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Betel quid seller syndrome
  1. G Dwivedi1,
  2. S Dwivedi2
  1. 1University Department of Medicine, City Hospital, Dudley Road, Birmingham, UK
  2. 2Department of Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India
  1. Correspondence to Professor S Dwivedi, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi-95, India; sdwivedi{at}

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People who sell betel quid in south Asia also sell smokeless, non-perishable and dried tobacco preparations like ‘gutkha’ and ‘pan masala’. Over the years they develop a characteristic body habitus comprising central obesity, brick-stained lips, damaged teeth and discoloured tips and palms of the hands. To the best of our knowledge the occupational hazards of such work have not been described so far. The present report concerns three such betel sellers who had the above features associated with premature cardiovascular disease.

Case 1

A 59-year-old man, a known hypertensive (7 years) and diabetic (5 years), presented to us with acute chest pain. This proved to be due to acute myocardial infarction. He had been in the betel profession for well over 40 years, spending about 8–12 h sitting, selling and …

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.