Orris

Make a presentation slide with reference for IBD

Asking for Preferences

Put everything definition etio patho diagnosis sign and symptoms treatment with guidelines and algorithm treatment

Asking for Preferences
Reading File
Reading File
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Finding Sources
Searching PubMed

"inflammatory bowel disease" AND "guidelines"

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Finding Sources
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Finding Sources
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Running Command

mkdir -p /home/daytona/workspace/ibd-presentation && ls /home/daytona/workspace/ibd-presentation/

Writing File

~/ibd-presentation/build_ibd.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Inflammatory Bowel Disease (IBD)";
pres.author = "Medical Education";

// ─── Color Palette ───────────────────────────────────────────────────────────
const C = {
  darkBg:    "0D2137",   // deep navy - title/section slides
  midBg:     "122B4A",   // medium navy
  lightBg:   "F0F4F8",   // off-white for content slides
  accent1:   "E8A020",   // amber/gold
  accent2:   "2ECC71",   // teal-green
  accent3:   "E74C3C",   // red
  accent4:   "3498DB",   // blue
  white:     "FFFFFF",
  textDark:  "1A2B3C",
  textMid:   "34495E",
  boxBlue:   "D6EAF8",
  boxGreen:  "D5F5E3",
  boxRed:    "FDEDEC",
  boxAmber:  "FEF9E7",
  boxPurple: "EBD5F5",
  headerBar: "1A4A6E",
};

// ─── Helper: Slide with header bar ────────────────────────────────────────────
function addContentSlide(title, subtitle) {
  const s = pres.addSlide();
  // White background
  s.background = { color: C.lightBg };
  // Top header bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: C.darkBg }, line: { color: C.darkBg } });
  // Accent stripe
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.75, w: 10, h: 0.07, fill: { color: C.accent1 }, line: { color: C.accent1 } });
  // Title
  s.addText(title, { x: 0.25, y: 0, w: 9.5, h: 0.75, fontSize: 22, bold: true, color: C.white, valign: "middle", margin: 0 });
  if (subtitle) {
    s.addText(subtitle, { x: 0.25, y: 0.82, w: 9.5, h: 0.35, fontSize: 11, color: C.accent1, italic: true });
  }
  return s;
}

// ─── Helper: colored box ──────────────────────────────────────────────────────
function addBox(slide, x, y, w, h, fillColor, borderColor) {
  slide.addShape(pres.ShapeType.rect, {
    x, y, w, h,
    fill: { color: fillColor },
    line: { color: borderColor || fillColor, width: 1.5 },
    shadow: { type: "outer", color: "AAAAAA", opacity: 0.25, blur: 4, offset: 2, angle: 45 },
  });
}

// ─── Helper: footer citation ──────────────────────────────────────────────────
function addFooter(slide, text) {
  slide.addText(text, {
    x: 0.2, y: 5.3, w: 9.6, h: 0.3,
    fontSize: 7.5, color: "888888", italic: true,
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.darkBg };

  // Big gradient-style accent block
  s.addShape(pres.ShapeType.rect, { x: 0, y: 3.5, w: 10, h: 2.125, fill: { color: C.midBg }, line: { color: C.midBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 3.5, w: 0.25, h: 2.125, fill: { color: C.accent1 }, line: { color: C.accent1 } });

  // Main title
  s.addText("Inflammatory Bowel Disease", {
    x: 0.5, y: 0.6, w: 9, h: 1.3,
    fontSize: 44, bold: true, color: C.white, align: "center",
    glow: { size: 8, opacity: 0.3, color: C.accent1 },
  });
  // Subtitle
  s.addText("IBD", {
    x: 0.5, y: 1.9, w: 9, h: 0.6,
    fontSize: 28, color: C.accent1, align: "center", bold: true,
  });
  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 2.55, w: 3, h: 0.06, fill: { color: C.accent1 }, line: { color: C.accent1 } });

  // Tagline
  s.addText("Definition · Etiology · Pathophysiology · Clinical Features\nDiagnosis · Treatment · Guidelines & Algorithms", {
    x: 0.5, y: 2.7, w: 9, h: 0.75,
    fontSize: 13, color: "A8C8E8", align: "center", italic: true,
  });

  // Bottom info
  s.addText("For Medical Students  |  Based on Current Guidelines (BSG 2025, ACG 2025, AGA 2024)", {
    x: 0.5, y: 3.6, w: 9, h: 0.4,
    fontSize: 10, color: "AAAAAA", align: "center",
  });
  s.addText("References: BSG Gut 2025 | ACG Am J Gastroenterol 2025 | AGA Gastroenterology 2024\nSleisenger & Fordtran's GI Disease | Maingot's Abdominal Operations | Harrison's Principles of Internal Medicine 22E", {
    x: 0.4, y: 4.8, w: 9.2, h: 0.7,
    fontSize: 8.5, color: "888888", align: "center", italic: true,
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – OUTLINE
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Overview / Outline", "Topics covered in this presentation");
  const topics = [
    ["01", "Definition & Classification", C.accent1],
    ["02", "Epidemiology", C.accent4],
    ["03", "Etiology & Risk Factors", C.accent2],
    ["04", "Pathophysiology", "#9B59B6"],
    ["05", "Clinical Features – UC vs. CD", C.accent3],
    ["06", "Extraintestinal Manifestations", C.accent4],
    ["07", "Diagnosis & Investigations", "#1ABC9C"],
    ["08", "Treatment Algorithm – UC", C.accent1],
    ["09", "Treatment Algorithm – CD", C.accent2],
    ["10", "Current Guidelines & References", C.accent4],
  ];

  topics.forEach(([num, label, color], i) => {
    const col = i < 5 ? 0 : 1;
    const row = i < 5 ? i : i - 5;
    const x = 0.3 + col * 4.9;
    const y = 1.3 + row * 0.78;
    addBox(s, x, y, 4.5, 0.62, "FFFFFF", color);
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.45, h: 0.62, fill: { color }, line: { color } });
    s.addText(num, { x, y, w: 0.45, h: 0.62, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(label, { x: x + 0.55, y: y + 0.05, w: 3.85, h: 0.52, fontSize: 12, color: C.textDark, valign: "middle" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – DEFINITION & CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Definition & Classification of IBD");

  // Definition box
  addBox(s, 0.3, 1.2, 9.4, 1.1, C.boxBlue, C.accent4);
  s.addText("Definition", { x: 0.45, y: 1.22, w: 9, h: 0.35, fontSize: 11, bold: true, color: C.accent4 });
  s.addText(
    "IBD is a group of idiopathic chronic relapsing-remitting inflammatory disorders of the GI tract, characterized by unregulated immune activation and mucosal destruction. The two main subtypes are Ulcerative Colitis (UC) and Crohn's Disease (CD).",
    { x: 0.45, y: 1.55, w: 9.1, h: 0.65, fontSize: 11, color: C.textDark }
  );

  // UC box
  addBox(s, 0.3, 2.45, 4.4, 2.5, C.boxAmber, C.accent1);
  s.addText("Ulcerative Colitis (UC)", { x: 0.45, y: 2.48, w: 4.1, h: 0.35, fontSize: 12, bold: true, color: C.accent1 });
  s.addText([
    { text: "• Continuous mucosal inflammation\n", options: { breakLine: false } },
    { text: "• Limited to the colon & rectum\n", options: { breakLine: false } },
    { text: "• Always involves rectum (rectal sparing = rare)\n", options: { breakLine: false } },
    { text: "• Superficial – mucosa & submucosa only\n", options: { breakLine: false } },
    { text: "• No skip lesions; no granulomas\n", options: { breakLine: false } },
    { text: "• Surgery is curative (colectomy)", options: {} },
  ], { x: 0.45, y: 2.87, w: 4.1, h: 2.0, fontSize: 11, color: C.textDark, lineSpacingMultiple: 1.3 });

  // CD box
  addBox(s, 5.3, 2.45, 4.4, 2.5, C.boxGreen, C.accent2);
  s.addText("Crohn's Disease (CD)", { x: 5.45, y: 2.48, w: 4.1, h: 0.35, fontSize: 12, bold: true, color: "1A8A50" });
  s.addText([
    { text: "• Transmural (full-thickness) inflammation\n", options: { breakLine: false } },
    { text: "• Can affect mouth to anus (any segment)\n", options: { breakLine: false } },
    { text: "• Most common: terminal ileum + colon\n", options: { breakLine: false } },
    { text: "• Skip lesions; cobblestone mucosa\n", options: { breakLine: false } },
    { text: "• Non-caseating granulomas (50% of specimens)\n", options: { breakLine: false } },
    { text: "• Surgery NOT curative – recurrence common", options: {} },
  ], { x: 5.45, y: 2.87, w: 4.1, h: 2.0, fontSize: 11, color: C.textDark, lineSpacingMultiple: 1.3 });

  addFooter(s, "Sleisenger & Fordtran's GI and Liver Disease | Maingot's Abdominal Operations | Schwartz's Principles of Surgery 11e");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Epidemiology");

  // Stats boxes
  const stats = [
    ["3–20 / 100,000", "UC Incidence\n(W. Europe/N. America)", C.accent1, C.boxAmber],
    ["5–10 / 100,000", "CD Incidence\n(N. America)", C.accent4, C.boxBlue],
    ["Bimodal peaks", "Age of onset: 15–30\nand 60–80 years", "#9B59B6", C.boxPurple],
    ["Equal M = F", "Gender distribution\n(slight F predominance in CD)", C.accent2, C.boxGreen],
  ];
  stats.forEach(([val, label, accent, bg], i) => {
    const x = 0.3 + i * 2.38;
    addBox(s, x, 1.3, 2.2, 1.7, bg, accent);
    s.addText(val, { x, y: 1.42, w: 2.2, h: 0.6, fontSize: 13, bold: true, color: accent, align: "center" });
    s.addText(label, { x, y: 2.0, w: 2.2, h: 0.85, fontSize: 9.5, color: C.textDark, align: "center" });
  });

  // Key points
  addBox(s, 0.3, 3.1, 9.4, 2.0, "FFFFFF", C.headerBar);
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.1, w: 9.4, h: 0.32, fill: { color: C.headerBar }, line: { color: C.headerBar } });
  s.addText("Key Epidemiological Facts", { x: 0.45, y: 3.1, w: 9, h: 0.32, fontSize: 11, bold: true, color: C.white, valign: "middle" });
  s.addText([
    { text: "• Highest prevalence in Western countries; rapidly rising in Asia, Africa, South America (westernization)\n", options: { breakLine: false } },
    { text: "• UC: 8–15 / 100,000 (USA/N. Europe); considerably lower in Asia & Africa\n", options: { breakLine: false } },
    { text: "• Jewish populations have higher risk (2–4×), especially Ashkenazi Jews\n", options: { breakLine: false } },
    { text: "• Family history: 10–15% of patients have a first-degree relative with IBD", options: {} },
  ], { x: 0.45, y: 3.45, w: 9.1, h: 1.55, fontSize: 11, color: C.textDark, lineSpacingMultiple: 1.3 });

  addFooter(s, "Schwartz's Principles of Surgery 11e | Harrison's Principles of Internal Medicine 22E (2025) | BSG Guidelines 2025 [PMID: 40550582]");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – ETIOLOGY & RISK FACTORS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Etiology & Risk Factors");

  const factors = [
    { title: "Genetic Factors", color: "#9B59B6", bg: C.boxPurple, items: [
      "NOD2/CARD15 gene (chr 16q12) – CD susceptibility",
      "HLA associations (especially UC)",
      "10–15% familial aggregation",
      "Monozygotic twins: 50% concordance in CD, 15% in UC",
    ]},
    { title: "Immune Dysregulation", color: C.accent4, bg: C.boxBlue, items: [
      "Defective mucosal barrier → abnormal antigen exposure",
      "Th1/Th17 overactivation in CD; Th2 in UC",
      "Excess TNF-α, IL-6, IL-12, IL-23 production",
      "Loss of T-regulatory cell function",
    ]},
    { title: "Environmental Triggers", color: C.accent1, bg: C.boxAmber, items: [
      "Smoking: protective in UC; risk factor in CD",
      "NSAIDs, oral contraceptives (possible triggers)",
      "Appendectomy is protective for UC",
      "Westernized diet, antibiotics in childhood",
    ]},
    { title: "Microbial / Gut Flora", color: C.accent2, bg: C.boxGreen, items: [
      "Altered gut microbiome (dysbiosis)",
      "Reduced microbial diversity in IBD patients",
      "Mycobacterium paratuberculosis (proposed; not confirmed)",
      "Hygiene hypothesis: reduced early microbial exposure",
    ]},
  ];

  factors.forEach((f, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.85;
    const y = 1.2 + row * 2.05;
    addBox(s, x, y, 4.5, 1.9, f.bg, f.color);
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.5, h: 0.32, fill: { color: f.color }, line: { color: f.color } });
    s.addText(f.title, { x, y, w: 4.5, h: 0.32, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(f.items.map(it => "• " + it).join("\n"), {
      x: x + 0.12, y: y + 0.35, w: 4.3, h: 1.48,
      fontSize: 10, color: C.textDark, lineSpacingMultiple: 1.3,
    });
  });

  addFooter(s, "Maingot's Abdominal Operations | Mulholland & Greenfield's Surgery 7e | Schwartz's Principles of Surgery 11e");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – PATHOPHYSIOLOGY
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Pathophysiology of IBD");

  // Central concept
  addBox(s, 3.3, 1.2, 3.4, 0.75, C.darkBg, C.accent1);
  s.addText("Genetically susceptible host\n+ Environmental triggers\n→ Uncontrolled mucosal inflammation", {
    x: 3.3, y: 1.2, w: 3.4, h: 0.75, fontSize: 9.5, color: C.white, align: "center", valign: "middle",
  });

  // Arrow
  s.addShape(pres.ShapeType.rect, { x: 4.85, y: 1.95, w: 0.3, h: 0.25, fill: { color: C.accent1 }, line: { color: C.accent1 } });

  // Steps
  const steps = [
    { label: "1. Antigen Exposure", text: "Increased intestinal permeability → luminal antigens (bacteria, dietary) cross the epithelial barrier → activate mucosal dendritic cells", color: C.accent4, bg: C.boxBlue },
    { label: "2. Innate Immunity", text: "Macrophages & neutrophils release TNF-α, IL-1β, IL-6 → acute inflammation; neutrophil cryptitis & crypt abscesses (UC hallmark)", color: "#E67E22", bg: "#FEF0E0" },
    { label: "3. Adaptive Immunity", text: "CD4+ T-cell differentiation: Th1/Th17 (↑ IL-12, IL-23, IFN-γ) in CD; Th2 (↑ IL-4, IL-5, IL-13) in UC → perpetuating mucosal injury", color: "#9B59B6", bg: C.boxPurple },
    { label: "4. Tissue Injury", text: "UC: Superficial mucosal ulceration, goblet cell depletion, pseudopolyps\nCD: Transmural inflammation, fissuring ulcers, non-caseating granulomas, fistulas, strictures", color: C.accent3, bg: C.boxRed },
  ];

  steps.forEach((step, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.85;
    const y = 2.25 + row * 1.55;
    addBox(s, x, y, 4.5, 1.4, step.bg, step.color);
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.22, h: 1.4, fill: { color: step.color }, line: { color: step.color } });
    s.addText(step.label, { x: x + 0.3, y: y + 0.05, w: 4.1, h: 0.3, fontSize: 11, bold: true, color: step.color });
    s.addText(step.text, { x: x + 0.3, y: y + 0.35, w: 4.1, h: 0.98, fontSize: 10, color: C.textDark, lineSpacingMultiple: 1.25 });
  });

  addFooter(s, "Maingot's Abdominal Operations | Mulholland & Greenfield's Surgery 7e | Goldman-Cecil Medicine 2024");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – CLINICAL FEATURES
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Clinical Features: UC vs. Crohn's Disease");

  // Header row
  s.addShape(pres.ShapeType.rect, { x: 2.85, y: 1.2, w: 3.2, h: 0.35, fill: { color: C.accent1 }, line: { color: C.accent1 } });
  s.addText("Ulcerative Colitis", { x: 2.85, y: 1.2, w: 3.2, h: 0.35, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 6.15, y: 1.2, w: 3.6, h: 0.35, fill: { color: C.accent2 }, line: { color: C.accent2 } });
  s.addText("Crohn's Disease", { x: 6.15, y: 1.2, w: 3.6, h: 0.35, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.2, w: 2.5, h: 0.35, fill: { color: C.headerBar }, line: { color: C.headerBar } });
  s.addText("Feature", { x: 0.3, y: 1.2, w: 2.5, h: 0.35, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });

  // Table rows
  const rows = [
    ["Diarrhea", "Bloody, frequent (>6/day severe)", "Non-bloody or loose; ± blood if colon involved"],
    ["Abdominal Pain", "Crampy, lower abdominal / tenesmus", "RLQ pain (postprandial), colicky → chronic"],
    ["Location", "Rectum → proximal (colon only)", "Anywhere mouth to anus; terminal ileum most common"],
    ["Rectal Bleeding", "Very common (hallmark)", "Less common"],
    ["Fistulas/Abscesses", "Rare (toxic megacolon only)", "Common (enterocutaneous, perianal, enterovesical)"],
    ["Weight Loss", "Mild", "Marked (malabsorption, anorexia)"],
    ["Fever", "Moderate (severe disease)", "Common – even in early disease"],
    ["Perianal Disease", "Absent", "Common – skin tags, fistulas, fissures"],
  ];

  rows.forEach((row, i) => {
    const y = 1.58 + i * 0.46;
    const bg = i % 2 === 0 ? "F8F9FA" : "FFFFFF";
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 9.45, h: 0.44, fill: { color: bg }, line: { color: "DDDDDD" } });
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 0.06, h: 0.44, fill: { color: C.headerBar }, line: { color: C.headerBar } });
    s.addText(row[0], { x: 0.42, y, w: 2.35, h: 0.44, fontSize: 10, bold: true, color: C.textDark, valign: "middle" });
    s.addText(row[1], { x: 2.82, y, w: 3.25, h: 0.44, fontSize: 9.5, color: "7D4400", valign: "middle" });
    s.addText(row[2], { x: 6.12, y, w: 3.55, h: 0.44, fontSize: 9.5, color: "1A6B3C", valign: "middle" });
  });

  addFooter(s, "Tintinalli's Emergency Medicine | Rheumatology 2-Volume Set 2022 | Sleisenger & Fordtran's GI Disease");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – EXTRAINTESTINAL MANIFESTATIONS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Extraintestinal Manifestations (EIMs) of IBD");

  const systems = [
    { sys: "Musculoskeletal (25–40%)", items: ["Peripheral arthritis (type 1: <5 joints, mirrors disease; type 2: >5 joints, independent)", "Axial arthropathy: sacroiliitis, ankylosing spondylitis", "Osteoporosis (steroid-related)"], color: C.accent3, bg: C.boxRed },
    { sys: "Dermatological (5–15%)", items: ["Erythema nodosum (correlates with disease activity)", "Pyoderma gangrenosum (independent of activity)", "Sweet's syndrome", "Aphthous stomatitis"], color: "#E67E22", bg: "#FEF0E0" },
    { sys: "Ocular (2–5%)", items: ["Uveitis / iritis (anterior most common)", "Episcleritis (correlates with activity)", "Scleritis (independent of activity)"], color: "#9B59B6", bg: C.boxPurple },
    { sys: "Hepatobiliary (5–10%)", items: ["Primary sclerosing cholangitis (PSC) – UC>CD; risk for cholangiocarcinoma", "Fatty liver, autoimmune hepatitis", "Gallstones (CD – ileal malabsorption)"], color: C.accent2, bg: C.boxGreen },
    { sys: "Renal/Urological", items: ["Nephrolithiasis (oxalate stones in CD)", "Enterovesical fistula (CD)", "Hydronephrosis (ureteric compression)"], color: C.accent4, bg: C.boxBlue },
    { sys: "Haematological", items: ["Iron deficiency anemia (blood loss)", "B12/folate deficiency (CD – ileal disease)", "Thromboembolic disease (↑ DVT/PE risk)"], color: C.headerBar, bg: "E8EFF6" },
  ];

  systems.forEach((sys, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.3 + col * 3.22;
    const y = 1.22 + row * 1.98;
    addBox(s, x, y, 3.05, 1.85, sys.bg, sys.color);
    s.addShape(pres.ShapeType.rect, { x, y, w: 3.05, h: 0.3, fill: { color: sys.color }, line: { color: sys.color } });
    s.addText(sys.sys, { x, y, w: 3.05, h: 0.3, fontSize: 9.5, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(sys.items.map(it => "• " + it).join("\n"), {
      x: x + 0.1, y: y + 0.33, w: 2.88, h: 1.45,
      fontSize: 9, color: C.textDark, lineSpacingMultiple: 1.3,
    });
  });

  addFooter(s, "Rheumatology 2-Volume Set 2022 | Fitzpatrick's Dermatology | BSG Guidelines 2025 [PMID: 40550582]");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – DIAGNOSIS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Diagnosis & Investigations");

  const cols = [
    { title: "Clinical", color: C.accent1, bg: C.boxAmber, items: [
      "History: diarrhea duration, blood, pain, weight loss, family Hx",
      "Rectal bleeding + tenesmus → UC",
      "RLQ pain, perianal Sx → CD",
      "Exclusion of infectious causes first",
      "Severity scoring: Mayo (UC) / Harvey-Bradshaw (CD)",
    ]},
    { title: "Laboratory", color: C.accent4, bg: C.boxBlue, items: [
      "FBC: anemia (IDA), leukocytosis",
      "CRP / ESR: ↑ in active disease",
      "Fecal calprotectin: sensitive marker of mucosal inflammation (>50 μg/g abnormal)",
      "Stool cultures & C. diff PCR (exclude infection)",
      "Serology: ANCA (UC), ASCA (CD)",
      "Albumin, B12, iron studies (CD)",
    ]},
    { title: "Endoscopy & Histology", color: "#1ABC9C", bg: "#E8FAF5", items: [
      "Colonoscopy (gold standard) – full assessment to terminal ileum",
      "UC: continuous inflammation from rectum; granularity, friability, pseudopolyps",
      "CD: discontinuous skip lesions; cobblestoning; aphthous ulcers",
      "Biopsy mandatory: cryptitis, crypt distortion, goblet cell depletion (UC); non-caseating granulomas (CD)",
    ]},
    { title: "Imaging", color: "#9B59B6", bg: C.boxPurple, items: [
      "CT Enterography / MR Enterography: small bowel CD assessment",
      "Plain AXR: toxic megacolon (colon >6 cm)",
      "USS: abdominal pain assessment",
      "MRI pelvis: perianal CD fistula mapping (investigation of choice)",
      "Capsule endoscopy: small bowel CD",
    ]},
  ];

  cols.forEach((col, i) => {
    const x = 0.3 + i * 2.38;
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    s.addShape(pres.ShapeType.rect, { x, y: 1.2, w: 2.2, h: 0.32, fill: { color: col.color }, line: { color: col.color } });
    s.addText(col.title, { x, y: 1.2, w: 2.2, h: 0.32, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(col.items.map(it => "• " + it).join("\n"), {
      x: x + 0.1, y: 1.55, w: 2.05, h: 3.55,
      fontSize: 9, color: C.textDark, lineSpacingMultiple: 1.3,
    });
  });

  addFooter(s, "Goldman-Cecil Medicine 2024 | Clinical GI Endoscopy 3e | Harrison's Internal Medicine 22E | Sleisenger & Fordtran");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – TREATMENT ALGORITHM UC
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Treatment Algorithm – Ulcerative Colitis (Step-Up Approach)");

  // Step-up flow
  const steps = [
    { label: "MILD UC\nMayo 0–4", drug: "Oral & topical 5-ASA (mesalazine)\n± Topical corticosteroids\nGoal: mucosal healing", color: C.accent2, bg: C.boxGreen },
    { label: "MODERATE UC\nMayo 5–8", drug: "Add oral corticosteroids\n(prednisolone 40–60 mg/day)\nIf steroid-dependent → azathioprine / 6-MP\nor early biologic (infliximab / vedolizumab)", color: C.accent1, bg: C.boxAmber },
    { label: "MODERATE–SEVERE UC\n(Biologic-naive)", drug: "Anti-TNF: infliximab / adalimumab\nAnti-integrin: vedolizumab\nAnti-IL-12/23: ustekinumab\nJAK inhibitor: tofacitinib / upadacitinib\n(Per AGA 2024 & ACG 2025 guidelines)", color: "#E67E22", bg: "#FEF0E0" },
    { label: "ACUTE SEVERE UC\n(Hospitalize)", drug: "IV methylprednisolone 60 mg/day\nNo response after 72 hrs:\n→ Infliximab (rescue) OR cyclosporine\nNo improvement → colectomy", color: C.accent3, bg: C.boxRed },
  ];

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    s.addText(step.label, { x: 0.58, y, w: 2.27, h: 0.92, fontSize: 10, bold: true, color: step.color, valign: "middle" });

    addBox(s, 3.1, y, 6.6, 0.92, "FFFFFF", step.color);
    s.addText(step.drug, { x: 3.25, y: y + 0.05, w: 6.35, h: 0.8, fontSize: 10, color: C.textDark, valign: "middle", lineSpacingMultiple: 1.25 });

    if (i < 3) {
      s.addShape(pres.ShapeType.rect, { x: 1.5, y: y + 0.92, w: 0.1, h: 0.14, fill: { color: C.accent3 }, line: { color: C.accent3 } });
    }
  });

  // Maintenance box
  addBox(s, 0.3, 5.4, 9.4, 0.32, C.darkBg, C.accent1);
  s.addText("Maintenance: Continue 5-ASA (UC mild–moderate) | Biologics for moderate–severe | Surveillance colonoscopy after 8 years for CRC risk", {
    x: 0.45, y: 5.4, w: 9.1, h: 0.32, fontSize: 9, color: C.accent1, valign: "middle",
  });

  addFooter(s, "ACG Clinical Guideline Update: UC 2025 [PMID: 40701556] | AGA Living CPG: UC 2024 [PMID: 39572132] | BSG 2025 [PMID: 40550582]");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – TREATMENT ALGORITHM CD
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Treatment Algorithm – Crohn's Disease");

  // Two-column: Step-up vs Top-down
  addBox(s, 0.3, 1.2, 4.55, 0.38, C.accent2, C.accent2);
  s.addText("STEP-UP APPROACH", { x: 0.3, y: 1.2, w: 4.55, h: 0.38, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });
  addBox(s, 5.15, 1.2, 4.55, 0.38, C.accent4, C.accent4);
  s.addText("TOP-DOWN APPROACH", { x: 5.15, y: 1.2, w: 4.55, h: 0.38, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });

  const stepUp = [
    ["Mild CD", "Budesonide (ileal/RC) or\n5-ASA (limited evidence)\nEnteral nutrition (esp. pediatrics)", C.accent2, C.boxGreen],
    ["Moderate CD", "Corticosteroids for induction\n+ Immunomodulator (AZA/6-MP/MTX)\nfor maintenance", C.accent1, C.boxAmber],
    ["Severe / Fistulizing", "Anti-TNF: infliximab / adalimumab\nVedolizumab (gut-selective)\nUstekinumab (anti-IL-12/23)\nRisankizumab (anti-IL-23)", C.accent3, C.boxRed],
  ];

  const topDown = [
    ["High-risk features\n(young, fistula, stricture)", "Start biologic early\n± Immunomodulator\n(combo therapy)", C.accent4, C.boxBlue],
    ["Anti-TNF +\nImmuno modulator\n(combo)", "Infliximab + AZA\n↓ Immunogenicity\n↑ Mucosal healing", "#9B59B6", C.boxPurple],
    ["No response", "Switch biologic class OR\nConsider surgery:\nileocaecal resection (ileitis)\nstrictureplasty (stricture)", C.headerBar, "E8EFF6"],
  ];

  stepUp.forEach((step, i) => {
    const y = 1.65 + i * 1.1;
    addBox(s, 0.3, y, 4.55, 1.0, step[3], step[2]);
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 4.55, h: 0.28, fill: { color: step[2] }, line: { color: step[2] } });
    s.addText(step[0], { x: 0.38, y, w: 4.35, h: 0.28, fontSize: 10, bold: true, color: C.white, valign: "middle" });
    s.addText(step[1], { x: 0.42, y: y + 0.3, w: 4.3, h: 0.65, fontSize: 10, color: C.textDark, lineSpacingMultiple: 1.2 });
  });

  topDown.forEach((step, i) => {
    const y = 1.65 + i * 1.1;
    addBox(s, 5.15, y, 4.55, 1.0, step[3], step[2]);
    s.addShape(pres.ShapeType.rect, { x: 5.15, y, w: 4.55, h: 0.28, fill: { color: step[2] }, line: { color: step[2] } });
    s.addText(step[0], { x: 5.23, y, w: 4.35, h: 0.28, fontSize: 10, bold: true, color: C.white, valign: "middle" });
    s.addText(step[1], { x: 5.27, y: y + 0.3, w: 4.3, h: 0.65, fontSize: 10, color: C.textDark, lineSpacingMultiple: 1.2 });
  });

  addFooter(s, "Schwartz's Principles of Surgery 11e | Mulholland & Greenfield's Surgery 7e | ECCO/ESPGHAN Guidelines 2025 [PMID: 40528309]");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 – DRUG SUMMARY
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Pharmacological Summary of IBD Medications");

  const drugs = [
    { class: "5-Aminosalicylates (5-ASA)", examples: "Mesalazine, sulfasalazine, olsalazine", use: "UC maintenance & mild–moderate induction; ± mild CD", moa: "Inhibit prostaglandin synthesis & NF-κB; local anti-inflammatory", color: C.accent2 },
    { class: "Corticosteroids", examples: "Prednisolone (systemic), budesonide (topical/oral)", use: "Induction of remission (NOT maintenance)", moa: "Broad immunosuppression, ↓ cytokine transcription via glucocorticoid receptor", color: C.accent1 },
    { class: "Immunomodulators", examples: "Azathioprine, 6-mercaptopurine, methotrexate", use: "Steroid-sparing maintenance; combo with anti-TNF", moa: "Inhibit purine synthesis → suppress T & B lymphocyte proliferation", color: "#9B59B6" },
    { class: "Anti-TNF Biologics", examples: "Infliximab (IV), adalimumab (SC), certolizumab, golimumab", use: "Moderate–severe UC & CD, perianal CD, fistulizing disease", moa: "Neutralize soluble & membrane-bound TNF-α → apoptosis of activated T cells", color: C.accent3 },
    { class: "Anti-Integrin", examples: "Vedolizumab (gut-selective), natalizumab", use: "Moderate–severe UC & CD (especially UC); steroid-dependent/refractory", moa: "Block α4β7 integrin → prevent lymphocyte trafficking to gut mucosa", color: C.accent4 },
    { class: "Anti-IL-12/23 / Anti-IL-23", examples: "Ustekinumab, risankizumab, mirikizumab", use: "Moderate–severe CD & UC; biologic failure", moa: "Block IL-12/IL-23 p40 subunit → ↓ Th1/Th17 differentiation", color: "#1ABC9C" },
    { class: "JAK Inhibitors", examples: "Tofacitinib (UC), upadacitinib (UC & CD)", use: "Moderate–severe UC; CD (upadacitinib)", moa: "Inhibit JAK1/3 → block cytokine signaling (IL-6, IFN-γ, IL-2, IL-4)", color: "#E67E22" },
  ];

  // Header row
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.2, w: 9.45, h: 0.3, fill: { color: C.headerBar }, line: { color: C.headerBar } });
  ["Drug Class", "Examples", "Use in IBD", "Mechanism"].forEach((h, i) => {
    const widths = [1.9, 2.3, 2.5, 2.65];
    const xs = [0.3, 2.2, 4.5, 7.0];
    s.addText(h, { x: xs[i], y: 1.2, w: widths[i], h: 0.3, fontSize: 10, bold: true, color: C.white, valign: "middle", align: "center" });
  });

  drugs.forEach((d, i) => {
    const y = 1.52 + i * 0.53;
    const bg = i % 2 === 0 ? "F8F9FA" : "FFFFFF";
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 9.45, h: 0.51, fill: { color: bg }, line: { color: "DDDDDD" } });
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 0.1, h: 0.51, fill: { color: d.color }, line: { color: d.color } });
    s.addText(d.class, { x: 0.44, y, w: 1.72, h: 0.51, fontSize: 8.5, bold: true, color: d.color, valign: "middle" });
    s.addText(d.examples, { x: 2.22, y, w: 2.24, h: 0.51, fontSize: 8.5, color: C.textDark, valign: "middle" });
    s.addText(d.use, { x: 4.52, y, w: 2.44, h: 0.51, fontSize: 8.5, color: C.textDark, valign: "middle" });
    s.addText(d.moa, { x: 7.02, y, w: 2.6, h: 0.51, fontSize: 8, color: C.textMid, valign: "middle", italic: true });
  });

  addFooter(s, "Goodman & Gilman's Pharmacological Basis of Therapeutics | AGA 2024 [PMID: 39572132] | ACG 2025 [PMID: 40701556]");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – SURGICAL MANAGEMENT
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Surgical Management of IBD");

  // UC
  addBox(s, 0.3, 1.2, 4.6, 4.0, C.boxAmber, C.accent1);
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.2, w: 4.6, h: 0.32, fill: { color: C.accent1 }, line: { color: C.accent1 } });
  s.addText("Ulcerative Colitis – Indications for Surgery", {
    x: 0.3, y: 1.2, w: 4.6, h: 0.32, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle",
  });
  s.addText([
    { text: "Elective:\n", options: { bold: true, breakLine: false } },
    { text: "• Medical refractory disease (failure of biologics)\n• Steroid-dependent or steroid-intoxicated\n• Dysplasia / colorectal cancer\n• Growth failure in pediatrics\n\n", options: { breakLine: false } },
    { text: "Emergency:\n", options: { bold: true, breakLine: false } },
    { text: "• Acute severe UC unresponsive to IV steroids / infliximab rescue\n• Toxic megacolon (colon >6 cm + systemic toxicity)\n• Free perforation\n• Massive hemorrhage\n\n", options: { breakLine: false } },
    { text: "Procedure of Choice:\n", options: { bold: true, breakLine: false } },
    { text: "Restorative proctocolectomy with IPAA (ileal pouch-anal anastomosis)\n= CURATIVE", options: {} },
  ], { x: 0.45, y: 1.55, w: 4.3, h: 3.55, fontSize: 10, color: C.textDark, lineSpacingMultiple: 1.3 });

  // CD
  addBox(s, 5.1, 1.2, 4.6, 4.0, C.boxGreen, C.accent2);
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.2, w: 4.6, h: 0.32, fill: { color: C.accent2 }, line: { color: C.accent2 } });
  s.addText("Crohn's Disease – Indications for Surgery", {
    x: 5.1, y: 1.2, w: 4.6, h: 0.32, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle",
  });
  s.addText([
    { text: "Indications:\n", options: { bold: true, breakLine: false } },
    { text: "• Fibrostenotic stricture (obstruction)\n• Perforating disease: abscess / fistula\n• Medically refractory disease\n• Growth retardation (pediatrics)\n• Ileocecal disease (ileocecal resection)\n\n", options: { breakLine: false } },
    { text: "Key Principles:\n", options: { bold: true, breakLine: false } },
    { text: "• Surgery is NOT curative; recurrence common\n• Bowel-conserving operations (strictureplasty)\n• Perianal CD: seton placement for fistulas\n• Post-resection: azathioprine ± anti-TNF to\n  prevent recurrence (Rutgeerts score >i2)", options: {} },
  ], { x: 5.25, y: 1.55, w: 4.3, h: 3.55, fontSize: 10, color: C.textDark, lineSpacingMultiple: 1.3 });

  addFooter(s, "Sabiston Textbook of Surgery 21e | Fischer's Mastery of Surgery 8e | Maingot's Abdominal Operations | Mulholland & Greenfield 7e");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 – GUIDELINES & REFERENCES
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.darkBg };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.7, fill: { color: C.midBg }, line: { color: C.midBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.7, w: 10, h: 0.07, fill: { color: C.accent1 }, line: { color: C.accent1 } });
  s.addText("Current Guidelines & References", { x: 0.3, y: 0, w: 9.4, h: 0.7, fontSize: 22, bold: true, color: C.white, valign: "middle" });

  const guidelines = [
    { label: "BSG 2025", ref: "Moran GW, et al. British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025. Gut. 2025 Jun 23. PMID: 40550582", color: C.accent1 },
    { label: "ACG 2025", ref: "Rubin DT, et al. ACG Clinical Guideline Update: Ulcerative Colitis in Adults. Am J Gastroenterol. 2025 Jun. PMID: 40701556", color: C.accent2 },
    { label: "AGA 2024", ref: "Singh S, Loftus EV Jr, Limketkai BN. AGA Living Clinical Practice Guideline on Pharmacological Management of Moderate-to-Severe Ulcerative Colitis. Gastroenterology. 2024 Dec. PMID: 39572132", color: C.accent4 },
    { label: "ESPGHAN 2025", ref: "Assa A, et al. Management of paediatric ulcerative colitis, part 2: Acute severe colitis. J Pediatr Gastroenterol Nutr. 2025. PMID: 40528309", color: "#1ABC9C" },
  ];

  guidelines.forEach((g, i) => {
    const y = 0.85 + i * 0.62;
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    s.addText(g.label, { x: 0.3, y, w: 1.0, h: 0.46, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x: 1.35, y, w: 8.35, h: 0.46, fill: { color: "1E3555" }, line: { color: "2E4565" } });
    s.addText(g.ref, { x: 1.5, y, w: 8.1, h: 0.46, fontSize: 9.5, color: "D0E4F5", valign: "middle" });
  });

  // Textbooks
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.4, w: 9.4, h: 0.28, fill: { color: C.accent1 }, line: { color: C.accent1 } });
  s.addText("Textbook References", { x: 0.5, y: 3.4, w: 9, h: 0.28, fontSize: 11, bold: true, color: C.darkBg, valign: "middle" });

  const textbooks = [
    "Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 11e (Elsevier)",
    "Maingot's Abdominal Operations, 13e (McGraw-Hill)",
    "Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 21e",
    "Schwartz's Principles of Surgery, 11e (McGraw-Hill)",
    "Mulholland & Greenfield's Surgery: Scientific Principles and Practice, 7e",
    "Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14e",
    "Harrison's Principles of Internal Medicine, 22E (2025, McGraw-Hill)",
    "Fischer's Mastery of Surgery, 8e | Tintinalli's Emergency Medicine | Rheumatology 2-Volume Set 2022",
  ];

  textbooks.forEach((tb, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.85;
    const y = 3.75 + row * 0.37;
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.18, h: 0.28, fill: { color: C.accent1 }, line: { color: C.accent1 } });
    s.addText(tb, { x: x + 0.24, y, w: 4.55, h: 0.33, fontSize: 8.8, color: "C8DCF0", valign: "middle" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ═══════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/ibd-presentation/IBD_Presentation.pptx" })
  .then(() => console.log("SUCCESS: IBD_Presentation.pptx created"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });
Running Command

cd /home/daytona/workspace/ibd-presentation && node build_ibd.js 2>&1

Running Command

ls -lh /home/daytona/workspace/ibd-presentation/IBD_Presentation.pptx

Your IBD presentation is ready!

IBD Presentation

Presentation · PPTX

What's inside (14 slides)

#SlideContent
1TitleCover slide with guideline citations
2Outline10-topic visual index
3Definition & ClassificationUC vs. CD side-by-side comparison boxes (mucosa vs. transmural, location, skip lesions, granulomas)
4EpidemiologyIncidence stats, bimodal age, ethnic risk, rising global burden
5Etiology & Risk Factors4 domains: genetics (NOD2/CARD15), immune dysregulation (Th1/Th17), environment (smoking, NSAIDs), microbiome
6Pathophysiology4-step cascade: antigen exposure → innate → adaptive immunity → tissue injury (UC superficial vs. CD transmural)
7Clinical FeaturesFull comparison table: diarrhea, pain, rectal bleeding, fistulas, perianal disease, weight loss
8Extraintestinal Manifestations6 system boxes: MSK, dermatological, ocular, hepatobiliary, renal, haematological
9Diagnosis & Investigations4-column layout: clinical, laboratory (calprotectin, ANCA/ASCA), endoscopy/histology, imaging (MRE, capsule)
10Treatment Algorithm – UCStep-up flow: mild 5-ASA → moderate steroids → severe biologics/JAKi → acute severe IV steroids/rescue infliximab
11Treatment Algorithm – CDStep-up vs. Top-down approach side by side
12Pharmacological SummaryFull table: 7 drug classes with examples, indications, mechanism
13Surgical ManagementUC (IPAA = curative) vs. CD (bowel-conserving, strictureplasty, not curative)
14Guidelines & ReferencesBSG 2025, ACG 2025, AGA 2024, ESPGHAN 2025 + 8 textbook references
Key references included:
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