CD4 and Lymphocyte count

A 30 yo man from Zambia comes to the ED accompained by his girlfriend, he is HIV positive and he has pneumonia, he never done CD4 count. CD4 count of < 200 signifies a greater risk for opportunistic infections = recovery. I can’t  wait for the reponse of the CD4 count…

How much an absolute lymphocite count (ALC) is predictive for a low CD4 count (< 200)?

Conclusion 

Absolute lymphocyte count was predictive of a CD4 count of <200 · 106 cells ⁄ lL in HIV+ patients who present to the ED, necessitating hospital admission. A CD4 count of <200 · 106 cells ⁄ lL is very likely if the ED ALC is <950 · 106 cells ⁄ lL and less likely if the ALC is >1,700 · 106 cells ⁄ lL.

Bibliography

Absolute Lymphocyte Count in the Emergency Department Predicts a Low CD4 Count in Admitted HIV-positive Patients. Napoli AM Acad Emerg Med 2011; 18:385-389

Acute HIV infection: diagnosis and management in the Emergency Department. Wesley HS. Emerg Med Clin N Am 28 (2010) 381–392.

HIV infection and complications in Emergency Medicine. Marco CA. Emerg Med Clin N Am 26 (2008) 367-387

Ciro Paolillo

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D-dimer and Aortic dissection

It’s 3.00 am when a 55 yo man is accompained to the ED by his wife because of sudden onset precordial pain, he has not clinical history, he does not smoke and he has an active life style, you find a normal blood pressure and clinical examination and a normal ECG, but the pain is severe and continuos. The patient start sweating, and you too. You give morfine and start thinking about….AORTA! you don’t find any pulse difference, but your feeling increases, how can you explain your feeling to the radiologist? 

Can something else help you to rule-out aortic dissection….

Conclusion The presence of pulse deficits or focal neurological deficits increases the likelihood of an acute thoracic aortic dissection in the appropriate clinical setting. Conversely, a completely normal chest radiograph result or the absence of pain of sudden onset lowers the likelihood. Overall, however, the clinical examination is insufficiently sensitive to rule out aortic dissection given the high morbidity of missed diagnosis. A negative D-dimer (<500) can rule-out an aortic dissection. Unfortunately a positive test does not give any additional chance to persuade radiologist… Bibliography Epidemiology of thoracic aortic dissection. LeMaire SA, Russell L. Nat Rev Cardiol. 2011 Feb;8(2):103-13. Epub 2010 Dec 21. Does this patient have an acute thoracic aortic dissection? Klompas M. JAMA. 2002 May 1;287(17):2262-72. Meta-analysis of usefulness of d-dimer to diagnose acute aortic dissection. Shimony A, Filion KB, Mottillo S, Dourian T, Eisenberg MJ. Am J Cardiol. 2011 Apr 15;107(8):1227-34. Epub 2011 Feb 4. D-dimer in ruling out acute aortic dissection: a systematic review and prospective cohort study. Eur Heart J. 2007 Dec;28(24):3067-75. Epub 2007 Nov 6. Sodeck G, Domanovits H, Schillinger M, Ehrlich MP, Endler G, Herkner H, Laggner A. D-dimer as the sole screening test for acute aortic dissection: a review of the literature. Sutherland A, Escano J, Coon TP. Ann Emerg Med. 2008 Oct;52(4):339-43. Diagnostic and prognostic value of circulating D-Dimers in patients with acute aortic dissection. Ohlmann P, Faure A, Morel O, Petit H, Kabbaj H, Meyer N, Cheneau E, Jesel L, Epailly E, Desprez D, Grunebaum L, Schneider F, Roul G, Mazzucotteli JP, Eisenmann B, Bareiss P. Crit Care Med. 2006 May;34(5):1358-64.  Ilenia Spallino

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Why Likelihhod Ratios

http://www.youtube.com/watch?v=ppt0WrsTD4w Read more...

why this blog?

A Life at Risk:what is the risk for a returning traveler with fever from an area at risk for malaria despite a negative blood smear? what is the risk for a patient with a right-sided pain to have a AAA that mimic a acute cholecystitis? what is the risk to a woman that complains of fever and stranguria and urine negative to have a urinary tract infection? we will discuss this and more on our blog.

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