scholarly journals Clinical predictors of hypoxemia in children with WHO classified pneumonia

2018 ◽  
Vol 5 (4) ◽  
pp. 1176
Author(s):  
Meenakshi S. Kushwah ◽  
Yogendra S. Verma ◽  
Ajay Gaur
Keyword(s):  
Pulse Oximeter ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Respiratory Illness ◽  
P Value ◽  
Health Providers ◽  
Impaired Consciousness ◽  
Clinical Predictors ◽  
Medical College

Background: In developing countries were health providers have to rely on signs and symptoms to identify hypoxemia in pneumonia and start oxygen therapy, this study was therefore conducted to assess the prevalence and predictors of hypoxemia with the hypothesis to design a severity score for hypoxemia in children with pneumonia.Methods: This prospective observational study was carried out at the paediatric emergency department of Gajra Raja Medical College, Gwalior, on children of age 1-60 months admitted with respiratory illness categorised on basis of “Revised WHO Classification of Pneumonia”. Various demographic and clinical features were noted. Oxygen saturation was measured via a pulse oximeter. Hypoxemia was defined as SpO2 <90%. Statistical analysis was done.Results: Of the 200 children studied, 67 (33.5%) had hypoxemia. Fever, breathing difficulty, and crepitations were the most sensitive, while inability to feed, cyanosis, grunting, head nodding and impaired consciousness were the most specific indicators for hypoxemia. Fever, lethargy, inability to feed, nasal flaring, grunting, impaired consciousness and cyanosis were found significant (p value<0.05). Combinations of tachypnea with nasal flaring, grunting, cyanosis, and retractions with grunting were also found significant in predicting hypoxemia. Combinations of tachypnea with grunting (90.2%) and cyanosis (94.7%) were found highly specific.  Using these combinations, a new hypoxemia scoring system was designed to predict the severity of hypoxemia.Conclusions: Study suggested that combination of clinical signs may be utilized as markers for hypoxemia in conditions where pulse-oximeter is not available.

scholarly journals Comparison of two ophthalmic solutions of olopatadine hydrochloride (0.1%) and epinastine hydrochloride (0.05%) on clinical signs of vernal keratoconjunctivitis and side effects of the two drugs

2020 ◽  
Vol 8 (10) ◽  
pp. 3565
Author(s):  
Tahir Husain Ansari ◽  
Yusuf Rizvi
Keyword(s):  
Side Effects ◽  
Clinical Signs ◽  
Treated Group ◽  
Vernal Keratoconjunctivitis ◽  
P Value ◽  
Medical College ◽  
Ocular Itching ◽  
Dry Climates ◽  
Ophthalmic Solutions ◽  
Olopatadine Hydrochloride

Background: Vernal keratoconjunctivitis (VKC) is a recurrent, bilateral, external, ocular inflammation primarily affecting young adults living in warm dry climates. The objectives of the research was to compare the two ophthalmic solutions of olopatadine hydrochloride (0.1%) and epinastine hydrochloride (0.05%) on clinical signs of vernal keratoconjuntivitis and to determine side effects of both the drugs.Methods: The study was carried out in 40 patients who attended the out-patient department (OPD) Ophthalmology, Darbhanga Medical College and Hospital, Laheriasarai from July 2007 to December 2008.  Forty patients with symptoms of VKC (ocular itching, ropy discharge, papillary hypertrophy, gelatinous thickening and horner-trantas spots were selected and included in our study.Results: Mean score of palpebral hyperemia at 0, 14, 28 and 42 days in olopatadine treated eye were 2.1, 1.4, 0.8 and 0.4 respectively having p value <0.01, and <0.01 and <0.05 respectively, while mean score at same stages in placebo eye were 2.1, 2, 1.9, and 1.5 having value >0.05. Epinastine treated group mean score of palpebral hyperemia were <0.01 and <0.01 respectively in epinastine treated eye whereas in placebo treated eye, mean score were 2.1, 2.0, 1.8 and 1.6 respectively having p value >0.05 in all stages. Statistically insignificant reduction at day 14 while very significant reduction at day 28 and 42 was observed in epinastine treated eye as compared to placebo.Conclusions: The present study had shown that both olopatadine and epinastine were effective in treating clinical signs of VKC as compared to placebo.

scholarly journals Clinico-epidemiological features of Japanese encephalitis patients hospitalized in a tertiary care center

2018 ◽  
Vol 5 (10) ◽  
pp. 4548
Author(s):  
Abu Hasan Sarkar ◽  
Bishnu Ram Das
Keyword(s):  
Japanese Encephalitis ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Complete Recovery ◽  
High Morbidity ◽  
Medical College ◽  
Clinical Signs And Symptoms ◽  
One Year

Background: Japanese encephalitis (JE) is of particular interest as it has a high morbidity and mortality. Neurological sequale is the most dreaded damage caused by JE. It is a preventable disease with specific interventions. The objective of the study was to study the demography, clinical profile and outcome of patients with Japanese Encephalitis admitted to the wards of Internal Medicine and Pediatrics at Jorhat Medical College Hospital.Methods: Hospital based observational study for one year in Jorhat Medical College, Jorhat, Assam.Results: The mean age for JE was 32.25±27 years for male, 27.47±22 years for female and 29.94±24 years overall. Assessment of clinical signs and symptoms showed that fever and change in mental status were present in 100% of JE cases followed by neck rigidity in 79.3% and headache in 68.9%. 44.8% of JE cases had history of seizure, 37.9% had vomiting, 34.5% had irritability, 13.8% were unconscious. The peak of JE incidence occurred in the month of July (77.6%). Complete recovery was seen in 39.2%, followed by death in 32.6% and recovery with neurological sequalae in 28.2% at the time of discharge.Conclusions: Vigorous awareness activities should be carried out to sensitize people on prevention of JE. 

scholarly journals Evaluation of knowledge and perception regarding pneumonia among the mothers of under-ten children in Tangail, Bangladesh

2019 ◽  
Vol 5 (10) ◽  
pp. 271
Author(s):  
M. Masuder Rahman ◽  
M. Khairul Azam
Keyword(s):  
Family Income ◽  
Signs And Symptoms ◽  
Public Health Education ◽  
Health Providers ◽  
Self Medication ◽  
College Hospital ◽  
Medical College ◽  
Pediatric Clinic ◽  
Socio Demographic Factors ◽  
Disease Study

<p class="abstract"><strong>Background:</strong> Childhood pneumonia is a serious infection and the single largest infectious cause of death in children. The study aims to evaluate knowledge and perception among mothers on pneumonia diseases among the children.</p><p class="abstract"><strong>Methods:</strong> A hospital based study was conducted to describe socio-demographic factors of mothers, their knowledge and perception of pneumonia disease. Study was conducted at Sheikh Hasina Medical College Hospital in Tangail from June to July 2018 by interviewing 215 mothers of children under-ten years attending a pediatric clinic by using structured questionnaire.  </p><p class="abstract"><strong>Results:</strong> The parents were predominantly primary school graduates (70.7%). The majority of the father worked as daily laborer (61.9%) with about 5-10K BDT of family income per month. Around 88.4% of the mothers had fair knowledge about pneumonia. For children treatment, 90.2% parents consulted with qualified doctor, about 10% utilized self-medication. About 44.7% children were suffered from fever during pneumonia, about 42.8% was experienced shortness of breath, and about 28.4% experienced of wheezing. About 90.2% parents believed that the indoor temperature, humidity and air movement has effect on pneumonia. About 92.6% cares of reducing indoor smoke and dust, about 40.5% families have a smoker. The lack of knowledge among mothers about simple signs and symptoms of pneumonia and also about its causes and factors related with it has become important findings of this study.</p><p class="abstract"><strong>Conclusions:</strong> Community based public health education and training for health providers at all levels have to be provided about correct and applicable prevention and assessments of pneumonia.</p>

scholarly journals Clinico-pathological Correlation with Liver Enzymes in Dengue Infection

2017 ◽  
Vol 27 (Number 2) ◽  
pp. 27-30
Author(s):  
A H M Kamal ◽  
K H Mollah ◽  
K E Khuda ◽  
A Lslam ◽  
N Sultana ◽  
...  
Keyword(s):  
Liver Enzymes ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
P Value ◽  
Care Hospital ◽  
College Hospital ◽  
Medical College ◽  
Hepatic Involvement ◽  
Atypical Manifestations

Dengue infection is a major vector borne disease. The classical signs and symptoms include high fever, severe headache, chill, and rash. Atypical manifestations of dengue infection with hepatic involvement are frequently reported, ranging from mild elevations of liver enzymes to acute liver failure. Analysis of 110 serologically confirmed cases of dengue infection in Holy Family Red Crescent Medical College hospital a tertiary care hospital was done. Patients with normal aminotransferase levels were categorized into Grade A, patients with at least one of the enzymes raised above normal but less than 3 times were categorized into Grade B, those with at least one of the enzymes elevated more than 3 times but less than 10 times were graded as C, and those with elevations more than 10 times as Grade D. 83.7% patients had alterations of transaminase levels, with 45.5% categorized into grade b, 30.9% into grade C, and 7.3% into grade D or acute hepatitis (P value 0.224). Rise of aspartate aminotransferase (AS7) levels were higher compared to the levels of alanine aminotransferase (AL7). Liver damage with alteration of aminotransferases is a common manifestation of dengue infection and also valuable markers for monitoring these patients.

scholarly journals AN OBSERVATIONAL STUDY ON ASSESSMENT OF POSTOPERATIVE COMPLICATIONS AMONG PERFORATION PERITONITIS USING CLAVIEN-DINDO CLASSIFICATION IN TERTIARY CARE CENTER OF CENTRAL INDIA

2021 ◽  
Vol 9 (02) ◽  
pp. 922-937
Author(s):  
Ankur Deshwali ◽  
◽  
Sanjay Prasad ◽  
Akhilesh Kumar Patel ◽  
Rohan Chaphekar ◽  
...  
Keyword(s):  
Observational Study ◽  
Abdominal Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
P Value ◽  
Complication Rates ◽  
Medical College ◽  
Sri Aurobindo ◽  
Perforation Peritonitis

Introduction :Surgical team always tries to provide consistently low incidence of major complications for patient undergoing any operation. Clavien-Dindo (CD) classification is the simplest way of reporting all complications. The main aim of this study was to test the usefulness of Clavien-Dindo classification in patients undergoing the abdominal surgery. In this study Clavien-Dindo classification has been used for assessment of postsurgical complications after major abdominal surgery. Material and method: It was an observational study of all perforation peritonitis patients admitted in sri aurobindo medical college and post graduate institute between november 2017 to may 2019 (1 and 1/2 Year) on the basis of Clavien-Dindo classification. Results :This was an observational prospective study was carried out in Department of General Surgery, Sri Aurobindo Medical College and P.G. Institute, Indore, which includes total 60 patients of perforation peritonitis admitted and treated in the department, During the period of November 2017 to May 2019. In our study Most common symptoms in patients presenting with perforation is Abdominal pain in 60 (100%) patients. 45(75%) patients had constipation & obstipation, 41 (68.33%) patients had vomiting ,33(55%) of patients had fever 17 (28.33%) patients had abdominal distensions the other common symptoms. Out of 60 patients, all 60(100%) patients had abdominal tenderness and guarding, 47 (78.33%) patients had absent bowel sounds, 42(70%) patients had tachycardia, 26 (43.33%) patients had hypotension, 23 (38.33%) patients had tachypnoea and 21 (35%) patients had low urinary output. In 16 (26.6%) patients comorbid conditions were present. In 10 (16.66%) patients multiple perforations were found out of which only 01 (10%) patient is haemodynamically stable and 09 (90%) patients were unstable. Complication occurred in 09(90%) patients and no complication were only in 01 (10%) patients. In this group 04(40%) patients got discharged and 6(60%) patient expired. P Value was 0.001 which is significant. In our study most common site of perforation was gastric perforation 30(49.18%) Complication according to clavien -dindo classification 14 out of 60 (23.33%) patients had no complications, 4 (6.66%) had grade I complication, 5 (8.33%) had grade II complications, 12 (20%) had grade III complications, 11 (18.33%) had grade IV complications, and 14 (23.33%) had grade V complication rates. Conclusion :Perforation peritonitis is a life-threatening condition and requires urgent hospital care, resuscitation and surgery. Early resuscitation and surgery are required to decrease morbidity and mortality. On the basis of risk stratification in Peritonitis patients its management requires lots of expensive modalities, skill, monitoring and treatment to provide better care to the patient. For the classification of complications, a new system is proposed by Clavien–Dindo which is very helpful during perforation surgery.Clavien- Dindo classification helps us to distinguish a normal postoperative course and the severity of complications, which allows us to compare postoperative morbidity and evaluate the outcomes. We also recommend a larger study with a bigger sample size for better analysis of clavien-dindo classification of complications and to confirm the findings of our study.

scholarly journals Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

2017 ◽  
Vol 4 (4) ◽  
pp. 1341 ◽  
Author(s):  
Sadhan Kumar Cheekuri ◽  
Alok Mohanty ◽  
T. Ganesh ◽  
R. Kannan ◽  
Robinson Smile
Keyword(s):  
Observational Study ◽  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Complicated Appendicitis ◽  
Total Serum ◽  
P Value ◽  
Predictive Capacity ◽  
Computed Tomography Scanning

Background: Appendicitis is the most common acute abdominal condition requiring emergency surgery, with a lifetime risk of 6%. Appendectomy continues to be one of the commonest procedures in general surgery, accounts for approximately 1% of all surgical operation. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%). The aim of this study was to whether Serum Bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about complicated appendicitis.Methods: This was prospective observational study done in Mahatma Gandhi Medical College and Research Institute, Pondicherry between November 2014 and August 2016. About 110 patients of acute appendicitis who had undergone appendicectomy were studied. Data was collected and analyzed critically.Results: Males 66 (60%) outnumbered females 44 (40%) and overall mean age was 26.61±12.37 years. Of the 110 patients, 9% were normal appendix, 59.09% were confirmed as acute appendicitis while 31.81% were diagnosed with complicated appendicitis on biopsy. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis and complicated appendicitis was 47.6% and 90.9% respectively. Similarly, the Positive predicative value and Negative predicative value for the same was 88.5% and 61.5% respectively with odds ratio 12.4 with significant p value <0.0001.Conclusions: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia should be identified as having a higher probability of complicated appendicitis. Hence, serum bilirubin levels have a predictive potential for the diagnosis of severity of acute appendicitis and need for early appendicectomy. If total serum bilirubin is added to already existing laboratory tests, then the diagnosis of complicated appendicitis in clinically suspected cases can be made with fair degree of accuracy, the need for CECT and MRI can be reduced and unnecessary delay in appendicectomy can be avoided.

scholarly journals Diagnosis of tuberculosis among COVID-19 suspected cases in Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261849
Author(s):  
Theophilus Afum ◽  
Prince Asare ◽  
Adwoa Asante-Poku ◽  
Isaac Darko-Otchere ◽  
Portia Abena Morgan ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Early Stage ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Respiratory Illness ◽  
Drug Susceptibility ◽  
Contact Tracing ◽  
National Guidelines ◽  
Tuberculosis Case ◽  
Clinical Signs And Symptoms

Background Tuberculosis (TB) and COVID-19 pandemics are both diseases of public health threat globally. Both diseases are caused by pathogens that infect mainly the respiratory system, and are involved in airborne transmission; they also share some clinical signs and symptoms. We, therefore, took advantage of collected sputum samples at the early stage of COVID-19 outbreak in Ghana to conduct differential diagnoses of long-standing endemic respiratory illness, particularly tuberculosis. Methodology Sputum samples collected through the enhanced national surveys from suspected COVID-19 patients and contact tracing cases were analyzed for TB. The sputum samples were processed using Cepheid’s GeneXpert MTB/RIF assay in pools of 4 samples to determine the presence of Mycobacterium tuberculosis complex. Positive pools were then decoupled and analyzed individually. Details of positive TB samples were forwarded to the NTP for appropriate case management. Results Seven-hundred and seventy-four sputum samples were analyzed for Mycobacterium tuberculosis in both suspected COVID-19 cases (679/774, 87.7%) and their contacts (95/774, 12.3%). A total of 111 (14.3%) were diagnosed with SARS CoV-2 infection and six (0.8%) out of the 774 individuals tested positive for pulmonary tuberculosis: five (83.3%) males and one female (16.7%). Drug susceptibility analysis identified 1 (16.7%) rifampicin-resistant tuberculosis case. Out of the six TB positive cases, 2 (33.3%) tested positive for COVID-19 indicating a coinfection. Stratifying by demography, three out of the six (50%) were from the Ayawaso West District. All positive cases received appropriate treatment at the respective sub-district according to the national guidelines. Conclusion Our findings highlight the need for differential diagnosis among COVID-19 suspected cases and regular active TB surveillance in TB endemic settings.

scholarly journals A CASE STUDY ON ANJANANAMIKA W.S.R TO STYE

AYUSHDHARA ◽  
2020 ◽  
pp. 2815-2818
Author(s):  
Nisarga M S ◽  
Prakruthi G
Keyword(s):  
Clinical Signs ◽  
Signs And Symptoms ◽  
Research Centre ◽  
College Hospital ◽  
Apocrine Glands ◽  
Mild Pain ◽  
Medical College ◽  
Outer Canthus ◽  
Clinical Signs And Symptoms

Stye is an infection of the sebaceous glands of zeis at the base of the eye lashes, or an infection of the apocrine glands of moll. In Ayurvedic science, based on clinical signs and symptoms, stye can be correlated to Anjananamika where the symptoms include Dahatodavatitamrapidaka– i.e., boil which will be in Tamravarna associated with burning sensation and pricking sensation at Vartmapradesha i.e., in the lid and the other symptoms includes Mridvimandaruja– it will be soft and associated with mild pain. The line of treatment of the disease Anjananamika (stye) includes Swedana (hot compress), Nishpidana (pressure applying to drain out pus), Bhedana (incision), Pratisarana (rubbing of medicaments over the lids), Anjana (collyrium). The objective of the present study is to evaluate the effect of Bidalaka and Aschyotana along with internal medicines. A 19-year female patient approached the Shalakya tantra OPD of Sri Paripoorna Sanathana Ayurveda Medical College, Hospital and Research centre, Nelamangala, Bangalore with the complaints of swelling in the left eye lid since 3 days with mild pain and redness of the eyes. On examination, the whole edge of the left eye lid was oedematous along with the presence of an abscess in outer canthus. On these signs and symptoms, the patient was diagnosed as a case of stye and advised Kriyakalpa based on the Roga and Rogibala along with internal medicines which have given promising results with the complete absence of the symptoms within 10 days.

scholarly journals Prevalence of Demodex in Association with Ocular Signs and Symptoms: Evidence from a Large Population of Male Soldiers Living in Garrison

2021 ◽  
Vol 18 (4) ◽  
Author(s):  
Ali Fatourechi ◽  
Maryam Fakhri ◽  
Keyvan Shirzad ◽  
Keyvan Khosravi ◽  
Ali Makateb
Keyword(s):  
Transmission Rate ◽  
Strong Association ◽  
Large Population ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
P Value ◽  
Cross Sectional ◽  
Ocular Symptoms ◽  
Demodex Infestation

Background: The Demodex mite is the most common ectoparasite on human skin. It’s a matter of debate whether this colonization should be an area of concern and can cause pathologic consequences or, in contrast, Demodex should merely be considered as an innocent saprophytic organism living on the skin. Objectives: We aimed to evaluate the prevalence of ocular Demodex infestation in a large population of male soldiers with a similar range of age, in whom we expected a high transmission rate due to environmental factors and close contacts. Besides, we evaluated the correlation between Demodex and ocular clinical manifestations. Methods: In total 903 soldiers living on a military base in Iran were enrolled in this epidemiological cross-sectional prevalence study conducted in the summer of 2020. Data were collected using a questionnaire on ocular symptoms, and participants were assessed for the presence of Demodex spp. Results: A total of 904 males with a mean age of 21 ± 2 years (ranging from 19 to 25) were included. The overall prevalence of Demodex infestation was 77.2% (86.8 and 26% in patients with and without blepharitis, respectively). Of 698 patients who were positive for Demodex, 58.6% reported eye discomfort, whereas it was experienced by 23.9% of Demodex negative participants, the difference was statistically significant (P-value < 0.001). Conclusions: There is a strong association between the prevalence of Demodex spp. and symptoms, in particular itchy eyes. However, some patients are asymptomatic. This finding supports the notion that the number of mites may be important concerning the manifestation of clinical signs of blepharitis; however, the role of Demodex spp., as a commensal, should not be overlooked. Treatment should not be aimed at full eradication of the mite but rather restoring the ocular ecology to a balanced state.

scholarly journals Pattern of diseases among Bangladeshi Hajj Pilgrimsin Mecca, Saudi Arabia

2021 ◽  
Vol 10 (1-2) ◽  
pp. 96-101
Author(s):  
Md Nurul Amin ◽  
Md Rafiqul Islam ◽  
Md Rafiqul Islam
Keyword(s):  
Saudi Arabia ◽  
Heart Diseases ◽  
Medical Center ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Respiratory Illness ◽  
Cross Sectional ◽  
Female Ratio ◽  
Ulcer Disease ◽  
Mass Migration

Background & objective: Each year millions of Muslims embark on a religious pilgrimage called the “Hajj” to Mecca in Saudi Arabia. The mass migration during the Hajj is unparalleled in scale, and pilgrims face numerous health hazards. Performing the tasks of pilgrimage is stressful and laborious and as such requires immense mental and physical fitness on the part of the pilgrims. But a substantial proportion of the pilgrims lack it. Besides, the hot and dry environment and untold overcrowding predispose them to the risk of many communicable diseases. The present study, was therefore, intended to find the pattern of diseases among Bangladeshi Hajj pilgrims at Mecca, Saudi Arabia. Methods: This descriptive cross-sectional study was carried out on Bangladeshi Hazz pilgrims in Mecca Saudi Arabia over a period of 1 month from mid-September to mid-October, 2015. A total of 710 pilgrims (18 or > 18 years) attending at Bangladeshi Hazz Medical Center (BHMC) in Mecca, Saudi Arabia during the period were consecutively included in the study after having voluntary verbal consent obtained from them. Diseases were diagnosed mainly on the basis of clinical signs and symptoms with provision of only random and fasting blood sugar estimation and ECG. The diagnosed diseases were grouped into major and minor problems or conditions and were treated as out-patient basis. Result: In the present study upper middle-aged (50 – 60 years) and elderly (≥ 60 years) pilgrims together formed nearly 73% of the patients with mean age of the patients being 56 years. Males were a bit higher than the females with male-female ratio being roughly 11:9. The study demonstrated that the commonest cause of out-patient visit was respiratory illness (41.2%) followed by diabetes (17.2%), peptic ulcer disease (PUD) (11.7%) and cardiovascular diseases (10.7%)(which included hypertension, new onset ischemia or exacerbation of preexisting ischemic heart diseases). A few (3.2%) of the patients presented with diarrhoeal diseases (loose motion or dysentery). Other minor ailments were allergy or dermatitis, insomnia, paronychia, anxiety, UTI, hemorrhoids, epistaxis, glossitis, oral ulcer, earache, conjunctivitis, worm infestation, spot bleeding etc., accounting for 4.8% of the patients. Conclusion: The study concluded that respiratory illness is the most common health problems among pilgrims visiting to Mecca, Saudi Arabia followed by diabetes, PUD and cardio-vascular diseases. The pilgrims should be educated in their home country before starting for pilgrimage as how to maintain their health in their new and challenging environment and Bangladesh Hazz Mission in Mecca should ensure enough medical support to them. Ibrahim Card Med J 2020; 10 (1&2): 96-101

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