Parathyroid carcinoma is a rare malignant disease that presents as a sporadic or familial primary hyperparathyroidism (PHP). The latter is associated with some genetic syndromes. It occurs with equal frequency in both sexes, unlike PHP caused by parathyroid adenoma that is more common in women. It should be suspected in cases of severe hypercalcemia, with high parathyroid hormone levels and a palpable cervical mass. Given the difficulty in distinguishing between parathyroid carcinoma and adenoma prior to the surgery, the diagnosis is often made after parathyroidectomy. The only curative treatment is complete surgical resection with oncologic block resection of the primary tumor to ensure free margins. Adjuvant therapies with chemotherapy or radiation therapy do not modify overall or disease-free survival. Recurrences are common and re-operation of resectable recurrent disease is recommended. The palliative treatment of symptomatic hypercalcemia is crucial in persistent or recurrent disease after surgery since morbidity and mortality are more associated with hypercalcemia than with tumor burden.

Background: Among older people, physical exercise improves cognitive function, aerobic fitness, and thus functional independence. Aim: To determine the effects of a walking training program on aerobic fitness and cognitive function in older women with type 2 diabetes mellitus. Material and Methods: An experimental study was carried out in 76 women with type 2 diabetes mellitus aged between 64 and 78 years. Thirty-eight women in the exercise group (EG) participated in a controlled walking program 3 times a week for 48 sessions (60min /day) and 38 women in the control group (CG) were not trained. Weight, height, body mass index (BMI), estimated maximal oxygen uptake (VO2max), and cognitive function using the Minimental test were evaluated at baseline and the end of the intervention. Results: The Minimental test improved significantly in the exercise group and did not change in the control group. Estimated VO-2max improved in women aged between 69 and 78 years. The distance walked in 6 minutes increased in all women of the experimental group. No changes in these parameters were observed in the control group. Conclusions: A structured walking program improved cognitive function, estimated aerobic capacity, and walking distance in these diabetic women.

The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.

Introduction: Sport is one of the most popular social events worldwide. It becomes interesting to characterize its practitioners, even more in some poorly studied groups such as Paralympic athletes. The main objective of this study is to determine the anthropometric profile of Chilean Elite Paralympic Athletes (CEPA) through body composition and somatotype. Material and Methods: A cross-sectional study was conducted with 41 subjects (93%) of the classified to the Para-Panamerican Games Toronto 2015, who practiced table tennis (n=6), football 5 (n=11), swimming (n=8), rugby (n=7), powerlifting (n=6) and wheelchair tennis (n=3). The body composition and somatotype were assessed through the protocol described by the International Society for the Advancement of Kinanthropometry (ISAK). Results: The CEPA reach an average for that classifies somatotype mostly as meso-endomorphic (5.3 - 7.8 - 0.5), a BMI of 27.4 kg/m², and body composition for fat mass reaches 29.8% in women and 25.7% in men, while muscle mass gain 42.6% (women) and 44.5% (men). Conclusions: The CEPA have a somatotype profile that classifies mostly as meso-endomorphic, body composition has a predominance muscle mass and high fat mass, although is similar to other Paralympics athletes.

Introducción: El deporte es una de las manifestaciones sociales más populares a nivel mundial, por lo que caracterizar a sus practicantes se vuelve interesante, más aún, en grupos de la población poco estudiados como son los deportistas paralímpicos. El objetivo del presente estudio es determinar el perfil antropométrico de deportistas paralímpicos de élite chilenos (DEPEC) a través de la composición corporal y el somatotipo. Material y Métodos: Se realizó un estudio transversal con 41 sujetos (93% de los clasificados a los Juegos Para-Panamericanos de Toronto 2015), quienes practicaban tenis de mesa (n=6), fútbol 5 (n=11), natación (n=8), rugby (n=7), powerlifting (n=6) y tenis silla (n=3). Las variables de composición corporal y somatotipo fueron evaluadas a través del protocolo descrito por la Sociedad Internacional para el avance de la Cineantropometría (ISAK). Resultados: Los DEPEC alcanzan una media para el somatotipo que los clasifica mayormente como meso-endomorfos (5,3 - 7,8 - 0,5), un IMC de 27,4 kg/m² y su composición corporal alcanza para la masa adiposa un 29,8% en mujeres y 25,7% en varones, mientras que para la masa muscular obtienen un 42,6% (mujeres) y 44,5% (varones). Conclusiones: Los DEPEC presentan un perfil somatotípico que los clasifica mayormente como meso-endomorfos, su composición corporal presenta predominancia de la masa muscular y una elevada masa grasa, que si bien alta, es similar a otros deportistas paralímpicos.

Introduction: the sleep takes part in diverse biological and physiological functions, associating his restriction, with minor performance in the sport, nevertheless the quantity and quality of sleep is not known in paralympic athletes. Objective: to determine the sleep quality, insomnia and excessive daytime sleepiness in Chilean paralympic athletes. Methods: descriptive transverse Study, the sample included 33 paralympic athletes (24.2% women), those who were practicing swimming, tennis of table, football 5, powerlifting and tennis chair. The studied variables measured up across two surveys of dream: the Questionnaire of Insomnia and the Pittsburgh Sleep Quality Index. Results: the paralympic athletes sleep were 6.9 ± 1.4 hours, 27.7% presents daytime sleepiness, 69.6 % insomnia (Survey of insomnia =7), whereas 78.7 % exhibits a bad sleep quality. The age showed a positive correlation with latency to the sleep (r=0.417*), the insomnia with latency to the sleep (r=0.462**), the Pittsburg score was correlated negatively by the sleep duration (r =-0.323) and latency to the sleep is correlated positively by the Pittsburgh score (r=0.603 **). Conclusion: the chilean paralympic athletes, present a low sleep quality, insomnia and excessive daytime sleepiness, situation that might influence negatively the sports performance.

Introducción: el sueño participa en diversas funciones biológicas y fisiológicas, asociando su restricción con menor rendimiento en el deporte; sin embargo, se desconoce la cantidad y calidad del sueño en deportistas paralímpicos. Objetivo: determinar la calidad del sueno, el insomnio y la somnolencia diurna en deportistas paralímpicos de elite chilenos. Material y métodos: estudio descriptivo transversal. La muestra incluyo 33 deportistas paralímpicos (24,2% mujeres), quienes practicaban natacion, tenis de mesa, fútbol 5, powerlifting y tenis silla. Las variables estudiadas se midieron a través de dos encuestas de sueño: el Cuestionario de Insomnio y el Indice de Calidad del Sueño de Pittsburgh. Resultados: los deportistas paralímpicos chilenos duermen 6,9 �} 1,4 horas, un 27,7% presenta somnolencia diurna excesiva y el 69,6% insomnio (Encuesta de insomnio ≥7), mientras que el 78,7% exhibe una mala calidad del sueño. La edad mostró una correlación positiva con latencia al sueño (r=0,417*), el insomnio con latencia al sueño (r=0,462**), el puntaje de Pittsburgh se correlacionó negativamente con la cantidad de sueño (r= -0,323) y latencia al sueño se correlaciona positivamente con el puntaje de Pittsburgh (r=0,603**). Conclusión: los deportistas paralímpicos chilenos presentan una baja calidad del sueño, insomnio y somnolencia diurna excesiva, situacion que podria influir negativamente sobre el rendimiento deportivo.

Climate change effects on biodiversity occur at different level of organization (organisms, species and ecosystems). Vegetation type bears a close relationship with climate, such that global warming is ex-pected to alter the distribution of major vegetation types in the near future. Using a bioclimatic envelope modeling approach, the major vegetation types of Chile were modeled and projected using IPCC scenarios for year 2080. The results show transitions among vegetation types in relation to their current latitudinal and altitudinal distribution. Major changes include an upward shift of the alpine vegetation and southward expansion of absolute desert and desert scrub into the present area of sclerophyllous forest. Changes in the relative representation of different vegetation types in Chile´s protected areas can be expected. The limitations of modeling exercises are discussed along with need for better scientific knowledge on key biological processes such as dispersal and pollination.

Los efectos del cambio climático sobre la biodiversidad ocurren a diferentes niveles de organización (organismos, especies y ecosistemas). La vegetación se encuentra relacionada directamente con el clima, por lo que se espera que el calentamiento global altere la distribución de los tipos de vegetación para el futuro cercano. Usando un enfoque de envoltura bioclimática, los tipos de vegetación de Chile fueron modelados y proyectados usando escenarios del IPCC para el año 2080. Los resultados presentan diferentes transiciones entre los tipos de vegetación, en relación a su distribución latitudinal y altitudinal actual. Entre los cambios principales, se identifica el avance altitudinal de la vegetación alpina, la expansión hacia el sur del desierto absoluto y del matorral desértico sobre el bosque escleróflo. Se esperan cambios en la representación relativa de las áreas protegidas dentro de los diferentes tipos de vegetación de Chile. Las limitaciones del ejercicio de modelación son discutidas junto a la necesidad de mejorar el conocimiento científico sobre procesos biológicos claves como dispersión y polinización.

Triatoma infestans is one of the main domestic vectors of Chagas disease. Reports of wild habitat occurrences have recently increased. In Chile, after a successful elimination campaign of T. infestans domestic infestation, a sylvatic focus was reported in bromeliads in the metropolitan region. Here, we report a new focus of sylvatic T. infestans inhabiting rock piles in the Valparaíso region in central Chile. All T. infestans captured were nymphal instars living among the stones, which were inhabited by several mammal species, along with the sylvatic triatomine vector Mepraia spinolai. We found a prevalence of infection with Trypanosoma cruzi of 36.54% in T. infestans, similar to the previous report for sylvatic specimens from bromeliads. Sylvatic populations of T. infestans should be studied at different geographic scales to elucidate their role in the maintenance of the sylvatic transmission cycle of T. cruzi and their possible role in threatening the domestic elimination of this vector. This information should be used to re-design the control programs in Chile to avoid the re-establishment of the domestic cycle.

Between January and July, 2003, a single blinded matched trial was done to assess focalized biliary ultrasound (US) and MR cholangiography (MRCP) compared with ERCP or surgery as reference standard in patients with suspected biliary obstruction. Focalized US was performed 24 hrs before/after MRCP. Patients were triage according symptoms, signs and laboratory in high, intermediate and low risk for obstruction. Radiologists sonographers were divided in low and highly experienced. None of the radiologist who reported either US or MRCP was aware to the other test results. Sensitivity, Specificity, PPV and NPV, (LR) Likelihood Ratios and pre and post-test odds for positive and negative test were estimated. We analized 64 out of 76 sampled patients, the prevalence of obstruction was 37 % (24 out of 64 patients). US found biliary tree dilated in 50% and MRCP in 48% of the patients. Main cause of obstruction was common bile duct stones in (16) 25%. and tumors were the second more common cause. US shown a Sensitivity (S) 58.3% when a non experienced radiologist perform the exam, and 70% when an experienced radiologist doest it. Specificity (Sp) 82,5%, PPV 66.7% and NPV 76.7%. RMCP Shown S 95.8%, Sp 87.5%, PPV 82.1%, NPV 97.2% For common bile duct stones US shown a PPV 53.3% and NPV 83.6% on the other hand MRCP a PPV 70% and NPV 95.4%. MRCP perform better than focalized US in overall patients with high risk of obstruction (37.5%), detecting the cause of obstruction but using aditional sequences rising the examination time and costs. With a positive ultrasound and LR(+) 3.3 pre-test odds rise from 0.37/37% to a post-test odds of 0.55/55% and with negative test result and LR(-) 0.49 pre-test odds 0.37/37% will decrease to post-test odds of 0.2/20%. With MRCP a positive test with LR(+) 7.7 initial pre-test odds 0.37/37.5% to post-test odds of 0.8/ 80% and with a negative test result LR(-) 0.05 pretest odds 0.37/37% will decrease to post-test odds of 0.03%. Ultrasound performed by experienced sonographers has a Specificity and NPV over 80%, and perform similar to MRCP for detecting biliary tree dilatation the best predictor of obstruction. In patients with low pre-test odds (low risk) of obstruction, to use focalized US and then MRCP, when the cause of obstruction is not diagnosed could be the more cost/efective initial alternative in this patients. This data must be confirmed with further studies with cost/effectivenes analysis.

Introducción. Existe controversia en el algoritmo de estudio de obstrucción de la vía biliar (VB). La colangiopacreatografía endoscópica retrógrada (ERCP) ha sido el examen de referencia. La colangioresonancia (CPRM) es un examen no invasivo con buena correlación entre observadores al evaluar la VB, pero aún cuestionada en nuestro medio por su mayor costo. El US convencional focalizado detecta dilatación de VB y disminuye los costos del algoritmo de estudio, seleccionando los pacientes que debieran referirse a otros métodos de estudio más costosos o invasivos (CPRM-ERCP). Objetivo. Comparar la validez, valores predictivos y cambios de probabilidad post-test de CPRM y US focalizado a la VB, en el estudio de pacientes con ictericia o sospecha de obstrucción biliar. Materiales y métodos. Se realizó un ensayo clínico pareado ciego. La muestra la constituyeron pacientes con sospecha de patología obstructiva de la VB a los cuales se les solicitó CPRM entre Enero-Julio 2003. Se les realizó US 24 hr antes o después de la CPRM por ecografistas de diferente experiencia. La CPRM se realizó con protocolos estándar, se registró el uso de Gadolinio y secuencias adicionales. El estándar dorado lo constituyeron la cirugía, la ERCP, seguimiento de al menos 30 días y revisión de informes de Anatomía Patológica. Se clasificó el riesgo de obstrucción de la VB en alto, moderado o bajo. Análisis. Se construyeron tablas de contingencia de 2x2 para estimar los valores del test: Sensibilidad (S), Especificidad (E), Valores predictivos positivo (VPP) y negativo (VPN), Likelihood ratios (LR) y probabilidades pre y post test. Resultados. Muestra constituida por 76 pacientes de los cuales 64 han completado el seguimiento. En el grupo de Alto riesgo en 21 pacientes se comprobó obstrucción, en 1 de los de moderado, en ninguno de los de bajo riesgo y en 2 de los no clasificados. La prevalencia de obstrucción (probabilidad pre-test) fue de 24/64 (37.5%). El US encontró dilatación de la VB en el 50% de los pacientes y la CPRM en el 48%. La principal causa de obstrucción fue la coledocolitiasis (25%), siendo las neoplasias la segunda. Para el diagnóstico de obstrucción de la vía biliar de cualquier causa el US mostró una S de 58.33%, la cual aumentó a 70% cuando el ecografista era experimentado, una E de 82.5%, VPP de 66.67% y VPN de 76.74% y LR(+) de 3.3 con una probabilidad post-test de 55%, un LR(-) de 0.49 con una probabilidad post-test de 20%. La CPRM para este mismo diagnóstico presentó una S de 95.83% y una E de 87.5%, así como un VPP de 82.14% y VPN de 97.22%; un LR(+) de 7.7 lo que lleva a una probabilidad post-test de 80% y un LR(-) de 0.05, con una probabilidad post-test de 3%. Para coledocolitiasis los VP(+) y VP(-) fueron, respectivamente, 53.33% y 83.67% para el US, y 70% y 95.45% para la CPRM. Conclusiones. CPRM posee sensibilidad, valores predictivos y LR(s) mejores que ultrasonido focal en la detección de obstrucción de la vía biliar. Ambos métodos poseen valores cercanos de Especificidad y de detección de dilatación de los conductos biliares. En el algoritmo de estudio de un paciente con sospecha de obstrucción de la vía biliar usar US en serie y luego CPRM cuando no se diagnostica la causa de obstrucción, sería la alternativa actual, probablemente más costo-efectiva en el estudio de estos pacientes.

Santuario de la Naturaleza Yerba Loca (SN Yerba Loca), Metropolitan Region (MR), 33º S, Chile is analyzed for its conservation value and efficiency in protecting native vascular plants in a regional context. The reserve's flora of 500 species and subtaxa was evaluated for species richness, endemism, range size and marginally distributed taxa, using species-area analysis, and tendencies in the floras of the MR (1.434 species and subtaxa) and MR-Fifth regions (1,841 species and subtaxa) to set the regional pattern. The reserve (0.7 % of MR land area and 0.3 % MR-Fifth land area) contains 34 % of the MR and 27% of the MR-Fifth floras, and around 16-17 % of the mediterranean-climate area (regions IV-VIII) flora of central Chile. Veech's Relative Richness Index (RRI) revealed that SN Yerba Loca houses exaggerated richness in relation to its land area (28 % more species than expected from the regional model). However, endemism rates (35 % Continental Chile endemics, 22 % Mediterranean endemics, 3% MR-Vth endemics) are statistically lower than in the MR (44 %, 29 %, 9 %) and the MR-Vth (48 %, 31 %, 11 %) floras, and SN Yerba Loca houses proportionately fewer MR endemics (2 %) than the MR (6 %). Compared with the regional floras, the reserve contains statistically fewer marginally distributed species, and range size (median = five administrative regions) is significantly larger. The reserve's outstanding species richness compensates for its low endemism rates bringing the absolute number of endemics to 92 % of the regional expectation. Corresponding values for marginally distributed species are 81 % (northern limits), 63% (southern limits) and for median and shorter range taxa, 100 %. It is concluded that SN Yerba Loca is a highly efficient reserve from the point of view of vascular plant conservation, and represents an excellent conservation choice. SN Yerba Loca and MN El Morado (a second state protected area in the MR), conservatively, house 39 % of the native vascular plant flora of the MR (30 % of that of the MR-Fifth) on 0.9 % of MR land area. Our study emphasizes that relatively small land areas in central Chile can house significant amounts of biodiversity, and that moreover, the RM and RM-Fifth are areas of high species richness within the central Chilean biodiversity hotspot. The outstanding conservation value of SN Yerba Loca calls for a management plan designed to assure the integrity of the reserve under increasing pressures from the Metropolitan Region with six million inhabitants

Santuario de la Naturaleza Yerba Loca (SN Yerba Loca), 33ºS, un área protegida en la Región Metropolitana (RM) de Chile, es analizado en términos de su aporte a la conservación de la flora vascular y su eficiencia en un contexto regional. Se analizó la flora vascular nativa, compuesta por 500 taxa en terminos de riqueza de especies, endemismos, rango de distribución, y presencia de taxa con límites de distribución geográfica en la zona de estudio, empleando análisis de especie-área y en base de tendencias en las floras de la RM (1-434 especies y subtaxa) y RM-Quinta Región (1.841 especies y subtaxa). La reserva (de 0,7 % de la superficie de RM y 0,3 % de RM-Quinta Región) contiene el 34 % de la flora nativa de RM y el 27 % de RM-Quinta Región, y alrededor de 16-17 % de la flora mediterránea (regiones IV-VIII) de Chile central. El Índice de Riqueza Relativa (IRR) de Veech indica que SN Yerba Loca alberga una riqueza extraordinaria en relación a su superficie (28 % más especies de lo esperado del modelo regional). Sin embargo, los niveles de endemismo para SN Yerba Loca (35 % endémicos de Chile continental, 22 % endémicos de la zona mediterránea y 3 % endémicos a RM-Quinta Región) son estadísticamente más bajos que los niveles regionales (RM: 44, 29 y 9 %; RM-Quinta Región: 48, 31, y 11 %), y SN Yerba Loca alberga proporcionalmente menos taxas endemicos a RM (2 %) que RM (6 %). En comparasión con las floras regionales, SN Yerba Loca contiene menos especies marginalmente distribuidas, y los rangos geográficos para especies presentes en SN Yerba Loca (mediana = cinco regiones administrativas) son significativamente mayores que en las floras regionales. La riqueza destacada de la reserva compensa su bajo nivel de endemismos, con el número absoluto de taxas endemicos llegando al 92 % de la expectación regional. Valores correspondientes para especies con distribuciones marginales son 81 % (límites norte), 63 % (límites sur) y para taxas con rangos cortas, 100 %. Se concluye que SN Yerba Loca es una reserva muy eficiente desde el punto de vista de conservación de la flora vascular. SN Yerba Loca y MN El Morado (un segundo área protegida en RM) constituyen el 0,9 % de la superficie de RM. Albergan alrededor del 39 % de la flora de la RM (y 30 % de la flora de RM y RM-Quinta Región). Nuestro estudio indica que áreas pequeñas en Chile central pueden albergar mucha biodiversidad, y que RM y RM-Quinta Región son áreas de alta riqueza de especies dentro del "hotspot" Chile central de biodiversidad. El sobresaliente valor de SN Yerba Loca en lo respecto a la conservación exige un plan de manejo para asegurar la integridad de la reserva frente de presiones de la Región Metropolitana con seis millones de inhabitantes