The effect of ketogenic diet escalation in adolescents and adults with drug-resistant epilepsy: a prospective study.

BACKGROUND: Ketogenic diet (KD) is an accepted and effective treatment modality in patients with drug-resistant epilepsy (DRE). Different versions of ketogenic diets have been studied, however, the effect of ratio escalation in adolescence and adults has not been previously investigated. METHODS: The current open-labeled interventional study was conducted on 80 patients with drug-resistant epilepsy DRE, 40 patients (intervention group) were exposed to dietary intervention besides their regular antiseizure medication (ASM) and compared to 40 control patients. The intervention group received Ketogenic diet in 2:1 ratio for 1 month then were divided into 2 subgroups, group A1 continued the 2:1 ratio for another 2 months while group A2 escalated to 3:1 dietary regimen. Socio-demographic, anthropometric measurements, epilepsy clinical parameters, and laboratory tests were recorded in addition to safety and tolerability documentation. The response rate was recorded after 1month and 3month. RESULTS: Significant decrease in seizure frequency and severity were detected in Group A1 and A2 patients compared to controls after the 3 month period of intervention with significant improvement of quality of life scores in both subgroups. Both subgroups also showed comparable results regarding their response rate to KD. Better acceptance of diet taste were reported by subgroup A1 with a significantly higher lipid profile detected in subgroup A2. CONCLUSION: KD has a beneficial effect as adjunctive treatment in adolescents and adults with DRE. Escalation from 2:1 to 3:1 ratio is associated with less compliance rather than better response in patients with DRE.

Community-based interventions to support maternal and child health practices in Upper Egypt.

BACKGROUND: Actions to improve mother and child health should address the needs and demands of the local population. Community-based interventions contribute to understanding the current situation, mobilization of local resources, commitment to achievements and better chance for sustainability. AIMS: This was a community-based intervention implemented in two Upper Egypt governorates to improve coverage of selected maternal and child health interventions in Egyptian villages. METHODS: The study was conducted between May 2016 and December 2017. The National Population Council started communication with Governorate leaders, Directors of Local Unit, Health District and Health Unit to facilitate implementation. A three-day training of trainers workshop was held for eight public health universities' staff from two selected governorates. More than 30 National Population Council coordinators were trained for using an observation checklist. University trainers implemented a four-day workshop attended by 37 Mother and Child Friends participants from Fayoum and 38 from Beni-Sweif. The Mother and Child Friends team selected 1200 women to attend the Health education sessions, and a total of 143 and 121 women participated in the focus group discussions before the first and after the last Health education session for evaluation. RESULTS: An 18 items pre-test questionnaire completed by the trainees was useful to identify major gaps in knowledge and to evaluate the effect of training. There was significant improvement in the post-test in Fayoum (15.6 ± 1.3 SD) and in Beni-Sweif (14.1± 1.5 SD). Likert scale evaluation revealed Mother and Child Friends satisfaction with the training and Mother and Child Friends team provided Health education to the participants. Most of the sessions had no negative comments by the observers. Focus group discussions held after the Health education classes revealed positive changes in the participants' knowledge and attitude. CONCLUSIONS: Implementation revealed that more needs were expressed by women and the Mother and Child Friends team. Future activities should consider customization to address community needs and expectations.