[Type 3 c diabetes: Approach from the first level doctor]. / La diabetes tipo 3c. Abordaje desde el médico del primer nivel.

DM3c is diabetes (DM) of the exocrine pancreas that must be suspected whenever there is a history of chronic pancreatitis (CP), acute pancreatitis (AP) or recurrence (80% of cases) or new-onset DM in individuals from over 50 years of age without any other justification (negative autoimmunity tests, Glutamic Acid Decarboxylase antibodies). It is an entity misdiagnosed as type 2 diabetes (DM2) (90%) and therefore, if it is not suspected, it can go unnoticed. For its diagnosis, abdominal ultrasound, determination of the CA 19.9 tumor antigen (carbohydrate antigen 19-9), nuclear magnetic resonance (NMR) or computerized axial tomography (CT) are useful. The treatment is the same as DM2, although certain specifications depend on the type of drugs and with the particularity that in dealing with «fragile diabetes¼ greater caution must be taken with hypoglycemia (monitoring). Likewise, as it is a disease of the exocrine pancreas, it will have to be specifically treated to avoid metabolic, malabsorptive and/or nutritional alterations.

[Adherence to healthy lifestyle behaviours in patients with type 2 diabetes in Spain]. / Adherencia a un estilo de vida saludable en pacientes con diabetes mellitus tipo 2 en España.

OBJECTIVES: The aim of this study was to report on the main lifestyle components and related factors in adults with diabetes type 2 treated in Primary Care clinics in Spain. MATERIAL AND METHODS: A cross-sectional and multicentre study was performed on a consecutive sample of patients with type 2 diabetes attending 25 Primary Care clinics between April 2018 and April 2019. Data were collected by auditing the computerised medical records, and an interview. An analysis was carried out on adherence to 4 healthy lifestyle trends (Mediterranean diet, regular exercise, not smoking, and emotional well-being). RESULTS: A total of 412 patients were included in the analysis (mean age 69 (SD 8.65) years; 50.2% men). Only a minority was highly adherent to the Mediterranean diet, 92 (22.3%). Regular physical activity was carried out by 189 (45.8%). A total of 361 (87.6%) were non-smoking, and 259 (62.8%) felt emotional well-being. A small number (9, 2.1%) of patients had not followed any of the healthy lifestyle recommendations, with 87 (21.1%) following one, 145 (35.1%) two, 128 (31%) three, and 43 (10.4%) all 4 healthy habits: diet, exercise, not smoking, and emotional well-being. Healthy lifestyle adherence was related to gender. Obesity is poorly associated with adherence to diet and physical activity. The results for age, time with the disease, socioeconomic status, and treatment regimen were not consistent. CONCLUSIONS: This study suggest that adherence to a healthy lifestyle pattern in DM2 is low. Less than a quarter follow a healthy diet, and less than a half practice regular exercise. Gender is the variable that most influences a healthy lifestyle in DM2, but not age, time with the disease, or treatment regimen.

[Correlation between clinical, dermatoscopic, and histopathologic variables in atypical melanocytic nevi]. / Estudio de correlación clínica, dermatoscópica e histopatológica de nevus melanocíticos atípicos.

INTRODUCTION: Atypical melanocytic nevi are acquired melanocytic lesions that were described for the first time by Clark in studies of melanocytic nevi in patients with melanomas. Today, the use of dermatoscopy has made identification of this type of nevus much easier. OBJECTIVE: Our aim was to study the correlation between the clinical, dermatoscopic, and histopathologic findings of melanocytic nevi and compare our findings with those of previous studies. We also aimed to investigate the value of dermatoscopy for identifying atypical melanocytic nevi. MATERIAL AND METHODS: In this cross-sectional, observational study, 200 melanocytic lesions were analyzed in 166 patients examined between January 1, 2005 and December 31, 2005. We recorded the clinical, dermatoscopic, and histopathologic characteristics of each lesion and established the correlation between the different findings on a case-by-case basis. We then determined the agreement between diagnoses and assessed the value of dermatoscopy for identifying atypical melanocytic melanoma. RESULTS: The clinical characteristics associated with atypical histology were a macular component (P < .001), irregular borders, and presence of 3 or more colors. Asymmetry, diameter greater than 5 or 6 mm, and progression were not associated with atypical histopathologic characteristics (P > .05). Agreement between clinical and histologic diagnosis was weak (kp = 0.38), whereas the agreement between dermatoscopic and histologic diagnosis was moderate (kp = 0.52). The area under the receiver operating characteristic curve for the model that included dermatoscopy was larger than that for the model that only included clinical data, and this difference was statistically significant. CONCLUSIONS: Atypical clinical features were not found to correspond to atypical histology. Dermatoscopy improved the accuracy of clinical diagnosis of atypical melanocytic nevus.

Progressive nodular histiocytosis accompanied by systemic disorders.

Progressive nodular histiocytosis is a proliferative process of histiocytes, the main element of which is the dermal dendrocyte. It is considered to form part of a group of histiocytic disorders related to juvenile xanthogranuloma, which also includes xanthoma disseminatum, benign cephalic histiocytosis, spindle cell xanthogranuloma and generalized eruptive histiocytosis; disorders which perhaps represent the spectrum of one single entity. We present the case of a 57-year-old man who, for 26 years, had had a progressively deforming process of cutaneous lesions, with systemic involvement, including chronic myeloid leukaemia, hepatosplenomegaly, hypothyroidism, hyperuricaemia and hypocholesterolaemia. We have not been able to establish precisely the relationship between these features.