Cervical necrotizing fasciitis in an uncontrolled type II diabetic patient

We report a case of cervical necrotizing fasciitis (CNF) in a female having uncontrolled type II diabetes mellitus. The patient was presented to us after 20 days of preliminary symptoms. The aetiology of microbial inoculation in subdermal tissue was not known. The isolate was Staphylococcus aureus. In spite of the delay in presentation, the patient was successfully treated with combined antimicrobial and surgical intervention.     

Klippel-feil syndrome-appropos of a case

Klippel-FEIL syndrome is a congenital skeletal malformation characterised by the fusion of various cervical and occasionally thoracic vertebrae, leading to low hair line and short neck. Occasionally it is associated with hearing loss and Sprengel deformity with winging of scapulae. This case is being reported for its rarity     

Development of virtual ophthalmic surgical skills training

BackgroundThis study aims to assess whether ophthalmic surgical skills can be taught successfully online to a diverse international and interprofessional student group.MethodsMixed methods study involving 20 students and 5 instructors. Each student completed a pre-session and post-session questionnaire to assess their perceptions regarding online instruction. Changes in questionnaire responses were analysed using Wilcoxon signed rank (SPSS 25). Semi-structured interviews were conducted to assess instructor perceptions towards virtual surgical skills teaching. Thematic analysis was undertaken using NVivo 12.0 software.ResultsThere was a 100% completion rate of pre- and post-session questionnaires. Prior to the session, lack of instructor supervision and inability to provide constructive feedback were emergent themes from students. Pre-session concerns regarding online delivery: 40% of students thought their view of skills demonstration would be negatively impacted, 60% their level of supervision and 55% their interaction with instructors. Following the session 10%, 15% and 5% held this view respectively. All students were ‘satisfied’ or ‘very satisfied’ regarding the ‘Surgeon’s View’ camera angle as well as the use of breakout rooms. 75% perceived an improvement in their confidence in instrument handling, 80% in cable knot tying and 70% in suture tying. Overall student rating for the virtual surgical skills session was 8.85 (±1.19) out of 10 (10 being most satisfied).ConclusionsWe demonstrate that successful delivery of a virtual ophthalmic surgical skills course is feasible. We were able to widen accessibility and participation through virtual delivery, which has future implications for ophthalmic surgical teaching and its reach.Subject terms: Education, Outcomes research     

Care and monitoring of the anaesthetized patient

Anaesthesia and surgery produce significant physiological changes in the human body. These significant changes mandate the need to monitor the continuously changing physiological parameters for patient safety and optimization. It is not uncommon to encounter iatrogenic harm to the patient during anaesthetic and surgical intervention. This article covers the importance of monitoring and interventions to reduce harm to the patients and promote safety.     

A study of non-obese diabetes mellitus in adults in a tertiary care hospital in Kerala, India

The term Latent Autoimmune Diabetes in Adults (LADA) was introduced to define adult diabetic patients initially non–insulin-requiring but with immune markers of type 1 diabetes that, in a number of cases, progress to insulin dependency. This term has been largely used in the last few years when referring to autoimmune forms of diabetes not requiring insulin initially. In the present study we looked for the clinical, biochemical and immunological parameters of non-obese type 2 diabetes mellitus in adults and studied the frequency of antibodies to glutamic acid decarboxylase (GAD) and pancreatic islet cell antibodies (PICA). Subjects of 30 years or older with a history of diabetes of duration not more than 36 months and body mass index (BMI) of less than 23 kg/m² were included. Fasting serum C-peptide, GAD antibody and islet cell auto antibody was estimated. GAD antibodies were positive in 25.81 %, ICA in 22.58 % and both in 9.70 % of lean diabetes. Fasting serum C-peptide was less than normal in 45.16 % of them.