| 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:
- 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.
- 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.
- 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.
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