Stroke-like manifestation of a spontaneous spinal epidural hematoma with spontaneous resolution: a case report.

BACKGROUND: This case report presents the case of a man with no known coagulopathy or preceding trauma, who spontaneously developed a spinal epidural hematoma (SEH). This is an uncommon condition which can have variable presentations including hemiparesis mimicking stroke, resulting in the potential for misdiagnosis and inappropriate treatment. CASE PRESENTATION: A 28-year-old Chinese male with no past medical history presented with sudden onset neck pain associated with bilateral upper limbs and right lower limb subjective numbness but intact motor function. He was discharged after adequate pain relief but re-attended the emergency department with right hemiparesis. A magnetic resonance imaging of his spine revealed an acute cervical spinal epidural hematoma at C5 and C6. While admitted, he had spontaneous improvement of his neurological function and was eventually managed conservatively. CONCLUSIONS: SEH, although uncommon, can be a mimic of stroke and it is important to avoid misdiagnosis as it is a time critical diagnosis, and administration of thrombolysis or antiplatelets can lead to unfavourable outcomes. Having a high clinical suspicion can help to guide us in the choice of imaging and interpretation of subtle signs to reach the correct diagnosis in a timely manner. Further research is required to better understand the factors that would favour a conservative approach as opposed to surgical treatment.

Emergence of Raoultella ornithinolytica on O'ahu: a case of community-acquired R. ornithinolytica urinary tract infection.

Human infection with Raoultella ornithinolytica is rare, with only ten cases having been reported previously. This case report describes a local patient diagnosed with community-acquired R. ornithinolytica urinary tract infection in 2014.

Aeroallergen sensitivity in Hawai'i: association with asthma and increased prevalence of sensitivity to indoor allergens since 1966.

Asthma and allergic diseases have increased globally. Earlier studies suggest a history of excess asthma morbidity and mortality in Hawai'i, with high prevalence of sensitization to outdoor aeroallergens among atopic children. This study was undertaken to test the hypotheses that specific allergens are more associated with asthma, and that sensitivity to common aeroallergens has increased in Hawai'i since 1966. Adult participants were recruited between 2001-2013, according to approved protocols. Data from 211 adults who reported physician-diagnosed asthma and 404 non-asthmatic controls are included in this analysis. Skin test responses to 8 common aeroallergens were assessed, and association between specific aeroallergen response and asthma diagnosis evaluated, using Chi-squared analysis. P-values < .05 were considered statistically significant. Compared to non-asthmatic controls, asthmatic participants were older, more likely to be of Mixed and non-White race, and more likely to be obese. Allergen sensitivity (atopy) was found in 85% of asthmatic and 72% of the controls. Prevalence (%) of positive responses to specific aeroallergens in asthmatic, non-asthmatic, and all atopic subjects, were: D. farinae (74, 59, 83), D. pteronyssinus (68, 52, 75), roach (42, 31, 46), cat (45, 19, 37), dog (27, 15, 25), grasses (34, 26, 37), weeds (22, 18, 25), and molds (18, 11, 17). Adjusted for age, race, and BMI, highest prevalence ratios [PR (95% CI)] were: D. farinae [1.16 (1.1-1.2)], D. pteronyssinus [1.16 (1.1-1.3)], cat [1.34 (1.2-1.5)], and dog [1.19 (1.1-1.3)]. This data indicates a strong association with asthma, and an increased prevalence in sensitivity to indoor allergens.

Elevated blood pressure: Our family's fault? The genetics of essential hypertension.

AIM: To provide an updated review on current genetic aspects possibly affecting essential hypertension (EH), and to further elucidate their role in EH. METHODS: We searched for genetic and epigenetic factors in major studies associated with EH between Jan 2008-Oct 2013 using PubMed. We limited our search to reviews that discussed mostly human studies, and were accessible through the university online resource. We found 11 genome wide association studies (GWAS), as well as five methylation and three miRNA studies that fit our search criteria. A distinction was not made between genes with protective effects or negative effects, as this article is only meant to be a summary of genes associated with any aspect of EH. RESULTS: We found 130 genes from the studies that met our inclusion/exclusion criteria. Of note, genes with multiple study references include: STK39, CYP17A1, MTHFR-NPPA, MTHFR-NPPB, ATP2B1, CSK, ZNF652, UMOD, CACNB2, PLEKHA7, SH2B3, TBX3-TBX5, ULK4, CSK-ULK3, CYP1A2, NT5C2, CYP171A, PLCD3, SH2B3, ATXN2, CACNB2, PLEKHA7, SH2B3, TBX3-TBX5, ULK4, and HFE. The following genes overlapped between the genetic studies and epigenetic studies: WNK4 and BDKRB2. Several of the identified genes were found to have functions associated with EH. Many epigenetic factors were also correlated with EH. Of the epigenetic factors, there were no articles discussing siRNA and its effects on EH that met the search criteria, thus the topic was not included in this review. Among the miRNA targets found to be associated with EH, many of the genes involved were also identified in the GWAS studies. CONCLUSION: Genetic hypertension risk algorithms could be developed in the future but may be of limited benefit due to the multi-factorial nature of EH. With emerging technologies, like next-generation sequencing, more direct causal relationships between genetic and epigenetic factors affecting EH will likely be discovered creating a tremendous potential for personalized medicine using pharmacogenomics.