Boerhaave Syndrome: An Uncommon Cause of Hydropneumothorax

We report the case of a 52-year-old patient with type 2 diabetes mellitus diagnosed with adenocarcinoma rectum, presenting with the complaint of breathlessness to the emergency department. Chest radiograph done showed a left-sided hydropneumothorax with mediastinal shift to the right side. Tube thoracostomy was done. Pleural fluid was exudative; there was no evidence of malignancy. The patient developed a right-sided pleural effusion; anaerobic bacteria were grown on pleural fluid culture. Computed tomography (CT) of the chest was done in view of the new onset empyema on the right side. The CT showed pneumomediastinum and periesophageal air pockets. Orally administered methylene blue had appeared in the pleural drain confirming the diagnosis. The patient was taken up for feeding jejunostomy and repair of tear was planned for a later date. He succumbed to sepsis due to empyema.

Detection of HIV drug resistance mutations in pregnant women receiving single dose Nevirapine in south India.

Background: Single dose of Nevirapine to prevent mother to child transmission of HIV is the commonest preventive regimen in resource-limited countries. Objectives: The objective of this study was to detect drug-resistant virus after single dose of Nevirapine (sdNVP) provided to delivering HIV seropositive (HIV+ve) women and to evaluate the time taken for its decay. Results: Of the 36 consenting HIV+ve pregnant women enrolled into the study, the mean hemoglobin and total lymphocyte counts were 10.8 g/dl and 1843 cells/mm 3 , respectively. Mean CD4 counts in 64% of women was 363 cells/mm 3 and mean viral load for 16/36 women was 28,143 copies/ml of plasma. Nevirapine-resistance mutations were detected in 28% of women at delivery; using OLA (Oligonucleotide Ligation Assay). K103N mutations were seen in 19.4% of women while the Y181C mutation was seen in 5%. Both the mutations were detected in 2.7% of women. Sequential blood samples collected at delivery, 7-10 days, 6 weeks, 4 months, 6 months and one year postpartum showed that 81% of K103N mutations and 66.7% of Y181C mutations were detected at 6 weeks postpartum . Wild-type virus had replaced the mutants by one year postpartum in all women except one. Conclusion : These observations are relevant for future treatment with antiretroviral therapy in these women for their HIV disease.