Snuff Use Research Articles

Daily snuff use during pregnancy, gestational length and birth weight; register-based study

BackgroundSnuff is a smokeless source of nicotine that is common in Scandinavia and increasingly used by women of fertile age. Persistent use of snuff during pregnancy has been associated with adverse pregnancy outcomes. Emerging data from the Medical Birth Registry of Norway distinguishes between occasional use and daily use. We provide preliminary estimates of associations between frequency of snuff and gestational length and birth weight.MethodsData on snuff use during pregnancies delivered in 2020 and 2021 were available for the west and central regions of Norway. Associations of snuff use with gestational length and birth weight at term (39–41 weeks) were estimated using quantile regression at the 25th, the 50th and the 75th percentiles, with adjustments for mother’s age, pre-pregnancy weight, and parity. We compared associations with the pregnancy outcomes according to maternal snuff and cigarette use.Results12.4% of 18 042 non-smoking women reported daily use of snuff before pregnancy, and 4.6% reported continuing use during pregnancy, with 1.2% still reporting daily use in the last trimester. Women with daily use through the last trimester delivered babies with a median gestational length reduced by 3.4 days (95% CI: -5.0 to -1.7 days) compared with women who never used snuff. The reduction was even stronger at the 25th percentile of gestational age. The median term birth weight was reduced by 44 g (95% CI: -134 to 46 g). These associations were much weaker for women who quit snuff at some point during pregnancy or used snuff only occasionally. Mothers who smoked daily through the last trimester had a median gestational length reduced by 2.1 days (95% CI: -2.7 to -1.4) and a median term birth weight reduced by 294 g (95% CI: -325 to -262) compared with never-smokers.ConclusionsDaily snuff use through the last trimester reduced the median gestational length by more than three days. Snuff reduced birth weight, but not as much as smoking, suggesting that the predominant effect of smoking on fetal growth is not through nicotine but through the additional toxic chemicals in cigarettes or by reduced oxygen supply to the fetus.

Snuff use: Motivations, tips to quit, and readiness to quit in a South African township

Background: Regardless of how tobacco products are consumed, they increase the risk of morbidity and mortality for users. This study aims to determine the motivations for using snuff, assess awareness of tips to quit, and determine readiness to quit snuff use in patients at a clinic in a Pretoria township, in South Africa.Methods: A descriptive cross-sectional survey using a piloted, structured, and self-administered questionnaire was given to patients at Ramotse clinic.Results: The mean age of the 402 participants was 49.0 years, with a range of 18–104 years. The majority (83.8%) of the participants were females. Of the participants, 26.6% were 60 years of age or older, 59.7% were unemployed, 57.5% were married, and 41.5% had finished primary school. Socio-cultural practices and behaviour were mentioned by 38.1% as the main reason for snuff usage, while 77.2% were uninformed about tips for quitting snuff, and 63.25% were unwilling to give up snuff.Conclusion: The study found that unemployed, married, mostly female, 40 years of age or older, and had a basic education match with the profile of participants. Socio-cultural practices and behaviour and health benefits influenced the habit. Most participants were unaware of tips to quit habits and unprepared to do so.Contribution: Healthcare professionals need to be aware of the health hazards that their patients may face, make sure they are equipped to address them and offer community-saving tips for improvement.

Mass spectrometry-based metabolomics study of nicotine exposure in THP-1 monocytes

The tobacco alkaloid nicotine is known for its activation of neuronal nicotinic acetylcholine receptors. Nicotine is consumed in different ways such as through conventional smoking, e-cigarettes, snuff or nicotine pouches. The use of snuff has been associated with several adverse health effects, such as inflammatory reactions of the oral mucosa and oral cavity cancer. We performed a metabolomic analysis of nicotine-exposed THP-1 human monocytes. Cells were exposed to 5 mM of the alkaloid for up to 4 h, and cell extracts and medium subjected to untargeted liquid chromatography high-resolution mass spectrometry. Raw data processing revealed 17 nicotine biotransformation products. Among these, cotinine and nornicotine were identified as the two major cellular biotransformation products. The application of multi- and univariate statistical analyses resulted in the annotation, up to a certain level of identification, of 12 compounds in the cell extracts and 13 compounds in the medium that were altered by nicotine exposure. Of these, four were verified as methylthioadenosine, cytosine, uric acid, and l-glutamate. Methylthioadenosine levels were affected in both cells and the medium, while cytosine, uric acid, and l-glutamate levels were affected in the medium only. The effects of smoking on the pathways involving these metabolites have been previously demonstrated in humans. Most of the other discriminating compounds, which were merely tentatively or not fully identified, were amino acids or amino acid derivatives. In conclusion, our preliminary data suggest that some of the potentially adverse effects related to smoking may also be expected when nicotine is consumed via snuff or nicotine pouches.

Immunohistochemical (IHC) Expression of p16 in Various Grades of Oral Squamous Cell Carcinoma (OSCC) with Snuff Use in Tertiary Care Hospitals of Peshawar

Oral squamous cell carcinoma (OSCC) is a significant health concern, with various factors influencing its development and progression. Understanding these factors, including p16 expression and clinicopathologic features, is crucial for improved diagnosis and treatment. Objective: To compare various grades of OSCC based on immunohistochemical expression of p16 and clinicopathologic parameters. Methods: The comparative cross-sectional study was conducted at the Department of Pathology, Peshawar Medical College (PMC), and Peshawar Dental College (PDC) from August 2020 to August 2021. It included 53 cases of OSCC with documented snuff use history. Tumor sections were stained with Hematoxylin and Eosin and underwent immunohistochemical staining for p16 expression. Sample size calculation utilized G Power software. Statistical analysis was performed using SPSS version 20.0, employing the Chi-Square test to assess categorical variables. Results: Among the 53 OSCC cases, the majority were male (66.0%) with ages ranging from 26 to 85 years, the most common age group being 51-70 years. The tongue was the primary site for OSCC development. Well-differentiated cases were predominant (64.2%), followed by moderate (20.8%) and poor grade cases (15.1%). However, no significant association was found between p16 expression and OSCC grades. Notably, p16 expression tended to be higher in snuff users and well-differentiated OSCC cases, although not statistically significant. Conclusions: Well-differentiated OSCC cases exhibited the highest expression of p16, followed by moderate and poorly differentiated cases. However, no significant correlation was observed between p16 expression and OSCC in snuff users.

Investigation of Hepatic and Renal Parameters Content in Blood Samples of Snuff Addicted Individuals in Gusau Metropolis

In Nigeria, the use of dry nasal snuff is spreading considerably throughout all age groups in both rural and urban areas. This is due to various ethno-cultural beliefs that have not been scientifically confirmed. Various people do not realize the negative impact of snuff on one's health, such as liver and kidneys failure, elevation of blood pressure, and a higher chance of oral cancer. The hepatotoxicity and nephrotoxicity of the local nasal snuff on snuff addicted individual was poorly understood. This study was carried out on snuff addicted individuals to assess hepatotoxicity and nephrotoxicity of the local nasal snuff. One hundred and fifty individuals used in the study were group into three of fifty people each. Group one served as a control which include individuals who never use snuff, Groups two and three comprise individuals who are addicted to snuff, with ages ranging from 18 to 30, and above thirty, respectively. The hepatotoxicity study revealed that, there were significant (p<0.05) increase in concentration of ALT, AST, Total Bilirubin and Direct Bilirubin of group two and group three compared with control. The concentration of ALT, AST, Total Bilirubin and Direct Bilirubin of group three were also significantly (p<0.05) higher than that of group two. While there were significant (p<0.05) decrease in concentration of total protein and albumin in group two and three compared with control. The nephrotoxicity study revealed that, there were significant (p<0.05) increase in concentration of creatinine of group two and group three compared with control. The concentration of creatinine in group three was even significantly higher than that of group two. Whereas, there were significant (p<0.05) decrease in concentration of Urea, Sodium, Potassium and Chlorine in group two and three compared with control. This study was concluded that, there was health risks (Hepatotoxicity and Nephrotoxicity) associated with snuff addiction.

Prevalence of major noncommunicable diseases and their associated risk factors in Afghanistan

Abstract Objective Afghanistan is dealing with a double burden of diseases and yet there has been no evidence synthesis of the scientific literature on noncommunicable disease (NCDs), thus this study fills the gap by systematically analysing the prevalence of four major NCDs and the associated risk factors. Methods We performed a systematic review and meta-analysis of the studies published since 2000, reporting the prevalence of diabetes, chronic respiratory diseases (CRDs), cardiovascular disease (CVDs) or cancer, and their risk factors in Afghanistan. Four online databases (PubMed, Web of Science, Cochrane, and Google Scholar) and two local peer reviewed journals in Afghanistan were systematically searched using the predefined keywords. Two reviewers independently screened and appraised the quality of the papers. Data extraction and data synthesis were carried out using tabulated template. Stata 13 was used to perform the meta-analysis. Results 58 articles included in this review of which 13 focused on cancer, 10 on diabetes, 7 on CVDs, 5 on CRDs, and 23 on any of the risk factors as primary outcome. Very few articles reported the prevalence of 4 NCDs in general population where cancer was reported 0.15%, asthma ranged between 12.5% to 17.3% and no evidence on CVDs. The pooled prevalence for diabetes, hypertension, and overweight were 12%, 31%, and 35% respectively. Central obesity was almost twice prevalent in females (76% vs 40%). Similarly, the pooled prevalence of smoking and snuff use were 14% and 25% in males, and 2% and 3% in females respectively. Conclusions Less evidence is available on the prevalence of major NCDs in Afghanistan, however, the risk factors for NCDs are prevalent across the country. The quality of the available data specially those of the local resources are poor, therefore, further research should be conducted to generate reliable evidences to inform the policy makers on prioritization of the interventions for the control of NCDs in Afghanistan. Key messages • The prevalence of NCDs is escalating in Afghanistan, and the local data show higher estimates of NCDs and their associated risk factors. • Prevalence of NCD risk factors is relatively high in Afghanistan, and considering the political emergency situation, if preventive measures are not taken properly, the burden of NCDs may increase.

O.5.1-11 Index for Promoting Sustainable, Healthy and Environment friendly Lifestyles and its association with metabolic syndrome: findings from a Swedish Population-Based Cohort Study

Abstract Purpose The purpose of this study was to investigate the association between sustainable and healthy lifestyle factors and the risk of metabolic syndrome, with a focus on promoting sustainable, healthy and environment friendly behaviours. By creating Index for Promoting Sustainable, Healthy and Environment friendly Lifestyles (IPSHEL), we aimed to assess the combined impact of various lifestyle factors on the development of metabolic syndrome. Methods A population-based cohort study was conducted in Sweden, involving a total of 5,364 participants. Lifestyle factors related to physical activity, food habits, tobacco use, alcohol, and sleep were assessed through questionnaires. To quantify the influence of these factors, an Index called IPSHEL was developed. Each lifestyle factor was graded and aggregated into an overall index score for each participant. Results The results showed a significant association between IPSHEL and the risk of metabolic syndrome. Individuals with the highest IPSHEL scores had reduced relative risk of developing metabolic syndrome compared to those with the lowest IPSHEL scores. Notable lifestyle factors strongly associated with metabolic syndrome included the intake of fast food and soda, portion sizes of meat and other protein-rich foods, intake of red and processed meat, consumption of cakes, candy, chocolate, ice-cream, chips, total sitting time, snuff use, and the climate impact from diet. Conclusions This study highlights the importance of adopting a sustainable and healthy lifestyle in reducing the risk of metabolic syndrome. The IPSHEL proved to be a valuable tool in assessing the combined impact of multiple lifestyle factors. These findings suggest the practical application of the index in public health contexts, serving as a useful tool for surveys, interventions, and evaluations targeting healthy behaviours. By promoting sustainable, healthy and environment friendly lifestyle choices, we can strive towards improved population health and the achievement of global development goals.

PREVALENCE AND RISK FACTORS OF HELICOBACTER PYLORI INFECTION AMONG INDIVIDUALS WITH TOBACCO CONSUMPTION HABITS IN DISTRICT PESHAWAR: A CROSS-SECTIONAL STUDY

This cross-sectional study aimed to determine the prevalence of Helicobacter pylori infection and its association with tobacco consumption (smoking and snuff use) in Peshawar, Pakistan. 150 blood samples were collected from H. pylori suspected patients in tertiary care hospitals. Demographic data, tobacco consumption habits, and potential risk factors were gathered through a questionnaire. The prevalence of H. pylori among smokers and snuff users was 42%. All participants had a history of tobacco use, with 59% being smokers and 41% being snuff users. Most participants (81%) had not been tested for H. pylori before. Eight risk factors associated with H. pylori infection were investigated, including family history, stomach ulcers or gastritis, consumption of spicy or heavily seasoned food, poor hygiene practices, low socioeconomic status, history of antibiotic use, close contact with infected individuals, and consumption of contaminated food or water. Participants' opinions and beliefs about these risk factors varied. The study demonstrated significant associations between H. pylori antigen detection and smoking, snuff use, overcrowding, and various risk factors such as family history, dietary habits, hygiene practices, socioeconomic status, antibiotic use and exposure to contaminated water or food. The study emphasizes the need for further research to understand these risk factors and their impact on H. pylori infection.

Influence of oral tobacco versus smoking on multiple sclerosis disease activity and progression

We aimed to study the influence of smoking habits, exposure to passive smoking and snuff use on disease progression, cognitive performance and quality of life in patients with multiple sclerosis...

Recently Top Trending Cancers in a Tertiary Cancer Hospital in Pakistan

Cancer is a leading cause of death, and its incidence is increasing, as reported in recent studies by GLOBOCAN. Cancer registry programs provide insights into currently trending tumors worldwide and aid in determining possible risk factors. This study was based on 7 years of cancer registry data recorded at NIMRA cancer hospital, Sindh, from 2015 to 2021. A total of 16,191 cancer patients were registered. In men, head and neck, lung, liver, colorectal and urinary tract cancers were most common. In women, breast cancer, head and neck cancer, gynecological tumors, esophageal cancer and colorectal cancer predominated. The overall data analysis indicated trending cancers in both sexes, including head and neck cancer (37.76%), breast cancer (13.83%), gynecological tumors (10.22%), esophageal cancer (5.18%), lung cancer (4.79%), colorectal cancer (4.27%), liver cancer (3.87%), lymphoma (3.16%), urinary tract cancer (3.11) and prostate cancer (1.53%). The mean age was 50.41 ± 11.78 years in men and 48.47 ± 11.88 years in women. Cancer prevalence has markedly increased worldwide, and is particularly alarming in developing countries. Various risk factors are involved in this increase, including the use of tobacco, areca nut, chewable tobacco, snuff or niswar. Current disease trends are substantially different from those in older studies at the institute.

Onset of periodontitis — a registry-based cohort study

ObjectivesThe present retrospective registry-based cohort study aimed to identify parameters associated with the onset of periodontitis in young adults.Material and methodsA total of 345 Swedish subjects were clinically examined at age 19 years (as part of an epidemiological survey) and then followed up to 31 years through the Swedish Quality Registry for Caries and Periodontal diseases (SKaPa). The registry data including periodontal parameters were obtained for the period 2010–2018 (23–31 years). Logistic regression and survival models were used to identify risk factors for periodontitis (PPD ≥6 mm at ≥2 teeth).ResultsThe incidence of periodontitis during the 12-year observation period was 9.8%. Cigarette smoking (modified pack-years; HR 2.35, 95%CI 1.34–4.13) and increased probing pocket depth (number of sites with PPD 4–5 mm; HR 1.04, 95%CI 1.01–1.07) at 19 years were risk factors for periodontitis in subsequent young adulthood. No statistically significant association was identified for gender, snuff use, plaque and marginal bleeding scores.ConclusionCigarette smoking and increased probing pocket depth (≥4 mm) in late adolescence (19 years) were relevant risk factors for periodontitis in young adulthood.Clinical relevanceOur study identified cigarette smoking and increased probing depth in late adolescence as relevant risk factors of periodontitis in young adulthood. Preventive programs should therefore consider both cigarette smoking and probing pocket depths in their risk assessment.

Association of maternal snuff use and smoking with Sudden Infant Death Syndrome: a national register study

BackgroundThe aim was to study whether non-combustible nicotine (Swedish snuff) use in pregnancy is associated with elevated risk of post neonatal mortality, Sudden Infant Death Syndrome (SIDS), and Sudden Unexpected Infant Death (SUID) and to study how cessation before the antenatal booking influenced these risks.MethodsThis was a population-based register study of all infants with information on tobacco exposure in early pregnancy born in Sweden 1999–2019, n = 2,061,514. Self-reported tobacco use in early pregnancy was categorized as nonuse, snuff use, and moderate and heavy smoking. Multiple logistic regression models were used to estimate crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs).ResultsMaternal snuff use was associated with increased risks of post neonatal mortality, SIDS, and SUID. The risks of snuff use and moderate smoking were of similar magnitude. Heavy smoking was associated with the highest risks. Cessation of smoking and snuff use before the antenatal booking was associated with lower risks of SIDS and SUID compared to that of continuous usage.ConclusionsMaternal snuff use was associated with increased risks of post neonatal mortality, SIDS, and SUID. Nicotine is the common substance in cigarette smoke and snuff. These findings support the hypothesis that nicotine contributes to an elevated risk of SIDS.ImpactMaternal snuff use and smoking in early pregnancy were associated with increased risks of post neonatal mortality, SIDS, and SUID.Cessation of smoking and snuff use before the first antenatal visit was associated with reduced risks of SIDS and SUID.The common substance in cigarette smoke and snuff is nicotine. Our findings suggest that nicotine contributes to an elevated risk of SIDS and SUID.The implication of our findings is that all forms of nicotine should be avoided in pregnancy.

Associations between observed neighborhood physical disorder and health behaviors, New Jersey behavioral risk factor Surveillance System 2011–2016

This study tested associations between observed neighborhood physical disorder and tobacco use, alcohol binging, and sugar-sweetened beverage consumption among a large population-based sample from an urban area of the United States. Individual-level data of this cross-sectional study were from adult respondents of the New Jersey Behavioral Risk Factor Surveillance System, 2011–2016 (n = 62,476). Zip code tabulation area-level observed neighborhood physical disorder were from virtual audits of 23,276 locations. Tobacco use (current cigarette smoking or chewing tobacco, snuff, or snus use), monthly binge drinking occasions (5+/4+ drinks per occasion among males/females), and monthly sugar-sweetened beverages consumed were self-reported. Logistic and negative binomial regression models were used to generate odds ratios, prevalence rate ratios (PRR), 95 % confidence intervals (CI) by levels of physical disorder. Compared to the lowest quartile, residence in the second (PRR: 1.16; 95 % CI: 1.03, 1.13), third (PRR: 1.24; 95 % CI: 1.10, 1.40), and fourth (highest) quartile of physical disorder (PRR: 1.24; 95 % CI: 1.10, 1.40) was associated with higher monthly sugar-sweetened beverage consumption. Associations involving tobacco use and alcohol binging were mixed. Observed neighborhood disorder might be associated with unhealthy behaviors, especially sugar-sweetened beverage consumption.

Swedish Snuff (Snus), Cigarette Smoking, and Risk of Type 2 Diabetes

Cigarette smoking is a known risk factor for Type 2 diabetes, but evidence regarding former smoking and moist snuff (snus) use and Type 2 diabetes risk is inconclusive. This study investigated the relationships of cigarette smoking and Swedish snus use with the risk of Type 2 diabetes in a cohort of middle-aged and elderly participants. Participants (N=36,742; age range=56-95 years) were followed for incident Type 2 diabetes and death between 2009 and 2017 through linkage to the Swedish National Patient, Prescribed Drug and Death Registers. Cox proportional hazards regression was used to obtain hazard ratios and 95% CIs adjusted for potential confounders, including physical activity, education, BMI, and alcohol intake. Analyses were conducted in 2021‒2022. Former and current smoking was associated with an increased risk of Type 2 diabetes (hazard ratios [95% CI]=1.17 [1.07, 1.29] and 1.57 [1.36, 1.81], respectively). In those who stopped smoking, Type 2 diabetes risk remained elevated up to approximately 15 years after cessation. In participants who have never smoked, snus use was linked to a higher risk of Type 2 diabetes in the model adjusted for age and sex (hazard ratio [95% CI]=1.49 [1.04, 2.15]), but this was attenuated after multivariable adjustment (hazard ratio [95% Cl]=1.29 [0.89, 1.86]). This study indicates that current and former smoking are associated with an increased risk of Type 2 diabetes in middle-aged and older individuals. There was less evidence of an association of snus use with the risk of Type 2 diabetes, suggesting that compounds other than nicotine may underlie the detrimental association of smoking with the risk of Type 2 diabetes.

Sonographic Assessment of the Salivary Glands among Sudanese Snuff-dippers.

The parotid, submandibular, and sublingual glands, as well as the smaller subsidiary glands, are all the examples of the salivary glands. The likelihood of the salivary glands being impacted by snuff components increases due to this close proximity of the salivary glands to the mouth when snuff is used. The aim of this study was to evaluate the salivary glands of the Sudanese snuff-dippers. Sixty-five adult snuff-dippers (research group) and 36 adult nonusers (control group) were enrolled in the study. Sonography of the submandibular and parotid glands was performed; size, blood flow, echogenicity, echotexture, and any other pathological changes were evaluated. The study was conducted in the ultrasound unit at our institution from June 2021 to June 2022. The result of the study showed that the average size of the left submandibular gland and left and right parotid glands of snuff-dippers was significantly greater than the average size of nonusers. Blood supply and tissue characteristics were normal. The study concluded that the snuff use could affect the parotid and submandibular glands; ultrasonography is a modality of choice in the examination of the salivary glands of snuff users and other tobacco users.

A cross-sectional study of attitudes and behaviors of snuff use and cessation among people with and without HIV in South Africa.

Despite a high (48%) prevalence of snuff use among women with HIV in South Africa, little is known of the attitudes and behaviors of use, strategies for cessation, and potential health risks. In a cross-sectional study, a questionnaire was administered to adults (≥18years) with (HIV+) and without HIV (HIV-) who self-reported current snuff use to collect information on demographics, snuff use and cessation attempts, preferred strategies for cessation, other substance use, history of respiratory illness, and mental health. 150 (74 HIV+, 76 HIV-) participants were enrolled; 115 (77%) were daily snuff users, 6 (4%) were current smokers, and 17 (11%) former smokers. Top reasons for current snuff use included improving health (n = 48, 32%), reducing stress (n = 26, 16%), and "being a habit" (n = 38, 25%). Participants believed snuff use to have mostly positive (n = 68, 46%) or no (n = 54, 36%) health impacts, and 57 (38%) participants believed snuff cures headaches. 103 (69%) participants reported a previous quit attempt, and 110 (73%) indicated high interest in quitting snuff. Although 105 (70%) participants indicated that advice from a healthcare provider would aid them in quitting snuff, only 30 (20%) reported ever receiving that advice. A majority of participants (n = 141, 94%) suffer from moderate to high levels of perceived stress, and overall few differences were seen by HIV status. Education on negative impacts of snuff, advice to quit from healthcare providers, and nicotine replacement therapy should be considered in the development of a snuff cessation program.

Association of High Immunohistochemical Expression of Minichromosome Maintenance 3 with Human Oral Squamous Cell Carcinoma—A Preliminary Study

Oral squamous cell carcinoma (OSCC) may arise from premalignant oral lesions (PMOL) in most cases. Minichromosome maintenance 3 (MCM3) is a proliferative marker that has been investigated as a potential diagnostic biomarker in the diagnosis of oral cancer. To evaluate the association of MCM3 expression, its clinicopathologic parameters and to identify snuff (also called naswar) as a potential risk factor for changes in MCM3 expression in PMOL and OSCC. Immunohistochemistry (IHC) of MCM3 was performed on 32 PMOL, 32 OSCC and 16 normal controls after optimization of IHC methodology. Histoscore (0-300) was used as a scoring system and seven different cut-offs were identified for analyses. Data were analyzed using various statistical tests. Among the seven cutoffs, 40% strong positive cells were found to be a better cut-off as they were associated with many pathological variables (Broder's grade, Aneroth's grade, and mitotic activity). The differential MCM3 expression in oral lesions (PMOL and OSCC) was statistically significant (p = 0.03). Moreover, MCM3 expression is raised with increased duration and frequency of snuff use. High MCM3 expression is associated with disease progression and is a potential indicator of malignant transformations from PMOL to OSCC. Moreover, the use of snuff is associated with MCM3 over-expression.

Epidemiologic and clinical characteristics of diabetic foot ulcer among patients with diabetes in Afghanistan: An IDF supported initiative

AimThe aim is to illustrate epidemiological and clinical characteristics of diabetic patients with foot ulcer (DFU) in Kabul diabetic medical center (KDMC), Afghanistan. MethodIt is a descriptive study explaining the characteristics of diabetic patients with DFU admitted to KDMC, between 1/9/2019 to 31/8/2020 which is a center for management of diabetic patients including DFU. The university of Texas diabetic classification for DFU was used. ResultsTotally 3159 patients admitted to KMDC of whom 47.4% were females and 96.7% type 2 diabetes. The proportion of DFU was 9.2%. The patients’ mean age was 55.4 ± 10.6 years and 78% were coming from Kabul. Prevalence of smoking and snuff use were 8.6% and 5.6% respectively. Majority of females 93% were housewives. The duration of diabetes was 5–19 years. Almost two-third were under glycaemia and HbA1c control and 9.2% had history of amputation. The common symptoms were burning, aching, numbness and tingling. The most common cause of DFU was both neuropathy and arteriopathy. After treatment 16% were referred for orthopedic procedures. ConclusionsDFU affects almost one-tenth of diabetics while a significant number of patients attend at late stage requiring orthopedic treatment. Monitoring of diabetic patients to prevent DFU is important is recommended.

The association of smoking, use of snuff, and preconception alcohol consumption with spontaneous abortion: A population-based cohort study.

It is unclear whether tobacco in early pregnancy and alcohol use preceding pregnancy are associated with spontaneous abortion. The purpose was to investigate if use of tobacco and/or alcohol is associated with spontaneous abortion among women attending antenatal care, and if age and body mass index (BMI) attenuate the risk. A population-based cohort study based on data from the Swedish Pregnancy Register. All pregnant women having had the first antenatal visit from January 2014 to July 2018 were included (n=525 604). The register had information about smoking and use of snuff before and in early pregnancy, as well as data on alcohol habits before pregnancy, measured by the Alcohol Use Disorders Identification Test (AUDIT), a validated questionnaire. Logistic regression analysis was used to estimate the association between lifestyle factors and spontaneous abortion, and multiple imputation was used to impute missing data. In total, 34 867 (6.6%) pregnancies ended in a spontaneous abortion after the first visit to maternal health care. At the first maternal healthcare visit, daily smoking was reported by 24 214 (5.1%), and 6403 (1.2%) used snuff. For 19 837 (4.2%) women, a high alcohol score was reported for the year preceding pregnancy. After adjusting for potential confounders and multiple imputation, use of tobacco was associated with spontaneous abortion; smoking 1-9 cigarettes/day (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.04-1.18), smoking 10 or more cigarettes/day (aOR 1.12, 95% CI 1.-1.26), and use of snuff (aOR 1.20, 95% CI 1.06-1.37). Higher AUDIT scores were not significantly associated with spontaneous abortion (AUDIT 6-9: aOR 1.03, 95% CI 0.97-1.10 and AUDIT 10 or more: aOR 1.07, 95% CI 0.94-1.22). Increasing maternal age showed the highest risk of spontaneous abortion from the age of 35, and BMI of 30 kg/m2 or more increased the risk. There were interactions between different lifestyle factors associated with spontaneous abortion that could either increase or decrease the risk of spontaneous abortion. Smoking and use of snuff were associated with an increased risk of spontaneous abortion. The AUDIT scores preceding pregnancy were not associated with an increased risk of spontaneous abortion, which contradicts the results from previous studies.

Use of snuff and its main constituents for religious purposes in an alternative community with shamanic practices in the south of Brazil

Abstract Snuff is a fine aromatic powder composed of dried and thin leaves combined with tobacco, roots, peels, and seeds. Its use for indigenous religious purposes has appeared since pre-Columbian period in various localities of American continent. Practice is considered sacred in indigenous culture and suffered from trivialization of consumption due to influence of colonizers, which triggered subsequent industrialization of this complex for commercial purposes. Commercial snuff is essentially made from industrialized tobacco without addition of other medicinal plants and without therapeutic or spiritual purposes beyond its indiscriminate and inappropriate use, causing health risks. Therefore, this study aimed to make a review on snuff in Brazilian culture and a tour of a local community. In shamanism, plants are used as access vehicles to other religions of cosmos and its inhabitants, from where experts dialogue, bring songs, news, omens, and acquire new knowledge. The plants used in shamanic composition of snuff vary with the locality of indigenous villages in America and are essential ingredients of this interaction between humans and non-humans, a special mediator of intersubjective interactions. Several studies show the use and meaning of Erythroxylum coca used in different communities of the Amazon, besides Chacrona and Mariri, popular names of plants used in manufacture of Ayahuasca drink by doctrine Santo Daime. Because of this, it is essential to establish differences between recreational snuff and shamanic and their effects on body as well as studies on use of shamanic snuff should be directed according to their applications and plants employed by communities.