Gluten-free pasta as an alternative in the diet of patients with celiac disease.

Celiac disease (CD) is an autoimmune disorder that produces inflammation in the gut mucosa, affecting nutrient digestion and absorption. CD affects 0.3% to 1.0% of the world's population and only 15% have a clinical diagnosis. The only effective treatment is a gluten-free diet. The objective of this study was to develop a dough for gluten-free pasta prepared with mixtures of flours from corn, amaranth, soy, and rice. According to the FAO standard of 1975, the resultant mixtures should have a protein content greater than 11.0% and a chemical rating of not less than 70. Three mixtures were obtained: corn‒soy (81-19), corn‒rice‒soy (48-37-15), and corn‒rice‒amaranth (49-32-14). To improve the handling of the pasta and its physical characteristics (sedimentation, degree of absorption, and cracked shaped pasta) compared to a control (commercial) gluten-free pasta, carboxymethylcellulose, an emulsifier (distilled monoglycerides), and egg albumin were added at concentrations of 0.3, 0.5, and 5.0%, respectively. The corn flour was pregelatinized, and the extrusion was repeated twice. The experimental pasta had a protein content of 14.0%, which was higher than the commercial pasta (4.5%), and a gluten content of less than 20 mg/kg which, according to the Codex Alimentarius International Food Standard (2015), it is considered gluten-free. The corn‒rice‒soy pasta obtained had an acceptance and liking similar to a commercial brand. This pasta may widen the gluten-free products commercially available to CD patients in Mexico, which nowadays is limited and expensive. PRACTICAL APPLICATION: Raw materials available in our country were selected to promote their consumption and diversify the ingredients used in the production of gluten-free products. The pasta obtained presented a higher nutritional content than a commercial gluten-free pasta and was comparable to that of a pasta made with wheat.

Stereo-electroencephalographic seizure localization in patients with mesial temporal sclerosis: A single center experience.

Objective: Epilepsy patients with mesial temporal sclerosis (MTS) on imaging who are drug-resistant usually undergo epilepsy surgery without previous invasive evaluation. However, up to one-third of patients are not seizure-free after surgery. Prior studies have identified risk factors for surgical failure, but it is unclear if they are associated with bilateral or discordant seizure onset. Methods: In this retrospective case series, we identified 17 epilepsy patients who had MRI-confirmed MTS but received invasive stereo-EEG (SEEG) evaluation before definitive intervention. We analyzed their presurgical risk factors in relation to SEEG seizure onset localization and MRI/SEEG concordance. Results: SEEG ictal onset was concordant with MTS localization (i.e. seizures started only from the hippocampus with MTS) in 5 out of 13 patients with unilateral MTS (UMTS) and in 3 out of 4 patients with bilateral MTS.No statistically significant association regarding concordance of SEEG ictal onset and MTS location was found in patients with such risk factors as a history of non-mesial temporal aura, frequent focal to bilateral tonic-clonic seizures, prior viral brain infection, or family history of epilepsy. Nine out of 13 UMTS patients had resective surgery only, 5 out of 9 (56 %) have Engel class I outcome at most recent follow-up (median 46.5 months, range 22-91 months). In Engel class I cohort, the SEEG ictal onset was concordant with MTS location in 3 out of 5 patients, and 2 patients had ipsilateral temporal neocortical ictal onset. Conclusions: Our findings suggest that patients with MTS might have discordant SEEG ictal onset (in 61.5% patients with UMTS in presented cohort), which may explain poor surgical outcome after destructive surgery in these cases. Significance: Although no statistically significant association was found in this under-powered study, these findings could be potentially valuable for future meta-analyses.

Real-Time Seizure Detection Using Behind-the-Ear Wearable System.

INTRODUCTION: This study examines the usability and comfort of a behind-the-ear seizure detection device called brain seizure detection (BrainSD) that captures ictal electroencephalogram (EEG) data using four scalp electrodes. METHODS: This is a feasibility study. Thirty-two patients admitted to a level 4 Epilepsy Monitoring Unit were enrolled. The subjects wore BrainSD and the standard 21-channel video-EEG simultaneously. Epileptologists analyzed the EEG signals collected by BrainSD and validated it using video-EEG data to confirm its accuracy. A poststudy survey was completed by each participant to evaluate the comfort and usability of the device. In addition, a focus group of UT Southwestern epileptologists was held to discuss the features they would like to see in a home EEG-based seizure detection device such as BrainSD. RESULTS: In total, BrainSD captured 11 of the 14 seizures that occurred while the device was being worn. All 11 seizures captured on BrainSD had focal onset, with three becoming bilateral tonic-clonic and one seizure being of subclinical status. The device was worn for an average of 41 hours. The poststudy survey showed that most users found the device comfortable, easy-to-use, and stated they would be interested in using BrainSD. Epileptologists in the focus group expressed a similar interest in BrainSD. CONCLUSIONS: Brain seizure detection is able to detect EEG signals using four behind-the-ear electrodes. Its comfort, ease-of-use, and ability to detect numerous types of seizures make BrainSD an acceptable at-home EEG detection device from both the patient and provider perspective.

Insulinoma Associated with MEN1 Syndrome: A Case of Persistent Hypoglycemia in School-aged Child.

Insulinoma is a rare cause of non-ketotic hypoglycemia both in adults and in children. Pediatric patients account for approximately 5% of all cases, mostly due to isolated benign lesions, but it can also be part of a multiple endocrine neoplasia type 1 syndrome (MEN1). We report the case of a patient with multiple hospitalizations related to hypoglycemia and neuroglycopenia symptoms, with multiple studies demonstrating the presence of an insulinoma as part of the spectrum of MEN1 syndrome. The primary significance of our report is to underscore that insulinoma can present as the initial manifestation of MEN1 syndrome in 10% of pediatric patients. Furthermore, we describe a likely pathogenic variant in the MEN1 gene not previously reported in the literature. Our report highlights the importance of the convergence of clinical, biochemical and molecular investigations in establishing a precise diagnosis, prognosis, and appropriate follow-up for pediatric patients with hypoglycemia.

Comportamiento epidemiológico de SARS-CoV-2 en población trabajadora afiliada al Instituto Mexicano del Seguro Social / SARS-CoV-2 epidemic behavior in worker population affiliated to the Mexican Social Security Institute

Resumen: Objetivo: Describir el comportamiento de la epidemia de SARS-CoV-2 entre los trabajadores afiliados al Instituto Mexicano del Seguro Social (IMSS). Material y métodos: Se analizaron las incapacidades temporales para el trabajo por enfermedades respiratorias (ITT-ER), las hospitalizaciones y defunciones asociadas durante el periodo del 1 marzo al 31 diciembre 2020. Se estimó la tasa de ataque (TA) por SARS-CoV-2, así como los riesgos relativos (RR) de ITT-ER, hospitalización y defunción. Resultados: De los trabajadores afiliados al IMSS, 8.8% (n=1 730 334) recibió al menos una ITT-ER. La TA fue mayor en mujeres y en ambos sexos fue menor en el grupo de >60 años. Los RR de hospitalización y defunción fueron mayores en hombres y aumentaron con la edad. Comparado con las ITT-ER de 2015-2019, Durango, Tamaulipas y Nuevo León tuvieron un RR mayor de ITT-ER que el resto del país. Conclusiones: La epidemia de SARS-CoV-2 tuvo repercusiones importantes en los trabajadores afiliados al IMSS; se observó un exceso de ITT-ER de 4.6 veces respecto a la frecuencia esperada y cerca de un millón de casos de SARS-CoV-2. Los datos sugieren que el sistema de ITT-ER puede ser utilizado como elemento adicional para la vigilancia epidemiológica de enfermedades emergentes.

Abstract: Objective: To describe the behavior of SARS-CoV-2 epidemic among workers affiliated to the Mexican Social Security Institute. Materials and methods: We analyzed Short Term Disability Claims due to Respiratory Diseases (RD-STDC), associated hospitalizations and deaths (March 1 - December 31, 2020). We estimated the attack rate (AR) for SARS-CoV-2, and relative risks (RR) of TWD-RD, hospitalization and deaths. Results: 1 730 334 workers received at least one RD-STDC. AR was higher in women and in both sexes it was lower in >60 years old. RR of hospitalization and death were higher in men and increased with age. Compared with RD-STDC of 2015-2019, the states of Durango, Tamaulipas and Nuevo Leon had a higher RR of RD-STDC than the rest of the country. Conclusions: The SARS-CoV-2 epidemic impacted IMSS-affiliated workers significantly. We observed a 4.6 fold excess in RD-STDC compared to the expected frequency and nearly 1 million SARS-CoV-2 cases in this population. Our data suggest that the RD-STDC system can be used as an additional resource for epidemiological surveillance of emerging diseases.

Emergency department visits and readmissions in patients with psychogenic nonepileptic seizures (PNES) at a safety net hospital.

INTRODUCTION: Readmissions and emergency department (ED) visits after an index admission have been become a quality measure due to associations with poor outcomes and increased healthcare costs. Readmissions and ED encounters have been studied in a variety of conditions including epilepsy but have not been examined exclusively in psychogenic nonepileptic seizures (PNES). In this study we examined the rate of readmissions and ED visits after a discharge from an Epilepsy Monitoring Unit (EMU) in a safety net hospital. We also determined patient phenotypes that are associated with readmissions. MATERIAL AND METHODS: This was a retrospective chart review study with index admission being a discharge from an EMU between January 1 and December 31 2016 with follow-up until August 31 2020. We obtained data regarding demographics, medical and psychiatric history, and social history and treatment interventions. Our outcome variables were both all-cause and seizure-related hospital readmissions and ED visits 30 days following the index discharge and readmissions and ED visits 30 days thereafter. RESULTS: Eleven of 122 patients (9%) had a non-seizure-related ED visit and/or hospitalization within 30 days of index discharge while 45 (37%) had re-contact with the health system thereafter for non-seizure-related issues. Seven of 122 patients (6%) had a seizure-related ED visit or hospital readmission within 30 days of discharge. Twenty-eight (23%) had a seizure-related readmission or ED visit after 30 days. Of these 28, 4 patients had been to an ER within 7 days of EMU discharge. The majority of subsequent encounters with the healthcare system were through the ED (n = 38) as compared to hospital (n = 10) and EMU readmissions (n = 9). On bivariate statistical analysis, charity or self-pay insurance status (p < 0.01), homelessness (p < 0.01), emergent EMU admission on index admission (p < 0.01), history of a psychiatric diagnosis (p < 0.02), and ED encounters 12 months prior to admission (p < 0.01) were significantly associated with readmission; however, on multivariate analysis only charity insurance status was a significant predictor. CONCLUSIONS: In this study of readmissions and ED visits after discharge with a diagnosis of PNES at a safety net hospital, we found a seizure-related readmission rate of approximately 6% in 30 days and 23% thereafter with the majority of re-contact with the hospital being in the ED. On multi-variate analysis insurance status was a significant factor associated with readmission and ED visits. Our future research directions include examining referrals and treatment completion at the hospital's PNES clinic as well as creating a risk score to better identify patients with PNES at risk of readmission.

Emergent Admissions to the Epilepsy Monitoring Unit in the Setting of COVID-19 Pandemic-related, State-mandated Restrictions: Clinical Decision Making and Outcomes.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the state of Texas-limited elective procedures to conserve beds and personal protective equipment (PPE); therefore, between March 22 and May 18, 2020, admission to the epilepsy monitoring unit (EMU) was limited only to urgent and emergent cases. We evaluated clinical characteristics and outcomes of these patients who were admitted to the EMU. Nineteen patients were admitted (one patient twice) with average age of 36.26 years (11 female) and average length of stay 3 days (range: 2-9 days). At least one event was captured on continuous EEG (cEEG) and video monitoring in all 20 admissions (atypical in one). One patient had both epileptic (ES) and psychogenic non-epileptic seizures (PNES) while 10 had PNES and 9 had ES. In 8 of 9 patients with ES, medications were changed, while in 5 patients with PNES, anti-epileptic drugs (AED) were stopped; the remaining 5 were not on medications. Of the 14 patients who had seen an epileptologist pre-admission, 13 (or 93%) had their diagnosis confirmed by EMU stay; a statistically significant finding. While typically an elective admission, in the setting of the COVID-19 pandemic, urgent and emergent EMU admissions were required for increased seizure or event frequency. In the vast majority of patients (13 of 19), admission lead to medication changes to either better control seizures or to change therapeutics as appropriate when PNES was identified.

Non-lesional mesial temporal lobe epilepsy requires bilateral invasive evaluation.

PURPOSE: Mesial temporal lobe epilepsy (MTLE) usually responds well to surgical treatment, although in non-lesional cases up to 50% of patients experience seizure relapse. The possibility of bilateral independent seizure onset should be considered as a reason for epilepsy surgery failure. METHODS: In a cohort of 177 patients who underwent invasive presurgical evaluation with stereo-tactically placed electrodes in two level four epilepsy centers, 29 had non-lesional MTLE. Invasive evaluation results are described. RESULTS: Among 29 patients with non-lesional MRI and mesial temporal lobe seizure onset recorded during stereo-EEG (SEEG) evaluation, four patients with unilateral preimplantation hypothesis had independent bilateral mesial temporal seizures on SEEG despite of unilateral non-invasive evaluation data. Three of these patients were treated with bitemporal responsive neurostimulator system (RNS). Independent bilateral mesial temporal seizures have been confirmed on RNS ECoG (electrocorticography). The fourth patient underwent right anterior temporal lobectomy. CONCLUSION: We propose that patients with non-lesional mesial temporal lobe epilepsy would benefit from bilateral invasive evaluation of mesial temporal structures to predict those patients who would be at most risk for surgical failure. Neurostimulaiton could be an initial treatment option for patients with independent bitemporal seizure onset.

Comportamiento epidemiológico de SARS-CoV-2 en población trabajadora afiliada al Instituto Mexicano del Seguro Social.

Objetivo. Describir el comportamiento de la epidemia de SARS-CoV-2 entre los trabajadores afiliados al Instituto Mexicano del Seguro Social (IMSS). Material y métodos. Se analizaron las incapacidades temporales para el trabajo por enfermedades respiratorias (ITT-ER), las hospitalizaciones y defunciones asociadas durante el periodo del 1 marzo al 31 diciembre 2020. Se estimó la tasa de ataque (TA) por SARS-CoV-2, así como los riesgos relativos (RR) de ITT-ER, hos-pitalización y defunción. Resultados. De los trabajadores afiliados al IMSS, 8.8% (n=1 730 334) recibió al menos una ITT-ER. La TA fue mayor en mujeres y en ambos sexos fue menor en el grupo de >60 años. Los RR de hospitalización y defunción fueron mayores en hombres y aumentaron con la edad. Comparado con las ITT-ER de 2015-2019, Durango, Tamaulipas y Nuevo León tuvieron un RR mayor de ITT-ER que el resto del país. Conclusiones. La epidemia de SARS-CoV-2 tuvo repercusiones importantes en los trabajadores afiliados al IMSS; se observó un exceso de ITT-ER de 4.6 veces respecto a la frecuencia esperada y cerca de un millón de casos de SARS-CoV-2. Los datos sugieren que el sistema de ITT-ER puede ser utilizado como elemento adicional para la vigilancia epidemiológica de enfermedades emergentes.

Association of epileptiform abnormalities and seizures in Alzheimer disease.

OBJECTIVE: To examine the relationship between scalp EEG biomarkers of hyperexcitability in Alzheimer disease (AD) and to determine how these electric biomarkers relate to the clinical expression of seizures in AD. METHODS: In this cross-sectional study, we performed 24-hour ambulatory scalp EEGs on 43 cognitively normal elderly healthy controls (HC), 41 participants with early-stage AD with no history or risk factors for epilepsy (AD-NoEp), and 15 participants with early-stage AD with late-onset epilepsy related to AD (AD-Ep). Two epileptologists blinded to diagnosis visually reviewed all EEGs and annotated all potential epileptiform abnormalities. A panel of 9 epileptologists blinded to diagnosis was then surveyed to generate a consensus interpretation of epileptiform abnormalities in each EEG. RESULTS: Epileptiform abnormalities were seen in 53% of AD-Ep, 22% of AD-NoEp, and 4.7% of HC. Specific features of epileptiform discharges, including high frequency, robust morphology, right temporal location, and occurrence during wakefulness and REM, were associated with clinical seizures in AD. Multiple EEG biomarkers concordantly demonstrated a pattern of left temporal lobe hyperexcitability in early stages of AD, whereas clinical seizures in AD were often associated with bitemporal hyperexcitability. Frequent small sharp spikes were specifically associated with epileptiform EEGs and thus identified as a potential biomarker of hyperexcitability in AD. CONCLUSION: Epileptiform abnormalities are common in AD but not all equivalent. Specific features of epileptiform discharges are associated with clinical seizures in AD. Given the difficulty recognizing clinical seizures in AD, these EEG features could provide guidance on which patients with AD are at high risk for clinical seizures.

Determinación del índice glucémico y la carga glucémica de productos lácteos fermentados en sujetos adultos sanos, sedentarios y deportistas.

Introducción: el índice glucémico (IG) y la carga glucémica (CG) de productos lácteos fermentados (PLF) con lactobacilos puede ser una recomendación útil para pacientes diabéticos y para la población en general.Objetivo: el objetivo del estudio fue medir el IG y la CG de PLF con lactobacilos en sujetos sedentarios y deportistas, y evaluar si existe diferencia entre ellos.Métodos: el estudio se realizó en México (DF) de acuerdo con la ISO26642:210 (Organización Internacional de Normalización). Los participantes fueron: 10 sedentarios y 10 deportistas. Los PLF analizados fueron: Soful, Yakult, Gastroprotect, BeneGastro, Bonacult, Lala Bio 4 y leche descremada con sacarosa (LDS) y la cantidad de alimento que ingirieron dependió de ajustar a 25 g los HC en la porción.Resultados: el IG de la mayoría de los PLF fue bajo para ambos grupos de sujetos; en los deportistas los PLF Yakult y Bonacult presentaron los mayores IG y solo el Yakult puede considerarse como de IG medio para este grupo; estos dos PLF presentaron la menor relación de proteína/HC. La LDS, lácteo con los HC no fermentados, presentó un IG alto para ambos grupos. La CG de los PLF se encontró entre 4 a 7,6 y solo Gastroprotect presentó estadísticamente la menor CG, lo que pudo deberse a su bajo IG, aun cuando su tamaño de ración no fue la menor, entre los PLF.Conclusión: en general los valores de IG y CG de los PLF fueron bajos para ambos grupos. Por tanto, su consumo puede recomendarse en forma moderada. El IG y CG entre productos lácteos con azúcares fermentados y con azúcares no fermentados fueron diferentes.

Determinación del índice glucémico y la carga glucémica de productos lácteos fermentados en sujetos adultos sanos, sedentarios y deportistas / Determination of the glycemic index and glycemic load of fermented dairy products in sedentary healthy adults and athletes

Introducción: el índice glucémico (IG) y la carga glucémica (CG) de productos lácteos fermentados (PLF) con lactobacilos puede ser una recomendación útil para pacientes diabéticos y para la población en general. Objetivo: el objetivo del estudio fue medir el IG y la CG de PLF con lactobacilos en sujetos sedentarios y deportistas, y evaluar si existe diferencia entre ellos. Métodos: el estudio se realizó en México (DF) de acuerdo con la ISO26642:210 (Organización Internacional de Normalización). Los participantes fueron: 10 sedentarios y 10 deportistas. Los PLF analizados fueron: Soful, Yakult, Gastroprotect, BeneGastro, Bonacult, Lala Bio 4 y leche descremada con sacarosa (LDS) y la cantidad de alimento que ingirieron dependió de ajustar a 25 g los HC en la porción. Resultados: el IG de la mayoría de los PLF fue bajo para ambos grupos de sujetos; en los deportistas los PLF Yakult y Bonacult presentaron los mayores IG y solo el Yakult puede considerarse como de IG medio para este grupo; estos dos PLF presentaron la menor relación de proteína/HC. La LDS, lácteo con los HC no fermentados, presentó un IG alto para ambos grupos. La CG de los PLF se encontró entre 4 a 7,6 y solo Gastroprotect presentó estadísticamente la menor CG, lo que pudo deberse a su bajo IG, aun cuando su tamaño de ración no fue la menor, entre los PLF. Conclusión: en general los valores de IG y CG de los PLF fueron bajos para ambos grupos. Por tanto, su consumo puede recomendarse en forma moderada. El IG y CG entre productos lácteos con azúcares fermentados y con azúcares no fermentados fueron diferentes (AU)

Introduction: Glycemic Index (GI) and glycemic load (GL) of natural dairy products fermented with lactobacilli may be useful for diabetic patients and the general population. Objective: To measure the GI and GL in natural dairy products fermented with lactobacilli in sedentary individuals and athletes, and seeing if there is any difference between them. Methods: The study was conducted in Mexico City (DF) according to the ISO26642:210, with a group of 10 sedentary individuals and 10 athletes. The GI was determined in the following diary drinkable products, all adjusted to contain 25 g of carbohydrates: Soful, Yakult, Gastroprotect, BeneGastro, Bonacult, Lala Bio 4 and Skimmed milk with sucrose (SMS). Results: The GI of most dairy fermented products were low for sedentary and athletes, but in athletes Yakult and Bonacult showed the highest GI and Yakult’s GI can be considered as medium for these group; these two dairy products had the lowest protein/carbohydrates ratio. SMS, which contain unfermented carbohydrates, had the highest GI in both groups. The GL of dairy fermented products was 4 to 7.6 and only Gastroprotect had statistically the lowest GL, it may be due to its low GI, even its serving size was not the least among dairy fermented products. Conclusion: The GI and GL levels were relatively low for all the dairy products considered on each of the groups studied, therefore the moderate consumption of these can be recommended (AU)

Widespread changes in network activity allow non-invasive detection of mesial temporal lobe seizures.

Decades of experience with intracranial recordings in patients with epilepsy have demonstrated that seizures can occur in deep cortical regions such as the mesial temporal lobes without showing any obvious signs of seizure activity on scalp electroencephalogram. Predicated on the idea that these seizures are purely focal, currently, the only way to detect these 'scalp-negative seizures' is with intracranial recordings. However, intracranial recordings are only rarely performed in patients with epilepsy, and are almost never performed outside of the context of epilepsy. As such, little is known about scalp-negative seizures and their role in the natural history of epilepsy, their effect on cognitive function, and their association with other neurological diseases. Here, we developed a novel approach to non-invasively identify scalp-negative seizures arising from the mesial temporal lobe based on scalp electroencephalogram network connectivity measures. We identified 25 scalp-negative mesial temporal lobe seizures in 10 patients and obtained control records from an additional 13 patients, all of whom underwent recordings with foramen ovale electrodes and scalp electroencephalogram. Scalp data from these records were used to train a scalp-negative seizure detector, which consisted of a pair of logistic regression classifiers that used scalp electroencephalogram coherence properties as input features. On cross-validation performance, this detector correctly identified scalp-negative seizures in 40% of patients, and correctly identified the side of seizure onset for each seizure detected. In comparison, routine clinical interpretation of these scalp electroencephalograms failed to identify any of the scalp-negative seizures. Among the patients in whom the detector raised seizure alarms, 80% had scalp-negative mesial temporal lobe seizures. The detector had a false alarm rate of only 0.31 per day and a positive predictive value of 75%. Of the 13 control patients, false seizure alarms were raised in only one patient. The fact that our detector specifically recognizes focal mesial temporal lobe seizures based on scalp electroencephalogram coherence features, lends weight to the hypothesis that even focal seizures are a network phenomenon that involve widespread neural connectivity. Our scalp-negative seizure detector has clear clinical utility in patients with temporal lobe epilepsy, and its potential easily translates to other neurological disorders, such as Alzheimer's disease, in which occult mesial temporal lobe seizures are suspected to play a significant role. Importantly, our work establishes a novel approach of using computational approaches to non-invasively detect deep seizure activity, without the need for invasive intracranial recordings.

Medication prescribing and patient-reported outcome measures in people with epilepsy in Bhutan.

OBJECTIVE: The aim of this study was to assess medication prescribing and patient-reported outcomes among people with epilepsy (PWE) in Bhutan and introduce criteria for evaluating unmet epilepsy care needs, particularly in resource-limited settings. METHODS: People with epilepsy in Bhutan (National Referral Hospital, 2014-2015) completed a questionnaire, the Quality of Life in Epilepsy Inventory (QOLIE-31), and an electroencephalogram (EEG). Management gap was the proportion of participants meeting any of six prespecified criteria based on best practices and the National Institute for Health and Care Excellence (NICE) guidelines. RESULTS: Among 253 participants (53% female, median: 24years), 93% (n=235) were treated with antiepileptic drugs (AEDs). Seventy-two percent (n=183) had active epilepsy (≥1 seizure in the prior year). At least one criterion was met by 55% (n=138) of participants, whereas the treatment gap encompassed only 5% (n=13). The criteria were the following: 1. Among 18 participants taking no AED, 72% (n=13) had active epilepsy. 2. Among 26 adults on subtherapeutic monotherapy, 46% (n=12) had active epilepsy. 3. Among 48 participants reporting staring spells, 56% (n=27) were treated with carbamazepine or phenytoin. 4. Among 101 female participants aged 14-40years, 23% (n=23) were treated with sodium valproate. 5. Among 67 participants reporting seizure-related injuries, 87% (n=58) had active epilepsy. 6. Among 111 participants with a QOLIE-31 score below 50/100, 77% (n=86) had active epilepsy. Years since first AED treatment (odds ratio: 1.07, 95% CI: 1.03, 1.12) and epileptiform discharges on EEG (odds ratio: 1.95, 95% CI: 1.15, 3.29) were significantly associated with more criteria met. CONCLUSIONS: By defining the management gap, subpopulations at greatest need for targeted interventions may be prioritized, including those already taking AEDs.

Venlafaxine treatment after endothelin-1-induced cortical stroke modulates growth factor expression and reduces tissue damage in rats.

Neuromodulators, such as antidepressants, may contribute to neuroprotection by modulating growth factor expression to exert anti-inflammatory effects and to support neuronal plasticity after stroke. Our objective was to study whether early treatment with venlafaxine, a serotonin-norepinephrine reuptake inhibitor, modulates growth factor expression and positively contributes to reducing the volume of infarcted brain tissue resulting in increased functional recovery. We studied the expression of BDNF, FGF2 and TGF-ß1 by examining their mRNA and protein levels and cellular distribution using quantitative confocal microscopy at 5 days after venlafaxine treatment in control and infarcted brains. Venlafaxine treatment did not change the expression of these growth factors in sham rats. In infarcted rats, BDNF mRNA and protein levels were reduced, while the mRNA and protein levels of FGF2 and TGF-ß1 were increased. Venlafaxine treatment potentiated all of the changes that were induced by cortical stroke alone. In particular, increased levels of FGF2 and TGF-ß1 were observed in astrocytes at 5 days after stroke induction, and these increases were correlated with decreased astrogliosis (measured by GFAP) and increased synaptophysin immunostaining at twenty-one days after stroke in venlafaxine-treated rats. Finally, we show that venlafaxine reduced infarct volume after stroke resulting in increased functional recovery, which was measured using ladder rung motor tests, at 21 days after stroke. Our results indicate that the early oral administration of venlafaxine positively contributes to neuroprotection during the acute and late events that follow stroke.

[ACCEPTANCE OF PULP FRUIT BEVERAGES FORTIFIED WITH FERROUS FUMARATE; AN ALTERNATIVE SUPPLEMENT FOR A HEALTH PROGRAM]. / EVALUACIÓN DE LA ACEPTACIÓN DE JUGOS DE PULPA DE FRUTA ADICIONADOS CON FUMARATO FERROSO; ALTERNATIVA DE SUPLEMENTO PARA UN PROGRAMA DE SALUD.

INTRODUCTION: undernutrition and individual nutrients deficiencies are common public health problems worldwide and Mexico is not the exception, where the highest prevalence occurs in rural areas. One way to solve these nutritional deficiencies is with the use of dietary supplements. However, these supplements need to be readily available for and accepted by the objective population. OBJECTIVES: to develop a flavored-multivitamin supplement (MVS) for the Health and Nutrition Program for Indigenous People (PSNPI-Mexico) and to evaluate its acceptance by 6 to 24 months old infants in rural and urban areas. METHODS: the MVS was developed in three different flavors, their vitamin and mineral content in accordance with PSNPIs guidelines. Acceptance of the MVS by the infants was evaluated with "scale faces" and this was further corroborated in the 6 to 12 mo by registering the amount consumed. The differences in acceptance by age and gender, as well as locations (urban vs rural) were determined with chi-squared test. RESULTS: the MVS developed for this study constitute a better alternative to supplement currently used by PSNPI.

Introducción: la desnutrición y la deficiencia de hierro son problemas de salud pública en varios países, México no es la excepción, y la mayor prevalencia se presenta en el medio rural. Una forma de atenderla es a través de la suplementación. El suplemento que se seleccione debe ser aceptado sensorialmente por el consumidor final para que la intervención sea exitosa. Objetivos: elaborar un suplemento multivitamínico para el programa "Salud y Nutrición para Pueblos Indígenas" y evaluar su aceptación en la población infantil urbana y rural. Métodos: se determinaron las características fisicoquímicas del producto a desarrollar y el método de elaboración y de preparación para su consumo. La aceptación se evaluó en niños de entre 6 a 24 meses de edad, con una prueba de caritas, y en los infantes de 6 a 12 meses se corroboró con el registro del volumen consumido. Para determinar las diferencias en la aceptación por edad y género en la misma población y para establecer diferencias entre poblaciones se aplicó una Ji cuadrada. Resultados: los suplementos, en los tres sabores evaluados, cumplieron con la concentración de vitaminas y nutrimentos inorgánicos establecidos en el programa citado. El 80% de los niños aceptaron los suplementos multivitamínicos (SM) en sus tres sabores. La edad de los niños fue el factor que más influyó en la aceptación. Conclusión: los SM desarrollados en este estudio son una alternativa al suplemento que actualmente proporciona el PSNPI, para los niños mayores a seis meses.

Evaluación de la aceptación de jugos de pulpa de fruta adicionados con fumarato ferroso; alternativa de suplemento para un programa de salud / Acceptance of pulp fruit beverages fortified with ferrous fumarate; an alternative supplement for a health program

Introducción: la desnutrición y la deficiencia de hierro son problemas de salud pública en varios países, México no es la excepción, y la mayor prevalencia se presenta en el medio rural. Una forma de atenderla es a través de la suplementación. El suplemento que se seleccione debe ser aceptado sensorialmente por el consumidor final para que la intervención sea exitosa. Objetivos: elaborar un suplemento multivitamínico para el programa “Salud y Nutrición para Pueblos Indígenas” y evaluar su aceptación en la población infantil urbana y rural. Métodos: se determinaron las características fisicoquímicas del producto a desarrollar y el método de elaboración y de preparación para su consumo. La aceptación se evaluó en niños de entre 6 a 24 meses de edad, con una prueba de caritas, y en los infantes de 6 a 12 meses se corroboró con el registro del volumen consumido. Para determinar las diferencias en la aceptación por edad y género en la misma población y para establecer diferencias entre poblaciones se aplicó una Ji cuadrada. Resultados: los suplementos, en los tres sabores evaluados, cumplieron con la concentración de vitaminas y nutrimentos inorgánicos establecidos en el programa citado. El 80% de los niños aceptaron los suplementos multivitamínicos (SM) en sus tres sabores. La edad de los niños fue el factor que más influyó en la aceptación. Conclusión: los SM desarrollados en este estudio son una alternativa al suplemento que actualmente proporciona el PSNPI, para los niños mayores a seis meses (AU)

Introduction: undernutrition and individual nutrients deficiencies are common public health problems worldwide and Mexico is not the exception, where the highest prevalence occurs in rural areas. One way to solve these nutritional deficiencies is with the use of dietary supplements. However, these supplements need to be readily available for and accepted by the objective population. Objectives: to develop a flavored-multivitamin supplement (MVS) for the Health and Nutrition Program for Indigenous People (PSNPI-Mexico) and to evaluate its acceptance by 6 to 24 months old infants in rural and urban areas. Methods: the MVS was developed in three different flavors, their vitamin and mineral content in accordance with PSNPIs guidelines. Acceptance of the MVS by the infants was evaluated with “scale faces” and this was further corroborated in the 6 to 12 mo by registering the amount consumed. The differences in acceptance by age and gender, as well as locations (urban vs rural) were determined with chi-squared test. Results: the MVS developed for this study constitute a better alternative to supplement currently used by PS-NPI (AU)

Sensory evaluation of dairy supplements enriched with reduced iron, ferrous sulfate or ferrous fumarate / Evaluación sensorial de suplementos lácteos enriquecidos con hierro reducido, sulfato ferroso o fumarato ferroso

Objective. To determine the degree of liking of the Oportunidades programme dietary supplements (DS) -purees and beverages- added with different iron salts (IS): reduced iron (RI), ferrous sulphate (FS) or ferrous fumarate (FF) during 24 weeks of storage. Materials and methods. The DS were evaluated through a hedonic scale for aroma, flavour and colour attributes; at time zero and every eight weeks, each panel member evaluated three DS with same flavour and presentation but different IS. Seventy women participated as panel members. Results. The chocolate and banana DS exhibited a change in preference by colour and flavour due to storage. DS with FS or RI showed the least preference by flavour and colour in the context of the three IS considered. The chocolate and neutral DS enriched with FS changed their colour and flavour. Conclusion. DS were, in general, well-liked; nonetheless, for purees enriched with FS and for beverages enriched with RI, the less-liked attributes were colour and flavour.

Objetivo. Determinar el nivel de agrado de los suplementos alimenticios (SA) (papillas y bebidas) del Programa Oportunidades, adicionados con diferentes sales de hierro (SH): hierro reducido (HR), sulfato ferroso (SF) o fumarato ferroso (FF), durante 24 semanas de almacenamiento. Material y métodos. Se evaluaron mediante una escala hedónica los atributos olor, sabor y color; a tiempo cero y cada ocho semanas, cada juez evaluó tres suplementos, mismo sabor, presentación y diferente SH. Participaron 70 mujeres. Resultados. Los SA sabor chocolate y plátano presentaron modificación del agrado por color y sabor durante el almacenamiento. Los SA con SF o HR presentaron el menor agrado para sabor y olor por efecto de las SH. En los SA sabor chocolate y natural adicionados con SF se afectó el color y el sabor. Conclusión. Los SA en general presentaron agrado; sin embargo, en las papillas adicionadas con SF y las bebidas con HR los atributos limitantes fueron color y sabor.

Sensory evaluation of dairy supplements enriched with reduced iron, ferrous sulfate or ferrous fumarate.

OBJECTIVE: To determine the degree of liking of the Oportunidades programme dietary supplements (DS)--purees and beverages--added with different iron salts (IS): reduced iron (RI), ferrous sulphate (FS) or ferrous fumarate (FF) during 24 weeks of storage. MATERIALS AND METHODS: The DS were evaluated through a hedonic scale for aroma, flavour and colour attributes; at time zero and every eight weeks, each panel member evaluated three DS with same flavour and presentation but different IS. Seventy women participated as panel members. RESULTS: The chocolate and banana DS exhibited a change in preference by colour and flavour due to storage. DS with FS or RI showed the least preference by flavour and colour in the context of the three IS considered. The chocolate and neutral DS enriched with FS changed their colour and flavour. CONCLUSION: DS were, in general, well-liked; nonetheless, for purees enriched with FS and for beverages enriched with RI, the less-liked attributes were colour and flavour.