Metabolic syndrome (MSyn) constitutes a litany of pathophysiological conditions, such as central adiposity, hypertension, dyslipidemia, and hyperglycemia. As a result of the epidemic levels of MSyn, several efforts have been made to identify the etiologies of the condition and develop methods by which to reduce its prevalence. The attenuation of the gut microflora ratio of Firmicutes/Bacteroidetes through bioactive compounds found in the Mediterranean diet, dietary polysaccharides, and pre- and probiotics can be used as functional foods to improve derangements in cardiometabolic markers correlated with the development of MSyn. Although more studies are needed to understand the role of manipulating the gut microbiota in health and disease in human models, this review based on current data from epidemiologic studies and clinical trials will serve as a review to elucidate the role nutrition plays in attenuating the gut microbiota in preventing and managing MSyn.

Levetiracetam is a second-generation antiepileptic drug that is chemically unrelated to other antiepileptic drugs. Levetiracetam is a broad-spectrum antiseizure medication that is approved as an adjunctive therapy in the treatment of partial and generalized tonic-clonic seizures in children and adults with epilepsy. The mechanism by which Levetiracetam induces behavioral changes remains unknown. Its proposed mechanism of action involves binding to synaptic vesicle protein 2A (SV2A) and this leads to neuronal inhibition. Though, the drug has a convenient dosing regimen and is relatively well tolerated, neuropsychiatric side effects can emerge beyond the initial titration period and may be the most common reason for drug discontinuation. Levetiracetam has been reported to cause varying degrees of psychiatric adverse effects including behavioral disturbance such as agitation, hostility and psychosis, and mood symptoms and suicidality. It has been shown to induce psychiatric side effects in 13.3% of adults, with only 0.7% presenting with severe symptoms such as depression, agitation, or hostility. The prevalence rate of development of psychosis in these patients is estimated to be about 1.4%. A review of literature has demonstrated a relative correlation between Levetiracetam use and the development of neurobehavioral symptoms which is increased in predisposed individuals. This research describes the case of a 28-year-old woman with seizure disorder and a psychiatric history of schizoaffective disorder who developed aggressive behavior, paranoia, and severe hostility following administration of Levetiracetam 750 mg orally twice daily. She developed acute behavioral symptoms which were reversed with cessation of Levetiracetam. This report emphasizes the need for developing an appropriately high index of suspicion in promoting surveillance and prompt identification of behavioral adverse effects associated with Levetiracetam especially in high-risk patient population.

Louis-Jean et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Background: Immunonutrition is a term given to nutritional interventions that modulate the immune and inflammatory responses in critically-ill and surgical patients.  This is accomplished via the enteral or parenteral administration of formulas containing an array of immunonutrients in amounts greater than normally found in the diet. Some of the more commonly used immunonutrients include arginine, glutamine, branched-chain amino acids, omega-3 (n-3) fatty acids, trace metals (e.g. zinc, copper, iron), and nucleotides or antioxidants.