Antibiocoprofilaxia de endocardite bacteriana em procedimentos realizados na odontologia / Antibiotic prophylaxis for the bacterial endocarditis during dental procedures

O uso de antibióticos na prevenção da endocardite bacteriana deve ser realizado em pacientes com risco de desenvolvimento da doença, durante procedimentos odontológicos invasivos que causem bacteremia. Os estreptococos do grupo viridans estão na cavidade bucal e são mais frequentemente associados à endocardite subaguda, em procedimentos odontológicos. A profilaxia, de forma racional, traz mais benefícios do que a manutenção de um paciente com endocardite. Os protocolos, como os da American Heart Association e da Sociedade Britânica de Antimicrobianos e Quimioterápicos, orientam a conduta prescricional do clínico, que deve conhecer os aspectos farmacológicos das drogas mencionadas nas orientações. A racionalização da profilaxia antimicrobiana, mudanças em atitudes dos profissionais da área de saúde, dos pacientes e da populaçào que utilizam abusivamente antimicrobianos que podem auxiliar no controle da disseminação de microrganismos resistentes. O presente trabalho tem por objetivo revisar a antibiocoprofilaxia de endocardite bacteriana na odontologia, abordando tópicos importantes para a racionalização do seu uso entre cirurgiões-dentistas

Purification and partial characterization of kininogenase activity from Schistosoma mansoni adult worms.

An enzyme presenting kallikrein-like activity (designated sK1) was purified from the supernatant of Schistosoma mansoni adult worm homogenate. The enzyme cleaves bradykinin from purified rat plasma kininogen. Activity was optimal at pH 9.0 and the enzyme showed amidolytic activity, since it hydrolysed the kallikrein synthetic substrate D-Pro-Phe-Arg-p-nitroanilide. The activity of sK1 upon rat plasma kininogen was strongly inhibited by the serine proteinase inhibitors phenylmethanesulfonyl fluoride, aprotinin or soybean trypsin inhibitor, but not by ethylenediaminetetraacetic acid or sodium tetrathionate. The molecular mass of sK1, as determined by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate, was 66 kDa and the pI value, estimated by analytical chromatofocusing, was 4.2. Physical and chemical properties suggest that sK1 is a serine proteinase of the kallikrein family. Evidence is presented which suggests that sK1 is a component of the tegumental surface of the parasite and the levels of its activity in the male adult worm are approximately 21 times higher than those in the female adult worm. The intravenous injection of 3 micrograms of sK1 into an anaesthetized rat induced a drastic reduction in the arterial blood pressure of the animal. This effect lasted for about 1 min, and was followed by a progressive recovery of the arterial pressure. Neither bradycardia nor cardiac arrhythmias were noticed, suggesting a peripheral vasodilation effect. The presence of sK1 on the surface of adult male worms could play an important role in the wandering capacity of coupled worms into the visceral vasculature of the host.