How to reverse HbA1c levels in a child of 6 years? - #26749

Don’t worry Sandeep ji, NEED PERSONAL CONSULTATION

visit nearby ayurvedic physician (BAMS MD pediatrician)for further advice and treatment…

TAKE CARE😊

Please read it patiently I have tried my best to help you please don’t worry😊

Based on the blood test results you provided, your son’s HbA1c level is 6% and his Vitamin D level is 9 ng/mL. Here is a breakdown of what these numbers mean, what you can do, and an Ayurvedic perspective on the situation.

Understanding the Results

HbA1c (Hemoglobin A1c): This test measures your average blood sugar levels over the past 2-3 months. A result of 6% is considered in the pre-diabetic range. For children, a normal HbA1c level is typically below 5.7%. While this is a significant finding, it doesn’t mean your son has diabetes yet. It’s a wake-up call to make immediate lifestyle and dietary changes to prevent it from developing.

Vitamin D: A level of 9 ng/mL is considered a severe deficiency. The normal range for Vitamin D is usually between 30 and 100 ng/mL. This deficiency can affect bone health, immune function, and overall well-being, which may be contributing to his frequent throat infections.

It’s crucial to consult with your son’s pediatrician and a pediatric endocrinologist immediately. They will provide a comprehensive diagnosis and create a personalized treatment plan. Here are some general recommendations you can start

Dietary Changes:

Reduce Sugar and Processed Foods: Eliminate sugary drinks, candies, processed snacks, and white bread from his diet.

Increase Fiber: Incorporate more whole grains, fruits, and vegetables. Fiber helps regulate blood sugar levels.

Healthy Fats and Proteins: Ensure his meals include healthy fats (like those in avocados and nuts) and lean proteins to help him feel full and stable.

Physical Activity: Encourage at least 60 minutes of physical activity daily. This could be playing outdoors, cycling, swimming, or any other activity he enjoys. Exercise is a powerful tool for improving insulin sensitivity and managing blood sugar.

Vitamin D Supplementation: Your doctor will likely prescribe a high-dose Vitamin D supplement to correct the deficiency. Make sure he gets enough sunlight exposure, as this helps the body produce Vitamin D naturally.

Ayurvedic Perspective

According to Ayurveda, the issues of high blood sugar (pre-diabetes) and low immunity (frequent infections) are often linked to an imbalance of the three doshas: Kapha, Pitta, and Vata. High blood sugar is primarily seen as a Kapha imbalance, characterized by excess phlegm, heaviness, and sluggishness. Low immunity is often a result of poor agni (digestive fire) and the accumulation of ama (toxins). The goal of Ayurvedic treatment is to restore balance through diet, lifestyle, and herbal remedies.

Ayurvedic Recommendations

Dietary Adjustments:

Reduce Kapha-Aggravating Foods: Avoid dairy, cold foods, sweets, and heavy, oily foods.

Favor Kapha-Balancing Foods: Include bitter, pungent, and astringent tastes in his diet. Foods like turmeric, fenugreek, and cinnamon are beneficial.

Timing of Meals: Ensure he eats his main meal at lunchtime when digestive fire (agni) is strongest. Avoid heavy meals in the evening.

Herbal Remedies: An Ayurvedic practitioner may suggest herbs that help balance blood sugar and boost immunity. Some common examples include:

Vijaysar (Pterocarpus marsupium): Known for its anti-diabetic properties.

Guduchi (Tinospora cordifolia): A powerful immune-booster and detoxifier.

Neem (Azadirachta indica): Helps in purifying the blood.

Lifestyle and Routines:

Dinacharya (Daily Routine): Establish a regular sleep schedule. Waking up early and going to bed on time helps balance the doshas.

Daily Massage (Abhyanga): A gentle massage with warm sesame oil can help improve circulation and boost immunity.

Pranayama (Breathing Exercises): Simple breathing exercises can help calm the mind and strengthen the body.

Gemini

2.5 Flash

Conversation with Gemini My son is 6 years old, and day before yesterday we did his blood tests to identify that why he is getting throat infection on a regular basis. To my surprise his HBA1c level was 6 and vitamin D level was 9. I am very tensed since then and don’t know that how his HbA1c level is 6 at such a young age. Request you to kindly suggest what can be done and what according to ayurveda should be given to him to reverse it. He is 21.1 kg in weight with a decent height.

Ayurveda opinion

Based on the blood test results you provided, your son’s HbA1c level is 6% and his Vitamin D level is 9 ng/mL. Here is a breakdown of what these numbers mean, what you can do, and an Ayurvedic perspective on the situation.

Understanding the Results HbA1c (Hemoglobin A1c): This test measures your average blood sugar levels over the past 2-3 months. A result of 6% is considered in the pre-diabetic range. For children, a normal HbA1c level is typically below 5.7%. While this is a significant finding, it doesn’t mean your son has diabetes yet. It’s a wake-up call to make immediate lifestyle and dietary changes to prevent it from developing.

Vitamin D: A level of 9 ng/mL is considered a severe deficiency. The normal range for Vitamin D is usually between 30 and 100 ng/mL. This deficiency can affect bone health, immune function, and overall well-being, which may be contributing to his frequent throat infections.

Recommended Actions It’s crucial to consult with your son’s pediatrician and a pediatric endocrinologist immediately. They will provide a comprehensive diagnosis and create a personalized treatment plan. Here are some general recommendations you can start implementing under medical supervision:

Dietary Changes:

Reduce Sugar and Processed Foods: Eliminate sugary drinks, candies, processed snacks, and white bread from his diet.

Increase Fiber: Incorporate more whole grains, fruits, and vegetables. Fiber helps regulate blood sugar levels.

Healthy Fats and Proteins: Ensure his meals include healthy fats (like those in avocados and nuts) and lean proteins to help him feel full and stable.

Physical Activity: Encourage at least 60 minutes of physical activity daily. This could be playing outdoors, cycling, swimming, or any other activity he enjoys. Exercise is a powerful tool for improving insulin sensitivity and managing blood sugar.

Vitamin D Supplementation: Your doctor will likely prescribe a high-dose Vitamin D supplement to correct the deficiency. Make sure he gets enough sunlight exposure, as this helps the body produce Vitamin D naturally.

Ayurvedic Perspective According to Ayurveda, the issues of high blood sugar (pre-diabetes) and low immunity (frequent infections) are often linked to an imbalance of the three doshas: Kapha, Pitta, and Vata. High blood sugar is primarily seen as a Kapha imbalance, characterized by excess phlegm, heaviness, and sluggishness. Low immunity is often a result of poor agni (digestive fire) and the accumulation of ama (toxins). The goal of Ayurvedic treatment is to restore balance through diet, lifestyle, and herbal remedies.

Ayurvedic Recommendations (Consult an Ayurvedic Practitioner) Dietary Adjustments:

Reduce Kapha-Aggravating Foods: Avoid dairy, cold foods, sweets, and heavy, oily foods.

Favor Kapha-Balancing Foods: Include bitter, pungent, and astringent tastes in his diet. Foods like turmeric, fenugreek, and cinnamon are beneficial.

Timing of Meals: Ensure he eats his main meal at lunchtime when digestive fire (agni) is strongest. Avoid heavy meals in the evening.

Herbal Remedies: An Ayurvedic practitioner may suggest herbs that help balance blood sugar and boost immunity. Some common examples include:

Vijaysar (Pterocarpus marsupium): Known for its anti-diabetic properties.

Guduchi (Tinospora cordifolia): A powerful immune-booster and detoxifier.

Neem (Azadirachta indica): Helps in purifying the blood.

Lifestyle and Routines:

Dinacharya (Daily Routine): Establish a regular sleep schedule. Waking up early and going to bed on time helps balance the doshas.

Daily Massage (Abhyanga): A gentle massage with warm sesame oil can help improve circulation and boost immunity.

Pranayama (Breathing Exercises): Simple breathing exercises can help calm the mind and strengthen the body.

Remember, any Ayurvedic treatment should be given under the strict guidance of a qualified Ayurvedic doctor, especially for a child. It’s essential to integrate these approaches with the advice of his allopathic pediatrician.

Diet chart for 6 year old pre diabetes

Thank you for reaching out. It’s completely understandable to be concerned about your son’s health. While I cannot provide a specific medical diet chart, as that should be created by a qualified healthcare professional like a registered dietitian or a pediatric endocrinologist who knows your son’s specific needs, I can offer general principles and a sample meal plan based on the nutritional recommendations for children with pre-diabetes.

The goal is to manage blood sugar levels and promote healthy growth without being overly restrictive, which is vital for a 6-year-old. The focus should be on a balanced diet of whole foods, regular meal times, and controlling portion sizes, especially for carbohydrates.

Core Principles of the Diet Prioritize Whole Foods: Choose foods in their most natural state—fresh fruits, vegetables, whole grains, and lean proteins—over highly processed and packaged foods.

Control Carbohydrate Portions: Carbohydrates have the biggest impact on blood sugar. The goal is not to eliminate them but to choose complex carbohydrates (which are digested more slowly) and to manage the amount at each meal and snack.

Increase Fiber Intake: Fiber-rich foods (vegetables, fruits, and whole grains) slow down the absorption of sugar and help keep blood sugar levels stable. Aim for about 25-30 grams of fiber per day.

Include Lean Protein and Healthy Fats: Pairing carbohydrates with protein and healthy fats helps to further slow down sugar absorption and keeps your child feeling full and satisfied.

Eliminate Sugary Drinks: This is one of the most important changes you can make. Replace all sugary beverages (sodas, juices, sweetened teas, etc.) with water.

Regular Meal Times: Skipping meals can cause blood sugar levels to spike at the next meal. Stick to a consistent schedule of three meals and 2-3 healthy snacks per day.

Sample Meal Plan for a 6-Year-Old (Prediabetes)

This is a general template. Please adjust portions and food choices based on your son’s appetite and preferences.

Breakfast Option 1: A bowl of plain oatmeal (made with milk or water) topped with a handful of berries and a sprinkle of nuts or seeds.

Option 2: One whole-wheat toast with a thin layer of natural peanut butter and a few apple slices.

Option 3: A small vegetable omelet with two eggs and a side of half a cup of Greek yogurt.

Mid-Morning Snack A piece of fruit like an apple or a small banana.

A handful of almonds or walnuts.

A small bowl of plain curd (yogurt) with a few berries.

Lunch Option 1: A whole-wheat roti with a serving of a dal (lentil) and a vegetable curry.

Option 2: A brown rice bowl with a lean protein like grilled chicken or chickpeas, and plenty of steamed or stir-fried vegetables (broccoli, carrots, peas).

Option 3: A sandwich on whole-wheat bread with a lean protein like boiled egg slices or a spread of hummus, along with a side of cucumber and carrot sticks.

Afternoon Snack A bowl of sprouts.

A hard-boiled egg.

A small portion of roasted chana (chickpeas).

Dinner Option 1: A bowl of vegetable soup with a small serving of grilled fish.

Option 2: A whole-wheat roti with a portion of paneer (cottage cheese) or tofu, and a side of cooked greens.

Option 3: A small bowl of mixed-vegetable quinoa with a serving of lean meat or beans.

Before Bed (If needed and with doctor’s approval) A small glass of milk.

Foods to Limit or Avoid: Sugary Drinks: Soda, fruit juices (even 100% juice), flavored milk, energy drinks.

Refined Grains: White bread, white rice, white pasta, and pastries.

Sweets and Desserts: Candy, cookies, cakes, ice cream, chocolates.

Fried and Processed Foods: Chips, crackers, most fast food, fried snacks.

The Plate Method A simple way to portion meals is to use the “plate method.” For lunch and dinner, aim for:

Half of the plate: Non-starchy vegetables (broccoli, leafy greens, carrots, beans).

One-quarter of the plate: Lean protein (chicken, fish, eggs, legumes, paneer).

One-quarter of the plate: Complex carbohydrates (whole-wheat roti, brown rice, whole-wheat pasta, sweet potato).

Yoga Therapy

Asanas

Uttanapada Chakrasana (3 rounds)

Akarna Dhanurasana (1 minute on wach side)

Dhanurasana 3 rounds (1 minute each)

Udarsanchalan (3 rounds)

Ashwini Mudra in Sarwangasana (3 minutes)

Hansasana or Mayurasana (3 rounds each)

Halasana (1 minute)

Privart Trikonasana (1 minute on each side)

Matsyasana (30 seconds)

Veerasana (1 minute on each side)

Ardhamatsyendrasana (2 minutes on each side)

Shavasana (when needed)

Paschimottasana (1 minute)

Pranayama

Suryabhedana Pranayama with Kumbhaka

Bhastrika Pranayama with Kumbhaka

HELLO SANDEEP JI,

1. Include barley,Yava, wheat, kodo millet, and rice that crops within 60 days.

2.Incorporate adhaki (red gram), horse gram, and green gram.

3. Include bitter food in his diet.

4.Include orange, watermelon, apple, jambu, kapitha, amla, papaya, and other fruits with low sugar content.

5. Soyabean, groundnut, and mustard oil may be beneficial.

6.Avoid sugary and oily foods, dairy products, red meat, and tubers,guru ahar(heavy to digest)etc.

7. Encourage regular physical activity, including brisk walking, running, and aerobics. Yoga postures like Kati Chakrasana, Vakrasana, Tadasana, Ustrasana, Pranayama, and Surya Namaskar are also recommended.

8. Aim for a consistent sleep schedule to support hormonal balance and blood sugar regulation.

TAKE CARE 😊

Hello Sandeep ji, I completely understand your concern. An HbA1c of 6% in a 6-year-old means the average blood sugar over the last 2–3 months is slightly above the normal range. ☑️ This does not necessarily mean diabetes, but it shows a tendency towards prediabetes or altered carbohydrate metabolism. ☑️ A Vitamin D level of 9 ng/mL is quite low, and this deficiency can reduce immunity, making throat infections more frequent.

AYURVEDIC PERSPECTIVE From an Ayurvedic perspective, this is suggestive of:

👉Kapha–Medo Dushti imbalance in Kapha and lipid/glucose metabolism. 👉Mandagni - sluggish digestion leading to accumulation of Ama (toxins). 👉Oja-Kshaya- reduced immunity and resilience.

☑️YES THIS CAN BE REVERESED By correcting digestion, metabolism, and immunity early, this can be completely reversible.

✅DIETARY MODIFICATIONS As he is just 6 years old i will suggest to rely more on dietary changes this will help him in long run

❌Avoid ➡️Refined sugar, chocolates, biscuits, cakes, packaged juices, fried food. ➡️Excess milk-based cold drinks and ice creams.

✅Include: ➡️Warm, freshly cooked home food. ➡️Moong dal khichdi, vegetable upma, daliya with vegetables. ➡️Seasonal fruits like papaya, guava, apple (avoid banana & grapes for now). ➡️Whole grains & millets (ragi, jowar, bajra in rotation). ➡️Soaked almonds (3–4) and walnuts (1–2) in the morning.

✅Lifestyle Advice 👉Daily 20–30 minutes of morning sunlight for Vitamin D. 👉Encourage outdoor physical play. 👉Maintain a fixed sleep routine — 9–10 hours at night. 👉Avoid daytime sleeping unless unwell.

✅Ayurvedic Support for Immunity

Guduchi powder — ¼ tsp in warm water once daily after meals for immunity and metabolism. Haridra (turmeric) milk — ½ tsp turmeric in boiled cow’s milk at night. Chyawanprash — ½ tsp daily for immunity (preferably sugar-free variant).

👉For throat infections: Warm water gargles with turmeric + rock salt

☑️Follow-up & Monitoring is most important

☑️Repeat HbA1c after 3 months. ☑️Check fasting blood sugar and fasting insulin. ☑️Monitor weight & activity levels regularly.

Children’s metabolism responds quickly to diet and lifestyle changes. With proper care, both HbA1c and Vitamin D levels can be brought back to normal, and the frequency of throat infections can be greatly reduced.

Wish him a Good healthy Life ahead😊

Warm Regards Dr Snehal Vidhate

Hba1c levels shows u the average of 3 months sugar level so with only hba1c levels 6 we can’t finalize the child as diabetic and start medication So the main thing here is to monitor the sugar level and change the food habits and lifestyle Take more of fibre rich food and natural sugars like fruits Avoid extra processed sugar and junk food Expose the body the the sunlight Tell to do some physical activities By these only sugar will be controlled And for the throat infection U can add a pinch of turmeric powder in milk and take twice a day it will be beneficial Thank you 😊

Vitamin D 9 means very deficient. This can weaken immunity. Likely a key cause behind throat infection.

Consult a paediatrician for vitamin D3 supplement.

HbA1C - 6 may suggest mild insulin resistance. It doesn’t mean he has diabetes. Kindly recheck test after 2 weeks. Also check FBS,OGTT to rule out type 1 diabetes.

Avoid packaged items, bakery products etc. Encourage physical play minimum 1 hour. Expose to sunlight for 20-30 minutes. Include sesame seeds in diet.

Do not worry as for children HBA1c will be slightly at higher levels it dosent mean that the child is prediabetic instead there are several reasons lik intake of exc sugar/refined/low physical activity/recurrent infections/genetic history and sometimes due to less exposure to sun and leading to low immunity Avoid sugary products Deep fried/high carbs Expose to sun daily early morning exposure is good Out door play Reduce screen time Give turmeric milk Take paediatrician consultation for VIT D correction and some multivitamin and repeat the tests after 3 months

Dear Sandeep. HBA1C 6 , shows prediabetic stage do not worry, just cut down on sweets, pastries, and sugary foods, also avoid jaggery, honey infused foods. Let him have nutritious ghar ka khana Let him remain active physically, For low Vitamin D, give him oil massage with sesame oil during cold season and coconut oil or olive oil during summer season, after oiling exposure him to sunrays preferably at Sunrise and sunset time as these rays contains ultraviolet light that helps in synthesis of Vitamin D. Include food rich in calcium like sesame seeds …in his diet. Give karela jamun juice 10ml daily with water

Madhumeha kusumakar rasa 1/4 tab once daily with honey, after meal Gudmar churan 250 mg once daily with warm water, after meal Drakshavaleha 1/2 tsp twice daily with warm milk, after meal Moringa Capsules 1 cap. once a day with water, after meal

Foods to include: Millets, drumstick, amla, papaya, gyava, moong daal, soaked almonds, mushrooms.

Foods to avoid: Candies, packaged juices, bakery items, ice cream, fried snacks, flavored milk, instant noodles

Lifestyle modifications: morning sun exposure 15-20 min sesame oil body massage gentle yoga and outdoor play activites

Adv. to consult with a pediatrician

DNT WORRY SANDEEP DHIMAN JI.HBA1C 6% IS SLIGHTLY HIGHER FOR 6YEAR CHILD .DNT PANIK USE OF EXCESSIVE AMOUNT OF SWEETS. SEDENTARY LIFE STYLE…GENTICS CAN PLAY ROLE OF THIS. BUT HBA1C ABOVE 7% IS DIGONESD DIABETES…ITS INTERNATIONAL DIABETES CAUNCIL RATIO…

BUT ONE THINGS IF YOU DNT TAKE SERIOUSLY…YOUR CAN CAN HAVE TYPE 1 DIABETES…ITS VERY HARD TO CONTROL…SO PLZZ MAINTED HEALTY RAW DIET…AND BAOUGHT A CYCLE FOR YOUR CHILD …

MADICATION:- HE IS NOT THE CERTAIN AGR OF TAKEING MOST OF AYURVEDIC FORMULATION BCZ ITS BITTER IN TASTE…

SO … DIVYA MADUKALP VATI=1-1 TAB BEFORE MEAL TWICE DAILY

DIVYA CHANDRAPRABHA VATI=1-1 TAB AFTER MEAL TWICE DAILY…ITS A MED TAKE PREDIABETES…ANY ONE CAN TAKE THIS MED…ITS HARMLESS …

DIET MAINTAINANCE=TAKE FRUITS DAILY BASIS/SPROUTS/MULTI GRAIN ROTI…

AVOID TAKE JUNK/MAIDA/EXCESSIVE SWEETS…

RIDE BICYCLE REGULARLY…

MAINTAIN YOUR SLEEPING CYCLYE .

FOR VIT D DEFICIENCY=NUTRELA D2K=1 TAB CHEW ANY TIME IN DAY…

YOU CAN EAISLY CURED

HELLO SANDEEP,

Your child’s HbA1c= 6% means his average blood sugar over the past 3 months has been slightly higher than normal

NORMAL= <5.7% BODERLINE/ PREDIABETES= 5.7- 6.4 % DIABETES= >6.5 %

It’s not diabetes yet, but it is a warning signal that his body is starting to resist insulin- the hormone that helps sugar enter cells for energy. If not corrected now, it could progress in future years

His vitamin D= 9 ng/mL is very low. vitamin D deficiency can -weaken immunity frequent throat infections -reduce insulin sensitivity raising blood sugar -affect bone health and growth

WHY THIS HAPPENS IN CHILDREN POSSIBLE CAUSES -diet high in sweets, sugary drinks, biscuits, chocolates, fried food -lack of outdoor activity -excess screen time -genetic tendency if parents/grandparents have diabetes -vitamin D deficiency reducing immune and metabolic efficiency -frequent infections causing internal inflammation, which worsens sugar control

In Ayurveda, this is an early stage of prameha. (pre diabetic condition) with kapha dominance and mild pitta involvement -KAPHA IMBALANCE= heaviness, sluggish digestion, mucus formation (frequent throat infections) -LOW AGNI (digestive fire)= poor nutrient assimilation , metabolic waste accumulation -OJAS DEPLETION= lowered immuit

TRETMENT GOALS -reverse kapha and ama accumulation = lighten the system -improve agni for better metabolism -strengthen Ojas (immunity) -balanc blood sugar naturally -correct vitamin D deficiency -prevent progression to diabetes in adulthool

INTERNAL SUPPORT

1) GUDUCHI SATVA= 125 mg with honey once daily in morning for 3 months =boosts immunity, reduces toxins, mild sugar control

2) FRESH OR JUICE AMLA= 1 tsp juice with water in morning =vitamin c, antioxidants, Rasayana for immunity and metabolism

3) HALDI WITH MILK= 1/2 tsp turmeric in 100 ml warm milk =anti inflammatory immunity booster

4) SHUNTHI (dry ginger powder) + honey= pinch of powder with 1/2 tsp honey- 2-3 weeks during infection season =improves digestion, clears mucus

5) CHYAWANPRASHA= sugar free variant for kids= 1/2 tsp in morning =immunity and energy

EXTERNAL TREATMENT

1) DAILY GENTLE OIL MASSAGE with warm BALA oil= improves circulation, immunity, bone strength and mood

2) Sun exposure immediately after massage to boost vitamin D

3) steam inhalation with tulsi + ajwain leaves during infection season to reduce throat infection frequency

DIET

AVOID -refined sugar, candies, pastries, sweet drinks, apackaged snacks -excess milk products like ice cream, cheese except small warm milk in morning -deep fried snacks -cold stored food and aerated drinks

INCLUDE -millets and whole grains -fresh vegetables= bottle gourd, ridge gourd, carrots, spinach, beans -fruits= apple , guava , papaya, pomegranate whole fruit, not juice -moong dal, green gram sprouts -nuts= 2-3 soaked almonds, 1 walnut daily -warm watr sipping during the day to aid digestion

LIFESTYLE CHANGES -out door play for 60-90 minutes daily- cycling, running, football, skipping -mornin sunlight 15-20 minutes daily -sleep= 9-10 hours at night - reduce screen time to <1 hour/daay -eat dinner at least 2 hours before bedtime

CHILD FRIENDLY YOGA ASANA -Tadasana= improves posture and growth -Vrikshasana= balance and concentration -Bhujangasana= strengthens back, improves digestion -Anulom Vilom= calms mind, balances metabolism -Bhramari= improves immunity reduces throat infection

HOME REMEDIES -tulsi+ honey= 2-3 leaves chewed daily for immunity

-ajwain water= boil 1/2 tsp ajwain in 1 cup water, cool, giver warm after meals during congestion

-amla candy no sugar= for vitamin c and digestion

-sprouted mung with lemon= improves metabolism

INVESTIGATION NEEDED NOW AND LATER

NOW -fasting blood sugar -postprandial blood sugar -lipid profile -thyroid profile -repeat vitamin D and HbA1c after 3-4 months

LATER -monitor growth chart height, weight every 6 months -keep track of infection frequency

DURATION OF TREATMENT -herbal + dietary corrections= 3 months strictly, then continue healthy lifestyle lifelong -vitamin D correction= 6-8 weeks supplementation, recheck then maintain through sunlight and food

You’ve caught this early- which is the best news. At 6 years old, his metabolism is still adaptable, and with Ayurveda + modern monitoring, you can bring HbA1c down to normal and prevent future problems. Your focus should be on playful activity, simple whole foods, regular sunlight, and immunity-boosting herbs.

The goal is not to “treat diabetes” but to build a lifelong healthy metabolism

HOPE THIS MIGHT BE HELPFUL

THANK YOU

DR. MAITRI ACHARYA