Eculizumab-related drug reaction in a patient with neuromyelitis optica.

Eculizumab is approved for treatment of antibody positive neuromyelitis optica, myasthenia gravis, and hematologic disorders like paroxysmal nocturnal hemoglobinuria. Drug rash has not yet been reported as a side effect of eculizumab. We report a case of a cutaneous drug reaction soon after introduction of eculizumab therapy in a patient with refractory neuromyelitis optica. Clinicians should be aware of a drug reaction as a possible adverse reaction to eculizumab.

Efficacy of Platelet-Rich Plasma in Reduction of Post-Operative Split-Thickness Skin Graft Loss and Hematoma Formation: A Meta-Analysis.

Split-thickness skin grafting is a very popular technique of wound closure, especially for large wounds. The success rate of a split-thickness skin graft (STSG) has consistently been in the range of 70-90%. Multiple techniques have been introduced to further improve graft survival, for example, the use of autologous platelet-rich plasma (PRP), thrombin gel, platelet-rich fibrin matrix, and negative pressure wound therapy. We evaluated the impact of PRP use on the survival of STSG through a meta-analysis. We conducted the analysis in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) protocol and performed a literature search using the following databases: PubMed, Cochrane, and ClinicalTrials.gov. A total of 126 articles were yielded by the search, out of which four randomized controlled trials (RCTs) were included according to our eligibility criteria and irrelevant articles were excluded. The intervention group received PRP application to the wound bed before applying the graft while the control group received treatment with conventional fixation procedures (sutures and staples). We estimated the pooled odds ratio with a 95% confidence interval (CI). The total number of participants in the analysis was 460. The participants had wounds of varying etiology. Post-operative graft loss and hematoma formation were taken to be the primary and secondary outcome measures, respectively. Thirty-four participants suffered graft loss of differing extent in the control group while three participants suffered graft loss in the intervention group. The pooled odds ratio for graft loss was 0.15 (95% CI: 0.05-0.49; I2=38%; p=0.184) signifying that PRP use decreased the odds of graft loss by 85%. For our secondary outcome measure, 440 participants were studied. Forty-four participants suffered hematoma formation in the control group versus 11 in the intervention group. The pooled odds ratio for hematoma formation was calculated as 0.21 (95% CI: 0.09-0.50; I2=0%; p=0.869) signifying that PRP use decreased the odds of hematoma formation by 79%. PRP appears to significantly impact graft survival, and further studies are needed to strengthen the evidence base for its use in split-thickness skin grafting.

Moyamoya Disease: A Review of Current Literature.

Moyamoya disease (MMD) is an infrequent disease of cerebral vasculature characterized by long-standing and progressive occlusion of large intracranial arteries. It is seen predominantly in the East Asian population. Most of the cases of MMD are sporadic, but there is a small percentage that is familial. The mode of inheritance is reported to be autosomal dominant with incomplete penetrance. Studies show that the susceptibility gene of MMD is located on chromosome 17. The clinical presentation is variable and is influenced by the age and geographic region of the patient. Children mainly present with ischemia-related neurologic episodes whereas MMD in adults can manifest as either an ischemic event or an intracranial hemorrhage (ICH). The gold standard investigation for diagnosis is cerebral angiography which reveals a smoky appearance of arteries at the base of the skull, thus granting the disease its name. The treatment is mostly surgical and includes direct and indirect revascularization procedures, which prevent the recurrence of both ischemic and hemorrhagic strokes. However, combination revascularization procedures are now on the rise due to studies showing better long-term outcomes. The aim of the article is to critically analyze the current literature and updates on various aspects of MMD including, but not limited to, etiology, diagnosis, and treatment.