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BACKGROUNDAlcohol consumption is more common across subpopulations of South India. But the complications associated with alcohol consumption varies across the groups including those defined by age and gender of patient, amount, duration, brand of the alcohol used by the patient. Epidemiological survey conducted across world found that young adults (18 to 25) are at high risk of complications. With respect to gender, men reported more alcohol consumption and binge drinking than women. MATERIALS AND METHODSAll patients with history of alcohol consumption admitted in ICU of Government Royapettah Hospital, Chennai were assessed and followed up from July 2016 to Feb 2017. The diagnosis was made based on the clinical presentation such as ascites, jaundice, upper GI bleed, hepatic encephalopathy, Wernicke's encephalopathy with respect to age, sex, amount and duration of alcohol consumption. RESULTSOut of 52 patients in our study, 2 (3.8%) were female and remaining 50 (96.2%) were male. The higher incidence of complications was in the age group 40-59 yrs., which constituted 33 cases (63%), followed by 20-39 yrs. constituted 17 cases (33%). The least incidence was observed in the age group >60 yrs., 2 cases (4%). The incidence of complications observed in our study were symptomatic liver cirrhosis with minor complications (31%), upper GI bleeding (27%), hepatic encephalopathy (13%), Wernicke's encephalopathy (13%), seizures (12%), hypoglycaemia (4%). CONCLUSIONWe observed that there is an increase in incidence of alcohol-related complications in younger age group. Acute complications without liver cirrhosis like UGI bleed due to erosive gastritis, Wernicke's encephalopathy, seizures and hypoglycaemia were more with those who consumed large quantity of alcohol. Acute-on-chronic complications like UGI bleed secondary to liver cirrhosis and hepatic encephalopathy were directly proportional to duration of alcohol ingestion. In our study, we found that there is transition of acute alcohol-related complications from middle and older age group to younger age group. Hence, proper health education, legislation, early identification and treatment will decrease the morbidity and mortality due to acute alcohol-related complications.

Hypokalaemia presenting as quadriplegia is common, but association with renal tubular acidosis and Sjogren's syndrome is a rare entity. We present a case of 35-year-old female admitted with acute onset quadriplegia with dysphagia for solids and parotid enlargement with normal anion gap metabolic acidosis. CT-abdomen showed bilateral renal stone disease and high positivity of autoantibody (SS-A)/anti Ro and histopathology of minor salivary gland showed lymphocytic infiltrations suggestive of immune mediated destruction of salivary gland meeting the American-European Consensus Classification Criteria of primary Sjogren's syndrome. Patient was managed appropriately with correction of hypokalaemia and acidosis and recovered completely three days after admission.

Primary Pulmonary Hypertension is a rare disease occurring in 1-2 per million population. It is 2-4 times more common in female. Idiopathic or primary pulmonary hypertension is defined as a disorder with no identifiable cause in which resting mean pulmonary artery pressure in adults is above 25 mmHg and 30 mmHg with exercise. Idiopathic or primary pulmonary hypertension is diagnosed after ruling out all the possible secondary causes of pulmonary hypertension. We are presenting a case of middle-aged male who presented with dyspnoea and on further evaluation found to have primary pulmonary hypertension, which is uncommon in male. KEYWORDSPrimary Pulmonary Hypertension, Dyspnoea. On examination, patient was dyspnoeic and tachypnoeic. He was not pale, not icteric; no cyanosis, no clubbing and no bilateral pitting pedal oedema. JVP was elevated and pressure was 12 cm of blood. Pulse 86/min, normal volume, regular rhythm and BP -100/70 mmHg. On examination of cardiovascular system, P2 was palpable, parasternal heave of grade 2 was present, epigastric pulsations were noted. On auscultation second heart sound was loud in pulmonary area with narrow split, ejection systolic murmur heard in the pulmonary area. Mitral, tricuspid and aortic areas S1, S2 heard normally. No other murmur heard. Respiratory system, Gastrointestinal system and Central Nervous System was clinically normal. Clinical features suggested pulmonary hypertension, but the aetiology could not be determined clinically. Patient was further investigated. HOW TO CITE THIS ARTICLE:Complete blood count was normal, urea 36 mg, creatinine 0.9 mg, serum electrolytes were within normal limits.Chest X-ray PA view showed dilated main pulmonary artery with cardiomegaly. Financial or Other, Competing Interest: None. Submission 24-06-2016, Peer Review 22-07-2016, Acceptance 28-07-2016, Published 08-08-2016. Corresponding Author: Poongavanam Paranthaman, 26/5 Moorthy Nagar, Villivakkam, Chennai-49. E-mail: paranthaman1964@rediffmail.com DOI: 10.14260/jemds/2016/1024

BACKGROUND Acute myocardial infarction is one of the most common diagnosis in hospitalised patients, the typical patient with myocardial infarction is a man more than 50 years and a woman more than 60 years of age who presents with severe retrosternal chest pain which is squeezing, heaviness, choking or smothering radiating to left shoulder or jaw. We recently observed that acute myocardial infarction occurs in much younger age, more common in people with history of driving auto rickshaw in Chennai city. We know that risk factors for myocardial infarction are smoking, hypertension, diabetes, dyslipidaemia, obesity, inactivity, etc. but we do not know whether any particular occupation is a risk factor for myocardial infarction. We recently observed that more admissions in ICCU in our hospital with myocardial infarction are young males with history of driving auto rickshaw in the Chennai city for many years. This study aims to find the incidence of acute myocardial infarction in young adults in Chennai city in relation to different occupations.