Resumo Introdução. As escolas hospitalares são um contexto educativo caracterizado pela elevada heterogeneidade dos seus alunos (diferentes idades, diferentes doenças e diferentes repertórios educativos anteriores) e por práticas pedagógicas que se materializam através de processos dialéticos e de negociação, em tempos e espaços relativos. Objetivo. Analisar certas tensões que ocorrem no processo educativo dos estudantes que são educados nas escolas hospitalares. Três fatores-chave do processo fazem parte desta análise. Discussão. Os aspectos filosóficos, económicos e tecnológicos estão interligados e moldam o atual panorama educativo das escolas no hospital. De uma perspectiva filosófica, o tempo e o espaço nas escolas hospitalares são apresentados como dimensões que permitem introduzir abordagens educativas não convencionais, desafiando o tradicional. Do ponto de vista económico, surge a problemática do financiamento destas escolas devido à sua particular implementação. Por fim, a tecnologia surge como um fator crucial para garantir a continuidade do processo educativo das crianças e jovens afetados pela doença. Conclusão. Os três fatores analisados ilustram como as modificações desenvolvidas no contexto das escolas hospitalares podem oferecer orientações valiosas para o sistema de ensino regular. A eclosão da pandemia de Covid-19 pôs em evidência a necessidade imperiosa de mecanismos adaptáveis e eficazes, capazes de sustentar a continuidade dos processos educativos para todos os alunos. Somos convidados a aprender com abordagens fora do comum para enriquecer e reforçar o nosso sistema educativo como um todo.

Resumen Introducción. Las escuelas hospitalarias son un contexto educativo que se caracteriza por la alta heterogeneidad de sus estudiantes (distintas edades, distintas enfermedades y distintos repertorios educativos previos), y por prácticas pedagógicas que se materializan a través de procesos dialécticos y de negociación, en tiempos y espacios relativos. Propósito. Analizar ciertas tensiones que se producen en el proceso educativo de estudiantes que se educan en escuelas hospitalarias. Tres factores claves del proceso son parte de este análisis. Discusión. Se entrelazan aspectos filosóficos, económicos y tecnológicos que moldean el panorama educativo actual de las escuelas en el hospital. Desde una perspectiva filosófica, el tiempo y el espacio en las escuelas hospitalarias se presentan como dimensiones que posibilitan la introducción de enfoques educativos no convencionales, desafiando lo tradicional. En lo económico, surge la cuestión problemática de la financiación de estas escuelas, debido a su implementación particular. Por último, lo tecnológico emerge como un factor crucial en asegurar la continuidad del proceso educativo para niños, niñas y jóvenes aquejados por enfermedades. Conclusión. Los tres factores examinados ilustran cómo las modificaciones desarrolladas en el contexto de las escuelas hospitalarias podrían ofrecer pautas valiosas al sistema educativo convencional. La irrupción de la pandemia de Covid-19 ha resaltado la imperiosa necesidad de contar con mecanismos adaptables y eficaces, capaces de sostener la continuidad de los procesos educativos de todos los grupos de estudiantes. Se invita a aprender de enfoques fuera de lo habitual para enriquecer y fortalecer nuestro sistema educativo en su totalidad.

Abstract Introduction. Hospital schools are an educational environment characterized by the high heterogeneity of their students, encompassing different ages, illnesses, and previous educational repertoires. Pedagogical practices within these schools manifest through dialectical and negotiation processes, occurring in relative times and spaces. Purpose. This study aims to analyze certain tensions that occur in the educational process of students attending hospital schools. Three key factors of the process are part of this analysis. Discussion. Philosophical, economic, and technological aspects intertwine, shaping the current educational landscape within hospital schools. From a philosophical perspective, time and space in hospital schools are presented as dimensions that facilitate the introduction of non-conventional educational approaches, challenging the traditional one. On the economic side, the problematic issue of financing these schools arises due to their particular implementation. Finally, technology emerges as a crucial factor in ensuring the continuity of the educational process for children and young people affected by illness. Conclusion. The three examined factors illustrate how the modifications developed in the context of hospital schools could provide valuable guidance to the mainstream education system. The outbreak of the Covid-19 pandemic has highlighted the imperative need for adaptable and effective mechanisms capable of sustaining the continuity of educational processes for all students. We are invited to learn from out-of-the-ordinary approaches to enrich and strengthen our education system as a whole.

Resumen Presentamos el caso de un escolar de 10 años, con el diagnóstico de una recaída de una leucemia mieloide aguda que cursó con un episodio de una neutropenia febril de alto riesgo, posterior a un ciclo intensivo de quimioterapia, evolucionando con una infección fúngica invasora demostrada por histopatología. Se inició tratamiento con voriconazol intravenoso, evolucionando con concentraciones plasmáticas erráticas que requirieron sucesivos ajustes de dosis, lo que también ocurrió con la administración oral del medicamento. Finalmente, tuvo una respuesta favorable al tratamiento, a pesar de la dificultad de la dosificación para alcanzar niveles terapéuticos. La búsqueda activa y la terapia antifúngica anticipada, así como la monitorización seriada de concentraciones terapéuticas de voriconazol, permitieron un tratamiento antifúngico óptimo y oportuno, mejorando el pronóstico del paciente.

Abstract We present a 10-year-old male patient with a diagnosis of relapsed acute myeloid leukemia (AML), presenting with high-risk febrile neutropenia (HRFN), after a cycle of intensive chemotherapy, evolving with an invasive fungal infection demonstrated by histopathology. Treatment with intravenous voriconazole was started, with erratic plasmatic levels, which require successive dose adjustments which also occurred with oral administration. Finally, he had a favorable response to treatment, despite of the dosing difficulties to reach therapeutic levels. Active search as well as preemptive antifungal therapy, together with plasmatic level monitorization of voriconazole allowed a prompt recovery and improved the patient prognosis.

ABSTRACT:This study classifies hyperlinks or Complementary Digital Resources (CDR) present on the printed version of School Textbooks in terms of the a) Knowledge Genres or Curricular Genres to which they lead and b) the functions they play in the process of knowledge recontextualization. For this, a corpus constituted by 89 hyperlinks extracted from Language and Communication high school textbooks was analysed. The manual analysis was based on the following criteria: communicative purpose, modality, support of the discourse genres, and also the function these genres play in the pedagogical area. The results indicate that 55% of the CDR corresponds to Knowledge Genres (KG) such as Note or Biography, while the remaining 45%, to Curricular Genres (CG) such as Poems or Ted Talks. It was also observed that both KGs and CGs play, mainly, complementary functions.

RESUMEN: El presente estudio tuvo por objetivo clasificar los hipervínculos o Recursos Digitales Complementarios (RDC) presentes en la versión impresa de Textos Escolares en términos de a) los Géneros del Conocimiento (GCO) o Géneros Curriculares (GCU) a los que remiten y b) las funciones que estos cumplen en la recontextualización del conocimiento. Para esto, se analizó un corpus de 89 hipervínculos presentes en el Texto Escolar de Lenguaje y Comunicación de Enseñanza Media. El análisis manual se realizó a partir de los siguientes criterios: propósito comunicativo, modalidad, soporte de los géneros discursivos y también la función que cumplen estos géneros en el ámbito pedagógico. Los resultados indican que el 55% de los RDC corresponde a Géneros del Conocimiento como Nota y Biografía, mientras que el 45% restante, a Géneros Curriculares como Poemas o Charlas TED. Se observó, además, que tanto los CGO como los CGU cumplen, principalmente, funciones complementarias.

Abstract This text focuses on different artistic/curatorial practices that, since the late 1980s, have proposed possible responses to the stagnation of institutions and their incapacity to dialogue -from the art system- with conjunctural socio-political processes in the territories of Abya Yala. We make an approach to these situated practices based on G. Pollock's notions of virtuality, D. Haraway's encounter and fabulation, and S. Rivera Cusicanqui's ch'ixi. In them we highlight different poetic/political operations that function as antecedents to propose an artistic/curatorial practice in the present, which we have called Hacer(nos) fuego. The aim of the project is to tension, among others, the following questions: What kind of artistic/curatorial operations can we expect today, in the context of social and pandemic outbursts? In what space-time and with what methodologies could artistic events take place and give rise to other epistemologies?

Resumen Este texto se detiene en distintas prácticas artísticas/curatoriales que, desde finales de los años ochenta, han propuesto posibles respuestas al anquilosamiento de las instituciones y su imposibilidad de dialogar -desde el sistema del arte- con procesos sociopolíticos coyunturales en territorios de Abya Yala. A partir de las nociones de virtualidad de G. Pollock, encuentro y fabulación de D. Haraway, y lo ch’ixi de S. Rivera Cusicanqui, nos aproximamos a estas prácticas situadas. En ellas destacamos distintas operaciones poéticas/políticas que funcionan como antecedentes para proponer una práctica artística/curatorial en el presente, que hemos llamado Hacer(nos) fuego. Esta busca tensionar, entre otras, las siguientes preguntas: ¿Qué tipo de operaciones artístico/curatoriales podemos pensar hoy, en el contexto de los estallidos sociales y pandémicos? ¿En qué espacio-tiempo y con qué metodologías pueden ocurrir acontecimientos artísticos que den lugar a otras epistemologías?

Abstract Quillagua is a small oasis found next to the Loa River. Ethnohistory note the coexistence of indigenous populations from different cultural traditions in this space. Picas had territorial rights in one direction from a brushed and painted wooden post, while Atacamas held the land upwards. These categories were not geographic but instead indications of dual social organization. Here, we investigate the material and visual expressions of this tense intercultural occupation, focusing specifically on the archaeological record after AD 900, when these actors developed numerous social-political exercises, through the construction of a visual landscape.

Resumen Quillagua es un pequeño oasis junto al río Loa. La etnohistoria registra la convivencia de poblaciones indígenas de distinta tradición cultural. Picas tenían derechos territoriales hacia abajo de un poste de madera pintado y cepillado, mientras Atacamas hacia arriba. Estas categorías no eran geográficas sino indicaciones de una organización social dual. Aquí, indagamos en las expresiones materiales y visuales de esta tensa ocupación intercultural. Ponemos atención al registro arqueológico posterior al 900 d. C., época en que los actores desarrollaron numerosos ejercicios político-sociales, mediante la construcción de un paisaje visual.

Abstract The coronavirus disease 2019, caused by the SARS-CoV2 virus, was declared a pandemic in March 2020 by the WHO. Protein S from the viral surface has been identified as the optimal antigen for vaccine development. In a pandemic, the traditional vaccine development process has had to be accelerated to advance in an adequate response to the problem, shortening the times. Safety, immunogenicity, protection against infection, antibody dependent enhancement phenomena and duration of protection are studied in parallel, unlike the traditional way in which it was carried out in successive stages. Currently in Phase III there are 4 types of vaccines: inactivated; based on purified or recombinant proteins, based on DNA / RNA nucleic acids and based on viral vectors. The objective of this review is to understand the studies that precede the vaccines that are currently in Phase III studies and to describe the main characteristics of these studies. Currently the world is in a situation unprecedented in the last century. Among the options to face this fact, one vaccine or, ideally, several, safe, effective and immunogenic, seem to be one of the best alternatives to regain lost normality within a reasonable time.

Resumen La enfermedad por coronavirus 2019, causada por el virus SARS-CoV2, fue declarada pandemia en marzo de 2020 por la OMS. La proteína S, de la superficie viral ha sido identificada como antígeno óptimo para el desarrollo de vacunas. En pandemia, el proceso tradicional de desarrollo de vacunas ha debido acelerarse para avanzar en una respuesta adecuada al problema, acortando los tiempos. La seguridad, inmunogenicidad, protección frente a la infección, fenómeno de “aumento dependiente de anticuerpos”, duración de la protección se estudian en paralelo, a diferencia de la manera tradicional en que se llevaba a cabo en etapas sucesivas. Actualmente en Fase III hay 4 tipos vacunas: inactivadas; en base a proteínas purificadas o recombinantes, en base a ácidos nucleicos ADN/ARN y en base a vectores virales. El objetivo de esta revisión es conocer los estudios que preceden a las vacunas que actualmente están en estudios de Fase III y describir las características principales de estos estudios. Actualmente el mundo se encuentra en una situación inédita en el último siglo. Dentro las opciones para enfrentar este hecho, una vacuna o idealmente varias, seguras, eficaces e inmunogénicas, parecen ser una de las mejores alternativas para retomar en un plazo razonable la normalidad perdida.

Resumen Introducción. El parto pretérmino es aquel que ocurre antes de la semana 37 de gestación. Este tipo de parto se asocia a múltiples factores de riesgo, algunos de los cuales pueden ser prevenidos. En Colombia son escasos los estudios sobre los factores de riesgo asociados al parto pretérmino, de ahí la importancia de su análisis. Objetivo. Identificar los factores de riesgo para parto pretérmino en un grupo de gestantes de Bogotá D.C., Colombia. Materiales y métodos. Estudio de cohorte retrospectivo. La muestra estuvo compuesta por 452 pacientes que habían participado en un estudio primario y que ya habían dado a luz. Resultados. La incidencia de parto pretérmino fue de 10.40% (IC95%: 7.60-13.20) y los factores de riesgo asociados fueron los siguientes: ser diagnosticada con preeclampsia severa, con un riesgo relativo (RR) de 7.47 (IC95%: 4.59-11.95); tener preeclampsia (severa y no severa), con un RR=5.05 (IC95%: 3.0-8.51), y ocurrencia de restricción del crecimiento intrauterino (RCIU), con un RR=4.40 (IC95%: 2.44-7.98). Conclusiones. De acuerdo con los hallazgos reportados en el presente estudio, es necesario planear e implementar estrategias y políticas públicas en Bogotá D.C. que promuevan mejores prácticas de atención prenatal que, a su vez, permitan la detección temprana de condiciones como la preeclampsia y la RCIU, lo que hará posible reducir la incidencia de partos pretérmino en la ciudad y utilizar la experiencia y resultados obtenidos en el resto del país.

Abstract Introduction: A preterm birth occurs before the 37th week of pregnancy. It is associated with multiple risk factors, some of which can be prevented. In Colombia, few studies have addressed the risks factors associated with preterm birth, hence the importance of analyzing them. Objective: To identify risk factors for preterm birth in a population of pregnant women in Bogotá D.C., Colombia. Materials and methods: Retrospective cohort study. The sample was composed of 452 patients who had participated in a primary study and had already given birth. Results: The incidence of preterm birth was 10.40% (95%CI: 7.60-13.20). The following risk factors associated with preterm delivery were found: being diagnosed with severe preeclampsia, with a relative risk (RR)=7.47 (95%CI: 4.59-11.95); having preeclampsia (severe and non-severe), with a RR=5.05 (95%CI: 3.0-8.51); and occurrence of intrauterine growth restriction (IUGR), with a RR=4.40 (95%CI: 2.44-7.98). Conclusions: According to the findings reported in this study, it is necessary to plan and implement strategies and public policies in Bogotá D.C. that promote better prenatal care practices that, in turn, allow the early detection of conditions such as preeclampsia and IUGR. This will reduce the incidence of preterm birth in the city and will allow using the experience and results obtained here in the rest of the country.

Resumen El síndrome de Morquio B es una enfermedad rara y de baja prevalencia, por lo cual poco se ha estudiado sobre el funcionamiento neuropsicológico y estado cognitivo de quienes lo padecen. Este estudio de caso presenta los resultados del funcionamiento en atención, memoria, lenguaje, gnosias, praxias y funciones ejecutivas de un adulto colombiano diagnosticado con este síndrome. Se encontró que el paciente puede adquirir nuevo conocimiento; muestra memoria visoespacial y de trabajo verbal conservadas; repite, lee y escribe información sencilla que es conocida para él; sigue órdenes simples a partir de comandos verbales; muestra habilidades viso perceptuales y grafomotoras; tiene un desarrollo normal de pensamiento abstracto y asociativo, y es capaz de planear y solucionar problemas. Sin embargo, presenta dificultades en atención visual sostenida, atención audio-verbal, velocidad de procesamiento, lenguaje comprensivo, repetición y escritura al dictado de frases completas, flexibilidad cognitiva, y fluidez verbal semántica y fonológica. Se discute como factores más relevantes del funcionamiento cognitivo del paciente la relación entre el síndrome de Morquio B y la gangliosidosis GM1, y la falta de entrenamiento en el manejo de información de alta complejidad, dada su condición de desescolarización.

Abstract Since Morquio B syndrome is a low-prevalence rare disease, scarce evidence about neuropsychological functioning and cognitive status in diagnosed people is known. This case study shows the results of functioning in attention, memory, language, gnosias, praxias, and executive functions in a Colombian man diagnosed with this syndrome. It was found that the patient is capable of acquiring new information and exhibits preserved visuospatial and verbal working memory; he is also able to repeat, read and write simple information as long as it is familiar to him, and is capable of following simple verbal instructions with no difficulty; moreover, he displays preserved visuospatial and graphomotor abilities, has a normal development of abstract and associative thinking, and is able to plan and solve problems. Nonetheless, he exhibits difficulties in audio-verbal and sustained visual attention, as well as in processing speed, comprehensive language, repetition and writing of complete phrases, cognitive flexibility, and semantic and phonological verbal fluency. It is discussed the association between Morquio B syndrome and gangliosidosis GM1 as well as the lack of training in the management of highly complex information due to unschooling of this patient as the two most relevant factors of his cognitive functioning.

Resumen Introducción: Los pintores de vehículos automotores están rutinariamente expuestos a agentes como los solventes orgánicos, capaces de producir efectos mutágenos y carcinógenos. Objetivo: Caracterizar la susceptibilidad poblacional y evaluar los efectos genotóxicos debidos a la exposición a solventes orgánicos. Métodos: Estudio de corte transversal que comparó a un grupo de pintores de carros expuestos a solven tes orgánicos con un grupo de personas no expuestas. Fueron determinados tanto los polimorfismos de CYP2E1 como la presencia de micronúcleos en linfocitos. Resultados: Participaron 122 personas, 62 trabajadores de talleres de pintura de autos expuestos a solventes y 60 personas no expuestas. Con relación al cuestionario Q 16, 32% de los expuestos refirieron síntomas sugestivos de neurotoxicidad. Las frecuencias de células micronucleadas y de puentes nucleoplásmicos fueron significativamente mayores en los expuestos que en los no expuestos: p= 0.042 y p= 0.046, respectivamente, Razón de verosimilitud exacta). Fueron halladas diferencias significativas en la interacción de CYP2E1 (c1c1) y la exposición ocupacional a solventes, con mayores frecuencias de micronúcleos (p= 0.013) y de células micronucleadas (p= 0.015). Conclusiones: Este estudio reafirma que los trabajadores expuestos a solventes orgánicos con polimorfismos de CYP2E1, específicamente con genotipo c1c1, tienen mayor probabilidad de presentar mutaciones en las células somáticas, condición asociada con una mayor susceptibilidad a enfermedades como el cáncer

Abstract Introduction: Car painters are routinely exposed to organic solvents classified as carcinogenic and mutagenic substances. Objective: To characterize the population susceptibility and evaluate the genotoxic effects of exposure to organic solvents. Methods: A cross-sectional study comparing a group of car painters exposed to organic solvents with a non-exposed group. CYP2E1 polymorphisms and the presence of micronuclei in lymphocytes were determined. Results: One hundred twenty-two workers participated in the study: 62 who worked in car paint shops and were exposed to solvents, and 60 who were not exposed. There were statistically significant differences between the two groups regarding micronucleated cells and nucleoplasmic bridges frequencies (p=0.042 and p=0.046, respectively; exact likelihood ratio). Significant differences were found at the interaction between the CYP2E1 genotype c1c1 and occupational exposure to solvents, with higher frequencies of micronuclei (p= 0.013) and micronucleated cells (p= 0.015). However, when the frequencies of micronuclei, micronucleated cells and nucleoplasmic bridges in the exposure group were compared between the c1c1 and c2c2/c1c2 allele groups of the CYP2E1 polymorphism, statistically significant differences were found. Conclusions: This study confirms that when workers with CYP2E1 polymorphisms, specifically the c1c1 genotype, are exposed to organic solvents, they are more likely to have somatic cell mutations, a condition associated with increased susceptibility to diseases such as cancer

Abstract: The aim of the following communication is developing a set of guidelines for teaching the cultural heritage of human rights. It is possible through the theoretical and methodological articulation of the pedagogical approaches of the educating city, human rights and didactic of the cultural heritage from a controversial approach. A qualitative methodology is proposed through the use of secondary sources with focus on: ¿what are the didactic orientations of the cultural heritage that allow the teaching of human rights in favor of the memorial and responsible citizenships for the inherited recent past?. There is a need to propose an articulated treatment between academic and social knowledge. This controversial view promote in the students the development of conscious learning to ensure the care of memory places from an active citizenship.

Resumen: La siguiente comunicación tiene por objetivo elaborar un conjunto de orientaciones de enseñanza del patrimonio cultural de los Derechos Humanos a través de la articulación teórica y metodológica de la ciudad educadora, los derechos humanos y didáctica del patrimonio cultural desde un enfoque controversial. Se propone una metodología cualitativa a través del uso de fuentes secundarias que para los efectos de esta propuesta, se centrará en: ¿cuáles son las orientaciones didácticas del patrimonio cultural que permiten la enseñanza de los Derechos Humanos para favorecer las ciudadanías memoriales y responsables del pasado reciente heredado? Se constata la necesidad de proponer un tratamiento articulado entre el saber académico y el conocimiento social, potenciando entre los y las estudiantes el desarrollo de aprendizajes para asegurar la salvaguardia consciente de los lugares de memoria desde una ciudadanía activa.

Environmental factors may influence the development of Inflammatory Bowel Disease and modify its natural history. The objective of this review is to evaluate current evidence about environmental factors associated with the disease. A better knowledge about the pathogenesis of the disease can lead to better treatment strategies and suggestions to prevent the disease.

Background: Primary non-response and secondary loss of response (LOR) are significant problems of biological therapy for inflammatory bowel disease (IBD). Therapeutic drug monitoring (TDM) in IBD patients receiving these drugs can improve outcomes. Aim: To measure serum infliximab levels and anti-infliximab antibodies (ATI) in patients with IBD post-induction phase and during maintenance therapy assessing the clinical course of IBD. Patients and Methods: Prospective study of IBD patients receiving infliximab between July 2016-May 2017. Group-A included patients who received induction therapy while Group-B included patients who were in maintenance therapy. TDM was performed in serum samples collected at weeks-14 and 30 in Group-A and before the infliximab maintenance dose in Group-B. Clinical scores, fecal calprotectin and endoscopic score were also evaluated. Results: Of 14 patients in Group-A, 57% achieved endoscopic response. Median serum infliximab concentrations at week-14 and 30 were 2.65 AU/mL (0.23-32.58) and 2.3 AU/mL (0.3-16.8), respectively. Patients with mucosal healing had non-significantly higher median infliximab concentrations at week- 14, as compared to week 30 (median 3.2 vs 2.2 AU/ml, respectively, p 0.6). ATI >10 ug/mL were found in one and seven patients at week-14 and 30, respectively. At 52 weeks of follow-up, four patients (31%) had LOR. Group-B included 36 patients, 33% had LOR. Median serum concentrations of infliximab were 1.4 AU/mL (0.27-7.03). No significant differences in serum infliximab concentration were observed between patients in remission and those with inflammatory activity. Seventeen patients had ATI >10 ug/mL. Conclusions: Clinical algorithms using TDM might help to optimize the pharmacological therapy of IBD.

Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition that requires early recognition, hospitalization and adequate treatment. Currently, the use of infliximab in ulcerative colitis (UC) is recommended in the case of severe disease refractory to corticosteroids, once that superimposed bacterial or viral infections (such as cytomegalovirus or Clostridium difficile) have been excluded. However, conventional weight-based regimens of infliximab might be insufficient for patients with ASUC. Accelerated infliximab induction regimen may increase its serum concentration levels and efficacy by reducing early colectomy rates in these patients. We report a 34 year old female presenting with an ASUC. She was initially treated with hydrocortisone 300 mg/day and mesalazine enemas 4 g/day with an unfavorable clinical response. At the fifth day of therapy, an accelerated induction therapy with infliximab was started in doses of 10 mg/kg at weeks 0, 1 and 4. After the second dose, there was a favorable response with reduction of abdominal pain, stool frequency and hematochezia. She was discharged with prednisone and azathioprine. After a year of starting infliximab, the patient remains in clinical remission.

Background: The widespread growth of higher education is increasing the heterogeneity of university students in terms of socioeconomic characteristics, academic story and cultural background. Medical schools are not an exception of this phenomenon. Aim: To compare the academic background and self-directed learning behavior of students who entered to a public medial school between 2010 and 2014. Material and Methods: A non-probabilistic sample of 527 medical students aged between 17 and 29 years (60% men), was studied. Their academic information was collected from the University data base; they answered the Self-directed learning readiness scale of Fisher. Results: Students from the 2014 cohort had higher high school grades than their counterparts. The scores in mathematics of the Scholarship Aptitude Test (SAT) were higher in the cohorts of 2010 and 2011. Those of the sciences test were superior in the 2013 cohort. The 2014 cohort had the lower general score of self-directed learning behaviors. Conclusions: The lower SAT and self-directed learning scores of the students entering medical school in 2014, indicate the progressive increase in the heterogeneity of Medical students.

Anti-tumor necrosis factor-α (TNF) agents have dramatically changed the management of Crohn’s Disease (CD). However, a significant number of these patients do not respond at all or cease to respond to antibodies against TNF. In this clinical situation, the options include intensification of anti-TNF therapy by either increasing the dose or by shortening the administration interval, the use of a second anti-TNF or medications with a different mechanism of action. Among the later, Natalizumab, a humanized IgG4 monoclonal antibody against α4β1 and α4β7 integrins, is safe and effective in inducing and maintaining remission in active CD patient’s refractory to anti-TNF. In spite of this, Natalizumab use has been limited because of an increased risk of progressive multifocal leukoencephalophaty which results from reactivation of the John Cunningham (JC) virus. However, the presence of antibodies against JC virus in serum can be used to reduce the risk for this complication. We report three patients with Crohn’s disease refractory to treatment with infliximab, who responded successfully to the use of Natalizumab.