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Ali SA, Destaye AG. Apparent Khat chewers exposure to DDT in Ethiopia and its potential toxic effects: A scoping review. Regul Toxicol Pharmacol 2024; 147:105555. [PMID: 38142813 DOI: 10.1016/j.yrtph.2023.105555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
Dichlorodiphenyltrichloroethane (DDT) is an insecticide, a member of dirty dozen persistent organic pollutants, used widely in the world until it was banned in the 1970s.The banning of DDT was strengthened by the Stockholm Convention in 2001. DDT is allowed only for malaria control in Ethiopia. However, farmers are misusing DDT and applying it to Khat (Catha edulis) farming. So, this review analyzes available data in the literature on the current trend, application, occurrence, fate and effects of DDT and its metabolites, dichlorodiphenyldichloroethane (DDD), dichlorodiphenyldichloroethylene (DDE), in the chewable parts of Khat. Generally, the concentration level of DDT, DDD, and DDE, designated as DDTs, is detected in different farmlands of Ethiopia. Some of the DDTs concentrations detected are very high (141.2-973 μg/kg (Gelemso), 194.4-999 μg/kg (Aseno) and 6253-8413.3 μg/kg (Gurage), and these concentrations may indicate increasing recent unmonitored application of DDT on Khat leaves. Some of the detected concentrations of DDT in the literature were above the maximum residue limit (MRL) set by FAO/WHO (100 μg/kg) and the European Commission 10 μg/kg in vegetables and 50 μg/kg in cereals. DDT exposure of Khat chewers linked to the concentration of DDT on Khat leaves and the amount of Khat consumed. DDT might pose health risks to chewers due to chronic toxicity, bioaccumulation, persistent and endocrine disruption properties.
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Affiliation(s)
- Shimels Ayalew Ali
- Department of Biology, Environmental Toxicology, Dire Dawa University, Ethiopia.
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Githua KK, Maitho TE, Nguta JM, Okumu MO. Studies on the ethnopharmacology, antimicrobial activity, and toxicity of Catha edulis (Vahl.) Endl., in Sprague Dawley rats. F1000Res 2022; 11:286. [PMID: 37767078 PMCID: PMC10521044 DOI: 10.12688/f1000research.109243.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 09/29/2023] Open
Abstract
Background: The Mbeere South community of Embu County consume leaves of Catha edulis for its stimulant and euphoretic actions. Other indigenous uses of the plant are undocumented. Information on the pharmacology and safety of this plant is also scanty. This study aimed to document the ethnopharmacology, antimicrobial properties, and toxicity of C. edulis leaves collected from the Mbeere South community in Kenya. Methods: Ethnopharmacological data was collected from 35 informants using semi-structured questionnaires. Leaf extracts of C. edulis were prepared using acetone, water, and methanol. The antimicrobial properties of these extracts were evaluated against Bacillus cereus, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans. The toxicity of the aqueous extract was determined using hematological, biochemical, and histopathological parameters in male and female Sprague Dawley rats at 250 mg/kg, 500 mg/kg, and 1000 mg/kg doses over 28 days. p<0.05 was considered significant. Results: All informants were male, most were married, >50 years old, with >10 years of experience. The sources, local names, preparation, storage conditions, indications, frequency of use, dosage, and side effects of C. edulis were documented. All extracts were ineffective against E. coli, P. aeruginosa, and C. albicans. They had limited efficacy against B. cereus and S. aureus. Significant differences were observed in the hematological and biochemical parameters of rats at the tested doses. Low, intermediate, and high doses of the aqueous extract of C. edulis produced local congestion of the cardiac and hepatic vessels. Localized interstitial connective tissue proliferation, multifocal kidney interstitial hemorrhage, and localized tubular epithelium necrosis were also observed in female rats. Conclusions: The ethnobotanical uses of C. edulis among the Mbeere South community were documented for the first time. Limited antimicrobial efficacy and toxicity at high doses limit the use of leaves of C. edulis.
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Affiliation(s)
- Kevin Kariuki Githua
- Health, County Government of Embu, Embu, Embu, +254, Kenya
- Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Nairobi, 254, Kenya
| | - Timothy Elias Maitho
- Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Nairobi, 254, Kenya
| | - Joseph Mwanzia Nguta
- Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Nairobi, 254, Kenya
| | - Mitchel Otieno Okumu
- Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Nairobi, 254, Kenya
- Pharmacy, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kisumu, +254, Kenya
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“It hurts so much to live for nothing”: Lived Experiences of Substance Use Among Refugee Youth in Displacement. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00472-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Alhazmi HA, Bakri MA, Mohzari YA, Alshigaify YG, Al Bratty M, Javed SA, Najmi A, ur Rehman Z, Ahsan W, Mohamed Elhassan Taha M. Study of influence of Catha edulis (Khat) chewing on oral pharmacokinetics of Irbesartan in rats using a newly developed HPLC-UV method. Saudi Pharm J 2022; 30:237-244. [PMID: 35498225 PMCID: PMC9051964 DOI: 10.1016/j.jsps.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
Abstract
Khat consumers might use a number of drugs for underlying conditions; however the potential drug-herb interaction between khat and other drugs including Irbesartan (IRB) is unknown. The present study was conducted to evaluate the effects of khat chewing on pharmacokinetic profile of IRB, a commonly available antihypertensive agent. The pharmacokinetic profile of orally administered IRB (15.5 mg/kg) with and without pre-administration of khat (12.4 mg/kg) were determined in Sprague-Dawley rats. IRB was estimated in rat plasma samples using a newly developed HPLC method. The chromatographic separation of the drug and internal standard (IS) was performed on a C-18 column (Raptor C-18, 100 mm × 4.6 mm id.; 5 µm) using a mobile phase consisting of 10 mM ammonium acetate buffer (pH 4.0) and acetonitrile in a ratio 60:40 v/v. Acceptable linearity for IRB was recorded at 1 – 12 µg/mL concentration range (R2 > 0.99). Intra-day and inter-day precision (%RSD = 0.44% − 3.27% and 0.39–1.98% respectively) and accuracy (% recovery = 98.3 – 104.3%) in rat plasma was within the acceptable limit according to USFDA guidelines. The AUC0-t was found to be significantly increased in IRB-khat co-administered rats as compared to rats receiving IRB only; whereas, the Tmax (0.5 h) value remained unchanged. Results of this study revealed that the IRB level considerably increased in rat plasma upon co-administration of khat. This might be due to the inhibition of CYP2D9 by khat which is the principal cytochrome P450 isoform responsible for IRB metabolism.
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Alshahrani SA, Al-Qahtani WS, Almufareh NA, Domiaty DM, Albasher GI, Safhi FA, AlQassim FA, Alotaibi MA, Al-Hazani TM, Almutlaq BA. Oral cancer among Khat users: finding evidence from DNA analysis of nine cancer-related gene mutations. BMC Oral Health 2021; 21:626. [PMID: 34876124 PMCID: PMC8650367 DOI: 10.1186/s12903-021-01981-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/22/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Khat leaves contain the alkaloid cathinone. Research shows that khat might provoke toxicity, mutagenicity, as well as carcinogenicity. METHODS Two groups were identified as khat abusers and were categorized by abuse time and diagnosis of oral squamous cell carcinoma (OSCC). Here, 41 participants from Group 2 were short-term khat users, and 42 participants were long-term khat users. The control group included 30 healthy individuals. The coding exons included nine cancer-related genes and were analysed. The histopathological research was conducted with H&E staining along with the TP53 protein expression by implementing immunohistochemical analyses. RESULTS Here, 41 short-term khat users carried seven somatic mutations in four out of nine cancer-related genes: 29/41(70.73%) ARID1A, 24/41(58.53%) MLH1, 34/41(82.92%) PIK3CA and 36/41(87.80%) TP53. The 42 long-term khat users incorporated nine somatic mutations in five out of nin ecancer-related genes: 40/42(95.23%) ARID1A, 36/42(85.71%) ARID2, 29/42(69.04%) PIK3CA, 27/42(64.28%) MLH1, and 35/42(83.33%) TP53. Every khat user had somatic mutations related to OSCC affecting the gingiva and the lower lip. TP53 protein expression was confirmed in all immunohistochemical oral tests. Carcinoma was also positive in the histopathological analysis. CONCLUSIONS Khat is a mutagenic and carcinogenic plant that provoked OSCC among short-term khat users (<15 years of use) and long-term users (>15 years of use).
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Affiliation(s)
| | - Wedad Saeed Al-Qahtani
- Department of Forensic Sciences, College of Criminal Justice, Naif Arab University for Security Sciences, P.O. Box 6830, 11452, Riyadh, Saudi Arabia.
| | - Nawaf Abdulrahman Almufareh
- Department of Paediatric Dentistry and Preventive Dental Sciences, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Dalia Mostafa Domiaty
- College of Science, Department of Biology, University of Jeddah, P.O. Box 13151, 21493, Jeddah, Saudi Arabia
| | | | - Fatmah Ahmed Safhi
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | | | - Tahani Mohamed Al-Hazani
- Department of Biology, College of Sciences and Humanities, Prince Sattam Bin Abdulaziz University, P.O. Box 83, 11940, Al-Kharj, Saudi Arabia
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Abou-Elhamd AS, Kalamegam G, Ahmed F, Assidi M, Alrefaei AF, Pushparaj PN, Abu-Elmagd M. Unraveling the Catha edulis Extract Effects on the Cellular and Molecular Signaling in SKOV3 Cells. Front Pharmacol 2021; 12:666885. [PMID: 34040530 PMCID: PMC8141790 DOI: 10.3389/fphar.2021.666885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022] Open
Abstract
Khat (Catha edulis (Vahl) Endl.) is an evergreen flowering shrub used as a stimulant in many regions worldwide including East Africa, the Arabian Peninsula, Europe, and the United States. Chewing leaves of khat induces excitement and euphoria, which are primarily attributed to two major constituents, cathinone and cathine. Khat also contains other important constituents such as cathedulins. A considerable number of studies reported side effects induced by the khat extracts to both embryos and adults. These include teratogenicity and developmental retardation, oral cancer and ulcers, high blood pressure, and myocardial infarction. So far, little attention has been paid to the effects of khat extracts on the molecular signaling interactions. We aimed in this study to investigate this through evaluating the effects of khat extracts on SKOV3, a human ovarian adenocarcinoma cell line. We show, by in vitro assays, that khat induces several cellular defects including reduced cell size, cell membrane damage, and apoptosis. At high khat extract concentrations, the cell metabolic activity, cell cycle, and cellular proliferation were affected. RT-qPCR analysis showed an increase in the gene expression of the apoptotic marker BAX, the tumor suppressor p53, and the inflammatory cytokine IL-6. Protein expression analysis by immunostaining showed downregulation of β-catenin, E-cadherin, and Ki-67 and upregulation of FZD8 and SPRY2, suggesting that Wnt and FGF signaling were implicated. SwissTargetPrediction in silico analysis showed that khat constituents cathine, cathinone, catheduline K2, and catheduline E5 bind to family A G-protein-coupled receptor, cause many neurological diseases and disorders such as Alzheimer's, schizophrenia, depression, and anxiety, and induce many ovarian cancer-related diseases. The analysis also showed that important signaling pathways such as CREB, Wnt, FGF, IL-6, and ERK/MAPK, and that of the endometrial cancer, and cell cycle were implicated. Upstream regulators of cathine and cathinone were found to potentially target several molecules including interleukin-8, MMP2, PLAU, and micro-RNAs. In conclusion, khat induces significant cellular and molecular changes that could potentially cause a wide range of serious diseases and syndromes. Such an impact could have a heavy burden on the health care system in the countries where khat is consumed.
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Affiliation(s)
- Alaa Sayed Abou-Elhamd
- Department of Anatomy and Histology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.,Department of Respiratory Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Gauthaman Kalamegam
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Farid Ahmed
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mourad Assidi
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Peter Natesan Pushparaj
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muhammad Abu-Elmagd
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
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Tesfaye E, Krahl W, Alemayehu S. Khat induced psychotic disorder: case report. Subst Abuse Treat Prev Policy 2020; 15:27. [PMID: 32245382 PMCID: PMC7119018 DOI: 10.1186/s13011-020-00268-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/23/2020] [Indexed: 01/22/2023] Open
Abstract
Background Khat (Catha edulis) is a stimulant leaf khat comes from a tree which grows in countries bordering the Red Sea which are along the east coast of Africa and in west Asia. The psycho- active component within these leaves is cathinone. In Ethiopia, Khat is chewed routinely by users for its euphoric effects and as a recreational drug, and chewing khat has an important role as well in both traditional and religious ceremonies. In this case report, we describe the case of a 33-year-old male patient presented with psychotic symptoms after prolonged and heavy khat chewing. Case presentation Findings on psychiatric evaluation encompassing detailed history and mental state examination suggest khat induced psychotic disorder severe in full remission; khat use disorder, severe, in early remission. Conclusions This case demonstrates that the use of excess khat above 2 bundles for prolonged duration can manifest with psychotic episodes. A small number of case studies had supported a causal relationship between heavy khat use and psychosis or psychotic symptoms. There have been suicidal attempts and homicidal acts in those who used excess and prolonged use of khat. In our case, the improvement attributed to stopping the khat rather than taking antipsychotics. Therefore, we recommend an urgent social intervention to change the community norms regarding Khat use through psycho-education in media, institution and in person about the relationship between khat use and mental illness. In addition, we suggest the role of religious institutions on the management of khat use not be overlooked. Finally, this study makes a powerful argument for researchers and policy makers to do clinical study to settle a causal effect relation of khat on mental health.
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Assessment of Exposure to Sexually Explicit Materials and Substance Abuse among High-School Adolescents in North Shewa Zone: Application of Logistic Regression Analysis. JOURNAL OF ADDICTION 2020; 2020:8105087. [PMID: 32455048 PMCID: PMC7238327 DOI: 10.1155/2020/8105087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/27/2020] [Indexed: 02/02/2023]
Abstract
Background The use of substances such as cigarettes, khat, alcohol, and other illicit drugs like hashish, heroine, cannabis, and cocaine is a global major public threat, which affects young adult people particularly in developing countries. This study aims to assess the risk factors associated with substance use and exposure to sexually explicit materials among high-school adolescents in north Shewa zone, Oromia region. Method A cross-sectional study was conducted to assess substance use and exposure to sexually explicit materials among high-school adolescents in North Shewa zone, Oromiya, Ethiopia, using a structured self-administered questionnaire adapted from the 2008 “Community That Care Youth Survey” for adolescent substance use and problem behaviors. The study used descriptive statistics and logistic regression analysis to identify the significant factors associated with substance use and exposure to sexually explicit materials among high school adolescents in the study area. Result The prevalence of lifetime and current substance use was 47.7% (95% CI: 0.427, 0.527) and 30.4% (95% CI: 0.258, 0.350), respectively. 17.8% use khat in their life and 16.6% used khat in the past 30 days; 42.2% ever used alcohol and 26.1% currently uses alcohol; 4.8% and 4.5% used cigarette in lifetime and in the past 30 days, while 16.4% use other illicit drugs in lifetime and 8.4% use illicit drugs in the past 30 days, respectively. Distributions of substance use by sex indicate that male adolescents are more like likely 61.1% use substances than females. While, the prevalence of exposure to sexually explicit materials among high school adolescents was 35.8% (95% CI: 0.310, 0.406). Factors positively associated with increased substance use were being male (OR = 2.334, 95% CI: 1.549, 9.926), living through high level of family conflict (OR = 6.25, 95% CI: 1.745, 10.00), poor family management OR = 27.084, 95% CI: 1.624, 45.56), peer pressure (OR = 12.882, 95% CI: 1.882, 88.153), poor academic performance (OR = 14.48, 95% CI: 1.290, 162.58), and low school commitment (OR = 11.951, 95% CI: 1.418, 100.73). While, being male (OR = 7.52, 95% CI: 2.611, 21.739), age 14–16 (OR = 0.201, 95% CI: 0.071, 0.565), friends watch/read sexually explicit materials (OR = 5.376, 95% CI: 1.010, 28.571), and khat chewing (OR = 12.5, 95% CI: 2.924, 25.632) were factors significantly associated with high-school adolescents exposure to sexually explicit materials. Conclusion The magnitude of prevalence for substance uses and exposure to sexually explicit materials in the study area was still higher. Therefore, interventions that focus on family management, peer pressure, and school commitment are required to decrease the prevalence of substance uses and exposure to sexually explicit materials among high-school adolescents.
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Limenie AA, Tolessa T, Makonnen E, Seifu D. Rewarding Effect of Catha edulis (Khat) and the Sex Differences to the Responses in Swiss Albino Mice. Psychol Res Behav Manag 2020; 13:279-289. [PMID: 32273781 PMCID: PMC7106998 DOI: 10.2147/prbm.s242036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background Burden of substance abuse is becoming a worldwide problem. One of the psychostimulant plants widely consumed in Ethiopia and other East African countries is Catha edulis Forsk (khat). Most of the users claim that its stimulatory effect is the determinant factor that makes them use. However, its rewarding and reinforcing potential and variation between sexes have not been investigated. This study was, therefore, designed to measure the rewarding effect of khat extract (ke) in the addiction mice model of both sexes. Materials and Methods Forty-eight Swiss albino mice of both sexes (age 6–7 weeks) weighing 21–33 gm were used. The mice were conditioned to ke (100 mg/kg, 200 mg/kg and 300 mg/kg b.w). The control group was conditioned to tween 80 (2%, v/v) in distilled water. The reinforcing effect of khat was evaluated using the conditioned place preference paradigm. The classical pairing to the extract was made using the place conditioning box. Post-conditioning tests have been conducted four times and the average values were taken for analysis using SPSS version 21.0. Results Time spent in the khat-paired compartment was significantly higher for mice conditioned to ke 200 mg/kg (p<0.05) and ke 300 mg/kg (p<0.001). The rewarding effect of khat was strong in females at a higher dose when compared to the same sex of mice conditioned to the vehicle (p<0.001) or male mice conditioned to the same dose of khat extract (p<0.05). Repeated administration increased khat rewarding sensitization at all doses. Though the crude khat extract did not affect the food consumption and total body weight, water consumption was significantly less in mice received ke 100 mg/kg (p<0.01), where it was significantly higher in mice received ke 300 mg/kg (p<0.01). Sniffing (p<0.05) and climbing (p<0.05) psychomotor activities of mice were also affected by the crude khat extract. Conclusion Mice showed place conditioning to khat extract, and the response was significantly higher in female mice. The crude khat extract did not affect food consumption and total body weight. The mechanisms behind the rewarding response of khat extract and sexual differences should be investigated.
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Affiliation(s)
- Abebaye Aragaw Limenie
- Department of Physiology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Tesfaye Tolessa
- Department of Physiology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- Department of Pharmacology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Daniel Seifu
- Department of Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
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Begum S, Bogosian A, McBain H. The Experiences of People Who Quit Khat and the Health Care Professionals Who Support them. ADDICTION & HEALTH 2020; 11:243-255. [PMID: 32206217 PMCID: PMC7073807 DOI: 10.22122/ahj.v11i4.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background This study aimed to explore the barriers and enablers to quitting khat from the perspective of users and the barriers and enablers to supporting users to quit from the perspective of healthcare professionals (HCPs). Methods The present qualitative study was conducted using semi-structured interviews and the Theoretical Domains Framework (TDF) to collect and analyse data. Findings Overall, 10 khat users and 3 professionals were interviewed. Beliefs about the consequences of continued use facilitated user’s decisions to quit. Social influences were both a barrier and an enabler. For professionals, the social influence of other colleagues and working together was key in enabling them to support clients. Social/professional role and identity was also an important enabler, as professionals saw supporting users to quit as an integral part of their role. A range of behaviour change techniques was identified as potential ways in which quitting attempts could be more successful, from the perspective of users and professionals. Conclusion The study reveals the complexity of khat chewing and quitting from the perspective of khat users, such as the varied influence of family and friends. It also identifies the many barriers and enablers that professionals experience when supporting individuals to quit, such as working with other professionals. There is little evidence for the effectiveness of current services provided for quitting khat or little information outlining how they were developed. Current services would benefit from evaluating the effectiveness of the interventions using established methodology. Recommendations have been provided for practice in the field of substance misuse.
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Affiliation(s)
- Suhana Begum
- School of Health Sciences, Division of Health Services Research and Management, University of London, London, England
| | - Angeliki Bogosian
- School of Health Sciences, Division of Health Services Research and Management, University of London, London, England
| | - Hayley McBain
- School of Health Sciences, Division of Health Services Research and Management, University of London, London, England
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Berihu BA, Asfeha GG, Welderufael AL, Debeb YG, Zelelow YB, Beyene HA. Toxic effect of khat ( Catha edulis) on memory: Systematic review and meta-analysis. J Neurosci Rural Pract 2019; 8:30-37. [PMID: 28149078 PMCID: PMC5225718 DOI: 10.4103/0976-3147.193524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People use khat (Catha edulis) for its pleasant stimulant effect of physical activity, consciousness, motor, and mental functions. Although there are reports assessing the effect of khat on memory, there was no study based on formal systematic review and meta-analysis. OBJECTIVE We have therefore conducted this meta-analysis to determine the level of evidence for the effect of khat (C. edulis Forsk) on memory discrepancy. METHODS MEDLINE, Cochrane Library, PubMed, Academic Search Complete, SPORTDiscus, ScienceDirect, Scopus, Web of Science, and Google Scholar were searched to retrieve the papers for this review. Keywords utilized across database search were khat, cat, chat, long-term memory, short-term memory, memory deficit, randomized control trial, and cross-sectional survey. The search was limited to studies in humans and rodents; published in English language. RESULT Finding of various studies included in our meta-analysis showed that the effect of acute, and subchronic exposure to khat showed that short-term memory appears to be affected depending on the duration of exposure. However, does not have any effect on long-term memory. CONCLUSION Although a number of studies regarding the current topic are limited, the evidenced showed that khat (C. edulis) induced memory discrepancy.
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Affiliation(s)
- Birhane Alem Berihu
- Department of Anatomy and Histology, Institute of Bio-Medical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebrekidan Gebregzabher Asfeha
- Department of Biochemistry and Molecular Biology, Institute of Bio-Medical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Abadi Leul Welderufael
- Department of Pediatrics and Gynecology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yared Godefa Debeb
- Department of Physiology, Institute of Bio-Medical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yibrah Berhe Zelelow
- Department of Pediatrics and Gynecology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hafte Assefa Beyene
- Department of Anatomy and Histology, Institute of Bio-Medical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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El-Setouhy M, Alsanosy R, Makeen AM, Ghailan KY, Alsharqi A, Sheikh KA. Impact of khat price increases on consumption behavior - price elasticity analysis. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:19. [PMID: 31088478 PMCID: PMC6518615 DOI: 10.1186/s13011-019-0208-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/17/2019] [Indexed: 12/16/2022]
Abstract
Background The long border of Saudi Arabia with Yemen is the primary route for khat entry to the Kingdom. As of April 2015, the government of SA tightened the border, making it more difficult to import khat into the country. As a result, local user prices of khat probably increased due in part to higher supply costs and perhaps lower quantities. One anti-drug strategy is to increase consumption cost by increasing the price of supply. We aim in this study to measure the responsiveness of khat demand to price changes. Methods This study used a cross-sectional survey design. Two stage sampling was used to recruit 350 khat chewers from four selected primary healthcare centers in Jazan province (South western province of Saudi Arabia). The data were collected during the first quarter of 2017. This study used both contingent valuation and revealed preference methods to assess the impact of price increases on the purchasing of khat. Graphical analysis, paired-samples t-test, and one-way repeated measures analysis of variance (ANOVA) were used to assess the impact of price increases on khat consumption. Results The study results showed a significant decrease in khat consumption amount (t = 8.63, p ≤ 0.05), frequency (t = 30.42, p ≤ 0.05), and expenditure (t = 34.67, p ≤ 0.05) after the tightening of the Saudi–Yemeni border. Hence khat demand is price elastic. The price elasticity of khat demand in Jazan is estimated to be between − 2.38 and − 1.07. Therefore, each 1% increase in price is associated with 1–2% reduction in quantity demanded. This means khat chewers are relatively responsive to price changes (i.e., khat demand is price elastic). Repeated measures analysis of variance showed price increases significantly affect the quantity {F(4, 2.58) = 257, p ≤ 0.05, ηp2 = 0.423} and frequency {F(4, 1.83) = 415, p ≤ 0.05, ηp2 = 0.543} of khat chewing. Conclusions Increased prices for khat would significantly decrease demand. Accordingly, we recommend implementing law enforcement strategies focused on disrupting the khat supply chain to realize high prices and so discourage use, hence reducing the incidence of khat-related illnesses.
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Affiliation(s)
- Maged El-Setouhy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.,Department of Community, Occupational and Environmental Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rashad Alsanosy
- Substance Abuse Research Center (SARC), Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Anwar M Makeen
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Khalid Yaser Ghailan
- Department of Epidemiology, Faculty of Public Health &Tropical Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | | | - Kamaludin Ahmed Sheikh
- Department of Epidemiology, Faculty of Public Health &Tropical Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
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Mohan S, Shaheen E, El-Amir Y, Khadashi H, Ncibi S, Farasani A, Abdelwahab S. Catha edulis-induced skeletal muscle toxicity in experimental rats via regulation of rhabdomyolysis biomarkers. Pharmacogn Mag 2019. [DOI: 10.4103/pm.pm_142_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lim SYM, Binti Azidin AR, Ung YT, Al-Shagga M, Alshawsh MA, Mohamed Z, Ong CE, Pan Y. Effect of 95% Ethanol Khat Extract and Cathinone on in vitro Human Recombinant Cytochrome P450 (CYP) 2C9, CYP2D6, and CYP3A4 Activity. Eur J Drug Metab Pharmacokinet 2018; 44:423-431. [DOI: 10.1007/s13318-018-0518-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Widmann M, Apondi B, Musau A, Warsame AH, Isse M, Mutiso V, Veltrup C, Ndetei D, Odenwald M. Comorbid psychopathology and everyday functioning in a brief intervention study to reduce khat use among Somalis living in Kenya: description of baseline multimorbidity, its effects of intervention and its moderation effects on substance use. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1425-1434. [PMID: 28321455 DOI: 10.1007/s00127-017-1368-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Migration and khat use were found to correlate with high rates of psychopathology. In this paper we aimed for assessing baseline multimorbidity and its interactions with a Brief Intervention. METHODS In the RCT, 330 male Somali khat users were assigned to treatment conditions (khat use is a predominantly male habit). The ASSIST-linked BI for khat users was administered. Using the TLFB Calendar, the PHQ-9, a Somali short version of the PDS and parts from the CIDI, khat use and comorbidity was assessed. With a regression analysis we tested for the influence of comorbidity and with mixed effect models group differences over time in sleep duration, khat use-time and everyday functioning. RESULTS We found high rates of baseline multimorbidity: 51% (N = 168) for depression, 22% (N = 74) for PTSD and 23% (N = 73) for khat-psychotic symptoms. Depression and khat-psychotic symptoms, but not PTSD symptoms decreased without group differences. Khat use-time decreased and functional time increased with significant time × group interactions (p ≤ 0.046). Depression and PTSD did not influence therapy success but in participants without comorbid psychopathology, more khat use reduction after the intervention was found (p = 0.024). CONCLUSION Somali khat users in Kenya are highly burdened by multimorbidity of depression, PTSD and khat-psychotic symptoms. The main effects for time and differences in healthy vs. mentally ill khat users indicate potential of unspecific support and the specific need for mental health care in combination with substance abuse treatment. The increase of everyday functioning promises more options for alternative activities, preventing excessive use and addiction.
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Affiliation(s)
- Marina Widmann
- University of Konstanz, Box 23, 78457, Konstanz, Germany.,vivo international e.V., PO Box 5108, 78430, Konstanz, Germany
| | - Bernice Apondi
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | - Abednego Musau
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | | | - Maimuna Isse
- Tawakal Medical Clinic, 5th street, Eastleigh, Nairobi, Kenya
| | - Victoria Mutiso
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | - Clemens Veltrup
- Fachklinik Freudenholm-Ruhleben, Postfach 5, 24301, Plön, Germany
| | - David Ndetei
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya.,University of Nairobi, Nairobi, Kenya
| | - Michael Odenwald
- University of Konstanz, Box 23, 78457, Konstanz, Germany. .,vivo international e.V., PO Box 5108, 78430, Konstanz, Germany.
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Nakajima M, Molla K, Belachew B, Mohammed A, Hassan A, Kroll J, al'Absi M. Khat Use is Associated with Tobacco, Alcohol, and Illicit Drug Use: A Cross-Sectional Examination in the United States. J Psychoactive Drugs 2017; 49:413-419. [PMID: 28699844 DOI: 10.1080/02791072.2017.1342155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
No study has systematically examined khat (Catha edulis) use and its linkages with other substance use in the United States. This study provides novel findings related to the associations of khat with other substance use among immigrants in metropolitan areas of Minnesota where large East African communities reside. Using a convenience sampling, a total of 261 individuals completed a brief face-to-face interview during which demographic information and substance use were assessed. The proportion of lifetime and current use were 30% and 6.6% for khat, 35% and 18% for tobacco, 35% and 21% for alcohol, and 13% and 10% for other illicit drugs. Self-report history of khat use was associated with tobacco, alcohol, and other drug use. Tobacco use was related to alcohol and use of other drugs. The results suggest that a history of khat use is useful in identifying individuals who are vulnerable to substance-use-related problems. The findings indicate the need for more research on khat in the U.S.
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Affiliation(s)
- Motohiro Nakajima
- a Assistant Professor, Department of Biobehavioral Health and Population Sciences , University of Minnesota Medical School , Duluth , MN , USA
| | - Kalkidan Molla
- b Research Assistant, Department of Biobehavioral Health and Population Sciences , University of Minnesota Medical School , Duluth , MN , USA
| | - Brook Belachew
- b Research Assistant, Department of Biobehavioral Health and Population Sciences , University of Minnesota Medical School , Duluth , MN , USA
| | - Abduselam Mohammed
- b Research Assistant, Department of Biobehavioral Health and Population Sciences , University of Minnesota Medical School , Duluth , MN , USA
| | - Abdikadir Hassan
- b Research Assistant, Department of Biobehavioral Health and Population Sciences , University of Minnesota Medical School , Duluth , MN , USA
| | - Jerome Kroll
- c Professor Emeritus, Department of Psychiatry , University of Minnesota Medical School , Duluth , MN , USA
| | - Mustafa al'Absi
- d Professor, Department of Biobehavioral Health and Population Sciences , University of Minnesota Medical School , Duluth , MN , USA
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Nabben T, Korf DJ. Consequences of criminalisation: the Dutch khat market before and after the ban. DRUGS-EDUCATION PREVENTION AND POLICY 2017. [DOI: 10.1080/09687637.2017.1338669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ton Nabben
- Universiteit van Amsterdam Bonger Instituut voor Criminologie, Amsterdam, the Netherlands and
| | - Dirk J. Korf
- Bonger Institute of Criminology, Faculty of Law, University of Amsterdam, Amsterdam, the Netherlands
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Sayed ME, Hamdi AD, Hakami BM, Mugri MH, Bhandi SH. Tooth Wear Patterns among Khat and Shammah Users in Jazan City, Kingdom of Saudi Arabia: A Cross-sectional Survey. J Contemp Dent Pract 2017. [PMID: 28621269 DOI: 10.5005/jp-journals-10024-2060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The effect of Khat and Shammah habits, with the para-functional jaw activities that accompany them, on the structure and integrity of the natural dentition has not yet been investigated. The literature lacks studies that identify the patterns of tooth wear among Khat and Shammah users. Therefore, this study is the first attempt to address this concern in Jazan City population, Kingdom of Saudi Arabia. MATERIALS AND METHODS A cross-sectional survey study was conducted among 300 recruits among dental clinics in Jazan City, Kingdom of Saudi Arabia from October 1, 2015, to April 30, 2016. Questionnaires were used for data collection on oral habits (Khat and Shammah use), age, gender, intake of acidic food or beverages, food habits (intake of fruits, grains, and vegetables), systemic diseases, oral hygiene habits (brushing frequency, technique, and type of toothbrush), parafunctional habits, stress, and acid reflux. Clinical examination was performed to assess the grade of tooth wear. Bivariate analysis was performed to determine the empirical relationship between the independent variables and outcomes. In addition, binary logistic regressions were used to measure the relationship between the independent variables and each of the dependent variables (presence of occlusal wear, tooth wear grade 0 through 4). RESULTS Khat and Shammah use was statistically significantly associated with tooth wear (p < 0.05). A significant association of tooth wear was observed with age, gender, intake of acidic food and beverages, oral hygiene habits, and stress. CONCLUSION Consumption of Khat and Shammah may be attributed as one of the major reasons associated with tooth wear among the Saudi population. CLINICAL SIGNIFICANCE The habitual use of Khat and Shammah causes tooth wear of varying severity, which may negatively affect esthetics, phonetics, and function and necessitate a complex restorative treatment.
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Affiliation(s)
- Mohammed E Sayed
- Department of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, New Jersey, USA; Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan Kingdom of Saudi Arabia, Phone: +12014062039, e-mail:
| | - Ammar D Hamdi
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Bassam M Hakami
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Maryam H Mugri
- Department of Preventive Dental Sciences, College of Dentistry Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Shilpa H Bhandi
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
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Abera SF, Adane K. One-fourth of the prisoners are underweight in Northern Ethiopia: a cross-sectional study. BMC Public Health 2017; 17:449. [PMID: 28506311 PMCID: PMC5433041 DOI: 10.1186/s12889-017-4410-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/09/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite the fact that prisoners are exposed to different health problems, prison health problems are often overlooked by researchers and no previous study has investigated nutritional problems of prisoners in Ethiopia. METHODS Cross-sectional data were collected from 809 prisoners from nine major prison setups in the Tigray region of Ethiopia. A proportional stratified sampling technique was used to select the total number of participants needed from each prison site. The outcome of this study was underweight defined as body mass index (BMI) of less than 18.5 kg/m2. Multivariable binary logistic regression was performed to identify determinants of underweight at a p-value of less than 0.05. RESULTS The prevalence of underweight was 25.2% (95% CI; 22.3%- 28.3%). Khat Chewing (OR = 2.08; 95% CI = 1.17, 3.70) and longer duration of incarceration (OR = 1.07; 95% CI = 1.01, 1.14) were associated with a significantly increased risk of underweight. Additionally, previous incarceration (OR = 1.54; 95% CI = 0.99, 2.42) was a relevant determinant of underweight with a borderline significance. In contrast, family support (OR = 0.61; 95% CI = 0.43, 0.85) and farmer occupation (OR = 0.59; 95% CI = 0.36, 0.98) compared to those who were unemployed were important protective determinants significantly associated with lower risk of underweight. CONCLUSION In summary, the burden of underweight was higher among prisoners in Tigray region who had respiratory tract infections. The study has enhanced our understanding of the determinants of underweight in the prison population. We strongly recommend that nutritional support, such as therapeutic feeding programs for severely or moderately underweight prisoners, and environmental health interventions of the prison setups should be urgently implemented to correct the uncovered nutritional problem and its associated factors for improving the health status of prisoners.
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Affiliation(s)
- Semaw Ferede Abera
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. .,Kilte Awlaelo- Health and Demographic Surveillance Site, Mekelle University, Tigray, Ethiopia.
| | - Kelemework Adane
- Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Sallam MA, Sheikh KA, Baxendale R, Azam MN, El-Setouhy M. The physiological and perceptual effects of plant extracts (Catha Edulis Forsk) during sustained exercise. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:18. [PMID: 27165661 PMCID: PMC4862078 DOI: 10.1186/s13011-016-0063-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 05/03/2016] [Indexed: 11/30/2022]
Abstract
Background Khat (Catha Edulis Forsk) is a natural psychoactive substance that contains addictive substances such as Cathine and Cathinone which have similar structure and action to amphetamine. This substance has been suggested that it can decrease perceived exertion and thus improve performance. There is no study in the literature regarding the effect of khat on exercise performance. Therefore, the aim of this study is to find out whether khat leaves can decrease perceived exertion in humans. Methods This study is an experimental crossover study conducted at the Substance Abuse Research Centre in Jazan University, Saudi Arabia. Twenty one healthy volunteers were randomly assigned into two experiment trials. Each volunteer visited the lab three times. The first visit was a familiarization session about the nature of the study and the equipment. On the second visit, 45 min before the experiment volunteers ingested either 33 ml of fruit juice (placebo) or the juice mixed with 45 g of ground khat leaves. Then the participants were instructed to perform a 10 Km cycling on an ergometer and recorded the following physiological variables repeatedly on every 5 min of cycling: heart rate, time to complete 10 km cycling, tympanic temperature, and perceived exertion rate. On the third visit a crossover trial was conducted one week after the second visit; then the same cycling test was performed and the same variables were recorded as the second visit. The experimental protocol was reviewed and approved by Research Ethical Committee of the Medical Research Centre, Jazan University. Results According to study results, khat dramatically decreased time taken to complete a 10 km cycling time trail (p < 0.05), and significantly increased heart rate (p < 0.05) and tympanic temperature (p < 0.01). However, khat did not reduce participant's perceived exertion during the physical trial. The Bonferrini simultaneous confidence intervals using multivariate Hotelling’s T2 was performed to test the significance of the mean vectors for the placebo group and the Khat group and found that groups are statistically significant. Conclusions Khat showed a clear enhancing effect on physical performance. The most parsimonious explanation for this effect is that, like the related amphetamines, cathine/cathinone act as stimulants to increase the capacity to perform exercise. Thus, khat produces the same effects which lead to the banning of amphetamine. These findings conform & endorse the recent prohibition of cathinone by the World Anti-Doping Agency (WADA, 2014).
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Affiliation(s)
- Mowaffaq Awad Sallam
- Substance Abuse Research Center, Jazan University, Jazan, Kingdom of Saudi Arabia
| | | | - Ronald Baxendale
- School of Life Science, College of Medical, Veterinary and Life Science, University of Glasgow, Glasgow, UK
| | - Mohammad Nurul Azam
- Researchers support and service unit, Deanship of Scientific Research, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Maged El-Setouhy
- Substance Abuse Research Center, Jazan University, Jazan, Kingdom of Saudi Arabia
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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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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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Birhanu AM, Bisetegn TA, Woldeyohannes SM. High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia: multi-domain factor analysis. BMC Public Health 2014; 14:1186. [PMID: 25410657 PMCID: PMC4289242 DOI: 10.1186/1471-2458-14-1186] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 11/06/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Substance use is a major public health concern in global settings, and is very common during adolescence period leading to physical and/or mental health complications. This study assessed the prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia, 2012. METHODS A school based cross-sectional study was conducted from April 7 to April 15, 2012 amongst 684 9th to 12th grade high school students in the town of Woreta. Participants were selected by stratified sampling, and data were collected using an anonymous questionnaire adapted from the 2008 Community That Care Youth Survey. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with substance use. RESULTS A total of 651 students participated in the study with a response rate of 95.2%. The current prevalence of substance use among Woreta high school students was 47.9% and life-time prevalence was 65.4%. The current and lifetime prevalence of alcohol use was 40.9% and 59% respectively. Siblings' use of substances (AOR [95% CI]: 2.72 [1.79, 4.14]), family history of alcohol and substance use (AOR [95% CI] 2.24 [1.39-3.59]) and friends' use of substances (AOR [95% CI] 2.14 [1.44-3.18]) were factors positively associated with substance use. On the other hand, religiosity and social skill were found to be 54% (AOR [95% CI] 0.46, [0.31-0.68]) and 39% (AOR [95% CI] 0.6 [0.40-0.91]) negatively associated with substance use. CONCLUSIONS The prevalence of substance use amongst adolescents was high for the three substances namely alcohol, cigarette and khat with alcohol being the most common. Community norms favorable to substance use, family history of alcohol and substance use, siblings' substance use, poor academic performance, low perceived risk of substances and friends' use of substances had positive association with adolescent substance use while religiosity and social skills were found to have negative association with adolescent substance use. Initiate public awareness campaigns to inform adolescents and adults, particularly parents, of the risk of substance use. Developing culture friendly, gender based adolescent and family based programs and initiating public awareness are recommended to decrease substance use by adolescents.
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Affiliation(s)
- Anteneh Messele Birhanu
- Department of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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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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Sheikh KA, El-Setouhy M, Yagoub U, Alsanosy R, Ahmed Z. Khat chewing and health related quality of life: cross-sectional study in Jazan region, Kingdom of Saudi Arabia. Health Qual Life Outcomes 2014; 12:44. [PMID: 24708622 PMCID: PMC3977689 DOI: 10.1186/1477-7525-12-44] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 03/29/2014] [Indexed: 12/04/2022] Open
Abstract
Background The chewing of Khat leaves, a natural psychoactive substance is widely chewed in countries of East Africa and the southern Arabian Peninsula, and is reported to be associated with a range of unfavorable health outcomes including khat dependence. The impact of Khat chewing on Health Related Quality of Life is yet to be explored. Aims: to measure and compare the quality of life of the khat chewers and non-khat chewers using a short form health survey (SF36), and to assess factors associated with Khat chewing using SF36 in a sample of adult population in Jazan region, Kingdom of Saudi Arabia. Methods A total of 630 participants from two independent male populations of khat chewers and non-khat chewers were recruited into a cross-sectional survey study. A self administrative survey based on the SF-36 questionnaire was used to collect data on measures of health-related quality of life (HRQoL). Socioeconomic data of the respondents were also collected for detailed analysis. Data analysis include: descriptive statistics, reliability tests (Cronbach’s alpha and intraclass correlation coefficient), and bivariate analysis (Chi square and Mann–Whitney U-test) to compare HRQoL of Khat chewers and non-Khat chewers. Results The odds of being a khat chewer were higher in respondents with a lower socioeconomic status. The SF-36 scores were significantly lower in all domains for respondents with khat chewing, indicating that non-khat chewers had higher health perceptions compared with those chewing khat. The overall mean score of HRQoL for non-khat chewers was 92.7% (SD 5.53) compared with 63.5% (SD 21.73) for the khat chewing group. The study had shown good internal consistency and reproducibility across the eight subscales of SF-36 questionnaire (α 0.74-0.95). The Mann–Whitney U-test showed a significant difference between khat chewers and non-khat chewers (P < 0.001). Conclusions This study measured and compared the quality of life of khat chewers and non-khat chewers using a generic health survey (SF36). The study had shown that khat chewing is associated with lower quality of life (HRQoL) and lower socioeconomic status. However in future a more refined SF36 developed especially for Khat chewers can provide more useful information.
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Aziz HA, Peh KK, Tan YTF. Herbal delivery system for treatment of obesity administration of encapsulated khat-extracts on body weight of rats. Obes Res Clin Pract 2013; 5:e267-360. [PMID: 24331133 DOI: 10.1016/j.orcp.2011.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 03/13/2011] [Accepted: 03/23/2011] [Indexed: 02/01/2023]
Abstract
SUMMARY Obesity is one of the most important problems worldwide. Khat (Catha edulis), an evergreen shrub, is thought to reduce body-weight. Its effect is more prominent when khat leaves are chewed. Thus, anti-obesity effects of khat and its associated side effects may depend on the release rate of its active constituents. The present study aimed to investigate the effect of a selected low dose of dried-khat, extracted, formulated as controlled release delivery systems on the body weight (BW), food intake (FI), cholesterol (CS) and triglyceride (TG) levels in rats. Khat extract (KE) was microencapsulated (KE235) and formulated into a parenteral implant (InjKE235). The effects of KE, KE235 and InjKE235 on BW, FI, CS and TG in rats were investigated. The results showed that microcapsules sustained the khat alkaloid release with T50% 1.58 h for KE235 and 14.41 days for InjKE235. KE and KE235 caused maximum reduction in BW, FI, CS and TG during the first to third weeks but rebound gradually thereafter. On the contrary, InjKE235 exhibited a sustained reduction in BW, FI, CS and TG levels for 2 months. The T50% of KE, KE235 and InjKE235 correlated with the reduction in BW, CS and TG but not with FI. In conclusion, the subcutaneous injection and sustained release rate of khat extract play an important role in enhancing the anti-obesity effect in SD rats.:
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Affiliation(s)
- Hesham Abdul Aziz
- Department of Pharmaceutical Technology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia.
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Thomas S, Williams T. Khat (Catha edulis): A systematic review of evidence and literature pertaining to its harms to UK users and society. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/2050324513498332] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of khat ( Catha edulis) has been associated with a large number of physiological and societal harms, leading to calls for it to be controlled in the UK. The evidence of these harms is often equivocal, limited by confounding factors, or entirely anecdotal: high-powered, quality-controlled studies are lacking. Regardless, the body of relevant literature indicates that the once socially-regulated use of khat has been eroded. Some individuals have developed excessive consumption patterns, either using khat daily or in binge-sessions, though daily consumption is not necessarily problematic per se. The majority of users seem to use khat in moderation, where the associated harms appear low. For excessive users, harms associated with khat are greater, particularly relating to mental health. Social harms also seem to be largely related to excessive khat use rather than khat use itself. Even in cases of excessive khat use, however, causal relationships between chewing and harms have not been described. More research is required to establish the role of khat in liver disease, coronary problems, cancers of the digestive tract and incidents of domestic violence. Studies should consider the likeliness that certain users are more vulnerable to developing patterns of excessive khat use due to an interwoven set of factors such as social health determinants and pre- and post-migration experiences.
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van Amsterdam J, Pennings E, Brunt T, van den Brink W. Physical harm due to chronic substance use. Regul Toxicol Pharmacol 2013; 66:83-7. [PMID: 23542091 DOI: 10.1016/j.yrtph.2013.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/17/2013] [Accepted: 03/19/2013] [Indexed: 11/25/2022]
Abstract
Chronic use at high dose of illicit drugs, alcohol and tobacco is associated with physical disease. The relative physical harm of these substances has not been described before, but will benefit the guiding of policy measures about licit and illicit substances. The physical harm of 19 addictive substances (including alcohol and tobacco), consisting of toxicity and the risk and severity of somatic disease (not psychiatric disease) was assessed based on literature data and the professional opinion of experts using scores ranging from 0 (no physical harm) to 3 (very serious physical harm). For alcohol, tobacco and some illicit drugs strong associations between long-term use or use in high dose versus the risk of somatic disease have been described, whereas for other substances such data are not available. Magic mushrooms, LSD and methylphenidate obtained relatively low scores (0.45-0.65) for physical harm, whereas relatively high scores were given for heroin (2.09), crack (2.32), alcohol (2.13) and tobacco (2.10). For cannabis, tobacco, and alcohol the estimated societal disease burden was higher than at individual level. The present ranking solely based on their physical harm was very similar to a previous ranking based on a combination of dependence liability, physical harm and social impairments.
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Affiliation(s)
- Jan van Amsterdam
- National Institute of Public Health and the Environment (RIVM), Centre for Health Protection, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
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van Amsterdam JG, van Laar M, Brunt TM, van den Brink W. Risk assessment of gamma-hydroxybutyric acid (GHB) in the Netherlands. Regul Toxicol Pharmacol 2012; 63:55-63. [DOI: 10.1016/j.yrtph.2012.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/22/2012] [Accepted: 03/07/2012] [Indexed: 11/26/2022]
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Colzato LS, Ruiz MJ, van den Wildenberg WPM, Hommel B. Khat use is associated with increased response conflict in humans. Hum Psychopharmacol 2012; 27:315-21. [PMID: 22585591 DOI: 10.1002/hup.2229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Khat consumption has become a worldwide phenomenon broadening from Eastern Africa and the south west of the Arabian Peninsula to ethnic communities in the rest of the world. Only few studies have systematically looked into cognitive impairments in khat users. We studied whether khat use is associated with changes in the emergence and resolution of response conflict, a central cognitive control function. METHOD Khat users (n = 16) and khat-free controls (n = 16) were matched in terms of sex, ethnicity, socio-economical situation, age, alcohol and cannabis consumption, and IQ (Raven's Progressive Matrices). Groups were tested on response conflict, as measured by the Simon task. RESULTS Khat users performed significantly slower than controls and were more strongly affected by stimulus-induced response conflict. CONCLUSIONS Khat use is associated with specific impairments in behavioral control: general slowing and less efficient resolution of response conflicts, which is likely to impair decision making in everyday life.
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Affiliation(s)
- Lorenza S Colzato
- Institute for Psychology, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands.
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Burillo-Putze G, Domínguez-Rodríguez A, Abreu-González P, Nogué Xarau S. Khat, mefedrona y dolor torácico. Med Clin (Barc) 2011; 137:712-3. [DOI: 10.1016/j.medcli.2011.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 03/14/2011] [Accepted: 03/17/2011] [Indexed: 10/15/2022]
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Kelly JP. Cathinone derivatives: A review of their chemistry, pharmacology and toxicology. Drug Test Anal 2011; 3:439-53. [DOI: 10.1002/dta.313] [Citation(s) in RCA: 240] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 05/19/2011] [Accepted: 05/19/2011] [Indexed: 11/05/2022]
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Colzato LS, Ruiz MJ, van den Wildenberg WPM, Hommel B. Khat use is associated with impaired working memory and cognitive flexibility. PLoS One 2011; 6:e20602. [PMID: 21698275 PMCID: PMC3115937 DOI: 10.1371/journal.pone.0020602] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 05/07/2011] [Indexed: 11/30/2022] Open
Abstract
Rationale Khat consumption has increased during the last decades in Eastern Africa and has become a global phenomenon spreading to ethnic communities in the rest of the world, such as The Netherlands, United Kingdom, Canada, and the United States. Very little is known, however, about the relation between khat use and cognitive control functions in khat users. Objective We studied whether khat use is associated with changes in working memory (WM) and cognitive flexibility, two central cognitive control functions. Methods Khat users and khat-free controls were matched in terms of sex, ethnicity, age, alcohol and cannabis consumption, and IQ (Raven's progressive matrices). Groups were tested on cognitive flexibility, as measured by a Global-Local task, and on WM using an N-back task. Result Khat users performed significantly worse than controls on tasks tapping into cognitive flexibility as well as monitoring of information in WM. Conclusions The present findings suggest that khat use impairs both cognitive flexibility and the updating of information in WM. The inability to monitor information in WM and to adjust behavior rapidly and flexibly may have repercussions for daily life activities.
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Affiliation(s)
- Lorenza S Colzato
- Institute for Psychological Research and Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.
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Feigin A, Higgs P, Hellard M, Dietze P. The impact of khat use on East African communities in Melbourne: a preliminary investigation. Drug Alcohol Rev 2011; 31:288-93. [PMID: 21463373 DOI: 10.1111/j.1465-3362.2011.00312.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND AIMS Catha Edulis Forsk (khat) is a plant-reported to have a stimulant effect similar to that of amphetamines-grown and used by eastern African communities worldwide. Khat can be legally consumed in many parts of the world, including Victoria, Australia. Recent concerns have been raised about the social and economic impacts of khat consumption among Victoria's East African community members. This study explores khat use and the social impact it has on East African families and communities in Melbourne, Australia. DESIGN AND METHODS Focus groups and individual interviews were conducted in 2009 with 29 members of Melbourne's East African community recruited via community leaders and snowball sampling. Fifty-five per cent of the sample reported khat use and the remainder reported only having experience of other people's use of the drug. RESULTS Participants who did not report chewing khat were mainly concerned with the negative social impacts of its use, such as the extended time men spent away from their families while consuming the drug. These participants (mainly women) expressed their hope that khat would be prohibited in Victoria. Participants who reported the use of khat (mainly men) reported that any social problems existed independently of khat consumption. DISCUSSION AND CONCLUSIONS This study found only limited evidence that khat use has been impacting directly on people's health and well-being. Any moves to prohibit khat use may further marginalise already vulnerable groups of people.
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Affiliation(s)
- Anita Feigin
- Centre for Population Health, Burnet Institute, Melbourne, Australia.
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Colzato LS, Ruiz MJ, van den Wildenberg WPM, Bajo MT, Hommel B. Long-term effects of chronic khat use: impaired inhibitory control. Front Psychol 2011; 1:219. [PMID: 21833274 PMCID: PMC3153824 DOI: 10.3389/fpsyg.2010.00219] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 11/18/2010] [Indexed: 01/19/2023] Open
Abstract
So far no studies have systematically looked into the cognitive consequences of khat use. This study compared the ability to inhibit and execute behavioral responses in adult khat users and khat-free controls, matched in terms of age, race, gender distribution, level of intelligence, alcohol and cannabis consumption. Response inhibition and response execution were measured by a stop-signal paradigm. Results show that users and non-users are comparable in terms of response execution but users need significantly more time to inhibit responses to stop signals than non-users.
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Affiliation(s)
- Lorenza S Colzato
- Cognitive Psychology Unit, and Leiden Institute for Brain and Cognition, Leiden University Leiden, Netherlands
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Klein A, Metaal P. A good chew or good riddance--how to move forward in the regulation of khat consumption. JOURNAL OF ETHNOPHARMACOLOGY 2010; 132:584-589. [PMID: 20655377 DOI: 10.1016/j.jep.2010.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 07/01/2010] [Accepted: 07/02/2010] [Indexed: 05/29/2023]
Abstract
AIMS To review the status of khat, the most recent plant based psychoactive substance to reach a global market, and consider policy making processes in general and the framework of drug control in particular. MATERIALS AND METHODS Desk review of literature on khat and wider drug policy processes. RESULTS The risk assessment and classification of psychoactive drugs is a contested arena where political, economic and moral agendas collide, leaving countries that have banned khat, with significant social costs. To best manage the risks arising from the increasing availability of khat it is therefore suggested to draft a regulatory framework with clear objectives and guiding principles. CONCLUSIONS Given that medical risks of khat use are modest, the objective of the regulatory framework should be the protection of consumers and community. This is best achieved by establishing processes for the quality control of khat imports, and by regulating access and availability. It should therefore not be considered as a drug to be controlled but as a licit substance that needs to be regulated.
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Affiliation(s)
- Axel Klein
- Centre for Health Services Studies, University of Kent, Canterbury, Kent CT27PD, United Kingdom.
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Odenwald M, Warfa N, Bhui K, Elbert T. The stimulant khat--another door in the wall? A call for overcoming the barriers. JOURNAL OF ETHNOPHARMACOLOGY 2010; 132:615-619. [PMID: 19913607 DOI: 10.1016/j.jep.2009.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 10/22/2009] [Accepted: 11/03/2009] [Indexed: 05/28/2023]
Abstract
AIM In this article, we comment on the current international discourse on khat, we highlight pitfalls and and suggest balanced national international regulatory actions. METHOD A brief an focussed review of the available literature on khat and health and examples from our own research are provided. RESULTS The use patterns of catha edulis (khat) have changed throughout the last decades. During this period khat has had a remarkable economic boom and developed from a niche crop to the backbone of the regional economy. Now it contributes to the livelihoods of millions of people. Today, khat use is often the proverbial "Door in the wall" for large parts of the populations in African and Arab countries beyond the traditional user groups. Its use is often excessive and not restricted by social regulation mechanisms. Under such conditions, problematic khat use patterns develop rapidly, exemplified by the growing group of binge users, and it gets even prevalent among especially vulnerable groups such as children, people with mental disorders or pregnant women. The currently existing scientific evidence suggests that problematic use patterns not the use per se can be linked to numerous health consequences. CONCLUSION This paper argues that changed patterns of khat use are a burden for some of the most underdeveloped countries in the world. But the debate around khat is stuck between extreme poles arguing for prohibition or for de-regulation. Here, we call for a balanced action of governments and international organizations leaving behind the decades of debilitating debate pro vs. contra scheduling and banning khat leaves. Instead, regulation and harm-reduction measures are urgently needed. We suggest a number of steps that should be taken immediately to better understand current khat use patterns, to address noxious excesses and to relieve suffering.
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Al-Motarreb A, Al-Habori M, Broadley KJ. Khat chewing, cardiovascular diseases and other internal medical problems: the current situation and directions for future research. JOURNAL OF ETHNOPHARMACOLOGY 2010; 132:540-548. [PMID: 20621179 DOI: 10.1016/j.jep.2010.07.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 06/04/2010] [Accepted: 07/01/2010] [Indexed: 05/29/2023]
Abstract
The leaves of khat (Catha edulis Forsk.) are chewed as a social habit for the central stimulant action of their cathinone content. This review summarizes the prevalence of the habit worldwide, the actions, uses, constituents and adverse health effects of khat chewing. There is growing concern about the health hazards of chronic khat chewing and this review concentrates on the adverse effects on health in the peripheral systems of the body, including the cardiovascular system and gastrointestinal tract. Comparisons are made with amphetamine and ecstasy in particular on the detrimental effects on the cardiovascular system. The underlying mechanisms of action of khat and its main constituent, cathinone, on the cardiovascular system are discussed. Links have been proposed between khat chewing and the incidence of myocardial infarction, dilated cardiomyopathy, vascular disease such as hypertension, cerebrovascular ischaemia and thromboembolism, diabetes, sexual dysfunction, duodenal ulcer and hepatitis. The evidence, however, is often based on limited numbers of case reports and only few prospective controlled studies have been undertaken. There is therefore an urgent need for more thorough case-control studies to be performed. This review outlines the current knowledge on the adverse health effects of khat chewing on the cardiovascular system and other internal medical problems, it assesses the evidence and the limitations of the studies and identifies the questions that future studies should address.
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Affiliation(s)
- A Al-Motarreb
- Cardiac Centre, Internal Medicine Department, Sana'a University, Sana'a, Yemen
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Wood DM, Davies S, Puchnarewicz M, Button J, Archer R, Ovaska H, Ramsey J, Lee T, Holt DW, Dargan PI. Recreational use of mephedrone (4-methylmethcathinone, 4-MMC) with associated sympathomimetic toxicity. J Med Toxicol 2010; 6:327-30. [PMID: 20358417 PMCID: PMC3550484 DOI: 10.1007/s13181-010-0018-5] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Cathinone is a pharmacologically active alkaloid that can be extracted from the leaves of the khat plant (Catha edulis). There are synthetic derivatives of cathinone entering the recreational drug market, including mephedrone (4-methylmethcathinone, 4-MMC). There are discrepancies in the legal status of both the khat plant and its extracted alkaloids between the UK and the USA. CASE REPORT A 22-year-old man purchased 4 g of mephedrone powder over the Internet from a chemical supplier based in China. He initially ingested 200 mg of the mephedrone orally, with no perceived clinical effects, and thereafter injected the remaining 3.8 g intramuscularly into his thighs. Shortly after the injection, he developed palpitations, "blurred tunnel vision," chest pressure, and sweating and felt generally unwell; he presented to hospital with continuing features of sympathomimetic toxicity. His symptoms settled over the next 4 h after a single dose of oral lorazepam. Qualitative analysis of the urine and serum sample was undertaken using gas chromatography with mass spectrometric (GC/MS) detection, both positive for the presence of 4-methylmethcathinone. Quantitative analysis of the serum sample was undertaken by liquid chromatography with tandem mass spectrometric detection; the estimated mephedrone concentration was 0.15 mg/l. Routine toxicological analysis of the serum and urine specimens using a broad GC/MS toxicology screen did not detect any other drugs or alcohol. DISCUSSION This is the first case of isolated 4-MMC toxicity, with confirmatory analytical findings. It is important that clinical toxicologists and emergency physicians work together to ensure a better understanding of the toxicity of novel/emerging drugs such as 4-MMC.
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Affiliation(s)
- David M Wood
- Clinical Toxicology, Guy's and St. Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
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Abstract
Khat (Catha edulis) is a shrub or tree whose leaves have been chewed for centuries by people who live in the Eastern part of Africa and the Arabian Peninsula. It has recently turned up in North America and Europe, particularly among emigrants and refugees from countries such as Somalia, Ethiopia and Yemen. Khat contains a number of chemicals, among which are two controlled substances, cathinone (Schedule I) and cathine (Schedule IV). Both chemicals are stimulant drugs with effects similar to amphetamine. Chewing the leaves makes people feel more alert and talkative, and suppresses appetite. Chewing khat leaves releases cathinone, a stimulant that produces the feeling of euphoria. When cathinone is broken down in the body, it produces chemicals including cathine and norephedrine, which have a similar structure to amphetamine and adrenaline (epinephrine). Regular khat use is associated with a rise in arterial blood pressure and pulse rate, corresponding with levels of cathinone in the plasma. Moreover, regular khat chewers have gingivitis and loose teeth, but there appears to be no convincing unusual incidence of oral cancer. Among khat users in Yemen there is, however, a higher incidence of esophageal cancer compared with gastric cancer. Long term use or abuse can cause insomnia, anorexia, gastric disorders, depression, liver damage and cardiac complications, including myocardial infarction. Manic and delusional behavior, violence, suicidal depression, hallucinations, paranoia and khat-induced psychosis have also been reported. On the basis of the scientific data it seems clear that khat use has negative consequences on the economic development of a country and on the health of the society.
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Corkery J. Conference report. DRUGS AND ALCOHOL TODAY 2009. [DOI: 10.1108/17459265200900041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Odenwald M, Hinkel H, Schauer E, Schauer M, Elbert T, Neuner F, Rockstroh B. Use of khat and posttraumatic stress disorder as risk factors for psychotic symptoms: A study of Somali combatants. Soc Sci Med 2009; 69:1040-8. [DOI: 10.1016/j.socscimed.2009.07.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Indexed: 11/15/2022]
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Al-Goshae H, Al-Karewany M, Bamosmoosh M, Modesti PA. Keep an eye on the pupil: developing countries under chemical attack. Intern Emerg Med 2009; 4:231-3. [PMID: 19367469 DOI: 10.1007/s11739-009-0242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 03/04/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Husni Al-Goshae
- Hospital of University of Science and Technology, Sana'a, Yemen
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