Transvesical laparoscopy for bladder leiomyoma excision: a novel surgical technique.

INTRODUCTION AND HYPOTHESIS: Leiomyomas of the urinary bladder are rare tumors. Submucosal leiomyomas, when small and easily accessible, can be treated with transurethral resection, while unfavorably positioned or larger leiomyomas may be treated through an abdominal approach. In these cases, a laparoscopic approach for intravesical surgery is an alternative that may be considered. We aim to demonstrate a novel transvesical laparoscopic approach to bladder leiomyoma excision with a video. METHODS: A 45-year-old woman with urinary symptoms and a 40-mm submucosal bladder leiomyoma located at the interureteric ridge was referred to our hospital (tertiary referral hospital). Due to the location and size of the leiomyoma, and to increase the probability of complete resection, a transvesical laparoscopic approach was decided. A step-by-step video is presented to describe the surgical technique. RESULTS: There were no intra- or postoperative complications. The patient was discharged 48 h after the surgery. At 60 months' follow-up, the patient remains asymptomatic. CONCLUSIONS: Transvesical laparoscopy may be considered for excision of bladder leiomyomas. This approach is feasible for trained surgeons as it requires a small working space.

Coarse-Fine Convolutional Deep-Learning Strategy for Human Activity Recognition.

In the last decade, deep learning techniques have further improved human activity recognition (HAR) performance on several benchmark datasets. This paper presents a novel framework to classify and analyze human activities. A new convolutional neural network (CNN) strategy is applied to a single user movement recognition using a smartphone. Three parallel CNNs are used for local feature extraction, and latter they are fused in the classification task stage. The whole CNN scheme is based on a feature fusion of a fine-CNN, a medium-CNN, and a coarse-CNN. A tri-axial accelerometer and a tri-axial gyroscope sensor embedded in a smartphone are used to record the acceleration and angle signals. Six human activities successfully classified are walking, walking-upstairs, walking-downstairs, sitting, standing and laying. Performance evaluation is presented for the proposed CNN.

Peak Quadriceps Muscle Torque and Electromyographic Output in Patients With Chronic Respiratory Disorders: Effects of Pulmonary Rehabilitation.

Objective: To assess the change in relation of the peak quadriceps electromyographic signal to the peak torque produced during a train of 5 isokinetic knee extensions (from 90 degrees below horizontal at a constant speed of 60 degrees/s) at baseline, and at 4 and 8 weeks of pulmonary rehabilitation. Design: In this prospective observational study, isokinetic contractions were recorded during the extensions from the knee bent at 90 degrees to the horizontal plane against graded resistance. Peak quadriceps torque signal (Tq) and peak electromyographic signal (Eq) were recorded by dynamometry and surface electrodes placed at designated locations over the muscle group, respectively. Setting: Physical therapy department in a tertiary care medical center. Participants: Eighteen patients (9 restrictive lung disease, 6 chronic airflow limitation, 3 non-ILD restrictive; N=18) were compared with 11 healthy control subjects. Interventions: Patients underwent an 8-week pulmonary rehabilitation program. Main Outcome Measures: Comparisons of Tq, Eq, and Tq/Eq ratio among patients and controls were by analysis of variance. Associations between physiological variables were determined by multivariable Pearson's correlation. Results: Compared with patients, controls exhibited a 22% higher baseline mean peak Eq (P<.05) and 76% higher mean peak Tq (P=.02) during knee extensions. Patients' peak Eq/Tq was twice as high as in the controls (P=.02); at 4 weeks, Eq/Tq in patients decreased by 44% (P<.04) with no further decline at 8 weeks; changes in Eq/Tq of 5 of 6 patients paralleled changes in their respective St George's Respiratory Questionnaire scores. There was no change in Tq or Eq/Tq over time among the control cohort. Conclusions: Eight weeks of pulmonary rehabilitation result in a decrease in Eq/Tq, indicating improvement in force generation of limb muscles, with the change occurring in the first 4 weeks.

U.S. Military veterans and the opioid overdose crisis: a review of risk factors and prevention efforts.

U.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010-2019. Risk for overdose among veterans is complex and influenced by ongoing interaction among physiological/biological, psychological, and socio-structural factors. A thorough understanding of opioid-related overdose among veterans, one that goes beyond simple pharmacological determinism, must examine the interplay of pain, pain treatment, and stress, as well as psychological and social experiences-before, during, and after military service. Comprehensive efforts to tackle the overdose crisis among veterans require interventions that address each of these dimensions. Promising interventions include widespread naloxone distribution and increased provision of low-threshold wrap-around services, including medications for opioid use disorder (MOUD) and holistic/complementary approaches. Interventions that are delivered by peers - individuals who share key experiential or sociodemographic characteristics with the population being served - may be ideally suited to address many of the barriers to opioid-related risk mitigation common among veterans. Community care models could be beneficial for the large proportion of veterans who are not connected to the Veterans Health Administration and for veterans who, for various reasons including mental health problems and the avoidance of stigma, are socially isolated or reluctant to use traditional substance use services. Interventions need to be tailored in such a way that they reach those more socially isolated veterans who may not have access to naloxone or the social support to help them in overdose situations. It is important to incorporate the perspectives and voices of veterans with lived experience of substance use into the design and implementation of new overdose prevention resources and strategies to meet the needs of this population. Key messagesU.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010-2019.The risks for overdose that veterans face need to be understood as resulting from an ongoing interaction among biological/physiological, psychological, and social/structural factors.Addressing drug overdose in the veteran population requires accessible and non-judgemental, low threshold, wraparound, and holistic solutions that recognise the complex aetiology of overdose risk for veterans.

Low-Cost Light-Based GelMA 3D Bioprinting via Retrofitting: Manufacturability Test and Cell Culture Assessment.

Light-based bioprinter manufacturing technology is still prohibitively expensive for organizations that rely on accessing three-dimensional biological constructs for research and tissue engineering endeavors. Currently, most of the bioprinting systems are based on commercial-grade-based systems or modified DIY (do it yourself) extrusion apparatuses. However, to date, few examples of the adoption of low-cost equipment have been found for light-based bioprinters. The requirement of large volumes of bioinks, their associated cost, and the lack of information regarding the parameter selection have undermined the adoption of this technology. This paper showcases the retrofitting and assessing of a low-cost Light-Based 3D printing system for tissue engineering. To evaluate the potential of a proposed design, a manufacturability test for different features, machine parameters, and Gelatin Methacryloyl (GelMA) concentrations for 7.5% and 10% was performed. Furthermore, a case study of a previously seeded hydrogel with C2C12 cells was successfully implemented as a proof of concept. On the manufacturability test, deviational errors were found between 0.7% to 13.3% for layer exposure times of 15 and 20 s. Live/Dead and Actin-Dapi fluorescence assays after 5 days of culture showed promising results in the cell viability, elongation, and alignment of 3D bioprinted structures. The retrofitting of low-cost equipment has the potential to enable researchers to create high-resolution structures and three-dimensional in vitro models.

[Treatment of advanced epithelial ovarian tumor. Hospital Italiano de Buenos Aires experience]. / Tratamiento de tumores malignos epiteliales de ovario en estadios avanzados. Experiencia del Hospital Italiano de Buenos Aires.

Ovarian cancer represents the third gynecological cancer in frequency in Argentina. There is a lack of information on this pathology in our country regarding the treatment and evolution of patients who suffer it. The aim of this study was to evaluate the perioperative and oncological results in patients with advanced epithelial ovarian tumor. We present a retrospective cohort in which we evaluated disease-free survival and overall survival in patients with epithelial ovarian tumor treated at the Hospital Italiano de Buenos Aires between June 2009 and June 2017. Of 170 patients included in the study, 72 (42.4%) received primary debulking surgery (CCP), while 98 (57.6%) received neoadjuvant therapy and interval surgery (CI). The optimal cyto-reduction rate was 75% and 79% respectively. No differences were found in perioperative outcomes, or in severe complications between the two groups. The median disease-free survival in the CCP group was 2.5 years (95% CI 1.6-3.1) while in the CI group it was 1.4 (95% CI 1.2-1.7) p < 0.001. The median overall survival was 5.8 years in CPP, and 3.5 years in CI. Faced with a meticulous selection by a group of experts, patients with advanced ovarian cancer treated with CCP present better oncological results than those who received neoadjuvant therapy and CI.

El cáncer de ovario ocupa el tercer lugar en frecuencia entre los cánceres ginecológicos en Argentina. Existe un déficit de información de esta enfermedad en nuestro país respecto al tratamiento y evolución oncológica de las pacientes. El objetivo de nuestro trabajo fue evaluar los resultados perioperatorios y oncológicos, en pacientes con tumor epitelial de ovario con estadios avanzados. Presentamos una cohorte retrospectiva en la que se evaluó la supervivencia libre de enfermedad y la supervivencia global en pacientes con tumores epiteliales de ovario tratadas en el Hospital Italiano de Buenos Aires entre junio del 2009 a junio del 2017. De 170 pacientes incluidas en el estudio, 72 (42.4%) fueron tratadas con una cirugía de citorreducción primaria (CCP), mientras que 98 (57.6%) recibieron neoadyuvancia y luego cirugía del intervalo (CI). La tasa de citorreducción óptima fue de 75% y de 79% respectivamente. No se encontraron diferencias en los resultados perioperatorios, ni en las complicaciones graves entre ambos grupos. La mediana de SLE en el grupo de CCP fue de 2.5 años (IC 95% 1.6-3.1) mientras que en el grupo de CI fue de 1.4 (IC 95% 1.2-1.7) p < 0.001. La mediana de supervivencia global fue de 5.8 años en CCP, y de 3.5 años en CI. En pacientes adecuadamente seleccionadas la CCP presenta mejores resultados oncológicos a la neoadyuvancia y CI. La selección correcta de las pacientes para tratamiento primario es fundamental para definir la conducta terapéutica.

Oral supplementation with omega-3 fatty acids and inflammation markers in patients with chronic kidney disease in hemodialysis.

Chronic kidney disease (CKD) is an increasingly common public health problem that increases the risk of death because of cardiovascular complications by 2-3 times compared with the general population. This research concerns a prospective, randomized, double-blind study in patients with CKD undergoing hemodialysis. The participants were assigned to 1 of 2 groups: the study group (group A; 46 patients) received 4 capsules (2.4 g) of omega-3 fatty acids daily during the 12-week intervention, while patients in the control group (group B; 47 patients) received 4 capsules of paraffin oil. The patients' general characteristics, nutritional indicators, renal disease markers and inflammatory markers (C-reactive protein, interleukin (IL)-6, IL-10, and tumour necrosis factor alpha (TNF-α)) were evaluated. No differences were found between the general characteristics of the patients (P < 0.05), and no differences were shown in the nutritional indicators and markers of kidney disease (P < 0.05). Patients in group A showed significant decreases in levels of C-reactive protein, IL-6, TNF-α, and the IL-10/IL-6 ratio after 12 weeks of supplementation (P < 0.05). Patients in group B did not show any significant changes in concentrations of inflammatory markers during the intervention (P < 0.05). In conclusion, oral supplementation with omega-3 fatty acids produces a significant decrease in the concentrations of inflammation markers in patients with chronic kidney disease on hemodialysis. Novelty Oral supplementation with omega-3 fatty acids produced significant decreases in the concentrations of inflammation markers. This supplementation could be given to patients with uremic syndrome and coronary heart disease to reduce cardiovascular risk.

Effect of population density of lettuce intercropped with rocket on productivity and land-use efficiency.

The objective of this study was to evaluate the influence of the spacing of lettuce rows on the production of a lettuce-rocket intercropping system over two growing seasons (11 August to 25 September 2011 and 12 January to 24 February 2012) in Jaboticabal, São Paulo, Brazil. We evaluated 11 treatments in each season: lettuce-rocket intercrops with five row spacings for the lettuce (0.20, 0.25, 0.30, 0.35 and 0.40 m) and the rocket planted midway between the lettuce rows, sole crops of lettuce at the same five row spacings and a sole crop of rocket. Fresh and dry masses of the lettuce and rocket and number of lettuce leaves per plant were highest with a lettuce row spacing of 0.40 m, but the productivities of the lettuce and rocket were higher with a lettuce row spacing of 0.20 m. The productivities and fresh and dry weights of the lettuce and rocket and the number of lettuce leaves per plant were highest in the sole crops, but the fresh and dry weights of the rocket were higher with intercropping. The land equivalent ratios were >1.0 in both seasons in all intercrops and were highest for the densest crop (1.41). Intercropping was therefore 41% more efficient than sole cropping for the production of lettuce and rocket.

Influence of drainage and nutrient-solution nitrogen and potassium concentrations on the agronomic behavior of bell-pepper plants cultivated in a substrate.

The interactive effects of N (6, 9, 12 and 15 mmol L-1) and K (3, 5, 7, and 9 mmol L-1) concentrations in nutrient solutions were evaluated on bell pepper grown in a coconut-coir substrate and fertilized without drainage. An additional treatment with drainage was evaluated using N and K concentrations of 12 and 7 mmol L-1, respectively. The hybrid Eppo cultivar of yellow bell pepper was cultivated for 252 days beginning 9 November 2012. Electrical conductivity (EC), the N and K concentrations in the substrate solution, marketable fruit yield, total dry weight and macronutrient concentrations in shoots were periodically evaluated. Fruit production was lower in the system without drainage, regardless of the N and K concentrations, compared to the recommended 10-20% drainage of the volume of nutrient solution applied. Higher K concentrations in the nutrient solution did not affect plant production in the system without drainage for the substrate with an initial K concentration of 331.3 mg L-1. Fruit yield was higher without drainage at a nutrient-solution N concentration of 10.7 mmol L-1. The upper EC limit of the substrate solution in the system without drainage was exceeded 181 days after planting. Either lower nutrient concentrations in the nutrient solution or a drainage system could thus control the EC in the substrate solution.

Tratamiento de tumores malignos epiteliales de ovario en estadios avanzados. Experiencia del Hospital Italiano de Buenos Aires / Treatment of advanced epithelial ovarian tumor. Hospital Italiano de Buenos Aires experience

Resumen El cáncer de ovario ocupa el tercer lugar en frecuencia entre los cánceres ginecológicos en Argentina. Existe un déficit de información de esta enfermedad en nuestro país respecto al tratamiento y evolución oncológica de las pacientes. El objetivo de nuestro trabajo fue evaluar los resultados perioperatorios y oncológicos, en pacientes con tumor epitelial de ovario con estadios avanzados. Presentamos una cohorte retrospectiva en la que se evaluó la supervivencia libre de enfermedad y la supervivencia global en pacientes con tumores epiteliales de ovario tratadas en el Hospital Italiano de Buenos Aires entre junio del 2009 a junio del 2017. De 170 pacientes incluidas en el estudio, 72 (42.4%) fueron tratadas con una cirugía de citorreducción primaria (CCP), mientras que 98 (57.6%) recibieron neoadyuvancia y luego cirugía del intervalo (CI). La tasa de citorreducción óptima fue de 75% y de 79% respectivamente. No se encontraron diferencias en los resultados perioperatorios, ni en las complicaciones graves entre ambos grupos. La mediana de SLE en el grupo de CCP fue de 2.5 años (IC 95% 1.6-3.1) mientras que en el grupo de CI fue de 1.4 (IC 95% 1.2-1.7) p < 0.001. La mediana de supervivencia global fue de 5.8 años en CCP, y de 3.5 años en CI. En pacientes adecuadamente seleccionadas la CCP presenta mejores resultados oncológicos a la neoadyuvancia y CI. La selección correcta de las pacientes para tratamiento primario es fundamental para definir la conducta terapéutica.

Abstract Ovarian cancer represents the third gynecological cancer in frequency in Argentina. There is a lack of information on this pathology in our country regarding the treatment and evolution of patients who suffer it. The aim of this study was to evaluate the perioperative and oncological results in patients with advanced epithelial ovarian tumor. We present a retrospective cohort in which we evaluated disease-free survival and overall survival in patients with epithelial ovarian tumor treated at the Hospital Italiano de Buenos Aires between June 2009 and June 2017. Of 170 patients included in the study, 72 (42.4%) received primary debulking surgery (CCP), while 98 (57.6%) received neoadjuvant therapy and interval surgery (CI). The optimal cyto-reduction rate was 75% and 79% respectively. No differences were found in perioperative outcomes, or in severe complications between the two groups. The median disease-free survival in the CCP group was 2.5 years (95% CI 1.6-3.1) while in the CI group it was 1.4 (95% CI 1.2-1.7) p < 0.001. The median overall survival was 5.8 years in CPP, and 3.5 years in CI. Faced with a meticulous selection by a group of experts, patients with advanced ovarian cancer treated with CCP present better oncological results than those who received neoadjuvant therapy and CI.

Factores psicosociales que influyen en el embarazo en adolescentes de un colegio de la provincia del Guayas / Psychosocial factors that influence teenage pregnancy in a school in the province of Guayas

Introducción.El embarazo en la adolescente es un tema actual y recurrente en nuestras sociedades, dado que es un fenómeno natural que está biológicamente disponible para prácticamente todas las adolescentes, considerado un problema de salud pública en Ecuador. Objetivo.Determinar los factores psicosocialesque influyen en el embarazo de las adolescentes de 12 a 17 años, del Colegio Fiscal Dr. José María Velasco Ibarra de la ciudad de Milagro, año 2016.Materiales y método.Se realizó un estudio de enfoque cuantitativo, diseño no experimental de tipo descriptivo, de corte transversal, en estudiantes de 12 a 17 años de edad, del que se obtuvo una muestra de 335 adolescentes que cumplieron con los criterios de selección. Resultados.El 31 % de las adolescentes pertenece a la edad de 16 años y la mayor parte vive en el sector urbano. El 63 % reconoce las características de las tres etapas de la adolescencia; el 92 % conoce sobre el desarrollo de todos los órganos de la reproducción y los cambios físicos que se producen en ellos; el 69,55 % resalta que las características que primero identifican en su grupo de pares es la amistad y aceptación. El 85 % señaló que vive en un hogar funcional. Conclusiones. Los factores psicosociales que influyen en el embarazo en la adolescencia son los cambios físicos relacionados con el crecimiento, cambio corporal y a la maduración sexual; siendo en la adolescencia intermedia el desarrollo cognitivo han demostrado la característica de tener un pensamiento más reflectivo.

Adolescent pregnancy is a current and recurrent theme in our societies given that it is a natural phenomenon that is biologically available for practically all adolescents, considered a public health problem in Ecuador. Objective.Determine the psychosocial factors that influence the pregnancy of adolescents aged 12 to 17 years, from the tax school Dr. José María Velasco Ibarra from the city of Milagro, 2016. Materials and Method.A quantitative, non-experimental descriptive, cross-sectional study was carried out in 12 to 17-year-old students, from which a sample of 335 adolescents who met the selection criteria was obtained. Results.31 % of adolescents belong to the age of 16 and most of these live in the urban sector. 63 % recognize the characteristics of the three stages of adolescence; 92 % know about the development of all the organs of reproduction and the physical changes that occur in them; 69,55 % emphasize that the characteristics that they first identify in their peer group are friendship and acceptance. 85% said they live in a functional home. Conclusions.The psychosocial factors that influence adolescent pregnancy are the physical changes related to growth, body change and sexual maturation; Being in the middle adolescence the cognitive development have demonstrated the characteristic of having a more reflective thought.

Valoración nutricional y hábitos alimenticios en niños de las Comunidades Indígenas Shuar, Morona Santiago - Ecuador / Nutritional assessment and food habits in children of Indigenous Communities Shuar, Morona Santiago - Ecuador / Avaliação nutricional e hábitos alimentares em crianças de Comunidades Indígenas Shuar, Morona Santiago

Resumen Introducción: No existen programas nutricionales significativos, dirigidos al conocimiento del estado nutricional y hábitos alimentarios de las comunidades indígenas Shuar que generen la promoción de programas de salud. La población más vulnerable de la etnia indígena Shuar es la infantil; quienes viven en zonas rurales y urbanas marginales con limitaciones en servicios de salud y educación debido a su asentamiento en zonas selváticas de difícil acceso. Objetivo: Evaluar el estado nutricional y hábitos alimenticios en niños y niñas de 0 a 12 años, mediante el análisis de datos antropométricos y pruebas bioquímicas como línea de base para intervenciones futuras en salud comunitaria. Materiales y métodos: Es un estudio con alcance cuantitativo de tipo no experimental, transversal-descriptivo. Se realizaron historias clínicas nutricionales, recordatorio de 24 horas, frecuencia de consumo de alimentos, así como una confrontación de datos antropométricos y muestra sanguínea para cuantificación de hematocrito capilar. Resultados: El 21,79% del total de niños atendidos en las 3 comunidades indígenas presenta Desnutrición. El 6,41% del total de niños atendidos en las 3 comunidades indígenas presenta bajo peso. El 1,92% del total de niños atendidos en las 3 comunidades indígenas presenta sobrepeso. Conclusión: La desnutrición se debe a múltiples factores, entre los cuales se ha identificado la ingesta de alimentos con escaso valor nutritivo, factores socioeconómico-culturales y a las grandes distancias para obtener alimentos diversificados.

Abstract Introduction: There are no significant nutritional programs, aimed at understanding the nutritional status and eating habits of the indigenous Shuar communities that generate the promotion of health programs. The most vulnerable population of the Shuar indigenous ethnic group is the infantile population; those who live in marginal rural and urban areas with limitations in health and education services due to their settlement in jungle areas of difficult access. Objective: Evaluate the nutritional status and eating habits of children from 0 to 12 years old, by analyzing anthropometric data and biochemical tests as a baseline for future community health interventions. Material and methods: It is a study with a quantitative scope of a non-experimental, transversal-descriptive nature. Nutritional clinical histories, 24-hour reminder, frequency of food consumption, as well as a comparison of anthropometric data and blood sample for quantification of capillary hematocrit were performed. Results: 21.79% of the total number of children served in the 3 indigenous communities presents Malnutrition. 6.41% of the total number of children served in the 3 indigenous communities is underweight. 1.92% of the total number of children treated in the 3 indigenous communities is overweight. Conclusions: Malnutrition is due to multiple factors, among which has been identified the intake of food with low nutritional value, socioeconomic-cultural factors and the great distances to obtain diversified food.

Resumo Introdução: Não existem programas nutricionais significativos, visando a compreensão do estado nutricional e hábitos alimentares das comunidades indígenas Shuar que geram a promoção de programas de saúde. A população mais vulnerável do grupo étnico indígena Shuar é a população infantil; aqueles que vivem em áreas rurais e urbanas marginais, com limitações nos serviços de saúde e educação, devido ao seu assentamento em áreas de difícil acesso na selva. Objetivo: Avaliar o estado nutricional e hábitos alimentares de crianças de 0 a 12 anos, analisando dados antropométricos e testes bioquímicos como base para futuras intervenções de saúde comunitária. Materiais e métodos: Trata-se de um estudo com escopo quantitativo, de natureza não-experimental, de natureza transversal-descritiva. Foram realizadas histórias clínicas nutricionais, lembrete de 24 horas, frequência de consumo alimentar, comparação de dados antropométricos e amostra de sangue para quantificação do hematócrito capilar. Resultados: 21,79% do total de crianças atendidas nas 3 comunidades indígenas apresenta Desnutrição. 6,41% do total de crianças atendidas nas três comunidades indígenas está abaixo do peso. 1,92% do total de crianças tratadas nas três comunidades indígenas está acima do peso. Conclusões: A desnutrição deve-se a múltiplos fatores, dentre os quais se identificou a ingestão de alimentos de baixo valor nutricional, fatores socioeconômicos-culturais e as grandes distâncias para obtenção de alimentos diversificados.

Satisfacción de usuarios y calidad de atención en unidades primarias de Salud de Milagro / Satisfaction of the users and quality of attention In Primary Health Care Units-Milagro

Introducción: Uno de los problemas con mayor relevancia dentro del sistema de Salud Pública del Ecuador es la satisfacción de los usuarios ante los servicios recibidos, los que se relacionan con la efectividad, eficiencia y percepción del paciente a la atención brindadaal dolor que le aqueja, así como la sensación del bienestar físico y mental. Objetivo: Se planteó como objetivo identificar la satisfacción de los usuarios y la calidad de la atención que se brinda en las unidades operativas de atención primaria de Salud en la ciudad deMilagro.Metodología: La metodología utilizada se basó en un enfoque cuantitativo, de tipo no experimental, transversal-descriptivo; el instrumento de medición para la satisfacción de usuarios se alineó a los parámetros del modeloSERVQUAL. Resultados: El 77 % de los usuarios se encuentra satisfecho con el equipamiento e infraestructura respectiva en los centros de salud; de la misma forma, el 81 % señala estar satisfecho con la atención del personal que labora en dichas dependencias, mientras que el 80 % considera que la cantidad de las camillas cumple con sus expectativas. Conclusión: Con el estudio de estas dimensiones a través de la percepción del usuario se determinó que la calidad de la atención es media y en igual forma la variable satisfacción delusuario

Introduction: One of the problems with greater relevance within the Public Health System of Ecuador is the satisfaction of the users with the services received, which are related to the effectiveness, efficiency and patient perception to the attention given to the pain that afflicts, as well as the sensation of the physical and mental well-being. Objective the objective of the research it is based on identifies the user's satisfaction and quality of care that is provided in the Operational Units of Primary Health Care in the city of Milagro. Methods this study was based on a quantitative approach, non-experimental, cross-sectional-descriptive; the measuring instrument for the satisfaction of users was aligned to the parameters of the Servqual model. Results: The process data showed that 77 % of users are satisfied with the respective equipment and infrastructure in the health centers; in the same way, the 81 % reported being satisfied with the attention of the personnel working in these units, While 80 % believe that the quantity of the stretchers meet their expectations. Conclusion: With the study of these dimensions through the user's perception, it was determined that the quality of care is average and in the same way asthe user satisfactionvariable.

Genetic diversity of Triatoma infestans (Hemiptera: Reduviidae) in Chuquisaca, Bolivia based on the mitochondrial cytochrome b gene.

Partial cytochrome b DNA sequences for 62 Triatoma infestans were analyzed to determine the degree of genetic variation present in populations of this insect in the northwest region of Chuquisaca, Bolivia. A total of seven haplotypes were detected in the localities sampled. The phylogenetic relationship and population genetic structure of the haplotypes found in this region, indicate that there is greater variation in this relatively small region of Bolivia than what has been previously reported by studies using the same gene fragment, for more distant geographic areas of this country. In addition, a comparison of rural and peri-urban localities, indicate that there is no difference in the genetic variation of T. infestans between these two environments.

Genetic diversity of Triatoma infestans (Hemiptera: Reduviidae) in Chuquisaca, Bolivia based on the mitochondrial cytochrome b gene

Partial cytochrome b DNA sequences for 62 Triatoma infestans were analyzed to determine the degree of genetic variation present in populations of this insect in the northwest region of Chuquisaca, Bolivia. A total of seven haplotypes were detected in the localities sampled. The phylogenetic relationship and population genetic structure of the haplotypes found in this region, indicate that there is greater variation in this relatively small region of Bolivia than what has been previously reported by studies using the same gene fragment, for more distant geographic areas of this country. In addition, a comparison of rural and peri-urban localities, indicate that there is no difference in the genetic variation of T. infestans between these two environments.