Ectopic pregnancies are one of the most common obstetric diagnoses made in the emergency department. Once diagnosed, patients can be managed expectantly, medically, or surgically. Decisions regarding patient management are made using evidence-based protocols. Hemodynamically stable patients with reduced beta-human chorionic gonadotropin (HCG) levels and a small mass on ultrasonography are managed with methotrexate therapy. Although most patients adequately treated with methotrexate resolve, there are a few rare instances where patients progress to develop a ruptured ectopic despite having low and declining beta-HCG levels. These patients must be taken for surgical evacuation at the earliest opportunity to prevent life-threatening hemorrhage. Hence, obstetricians must be prepared for such potential complications of low-risk ectopic pregnancies.

Endometrial carcinoma is the leading cause of gynecologic malignancies in the United States. Unlike other malignancies, endometrial carcinoma presents early with the most common clinical symptom being uterine bleeding (including irregular menses, inter-menstrual bleeding, and postmenopausal bleeding, or PMB). Hence, the evaluation of PMB should have efficient and effective strategies to prevent a missed diagnosis of malignancy and to facilitate an early diagnosis for potentially curative treatment.Transvaginal ultrasound is appropriate to evaluate PMB initially. If imaging reveals an endometrial thickness of ≤4 mm, endometrial sampling is not warranted, given the high negative predictive value (>99%) of this finding for endometrial carcinoma. In women with persistent or recurrent bleeding, if blind endometrial sampling does not show endometrial hyperplasia or malignancy, further testing with hysteroscopy with dilation and curettage is indicated. However, in cases of PMB with an endometrial thickness of ≤4 mm on transvaginal ultrasound, little information can be gained from endometrial sampling alone as the chance of getting an adequate sample is low and malignancy is rare. For such patients, outpatient hysteroscopy has become a convenient and cost-effective procedure that may be done before an endometrial sampling.

BACKGROUND Dermatoglyphics is considered to be a window to a child's personal characteristics and a sensitive indicator of brain function abnormalities. Widespread interest in epidermal ridges is developing in the medical field. In this study, certain specific patterns were prominent in high, intermediate and low IQ groups which were characteristic of these groups. METHODS This cross-sectional study was conducted on 1000 school going children in the South Indian population. Hand prints were taken using the lipstick method. A modified version of the Wechsler PreSchool and Primary Scale of Intelligence was used to assess the intelligence of the students and they were accordingly grouped into high, intermediate, and low intelligence quotient groups. The hand prints from each of the intelligence groups were analysed thoroughly using standard parameters such as fingertip pattern, finger ridge count, palmar ridge count, and palmar angles. The results were tabulated and interpreted. RESULTS High intelligence levels showed the highest proportion of loops in all their digits. As the intelligence level decreased, the incidence of the arches and whorls increased. The thumb and 1 st digit especially showed these variations. The 4 th digit shows the highest incidence of loops in the high intelligence group with a number of 468, that is, 80.7% of loops. When taking the 1 st digit into consideration, the high intelligence quotient group showed 61.4% of loops, while the intermediate level shows just 54.5% of loops. The 1 st digit of the low intelligence level is the only one in the entire study to show more number of whorls than loops. Nearly half the patterns, that is 47.9%, were whorls in the low IQ group. The thumb also showed a higher number of whorl patterns and arch patterns with 36.6% and 20.6% respectively in low IQ group. In the low IQ level group, there is a significant difference between the total and absolute finger ridge count, indicating a greater prominence of whorl patterns. As the intelligence decreases, the difference between the total and absolute finger ridge counts increases, which correlates with the increase in the incidence of whorls. And finally, we found that the A-B ridge count increases as the intelligence decreases. CONCLUSIONS This study thus attempts to determine certain dermatoglyphic patterns in children of 4 to 7 years of age of varying intelligence quotient which may be extremely helpful in future studies by proving a basal patterning. It calls for further studies in the future to establish a definite relationship between intelligence and observed patterns.

Background: Hard faeces result in local trauma to the rectal mucosa which secondarily activates internal anal sphincter hypertonia. This will compress end arteries of the anus and cause ischemia of the posterior commissure and eventually anal fissures. A precipitating history of constipation is found in approximately 20% of patients with anal fissures. Constipation is one of the classic signs of hypothyroidism.Methods: Patients who presented to the surgical OPD of Saveetha Medical College and Hospital, Thandalam, India during the months of March and April of 2019 with lower abdominal complaints were screened for fissure in ano. The thyroid profile of these patients was analysed.Results: 38.2% of patients with lower gastrointestinal complaints and 3.6% of the total number of patients presenting to the surgical OPD were attributed to an anal fissure. The incidence of hypothyroidism in patients with an anal fissure is 32%. Since the incidence of hypothyroidism in our study is higher than the prevalence of hypothyroidism in the general population as documented by multiple studies in the past, we can conclude that there is a significant association between hypothyroidism and development of anal fissures.Conclusions: By analysing the thyroid profile in patients with anal fissures, we found an association between the two entities. This information can be used to predict and prevent anal fissures in hypothyroid patients.