Medical Fields - Introduction

There are many different careers in the world. One of the largest career fields is in medicine. So this time lets talk over medical fields, and later on we will go further with the topic.

INTRODUCTION

Medicine is the field of health and healing, which includes nurses, doctors, and various other specialists. It covers so many aspects of health such as, diagnosis, treatment, prevention of disease, medical research and the list goes on..

Morden medicine has many fields and aspects. Here are some of them :

1. Clinical Practice
2. Clinical Researches
3. Biomedical Researches
4. Therapies
5. Medications
6. Surgeries

CLINICAL PRACTICE

It is a UK term, referring to the agreed-upon and customary means of delivering health care by doctors, nurses and other health professionals.

Clinical practice was formerly referred to as full time student teaching. Clinical practice serves as the culminating field experience where teacher candidates assume more responsibility of the classroom, student learning, and assessment throughout the semester.

There are some guidelines which are meant to help ensure that patients receive appropriate treatment and care

CLINICAL RESEARCHES

Clinical research are studies performed in people that are aimed at evaluating a medical, surgical, or behavioral intervention. They are the primary way that researchers use to find out if a new treatment, like a new drug or diet or medical device is safe and effective in people or not.

BIO-MEDICAL RESEARCHES

Biomedical researches are techniques that are used by scientists to study biological processes and diseases. Their aim is to develop successful treatments and cures.

Biomedical research requires careful experimentation, development, and evaluation. It involves biologists, chemists, doctors, pharmacologists, and others.

THERAPIES

Therapy is the treatment of someone with mental or physical illness without the use of drugs or operations. These include :

• Psychotherapy
• Physical therapy
• Occupational therapy

MEDICATION

It deals with the usage of drugs and medicines for the treatment, care and also for the prevention of a particular disease or infection. It includes:

• Alternative medicines
• Complementary medicines

SURGERIES

The exact definition of surgery is as follows

"It is the branch of medical practice that treats injuries, diseases, and deformities by the physical removal, repair, or re-adjustment of organs and tissues, often involving cutting into the body."

It is a sterile procedure where they use instrumental and manual means rather than medication.

REACHING TO THE CONCLUSION

This was just an introductory part. Later on we will be discussing on various sub topics under Medical Fields such as, different aspects, fields, professions and many more.

Wishing you good health and more happiness with each coming day.
Stay healthy and safe.

 

-Jeslin Mariam Jose

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DIABETES MELLITUS

Diabetes Mellitus (DM), more commonly or simply known as diabetes, is a very common disease that all of us are familiar with. It affects nearly 10% of the world population and over 25%  or 1 in 4 people over the age of 65 have diabetes. Okay, leaving all these data behind, we all know someone who is diabetic in our family or among our near and dear ones, right? So this time let's talk about a very common and also a very familiar disease condition in detail.

Coming to the topic, Diabetes Mellitus is a group of diseases that results in too much sugar in the blood, or it can also be termed as a metabolic disease that causes high levels of glucose (sugar) in the blood.

In simple language, normally after we eat or drink, our body breaks down the sugar from those foods we consumed and use them in our cells for energy. To facilitate this process, a hormone called Insulin is produced by the Pancreas. Insulin basically pulls sugar from the blood and gives it to the cells. Diabetes Mellitus occurs when the body has some trouble moving glucose from the body into the cells because of insulin deficiency, resulting in a high glucose level in the blood.

TYPES

Type 1 Diabetes Mellitus -

It is a condition where the body does not make enough insulin to control blood sugar levels. Type 1 diabetes was previously called insulin-dependent diabetes or juvenile diabetes. It is basically an autoimmune disorder in which the immune system attacks its own insulin-making cells in the body. These cells are known as beta cells. This is usually seen in children and young people and is called as Juvenile Diabetes.

Type 2 Diabetes Mellitus -

Type 2 DM is more common than Type 1 DM and is also a chronic disease condition. It is also known as Adult-onset Diabetes because it is seen usually in middle and late adulthood. This can be caused either due to insulin resistance i.e, the body's cells don't respond normally to the insulin produced, or due to insufficient production of insulin by the pancreas. 

Gestational Diabetes - 

It is a condition during pregnancy when the blood sugar level rises. This happens with those pregnant women who haven't ever been diagnosed with diabetes earlier. It usually subsides after delivery can cause serious complications to the baby. If it doesn't subside after delivery, then this can be developed as Type 2 Diabetes Mellitus in the mother later in life.

Other types :

LADA (Latent Autoimmune Diabetes in Adults)-

It is a slow-progressing form of autoimmune diabetes. LADA occurs when the pancreas stops producing adequate insulin, most likely from some "insult" that slowly damages the insulin-producing cells in the pancreas.

MODY (Maturity Onset Diabetes of Youth) -

It is an inherited form of Diabetes Mellitus which is caused by errors, or mutations, in a single gene, and in most cases, the gene mutation is inherited from a parent. 

Secondary Diabetes Mellitus -

Secondary Diabetes can be defined as a diabetic condition that develops after the destruction of the beta-cells that results as a consequence of another disease or any medical condition.

Health conditions that can result in Secondary Diabetes include:

• Cystic Fibrosis
• Hemochromatosis
• Chronic Pancreatitis
• Polycystic Ovary Syndrome (Pcos)
• Cushing’s Syndrome
• Pancreatic Cancer
• Glucagonoma

SYMPTOMS

Symptoms of Diabetes Mellitus vary depending upon the level of blood sugar elevated. People who have been diagnosed with prediabetes (a condition in which blood sugar is high, but enough to be type 2 diabetes) or type 2 diabetes, may sometimes not experience any symptoms. 

Some common symptoms are :

• Thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there is not enough available insulin)
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as gums or skin infections and vaginal infections

RISK FACTORS

As we all think or say, sugar isn’t always the primary cause of diabetes, though consuming a lot of sugary food items can definitely contribute to increased glucose levels in the blood and also cause tooth decay. The exact cause of diabetes mellitus is still not known but here are some of the risk factors of DM :

Hereditary -

Family history plays a significant cause in diabetes in its next generation. If you have a family history or a personal history of gestational diabetes, then you are at a higher risk. 

Race -

Belonging from the African-American race, Native American, Pacific Islander, or Asian-American increases the risk of getting diabetes mellitus.

Autoimmune disease  -

A self-attack on the body parts can also cause diabetes as in case of type 1 Diabetes Mellitus.

Age -

The risk of developing Diabetes Mellitus increases with the increasing age. 

Injury -

Any harm or injury to the pancreas can also cause diabetes through infection, tumor, accident, or surgical procedures. 

Other risk factors include -

• Smoking
• High blood pressure
• Abnormal blood cholesterol or triglyceride levels
• Obesity
• Intake of medication, like steroids

COMPLICATIONS

Long-term complications of diabetes develop gradually. The longer you have diabetes and the less controlled your blood sugar the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. These include:

Cardiovascular disease -

Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, and narrowing of arteries (atherosclerosis). If you have diabetes, you're more likely to have heart disease or stroke.

Nerve damage (neuropathy) -

Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning, or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

Kidney damage (nephropathy) -

The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.

Eye damage (retinopathy) -

Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

Foot damage -

Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot, or leg amputation.

Skin conditions -

Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.

Hearing impairment -

Hearing problems are more common in people with diabetes.

Alzheimer's disease -

Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.

Depression -

Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.

REACHING TO THE CONCLUSION

NOTE - IF YOU ARE HAVING ANY OF THESE SYMPTOMS OR YOU FEEL THAT YOU MIGHT BE DIABETIC, I RECOMMEND YOU TO CONSULT A DOCTOR AND NOT TO SELF DIAGNOSE ANY DISEASE. DOING THIS CAN CAUSE SERIOUS COMPLICATIONS AND IS DANGEROUS. IN THE SAME WAY, DO NOT SELF MEDICATE YOURSELF, RATHER I URGE YOU TO TAKE MEDICAL OPINIONS.

Hope you all have attained some more information about Diabetes Mellitus. This year let us all be happy and healthy, eating good food, staying fit and energetic, and making this year a better one by creating good memories and doing our best at everything.
Stay healthy, stay safe.

Jeslin Mariam Jose

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ANEMIA

We all have some knowledge about Anemia, right? Like what it is, why it occurs, some common symptoms, and all. It is a very common blood disease and a serious global public health problem.

WHO estimates that 42%of children less than 5 years of age and 40%of pregnant women worldwide are anemic.

So this time we will go through the topic ANEMIA, its standard definition, categorizations, symptoms, and causes. Here we begin.

DEFINITION

According to the World Health Organization (WHO), Anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men.

Anemia is a condition in which the number of red blood cells or the hemoglobin concentration within the cells is lower than normal. Hemoglobin is needed to carry oxygen and if the Red Blood count in a body is too low or abnormal, or not enough hemoglobin, then there will be a decreased capacity of the blood to carry oxygen to the body’s tissues which results in symptoms.

CLASSIFICATION OF ANEMIA

Anemia can be classified in two different ways :

 ETIOLOGICAL CLASSIFICATION -

The etiological approach classifies anemia based on causes, which can be further divided into three groups :

Decreased RBC production :

In this case, enough Red Blood Cells may not be created in the body, or they may not function in the way they should, because of insufficient minerals and vitamins needed in the formation of RBCs.

The things that typically decrease RBC production, causing anemia, include:

• Inadequate stimulation of red blood cell production by the hormone erythropoietin, which is produced by the kidneys.
• Inadequate dietary intake of iron, vitamin B12, or folate.
• Hypothyroidism (under-active thyroid).

Increased RBC destruction :

The destruction of RBCs is called hemolysis. It can be caused due to an autoimmune problem in which the immune system malfunctions and sees your own RBCs as foreign substances and destroys them. Many more conditions are resulting in increased RBC destruction hence causing anemia.

Blood loss :

We all know that blood is made up of 4 main components i.e, Red Blood Cells, White Blood Cells, Plasma, and Platelets. So when there occurs severe blood loss, the RBCs are also decreasing. Not only in severe conditions, but this can also happen slowly over a long period of time, without being noticed by us. The best possible example of this is Menstruation. Women who suffer from heavy menstrual periods are more prone to this type of anemia where red blood cells are lost to bleeding. Other conditions include :

• Accidents
• Child Birth
• Post Surgical bleeding
• Liver cirrhosis
• Excessive Uterine bleeding
• Fibrosis (scar tissue) within the bone marrow
  
  

MORPHOLOGICAL CLASSIFICATION -

The morphological approach categorizes anemia based on the size of RBCs (e.g. the Mean Corpuscular Volume - MCV), This is also further arranged into three groups :

Microcytic (small RBCs) :

Microcytic Anemia is defined as the presence of small, red blood cells in a peripheral blood smear and is usually characterized by a low MCV (less than 83 microns 3). 

Normocytic (normal-sized RBCs) :

In Normocytic anemia, the Red Blood Cells are normal sized but in a very low number. The mean corpuscular volume (MCV) in Normocytic anemia is between 80 and 100 femtolitres (fL), which is within the normal and expected range but, the hematocrit and hemoglobin are decreased.

Macrocytic (large RBCs) :

Macrocytic anemia is a type of anemia that causes unusually large red blood cells. Red blood cells larger than 100 fL are considered macrocytic.

So these were the grouping or categorization of Anemia. Now let us move on to the types of Anemia one by one.

TYPES OF ANEMIA

There are more than 400 types of Anemia at present, yeah of course we can't talk about all of those now, so we will only focus on the main types of anemia. Here they are :

Iron Deficiency Anemia -

This is the most common type of anemia among the population. As the name implies, Iron Deficiency Anemia occurs due to insufficient iron in the body. Without enough iron, our body can't produce enough Hemoglobin - a substance in red blood cells that enables them to carry oxygen.

This can cause due to the inability of the body to absorb iron from food that we consume, or because of less intake of iron-rich food. In terms of pregnant and breastfeeding mothers, even after taking iron-rich food and the body being able to absorb iron, some women may diagnose Iron Deficiency Anemia. This is because, the body needs more iron in these conditions, than what is normally required.

Megaloblastic Anemia -

Megaloblastic anemia is caused when RBCs are not produced properly, like, the cells may be too large in size, and may not be fully matured. These cells fail to exit the bone marrow to enter the bloodstream and deliver oxygen because of this abnormal structure. 

It is caused by medications or inherited defects in the metabolism of vitamin B12 or folic acid.

Pernicious Anemia -

It is a type of megaloblastic anemia in which the body is unable to absorb vitamin B12 due to a lack of intrinsic factor in stomach secretions, leading to decreased RBCs

It is an autoimmune condition that is rarely be found in 0.1 percent of the total population. People over 60 years of age are the highly vulnerable group are those who are thought to be affected by this condition.

Hemolytic Anemia -

 It is a type of anemia in which red blood cells are destroyed faster than they can be made. The destruction of red blood cells is called hemolysis. 

It can be caused due to medication reactions, diseased heart valves, autoimmune conditions, and many more. Hemolytic Anemia can be divided into two :

• Inherited Hemolytic Anemia
• Acquired Hemolytic Anemia

In Inherited Hemolytic Anemia there are 2 other types of anemia,

• Sickle Cell Anemia -
  In this, the red blood cells have an abnormal crescent shape, block small blood vessels, and do not last as long as normal red blood cells.
• Thalassemia -
  In this, the body produces an abnormal form of hemoglobin which results in excessive destruction of RBCs.
  
  

Aplastic Anemia -

It is a condition that occurs when our body stops producing enough new blood cells.

Aplastic anemia occurs as a result of bone marrow damage. The damage may be present at birth or occur after exposure to radiation, chemotherapy, toxic chemicals, drug effects, or infection.

SYMPTOMS OF ANEMIA

The symptoms of anemia vary from person to person. It depends on how severe the anemia is and how quickly it develops. Usually, the symptoms increases as anemia get worst.

Some symptoms include:

• Weakness and loss of energy
• Dizziness
• Headache
• Sore tongue
• Pale skin, dry skin, or easily bruised skin
• Unintended movement in the lower leg
• Rapid (fast) heartbeat
• SOB (Shortness Of Breath)

Symptoms of Anemia

REACHING  TO THE CONCLUSION

NOTE - IF YOU ARE HAVING ANY OF THESE SYMPTOMS OR YOU FEEL THAT YOU MIGHT BE ANEMIC, I RECOMMEND YOU TO CONSULT A DOCTOR AND NOT TO SELF DIAGNOSE ANY DISEASE. DOING THIS CAN CAUSE SERIOUS COMPLICATION AND IS ABSOLUTELY DANGEROUS. IN THE SAME WAY, DO NOT SELF MEDICATE YOURSELF, RATHER I URGE YOU TO TAKE MEDICAL OPINIONS. 

Hope you all have attained some more information about Anemia. Eat healthy and iron-rich foods and get enough of vitamin B12 and folic acid in your diet, so as to prevent anemia.
This year, let us be healthy, staying away from all illnesses and preserving our precious health, after all, we are fighting a great pandemic and have made it till now. Let us carry a hope that at least this year we will be able to fight this Covid 19 efficiently and completely.

Stay Healthy and Safe.

-JESLIN MARIAM JOSE

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EVOLUTION OF HEALTH CARE

How do you feel when you are having a fever and not able to do things of your interest? None of us will be happy about that and never want to be on sick beds right? We all wish for good health but sometimes even after giving our best, we do fall sick because of the environment, climate, or any virus invasion. But nothing to worry much about, as now, in this present scenario we have treatments and solutions for everything. Do you know where the root begin? So here, we will look forward to the history of health care and the evolution of medical science. Let's begin with the word "Health".

HEALTH

The word health is originated from the word 'Hale' (old English) which means "wholeness, being whole, sound or well."

The standard definition of Health by the World Health Organization in the year 1948 :
"Health is a state of complete physical, mental, and social well-being and not merely the absence of any disease or infirmity."

HEALTH CARE THROUGH THE TIMES

Primitive Times (4000 BC - 3000 BC) :

People at those times believed that illnesses and diseases were caused by evil spirits and demons. Because of this reason, they used to call tribal witch doctors to treat them with ceremonies to drive out evil spirits so that they can get rid of their illnesses

Even though their perception of illnesses was different and had firm beliefs, they still used herbs and plants to cure diseases along with some medicines like Morphine as an analgesic (pain reliever) which is still in use.

Not only the medicines, there found pieces of evidence of Trepanation, the first surgical procedure. It was the practice of drilling or cutting a hole through the skull to expose the brain. This was thought to cure mental illness, migraines, and epileptic seizures.

Ancient Romans (753 BC - AD 410) :

They were the first to organize health care by providing treatment to soldiers. They had a system of Public Health and Sanitation (aqueducts/sewers), and drained wetlands to reduce the spread of Malaria. Their life expectancy was about 35 years.

Ancient Egyptians (3000 BC - 300 BC) :

The Ancient Egyptians believed that body consists of a system of channels or ducts ("Metu"). They followed the practice of Bloodletting, which is withdrawing blood from a person's veins for therapeutic reasons and is thought to have originated in Ancient Egypt only.

As we all know about their practice of preserving dead bodies as Mummies. It was not just a burial but using special processes, they removed all moisture from the dead body, leaving only a dried form that would not easily decay. This meant that they were having a good understanding of the human body and also learned something about how the body works.

Ancient Chinese (1700 BC - AD 220) :

China has one of the world's best and oldest medical systems. The TCM (Traditional Chinese Medicine) philosophy proposes that everything including the organs of the body is composed of five elements: fire, earth, metal, water, and wood.

They used this method called Acupuncture as a medical technique for relieving pain, curing disease, and improving general health. TCM also includes herbal medicines, remedies, massage, exercises, and diet therapies.

Ancient Greeks (1200 BC - 200 BC) :

The ancient Greeks, the ones who embraced the concept of “a healthy mind in a healthy body,” and their view of medicine incorporated both physical and mental wellbeing.

The most famous and probably the most important medical figure in ancient Greece was Hippocrates, who we know today as “the father of medicine.” He developed an organized method to observe the human body and also recorded signs and symptoms.

Aristotle, another great mind that ever existed, is indeed the godfather of evidence-based medicine. His teachings of logic and philosophy have been a driving force continuously guiding medicine away from superstitions and more towards scientific methods. He is known as "the father of biology" because he was fascinated with wildlife which led to the birth of a new science known as Biology.

Ancient Romans (753 BC-AD 410) :

They made progress in many areas with advanced knowledge and practices such as the provision of public health facilities, sanitation systems, development of medicines, and a lot more.

Aelius Galenus or Claudius Galenus, a physician who was first to describe correctly the function of kidneys and believed that human health requires an equilibrium between the four main bodily fluids (humor): blood, yellow bile, black bile, and phlegm.

Dark Ages (AD 400 - AD 800) :

Diseases and sicknesses were very common during this period due to lack of hygiene. No importance was given to the study of medicines and they mainly focused on curing the disease rather than their causes. Often it was believed that the cause of the disease was supernatural.

Middle Ages (AD 800 - AD 1400) :

During this period, several steps were taken for public health which includes, attempts to cope with the unsanitary conditions of the cities and, utilizing quarantine, to limit the spread of diseases, also the establishment of hospital and provision of medical care and social assistance. Around 3/4th population of Europe and Asia were killed.

Renaissance (AD 1350 - AD 1650) :

Artists, such as Michelangelo and Leonardo Da Vinci, studied the human body closely to replicate it in the art which helped to further increase their medical, especially anatomical knowledge.

The printing press allowed for information to be distributed to a wide audience which helped to spread new scientific discoveries and to share knowledge and awareness with the people.

During this time only, the first set of Anatomy books "De Humani Corporis Fabrica Libri Septem" were published by Andreas Vesalius.

16th and 17th Centuries :

Even at these times, the causes of diseases were still not known.

Ambroise Pare, who is considered as one of the fathers of surgery and modern forensic pathology, introduced many surgical instruments and contributed both to the practice of surgical amputation and to the design of limb prostheses.

Another personality, William Harvey was an English physician who made influential contributions in anatomy and physiology being the first to recognize the full circulation of the blood in the human body.

18th Century :

Some important inventions made during this period include;

• Daniel Gabriel Fahrenheit, a physician, invented Mercury-in-glass Thermometer and Alcohol Thermometer
• The invention of Bifocals by Benjamin Franklin.
• Edward Jenner developed the vaccination for smallpox

19th Century :

The 19th century witnessed several significant developments by great personalities. Pointing down some of them briefly -

• French Barbers - Acted as surgeons by extracting teeth, using leeches for treatment, and giving enemas
• Dr. James Blundell - Performed the first human blood transfusion for the treatment of hemorrhage in 1818.
• Rene Laennec - Invented Stethoscope in the year 1819.
• Elizabeth Blackwell - First Female physician in the US (1849).
• Florence Nightingale - Founder of modern Nursing, also referred to as "The Lady with The Lamp".
• Joseph Lister - Began the use of disinfectants and antiseptics in surgery in 1865 to prevent infection.
• Louis Pasteur -  Best known for inventing the process that bears his name, Pasteurization. In 1885, while studying rabies, he developed the vaccination for Rabies.
• Dmitri Iosifovich Ivanovsky - A Russian botanist, he discovered viruses and is one of the founders of virology.
• Wilhelm Conrad Rontgen - A German mechanical engineer and physicist, who, on 8 November 1895, produced and detected electromagnetic radiation in a wavelength range known as X-rays or Rontgen rays. He won the inaugural Nobel Prize in Physics in 1901 for this achievement.

20th Century :

A rapid growth in modern healthcare occurred during this period. Many unidentified diseases were found, studied, treated, and cured. Standard of care was established, technology integrated into healthcare, and is used in every aspect of medical care today.

Some important personalities and their contributions during this period are as follows-

• Karl Landsteiner - He distinguished the main blood groups in 1900, hence developing the modern system of classification of blood groups.
• Sigmund Freud -Formed the basis for Psychology and Psychiatry, and is a founder of psychoanalysis.
• Frederick Banting and Charles Best - Discovered and successfully isolated the hormone insulin for the first time in 1922.
• Sir Alexander Fleming - Discovered the antibiotic Penicillin in the year 1928.
• George Papanicolaou - Discovered "Pap Smear" to detect cervical cancer in females.
• Jonas Edward Salk - An American virologist and medical researcher who developed one of the first successful polio vaccines in 1952.
• Francis Crick and James Watson - discovered the structure of DNA, our genetic blueprint in the year 1953.
• Christian Barnard - Performed first Heart transplant in the year 1968.
• Sir Godfrey Housefield - Invented the first CT scanner at EMI Central Research Laboratories using x-ray technology in 1967.
• Louise Brown - In 1978, the first Test tube baby was conceived in a laboratory.
• Ben Carson - First to separate conjoined twins and had pioneered many new procedures.

The earliest known case of infection with HIV-1 in a human was detected in a blood sample collected in 1959 from a man in Kinshasa. In 1981, the first case of Acquired Immune Deficiency Syndrome (AIDS) was identified.

 

REACHING TO THE CONCLUSION :

So this was a quick and brief history of healthcare throughout the years. Apart from all these, there are still more contributions and achievements in health care and of course, many more to come.

In this present scenario, we all are very much concerned about our health because of the spread of a novel Coronavirus. This pandemic made us realize that above everything health is important. Don't panic, don't fear these illnesses, but be brave and protect yourself. Yes, it is easier said than done, but we all are fighting against it. 

Stay safe and healthy.

- Jeslin Mariam Jose

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