BACKGROUND: There is an increase in the sale of legal drugs in our country. One of these substances is kratom. Kratom (Mitragyna speciosa) is a partial agonist of the opioid kappa, mu, and delta receptors. It acts as a stimulant at low concentrations, making users feel more energetic and euphoric. It has sedative and antinociceptive effects at higher doses. CASE SUMMARY: An 18-year-old man collapsed during football training and required cardiopulmonary resuscitation; the initial rhythm was ventricular fibrillation managed by defibrillation. Laboratory parameters were unremarkable. Blood samples sent for toxicological evaluation were positive for kratom and caffeine. Echocardiographic examination, coronary computed tomography angiography, and cardiac magnetic resonance imaging did not prove the cause. Genetic testing did not find a pathogenic gene variant associated with familial ventricular fibrillation, but a variant of unknown significance was found in MYOM1. Given this situation, we implanted an implantable cardioverter-defibrillator (ICD) from the secondary prevention of sudden cardiac death (SCD) according to the guidelines of the European Society of Cardiology (ESC). No recurrence of ventricular arrhythmia has been reported by ambulatory ICD memory checks on our patient. DISCUSSION: In some country, kratom is freely available and sold as a plant, not a drug. Only incident cases of ventricular fibrillation after kratom use are described in the literature. There is insufficient scientific evidence linking kratom to ventricular fibrillation. This is an absolutely crucial case report of this type, which has not yet been published in similar circumstances in the world. Therefore, the development of ventricular fibrillation was assumed to be due to a combination of kratom, caffeine, and exercise. The safety profile and effects of kratom should be the subject of future research. We would like to stress the importance of reporting further case series for more scientific evidence and thus increasing the pressure for stricter availability and regulation of kratom in some countries, especially where it is over-the-counter.

• Klíčová slova
• Case report, Implantable cardioverter-defibrillator, Kratom, MYOM1, Mitragyna speciosa, Mitragynine, Ventricular fibrillation,
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

This report describes the case of a 31-year-old male lumberjack with severe self-inflicted injuries, including the amputation of both auricles and the penis, under the influence of cannabinoids, mitragynine, and 7-hydroxymitragynine. Emergency surgery was performed, and psychiatric evaluation revealed substance-induced psychosis. The patient's motivation for reconstructive penile surgery led to abstinence from the substance use and cooperation with treatment. Five months after hospitalization, successful penile reconstruction was completed. The patient remained abstinent and was engaged in regular psychiatric follow-ups, showing no signs of acute psychopathology. This case underscores the importance of using a multidisciplinary approach to manage severe self-harm behaviors, and highlights the critical role of patient motivation in achieving positive outcomes.

• Klíčová slova
• cannabinoids, case report, kratom, paranoia, psychotic episodes, self-amputation, self-inflicted injuries, substance-induced psychosis,
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Mitragynine (MG) is the most abundant alkaloid component of the psychoactive plant material "kratom", which according to numerous anecdotal reports shows efficacy in self-medication for pain syndromes, depression, anxiety, and substance use disorders. We have developed a synthetic method for selective functionalization of the unexplored C11 position of the MG scaffold (C6 position in indole numbering) via the use of an indole-ethylene glycol adduct and subsequent iridium-catalyzed borylation. Through this work we discover that C11 represents a key locant for fine-tuning opioid receptor signaling efficacy. 7-Hydroxymitragynine (7OH), the parent compound with low efficacy on par with buprenorphine, is transformed to an even lower efficacy agonist by introducing a fluorine substituent in this position (11-F-7OH), as demonstrated in vitro at both mouse and human mu opioid receptors (mMOR/hMOR) and in vivo in mouse analgesia tests. Low efficacy opioid agonists are of high interest as candidates for generating safer opioid medications with mitigated adverse effects.

• MeSH
• analgetika chemie   farmakologie   MeSH
• chemické modely MeSH
• ethylenglykol chemie   MeSH
• lidé MeSH
• Mitragyna chemie   MeSH
• molekulární struktura MeSH
• myši knockoutované MeSH
• myši MeSH
• receptory opiátové mu agonisté   genetika   metabolismus   MeSH
• rostlinné extrakty chemie   farmakologie   MeSH
• sekologanin-tryptaminové alkaloidy chemie   farmakologie   MeSH
• vazba proteinů MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Názvy látek
• 7-hydroxymitragynine MeSH Prohlížeč
• analgetika MeSH
• ethylenglykol MeSH
• receptory opiátové mu MeSH
• rostlinné extrakty MeSH
• sekologanin-tryptaminové alkaloidy MeSH