No abstract

Background:Hirsutism is a common clinical condition characterized by presence of terminal hair at body sites under androgenic influence. Inspite of the significant worldwide prevalence of hirsutism, studies on hirsutism from India are not many.Objective:To assess the etiology of hirsutism and correlate its severity with underlying causes and various hormone levels.Materials and Methods:In this prospective study, 40 patients of hirsutism enrolled on first come basis were included. All patients underwent detailed clinical assessment and transabdominal ultrasonography. Free and total testosterone, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, luteinizing hormone, follicle stimulating hormone, prolactin, free tri-iodothyronine, free tetra-iodothyronine, and thyroid stimulating hormone, and sex hormone binding globulin were estimated. Forty age-matched controls without features of hyperandrogenemia were included for the comparison.Results:Thirteen (32.5%) patients had mild, 52.5% had moderate whereas 15% had severe hirsutism. Positive family history was documented in 42.5% patients. The clinical features found to be associated with hirsutism included acne (55%), menstrual irregularities (40%), acanthosis nigricans (37.5%), obesity (37.5%), and androgenetic alopecia in 27.5% of patients. Polycystic ovarian syndrome (PCOS) was the underlying cause in 70%, non-classical congenital adrenal hyperplasia and hypothyroidism in 7.5% each whereas idiopathic hirsutism was found in 15% patients.Conclusion:PCOS was the most common cause of hirsutism found in the instant study. Further, there was positive correlation between severity of hirsutism and free testosterone levels.

Methylmalonic acidemia (MMA) is most common inherited type of organic acidemia. It has diverse presentation in older infants without any initial apparent symptoms. MMA sometimes present with sudden metabolic decompensation, which may mimics common emergencies like septic shock and diabetic ketoacidosis (DKA) without early recognition can be fatal. In born error of metabolism especially organic acidemia should be suspected in any infant presented with severe high anion gap metabolic acidosis. We report two cases of MMA in infants presented acutely mimicking DKA and septic shock.

Introduction: Varicella gangrenosa is an uncommon but serious complication of chicken pox in young children. It should be suspected in any child with a history of varicella infection and increasing complaints of pain and swelling in an extremity or other body area, along with increasing fever, erythema, lethargy, and irritability. Early surgical intervention with intensive antibiotic therapy is essential to prevent fatal consequences. Case Presentation: We describe a case of a previously healthy child who presented with sepsis due to varicella gangrenosa. While she initially responded well to a conservative antibiotic and acyclovir treatment, her subsequent rapid deterioration required urgent and repeated debridement. Conclusions: This report highlights the significance of prompt diagnosis and early surgical intervention for management of varicella gangrenosa.