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Background- Gestational diabetes mellitus (GDM) is the most prevalent metabolic disorder during pregnancy and is associated with increased risks of cardiovascular morbidity and mortality in later life. Compromised cardiac energy production is an important contributor to most forms of heart disease. The changes in myocardial energetics in GDM have not been characterized previously. Objective- We investigated if women with GDM in the third trimester of pregnancy exhibit adverse cardiac alterations in myocardial energetics, function or tissue characteristics. Methods- Thirty-eight healthy pregnant (HP) women and thirty women with GDM were recruited. Participants underwent phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance for assessment of myocardial energetics (phosphocreatine to ATP ratio (PCr/ATP)), tissue characteristics, biventricular volumes and ejection fractions, left ventricular (LV) mass, global longitudinal shortening (GLS) and mitral in-flow E/A ratio. Results- Participants were matched for age, gestational age and ethnicity. The women with GDM had higher body-mass index (27±4 versus 33±5kg/m2; p=0.0001), systolic (115±11 versus 121±13mmHg; p=0.04) and diastolic (72±7 versus 76±9mmHg; p=0.04) blood pressure. There was no difference in NTproBNP concentrations between the groups. The women with GDM had lower myocardial PCr/ATP ratio (2.2±0.3 versus 1.9±0.4; p Conclusions- Despite no prior diagnosis of diabetes, women with obesity and GDM manifest impaired myocardial contractility and higher LV mass, associated with reductions in myocardial energetics in late pregnancy compared to lean women with healthy pregnancy. These findings may aid our understanding of the long-term cardiovascular risks associated with GDM.

Kikuchi's disease is a rare condition that mainly presents in young females along with lymphadenitis. Involvement of the nervous system is rare. We report a young female who presented with fever, headache, vomiting, lymphadenopathy and neurological manifestations in the form of aseptic meningitis, ataxia and paraparesis. Since the disease can be mistaken clinically and histologically for SLE, lymphoma and tuberculosis it is important to differentiate it from these conditions. Also our case emphasizes the importance of recognising this disorder in diagnosing patients with meningitis.

Drug hypersensitivity with myocarditis is known to occur with many drugs especially with antiepileptics, sulpha-compounds and daposne. Dapsone (4, 4 diaminodiphenyl sulphone) induced hypersensitivity is known to occur in about 2% of leprosy patients on treatment and an incidence of 1.66% in non-leprosy patients. We report this rare case of dapsone hypersensitivity syndrome in a girl on dapsone who presented with fever, anaemia, jaundice, skin rash, lymphadenopathy, and hepatomegaly and later developed myocarditis. The drug was withdrawn and the patient was treated with steroids. She improved and was discharged. She relapsed after the corticosteroids were discontinued at home.