const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Gynecology Resident";
pres.title = "Uterine Fibroids: Impact on Women's Health and Quality of Life";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const C = {
  deepBurgundy: "6B1A2E",  // dominant dark
  crimson:      "A31C3A",  // accent / headings
  blush:        "F5D9E0",  // light panel bg
  cream:        "FDF6F0",  // slide bg
  charcoal:     "2C2C2C",  // body text
  white:        "FFFFFF",
  teal:         "1B6B6E",  // secondary accent
  tealLight:    "E0F0F1",
  gold:         "C4903A",
  amber:        "FFF3CD",
  coral:        "E85D5D",
  paleBlue:     "EAF4FB",
  slate:        "4A5568",
};

// ─── HELPERS ─────────────────────────────────────────────────────────────────
function addTitleSlide(title, subtitle) {
  const s = pres.addSlide();
  // full dark bg
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.deepBurgundy } });
  // decorative bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.2, w: 10, h: 0.08, fill: { color: C.gold } });
  // accent strip left
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.crimson } });
  // small uterus icon block
  s.addShape(pres.ShapeType.ellipse, { x: 7.8, y: 0.5, w: 1.8, h: 2.2, fill: { color: C.crimson }, line: { color: C.gold, width: 2 } });
  s.addText("🔬", { x: 7.9, y: 0.9, w: 1.6, h: 1.4, fontSize: 52, align: "center", valign: "middle" });

  s.addText(title, {
    x: 0.4, y: 1.0, w: 7.2, h: 1.8,
    fontSize: 34, bold: true, color: C.white,
    fontFace: "Calibri", align: "left", valign: "middle",
    wrap: true,
  });
  s.addText(subtitle, {
    x: 0.4, y: 2.9, w: 7.2, h: 0.7,
    fontSize: 17, color: C.gold, fontFace: "Calibri", align: "left",
  });
  s.addText("Case Presentation | Gynecology Grand Rounds", {
    x: 0.4, y: 3.6, w: 7.0, h: 0.4,
    fontSize: 13, color: C.blush, fontFace: "Calibri", align: "left",
  });
  s.addText("May 2026", {
    x: 0.4, y: 4.8, w: 4, h: 0.35,
    fontSize: 11, color: C.gold, fontFace: "Calibri",
  });
}

function sectionDivider(title, subtitle) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.crimson } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 2.6, w: 10, h: 0.06, fill: { color: C.white }, transparency: 60 });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.2, h: 5.625, fill: { color: C.gold } });
  s.addText(title, {
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    fontSize: 36, bold: true, color: C.white, fontFace: "Calibri", align: "center",
  });
  if (subtitle) {
    s.addText(subtitle, {
      x: 0.5, y: 2.9, w: 9, h: 0.7,
      fontSize: 16, color: C.blush, fontFace: "Calibri", align: "center",
    });
  }
}

function contentSlide(title, opts = {}) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream } });
  // top bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: C.deepBurgundy } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.75, w: 10, h: 0.05, fill: { color: C.gold } });
  s.addText(title, {
    x: 0.2, y: 0, w: 9.6, h: 0.75,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", align: "left", valign: "middle", margin: 8,
  });
  return s;
}

function addBullets(slide, items, x, y, w, h, opts = {}) {
  const textArr = items.map((item, i) => ({
    text: typeof item === "object" ? item.text : item,
    options: {
      bullet: typeof item === "object" && item.sub ? { indent: 30 } : true,
      breakLine: i < items.length - 1,
      fontSize: typeof item === "object" && item.sub ? 13 : (opts.fontSize || 14),
      color: typeof item === "object" && item.bold ? C.crimson : C.charcoal,
      bold: typeof item === "object" && item.bold ? true : false,
    },
  }));
  slide.addText(textArr, { x, y, w, h, fontFace: "Calibri", valign: "top" });
}

function labelBox(slide, label, value, x, y, w, h, bg, accent) {
  slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: bg }, line: { color: accent, width: 1.5 } });
  slide.addShape(pres.ShapeType.rect, { x, y, w, h: 0.32, fill: { color: accent } });
  slide.addText(label, { x: x + 0.08, y: y + 0.03, w: w - 0.16, h: 0.28, fontSize: 10, bold: true, color: C.white, fontFace: "Calibri" });
  slide.addText(value, { x: x + 0.08, y: y + 0.36, w: w - 0.16, h: h - 0.44, fontSize: 12.5, color: C.charcoal, fontFace: "Calibri", valign: "top", wrap: true });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1: TITLE
// ─────────────────────────────────────────────────────────────────────────────
addTitleSlide(
  "Uterine Fibroids:\nImpact on Women's Health\n& Quality of Life",
  "A Case-Based Presentation for Gynecology Residents"
);

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2: LEARNING OBJECTIVES
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Learning Objectives");
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.95, w: 9.4, h: 4.45, fill: { color: C.blush }, line: { color: C.blush } });
  addBullets(s, [
    { text: "1.  Recognize the epidemiology and risk factors of uterine leiomyomas", bold: false },
    { text: "2.  Classify fibroids by FIGO/PALM-COEIN system and location", bold: false },
    { text: "3.  Identify the multidimensional impact of fibroids on quality of life", bold: false },
    { text: "4.  Apply a structured approach to diagnosis including symptom scoring (UFS-QoL)", bold: false },
    { text: "5.  Outline evidence-based medical and surgical management options", bold: false },
    { text: "6.  Discuss fertility implications and psychosocial burden", bold: false },
  ], 0.6, 1.1, 8.8, 4.2, { fontSize: 14.5 });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 3: CASE PRESENTATION
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Case Presentation");
  // Patient card
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.9, w: 4.3, h: 4.45, fill: { color: C.paleBlue }, line: { color: C.teal, width: 1.5 } });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.9, w: 4.3, h: 0.38, fill: { color: C.teal } });
  s.addText("PATIENT PROFILE", { x: 0.4, y: 0.92, w: 4.1, h: 0.32, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri" });
  addBullets(s, [
    { text: "Mrs. R.K.  |  Age: 34 years", bold: true },
    "G1P1 (1 NVD, 4 years ago)",
    "Occupation: School teacher",
    "BMI: 27 kg/m²",
    "No known drug allergies",
    "Family Hx: Mother had hysterectomy at 42",
    "No co-morbidities",
  ], 0.45, 1.35, 4.0, 3.8, { fontSize: 13 });

  // Chief complaints
  s.addShape(pres.ShapeType.rect, { x: 4.9, y: 0.9, w: 4.85, h: 4.45, fill: { color: C.amber }, line: { color: C.gold, width: 1.5 } });
  s.addShape(pres.ShapeType.rect, { x: 4.9, y: 0.9, w: 4.85, h: 0.38, fill: { color: C.gold } });
  s.addText("PRESENTING COMPLAINTS", { x: 5.0, y: 0.92, w: 4.65, h: 0.32, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri" });
  addBullets(s, [
    { text: "Heavy menstrual bleeding — 8 months", bold: true },
    "Soaking 10-12 pads/day; clots passing",
    "Cycle: 5-7 days, interval 24 days",
    { text: "Pelvic pressure & heaviness — 6 months", bold: true },
    "Urinary frequency (voiding every 1.5 hrs)",
    { text: "Dysmenorrhea — worsening × 4 months", bold: true },
    "Fatigue, exertional dyspnea (Hb: 7.6 g/dL)",
    { text: "Unable to work on heavy bleeding days", bold: true },
  ], 5.05, 1.35, 4.55, 3.8, { fontSize: 13 });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 4: EPIDEMIOLOGY & RISK FACTORS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Epidemiology & Risk Factors");

  // Big stat boxes
  const stats = [
    { label: "Lifetime Risk", val: ">70%\nwomen by age 50" },
    { label: "Black Women", val: "2-3×\nhigher risk & earlier onset" },
    { label: "Peak Age", val: "35-50\nreproductive years" },
    { label: "Symptomatic", val: "25-50%\nrequire treatment" },
  ];
  stats.forEach((st, i) => {
    const x = 0.25 + i * 2.38;
    s.addShape(pres.ShapeType.rect, { x, y: 0.9, w: 2.2, h: 1.35, fill: { color: C.deepBurgundy }, line: { color: C.gold, width: 1.5 } });
    s.addText(st.label, { x, y: 0.92, w: 2.2, h: 0.35, fontSize: 10, bold: true, color: C.gold, fontFace: "Calibri", align: "center" });
    s.addText(st.val, { x, y: 1.28, w: 2.2, h: 0.92, fontSize: 15, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  });

  // Risk factor columns
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 2.45, w: 4.6, h: 2.85, fill: { color: C.blush }, line: { color: C.crimson, width: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 2.45, w: 4.6, h: 0.35, fill: { color: C.crimson } });
  s.addText("NON-MODIFIABLE RISK FACTORS", { x: 0.35, y: 2.47, w: 4.4, h: 0.3, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri" });
  addBullets(s, [
    "Age (peak 35–50 yrs)",
    "African-American ethnicity",
    "Family history (1st-degree relative)",
    "Nulliparity",
    "Early menarche (< 11 yrs)",
    "Germline FH / MED12 mutations",
  ], 0.4, 2.85, 4.3, 2.35, { fontSize: 13 });

  s.addShape(pres.ShapeType.rect, { x: 5.15, y: 2.45, w: 4.6, h: 2.85, fill: { color: C.tealLight }, line: { color: C.teal, width: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 5.15, y: 2.45, w: 4.6, h: 0.35, fill: { color: C.teal } });
  s.addText("MODIFIABLE RISK FACTORS", { x: 5.25, y: 2.47, w: 4.4, h: 0.3, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri" });
  addBullets(s, [
    "Obesity / high BMI (estrogen ↑)",
    "Red meat diet (high), low fruit/vegetables",
    "Hypertension",
    "Alcohol consumption",
    "Protective: parity, OCP use, high vit D",
    "Protective: physical activity",
  ], 5.3, 2.85, 4.3, 2.35, { fontSize: 13 });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 5: PATHOPHYSIOLOGY & CLASSIFICATION
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Pathophysiology & FIGO Classification");

  // Pathophysiology box
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.9, w: 4.5, h: 4.45, fill: { color: C.blush }, line: { color: C.crimson, width: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.9, w: 4.5, h: 0.38, fill: { color: C.crimson } });
  s.addText("PATHOPHYSIOLOGY", { x: 0.35, y: 0.92, w: 4.3, h: 0.32, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri" });
  addBullets(s, [
    { text: "Origin: monoclonal smooth muscle cell proliferation", bold: false },
    "MED12 gene mutations — ~70% of leiomyomas",
    "HMGA2 / HMGA1 rearrangements — ~40%",
    "Fumarate hydratase (FH) — HLRCC syndrome",
    { text: "Estrogen + Progesterone dependent growth", bold: true },
    "↑ ER/PR receptors vs. normal myometrium",
    "Shrink post-menopause / with GnRH analogs",
    { text: "Benign; malignant change to LMS: 0.1%", bold: false },
    "Whorled pattern on cut section",
    "Abundant fibrous ECM (fibrotic stroma)",
  ], 0.4, 1.35, 4.2, 3.85, { fontSize: 12.5 });

  // FIGO classification
  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 0.9, w: 4.7, h: 4.45, fill: { color: C.paleBlue }, line: { color: C.teal, width: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 0.9, w: 4.7, h: 0.38, fill: { color: C.teal } });
  s.addText("FIGO CLASSIFICATION (PALM-COEIN)", { x: 5.15, y: 0.92, w: 4.5, h: 0.32, fontSize: 10, bold: true, color: C.white, fontFace: "Calibri" });

  const figoRows = [
    ["Type 0", "Pedunculated submucosal"],
    ["Type 1", "< 50% intramural — submucosal"],
    ["Type 2", "≥ 50% intramural — submucosal"],
    ["Type 3", "100% intramural, contacts endometrium"],
    ["Type 4", "Intramural (no contact w/ endometrium)"],
    ["Type 5", "Subserosal ≥ 50% intramural"],
    ["Type 6", "Subserosal < 50% intramural"],
    ["Type 7", "Subserosal pedunculated"],
    ["Type 8", "Other (cervical, parasitic, etc.)"],
  ];
  figoRows.forEach(([type, desc], i) => {
    const rowY = 1.36 + i * 0.44;
    const bg = i % 2 === 0 ? "DDEEF5" : "EAF4FB";
    s.addShape(pres.ShapeType.rect, { x: 5.05, y: rowY, w: 1.1, h: 0.42, fill: { color: C.teal } });
    s.addText(type, { x: 5.05, y: rowY, w: 1.1, h: 0.42, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x: 6.15, y: rowY, w: 3.6, h: 0.42, fill: { color: bg } });
    s.addText(desc, { x: 6.2, y: rowY, w: 3.5, h: 0.42, fontSize: 11, color: C.charcoal, fontFace: "Calibri", valign: "middle" });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 6: SYMPTOMS & QoL IMPACT
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Fibroid Symptoms & Quality of Life Impact");

  const domains = [
    {
      title: "MENSTRUAL SYMPTOMS",
      color: C.crimson,
      bg: C.blush,
      items: ["Heavy menstrual bleeding (HMB) — most common", "Prolonged / irregular bleeding", "Dysmenorrhea", "Intermenstrual bleeding (submucosal)", "Iron-deficiency anaemia — fatigue, dyspnea"],
    },
    {
      title: "BULK / PRESSURE SYMPTOMS",
      color: C.teal,
      bg: C.tealLight,
      items: ["Pelvic heaviness & pressure", "Urinary frequency / urgency / incomplete emptying", "Constipation / rectal pressure", "Abdominal distension", "Low back pain"],
    },
    {
      title: "REPRODUCTIVE IMPACT",
      color: C.gold,
      bg: C.amber,
      items: ["Infertility (submucosal > intramural > subserosal)", "Recurrent pregnancy loss", "Fetal malpresentation", "Preterm labour & placenta praevia", "Postpartum haemorrhage & uterine atony"],
    },
    {
      title: "PSYCHOSOCIAL / QoL BURDEN",
      color: "8B3A6A",
      bg: "F5E6F0",
      items: ["Anxiety, depression (validated in 67 studies, 2024)", "Work absenteeism & reduced productivity", "Sexual dysfunction / avoidance", "Body image disturbance", "Fear of cancer, social isolation"],
    },
  ];

  domains.forEach((d, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.2 : 5.15;
    const y = row === 0 ? 0.9 : 3.15;
    const w = 4.7;
    const h = 2.12;
    s.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: d.bg }, line: { color: d.color, width: 1.5 } });
    s.addShape(pres.ShapeType.rect, { x, y, w, h: 0.33, fill: { color: d.color } });
    s.addText(d.title, { x: x + 0.1, y: y + 0.03, w: w - 0.2, h: 0.28, fontSize: 10, bold: true, color: C.white, fontFace: "Calibri" });
    const textArr = d.items.map((item, j) => ({
      text: item,
      options: { bullet: true, breakLine: j < d.items.length - 1, fontSize: 11.5, color: C.charcoal },
    }));
    s.addText(textArr, { x: x + 0.12, y: y + 0.36, w: w - 0.24, h: h - 0.45, fontFace: "Calibri", valign: "top" });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 7: UFS-QoL SCORING (CASE APPLICATION)
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Case Assessment: UFS-QoL Score");

  // Intro text
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.9, w: 9.5, h: 0.55, fill: { color: C.deepBurgundy } });
  s.addText("The Uterine Fibroid Symptom and Quality-of-Life Questionnaire (UFS-QoL) — Gold Standard Validated Tool", {
    x: 0.35, y: 0.92, w: 9.3, h: 0.48, fontSize: 12, color: C.gold, bold: true, fontFace: "Calibri", valign: "middle",
  });

  // Symptom severity section
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.55, w: 4.55, h: 3.75, fill: { color: C.blush }, line: { color: C.crimson, width: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.55, w: 4.55, h: 0.35, fill: { color: C.crimson } });
  s.addText("SYMPTOM SEVERITY SCORE (SSS)", { x: 0.35, y: 1.57, w: 4.35, h: 0.3, fontSize: 10.5, bold: true, color: C.white, fontFace: "Calibri" });
  addBullets(s, [
    { text: "8 items scored 1–5 (never → always)", bold: true },
    "Heavy/prolonged periods: 5",
    "Clotting: 5",
    "Pelvic pressure: 4",
    "Urinary frequency: 4",
    "Bladder pressure: 3",
    "Fatigue/low energy: 5",
    "Pelvic pain: 3",
    { text: "Patient SSS: 72/100 (SEVERE)", bold: true },
  ], 0.4, 1.95, 4.2, 3.25, { fontSize: 12 });

  // QoL section
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.55, w: 4.65, h: 3.75, fill: { color: C.tealLight }, line: { color: C.teal, width: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.55, w: 4.65, h: 0.35, fill: { color: C.teal } });
  s.addText("HRQOL SUBSCALES (6 domains)", { x: 5.2, y: 1.57, w: 4.45, h: 0.3, fontSize: 10.5, bold: true, color: C.white, fontFace: "Calibri" });
  addBullets(s, [
    "Concern: 22/100",
    "Activities: 35/100",
    "Energy/Mood: 28/100",
    "Control: 18/100",
    "Self-consciousness: 25/100",
    "Sexual function: 30/100",
    { text: "Total HRQOL: 26/100 (SEVERELY IMPAIRED)", bold: true },
    "High SSS + Low HRQOL = Treatment warranted",
  ], 5.25, 1.95, 4.3, 3.25, { fontSize: 12 });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 8: CLINICAL EXAMINATION & INVESTIGATIONS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Clinical Examination & Investigations");

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.9, w: 4.55, h: 4.45, fill: { color: C.blush }, line: { color: C.crimson, width: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.9, w: 4.55, h: 0.38, fill: { color: C.crimson } });
  s.addText("CLINICAL EXAMINATION", { x: 0.35, y: 0.92, w: 4.35, h: 0.32, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri" });
  addBullets(s, [
    { text: "General:", bold: true },
    { text: "Pallor +++, HR 102, BP 108/70", sub: true },
    { text: "Abdominal exam:", bold: true },
    { text: "Uterus palpable 18-week size, firm, irregular nodular surface, non-tender", sub: true },
    { text: "P/V examination:", bold: true },
    { text: "Bulky uterus, irregular outline, right-sided lump; fornices free; no adnexal mass", sub: true },
    { text: "P/S examination:", bold: true },
    { text: "Cervix healthy, no bleeding on touch", sub: true },
  ], 0.4, 1.35, 4.2, 3.85, { fontSize: 12.5 });

  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 0.9, w: 4.7, h: 4.45, fill: { color: C.paleBlue }, line: { color: C.teal, width: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 0.9, w: 4.7, h: 0.38, fill: { color: C.teal } });
  s.addText("INVESTIGATIONS", { x: 5.15, y: 0.92, w: 4.5, h: 0.32, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri" });

  const invRows = [
    ["CBC", "Hb 7.6 g/dL, MCV 68, MCHC low — IDA"],
    ["Pelvic USG", "3 fibroids: 8×7 cm intramural, 4×3.5 cm submucosal (Type 2), 3×2.5 cm subserosal"],
    ["Serum ferritin", "8 μg/L (low)"],
    ["Thyroid (TSH)", "Normal — 2.1 mIU/L"],
    ["Coagulation", "PT/APTT normal"],
    ["Pap smear", "Normal (NILM)"],
    ["Endometrial bx", "Proliferative endometrium"],
    ["MRI pelvis", "Confirms fibroid map; no malignant features; endometrium normal"],
  ];
  invRows.forEach(([test, result], i) => {
    const rowY = 1.35 + i * 0.49;
    const bg = i % 2 === 0 ? "D6EEF5" : "EAF4FB";
    s.addShape(pres.ShapeType.rect, { x: 5.05, y: rowY, w: 1.5, h: 0.46, fill: { color: C.teal } });
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}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 9: DIAGNOSIS SUMMARY
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Diagnosis & Problem List");

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  s.addText("Final Diagnosis: Multiple Uterine Leiomyomas (FIGO Type 2 + Type 4 + Type 6) with Severe Symptomatic Burden", {
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    { title: "Problem 2", desc: "Bulk Symptoms: Pelvic pressure, Urinary frequency, Abdominal distension", color: C.teal, bg: C.tealLight },
    { title: "Problem 3", desc: "Dysmenorrhea and Pelvic Pain — impacting daily activities", color: C.gold, bg: C.amber },
    { title: "Problem 4", desc: "Psychosocial: Work absenteeism, fear, sexual dysfunction — UFS-QoL HRQOL: 26/100", color: "8B3A6A", bg: "F5E6F0" },
    { title: "Problem 5", desc: "Reproductive Concern: Future pregnancy planning (Type 2 submucosal fibroid)", color: "1A6B3A", bg: "E0F5EA" },
  ];

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}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 10: MANAGEMENT — MEDICAL
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Management: Medical Therapy");

  const medRows = [
    {
      drug: "GnRH Agonists\n(Leuprolide)",
      mech: "↓ Estrogen → fibroid shrinkage ~30–50%",
      use: "Pre-op, high Hb correction",
      note: "Max 6 months; add-back therapy required; bone density risk",
      color: C.crimson,
    },
    {
      drug: "GnRH Antagonists\n(Elagolix, Relugolix)",
      mech: "Rapid GnRH receptor blockade",
      use: "HMB control; fibroid shrinkage",
      note: "Relugolix combo: FDA-approved 2021 (LIBERTY trial)",
      color: C.teal,
    },
    {
      drug: "Levonorgestrel IUS\n(Mirena 52 mg)",
      mech: "Local progestogen → endometrial atrophy",
      use: "HMB control; NOT fibroid reduction",
      note: "May be expelled if cavity distorted by submucosal fibroid",
      color: "8B3A6A",
    },
    {
      drug: "Tranexamic Acid\n+ NSAIDs",
      mech: "Anti-fibrinolytic / PG synthesis inhibition",
      use: "Acute HMB management",
      note: "No fibroid shrinkage; symptom control only",
      color: C.gold,
    },
    {
      drug: "Iron Supplementation",
      mech: "Correct IDA pre-op",
      use: "Hb: 7.6 → target >10 before surgery",
      note: "IV iron if intolerant/time constrained; consider transfusion",
      color: "1A6B3A",
    },
  ];

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// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 11: MANAGEMENT — SURGICAL
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Management: Surgical & Minimally Invasive Options");

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    {
      name: "Hysteroscopic\nMyomectomy",
      indication: "Submucosal fibroid (Type 0,1,2)\n< 4–5 cm",
      advantage: "Uterine sparing; outpatient/day care; fertility preserved",
      caveat: "Fluid overload risk; resection of deep Type 2 may need staged procedure",
      color: C.teal,
      bg: C.tealLight,
    },
    {
      name: "Laparoscopic\nMyomectomy",
      indication: "Subserosal / intramural fibroids < 8–10 cm, ≤ 4 fibroids",
      advantage: "Fertility preserving; shorter hospital stay vs open",
      caveat: "Power morcellation restricted (LMS risk); uterine scar quality concern",
      color: "1A6B3A",
      bg: "E0F5EA",
    },
    {
      name: "Open\nMyomectomy",
      indication: "Large (>8 cm), multiple, deep intramural fibroids",
      advantage: "Best exposure; definitive fibroid removal; fertility preserved",
      caveat: "Scar, hospital stay 3–5 days; fibroid 'new appearance' ~27% at 14 yrs",
      color: C.gold,
      bg: C.amber,
    },
    {
      name: "Uterine Artery\nEmbolization (UAE)",
      indication: "Completed family; declining surgery; heavy bleeding",
      advantage: "Non-surgical; 85–90% symptom improvement; 40–50% volume reduction",
      caveat: "Uncertain fertility outcomes; UAE preferred over myomectomy for symptoms only (NEJM 2020)",
      color: C.crimson,
      bg: C.blush,
    },
    {
      name: "Hysterectomy",
      indication: "Completed family; failed/declined other Rx; large/multiple fibroids",
      advantage: "Definitive cure; no recurrence",
      caveat: "Surgical menopause if bilateral SO; 1st choice only when fertility not desired",
      color: "6B2A6E",
      bg: "F0E6F5",
    },
    {
      name: "Focused Ultrasound\n/ RFA",
      indication: "Selected patients; fibroid size < 10 cm",
      advantage: "Non-invasive (MRgFUS); minimal recovery; radiofrequency ablation (Acessa)",
      caveat: "Limited availability; requires specific imaging criteria; AAGL 2025 meta-analysis supports safety",
      color: "1A3A6B",
      bg: C.paleBlue,
    },
  ];

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// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 12: CASE MANAGEMENT PLAN
// ─────────────────────────────────────────────────────────────────────────────
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  s.addText("Mrs. R.K. | Age 34 | G1P1 | Wishes future pregnancy | Hb 7.6 | Multiple fibroids (8 cm intramural + Type 2 submucosal)", {
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  });

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    {
      phase: "IMMEDIATE (0–4 wks)",
      color: C.crimson,
      bg: C.blush,
      actions: [
        "IV Iron (ferric carboxymaltose) to correct Hb → target ≥ 10 g/dL",
        "Tranexamic acid during menstruation for acute HMB control",
        "GnRH agonist: Leuprolide 3.75 mg depot × 3 months (pre-op shrinkage + Hb recovery)",
        "Nutritional support; dietary counseling",
        "Psychosocial referral: counseling for anxiety, work-related stress",
      ],
    },
    {
      phase: "SHORT-TERM (1–3 months)",
      color: C.teal,
      bg: C.tealLight,
      actions: [
        "Repeat USG/MRI after GnRH course to reassess fibroid size",
        "Planned: Open (or laparoscopic) myomectomy — intramural 8 cm + Type 2 submucosal",
        "Hysteroscopic component for submucosal fibroid (staged or combined)",
        "Intra-op: vasopressin + cell saver to minimise blood loss (Berek & Novak's)",
        "Consent for conversion to hysterectomy only if life-threatening bleeding",
      ],
    },
    {
      phase: "LONG-TERM FOLLOW-UP",
      color: "8B3A6A",
      bg: "F5E6F0",
      actions: [
        "Post-op: Hb recheck at 6 weeks; USG at 3 months",
        "Contraception: 12–18 months interval before conception attempt",
        "Monitor 'new appearance' rate — 27% cumulative at 14 years",
        "Annual UFS-QoL re-scoring to track QoL recovery",
        "Pregnancy counseling: lower uterine segment scar if fundal incision avoided",
      ],
    },
  ];

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// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 13: EVIDENCE BASE & KEY TRIALS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Evidence Base: Key Studies & Guidelines");

  const evidence = [
    {
      study: "Neumann et al., 2024\nFertility & Sterility",
      tier: "Systematic Review\n67 studies (18 RCTs)",
      finding: "ALL fibroid interventions (medical, surgical, radiological) significantly improved QoL and reduced SSS. Fibroids cause substantial mental health burden — anxiety & depression validated.",
      color: C.crimson,
    },
    {
      study: "Manyonda et al., 2020\nNEJM",
      tier: "RCT",
      finding: "UAE non-inferior to myomectomy for QoL outcomes at 2 years. Myomectomy superior for fertility outcomes in submucosal fibroids.",
      color: C.teal,
    },
    {
      study: "Al-Hendy et al., 2021\nNEJM (LIBERTY trial)",
      tier: "Phase 3 RCT",
      finding: "Relugolix combination therapy significantly reduced HMB volume and improved QoL. FDA-approved for uterine fibroid symptoms.",
      color: "8B3A6A",
    },
    {
      study: "Chen et al., 2025\nAAGL — J Min Inv Gynecol",
      tier: "Meta-Analysis\nAAGL Practice Committee",
      finding: "Radiofrequency ablation (RFA) is safe and effective for symptomatic fibroids. Significant symptom improvement and QoL gain at 12 months post-procedure.",
      color: C.gold,
    },
    {
      study: "GBD 2019 / Lou et al., 2023\nBMC Public Health",
      tier: "Epidemiological\nGlobal Burden Study",
      finding: "Age-standardized fibroid incidence increasing globally. Women 35–39 years at highest risk. Eastern Europe, Brazil, India bear greatest burden.",
      color: "1A6B3A",
    },
  ];

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// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 14: FERTILITY & SPECIAL CONSIDERATIONS
// ─────────────────────────────────────────────────────────────────────────────
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  const s = contentSlide("Fertility, Anaemia & Racial Disparities");

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    {
      title: "FIBROID & FERTILITY",
      color: "1A6B3A",
      bg: "E0F5EA",
      points: [
        "Submucosal fibroids (Type 0–2) most detrimental to implantation — distort cavity",
        "Intramural fibroids reduce IVF success by ~21% (meta-analysis)",
        "Myomectomy improves conception rates in infertile women with submucosal fibroids",
        "Counsel: 12–18 months post-myomectomy before TTC",
        "LUS scar: uterine rupture risk in subsequent pregnancies — planned LSCS",
      ],
    },
    {
      title: "ANAEMIA MANAGEMENT",
      color: C.crimson,
      bg: C.blush,
      points: [
        "IDA affects ~40% of women with HMB due to fibroids",
        "Iron stores deplete before Hb falls — check ferritin (< 15 μg/L diagnostic)",
        "IV iron (ferric carboxymaltose 1000 mg) — rapid Hb correction within 2–4 weeks",
        "Pre-operative Hb target ≥ 10 g/dL; GnRH agonist helps (↓ bleeding, ↑ Hb)",
        "Blood transfusion if Hb < 7 and symptomatic or pre-op",
      ],
    },
    {
      title: "RACIAL & HEALTH DISPARITIES",
      color: C.gold,
      bg: C.amber,
      points: [
        "Black / African-American women: 2–3× higher prevalence, earlier onset, larger fibroids",
        "Longer time to diagnosis; under-representation in fibroid trials",
        "Greater fertility impact and more surgical interventions",
        "Socioeconomic barriers to minimally invasive treatment access",
        "Cultural competence in counseling essential — fertility desires, treatment preferences",
      ],
    },
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// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 15: DISCUSSION QUESTIONS
// ─────────────────────────────────────────────────────────────────────────────
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  const s = contentSlide("Discussion Points for Residents");

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  s.addText("Case Discussion — Think, Discuss, Decide", { x: 0.35, y: 0.92, w: 9.3, h: 0.44, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", valign: "middle" });

  const qs = [
    { n: "Q1", text: "What is the FIGO classification of the fibroid most likely responsible for her HMB, and why does location matter for symptom pattern?", color: C.crimson, bg: C.blush },
    { n: "Q2", text: "At Hb 7.6 g/dL, she wants to avoid transfusion. What is your step-wise pre-operative optimization strategy?", color: C.teal, bg: C.tealLight },
    { n: "Q3", text: "She wants another pregnancy. How does this change your surgical approach, and what consent issues arise regarding uterine scar?", color: C.gold, bg: C.amber },
    { n: "Q4", text: "Her UFS-QoL HRQOL score is 26/100. What validated tool would you use at follow-up to measure treatment success? What score improvement is clinically meaningful?", color: "8B3A6A", bg: "F5E6F0" },
    { n: "Q5", text: "What is the latest evidence (2021–2025) for GnRH antagonist-based medical therapy in symptomatic fibroids?", color: "1A3A6B", bg: C.paleBlue },
  ];

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// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 16: KEY TAKE-AWAYS & CLOSING
// ─────────────────────────────────────────────────────────────────────────────
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    "Fibroids affect >70% of women by age 50 — common but NOT always benign in their QoL impact",
    "Symptom burden is multi-dimensional: HMB, bulk symptoms, fertility, mental health, and work productivity",
    "FIGO classification guides treatment choice — submucosal fibroids cause greatest reproductive impact",
    "UFS-QoL is the validated gold-standard tool to measure symptom severity and QoL impairment",
    "Medical therapy (GnRH analogs, LNG-IUS, tranexamic acid) precedes or complements surgery",
    "Myomectomy is the fertility-preserving surgical standard; UAE is an alternative for completed family",
    "ALL interventions improve QoL — counsel patients and set realistic expectations (Neumann 2024)",
    "Racial disparities are real — tailor counseling and ensure equitable access to minimally invasive options",
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  s.addText("References: Neumann et al. Fertil Steril 2024 | Manyonda et al. NEJM 2020 | Al-Hendy et al. NEJM 2021 | Chen et al. J Min Inv Gynecol 2025 | Robbins & Kumar Pathologic Basis of Disease | Berek & Novak's Gynecology | Goldman-Cecil Medicine", {
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// ─────────────────────────────────────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────────────────────────────────────
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