Good's syndrome or thymoma-associated immunodeficiency is a rare clinical entity that is often presumed to be common variable immunodeficiency, due to lack of awareness and recognition of this syndrome. This syndrome more often goes unrecognized if a thymoma is not detected. An appropriate immunological work-up that aids timely diagnosis and adequate therapy with antimicrobials and intravenous immunoglobulins are mandatory to prevent the long-term complications and mortality associated with this syndrome. We present the clinical and immunological profile of a young man with Good's syndrome that was initially presumed to be common variable immunodeficiency.

The guidelines for cardio-pulmonary resuscitation are updated every five years. Basic life support is the foundation for saving lives after cardiac arrest. BLS encompasses three major aspects: airway control, artificial respiration and cardiac massage.The 5 links in the adult Chain of Survival areA strong Chain of Survival can improve chances of survival and recovery for victims of heart attack, stroke and other emergencies. In this article, we reviewed the recent advances in the updated CPR guidelines.

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BACKGROUNDPneumomediastinum is an uncommon condition which is defined by the presence of air in the mediastinum. It may result from a number of causes, but at times the underlying aetiology remains obscure. The present study aims to review the clinical and imaging features in patients who presented with pneumomediastinum alone or in association with other findings in order to establish the aetiological diagnosis. We report here, a series of cases with pneumomediastinum of various unusual aetiologies and also the clinical profile, predisposing factors and outcome of these patients along with the associated complications. METHODSWe retrospectively reviewed the records of all patients who presented to the respiratory unit of our hospital with the diagnosis of pneumomediastinum over a period of 2 years from 2013-2015. The cases of pneumomediastinum resulting from trauma and iatrogenic causes were excluded from the study. RESULTSA total of six patients (4 males and 2 females) with pneumomediastinum were identified during the study period after applying the exclusion criteria. The most common presenting symptom in these cases was shortness of breath followed by dry cough, chest pain and fever. Subcutaneous emphysema and Hamman sign was identified in one patient each. Of the six cases, preexisting lung disease was identified in 3 patients and these included connective tissue disease related interstitial lung disease in two cases and combined pulmonary fibrosis and emphysema in one case. In the remaining three cases, the causes of pneumomediastinum were Pneumocystis carinii pneumonia (PCP) in HIV positive patient, pulmonary tuberculosis in another and spontaneous oesophageal perforation in the third. Coexisting pneumothorax was present in 3 out of 6 cases. The mean duration of hospital stay in these six patients was 8 days. No recurrence of pneumomediastinum was seen in any of the six patients during six months of followup. CONCLUSIONSPneumomediastinum is a condition with diverse aetiologies. It is important to identify the underlying cause of pneumomediastinum in order to manage these patients. Spontaneous pneumomediastinum needs to be differentiated from secondary pneumomediastinum as the latter is a more morbid condition and has to be managed promptly in order to avoid unfavourable outcome.