As part of Microsoft’s AI Network for Healthcare initiative, Microsoft India and Apollo Hospitals Group have set up a National Clinical Coordination Committee (NCCC) for the AI-powered Cardiovascular Disease Risk Score API (application program interface). The committee consists of leading doctors from Apollo Hospitals; All India Institute of Medical Sciences, New Delhi; and King George’s Medical University, Lucknow. Cardiovascular diseases (CVDs) are the biggest cause of mortality in India with nearly 25 percent of mortalities – amongst the age group of 25 to 69 years. The condition also seems to affect Indians at least a decade earlier as compared to Europeans. Given the high prevalence of CVDs affecting Indians, Apollo Hospitals and Microsoft India, in 2018, launched the first ever AI-powered CVD Risk Score API, designed specifically to predict the risk of Cardiovascular Disease (CVD) in the Indian population. Till date, over 200,000 people have already been screened using the AI-powered API across Apollo Hospitals and in many cases, physicians have been able to predict the risk score of patients 5 to 7 years in advance. Built on Microsoft Azure, the API aims to determine a more accurate CVD risk score for the Indian population taking into consideration risk factors including lifestyle attributes like diet, tobacco & smoking preferences, physical activity and psychological stress & anxiety. Speaking about the National Clinical Coordination Committee, Ms. Sangita Reddy, Joint Managing Director, Apollo Hospitals Group, said, “We have brought some of the best cardiologists from renowned hospitals like AIIMS and KGMU together to be a part of this committee. The NCCC will help us immensely in our fight against the rising tsunami of Non-Communicable Diseases (NCDs). We are also extending the scope of our partnership with Microsoft to meet the growing healthcare demands of people across the country and contribute more towards saving precious lives.” The NCCC will be assisting the core team at Apollo Hospitals and Microsoft by providing guidance on all cardiology and cardiovascular related AI projects; clinical insights on developing clinical algorithm and treatment guidelines based on the inferences of national, multi centre prospective study. “The NCCC is a great step forward as part of our partnership with Apollo. We are also engaging global consortium partners to scale the AI-powered API. We have already received approval for a pilot study and we hope that the findings will enable physicians to better understand the causes of CVDs in Indian population,” said Anil Bhansali, Corporate Vice President, Cloud & Enterprise, Microsoft. Apollo Hospitals and Microsoft India are already in discussions with renowned health systems across the world to scale the API and contribute towards World Health Organization’s goal of reducing the risk of premature mortality (30 to 69 years of age) from NCDs, including CVDs, by 25% by 2025.11 https://www.who.int/nmh/events/ncd_action_plan/en/

  Doctors at Indraprastha Apollo Hospitals saved the life of a three-week-old baby girl Inaya from a rare heart condition known as Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA). A resident of Bulandshahr, Inaya presented with complaints of respiratory distress with excessive sweating and fast breathing with difficulty. When her parents brought her to the emergency department of Apollo Hospitals, New Delhi the child suffered from a heart attack, which means, her heart stopped beating. Read more about the complicated case of ALCAPA and how our doctors brought her back to good health

Things were not going too well with the health of the 59-year-old Mr. Devaraj who visited Dr. Rajkumar P. Wadhwa – Chief Gastroenterologist & Head of Department of Gastro Sciences, Apollo BGS Hospitals, Mysore on 13th April 2019. He was diagnosed with severe jaundice and fever, further evaluation revealed a large stone that was blocking the bile duct which was life threatening. This stone could not be operated upon. “This large stone was formed over the last 4 years where initially he was diagnosed with Liver Cirrhosis. He had excessive bleeding while he underwent a surgery at a different hospital and for the same he was infused with 12 units of blood. After the surgery the flow from the bile duct to his intestine was blocked and it was managed with a stent with a plastic tube inside for several years. 4 years later in the year 2015, the stent was removed following which he was brought to Apollo BGS Hospitals, Mysore a month back in a very critical state with a large stone in his bile duct” said Dr. Rajkumar P. Wadhwa. The stone was big and it could not have been brought out in a normal way as there was narrowing of the tube and surgical intervention would have led to patient’s death due to excess bleeding similar to his earlier attempt of a surgery which almost risked his life. At Apollo BGS Hospitals, Mysore, with the latest technology and the experienced skills of the consultant, an equipment called Spy Cholangioscopy with Electrohydraulic Lithotripsy was used. This scope was inserted through the bile duct inside the liver to blast the large stone into small pieces. These small pieces were brought out completely and Mr. Devaraj is absolutely leading a normal life now. “State of the art technology, Apollo Doctors skills and the quality of the procedure provided by the department of Gastro Sciences lead by Dr. Rajkumar P. Wadhwa has given a new life to Mr. Devaraj through this minimally invasive gastro procedure. Mr. Devraj would have developed serious infections, sepsis & other complications if this minimally invasive procedure was not performed. Apollo BGS Hospitals, Mysore specializes in all kinds of Minimally Invasive Gastro procedures including complex surgeries using endoscopy. This life-saving procedure is the first of its kind in the whole state of Karnataka. People travel from all over Karnataka including Bangalore to get this procedure done at Mysore. Mysoreans need not go outside the city to get this minimally invasive procedure done” says, Mr. N. G. Bharateesha Reddy, Vice President & Unit Head, Apollo BGS Hospitals, Mysore  

Samsung India Electronics and Apollo Hospitals Group has launched the ‘Samsung-Apollo Mobile Clinic’ to provide access to quality, preventive healthcare against growing non-communicable diseases (NCDs) to the less privileged. With this program, the two organisations aim to leverage technology to ensure citizens in rural areas in need of healthcare have access to it. The Samsung-Apollo Mobile Clinic was inaugurated by Hon’ble Governor of Tamil Nadu, Shri. Banwarilal Purohit in the presence of Dr. Prathap C Reddy, Chairman of Apollo Hospitals Group, Ms Sangita Reddy, Joint Managing Director, Apollo Hospitals and Mr. Jae Young Yang, Managing Director, Samsung Manufacturing Plant, Chennai. Samsung-Apollo Mobile Clinic is well equipped with high-end technology for advanced screening of NCDs. Read more about Samsung-Apollo Mobile Clinic

A 2-day-old male baby, suffering from a rare bleeding disorder, was saved by the Peadiatric and Neonatology team at Apollomedics Supper Speciality Hospitals, Lucknow. Dr Mritunjai Kumar, Paediatrician along with Dr. Shefalika, Dr. Shivani, Dr. Indrapal and Dr. Sidharth conducted the treatment of this rare disease called Christmas disease at Apollomedics Hospitals Lucknow. Founder and Co-Chairman of Apollomedics Super Speciality Hospital Dr. Sushil Gattani said that “the baby was rushed at 40 hours of life in a gasping state. After initial resuscitation baby was referred to Apollomedics Supper Specialty Hospitals where we immediately intubated the baby. Baby was extremely pale and was in severe shock. We immediately put him on mechanical ventilator, the baby was persistently bleeding and we had to use highest permissive pressures on ventilator. Even after using a very high pressure, it was really tough for us to maintain SPO2 >50% because of massive lung haemorrhage.” Dr Mritunjai Kumar, Paediatrician, Apollomedics Super Speciality Hospital further said that “after 3 days, baby became slightly better hemodynamically and ventilator support was reduced a little. But the same day, we experienced an unpredictable scare as the baby developed a second episode of massive pulmonary hemorrhage. Gross haematuria persisted and gradually urine output started falling. After 2 days of dialysis, baby started passing urine again and KFT and electrolytes improved. Coagulation profile was deranged severely and we could achieve bleeding control only by the 7th day of admission. We had a very tough time maintaining nutrition for the baby and maintaining RBS as we were left with hardly any space for fluids because of too many blood product transfusions. Initially baby was managed by total parenteral nutrition and now has been put on breast feeds.” Dr Mritunjai, giving further information about the disease ,mentioned that Haemophilia B is 4 times less common than Haemophilia A, making it a 1 in 20000 incidence. The condition is caused by defects in the genes responsible for the production of proteins important in the blood clotting mechanism. In haemophilia A, which represents 80-85% of cases, defects occur in the gene responsible for the production of a protein called factor VIII (FVIII), whereas the defect in haemophilia B affects factor IX (FIX) production, though the two conditions are clinically indistinguishable. If a female (karyotype XX) inherits an abnormal copy of the haemophilia gene from one parent, she becomes a carrier but is not clinically affected because she has a second normal copy of the gene on her other X chromosome. However, a male (karyotype XY) inheriting an abnormal copy will always be affected as he only has one X chromosome. Although haemophilia can be inherited, it is important to remember that around a third of cases occur due to a sporadic mutation of the gene, meaning there will be no family history of the condition. In haemophilia, the APTT is prolonged but PT, fibrinogen and platelets are normal. Diagnosis is confirmed by FVIII and FIX assays. In haemophilia A, the diagnosis can be made at birth because factor VIII levels are within the adult range in both term and preterm babies. In the case of haemophilia B, diagnosis of severe cases is possible, but factor IX levels in mild cases overlap with the normal newborn range, so definitive diagnosis may not be possible until around six months of age. Apollomedics Super Speciality Hospital was successful in treating this rare disease and gave a new lease of life to the baby.

TAVR or Trans Catheter Aortic Valve Replacement, a percutaneous procedure, was successfully performed at Apollo Hospitals, Visakhapatnam on a 69-year-old man; where open heart valve replacement surgery was contraindicated due to co-existing health issues including past history of cardiac bypass surgery. Our patient, a 69-year-old male presented with shortness of breath mostly increasing after dinner forcing him to sit. He was hypertensive, hyperlipidaemic, and had previously undergone bypass surgery in 2000 with two arterial grafts LIMA and RIMA, two venous grafts to D1 and OM. He had also undergone angioplasty to vein graft to D1 in 2011 and vein graft to OM in 2016. Echocardiography showed a gradient of 65 mmHg across aortic valve suggesting severe aortic stenosis and EF of 49% suggesting LV dysfunction. His surgical STS score was 5.8%. AVR surgery was considered very high risk in view of REDO open heart surgery. TAVR was done successfully on 30th May, 2019. A 23 mm valve was delivered through 14 Fr expandable python sheath. The wound in the thigh was closed non-surgically by ProGlide device. He was discharged on day five. His gradient across aortic valve was 11 -17mmHg without aortic regurgitation at the end of one-month post discharge. TAVR is performed in a highly specialised tertiary care centre. The centre should have sophisticated Cath Lab with Cardiothoracic OT back up and surgeons to deal with complications that may arise during the procedure. The centre also should have attached 24×7 Critical Care and a Blood Bank if the need for transfusion may arise. The whole procedure is to be done under in an aseptic condition and to achieve such type of environment; the infection control team should have robust protocols and implement them. Here at Apollo Hospitals, Health City, Visakhapatnam; we not only have the skilled human resources in Cath Lab to handle such a highly technical procedure but also infrastructure and aseptic environment, where procedure can be done successfully with best outcomes. Dr. Nanda Kishore Panigrahi, Senior Interventional Cardiologist, Apollo Hospitals, Visakhapatnam explained, “In TAVR, a miniaturized valve is inserted through a catheter, a thin flexible tube, from the groin into the heart. The deployed valve reaches the base of the aorta at the site of the previous aortic valve. The doctor then opens a balloon which inflates the valve, pushing aside the old valve and overcoming the stenosis or narrowing. The entire procedure is conducted under general anaesthesia or mild sedation and takes about an hour as compared to 5-6 hours required for an open heart surgery.” TAVR is a game changer for patients with valve disease in India. While the expenses are more as compared to conventional open heart surgery, the benefits are incomparable. TAVR allows many patients with severe aortic valve stenosis who were previously classified as too high risk or inoperable, to be effectively treated, giving them a second opportunity at a healthy life. Interventional cardiology methods such as ‘TAVR’ have redefined the lives of people with an improved quality of life, even in people aged above 70 years or 80 years. Interventional methods can help many patients who are suffering from severe cardiac risks. The patient showed remarkable improvement. He started speaking normally right after 45 minutes of the procedure and has been discharged from the hospital, in a stable condition. Dr. Sami, Units Head, Apollo Hospitals, Visakhapatnam, said, ” We did our first balloon expandable TAVR in the city and we are glad to share that this valve system is totally designed and manufactured in India. The face of healthcare in the Visakhapatnam region is undergoing a sea change with advanced medical technology available to help address complex conditions in patients. From organ transplants including heart transplants, minimally invasive cardiac hybrid surgeries to interventional cardiology, the incomparable benefits of the latest advances will help patients who are inoperable or at high risk to be treated effectively and get a second opportunity for a healthy life.”

The Neurology department of Apollomedics Super Specialty Hospital, Lucknow saved the life of an aneurysm patient by performing a critical surgery. Dr Ravi Shankar, said that a 35-year-old Mr. Manoj Verma, a resident of Barabanki, was referred to the Apollomedics Hospital in a critical condition and was brought to the hospital in unconscious state. Dr. Ravi Shankar further added that in Brain Aneurysm, a balloon of blood had formed in the patient’s blood vessel. This was treated by Craniotomy and Clipping of Aneurysm in which the blood balloon in the vessel was closed by a clip. In this type of case, mortality rate is higher even after surgery. We found in reports that a balloon was formed in the dominant portion of the brain near two vessels which was arising from main blood vessel. The Aneurysm was attached to the vessels. In this condition, there was a possibility of blockage or damage of the vessels which could lead to inability to understand think & speak. Also, there is possibility of patient’s right side getting paralysed or even death. Therefore, firstly, we decided to contract the Aneurysm (balloon). During this 7 hours long operation, we stopped the patient’s heart beat for about 45 seconds, 4 times and took the patient into the state of temporary death (cardiac arrest). In this process, we had to work at a speed 100 times faster than normal surgical speed which requires special skills & training. Post-surgery, the patient recovered and started speaking immediately after the operation. Dr. Ravi Shankar said that the cause of the disease could have been due to hereditary reasons, excessive smoking and drinking. The symptoms of this disease could not be identified initially. In most of the cases, it is diagnosed after the explosion of aneurysm or balloon, which results to unconsciousness or coma. 50% of patients suffering from this, die before reaching the hospital. Dr. Sushil Gattani, Chairman of Apollomedics Super Specialty Hospital, gave credit of this successful surgery to the entire team and said that their first objective is to provide world-class medical facilities to every patient coming to Apollo Medics Super Specialty Hospital. This is the first time in Lucknow where such type of surgery has been successfully performed.

The team of doctors at Indraprastha Apollo Hospitals, Delhi successfully performed a dual lobe liver transplant on a patient from Yemen, in which parts of liver from two donors were grafted in to the recipient’s body. Mr. Al Naqeeb, a Yemeni national patient who was suffering from end-stage liver disease, was told by doctors that he needed a liver transplant. All three of his children offered to donate a part of their organ to save their father. However, as Mr. Naqeeb’s son was obese, he was ruled out as a potential donor. On the request of family, the doctors at Indraprastha Apollo Hospitals, Delhi started investigating Mr. Naqeeb’s daughters — Bahaja and Sarah, for organ donation. For liver transplants in cases of living donors, a patient’s diseased liver is replaced with a partial healthy liver from another person. In a typical adult recipient, 55% to 70% of the liver (the right lobe) is removed from a healthy living donor. The donor’s liver regenerates approaching 100% function within four to six weeks. However, in this case, investigation reports revealed that both daughters, who are in their 20s, had less than the required volume of liver. Hence, the doctors could not perform the transplant with either girl as donor. Since there were no other donors, the daughters insisted that doctors explore if they could both donate parts of their liver, which could be used together for the transplant. “Dual lobe liver transplant is possible, but it is more complex. Because we didn’t have any other option to save the patient’s life, we give it a chance and succeeded,” said Dr Goyal, Senior Consultant , Liver Transplant at the hospital. He explained that they took out the right lobe of Bahaja’s liver, weighing 400 grams, and the left lobe of Sarah’s liver that weighed 240 grams, and implanted both in the recipient. “There was a lot of pressure on our team as two donors were involved in the process. The patient’s transplant was already a high-risk one due to his multiple problems. But we succeeded in giving the patient a new lease of life,” Dr Goyal said. The life-saving transplant was performed on May 23rd 2019. Both the donors – Bahaja and Sarah are normal and healthy. The recipient, Mr. Al Naqeeb, was discharged with a healthy liver. Dual lobe liver transplants are rare because they are complex. In a single donor transplant, the venous channel in only side of the liver has to be connected in the recipient. But in a dual lobe transplant, venous channels of both the right lobe and the left lobe have to be joined, the doctor explained.

Nirali Memorial Medical Trust (NMMT), established by Mr. A. M. Naik, Group Chairman, Larsen and Toubro, will set up a multispeciality hospital at Navsari in Gujarat. The multispeciality hospital will be operated and managed by Apollo Hospitals Group. The agreement to this effect was signed by Mr. Naik and Dr Prathap C Reddy, Chairman, Apollo Hospitals Group. Named in the memory of Nirali, granddaughter of Mr. Naik who passed away due to cancer at the age of two. NMMT was set up by Mr. Naik and family to help needy patients without access to quality medical treatment. NMMT, a public charitable trust founded by Mr. Naik to carry out philanthropic activities in medical care, possesses the land parcel for this multispeciality hospitals. NMMT will build the infrastructure, install the medical equipment and appoint qualified doctors and paramedical staff to run the hospital. Apollo Hospitals Group will offer their medical expertise and facilitate operations and maintenance of the hospital. On the occasion, Mr. A. M. Naik said, “We owe a lot to the society we live in and are indebted to give it back to the people. It is endeavour of Nirali Memorial Medical Trust to provide best-in-class secondary and tertiary medical care facilities to rural and underprivileged social groups. The setting up of multispeciality hospital is a momentous step in the direction of extending affordable healthcare to all. We are delighted to have reputed healthcare group Apollo Hospitals joining this mission at Navsari in South Gujarat.” Dr Reddy said, “Since our inception thirty-five years ago, the resolute mission of Apollo Hospitals has been to make an international standard of healthcare accessible to every individual. Since then, every endeavour that we have undertaken has been a focussed step towards fulfilling our mission. Apollo Hospitals is honoured to support Mr. Naik’s noble efforts in setting up a multispeciality hospital in Navsari, which will offer succour to the people in the region by facilitating early detection of disease and timely intervention, thereby saving precious lives.” NMMT has developed ‘A. M. Naik Healthcare Complex’ at Sisodra (Ganesh) in Navsari. The complex spread over 9 acres houses an under-construction Cancer Hospital, will have a Multispeciality hospital and other medical care facilities. The under-construction cancer hospital at the complex will be operated and managed by Tata Trust. Mr. Naik has been instrumental in getting the best-in-class health facilities in the rural hinterlands of South Gujarat. NMMT runs the ‘Nirali Memorial Radiation Centre in Surat, Multidisciplinary hospital at Powai and provides modern medical facilities at a hospital in Kharel in South Gujarat. Along with NMMT, Mr. Naik has also founded the Naik Charitable Trust (NCT), which is focused on providing quality education and vocational training to the underprivileged sections of the society. Mr. A. M. Naik is a recipient of Padma Vibhushan and is also Chairman of National Skill Development Corporation.

In an extremely rare case of Budd Chiari Syndrome with Biliary Atresia, doctors at Indraprastha Apollo Hospitals, Delhi saved the life of a 5-month-old baby girl Surampudi Sehitha from Kakinada, Andhra Pradesh. The baby developed jaundice when she was just one month old. Her condition worsened as her abdomen started distending due to progressive swelling. Dr Anupam Sibal, Group Medical Director and Senior Pediatric Gastroenterologist and Hepatologist, Apollo Hospitals Group said, “In Biliary Atresia, which is seen 1 in 12000 babies there is no connection between the liver and the intestine. The first step in treatment is to create a connection between the liver and the intestine. This was attempted at the local hospital initially to treat the baby’s condition but as Baby Surampudi’s liver was already severely shrunken (due to cirrhosis), the procedure was abandoned. She was further referred to Apollo Hospitals, Delhi for a liver transplant.” “She weighed 5.5 kg when she first came to our hospital, including abdominal fluid of about 1 litre. So effectively, her weight was 4.5 kg. CT Angiography showed that she was suffering from occluded hepatic venous channels which drain the liver. The diagnosis of Budd Chiari Syndrome was made. It is a very rare disease which afflicts 1 in 2 million children. Budd Chiari Syndrome had resulted in rapid worsening of the baby’s condition which necessitated an urgent liver transplant. While Biliary Atresia is the most common condition for which liver transplantation in children are performed, Budd Chiari syndrome is extremely rare. Of the 320 liver transplants that we have performed in children, more than 140 have been for children with Biliary Atresia. The combination of Budd Chiari syndrome with Biliary Atresia in a baby is the rarest of rare case” Dr Sibal added. Baby Surampudi underwent a living donor liver transplant on 25th March, 2019 with her mother being her donor. Dr Neerav Goyal, Senior Consultant liver transplant and Hepatobiliary and Pancreatic surgeon, Apollo Hospitals Group, explained, “A combination of Budd Chiari and Biliary Atresia made the liver transplant very high risk. The blood vessels in a baby are very small (3-4 mm) and with Budd Chiari Syndrome the risk of clotting in the blood vessels is increased. We explained the procedure to the parents in detail and counselled them so that they make an informed decision. Initially, the father was worked up as the donor but his liver was found unsuitable for donation. The mother’s liver turned out to be compatible. After her surgery, Baby Surampada, recovered well and was discharged after three weeks. Today, she is on medications to prevent re-occlusion of her tiny vessels and to prevent rejection of the transplanted liver.” “As the family had limited resources, they received financial help from many benevolent people who came forward to contribute for her treatment through a crowd-funding platform” he added. The parents of the child said, “Having to watch our newly born in so much pain and is one of the toughest burdens that we had to bear as parents. However, doctors at Apollo Hospitals did not let our confidence shatter and worked dedicatedly to save the life of our baby girl. We are extremely thankful to the team of doctors at Apollo Hospitals as well as the people who came forward to help us out financially through this tough time. Our baby is alive and well, thanks to the kindness of many strangers.” The team included, Dr. Shishir Parikh, Liver Transplant and Pancreatic surgeon, Dr. V Arun Kumar, Liver Transplant and Pancreatic surgeon, Dr. Hitender Garg, Gastroenterologist and Hepatologist, Dr Namit Jerath, Pediatric Intensivist and Dr. Smita Malhotra, Pediatric Gastroenterologist and Hepatologist.

Apollo Hospitals introduces the first of its kind Digital PET CT – Biograph Vision 600™ scanning machine. The state-of-the-art scanning machine is a radioactive diagnostic agent used in positron emission tomography (PET) imaging. The inauguration was done in the presence of Dr. Prathap C Reddy, Founder and Chairman – Apollo Hospitals, Ms. Suneeta Reddy, Managing Director, Apollo Hospitals Group and Mr. Vivek Kanade, Executive Director, Siemens Healthineers India. Know more about Digital PET CT – Biograph Vision 600™

Apollo Proton Cancer Center, Chennai brings the best and latest medical technology in India, by successfully performing India’s first Total Marrow Irradiation (TMI) as a conditioning protocol prior to Bone Marrow Transplant on a 35-year-old female patient from Oman. Read more about India’s first Total Marrow Irradiation (TMI)