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Objetivo: La acumulación de factores de riesgo en los pacientes atendidos en el hospital es uno de los elementos que condicionan el aumento de la infección nosocomial y su mayor frecuencia en las unidades de cuidados intensivos (UCI). Nuestro objetivo es la identificación de los factores de riesgo de la infección nosocomial en la UCI de nuestro hospital. Métodos: Se efectuó un estudio de cohortes prospectivo sobre los 1.134 pacientes ingresados, al menos durante 24 h en dicha UCI durante el año 2001. El seguimiento de los pacientes prosiguió 48 h tras el alta del paciente de la unidad. Los factores de riesgo se identificaron mediante un análisis multivariable de regresión de Cox. Resultados: Los factores de riesgo intrínsecos integrantes del modelo son el diagnóstico principal que motivó el ingreso del paciente en la unidad, la presencia de traumatismo craneoencefálico y la insuficiencia renal. Las técnicas invasivas que se asocian de forma independiente a la infección nosocomial son, de mayor a menor riesgo, el sondaje urinario, la traqueostomía, la ventilación mecánica, la inserción de un catéter de Swan-Ganz y la nutrición parenteral. Conclusiones: Si bien la mayor fuerza de asociación se encuentra entre los factores de riesgo endógenos, ya que son poco modificables, habrá que orientar las propuestas de mejora hacia los siguientes factores exógenos: ventilación mecánica, traqueostomía, sondaje urinario, catéter de Swan-Ganz y nutrición parenteral.Objective: The accumulation of risk factors in hospitalized patients is one of the elements contributing to the increase in the frequency of nosocomial infection in the intensive care unit (ICU). Our aim was to identify nosocomial infection risk factors in the ICU of our hospital. Methods: We performed a prospective cohort study of 1134 patients admitted to the ICU for at least 24 hours in 2001. The patients were followed-up for 48 hours after leaving the ICU. Multivariate Cox regression analysis was used to identify risk factors. Results: The intrinsic risk factors identified were the principal diagnosis motivating admission to the ICU, traumatic brain injury and renal insufficiency. Invasive techniques that were independently associated with nosocomial infection (from high to low risk) were urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheter, and total parenteral nutrition. Conclusions: Although endogenous risk factors, which cannot be modified, represented the most important associated factors, steps to reduce nosocomial infections should concentrate on the following exogenous risk factors: urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheters, and total parenteral nutrition.

Background Alopecia areata totalis ( AAT) and universalis ( AAU) pose a therapeutic challenge. Objective To describe the clinical and epidemiological features, therapeutic response and prognostic factors in a large series of patients diagnosed with AAT and AAU. Methods This retrospective multicenter study included patients diagnosed with AAT/ AAU with a minimum follow-up of 12 months. Response was assessed based on the regrowth of scalp hair. Results In all, 132 patients (92 women and 40 men) - 80 (61%) diagnosed with AAU and 52 (39%) diagnosed with AAT - were included. The median time between the presentation of alopecia areata ( AA) and the development of extensive AA was 1 year and it was less than 4 years in 121 patients (91%). There was an initial response to treatment in 64% of patients, although only 14% presented a persistent response. Adverse side effects from the medications used were detected in 33% of patients. The prognostic factors associated with poor response were the presence of AAU and a positive family history of AA. Conclusions Treatment of AAT and AAU is challenging. Although an initial regrowth may be achieved, the duration of response is usually short. There were no significant differences on the effectiveness or duration of response between the various systemic therapies. [ABSTRACT FROM AUTHOR]

Background Alopecia areata on the beard area ( BAA) is a common clinical manifestation, but there are no studies about its characteristics. Objective To describe the epidemiology, comorbidities, clinical presentation, evolution, diagnostic findings and therapeutic choices in a series of patients with BAA. Methods This retrospective multicentre review included patients diagnosed with BAA as the first and unique clinical manifestation with at least 12 months of follow-up. Diagnosis was performed based on the typical clinical features. Extra-beard involvement was monitored in all cases. Results Overall, 55 male patients with a mean age of 39.1 years (range 20-74) were included. Twenty-five patients (45.5%) developed alopecia of the scalp during follow-up and more than 80% of cases appeared in the first 12.4 months. Clinical presentation of AA on the scalp was patchy AA (less than 5 patches) (52%), multifocal AA (28%), AA totalis (12%) and AA universalis (8%). Multivariate analysis revealed a trend of association between scalp involvement and family history of AA without statistical significance. Conclusions According to this study, BAA may progress to scalp AA in a significant number of patients (45.5% of the patients with a follow-up interval of at least 12 months). In the group of patients who developed scalp AA, 80% of them did it within the first 12 months, so follow-up of patients with BAA is highly encouraged. [ABSTRACT FROM AUTHOR]