Non-responder migraine patients to a first anti-CGRP monoclonal antibody benefit from a switch to a second one. / Efecto beneficioso del cambio a un segundo anticuerpo monoclonal anti-CGRP en pacientes con migraña no respondedores a un primero.

TITLE: Efecto beneficioso del cambio a un segundo anticuerpo monoclonal anti-CGRP en pacientes con migraña no respondedores a un primero.

Síndrome tóxico del segmento anterior: investigación de un brote / Toxic anterior segment syndrome (TASS): studying an outbreak

Introducción: En los últimos años se ha descrito una complicación asociada a la cirugía de cataratas, el síndrome tóxico del segmento anterior. Es un proceso inflamatorio que aparece en las primeras horas tras la cirugía, de carácter no infeccioso y que generalmente se resuelve bien con corticoides tópicos si el tratamiento se instaura con prontitud. En el presente trabajo se describe este síndrome y se analizan las posibles causas de un brote que tuvo lugar en nuestro centro y que afectó a 5 pacientes. Métodos: Se creó un grupo de investigación en el centro que revisó todos los procedimientos implicados, puesto que las causas del síndrome pueden ser múltiples. Se analizaron desde los métodos de lavado y esterilización de material hasta los medicamentos y sustancias utilizadas que pudieron ser causa del brote. Entre estos últimos, se revisaron las sustancias elaboradas en el servicio de farmacia, en especial la solución salina irrigadora, utilizada en todos los casos. Resultados: Los resultados bioquímicos, microbiológicos, de pH, osmolaridad y de endotoxinas indicaron que las soluciones elaboradas en el servicio de farmacia eran correctas. Discusión: Dado que los resultados de los análisis de las sustancias empleadas eran correctos, corroborados con su reintroducción sin efecto adverso alguno, se llegó a la conclusión de que el brote más bien estaría relacionado con el proceso de lavado previo a la esterilización del instrumental utilizado en la cirugía, ya que no se estaban siguiendo las recomendaciones de uso de agua destilada y estéril para este fin, sino que, por el contrario, se estaba utilizando agua corriente de la red (AU)

Introduction: An effect associated with cataract surgery known as Toxic Anterior Segment Syndrome (TASS) has been reported in recent years. It is an inflammatory non-infectious process which appears within the first few hours after surgery and generally resolves well with topical steroids if the course of treatment is started promptly. In this paper we describe the syndrome and analyze the possible causes for the TASS outbreak that occurred in our hospital and affected 5 patients. Methods: As the syndrome may be due to multiple causes, the members of a research team created at the hospital reviewed all the procedures involved. The washing and sterilization methods applied to the materials were analyzed, as well as the drugs and substances used which might have caused the outbreak. We verified the substances prepared by the Pharmacy Department, specially the irrigating solution which was used in all the cases. Results: According to the results obtained in the biochemical, micro-biological, pH, osmolarity and endotoxins assays, the solutions prepared by the Pharmacy Department were all correct. Discussion: Since the results obtained in the analyses of the substances used were correct and no adverse effect was observed after the re-administration of the substances, we may conclude that the outbreak would be related to the washing process performed previously to the sterilization of the instrumentation used in the surgery, mainly because the recommendation to use distilled and sterile water for this purpose was not followed and, on the contrary, tap water continued to be used (AU)

[Toxic Anterior Segment Syndrome (TASS): studying an outbreak]. / Síndrome tóxico del segmento anterior: investigación de un brote.

INTRODUCTION: An effect associated with cataract surgery known as Toxic Anterior Segment Syndrome (TASS) has been reported in recent years. It is an inflammatory non-infectious process which appears within the first few hours after surgery and generally resolves well with topical steroids if the course of treatment is started promptly. In this paper we describe the syndrome and analyze the possible causes for the TASS outbreak that occurred in our hospital and affected 5 patients. METHODS: As the syndrome may be due to multiple causes, the members of a research team created at the hospital reviewed all the procedures involved. The washing and sterilization methods applied to the materials were analyzed, as well as the drugs and substances used which might have caused the outbreak. We verified the substances prepared by the Pharmacy Department, specially the irrigating solution which was used in all the cases. RESULTS: According to the results obtained in the biochemical, micro-biological, pH, osmolarity and endotoxins assays, the solutions prepared by the Pharmacy Department were all correct. DISCUSSION: Since the results obtained in the analyses of the substances used were correct and no adverse effect was observed after the re-administration of the substances, we may conclude that the outbreak would be related to the washing process performed previously to the sterilization of the instrumentation used in the surgery, mainly because the recommendation to use distilled and sterile water for this purpose was not followed and, on the contrary, tap water continued to be used.