Proper way to use inhalers in Asthma

Incorrect usage of inhalers is very common in adults and children, including experienced inhaler users. Full dose of medicine will not reach the lung if incorrect method is used, leading to poor symptom control. Incorrect method can increase the risk of hospitalisation, emergency visits and also use of oral medication. As it is very common to use incorrect technique, doctor will always evaluate the technique of using inhalers before increasing the dose. Correct technique depends on the inhaler type, so patients need to understand the right steps for their own inhaler.

How to use Asthma Inhaler:

  1. Take the cap of the inhaler and make sure the mouthpiece and spray hole are clean.
  2. Shake the inhaler for at least 10-15 times before the use.
  3. Stand up or sit up straight 
  4. Take a breathe and breathe out all the way by tilting the head back slightly without the inhaler
  5. Holding the inhaler plays an important role, so hold it upright.
  6. Keep the inhaler in your mouth above the tongue and between the teeth, seal the inhaler with your lips.
  7. Start breathing slowly and press down the inhaler simultaneously on time and keep breathing in.
  8. Hold your breath for 5-10secs which prevents exhaling the medicine out.
  9. Take the inhaler of your mouth, now open your mouth and breathe out slowly.
  10. If you are supposed to take 2 puffs of medicine per dose, wait one minute and repeat steps 3 through 9.
  11. If you are using an inhaled corticosteroid, rinse out your mouth with water and spit it out after each dose to reduce the risk of oropharyngeal candidiasis also called as oral thrush caused by medicine deposited in the mouth.

Below are some tips to avoid incorrect usage of inhalers:

  1. Ask your doctor to explain the technique before you start using the inhaler.
  2. Show your doctor the technique followed by you if you are not trained earlier and check if there are any mistakes in the usage.
  3. Check with your doctor every 3 months to make sure you are using the correct technique without miss.
  4. Don’t tilt the device while using it
  5. Exhale fully before inhaling the medicine
  6. Inhale the medicine completely and slowly
  7. Exhaling into the device mouthpiece before or after Inhaling is a wrong technique
  8. Close the inhaler after every use
  9. Check for expiry date before the usage
  10. Follow the manufacturer’s instructions about usage and cleaning of the devices.



Dr. Y. Alekhya.



Anxiety is an emotion and that is normal in human beings. But it is termed as Anxiety disorder if the fear/anxiety is excess in relation to the situation and affects one’s day to day daily activities such as sleeping, eating, working, etc.

Anxiety disorder is not known to affect about 30% of population at some point in their lives. Everyone has their ups and downs, high and lows in life due to the circumstances of life, various incidents, etc. but people with anxiety disorder try to avoid situations or triggers that worsen their symptoms. 

The criteria for one to be diagnosed with Anxiety disorder are

  • The fear/anxiety is out of proportion to the situation. 
  • The symptoms affect the normal function causing disturbances in personal life, work and daily activities. 



  • Generalized anxiety disorder : It involves persistent and excessive worry and fear about everyday activity causing symptoms such as easy fatigue, difficulty in sleeping and concentration, muscle tension, dizziness, difficulty in breathing, etc. 


  • Panic disorder : Panic attacks are usually recurrent. The symptoms are sudden and a combination of psychological and physical distress. One may feel they have a heart attack often. 
  • Phobia : Excess fear to specific object, situation, activity, that is normally not harmful. It is extremely difficult for the individual to overcome the fear and one may try to avoid it any cost. Examples are fear of heights, fear of spiders, fear of escalators, etc.
  • Agoraphobia : Fear of certain situations such as being in open places, outside of home alone, use of public transport, etc. One may always need a companion and may sometimes get severe to an extent that one refuses to leave the house, when left untreated.
  • Social anxiety disorder : One may have severe discomfort and fear of being in social situations or gatherings due to fear of being embarrassed, humiliated, looked down, etc. There may try to avoid social gatherings, meet new people, eat/drink in public, etc. and may affect daily activities and work life.
  • Separation anxiety disorder : This is most commonly seen in children but may extend to adulthood as well with a fear of separation from loved ones or those to whom he/she is attached. 



Risk factors

Specific causes of anxiety disorder are unknown but a few risk factors can be genetic, hereditary, environmental, psychological, traumatic events, developmental. 

  • A few personality traits such as pessimism, low self esteem, lack of self confidence, being too dependent on others, etc.
  • Emotional, physical, sexual abuse, etc.
  • Traumatic events in life such as relationship problems, divorce, change in job/location, loss of a person, etc.
  • Associated mental health disorders such as anxiety disorder, post traumatic stress disorders, sleep and eating disorders, etc.

A few medical conditions, that are known to be associated with anxiety are

  • Heart disorders. 
  • Diabetes. 
  • Hyperthyroidism. 
  • Alcohol, recreational drug intake or addiction, withdrawal.
  • Withdrawal from a few medications. 
  • Respiratory disorders such as COPD, asthma, etc.


Symptoms can be psychological or physical or a combination of both. 

A few psychological symptoms are

  • Restlessness, sense of dread and fear.
  • Difficulty in thinking clearly, focus and concentration.
  • Irritability.
  • Urge to avoid situations, events, that trigger anxiety.

A few physical symptoms are

  • Dizziness. 
  • Bodyache, tiredness, restlessness, muscle ache.
  • Excessive sweating. 
  • Rapid breathing.
  • Palpitations (elevated heart rate causing pounding heart).
  • Shaking.
  • Dry mouth, excessive sweating.
  • Pain abdomen, constipation. 
  • Headache, pins and needles sensation.
  • Social isolation. 
  • Excessive use of alcohol, drugs, etc. 
  • Insomnia with difficulty in initiating and staying asleep.

All symptoms may not be experienced by all individuals with anxiety but a few symptoms may be related by many individuals. The severity and duration of symptoms may vary between people, based on the cause/risk factor, etc.


Diagnosis is made by a psychiatrist or a psychologist after talking for some time to know about one’s feelings, attitude, behavior, approach to life, history of physical or emotional traumatic events, etc. to estimate probable underlying cause. Tests such as a hemogram, thyroid tests, ECG, etc. may be done to rule out an underlying medical condition. 

A mental health assessment is done and diagnosis may be made with criteria from DSM-5 (Diagnostic and Statistical Manual for mental disorders).


Anxiety is treatable and two main modes of treatment are psychotherapy and medications. 

  • Medications may help in treating anxiety, that is prescribed by the psychiatrist after a detailed mental health assessment, evaluation and grading type of anxiety. One may need to try different medications and doses sometimes to find the right fit of medication that helps with one’s symptoms best and with less side effects because it may vary between individuals. It may also typically take about 2-4 weeks for the medications to work effectively with symptoms such as sleep, concentration, etc. Medications are to be taken as per prescription and can be tapered off gradually by the psychiatrist, if it is decided to be stopped based on an evaluation. Medication should not be stopped abruptly or without informing the treating doctor because one may experience withdrawal symptoms. 
  • Psychotherapy or talk therapy or counseling may be done one-on-one or in a group to help address the symptoms and educate on how to tackle and approach issues better. Education on causes, ways to help get relief from symptoms, changes in lifestyle, etc. may be guided through. It includes cognitive behavioral therapy primarily.
  • Lifestyle changes with a healthy diet and sleep cycle, regular exercises, working around the ways to control emotions and deal life challenged better.
  • Other options can be deep breaths, yoga, meditation, laughter therapy, acupuncture, massage therapy, etc.
  • Support groups help in coping up better.


Anxiety when left untreated or unnoticed, discontinuation of prescribed medications or treatment may lead to complications, that worsens the lifestyle.

  • Alcohol and drug abuse.
  • Depression.
  • Social isolation.
  • Difficulty in sleeping.
  • Family conflicts, relationship issues, etc.


 Dr. Divya Teja Pasupuleti

Vitamin A Deficiency

Vitamin A rich foods are essential for many important body functions. There are two types of vitamin A depending on the source from which they are derived. Vitamin A from animal sources is available in the ready form of retinol. Vitamin A is a fat-soluble vitamin and excess intake of it can lead to toxicity. 

Rich sources of vitamin A are eggs, dairy, fish oils, and liver.

Vitamin A derived from plant-based sources is called provitamin A of which carotenoids are the most popular and a readily available form. 

Carrots, sweet potato, pumpkin, broccoli, leafy greens like kale, mustard greens and spinach are some of the rich sources of vitamin A. Fruits rich in vitamin A are cantaloupe, mango, papaya, pink grapefruit, and apricots.

A deficiency of vitamin A in the diet can cause vision difficulties and also make the body susceptible to infections, whereas high doses of vitamin A can lead to toxicity. Vitamin A supplement use is not recommended to take in a tablet form and it is best to derive this nutrient from natural food sources. It is therefore important to consume food sources containing sufficient vitamin A on a daily basis.

Causes of Vitamin A Deficiency:

  •  Minimal consumption of animal liver, seafood, eggs, yellow & green vegetables, and fruits, milk products.
  •  Diseases like cystic fibrosis, bile duct obstruction, cirrhosis, duodenal bypass, celiac disease, giardiasis, persistent diarrhea, and pancreatic insufficiency which reduce the absorption, storage, and availability of vitamin A and thus cause a deficiency.

Symptoms of Vitamin A Deficiency:

  •         Earliest symptom of night blindness caused by Retinal damage.
  •         Dryness of conjunctiva and cornea of the eyes (xeropthalmia).
  •         Foamy deposits (Bitot spots) in the sclera of the eye.
  •         Blindness can occur in untreated cases.
  •         Weak immunity and therefore, recurrent infections, especially seen in children and infants.
  •         Dryness and scaly skin.

Treatment Using Vitamin A Palmitate:

  •         In chronic cases of vitamin A deficiency usually doctors give oral supplements.
  •         Usually vit A drops are given to prevent blindness and its complications in health centers.
  •         An overdose of vitamin A can cause toxicity and thus vitamin A must not be consumed without medical prescription.

 Prevention of Vitamin A Deficiency:

  •  Including dark leafy vegetables along with bright and yellow colored fruits and vegetables like pumpkin, papaya, oranges, and carrots in the daily diet will be helpful.
  • Animal liver, seafood, cod liver oil, eggs, and Vitamin A fortified milk products are rich sources of Vitamin A.

-Dr.Bhavani Sagar Surampally



What is creatinine? What does elevated creatinine mean?

Serum creatinine is one of the most commonly measured products in clinical chemistry laboratories worldwide. 

Creatinine is a chemical waste product in the blood that passes through the kidneys to be filtered and eliminated in urine. It is a by-product of normal muscle function. The more muscle a person has, the more creatinine they produce. Levels of creatinine in the blood reflects both the amount of muscle a person has and their kidney function.

Most men with normal kidney function have approximately 0.6 to 1.2 mg/dL(milligrams/decilitre) of creatinine. Most women with normal kidney function have between 0.5 to 1.1 mg/dL of creatinine. Women usually have lower creatinine levels than men because women on average have less muscle mass than men.

Other factors that may affect the level of creatinine in the blood include body size, activity level and medications.

What does elevated creatinine mean?

When there is kidney damage or kidney disease, and the kidneys are not able to filter waste efficiently there will be a rise of creatinine levels in the blood.

Raised creatinine levels in routine blood tests indicate advanced kidney disease.

Creatinine is produced endogenously within the body and is freely filtered by the glomerulus. These characteristics make creatinine a useful marker for creatinine clearance. If the GFR(glomerular filtration rate, filtration capacity of kidney) is decreased, as is in renal disease, creatinine clearance via the urine is compromised. The reduced GFR will then lead to an increase in plasma(blood) creatinine concentration. 

Plasma creatinine levels may not be affected until significant kidney damage has occurred i.e. a blood creatinine level that is within normal reference range does not indicate a normal functioning kidney.

-Dr Prerna Gaur



Nail fungus

Nail infection or Onychomycosis is the infection of nail by microscopic fungus.  It is the most common disease affecting nails and make up to 50% of all nail abnormalities. Both fingernails and toenails are susceptible to infection. Nail fungus usually appears as discoloration or thickening of the nail with crumbling edges. The condition is more common in toenails. 

Risk factors

Factors that can increase the risk of developing nail fungus includes:

  • Old age – Due to reduced blood flow and years of exposure to fungi.
  • Heavy sweating
  •  History of athlete’s foot(fungal infection)
  • Walking barefoot in damp public areas, such as swimming pools, gyms and shower rooms
  • Minor skin or nail injury or psoriasis(skin disease)
  • Diabetes or blood circulation issues 
  • Weak immune system


You may have a nail fungus if one or more of your nails are:

  • Thickened
  • Whitish to yellow-brown discoloration
  • Brittle and crumbly/ragged
  • Distorted in shape
  • Dark in color caused by debris under the nail
  • Foul smelling


The physician will examine your nails and may take nail clippings or scrape debris from under the nails to send the sample to a lab to identify the type of fungus causing the infection.

Microorganisms such as yeast and bacteria can also infect the nails. Knowing the cause of infection helps in determining the best course of treatment.

Other conditions like psoriasis can mimic a fungal infection of the nail. 


Fungal nail infections can be difficult to treat. Treatment depends on the severity of your condition and the type of fungus causing it. It can take months for any results and reinfections are common.

Your physician may prescribe antifungal drugs which are to be taken orally or apply to the nail. In some situations both oral oral and topical antifungal medicines are advised.

Oral antifungal drugs. These are often the first choice drugs because they clear the infection more quickly than topical (applied on skin surface) drugs. It is typically advised for six to 12 weeks but results won’t be visible until the nail grows back completely. It may take four months or longer to completely eliminate the infection. These medications are not recommended for people with liver disease or congestive heart failure or those taking certain medications.

In few cases medicated nail paints and creams are advised to apply over the nail.


The following habits can help prevent nail fungus or reinfection:

  • Wash your hands and feet regularly. Wash your hands after touching an infected nail. 
  • Trim nails regularly by smoothening the edges with a file and file down thickened areas. Disinfect nail clippers after each use.
  • Wear sweat-absorbing socks or change your socks everyday.
  • Choose shoes made of materials that allow air circulation
  • Discard old shoes or treat them with disinfectants or antifungal powders.
  • Avoid walking barefoot in public areas like near pool areas or locker rooms.
  • Avoid applying nail polish and artificial nails.

Consult your dermatologist if you have any of the symptoms as above as nail fungal infection may take a few months of treatment to resolve.

-Dr Prerna Gaur



Cigarette smoking is the leading cause of preventable deaths worldwide but despite being constantly bombarded with advertisements of the dangers of smoking, tens of millions of Indians continue to smoke.

Nicotine addiction can lead to the de person prematurely every six seconds. 50% tobacco users will die from tobacco addiction.This epidemic depicts the highly addictive nature of nicotine.

Smoking is commonly used as a stress buster, appetite suppressant and controlling weight


1.Circulatory problems. It affects the blood circulation in the body
2. Risk of impotence in men is 50% more likely in smokers
3. Sleep Disturbance- Smokers are four times likely to feel unrefreshed/unrested after a night’s sleep
4. Smokers have a lower bone density than non-smokers which increases the risk of bone fractures 

  1. Higher likelihood of developing heart diseases
    6. Ages your skin by upto 19 years
    7. 90% higher likelihood of lung cancer


“Cigarette smoking is injurious to health.” 

How often do we hear this, yet continue to light up our favorite cancer sticks at every given a chance? Ever wondered why?

Cigarette smoking or tobacco smoking in different forms start as a statement of being “cool” by our peers and colleague and soon becoming the quick fix to an adrenaline rush on our bad days. Having an almost immediate effect on our hearts and our brains, nicotine is known as a highly addictive drug with increased tolerance through everyday use. 

Within 10 seconds of inhalation, Nicotine can cross the blood-brain barrier triggering dopamine to be released. Smokers feel pleasure and calm, reducing their withdrawal symptoms. 

Nicotine addiction is termed as harmful and as addictive as heroin or cocaine by the Royal College of Physicians, delivering a dose of nicotine rapidly to the brain. Classified by the Diagnostic and Statistical Manual of Mental Disorders, under the sub-category of dependence and withdrawal, smoking has soon become one of the most prevalent, preventive causes of death!

Dopamine depletion causes these symptoms return, and with it, the urge to smoke. The process of trying to quit smoking brings with it, unpleasant withdrawal symptoms such as anxiety and difficulty concentrating, irritability and depression, often leads smokers back to cigarettes.

Scary enough to make you want to quit?

Quitting sounds easy, but it is not really. Nicotine addiction is the silent killer that sneaks into your lifestyle without even you noticing it — preparing to live smoke-free works as the first step to making a successful plan to quit. However, laying your hands off those cigarettes still don’t seem easy. Let’s look at what happens once you decide “NO MORE”

What happens when you quit?

Other than your body saying a big thank you!  The positive impact of quitting can be seen as soon as 20 minutes, lowering your heart rate and improving your lung function as early as two weeks. Every stage of being smoke-free has a horde of benefits that you have silently been depriving your body of. A glance below sums it all!


According to International Classification of Diseases(ICD-10), these are the symptoms of Nicotine Addiction

Dependence is a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

1. Tolerance, as defined by either

• a need for markedly increased amounts of the substance to achieve the desired effect
• markedly diminished effect with continued use of the same amount of substance. 

2. Withdrawal, as manifested by either the characteristic withdrawal syndrome for the substance, the substance being taken to relieve or avoid withdrawal symptoms.

3. Taking larger amounts of the substance or over a longer period than was intended.

4. A persistent desire for,  or unsuccessful efforts to cut down on substance use.

5. A great deal of time is spent in activities necessary to obtain or use a substance.

6. Abandonment or reduction of important social, occupational, or recreational activities because of substance abuse.


Withdrawal produces a collection of symptoms that tobacco users may experience when they stop tobacco use abruptly

Withdrawal symptoms vary but include a craving for nicotine, irritability, frustration or anger, anxiety, depression, difficulty concentrating, restlessness, and increased appetite (which can lead to weight gain).

Most symptoms reach maximum intensity 24 to 48 hours after cessation and then gradually diminish over a period of a few weeks.19 Some withdrawal symptoms, such as dysphoria,18 mild depression,18 anhedonia,18 and increased appetite,6,40,33 may persist for months.

It is not uncommon for smokers to relapse after a quit attempt. Most smokers who manage to quit will make 8 to 11 attempts before actually succeeding.6 For most smokers, quitting represents stopping an addiction they have had for many years. Aside from breaking the addiction to nicotine, smokers have to break the many associations they have with smoking (e.g. smoking while relaxing, talking on the phone, or in a car). It is not difficult to understand why so many smokers who have quit slip or relapse when these triggers are present. Slips can be defined as the re-engagement of some smoking behavior (e.g. smoking less than a whole cigarette).                               


Cold turkey or gradual reduction, the choice is yours. Whatever you pick, you’ll never go wrong. A few people find it easier to quit smoking at one, no replacement, no medicines just cold turkey. While a few find this the best way to let go. Just ripping the band-aid off at once, a few find it easier to withdraw gradually. A researched fact about quitting cold turkey remains that only 4 to 7% of people who attempt to quit smoking can do it cold turkey. Getting support from your healthcare provider, which includes counseling and medication, can double your chances for a successful quit.

Cutting down on the number of cigarettes, a little bit each day can help you slowly reduce the amount of nicotine intake per day. Replacements such as nicotine gum, electronic cigarettes, vape pens, tobacco lozenges and pouches work as effective replacements for gradual quitters.

It is not all sunshine and daisies when you quit.

Short-term effects are known with smoking cession do include weight gain, irritability, and anxiety. Some people try several times before they succeed. However, ask us, we know that trying is what matters!

Whenever there’s an urge to use tobacco, remember that although it may be intense, it will probably pass within five to 10 minutes whether or not you indulge in your craving or give in to your urge. Each time you resist a tobacco craving, you are one step closer to stopping tobacco use for good.

Here are a few ways to quit smoking for good


  • Nicotine replacement therapy


Nicotine replacement is one of the most accessible alternatives to smoking, but should never be done without the consultation of a doctor. Nasal sprays, inhalers, nicotine patches, gum and lozenges available at over the counter. Prescription nicotine medications such as bupropion (Zyban) and varenicline (Chantix) work to curb the cravings as well. 

Short-term nicotine replacement therapies — such as nicotine gum, lozenges, nasal sprays or inhalers can help you overcome commonly intense cravings. 

1. Electronic cigarettes 

Grabbing attention around the globe, e-cigarettes or vape pens are an alternative to smoking conventional cigarettes. While easily accessible to children, these may be harmful due to prolonged use due to the presence of nicotine in the vape liquids as well. No research yet qualifies these as a long-term solution to smoking cession. 

2. Identifying triggers and Delaying cravings

The urge for a smoke is one of the greatest barriers to smoking cession. Habitual triggers such as smoking after food, with alcohol, after sex or due to stress, anxiety, loneliness or boredom may be identified through therapy and help in overcoming one’s cravings. 

It is very easy to fall back into a smoking relapse while encountering these triggers. If you typically smoke while you talked on the phone, for example, keep a pen and paper nearby to occupy yourself with scribbling rather than engaging in the act of smoking.

Delaying one’s cravings also helps take your mind off the urge. Waiting for a few more minutes, drinking some water or chewing on gum helps fight the craving. 

3. Do not give in to ‘just one’

You may be drawn to have just one cigarette to satisfy a tobacco craving. However, do not chump yourself into trusting that you can stop right there. In most cases, having just one leads to another, and you may end up indulging into tobacco again and losing track of your progress of trying to quit smoking.

4. Cognitive Behavioural Therapy (CBT) for smoking cessation

Clinically approved by researchers around the globe, CBT refuses to look at addiction as a lifelong disease, viewing it as a learned behaviour instead. The goal of Cognitive-behavioural treatment is learning new, more effective behaviours to take the place of the addiction behaviours. 

It focuses primarily on shifting one’s cognitions or thought process about smoking and replacing it with divergent behaviour instead. A change in your thoughts can be implemented by examining thought patterns that lead to smoking and then learning more effective pattern learning alternate behaviours involve identifying the functions that smoking serve, replacing smoking with other behaviours that serve the same function.  Physical activity, sports, exercise, swimming and varied muscle relaxation techniques have proven to help overcome urges which in turn help fighting the urge for one more cigarette.

The end to cigarette smoking is not impossible, difficult yes but never impossible. With multiple alternatives at our reach, it is time you put it out, before it puts you!

5. Motivational Interviewing for Smoking Cessation

This is a brief psychotherapeutic technique intended to facilitate the likelihood that an individual attempts to act on/alter their harmful behaviour. It has been primarily employed for the behavioural management of disorders. It has been used to treat alcohol abuse, drug addiction,weight loss, compliance with treatment for asthma and diabetes as well as for smoking cessation.


By observing and non-judgmentally accepting uncomfortable mind- and body-states rather than reacting to them, MT may help individuals to replace stress-induced habitual reactions with more adaptive response. By helping people change their relationship to negative affect and physically unpleasant states (e.g. craving) and thoughts, MT may bolster their ability to ‘ride out’ cravings and subsequently quit smoking or other addictions 31,56,72. Smokers may learn to bring mindful awareness to the sensations and thoughts that accompany a craving, and just observe rather than immediately react to it. This awareness can lead to two important insights. First, by stepping back and exploring what cravings actually feel like in their body, an individual may learn that they are physical sensations and not something they have to get rid of immediately. Second, each time she rides-out a craving an individual may learn that they are not permanent and will subside even if unsatisfied. Cravings may continue to arise, but by learning to observe and not immediately react to them, an individual can begin to disrupt the associative learning process and dismantle the addictive loop


  • Recognize the craving that is arising, and relax into it.
  • Accept this moment. Don’t ignore it, distract yourself, or try to do something about it.
  • Investigate the experience as it builds. Ask yourself, “What is happening in my body right now?”
  • Note what is happening. As you note pressure, dullness, tightness, or whatever, it becomes clear that these are nothing more than body sensations. You don’t have to act on them. You can simply ride out the sensations until they subside.

Being mindful can help you get past a craving. If a craving hits, try to:

  • Stop, take a breath, and notice what’s going on right now. How does your body feel? What thoughts are you having? Notice what is happening and take in the experience.
  • Imagine your craving like an ocean wave. It might feel like it gets bigger and bigger. But eventually it will become smaller and less intense, just like a wave. 
  • Recognize the physical feelings in your body that mean you’re becoming stressed. Take a moment to step away from what you’re doing and notice your breathing.
  • Take a walk outdoors. Walk slowly and really focus on being there. Notice what you see, hear, and smell. 
  • Involve yourself fully in something you enjoy, like a hobby. You’ll get positive effects from keeping your brain busy and having something else to think about instead of the craving.
  • Take a journey in your mind. Think of yourself at the beach or in a garden or the mountains…anywhere you want. Close your eyes and think about what it would feel like to be there right now. Enjoy all the little things in this beautiful place. Focusing on something else can help you get through your craving easier.
  • Formal practices consisted of: 1) the ‘body scan’ which teaches individuals to systematically pay attention to different parts of their bodies as a way to reduce habitual mind-wandering and strengthen their attentional capacities, 2) ‘loving-kindness’ meditation, which is practiced by wishing well for others, usually by repeating a phrase such as ‘may X be happy,’ and 3) ‘awareness of breath’ meditation in which attention is focused on the breath, with the additional intention of helping individuals become more aware of the present moment and refrain from habitually engaging in self-related pre-occupations concerning the future or the past. Informal practices consisted of 1) setting daily aspirations, 2) performing daily activities mindfully.  

Hair Care For Rainy Season

Along with the joy and happiness, monsoon also brings some troubles. High humidity in the air during rainy season can affect your hair as well as skin. 

Due to the pollution which is steadily on the rise, the rain which falls can contain carbon dust and other substances. Hair is at risk of being frizzy in this season. This increases the probability of dandruff, hair fall, and other problems. In fact, your hair is at its weakest condition during this time, and so, your hair needs maximum care. Following some basic tips can make your hair look healthy and shiny even during the rainy season.

Tips to protect your hair from rainy season: 

  1. As we are tempted to step out in the rain even if it is drizzling, the acidic rain can cause damage to the hair if it is not washed right away. If you have to step out in rain, use an umbrella to cover yourself.
  2. Due to the high oil secretion from the scalp during the rainy season, it is important to wash your hair at least 2-3 times a week.
  3. Using conditioner during rainy season will prevent frizziness.
  4. Styling your hair in a proper way also helps you in protecting your hair. Braiding your hair instead of leaving it open can protect hair from the damage.
  5. Use coconut oil 15 minutes before you shampooing your hair. A gentle massage will avoid hair breakage and provide deep conditioning which keeps hair healthy and smooth.
  6. Using a wide toothed comb while dealing with the wet hair is the best option.
  7. Use a microfiber towel which will absorb the water rapidly and reduce the friction between hair and towel, preventing hair fall.
  8. Proper diet is important for your hair to look healthy. It is important in any season. Adding protein-rich food like eggs, walnuts, dairy products, and whole grains along with green vegetables to your regular diet is important as they provide shine to your hair.
  9. Make sure to carry an umbrella or waterproof caps during rainy season to protect your hair from the acidic rains.
  10. Try some natural hair packs at home which don’t contain any harmful chemicals. They will moisturize the hair and keep the hair conditioned.





Dr. Y. Alekhya.



Vitiligo is a disease that causes loss of skin color in patches.

Color loss from vitiligo is unpredictable.
It will have an effect on the skin on any part of your body, It may additionally have an effect on hair and the inside of the mouth

However, vitiligo is non-contagious i.e, One person cannot catch it from another.


Vitiligo is the result of the skin’s melanocytes being destroyed. Melanocytes are cells present within the skin that produce melanin, which are responsible for giving the skin its color. Vitiligo is generally thought to be an autoimmune disease in which the body mistakenly destroys its own melanocytes. The exact cause is unknown.
It affects men and women equally and is more noticeable in darker people.

Vitiligo may run in families. You’re more likely to get it when someone else in your family has it, or when people in your family get gray hair prematurely.

There are various triggers for this skin condition, which include stress, genetic predisposition, autoimmune diseases, extensive exposure to sunlight and chemical exposure.

The main sign of vitiligo is the patchy loss of skin color. Usually, the discoloration first shows on sun-exposed areas, such as the hands, feet, arms, face, and lips.
Normally, however, it does not cause any discomfort, irritation, soreness, or dryness in the skin.

It begins as a simple spot, a little paler than the rest of the skin, but as time passes, this spot becomes paler until it turns white.
There are some other signs of vitiligo, including

Hair turning gray or white prematurely
Eyelashes or eyebrows losing color and turning white
Change of color in the retina of the eye
Color loss in the nose and mouth


Most of the time, the doctor will diagnose vitiligo by clinically identifying white patches on the skin and reviewing your medical history.

Other tests might include

Wood lamp, which uses ultraviolet light to identify pigment loss.
2. skin biopsy, which will show whether melanocytes are present in the skin. Absence or lack of melanocytes is an indication of vitiligo.
3. And also ask for a blood test to see if you have another autoimmune disease.

Few treatment options that can help minimize the appearance of the white spots are listed here.


No drug can stop the process of vitiligo
But some drugs, like steroids and antibiotics, are used alone or with light therapy, can help restore some skin tone.
corticosteroid creams and ointments containing tacrolimus or pimecrolimus may help.


Light therapy and PUVA light therapy using UV light.
Depigmentation i.e, Pigment removal from the unaffected skin.

1. Protect your skin from the sun and artificial sources of UV light by using a broad-spectrum, water-resistant sunscreen with an SPF of at least 30. Apply sunscreen generously and reapply every two hours
2. Wear clothing that protects your skin from the sun.

3. Do not use tanning beds and sun lamps.

Use concealing products that improve the appearance of the skin and help you feel better about yourself, especially if your vitiligo patches are on the exposed skin. Engage in physical activity and do things which you like may avoid anxiety, depression and psychological stress.


Dr. Krishna Priya




What is anterior cruciate Ligament?

It is ligament which joins the thigh bone (femur) to shin bone (Tibia) and which prevents the shin bone from moving forward excessively under the thigh bone.

Common causes for ACL tear:

  • Direct trauma or blow to the side or behind the knee
  • Sudden change of direction while running leading to ACL tear due to twisting of femur while tibia is stationary
  • Over extension which happens when landing from a jump.


ACL tear is accompanied by a

  • Pop sound during ligament tear followed by Intense pain
  • Immediate swelling
  • Inability to bear weight
  • Knee instability
  • Loss of range of movement

Risk factors:

  • Sports: Athletes are at risk of ACL tear due to frequent bending and twisting movements. Ex – soccer, basketball, high jump etc.
  • Gender: ACL tear is most common in women because of thigh muscle imbalances due to weak hamstrings.
  • Environmental: Uneven surface or wet surface may also contribute to ACL tear.


First line treatment is conservative management to:

  • reduce knee pain and swelling
  • increase range of knee movement
  • increase muscle strength
  • increase stability of the knee
  1. Physiotherapy
  • The above goals are achieved using a range of physiotherapy treatments such as exercise therapy. Treatment is progressed over a period of 3-6 months, and improvements are unique to each individual, depending on severity of the injury.
  1. Medications:
  • Pain and swelling can be managed by anti-inflammatories and analgesics.
  1. Surgery
  • ACL reconstruction surgery involves replacing the torn ACL with graft from the knee. Commonly harvested grafts are patella and hamstring tendon.

What can I do to help myself?

  • Protect your knee by wearing knee brace
  • Restricting knee bending and twisting movements
  • Ice your knee after exercises
  • Elevate the limb during rest
  • Do not return to any sport activities when u have weakness in muscles.




References :–conditions/anterior-cruciate-ligament-acl-injuries/



Falls are one of the common geriatric problems threatening the independence of older people. Between 30 to 40 percent of adults older than 65 years fall each year. Falls are associated with increased morbidity and mortality. Most of the falls have multiple causes as listed below

Falls are common in old age, above 65 years. People in this age group, when they fall, suffer from:

  1. 22-60%- suffer injuries
  2. 10-15 % suffers serious injuries
  3. 2-6 % suffers fractures
  4. 0.2-5% suffer hip fractures

Risk factors for falls:

  • Aging- falls increase with age and fragility of an individual
  • Gender- men tend to have fatal injuries during a fall than a women
  • Medications-medications such as diuretics, beta blockers, nitrates, antidepressants, antihistamines causes orthostatic hypotension leading to falls
  • Polypharmacy- taking four or more medications at once has drug-drug interactions and adverse reactions leading to falls
  • Alcohol abuse- alcohol abuse is one of the major risk factors for falls in all age groups
  • Diabetes- it can be one of the predisposing factor which leads to balance impairments, motor weakness and lower extremity weakness which causes tripping leading to falls
  • Visual disturbances- falls are common in visually impaired individuals.  Conditions such as presbyopia, cataract, and glaucoma lead to increased chance of falls in old age
  • Coordination and balance- musculoskeletal impairments resulting in disorders of gait and lower extremity weakness leads to falls
  • Depression- studies show that people suffering from depression are tend to fall more due to antidepressant medication and decreased physical functioning.

Interventions to prevent falls include:

Strength and balance training

Older people tend to lose muscle strength as they grow old and few lose by decreased physical activity and the loss of strength in lower limb increases risk of falling.

Strengthening exercises that target lower limbs reduces falls.

Review medications

Medications are one the reasons for falls and are modifiable risk factor for falls. Medications which have effects on central nervous system leading to drowsiness, decreased reflexes are inappropriate for older age group.

Older age group who are on antidepressants and other psychotropic drugs should be reviewed regularly.

Sedatives which are prescribed for inducing sleep should be reduced and alternative strategies to enhance sleep can be effective in reducing falls

Vitamin D supplementation:

People aged over 65 years have low levels of hydroxyl vitamin D which is associated with loss of muscle strength and muscle mass and hip fractures. Intake of vitamin d supplementation may improve the bone mineral density and muscle function and in turn reduces the risk of fall

Vitamin D supplementation at doses of 700–1000 IU a day should be taken.

Vision assessment:

People with vision impairment are more likely to fall than those with normal sight. People suffering from altered depth perception, reduced visual field and poor distance vision are associated with falls. Proper assessment and correction will help in reducing the falls.

People who are wearers of multifocal glasses are at risk of falls because objects on the ground are viewed through lower segment of multifocal glasses leading to blurred vision and impaired depth perception.

Home hazard assessment and modification:

Most of the falls occur at residence of an individual, so proper assessment of home and modification reduces the risk of falls. This can be provided by experienced occupational therapist who can organize the changes according to an individual. These can be as simple as mat removal and installation of rails

Cardiovascular assessment: Impaired balance can be attributed to cardiovascular conditions, including dysrhythmias and vasculopathies. Regular cardiovascular checkups may help in intervention of such conditions.