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Sri Krishna Hospital

General Physician Clinic

#59, Sri Krishna Hospital, Bannerghatta Road, Hulimavu Bangalore
1 Doctor
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Sri Krishna Hospital General Physician Clinic #59, Sri Krishna Hospital, Bannerghatta Road, Hulimavu Bangalore
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Our medical care facility offers treatments from the best doctors in the field of General Physician . We will always attempt to answer your questions thoroughly, so that you never have to......more
Our medical care facility offers treatments from the best doctors in the field of General Physician . We will always attempt to answer your questions thoroughly, so that you never have to worry needlessly, and we will explain complicated things clearly and simply.
More about Sri Krishna Hospital
Sri Krishna Hospital is known for housing experienced General Physicians. Dr. Suresh Shetty, a well-reputed General Physician, practices in Bangalore. Visit this medical health centre for General Physicians recommended by 80 patients.

Timings

MON-SAT
09:00 AM - 09:00 PM

Location

#59, Sri Krishna Hospital, Bannerghatta Road, Hulimavu
Hulimavu Bangalore, Karnataka - 560076
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Dr. Suresh Shetty

BAMS
General Physician
26 Years experience
Available today
09:00 AM - 09:00 PM
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How To Prevent Alzheimer's Disease?

M. Ch (Neuro Surgery), MS - General Surgery, MBBS
Neurologist, Gurgaon
How To Prevent Alzheimer's Disease?

Alzheimer’s disease is a neurological, irreversible, progressive brain disorder. It is a chronic neurodegenerative dementia that causes the death of brain cells, causing memory loss and cognitive decline. It affects a person’s thinking and behavior. The symptoms develop slowly and get worse as time passes.

Causes:
As it is a kind of dementia, Alzheimer’s is caused by the death of brain cells. Over a course of time, brain cells die progressively and at the end, the tissue is left with fewer nerve cells and connections. As a result, the total brain size shrinks. Tiny inclusions called plaques and tangles can be seen in the postmortem. These cannot be seen or tested in a living Alzheimer’s affected brain. These plaques are given the name “amyloid plaques” because they are found among the dying cells of the brain when a protein called beta-amyloid builds. The tangles stay in the neurons; they are formed from a protein called tau.

There are several reasons behind all this, some of which are listed below-

  1. Anti-anxiety medications
  2. Hitting on the head too many times
  3. Regularly sleep-deprived
  4. Loneliness
  5. Diabetes in the brain
  6. Old age
  7. Genetic line
  8. Down’s syndrome
  9. Cardiovascular diseases

Symptoms:
Alzheimer’s disease damages the brain, so the clinical signs and symptoms begin to show very early. The symptoms are-

  1. Memory loss
  2. Agitation and mood swings
  3. Poor judgment
  4. The trouble with money calculations
  5. Difficulty doing familiar tasks
  6. Trouble in planning or solving a problem
  7. Confusion with time and place
  8. Difficulty in communicating
  9. Loss of motivation
  10. Inappropriate behavior
  11. Aggressive personality
  12. Childlike behavior

Preventing Alzheimer’s disease:
Alzheimer’s disease ultimately results in death. Even if there are treatments, they cannot fully cure it. So it’s better to try to prevent it before it happens. Ways to prevent Alzheimer’s disease are-

  1. Eating more fruits and vegetables.
  2. Eating berries every day.
  3. Increasing omega-3 fatty acids.
  4. Taking folic acid supplements.
  5. Drinking grape juice or red wine with evening meal.
  6. Doing the Mediterranean style diet.
  7. Controlling the blood pressure.
  8. Having strong social support.

Treatment of Alzheimer’s disease:

  1. Treatment of Alzheimer’s disease is a long time process.
  2. First of all, doctors perform a physical exam to check the overall neurological health. By this, they check muscle strength, reflexes, walking ability, sense of sight and hearing, coordination and balance.
  3. Then comes the blood test to find the cause of confusion and memory loss by checking the thyroid disorder and vitamin deficiency.
  4. Then they perform the neuropsychological test and check the mental status.
  5. Then there are other tests, like MRI, CT, and PET.
  6. After all this, drugs are given and a safe and supportive environment is created with proper exercise and nutrition.

Alzheimer’s disease is undoubtedly the worst kind of disease. Hence, it is highly recommended to contact a doctor as soon as any symptom is noticed.

Premature Menopause - What Causes It?

MBBS, MS - Obstetrics and Gynaecology
Gynaecologist, Ahmedabad
Premature Menopause - What Causes It?

During the natural course of events, a women's body starts its reproductive phase with menarche and at about 50 years of age, attains menopause. This is when the reproductive function ceases and the ovaries stop producing the hormone estrogen and progesterone. In some cases, for various reasons including medical, the ovaries stop functioning earlier, and this is medically termed early or premature menopause. Menopause that occurs before 40 years of age is termed premature menopause; it is due to primary ovarian insufficiency and occurs in 1% of the women.  If it occurs between 45 to 50 years, it is termed early menopause.

Causes: Normal ageing, family history, genetic disorders, autoimmune disorders, toxins, and surgery are some reasons that could lead to premature menopause.

Effects: Estrogen and progesterone have a lot of beneficial effects on a women's body. Reduction in their levels leads to some of the below changes:

-        Emotional changes like mood swings, irritability, and in some cases depression, especially in premature menopause.
-        Irregular cycles before complete cessation of the menstrual cycles.
-        General mucosal dryness leading to vaginal dryness, dry skin, dry eyes.
-        There also would be urinary incontinence and reduced sex drive due to reduced hormone levels.
-        For women who still would want to have children, infertility would be a big cause for concern. This could lead to other emotional issues, worsening the depression.
-        Osteoporosis - Bones lose their density and get weak and are more prone to fracture.
-        Cardiovascular health - Post menopause, women are more prone to heart attacks and stroke. Though not fully proven, this is believed to be true as the good role that estrogen plays on blood vessels is negated with menopause.
-        Accelerated ageing - Menopause leads to accelerated damage of genetic structures, thereby leading to faster ageing. This also leaves a feeling in the women of being less attractive and less desirable.

There is also a good news, that after menopause women are at lesser risk of cancer - especially breast and ovarian. 

It is not easy for women to handle premature menopause. The body undergoes some changes much earlier than expected, and it requires a lot of support and caring and comforting to come to terms with it - especially if associated with infertility or chemotherapy for cancer. Emotional issues of not being able to have children and feeling less attractive require frank talks to boost the person's confidence and increase self-worthiness.

It is easier said than done, but one of the key ways to handle premature menopause is an open discussion.

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Hernia - Knowing The Types & Role Of Laproscopy!

MS - General Surgery
General Surgeon, Pune
Hernia - Knowing The Types & Role Of Laproscopy!

Laparoscopy surgery is the modern approach to the hernia repair. Studies have demonstrated rapid recovery, less pain, small incisions and early return to work as the benefits of laparoscopic surgery approach. Patient who is fit for General anaesthesia can undergo laparoscopic surgery if not contraindicated otherwise. Candidates for this approach of surgery are the ones who have bilateral inguinal hernias, ventral incisional hernia, umbilical hernia, Paraumbilical hernia and those with recurrence.

Laparoscopic hernia repair- inguinal

A laparoscopic surgery requires an incision of 1-2 cm near the belly button. Small telescope is passed inside the tissue plane. A tiny camera is attached to the near end and large images of the part being operated are seen on the monitor. Few other small punctures are done to pass operating instruments inside. Those operating instruments have a very tiny diameter.

The Procedure:

Camera and telescope unit help in visualising the part and the operating instruments help in doing the actual surgery. Initially the proper space is created. Hernial defect is delineated and the weakness is protected by covering the defect with an inert mesh. Use of the mesh ensures tension-free repair. This mesh reinforces the weak part of the abdominal wall muscles and acts as scaffolding for future deposition of fibrosis by healing process.

Same principle applies to various other types of hernia. The only difference being the type and the size of the mesh used and the quality of the mesh desired for the particular type. Cost of the mesh differs as per the type of the mesh and fixation device required.

Fixation of the mesh is done using either by suturing techniques or various other fixation devices. Rapid recovery, less pain, early return to work and tiny incisions are the advantages of laparoscopic hernia surgery. While the need for general anaesthesia, discomfort of occasional seroma formation, discomfort of transfacial sutures, increased cost and operating time are the downsides.

Cases been reported in whom mesh removal was needed as well. Hernia needs surgery for its repair. Open hernia repair and laparoscopic hernia repair are the two options available. The patient should choose the option by having a full discussion with his surgeon. Presently more and more patients are choosing laparoscopic hernia repair approach for many advantages this technique offers.

Acute Kidney Failure - Know Its Causes!

MD - Medicine, DM - Nephrology, MBBS
Nephrologist, Guwahati
Acute Kidney Failure - Know Its Causes!

You're said to suffer from the problem of acute kidney failure if your kidneys suddenly stop working and lose their ability to eliminate waste materials including excess fluids and salts from the blood. The condition usually develops quickly over a few days or even a few hours. When this happens, waste materials accumulate in your blood, disrupting the chemical balance of your bloodstream.

So, what causes this problem?

Acute kidney failure can occur because of any one of these reasons:

1. A drop or slowdown of blood flow to the kidneys - Adequate blood circulation to the kidneys is of great importance as without it the kidneys may end malfunctioning. If blood flow to the kidney is hampered, a part of or the entire kidney may die. You may suffer from acute kidney failure if blood flow to the kidneys gets impaired due to conditions like

2. Urinary obstructions - A sudden blockage that hampers your kidney's ability to eliminate urine can also bring about acute kidney failure. When this happens, it leads to a build up of toxins in the body, causing an overload of the kidneys. Conditions that bring about this urinary obstruction include:

3. Disease within the kidneys - Even instances of clotting within the blood vessels of the kidneys can lead to acute kidney failure. This is because if the movement of blood cells within the blood vessels gets hampered, kidneys are not able to filter out toxins from the body. The conditions and diseases that may cause clotting, and subsequently damage to the kidneys include:

  • Scleroderma (an autoimmune disease that affects connective tissues and skin)
  • Build-up of cholesterol deposits
  • Glomerulonephritis (an inflammatory condition of the kidney's ball-shaped structures called glomeruli)
  • Hemolytic uremic syndrome (a condition that occurs due to untimely death of red blood cells)
  • Lupus (a disorder of the body's immune system that brings about damage to the body's own organs and tissues)
1 person found this helpful

Heart Valve Disease - Know Symptoms Of It!

MBBS Bachelor of Medicine and Bachelor of Surgery, DNB-Cardialogist, DM - Cardiology
Cardiologist, Bangalore
Heart Valve Disease - Know Symptoms Of It!

Complications in the heart valve occur when the functioning of the heart valve is impaired. Valves of the heart allow the blood in one direction and prevent the blood from flowing back into the ventricles of the heart.

Heart valve diseases can be classified as follows:

1. Valvular stenosis:
This condition occurs when the valves of the heart do not open completely due to stiffness. As the opening is narrow, the heart has to work hard to pump blood. This condition may lead to heart failure.

2. Valvular insufficiency:
This is a condition where the valve does not close tightly. This causes some of the blood to flow back to the valve. As this condition deteriorates the heart has to work harder to pump blood. 

Types and Causes of valve diseases:

1. Acquired valve disease 
The structure of the valve changes due to various infections or rheumatic fever. Rheumatic fever is caused by bacterial infection that had not been treated. It tends to occur in children and cause inflammation of the valves of the heart.

2. Congenital valve disease
This condition usually affects the pulmonary valve where the size of the valve is abnormal.

3. Bicuspid aortic valve disease
It is a type of valve disease that impairs the aortic valve. Instead of the regular three cusps, the bicuspid valve only has two. This may cause the valve to be stiff or cause it to leak.

4. Mitral valve prolapse
This condition causes the valve to flop back when the heart contracts. This condition also causes the leaflets of the valve to turn irregularly and cause it to stretch. This condition causes the valve to leak.

Symptoms:

The symptoms of valve disease are as follows:

1. Weakness: This condition may cause weakness and cause severe discomfort while performing daily activities.
2. Palpitations: Symptoms such as irregular heartbeats, skipped beats and rapid heart rhythm occurs in this condition.
3. Rapid weight gain: This condition can cause you to gain weight very rapidly.
4. It may cause swelling in your ankles, abdomen and feet.
5. This condition causes shortness of breath
 

1 person found this helpful

Psoriasis - Homeopathic Approach To Treat It Well!

B.H.M.S., Homoeoapthy, C.S.D Skin Disease ( Dermatology), Child Health (Pediatric) CCH
Homeopath, Ahmedabad
Psoriasis - Homeopathic Approach To Treat It Well!
  1. What is Psoriasis

Psoriasis is a common skin disease characterized by thickened patches of inflamed, red skin covered with thick, silvery scales. The elbows and knees are the most common areas affected by psoriasis. It will often appear in the same place on both sides of the body. The patches can range in size from smaller than a dime to larger than a hand. 

Description of Psoriasis-

Normally, skin cells mature and shed after about a month. In psoriasis, the cell maturation speeds up, taking only three to four days. Because the lower layer of skin cells divide more rapidly than normal, dead cells accumulate in thicker patches on the skin's outermost layer called the 'Epidermis'. 

Forms & Classifications-

Psoriasis occurs in a variety of forms that differ in their intensity, duration, location, shape and pattern of scales. The most common forms are: 

  1. Plaque Psoriasis: Plaque psoriasis is the most common form of psoriasis. It is characterized by raised, inflamed, red lesions covered with a silvery-white buildup of dead skin cells (scales). This is found primarily on the Body, elbows, knees, scalp and finger or toe nails. 
  2. Guttate Psoriasis: Guttate psoriasis occurs most frequently in children and is characterized by numerous small, red, drop-like scaly macules that develop rapidly over a wide area of skin. This may appear following an infection, most frequently strep throat
  3. Inverse Psoriasis: Inverse psoriasis occurs in the armpit, under the breast, in skin folds, around the groin, in the cleft between the buttocks and around the genitals. It is usually pink and irritated but lacks the thick scale seen in other forms of psoriasis. 
  4. Pustular Psoriasis: Pustular psoriasis is a rare form characterized by small pustules (whitehead-like lesions) found all over the body or confined all over the body or confined to the palms, soles and other isolated areas of the body. 

Some dermatologists classify psoriasis as mild, moderate, or severe- Mild psoriasis is considered to be scaling over less than 5-10 percent of the body, moderate psoriasis is considered to be scaling over 10 to 20 percent of the body and severe psoriasis is considered to be scaling more than 20 percent of the body. 

In 5 percent of all psoriasis sufferers, arthritis will develop. This condition is called psoriatic arthritis. Arthritis is inflammation of a joint, usually accompanied by painswelling and changes in joint structure. 

Causes: 
The underlying psoriasis cause is unknown; however, it can be genetically inherited or passed from generation to generation. Most researchers agree that the Auto Immunity is somehow mistakenly triggered, which speeds up the growth cycle of skin cells. Psoriasis can be triggered by a number of factors, such as stress, climate changes, streptococcal or HIV infection, superficial wounds, physical illness, or taking certain drugs such as lithium, beta-blockers such as propranololquinidine (Heart medication) or antimalarial medications. 

Treatment-
Homeopathy is preferred over other methods due to the reason that it does not entail any side effects. Instead of suppressing inflammation like other methods of treatment, it aims to cure the root cause of the disease. Yes, psoriasis can be cured permanently through constitutional Homeopathy treatment but the question is how can a patient know whether eruptions are disappearing for permanently or temporarily? 

Permanent Cure takes place as follows: 

Cure is taken place from Upward to downwards and Center to periphery. First, the cracks come down with arresting of blood coming out from it. After that, the eruption on scalp comes down, if the scaling is thick it becomes gradually thin and then becomes powdery and with time, the scaling disappears totally. After that, eruptions on face and body come down, and at same time eruptions in hands & legs may increase with itching. Eruptions on elbows reduce, after sometime eruptions near to hands, also reduce. While eruptions on legs itches more. However, eruptions on legs also get disappeared. During the total process of cure, you will feel sleepy, and the bowel movement will be regular, sometimes there may be loose stools as well. The various homeopathic remedies that are used to treat psoriasis: Lycopodium, Sulphur, Pulasatilla, Staphysagria, Graphitis, sepia, Arsenic alb, Natrum mur etc.

7 Ways To Get Rid Of Sinusitis Naturally!

Bachelor of Ayurveda, Medicine & Surgery (BAMS)
Ayurveda, Lucknow
7 Ways To Get Rid Of Sinusitis Naturally!

Sinusitis is an irritation or swelling of the tissue covering the sinuses. Healthy sinuses are loaded with air. But there are times when they get blocked and loaded with fluid. In such cases, germs can develop and cause an infection. Due to this infection, your nose gets heavily blocked along with you sinuses and might make it difficult for you to breathe.

Conditions that can bring about sinus blockage include the following:

Here are some of the ways you can get rid of sinusitis naturally:

  1. Stay Hydrated: Drink a lot of water, soup or broth, along with juices with no added sugar and hot tea. These liquids will disperse bodily fluids and drain it from the disturbed sinuses.

  2. Salt Water Rinse: In case you suffer from sinus infections often, invest in a neti pot. This helpful container makes it simple to hydrate your nasal tract, getting out undesirable bodily fluids and any contaminants you may have breathed, an which may have been caught in the nasal cavity.

  3. Turmeric/Ginger Root: Turmeric root is an excellent fragrant spice found in most Indian and Middle Eastern dishes. Turmeric not only contains the regular calming and anti-inflammatory curcumin, it is also an antioxidant. When it is mixed with hot ginger ale and blended with hot tea, this mixture can remove excess fluid from the clogged nasal sections, ease sinus pressure and make you feel better.

  4. Spicy Food: Spicy ingredients such as mustard, hot peppers, curry, horseradish, and masala in one’s food may help in clearing sinuses. In case you like spices, think about including some hot flavours to your food to open your nasal entries.

  5. Apply Warm Packs: You can use a warm pack to keep the nasal tissues damp. Also, fill a round bowl or pot with steaming water and place your face over it with a towel around your head to inhale the steam in. This will open up your sinuses and make an easy path for fluid drainage.

  6. Take a Steam: High temperature water vapour can saturate the sinuses. Sprinkle a couple drops of eucalyptus or menthol in the shower or bath and steam up your bathroom. A hot shower can also relax the bodily fluid as well as the mucus and debris that are stuck inside your nose.

  7. Apple Cider Vinegar: Apple cider vinegar is not only powerful in disposing off sinus issues; it can also be used for different skin and hair issues. What it does essentially for sinus infection is that it clears up the nose so that the bodily fluid can be removed quickly.

Aortic Valve Stenosis - Ways To Diagnose It!

MBBS, MD - Medicine, DM - Cardiology
Cardiologist, Dehradun
Aortic Valve Stenosis - Ways To Diagnose It!

Aortic valve stenosis is a heart condition in which the valve to the biggest artery- the one which provides oxygen-rich blood to our body, called aorta, is narrowed. This prevents the valve from opening fully, obstructing the blood flow from your heart into your body.

When the aortic valve doesn’t open, your heart needs to work harder to pump blood to your body making the heart muscle weak. If left undiagnosed aortic stenosis is fatal.

Symptoms

These symptoms should spur you on to seek medical care right away:

  1. Chest pain or tightness

  2. Feeling faint with exertion

  3. Shortness of breath

  4. Fatigue after increased activity

  5. Heart palpitations — rapid, fluttering heartbeat

  6. Heart murmur

The disorder doesn’t produce symptoms right away and is usually diagnosed during routine physical exams when your doctor listens to your heart with a stethoscope. He usually hears a heart murmur resulting from turbulent blood flow through the narrowed aortic valve.

Diagnostic Tests

There are other ways to diagnose aortic valve stenosis and gauge the severity of the problem, like:

  1. Echocardiogram – This produces an image of your heart using sound. It is the primary test to diagnose a heart valve problem. Sound waves are directed at your heart here and these bounce off your heart and are processed electronically to provide images of your heart. This test helps your doctor check diagnose aortic valve stenosis and its severity plus chalk out a treatment plan.

  2. Electrocardiogram (ECG) –  In this test, patches with electrodes are attached to your chest to measure electrical impulses given out by your heart. These are then recorded as waves on a monitor and printed on paper. Though this can’t diagnose aortic stenosis directly, it can tell you that the left ventricle in your heart is thickened which normally happens due to aortic stenosis.

  3. Chest X-ray – This allows the doctor to see the shape and size of your heart directly. If the left ventricle is thickened, it points to aortic stenosis. It also helps doctor check the lungs. Aortic stenosis leads to fluid and blood in the lungs, causing congestion.

  4. Exercise Tests – Exercise is used to increase your heart rate and make your heart work harder. This test is done to see how your heart reacts to exertion.

  5. Computerised Tomography (CT) Scan –  This means a series of X-rays to create images of your heart and observes the heart valves. It is also used to measure the size of aorta and the aortic valve.

  6. Magnetic Resonance Imaging (MRI) –  This uses powerful magnets and radio waves to create images of your heart and valves.

Once aortic valve stenosis is confirmed, you may have to go in for monitoring or heart valve surgery according to your doctor’s advice.

Postures For Fit Spine

MBBS, MS - Orthopaedics
Orthopedist, Kolkata
Postures For Fit Spine

The way we sit, walk, bend or stand is hugely dependent on one very vital organ of the human body; the spine. The spinal column provides strength and support to your entire framework. It has nerves, muscles, bones and tendons; all of which enhance proper functioning of your body. The human brain sends signals to the nerves in your spinal cord- a mass of nerve fibers and tissues ensconced within the spine- that further prompts every single part of your body to perform minute and notable actions all the same. A spine injury can thus impair your health; in many cases it can even turn out as fatal. Care should be taken to avoid sources of spine shock or injury. If an injury has already been acquired, it should be treated either through exercising or through medical assistance. 

A few postures to reap the benefits of a fit spine:-

1. Twist your spine either early in the morning or after a tiring day

Fold one leg while the other leg remains perched on the folded one. If the left leg is folded the left elbow should be rested on your perched right knee and the right palm should be placed on the yoga mat behind your right hip. This posture can be repeated by folding the right leg as well. It increases spine mobility by twisting it to the end of its range sideways. Muscular spine aches can be remedied by following this posture once each day.
  
2. Do not slouch but sit straight

Some people are in the habit of slouching when they sit or stand. This is an absolutely wrong thing to do if your spine health is of any concern to you. Stretch out your shoulder blades and remain erect while standing and the same should be followed while sitting. Bending one's spine, unless it is necessary, can be very harmful.  
    
3. Stretch your spine in three directions

This exercise is a good way to allay the tension your spine has to undergo every day. Sit with folded legs, intertwine your fingers and stretch your arms upward, in front and at the back to expand your spine to the full. 
  
4. The downward doggy posture can relieve back pain

In this yoga posture, one is expected to stretch his or her legs according to the width of the person's back and stoop forward by placing the palms on a yoga mat. Knees and elbows should not bend.
 

1 person found this helpful

Hernia - How To Deal With It?

MS (Gen. Surgery)
General Surgeon, Coimbatore
Hernia - How To Deal With It?

When an organ residing in a cavity such as the abdomen tries to push through the muscular layer it resides, it is called as hernia.

Though said to be genetic, hernias can be caused by things such as improper heavy lifting, incorrect posture, or chronic constipation and as a result of surgical complication or injury. Factors like obesity, pregnancy, smoking, chronic lung disease aggravate the severity of the hernia. It is believed that about 27% of all males and 3% of females can have a hernia during their lifetime.

Types of hernias:

Inguinal hernia - The groin is the most common area, where the abdomen pushes through a weak spot in the lower abdominal wall, causing a protrusion into the inguinal canal. More common in men than women.

Hiatal hernia - The abdomen has the diaphragm separating it from the thoracic cavity in the upper border. When it pushes through the diaphragm, a hernia is caused and there is almost always associated food reflux in these cases. Though the most common cause is associated old age, due to muscle weakness, there also are cases of congenital hiatal hernias.

Umbilical hernia - The abdomen finds a weak layer along its length and protrudes through the skin on the stomach. Most commonly seen in babies around the bellybutton, it gradually corrects itself on its own. Quiet rare in adults, seen during pregnancy and in chronic obese people.

Incisional - These are post-surgical, and happen when the organ protrudes through the weakened wall due to surgery. The abdomen is again the most common area and the hernia can happen either onto the external surface or internally, when they are called ventral hernias.
These are the most frequent types, though hernia affects other organs like the spine, brain, appendix, etc.

Treatment -

This includes a combination of constant monitoring followed by a decision to do surgical treatment. Hiatal hernias and umbilical hernias can be monitored for a while before deciding on surgery. Inguinal hernias may require surgery earlier in the stage. Post-surgery, a mesh is placed to hold back the tissue in its corrected place. The umbilical hernia in children could be self-limiting. If it does not get auto-corrected in the first year of life, that also would qualify for a surgical treatment.

Dependent on each patient, hernias need to be managed under medical supervision.

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