Combining 2 Commonly Adopted Nutrition Instruments in the Critical Care Setting Is Superior to Administering Either One Alone

Background: This study aimed to determine the agreement between the modified Nutrition Risk in Critically ill Score (mNUTRIC) and the Subjective Global Assessment (SGA) and compare their ability in discriminating and quantifying mortality risk independently and in combination. Methods: Between August 2015 and October 2016, all patients in a Singaporean hospital received the SGA within 48 hours of intensive care unit admission. Nutrition status was dichotomized into presence or absence of malnutrition. The mNUTRIC of patients was retrospectively calculated at the end of the study, and high mNUTRIC was defined as scores ≥5. Results: There were 439 patients and 67.9% had high mNUTRIC, whereas only 28% were malnourished. Hospital mortality was 29.6%, and none was lost to follow‐up. Although both tools had poor agreement (κ statistics: 0.13, P < .001), they had similar discriminative value for hospital mortality (C‐statistics [95% confidence interval (CI)], 0.66 [0.62–0.70] for high mNUTRIC and 0.61 [0.56–0.66] for malnutrition, P = .12). However, a high mNUTRIC was associated with higher adjusted odds for hospital mortality compared with malnutrition (adjusted odds ratio [95% CI], 5.32 [2.15–13.17], P < .001, and 4.27 [1.03–17.71], P = .046, respectively). Combination of both tools showed malnutrition and high mNUTRIC were associated with the highest adjusted odds for hospital mortality (14.43 [5.38–38.78], P < .001). Conclusion: The mNUTRIC and SGA had poor agreement. Although they individually provided a fair discriminative value for hospital mortality, the combination of these approaches is a better discriminator to quantify mortality risk.     

Eyelid grafting as a preprosthetic measure for restoring facial defects

Prosthetic restoration of a facial defect involving the loss of an eye and associated orbital tissues may be restricted by incorrect orientation of the prosthesis if the reconstructed tissue bed is uniform and without distinctive orbital landmarks. A surgically grafted eyelid is useful in this situation. The lower eyelid graft serves to provide an anatomical guide with which to position the ocular component of the orbital prosthesis in relation to its established visual axis. This assists the subsequent orientation of the adjoining tissue portion of the orbital prosthesis, contributing to a well-positioned and cosmetically pleasing result.     

Histiocytosis X (Langerhans-cell histiocytosis) of the palate. Case report

A case of histiocytosis X (Langerhans-cell histiocytosis) occurring in the maxilla of a two-year-old boy is presented. Common dental and oral conditions were considered and eliminated. Diagnosis was made through a biopsy which showed aggregates of histiocytes. Management consisted of multi-modal treatment. Full skeletal radiographic survey and review were essential to detect other possible sites of involvement. None was found in this case over a four-year review.