Khat (Catha edulis)-an updated review

Exploring natural herbs: their role in treating male infertility, enhancing sexual desire and addressing urological disorders

Infertility affects 8-12% of couples globally, with male factors contributing to around 40% of cases. Common male infertility issues include erectile dysfunction (ED) and low sperm count or quality, which account for over 90% of cases. These problems often result from anatomical, hormonal, or genetic abnormalities. This review focuses on natural aphrodisiac herbs commonly used to address ED, providing detailed information on their botanical characteristics, metabolic pathways, recommended dosages, phytochemical properties, side effects, origins, and traditional uses. It also reviews recent studies on medicinal herbs that boost sexual desire and treat urological conditions. By compiling reliable findings from the past decade, the study aims to serve as a comprehensive resource for individuals dealing with sexual health issues. Through careful evaluation of each herb, it offers insights into their effectiveness and limitations, emphasizing the potential of natural treatments as complementary alternatives to conventional therapies for male infertility and related conditions.

Areca nut-induced oral fibrosis - Reassessing the biology of oral submucous fibrosis

BACKGROUND

Oral submucous fibrosis (OSF) is a pathological condition characterized by excessive tissue healing resulting from physical, chemical, or mechanical trauma. Notably, areca nut consumption significantly contributes to the development of oral fibrosis. The current definition of OSF, recognizing its potential for malignant transformation, necessitates a more comprehensive understanding of its pathophysiology and etiology.

HIGHLIGHTS

Areca nut induces fibrotic pathways by upregulating inflammatory cytokines such as TGF-β and expressing additional cytokines. Moreover, it triggers the conversion of fibroblasts to myofibroblasts, characterized by α-SMA and γSMA expression, resulting in accelerated collagen production. Arecoline, a component of areca nut, has been shown to elevate levels of reactive oxygen species, upregulate the expression of various cytokines, and activate specific signaling pathways (MEK, COX2, PI3K), all contributing to fibrosis. Therefore, we propose redefining OSF as "Areca nut-induced oral fibrosis" (AIOF) to align with current epistemology, emphasizing its distinctive association with areca nut consumption. The refined definition enhances our ability to develop targeted interventions, thus contributing to more effective prevention and treatment strategies for oral submucous fibrosis worldwide.

CONCLUSION

Arecoline plays a crucial role as a mediator in fibrosis development, contributing to extracellular matrix accumulation in OSF. The re-evaluation of OSF as AIOF offers a more accurate representation of the condition. This nuanced perspective is essential for distinguishing AIOF from other forms of oral fibrosis and advancing our understanding of the disease's pathophysiology.

Individual and community-level factors associated with khat (Catha edulis) use among women of reproductive age in Halaba zone, South Ethiopia: a multilevel mixed effect analysis

Introduction

There is a paucity of data on factors associated with khat chewing among women of reproductive age using multilevel analysis. Furthermore, the effects of some potential factors like stressful life events, knowledge about and attitude toward the effects of khat have been given little attention and are not well understood. Therefore, this study aimed to examine the prevalence and multilevel factors associated with khat use among women of reproductive age in Halaba zone, South Ethiopia.

Methods

A community-based cross sectional study was conducted in Halaba zone from February to July, 2023. Systematic random sampling technique was used to include 1573 study participants. The dependent variable was current khat use, which is operationalized as using khat within 30 days preceding the study. An interviewer administered questionnaire was used for the data collection.

Results

The prevalence of current khat use among women of reproductive age was 65.9% [95%CI (63.5-68.2%)]. Factors significantly associated with khat use were; ages of women 35 and above years [Adjusted Odds Ratio (AOR) = 6.35, 95% CI: (3.62, 11.13)], ever married [AOR = 2.41, 95% CI: (1.10, 5.31)], secondary and above education [AOR = 0.28, 95% CI: (0.15, 0.49)], belong to richer household [AOR = 1.75, 95% CI: (1.12, 2.75)], mass media use [AOR = 3.12, 95% CI: (1.85, 4.81)], low knowledge about khat effects [AOR = 3.12, 95% CI: (1.85, 5.24)], positive attitude towards khat use [AOR = 11.55, 95% CI: (6.76, 19.71)], and strong social support [AOR = 0.43, 95% CI: (0.28, 0.64)] and non-user friend [AOR = 0.31, 95% CI: (0.20, 0.48)]. From the community level variables: rural residence [AOR = 5.06, 95% CI: (1.82, 14.09)] was significantly associated with khat use.

Conclusion

Khat use among women of reproductive age was found to be very high. From individual-level factors: advanced ages of women, secondary and above education, live in the richer wealth quintile, mass media exposure, low knowledge on khat effects, positive attitude towards khat use, strong social support, and from community-level variables: residing in rural area were significantly associated with khat use. Khat use screening for all women of childbearing age, as well as referral to substance use disorder centers for those women identified as having khat use disorder, should become a standard of care in all health facilities.

Khat chewing and its associated factors among pregnant women in Chiro district, eastern Ethiopia: a community-based study

Introduction

Despite its deleterious consequences, khat chewing is escalating worldwide. However, there is a lack of evidence about the extent of khat chewing among pregnant women in Ethiopia, particularly in the current study area. Therefore, this study aimed to assess the prevalence of current khat chewing and its associated factors among pregnant women in Chiro district, eastern Ethiopia.

Methods

This community-based cross-sectional study was conducted in Chiro district from November 1 to 30, 2022 G.C. Study participants were selected using the systematic random sampling technique. An interview-administered structured questionnaire was used to collect data through a house-to-house survey. The data were entered into EpiData version 3.1 and analyzed in STATA 14 software. Characteristics of study participants were summarized using descriptive analysis, and binary logistic regression was used to identify determinants of khat chewing.

Results

A total of 409 pregnant women participated in this study, with a response rate of 99%. The overall prevalence of khat chewing was 60.4% (95% CI: 55.5%, 65.2%). Religion (AOR: 2.08; 95% CI: 1.13, 3.82), khat cultivation (AOR: 0.43; 95% CI: 0.25, 0.77), partner khat use (AOR: 5.54; 95% CI: 3.11, 9.88), pre-pregnancy khat use (AOR: 9.95; 95% CI: 5.55, 17.81), antenatal care (ANC) visit (AOR: 2.71; 95% CI: 1.41, 5.21), and mental distress (AOR: 4.89; 95% CI: 2.38, 10.02) were significantly associated with current khat chewing.

Conclusion

The majority of pregnant women in the study area practice khat chewing. Thus, accessible and comprehensive pre-conception and pre-natal care incorporating the prevention and management of antenatal khat chewing is crucial to overcome this problem. Provision of mental healthcare involving partners of pregnant women is also important to reduce the extent and impacts of khat chewing during pregnancy. Further longitudinal studies triangulated with qualitative designs are recommended.

Perceived harms and protective behavioural strategies among khat chewers: a qualitative study in Jimma, Ethiopia

BACKGROUND

While there have been many previous studies focusing on the adverse effects of khat chewing, attempts to investigate the protective behavioural strategies (PBS) employed by the khat using population are rare. PBS are strategies that substance users employ to minimize or alleviate the possible negative consequences related to the behaviour. This study focuses on the harms that chewers associate with khat use, and the behavioural strategies they practise to prevent or minimize these harms.

METHODS

A community-based qualitative study was conducted using a snowball sampling technique to recruit a diverse sample of khat chewing participants (N = 102) in Jimma city, Ethiopia. Face-to-face in-depth interviews were carried out with the participants.

RESULTS

Participants identified a variety of harms likely to result from chewing khat. These include impacts on their finances, work, social life and health. The PBS that participants employed to avoid or minimize the risks were classified into four themes based on their temporal sequence with khat chewing sessions: prior to chewing, during chewing, after chewing and general PBS covering the whole of their khat chewing career. The PBS enable khat chewers to prevent or minimize the adverse health consequences of chewing, socialize and work without or with fewer difficulties and manage their economy successfully.

CONCLUSION

The study participants believe that khat-related harms are avoidable if khat users implement appropriate strategies prior to, during and after chewing, and if they apply PBS to khat-related factors (e.g. type, amount and frequency), set factors (e.g. reason for using and health behaviour) and setting factors (e.g. place of use, when used, with whom used and social norms) covering the whole of their khat chewing career.

Is chewing khat associated with mental health disorders? A scoping review of the content and quality of the current evidence base

BACKGROUND

Khat (Catha edulis) is a plant commonly found in the horn of Africa whose leaves are chewed for their psycho-stimulant effects. Several studies have demonstrated the association between khat use and mental health problems. Nevertheless, evidence is mixed and inconsistent, warranting further review of available studies. This scoping review is aimed at investigating the content and quality of evidence base on the associations between khat use and mental health disorders and suggesting avenues for further research.

METHODS

We used a scoping review methodology to map the existing evidence using PubMed, SCOPUS, Embase, and CINAHL databases. Primary studies focusing on the association between any pattern of khat use and any form of mental health disorders are included. The review focused on all age groups, any study design, all geographical locations, and any publication year. The terms used for searching eligible studies include khat, mental disorders, and various alternative terminologies. Narrative review is employed to present findings.

RESULTS

7,121 articles were found, of which 108 were eligible, conducted across 12 different countries. The majority of the studies was done during the last ten years and the studies mostly employed cross-sectional design. About 10 different categories of mental health disorders have been identified as showing associations with khat use. Despite many contradictory findings between the studies, most of the evidence base suggests that khat use is associated with mental health disorders. Non-specific psychological distress is the most frequently mentioned mental health problem (reported in 26.9% of the studies). Khat use as a predictor variable is mostly assessed using a 'yes/no' category, and as a result, dose-dependent effects of khat use on mental health are not given much consideration.

CONCLUSION

Although most of the studies associate khat use with mental health disorders, the causal relationships are inconclusive given the cross-sectional design of the studies, and the presence of potential confounders and several forms of biases. Available studies also report contradictory findings. Further studies are recommended using prospective designs, standardized and valid measures of khat use, and focusing on specific types of mental health disorders.

Dental caries experience among qat chewers in dental college clinics, Jazan, Saudi Arabia

AIMS

There is a considerable debate on the impact of qat chewing on dental and oral health. Thereby, this study aimed at assessing the dental caries among qat chewers (QC) and non-qat chewers (NQC) who attend outpatient dental clinics, College of Dentistry, Jazan, Saudi Arabia.

MATERIALS AND METHODS

A sample of 100 QC and 100 NQC were recruited amongst those attended dental clinics, college of dentistry, Jazan University during the 2018-2019 academic year. Their dental health was assessed by three pre-calibrated male interns using DMFT index. The Care Index, Restorative Index and Treatment Index were calculated. Comparisons between both subgroups were done using independent t test. Multiple linear regression analyses were further conducted to stand on the independent determinants of the oral health among this population.

RESULTS

QC were unintentionally older (36.55 ± 8.74 years) than NQC (32.96 ± 8.49 years; P = 0.004). Fifty-six percent of QC reported brushing their teeth compared to only 35% (P = 0.001). NQC with university and postgraduate educational levels were more than QC. The mean Decayed [5.91 (5.16)] and DMFT [9.15 (5.87)] were higher among QC compared to NQC [3.73 (3.62) and 6.7 (4.58); P = 0.001 and 0.001, respectively]. The other indices were not different between both subgroups. The multiple linear regression revealed that qat chewing and age, individually or together, as independent determinants for the dental decay, missing, DMFT and TI.

CONCLUSION

Qat chewing habit has a detrimental impact on dental health. It is associated with higher dental caries and missing teeth, and a lower treatment index.

Habitual khat chewing and oral melanoacanthoma: A case report

BACKGROUND

Habitual khat (Catha edulis) chewing has been proven to cause numerous oral tissue changes. However, oral melanoacanthoma triggered by chronic khat chewing is rare. Oral melanoacanthoma is an uncommon, sudden, asymptomatic, benign pigmentation of the oral cavity. Under the microscope, the epithelial layer of the oral mucosa showed dendritic melanocyte proliferation and acanthosis. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma.

CASE SUMMARY

In the current study, we report a case of a 26-year-old male patient with a rare presentation of oral melanoacanthoma triggered by regular khat chewing. Many intrinsic and extrinsic factors can cause oral pigmentation. Chewing khat is an extrinsic factor that can cause several diseases, including oral pigmentation. In this case, the definitive diagnosis was oral melanoacanthoma. This diagnosis was made based on the patient’s history, clinical lesion presentation, and microscopic biopsy results.

CONCLUSION

Habitual khat (Catha edulis) chewing causes many oral tissue changes including oral melanoacanthoma. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma.

Khat use and associated factors during pregnancy in eastern Ethiopia: A community-based cross-sectional study

INTRODUCTION

Women of reproductive age are increasingly using khat. The use of khat is associated with prelabor rupture of membranes, anemia among pregnant women, and other problems related to motherhood and infanthood. Most of the previous studies performed at the facility level revealed that different factors were associated with khat use among pregnant women. Lower educational status, low wealth index, and the age of the mother were the factors significantly associated with maternal khat use. Partner substance use also has a significant association with maternal khat use. However, there is limited information about khat use and its associated factors among pregnant women in the study area.

OBJECTIVE

This study aims at assessing the prevalence of khat use and associated factors among pregnant women in Kersa and Haramaya Health and Demographic Surveillance System Sites, eastern Ethiopia.

METHODS

A community-based cross-sectional study design was employed among randomly selected 1,015 pregnant women from an open cohort from Kersa and Haramaya Health and Demographic Surveillance System Sites in Ethiopia. Data were collected through face-to-face interviews from January 30 to April 30, 2021, using Open Data Kit (ODK) software and analyzed using SPSS v-26. Descriptive statistics were used to summarize the characteristics of pregnant women. Factors associated with khat use were identified by bivariate and multivariable logistic regression analyses; an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was estimated. Statistical significance was declared at p < 0.05.

RESULTS

The prevalence of khat use among pregnant women was 15.5% (95% CI, 13.3-17.7). Age of the pregnant women; being in the age group between 25 and 35 years (AOR = 2.27, 95% CI, 1.33-4.89) and 35 years and greater (AOR = 2.33, 95% CI, 1.29-4.20); having a chronic medical illness (AOR = 3.28, 95% CI, 1.27-8.48); and having a history of abortion (AOR = 2.87 95% CI, 1.73-4.76) significantly increased the likelihood of khat use among pregnant women.

CONCLUSION

The current study revealed a relatively high magnitude of khat use in pregnant women as compared with previous studies. The age of the pregnant women, history of medical illness, and history of abortion were significantly associated with khat use during pregnancy.

Natural Sympathomimetic Drugs: From Pharmacology to Toxicology

Sympathomimetic agents are a group of chemical compounds that are able to activate the sympathetic nervous system either directly via adrenergic receptors or indirectly by increasing endogenous catecholamine levels or mimicking their intracellular signaling pathways. Compounds from this group, both used therapeutically or abused, comprise endogenous catecholamines (such as adrenaline and noradrenaline), synthetic amines (e.g., isoproterenol and dobutamine), trace amines (e.g., tyramine, tryptamine, histamine and octopamine), illicit drugs (e.g., ephedrine, cathinone, and cocaine), or even caffeine and synephrine. In addition to the effects triggered by stimulation of the sympathetic system, the discovery of trace amine associated receptors (TAARs) in humans brought new insights about their sympathomimetic pharmacology and toxicology. Although synthetic sympathomimetic agents are mostly seen as toxic, natural sympathomimetic agents are considered more complacently in the terms of safety in the vision of the lay public. Here, we aim to discuss the pharmacological and mainly toxicological aspects related to sympathomimetic natural agents, in particular of trace amines, compounds derived from plants like ephedra and khat, and finally cocaine. The main purpose of this review is to give a scientific and updated view of those agents and serve as a reminder on the safety issues of natural sympathomimetic agents most used in the community.

An Update on the Implications of New Psychoactive Substances in Public Health

The emergence of new psychoactive substances has earned a great deal of attention, and several reports of acute poisoning and deaths have been issued involving, for instance, synthetic opiates. In recent years, there have been profound alterations in the legislation concerning consumption, marketing, and synthesis of these compounds; rapid alert systems have also been subject to changes, and new substances and new markets, mainly through the internet, have appeared. Their effects and how they originate in consumers are still mostly unknown, primarily in what concerns chronic toxicity. This review intends to provide a detailed description of these substances from the point of view of consumption, toxicokinetics, and health consequences, including case reports on intoxications in order to help researchers and public health agents working daily in this area.

Clinical characteristics and treatment outcomes of patients with newly diagnosed schizophrenia: A 4-year single-center experience in Saudi Arabia

Objectives

Understanding how local “psychiatry clinic” characteristics shape research findings is essential for applying research into evolution, outcomes, and costs of mental health. However, a paucity of “psychiatry clinics” details has implications for the interpretation and utilization of this research.

Methods

We reviewed data of 746 patients with new‐onset schizophrenia on antipsychotic monotherapy seen over four years in an “adult psychiatry clinic” at Jazan Health, Saudi Arabia. Protocol‐driven interviews and investigations were recorded prospectively and extracted from the medical records for the study. Summary statistics and logistic regression analyses were applied to assess patients' characteristics and outcomes.

Results

The median patient age was 32 (IQR 27‐39) years. Of patients, 589 (79.0%) were male, and 679 (91.0%) had a low‐level education. The median follow‐up duration was 51.4 (IQR 27.4‐96.3) weeks. The most used initial antipsychotic drugs were olanzapine (48.8%), haloperidol (13.9%), and aripiprazole (11.3%). The numbers of patients who retained the initial drug at 24 and 52 weeks were 539 (72.3%) and 325 (43.6%), respectively. The initial drug was changed in 246 (33.0%) patients. The median time to initial drug change was 43.9 (IQR 14.8‐85.0) weeks. The logistic regression demonstrated that male sex (P < 0.004), young adult age group (P < 0.027), predominant positive symptoms (P < 0.021), treatment with haloperidol (P < 0.024), and khat use (P < 0.006) were significant factors for drug change.

Conclusions

This clinical records study demonstrated substantial individual variations in characteristics and in responding to initial antipsychotic medication. Insight into these findings will facilitate the planning for comprehensive research programs.

Khat, a Cultural Chewing Drug: A Toxicokinetic and Toxicodynamic Summary

Khat (Catha edulis) is a recreational, chewed herbal drug that has been used as a psychostimulant for centuries in East Africa and the Arabian Peninsula, namely in Somalia, Ethiopia, and Yemen. However, the growing worldwide availability of khat has produced widespread concern. The plant comprises a large number of active substances, among which cathinone, cathine, and norephedrine are the main constituents, which can be included in the group of sympathomimetics of natural origin. In fact, these compounds are amphetamine analogues, and, as such, they have amphetamine-like nervous system stimulant effects. Chewing the leaves gives people a sensation of well-being and increases energy, alertness, and self-confidence. The chronic use of khat is, however, associated with severe cardiac, neurological, psychological, and gastrointestinal complications. The psychological dependence and withdrawal symptoms of khat are the reasons for its prolonged use. The aim of this paper is to review current knowledge on the khat plant with toxicokinetic and toxicodynamic perspectives. Namely, this review paper addresses in vitro, in vivo, and human studies. The models used, as well as the concentrations and doses with the respective biological effects, are discussed. Additionally, the main drug interactions involved with khat are described.

Progress and Research Trends on Catha edulis (Vahl) Endl. (Catha edulis): A Review and Bibliometric Analysis

Catha edulis (Vahl) Endl., known as Catha edulis or Khat is a traditional and regional plant for chewing, smoking and drinking, that has posed a worldwide public health problem due to its recent emerging abused consumption. In the face of the massive use of Catha edulis, we reviewed related publications to analyze the progress and research trends through bibliometric methods. After screening, a total of 514 scientific publications published from 1997 to 2020 were included by systematic retrieval from the Web of Science (WoS) database. According to further scientometric analysis, the annual number of publications output kept rising in most of the years. Ethiopia and the United States of America (USA) have been devoting significant contributions to the field. Though the research emphasis had been the chemical composition and pharmacological and toxicological effects for several years, the hot spots were transferred; the mechanism investigations of Catha edulis have been the focus in recent years, which might be continued in the future. Furthermore, co-operations of multi-disciplinary researchers are needed to minimize abuse harms and maximize the medicinal benefits of Catha edulis to human beings.

Oral cancer among Khat users: finding evidence from DNA analysis of nine cancer-related gene mutations

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).

Exposure to DDT and HCH congeners and associated potential health risks through khat (Catha edulis) consumption among adults in South Wollo, Ethiopia

Khat (Catha edulis) chewing is widespread in the region of East Africa. Even low levels of organochlorine pesticides (OCPs) in khat could induce public health concern. In a market-based study, from five popular khat varieties, a total of 35 composite khat samples were analyzed for dichlorodiphenyltrichloroethane (DDT) and its main transformation products, and four hexachlorocyclohexane (HCH) isomers. Extraction was carried out by quick, easy, cheap, effective, rugged and safe method (QuEChERS). OCP concentrations were determined by head space solid phase microextraction coupled to gas chromatography-mass spectrometry (HS-SPME-GC-MS). Every sample contained β-HCH above the maximum residue limit set by the European Commission. For total DDT, this was the case for 25.7% of the samples. The ratios of (p,p'-DDD + p,p'-DDE) to p,p'-DDT were less than one for 85% of khat samples, demonstrating recent use of DDT in khat farmlands. Conversely, the ratio of β-HCH to total HCH varied from 0.56 to 0.96, implying historical input of technical HCH. Assuming a daily chewable portion of 100 g, dietary intakes of p,p'-DDT, total DDT and total HCH by adults ranged from 3.12 to 57.9, 6.49 to 80.2 and 39.2 to 51.9 ng (kg body weight)^-1 day^-1, respectively. These levels are below acceptable levels suggested by international organizations. Chewing khat showed lower non-cancer health risk, but showed relatively higher cancer risk in terms of OCPs. Because khat is chewed without being subjected to any treatment, uncertainties associated with estimated intakes and health risks should be low. Therefore, this practice is of great concern.

An updated review on synthetic cathinones

Cathinone, the main psychoactive compound found in the plant Catha edulis Forsk. (khat), is a β-keto analogue of amphetamine, sharing not only the phenethylamine structure, but also the amphetamine-like stimulant effects. Synthetic cathinones are derivatives of the naturally occurring cathinone that largely entered the recreational drug market at the end of 2000s. The former "legal status", impressive marketing strategies and their commercial availability, either in the so-called "smartshops" or via the Internet, prompted their large spread, contributing to their increasing popularity in the following years. As their popularity increased, the risks posed for public health became clear, with several reports of intoxications and deaths involving these substances appearing both in the social media and scientific literature. The regulatory measures introduced thereafter to halt these trending drugs of abuse have proved to be of low impact, as a continuous emergence of new non-controlled derivatives keep appearing to replace those prohibited. Users resort to synthetic cathinones due to their psychostimulant properties but are often unaware of the dangers they may incur when using these substances. Therefore, studies aimed at unveiling the pharmacological and toxicological properties of these substances are imperative, as they will provide increased expertise to the clinicians that face this problem on a daily basis. The present work provides a comprehensive review on history and legal status, chemistry, pharmacokinetics, pharmacodynamics, adverse effects and lethality in humans, as well as on the current knowledge of the neurotoxic mechanisms of synthetic cathinones.

Determinants of Weight-Related Behaviors in Male Saudi University Students: A Qualitative Approach Using Focus Group Discussions

Obesity is a serious public health concern in the Gulf States. Students are exposed to many unhealthy weight-related behaviors due to college life. However, research that gives insight into regional and culture-specific aspects and determinants of weight-related behaviors in students is lacking. The purpose of this study was to explore the potential determinants of weight change, eating behaviors, physical activity, sedentary behaviors, and sleep behaviors in Saudi university students. Five semi-structured focus group discussions guided by Social Cognitive Theory were conducted, consisting of 33 male university students 20 to 22 years old. The data were transcribed, coded, and organized according to themes. The students reported weight gain due to personal, social, and environmental factors related to university lifestyle, such as unhealthy eating behaviors, low physical activity, high sedentary behaviors, and inadequate sleep. Both eating behaviors and physical activity shared similar personal aspects found in other studies, such as knowledge, stress, lack of time, and lack of motivation. However, there were some unique social and environmental factors in the region, such as the social norms, cultural aspects, weather conditions, passive transport dependency, and khat consumption, compared with studies worldwide. Such differences are key factors to developing effective interventions in the future.

Tobacco use and associated factors among adults reside in Arba Minch health and demographic surveillance site, southern Ethiopia: a cross-sectional study

BACKGROUND

Tobacco use is one of the world-leading preventable killers. There was a varied prevalence of tobacco use and cigarette smoking across different areas. The aim of the study was to assess the prevalence and factors associated with current tobacco use among adults residing in Arba Minch health and demographic surveillance site (HDSS).

METHODS

A community-based cross-sectional study was conducted among adults residing in Arba Minch HDSS in 2017. The estimated sample size was 3368 individuals which were selected by simple random sampling techniques using Arba Minch HDSS dataset. Data collection tools were obtained from the WHO STEPwise. Current use of tobacco, which defined as the current use of smoked and/or smokeless tobacco, was considered as the dependent variable. A binary logistic regression model was used to identify candidate variables for the multivariable logistic regression model. An adjusted odds ratio (AOR) at a p-value of less than 0.05 was used to determine a statistically significant association between independent and dependent variables.

RESULT

The prevalence of tobacco use among adults was 20.2% (95% CI: 18.9-21.6%). The current use of smoked and smokeless tobacco were 17.1% (95%CI: 15.8-18.4%) and 9.7% (95%CI: 8.8-10.8%), respectively. The current use of tobacco was significantly associated with sex (female [AOR 0.54; 95%CI: 0.42-0.68] compared to men), age group (35-44 [AOR 1.57; 95%CI: 1.14-2.17], 45-54 [AOR 1.99; 95%CI: 1.45-2.74], and 55-64 [AOR 3.26; 95%CI: 2.37-4.48] years old compared to 25-35 years old), physical activity (moderate physical activity level [AOR 0.65; 95%CI: 0.44-0.96] compared with low) and residency (highland [AOR 4.39; 95% CI: 3.21-6.01] compared with at lowlander). Also, heavy alcohol consumption (AOR 3.97; 95% CI: 3.07-5.12), and Khat chewing (AOR 3.07(95%CI: 1.64-5.77) were also associated with the use of tobacco among the study participants.

CONCLUSION

Nearly one in five adults used tobacco currently in the study area, which is more than the national reports. Interventions for the reduction of tobacco use need to give due attention to men, older adults, uneducated, poor, and highlanders.

Prevalence of heavy episodic drinking and associated factors among adults residing in Arba Minch health and demographic surveillance site: a cross sectional study

BACKGROUND

Alcohol consumption is associated with different types of illnesses; particularly heavy episodic drinking is one of the risk factors for the disease burden of alcohol intake. The aim of the study was to assess the prevalence of heavy episodic drinking and associated factors in Arba Minch Health and Demographic Surveillance Site (HDSS).

METHODS

A community-based cross-sectional study was conducted in 2017 among adult residents of Arba Minch HDSS. Using Arba Minch HDSS database, 3368 individuals were selected by simple random sampling techniques. From WHO STEPS instruments, step one was applied for this study. Variables with a p-value of less than 0.10 for bivariate analysis entered into a multivariable logistic regression model to outline the independent predictors of the heavy episodic drinking. To assess the presence of an association between dependent and independent variables, a p-value of less than 0.05 was considered.

RESULTS

The prevalence of heavy episodic drinking was 13.7% (95% CI: 12.6-14.9). The study has shown that heavy episodic drinking was significantly associated with occupation (daily laborer [AOR = 0.49; 95% C.I: 0.29-0.85] and housewives [AOR = 0.63; 95% C.I: 0.45-0.88] compared with farmers), wealth index (2nd quintiles [AOR =0.55; 95% C.I: 0.41-0.74) and 3rd quintiles [AOR = 0.66; 95% C.I: 0.46-0.93] compared with 1st quintiles), and climatic zone (midland [AOR = 1.80;95% CI: 1.11-2.93), highland [AOR = 1.95;95% CI: 1.19-3.18] compared with lowland). In addition, tobacco use [AOR = 4.28;95% CI: 3.38-5.43], and khat use [AOR = 4.75; 95% CI: 2.66-8.50) were also associated with heavy episodic drinking among the study participants.

CONCLUSIONS

More than one in ten adults reported heavy episodic drinking in the study area. Intervention programs that aim to prevent heavy episodic drinking should be designed appropriately for individuals from lower wealth status, and for highlander.

Khat induced psychotic disorder: case report

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.

Flakka: New Dangerous Synthetic Cathinone on the Drug Scene

New psychoactive substances are being used as drugs and appear to be quite popular nowadays. Thanks to their specific properties, these drugs create inimitable experiences for intoxicated people. Synthetic cathinones are the most common compounds in these new drugs. Among them, α-pyrrolidopentadione (α-PVP), or “Flakka” (street name), is one of the most famous cathinone-designed drugs. Similar to other synthetic cathinone drugs, α-PVP can effectively inhibit norepinephrine and dopamine transmitters. The adverse reactions of α-PVP mainly include mania, tachycardia, and hallucinations. An increasing number of people are being admitted to emergency wards due to the consequences of their use. This work mainly summarizes the history, synthesis, pharmacology, toxicology, structure–activity relationship, metabolism, clinical process and health risks, poisoning and death, forensic toxicology, and legal status of α-PVP. We hope this review will help bring more attention to the exploration of this substance in order to raise awareness of its negative impacts on humans.

Catha edulis Forsk (khat) reduces spontaneous and rewarded alternation in female mice

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Khat is a widely used plant-based psychostimulant.

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Administration of khat leads to disruption of spatial working memory in mice.

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It promotes in mice perseverative behavior rather than alternation behavior.

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Khat treated mice also show right side position preference.

Around 10 million people chew the fresh leaves and twigs of Catha edulis Forsk (khat), which synthesize cathinone, for its psychostimulatory effect. Several studies have reported that regular khat users show executive and cognitive dysfunction, such as impaired inhibitory control and poor performance on memory tests. In this study, the effect of fresh khat extract (100 and 250 mg/kg) on spatial working memory and short-term memory in mice was assessed using spontaneous and rewarded alternation T-maze tests. In the spontaneous alternation test, mice treated with fresh khat extract decreased their spontaneous alternation level to around chance level, and it remained at this level over the 7 days of khat administration and testing. On testing after a 7-day khat free period, the previously khat treated mice showed alternation level above chance but below their pre-khat alternation level. In the rewarded alternation test, acute treatment with khat caused the mice to alternate well below chance level, and then over the next 3 days of khat treatment, the alternation level increased. After a 2 and 9-day khat-free period, the previously khat treated mice alternated above chance level but below their pre-khat level. In both these tests, the mice did not show any position preference before khat treatment; however, during the khat treatment, the mice showed a right side tendency. The results show that khat treatment causes persistent changes in alternation behavior and promotes perseverative behavior, presumably due to its effect on the neural circuits activity and the neurotransmitters and promotion of position preference.

Plasma cell mucositis related to qat chewing: a report of 2 cases and review of the literature

Plasma cell mucositis is a rare, benign mucosal condition with characteristic histological features of a dense polyclonal plasmacytic infiltrate. A variety of mucosal sites are affected and the presentation varies from a cobblestone to an intensely erythematous, lobulated appearance. Idiopathic cases are well documented and it has been attempted to define the entity as a hypersensitivity reaction, however reports show inconsistencies. The last two decades have highlighted an emerging association between qat (khat) chewing and plasma cell mucositis. This report provides a review of the most pertinent literature and describes two cases intimately related to qat chewing, whereby resolution occurred upon qat cessation. One case requiring systemic steroidal therapy due to severe symptoms. This highlights the need for an increased awareness amongst clinicians of a potential aetiological link between qat and plasma cell mucositis, emphasises the benefit of qat cessation and the scenarios whereby systemic steroidal therapy should be considered.

Coenzyme Q10 nullified khat-induced hepatotoxicity, nephrotoxicity and inflammation in a mouse model

Ethnopharmacological relevance

The consumption of khat (Catha Edulis, Forsk) is on the rise despite the much publicized associated deleterious health effects. How chemicals present in khat, affect various physiological and biochemical processes requires further scrutiny. A clear understanding of these processes will provide an avenue for countering khat-driven negative effects using appropriate pharmacological and/or nutritional interventions.

Aim of the study

The current study investigated the effect of khat on vital physiological and biochemical processes such as oxidative stress, inflammation and immune responses and the role of Coenzyme-Q₁₀ (CoQ₁₀), a potent antioxidant and anti-inflammatory, in modulating any negative effects due to khat exposure.

Methodology

Three (3) weeks old forty (40) Swiss albino mice were randomly assigned into four treatment groups (n = 10). The first group was the control that was not administered with khat or CoQ₁₀. The second group received 200 mg/kg body weight (b/w) of CoQ₁₀, while the third group received 1500 mg/kg b/w of khat extract and finally the forth group was co-treated with 200 mg/kg b/w of CoQ₁₀ and 1500 mg/kg b/w of khat extract. The experiment was conducted for 90 days after which samples were collected for physiological and biochemical analyses.

Results

The effects of khat and CoQ₁₀ on the weights of brain, liver, kidney and spleen was determined. Administration of khat decreased the levels of RBCs and its subtypes (MCV, MCH, RDW-SD and RDW-CV), a clear indicator of khat-induced normochromic microcytic anemia. White blood cells (lymphocytes, monocytes, neutrophils and eosinophil) which are vital in responding to infections were markedly elevated by khat. Moreover, these results provide evidence for khat-induced liver and kidney injury as shown by increased biomarkers; AST, ALT, GGT and creatinine respectively. Standard histopathological analysis confirmed this finding for khat-driven liver and kidney injury. Further studies showed evidence for khat-induced inflammation and oxidative stress as depicted by increased levels of the pro-inflammatory cytokine TNF-alpha and elevation of GSH in the brain, liver and spleen. Remarkably, this is the first study to demonstrate the potential of CoQ₁₀ in ameliorating khat-induced negative effects as outlined. CoQ₁₀ supplementation restored the khat-induced reduction in RBC subtypes, and was protective against liver and kidney injury as shown by the appropriate biomarkers and standard histopathology analysis. The other significant finding was the CoQ₁₀-driven normalization of GSH and TNF-α levels, indicating a protective effect from khat-driven oxidative stress and inflammation respectively.

Conclusion

From this study, we conclude that CoQ₁₀ may be useful in nullifying khat-driven deleterious events among chronic khat users.

Prevalence of hypertension and associated factors among adult residents in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia

Hypertension is the leading risk factor for mortality and it is also one of the major risk factors for other non-communicable diseases (NCDs). The objective of the study was to assess the prevalence of hypertension and its associated factors among adults residing in Arba Minch health and demographic surveillance site (HDSS), Southern Ethiopia. A community-based cross-sectional survey was conducted in 2017 on the estimated sample size of 3,368 adults at Arba Minch Health and Demographic Surveillance site (HDSS). Data were collected using the WHO STEPS survey tools. Bivariate analysis was done to detect candidate variables at P-value less than 0.25 and entered into the final model to identify the independent predictors of hypertension. The prevalence of hypertension was 18.92% (95% CI: 17.63-20.28). The magnitude increase among respondents in the older age group [AOR 1.39 (95%CI: 1.05-1.84), 1.68 (95% CI: 1.26-2.23) and 2.67 (95%CI: 2.01-3.56) for age group 35-44, 45-54 and 55-64, respectively, compared to 25-34 years old group] and those with the higher wealth index [AOR 1.86 (95%CI: 1.33-2.59), 2.68 (95% CI: 1.91-3.75) and 2.97 (95%CI: 2.08-4.25) for 3rd quantile, 4th quantile and 5th quantile, respectively, compared to 1st quantile]. The odds of hypertension reduce among married participants (AOR 0.66, 95%CI: 0.51-0.85). Respondents with overweight (AOR 1.44, 95%CI: 1.02-2.02), khat chewing (AOR3.31, 95%CI: 1.94-5.64), low fruit and/or vegetable consumption (AOR 1.27, 95%CI: 1.05-1.53) and those who do not use coffee and tea (AOR 1.52, 95%CI: 1.03-2.24) had significantly higher likelihood of hypertension. Nearly one out of five participants have hypertension in this population. As hypertension is one of the silent killers, it is advisable to develop a system for enabling early detection and monitoring in the older age groups and overweight individuals.

An intimate partner violence prevention intervention for men, women, and couples in Ethiopia: Additional findings on substance use and depressive symptoms from a cluster-randomized controlled trial

BACKGROUND

Intimate partner violence (IPV) is linked to substance use by male perpetrators and is associated with an increased risk of depression for women who experience violence. Unite for a Better Life (UBL) is a gender-transformative intervention delivered to men, women, and couples in Ethiopia; previous evidence demonstrated the intervention significantly reduced experience of and perpetration of IPV when delivered to men and led to more equitable household task-sharing when delivered to men and couples. The aim of this analysis is to assess engagement in the UBL intervention and to examine the relationship between random assignment to the intervention and men's past-year substance use and women's reported depressive symptoms as measured at the individual level.

METHODS AND FINDINGS

A sample of 64 villages in Gurague zone, Ethiopia, was randomly allocated to 4 arms (men's UBL, women's UBL, couples' UBL, or control). In each village, 106 households were randomly sampled, and households in the intervention arms were invited to participate in UBL, consisting of 14 sessions delivered by trained facilitators. Households in the control arm were offered a short educational session on IPV. Descriptive data on participant engagement in the intervention are reported, and outcomes assessed in an intention-to-treat (ITT) analysis include male use of substances (alcohol and khat) and women's depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9). Results from both adjusted and unadjusted specifications are reported, the latter adjusting for baseline covariates including age, education level, marriage length, polygamy, socioeconomic status, months between intervention and endline, and the baseline level of the outcome variable. The baseline sample includes 6,770 respondents surveyed in 2014-2015, and follow-up data were available from 88% of baseline respondents surveyed in 2017-2018; the majority of respondents report no education, and 61% are Muslim. Respondents reported high attendance rates and engagement in the intervention. In addition, there was evidence of a significant reduction in frequent past-year alcohol intoxication self-reported by men (adjusted odds ratio [AOR] = 0.56, 95% CI 0.36-0.85, p = 0.007), and a significant increase in the probability of frequent khat use self-reported by men (AOR = 3.09, 95% CI 1.37-6.96, p = 0.007), both observed in the couples' UBL arm at 24 months' follow-up relative to the control arm. There was a significant increase in symptoms of moderate depression among women in the women's UBL arm only (AOR = 1.65, 95% CI 1.13-2.41, p = 0.010), again relative to the control arm. There was no evidence of shifts in symptoms of mild or severe depression. The primary limitation of this study is the reliance on self-reported data around sensitive behaviors.

CONCLUSIONS

The findings suggest that the UBL intervention was associated with a reduction in men's use of alcohol when delivered to couples, but there was no evidence of a decrease in reported symptoms of depression among women in any experimental arm, and some evidence of an increase in symptoms of moderate depression in the women's UBL arm. Further research should explore how to optimize IPV prevention interventions to target related risks of mental health and substance use.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02311699; Socialscienceregistry.org AEARCTR-0000211.

Oral squamous cell carcinoma: metastasis, potentially associated malignant disorders, etiology and recent advancements in diagnosis

Oral squamous cell carcinoma (OSCC) is a commonly occurring head and neck cancer. It has a high prevalence in certain parts of the world, and is associated with a high mortality rate. In this review, we describe metastasis related to OSCC, and disorders that could lead to OSCC with common etiological factors. In addition, a brief account of the diagnosis of OSCC and role of salivary biomarkers in its early detection has also been highlighted. Google Scholar and PubMed search engines were searched with keywords including “oral squamous cell carcinoma”, “OSCC”, “oral cancer”, “potentially malignant disorders in oral cavity”, “etiological factors of OSCC”,  “diagnosis of OSCC”, and “salivary biomarkers and OSCC” to gather the literature for this review. The review concludes that OSCC has the potential for regional as well as distant metastasis, and many potentially malignant diseases can transform into OSCC with the help of various etiological factors. Diagnosis of OSCC involves traditional biopsy, but salivary biomarkers could also be utilized for early recognition.

Polysubstance use patterns and novel synthetics: A cluster analysis from three U.S. cities

The rapid emergence of novel psychoactive substances within the past decade has raised new concerns about the harms associated with unregulated drug use. Synthetic analogues-chemically related to established psychoactive substances like cannabis sativa and catha edulis-in particular have proliferated rapidly, allowing little opportunity for scientific research or the establishment of informal guidelines for safe use among consumers. To explore how synthetic substance use relates to other forms of use, this paper presents an analysis of polysubstance use among a sample of 676 people who use illicit substances in the United States. Participants were sampled from three greater metropolitan areas (Houston/Galveston, Texas; New York City; and New Orleans, Louisiana). Study researchers used cluster-type analyses to develop dendrogram visualizations of the interrelationships between substance types. Results suggest a considerable variation in substance and polysubstance use patterns across states in the U.S. Polysubstance use clustered around well-observed combinations like MDMA/cannabis and cocaine/heroin. Synthetic cannabinoids and cathinones showed no strong clustering with other substances. High rates of binge drinking among users of other substances further support the importance of interventions sensitive to the clinical challenges of polysubstance use.

α-Pyrrolidinopentiophenone ("Flakka") Catalyzing Catatonia: A Case Report and Literature Review

: Synthetic cathinones are a class of novel psychoactive substances. α-Pyrrolidinopentiophenone (α-PVP), or "Flakka", is one of these substances. Users often present acutely psychotic or agitated. We present the case of a 20-year-old male without prior psychiatric history who was brought to the hospital by his family because of increasingly bizarre and erratic behavior after reported ingestion of Flakka. What ensued was a prolonged course of psychosis and severe catatonia. Synthetic cathinones are thought to cause catatonia in approximately 1% of cases. Awareness of the possible presentations associated with α-PVP intoxication is increasingly important and should be further explored, as they can have important implications in setting expectations for care. Additionally, providers should have a low threshold for asking patients about bath salt ingestion.

Involvement of CB2 Receptors in the Neurobehavioral Effects of Catha Edulis (Vahl) Endl. (Khat) in Mice

There is behavioral evidence for the interaction between crude khat extract and the endocannabinoid system, whereby the endocannabinoid system alters khat extract-mediated behavioral effects through modulation of the monoaminergic system. The objective of this study was to investigate the role of the endocannabinoid system on the neurobehavioral effect of khat extract in mice following concomitant administration of khat extract and the CB2R agonist, JWH133. Locomotor activity test, immunohistochemistry, and reverse transcriptase polymerase chain reaction technique were utilized to assess locomotor activity, tyrosine hydroxylase immunoreactivity, and expression of dopamine transporter mRNA gene. The results show sub-acute administration of khat extract alone increased locomotor activity in mice and co-administration of the CB2R agonist, JWH133, reduced khat extract induced hyperlocomotor activity. The data revealed that cell type specific deletion of CB2Rs on dopaminergic neurons increased the hyperlocomotor behavior of khat extract. Furthermore, the results revealed that khat extract attenuated MPTP induced motor deficits, which is enhanced by JWH133. Khat extract also increased expression of tyrosine hydroxylase positive cells and expression of dopamine transporter mRNA gene in wild type mice. Nevertheless, JWH133 did not alter the effect of khat extract on tyrosine hydroxylase immunoreactivity and dopamine transporter mRNA expression when given together with khat extract. Taken together, the results suggest that the CB2Rs selectively interact with khat extract-mediated locomotor effects and could be utilized as therapeutic target in central nervous system movement disorders associated with dopamine dysregulation.

Poor sleep quality and its predictors among type 2 diabetes mellitus patients attending Jimma University Medical Center, Jimma, Ethiopia

Objectives

The aim of this study is to determine the prevalence of poor sleep quality and its associated factors among people with type 2 diabetes mellitus at Jimma University Medical Center, Jimma, Ethiopia 2018. Comparative cross-sectional study was employed on 198 participants (99 cases and 99 controls). Data were collected using Pittsburgh Sleep Quality Index (PSQI) and analyzed using SPSS version 20. Variables with p value ≤ 0.05 in multivariable logistic regression were treated as significant predictors of poor sleep quality.

Results

The prevalence of poor sleep quality was 55.6% among people with type 2 diabetes mellitus and 32.3% among controls. Longer duration of diabetes since diagnosis (> 10 years) [AOR = 4.88 CI (1.27, 18.66) p = 0.021], co-morbid hypertension [AOR = 3.2, CI (1.16, 8.84) p = 0.025], poor glycemic control [AOR = 3.16 CI (1.2, 8.27), p = 0.02] and current khat chewing [AOR = 3.06, CI (1.04, 8.98), p = 0.042] were factors significantly associated with poor sleep quality. The prevalence of poor sleep quality was significantly higher among people with diabetes than those who didn’t have diabetes (controls). Poor sleep quality may bring about mental impairment and reduce working capacity of individuals with diabetes mellitus. Therefore, diabetes mellitus patients need to have heath education about risk factors for poor sleep quality.

Impact of chronic khat (Catha edulis Forsk) chewing on pulmonary function test and oxygen saturation in humans: A comparative study

Background:

Chronic consumption of khat affects many organ systems and leads to various health disturbances in the chewers. Few studies examined the acute effects of khat ingestion on lung function parameters. However, studies which assessed the long-term effects of khat chewing on pulmonary function parameters and oxygen saturation are lacking.

Objective:

The aim of this study was to assess the impact of chronic Khat chewing on pulmonary function parameters and oxygen saturation among chronic Khat chewers in Wolkite, Ethiopia.

Methods:

A community-based comparative cross-sectional study was conducted in Wolkite, Ethiopia from 1 June 2018 to 15 August 2018. A total of 324 participants, 162 khat chewers and 162 non-chewers were included in the study. The data were collected through face-to-face interview by trained data collectors. British Medical Research Council respiratory questionnaire was used to assess respiratory symptoms. A spirometer was used to assess various lung function parameters. Moreover, oxygen saturation of hemoglobin was measured using pulse oximeter. Data were entered into CSPro version 6.2 and analyzed using SPSS version 23.

Results:

This study showed statistically significant (p < 0.05) reduction in the mean values of forced vital capacity, forced expiratory volume in first second and maximum ventilation volume among khat chewers as compared to non-chewers. There was no significant difference in the mean values of other lung function parameters between the two groups. Similarly, there was no significant difference (p = 0.642) in mean oxygen saturation of hemoglobin (SaO₂) across the two groups.

Conclusion:

It is evident from this study that long-term khat consumption is associated with decreased mean forced vital capacity, forced expiratory volume in first second and maximum ventilation volume. Hence, there is a need for further study to strengthen the current findings and to explore the mechanisms of khat chewing effect on lung function parameters.

Effects of Khat (Catha edulis) use on catalytic activities of major drug-metabolizing cytochrome P450 enzymes and implication of pharmacogenetic variations

In a one-way cross-over study, we investigated the effect of Khat, a natural amphetamine-like psychostimulant plant, on catalytic activities of five major drug-metabolizing cytochrome P450 (CYP) enzymes. After a one-week Khat abstinence, 63 Ethiopian male volunteers were phenotyped using cocktail probe drugs (caffeine, losartan, dextromethorphan, omeprazole). Phenotyping was repeated after a one-week daily use of 400 g fresh Khat leaves. Genotyping for CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A5 were done. Urinary cathinone and phenylpropanolamine, and plasma probe drugs and metabolites concentrations were quantified using LC-MS/MS. Effect of Khat on enzyme activities was evaluated by comparing caffeine/paraxanthine (CYP1A2), losartan/losartan carboxylic acid (CYP2C9), omeprazole/5-hydroxyomeprazole (CYP2C19), dextromethorphan/dextrorphan (CYP2D6) and dextromethorphan/3-methoxymorphinan (CYP3A4) metabolic ratios (MR) before and after Khat use. Wilcoxon-matched-pair-test indicated a significant increase in median CYP2D6 MR (41%, p < 0.0001), and a marginal increase in CYP3A4 and CYP2C19 MR by Khat. Repeated measure ANOVA indicated the impact of CYP1A2 and CYP2C19 genotype on Khat-CYP enzyme interactions. The median MR increased by 35% in CYP1A2*1/*1 (p = 0.07) and by 40% in carriers of defective CYP2C19 alleles (p = 0.03). Urinary log cathinone/phenylpropanolamine ratios significantly correlated with CYP2D6 genotype (p = 0.004) and CYP2D6 MR (P = 0.025). Khat significantly inhibits CYP2D6, marginally inhibits CYP3A4, and genotype-dependently inhibit CYP2C19 and CYP1A2 enzyme activities.

Prediction of designer drugs: Synthesis and spectroscopic analysis of synthetic cathinone analogs that may appear on the Swedish drug market

The use of hyphenated analytical techniques in forensic drug screening enables simultaneous identification of a wide range of different compounds. However, the appearance of drug seizures containing new substances, mainly new psychoactive substances (NPS), is steadily increasing. These new and other already known substances often possess structural similarities and consequently they exhibit spectral data with slight differences. This situation has made the criteria that ensure indubitable identification of compounds increasingly important. In this work, 6 new synthetic cathinones that have not yet appeared in any Swedish drug seizures were synthesized. Their chemical structures were similar to those of already known cathinone analogs of which 42 were also included in the study. Hence, a total of 48 synthetic cathinones making up sets of homologous and regioisomeric compounds were used to challenge the capabilities of various analytical techniques commonly applied in forensic drug screening, ie, gas chromatography-mass spectrometry (GC-MS), gas chromatography-Fourier transform infrared spectroscopy (GC-FTIR), nuclear magnetic resonance (NMR), and liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS). Special attention was paid to the capabilities of GC-MS and GC-FTIR to distinguish between the synthetic cathinones and the results showed that neither GC-MS nor GC-FTIR alone can successfully differentiate between all synthetic cathinones. However, the 2 techniques proved to be complementary and their combined use is therefore beneficial. For example, the structural homologs were better differentiated by GC-MS, while GC-FTIR performed better for the regioisomers. Further, new spectroscopic data of the synthesized cathinone analogs is hereby presented for the forensic community. The synthetic work also showed that cathinone reference compounds can be produced in few reaction steps.

The long tail of a demon drug: The 'bath salts' risk environment

Using the case of synthetic cathinones (commonly referred to as 'bath salts' in the US context), this paper analyses structural factors surrounding novel psychoactive substances (NPS) as contributing to the unique risk environment surrounding their use. Drawing on interviews with 39 people who use bath salts from four U.S. cities and analysis of the infrastructural, social, economic, and policy contexts, we document the unique harms related to changing contexts for illicit drug regulation, manufacture, and consumption. Findings suggest that NPS and designer drug markets, which are highly reliant upon the internet, share characteristics of the entertainment industry which has come to rely more heavily upon profits derived from the 'long tail' of myriad lesser-known products and the diminished centrality of 'superstars' and 'hits'. Findings point toward increased theoretical and policy attention to changing drug market structures, more rigorous evaluations of drug 'analogues' legislation and greater involvement with NPS education and testing by harm reduction agencies.

Neuropharmacology of Synthetic Cathinones

Synthetic cathinones are derivatives of the naturally occurring compound cathinone, the main psychoactive ingredient in the khat plant Catha edulis. Cathinone is the β-keto analog of amphetamine, and all synthetic cathinones display a β-keto moiety in their structure. Several synthetic cathinones are widely prescribed medications (e.g., bupropion, Wellbutrin^®), while others are problematic drugs of abuse (e.g., 4-methylmethcathinone, mephedrone). Similar to amphetamines, synthetic cathinones are psychomotor stimulants that exert their effects by impairing the normal function of plasma membrane transporters for dopamine (DAT), norepinephrine (NET), and 5-HT (SERT). Ring-substituted cathinones like mephedrone are transporter substrates that evoke neurotransmitter release by reversing the normal direction of transporter flux (i.e., releasers), whereas pyrrolidine-containing cathinones like 3,4-methylenedioxypyrovalerone (MDPV) are potent transporter inhibitors that block neurotransmitter uptake (i.e., blockers). Regardless of molecular mechanism, all synthetic cathinones increase extracellular monoamine concentrations in the brain, thereby enhancing cell-to-cell monoamine signaling. Here, we briefly review the mechanisms of action, structure-activity relationships, and in vivo pharmacology of synthetic cathinones. Overall, the findings show that certain synthetic cathinones are powerful drugs of abuse that could pose significant risk to users.

Khat and synthetic cathinones: Emerging drugs of abuse with dental implications

The rising global availability of the stimulant and euphoric substances, khat and synthetic cathinones, has become a cause for concern in many countries, including the United States. Both substances are illegal in United States, although this has not deterred their use. Besides central nervous system effects, these drugs also cause sympathomimetic and orodental adverse effects, similar to those of amphetamine. Although synthetic cathinones are stronger than khat in most cases, the latter additionally contains tannins, which have astringent effects on tissues components, including those in the oral cavity. Recognizing the use prevalence and reported orodental adverse effects of khat and synthetic cathinones, dental practitioners should be more familiar with these substances to optimally treat and educate their patients abusing them. This paper reviews the pharmacology and adverse effects of khat and synthetic cathinones, along with the extent of their use in United States, with particular emphasis on dental implications.

Is Khat (Catha edulis) chewing a risk factor for periodontal diseases? A systematic review

Background

Khat (Catha edulis) chewing is a highly prevalent habit in the Arabian Peninsula and East Africa, and has recently spread to Western countries. The association between khat chewing and oral mucosal lesions is well documented in the literature. However, there is no concrete evidence on the association between khat chewing and periodontal disease. The purpose of this systematic review was to analyze the influence of khat chewing on periodontal health.

Material and Methods

A literature search of PubMed, Scopus and Web of Sciences databases was carried out to identify relevant articles published from 1990 to May 2017. The inclusion criteria were all clinical studies that assessed the relationship between khat chewing and periodontal disease.

Results

The search yielded 122 articles, of which 10 were included in this systematic review. Most of the studies exhibited a positive correlation between khat chewing and periodontal disease.

Conclusions

Altogether, the analysis of the current evidence reveals that khat chewing is destructive to the periodontium and enhances the risk of periodontal disease progression. However, due to variability of studies, more longitudinal case-controlled studies are highly warranted to establish a causal relation between khat chewing and periodontal disease.

Key words:Khat chewing, periodontal health, periodontal disease, risk factor.

Khat (Catha edulis) and its oral health effects: An updated review

Khat or qat (Catha edulis) is a plant that grows in East Africa and southern Arabia. The leaves and twigs of this small tree are chewed by several millions of people worldwide for their stimulating amphetamine-like effects. The reported prevalence of khat chewing in Europe and the USA is on the rise, especially with global migration. Long-term khat chewing has several detrimental general and oral health effects. The aim of the present study was to review the current literature regarding khat use and its association with oral and dental diseases, with particular emphasis on its link with oral keratotic white lesions and oral cancer. We searched the literature to identify all relevant articles. Studies showed that khat is associated with several oral and dental conditions, including keratotic white lesions, mucosal pigmentation, periodontal disease, tooth loss, plasma cell stomatitis, and xerostomia. There are limited data on the incidence of dental caries among khat chewers. The evidence that khat chewing is a risk factor for oral cancer is still weak, and is mainly based on anecdotal case reports and uncontrolled studies.

Pharmacological and Toxicological Effects of Catha edulis F. (Khat)

Khat chewing is deeply rooted in the culture and tradition of communities in khat belt countries, and its consumption is spread to other countries through the suitcase trade. The aim of this article is to review current knowledge on the chemistry, social, pharmacology and toxicology of khat and its use. Khat produces effect invariably in every system, which is harmful or beneficial in some instances. Harmful effects are observed in heavy users, although firm evidence is lacking. Chewing khat acutely elicits states of euphoria, which is followed by low mood. Khat contains alkaloids with psychostimulant properties, but the effect cannot be totally explained by these alkaloids. It is also not clear whether the effect produced in some organs like liver could be attributed to khat or pesticides sprayed during farming. Although the evidence indicates that khat has adverse effects in most organs, our understanding of the complex interaction between use and effect is incomplete, and causal relationships have not yet been described. Moreover, khat has positioned itself well in the social, economic and political arena. Thus, a multidisciplinary research is required to understand the different dimensions and come up with ways that maximize the benefit while minimizing the risk. Copyright © 2017 John Wiley & Sons, Ltd.

Oral hygiene and periodontal health status among khat chewers. A case-control study

Background

Habitual khat chewing is a widespread male habit in Southern Arabia and East Africa. The aim of this study was to assess the effect of Khat chewing on oral hygiene and periodontal health status among Yemeni male khat chewers.

Material and Methods

This case- control study included 310 khat chewers, aged 20-65 years, and 72 age- and gender- matched non-chewers as controls. Periodontal examination included recording of dental plaque index (PI), gingival index (GI), probing pocket depth (PPD), attachment level (AL) and gingival recession (GR). Demographic data, oral hygiene practices, and duration, frequency and site of khat chewing were obtained using questionnaires. SPSS was used for data analysis. ANOVA and t- tests were used to compare groups.

Results

Khat chewers had significantly higher mean PI, AL, GR scores than non-chewers (P < 0.05). However, no significant differences in the GI and PPD mean scores were observed between both groups (p > 0.05). Interestingly, the results showed that the chewing side had less PI, GI and PPD than non-chewing side. However, gingival recession was significantly higher in the chewing side. The duration of chewing showed a significant effect on PI, PPD, AL, and GR but had no effect on the gingival condition. Likewise, the frequency of chewing showed a significant effect on PPD, AL, and GR, but had no effect on other indices (PI and GI).

Conclusions

The results of this study indicate that khat chewing have a detrimental effect on the periodontium.

Key words:Khat chewing, periodontal health, oral hygiene.