A kidney transplant patient on cyclosporine therapy presenting with dural venous sinus thrombosis: a case report

Dural vein thrombosis is an important but rare cause of headache. Therapy with cyclosporine has been reported to result in thrombotic events. We report an unusual case of superior sagittal and transverse sinus thrombosis associated with cyclosporine therapy in a kidney transplant patient

Effects of the “plate model” as part of dietary intervention on modification of selected cardiometabolic risk factors in post-myocardial infarction patients: study protocol for a randomized controlled trial

Abstract Background Cardiovascular disease remains the leading cause of morbidity and mortality worldwide, and there is a rising global burden. The effects of diet on cardiometabolic risk factors have been studied extensively. Healthy eating as a cost-effective approach to risk reduction in post-myocardial infarction patients is proven to be beneficial, and the “plate model” is one of the practical methods to achieve this objective. Methods/design The study will be conducted as a randomized, single-blind, controlled clinical trial for a period of 3 months. A total of 120 overweight (body mass index >23 kg/m2) inpatients (aged 20–70 years) with a history of troponin-positive acute coronary syndrome (ACS) within the 1 month preceding the study will be recruited. Simple randomization will be used in participant allocation. The intervention group will receive the model plate diet. The control group will be provided with routine dietary advice. Other domains, such as advice on exercise and lifestyle modification, will be equalized among patients in both the groups. The visits and evaluations will be done at recruitment (visit 0), 4 weeks, and 12 weeks after the intervention. The primary outcome will be a mean body weight reduction of 10%, and the secondary outcomes will include mean reduction of systolic and diastolic blood pressure, improvement of anthropometric parameters, and improvement of lipid profile and liver enzymes in the test group compared with the control group at 12 weeks following the plate model diet. Discussion This study protocol is designed to establish the effects of the plate model diet on modification of cardiometabolic risk factors in patients with ACS. This will also be a pioneering study designed to investigate the practicality of the model plate in local settings and in the South Asian region. Trial registration Sri Lanka Clinical Trials Registry identifier: SLCTR/2016/22. Registered on 22 September 2016 ( http://www.slctr.lk/trials/483 )

Effects of 'plate model' as a part of dietary intervention for rehabilitation following myocardial infarction: A randomized controlled trial

Background: Reducing body weight by nutritional management is an integral element of cardiac rehabilitation and in secondary prevention of cardiovascular diseases. Administration of a "plate model" is one practical aspect to control calorie intake. The study aimed to evaluate the effectiveness of the plate model as a part of dietary modification in losing excess weight in post-myocardial infarction (MI) patients. Methods: An interventional, randomized, single-blinded study with parallel subject allocation was conducted among patients with a history of troponin-positive acute coronary syndrome (ACS). A total of 120 patients were recruited to intervention and control groups. The Intervention cluster was provided with 'plate model' and both groups received standard cardiac rehabilitation care. Anthropometric, clinical and metabolic parameters were measured at recruitment and repeated during 4th and 12th week. Results: A sample of 79 patients (the intervention group: 40, the control group: 39) completed the study. At the end of 12 weeks participants in the intervention group exhibited a significant weight loss (-1.27±3.58 vs. -0.26±2.42 kg; P=0.029) and a significant reduction in BMI (-0.48±1.31 vs. -0.10±0.89 kg/m2; P=0.023). Overweight and obese patients (BMI >23 kg/m2) displayed greater weight loss (-2.13±3.46 vs. 0.12±2.62 kg; P=0.013). Many of overweight and obese patients in the test group (35.7%) experienced a weight loss ≥5% compared to the control group (13.04%) which was a nearly significant result (P=0.065). No significant changes observed in other metabolic parameters. Conclusions: Plate model is an effective dietary intervention in view of weight reduction in post-MI patients.</p

Heart disease complicating pregnancy as a leading cause of maternal deaths in LMIC settings: the Sri Lankan experienceResearch in context

Summary: Background: Heart disease (HD) is one of the leading indirect causes of maternal deaths worldwide, both in high- and low- and middle-income countries (LMICs). This study aims to describe maternal deaths due to cardiovascular disease complicating pregnancy in Sri Lanka. Methods: The national Maternal Death Surveillance Response (MDSR) system in Sri Lanka investigates all female deaths during pregnancy and 12 months after delivery. These maternal death investigation records were perused in this analysis. Maternal deaths from 2006 to 2018 with HD complicating pregnancy as the immediate or underlying cause of death were re-coded using the ICD-11 classification. Findings: Of the 2855 pregnancy-related deaths reported to the MDSR from 2006 to 2018, 1646 (57.7%) were confirmed as maternal deaths. Of those, 284 (17.25%) were attributed to HD complicating pregnancy. The cause-specific maternal mortality ratio due to heart disease from 2006 to 2018 was 7.24 per 100,000 live births. Rheumatic heart disease was the leading cause of HD (60, 21.1%), while cardiomyopathies (59, 20.7%) and congenital anomalies (34, 12.0%) accounted for a sizeable share. Medically contraindicated pregnancies accounted for 54 (19%) deaths. Application of the 3-delay model identified 186 (65.5%) cases with possible delays. Out of all deaths, 158 (55.6%) cases were categorized as preventable. Interpretation: Preventing maternal mortality from HD in LMICs requires a lifecycle approach with situation-specific interventions and highly specialized care. Community awareness, capacity building related to management, and specific infrastructure development will be key strategies. Funding: None

Additional file 1: of Effects of the “plate model” as part of dietary intervention on modification of selected cardiometabolic risk factors in post-myocardial infarction patients: study protocol for a randomized controlled trial

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 122 kb

Weight Change During Hospitalization in a Tertiary Cardiological Center in Sri Lanka

Malnutrition is common in hospitalized patients and many undergo further deterioration of the nutritional level during the stay at the hospital. Patients who are malnourished on admission have a tendency to further depletion of nutrition level during the hospital stay. The aim of this study was to assess the weight changes of hospitalized patients during the hospital admission. Body weight was measured on admission and discharge for two hundred and ninety four patients in a cardiology hospital. Body mass index (BMI) cut offs were used to categorized patients to underweight (BMI&lt;18.5kg.m-2), normal (18.5-22.9kg.m-2), overweight (23.0-24.9kg.m-2), obese (25.0-29.9kg.m-2) and very obese. Study population included 190 (64.4%) males and 105 (35.6%) females. One hundred and twenty eight (43.4%) patients lost their weight, while 131 (44.4%) and 36 (12.2%) patients had gained and had no change in their weight respectively. Of the patients who had their BMI in the underweight category (26, 8.81%), most (15, 57.7%) gained their weight. In the normal BMI range (112, 37.97%) majority (51, 45.5%) gained their weight. In the category of overweight (64, 21.69%), half of the patients (32, 50.0%) lost their weight. Forty three patients (46.23%) who were in the obese or very obese category (93, 31.53%) lost their weight. Weight changes withi

Predicting clinical outcome of cardiac patients by six malnutrition screening tools

BACKGROUND: Malnutrition is highly prevalent among hospital admissions and associated with, poor response to medical treatment, prolonged hospital stay, increased mortality and cost to the state. The aim of this study is to assess the ability of the nutrition screening tools to predict the clinical outcome of cardiac patients. METHODS: Five hundred and twenty six patients underwent nutritional screening via Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Short Nutritional Assessment Questionnaire (SNAQ), Mini Nutritional Assessment-Short Form (MNA-SF), Nutritional Risk Screening (NRS) and Subjective Global Assessment (SGA) tools on admission and each subject was followed up until discharge and after one month to identify the clinical course and outcome. RESULTS: The mean hospital stay was 5.3 days and median hospital stay was 4.0 days. The mean hospital stay is increasing with the malnutrition level in MUST, NRS, MNA-SF, MST, NRS and SGA tools. The inpatient mortality is higher in high risk nutritional categories of all six malnutrition screening tools. MNA-SF, MST and SGA tools demonstrate a positive relationship between non-prophylactic antibiotic usage and poor nutritional status. High risk nutritional categories of MNA-SF and MST are associated with prescription of multivitamin/minerals. According to MNA-SF, MST and SGA the follow up mortality was increased with worsening nutritional status. The incidence of readmissions was increased gradually with deteriorating nutritional status categorized by MUST, SNAQ, MST and SGA tools. CONCLUSION: Malnutrition may be associated with poor clinical outcome of the cardiac patients during and after the hospital stay. Each tool reported a variable prediction in outcomes such as death, infection and prolonged hospital stay due to the poor nutritional status

Additional file 1: of Body weight perception among Sri Lankan cardiac patients

Multiple logistic regression models for under-perception, correct perception and over perception of body weight. (DOCX 17 kb