ABSTRACT
The Diabetes Care in Haemodialysis (DiH) working group aims to improve the care of people with diabetes mellitus on the haemodialysis unit by supporting the implementation of the 2016 JBDS guidelines. In order to support the implementation of the guideline recommendations the DiH working group have established a set of standards, developed an audit tool to demonstrate adherence to standards, and have developed educational support for haemodialysis staff both online and delivered face-to-face. We publish audit findings from five distinct haemodialysis units, highlighting the impact of the educational programme on the achievement of guideline standards. We also report the impact of the COVID-19 pandemic on diabetes care and quality improvement.
ABSTRACT
Objective: To determine the efficacy and safety of a self-administered nasal spray targeting the sphenopalatine ganglion (SPG) for acute migraine treatment during the COVID-19 pandemic. Background: The SPG is a nerve bundle that lies in the pterygopalatine fossa with important parasympathetic outflow to the craniofacial structures. It is a known target for the acute treatment of migraine. Anesthetic blocking of the SPG may modulate sensory processes in the trigeminal nucleus caudalis, possibly reducing central sensitization of pain in headache. Blocks can be done via needle injection or catheter device insertion to deliver anesthetic to the SPG. During clinic closures due to COVID-19, visits were shifted to telemedicine and there was an increasing need for treatments that would minimize office and emergency room visits. Design/Methods: At the start of the pandemic, a nasal spray anesthetic targeting the SPG was prescribed to patients with migraine. Patients were prescribed 1% lidocaine, 2% lidocaine, or 0.5% ropivacaine spray. They were instructed to deliver 0.1cc per dose spray in each nostril and lie back with their head tilted towards the ipsilateral side, for use up to 5 times monthly as needed. A retrospective chart review of 53 patients receiving this treatment was conducted. Analysis included headache improvement and reported side effects. Results: Overall 76% of patients reported headache improvement acutely. Further, response to all 3 formulations demonstrated majority improvement (89% with 1% lidocaine, 68% with 2% lidocaine, and 81% with 0.5% ropivacaine). Few side effects were reported, only a brief episode of epistaxis in one patient on the 5th usage and transient headache exacerbation in one other patient. Conclusions: Self-administered anesthetic nasal spray targeting the SPG is likely an effective and safe home acute treatment for migraine attacks. This treatment was of particular benefit for patients during pandemic clinic closures.
ABSTRACT
The outbreak of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in mid-December 2019, from Wuhan, Hubei Province, China, and its spread across China and beyond has taken the world by surprise. On March 11, 2020 WHO (World Health Organization) declared it a global pandemic. Herein, we discuss the epidemiological trends, clinical and diagnostic findings, management, and investigative therapies of this disease and also reflect upon how it might be different in India from the rest of the world.