Common Chronic Disease Patterns in Arabian Gulf, Saudi Arabia & YemenDr. O. P. Kapoor
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Functional Arab Syndrome

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This syndrome is most commonly seen in Yemenis. Sometimes it is seen in patients coming from U.A.E. and rarely from other Arab countries. So common is the "combination" of the following symptoms, that I have labelled it as a "Syndrome" The complaints are :
  1. Severe retrosternal burning and water brash or vomiting.
  2. Epigastric or high epigastric pain, often not related to meals as in a case of typical duodenal ulcer.
  3. Severe constipation or obstipation and hard stools requiring straining at the time of defecation.
  4. Colonic pains in different areas of the abdomen
  5. Abdominal distension after meals and gases.
  6. Borborygmi.
  7. 'Piles' or suspicion of having piles.
  8. Dryness of mouth.
  9. Poor appetite.
  10. Sexual weakness.
  11. Low backache, increased in the morning after having marital relations the previous night.
  12. Pain over both the sacro-iliac joints at the back
  13. Pain over the scapular area at the upper back.
  14. Pain in the knee joints.
  15. Pain in both the loins.
  16. Burning of urine off and on.
  17. Burning of the arms and legs and often palms and soles.
  18. Feeling of cold over the arms and legs.
  19. Palpitations after climbing steps or heavy exertion.
  20. Dyspnoea on excessive exertion.
  21. Insomnia or sleep disturbed by dreams.
  22. Pruritus off and on.
  23. Excessive weakness.
  24. Excessive tiredness.
  25. Excessive malaise.
  26. Increased anger.
  27. Giddiness, off and on with headache.
  28. Tension and anxiety, especially of the job and the imaginary illness.
  29. Ear, nose and throat problems.
  30. Loss of smell and taste.

ALL THE ABOVE SYMPTOMS ARE NARRATED BY THE PATIENTS, USING THEIR HANDS AT THE SAME TIME AND ELICITING ASSOCIATED "TENDERNESS". THEY MAKE VIOLENT FACIAL GESTURES (see fig. alongside), WHILE COMPLAINING OF PAIN.

Most of them are smokers. Yemenis consume 'Qat' and many of them have a past history of or are suspicious of suffering from— either

  1. Bilharziasis—urinary or colonic.
  2. Giardiasis or
  3. Amoebiasis.

On examination :
The patient is usually underweight, but there are no signs of anaemia. Besides colonic, epigastric and musculoskeletal tenderness, there are no positive findings. The blood pressure, heart, lungs and liver are usually normal.

Most of the investigations including electrocardiogram,SMA 12/60, X-rays of G.l. tract, kidneys and gali-bladder are normal.

X-ray chest often shows old, healed, calcified, parenchymal lesions see fig. alongside). Endoscopy of the upper G.l. tract may show minimal congestion or erosions. Minimal piles are often seen on proctoscopy and/or sigmoidoscopy examinations.

Urine examination shows presence of occasional pus cells. Stool examination often shows presence of giardia or Cysts of amoeba.

Finally, on most of the occasions, the patient has consulted a couple of specialists and has been investigated and treated extensively without any relief.

 

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