Epilepsy in the pediatric and adolescent populations is a devastating condition where individuals are prone to recurrent epileptic seizures or changes in behavior or movement that is the direct result of a primary change in the electrical activity in the brain. Although many children with epilepsy will have seizures controlled with antiseizure medications (ASMs), a large percentage of patients are refractory to drug therapy and may consider initiating a ketogenic diet. The term Ketogenic Diet or Ketogenic Diet Therapy (KDT) refers to any diet therapy in which dietary composition results in a ketogenic state of human metabolism. Currently, there are 4 major Ketogenic diet therapies—the classic ketogenic diet (cKD), the modified Atkins diet (MAD), the medium chain triglyceride ketogenic diet (MCTKD) and the low glycemic index treatment (LGIT). The compositions of the 4 main KDTs differ and limited evidence to distinguish the efficacy among different diets currently exists. Although it is apparent that more randomized controlled trials (RCTs) and long-term studies are needed to evaluate efficacy, side effects and individual response to the diet, it is imperative to study and understand the metabolic profiles of patients with epilepsy in order to isolate which dietary restrictions are necessary to maximize clinical benefit.

Alzheimer’s disease (AD) and Parkinson’s disease (PD) are neurodegenerative disorders that affect millions of individuals worldwide. As incidence of these conditions increases with age, there will undoubtedly be an increased prevalence of cases in the near future. Neuroinflammation is a hallmark in the development and progression of neurodegenerative diseases and prevention or resolution of chronic neuroinflammation may represent a novel approach to treatment. The present review highlights the potential of the anti-inflammatory and pro-resolving effects of polyunsaturated fatty acid (PUFA)-derived mediators (Specialized Pro-resolving Mediators—SPM) in neurodegenerative disorders. PUFA-derived SPM are biosynthesized in response to chemicals produced from acute inflammatory responses. Preclinical studies from both AD and PD models suggest a dysregulation of SPM and their receptors in neurological disorders. Decreased SPM may be due to inadequate substrate, an imbalance between SPM and pro-inflammatory mediators or a disruption in SPM synthesis. SPMs hold great promise for neuroprotection in AD by altering expression of pro-inflammatory genes, modulating macrophage function, serving as a biomarker for AD status, and promoting resolution of neuroinflammation. In PD, data suggest SPM are able to cross the blood-brain barrier, inhibit microglial activation and decrease induced markers of inflammation, possibly as a result of their ability to downregulate NFκB signaling pathways. Several in vivo and in vitro studies suggest a benefit from administration of SPMs in both neurodegenerative disorders. However, extrapolation of these outcomes to humans is difficult as no models are able to replicate all features of AD or PD. Minimal data evaluating these PUFA-derived metabolites in humans with neurodegenerative disorders are available and a gap in knowledge exists regarding behavior of SPM and their receptors in patients with these conditions. There is also large gap in our knowledge regarding which lipid mediator would be most effective in which model of AD or PD and how dietary intake or supplementation can impact SPM levels. Future direction should include focused, translational efforts to investigate SPM as an add-on (in addition to standard treatment) or as standalone agents in patients with neurodegenerative disorders.

OBJECTIVE: Provide an up-to-date review for health care providers regarding clinically significant food-drug interactions and summarize recommendations for optimal medication administration in older adults and long-term care patients. DATA SOURCES: A literature search was performed using MEDLINE, PUBMED, and IPA abstracts to locate relevant articles published between January 1982 and July 2017. DAILYMED was used to identify manufacturer-specific medication administration recommendations. STUDY SELECTION AND DATA EXTRACTION: Articles were reviewed for inclusion based on their relevance to this subject matter and the integrity of the information provided. Additionally, the package labeling of included products was reviewed. DATA SYNTHESIS: The current recommendations for specific medication administration with regard to food are summarized descriptively. CONCLUSION: Clinically significant food-drug interactions are common and have been reported with multiple classes of medications. However, there are a limited number of studies examining food-drug interactions, and the majority of recommendations are made by product-specific manufacturers. Pharmacists should be aware of common food-drug interactions in the community, assisted living, long-term care, subacute care, and hospital settings. To optimize medication therapy and improve therapeutic outcomes, it is important for pharmacists and other health care providers to identify agents with potential for food-drug interactions and to understand the clinical relevance of such interactions.

Background: Coronavirus disease 2019 (COVID‐19) is now the third leading cause of death in the United States. Malnutrition in hospitalized patients increases risk of complications. However, the effect of malnutrition on outcomes in patients infected is unclear. This study aims to identify the impact of malnutrition on mortality and adverse hospital events in patients hospitalized with COVID‐19.Methods: This study used data from the National COVID Cohort Collaborative (N3C), a COVID‐19 repository containing harmonized, longitudinal electronic health record data from US health systems. Malnutrition was categorized into three groups based on condition diagnosis: (1) none documented, (2) history of malnutrition, and (3) hospital‐acquired malnutrition. Multivariable logistic regression was performed to determine whether malnutrition was associated with mortality and adverse events, including mechanical ventilation, acute respiratory distress syndrome, extracorporeal membrane oxygenation, and hospital‐acquired pressure injury, in hospitalized patients with COVID‐19.Results: Of 343,188 patients hospitalized with COVID‐19, 11,206 had a history of malnutrition and 15,711 had hospital‐acquired malnutrition. After adjustment for potential confounders, odds of mortality were significantly higher in patients with a history of malnutrition (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.63–1.79; P < 0.001) and hospital‐acquired malnutrition (OR, 2.5; 95% CI, 2.4–2.6; P < 0.001). Adjusted odds of adverse hospital events were also significantly elevated in both malnutrition groups.Conclusions: Results indicate the risk of mortality and adverse inpatient events in adults with COVID‐19 is significantly higher in patients with malnutrition. Prevention, diagnosis, and treatment of malnutrition could be a key component in improving outcomes in these patients.

Background: Long coronavirus disease consists of health problems people experience after being infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). These can be severe and include respiratory, neurological, and gastrointestinal symptoms, with resulting detrimental impacts on quality of life. Although malnutrition has been shown to increase risk of severe disease and death during acute infection, less is known about its influence on post–acute COVID‐19 outcomes. We addressed this critical gap in knowledge by evaluating malnutrition's impact on post–COVID‐19 sequelae.Methods: This study leveraged the National COVID Cohort Collaborative to identify a cohort of patients who were at least 28 days post–acute COVID‐19 infection. Multivariable Cox proportional hazard models evaluated the impact of malnutrition on the following postacute sequelae of SARS‐CoV‐2: (1) death, (2) long COVID diagnosis, (3) COVID‐19 reinfection, and (4) other phenotypic abnormalities. A subgroup analysis evaluated these outcomes in a cohort of hospitalized patients with COVID‐19 with hospital‐acquired (HAC) malnutrition.Results: The final cohort included 4,372,722 individuals, 78,782 (1.8%) with a history of malnutrition. Individuals with malnutrition had a higher risk of death (adjusted hazard ratio [aHR]: 2.10; 95% CI: 2.04–2.17) and SARS‐CoV‐2 reinfection (aHR: 1.52; 95% CI: 1.43–1.61) in the postacute period than those without malnutrition. In the subgroup, those with HAC malnutrition had a higher risk of death and long COVID diagnosis.Conclusion: Nutrition screening for individuals with acute SARS‐CoV‐2 infection may be a crucial step in mitigating life‐altering, negative postacute outcomes through early identification and intervention of patients with malnutrition.