Eye Care: Understanding Floaters and Cataracts

I have mild cataracts in both of my eyes. Besides, I occasionally see dark floating objects when I suddenly move my eyes from one direction to another. 

I was worried about the issue, so I did some online research and found this interesting information:

Understanding Floaters and Vitreous Gel:

Our eye contains a colourless, transparent, jelly-like substance called vitreous gel. It fills the large space between the eye's lens and retina and occupies roughly 80% of the eye's volume. It maintains the eyeball's shape and provides a clear path for the light travelling to the retina.

The vitreous gel consists of over 98% water, with the remainder a meshwork of collagen fibers and hyaluronic acid that helps maintain its structure.

The vitreous gel in our eyes changes as we age. 

At birth, the Gel is firm and intact. It slowly becomes a thin liquid as you grow older. Especially after age 60, the gel breaks down, forming tiny clumps that cast shadows on your retina. You begin to visualise floating objects as you move your eyelids.

Diagnosis of Symptom 

I visited an eye specialist. They tested my eyes for visual perfection as well as cataracts and related symptoms.

They confirmed that the "flea-like" object moving with my eyes is a benign eye floater. It is a shadow cast by tiny protein clumps inside the gel of your eye.

Additionally, I have cataracts in both eyes. Though they are not of any significance, I have been advised to plan for cataract surgery as soon as I am ready.

Floaters vs. Cataracts

• Floaters are moving specks or "flies" in the eye's fluid (moving spots/stains in the vitreous gel). They are the result of ageing. The broken clumps of the vitreous gel, which are casting shadows, seem to be floating in the air as and when I move my eyes.
• Cataracts are a stationary clouding of the eye’s lens that causes constant blurry or hazy vision.

When to Seek Urgent Medical Care: 

This is what I was informed.

Contact an eye specialist immediately if you experience:

• A sudden shower of many new floaters at once.
• New flashes of light (like lightning streaks).
• A dark shadow or curtain covering part of your vision.
• A sudden, significant blurring of vision.
• An injury to the eye with pain and/or bleeding.

Please Note:

This information is only for awareness and is not to be treated as medical advice.

Tinnitus- Are Your Ears Ringing?

Are you concerned about persistent buzzing sounds in your ears? 

Tinnitus is the medical term for hearing noises—such as ringing, buzzing, or hissing—in your ears or head when no external sound is present. 

It may not be a disease on its own, but a symptom of an underlying issue, usually when the auditory system misinterprets the sound waves and signals. 

Natural Sounds vs Tinnitus

Sometimes, your environment can be the source of persistent sounds and whooshing noise. In such cases, the continuous noise in your ears may not be a medical condition of Tinnitus.

When millions of insects, such as cicadas and crickets, call out at the same time during the day, their sounds create an acoustic "blanket" that fills the air. This creates an ambient noise level that easily passes through windows and reverberates inside, making it seem as if the noise surrounds you indoors. 

Outdoor insects like moles, crickets, or stray bees might have entered the house through gaps in doors or windows. 

Cicadas probably cause the loud, widespread daytime drone. Their high-frequency vibrations bounce off buildings and walls, creating a "wall of sound" that fills yards and enters indoors.

Other External Machinery: Large, community-wide infrastructure—such as neighborhood electrical transformers, commercial HVAC units, or nearby construction—can emit a low-frequency hum that resonates deeply through residential walls.

How to Identify Tinnitus?

To confirm whether you are suffering from tinnitus, you can do the following test.

Finger Drumming Technique:

1. Cover your ears: Firmly press the palms of your hands over your ears, with fingers wrapping around the back of your head.

2. Position your fingers: Align your middle fingers so they point toward each other just above the base of your skull.

3. Snap and drum: Rest your index fingers on top of your middle fingers, then snap them downward onto your skull in a drumming motion.

4. Repeat: Continue drumming quickly 20 to 30 times.

If the sound or noise persists, it is the result of your surroundings.

Otherwise, if the noise or the buzzing of the ear softens, it is a medical condition called tinnitus.

Common Symptoms of Tinnitus

The noises people experience can vary widely and can be soft, loud, constant, or intermittent: 

• Ringing or buzzing
• Hissing or whistling
• Roaring or whooshing
• Clicking or humming

Primary Causes of Tinnitus

Tinnitus often results from damage to the sensitive hair cells within the inner ear. 

• Common causes include prolonged exposure to loud noises like music, machinery, or firearms;
• age-related hearing decline, since hearing often weakens over time; 
• blockages such as earwax buildup, infections, or fluid accumulation; 
• and certain medical conditions like high blood pressure, TMJ (jaw) disorders, or side effects from medications.

Management & Treatment 

They say that there is no scientifically proven cure for most cases of tinnitus, but it can usually be effectively managed through the following procedures:

Hearing Aids: Since tinnitus is frequently linked to hearing loss, using hearing aids to restore hearing can help greatly decrease tinnitus perception.

Sound Therapy: Background noises, like fans, white noise machines, or ear-level masking devices, help divert the brain's attention from tinnitus.

Counseling/Therapy: Tinnitus Retraining Therapy (TRT) or Cognitive Behavioral Therapy (CBT) can teach you to ignore the sound and lower anxiety.

Note:

This information is provided for awareness only and should not be taken as professional advice. Always consult a medical professional for any concerns.

References:

https://my.clevelandclinic.org/health/symptoms/14164-tinnitus

https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156

https://americanhearing.us/all-about-tinnitus-2025-2/

Acupressure Points: Traditional Qi vs Scientific Explanations

 Acupressure is based on the principle that pressing specific points on the skin stimulates the nervous system to release chemicals, alter pain signals, and promote natural healing. 

While traditional theories attribute this to invisible energy pathways, modern medical science explains these effects through nerve stimulation, connective tissue pathways, and endorphin release.

Here is how acupressure stimulation functions from both a traditional and scientific perspective:

The Traditional Chinese Concept of Qi and Meridians

Traditional Chinese Medicine views acupressure through an energetic lens:

Meridians: Our body contains 12 major invisible pathways called meridians that transport energy, known as "Qi" (pronounced chee, similar to "cheese"). The twelve meridians are classified into six Yin and six Yang forces.

Yin: Yin meridians are strong and run along the inner (anterior) surfaces of the limbs connected to the storing organs.

Yang: Yang meridians run along the posterior (outer) surfaces of the limbs and connect to the processing organs.

Energy Blocks: When Qi gets blocked or stagnant along a meridian due to physical illness, stress, or pain, it causes issues.

Acupoints: Acupressure points act like natural valves; applying pressure helps clear blockages and promotes smooth energy flow.

The Ancient Vedic Concept of Marma Shastra

Vedic science explains acupressure through the Sushruta Samhita.

Anatomical Junctions: Our body has 107 vital anatomical junctions where flesh, blood vessels, nerves, ligaments, and joints meet.

Energy-Flow Points: These points act as gateways for Prana and Chetana, the life force and consciousness.

Seven Nadis: Similar to the meridians in the Chinese concept, Vedic philosophy speaks of seven life-flow points known as Nadis. The Prana, or life force, travels through these points and controls the entire body. Humans can cure all their health problems by properly activating these Nadis.

So, while traditional Chinese Medicine maps acupressure through the concept of distinct invisible meridians, the Vedic concept explains it through structural and spiritual nodal junctions known as Marma bindus.

The Modern Scientific Explanation: Neural and Tissue Stimulation

Contemporary medical research explains acupressure using measurable anatomical systems, such as neural and tissue stimulation. It is similar to the Vedic approach, but in a modern scientific framework.

This is how the scientific approach works:

Nerve Activation

Acupressure points typically sit over dense clusters of nerve endings, blood vessels, or muscle junctions. Pressing them sends a powerful signal to the spinal cord and brain.

Neural Gate Control 

Physical pressure sends "touch" signals to the brain more quickly than "pain" signals, effectively closing the neurological "gate" and reducing the sensation of pain. 

Chemical Releases 

Stimulating acupressure points causes the brain to release endorphins and serotonin, which are natural painkillers and mood stabilizers, thereby lowering overall stress.

Pressure on Fascia and Connective Tissues

Applying pressure to these points stretches the connective tissue surrounding muscles and organs. This helps relax tight muscles, enhances local blood flow, and decreases inflammation.

Distant Stimulations

Just like your nervous system wires a toe to a back nerve, acupressure maps distinct points that relieve symptoms elsewhere in the body.

For example, pressing a point on the top of the foot, between the big toe and the second toe, can relieve lower back pain, eye strain, and stress.

References:

https://pmc.ncbi.nlm.nih.gov/articles/PMC5765676/

https://pmc.ncbi.nlm.nih.gov/articles/PMC10440639/

Digestive Process: Inside Small Intestine, Large Intestine, and Importance of Chewing

The intestines digest food through a complex process. It involves several stages, including mechanical mixing, chemical breakdown (using enzymes and acids), and bacterial fermentation. Unlike the chewing process (mastication) that occurs in the mouth, the digestive tract relies on muscle movements, such as peristalsis and segmentation, to mix and move the food forward. This process reduces food to a liquid-like state. It is a state where the food particles are broken down into molecules.

Let us see how the food we eat passes through different stages of the intestines.

Here is how the intestines break down food: 

1. Mechanical Breakdown 

It involves movement of food inside the stomach. 

While the mouth uses teeth to crush food, the lower digestive tract uses different, highly effective mechanical methods to move and mix food. They are as follows: 

a) Peristalsis: This is automatic, wave-like contractions and expansions of muscles that push food along the digestive tract. The process is similar to a cream or paste emerging from the tube when squeezed. It happens throughout the digestive tract.

b) Segmentation: Primarily in the small intestine, this involves the contraction of circular muscles that divide the intestine into small segments, pushing the contents back and forth, mixing it with digestive juices, and breaking it into smaller pieces. 

c) Stomach Churning: The stomach muscles mix and mash food with gastric juices, turning it into a thick liquid called chyme.

2. Chemical Breakdown (Enzymes and Acids) 

The stomach and small intestine, assisted by the pancreas and liver, use chemical agents to break down food into its molecular building blocks: 

i) Stomach Acid (Hydrochloric acid): This acid breaks down food and kills bacteria. 

ii) Digestive Enzymes: 

• Stomach: Produces pepsin to break down proteins. 
• Pancreas: Secretes enzymes that break down carbohydrates, fats, and proteins in the small intestine. 
• Bile: Produced by the liver and stored in the gallbladder, bile acts as an emulsifier that breaks down large fat molecules into smaller, manageable particles. 

3. Nutrient Absorption (through Villi and Microvilli) 

The inner lining of the small intestine is covered in millions of microscopic, finger-like projections called villi, and even smaller ones called microvilli. 

• These structures vastly increase the surface area of the intestine, allowing the body to absorb nutrients efficiently. 

• As food, now in a highly processed, liquid state, passes over these villi, the nutrients are absorbed directly into the bloodstream.  

4. Breakdown by Gut Microbiota (in Large Intestine) 

In the large intestine (colon), bacteria break down any remaining undigested food particles through fermentation. This process also helps produce necessary vitamins, such as vitamin K, which is essential for bone health. 

Chewing is Important for Proper Digestion 

When food isn't chewed thoroughly, the intestines must exert more effort, potentially causing bloating, discomfort, and decreased nutrient uptake. Chewing involves using teeth and jaw muscles to break food into smaller pieces.

Chewing (scientifically known as mastication) is the crucial first step of digestion, breaking food into smaller particles and mixing it with saliva to increase surface area for enzyme action. It enhances nutrient absorption, aids weight management by promoting satiety, and reduces digestive issues like bloating. 

Key Aspects and Benefits of Proper Chewing: 

1) Improved Digestion and Absorption: Chewing breaks food down, allowing enzymes in saliva to begin breaking down carbohydrates and fats before they reach the stomach. This reduces the workload on the stomach and small intestine. 

2) Enhanced Nutrient Absorption: Thoroughly chewing releases more nutrients from food, ensuring the body can absorb vitamins, minerals, and energy efficiently. 

3) Weight Management and Satiety: Chewing food thoroughly slows down eating, giving the brain enough time (around 20 minutes) to receive signals from the stomach that it is full, which helps prevent overeating. 

4) Reduced Digestive Issues: Improperly chewed food can lead to poor digestion, causing issues like indigestion, bloating, gas, and constipation. Proper chewing aids in the complete digestion of food.

5) Promotes Oral Health: The mechanical act of chewing helps clean teeth, reduces plaque buildup, and increases saliva flow, which restores pH balance in the mouth, which is essential for overall health.

How to Properly Chew Food

It is recommended to chew each bite roughly 30 to 32 times, though most of us may not be doing that. 

Take time with meals and avoid rushing, which often leads to swallowing larger, unchewed pieces. 

Smaller Bites are helpful. Using smaller spoons or taking smaller bites makes it easier to chew thoroughly. 

Harder foods like meat and nuts require more chewing to break them down properly than softer or liquid items. 

Disclaimer:

This article is for informational purposes only and should not be treated as medical advice.

Staple Crop Meaning and Types of Food Staples

A staple crop is a plant cultivated in large quantities that forms the primary component of a population's daily diet, supplying essential energy and nutrients. Examples of staple crops include rice, wheat, maize (corn), tubers like potatoes and cassava, and legumes. These crops are vital for food security as they offer long-term storage, easy accessibility, and nutritional value. 

Key Characteristics of Staple Crop

High Consumption: Procured/consumed regularly and in large amounts.

Affordability: Staple crops are generally affordable to both the rich and the poor equally at a reasonable price.

High Caloric Value: Supplies a major proportion of energy needs.

Storage Stability: Often chosen for their ability to be stored over long periods. 

Synonyms for Staple Crop

Main crop

Primary crop

Cereal crop

Food staple 

Staple Crop Types

Cereals: Rice, maize, wheat, sorghum, barley, millet, oats, rye.

Root Crops/Tubers: Potatoes, cassava, sweet potatoes, yams, taro.

Legumes/Pulses: Beans, lentils, soybeans

Staple Crop usage under different Contexts

While speaking of a Regional Diet: "Rice is the main staple crop in Southeast Asia, while wheat is the primary staple in many Western nations".

While talking about an Agricultural Field: "Farmers in this region dedicated the majority of their farmland to growing cassava (known as "karra pendalam" in Telugu and "maracheeni or kappa" in Malayalam) as their primary staple crop".

Talking about Food Security: "Our country is trying to reduce its reliance on a single staple crop by encouraging farmers to grow different varieties (that can be grown with less water) to avoid widespread famine in case of drought". 

Hypothermia and Frostbite - Key Details and Awareness

Image created by Gemini

 

Hypothermia is a dangerous medical emergency that occurs when the body loses heat faster than it can produce it, lowering the core temperature below 95°F (35°C). It typically results from prolonged exposure to cold, wet, or windy conditions, impairing brain function and bodily systems. Symptoms progress from intense shivering and confusion to loss of consciousness, requiring immediate emergency medical care.

Key Details About Hypothermia 

• An involuntary drop in body temperature below 35 C,
• Causes: Exposure to cold and wet environments, or, for infants and the elderly, even cool indoor temperatures. 

Stages & Symptoms: 

• Mild: Shivering, confusion, increased heart rate, and cold skin
• Moderate: Shivering may stop, but confusion worsens, and lethargy and drowsiness 
• Severe Stage: Loss of consciousness, slow/weak pulse, or no pulse. 

Treatment: 

Immediate removal from the cold atmosphere, covering with blankets, and seeking emergency medical help. 

Don't try to rewarm the person with a hot bath or rubbing his arms and legs. The strain can tense his heart and lungs.

It is important to remember that it is not just extreme cold that poses a threat, but also the combination of factors like moisture and wind.

It is recommended that the patient be dressed in multiple layers to provide heat and warmth. Stay dry and covered with blankets in cold weather.

Hypothermia vs Frostbite

Hypothermia should not be confused with a similar condition known as Frostbite. Frostbite affects a portion of the body, whereas Hypothermia affects the whole body. Both are emergency cases. 

Hypothermia is more serious than frostbite because it is a life-threatening, system-wide emergency, whereas frostbite is localized tissue damage. 

Hypothermia affects the whole body, lowering core body temperature and causing cognitive impairment, while frostbite causes skin and underlying tissues to freeze. Both require prompt medical attention. 

Key Differences and Seriousness:

Hypothermia is More Serious: 

This happens when your body loses heat faster than it can produce it, dropping your core temperature below 95°F 

It affects the brain, causing confusion, memory loss, and poor coordination, making it harder for the person to help themselves.

Frostbite is Localized: 

Frostbite is the freezing of specific skin and underlying tissues, often on the fingers, toes, nose, or ears. It can cause permanent damage, including blisters and gangrene, but it does not initially affect the whole body system. 

Risk Factor: 

You can have both conditions at the same time, but if a person shows signs of both, treat the hypothermia first.

Symptoms: 

Both involve numbness, but hypothermia involves intense shivering and confusion, while frostbite turns skin white, grayish-yellow, or waxy.

Note:

This information is only for awareness and is not to be treated as medical advice.

You may refer to this article on mayoclinic.org and,

This article on the Department of Public Health- Connecticut's website

FODMAP, Digestion Issues, and Remedies

Eliminate High FODMAPs from your diet

FODMAP stands for fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. 

These are a group of short-chain carbohydrates that are poorly absorbed in the small intestine. In some individuals, they can cause digestive discomfort like bloating, gas, and abdominal pain.

 A low FODMAP diet involves limiting or avoiding foods high in these carbohydrates to help manage symptoms.


Here is a more Detailed Explanation:

FODMAPs are a group of carbohydrates:
They include various types of sugars and sugar alcohols found in many common foods.


They are poorly absorbed in the small intestine:

The small intestine is designed to break down and absorb carbohydrates for energy. However, some FODMAPs are not easily absorbed in the small intestine.


They cause Fermentation in the Large Intestine:

When undigested FODMAPs reach the large intestine, they are fermented by bacteria, producing gas and other byproducts. Though this is normal and beneficial to the Gut Biome, it can also lead to unwarranted issues, as discussed in the following lines.

Key Aspects of Intestinal Fermentation:

Normal Function: It is the primary way the body breaks down dietary fiber that escapes digestion in the small intestine. Because the small intestine cannot break down the fiber, it reaches the large intestine semi-digested. Fermentation then occurs there to digest the remaining particles.

Benefits: This process produces healthy compounds, including acetate, propionate, and butyrate, which maintain a healthy microbiome.

Byproducts: Fermentation produces beneficial short-chain fatty acids (SCFAs), which provide energy for colon cells and support gut health. The fatty acids and gases (like butyrate, hydrogen, methane, carbon dioxide) are expelled, with excessive production sometimes leading to bloating or discomfort  

Fermentation can cause digestive discomfort:
The fermentation process and the resulting gas can cause symptoms such as bloating, gas, diarrhea, or constipation in some people.

Low FODMAP Diet:

The low FODMAP diet is a temporary dietary plan where individuals limit or avoid foods high in FODMAPs. This can help in the identification of trigger foods and thereby reduce symptoms (if the intake of such foods is avoided) for individuals who experience digestive issues after eating foods high in  FODMAPs.

Examples of Foods High in FODMAPs:

Oligosaccharides: Fructans (found in wheat, rye, onions, garlic) and galacto-oligosaccharides (GOS) (found in legumes/pulses).

Disaccharides: Lactose (found in dairy products).

Monosaccharides: Fructose (found in honey, apples).

Polyols: Sugar alcohols like sorbitol and mannitol (found in some fruits and candies).

Further Explanation:

The term "Monosaccharide" refers to a single sugar (carbohydrate) molecule. 

In contrast, a disaccharide is a molecule composed of two combined molecules. 

An oligosaccharide is a carbohydrate of two to ten molecules. 

Polyols are hydroxide compounds that are easily soluble in water.

Fructans are a type of carbohydrate (a chain of fructose molecules) that are not easily digestible for some sensitive individuals. 

Fructose is a simple sugar, whereas fructan is a complex chain of sugar molecules. Sugars are carbohydrates that provide energy to the body.

Remedies & Treatment

The treatment involves the identification and avoidance of High FODMAP items. It consists of three phases.

Elimination Process: At this phase, you will keep eliminating the High FODMAP items gradually from your meals. You may experience some relief in your body after one or two weeks.

Reintroduction Phase: After 2 to 3 weeks, you can begin adding the items one by one to your plate of meals. At the same time, keep watching for the return of the digestive issues. By doing so, you can identify which item is causing you the problem.

Maintenance Phase: This is the final phase where you identify which FODMAP items are good for you and which are problematic. Thereby, you can finalise your food chart and adhere to it consistently.

This article by the Cleveland Clinic provides a detailed list of foods High in FODMAPs and their substitutes (Low FODMAP foods). You can test your diet components using their chart to confirm which food items are causing trouble for you. You can alter your food compositions accordingly.

Gut Biome - What is it? How Does it Affect Your Health?

Gut Biome is a community of microbes (bacteria and fungi) that live in your intestines, interact with your digestive system, and contribute to your health and immunity. Your food habits and genetics define your Gut Biome.

Your gut biome carves your physical and mental health. But a healthy biome/microbiome depends on your food choices and the environment surrounding you.

The "gut biome," also known as the gut microbiome, refers to the community of microorganisms, including bacteria, viruses, fungi, and other microbes, that live in the human digestive tract. These microorganisms play a vital role in various bodily functions, including digestion, immune system regulation, and even mental health.

Here's a more detailed explanation: 

What it is: The gut biome is essentially a miniature ecosystem within your intestines, populated by trillions of these microorganisms.

What it includes: The Biome encompasses a diverse range of bacteria, viruses, fungi, and other microorganisms. 

Why is it important:

These microorganisms are crucial for Digestion: They help break down and digest food, extract nutrients, and train and regulate the immune system. 

Other functions: They influence our body metabolism, mood, and, potentially, even prevent disease.

Individuality: Each person's gut biome is unique and can be influenced by factors like diet, environment, and even genetics.

Dysbiosis: An imbalance in the gut microbiome, where harmful microorganisms may outnumber beneficial ones, can lead to various health issues.

In essence, the gut biome is a complex and dynamic community of microorganisms that significantly impacts human health and well-being.

For some important points, please refer to this article: "20 things you didn't know about your gut biome" on NIH.com

PRP Treatment Meaning and Significance

Intra-articular PRP (Platelet-Rich Plasma) treatment involves injecting a concentration of a patient's own platelets into a (damaged) joint to promote healing and reduce pain. This is often used for conditions like tendinitis and osteoarthritis (OA), where cartilage damage and inflammation are present. Platelets release growth factors (bioactive proteins) that stimulate tissue regeneration and reduce inflammation, potentially offering a more effective, longer-lasting solution than some traditional treatments. 

Here's a more detailed explanation: 

• What it is: PRP treatment utilizes a patient's own blood, which is drawn and processed to concentrate the platelets. These platelets are then injected directly into the affected joint. 
• How it works: Platelets contain growth factors that are crucial for tissue repair and regeneration. When injected into the joint, these growth factors stimulate the body's natural healing process by promoting cell division, vessel growth, matrix formation (secretion of osteoid/collagen that transforms into rigid bone), and new cell formation.  
• Which conditions get treated: PRP injections are commonly used for knee osteoarthritis (OA), other joint problems, and tendon inflammation and injuries. 

Benefits: Studies suggest that PRP can be more effective than standard treatments like hyaluronic acid injections (substances derived from animal tissues or plants like wheat and corn). They were found to be more effective in younger, more active patients with early-stage OA. It may also reduce pain and improve joint function.

Safety: PRP injections are generally considered safe because they use the patient's own blood, minimizing the risk of allergic reactions or other complications.

LIMITATIONS;

The effectiveness of PRP (Platelet-Rich Plasma) injections typically lasts for six to nine months, although some individuals may experience benefits for up to two years or more. The duration can vary based on factors like the individual's response, the severity of the condition being treated, and adherence to post-treatment care. 

Initial Improvement:

Noticeable improvements from PRP injections may take four to six weeks to appear.

Peak Effectiveness:

The PRP continues to aid healing for several months, with benefits potentially lasting for six to nine months, and sometimes up to two years or more.

Individual Variability:

The duration of effectiveness can vary significantly between individuals and conditions. 

Maintenance:

Some individuals may require additional injections to maintain the benefits over time

Factors affecting Effectiveness:

Part of this is due to the number of red blood cells in your plasma. 

When we extract platelet-rich plasma from your blood, we often see that some people receive less PRP than others. 

Less PRP means fewer growth factors, which can result in your outcomes not being as good as they could have been. 

Sometimes, poor cardiovascular health and a compromised immune system can hinder our body’s ability to regenerate. 

Certain pharmaceuticals, over-the-counter pain medications, recreational drugs, and alcohol can reduce the effectiveness of your PRP procedure.

Note: This article is based on some collected points and browsing results and is not professionally or personally evidenced.

For more information, please go through this article from WebMD.