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An Update on Pathophysiology and Medical Management of Endometriosis

Advances in Reproductive Sciences 2016年第2期4卷 53-73页

作者： Kulvinder Kochar Kaur gautam allahbadia Department of Obstetrics and Gynaecology (Reproductive Neuroendocrinology and Infertility) Dr. Kulvinder Kaur Centre for Human Reproduction Jalandhar India Rotunda—A Centre for Human Reproduction Mumbai India

Endometriosis is an inflammatory oestrogen dependent disease defined by the presence of endometrial glands and stroma at extrauterine sites. The modern advance in treatment of endometriosis management is tackling the debilitating pain it causes, besides the infertility in patients desiring fertility in reproductive age group. This can be achieved by surgical or medical means, although in most cases a combination of both treatments is required. Usually, long term treatment is required in most cases. Unfortunately in most cases, pain symptoms recur between 6months and 12 months once treatment is stopped. A lot of research has gone in understanding the pathogenesis and further medical management of endometriosis besides surgery to be useful in relieving pain and use in patients desiring fertility besides hormonal treatments used earlier like hormonal contraceptives (oral, transdermal or vaginal administration), progestogens, danazol, Gonadotrophic releasing hormone agonist (GnRH), aromatase inhibitors. Newer agents like antiangiogenic drugs, phytochemical agents like resveratrol, TNF-α inhibitors, GnRH antagonists like egalogolix, statins, antiinflammatory agents like COX2 Inhibitors and PPARγ inhibitors like pioglitazone etc., with recent work of combined efficacy of telmesartan of both PPARγ partial agonism along with angiotensin 1 receptor agonism having more efficacy, role of immunomodulators like rapamycin, lipoxin 4 and pentoxyphylline, GnRH antagonists like egalogolix are still under study undergoing phase III trials although preliminary results show promising results with fewer side effects as compared to similar duration of GnRH agonist and much less BMD side effects. Increasing number of trials show the safety of SPRM’s, along with efficacy although disadvantage is suppression of fertility so cannot be used for women desiring fertility. Currently, only mifepristone and ulipristal have received FDA approval for indication in fibroid treatment, MTP and not for

关键词： Antiangiogenic Agents Phytotherapeutics Drugs (Resveratrol) PPAR Gamma Agonism with AT1R Agonism (Telmesartan) GnRH Antagonist (Elagolix) IL-17A SPRM Modulators (Ulipristal) Immunomodulators (Pentoxyphylline) Statins (Atorvastatin)

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The Association of Non Viral Liver Diseases from NAFLD to NASH to HCC with the Pandemic of Obesity,Type 2 Diabetes,or Diabesity&Metabolic Syndrome Etiopathogenetic Correlation along with Utilization for Diagnostic&Therapeutic Purposes-A Systematic Review

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Journal of Endocrinology Research 2021年第2期3卷 10-33页

作者： Kulvinder Kochar Kaur gautam allahbadia Mandeep Singh Kaur Centre For Human Reproduction 721G.T.B.NagarJalandharPunjab144001India Ex-Rotunda-A Centre for Human Reproduction 672Kalpak GardenBandra(W)-Mumbai400040India Swami Satyanand Hospital JalandharPunjabIndia

Earlier we have been reviewing the etiopathogenesis(EP)of obesity,type2 Diabetes mellitus(T2DM),Metabolic Syndrome(MetS),Non Alcoholic Fatty Acid Liver Disease(NAFLD)non alcoholic steatohepapititis(NASH),along with its propagation to Hepatocellular carcinoma(HCC)in addition to their therapies exhaustively.T2DM continues to be a major health issue with reaching epidemic to pandemic *** disease includes a spectrum of liver injury varying from isolated steatosis known as Non Alcoholic Fatty Acid Liver Disease(NAFLD)to *** it has been observed that the coexistence of NAFLD as well as T2DM is prevalent.T2DM aids in the biological events that results in escalation of robustness of NAFLD that constitutes the primary etiology of chronic liver *** the past 2 decades the incidence of nonviral NAFLD/NASH,obtained HCC has been escalating at a fast *** view of no appropriate agents for therapy of NAFLD/NASH,a thiazolidenedione group of drug pioglitazone used for T2DM therapy is utilized *** here we conducted a systematic review utilizing search engine pubmed,google scholar;web of science;embase;Cochrane review libraryutilizingtheMeSHterms like T2DM;MetS;NAFLD;NASH;HCC;WAT;BAT;VisceralAT;Obesity;BMI;Adipocytokines;adiponectin;leptin;resistin;visfatin;irisin;Hepatokines;angiopoietin like protein 2;hepatosscin;retinol binding protein 4;treatment like pioglitazone;liraglutide;elafibranor CVC(cerviciroc);obeticholic acid;aramchol;selonosertib;simtuzumab;Oxidative stress(OS);insulin resistance(IR)from 1980’s to 2021 till *** found a total of 1050 articles out of which we selected 236 articles for this *** meta-analysis was *** diagnosis avoidance in addition to treatment of the generation as well as propagation of NAFLD/NASH are significant areas needing *** here we have summarized the EP of NAFLD/NASH,as well as NAFLD/NASH,obtained HCC along with the present advantageous therapies under trial,for NAFLD/NASH

关键词： T2DM Obesity NAFLD NASH HCC Adipokines Hepatokines

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An update on the role of prokineticins in human reproduction-potential therapeutic implications

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Open Journal of Genetics 2013年第3期3卷 201-215页

作者： Kulvinder Kochar Kaur gautam allahbadia Mandeep Singh Dr Kulvinder Kaur Centre for Human Reproduction Jalandhar India Rotunda—A Centre for Human Reproduction Mumbai India Swami Satyanand Hospital Jalandhar India

Objective: Prokineticin-1 (PROK1) is a recently described protein with a wide range of functions including tissue specific angiogenesis, modulation of inflammatory responses and regulation of haematopoiesis. PROK1 has been found in the steroidogenic organs like ovary, testis, adrenal and specially placenta and they have been found to have a role in development of the olfactory system and GnRH system. The aim was to update the role of PROK1 and PROK2 inhuman reproduction since the review was provided by Maldono-Perez (2007) on the potentials of prokineticins in reproduction. Design: A review of international scientific literature by a search of Pubmed and the authors files was done for citation of articles relevant to prokineticins in reproduction, be it its role in ovary, testis, uterus with special emphasis on implantation, normal pregnancy, in labour, pathophysiological states like tubal pregnancy, pcos, various genital tumours, and cases of isolated hypogonadotropic hypogonadism with mutations with PROK2/ PROKR2 and studies detailing functional mechanisms. Results: In the normal cycle, PROK1 has been found to have important roles in implantation, regulating several genes like COX-2, IL-8, IL-11, CTGF related to implantation. Initially murine studies revealed a critical role of PROK2 pathway on olfactory bulb morphogenesis and GnRH secretion which was accidentally discovered and since then several studies on mutations in PROK2/PROKR2 showed that they underlie some case of KS in humans. Although in mouse heterozygote state is not associated with clinical phenotype, most of human mutations are heterozygous. Conclusions: Role of PROK-1 in the process of implantation, with a deeper understanding of the process success rates in IVF and ART can be improved, besides understanding the pathophysiology of tubal pregnancy. Further presence in ovarian follicles of PROK1 can be used to plan a strategy for treating pcos. Development of antagonism of PROK’S may be a helpful stra

关键词： Prokineticin 1 Prokineticin Receptor 2 Kallmanns Syndrome Implantation GnRH Development

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An Update on Management of Nonalcoholic Fatty Liver Disease&Nonalcoholic Steatohepapititis is the Time Ripe for Achieving Resolution of NAFLD&NASH Soon

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Journal of Endocrinology Research 2021年第2期3卷 44-59页

作者： Kulvinder Kochar Kaur gautam allahbadia Mandeep Singh Dr Kulvinder Kaur Centre For Human Reproduction JalandharPunjab144001India Ex-Rotunda-A Centre for Human Reproduction MumbaiIndia Swami Satyanand Hospital JalandharPunjabIndia

We earlier reviewed how obesity has assumed an endemic/pandemic proportions that has resulted in escalating incidence and prevalence of associated escalating worldwide incidence of Metabolic Syndrome(MetS)with non alcoholic fatty liver disease(NAFLD),that is correlated with enhanced *** we tried to detail how probiotics,L-Carnitine(LC),Nicotinamide Ribose(NR)Combination,along with Apical Sodium Dependent Bile Acids Transporter(ASBT)or Volixibat and Silybin,Vitamin D,Allyl Isothiocyanate(AITC),might aid in treating and understand the etiopathogenesis of *** prevalence of NAFLD all over the world is approximately 25%,with that of non alcoholic steatohepapititis(NASH),varying from 1.5%=6.45%.Particularly NASH,specifically the ones associated with fibrosis possess a greater chance of generation of side effects that include progression to cirrhosis as well as liver-associated *** an improvement was observed with vitamin E,*** in histological appearance in liver randomized controlled clinical trials(RCT),at present no drugs exists that have received FDI approval for *** aim of this review was to update the newer drugs getting evaluated,undergoing phase 2-3 *** there are Obeticholic acid,elafibranor,cenicriviroc,resmetriom,in addition to aramchol,that are the five agents that are getting analysed in big,histology dependent phase 3 *** within another 2-4 years,newer,efficacious drugs will be available for the therapy of *** that a lot of phase 2 trials are continuing for different *** depending on outcomes of phase 2-3 trials,combination treatments are getting *** future therapeutic approaches would be made up of variations in NASH phenotypes,besides personalized approaches based on various NASH phenotypes in addition to response of every single *** recently there were reports of utilization of curcumin with nonselective beta blocker for regression fr

关键词： NAFLD NASH Drug treatments Combination therapy Fibrosis Cirrhosis

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