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Left ventricular hypertrophy is an adaptive state of the heart to increase in wall stress. It is common in hypertension. The prevalence of Left ventricular hypertrophy increases with age and based on ECG criteria is nearly 10 times more common in patients with blood pressure of more than 160/90 mm hg than in normotensives. Furthermore the presence of LVH has important prognostic implications for patients with hypertension. Though echocardiography is superior to electrocardiography in detecting LVH in patients with hypertension, it is costly and not widely available in our country. Hence it is important to study the reliability of clinical signs, chest X-ray and electrocardiography in diagnosing LVH in hypertensive patients.

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In the past, only people diagnosed with celiac disease, approximately 1% of the population, avoided gluten consumption through all their meals. However, popular media often now mistakenly present gluten-free foods as being a healthier choice, and more people have now concluded that gluten is a harmful part of the diet. A review of literature on gluten-free diets, gluten sensitivity, celiac disease, and attitudes toward gluten consumption was undertaken to examine the prevalence and consequences of adopting a gluten-free diet and to provide guidance to healthcare practitioners whose patients are now often adopting this diet without medical input. Aside from celiac disease, nonceliac gluten sensitivity (NCGS) occurs in those persons in which gluten ingestion leads to symptomatic manifestations in the absence of celiac disease or wheat allergy but who report a remission of certain symptoms after removing gluten from their diet. However, it was been shown that a large percentage of people who claim NCGS do not feel those manifestations under a double-blind challenge to gluten. Moreover, some parents, believing that ingesting gluten is detrimental for their health, adopt gluten-free diets for their children. A review of existing data shows that there are detrimental effects to going gluten free, including loss of the dietary fiber, deficiencies in dietary minerals and vitamins, and potential heavy metal exposure. Healthcare practitioners should query patients about their dietary choices, and in cases of questionable adoption of gluten-free diet, patients and parents are educated about the detriments of a gluten-free diet, and in cases where patients continue to insist on gluten-free foods, referrals to nutritional counseling are warranted in order to minimize potential harm

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The association of a thyroid storm and diabetes ketoacidosis is relatively rare. We report two cases.The first one is a 20 years old woman, with no history of diabetes, who came with ketoacidosis, a history of non-medicated thyrotoxicosis, and she was complaining about fever, a thyrotoxicosis syndrome, a vascular goiter, and exophthalmos. Her general condition had improved significantly after the treatment in emergency and under maintenance therapy.The second one is a 54 years old female, with a case of diabetes mellitus, who presented a ketoacidosis. But despite the control of the situation, the patient’s consciousness level became disturbed and she presented hyperthermia. The thyroid function tests revealed hyperthyroidism. Thus, thyroid storm was evocated and managed. The patient finally passed away despite the prompt medical care. In these two cases, a thyroid storm, associated with Graves’ disease covered by diabetic ketoacidosis was the final diagnostic.Thereby, for patients having diabetic ketoacidosis we should seek an eventual thyroid storm, and vice versa: in fact, there are some symptoms in common. But there are scores to help systematize the diagnosis. The management is acutely controlled based on antithyroid drugs in high doses, betablockers and corticosteroids. We should not disregard the search for and treatment of precipitating factors: ketoacidosis in our cases. And identify the thyroid underlying disease: most commonly Graves' disease

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A carbuncle is a bacterial infection that develops from cluster of furuncles leading to a single large mass. It is common in diabetics and occurs frequently at nape of the neck and back. Treatment of carbuncle is surgical and occasionally they can end up in local and systemic complications based on their location. We hereby report a case of carbuncle that occurred in a 50 year old patient which diabetes. He underwent wide excision.