Pharmacology
Pharmacodynamics
Opioid receptor modulator
Buprenorphine has been reported to possess these following pharmacological activities:
μ-Opioid receptor (MOR): Very high affinity partial agonist: at low doses, the MOR-mediated effects of buprenorphine are comparable to those of other narcotics, but these effects reach a "ceiling" as the receptor population is saturated. This behavior is responsible for several unique properties: buprenorphine greatly reduces the effect of most other MOR agonists, can cause precipitated withdrawal when used in actively opioid dependent persons, and has a lower incidence of respiratory depression and fatal overdose relative to full MOR agonists. κ-Opioid receptor (KOR): High affinity antagonist—this activity is hypothesized to underlie some of the effects of buprenorphine on mood disorders and addiction. δ-Opioid receptor (DOR): High affinity antagonist
Nociceptin receptor (NOP, ORL-1): Weak affinity, very weak partial agonistIn simplified terms, buprenorphine can essentially be thought of as a nonselective, mixed agonist–antagonist opioid receptor modulator, acting as an unusually high affinity weak partial agonist of the MOR, a high affinity antagonist of the KOR and DOR, and a relatively low affinity, very weak partial agonist of the ORL-1/NOP.Although buprenorphine is a partial agonist of the MOR, human studies have found that it acts like a full agonist with respect to analgesia in opioid-intolerant individuals.
The disease is listed by the World Health Organization (WHO) as a neglected tropical disease. Risk
Frequent exposure to penetrating wounds by thorns or splinters is a risk factor. This risk can be reduced by disinfecting wounds and wearing shoes. Pathogenesis
Mycetoma is caused by common saprotrophs found in the soil and on thorny shrubs in semi-desert climates. Some common causative agents are:
Madurella mycetomatis (fungus)
Nocardia brasiliensis (bacteria)
Actinomadure madura (bacteria)
Streptomyces somaliensis (bacteria)
Actinomadura pelletieri (bacteria)Infection is caused as a result of localized skin trauma, such as stepping on a needle or wood splinter, or through a pre-existing wound.The first visible symptom of mycetoma is a typically painless swelling beneath the skin; over several years, this will grow to a nodule (lump). Affected people will experience massive swelling and hardening of the area, in addition to skin rupture and the formation of sinus tracts that discharge pus and grains filled with organisms. In many instances, the underlying bone is affected. Some people with mycetoma will not experience pain or discomfort, while others will report itching and/or pain. Diagnosis
There are currently no rapid diagnostic tools for mycetoma. Mycetoma is diagnosed through microscopic examination of the grains in the nodule and by analysis of cultures. Since the bacterial form and the fungal form of mycetoma infection of the foot share similar clinical and radiological features, diagnosis can be a challenge. Magnetic resonance imaging is a very valuable diagnostic tool. However, its results should be closely correlated with the clinical, laboratory and pathological findings.