Guidelines for selecting initial drug treatment of Hypertension

For adults of age 18 years & more, hypertension is systolic blood pressure >140 mmHg and/ or diastolic blood pressure >90 mmHg.

1. Diuretics

This group of drugs flushes excess sodium from the body, which reduces the amount of fluid in the blood and helps to lower your blood pressure. Examples Chlorothiazide, Chlorthalidone, etc.

Compelling indications:

• Heart failure 
• Elderly patients
• Systolic hypertension

Compelling contraindications:

• Gout

2. Beta-blockers (BB) 

This group of drugs helps the heart to beat slower and with less force. As a result, the heart pumps less blood through blood vessels, which can help to lower blood pressure. Examples Atenolol, Propranolol, etc.

Compelling indications:

• Angina 
• After MI 
• Tachyarrhythmia 

Possible indications: 

• Heart failure 
• Pregnancy

Compelling contraindications:

• Uncontrolled asthma and Chronic obstructive pulmonary disease (COPD) 
• Heart block ( second or third-degree atrioventricular block)

Possible contraindications:

• Athletes and physically active patients 
• Peripheral vascular disease

3. Angiotensin-converting enzyme (ACE) inhibitors:

Angiotensin-II is a hormone that narrows blood vessels, increasing blood pressure. ACE converts Angiotensin I to Angiotensin II. ACE inhibitors block this process, which stops the production of Angiotensin II, lowering blood pressure. Examples Lisinopril, Enalapril, etc.

Compelling indications:

• Heart failure
• LV dysfunction
• After MI
• Diabetic nephropathy

Possible indications:

• Chronic renal parenchymal disease

Compelling contraindications:

• Pregnancy
• Hyperkalemia
• Bilateral renal artery stenosis

4. Angiotensin receptor blockers (ARB)

This group of drugs blocks angiotensin II hormone from binding with receptors in the blood vessels. When angiotensin II is blocked, the blood vessels do not constrict or narrow, which can lower your blood pressure. Examples Losartan, Telmisartan, etc.

Compelling indications:

• ACE inhibitor cough
• Heart failure
• Diabetic nephropathy

Possible indications:

• Chronic renal parenchymal disease

Compelling contraindications:

• Pregnancy
• Bilateral renal artery stenosis
• Hyperkalemia

5. Calcium channel blockers (CCB)

This group of drugs keeps calcium from entering the muscle cells of the heart and blood vessels. This allows blood vessels to relax, which can lower blood pressure. Examples Amlodipine, Nifedipine, etc.

Compelling indications:

• Angina
• Elderly patients
• Systolic hypertension

Possible indications:

• Peripheral vascular disease

Compelling contraindications:

• Heart block ( second or third-degree atrioventricular block with verapamil or diltiazem)

Possible contraindications:

• Congestive heart failure ( Verapamil or diltiazem) 

References:

1. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jamenson J. Harrinson´ s manual of medicine. 2013.
2. Reid J. John Murtagh's General Practice (; John Murtagh and Jill Rosenblatt). 2015.
3. https://www.nhp.gov.in/disease/cardio-vascular/hypertension-high-blood-pressure

Components & Interventions of ICDS Scheme

Integrated child development services (ICDS) is a unique early childhood development program, aimed at addressing malnutrition, health and also developmental needs of young children, pregnant, and nursing mothers. 

It consists of 4 different components: 

1. Early Childhood Care Education & Development (ECCED) 

2. Care & Nutrition Counselling 

3. Health Services 

4. Community Mobilisation Awareness, Advocacy &Information, Education and Communication

1. Early Childhood Care Education & Development (ECCED):

2. Care & Nutrition Counselling:

3. Health Services 

4. Community Mobilisation Awareness, Advocacy &Information, Education and Communication

Reference:

1. https://icds.gov.in/
2. https://darpg.gov.in/sites/default/files/ICDS.pdf

Kidney disease: Early attention needed

Kidney disease is particularly common in people with poorly controlled diabetes and high blood pressure. Other causes are glomerulonephritis, reflux kidney damage, drugs, polycystic kidney disease, and renal artery stenosis. Kidney (renal) failure can occur in one of three forms: 

• Acute failure—the kidneys suddenly stop functioning. 

• Chronic failure—the disorder develops gradually over many years. 

• End-stage failure—kidney function is so poor that technical support is needed to take over kidney function.

What is Chronic kidney disease (CKD)?

CKD is a condition where the kidneys are damaged and do not filter the waste products out of the blood efficiently. Kidneys also regulate blood pressure, fluid level, levels of salts including sodium and potassium, and help to prevent anemia. Kidney failure is nothing but a breakdown in kidney function. It usually develops gradually over a long period of time and people can be unaware they have CKD. There are five stages of CKD and special care is needed to manage stages 4 and 5 which are dangerous.

What are the symptoms of CKD? 

Most of the people with mild to moderate CKD (stages 1, 2, and possibly 3) do not have any symptoms, which tend to manifest at stages 4 and 5. These include: 

• Generally feeling unwell

• Tiredness and lethargy

• Anorexia (poor appetite)

• Nausea and vomiting

• Muscle cramps

• Dry and itchy skin

What are the risk factors for CKD? 

• Diabetes 

• High blood pressure 

• Obesity 

• Family history of kidney disease 

• Increasing age 

• Aboriginal or Torres Strait Islander descent 

• Smoking 

• Drug overuse and abuse

What are the complications of CKD? 

There is a gradual accumulation of waste products (e.g. urea) and chemicals (e.g. potassium) in the blood. The kidneys face difficulty in limiting the amount of water passing into the urine. Early signs are 

• The effects of anemia and 

• Increasing blood pressure (which can be both a cause and a result of CKD)

How is CKD diagnosed?

• The levels of creatinine and albumin in the blood and urine- give an indication of kidney function and the presence of disease. 
• A blood test known as the eGFR (estimated glomerular filtration rate) is commonly used. 
• Normal is >90 while <30 indicates severe failure and less than 15 end-stage failure.

What is the treatment of CKD? 

Early-stage CKD is treated with 

• Advice about diet 

1. Low in protein, fat, and salt—(sodium and potassium) 

1. Careful use of drugs 

1. Ample fluids (take care with fluids—keep fluid in/fluid out diary) 

1. Avoid smoking and 

1. Regular physical activity. 

• The medication used in early-stage disease is 

1.  ACE inhibitor drug, which also helps lower blood pressure. 

End-stage treatment options are: 

• Dialysis 

• Kidney transplantation

What is dialysis? 

Dialysis is a method of removing waste products from the blood after kidney failure. It can be provided in two main ways. 

Haemodialysis: 

• Done using an ‘artificial kidney’ machine to take blood from the body and pump it through a filtering machine, then returning the purified blood to the body at the same rate at which it is taken. 
• Each treatment, which can be done in a ‘dialysis unit’ or at home, takes about 4 to 6 hours and is generally given 2-3 times a week. 
• A new approach is a nocturnal dialysis which is given overnight during sleep. 

Peritoneal dialysis: 

• Here the fluid is exchanged by infusing a cleansing fluid into the peritoneal cavity of the abdomen and then draining away the used fluid. 
• It is usual to have an indwelling catheter in the cavity. 
• The doctor decides the number of exchanges needed, which can vary from one person to another. 
• It can be done at home provided sterile practice is followed. 
• Varieties of this type are continuous ambulatory peritoneal dialysis (CAPD) performed for about 30 minutes about 4 times a day and automated peritoneal dialysis (APD) where a machine (cycler) exchanges fluid during sleep.

What is kidney transplantation?

• A kidney transplant is done from a living or deceased donor allows more freedom in lifestyle but has its downside also. 
• The recipient requires a lifetime of care and medical management including medication to avoid rejection. 
• The old kidneys are left in the body but do no harm.

References:

1. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
2. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
3. https://www.healthdirect.gov.au/kidney-disease-treatment photo credit
4. https://chemical-materials.elsevier.com/new-materials-applications/materials-medicine-hemodialysis-prosthetic-vascular-grafts/ photo credit

हृदय रोगों से बचाव के 10 उपाय

हृदय रोगों के कई कारक हैं। हृदय रोगों से बचाव के 10 सरल उपाय इस प्रकार हैं:

1. किसी भी प्रकार से धूम्रपान न करें।

2. शराब बहुत कम मात्रा में ही पीएं या बिल्कुल नहीं।

3. एक आदर्श वजन और कमर के आकार रखें और एक स्वस्थ, संतुलित आहार लें।

4. संतृप्त वसा से बचें, एक उच्च फाइबर आहार लें, जिसमें ताजे फल, सब्जियां और साबुत अनाज शामिल हैं।

5. कम-जीआई खाद्य पदार्थों का चयन करें।

6. कम नमक वाला आहार लें और हो सके तो कम सोडियम वाले नमक लें।

7. अतिरिक्त CATS से सावधान रहें- कैफीन, शराब, तंबाकू, चीनी।

8. एक शिथिल जीवन शैली से बचें और नियमित रूप से व्यायाम करें।

9. योग और विश्राम का अभ्यास करें।

10. अपने रक्तचाप की नियमित रूप से निगरानी करें और यदि किसी असामान्यता के लिए आपके चिकित्सक द्वारा सलाह दी जाती है, तो उचित दवा लें।

संदर्भः

1. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
2. https://www.nhp.gov.in/disease/cardio-vascular/heart/coronary-heart-disease
3. https://www.istockphoto.com/vector/smoking-kills-gm468442197-26204678 photo credit
4. https://tobaccofreelife.org/tobacco/tobacco-products/ photo credit
5. https://www.castorandpollux.co.uk/jeremyville-please-dont-smoke.html photo credit
6. https://americanaddictioncenters.org/health-complications-addiction/reverse-alcohol-damage photo credit
7. https://www.clipartmax.com/middle/m2i8N4N4m2G6A0K9_beer-vodka-wine-alcoholic-drink-clip-art-don-t-drink-alcohol/ photo credit
8. https://www.alimentarium.org/en/magazine/nutrition/what-exactly-balanced-meal photo credit
9. https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/ideal-weight-for-indian-women-and-men-increased-to-55-65-kg-here-are-a-few-tips-to-stay-fit/photostory/78405359.cms photo credit
10. https://www.weightwatchers.com/nz/food/unhealthy-vs-healthy-fats photo credit
11. https://in.pinterest.com/pin/134474738862083131/ photo credit
12. https://www.verywellfit.com/what-kind-of-salt-is-healthiest-4157937 photo credit
13. https://www.amazon.in/Tata-Salt-Lite-Low-Sodium/dp/B01HBEUAI4 photo credit
14. https://www.daravinto.com/2020/03/18/control-your-blood-sugar-with-low-glycemic-index-food/ photo credit
15. https://www.shutterstock.com/search/sugar+bowl photo credit
16. https://publicfinance.lk/2018/07/31/tobacco-policy-mitigating-the-influence-of-vested-interests/ photo credit
17. https://www.talktofrank.com/drug/alcohol photo credit
18. https://login.medscape.com/login/sso/getlogin?wcode=102&client=213312&urlCache=aHR0cHM6Ly93d3cubWRlZGdlLmNvbS9wZWRpYXRyaWNzL2FydGljbGUvMTkyNjUyL21lbnRhbC1oZWFsdGgvY29uc2lkZXItY2FmZmVpbmUtZWZmZWN0cy1jaGlsZHJlbi1hbmQtYWRvbGVzY2VudHM_c3NvPXRydWU photo credit
19. https://www.vivehealth.com/blogs/resources/how-to-take-your-blood-pressure photo credit
20. https://www.vectorstock.com/royalty-free-vector/set-women-practice-yoga-pose-vector-24478238 photo credit

10 Tips to prevent Cardiovascular diseases

There are many risk factors for cardiovascular diseases. 10 simple tips to prevent cardiovascular diseases are as follows:

1. Do not smoke in any form.

2. Drink alcohol in only very small amounts or not at all.

3. Keep to an ideal weight and waist size, take a healthy, balanced diet.  

4. Avoid saturated fats, a high-fiber diet is recommended, including plenty of fresh fruit, vegetables, and whole grains.

5. Select preferably low-GI foods.

6. Have a low-salt diet & take low sodium salt if possible.

7. Be careful of excess CATS—Caffeine, Alcohol, Tobacco, Sugar.

8. Avoid a sedentary lifestyle & exercise regularly.

9. Practice yoga & relaxation.

10. Monitor your blood pressure regularly & take the appropriate medication if advised by your physician for any abnormality.

References:

1. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
2. https://www.nhp.gov.in/disease/cardio-vascular/heart/coronary-heart-disease
3. https://www.istockphoto.com/vector/smoking-kills-gm468442197-26204678 photo credit
4. https://tobaccofreelife.org/tobacco/tobacco-products/ photo credit
5. https://www.castorandpollux.co.uk/jeremyville-please-dont-smoke.html photo credit
6. https://americanaddictioncenters.org/health-complications-addiction/reverse-alcohol-damage photo credit
7. https://www.clipartmax.com/middle/m2i8N4N4m2G6A0K9_beer-vodka-wine-alcoholic-drink-clip-art-don-t-drink-alcohol/ photo credit
8. https://www.alimentarium.org/en/magazine/nutrition/what-exactly-balanced-meal photo credit
9. https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/ideal-weight-for-indian-women-and-men-increased-to-55-65-kg-here-are-a-few-tips-to-stay-fit/photostory/78405359.cms photo credit
10. https://www.weightwatchers.com/nz/food/unhealthy-vs-healthy-fats photo credit
11. https://in.pinterest.com/pin/134474738862083131/ photo credit
12. https://www.verywellfit.com/what-kind-of-salt-is-healthiest-4157937 photo credit
13. https://www.amazon.in/Tata-Salt-Lite-Low-Sodium/dp/B01HBEUAI4 photo credit
14. https://www.daravinto.com/2020/03/18/control-your-blood-sugar-with-low-glycemic-index-food/ photo credit
15. https://www.shutterstock.com/search/sugar+bowl photo credit
16. https://publicfinance.lk/2018/07/31/tobacco-policy-mitigating-the-influence-of-vested-interests/ photo credit
17. https://www.talktofrank.com/drug/alcohol photo credit
18. https://login.medscape.com/login/sso/getlogin?wcode=102&client=213312&urlCache=aHR0cHM6Ly93d3cubWRlZGdlLmNvbS9wZWRpYXRyaWNzL2FydGljbGUvMTkyNjUyL21lbnRhbC1oZWFsdGgvY29uc2lkZXItY2FmZmVpbmUtZWZmZWN0cy1jaGlsZHJlbi1hbmQtYWRvbGVzY2VudHM_c3NvPXRydWU photo credit
19. https://www.vivehealth.com/blogs/resources/how-to-take-your-blood-pressure photo credit
20. https://www.vectorstock.com/royalty-free-vector/set-women-practice-yoga-pose-vector-24478238 photo credit

बालों के झड़ने या एलोपेसिया के कारण

अधूरे या पूरी तरह से बालों के झड़ने को एलोपेसिया कहा जाता है|

बालों के झड़ने के बहुत सारे कारण हैं| इनमें से कुछ प्रमुख इस प्रकार हैं

1. बालों की बीमारियां

(क) बालों का अनुवांशिक पतलापन या गंजापन:

• सबसे आम कारण
• इसे एंड्रोजेनिक एलोपेसिया भी कहते हैं|
• पुरुषों में घटते हुए हेयरलाइन के साथ-साथ स्कैल्प के बाल भी झड़ते हैं|
• महिलाओं में सामने और स्कैल्प के बाल पतले हो जाते हैं|

(ख) एलोपेसिया एरिएटा:

• यह एक ऑटोइम्यून बीमारी है|
• इसकी वजह से स्कैल्प तथा शरीर के अन्य जगहों पर भी बाल झड़ सकते हैं|
• यह सभी उम्र के लोगों में हो सकता है|
• इसमें बाल पैचेज (चित्तियो) में झड़ते हैं|

(ग) सिकेट्रिशल एलोपेसिया:

• यह स्वस्थ महिलाओं और पुरुषों में भी हो सकता है|
• यह एक रेयर कंडीशन है जिसमें बालों के फॉलिकल्स बर्बाद हो जाते हैं|
• यहां फॉलिकल होते हैं, वहां स्कार (निशान) बन जाते हैं और बालों का फिर से बढ़ना संभव नहीं हो पाता है|
• उपचार में सूजन को रोकने की कोशिश की जाती है, जो फॉलिकल्स को बर्बाद कर देते हैं|

2. बीमारियां

(क) अंदरुनी स्वास्थ्य:

• बालों का झड़ना करीब 30 बीमारियों के चेतावनी लक्षण हो सकते हैं|
• अंदरुनी बीमारी का इलाज करके बालों का झड़ना रोका जा सकता है|
• उदाहरण के तौर पर थायराइड की बीमारी और आयरन की कमी से होने वाली रक्ताल्पता|

(ख) कैंसर का इलाज:

• रेडिएशन थेरेपी
• कीमोथेरेपी की दवाइयां
• इसमें बालों का झड़ना टेम्पररी ही होता है लेकिन काफी तनावपूर्ण हो सकता है|

(ग) स्कैल्प का रिंगवर्म या खुजली:

• फंगल इनफेक्शन (बच्चों में आम)
• यह स्कैल्प (सिर) पर स्केलिंग और गंजापन कर सकता है|

(घ) ट्रिचोतिलोमानिया (trichotillomania):

• यह एक ऐसी बीमारी है जिसमें लोग अपने ही बाल बार-बार नोचते/ खींचते रहते हैं|
• यह लोग स्कैल्प के बालों के अलावा पलकों, भौहों, नाक और शरीर के अन्य भागों के बाल भी नोचते रहते हैं|

3. तनाव और हार्मोन्स

(क) तनाव:

• मानसिक या शारीरिक तनाव
• जैसे कि मेजर सर्जरी, हाई फीवर, इनफेक्शन, फ्लू आदि|

(ख) हार्मोन्स के स्तर में बदलाव:

• हार्मोन्स के स्तर में परिवर्तन (विशेषकर महिलाओं में)
• मेनोपॉज और बच्चे की डिलीवरी के बाद एस्ट्रोजेन के स्तर में गिरावट को वज़ह से यह आम होता है|
• सामान्य होने पर बाल फिर से आ सकते हैं|

4. डायट या आहार

• वज़न का कम होना: बहुत ही आम है, अच्छा खाना और फिर से वजन ठीक पर बाल फिर से बढ़ सकते हैं|
• विटामिन ए की अधिकता
• बहुत कम प्रोटीन लेना: प्रचुर मात्रा में प्रोटीन लेने से बालों का झड़ना कम हो सकता है|
• बहुत कम मात्रा में आयरन लेना: आयरन के शाकाहारी स्रोत हैं- आयरन फोर्टीफाइड सेरेल्स,  सोयाबीन, पम्पकिन सीड्स, उजले सेम, लेंटिल्स, स्पिनाच आदि|
• क्लाम्स, ओयेस्टर्स, ऑर्गन मीट्स आदि आयरन के जंतु स्रोत हैं|
• खाने से जुड़ी बीमारियां: जैसे कि एनोरेक्सिया और बुलिमिया
• जिंक की कमी
• कुपोषण

5. दवाइयां

दवाएं जिन से बाल झड़ सकते हैं वह इस प्रकार हैं

• रक्त पतला करने वाली दवाइयां
• अत्यधिक विटामिन ए का सेवन
• अर्थराइटिस, डिप्रेशन, गठिया, हृदय रोग और उच्च रक्त चाप की दवाइयां
• गर्भ निरोधक गोलियां

6. बालों के देखभाल की तरीके:

(क) हेयर कॉस्मेटिक्स: बालों के कलर, जेल, रिलैक्सर, स्प्रेज आदि | चिकित्सक इन चीजों के कम इस्तेमाल की सलाह देते हैं, जिससे कि बालों का टूटना कम हो सके |

(ख) ब्लो ड्रायर, फ्लैट और कर्लिंग आईरन: ब्लो ड्रायर से निकलने वाली उच्च उष्मा बालों के शाफ्ट में उपस्थित पानी को सूखा सकते हैं, जिससे कि बाल भंगुर होने लगते हैं तथा अधिक टूटने की संभावना हो जाती है|

(ग) हेयर पिन्स, क्लिप्स और रबर बैंड्स: अगर बालों को रबर बैंड्स, हेयर पिंस, क्लिप्स से कस कर बांधा जाए तो उनके टूटने की संभावना बढ़ जाती है| इसलिए हेयर क्लिप्स ऐसे लगाने चाहिए जो ढीले हों और सिर के अलग अलग हिस्सों में लगाना चाहिए ताकि बालों का टूटना एक ही जगह से ना हो|

(घ) बालों को बहुत अधिक सवारना: रेगूलर शैंपू, कंधी या ब्रश करना (दिन में 100 से अधिक स्ट्रोक) भी बालों के टूटने का कारण हो सकता है|

संदर्भ:

1. https://www.nhp.gov.in/disease/skin/alopecia-hair-loss
2. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
3. https://thehairlust.co.uk/blogs/blog/androgenetic-alopecia photo credit
4. https://www.medicalnewstoday.com/articles/70956 photo credit
5. https://medium.com/@poojasheth789/some-common-myths-about-scarring-alopecia-treatment-e9ff621852b6 photo credit
6. https://www.pulsetoday.co.uk/clinical-feature/clinical-areas/prescribing/guideline-of-the-month-thyroid-disease/ photo credit
7. https://www.medicalnewstoday.com/articles/326665 photo credit
8. https://es.123rf.com/photo_22764027_hair-clips-and-rubber-bands-on-isolated-white.html photo credit
9. https://www.snapdeal.com/product/bentag-combo-of-hair-curling/627336280340 photo credit
10. https://www.harpersbazaar.com/beauty/hair/advice/g4624/best-hair-products/ photo credit
11. https://www.scientificamerican.com/article/birth-control-pills-affect-womens-taste/ photo credit
12. https://health.clevelandclinic.org/how-do-i-know-what-blood-thinner-is-right-for-me/ photo credit
13. https://www.irishnews.com/lifestyle/2020/01/02/news/can-stress-cause-hair-loss-we-asked-an-expert-to-explain-1784210/ photo credit
14. https://youngwomenshealth.org/2019/02/06/trichotillomania-hair-pulling/ photo credit

Causes of Alopecia or hair loss

Alopecia or hair loss is nothing but partial or complete loss of hair. Hair loss generally develops gradually and may be patchy or diffuse (all over). 

There are many reasons for hair loss.  Important ones are as follows 

1. Disorders of hair:

Hereditary thinning or baldness: 

• Most common cause.
• Also known as androgenetic alopecia. 
• In men, it is seen as a receding hairline as well as hair loss on top of the scalp.
• In women, tends to have their hairline and have visible thinning of hair over the front and top of the scalp.

Alopecia areata:

• An autoimmune disease
• Causes hair loss on the scalp and elsewhere on the body. 
• Develops in people of all ages and hair is lost in patches. 

Cicatricial (scarring) alopecia: 

• Can develop in healthy men and women, 
• A rare condition that destroys hair follicles. 
• Scar tissue forms where the follicles once were and re-growth are not possible. 
• Treatment attempts to stop the inflammation that destroys the hair follicles.

2. Diseases

Underlying medical condition: 

• Hair loss may be a warning sign for about 30 diseases. 
• Hence, hair loss often can be stopped or reversed with treatment for the underlying disease. 
• Examples are Thyroid diseases and iron deficiency anemia.  

Some cancer treatments: 

• Radiation therapy and 
• Chemotherapeutic medications can also cause hair loss. 
• While hair loss is usually a temporary but distressing part of therapy. 

Ringworm of the scalp:

• Fungal infection (most common in children) 
• Can cause balding and scaling on the scalp

Trichotillomania:

• It is a disorder that causes people to repeatedly pull out their own hair. 
• Aside from a constant urge to pull out the hair on the scalp, sufferers often feel compelled to pull out their eyelashes, nose hair, eyebrows, and other hair on their bodies.

3. Stress and Hormones

Stress: 

• Mental or physical stress, 
• After a major surgery, high fever, severe infection, or even flu. 

Hormone fluctuations: 

• Changes in hormonal levels (especially in women) 
• Common during menopause and after childbirth due to falling estrogen levels which is usually temporary. 
• Hair can be re-grown.

4. Diet

• Weight loss: Common, and hair growth can return to normal with proper diet and weight. 
• Vitamin A excess: Intake of too much vitamin A.
• Protein intake too low: Can be reversed and prevented by eating enough protein.  
• Iron intake too low: Vegetarian sources of iron are iron-fortified cereals, soybeans, pumpkin seeds, white beans, lentils, and spinach. Clams, oysters, and organ meats are good animal sources of iron. 
• Eating disorder: Anorexia or bulimia is the other cause of hair loss.
• Zinc deficiency 
• Malnutrition

5. Medication

Medications that can cause hair loss are

• Blood thinners
• High-dose vitamin A
• Medicines for arthritis, depression, gout, heart problems, and high blood pressure
• Birth control pills: Women taking or discontinuing birth control pills experience hair loss. It occurs in women with an inherited tendency toward hair thinning.

6. Hair Care Practices

Hair cosmetics:  

• Frequent coloring of hair 
• Regular or improper use of dyes, gels, relaxers, and sprays  
• Doctors recommend limiting the use of these hair cosmetics to decrease hair breakage. 

Blow dryers, flat irons, and similar devices:

• Regular use of a blow dryer 
• The high heat from a blow dryer can boil the water in the hair shaft leaving the hair brittle and prone to breakage. 
• Doctors also recommend limiting the use of flat irons, which straighten hair by using high heat, and other devices such as curling irons.

Hairpins, clips, and rubber bands: 

• If the hair is held tightly with hairpins, clips, and rubber bands, it can break hair. 
• To minimize the breakage, one should use loosely fitting clips and wear them in different areas of the scalp so that hair breakage is not localized.

Too much or vigorous grooming: 

• Regular shampooing, combing or brushing (100 strokes or more a day) 
• Doing any of these too vigorously can cause hair breakage. 
• When hair breakage occurs, the hair appears shaggy or too thin

References:

1. https://www.nhp.gov.in/disease/skin/alopecia-hair-loss
2. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
3. https://thehairlust.co.uk/blogs/blog/androgenetic-alopecia photo credit
4. https://www.medicalnewstoday.com/articles/70956 photo credit
5. https://medium.com/@poojasheth789/some-common-myths-about-scarring-alopecia-treatment-e9ff621852b6 photo credit
6. https://www.pulsetoday.co.uk/clinical-feature/clinical-areas/prescribing/guideline-of-the-month-thyroid-disease/ photo credit
7. https://www.medicalnewstoday.com/articles/326665 photo credit
8. https://es.123rf.com/photo_22764027_hair-clips-and-rubber-bands-on-isolated-white.html photo credit
9. https://www.snapdeal.com/product/bentag-combo-of-hair-curling/627336280340 photo credit
10. https://www.harpersbazaar.com/beauty/hair/advice/g4624/best-hair-products/ photo credit
11. https://www.scientificamerican.com/article/birth-control-pills-affect-womens-taste/ photo credit
12. https://health.clevelandclinic.org/how-do-i-know-what-blood-thinner-is-right-for-me/ photo credit
13. https://www.irishnews.com/lifestyle/2020/01/02/news/can-stress-cause-hair-loss-we-asked-an-expert-to-explain-1784210/ photo credit
14. https://youngwomenshealth.org/2019/02/06/trichotillomania-hair-pulling/