const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Intra-Articular Injections in Orthopaedics";

// ── PALETTE ──────────────────────────────────────────────────────────────────
const C = {
  navy:    "0A2342",   // dominant dark
  teal:    "1A7A8A",   // accent
  tealLt:  "2DA8BC",   // lighter teal
  white:   "FFFFFF",
  offWhite:"F4F8FB",
  gray:    "546E7A",
  grayLt:  "B0BEC5",
  amber:   "F59E0B",
  red:     "D93025",
  green:   "1B7A4A",
  lightBg: "EBF4F7",
};

// ── HELPERS ───────────────────────────────────────────────────────────────────
function darkSlide(slide) {
  slide.background = { color: C.navy };
}
function lightSlide(slide) {
  slide.background = { color: C.offWhite };
}
function addAccentBar(slide, color) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: color || C.teal }, line: { type: "none" } });
}
function sectionHeader(slide, title, sub) {
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  // left bold bar
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}

// ── SLIDE 1 — TITLE ───────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  darkSlide(s);
  // gradient-like layered rects
  s.addShape(pres.ShapeType.rect, { x: 6.5, y: 0, w: 3.5, h: 5.625, fill: { color: C.teal }, line: { type: "none" } });
  s.addShape(pres.ShapeType.rect, { x: 6.3, y: 0, w: 0.35, h: 5.625, fill: { color: C.tealLt }, line: { type: "none" } });
  // red accent dot
  s.addShape(pres.ShapeType.ellipse, { x: 0.55, y: 0.55, w: 0.18, h: 0.18, fill: { color: C.amber }, line: { type: "none" } });
  s.addShape(pres.ShapeType.ellipse, { x: 0.55, y: 0.95, w: 0.18, h: 0.18, fill: { color: C.tealLt }, line: { type: "none" } });

  s.addText("INTRA-ARTICULAR", { x: 0.6, y: 1.0, w: 5.6, h: 0.75, fontSize: 13, bold: true, color: C.tealLt, charSpacing: 5, fontFace: "Calibri" });
  s.addText("Injections", { x: 0.6, y: 1.7, w: 5.6, h: 1.3, fontSize: 58, bold: true, color: C.white, fontFace: "Calibri" });
  s.addText("in Orthopaedics", { x: 0.6, y: 2.95, w: 5.6, h: 0.75, fontSize: 28, color: C.grayLt, fontFace: "Calibri", italic: true });
  s.addShape(pres.ShapeType.line, { x: 0.6, y: 3.85, w: 4.5, h: 0, line: { color: C.tealLt, width: 2 } });
  s.addText("Principles • Techniques • Evidence", { x: 0.6, y: 4.05, w: 5.6, h: 0.5, fontSize: 14, color: C.grayLt, fontFace: "Calibri", charSpacing: 2 });

  // syringe icon (simplified shapes on right panel)
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  s.addShape(pres.ShapeType.rect,    { x: 7.9, y: 1.72, w: 0.6, h: 1.6, fill: { color: C.white }, line: { type: "none" }, rounding: 0.05 });
  s.addShape(pres.ShapeType.rect,    { x: 8.05, y: 3.32, w: 0.3, h: 0.55, fill: { color: C.navy }, line: { type: "none" } });
  s.addShape(pres.ShapeType.rect,    { x: 8.12, y: 3.87, w: 0.16, h: 0.55, fill: { color: C.navy }, line: { type: "none" } });
  // plunger line
  s.addShape(pres.ShapeType.line,    { x: 8.2, y: 1.75, w: 0, h: 1.3, line: { color: C.teal, width: 3 } });
  // barrel markings
  s.addShape(pres.ShapeType.line,    { x: 7.93, y: 2.15, w: 0.25, h: 0, line: { color: C.tealLt, width: 1.5 } });
  s.addShape(pres.ShapeType.line,    { x: 7.93, y: 2.55, w: 0.25, h: 0, line: { color: C.tealLt, width: 1.5 } });
  s.addShape(pres.ShapeType.line,    { x: 7.93, y: 2.95, w: 0.25, h: 0, line: { color: C.tealLt, width: 1.5 } });
}

// ── SLIDE 2 — OVERVIEW / AGENDA ───────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.teal);
  s.addText("What We Will Cover", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  const topics = [
    { num: "01", label: "Definition & Anatomy" },
    { num: "02", label: "Indications" },
    { num: "03", label: "Contraindications" },
    { num: "04", label: "Types of Injectable Agents" },
    { num: "05", label: "Technique & Approach (Knee, Hip, Shoulder, Ankle)" },
    { num: "06", label: "Ultrasound Guidance" },
    { num: "07", label: "Complications" },
    { num: "08", label: "Post-Injection Care" },
    { num: "09", label: "Key Evidence & Summary" },
  ];
  topics.forEach((t, i) => {
    const col = i < 5 ? 0 : 1;
    const row = i < 5 ? i : i - 5;
    const x = col === 0 ? 0.45 : 5.25;
    const y = 1.05 + row * 0.82;
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.52, h: 0.52, fill: { color: C.teal }, line: { type: "none" }, rounding: 0.08 });
    s.addText(t.num, { x, y, w: 0.52, h: 0.52, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(t.label, { x: x + 0.62, y: y + 0.05, w: col === 0 ? 4.0 : 4.5, h: 0.42, fontSize: 15, color: C.navy, fontFace: "Calibri" });
  });
}

// ── SLIDE 3 — DEFINITION & ANATOMY ────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.navy);
  s.addText("Definition & Anatomy", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  // definition box
  s.addShape(pres.ShapeType.rect, { x: 0.45, y: 1.0, w: 9.1, h: 0.85, fill: { color: C.teal }, line: { type: "none" }, rounding: 0.1 });
  s.addText("Intra-articular (IA) injection is the direct delivery of a therapeutic or diagnostic agent into a synovial joint space, bypassing systemic circulation for localised effect.", {
    x: 0.55, y: 1.05, w: 8.9, h: 0.75, fontSize: 14, color: C.white, fontFace: "Calibri", italic: true
  });

  // joint anatomy diagram (simplified cross-section)
  // outer bone shapes
  s.addShape(pres.ShapeType.rect, { x: 1.0, y: 2.05, w: 2.8, h: 0.7, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.12 });
  s.addShape(pres.ShapeType.rect, { x: 1.0, y: 4.1, w: 2.8, h: 0.7, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.12 });
  // cartilage
  s.addShape(pres.ShapeType.rect, { x: 1.05, y: 2.72, w: 2.7, h: 0.28, fill: { color: C.tealLt }, line: { type: "none" } });
  s.addShape(pres.ShapeType.rect, { x: 1.05, y: 3.85, w: 2.7, h: 0.28, fill: { color: C.tealLt }, line: { type: "none" } });
  // synovial fluid space
  s.addShape(pres.ShapeType.rect, { x: 1.05, y: 3.0, w: 2.7, h: 0.85, fill: { color: C.lightBg }, line: { color: C.tealLt, width: 1 } });
  // synovial membrane lines
  s.addShape(pres.ShapeType.line, { x: 1.05, y: 3.0, w: 0, h: 0.85, line: { color: C.amber, width: 2.5 } });
  s.addShape(pres.ShapeType.line, { x: 3.75, y: 3.0, w: 0, h: 0.85, line: { color: C.amber, width: 2.5 } });
  // needle
  s.addShape(pres.ShapeType.line, { x: 3.9, y: 2.8, w: -0.55, h: 0.65, line: { color: C.red, width: 2.5 } });
  s.addShape(pres.ShapeType.rect, { x: 3.88, y: 2.72, w: 0.55, h: 0.14, fill: { color: C.red }, line: { type: "none" }, rounding: 0.04 });

  // labels
  s.addText("Bone (Cortex)", { x: 0.2, y: 2.05, w: 1.7, h: 0.35, fontSize: 10, color: C.gray, fontFace: "Calibri", align: "right" });
  s.addText("Articular Cartilage", { x: 0.2, y: 2.72, w: 1.7, h: 0.3, fontSize: 10, color: C.teal, fontFace: "Calibri", align: "right" });
  s.addText("Synovial Space", { x: 0.2, y: 3.2, w: 1.7, h: 0.3, fontSize: 10, color: C.navy, fontFace: "Calibri", align: "right" });
  s.addText("Synovial Membrane", { x: 0.2, y: 3.55, w: 1.7, h: 0.3, fontSize: 10, color: C.amber, fontFace: "Calibri", align: "right" });
  s.addText("Needle", { x: 4.5, y: 2.72, w: 1.0, h: 0.3, fontSize: 10, color: C.red, fontFace: "Calibri", bold: true });

  // anatomy key points
  const pts = [
    "Joints are lined by synovial membrane that produces synovial fluid for lubrication",
    "Hyaline cartilage covers articular surfaces — avascular, relies on synovial fluid for nutrition",
    "Joint capsule provides mechanical stability and encloses the synovial space",
    "Correct needle placement = within the joint space, not in periarticular soft tissue",
  ];
  s.addText(pts.map(p => ({ text: p, options: { bullet: { type: "bullet" }, breakLine: true, paraSpaceAfter: 4 } })),
    { x: 4.8, y: 1.0, w: 4.8, h: 3.9, fontSize: 13.5, color: C.navy, fontFace: "Calibri", valign: "top" });
}

// ── SLIDE 4 — INDICATIONS ─────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.teal);
  s.addText("Indications", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  const boxes = [
    { label: "Degenerative", color: C.teal,  items: ["Osteoarthritis (knee, hip, shoulder)", "Chondromalacia patellae", "Post-traumatic arthritis"] },
    { label: "Inflammatory", color: C.navy,  items: ["Rheumatoid arthritis", "Gout & Pseudogout (crystalloid arthropathy)", "Psoriatic arthritis", "Reactive arthritis"] },
    { label: "Mechanical",   color: C.amber, items: ["Meniscal tears", "Effusion / haemarthrosis", "Synovitis", "Intra-articular derangement"] },
    { label: "Diagnostic",   color: C.gray,  items: ["Confirm joint-source pain (LA test)", "Arthrography contrast medium", "Pre-operative assessment"] },
  ];
  boxes.forEach((b, i) => {
    const x = 0.45 + (i % 2) * 4.6;
    const y = 1.0 + Math.floor(i / 2) * 2.25;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.3, h: 2.1, fill: { color: C.white }, line: { color: b.color, width: 2 }, rounding: 0.12 });
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.3, h: 0.46, fill: { color: b.color }, line: { type: "none" }, rounding: 0.12 });
    s.addShape(pres.ShapeType.rect, { x, y: y + 0.23, w: 4.3, h: 0.23, fill: { color: b.color }, line: { type: "none" } });
    s.addText(b.label, { x: x + 0.15, y: y + 0.07, w: 4.0, h: 0.36, fontSize: 15, bold: true, color: C.white, fontFace: "Calibri" });
    s.addText(b.items.map(it => ({ text: it, options: { bullet: { type: "bullet" }, breakLine: true } })),
      { x: x + 0.12, y: y + 0.52, w: 4.06, h: 1.52, fontSize: 12.5, color: C.navy, fontFace: "Calibri", valign: "top" });
  });
}

// ── SLIDE 5 — CONTRAINDICATIONS ───────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.red);
  s.addText("Contraindications", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  const abs = [
    "Active septic arthritis in the joint",
    "Local overlying skin infection (cellulitis, abscess)",
    "Bacteraemia / systemic infection",
    "Prosthetic joint (risk of seeding)",
    "Known allergy to injectable agent",
    "Fracture through the joint (acute)",
  ];
  const rel = [
    "Anticoagulation / bleeding diathesis",
    "Poorly controlled diabetes (steroid injections)",
    "Recent injection at same site (< 3 months)",
    "Joint instability or ligamentous laxity",
    "Immunosuppression",
    "Patient refusal / uncooperative patient",
  ];

  // absolute box
  s.addShape(pres.ShapeType.rect, { x: 0.45, y: 1.0, w: 4.3, h: 4.2, fill: { color: C.white }, line: { color: C.red, width: 2 }, rounding: 0.12 });
  s.addShape(pres.ShapeType.rect, { x: 0.45, y: 1.0, w: 4.3, h: 0.5, fill: { color: C.red }, line: { type: "none" }, rounding: 0.12 });
  s.addShape(pres.ShapeType.rect, { x: 0.45, y: 1.25, w: 4.3, h: 0.25, fill: { color: C.red }, line: { type: "none" } });
  s.addText("ABSOLUTE", { x: 0.6, y: 1.05, w: 4.0, h: 0.38, fontSize: 15, bold: true, color: C.white, fontFace: "Calibri" });
  s.addText(abs.map(it => ({ text: it, options: { bullet: { type: "bullet" }, breakLine: true, paraSpaceAfter: 5 } })),
    { x: 0.6, y: 1.58, w: 4.0, h: 3.5, fontSize: 13, color: C.navy, fontFace: "Calibri", valign: "top" });

  // relative box
  s.addShape(pres.ShapeType.rect, { x: 5.15, y: 1.0, w: 4.4, h: 4.2, fill: { color: C.white }, line: { color: C.amber, width: 2 }, rounding: 0.12 });
  s.addShape(pres.ShapeType.rect, { x: 5.15, y: 1.0, w: 4.4, h: 0.5, fill: { color: C.amber }, line: { type: "none" }, rounding: 0.12 });
  s.addShape(pres.ShapeType.rect, { x: 5.15, y: 1.25, w: 4.4, h: 0.25, fill: { color: C.amber }, line: { type: "none" } });
  s.addText("RELATIVE", { x: 5.3, y: 1.05, w: 4.0, h: 0.38, fontSize: 15, bold: true, color: C.white, fontFace: "Calibri" });
  s.addText(rel.map(it => ({ text: it, options: { bullet: { type: "bullet" }, breakLine: true, paraSpaceAfter: 5 } })),
    { x: 5.3, y: 1.58, w: 4.1, h: 3.5, fontSize: 13, color: C.navy, fontFace: "Calibri", valign: "top" });
}

// ── SLIDE 6 — TYPES OF AGENTS ─────────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.teal);
  s.addText("Types of Injectable Agents", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  const agents = [
    {
      icon: "CS", color: C.navy, title: "Corticosteroids",
      sub: "Most commonly used",
      pts: ["Methylprednisolone, Triamcinolone, Betamethasone", "Reduces synovial inflammation via phospholipase inhibition", "Effect onset: 24–48 hrs; duration: weeks to months", "Limit: max 3–4 injections/year per joint"],
    },
    {
      icon: "HA", color: C.teal, title: "Hyaluronic Acid",
      sub: "Viscosupplementation",
      pts: ["Restores viscoelasticity of synovial fluid", "Reduces cartilage wear and improves lubrication", "3–5 weekly injections; mainly used in knee OA", "Benefit lasts 3–6 months"],
    },
    {
      icon: "LA", color: C.gray, title: "Local Anaesthetic",
      sub: "Diagnostic & adjunct",
      pts: ["Lidocaine, Bupivacaine", "Used alone for diagnostic blocks", "Mixed with steroids to reduce post-injection pain", "Short-term relief; can be repeated"],
    },
    {
      icon: "PRP", color: C.amber, title: "Platelet-Rich Plasma",
      sub: "Biologics / regenerative",
      pts: ["Concentrated autologous growth factors", "Promotes cartilage repair and reduces inflammation", "Best evidence for knee OA and lateral epicondylitis", "2–3 injections; requires centrifugation preparation"],
    },
    {
      icon: "SC", color: C.green, title: "Stem Cells / Biologics",
      sub: "Emerging therapy",
      pts: ["Mesenchymal stem cells from bone marrow / adipose", "Promotes chondrogenesis and anti-inflammation", "Limited but growing RCT evidence", "Currently off-label in most jurisdictions"],
    },
    {
      icon: "OT", color: "#7B5EA7", title: "Others",
      sub: "Specialist use",
      pts: ["Radiosynovectomy (Yttrium-90, Rhenium-186)", "Osmic acid — chemical synovectomy", "Contrast agents — for arthrography", "Botulinum toxin A — chronic pain, spasticity"],
    },
  ];
  agents.forEach((a, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.45 + col * 3.12;
    const y = 1.0 + row * 2.22;
    s.addShape(pres.ShapeType.rect, { x, y, w: 3.0, h: 2.1, fill: { color: C.white }, line: { color: a.color, width: 1.5 }, rounding: 0.1 });
    s.addShape(pres.ShapeType.ellipse, { x: x + 0.12, y: y + 0.12, w: 0.55, h: 0.55, fill: { color: a.color }, line: { type: "none" } });
    s.addText(a.icon, { x: x + 0.12, y: y + 0.12, w: 0.55, h: 0.55, fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(a.title, { x: x + 0.75, y: y + 0.1, w: 2.15, h: 0.32, fontSize: 13.5, bold: true, color: a.color, fontFace: "Calibri" });
    s.addText(a.sub, { x: x + 0.75, y: y + 0.42, w: 2.15, h: 0.26, fontSize: 10.5, color: C.gray, fontFace: "Calibri", italic: true });
    s.addText(a.pts.map(p => ({ text: p, options: { bullet: { type: "bullet" }, breakLine: true } })),
      { x: x + 0.12, y: y + 0.73, w: 2.76, h: 1.3, fontSize: 10.5, color: C.navy, fontFace: "Calibri", valign: "top" });
  });
}

// ── SLIDE 7 — GENERAL TECHNIQUE ───────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.navy);
  s.addText("General Injection Technique", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  const steps = [
    { n: "1", title: "Patient Assessment", desc: "Confirm indication, review history, allergy check, informed consent" },
    { n: "2", title: "Positioning",         desc: "Comfortable, expose joint; relaxed muscles improve accuracy" },
    { n: "3", title: "Landmark Palpation",  desc: "Identify anatomical landmarks; mark entry point with thumbnail or pen" },
    { n: "4", title: "Aseptic Preparation", desc: "Clean technique: gloves, povidone-iodine or chlorhexidine; sterile field" },
    { n: "5", title: "Needle Insertion",    desc: "Insert at marked point; angle depends on joint. Advance until loss of resistance felt" },
    { n: "6", title: "Confirm Position",    desc: "Aspirate: free flow of fluid or aspiration of existing effusion confirms placement" },
    { n: "7", title: "Injection",           desc: "Inject slowly; no resistance should be felt. Stop if patient reports severe pain" },
    { n: "8", title: "Post-Injection",      desc: "Apply dressing; gentle ROM; advise rest 24–48 h; document dose/site/batch" },
  ];
  // draw as a flow with connecting arrows
  steps.forEach((st, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.45 + col * 4.7;
    const y = 1.0 + row * 1.15;
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.42, h: 0.62, fill: { color: C.teal }, line: { type: "none" }, rounding: 0.07 });
    s.addText(st.n, { x, y, w: 0.42, h: 0.62, fontSize: 17, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(st.title, { x: x + 0.52, y: y, w: 3.95, h: 0.3, fontSize: 13, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
    s.addText(st.desc, { x: x + 0.52, y: y + 0.3, w: 3.95, h: 0.42, fontSize: 11.5, color: C.gray, fontFace: "Calibri", margin: 0 });
    // horizontal connector within same column
    if (row < 3 && col === 0) {
      s.addShape(pres.ShapeType.line, { x: x + 0.21, y: y + 0.62, w: 0, h: 0.53, line: { color: C.grayLt, width: 1.5 } });
    }
  });
}

// ── SLIDE 8 — KNEE INJECTION ──────────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.teal);
  s.addText("Knee Joint Injection", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  // knee diagram (frontal view simplified)
  // femur
  s.addShape(pres.ShapeType.rect, { x: 1.1, y: 1.0, w: 1.5, h: 1.4, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.18 });
  // femoral condyles
  s.addShape(pres.ShapeType.ellipse, { x: 1.0, y: 2.2, w: 0.85, h: 0.65, fill: { color: C.gray }, line: { type: "none" } });
  s.addShape(pres.ShapeType.ellipse, { x: 1.85, y: 2.2, w: 0.85, h: 0.65, fill: { color: C.gray }, line: { type: "none" } });
  // patella
  s.addShape(pres.ShapeType.ellipse, { x: 1.35, y: 2.05, w: 1.0, h: 0.55, fill: { color: C.grayLt }, line: { color: C.gray, width: 1 } });
  // cartilage
  s.addShape(pres.ShapeType.rect, { x: 1.05, y: 2.82, w: 1.6, h: 0.2, fill: { color: C.tealLt }, line: { type: "none" } });
  // tibia
  s.addShape(pres.ShapeType.rect, { x: 1.05, y: 3.0, w: 1.6, h: 1.5, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.1 });
  // joint space
  s.addShape(pres.ShapeType.rect, { x: 1.05, y: 2.83, w: 1.6, h: 0.18, fill: { color: C.lightBg }, line: { color: C.tealLt, width: 1 } });
  // fibula
  s.addShape(pres.ShapeType.rect, { x: 2.72, y: 3.1, w: 0.35, h: 1.35, fill: { color: C.grayLt }, line: { type: "none" }, rounding: 0.07 });

  // Approaches arrows
  // Superolateral (most common)
  s.addShape(pres.ShapeType.line, { x: 3.3, y: 2.18, w: -1.05, h: 0.42, line: { color: C.teal, width: 2.5 } });
  s.addShape(pres.ShapeType.ellipse, { x: 2.22, y: 2.57, w: 0.1, h: 0.1, fill: { color: C.teal }, line: { type: "none" } });
  // Medial midpatellar
  s.addShape(pres.ShapeType.line, { x: 0.55, y: 2.45, w: 0.48, h: 0.2, line: { color: C.amber, width: 2.5 } });
  s.addShape(pres.ShapeType.ellipse, { x: 1.0, y: 2.62, w: 0.1, h: 0.1, fill: { color: C.amber }, line: { type: "none" } });
  // Inferomedial
  s.addShape(pres.ShapeType.line, { x: 0.55, y: 3.15, w: 0.5, h: -0.2, line: { color: C.navy, width: 2.5 } });
  s.addShape(pres.ShapeType.ellipse, { x: 1.02, y: 2.92, w: 0.1, h: 0.1, fill: { color: C.navy }, line: { type: "none" } });

  // labels
  s.addText("Superolateral\n(preferred)", { x: 3.35, y: 2.02, w: 1.8, h: 0.5, fontSize: 11, color: C.teal, fontFace: "Calibri", bold: true });
  s.addText("Medial Mid-patellar", { x: 0.0, y: 2.28, w: 0.52, h: 0.45, fontSize: 9, color: C.amber, fontFace: "Calibri", align: "right" });
  s.addText("Inferomedial\n(AM approach)", { x: 0.0, y: 3.0, w: 0.52, h: 0.5, fontSize: 9, color: C.navy, fontFace: "Calibri", align: "right" });

  // technique points right side
  const kpts = [
    { head: "Position:", body: "Supine, knee extended (or 90° flexed for infrapatellar approach)" },
    { head: "Needle:", body: "18–21G, 1.5 inch" },
    { head: "Superolateral approach:", body: "1–2 cm proximal and lateral to patella; angle 45° medial and distal into suprapatellar pouch" },
    { head: "Medial approach:", body: "Medial joint line with knee slightly flexed; aim toward joint space" },
    { head: "Accuracy:", body: "Landmark-guided: 70–80%. US-guided: >95% (preferred for dry joints or obese patients)" },
    { head: "Volume:", body: "Aspirate effusion first; inject 2–5 mL depending on agent" },
  ];
  let ky = 1.0;
  kpts.forEach(kp => {
    s.addText([
      { text: kp.head + " ", options: { bold: true, color: C.teal } },
      { text: kp.body, options: { color: C.navy } },
    ], { x: 5.4, y: ky, w: 4.2, h: 0.65, fontSize: 12.5, fontFace: "Calibri", valign: "top" });
    ky += 0.68;
  });
}

// ── SLIDE 9 — HIP & SHOULDER ──────────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.navy);
  s.addText("Hip & Shoulder Injections", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  // HIP
  s.addShape(pres.ShapeType.rect, { x: 0.45, y: 1.0, w: 4.3, h: 0.45, fill: { color: C.navy }, line: { type: "none" }, rounding: 0.08 });
  s.addText("HIP JOINT", { x: 0.55, y: 1.04, w: 4.1, h: 0.36, fontSize: 15, bold: true, color: C.white, fontFace: "Calibri" });

  // Hip diagram (simplified frontal)
  // acetabulum
  s.addShape(pres.ShapeType.ellipse, { x: 0.6, y: 1.55, w: 1.5, h: 1.5, fill: { color: C.grayLt }, line: { color: C.gray, width: 2 } });
  s.addShape(pres.ShapeType.ellipse, { x: 0.75, y: 1.7, w: 1.2, h: 1.2, fill: { color: C.lightBg }, line: { type: "none" } });
  // femoral head
  s.addShape(pres.ShapeType.ellipse, { x: 0.88, y: 1.83, w: 0.95, h: 0.95, fill: { color: C.gray }, line: { type: "none" } });
  // femoral neck + shaft
  s.addShape(pres.ShapeType.rect,    { x: 1.55, y: 2.55, w: 0.6, h: 1.5, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.08 });
  // joint space ring
  s.addShape(pres.ShapeType.ellipse, { x: 0.86, y: 1.81, w: 0.99, h: 0.99, fill: { color: "transparent" }, line: { color: C.tealLt, width: 1.5, dashType: "dash" } });
  // anterior approach needle
  s.addShape(pres.ShapeType.line,    { x: 2.45, y: 1.75, w: -0.65, h: 0.5, line: { color: C.teal, width: 2.5 } });
  s.addText("Anterior\napproach", { x: 2.5, y: 1.65, w: 1.5, h: 0.45, fontSize: 10, color: C.teal, fontFace: "Calibri", bold: true });
  // lateral approach
  s.addShape(pres.ShapeType.line,    { x: 0.52, y: 2.55, w: 0.5, h: -0.35, line: { color: C.amber, width: 2.5 } });
  s.addText("Lateral\napproach", { x: 0.0, y: 2.42, w: 0.5, h: 0.42, fontSize: 9, color: C.amber, fontFace: "Calibri", align: "right" });

  s.addText([
    { text: "Approaches: ", options: { bold: true, color: C.navy } },
    { text: "Anterior (most used) and Lateral (image-guided preferred)", options: { color: C.gray } },
  ], { x: 0.45, y: 3.18, w: 4.3, h: 0.38, fontSize: 12, fontFace: "Calibri" });
  const hpts = [
    "US or fluoroscopy strongly recommended — deep joint, close to femoral NVB",
    "Needle: 20–22G spinal needle (3.5 inch)",
    "Patient: supine, hip in neutral rotation",
    "Inject 5–8 mL; aspirate to confirm placement",
  ];
  s.addText(hpts.map(p => ({ text: p, options: { bullet: { type: "bullet" }, breakLine: true, paraSpaceAfter: 3 } })),
    { x: 0.45, y: 3.58, w: 4.3, h: 1.7, fontSize: 12, color: C.navy, fontFace: "Calibri", valign: "top" });

  // SHOULDER
  s.addShape(pres.ShapeType.rect, { x: 5.15, y: 1.0, w: 4.4, h: 0.45, fill: { color: C.teal }, line: { type: "none" }, rounding: 0.08 });
  s.addText("SHOULDER (Glenohumeral)", { x: 5.25, y: 1.04, w: 4.2, h: 0.36, fontSize: 15, bold: true, color: C.white, fontFace: "Calibri" });

  // shoulder diagram
  // glenoid
  s.addShape(pres.ShapeType.rect,    { x: 5.3, y: 1.6, w: 0.35, h: 1.45, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.05 });
  // humeral head
  s.addShape(pres.ShapeType.ellipse, { x: 5.55, y: 1.52, w: 1.25, h: 1.25, fill: { color: C.gray }, line: { type: "none" } });
  s.addShape(pres.ShapeType.ellipse, { x: 5.58, y: 1.55, w: 1.18, h: 1.18, fill: { color: C.grayLt }, line: { type: "none" } });
  // joint space
  s.addShape(pres.ShapeType.rect,    { x: 5.6, y: 1.78, w: 0.22, h: 0.7, fill: { color: C.lightBg }, line: { type: "none" } });
  // humeral shaft
  s.addShape(pres.ShapeType.rect,    { x: 6.2, y: 2.6, w: 0.55, h: 1.6, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.08 });
  // acromion
  s.addShape(pres.ShapeType.rect,    { x: 5.3, y: 1.42, w: 1.5, h: 0.22, fill: { color: C.grayLt }, line: { type: "none" }, rounding: 0.05 });
  // posterior approach needle
  s.addShape(pres.ShapeType.line,    { x: 7.25, y: 2.08, w: -0.9, h: 0.12, line: { color: C.teal, width: 2.5 } });
  s.addText("Posterior\n(preferred)", { x: 7.3, y: 1.95, w: 1.7, h: 0.4, fontSize: 10, color: C.teal, fontFace: "Calibri", bold: true });
  // anterior approach
  s.addShape(pres.ShapeType.line,    { x: 5.2, y: 2.1, w: 0.45, h: 0.1, line: { color: C.amber, width: 2.5 } });
  s.addText("Anterior", { x: 4.7, y: 2.02, w: 0.45, h: 0.3, fontSize: 9, color: C.amber, fontFace: "Calibri", bold: true });

  const spts = [
    "Posterior approach: 2 cm inferior and medial to posterolateral acromion corner; aim anteriorly toward coracoid",
    "Anterior approach: 1 cm lateral to coracoid process; aim posteriorly",
    "Needle: 22G, 1.5–3.5 inch; Volume: 5–10 mL",
    "Used in adhesive capsulitis, glenohumeral OA, RA",
    "US-guided has higher accuracy; reduces number of attempts",
  ];
  s.addText(spts.map(p => ({ text: p, options: { bullet: { type: "bullet" }, breakLine: true, paraSpaceAfter: 3 } })),
    { x: 5.15, y: 3.18, w: 4.4, h: 2.1, fontSize: 12, color: C.navy, fontFace: "Calibri", valign: "top" });
}

// ── SLIDE 10 — ANKLE, WRIST, ELBOW ────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.teal);
  s.addText("Ankle, Wrist & Elbow Injections", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  const joints = [
    {
      name: "ANKLE", color: C.teal,
      diag: { type: "ankle" },
      pts: [
        "Position: supine, foot plantar-flexed",
        "Approach: anteromedial — medial to tibialis anterior tendon, 1 cm proximal to tibiotalar joint",
        "Needle: 22G, 1.5 inch; Volume: 3–5 mL",
        "Avoid dorsalis pedis artery (lateral to EHL)",
        "US guidance reduces risk of tendon/vessel injury",
      ],
    },
    {
      name: "WRIST", color: C.navy,
      pts: [
        "Approach: dorsal — between EPL and EDC tendons at radiocarpal joint (Lister's tubercle landmark)",
        "Slight wrist flexion to open dorsal joint space",
        "Needle: 25G, 1 inch; Volume: 2–3 mL",
        "Used in RA, SLAC wrist, TFCC pathology",
        "Avoid radial artery (volar-radial side)",
      ],
    },
    {
      name: "ELBOW", color: C.amber,
      pts: [
        "Lateral approach: enter between radial head, lateral epicondyle and olecranon tip (soft spot)",
        "Elbow at 90° flexion; forearm pronated",
        "Needle: 22G, 1 inch; Volume: 2–3 mL",
        "Used in OA, RA, post-traumatic arthritis, loose bodies",
        "Aspiration of effusion first aids placement",
      ],
    },
  ];
  joints.forEach((jt, i) => {
    const x = 0.45 + i * 3.12;
    s.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 3.0, h: 0.42, fill: { color: jt.color }, line: { type: "none" }, rounding: 0.08 });
    s.addText(jt.name, { x: x + 0.1, y: 1.04, w: 2.8, h: 0.34, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri" });

    // simple anatomical shape for each joint
    if (jt.name === "ANKLE") {
      // tibia
      s.addShape(pres.ShapeType.rect, { x: x + 0.75, y: 1.52, w: 0.8, h: 0.9, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.06 });
      // fibula
      s.addShape(pres.ShapeType.rect, { x: x + 1.62, y: 1.6, w: 0.35, h: 0.75, fill: { color: C.grayLt }, line: { type: "none" }, rounding: 0.05 });
      // talus
      s.addShape(pres.ShapeType.rect, { x: x + 0.7, y: 2.52, w: 1.3, h: 0.55, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.08 });
      // joint space
      s.addShape(pres.ShapeType.rect, { x: x + 0.72, y: 2.42, w: 0.88, h: 0.12, fill: { color: C.lightBg }, line: { color: C.tealLt, width: 1 } });
      // cartilage
      s.addShape(pres.ShapeType.rect, { x: x + 0.72, y: 2.39, w: 0.88, h: 0.06, fill: { color: C.tealLt }, line: { type: "none" } });
      // needle — anteromedial
      s.addShape(pres.ShapeType.line, { x: x + 0.45, y: 2.2, w: 0.35, h: 0.28, line: { color: C.teal, width: 2.5 } });
      s.addText("AM\nneedle", { x: x + 0.05, y: 2.08, w: 0.65, h: 0.4, fontSize: 9, color: C.teal, fontFace: "Calibri" });
    } else if (jt.name === "WRIST") {
      // radius
      s.addShape(pres.ShapeType.rect, { x: x + 0.62, y: 1.52, w: 0.65, h: 1.0, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.06 });
      // ulna
      s.addShape(pres.ShapeType.rect, { x: x + 1.35, y: 1.52, w: 0.5, h: 0.9, fill: { color: C.grayLt }, line: { type: "none" }, rounding: 0.06 });
      // carpals row
      s.addShape(pres.ShapeType.rect, { x: x + 0.55, y: 2.62, w: 1.5, h: 0.55, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.08 });
      // joint space
      s.addShape(pres.ShapeType.rect, { x: x + 0.56, y: 2.52, w: 1.25, h: 0.12, fill: { color: C.lightBg }, line: { color: C.tealLt, width: 1 } });
      // needle
      s.addShape(pres.ShapeType.line, { x: x + 0.88, y: 2.12, w: 0.1, h: 0.38, line: { color: C.navy, width: 2.5 } });
      s.addText("Dorsal\nentry", { x: x + 0.7, y: 1.95, w: 0.8, h: 0.4, fontSize: 9, color: C.navy, fontFace: "Calibri" });
    } else if (jt.name === "ELBOW") {
      // humerus
      s.addShape(pres.ShapeType.rect, { x: x + 0.85, y: 1.52, w: 0.7, h: 0.9, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.08 });
      // radial head
      s.addShape(pres.ShapeType.ellipse, { x: x + 1.62, y: 2.22, w: 0.55, h: 0.55, fill: { color: C.gray }, line: { type: "none" } });
      // olecranon
      s.addShape(pres.ShapeType.rect, { x: x + 0.82, y: 2.22, w: 0.6, h: 0.6, fill: { color: C.grayLt }, line: { type: "none" }, rounding: 0.06 });
      // soft spot / joint space
      s.addShape(pres.ShapeType.ellipse, { x: x + 1.42, y: 2.32, w: 0.25, h: 0.25, fill: { color: C.lightBg }, line: { color: C.tealLt, width: 1 } });
      // needle
      s.addShape(pres.ShapeType.line, { x: x + 2.35, y: 2.22, w: -0.65, h: 0.25, line: { color: C.amber, width: 2.5 } });
      s.addText("Lateral\nsoft spot", { x: x + 2.2, y: 2.06, w: 0.8, h: 0.38, fontSize: 9, color: C.amber, fontFace: "Calibri" });
    }

    s.addText(jt.pts.map(p => ({ text: p, options: { bullet: { type: "bullet" }, breakLine: true, paraSpaceAfter: 3 } })),
      { x: x + 0.05, y: 3.2, w: 2.9, h: 2.1, fontSize: 10.5, color: C.navy, fontFace: "Calibri", valign: "top" });
  });
}

// ── SLIDE 11 — ULTRASOUND GUIDANCE ────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.teal);
  s.addText("Ultrasound-Guided Injection", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  // US screen mock
  const ux = 0.5, uy = 1.05;
  s.addShape(pres.ShapeType.rect,    { x: ux,      y: uy,      w: 4.0, h: 3.2, fill: { color: "111111" }, line: { color: C.gray, width: 2 }, rounding: 0.12 });
  s.addShape(pres.ShapeType.rect,    { x: ux+0.15, y: uy+0.18, w: 3.7, h: 2.65, fill: { color: "001122" }, line: { type: "none" } });
  // US layers (tissue planes)
  s.addShape(pres.ShapeType.rect,    { x: ux+0.15, y: uy+0.18, w: 3.7, h: 0.4,  fill: { color: "223344" }, line: { type: "none" } }); // skin/subcut
  s.addShape(pres.ShapeType.rect,    { x: ux+0.15, y: uy+0.58, w: 3.7, h: 0.55, fill: { color: "334455" }, line: { type: "none" } }); // muscle
  s.addShape(pres.ShapeType.rect,    { x: ux+0.15, y: uy+1.13, w: 3.7, h: 0.18, fill: { color: C.tealLt }, line: { type: "none" } }); // cartilage
  s.addShape(pres.ShapeType.rect,    { x: ux+0.15, y: uy+1.31, w: 3.7, h: 0.35, fill: { color: "003355" }, line: { type: "none" } }); // joint fluid
  s.addShape(pres.ShapeType.rect,    { x: ux+0.15, y: uy+1.66, w: 3.7, h: 1.17, fill: { color: "1a2a3a" }, line: { type: "none" } }); // bone shadow
  // bone hyperechoic line
  s.addShape(pres.ShapeType.line,    { x: ux+0.15, y: uy+1.62, w: 3.7, h: 0, line: { color: "DDDDDD", width: 2 } });
  // needle echo
  s.addShape(pres.ShapeType.line,    { x: ux+0.5,  y: uy+0.35, w: 1.8, h: 0.98, line: { color: "FFFFFF", width: 1.5 } });
  s.addShape(pres.ShapeType.ellipse, { x: ux+2.25, y: uy+1.3,  w: 0.1, h: 0.1, fill: { color: "FFFFFF" }, line: { type: "none" } });
  // US annotations
  s.addText("SKIN", { x: ux+0.2, y: uy+0.2, w: 0.7, h: 0.25, fontSize: 8, color: "AACCEE", fontFace: "Calibri" });
  s.addText("MUSCLE", { x: ux+0.2, y: uy+0.62, w: 0.9, h: 0.25, fontSize: 8, color: "AACCEE", fontFace: "Calibri" });
  s.addText("CARTILAGE", { x: ux+0.2, y: uy+1.16, w: 1.1, h: 0.2, fontSize: 8, color: C.tealLt, fontFace: "Calibri" });
  s.addText("JOINT SPACE", { x: ux+0.2, y: uy+1.35, w: 1.3, h: 0.22, fontSize: 8, color: "6699BB", fontFace: "Calibri" });
  s.addText("BONE", { x: ux+0.2, y: uy+1.7, w: 0.7, h: 0.22, fontSize: 8, color: "CCCCCC", fontFace: "Calibri" });
  s.addText("NEEDLE", { x: ux+1.1, y: uy+0.5, w: 0.8, h: 0.22, fontSize: 8, color: "FFFFFF", italic: true, fontFace: "Calibri" });
  // probe label
  s.addShape(pres.ShapeType.rect,    { x: ux+1.3, y: uy+3.05, w: 1.1, h: 0.22, fill: { color: C.gray }, line: { type: "none" }, rounding: 0.04 });
  s.addText("US PROBE", { x: ux+1.3, y: uy+3.06, w: 1.1, h: 0.2, fontSize: 8, color: C.white, align: "center", fontFace: "Calibri" });

  // right side points
  const upts = [
    { h: "Real-time visualisation",       b: "Needle tip seen throughout procedure; reduces risk of inadvertent vessel or nerve injury" },
    { h: "Higher accuracy",                b: "US-guided: 95–100% vs. landmark: 60–80% for shoulder and hip" },
    { h: "In-plane technique",             b: "Needle parallel to probe; entire shaft visible on screen — preferred for IA injections" },
    { h: "Out-of-plane technique",         b: "Needle perpendicular to probe; tip appears as bright dot — used in tight spaces" },
    { h: "When to use US guidance",        b: "Obese patients, failed landmark attempt, deep joints (hip), dry joints, prosthetic joints" },
    { h: "Probe frequency",                b: "Superficial joints: 10–15 MHz linear. Deep joints: 3–5 MHz curvilinear" },
  ];
  let ry = 1.05;
  upts.forEach(p => {
    s.addText([
      { text: p.h + ": ", options: { bold: true, color: C.teal } },
      { text: p.b, options: { color: C.navy } },
    ], { x: 4.9, y: ry, w: 4.7, h: 0.65, fontSize: 12.5, fontFace: "Calibri", valign: "top" });
    ry += 0.68;
  });
}

// ── SLIDE 12 — COMPLICATIONS ──────────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.red);
  s.addText("Complications", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  const comps = [
    {
      group: "Immediate", color: C.red,
      items: [
        ["Post-injection flare", "Transient pain/swelling 12–24 h after steroid injection; self-limiting in 2–3 days; seen in up to 25%"],
        ["Vasovagal reaction",   "Rare; manage with supine position and reassurance"],
        ["Haemarthrosis",        "Uncommon; direct vessel puncture; risk in anticoagulated patients"],
      ],
    },
    {
      group: "Short-Term", color: C.amber,
      items: [
        ["Infection / Septic Arthritis", "Most feared; incidence < 1 in 10,000; strict asepsis is key"],
        ["Skin depigmentation",          "Subcutaneous steroid tracking; more common in dark skin; use Z-track or two-needle technique"],
        ["Fat atrophy",                  "Localised soft tissue atrophy around injection site"],
      ],
    },
    {
      group: "Long-Term", color: C.navy,
      items: [
        ["Cartilage degeneration",   "Repeated corticosteroid injections (> 3–4/year) can accelerate articular cartilage loss"],
        ["Tendon rupture",           "Avoid direct tendon injection; inject into sheath only"],
        ["Hyperglycaemia",           "Steroid-related; monitor BGL in diabetics for 48–72 h post-injection"],
        ["HPA axis suppression",     "Rare with limited injections; theoretical with frequent use"],
      ],
    },
  ];

  comps.forEach((grp, gi) => {
    const y0 = 1.02 + gi * 1.55;
    s.addShape(pres.ShapeType.rect, { x: 0.45, y: y0, w: 1.5, h: 1.45, fill: { color: grp.color }, line: { type: "none" }, rounding: 0.08 });
    s.addText(grp.group, { x: 0.45, y: y0, w: 1.5, h: 1.45, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", rotate: 0 });
    grp.items.forEach((it, ii) => {
      const iy = y0 + ii * 0.46;
      s.addShape(pres.ShapeType.rect, { x: 2.05, y: iy + 0.03, w: 7.5, h: 0.42, fill: { color: ii % 2 === 0 ? C.white : C.lightBg }, line: { type: "none" }, rounding: 0.05 });
      s.addText([
        { text: it[0] + "  ", options: { bold: true, color: grp.color } },
        { text: it[1], options: { color: C.navy } },
      ], { x: 2.15, y: iy + 0.05, w: 7.3, h: 0.38, fontSize: 12, fontFace: "Calibri" });
    });
  });
}

// ── SLIDE 13 — POST-INJECTION CARE ────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.teal);
  s.addText("Post-Injection Care & Counselling", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  const cards = [
    { icon: "REST",   color: C.teal,  title: "Rest",          body: "Avoid strenuous activity for 24–48 hours. Light activity after this is acceptable. For weight-bearing joints, limit loading for 2–3 days." },
    { icon: "ICE",    color: C.navy,  title: "Ice & Comfort", body: "Apply ice pack (wrapped) for 15–20 mins at a time if soreness develops. NSAIDs may be used short-term for post-injection flare." },
    { icon: "MON",    color: C.amber, title: "Monitoring",    body: "Warn patient about post-injection flare (24 h). Monitor diabetics for hyperglycaemia. Return if increasing pain, fever, or swelling after 48 h." },
    { icon: "RPT",    color: C.gray,  title: "Repeat Timing", body: "Steroid: no more than 3–4 per joint per year; minimum 3-month interval. HA: 3–5 weekly injections. PRP: repeat at 6 weeks if needed." },
    { icon: "DOC",    color: C.green, title: "Documentation", body: "Record: injection site, agent, batch number, dose/volume, needle gauge, number of attempts, patient response, consent obtained." },
    { icon: "REHAB",  color: "#7B5EA7", title: "Rehabilitation", body: "Injection is adjunct to rehabilitation — refer for physiotherapy. Window of reduced pain allows more effective exercise therapy." },
  ];
  cards.forEach((c, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.45 + col * 3.12;
    const y = 1.0 + row * 2.28;
    s.addShape(pres.ShapeType.rect, { x, y, w: 3.0, h: 2.15, fill: { color: C.white }, line: { color: c.color, width: 1.8 }, rounding: 0.12 });
    s.addShape(pres.ShapeType.rect, { x, y, w: 3.0, h: 0.45, fill: { color: c.color }, line: { type: "none" }, rounding: 0.12 });
    s.addShape(pres.ShapeType.rect, { x, y: y+0.23, w: 3.0, h: 0.22, fill: { color: c.color }, line: { type: "none" } });
    s.addText(c.title, { x: x+0.12, y: y+0.07, w: 2.75, h: 0.33, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri" });
    s.addText(c.body, { x: x+0.1, y: y+0.52, w: 2.8, h: 1.6, fontSize: 11.5, color: C.navy, fontFace: "Calibri", valign: "top" });
  });
}

// ── SLIDE 14 — EVIDENCE SUMMARY ───────────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addAccentBar(s, C.navy);
  s.addText("Key Evidence & Clinical Pearls", { x: 0.45, y: 0.22, w: 9.2, h: 0.6, fontSize: 26, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.45, y: 0.9, w: 9.1, h: 0, line: { color: C.grayLt, width: 1 } });

  const evrows = [
    { agent: "Corticosteroid", condition: "Knee OA", evidence: "Strong short-term pain relief (4–6 weeks). No disease modification. Limit to 3–4/year.", level: "HIGH" },
    { agent: "Corticosteroid", condition: "Adhesive capsulitis", evidence: "Best benefit when given early (< 2 months of symptoms) combined with PT.", level: "HIGH" },
    { agent: "Hyaluronic Acid", condition: "Knee OA", evidence: "Modest pain relief, lower risk than steroids, effect up to 6 months.", level: "MOD" },
    { agent: "PRP", condition: "Knee OA", evidence: "Superior to HA and steroids for pain and function at 6 months in RCTs.", level: "MOD" },
    { agent: "PRP", condition: "Lateral epicondylitis", evidence: "Effective, especially single injection; benefit over steroid at 1 year.", level: "MOD" },
    { agent: "Stem cells", condition: "Knee OA / cartilage defects", evidence: "Promising but limited RCT data. Not yet standard of care.", level: "LOW" },
    { agent: "US guidance", condition: "All joints", evidence: "Consistently improves accuracy vs. landmark-guided; reduces number of attempts and complications.", level: "HIGH" },
  ];

  // table header
  s.addShape(pres.ShapeType.rect, { x: 0.45, y: 1.0, w: 9.1, h: 0.38, fill: { color: C.navy }, line: { type: "none" }, rounding: 0.06 });
  const cols = ["Agent", "Condition", "Evidence Summary", "Level"];
  const cw = [1.5, 1.8, 5.0, 0.8];
  let cx = 0.55;
  cols.forEach((col, ci) => {
    s.addText(col, { x: cx, y: 1.02, w: cw[ci], h: 0.32, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri" });
    cx += cw[ci];
  });
  evrows.forEach((row, ri) => {
    const ry = 1.4 + ri * 0.54;
    s.addShape(pres.ShapeType.rect, { x: 0.45, y: ry - 0.04, w: 9.1, h: 0.5, fill: { color: ri % 2 === 0 ? C.white : C.lightBg }, line: { type: "none" } });
    const lvlColor = row.level === "HIGH" ? C.green : row.level === "MOD" ? C.amber : C.gray;
    s.addShape(pres.ShapeType.rect, { x: 8.95, y: ry, w: 0.55, h: 0.36, fill: { color: lvlColor }, line: { type: "none" }, rounding: 0.06 });
    s.addText(row.level, { x: 8.95, y: ry, w: 0.55, h: 0.36, fontSize: 8.5, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(row.agent, { x: 0.55, y: ry + 0.02, w: 1.4, h: 0.36, fontSize: 11.5, bold: true, color: C.navy, fontFace: "Calibri" });
    s.addText(row.condition, { x: 2.05, y: ry + 0.02, w: 1.7, h: 0.36, fontSize: 11, color: C.gray, fontFace: "Calibri" });
    s.addText(row.evidence, { x: 3.85, y: ry + 0.02, w: 5.0, h: 0.36, fontSize: 11, color: C.navy, fontFace: "Calibri" });
  });

  // footer pearl
  s.addShape(pres.ShapeType.rect, { x: 0.45, y: 5.05, w: 9.1, h: 0.38, fill: { color: C.teal }, line: { type: "none" }, rounding: 0.08 });
  s.addText("Clinical Pearl: Injection is an adjunct — always combine with rehabilitation, activity modification, and patient education for best outcomes.", {
    x: 0.55, y: 5.07, w: 8.9, h: 0.32, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri"
  });
}

// ── SLIDE 15 — SUMMARY / CLOSE ────────────────────────────────────────────────
{
  const s = pres.addSlide();
  darkSlide(s);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy }, line: { type: "none" } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.0, w: 10, h: 1.625, fill: { color: C.teal }, line: { type: "none" } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 3.65, w: 10, h: 0.38, fill: { color: C.tealLt }, line: { type: "none" } });

  s.addText("Key Takeaways", { x: 0.6, y: 0.3, w: 8.8, h: 0.7, fontSize: 30, bold: true, color: C.white, fontFace: "Calibri" });

  const takes = [
    "IA injections are safe, effective, and minimally invasive tools in orthopaedic practice",
    "Strict aseptic technique eliminates most infective risk (< 0.003%)",
    "Choose the right agent for the right indication — steroid for inflammation, HA for lubrication, PRP for regeneration",
    "Ultrasound guidance improves accuracy in all joints, especially hip and shoulder",
    "Limit steroid injections — repeated use risks cartilage damage and tendon changes",
    "Always combine injection with rehabilitation for durable, meaningful clinical benefit",
  ];
  takes.forEach((t, i) => {
    s.addShape(pres.ShapeType.ellipse, { x: 0.6, y: 1.1 + i * 0.42, w: 0.25, h: 0.25, fill: { color: C.tealLt }, line: { type: "none" } });
    s.addText(t, { x: 0.97, y: 1.1 + i * 0.42, w: 8.6, h: 0.38, fontSize: 14, color: C.white, fontFace: "Calibri" });
  });

  s.addText("Intra-Articular Injections in Orthopaedics", { x: 0.6, y: 4.1, w: 8.8, h: 0.45, fontSize: 16, bold: true, color: C.white, fontFace: "Calibri" });
  s.addText("Principles • Techniques • Evidence-Based Practice", { x: 0.6, y: 4.6, w: 8.8, h: 0.35, fontSize: 13, color: C.lightBg, fontFace: "Calibri", italic: true });
}

// ── WRITE FILE ────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/intra-articular-ppt/Intra_Articular_Injections_Orthopaedics.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error(e); process.exit(1); });