Multiple endocrine neoplasia type 1 familial case in a patient with insulinoma and primary hyperparathyroidism: First report in literature and in the Costa Rican population of the c.1224_1225insGTCC pathogenic variant.

Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant disorder without a good genotype-phenotype correlation, characterized by tumor predisposition in the parathyroid gland, anterior pituitary, and pancreatic islet cells. Here, we describe a 37-year-old male with previous history of nephrolithiasis, with a 1-year history of recurrent hypoglycemic episodes. Physical examination revealed the presence of two lipomas. Family history revealed primary hyperparathyroidism (PHPT), hyperprolactinemia, and multiple non-functioning pancreatic neuroendocrine tumors. Initial laboratories revealed hypoglycemia and primary hyperparathyroidism. A fasting test was positive after 3 hours of initiation. An abdominal CT Scan demonstrated a 28 × 27 mm mass in the pancreatic tail and bilateral nephrolithiasis. A distal pancreatectomy was done. After surgery, the patient persisted with hypoglycemic episodes that were managed with diazoxide and frequent feedings. A parathyroid Tc-99 m MIBI scan with SPECT/CT imaging demonstrated two hot uptake lesions compatible with abnormally functioning parathyroid tissue. Surgical treatment was offered; however, the patient decided to postpone the procedure. Direct sequence analysis of MEN1 gene revealed heterozygosity for a pathogenic insertion c.1224_1225insGTCC (p.Cys409Valfs*41). DNA sequence analysis was done to six of his first-degree relatives. A sister with clinical diagnosis of MEN1 and a pre-symptomatic brother were positive for the same MEN1 variant. To our knowledge, this is the first report of a genetically confirmed case of MEN1 in our country and is the first report in literature of the c.1224_1225insGTCC variant related to a clinically affected family.

[Clinical profile of patients with chronic urticaria in a tertiary care hospital of the social security system in Costa Ricas]. / Perfil clínico de los pacientes con urticaria crónica en un hospital de tercer nivel de atención del sistema de seguridad social de Costa Rica.

OBJECTIVE: To describe the medical and laboratory profile of the patients who have been diagnosed with chronic urticaria in the outpatient clinic of a tertiary care hospital of the social security system in Costa Rica. METHODS: All patients over 13 years of age who had been diagnosed with chronic urticaria between January 1st, 2014, and December 31st, 2018 were included. Variables of medical and laboratory data were statistically analyzed, and the treatment of the patients between their first and last medical consultation was compared. RESULTS: This was about 160 patients who had been diagnosed with chronic urticaria; 129 of them were women, 45.7 % between the ages of 30-49 years; in 17.5 % of them (28 patients), inducible urticaria was associated; 54.8 % (46/84) had positive antithyroperoxidase antibodies; 16.9 % (27 patients) maintained a single dose of second-generation anti-H1 antihistamines in the last consultation; 16.3 % (26 patients) no longer required antihistamine treatment in the last consultation. Cyclosporine was used in 8.8 % (14 patients), and omalizumab was used in 2.5 % (four patients). CONCLUSION: Since this is a real-life study in a geographic region with limited publications on this pathology, we trust that the provided information will contribute to the scientific community in order to improve the quality of life of patients with chronic urticaria through a timely diagnosis and an effective and efficient treatment.

Objetivo: Describir el perfil clínico y de laboratorio de los pacientes diagnosticados con urticaria crónica en la consulta externa de alergología en un hospital de tercer nivel de atención del sistema de seguridad social de Costa Rica. Métodos: Se incluyeron todos los pacientes mayores de 13 años diagnosticados con urticaria crónica entre el 1 de enero de 2014 y el 31 de diciembre de 2018. Se analizaron estadísticamente variables de datos clínicos y de laboratorio y se comparó el tratamiento de los pacientes entre la primera y última consulta. Resultados: Se trató de 160 pacientes con diagnóstico de urticaria crónica: 129 del sexo femenino, 45.7 % con edad entre 30 y 49 años, en 17.5 % (28 pacientes) se asoció urticaria inducible, 54.8 % (46/84) presentó anticuerpo antitiroperoxidasa positivo, 16.9 % (27 pacientes) se mantuvo en la última consulta con una dosis de antihistamínicos anti-H1 de segunda generación; 16.3 % (26 pacientes) ya no requería tratamiento antihistamínico en la última consulta. En 8.8 % de los casos (14 pacientes) se utilizó ciclosporina y en 2.5 % (cuatro pacientes), omalizumab. Conclusión: Al tratase de un estudio de vida real en una región geográfica con limitadas publicaciones sobre esta patología, confiamos que la información provista contribuya a la comunidad científica a mejorar la calidad de vida de los pacientes con urticaria crónica mediante un diagnóstico oportuno y un tratamiento eficaz y efectivo.

Contact dermatitis: Clinical practice findings from a single tertiary referral hospital, a 4-Year retrospective study.

BACKGROUND: It is estimated that 20% of the general population is sensitized to some kind of contact allergen. Contact dermatitis is one of the major occupational diseases worldwide. This disease has a higher prevalence in the female gender and is more frequently observed in the third or fourth decade of life. The main objective of this study was to describe the main sociodemographic and clinical characteristics of patients with contact dermatitis treated in the Allergy Unit of the San Juan De Dios Hospital - Caja Costarricense de Seguro Social. METHODS: Clinical records of contact dermatitis outpatients from a single hospital were analyzed, in a 4-year retrospective observational study. RESULTS: At the time of the patch testing, patients showed a mean age of 42.2 years. Disease frequency was higher in the female population (female/male ratio of 4.2:1) and in patients mostly dedicated to household workchores. Most patients presented several years of disease history, and the hands were the highest affected body part. Patch testing revealed that nickel sulfate, Cl+Me-Isothiazolinone (Kathon CG), and thimerosal were allergens regularly associated with contact dermatitis in the analyzed population. CONCLUSIONS: To a great extent, sociodemographic and clinical characteristics identified in these patients resemble what is reported in other regions, including the Americas and worldwide. It is worth highlighting a high female proportion rate probably related to cultural aspects, a smaller percentage of irritant contact dermatitis that may be associated to institutional patient management, and a slight difference in the most common allergens when compared to other published studies.

[Mycoplasma pneumoniae-induced atypical Steven-Johnson syndrome: a diagnostic challenge]. / Síndrome de Steven-Johnson atípico inducido por Mycoplasma pneumoniae: un reto diagnóstico.

BACKGROUND: Atypical Steven-Johnson syndrome is a rare disease that can be caused by Mycoplasma pneumoniae; it is characterized by respiratory symptoms, mucosal lesions of variable severity and constitutional symptoms, in the absence of cutaneous involvement. CASE REPORT: We present the case of a 35-old-man who developed mucositis in the conjunctiva, oral cavity and genitalia after the onset of respiratory symptoms. Mycoplasma pneumoniae infection was confirmed, and treatment with antibiotic and steroids was therefore started, whereby clinical manifestations subsided. CONCLUSIONS: Mycoplasma pneumoniae-induced atypical Steven-Johnson syndrome diagnosis can be challenging. The differential diagnosis of fever and oral, genital and conjunctival mucositis associated with respiratory symptoms should include infection with this bacteria in order to provide accurate and timely treatment.

Antecedentes: El síndrome de Steven-Johnson atípico es una enfermedad poco común que puede ser causada por Mycoplasma pneumoniae; se caracteriza por síntomas respiratorios, lesiones en mucosas de gravedad variable y síntomas constitucionales, en ausencia de compromiso cutáneo. Reporte de caso: Hombre de 35 años quien desarrolló mucositis en conjuntiva, cavidad oral y genitales después de la presentación de síntomas respiratorios. Se confirmó la infección por Mycoplasma pneumoniae, por lo que se inició tratamiento con antibiótico y esteroides, con lo cuales remitieron las manifestaciones clínicas. Conclusiones: El diagnóstico de síndrome de Steven-Johnson atípico inducido por Mycoplasma pneumoniae puede ser difícil. El diagnóstico diferencial de fiebre y mucositis oral, genital y conjuntival asociadas con síntomas respiratorios debe incluir infección por esta bacteria, con el fin de brindar un tratamiento certero y oportuno.

Recomendaciones para el diagnóstico, clasificación y el manejo de la urticaria / Recommendations for the diagnosis, classification and management of urticaria

La urticaria es la aparición súbita de habones en la piel con o sin angioedema, es una enfermedad con un curso benigno, pero con un impacto negativo en la calidad de vida de quien la padece; se trata de una entidad relativamente común, desencadenada por varios gatillos, muchas veces reconocibles con una buena historia clínica, sin embargo, en la mayoría de los casos estos son desconocidos, como en la urticaria crónica. Su fisiopatología está mediada por una respuesta inmune y su tratamiento es sintomático con antihistamínicos, aunque en ocasiones se debe recurrir a inmunomoduladores.

Urticaria is a sudden onset of hives with or without angioedema, it is a disease with a benign course but with a negative impact on the quality of life of patients. It is a relatively common entity, triggered by various stimuli, often recognizable with a good clinical history, however in most cases these are unknown like in chronic urticaria. Its pathophysiology is usually mediated by an immune response and treatment is symptomatic with antihistamines, however some patients have to be immune regulated.

Vitamin d insufficiency and asthma severity in adults from costa rica.

PURPOSE: Non-classical actions of vitamin D as a cytokine are related to the immunopathology of asthma. Few studies have examined vitamin D levels and asthma severity in adults. The aim of this research was to assess the relationship between vitamin D levels, atopy markers, pulmonary function, and asthma severity. METHODS: We analyzed 25-hydroxyvitamin D levels in serum collected from 121 asthmatic adults from Costa Rica to investigate the association between vitamin D levels (categorized as sufficient, ≥30 ng/mL, or insufficient, <30 ng/mL), allergic rhinitis, total IgE and peripheral blood eosinophils (as markers of atopy), asthma severity, baseline forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). Univariate and multivariate analyses were performed to assess these relationships. RESULTS: When the population was stratified by vitamin D status, 91% of asthmatic patients with vitamin D levels below 20 ng/mL (n=36) and 74% of patients with vitamin D levels between 20 and 30 ng/mL (n=73) had severe asthma versus 50% of those with vitamin D sufficiency (n=12; P=0.02). Vitamin D insufficiency was associated with a higher risk of severe asthma (odds ratio [OR], 5.04; 95% Confidence interval [CI], 1.23-20.72; P=0.02). High vitamin D levels were associated with a lower risk of hospitalization or emergency department visit during the last year (OR, 0.90; 95% CI, 0.84-0.98; P=0.04). Although there appeared to be a direct relationship between vitamin D levels and FEV1 (regression coefficient=0.48; r(2)=0.03), it did not reach statistical significance (P=0.07). CONCLUSIONS: Our findings suggest that vitamin D insufficiency is common among our cohort of asthmatic adults. Lower vitamin D levels are associated with asthma severity.

Atmospheric pollen count in Monterrey, Mexico.

There are few reports of pollen count and identification in Mexico; therefore, it is important to generate more information on the subject. This study was designed to describe the prevalence of pollen in the city of Monterrey, Mexico, during the year 2004. Atmospheric pollen was collected with a Hirst air sampler, with an airflow of 10 L/minute during 2004. Pollen was identified with light microscopy; the average monthly pollen count as well as total was calculated from January 2004 to January 2005. The months with the highest concentration of pollen were February and March (289 and 142 grains/m(3) per day, respectively), and July and November had the lowest concentration (20 and 11 grains/m(3) per day, respectively). Most of the pollen recollected corresponded to tree pollen (72%). Fraxinus spp had the highest concentration during the year (19 grains/m(3) per day; 27.5% of the total concentration of pollen). Tree pollen predominated from January through March; with Fraxinus spp, Morus spp, Celtis spp, Cupressus spp, and Pinus spp as the most important. Weed pollen predominated in May, June, and December and the most frequently identified, were Amaranthaceae/Chenopodiaceae, Ambrosia spp, and Parietaria spp. The highest concentration of grass pollen was reported during the months of May, June, September, October, and December with Gramineae/Poaceae predominating. Tree pollen was the most abundant during the year, with the ash tree having the highest concentration. Weed and grass pollen were perennial with peaks during the year.

[Sensitization to Ficus benjamina prevalence in adult patients with moderate-severe allergic rhinitis]. / Prevalencia de sensibilización a Ficus benjamina en pacientes adultos con rinitis alérgica moderada-severa.

BACKGROUND: Allergic rhinitis can be caused by allergens such as house dust mites, pollen, fungi, and animals. A less common cause is allergy to Ficus benjamina. OBJECTIVES: To determine the prevalence of sensitization to Ficus benjamina on patients with moderate-severe allergic rhinitis, and to describe the epidemiologic factors associated to Ficus benjamina sensitization. PATIENTS AND METHOD: It is an observational, transversal, prospective study; patients with persistent moderate-severe allergic rhinitis diagnosis were included; skin tests to the most frequent aeroallergens and to Ficus benjamina were applied to these patients, as well as a questionnaire in order to investigate the degree of exposure to Ficus benjamina. RESULTS: 89 patients with persistent moderate-severe allergic rhinitis were included. 59% had a Ficus benjamina plant at home or at work, 97% were located outdoors. Nine patients (10.1%) were sensitized to Ficus benjamina. A statistically significant association was found between sensitization to Ficus benjamina and to Felix domesticus, Canis familiaris, and Periplaneta. CONCLUSIONS: Prevalence of sensitization to Ficus benjamina was similar to that reported in the literature, and it is associated to three or more indoor allergens. Patients with allergic rhinitis should avoid contact with Ficus benjamina because of the risk of acquiring sensitization.

[Prevalence of reactions secundary to mosquito bites Aedes aegypti at en el Regional Center of Allergy and Clinical Immunology, University Hospital, de Monterrey, Nuevo Leon]. / Prevalencia de reacciones secundarias por picadura del mosquito aedes aegypti en el centro Regional de Alergia e Inmunología Clínica del Hospital Universitario, Monterrey, Nuevo León.

BACKGROUND: although systemic reactions resulting from hymenoptera stings have been studied extensively, the prevalence of allergic reactions to mosquitoes is unknown. OBJECTIVE: to investigate the prevalence of allergic reactions to Aedes aegypti bites in patients seeking treatment at the Allergy and Clinical Immunology Regional Center of Jose E Gonzalez University Hospital in Monterrey, Mexico. MATERIAL AND METHOD: we carried out a cross-sectional, descriptive study that included patients receiving skin tests for aeroallergens; skin sensitivity to mosquito bites was also tested. A questionnaire was used to obtain information about previous allergic reactions to mosquito bites. RESULTS: a total of 482 patients between 2 and 60 years of age were included; 53% were female, 407 (84.4%) had a history of local reactions to mosquito bites. Twelve patients (2.4%) stated a history of large local reaction; three (0.6%) of them with a positive skin prick test, one (0.2%) of those had systemic reaction history to mosquito. Eighty five (17.6%) patients had a positive mosquito skin test and 307 (63.6%) had a positive skin test for at least one aeroallergen. Seventy-eight (91.7%) of the 85 patients with a positive mosquito skin test had a history of local skin reactions to mosquito bite (odds ratio: 2.303 [confidence interval (CI) 1.037-5.10]. There was no statistically significance association between allergic diseases and mosquito allergy. CONCLUSIONS: adverse reactions and allergic reactions to mosquito bites occur frequently. However mosquito allergy is low. Further studies are required to determine the prevalence of mosquito allergy in the general population.

[Adverse reactions to mosquito bites in scholars from Monterrey, Nuevo Leon, Mexico]. / Reacciones adversas a las picaduras de mosquito en niños escolares de Monterrey, Nuevo León.

BACKGROUND: Allergic reactions to insect bites are a global problem, the true incidence and prevalence of morbidity from adverse reactions to mosquito bites are unknown. OBJECTIVE: To describe the adverse reactions to mosquito bites in school-age children of Monterrey, Nuevo Leon. MATERIAL AND METHODS: A cross-sectional descriptive study was made via a randomized application of questionnaires to children from public elementary schools in the metropolitan area of Monterrey, Nuevo Leon. RESULTS: A total of 11 public schools randomly selected were included in the study. One thousand questionnaires were submitted, of which 506 fulfilled the inclusion criteria; 55% were females. Seventy-six percent referred adverse reactions to mosquito bites, itching (75%) and rash (72%) being the most frequent ones, in the last 12 months. CONCLUSIONS: Adverse reactions to mosquito bites occur frequently. Early detection is important to establish a prompt treatment.