Best Neurosurgery Hospital in Tirupati

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Wakefulness testing

Mean Sleep Latency Test

Mean Sleep Latency Test is a daytime nap test, that can measure how sleepy you are. It will help your doctor diagnose disorders of daytime sleepiness such as narcolepsy and idiopathic hypersomnia. After a sleep study is performed the previous night, you will be given 5 opportunities to nap, while your brain waves are recorded to see if you fall asleep. The naps are 2 hours apart from each other, with the first nap starting 2 hours after you wake up. AMARA Sleep is one of the few centers in the country which has the capability of performing this test.

Cognitive-behavioral therapy

Cognitive-Behavioral Therapy for insomnia (CBT-I)

Insomnia or difficulty sleeping at night, has many possible causes. Treatment includes both medication and behavioral therapies. CBT-I is an effective therapy for insomnia, and should be tried first before medication treatment.

CBT-I is a structured program that helps you identify and replace thoughts and behaviors that cause and worsen sleep, with habits that promote sound sleep. Unlike sleeping pills, CBT-I will help you overcome the behavior causing poor sleep, allowing you to sleep peacefully again.

Dr. Ramadevi Gourineni and her team are specialized in CBT-I and will individualize a treatment plan that works for you.

Sleep Studies

Sleep Studies (hospital, home)

Amara Sleep testing

Polysomnogram (night time sleep study) can be performed in the hospital or at your home.

Home sleep study can be performed in the comfort of your own home.

Hospital-based sleep study monitors your sleep stages, respiration, oxygen level and other parameters while you sleep in the hospital overnight. It will help your doctor diagnose disorders such as sleep apnea, restless legs and night-time behaviors such as sleep-walking.

CPAP and Bi-level Therapy

CPAP/ Bi-level Therapy

Continuous positive airway pressure (CPAP) is the gold standard treatment for people with obstructive sleep apnea (OSA) (when a person stops breathing for 10 seconds or longer during sleep due to airway collapse). CPAP is a small square machine which generates positive air pressure that is delivered through a hose and mask, which patient wears on the face. This positive air pressure will prevent the airway from collapsing.

There are 2 types of CPAP machines: 1) auto-CPAP (machine determines and delivers the pressure you require) 2) manual CPAP (doctor sets the correct pressure). Your doctor will determine what type of machine is suitable for you.

People with heart and lung problems or hypoventilation (poor respiratory effort), may require Bi-level therapy. While CPAP delivers the same pressure when you breathe in and breathe out, during Bi-level therapy, you will receive a higher pressure while you breathe in. Bi-level machines can also help you take a deeper breath, reducing the work of breathing in people with poor respiratory effort (neuromuscular disorders, diaphragm paralysis, obesity-hypoventilation)

Amara Sleep is one of the few labs in India with the expertise to perform complex Bi-level titrations.

Sleep Clinic

Amara Sleep Clinic

Open Monday, Wednesday and Friday 9am to 12pm, and 3pm to 5pm
We are also available for Tele Consultation

We evaluate and manage patients with all categories of sleep problems including difficulty sleeping at night, daytime sleepiness, snoring, sleep apnea, restlessness and movements at night, as well as behaviors at night such as sleep-walking, night terrors and violent behavior at night.

Pulmonary rehabilitation

Pulmonary rehabilitation is a comprehensive program designed to improve the quality of life for individuals with chronic respiratory conditions like COPD, asthma, or pulmonary fibrosis. It typically includes:

Exercise Training: Tailored physical activities to enhance endurance and strength.
Education: Information on managing symptoms, medication use, and breathing techniques.
Nutrition Counseling: Guidance on diet to support overall health and lung function.
Behavioral Therapy: Support for coping with the psychological aspects of chronic lung disease.

Sexual Disorders Assessment & Treatment

Confidential assessment and evidence-based treatment for common sexual health concerns:

Erectile Dysfunction
Premature Ejaculation
Performance Anxiety

Pulmonary function testing

Pulmonary function testing (PFT) evaluates lung performance through several key tests:

Spirometry: Measures airflow and lung capacity. You breathe into a device to gauge how much and how quickly you can exhale.
Lung Volumes: Assesses total lung capacity and air trapping, often using a body plethysmograph or gas dilution techniques.
Diffusion Capacity (DLCO): Measures how well gases like oxygen pass from the lungs into the blood by inhaling a small amount of carbon monoxide.
Peak Expiratory Flow (PEF): Measures the maximum speed of exhalation using a peak flow meter, commonly used for asthma monitoring.
Bronchial Provocation Testing: Determines airway sensitivity by inhaling a substance that may induce constriction, followed by spirometry.

Emergency pulmonary services

Emergency pulmonary services provide urgent care for severe respiratory issues and crises. They focus on:

Acute Respiratory Distress: Immediate treatment for conditions like severe asthma attacks, COPD exacerbations, or pneumonia.
Advanced Monitoring: Rapid assessment of lung function and oxygen levels using tools like spirometry and blood gas analysis.
Interventions: Administration of medications (e.g., bronchodilators, corticosteroids), oxygen therapy, and mechanical ventilation if needed.
Stabilization and Transfer: Stabilizing the patient and arranging for further care or transfer to a specialized facility if necessary.

De-Addiction

Comprehensive, medically-supervised treatment for substance use disorders — including alcohol, smoking, opioids and other drugs.

Detailed addiction assessment
Medically supervised detoxification
Relapse-prevention & craving management
Counselling & long-term recovery support

Pulmonary medicine clinic

A pulmonary medicine clinic focuses on diagnosing, treating, and managing diseases and conditions of the lungs and respiratory system. These clinics often deal with a range of issues, including:

Chronic Obstructive Pulmonary Disease (COPD): A group of diseases that cause airflow blockage and breathing-related problems.
Asthma: A condition where your airways become inflamed, narrow, and swell, making breathing difficult.
Pulmonary Fibrosis: A lung disease that occurs when lung tissue becomes damaged and scarred.
Sleep Apnea: A serious sleep disorder where breathing repeatedly stops and starts.
Lung Cancer: A type of cancer that begins in the lungs.
Interstitial Lung Disease: A group of disorders that cause progressive scarring of lung tissue.

These clinics typically offer services such as:

Pulmonary Function Tests: Tests to measure lung capacity and function.
Bronchoscopy: A procedure to view the airways and diagnose abnormalities.
Imaging Studies: X-rays or CT scans to view the lungs and surrounding structures.
Respiratory Therapy: Treatments to help improve breathing, including inhalers and nebulizers.
Sleep Studies: Tests to diagnose sleep disorders.

Child & Adolescent Psychiatric Clinic

Specialised psychiatric care for children and adolescents, covering:

Intellectual Disability / Mental Retardation
Autism
ADHD
Separation Anxiety Disorder
School Refusal
Behavioural Disturbances

Fitness counselling

AMARA Fitness Evaluation (AFE) is designed to determine your physical fitness level. It measures 5 components: Body Composition, Cardiovascular Endurance, Muscle Strength, Flexibility and Balance. Results of this evaluation will help us understand your strengths and weaknesses so that we can help you set up a regular physical exercise routine.

AFE is meant for people who may anticipate difficulties in becoming more physically active.

Comprehensive Geriatric Assessment

What is geriatric assessment?

Frequently, older people have multiple doctors who each prescribe multiple medications for various medical problems. This often results in them being on a high number of medications. Medication interactions may also occur if the doctors do not communicate with each other. In addition, functional limitations with gait, balance and other problems may be missed, if not specifically checked for.

At Amara Hospital, geriatric assessment is a team-based assessment of an older person’s physical health, functional ability, cognitive function, mental health, and environment.

Pediatric Orthopedics

At Amara Hospital, our Pediatric Orthopedics team is dedicated to providing exceptional care for children with musculoskeletal conditions. Whether your child is dealing with congenital deformities, sports injuries, or growth-related issues, our specialized pediatric orthopedic surgeons and healthcare professionals are here to support your child’s health and well-being at every stage of development.

Our comprehensive pediatric orthopedics services include:

Diagnosis and Treatment of Bone and Joint Conditions: From fractures and sprains to more complex issues like scoliosis and hip disorders, our team uses the latest diagnostic tools and treatment methods to ensure accurate diagnoses and effective treatments.
Minimally Invasive Procedures: We focus on advanced, minimally invasive techniques that promote faster recovery times and reduced discomfort, ensuring your child can return to their normal activities as quickly as possible.
Rehabilitation and Physical Therapy: Our physical therapists work closely with each patient to design personalized rehabilitation plans that foster strength, mobility, and overall recovery.
Sports Medicine for Kids: We specialize in treating sports-related injuries in children and young athletes, offering tailored solutions to get them back on track safely and efficiently.

Our pediatric orthopedic experts understand the importance of compassionate care, and we strive to create a comfortable environment for both children and parents throughout the entire treatment process.

At Amara Hospital, your child’s health is our priority. We are committed to providing expert care that promotes growth, recovery, and a brighter future.

Nutritional counselling

Overview

Nutrition is an important part of a healthy lifestyle and is essential for good health. Without proper nutrition, your body is more vulnerable to illness and disease. An unhealthy diet is a major risk factor for chronic diseases like malnutrition, obesity, diabetes, cardiovascular disorders and cancer.

Smoking cessation

Why should I quit smoking?

The decision to quit smoking is the most important step you can take in improving your overall health. Smoking is associated with a large number of health problems.

Pediatric Sleep Care

At our Pediatric Sleep Center, we specialize in diagnosing and treating sleep disorders in children of all ages — from infants to teenagers. Healthy sleep is essential for your child’s growth, development, and overall well-being. Our team of pediatric sleep specialists works closely with families to identify and manage a wide range of sleep issues, including:

Sleep apnea
Insomnia
Night terrors and sleepwalking
Delayed sleep phase syndrome
Restless leg syndrome
Behavioral sleep challenges in children with special needs

We offer comprehensive sleep evaluations, overnight sleep studies (polysomnography), and customized treatment plans tailored to each child’s unique needs. Our child-friendly environment and compassionate team help ensure a comfortable and supportive experience for both children and their caregivers.

Let us help your child — and your family — get the restful, restorative sleep you all deserve.

Obesity Services

What is obesity?

Obesity means that you have too much body fat. This is measured using BMI (Body Mass Index). Calculate your BMI by entering your height and weight: https://www.calculator.net/bmi-calculator.html.

Childhood Obesity Services

Who needs assessment?

Any child who is overweight (BMI between 85% to 94.9%) or obese (BMI at or above 95%) will benefit from our Childhood Obesity Services. Also, if your family has a strong history of obesity and you want to prevent your child from becoming obese, these services will be useful.

An obese child should not be put on a diet, without proper medical guidance.

Pediatric Dental Check-ups

At our hospital, we understand that a healthy smile starts early. Our Pediatric Dental Check-ups are designed to ensure your child’s oral health is on the right track from the very beginning.

Our experienced pediatric dentists provide gentle, comprehensive care in a welcoming environment that helps children feel safe and at ease. Regular check-ups help us monitor the growth and development of your child’s teeth, identify potential issues early, and offer personalized guidance on brushing, flossing, and healthy eating habits.

We recommend that children have their first dental visit by their first birthday, followed by regular check-ups every six months. During these visits, we:

Examine teeth and gums
Check for cavities and early signs of dental problems
Provide professional cleaning
Offer fluoride treatments if needed
Educate parents and children on proper oral hygiene

Your child’s comfort and confidence are our top priorities. Let us help lay the foundation for a lifetime of healthy smiles.

Schedule your child’s dental check-up today!

Health packages

Invest in your health by making an appointment today

What is PHC?

Preventive Health Check-ups (PHC) will identify and minimize risk factors and detect illnesses at an early stage. This will allow us to initiate appropriate treatments and counsel you on proper lifestyle habits like diet, exercise, sleep and mental wellness. With early intervention, chronic illnesses can be prevented or treated before they start or get worse.

Pediatric Services

We offer excellent pediatric primary
(Well Baby and Well Child Health Checks) as well as child-focused inpatient and emergency care.

For children with chronic medical problems, we provide appropriate team-based care to improve their functional ability and quality of life. It will also reduce unnecessary emergency department visits and hospitalizations, thereby reducing stress to the family.

Well Child Health Checks

Most parents are good about taking children to the doctor when they are sick, but regular pediatrician visits are just as important for healthy children.

Comprehensive GI care

Amara hospital is fully equipped with advanced endoscopy system including ERCP, Endoscopic ultrasound & manometry. We are here to deliver the best quality of care for all kind of gastrointestinal diseases.

Inflammatory bowel disease care

Inflammatory bowel disease presents with pain abdomen or bloody stools or mucoid diarrhea. In chronic diarrhea patients who are getting treatment without proper evaluation, the diagnosis may be delayed. So thorough workup including colonoscopy is mandatory in detecting the disease at early stage. Patients need long course of treatment and follow up and Amara hospital is here to take care of these patients with utmost care.

Well Baby Health Checks

A new baby is a bundle of joy and fun. Yet understanding all of your responsibilities as a new parent can become overwhelming and stressful. Amara is here to support you through this process. Appropriately scheduled Well Baby Checks are important in monitoring your baby’s growth, development, eating and sleeping habits. They also ensure that your baby receives the necessary vaccination in time.

Let us be partners in ensuring your baby’s health.

Esophageal & Anorectal Manometry

Esophageal manometry is a test that shows how well the esophagus is working. It measures muscle contractions of the esophagus as water moves through to the stomach. This test can be helpful in diagnosing esophageal conditions, especially if you have trouble swallowing. Esophageal manometry helps in diagnosing motility disorders causing swallowing difficulty like Achalsia cardia, diffuse esophageal spasm, Scleroderma etc. Anorectal manometry is for diagnosing functional constipation or anorectal incontinence.

ERCP treatment

Endoscopic Retrograde Cholangio Pancreatogram is a diagnostic and therapeutic maneuver helps in treating obstructive jaundice. This is the most complex procedure utilizing in managing diseases like common bile duct stones, bile duct injuries, bile duct strictures, hepatobiliary cancers causing obstructive jaundice.

Endoscopic Ultrasound

Endoscopic ultrasound (EUS), also known as echo-endoscopy, is a medical procedure that combines endoscopy with ultrasound. During EUS, a thin, flexible tube called an echoendoscope is inserted into the digestive tract to create images of internal organs in the chest, abdomen, and colon. It allows visualization of the walls of these organs and adjacent structures. EUS helps in taking biopsies from mediastinal or intra-abdominal lesions. It also facilitates large pseudocyst/walled off necrosis drainage in pancreas and biliary drainage procedures in altered anatomy cases. It also facilitates the minimally invasive procedures for palliation of advanced GI cancers, like celiac plexus block, endoscopic Gastrojejunostomy etc.

Upper GI endoscopy & Colonoscopy

Upper GI endoscopy can be used for diagnosing and treating upper gastrointestinal disorders includes esophageal, stomach and duodenal diseases. Colonoscopy helps in evaluating diseases involving large intestine and terminal ileum (last part of small bowel).

Head and neck conditions

Thyroid Disorders: Including over and under active glands, Enlarged thyroid, Tumors, and cancer
Head & Neck Cancer
Laryngeal Cancer’s
Thyroid Surgery
Parotid And Submandibular Surgery

Abdominal emergency Surgeries

24×7 Highly trained Surgeons available to address the Emerging Abdominal problem including trauma. With a comprehensive Emergency and Intensive Care our Gastro team ensures to give you best results ion Abdominal Emergency

Laser surgery for hemorrhoids and fissure

State of the art Laser Equipment and Expertise in management all proctology related issues. Highly Experienced team in Laser Surgeries for all hemorrhoid, fistula and fissure related problems.

Laryngology and throat care

Hoarseness, laryngitis
Vocal cord lesions
Sore throat
Tonsil and Adenoid Problems
Gastroesophageal Reflux (GERD)
Laryngopharyngeal Reflux (LPRD
Laryngeal cancer
Throat cancer

Tonsillectomy (Coblation)
Adenoidectomy
Tongue Tie Release
DL Scopy (Direct Laryngoscopy)
VL Scopy (Video Laryngoscopy)
Tracheostomy
Vocal Cord Polyp, Nodule Excision
Voice Disorder

Upper GI endoscopy

We had facilities for all advanced therapees and diagnostic Endoscopy procedures. We provide all round Endoscopic Services for all abdominal emergencies.

Minimally invasive surgery

Only Centre providing Advanced Laparoscope. Gastro care in surrounding districts for all Gastro Cancers and Gastro problems. We have a highly skilled advanced Laparoscopic Surgeons with vast experience. For any large Surgeries we provide Scarless operations with Early recovery and no complications .

Gastrointestinal Clinic

Gastro clinics in our center is dedicated entirely to Gastro problems to provide all medical & surgical expertise to you all round with star of art Equipment and Vast Experience.

Rhinology and sinus care

Nasal Disorders: Allergies, Fractures, Nosebleeds, Obstructions, Postnasal drip, Polyps, Septum correction, Stuffy nose, Snoring
Sinus Disorders: Sinusitis, Bacterial infections, Fungal infections
Turbinate Surgery
Septoplasty
Dacryocystorhinostomy (DCR)
FESS (Functional Endoscopic Sinus Surgery)
Nasal Tumors

Advanced dental treatments

Tooth socket preservation after removal
Immediate implant after tooth removal with crown
Sinus lift procedure
Full mouth implants with fixed teeth
Full mouth disinfection with LASER
Rehabilitation of full mouth
Invisalign treatment (invisible aligners) for irregular teeth
Maxillofacial cosmetic procedures

Smile designing
Computer made natural tooth colour Zirconium fillings
Computer made natural tooth colour zirconium crowns
Treatment of painful tooth without RCT in children
Iinvisible aligners for spaces in between teeth

Basic dental treatments

Teeth cleaning
Teeth polishing
Teeth brightening & whitening with LASER
Gum cleaning with LASER
Gum depigmentation (Lightening) with LASER
Tooth filling (tooth coloured) with LASER
Tooth removal
Treatment for mobile tooth

Treatment for crooked teeth
Fluoride treatment for children and adults
Treatment for oral ulcers with LASER
Treatment for tooth fractures
Treatment for jaw fractures
Treatment for missing tooth/teeth
Treatment for discoloured teeth
Metal braces treatment for irregular teeth
Ceramic braces treatment for irregular teeth
Tooth jewellery
Treatment for painful tooth

Otology care

Dizziness
Ear Infections
Ear Injuries and Deformities
Ear Tubes
Vertigo & Motion Sickness
Myringoplasty
Tympanoplasty
Modified Radical Mastoidectomy
Myringotomy Grommet Insertion
Ossiculoplasty
Ear Tumors

Dental health check-ups

Adult dental health checkups
Paediatric dental health checkups (children)
Geriatric dental health checkups (old age)
Dental health checkups for people with special needs (physically and mentally challenged)

Post-Anesthesia Care Unit

After surgery, you will be sent to the PACU to recover and wake up. PACU is a critical care unit where your blood pressure, pulse, breathing, oxygen level will be monitored. While the anesthetic medication levels fall, you may experience nausea, chills, pain and the throat may feel dry due to the breathing tube that was used. Our team provides comfort and helps you with these issues.

You will remain here for 1 to 3 hours depending on the type of surgery, complications and your medical history. Our PACU team is skilled in recognizing and managing problems that may arise in the post-operative period.

Most people will remember their recovery period and we want this experience to be pleasant for you.

Types of Anesthesia

All types anesthesia are administered to keep you comfortable and pain-free during surgery, medical procedures and tests. The type you receive will depend on the type of procedure, your health and personal preference.

There are different types of anesthesia that include:

General Anesthesia (GA)

This is used for major operations such as knee and hip replacements and heart surgeries. GA is medicine administered through a mask or an IV placed in the vein. You will remain unconscious during the procedure, and breathe through a tube placed in your throat. Our anesthesiologist will monitor your blood pressure, heart rate and breathing.

Regional Anesthesia (RA)

RA includes spinal blocks and epidurals. An epidural is the most common type of pain control method used for labor and delivery. It allows the mother to remain awake and push, while the pain is numbed. The spinal block is used for cesarean deliveries, allowing the doctor to deliver the baby without causing pain to the mother. This way the baby is not exposed to high doses of sedating medications

Conscious Sedation (CS)

Conscious or Intravenous (IV) Sedation is used for minimally invasive procedures. It will reduce pain and help you feel relaxed. You will remain awake, but may not remember the procedure.

Pre-anesthesia Clinic

Patients scheduled for surgery will be evaluated by our Pre-anesthesia team. Your medical condition, medications, fitness for surgery and special needs will be assessed, either over phone or at the hospital. Any testing (blood tests, ECG, X-rays) you require prior to surgery, will be completed. If you are travelling from another city, you may be asked to come a day early to complete testing or given the option to do it in your hometown. Appropriate Pre-anesthesia evaluation will help ensure a safer surgical journey with fewer hassles.

Emergency Anesthesia Services

Our Anesthesia team is committed to providing round the clock anesthesia services. We are capable of handling emergency cases by providing anesthesia, as well as advanced care and life-support to critically ill patients requiring immediate surgery. We provide anesthesia to complex adult and pediatric trauma cases.

Cardiac Rehabilitation

Cardiac rehabilitation is a medically supervised program designed to improve heart health after a cardiac event or surgery. It typically includes:

Exercise Training: Structured physical activity to strengthen the heart and improve fitness.
Education: Information on managing heart disease, including lifestyle changes, diet, and medication adherence.
Counseling: Support for mental well-being, stress management, and coping strategies.
Risk Factor Management: Personalized plans to address risk factors like high blood pressure, diabetes, and smoking.

Cardiac ICU

The Cardiac ICU (Intensive Care Unit) provides specialized, around-the-clock care for patients with severe or complex heart conditions. It offers:

Advanced Monitoring: Continuous observation of heart function using EKGs, telemetry, and other diagnostic tools.
Critical Care: Management of life-threatening cardiac issues, including severe arrhythmias, heart attacks, and post-surgical care.
Intensive Interventions: Administration of medications, mechanical support (e.g., ventilators, intra-aortic balloon pumps), and emergency procedures as needed.
Multidisciplinary Team: Care provided by cardiologists, surgeons, intensivists, and nurses specialized in cardiac care.

Trauma Services

Trauma services deliver urgent care for severe injuries and critical conditions resulting from accidents, falls, or violence. They include:

Emergency Assessment: Rapid evaluation and stabilization of trauma patients, often involving advanced imaging and diagnostic tests.
Surgical Intervention: Immediate surgeries to address life-threatening injuries, including repair of internal damage and fracture fixation.
Critical Care: Intensive monitoring and support in specialized units for severe or complex trauma cases.
Rehabilitation: Post-trauma care to support recovery, including physical therapy and psychological support.

Pediatric Cardiac Services

Pediatric cardiac services focus on diagnosing and treating heart conditions in infants, children, and adolescents. They include:

Diagnostic Testing: Advanced imaging (e.g., echocardiograms, MRI), EKGs, and stress tests to assess heart function and structure.
Medical Management: Treatment of congenital and acquired heart conditions with medications and lifestyle modifications.
Surgical Interventions: Procedures such as congenital heart defect repairs, valve replacements, and catheter-based treatments.
Follow-Up Care: Ongoing monitoring and support to manage heart health and ensure proper growth and development.

Cardiac Surgical Services

Cardiac surgical services provide advanced surgical interventions for heart conditions. These services include:

Coronary Artery Bypass Grafting (CABG): A procedure to bypass blocked coronary arteries using grafts to restore blood flow to the heart.
Heart Valve Surgery: Repair or replacement of damaged heart valves to improve blood flow and heart function.
Aneurysm Repair: Surgical correction of weakened or enlarged sections of the heart or aorta.
Arrhythmia Surgery: Procedures to correct abnormal heart rhythms, such as the implantation of a pacemaker or defibrillator.

Angiogram & Angioplasty

Angiogram: An imaging test that uses X-rays and a contrast dye injected into blood vessels to visualize the heart’s arteries and other blood vessels. It helps diagnose blockages, narrowing, or other abnormalities.

Angioplasty: A procedure performed to open narrowed or blocked arteries. A balloon is inflated within the artery to widen it, often accompanied by placing a stent to keep the artery open. Angioplasty improves blood flow and relieves symptoms like chest pain.

Emergency Cardiac Services

Emergency cardiac services provide immediate care for acute heart conditions. They typically include:

Acute Intervention: Rapid treatment for heart attacks, severe arrhythmias, and other critical conditions.
Advanced Monitoring: Use of EKGs, cardiac enzymes, and imaging to assess heart function and damage.
Emergency Procedures: Administration of medications (e.g., thrombolytics), angioplasty, and stenting as needed.
Stabilization and Transfer: Immediate stabilization of the patient and, if necessary, transfer to specialized care units or facilities.

Cardiac Diagnostic Services

Cardiac diagnostic services are essential for assessing heart health and identifying conditions. They typically include:

Electrocardiogram (EKG/ECG): Records the electrical activity of the heart to detect abnormalities.
Echocardiogram: Uses ultrasound to visualize heart structure and function.
Stress Test: Monitors heart performance under physical exertion or medication-induced stress.
Holter Monitor: A portable device that records heart activity over 24-48 hours to detect irregularities.
Cardiac MRI/CT: Advanced imaging techniques for detailed views of heart anatomy and function.

Cardiac & Cardiac Surgery Clinic

A Cardiac & Cardiac Surgery Clinic specializes in diagnosing and treating heart conditions and providing surgical interventions. Services typically include:

Cardiac Diagnostics: Tests like EKGs, echocardiograms, stress tests, and cardiac imaging to assess heart function.
Medical Management: Treatment of heart diseases through medications, lifestyle changes, and monitoring.
Surgical Interventions: Procedures such as coronary artery bypass grafting (CABG), valve repairs or replacements, and other heart surgeries.
Post-Surgery Care: Follow-up care and rehabilitation to ensure recovery and optimal heart health.

Male Infertility & Sexual Problems

Many underlying conditions cause male infertility and sexual dysfunction in men. However, both are often treatable and, in some cases, curable.

Our experts help get to the root cause and provide treatment for the best outcomes. They have the expertise and experience to help with everything from sperm disorders to structural issues in the urinary tract system to sexual dysfunctions including erectile dysfunction, ejaculatory conditions, premature ejaculation and retrograde ejaculation.

From medicine that regulates hormones to minimally invasive procedures that optimize reproduction, we provide a range of treatments help restore male fertility and sexual health.

Pediatric Urology

Amara’s team also includes specialists in pediatric urology to provide reassuring care for our younger patients. Their areas of expertise include:

Circumcision:

An elective urological procedure to remove the foreskin that covers the tip of the penis, it is usually performed in the first few days after the birth of the baby.

Hypospadias:

A birth defect where the opening of the urethra doesn’t develop properly and forms somewhere on the shaft of the penis instead of at the tip. Curvature of the penis and an abnormality of the scrotum (penoscrotal transposition) may also be present. Surgery is typically recommended between 6 and 12 months of birth.

Undescended Testis:

When a male baby is still in the uterus, the testicles develop in the abdomen. Before birth, the testicles normally drop down into the scrotum. If a child’s testicles don’t drop into the scrotum by the time he’s six months old, it’s time to consult a pediatric urologist. Treatment options include hormone therapy and surgery.

Urethral Surgery

Conditions that cause significant damage to the urethra may lead to urinary strictures or obstructions. It can lead to symptoms such as a weak stream, urgency to urinate, leakage of urine, retention of urine and painful urination.

Urologists at Amara are well-versed with the new techniques and technologies to deal with this problem.

Visual Internal Urethrotomy (VIU)

Is a simple surgical procedure to widen the urethral passage and improve the flow of urine. The narrowing of the urethra can be a result of scar tissue formation following inflammation, infection or injury in the tissue. Apart from slow flow of urine, urethral stricture can also cause infection, bleeding and pain during urination

Urethroplasty

Is open reconstructive surgery to repair or replace the urethra when scar tissue forms inside it, causing difficulty in urination. The surgeon connects the two ends of the urethra after cutting out the scar tissue, or may take tissue from another part of the body to rebuild the portion of the urethra.

Perineal Urethrostomy

creates a permanent opening to the urethra from the perineum (the area between the scrotum and anus) for urine to flow out. This treatment is used for men with complex strictures who are willing to sit to urinate and want to avoid more complex reconstructive procedures.

Penile & Testicular Tumor Treatment

At Amara, our team has the necessary expertise and experience to treat cancers of the penis and testicles with the latest techniques.

Penile Cancer

Early detection ensures successful, low-risk treatment of penile cancer. If the tumor is small and on top of the skin, it may be treated with a skin cream or external beam radiation. If the lesion is about the size of a pea, a small local excision or “Moh’s surgery” may be done. With larger tumors, more tissue needs to be removed and the surgeon could also consider taking out or draining lymph nodes in the groin. A mix of surgery, radiation, and chemotherapy may be recommended. In cases where the cancer is more advanced, the whole penis may need to be removed.

Testicular Cancer

Depending upon the severity of the case, along with radiation therapy and chemotherapy, the following surgeries may also be used to treat testicular cancer:

Radical Inguinal Orchiectomy
This is a surgery to remove the testicleand is considered the primary treatment for almost all stages and types of testicular cancer. The surgeon makes an incision in the groin and extracts the entire testicle through the opening. A prosthetic, saline-filled sac can be inserted to provide a balanced look.
Retroperitoneal Lymph Node Dissection
Surgery to remove lymph nodes in the abdomen may be performed to prevent the spread of testicular cancer. During the procedure, the surgeon will make an incision in the abdomen to remove lymph nodes on the same side as the affected testicle. The main goal of this procedure is to remove all cancer so that it does not spread.

Kidney, Bladder & Prostate Cancer Treatment

Our urologic cancer specialists are part of a multidisciplinary team approach to treat prostate and urological cancers. Experts from several specialties work in coordination to design a customized treatment plan specifically for each individual patient, which may include one or more of the following:

Active surveillance, or watchful waiting
Cancer surgery – uses minimally invasive techniques such as robotic-assisted surgery
Chemotherapy – medications that work to remove, kill or damage cancer cells
Hormone therapy – for prostate cancer that has spread
Immunotherapy – activates the body’s own immune system to fight the cancer (for advanced prostate cancer)
Radiation therapy – uses ionizing radiation to kill cancer cells and shrink tumors and includes stereotactic body radiation therapy (SBRT)
Targeted therapies – employs antibodies that target specific molecules within cancer cells

Urinary Incontinence

This condition is the loss of bladder control which results in involuntary leakage of urine while sneezing, coughing or laughing. Although a common problem, it is an embarrassing and frustrating issue that can lead to mental tension and reluctance to seek medical treatment. In most cases, lifestyle and dietary changes can successfully solve the problem, while in some, your doctor may recommend surgical intervention to address the underlying cause.

Urinary Tract Infection

A urinary tract infection or UTI, is an inflammation in the bladder and/or urinary tract as a result of bacteria or viruses. More common in women, it typically causes burning sensation during urination, lower back pain and frequent urge to urinate among others. If a UTI spreads to the kidneys or into the bloodstream, it can cause serious medical problems. Hence, it is very important to properly diagnose and treat a UTI as soon as possible. The most effective treatment is a short course of antibiotics which usually clears the infection in 5 to 7 days.

Benign Prostatic Hyperplasia Surgery

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland and is common in men aged 50 and above. It puts additional pressure on the urethra, through which the urine passes, causing symptoms such as a frequent urge to urinate and a feeling that the bladder has not emptied.

At Amara, we offer advanced treatment options to remove prostate tissue blockage and improve urine flow, including:

Bladder Neck Incision (BNI) is usually done for smaller benign prostate glands which cause obstruction, or to treat narrowing of the bladder neck. During the procedure, a fine instrument called a cystoscope is placed into the urethra and a thin band with cautery or a laser fibre is used to make two incisions along the sides of the bladder neck. This results in widening the outflow channel exiting the bladder through the prostate.

Laser Surgery for Kidney Stones

For those suffering from kidney stones, our skilled endourologist provides relief with the most advanced Retrograde Intrarenal Surgery (RIRS)

In RIRS, a fibrotic endoscope is inserted through the urethra into the bladder and then through the ureter into the urine-collecting part of the kidney. The stone is seen through the scope and is then manipulated or crushed by an ultrasound probe or disintegrated by a laser probe or grabbed by small forceps.

The advantages of RIRS over open surgery include a quicker solution to the problem, no prolonged pain after surgery, and much quicker recovery.

Endoscopic Surgery for Kidney & Bladder Stones

To rid you of the pain and problems of kidney or bladder stones, our team is fully geared with the latest treatment techniques.

Percutaneous Nephrolithonomy (PCNL) :

is a procedure to remove stones in the kidney or upper ureter that are too large for other forms of stone treatment. It involves making a small 1 cm incision in the patient’s flank area through which a tube is placed into the kidney under x-ray guidance. A small telescope is then passed through the tube in order to see the stone, break it up and remove it from the body. The benefits of PCNL include less post-operative pain, shorter hospital stay, and faster return to daily activities as compared to open stone surgery.

Ureteroscopic Lithotripsy (URSL) –

typically performed with the patient under general anaesthesia, the procedure entails insertion of a ureteroscope, a long, thin cable with a tiny camera at the end, through the urethra and bladder into the ureter or kidney. X-ray images with a contrast dye enable the urologist to see where the stone is located. Once located, it is pulled out with a “stone basket” or a laser is used to break the stone into smaller pieces before extraction.

Cystolithotripsy (CLT)

is performed to remove bladder stones. In this procedure, a camera is inserted through the urethra to locate the stones. Then a lithotripter, which is attached to the camera, is used to crush the stones into small pieces before removing them. At the end of the procedure, a catheter is placed.

Permcath Placement

A Permcath (Permanent Catheter) Placement is a medical procedure used to insert a long-term catheter into a patient’s vein, typically for the purpose of dialysis or long-term intravenous access. This procedure is often performed in patients with chronic kidney disease or other conditions requiring frequent or continuous vascular access.

Procedure Overview:

Preparation: The patient is positioned comfortably, and local anesthesia is administered to numb the area where the catheter will be inserted, typically in the neck, chest, or groin.
Insertion: A small incision is made, and the catheter is carefully threaded into a large vein. It is placed securely to allow for the efficient flow of blood and fluids.
Post-Procedure Care: After the placement, the catheter is securely fixed in place, and the patient is monitored for any complications or signs of infection. The area around the insertion site is cleaned and dressed to minimize the risk of infection.

Why is Permcath Placement Performed?

Permcath placement is often used for:

Hemodialysis: In patients with kidney failure who require regular dialysis treatments.
Chemotherapy: To provide an access point for administering chemotherapy in cancer patients.
Long-term intravenous therapy: For patients requiring extended treatments or medications through an IV.

Benefits:

Provides a reliable and long-term solution for vascular access.
Minimizes the discomfort of frequent needle insertions.
Allows for consistent and controlled treatment administration.

Post-Procedure Care:

Patients should avoid heavy lifting or strenuous activity for a few days after the procedure.
Regular monitoring for signs of infection, such as redness, swelling, or fever, is essential.
The catheter site should be kept clean and dry.

Permcath placement is a safe and effective procedure, ensuring patients receive the necess

Continuous Renal Replacement Therapy (CRRT)

Continuous Renal Replacement Therapy (CRRT) is an advanced form of dialysis used to support critically ill patients with acute kidney injury (AKI) who are hemodynamically unstable. Unlike traditional dialysis, CRRT works continuously over 24 hours, gently removing waste products, excess fluids, and toxins from the blood. This slow and steady process helps maintain electrolyte balance and blood pressure more effectively in critically ill patients.

CRRT is commonly provided in the Intensive Care Unit (ICU) and is closely monitored by a multidisciplinary team, including nephrologists, intensivists, and specially trained nurses. It can be tailored to meet the individual needs of each patient, offering a safer and more controlled approach to renal support during severe illness.

Nephrotic Syndrome : Children & Adults

Nephrotic syndrome is a kidney disorder that occurs when the glomeruli—tiny filtering units within the kidneys—become damaged. This damage leads to the leakage of large amounts of protein into the urine (proteinuria), resulting in swelling (edema), low blood protein levels, and high cholesterol.

Nephrotic syndrome can affect both children and adults, though the causes and treatment approaches may vary by age group.

In Children

Nephrotic syndrome in children is most commonly caused by a condition called minimal change disease, which often responds well to corticosteroid treatment. Children may experience:

Swelling around the eyes, ankles, and abdomen
Fatigue
Frothy or foamy urine
Weight gain due to fluid retention

In Adults

In adults, nephrotic syndrome may result from primary glomerular diseases such as focal segmental glomerulosclerosis (FSGS) or membranous nephropathy, or as a complication of systemic diseases like diabetes or lupus. Adults may present with:

Persistent swelling
High blood pressure
Increased risk of blood clots and infections
Progressive loss of kidney function

Diagnosis & Treatment

Diagnosis involves urine tests, blood tests, and often a kidney biopsy to identify the underlying cause. Treatment focuses on:

Managing symptoms (e.g., diuretics for swelling, statins for cholesterol)
Controlling blood pressure
Treating the underlying cause
Preventing complications

Comprehensive Care at Amara Hospital

At Amara Hospital, our nephrology team offers specialized, age-appropriate care for patients with nephrotic syndrome. From advanced diagnostics to individualized treatment plans and long-term management, we are dedicated to improving kidney health and quality of life for both children and adults.

Post-Transplant Follow-ups

After an organ transplant, ongoing care is essential to ensure the health and longevity of both the patient and the transplanted organ. Our Post-Transplant Follow-up Program provides comprehensive, long-term care tailored to each patient’s needs.

Our multidisciplinary team closely monitors patients through regular clinic visits, lab tests, and imaging to detect any signs of rejection, infection, or complications early. We also provide personalized medication management, lifestyle guidance, and support for emotional well-being.

Our goal is to help every transplant recipient achieve the best possible quality of life with continuous, compassionate care.

Renal Biopsy

A renal biopsy, also known as a kidney biopsy, is a medical procedure used to collect a small sample of kidney tissue for examination under a microscope. This helps doctors diagnose kidney conditions, assess the severity of kidney disease, and guide appropriate treatment plans.

Why is a Renal Biopsy Performed?

A renal biopsy may be recommended if you have:

Unexplained kidney problems such as blood or protein in the urine
Decreased kidney function
Suspected inflammation or infection of the kidneys
Kidney disease of unknown cause
Monitoring after a kidney transplant

How is the Procedure Done?

Most renal biopsies are performed using a needle biopsy:

The patient lies on their stomach or side, depending on which kidney is being biopsied.
The skin is cleaned and numbed with a local anesthetic.
Using imaging guidance (ultrasound or CT scan), the doctor inserts a thin needle through the skin to obtain a tissue sample.
The sample is sent to a laboratory for analysis.

The procedure usually takes about 30 to 60 minutes and is followed by a period of observation to monitor for any complications.

Risks and Safety

Renal biopsy is generally safe, but as with any invasive procedure, there are potential risks, including:

Bleeding at the biopsy site
Infection
Pain or discomfort
Rarely, injury to the kidney

Our team takes all necessary precautions to ensure patient safety and comfort during and after the procedure.

Aftercare

Following the biopsy, patients are usually observed for several hours and may be advised to:

Avoid heavy lifting or strenuous activity for a few days
Monitor for symptoms such as fever, worsening pain, or blood in the urine
Stay hydrated and rest as advised by the care team

Peritoneal Dialysis: IPD & CAPD

Peritoneal Dialysis (PD)

Peritoneal Dialysis (PD) is an effective treatment option for patients with kidney failure. It uses the lining of the abdomen (peritoneum) as a natural filter to remove waste products and excess fluid from the blood, offering an alternative to traditional hemodialysis. PD is especially beneficial for patients seeking greater flexibility and independence in managing their treatment.

Types of Peritoneal Dialysis:

1. Intermittent Peritoneal Dialysis (IPD)

Intermittent Peritoneal Dialysis (IPD) is typically performed in a hospital setting and is suitable for patients who require temporary or short-term dialysis. During IPD, dialysis fluid is infused into the abdominal cavity for a set period and then drained out in cycles. Each session may last several hours and is usually carried out multiple times a week.

Benefits of IPD:

Short-term dialysis support
Useful for patients recovering from acute kidney injury
Supervised by medical professionals in a clinical environment

2. Continuous Ambulatory Peritoneal Dialysis (CAPD)

Continuous Ambulatory Peritoneal Dialysis (CAPD) is a home-based, manual form of dialysis that does not require a machine. Patients perform several exchanges of dialysis fluid throughout the day, allowing them to maintain an active lifestyle while managing their treatment.

Key Features of CAPD:

Performed manually 3–5 times a day
Each exchange takes about 30–40 minutes
Offers greater independence and flexibility
Can be integrated into daily routine at home or work

Why Choose Peritoneal Dialysis?

Less dietary restrictions compared to hemodialysis
Better blood pressure control
Preserves residual kidney function
Suitable for patients who prefer home-based care

Our nephrology team provides comprehensive training and support to help patients confidently manage peritoneal dialysis at home. Whether you need temporary support through IPD or are considering CAPD for long-term care, we are here to guide you every step of the way.

Hemodialysis

Hemodialysis is a life-saving treatment for patients with advanced kidney failure or end-stage renal disease (ESRD). It helps to remove waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions naturally.

During the procedure, the patient’s blood is filtered through a dialysis machine (also called an artificial kidney) via a special access point, typically in the arm. The clean, filtered blood is then returned to the body. Each session typically lasts 3 to 5 hours and is usually performed three times a week.

At our hospital, we provide state-of-the-art hemodialysis services in a comfortable, safe, and closely monitored environment. Our expert nephrologists, trained nurses, and dedicated dialysis team ensure personalized care and attention to every patient.

Key Features:

Advanced dialysis machines for efficient treatment
Strict infection control protocols
Individualized treatment plans
Comfortable, patient-friendly dialysis units
24/7 emergency support for dialysis patients

If you or a loved one is in need of hemodialysis, our team is here to support you every step of the way.

Management of Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a long-term condition characterized by a gradual loss of kidney function over time. Effective management is essential to slow disease progression, prevent complications, and improve quality of life.

At Amara Hospital, our multidisciplinary team of nephrologists, dietitians, and healthcare professionals provides comprehensive care tailored to each patient’s needs. Our approach includes:

Early Detection & Diagnosis: Regular screening for at-risk individuals, including those with diabetes, high blood pressure, or a family history of kidney disease.
Medication Management: Prescribing and adjusting medications to control blood pressure, blood sugar, and reduce proteinuria.
Dietary & Lifestyle Counseling: Personalized nutrition plans to reduce kidney workload, along with support for smoking cessation, weight management, and physical activity.
Monitoring & Follow-up: Routine lab tests and imaging to track kidney function and manage associated conditions such as anemia, bone disease, and electrolyte imbalances.
Preparation for Advanced Care: When necessary, we guide patients through options like dialysis and kidney transplantation, ensuring they are well-informed and supported throughout the process.

Our goal is to empower patients with the knowledge and tools to manage CKD effectively, preserve kidney function, and maintain a healthy, active life.

Management of Acute Kidney Injury

Acute Kidney Injury (AKI) is a sudden episode of kidney failure or kidney damage that occurs within a few hours or days. It causes a build-up of waste products in the blood and can affect other organs if not promptly managed. AKI is often reversible with timely diagnosis and appropriate treatment.

At our hospital, we provide comprehensive and evidence-based management of AKI, guided by a multidisciplinary team including nephrologists, intensivists, and specialized nurses. Our approach includes:

Early Detection and Monitoring: Prompt recognition through clinical evaluation and laboratory testing (e.g., serum creatinine, urine output).
Identifying and Treating the Underlying Cause: Such as infections, dehydration, medication toxicity, or obstruction.
Fluid and Electrolyte Management: Careful regulation of fluids and electrolytes to support kidney recovery and prevent complications.
Medication Review and Adjustment: Avoiding nephrotoxic drugs and adjusting dosages based on kidney function.
Renal Replacement Therapy (Dialysis): Initiated when necessary, using state-of-the-art equipment and protocols.
Ongoing Monitoring and Follow-up Care: Ensuring recovery or managing the transition to chronic kidney disease if applicable.

Our goal is to provide timely and effective care to reduce the risk of complications and improve patient outcomes. We are committed to supporting patients and families through education and personalized treatment plans.

Molecular Biology

Gene-Xpert, a CBNAAT (catridge based nucleic acid amplification test) is a widely accepted diagnostic test for Tuberculosis. This test is a rapid diagnostic test for Tuberculosis detection as well as Rifampicin resistance in direct smear negative cases. Due to of non availability and lack of cost effectiveness it is still not common in developing countries like India. Bronchial washings, sputum, pleural samples(pleural fluid, pleural biopsies), tissue biopsy and other samples from patients of suspected Tuberculosis were sent for direct smear/culture for AFB as well as Gene-Xpert.

Histopathology

The Histopathology laboratory caters the need of all kinds of cases from Gynae, Urology, Gastro-intestinal, Cardiovascular, Orthopaedic and Respiratory Medicine and highly specialized areas are such as Neuropathology, Oncology and pathology departments. Neurosurgical cases are done routinely. Frozen section studies is being started soon. Outside cases in the form of specimens for review slides are also undertaken.
In order to achieve the goal of early and reliable reporting, the laboratory is equipped with high quality precision equipments including the Leica-Automated tissue processor, Leica- Rotary microtome, embedding station and cryostat Microtome.

Cytopathology

The Cytopathology section is well equipped. Both Exfoliative and Interventional Cytology (Fine Needle aspiration Cytology) are carried out with the help from Radiology dept, for imaging guidance (under Ultrasound and Computed Tomography) renders virtually all body sites accessible to the Fine Needle (for FNAC), thus allowing reliable tissue diagnoses at economical rates and minimal discomfort.

Haematology

The Haematology Department features state-of-the-art equipment, including automated cell counters & coagulometers. It provides a wide range of services for the diagnosis and treatment of blood disorders.

The lab has provision to diagnose several blood deficiencies, anaemia, and clotting abnormalities. Comprehensive tests for the identification of bleeding disorders and all types of hyper-coagulability disorders are also available.

The laboratory, with a team of clinicians & technicians and strong automation, provides accurate, dependable results within a short period of time while maintaining a high degree of quality control.

Clinical Pathology

The Clinical Pathology Department supports the diagnosis of disease, using laboratory testing of blood and other bodily fluids.

The department employs digitally equipped automated analyzer. A wide range of point-of-care equipment is also available, to get specimen testing straight to the Intensive Care Units and Operating Rooms.

The laboratory technicians and clinicians work in close coordination with the Clinical Biochemistry and Haematology Departments, to deliver high quality, timely and affordable services.

Clinical Biochemistry

The Clinical Biochemistry Department provides comprehensive clinical laboratory services in the vast area of Clinical Chemistry. Diseases like diabetes, heart attacks, chronic kidney disease, fatty liver, can be diagnosed by the examination of body fluids including blood & urine. A range of advanced tests such as HbA1c quantification based on Nephelometry Principle and a provision of POCT etc., are carried out.

The team of professionals, including clinicians, laboratory technicians, technical assistants and phlebotomists, is capable of furnishing the medical and scientific expertise needed to deliver high precision results.

The highest Quality Control and Quality Assurance standards are strictly adhered to in the lab.

Employer Services

Employer Services offered by Amara include:
1. Ergonomic evaluation of the work environment.
2. Education to employees on the appropriate posture to be adopted during the course of their daily work.
3. Classes on exercises

Fitness Evaluation

Amara Fitness Evaluation (AFE) is designed to determine your physical fitness level. It measures 5 components: Body Composition, Cardiovascular Endurance, Muscle Strength, Flexibility and Balance. Results of this evaluation will help us understand your strengths and weaknesses so that we can help you set up a regular physical exercise routine.

AFE is meant for people want guidance in developing a physical activity routine or if they anticipate difficulties in becoming more physically active. This can also be combined with nutritional counselling.

Occupational Therapy

Occupational Therapy focuses on restoring function and increasing independence with activities of daily living, particularly after an injury or illness. Especially when simple movements such as picking up a glass, making a cup of coffee, walking and taking a bath become difficult.

Our therapists will develop a treatment plan customized to your condition and needs. They will work with you on improving your strength, balance, coordination and activities to help you become self-dependent and improve your quality of life.

Balance Therapy

Balance Therapy is useful for people with dizziness and balance problems. Elderly people, who are at high risk of falls will benefit from this. At Amara, our therapists address problems related to:

Vertigo
Dizziness
Muscle weakness
Arthritis
Neuropathy
Fear of falling

Physical Therapy

Physical Therapy is a safe and effective way to manage your pain. We are staffed with well-trained therapists that work under the guidance of Orthopedic, Neurology and Pain Medicine specialists. This allows us to treat conditions that affect the back, neck, shoulder, elbow, wrist, hand, hip, knee, ankle and foot. We also work with patients having weakness and gait problems associated with stroke, and other neurological and orthopedic conditions.

We are committed to helping you get back to a normal life as quickly and safely as possible. Our physical therapists provide:

Education about your condition
Exercises to improve your range of motion, manual therapy, balance, flexibility, and muscle strength

Neurosurgery

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Dr. Gowtham Kuncha

SERVICES

Brain Tumor Surgery

Spine Surgery

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Pituitary Tumor Surgery

Pediatric Neurosurgery

Hydrocephalus & VP Shunt Surgery

Peripheral Nerve Surgery

Epilepsy Surgery

Functional Neurosurgery

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Emergency Neurosurgical Care

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