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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.

Treatment of an unusual gingival recession induced by khat chewing habit.Gingival recession induced by khat chewing was confirmed by many authors. However, there is no proposal for treatment of gingival recession induced by chewing khat.A systemically healthy nonsmoking male khat chewer aged 38 years presented with class III gingival recession around the lower right incisor. The treatment approach involved a subepithelial connective tissue graft with a tunnel procedure.A full coverage of khat-induced recession was achieved by using tunnel technique utilizing subepithelial connective tissue graft at 1-year follow-up.Treatment of gingival recession, including those induced by mechanical trauma such as chewing habits is considered as an esthetic demand and it is the responsibility of the clinician to determine the proper treatment plan for the correcting esthetic and functional defects of the periodontal tissues. How to cite this article: Al-Akhali MS, Successful Management of Khat Chewing-induced Gingival Recession by Using Tunnel Technique Utilizing Subepithelial Connective Tissue Graft: A Case Report. J Contemp Dent Pract 2019;20(10):1235-1238.

BackgroundCongenital malformations are structural, functional, and metabolic defects that develop during the organogenesis period and present at birth or later in life. There has been little research on congenital malformations in Ethiopia, knowledge on the incidence of birth defects at birth is unknown and the etiologies of the anomalies are limited. This study, therefore, aimed to assess the modifiable risks of congenital anomalies among women in Bale zone hospitals, Ethiopia.MethodsAn unmatched case-control study was conducted from February 2018 to January 2019 in the Bale zone; namely Goba referral hospital, Robe, Ginnir and Dolomena hospitals. A total of 409 women were selected. Mothers who gave birth with any type of congenital malformation were assigned as cases and those who gave live births without any congenital abnormalities were assigned as controls. Controls were selected by the lottery method from the labor ward. For each case, two consecutive controls were included. Data were entered into Epi-data 3.1 and exported into Statistical Package for the Social Sciences (SPSS) version 21 for analysis. Logistic regression was conducted to analyze the data.ResultsAlarmingly, women who had been exposed to pesticides during the current pregnancy were two times more prone to give congenital malformed infants than their counterparts (AOR = 3.19; 95% CI = 1.31, 10.96). Additionally, those women who chewedkhatduring the periconceptional period were two times more likely to have congenital malformed infants as compared to women who did not engage in this activity (AOR = 2.40; 95% CI = 1.11, 5.19).ConclusionsUrgent attention needs to be given by public health professionals and services tokhatchewing and maternal exposure to pesticides during pregnancy to reduce the risk of congenital malformations.

Khat contains the amphetamine-like cathinone, and can trigger onset of schizophrenia and exacerbate pre-existing psychosis. However, it remains unknown whether the use of khat complicates the outcome of schizophrenia treatment.We tested the hypothesis that patients with schizophrenia who are using khat will fail to respond to standard antipsychotic treatment.We retrospectively studied a consecutive series of patients who presented to an adult psychiatric clinic in Al-Amal Psychiatric Hospital in Jazan, Saudi Arabia, between January 1, 2013 and December 31, 2016. Patients with newly diagnosed schizophrenia on antipsychotic monotherapy (n = 1007, 817 men) were included and categorized into khat and non-khat users. A khat chewing index was developed to further categorize low, mild, moderate and heavy khat users. Antipsychotic medications were reviewed to determine their potential and the cause of substitution in association with khat use.There were 483 (48%) khat users. Olanzapine, haloperidol and aripiprazole were the most frequently used drugs (46.3%, 15.6% and 10%, respectively). The retention rate of the initial drug differed between the khat users and nonusers (53.8% and 78.4%, respectively). The proportion of moderate and heavy users (55% and 49%, respectively) who changed their initial drug was greater than that of low and mild users (35.6% and 44.7%, respectively). Lack of drug efficacy was the most appealing reason for switching the initial drug among moderate (51.7%) and heavy khat users (48.4%).Khat use hinders an individual's response to initial antipsychotic drug treatment for schizophrenia. Further studies are warranted to investigate the treatment decisions for this group of patients.آثار استخدام القات على استجابة مرضى الفصام المشخصين حديثًا للأدوية المضادة للذهان: دراسة استرجاعية.طاهر حكمي، محمود محمود، بركات محمد، ماجد السطوحي.القات يحتوي على «كاثينون» مشابه للأمفيتامين، ويمكن أن يؤدي إلى ظهور الفصام وتفاقم الذهان الموجود مسبقًا. ومع ذلك، لا يزال من غير المعروف ما إذا كان تعاطي القات يعقّد ويفاقم نتائج علاج الفصام.هدفت هذه الدراسة إلى اختبار فرضية أن مرضى الفصام الذين يستخدمون القات سيفشلون في الاستجابة للعلاج المعياري المضاد للذهان.درسنا بأثر رجعي سلسلة متتالية من المرضى الذين قدموا إلى عيادة نفسية للبالغين في مستشفى الأمل والطب النفسي في جازان، المملكة العربية السعودية، في الفترة ما بين 1 يناير/ كانون الثاني 2013 و31 ديسمبر/ كانون الأول 2016. مرضى الفصام الذين تم تشخيصهم حديثًا على العلاج الأحادي بمضادات الذهان (العدد = 1007 ؛ 817 رجلاً) تم إدراجهم وتصنيفهم إلى متعاطي القات وغير القات. تم تطوير مؤشر مضغ القات لتصنيف متعاطي القات المنخفض، والمعتدل، والمتوسط، والثقيل. تمت مراجعة الأدوية المضادة للذهان لتحديد إمكاناتها وسبب الاستبدال بالاشتراك مع استخدام القات.كان هناك 483 شخصًا (48٪) من مستخدمي القات. وكانت الأدوية الأكثر استخدامًا هي أولانزابين وهالوبيريدول وأريبيبرازول (46.3٪ و15.6٪ و10٪ على التوالي). واختلف معدل استبقاء العقار الأولي بين متعاطي القات وغير المتعاطين (15.8٪ و78.4٪ على التوالي). وكانت نسبة معتدلي التعاطي للقات وكثيفي التعاطي (55٪ و49٪ على التوالي) الذين غيّوا تعاطيهم الأولي أكبر من نسبة منخفضي التعاطي ومتوسطي التعاطي (35.6٪ و44.7٪ على التوالي). وكان عدم فعالية الأدوية هو السبب الأكثر لتغيير الدواء الأولي بين متعاطي القات المعتدلين (51.7٪) ومتعاطي القات بكثافة (48.4٪).يعوق تعاطي القات استجابة المصاب بالفصام للعلاج بالدواء الأولي المضاد للذهان. وهناك ما يبرر إجراء مزيد من الدراسات لاستقصاء قرارات العلاج لهذه الفئة من المرضى.Effets de la consommation de khat sur la réponse aux médicaments antipsychotiques chez les patients atteints de schizophrénie récemment diagnostiquée : étude rétrospective.Le khat contient de la cathinone de type amphétamine, qui peut déclencher une schizophrénie et exacerber une psychose préexistante. Cependant, on ne sait toujours pas si l'utilisation du khat complique le résultat du traitement de la schizophrénie.Notre objectif était de tester l'hypothèse selon laquelle les patients atteints de schizophrénie qui consomment du khat ne répondront pas au traitement antipsychotique standard.Nous avons procédé à une étude rétrospective sur une série de patients qui se sont présentés dans une clinique psychiatrique pour adultes à l'hôpital psychiatrique Al-Amal de Jazan, en Arabie saoudite, entre le 1er janvier 2013 et le 31 décembre 2016. Les patients souffrant de schizophrénie nouvellement diagnostiquée et suivant une monothérapie antipsychotique (n = 1007, 817 hommes) ont été inclus dans l’étude et classés en deux catégories : les consommateurs et les non consommateurs de khat. Un indice de consommation du khat a été mis au point pour mieux catégoriser les personnes ayant une consommation faible, légère, modérée et importante. Les médicaments antipsychotiques ont été examinés afin de déterminer leur potentiel et la cause de la substitution en association avec la consommation de khat.Il y avait 483 consommateurs de khat (48 %). L'olanzapine, l'halopéridol et l'aripiprazole étaient les médicaments les plus fréquemment utilisés (46,3 %, 15,6 % et 10 %, respectivement). Le taux de rétention du médicament initial différait entre les consommateurs et les non consommateurs de khat (53,8 % et 78,4 %, respectivement). La proportion de personnes ayant une consommation modérée et importante (55 % et 49 %, respectivement) qui ont changé leur médicament initial était supérieure à celle des personnes ayant une consommation faible et légère (35,6 % et 44,7 %, respectivement). Le manque d'efficacité du médicament a été la raison la plus populaire pour changer le médicament initial chez les personnes ayant une consommation modérée (51,7 %) et importante (48,4 %).La consommation de khat entrave la réponse d'un individu au traitement antipsychotique initial de la schizophrénie. Des études supplémentaires sont nécessaires pour examiner les décisions thérapeutiques pour ce groupe de patients.

Introduction Glucocorticoid activity is disrupted in substance users including khat chewers who also use tobacco. Anger, dysphoria, and anxiety can mediate this relationship. The aim of this study was to contrast emotion dysregulation and substance use variables as predictors of post-stress cortisol output. Materials and methods Comparable numbers of males (n = 90) and females (n = 85) including controls, khat only, and concurrent khat and tobacco users participated in a stress study. Depressive affect, anxiety, anger, substance use patterns, and saliva samples were collected following a standardized laboratory stress manipulation. Results Regression analysis showed that high depression and low anxiety was associated with high post-stress cortisol, but only in co-users of tobacco and khat. Males, but not females, showed a significant association between co-use of khat and tobacco and cortisol, which appears to be mediated by frequency of use. The link between anxiety and post-stress cortisol in the co-users remained significant after controlling for nicotine dependence and substance use frequency. Conclusion Anxiety predicted the neuroendocrine consequences of concurrent use of tobacco and khat above and beyond sex, nicotine dependence, anger, and substance use frequency. Sex differences, however, are related to differences in nicotine dependence.

The chewing of the leaves of Catha edulis (khat) has been implicated in the development of liver disease, but no controlled observations have been undertaken. The objective of the present study was to determine whether khat chewing is associated with development of chronic liver disease (CLD). A case-control study was conducted at two public hospitals in Harar, Ethiopia, between April 2015 and April 2016. A consecutive sample of 150 adult hospital attendees with CLD were included as cases, and 300 adult hospital attendees without clinical or laboratory evidence of CLD were included as controls. Khat consumption was quantified in "khat years"; 1 khat year was defined as daily use of 200 g of fresh khat for 1 year. A logistic regression model was used to control for confounders. There was a significant association between chewing khat and the risk for developing CLD (crude odds ratio, 2.64; 95% confidence interval [CI], 1.56-4.58). In men, this risk, following adjustment for age, alcohol use, and chronic hepatitis B/C infection, increased with increasing khat exposure; thus, compared to never users the adjusted odds ratios were for low khat exposure 3.58 (95% CI 1.05-12.21), moderate khat exposure 5.90 (95% CI 1.79-19.44), and high khat exposure 13.03 (95% CI 3.61-47.02). The findings were robust in a post hoc sensitivity analysis in which individuals with identifiable risk factors for CLD were excluded. Conclusion A significant association was observed between chewing khat and the risk for developing CLD, and in men the association was strong and dose-dependent, suggesting a causal relationship; as the prevalence of khat chewing is increasing worldwide, these findings have major public health implications. (Hepatology 2018;68:248-257).

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.

Background: Pesticide applicators are at risk of developing neurological symptoms and neurobehavioral deficits. This risk may increase if the applicator chews stimulant plants like khat. Objective: To examine the sociodemographic and exposure determinants of neurological symptoms presentation, neurobehavioral performance, and cholinesterase activity among pesticide applicators in a vector control unit, Saudi Arabia. Methods: In a cross-sectional study, 30 pesticide applicators and 32 non-applicators from a vector control unit in Jazan region, Saudi Arabia, were studied. The study participants completed an exposure and medical questionnaire, and a neurobehavioral test battery. Their blood samples were also tested for the measurement of butyryl cholinesterase (BChE). Results: The mean blood BChE level was no significantly different between the applicators and non-applicators. Working in pesticide application and chewing khat were significant predictors of the neurological symptoms presentation and neurobehavioral deficits among the study participants. Each factor was associated with about 40% of the symptoms included in the questionnaire. Exposure to pyrethroids was significantly associated with a decrement in symbol digit test latency, tapping (TAP) non-preferred hand, and TAP alternating hands measures, representing the executive and motor speed/coordination functions. Khat chewing was associated with TAP preferred and non-preferred hands and serial digit learning measures, representing the memory and motor speed/coordination functions. Conclusions: It seems that being exposed to pyrethroids and chewing khat are associated with neurological and neurobehavioral drawbacks among pesticide applicators.

Backgrounds: People in Yemen and in East African countries chew khat more than five hours daily. Objectives: The aim of this study was to assess the relationship between khat and occlusal caries progression. Methods: A cohort study was carried out among 98 Yemeni khat chewers and 101 non-chewers aged 18-35 years old with early occlusal caries lesions. All participants answered questions on socio-demographic, khat , oral hygiene , sugar intake, and oral health knowledge at baseline. All posterior teeth with an early enamel lesion on occlusal surfaces detected by visual inspection at baseline were also subjected to DIAGNOdent assessment to confirm early lesion (DIAGNOdent reading 13-24). Participants were re-examined after 12 weeks. Caries progression was considered to occur when the DIAGNOdent reading was >25. Data were analyzed using Relative risk, Mann–Whitney U test, a Wilcoxon Signed-Rank test and logistic regression analysis. Results: Occlusal caries progression incidence between khat chewers and non-chewers, with the relative risk was 1.68. There was no significant difference in occlusal caries progression on chewing side and non-chewing side among khat chewers. Khat chewing was a statistical predictor for those with low income. Conclusion: Khat is a risk factor for occlusion caries progression among low income group. Keywords: Khat, caries progression, DIAGNOdent pen.

BackgroundThe burden of hypertension is more devastating in low-and middle-income countries, including sub-Saharan Africa than in high-income countries. Among the modifiable risk factors, dyslipidemia and khat chewing were expanding at an alarming rate in Ethiopia but were still underestimated. Thus, this study aimed to assess heavy khat (Catha edulis) chewing and dyslipidemia as modifiable hypertensive risk factors among patients in the southwest, Ethiopia.MethodsA facility-based case-control study was conducted among 136 cases and 270 controls from May 15 to July 30, 2017. A consecutive sampling technique was used in this study. Epi data version 3.1.1 and SPSS version 21 were used for data entry and analysis. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed. Both crude and adjusted odds ratios and 95% confidence intervals were reported.ResultsThe majority of the cases had a total cholesterol to high-density lipoprotein ratio of >5 (72.1%). The odds of hypertension increased among participants who had attended no formal education [AOR = 2.25, 95% CI: (1.05–4.82)], history of alcohol consumption [AOR = 5.93,95% CI:(3.11–11.30)], moderate khat chewing [AOR = 3.68, 95% CI:(1.69,8.01)], heavy khat chewing [AOR = 18.18, 95% CI: (3.56–92.89)], mild intensity physical activity [AOR = 3.01, 95% CI: (1.66–5.47)], type of oil used for food preparation [AOR = 2.81, 95% CI: (1.49–5.28)], and dyslipidemia [AOR = 6.68, 95% CI: (2.93–15.23)].ConclusionThe study showed that modifiable risk factors were the major factors associated with the development of hypertension. The findings of this study highlighted that health education is needed to focus on physical exercise, quitting excess alcohol consumption, quitting khat chewing by giving special emphasis to those who had no formal education. In addition, consideration should be given to a healthy diet free of cholesterol and unhealthy behavior.

Khat, a plant native to East Africa, has amphetamine-like psychoactive constituents, and is a potential risk factor for HIV infection. Chronic use can cause cognitive impairment and other mental disorders, raising concerns about effects on retention and adherence with HIV care. During 2013–2014, 322 Ethiopian patients newly enrolled at HIV clinics in Dire Dawa and Harar were surveyed about khat use and prospectively followed for 1 year; 9% died, 18% transferred care to other clinics, and 22% were lost to follow-up (LTFU) (no clinic visit for >3 months). Of 248 patients who received a 12-month follow-up survey, 37% used khat in the year after enrollment, with a median use of 60 h in a typical month. Those using khat ≥60 h/month (median among users) were more likely than others to be LTFU (31% vs. 16%, p = .014); those using khat ≥150 h/month (upper quartile) had 44% LTFU rates versus 16% for others (p = .002). Complete 3-day adherence (taking all doses) of antiretroviral therapy was reported by 77% of those using khat ≥60 h/month versus 95% of all others (p

Background Psychoactive substance use has become a major public health problem among students in Ethiopian universities. Hence, this study aimed to investigate the magnitude and determinants of psychoactive substances use (khat chewing, alcohol drinking and cigarette smoking) among undergraduate students of Woldia University, Ethiopia. Methods Institution based quantitative cross-sectional study was employed on Woldia University students in April 2015. 730 students were included in the study. Data were collected using self-administered questionnaires. EpiData version 3.02 was used to enter data. Then, data were exported to SPSS version 20 for analysis. Results The lifetime prevalence of alcohol drinking, khat chewing and cigarette smoking among the study students were 33.1, 13 and 7.9%, respectively. Likewise, the current prevalence of alcohol drinking, khat chewing and cigarette smoking was 27.9, 10.4 and 6.4%, respectively. More than half of the surveyed students (59.1%) were introduced to psychoactive substance use by peer pressure. About 66% of the study participants believed that psychoactive substances are important for relaxation, and 19% to relief from stress. Students who were Muslims [adjusted odds ratio (AOR) 3.74, 95% CI (1.57, 8.91)], Oromo ethnic group [AOR 2.63, 95% CI (1.19, 5.81)], ever drunk alcohol [AOR 6.32, 95% CI (2.96, 13.48)] and ever smoked cigarette [AOR: 9.16, 95% CI (4.33, 19.38)] were positively associated with khat chewing. Furthermore, pocket money and ever khat chewing were associated with alcohol drinking and cigarette smoking. Conclusion This study showed that psychoactive substances use is somewhat prevalent among students in Woldia University. Hence, support of religious institutions in providing education aimed at preventing substance use, establishing and strengthening peer educators in the university are important interventions to tackle psychoactive substances use.

Khat (Catha edulis Forsk) is a natural psychoactive substance which contains two main addictive substances; Cathine and Cathinone. Khat is widely used in east Africa and southern Arabian Peninsula. Khat chewers believe that it improves work capacity and increases energy level and alertness. That is why we aimed in this study to investigate the physiological and ergogenic effects of khat extract.This study is an experimental study conducted at the Substance Abuse Research Centre in Jazan University, Saudi Arabia. Thirty healthy young volunteers were randomly assigned into two experimental groups. The first group ingested 45 g of grounded khat leaves extract mixed with juice in the first session then placebo (juice only) in the second session. While the second group ingested the placebo in the first session and the grounded khat leaves with juice in the second session. Experiments were done between December 2012 and March 2013. We recorded the blood pressure, heart rate, grip strength, and reaction time every 15 min for 75 min after each ingestion. The study proposal was reviewed and approved by Research Ethics Committee (REC) of the Medical Research Centre in Jazan University.The results showed the consumption of 45 g of grounded khat leaves contributed to the increase in blood pressure (SBPDBP) and reaction time (p0.05); but had no significant effect on heart rate and grip strength (p0.05).The findings of this study showed that Khat has an acute effect on some physiological parameters. These findings support the prohibition of cathinone and cathine by the World Anti-Doping Agency (WADA, 2016).

Background: Chronic periodontal diseases are one of diabetes mellitus complications. The present study aims to compare the periodontal status of type II diabetic patients to a control group and assess the role of risk factors in both groups. Materials and methods: A case-control study was conducted of 270 individuals (132 type II diabetics and 138 non-diabetics). Full mouth periodontal examination including plaque index, gingival bleeding, gingival recession, clinical attachment loss (CAL), tooth mobility, furcation involvement and the number of missing teeth. The case group was subdivided according to glycosylated hemoglobin (HbA1c) status (poorly controlled HbA1c >8 and well controlled HbA1c ≤8) Likewise, the duration of diabetes mellitus as short or long duration (DM ≤10 or >10). The diabetic group was also subdivided according to smoking and Khat chewing habits. Result: The severity of periodontal disease among type II diabetic patients were significantly higher compared to the control group regarding the plaque index 2.6 (1.6-4.3), bleeding on probing 3.5 (2.3-13.0), gingival recession 2.0 (1.2-3.4), furcation involvement 4.0 (2.3-6.7), clinical attachment loss 5.7 (3.1-10.5), tooth mobility 2.0 (1.2-3.4), and number of missing teeth 4.4 (2.3-8.5). In addition, poorly controlled type II DM and long duration had higher CAL and number of missing teeth than well-controlled DM and short duration. No significant differences were found between smokers/nonsmokers and Khat chewers/non-chewers among the diabetic group. Conclusion: Type II diabetic patients have severe periodontal destruction and tooth loss compared to non-diabetic people and there were no differences within the diabetic group in regards to smoking and Khat chewing habits.

International audience; Although there is a general agreement that a khat chewing habit produces clinicopathological changes in the oral mucosa. However there is no reliable evidence of the effects of a khat chewing habit on the periodontal tissues. Thus, authors aimed to investigate the influence of khat chewing habits on periodontal, oral health, by comparing khat chewers to non‐chewers in respect of gingival recession, periodontal pocketing depth and loss of attachment. A systematic review and meta‐analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. We searched PubMed, the Cochrane Library, Web of Science, Scopus and grey literature. The inclusion criteria were all studies with aims of comparing khat chewers and/or sides to non‐chewers and/or sides in respect of gingival recession, periodontal pocketing depth and loss of attachment. For continuous data, we computed weighted mean difference or standard mean difference analyses. An odds ratio using a random effect model was used if heterogeneity was detected; otherwise, a fixed effects model with a 95% confidence interval was used for continuous data. Two subgroups were analysed: khat chewers vs non‐chewers and khat chewer sides vs non‐chewer sides of the chewer's individuals. A total of 6373 participants were enrolled in 12 studies (khat chewers=3812, non‐chewers=2561). There were statistically significant differences between khat and non‐chewers in both subgroup analyses regarding gingival recession, periodontal pocketing depth and loss of attachment (P

Background Recently, khat chewing has become a common practice among high school, college, and university students. Regular khat chewing is thought to be a predisposing factor for different physical and mental health problems. It can lead to absenteeism from work and classes. In Ethiopia, to our knowledge no published study has investigated khat withdrawal symptoms. Therefore, this study was conducted to determine the prevalence, withdrawal symptoms, and associated factors of khat chewing among regular undergraduate students on the main campus of Jimma University in Ethiopia. Methods The institution-based, cross-sectional study was conducted in January 2016. Data were collected from 651 main campus regular undergraduate students with a structured, self-administered questionnaire, entered into Epidata 3.1 and exported to SPSS version 20 for Windows. Bivariate and multivariate logistic regressions were used to explore associations and identify variables independently associated with khat chewing. Results The study found that the lifetime and current prevalence of khat chewing among students were 26.3% (95% CI: 24.3, 28.3) and 23.9% (95% CI: 21.94, 25.86), respectively. About 25.7% of students started chewing after joining university, and 60.5% of these students started during their first year. The main reason given for starting khat chewing was for study purposes (54.6%), followed by socialization purposes (42.3%). Among current khat chewers, 72.9% reported that they had chewed khat for 1 year or more and 68.2% reported that they had experienced various withdrawal symptoms. The most frequently reported withdrawal symptoms were feeling depressed, craving, and feeling fatigued. Being male, attending a place of worship daily/2–3 times per week, cannabis use, smoking cigarettes, and having family members currently chewing khat were independently associated with khat chewing. Conclusions This study found that large numbers of university students were currently chewing khat. In this study withdrawal symptoms and factors that significantly affect khat chewing were identified. Besides it gave new ideas regarding khat withdrawal symptoms in Ethiopia. It serves as a critical role of providing information to form rational foundation for public health policy, prevention and planning to bring change in contributing factors for Khat chewing. The finding will be serving as base line information for further study.

Migration and khat use were found to correlate with high rates of psychopathology. In this paper we aimed for assessing baseline multimorbidity and its interactions with a Brief Intervention.In the RCT, 330 male Somali khat users were assigned to treatment conditions (khat use is a predominantly male habit). The ASSIST-linked BI for khat users was administered. Using the TLFB Calendar, the PHQ-9, a Somali short version of the PDS and parts from the CIDI, khat use and comorbidity was assessed. With a regression analysis we tested for the influence of comorbidity and with mixed effect models group differences over time in sleep duration, khat use-time and everyday functioning.We found high rates of baseline multimorbidity: 51% (N = 168) for depression, 22% (N = 74) for PTSD and 23% (N = 73) for khat-psychotic symptoms. Depression and khat-psychotic symptoms, but not PTSD symptoms decreased without group differences. Khat use-time decreased and functional time increased with significant time × group interactions (p ≤ 0.046). Depression and PTSD did not influence therapy success but in participants without comorbid psychopathology, more khat use reduction after the intervention was found (p = 0.024).Somali khat users in Kenya are highly burdened by multimorbidity of depression, PTSD and khat-psychotic symptoms. The main effects for time and differences in healthy vs. mentally ill khat users indicate potential of unspecific support and the specific need for mental health care in combination with substance abuse treatment. The increase of everyday functioning promises more options for alternative activities, preventing excessive use and addiction.

Khat use is a drug problem characteristic of the Eastern Mediterranean Region, which is a widespread culturally accepted practice in some countries and is becoming more prevalent in others. Although limited use may not be accompanied by serious consequences, prolonged exposure could lead to dependence, psychosis and other psychiatric disorders and physical conditions such as hypertension, cardiovascular complications, sexual dysfunction, hepatoxicity and reduced birth weight of infants born to khat-chewing mothers. The widespread use and its burden on health and economy has raised concerns in the Region, although the extent of the problem is not well assessed. Additionally, most countries do not have a clear policy and plan with regard to khat use, and therefore there is hardly any structured prevention and treatment plan in place to respond to the problem. This review presents a picture of the extent of the problem, elaborates on related existing research initiatives and international treaties, policies and health service provisions, and outlines best policy and programme interventions in khat-use countries.تعاطي القات وما يتصل به من اضطرابات إدمانية ونفسية وبدنية: ضرورة التصدِّي للمخاطر المتنامية.مايكل أودنفالد، مصطفى العبسي.يمثّل تعاطي القات مشكلة إدمان تميز إقليم شرق المتوسط، بل إنه يعد ممارسة تحظَى بقبول ثقافي واسع النطاق في بعض البلدان ويتزايد انتشارها في أخرى. ولئن كان تعاطي القات بقدر ضئيل قد لا يسبب آثاراً خطرة، فإن التعرض له لفرة طويلة يمكن أن يؤدِّي إلى الإدمان وبعض الاضطرابات النفسية والأمراض البدنية مثل ارتفاع ضغط الدم، والمضاعفات القلبية الوعائية، واختال الأداء الجني، وتسمُّم الكبد، وانخفاض وزن المواليد لأمهات تتعاطن القات. ولقد أدَّى انتشار التعاطي والعبء الواقع عى الصحة والاقتصاد إلى زيادة المخاطر في الإقليم، وإن كان مدى المشكلة لم يخضع لتقييم ملائم بعد. وعاوةً عى ذلك، لا تطبق معظم البلدان المعنية سياسة وخطة واضحتن بشأن تعاطي القات، وبالتالي تكاد لا توجد أي خطة منظّمة للوقاية والعاج من أجل مواجهة هذه المشكلة. ويقدّم هذا الاستعراض صورة لمدى انتشار المشكلة، ويتناول بالتفصيل المبادرات البحثية والمعاهدات الدولية والسياسات والخدمات الصحية القائمة ذات الصلة، ويعرض أفضل التدخات عى مستوى السياسات والبرامج في البلدان التي ينتر بها تعاطي القات.Consommation de khat, dépendance, affections de santé mentale et troubles physiques associés : nécessité de s’attaquer à un risque croissant.La consommation de khat est un problème de toxicomanie caractéristique de la Région de la Méditerranée orientale. Elle constitue une pratique largement acceptée au plan culturel dans certains pays et devient de plus en plus prévalente dans d’autres. Bien qu’une consommation limitée ne s’accompagne pas de conséquences graves, une exposition prolongée peut conduire à la dépendance, à la psychose et à d’autres troubles psychiatriques, ainsi qu’à des états pathologiques physiques telles que l’hypertension, des complications cardio-vasculaires, un dysfonctionnement sexuel, une hépatotoxicité et une réduction du poids à la naissance pour les enfants nés de mères consommatrices de khat. L’utilisation répandue du khat et la charge qu’elle exerce sur la santé et l’économie suscitent des inquiétudes dans la Région, bien que l’étendue du problème ne soit pas parfaitement estimée. En outre, la plupart des pays ne disposent pas de politiques et de plans clairs concernant la consommation de khat. Il n’y a donc pour ainsi dire quasiment aucun plan de prévention et de traitement structuré en place pour répondre à ce problème. La présente analyse donne un aperçu de l’étendue du problème, détaille les initiatives de recherche et les traités internationaux existants sur la question, les politiques et les prestations de services, et définit les meilleurs politiques et programmes d’intervention dans les pays où la consommation de khat existe.

Background: Medical students are at risk of common mental disorders due to difficulties of adjustment to the medical school environment, exposure to death and human suffering. However there is limited data on this aspect. Therefore, the current study assessed the magnitude of common mental disorders and contributing factors among medical students. Methods: An institutional based cross-sectional study was conducted from May 12–16, 2015 using stratified sampling technique. Three hundred and five medical students participated in the study. Common mental disorders were assessed using the self-reported questionnaire (SRQ-20). Logistic regression analysis was used to identify factors associated with common mental disorders among students. Adjusted odds ratios with 95% confidence interval were computed to determine the level of significance. Result: Prevalence of common mental disorders among medical students was 35.2%. Being female, younger age, married, having less than 250 birr monthly pocket money, attending pre-clinical class, khat chewing, smoking cigarettes, alcohol drinking and ganja/shisha use were significantly associated with common mental disorders. Conclusion: The overall prevalence of common mental disorders among medical students was high. Therefore, it is essential to institute effective intervention strategies giving emphasis to contributing factors to common mental disorders. Keywords: Common mental disorders, medical students, prevalence, Ethiopia

The main aim of this study was to assess psychological, economic, and social impact of khat chewing among adolescents, in Nekemte town, East Welega Zone. A community based cross-sectional study was conducted from March to June 2016 using both quantitative and qualitative methods of data collection. A total of 359 samples were included in the study. A pretested, interviewer based structured questionnaire was employed during data collection. The study found the current prevalence of khat chewing practices was 48.6%. Perceived psychological problems especially depression and anxiety were associated with khat chewing practices. The risk of depression was about 25 times higher among khat chewers compared to nonchewers. Similarly the risk of anxiety among khat chewers was about 5 times higher compared to nonchewers. Generally current khat chewing practices in the study area are relatively high. The occurrence of reported, perceived psychological problems mainly depression and anxiety was significantly higher among khat chewers compared to nonchewers. Thus efforts like creating awareness about negative effect, making different recreation methods available, and formulating common conventions regarding khat use mainly by young generations are necessary to decrease the magnitude of chewing practices and thereby its associated consequences.

Khat, a psychostimulant cultivated and commonly used in Eastern Africa and the Arabian penin-sula, has a longstanding history of use embedded within the cultures of these regions. Due to changing patterns of use and the adverse effects of dependence, khat has become a growing pub- lic health concern. Despite extensive findings regarding the detrimental psychiatric, physical, and social consequences of khat dependence, research on interventions in this area is glaringly sparse. The present paper aims to summarize the consequences of chronic khat use and review existing research on interventions.

Objectives Hypertension is a growing public health problem in many developing countries. However, there is an insufficiency of scientific evidence on the prevalence of hypertension (HTN) at a community level in the study area. The aim of the study was exploring the prevalence and associated factors of hypertension among adults in Nekemte town, Ethiopia. A community-based cross-sectional study was conducted on 711 adults who were selected by the multistage sampling procedure. Height, weight, blood pressure and waist circumference were measured with standard procedures. Data were analyzed by statistical package for social sciences (SPSS) version 20, and multiple logistic regression model was used to determine the independent risk factors for hypertension. Result The overall prevalence of hypertension was 34.9% among the adult population. Of them, only 52.7% know their status, and 22.4% were on antihypertensive medication. The prevalence of hypertension was higher among the older aged; AOR 5.85 (95% CI 1.74–20), Obese and over-weighted; (AOR 1.71 (95% CI 1.09–2.67)), Khat chewers in the past year; AOR 2.44 (95% CI 1.05–5.68), and with higher formal education (college and above); AOR 2.75 (95% CI 1.26–6.03) than their respective counterparts. Community-level prevention and treatment of hypertension should get due attention.

Objective Trauma exposure and alcohol use are closely related, and large proportion of trauma-exposed individuals use alcohol. The data presented in this paper were obtained as part of a study on substance use disorder and associated factors among prisoners in the correctional institution in Jimma, Southwest Ethiopia. Therefore, in this study we examined comorbidity of traumatic life experiences and alcohol use disorder in inmates of correctional institution in Jimma, Southwest Ethiopia. Results The overall prevalence of lifetime alcohol use disorder was 40.1%, and the prevalence of alcohol use disorder among prisoners with lifetime trauma exposure was 44.0%. Participants with multiple trauma exposures had 2.5-fold higher odds of association for alcohol use disorder than their counterparts (AOR = 2.47 [1.23–4.94]). Living in urban areas (AOR = 4.86 [2.38–9.94]), presence of psychopathy (AOR = 3.33 [1.25–8.86]), khat abuse (AOR = 7.39 [3.99–13.68]), and nicotine dependence (AOR = 2.49 [1.16–5.34]) were also positively associated with alcohol use disorder. The prevalence of alcohol use disorder was higher among prisoners with lifetime trauma exposure. Also, this study indicates that prisoners with multiple trauma exposures had higher odds of association for alcohol use disorder than those with no trauma exposure. A public health intervention targeting survivors of traumatic experiences needs to be designed and implemented.

Background Conducting systematic review to evaluate plant use as a risk factor to cancer could be challenging. A systematic and well-balanced method should be applied to accommodate in vivo and in vitro studies to make a final decision. In this article, khat, a recreational plant used in some Arabic and African regions, was employed as an example to systematically determine its relationships to the premalignant and cancerous conditions. Methods Systematic database search was performed to recruit original human, animal or in vitro studies on khat and cancer. Sixteen studies fulfilled the inclusion criteria and subjected to assessment using Risk of Bias (RoB). Office of Health and Translation (OHAT) approach was used to rate the confidence level in the body of evidence. The evidence was integrated to establish the relationships between khat, premalignant conditions and cancer. Results Seven out of eight studies showed that khat causes premalignant oral lesions with moderate evidence level. Four studies showed that khat causes cancer with low evidence level and another three studies showed that khat has anti-cancer effect with moderate to high evidence level. Only one study suggested that khat is unrelated to cancer. Conclusion RoB and OHAT approach are reliable systematic tools to evaluate plant risk to cancer and provide objective and uniform summary regardless of the study type. In conclusion, our pooled analysis did not find a direct relationship between khat and cancer but anti-cancer effect would require to be proofed on human studies.

Khat (Catha edulis (Vahl) Forssk.) is a herb from the Celastraceae family (also known as qat, gaad, or mirra) that is widely-consumed in East Africa and in the Arabian peninsula. The green leaves and small stems are consumed primarily at recreational and social gatherings, and medicinally for their antidiabetic and appetite-suppression effects.The objectives of this study were to determine the effects of khat and its active alkaloid, cathinone, on food intake and body weight in mice maintained on a high-fat diet, and to investigate its mechanism of action in white adipose tissue and in the hypothalamus.Adult male mice (C57BL/6J) were fed a high fat diet (HFD) for 8 weeks (n = 30), then divided into 5 groups and treated daily for a further 8 weeks with HFD + vehicle [control (HFD)], HFD + 15 mg/kg orlistat (HFDO), HFD + 200 mg/kg khat extract (HFDK200), HFD + 400 mg/kg khat extract (HFDK400) and HFD + 3.2 mg/kg cathinone (HFDCAT). Treatments were carried out once daily by gastric gavage. Blood and tissue samples were collected for biochemical, hormonal and gene expression analyses.Khat extracts and orlistat treatment significantly reduced weight gain as compared to control mice on HFD, and cathinone administration completely prevented weight gain in mice fed on HFD. Khat treatment caused a marked reduction in body fat and in serum triglycerides. A dose-dependent effect of khat was observed in reducing serum leptin concentrations. Analysis of gene expression in adipose tissue revealed a significant upregulation of two lipolysis pathway genes:(adipose triglyceride lipase (PNPLA-2) and hormone-sensitive lipase (LIPE). In the hypothalamic there was a significant (P 0.05) upregulation of agouti-related peptide (AgRP) and cocaine-amphetamine regulated transcript (CART) genes in the HFDK400 and HFDCAT groups.Cathinone treatment blocked body weight gain, while high dose khat extract significantly reduced the weight gain of mice on an obesogenic diet through stimulation of lipolysis in white adipose tissue.

Background Intimate partner violence (IPV) is the most common form of gender-based violence affecting women and girls worldwide and is exacerbated in humanitarian crises. There is evidence that substance use is associated with male perpetration of IPV. Consumption of khat —a plant containing amphetamines traditionally chewed in the horn of Africa and legal in some countries including Ethiopia—may increase risk of IPV toward women. This analysis aimed to assess perceptions on khat use among Somali refugees in Dollo Ado, Ethiopia and its association with IPV to inform an IPV and HIV prevention intervention. Methods A descriptive qualitative study comprising individual interviews (n = 30) and focus group discussions (n = 10) was conducted in Bokolmayo refugee camp in Dollo Ado, Ethiopia in October 2016. A purposive sample of male and female Somali refugees, religious and community leaders, and service providers (n = 110 individuals; 44 women and 66 men) was included. Trained interviewers from the camp conducted the interviews and discussion, which were audio recorded, transcribed and translated. A content analysis was conducted on coded excerpts from the transcripts to identify factors contributing to IPV toward women, including khat use. Results Participants reported that displacement has resulted in limited employment opportunities for men and increased idle time, which has led to increased khat use among men as a coping mechanism. Male khat use was perceived to be associated with perpetration of physical and sexual IPV through several mechanisms including increased anger and aggression and enhanced sexual desire. Khat use also contributes to intra-marital conflict as money allocated for a household is spent on purchasing khat. Conclusion Khat use should be addressed as part of IPV prevention programming in this context. Livelihood interventions and other strategies to improve economic conditions, should be explored in collaboration with refugee camp authorities and community leaders as a potential avenue to mitigate the impact of khat use on women and families.

Objective Tuberculosis remains deadliest communicable diseases accountable for health problem among various individuals annually and is related to malnutrition. Addressing nutritional deficiency in Tuberculosis patients is a crucial side of tuberculosis management programme. Therefore, the aim was to assess the magnitude of nutritional deficiency and associated factors among new pulmonary tuberculosis patients of Bale Zone Hospitals, south-east Ethiopia, 2018. Cross-sectional study design was utilized. Data collection was carried out using structured questionnaires and anthropometric measurements. Body mass index was calculated to see nutritional deficiency. Crude and adjusted odds ratios in conjunction with their corresponding 95% confidence intervals were computed. p-value Results Prevalence of nutritional deficiency was 63.2%. The mean Body mass index for all listed participants was 17.86 kg/m2. Employment status of the patients, p-value 0.012 (AOR = 1.82; 95% CI 1.14, 2.89) and Khat chewing, p-value 0.02 (AOR = 0.43; 95% CI 0.23, 0.85) were factors independently associated with nutritional deficiency. Prevalence of nutritional deficiency was found to be high. Nutritional support for the impoverished, regular nutritional assessment and dietary counseling are necessary for better treatment outcome and effective Tuberculosis management programme.

Objectives Khat is an herbal cultivated plant growing mainly in Eastern Africa and Arabians. Chronic khat chewing leads to the development of liver toxicity, cardiovascular disease, sleeping disorder, psychosis, memory impairment, poor academic performance and variety of social and economic problems affecting the consumers and their families. Therefore, this study aimed to determine the prevalence of khat chewing and associated factors among Jimma university staff. An institution-based cross-sectional study was employed on 354 university staff. A self-administered questionnaire was used to collect the data. The analysis was done using Stata 14. A multivariable logistic regression model was used to identify associated factors of khat chewing among university staff. p ≤ 0.05 was employed to declare statistically significant factors. Results The lifetime prevalence of khat chewing among university staff was 41.0% (95% CI 35.9–46.1%). The odds of khat chewing was higher among males (AOR = 2.66 95%, CI 1.52–4.68), participants who had khat chewer friends (AOR = 2.15 95% CI 1.18–3.93), alcohol users (AOR = 9.02, 95% CI 4.96–16.42) and participants who had khat chewer family member (AOR = 4.03, 95% CI 1.16–13.99). Since a significant proportion of staff chew khat, appropriate measures need to be taken to reduce its prevalence and adverse social and health consequences.

The chronic use of khat, a plant with psychostimulant properties, has been associated with physical and mental health problems. Previous research found that non-khat users were more likely than khat users to perceive its use to be associated with poor health.We aimed to identify differences in the perception of specific khat-associated health problems between khat users and non-users.In 2012, 133 adults (≥ 18 years) from African migrant communities in 4 state capital cities in Australia completed questionnaires to ascertain their perception of whether specific health problems were associated with khat use. Multivariable log-linked Poisson regression was used to compare the perceptions of the 2 groups and identify differences, adjusting for sociodemographic factors, tobacco use and years living in Australia.Overall, 58 (44%) and 75 (56%) participants reported current khat use and no use respectively. Adjusted log-linked Poisson regression showed that people who use khat were less likely than non-users to perceive certain health and related problems were associated with khat use, including, poor health in general [prevalence risk ratio (PRR) = 0.86; 95% CI: 0.75, 1.00]; laziness (PRR = 0.86; 95% CI: 0.75, 0.99); stomach and throat problems (PRR = 0.83; 95% CI: 0.72, 0.96); and teeth, gum and mouth problems (PRR = 0.81; 95% CI: 0.67, 0.99).Khat users are less likely to perceive use being associated with health problems than non-users. Providing information on the health problems associated with khat use may be an important component of health promotion strategies and interventions aimed at minimising khat-related harm.تعاطي القات والمشاكل الصحية المُتصورة بين المهاجرين الأفارقة في أستراليا: دراسة استكشافية.كريج كمينج، جوليا بات، عبدي هرسي، أحمد توهو، جيسي ينج.ارتبط إدمان تعاطي القات، وهو نبات له خصائص المُنبِّهات النفسية، بمشاكل بدنية ونفسية. وكشفت البحوث السابقة عن أن الأشخاص الذين لا يتعاطون القات كانوا أكثر ميلاً من متعاطيه لإدراك أن تعاطي القات يرتبط باعتلال الصحة.هدفت هذه الدراسة إلى تحديد الاختلافات في إدراك أن تعاطي القات يرتبط بمشاكل صحية مُعينة بين متعاطي القات والذين لا يتعاطونه.في عام 2012، استكمل 133 بالغًا (≥ 18 عامًا) من مجتمعات المهاجرين الأفارقة في 4 مدن من عواصم الولايات في أستراليا استبيانات للتأكد من إدراكهم لارتباط تعاطي القات بمشاكل صحية مُعينة. واستُخدم نموذج انحدار پواسون المرتبط بسجل والمتعدد المتغيرات للمقارنة بين مفاهيم مجموعتين من الأشخاص وتحديد الاختلافات، مع التعديل وفقًا للعوامل الاجتماعية السكانية، وتعاطي التبغ، وعدد سنوات العيش في استراليا.بوجه عام، أفاد 58 مشاركًا (44٪) أنهم يتعاطون القات، بينما أفاد 75 مشاركًا (56٪) أنهم لا يتعاطونه. وأظهر نموذج انحدار پواسون المرتبط بسجل والمتعدد المتغيرات أن متعاطي القات كانوا أقل ميلاً عن غير متعاطيه إلى إدراك ارتباط بعض الظروف الصحية والمشاكل المرتبطة بها بتعاطي القات، ويشمل ذلك اعتلال الصحة بشكل عام [نسبة خطر الانتشار = 0.86، بفاصل ثقة قدره 95٪: 0.75، 1.00]؛ والخمول (نسبة خطر الانتشار = 0.86، بفاصل ثقة قدره 95٪: 0.75، 0.99)؛ ومشاكل المعدة والحلق (نسبة خطر الانتشار = 0.83؛ بفاصل ثقة 95٪: 0.72، 0.96)؛ ومشاكل الأسنان واللثة والفم (نسبة خطر الانتشار = 0.81؛ بفاصل ثقة: 0.67، 0.99).من غير المرجح أن يدرك متعاطو القات ارتباط تعاطيه بمشاكل صحية معينة، مقارنة بغير المتعاطين. وقد يكون توفير معلومات بشأن المشاكل الصحية المرتبطة بتعاطي القات عنصرًا مهمً في استراتيجيات وتدخلات تعزيز الصحة الرامية إلى التقليل إلى أدنى حد ممكن من الأضرار المرتبطة بتعاطيه.Consommation de khat et problèmes de santé perçus chez les migrants africains en Australie : une étude exploratoire.L'utilisation chronique du khat, une plante aux propriétés psychostimulantes, a été associée à des problèmes de santé physique et mentale. Des recherches antérieures ont révélé que les non-consommateurs de khat étaient plus susceptibles que les consommateurs de percevoir son utilisation comme étant associée à une mauvaise santé.Notre objectif était d'identifier les différences de perception des problèmes de santé spécifiques liés au khat entre les consommateurs et les non-consommateurs.En 2012, 133 adultes (≥ 18 ans) issus de communautés de migrants africains dans quatre capitales d'États d’Australie ont répondu à des questionnaires afin de déterminer s’ils percevaient des problèmes de santé spécifiques associés à la consommation de khat. La régression de Poisson log-linéaire multivariable a été utilisée pour comparer les perceptions des deux groupes et identifier les différences, avec ajustement en fonction de facteurs sociodémographiques, de la consommation de tabac et des années de vie passées en Australie.Au total, 58 (44 %) et 75 (56 %) participants ont déclaré consommer et ne pas en consommer de khat, respectivement, au moment de l’étude. La régression de Poisson log-linéaire ajustée a montré que les consommateurs de khat étaient moins susceptibles que les non-consommateurs de percevoir certains problèmes de santé et problèmes connexes associés à cette pratique, y compris une mauvaise santé en général [rapport risque/prévalence = 0,86 ; IC à 95 % : 0,75, 1,00] ; la paresse (rapport risque/prévalence = 0,86 ; IC à 95 % : 0,75, 0,99) ; les problèmes d'estomac et de gorge (rapport risque/prévalence = 0,83 ; IC à 95 % : 0,72, 0,96) ; et les problèmes de dents, de gencives et de bouche (rapport risque/prévalence= 0,81 ; IC à 95 % : 0,67, 0,99).Les consommateurs de khat sont moins susceptibles de percevoir l'usage comme étant associé à des problèmes de santé que les non-consommateurs. La fourniture d’informations sur les problèmes de santé associés à la consommation de khat peut être une composante importante des stratégies et interventions de promotion de la santé visant à réduire au minimum les méfaits de cette substance.

The main psychoactive compound in Khat is cathinone which consists of two enantiomers, S-(-)-cathinone being more stimulant than its R antipode. This study aimed to the enantioseparation and determination of these two stereoisomers in different parts of fresh Catha edulis. The samples were solvent extracted and cathinone was derivatized with menthyl chloroformate. The separation of the two diastereomeric derivatives was carried out by gas chromatography and showed an excellent resolution, while their structure was confirmed by mass spectrometry. The quantitative determination of both enantiomers showed a different distribution in various investigated parts of the plant, as shown in their enantiomeric excess. Unlike the results published in some previous articles, the current study confirmed the presence of both S and R cathinone in all parts of the fresh plant. The concentration of S-cathinone was higher in stems while its values were lower in leaves. The obtained concentrations were in the ranges 0.081-0.290 and 0.087-0.211 mg/g for S and R antipodes, respectively. Also, S-cathinone which is the most psychoactive stereoisomer showed an increasing concentration from lower to upper stems of the plant. The present study is the first quantitative investigation of the two cathinone enantiomers in different parts of fresh Catha edulis.

Background: Nowadays khat chewing habit is increasing among population in southern part of Saudi Arabia, Jazan and till date there is no literature investigating the effect of khat on oral biofilm on dental materials. Objective: To evaluate and compare the bacterial biofilm on different types of dental restorative materials used in replacing missing tooth structures among khat chewers and non-khat chewers. Materials and Methods: Hundred and twenty biofilm samples were collected from different dental restorations, such as All-ceramic (AL), Metal Ceramic (MC), Metal crowns or bridges (M), Composite (C), Glass Ionomer (GI) and Amalgam (A) restorations in non-khat and khat chewers (K). DNA extraction was done and subjected to PCR. Bacterial species, such as Streptococcus, Neisseria, Bacillus, Granulicatella and Veillonella were identified and counted. PCR products were also sequenced to detect similarity. Association between bacterial type and dental materials among non-khat and khat chewers were tested with Chi-Square test (Fishers Exact test). Results: he frequency and percentage of Streptococcus species were marginally higher among khat chewers (42; 70%) compared with non-khat chewers (38; 63.3%) group. But the Veillonella species were higher among non-khat chewers (9: 15%), compared to the khat chewers group (7; 11.7%). No statistically significant difference was detected among species in both groups. In non-khat and khat chewer group, the maximum hits were related to Streptococcus spp. in glass ionomer, amalgam, and composite (restorative materials), followed by metal ceramic and metal (prosthetic materials). Veillonella spp. showed maximum hits in the metal group among non-khat chewers and in all-ceramic among khat chewers. Statically significant differences were recorded among composite and amalgam samples with p values 0.047 and 0.036 in khat chewer group. Conclusion: Khat chewers showed statistically significant differences in oral biofilm in the composite and amalgam restorative materials, but there were no significant differences found among any materials and species between the groups.

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.