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As the new kid on the OB/GYN Clinical Alert block, and as the generalist among the editors, I intend to focus on topics that come up commonly in my own practice of obstetrics and gynecology. The beauty of having this format is that cutting edge science can be presented, but also sacred cows can be challenged.
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Moderate levels of activity, including walking, are associated with substantially lower risks of hip fracture in postmenopausal women.
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Delay in treatment to allow for fetal maturity is safe in patients with early stage I cervical carcinoma associated with pregnancy.
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A single dose of 1.5-mg levonorgestrel and a single low dose of 10-mg mifepristone are effective methods for emergency contraception.
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Ventilation/perfusion scanning appears to be safe and effective, at least in ruling out significant clinical pulmonary embolism in pregnant patients. However, prospective studies over longer time periods should be undertaken to validate these conclusions.
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The FDA has mandated a Black Box warning for all estrogen and estrogen/progestin products for use by postmenopausal women. The new warnings are based on analysis of data from the Womens Health Initiative (WHI) study that was published July 2002.
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Within minutes of an acute cerebral ischemic insult, diffusion-weighted magnetic resonance imaging (DWI) demonstrates ischemic regions with a decline in the apparent diffusion coefficient (ADC) of water. ADC decline is associated with impaired high-energy metabolism and loss of ion homeostasis. Animal studies and preliminary observations in humans demonstrate that initial DWI and ADC abnormalities are reversible by early reperfusion.
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Among patients with coronary artery disease, HMG CoA reductase inhibitors (statins) are a mainstay of therapy. These drugs have also become widely prescribed with a low threshold to patients with elevated cholesterol and even minimal cardiac risk factors.
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Intravenous immunoglobulin (IVIG) is safe and effective therapy for acute exacerbations of myasthenia gravis (MG), myasthenic crisis, and for optimizing patients conditions in preparation for thymectomy. Its role in the long-term management of MG remains to be defined.
