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Fulltext Characteristic imaging findings in pulmonary fat embolism syndrome (FES)

Ong SCL, Balasingam V

BMJ Case Rep, 2017 Nov 23;2017.
PMID: 29170189 DOI: 10.1136/bcr-2017-223007
Isolated azygos vein thrombosis: a rare phenomenon

Liew YH, Ong SCL, Balasingam V

BMJ Case Rep, 2017 Nov 14;2017.
PMID: 29141933 DOI: 10.1136/bcr-2017-222821
Fulltext Factors associated with quality of life (QOL) scores among methadone patients in Myanmar

Tun S, Balasingam V, Singh DS

PLOS Glob Public Health, 2022;2(8):e0000469.
PMID: 36962722 DOI: 10.1371/journal.pgph.0000469

The Drug Dependency Treatment and Research Unit (DDTRU) in Myanmar established opioid substitution with methadone in 2006. Reducing HIV transmission could be affected by eliminating the unsafe needle sharing among injecting drug uses and treatment with opioid substitution. The quality of life (QOL) among the clients retained in the methadone program is important for their personal development and is an indication of the treatment efficacy. This study evaluated factors associated with the QOL of methadone patients to ensure efficient service delivery. It also identified how patients' characteristics had differed QOL scores of respondents. This cross-sectional study was conducted in five cities with stratified random sampling. The study assessed the QOL of methadone patients in Myanmar. The study recruited 210 respondents to answer structured questionnaires for their quality of life: WHOQOL-BREF questionnaires and urine sample collection for methadone and illicit drug use. Survey responses on the QOL were transformed into 100-scale ratings, and higher QOL scores reflect better QOL. The average score of total QOL was 60.82%; precisely 60.09% in the physical domain, 63.11% in the psychological domain, 59.87% in the social relation domain, 60.41% in the environmental domain respectively. Respondents who reported illicit drug use had lower QOL scores. Statistically significant association of the QOL category of the methadone patients was identified with frequent methadone treatment episodes, the infection status of HIV, current treatment on antiretroviral therapy (ART), tuberculosis (TB) treatment history, sexually transmitted infections (STI) history in their lifetime, current work status as peer, Addiction Severity Index (ASI) for drug use, satisfaction with current marital status, satisfaction with current leisure status, history of psychological abuse within 30 days, heroin injection within 30 days, frequency of injection, and reported use of barbiturates (p<0.05). Addressing these factors will improve the treatment service intervention and the quality of life among methadone patients.
Self-reported prevalence and severity of opioid and kratom (Mitragyna speciosa korth.) side effects

Saref A, Suraya S, Singh D, Grundmann O, Narayanan S, Swogger MT, et al.

J Ethnopharmacol, 2019 Jun 28;238:111876.
PMID: 31014959 DOI: 10.1016/j.jep.2019.111876

ETHNOPHARMACOLOGICAL RELEVANCE: Mitragyna speciosa (Korth.) is a traditional medicinal plant widely used in Southeast Asia for its opioid-like effects. Although kratom produces analgesia through binding of mitragynine and other alkaloids at the mu-opioid receptor (MOR), the association of long-term kratom use with adverse opioid-like effects remains unknown.
AIM OF THE STUDY: To determine the self-reported prevalence and severity of opioid-related adverse effects after kratom initiation in a cohort of illicit opioid users.
MATERIALS AND METHODS: A total of 163 illicit opioid users with current kratom use history were recruited through convenience sampling from the northern states of Peninsular Malaysia. Face-to-face interviews were conducted using a semi-structured questionnaire.
RESULTS: Respondents were all males, majority Malays (94%, n = 154/163), with a mean age of 37.10 years (SD = 10.9). Most were single (65%, n = 106/163), had 11 years of education (52%, n = 85/163) and employed (88%, n = 144/163). Half reported using kratom for over >6 years (50%, n = 81/163), and 41% consumed >3 glasses of kratom daily (n = 67/163). Results from Chi-square analysis showed kratom initiation was associated with decreased prevalence of respiratory depression, constipation, physical pain, insomnia, depression, loss of appetite, craving, decreased sexual performance, weight loss and fatigue.
CONCLUSIONS: Our findings indicate that kratom initiation (approximately 214.29 mg of mitragynine) was associated with significant decreases in the prevalence and severity of opioid adverse effects.
Self-Report Data on Regular Consumption of Illicit Drugs and HIV Risk Behaviors after Kratom (Mitragyna Speciosa korth.) Initiation among Illicit Drug Users in Malaysia

Saref A, Suraya S, Singh D, Grundmann O, Narayanan S, Swogger MT, et al.

J Psychoactive Drugs, 2019 11 04;52(2):138-144.
PMID: 31682782 DOI: 10.1080/02791072.2019.1686553

This study sought to determine the relationship between kratom (Mitragyna speciosa) initiation and regular consumption of illicit drugs and HIV risk behaviors in a cohort of illicit drug users in Malaysia. 260 illicit drug users with current kratom use were recruited through convenience sampling for this cross-sectional study. All were male, with the majority being Malays (95%, n = 246/260). Results suggest that kratom initiation was associated with significant decrease in the regular use of heroin (odds ratio (OR) = 0.50, 95% confidence interval (CI): 0.40- 0.72; p = .0001), methamphetamine (OR = 0.23, CI: 0.16- 0.35; p < .0001), and amphetamine (OR = 0.17, CI: 0.09- 0.34; p < .0001). Kratom initiation was also associated with reduction in regular HIV risk behaviors such as having sex with sex workers (OR = 0.20, CI: 0.12-0.32; p < .0001), using drugs before sexual intercourse (OR = 0.20, CI: 0.13- 0.31; p < .0001), injecting behaviors (OR = 0.10, CI: 0.04- 0.25; p < .0001), sharing of injection equipment (OR = 0.13, CI: 0.04- 0.43; p < .0001), and injecting with other injection drug users (IDUs) (OR = 0.07, CI: 0.02- 0.24; p < .0001).
Public Perceptions toward Kratom (Mitragyna Speciosa) Use in Malaysia

Singh D, Narayanan S, Suraya S, Saref A, Grundmann O, Prozialeck WC, et al.

J Psychoactive Drugs, 2020 03 10;52(3):282-288.
PMID: 32153252 DOI: 10.1080/02791072.2020.1738603

Kratom (Mitragyna speciosa), an indigenous medicinal plant of Southeast Asia, is believed to be harmful. We compared the perceptions toward kratom use among kratom users and non-users in Malaysia. 356 respondents (137 kratom users and 219 non-users) were recruited for this cross-sectional study. The majority of respondents were male (60%, n = 212/356), Malays (88%), and 51% were ≥37 years old. Non-users showed higher unadjusted odds of reporting a perception that kratom use can cause addiction (OR = 6.72, CI: 3.91-11.54, p
Patterns and reasons for kratom (Mitragyna speciosa) use among current and former opioid poly-drug users

Singh D, Yeou Chear NJ, Narayanan S, Leon F, Sharma A, McCurdy CR, et al.

J Ethnopharmacol, 2020 Mar 01;249:112462.
PMID: 31816368 DOI: 10.1016/j.jep.2019.112462

ETHNOPHARMACOLOGICAL RELEVANCE: Kratom (Mitragyna speciosa) is a native medicinal plant of Southeast Asia widely reported to be used to reduce opioid dependence and mitigate withdrawal symptoms. There is also evidence to suggest that opioid poly-drug users were using kratom to abstain from opioids.
AIM OF THE STUDY: To determine the patterns and reasons for kratom use among current and former opioid poly-drug users in Malaysia.
MATERIALS AND METHODS: A total of 204 opioid poly-drug users (142 current users vs. 62 former users) with current kratom use history were enrolled into this cross-sectional study. A validated UPLC-MS/MS method was used to evaluate the alkaloid content of a kratom street sample.
RESULTS: Results from Chi-square analysis showed that there were no significant differences in demographic characteristics between current and former opioid poly-drug users except with respect to marital status. Current users had higher odds of being single (OR: 2.2: 95%CI: 1.21-4.11; p