Clinical Approach and Management Strategies of Medical Ailments in Women: Oorja—The Power of Her Shibba Takkar Chhabra, Aastha Takkar Kapila, Anubha Rathi
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flow chart, and t refer to table.
A
Abortion
incomplete 332
missed 332
unsafe 408
Abortive treatment plan 84
Abscesses 335
Abstinence 407
Acanthosis nigricans 119
Acetaminophen 190, 191t
Acinetobacter 221
Acne 119, 396
diagnosis 397
presentation 396
prognosis 398
treatment 397
vulgaris 397f
Acquired immunodeficiency syndrome 327, 408
Acquired nasolacrimal duct obstruction, primary 359
Activated partial thromboplastin time 234
Active estrogen metabolites 374
Acute coronary syndrome 26, 32, 42, 43, 50
non-ST segment elevation of 50
Acute fatty liver 230, 231, 233, 234, 238, 295
diagnosis of 234t
Acute hepatic necrosis, drug-induced 245
Acute kidney injury 285, 291, 295
diagnosis of 292
network 292
Adalimumab 287
Adapalene 397
Adenocarcinoma 241
esophageal 214
Adenoid cystic carcinoma 359
Adenomas, adrenal benign 142
Adenomyosis 131
Adenosine
A1-agonists, partial 44
monophosphate, propionate activates 222
Adipogenicity 221
Adiposity, abdominal 26
Adnexa 358
disorders of 358
Adnexal torsion 417
Adolescent education programme 407, 411
Adolescent Friendly Health Clinics 412
Adolescent girls
medical ailments in 402
sex education of 407
Adolescent Life Skill Training Program 412
Adrenal hyperplasia, nonclassic congenital 122, 142
Adrenocortical axis 142
Advanced disease, locally 255
Age-related macular degeneration 357
Airway 169
Akkermansia muciniphila 222
Alanine aminotransferase 234, 275, 277, 294
Alcohol 40
consumption, moderate 26
dehydrogenase 239
Aldosterone antagonist 124
Alemtuzumab 200
Alkaline phosphatase 231
Allopregnanolone 388
Alopecia 119, 398
areata 398, 399
diagnosis 399
presentation 398
prognosis 399
treatments for 399, 399t
Alzheimer's disease 142
Amaurosis fugax 207
Amblyopia 363
Amebiasis 335
Amenorrhea
functional hypothalamic 22
hypothalamic 122
American Association of Blood Banks 429
American College of Cardiology 139
American College of Obstetricians and Gynecologists 127
American College of Rheumatology 148, 282
Criteria 283
American Congress of Obstetrics and Gynecology 257
American Heart Association 19, 39, 139
American Society of Reproductive Medicine 118, 121
American Thyroid Association 108, 141
Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid 202
Aminoglycosides 304
Amiodarone 43, 103, 395
Amitriptyline 191
Amlodipine 27
Ammonia, high 234
Amniotic fluid embolism 319
Anakinra 287
Androgen 388
excess society 118
receptor 132
secreting tumor 122
Anemia 21, 40, 42, 53
Anencephaly 93
Angina
microvascular 33
stable 50
symptoms of 32
Angiogram 20
Angiotensin receptor
blockers 42, 74, 296
neprilysin inhibitor 42
Angiotensin-converting enzyme 23, 42, 50
inhibitors 74, 153, 296
Angle closure glaucoma 358
Ankle swelling 38
Anorectal atresia 93
Anorexia nervosa 391
Anovulatory infertility, treating 414
Anthracyclines 256
Antiandrogens 399
Anti-AQP4 antibody, presence of 198
Antiarrhythmic drugs 70
Antibiotics 226, 303
use of 222
Antibody testing 198
Anticardiolipin 152
Anti-CD20 monoclonal antibody 286
Anti-CD22 antibodies 287
Anticentromere 208
Anti-citrullinated peptide antibodies 157
Anticonvulsants 395
Anticyclic citrullinated peptide 148
Anticytokine therapy 148
Antiepileptic drugs 163, 166, 167, 169
fetal risk of 167
hormonal interactions of 166
management 168
Antigen, prostate-specific 205
Antihypertensive medications 278
Antihypertensive treatment 20
Anti-müllerian hormone 165, 217, 415
Antineuronal nuclear antibody
type 1 201
type 2 201
Antineutrophil cytoplasmic antibody-associated vasculitis 205
Antinuclear antibody 283, 374
Antiphospholipid antibody
role of 157
syndrome 152, 156, 157, 207, 278, 295
Antiplatelet 50
therapy 53
Antipsychotics 395
Antiretroviral therapy 327
Antirheumatic drugs, disease-modifying 148, 159
Antisynthetase antibodies 320
Antithrombotic therapy 51
Antithymocyte globulin 308
Antithyroid
autoantibodies, presence of 104
peroxidase antibodies 109
Antithyroidal drugs 100, 103
Antitumor necrosis factor-α inhibitors 287
Anxiety 143, 215
disorders 387, 390
Aorta, coarctation of 71-74, 79, 93
Aortic dilatation 73
Aortic diseases, prevalence of 76
Aortic dissection 81
Aortic root dilatation 79
Aortic stenosis 59, 70-72, 74
congenital 79
severe symptomatic 69, 73
Aorto-left ventricular tunnel 8
Aorto-right ventricular tunnel 9
Apgar scores 167
Appendicitis 302
Aquaporin-4, extracellular domain of 196
Aromatase inhibitors 416
Arrhythmia 40, 43, 63, 80
cardiac 83
ventricular 72
Arterial thrombosis 207
Arteritis, coronary 156
Artery
brachial 159
disease, peripheral 25
Arthralgias 208
Arthritis, inflammatory 151
Artificial reproductive techniques 415
Ascites 233, 234
Aspartate aminotransferase 231, 234, 235, 275, 277
Aspergillosis, chronic pulmonary 350
Aspiration, manual vacuum 332
Aspirin 23, 25, 50, 53, 418
high dose 191
low dose 191
Assisted reproductive techniques 419
Asthma 313
bronchial 313, 321
treatment of 322
Astigmatism 363
Atenolol 191
Atherogenesis 157
Atherosclerosis 19, 20, 32
accelerated 156
multi-ethnic study of 20
Atherosclerotic diseases 17
Atopic eruption 399, 400
Atorvastatin 27
Atresia 71
Atrial appendage, left 58
Atrial fibrillation 20, 40, 42, 57, 80
Atrial flutter 80
Atrial septal defect 56, 71, 72, 93, 74
Atrioventricular valve regurgitation 74
Attack
acute 190
prevention 198, 200
Atypical hemolytic uremic syndrome 293
Australian National Blood Authority 429
Autoantibody 156
Autoimmune
disease 31, 103, 155, 158, 160, 313, 360, 368, 375
disorders 196, 206
inflammatory 373
encephalities 169, 201, 201t, 202, 202t, 203b, 205b
diagnosis of 203
treatment of 204
encephalopathies 195
etiology 373
inflammatory disorder 359
systemic diseases 362
uveitides, revalence of 374
Autonomic tone 216
Auxiliary nurse midwife 412
Azathioprine 209, 217, 247, 308
B
Bacterial translocation 222
Bacteriuria, asymptomatic 337
Bacteroides 224, 423
Bad adipose tissue 221
Balanitis 302
Balloon mitral valvuloplasty 66
management with 66
Balloon valvotomy 80
Bariatric surgery 227
Barrett's esophagus 214
Basal cell carcinoma 359
Basal hormonal profile 415
Basiliximab 308
B-cell 373
targeted therapies 286
Belatacept 308
Bell's palsy 384
Benzathine penicillin 329
Beta-blockers 43, 50, 191
Beta-lactams 304
Bethanechol 304
Bevacizumab 260
Bifidobacterium 224, 225
Bile acid binder 233
Biliary cirrhosis, primary 239, 240, 245
Biliary diseases 231
Bilirubin, high 234
Binge eating disorder 391
Biochemistry 301
Biopsy, endomyocardial 42
Bipolar disorder 387
Birdshot chorioretinopathy 375
Birth
anomaly 93
control 126
defects
congenital 94
risk of 93
injury 94
Bitot's spots 360
Bivalirudin 51
Bladder 296
relaxant agents 303
ultrasonography of 302
Blindness 277, 358, 373
causes of 363
incidence of 357
Blood
culture 335
donors 426, 427, 427t
film, peripheral 335
glucose 41, 335
pressure 13, 65, 128, 130, 273
diastolic 26
systolic 18, 19, 26, 293
recipients 428
smear, peripheral 235
transfusion 428
volume 65
B-lymphocyte
stimulator blockers 287
tolerogens 287
Body
growth of 402
mass index 20, 82, 120, 130, 225, 415
Bone
health 129, 218
mineral density 129, 139
Botulinum toxin 183
Bouchard's nodes 149
Bowel
disease, inflammatory 213, 216
syndrome, irritable 213, 215
Brachytherapy 257
Brain
infarction, hypoperfusion-induced 206
magnetic resonance imaging of 203f, 204f
natriuretic peptide, measurement of 42
Brainstem 83
Breast 31
calcification 21
cancer 22, 31, 133, 253-255, 262
diagnosis of 254
risk of 131
screening for 254
surgery in 254
syndrome, hereditary 258
conservative surgery 255
development of 402
Breastfeeding 307, 353, 389
Breath, shortness of 57, 69
Breathing 169
Breathlessness 38, 41
Bronchiectasis 350
B-type natriuretic peptide 79
Budd–Chiari syndrome 231, 245
Bulimia nervosa 391
C
Cabergoline 417
Cadmium 315
Caffeine 191
Calcinosis cutis 208
Calcitonin gene-related peptide 188
Canadian Angiographic Study 31
Cancer 253
adrenocortical 142
early stage 258
endometrial 117, 122, 132, 261, 262
gingival 424
gynecological 253, 262
therapy 264
Candesartan 191
Candidiasis 300
Carbamazepine 166, 167
Carbapenams 304
Carbidopa 181
Carbon
monoxide 315
particles 315
Carboxymethyl cellulose 371
Carcinoma
endometrial 114
hepatocellular 238, 239, 241, 244
Cardiac disease 64
Cardiac lesions, congenital 70
Cardiac pathology, pre-existing 64
Cardiac resynchronization therapy 42
Cardiac shunts 69, 76
Cardiac surgery 66, 79
Cardiac tamponade 42
Cardiology 1
beginning of 3
development of 3
pioneers in 4
Cardiometabolic risk factors 114
Cardiomyopathy 39, 80
end-stage 42
hypertrophic 33, 40
idiopathic 40
peripartum 22, 38, 40, 80, 81
restrictive 40
Cardiovascular disease 13, 16, 17, 31, 36, 49, 56, 69, 76, 78, 82, 94, 114, 120, 128, 130, 136, 138, 155, 158, 316
atherosclerotic 20, 158
prevention 22
primary 25
primary prevention of 22, 23
Cardiovascular health 128, 138
Cardiovascular illnesses
prevention of 70
treatment of 70
Cardiovascular risk 117, 122
assessment 13, 158
factors 44
management of 159
Carotid intima medial thickness 156, 159
Cataract 363
blind 358
congenital 363
formation 363
Catch-up vaccines 343
Catechol-O-methyltransferase 181
Catheter-based interventions, journey of 10
Caudal regression syndrome 93
Centers for Disease Control and Prevention 73
Central nervous system 93, 169, 199, 286
dysfunction of 276
symptoms of 276
Cephalosporins 384
Cerebellar ataxia 207
Cerebral
artery, middle 83
venous thrombosis 169, 177
Cerebrospinal fluid 197, 199, 204
analysis 197
spontaneous 380
Cerebrovascular disorders 173
Certolizumab pegol 287
Cervical
cancer 133, 256, 257, 329, 330
cytology and screening 415
intraepithelial neoplasia, risk of 330
Cesarean section 94
hemodynamic effects of 65
Cetuximab 260
Chemical peels like lactic acid 396
Chemokines 371
Chemotherapy 257, 258, 260, 262, 264-266
lesser effect of 265
Chest
pain 32
X-ray 42, 79, 323
Chlamydia trachomatis 341
Chlamydial infections 341
Chlorinated dioxins 315
Chlormadinone acetate 131
Cholelithiasis 231
Cholestasis 239
infantile 234
intrahepatic 230-233, 400
Cholesterol 15, 22
lower total 156
Cholestyramine 233
Cholinergic drugs 304
Chorea 207
Chorioretinopathy, central serous 364
Choroid 374
Choroidal lesions 375
Choroidal neovascular membranes 376
Chronic inflammatory
diseases 148
disorders 368
Chronic obstructive pulmonary disease 313, 322
Churg–Strauss syndrome 362
Chylocorporrhea 318
Chylopericardium 318
Chyloperitoneum 318
Chylothorax 318
Chyluria 318
Ciliary body 373
Circulation 169
Cirrhosis 231, 239
autoimmune linked 245
cryptogenic 245
Cisplatin 257
Cladribine 200
Cleft
lip 93
palate 93
Clindamycin 384
Clinically isolated syndrome 197, 199
Clobazam 166
Clomiphene citrate 416
Clonazepam 166, 167
Clonus 277
Clostridium difficile 227
Clubfoot 93
Coagulation, tests of 277
Coarctation of aorta, severe 69
Cocaine 40
Codeine 191
Collagen vascular disease 40
Collapsin response mediator protein 5 201
Colony-forming units 226
Combined oral contraceptives 127, 267
mechanism of action of 132fc
Compared menopausal hormone therapy 138
Complete blood count 41, 301
Comprehensive sexuality education 407
content of 409, 411
delivery forms of 410
effectiveness of 410
Computed tomography
cardiac 42
contrast-enhanced 122
guided image-based planning 255
Congenital heart block, complete 152
Congenital heart disease 9, 69, 71, 74, 81
acyanotic 79
birth prevalence of 70
cyanotic 79
prevalence of common 71t
Congestion, capillary 314
Conjunctiva 360, 370
diseases of 358
disorders of 359
malignant lesion of 360
Conjunctival impression 370
Conjunctival nevi, benign 360
Connective tissue disease 313, 319, 335
treatment of 151
Connective tissue disorders 209
Contact immunotherapy 399
Contactin-associated protein 2 202
Contraception 126, 166, 264, 266, 307, 332, 407
devices, intrauterine 267
estrogen-containing 267
hormonal 133, 320
method of 126
Contraceptive 332, 410
estrogen-containing 320
hormonal 126, 130t
methods 320
progesterone based 333
types of 126fc
Copper chelation 184
Cornea
diseases of 358
disorders of 361
Corneal ablative procedures 368
Corneal dystrophies 362f
Corneal sensations 370
Coronary angiogram 35, 62f
Coronary angiography 42, 51
Coronary artery 51, 83
bypass graft surgery 36
calcification 20
calcium 20
disease 14, 32, 33, 34fc, 35t, 69, 70, 80, 120, 221
management of 49, 50
microvascular 36
prevention of 19
dissection, spontaneous 33, 50, 52, 52f, 81
left main 51
revascularization 26
right 51
risk development 20
wall thickness 21
Coronary calcium
evaluation of 20
score 21
Coronary computed tomography angiography 35
Coronary flow reserve 159
Coronary syndromes 80
Coronary vasomotor disorders 31
Corticosteroids 308, 371
intralesional 399
Corticotropin-releasing hormone 91, 388
Cortisol 388
Corynebacterium xerosis 360
Council of Boards of School Education 411
C-reactive protein 156, 417
highly sensitive 19, 159
Crohn's diseas 216
Cryoglobulinemia 148, 205
Cryopreservation 266
Crystalline lens 363
Cushing's syndrome 122, 142
Cyclophosphamide 151
Cycloserine 352
Cyclosporine 308
Cyproterone acetate 131, 399
Cystadenoma, biliary 241
Cystic degeneration 360f
Cystitis, interstitial 302
Cytochrome 232
Cytokine inhibition 287
Cytomegalovirus 337, 339
Cytotoxic T-lymphocyte antigen-4 287
D
Darifenacin 303
Data Collection and Monitoring System 353
de Quervain's thyroiditis 103
Death rate 31
Decarboxylase inhibitor, peripheral 181
Deep brain stimulation 182
Deep vein thrombosis, high-risk of 140
Dehydroepiandrosterone sulfate 116, 122, 141, 397
Delirium 207
Dementia 391
Dengue 344
Dental
health 423
issues, puberty-related 424
Depression 117, 142, 215, 403, 421
cortical spreading 188
measures of 143
Depressive disorder 390
contribution of 390
Depressive symptoms 391
Deprivation 20
Dermatomyositis 208, 319
Desulfovibrio 224
Device therapy 43
Dexamethasone 233
Dextran 371
sulfate apheresis 294
Dextrocardia 93
Diabetes 13, 22, 89, 90, 90t
mellitus 20, 22, 40, 50, 78, 80, 138, 157, 240, 301, 424
management of type 2 25
pre-existing 89
pregestational 278
risk of 114
type 1 15, 91
type 2 98, 122, 137, 221
pregestational 93t
study cardiac risk score 20
Diclofenac 191
Dienogest 131
Diet 225
high-carbohydrate 222
high-fat 222
high-fiber 222
Dietary
changes 96, 225
fibers 222
strategies 224
Dimethyl fumarate 200
Dipeptidyl peptidase-like protein 6 202
Diphtheria 343
Dipstick test 274
Director National Blood Transfusion Council 429
Disability adjusted life years 387
Disease-specific risk factors 156
Disseminated intravascular coagulation 236, 277, 294
Diverticulitis 302
Dizziness 381
Donors
motivating potential 426
selection of 426
Dopamine dysregulation syndrome 182
Dopa-responsive dystonia 183
Double outlet right ventricle 71
Double vessel disease 51
Double-stranded deoxyribonucleic acid 283
genome 328
Doxylamine 232
Drospirenone 131
Drug 43, 227
abuse 142
fever 335
use 142
Dry eye 366, 368
deficient 367
disease 362, 366, 367
development of 368
diagnosis of 370
evaporative 367, 370
higher propensity of 367
holistic treatment of 372
incidence of 367
management of 370, 371
mild-to-moderate 370
moderate-to-severe 370
pathophysiology of 367, 370
perimenopausal 367
preservative with 371
prevalence of 367
risk of developing 368
symptoms of 367, 368, 371
pregnancy related 364
related quality-of-life score 368
subtypes of 367
symptoms 369f
Dual antiplatelet therapy 52
Dual-energy X-ray 218
absorptiometry 135, 139
Duodenal atresia 93
Dysbiosis 222
Dyslipidemia 15, 22, 24, 53, 240
Dyspareunia 268, 392
Dysphoric disorder, premenstrual 131, 388
Dystonia 181, 183
common focal 183
parkinsonism, X-linked 183
E
Ear
changes 383
discharge 379
diseases 380
nose, and throat
disorder 383
trauma 381
problems, common 379
Eating disorders 391, 403, 424
lifetime prevalence of 391
Ebstein's anomaly 71, 80
Echocardiography 42
Eclampsia 31, 44, 53, 78, 81, 231, 234, 277
Ectopia
lentis 363
traumatic 363
Eculizumab 287, 293, 294
Edema 41
peripheral 38
Eisenmenger syndrome 72
Ejection fraction 38
preserved 43
Electrocardiogram 283
Electrocardiography 42
Electroencephalogram 204
Electrolytes 275
Eletriptan 191
Elevated jugular venous pressure 38
Embryo cryopreservation 265
Emotional support programs, development of 421
Enalapril 26, 74
Encephalocele 93
Encephalopathy 233, 234
Endocarditis 63, 335
infective 72
Endocrinal profile 423
Endocrine
changes 136
disorders 40
Endogenous hormone levels 71
Endometrial cancer
early stage 261
risk of 131
Endometriosis 131, 318
Endothelial dysfunction 83, 158
Endothelin receptor antagonists 321
Endovascular dysfunction 82
Endovascular system 82
Entacapone 181
Enzyme-linked immunosorbent assay 283, 328
Epilepsy 163-166, 168, 170, 207
catamenial 164, 165f
localization-related 164
Epiphora 359
Episcleritis 360
Epistaxis 379, 384
Epithelial ovarian cancer 258
Eplerenone 42
Ergot derivatives 191
Erythematous papules 397f
Erythrocyte sedimentation rate, high 157
Erythromycin 384
Escherichia coli 299
Eslicarbazepine 166
Esophageal acid exposure 214
Esophageal dysmotility 213
Esophageal epithelial barrier function 214
Esophageal motility 214
disorder, reflux-related 214
Esophageal nociception 214
Esophageal sphincter pressure, lower 214
Estimated glomerular filtration rate 304
Estradiol 138, 389
limits monoamine oxidase 390
presence of 314
Estrogen 101, 164, 214, 216, 314, 374, 388, 419
contains pills 152
high-dose 126
in strokes, role of 174
levels of 374, 388
low-dose 126
metabolism 241
receptor 314
role of 390
Ethambutol 352
Ethionamide 352
Ethosuximide 166
Eubiosis 222
European League Against Rheumatism 148, 155
European Society of Cardiology 15
European Society of Human Reproduction and Embryology 118
Eustachian tube dysfunction 383
Exercise 225
electrocardiogram 42
Extensive pulmonary destruction 350
Extracellular antigens 202t
antibody directed against 201
Extracorporeal membrane oxygenation 319
Extractable nuclear antigen 284
Eye 361f, 362, 370f
blanches, inflamed 360
diseases, treating 358
disorders 358
dryness, evaluation of 368
examination survey 357
health 357
related conditions 357
inflammatory disorders of 373
movement, rapid 181
Eyelids, disorders of 358
Ezogabine 166
F
Facet joints 149
Facial
defects, midline 93
migraine 188
pain 379
Faecalibacterium prausnitzii 228
Fair sex 45, 69
Family planning 329
Farnesoid X receptor 222, 223, 232
Fasting plasma glucose 90
Fastrointestinal disorders, functional 215
Fatigue 38, 57, 69, 240
Fatty acid
infiltration of 240
oxidation inhibitor 44
short-chain 222
Fatty liver 234
Fecal microbiota transplant 227
Felbamate 166
Female orgasmic disorder 392
Female sexual
arousal disorder 391
dysfunction 391, 392
pain disorders 392
Feminism 433
Fenestrations 318
Ferriman–Gallwey
scoring system, modified 119f
syndrome 120
Fertility 151, 217, 264
management 124
treatment, principles of 415
Fetal
circulation, normal 57
complications 94
death, intrauterine 233, 294
growth restriction 277
thyroid gland 106
toxicity, potential for 124
Fetus, recurrence in 74t
Fever 334, 335b
causes of 335t
Fibrinogen 16
Fibromyalgia syndrome 150
Fibrosis, interstitial 285
Finasteride 124, 399
Fingolimod 200
Firmicutes 221
First venous thrombosis, absolute risk of 322f
Fish oil 25
supplementation 25
Fluid-attenuated inversion recovery 203, 203f, 204, 204f
Fluorodeoxyglucose 204, 205
Fluoroquinolones 304
Flutamide 124, 399
Follicle-stimulating hormone 122, 135, 397, 415, 416
Food and Agriculture Organization 139
Formaldehyde 315
Fracture-risk assessment 140
Framingham Risk Score 13, 18
interpretation of 14
limitations of 14
Fuchs endothelial corneal dystrophy 361
Fundus examination 206
Fungal infections 301, 337
G
Gabapentin 166, 167
Gallbladder 335
malignancy 242
Gallstones 238, 239, 242
Gamma-aminobutyric acid 165, 202
Gamma-glutamyltransferase 231
Gas gangrene 335
Gastric acid 213
Gastroesophageal reflux disease 208, 213, 214
Gastrointestinal
disorders 213, 230, 259
physiology 213
system 93
tract 221
Generalized chronic musculoskeletal pain, causes of 150t
Genetic
hemochromatosis 238, 241
polymorphism 42
Genital
graft versus host disease 264, 267
herpes simplex 329
host disease, management of 267
Genitourinary system 93
Gestational age
large for 95
small for 95
Gestational diabetes mellitus 31, 78, 81, 89, 90t
pathogenesis of 92f
risk of 117
Gestational hypertension 81, 274, 275, 277b, 279
clinical diagnosis of 275
diagnosis of 275
transient 274, 275
Giant cell
arteritis 205, 206
granulomas 375
Glatiramer acetate 200
Glaucoma 358, 363
tension 363
treatment for 363
Glomerular filtration rate, lower 71
Glomerulonephritis 301
Glomerulosclerosis, focal segmental 286
Glucagon-like peptide-1 223
Glucose
metabolism 127
regulation 16
Glutamate, interstitial 83
Glycol acid 396
Glycosylated hemoglobin 90, 138, 225
Golimumab 287
Gonadotropic hormones, secretion of 165
Gonadotropin 416
releasing hormone 115, 265
Gonorrhea 340
Gout 158
Graft
outcome 309
size of 246
Granuloma gravidarum 384
Granulomatosis 205
eosinophilic 205
Granulomatous disorder, chronic 375
Graves’ disease 103, 111, 359, 404
management of 100
Graves’ ophthalmopathy 105
Great arteries, transposition of 70, 71
Great vessels, transposition of 93
Growth factor 91
Gut microbiome 220
Gut microbiota 221, 222
characteristics of 223fc
Gynecological malignancy 114
risk 131
H
Hair loss, female pattern 398, 399
Hashimoto's thyroiditis 101, 103, 359, 376, 404
Headache 187, 188, 188t
causes of 192
cluster 187
disorders 187
first 188
new onset 188
severe 277
tension type 187
type of 187
worsening 188
worst 188
Health
assessment questionnaire 152
problems 402
status 344
Healthcare
utilization of 75
worker 347
Healthy diet 23, 26
Hearing impairment during pregnancy 383
Hearing loss
age-related 380
sensorineural 383, 384
Heart
block, complete 80
defect, congenital 56, 93
disease 9, 25, 49, 64, 78
acquired 63
coronary 13, 14t, 17, 316
cyanotic 79, 80
etiology of 64
ischemic 31, 32, 34, 35, 51, 82
management of congenital 7
prevalence of congenital 75
risk of congenital 74t
type of congenital 71
failure 24, 38-40, 40t, 43-45, 50
causes of 39, 40
congestive 40, 57
diagnosis of 41
etiology of 40
management of 43, 44
medications 38
pathophysiology of 41
right 320
signs of 39t, 41
stages of 39
symptoms of 39t, 41
types of 38, 39t
physiology of 76
rate 65
accelerated 65
univentricular 72
Heat shock protein–60 159
Hemangioma, cavernous 239
Hematological malignancies 264
Hematology 301
Hematopoietic stem cell 264
transplant 264
Hemochromatosis 239
Hemodynamic changes 65, 78
Hemoglobin 21, 275, 277
Hemolysis and elevated liver enzymes and low platelets syndrome 94, 230, 231, 235,235t, 291, 293, 294
complications of 236
Hemoptysis 350
catamenial 317
Hemorrhage
intracerebral 177
subarachnoid 316
Henoch–Schönlein purpura 205
Heparin, unfractionated 51
Hepatic adenomas, reports of 129
Hepatic disorders 231t, 236
Hepatic failure, fulminant 232
Hepatic glucose production 138
Hepatitis
A 231, 336, 344
virus 240
acute viral 231
autoimmune 239, 240
B 231, 344
chronic 241
infection 239
vaccine 344
virus 240, 336
C 336
infection 239
virus 240
D 336
virus 241
E 231, 336
virus 240
Hepatobiliary disorders 238
Hepatotoxicity, drug-induced 231
Herpes simplex virus 268, 338, 341, 384
High-density lipoprotein 226
cholesterol 13
Higher pulmonary artery pressures 72
Highly active antiretroviral therapy 337
High-resolution computed tomography chest 316
Hirsutism 119f
management of 124
score 119
Hoarseness 385
Hodgkin's lymphoma 264, 265
Holdemania 224
Holoprosencephaly 93
Homeostatic model assessment-insulin resistance 127
Homocystinuria 363
Honeymoon cystitis 299
Hormonal changes 358, 364
Hormonal disorders 364
Hormonal functions 35
Hormonal therapy 137, 265
impact of 137
Hormone 100
adrenocorticotropic 122
replacement 174
therapy 127, 138, 191, 215, 363, 367, 374
Household air pollution 314, 315
effect of 315
Human body and development 410
Human chorionic
gonadotropin 122, 231, 292
somatotropin 91
Human immunodeficiency virus 267, 327, 347, 349, 349t, 351
characteristics of 328
diagnosis 337
gynecological problems of 328
infection 336, 408
perinatal transmission of 336
related malignancies 329
related tumors 330
treatment center for 332
Human leukocyte antigen 232, 306
Human papillomavirus 256, 268, 343, 344
Human placental lactogen 91
Human sexual anatomy 407
Huntington's disease 183
Hyaluronic acid 314, 371
Hydranencephaly 93
Hydrocarbon complexes 315
Hydrochlorothiazide 27
Hydronephrosis 93
Hydroxychloroquine 153
Hydroxyprogesterone 122
Hydroxypropyl methylcellulose 371
Hydroxytryptamine 188
Hyperandrogenism 116, 120, 132fc, 165
clinical signs of 397
symptoms of 131
Hyperbilirubinemia, neonatal 94
Hypercholesterolemia 82, 157
Hyperemesis gravidarum 230, 231, 292
Hyperglycemia 94t, 246
classification of 90, 90fc
management of 95
pathophysiology of 91
Hyperlipidemia 82, 83
Hypermetabolism, bilateral striatal 204
Hyperplasia 314
congenital adrenal 131
endometrial 131
focal nodular 241
Hyperprolactinemia 122, 165
Hypertension 22, 24, 53, 81-83, 233-235, 240, 273-275, 301, 307
benign intracranial 364, 380
chronic 274, 275, 277, 278
classification of 274, 274b
control of 24, 278
development of diastolic 273
diagnosis of 274
masked 274
portal 231
pregnancy induced 31, 78, 81, 94
risk factor for 158
Hypertensive disorders 78, 273, 280
diagnosis of 274
management for 278
pregnancy related 276b
Hyperthyroidism 105
during pregnancy 111t, 112
management of 100
mild 292
per se 100
severity of 100
subclinical 141
Hypertriglyceridemia 246
Hypertrophic obstructive cardiomyopathy 59
Hyperuricemia 158
Hypoactive sexual desire disorder 391
Hypocalcemia 94, 234
Hypoglycemia 94, 233, 234
neonatal 94
risk of 25
Hypopituitarism 103
Hypoplasia, femoral 93
Hypoplastic left heart syndrome 71
Hypoplastic pelvis, sacral agenesis with 93
Hypothalamic failure 103
Hypothalamic pituitary-ovarian axis 136
Hypothyroidism 101-103, 108, 108t, 109t, 122
causes of 104
management of 110
primary 103
secondary 103
subclinical 109, 135, 141
tertiary 103
I
Iatrogenic injuries 296
Ibuprofen 191
Ileal pouch-anal anastomosis 217
Immune
aberrations 195
complexes 284
deficiency syndrome 335
response 214
cell-mediated 374
system 101
Immunoglobulin
G 200
intravenous 169
Immunosuppressive
agents 207
drugs 308, 308t
state 344
Impulse control disorders 182
In vitro fertilization 265, 414, 419
In vitro maturation 265
Inclusion body myositis 208
India Ukieri Study 40
Indian Academy of Pediatrics 343
Indomethacin 191
Infarction 83
Infection 43, 94, 402, 403
Infertility 165, 329, 420
causes of 415
female 415
management of 415
treatment 414, 415
Inflammatory cells 376, 384
infiltration of 359
Inflammatory demyelinating
diseases 195
disorders 196
Inflammatory disorders 206
Infliximab 287
Influenza vaccination 344
Inner ear circulation 384
Inositol 124
Insulin
requirements 94
resistance 24, 31, 119
and diabetes, management of 124
model assessment of 138
pregnancy with 92
therapy 97
Intellectual disability 387
Intercellular adhesion molecules 159
Interferons, types of 200
Interleukins 1 and 6 156
International Association of Diabetes and Pregnancy Study Groups 90
International Classification of Headache Disorders-3 187
International Diabetes Federation 89
International League of Associations for Rheumatology 374
International normalized ratio 275
International Society for Study of Hypertension 274
International Society of Hypertension 18, 19
International Society of Nephrology 285
Classification 282
Interphalangeal joints and wrists, swelling of proximal 148f
Intestinal endocannabinoid system 223
Intracellular antigens 201t
antibody directed against 201
Intracranial pressure 364
Intracytoplasmic sperm injection 415
Intranatal screening 168
Intraocular lens 358
Intraocular pressure 364
Intrauterine devices 123, 320
Intrauterine insemination 415, 419
Iodine
deficiency 101, 103
therapy 103
Iris 373
inflammation of 364
Iron 315
Irradiation, external 103
Ischemia 32, 83
subendocardial 33, 51
Ischemic attacks, transient 207
Ischemic heart disease 31, 32, 34, 35, 51, 82
risk of 82
stable 34
treatment of 35
Isoniazid 352, 397
Itching 268
J
Joints
apophyseal 149
interphalangeal 149
Juvenile idiopathic arthritis 374
Juxtacortical demyelinating plaque 203f
K
Kanamycin 352
Kaposi sarcoma 331
Kawasaki disease 205
Keratitis 362
Keratoconjunctivitis sicca 374
Ketoacidosis, diabetic 94
Ketorolac 191
Kidney
biopsy 285
disease, chronic 20, 221, 285, 292, 301
donors 308
injury
management of acute 296
postrenal acute 296
pregnancy related acute 291, 292
transplantation 306
ultrasonography of 302
Kupffer cells 239
L
Labor
premature 351
preterm 94
stage of 75
Labyrinthine vertigo, treatment of 381
Lacosamide 166
Lacrimal apparatus 358
disorders of 358
Lacrimal disorders 358
Lacrimal gland 359
function 367
Lactate dehydrogenase 235, 275, 293
Lactobacillus 221, 225
acidophilus 226
gasseri 226
Lamina propria 385
Lamotrigine 166, 167
Landry–Guillain–Barré syndrome 347
Language deficits 167
Laparoscopy procedure 420
Laryngopathia gravidarum 385
Laryngotracheal trauma 381
Lead 315
Left ventricular
aneurysm 58
ejection fraction 39
systolic dysfunction, severe 79
Lens
diseases of 358
disorders of 363
Leptospirosis 335
Lesions, milder 73
Letrozole 416
Leucine-rich glioma-inactivated protein 1 202
Leukemia, acute 264
lymphoblastic 265
myeloid 265
Leukocytosis 234
Levetiracetam 166, 167, 169
Levofloxacin 352
Levonorgestrel intrauterine devices 331
Levothyroxine treatment 109t
Lids, disorders of 358
Limbic encephalitis 202
Lipid metabolism 127
Lipopolysaccharides 223
Lipoprotein 156
cholesterol, low-density 15
levels of low-density 156
low-density 156, 226
Lithium 397
Liver 129, 234
biopsy 232, 234
disease 230, 231
alcoholic 238, 239
autoimmune 231
common 239t
drug-induced 238, 241
end-stage 239, 347
hypertension-related 231
immune-mediated 238, 240
disorders 230, 231
donors 247
enzymes 277
elevated 235
values 275
function test 41, 230, 275, 335, 417
infarction 231
injury, drug-induced 239, 241, 245
involvement 277
lesions, benign 239
mass lesions in 241
physiological changes in 230
rupture 231
transaminases 293
transplantation 244, 245, 247
tumors 231
Living donor liver transplantation 246
Living kidney donors 306
Losartan 27
Low birth weight 279
Low-fat mediterranean diet 222
Low-molecular-weight heparin 295, 417
Lung
biopsy 317
cancer 313
crepitations 41
disease, interstitial 209, 319, 320
nodules 317
transplantation 317
Lupus nephritis 282, 284, 285, 295
diagnosis of 282, 284
etiopathogenesis of 284
treatment of 285
Luteinizing hormone 122, 132, 136, 397, 415
mid-cycle 404
resulting in 115
secretion of 131
Lymphadenopathy, hilar 350
Lymphangioleiomyomatosis 313, 316, 318, 318t
Lymphatic pulmonary congestion 318
M
Magnesium sulphate, infusions of 294
Magnetic resonance imaging 257
Malaria 334
Malarial parasite 335
Marfan's syndrome 73, 74, 79, 363
Mass lesions 238
Maternal and fetal demises 234
Maternal body mass index 278
Maternal complications 94
Maternal heart disease 64
Maternal hyperglycemia, uncontrolled 93t
Maternal insulin resistance 92
Maternal obesity 222
Maternal organ dysfunction 277
Maternal saturation 73
Maternoplacental syndrome 78, 81
Matrix metalloproteinases 371
Maturity onset diabetes of young 91
McDonald's diagnostic criteria, revised 199t
Measles 343
mumps, rubella 344
Mechanical circulatory support 43
Mechanical thrombectomy 176
Medial temporal lobe hyperintensities, bilateral 204f
Medical community 431
Medical officers 412
Medical therapy, guideline-directed 43
Medicamentosa 384
Medication safety 217
Mediterranean diet 225
Medroxyprogesterone 262
Megestrol acetate 262
Meibography 371
Meibomian gland 367
Meibomian gland ducts 368
Meigs syndrome 318
Melanocytic lesions, malignant conjunctival 360
Melanoma, malignant 360
Melasma 395, 395f
diagnosis 395
differential diagnosis of 395
presentation 395
prognosis 396
treatment 396
Memantine 191
Memory recall 143
Ménière's disease 384
Meningioma 359
Meningitis, aseptic 207
Meningomyelocele 93
Menometrorrhagia 267
Menopausal factors 389
Menopausal hormone therapy 139
Menopausal transition 135, 141
Menopausal women 140, 390
Menopause 31, 102, 135, 136, 138, 142, 218, 424
and diabetes 136, 138b
and osteoporosis 139
correlated significantly 136
decision-support algorithm 139
premature 165, 268
timing of 137
type of 137
Menorrhagia 267
Menstrual cycle 165f, 388, 397, 404
phases, track of 165
Menstrual disorders 329, 331
Menstrual dysfunction 391
Menstrual function 316
Menstrual hygiene 402, 404
scheme 412
Menstrual irregularity 22, 131
management of 123
Menstrual migraine 189
diagnostic criteria for 190t
Menstrual problems 402, 404
Menstruation 216, 402, 407
Mental health 387, 420
and illnesses 388
disparities 392
issues 403, 405
professional, role of 421
Mental illnesses 387
Mental status, altered 277
Mental stress 31
Mercaptopurine 217
Mesial temporal lobe epilepsy 164
Metabolic diseases 231, 241
Metabolic disorders 40
Metabolic dysfunction 117
Metabolic syndrome 158, 240
Metabolite
estradiol exerts proconvulsant 164
microbiota-derived 222
Metastatic disease 255, 256
Metatarsophalangeal joint 149, 151
Metformin 124, 227, 417
Metoclopramide 191, 384
Metoprolol 191
Metrorrhagia 267
Microangiopathic hemolytic anemia 293, 294
Microgenderome 216
Microsomal enzyme induction, degree of 166
Microvesicular steatosis 233, 234
Midlife depression, risk factors for 390
Migraine 82, 84, 84f, 187, 190, 191
attack 83f
burden of 83
during breastfeeding 191t
headache 53, 85, 188
in perimenopausal
period 191
state 189
in pregnant women 189
management of 83
pain, reduction in 84
pathophysiology of 82, 188, 191
prevalence of 189
prevention of 83
prognosis of 190
prophylaxis, future of 85
risk factors for 83
role of hormones in 189
treatment 84
types of 188
with aura 83, 84t, 188
without aura 188
menstrually-related 190
pure menstrual 190
Miliary dissemination 350
Mineralocorticoid receptor antagonist 42
Minimal change disease 286
Minocycline 395
Minoxidil, topical 399
Miscarriage 329, 331, 351
increased risk of 152
Misoprostol 332
Mississippi protocol 235
Mitochondrial enhancer 44
Mitochondrial trifunctional protein 233
Mitoxantrone 200
Mitral annular calcification 21
Mitral regurgitation 59, 63, 66
Mitral stenosis 58, 64, 66
Molecular studies 232
Monoamine oxidase 181
Monoclonal antibodies 84
Mood disorders 117
Mortality 73
Mother-to-child transmission, risk of 332
Motility 215
Mouth, dryness of 303
Movement disorder 180, 183, 207
Moxifloxacin 304
Mucosal edema 383
Mucous gland hypertrophy 314
Multidisciplinary care 151
Multidrug-resistant tuberculosis 351-353
Multifactorial disorder 366
Multifocal choroiditis 376
Multifunctional organ, largest 394
Multiple gestation 44, 277
Multiple pregnancies 419
Multiple sclerosis 132, 196, 198-200, 375
clinical features of 197, 198t
diagnostic criteria of 199t
investigations 197
pathogenesis of 196
prevalence 196
primary progressive 197
progressive-relapsing 197
relapsing-remitting 197
secondary progressive 197
treatment protocol for 198
types of 196
Mumps 343
Murmur 41
Muromonab-CD3 308
Muscle function, abdominal 385
Musculoskeletal complications 208
Musculoskeletal pain, chronic 150
Musculoskeletal system 93
Myalgias 208
Mycophenolate 247
mofetil 209, 308
sodium, enteric-coated 308
Myelin oligodendrocyte glycoprotein 198
Myelopathy 207
transverse 207
Myocardial dysfunction 157
Myocardial infarction 22, 32t, 33fc, 51, 81, 157
acute 53
history of 40
Myocardial ischemia, risk of 157
Myocarditis 40, 63, 156, 209
Myoclonus-dystonia 183
Myoma 131
Myopathy
idiopathic inflammatory 208
inflammatory idiopathic 319
Myopia 363
Myositis 319
N
Nadolol 191
Nailfold capillary changes 208
Naproxen 191
Nasal changes 384
Nasal discharge 379
Nasal obstruction 379
Nasolacrimal duct 358
Natalizumab 200
National blood cell incharge 429
National Blood Transfusion Committee 429
National Council of Educational Research and Training 411
National Education Programme 411
National Eye Institute 370
National Family Health Survey 403
National Health and Nutrition Examination Survey 83, 137
National Institute of Health 118
National Institute of Open Schooling 411
National Level Health Programs 411
National Tuberculosis Control Programme, revised 352
Natriuretic peptides 41
Necrosis, acute cortical 296
Necrotizing autoimmune myositis 208
Neoadjuvant chemotherapy 255, 260
Neonatal complications 94
Neonatal unit care 279
Neoplasms 335
Nephritis, interstitial 301
Nephropathy 25
diabetic 94
Nervous system 195
peripheral 206
sympathetic 41
Neural tube defects 93, 167
Neurocognitive health 128, 142
Neurodegenerative diseases 143
Neuroendocrine 388
Neuroimmunological disorders 195, 196
Neuroimmunology 195
Neurological complications 277
Neurological disorders 180
Neurology outpatient department 187
Neuromyelitis optica 195, 196, 198
clinical features of 198t
diagnostic criteria of 199t, 200t
spectrum disorders 196, 200
Neuronal injury, prevent 83
Neuro-ophthalmologic
abnormalities 364
disorders 358
Neuropathy 25
Nitrates 50
Nitric oxide 188
Nitrogen dioxide 315
Nitroglycerine mediated dilation 159
N-methyl-D-aspartate 165
receptors 164, 202
Nodular scleritis 361f
Nodules
autonomously functioning 105
benign 105
Nonalcoholic fatty liver disease 114, 220, 231, 238-240
prevalence of 117
Nonalcoholic steatohepatitis 240, 245
Noncardiac structural anomalies 73
Noncommunicable diseases, rise of 173
Noncontraceptive health 131
Nonerosive reflux disease 214
Nonhereditary ovarian cancer 260
Non-Hodgkin's lymphoma 264, 331
Noninfectious keratitis 362
Noninfectious uveitis 373
with systemic involvement 374
without systemic involvement 375
Noninvasive breakup time 368
Nonmotor symptoms 182
Nonobstructive coronary artery 33, 51
disease 31, 32
Nonpharmacologic measures 24
Non-ST segment elevation myocardial infarction 35
Nonsteroidal anti-inflammatory drug 84, 157, 158, 417
minimizing 159
Nortriptyline 191
Nose problems, common 380
Nutcracker esophagus 214
Nutritional deficiencies 403, 404
O
Obesity 22, 116, 142, 220, 222t, 223, 224, 227, 240
abdominal 22
increased risk of 222
Obsessive-compulsive disorder 389
Obstetrics and gynecology 432
Obstructive lesions, symptomatic 79
Obstructive sleep apnea 114, 117, 122
Obstructive uropathy 296
Ocrelizumab 200
Ocular conjunctival melanocytic lesions 360
Ocular exocrine dysfunction, evidence of 208
Ocular morbidities, non-life-threatening 357
Ocular surface
assessment 370
disease index 368, 369f
inflammation 366, 371
squamous neoplasia 360, 361f
Offspring complications 74
Oligoclonal immunoglobulin, synthesis of 198
Oligometastatic disease 255
Omphalocele 93
Onabotulinum toxin A 191
Onconeural antibody-mediated autoimmune encephalitis 203
Oocyte cryopreservation 266
Open angle glaucoma 363
Operational taxonomic unit 225
Optic nerve 374
inflammation of 364
Optic neuritis 364
Optic neuropathy, ischemic 207
Oral anticoagulants 74
Oral antihypertensive 279
Oral cancer 424
Oral cavity changes 384
Oral conjugated estrogen, effect of 138
Oral contraceptive 22, 364
and risk of
malignancies 132
strokes 174
effect of 127
estrogen 374
pills 50, 123, 131, 152, 323, 423
treatment remains 124
Oral health concerns 423
Oral hypoglycemic agents 97
Oral immunosuppressives 399
Oral infections and tooth decay 423
Orbit, disorders of 358
Organic heart valve 63
Orthopnea 41
Osteoarthritis 149
Osteoporosis 246, 264, 268
treatment of 140
Otalgia 379
Otolaryngorhinology 379
Otosclerosis 383
Outpatient department 329
Ovarian cancer 132, 258, 259
recurrent 260
risk of 131, 260
syndrome, hereditary 258
Ovarian cysts 131
Ovarian failure, primary 122
Ovarian hyperstimulation syndrome 265, 416
management of 417
prevention of 417
risk of 415
Ovarian hyperthecosis 142
Ovarian rupture 417
Ovarian sex-cord stromal tumors 142
Ovarian tissue cryopreservation and reimplantation 266
Ovarian transposition 266
Ovarian twisting 417
Ovary, metastases to 142
Overlap syndromes 157
Overt hypothyroidism 109
Overweight
and obesity 22
subjects, treatment for 24
Ovulation disorder 415
Ovulation drugs-induced side effects 419
Ovulation induction 415
drugs 415
Ovulatory dysfunction 116
Oxcarbazepine 166, 167
Oxford-Family Planning Association 133
Oxidative stress 363
Oxygen and ventilatory support 43
Oxytocin 388
P
P2Y12 inhibitors 53
Packed cell volume 417
Pain 268
abdominal 234
chronic 150
epigastric abdominal 277
genitopelvic 392
Painless thyroiditis 103
Palpitations 57
Parieto-occipital cortices 204
Parkinson's disease 181
clinical features 181
epidemiology 181
management issues 181
Parkinsonism 180
Paroxysmal nocturnal dyspnea 41
Paroxysmal vertigo 381
Patchy transverse myelitis 197
Patent ductus arteriosus 58, 71, 74, 79, 93
Patent foramen ovale 57, 84
Patulous eustachian tube 383
Peer Education Program 411
Pelvic inflammatory disease 131, 329, 403
chronic 353
Pelvis, imaging of 415
Pemphigoid gestationis 400
Penetration disorder 392
Penicillin 384
Peptic ulcer disease 213
Perampanel 166
Percutaneous coronary intervention 36
primary 50
related complications 52
Percutaneous mitral balloon valvuloplasty 58
Percutaneous therapy 60
Pericarditis 40, 42, 63
Peridiskal neovascularization 206
Perimenopausal women 170
Perineal injuries 94
Pertinent hemato-oncological issues 264
Pharmacological therapy 24, 97
Pharmacotherapy 421
Phenobarbitone 166
Phenols 315
Phenytoin 166, 167, 397
Physical activity 24, 96
Physical development 402
Physical inactivity 22
Physically active 26
Pinguecula 359
Pituitary tumor 103
Placental abruption 294
Placental defects 294
Placental growth
factor 277
hormone, secretion of 91
Plasma
exchange 293
regain, rapid 283
volume 230
Plasmapheresis 234
Plasminogen activator inhibitor-1 128
Plasmodium vivax 335
Platelet 293
aggregation 82
count 235, 275, 277, 293, 294
low 94, 235
dysfunction 156
transfusions 295
Pneumonia 42
Pneumothorax 350
catamenial 317
Polyangiitis 205
microscopic 362
Polyarteritis nodosa 205, 362
Polychondritis, relapsing 362
Polycyclic aromatic hydrocarbons 315
Polycystic ovarian disease 22, 31, 391
Polycystic ovarian syndrome 114, 117, 118, 118t, 120, 122, 125, 142, 165, 397, 414
clinical presentation 116
complications in 122t
core components of 115f
diagnostic approach to 118
differential diagnosis of 117
management 123
pathophysiology 115
phenotypes of 118t
women with 120t
Polycythemia 94
Polydipsia 234
Polyhydramnios 94
Polymorphic eruption 400
Polymyositis 208, 319
Polypill 26
advantages of 26
Polyuria 234
Polyvinyl alcohol 371
Post-fibrinolysis 36
Postinflammatory hyperpigmentation 395
Post-liver transplantation state 231
Postmenopausal hyperandrogenism 141
causes of 142t
Postmenopausal women 35, 137
Post-myocardial infarction 31
Postnasal drip 379
Postnatal care and breastfeeding 169
Postpartum 279
bleeding 294
cardiomyopathy 40
care 98
hypertension 313
major depression 389
psychiatric disorders 389
psychosis 389
pulmonary hypertension 317
thyroiditis 103
Postprandial glucose values 138
Potential reproductive consequences 163
Pramipexole 181
Prebiotics 225
Prednisolone 308
Preeclampsia 31, 44, 53, 78, 81, 82, 94, 231, 234, 276, 277, 278b, 293, 321
antenatal 279
conditions 277b
diagnostic criteria of 293
prediction of 277
pregnant patients 83
prevention of 277
prior 277
Pregabalin 166
Pregnancy 136, 217, 230, 315
and cardiac disease 66
and congenital heart disease 73
and coronary intervention 53
and eye 364
and heart 78
failure 44
and postpartum 102
and rheumatological illness 151
and stroke 175
complications 152
counseling 320
dermatosis 399
treatment 400
disorders, hypertensive 81
ectopic 417
implications for 340
normal 73
outcome, predictors of 295
related factors 388
rhinitis 384
risks 152
teenage 402, 403, 408
tubal 417
tumor 384
Premenopausal females 52
Premenopausal women, symptomatic 34
Premenstrual syndrome 131
Prenatal care 337
Prenatal counseling 168
Prenatal factors 388
Prepregnancy planning 95
Presbycusis 380
Preterm births 152
Primary disease, progressive 350
Primidone 166
Primigravida 44
Proangiogenic mediators, concentration of 294
Probiotics 226
Prochlorperazine 191
Professional Society Leaders 431
Progesterone 314, 388, 418
only contraceptives 129
receptor 255
Progestin only pills 123
Proinflammatory cytokines 156
Prolactin 101, 388, 415
inhibitors, role of 44
Proliferative obliteration 156
Propranolol 191
Proptosis, bilateral axial 359f
Prostatitis 302
Prosthetic valves 79
Protein excretion, estimation of 275
Proteinuria 234, 274, 277, 293
Prothrombin time 234
Proton pump inhibitor 215, 227
Pruritus gravidarum 400
Psychological disturbances 114
Psychotherapy 421
Pterygium 359, 360f
development of 359
prevalence of 359
Pubertal factors 388
Puberty and menstruation 101
Pubic hair, growth of 402
Pulmonary arterial hypertension 157, 313, 320
Pulmonary crackles 38
Pulmonary edema 42, 78, 293
Pulmonary embolism 42
Pulmonary function test 317
Pulmonary hypertension 42, 69, 71, 79, 317
severe 79
Pulmonary hypoplasia 93
Pulmonary stenosis 71, 74, 80
Pulmonary thromboembolism 323, 313
Pulmonary vascular
disease 72
obstructive 72
Pulmonology 313
Pulse, irregular 41
Pulseless disease 205
Punctate inner choroidopathy 376
Purkinje cell cytoplasmic antibody type 1 201
Pyelonephritis 338
acute 307
chronic 301
Pyrazinamide 352
Q
Q-fever 335
R
Radiation
chemotherapeutic agents 40
therapy 257
Radioiodine therapy 101, 103
Radiotherapy 255, 264
Ramipril 74
Rapamycin, mechanistic target of 317
Rasagiline 181
Rashtriya Kishor Swasthya Karyakram 411
Raynaud's phenomenon 151, 208
Refraction 364
Refractive errors 363
Refractive surgery 364
Regurgitant lesions 80
Regurgitation, aortic 63
Renal abnormality 276
Renal agenesis 93
Renal angiomyolipomas 316, 318
Renal calculi 296, 302
Renal deterioration 307
Renal disease 278
Renal dysfunction 246
Renal failure 234
acute 291
Renal function 36
test 41, 335, 417
Renal insufficiency 42
Renal Pathology Society 285
classification 282
Renal transplant, challenges of 306
Renal transplantation 309
Renin–angiotensin–aldosterone system 41
Reproductive and sexual dysfunction 165
Reproductive health 332
Reproductive tract infections 329
Respiratory diseases 313, 314, 316, 319
treatment 322
Respiratory system 316
Retina 374
diseases of 264, 358
posterior pole of 376
Retinal artery occlusion 207
Retinal vasculitis 375
Retinitis pigmentosa, treatment of 364
Retinoids, topical 397
Retinopathy 25
acute zonal occult outer 376
Retroperitoneal infection 335
Reynolds risk score 18
Rheumatic diseases 147, 151, 153
and safety 153t
inflammatory 147
Rheumatic disorders 147
Rheumatic fever 67, 335
acute 63
Rheumatic heart disease 39, 63, 64, 75, 81
A to Z of 63
Rheumatic valvular lesion 64
Rheumatoid arthritis 20, 132, 148, 149t, 155, 156, 158, 319, 335, 360, 368, 375
disease activity 152
Rheumatoid factor 148
Rheumatological diseases 150
Rhinitis, atrophic 380
Riboflavin 191
Rifampicin 352
Ringing sensation 380
Rituximab 286
Rontalizumab 287
Ropinirole 181
Roseburia 224
Roux-en-Y gastric bypass 228
Rubella 338, 339, 343
syndrome, congenital 70
Rufinamide 166
S
Salicylic acid 396
Salpingo-oophorectomy, bilateral 260, 261
Salzmann's nodular degeneration 361
Sarcoidosis 335, 375, 376
Schirmer test 370
Schistocytes 294
Schizophrenia 387
Sclera
diseases of 358
disorders of 359
Scleritis 360
Sclerodactyly 208
Scleroderma 208
Sclerosing cholangitis, primary 231, 239, 240
Sclerosis, benign multiple 197
Score risk charts 15
Sebaceous cell carcinoma 359
Seborrhea 119
Sedentary lifestyle 222
Seizure
control 168
cyclic exacerbation of 164
exacerbation, risk for 169
management of 169fc
Selective estrogen receptor modulators 140, 416
Selegiline 181, 182
Sepsis 42, 294
Septicemia 335
Serological testing 337
Seropositive cases 337
Serotonin reuptake inhibitor, selective 216, 318, 388
Serum 122
albumin 275
anti-müllerian hormone 121
bilirubin 275
creatinine 234, 275, 277
electrolytes 41
iron profile 41
triglyceride levels 127
uric acid 277
Sex hormone 163
affecting autoimmune response, role of 373
binding globulin 115, 131, 132, 388
levels of 136
female 176
Sex specific differences 70
Sexual abuse 408
Sexual activity 407
Sexual and reproductive health 410
Sexual attraction 392
Sexual behavior 392, 410
Sexual function assessment 268
Sexual health 264
assessment 268
Sexual identity 392
Sexual minority 392
Sexual orientation 407
Sexual reproduction 407
Sexual reproductive health 410
Sexuality education 407, 409, 410, 412
content of 409
delivery of 409
evolution of 408
role of media in 410
Sexually transmitted disease 299, 334, 340, 403
prevention 411
Sexually transmitted infections 329, 402, 407, 408
Sheehan's syndrome 103
Shock 82
cardiogenic 43
Sifalimumab 287
Sildenafil 418
Silica 315
Sinusitis 384
Siponimod 200
Sirolimus 308, 317
Sjögren's syndrome 150, 208, 367, 368
primary 151, 319
Skeletal muscle 234
Skin
ailments 394
disorders 394
tags 119
Sleep
behavior disorder 181
sisturbed 181
Small vessel 158
vasculitis 205
Smoking 22
avoidance and cessation 23
Social issues 170
Social media 410
Sociocultural effects 315
Socioeconomic factors and gender barriers 350
Sodium fluoride 384
Solifenacin 303
Somatic nociception 215
Spina bifida 93
Spironolactone 42, 124, 399
Spondyloarthropathy 150, 156, 157
Spotting 419
Squamous cell carcinoma 359
Staphylococcus saprophyticus 299
Statin 23, 50, 83
use of 176
Status epilepticus, management of 169fc
Stenotic lesions 80
Steroid
low-dose 153
sex hormones 423
sparing agent 209
Streptomycin 352
Stress
challenges 388
tests 35t
Stroke 17, 25, 173, 174, 207, 277
cryptogenic 57
ischemic 83, 176, 316
issues of 173
occupy 173
primary prevention of 26
risk 174
volume 65
Structural birth defects 93t
Structural heart
disease 3, 56, 60
spectrum of 56
treatment of 59
interventions 59
ST-segment elevation myocardial infarction 35
Sudden cardiac
arrest 82
death 82, 83
Sudden death 24
Sudden infant death syndrome 315
Sulfasalazine 153
Sulfur dioxide 315
Sumatriptan 191
Surgery 254
and radiation 261
therapy 257, 259
Swansea criteria 233
Sydenham's chorea 183
Symbiotics, use of 222
Syphilis 340
congenital 340
primary 329
secondary 335
Systematic coronary risk evaluation 15-17, 158
Systemic dentistry 424
Systemic lupus erythematosus 148, 150, 155, 157, 205, 206, 207, 267, 278, 282, 283t, 284, 295, 319, 335, 360, 374
diagnosis of 282
Systemic lupus international collaborating clinics 282, 283
Systemic sclerosis 151, 152, 155, 157, 208, 319
Systemic therapy 255
Systemic treatment 259
Systemic vascular resistance 65
T
Tachyarrhythmias 80
Tachycardia 41
ventricular 83
Tachypnea 41
Tacrolimus 308
Takayasu arteritis 205
Taxonomy 32
Tazarotene 397
T-cell 373
target 287
Tear
breakup time 368
cytokines 371
film 367
homeostasis 366
stability 368
meniscometry 370
meniscus 370
volume 370
Telangiectasias, cutaneous 208
Telogen effluvium 398, 399
Teratogenicity 167
Teriflunomide 200
Terrien's marginal degeneration 361
Tetanus 335, 343
diphtheria 344
and pertussis 344
Tetralogy of Fallot 72, 74
Therapeutic lifestyle changes 23
Thermoregulation, role in 394
Thoracentesis 317
Thoracic endometriosis 317
Thoracoscopic surgery, video-assisted 317, 318
Thorough history taking 299
Throat problems, common 380
Thrombocytopenia 276, 277, 293
therapy-induced 267
Thromboembolism 206, 335
Thrombolysis 175
safety of 176
Thrombophilia 53
Thrombotic microangiopathy 223, 286
Thrombotic thrombocytopenic purpura 285, 295
Thyroid
and menopause 140
antithyroglobulin antibody 110
autoantibodies 104, 109
binding globulin 107
cancer 105, 106, 112
disease 40, 100, 368
autoimmune 104
etiology of 140
management of 110, 140
disorders 100-102, 403, 404
anatomical 105
autoimmune 101
functional 102
disturbances 364
dysfunction 100
causes of 103t
risk factors for 104b
eye disease 358, 359, 359f
function 101
abnormal 102
interpretation of 107
function test 41, 110
interpretation of 103t
gland 101, 107
hormone, regulation of 101f
nodules 105
peroxidase 103
physiology during pregnancy 106, 107t
stimulating activity 292
stimulating hormone 101f, 103, 107-110, 359, 415
level 140
receptor antibodies 100
trimester-specific 108t
Thyroidectomy 103
Thyroiditis 70
atrophic 103
autoimmune 101
subacute 103
Thyrotoxicosis 103, 110
Thyrotropin-releasing hormone 101f
Thyroxine 103, 107, 110
Tiagabine 166
Tinnitus 379, 380
Tocilizumab 157, 287
Tocolytic pulmonary edema 319
Tooth decay and infections 424
Topiramate 166, 167, 191
TORCH infections 338
Total cholesterol 13
Tourette syndrome 183
Toxic
adenoma 103
cardiomyopathy 40
nodular goiter 103
Toxoplasmosis 337, 338
Transformation zone, large loop excision of 330
Transforming growth factor-β 165
Transfusion medicine 426, 429
Transgender women 392
Transvaginal ultrasonography 258
Transvaginal ultrasound 397
Transverse myelitis, longitudinally extensive 200
Treatment regimen 352t
Tremor, essential 182
Tretinoin 397
Trichloroacetic acid 396
Triglycerides 16
Triiodothyronine 100, 102, 107, 110
N-oxide 222, 223f
Trivalent influenza vaccine 344
Trivandrum Heart Failure Registry 40
Truncus arteriosus 93
Tubal patency 415
Tuberculoma 350
Tuberculosis 313, 322, 323, 329, 330, 334, 335, 337, 338, 349, 351, 352
advance diagnostic techniques 353
and breastfeeding 351
and pregnancy 350
burden 349
clinical manifestations of 350
diagnosis of 353
drug-resistant 323, 352t
drug-susceptible 352t
impact of 351
increases risk of 351
negative impact of 352
newborns of mothers with 351
notification of 353
pulmonary complications of 350
treatment of 351, 353
women mortality to 349t
Tuberous sclerosis complex 316
Tubo-ovarian masses 329
Tubular atrophy 285
Tumor necrosis factor 246
alpha 156
Typhoid 334, 344
U
Ulcer, corneal 362
Ulcerative colitis 216
Ulcerative keratitis, peripheral 362
Ultrasonography 122
Umbilical artery, abnormal 277
Unhealthy diet 22
Universal Immunization Programme 343
Ureter 296
duplication 93
ultrasonography of 302
Uric acid 275
high 234
Urinalysis
and culture 335
and microscopy 275
Urinary tract
anatomy 299f
lower 300
symptoms, causes of 300f
Urinary tract infection 94, 298, 299, 301, 334, 335, 337, 391, 402
bacterial 307
challenges of 298
management of 305
Urine
dipstick 302f
human chorionic gonadotropin 122
postvoid residual 302
routine examination 301
Uroflow patterns 303
Urticarial vasculitis, hypocomplementemic 205
Uterine artery doppler 277
Uterine bleeding
abnormal 264
management of abnormal 267
Uterine pathology, local 52
Uteroplacental dysfunction 277
Uvea
diseases of 358, 364
inflammation of 373
Uveitis 364, 373, 375
causes of 374
role of gender in 376
V
Vaccination, adolescent 343
Vaccine 344
mandatory 343
preventable diseases 343
Vaginal bleeding, abnormal 267
Vaginal delivery 75, 234, 307
Vaginal scarring, management of 268
Vaginitis 302
Valproate 166, 167
Valproic acid 191
Valvar obstruction 80
Valve surgery 66
Valvular heart disease 40, 58, 63, 80
Valvular lesions during pregnancy 66
Varicella 344
vaccine 344
zoster immunoglobulin 344
Vascular complications 82
Vascular disease 158
Vascular endothelial growth factor 294, 317
Vascular function, assessment of 159
Vascular thromboembolism, risk of 128
Vasculitic disorders 195, 205
Vasculitis 158, 205
primary 205
secondary 206
Vasomotor disorders 32
Vasomotor symptoms, treatment of 137
Vasospasm myocarditis, coronary 33
Venous thromboembolism 138, 320
Ventricular dysfunction 74, 80
right 42
Ventricular function postpartum 80
Ventricular septal defect 57, 74, 79, 93
Verbal intelligence 167
Vertigo 82
and women 381
Vessel disease, triple 51
Vessels pulse wave velocity, peripheral 159
Vestibular rehabilitation 381
Vigabatrin 166
Vigorous-intensity exercise 24
Vijaya's echo criteria 9
Violence and staying safe 409
Viral hepatitis 238, 240, 334, 336
Viral infections 335
Virgo classification system 32t
Visceral nociception 215
Visceral stimuli, central processing of 216
Vision-threatening complications 374
Visual disability, permanent 363
Visual impairment 357
severe 373
Visual scotomata, persistent 277
Vitamin
A deficiency 360
B6 232
D 83
Vitreous 376
Vitritis 375
Vogt–Koyanagi–Harada disease 375
Voiding symptoms, evaluation of 300
Volatile organic compounds 315
Vomiting 234
von Willebrand factor 295
Vulvovaginal candidiasis 329
W
Weakness 69
Wegener granulomatosis 362
Weight gain
insufficient 351
restricting 96
Weight loss 24
Weight reduction 123
Weill–Marchesani syndrome 363
White dot syndromes 376
White-coat hypertension 274, 278
Widal test 335
Wilson's disease 184, 231, 241, 242, 245
Woman's body 383
Women empowerment 352
Women's health 387
across nation 142
Women's ischemia syndrome evaluation 32
World Health Organization 17-19, 130, 139, 163, 226, 408
X
X chromosome inactivation 101
Y
Yentl syndrome 33, 36
Z
Zoledronic acid 256
Zonisamide 166, 167
×
Chapter Notes

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1Cardiology
SECTION EDITORS Shibba Takkar Chhabra, Gurbhej Singh2

Role of Women in Development of Cardiology in IndiaCHAPTER 1

IB Vijayalakshmi

ABSTRACT

Women in cardiology have been outnumbered by their male colleagues not only in India but all over the universe. The present review highlights the role of pertinent women who have been instrumental in development of cardiology in India. Their struggle has paved way for several young lady cardiologists who now tread the path with confidence and zeal.
 
INTRODUCTION
Dr Helen Brooke Taussig, a pediatrician at Johns Hopkins, was the codeveloper of first successful “Blue Baby” operation at Johns Hopkins Hospital. The two great Indian pioneers of pediatric cardiology in India, Dr Kamala I Vytilingam and Dr S Padmavati both were trained in Johns Hopkins hospital, under Dr Helen Brooke Taussig, “Mother of pediatric cardiology.” The journey of cardiology in India started with toddlers steps of pediatric cardiology by women! Thus, it has been truly fascinating and full of challenges, determination, and dedication by many illustrious women. So much so that once great cardiac anatomist and a world authority, Bob Anderson once exclaimed during world congress of pediatric cardiology to Dr IB Vijayalakshmi- “Oh Vijay I thought you were a man!!. We have laid the solid foundation for structural heart diseases, now it is to the young Indian pediatric cardiologist to build it further.” The remarkable journey of cardiology in India has many women luminaries who have brightened the path of future cardiologists.
 
HISTORY OF BEGINNING OF CARDIOLOGY IN INDIA
The first formal department of cardiology in India was started in Christian Medical College (CMC) Hospital, Vellore in 1957 by Dr Kamala I Vytilingam, after training at Johns Hopkins Hospital, Baltimore. The DM cardiology training course was initiated in CMC in 1965. The birth of the specialty of pediatric cardiology in India took place at Vellore under Dr Reeve Betz who started the first cardiothoracic surgery department at Vellore in 1949. Dr T Thomas and Dr Gopinath joined Dr Betz subsequently and initiated the first open heart surgery program in 1960. Late Dr Vytilingam established one of the 4earliest cardiac catheterization laboratories in India. Butreal interventional cardiology started only in 1985.
 
PIONEERS IN CARDIOLOGY
 
Dr S Padmavati
Dr Sivaramakrishna Iyer Padmavati, widely regarded as the doyenne of cardiology in India. She is India's first woman cardiologist and woman of many firsts! The first Indian doctor who completed training in pediatric cardiology is Dr S Padmavati who studied CHD as a fellow with Dr Helen Taussig from 1948 to 1951 and subsequently in pediatric cardiology department in Boston at the Massachusetts general hospital. She had rare privilege of publishing a paper “Results of Operation for Pulmonary Stenosis and Atresia Transactions” with Dr Helen Taussig in Association of American Physicians in 1951. On her return to India, she was amazed to find the wards full of young women and children with acute rheumatic fever (ARF) and rheumatic heart disease (RHD). As she did not have access to surgical management of pediatric cardiac patients, she had to predominantly look after adults. She opened a cardiac clinic in Lady Hardinge hospital where there were a lot of children with CHD. In 1980, she published her paper “Congenital Heart Disease in Delhi School Children.”
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Dr Kamala I Vytilingam
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Dr S Padmavati
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Dr P S Sreemathi
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Dr Savitri Shrivastava
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Dr (Mrs) Ramesh Arora
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Dr Lekha Pathak
5  
Dr Kamala I Vytilingam
The first formal Department of Cardiology in India, was started in Christian Medical College (CMC) Hospital, Vellore in 1957, by Dr Kamala I Vytilingam, who brought modern cardiology to India after a period of training at Johns Hopkins Hospital, Baltimore in the early 1950s. She did a year's training with Dr Helen Taussig in 1961. The availability of surgical help allowed her to look after both adult as well as pediatric patients. She established one of the earliest cardiac catheterization laboratories in India.
 
Dr Savitri Shrivastava
Professor Savitri Shrivastava did her MBBS from GRM College, Gwalior, Agra University in 1957 and MD (Medicine) at GRM College, Vikram University in 1961. She did her DM (Cardiology) at All India Institute of Medical Sciences, Delhi, India in 1971. Subsequently between 1975 and 1976, she did her fellowship in pediatric cardiology at University of Minnesota, Minneapolis, USA. She came back to AIIMS. Her special achievement in field of interventional cardiology described for the first time in the world was an original technique of balloon dilatation of the atrial septum (static balloon) in transposition of great vessels. This was published in Indian Heart Journal in 1988. She also reported for the first time in the world “Percutaneous catheter commissurotomy in rheumatic mitral stenosis” in the New England Journal of Medicine in 1985. She was also instrumental in doing a lot of procedures for the first time in India at AIIMS. The procedures were balloon valvuloplasty for pulmonary valve, aortic valve, balloon dilation of aortic coarctation, aortoarteritis, peripheral pulmonary arteries, coil occlusions of BT Shunt, coronary AV fistula, and aortopulmonary collaterals. She was awarded “PICS Achievement Award” at the Annual PICS (Pediatric Interventional Cardiology Symposiums) meeting held in Miami, Florida on January 21, 2013. This is a great honor for an Indian. After her retirement from AIIMS, the good work is being continued at present by Dr Anitha Saxena who did school surveys for RHD disease with mobile echo machine and Dr Shyam Kothari who has worked on pulmonary hypertension.
 
Dr (Mrs) Ramesh Arora (Fig. 1)
She established a registry of transcatheter noncoronary interventional procedures in the country and was awarded with national interventional council of CSI award for development of noncoronary interventional cardiology in India (1999). She started nonsurgical (device) closure of patent ductus arteriosus (PDA) in 1987 by using Rashkind umbrella device for the first time in the country.
For valvular lesions specially percutaneous transvenous mitral commissurotomy (PTMC) in children was done in 1987 by her using double Mansfield balloon technique and in 1990 with Inoue balloon. Nonsurgical closure of atrial septal defect (ASD) was first time attempted in the country by using various sizes of Sideris devices (1993), followed by Starflex, Cardioseal, and Amplatzer devices (1998). She started devices closure of ventricular septal defect (VSD), both perimembranous and muscular by using Rashkind umbrella device in 1995 and this was replaced by muscular Amplatzer VSD device in 1999. First human use of specially designed perimembranous VSD device was done in 6December 2000 by Dr Ramesh Arora. Various other rare cardiac lesions were attempted like coronary arteriovenous (AV) fistula, ruptured sinus of valsalva pulmonary AV fistula, PA to LA fistula, etc. She made all Indians proud by having done the highest number of PTMC and perimembranous VSD closure by device in the world, at a particular time! She is a bundle of energy and enthusiasm for innovations. So much so when Dr IB Vijayalakshmi showed her the booklet with the diagram of Amplatzer device drawn by Kurt himself she had jumped with joy!
 
Dr Lekha Pathak
Dr Lekha Pathak is the Director and Head of the Cardiology Department at Nanavati Super Speciality Hospital, Mumbai, India. She completed MBBS from Netaji Subhash Chandra Bose Medical College, Jabalpur in 1965, and MD-General Medicine from Netaji Subhash Chandra Bose Medical College, Jabalpur in 1968, DM-Cardiology from King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College in 1971. She has done over 10,000 interventional procedures for past 10 years. Dr Lekha Pathak has been awarded with Lifetime Achievement Award by Ex-President APJ Abdul Kalam for outstanding contribution in the field of cardiology 2008, Priyadarshini award in 2008, Doctor of Science (DSc) by University of Loyola, Chicago, USA in 2012 and many more. She is a member of Maharashtra University of Health Sciences, Padmashree Dr D Y Patil University-Member Management Council, Association of Physicians of India (API) and Indian College of Physician. Some of the services provided by the doctor are carotid angioplasty and stenting, coronary and noncoronary interventions, angioplasty and stenting, interventional procedures and minimally invasive cardiac surgery. She is the second woman to be president of CSI after Dr Padmavathi. She is a cardiologist in Vile Parle West, Mumbai and has an experience of 47 years in this field.
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FIG. 1: Dr Ramesh Arora is seen presenting on rheumatic fever and rheumatic heart disease (RHD) in June 1980 in London in the first world congress of pediatric cardiology.
7  
Dr Anitha Saxena
She was born in November 1956, presently serving as full professor of cardiology since 1998, at the All India Institute of Medical Sciences, New Delhi, a very high volume tertiary care public hospital catering primarily to northern, central, and eastern parts of India. Her responsibilities include teaching, research, and patient-related clinical work. She is regularly teaching postgraduate fellows and residents who are undergoing 3 years structured training programs in cardiology and has served as guide/co-guide for thesis for over 50 postdoctoral students.
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She completed her education with MBBS, MD, and DM degrees, all from University of Delhi, and has been a gold medalist throughout the academic carrier. She has over 33 years of experience in the subspecialty of pediatric cardiology and adults with CHD. She has many publications with over 312 research articles in reputed national and international journals. Some of the landmark articles are frequently cited in literature and textbooks. She has been the principle investigator for a number of community-related research projects on public health issues related to cardiology. Some of her publications on community research, related primarily to rheumatic and CHD, have been widely cited.
She is actively engaged in the formulation of national guidelines for the management of CHD and RHD and has published extensively on status and management of CHD in India. She is also a member of several international groups dealing with global burden of RHD and the co-chair of the Working Group of Task Force on Rheumatic Heart Disease, set up by the World Heart Federation, Geneva. She is frequently invited as an expert group member by the Ministry of Health and Family Welfare, Government of India, for formulation of policies and guidelines related to the specialty of cardiology. The Indian Council of Medical Research has also been regularly inviting her as one of the experts for evaluation of research projects and for policymaking decisions, related to the specialty of cardiology.
She has held important positions in several national and international academic organizations including President of Asia Pacific Pediatric Cardiac Society, Pediatric Cardiac Society of India, and National Rheumatic Heart Consortium. She has been awarded Fellow of American College of Cardiology.
 
Dr IB Vijayalakshmi (Figs. 2 and 3)
On November 14, 1998 for the first time in South India government set up pediatric cardiology department was started in Sri Jayadeva Institute of Cardiology. Dr IB Vijayalakshmi, first lady cardiologist of Karnataka, who headed the department, was the first one to use Amplatzer septal occluder and Amplatzer duct occluder (ADO) on January 27, 1999 in South India. Thanks to Children's Heart link, Minnesota, she was trained in four best centers in USA: (1) Fairview University Children's Hospital (Minneapolis), (2) St. Mary's Hospital (Rochester), teaching hospital of Mayo Clinic Medical School, (3) Children's Hospital Medical Centre (Boston, Massachusetts), teaching hospital of Harvard University in 1998, and later was (4) trained at Children's Hospital at Chicago University in 2002 under Dr Ziyad Hijazi.8
Thanks to the excellent training that she received, she went on to do several interventions for the first time in the world. One such case was a 4-year-old child with noncompaction of left ventricle with the aorto-left ventricular tunnel (ALVT) closed with Amplatzer device in 2001. When the first ALVT was closed surgically by Evalon plug from aortic end by Dr Lillehei Minnesota, Dr Kurt Amplatz was part of that great team! So Kurt was excited about the ALVT being closed by his device. He donated three devices to be tried for this case and wrote “Nobody can advise you, as no one has any experience, use your clinical acumen and all the best.” True to his words, the two sizes of VSDs were too big and compressing on the aortic valve, the third, 16 × 14 largest ADO was a bit small to block the aneurysmally dilated extra cardiac portion of the tunnel, leading to hemolysis for 5 days. This case was presented at 37th Annual Scientific meeting and AGA Medical 4th International Symposium at Porto, Portugal, on 15 May, 2002 and published in pediatric cardiology journal. And also in the same meeting, the first case of isolated dextrocardia with mid-muscular VSD closed through the jugular approach with 16 mm Amplatzer device was presented by her.
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FIG. 2: From left to right Dr IB Vijayalakshmi with her source of inspiration Dr S Padmavati, Dr Kurt Amplatz, Dr Richard Van Praagh, and Dr Fontan.
9
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FIG. 3: Dr IB Vijayalakshmi is seen putting the red pin on Bengaluru to mark the centers using Amplatzer device. Dr Kurt Amplatz and his son-in-law watching the global map in the head office of AGA in 1998.
When it was explained to Dr Kurt, that the available Amplatzer devices require larger French sheaths to introduce and hence it was difficult to do the device closure in emaciated low-weight Indian children, he came out with innovative “modified Amplatzer device” in which only one layer of polyester material was stitched, instead of three layers! Thanks to this alteration, a large PDA in a 3.9 kg infant was closed with 10 × 8 ADO in 2002 and was presented in PICS-VI at Chicago, USA in September, 2002 and initial experience in 10 infants was published in 2006. This was done when nobody was doing device closure in children weighing <6 kg. When the angiogram of a PDA larger than aorta in a 4.5 kg infant was mailed to Dr Kurt, he came out with the custom made angled PDA device which had no polyester material at all in it! These custom made angled devices became the prototype for ADO II additional size (ADO II AS) which were used in infants and newborns later! For the first time in the world, a case of sickle cell anemia with ASD was closed with device closure in 2005. This was presented in World Congress in Buenos Aires, Argentina. Thanks to the low profile and easy trackability of ADO II, first time in the world a case of left coronary cameral fistula to RV was closed with ADO II in 2011, which topped the top 20 publications in noncoronary section in 2013. For the first time in the world, a case of aorto-right ventricular tunnel (ARVT) (only the 17th case) was closed with ADO II in 2013. For the first time in India, the workshop of PDA closure with Nit Occlud was done in 2002 with Dr Lee. For the first time, ADO II was used to close Gerbode defects with no complete heart block.
Dr IB Vijayalakshmi has written four textbooks for the cardiologists, (1) A monogram on “Acute Rheumatic fever and Rheumatic heart Disease,” (2) “Step by Step to Echo in Congenital Heart Disease,” (3) Chief editor of a textbook “A Comprehensive Approach to Congenital Heart Disease” for which the book review has been written by Dr Crystal R Bonnichsen of Mayo clinic and published in European Heart Journal. Dr Crystal writes “As stated in the epilogue, the editors used the approach of “A Lifelong Journey” to describe the management of congenital heart disease through the various stages, often called the “womb to tomb” approach. The editors undertook a formidable challenge by covering all aspects of congenital heart disease at all stages of life”. For the first time in the world, she has proposed and published “Vijaya's Echo criteria” for diagnosis of carditis in ARF. In the recently revised Jones criteria, her two studies are cited and echo features are incorporated. Her study has been quoted in latest editions of standard pediatric cardiology textbooks like Heart Diseases in Infants and Children by Moss and Adams’ and Park's Pediatric Cardiology for Practitioners.10
 
Dr Suman Rao
Dr Suman Rao, the first cardiologist of Himachal Pradesh, born on May 3, 1946, did her MD (medicine) as well as DM in cardiology from PGIMER, Chandigarh. She is a WHO fellow from cardiovascular institute, Mount Sinai, New York, USA. She worked as professor and head of the department of cardiology at IGMC Shimla for 12 years. She held post of director of medical education in the state of Himachal Pradesh and has been advisor to the state government. She is principal of Tanda Medical College. She has number of publications in national journals on cardiac status at high altitudes. In addition, she has a number of publications in national and international journals of cardiology. She is the recipient of DP Basu Complimentary Award at CSI Conference and has taken active part in national and international conferences of cardiology.
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JOURNEY OF CATHETER-BASED INTERVENTIONS BY WOMEN
The various pediatric cardiac catheter interventions initiated in India are:
  • Rashkind balloon septostomy in d-TGA in early 1970s—CMCH, Vellore.
  • Balloon pulmonary valvotomy in 1985 by Dr M Khalilullah and Dr Ramesh Arora at GB Pant Hospital, New Delhi.
  • Balloon aortoplasty of coarctation of the aorta (CoAo) 1985 by Dr M Khalilullah and Dr Ramesh Arora, New Delhi.
  • The first PTMC in rheumatic mitral stenosis was done in 1985 by legendary Dr Savitri Shrivastava.
  • Balloon aortic valvuloplasty in 1986 by Dr M Khalilullah and Dr Ramesh Arora, New Delhi.
  • Procedure of balloon dilatation of the atrial septum in transposition of great vessels by static balloon was introduced in 1988 by Dr Savitri Shrivastava and followed by Dr Ramesh Arora.
  • Dr Ramesh Arora started nonsurgical (device) closure of PDA in 1988 by using Rashkind umbrella device for the first time in the country.
  • Device closure of PDA in 1988 by Dr Ramesh Arora at GB Pant Hospital, New Delhi and subsequently by using Amplatzer devices (1998).
  • Nonsurgical transcatheter closure of ASD was first time attempted in the country by using various sizes of Sideris devices (1993), followed by Starflex, Cardioseal by Dr Ramesh Arora.
  • Dr Ramesh Arora also did the first device closure of VSD, both perimembranous and muscular by using Rashkind umbrella device in 1995 and this was replaced by muscular Amplatzer VSD device in 1999.
  • Later for the first time in India, various Amplatzer devices were used to close ASD and PDA by Dr Ramesh Arora in North India and Dr IB Vijayalakshmi in South India in January 1999.
  • The valvular lesions, especially PTMC in children, was done in 1987 by using double Mansfield balloon technique and in 1990 with Inoue Balloon by Dr Savitri Shrivastava, Dr Satyvan Sharma, and Dr Ramesh Arora.
  • For the first time, transcatheter noncoronary interventional procedures council was established in 1999 in the country and Dr Ramesh Arora was awarded the national 11interventional council of CSI award for development of noncoronary interventional cardiology in India.
  • First human use of specially designed perimembranous VSD device was done in December 2000 by Dr Ramesh Arora.
  • Along with Dr Ramesh Arora, Dr IB Vijayalakshmi did the first PDA closure with specially designed angled device in neonates (2003). Incidentally, this was the first case in the world in whom 8.6 mm PDA larger than aorta (8.2 mm) was closed in 4.5 kg infant.
Various other rare cardiac lesions were attempted like coronary AV fistula, ruptured sinus of valsalva pulmonary AV fistula, PA to LA fistula, etc., by Dr Ramesh Arora and Dr IB Vijayalakshmi.
For the first time in the country, a national policy for CHD was proposed by Dr IB Vijayalakshmi in 2004. Since then many centers started coaching fellows in pediatric cardiology. Now, DNB itself has identified 11 centers training 22 fellows in pediatric cardiology and two centers in India offering DM in pediatric cardiology.
 
CONCLUSION
The situation is not very different in India from west where 20% of cardiologists are women, though there is no compiled data available. More women are now heart specialists in India. The journey of cardiology started virtually with only three centers having just M-mode echocardiograms in India. But the cardiac catheterization laboratory has clearly transformed from a diagnostic facility to a place for providing definitive treatment to nearly 65% of simple CHDs without scar on the chest. So fascinating is the history of interventional cardiology. Many surprises are bound to come as gifted minds toil night and day to make this world a better place with less suffering. Thanks to medical tourism, today India is the destination for interventions in cardiology and women are contributing a great deal in taking care of hearts of ailing patients.
“One hundred years from now, it will not matter what kind of car I drove, what kind of house I lived in, how much was my bank account, nor what my clothes looked like. BUT the world may be a little better because I was important in the life of a child”— Anonymous
SUGGESTED READING
  1. Tandon R. Development of Pediatric Cardiology in India.
  1. Taussig HB, King JT, Bauersfeld R, Padvamati-Iyer S. Results of operation for pulmonary stenosis and atresia; (report of 1000 cases). Trans Assoc Am Physicians. 1951;64:67–73.
  1. Shrestha NK, Padmavati S. Congenital heart disease in Delhi school children. Indian J Med Res. 1980;72:403–7.
  1. Shrivastava S, Radhakrishnan S, Dev V, Singh LS, Rajani M. Balloon dilatation of atrial septum in complete transposition of great artery--a new technique. Indian Heart J. 1987;39(4):298–300.
  1. Lock JE, Khalilullah M, Shrivastava S, Bahl V, Keane JF. Percutaneous catheter commissurotomy in rheumatic mitral stenosis. N Engl J Med. 1985;313:1515–8.
  1. Arora R, Jain P, Rajagopal S, Nair M, Keane JK, Khalilullah M. Transcatheter closure of patent ductus arteriosus: preliminary experience with five patients. Indian Heart J. 1988;40(4):253–7.
  1. Arora R, Nair M, Rajagopal S, Sethi KK, Mohan JC, Nigam M, et al. Percutaneous balloon mitral valvuloplasty in children and young adults with rheumatic mitral stenosis. Am Heart J. 1989;118(5 Pt 1):883–7.
  1. Arora R, Nair M, Kalra GS, Sethi KK, Mohan JC, Nigam M, et al. Non-surgical mitral valvuloplasty for rheumatic mitral stenosis. Indian Heart J. 1990;42:329–34.

  1. 12 Arora R, Trehan VK, Kalra GS, Chawla R, Jhamb U, Nigam M, et al. Transcatheter closure of atrial septal defect using buttoned device--Indian experience. Indian Heart J. 1996;48(2):145–9.
  1. Kalra GS, Verma PK, Dhall A, Singh S, Bhardwaj S, Arora R. Transcatheter closure of secundum atrial septal defect with atrial septal defect occlusion system (ASDOS): initial experience and short-term follow-up. Indian Heart J. 1998;50(4):409–13.
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