Apollo Health Blog
What are febrile seizures? How common are febrile seizures?
Febrile seizures are fits or convulsions that are brought on by fever. These are common and occur in about in 3-5 % of otherwise healthy children, between the ages of 6 months and 6 years. Peak occurrence around 18 months.
The febrile seizures are usually brief and last from a few seconds to about 10 minutes. They typically occur on the first day of fever and with a temperature above 101° F. In some cases, the child may not have a fever at the time of seizure but may develop subsequently.
Usually, there is a history of febrile seizures in the family. About 30 % of Children tend to have recurrences.
These seizures usually are not a cause of other seizure disorders or epilepsy (epilepsy is a tendency to have recurrent fits without a known cause).
What precautions should be taken during a seizure?
- Stay calm.
- Don’t panic.
- Please time the event.
- Make sure that the child is safe and away from obstacles.
- Loosen any tight clothing.
- Don’t attempt to stop the seizure or slap or shake the child in an attempt to wake him/her. The child may move around during the seizure, and parents should not try to hold the child down.
- Do not stop the fit movements.
- Do not force anything in the mouth to prevent from biting the tongue.
- After the child stops fitting, turn him to one side to prevent choking.
- Seek immediate attention if it is a first febrile seizure.
Are febrile seizures harmful?
Though they typically do not cause damage to the brain, they are quite frightening and dramatic for the parents who witness these.
Majority of these seizures are short-lasting and do not cause any long term damage. During a seizure, there is a small chance that the child may be injured by falling or choking on food or saliva in the mouth. Using proper first aid measures as described above can help avoid these.
Children usually have a normal school achievement and perform well on Intellectual tests as their siblings who do not have the seizures.
Most children who have a brief (< 10 minutes) or multiple seizures do not go on to develop epilepsy.
Children with a family history of epilepsy, cerebral palsy, delayed development, or other neurological conditions are at increased risk of developing epilepsy. Febrile seizures may be more common in these children, but do not contribute much to the overall risk of development of epilepsy.
However, children with focal seizure ( a seizure that starts in one part of the body), Prolonged seizure ( > 10 minutes,), a seizure that recurs within 24 hours have an increased risk ( 10%) of developing epilepsy as compared to the general population.
How should febrile seizures be evaluated?
These fits or seizures happen when a child usually has a fever due to a minor infection.
However serious infections like brain infection need to be excluded and hence the diagnosis of febrile seizures needs to be made only by qualified healthcare professionals. A careful history and examination along with laboratory workup might be needed.
EEG’s and neuroimaging studies like CT scan or MRI should only be performed if there is clinical suspicion. Routine performance of scan and EEG’s have been found to have limited value. Abnormalities on EEG do not predict the occurrence of future seizures or the subsequent development of epilepsy.
Can subsequent febrile seizures be prevented?
The rapid rise of temperature seems to trigger seizures rather than the actual degree of fever.
Regular, round the clock usage of antipyretics, may be given at first sign of infection in children with known febrile seizures. This might help to prevent fever spikes that are the triggers for a seizure. However available studies show that this does not reduce the risk of having another febrile seizure.
The regular usage of anticonvulsants is not recommended. They might prevent recurrences but will not prevent the subsequent development of epilepsy. As these seizures are usually short-lasting and do not cause brain damage, the side effects of these medicines outweigh any benefits.
As children prone to prolonged seizures are at risk of potential injury and the risk of developing epilepsy, one might consider using medication to prevent prolonged episodes.
Thyroid disorders are the second most common endocrine disease prevalent in society, diabetes being the first. No age is immune to this problem. But what is comforting is that with timely diagnosis and treatment, most of these can be controlled.
4-10% of the general population is suffering from thyroid disorders. Awareness both among the public and medical fraternity is now increasing with regards to thyroid gland problems.
The disorders are divided into hypothyroidism (an under-functioning thyroid gland), hyperthyroidism(an over-functioning thyroid gland), a nodular disease of the thyroid including thyroid cancer. Treatment of these varied conditions needs a proficient and focused approach.
Even though the thyroid disorders are thought to be more common in the middle age, more and more cases are being diagnosed in the age groups below 30 years.
Therapy in all the age groups is an important but effective treatment in childhood is extremely important because the disorders have long-term complications such as short stature, mental retardation, delay in puberty. Newborn screening is an important tool which helps us in identifying the cases early in life, it is mandatory in most of the developed countries.
It is a growing problem, though not in the epidemic proportions unlike diabetes in our country, improved awareness will help in better management.
Dr. Sridevi Paladugu, MBBS, MD, DM
Endocrinologist, Apollo Hospitals, Hyderguda
Book Appointments with Dr. Sridevi Paladugu here
If you think someone is having a heart attack follow these basic steps
- Make the person sit down and try to keep calm.
- Loosen his tight clothes, if any.
- Ask the person if he takes any chest pain or any other medication, and help him in taking the medication.
- Immediately call an ambulance or a know emergency center for more help.
- Don’t leave the person alone except to call for help, if necessary.
- Don’t delay to call for emergency help.
- Don’t wait for the symptoms to come down.
- Don’t give any personal medication, unless its a prescribed medication for heart attack.
- Don’t panic & make the person more worried. Stay calm until you get help.
Book Appointment with a Renowned Cardiologist here
Mrs Mehta came to my opd and she was looking stressed out as her pregnancy test was positive. She was feeling guilty as she had delivered a baby 8 months back only and she was not prepared for this pregnancy. Had she or her husband used some contraceptive method she would have been in a better position today.
Contraception has many advantages as it helps in spacing and family planning, also prevents maternal morbidity from unwanted abortions for unwanted pregnancies and for new mothers it gives time to replenish their stores of iron and calcium so after a gap of two to three years they are ready to bear another healthy pregnancy. There are some myths associated with all types of contraceptive methods so it’s always better to discuss all options with your gynaecologist and choose one which best suits your needs.
For men, we have barrier contraceptive called condoms and if used regularly and consistently it’s very good and has very few failure rates. For women, there is a wide range of contraceptives and it’s also called as Cafeteria approach in which we offer all type of contraceptives to them and woman has a right to make her informed decision and she can choose the contraceptive which will fulfil all her needs. Most popular women contraceptive is oral contraceptive pills or OCP but there are also some strong myths associated with OCPs such as weight gain but as said it’s a myth and has no scientific evidence. There are different combinations of pills available and also very low dose pills are available which have minimal or no side effects. One more type of pill is available called POP (Progestogen-only pill) which can be used immediately post-partum without affecting the milk production. Now hormonal contraception is also available in the form of a vaginal ring with similar efficacy and mechanism of action. Another hormonal contraception Emergency Contraception is the most misused contraceptive and it should be avoided and should strictly be used for emergency situations such as failure of other contraceptives, slippage, leakage of condom, or conditions such as rape and should never be used as a regular contraceptive. Among other methods are the Intrauterine devices such as Copper – T and Mirena and they are also called as Long Term Reversible Contraceptives as fertility returns as soon as they are removed. Some injectable contraceptives and female condoms, diaphragms, cervical caps are also available.
If we talk about permanent methods, for females tubectomy is done and for males, Vasectomy is done. With the latest technology, both procedures are daycare procedures with immediate recovery. Permanent methods should only have opted if family if complete and there is no desire to have more children later.
Make your informed choice and live a healthy and safe life.
What is Arthritis and who can get it?
Arthritis is a name for a group of conditions affecting the joints which cause symptoms of joint pain and stiffness. Arthritis can affect people of all ages, lifestyles and background and even the children can get arthritis. It is not a disease due to aging but is generally believed because some conditions are more common in elderly. There are more than 100 different types of arthritis and each type affects the joints differently. Some of the common forms of arthritis are osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout and others.
What are the symptoms of arthritis?
Patients with arthritis have multiple symptoms like pain, stiffness, swelling, redness and other general symptoms like feeling tired, unwell and fatigued.
How can you diagnose arthritis?
Not all joint or muscle pain is due to arthritis. It could be due to injury. You should consult a rheumatologist if the joint pain fails to settle in a few days or is associated with swelling, warmth and redness of the joints. The rheumatologist will ask you questions regarding your symptoms, examine your joints and may order investigations such as x-rays to make a diagnosis.
What are the treatment options for arthritis?
The “window of opportunity” in the treatment of arthritis is in the early stages. Hence, it is important to diagnose and treat arthritis early before the joint is permanently damaged. Research and new drug development have made the treatment options for arthritis broader. In this modern era of health care, treatment options for arthritis are available but need to be tailored to the individual needs. Your symptoms can be effectively controlled in most instances with medications or if needed, a joint injection. It is important you discuss with your rheumatologist about the various options available for treatment.
Are there any lifestyle measures I can take for my arthritis?
Regular exercise and maintaining an ideal body weight are simple measures to improve your joint health along with the medications prescribed.
Magnesium Rich Food Sources
Certain foods that provide a part of recommended Magnesium:
- Whole grain breads
- Soy milk
- Black beans
- Dark green vegetables
- Fresh plantain
- Pumpkin and its seeds
- Raw broccoli
Huge Health Benefits From Eating Magnesium Foods:
Magnesium is a vital mineral that is extremely essential to a vast assortment of body functions. In fact, more than three hundred reactions that occur in your body need Magnesium as part of the course.
- Role of Magnesium as an anti-anxiety mineral:
This miracle mineral is regarded as an anti-anxiety agent and is employed in times of stress which bring on decreased levels of magnesium. Reduced levels of magnesium are involved in intensifying anxiety. This can consequently become a malicious succession i.e. whenever you are under any sort of strain; your levels of Magnesium dwindle; this further aggravates anxiety; the latter in turn serves to lessen the level of Magnesium in the body.
- The responsibility of Magnesium in dealing with bronchial asthma:
One approach that can be used to aid in the regulation of bronchial asthma is by including more magnesium to your meals. Magnesium perks up the task of the lungs and can be taken as an additional. If you uphold adequate levels of magnesium in your body, it assists in comforting smooth muscles of the airway and expands and loosens up bronchioles in the lungs. It also diminishes the discharge of histamine as well as swelling of the airways and lungs by steadying mast cells and T- lymphocytes. Research investigations reveal that enhancing the ingestion of magnesium assists in lessening and putting a stop to the symptoms of allergy and asthma.
- The function of Magnesium in lowering your blood pressure:
A significant function of Magnesium is its potential to standardize the level of potassium and calcium in the cells of the body. It also assists in organizing sodium which is the bonafide offender in hypertension. Excessive sodium in the cells has a propensity to cause an elated reading of blood pressure. Additionally, it assists in lowering the levels of bad cholesterol in the blood and endorses healthful heart. Magnesium assists in lessening your blood pressure by expanding the arteries. Magnesium also makes an effort towards calming down asymmetrical heartbeats. It performs the job of decreasing the hazard of heart attacks and strokes. In case of somebody having sustained a heart attack or stroke, Magnesium should be used to curtail the improvement time of the patient.
- The task of Magnesium in treating sleeplessness:
Magnesium has been utilized for the purpose of enabling you to get a calming sleep at night. It has been said that a deficiency in certain types of magnesium can cause migraines. A form of sleeplessness known as Restless leg syndrome (identified by an awe-inspiring impulse to shift and shove the legs during rest, particularly during sleep) has been linked with the deficiency of Magnesium. Rundown levels of Magnesium in your body can cause insomnia as well as over -shortening and spasms (painful and involuntary muscle contraction) of muscles during sleep. The reason being that, the nervous system needs Magnesium, and without it, the nerves do not perform adequately and become amply impulsive.
- Role of Magnesium in the prevention of type 2 diabetes:
According to various research investigations, a suitable amount of dietary magnesium can put stop to Type 2 diabetes. The deficiency of Magnesium in your systems influences the amount of insulin that the pancreas can ooze and augment insulin resistance in the tissues. It has been revealed that people with diabetes tend to have minimal levels of Magnesium, on account of the fact that when the glucose levels in the blood get elevated, the kidneys mislay their capacity to keep hold of Magnesium, which thus departs with urine. Moreover, Magnesium is very vital for making insulin which assists the body to come to blows with high blood glucose levels.
It is very vital to have plenty of Magnesium in your system for optimum functioning of bodily processes critical for maintaining great health.
India became liberal. India is one of the fastest growing alcohol markets in the world
In 2014, the World Health Organization or the WHO released its Global Status report on Alcohol and Health. The data was compiled taking into account individuals over the age of 15 and above, who consumed alcohol.
According to the report, around 30% of the total population of India consumed alcohol regularly in the year 2010.
According to an Organization for Economic Cooperation and Development (OECD) report released in May 2015, alcoholism consumption in India increased by about 55 percent between 1992 and 2012.
More worryingly, the young are getting initiated to alcohol much earlier, while more women are indulging in hazardous and binge drinking
The percentage of under-15 boys who have not had alcohol has gone down from 44 percent to 30 percent and for girls, it has decreased from 50 percent to 31 percent, reveals another study done by the Organisation for Economic Cooperation and Development (OECD
Another worrying trend from India is that the average age of initiation of alcohol use has reduced from 28 years during the 1980s to 17 years in 2007. Alarmingly, another study recently found that the “average age of initiation” had dropped down to 13 years.
Based on the beer sales (more popular in male and female young people) in AP and Telangana there is a rise of above 50% from 2012-2018. Just in last 1 year, there was about 30% increase in beer consumption in Telugu states.
“Major crimes and accidents are fuelled by alcohol, which also leads to sexual harassment of women and robberies”, S Raju, of Tamil Nadu’s Makkal Adhikaram (People’s Power) told the BBC.
“Alcohol abuse is also the reason why Tamil Nadu has the largest number of widows under 30 years of age”, he added.
A quarter of all hospital admissions and 69 percent of all crimes in Kerala is due in part to intoxication, according to the Alcohol and Drug Information Centre, an NGO, quoted in The Economist.
Alcohol consumption causes significant health, legal, and socio-economic damage
Alcohol consumption causes diseases of nervous system, heart, liver, pancreas, gastrointestinal system, cancer and contributes to over 200 diseases and injury-related health conditions including dependence and addiction, and unintentional injuries such as motor vehicle accidents, falls, burns, assaults, and drowning.
Overall there is a serious growth in Liver Diseases day by day. Due to lack of awareness people are at risk of acquiring serious medical disorders.
Dr. K S Soma Sekhar Rao,
MBBS, MD (Gen Med), DM ( Gastro)
Consultant Medical Gastroenterology & Hepatology, Apollo Hospital, Jubilee Hills Hyderabad
Summer brings in the tastiest, beautiful fruit ever…’The Mangoes’. There is no one who denies eating Mangoes. As each fruit has its own benefits, Mangoes also are beneficial to our health. They are built with many vitamins & minerals. They boost our energy levels immediately.
Health Benefits Of Mango
1. Prevents Cancer
2. Lowers Cholesterol
3. Clears the Skin
4. Eye Health
5. Alkalizes the Whole Body
6. Helps in Diabetes
7. Improves Digestion
8. A remedy for Heat Stroke
9. Boosts Immune system
10. Improves Brainpower
World sleep day
World sleep a day- 2017 -march 17th 2017- is being organised across the world with the slogan, “sleep soundly & nurture life”Sleep-disordered respiration – a potentially dangerous medical disorder “sleep soundly to nurture your precious life”
World sleep a day- 2017 -march 17th 2017- is being organised across the world with the slogan, “sleep soundly & nurture life”Sleep-disordered respiration – a potentially dangerous medical disorder “sleep soundly to nurture your precious life”
The term ‘sleep-disordered breathing’(SDB) encompasses a range of conditions characterised by abnormal breathing during sleep; in many cases, this is associated with narrowing or obstruction of the upper airway (pharynx). The disordered breathing ranges from intermittent, partial obstruction of the airway without sleep disturbance (snoring) to, at the other end of the spectrum, frequent apnoeas associated with repetitive hypoxaemia (decrease in oxygen content of blood) and arousals leading to sleep disruption. This frequent sleep disruption is called Sleep Fragmentation, which leads to a non-restorative sleep & hence daytime sleepiness. The sleep disruption results in daytime sleepiness and, in the long term, it can lead to cognitive impairment and cardiovascular morbidity. The prevalence of OSAS is higher in certain groups, particularly in the obese, diabetics, hypertensives requiring many drugs to control blood pressure or difficult to control blood pressure, heart disease, kidney patients & those receiving treatment for epilepsy & psychiatric conditions. The term ‘obstructive sleep apnoea’ (OSA) refers to intermittent obstruction of the airway, irrespective of the presence of daytime symptoms. If symptoms result, the condition is called obstructive sleep apnoea syndrome (OSAS).
WHY & HOW of Sleep Disordered Breathing: Any change that narrows the upper airway when awake will predispose the individual to obstructive apnoea or hypopnoea when asleep. Obesity is the single most common predisposing factor, but patients with OSAS may have other contributory factors that narrow the upper airway, such as a large tongue, enlarged tonsils, the increased total soft tissue in the pharynx or a retroposition mandible (receding jaw).
OSAS is characterised by episodes of upper airway occlusion: these are termed apnoeas if the airway is completely occluded and hypopnoeas if the occlusion is partial. An obstructive apnoea is defined pragmatically as the cessation of airflow despite continued breathing efforts for at least 10 s. At their termination, apnoeas/hypopnoeas are often, but not always, associated with a change in the electroencephalographic (EEG) signal indicative of arousal and with a drop in blood oxygen saturation. In most instances, such brief arousals are not accompanied by complete awakening and the patient is usually unaware of them.
OSAS is more common in men than women and is attributed to differences in anatomical and functional properties of the upper airway, differences in craniofacial morphology and fat deposition, and different ventilatory responses to arousal from sleep. The disease prevalence is higher in postmenopausal women and hormone replacement therapy is associated with a lower prevalence; the prevalence of OSAS increases during pregnancy, particularly in the third trimester.
Congenital conditions affecting craniofacial development, such as Marfan syndrome, Down syndrome and the Pierre Robin sequence, predispose to OSAS, as do acromegaly and hypothyroidism.
Smoking is associated with a higher prevalence of snoring and OSAS, and alcohol can increase upper airway collapsibility leading to apnoeas.
Muscle-relaxant medication (sedative-hypnotic drugs, opiates), sleep deprivation and supine posture can all exacerbate OSAS, although the degree to which sleep-disordered breathing is worsened in the individual may depend on the predominant pathological mechanism in the individual patient and his or her intrinsic physiological responses.
Reduced nasal patency, due to congestion or anatomical defects, as well as respiratory allergy are also potential contributors.
CLINICAL MANIFESTATIONS :
The most common complaint is excessive daytime sleepiness (EDS). However, the absence of EDS doesn’t rule out OSAS. However, other causes of diurnal sleepiness, such as shift work, medication (sedatives) and alternative diagnoses – like periodic limb movement disorder and narcolepsy have to be ruled out by clinicians before labelling as OSAS. Nocturnal symptoms of OSAS are generally reported by a bed partner. The most common are snoring (which is almost always a feature), snorting, choking attacks terminating a snore, and witnessed apnoeas. Apnoeic episodes are reported by about 75% of bed partners.
How to arrive at a diagnosis ?
Polysomnography(PSG), which simultaneously monitors, nasal and/or oral airflow, thoracoabdominal movement, snoring, electroencephalogram (EEG), electrooculogram (EOG), electromyogram (EMG) & oxygen saturation is the gold standard in diagnosis. In some complex sleep disorder evaluation, we will recommend Video monitoring of sleep in addition to PSG called Video-PSG.
Simpler diagnostic investigations are increasingly being used and these often take place in the patient’s home rather than in the hospital, called as home sleep testing (HST). All home testings are of a not uniform standard. At least Level 2 testing is recommended.
OSAS is an independent risk factor for hypertension and is associated with an increased risk of cardiovascular disease, abnormal glucose metabolism, depression and sleepiness-related accidents. OSAS results in higher medical costs than those incurred by age-and sex-matched healthy individuals. Even a single road accident due to sleepiness caused by OSAS can incur considerable health costs & the risk of having an accident is 4 fold more than a normal population.
Once OSAS is diagnosed, its treatment is relatively straightforward.
- Lifestyle measures, such as weight loss, alcohol consumption and smoking are the more important ones to address. Pranayam, Practicing YOGA & some exercises of tongue muscles& neck muscles can play an important role in the prevention of upper airway collapse.
- Continuous positive airway pressure (CPAP) is the commonest and most rapidly effective treatment for moderate-to-severe OSAS. This is usually delivered through the upper airway using a mask over the nose, attached by a hose to an air compressor that generates a flow of air at positive pressure throughout the breathing cycle, of sufficient magnitude to keep the upper airway open and prevent it from collapsing. CPAP thereby acts as a pneumatic splint for the upper airway. Unfortunately, CPAP does not permanently restore or correct the problems leading to upper airway obstruction; it, therefore, needs to be applied throughout each night for maximum effect. If well tolerated and used consistently, CPAP has been shown to reverse or ameliorate the somnolence, cognitive deficit, reduced health status, hypertension and metabolic disturbances associated with OSAS.
- In snoring or mild OSAS, an alternative therapy like the mandibular repositioning device, constructed by a trained professional can be used.
- Surgeries like a tonsillectomy, adenoidectomy, upper airway surgery and bariatric surgery are recommended in special cases only.
- Hypoglossal nerve pacing is increasingly being trialled in patients with OSAS who fail to respond to more conventional modes of therapy. This modality is yet to get USFDA approval for clinical application.
- No effective pharmacological therapies are currently available.PROGNOSIS:
The prognosis for OSAS is very good and reverts to that of the non-OSAS population, particularly in terms of cardiovascular mortality and morbidity. Adherence to the recommended modality of treatment (especially CPAP) is very crucial for the overall favourable outcome.
On the occasion of World Sleep Day on March 17, Apollo Hospitals announces the creation of a comprehensive sleep management system for outpatients and inpatients. The value of sleep is only known to those who do not get enough of it or have poor quality sleep. This can be life threatening with significant increase in diabetes, hypertension, heart disease, obesity, accidents and poor general well being. Our multidisciplinary team has the expertise of world-class neurology, pulmonology and psychiatry with the excellent surgical skills of our ENT. This exceptional team is backed by the latest in sleep lab technology and the best testing equipment. We have the latest devices with CPAP, BiPAP, auto modes; oxygen support and partnership with various equipment vendors to become a one-stop center for sleep care. Parasomnias, narcolepsy, restless leg syndromes and complex central and mixed sleep apnea can be efficiently managed at our center. We are initiating a weekly multidisciplinary clinic where patients with complex sleep disorders will be reviewed by the entire team and a plan for further care developed. Remote monitoring of the care of outstation patients is also planned to enhance the level of support for our numerous patients who come from all over the world.
Sleep well and stay healthy! This year the theme of World Sleep Day is
‘Sleep soundly, nurture life’.
Some facts about sleep. See the World Sleep Day website for more information.
A third of our lives is spent sleeping and it is a basic human need, and critical to health and well being. Sleep, like exercise and nutrition, is essential for metabolic regulation in children. There is evidence for a link between sleep duration and childhood obesity. The findings are more apparent in girls. Sleep duration is the effect of day-to-day variability of sleep-wake timing.
Breathing regularly during sleep is vital and continuous interruption of breathing during sleep is called sleep apnea. This is a common disorder that affects 4% of men and 2% of women.
Obstructive sleep apnea (OSA) significantly impacts health and well-being. The drop in oxygen that occurs when breathing stops due to OSA puts a strain on the heart and can lead to a number of serious health conditions.
Each breathing pause can last from 10 seconds to more than a minute and is accompanied by a drop in oxygen associated with each event. The events may occur 5 to 50 times or more each hour. This puts a strain on the heart and can lead to a number of serious health conditions.
71,000 people suffer injuries every year due to sleep-related accidents.
In northern India, the prevalence of obstructive sleep apnea syndrome is 13.7%.
Sleep apnea is diagnosed with polysomnography in the sleep laboratory. Treatment with non-invasive positive airway (continuous positive airway pressure, or CPAP) ventilation is generally successful.
Surgery to remove excessive tissues in the oropharynx may be considered for individuals who cannot tolerate non-invasive equipment or who have obvious obstruction to airflow in the oropharynx by redundant tissue growth or large tonsils. There is proof that successful correction of sleep apnea with non-invasive positive airway pressure ventilation lowers mean blood pressure and may reduce the risk of myocardial infarction and stroke.
There is an Indian Sleep Disorders Association (http://www.isda.co.in/), which also publishes a journal along with several international resources from the CDC (https://www.cdc.gov/sleep/index.html) and the WHO (http://www.who.int/respiratory/other/Obstructive_sleep_apnoea_syndrome/en/).
Apollo Hospitals also has several web based resources including sites such as http://www.apollolife.com/HealthyLiving/Sleep/SnoringandSleepApnoea.aspx
Team Members with combined expertise of over 20 years of training and practice!
Sleep Lab: Mr. Mallikarjun
ENT: Dr Ram Babu, Dr EC Vinaya Kumar, Dr Jaswinder Saluja
Neurology: Dr Sudhir Kumar, Dr C Rajesh Reddy, Dr Sandeep Nayani, Dr Subhashini Prabhakar
Pulmonology: Dr Sai Praveen Haranath, Dr Vijay Kumar Chennamchetty, Dr R Vijaikumar