Procalcitonin versus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial.

OBJECTIVE: We sought to evaluate whether procalcitonin was superior to C-reactive protein in guiding antibiotic therapy in intensive care patients with sepsis. DESIGN: Randomized open clinical trial. SETTING: Two university hospitals in Brazil. PATIENTS: Patients with severe sepsis or septic shock. INTERVENTIONS: Patients were randomized in two groups: the procalcitonin group and the C-reactive protein group. Antibiotic therapy was discontinued following a protocol based on serum levels of these markers, according to the allocation group. The procalcitonin group was considered superior if the duration of antibiotic therapy was at least 25% shorter than in the C-reactive protein group. For both groups, at least seven full-days of antibiotic therapy were ensured in patients with Sequential Organ Failure Assessment greater than 10 and/or bacteremia at inclusion, and patients with evident resolution of the infectious process had antibiotics stopped after 7 days, despite biomarkers levels. MEASUREMENTS AND MAIN RESULTS: Ninety-four patients were randomized: 49 patients to the procalcitonin group and 45 patients to the C-reactive protein group. The mean age was 59.8 (SD, 16.8) years. The median duration of antibiotic therapy for the first episode of infection was 7.0 (Q1-Q3, 6.0-8.5) days in the procalcitonin group and 6.0 (Q1-Q3, 5.0-7.0) days in the C-reactive protein group (p=0.13), with a hazard ratio of 1.206 (95% CI, 0.774-1.3; p=0.13). Overall, protocol overruling occurred in only 13 (13.8%) patients. Twenty-one patients died in each group (p=0.836). CONCLUSIONS: C-reactive protein was as useful as procalcitonin in reducing antibiotic use in a predominantly medical population of septic patients, causing no apparent harm.

Genetic contribution for non-syndromic cleft lip with or without cleft palate (NS CL/P) in different regions of Brazil and implications for association studies.

Non-syndromic cleft lip with or without cleft palate (NS CL/P) is a complex disease in which heritability estimates vary widely depending on the population studied. To evaluate the importance of genetic contribution to NS CL/P in the Brazilian population, we conducted a study with 1,042 families from five different locations (Santarém, Fortaleza, Barbalha, Maceió, and Rio de Janeiro). We also evaluated the role of consanguinity and ethnic background. The proportion of familial cases varied significantly across locations, with the highest values found in Santarém (44%) and the lowest in Maceió (23%). Heritability estimates showed a higher genetic contribution to NS CL/P in Barbalha (85%), followed by Santarém (71%), Rio de Janeiro (70%), Fortaleza (64%), and Maceió (45%). Ancestry was not correlated with the occurrence of NS CL/P or with the variability in heritability. Only in Rio de Janeiro was the coefficient of inbreeding significantly larger in NS CL/P families than in the local population. Recurrence risk for the total sample was approximately 1.5-1.6%, varying according to the location studied (0.6-0.7% in Maceió to 2.2-2.8% in Barbalha). Our findings show that the degree of genetic contribution to NS CL/P varies according to the geographic region studied, and this difference cannot be attributed to consanguinity or ancestry. These findings suggest that Barbalha is a promising region for genetic studies. The data presented here will be useful in interpreting results from molecular analyses and show that care must be taken when pooling samples from different populations for association studies.

Effects of acute administration of the hydroalcoholic extract of mate tea leaves (Ilex paraguariensis) in animal models of learning and memory.

AIM OF THE STUDY: Ilex paraguariensis St. Hilaire (Aquifoliaceae) is a plant widely cultivated in South America that is used to prepare a tea-like beverage with a reputation to improve cognitive function, a response that has been attributed to the constituents of the leaves, especially caffeine. Our previous study indicated that the hydroalcoholic extract of Ilex paraguariensis presents an antiparkinsonian profile in reserpine- and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride (MPTP)-treated rodents. MATERIALS AND METHODS: In the present study, the effects of the hydroalcoholic extract of Ilex paraguariensis on the short- and long-term learning and memory of rats were assessed with the social recognition, Morris water maze, and step-down inhibitory avoidance tasks. RESULTS: A preliminary HPLC fingerprint of the plant extract confirmed the presence of caffeine (the major compound), rutin and kaemperol, and revealed the absence of detectable concentrations of caffeic acid, quercetin and ursolic acid. Acute pre-training intraperitoneal (i.p.) or oral administration of the extract of Ilex paraguariensis improved the short-term social memory in a specific manner as well as facilitated the step-down inhibitory avoidance short-term memory evaluated 1.5h after training. Moreover, a synergistic response was observed following the co-administration of 'non-effective' doses of caffeine and Ilex paraguariensis in the social memory. In contrast, pre-training administration of hydroalcoholic extract of Ilex paraguariensis did not alter the step-down inhibitory avoidance long-term memory evaluated 24h after training, while the highest dose tested (250 mg/kg, i.p.) disrupted the animals' performance in a cued version of the Morris water maze. CONCLUSION: These results partly substantiate the traditional use of mate tea for improvement of cognition indicating that acute administration of hydroalcoholic extract of Ilex paraguariensis differentially modulates short- and long-term learning and memory in rats probably through its antagonist's action on adenosine receptors.