const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Deformities of the Shoulder and Upper Limb";
pres.author = "Orthopaedics Education";

// ── COLOR PALETTE ──────────────────────────────────────────────
const C = {
  navy:    "0D2B4E",   // dominant dark
  teal:    "1E6A7A",   // supporting
  gold:    "D4A017",   // accent
  white:   "FFFFFF",
  lightBg: "EAF3F6",
  slate:   "4A6278",
  offW:    "F4F8FA",
};

// ── HELPER FUNCTIONS ────────────────────────────────────────────
function fetchImagesBase64(urls) {
  try {
    const result = execSync(
      `node /home/daytona/skills/shared/scripts/fetch_images.js ${urls.map(u => `"${u}"`).join(" ")}`,
      { timeout: 30000 }
    ).toString();
    return JSON.parse(result);
  } catch (e) {
    return urls.map(() => ({ base64: null, error: e.message }));
  }
}

function addTitleSlide(pres) {
  const slide = pres.addSlide();
  // Background
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
  // Teal accent bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 4.2, w: 10, h: 0.08, fill: { color: C.teal } });
  // Gold vertical stripe
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.gold } });

  slide.addText("Deformities of the", {
    x: 0.4, y: 1.0, w: 9.2, h: 0.7,
    fontSize: 32, bold: false, color: C.gold,
    fontFace: "Calibri", align: "center",
  });
  slide.addText("Shoulder & Upper Limb", {
    x: 0.4, y: 1.65, w: 9.2, h: 0.9,
    fontSize: 44, bold: true, color: C.white,
    fontFace: "Calibri", align: "center",
  });
  slide.addText("Congenital, Developmental & Acquired", {
    x: 0.4, y: 2.75, w: 9.2, h: 0.5,
    fontSize: 20, color: "A8C8D8",
    fontFace: "Calibri", align: "center", italic: true,
  });
  slide.addText("Orthopaedics  |  Paediatrics  |  Neurology", {
    x: 0.4, y: 4.4, w: 9.2, h: 0.4,
    fontSize: 14, color: "A8C8D8",
    fontFace: "Calibri", align: "center",
  });
}

function sectionDivider(pres, number, title, subtitle) {
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.teal } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.12, fill: { color: C.gold } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.5, w: 10, h: 0.12, fill: { color: C.gold } });

  slide.addText(number, {
    x: 0.5, y: 1.2, w: 9, h: 1.1,
    fontSize: 72, bold: true, color: "FFFFFF20",
    fontFace: "Calibri", align: "center",
  });
  slide.addText(title, {
    x: 0.5, y: 1.7, w: 9, h: 1.0,
    fontSize: 40, bold: true, color: C.white,
    fontFace: "Calibri", align: "center",
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.5, y: 2.85, w: 9, h: 0.6,
      fontSize: 20, color: "D0EBF0",
      fontFace: "Calibri", align: "center", italic: true,
    });
  }
}

function slideHeader(slide, title, pres) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.72, fill: { color: C.navy } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.72, w: 10, h: 0.06, fill: { color: C.gold } });
  slide.addText(title, {
    x: 0.3, y: 0, w: 9.4, h: 0.72, margin: 0,
    fontSize: 22, bold: true, color: C.white,
    fontFace: "Calibri", valign: "middle",
  });
}

function bullets(items) {
  return items.map((t, i) => ({
    text: t,
    options: { bullet: { code: "25CF", indent: 15 }, fontSize: 16, color: C.navy, fontFace: "Calibri", breakLine: i < items.length - 1 },
  }));
}

function subBullets(items, color) {
  return items.map((t, i) => ({
    text: t,
    options: { bullet: { code: "2013", indent: 30 }, fontSize: 14, color: color || C.slate, fontFace: "Calibri", breakLine: i < items.length - 1 },
  }));
}

function addLabelBox(slide, x, y, w, h, label, value, pres) {
  slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: C.lightBg }, line: { color: C.teal, width: 1.5 } });
  slide.addText([
    { text: label + "\n", options: { bold: true, fontSize: 12, color: C.teal, fontFace: "Calibri" } },
    { text: value, options: { fontSize: 13, color: C.navy, fontFace: "Calibri" } },
  ], { x, y, w, h, margin: 8, valign: "middle" });
}

// ── IMAGE FETCHING ──────────────────────────────────────────────
const imgUrls = [
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_fb6f90f724fc346bd0c1d9a8cf427d145eebead2e2481167f4ed680d678194f8.jpg", // Sprengel
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_80408838d023a8a3c52b0e346277bf46cbd506df950646b4541c92c462d86dc2.jpg", // Erb waiter's tip
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_3329325bb31850a33f60190ff172f8fc9689a091a184e51de809d97f8c38ff1e.jpg", // cubitus varus
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_f7be9f89342b4058a005fa3737c00a17ca9a2f9264eaed48e5ac20ec5d2832d0.jpg", // cubitus valgus
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_1cda6423c45f7fa80d26fccd68c164aad7581ee4ae128f4e7c3bb16cfb59bd22.jpg", // Madelung clinical
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_e4b4eecee9c0c9848f534ade8453747b5bd5a44cf527ccdc5213f9338e26f56c.jpg", // Madelung xray
  "https://cdn.orris.care/cdss_images/9cc397c158f20cf91592b51a52365dca97089ec937233840a52cb4fb2221b3a7.png",  // brachial plexus diagram
];

console.log("Fetching images...");
const imgs = fetchImagesBase64(imgUrls);
const [sprengel_img, erb_img, cubvarus_img, cubvalgus_img, madelungClin_img, madelungXray_img, plexusDiag_img] = imgs;
console.log("Images fetched:", imgs.map(i => i.error ? "ERROR: "+i.error : "OK"));

// ── SLIDE 1: TITLE ──────────────────────────────────────────────
addTitleSlide(pres);

// ── SLIDE 2: OVERVIEW ──────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Overview — Classification of Upper Limb Deformities", pres);

  const cats = [
    { label: "Shoulder", color: C.navy, items: ["Sprengel deformity", "Brachial plexus palsy", "Shoulder dislocation deformity", "Pseudarthrosis of clavicle", "Fibrotic deltoid"] },
    { label: "Elbow", color: C.teal, items: ["Cubitus valgus", "Cubitus varus (gunstock)", "Pulled elbow", "Traumatic elbow deformities"] },
    { label: "Forearm & Wrist", color: "#B5651D", items: ["Madelung deformity", "Radial club hand", "Radioulnar synostosis"] },
    { label: "Hand", color: "#6A0572", items: ["Syndactyly", "Polydactyly", "Camptodactyly", "Clinodactyly", "Ectrodactyly"] },
  ];

  cats.forEach((cat, i) => {
    const x = 0.25 + i * 2.42;
    slide.addShape(pres.ShapeType.rect, { x, y: 0.95, w: 2.25, h: 0.42, fill: { color: cat.color }, radius: 3 });
    slide.addText(cat.label, { x, y: 0.95, w: 2.25, h: 0.42, fontSize: 15, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    slide.addShape(pres.ShapeType.rect, { x, y: 1.4, w: 2.25, h: 3.8, fill: { color: C.white }, line: { color: cat.color, width: 1.5 } });
    const textItems = cat.items.map((t, j) => ({
      text: "• " + t,
      options: { fontSize: 13, color: C.navy, fontFace: "Calibri", breakLine: j < cat.items.length - 1 },
    }));
    slide.addText(textItems, { x: x + 0.1, y: 1.5, w: 2.05, h: 3.6, margin: 4, valign: "top" });
  });
}

// ── SECTION 1 DIVIDER ──────────────────────────────────────────
sectionDivider(pres, "01", "Shoulder Deformities", "Congenital & Developmental");

// ── SLIDE 3: SPRENGEL DEFORMITY ────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Sprengel Deformity (Congenital Elevation of the Scapula)", pres);

  slide.addText([
    ...bullets(["Most common congenital anomaly of the shoulder in children", "Failure of scapula to descend from mid-cervical → mid-thoracic position (6th–8th week)"]),
  ], { x: 0.3, y: 0.9, w: 5.8, h: 1.4, valign: "top" });

  // Boxes
  addLabelBox(slide, 0.3, 2.3, 2.6, 1.2, "Clinical Features", "Elevated, small, wide scapula\nMedial rotation\nWinging of scapula\nRestricted abduction", pres);
  addLabelBox(slide, 3.05, 2.3, 2.6, 1.2, "Associations", "Klippel-Feil syndrome (1/3)\nScoliosis\nKidney disease\nDiastematomyelia", pres);
  addLabelBox(slide, 0.3, 3.65, 5.35, 1.1, "Treatment", "Woodward procedure (distal muscle advancement)\nSchrock / Green procedures (scapular movement)\nClavicular osteotomy if BPI risk — Best age: 3–8 years", pres);

  if (sprengel_img && !sprengel_img.error) {
    slide.addImage({ data: sprengel_img.base64, x: 5.9, y: 0.9, w: 3.8, h: 4.3, sizing: { type: "contain" } });
  }
  slide.addText("Sprengel deformity: elevated left scapula", {
    x: 5.9, y: 5.1, w: 3.8, h: 0.3, fontSize: 10, italic: true, color: C.slate, align: "center", fontFace: "Calibri",
  });
}

// ── SLIDE 4: BRACHIAL PLEXUS PALSY ─────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Brachial Plexus Palsy (Obstetric)", pres);

  // Table
  const tableData = [
    [
      { text: "Type", options: { bold: true, color: C.white, fill: C.navy, fontFace: "Calibri", fontSize: 14 } },
      { text: "Roots", options: { bold: true, color: C.white, fill: C.navy, fontFace: "Calibri", fontSize: 14 } },
      { text: "Deficit / Deformity", options: { bold: true, color: C.white, fill: C.navy, fontFace: "Calibri", fontSize: 14 } },
      { text: "Prognosis", options: { bold: true, color: C.white, fill: C.navy, fontFace: "Calibri", fontSize: 14 } },
    ],
    [
      { text: "Erb-Duchenne (most common)", options: { fontFace: "Calibri", fontSize: 13 } },
      { text: "C5, C6", options: { fontFace: "Calibri", fontSize: 13 } },
      { text: "Waiter's tip: shoulder adducted + IR, elbow extended, wrist flexed", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Best", options: { color: "1A7A1A", bold: true, fontFace: "Calibri", fontSize: 13 } },
    ],
    [
      { text: "Klumpke", options: { fontFace: "Calibri", fontSize: 13 } },
      { text: "C8, T1", options: { fontFace: "Calibri", fontSize: 13 } },
      { text: "Claw hand, intrinsic weakness; Horner syndrome", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Poor", options: { color: "CC3300", bold: true, fontFace: "Calibri", fontSize: 13 } },
    ],
    [
      { text: "Total Plexus Palsy", options: { fontFace: "Calibri", fontSize: 13 } },
      { text: "C5–T1", options: { fontFace: "Calibri", fontSize: 13 } },
      { text: "Flaccid arm, complete sensorimotor loss", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Worst", options: { color: "CC3300", bold: true, fontFace: "Calibri", fontSize: 13 } },
    ],
  ];
  slide.addTable(tableData, { x: 0.3, y: 0.9, w: 5.6, h: 2.2, colW: [1.8, 0.7, 2.2, 0.9], border: { color: "CCDDEE", pt: 1 }, fill: "FAFCFF" });

  slide.addText("Causes: shoulder dystocia, large neonate, forceps/breech delivery", {
    x: 0.3, y: 3.18, w: 5.6, h: 0.3, fontSize: 13, color: C.slate, italic: true, fontFace: "Calibri",
  });

  slide.addText("Treatment", { x: 0.3, y: 3.55, w: 5.6, h: 0.3, fontSize: 15, bold: true, color: C.navy, fontFace: "Calibri" });
  slide.addText([
    ...bullets([
      ">90% resolve without intervention — passive ROM therapy key",
      "Lack of biceps at 6 months = poor prognosis",
      "Microsurgical nerve grafting / neurolysis (early)",
      "L'Episcopo procedure (latissimus/teres major transfer) for shoulder ER",
      "Proximal humerus rotational osteotomy (>5 yrs) for IR contracture",
    ])
  ], { x: 0.3, y: 3.9, w: 5.6, h: 1.5, valign: "top" });

  if (erb_img && !erb_img.error) {
    slide.addImage({ data: erb_img.base64, x: 6.1, y: 0.9, w: 3.6, h: 3.5, sizing: { type: "contain" } });
  }
  slide.addText("Erb's palsy: waiter's tip posture", {
    x: 6.1, y: 4.45, w: 3.6, h: 0.3, fontSize: 10, italic: true, color: C.slate, align: "center", fontFace: "Calibri",
  });

  if (plexusDiag_img && !plexusDiag_img.error) {
    slide.addImage({ data: plexusDiag_img.base64, x: 6.1, y: 4.8, w: 3.6, h: 0.7, sizing: { type: "contain" } });
  }
}

// ── SLIDE 5: SHOULDER DISLOCATION DEFORMITIES ──────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Shoulder Dislocation & Associated Deformities", pres);

  const boxes = [
    { x: 0.3, label: "Anterior Dislocation (95%)", color: C.navy,
      lines: ["Loss of normal deltoid contour ("squared" shoulder)", "Arm held in slight abduction/ER", "Sulcus sign (inferior)", "Bankart lesion (labral tear)", "Hill-Sachs lesion (humeral head compression)"] },
    { x: 3.55, label: "Posterior Dislocation (rare)", color: C.teal,
      lines: ["Often missed — may lack obvious deformity", "Arm fixed in adduction + IR", "Loss of anterior fullness", "\"Reverse\" Hill-Sachs / McLaughlin lesion", "Associated with seizures, electrocution"] },
    { x: 6.8, label: "Chronic/Recurrent", color: "#6B2D8B",
      lines: ["Voluntary/involuntary recurrence", "Anterior labral/capsular laxity", "Rotator cuff tear deformity", "Shoulder asymmetry", "Bankart repair / Latarjet procedure"] },
  ];

  boxes.forEach(b => {
    slide.addShape(pres.ShapeType.rect, { x: b.x, y: 0.9, w: 3.0, h: 0.45, fill: { color: b.color }, radius: 3 });
    slide.addText(b.label, { x: b.x, y: 0.9, w: 3.0, h: 0.45, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    slide.addShape(pres.ShapeType.rect, { x: b.x, y: 1.38, w: 3.0, h: 3.9, fill: { color: C.white }, line: { color: b.color, width: 1.5 } });
    b.lines.forEach((line, j) => {
      slide.addText([{ text: "• " + line, options: { fontSize: 13, color: C.navy, fontFace: "Calibri" } }],
        { x: b.x + 0.1, y: 1.5 + j * 0.68, w: 2.8, h: 0.6 });
    });
  });

  slide.addText("Always obtain AP + axillary lateral radiographs. CT for occult posterior dislocation.", {
    x: 0.3, y: 5.22, w: 9.4, h: 0.3, fontSize: 12, italic: true, color: C.slate, fontFace: "Calibri",
  });
}

// ── SLIDE 6: OTHER SHOULDER ─────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Other Congenital Shoulder Deformities", pres);

  slide.addText("Congenital Pseudarthrosis of the Clavicle", {
    x: 0.3, y: 0.9, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.teal, fontFace: "Calibri",
  });
  slide.addText([
    ...bullets([
      "Failure of union of medial & lateral ossification centres — almost always RIGHT clavicle",
      "Non-painful swelling over mid-clavicle in neonate; no overlying skin discolouration",
      "Distinguish from birth fracture (callus absent, no overlying ecchymosis)",
      "Treatment: surgical stabilisation & bone graft if symptomatic (usually cosmetic indication)",
    ])
  ], { x: 0.3, y: 1.35, w: 9.4, h: 1.5, valign: "top" });

  slide.addShape(pres.ShapeType.line, { x: 0.3, y: 2.95, w: 9.4, h: 0, line: { color: C.teal, width: 1, dashType: "dash" } });

  slide.addText("Fibrotic Deltoid / Deltoid Contracture", {
    x: 0.3, y: 3.05, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.teal, fontFace: "Calibri",
  });
  slide.addText([
    ...bullets([
      "Short fibrous bands replace deltoid muscle tissue → abduction contractures at shoulder",
      "Scapular elevation and winging when arms are adducted",
      "Cause: repeated IM injections into deltoid in infancy (commonest cause in developing countries)",
      "Treatment: surgical resection of fibrotic bands",
    ])
  ], { x: 0.3, y: 3.5, w: 9.4, h: 1.5, valign: "top" });
}

// ── SECTION 2 DIVIDER ──────────────────────────────────────────
sectionDivider(pres, "02", "Elbow Deformities", "Cubitus Valgus, Cubitus Varus & More");

// ── SLIDE 7: CUBITUS VALGUS & VARUS ────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Cubitus Valgus vs Cubitus Varus (Gunstock Deformity)", pres);

  // Cubitus Valgus
  slide.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.9, w: 4.4, h: 0.42, fill: { color: C.teal } });
  slide.addText("Cubitus Valgus", { x: 0.3, y: 0.9, w: 4.4, h: 0.42, fontSize: 16, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
  slide.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.35, w: 4.4, h: 2.5, fill: { color: C.white }, line: { color: C.teal, width: 1.5 } });
  slide.addText([
    ...bullets(["Increased carrying angle (>15° in males, >20° in females)", "Commonest cause: malunited lateral condyle fracture", "Tardy ulnar nerve palsy (late complication)", "Treatment: corrective osteotomy + ulnar nerve transposition if neuropathy"])
  ], { x: 0.45, y: 1.45, w: 4.1, h: 2.3, valign: "top" });

  // Cubitus Varus
  slide.addShape(pres.ShapeType.rect, { x: 5.2, y: 0.9, w: 4.4, h: 0.42, fill: { color: C.navy } });
  slide.addText("Cubitus Varus (Gunstock)", { x: 5.2, y: 0.9, w: 4.4, h: 0.42, fontSize: 16, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
  slide.addShape(pres.ShapeType.rect, { x: 5.2, y: 1.35, w: 4.4, h: 2.5, fill: { color: C.white }, line: { color: C.navy, width: 1.5 } });
  slide.addText([
    ...bullets(["Decreased/reversed carrying angle (<0°)", "Commonest cause: malunited supracondylar fracture of humerus", "Cosmetic deformity — usually no functional deficit", "Treatment: corrective lateral closing-wedge osteotomy", "Baumann's angle decreased on X-ray"])
  ], { x: 5.35, y: 1.45, w: 4.1, h: 2.3, valign: "top" });

  // Images
  if (cubvalgus_img && !cubvalgus_img.error) {
    slide.addImage({ data: cubvalgus_img.base64, x: 0.3, y: 3.95, w: 4.4, h: 1.45, sizing: { type: "contain" } });
  }
  if (cubvarus_img && !cubvarus_img.error) {
    slide.addImage({ data: cubvarus_img.base64, x: 5.2, y: 3.95, w: 4.4, h: 1.45, sizing: { type: "contain" } });
  }
  slide.addText("Cubitus valgus: increased carrying angle", { x: 0.3, y: 5.35, w: 4.4, h: 0.22, fontSize: 9, italic: true, color: C.slate, align: "center", fontFace: "Calibri" });
  slide.addText("Cubitus varus: gunstock deformity with varus angulation", { x: 5.2, y: 5.35, w: 4.4, h: 0.22, fontSize: 9, italic: true, color: C.slate, align: "center", fontFace: "Calibri" });
}

// ── SECTION 3 DIVIDER ──────────────────────────────────────────
sectionDivider(pres, "03", "Forearm & Wrist Deformities", "Madelung, Radial Club Hand & Synostosis");

// ── SLIDE 8: MADELUNG DEFORMITY ────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Madelung Deformity", pres);

  slide.addText([
    ...bullets([
      "Premature fusion of the MEDIAL half of the distal radial physis",
      "Results in short, bowed radius; dorsal subluxation of distal ulna; volar displacement of carpus",
      "Inheritance: Autosomal dominant (Léri-Weill dyschondrosteosis / SHOX gene mutation)",
    ])
  ], { x: 0.3, y: 0.9, w: 5.7, h: 1.3, valign: "top" });

  addLabelBox(slide, 0.3, 2.28, 2.6, 1.3, "Radiological Signs", "↑ Radial inclination\nWedging of carpal bones\nProximal migration of lunate\nBony spur on medial radius (Vickers lig.)", pres);
  addLabelBox(slide, 3.05, 2.28, 2.9, 1.3, "Clinical Features", "Wrist pain & reduced ROM\nDorsal prominence of distal ulna\n\"Bayonet\" / \"dinner-fork\" deformity\nMore common in females, bilateral", pres);
  addLabelBox(slide, 0.3, 3.72, 5.65, 1.2, "Treatment", "Conservative (splinting) for mild cases\nVickers ligament release + physiolysis (skeletally immature)\nCorrective osteotomy of radius ± ulna shortening (mature)\nDistal ulna resection (Darrach) if symptomatic DRUJ instability", pres);

  if (madelungClin_img && !madelungClin_img.error) {
    slide.addImage({ data: madelungClin_img.base64, x: 6.1, y: 0.9, w: 1.8, h: 2.2, sizing: { type: "contain" } });
  }
  if (madelungXray_img && !madelungXray_img.error) {
    slide.addImage({ data: madelungXray_img.base64, x: 8.05, y: 0.9, w: 1.8, h: 2.2, sizing: { type: "contain" } });
  }
  slide.addText("Clinical (bayonet wrist)", { x: 6.1, y: 3.12, w: 1.8, h: 0.25, fontSize: 9, italic: true, color: C.slate, align: "center", fontFace: "Calibri" });
  slide.addText("X-ray (AP wrist)", { x: 8.05, y: 3.12, w: 1.8, h: 0.25, fontSize: 9, italic: true, color: C.slate, align: "center", fontFace: "Calibri" });
}

// ── SLIDE 9: RADIAL CLUB HAND & SYNOSTOSIS ─────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Radial Club Hand & Radioulnar Synostosis", pres);

  slide.addText("Radial Club Hand (Radial Longitudinal Deficiency)", {
    x: 0.3, y: 0.9, w: 9.4, h: 0.36, fontSize: 16, bold: true, color: C.teal, fontFace: "Calibri",
  });
  slide.addText([
    ...bullets([
      "Aplasia / hypoplasia of the radius and/or thumb/first ray",
      "Wrist deviates radially; hand \"clubbed\" at radial side",
      "Associations: VATER/VACTERL, Holt-Oram, Fanconi anaemia, thrombocytopenia syndromes",
      "Also caused by thalidomide, methotrexate, amniotic band disruption",
      "Treatment: serial stretching/casting → centralisation of carpus on ulna → thumb reconstruction",
    ])
  ], { x: 0.3, y: 1.32, w: 9.4, h: 2.0, valign: "top" });

  slide.addShape(pres.ShapeType.line, { x: 0.3, y: 3.4, w: 9.4, h: 0, line: { color: C.teal, width: 1, dashType: "dash" } });

  slide.addText("Congenital Radioulnar Synostosis", {
    x: 0.3, y: 3.5, w: 9.4, h: 0.36, fontSize: 16, bold: true, color: C.navy, fontFace: "Calibri",
  });
  slide.addText([
    ...bullets([
      "Bony fusion of proximal radius and ulna → fixed forearm pronation",
      "Presents as inability to supinate forearm (child cannot turn palm upward)",
      "Usually bilateral; often missed until school age",
      "Treatment: observation if mild; derotational osteotomy if severe functional limitation",
    ])
  ], { x: 0.3, y: 3.92, w: 9.4, h: 1.6, valign: "top" });
}

// ── SECTION 4 DIVIDER ──────────────────────────────────────────
sectionDivider(pres, "04", "Hand Deformities", "Syndactyly, Polydactyly, Camptodactyly & More");

// ── SLIDE 10: HAND DEFORMITIES ─────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Congenital Hand Deformities", pres);

  const conditions = [
    { name: "Syndactyly", color: C.navy,
      facts: ["Fusion of soft tissue (simple) ± bone (complex)", "Most common in 3rd web space", "Treatment: surgical separation with Z-plasty / skin grafting", "Complex types treated same as foot syndactyly"] },
    { name: "Polydactyly", color: C.teal,
      facts: ["Extra digit — pre-axial (thumb side) or post-axial (ulnar)", "Post-axial often autosomal dominant", "AP axis controlled by zone of polarizing activity", "Treatment: excision at 9–12 months; rudimentary digits can be ligated in nursery"] },
    { name: "Camptodactyly", color: "#8B4513",
      facts: ["Flexion deformity of PIP joint (usually little finger)", "Can be congenital or adolescent onset", "Due to imbalance of intrinsic/extrinsic tendons", "Treatment: splinting; surgical release if severe"] },
    { name: "Clinodactyly", color: "#6A0572",
      facts: ["Angular deformity in radio-ulnar plane", "Usually radial deviation of little finger", "Delta phalanx (C-shaped physeal plate)", "Treatment: closing-wedge osteotomy of delta phalanx if >35°"] },
  ];

  conditions.forEach((c, i) => {
    const x = 0.22 + i * 2.42;
    slide.addShape(pres.ShapeType.rect, { x, y: 0.9, w: 2.28, h: 0.42, fill: { color: c.color }, radius: 3 });
    slide.addText(c.name, { x, y: 0.9, w: 2.28, h: 0.42, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    slide.addShape(pres.ShapeType.rect, { x, y: 1.35, w: 2.28, h: 3.9, fill: { color: C.white }, line: { color: c.color, width: 1.5 } });
    const textItems = c.facts.map((f, j) => ({
      text: "• " + f,
      options: { fontSize: 12.5, color: C.navy, fontFace: "Calibri", breakLine: j < c.facts.length - 1 },
    }));
    slide.addText(textItems, { x: x + 0.1, y: 1.45, w: 2.08, h: 3.75, margin: 4, valign: "top" });
  });
}

// ── SLIDE 11: CEREBRAL PALSY UPPER LIMB DEFORMITIES ────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Upper Limb Deformities in Cerebral Palsy", pres);

  slide.addText("Pattern of Deformities (Spastic Hemiplegia)", {
    x: 0.3, y: 0.88, w: 5.6, h: 0.36, fontSize: 16, bold: true, color: C.teal, fontFace: "Calibri",
  });

  const levels = [
    { joint: "Shoulder", deformity: "Adduction & internal rotation contracture" },
    { joint: "Elbow", deformity: "Flexion contracture" },
    { joint: "Forearm", deformity: "Pronation deformity" },
    { joint: "Wrist", deformity: "Flexion + ulnar deviation" },
    { joint: "Fingers/Thumb", deformity: "Clenched fist; thumb-in-palm deformity" },
  ];

  levels.forEach((l, i) => {
    const y = 1.32 + i * 0.62;
    slide.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 1.7, h: 0.52, fill: { color: C.navy }, radius: 2 });
    slide.addText(l.joint, { x: 0.3, y, w: 1.7, h: 0.52, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    slide.addShape(pres.ShapeType.rect, { x: 2.1, y, w: 3.7, h: 0.52, fill: { color: C.white }, line: { color: C.teal, width: 1 } });
    slide.addText(l.deformity, { x: 2.15, y, w: 3.6, h: 0.52, fontSize: 13.5, color: C.navy, fontFace: "Calibri", valign: "middle", margin: 4 });
  });

  slide.addText("Treatment Principles", { x: 6.0, y: 0.88, w: 3.7, h: 0.36, fontSize: 16, bold: true, color: C.teal, fontFace: "Calibri" });
  slide.addText([
    ...bullets([
      "Botulinum toxin A — temporary spasticity relief",
      "Serial casting / splinting",
      "Contracture releases (musculotendinous lengthening)",
      "Tendon transfers for functional positioning",
      "Thumb-in-palm: FPL lengthening + EPL transfer",
    ])
  ], { x: 6.0, y: 1.32, w: 3.7, h: 3.5, valign: "top" });
}

// ── SLIDE 12: SUMMARY TABLE ─────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offW } });
  slideHeader(slide, "Summary — Key Points at a Glance", pres);

  const rows = [
    [
      { text: "Deformity", options: { bold: true, color: C.white, fill: C.navy, fontFace: "Calibri", fontSize: 13 } },
      { text: "Key Feature", options: { bold: true, color: C.white, fill: C.navy, fontFace: "Calibri", fontSize: 13 } },
      { text: "Cause", options: { bold: true, color: C.white, fill: C.navy, fontFace: "Calibri", fontSize: 13 } },
      { text: "Treatment", options: { bold: true, color: C.white, fill: C.navy, fontFace: "Calibri", fontSize: 13 } },
    ],
    [
      { text: "Sprengel Deformity", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Elevated scapula", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Failure of scapular descent", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Woodward / Schrock procedure", options: { fontFace: "Calibri", fontSize: 12 } },
    ],
    [
      { text: "Erb-Duchenne Palsy", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Waiter's tip (C5,C6)", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Birth trauma / dystocia", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Passive ROM → surgery", options: { fontFace: "Calibri", fontSize: 12 } },
    ],
    [
      { text: "Cubitus Varus", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Gunstock deformity", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Malunited supracondylar #", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Lateral closing-wedge osteotomy", options: { fontFace: "Calibri", fontSize: 12 } },
    ],
    [
      { text: "Cubitus Valgus", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Tardy ulnar nerve palsy", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Malunited lateral condyle #", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Osteotomy + ulnar nerve transposition", options: { fontFace: "Calibri", fontSize: 12 } },
    ],
    [
      { text: "Madelung Deformity", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Bayonet wrist deformity", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Premature medial radial physis fusion (SHOX)", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Vickers release / corrective osteotomy", options: { fontFace: "Calibri", fontSize: 12 } },
    ],
    [
      { text: "Radial Club Hand", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Radial deviation of hand", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Radial aplasia/hypoplasia", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Centralisation + thumb reconstruction", options: { fontFace: "Calibri", fontSize: 12 } },
    ],
    [
      { text: "Syndactyly", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Fused digits", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Failure of apoptosis between digits", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Surgical separation + Z-plasty", options: { fontFace: "Calibri", fontSize: 12 } },
    ],
    [
      { text: "Polydactyly", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Extra digit", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Excess AP axis activity", options: { fontFace: "Calibri", fontSize: 12 } },
      { text: "Excision at 9–12 months", options: { fontFace: "Calibri", fontSize: 12 } },
    ],
  ];

  slide.addTable(rows, {
    x: 0.2, y: 0.88, w: 9.6, h: 4.5,
    colW: [2.2, 2.2, 2.7, 2.5],
    border: { color: "CCDDEE", pt: 0.8 },
    fill: "FAFCFF",
    autoPage: false,
  });
}

// ── SLIDE 13: END ───────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.gold } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 4.2, w: 10, h: 0.08, fill: { color: C.teal } });
  slide.addText("Thank You", { x: 0.4, y: 1.4, w: 9.2, h: 1.0, fontSize: 52, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
  slide.addText("Deformities of the Shoulder & Upper Limb", { x: 0.4, y: 2.6, w: 9.2, h: 0.5, fontSize: 20, color: C.gold, fontFace: "Calibri", align: "center", italic: true });
  slide.addText("Sources: Miller's Review of Orthopaedics 9e  |  Grainger & Allison Diagnostic Radiology  |  Mulholland & Greenfield Surgery 7e", {
    x: 0.4, y: 4.5, w: 9.2, h: 0.4, fontSize: 11, color: "A8C8D8", fontFace: "Calibri", align: "center",
  });
}

// ── WRITE FILE ──────────────────────────────────────────────────
const outputPath = "/home/daytona/workspace/shoulder-deformities-ppt/Shoulder_Upper_Limb_Deformities.pptx";
pres.writeFile({ fileName: outputPath }).then(() => {
  console.log("SUCCESS: " + outputPath);
}).catch(err => {
  console.error("ERROR:", err);
  process.exit(1);
});

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/shoulder-deformities-ppt/create_ppt.js'