const pptxgen = require("pptxgenjs");

// Fetch images helper
const { execSync } = require("child_process");

function getImages(urls) {
  try {
    const result = execSync(
      `node /home/daytona/skills/shared/scripts/fetch_images.js ${urls.map(u => `"${u}"`).join(" ")}`,
      { timeout: 30000 }
    ).toString();
    return JSON.parse(result);
  } catch (e) {
    return urls.map(() => ({ base64: null, error: e.message }));
  }
}

// Fetch clinical images
const imageUrls = [
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_470e0e562fce5d66e77298905bb7405112ccc7a9c7636f8550c73d48c60e0f48.jpg",
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_cfdd63d3ea83324adb0c3bcfc5500835c9b6c6d65715962f13d8c83bd663edd6.jpg",
  "https://cdn.orris.care/cdss_images/88e38964082c0b6bfc7599b333a9481c3321c64d34da8a744121ad901dbb53ce.png"
];

console.log("Fetching images...");
const imgs = getImages(imageUrls);
console.log("Images fetched:", imgs.map(i => i.error ? "FAILED:" + i.error : "OK"));

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Orris Medical";
pres.title = "Pharyngitis: A Clinical Overview";

// ─── Color palette ────────────────────────────────────────────────────────────
const C = {
  navy:    "0D2137",   // dominant dark bg
  teal:    "1A7B74",   // accent/header bars
  gold:    "F4A225",   // accent highlight
  white:   "FFFFFF",
  offwhite:"EDF2F7",
  lightTeal:"A8D5D1",
  grayText:"B0C4D0",
  darkCard:"12304A",
};

// Helper: add slide with dark background + decorative top bar
function addSlide(opts = {}) {
  let s = pres.addSlide();
  // full background
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy }, line: { color: C.navy } });
  // top teal bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.07, fill: { color: C.teal }, line: { color: C.teal } });
  // bottom accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.555, w: "100%", h: 0.07, fill: { color: C.gold }, line: { color: C.gold } });
  return s;
}

// ─── SLIDE 1: Title ────────────────────────────────────────────────────────────
{
  let s = pres.addSlide();
  // gradient-like layered rectangles
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy }, line: { color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 3.5, h: "100%", fill: { color: C.teal }, line: { color: C.teal } });
  s.addShape(pres.ShapeType.rect, { x: 3.2, y: 0, w: 0.5, h: "100%", fill: { color: C.gold }, line: { color: C.gold } });

  // vertical title text on left bar
  s.addText("PHARYNGITIS", {
    x: 0, y: 1.2, w: 3.5, h: 3,
    fontSize: 40, bold: true, color: C.white,
    fontFace: "Calibri", align: "center", valign: "middle",
    rotate: 0,
  });

  s.addText("A Clinical Overview", {
    x: 3.9, y: 1.5, w: 5.8, h: 0.7,
    fontSize: 28, bold: false, color: C.gold,
    fontFace: "Calibri", align: "left",
  });

  s.addText("Etiology · Diagnosis · Management · Complications", {
    x: 3.9, y: 2.3, w: 5.8, h: 0.5,
    fontSize: 14, color: C.lightTeal,
    fontFace: "Calibri", align: "left",
  });

  s.addShape(pres.ShapeType.rect, { x: 3.9, y: 2.95, w: 5.5, h: 0.04, fill: { color: C.teal }, line: { color: C.teal } });

  s.addText([
    { text: "Sources: ", options: { bold: true } },
    { text: "Goldman-Cecil Medicine · Rosen's Emergency Medicine · Tintinalli's Emergency Medicine · Lee's Essential Otolaryngology" }
  ], {
    x: 3.9, y: 3.2, w: 5.8, h: 0.8,
    fontSize: 10, color: C.grayText,
    fontFace: "Calibri", align: "left",
  });
}

// ─── SLIDE 2: Definition & Overview ──────────────────────────────────────────
{
  let s = addSlide();
  // section pill
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 0.18, w: 2.2, h: 0.38, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.1 });
  s.addText("OVERVIEW", { x: 0.4, y: 0.18, w: 2.2, h: 0.38, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });

  s.addText("What is Pharyngitis?", { x: 0.4, y: 0.72, w: 9.2, h: 0.55, fontSize: 26, bold: true, color: C.white });

  const defBox = { x: 0.4, y: 1.35, w: 9.2, h: 1.05, fill: { color: C.darkCard }, line: { color: C.teal, pt: 1.5 } };
  s.addShape(pres.ShapeType.rect, defBox);
  s.addText(
    "Tonsillopharyngitis (pharyngitis) is a generally benign, self-limited inflammatory syndrome of the oropharynx. Although most cases are mild, severe cases may lead to airway swelling, dehydration, and suppurative complications including peritonsillar abscess, deep space infection, and hematogenous spread.",
    { x: 0.55, y: 1.42, w: 8.9, h: 0.9, fontSize: 13, color: C.offwhite, fontFace: "Calibri" }
  );

  // 3 stat cards
  const cards = [
    { title: "Pediatric cases", val: "50–80%", sub: "viral etiology" },
    { title: "Adult cases", val: "5–15%", sub: "bacterial (GAS)" },
    { title: "Resolution", val: "85%", sub: "within 1 week (viral)" },
  ];
  cards.forEach((c, i) => {
    const x = 0.4 + i * 3.13;
    s.addShape(pres.ShapeType.roundRect, { x, y: 2.6, w: 2.9, h: 1.3, fill: { color: C.darkCard }, line: { color: C.gold, pt: 1 }, rectRadius: 0.12 });
    s.addText(c.val, { x, y: 2.65, w: 2.9, h: 0.7, fontSize: 30, bold: true, color: C.gold, align: "center" });
    s.addText(c.title + "\n" + c.sub, { x, y: 3.3, w: 2.9, h: 0.5, fontSize: 10.5, color: C.lightTeal, align: "center" });
  });

  s.addText("Transmission: direct contact or aerosolized respiratory secretions. Crowding (schools, military facilities) increases risk.", {
    x: 0.4, y: 4.15, w: 9.2, h: 0.5, fontSize: 11.5, color: C.grayText, italic: true
  });
}

// ─── SLIDE 3: Etiology ────────────────────────────────────────────────────────
{
  let s = addSlide();
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 0.18, w: 2.2, h: 0.38, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.1 });
  s.addText("ETIOLOGY", { x: 0.4, y: 0.18, w: 2.2, h: 0.38, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });

  s.addText("Causes of Pharyngitis", { x: 0.4, y: 0.72, w: 9.2, h: 0.55, fontSize: 26, bold: true, color: C.white });

  // Two columns: Viral | Bacterial
  // Viral column header
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.38, w: 4.55, h: 0.38, fill: { color: C.teal }, line: { color: C.teal } });
  s.addText("🦠  VIRAL (most common)", { x: 0.4, y: 1.38, w: 4.55, h: 0.38, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });

  const viralItems = [
    "Rhinovirus, Coronavirus (30–60% of cases)",
    "Adenovirus — pharyngoconjunctival fever",
    "Epstein-Barr Virus — infectious mononucleosis",
    "Enterovirus (Coxsackievirus) — herpangina",
    "Herpes simplex virus 1 & 2",
    "Influenza A & B, Parainfluenza",
    "CMV, HIV (acute retroviral syndrome)",
  ];
  s.addText(viralItems.map(t => ({ text: t, options: { bullet: { indent: 15 }, breakLine: true, color: C.offwhite } })),
    { x: 0.4, y: 1.82, w: 4.55, h: 3.3, fontSize: 11.5, fontFace: "Calibri", color: C.offwhite });

  // Bacterial column header
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.38, w: 4.55, h: 0.38, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText("🔬  BACTERIAL", { x: 5.1, y: 1.38, w: 4.55, h: 0.38, fontSize: 12, bold: true, color: C.navy, align: "center", valign: "middle" });

  const bacterialItems = [
    "Group A β-hemolytic Strep (GAS/GABHS) — most common bacterial cause",
    "Non-group A Strep (B, C, G)",
    "Fusobacterium — Lemierre syndrome",
    "Mixed anaerobes — Vincent angina",
    "Corynebacterium diphtheriae — diphtheria",
    "Neisseria gonorrhoeae",
    "Mycoplasma pneumoniae, Chlamydia pneumoniae",
    "Arcanobacterium haemolyticum — scarlatiniform rash",
  ];
  s.addText(bacterialItems.map(t => ({ text: t, options: { bullet: { indent: 15 }, breakLine: true, color: C.offwhite } })),
    { x: 5.1, y: 1.82, w: 4.55, h: 3.3, fontSize: 11, fontFace: "Calibri", color: C.offwhite });

  s.addText("Fungal: Candida spp. (immunocompromised patients)", {
    x: 0.4, y: 5.05, w: 9.2, h: 0.38, fontSize: 11, color: C.gold, italic: true
  });
}

// ─── SLIDE 4: Clinical Features ───────────────────────────────────────────────
{
  let s = addSlide();
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 0.18, w: 2.8, h: 0.38, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.1 });
  s.addText("CLINICAL FEATURES", { x: 0.4, y: 0.18, w: 2.8, h: 0.38, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });

  s.addText("Signs & Symptoms", { x: 0.4, y: 0.72, w: 9.2, h: 0.55, fontSize: 26, bold: true, color: C.white });

  // Left: symptoms
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.38, w: 4.3, h: 0.38, fill: { color: C.teal }, line: { color: C.teal } });
  s.addText("SYMPTOMS", { x: 0.4, y: 1.38, w: 4.3, h: 0.38, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });
  const symptoms = [
    "Sore throat & odynophagia", "Fever", "Headache",
    "Abdominal pain, nausea, vomiting", "Myalgias & arthralgias",
    "Malaise & lethargy", "Cough, hoarseness, coryza (suggest viral)"
  ];
  s.addText(symptoms.map(t => ({ text: t, options: { bullet: true, breakLine: true } })),
    { x: 0.4, y: 1.82, w: 4.3, h: 2.3, fontSize: 12, color: C.offwhite });

  // Right: exam findings
  s.addShape(pres.ShapeType.rect, { x: 4.9, y: 1.38, w: 4.7, h: 0.38, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText("EXAM FINDINGS", { x: 4.9, y: 1.38, w: 4.7, h: 0.38, fontSize: 12, bold: true, color: C.navy, align: "center", valign: "middle" });
  const examFindings = [
    "Tonsillopharyngeal erythema ± exudates",
    "Soft palate petechiae",
    "Uvulitis / uvular edema",
    "Anterior cervical lymphadenitis",
    "Tonsillar hypertrophy",
    "Scarlatiniform rash (Arcanobacterium)",
    "Discrete ulcerative lesions (enterovirus)",
    "Conjunctivitis (adenovirus)"
  ];
  s.addText(examFindings.map(t => ({ text: t, options: { bullet: true, breakLine: true } })),
    { x: 4.9, y: 1.82, w: 4.7, h: 2.3, fontSize: 12, color: C.offwhite });

  // Warning box
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 4.22, w: 9.2, h: 0.55, fill: { color: "2E1A00" }, line: { color: C.gold, pt: 1.5 }, rectRadius: 0.08 });
  s.addText("⚠  Tonsillar exudate does NOT imply bacterial etiology — it is often difficult to distinguish viral from bacterial pharyngitis on physical exam alone.", {
    x: 0.55, y: 4.22, w: 9.0, h: 0.55, fontSize: 11.5, color: C.gold, valign: "middle"
  });
}

// ─── SLIDE 5: Clinical Image ──────────────────────────────────────────────────
{
  let s = addSlide();
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 0.18, w: 2.6, h: 0.38, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.1 });
  s.addText("CLINICAL PHOTOS", { x: 0.4, y: 0.18, w: 2.6, h: 0.38, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });

  s.addText("Pharyngitis — Oropharyngeal Findings", { x: 0.4, y: 0.72, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: C.white });

  if (imgs[0] && imgs[0].base64) {
    s.addImage({ data: imgs[0].base64, x: 0.4, y: 1.38, w: 5.5, h: 3.8 });
  }
  if (imgs[2] && imgs[2].base64) {
    s.addImage({ data: imgs[2].base64, x: 6.1, y: 1.38, w: 3.5, h: 2.5 });
  }

  s.addText("Comparison of healthy (left) vs. streptococcal pharyngitis (right): erythema, tonsillar hypertrophy, exudates, petechiae on soft palate.", {
    x: 0.4, y: 5.1, w: 9.2, h: 0.42, fontSize: 11, color: C.lightTeal, italic: true
  });
}

// ─── SLIDE 6: Centor / McIsaac Score ─────────────────────────────────────────
{
  let s = addSlide();
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 0.18, w: 2.8, h: 0.38, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.1 });
  s.addText("DIAGNOSIS", { x: 0.4, y: 0.18, w: 2.8, h: 0.38, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });

  s.addText("Modified Centor Score (McIsaac)", { x: 0.4, y: 0.72, w: 9.2, h: 0.55, fontSize: 26, bold: true, color: C.white });

  // Table header
  const colW = [5.2, 2.0, 2.0];
  const colX = [0.4, 5.62, 7.62];
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.38, w: 9.2, h: 0.42, fill: { color: C.teal }, line: { color: C.teal } });
  ["Criterion", "Points", "Score → Action"].forEach((h, i) => {
    s.addText(h, { x: colX[i], y: 1.38, w: colW[i], h: 0.42, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });
  });

  const rows = [
    ["Tonsillar exudates present", "+1", "0–1 → No testing, no antibiotics"],
    ["Tender anterior cervical lymphadenopathy", "+1", "2–3 → Rapid antigen test"],
    ["Absence of cough", "+1", "≥4 → Consider empiric antibiotics"],
    ["Fever >38°C (100.4°F)", "+1", ""],
    ["Age 3–14 years", "+1; Age ≥45: −1", ""],
  ];
  rows.forEach((row, i) => {
    const bg = i % 2 === 0 ? C.darkCard : C.navy;
    s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.82 + i * 0.45, w: 9.2, h: 0.45, fill: { color: bg }, line: { color: "1A3A55", pt: 0.5 } });
    row.forEach((cell, j) => {
      s.addText(cell, {
        x: colX[j], y: 1.82 + i * 0.45, w: colW[j], h: 0.45,
        fontSize: 11, color: j === 2 ? C.gold : C.offwhite,
        align: j === 0 ? "left" : "center", valign: "middle", margin: 4
      });
    });
  });

  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 4.2, w: 9.2, h: 0.65, fill: { color: C.darkCard }, line: { color: C.teal, pt: 1 }, rectRadius: 0.08 });
  s.addText("Gold standard: throat swab culture for S. pyogenes. Rapid nucleic acid testing (sensitivity 97.5%, specificity 95%) preferred over antigen test (sensitivity ~85%). In adults, backup culture is generally NOT required due to low risk of rheumatic fever.", {
    x: 0.55, y: 4.22, w: 8.85, h: 0.6, fontSize: 11, color: C.lightTeal, valign: "middle"
  });
}

// ─── SLIDE 7: GAS Pharyngitis Deep Dive ──────────────────────────────────────
{
  let s = addSlide();
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 0.18, w: 2.8, h: 0.38, fill: { color: C.gold }, line: { color: C.gold }, rectRadius: 0.1 });
  s.addText("GAS PHARYNGITIS", { x: 0.4, y: 0.18, w: 2.8, h: 0.38, fontSize: 11, bold: true, color: C.navy, align: "center", valign: "middle" });

  s.addText("Group A Streptococcal Pharyngitis", { x: 0.4, y: 0.72, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: C.white });

  // Left column
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.38, w: 4.5, h: 0.38, fill: { color: C.teal }, line: { color: C.teal } });
  s.addText("CLASSIC PRESENTATION", { x: 0.4, y: 1.38, w: 4.5, h: 0.38, fontSize: 11.5, bold: true, color: C.white, align: "center", valign: "middle" });
  const gasPresentation = [
    "Peak incidence: children aged 5–15 years",
    "Accounts for 20–40% of pediatric pharyngitis",
    "5–15% of adult pharyngitis",
    "Abrupt onset of fever & sore throat",
    "Submandibular adenopathy",
    "Edematous uvula, hypertrophied tonsils",
    "Palatal petechiae, pharyngeal exudate",
    "Cough & hoarseness are RARE (suggest viral)",
  ];
  s.addText(gasPresentation.map(t => ({ text: t, options: { bullet: true, breakLine: true } })),
    { x: 0.4, y: 1.82, w: 4.5, h: 3.25, fontSize: 11, color: C.offwhite });

  // Right column
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.38, w: 4.55, h: 0.38, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText("COMPLICATIONS", { x: 5.1, y: 1.38, w: 4.55, h: 0.38, fontSize: 11.5, bold: true, color: C.navy, align: "center", valign: "middle" });
  const gasComplications = [
    "Suppurative:", "  · Peritonsillar abscess", "  · Retropharyngeal abscess",
    "  · Otitis media", "  · Sinusitis", "  · Bacteremia",
    "Non-suppurative:", "  · Acute Rheumatic Fever",
    "  · Post-streptococcal glomerulonephritis",
    "  · Streptococcal toxic shock syndrome",
    "  · Scarlet fever"
  ];
  s.addText(gasComplications.map(t => ({ text: t, options: { breakLine: true, bold: t.endsWith(":") } })),
    { x: 5.1, y: 1.82, w: 4.55, h: 3.25, fontSize: 11, color: C.offwhite });

  s.addText("Even without treatment, pain, swelling, and fever usually resolve spontaneously in 3–6 days.", {
    x: 0.4, y: 5.1, w: 9.2, h: 0.35, fontSize: 11, color: C.grayText, italic: true
  });
}

// ─── SLIDE 8: EBV / Mononucleosis ─────────────────────────────────────────────
{
  let s = addSlide();
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 0.18, w: 2.8, h: 0.38, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.1 });
  s.addText("VIRAL PHARYNGITIS", { x: 0.4, y: 0.18, w: 2.8, h: 0.38, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });

  s.addText("EBV — Infectious Mononucleosis", { x: 0.4, y: 0.72, w: 9.2, h: 0.55, fontSize: 26, bold: true, color: C.white });

  const ebvPoints = [
    { icon: "📋", title: "Clinical Features", points: ["Malaise, headache, fever as prodrome", "Exudative pharyngitis", "Posterior cervical lymphadenopathy", "Splenomegaly & hepatomegaly", "Atypical lymphocytes on CBC"] },
    { icon: "🧪", title: "Diagnosis", points: ["Monospot (heterophile test) — insensitive in young children (25% at 10–24 months vs 75% at 24–28 months)", "EBV IgM/IgG — sensitive & specific", "Negative monospot does NOT exclude EBV"] },
    { icon: "💊", title: "Treatment", points: ["Largely supportive (IV fluids, analgesia)", "Steroids may reduce tonsillar swelling", "Avoid amoxicillin/ampicillin — causes pruritic maculopapular rash", "Contact sports restriction if splenomegaly"] },
  ];

  ebvPoints.forEach((block, i) => {
    const x = 0.3 + i * 3.2;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.38, w: 3.05, h: 3.9, fill: { color: C.darkCard }, line: { color: C.teal, pt: 1 }, rectRadius: 0.1 });
    s.addText(block.icon + "  " + block.title, { x: x + 0.1, y: 1.44, w: 2.85, h: 0.4, fontSize: 12.5, bold: true, color: C.gold });
    s.addText(block.points.map(p => ({ text: p, options: { bullet: true, breakLine: true } })),
      { x: x + 0.1, y: 1.9, w: 2.85, h: 3.3, fontSize: 10.5, color: C.offwhite });
  });
}

// ─── SLIDE 9: Treatment ───────────────────────────────────────────────────────
{
  let s = addSlide();
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 0.18, w: 2.4, h: 0.38, fill: { color: C.teal }, line: { color: C.teal }, rectRadius: 0.1 });
  s.addText("MANAGEMENT", { x: 0.4, y: 0.18, w: 2.4, h: 0.38, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });

  s.addText("Treatment of Pharyngitis", { x: 0.4, y: 0.72, w: 9.2, h: 0.55, fontSize: 26, bold: true, color: C.white });

  // Viral management
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.38, w: 2.5, h: 0.38, fill: { color: C.teal }, line: { color: C.teal } });
  s.addText("VIRAL", { x: 0.4, y: 1.38, w: 2.5, h: 0.38, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });
  const viralTx = ["Supportive care (analgesics, hydration)", "Antipyretics (paracetamol/ibuprofen)", "Throat lozenges, warm saline gargles", "No antibiotics needed", "Self-limiting — resolves in ~7 days"];
  s.addText(viralTx.map(t => ({ text: t, options: { bullet: true, breakLine: true } })),
    { x: 0.4, y: 1.82, w: 2.5, h: 1.8, fontSize: 11, color: C.offwhite });

  // GAS antibiotics table
  s.addShape(pres.ShapeType.rect, { x: 3.1, y: 1.38, w: 6.5, h: 0.38, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText("BACTERIAL (GAS) — ANTIBIOTICS", { x: 3.1, y: 1.38, w: 6.5, h: 0.38, fontSize: 12, bold: true, color: C.navy, align: "center", valign: "middle" });

  const txRows = [
    ["Drug", "Dose", "Duration", "Notes"],
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// ─── SLIDE 10: Complications & Red Flags ─────────────────────────────────────
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// ─── SLIDE 11: Special Populations & Tonsillectomy ────────────────────────────
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    "Children <3 years: strep testing generally NOT required — low rate of suppurative complications",
    "Immunocompromised: consider Candida esophagitis, CMV, HSV",
    "Sexually active: consider gonococcal pharyngitis",
    "HIV-positive: acute retroviral syndrome — seroconversion illness",
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    "  · >2 weeks school/work missed/year",
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// ─── SLIDE 12: Summary ────────────────────────────────────────────────────────
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    { num: "01", text: "Viruses cause the majority of pharyngitis. Antibiotics should NOT be prescribed based on symptoms and exam alone." },
    { num: "02", text: "Use the Modified Centor Score to guide testing. Scores of 0–1: no testing, no antibiotics. Scores ≥2: rapid antigen test." },
    { num: "03", text: "First-line treatment for GAS pharyngitis: Penicillin VK or IM Benzathine Penicillin G. Penicillin allergy: azithromycin or clindamycin." },
    { num: "04", text: "Antibiotics prevent rheumatic fever but do NOT prevent post-streptococcal glomerulonephritis. A single dose of dexamethasone reduces symptom severity." },
    { num: "05", text: "Neck pain + hoarseness with benign oral exam → think deep space infection or epiglottitis. Order CT. Secure airway early." },
    { num: "06", text: "Amoxicillin/ampicillin in EBV → characteristic pruritic maculopapular rash. Always consider EBV in exudative pharyngitis." },
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// Save
pres.writeFile({ fileName: "/home/daytona/workspace/pharyngitis-pptx/Pharyngitis_Clinical_Overview.pptx" })
  .then(() => console.log("Saved: Pharyngitis_Clinical_Overview.pptx"))
  .catch(e => { console.error("Error:", e); process.exit(1); });