Prospective study of the modified Atkins diet in adult drug-resistant epilepsy: effectiveness, tolerability, and adherence.

INTRODUCTION: Drug-resistant epilepsy presents high worldwide prevalence and is difficult to control despite the wide variety of available antiepileptic drugs (AED). The modified Atkins diet (MAD) is an additional treatment alternative. Several studies have addressed the use of the ketogenic diet and MAD in children with drug-resistant epilepsy, but insufficient research has been conducted into adults with the same condition. OBJECTIVE: To evaluate the effectiveness and tolerability of, and adherence to, the MAD in adults with drug-resistant epilepsy. MATERIAL AND METHODS: We conducted a 6-month pre-post prospective study at a reference hospital. Patients were prescribed the MAD with limited carbohydrate intake and unlimited fat intake. We conducted clinical and electroencephalographic follow-up according to the relevant guidelines, and assessed adverse effects changes in laboratory findings, and adherence. RESULTS: Thirty-two patients with drug-resistant epilepsy were included in the study. Patients' mean age was 30 years, mean disease progression time was 22 years, and all patients had focal or multifocal epilepsy. Thirty-four percent of patients presented > 50% decreases in overall seizure frequency (P =  .001); seizure control was greater in the first month and subsequently declined. These patients presented weight loss (RR: 7.2; 95% CI, 1.3-39.5; P = .02), good to fair adherence only in the first and third months (RR: 9.4; 95% CI, 0.9-93.6; P = .04 and RR: 0.4; 95% CI, 0.30-0.69; P = .02, respectively). Tolerability data showed that the MAD is safe: adverse effects were minor and short-lived in most cases, with the exception of mild to moderate hyperlipidaemia in one-third of patients. The adherence rate was 50% at the end of the study. CONCLUSIONS: In adults with drug-resistant focal epilepsy, the MAD showed adequate tolerability and moderate but decreasing effectiveness and adherence, probably due to a preference for a carbohydrate-based diet.

[EORTC QLQ-C30 questionnaire role as predictor for malnutrition risk in head and neck cancer Mexican patients]. / Papel del cuestionario EORTC QLQ-C30 en la predicción de riesgo de desnutrición en pacientes mexicanos con cáncer de cabeza y cuello.

INTRODUCTION: Head and neck cancer treatment restricts oral intake and conditioning malnutrition. Adequate nutritional support during treatment can limit the impact of side effects. OBJECTIVE: To describe EORTC QLQ-C30 role for malnutrition risk screening in head and neck cancer patients. METHODS: Analytical and cross-sectional, diagnostic test study in head and neck cancer patients. We correlated malnutrition diagnosis with subjective global assessment (SGA) and score for the EORTC QLQ-C30 scales with Pearson and Spearman correlation. We realized COR (Receiver Operating Characteristic) curves to calculate cut point in the score for the EORTC QLQ-C30 scales; we calculated sensitivity, specificity, positive predictive value, negative predictive value and Odds Ratio through logistic regression. RESULTS: Functional scales (role, physic, global health status/QoL) showed limited utility to malnutrition risk estimation in people with head and neck cancer. Symptoms' scales with strong association were: pain (sensitivity 76.47%, specificity 69.23%), insomnia (sensitivity 88.24%, specificity 53.85%), fatigue (sensitivity 70.59%, specificity 76.92%). CONCLUSIONS: EORTC QLQ-C30 questionnaire is a useful tool to early malnutrition diagnosis in head and neck cancer patients with short term results in nutritional condition, treatment response and a better QoL in this kind of patients.

Oral Health: Validation of a questionnaire of self-perception and self-care habits in Diabetes Mellitus 2, hypertensive and obese patients. The UISESS-B scale.

OBJECTIVES: To develop and to evaluate a questionnaire of self-perception and self-care habits on oral health on a first level population. METHODS: A descriptive, observational study was performed to validate a questionnaire on oral health self-perception (UISESS-B). After non-probabilistic sampling, 94 users, 30-59 years of age, with either diabetes mellitus 2, hypertension or obesity were included. Duration of disease was lesser than 10 years. Pearson's r, Cornbach's , factorial analysis, chi-square and Snedecor's F tests were employed. RESULTS: A Pearson's r of 0.7 and Cronbach's of 0.82 was observed on the pre-post values of the global questionnaire. In the factorial analysis, the variance explained more than 60% for a first factor. A punctuation of very high risk for the three groups with the scale UISESSS-B that coincides with the index CPO-D and the index UISESS-F was observed. CONCLUSIONS: The UISESS-B scale shows significant validity and reliability, suggesting its use as a sensitive instrument for the measurement of oral health in people with chronic illnesses such as diabetes, hypertension and obesity.

Consensus theory model of AIDS/SIDA beliefs in four Latino populations.

To describe Latino beliefs about AIDS (SIDA), Latino adults were sampled at two U.S. sites (Connecticut and Texas) and two international sites (Mexico and Guatemala). A 125-item questionnaire covered risk factors, symptoms, treatments, and sequellae of AIDS. The cultural consensus model was used to determine the cultural beliefs for each sample. Responses from 161 people indicated that a single set of beliefs was present at each site and that beliefs were shared across sites. Comparison of answers between samples indicated high agreement (p < .0007). The proportion of shared beliefs, however, decreased significantly between samples: .68 in Connecticut, .60 in Texas, .51 in Mexico, and .41 in Guatemala (p < .05). The proportion of positive answers similarly decreased from Connecticut to Guatemala (p < .001). Beliefs were stronger and more detailed in the higher prevalence areas. Furthermore, Latino beliefs tended to converge on biomedical beliefs about the disease.

Latino beliefs about diabetes.

OBJECTIVE: To describe Latino beliefs about diabetes and assess heterogeneity in beliefs across different groups. RESEARCH DESIGN AND METHODS: This study comprised a survey of 161 representative Latino adults from four diverse communities: Hartford, Connecticut; Edinburg, Texas; Guadalajara, Mexico; and rural Guatemala. A 130-item questionnaire covered causes symptoms, and treatments for diabetes. Information on demographics and acquaintanceship with someone with diabetes was also collected. The cultural consensus model was used to analyze the variation in responses to determine whether the degree of consistency within and between samples was sufficient to warrant aggregation and description as a single set of beliefs. RESULTS: Homogeneous beliefs were present within each of the four samples. Although variability in responses increased significantly from Connecticut to Guatemala (P < 0.00005), there was significant agreement between samples on the answers (P < 0.0005). Answers tended to be concordant with the biomedical description of diabetes. Greater acculturation, higher educational attainment, and higher diabetes prevalence were associated with greater cultural knowledge about diabetes. In Connecticut, greater knowledge correlated with longer mainland U.S. residency (P < 0.05). In Mexico, those with average educational attainment knew more (P < 0.05). Finally, average knowledge levels were higher in communities with greater diabetes prevalence. CONCLUSIONS: The cultural consensus model facilitated assessment of cultural beliefs regarding diabetes and diabetes management. Overall, Latino cultural beliefs about diabetes were concordant with the biomedical model. Variation in responses tended to characterize less knowledge or experience with diabetes and not different beliefs.

[Congenital hip dislocation and the seasons]. / Luxación congénita de cadera y estacionalidad.

This report deals with the data gathered for a year concerning the incidence of luxation coxae congenita at the Hospital de Gineco-Obstetricia (Gynecology-Obstetrics Hospital) of the Unidad Médica Oblatos (Oblatos Medical Unit) of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) in the city of Guadalajara, Jalisco, México. The results show an inverse correlation between the temperature and the number of cases, both statistically significant, demonstrating seasonality for luxation coxae congenita.