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Let us read about our satisfied patient Mr. Balaram Das. He was admitted to B.P. Poddar Hospital three months back. He was suffering from recurrent chest pain which was exacerbated during strenuous activities. After Doctor visit, he was advised Angiography where he was diagnosed with Coronary Artery Disease. Treatment of CAD includes either PTCA (Percutaneous Transluminal Coronary Angioplasty) or CABG (Coronary Artery Bypass Grafting). Doctor suggested him to undergo CABG surgery. Let us know more about CABG surgery.

Coronary artery bypass graft surgery (CABG) is a procedure used to treat coronary artery disease. Coronary artery disease (CAD) is the narrowing of the coronary arteries – the blood vessels that supply oxygen and nutrients to the heart muscle. CAD is caused by a build-up of fatty material within the walls of the arteries. This build-up narrows the inside of the arteries, limiting the supply of oxygen-rich blood to the heart muscle.

One way to treat the blocked or narrowed arteries is to bypass the blocked portion of the coronary artery with a piece of a healthy blood vessel from elsewhere in your body. Blood vessels, or grafts, used for the bypass procedure may be pieces of a vein from your leg or an artery in your chest. An artery from your wrist may also be used. Your doctor attaches one end of the graft above the blockage and the other end below the blockage. Blood bypasses the blockage by going through the new graft to reach the heart muscle. This is called coronary artery bypass surgery.

Traditionally, to bypass the blocked coronary artery, your doctor makes a large incision in the chest and temporarily stops the heart. To open the chest, your doctor cuts the breastbone (sternum) in half lengthwise and spreads it apart. Once the heart is exposed, your doctor inserts tubes into the heart so that the blood can be pumped through the body by a heart-lung bypass machine. The bypass machine is necessary to pump blood while the heart is stopped.

While the traditional "open heart" procedure is still commonly done and often preferred in many situations, less invasive techniques have been developed to bypass blocked coronary arteries. "Off-pump" procedures, in which the heart does not have to be stopped, were developed in the 1990's. There is also a minimally invasive procedure which we are referring to as 4 Inches cut Heart Bypass. It is a truly minimally invasive procedure where a very small incision is made generally below the left nipple. The biggest advantage of 4 inches cut heart bypass is that, no bones are cut. There is lesser bleeding, lesser pain and the recovery is also faster. There is lesser chance of infection.

হার্ট বাইপাস করে সম্পূর্ণ সুস্থ শ্রীযুক্ত বলরাম দাস

এখানে আমরা বলরাম দাস সম্পর্কে জানবো। প্রায় তিন মাস আগে তিনি বি.পি. পোদ্দার হাসপাতালে ভর্তি হন। বলরামবাবু বারবার বুকে ব্যথার সমস্যায় ভুগছিলেন, যা ভারী কোনও কাজের সময় আরও বেড়ে যাচ্ছিল। ডাক্তার দেখার পর অ্যাঞ্জিওগ্রাফি করার পরামর্শ দেন। অ্যাঞ্জিওগ্রাফি করার পর তাঁর করোনারি আর্টারি ডিজিজ ধরা পড়ে। সাধারণত সিএডি-র চিকিৎসায় দুধরনের পদ্ধতি অনুসরণ করা হয়। একটি হল ‘পিটিসিএ’ পদ্ধতি। অপরটি হল ‘সিএবিজি’ পদ্ধতি। বলরামবাবুর ক্ষেত্রে ডাক্তার সিএবিজি সার্জারির পরামর্শ দেন। আসুন আমরা জেনে নি, কী এই চিকিৎসা পদ্ধতি?
করোনারি আর্টারি বাইপাস গ্রাফ সার্জারি (সিএবিজি) একটি উন্নত চিকিৎসা পদ্ধতি যা করোনারি আর্টারির সমস্যার জন্য ব্যবহৃত হয়। করোনারি আর্টারি ডিজিজে সাধারণত করোনারি আর্টারিগুলোর পথ সংকীর্ণ হয়ে যায়, ফলে রক্তনালীগুলি হৃৎপিণ্ডের পেশীতে অক্সিজেন এবং পুষ্টি সরবরাহে বাধা সৃষ্টি করে। আর্টারি ওয়ালে চর্বিযুক্ত উপাদান বৃদ্ধি পেতে থাকে আর আর্টারির ভিতরের অংশকে সঙ্কুচিত করে তোলে, ফলে হৃদপিন্ডের পেশীতে অক্সিজেন সমৃদ্ধ রক্তের সরবরাহ সীমিত করে।
অবরুদ্ধ বা সংকীর্ণ আর্টারির চিকিৎসার একটি উপায় হল আপনার শরীরের অন্য কোনও অংশ থেকে একটি সুস্থ রক্তনালীর টুকরো দিয়ে করোনারি আর্টারির অবরুদ্ধ অংশটিকে বাইপাস করা। যেমন আমরা মেইন রোডে জ্যাম থাকলে পাশের বাইপাস রাস্তা দিয়ে গাড়ি নিয়ে বেরিয়ে যাই, এই পদ্ধতিও ঠিক তেমনই। বাইপাস পদ্ধতির জন্য ব্যবহৃত রক্তনালী বা গ্রাফগুলি আপনার পায়ের শিরা বা আপনার বুকের একটি ধমনী থেকে নেওয়া হতে পারে। এমনকি আপনার কব্জি থেকে একটি ধমনীও ব্যবহার করা যেতে পারে। সার্জারির সময় গ্রাফের এক প্রান্ত ব্লকেজের উপরে এবং অন্য প্রান্তটি ব্লকেজের নীচে সংযুক্ত করা হয়। রক্ত নতুন গ্রাফের মধ্য দিয়ে গিয়ে হৃৎপিণ্ডের পেশীতে পৌঁছানোর জন্য ব্লকেজকে বাইপাস করে। একে বলা হয় করোনারি আর্টারি বাইপাস সার্জারি।
প্রথাগতভাবে, অবরুদ্ধ করোনারি ধমনীকে বাইপাস করার জন্য, আপনার বুকে একটি বড় ছেদ তৈরি করা হয়। এবং অস্থায়ীভাবে হার্ট বন্ধ করে দেওয়া হয়। বুক খোলার জন্য, আপনার বুকের পাঁজড়ের হাড় (স্টার্নাম) অর্ধেক লম্বা করে কেটে আলাদা করে নেওয়া হয়। একবার হৃৎপিণ্ড উন্মুক্ত হয়ে গেলে, ডাক্তার হৃৎপিণ্ডে টিউব প্রবেশ করান, যাতে হার্ট-ফুসফুস বাইপাস মেশিনের মাধ্যমে শরীরে রক্ত পাম্প করা যায়। হার্ট বন্ধ থাকা অবস্থায় রক্ত পাম্প করার জন্য বাইপাস মেশিন প্রয়োজন।
যদিও প্রথাগত ‘ওপেন হার্ট’ পদ্ধতি অনেক পরিস্থিতিতে প্রায়ই পছন্দ করা হয়। অবরুদ্ধ করোনারি ধমনীকে বাইপাস করার জন্য আরও ভালো কৌশল হচেছ ‘অফ-পাম্প’ পদ্ধতি। এতে হৃদপিণ্ড বন্ধ করতে হয় না, ১৯৯০-এর দশকে এই পদ্ধতি বিকশিত হয়েছিল। এছাড়াও আর একটি পদ্ধতি রয়েছে যা আমরা ৪ ইঞ্চি কাটা হার্ট বাইপাস হিসাবে উল্লেখ করে থাকি। এটি একটি সত্যই অতি ভালো পদ্ধতি যেখানে সাধারণত বুকের বাঁদিকে নীচে একটি খুব ছোট ছেদ তৈরি করা হয়। ৪ ইঞ্চি কাটা হার্ট বাইপাসের সবচেয়ে বড় সুবিধা হল, কোনও হাড় কাটা হয় না। কম রক্তপাত হয়, কম ব্যথা হয় এবং রোগী দ্রুত সেড়ে ওঠেন। পাশাপাপাশি সংক্রমণের সম্ভাবনা Ã Â¦â€¢Ã Â¦Â® Ã Â¦Â¥Ã Â¦Â¾Ã Â¦â€¢Ã Â§â€¡Ã Â¥Â¤

What is Leprosy?

Leprosy is a chronic, progressive bacterial infection caused by the bacterium Mycobacterium leprae. It primarily affects the nerves of the extremities, the skin, the lining of the nose, and the upper respiratory tract. Leprosy is also known as Hansen’s disease.

Hansen’s disease produces skin ulcers, nerve damage, and muscle weakness. If it isn’t treated, it can cause severe disfigurement and significant disability.

Hansen’s disease is one of the oldest diseases in recorded history. The first known written reference to Hansen’s disease is from around 600 B.C.

What are the symptoms of Hansen’s disease?

The main symptoms of Hansen’s disease include:

• muscle weakness
• numbness in the hands, arms, feet, and legs
• skin lesions

The skin lesions result in decreased sensation to touch, temperature, or pain. They don’t heal, even after several weeks. They’re lighter than your normal skin tone or they may be reddened from inflammation.

How does Hansen’s disease spread?

The bacterium Mycobacterium leprae causes Hansen’s disease. It’s thought that Hansen’s disease spreads through contact with the mucosal secretions of a person with the infection. This usually occurs when a person with Hansen’s disease sneezes or coughs.

The disease isn’t highly contagious. However, close, repeated contact with an untreated person for a longer period of time can lead to contracting Hansen’s disease.

The bacterium responsible for Hansen’s disease multiplies very slowly. The disease has an average incubation period (the time between infection and the appearance of the first symptoms) of five yearsTrusted Source, according to the World Health Organization (WHO).

Symptoms may not appear for as long as 20 years.

What are the types of Hansen’s disease?

There are three systems for classifying Hansen’s disease.

1. Tuberculoid Hansen’s disease vs. lepromatous Hansen’s disease vs. borderline Hansen’s disease

The first system recognizes three types of Hansen’s disease: tuberculoid, lepromatous, and borderline. A person’s immune response to the disease determines which of these types of Hansen’s disease they have:

• In tuberculoid Hansen’s disease, the immune response is good. A person with this type of infection only exhibits a few lesions. The disease is mild and only mildly contagious.
• In lepromatous Hansen’s disease, the immune response is poor. This type also affects the skin, nerves, and other organs. There are widespread lesions, including nodules (large lumps and bumps). This form of disease is more contagious.
• In borderline Hansen’s disease, there are clinical features of both tuberculoid and lepromatous Hansen’s disease. This type is considered to be between the other two types.

2. World Health Organization (WHO) classification

WHO categorizesTrusted Source the disease based on the type and number of affected skin areas:

• The first category is paucibacillary. There are five or fewer lesions and no bacterium detected in the skin samples.
• The second category is multibacillary. There are more than five lesions, the bacterium is detected in the skin smear, or both.

3. Ridley-Jopling classification

Clinical studies use the Ridley-Jopling system. It has five classifications based on severity of symptoms.

There’s also a form a Hansen’s disease called indeterminate Hansen’s disease that isn’t included in the Ridley-Jopling classification system. It’s considered to be a very early form of Hansen’s disease where a person will have only one skin lesion that’s just slightly numb to the touch.

Indeterminate Hansen’s disease may resolve or progress further to one of the five forms of Hansen’s disease within the Ridley-Jopling system.

How is Hansen’s disease diagnosed?

Your doctor will conduct a physical exam to look for telltale signs and symptoms of the disease. They’ll also perform a biopsy in which they remove a small piece of skin or nerve and send it to a laboratory for testing.

Your doctor may also perform a lepromin skin test to determine the form of Hansen’s disease. They’ll inject a small amount of Hansen’s disease-causing bacterium, which has been inactivated, into the skin, typically on the upper forearm.

People who have tuberculoid or borderline tuberculoid Hansen’s disease will experience a positive result at the injection site.

How is Hansen’s disease treated?

WHO developed a multidrug therapyTrusted Source in 1995 to cure all types of Hansen’s disease. It’s available free of charge worldwide.

Additionally, several antibiotics treat Hansen’s disease by killing the bacteria that causes it. These antibiotics include:

• dapsone (Aczone)
• rifampin (Rifadin)
• clofazimine (Lamprene)
• minocycline (Minocin)
• ofloxacin (Ocuflux)

Every year, World COPD Day is held to increase public awareness of Chronic Obstructive Pulmonary Disease (COPD) and to educate people worldwide about this respiratory disorder. A global group called GOLD- Global Initiative for Chronic Obstructive Lung Disease launched in 2002 which brings together medical professionals from many nations to organize public awareness campaigns regarding COPD, its prevention and to support better medical care and treatment outcomes for people who have already been diagnosed with the disease.

          The emphasis on lifelong lung health is a part of this year's theme. We only have one set of lungs when we all are born. Keeping our lungs healthy is essential for our future health and wellbeing from childhood through maturity. This campaign will concentrate on the causes of COPD from infancy to adulthood and what can be done to encourage lifetime lung health and safeguard the vulnerable population.

What is COPD?

Chronic obstructive pulmonary disease, or COPD, is a common respiratory ailment that affects people of all ages worldwide. Emphysema and chronic bronchitis are the two most common progressive lung diseases that affect the air sacs and bronchial tubes in the lungs, impairing breathing and causing lung damage. COPD is an umbrella term that refers to a variety of these conditions. The typical course of COPD is several years and in rare circumstances, it might even be a chronic condition.

          In addition to causing direct lung damage, COPD also increases a person's risk of developing heart disease, angina and respiratory infections. COPD usually leads to shortness of breath and irreparable lung damage by obstructing the airways and deteriorating pulmonary cells and tissues. However, COPD symptoms can be controlled and severe lung damage can be avoided with prompt diagnosis and treatment.

Causes of COPD

1. Direct inhalation of toxic chemicals, fumes and dust in an occupational setting.
2. Living in homes with inadequate ventilation and inhaling fumes from the burning of coal and fuel for cooking and heating purposes.
3. Tobacco smoking.
4. Continuous exposure to air pollution, dust, particulate matter etc.

Symptoms

Some persons who have both COPD and asthma experience symptoms that are similar to each other since COPD is an inflammatory lung disorder. The following symptoms are usually seen:

1. Difficulty in breathing.
2. Wheezing
3. Loss of weight.
4. Fatigue and uneasiness.
5. Coughing with phlegm discharge.
6. Tight clenching sensation in the chest.
7. Accumulation of mucus in the nasal passage.

Treatment

COPD has no known cure but with the right care, the condition can be effectively treated. The corrective actions include:

1. People with arthritis can improve their general health and lessen the severity of their symptoms by maintaining a healthy, balanced diet, getting the right amount of exercise, and refraining from smoking and excessive alcohol consumption.
2. Bronchodilators- Inhaled drugs that clear blockages from the airways, expand the lungs and promote comfortable breathing.
3. Prescribed medications as suggested by the doctor.
4. In case of serious COPD, Oxygen therapy and surgery are done to remove the inflamed tissues within the lungs in order to normalize the oxygen supply.

Prevention of COPD

1. By avoiding smoking tobacco.
2. By improving ventilation in the houses and work areas.
3. By wearing masks or protective clothing while stepping outside in the polluted areas to avoid the toxic fumes and pollutants in the air.

Diabetes Prevention

Can Type 2 Diabetes Be Prevented?

Yes! You can prevent or delay type 2 diabetes with proven, achievable lifestyle changes; such as losing a small amount of weight and getting more physically active even if you're at high risk. Read on to find out about  lifestyle change program and how you can join.

What is Prediabetes?

Before developing type 2 diabetes, most people have prediabetes; their blood sugar is higher than normal but not high enough yet for a diabetes diagnosis. Prediabetes is really common. The good news is that prediabetes can be reversed.

DOs and DONTs in Diabetes

DOs if you have diabetes

Iodine is a crucial component for maintaining human health. Iodine deficiency disorders (IDD) may develop if the thyroid gland is not able to operate properly. Goiters, mental impairment and even death are among the health issues IDD can cause. IDD affects millions of people each year making it a significant public health issue. The World Health Organization established October 21 as the World Iodine Deficiency Day in order to promote iodine supplementation as a successful means of preventing IDD.

What is Iodine Deficiency?

Iodine is a crucial trace element needed for the synthesis of thyroid hormones. The growth and development of the brain depend on these chemicals. Iodine shortage can result in a variety of health issues such as cretinism, mental retardation and goitre (an enlarged thyroid gland) which is characterized by stunted physical growth and mental development.

Causes

Iodine is a crucial trace element needed for the synthesis of thyroid hormones. Numerous crucial physiological functions, including as metabolism, growth, and development, are regulated by thyroid hormones. The most frequent worldwide cause of reversible mental impairment and brain damage is iodine deficiency. Making sure to regularly eat iodized salt is the greatest approach to avoid an iodine shortage.

Symptoms

1. Goiter which happens when the thyroid gland enlarges as a result of a lack of iodine is the most typical symptom of iodine deficiency. Goiter may be nodular or diffuse (an enlargement of the entire or more areas of the gland).
2. Fatigue
3. Weight gain
4. Dry skin
5. Loss of hair
6. Cold intolerance
7. Constipation
8. Depression.
9. Cretinism and mental impairment can result from severe iodine deficiency.
   
   

Prevention and Treatment

Universal salt iodization: Every nation should make sure that the iodization of salt used for human consumption is sufficient. The most successful and long-lasting method of Iodine Deficiency Disease (IDD) prevention.

Iodine fortification of other foods: In some nations, staple foods like rice and flour may be given an iodine boost. The context and requirements of the local area should inform this strategy.

Health education and awareness-raising: It's critical to raise understanding of iodine's role in preventing IDD and the necessity of eating foods high in iodine.

Osteoporosis literally means "porous bone." Since the condition weakens bones and increases the chance of sudden, unforeseen bone fractures. If a person has osteoporosis then the bones become weaker and light in mass. The condition frequently progresses without any warning signs or discomfort and it is typically not detected until the weakening of bones result in fractures. The majority of these involve hip, wrist, and spine fractures.

World Osteoporosis Day proposes educating people about osteoporosis and its effects which relies on five steps to osteoporosis prevention. The first step is to eat meals that are rich in calcium, vitamins, proteins, and other nutrients, maintaining body weight by engaging in at least 40 minutes of exercise daily and by avoiding excessive alcohol consumption and smoking. It also creates awareness of elements such as illnesses, genetics, medications, and menopause which are the factors for osteoporosis.

Causes

The exact cause of osteoporosis is unknown as it develops inside the living, expanding tissue which makes up the bones. Trabecular bone, which constitutes the inside of healthy bones, resembles a sponge. The cortical bone, a spongy bone, is encased in a tough outer layer of bone. Osteoporosis weakens the inside of the bone by causing the "holes" in the "sponge" to enlarge and multiply. The body breaks down and rebuilds the bone when it requires calcium. This procedure is known as bone remodeling which maintains the strength of the bones while supplying the body with the calcium it requires. After age 35, bone deterioration outpaces bone formation, resulting in a steady decrease of bone mass which usually increases after menopause.

Symptoms

Osteoporosis typically shows no symptoms. Thus it is sometimes also referred as ‘silent sickness’ for this reason. However, the following symptoms are observed:

1. Decrease in height (getting shorter by an inch or more).
2. Bad posture (stooping or bending forward).
3. Difficulty in breathing (smaller lung capacity due to compressed disks).
4. Broken bones.
5. Lower back pain
   
   

Risk factors

1. Age- osteoporosis usually happens with age.
2. Gender- women are majorly affected with osteoporosis than men.
3. Lifestyle- due to bad lifestyle like obesity have the higher risks of having osteoporosis.
4. Family history- people with a family history of arthritis are more likely to have it in the future.
5. The risk of getting osteoporosis is highest in postmenopausal or older women.

Diagnosis

1. Dual-energy X-ray absorptiometry, often known as a DEXA or DXA scan to assess the bone health.
2. Bone Mineral Density (BMD) examinations to check the strength of the spine, hip, and wrist bones.
3. X-rays which emit very modest doses of radiation can detect only the highly advanced osteoporosis.

Treatment

The goals of osteoporosis treatment include managing pain, reducing joint deterioration, and enhancing or maintaining function and quality of life. This can be accomplished while also protecting joints from future harm by supplementing a variety of drugs and lifestyle choices.

1. Medications like analgesics, Nonsteroidal anti- inflammatory drugs (NSAIDs) etc.
2. People with osteoporosis can improve their general health and lessen the severity of their symptoms by maintaining a healthy, balanced diet, getting the right amount of exercise, and refraining from smoking and excessive alcohol consumption.
3. Physiotherapy and exercises.
4. Surgery- in case of severe arthritis, surgeries like Total Knee Replacement, Total Hip Replacement, joint fusion, synovectomy, osteotomy etc.

Arthritis is the medical term for swelling or joint inflammation. It describes more than 100 ailments that have an impact on connective tissues, joints, and surrounding tissues. Depending on the type of arthritis, specific symptoms can vary, although stiffness and pain in the joints are typically present.

Types of Arthritis

Rheumatoid arthritis and osteoarthritis are the two most prevalent kinds of arthritis.

1. Osteoarthritis- It is the deterioration of the cartilage which is a hard, smooth coating on the ends of bones where they form a joint which gets worn down due to damage. This deterioration may take place gradually over many years or may be sped up by an infection or joint damage. The lining of the joint may swell and become inflamed if the cartilage in the joint is significantly damaged. This results in grinding of the bones directly against each other, causing pain and limiting movement.
2. Rheumatoid arthritis- The strong membrane that encloses all the joint components is attacked by the body's immune system. Due to this, the synovial membrane swells and becomes irritated. Bone and cartilage in the joint may eventually be destroyed by the illness.

Other forms of arthritis can be brought on by infections or underlying conditions like lupus or psoriasis. Gout can be brought on by uric acid crystals, which develop when your blood uric acid level is too high.

Symptoms

1. Intense pain in the joints.
2. Swelling in the joints.
3. Redness and stiffness in the joints.
4. Decreased range of movements.

Risk factors

1. Age- osteoarthritis usually happens with age.
2. Family history- people with a family history of arthritis are more likely to have it in the future.
3. Gender- women are majorly affected with rheumatoid arthritis than men, whereas gout usually happens in men.
4. Lifestyle- due to bad lifestyle like obesity have the higher risks of having arthritis.
5. People are more prone to develop arthritis in a joint that has been injured, possibly while participating in sports.

Treatment

The goals of arthritis treatment include managing pain, reducing joint deterioration, and enhancing or maintaining function and quality of life. This can be accomplished while also protecting joints from future harm by supplementing a variety of drugs and lifestyle choices.

1. Medications like analgesics, Nonsteroidal anti- inflammatory drugs (NSAIDs) etc.
2. People with arthritis can improve their general health and lessen the severity of their symptoms by maintaining a healthy, balanced diet, getting the right amount of exercise, and refraining from smoking and excessive alcohol consumption.
3. Physiotherapy and exercises.
4. Surgery- in case of severe arthritis, surgeries like Total Knee Replacement, Total Hip Replacement, joint fusion, synovectomy, osteotomy etc.

On October 10, we celebrate World Mental Health Day to escalate our knowledge of mental health advancements. Our increased self-awareness and sensitivity to it have improved the situation. It is noted that there has never been a more pressing need to reduce the stigma associated with mental illness and to promote its understanding and treatment. The main objective of this day is to raise the awareness about mental health and to raise the support and effort for a better mental health.

This day serves as a reminder that a person is not suffering alone. We tend to believe that we are the only ones going through difficult times and knowing that others have experienced it and come out on the other side is encouraging. We are also reminded that we are capable of overcoming the pain and progress towards the betterment.

Importance

1. The stigma associated with mental health concerns can be reduced by normalizing them. Even while this is getting better, many people still feel embarrassed to talk about their feelings or go to therapy. Campaigns like this one can compel people to take good care of their mental health.
2. People can be kept safe by raising awareness of the symptoms of mental health problems, can have important conversations with those close to them when they are aware of the warning signals of poor mental health. In this way, it can be understood whether he/she needs expert assistance.
3. A greater understanding of mental health concerns also makes persons who experience them feel less isolated. When the reality about their prevalence is revealed then the people feel less alone or less humiliated.
4. Encouragement of nations to allot more of their money for mental health resources particularly crucial in low-income nations as very few people in these nations have access to medical care.

Symptoms of mental illness

1. Being depressed or sad.
2. Unclear thinking or a diminished capacity to focus.
3. Anxiety, hallucination, feeling stressed or guilty feeling.
4. Extremely high and low mood swings, e.g.; anger.
5. Withdrawal from relationships, hobbies and interests.
6. Significant exhaustion, low energy, or insomnia.
7. Suicidal thoughts or self-harm.

 How to overcome?

1. By talking and sharing thoughts with a close one- be it a friend, or a family member.
2. Remedial counseling with the therapists.
3. Self- help groups which are involved in identifying the people suffering from the problems and encourage them to have an activity together in order to overcome the mental illness.
4. By reaching out to the affected individual and extend help and medical support.
5. Medications as prescribed by the doctor.

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