Abstract: In a mixed-integer nonlinear programming problem, integer restrictions divide the feasible region into discontinuous feasible parts with different sizes. Meta-heuristic optimization algorithms quickly lose diversity in such scenarios and get trapped in local optima. In this work, we propose an Estimation of Distribution Algorithm (EDA) with two modifications from its previous version ( E D A m v). The first modification consists in establishing the exploration and exploitation components for the histogram of discrete variables, aimed at improving the performance of the algorithm during the evolution. The second modification is a repulsion operator to overcome the population stagnation in discontinuous parts, so as continuing the search for possible solutions in other regions. From a comparative study on 16 test problems, the individual contribution of each modification was verified. According to statistical test results, the new proposal shows a significantly better performance than the other competitors tested.

Resumen Introducción: Los ganglioneuromas son neoplasias histológicamente benignas derivadas del sistema nervioso simpático, cuya ocurrencia en el tubo digestivo es rara y comúnmente sindromática. De acuerdo con el patrón de la lesión y la extensión se dividen en ganglioneuroma polipoide, poliposis ganglioneuromatosa y ganglioneuromatosis difusa. El objetivo de este trabajo es presentar el hallazgo incidental post mortem de ganglioneuromatosis difusa del tubo digestivo en una paciente sin afectación sindromática. Caso clínico: Se describe el caso de un paciente de sexo femenino de 2 años con atresia traqueoesofágica tipo III corregida quirúrgicamente que cursó con recanalización fistulosa, múltiples episodios de neumonía por aspiración y choque séptico. Durante el último ingreso cursó con hemorragia pulmonar masiva y falla multiorgánica. En el estudio post mortem se identificó hipertrofia del píloro y de los troncos y plexos nerviosos entéricos con células ganglionares maduras entremezcladas. Se identificó ganglioneuromatosis que afectaba todos los segmentos del tubo digestivo, con predominio de los plexos mientéricos. Conclusiones: La ganglioneuromatosis intestinal es una rara enfermedad que presenta un espectro de lesiones desde una forma aislada hasta sindromática con morbimortalidad elevada. Por ello, es necesario conocer la enfermedad, indagar sistemáticamente cuando se sospeche y apoyarse de estudios genéticos que confirmen o descarten alguna asociación sindromática.

Abstract Background: Ganglioneuromas are histologically benign neoplasms derived from the sympathetic nervous system, whose occurrence in the gastrointestinal tract is rare and often syndromic. According to the injury pattern and extension, lesions are divided into polypoid ganglioneuroma, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. This work aimed to present the incidental post mortem finding of diffuse ganglioneuromatosis of the gastrointestinal tract in a patient without syndromic involvement. Case report: We describe the case of a two-year-old female patient with surgically corrected type III tracheoesophageal atresia and fistulous recanalization, multiple episodes of aspiration pneumonia, and septic shock. During the last admission, she developed massive pulmonary hemorrhage and multi-organ failure. Post mortem histopathological study identified hypertrophy of the pylorus and enlarged enteric nerve trunks and plexuses with intermingled mature ganglion cells. We identified ganglioneuromatosis affecting all gastrointestinal tract segments with the predominance of the myenteric plexuses. Conclusions: Intestinal ganglioneuromatosis is a rare disease with a spectrum of lesions ranging from isolated to syndromic with high morbidity and mortality. Therefore, it is necessary to know the condition, investigate systematically when it is suspected, and rely on genetic studies to confirm or rule out any syndromic association.

RESUMEN Objetivo Realizar la notificación y verificar el seguimiento de cinco alertas sanitarias de medicamentos a un grupo de prestadores de salud en Colombia. Métodos Estudio cuasi-experimental, prospectivo, antes y después, sin grupo control, mediante una intervención en médicos prescriptores de ketoconazol, metoclopramida, nimesulida, diacereina, ranelato de estroncio. Se tomó como población universo a los afiliados al régimen contributivo del Sistema de Salud Colombiano en 13 entidades promotoras de salud (EPS) de Colombia. Se identificaron los pacientes que recibían mensualmente estos medicamentos previamente a la alerta. Se realizó una intervención educativa y posteriormente se midió la proporción de cambio en la dispensación. Resultados Se realizaron en total unas 26 actividades diferentes a 500 médicos prescriptores. De un total de 4 121 954 de personas se identificaron 13 979 pacientes mensuales en 2013 que recibían alguno de los cinco medicamentos y se observó una reducción en 1 470 sujetos al mes (-10,5%) para 2014. El medicamento con el que se consiguió la mayor reducción fue ketoconazol (-31,1% de casos), seguido de ranelato de estroncio (-30,3%) y metoclopramida (-8,6%). Para nimesulida (+0,7%) y diacereina (+16,4%) no se obtuvieron resultados favorables. Conclusiones Se mantienen prescripciones potencialmente riesgosas en pacientes de Colombia. Con intervenciones basadas en farmacovigilancia posterior al reporte de alertas por agencias reguladoras sanitarias, se puede disminuir la proporción de pacientes que utilizan estos medicamentos.

ABSTRACT Objective Make the notification and monitoring compliance with five health drug alerts to a group of health care providers in Colombia. Methods Quasi-experimental, prospective, before-after study, without control group, by intervening in physician prescribers of ketoconazole, metoclopramide, nimesulide, diacerein, strontium ranelate. The affiliated population of the contributory system of the Colombian Health System was taken as the universe population sample from 13 health promoting entities (EPS) of Colombia. Patients receiving monthly these drugs prior to the alert were identified. An educational intervention was performed and then the rate of change in the dispensation was measured. Results About 26 different activities were conducted on 500 prescribers. Out of a total of 4 121 954 people, 13 979 patients were identified monthly in 2013, who received some of the five medications. Likewise, a reduction in 1,470 subjects per month (-10.5%) for 2014 was observed. The drug which achieved the greatest reduction was ketoconazole (-31.1% of cases), followed by strontium ranelate (-30.3%) and metoclopramide (-8.6%). For nimesulide (+ 0.7%) and diacerein (+ 16.4%) no favorable results were obtained. Conclusions Patients with potentially risky prescriptions remain in Colombia; educational pharmacovigilance interventions made after the report alerts given by drug regulatory agencies may decrease the proportion of patients using these drugs.

ABSTRACT Objective Make the notification and monitoring compliance with five health drug alerts to a group of health care providers in Colombia. Methods Quasi-experimental, prospective, before-after study, without control group, by intervening in physician prescribers of ketoconazole, metoclopramide, nimesulide, diacerein, strontium ranelate. The affiliated population of the contributory system of the Colombian Health System was taken as the universe population sample from 13 health promoting entities (EPS) of Colombia. Patients receiving monthly these drugs prior to the alert were identified. An educational intervention was performed and then the rate of change in the dispensation was measured. Results About 26 different activities were conducted on 500 prescribers. Out of a total of 4 121 954 people, 13 979 patients were identified monthly in 2013, who received some of the five medications. Likewise, a reduction in 1,470 subjects per month (-10.5%) for 2014 was observed. The drug which achieved the greatest reduction was ketoconazole (-31.1% of cases), followed by strontium ranelate (-30.3%) and metoclopramide (-8.6%). For nimesulide (+ 0.7%) and diacerein (+ 16.4%) no favorable results were obtained. Conclusions Patients with potentially risky prescriptions remain in Colombia; educational pharmacovigilance interventions made after the report alerts given by drug regulatory agencies may decrease the proportion of patients using these drugs.

RESUMEN Objetivo Realizar la notificación y verificar el seguimiento de cinco alertas sanitarias de medicamentos a un grupo de prestadores de salud en Colombia. Métodos Estudio cuasi-experimental, prospectivo, antes y después, sin grupo control, mediante una intervención en médicos prescriptores de ketoconazol, metoclopramida, nimesulida, diacereina, ranelato de estroncio. Se tomó como población universo a los afiliados al régimen contributivo del Sistema de Salud Colombiano en 13 entidades promotoras de salud (EPS) de Colombia. Se identificaron los pacientes que recibían mensualmente estos medicamentos previamente a la alerta. Se realizó una intervención educativa y posteriormente se midió la proporción de cambio en la dispensación. Resultados Se realizaron en total unas 26 actividades diferentes a 500 médicos prescriptores. De un total de 4 121 954 de personas se identificaron 13 979 pacientes mensuales en 2013 que recibían alguno de los cinco medicamentos y se observó una reducción en 1 470 sujetos al mes (-10,5%) para 2014. El medicamento con el que se consiguió la mayor reducción fue ketoconazol (-31,1% de casos), seguido de ranelato de estroncio (-30,3%) y metoclopramida (-8,6%). Para nimesulida (+0,7%) y diacereina (+16,4%) no se obtuvieron resultados favorables. Conclusiones Se mantienen prescripciones potencialmente riesgosas en pacientes de Colombia. Con intervenciones basadas en farmacovigilancia posterior al reporte de alertas por agencias reguladoras sanitarias, se puede disminuir la proporción de pacientes que utilizan estos medicamentos.

Resumen Objetivo: Determinar la frecuencia de prescripción del losartán por encima de 100 mg/día, notificar a los responsables de la atención sanitaria los limitados beneficios y conseguir una reducción en el número de quienes así lo utilizan. Métodos: Estudio cuasiexperimental, antes y después, sin un grupo control, sobre los prescriptores de pacientes con diagnóstico de hipertensión arterial en manejo con losartán entre el 1 de enero de 2010 (41.624 pacientes) y el 31 de diciembre de 2014 (75.126 pacientes). Posteriormente se identificaron las personas que recibieron dosis superiores a 100 mg/día. Se realizaron intervenciones educativas a partir de junio de 2012 y se evaluaron los resultados en términos de proporción de pacientes que dejaron de utilizarlo en estas dosis. Resultados: En el año 2012 se identificaron 7.205 sujetos (12,8% de pacientes con losartán) con más de 100 mg/día, que tras 108 actividades educativas se redujeron a 5.373 en el año 2014 (7,1% de usuarios del antihipertensivo; reducción de 25,4%), a pesar que la población afiliada tuvo un incremento del 29,3% en el período de seguimiento. Tras la intervención se consiguió un ahorro de COP$ 204.293.878 en dos años. Conclusiones: Se logró reducir la prescripción del losartán en dosis superiores a las estimadas como efectivas, lo que implica una reducción en el riesgo de la hiperkalemia y de los costos por dosificación mayor a la recomendada. Es importante reforzar las actividades de educación médica continuada para promover el uso apropiado de los medicamentos.

Abstract Objetive: To determine frequency of prescription of losartan over 100 mg/day, to notify the physicians responsible for the healthcare about the limited benefits and to thus achieve a decrease in the number of individuals taking this dose. Methods: Quasi-experimental study, before and after, without a control group, on prescription factors in patients with a diagnosis of arterial hypertension taking losartan between January 1st 2010 (41,624 patients) and December 31st 2014 (75,126 patients). Afterwards, people receiving doses over 100 mg/day were identified. Educational interventions were conducted starting June 2012, and results were measured in terms of the proportion of patients who stopped taking losartan in these doses. Results: In 2012, 7,205 individuals were identified (12.8% of patients with losartan) with more than 100 mg/day, who after 108 educational activities were reduced to 5,373 by year 2014 (7.1% of patients taking antihypertensive agents; a 25.4% decrease) despite a 29.3% rise in registered participants during the follow-up period. After the intervention, a COP$ 204,293,878 saving was achieved over the course of two years. Conclusions: Prescriptions of losartan in doses higher as what were deemed effective were reduced, which implies a reduction of both the risk of hyperkalemia and the costs due to taking a higher dose than recommended. It is important to reinforce ongoing medical education activities in order to promote appropriate drug consumption.

Resumen Introducción. La tutela es una herramienta legal empleada para garantizar el derecho a la salud en Colombia. Objetivo. Evaluar la racionalidad terapéutica de prescripciones de medicamentos autorizadas por tutela en pacientes afiliados al Sistema General de Seguridad Social en Salud. Materiales y métodos. Estudio descriptivo con recolección retrospectiva de información de bases de datos e historias clínicas de pacientes con medicamentos ordenados por acción judicial para tres aseguradoras en Bogotá, D.C. durante los años 2010 y 2011. Se consideraron la indicación, los consumos, las dosis, la duplicidad terapéutica, el riesgo de interacciones y los costos. Resultados. Se obtuvo información de 3 469 pacientes que solicitaron 2 419 medicamentos por tutela, siendo los más comunes antiepilépticos (10.7%), vitaminas (10%), hipoleipemiantes (5%)y antidiabéticos (4.8%). En el 75.5% de los casos el medicamento se correlacionó con el diagnóstico y el 66% de los pacientes estuvo expuesto a riesgos de interacciones farmacológicas. Se observó mayor duplicidad terapéutica en antiinflamatorios no esteroideos y antihipertensivos. El costo promedio de cada dispensación por tutela se estimó en COP 453 221 (USD 236.5). Conclusiones. Se evidencian problemas de racionalidad terapéutica en medicamentos ordenados por tutela, lo cual puede implicar mayores riesgos para la salud de los pacientes. Es recomendable un asesoramiento científico más riguroso con la finalidad de evitar posibles riesgos de interacciones y duplicidades terapéuticas.

Abstract Introduction: Judicial protection (tutela in Spanish) is a legal tool used to ensure the right to health in Colombia. Objective: To evaluate the therapeutic rationale of drug prescriptions authorized through judicial protection for patients enrolled in the General Social Security Health System. Materials and methods: Descriptive study with retrospective collection of information from databases and patient records associated with medications ordered by court action against three health insurers in Bogotá, D.C., during 2010 and 2011. Prescription, consumption, doses, therapeutic duplication, risk of interactions and costs were considered. Results: Information of 3 469 patients who requested 2 419 prescribed drugs through judicial protection was obtained; the most common drugs were anticonvulsants (10.7%), vitamins (10%), lipid-lowering medications (5%) and anti-diabetic drugs (4.8%). In 75.5% of cases the drug was correlated with the diagnosis and 66% of patients were exposed to drug interaction risks. Greater therapeutic duplication was observed in non-steroidal anti-inflammatory and antihypertensive drugs. The average cost of each dispensation per judicial protection issued was estimated at COP 453 221 (USD 236.5). Conclusions: Therapeutic rationality issues are evident in prescription drugs ordered by judicial protection, which may involve greater risks to the health of patients. A more rigorous scientific advice is recommended in order to avoid possible interactions and therapeutic duplications.

Introducción: Se buscaron pacientes con prescripciones inapropiadas de alendronato de 70 mg y mediante una intervención educativa reducir los errores de medicación. Métodos: Se realizó un estudio cuasiexperimental, prospectivo, antes y después, sin grupo control, donde se llevó a cabo una intervención en prescriptores de pacientes que se encontraban en manejo farmacológico con alendronato de 70 mg en el período comprendido entre el 1 de julio de 2013 y el 30 de junio de 2014, incluyendo todos los sujetos que recibían más de 4 tabletas por mes. La intervención consistió en suministrar información actualizada a los responsables de la atención sanitaria y evaluar, meses después, si se modificó o no la prescripción de los pacientes identificados. Resultados: De un total de 2.283 usuarios que recibían alendronato, se hallaron, en promedio, 105 pacientes mensuales con diagnóstico de osteoporosis que estaban recibiendo la presentación de 70 mg, con edad promedio de 66,0 ± 5,5 años y predominio femenino (n =159; 95,8%). En promedio a 22 pacientes se les dispensaba más de 4 tabletas por mes (rango: 8-38 tabletas/mes). La intervención consiguió reducir a 8 pacientes con dosis superiores a las recomendadas, (63,6% de casos). Los aseguradores estaban pagando en promedio COP $459.166 más, cada mes, por el exceso de tabletas dispensadas y la intervención logró un ahorro de COP $3.491.592 al año. Conclusiones: Las intervenciones educativas sobre los médicos prescriptores pueden conseguir disminuir el número de prescripciones potencialmente inapropiadas y de errores de medicación para reducir el riesgo sobre los pacientes y costes de atención en salud.

Introduction: The aim of the study is to identify patients with inappropriate prescriptions of alendronate (70 mg) and to use an educational intervention to reduce medication errors. Methods: A quasi-experimental, prospective before and after study was conducted, without a control group, where an intervention was conducted on prescribers of patients on pharmacological treatment with alendronate 70 mg in the period from 1 July 2013 to 30 June 2014. All subjects receiving more than 4 tablets per month were included. The intervention was to provide updated information to those responsible for health care and then assess whether or not they modified the patient prescription. Results: Out of a total of 2,283 patients receiving alendronate, it was found that a mean of 105 patients per month diagnosed with osteoporosis received the presentation of 70 mg. The mean age was 66.0 ± 5.5 years, and the large majority (n =159; 95.8%) were female. A mean of 22 patients were dispensed with more than 4 tablets per month (range: 8-38 tablets/month). The intervention managed to reduce those with a higher than recommended doses to 8 patients (63.6% of cases). Insurers were paying COP $459,166 more on average each month for excess tablets dispensed, and the intervention achieved savings of COP $3,491,592 per year. Conclusions: Educational interventions on prescribers can reduce the number of potentially inappropriate prescribing and medication errors and reduce the risk to patients and health care costs.

Abstract: Memetic algorithms (MA), explored in recent literature, are hybrid metaheuristics formed by the synergistic combination of a population-based global search technique with one or more local search algorithms, which in turn can be exact or stochastic methods. Different versions of MAs have been developed, and although their use was focused originally on combinatorial optimization, nowadays there are memetic developments to solve a wide selection of numerical type problems: with or without constraints, mono or multi objective, static or dynamic, among others. This paper presents the design and application of a novel memetic algorithm, MemMABC, tested in a case study for optimizing the synthesis of a four-bar mechanism that follows a specific linear trajectory. The proposed method is based on the MABC algorithm as a global searcher, with the addition of a modified Random Walk as a local searcher. MABC is a modified version of the Artificial Bee Colony algorithm, adapted to handle design constraints by implementing the feasibility rules of Deb. Four-bar mechanisms are a good example of hard optimization problems, since they are used in a wide variety of industrial applications; simulation results show a high-precision control of the proposed trajectory for the designed mechanism, thus demonstrating that MemMABC can be applied successfully as a tool for solving real-world optimization cases.

In this paper the variation of the velocity error of a four-bar mechanism with spring and damping forces is reduced by solving a dynamic optimization problem using a differential evolution algorithm with a constraint handling mechanism. The optimal design of the velocity control for the mechanism is formulated as a dynamic optimization problem. Moreover, in order to compare the results of the differential evolution algorithm, a simulation experiment of the proposed control strategy was carried out. The simulation results and discussion are presented in order to evaluate the performance of both approaches in the control of the mechanism.

The construction of a Virtual Reality and Visualization Center in a public or private University results in a series of benefits; it allows the students to interact with modern technology, to learn with different tools. Specifically, this paper focuses on a Virtual Reality and Visualization Center built at the Bachelor in Computer Engineering at the Autonomous University of Tlaxcala, this center is called VirtUATx. VirtUATx allows building different virtual environment multi-screen considering the head movements through a professional head tracker, a full navigation system by means of recognition of body movement's using Kinect or manual using keyboard. Furthermore, VirtUATx incorporates 3D object manipulation, anaglyphic and active stereoscopy and 3D sound. This Center is used in different courses, such as Research Seminars, Computer Graphics, Research Methodology, and Interaction Human-Computer, but in the future this center will benefit other bachelors.

En este artículo, se presenta el análisis cinemático y una metodología de diseño paramétrico de la falange proximal para un dedo antropomórfico1 de un grado de libertad. el diseño del mecanismo se lleva a cabo, tomando diez posiciones de la barra de salida del mismo. Se presenta la simulación dinámica, utilizando un modelo de CAD para comprobar la factibilidad de los resultados obtenidos por el mecanismo. Por último, se muestra el análisis comparativo entre los resultados de la cinemática obtenidos numéricamente y los experimentales.

This paper shows the kinematic analysis and a parametric design methodology of the proximal phalanx for an anthropomorphic finger using a one degree-of-freedom. The mechanism design is done by taking ten positions from its output bar. A dynamic simulation is given using a CAD model to verify the feasibility of the mechanism results. Finally, we show the comparative analysis between kinematics numerically obtained and other experimental results.

Treatment for pulmonary tuberculosis (TB) is drug-based but the emergence of drug-resistance has decreased itstherapeutic efficacy. Pulmonary surgery is an important beneficial adjuvant strategy for MDR TB treatment in this context.Objectives. To describe the clinical characteristics results and complications in a series of 304 patients with MDR TBsubmitted to surgical therapy. Material and methods. Between May of 1999 and January of 2007 a total of 336 surgicalinterventions were performed on 304 patients from the National Program of TB Control who, were operated by a surgicalteam of the Ministry of Health in the Hipolito Unanue National Hospital and in a Private Center in Lima. Results. Mostcases were male (60%) and the mean age was 28 years. Patients were resistant to a median of 5 drugs. Cavitarylesions were the most common (91.8%) and lobectomy was the most commonly performed surgical procedure (68.4%).Postoperative morbidity and mortality occurred in 12.8% and 2% respectively. Patients were followed post-operativelyfor a maximum time of 79.3 months and healing was reached in the 77.2% of cases. Conclusions. Pulmonary adjuvantsurgery on MDR TB patients is an effective alternative for cure. This strategy should be included as part of treatmentprograms for MDR TB.

El tratamiento de la tuberculosis pulmonar (TB) es esencialmente farmacológico, pero debido a la aparición de resistenciaa drogas, el tratamiento se ha dificultado. En ese contexto la cirugía pulmonar es una importante estrategia coadyuvantepara el tratamiento de la tuberculosis multidrogo resistente (TB MDR). Objetivo. Describir las características clínicas,resultados y complicaciones en una serie de 304 pacientes con TB MDR sometidos a terapia quirúrgica. Materiales ymétodos. Entre mayo de 1999 y enero del 2007 un total de 336 intervenciones quirúrgicas fueron realizadas en 304pacientes, pertenecientes al Programa Nacional de Control de la Tuberculosis, los cuales fueron operados por un equipoquirúrgico del Ministerio de salud, en el Hospital Nacional Hipólito Unanue y en un Centro Privado de Lima. Resultados. Lamayoría de casos fueron de sexo masculino (60%) y el promedio de edad fue 28 años. Los pacientes tuvieron resistenciaa una mediana de 5 drogas. Las lesiones cavitarias fueron las más frecuentes (91.8%) y la lobectomía fue el procedimientoquirúrgico más utilizado (68.4%). La morbilidad postoperatoria ocurrió en 12,8% de los casos y la mortalidad post-operatoriafue de 2%. Los pacientes fueron seguidos hasta 79,3 meses y la curación fue alcanzada en el 77,2% de los casos.Conclusiones. La cirugía pulmonar coadyuvante es una alternativa efectiva para la curación en pacientes con TB MDR.Esta estrategia debe ser incluida como parte de los programas de tratamiento de la TB MDR.