ABSTRACT
La diabetes mellitus tipo 3c (DM3c) es una diabetes (DM) del páncreas exocrino que habrá que sospechar siempre que existan antecedentes de pancreatitis crónica (PC), pancreatitis aguda (PA) o recidivante (PAR) (80% de los casos) o una DM de nueva aparición en individuos a partir de los 50 años sin otra justificación (pruebas de autoinmunidad negativas, anticuerpos contra la descarboxilasa del ácido glutámico). Se trata de una entidad mal diagnosticada como diabetes tipo 2 (DM2) (90%) y, por ello, de no sospecharla puede pasar inadvertida. Para su diagnóstico son de utilidad la ecografía abdominal, la determinación del antígeno tumoral carbohydrate antigen 19-9 (CA 19.9), la resonancia magnética nuclear (RMN) o la tomografía axial computarizada (TAC). El tratamiento es el mismo de la DM2, aunque con ciertas especificaciones según el tipo de fármacos y con la particularidad de que al tratarse de una «diabetes frágil» habrá que tener mayor precaución con las hipoglucemias (monitorización). Asimismo, al ser una enfermedad del páncreas exocrino habrá que tratar específicamente esta para evitar las alteraciones metabólicas, malabsortivas y/o nutricionales (AU)
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 diabetes» 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 (AU)
Subject(s)
Humans , Diabetes Mellitus/classification , Diabetes Mellitus/etiology , Diabetes MellitusABSTRACT
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.
Subject(s)
Diabetes Mellitus, Type 2 , Pancreatitis , Humans , Middle Aged , Pancreatitis/diagnosis , Diabetes Mellitus, Type 2/diagnosis , Acute DiseaseABSTRACT
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.
Subject(s)
Diabetes Mellitus, Type 2 , Diet, Mediterranean , Health Behavior , Adult , Aged , Cross-Sectional Studies , Female , Healthy Lifestyle , Humans , Life Style , Male , SpainABSTRACT
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Subject(s)
Humans , Nevus, Pigmented/classification , International Classification of Diseases , Nevus, Pigmented/diagnosisABSTRACT
Introducción. Los nevus melanocíticos atípicos (NMA) son lesiones melanocíticas adquiridas descritaspor primera vez por Clark en estudios de nevus melanocíticos (NM) en pacientes con melanomas. Actualmente, el uso de la dermatoscopia ha facilitado en gran medida la identificación de esta variante de nevus. Objetivo. Estudiar la correlación entre los hallazgos clínicos, dermatoscópicos e histopatológicos de los NM a estudio y comparar nuestros resultados con trabajos previos. Establecer el valor de la dermatoscopia para la identificación de NMA. Material y métodos. Estudio observacional, transversal de 200 lesiones melanocíticas correspondientes a166 pacientes, llevado a cabo desde el 1 de enero de 2005 hasta el 31 de diciembre de 2005. Describimos las características clínicas, dermatoscópicas e histopatológicas de cada lesión y establecimos la correlación entre los diferentes hallazgos obtenidos, caso por caso. Posteriormente determinamos la concordancia entre diagnósticos y establecimos el valor de la dermatoscopia para la identificación de NMA. Resultados. Las características clínicas que se asociaron a atipia histológica fueron componente macular (p < 0,001), bordes irregulares y presencia de tres o más colores. La asimetría, diámetro mayor de 5 o 6 mm ola evolución no se correspondieron con atipia desde el punto de vista histopatológico (p > 0,05). La concordancia entre diagnóstico clínico e histológico fue baja (índice kappa ponderado [kp]: 0,38), mientras que entre diagnóstico dermatoscópico e histológico fue moderada (índice kp: 0,52). Mediante curvas ROC (receiver operating characteristic) comprobamos que el modelo que contenía la dermatoscopia presentaba un incremento bajo la curva estadísticamente significativo respecto al modelo que sólo incluía los datos clínicos. Conclusiones. La atipia clínica no es equivalente a atipia histológica. La dermatoscopia mejora la precisión del diagnóstico clínico de NMA (AU)
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 < 0.001), 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 > 0.05). Agreement betweenclinical 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 (AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Middle Aged , Aged , Nevus, Pigmented/diagnosis , Nevus, Pigmented/pathology , Analysis of Variance , Melanoma/diagnosis , Melanoma/surgery , Cross-Sectional Studies , Hyperpigmentation/diagnosis , Melanoma/ultrastructure , Melanoma , Logistic ModelsABSTRACT
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.
Subject(s)
Dermoscopy , Nevus, Pigmented/pathology , Skin Neoplasms/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Cross-Sectional Studies , Female , Humans , Male , Middle AgedABSTRACT
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.
Subject(s)
Histiocytosis, Non-Langerhans-Cell/complications , Cholesterol/blood , Hepatomegaly/etiology , Histiocytosis, Non-Langerhans-Cell/blood , Histiocytosis, Non-Langerhans-Cell/pathology , Humans , Hypothyroidism/complications , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications , Male , Middle Aged , Splenomegaly/etiology , Uric Acid/bloodABSTRACT
Se pesquisan 868 niños de segundo y cuarto año de vida de los círculos infantiles de Sancti Spíritus. Se encuentran 20 niños con diferentes patologías, siendo la más frecuente el strabismo, tanto manifiesto como latente; 15 de los niños detectados no tenian tratamiento previo en ningún centro asistencial.(AU)
Subject(s)
Humans , Child , Eye Diseases/prevention & control , Schools, NurseryABSTRACT
Se pesquisan 868 niños de segundo y cuarto año de vida de los círculos infantiles de Sancti Spíritus. Se encuentran 20 niños con diferentes patologías, siendo la más frecuente el estrabismo, tanto manifiesto como latente; 15 de los niños detectados no tenian tratamiento previo en ningún centro asistencial.(AU)
Subject(s)
Humans , Child , Eye Diseases/prevention & control , Schools, NurseryABSTRACT
Se estudian 370 pacientes que asistieron a las interconsultas de oftalmología con los médicos de la familia de los policlínicos de Fomento y área Norte de la Ciudad de Sancti Spíritus. Se analiza la prevalencia de las enfermedades en tres grupos de edades. Se encontró una alta incidencia de ametropías y presbicia. El diagnóstico presuntivo se comparó con el oftalmologo para valorar la efectividad de la interconsulta. (AU)
Subject(s)
Humans , Eye Diseases/epidemiology , Physicians, FamilyABSTRACT
Se estudian 370 pacientes que asistieron a las interconsultas de oftalmología con los médicos de la familia de los policlínicos de Fomento y área Norte de la Ciudad de Sancti Spíritus. Se analiza la prevalencia de las enfermedades en tres grupos de edades. Se encontró una alta incidencia de ametropías y presbicia. El diagnóstico presuntivo se comparó con el oftalmologo para valorar la efectividad de la interconsulta. (AU)
