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 Methotrexate (50 mg/m2 intramuscularly and 50 mg orally) followed by vaginal misoprostol have proven to be > 90% effective at causing abortion in women at less than 49 days’gestation. Although the effectiveness of the oral dose (which has a lower serum bioavaiIability) demonstrates that a methotrexate dose of 50 mglm’may be more than necessary, an intramuscular regimen is more advantageous because it is less costly. This trial was designed to investigate the potential effectiveness of a single dose of methotrexate, 75 mg intramuscularly, in a regimen for early abortion. One hundred subjects received 75 mg methotrexate intramuscularly followed 5 to 6 days later by 800 pg misoprostol vaginally. The misoprostol dose was repeated if the abortion did not occur. Outcome measures included successful abortion (complete abortion without requiring a surgical proce- dure), duration of vaginal bleeding, and side effects. One subject was lost to Jollow-up. Complete abortion oc-

 Contraception Volume 56, Issue 6, December 1997, Pages 367-371 Original research article Medical abortion with methotrexate 75 mg intramuscularly and vaginal misoprostol Author links open overlay panelMitchell D.Creinin https://doi.org/10.1016/S0010-7824(97)00173-X Get rights and content Abstract Methotrexate (50 mg/m2 intramuscularly and 50 mg orally) followed by vaginal misoprostol have proven to be > 90% effective at causing abortion in women at less than 49 days' gestation. Although the effectiveness of the oral dose (which has a lower serum bioavailability) demonstrates that a methotrexate dose of 50 mg/m2 may be more than necessary, an intramuscular regimen is more advantageous because it is less costly. This trial was designed to investigate the potential effectiveness of a single dose of methotrexate, 75 mg intramuscularly, in a regimen for early abortion. One hundred subjects received 75 mg methotrexate intramuscularly followed 5 to 6 days later by 800 μg misoprostol v

  Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs.[5] This initial stage is followed by suppression of the immune system.[9] Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.[2] There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection.[3] The very young, old, and people with a weakened immune system may have no symptoms of a specific infection, and the body temperature may be low or normal instead of having a fever.[3] Severe sepsis causes poor organ function or blood flow.[10] The presence of low blood pressure, high blood lactate, or low urine output may suggest poor blood flow.[10] Septic shock is low blood pressure due to sepsis that does not improve after fluid replacement.[10] SEPSIS Sepsis Andrew J Brent   Abstract Sepsis occurs when a dysregulated host respon

 CERVICOGENIC HEADACHE Samer Narouze, MD, MSc, DABPM, FIPP Cervicogenic headache was initially defined as unilateral headache that is provoked by neck movement or pressure over tender points in the neck with associated reduced range of movement of the cervical spine. The headache occurs in nonclustering episodes and is usually nonthrob- bing in nature, originating from the neck, and spreading over the head.'? It is sometimes difficult to differentiate among cervicogenic headache, migraine, and tension-type headache based only on the clinical presentation.+¢ How- ever, diagnostic blockade of the nerve supply of these cervical structures or intra-articular injection of local anes- thetic into the affected joint help establish the diagnosis; in fact, this is now considered a major criterion for the diag- nosis of cervicogenic headache.’ Also, it was long thought that cervicogenic headache should be only unilateral, but recent reports state that cervicogenic headache can be either unil

 Urine Osmolality Urine osmolality is used to measure the number of dissolved particles per unit of water in the urine. As a measure of urine concentration, it is more accurate than specific gravity. Urine osmolality is useful in diagnosing disorders of urinary concentration such diabetes insipidous and in assessing hydration status. Often, the assessment of any disorder involving antidiuretic hormone (ADH) will require both serum and urine osmolality to assess concentrating ability of the kidney. Normal urine osmolality is as follows [1] : 12- to 14-hour fluid restriction: >850 mOsm/kg H 2O (SI units) Random specimen: 50-1200 mOsm/kg H 2O, depending on fluid intake, or 50-1200 mmol/kg (SI units) Interpretation An individual with a normal diet and normal fluid intake has a urine osmolality of approximately 500-850 mOsm/kg water. After age 20 years, the upper level of the reference range declines by about 5 mOsm/kg/year. In the setting of excess fluid intake, a healthy kidney can con

 Uses of Misoprostol in Obstetrics and Gynecology Rebecca Allen, MD, MPH and Barbara M O’Brien, MD Abstract Misoprostol is a synthetic prostaglandin E1 analogue that is used off-label for a variety of indications in the practice of obstetrics and gynecology, including medication abortion, medical management of miscarriage, induction of labor, cervical ripening before surgical procedures, and the treatment of postpartum hemorrhage. Due to its wide-ranging applications in reproductive health, misoprostol is on the World Health Organization Model List of Essential Medicines. This article briefly reviews the varied uses of misoprostol in obstetrics and gynecology. Key words: Misoprostol, Induced abortion, Induction of labor, Postpartum hemorrhage, Cervical ripening, Hysteroscopy Misoprostol is a synthetic prostaglandin E1 analogue marketed as an oral preparation used to prevent and treat gastroduodenal damage induced by nonsteroidal anti-inflammatory drugs (NSAIDs). However, misoprostol is