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San Carlos, CA, United States

Hawaii Medical Service Association is a nonprofit health insurer in the state of Hawaii. HMSA was founded in 1938, is an independent licensee of the Blue Cross Blue Shield Association, and is the largest insurer in the state of Hawaii serving more than 700,000 people. Wikipedia.


Background: The five needle auricular acupuncture technique known as the NADA protocol was originally developed to address issues of addiction. It has since found wider applications in behavioral health, including use in the treatment of Post Traumatic Stress Disorder. Objective: To optimize applications of the NADA protocol as it is used in communities affected by physical or mental trauma, particularly those residing in developing countries. Methods: NADA trainings were conducted in Kenya among refugees after the 2007 post-election violence which left hundreds of thousands of persons displaced and traumatized. Conclusion: Our experience shows that the NADA protocol can have a profound effect on communities experiencing hardship and transition. Elements we found to be important to the success of such trainings include sponsorship by an international agency, contacts among local service-providing organizations, inclusion of community members in decision-making, follow-up communication with all collaborators and participants, and complete flexibility around clearly defined goals.


Use of supplement and alternative drugs continues to thrive and is becoming an increasing cause of concern since many of these substances may have unexpected or unexplained medical consequences. We present below the first reported case of hepatotoxicity from Hydroxycut(®) in Hawaii. Hawaii Medical Journal Copyright 2010.


Botev R.,Hawaii Medical | Mallie J.-P.,University of Lorraine | Wetzels J.F.M.,Radboud University Nijmegen | Couchoud C.,Coordination of the French ESRD registry REIN | Schuck O.,University Hospital Motol
Clinical Journal of the American Society of Nephrology | Year: 2011

The GFR has a paramount diagnostic and staging role in the Kidney Disease Outcome Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease (K/DOQI-CKD). The most widely used serum creatinine-based formulas in adults for estimated GFR (eGFR) are the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease Study (MDRD). Recently, a new Chronic Kidney Disease Epidemiology Collaboration equation has been developed. Review of the literature revealed that CG and MDRD formulas correctly assigned overall only 64% and 62%, respectively, of the subjects to their actual K/DOQI-CKD classification's GFR groups as determined by measured GFR (mGFR). This suggests that approximately 10 million (38%) subjects may have been misclassified on the basis of estimated CKD prevalence of 26.3 million adults in the United States. The purpose of this review is to help the clinician understand the limitations of using eGFR in daily practice. We also elaborate upon issues such as the differences among markers of mGFR, the validity of adjusting GFR for body surface area in certain populations, the limited data on boundaries for normal mGFR according to age, gender, and race, the need for calibration of a wide spectrum of serum creatinine measurements, the lack of actual eGFR value above 60 ml/min per 1.73 m2 and reference for normal mGFR in the clinical laboratories' reports, and the performance evaluation of the eGFR formulas. Several pitfalls have to be overcome before we can reliably determine health and disease in daily nephrology practice to preserve the first rule of practicing medicine: primum non nocere. © 2011 by the American Society of Nephrology.


Yanagimachi R.,Hawaii Medical
Systems Biology in Reproductive Medicine | Year: 2011

For natural fertilization to occur successfully, millions of spermatozoa must be deposited in the lower end of the female genital tract during mating. Considerably fewer spermatozoa are required for fertilization when spermatozoa are deposited in the upper region of the female tract. The extreme case of assisted fertilization is the direct injection of a single spermatozoon into an oocyte in vitro, which is referred to as intracytoplasmic sperm injection or ICSI. All that is required to fertilize an oocyte is a single spermatozoon with a genetically and epigenetically normal nucleus. Even spermatozoa with grossly misshapen heads and no motility at all are able to produce normal offspring by ICSI as long as their nuclei are normal. There is a distinct difference between natural and ICSI fertilization. In ICSI the sperm plasma membrane and the acrosome, which never enter the oocyte's cytoplasm during natural fertilization, are injected into an oocyte. There are reports that the oocytes injected with acrosome-less spermatozoa develop better than those injected with acrosome-intact spermatozoa. At least in the mouse, pre-spermatozoal cells (e.g., round spermatids) are able to produce fertile offspring by injection into oocytes. Whether 'spermatozoa' produced from embryonic stem (ES) or induced pluri-potent stem (iPS) cells are functional remains to be determined. Will assisted reproduction increase overall male infertility by spreading genes involved in infertility? This is most unlikely in view of the widespread propagation of spontaneous mutation in the general population. When assisted reproduction technologies are perfected, pregnancy through assisted reproduction will become as safe as pregnancy through natural conception. Copyright © 2011 Informa Healthcare USA, Inc.


Srikiatkhachorn A.,University of Massachusetts Medical School | Kelley J.F.,Mahidol University | Kelley J.F.,Hawaii Medical
Antiviral Research | Year: 2014

Therapies to prevent or reverse endothelial dysfunction and vascular leak found in dengue hemorrhagic fever (DHF) have not been identified. In this review we summarize dengue viruses and the spectrum of human disease and highlight evidence of endothelial cell dysfunction in DHF based on studies in patients and mouse and tissue culture models. Evidence suggests that both virus antigen and host immune response, can cause endothelial cell dysfunction and weaken endothelial barrier integrity. We suggest possible therapeutic interventions and highlight how therapies targeting altered endothelial function might be evaluated in animal models and in patients with DHF. © 2014 Elsevier B.V. All rights reserved.

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