To assess the effect of vitamin D supplementation on parameters of insulin sensitivity/resistance (IS/IR) and insulin secretion in subjects with polycystic ovarian syndrome (PCOS). A prospective double-blind randomized control trial was conducted to assess the effect of vitamin D on insulin kinetics in women with PCOS. The trial was conducted in a tertiary care research hospital. A total of 36 subjects with PCOS, aged 18–35 years, were included in this study. Vitamin D3 4000 IU/day versus placebo was given once a month for 6 months and both groups received metformin. IS (by whole-body IS index or Matsuda index), IR (by homeostasis model assessment IR (HOMA-IR)), and insulin secretion (by insulinogenic index; II30) were the main outcome measures. Secondary outcome included blood pressure (BP), lipid profile, disposition index (DI), and vascular stiffness. Out of 36 subjects who consented, 32 completed the study. Subjects were randomized into two groups: group A (n=15; metformin and vitamin D 4000 IU/day) or group B (n=17; metformin and placebo). Oral glucose tolerance tests with 75 g glucose were carried out at baseline and 6 months after supplementation. Hypovitaminosis D was observed in 93.8% of all subjects with mean serum 25 hydroxy vitamin D level of 7.30±4.45 ng/ml. After 6 months of vitamin D supplementation, there was no significant difference in any of the parameters of IS/IR (area under curve (AUC)–glucose, AUC–insulin, insulin:glucose ratio, HOMA-IR, Matsuda index, insulinogenic index, and DI), II30, and cardiovascular risk factors between the two groups. Supplementation of vitamin D, at a dose of 4000 IU/day for 6 months, did not have any significant effect on parameters of IS/IR and insulin secretion in subjects with PCOS.

Coronary cameral fistula is a rare entity and is characterized by an abnormal communication between coronary artery and a cardiac chamber. It is usually congenital and asymptomatic in majority of patients. If symptomatic the patients usually present in childhood. We present a case of 45-year-old male who presented with anginal chest pain and dyspnea on exertion for last 1 year. His exercise treadmill test was positive for ischemic changes and ECG-gated contrast enhanced CT was done for further evaluation. CT showed a large right coronary artery to right atrium fistula. It also ruled out any coronary atherosclerosis as reason for chest pain and ischemic symptoms on exercise treadmill test. The fistula was successfully closed by surgery and there was resolution of chest pain and dyspnea.

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Disorders of sexual development are congenital in nature. Complete androgen insensitivity syndrome (CAIS) is a rare disorder with an incidence of nearly 1 in 20,000 male births. The majority of patients present with complaints of primary amenorrhoea and are phenotypically female but genotypically male. We report a case of a 40-year-old female presenting with backache and skin ulcers who was found to have exogenous Cushing's syndrome with long glucocorticoid administration and suspected CAIS. The ulcers were secondary to intramuscular pentazocine injections.

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