const pptxgen = require('pptxgenjs');

const pptx = new pptxgen();
pptx.layout = 'LAYOUT_WIDE';
pptx.author = 'Dr. Hafiz Naveed Ul Hassan Sajid';
pptx.company = 'University of Health Sciences, Lahore';
pptx.subject = 'MS Urology Synopsis Defense';
pptx.title = 'Evaluation of Holmium YAG Laser vs Cold Knife in OIU';
pptx.lang = 'en-US';
pptx.theme = {
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// Slide 1: Title
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  slide.addText('Evaluation Of Holmium YAG Laser Versus Cold Knife In Optical Internal Urethrotomy', {
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  slide.addText('By Dr. Hafiz Naveed Ul Hassan Sajid\nPost Graduate Resident MS (Urology)', {
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    'University: University of Health Sciences, Lahore, Pakistan',
    'Discipline: M.S Urology',
    'Applicant: Dr. Hafiz Naveed Ul Hassan Sajid',
    'Registration No: 2016-SHMC-0071-UHS',
    'Supervisor: Prof. Dr. Nisar Ahmad',
    'Institution: Sahiwal Teaching Hospital, Sahiwal'
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// Slide 3: Project Summary
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    'Anterior urethral strictures <1.5 cm cause significant morbidity and reduced quality of life',
    'Study compares Holmium:YAG laser vs cold knife optical internal urethrotomy',
    'Sample size: 66 patients (33 per group), quasi-experimental design',
    'Follow-up at 1, 3, 6 and 12 months for efficacy and safety outcomes',
    'Primary outcomes: success rate, Qmax improvement, recurrence',
    'Secondary outcomes: complications, operative time, satisfaction'
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// Slide 4: Introduction
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    'Urethral stricture is narrowing of urethra due to trauma, infection, inflammation or iatrogenic injury',
    'Common treatment options: dilation, OIU and urethroplasty',
    'Cold knife OIU is traditional, simple and widely practiced',
    'Holmium:YAG laser offers precision and potentially less tissue trauma',
    'Comparative effectiveness in short strictures (<1.5 cm) requires local evidence'
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// Slide 5: Literature Review
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    'Both HIU and CIU improve Qmax and symptoms in short-segment strictures',
    'Meta-analyses show lower recurrence and lower bleeding risk with laser in many studies',
    'Some studies report shorter operative time with cold knife for very short strictures',
    'Current evidence is not fully conclusive across settings and populations',
    'Need for institution-specific comparative evidence in our patient population'
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// Slide 6: Recent Reviews (condensed table)
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  addHeader(slide, 'Recent Systematic Reviews and Meta-Analyses (2021-2024)');

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    'Chi et al., 2024: Qmax +2.62 ml/s, Recurrence RR 0.44 (laser favored)',
    'Chen et al., 2024: Qmax +2.13 ml/s, Recurrence RR 0.67 (laser favored)',
    'Faizan et al., 2024: 14 studies, recurrence OR 0.42 (laser favored)',
    'Ali et al., 2023 RCT: both effective, laser lower recurrence and fewer complications',
    'Gamal et al., 2021 RCT (<1.5 cm): laser higher success, cold knife faster'
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// Slide 7: Hypothesis
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// Slide 8: Objectives
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    'Compare efficacy of Holmium:YAG laser vs cold knife OIU in strictures <1.5 cm',
    'Compare treatment success rates between both groups',
    'Compare improvement in urinary flow (Qmax)',
    'Compare recurrence rates at follow-up',
    'Assess comparative perioperative and postoperative safety profile'
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// Slide 9: Operational Definitions I
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    'Urethral stricture: fibrotic narrowing of urethra; study includes anterior strictures <1.5 cm',
    'Cold Knife OIU: endoscopic incision at 12 o clock using Sachse knife',
    'Holmium:YAG OIU: laser incision at 12 o clock under direct vision',
    'Success: no recurrence + satisfactory Qmax without additional intervention'
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    'Recurrence: return of obstructive symptoms and/or imaging/endoscopic evidence requiring treatment',
    'Complications graded with Clavien-Dindo classification',
    'Operative time: from endoscope insertion to catheter placement',
    'Catheterization: 14-18 Fr catheter for standardized 3-7 days',
    'Follow-up: 1, 3, 6, 12 months with Qmax, PVR, IPSS and exam'
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// Slide 11: Materials and Methods
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    'Study design: Comparative quasi experimental study',
    'Setting: Department of Urology, Sahiwal Teaching Hospital',
    'Duration: 15-18 months after approval',
    'Sample size: 66 patients (33 per group), power 80%, confidence 95%',
    'Sampling: non probability consecutive sampling'
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// Slide 12: Inclusion and Exclusion Criteria
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    'Male patients age >18 years',
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    'Single short segment stricture <=1.5 cm',
    'Informed consent provided'
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    'Stricture >1.5 cm',
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// Slide 13: Variables and Grouping
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    'Independent variable: intervention type (HIU vs CIU)',
    'Dependent variables: Qmax, PVR, IPSS, operative time, complications, recurrence',
    'Confounders: age, stricture length/location, etiology, baseline urinary function, comorbidities',
    'Group A: Holmium:YAG laser OIU',
    'Group B: Cold knife OIU',
    'Allocation method: lottery method'
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// Slide 14: Procedure and Follow-up
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    'Pre-op: history, exam, Qmax, IPSS, PVR, RUG/ascending cystourethrogram',
    'Equipment: 20.5 Fr rigid cystoscope in both groups',
    'Laser settings: 365 micron fiber, 1 J, 15 Hz, 15 W',
    'Incision at 12 o clock in both techniques',
    'Post-op catheter: 14-18 Fr for 3-7 days',
    'Follow-up at 1, 3, 6, 12 months; RUG if Qmax <10 mL/s'
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// Slide 15: Data Collection Tools
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    'Uroflowmeter: objective Qmax measurement',
    'Ultrasound bladder scanner: PVR measurement',
    'IPSS questionnaire: symptom and quality of life assessment',
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    'Operative records: time, findings and complications',
    'Clavien-Dindo grading for standardized complication reporting',
    'Structured case report form and SPSS database entry'
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// Slide 16: Statistical Analysis
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    'Software: latest SPSS version',
    'Continuous variables: mean +/- SD or median (IQR)',
    'Categorical variables: frequency and percentage',
    'Independent t-test / Mann-Whitney U test for between-group comparison',
    'Chi-square/Fisher exact test for categorical outcomes',
    'Repeated measures ANOVA/Friedman test for longitudinal outcomes',
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// Slide 17: Outcome Utilization
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    'Define comparative efficacy and safety of HIU vs CIU in strictures <1.5 cm',
    'Support evidence-based local protocol development',
    'If laser superior: potential for lower recurrence and fewer complications',
    'If cold knife comparable: support cost-conscious and efficient OR use',
    'Improve patient quality of life, satisfaction and resource allocation'
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// Slide 18: Ethical Considerations
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    'Formal permission from Institutional Ethical Review Committee',
    'Written informed consent from all participants',
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// Slide 19: Budget and Timeline
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    'Stationery: 700',
    'A4 paper: 1800',
    'Photocopy: 1500',
    'Miscellaneous: 2000',
    'Intervention and assessment tools available at hospital'
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    'Month 1-2: literature review, ethics approval',
    'Month 3-8: recruitment and data collection',
    'Month 9-12: follow-up',
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    'Month 14-15: manuscript drafting and submission'
  ], 7.0, 2.0, 5.5, 4.6, 28);
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// Slide 20: Study Proforma
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    'Section 1: Demographic and baseline data (age, comorbidities, etiology, location)',
    'Section 2: Preoperative variables (Qmax, PVR, IPSS, RUG/MCUG)',
    'Section 3: Intraoperative data (group, operative time, complications, catheter details)',
    'Section 4: Follow-up at 1, 3, 6, 12 months (Qmax, PVR, IPSS, recurrence, redo surgery)',
    'Section 5: Patient-reported outcomes and consent confirmation'
  ], 0.7, 1.0, 12.0, 5.9, 32);
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}

// Slide 21-23: Detailed Study Proforma Form Layout
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addProformaSlide('Study Proforma Appendix I', [
  'Study Title: Evaluation of Holmium YAG Laser versus Cold Knife in OIU (<1.5 cm)',
  'Patient SR No: _____________      Date: _____________',
  '1. Demographic and Baseline Data:',
  'Age: ______ years      Comorbidities: HTN / DM / Heart disease / Other',
  'Etiology: Idiopathic / Trauma / Iatrogenic / Infection / Other',
  'Stricture Location: Bulbar / Penile',
  '2. Preoperative Assessment:',
  'Qmax: ______ mL/s      PVR: ______ mL      IPSS: ______',
  'Imaging Findings (RUG/MCUG): ____________________'
]);

addProformaSlide('Study Proforma Appendix II', [
  '3. Intraoperative Data:',
  'Group Allocation: Holmium:YAG Laser / Cold Knife',
  'Operative Time: ______ minutes',
  'Complications: None / Bleeding / Perforation / Other',
  'Catheter Size: ______ Fr      Catheter Duration: ______ days',
  '4. Follow-up Data (RUG if Qmax <10 mL/s):',
  '1 Month: Qmax ___ PVR ___ IPSS ___ Recurrence Y/N Redo Y/N Complications ___',
  '3 Month: Qmax ___ PVR ___ IPSS ___ Recurrence Y/N Redo Y/N Complications ___',
  '6 Month: Qmax ___ PVR ___ IPSS ___ Recurrence Y/N Redo Y/N Complications ___',
  '12 Month: Qmax ___ PVR ___ IPSS ___ Recurrence Y/N Redo Y/N Complications ___'
]);

addProformaSlide('Study Proforma Appendix III', [
  '5. Patient-Reported Outcomes:',
  'Overall Satisfaction: Very dissatisfied / Dissatisfied / Neutral / Satisfied / Very satisfied',
  'New Symptoms: Urgency / Frequency / Hesitancy / Straining / Incomplete emptying',
  'Additional Symptoms: Pain / Incontinence / Other: ____________________',
  'Consent Confirmation:',
  'I confirm informed consent was obtained before enrollment.',
  'Researcher Name & Signature: ____________________',
  'Patient Name & Signature/Thumb impression: ____________________'
]);

// Slide 24: Informed Consent
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    'Participants receive complete explanation of purpose, procedures, risks and benefits',
    'Confidentiality ensured for all personal and clinical data',
    'English and Urdu informed consent proforma included',
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    'IRB approval from Sahiwal Medical College/Teaching Hospitals required and documented'
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// Slide 25: References
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  addHeader(slide, 'Key References');
  addBullets(slide, [
    'Chi J et al. Int J Surg. 2024;110:4382-4392',
    'Chen C et al. Medicine. 2024;103',
    'Faizan M et al. Lasers Med Sci. 2024;39:209',
    'Ali M et al. World J Urol. 2023;41:1897-1904',
    'Akdemir F et al. J Urol Surg. 2023',
    'Ahmed M et al. Egypt J Hosp Med. 2023',
    'Gamal M et al. J Lasers Med Sci. 2021;12:e35',
    'Jain S et al. Urol Ann. 2014;6:328-333'
  ], 0.7, 1.0, 12.0, 5.9, 28);
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}

// Slide 26: Thank You
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  slide.addText('Dr. Hafiz Naveed Ul Hassan Sajid | MS Urology', {
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