السلام عليكم ورحمة الله
شكرا لك أخي العزيز ولنحاول في هذا الموضوع جمع أكبر عدد من المقالات الطبيه المتعلقه بموضوع أكل القات وأخطاره الصحية
Khat chewing is a risk factor for acute myocardial infarction: a case-control study
Author Al-Motarreb, A. 1; Briancon, S. 2; Al-Jaber, N. 1; Al-Adhi, B. 1; Al-Jailani, F. 1; Salek, M S. 3; Broadley, K J. 3
Institution (1)Al Thawrah Teaching Hospital, Sana'a, Yemen
(2)School of Public Heath, Clinical Epidemiology and Evaluation CHU, Nancy and School of Public Health, Nancy I Henri Poincare University, France
(3)Welsh School of Pharmacy, Cardiff University, UK
Title Khat chewing is a risk factor for acute myocardial infarction: a case-control study.[Miscellaneous]
Source British Journal of Clinical Pharmacology. 59(5):574-581, May 2005.
Abstract Aim: Khat chewing is a common habit in Yemen and east African countries. Millions of people chew khat leaves daily for its euphoric and energetic effects and to increase alertness. Cathinone, the main active substance in fresh khat leaves, has sympathomimetic effects which increase heart rate and blood pressure. The aim was to examine the hypothesis that khat chewing is a risk factor for acute myocardial infarction (AMI) using a hospital-based matched case-control study.
Method: Between 1997 and 1999, we selected 100 patients admitted to the Al-Thawra teaching hospital Sana'a ICU, Yemen with acute myocardial infarction. 100 control subjects, matched to cases for *** and age, were recruited from the outpatients clinics of the same hospital. A questionnaire was completed for case and control groups covering personal history of khat chewing, smoking, hypertension, diabetes and any family history of myocardial infarction. A blood sample was collected for performing lipid profiles. Cases and controls were compared by analysis conducted using conditional logistic regression which corrected for baseline imbalances leading to less biased estimations of odds ratio (OR). The risk associated with each classical factor and khat chewing habits was then investigated. OR values greater than 2.5 indicated a significant risk factor.
Results: Khat chewing was significantly higher among the AMI case group than control group (OR = 5.0, 95% CI 1.9-13.1). A dose-response relationship was observed, the heavy khat chewers having a 39-fold increased risk of AMI.
Conclusion: This study indicates that khat chewing is associated with AMI and is an independent dose-related risk factor for the development of myocardial infarction.
Copyright (C) 2005 Blackwell Publishing Ltd
Accession Number 00005249-200407000-00009.
Author Ali, Aiman A. 1; Al-Sharabi, Ali K. 2; Aguirre, Jose M. 3; Nahas, R. 4
Institution (1)Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Sana'a, Yemen
(2)Department of Periodontology, Faculty of Dentistry, University of Sana'a, Yemen
(3)Department of Stomatology, University of the Basque Country/EHU, Spain
(4)Consultant Oral Surgery-Implantology, Bremen, Germany
Title A study of 342 oral keratotic white lesions induced by qat chewing among 2500 Yemeni.[Article]
Source Journal of Oral Pathology & Medicine. 33(6):368-372, July 2004.
Abstract BACKGROUND: Qat chewing is a common habit in Yemen. Various studies demonstrated clear effects of this habit on the systemic organs of the human body. The lack of studies, however, on the effects of this habit on oral mucosa was the major motive of this study.
METHODS: This cross-sectional study was made on 2500 Yemeni citizens (mean age 27 years, 1818 males and 682 females). Clinical protocol was made for all cases with a full intraoral examination. A new grading system was applied for each case with oral white lesion.
RESULTS: Of our sample, 1528 cases (61.12%) were qat chewers; of them, 342 cases (22.4%) had oral keratotic white lesions at the site of qat chewing, while only 6 (0.6%) non-chewer cases had white lesions in their oral cavity (P < 0.000000, Odds ratio = 46.43, RR = 36.26). According to our grading system; 14, 5.9 and 2.4% were grade I, II and III.
CONCLUSIONS: We conclude that qat chewing can provoke the development of oral keratotic white lesions at the site of chewing. The prevalence of these lesions and its severity increase as duration and frequency increase.
Copyright (C) 2004 Blackwell Publishing Ltd.
Author Numan, Nabil
Institution National Institute of Psychiatry and Neurology, Semmelweis University, Budapest, Hungary
Title Exploration of adverse psychological symptoms in Yemeni khat users by the Symptoms Checklist-90 (SCL-90).[Report]
Source Addiction. 99(1):61-65, January 2004.
Abstract Aim: The present study was aimed at assessing associations between psychological symptoms and khat use in the Yemeni population.
Setting: The survey was performed in 2000/2001, in different zones including three urban and three rural areas.
Participants: The survey was carried out in 800 Yemeni adults (15-76), both male and female, representing mainly urban populations of students, state employees and housewives.
Design: A cross-sectional survey was undertaken using face-to-face interviews and no preset selection criteria regarding profession, socio-economic status, age or gender.
Measurement: The Symptoms Checklist-90 (SCL-90) was used containing 90 items, which cover nine scales of the following domains: somatization, depression, anxiety, phobia, hostility, interpersonal sensitivity, obsessive-compulsive, hostility, interpersonal sensitivity, paranoia and psychoticism. Details of khat use and socio-demographic data were also collected.
Findings: At least one life-time episode of khat use was reported in 81.6% of men and 43.3% of women. Male users tended to use more frequently. The incidence of adverse psychological symptoms was not greater in khat users; in fact, there was a negative association between the incidence of phobic symptoms and khat use.
Conclusions: Khat use is very common in the Yemeni population, particularly men, but it is not associated with adverse psychological symptoms.
(C) 2004 Blackwell Science Ltd.
Khat chewing and acute myocardial infarction
Al-Motarreb, A1; Al-Kebsi, M1; Al-Adhi, B1; Broadley, K J2
1Cardiac Unit, Department of Medicine, Al-Thawra hospital, Sana'a, Yemen
2Division of Pharmacology, Welsh School of Pharmacy, Cardiff, UK University, Cardiff, UK
Correspondence torofessor K J Broadley, Division of Pharmacology, Welsh School of Pharmacy, Cardiff University, Cathays Park, King Edward VII Avenue, Cardiff CF10 3XF, UK; BroadleyKJ.Cardiff.ac.uk
Accepted 24 October 2001
AMI, acute myocardial infarction; CPK, creatinine phosphokinase; LDH, lactate dehydrogenase; MDMA, 3,4-methylenedioxymethamphetamine,
Fresh leaves from khat trees (Catha edulis Celestrasae) are chewed daily by over 20 million people in Yemen and East African countries. Chewing khat (qat) is a popular social habit which has spread to Yemeni, Somali or East African communities in the USA and UK. 1 The pleasure derived from khat chewing is attributed to the euphoric actions of S-(-)-cathinone, a sympathomimetic amine with properties similar to amphetamine. 2 Although cathinone is restricted in the UK under the Misuse of Drugs Act 1971, khat possession and use are not. 1 Cathinone increases blood pressure and heart rate through noradrenaline (norepinephrine) release from peripheral neurones similar to amphetamine. 2 Controlled studies in human volunteers have shown increases in blood pressure after chewing khat coinciding with raised plasma cathinone concentrations. 3 Cardiovascular complications from cathinone abuse may therefore be similar to those of amphetamine. We have noticed increasing numbers of patients presenting with acute heart attack in the evening either during or after a khat chewing session. This prospective study was therefore undertaken to examine whether khat chewing has a role in precipitating acute myocardial infarction.
PATIENTS AND METHODS
One hundred and fifty seven patients of Arabian origin admitted to the intensive care unit of Al-Thawra hospital, Sanaa, Yemen with acute myocardial infarction (AMI) between November 1995 and November 1997 underwent history taking, clinical examination, resting ECG monitoring, and determination of serum concentrations of total cholesterol, triglycerides and the cardiac enzymes, lactate dehydrogenase (LDH) and creatinine phosphokinase (CPK). Patients unable to provide the precise time of onset of symptoms were excluded. Patients were divided into khat chewers (79%) and non-chewers. Diagnosis of AMI was based on clinical symptoms, recent ECG changes, and a doubling of serum CPK concentrations. The criteria for positive diagnosis from ECG changes were: pathological Q waves, 1 mm ST segment elevation in two or more leads, a new left bundle branch block, or new persisting ST-T changes diagnostic of non-Q wave MI. Serum concentrations of total cholesterol, triglyceride, CPK and LDH were regarded as elevated when they exceeded 5.2 mmol/l, 0.9–1.6 mmol/l, 24–190 u/l, and 230–460 u/l, respectively.
Ninety two per cent of khat chewers consumed khat daily and almost 90% consumed khat for more than three hours daily; 89.8% of patients were male, of which 83% were khat chewers, while 43.7% of female subjects chewed khat. The average age (SEM) and range of khat chewers (47 (9) and 27–60 years) were higher than non-chewers (55 (8) and 40–75 years). Twenty one per cent of khat chewers presenting with AMI were in the 20–29 and 30–39 year age groups, whereas there were none among the non-chewers (fig 1A). The incidence of hypertension or diabetes did not differ between the groups, but more patients had a family history of cardiovascular disease among non-khat chewers (14.8%) than chewers (5.4%). Serum concentrations of CPK and LDH were raised above normal in virtually all patients admitted, confirming the existence of AMI. No differences in the distribution of type of AMI were noted between khat chewers and non-chewers.
Figure 1. (A) Age band distribution of patients presenting with acute
myocardial infarction. Patients were divided into khat chewers (closed histograms) and non-chewers (open histograms). (B) Time of onset of symptoms of acute myocardial infarction. The numbers of patients reporting onset of symptoms during the khat effective period (1400–2400 hours) or non-khat effective period (0000–1330 hours) expressed as a percentage of the total group size.
The most surprising result was a difference in the peak period for presentation with symptoms of AMI between khat chewers and non-chewers. In non-chewers, there was a progressive increase in numbers from 0300 to 0900 hours and after 1500 hours there was a gradual decline until there were none in the last three hours of the day. This confirms the pronounced circadian rhythm in the time of onset of acute myocardial infarction which peaks in the early hours of the day 4 and is associated with increased sympathetic outflow and circulating catecholamines producing increases in heart rate, blood pressure, myocardial contractility, and oxygen demand soon after rising. By contrast, in khat chewers the peak period of presentation was during the afternoon, commencing at 1500 hours, continuing until 2100 hours, and then declining towards a trough at 0300 hours. The mean (SEM) time of onset of symptoms was significantly (p < 0.005) later in the khat chewers (1406 (0050) hours) than in the non-chewers (1088 (0092) hours). Since khat chewing sessions usually commence in the early afternoon and may extend into the evening, the khat effective period was defined as 2 pm to 12 midnight. Fifty nine per cent of khat chewers had onset of symptoms during the khat-effective period, compared with only 36.4% of non-khat chewers (fig 1B).
Increases in blood pressure and heart rate have been observed in human volunteers after chewing khat which coincide with raised plasma cathinone concentrations, 3 the peak occurring at 1.5–3.5 hours. 5 Thus, we suggest that the shift in the circadian rhythm is associated with khat chewing. The only other major difference between khat chewers and non-chewers was that 80.6% of khat chewers had an increased desire to smoke ******* compared with only 15.2% of non-chewers. A uniform pattern of smoking can, however, be assumed throughout the day. The shift in the time of presentation with AMI could not therefore be attributed to the smoking habit but to the khat chewing which occurred only in the afternoon and early evening. The other difference was that serum triglyceride and total cholesterol concentrations were above normal in almost twice the number of non-khat chewers admitted with AMI (27.5% and 24.1%, respectively) than the khat chewers (16.0% and 16.8%). Raised serum lipid concentrations are a recognised risk factor for cardiovascular disease, 6 implying that khat chewing and smoking were determinants for precipitating AMI in the khat chewers, while in non-chewers other risk factors such as the raised serum lipids played a role.
Cathinone, the main constituent of khat, is an amphetamine-like substance which releases endogenous catecholamines from peripheral and central neurones. The relation between misuse of amphetamine 7 and its analogue, “ecstasy” (3,4-methylenedioxymethamphetamine, MDMA), 8 and AMI and arrhythmias, respectively, is well documented. Cardiovascular complications from cathinone abuse may therefore be similar to those of amphetamine. AMI could be precipitated by the increased myocardial oxygen demands from cardiac stimulation and peripheral vasoconstriction by cathinone and coronary vasoconstriction. Thus, our study demonstrates that khat chewing is a potential risk factor for AMI, further highlighted by the high proportion of khat chewers with AMI under 45 years of age.
1. Griffiths P. Qat use in London: a study of qat use among a sample of Somalis living in London. Home Office drugs prevention initiative. London: Home Office, 1998. [Context Link]
2. Kalix P. Cathinone, a natural amphetamine. Pharmacol Toxicol 1992;70:77–86. Bibliographic Links Library Holdings [Context Link]
3. Widler P, Mathys K, Brenneisen R, et al. Pharmacodynamics and pharmacokinetics of khat: a controlled study. Clin. Pharmacol Ther 1994;55:556–62. [Context Link]
4. Selwyn AP, Raby K, Vita JA, et al. Diurnal rhythms and clinical events in coronary artery disease. Postgrad Med J 1991;67:S44–7. Bibliographic Links Library Holdings [Context Link]
5. Halket JM, Karasu Z, Murray-Lyon IM. Plasma cathinone levels following chewing khat leaves (Catha edulis Forsk.). J Ethnopharmacol 1995;49:111–3. Full Text Bibliographic Links Library Holdings [Context Link]
6. Shepherd J, Betterridge DJ, Durrington P, et al. Strategies for reducing coronary heart disease and desirable limits for blood lipid concentration: guidelines of the British Hyperlipidaemia Association. BMJ 1987;295:1245–6. Bibliographic Links Library Holdings [Context Link]
7. Bashour TT. Acute myocardial infarction resulting from amphetamine abuse: a spasm-thrombus interplay? Am Heart J 1994;128:1237–9. Bibliographic Links Library Holdings [Context Link]
8. Henry JA, Jeffries KJ, Dawling S. Toxicity and deaths from 3,4-methylene dioxymethamphetamine (“ecstacy”). Lancet 1992;340:384–6. [Context Link]
017 KHAT (CATHA EDULIS) SUPPRESSES APPETITE BUT HAS NO EFFECT ON GHRELIN OR PEPTIDE YY LEVELS
[Abstracts: Small bowel/nutrition free papers]
Murray, C. D. R.1 2; Le Roux, C.2; Ghatei, M.2; Emmanuel, A. V.1,2; Murray-Lyon, I. M.2
1St Mark’s Hospital, Harrow; 2Imperial College of Science, Technology and Medicine, London, UK
Background: The leaves of the Khat plant are chewed in the Yemen and parts of East Africa for their pleasurable effects. Chewing releases several sympathomimetic alkaloids, slowing gastric emptying and decreasing appetite, through unknown mechanisms. Plasma ghrelin levels increase with hunger and decrease immediately post-prandially. Peptide YY is released following a meal and exogenous administration decreases appetite. Both these gut derived peptides may have a role in hunger and satiety. It is not known whether the anorexigenic effects of khat are mediated through changes in these gut peptides.
Methods: Six habitual male (median age 40 years, range 36–56) khat chewers attended on two separate occasions for a period of three hours during which they chewed either khat leaves or lettuce after a minimum 6 hour fast. Mean arterial blood pressure (MAP) and pulse rate (PR) were monitored throughout. Blood samples were taken at 0, 30, 60, 120, and 180 minutes and analysed for PYY and ghrelin levels. Subjective assessment of appetite, hunger, and fullness were assessed with standardised description anchored visual analogue scores at the same time as blood testing. Statistical analysis was by ANOVA.
Results: The mean baseline level of ghrelin was 398 pmol/l, and of PYY was 35 pmol/l, compatible with pre-meal levels. Chewing lettuce had no effect on ghrelin or PYY levels and had no effect on subjective feelings of hunger, appetite, and satiety (p>0.05). Chewing khat also had no effect on ghrelin or PYY levels (p>0.05), although it significantly decreased subjective feelings of hunger and appetite and increased fullness (p<0.01). Khat, not lettuce, significantly increased PR and MAP (p<0.05).
Conclusions: Chewing khat decreases subjective feelings of hunger and appetite, increases fullness and results in heightened sympathetic tone. However khat has no effect on ghrelin or PYY levels. This raises the possibility that the anorexigenic effect of khat is mediated through central sympathomimetic mechanisms, independent of these peptides.
Accession Number: 00003970-200504002-00017
J Neurol Neurosurg Psychiatry 1999;67:556 ( October )
Letters to the editor
Leukoencephalopathy associated with khat misuse
The leaves of the tree Catha edulis, or khat (also qat and kat) are chewed by a large proportion of the adult population of the Yemen, and throughout Saharan and sub-Saharan Africa. The leaves are also chewed by members of the Yemeni and Somali community in the United Kingdom.1 The psychoactive constituents of khat are cathin (d-norisoephedrine), cathidine, and cathinone (an alkaloid with a structure resembling ephedrine and amphetamine) and users report a mild euphoria similar to that of amphetamine.1 Khat is acknowledged as a precipitant of psychosis and has also been reported to cause cognitive impairment.2 We report a case in which khat chewing has been associated with a severe and disabling neurological illness.
A 56 year old Somali living in the United Kingdom for the past 18 years was admitted to a psychiatric hospital with a 5 week history of progressive confusion and agitation. His family reported that he had been chewing khat, in their opinion to excess, every day during that time but had stopped 2 days before admission. There was one previous admission to hospital 9 months previously with khat induced psychosis, from which he recovered without complications within 24 hours. On this occasion, shortly after admission, his conscious level deteriorated abruptly and he was referred for neurological opinion. He was apyrexial and general medical examination was normal. He opened his eyes spontaneously but there was no verbal response and he did not obey commands. He withdrew all four limbs to pain. Upper and lower limbs were held in flexion with markedly increased tone. Reflexes were brisk but equal. The right plantar was extensor. There were bilateral palmomental and grasp reflexes.
Full blood count, urea and electrolytes, glucose, liver function tests, thyroid function test, viral serology, and malaria screen all gave normal results. Tests for HIV antibody, serum angiotensin converting enzyme, white cell enzymes, and serum and urinary porphyrins were negative. Erythrocyte sedimentation rate on admission was 58 mm/h.
Examination of the CSF showed normal opening pressure, protein 0.27 g/l, glucose 4.3 mmol/l (blood glucose 6.1 mmol/l), and no cells. His initial EEG was abnormal with diffuse slow waves indicative of widespread cerebral dysfunction.
A chest radiograph and ultrasound examination of the abdomen were normal. Cranial MRI, although contaminated by movement artefact, showed diffuse abnormality in the deep cerebral white matter of both cerebral hemispheres. Fourteen days after admission he was witnessed to have a single brief adversive seizure with eye and head deviation to the right.
The patient was admitted to a rehabilitation unit. His mini mental state examination score and Barthel scores were zero. Feeding by percutaneous gastrostomy was started. A trial of intravenous methylprednisolone (1 g on 3 consecutive days) gave no benefit. Repeated EEGs (on four occasions) showed diffuse slow waves only. A second MRI (figure) 3 months after onset of symptom showed the presence of a continuing diffuse extensive abnormal signal in the deep white matter of both cerebral hemispheres with marked cortical atrophy. Brain biopsy (via right frontal craniotomy) was performed 3 months after the onset of his illness. There was no evidence of acute inflammation, vasculitis, or infarction.
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Cranial MRI 3 months after onset of symptoms showing diffuse signal abnormality in the deep white matter of both cerebral hemispheres. There is also marked cortical atrophy.
While undergoing rehabilitation there has been slow improvement in his cognitive and locomotor function. After 1 year he is able to open and close his eyes, occasionally verbalise, localise pain, and obey simple commands. His plantars are flexor but he has persistent grasp and palmomental reflexes. His nutrition is maintained by gastrostomy and he has an indwelling catheter.
The clinical presentation, EEG, and MRI findings suggest a rapidly progressive leukoencephalopathy. There are no previous reports of leukoencephalopathy in association with khat or amphetamine misuse; it has, however, been reported in association with other recreational drugs taken by mouth or inhalation.3 4 An alternative for this man's presentation is a necrotising vasculitis, a well described complication of oral amphetamine misuse.5 The clinical features, MRI appearance, brain biopsy, absence of haemorrhage, and lack of response to steroids make this unlikely.
The likely precipitant of this man's illness seems to be his use of khat. A drug screen on admission was negative, and his family denied misuse of other drugs. It remains possible that the sample of khat chewed by this man was contaminated. We are unaware of any previous reports of khat misuse with severe neurological deterioration; previous cases may not have been investigated or reported. In reporting this case our intention is to alert others to a possible complication of the misuse of this drug. Evidence of other cases would provide a powerful argument for the restriction of import and sale of khat.
P K MORRISH, N NICOLAOU, P BRAKKENBERG, P E M SMITH
Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF4 4XN, UK
Correspondence to: Dr PK Morrish, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF4 4XN, UK. Telephone 0044 1222 747747; fax 004 1222 744166; email: morrishpk.cardiff.ac.uk
1. Pantelis C, Hindler CG, Taylor JC. Use and abuse of khat (Catha edulis): a review of the distribution, pharmacology, side effects and a description of psychosis attributed to khat chewing. Psychol Med 1989;19:657-668[Medline].
2. Khattab NY, Galal A. Undetected neuropsychological sequelae of khat chewing in standard aviation medical examination. Aviat Space Environ Med 1995;66:739-744[Medline].
3. Celius EG, Andersson S. Leucoencephalopathy after inhalation of ******: a case report. J Neurol Neurosurg Psychiatry 1996;60:694[Medline].
4. Walters EC, van Wijngaarden GK, Stam FC, et al. Leucoencephalopathy after inhaling "******" pyrolysate. Lancet 1982;ii:1233-1237.
5. Salanova V, Taubner R. Intracerebral haemorrhage and vasculitis secondary to amphetamine use. Postgrad Med J 1984;60:429-430[Abstract].
[FRAME="11 70"]A memorable experience: The qat party[/FRAME]
A memorable experience: The qat party
Baron, D N
Retired professor of chemical pathology, London
About 15 years ago I went on a medical academic visit to the Yemeni capital, Sana'a. Everyone was very hospitable, and one afternoon a Yemeni colleague invited me to join him socially to chew qat [khat]. This grows as a small tree (Catha edulis) that flourishes around the Red Sea, with leaves like privet. These leaves contain cathinone ([small alpha, Greek]-aminopropiophenone, related to amphetamine) as the most powerful substance, which breaks down within days to the weaker cathine (norpseudoephedrine), and related compounds. So they act as uppers; a near equivalent Western upper is "speed". For maximum potency qat must be picked in the morning and chewed that afternoon, though it is transported by air and used by the Yemeni community in Britain and elsewhere. Doctors in Britain might see patients with problems related to qat.
We went to a middle class house where there were about 10 local men, and sat in a room around a low Table coveredwith rugs: a pile of twigs covered with leaves, and a cup were already laid out by each place. I was proudly told that the leaves were top quality, and was instructed what to do. I picked a few leaves, chewed them to a pulp, then transferred the pulp to my left cheek and sucked the almost tasteless juice. The process was repeated over the next couple of hours while my cheek got fatter and fatter. A manservant came round regularly to fill our cups with weak tea. There were hookahs in the middle of the table, and I took turns in inhaling the ******* smoke. The main effect on me was insensibility to the passage of time. When the party ended after about three hours and we spat out the leaves, my colleague and I went to the hammam with the water heated by burning bullocks' heads that were stored in piles outside-but that is another story-I thought that barely an hour had passed. I was euphoric, very wide awake, extremely friendly, and talkative with a free flow of ideas, but afterwards could remember little of the conversation. My mouth was dry, hence the need for much fluid. The effects wore off after about an hour.
It was explained to me that there are several problems from the ubiquity of qat chewing. In the town in the mornings you see the stalks being brought in from plantations that should be producing food, or growing coffee for export, but qat brings better profits for the farmers. In the afternoons men are seen in public alone or in groups, as well as being at home (where women also indulge), chewing qat for hours instead of working, and using money that should have been spent on their households.
Every society has its own forms of chemical escape.
D N Baron, retired professor of chemical pathology, London
Accession Number: 00002591-199908210-00029
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