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El ensayo que se muestra a continuación trata de un tema muy general como lo es la didáctica en la Educación Superior. Su objetivo fundamental está dirigido a analizar sus principios didácticos y algunos elementos del proceso enseñanza aprendizaje de la universidad con los nuevos paradigmas que se están imponiendo a nivel global, los cuales a su vez descansan en varias fuentes de teóricos notables que han ido evolucionando según lo hace la sociedad. El método, descansó en la revisión y análisis de diferentes fuentes teóricas de carácter documental y su relación con el tema, que a la vez aparecen en las referencias. En el mismo no se han trazado esquemas rígidos ni se brindan fórmulas al tratar con elementos específicamente cualitativos, sin embargo, se ofrecen algunas sugerencias que de forma directa enlazan a la llamada Sociedad del Conocimiento con los cambios didácticos necesarios que requieren de vías activas para que el alumno se convierta en actor y creador de su propio conocimiento. En ese sentido se ha hecho hincapié en las nuevas herramientas tecnológicas que han surgido precisamente del desarrollo del propio conocimiento, analizando con brevedad los pros y los contras de esa utilización; dando por sentado que significan un paso de avance notable siempre y cuando se profundice en su esencia y se apliquen adecuadamente. Aunque el trabajo está dirigido a la realidad peruana, no es menos cierto que también compromete a otros países del área donde los cambios didácticos resultan un denominador común de acuerdo con la evolución social actual.

Objective: To determine whether hand grip strength (HGS) is a prognostic factor for mortality in a palliative care unit (PCU), using two variables: A1: The HP on admission; A2: The progression of the HGS in the first 12days of admission., Material and Methods: A prospective, observational and comparative study of patients with advanced cancer admitted consecutively over a 4 month period into a PCU. A series of 4 determinations of HGS were made using a JAMAR(®) 5030J1 dynamometer. A total of 78 patients fulfilled the inclusion criteria, of which 61 (78.2%) agreed to take part., Results: Objective A1: Of the 61 enrolled patients, the survivors (n=25) differed by -1.8 (Standard Deviation (SD) 0.8) from the reference values for age and gender, and for those that died (n=36) it was -1.9 (1.1) (P=.6). A survival analysis was performed with this sample. The sample was subdivided into those who were > -2 SD (n=34) and those < -2 SD (n=27) (P=.3). Those patients who managed 4 determinations (n=49) were included in objective A2. At discharge there were 26 deaths and 23 alive. There were no statistically significant differences between the determinations. Only the comparison between the difference between the 4th and 1st determination in the two groups showed a significant result (P=.01)., Conclusions: The HGS measured at admission, as well as in the first 12days, was not a prognostic factor for mortality in the sample studied., (Copyright © 2010 SEGG. Published by Elsevier Espana. All rights reserved.)

A diagnostic protocol was started to study the etiology of pulmonary infiltrates in immunosuppressed patients. The diagnostic yields of the different techniques were analyzed, with special emphasis on the importance of the sample quality and the role of rapid techniques in the diagnostic strategy. In total, 241 patients with newly developed pulmonary infiltrates within a period of 19 months were included. Noninvasive or invasive evaluation was performed according to the characteristics of the infiltrates. Diagnosis was achieved in 202 patients (84%); 173 patients (72%) had pneumonia, and specific etiologic agents were found in 114 (66%). Bronchoaspirate and bronchoalveolar lavage showed the highest yields, either on global analysis (23 of 35 specimens [66%] and 70 of 134 specimens [52%], respectively) or on analysis of each type of pneumonia. A tendency toward better results with optimal-quality samples was observed, and a statistically significant difference was found in sputum bacterial culture. Rapid diagnostic tests yielded results in 71 of 114 (62.2%) diagnoses of etiological pneumonia.

Objective: To study the incidence, etiology, and outcome of pulmonary infiltrates (PIs) in HIV-infected patients and to evaluate the yield of diagnostic procedures., Design: Prospective observational study of consecutive hospital admissions., Setting: Tertiary hospital., Patients: HIV-infected patients with new-onset radiologic PIs from April 1998 to March 1999., Methods: The study protocol included chest radiography, blood and sputum cultures, serologic testing for "atypical" causes of pneumonia, testing for Legionella urinary antigen, testing for cytomegalovirus antigenemia, and bronchoscopy in case of diffuse or progressive PIs., Results: One hundred two episodes in 92 patients were recorded. The incidence of PIs was 18 episodes per 100 hospital admission-years (95% confidence interval [CI]: 15-21). An etiologic diagnosis was achieved in 62 cases (61%). Bacterial pneumonia (BP), Pneumocystis carinii pneumonia (PCP), and mycobacteriosis were the main diagnoses. The incidences of BP and mycobacteriosis were not statistically different in highly active antiretroviral therapy (HAART) versus non-HAART patients. The incidence of PCP was lower in those receiving HAART (p =.011), however. Nine patients died (10%). Independent factors associated with higher mortality were mechanical ventilation (odds ratio [OR] = 83; CI: 4.2-1,682), age >50 years (OR = 23; CI: 2-283), and not having an etiologic diagnosis (OR = 22; CI: 1.6-293)., Conclusions: Pulmonary infiltrates are still a frequent cause of hospital admission in the HAART era, and BP is the main etiology. There was no difference in the rate of BP and mycobacteriosis in HAART and non-HAART patients. Not having an etiologic diagnosis is an independent factor associated with mortality.

Unlabelled: To determine the need of prenatal screening for toxoplasmosis in our hospital from a seroepidemiological point of view., Patients and Methods: The prevalence of IgG anti-T. gondii was retrospectively analyzed in 7.090 women of childbearing age attended in the Hospital Clínic of Barcelona from February 1992 to April 1999. The association among the seroprevalence and the variables year, age, birthplace (province of Barcelona/other provinces) and place of residence (urban/rural) was analyzed. A decreasing trend was observed in the prevalence (p < 0.001), currently being < 40% in the average women between 15 and 45 years. Infection was also directly related to age of women (p < 0.001) and birthplace out of the province of Barcelona (p = 0.001). Habitat (rural or urban) was not associated with seroprevalence. Prenatal screening for toxoplasmosis is necessary due to the high rate of seronegative women exposed to infection and the evidence of a high number of primoinfections in the childbearing period.

Background: To study the usefulness of IgG and IgM titration, and avidity of IgG to date IgM anti-Toxoplasma gondii., Methods: VIDAS Toxo IgG, VIDAS Toxo IgM and VIDAS Toxo IgG Avidity tests were used. 64 sera containing both IgM and IgG T. gondii antibodies were analyzed, 32 from 12 individuals infected 40 weeks previously (group I), and the remainder from 17 individuals with an infection of more than 40 weeks (group II)., Results: An IgM index < 1.05 was associated with an infection > 12 weeks. An avidity index > 0.164 excluded 100% infections of < or = 12 weeks. Avidity indexes > 0.26 and 0.45 excluded infections of < or = 20 and < or = 40 weeks, respectively., Conclusions: The serology methods used in this study can adequately identify residual IgM anti-T. gondii, often avoiding the need of a new blood extraction to analyze IgG kinetics in pregnant women.