MyMedR (Malaysian Medical Repository) is an open-access collection of Malaysian health and biomedical research. The materials are imported from PubMed and MyJurnal. We gratefully acknowledge the permission to reuse the materials from the National Library of Medicine of the United States and the Malaysian Citation Centre. This project is funded by the Academy of Family Physicians of Malaysia. The project team members are CL Teng, CJ Ng, EM Khoo, Mastura Ismail, Abrizah Abdullah, TK Chiew, and Thanaletchumi Dharmalingam.
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METHODS: A secondary analysis of cohorts from two quasi-experimental studies among patients aged ≥65 years old presenting to the ED of a 1,700-bed tertiary hospital. We compared both groups for baseline characteristics using univariate analyses, and performed multiple linear regression to examine the association between Modified Barthel Index (MBI) and Lawton's instrumental activities of daily living (IADL) against SARC-F, and binary logistic regression to examine the associations between individual ADL domains and SARC-F+. We compared the area under receiver operating characteristic curves (AUC) to detect SARC-F+ for MBI, IADL, frailty, age, cognition and comorbidity.
RESULTS: SARC-F+ patients were older (86.4±7.6 years), predominantly female (71.5%) and frail (73.9%), more dependent on walking aids (77.2%), and had lower premorbid MBI (median 90.0 [interquartile range 71.0-98.0]) and IADL (4.0 [2.0-5.0]) (both p<0.001). MBI (β=-0.07, 95% confidence interval [CI] -0.086 to -0.055) and IADL (β=-0.533, 95% CI -0.684 to -0.381) were significantly associated with SARC-F. Dependency in finances (odds ratio [OR]=14.7, 95% CI 3.57-60.2, p<0.001), feeding (OR=12.4, 95% CI 1.45-106, p=0.022), and stair-climbing (OR=10.49, 95% CI 4.96-22.2, p<0.001) were the top three functional items associated with SARC-F. MBI (AUC=0.82, 95% CI 0.77-0.84) and IADL (AUC=0.78, 95% CI 0.72-0.84) showed superior discrimination for SARC-F+ compared to other measures (AUC=0.58-0.70).
CONCLUSION: Functional dependency is strongly associated with positive SARC-F screen among older adults at the ED. This highlights the need for increased vigilance, especially in the presence of dependency in relevant domains such as managing finances, feeding, and stair-climbing.
METHOD: The draft definitions were based on existing criteria, standardized, and discussed by a panel of international experts using nominal group technique over 18 months to achieve consensus. All criteria use the same format: (1) presence of infection/fever; (2) clinical features including encephalopathy; (3) neuroradiological features on magnetic resonance imaging; (4) exclusion of other causes.
RESULTS: We first highlighted differences between ITES and infectious and autoimmune encephalitis, which is the most important differential diagnosis. Consensus was achieved to define five specific ITESs: acute encephalopathy with biphasic seizures and late reduced diffusion; acute necrotizing encephalopathy; mild encephalopathy with a reversible splenial lesion; acute fulminant cerebral oedema; and acute shock with encephalopathy and multiorgan failure. Two further conditions that are currently classified as epilepsy syndromes but have similar features to ITES, namely febrile infection-related epilepsy syndrome and hemiconvulsion-hemiplegia-epilepsy syndrome, are also discussed.
INTERPRETATION: The consensus definition is expected to improve awareness of this disease concept, provide diagnostic framework, and facilitate future international research and clinical trials.
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