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Mihretu A, Teferra S, Fekadu A. Problematic khat use as a possible risk factor for harmful use of other psychoactive substances: a mixed method study in Ethiopia. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:47. [PMID: 29096691 PMCID: PMC5668959 DOI: 10.1186/s13011-017-0132-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/24/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Substance use disorders along with neuropsychiatric disorders contributed about 14% of the global burden of disease. Harmful alcohol use, is a known contributor for many harms (accidents, suicide, violence, and complication of other psychiatric and medical disorders). In the Western countries, alcohol and nicotine are gateway drugs to cannabis use, and cannabis use is a risk factor for other illicit drugs such as cocaine and heroin. Khat use is another psychoactive substance which is common in East African and Arabian Peninsula. But there is a knowledge gap regarding the position of khat use or problematic khat use in sequential progression of different psychoactive substances. Therefore, we aimed to understand and investigate the relationship of problematic khat use and other psychoactive substances in Ethiopia. METHODS Exploratory mixed methods study was employed. Quantitative cross sectional survey was done among 102 khat users, and 4 focus group discussions and 11 in-depth interviews were conducted to understand the pathways between khat use and other psychoactive substances use in 2014. Non random sampling (purposive and snowballing) was employed for both quantitative and qualitative studies. Khat users from khat cafeterias, shops, and from other open markets of khat in Addis Ababa were invited to participate. RESULT Currently significant majorities of khat users (86.3%) used at least one other psychoactive substance after they started khat use. The prevalence of harmful drinking was 53.9% among khat users. Problematic khat use was a significant predictor of harmful drinking (p < 0.05). About one from ten respondents engaged to risky sexual behavior pushed by the effect of khat after chewing. CONCLUSION The proportion of psychoactive substances use especially harmful drinking among khat users was observed higher compared to other cross sectional surveys conducted among general population. In Ethiopia, intervention and policy on harmful alcohol use could consider problematic khat use as one possible risky factor. A rigorous methodology which could test gateway hypothesis of problematic psychoactive substances use could be warranted.
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Affiliation(s)
- Awoke Mihretu
- Department of Clinical Psychology, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. .,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Harvard T.H. Chan School of public Health, Boston, USA
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Psychological Medicine, Centre for Affective Disorders, King's College London, London, UK
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Lu Y, Li Y, Xiang M, Zhou J, Chen J. Khat promotes human breast cancer MDA-MB-231 cell apoptosis via mitochondria and MAPK-associated pathways. Oncol Lett 2017; 14:3947-3952. [PMID: 28943902 PMCID: PMC5604101 DOI: 10.3892/ol.2017.6708] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/23/2017] [Indexed: 12/21/2022] Open
Abstract
Khat (Catha edulis Forsk) is a flowering evergreen plant in Eastern Africa and Southwestern Arabia. Consumption of Khat has been associated with the development of oral cancer, but its mechanism of action on the molecular level remains unclear. The present study demonstrated the cytotoxic effect of khat extracts on the human breast cancer cell line MDA-MB-231. Trypan blue exclusion assays, flow cytometry, fluorescent and electron microscopy, as well as western blotting were used to analyze the effects of Khat on the cell viability of breast cancer cells, expression of apoptotic-associated proteins and the levels of reactive oxygen species (ROS). The results of the present study demonstrated that treatment with 400 µg/ml khat was able to induce cell death in breast cancers, with an increase in the protein expression of apoptosis regulator Bax and a decrease in the expression of B-cell lymphoma 2, along with a decrease in ROS levels in a time-dependent manner. Furthermore, the expression of activated c-Jun N-terminal and extracellular regulated protein kinases was increased in khat-treated cells compared with untreated cells. Mitochondria participated in cell apoptosis through the release of apoptogenic proteins to the cytosol and the generation of excess reactive oxygen species. The results of the present study suggest that khat induces MDA-MB-231 cell apoptosis via MAPK activation and mitochondrial-mediated death.
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Affiliation(s)
- Yu Lu
- Department of Endocrinology, Taizhou People's Hospital, Nantong University, Taizhou, Jiangsu 225300, P.R. China
| | - Yanyan Li
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Min Xiang
- Department of Biochemistry and Molecular Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Jie Zhou
- Department of Biochemistry and Molecular Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Juan Chen
- Department of Biochemistry and Molecular Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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Al-Akhali MS, Al-Moraissi EA. Khat chewing habit produces a significant adverse effect on periodontal, oral health: A systematic review and meta-analysis. J Periodontal Res 2017. [PMID: 28626895 DOI: 10.1111/jre.12468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Although there is a general agreement that a khat chewing habit produces clinicopathological changes in the oral mucosa. However there is no reliable evidence of the effects of a khat chewing habit on the periodontal tissues. Thus, authors aimed to investigate the influence of khat chewing habits on periodontal, oral health, by comparing khat chewers to non-chewers in respect of gingival recession, periodontal pocketing depth and loss of attachment. A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, the Cochrane Library, Web of Science, Scopus and grey literature. The inclusion criteria were all studies with aims of comparing khat chewers and/or sides to non-chewers and/or sides in respect of gingival recession, periodontal pocketing depth and loss of attachment. For continuous data, we computed weighted mean difference or standard mean difference analyses. An odds ratio using a random effect model was used if heterogeneity was detected; otherwise, a fixed effects model with a 95% confidence interval was used for continuous data. Two subgroups were analysed: khat chewers vs non-chewers and khat chewer sides vs non-chewer sides of the chewer's individuals. A total of 6373 participants were enrolled in 12 studies (khat chewers=3812, non-chewers=2561). There were statistically significant differences between khat and non-chewers in both subgroup analyses regarding gingival recession, periodontal pocketing depth and loss of attachment (P<.05). The odds ratios for khat chewers compared to non-chewers, in respect of depth of periodontal pocket and gingival recession were 4.797 and 6.853 respectively. The results of this meta-analysis have shown that the khat chewing habit produces a destructive and adverse effect on periodontal, oral health.
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Affiliation(s)
- M S Al-Akhali
- Department of Preventive Dentistry, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
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Sharaf Al- A. Genotoxicity Assessment of Fresh Khat Leaves Extract in Chinese Hamster Ovary Cell Lines. JOURNAL OF MEDICAL SCIENCES 2017. [DOI: 10.3923/jms.2017.126.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Engidawork E. Pharmacological and Toxicological Effects of Catha edulis F. (Khat). Phytother Res 2017; 31:1019-1028. [PMID: 28557133 DOI: 10.1002/ptr.5832] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 01/02/2023]
Abstract
Khat chewing is deeply rooted in the culture and tradition of communities in khat belt countries, and its consumption is spread to other countries through the suitcase trade. The aim of this article is to review current knowledge on the chemistry, social, pharmacology and toxicology of khat and its use. Khat produces effect invariably in every system, which is harmful or beneficial in some instances. Harmful effects are observed in heavy users, although firm evidence is lacking. Chewing khat acutely elicits states of euphoria, which is followed by low mood. Khat contains alkaloids with psychostimulant properties, but the effect cannot be totally explained by these alkaloids. It is also not clear whether the effect produced in some organs like liver could be attributed to khat or pesticides sprayed during farming. Although the evidence indicates that khat has adverse effects in most organs, our understanding of the complex interaction between use and effect is incomplete, and causal relationships have not yet been described. Moreover, khat has positioned itself well in the social, economic and political arena. Thus, a multidisciplinary research is required to understand the different dimensions and come up with ways that maximize the benefit while minimizing the risk. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O Box 1176, Addis Ababa, Ethiopia
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Abdeta T, Tolessa D, Adorjan K, Abera M. Prevalence, withdrawal symptoms and associated factors of khat chewing among students at Jimma University in Ethiopia. BMC Psychiatry 2017; 17:142. [PMID: 28412950 PMCID: PMC5392995 DOI: 10.1186/s12888-017-1284-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 03/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, khat chewing has become a common practice among high school, college, and university students. Regular khat chewing is thought to be a predisposing factor for different physical and mental health problems. It can lead to absenteeism from work and classes. In Ethiopia, to our knowledge no published study has investigated khat withdrawal symptoms. Therefore, this study was conducted to determine the prevalence, withdrawal symptoms, and associated factors of khat chewing among regular undergraduate students on the main campus of Jimma University in Ethiopia. METHODS The institution-based, cross-sectional study was conducted in January 2016. Data were collected from 651 main campus regular undergraduate students with a structured, self-administered questionnaire, entered into Epidata 3.1 and exported to SPSS version 20 for Windows. Bivariate and multivariate logistic regressions were used to explore associations and identify variables independently associated with khat chewing. RESULTS The study found that the lifetime and current prevalence of khat chewing among students were 26.3% (95% CI: 24.3, 28.3) and 23.9% (95% CI: 21.94, 25.86), respectively. About 25.7% of students started chewing after joining university, and 60.5% of these students started during their first year. The main reason given for starting khat chewing was for study purposes (54.6%), followed by socialization purposes (42.3%). Among current khat chewers, 72.9% reported that they had chewed khat for 1 year or more and 68.2% reported that they had experienced various withdrawal symptoms. The most frequently reported withdrawal symptoms were feeling depressed, craving, and feeling fatigued. Being male, attending a place of worship daily/2-3 times per week, cannabis use, smoking cigarettes, and having family members currently chewing khat were independently associated with khat chewing. CONCLUSIONS This study found that large numbers of university students were currently chewing khat. In this study withdrawal symptoms and factors that significantly affect khat chewing were identified. Besides it gave new ideas regarding khat withdrawal symptoms in Ethiopia. It serves as a critical role of providing information to form rational foundation for public health policy, prevention and planning to bring change in contributing factors for Khat chewing. The finding will be serving as base line information for further study.
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Affiliation(s)
- Tilahun Abdeta
- Department of Psychiatry, School of Nursing and Midwifery, College of Medical and Health Sciences, Haramaya University, Harar, Ethiopia
| | - Daniel Tolessa
- Department of Psychiatry, Medical College, Adama, Ethiopia
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics, Munich, Germany
- Center for International Health, Ludwig-Maximilians-University, Munich, Germany
| | - Mubarek Abera
- Department of Psychiatry, College of Health Sciences, Jimma University, Jimma, Ethiopia
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Mihretu A, Teferra S, Fekadu A. What constitutes problematic khat use? An exploratory mixed methods study in Ethiopia. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:17. [PMID: 28327160 PMCID: PMC5361726 DOI: 10.1186/s13011-017-0100-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
Background Khat is a psycho-stimulant herb, which has been in use in traditional societies in East Africa and the Middle East over many centuries. Although khat is reported to cause various health problems, what constitutes problematic khat use has never been systematically investigated. This study explored the acceptable and problematic uses of khat from the perspective of users. Methods The study used a mixed methods design (exploratory sequential) in which qualitative (emic) data were collected to develop a framework to define problematic khat use. The qualitative data were gathered through in-depth interviews (N = 13) and focus group discussions (N = 34). By supplementing the emic experiences considered to constitute problematic khat use with an etic definition, DSM-5 criteria for stimulant related disorders, a structured questionnaire was developed. Subsequently a cross-sectional evaluation of 102 respondents was carried out. Respondents both for qualitative and quantitative study were selected through purposive sampling and snowballing methods. Qualitative data were transcribed and subjected to thematic analysis whereas quantitative data were analyzed using descriptive and nonparametric statistics. Results Khat use was acceptable socio-culturally and for functional purposes. However, even in these acceptable contexts there was a restriction to the amount, frequency and type of khat used, and in relation to the experience of the individual using khat and other personal characteristics. More specifically, khat use was considered problematic if there was: 1) Impairment (in social and occupational functioning); 2) loss of control in the use of khat; and 3) withdrawal symptoms when not using khat. Among the participants who use khat (n = 102), 45.1% (n = 46) used khat on a daily basis. The commonest indicators of problematic khat use endorsed by the khat users were loss of control over chewing (73.5%), continuing use of khat despite harm (72.5%) and efforts to avoid withdrawal from khat (61.8%). Conclusion Despite reported religious, sociocultural and functional benefits to the use of khat, those with defined problematic khat use have impaired mental health, and social and occupational performance. Comparison of these respondent defined indicators of problem behavior matched almost completely to the DSM-5 (etic-defined) understanding of problematic stimulant use. Although the findings have relevant clinical, research and policy implications, the study focused on users purposively identified. Future larger scale definitive studies are required to make concrete policy recommendations.
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Affiliation(s)
- Awoke Mihretu
- Department of Clinical Psychology, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. .,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Psychological Medicine, Centre for Affective Disorders, King's College London, London, UK
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Ibrahim M, Malik BHA, Gameraddin M. Doppler Assessment of the Effect of Chewing Qat on Hemodynamics of the Common Carotid Arteries. JOURNAL OF MEDICAL SCIENCES 2017. [DOI: 10.3923/jms.2017.95.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Perceived Psychological, Economic, and Social Impact of Khat Chewing among Adolescents and Adults in Nekemte Town, East Welega Zone, West Ethiopia. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7427892. [PMID: 28265577 PMCID: PMC5317140 DOI: 10.1155/2017/7427892] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/26/2016] [Accepted: 12/25/2016] [Indexed: 11/22/2022]
Abstract
The main aim of this study was to assess psychological, economic, and social impact of khat chewing among adolescents, in Nekemte town, East Welega Zone. A community based cross-sectional study was conducted from March to June 2016 using both quantitative and qualitative methods of data collection. A total of 359 samples were included in the study. A pretested, interviewer based structured questionnaire was employed during data collection. The study found the current prevalence of khat chewing practices was 48.6%. Perceived psychological problems especially depression and anxiety were associated with khat chewing practices. The risk of depression was about 25 times higher among khat chewers compared to nonchewers. Similarly the risk of anxiety among khat chewers was about 5 times higher compared to nonchewers. Generally current khat chewing practices in the study area are relatively high. The occurrence of reported, perceived psychological problems mainly depression and anxiety was significantly higher among khat chewers compared to nonchewers. Thus efforts like creating awareness about negative effect, making different recreation methods available, and formulating common conventions regarding khat use mainly by young generations are necessary to decrease the magnitude of chewing practices and thereby its associated consequences.
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Gupta S, Dutta ES, Raju MSVK, Kumar A. Leaf it or not: A case of khat dependence from India. Indian J Psychiatry 2017; 59:126-127. [PMID: 28529375 PMCID: PMC5419001 DOI: 10.4103/psychiatry.indianjpsychiatry_276_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sriniwas Gupta
- Department of Psychiatry, 166 Military Hospital, Jammu, Jammu and Kashmir, India
| | - Era S Dutta
- Department of Mental and Behavioural Sciences, Fortis Healthcare groups of Hospitals, Mumbai, Maharashtra, India. E-mail:
| | - M S V K Raju
- Department of Psychiatry, Peoples College of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhishek Kumar
- Assistant Professor, Central Institue of Psychiatry, Ranchi, Jharkhand, India
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Manzar MD, Salahuddin M, Sony P, Maru TT, Pandi-Perumal SR, Moscovitch A, Bahammam AS. Sleep disturbances and memory impairment among pregnant women consuming khat: An under-recognized problem. Ann Thorac Med 2017; 12:247-251. [PMID: 29118856 PMCID: PMC5656942 DOI: 10.4103/atm.atm_24_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Khat (Catha edulis) is a evergreen flowering shrub that is cultivated at high altitudes, especially in East Africa and the southwest of the Arabian Peninsula. The plant contains alkaloids, of which cathinone and cathine have structural similarity and pharmacological action similar to amphetamines. The leaves are, therefore, consumed in some regions as a psychoactive stimulant due to cultural beliefs and misperceptions on the health benefits of khat consumption. This resulted in a growing prevalence of khat consumption among pregnant women. The myriad of physiological changes associated with pregnancy impairs sleep and memory. Moreover, khat has also been shown to have adverse effects on memory and sleep. Therefore, its use during pregnancy may further aggravate those impairments. The purpose of this mini-review is to summarize the changes in sleep and memory during pregnancy and the evidence supporting a relationship between khat consumption and neurocognitive deficits and sleep dysfunctions. The misperceptions of beneficial effects of khat, the high prevalence of consumption among pregnant women, and the possibility of under-reporting of khat abuse do necessitate the development of alternative methodologies to identify cases of unreported khat abuse in pregnant women. It is proposed that screening for sleep problems and memory deficits may help identify under-reported cases of khat abuse in pregnant women.
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Affiliation(s)
- Md Dilshad Manzar
- Department of Biomedical Sciences, College of Health Sciences, Mizan-Tepi University, (Mizan Campus), Mizan Teferi, Ethiopia
| | - Mohammed Salahuddin
- Department of Pharmacy, College of Health Sciences, Mizan-Tepi University, (Mizan Campus), Mizan Teferi, Ethiopia
| | - Peter Sony
- Department of Biomedical Sciences, College of Health Sciences, Mizan-Tepi University, (Mizan Campus), Mizan Teferi, Ethiopia
| | - Tarekegn Tesfaye Maru
- Department of Pharmacy, College of Health Sciences, Mizan-Tepi University, (Mizan Campus), Mizan Teferi, Ethiopia
| | - Seithikurippu R Pandi-Perumal
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Adam Moscovitch
- Sleep and Fatigue Institute, The University of Calgary, Calgary, Canada
| | - Ahmed S Bahammam
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Challenges in Laboratory Detection of Unusual Substance Abuse: Issues with Magic Mushroom, Peyote Cactus, Khat, and Solvent Abuse. Adv Clin Chem 2017; 78:163-186. [PMID: 28057187 DOI: 10.1016/bs.acc.2016.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Drug abuse is a worldwide problem. Although commonly abused drugs can be identified during routine urine drug testing, less commonly abused drugs may escape detection. These less commonly abused drugs not only include some designer drugs such as synthetic cannabinoid but also include abuse of psychedelic magic mushroom (active ingredients: psilocybin and psilocin), peyote cactus (active ingredient: mescaline), and khat plants (active ingredient: cathinone). Moreover, solvent and glue abuse is gaining popularity among teenagers and young adults which may even cause fatality. Amphetamine/methamphetamine immunoassay has a low cross-reactivity with psilocin. Cathinone, if present in the urine, can be detected by amphetamine/methamphetamine immunoassay due to cross-reactivity of cathinone with assay antibody. Currently there is one commercially available immunoassay which is capable of detecting synthetic cathinone known as bath salts as well as mescaline. However, gas chromatography combined with mass spectrometry as well as liquid chromatography combined with tandem mass spectrometry (LC/MS/MS)-based method is available for confirmation of the active ingredients present in magic mushroom, peyote cactus, and khat plant. Such chromatography-based methods also offer more sensitivity and specificity compared to an immunoassay.
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Atlabachew M, Combrinck S, Viljoen AM, Hamman JH, Gouws C. Isolation and in vitro permeation of phenylpropylamino alkaloids from Khat (Catha edulis) across oral and intestinal mucosal tissues. JOURNAL OF ETHNOPHARMACOLOGY 2016; 194:307-315. [PMID: 27616032 DOI: 10.1016/j.jep.2016.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Khat, the leaves of Catha edulis, is used as a "natural amphetamine-like" stimulant in eastern and southern Africa, as well as in the Arabian Peninsula. Leaves are masticated to elicit a state of euphoria. Although the psychostimulatory effects of the leaves are attributed to the presence of phenylpropylamino alkaloids (i.e. cathinone, cathine and norephedrine), the extent of permeation of these alkaloids across the oral and intestinal mucosa has not been established. MATERIALS AND METHODS Cathinone was isolated in the form of the oxalate salt from young buds, following acid-base extraction. High performance countercurrent chromatography (HPCCC) was used to isolate cathine and norephedrine, following borohydride reduction of a mixture of the three alkaloids. The in vitro permeability of these three alkaloids in their pure form, as well as in a crude extract, was evaluated across Caco-2 cell monolayers and across excised porcine intestinal, sublingual and buccal tissues. RESULTS The purities of the isolated cathine and norephedrine were in excess of 90%, thereby proving that HPCCC can be applied for efficient separation of these alkaloids from extracts of Khat. The apparent permeability (Papp) coefficients for the Khat alkaloids in their pure form were all above 1.0×10-6cm/s, indicating that the transport of the three alkaloids across the selected biological membranes is comparable to that of the highly permeable reference compound, caffeine. Although readily transported across the various membranes, the alkaloids were transported to a lesser extent when present in a leaf extract, suggesting that other phytochemicals present in the extract influence their permeation. CONCLUSIONS These results provide evidence that chewing of Khat contributes to the buccal and sublingual absorption of the psychoactive alkaloids in the bloodstream directly across the oral mucosal membranes. In addition, it confirms that these metabolites will be readily absorbed from the gastrointestinal tract when swallowed.
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Affiliation(s)
- Minaleshewa Atlabachew
- Department of Chemistry, Tshwane University of Technology, Pretoria 0001, South Africa; Department of Chemistry, Bahir Dar University, P.O. Box 79, Ethiopia.
| | - Sandra Combrinck
- Department of Pharmaceutical Sciences, Tshwane University of Technology, Pretoria 0001, South Africa; SAMRC Herbal Drugs Research Unit, Tshwane University of Technology, Pretoria 0001, South Africa.
| | - Alvaro M Viljoen
- Department of Pharmaceutical Sciences, Tshwane University of Technology, Pretoria 0001, South Africa; SAMRC Herbal Drugs Research Unit, Tshwane University of Technology, Pretoria 0001, South Africa.
| | - Josias H Hamman
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - Chrisna Gouws
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
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Nakajima M, Dokam A, Khalil NS, Alsoofi M, al'Absi M. Correlates of Concurrent Khat and Tobacco Use in Yemen. Subst Use Misuse 2016; 51:1535-1541. [PMID: 27486991 PMCID: PMC5055457 DOI: 10.1080/10826084.2016.1188950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Habitual substance use poses public health threat. This is a growing concern in countries where one or more substances are commonly used. Many individuals in Middle Eastern and East African countries use khat (Catha edulis), a stimulant often accompanied by smoking. However, few systematic attempts have been made to characterize patterns of concurrent khat and tobacco use. OBJECTIVES To examine correlates such as gender and patterns of khat and tobacco use in concurrent users and khat-only users. METHODS This study used a cross-sectional design with a face-to-face interview method including 151 (74 women) concurrent users of khat and tobacco and 141 (76 women) khat-only users in Yemen. Data collection was completed in 2012. Analysis of variance (ANOVA) and logistic regressions were conducted to examine gender and khat use group differences in use patterns. RESULTS Reported frequency and intensity of khat use were greater in men than in women. Men and women khat users used different tobacco products and beverages while using khat. Khat use was more frequent in concurrent users relative to khat-only users. Earlier age of onset of khat use was associated with greater number of cigarettes smoked during a typical khat session. Approximately 70% of concurrent users reported initiating khat use prior to tobacco use. Conclusions/Importance: The results provide support for gender differences in khat and tobacco use, differences in khat use pattern between concurrent users of khat and tobacco and khat-only users, and positive associations between khat and tobacco use.
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Affiliation(s)
- Motohiro Nakajima
- a Department of Biobehavioral Health and Population Sciences , University of Minnesota Medical School , Duluth , Minnesota , USA
| | - Anisa Dokam
- b School of Education, Taiz University , Taiz , Yemen
| | | | | | - Mustafa al'Absi
- a Department of Biobehavioral Health and Population Sciences , University of Minnesota Medical School , Duluth , Minnesota , USA
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Tantry MA, Khuroo MA, Shawl AS, Najar MH, Khan IA. Dihydro- β -agarofuran sesquiterpene pyridine alkaloids from the seeds of Euonymus hamiltonianus. JOURNAL OF SAUDI CHEMICAL SOCIETY 2016. [DOI: 10.1016/j.jscs.2012.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kassa A, Wakgari N, Taddesse F. Determinants of alcohol use and khat chewing among Hawassa University students, Ethiopia: a cross sectional study. Afr Health Sci 2016; 16:822-830. [PMID: 27917217 PMCID: PMC5111982 DOI: 10.4314/ahs.v16i3.24] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Students' alcohol and khat use have been associated with various health related problems. However, its magnitude and associated factors among Ethiopian students are not yet well documented. OBJECTIVE The study aimed to assess the prevalence of alcohol use, khat chewing and its associated factors among Hawassa University students. METHODS A cross-sectional study was conducted from June to July 2011. Multistage stratified sampling technique was employed to select 590 students. Self administered questionnaires were used to collect data. Data was entered and analysed by SPSS version 20.0. Logistic regression analyses were used to identify the association of different variables. RESULTS The current prevalence of student's alcohol and khat use were 29.5% (95% CI: 25.8-33.3) and 16.3% (95% CI: 13.7-20.0) respectively. Being male (AOR 1.8; 95% CI 1.1-3.0) and living alone (AOR 20.1; 95% CI 2.5-166.7) had a higher odds of alcohol use. Similarly, family substance use history (AOR 4.8; 95% CI 2.5-9.3) and peer influence (AOR 4.6; 95% CI 2.3-9.0) had also higher odds of khat use. CONCLUSION AND RECOMMENDATION The proportion of student's khat chewing and alcohol use was significant. Hence, higher education in collaboration with other stakeholders should work on convincing students about the ill effects of these substances.
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Affiliation(s)
- Andargachew Kassa
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Negash Wakgari
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Fiker Taddesse
- School of Medicine, Pharmacology Unit, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Petersen AB, Thompson LM, Dadi GB, Tolcha A, Cataldo JK. Factors associated with secondhand tobacco smoke in the home: an exploratory cross-sectional study among women in Aleta Wondo, Ethiopia. BMC Public Health 2016; 16:910. [PMID: 27582041 PMCID: PMC5007692 DOI: 10.1186/s12889-016-3588-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 08/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Ethiopia, female smoking rates are currently low (1 %). However, because of male smoking rates (overall 7.7 % and up to 27 % depending on region), women and children's risk of second hand smoke (SHS) exposure is a pressing concern. In order to develop effective public health interventions that prevent the uptake and exposure to smoking, thereby averting the projected increase in tobacco-induced disease, an understanding of Ethiopian women's practices regarding tobacco is needed. The purpose of this study was to explore Ethiopian women's tobacco use and prevalence of SHS exposure, and to identify covariates associated with SHS exposure. METHODS We conducted an exploratory cross-sectional study in Southern Ethiopia between August and October 2014, and systematically sampled households in Aleta Wondo town and surrounding districts. Trained interviewers verbally administered surveys to women 18-55 years of age. Descriptive statistics and multiple logistic regression analyses were performed. RESULTS None of the 353 participants reported current tobacco use and less than 1 % reported ever use, however, 11 % reported ever use of the stimulant leaf khat. Twenty-seven women (7.6 %) reported living with a tobacco user, however, twice that number (14.4 %) overall, and 22 % of urban participants reported that smoking occurred daily in their home. When controlling for other factors, living with a tobacco user (OR = 9.91, 95 % CI [3.32, 29.59]), allowing smoking in the home (OR = 5.67, 95 % CI [2.51, 12.79]), place of residence (OR = 2.74, 95 % CI [1.11, 6.74)]), and exposure to point-of-sale advertising within the last 30 days (OR = 2.87, 95 % CI [1.26, 6.54]) contributed significantly to a model predicting the likelihood of reporting daily occurrence of smoking/SHS in the home. CONCLUSIONS While few women reported having ever used tobacco, one in seven women in this study reported that smoking/SHS occurred daily in their homes. Therefore SHS exposure is a potential health concern for women and children in this rural community. Findings from this study provide baseline data for monitoring tobacco control policies in Ethiopia, particularly in relation to the promotion of smoke-free homes, and could be used to inform prevention program development.
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Affiliation(s)
- Anne Berit Petersen
- Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA 94143 USA
- Loma Linda University School of Nursing, West Hall, 11262 Campus St, Loma Linda, CA 92354 USA
| | - Lisa M. Thompson
- Department of Family Health Care Nursing & Global Health Sciences Program, University of California, San Francisco, 2 Koret Way, Nursing, Rm 405J, UCSF Box 0606, San Francisco, CA 94143 USA
| | - Gezahegn Bekele Dadi
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, PO Box 1560, Hawassa, Ethiopia
| | - Alemu Tolcha
- School of Public & Environmental Health, College of Medicine and Health Sciences, Hawassa University, PO Box 1560, Hawassa, Ethiopia
| | - Janine K. Cataldo
- Department of Physiological Nursing & Center for Tobacco Control Research and Education, 2 Koret Way, N611Q, San Francisco, CA 94143 USA
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A comprehensive computational analysis of cathinone and its metabolites using quantum mechanical approaches and docking studies. Struct Chem 2016. [DOI: 10.1007/s11224-016-0779-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Geresu B. Khat (Catha edulis F.) and cannabinoids: Parallel and contrasting behavioral effects in preclinical and clinical studies. Pharmacol Biochem Behav 2016; 138:164-73. [PMID: 26469212 DOI: 10.1016/j.pbb.2015.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 09/17/2015] [Accepted: 09/27/2015] [Indexed: 11/19/2022]
Abstract
After a brief outline of Catha edulis F. (khat) and the cannabinoid systems, the interactions between the pharmacological effects of khat and cannabinoids will be reviewed. Khat chewing is a widespread habit that has a deep-rooted sociocultural tradition in Africa and the Middle East. Experimental studies conducted to investigate khat's central and peripheral effects have revealed an amphetamine-like mechanism of action mediated through the dopaminergic system. The endocannabinoid system comprises the receptors, the endogenous agonists and the related biochemical machinery responsible for synthesizing these substances and terminating their actions. Endocannabinoids are synthesized "on demand" from membrane phospholipids and then rapidly cleared by cellular uptake and enzymatic degradation. Khat and cannabinoids produce a body of parallel and contrasting behavioral effects. Concurrent consumption of khat and cannabinoids may increase the risk of getting or precipitating psychosis, has rewarding and motivational effect, increases the threshold of pain perception and impairs learning and memory. On the other hand, the action of cannabis to enhance food intake is likely to reduce khat's appetite suppressant effects.
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Affiliation(s)
- Berhanu Geresu
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Alsalahi A, Alshawsh MA, Mohamed R, Alyousefi NA, Alshagga MA, Shwter AN, Al-Maqtari A, Ahmed RH, Mohamed Z. Conflicting reports on the role of the glycemic effect of Catha edulis (Khat): A systematic review and meta-analysis. JOURNAL OF ETHNOPHARMACOLOGY 2016; 186:30-43. [PMID: 27025406 DOI: 10.1016/j.jep.2016.03.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/03/2016] [Accepted: 03/18/2016] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditionally, the leaves of Catha edulis Forsskal (Khat) are consumed by the people of Yemen primarily for its recreational effect, and secondarily, for achieving certain tasks. Additionally, Yemeni diabetics chew such leaves in the belief that this can control their elevated blood glucose level. AIMS This review focuses on outlining the findings of studies that have been conducted to display the glycemic effect of Catha edulis, while trying to balance it with findings of the association of its chewing with the development of type 2 diabetes mellitus (DM). MATERIALS AND METHODS The search strategy adopted was based on a comprehensive research in Medline, PubMed, Web of Science, JSTOR, Scopus and Cochrane for articles, proceeding abstracts and theses to identify complete reports written in the English language about the glycemic effect of Catha edulis in humans and animals from 1976 to 2016. In addition, bibliographies were also reviewed to find additional reports not otherwise published. Thirty seven records were identified of which, 25 eligible studies were included in the meta-analysis using blood glucose as an outcome measurement. Studies were divided into four subgroups according to the experimental model, namely; non-diabetic animals, diabetic animals, non-diabetic humans and diabetic humans. The pooled mean difference (MD) of blood glucose between experimental and control were calculated using random effects model of the weighted mean difference of blood glucose with 95% confidence interval (CI). Heterogeneity between studies was tested using I(2) statistic and a value of P<0.05 was considered to indicate statistical significance. RESULTS The scientific reports in the literature prevailed that the glycemic effect of Catha edulis were greatly conflicting with the majority of studies indicating that Catha edulis has a mild hypoglycemic effect. However, the meta-analysis indicted that the overall result showed an insignificant reduction in blood glucose (MD=-9.70, 95% CI: -22.17 to 2.76, P=0.13, with high heterogeneity between subgroups, I(2)=88.2%, P<0.0001). In addition, pooled mean difference of blood glucose of non-diabetic animals, diabetic animals and non-diabetic humans showed an insignificant reduction in blood glucose (MD=-18.55, 95% CI: -39.55 to 2.50, P<0.08, MD=-52.13%, 95% CI: -108.24 to 3.99, P=0.07 and MD=-2.71%, 95% CI: -19.19 to -13.77, P=0.75) respectively. Conversely, a significant elevation in the pooled mean difference of blood glucose in diabetic humans was indicated (MD=67.18, 95% CI: 36.93-97.43, P<0.0001). The conflict shown in the glycemic effect of Catha edulis is thought to be cultivar-related, while demographic and epidemiological reports suggested that chewing Catha edulis might be a predisposing factor contributing to the development of type 2 DM. CONCLUSION It was difficult to draw a meaningful conclusion from both the systematic and the meta-analysis with respect to the glycemic effect of Catha edulis since the meta-analysis results were insignificant with high heterogeneity among subgroups and are greatly conflicting. The variation is most likely due to unadjusted experimental factors or is related to Catha edulis itself, such as the differences in the phytochemical composition. Therefore, it is highly recommended that further studies of the glycemic effect of the cultivar of Catha edulis being studied should come with the identification and quantification of phytochemical content so that a meaningful assessment can be made with regard to its hypoglycemic properties. In addition, well-controlled clinical studies should be conducted to confirm whether or not chewing Catha edulis is associated with the development of type 2 DM, since this would be a source of concern seeing that the plant is widely consumed in certain populations.
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Affiliation(s)
- Abdulsamad Alsalahi
- Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mohammed A Alshawsh
- Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Rosmawati Mohamed
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Naelah A Alyousefi
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mustafa Ahmed Alshagga
- Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Abdrabuh N Shwter
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ali Al-Maqtari
- Faculty of Dentistry, University of Malaya, Kuala Lumpur, 50603 Kuala Lumpur, Malaysia
| | - Radwan H Ahmed
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Zahurin Mohamed
- Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Bogale T, Engidawork E, Yisma E. Subchronic oral administration of crude khat extract (Catha edulis forsk) induces schizophernic-like symptoms in mice. Altern Ther Health Med 2016; 16:153. [PMID: 27245332 PMCID: PMC4896131 DOI: 10.1186/s12906-016-1145-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 05/27/2016] [Indexed: 11/24/2022]
Abstract
Background Chewing fresh leaves of the khat plant (Catha edulis forsk) is a deep rooted and widespread habit in East Africa and the Middle East. Although a body of knowledge exists about the adverse effects of khat on health, data are sparse with regard to the consequences of long-term khat chewing in resulting schizophrenic like symptoms. Methods A crude extract of khat at different doses (100 mg/kg (K (khat)100), 200 mg/kg (K200) and 400 mg/kg (K400)) were administered for experimental group of mice whereas standard (ketamine (KT) 10 mg/kg- positive controls (KT10)) and vehicle (2 % v/v Tween-80 in distilled water – negative control groups (CON)) were administered for control groups of mice daily for two months to evaluate subchronic oral administration of crude khat extract to induce schizophrenic-like symptoms in mice. Mice were subjected to a battery of behavioural tests and parameters like locomotor activity, total time spent in social interaction and level of cognition among different groups of mice were measured and analyzed. Results Khat at all doses significantly increased (p < 0.001) the mean locomotor activity score of mice compared to CON. However, the mean locomotor activity score of mice treated with khat was significantly lower (p < 0.001) compared to the mean locomotor activity score of KT10 mice (p < 0.001). The mean total time score (in seconds) spent in social interaction, mean total time score (in seconds) spent in sniffing and following the partner was significantly higher (p < 0.001) in CON groups of mice compared to khat and ketamine treated groups. Moreover, in spatial memory task, the mean latency score (in seconds) to find the platform of khat and ketamine treated mice was significantly higher (p < 0.05) when compared to CON. Conclusions Subchronic oral administration of khat showed an enhanced locomotor activity, reduced social interaction and impaired cognitive function, which demonstrated that long-term use of khat is associated with schizophernic-like symptoms.
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72
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El-Setouhy M, Alsanosy RM, Alsharqi A, Ismail AA. Khat Dependency and Psychophysical Symptoms among Chewers in Jazan Region, Kingdom of Saudi Arabia. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2642506. [PMID: 27022605 PMCID: PMC4789047 DOI: 10.1155/2016/2642506] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 12/26/2015] [Accepted: 02/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Khat chewing is highly prevalent in Africa, Yemen and Jazan region, southwest of Saudi Arabia. Most of Jazani Khat chewers consider khat session as a social activity and do not consider khat dependency. The aim of this study was to explore khat dependency and its relationship with the psychophysical symptoms among chewers. METHODS Cross-sectional study on seventy Saudi male khat chewers living in Jazan area. Psychological dependence to khat chewing was evaluated using the Severity of Dependency Scale (SDS). The participants filled in a self-administrated assisted structured questionnaire designed to collect data about their medical history, neurological symptoms, and their chewing behavior. RESULTS Half (52.2%) of khat chewers showed psychological dependency. Those having longer khat sessions (≥6 hours) were more liable for dependency. Physical and psychological symptoms were more prevalent among khat dependent chewers. CONCLUSIONS khat has a psychological dependence effect that can be measured by the SDS, even in low doses and with irregular use. SDS scale is a useful tool to expect the burden of either physical or psychological symptoms on khat chewers.
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Affiliation(s)
- Maged El-Setouhy
- Substance Abuse Research Center (SARC), Jazan University, Jazan, Saudi Arabia
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rashad M. Alsanosy
- Substance Abuse Research Center (SARC), Jazan University, Jazan, Saudi Arabia
| | - Abdallah Alsharqi
- Substance Abuse Research Center (SARC), Jazan University, Jazan, Saudi Arabia
- Psychcare Center, Riyadh, Saudi Arabia
| | - Ahmed A. Ismail
- Occupational and Environmental Health Department, College of Public Health University of Iowa, Iowa City, IA, USA
- Department of Community Medicine and Public Health, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
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Kassim S, Farsalinos KE. E-Cigarette as a Harm Reduction Approach among Tobacco Smoking Khat Chewers: A Promising Bullet of Multiple Gains. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:240. [PMID: 26907315 PMCID: PMC4772260 DOI: 10.3390/ijerph13020240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/05/2016] [Accepted: 02/15/2016] [Indexed: 12/27/2022]
Abstract
Khat chewing/use, a green leaf with amphetamine-like effects is socially integrated in the Middle East and Africa. Khat chewing is often associated with tobacco smoking and occurs in closed places, such as a family home setting where the smoke-free laws cannot be implemented. Tobacco cigarette smoking among khat chewers is a significant concern, but there is also second-hand exposure to smoke at home or in places where khat users gather. Evidence suggests that e-cigarettes represent a significantly less harmful form of nicotine intake. Evaluating the effects of e-cigarettes among khat chewers could be important in understanding the impact of e-cigarettes as a harm reduction approach, with the potential to reduce the health risk associated with smoking.
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Affiliation(s)
- Saba Kassim
- College of Dentistry, Taibah University, Al-Madinah Al-Munawwarah 43353, Saudi Arabia.
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Kimani ST, Patel NB, Kioy PG. Memory deficits associated with khat (Catha edulis) use in rodents. Metab Brain Dis 2016; 31:45-52. [PMID: 26423676 DOI: 10.1007/s11011-015-9738-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022]
Abstract
Khat products and chewing practices are common in East Africa, Middle East for centuries with concomitant socio-economic and public health repercussions. We assessed memory deficits associated with khat use in rodents. Young male CBA mice, 5-7 weeks old (n = 20), weighing 25-35 g were used. Mice were treated with either 40, 120 or 360 mg/kg body weight (bw) methanolic khat extract, or 0.5 ml saline for 10 days. Spatial acquisition, reversal and reference memory were assessed using modified Morris Water maze (MMWM). Mice treated with 40 mg/kg khat extract had longer (t4 = 4.12 p = 0.015) and t4 = 2.28 p = 0.065) escape latency on first and second day during reversal relative to the baseline. Under 120 mg/kg khat dose, the escape latency was shorter (t4 = -2.49 p = 0.05) vs (t3 = -2.5 p = 0.05) on third and fourth day. Further, treatment with 360 mg/kg khat extract resulted in significantly longer time (49.13, 33.5, 40.2 and 35.75) vs. (23.5 s), compared to baseline. Mice treated with khat or control preferred the target quadrant post acquisition while differential pattern was seen during reversal phase. Mice treated with 40 or 120 mg/kg khat showed significant preference for target quadrant. Substantial time (19.9) was spent in the old target compared to the new (16.9 s) by animals treated with highest dose however, the difference was not significant. There is a biological plausibility that chronic khat use may induce memory deficits and impair cognitive flexibility. The differential patterns of memory deficits may reflect the differences in dose effect as well as time dependent impairment.
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Affiliation(s)
- S T Kimani
- School of Nursing Sciences, University of Nairobi, P.O Box 30197, 00100, Nairobi, Kenya.
| | - N B Patel
- Department of Medical Physiology, University of Nairobi, P.O Box 30197, 00100, Nairobi, Kenya
| | - P G Kioy
- Department of Medical Physiology, University of Nairobi, P.O Box 30197, 00100, Nairobi, Kenya
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Alghamdi M, Alqahtani B, Alhowti S. Cardiovascular complications among individuals with amphetamine-positive urine drug screening admitted to a tertiary care hospital in Riyadh. J Saudi Heart Assoc 2016; 28:129-35. [PMID: 27358529 PMCID: PMC4917642 DOI: 10.1016/j.jsha.2015.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/14/2015] [Accepted: 12/29/2015] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Amphetamine-type stimulants (ATS) are the most commonly used illicit drugs in Saudi Arabia. Frequency and outcome of ATS-related cardiovascular (CV) complications in the Saudi community have not been previously studied. AIM We aimed to determine the incidence and the clinical outcomes of CV complications among individuals with amphetamine-positive urine drug screening (APUDS) tests admitted to a tertiary care facility in Riyadh, Saudi Arabia. METHODS Retrospective review of consecutive cases with APUDS and concurrently positive cardiac biomarkers admitted to King Abdul-Aziz Medical City in Riyadh, Saudi Arabia, between January 2006 and December 2013. The laboratory database was queried to identify patients with positive APUDS and abnormal cardiac biomarkers. Clinical data were extracted from the electronic medical records. RESULTS A total of 7450 urine drug screening tests were performed during the study period, out of which 720 (9.6%) were positive for ATS (APUDS group). Forty-two cases in the APUDS group were documented to have CV complications. All cases were men with a median age of 39 years (range, 21-60 years). Acute coronary syndrome/myocardial infarction was the most frequent clinical presentation (n = 31, 74%), predominantly in the form of ST-elevation myocardial infarction. Other less frequent complications included myopericarditis, cardiomyopathy, and arrhythmia. Coronary procedures were performed in 30 cases. Median hospital stay was 5 days (range, 1-28 days) and in-hospital mortality was 7.2%. CONCLUSION APUDS is frequently encountered in young Saudi men presenting to the emergency department of our institution. Individuals with APUDS are at increased risk of CV complications and in-hospital mortality. The most frequent APUDS-related CV complication is acute coronary syndrome.
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Affiliation(s)
- Mohammad Alghamdi
- King Abdul-Aziz Medical City-Riyadh and King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, aSaudi Arabia
| | - Bader Alqahtani
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, bSaudi Arabia
| | - Sultan Alhowti
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, bSaudi Arabia
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Girma T, Mossie A, Getu Y. Association between body composition and khat chewing in Ethiopian adults. BMC Res Notes 2015; 8:680. [PMID: 26578211 PMCID: PMC4650344 DOI: 10.1186/s13104-015-1601-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/19/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Khat (Catha edulis Forsk) is a psychostimulant herb widely cultivated and used in Ethiopia. The link between khat use and body composition is little known. OBJECTIVE The aim was to determine the association between body composition and khat use. METHODS We recruited 415 individuals 18-78 years of age from Jimma Town. Sociodemographic and lifestyle data were collected using structured questionnaires. Fat mass (FM, kg) and fat-free mass (FFM, kg) were estimated from whole-body bio impedance. Weight (kg), FM and FFM were indexed to height (m) as BMI (kg/m(2)), fat mass index (FMI) (kg/m) and fat-free mass index (FFMI) (kg/m), respectively. Independent predictors of BMI, FMI and FFMI were identified using regression analysis. RESULT Participants' mean ± SD of age was 37 ± 13 years and 205 (53.2 %) were males. Mean ± SD of BMI, FMI and FFMI were 21.0 kg/m(2) ± 4.1, 6.8 kg/m ± 5.2 and 27.9 kg/m ± 3.8, respectively. Multivariable model showed that, compared with non-chewers, khat chewers had a lower BMI (B = -1.56, 95 % CI -0.78, -2.33) and FMI (B = 2.19, 95 % CI -1.32, -3.06). FMI was lower in cigarette smokers than non-smokers by -1.36 kg/m (95 % CI -0.23, -2.49). Concurrently, khat and cigarette users increased FMI by 2.78 (95 % CI 0.11, 5.44). FFMI decreased with age (B = -0.02, 95 % CI -0.05, -0.002). CONCLUSION FMI and BMI were lower in khat users than non-users, but there was no difference in lean mass. The consequence of this body composition change should be investigated.
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Affiliation(s)
- Tsinuel Girma
- Department of Paediatrics and Child Health, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia.
| | - Andualem Mossie
- Department of Biomedical Sciences (Physiology), College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia.
| | - Yesufe Getu
- Save the Children International, Jimma, Ethiopia.
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Nyongesa A, Oduma J, al'Absi M, Chirwa S. Immunohistochemical localization of anterior pituitary cell types of vervet monkey (Chlorocebus aethiops) following sub-chronic cathinone exposure. JOURNAL OF ETHNOPHARMACOLOGY 2015; 174:168-177. [PMID: 26277490 DOI: 10.1016/j.jep.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/03/2015] [Accepted: 08/06/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Khat (Catha edulis) contains cathinone, an active principal that is customarily used as a psychostimulant that wards off fatigue and to some extent used as an aphrodisiac. AIM OF STUDY To investigate effects of escalating doses of cathinone on hormone expression by different anterior pituitary cell types using specific antibodies. MATERIAL AND METHODS Eleven vervet monkeys (6 males and 5 females) divided into tests (n=9) and controls (n=2) were used. Animals were allocated as group I (saline controls), group II (0.8 mg/kg), group III (3.2 mg/kg) and group IV (6.4 mg/kg) of cathinone. All treatments were via oral route at alternate days of each week. At the end of 4-month treatment phase, GnRH agonist (ZOLADEX) was administered to group II (low dose) and group IV (high dose) alongside cathinone for 2 additional weeks. RESULTS High cathinone dose at long-term exposure caused proliferation of gonadotrophs but decrease in lactotrophs and corticotrophs in anterior pituitary sections of animals while effect of low dose on these cells was insignificant. Subsequent GnRH agonist co-treatment with low and high cathinone doses enhanced gonadotroph proliferation but no change on decline of lactotrophs and corticotrophs. CONCLUSION We believe that there was a possible potentiation of cathinone on pituitary hormone synthesis thereby influencing reproductive function. Suppression of corticotrophic and lactotrophic functions suggest lowering of stress levels and modulation of reproductive function based on dose level and chronicity of exposure. The findings are consistent with the hypothesis that cathinone interferes with pituitary cell integrity and consequently target organs, but further studies are required to address the precise mechanism underlying this phenomenon.
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Affiliation(s)
- Albert Nyongesa
- Department of Veterinary Anatomy and Physiology, University of Nairobi, P.O. Box 30197, 00100 Nairobi, Kenya.
| | - Jemimah Oduma
- Department of Veterinary Anatomy and Physiology, University of Nairobi, P.O. Box 30197, 00100 Nairobi, Kenya
| | - Mustafa al'Absi
- Duluth Medical Research Institute, University of Minnesota, Duluth, MN 55812, USA
| | - Sanika Chirwa
- Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, USA
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Alvi A, Fatima N, Jerah AA, Rizwan M, Hobani YH, Sunosi RA, Taha MMEH, Habiballah EM, Agarwal PK, Abdulwahab SI. Correlation between Resistin, Tuberculosis and Khat Addiction: A Study from South Western Province of Saudi Arabia. PLoS One 2015; 10:e0140245. [PMID: 26448186 PMCID: PMC4598132 DOI: 10.1371/journal.pone.0140245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 09/23/2015] [Indexed: 11/19/2022] Open
Abstract
Tuberculosis(TB) is a disease of global significance, which accounts for a death in every 15 seconds. Recent studies shows TB is rising in certain parts of the world, and Saudi Arabia is one of them. Several factor contribute in predisposing the subjects for infection including but not limited to addiction to various compounds which have immune modulation properties, such as amphetamines and Heroin etc. Khat a plant whose leaves are chewed for its euphoric effect in east Africa and Arabian Peninsula including Saudi Arabia, is considered as mildly addictive, and its principle compound, Cathinone shares structural and functional similarity with amphetamine a known immunomodulator. Tuberculosis being a disease of immune modulation has a varied spectrum of complex interplay of proinflammatory molecules, resistin is one of them. In the present study, we try to explore the trinity of khat addiction, serum resistin level and tuberculosis by correlating the serum resistin level in non khat addicted healthy subjects, khat addicted healthy subjects, and in patients, both khat addicted and non khat addicted, with active tuberculosis. We observed significantly higher resistin level among the apparently healthy khat addicted subjects as compared to non addicted healthy controls. Thereafter, when we compare the resistin levels between khat addicted and non khat addicted TB patients we did not found significant difference between the two groups. However bacillary load was observe to be significantly higher among the khat addicted TB patient as compare to non addicted one. Validation of above results in animal model revealed dose dependant increase in bacillary growth in the Wistar rats treated with khat. Taken together these results suggest the role of khat in immune modulation albeit in the limited frame of resistin level.
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Affiliation(s)
- Ayesha Alvi
- Department of Genetics and Molecular Biology, Faculty of Applied Medical Sciences, Jazan University, Jazan, KSA
- * E-mail:
| | - Nuzhath Fatima
- Department of Microbiology, Faculty of Applied Medical Sciences, Jazan University, Jazan, KSA
| | - Ahmed Ali Jerah
- Department of Biochemistry, Faculty of Applied Medical Sciences, Jazan University, Jazan, KSA
| | - Mohammed Rizwan
- Department of Biochemistry, College of Nursing, Jazan University, Jazan, KSA
| | - Yahya Hasan Hobani
- Department of Genetics and Molecular Biology, Faculty of Applied Medical Sciences, Jazan University, Jazan, KSA
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Ismail AA, El Sanosy RM, Rohlman DS, El-Setouhy M. Neuropsychological functioning among chronic khat users in Jazan region, Saudi Arabia. Subst Abus 2015; 35:235-44. [PMID: 24965057 DOI: 10.1080/08897077.2013.832469] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Khat chewing effects in the central nervous system are attributed to cathinone and cathine, which are structurally related to amphetamine. However, studies on neuropsychological problems arising from khat use in humans are not extensive and have only included observational and single-case studies. The aims of this study were to (1) to examine neuropsychological functions among khat chewers, and (2) to determine factors affecting neuropsychological outcomes among khat chewers. METHODS A sample of 70 adult male khat chewers and a control group of 72 nonchewers were recruited from the Jazan region in southwest Saudi Arabia. A questionnaire examining socioeconomic background, medical and occupational history, education, and khat chewing behaviors was administered. Neuropsychological performance was assessed using computerized tests from the Behavioral Assessment and Research System (BARS) that assessed learning, episodic and working memory, motor speed/coordination, attention/information processing speed, sustained attention, set-shifting/response inhibition, and perceptual functions; noncomputerized tests, Trail Making A and B, Block Design, and Benton Visual Retention tests were also administered. RESULTS Khat chewers performed significantly worse on 3 out of 14 neuropsychological subtests compared with the control group, representing learning, motor speed/coordination, and set-shifting/response inhibition functions. Age and educational level were identified as predictors of neuropsychological outcomes of khat chewers. CONCLUSIONS The chronic chewing of khat leaves is associated with deficits in some neuropsychological functions, which may affect the mental and neurological health of communities in which khat chewing is a common habit.
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Affiliation(s)
- Ahmed A Ismail
- a Department of Community and Family Medicine, Faculty of Medicine , Jazan University , Jizan , Saudi Arabia
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Qat Chewing and Periodontal Pathogens in Health and Disease: Further Evidence for a Prebiotic-Like Effect. BIOMED RESEARCH INTERNATIONAL 2015; 2015:291305. [PMID: 26351631 PMCID: PMC4553167 DOI: 10.1155/2015/291305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/28/2015] [Indexed: 11/18/2022]
Abstract
AIM Qat chewing has been reported to induce subgingival microbial shifts suggestive of prebiotic-like properties. The objective here was to assess the effect of qat chewing on a panel of classical and new putative periopathogens in health and periodontitis. MATERIALS AND METHODS 40 qat chewers and 40 nonchewers, equally stratified by periodontal health status, were recruited. Taqman, real-time PCR was used to quantify total bacteria, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Parvimonas micra, Filifactor alocis, Synergistetes, and TM7s in pooled subgingival biofilm samples. Differences in microbial parameters between the study groups were analysed using ordinal regression. RESULTS In health, the qat chewers harboured significantly lower relative counts of P. gingivalis, T. forsythia, Synergistetes, and TM7s after adjustment for multiple comparisons (P ≤ 0.007). At nominal significance level, they also carried lower counts of TM7s and P. micra (P ≤ 0.05). In periodontitis, the chewers had lower counts of all taxa; however, only T. denticola withstood correction for multiple comparisons (P ≤ 0.0063). CONCLUSIONS Qat chewing is associated with lower proportions of periopathogens, particularly in subjects with healthy periodontium, which supports previous reports of its prebiotic-like properties. This potentially beneficial biological effect can be exploited by attempting to isolate the active fraction.
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Zyoud SH. Bibliometric analysis on global Catha edulis (khat) research production during the period of 1952-2014. Global Health 2015; 11:39. [PMID: 26337534 PMCID: PMC4558725 DOI: 10.1186/s12992-015-0124-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/24/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Publication of scientific articles related to khat (Catha edulis) in peer-reviewed journals is considered a measure of research productivity. The principal objectives of this study were to quantify the research contribution related to khat at the global level, as well as to determine its relative growth rate, collaborative measures taken, productivity at the institutional level, and the most prolific journals publishing on the topic. METHODS On the basis of title words related to khat, publications were identified for all data in Scopus bibliographic database's history up to December 31, 2014. The research productivity for the top 10 countries was evaluated in relation to the population size and gross domestic product (GDP) in 2013. RESULTS The criteria were met by 651documents published in 51 countries. The largest number of articles associated with khat was from the UK (15.2 %), followed by Yemen (10.3 %), the USA (9.7 %) and Ethiopia (9.1 %). Ethiopia, Yemen, and Kenya had the highest productivity of publications after standardization by population size and GDP. Furthermore, Yemen achieved the highest number of collaborations, by having researchers from 19 countries. Ethiopia followed, having researchers from 16 countries. CONCLUSIONS This bibliometric study provides a demonstration for the worldwide research activity regarding khat. The number of articles related to khat has increased rapidly over the last 10 years. The present study is a good starting point to evaluate research activity in the field of khat. Although the data shows a promising increase in the research activity, the quantity of khat-related research is still too little compared to the massive use of khat in certain countries.
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Affiliation(s)
- Sa'ed H Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
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Kassim S, Jawad M, Croucher R, Akl EA. The Epidemiology of Tobacco Use among Khat Users: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:313692. [PMID: 26273606 PMCID: PMC4529904 DOI: 10.1155/2015/313692] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/30/2015] [Indexed: 01/12/2023]
Abstract
Khat, an "amphetamine-like green leaf," may influence the consumption of tobacco. This study reviews the epidemiology of tobacco use among khat users. Electronic database searches using appropriate keywords/terms were conducted to identify observational studies of khat use. Assessment of quality and risk of bias of all included studies was conducted, and the results were synthesised descriptively. Nine eligible cross-sectional studies were identified. All assessed self-reported tobacco among khat users and were carried out in Africa and the Middle East. Eight reported cigarettes and one reported waterpipes as the mode of use. Methods of tobacco use prevalence assessment varied. Prevalence of "current" tobacco use among students and university teachers ranged from 29 to 37%; "lifetime" tobacco use in university teachers was 58% and "undefined" tobacco use in nonspecific adults and students ranged from 17 to 78%. Daily tobacco use among adults was reported as 17% whilst simultaneous tobacco and khat use was reported as between 14 and 30% in students. In conclusion, tobacco prevalence among khat users appears significant. Findings should be interpreted cautiously due to self-reported tobacco use, diversity in questions assessing tobacco use, and type of tobacco consumption. Future research should address the methodological shortcomings identified in this review before appropriate policy interventions can be developed.
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Affiliation(s)
- Saba Kassim
- Barts and The London School of Medicine and Dentistry and Institute of Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton SO16 6YD, UK
| | - Ray Croucher
- Barts and The London School of Medicine and Dentistry and Institute of Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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El-Zaemey S, Schüz J, Leon ME. Qat Chewing and Risk of Potentially Malignant and Malignant Oral Disorders: A Systematic Review. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2015; 6:129-43. [PMID: 26174990 PMCID: PMC6977049 DOI: 10.15171/ijoem.2015.537] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/16/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Qat (also known as Khat, Kat and Miraa) is a green-leaved plant (Catha edulis). It is a shrub indigenous to Yemen and certain parts of eastern Africa. Chewing the leaves, which have sympathomimetic and euphoric effects, has been documented in many countries and increased with worldwide migration. The effect of long-term chewing Qat on the oral cavity is unknown. OBJECTIVE A systematic review was performed to identify any associations between Qat chewing and the occurrence of potentially malignant and malignant oral disorders. METHODS Medline and the Web of Science were searched for articles published before May 2014 without limits with regard to publication date and language. RESULTS From a total of 890 papers identified, 17 English papers reported potentially malignant or malignant oral disorders and Qat chewing. One additional paper in Arabic language was identified from reviewing the list of references of eligible papers. It was found that exposure to Qat may be associated with potentially malignant and malignant oral disorders, but methodological issues, such as inadequate study design, sample size, selection of study subjects, clinical evaluations of outcome and limited adjustment for confounders, limit the strength of the evidence base in this area. CONCLUSION The association between Qat chewing and potentially malignant and malignant oral disorders remains debatable and requires further investigations.
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Affiliation(s)
- S El-Zaemey
- Section of Environment and Radiation International Agency for Research on Cancer, Lyon, France.
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Khat Chewing Practice and Associated Factors among Adults in Ethiopia: Further Analysis Using the 2011 Demographic and Health Survey. PLoS One 2015; 10:e0130460. [PMID: 26090658 PMCID: PMC4474667 DOI: 10.1371/journal.pone.0130460] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 05/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Khat chewing has become a highly prevalent practice and a growing public health concern in Ethiopia. Although there have been many small scale studies, very limited national information has been available in the general population. This study aimed to identify factors associated with khat chewing practice among Ethiopian adults. METHODS The study used the 2011 Ethiopian demographic and health survey data. The survey was cross-sectional by design and used a multistage cluster sampling procedure. Bivariate and multivariable logistic regression models with adjusted odds ratio (AOR) and their 95% confidence intervals (CI) were used to quantify the predictors. RESULTS The overall khat chewing prevalence was 15.3% (95% CI: 14.90-15.71). Regional variation was observed with the highest in Harari [(53.2% (95% CI: 43.04-63.28)] and lowest in Tigray regional state [(1.1% (95% CI: 0.72-1.66)]. Multivariable analysis showed that Islam followers were 23.8 times more likely to chew khat as compared to Orthodox followers. Being a resident in Oromiya, South Nation, Nationalities and People (SNNP), Gambella, Harari and Dire Dawa regions had 1.9, 1.6, 3.1, 5.2 and 3.5 times higher odds of chewing khat as compared to Addis Ababa residents, respectively. Adults in the age group 45-49 years were 3.6 times more likely to chew khat as compared to 15-19 years. The middle and richest wealth quintiles were 1.3 and 1.5 times more likely to chew khat, respectively, as compared to the poorest category. Rural residents had 1.3 odds of chewing khat than urban residents. Those individuals who had occupation in sales, agriculture, service sector, skilled and unskilled manual workers were 1.6, 1.3, 2.4, 1.7 and 2.3 times more likely to chew khat, respectively, as compared to those who have no occupation. Females were 77% less likely to chew khat as compared to males. Formerly married and those experienced in child death had 1.4 and 1.2 times higher odds to chew khat as compared with those never married and never had child death, respectively. Those who attended mass media were 1.4 times more likely to chew khat compared with not attended. CONCLUSION Khat chewing is a public health concern in Ethiopia. The highest wealth quintiles, older age group, rural residence, child death, formerly married, males, regions of Oromiya, SNNP, Gambella, Harari and Dire Dawa and Islamic followers had statistically significant association with khat chewing. Due attention needs to be given for these factors in any intervention procedures.
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Kassim S, Dalsania A, Nordgren J, Klein A, Hulbert J. Before the ban--an exploratory study of a local khat market in East London, U.K. Harm Reduct J 2015; 12:19. [PMID: 26066043 PMCID: PMC4465728 DOI: 10.1186/s12954-015-0048-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Khat is a green leaf with amphetamine-like effects. It is primarily used among people in Africa, the Middle East and in the diaspora communities from these countries. Prior to the prohibition of khat in the UK on 24 June 2014, there was almost no information available on key aspects of the local khat market. METHODS A cross-sectional study was conducted in 2012 using snowball sampling, Privileged Access Interviewing and area mapping in order to identify khat sale establishments. Data was collected via face-to-face interviews using mixed methods for data collection. This included information about the establishments selling khat, khat pricing and its use among different ethnic minority groups, in addition to the potential sale of khat to children and risk assessment (e.g., use of pesticides on khat). RESULTS Five out of seven sellers identified agreed to participate. Sellers described their khat sale establishments as 'community centres' which included, for example, a restaurant basement. The sellers' history of selling khat ranged between 1-15 years and khat's sale took place between 2pm-10pm. Miraa (e.g., Lara) from Kenya was the most popularly used khat variety, sold in pre-wrapped bundles of approximately 250 g costing £3 each and delivered four days a week. Harari (e.g., Owdi) from Ethiopia was sold in 200 g, 400 g and 1 kg bundles, priced between £5 and £20 and delivered two days a week. The primary benefit of khat use was reported to be social interaction. The customers were predominantly adult males of Somali origin. Most sellers claimed a self-imposed ban on sales to children under 18 years old. Khat bundles had no labelling describing variety or weight and sellers had no knowledge of the use of pesticides on khat and did not advertise the risks associated with khat use. CONCLUSIONS Khat selling establishments were businesses that did not adhere to trade standards regulations (e.g., labelling khat bundles). They claimed to provide a community service (facilitating social interaction) to their predominately Somali customers. Without a better understanding of the dynamics of the khat market there is a risk that both health and social needs of the vulnerable populations involved in the market continue to go unaddressed. Future research should track changes in the now illicit khat market in order to evaluate the social and public health implications following the recent changes to the current U.K. regulatory environment regarding khat.
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Affiliation(s)
- Saba Kassim
- Queen Mary, University of London, Barts and The London School of Medicine and Dentistry, Institute of Dentistry, 4 Newark Street, London, E1 2AT, UK.
| | - Asha Dalsania
- Queen Mary, University of London, Barts and The London School of Medicine and Dentistry, Institute of Dentistry, 4 Newark Street, London, E1 2AT, UK.
| | - Johan Nordgren
- Department of Social Work, Malmö University, Malmö, Sweden.
| | - Axel Klein
- Project Office with Egmont, Institute for International Relations, Brussels, Belgium.
| | - Josh Hulbert
- Drugscience, the Independent Scientific Committee on Drugs, London, UK.
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Ketema T, Yohannes M, Alemayehu E, Ambelu A. Effect of chronic khat (Catha edulis, Forsk) use on outcome of Plasmodium berghei ANKA infection in Swiss albino mice. BMC Infect Dis 2015; 15:170. [PMID: 25886020 PMCID: PMC4392739 DOI: 10.1186/s12879-015-0911-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/23/2015] [Indexed: 12/22/2022] Open
Abstract
Background The objective of this study was to explore effects of khat (Catha edulis) on outcome of rodent malaria infection and its anti-plasmodial activities on Plasmodium berghei ANKA (PbA). Methods Female Swiss albino mice were orally treated with crude khat (Catha edulis) extracts (100, 200 and 300 mg/kg) on a daily basis for 4 weeks prior to PbA infection. Physical, clinical, hematological, biochemical and histo-pathological features of the mice were assessed. In addition, in vivo anti-plasmodial activities of khat were evaluated. Results The finding of this study showed that khat use was strongly associated with increment of levels of liver and kidney biomarkers, leucopenia, severe anemia, rise in level of inflammation biomarkers: C-reactive protein (CRP), uric acid (UA), increased monocyte-lymphocyte count ratio (MLCR), manifestation of cerebral malaria symptoms such as ataxia, paralysis and deviation of the head but with no pulmonary edema. Significantly lower level of parasitemia (P < 0.05), rectal temperature, but, high level of hemoglobin were observed at the early stage of the PbA infection in khat treated mice than the control. With extension of the treatment period, however, drastic increments were observed in parasite load and rectal temperature although there was reduction in hemoglobin (Hb) level. Moreover, khat showed poor anti-plasmodial activity with <10% parasite suppression activity and lack protection against major malaria symptoms. The significant reduction (P < 0.01) of hematological parameters during PbA infection strengthen the notion that hematological parameters could be good predictors of severe malaria complications in human. Conclusions In mice model treated with khat prior to infection with the rodent malaria parasite, khat was found to worsen manifestation of most malaria complications. Furthermore, the same plant showed poor in vivo anti-plasmodial activity and protection against major malaria symptoms.
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Affiliation(s)
- Tsige Ketema
- Department of Environmental Health Sciences and Technology, College of Health Sciences, Jimma University, Jimma, Ethiopia. .,Department of Biology, College of Natural Sciences, Jimma University, Jimma, Ethiopia.
| | - Moti Yohannes
- Department of Microbiology and Veterinary Public Health, College of Agriculture and Veterinary Medicine, Jimma University, Jimma, Ethiopia.
| | - Esayas Alemayehu
- School of Civil and Environmental Engineering, Jimma University Institute of Technology, Jimma, Ethiopia.
| | - Argaw Ambelu
- Department of Environmental Health Sciences and Technology, College of Health Sciences, Jimma University, Jimma, Ethiopia.
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Kumari A, Baskaran P, Van Staden J. Enhanced HIV-1 Reverse Transcriptase Inhibitory and Antibacterial Properties in Callus of Catha edulis Forsk. Phytother Res 2015; 29:840-3. [PMID: 25753483 DOI: 10.1002/ptr.5318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/21/2015] [Accepted: 02/05/2015] [Indexed: 11/05/2022]
Abstract
Developing tissue culture systems for medicinal plants is important in that they may offer an alternative to protect wild populations. However, analysis of bioactivity for tissue culture developed plant tissues is required to offer support and allow acceptance in traditional medicine. The use of propagated callus could provide potential material for therapeutic purposes. This study was aimed at evaluating the anti-HIV and antibacterial properties of a three-month-old tissue culture-derived calli and leaves of cultivated mother plants of Catha edulis Forsk. The calli were derived from leaf explants using different plant growth regulators. The calli obtained from callus cultured on 9.8 μM indole-3-butyric acid plus 2.7 μM naphthalene acetic acid exhibited the highest HIV-1 reverse transcriptase inhibitory effects when compared with other treatments and the mother plants. Different extracts of callus exhibited high antibacterial activity (<1 mg/mL: minimum inhibitory concentration from 0.098 to 0.78 mg/mL) against both gram-positive and gram-negative bacteria. Leaf acetone extracts showed moderate activity (minimum inhibitory concentration of 0.78 mg/mL) against Staphylococcus aureus. The present study indicated that tissue culture-derived calli could be used as therapeutic agents for traditional medicine. The choice of treatment used in the tissue culture system and the age of the callus for production of biomass may significantly influence its therapeutic potential.
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Affiliation(s)
- Aloka Kumari
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville, 3209, South Africa
| | - Ponnusamy Baskaran
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville, 3209, South Africa
| | - Johannes Van Staden
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville, 3209, South Africa
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Ketema T, Yohannes M, Alemayehu E, Ambelu A. Evaluation of immunomodulatory activities of methanolic extract of khat (Catha edulis, Forsk) and cathinone in Swiss albino mice. BMC Immunol 2015; 16:9. [PMID: 25879529 PMCID: PMC4341871 DOI: 10.1186/s12865-015-0072-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/03/2015] [Indexed: 01/25/2023] Open
Abstract
Background The objective of this study was to explore the immunomodulatory effect of khat and its active component, cathinone, using mice. Materials and methods Female Swiss albino mice aged 7–8 weeks weighing 25-30 g were used in the study. Mice were randomized into eight groups of 6 each and oral treatment of khat crude extract and cathinone were given daily for four weeks. Physical, hematological, biochemical, and immunological parameters were measured. Immunological studies included humeral immunity (IgG and IgM), cellular immune response (delay type hypersensitivity), phagocytic activities of reticuloendothelial system, and determination of T-lymphocyte population: CD3+, CD4+, CD8+ count and CD4+/CD8+ status. Results Findings of this study showed that, khat and its major metabolite, cathinone, can positively affect immune system in dose dependent manner. When doses of crude khat extract and cathinone increase, the induction of humeral (IgG and IgM) and cellular immune responses were up-regulated significantly (P < 0.05), while at higher dose of khat (200 mg/kg) cellular immune response was suppressed. In support of this, as doses of the two test substances increased, the count of T helper cells (CD4+) was significantly increased (P < 0.05), while higher dose significantly reduced whole white blood cell (WBC), CD8+, and CD3+ counts. Conclusion At relatively lower dose (50-100 mg/kg), crude khat extract has immune stimulating property, although higher dose (200 mg/kg) leads to suppression of cellular immune response. Cathinone also share all immune modulating property of its parent compound, khat, but with intense strength. Thus, it calls for further detailed investigation of khat for practical application of the same in human medication. Electronic supplementary material The online version of this article (doi:10.1186/s12865-015-0072-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tsige Ketema
- Department of Environmental Health Sciences and Technology, Jimma University, College of Public Health and Medical Sciences, Jimma, Ethiopia. .,Department of Biology, Jimma University, College of Natural Sciences, Jimma, Ethiopia.
| | - Moti Yohannes
- Department of Microbiology and Veterinary Public Health, Jimma University, College of Agriculture and Veterinary Medicine, Jimma, Ethiopia.
| | - Esayas Alemayehu
- Jimma University Institute of Technology, School of Civil and Environmental Engineering, Jimma, Ethiopia.
| | - Argaw Ambelu
- Department of Environmental Health Sciences and Technology, Jimma University, College of Public Health and Medical Sciences, Jimma, Ethiopia.
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Alsharafi WA, Bi FF, Hu YQ, Mujlli HM, Xiao B. Effect of Khat on apoptosis and related gene Smac/DIABLO expression in the cerebral cortex of rats following transient focal ischemia. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2015; 39:424-432. [PMID: 25569323 DOI: 10.1016/j.etap.2014.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The leaves of the Khat shrub contain the major alkaloid compounds (cathinone) and cathine. These compounds can induce apoptosis and exacerbate the acute cerebral infarction, but the underlying mechanism is poorly understood. The present study aimed to investigate the effects of Khat treatment on the expression and cellular localization of Smac/Diablo (second mitochondrial activator of caspase) in the cortex of ischemic rat brain. METHODS Adult male Sprague-Dawley rats were administered Khat (3g/kg) twice daily for 4 weeks, then underwent left middle cerebral artery occlusion (MCAO) for 2h and reperfusion for 3, 6 and 12h, respectively. The infarction area was evaluated with 2,3,5-triphenyltetrazolium chloride (TTC) staining. Apoptosis was assessed by terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL). Smac/DIABLO expression levels in experimental and control groups were examined by immunohistochemistry and Western blot. RESULTS Khat significantly exacerbates the neurological damage compared with control (p<0.05). In addition, Khat-treatment significantly increased the number of TUNEL-positive cells 3h (p<0.01) and 12h (p<0.05) after reperfusion. Ischemia/reperfusion enhanced the release of Smac/DIABLO from the mitochondria to the cytosol after reperfusion. Such release of Smac/DIABLO was elevated after the rats were pretreated with Khat. CONCLUSIONS Our results indicate that Khat treatment can induce apoptosis through enhancing the release of Smac/DIABLO from the mitochondria to the cytosol after transient focal ischemia which may be an important mechanism of Khat neurotoxicity. Therefore, Khat chewing should be avoided by people who have cerebrovascular problems.
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Affiliation(s)
- Walid A Alsharafi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Fang-Fang Bi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Yue-Qiang Hu
- Department of Neurology, The First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning, China
| | | | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
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90
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Safhi MM, Alam MF, Hussain S, Hakeem Siddiqui MA, Khuwaja G, Jubran Khardali IA, Al-Sanosi RM, Islam F. Cathinone, an active principle of Catha edulis, accelerates oxidative stress in the limbic area of swiss albino mice. JOURNAL OF ETHNOPHARMACOLOGY 2014; 156:102-106. [PMID: 25153022 DOI: 10.1016/j.jep.2014.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/11/2014] [Accepted: 08/09/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Cathinone hydrochloride is an active principle of the khat plant (Catha edulis) that produces pleasurable and stimulating effects in khat chewers. To the best of our knowledge no data of cathinone on oxidative stress in limbic areas of mice is available. This is the first study of cathinone on oxidative stress in limbic areas of the brain in Swiss albino male mice. MATERIALS AND METHODS The animals were divided into four groups. Group-I was the control group and received vehicle, while groups-II to IV received (-)-cathinone hydrochloride (0.125, 0.25 and 0.5 mg/kg body wt., i.p.) once daily for 15 days. RESULTS The level of lipid peroxidation (LPO) was elevated dose-dependently and was significant (p<0.05, p<0.01) with doses of 0.25 and 0.5mg/kg body wt. of cathinone as compared to control group. In contrast, the content of reduced glutathione (GSH) was decreased significantly (p<0.01, p<0.001) with doses of 0.25 and 0.5mg/kg body wt. of cathinone as compared to control group. The activity of antioxidant enzymes (GPx, GR, GST, CAT, and SOD) was also decreased dose-dependently: the decreased activity of GPx, GR, catalase and SOD was significant with doses of 0.25 and 0.5 mg of cathinone as compared to control group, while the activity of GST was decreased dose-dependently and was significant with 0.5mg of cathinone as compared to control group. CONCLUSIONS The results indicate that the cathinone generated oxidative stress hampered antioxidant enzymes, glutathione and lipid peroxidation.
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Affiliation(s)
- Mohammed M Safhi
- Neuroscience and Toxicology Unit, College of Pharmacy, Jazan University, Ministry of Higher Education, Jazan, Saudi Arabia
| | - Mohammad Firoz Alam
- Neuroscience and Toxicology Unit, College of Pharmacy, Jazan University, Ministry of Higher Education, Jazan, Saudi Arabia
| | - Sohail Hussain
- Neuroscience and Toxicology Unit, College of Pharmacy, Jazan University, Ministry of Higher Education, Jazan, Saudi Arabia
| | - Mohammed Abdul Hakeem Siddiqui
- Neuroscience and Toxicology Unit, College of Pharmacy, Jazan University, Ministry of Higher Education, Jazan, Saudi Arabia
| | - Gulrana Khuwaja
- Neuroscience and Toxicology Unit, College of Pharmacy, Jazan University, Ministry of Higher Education, Jazan, Saudi Arabia
| | | | - Rashad Mohammed Al-Sanosi
- Substance Abuse Research Center, Jazan University, Ministry of Higher Education, Jazan, Saudi Arabia
| | - Fakhrul Islam
- Neuroscience and Toxicology Unit, College of Pharmacy, Jazan University, Ministry of Higher Education, Jazan, Saudi Arabia.
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91
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Alsanusy R, El-Setouhy M. Why would khat chewers quit? An in-depth, qualitative study on Saudi Khat quitters. Subst Abus 2014; 34:389-95. [PMID: 24159910 PMCID: PMC3827665 DOI: 10.1080/08897077.2013.783526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Khat chewing, which has many adverse health and social consequences, is highly prevalent and socially accepted in the Jazan region of the Kingdom of Saudi Arabia. Methods: A qualitative study was conducted with 47 adult male former khat users regarding their khat initiation, continuance, and cessation, the amounts of khat they had used, and the health and social consequences of their use and cessation of use. Results: Participants noted a desire to show maturity, ease of availability of khat, and peer pressure as reasons for initiating khat chewing. Many noted long leisure times with little to do as a reason for continuing use. Negative consequences of khat use were seen in economic, health, familial, and sexual areas of their lives. After quitting khat use, participants saw improvements in all of these areas. Conclusions: A comprehensive community development program (CCDP) tackling, among other issues, the normalization of khat use, substantial leisure times with few positive activities, and misinformation about the “benefits” of khat use, as well as developing peer and family training programs to help prevent or stop khat use, would be useful to reduce khat chewing in this community.
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Affiliation(s)
- Rashad Alsanusy
- a Substance Abuse Research Center (SARC) , Jazan University , Jazan , Kingdom of Saudi Arabia
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92
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al’Absi M, Nakajima M, Dokam A, Sameai A, Alsoofi M, Khalil NS, Habori MA. Concurrent tobacco and khat use is associated with blunted cardiovascular stress response and enhanced negative mood: a cross-sectional investigation. Hum Psychopharmacol 2014; 29:307-15. [PMID: 24706595 PMCID: PMC5763500 DOI: 10.1002/hup.2403] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 01/07/2014] [Accepted: 02/24/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Khat (Catha edulis), an amphetamine-like plant, is widely used in East Africa and the Arabian Peninsula and is becoming a growing problem in other parts of the world. The concurrent use of tobacco and khat is highly prevalent and represents a public health challenge. We examined for the first time associations of the concurrent use of tobacco and khat with psychophysiological responses to acute stress in two sites in Yemen. METHODS Participants (N = 308; 135 women) included three groups: users of khat and tobacco, users of khat alone, and a control group (nonsmokers/nonusers of khat). These individuals completed a laboratory session in which blood pressures (BP), heart rate, and mood measures were assessed during rest and in response to acute stress. RESULTS Concurrent use of khat and tobacco was associated with attenuated systolic BP, diastolic BP, and heart rate responses to laboratory stress (ps < 0.05) and with increased negative affect relative to the control group (ps < 0.05). CONCLUSIONS Results demonstrated blunted cardiovascular responses to stress and enhanced negative affect in concurrent khat and tobacco users. These findings extend previous studies with other substances and suggest that adverse effects of khat use may lie in its association with the use of tobacco.
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Affiliation(s)
- Mustafa al’Absi
- Duluth Medical Research Institute, University of Minnesota Medical School, Duluth, Minnesota, USA
| | - Motohiro Nakajima
- Duluth Medical Research Institute, University of Minnesota Medical School, Duluth, Minnesota, USA
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93
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Family context and Khat chewing among adult Yemeni women: a cross-sectional study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:505474. [PMID: 24982886 PMCID: PMC4055061 DOI: 10.1155/2014/505474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/01/2014] [Indexed: 11/23/2022]
Abstract
Khat chewing is associated with unfavourable health outcomes and family dysfunction. Few studies have addressed the factors associated with khat chewing among Yemeni women. However, the family and husband effects on chewing khat by women have not been addressed. This study aimed to determine the prevalence of khat chewing among Yemeni women and its associated factors, particularly husbands and family factors. A cross-sectional study was conducted among 692 adult Yemeni women in the city of Sana'a in Yemen using structured “face to face” interviews. Mean (±SD) age of women was 27.3 years (±6.10). The prevalence of chewing khat by women was 29.6%. Factors associated with chewing khat among women were chewing khat by husbands (OR = 1.8; 95% CI: 1.26, 2.53), being married (OR = 2.0; 95% CI: 1.20, 3.37), frequent family social gatherings (OR = 1.5; 95% CI: 1.06, 2.10), high family income (OR = 1.57; 95% CI: 1.12, 2.21), larger house (OR = 1.63; 95% CI: 1.16, 2.31), and age of women (OR = 0.64; 95% CI: 0.44, 0.92). It is concluded that khat chewing by women in this study was significantly associated with family factors and with khat chewing by their husbands. Urgent action is needed to control khat chewing particularly among women.
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94
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Kassim S, Rogers N, Leach K. The likelihood of khat chewing serving as a neglected and reverse 'gateway' to tobacco use among UK adult male khat chewers: a cross sectional study. BMC Public Health 2014; 14:448. [PMID: 24885131 PMCID: PMC4039549 DOI: 10.1186/1471-2458-14-448] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chewing khat leaves is often accompanied by tobacco use. We assessed aspects of tobacco use and explored factors associated with tobacco use patterns (frequency of use per week) among khat chewers who used tobacco only when chewing khat ("simultaneous tobacco and khat users", STKU). METHODS A sample of 204 male khat chewers was recruited during random visits to khat outlets. Data collected included socio-demographic items, tobacco use and khat chewing behaviours. Both psychological and physical dependence on khat were assessed using the Severity of Psychological Dependence on Khat (SDS-Khat) Scale, the Diagnostic Statistical Manual IV (DSM-IV) and adapted items from the Fagerström Test for Nicotine Dependence (chewing even when ill, and difficulty in abstaining from khat chewing for an entire week). Descriptive statistics and non-parametric analyses were conducted. RESULTS Of the 204 khat chewers, 35% were khat chewers only, 20% were STKU, and the remainder were daily cigarette smokers. The mean age of STKU was 38.12 (±14.05) years. Fifty seven percent of STKU smoked tobacco and chewed khat for two days per week and 43% smoked and chewed more frequently (three to six days: 33%, daily: 10%). Three quarters (74%) were former daily tobacco users. Khat chewing initiated tobacco smoking among 45% of STKU and 71% reported attempts to quit tobacco smoking during khat chew. Among STKU, smoking tobacco for more than two days per week was significantly associated (p < 0.05) with psychological dependence (increased levels of SDS-Khat), physical dependence (increased levels of DSM-IV symptoms, chewing even when ill, difficulty in abstaining from chewing for an entire week and self-reported health conditions) and behavioural factors (e.g. amount of khat chewed in typical khat session). CONCLUSIONS Khat chewing may promote different patterns of tobacco smoking, initiate and sustain tobacco smoking, and trigger tobacco cessation relapses among STKU. Increased frequency of tobacco smoking among STKU was linked to psycho-physical and behavioural factors. Further investigation within large and representative samples of both sexes of STKU in different contexts should be considered for health research and policy development. Khat chewing should be considered when designing tobacco prevention uptake, cessation interventions and relapse prevention programmes.
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Affiliation(s)
- Saba Kassim
- Institute of Dentistry, Queen Mary, University of London, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK
| | - Nikki Rogers
- Wright State University Boonshoft School of Medicine, Dayton 45420, OH, USA
| | - Kelly Leach
- Wright State University Boonshoft School of Medicine, Dayton 45420, OH, USA
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Does khat chewing increases the risk of Mycobacterium tuberculosis infection by macrophage immune modulation? Med Hypotheses 2014; 82:667-9. [PMID: 24661941 DOI: 10.1016/j.mehy.2014.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/24/2014] [Indexed: 11/23/2022]
Abstract
Drug abuse is a serious problem associated with different pathological outcomes including modulating the immune system. Drug abuse is rising in Saudi Arabia and so as TB, a disease of worldwide significance, caused by immunological modulation in the host system. Khat chewing is a common practice in Arabian Peninsula which is now gaining momentum in other parts of the world. It is considered as an addiction. It has been associated with different adverse outcomes such as periodontitis, oral leukoplakia and oral cancer and also has shown to promote apoptotic cell death through cysteine proteases. The active ingredient of khat, cathinone is shown to have immunomodulatory effect. In principle, this leads to enhanced susceptibility to various infections. The present study is designed to delineate the mechanism of immunomodulation produced by khat/cathinone in human/mouse macrophage. Further, this activity will be evaluated both in vivo and in vitro in response to infection with Mycobacterium smegmatis to get an insight if there exists a co relation between the Mycobacterium tuberculosis infection and khat chewing.
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96
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Tilahun M, Ayele G. Factors associated with Khat use among youths visiting HIV testing and counseling centers in Gamo Gofa, Southern Ethiopia. BMC Public Health 2013; 13:1199. [PMID: 24350990 PMCID: PMC3878357 DOI: 10.1186/1471-2458-13-1199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 12/12/2013] [Indexed: 11/10/2022] Open
Abstract
Background The use of khat among youths can be harmful leading to decreased academic performance, increased risk of contracting HIV and other sexually transmitted diseases or other psychiatric symptoms. It is believed to be one of the factors associated with unprotected risky sexual behavior predisposing the youth for HIV infection and transmission. Methods A cross-sectional study was conducted in South West Ethiopia. A total of 410 participants were recruited in the study using stratified sampling technique. Data were collected by using interviewer administered structured questionnaire. Multiple logistic regression and Cox regression were used to assess the association of independent variables with the outcome variable. Result Khat use was positively associated with male gender (OR 2.9; C.I. 1.4 to 6.0), alcohol use (OR 4.8; C.I. 2.1 to 10.6), no education level (OR 2.6; C.I. 1.1 to 6.2) and not having communication with parents about khat chewing (OR 2.6; C.I. 1.1 to 6.2). Conclusion Strategies should be designed to increase awareness of factors associated with khat use among youths and their parents in order to reduce the prevalence of khat use and its adverse social and health consequences.
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Affiliation(s)
- Marelign Tilahun
- Department of Public Health, College of Medicine and Health Sciences, Arba-Minch University, P,O, Box: 21, Arba-Minch, Ethiopia.
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97
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Wood S, Sage JR, Shuman T, Anagnostaras SG. Psychostimulants and cognition: a continuum of behavioral and cognitive activation. Pharmacol Rev 2013; 66:193-221. [PMID: 24344115 PMCID: PMC3880463 DOI: 10.1124/pr.112.007054] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Psychostimulants such as cocaine have been used as performance enhancers throughout recorded history. Although psychostimulants are commonly prescribed to improve attention and cognition, a great deal of literature has described their ability to induce cognitive deficits, as well as addiction. How can a single drug class be known to produce both cognitive enhancement and impairment? Properties of the particular stimulant drug itself and individual differences between users have both been suggested to dictate the outcome of stimulant use. A more parsimonious alternative, which we endorse, is that dose is the critical determining factor in cognitive effects of stimulant drugs. Herein, we review several popular stimulants (cocaine, amphetamine, methylphenidate, modafinil, and caffeine), outlining their history of use, mechanism of action, and use and abuse today. One common graphic depiction of the cognitive effects of psychostimulants is an inverted U-shaped dose-effect curve. Moderate arousal is beneficial to cognition, whereas too much activation leads to cognitive impairment. In parallel to this schematic, we propose a continuum of psychostimulant activation that covers the transition from one drug effect to another as stimulant intake is increased. Low doses of stimulants effect increased arousal, attention, and cognitive enhancement; moderate doses can lead to feelings of euphoria and power, as well as addiction and cognitive impairment; and very high doses lead to psychosis and circulatory collapse. This continuum helps account for the seemingly disparate effects of stimulant drugs, with the same drug being associated with cognitive enhancement and impairment.
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Affiliation(s)
- Suzanne Wood
- 9500 Gilman Dr MC 0109, La Jolla, CA 92093-0109.
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98
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Valente MJ, Guedes de Pinho P, de Lourdes Bastos M, Carvalho F, Carvalho M. Khat and synthetic cathinones: a review. Arch Toxicol 2013; 88:15-45. [PMID: 24317389 DOI: 10.1007/s00204-013-1163-9] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/05/2013] [Indexed: 11/25/2022]
Abstract
For centuries, 'khat sessions' have played a key role in the social and cultural traditions among several communities around Saudi Arabia and most East African countries. The identification of cathinone as the main psychoactive compound of khat leaves, exhibiting amphetamine-like pharmacological properties, resulted in the synthesis of several derivatives structurally similar to this so-called natural amphetamine. Synthetic cathinones were primarily developed for therapeutic purposes, but promptly started being misused and extensively abused for their euphoric effects. In the mid-2000's, synthetic cathinones emerged in the recreational drug markets as legal alternatives ('legal highs') to amphetamine, 'ecstasy', or cocaine. Currently, they are sold as 'bath salts' or 'plant food', under ambiguous labels lacking information about their true contents. Cathinone derivatives are conveniently available online or at 'smartshops' and are much more affordable than the traditional illicit drugs. Despite the scarcity of scientific data on these 'legal highs', synthetic cathinones use became an increasingly popular practice worldwide. Additionally, criminalization of these derivatives is often useless since for each specific substance that gets legally controlled, one or more structurally modified analogs are introduced into the legal market. Chemically, these substances are structurally related to amphetamine. For this reason, cathinone derivatives share with this drug both central nervous system stimulating and sympathomimetic features. Reports of intoxication and deaths related to the use of 'bath salts' have been frequently described over the last years, and several attempts to apply a legislative control on synthetic cathinones have been made. However, further research on their pharmacological and toxicological properties is fully required in order to access the actual potential harm of synthetic cathinones to general public health. The present work provides a review on khat and synthetic cathinones, concerning their historical background, prevalence, patterns of use, legal status, chemistry, pharmacokinetics, pharmacodynamics, and their physiological and toxicological effects on animals and humans.
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Affiliation(s)
- Maria João Valente
- REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal,
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Al-Juhaishi T, Al-Kindi S, Gehani A. Khat: A widely used drug of abuse in the Horn of Africa and the Arabian Peninsula: Review of literature. Qatar Med J 2013; 2012:1-6. [PMID: 25003033 PMCID: PMC3991038 DOI: 10.5339/qmj.2012.2.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 12/01/2012] [Indexed: 12/15/2022] Open
Affiliation(s)
- Taha Al-Juhaishi
- Weill Cornell Medical College, PO 24144, Education City, Doha, Qatar
| | - Sadeer Al-Kindi
- Weill Cornell Medical College, PO 24144, Education City, Doha, Qatar
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100
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Epicardial coronary arteries in khat chewers presenting with myocardial infarction. Int J Vasc Med 2013; 2013:857019. [PMID: 24222853 PMCID: PMC3814045 DOI: 10.1155/2013/857019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 08/29/2013] [Indexed: 01/08/2023] Open
Abstract
Background. Khat chewing is a common habit in Yemen despite increased evidence of its negative impact on the cardiovascular system. Aims. We aimed to study the epicardial coronary arteries in khat chewers presenting with myocardial infarction (AMI). Materials and Methods. A descriptive, cross-sectional study was conducted between November 2008 and May 2009 in Yemen. AMI patients who underwent coronary angiogram were enrolled and divided into groups (gp): gp1 (diabetic and khat chewers), gp2 (khat chewers and nondiabetic), and gp3 (diabetic and non-khat users). Results. Of 347 AMI patients 63%, 21%, and 16% were in gp 2, 3, and 1, respectively. Khat chewers were younger in comparison to non-khat users. Group 3 patients were more likely to have multivessel disease, severe left anterior descending (LAD), right coronary artery (RCA) stenosis and total RCA, and left circumflex (Lcx) occlusion compared to other groups. Group 1 patients were more likely to have total LAD occlusion and severe Lcx lesions. In multivariate analysis, age, diabetes mellitus, and smoking were significant independent predictors for significant coronary artery lesions; however, khat chewing did not show such association. Conclusions. Coronary spasm is the main mechanism of AMI in khat chewers. The impact of our finding for risk stratification and management warrants further studies.
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