Assessing Neutrophil-to-Lymphocyte Ratio as a Nutritional Indicator in Community-Dwelling Older Adults.

BACKGROUND: In an aging population, there is an increasing need for easily accessible nutritional markers. AIMS: To determine whether the neutrophil-to-lymphocyte ratio (NLR) can serve as an effective nutritional indicator compared to the Mini-Nutritional Assessment Short Form (MNA-SF) or other common markers such as albumin and body mass index (BMI). METHODS: Data were obtained from the SABE study in Ecuador, which included participants aged 60 years or older. This cross-sectional study collected comprehensive data, including demographics, health-related factors, and physical assessments. Neutrophil and lymphocyte counts were measured by complete blood count. Nutritional status was assessed by MNA-SF, and BMI was calculated. Several physical tests were performed to evaluate the participants' functional status. Confounding variables such as age, sex, and comorbidities were considered. RESULTS: The final sample consisted of 1790 subjects (48.9% male). The overall median age was 68 years (IQR 64,76). BMI and lymphocytes were higher in females, while NLR was higher in males. MNA-SF showed a negative association with NLR. Similarly, lymphocyte count shows a positive association with MNA-SF. Physical tests, such as the Romberg test and the Five Times Sit-to-Stand test, also showed correlations with NLR and lymphocyte count, respectively. CONCLUSION: The study results suggest a significant relationship between NLR and lymphocytes, and nutritional status. The correlation with albumin is stronger with NLR than with BMI. The simplicity and affordability of NLR may make it suitable for routine use in several medical fields, improving our understanding of the complex relationship between nutrition, inflammation, and overall health.

Neutrophil-to-lymphocyte ratio and lymphocyte count as an alternative to body mass index for screening malnutrition in older adults living in the community.

PURPOSE: Accurate height and weight measurement can be challenging in older adults and complicates nutritional status assessment. Other parameters like the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte count (LC) could be an option to these measurements. We aimed to test these variables as subrogates of body mass index (BMI) or calf-circumference (CC) for malnutrition screening in community-dwelling older adults. METHODS: This is a secondary analysis from the Salud, Bienestar y Envejecimiento (SABE) survey from Ecuador (2009). Includes data on demographics, health-related factors, physical assessments, and complete blood count, allowing to calculate NLR and LC to be used as part of the Mini Nutritional Assessment (MNA), instead of the BMI. Consequently, 4 models were included: standard MNA, MNA-CC, MNA-NLR and MNA-LC. Finally, age, sex, and comorbidities were considered as confounding variables. RESULTS: In our analysis of 1,663 subjects, 50.81% were women. Positive correlations with standard MNA were found for MNA-NLR (Estimate = 0.654, p < 0.001) MNA-CC (Estimate = 0.875, p value < 0.001) and MNA-LC (Estimate = 0.679, p < 0.001). Bland-Altman plots showed the smallest bias in MNA-CC. Linear association models revealed varying associations between MNA variants and different parameters, being MNA-NLR strongly associated with all of them (e.g. Estimate = 0.014, p = 0.001 for albumin), except BMI. CONCLUSION: The newly proposed model classified a greater number of subjects at risk of malnutrition and fewer with normal nutrition compared to the standard MNA. Additionally, it demonstrated a strong correlation and concordance with the standard MNA. This suggests that hematological parameters may offer an accurate alternative and important insights into malnutrition.

[Results of a home rehabilitation program after hospitalization in patients with hip fracture]. / Resultados de un programa de rehabilitación domiciliaria tras hospitalización en pacientes con fractura de cadera.

INTRODUCTION: Hip fracture is one of the most frequent disabling injuries, presenting serious complications during the acute and subacute phase. Rehabilitation at home, after hospital discharge, allows rapid functional recovery. The objective of this study is to evaluate the possible usefulness of a home rehabilitation program in patients with hip fracture integrated in a Hospital at Home Unit. METHODS: Retrospective study that consecutively included patients accepted for home rehabilitation treatment between September 9, 2019 and December 31, 2021 in the Hospital at Home Unit of the Hospital Universitario de la Ribera, Alzira, Valencia. Demographic, clinical, functional and quality of care variables were collected. RESULTS: Two hundred twenty-four subjects were included. The mean age was 84.6 (SD 7.7) years, with 66% women and 34% men, with 32% of patients diagnosed with dementia in one of its degrees of severity. The mean hospital stay was 8.4 (SD 4.1) days and 6.5 (5.3) days in the Hospital at Home Unit rehabilitation program. 90% of the patients included in the program reached the therapeutic goal outlined during hospital admission. CONCLUSIONS: The home rehabilitation of patients with hip fracture contributes to a functional recovery of the patient in a shorter time. Further studies are necessary to confirm the results obtained.

Resultados de un programa de rehabilitación domiciliaria tras hospitalización en pacientes con fractura de cadera / Results of a home rehabilitation program after hospitalization in patients with hip fracture

Introducción: La fractura de cadera es una de las lesiones incapacitantes más frecuentes, presentando complicaciones graves durante la fase aguda y subaguda. La rehabilitación en el domicilio, tras el alta hospitalaria, permite una rápida recuperación funcional. El objetivo de este estudio es evaluar la posible utilidad de un programa domiciliario de rehabilitación en pacientes con fractura de cadera integrado en la una unidad de hospitalización a domicilio. Métodos: Estudio retrospectivo que incluyó consecutivamente a los pacientes aceptados para tratamiento rehabilitador domiciliario entre el 9 de septiembre del 2019 y el 31 de diciembre del 2021en la Unidad de hospitalización a domicilio del Hospital Universitario de la Ribera, Alzira, Valencia. Se recogieron variables demográficas, clínicas, funcionales y de calidad asistencial. Resultados: Se incluyeron 224 sujetos. La edad media fue de 84,6 (DT 7,7) años, con un 66% de mujeres, estando un 32% de pacientes diagnosticados de demencia en alguno de sus grados de severidad. La estancia media en el hospital fue de 8,4 (DT 4,1) días y de 6,5 (5,3) días en el programa rehabilitador de la unidad de hospitalización a domicilio. El 90% de los pacientes incluidos en el programa alcanzaron el objetivo terapéutico trazado durante el ingreso hospitalario. Conclusiones: La rehabilitación domiciliaria de pacientes con fractura de cadera contribuye a una recuperación funcional del paciente en un menor tiempo. Son necesarios más estudios para confirmar los resultados obtenidos. (AU)

Introduction: Hip fracture is one of the most frequent disabling injuries, presenting serious complications during the acute and subacute phase. Rehabilitation at home, after hospital discharge, allows rapid functional recovery. The objective of this study is to evaluate the possible usefulness of a home rehabilitation program in patients with hip fracture integrated in a Hospital at Home Unit. Methods: Retrospective study that consecutively included patients accepted for home rehabilitation treatment between September 9, 2019 and December 31, 2021 in the Hospital at Home Unit of the Hospital Universitario de la Ribera, Alzira, Valencia. Demographic, clinical, functional and quality of care variables were collected. Results: Two hundred twenty-four subjects were included. The mean age was 84.6 (SD 7.7) years, with 66% women and 34% men, with 32% of patients diagnosed with dementia in one of its degrees of severity. The mean hospital stay was 8.4 (SD 4.1) days and 6.5 (5.3) days in the Hospital at Home Unit rehabilitation program. 90% of the patients included in the program reached the therapeutic goal outlined during hospital admission. Conclusions: The home rehabilitation of patients with hip fracture contributes to a functional recovery of the patient in a shorter time. Further studies are necessary to confirm the results obtained. (AU)

Utilidad de los relojes inteligentes en las unidades de hospitalización a domicilio / Usefulness of smartwatches in hospital at home units

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Frecuentación y síntomas de presentación en urgencias de pacientes paliativos en el departamento de salud de La Ribera / Frequentation and presentation symptoms at the emergency room for palliative care patients of "Departamento de salud de La Ribera"

OBJETIVO: Conocer la frecuencia con la que los pacientes paliativos solicitan atención urgente en el departamento de salud de La Ribera, así como los síntomas más frecuentes que requieren dicha atención. MÉTODOS: Se realizó un estudio longitudinal prospectivo en el que se incluyeron pacientes adultos que acudieron a urgencias tanto hospitalarias como de atención primaria del departamento de salud de La Ribera en los primeros 9 meses de 2017. RESULTADOS: Se atendieron 693 episodios; 209 se resolvieron desde atención primaria y 484 fueron atendidos en el hospital. Los síntomas más frecuentes fueron la disnea, el dolor y la fiebre. Los síntomas variaron significativamente en frecuencia cuando se analizaron en subgrupos según fueran o no pacientes oncológicos. DISCUSIÓN: Aunque la mayoría de los resultados obtenidos concuerdan con los publicados en la literatura, observamos algunas diferencias propias de nuestro departamento de salud. Además encontramos diferencias significativas en los síntomas de presentación en función de si se trata de pacientes oncológicos o no

OBJECTIVE: A prospective longitudinal study to know the frequency of urgent care for palliative care patients in Departamento de Salud de La Ribera, as well as the most frequent symptoms that required attention. METHODS: Inclusion of adult patients who visited the emergency room of hospitals and primary care centers belonging to Departamento de Salud de La Ribera during the first 9 months of 2017. RESULTS: A total of 693 events were attended; 209 were resolved within the primary care setting, and 484 were treated in hospital. Most frequent symptoms included dyspnea, pain, and fever. Symptoms vary significantly in frequency when they are analyzed in subgroups according to whether they were oncological or not. DISCUSSION: Although most of the results obtained are consistent with those previously published, we observed some differences that are specific to our health area. We also found significant differences in presentation symptoms according to whether patients were on palliative care or otherwise

Little things make big things happen: angiolymphatic invasion and tumor necrosis prognosticate the outcome of locally advanced non-small cell lung cancer treated with a prior induction therapy.

OBJECTIVES: Size, invasion of thoracic structures, and ipsilateral mediastinal lymph node involvement (pN2) are well-known prognostic factors that configure the staging of resectable, locally advanced non-small cell lung cancer (LA-NSCLC). The prognostic impact of angiolymphatic invasion (ALI) and tumor necrosis (TN) has been barely explored in LA-NSCLC treated with prior induction therapies. METHODS: We retrospectively reviewed 47 resected LA-NSCLCs treated with a prior platin-based chemotherapy or chemoradiation. The impact of ALI, TN, and other pathologic features on survival was analyzed. RESULTS: ALI was presented in 23.4% of cases and TN in 29.8%. Disease-free and overall survival decreased when ALI, TN, or pN2 was present. The incidence of ALI was lower in LA-NSCLC with a good response to induction. CONCLUSION: Our series is the first to report the prognostic impact of ALI and TN in induction-treated LA-NSCLC. The presence of ALI and TN should be included in the pathologic reports.

Age does not worsen the efficacy nor tolerance to combined induction therapies in locally advanced non-small cell lung cancer.

BACKGROUND: One third of non-small cell lung cancer (NSCLC) affects elderly patients in a locally advanced (LA) stage. Induction therapy followed by a curative approach is becoming the standard-of-care for LA-NSCLC. PATIENTS AND METHODS: We compared the efficacy and tolerance to induction chemotherapy or chemo-radiation followed by surgery or definitive radiotherapy in patients younger (N=64) and older (N=44) than 70 years with LA-NSCLC. RESULTS: Elderly patients trended towards having a worse baseline performance status, and presented a higher percentage of IIIB, and squamous tumors. Nevertheless, no significant differences in response rate, operability, or disease-free and overall survival were found between age groups in the whole series, nor in the sub-group of resected patients. Grade 3-4 toxicity tended to be lower in elderly patients. CONCLUSION: Age by itself did not significantly worsen either the efficacy or tolerance to combined induction and definitive treatment in patients with LA-NSCLC and Eastern Cooperative Oncology Group performance status 0-2.

Erupción cutánea en una paciente con neoplasia y neutropenia febril / A skin rash in a febrile neutropenic cancer patient

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Síndrome de artritis por antitiroideos / Syndrome of arthritis by antithyroid drugs

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Mil trasplantes renales en el CMN Siglo XXI (1963-1998): primera experiencia en México / One thousand kidney trasplants at National Medical Center \"Siglo XXI\" (1963-1998). First experience in Mexico

Se describe la experiencia del primer centro de trasplante renal en alcanzar mil trasplantes renales, efectuados en el período 1963 a 1998. Se destaca que el Centro Médico Nacional Siglo XXI efectuó el primer trasplante renal en México en octubre de 1963, siendo el segundo país de Latinoamérica, después de Argentina, quien lo efectuó en 1957. Los primeros 18 trasplantes se efectuaron entre 1963 y 1968, en los que 14 procedieron de donador cadáver (DC). Entre 1975 y 1985 se efectuaron 320 trasplantes, con gran actividad de trasplantes, sólo en 1975 se efectuaron 50 trasplantes de los que 18 procedieron de DC. A partir de 1992 el grupo de trasplante renal actual efectuó 509 trasplantes hasta 1998y acumuló la más grande experiencia de trasplantes renales en México.