Objectives The classic ketogenic diet (CKD) as a potential epilepsy treatment with high-fat has not good tolerability in some patients, and so many families refuse to use this diet for long term especially in children younger than 2 year. In the present study, the efficacy and tolerability of the CKD only diet were compared with CKD combined a formulabased powder in children between 1 and 3 yr with intractable epilepsy. Materials & Methods We randomly enrolled 45 children referred to Mofid Children’ s Hospital, Tehran, Iran from April 2016 to May 2017 with refractory epilepsy for CKD only (control group), and formula based CKD (experimental group) treatment. Subjects were followed up for at least six months. Results Most of the patients in CKD only group did not tolerate the diet and were reluctant to eat homemade foods with high fat. All families of the patients younger than 2 yr old in this group chose to discontinue CKD and pursued other options. About 33% of the families of the patients younger than 2 yr old and 41. 6% of the total patients between 1-3 yr old in experimental group stayed to the end of the trial, and all of them showed more than 90% reduction in seizure frequency after 6 months. Moreover, regardless of the other variables, using formula increased the chance of responding to treatment 7. 32 times. Conclusion A ketogenic diet using a powder ketogenic formula is effective, safe, and tolerable in infants and children with refractory seizure especially for younger patients who are reluctant to eat ketogenic homemade foods.

This study sought to molecularly determine the presence of TEM-1, VIM, and CTX Metallo Beta-Lactamase (MBL) genes in Bacillus cereus isolated from selected infant formula specimens, and 30 were designated for advanced analysis. Suspected colonies of B. cereus were obtained from the samples and subjected to morphological and biochemical characterization to confirm their identity as B. cereus isolates. Antibiotic susceptibility testing. This study was executed in alignment with the guidelines established by the Clinical and Laboratory Standards Institute (CLSI). To identify MBL genes, we implemented a phenotypic confirmatory test on Mueller Hinton agar to ensure reliable identification fortified with clavulanic acid was implemented. The detection of MBL genes was evidenced by an inhibition zone increase exceeding 5 mm on the plate with clavulanic acid relative to the plate lacking this supplement. For molecular detection, PCR was used to identify the MBL genes in the isolated strains. Among the 30 PCR-tested samples, 28 were found to harbor the TEM-1 gene, indicating its presence in the B. cereus isolated from the infant formula samples. However, none of the isolates tested positive for the VIM or CTX MBL genes. In conclusion, infant dry milk is identified as a conducive environment for B. cereus growth, and the TEM-1 gene is frequently present in the strains derived from these samples. However, the lack of detection of VIM and CTX genes indicates that these resistance genes are not widespread in the isolated B. cereus from infant powder milk.