Exploring the health and biochemical effects of kratom (Mitragyna speciosa) consumption within the local community of Putussibau district, Borneo, Indonesia

Kratom (Mitragyna speciosa) is a plant indigenous to Thailand and Southeast Asia. Kratom leaves produce complex stimulant and opioid-like analgesic effects. In Asia, kratom has been used to stave off fatigue and to manage pain, diarrhea, cough, and opioid withdrawal. Recently, kratom has become widely available in the United States and Europe by means of smoke shops and the Internet. Analyses of the medical literature and select Internet sites indicate that individuals in the United States are increasingly using kratom for the self-management of pain and opioid withdrawal. Kratom contains pharmacologically active constituents, most notably mitragynine and 7-hydroxymitragynine. Kratom is illegal in many countries. Although it is still legal in the United States, the US Drug Enforcement Administration has placed kratom on its "Drugs and Chemicals of Concern" list. Physicians should be aware of the availability, user habits, and health effects of kratom. Further research on the therapeutic uses, toxic effects, and abuse potential of kratom and its constituent compounds are needed.

Background:Kratom (Mitragyna speciosa) consumption and associated health effects have raised debates in the United States. Although most people using this herb do not experience adverse health effects associated with kratom use, medical providers should be knowledgeable of emerging substances and concurrent, sequential, or simultaneous use of other drugs which may impact healthcare recommendations and prescribing practices.Methods:The objective of this narrative review was to elucidate selected health effects associated with using kratom—either alone or with other substances. Since scientifically controlled human subjects research on kratom use is still limited, relevant case reports were also described.Results:Cardiovascular, gastrointestinal, neurological, and psychiatric effects associated with kratom use were especially notable, and in-utero exposure accompanied concern regarding a neonate’s risk for developing neonatal abstinence syndrome. Our ability to identify and understand the role of this herb in kratom-associated fatalities is complicated since kratom is not routinely screened for in standard forensic toxicology. If a screening is performed, it is usually for the major alkaloid, mitragynine, as a surrogate for kratom use. In addition to lacking a standard practice of screening decedents for kratom alkaloids, the association between mortality and kratom use may be confounded by polysubstance use, adulteration of kratom products, and drug-herb interactions.Conclusions:Increasing medical awareness of this herb is vital to ensuring prompt administration of best-practice medical advice or treatment for people seeking information related to kratom use or for patients experiencing an adverse health effect that may be associated with using or withdrawing from kratom. Knowledge gained from continued surveillance and study of kratom and its associated health effects may assist in guiding clinical decision-making and preventing development of adverse health effects among people using kratom.

Beneficial and adverse health effects of kratom (Mitragyna speciosa): A critical review of the literature

Kratom (Mitragyna speciosa) leaves contain the mu opioid partial agonists mitragynine and 7-hydroxymitragynine. The US Drug Enforcement Agency considers it a 'drug of concern', and the US FDA is reviewing kratom, but there is a paucity of information regarding health effects. Liver injury is often cited as a potential health consequence, however the same few case reports are repeatedly referenced, without a broader context. Furthermore, reports have largely lacked standardized causality assessment methods. The objective is to evaluate causality in kratom liver injury, through a comprehensive scoping review of human cases, and by reviewing epidemiologic, animal, and mechanistic reports that relate to kratom liver injury. Hepatotoxicity causality was systematically examined using the Roussel Uclaf Causality Assessment Method (RUCAM) for case reports. Biopsy findings, potential pathophysiologic mechanisms, and management options are discussed. This review identified 26 case reports and abstracts, in addition to 7 cases reported from the Drug-Induced Liver Injury Network, 25 in FDA databases, and 27 in internet user forums. Latency periods to symptom onset had a median of 20.6days and mean of 21days (range 2-49). Common presenting signs and symptoms were abdominal discomfort, jaundice, pruritis, and dark urine. Histologic findings were predominantly cholestatic, although, biochemically, the condition was heterogenous or mixed; the median R ratio was 3.4 and the mean was 4.6 (range 0.24-10.4). Kratom likely causes liver injury based on the totality of low-quality human evidence, and, in the context of epidemiologic, animal, and mechanistic studies. It remains unclear which subgroups of users are at heightened risk.

Ecotourism plays an important role in the development of rural areas. It generates rural employment and improves the socioeconomic condition of the local community. This study was initiated to assess the effects of eco-tourism on the local community in Chitral Lower district, Pakistan, and to identify various effects and problems for the promotion of eco-tourism in the study area. A total of 230 sample respondents from three villages were randomly selected. Data were collected with the help of questionnaires, random surveys, and interviews with key informants and observations. Through descriptive statistics and binary logistic regression, data were analyzed. From the coefficients of the logistic regression model, only four independent variables, namely income, education, lodging facility, and tour guide facility, had a statistically significant relationship with ecotourism. Having a high level of education gives community members a variety of opportunities to engage in high-value and high-paying ecotourism activities to increase their income level. Having proper lodging and tour guide facilities increases the engagement of tourists and visitors. Therefore, the findings clearly indicate that more education, income opportunities, lodging facilities, and availability of tour guides facilities will help increase eco-tourism in the area. This study recommends that to govern and manage the eco-tourism areas, in order to reach their full potential and provide long-term benefits to the local community, the government should explore the potential ecotourism benefits and create appropriate policies to furnish the ecotourism while security provisions to the community also help in the ecotourism improvement.

Mitragyna speciosa, commonly known as Ketum or Biak in Malaysia and Kratom in Thailand, is a native plant to Southeast Asia and has various pharmacological benefits. Mitragynine (MG) is the principal alkaloid found in the leaves of Mitragyna speciosa and has been reported to be responsible for the plant's therapeutic actions. Traditionally, local communities use Kratom preparations for relief from different types of pain. The potential analgesic effects of MG using rodent models have been reported in literatures. We have reviewed the published analgesic and pharmacokinetic studies and all of these findings showed the routes of drug administration, doses employed, and type of vehicles used to solubilize the drug, varied considerably; hence this posted difficulties in predicting the drug's pharmacokinetic-response relationship. A rational approach is warranted for accurate prediction of dose-response relationship; as this is essential for the development of MG as an alternative medicinal drug for pain management. PKPD modeling would serve as a better method to understand the dose-response relationship in future MG preclinical and clinical studies.

Mitragyna speciosa, commonly known as kratom, has gained popularity in the United States due to its stimulant and analgesic effects. Allegations of kratom-associated adverse health effects, primarily based on case reports/series, have obtained media attention. Thus, a systematic literature search using PubMed was conducted to identify patterns among cases involving kratom use and acute adverse health effects in humans. 95 patients were identified for review. Mitragynine presence was toxicologically confirmed in 55 cases; 35 were deceased (mitragynine blood levels ranged from 3.5 to 7,500 ng/mL), and 20 were living (range of 5 to 340 ng/mL). Reported adverse effects included pulmonary, cardiovascular, brain, liver, kidney, and gastrointestinal effects, as well as seizures, loss of consciousness, lethargy, fatigue, and altered mental state. Toxicology panels revealed confounding substances that could have caused or contributed to the acute adverse effects in 32 deceased and seven surviving cases (p = 0.0002), despite attribution of many adverse effects solely to kratom. Upon analysis of the identified case reports, a pattern of weak or inadequate toxicology testing and medical history was observed. Currently, the literature provides insufficient evidence to support the claim that kratom consumption alone increases the risk of severe acute adverse health effects. More research is necessary to isolate the effects of kratom from those of polypharmacy.

Kratom use and mental health: A systematic review

Extreme tourism is actively developing within Podillia, but spontaneously. The goal is to consider the peculiarities of regional differences in the development of extreme tourism, taking into account the availability of relevant natural and socio-economic resources of Podillia. The methods of system analysis and generalization, field landscape studies and tourism studies, modeling and GIS technologies were used. It is noted that geographers and landscape scientists still do not pay enough attention to researching the possibilities of the development of extreme tourism, in particular, its individual types. It is shown that Podillia has enough necessary natural and socio-economic resources for the development of various types of extreme tourism. For their better understanding and further development, it is expedient to use existing schemes of natural zoning, which partially take into account the socio-economic conditions of Podillia. An analysis of the existing sport tourism zoning scheme was also carried out, the structure of which includes extreme tourism. On the basis of these zonings, taking into account the available resources suitable for the development of the relevant types of extreme tourism, a zoning scheme for extreme tourism in Podillia was developed, with the separation of Zahidno-Podilsky, Kremenets-Gorbogirny, Tovtrovy, Podilsky Transnistria, Central-Podilskyi and Middle-Buzky districts. In each district, 2-3 leading types of extreme tourism and 1-2 promising ones in the future are selected. They need to be supported both by local village and district communities, and at the state level. The legal basis for the development of extreme tourism and its individual types, holding competitions, etc., also needs improvement. This especially applies to the relations between extreme tourists and local communities in connection with the complication of their established everyday life and activities.
 The development of the tourist and recreational sphere in the conditions of Podillia is determined by the presence of the necessary, often unique and even unique natural resources, appropriate socio-economic conditions and local traditions and customs. However, for a long period of time, the tourism and recreation sphere developed according to previously established criteria (until the 1990s). Since the beginning of the XXI century. clearly observed trends towards the reconstruction of the tourist and recreational sphere of Podillia, taking into account foreign experience and local conditions. Among the types of tourist and recreational activities, the importance of sports tourism is growing. In its structure, even now, extreme tourism remains in the "shadow", almost unrecognized. This often leads to its active spontaneous development, especially in such areas of Podillia as the Kremenets Mountains, Podil Transnistria, Podil Tovtry, and Middle Pobuzh. Moreover, for certain local communities, extreme tourism becomes profitable. For better development, extreme tourism must be separated from the structure of sports tourism, but developed together. In each of the designated extreme tourism areas of Podillia, 1-3 species will prevail. They need to be supported both by local village and district communities, and at the state level. The legal basis for the development of extreme tourism and its individual types, holding competitions, etc., also needs improvement. This especially applies to the relations between extreme tourists and local communities in connection with the complication of their established everyday life and activities.
 The proposed zoning scheme for extreme tourism in Podillia and its promising types identified in each district provide an opportunity to better develop directions for the development of individual types of extreme tourism, and to allocate costs for their development. In the future, this will require more detailed studies of the development possibilities of each type of extreme tourism, even those that are not leading in the isolated extreme tourism areas of Podillia, but will be promising in the future.
 It is noted that further research into the development of extreme tourism within Podillia will help to increase its diversity, the conduct of classes and the safety of training.
 Keywords. Podillia, natural resources, extreme tourism, zoning, development.

Epidemic cystic and alveolar echinococcosis in Kyrgyzstan: an analysis of national surveillance data

Forest biodiversity is crucial for the survival of local communities in Mahakam Ulu District, East Kalimantan Province, Indonesia, especially for the Punan Dayak, Bahau Bateq Hwang Lung Gelawang, and Bakumpai Dayak tribes who live in the Ratah Watershed area. For generations, local communities in the Ratah Watershed have had local wisdom to protect the resources in the forest around them. Unfortunately, various problems threaten the existence of forest biodiversity in the Ratah Watershed. The purpose of this study is to show the identification results of the potential, utilization, and management of biodiversity according to local communities in Mahakam Ulu District, East Kalimantan Province, and the threats faced. The data was obtained through interviews with key informants, FGDs, participatory mapping, and field observations with the people of Nyari Bungan Village, Long Gelawang Village, Danum Paroy Village, and Muara Ratah Village. The result of the study indicated that local communities in the Ratah Watershed find it more inconvenient to utilize forest resources because of the diminishing potential for biodiversity. The low level of welfare, unclear village boundaries, overlapping village areas with private companies (timber companies, oil palm) are the main problems. Conservation of biodiversity from forests in the Ratah Watershed requires the cooperation of various parties, especially in increasing community capacity in managing forest resources for better environment.

BackgroundAlthough the adverse impacts of conflict-driven displacement on health are well-documented, less is known about how health status and associated risk factors differ according to displacement experience. This study quantifies health status and quality of life among returning refugees, internally displaced persons, and the host community in a post-conflict district in Northern Sri Lanka, and explores associated risk factors.MethodsWe analysed data collected through a household survey (n = 570) in Vavuniya district, Sri Lanka. The effect of displacement status and other risk factors on perceived quality of life as estimated from the 36-item Short Form Questionnaire, mental health status from 9-item Patient Health Questionnaire, and self-reported chronic disease status were examined using univariable analyses and multivariable regressions.ResultsWe found strong evidence that perceived quality of life was significantly lower for internally displaced persons than for the host community and returning refugees, after adjusting for covariates. Both mental health status and chronic disease status did not vary remarkably among the groups, suggesting that other risk factors might be more important determinants of these outcomes.ConclusionsOur study provides important insights into the overall health and well-being of the different displaced sub-populations in a post-conflict setting. Findings reinforce existing evidence on the relationship between displacement and health but also highlight gaps in research on the long-term health effects of prolonged displacement. Understanding the heterogeneity of conflict-affected populations has important implications for effective and equitable humanitarian service delivery in a post-conflict setting.

The present review aims to explore the traditional plant knowledge and utilization practices among the local tribal communities in Yavatmal district, Maharashtra, India. To document ethnobotanical uses, the published literature including journals, floras and other online published sources was surveyed. A total of 370 taxa belonging to 290 genera and 82 families were identified. Local communities employ these plant species for various purposes. Traditional medicinal practices in local communities involve the use of both monoherbal and polyherbal remedies. Notably, this study indicated a higher prevalence of dermatological and gastrointestinal disorders in the district. Interestingly, research has also found that 34 invasive plant species are being utilized by the local tribal communities for healing various ailments. We have also computed the citation index (CI) and use index (UI) for each species. This study illuminates the rich traditional plant knowledge and its multifaceted applications within the local tribal communities of Yavatmal district of Maharashtra, India. The documentation of traditional plant knowledge in this region provides valuable insights into conservation efforts and the development of sustainable practices that respect the intricate bonds between people and nature.

This article aims to address the gap in understanding the current state of Chinese language learning among the Chinese community in District 5, Ho Chi Minh City, Vietnam. It begins by surveying the local Chinese community's learning situation and needs, analyzing data to identify challenges and influential factors in Chinese language education. The study specifically focuses on the declining situation at the Tran Boi Co School's Language Centre. Based on these findings, the paper offers targeted suggestions for improvements in Chinese language teaching at the school.

Local Folk Games and Health Promotion: Case Study, Saba Tossing Game of Thai Raman People in Ongkarak District, Nakornnayok Province