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.

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.

[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.

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.

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.