José Antonio Gullón Blanco

Hospital Universitario de Canarias, San Cristóbal de La Laguna, Canary Islands, Spain

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Publications (16)14.83 Total impact

  • Age and Ageing 12/2008; 37(6):715-8. · 3.82 Impact Factor
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    ABSTRACT: The aim of this study is to describe the changes in the aetiology of hospitalised patients with community-acquired pneumonia (CAP) during an 11-year observational period in a limited geographic area. Eight hundred and one (801) adult patients with CAP hospitalised were included. The patients were divided into three groups according to the time of presentation. Comprehensive microbiological laboratory tests were performed and differences in aetiology were analysed. In 228 patients (31%), a pathogen was detected, with Coxiella burnetii being the most common (20.1%). Significant variations in the prevalence of Chlamydophila pneumoniae were found between groups but not in other pathogens. In conclusion, long-term epidemiological studies may contribute to the knowledge of actual CAP aetiology.
    European Journal of Clinical Microbiology 08/2007; 26(7):495-9. · 3.02 Impact Factor
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    ABSTRACT: To analyze if cigarette smoking delays the sputum smear conversion in pulmonary tuberculosis. Ninety eight patients were diagnosed with pulmonary tuberculosis. Patients were all not immunosuppressed, infected by human immunodeficiecy virus (HIV) or drug resistant. Sixty four of them were smokers with a pack-year index (standard deviation) of 33.69 (23.12). Delayed sputum smear conversion (DC) was considered when 2 positive sputum culture results were obtained in the second month of anti-tuberculous treatment and was associated with the following variables in 2 groups: a) total group (in which all the patients were included): age, sex, smoking habits, risk factors (alcohol consumption, diabetes mellitus, immunosuppression, drug addicion, malnutrition), time with symptoms, radiologic presentation and bacterial load, and b) smokers: age, sex, risk factors, time with symptoms, radiologic presentation, bacterial load and pack-year index. For the statistical analysis, chi2 test, Student t test and logistic regression model were used, considering the dependant variable DC. In the total group, 17 patients (17.3%) had DC, 16 of them had a history of smoking and in the univariate analysis it was associated with: alcohol consumption, time with symptoms, radiologic presentation as bilateral cavitary infiltrates and smoking habits. The logistic regression analysis showed an association with smoking habits (odds ratio = 9.8; p = 0.03) and bilateral cavitary infiltrates (odds ratio = 3.61; p = 0.02). In the group of smokers, DC was associated in the univariate analysis with the female sex. Smoking habits delay sputum conversion in patients with pulmonary tuberculosis not associated with HIV and non-resistant bacilli. According to these results it is necessary to assist smoking cessation in patients who are receiving antituberculous treatment.
    Medicina Clínica 05/2007; 128(15):565-8. · 1.25 Impact Factor
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    ABSTRACT: Background and objective To analyze if cigarette smoking delays the sputum smear conversion in pulmonary tuberculosis. Patients and method Ninety eight patients were diagnosed with pulmonary tuberculosis. Patients were all not immunosuppressed, infected by human immunodeficiecy virus (HIV) or drug resistant. Sixty four of them were smokers with a pack-year index (standard deviation) of 33.69 (23.12). Delayed sputum smear conversion (DC) was considered when 2 positive sputum culture results were obtained in the second month of anti-tuberculous treatment and was associated with the following variables in 2 groups: a) total group (in which all the patients were included): age, sex, smoking habits, risk factors (alcohol consumption, diabetes mellitus, immuno-suppression, drug addicion, malnutrition), time with symptoms, radiologic presentation and bacterial load, and b) smokers: age, sex, risk factors, time with symptoms, radiologic presentation, bacterial load and pack-year index. For the statistical analysis, χ2 test, Student t test and logistic regression model were used, considering the dependant variable DC. Results In the total group, 17 patients (17.3%) had DC, 16 of them had a history of smoking and in the univariate analysis it was associated with: alcohol consumption, time with symptoms, radiologic presentation as bilateral cavitary infiltrates and smoking habits. The logistic regression analysis showed an association with smoking habits (odds ratio = 9.8; p = 0.03) and bilateral cavitary infiltrates (odds ratio = 3.61; p = 0.02). In the group of smokers, DC was associated in the univariate analysis with the female sex. Conclusions Smoking habits delay sputum conversion in patients with pulmonary tuberculosis not associated with HIV and non-resistant bacilli. According to these results it is necessary to assist smoking cessation in patients who are receiving antituberculous treatment.
    Medicina Clinica - MED CLIN. 01/2007; 128(15):565-568.
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    ABSTRACT: To study the course of disease and outcomes in a group of patients with community-acquired pneumonia caused by atypical pathogens (Mycoplasma pneumoniae, Legionella species ,Coxiella burnetii, and Chlamydophila pneumoniae) according to the empiric treatment received. Of a total of 390 patients admitted to our hospital with pneumonia between January 1996 and February 2001, the causative microorganism was an atypical pathogen in 89 cases. Patients were divided retrospectively into 2 groups according to the empiric treatment they received: group A, who had received an antibiotic regime (quinolones or macrolides) that provided coverage for atypical pathogens; and group B, who had received treatment that did not provide such coverage. Clinical course was assessed in terms of the differences between the 2 groups in length of hospital stay, radiographic resolution, readmission at 30 days after discharge, and mortality. A total of 89 patients with pneumonia caused by atypical pathogens (39 in group A and 50 in group B) were studied. No significant between-group differences in the variables were found. In this group of patients hospitalized for community-acquired pneumonia, antibiotic regimens providing coverage for atypical pathogens did not improve either clinical or radiographic evolution.
    Archivos de Bronconeumología 10/2006; 42(9):430-3. · 1.37 Impact Factor
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    ABSTRACT: Few studies have assessed whether the advantage chemotherapy has been shown to have in treating advanced non-small lung carcinoma in clinical trials is transferrable to normal health care activity. This could explain the skepticism of a large number of pneumologists towards this treatment. The objective of our study was to analyze prognostic factors related to survival and to see whether cytostatic treatment was an independent predictor. Patients enrolled in the study had been diagnosed with non-small cell carcinoma in stages IV or IIIB with pleural or N2-N3 involvement and with a performance status of 2 or below according to the Eastern Cooperative Oncology Group (ECOG). Survival was analyzed with regard to the following variables: age, sex, comorbidity, weight loss, laboratory test results, histological type, ECOG score, TNM staging, and treatment. The Student t test, the chi(2) test, the Kaplan-Meier method, the log-rank test, and Cox regression analysis were used in the statistical analysis. We enrolled 190 patients (157 men and 33 women) with a mean (SD) age of 61.75 (10.85) years (range, 33-85 years). Of these patients, 144 received cytostatic treatment and 46 palliative treatment. The median survival was 31 weeks and was related to absence of weight loss (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.26-2.39; P=.001), cytostatic treatment (HR, 1.85; 95% CI, 1.25-2.76; P=.002), and ECOG score of 0 to 1 (HR, 2.84; 95% CI, 1.62-5.00; P=.0001). In patients with ECOG scores of 0 to 1, weight loss and treatment were significant prognostic factors. Survival in the ECOG 2 group was 15 weeks for patients undergoing cytostatic treatment and 11 weeks for patients with symptomatic treatment. In normal clinical practice, chemotherapy significantly prolongs survival in patients with performance status of less than 2, more time being gained if there is no associated weight loss. We conclude that the reluctance shown by many pneumologists toward using this treatment is not entirely justified.
    Archivos de Bronconeumología 07/2006; 42(6):273-7. · 1.37 Impact Factor
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    ABSTRACT: Objective Few studies have assessed whether the advantage chemotherapy has been shown to have in treating advanced non-small lung carcinoma in clinical trials is transferrable to normal health care activity. This could explain the skepticism of a large number of pneumologists towards this treatment. The objective of our study was to analyze prognostic factors related to survival and to see whether cytostatic treatment was an independent predictor. Patients and methods Patients enrolled in the study had been diagnosed with non-small cell carcinoma in stages IV or IIIB with pleural or N2-N3 involvement and with a performance status of 2 or below according to the Eastern Cooperative Oncology Group (ECOG). Survival was analyzed with regard to the following variables: age, sex, comorbidity, weight loss, laboratory test results, histological type, ECOG score, TNM staging, and treatment. The Student t test, the χ2 test, the Kaplan-Meier method, the logrank test, and Cox regression analysis were used in the statistical analysis. Results We enrolled 190 patients (157 men and 33 women) with a mean (SD) age of 61.75 (10.85) years (range, 33-85 years). Of these patients, 144 received cytostatic treatment and 46 palliative treatment. The median survival was 31 weeks and was related to absence of weight loss (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.26-2.39; P=001), cytostatic treatment (HR, 1.85; 95% CI, 1.25-2.76; P=002), and ECOG score of 0 to 1 (HR, 2.84; 95% CI, 1.62-5.00; P=.0001). In patients with ECOG scores of 0 to 1, weight loss and treatment were significant prognostic factors. Survival in the ECOG 2 group was 15 weeks for patients undergoing cytostatic treatment and 11 weeks for patients with symptomatic treatment. Conclusions In normal clinical practice, chemotherapy significantly prolongs survival in patients with performance status of less than 2, more time being gained if there is no associated weight loss. We conclude that the reluctance shown by many pneumologists toward using this treatment is not entirely justified.
    Archivos de Bronconeumología. 06/2006; 42(6):273–277.
  • José Antonio Gullón Blanco
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    ABSTRACT: Objetivo: Pocas series han valorado si el beneficio que en los ensayos clínicos muestra la quimioterapia en el carcinoma broncogénico no microcítico en estadios avanzados es trasladable a la actividad asistencial habitual, lo que podría explicar el escepticismo de gran parte de los neumólogos. En este contexto, el objetivo de nuestro trabajo es analizar factores pronósticos relacionados con la supervivencia y si el tratamiento citostático influye de manera independiente. Pacientes y métodos: Se incluyó a pacientes diagnosticados de carcinoma no microcítico en estadios IV y IIIb con afectación pleural o N2-N3 y grado de actividad, según el Eastern Cooperative Oncology Group (ECOG), menor o igual a 2. Se relacionaron con la supervivencia las siguientes variables: edad, sexo, comorbilidad, pérdida de peso, parámetros analíticos, tipo histológico, ECOG, TNM y tratamiento. Para el análisis estadístico se emplearon las pruebas de la t de Student, de la ?², el método de Kaplan-Meier, el test de rangos logarítmicos y el modelo de regresión de Cox. Resultados: Se incluyó en el estudio a 190 enfermos (157 varones y 33 mujeres), con una edad media (± desviación estándar) de 61,75 ± 10,85 años (rango: 33-85), de los cuales 144 recibieron tratamiento citostático y 46 paliativo. La mediana de supervivencia fue de 31 semanas y se relacionó con: ausencia de pérdida de peso (razón de probabilidad [HR] = 1,73; intervalo de confianza [IC] del 95%, 1,26-2,39; p = 0,001), tratamiento citostático (HR = 1,85; IC del 95%, 1,25-2,76; p = 0,002) y ECOG 0-1 (HR = 2,84; IC del 95%, 1,62-5,00; p = 0,0001). En el grupo ECOG 0-1 mostraban significado pronóstico la pérdida de peso y el tratamiento. La supervivencia en ECOG 2 fue de 15 semanas en los pacientes con tratamiento citostático y de 11 semanas en aquellos con tratamiento sintomático. Conclusiones: En la práctica clínica habitual la quimioterapia prolonga la supervivencia significativamente en los pacientes con grado de actividad inferior a 2 y esta ganancia es mayor si no existe pérdida de peso asociada. Por tanto, creemos que la opinión poco favorable que muestra gran parte de los neumólogos acerca de este tratamiento no parece plenamente justificada.
    Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax (ALAT), ISSN 0300-2896, Vol. 42, Nº. 6, 2006, pags. 273-277. 01/2006;
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    ABSTRACT: Objective To study the course of disease and outcomes in a group of patients with community-acquired pneumonia caused by atypical pathogens (Mycoplasma pneumoniae, Legionella species, Coxiella burnetii, and Chlamydophila pneumoniae) according to the empiric treatment received. Patients and methods Of a total of 390 patients admitted to our hospital with pneumonia between January 1996 and February 2001, the causative microorganism was an atypical pathogen in 89 cases. Patients were divided retrospectively into 2 groups according to the empiric treatment they received: group A, who had received an antibiotic regime (quinolones or macrolides) that provided coverage for atypical pathogens; and group B, who had received treatment that did not provide such coverage. Clinical course was assessed in terms of the differences between the 2 groups in length of hospital stay, radiographic resolution, readmission at 30 days after discharge, and mortality. Results A total of 89 patients with pneumonia caused by atypical pathogens (39 in group A and 50 in group B) were studied. No significant between-group differences in the variables were found. Conclusions In this group of patients hospitalized for community-acquired pneumonia, antibiotic regimens providing coverage for atypical pathogens did not improve either clinical or radiographic evolution.
    Archivos De Bronconeumologia - ARCH BRONCONEUMOL. 01/2006; 42(9).
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    ABSTRACT: ObjectiveTo study the course of disease and outcomes in a group of patients with community-acquired pneumonia caused by atypical pathogens (Mycoplasma pneumoniae, Legionella species, Coxiella burnetii, and Chlamydophila pneumoniae) according to the empiric treatment received.Patients and methodsOf a total of 390 patients admitted to our hospital with pneumonia between January 1996 and February 2001, the causative microorganism was an atypical pathogen in 89 cases. Patients were divided retrospectively into 2 groups according to the empiric treatment they received: group A, who had received an antibiotic regimen (quinolones or macrolides) that provided coverage for atypical pathogens; and group B, who had received treatment that did not provide such coverage. Clinical course was assessed in terms of the differences between the 2 groups in length of hospital stay, radiographic resolution, readmission at 30 days after discharge, and mortality.ResultsA total of 89 patients with pneumonia caused by atypical pathogens (39 in group A and 50 in group B) were studied. No significant between-group differences in the variables were found.ConclusionsIn this group of patients hospitalized for community-acquired pneumonia, antibiotic regimens providing coverage for atypical pathogens did not improve either clinical or radiographic evolution.ObjetivoEstudiar la evolución de un grupo de neumonías extrahospitalarias causadas por gérmenes atípicos (Mycoplasma pneumoniae, Legionella spp., Coxiella burnetii y Chlamydophila pneumoniae) en función del tratamiento empírico recibido.Pacientes y métodosEntre enero de 1996 y febrero de 2001 ingresaron en nuestra unidad 390 casos de neumonía, de los que 89 estaban causados por gérmenes atípicos. Los pacientes se dividieron retrospectivamente en 2 grupos según el tratamiento empírico pautado: grupo A, al que se había proporcionado cobertura frente a gérmenes atípicos (quinolonas o macrólidos), y grupo B, al que no se había proporcionado dicha cobertura. Se estudió la evolución según las diferencias entre ambos grupos en la estancia hospitalaria, la resolución radiológica, el reingreso en el primer mes tras el alta y la mortalidad.ResultadosEl grupo de estudio lo constituyeron 89 pacientes con neumonía causada por gérmenes atípicos (39 en el grupo A y 50 en el B). Las variables estudiadas no mostraron diferencias significativas entre ambos grupos.ConclusionesEn nuestra serie de neumonías extrahospitalarias la cobertura antibiótica frente a gérmenes atípicos no mejoró la evolución clínica y radiológica de los pacientes.
    Archivos de Bronconeumología ((English Edition)). 01/2006;
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    ABSTRACT: Adenosine deaminase (ADA) is a cytoplasmic enzyme which activity is increased in disorders that stimulate cells involved in the immune system. In community-acquired pneumonia (CAP), increased levels of serum ADA have been associated with the presence of atypical microorganisms as the source of the former. Previous studies have shown ADA increases in non-infectious diseases. We evaluated the factors that may influence plasmatic ADA (ADAp) levels in CAP patients. A study with cases (245 episodes of CAP) and controls (49) was designed, and the differences in ADAp activity with regard to organisms, comorbidity factors and complications were analyzed. A logistic regression analysis was performed. CAP caused by atypical microorganisms were found to have increased ADAp values. Variables that independently increased ADAp levels were: atypical etiology (OR = 5.9), liver disease (OR = 5.8), diabetes mellitus (OR = 1.9), and prior antibiotic consumption (OR = 1.7). ADAp is an etiologic marker that could be useful in the empiric approach of the treatment of CAP.
    Medicina Clínica 11/2002; 119(13):481-4. · 1.25 Impact Factor
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    ABSTRACT: Intravenous antibiotic therapy (IVAT) is usually prescribed for patients hospitalized with community-acquired pneumonia (CAP). Studies have associated prolonged IVAT with longer hospital stays and higher costs. The aim of this study was to determine the factors that influence the expense generated by and mean stay of patients hospitalized for pneumonia, with special attention to the influence of IVAT duration. One hundred twenty-five CAP patients admitted to the respiratory medicine wards of our hospital were randomly assigned to five different staff physicians. IVAT was prescribed following the norms of the Spanish Society of Respiratory Medicine and Chest Surgery (SEPAR). IVAT was withdrawn when the attending physician considered it appropriate. We collected epidemiological, comorbidity, clinical and analytical data. Complications were recorded and severity of CAP was classified using the model proposed by Fine. Follow-up care was given at an outpatient clinic until symptoms disappeared and chest films resolved. Multivariate analysis determined the factors predicting mean hospital stay and high cost. Costs were calculated based on data issued by the billing department. The mean cost of care was 307,274 pesetas, mean duration of IVAT was 5.8 days and mean hospital stay was 9.4 days. Multivariate analysis showed that cost was related to mean hospital stay and IVAT. Mean hospital stay was associated with IVAT, the presence of respiratory insufficiency and the day of the week when admission took place (with weekend admission leading to longer stays). The duration of IVAT in CAP influences mean hospital stay and cost, without adding any evident therapeutic benefit (in the group of patients selected). Recommendations for diagnosing and treating CAP may be advisable.
    Archivos de Bronconeumología 11/2001; 37(9):366-70. · 1.37 Impact Factor
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    ABSTRACT: Pulmonary toxicity caused by carbamazepine seems to be a non dose-dependent process involving pulmonary infiltrates, eosinofilia and skin rash. We report a case with acute presentation that resolved successfully after the drug was withdrawn and the patient was treated with corticosteroids. Bronchoalveolar lavage showed an inversion of the lymphocyte ratio CD4/CD8 supporting the suggestion by other authors that drug-induced pulmonary toxicity.
    Archivos de Bronconeumología 12/1994; 30(9):471-2. · 1.37 Impact Factor
  • R. Fernández Álvarez, J.A. Gullón Blanco
    Medicine - Programa de Formación Médica Continuada Acreditado 8(78):4182–4187.
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    ABSTRACT: Background Adenosine deaminase (ADA) is a cytoplasmic enzyme which activity is increasedin disorders that stimulate cells involved in the immune system. In community-acquired pneumonia(CAP), increased levels of serum ADA have been associated with the presence of «atypical» microorganisms as the source of the former. Previous studies have shown ADA increases innon-infectious diseases. We evaluated the factors that may influence plasmatic ADA (ADAp) levelsin CAP patients. Patients and methods A study with cases (245 episodes of CAP) and controls (49) was designed,and the differences in ADAp activity with regard to organisms, comorbidity factors andcomplications were analyzed. A logistic regression analysis was performed. Results CAP caused by «atypical» microorganisms were found to have increased ADAp values.Variables that independently increased ADAp levels were: «atypical» etiology (OR = 5.9), liverdisease (OR = 5.8), diabetes mellitus (OR = 1.9), and prior antibiotic consumption (OR = 1.7). Conclusions ADAp is an etiologic marker that could be useful in the empiric approach of thetreatment of CAP.
    Medicina Clínica. 119(13):481–484.
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    ABSTRACT: Intravenous antibiotic therapy (IVAT) is usually prescribed for patients hospitalized with community-acquired pneumonia (CAP). Studies have associated prolonged IVAT with longer hospital stays and higher costs. The aim of this study was to determine the factors that influence the expense generated by and mean stay of patients hospitalized for pneumonia, with special attention to the influence of IVAT duration Material and methods One hundred twenty-five CAP patients admitted to the respiratory medicine wards of our hospital were randomly assigned to five different staff physicians. IVAT was prescribed following the norms of the Spanish Society of Respiratory Medicine and Chest Surgery (SEPAR). IVAT was withdrawn when the attending physician considered it appropriate We collected epidemiological, comorbidity, clinical and analytical data. Complications were recorded and severity of CAP was classified using the model proposed by Fine. Follow- up care was given at an outpatient clinic until symptoms disappeared and chest films resolved. Multivariate analysis determined the factors predicting mean hospital stay and high cost. Costs were calculated based on data issued by the billing department Results The mean cost of care was 307,274 pesetas, mean duration of IVAT was 5.8 days and mean hospital stay was 9.4 days. Multivariate analysis showed that cost was related to mean hospital stay and IVAT. Mean hospital stay was associated with IVAT, the presence of respiratory insufficiency and the day of the week when admission took place (with weekend admission leading to longer stays) Conclusions The duration of IVAT in CAP influences mean hospital stay and cost, without adding any evident therapeutic benefit (in the group of patients selected). Recommendations for diagnosing and treating CAP may be advisable
    Archivos de Bronconeumología. 37(9):366–370.