You are creating a comprehensive, visually professional PowerPoint (.pptx) presentation on **Diabetes Mellitus — Case Presentation for MD Anaesthesia** students. ## STEP 1: Read the PPTX skill Read `/home/daytona/skills/pptx/pptxgenjs.md` for full PptxGenJS instructions. ## STEP 2: Read relevant medical content from textbooks Use query_library_db to find and read diabetes mellitus sections from anaesthesia textbooks. Run these queries: Query 1 - Find diabetes sections in Barash/Miller/Morgan anaesthesia books: ```sql SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'diabetes' ORDER BY rank LIMIT 20 ``` Then read the most relevant blocks. Key textbooks are: - Barash Clinical Anesthesia 9e (ISBN 9781975199074) - Miller's Anesthesia 10e (ISBN 9780323935920) - Morgan and Mikhail's Clinical Anesthesiology 7e (ISBN 9781260473797) Also search: ```sql SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 50) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'diabetes perioperative insulin glucose management' ORDER BY rank LIMIT 10 ``` Read at least 2-3 relevant blocks to get enough content. ## STEP 3: Create the PPTX Create a professional presentation at `/home/daytona/workspace/dm-anaesthesia/DM_Anaesthesia_Case_Presentation.pptx` ### Slide Structure (20-22 slides): 1. **Title Slide** — "Diabetes Mellitus: Case Presentation" subtitle "MD Anaesthesia" with presenter line 2. **Learning Objectives** (4-5 objectives) 3. **Introduction / Epidemiology** — prevalence, surgical incidence in diabetics 4. **Classification of DM** — Type 1, Type 2, LADA, Gestational, Secondary 5. **Pathophysiology** — insulin resistance, beta-cell dysfunction, metabolic consequences 6. **Clinical Case Presentation** — A detailed fictional patient: "Mr. Ramesh Kumar, 58M, T2DM x 12 years, on metformin + glipizide, BMI 32, presenting for elective right hemicolectomy for carcinoma colon. HbA1c 8.2%, FBS 186 mg/dL, recent echo: LVEF 55%, mild LVH, ECG: ST changes V4-V5" 7. **Pre-anaesthetic Evaluation** — history taking points, comorbidities 8. **Systemic Complications of DM** — CVS (CAD, silent ischemia, CAN), Renal (nephropathy), Neuropathy, Retinopathy, Delayed gastric emptying 9. **Preoperative Investigations** — blood glucose, HbA1c, renal function, ECG, Echo, stress test 10. **Anaesthetic Significance of DM Complications** — CAN (orthostatic hypotension, resting tachycardia), autonomic neuropathy, difficult airway (stiff joint syndrome, limited mouth opening), gastroparesis 11. **Perioperative Glucose Management** — target glucose range (140-180 mg/dL), insulin protocols 12. **Drug Management** — stopping metformin 24-48h preop, sulfonylureas, insulin adjustment 13. **Choice of Anaesthesia** — GA vs Regional, pros/cons in DM 14. **Intraoperative Management** — monitoring (glucose every 1-2h), avoid hypoglycemia, manage stress response 15. **Glucose-Insulin-Potassium (GIK) Protocol** — rationale and dosing 16. **Postoperative Management** — glucose monitoring, when to restart oral drugs, ICU admission criteria 17. **Diabetic Ketoacidosis (DKA)** — precipitating factors, diagnosis, perioperative management 18. **Hyperosmolar Hyperglycaemic State (HHS)** — differentiation from DKA, management 19. **Stiff Joint Syndrome & Difficult Airway** — prayer sign, limited mouth opening, clinical significance 20. **Key Points / Take-Home Messages** 21. **References** — Miller's Anesthesia, Barash, Morgan & Mikhail ### Design: - **Color palette**: Deep navy blue (#0A1628) as primary background, gold/amber (#F0A500) as accent, white (#FFFFFF) text - Title slide: Large bold white title on deep navy, gold accent bar - Content slides: Navy header bar with gold accent line, white content area or dark background with white text - Use icons/symbols where possible (Unicode: ⚠ ✓ → ★ ▶) - Tables for comparison slides - Visual hierarchy: bold section labels, regular bullet content - Speaker notes on key slides with additional clinical details ### Technical notes: - Use pptxgenjs (Node.js): `const pptxgen = require("pptxgenjs");` - Layout: LAYOUT_16x9 (10" × 5.625") - Write script to `/home/daytona/workspace/dm-anaesthesia/create_pptx.js` - Run with: `node /home/daytona/workspace/dm-anaesthesia/create_pptx.js` - Output to: `/home/daytona/workspace/dm-anaesthesia/DM_Anaesthesia_Case_Presentation.pptx` First run `ls -la /home/daytona/workspace/` to check existing directories, then create the project directory if needed. Return: 1. Confirmation that the file was created 2. The full file path 3. A brief summary of slides included