from pptx import Presentation
from pptx.util import Inches, Pt
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.oxml.ns import qn
from lxml import etree

NAVY = RGBColor(0x0B, 0x25, 0x45)
TEAL = RGBColor(0x13, 0x8D, 0x90)
AMBER = RGBColor(0xE8, 0x9F, 0x2B)
RED = RGBColor(0xC0, 0x39, 0x2B)
LIGHT = RGBColor(0xF1, 0xF5, 0xF9)
WHITE = RGBColor(0xFF, 0xFF, 0xFF)
TEXT = RGBColor(0x1F, 0x29, 0x33)
GREY = RGBColor(0x62, 0x6F, 0x7D)
FONT = "Calibri"

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)
BLANK = prs.slide_layouts[6]
warnings = []


def est_height(paras, width_in):
    """rough estimate of text height in inches"""
    total = 0
    for text, size in paras:
        cpl = max(1, int(width_in * 72 / (size * 0.50)))
        lines = max(1, -(-len(text) // cpl))
        total += lines * size * 1.25 / 72 + 0.08
    return total


def rect(slide, x, y, w, h, fill, line=None, shape=MSO_SHAPE.RECTANGLE):
    s = slide.shapes.add_shape(shape, Inches(x), Inches(y), Inches(w), Inches(h))
    s.fill.solid()
    s.fill.fore_color.rgb = fill
    if line is None:
        s.line.fill.background()
    else:
        s.line.color.rgb = line
        s.line.width = Pt(1)
    s.shadow.inherit = False
    return s


def set_bullet(p, char="•", indent=0.22):
    pPr = p._p.get_or_add_pPr()
    pPr.set("marL", str(int(Inches(indent))))
    pPr.set("indent", str(-int(Inches(indent))))
    for tag in ("a:buNone", "a:buChar"):
        for e in pPr.findall(qn(tag)):
            pPr.remove(e)
    bu = etree.SubElement(pPr, qn("a:buChar"))
    bu.set("char", char)


def text(slide, x, y, w, h, items, size=16, color=TEXT, bullet=False,
         bold=False, align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.TOP, space=6, check=True):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.vertical_anchor = anchor
    tf.margin_left = tf.margin_right = Inches(0.05)
    tf.margin_top = tf.margin_bottom = Inches(0.03)
    if isinstance(items, str):
        items = [items]
    est = []
    for i, it in enumerate(items):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.alignment = align
        p.space_after = Pt(space)
        # allow (label, rest) tuples: bold label
        if isinstance(it, tuple):
            r1 = p.add_run()
            r1.text = it[0]
            r1.font.bold = True
            r1.font.size = Pt(size)
            r1.font.name = FONT
            r1.font.color.rgb = color
            r2 = p.add_run()
            r2.text = it[1]
            r2.font.size = Pt(size)
            r2.font.name = FONT
            r2.font.color.rgb = color
            est.append((it[0] + it[1], size))
        else:
            r = p.add_run()
            r.text = it
            r.font.size = Pt(size)
            r.font.bold = bold
            r.font.name = FONT
            r.font.color.rgb = color
            est.append((it, size))
        if bullet:
            set_bullet(p)
    if check:
        eh = est_height(est, w - 0.3 if bullet else w - 0.1)
        if eh > h:
            warnings.append(f"slide {len(prs.slides)}: text may overflow ({eh:.1f} > {h:.1f}): {est[0][0][:40]}")
    return tb


def base(title, kicker=None, source=None):
    s = prs.slides.add_slide(BLANK)
    rect(s, 0, 0, 13.333, 7.5, WHITE)
    rect(s, 0, 0, 0.25, 7.5, TEAL)
    if kicker:
        text(s, 0.65, 0.35, 11, 0.35, kicker.upper(), size=13, color=TEAL, bold=True, check=False)
    text(s, 0.65, 0.65, 12, 0.9, title, size=32, color=NAVY, bold=True, check=False)
    if source:
        text(s, 0.65, 6.95, 11.6, 0.4, "Source: " + source, size=11, color=GREY, check=False)
    n = len(prs.slides)
    text(s, 12.2, 6.95, 0.8, 0.4, str(n), size=11, color=GREY, align=PP_ALIGN.RIGHT, check=False)
    return s


def card(slide, x, y, w, h, header, items, color=TEAL, size=15, hsize=17):
    rect(slide, x, y, w, h, LIGHT)
    rect(slide, x, y, w, 0.55, color)
    text(slide, x + 0.1, y + 0.04, w - 0.2, 0.5, header, size=hsize, color=WHITE, bold=True,
         anchor=MSO_ANCHOR.MIDDLE, check=False)
    text(slide, x + 0.12, y + 0.68, w - 0.24, h - 0.78, items, size=size, bullet=True, space=5)


def table(slide, x, y, w, col_w, rows, size=14, header_fill=NAVY, row_h=0.55):
    nrows, ncols = len(rows), len(rows[0])
    gs = slide.shapes.add_table(nrows, ncols, Inches(x), Inches(y), Inches(w), Inches(row_h * nrows))
    t = gs.table
    for j, cw in enumerate(col_w):
        t.columns[j].width = Inches(cw)
    for i, row in enumerate(rows):
        t.rows[i].height = Inches(row_h)
        for j, val in enumerate(row):
            c = t.cell(i, j)
            c.fill.solid()
            c.fill.fore_color.rgb = header_fill if i == 0 else (LIGHT if i % 2 else WHITE)
            c.vertical_anchor = MSO_ANCHOR.MIDDLE
            c.margin_left = c.margin_right = Inches(0.1)
            tf = c.text_frame
            tf.word_wrap = True
            p = tf.paragraphs[0]
            r = p.add_run()
            r.text = val
            r.font.size = Pt(size)
            r.font.name = FONT
            r.font.bold = (i == 0) or (j == 0)
            r.font.color.rgb = WHITE if i == 0 else TEXT
            cpl = int(col_w[j] * 72 / (size * 0.5))
            if -(-len(val) // cpl) * size * 1.25 / 72 + 0.15 > row_h:
                warnings.append(f"slide {len(prs.slides)}: table cell tall: {val[:30]}")
    return t


def notes(slide, txt):
    slide.notes_slide.notes_text_frame.text = txt


# ---------- 1. Title ----------
s = prs.slides.add_slide(BLANK)
rect(s, 0, 0, 13.333, 7.5, NAVY)
rect(s, 0.8, 2.2, 0.12, 2.3, AMBER)
text(s, 1.15, 2.1, 11, 1.6, "Neuropathy in Hypertensive Patients", size=44, color=WHITE, bold=True, check=False)
text(s, 1.15, 3.5, 11, 1.0,
     "Causes, clinical clues and work-up of burning feet and other neuropathic symptoms",
     size=22, color=RGBColor(0xC9, 0xD6, 0xE3), check=False)
text(s, 1.15, 6.4, 11, 0.5, "Based on standard neurology, nephrology and internal medicine textbooks",
     size=14, color=RGBColor(0x9F, 0xB3, 0xC8), check=False)
notes(s, "Case prompt: hypertensive patient with bilateral burning feet, BP not controlled on telmisartan plus amlodipine. This deck covers why neuropathy and hypertension travel together.")

# ---------- 2. Why they travel together ----------
s = base("Why neuropathy and hypertension travel together", "Framework",
         "Adams and Victor's Principles of Neurology 12e; Bradley and Daroff's Neurology in Clinical Practice")
text(s, 0.65, 1.55, 12, 0.9,
     "Hypertension is rarely the sole cause of a peripheral neuropathy. The link usually runs through a shared disease, a target-organ complication or a drug. Finding the linked cause is the task.",
     size=18, color=TEXT, check=False)
card(s, 0.65, 2.7, 3.9, 3.95, "1. Shared disease", [
    "Diabetes and prediabetes",
    "Metabolic syndrome: obesity, high triglycerides and hypertension are themselves risk factors for diabetic polyneuropathy",
    "Chronic kidney disease",
], TEAL, size=15)
card(s, 4.72, 2.7, 3.9, 3.95, "2. Treatment effect", [
    "Hydralazine: B6-responsive neuropathy",
    "Dihydropyridine calcium channel blockers: erythromelalgia-like burning",
    "Metformin co-therapy: B12 deficiency",
], AMBER, size=15)
card(s, 8.79, 2.7, 3.9, 3.95, "3. Hypertension as a feature", [
    "Fabry disease",
    "Systemic vasculitis (polyarteritis nodosa)",
    "Acromegaly, polycythemia vera, erythromelalgia",
], NAVY, size=15)
notes(s, "The Adams and Victor statement about metabolic syndrome components, including hypertension, as risk factors for diabetic polyneuropathy refers to Tesfaye and colleagues.")

# ---------- 3. Pattern recognition ----------
s = base("Match the symptom pattern to the cause", "Clinical approach",
         "Synthesis of cited textbook sections; patterns are general teaching points")
rows = [
    ["Pattern", "What it suggests", "Typical causes in a hypertensive patient"],
    ["Symmetric, distal, burning, worse at night", "Length-dependent small-fiber neuropathy", "Diabetes, B12 or B6 deficiency, CKD, hypothyroidism, alcohol"],
    ["Episodic burning with red, warm feet; eased by cooling", "Erythromelalgia", "Calcium channel blocker, polycythemia vera, secondary causes"],
    ["Attacks of pain triggered by heat, exercise or fever", "Acroparesthesia", "Fabry disease (check kidneys and cornea)"],
    ["Asymmetric, stepwise, foot or wrist drop", "Mononeuritis multiplex", "Vasculitis such as polyarteritis nodosa"],
    ["Hand tingling at night", "Median nerve entrapment", "Acromegaly, diabetes, obesity, hypothyroidism"],
]
table(s, 0.65, 1.7, 12.0, [3.8, 3.3, 4.9], rows, size=15, row_h=0.88)

# ---------- 4. Diabetes ----------
s = base("Diabetes and metabolic syndrome", "Cause 1: the commonest link",
         "Adams and Victor's Principles of Neurology 12e, Diabetic Neuropathy; RACGP Burning feet syndrome")
text(s, 0.65, 1.65, 7.4, 5.0, [
    ("Most common cause ", "of symmetric burning feet. Hypertension and diabetes often coexist."),
    ("Risk factors: ", "triglycerides, body mass and hypertension are risk factors for diabetic polyneuropathy, independent of glycemic control."),
    ("Pattern: ", "distal, symmetric, small-fiber first. Burning, tingling and allodynia, often worse at night."),
    ("Prediabetes ", "can already produce painful small-fiber neuropathy."),
    ("Autonomic involvement ", "(orthostatic BP drop, supine hypertension) can make BP control harder."),
], size=17, bullet=True, space=10)
rect(s, 8.5, 1.75, 4.2, 4.7, LIGHT)
rect(s, 8.5, 1.75, 4.2, 0.55, TEAL)
text(s, 8.6, 1.79, 4.0, 0.5, "Tests", size=18, color=WHITE, bold=True, anchor=MSO_ANCHOR.MIDDLE, check=False)
text(s, 8.65, 2.5, 3.9, 3.8, [
    "Fasting glucose and HbA1c",
    "OGTT if borderline",
    "Vitamin B12 if on metformin",
    "Monofilament, vibration and pinprick on exam",
    "Nerve conduction studies may be normal in pure small-fiber disease",
], size=16, bullet=True, space=8)

# ---------- 5. CKD ----------
s = base("Chronic kidney disease", "Cause 2: hypertension as cause and consequence",
         "Goldman-Cecil Medicine, CKD clinical disorders table; Brenner and Rector's The Kidney, Uremic Polyneuropathy")
text(s, 0.65, 1.65, 7.4, 5.0, [
    ("Mechanism: ", "toxicity from retained solutes causes peripheral neuropathy, mainly at advanced stages (G5)."),
    ("Hyperkalemic depolarization ", "has been proposed as a contributor rather than middle molecules alone."),
    ("Dialysis patients ", "may develop burning feet, possibly from associated nutritional deficiency."),
    ("Why it matters here: ", "uncontrolled hypertension may be renal in origin, and CKD changes drug choices such as spironolactone."),
], size=17, bullet=True, space=10)
rect(s, 8.5, 1.75, 4.2, 4.7, LIGHT)
rect(s, 8.5, 1.75, 4.2, 0.55, NAVY)
text(s, 8.6, 1.79, 4.0, 0.5, "Check", size=18, color=WHITE, bold=True, anchor=MSO_ANCHOR.MIDDLE, check=False)
text(s, 8.65, 2.5, 3.9, 3.8, [
    "Creatinine and eGFR",
    "Urine albumin to creatinine ratio",
    "Electrolytes, especially potassium",
    "CBC for anemia",
    "Use caution with NSAIDs given for foot pain",
], size=16, bullet=True, space=8)

# ---------- 6. Drugs ----------
s = base("Drug-related neuropathy in treated hypertension", "Cause 3: look at the medication list",
         "Bradley and Daroff's (Hydralazine); Goodman and Gilman's (Toxicity); Adams and Victor's (Drug-Induced Neuropathies)")
card(s, 0.65, 1.7, 4.0, 4.95, "Hydralazine", [
    "Distal tingling and numbness in about 15% of patients",
    "Mechanism: binds pyridoxine to form a hydrazone, causing B6 deficiency",
    "Uncommon at 200 mg/day or less",
    "Improves after withdrawal; pyridoxine helps",
    "Very high-dose pyridoxine can itself cause a sensory ganglionopathy",
], RED, size=14)
card(s, 4.85, 1.7, 3.85, 4.95, "Dihydropyridine CCBs", [
    "Amlodipine, nifedipine",
    "Reported to trigger erythromelalgia-like burning, redness and warmth, plus ankle edema",
    "Evidence is mostly case reports",
    "Consider a switch of class if symptoms began after starting",
], AMBER, size=14)
card(s, 8.9, 1.7, 3.8, 4.95, "Co-prescribed drugs", [
    "Metformin: B12 deficiency can add to diabetic neuropathy",
    "NSAIDs for pain raise BP and blunt ARBs",
    "Duloxetine and tricyclics for pain can raise BP",
    "Telmisartan has no well-known direct neuropathy",
], NAVY, size=14)
notes(s, "The calcium channel blocker erythromelalgia point comes from general medical knowledge and case reports, not from the cited textbook passages. Metformin and B12 comes from NIDDK-sourced web material.")

# ---------- 7. Fabry ----------
s = base("Fabry disease", "Cause 4: burning pain, kidneys and blood pressure together",
         "Bradley and Daroff's; Harrison's 22e (Fabry Disease); Goldman-Cecil Medicine; Sleisenger and Fordtran's")
text(s, 0.65, 1.65, 7.4, 5.0, [
    ("Defect: ", "X-linked deficiency of lysosomal alpha-galactosidase A; glycosphingolipid deposits in endothelium and smooth muscle."),
    ("Neuropathy: ", "painful peripheral neuropathy and acroparesthesia lasting minutes to days, triggered by temperature change, exercise, fatigue or fever."),
    ("Other features: ", "renal disease, hypertension, cardiomegaly, autonomic dysfunction, angiokeratoma, anhidrosis."),
    ("Eye clue: ", "corneal and lenticular lesions on slit-lamp examination."),
], size=17, bullet=True, space=10)
rect(s, 8.5, 1.75, 4.2, 4.7, LIGHT)
rect(s, 8.5, 1.75, 4.2, 0.55, AMBER)
text(s, 8.6, 1.79, 4.0, 0.5, "Think of it when", size=18, color=WHITE, bold=True, anchor=MSO_ANCHOR.MIDDLE, check=False)
text(s, 8.65, 2.5, 3.9, 3.8, [
    "Young onset burning hands and feet",
    "Hypertension with proteinuria or CKD",
    "Family history of renal or cardiac disease",
    "Confirm with alpha-galactosidase A activity and GLA gene testing",
    "Enzyme replacement (agalsidase) is available",
], size=16, bullet=True, space=8)

# ---------- 8. Vasculitis ----------
s = base("Vasculitic neuropathy", "Cause 5: the one not to miss",
         "Goldman-Cecil Medicine (Medium-Vessel Vasculitides); Bradley and Daroff's; Dermatology 5e")
text(s, 0.65, 1.65, 7.4, 5.0, [
    ("Polyarteritis nodosa: ", "more than 80% in some series have vasculitic neuropathy, typically mononeuritis multiplex."),
    ("Hypertension: ", "renal artery involvement causes renovascular hypertension and renal failure."),
    ("Systemic signs: ", "fever, malaise, weight loss and hypertension; neuropathy is often the first manifestation."),
    ("Connective tissue disease: ", "rheumatoid vasculitis is the most common cause of vasculitic neuropathy in that group."),
], size=17, bullet=True, space=10)
rect(s, 8.5, 1.75, 4.2, 4.7, LIGHT)
rect(s, 8.5, 1.75, 4.2, 0.55, RED)
text(s, 8.6, 1.79, 4.0, 0.5, "Red flags and tests", size=18, color=WHITE, bold=True, anchor=MSO_ANCHOR.MIDDLE, check=False)
text(s, 8.65, 2.5, 3.9, 3.8, [
    "Asymmetric, acute or stepwise deficits",
    "Painful foot or wrist drop",
    "Constitutional symptoms, abdominal pain",
    "ESR, CRP, ANCA, ANA, RF, hepatitis B and C",
    "Nerve and muscle biopsy for confirmation",
], size=16, bullet=True, space=8)

# ---------- 9. Other contributors ----------
s = base("Other conditions linking hypertension and neuropathy", "Cause 6: less common contributors",
         "Mulholland and Greenfield's Surgery; Bradley and Daroff's; Fitzpatrick's Dermatology; Adams and Victor's")
rows = [
    ["Condition", "Hypertension link", "Neuropathic feature"],
    ["Acromegaly", "Higher rates of hypertension and diabetes", "Carpal tunnel syndrome"],
    ["Polycythemia vera", "Raised hematocrit; secondary erythromelalgia", "Burning feet, water-triggered itch"],
    ["Erythromelalgia", "Listed with atherosclerosis and hypertension", "Burning pain, redness and warmth of feet"],
    ["Amyloidosis", "Cardiac and renal involvement", "Painful small-fiber and autonomic neuropathy"],
    ["Hypothyroidism", "Diastolic hypertension", "Burning feet, entrapment neuropathy"],
    ["Alcohol and malnutrition", "Alcohol raises BP", "Length-dependent painful neuropathy, B-vitamin deficiency"],
]
table(s, 0.65, 1.7, 12.0, [3.0, 4.4, 4.6], rows, size=15, row_h=0.72)

# ---------- 10. Work-up ----------
s = base("Practical work-up", "Putting it together",
         "Synthesis of cited textbook content; tailor to the individual patient")
rows = [
    ["Step", "What to do"],
    ["1. History", "Drug list with start dates, alcohol, diet, family history, symptom timing and triggers"],
    ["2. Examination", "Pinprick, temperature, vibration, ankle reflexes, pulses, skin color, foot deformity, corneas and skin"],
    ["3. First-line labs", "Glucose, HbA1c, B12, CBC, TSH, creatinine and eGFR, electrolytes, LFTs, urine protein"],
    ["4. If unexplained", "SPEP, ESR and CRP, ANCA, alpha-galactosidase A, skin biopsy for small fibers"],
    ["5. Neurophysiology", "Nerve conduction studies and EMG for large-fiber or asymmetric disease"],
]
table(s, 0.65, 1.7, 12.0, [2.8, 9.2], rows, size=16, row_h=0.82)

# ---------- 11. Management ----------
s = base("Management principles", "What to do next",
         "Synthesis of cited textbook content and standard practice; follow local guidelines")
card(s, 0.65, 1.7, 5.9, 4.95, "Treat the cause", [
    "Optimize glucose control in diabetes",
    "Replace B12, B6 or other deficient vitamins",
    "Review hydralazine and calcium channel blocker use",
    "Manage CKD and secondary hypertension",
    "Refer for vasculitis or Fabry disease",
], TEAL, size=16)
card(s, 6.8, 1.7, 5.9, 4.95, "Control symptoms and BP", [
    "Pain options: duloxetine, pregabalin, gabapentin, amitriptyline, topical capsaicin or lidocaine",
    "Check pain drugs for BP effects and edema",
    "Escalate BP therapy stepwise: thiazide-like diuretic, then spironolactone",
    "Foot care and footwear advice",
], NAVY, size=16)

# ---------- 12. Takeaways ----------
s = base("Key takeaways", "Summary")
items = [
    "Hypertension is usually linked to neuropathy through diabetes, CKD, drugs or a systemic disease.",
    "Bilateral burning feet: check glucose, B12, kidney function and thyroid first.",
    "Review the antihypertensive list: hydralazine (B6) and amlodipine (erythromelalgia-like) can contribute.",
    "Painful neuropathy with hypertension and kidney disease: think Fabry disease.",
    "Asymmetric, stepwise deficits with hypertension: think vasculitis.",
    "Treat the cause, then the symptoms.",
]
y = 1.7
for i, it in enumerate(items):
    rect(s, 0.65, y, 0.55, 0.55, TEAL, shape=MSO_SHAPE.OVAL)
    text(s, 0.65, y, 0.55, 0.55, str(i + 1), size=16, color=WHITE, bold=True, align=PP_ALIGN.CENTER,
         anchor=MSO_ANCHOR.MIDDLE, check=False)
    text(s, 1.4, y - 0.02, 11.2, 0.62, it, size=18, anchor=MSO_ANCHOR.MIDDLE)
    y += 0.8
text(s, 0.65, 6.6, 12, 0.4,
     "Educational summary. Doses and thresholds should follow local guidelines.", size=12, color=GREY, check=False)

out = "/tmp/workspace/htn-neuropathy-ppt/output/Neuropathy_in_Hypertensive_Patients.pptx"
prs.save(out)
print("saved", out)
print("\n".join(warnings) if warnings else "no overflow warnings")