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  1. Dieffenbachia-Induced Transient Crystalline Keratopathy: A Case Report and Review of Previously Reported Cases
    Chong SH, Ch'ng TW, Mustapha M
    Cureus, 2022 Jan;14(1):e21146.
    PMID: 35165597 DOI: 10.7759/cureus.21146
    We report a case of transient crystalline keratopathy induced by contact with Dieffenbachia plant sap and review previous reports on plant-induced crystalline keratopathy. A 27-year-old man with underlying diabetes mellitus presented with ocular pain, redness, and tearing after Dieffenbachia plant sap accidentally entered his right eye while he had been cutting the grass one day prior to presentation. The visual acuity of his right eye was 6/9. His conjunctiva was injected with an epithelial defect over the inferior conjunctiva. There were fine needle-like oxalate crystals in the epithelial and stromal layer of the cornea inferiorly. He was treated with topical dexamethasone and levofloxacin. The crystals disappeared from the cornea when he was reviewed one month later. He maintained good visual acuity, and no corneal opacity was noted. In conclusion, patients with crystalline keratopathy after exposure to Dieffenbachia plant sap can have a full recovery without sequelae after supportive treatment. Eliciting the history from patients regarding the type of plant involved is imperative. Ophthalmologists should be aware of the possibility of crystalline keratopathy developing, even though most patients retain good vision.
  2. Association Between Energy Delivery and Outcomes in Adult Critically Ill Patients Diagnosed With or At Risk of Malnutrition: A Systematic Review and Meta-analysis With Trial Sequential Analysis
    Chong SH, Huang Y, Heng MS, Chong EST, Lim CDQ, Wong KW, et al.
    Nutr Rev, 2025 Apr 02.
    PMID: 40173413 DOI: 10.1093/nutrit/nuaf042
    CONTEXT: There is a common belief that adult critically ill patients diagnosed with or at risk of malnutrition would benefit from higher energy delivery.

    OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the association between energy delivery and mortality in adult critically ill patients diagnosed with or at risk of malnutrition.

    DATA SOURCES: Databases including Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, and Google Scholar were searched from inception to November 20, 2023.

    DATA EXTRACTION: Randomized controlled trials (RCTs) and observational studies that (1) included critically ill patients (aged ≥18 years) diagnosed with or at risk of malnutrition using validated tools following intensive care unit (ICU) admission, (2) had at least 20% energy difference between intervention and comparison groups, and (3) reported mortality outcomes were included. The random-effects model was used to pool the data.

    DATA ANALYSIS: Two RCTs (4681 at-risk patients) and 5 observational studies (1587 at-risk patients [including 389 high-risk patients]) were included. The pooled mean energy delivered during the first 7-14 days of ICU admission in higher vs lower energy groups was 25.6 ± 5.9 vs 9.7 ± 5.6 kcal/kg per day (P = .004) in RCTs and 21.0 ± 5.2 vs 13.3 ± 5.3 kcal/kg per day (P 

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