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

// Fetch images
const imageUrls = [
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_e99f60f6425c105d498ba9923e52984a16d8c0942eb1dcf5b2ac681c34943399.jpg", // MRSA identification flowchart
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_52274a245fec41584d810cfaf86854dccbf47e4d01af2d294589219a23e33f27.jpg", // Gram stain S. aureus
];

let images = [];
try {
  const raw = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js "${imageUrls[0]}" "${imageUrls[1]}"`,
    { timeout: 30000 }
  ).toString();
  images = JSON.parse(raw);
} catch (e) {
  console.error("Image fetch error:", e.message);
  images = [{ error: true }, { error: true }];
}

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "MRSA – Methicillin-Resistant Staphylococcus aureus";
pres.author = "Jawetz, Melnick & Adelberg's Medical Microbiology – LANGE";

// ─── COLOUR PALETTE ─────────────────────────────────────────────────────────
const RED    = "C0392B";  // accent / danger
const DARK   = "1A1A2E";  // background dominant
const MID    = "16213E";  // card fill
const LIGHT  = "0F3460";  // section bar
const WHITE  = "FFFFFF";
const YELLOW = "F5A623";
const LGRAY  = "E8EAF0";
const GREEN  = "27AE60";
const ORANGE = "E67E22";

// ─── HELPERS ────────────────────────────────────────────────────────────────
function addBg(slide, color) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color } });
}
function banner(slide, txt, color, y = 0, h = 0.7) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y, w: "100%", h, fill: { color } });
  slide.addText(txt, { x: 0.3, y: y + 0.05, w: 9.4, h: h - 0.1, fontSize: 22, bold: true, color: WHITE });
}
function sectionTag(slide, txt) {
  slide.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 0.08, w: 1.8, h: 0.4, fill: { color: RED }, rectRadius: 0.05 });
  slide.addText(txt, { x: 0.3, y: 0.08, w: 1.8, h: 0.4, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle" });
}
function card(slide, x, y, w, h, fillColor) {
  slide.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill: { color: fillColor }, rectRadius: 0.07, line: { color: LIGHT, width: 0.5 } });
}
function bullet(txt, bold = false) {
  return { text: txt, options: { bullet: { type: "bullet", characterCode: "25B6" }, color: LGRAY, fontSize: 14, bold, breakLine: true, indentLevel: 0 } };
}
function subbullet(txt) {
  return { text: txt, options: { bullet: { type: "bullet", characterCode: "25AA" }, color: "A0A8C0", fontSize: 12, breakLine: true, indentLevel: 1 } };
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, DARK);

  // Top red accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.18, fill: { color: RED } });

  // Biohazard-style decorative circle
  s.addShape(pres.ShapeType.ellipse, { x: 7.2, y: 0.6, w: 2.8, h: 2.8, fill: { color: LIGHT }, line: { color: RED, width: 2 } });
  s.addShape(pres.ShapeType.ellipse, { x: 7.55, y: 0.95, w: 2.1, h: 2.1, fill: { color: MID }, line: { color: RED, width: 1 } });
  s.addText("⚠", { x: 7.55, y: 0.95, w: 2.1, h: 2.1, fontSize: 64, color: RED, align: "center", valign: "middle" });

  s.addText("MRSA", { x: 0.4, y: 0.5, w: 6.5, h: 1.3, fontSize: 72, bold: true, color: RED, charSpacing: 8 });
  s.addText("Methicillin-Resistant\nStaphylococcus aureus", { x: 0.4, y: 1.75, w: 6.5, h: 1.1, fontSize: 26, color: LGRAY, lineSpacingMultiple: 1.3 });
  s.addText("Review of Medical Microbiology & Immunology", {
    x: 0.4, y: 2.95, w: 6.5, h: 0.5, fontSize: 15, color: YELLOW, italic: true,
  });
  s.addText("Jawetz, Melnick & Adelberg's Medical Microbiology  |  LANGE Series", {
    x: 0, y: 5.1, w: "100%", h: 0.35, fontSize: 12, color: "8899AA", align: "center",
  });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.45, w: "100%", h: 0.18, fill: { color: RED } });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW: What is MRSA?
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, DARK);
  banner(s, "What is MRSA?", LIGHT, 0, 0.65);
  sectionTag(s, "OVERVIEW");

  const items = [
    ["Gram-positive cocci", "Arranged in grape-like irregular clusters; catalase-positive"],
    ["S. aureus — major human pathogen", "Almost every person has some type of S. aureus infection in a lifetime"],
    ["MRSA definition", "Resistant to nafcillin, methicillin, oxacillin and all β-lactams (except ceftaroline)"],
    ["Resistance mechanism", "mecA / mecC genes → PBP2a (low-affinity penicillin-binding protein)"],
    ["SCCmec cassette", "Staphylococcal Cassette Chromosome mec — 12 types; types I–III, VI, VIII → HA-MRSA; type IV → CA-MRSA; IX/X → LA-MRSA"],
  ];

  items.forEach(([hd, body], i) => {
    const y = 0.78 + i * 0.92;
    card(s, 0.3, y, 9.4, 0.82, MID);
    s.addText(hd, { x: 0.55, y: y + 0.06, w: 3.0, h: 0.3, fontSize: 14, bold: true, color: YELLOW });
    s.addText(body, { x: 0.55, y: y + 0.38, w: 8.8, h: 0.38, fontSize: 12.5, color: LGRAY });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — EPIDEMIOLOGY: HA-MRSA vs CA-MRSA vs LA-MRSA
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, DARK);
  banner(s, "Epidemiology — HA-MRSA · CA-MRSA · LA-MRSA", LIGHT, 0, 0.65);
  sectionTag(s, "EPIDEMIOLOGY");

  const cols = [
    {
      title: "HA-MRSA", color: RED, sub: "Hospital-Acquired",
      pts: [
        "SCCmec types I, II, III, VI, VIII",
        "ICU, surgical wards, newborn nurseries",
        "Multi-drug resistant (MDR)",
        "~60% of nosocomial S. aureus in US ICUs",
        "Spread by contact — healthcare workers",
      ],
    },
    {
      title: "CA-MRSA", color: ORANGE, sub: "Community-Acquired",
      pts: [
        "SCCmec type IV — less resistant",
        "More transmissible; younger patients",
        "Skin & soft tissue infections, necrotizing pneumonia",
        "Carries PVL toxin gene",
        "USA300 clone dominant in the US",
      ],
    },
    {
      title: "LA-MRSA", color: GREEN, sub: "Livestock-Associated",
      pts: [
        "SCCmec types IX & X (mecC)",
        "Linked to pig, cattle, poultry farms",
        "Zoonotic transmission to farm workers",
        "Worldwide spread of distinct clones",
        "Emerging public health concern",
      ],
    },
  ];

  cols.forEach((col, i) => {
    const x = 0.2 + i * 3.27;
    card(s, x, 0.75, 3.1, 4.65, MID);
    s.addShape(pres.ShapeType.rect, { x, y: 0.75, w: 3.1, h: 0.52, fill: { color: col.color } });
    s.addText(col.title, { x: x + 0.08, y: 0.78, w: 2.94, h: 0.3, fontSize: 18, bold: true, color: WHITE });
    s.addText(col.sub,  { x: x + 0.08, y: 1.08, w: 2.94, h: 0.22, fontSize: 11, color: WHITE, italic: true });
    col.pts.forEach((pt, j) => {
      s.addText("▶  " + pt, { x: x + 0.12, y: 1.38 + j * 0.62, w: 2.88, h: 0.58, fontSize: 11.5, color: LGRAY, wrap: true });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — RESISTANCE MECHANISMS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, DARK);
  banner(s, "Resistance Mechanisms", LIGHT, 0, 0.65);
  sectionTag(s, "RESISTANCE");

  // Left column — 3 mechanism cards
  const mechs = [
    {
      n: "1", title: "β-Lactamase Production",
      color: RED,
      body: "Plasmid-encoded; inactivates penicillin G, ampicillin, piperacillin. Transmitted by transduction/conjugation. NOT responsible for methicillin resistance.",
    },
    {
      n: "2", title: "mecA / mecC Genes → PBP2a",
      color: ORANGE,
      body: "Encoded by SCCmec. PBP2a has low affinity for all β-lactams → resistance to nafcillin, methicillin, oxacillin, carbapenems, and most cephalosporins. Exception: ceftaroline retains activity.",
    },
    {
      n: "3", title: "Vancomycin Tolerance",
      color: YELLOW,
      body: "VISA (MIC 4–8 µg/mL): increased cell wall synthesis — not van genes. VRSA (MIC ≥16 µg/mL): rare; acquires vanA from enterococci. Rising vancomycin MIC creep is a clinical concern.",
    },
  ];
  mechs.forEach((m, i) => {
    const y = 0.78 + i * 1.57;
    card(s, 0.25, y, 5.8, 1.45, MID);
    s.addShape(pres.ShapeType.ellipse, { x: 0.3, y: y + 0.08, w: 0.55, h: 0.55, fill: { color: m.color } });
    s.addText(m.n, { x: 0.3, y: y + 0.08, w: 0.55, h: 0.55, fontSize: 18, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(m.title, { x: 0.95, y: y + 0.08, w: 5.0, h: 0.35, fontSize: 14, bold: true, color: m.color });
    s.addText(m.body, { x: 0.95, y: y + 0.45, w: 5.0, h: 0.92, fontSize: 11.5, color: LGRAY, wrap: true });
  });

  // Right column — susceptibility breakpoints box
  card(s, 6.35, 0.78, 3.4, 4.65, MID);
  s.addText("Vancomycin Breakpoints (S. aureus)", { x: 6.45, y: 0.86, w: 3.2, h: 0.4, fontSize: 13, bold: true, color: YELLOW });
  const bpts = [
    ["Susceptible",    "MIC ≤ 2 µg/mL",   GREEN],
    ["Intermediate\n(VISA)", "MIC 4–8 µg/mL",  ORANGE],
    ["Resistant\n(VRSA)", "MIC ≥ 16 µg/mL", RED],
  ];
  bpts.forEach(([label, val, col], i) => {
    const y = 1.38 + i * 1.35;
    s.addShape(pres.ShapeType.roundRect, { x: 6.45, y, w: 3.2, h: 1.15, fill: { color: col }, line: { color: DARK, width: 0.5 }, rectRadius: 0.07 });
    s.addText(label, { x: 6.5, y: y + 0.08, w: 3.1, h: 0.45, fontSize: 13, bold: true, color: WHITE, align: "center" });
    s.addText(val,   { x: 6.5, y: y + 0.55, w: 3.1, h: 0.45, fontSize: 16, bold: true, color: WHITE, align: "center" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — VIRULENCE FACTORS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, DARK);
  banner(s, "Virulence Factors", LIGHT, 0, 0.65);
  sectionTag(s, "VIRULENCE");

  const factors = [
    { icon: "🧫", name: "PVL Toxin", color: RED, desc: "Panton-Valentine Leukocidin — phage-encoded, 2 components (S + F); kills WBCs by pore formation. Key virulence factor in CA-MRSA; causes necrotizing infections." },
    { icon: "🩸", name: "Hemolysins (α,β,γ,δ)", color: ORANGE, desc: "α-hemolysin: broad-spectrum membrane damage. β-toxin: sphingomyelinase. γ-hemolysin: leukocidin with 6 two-component variants → massive IL-8, leukotriene, histamine release → necrosis." },
    { icon: "🔥", name: "TSST-1", color: YELLOW, desc: "Toxic Shock Syndrome Toxin-1 — superantigen; binds MHC class II → massive T-cell activation → fever, shock, multisystem failure, desquamative rash. Found in ~20% of MRSA isolates." },
    { icon: "🍽️", name: "Enterotoxins (A–P)", color: GREEN, desc: "15 heat-stable superantigen enterotoxins; ~50% of strains produce ≥1. Ingestion of 25 µg of toxin B → vomiting + diarrhea (1–8 h incubation). Acts on CNS vomiting center via gut neural receptors." },
    { icon: "🔬", name: "Exfoliative Toxins A & B", color: "3498DB", desc: "Epidermolytic toxins dissolve mucopolysaccharide matrix of epidermis → Scalded Skin Syndrome. ETA: phage-encoded, heat-stable. ETB: plasmid-mediated, heat-labile. Both are superantigens." },
    { icon: "🧬", name: "Coagulase & Protein A", color: "9B59B6", desc: "Coagulase: clots plasma → fibrin shield around abscess (hallmark of S. aureus). Protein A: binds IgG Fc → blocks opsonization + phagocytosis." },
  ];

  factors.forEach((f, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 4.95;
    const y = 0.78 + row * 1.6;
    card(s, x, y, 4.75, 1.48, MID);
    s.addShape(pres.ShapeType.ellipse, { x: x + 0.1, y: y + 0.1, w: 0.88, h: 0.88, fill: { color: f.color } });
    s.addText(f.icon, { x: x + 0.1, y: y + 0.1, w: 0.88, h: 0.88, fontSize: 26, align: "center", valign: "middle" });
    s.addText(f.name, { x: x + 1.1, y: y + 0.1, w: 3.55, h: 0.38, fontSize: 13.5, bold: true, color: f.color });
    s.addText(f.desc, { x: x + 1.1, y: y + 0.48, w: 3.55, h: 0.92, fontSize: 10.5, color: LGRAY, wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — CLINICAL DISEASES
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, DARK);
  banner(s, "Clinical Diseases Caused by MRSA", LIGHT, 0, 0.65);
  sectionTag(s, "CLINICAL");

  const diseases = [
    { cat: "Skin & Soft Tissue", icon: "🩹", color: RED,    items: ["Furuncles / abscesses (focal suppuration)", "Impetigo, pyoderma", "Bullous exfoliation (Scalded Skin Syndrome)", "Necrotizing fasciitis (CA-MRSA)"] },
    { cat: "Systemic Invasive",  icon: "🫀", color: ORANGE, items: ["Bacteremia & sepsis", "Infective endocarditis", "Pneumonia (necrotizing, esp. post-influenza)", "Meningitis & brain abscess"] },
    { cat: "Bone & Joint",       icon: "🦴", color: YELLOW, items: ["Acute hematogenous osteomyelitis (metaphysis)", "Septic arthritis", "Chronic osteomyelitis with necrosis", "Infection of prosthetic joints"] },
    { cat: "Toxin-Mediated",     icon: "☣️", color: GREEN,  items: ["Toxic Shock Syndrome (TSST-1, superantigen)", "Staphylococcal food poisoning (1–8h, no fever)", "Scalded Skin Syndrome (exfoliative toxins)"] },
  ];

  diseases.forEach((d, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 4.95;
    const y = 0.78 + row * 2.35;
    card(s, x, y, 4.75, 2.18, MID);
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.75, h: 0.52, fill: { color: d.color } });
    s.addText(d.icon + "  " + d.cat, { x: x + 0.1, y: y + 0.06, w: 4.55, h: 0.42, fontSize: 14, bold: true, color: WHITE });
    const bullets = d.items.map(it => ({ text: "▶  " + it, options: { color: LGRAY, fontSize: 12, breakLine: true } }));
    s.addText(bullets, { x: x + 0.18, y: y + 0.62, w: 4.45, h: 1.48, wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — DIAGNOSTIC APPROACH + IMAGE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, DARK);
  banner(s, "Diagnosis & Laboratory Tests", LIGHT, 0, 0.65);
  sectionTag(s, "DIAGNOSIS");

  const steps = [
    ["Specimens", "Pus/swab from abscess, blood, sputum, CSF; anterior nares swab for colonization screening"],
    ["Gram Smear", "Gram-positive cocci in clusters (cannot distinguish S. aureus from S. epidermidis by smear)"],
    ["Culture", "Blood agar: yellow-gray colonies ~3–4 mm, β-hemolysis. Chromogenic agars (CHROMagar) for MRSA screening — mauve colonies"],
    ["ID Tests", "Coagulase (+) distinguishes S. aureus from CoNS. Catalase (+) distinguishes from Streptococci"],
    ["MRSA Confirmation", "mecA/mecC PCR (NAAT) — rapid and highly sensitive; oxacillin/nafcillin resistance on screening agar"],
    ["Typing", "Pulsed-field gel electrophoresis (PFGE), MLST, spa typing — for outbreak investigation"],
  ];

  steps.forEach(([hd, body], i) => {
    const y = 0.8 + i * 0.78;
    card(s, 0.25, y, 5.6, 0.68, MID);
    s.addShape(pres.ShapeType.roundRect, { x: 0.28, y: y + 0.1, w: 0.65, h: 0.48, fill: { color: LIGHT }, rectRadius: 0.04 });
    s.addText((i + 1).toString(), { x: 0.28, y: y + 0.1, w: 0.65, h: 0.48, fontSize: 16, bold: true, color: YELLOW, align: "center", valign: "middle" });
    s.addText(hd, { x: 1.05, y: y + 0.06, w: 1.8, h: 0.28, fontSize: 12, bold: true, color: YELLOW });
    s.addText(body, { x: 1.05, y: y + 0.34, w: 4.7, h: 0.3, fontSize: 10.5, color: LGRAY, wrap: true });
  });

  // Image on right
  if (images[0] && !images[0].error) {
    s.addImage({ data: images[0].base64, x: 6.15, y: 0.78, w: 3.6, h: 4.68 });
    s.addText("MRSA Identification Algorithm", { x: 6.15, y: 5.46, w: 3.6, h: 0.2, fontSize: 9, color: "8899AA", align: "center", italic: true });
  } else {
    card(s, 6.15, 0.78, 3.6, 4.68, MID);
    s.addText("MRSA Identification Flowchart\n\n(CHROMagar → Coagulase → oxacillin screen)", {
      x: 6.2, y: 1.8, w: 3.5, h: 2.5, fontSize: 12, color: LGRAY, align: "center", valign: "middle", wrap: true,
    });
  }
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — TREATMENT
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, DARK);
  banner(s, "Treatment of MRSA Infections", LIGHT, 0, 0.65);
  sectionTag(s, "TREATMENT");

  // Header note
  s.addText("An organism that is mecA/mecC positive is resistant to ALL extended-spectrum penicillins, carbapenems & cephalosporins — EXCEPT ceftaroline.", {
    x: 0.3, y: 0.75, w: 9.4, h: 0.55, fontSize: 12.5, color: ORANGE, italic: true, wrap: true,
  });

  const drugs = [
    { name: "Vancomycin", color: LIGHT,    indication: "First-line for HA-MRSA bacteremia & endocarditis", note: "Monitor for VISA — rising MICs → seek alternatives" },
    { name: "Daptomycin",      color: "1B6CA8", indication: "Bacteremia, right-sided endocarditis; bactericidal", note: "Do NOT use for pulmonary MRSA (inactivated by surfactant)" },
    { name: "Linezolid",       color: "17A589", indication: "MRSA pneumonia, SSTI, bacteremia (bacteriostatic)", note: "Also available orally; consult ID re: side effects" },
    { name: "Ceftaroline",     color: GREEN,    indication: "Only cephalosporin active against MRSA — SSTI, CAP", note: "Active vs MRSA, VISA, penicillin-resistant pneumococci" },
    { name: "Ceftobiprole",    color: "27AE60", indication: "Broad-spectrum including MRSA; IV use", note: "Active vs MRSA + ampicillin-susceptible E. faecalis" },
    { name: "TMP-SMX / Doxy", color: ORANGE,    indication: "Oral option for CA-MRSA SSTIs & decolonisation", note: "Often combined with rifampin for nasal carriage" },
    { name: "Dalbavancin / Oritavancin", color: "7D3C98", indication: "Long-acting IV lipoglycopeptides for SSTI", note: "FDA-cleared; unique PK; once- or twice-dosing" },
    { name: "Mupirocin (topical)", color: "5D6D7E", indication: "Nasal decolonization pre-surgery", note: "Reduces post-surgical wound infection & bacteremia" },
  ];

  drugs.forEach((d, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 4.95;
    const y = 1.4 + row * 1.05;
    card(s, x, y, 4.75, 0.95, MID);
    s.addShape(pres.ShapeType.roundRect, { x: x + 0.08, y: y + 0.08, w: 1.6, h: 0.34, fill: { color: d.color }, rectRadius: 0.04 });
    s.addText(d.name, { x: x + 0.08, y: y + 0.08, w: 1.6, h: 0.34, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(d.indication, { x: x + 1.78, y: y + 0.06, w: 2.88, h: 0.34, fontSize: 11, color: LGRAY, wrap: true });
    s.addText("⚡ " + d.note, { x: x + 0.12, y: y + 0.55, w: 4.55, h: 0.34, fontSize: 10, color: "A0A8C0", wrap: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — INFECTION CONTROL & PREVENTION
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, DARK);
  banner(s, "Infection Control & Prevention", LIGHT, 0, 0.65);
  sectionTag(s, "PREVENTION");

  const sections = [
    {
      title: "Hospital Measures", color: RED,
      pts: [
        "Aggressive hand hygiene — cornerstone of MRSA containment",
        "Contact isolation for colonized / infected patients",
        "Active surveillance cultures (nasal swabs) in high-risk units: ICU, newborn nursery, OR",
        "Cohorting of MRSA patients; dedicated nursing staff",
        "Decolonization: mupirocin ointment (nares) ± chlorhexidine bathing for 5 days pre-surgery",
        "Exclude staff with active S. aureus lesions from high-risk areas",
        "Rifampin + 2nd oral drug for persistent carriage (rapid resistance risk)",
      ],
    },
    {
      title: "Community Measures", color: ORANGE,
      pts: [
        "Avoid sharing personal items (razors, towels)",
        "Wound hygiene — cover all skin breaks",
        "Avoid close skin-to-skin contact in sports settings",
        "Early identification and treatment of skin infections",
        "Education on appropriate antibiotic use",
      ],
    },
    {
      title: "High-Risk Hospital Areas", color: YELLOW,
      pts: [
        "Intensive Care Units (ICU)",
        "Newborn nurseries",
        "Operating rooms",
        "Cancer chemotherapy wards",
        "Haemodialysis units",
      ],
    },
  ];

  const widths = [5.5, 2.5, 1.85];
  let xCur = 0.25;
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — KEY SUMMARY (mnemonic / table)
// ═══════════════════════════════════════════════════════════════════════════
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    ["Resistance gene", "mecA / mecC → PBP2a", "β-lactam class resistance"],
    ["SCCmec IV", "CA-MRSA — more transmissible", "Younger patients, SSTIs, PVL+"],
    ["SCCmec I–III", "HA-MRSA — multi-drug resistant", "ICU patients, bacteremia"],
    ["PVL toxin", "Phage-encoded, 2-component", "Necrotizing pneumonia, furunculosis"],
    ["TSST-1", "Superantigen, ~20% of MRSA", "TSS: fever, rash, shock"],
    ["First-line Rx", "Vancomycin IV", "Monitor MICs; VISA watch"],
    ["Ceftaroline", "Only β-lactam active vs MRSA", "Exception to the rule"],
    ["Decolonization", "Mupirocin nasal + chlorhexidine", "Pre-surgical prevention"],
    ["Nasal carriage", "20–50% of healthy humans", "Reservoir for self-infection"],
    ["VISA mechanism", "↑ cell wall synthesis (not vanA)", "MIC 4–8; avoid vancomycin alone"],
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — REVIEW QUESTIONS
// ═══════════════════════════════════════════════════════════════════════════
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      q: "Q1. A patient with recurrent MRSA abscesses has vancomycin MIC progression: day 1 → 1, week 5 → 2, week 11 → 8 µg/mL. What is the mechanism of resistance?",
      a: "Answer: D — Increased cell wall synthesis and altered cell wall structure (VISA). Not vanA genes, not β-lactamase, not efflux pump.",
    },
    {
      q: "Q2. A 19-year-old contact sports player develops a painful boil caused by community-acquired MRSA. The most likely SCCmec type and associated toxin are:",
      a: "Answer: SCCmec type IV + PVL (Panton-Valentine Leukocidin). CA-MRSA is more transmissible and less multidrug resistant than HA-MRSA.",
    },
    {
      q: "Q3. Which antibiotic is the ONLY cephalosporin with proven activity against MRSA?",
      a: "Answer: Ceftaroline (5th-gen). Ceftobiprole also active. All other β-lactams are ineffective against mecA/mecC-positive strains.",
    },
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      q: "Q4. All of the following are key infection control strategies for MRSA EXCEPT:",
      a: "Answer: Routine screening of ALL hospital employees (high-resource, low-yield). Correct strategies: hand hygiene, contact isolation, nasal surveillance in high-risk patients, decolonization.",
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// ═══════════════════════════════════════════════════════════════════════════
// SAVE
// ═══════════════════════════════════════════════════════════════════════════
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