python3 << 'EOF' from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor import json prs = Presentation("/tmp/workspace/attachments/365db7e5-1886-450c-8646-ee32e1a64f0c/CASE STUDY.pptx") print(f"Slide dimensions: {prs.slide_width.inches:.2f} x {prs.slide_height.inches:.2f} inches") print(f"Total slides: {len(prs.slides)}") print("="*60) for i, slide in enumerate(prs.slides, 1): print(f"\n--- SLIDE {i} ---") print(f"Layout: {slide.slide_layout.name}") for shape in slide.shapes: print(f" Shape: '{shape.name}' | Type: {shape.shape_type}") if shape.has_text_frame: for para in shape.text_frame.paragraphs: txt = para.text.strip() if txt: # Get font info from first run if available font_info = "" if para.runs: run = para.runs[0] font_info = f" [Font: {run.font.name}, Size: {run.font.size}, Bold: {run.font.bold}, Color: {run.font.color.rgb if run.font.color and run.font.color.type else 'inherited'}]" print(f" TEXT: '{txt}'{font_info}") # Check for background/fill if hasattr(shape, 'fill'): try: fill = shape.fill if fill.type is not None: print(f" Fill type: {fill.type}") except: pass # Position and size try: print(f" Pos: left={shape.left/914400:.2f}\", top={shape.top/914400:.2f}\", width={shape.width/914400:.2f}\", height={shape.height/914400:.2f}\"") except: pass EOF

python3 << 'EOF' from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR import zipfile, os pptx_path = "/tmp/workspace/attachments/365db7e5-1886-450c-8646-ee32e1a64f0c/CASE STUDY.pptx" # Unpack to inspect XML and find theme colors with zipfile.ZipFile(pptx_path, 'r') as z: # List all files files = z.namelist() for f in files: print(f) EOF

python3 << 'EOF' import zipfile pptx_path = "/tmp/workspace/attachments/365db7e5-1886-450c-8646-ee32e1a64f0c/CASE STUDY.pptx" # Extract all media and theme files to inspect os.makedirs("/tmp/workspace/case_study_extracted", exist_ok=True) with zipfile.ZipFile(pptx_path, 'r') as z: # Read theme theme = z.read("ppt/theme/theme1.xml").decode("utf-8") print("=== THEME (first 3000 chars) ===") print(theme[:3000]) # Read slide 1 XML slide1 = z.read("ppt/slides/slide1.xml").decode("utf-8") print("\n=== SLIDE 1 XML (first 2000 chars) ===") print(slide1[:2000]) # Extract media files for f in z.namelist(): if f.startswith("ppt/media/"): data = z.read(f) fname = f.replace("ppt/media/", "") with open(f"/tmp/workspace/case_study_extracted/{fname}", "wb") as out: out.write(data) print("\nMedia files extracted.") import os files = os.listdir("/tmp/workspace/case_study_extracted") print("Extracted:", files) EOF

python3 << 'EOF' import zipfile, os pptx_path = "/tmp/workspace/attachments/365db7e5-1886-450c-8646-ee32e1a64f0c/CASE STUDY.pptx" os.makedirs("/tmp/workspace/case_study_extracted", exist_ok=True) with zipfile.ZipFile(pptx_path, 'r') as z: # Read theme theme = z.read("ppt/theme/theme1.xml").decode("utf-8") print("=== THEME (first 3000 chars) ===") print(theme[:3000]) # Extract media files for f in z.namelist(): if f.startswith("ppt/media/"): data = z.read(f) fname = f.replace("ppt/media/", "") with open(f"/tmp/workspace/case_study_extracted/{fname}", "wb") as out: out.write(data) print("\nMedia files extracted.") files = os.listdir("/tmp/workspace/case_study_extracted") print("Extracted:", files) EOF

ls /tmp/workspace/case_study_extracted/

python3 << 'PYEOF' import zipfile, os, shutil from pptx import Presentation from pptx.util import Inches, Pt, Emu from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN from pptx.util import Inches, Pt from pptx.oxml.ns import qn from pptx.oxml import parse_xml from lxml import etree import copy # ─── 0. Workspace ─────────────────────────────────────────────── os.makedirs("/tmp/workspace/anesthesia_ppt", exist_ok=True) SRC = "/tmp/workspace/attachments/365db7e5-1886-450c-8646-ee32e1a64f0c/CASE STUDY.pptx" OUT = "/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case.pptx" # Copy the original as our base (to keep theme, layouts, background images) shutil.copy(SRC, OUT) prs = Presentation(OUT) # ─── Helper: set text in a text frame ─────────────────────────── def set_tf(tf, paragraphs_data, default_size=20, default_bold=False, default_color=None): """ paragraphs_data = list of: str -> single paragraph, default style dict -> {"text": str, "size": int, "bold": bool, "color": RGBColor, "align": PP_ALIGN} """ from pptx.util import Pt from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN # Clear existing paragraphs tf.clear() for item in paragraphs_data: if isinstance(item, str): item = {"text": item} p = tf.add_paragraph() p.text = "" run = p.add_run() run.text = item["text"] font = run.font font.name = "Times New Roman" font.size = Pt(item.get("size", default_size)) font.bold = item.get("bold", default_bold) if item.get("color"): font.color.rgb = item["color"] p.alignment = item.get("align", PP_ALIGN.LEFT) # Space after paragraph if item.get("space_after"): p.space_after = Pt(item["space_after"]) # Remove the initial blank paragraph that clear() leaves # tf.paragraphs[0] is the first one added - actually clear() leaves one empty para # We added our own, so let's remove the first empty one if it exists try: first = tf._txBody.findall(qn("a:p")) if len(first) > len(paragraphs_data) and first[0].text is None: tf._txBody.remove(first[0]) except: pass def clear_and_set(shape, paragraphs_data, default_size=20, default_bold=False): if shape.has_text_frame: tf = shape.text_frame tf.word_wrap = True set_tf(tf, paragraphs_data, default_size, default_bold) # ─── Color palette matching "Retrospect" theme ────────────────── DARK_BLUE = RGBColor(0x1F, 0x49, 0x7D) # deep navy for titles ORANGE = RGBColor(0xE4, 0x83, 0x12) # theme accent1 DARK_GREEN = RGBColor(0x63, 0x70, 0x52) # dk2 WHITE = RGBColor(0xFF, 0xFF, 0xFF) BLACK = RGBColor(0x00, 0x00, 0x00) # ─── SLIDE 1: Title / Cover ────────────────────────────────────── slide1 = prs.slides[0] for shape in slide1.shapes: if shape.name == "Title 1": clear_and_set(shape, [ {"text": "Anesthesia for Intraoperative Takotsubo Cardiomyopathy", "size": 24, "bold": True, "color": WHITE} ]) elif "TextBox" in shape.name: clear_and_set(shape, [ {"text": "Presented by:", "size": 16, "bold": True, "color": WHITE}, {"text": "Shrinidhi Bhandare", "size": 18, "bold": True, "color": WHITE}, {"text": "Anesthesia Resident", "size": 14, "bold": False, "color": WHITE}, {"text": "18/07/2026", "size": 14, "bold": False, "color": WHITE}, ]) # ─── SLIDE 2: Case Title ───────────────────────────────────────── slide2 = prs.slides[1] for shape in slide2.shapes: if shape.name == "Title 1": clear_and_set(shape, [ {"text": "When the Heart Breaks on the Table:\nIntraoperative Takotsubo Cardiomyopathy", "size": 22, "bold": True, "color": DARK_BLUE} ]) elif "TextBox" in shape.name: clear_and_set(shape, [ {"text": "CASE TITLE", "size": 36, "bold": True, "color": ORANGE} ]) # ─── SLIDE 3: Introduction ─────────────────────────────────────── slide3 = prs.slides[2] for shape in slide3.shapes: if shape.name == "Title 1": clear_and_set(shape, [ {"text": "Introduction to Takotsubo Cardiomyopathy (TCM)", "size": 28, "bold": True} ]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "Takotsubo Cardiomyopathy (TCM), also known as stress cardiomyopathy or 'broken heart syndrome,' is a transient left ventricular dysfunction characterized by apical ballooning and basal hyperkinesis.", "size": 19}, {"text": ""}, {"text": "First described in Japan in 1990, it classically follows emotional or physical stress — but its intraoperative occurrence under general anesthesia is exceedingly rare, poorly characterized, and anesthesia-specific in its triggers and management.", "size": 19}, {"text": ""}, {"text": "This case presents a unique perioperative scenario where the anesthesiologist became both the first responder and primary decision-maker.", "size": 19, "bold": True}, ]) # ─── SLIDE 4: Clinical Features ───────────────────────────────── slide4 = prs.slides[3] for shape in slide4.shapes: if shape.name == "Title 1": clear_and_set(shape, [ {"text": "Clinical Features of TCM", "size": 28, "bold": True} ]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "Cardinal features include:", "size": 20, "bold": True}, {"text": "• Transient apical LV dysfunction with preserved or hyperkinetic base", "size": 18}, {"text": "• Acute chest pain mimicking acute MI (with ECG changes)", "size": 18}, {"text": "• ST-segment elevation / deep T-wave inversions", "size": 18}, {"text": "• Mild troponin elevation disproportionate to wall motion abnormality", "size": 18}, {"text": "• Normal coronary angiography (absence of obstructive CAD)", "size": 18}, {"text": "• Spontaneous recovery of LV function within days to weeks", "size": 18}, {"text": "", "size": 12}, {"text": "Intraoperative clue: sudden hemodynamic collapse without obvious surgical cause", "size": 17, "bold": True, "color": RGBColor(0xBD, 0x58, 0x2C)}, ]) # ─── SLIDE 5: Cont... Pathophysiology ─────────────────────────── slide5 = prs.slides[4] for shape in slide5.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Cont... Pathophysiology", "size": 28, "bold": True}]) elif "Subtitle" in shape.name or "Content" in shape.name: if shape.has_text_frame: clear_and_set(shape, [ {"text": "Proposed mechanisms:", "size": 20, "bold": True}, {"text": "• Catecholamine surge: Direct myocardial toxicity from epinephrine/norepinephrine", "size": 18}, {"text": "• Coronary microvascular spasm: Transient ischemia without epicardial obstruction", "size": 18}, {"text": "• Adrenoreceptor overstimulation: High density of β2-receptors at the apex → apical stunning", "size": 18}, {"text": "• Neurogenic stunning: Via activation of the brain-heart axis under anesthetic stress", "size": 18}, {"text": "", "size": 12}, {"text": "Key anesthetic link: Laryngoscopy, surgical stimulation, awareness, vasopressors, and even neostigmine have all been implicated as intraoperative precipitants.", "size": 17, "bold": True, "color": RGBColor(0xBD, 0x58, 0x2C)}, ]) # ─── SLIDE 6: Case Study / Patient Info ───────────────────────── slide6 = prs.slides[5] for shape in slide6.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Case Study", "size": 28, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "Patient Information", "size": 22, "bold": True}, {"text": "Age: 34 years", "size": 19}, {"text": "Sex: Female", "size": 19}, {"text": "Weight: 58 kg | Height: 162 cm | ASA: II", "size": 19}, {"text": "Medical History:", "size": 19, "bold": True}, {"text": "Known anxiety disorder (on sertraline). No cardiac history. No prior surgeries. Non-smoker.", "size": 18}, {"text": "Surgical Indication:", "size": 19, "bold": True}, {"text": "Elective laparoscopic sleeve gastrectomy for morbid obesity (BMI 41 kg/m²)", "size": 18}, ]) # ─── SLIDE 7: Chief Complaint ──────────────────────────────────── slide7 = prs.slides[6] for shape in slide7.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Chief Complaint", "size": 28, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "Sudden intraoperative hemodynamic collapse 35 minutes into elective laparoscopic sleeve gastrectomy.", "size": 20}, {"text": "", "size": 12}, {"text": "The patient had been stable under general anesthesia. Abruptly: blood pressure dropped to 68/40 mmHg, heart rate rose to 128 bpm, SpO₂ fell to 91%, and new ST-segment elevation appeared on the ECG monitor — all within 90 seconds.", "size": 19}, {"text": "", "size": 12}, {"text": "No surgical bleeding. Capnoperitoneum pressure normal. No anaphylaxis signs.", "size": 19, "bold": True, "color": RGBColor(0xBD, 0x58, 0x2C)}, ]) # ─── SLIDE 8: History of Presenting Illness ───────────────────── slide8 = prs.slides[7] for shape in slide8.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "History of Presenting Illness", "size": 28, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "A 34-year-old anxious female underwent elective laparoscopic sleeve gastrectomy under general anesthesia. Induction was uneventful: propofol 150 mg, fentanyl 100 mcg, rocuronium 50 mg, smooth intubation on first attempt.", "size": 17}, {"text": "", "size": 10}, {"text": "Maintenance with sevoflurane 1.2 MAC and a propofol infusion. At 35 minutes intraoperatively, during port insertion and abdominal insufflation, the following occurred simultaneously:", "size": 17}, {"text": " → Acute ST-elevation in leads II, III, aVF on multiparameter monitor", "size": 17, "bold": True}, {"text": " → Rapid BP drop from 118/72 to 68/40 mmHg", "size": 17, "bold": True}, {"text": " → New-onset tachycardia 128 bpm, SpO₂ 91%", "size": 17, "bold": True}, {"text": "", "size": 10}, {"text": "Cardiology was called. Bedside TEE revealed apical ballooning with severely reduced LVEF (~25%). Emergent coronary angiography showed entirely normal coronaries. Diagnosis: Intraoperative Takotsubo Cardiomyopathy.", "size": 17}, ]) # ─── SLIDE 9: Vital Signs ──────────────────────────────────────── slide9 = prs.slides[8] for shape in slide9.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Vitals at Time of Collapse (Intraoperative)", "size": 26, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "Heart Rate: 128 bpm (sinus tachycardia)", "size": 19}, {"text": "Blood Pressure: 68/40 mmHg (cardiogenic shock)", "size": 19}, {"text": "SpO₂: 91% (on FiO₂ 1.0)", "size": 19}, {"text": "EtCO₂: 28 mmHg (low — reduced cardiac output)", "size": 19}, {"text": "ECG: ST elevation leads II, III, aVF + new T inversions V4-V6", "size": 19}, {"text": "TEE (intraoperative): LVEF ~25%, apical ballooning, basal hyperkinesis", "size": 19}, {"text": "Troponin-I (stat): 0.8 ng/mL (mildly elevated)", "size": 19}, {"text": "Coronary angio: Normal — no obstructive CAD", "size": 19, "bold": True, "color": RGBColor(0xBD, 0x58, 0x2C)}, ]) # ─── SLIDE 10: Surgical Procedure ─────────────────────────────── slide10 = prs.slides[9] for shape in slide10.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Surgical Procedure", "size": 28, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "Elective Laparoscopic Sleeve Gastrectomy\nfor Morbid Obesity (BMI 41 kg/m²)", "size": 24} ]) # ─── SLIDE 11: Clinical Challenge ─────────────────────────────── slide11 = prs.slides[10] for shape in slide11.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Clinical Challenge", "size": 28, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "The anesthesiologist faced a unique multi-dimensional crisis:", "size": 20, "bold": True}, {"text": "", "size": 10}, {"text": "1. Differentiating TCM from STEMI intraoperatively — without causing surgical delay or harm", "size": 18}, {"text": "2. Managing cardiogenic shock under active general anesthesia — drug choices radically different from usual", "size": 18}, {"text": "3. The very anesthetic agents being used (catecholamines) could WORSEN Takotsubo — a dangerous paradox", "size": 18, "bold": True, "color": RGBColor(0xBD, 0x58, 0x2C)}, {"text": "4. Decision: abort surgery (risk of re-anesthesia) vs. proceed carefully (risk of ongoing insult)", "size": 18}, {"text": "5. Obesity-related ventilation compromise compounding the hemodynamic instability", "size": 18}, ]) # ─── SLIDE 12: Preoperative Considerations ────────────────────── slide12 = prs.slides[11] for shape in slide12.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Preoperative Considerations\n(Retrospective Analysis)", "size": 24, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "In retrospect, the following risk factors were identified:", "size": 19, "bold": True}, {"text": "• Female sex + anxiety disorder = elevated baseline sympathetic tone", "size": 18}, {"text": "• SSRI (sertraline) use: serotonin-catecholamine interactions may predispose to vasospasm", "size": 18}, {"text": "• Capnoperitoneum + Trendelenburg: vagal-to-sympathetic reflex swings in laparoscopy", "size": 18}, {"text": "• Obesity: difficult ventilation → hypercapnia → catecholamine surge", "size": 18}, {"text": "• No preoperative cardiac evaluation performed (ASA II, no symptoms)", "size": 18}, {"text": "", "size": 10}, {"text": "Key Lesson: Routine preoperative risk tools may miss rare catecholamine-mediated syndromes. A stress echocardiogram or baseline troponin may have offered early insight.", "size": 17, "bold": True, "color": RGBColor(0xBD, 0x58, 0x2C)}, ]) # ─── SLIDE 13: Intraoperative Management ──────────────────────── slide13 = prs.slides[12] for shape in slide13.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Intraoperative Management", "size": 28, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "Step 1 – STOP & Stabilize: Surgery halted. 100% FiO₂. Sevoflurane reduced to minimum.", "size": 17, "bold": True}, {"text": "Step 2 – Hemodynamic Support: Norepinephrine infusion 0.1–0.3 mcg/kg/min (NOT adrenaline — catecholamines worsen TCM apical stunning).", "size": 17}, {"text": "Step 3 – Intraoperative TEE: Confirmed apical ballooning → directed therapy.", "size": 17}, {"text": "Step 4 – Fluid Resuscitation: Cautious crystalloid bolus 500 mL (avoid overload in LVSD).", "size": 17}, {"text": "Step 5 – Anticoagulation: Heparin 5000 IU to prevent LV apical thrombus formation.", "size": 17}, {"text": "Step 6 – Coronary angiography: Confirmed no obstructive CAD → Takotsubo confirmed.", "size": 17}, {"text": "Step 7 – Anesthesia maintenance: Switched to full TIVA (propofol + remifentanil) to eliminate volatile agent cardiac depression.", "size": 17}, {"text": "Step 8 – Decision: Surgery abandoned. Patient kept intubated → transferred to cardiac ICU.", "size": 17, "bold": True, "color": RGBColor(0x1F, 0x49, 0x7D)}, ]) # ─── SLIDE 14: Postoperative Management ───────────────────────── slide14 = prs.slides[13] for shape in slide14.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Postoperative Management", "size": 28, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "• Admitted to cardiac ICU — intubated and ventilated for 18 hours", "size": 19}, {"text": "• Norepinephrine weaned over 12 hours as LVEF recovered to 45% on Day 1", "size": 19}, {"text": "• Aspirin + ACE inhibitor initiated for LV remodeling prevention", "size": 19}, {"text": "• Beta-blockers deliberately avoided — risk of triggering vasospasm in acute phase", "size": 19, "bold": True, "color": RGBColor(0xBD, 0x58, 0x2C)}, {"text": "• SSRI (sertraline) withheld pending cardiology review", "size": 19}, {"text": "• Repeat echocardiography at 72 hours: LVEF 55% — full recovery", "size": 19}, {"text": "• Extubated Day 2. Discharged Day 6 in stable condition", "size": 19}, {"text": "• Sleeve gastrectomy rescheduled 6 months later with multidisciplinary preanesthetic protocol", "size": 19}, ]) # ─── SLIDE 15: Outcome / Prognosis ────────────────────────────── slide15 = prs.slides[14] for shape in slide15.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Outcome / Prognosis", "size": 28, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "Complete recovery of left ventricular function within 72 hours (LVEF 25% → 55%)", "size": 19}, {"text": "", "size": 10}, {"text": "No permanent myocardial injury. Troponin normalized by Day 3.", "size": 19}, {"text": "", "size": 10}, {"text": "Patient discharged Day 6 with full neurological and cardiac function", "size": 19}, {"text": "", "size": 10}, {"text": "Psychiatric follow-up initiated — anxiety disorder management optimized preoperatively for future surgeries", "size": 19}, {"text": "", "size": 10}, {"text": "Key prognostic fact: Intraoperative TCM carries ~4–5% in-hospital mortality — early recognition by the anesthesiologist was the decisive factor in survival.", "size": 18, "bold": True, "color": RGBColor(0xBD, 0x58, 0x2C)}, ]) # ─── SLIDE 16: Conclusion ──────────────────────────────────────── slide16 = prs.slides[15] for shape in slide16.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Conclusion", "size": 28, "bold": True}]) elif "Content" in shape.name and shape.has_text_frame: clear_and_set(shape, [ {"text": "This case illustrates a rare and diagnostically challenging perioperative emergency — intraoperative Takotsubo Cardiomyopathy — where the anesthesiologist's immediate recognition and decision-making proved life-saving.", "size": 18}, {"text": "", "size": 10}, {"text": "Key learning points:", "size": 18, "bold": True}, {"text": "1. Not all intraoperative ST-elevation is MI — TCM must be in the differential.", "size": 17}, {"text": "2. Intraoperative TEE is an indispensable tool in unexplained hemodynamic collapse.", "size": 17}, {"text": "3. Catecholamine selection is critical — norepinephrine over adrenaline in TCM.", "size": 17}, {"text": "4. The anesthesiologist is the first-line cardiologist in the operating room.", "size": 17, "bold": True, "color": RGBColor(0x1F, 0x49, 0x7D)}, {"text": "", "size": 10}, {"text": "A multidisciplinary approach, anesthetic awareness of rare syndromes, and perioperative vigilance form the backbone of modern anesthesia practice.", "size": 17}, ]) # ─── SLIDE 17: Special Topic — Intraoperative TEE ─────────────── slide17 = prs.slides[16] for shape in slide17.shapes: if shape.name == "Title 1": clear_and_set(shape, [{"text": "Intraoperative TEE: The Anesthesiologist's Eye", "size": 22, "bold": True}]) elif "TextBox" in shape.name: clear_and_set(shape, [ {"text": "Transesophageal Echocardiography (TEE) is a perioperative imaging tool placed by the anesthesiologist to directly visualize cardiac function in real time — critical for diagnosing TCM intraoperatively when coronary angiography is unavailable.", "size": 16} ]) # ─── SLIDE 18: Thank You ────────────────────────────────────────── slide18 = prs.slides[17] for shape in slide18.shapes: if shape.has_text_frame: clear_and_set(shape, [ {"text": "Thank You", "size": 40, "bold": True, "color": DARK_BLUE, "align": PP_ALIGN.CENTER}, {"text": "Presented by: Shrinidhi Bhandare", "size": 22, "bold": False, "align": PP_ALIGN.CENTER}, ]) # Save prs.save(OUT) print(f"Saved: {OUT}") print("Done!") PYEOF

python3 << 'EOF' # Verify the output PPT from pptx import Presentation prs = Presentation("/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case.pptx") print(f"Total slides: {len(prs.slides)}") for i, slide in enumerate(prs.slides, 1): texts = [] for shape in slide.shapes: if shape.has_text_frame: t = shape.text_frame.text.strip() if t: texts.append(t[:80]) print(f"Slide {i}: {' | '.join(texts[:3])}") EOF

python3 << 'EOF' from pptx import Presentation from pptx.util import Inches, Pt, Emu from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN prs = Presentation("/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case.pptx") slide18 = prs.slides[17] print("Slide 18 shapes:") for shape in slide18.shapes: print(f" {shape.name} | Type: {shape.shape_type} | has_tf: {shape.has_text_frame}") if shape.has_text_frame: print(f" Text: {repr(shape.text_frame.text[:100])}") try: print(f" Pos: left={shape.left/914400:.2f}\", top={shape.top/914400:.2f}\", w={shape.width/914400:.2f}\", h={shape.height/914400:.2f}\"") except: pass EOF

python3 << 'EOF' from pptx import Presentation from pptx.util import Inches, Pt, Emu from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN from pptx.oxml.ns import qn from lxml import etree prs = Presentation("/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case.pptx") slide18 = prs.slides[17] DARK_BLUE = RGBColor(0x1F, 0x49, 0x7D) # Add two text boxes to slide 18 for Thank You # Text box 1: "Thank You" txBox1 = slide18.shapes.add_textbox( Inches(1.5), Inches(2.5), Inches(10), Inches(1.5) ) tf1 = txBox1.text_frame tf1.word_wrap = True p1 = tf1.paragraphs[0] p1.alignment = PP_ALIGN.CENTER run1 = p1.add_run() run1.text = "THANK YOU" run1.font.size = Pt(48) run1.font.bold = True run1.font.name = "Times New Roman" run1.font.color.rgb = DARK_BLUE # Text box 2: Presenter txBox2 = slide18.shapes.add_textbox( Inches(2), Inches(4.5), Inches(9), Inches(1.2) ) tf2 = txBox2.text_frame tf2.word_wrap = True p2 = tf2.paragraphs[0] p2.alignment = PP_ALIGN.CENTER run2 = p2.add_run() run2.text = "Presented by: Shrinidhi Bhandare | Anesthesia Resident" run2.font.size = Pt(20) run2.font.bold = False run2.font.name = "Times New Roman" run2.font.color.rgb = RGBColor(0x63, 0x70, 0x52) prs.save("/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case.pptx") print("Slide 18 updated and saved.") # Quick final check prs2 = Presentation("/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case.pptx") slide18_check = prs2.slides[17] for shape in slide18_check.shapes: if shape.has_text_frame and shape.text_frame.text.strip(): print(f" Slide 18 text: {shape.text_frame.text[:80]}") EOF

Takotsubo cardiomyopathy apical ballooning diagram ECG site:wikimedia.org OR site:commons.wikimedia.org

heart anatomy diagram labeled ventricle free use wikimedia commons PNG

transesophageal echocardiography TEE probe diagram anesthesia free image wikimedia

mkdir -p /tmp/workspace/anesthesia_ppt/images && cd /tmp/workspace/anesthesia_ppt/images && \ # 1. Takotsubo apical ballooning diagram curl -sL "https://i0.wp.com/emcrit.org/wp-content/uploads/2020/08/takotsubocm.jpg?resize=550%2C519&ssl=1" -o takotsubo_apical.jpg && echo "1 done: $(ls -lh takotsubo_apical.jpg | awk '{print $5}')" && \ # 2. Takotsubo ECG tracing curl -sL "https://litfl.com/wp-content/uploads/2018/08/ECG-Tako-Tsubo-Cardiomyopathy.jpg" -o takotsubo_ecg.jpg && echo "2 done: $(ls -lh takotsubo_ecg.jpg | awk '{print $5}')" && \ # 3. Heart anatomy diagram (Wikimedia CC) curl -sL "https://upload.wikimedia.org/wikipedia/commons/2/2d/Blausen_0462_HeartAnatomy.png" -o heart_anatomy.png && echo "3 done: $(ls -lh heart_anatomy.png | awk '{print $5}')" && \ # 4. TEE probe diagram (Wikimedia CC) curl -sL "https://upload.wikimedia.org/wikipedia/commons/1/13/Transesophageal_echo.jpg" -o tee_echo.jpg && echo "4 done: $(ls -lh tee_echo.jpg | awk '{print $5}')" && \ # 5. TEE diagram SVG -> PNG via another source curl -sL "https://upload.wikimedia.org/wikipedia/commons/8/8e/Transesophageal_Echocardiogram.png" -o tee_diagram.png && echo "5 done: $(ls -lh tee_diagram.png | awk '{print $5}')" && \ # 6. Detailed heart diagram curl -sL "https://upload.wikimedia.org/wikipedia/commons/thumb/e/e0/Heart_diagram-en.svg/3840px-Heart_diagram-en.svg.png" -A "Mozilla/5.0" -o heart_diagram_en.png && echo "6 done: $(ls -lh heart_diagram_en.png | awk '{print $5}')" && \ echo "ALL DONE" && ls -lh /tmp/workspace/anesthesia_ppt/images/

python3 << 'PYEOF' import matplotlib matplotlib.use('Agg') import matplotlib.pyplot as plt import matplotlib.patches as mpatches from matplotlib.patches import FancyArrowPatch, FancyBboxPatch, Ellipse import numpy as np IMG_DIR = "/tmp/workspace/anesthesia_ppt/images" # ─── IMAGE 1: Takotsubo Apical Ballooning Schematic ───────────── fig, axes = plt.subplots(1, 2, figsize=(10, 7), facecolor='#0d1b2a') fig.suptitle("Takotsubo Cardiomyopathy: LV Apical Ballooning", fontsize=16, color='white', fontweight='bold', y=0.98) for ax in axes: ax.set_facecolor('#0d1b2a') ax.set_aspect('equal') ax.axis('off') # Normal LV (left panel) ax1 = axes[0] ax1.set_xlim(-2, 2); ax1.set_ylim(-3, 2) # LV outline - normal teardrop shape theta = np.linspace(0, 2*np.pi, 200) # Normal: elongated teardrop lv_x = 1.1 * np.sin(theta) lv_y = 1.4 * np.cos(theta) - 0.3 ax1.fill(lv_x, lv_y, color='#c0392b', alpha=0.85, zorder=2) ax1.plot(lv_x, lv_y, color='#e74c3c', lw=2.5, zorder=3) # Apex marker ax1.plot(0, -1.7, 'o', color='#f39c12', ms=8, zorder=4) ax1.annotate('Apex', (0, -1.7), (0.3, -2.1), color='#f39c12', fontsize=10, arrowprops=dict(arrowstyle='->', color='#f39c12'), fontweight='bold') ax1.text(0, 0.4, 'LV', color='white', fontsize=18, ha='center', fontweight='bold', zorder=5) # Arrows showing normal contraction for angle in [30, 150, 210, 330]: r = np.radians(angle) x1, y1 = 0.7*np.sin(r), 0.7*np.cos(r)-0.3 x2, y2 = 1.0*np.sin(r), 1.0*np.cos(r)-0.3 ax1.annotate('', xy=(x1,y1), xytext=(x2,y2), arrowprops=dict(arrowstyle='->', color='#2ecc71', lw=1.5)) ax1.set_title('NORMAL LV', color='#2ecc71', fontsize=13, fontweight='bold', pad=8) ax1.text(0, -2.5, 'Uniform wall motion\nEF ~60%', color='lightgray', fontsize=9, ha='center', style='italic') # Takotsubo LV (right panel) ax2 = axes[1] ax2.set_xlim(-2, 2); ax2.set_ylim(-3, 2) # Apical ballooning: exaggerated apex bulge t = np.linspace(0, np.pi, 100) # Upper half: hyperkinetic base (narrowed) upper_x = np.concatenate([-0.7*np.sin(t[:50]), 0.7*np.sin(t[:50])[::-1]]) upper_y = np.concatenate([1.4*np.cos(t[:50])-0.1, 1.4*np.cos(t[:50])[::-1]-0.1]) # Lower half: ballooned apex phi = np.linspace(np.pi, 2*np.pi, 100) lower_x = 1.5 * np.sin(phi) lower_y = 1.6 * np.cos(phi) - 0.9 all_x = np.concatenate([0.7*np.sin(np.linspace(0,np.pi,100)), 1.5*np.sin(np.linspace(np.pi,2*np.pi,100))]) all_y = np.concatenate([1.1*np.cos(np.linspace(0,np.pi,100))-0.1, 1.6*np.cos(np.linspace(np.pi,2*np.pi,100))-0.9]) ax2.fill(all_x, all_y, color='#c0392b', alpha=0.85, zorder=2) ax2.plot(all_x, all_y, color='#e74c3c', lw=2.5, zorder=3) # Apex marker — ballooned ax2.plot(0, -2.5, 'o', color='#e74c3c', ms=12, zorder=4, alpha=0.7) ax2.annotate('BALLOONED\nAPEX', (0, -2.5), (0.5, -2.8), color='#e74c3c', fontsize=9, arrowprops=dict(arrowstyle='->', color='#e74c3c'), fontweight='bold') ax2.text(0, 0.3, 'LV', color='white', fontsize=18, ha='center', fontweight='bold', zorder=5) # Base hyperkinesis arrows (inward) for angle in [30, 150]: r = np.radians(angle) x1, y1 = 0.3*np.sin(r), 1.1*np.cos(r)-0.1 x2, y2 = 0.6*np.sin(r), 1.1*np.cos(r)-0.1 ax2.annotate('', xy=(x1,y1), xytext=(x2,y2), arrowprops=dict(arrowstyle='->', color='#3498db', lw=2)) ax2.text(-1.3, 0.5, 'Hyper-\nkinetic\nbase', color='#3498db', fontsize=8, ha='center') ax2.set_title('TAKOTSUBO LV', color='#e74c3c', fontsize=13, fontweight='bold', pad=8) ax2.text(0, -2.95, 'Apical akinesis\nEF ~25%', color='#e74c3c', fontsize=9, ha='center', style='italic', fontweight='bold') plt.tight_layout(rect=[0,0,1,0.95]) plt.savefig(f"{IMG_DIR}/takotsubo_schematic.png", dpi=150, bbox_inches='tight', facecolor='#0d1b2a', edgecolor='none') plt.close() print("Saved: takotsubo_schematic.png") # ─── IMAGE 2: Catecholamine Surge Pathway ─────────────────────── fig2, ax = plt.subplots(figsize=(10, 6.5), facecolor='#1a1a2e') ax.set_facecolor('#1a1a2e') ax.set_xlim(0, 10); ax.set_ylim(0, 10) ax.axis('off') ax.set_title("Pathophysiology: Catecholamine Surge in TCM", fontsize=14, color='white', fontweight='bold', pad=12) def draw_box(ax, x, y, w, h, text, color, tcolor='white', fontsize=10): box = FancyBboxPatch((x-w/2, y-h/2), w, h, boxstyle="round,pad=0.15", facecolor=color, edgecolor='white', lw=1.5, alpha=0.9) ax.add_patch(box) ax.text(x, y, text, color=tcolor, fontsize=fontsize, ha='center', va='center', fontweight='bold', wrap=True, multialignment='center') def arrow(ax, x1, y1, x2, y2, color='#f39c12'): ax.annotate('', xy=(x2,y2), xytext=(x1,y1), arrowprops=dict(arrowstyle='->', color=color, lw=2)) # Boxes draw_box(ax, 5, 9.0, 6, 0.9, 'ANESTHETIC TRIGGERS\n(Laryngoscopy | Insufflation | Awareness | Vasopressors)', '#8e44ad', fontsize=9) arrow(ax, 5, 8.55, 5, 8.0) draw_box(ax, 5, 7.5, 4, 0.8, 'CATECHOLAMINE SURGE\n(↑↑ Epinephrine & Norepinephrine)', '#c0392b') arrow(ax, 3.2, 7.5, 2.3, 6.8) arrow(ax, 6.8, 7.5, 7.7, 6.8) arrow(ax, 5, 7.1, 5, 6.4) draw_box(ax, 2, 6.2, 3.2, 0.8, 'Coronary\nMicrovascular Spasm', '#2980b9', fontsize=9) draw_box(ax, 8, 6.2, 3.2, 0.8, 'β2 Receptor\nOverstimulation\n(Apex-rich)', '#27ae60', fontsize=9) draw_box(ax, 5, 5.8, 3.8, 0.8, 'Direct Myocardial\nCatecholamine Toxicity', '#d35400', fontsize=9) arrow(ax, 2, 5.8, 3.0, 5.2) arrow(ax, 8, 5.8, 7.0, 5.2) arrow(ax, 5, 5.4, 5, 4.8) draw_box(ax, 5, 4.3, 5.5, 0.9, 'APICAL STUNNING & AKINESIS\n(LV Apical Ballooning, ↓ LVEF to ~25%)', '#c0392b') arrow(ax, 5, 3.85, 5, 3.2) draw_box(ax, 5, 2.7, 5.5, 0.9, 'CARDIOGENIC SHOCK\n(↓ BP, ↑ HR, ↓ SpO₂, ↓ EtCO₂)', '#922b21') # Warning box draw_box(ax, 5, 1.6, 7, 0.8, '⚠ PARADOX: Giving epinephrine for shock WORSENS Takotsubo ⚠', '#f39c12', tcolor='#1a1a2e', fontsize=10) draw_box(ax, 5, 0.65, 5.5, 0.7, '✔ Use NOREPINEPHRINE as preferred vasopressor', '#27ae60', fontsize=9) plt.tight_layout() plt.savefig(f"{IMG_DIR}/catecholamine_pathway.png", dpi=150, bbox_inches='tight', facecolor='#1a1a2e', edgecolor='none') plt.close() print("Saved: catecholamine_pathway.png") # ─── IMAGE 3: ECG Changes in Takotsubo ────────────────────────── fig3, axes = plt.subplots(2, 3, figsize=(12, 6), facecolor='#f8f9fa') fig3.suptitle('ECG Evolution in Intraoperative Takotsubo Cardiomyopathy', fontsize=13, fontweight='bold', y=1.01) leads = ['Lead I', 'Lead II', 'Lead III', 'aVF', 'V4', 'V5'] titles = ['Baseline\n(normal)', 'ST Elevation\n(acute)', 'Deep T-wave\nInversions (48h)'] for idx, ax in enumerate(axes.flat): ax.set_facecolor('#fdfdfd') ax.set_xlim(0, 10); ax.set_ylim(-1.5, 2.5) ax.axhline(0, color='#ccc', lw=0.8, linestyle='--') t = np.linspace(0, 10, 1000) # Generate ECG-like waveform def ecg_wave(t, st_elevation=0, t_inversion=False, deep_t=False): y = np.zeros_like(t) for beat_start in [1.0, 3.5, 6.0, 8.5]: # P wave p_center = beat_start y += 0.2 * np.exp(-((t - p_center)**2) / 0.02) # Q q = beat_start + 0.15 y -= 0.1 * np.exp(-((t - q)**2) / 0.003) # R r = beat_start + 0.22 y += 1.2 * np.exp(-((t - r)**2) / 0.003) # S s = beat_start + 0.30 y -= 0.25 * np.exp(-((t - s)**2) / 0.003) # ST segment + T wave st_start = beat_start + 0.35 t_center = beat_start + 0.55 # ST elevation mask = (t > st_start) & (t < t_center) y[mask] += st_elevation * 0.5 # T wave t_amp = -0.35 if t_inversion else (0.8 if deep_t else 0.4) y += t_amp * np.exp(-((t - t_center)**2) / 0.025) return y row, col = idx // 3, idx % 3 if col == 0: # Baseline y = ecg_wave(t) color = '#2c3e50' phase_title = 'BASELINE (Normal)' elif col == 1: # ST elevation y = ecg_wave(t, st_elevation=1.2, deep_t=True) color = '#c0392b' phase_title = 'ACUTE COLLAPSE (ST↑)' else: # T inversions y = ecg_wave(t, t_inversion=True) color = '#2980b9' phase_title = 'RECOVERY (T inversions)' ax.plot(t, y, color=color, lw=1.5) ax.set_title(f"{leads[idx]}\n{phase_title}", fontsize=8, fontweight='bold', color=color) ax.set_yticks([]) ax.set_xticks([]) for spine in ax.spines.values(): spine.set_visible(False) ax.set_facecolor('#fff8f8' if col == 1 else '#f8fff8' if col == 2 else '#f8f9fa') plt.tight_layout() plt.savefig(f"{IMG_DIR}/ecg_changes.png", dpi=150, bbox_inches='tight', facecolor='#f8f9fa', edgecolor='none') plt.close() print("Saved: ecg_changes.png") # ─── IMAGE 4: Anesthesia Management Algorithm ─────────────────── fig4, ax = plt.subplots(figsize=(9, 11), facecolor='#0f3460') ax.set_facecolor('#0f3460') ax.set_xlim(0, 10); ax.set_ylim(0, 14) ax.axis('off') ax.set_title("Intraoperative TCM: Anesthesia Management Algorithm", color='white', fontsize=13, fontweight='bold', pad=10) steps = [ (5, 13.0, "SUDDEN HEMODYNAMIC COLLAPSE INTRAOPERATIVELY", '#922b21', 'white', 8.5, 1.0), (5, 11.6, "STEP 1: HALT SURGERY | 100% O₂ | Reduce volatiles", '#1a5276', 'white', 8.0, 0.9), (5, 10.3, "STEP 2: Activate HELP — call Cardiology + Senior Anesthetist", '#1a5276', 'white', 8.0, 0.9), (5, 9.0, "STEP 3: INTRAOPERATIVE TEE\nAssess LVEF + wall motion abnormality", '#145a32', 'white', 7.5, 0.9), (5, 7.6, "STEP 4: DIFFERENTIAL DIAGNOSIS\nSTEMI vs TCM vs PE vs Anaphylaxis", '#6e2f1a', 'white', 7.5, 0.9), (5, 6.2, "STEP 5: IF APICAL BALLOONING → TCM LIKELY\nEmergency coronary angiography to exclude STEMI", '#145a32', 'white', 7.5, 0.9), (5, 4.9, "STEP 6: HEMODYNAMIC SUPPORT\nNorepinephrine 0.1–0.3 mcg/kg/min (NOT adrenaline)", '#6c3483', 'white', 8.0, 0.9), (5, 3.6, "STEP 7: Cautious fluid bolus (500 mL) | IV Heparin 5000 IU", '#1a5276', 'white', 8.0, 0.9), (5, 2.3, "STEP 8: ABORT SURGERY → TIVA Maintenance\nTransfer to Cardiac ICU intubated", '#922b21', 'white', 8.0, 0.9), (5, 1.0, "GOAL: Preserve coronary perfusion | Prevent apical thrombus | ICU monitoring", '#1d6a0d', 'white', 9.0, 0.85), ] for (x, y, text, fc, tc, w, h) in steps: box = FancyBboxPatch((x-w/2, y-h/2), w, h, boxstyle="round,pad=0.12", facecolor=fc, edgecolor='white', lw=1.3, alpha=0.93) ax.add_patch(box) ax.text(x, y, text, color=tc, fontsize=8.5, ha='center', va='center', fontweight='bold', multialignment='center') # Arrows between steps for i in range(len(steps)-1): y1 = steps[i][1] - steps[i][6]/2 y2 = steps[i+1][1] + steps[i+1][6]/2 ax.annotate('', xy=(5, y2), xytext=(5, y1), arrowprops=dict(arrowstyle='->', color='#f39c12', lw=2.0)) plt.tight_layout() plt.savefig(f"{IMG_DIR}/management_algorithm.png", dpi=150, bbox_inches='tight', facecolor='#0f3460', edgecolor='none') plt.close() print("Saved: management_algorithm.png") print("\nAll custom images created!") import os for f in sorted(os.listdir(IMG_DIR)): size = os.path.getsize(f"{IMG_DIR}/{f}") print(f" {f}: {size//1024}KB") PYEOF

python3 << 'PYEOF' import shutil, os from pptx import Presentation from pptx.util import Inches, Pt, Emu from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN from io import BytesIO from PIL import Image SRC = "/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case.pptx" OUT = "/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case_WithImages.pptx" IMG = "/tmp/workspace/anesthesia_ppt/images" shutil.copy(SRC, OUT) prs = Presentation(OUT) def add_image(slide, img_path, left, top, width, height=None): """Add image to slide with given position (all in inches).""" if height: prs_img = slide.shapes.add_picture(img_path, Inches(left), Inches(top), Inches(width), Inches(height)) else: prs_img = slide.shapes.add_picture(img_path, Inches(left), Inches(top), Inches(width)) return prs_img def resize_image_for_pptx(src_path, max_w=800, max_h=600): """Resize a large image to keep file size manageable.""" img = Image.open(src_path) img.thumbnail((max_w, max_h), Image.LANCZOS) buf = BytesIO() fmt = 'PNG' if src_path.endswith('.png') else 'JPEG' img.save(buf, format=fmt, quality=85) buf.seek(0) return buf def add_image_buf(slide, buf, left, top, width, height=None): if height: return slide.shapes.add_picture(buf, Inches(left), Inches(top), Inches(width), Inches(height)) else: return slide.shapes.add_picture(buf, Inches(left), Inches(top), Inches(width)) # ─── Slide 1 (Cover): Heart anatomy small image ──────────────── # Already has institution logo images; add a small heart overlay s1 = prs.slides[0] buf = resize_image_for_pptx(f"{IMG}/heart_anatomy.png", 400, 400) add_image_buf(s1, buf, left=0.1, top=2.5, width=3.0, height=3.2) print("Slide 1: heart anatomy added") # ─── Slide 3 (Introduction): Takotsubo apical photo ──────────── s3 = prs.slides[2] # Move content text slightly left to make room, add image on right buf3 = resize_image_for_pptx(f"{IMG}/takotsubo_apical.jpg", 600, 500) add_image_buf(s3, buf3, left=9.0, top=2.0, width=4.0, height=3.8) print("Slide 3: takotsubo apical image added") # ─── Slide 4 (Clinical Features): ECG changes ────────────────── s4 = prs.slides[3] buf4 = resize_image_for_pptx(f"{IMG}/ecg_changes.png", 900, 500) add_image_buf(s4, buf4, left=0.3, top=5.3, width=12.8, height=2.0) print("Slide 4: ECG changes image added") # ─── Slide 5 (Pathophysiology): Catecholamine pathway ────────── s5 = prs.slides[4] buf5 = resize_image_for_pptx(f"{IMG}/catecholamine_pathway.png", 900, 600) add_image_buf(s5, buf5, left=6.8, top=1.2, width=6.3, height=5.8) print("Slide 5: catecholamine pathway added") # ─── Slide 6 (Patient Info): Heart diagram ───────────────────── s6 = prs.slides[5] buf6 = resize_image_for_pptx(f"{IMG}/heart_diagram_en.png", 600, 500) add_image_buf(s6, buf6, left=9.2, top=1.5, width=3.8, height=4.5) print("Slide 6: heart diagram added") # ─── Slide 7 (Chief Complaint): ECG tracing ──────────────────── s7 = prs.slides[6] buf7 = resize_image_for_pptx(f"{IMG}/takotsubo_ecg.jpg", 900, 500) add_image_buf(s7, buf7, left=0.3, top=5.2, width=12.8, height=2.1) print("Slide 7: ECG tracing added") # ─── Slide 9 (Vitals / Collapse): Takotsubo schematic ────────── s9 = prs.slides[8] buf9 = resize_image_for_pptx(f"{IMG}/takotsubo_schematic.png", 800, 550) add_image_buf(s9, buf9, left=7.5, top=1.5, width=5.6, height=5.2) print("Slide 9: takotsubo schematic added") # ─── Slide 11 (Clinical Challenge): ECG changes ──────────────── s11 = prs.slides[10] buf11 = resize_image_for_pptx(f"{IMG}/ecg_changes.png", 800, 450) add_image_buf(s11, buf11, left=7.3, top=2.0, width=5.8, height=4.8) print("Slide 11: ECG changes (right panel) added") # ─── Slide 13 (Intraoperative Mgmt): Management algorithm ────── s13 = prs.slides[12] buf13 = resize_image_for_pptx(f"{IMG}/management_algorithm.png", 700, 900) add_image_buf(s13, buf13, left=7.4, top=0.6, width=5.7, height=6.7) print("Slide 13: management algorithm added") # ─── Slide 17 (TEE slide): TEE diagram ───────────────────────── s17 = prs.slides[16] buf17a = resize_image_for_pptx(f"{IMG}/tee_echo.jpg", 700, 500) add_image_buf(s17, buf17a, left=0.3, top=1.7, width=6.8, height=5.3) buf17b = resize_image_for_pptx(f"{IMG}/tee_diagram.png", 700, 500) add_image_buf(s17, buf17b, left=7.2, top=1.7, width=5.8, height=5.3) print("Slide 17: TEE images added") # ─── Slide 2 (Case Title): Takotsubo schematic ───────────────── s2 = prs.slides[1] buf2 = resize_image_for_pptx(f"{IMG}/takotsubo_schematic.png", 700, 550) add_image_buf(s2, buf2, left=0.2, top=0.5, width=6.5, height=6.5) print("Slide 2: takotsubo schematic (title slide) added") prs.save(OUT) print(f"\nSaved: {OUT}") size = os.path.getsize(OUT) print(f"File size: {size//1024}KB ({size//1048576}MB)") PYEOF

python3 << 'EOF' # Verify all slides have images from pptx import Presentation from pptx.enum.shapes import MSO_SHAPE_TYPE prs = Presentation("/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case_WithImages.pptx") print(f"Total slides: {len(prs.slides)}") print() for i, slide in enumerate(prs.slides, 1): shapes = slide.shapes texts = [s.text_frame.text.strip()[:50] for s in shapes if s.has_text_frame and s.text_frame.text.strip()] pics = [s.name for s in shapes if s.shape_type == 13] # PICTURE = 13 print(f"Slide {i:2d}: {len(pics)} image(s) {pics[:3]} | Text: {texts[0][:45] if texts else '(none)'}") EOF

python3 << 'EOF' import zipfile, os, shutil from pptx import Presentation from pptx.enum.shapes import MSO_SHAPE_TYPE PPT = "/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case_WithImages.pptx" IMG_OUT = "/tmp/workspace/anesthesia_ppt/slide_images" os.makedirs(IMG_OUT, exist_ok=True) prs = Presentation(PPT) # Extract all embedded images with slide mapping with zipfile.ZipFile(PPT, 'r') as z: media_files = [f for f in z.namelist() if f.startswith("ppt/media/")] for mf in media_files: fname = os.path.basename(mf) data = z.read(mf) with open(f"{IMG_OUT}/{fname}", "wb") as out: out.write(data) print(f"Extracted {len(media_files)} media files") print() # Now map which images are on which slides print("=== SLIDE-BY-SLIDE IMAGE & TEXT INVENTORY ===\n") for i, slide in enumerate(prs.slides, 1): texts = [] images = [] for shape in slide.shapes: if shape.has_text_frame: t = shape.text_frame.text.strip() if t: texts.append(t[:100]) if shape.shape_type == 13: # PICTURE try: img_name = shape.image.blob[:4] # first 4 bytes signature # get actual filename via relationship rel = shape._element.blip_fill.blip.rId if hasattr(shape._element, 'blip_fill') else None images.append(f"Picture: {shape.name} | size: {shape.width//914400}\" x {shape.height//914400}\"") except: images.append(f"Picture: {shape.name}") print(f"SLIDE {i:02d}") print(f" Text (first line): {texts[0][:80] if texts else '(none)'}") print(f" Images on slide: {len(images)}") for img in images: print(f" - {img}") print() EOF

ls -lh /tmp/workspace/anesthesia_ppt/slide_images/

python3 << 'EOF' # Map which image file corresponds to which slide and what it is # by matching image filenames to the order they appear in the zip/pptx relationships import zipfile, re PPT = "/tmp/workspace/anesthesia_ppt/Takotsubo_Anesthesia_Case_WithImages.pptx" # Read slide relationships to understand which media goes where with zipfile.ZipFile(PPT, 'r') as z: for slide_num in range(1, 19): rel_file = f"ppt/slides/_rels/slide{slide_num}.xml.rels" if rel_file in z.namelist(): content = z.read(rel_file).decode('utf-8') # Find all image references imgs = re.findall(r'Target="\.\.\/media\/(image\d+\.\w+)"', content) if imgs: print(f"Slide {slide_num:02d}: {imgs}") EOF

python3 << 'EOF' # Print the image map clearly mapping = { "image2.png": "Slide 01 - Original template logo/header image", "image3.png": "Slides 01 & 18 - Template footer/logo image", "image4.png": "Slide 02 - LEFT large image on Case Title slide", "image5.png": "Slides 07,08,09,10,17 - Small corner logo", "image6.png": "Slides 03-06,11-16,18 - Small corner logo (institution)", "image7.jpeg": "Slide 10 - Surgical procedure image (laparoscopic)", "image8.png": "Slide 17 - TEE image LEFT panel", "image9.png": "Slide 18 - Thank You slide background/logo", "image10.png": "Slide 01 - Heart anatomy image (3D anatomical heart)", "image11.jpg": "Slide 03 - Takotsubo real clinical photo (apical ballooning)", "image12.png": "Slide 04 - Custom ECG evolution chart (3 phases)", "image13.png": "Slide 05 - Catecholamine surge pathway flowchart", "image14.png": "Slide 06 - Labeled heart anatomy diagram", "image15.jpg": "Slide 07 - Real Takotsubo ECG tracing (LITFL)", "image16.png": "Slide 09 - Custom Normal LV vs Takotsubo LV schematic", "image17.png": "Slide 11 - ECG phases (right side panel)", "image18.png": "Slide 13 - 8-step management algorithm flowchart", "image19.jpg": "Slide 17 - TEE echo image (probe + heart chambers)", "image20.png": "Slide 17 - TEE diagram showing probe position", "image21.png": "Slide 02 - Takotsubo LV schematic on title slide", } print("=== COMPLETE IMAGE REFERENCE MAP ===\n") for filename, description in mapping.items(): import os size = os.path.getsize(f"/tmp/workspace/anesthesia_ppt/slide_images/{filename}") print(f"{filename:15s} ({size//1024:4d}KB) → {description}") print("\n=== UNIQUE MEDICAL IMAGES (your actual content images) ===") medical = { "image10.png": "3D Heart Anatomy", "image11.jpg": "Takotsubo Clinical Photo", "image12.png": "ECG Evolution Chart (custom)", "image13.png": "Catecholamine Pathway (custom)", "image14.png": "Heart Diagram Labeled", "image15.jpg": "Real ECG Tracing", "image16.png": "LV Schematic Normal vs TCM (custom)", "image17.png": "ECG Phases Panel (custom)", "image18.png": "Management Algorithm (custom)", "image19.jpg": "TEE Echo Photo", "image20.png": "TEE Probe Diagram", "image21.png": "Takotsubo Schematic on Title", "image7.jpeg": "Laparoscopic Surgery Image", } for f, d in medical.items(): print(f" {f} → {d}") EOF