Critical review of nutrition assessment tools to measure malnutrition in chronic kidney disease

The use of the Subjective Global Assessment (SGA) and similar clinical tools for nutrition assessment is integral in the nutritional management of chronic kidney disease (CKD) patients. The present paper is a critical review of the quality of studies introducing and validating SGA‐based tools in CKD. In the CKD literature, clinical, predictive and criterion validity were investigated by a number of studies. Common limitations identified include the use of questionable statistical methods, difference in prevalence of malnutrition based on tool or administrator (i.e. dietitan, nephrologist or nurse) and use of inadequate reference tests to establish true nutrition status. The SGA appears to have the best diagnostic evidence to adequately detect the presence of abnormal nutrition status and prognostic evidence to predict poor outcome. Modified scored versions may improve clinician’s ability to detect degree of malnutrition; however, the present review indicates more work is required. Tools based on the original SGA claiming validity in CKD and potentially other clinical areas should be approached with caution. Critical evaluation of study design, reference tests and statistical methods is recommended before implementing new tools in practice.     

Current concepts in the aetiology, diagnosis and treatment of TMJ and muscle dysfunction

The complexity of managing TMJ and muscle dysfunction is reflected in the variety of treatment modalities that are continually being advocated. The multidimensional nature of the problem is readily appreciated in a TMJ Oral-Facial Pain Clinic where most of the referred patients represent a broad spectrum of treatments that have failed. Where such a clinic has been present for several decades the introduction of new ideas, or the reintroduction of old forms of treatment, are readily seen as well as the quantity and quality of treatment successes and failures. A major shift in ideas concerning the natural history of TMJ/muscle dysfunction, and an explosion of treatment problems and failures related to mandibular repositioning appliances and surgery suggest the need to reconsider various approaches to the diagnosis and treatment of TMJ and muscle dysfunction. Guidelines for diagnosis and treatment of these disorders are discussed.     

Remarks on probability theory and TMJ diagnosis

On the basis of the classic concepts of events and probability theory, this article analyzes some recently introduced diagnostic probability concepts as they pertain to temporomandibular joint (TMJ) diseases and disorders.     

Excitatory response of jaw elevators associated with sudden discomfort during chewing

Abnormalities associated with the chewing contraction of the masseteric and anterior temporal muscles were evaluated in patients who sensed pain in the area of the temporomandibular joint during mandibular movement. The patients were instructed in the use of an electronic switch to mark any event of discomfort/pain during natural chewing. Individual stimulus to response reaction-times were determined. The electromyographic pattern of the jaw elevators was quantified by root mean square (r.m.s.) peak voltage and contraction time. The statistical analysis of group data showed significantly prolonged contraction times and greater r.m.s. amplitudes for chewing cycles with, compared to cycles without, indication of pain. Also, individual data showed statistically significant differences between painful and non-painful cycles in some cases. It is concluded, that the conscious perception of nociception during the closing phase of chewing is associated with an excitatory response of jaw elevators.     

Inhibition of adherence and cytotoxicity by circulating immune complexes formed in experimental filariasis

Summary Peritoneal exudate cells (PEC) from normal jirds ( Meriones unguiculatus ) showed adherence to Brugia pahangi microfilariae, and subsequent cytotoxicity in the presence of antimicrofilarial antisera. Heat inactiviation of the antisera diminished both adherence and cytotoxicity, but readdition of fresh normal jird sera only partially restored the reactions. Macrophages were the predominant adherent cell type. Circulating immune complexes precipitated with polyethylene glycol (PEG) from the sera of jirds with an 8-month infection inhibited both of these reactions. Complement consumption by the precipitated complexes was found not to be the cause of inhibition. Blocking of adherence and cytotoxicity by circulating immune complexes may be preventing the trapping of microfilariae in vivo , and may play a role in the persistence of microfilaraemia in the jird.