#!/usr/bin/env python3
"""
PMS/PMDD Academic Conference Presentation Builder
Complete 16-slide PPTX with diagrams, flowcharts, and clinical content
"""

import json, subprocess, base64, io
from io import BytesIO
from pptx import Presentation
from pptx.util import Inches, Pt, Emu
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 pptx.dml.color import RGBColor
import urllib.request

# ─── Color Palette ────────────────────────────────────────────────────────────
DEEP_TEAL    = RGBColor(0x00, 0x6D, 0x77)   # primary
LIGHT_TEAL   = RGBColor(0x83, 0xC5, 0xBE)   # accent
CORAL        = RGBColor(0xE2, 0x9D, 0x8A)   # warm accent
PEACH        = RGBColor(0xFF, 0xCB, 0xB4)   # light warm
DARK_NAVY    = RGBColor(0x1A, 0x2E, 0x4A)   # headings
WHITE        = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_GRAY   = RGBColor(0xF5, 0xF5, 0xF5)
MID_GRAY     = RGBColor(0x90, 0x90, 0x90)
GOLD         = RGBColor(0xF4, 0xD0, 0x3F)
PURPLE       = RGBColor(0x7B, 0x2D, 0x8B)
LIGHT_PURPLE = RGBColor(0xD7, 0xBF, 0xE8)

# ─── Image downloader ─────────────────────────────────────────────────────────
def download_image(url):
    try:
        result = json.loads(subprocess.check_output(
            ["python", "/tmp/skills/shared/scripts/fetch_images.py", url],
            timeout=30
        ))
        if result and result[0].get("base64"):
            raw = base64.b64decode(result[0]["base64"].split(",", 1)[1])
            return BytesIO(raw)
    except Exception as e:
        print(f"  Image fetch failed for {url}: {e}")
    return None

# ─── Helper: add text box ─────────────────────────────────────────────────────
def add_text(slide, text, x, y, w, h, size=14, bold=False, color=DARK_NAVY,
             align=PP_ALIGN.LEFT, italic=False, wrap=True, valign=None):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    if valign:
        tf.vertical_anchor = valign
    tf.margin_left = Pt(2)
    tf.margin_right = Pt(2)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = "Calibri"
    return tb

def add_rect(slide, x, y, w, h, fill_color, line_color=None, line_width=None):
    shape = slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE,
                                   Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    if line_color:
        shape.line.color.rgb = line_color
        if line_width:
            shape.line.width = Pt(line_width)
    else:
        shape.line.fill.background()
    return shape

def add_plain_rect(slide, x, y, w, h, fill_color, line_color=None):
    shape = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE,
                                   Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    if line_color:
        shape.line.color.rgb = line_color
    else:
        shape.line.fill.background()
    return shape

def set_slide_bg(slide, color):
    bg = slide.background
    bg.fill.solid()
    bg.fill.fore_color.rgb = color

def add_header_band(slide, title, subtitle=None):
    """Dark teal header band at top of slide"""
    band = add_plain_rect(slide, 0, 0, 13.333, 1.3, DEEP_TEAL)
    add_text(slide, title, 0.3, 0.1, 12.7, 0.7,
             size=24, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle:
        add_text(slide, subtitle, 0.3, 0.75, 12.7, 0.45,
                 size=13, bold=False, color=LIGHT_TEAL, align=PP_ALIGN.LEFT)

def add_slide_number(slide, n, prs):
    add_text(slide, str(n), 12.9, 7.2, 0.4, 0.25,
             size=9, color=MID_GRAY, align=PP_ALIGN.RIGHT)

# ─── Bullet helper ───────────────────────────────────────────────────────────
def add_bullet_box(slide, bullets, x, y, w, h, size=12, color=DARK_NAVY,
                   bullet_color=DEEP_TEAL, title=None, title_color=DEEP_TEAL,
                   bg_color=None, padding=0.15):
    if bg_color:
        add_rect(slide, x, y, w, h, bg_color, line_color=LIGHT_TEAL, line_width=0.5)
    if title:
        add_text(slide, title, x+padding, y+0.05, w-2*padding, 0.35,
                 size=13, bold=True, color=title_color)
        y_start = y + 0.42
    else:
        y_start = y + 0.05
    tb = slide.shapes.add_textbox(Inches(x+padding), Inches(y_start),
                                  Inches(w-2*padding), Inches(h-0.1))
    tf = tb.text_frame
    tf.word_wrap = True
    for i, bullet in enumerate(bullets):
        if i == 0:
            p = tf.paragraphs[0]
        else:
            p = tf.add_paragraph()
        p.space_before = Pt(2)
        run = p.add_run()
        run.text = f"• {bullet}"
        run.font.size = Pt(size)
        run.font.color.rgb = color
        run.font.name = "Calibri"
    return tb

# ─── Initialize Presentation ─────────────────────────────────────────────────
prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]

print("Building PMS/PMDD presentation...")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 1 — TITLE SLIDE
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)

# Full-width teal banner
banner = add_plain_rect(slide, 0, 0, 13.333, 3.8, DEEP_TEAL)
# Decorative coral stripe
stripe = add_plain_rect(slide, 0, 3.8, 13.333, 0.18, CORAL)
# Bottom light strip
bottom = add_plain_rect(slide, 0, 5.8, 13.333, 1.7, LIGHT_GRAY)

# Conference badge
badge = add_rect(slide, 0.4, 0.2, 3.2, 0.55, CORAL, line_color=CORAL)
add_text(slide, "ACADEMIC CONFERENCE PAPER PRESENTATION", 0.4, 0.25, 3.2, 0.45,
         size=8, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

# Main title
add_text(slide, "Premenstrual Syndrome (PMS)", 0.5, 0.95, 12.3, 0.9,
         size=34, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_text(slide, "& Premenstrual Dysphoric Disorder (PMDD)", 0.5, 1.75, 12.3, 0.8,
         size=28, bold=True, color=LIGHT_TEAL, align=PP_ALIGN.CENTER)
add_text(slide, "Advanced Management Strategies and Impact on Women's Health & Quality of Life",
         0.5, 2.55, 12.3, 0.65, size=15, bold=False, color=PEACH, align=PP_ALIGN.CENTER)

# Divider
add_plain_rect(slide, 3.5, 3.4, 6.3, 0.04, GOLD)

# Bottom info
add_text(slide, "Presented at the International Conference on Women's Health | July 2026",
         0.5, 4.05, 12.3, 0.45, size=13, bold=False, color=MID_GRAY, align=PP_ALIGN.CENTER)
add_text(slide, "Evidence-Based Review | DSM-5 Criteria | RCOG & ACOG Guidelines | Cochrane Systematic Reviews",
         0.5, 4.5, 12.3, 0.45, size=11, bold=False, color=MID_GRAY, align=PP_ALIGN.CENTER)

# Key stats at bottom
stats = [
    ("~80%", "Women experience\npremenstrual symptoms"),
    ("20-40%", "Meet PMS diagnostic\ncriteria"),
    ("3-8%", "Qualify for PMDD\ndiagnosis"),
    ("$4,333", "Annual productivity\nloss per woman"),
]
for i, (val, lbl) in enumerate(stats):
    x = 1.0 + i * 2.9
    add_rect(slide, x, 5.15, 2.4, 1.9, LIGHT_GRAY, line_color=LIGHT_TEAL, line_width=0.8)
    add_text(slide, val, x, 5.25, 2.4, 0.7,
             size=26, bold=True, color=DEEP_TEAL, align=PP_ALIGN.CENTER)
    add_text(slide, lbl, x, 5.9, 2.4, 0.9,
             size=10, bold=False, color=DARK_NAVY, align=PP_ALIGN.CENTER)

add_slide_number(slide, 1, prs)
print("  Slide 1 done (Title)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 2 — OVERVIEW / TABLE OF CONTENTS
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Presentation Overview",
                "A structured journey through PMS/PMDD — from pathophysiology to quality of life")

sections = [
    ("01", "Definition & Epidemiology", "Prevalence, burden, and global data"),
    ("02", "Pathophysiology", "Hormonal changes, serotonin, GABA-A, & neurobiological mechanisms"),
    ("03", "Diagnostic Criteria", "DSM-5, ICD-11, and symptom tracking tools"),
    ("04", "Menstrual Cycle Diagram", "Visual timeline of hormonal fluctuations and symptom onset"),
    ("05", "Clinical Features", "Physical, psychological, and behavioral symptoms"),
    ("06", "Diagnostic Flowchart", "Step-by-step diagnostic algorithm"),
    ("07", "Advanced Management", "Evidence-based pharmacological & non-pharmacological treatment"),
    ("08", "Treatment Flowchart", "RCOG/ACOG treatment decision algorithm"),
    ("09", "Impact on Quality of Life", "Work, social, mental & physical health domains"),
    ("10", "Special Populations", "Adolescents, perimenopause, comorbid conditions"),
    ("11", "Latest Evidence", "Cochrane Reviews 2024-2025, digital health interventions"),
    ("12", "Conclusions & Recommendations", "Key takeaways and clinical pearls"),
]

cols = 2
rows = 6
for i, (num, title, desc) in enumerate(sections):
    col = i % cols
    row = i // cols
    x = 0.4 + col * 6.5
    y = 1.45 + row * 0.98
    # background card
    add_rect(slide, x, y, 6.1, 0.88, LIGHT_GRAY, line_color=LIGHT_TEAL, line_width=0.3)
    # number circle
    circ = slide.shapes.add_shape(MSO_SHAPE.OVAL,
                                  Inches(x+0.08), Inches(y+0.12),
                                  Inches(0.58), Inches(0.58))
    circ.fill.solid(); circ.fill.fore_color.rgb = DEEP_TEAL
    circ.line.fill.background()
    add_text(slide, num, x+0.08, y+0.14, 0.58, 0.45,
             size=11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_text(slide, title, x+0.75, y+0.04, 5.25, 0.4,
             size=12, bold=True, color=DARK_NAVY)
    add_text(slide, desc, x+0.75, y+0.43, 5.25, 0.38,
             size=9, bold=False, color=MID_GRAY)

add_slide_number(slide, 2, prs)
print("  Slide 2 done (TOC)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 3 — DEFINITION & EPIDEMIOLOGY
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Definition & Epidemiology", "Understanding the scope of PMS/PMDD globally")

# Left column: Definitions
add_rect(slide, 0.3, 1.5, 6.0, 2.5, RGBColor(0xE8, 0xF6, 0xF5), line_color=DEEP_TEAL, line_width=1)
add_text(slide, "PMS — Definition", 0.5, 1.6, 5.7, 0.4, size=14, bold=True, color=DEEP_TEAL)
add_text(slide, "A collection of more than 100 physical and psychological symptoms recurring during "
         "the luteal phase (days 15-28) of the menstrual cycle, resolving within days of menstruation onset. "
         "Symptoms must cause significant functional impairment.",
         0.5, 2.0, 5.7, 1.85, size=11, color=DARK_NAVY, wrap=True)

add_rect(slide, 0.3, 4.1, 6.0, 2.5, RGBColor(0xF5, 0xEB, 0xF8), line_color=PURPLE, line_width=1)
add_text(slide, "PMDD — Definition (DSM-5 / ICD-11)", 0.5, 4.2, 5.7, 0.4, size=14, bold=True, color=PURPLE)
add_text(slide, "A more severe form occurring in 3-8% of ovulating women. Characterized by marked "
         "affective lability, irritability, depressed mood, and anxiety during the premenstrual week, "
         "with significant impairment in work, academic, or social function. Recently added to ICD-11.",
         0.5, 4.6, 5.7, 1.85, size=11, color=DARK_NAVY, wrap=True)

# Right column: Epidemiology
add_text(slide, "Global Epidemiology", 6.6, 1.5, 6.4, 0.45, size=16, bold=True, color=DARK_NAVY)
epi_data = [
    ("80%", "of women report ≥1 premenstrual symptom", LIGHT_TEAL),
    ("20-40%", "meet clinical PMS diagnostic criteria", CORAL),
    ("3-8%", "qualify for PMDD diagnosis", LIGHT_PURPLE),
    ("~150M", "women worldwide affected by PMDD", RGBColor(0xFD, 0xD8, 0x90)),
    ("$4,333", "annual work productivity loss per woman (US)", RGBColor(0xC8, 0xE6, 0xC9)),
]
for i, (val, desc, col) in enumerate(epi_data):
    y = 2.05 + i * 0.97
    add_rect(slide, 6.5, y, 6.5, 0.85, col, line_color=RGBColor(0xCC,0xCC,0xCC), line_width=0.3)
    add_text(slide, val, 6.6, y+0.05, 1.8, 0.55,
             size=20, bold=True, color=DARK_NAVY, align=PP_ALIGN.CENTER)
    add_text(slide, desc, 8.5, y+0.15, 4.3, 0.55,
             size=11, bold=False, color=DARK_NAVY)

add_slide_number(slide, 3, prs)
print("  Slide 3 done (Definition & Epidemiology)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 4 — PATHOPHYSIOLOGY
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Pathophysiology of PMS/PMDD",
                "Hormonal sensitivity, serotonin dysregulation, and neurobiological mechanisms")

# Central mechanism diagram using shapes
add_text(slide, "Core Pathophysiological Mechanisms", 0.3, 1.45, 12.7, 0.45,
         size=15, bold=True, color=DARK_NAVY, align=PP_ALIGN.CENTER)

mechanisms = [
    (0.3, 2.0, "Ovarian Hormone\nSensitivity",
     "Vulnerable women have abnormal CNS response to normal cyclic changes in estrogen & "
     "progesterone (NOT abnormal hormone levels). Subgroup identified with differential sensitivity.",
     DEEP_TEAL, RGBColor(0xE0,0xF4,0xF4)),
    (4.7, 2.0, "Serotonin\nDysregulation",
     "Reduced central serotonergic activity during luteal phase. SSRIs effective even with "
     "intermittent luteal dosing — suggests direct allopregnanolone modulation of GABA-A receptor.",
     PURPLE, RGBColor(0xF0,0xE8,0xF8)),
    (9.1, 2.0, "GABA-A Receptor\nModulation",
     "Allopregnanolone (progesterone metabolite) modulates GABA-A receptors. Abnormal sensitivity "
     "to this neurosteroid underlies mood symptoms in the luteal phase.",
     CORAL, RGBColor(0xFD,0xF0,0xEB)),
    (0.3, 4.5, "HPA Axis\n& Stress",
     "Dysregulated cortisol response and heightened stress reactivity during luteal phase. "
     "Sleep disruption amplifies symptom severity.",
     RGBColor(0x1A,0x7A,0x4A), RGBColor(0xE8,0xF8,0xEE)),
    (4.7, 4.5, "Biological\nRhythms",
     "Disrupted circadian rhythms and altered sleep architecture in luteal phase. "
     "Melatonin dysregulation may contribute (2024 systematic review).",
     RGBColor(0x7A,0x5C,0x1E), RGBColor(0xFD,0xF5,0xE0)),
    (9.1, 4.5, "Genetic\nFactors",
     "Heritability ~50%. ESR1 and SLC6A4 (serotonin transporter) gene variants associated. "
     "GABRA4 variants linked to PMDD susceptibility.",
     RGBColor(0x5C,0x3A,0x7A), RGBColor(0xF4,0xEE,0xFA)),
]

for x, y, title, body, title_col, bg_col in mechanisms:
    add_rect(slide, x, y, 4.1, 2.1, bg_col, line_color=title_col, line_width=1.2)
    add_text(slide, title, x+0.1, y+0.08, 3.9, 0.55,
             size=13, bold=True, color=title_col)
    add_text(slide, body, x+0.1, y+0.62, 3.9, 1.4,
             size=9.5, color=DARK_NAVY, wrap=True)

add_slide_number(slide, 4, prs)
print("  Slide 4 done (Pathophysiology)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 5 — MENSTRUAL CYCLE DIAGRAM (generated image)
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Menstrual Cycle & PMS Symptom Timeline",
                "Hormonal fluctuations and the premenstrual symptom window across a 28-day cycle")

img_url = "https://cdn.orris.care/image-gen/a843674fbb0c4fe68837f68952cc5ec8.png"
img_data = download_image(img_url)
if img_data:
    slide.shapes.add_picture(img_data, Inches(0.4), Inches(1.4), width=Inches(12.5))
    add_text(slide, "Figure 1: Menstrual cycle phases showing estrogen and progesterone fluctuations "
             "with PMS symptom onset in the late luteal phase (days 21-28).",
             0.4, 7.05, 12.5, 0.38, size=9, italic=True, color=MID_GRAY, align=PP_ALIGN.CENTER)
else:
    # Fallback: draw a text-based timeline
    add_text(slide, "[Menstrual Cycle Timeline Diagram]", 0.4, 3.0, 12.5, 1.0,
             size=16, color=MID_GRAY, align=PP_ALIGN.CENTER)

add_slide_number(slide, 5, prs)
print("  Slide 5 done (Cycle diagram)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 6 — DSM-5 DIAGNOSTIC CRITERIA
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Diagnostic Criteria — PMDD (DSM-5)",
                "Five or more symptoms in the majority of menstrual cycles, corroborated by 2 months of prospective ratings")

# Core criteria box
add_rect(slide, 0.3, 1.45, 7.8, 5.6, RGBColor(0xE8,0xF6,0xF5), line_color=DEEP_TEAL, line_width=1.5)
add_text(slide, "DSM-5 Criteria for PMDD (F32.81)", 0.5, 1.55, 7.5, 0.45,
         size=14, bold=True, color=DEEP_TEAL)

# Must have ≥1 core symptom
add_text(slide, "CORE SYMPTOMS — At least ONE required:", 0.5, 2.05, 7.5, 0.38,
         size=12, bold=True, color=DARK_NAVY)
core = ["Marked affective lability (sudden tearfulness, mood swings)",
        "Marked irritability, anger, or interpersonal conflict",
        "Marked depressed mood, hopelessness, self-deprecating thoughts",
        "Marked anxiety or tension, feeling on edge"]
for i, s in enumerate(core):
    y = 2.48 + i * 0.42
    circ2 = slide.shapes.add_shape(MSO_SHAPE.OVAL,
                                   Inches(0.5), Inches(y+0.05), Inches(0.28), Inches(0.28))
    circ2.fill.solid(); circ2.fill.fore_color.rgb = DEEP_TEAL
    circ2.line.fill.background()
    add_text(slide, s, 0.88, y, 7.1, 0.38, size=11, color=DARK_NAVY)

# Additional symptoms
add_text(slide, "ADDITIONAL SYMPTOMS — to reach 5 total:", 0.5, 4.22, 7.5, 0.38,
         size=12, bold=True, color=DARK_NAVY)
add_items = [
    "Decreased interest in usual activities",
    "Subjective difficulty concentrating",
    "Lethargy, easy fatigability",
    "Marked appetite change or food cravings",
    "Hypersomnia or insomnia",
    "Sense of being overwhelmed or out of control",
    "Physical: bloating, breast tenderness, joint/muscle pain",
]
for i, s in enumerate(add_items):
    col = i % 2
    row = i // 2
    x = 0.55 + col * 3.75
    y = 4.65 + row * 0.38
    add_text(slide, f"• {s}", x, y, 3.6, 0.35, size=10, color=DARK_NAVY)

# Right column: requirements
add_rect(slide, 8.4, 1.45, 4.7, 2.8, RGBColor(0xFD,0xF0,0xEB), line_color=CORAL, line_width=1.5)
add_text(slide, "Diagnostic Requirements", 8.6, 1.55, 4.4, 0.4, size=13, bold=True, color=CORAL)
req = ["Symptoms in MAJORITY of cycles",
       "Improve within days of menses onset",
       "Minimal/absent in postmenstrual week",
       "Cause significant functional impairment",
       "Not exacerbation of another disorder",
       "Confirmed by ≥2 months prospective daily ratings"]
for i, r in enumerate(req):
    add_text(slide, f"✓  {r}", 8.6, 2.05+i*0.38, 4.4, 0.36, size=10.5, color=DARK_NAVY)

# Screening note
add_rect(slide, 8.4, 4.35, 4.7, 2.65, RGBColor(0xE8,0xF4,0xE8), line_color=RGBColor(0x2E,0x7D,0x32), line_width=1)
add_text(slide, "Clinical Screening Essentials", 8.6, 4.45, 4.4, 0.4,
         size=13, bold=True, color=RGBColor(0x1B,0x5E,0x20))
screen = ["Screen for domestic abuse",
          "Assess life stressors & social factors",
          "Keep symptom records SEPARATE from menstrual records",
          "Rule out thyroid disorder, anemia, perimenopause",
          "Use validated tools: DRSP or PRISM calendar"]
for i, s in enumerate(screen):
    add_text(slide, f"• {s}", 8.6, 4.9+i*0.38, 4.4, 0.36, size=10, color=DARK_NAVY)

add_slide_number(slide, 6, prs)
print("  Slide 6 done (DSM-5 Criteria)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 7 — DIAGNOSTIC FLOWCHART
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Diagnostic Algorithm for PMS/PMDD",
                "Stepwise clinical approach using prospective symptom tracking")

from pptx.util import Pt as Ptt
from lxml import etree

def add_flow_box(slide, text, x, y, w, h, fill, txt_color=WHITE, size=11, bold=True, shape_type=None):
    st = shape_type or MSO_SHAPE.ROUNDED_RECTANGLE
    shape = slide.shapes.add_shape(st, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill
    shape.line.color.rgb = RGBColor(0xFF,0xFF,0xFF)
    shape.line.width = Pt(0.5)
    tf = shape.text_frame
    tf.word_wrap = True
    tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    p = tf.paragraphs[0]
    p.alignment = PP_ALIGN.CENTER
    run = p.add_run()
    run.text = text
    run.font.size = Pt(size)
    run.font.bold = bold
    run.font.color.rgb = txt_color
    run.font.name = "Calibri"
    return shape

def add_arrow(slide, x1, y1, x2, y2):
    from pptx.util import Emu
    line = slide.shapes.add_connector(1, Inches(x1), Inches(y1), Inches(x2), Inches(y2))
    line.line.color.rgb = DEEP_TEAL
    line.line.width = Pt(1.5)

# Flow boxes
add_flow_box(slide, "Patient presents with\ncyclical mood & physical symptoms",
             4.2, 1.45, 5.0, 0.75, DEEP_TEAL, size=12)
add_arrow(slide, 6.7, 2.2, 6.7, 2.55)

add_flow_box(slide, "Step 1: Symptom History\nAre symptoms in luteal phase only?",
             3.8, 2.55, 5.8, 0.8, RGBColor(0x00,0x8B,0x8B), size=11)
add_arrow(slide, 6.7, 3.35, 6.7, 3.65)

# Decision diamond
add_flow_box(slide, "≥5 symptoms?\nIncludes ≥1 core affective symptom?",
             4.0, 3.65, 5.4, 0.85, CORAL, txt_color=WHITE, size=11,
             shape_type=MSO_SHAPE.DIAMOND)

# YES path
add_arrow(slide, 6.7, 4.5, 6.7, 4.8)
add_flow_box(slide, "Step 2: Prospective Daily Rating\n(DRSP or PRISM — minimum 2 cycles)",
             3.8, 4.8, 5.8, 0.75, DEEP_TEAL, size=11)
add_arrow(slide, 6.7, 5.55, 6.7, 5.8)

# Confirm
add_flow_box(slide, "Symptoms confirmed in luteal phase?\nMinimal/absent post-menstrually?",
             4.0, 5.8, 5.4, 0.8, CORAL, txt_color=WHITE, size=11,
             shape_type=MSO_SHAPE.DIAMOND)

# YES to PMDD
add_flow_box(slide, "PMDD Diagnosis Confirmed\nInitiate treatment algorithm",
             8.5, 5.9, 4.5, 0.7, RGBColor(0x1A,0x7A,0x4A), size=11)
add_text(slide, "YES →", 7.5, 6.05, 1.0, 0.4, size=11, bold=True, color=RGBColor(0x1A,0x7A,0x4A))

# NO paths
add_flow_box(slide, "PMS (mild-moderate)\nLifestyle + symptom tracking",
             0.3, 5.9, 3.2, 0.7, LIGHT_TEAL, txt_color=DARK_NAVY, size=10)
add_text(slide, "← NO", 3.7, 6.05, 1.0, 0.4, size=11, bold=True, color=MID_GRAY)

# Exclude other diagnoses note
add_flow_box(slide, "NO → Rule out: MDD, GAD, thyroid disorder,\nperimenopause, premenstrual exacerbation of another condition",
             0.3, 3.7, 3.3, 1.0, RGBColor(0xFD,0xF5,0xE0),
             txt_color=DARK_NAVY, size=9, bold=False)
add_text(slide, "← NO", 3.7, 4.0, 0.7, 0.4, size=11, bold=True, color=MID_GRAY)

add_slide_number(slide, 7, prs)
print("  Slide 7 done (Diagnostic flowchart)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 8 — ADVANCED MANAGEMENT OVERVIEW
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Advanced Management of PMS/PMDD",
                "Evidence-based stepwise approach — RCOG Green-top Guideline & ACOG Practice Bulletin")

# Two-column layout
# Non-pharmacological
add_rect(slide, 0.3, 1.45, 6.1, 5.65, RGBColor(0xE8,0xF6,0xF5), line_color=DEEP_TEAL, line_width=1.5)
add_text(slide, "NON-PHARMACOLOGICAL", 0.5, 1.55, 5.8, 0.42, size=14, bold=True, color=DEEP_TEAL)

np_items = [
    ("Lifestyle Modifications", [
        "Regular aerobic exercise (reduces mood & physical symptoms)",
        "Caffeine elimination; smoking cessation",
        "Regular meals with complex carbohydrates",
        "Adequate sleep (7-9 hours); consistent sleep schedule",
        "Stress reduction: meditation, yoga, mindfulness"
    ]),
    ("Nutritional Supplements", [
        "Calcium 600 mg twice daily — RCT-proven efficacy",
        "Vitamin B6 (pyridoxine) 50-100 mg daily",
        "Magnesium — reduces fluid retention, bloating",
        "Chasteberry (Vitex agnus-castus) — modest evidence"
    ]),
    ("Psychological Therapies", [
        "Cognitive Behavioral Therapy (CBT) — Tier 1 evidence",
        "Symptom diary & psychoeducation",
        "Stress management counselling"
    ]),
]

y_offset = 2.05
for category, items in np_items:
    add_text(slide, category, 0.5, y_offset, 5.7, 0.35, size=12, bold=True, color=DARK_NAVY)
    y_offset += 0.38
    for item in items:
        add_text(slide, f"• {item}", 0.6, y_offset, 5.6, 0.33, size=9.5, color=DARK_NAVY)
        y_offset += 0.33
    y_offset += 0.1

# Pharmacological
add_rect(slide, 6.7, 1.45, 6.4, 5.65, RGBColor(0xF5,0xEB,0xF8), line_color=PURPLE, line_width=1.5)
add_text(slide, "PHARMACOLOGICAL", 6.9, 1.55, 6.1, 0.42, size=14, bold=True, color=PURPLE)

ph_items = [
    ("First-Line (Non-Hormonal)", [
        "SSRIs — FIRST-LINE (RCOG & ACOG endorsed)",
        "  Fluoxetine 20 mg/day (FDA approved)",
        "  Sertraline 50-150 mg/day (FDA approved)",
        "  Paroxetine CR 12.5-25 mg/day (FDA approved)",
        "  Citalopram 5-20 mg/day",
        "Continuous OR intermittent luteal-phase dosing",
        "CBT + SSRI combination superior to either alone"
    ]),
    ("First-Line (Hormonal)", [
        "COCP — especially drospirenone/EE (Yaz)",
        "  Cyclical or continuous (back-to-back) use",
        "  Improves overall PMS; less effect on depression"
    ]),
    ("Second-Line", [
        "Transdermal estradiol + progestogen protection",
        "  Preferred in women needing contraception",
        "  Bioidentical progesterone preferred"
    ]),
    ("Third-Line", [
        "GnRH analogues (leuprolide 3.75-7.5 mg IM/month)",
        "  Induces medical menopause — diagnostic & therapeutic",
        "  MUST add 'addback' HRT to prevent bone loss",
        "Danazol 200-400 mg/day (significant side effects)",
        "Surgical: hysterectomy + oophorectomy (last resort)"
    ]),
    ("Adjunct Options", [
        "Alprazolam 0.25 mg BID (luteal phase only)",
        "Spironolactone — bloating, fluid retention",
        "Bromocriptine — mastalgia"
    ]),
]

y_offset = 2.05
for category, items in ph_items:
    add_text(slide, category, 6.9, y_offset, 6.1, 0.35, size=11.5, bold=True, color=DARK_NAVY)
    y_offset += 0.35
    for item in items:
        add_text(slide, f"{'  ' if item.startswith('  ') else '• '}{item.strip()}", 
                 7.0, y_offset, 5.95, 0.3, size=9, color=DARK_NAVY)
        y_offset += 0.3
    y_offset += 0.08

add_slide_number(slide, 8, prs)
print("  Slide 8 done (Management)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 9 — TREATMENT FLOWCHART (textbook image)
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Treatment Decision Flowchart — PMDD/Severe PMS",
                "Pharmacological management algorithm (Maudsley Prescribing Guidelines, 15th Ed. / RCOG Green-top Guideline)")

flowchart_url = "https://cdn.orris.care/cdss_images/79426cf81bd351e7ac4fdd0e20724dfdb565deb1253e08a987530a276c556871.png"
fc_data = download_image(flowchart_url)
if fc_data:
    slide.shapes.add_picture(fc_data, Inches(1.2), Inches(1.4), width=Inches(11.0))
else:
    add_text(slide, "[Treatment Flowchart Image]", 1.2, 3.0, 11.0, 1.0,
             size=14, color=MID_GRAY, align=PP_ALIGN.CENTER)

add_text(slide, "Figure 2: Pharmacological management decision tree for PMDD/severe PMS. "
         "Source: The Maudsley Prescribing Guidelines in Psychiatry, 15th Edition, Figure 3.6.",
         0.4, 7.1, 12.5, 0.35, size=9, italic=True, color=MID_GRAY, align=PP_ALIGN.CENTER)

add_slide_number(slide, 9, prs)
print("  Slide 9 done (Treatment flowchart)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 10 — QoL IMPACT (generated image + data)
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Impact on Women's Health & Quality of Life",
                "Multidimensional burden across occupational, social, mental, and physical health domains")

qol_url = "https://cdn.orris.care/image-gen/e09f2b20350648d2ad8c8aeaf082552f.png"
qol_data = download_image(qol_url)
if qol_data:
    slide.shapes.add_picture(qol_data, Inches(0.3), Inches(1.4), width=Inches(7.0))

# Right side: data cards
add_text(slide, "Evidence-Based QoL Impact Data", 7.6, 1.45, 5.5, 0.42,
         size=14, bold=True, color=DARK_NAVY)

qol_cards = [
    ("Work & Productivity", "55-75% report reduced work performance during PMS/PMDD episodes. "
     "Estimated annual loss of $4,333/woman in the US (Freeman 2003).", DEEP_TEAL),
    ("Mental Health", "PMDD carries a lifetime risk of suicidal ideation in up to 15% of sufferers. "
     "Risk of co-existing major depression 2-3x higher.", PURPLE),
    ("Social Relationships", "67% report significant interpersonal conflict. Increased divorce/separation rates "
     "in untreated PMDD. Social withdrawal common.", CORAL),
    ("Academic Performance", "Female students with PMDD report 40% reduction in academic productivity "
     "during symptomatic days. Poor concentration is a DSM-5 criterion.", RGBColor(0x1A,0x7A,0x4A)),
    ("Physical Health", "Sleep disruption (insomnia/hypersomnia), fatigue, and chronic pain impact "
     "daily functioning. Comorbid IBS, migraine, and fibromyalgia are common.", RGBColor(0xC0,0x6E,0x20)),
]

for i, (title, body, col) in enumerate(qol_cards):
    y = 2.0 + i * 1.02
    add_rect(slide, 7.5, y, 5.6, 0.92, RGBColor(0xF8,0xF8,0xF8),
             line_color=col, line_width=1.5)
    # color accent bar on left
    add_plain_rect(slide, 7.5, y, 0.18, 0.92, col)
    add_text(slide, title, 7.78, y+0.05, 5.2, 0.35, size=12, bold=True, color=col)
    add_text(slide, body, 7.78, y+0.42, 5.2, 0.45, size=9, color=DARK_NAVY, wrap=True)

add_text(slide, "Figure 3: Multi-domain QoL impact of PMS/PMDD in reproductive-age women.",
         0.3, 7.1, 7.0, 0.35, size=9, italic=True, color=MID_GRAY, align=PP_ALIGN.CENTER)

add_slide_number(slide, 10, prs)
print("  Slide 10 done (QoL Impact)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 11 — SPECIAL POPULATIONS
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Special Populations & Comorbidities",
                "Tailored management considerations for adolescents, perimenopause, and women with comorbid conditions")

populations = [
    ("Adolescents", DEEP_TEAL, [
        "PMS prevalence 14-88% in adolescent females (wide range due to criteria variation)",
        "Non-pharmacological first: CBT, lifestyle, psychoeducation",
        "SSRIs safe in adolescents; start at low doses",
        "COCPs: consider impact on bone mineral density in <18",
        "Screen carefully for eating disorders & self-harm"
    ]),
    ("Perimenopause", PURPLE, [
        "PMS symptoms worsen and may merge with menopausal symptoms",
        "Distinguish PMDD from perimenopausal mood disorder",
        "GnRH agonists + addback therapy highly effective",
        "SSRIs beneficial for both PMS and vasomotor symptoms",
        "Surgical menopause (TAH-BSO) curative — consider only after medical failure"
    ]),
    ("Comorbid Psychiatric Conditions", CORAL, [
        "MDD: Treat premenstrual exacerbation vs. true PMDD",
        "Bipolar disorder: Luteal phase destabilization — AVOID SSRIs alone",
        "Anxiety disorders: SSRIs and CBT beneficial for both conditions",
        "ADHD: Stimulants may need dose adjustments across cycle",
        "Women on psychotropics: monitor menstrual irregularities (dopamine effects)"
    ]),
    ("Women Desiring Contraception", RGBColor(0x1A,0x7A,0x4A), [
        "COCP (especially Yaz — drospirenone/EE 3 mg/20 mcg) — dual benefit",
        "Continuous COCP use preferred for symptom suppression",
        "Levonorgestrel IUD may worsen mood in some women",
        "Progestogen-only pill: may worsen PMS symptoms in sensitive women",
        "Always discuss contraceptive needs alongside PMS management"
    ]),
]

for i, (title, col, items) in enumerate(populations):
    c = i % 2
    r = i // 2
    x = 0.3 + c * 6.6
    y = 1.5 + r * 2.85
    add_rect(slide, x, y, 6.3, 2.7, RGBColor(0xF8,0xF8,0xF8), line_color=col, line_width=1.5)
    add_plain_rect(slide, x, y, 6.3, 0.42, col)
    add_text(slide, title, x+0.15, y+0.05, 6.0, 0.32, size=13, bold=True, color=WHITE)
    for j, item in enumerate(items):
        add_text(slide, f"• {item}", x+0.2, y+0.52+j*0.42, 6.0, 0.4,
                 size=9.5, color=DARK_NAVY, wrap=True)

add_slide_number(slide, 11, prs)
print("  Slide 11 done (Special Populations)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 12 — LATEST EVIDENCE (2024-2025)
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Latest Evidence (2024-2025)",
                "Cochrane Reviews, systematic reviews, and emerging digital health interventions")

studies = [
    {
        "year": "2024",
        "type": "Cochrane Review",
        "title": "SSRIs for PMS/PMDD",
        "pmid": "PMID: 39140320",
        "finding": "SSRIs significantly reduce PMS/PMDD symptoms vs placebo. "
                   "Continuous and intermittent (luteal) dosing both effective. "
                   "Cochrane Database Syst Rev, 2024.",
        "color": DEEP_TEAL
    },
    {
        "year": "2025",
        "type": "Cochrane Review",
        "title": "GnRH Analogues for PMS",
        "pmid": "PMID: 40492482",
        "finding": "GnRH analogues superior to placebo for severe PMS/PMDD. "
                   "Must use addback therapy to mitigate hypo-oestrogenic side effects. "
                   "Cochrane Database Syst Rev, June 2025.",
        "color": PURPLE
    },
    {
        "year": "2024",
        "type": "Systematic Review",
        "title": "Biological Rhythms in PMDD",
        "pmid": "PMID: 39375682",
        "finding": "Circadian rhythm disruption identified as key mechanism. "
                   "Melatonin dysregulation and sleep architecture changes may offer new "
                   "therapeutic targets. BMC Women's Health, Oct 2024.",
        "color": CORAL
    },
    {
        "year": "2025",
        "type": "Systematic Review",
        "title": "Nutritional Interventions",
        "pmid": "PMID: 38684926",
        "finding": "Dietary interventions (magnesium, calcium, tryptophan-rich foods) show "
                   "modest improvement in psychological PMS symptoms. "
                   "Nutr Rev, Feb 2025.",
        "color": RGBColor(0x1A,0x7A,0x4A)
    },
    {
        "year": "2025",
        "type": "Systematic Review",
        "title": "Digital Health for Menstrual Symptoms",
        "pmid": "PMID: 40639860",
        "finding": "Mobile apps and digital interventions show promise for symptom tracking "
                   "and management. Evidence still limited — high-quality RCTs needed. "
                   "Women's Health Nursing, Jun 2025.",
        "color": RGBColor(0x7A,0x5C,0x1E)
    },
    {
        "year": "2021",
        "type": "Systematic Review",
        "title": "CBT for PMS",
        "pmid": "PMID: 32845159",
        "finding": "CBT identified as a primary mode for PMS management. "
                   "Significant improvement in mood, anxiety, and quality of life. "
                   "Should be offered alongside or before pharmacotherapy. Psychol Health Med.",
        "color": RGBColor(0xC0,0x6E,0x20)
    },
]

for i, study in enumerate(studies):
    c = i % 2
    r = i // 2
    x = 0.3 + c * 6.6
    y = 1.5 + r * 1.95
    col = study["color"]
    add_rect(slide, x, y, 6.3, 1.8, RGBColor(0xF8,0xF8,0xF8), line_color=col, line_width=1.2)
    # Year badge
    badge2 = add_plain_rect(slide, x+0.1, y+0.1, 0.72, 0.35, col)
    add_text(slide, study["year"], x+0.1, y+0.1, 0.72, 0.35, size=10, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    # Type badge
    add_rect(slide, x+0.9, y+0.1, 1.6, 0.35, RGBColor(0xEE,0xEE,0xEE), line_color=col)
    add_text(slide, study["type"], x+0.9, y+0.1, 1.6, 0.35, size=8.5, bold=True, color=col, align=PP_ALIGN.CENTER)
    # Title
    add_text(slide, study["title"], x+0.1, y+0.5, 6.0, 0.35, size=12, bold=True, color=DARK_NAVY)
    # PMID
    add_text(slide, study["pmid"], x+4.5, y+0.1, 1.7, 0.35, size=8, color=MID_GRAY, align=PP_ALIGN.RIGHT)
    # Finding
    add_text(slide, study["finding"], x+0.1, y+0.88, 6.0, 0.85, size=9.5, color=DARK_NAVY, wrap=True)

add_slide_number(slide, 12, prs)
print("  Slide 12 done (Latest Evidence)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 13 — MANAGEMENT COMPARISON TABLE
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Treatment Comparison — Evidence Levels",
                "Summary of treatment options with evidence grading (RCOG / Oxford CEBM system)")

# Table header
headers = ["Treatment", "Category", "Evidence Level", "Recommended Dose", "Key Notes"]
col_widths = [2.6, 1.6, 1.4, 2.5, 4.8]
x_starts = [0.25]
for cw in col_widths[:-1]:
    x_starts.append(x_starts[-1] + cw)

y_hdr = 1.5
hdr_h = 0.45
for j, (hdr, cw, xs) in enumerate(zip(headers, col_widths, x_starts)):
    add_plain_rect(slide, xs, y_hdr, cw, hdr_h, DEEP_TEAL)
    add_text(slide, hdr, xs+0.05, y_hdr+0.05, cw-0.1, hdr_h-0.1,
             size=11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

rows_data = [
    ["SSRIs (fluoxetine, sertraline, paroxetine)", "Non-hormonal", "Ia (Cochrane 2024)",
     "Continuous or luteal-phase dosing", "FDA approved; first-line RCOG/ACOG. CBT combination superior."],
    ["COCP (drospirenone/EE — Yaz)", "Hormonal", "Ib (RCT evidence)",
     "Daily; cyclical or continuous", "Improves overall PMS; weaker evidence for depressive symptoms."],
    ["Transdermal Estradiol + Progestogen", "Hormonal", "IIa",
     "Patches/gel; add progestogen for uterus", "Second-line; preferred if COCPs contraindicated."],
    ["GnRH Analogues + Addback", "Hormonal (3rd line)", "Ia (Cochrane 2025)",
     "Leuprolide 3.75-7.5 mg IM/month", "Highly effective; addback mandatory. Diagnostic value."],
    ["CBT", "Psychological", "Ia (SR 2021)",
     "6-12 structured sessions", "First-line for mild-moderate; combined with SSRIs for PMDD."],
    ["Calcium supplementation", "Non-pharmacological", "Ib (RCT)",
     "600 mg twice daily", "Well-tolerated; evidence for mood & physical symptoms."],
    ["Lifestyle (exercise, diet, sleep)", "Non-pharmacological", "IIb",
     "Daily aerobic exercise 30 min", "Recommended for all patients regardless of severity."],
    ["Danazol", "Hormonal (3rd line)", "Ib",
     "200-400 mg/day", "Effective but significant androgenic side effects."],
]

row_colors = [LIGHT_GRAY, WHITE, LIGHT_GRAY, WHITE, LIGHT_GRAY, WHITE, LIGHT_GRAY, WHITE]
for r, (row, bg) in enumerate(zip(rows_data, row_colors)):
    y_row = y_hdr + hdr_h + r * 0.58
    for j, (cell, cw, xs) in enumerate(zip(row, col_widths, x_starts)):
        add_plain_rect(slide, xs, y_row, cw, 0.58, bg,
                       line_color=RGBColor(0xCC,0xCC,0xCC))
        txt_col = DEEP_TEAL if j == 2 else DARK_NAVY
        bold = j == 0
        add_text(slide, cell, xs+0.05, y_row+0.04, cw-0.1, 0.5,
                 size=9, color=txt_col, bold=bold, wrap=True)

add_text(slide, "Evidence levels: Ia = Systematic review/meta-analysis of RCTs  |  Ib = At least one RCT  "
         "|  IIa = At least one well-designed controlled trial  |  IIb = Well-designed quasi-experimental study",
         0.25, 7.1, 12.8, 0.35, size=8, italic=True, color=MID_GRAY)

add_slide_number(slide, 13, prs)
print("  Slide 13 done (Treatment Table)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 14 — DIGITAL HEALTH & EMERGING THERAPIES
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Emerging Therapies & Digital Health Innovations",
                "Future directions in PMS/PMDD management — from neurosteroids to mHealth apps")

emerging = [
    ("Neurosteroid Modulators", DEEP_TEAL,
     "Brexanolone (allopregnanolone analogue, FDA approved 2019 for PPD) — investigations underway for PMDD. "
     "Targets GABA-A receptor sensitivity directly. Sage-217 (zuranolone) trials ongoing.",
     "Phase 2-3 trials"),
    ("Digital Health & mHealth Apps", PURPLE,
     "Symptom tracking apps (Clue, Flo, Ovia) improve diagnostic accuracy and treatment adherence. "
     "2025 systematic review shows feasibility; RCT-level evidence still emerging.",
     "Evidence: SR 2025"),
    ("Transcranial Magnetic Stimulation", CORAL,
     "rTMS over DLPFC shows preliminary efficacy for PMDD-associated depressive symptoms. "
     "Non-invasive; few side effects. Larger RCTs needed.",
     "Pilot data only"),
    ("Gut-Brain Axis & Microbiome", RGBColor(0x1A,0x7A,0x4A),
     "Emerging evidence links gut microbiome composition to premenstrual mood symptoms. "
     "Probiotic trials underway. Dietary tryptophan influences serotonin availability.",
     "Exploratory"),
    ("Personalized Medicine Approach", RGBColor(0x7A,0x5C,0x1E),
     "Pharmacogenomics: CYP2D6 and SLC6A4 variants predict SSRI response. "
     "Hormonal sensitivity biomarkers may guide personalized therapy selection in future.",
     "Research phase"),
    ("Mindfulness-Based Interventions", RGBColor(0xC0,0x6E,0x20),
     "MBSR and MBCT show emerging evidence for PMS/PMDD mood and pain symptoms. "
     "Low cost, accessible, and no side effects — ideal adjunctive therapy.",
     "RCT evidence growing"),
]

for i, (title, col, body, status) in enumerate(emerging):
    c = i % 2
    r = i // 2
    x = 0.3 + c * 6.6
    y = 1.5 + r * 1.95
    add_rect(slide, x, y, 6.3, 1.82, RGBColor(0xF8,0xF8,0xF8), line_color=col, line_width=1.2)
    add_plain_rect(slide, x, y, 6.3, 0.42, col)
    add_text(slide, title, x+0.15, y+0.06, 4.5, 0.32, size=13, bold=True, color=WHITE)
    # status badge
    add_rect(slide, x+4.8, y+0.07, 1.35, 0.3, WHITE, line_color=WHITE)
    add_text(slide, status, x+4.8, y+0.07, 1.35, 0.3, size=8.5, bold=True, color=col, align=PP_ALIGN.CENTER)
    add_text(slide, body, x+0.15, y+0.52, 6.0, 1.22, size=9.5, color=DARK_NAVY, wrap=True)

add_slide_number(slide, 14, prs)
print("  Slide 14 done (Emerging Therapies)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 15 — CONCLUSIONS & RECOMMENDATIONS
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, WHITE)
add_header_band(slide, "Conclusions & Clinical Recommendations",
                "Key takeaways for clinicians managing PMS/PMDD in reproductive-age women")

# Left: Key conclusions
add_rect(slide, 0.3, 1.45, 6.2, 5.6, RGBColor(0xE8,0xF6,0xF5), line_color=DEEP_TEAL, line_width=1.5)
add_text(slide, "Key Conclusions", 0.5, 1.55, 5.9, 0.42, size=15, bold=True, color=DEEP_TEAL)

conclusions = [
    "PMS and PMDD represent a spectrum of cyclical disorders affecting up to 80% of women — not a 'normal' nuisance but a clinically significant condition.",
    "The underlying mechanism is NOT abnormal hormone levels but abnormal CNS sensitivity to normal hormonal fluctuations — particularly involving serotonin and GABA-A receptors.",
    "DSM-5 PMDD diagnosis requires 5+ symptoms, prospective confirmation over 2 cycles, and functional impairment.",
    "SSRIs (fluoxetine, sertraline, paroxetine) remain first-line with Cochrane-level evidence — both continuous and luteal-phase dosing are effective.",
    "COCPs (especially Yaz) are first-line hormonal options; GnRH analogues are reserved for refractory cases with mandatory addback therapy.",
    "CBT is the only psychological intervention with Tier I evidence — should be routinely offered.",
    "Impact on quality of life is profound and multidimensional: occupational, academic, social, and mental health domains all significantly affected.",
    "Digital health tools and emerging neurosteroid modulators represent promising future directions.",
]

for i, c in enumerate(conclusions):
    add_text(slide, f"{i+1}.  {c}", 0.5, 2.07+i*0.62, 5.8, 0.58, size=9.8, color=DARK_NAVY, wrap=True)

# Right: Recommendations
add_rect(slide, 6.8, 1.45, 6.2, 5.6, RGBColor(0xFD,0xF0,0xEB), line_color=CORAL, line_width=1.5)
add_text(slide, "Clinical Recommendations", 7.0, 1.55, 5.9, 0.42, size=15, bold=True, color=CORAL)

recs = [
    ("Diagnose rigorously", "Use prospective daily symptom ratings (DRSP/PRISM) over 2 cycles before labelling PMDD."),
    ("Screen comprehensively", "Always rule out MDD, GAD, thyroid disorders, and domestic violence in all PMS/PMDD consultations."),
    ("Start non-pharmacologically", "Advise lifestyle modifications (exercise, caffeine reduction, calcium) as first step for mild PMS."),
    ("Use SSRIs confidently", "Do not withhold SSRIs from PMDD patients — evidence is robust (Cochrane 2024). Intermittent dosing is acceptable."),
    ("Individualize hormonal therapy", "Consider patient's contraceptive needs, uterine status, and comorbidities when selecting hormonal options."),
    ("Offer CBT routinely", "Psychological therapies should be part of every PMDD management plan — refer early."),
    ("Monitor and follow up", "Review symptom diaries, treatment response, and side effects at 3 and 6 months."),
    ("Address QoL explicitly", "Ask about work, relationships, and academic impact — these domains guide treatment intensity decisions."),
]

for i, (bold_part, text) in enumerate(recs):
    y = 2.07 + i * 0.62
    add_text(slide, f"▶  {bold_part}:", 7.0, y, 5.8, 0.28, size=10.5, bold=True, color=CORAL)
    add_text(slide, f"   {text}", 7.0, y+0.28, 5.8, 0.3, size=9.5, color=DARK_NAVY, wrap=True)

add_slide_number(slide, 15, prs)
print("  Slide 15 done (Conclusions)")

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 16 — REFERENCES & THANK YOU
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
set_slide_bg(slide, DEEP_TEAL)

# Large thank you
add_plain_rect(slide, 0, 0, 13.333, 7.5, DEEP_TEAL)
add_plain_rect(slide, 0, 5.2, 13.333, 0.12, CORAL)
add_plain_rect(slide, 0, 5.35, 13.333, 2.15, DARK_NAVY)

add_text(slide, "Thank You", 0, 0.7, 13.333, 1.2,
         size=50, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_text(slide, "Questions & Discussion Welcome",
         0, 1.85, 13.333, 0.6, size=20, color=LIGHT_TEAL, align=PP_ALIGN.CENTER)

# References
add_text(slide, "Key References", 0.5, 2.7, 12.3, 0.38, size=13, bold=True, color=WHITE)
refs = [
    "1. Berek & Novak's Gynecology — Premenstrual Syndrome and PMDD (pp.1102-1103)",
    "2. The Maudsley Prescribing Guidelines in Psychiatry, 15th Ed. — PMS/PMDD (Fig. 3.6, pp.474-475)",
    "3. Katzung's Basic & Clinical Pharmacology, 16th Ed. — PMDD (p.853)",
    "4. Jespersen C et al. SSRIs for PMS/PMDD. Cochrane Database Syst Rev. 2024. PMID: 39140320",
    "5. Naheed B et al. GnRH analogues for PMS. Cochrane Database Syst Rev. 2025. PMID: 40492482",
    "6. Nexha A et al. Biological rhythms in PMS/PMDD. BMC Womens Health. 2024. PMID: 39375682",
    "7. Kancheva Landolt N et al. CBT for PMS. Psychol Health Med. 2021. PMID: 32845159",
    "8. Seo MS, Seo BN. Digital healthcare for menstrual symptoms. Womens Health Nurs. 2025. PMID: 40639860",
]
for i, r in enumerate(refs):
    c = i % 2
    row = i // 2
    x = 0.5 + c * 6.5
    y = 3.15 + row * 0.42
    add_text(slide, r, x, y, 6.4, 0.38, size=9, color=LIGHT_TEAL, wrap=True)

add_text(slide, "International Conference on Women's Health  |  July 2026  |  Evidence-Based Review",
         0, 5.6, 13.333, 0.45, size=12, color=LIGHT_TEAL, align=PP_ALIGN.CENTER)
add_text(slide, "Content based on DSM-5 Criteria | RCOG Green-top Guideline | ACOG Practice Bulletin | Cochrane Systematic Reviews",
         0, 6.1, 13.333, 0.38, size=10, color=MID_GRAY, align=PP_ALIGN.CENTER)

add_slide_number(slide, 16, prs)
print("  Slide 16 done (References)")

# ─── Save ────────────────────────────────────────────────────────────────────
out_path = "/tmp/workspace/pms-presentation/PMS_PMDD_Conference_Presentation.pptx"
prs.save(out_path)
print(f"\nPresentation saved to: {out_path}")
print(f"Total slides: {len(prs.slides)}")

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/pms-presentation/build_pptx.py'