Common Chronic Disease Patterns in Arabian Gulf, Saudi Arabia & YemenDr. O. P. Kapoor
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Respiratory Diseases

Upper respiratory tract diseases are extremely common in Arab population. These have been discussed in the Chapter on E.N.T. diseases.

Chest diseases—Chronic chest diseases are relatively rare in Arabs. The following chest diseases are seen in this population:

  1. Allergic bronchial asthma or asthmatic bronchitis is the most common cause of chronic cough and attacks of dyspnoea. Although seen throughout the Arab world, it appears to be most common in Bahraini population. Though Bahrainis do consume more cold drinks ("Pepsi") and ice-creams ("Aishcream"), and use more perfumes and sprays, these habits are also found in rest of the Arab world.
  2. Smoker's bronchitis is the next common chest disease as the cause of cough with expectoration. Yet, what is interesting is that inspite of the habit of heavy smoking started at a young age, 'severe' smoker's bronchitis or chronic obstructive pulmonary disease is seen less often. Thus chronic bronchitis and emphysema with cor pulmonale is a rarity.
  3. Pulmonary or pleural Kochs is an uncommon disease in Arab countries. Although T.B. Hospital has been functioning in Bahrain, tuberculosis is seen more commonly in patients coming from Yemen or U.A.E. Chest X-rays of many of these patients show calcified lesions especially at the apices and the upper zones (see fig. alongside). Many radiologists report these lesions as "calcified kochs"—a diagnosis which I think is not justified. The reason is that such lesions are seen in every third or fourth patient and yet the incidence of active pulmonary kochs is relatively less. Also we see such lesions in overfed Arabs coming from the rest of the Arab world. This makes me feel that these lesions could be a manifestation of an old fungal (for example histoplasmosis) or atypical mycobacterial disease.

Active pulmonary kochs could be overdiagnosed in underweight Yemeni patients.

Symptoms of chronic cough ("Kaah"), fever ("Skuna" or "Humma") and sweating ("Arag") in the evenings ("Magrab") or nights ("Filail") if present are in favour of diagnosis of active kochs disease.

Regarding the symptoms of loss of appetite, unfortunately all Yemenis complain of this symptom, which just does not respond to any treatment (except perhaps to anti-depressants and tranquillisers.) Therefore it should not be given importance to assess the activity of kochs. Erythrocyte sedimentation rate (E.S.R.), which is done to "diagnose" active kochs is sometimes misguiding. For example, in many elderly patients a reading of 30 or 35 mm should be considered normal. Unfortunately, the pathologists do not print that a normal E.S.R. is higher in old people. It will also be profitable if other investigations like sputum examination and culture for A.F.B. are done to diagnose "active kochs", in these patients having caIcified lesions.

Often a negative Mantoux test would also exclude active kochs disease.