Rajiv Gandhi University of Health Sciences s124

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKAPROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION1 NAME OF THE CANDIDATE Ms. JERIN RAJU P AND ADDRESS ROOHI COLLEGE OF NURSING, KANNUR, BANGALORE-49 KARNATAKA2 NAME OF THE ROOHI COLLEGE OF INSTITUTION NURSING,KANNUR, BANGALORE 3 COURSE OF THE STUDY FIRST YEAR M.Sc NURSING AND SUBJECT PAEDIATRIC NURSING 2011 4 DATE OF ADMISSION TO 02.08.2011 COURSE1 1. INTRODUCTION“Children are the brightest treasures we bring forth into this world, but too large a percentage of the population continues to treat them as inconveniences & nuisances, when they are not treating them as possessions or toys”.“CHARLES DELINT”Children constitute a major proportion of the global population today. They are not only large in number but vulnerable to various health problems and considered as special risk groups. So children need special care to survive with good health.Scientists now detect chemicals in their body have serious implication for the future in the children. All kinds of modern diseases are due to modern plastic use. As said byDr.Landrigan “people gradually realize that children are particularly vulnerable to environmental hazards of plastics”1.Getting rid of plastic will not be easy, however, as it constitute700tonnes of the over 5,000tonnes of waste that Bangaluru throws up every day. Most of it made up of plastic sheets. Should a ban on plastic bags actually work on city will have 400tonnes less rubbish to dispose of every day.’ Says a senior officer of the Karnataka State pollution Control Board ,pointing out that plastic ,being non2 biodegradable ,takes over 500 years to decompose and so pollutes the soil, air and water when dumbed in landfills2Environmental pollution has an effect on the human life. In a period of ten years the hooker chemical and plastic corporation dumped 22000 tones of toxic waste in steel drums in an old canal. They covered the canal with top soil and the property was then turned over to the Niagara Falls public school, district. many homes, recreational fields and a school were built to notice odd smells. The steels drums were leaking toxic waste into sewers, lawns and even the basement of some homes .due to the actions concerned citizen. Lois Gibbs, of the state performed many health studies on the area and by 1978 the federal government declared love canal to be a disaster area.It costed the tax payers about 275 millions dollars to clean up the site2Plastic is a synthetic or semi synthetic organic solids used in the manufacture of industrial products. This material is both, easy & inexpensive to produce, its light weight, durability and versatility make a preferred material for packing and manufacturing. However its un controlled use leads to more problems, than it solves3.There are two types of plastics, thermoplastics & thermosetting polymers:-1) Thermoplastics are the plastics that don’t undergo chemical change in their composition when heated.Ex:- polyethylene, polysterene, polyvinylchloride etc.. 2) Thermosets can melt and take shape once, they have solidified, they stay solid.3 Some of the common plastics are used as follows:Food containers, disposable cups, plates, CD & cassette boxes. Electronic equipment case ex: ( computer monitors, printers, keyboards). Carbonated drinks bottles, jars, plastic films. Fibers, textiles. Toothbrush bristles. Eye glasses, lenses,Food packaging. Super market bags, plastic bottles, chewing gum3.Plastic uses are not only leads to health effects but also environmental effects like the plastics are durable & degrade very slowly, one billion tons of plastic have been discorded and may persists for hundreds or even thousands of years. Burning of plastics may create dioxin and often creates large quantities of chemical pollutions leads to depletion of the ozone layer3.Many chemical additives that give both environmental and human health effects.These effects include:- Direct toxicity as in the cases of lead, cadmium & mercury Carcinogens as in the case of diethylhexylphthalate (DEHP) Endocrine disruption, which can lead to cancers, birth defects immune system suppression and developmental problems in children and other problems like chronic bronchitis, ulcer, early puberty, obesity, hyperactivity, irritation of eyes, headaches etc’ 3Plastic causes serious damage to environment, to reduce the hazards of plastic pollution is to reduce the use of plastic & there by force a reduction in its production or using the chemical substances emitted during recycling of plastics3.4 Children products like food packaging can be safely packed with materials bearing ultraviolet / evidence based cured coating. Each manufacturer must perform its own analysis to determine whether its packaging is safe for food use. The art and creative materials are choosen carefully by the school children under established guidelines for labeling of non toxic art products (D-4236) look for these labels on arts& craft products including crayons, markers, etc…’ and select. 4Products made from plastics are useful and only a few types are suspected to release potentially harmful chemicals. Plastics with a recycling code of 3,6, or 7 should be avoided. 5Number ‘3’ – vinyl based – ‘plastic smell’Number ‘6’ – polysterene – disposable cups, bowls, opaque plastic spoons etc…Number ‘7’ – polycarbonates – baby bottles, sippy cups.Plastics with a recycling code of 1,2,4, or 5 are not suspected to releasing chemicals at harmful levels if used properly, don’t microwave food or drinks in plastics containers, use plastic containers for cool liquids, Don’t reuse – single use plastics, Avoid old, scratched plastics water bottles, Wash plastics on the top rack of the dish washer farther by hand, Don’t allow young children to handle or chew on plastic electronics, Wash hands before eat, Carry a glass or stainless steel water bottle,Cover food in the microwave with paper towel instead of plastics5.The consumer product safety commission our implementation of several product safety statutes, including the consumer product safety Act, the Federal5 Hazardous substance Act, and the poison prevention Act. The consumer product safety commission also has issued a specific ban on toys & other articles intended for used by children that bear lead-containing paint, where excelled 0.06% the non-volatile content of the paint5.6 6.1 NEED FOR THE STUDY“The deeds of the children are a testament to the upbringing they received from their parents”. “CHRISTOPHER PAOLINI”Everywhere you look in the world you can see and feel plastic. Its pivotal to over lives – it is hard to imagine life without plastic fantastic. No wonder plastic mouldings is a massive global business.Polyvinylchloride is the second largest commoditity plastic in production in the world today. It is used in many consumer products such as children toys, infant products, electronics, and food packaging. Polyvinylchloride is a known human carcinogen can increased the risk of liver cancer, impact the nervous system & increased incidence of birth defects6.Polyvinyl chloride harmful to workers have documented likelihood of developing diseases including angiosarcoma of the liver. In mid August 2007, no lessthan 8 workers were killed from major accidents at polyvinylchloride plants inIndia and Russia. On April 23, 2004, a polyvinylchloride plant illinosis exploded, killing 5 workers6.Homes are also filled with plastics and most of them really don’t know that what are made of or whether they are safe. The toxicity of plastics contain chemical additives to change the quality of the plastics for its intended use. Some of these7 ingredients or additives are harmful chemicals like bisphenol-A, Phthalates. These chemicals routinely migrated or leach into the food and water they contain7.The national toxicology program at the National Institute of health and food &Drug Administration now report that they have some concern about the potential effects of bisphenol-A on the brain, behaviour & prostate gland in fetus, infants & young children8.Many companies are now making bisphenol-A free bottles & sippy cups including Gerber, MAM, Mother’s milkmate, playschool thermos etc, while some like born free, only make bisphenol-A free versions of their bottles & sippy cups, others make both. So check the labels if you have a bisphenol A bottle or sippy cup9.Plastics leses leads to environmental pollution & health effects on the childrens. Some of common health problems faced by the childrens are respiratory problems, heart diseases, vision problems. Effect on immune system etc….Although there is no proof that the amount of bisphenol A that can leach out of water bottles is dangerous to avoid bisphenol-A. Switch to glass bottles. Avoid microwaving plastics containers. Avoid washing plastic containers with harsh detergents. Switch to bisphenol-A free plastic baby bottles.The total amount of plastic in the municipal solid waste stream in 2006 was almost 30 million tons. In 2006, the united statues generated 14 million tons of plastic through containers anmd packaging. The amount of plastic consumed as a percentage of total waste has increased from less than 1% in 1960 to 11.7% in 2006108 Americans threw more than 22 billion water bottles in 2006. 70 million bottles of water are consumed in the U.S was recycled in the united states of America in1997, the food contamination occurred in a large group, large amounts of dioxins were released from the chemical factory in seveso, Italy in 1976, as released into the air and eventually contaminated an area of 15 sq km where 37000 people lived10.In the united states, more than 100 municipal waste incinerators burn 500 too600 millin pounds of polyvinyl chloride each year. An average of 8,400 landfill fires are reported every year in the united states. Just 7% of polyvinyl chloride bottles were recycledin 200410India is said to generates 5,000 tones of plastic waste each day. New kerala.com reports that India centre of plastics in the environment shows about 60% ofIndia’s plastic production is recycled annually11.A professor of chemistry in a college located in Madurai has discovered a novel, using plastic carry bags & disposable cups that are collected from garbage dumps across Madurai as an important ingredient of the road construction material11.A senior scientist Dr. Anila Jacob tells that generally very little published research on the potential adverse health effects of chemicals that leach from plastic food containers. Because plastics are Ubiquitous today. Choose them carefully to minimize the exposures. Avoiding them altogether is not practical, so focus on those that are likely to come into contact with your mouth the most common way chemicals in plastic products enter the body. Plastic chemicals touch your mouth in an number of9 ways from your hands and your food and drinks. This is especially important for young children, who frequently put hands and objects in their mouths ( Anila Jacob) 12.Russ Hauser, a professor of environmental epidemiology at Harvard school of public health, shown the same problems in animals studies, lowered fertility % abnormal development of the reproductive organs, the study would follow kids from birth until puberty or even later and then there’s the fact that even in ICU babies, phthalates levels are not so high. Any effect on ICU babies is likely to be subtle-as light delay in puberty or fertility problem later in life, the effect of phthalates on other kids there is any would be even less obvious12.According to review of literature and investigators experience it was noticed that School children need knowledge regarding hazards of plastic use. Hence the investigators felt there is a need to conduct a programme regarding the hazards of plastic use and also to evaluate the effectiveness of structured teaching programme.10 6.3 REVIEW OF LITERATUREReview of literature is systemic identification, selection, critical analysis and reporting of existing information on the topic of material for the study.The review of literature is a key step in research process. An extensive review of literature relevant to the research was done to collect maximum information for laying the foundation for this study.The purpose of the review of literature is to obtain indepth knowledge & information about the hazards of plastic use.The review of literature of the present study is organized under the following headings:1. Studies related to plastic use in various methods.2. Studies related to hazards of plastic use and prevention among school children.3. Studies related to structured teaching programme 1. STUDIES RELATED TO PLASTIC USES IN VARIOUS METHODS:-A retrospective study was conducted on patch testing with plastics and glues series allergens between 2000 & 2007. a total of 444 patients were participated.the study showed results that patients 97 (22%) had irritant reactions and 201 (45%) had atleast one allergic reaction. Bis (2-dimethylaminoethyl) ether 1%, benzoyl peroxide 1% epoxyresin, bisphenol F 0.25 %, 2- hydroxylmethacrylate 2% & 2-hydroxyethyl, acrylate 0.1% had the highest alleric reaction rates1311 A study was conducted on analysis of 161 patients with intrinsic sphincter deficiency who under went a surgeon assembled polypropylene patch sling procedure.Medical recors for the 161 patients who underwent the procedure werw available to review the mean patient age was 62 years. 25 patients (16%) had concomitant detrusor overactivity, mean follow up was 4 years, negative findings in 93.4% of patients complete continence was reported by 80.3% of patients & marked improvement by7% the results concluded the use of a polypropylene patch sling is an effective treatment and less expensive than current using sling kits14.A prospective randomized comparative study conduct between the complications of proximal value polyurethane & distal value silicone peripherally inserted centered catheters, A total of 326 patients was assigned randomly to receive either a proximal value polyurethane (n=198) or a distal value silicone peripherally inserted central catheters (n=194) the results are concluded the complications were encountered in26.8% & 47.9% of the proximal & distal peripherally inserted central catheters.Significantly higher incidence of phlebitis (23.2%) & infection (6.2%) were noted. So the proximal value polyurethane were more durable than distal value silicone pics15.2. STUDIES RELATED TO HAZARDS OF PLASTIC USE ANDPREVENTION AMONG SCHOOL CHILDREN.A laboratory based study was conducted by national institute of health in united states, by 38 experts they examined the effects of bisphenol A between animals studies and effects on human beings. During animal studies, scientist have noted female reproductive problems, early onset of puberty, and cancer of the breast & prostate at even low levels of exposure to bisphenol A. the conclusion of this study in dicates that12 very low levels of Bisphenol A exposure could cause adverse health effects especially to a fetus and infant brain development, effect the children behaviour (hyperactivity).This study recommended that beneficial impacts of plastic use can reduce the health effects on school going childrens16.A national toxicology programme and Food and Drug administration (2010) conducted a survey in United States to determine the effects of bisphenol-A on the brain, behaviour & prostate gland in fetuses, infants & children at current exposures to bisphenol-A. the National Toxicology programme giving result in fetal or neonatal mortality, birth defects, or reduced birth weight are negligible concern to bisphenol-A the Food and Drug administration expressed the same level of concern17.A study was conducted on obesity 2008, on school going childrens has increased effect to bisphenol-A exposure by some scientists & public health officials.A 2009 review of available studies has persistent effects on body weight and adiposity is pesinatal bisphenol-A exposure, this review has concluded the “Eliminating exposure to bisphenol-A and improving nutrition during development offer the potential for reducing obesity and associated diseases. The study recommended that the investigator is in a position to provide preventive guidance on plastic use to parents and childrens18A study was conducted in Yale school of medicine on neurological issues on exposure to bisphenol-A (Plastic water bottles) in 2008, they demonstrated that advrse neurological effects occur in non human primates regularly exposure to bisphenol-A at levels equal to the environment protection agency’s in united states administered13 maimum safe dose of 50 µg/kg/day in mice. This research found a connection between bisphenol-A and interference with brain cell connections vital to memory, learningand mood. This study indicated that education about avoidance of bisphenol-A plastic water bottles reduces the neurological effect on childrens19.A laboratory based study was conducted in 2010 by the Yale school of medicine on rates prenatally exposed to 40 micrograms/kg/bw bisphenol-A, the study has concluded that corticosterone and its actions in the brain are sensitive to the programming effects of bisphenol-A.A study was conducted to find out perinatal exposure to 10 microgms/ml of bisphenol-A in drinking water enhanced allergic sensitization and bronchial inflammation responsiveness in an animal model of asthma. The study recommended that pregnant womens to avoid using the plastics can avoid the health problems to childrens from the womb itself.A cross-sectional study was published in the journal of the American medicalAssociation in sep.2008 on health effects on humans associated with bisphenol-A exposure, the sample was 1,500 people assessed to bisphenol-A by looking at the levels of the chemical in urine. An preliminary study needs to be confirmed andcannot prove casuality have the heart disease, diabetess & liver enzymes. The study confirmed despite of lower concentrations of bisphenol-A in the second study sample, increased risk of heart disease but not for diabetes or liver enzymes20.The Canadian health measures survey 2007 to 2009 ffound that teenagers carry30% more bisphenol-A in their bodies than older adults. This survey recommended14 that the extra reason for this is not known, but awareness compaign reduce the using of plastic water bottles can strengthen their health21.A study was conducted by a 12 member international expert form the Harvard center for Risk Assessment. the study reviewed all the published data on the quantity of styrene. Contributing to the diet due to migration of food packaging and disposable food contact and concluded no cause for general public from exposure to styrene from foods or styrenic materials used in food-contact applications21.The environmental protection Agency and centres for disease control and prevention survey was conducted in 2001 on vinyl chloride is a known human carcinogens that causes a rare cancer of the liver. Health assessment for vinyl chloride monomer plants cause or contribute air pollution that may increase in mortality or increase in serious (IRIS) data lowers the previous risk factor estimate by the 20 samples and concludes that liver is the most sensitive site and have consistent evidence for liver cancer and weaker association for other sites22.The prospective cohort study was conducted by the national cancer institute(NCI) in 2007, includes 25,691 male and female workers enrolled from 10 different formaldehyde producing or using plants. They investigated mortality for multiple cancer sites and duration of exposure. The result were increased risk of sinonasal cancers were observed among male 2.3 (95%), 13 exposed causes and female 2.4(95%), 4 exposed cases and 3 deaths one death from squamous cell sinonasal cancer and concluded no increase in risk was found among formaldehyde exposed workers22.15 A comparative study was conducted between environmental hazards due to plastic uses and respiratory health in young children in Dec 2006 the study period covered 11 years (1996-2006).640 documents were recovered from the united states accounted for 23.5% of articles. The factor most widely studied was air pollution the outdoor air pollution is (50%) and than indoor air pollution is (40%) predominanated in children 3 years of age the study concluded environmental hazards is fundamental in the management and prevention of respiratory problems in childhood. Moderation can avoid the using of plastics which leads to environmental pollution can reduce the health problems to the childrens23.3. STUDY RELATED TO STRUCTURED TEACHING PROGRAMME A study was conducted to evaluate the effectiveness of safety training to children to avoid consuming potentially hazardous substances that leads to health effects. The sample was 15 children. This study results showed that avoid using platics come contact with their food like microwaving food in plastic containers and using plastic water bottles etc. an awareness campaign reduce the plastic use, this study concluded that can decrease the risks of health effect on children24.A study was conducted to determine the knowledge regarding prevention of plastic use in selected school in Italy, the sample of 40 children was selected by using random sampling technique and study revealed that the post test knowledge score on prevention of plastic use was more than pre-test score. It indicated that the health teaching strategy is an effective method to improve the knowledge25. 16 STATEMENT OF THE PROBLEM:-" A STUDY TO ASSESS THE EFFECTIVENESS OF A STRUCTUREDTEACHING PROGRAMME TO THE SCHOOL STUDENTS BETWEEN THE AGEGROUP OF 14 TO 17 YEARS ON HAZARDS OF PLASTIC USE IN SELECTEDSCHOOLS OF KANNUR,BANGALORE”.6.3 OBJECTIVES OF THE STUDY: To assess the existing level of knowledge regarding hazards of plastic use among school children. To determine the effectiveness of structured teaching programme on hazards of plastic use among school children. To find the association between post test knowledge scores with the selected demographic variables.6.4 OPERATIONAL DEFINITIONS:ASSESS: refers to assessing the knowledge on school children regarding the hazards of plastic use.EFFECTIVENESS: it refers to desired changes brought about by the structured teaching programme hazards of plastics use among school children between the age group of 14 – 17 years.STRUCTURED TEACHING PROGRAMME: It refers to system of planned instruction desired to impart information in order to gain knowledge regarding hazards of plastic use among school children between the age group of 14 – 17 years.17 HAZARD: Risk caused by using plastics which is not conducive to good health.PLASTIC: It is a synthetic organic solids used in the manufacture of industrial products, its light weight, durability & versatility made it preferred material for packaging & manufacturing.6.5 HYPOTHESESH1:There is significant difference between the pre and post test knowledge scores of the school children regarding the hazards of plastic use.H2:There is a significant association between the post test knowledge score of the school children and selected demographic variables.6.6VARIABLES:6.6- 1. Dependent variables: knowledge of school children regarding hazards of plastic use.6.6 -2 Independent variable: Structured teaching programme.6.6 -3 Attributed variables: Age, sex, education type of family, economic status, type of food packing, type of water bottles source of information.6.7 DELIMITATIONS:This study will be conducted only in school children between the age group of14- 18 17 years The data collection period is limited to six weeks.6.8 MATERIALS AND METHODS: method of data collection:7.1 SOURCE OF DATA : school children in the age between 14-17 years.7.2 RESEARCH APPROACH : Evaluatory approach.7.2.1.1 RESEARCH DESIGN : Quasi experimental design.7.2.1.2 SETTING OF THE STUDY : This study will be conducted in selected schools at kannur.7.2.2 POPULATION : The population for this study includes school children.7.2.3 SAMPLE : school children with age group between 14- 17 years in selected schools at kannur7.2.4 SAMPLE SIZE: 60 students7.2.5 SAMPLING TECHNIQUE : simple random sampling technique7.2.6 SAMPLING CRITERIA:INCLUSION CRITERIA: - school children of 14 -17years of age - Both boys and girls are included- School children who are willing to participate in the studyEXCLUSION CRITERIA:- School children who are absent on the particular day of data collection.- Primary school children are not included 19 - School children who are sick during the time of study.7.2.7 TOOLS OF RESEARCH7.2.9 DESCRIPTION OF TOOL:Tool consists of 2 sectionsSection A: It consists of demographic variables like age, sex, class, income of the family, type of family and source of information.Section B: It consists of structured knowledge questionnaire regarding hazards of plastics use among school children.7.3 METHOD OF DATA COLLECTION:Structured interview schedule will be adopted to collect the data from subjects.The purpose of the study will be explained to involve the study and structured teaching programme will be implemented after the pretest assessment post test assessment will be done after 7 days of the implementation of the structured teaching programme.Tentative period of the study will be 6 weeks. The tool for data collection will be prepared. After validation by the experts, the further refinement the tool will be done, pilot study will be conducted before the main study.7.4 ANALYSIS AND INTERPRETATION OF DATA:20 Data is planned to analyze on the basis of objectives by using descriptive and inferential statistics. Descriptive statistics include frequency distribution, percentage, central tendency measurements (mean, median), standard deviation.Inferential statistics- chi- square test to find association between post test knowledge scores with selected demographic variables and paired ‘T’ test will be used to compare the pre and post test knowledge score. The result will be presented in the form of tables, graphs and diagrams.7.5 DOES THE STUDY REQUIRE ANY INVESTIGATION ORINTERVENTIONS TO BE CONDUCTED ON PATIENTS/ OTHER HUMANSOR ANIMALS?Yes, a structured teaching programme will be conducted on school children regarding hazards of plastic use.since it is teaching,it will not have any harm on the school children.7.6 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM CONCERNEDAUTHORITIES.Prior to the study, permission will be obtained from the concerned autority of the school & college to conduct the study on the school children at kannur and also from research committee of selected schools osf kannur Banglore.The purpose of the study will be explained to the school children.21 LIST OF REFERENCES:1. Henry George Liddell ,Robert Scott,”Plastikos”,A greek English lexican at perseus.2. Dadd ,debra,”National report on human Exposure to environmental chemicals “2001,Newyork.3. J.L.Daniels,etal,”Plastic food packaging” Environmental health perspectives,1997.pp-268 to 277.4. Berkeley,C.A “Ecology centre plastic task force report”1996.5. www.plastics info.org,American Chemistry council.6. http://www.care2.com/greenliving/safe plastics forlunch boxes.jan19,2010.7. www.toxicfree legacy.org.8. http://www.articles base.com/industrial-articles/plastic moulding innovation company-1445870.html.9. www.WHO.com10. Dr. Paul ekins, ms. Julia tomei, stimulating eco-efficiency in asia And the pacific:The role of public policy. Available from www.greengrowth.org/download/GGPD_CD.../Section%202B.pdf22 11. www.thegreen guide.com12.Shmidt.E,Farmer S.A ,”Department of Dermatology” mayo clinic,Rochester,M.N,USA.13.Ong CK,Wang S.C “Department of Diagnostic Imaging “National University health System,yong Loo Lin school of Medicine,Singapore.14.Cleveland – Clinic Florida, Weston,FL 33331,USA.15.Fuentes – Leonarte V,etal ,Research foundation,INMA project,AVDA companar,21 Valencia,Spain.16.T.Schettle.etal,”Toxic threats to child development”2000,www.igc.org/psr/ihvo.htm.17.J.R.Davis,etal,”plastic use and childhood brain cancer”Archives of EnvironmentalContamination and Toxicology,24(1993) pages 87-92.18.International journal of pediatric Otorhinolarynogology,volume-37,issue-3,November-1996,pages 243-251.19.American Academy of Pediatrics Technical Report,pediatric Exposure and potentional Toxicity of phthalate plasticizers,2003 pages: 1467-1474.20.Tel Hashomer etal “Department of plastic and Reconstructive Surgery” ,ShebaMedical Centre [email protected].21.http:// 23 www.Consrv.CA.gov/Cgs/minerals/hazardous minerals/Radsanta.Pdf.22. B.Lofquist,”Home hazards:Residential plastics pose threats to children’s health”,Alternatives Jounal,2002,pp 25-26.23.http://www.articles natch.com/Article/US-confirmed the Hazards of plastic products.24.http:// www.besafenet.com/pvc/safe.htm25.www.google.com 24 9 SIGNATURE OF THE CANDIDATE 1 REMARKS OF THE RECOMENDED 0 GUIDE11 NAME AND MRS. GEETHA SURESH DESIGNATION PRINCIPAL 11.1 GUIDE MRS. GEETHA SURESH11.2 SIGNATURE11.3 CO- GUIDE11.4 SIGNATURE11.5 HEAD OF THE MRS. GEETHA SURESH DEPARTMENT11.6 SIGNATURE 12 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL. 12.2 SIGANATURES25 26

Rajiv Gandhi University of Health Sciences s124

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