José Antonio Gullón Blanco

Age, comorbidity, treatment decision and prognosis in lung cancer

Fluid (ml) ‘Usual’ thickener 785 202 (701–903) 0.47 Pre-thickened 795 346 (745–1091) Protein (g) ‘Usual’ thickener 7 3 (4–7) 0.001 Pre-thickened 15 7 (10–17) Energy (kCal) ‘Usual’ thickener 267 50 (254–304) 0.0001 Pre-thickened 583 241 (543–784) Calcium (mg) ‘Usual’ thickener 25 8 (22–30) 0.0001 Pre-thickened 544 156 (467–623) Vitamin C (mg) ‘Usual’ thickener 35 48 (13–61) 0.001 Pre-thickened 170 134 (128–262) Vitamin D (μg) ‘Usual’ thickener 0 0 0.00001 Pre-thickened 5 2 (4–6)

Neumonía adquirida en la comunidad por gérmenes atípicos: tratamiento y evolución

Objetivo Estudiar la evolucion de un grupo de neumonias extrahospitalarias causadas por germenes atipicos ( Mycoplasma pneumoniae, Legionella spp., Coxiella burnetii y Chlamydophila pneumoniae ) en funcion del tratamiento empirico recibido. Pacientes y metodos Entre enero de 1996 y febrero de 2001 ingresaron en nuestra unidad 390 casos de neumonia, de los que 89 estaban causados por germenes atipicos. Los pacientes se dividieron retrospectivamente en 2 grupos segun el tratamiento empirico pautado: grupo A, al que se habia proporcionado cobertura frente a germenes atipicos (quinolonas o macrolidos), y grupo B, al que no se habia proporcionado dicha cobertura. Se estudio la evolucion segun las diferencias entre ambos grupos en la estancia hospitalaria, la resolucion radiologica, el reingreso en el primer mes tras el alta y la mortalidad. Resultados El grupo de estudio lo constituyeron 89 pacientes con neumonia causada por germenes atipicos (39 en el grupo A y 50 en el B). Las variables estudiadas no mostraron diferencias significativas entre ambos grupos. Conclusiones En nuestra serie de neumonias extrahospitalarias la cobertura antibiotica frente a germenes atipicos no mejoro la evolucion clinica y radiologica de los pacientes.

Prevalencia de enfermedad pulmonar obstructiva crónica en las Islas Canarias

INTRODUCTION The prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9-10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking. MATERIALS AND METHODS A random group of 1,353 subjects aged between 40 and 70years was selected from a sample population of 596,478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV1/FVC ratio was less than 0.70. RESULTS The prevalence of COPD was 7.3% (95%CI: 5.5-9.5) and was higher in males than in females (8.7% vs. 6.3%, P=.134). The incidence of smoking was 29.4% (95%CI: 25.4-33.1) and was also higher in males than in females (35.1% vs 25.4%, P<.001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in groupi, 69.9% in groupii, 10.4% in groupiii and 3.3% in groupiv. 71.6% of the subjects were underdiagnosed and 63.5% undertreated. CONCLUSIONS Despite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied.

Neumonía adquirida en la comunidad: adenosindesaminasa plasmática como marcador etiolÓgico

Fundamento La adenosindesaminasa (ADA) es una enzima intracitoplasmatica cuya elevacionha sido demostrada tanto en procesos infecciosos que estimulan la inmunidad celular como enotro tipo de enfermedades (diabetes y hepatopatias, entre otras). El objetivo de este estudio esdeterminar la capacidad del ADA plasmatico (ADAp) para predecir el tipo de germen causanteen la neumonia adquirida en la comunidad (NAC) y poder guiar el tratamiento antibiotico empirico. Pacientes y metodo Estudio de cohortes (245 casos y 49 controles) para contrastar las diferenciasen el valor de ADAp estudiando tanto variables microbiologicas (tipo de germen) como factoresde comorbilidad y complicaciones. Se practico una regresion logistica. Resultados Las NAC causadas por germenes atipicos elevan significativamente el valor delADAp, que se normaliza en la convalecencia. Las variables con capacidad independiente paraelevar dicho valor fueron la presencia de germen «atipico» (odds ratio [OR] = 5,9), hepatopatia(OR = 5,8), diabetes (OR = 1,9) y toma previa de antibioticos (OR = 1,7). Conclusiones La ADAp puede ser utilizada como marcador etiologico para guiar el tratamientoantibiotico empirico en la NAC, en ausencia de diabetes, hepatopatia y toma de antibioticosprevia a la determinacion.

Treatment and Course of Community-Acquired Pneumonia Caused by Atypical Pathogens

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 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. 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.

Chemotherapy and Survival in Advanced Non-Small Cell Lung Carcinoma: Is Pneumologists' Skepticism Justified?

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 log-rank 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.