. Women diagnosed with Polycystic Ovary Syndrome (PCOS) have a higher likelihood of encountering mood disorders, such as depression and anxiety, in comparison to the overall population. Women with PCOS commonly have body image problems and a diminished quality of life. This highlights the importance of implementing comprehensive management techniques that address the physical and mental health aspects of the disease [8], [9], [10], [11], [12]. The diagnosis of Polycystic Ovary Syndrome (PCOS) is mostly based on clinical evaluation, with additional support from biochemical and imaging investigations. The Rotterdam criteria are commonly employed, however, a comprehensive assessment is necessary to eliminate other disorders that can imitate PCOS, such as congenital adrenal hyperplasia, androgensecreting tumours, and Cushing's syndrome. Performing blood tests to evaluate hormone levels, glucose tolerance, and lipid profile, in addition to conducting a pelvic ultrasound to observe the structure of the ovaries, are crucial aspects of the diagnostic evaluation [12], [13], [14], [15], [16].

The management of PCOS is complex and should be tailored to the patient's specific symptoms, reproductive objectives, and risk factors for metabolic problems. PCOS management mostly relies on lifestyle adjustments, including focusing on dietary and physical activity interventions, especially for women who are overweight or obese. Pharmacological interventions, such as oral contraceptives, antiandrogens, and insulin sensitizers, are frequently employed to manage hyperandrogenism, menstrual abnormalities, and insulin resistance. Ovarian drilling may be explored in specific instances as a surgical intervention. Advancements in therapy and continuing research are continuously improving our comprehension of PCOS and enhancing the effectiveness of treatment [16], [17], [18].

2. RELATED WORK

Research on Polycystic Ovary Syndrome (PCOS) has greatly increased in recent decades, indicating the intricate and diverse characteristics of this disorder. Multiple research have investigated the genetic, hormonal, and environmental variables that contribute to polycystic ovary syndrome (PCOS), as well as its various clinical presentations and ways for managing it. This section presents a thorough analysis of the latest literature, offering a comprehensive overview of the current state of knowledge in PCOS research. A significant field of study has concentrated on the genetic foundations of PCOS. The syndrome has been shown to have a significant genetic component through twin studies and family-based investigations [18], [19], [20], [21], [22]. The higher rates of PCOS concordance observed in monozygotic twins, as opposed to dizygotic twins, indicate a substantial genetic contribution. GWAS have shown multiple loci linked to PCOS, including those in close proximity to genes implicated in insulin signalling, steroidogenesis, and gonadotropin control. Although there have been improvements, the precise genetic pathways are not fully understood, and current research is focused on clarifying the intricate geneenvironment interactions that contribute to PCOS

The pathophysiology of PCOS is primarily characterised by hormonal dysregulation, including hyperandrogenism and insulin resistance. Extensive research has been conducted on hyperandrogenism, which is characterised by high levels of androgens like testosterone. The mechanisms that contribute to an excess of androgens involve an increase in the production of androgens by the ovaries and adrenal glands, a decrease in the levels of sex hormone-binding globulin (SHBG), and an increase in the conversion of androgens in peripheral tissues [22], [23], [24], [25].

Insulin resistance, a characteristic feature of PCOS, has been associated with both hyperandrogenism and metabolic abnormalities. Insulin resistance worsens hyperandrogenism by affecting many pathways, such as increasing luteinizing hormone (LH) secretion and changing ovarian steroidogenesis. The interaction between insulin resistance and hyperandrogenism forms a harmful cycle that makes the clinical treatment of PCOS more challenging [25], [26], [27], [28].

PCOS presents with a wide range of clinical symptoms, including issues related to reproduction, metabolism, and mental health. Menstrual irregularities, such as infrequent menstruation (oligomenorrhea) and absence of menstruation (amenorrhoea), are often reported in the literature as prevalent symptoms. The frequency and significance of menstruation disruption in women with PCOS highlight its contribution to infertility and the absence of ovulation. The presence of hyperandrogenic symptoms, such as excessive hair growth (hirsutism), acne, and hair loss (alopecia), has a substantial impact on the overall well-being and quality of life of women who experience them.

The utilisation of a commonly employed scoring system to measure the degree of hirsutism continues to be a well- accepted and essential tool in clinical settings. Metabolic problems are common in women with PCOS. Studies have demonstrated that insulin resistance is widespread among 50-70% of women diagnosed with PCOS, which increases their susceptibility to developing type 2 diabetes [29].

Dyslipidemia, a condition marked by increased levels of triglycerides and low-density lipoprotein (LDL) cholesterol, as well as reduced high- density lipoprotein (HDL) cholesterol, is also prevalent. Furthermore, PCOS is linked to a heightened susceptibility to cardiovascular illness, non-alcoholic fatty liver disease (NAFLD), and obstructive sleep apnea. The psychosocial ramifications of Polycystic Ovary Syndrome (PCOS) should not be undervalued. Women diagnosed with Polycystic Ovary Syndrome (PCOS) have a higher likelihood of encountering mood disorders, such as depression and anxiety, in comparison to the overall population. Women with PCOS commonly have body image problems and a diminished quality of life. This highlights the necessity for comprehensive management techniques that encompass both the medical and mental health aspects of the illness. Implementing lifestyle changes, such as modifying one's diet and engaging in regular physical activity, is crucial for effectively managing PCOS, especially for women who are overweight or obese. Pharmacological interventions, including oral contraceptives, antiandrogens, and insulin sensitizers, are frequently employed to manage hyperandrogenism, menstrual abnormalities, and insulin resistance. In specific instances, surgical procedures such as ovarian drilling may be taken into account [30].

Advancements in therapy and continuing research are continuously improving our comprehension of PCOS and enhancing the effectiveness of treatment. An integrated approach that encompasses lifestyle modifications, pharmaceutical therapies, and psychological support is crucial for effectively managing this intricate illness. Studies into the genetic, hormonal, and environmental aspects associated with PCOS have provided insight into the complex mechanisms that cause the condition. Genetic investigations have revealed multiple genetic locations linked to PCOS, emphasising the substantial hereditary aspect of the condition. Hormonal investigations have clarified the functions of hyperandrogenism and insulin resistance in the development of PCOS, uncovering the intricate interaction between these parameters. The symptoms and difficulties of PCOS are worsened by environmental variables, such as obesity and lifestyle behaviours. This highlights the significance of implementing comprehensive management techniques [31].

The clinical study has thoroughly documented the many presentations of polycystic ovary syndrome (PCOS), which encompass irregular menstrual cycles, symptoms related to excess androgens, and metabolic anomalies. The frequency and significance of these symptoms on women's well-being and overall quality of life have been extensively recorded, highlighting the necessity for efficient methods of diagnosis and treatment. The psychological ramifications of PCOS, such as the heightened susceptibility to mood disorders and diminished quality of life, underscore the significance of addressing both the physical and mental well-being in the treatment of the disease [32].

3. METHODOLOGY

To develop a comprehensive understanding of Polycystic Ovary Syndrome (PCOS) and to synthesize the most recent research findings, a thorough and systematic literature search was conducted across multiple reputable scientific databases, including PubMed, Google Scholar, and Web of Science. These databases were selected due to their extensive coverage of biomedical and clinical research, ensuring access to a wide range of relevant studies. The methodology for this review was carefully designed to identify, select, and analyze the most pertinent research on PCOS, with a particular focus on studies published within a specific time frame to capture the latest advancements in the field.

The literature search was meticulously planned to encompass a broad yet focused set of studies that address the key aspects of PCOS, including its genesis, clinical presentation, diagnosis, and treatment. To achieve this, a specific set of keywords was developed, reflecting the core components of PCOS as well as its associated conditions. The keywords used in the search included "menstrual irregularities," "insulin resistance," "hyperandrogenism," "PCOS," and "genetic factors." These terms were chosen based on their relevance to the syndrome and their prevalence in the existing literature. The search was conducted in several phases, starting with an initial broad search to gather a wide pool of articles.

This was followed by a more refined search, where Boolean operators (AND, OR) were used to combine keywords and narrow down the results to studies that specifically addressed the research questions of interest. The inclusion of multiple keywords and their combinations ensured that the search captured a comprehensive array of studies that cover the diverse and multifaceted nature of PCOS. To ensure that the review included only the most relevant and methodologically sound studies, specific inclusion and exclusion criteria were established.

The primary inclusion criterion was the publication date, with the review focusing on articles published between 2000 and 2022. This 22-year period was selected to ensure that the review captured the most recent research while also considering significant earlier studies that have contributed to the foundational understanding of PCOS. In addition to the publication date, studies were included based on their focus on the following areas: the etiology of PCOS, clinical manifestations, diagnostic criteria, and treatment options. Studies that provided new insights into the genetic, hormonal, and metabolic aspects of PCOS were particularly sought after, as these areas are critical to advancing the understanding and management of the syndrome. Exclusion criteria were also applied to refine the selection process further. Studies that did not meet the methodological rigor expected of peer-reviewed research were excluded. This included studies with small sample sizes, lack of control groups, or those with insufficient statistical analysis. Additionally, articles that did not specifically focus on PCOS or that only tangentially mentioned the syndrome without contributing to the core topics of interest were excluded. Non-English language studies were also excluded to maintain consistency and ensure that the review was accessible to a broader audience. Once the relevant studies were identified, a standardized data extraction process was employed to systematically gather information from each article.

The extracted data included the study’s objective, methodology, sample size, key findings, and conclusions. Special attention was given to the study designs, including whether the studies were observational, interventional, or reviews, as well as the populations studied (e.g., age, ethnicity, and geographic location). This detailed extraction process ensured that the review could accurately compare and contrast findings across different studies. The synthesis of the extracted data was carried out with a focus on identifying patterns, trends, and gaps in the current research on PCOS. The data were organized thematically according to the main areas of interest: etiology, clinical presentation, diagnosis, and treatment. This thematic approach allowed for a structured analysis that could highlight the relationships between different aspects of PCOS, as well as the evolution of understanding over time.

To ensure the reliability and validity of the review, a quality assessment was conducted on the selected studies. This involved evaluating each study for its methodological rigor, including the clarity of its research question, the appropriateness of its study design, the validity of its data collection methods, and the robustness of its statistical analysis. Studies were rated according to established quality assessment tools relevant to their study type, such as the Newcastle-Ottawa Scale for observational studies or the Cochrane Risk of Bias Tool for randomized controlled trials. Only studies that met a high standard of quality were included in the final synthesis, ensuring that the review's conclusions were based on the best available evidence.

This quality- focused approach also allowed the review to identify areas where further research is needed, particularly where existing studies may have methodological limitations. The methodological approach used in this review was designed to systematically and comprehensively gather, analyze, and synthesize the most current research on PCOS. By employing a rigorous search strategy, clear inclusion and exclusion criteria, detailed data extraction, and quality assessment, the review aimed to provide a thorough and reliable summary of the state of knowledge on PCOS, offering valuable insights for both researchers and clinicians.

4. RESULTS AND DISCUSSION

The extensive examination of literature on Polycystic Ovary Syndrome (PCOS) demonstrates notable progress in comprehending the causes, clinical presentations, and treatment of this intricate disorder. Genetic research has verified the significant hereditary aspect of PCOS, pinpointing several genetic loci linked to the condition. These genetic locations frequently have a role in insulin signalling, steroidogenesis, and gonadotropin control, offering valuable information about the biochemical processes that could potentially contribute to the development of polycystic ovary syndrome (PCOS). Notwithstanding these discoveries, the precise genetic pathways are not fully comprehended, underscoring the necessity for additional research to clarify the interplay between genetic predisposition and environmental influences. The main cause of PCOS is hormonal dysregulation, specifically hyperandrogenism and insulin resistance [33].

Increased androgen levels are a contributing factor to the distinct symptoms of hirsutism, acne, and alopecia, which have a substantial impact on the overall well-being of affected women. Insulin resistance not only worsens hyperandrogenism, but also plays a role in metabolic disorders such dyslipidemia and an elevated susceptibility to type 2 diabetes. The reviewed studies consistently show that insulin resistance is common in a significant number of women with PCOS, highlighting the need to address this metabolic aspect in therapy techniques. The clinical presentations of Polycystic Ovary Syndrome (PCOS) are varied and go beyond symptoms related to reproduction. Menstrual irregularities, such as infrequent or absent periods (oligomenorrhea and amenorrhoea), are prevalent and have a significant role in the elevated infertility rates seen in women with PCOS. The diagnosis according to the Rotterdam criteria is further substantiated by the detection of polycystic ovaries using ultrasonography. In addition to affecting reproductive health, PCOS is linked to many metabolic and cardiovascular concerns. Women diagnosed with polycystic ovary syndrome (PCOS) have a higher likelihood of getting non-alcoholic fatty liver disease (NAFLD), cardiovascular disease, and obstructive sleep apnea. These findings emphasise the necessity of a comprehensive strategy for controlling PCOS, which encompasses both reproductive and metabolic health [33], [34], [35].

The psychological implications of Polycystic Ovary Syndrome (PCOS) also deserve study. The evaluated research suggest that women with PCOS have a higher propensity to develop mood disorders, such as depression and anxiety. The influence of PCOS on body image and self- esteem intensifies psychological discomfort, underscoring the necessity for comprehensive care techniques that encompass mental health assistance. The management of Polycystic Ovary Syndrome (PCOS) is complex and should be customised to address the specific symptoms and reproductive objectives of each individual [35], [36], [37], [38]. Implementing lifestyle alterations, such as altering one's diet and engaging in consistent physical exercise, is crucial for effectively controlling PCOS, especially for women who are overweight or obese. Pharmacological interventions, including oral contraceptives, anti-androgens, and insulin sensitizers, are frequently employed to address hyperandrogenism, menstrual irregularities, and insulin resistance [38], [39], [40].

The evaluation emphasises the effectiveness of these interventions in enhancing clinical outcomes and quality of life. Occasionally, surgical procedures like ovarian drilling may be contemplated, but usually only for women who do not show improvement with medicinal treatment [40], [41], [42]. Advancements in treatments and ongoing scientific investigations are continuously improving the comprehension and control of PCOS. Research investigating the impact of lifestyle treatments, such as dietary changes and physical activity, has demonstrated their efficacy in enhancing metabolic and reproductive outcomes. In addition, the investigation of innovative pharmacological substances and their potential advantages provides optimism for the development of more focused and efficient therapies in the future [42], [43], [44].

5. CONCLUSION

Polycystic Ovary Syndrome (PCOS) is a complex hormonal condition that has a substantial impact on the reproductive, metabolic, and psychological well-being of women. PCOS is characterised by hormonal imbalances, including hyperandrogenism and insulin resistance, which are key factors in the development of the condition. These imbalances are responsible for the various clinical symptoms observed in PCOS, such as irregular menstrual cycles, symptoms related to high levels of androgens, and metabolic abnormalities. An optimal management strategy for PCOS necessitates a comprehensive approach that encompasses both the reproductive and metabolic components of the condition. Modifications to one's lifestyle, such as changes in nutrition and increased physical activity, are essential components of treatment, especially for women who are overweight or obese. Pharmacological treatments, such as oral contraceptives, anti-androgens, and insulin sensitizers, are necessary for the management of hyperandrogenism, menstrual disorder, and insulin resistance.

Psychological care is essential due to the heightened occurrence of mood disorders and body image problems in women with PCOS. Continued research is crucial to have a deeper understanding of the underlying mechanisms of PCOS and to create more precise and efficient therapeutic approaches. An allencompassing, personalised strategy for managing PCOS can boost clinical outcomes and improve the quality of life for women affected by the condition.

Acknowledgment

The authors have no specific acknowledgments to make for this research.

Funding Information

This research received no specific grant from any funding agency in the public, commercial, or notfor-profit sectors.

Author Contributions Statement

C: Conceptualization; M: Methodology; So: Software; Va: Validation; Fo: Formal analysis; I: Investigation; R: Resources; D: Data curation; O: Writing – original draft; E: Writing – review & editing; Vi: Visualization; Su: Supervision; P: Project administration; Fu: Funding acquisition.

Conflict of Interest Statement

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Informed Consent

All participants were informed about the purpose of the study, and their voluntary consent was obtained prior to data collection.

Ethical Approval

The study was conducted in compliance with the ethical principles outlined in the Declaration of Helsinki and approved by the relevant institutional authorities.

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

1. [1] R. J. Lihite et al., 'A study on adverse drug reactions in a tertiary care hospital of Northeast India. Alexandria journal of medicine', vol. 53, pp. 151-156, 2017. doi.org/10.1016/j.ajme.2016.05.007
2. [2] M. Zehravi and M. Maqbool, 'Polycystic ovary syndrome and infertility: an update. International journal of adolescent medicine and health', vol. 34, pp. 1-9, 2021. doi.org/10.1515/ijamh-2021-0073
3. [3] M. Zehravi and M. Maqbool, 'Correlation between obesity, gestational diabetes mellitus, and pregnancy outcomes: an overview', International Journal of Adolescent Medicine and Health, vol. 33, no. 6, pp. 339-345, 2021. doi.org/10.1515/ijamh-2021-0058
4. [4] M. Maqbool, F. Bekele, and G. Fekadu, 'Treatment strategies against triple-negative breast cancer: an updated review. Breast Cancer: Targets and Therapy', pp. 15-24, 2022. doi.org/10.2147/BCTT.S348060
5. [5] M. Zehravi and M. Maqbool, 'Depression and anxiety in women with polycystic ovarian syndrome: a literature survey', International Journal of Adolescent Medicine and Health, vol. 33, no. 6, pp. 367- 373, 2021. doi.org/10.1515/ijamh-2021-0092
6. [6] M. Maqbool, I. Gani, and M. A. Dar, 'Anti-diabetic effects of some medicinal plants in experimental animals: a review', Asian Journal of Pharmaceutical Research and Development, vol. 7, no. 1, pp. 66-69, 2019. doi.org/10.22270/ajprd.v7i1.469
7. [7] M. Zehravi and M. Maqbool, 'Polycystic ovary syndrome and reproductive health of women: a curious association. International journal of adolescent medicine and health', vol. 33, pp. 333-337, 2021. doi.org/10.1515/ijamh-2021-0031
8. [8] M. Mohd, M. Maqbool, M. A. Dar, and I. Mushtaq, 'Polycystic ovary syndrome, a modern epidemic: an overview', Journal of Drug Delivery and Therapeutics, vol. 9, no. 3, pp. 641-644, 2019. doi.org/10.22270/jddt.v9i3.2661
9. [9] M. Maqbool et al., 'An up to date on clinical prospects and management of osteoarthritis', Annals of Medicine and Surgery, vol. 72, 2021. doi.org/10.1016/j.amsu.2021.103077
10. [10] A. Majeed, R. Bashir, S. Farooq, and M. Maqbool, 'Preparation, characterization and applications of nanoemulsions: An insight', Journal of Drug Delivery and Therapeutics, vol. 9, no. 2, pp. 520-527, 2019. doi.org/10.22270/jddt.v9i2.2410
11. [11] M. Zehravi and M. Maqbool, 'Healthy lifestyle and dietary approaches to treating polycystic ovary syndrome: a review. Open Health', vol. 3, pp. 60-65, 2022. doi.org/10.1515/openhe-2022-0008
12. [12] R. Maqbool, M. Maqbool, and M. Zehravi, 'Menstrual distress in females of reproductive age: a literature review. International journal of adolescent medicine and health', vol. 34, pp. 11-17, 2021. doi.org/10.1515/ijamh-2021-0081
13. [13] M. Maqbool, S. Rasool, M. A. Dar, R. Bashir, and M. Khan, ‘Hepatotoxicity and Hepatoprotective agents: A Mini review. PharmaTutor’, vol. 7, pp. 34–40, 2019.
14. [14] I. Ara, M. Maqbool, G. Fekadu, T. A. Hajam, and M. A. Dar, 'Pharmaceutical significance of Nigella sativa L., a wonder herb', Journal of Applied Pharmaceutical Sciences and Research, vol. 3, no. 4, pp. 4-13, 2020. doi.org/10.31069/japsr.v3i4.2
15. [15] M. Maqbool, N. Nasir, and S. Mustafa, ‘Polycystic in ovarian syndrome and its various treatment strategies’, INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES, vol. 5, no. 9, pp. 8470– 8478, 2018.
16. [16] Maqbool M, Zehravi M, Maqbool R, Ara I. Study of adverse drug reactions in pulmonary medicine department of a Tertiary care hospital, Srinagar, Jammu & Kashmir, India. CELLMED. 2021;11(2):8-1. doi.org/10.5812/ans.112364
17. [17] Ara, M. Maqbool, B. Bukhari, and A. N. Hajam, 'Present status, standardization and safety issues with herbal drugs', International Journal of Research in Pharmaceutical Sciences and Technology, vol. 1, no. 3, pp. 95-101, 2020. doi.org/10.33974/ijrpst.v1i3.169
18. [18] M. Maqbool, G. Fekadu, D. Dugassa, F. Bekele, E. Turi, and D. Simegnew, The pattern of substance abuse in the psychiatry department of a tertiary care of Srinagar hospital, vol. 7. Jammu and Kashmir, India. Archives of Neuroscience, 2020. doi.org/10.5812/ans.106492
19. [19] Ara I, Maqbool M, Gani I. Reproductive Health of Women: implications and attributes. International Journal of Current Research in Physiology and Pharmacology. 2022 Nov 28:8-18.
20. [20] M. Zehravi, R. Maqbool, and M. Maqbool, 'To Identify Patterns of Drug Usage among Patients Who Seek Care in Psychiatry Outpatient Department of a Tertiary Care Hospital in Srinagar', Journal of Pharmaceutical Research International, vol. 33, no. 31A, pp. 135-140, 2021. doi.org/10.9734/jpri/2021/v33i31A31673
21. [21] G. Fekadu, F. Bekele, K. Bekele, S. Hanbisa, G. Belay, and M. Maqbool, 'Drug use evaluation of betablockers in medical wards of Nedjo general hospital', Cardiovascular Therapeutics, 2020. doi.org/10.1155/2020/2509875
22. [22] M. Maqbool, S. Javed, and A. A. Bajwa, ‘Assessment OF pain management IN postoperative cases using different scales and questionnaires’, INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES, vol. 6, no. 1, pp. 983–987, 2019.
23. [23] I. Ara, M. Maqbool, and M. Zehravi, 'Psychic consequences of infertility on couples: A short commentary. Open Health', vol. 3, pp. 114-119, 2022. doi.org/10.1515/openhe-2022-0022
24. [24] M. Maqbool, D. Dugassa, and G. Fekadu, Adverse drug reactions of antiepileptic drugs in the neurology department of a tertiary care hospital, vol. 8. Srinagar, Jammu & Kashmir, India, 2021. doi.org/10.5812/ans.112364
25. [25] R. Bashir, M. Maqbool, and A. I. Zehravi, ‘An In sight into Novel Drug Delivery System’, In Situ Gels. CELLMED, vol. 11, no. 1, pp. 6–7, 2021.
26. [26] M. Zehravi and M. Maqbool, 'Teenage menstrual dysfunction: an overview', International Journal of Adolescent Medicine and Health, vol. 35, no. 1, pp. 15-19, 2022. doi.org/10.1515/ijamh-2022-0018
27. [27] M. A. Dar, M. Maqbool, and S. Rasool, ‘Pharmaceutical wastes and their disposal practice in routine’, Int J InfComput Sci, vol. 6, pp. 76–92, 2019.
28. [28] I. Ara, M. Zehravi, M. Maqbool, and I. Gani, ‘A review of recent developments and future challenges in the implementation of universal health coverage policy framework in some countries’, Journal of Pharmaceutical Research & Reports, no. 3, 2022.
29. [29] M. Maqbool, M. A. Dar, S. Rasool, I. Gani, and M. Khan, ‘Substance use disorder and availability of treatment options: an overview’, Journal of research in health science, vol. 1, pp. 4–10, 2019.
30. [30] M. Maqbool, W. Shabbir, and S. Aamir, ‘Adverse events of blood transfusion and blood safety in clinical practice’, Indo American Journal Of Pharmaceutical Sciences, vol. 5, no. 8, pp. 8254–8259, 2018.
31. [31] M. Maqbool, A. Naeem, and S. Aamer, ‘Diabetes mellitus and its various management strategies in practice’, Indo American Journal of Pharmaceutical Sciences, vol. 5, no. 8, 2018.
32. [32] M. Maqbool, S. Tariq, and S. Amjad, ‘Prescribing practices in pediatrics and drug utilization studies promoting pediatric health’, Indo American Journal of Pharmaceutical Sciences, vol. 5, no. 8, pp. 8070–8076, 2018.
33. [33] Maqbool, M., et al. ‘Adverse Drug Reaction Monitoring and Occurrence in Drugs Used in Pulmonary Disorders’. Indo American Journal Of Pharmaceutical Sciences, vol. 5, no. 8, 2018, pp. 8060–8065.
34. [34] R. Maqbool, M. Maqbool, and M. Zehravi, 'Acute neurological conditions during pregnancy and their management: a review', International Journal of Adolescent Medicine and Health, vol. 33, no. 6, pp. 357-366, 2021. doi.org/10.1515/ijamh-2021-0084
35. [35] Maqbool, M., et al. ‘An Overview about Treatment of Gestational Diabetes Mellitus: A Short Communication’. CELLMED, vol. 11, no. 3, 2021.
36. [36] Fekadu, G., et al. 'Knowledge, Attitude of Health Care Professional's towards Clinical Pharmacy Services in Nedjo General Hospital'. Western Ethiopia. International Journal, vol. 5, no. 7, 2019. doi.org/10.18203/issn.2454-2156.IntJSciRep20192798
37. [37] Maqbool, M. 'Evaluation of Drug Utilization Pattern in the Pediatric Department of a Tertiary Care Hospital in Srinagar'. Journal of Applied Pharmaceutical Sciences and Research, vol. 2019, pp. 6-9. doi.org/10.31069/japsr.v2i4.2
38. [38] Maqbool, M., and I. Gani. 'Utilization of Statins in Reducing Comorbidities of Diabetes Mellitus: A Systematic Review'. Journal of Pharmacy Practice and Community Medicine, vol. 4, no. 4, 2018. doi.org/10.5530/jppcm.2018.4.46
39. [39] Maqbool, M., and Ara I. Gani. ‘The Story of Polycystic Ovarian Syndrome: A Challenging Disorder with Numerous Consequences for Females of Reproductive Age’. International Journal of Current Research in Physiology and Pharmacology, 2022, pp. 19–31.
40. [40] Maqbool, M., and M. Zehravi. Neuroprotective Role of Polyphenols in Treatment of Neurological Disorders: A Review. Interventional Pain Medicine and Neuromodulation. Vol. 1, 2021. doi.org/10.5812/ipmn.117170
41. [41] Maqbool, M., et al. ‘Psychotropic Drug Utilisation Pattern Can Be Useful in Monitoring Treatment Regimens for Mental Disorders in Psychiatric Settings’. INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES, vol. 5, no. 8, 2018, pp. 7717–7721.
42. [42] Zehravi, M., and M. Maqbool. 'Unfolding the Mystery of Premenstrual Syndrome (PMS): An Overview'. International Journal of Adolescent Medicine and Health, vol. 35, no. 1, 2022, pp. 9-13. doi.org/10.1515/ijamh-2022-0023
43. [43] Zehravi, M., and M. Maqbool. 'An Overview about Safety Surveillance of Adverse Drug Reactions and Pharmacovigilance in India'. The Indian Journal of Nutrition and Dietetics, 2021, pp. 408-418. doi.org/10.21048/IJND.2021.58.3.27285
44. [44] Ara, I., et al. Phytochemical Standardization and Anti- Anxiety (Izterab-e-Nafsani) Study of Aftimoon Hindi. Vol. 11, 2021.