Nineteen of the top board alerts for Allergy & Immunology – pearls, tips, memory aids, and “secrets” from experts in the field.

1. Intranasal steroids are the single most effective drug for treatment of allergic rhinitis. Decongestion with topical adrenergic agents may be needed initially to allow corticosteroids access to the deeper nasal mucosa.
2. ACE inhibitors can cause dry cough and angioedema.
3. Beta blockers should be avoided whenever possible in patients with asthma because they may accentuate the severity of anaphylaxis, prolong its cardiovascular and pulmonary manifestations, and greatly decrease the effectiveness of epinephrine and albuterol in reversing the life-threatening manifestations of anaphylaxis.

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The bottom line is that soaking a Hamstring graft during surgery in a Vancomycin saline solution (500mg Vancomycin in 100cc NS) has been shown to completely eradicate HS ACLR infection.  There are 4 relevant recent papers on this point below. The abstracts are linked below.  

1. et al found that HS grafts had a 1.52% infection rate vs 1.03% for BTB grafts. This half percent difference is obviously quite small but has caused some to avoid HS grafts
2. et al in 2012 found that soaking the grafts in Vancomycin during surgery eliminated infections, whereas without Vancomycin the infection rate was 1.4%. et al from this same group in Australia published a larger follow-up study in 2017 with essentially identical results
3. et al found that 22% of grafts were culture positive.

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Elsevier authors share their advice for medical students preparing for residency.   “Approach every case with humility, not trying to show off what you already know, but trying to discover what new there is for you to learn. And on the days when you hate residency (and you will have those days) never forget thatMORE

Blood components are without a doubt some of the most utilized tools in a clinician’s arsenal to tackle a number of complications of hospitalized patients and of late a growing number of transfusion-dependent outpatients. At times, the use of blood seems … MORE