Medium-chain Triglyceride Diet Research Articles

The clinical characteristics of systemic lupus erythematosus-related thoracic duct obstruction: a retrospective case-control study from China.

To investigate the clinical characteristics and treatment strategies of patients with systemic lupus erythematosus-related thoracic duct obstruction (SLE-TDO). Clinical data, laboratory tests, imaging data, and treatment strategies were retrospectively collected from 428 SLE patients with TDO treated from January 2010 to December 2020 at Beijing Shijitan Hospital. TDO was confirmed by TD imaging examination. We retrospectively examined 20 SLE patients with TDO as the case group, and 80 randomly matched SLE patients without any lymph-vessel dysfunction as the control group. The prevalence of TDO in patients with SLE was 4.67%, and the in-hospital fatality rate was 5%. Of these patients, 50% presented with TDO as the initial manifestation of SLE, with the others first diagnosed with SLE followed by TDO. The average SLE disease activity index (SLEDAI) was 7 ± 3.8. All patients were treated with glucocorticoids (GC) and immunosuppressants combined with a medium-chain triglycerides (MCT) diet. Eleven patients received TD-related surgery in parallel with anti-rheumatic treatment. Polyserositis, anti-Sm antibody positivity, and SLEDAI score were found to be independent risk factors for TDO in patients with SLE. While SLE patients may develop TDO during the course of their disease, TDO can also be the initial presentation of SLE. TDO should therefore attract the attention of rheumatologists and the surgeon. GC and immunosuppressants combined with lymphatic surgery may be an effective therapeutic strategy for SLE-TDO to relieve symptoms and improve prognosis. Key Points • Thoracic duct obstruction (TDO) is a rare complication of SLE. • SLE may develop TDO during the disease course, while TDO can also be the initial presentation of SLE, which should attract the attention of physicians. • Glucocorticoids and immunosuppressants combined with lymphatic surgery may be an effective therapeutic strategy for SLE-TDO to relieve symptoms and to improve prognosis.

Influence of Postoperative Diet Type and Regimen on Hospital Comfort and Rehabilitation of Lung Cancer Patients

A reasonable and standardized dietary plan and procedure can help patients recovering quickly from lung cancer surgery. The aim of this study is to optimize the diet plan and procedure mainly based on medium chain triglyceride (MCT) diet and explore its clinical advantages for postoperative lung cancer patients. From October 2023 to December 2023, a total of 156 patients were collected, who underwent lung cancer surgery in Lung Cancer Center, West China Hospital of Sichuan University. The patients were randomized into MCT group (76 cases) and routine diet (RD) group (80 cases). Clinical symptoms, biochemical index, postoperative hospitalization time and cost, dietary satisfaction and hospitalization comfort between the two groups were analyzed. The mean anus exhausting time in MCT group [24.00 (9.75, 36.97) h] was significantly shorter than that in RD group [28.50 (24.00, 48.00) h] (P<0.001). And the incidence of dizziness (18.42%), nausea and vomiting (6.58%) in MCT group were remarkably lower than those in RD group (51.25%, 31.25%) (P<0.001). Hospitalization comfort score in MCT group [(16.74±1.70)] was significantly higher than that in RD group [(14.83±2.34)] (P=0.016). Meanwhile, the average hospitalization cost in MCT group [(39,701.82±8105.47)¥] showed an obvious decrease compared with RD group [(44,511.79±9593.19)¥] (P=0.007). Optimizing the dietary plan and procedure mainly based on MCT diet for postoperative lung cancer patients can help the recovery of gastrointestinal function and improve hospitalization comfort, which promoted overall postoperative rehabilitation of patients with lung cancer surgery.

Ketogenic Diet in the Treatment of Epilepsy.

Epilepsy is one of the most disabling neurological diseases. Despite proper pharmacotherapy and the availability of 2nd and 3rd generation antiepileptic drugs, deep brain stimulation, and surgery, up to 30-40% of epilepsy patients remain drug-resistant. Consequences of this phenomenon include not only decreased a quality of life, and cognitive, behavioral, and personal disorders, but also an increased risk of death, i.e., in the mechanism of sudden unexpected death in epilepsy patients (SUDEP). The main goals of epilepsy treatment include three basic issues: achieving the best possible seizure control, avoiding the undesired effects of treatment, and maintaining/improving the quality of patients' lives. Therefore, numerous attempts are made to offer alternative treatments for drug-resistant seizures, an example of which is the ketogenic diet. It is a long-known but rarely used dietary therapy for intractable seizures. One of the reasons for this is the unpalatability of the classic ketogenic diet, which reduces patient compliance and adherence rates. However, its antiseizure effects are often considered to be worth the effort. Until recently, the diet was considered the last-resort treatment. Currently, it is believed that a ketogenic diet should be used much earlier in patients with well-defined indications. In correctly qualified patients, seizure activity may be reduced by over 90% or even abolished for long periods after the diet is stopped. A ketogenic diet can be used in all age groups, although most of the available literature addresses pediatric epilepsy. In this article, we focus on the mechanisms of action, effectiveness, and adverse effects of different variants of the ketogenic diet, including its classic version, a medium-chain triglyceride diet, a modified Atkins diet, and a low glycemic index treatment.

Ketogenic Diet Interventions in Inborn Errors of Metabolism: A Review Article

Objective: The ketogenic diet, which has been used in the treatment of epilepsy since the 1920s, is a diet containing high fat, sufficient protein, and low carbohydrate. The ketogenic diet mimics the metabolic effects of fasting by shifting metabolism towards fat utilization. The ketogenic diet, which has different variants, such as the classical ketogenic diet, modified Atkins diet, and medium-chain triglyceride diet, is used in inborn errors of metabolism to target the underlying metabolic state by bypassing the damaged metabolic pathway or to treat the clinical symptoms of inborn errors of metabolism, such as epileptic seizures. In this review, we assessed the evidence for ketogenic diet interventions in the treatment of inborn errors of metabolism.&#x0D; Methods: The Google Scholar search engine, PubMed, Scopus, and Science Direct databases were used to find studies on the use of ketogenic diet interventions in the treatment of inborn errors of metabolism.&#x0D; Results: The beneficial effects of different variants of the ketogenic diet on glucose transport type 1 deficiency syndrome and pyruvate dehydrogenase complex deficiency have long been recognized. There are also favorable data on its use in myopathic glycogen storage diseases, mitochondrial diseases, and nonketotic hyperglycinemia accompanied by epilepsy.&#x0D; Conclusion: The evidence is mostly based on individual case reports, case series, and clinical trials with small sample sizes and is insufficient to make recommendations.

Dietary and Metabolic Approaches for Treating Autism Spectrum Disorders, Affective Disorders and Cognitive Impairment Comorbid with Epilepsy: A Review of Clinical and Preclinical Evidence.

Epilepsy often occurs with other neurological disorders, such as autism, affective disorders, and cognitive impairment. Research indicates that many neurological disorders share a common pathophysiology of dysfunctional energy metabolism, neuroinflammation, oxidative stress, and gut dysbiosis. The past decade has witnessed a growing interest in the use of metabolic therapies for these disorders with or without the context of epilepsy. Over one hundred years ago, the high-fat, low-carbohydrate ketogenic diet (KD) was formulated as a treatment for epilepsy. For those who cannot tolerate the KD, other diets have been developed to provide similar seizure control, presumably through similar mechanisms. These include, but are not limited to, the medium-chain triglyceride diet, low glycemic index diet, and calorie restriction. In addition, dietary supplementation with ketone bodies, polyunsaturated fatty acids, or triheptanoin may also be beneficial. The proposed mechanisms through which these diets and supplements work to reduce neuronal hyperexcitability involve normalization of aberrant energy metabolism, dampening of inflammation, promotion of endogenous antioxidants, and reduction of gut dysbiosis. This raises the possibility that these dietary and metabolic therapies may not only exert anti-seizure effects, but also reduce comorbid disorders in people with epilepsy. Here, we explore this possibility and review the clinical and preclinical evidence where available.

Management of idiopathic chylous peritonitis during laparoscopy: a case report and review of literature

Chylous ascites is rare. Etiology can be traumatic, atraumatic or idiopathic. We present a case of idiopathic peritonitis managed by laparoscopic drainage and a medium-chain triglyceride diet. We present a case of a 60-year-old white female who presented to the emergency department with diffused abdominal pain, migrated from the back, and clinical signs of peritonitis. Blood works showed high leukocytosis, and computed tomography showed a large amount of intraperitoneal and retroperitoneal fluid. During an emergency laparoscopy, a chylous ascites was seen and drained, but a causing factor was not identified intraoperatively. Postoperatively, medium-chain triglyceride diet was initiated for a period of 6 weeks, cytological, microbiological and chemical analysis showed elevated levels of triglycerides in absence of other disease. Multiple diagnostic tests revealed no malignancy nor another underlying pathological processes. patient recovered well with no complications. When confronted with chylous ascites, surgeons should drain the abdomen and do thorough evaluation. When no cause is found intraoperatively, surgeons should not take aggressive measures but instead initiate a medium-chain triglyceride diet and search for underlying causes by means of further laboratory testing and positron emission tomography combined with computed tomography (PET-CT). When no etiology is found, medium-chain triglyceride diet can be stopped with no reports of recurrence.

Dietary medium-chain triglycerides upregulate metabolic gene expression in the gastrocnemius and downregulate expression of muscle-degradation gene in the soleus in aged bromodomain-containing 4+/- heterozygous mice

PurposeBromodomain containing 4 (BRD4) positively regulates metabolic gene expression, and Brd4+/- heterozygous mice exhibit leanness and malnutrition-like features. We evaluated gene expression changes, particularly of metabolism and muscle synthesis/degradation, in the skeletal muscles of aged Brd4+/- mice fed a high medium-chain triglyceride (MCT) diet. MethodsEach organ weight of C57BL/6J male wild-type and Brd4+/-/C57BL/6J mice were assessed at approximately 100 weeks old. Male Brd4+/-/C57BL/6J mice (aged 54–84 weeks) were fed a control or MCT diet for approximately 5 months and mRNA expression changes in the gastrocnemius and soleus were quantified using mRNA microarray analysis and qRT-PCR. ResultsGastrocnemius and soleus weights decreased markedly in aged Brd4+/-, compared to wild-type mice; MCT-fed Brd4+/- mice had decreased mesenteric adipose tissue weight but no decrease in gastrocnemius and soleus weights. Metabolic gene expression was downregulated more in the gastrocnemius than in the soleus. Metabolic genes, including glycolytic and citric acid cycle, and Myh3, mediating regeneration of the skeletal muscle, in gastrocnemius, were upregulated in MCT-diet-fed Brd4+/-, whereas Murf1, which promotes degradation, was downregulated in soleus. ConclusionsAn MCT-rich diet altered mRNA expression of metabolic and muscle-regeneration and -degradation genes in the gastrocnemius and soleus of Brd4+/- mice.

Efficacy evaluation of a commercially available MCT enriched therapeutic diet on dogs with idiopathic epilepsy treated with zonisamide: a prospective, randomized, double-blinded, placebo-controlled, crossover dietary preliminary study

BackgroundIdiopathic epilepsy (IE) is a common, chronic brain dysfunction in dogs. Recently, the effect of feeding a diet enriched with medium-chain triglycerides (MCTs) on seizure frequency has been evaluated in several studies in dogs with IE. However, most dogs with IE in previous studies were treated with phenobarbital as the main antiseizure medication (ASM). In Japan, zonisamide (ZNS) is the most prescribed ASM for dogs with IE. The interaction between ZNS and various nutrients including MCTs and the potential effects on treatment efficacy resulting from combining these therapies have not been previously studied. A prospective, randomized, double-blinded, placebo-controlled, crossover dietary study was conducted. Dogs (n = 7) treated with ZNS were fed either a placebo diet (PL) or Purina ProPlan Veterinary Diet NeuroCare (NC) for 3 months, after which treatments were crossed over and continued for another 3 months. Seizure frequency (seizures/month; sz/m), blood tests including concentrations of ZNS and β-hydroxybutyric acid, and owner’s visual analogue scale score were collected from all dogs for both treatment periods.ResultsThere was no significant difference in the seizure frequency between PL (2.95 ± 0.80 sz/m) and NC (1.90 ± 0.57 sz/m) during the 6 months of trial. Three of 7 dogs showed ≥ 50% seizure reduction, and 1 of those 3 dogs achieved seizure freedom in NC period. However, 2 of 7 dogs had no changes in epileptic seizure frequency, 2 of 7 dogs had a deterioration in seizure frequency in the NC period. Feeding the MCT diet concurrent with ZNS showed no apparent adverse effects and did not affect ZNS concentration.ConclusionsThis study indicated that the commercially available MCT-enriched diet (NC) can be safely used concurrently with ZNS for dogs with IE.

Effect of Simultaneous Intake of Medium-Chain Triglyceride and d-Allulose on Body Fat Accumulation in Rats Fed a High-Fat Diet

Medium-chain triglycerides, lipids containing three 6−12 carbon medium-chain fatty acids, have antiobesity effects because they do not promote lipogenesis. d-Allulose, a low-calorie epimer of fructose commercially used as a low-calorie sweetener, suppresses hepatic lipogenesis and enhances postprandial fat oxidation. Therefore, we have explored whether a simultaneous intake of medium-chain fatty acids and d-allulose may exhibit a greater reduction in de novo lipogenesis and increase their antiobesity effects. To this end, 32 male Wistar rats were divided into four treatment groups of equal sizes: control, 3% d-allulose-treated, 5% medium-chain triglycerides-treated, and 3% d-allulose + 5% medium-chain triglycerides-treated. After 8 weeks of ad libitum exposure to these diets, d-allulose significantly decreased intra-abdominal adipose tissue and total body fat weight, with or without medium-chain triglyceride supplementation. The antiobesity effect of d-allulose was observed with or without dietary medium-chain triglyceride supplementation in high-fat diet-induced obese rats, but no synergistic effect was detected between d-allulose and medium-chain triglycerides.

Ketogenic therapy in childhood and adolescence: recommendations of the Brazilian experts group.

Ketogenic dietary therapies (KDTs) are a safe and effective treatment for pharmacoresistant epilepsy in children. There are four principal types of KDTs: the classic KD, the modified Atkins diet (MAD), the medium-chain triglyceride (MCT) diet, and the low glycemic index diet (LGID). The International Ketogenic Diet Study Group recommends managing KDTs in children with epilepsy. However, there are no guidelines that address the specific needs of the Brazilian population. Thus, the Brazilian Child Neurology Association elaborated on these recommendations with the goal of stimulating and expanding the use of the KD in Brazil.

Congenital Chylothorax with Cytomegalovirus Positivity

Background: Nonimmune hydrops fetalis (NIHF) due to congenital chylothorax (CC) is rare and is usually associated with high mortality. Chylothorax complicated with congenital cytomegalovirus (CMV) infection is extremely rare and the management becomes challenging. We present a case of CC in a preterm infant with associated CMV positivity, which was managed successfully. Clinical Description: A 2.25 kg, 34-week female newborn, with antenatally diagnosed hydrops, delivered by emergency cesarean section, presented with pleural effusion and poor respiratory efforts. Management: The baby was provided mechanical ventilation and all supportive treatments. Pleural fluid testing was suggestive of high proteins with high white cell counts, predominantly lymphocytes. Baby was also positive for CMV immunoglobulin M with a high number of copies in the urine polymerase chain reaction. The baby initially responded well to oral valgancyclovir but returned with severe respiratory distress on day 20 of life, at which time, was again found to have right-sided chylothorax. This was managed successfully with octreotide at a dose of 8 μg/kg/hour and 90% medium chain triglyceride diet. Conclusions: CC should be considered in the differential diagnosis of NIHF. An incidental serological test positivity for CMV may be superimposed on underlying CC. If the latter is managed optimally with close monitoring, the outcome is usually favorable.

Effect of a Ketogenic Medium Chain Triglyceride-Enriched Diet on the Fecal Microbiota in Canine Idiopathic Epilepsy: A Pilot Study.

Ketogenic diets have been successfully used in people and dogs with idiopathic epilepsy. This study examined the effect of a ketogenic medium chain triglycerides (MCT)- enriched diet administered for one month on the fecal microbiota of epileptic (n = 11) (six with drug-sensitive epilepsy, DSE; five with drug-refractory epilepsy, DRE) and non-epileptic beagle dogs (n = 12). A significant reduction after diet in the relative abundance of bacteria from the Actinobacteria phylum was observed in all dogs. Epileptic dogs showed a higher relative abundance of Lactobacillus compared with non-epileptic dogs at baseline but these differences disappeared after diet. Epileptic dogs also showed a significantly higher abundance of Negativicutes and Selenomonadales after dietary intervention. Baseline microbiota patterns were similar in non-epileptic beagles and dogs with DSE but significantly different from dogs with DRE. In non-epileptic and DSE groups, the MCT diet decreased the relative abundance of Firmicutes and increased that of Bacteroidetes and Fusobacteria, but the opposite effect was observed in dogs with DRE. These results suggest that the MCT diet effect would depend on individual baseline microbiota patterns and that ketogenic diets could help reduce gut microbiota differences between dogs with DRE and DSE.

Swimming Endurance Capacity of Mice is Increased by Chronic Consumption of Medium-Chain Triglycerides

The effect of chronic administration of medium-chain triglycerides (MCT) on swimming endurance (swim capacity) was investigated in male Std ddY mice. The mice were fed a diet containing 80 g MCT + 20 g long-chain triglycerides (LCT)/kg diet for 6 wk; mice fed diet containing 100 g LCT/kg diet were used as controls. After being accustomed to swimming, the mice were subjected to forced swimming every 2 d in the current water pool that we had developed, and the total swimming period until exhaustion was measured. The total swimming period was used as the index of swim capacity. The group fed MCT showed significantly greater swim capacity than the control group (89.5 ± 2.5 vs. 80.2 ± 2.0 min). In another experiment, after 4 wk of MCT diet consumption, significantly greater swim capacity was found in untrained mice. The major metabolic consequences of the adaptations of muscle to prolonged MCT administration during endurance training were higher activities of 3-oxo acid CoA-transferase (P < 0.01), citrate synthase (P < 0.1) and malate dehydrogenase (P < 0.1). These findings suggest that increases in the enzyme activities of the tricarboxylic acid cycle and ketone body utilization associated with the chronic administration of an MCT-containing diet enhance swim capacity in mice.

Застосування кетогенної дієти в педіатрії: спектр можливостей

Purpose - to describe the possibilities of using a ketogenic diet (KD) in the pediatric population for therapeutic purposes in refractory seizure syndrome and congenital metabolic disorders. The historical aspects of the development of special medical nutrition to achieve stable ketosis in children for the treatment of seizures of various genesis are briefly highlighted; the development of the evidence base for the effectiveness of the KD in children is presented. A review of current data on the multifactorial mechanisms of neuroprotective effects of KD is carried out. In particular, individual ways of modulating fundamental biochemical pathways, presynaptic and postsynaptic changes in vesicular transport and release of excitotoxic and inhibitory substrates at synapses are considered. Four types of diets are described according to the distribution of proteins, fats, and carbohydrates: the classic, modified Atkins diet, medium-chain triglyceride diet, and low glycemic index diet. The indications and contraindications for the appointment of medical ketogenic dietary therapy are considered. The most appropriate age periods of childhood for the type of KD are outlined to achieve maximum effectiveness. The authors describe in detail the main objectives of the stages of preparation of the child and family for the start of dietary treatment, the principles of initiation of KD, laboratory and instrumental monitoring and discontinuation of ketogenic dietary therapy. Particular attention is paid to the issue of counseling a child before starting a KD, the main steps in calculating the proportion of macronutrients and the principles of daily nutrition. The possibilities of prescribing medical ketogenic dietary therapy outside of refractory seizures, in particular, in glucose transaminase 1 deficiency syndrome, pyruvate dehydrogenase deficiency, mitochondrial disorders, heart failure, and brain injury, are analyzed. Available special products for medical purposes (clinical nutrition) for the organization of medical ketogenic therapy in pediatric patients, especially in the first years of life, are presented. No conflict of interests was declared by the authors.

Feeding Medium-Chain Triglycerides to Rats Decreases Degradation of Sucrase-Isomaltase Complex in the Jejunum

We demonstrated previously that feeding a diet containing medium-chain triglycerides (MCT) to rats causes an increase in the sucrase activity in jejunum relative to diets containing long-chain triglycerides (LCT). To explore the mechanism whereby MCT affect jejunal sucrase activity, 7-wk-old rats were fed a high LCT diet for 7 d, and then they were force-fed either the high LCT diet, a high MCT diet or a high carbohydrate (alpha-methylglucoside) diet for the subsequent 12 h. Feeding the high carbohydrate diet produced significantly greater sucrase and isomaltase activities in both upper and lower jejunum than feeding the LCT diet. Feeding the high MCT diet led to significantly greater sucrase activity in the lower jejunum, but isomaltase activity was not elevated. Rocket immunoelectrophoresis revealed that in the lower jejunum of the rats fed the high MCT diet the proportion of sucrase-isomaltase complex to its degradation product (i.e., isomaltase monomer) was elevated, suggesting that dietary MCT affects sucrase activity by retardation of degradation of sucrase-isomaltase. Because the amounts of total bile acids in the upper jejunum were 50% lower in rats fed the high MCT diet relative to animals fed the high LCT diet, it is likely that MCT feeding decreases secretion of bile into the lumen, which in turn decreases degradation of the sucrase subunit of the sucrase-isomaltase complex.

Efficacy and Safety of Dietary Therapies for Childhood Drug-Resistant Epilepsy

Despite advances in the understanding of dietary therapies in children with drug-resistant epilepsy, no quantitative comparison exists between different dietary interventions. To evaluate the comparative efficacy and safety of various dietary therapies in childhood drug-resistant epilepsy. Systematic review and network meta-analysis (frequentist) of studies in PubMed, Embase, Cochrane, and Ovid published from inception to April 2022 using the search terms ketogenic diet, medium chain triglyceride diet, modified Atkins diet, low glycemic index therapy, and refractory epilepsy. Randomized clinical trials comparing different dietary therapies (ketogenic diet, modified Atkins diet, and low glycemic index therapy) with each other or care as usual in childhood drug-resistant epilepsy were included. Abstract, title, and full text were screened independently by 2 reviewers. Data extraction was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Cochrane risk-of-bias tool was used to assess the study quality. Effect sizes were calculated as odds ratio with 95% CI using random-effects model. The hierarchy of competing interventions was defined using the surface under the cumulative ranking curve. Short-term (≤3 months) 50% or higher and 90% or higher reduction in seizure frequency and treatment withdrawal due to adverse events were the primary efficacy and safety outcomes. Of 2158 citations, 12 randomized clinical trials (907 patients) qualified for inclusion. In the short term, all dietary interventions were more efficacious than care as usual for 50% or higher seizure reduction (low glycemic index therapy: odds ratio [OR], 24.7 [95% CI, 5.3-115.4]; modified Atkins diet: OR, 11.3 [95% CI, 5.1-25.1]; ketogenic diet: OR, 8.6 [95% CI, 3.7-20.0]), while ketogenic diet (OR, 6.5 [95% CI, 2.3-18.0]) and modified Atkins diet (OR, 5.1 [95% CI, 2.2-12.0]) were better than care as usual for seizure reduction of 90% or higher. However, adverse event-related discontinuation rates were significantly higher for ketogenic diet (OR, 8.6 [95% CI, 1.8-40.6]) and modified Atkins diet (OR, 6.5 [95% CI, 1.4-31.2]) compared with care as usual. Indirectly, there was no significant difference between dietary therapies in efficacy and safety outcomes. This study found that all dietary therapies are effective in the short term. However, modified Atkins diet had better tolerability, higher probability for 50% or higher seizure reduction, and comparable probability for 90% or higher seizure reduction and may be a sounder option than ketogenic diet. Direct head-to-head comparison studies are needed to confirm these findings.

Evaluation of Clinical Findings in Children with Chylothorax: A Descriptive Study.

Chylothorax refers to the presence of chyle in the pleural space. There are multiple etiologies of chylothorax. Our aim in this study was to evaluate the clinical manifestations, causes, and treatment of chylothorax in childhood and also to show the differences between the 2 age groups admitted to a tertiary care children's hospital. The second aim was to evaluate the clinical and radiologic features of patients diagnosed as having Gorham-Stout disease via chylothorax. The archives were reviewed for chylothorax documented in the last 31 years. Twenty-two patients (11 girls and 11 boys) were included. Patients were divided into 2 groups: the younger group aged under 24 months and the older group aged over 24 months. A total of 22 patients had chylothorax, and 10 were aged younger than 24 months. In the younger group, etiologies were in order congenital heart surgery, congenital chylothorax, and Gorham-Stout disease. In the older group, etiologies were Gorham-Stout disease, congenital heart surgery, heart failure, heart transplantation, thrombus, intestinal lymphangiectasia, and idiopathic. The most common treatment in the younger group was the medium-chain triglyceride diet (70%), and in the older group, it was sirolimus (50%). There is a wide variety of underlying etiologies in childhood, so a multidisciplinary approach is important to identify the underlying diagnosis. The common etiologies were postoperative and Gorham-Stout disease in our study. All patients with Gorham-Stout disease had a good prognosis. Gorham-Stout disease should be considered in patients of any age with a diagnosis of chylothorax who have bone lesions.

Chylopericardium In a Young Woman Revealing A Mediastinal Cystic Lymphangioma: A Case Report

Isolated chylopericardium due to mediastinal cystic lymphangioma is a rare entity. We report a case of asymptomatic chylopericardium in an 18 years old female with no history of trauma, thoracic surgery, malignancy, infection, or tuberculosis sand who presented with cardiomegaly noticed on chest x-ray before surgery of mandibular subluxation. Echocardiography showed a large number of pericardial effusions and pericardiocentesis yielded 1.25 L of milky-colored fluid which showed a triglyceride level of 4.82 g/L and cholesterol of 0.29 g/L with a cholesterol to triglyceride ratio of &lt;1, characteristic of the chylous fluid. Chest computed tomography showed a huge mediastinal cystic lymphangioma. The patient successfully responded to continuous pericardial drainage and a medium-chain triglyceride diet then she was referred to the thoracic department for surgery. This type of case risks being misdiagnosed as tuberculosis, especially in countries where tuberculosis is endemic. Therefore, assessing pericardial fluid for chyle is crucial.

Ketogenic Diets in the Management of Lennox-Gastaut Syndrome-Review of Literature.

Epilepsy is an important medical problem with approximately 50 million patients globally. No more than 70% of epileptic patients will achieve seizure control after antiepileptic drugs, and several epileptic syndromes, including Lennox-Gastaut syndrome (LGS), are predisposed to more frequent pharmacoresistance. Ketogenic dietary therapies (KDTs) are a form of non-pharmacological treatments used in attempts to provide seizure control for LGS patients who experience pharmacoresistance. Our review aimed to evaluate the efficacy and practicalities concerning the use of KDTs in LGS. In general, KDTs are diets rich in fat and low in carbohydrates that put the organism into the state of ketosis. A classic ketogenic diet (cKD) is the best-evaluated KDT, while alternative KDTs, such as the medium-chain triglyceride diet (MCT), modified Atkins diet (MAD), and low glycemic index treatment (LGIT) present several advantages due to their better tolerability and easier administration. The literature reports regarding LGS suggest that KDTs can provide ≥50% seizure reduction and seizure-free status in a considerable percentage of the patients. The most commonly reported adverse effects are constipation, diarrhea, and vomiting, while severe adverse effects such as nephrolithiasis or osteopenia are rarely reported. The literature review suggests that KDTs can be applied safely and are effective in LGS treatment.

Potential of Capric Acid in Neurological Disorders: An Overview.

To solve the restrictions of a classical ketogenic diet, a modified medium-chain triglyceride diet was introduced which required only around 60% of dietary energy. Capric acid (CA), a small molecule, is one of the main components because its metabolic profile offers itself as an alternate source of energy to the brain in the form of ketone bodies. This is possible with the combined capability of CA to cross the blood-brain barrier and achieve a concentration of 50% concentration in the brain more than any other fatty acid in plasma. Natural sources of CA include vegetable oils such as palm oil and coconut oil, mammalian milk and some seeds. Several studies have shown that CA has varied action on targets that include AMPA receptors, PPAR-γ, inflammatory/oxidative stress pathways and gut dysbiosis. Based on these lines of evidence, CA has proved to be effective in the amelioration of neurological diseases such as epilepsy, affective disorders and Alzheimer's disease. But these studies still warrant more pre-clinical and clinical studies that would further prove its efficacy. Hence, to understand the potential of CA in brain disease and associated comorbid conditions, an advance and rigorous molecular mechanistic study, apart from the reported in-vitro/in-vivo studies, is urgently required for the development of this compound through clinical setups.