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Indian SLT-products undergo fermentation which affects the production of potential carcinogens called tobacco-specific nitrosamines (TSNAs) [84, 85] and are often combined with additives such as betel leaf ( Piper betle ), sliced areca nut ( Areca catechu ) and/or powdered agricultural lime [86], which further enhances their toxicity and psychotropic effect [87, 88]