"primary biliary cholangitis" AND treatment

AASLD primary biliary cholangitis practice guidance diagnosis treatment ursodeoxycholic acid 2021

primary biliary cholangitis histology florid duct lesion portal granuloma small bile ducts

primary biliary cholangitis clinical features xanthelasma jaundice

FDA obeticholic acid Ocaliva withdrawn primary biliary cholangitis 2025 current status

~/

mkdir -p "/tmp/workspace/pbc-mbbs-presentation/src" "/tmp/workspace/pbc-mbbs-presentation/output"

python - <<'PY' from pathlib import Path from textwrap import dedent p=Path('/tmp/workspace/pbc-mbbs-presentation/src/create_pbc_ppt.py') p.write_text(dedent(''' 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, MSO_CONNECTOR from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.text import MSO_AUTO_SIZE from pptx.enum.shapes import MSO_SHAPE_TYPE from pptx.enum.text import MSO_VERTICAL_ANCHOR OUT='/tmp/workspace/pbc-mbbs-presentation/output/Primary_Biliary_Cholangitis_MBBS_Final_Year.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(15,41,60); TEAL=RGBColor(0,133,139); AQUA=RGBColor(201,237,235); GOLD=RGBColor(231,174,58); RED=RGBColor(191,70,62); INK=RGBColor(27,42,52); GREY=RGBColor(90,106,116); PALE=RGBColor(245,249,249); WHITE=RGBColor(255,255,255); LIGHT=RGBColor(226,238,238); GREEN=RGBColor(47,132,101) def rect(slide,x,y,w,h,fill, line=None, radius=False): sh=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h)) sh.fill.solid(); sh.fill.fore_color.rgb=fill sh.line.color.rgb = line if line else fill if radius: sh.adjustments[0]=0.12 return sh def text(slide,x,y,w,h,s,size=18,color=INK,bold=False,align=PP_ALIGN.LEFT, font='Aptos', valign=MSO_ANCHOR.TOP): tb=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(.03); tf.margin_top=tf.margin_bottom=Inches(.02); tf.vertical_anchor=valign lines=s.split('\\n') for i,line in enumerate(lines): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=line; p.alignment=align; p.space_after=Pt(4) for r in p.runs: r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return tb def title(slide, n, ttl, sub=None): rect(slide,0,0,13.333,.2,TEAL) text(slide,.55,.34,11.7,.46,ttl,27,NAVY,True) if sub: text(slide,.57,.84,11.7,.3,sub,11,GREY) text(slide,12.28,.38,.5,.3,f'{n:02}',12,TEAL,True,PP_ALIGN.RIGHT) rect(slide,.55,1.17,12.2,.02,AQUA) def footer(slide, source='Sources: AASLD PBC Practice Guidance (2021 update); EASL CPG (2017).'): rect(slide,0,7.18,13.333,.32,NAVY) text(slide,.55,7.23,12.1,.16,source,8,WHITE) def bullet(slide,x,y,w,items,size=16,accent=TEAL): yy=y for item in items: rect(slide,x,yy+.12,.11,.11,accent) text(slide,x+.24,yy,w-.24,.48,item,size,INK) yy+=.58 def pill(slide,x,y,w,s,fill=TEAL): rect(slide,x,y,w,.42,fill,None,True); text(slide,x,y+.07,w,.22,s,11,WHITE,True,PP_ALIGN.CENTER) def arrow(slide,x1,y1,x2,y2,color=TEAL,width=2): l=slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(x1), Inches(y1), Inches(x2), Inches(y2)); l.line.color.rgb=color; l.line.width=Pt(width); l.line.end_arrowhead=True # Slide 1 s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY); rect(s,0,0,13.333,.18,TEAL) # abstract liver/biliary graphic rect(s,8.55,1.23,3.65,4.72,RGBColor(23,63,78),None,True) # liver sh=s.shapes.add_shape(MSO_SHAPE.ARC, Inches(8.95), Inches(1.7), Inches(2.9), Inches(1.6)); sh.fill.solid(); sh.fill.fore_color.rgb=GOLD; sh.line.color.rgb=GOLD # bile duct tree for a in [(10.35,3.0,10.35,4.6),(10.35,3.55,9.45,4.32),(10.35,3.55,11.25,4.32),(9.45,4.32,9.45,4.75),(11.25,4.32,11.25,4.75)]: arrow(s,*a,AQUA,2) rect(s,10.05,4.7,.6,.8,TEAL,None,True); text(s,8.1,1.32,4.65,.32,'AUTOIMMUNE SMALL-DUCT DISEASE',10,AQUA,True,PP_ALIGN.CENTER) text(s,.7,1.45,7.3,1.15,'Primary Biliary\\nCholangitis',38,WHITE,True) text(s,.73,3.1,6.8,.55,'Final-year MBBS teaching deck',20,AQUA) text(s,.73,3.85,6.6,.7,'Recognize cholestasis. Confirm the diagnosis. Treat early. Prevent complications.',19,WHITE) pill(s,.73,5.1,1.75,'HEPATOLOGY',TEAL); pill(s,2.65,5.1,1.8,'EXAM FOCUSED',GOLD) text(s,.73,6.35,6.6,.3,'Prepared for last-year MBBS | October 2026',11,AQUA) # Slide 2 s=prs.slides.add_slide(blank); title(s,2,'Why PBC matters','A chronic autoimmune cholestatic disease that is often detected before symptoms appear.') rect(s,.7,1.55,3.75,4.6,PALE,None,True); text(s,1.0,1.85,3.15,.55,'One-line definition',20,NAVY,True) text(s,1.0,2.68,3.12,1.7,'Immune-mediated destruction of small intrahepatic bile ducts causing persistent cholestasis, fibrosis and, if progressive, cirrhosis.',19,INK) rect(s,4.75,1.55,7.85,1.1,AQUA,None,True); text(s,5.05,1.78,7.25,.25,'PBC is not an obstructive extrahepatic biliary disease.',18,NAVY,True) for x,top,big,small,c in [(4.9,3.05,'~90-95%','AMA positive',TEAL),(7.45,3.05,'F:M ≈ 9-10:1','Usually middle age',GOLD),(10.0,3.05,'ALP ↑','Typical first clue',RED)]: rect(s,x,top,2.25,1.55,WHITE,LIGHT,True); text(s,x+.1,top+.28,2.05,.32,big,23,c,True,PP_ALIGN.CENTER); text(s,x+.1,top+.84,2.05,.26,small,12,GREY,False,PP_ALIGN.CENTER) text(s,4.95,5.15,7.3,.32,'Older term: “primary biliary cirrhosis” is obsolete.',16,NAVY,True) text(s,4.95,5.61,7.2,.3,'Think of PBC in unexplained, persistent cholestatic liver tests.',17,INK) footer(s,'Sources: Robbins Basic Pathology, PBC section; Tietz Laboratory Medicine, PBC section.') # Slide 3 s=prs.slides.add_slide(blank); title(s,3,'Pathogenesis: genetic susceptibility + trigger + immune injury') steps=[('1','Predisposition','Female predominance\\nHLA/immune genes'),('2','Environmental trigger','Smoking, infections and other exposures are associations'),('3','Loss of tolerance','AMA targets PDC-E2; autoreactive T cells'),('4','Duct injury','Lymphoplasmacytic cholangitis\\n“florid duct lesion”'),('5','Progression','Ductopenia → cholestasis → fibrosis → cirrhosis')] for i,(n,head,body) in enumerate(steps): x=.55+i*2.55; rect(s,x,2.05,2.18,2.55,PALE,LIGHT,True); rect(s,x+.08,2.15,.42,.42,TEAL,None,True); text(s,x+.08,2.23,.42,.18,n,12,WHITE,True,PP_ALIGN.CENTER); text(s,x+.25,2.76,1.7,.42,head,16,NAVY,True,PP_ALIGN.CENTER); text(s,x+.2,3.38,1.8,.8,body,12,INK,False,PP_ALIGN.CENTER) if i<4: arrow(s,x+2.2,3.3,x+2.5,3.3,GOLD,2) text(s,.8,5.3,11.6,.38,'Pathology pearl: small interlobular ducts are destroyed by lymphoplasmacytic inflammation, with or without granulomas.',19,NAVY,True,PP_ALIGN.CENTER) text(s,1.35,6.04,10.7,.3,'AMA is a diagnostic signature, but titre does not reliably track disease severity.',15,GREY,False,PP_ALIGN.CENTER) footer(s,'Sources: Robbins Basic Pathology, pp. 622-623; Tietz Laboratory Medicine, PBC section.') # Slide 4 s=prs.slides.add_slide(blank); title(s,4,'Clinical presentation: often silent, sometimes very symptomatic') # patient silhouette substitute rect(s,.72,1.5,3.0,4.9,PALE,None,True); text(s,1.0,1.78,2.5,.32,'Typical patient',19,NAVY,True,PP_ALIGN.CENTER) # simple body icon s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(1.9),Inches(2.4),Inches(.65),Inches(.65)).fill.solid(); s.shapes[-1].fill.fore_color.rgb=GOLD; s.shapes[-1].line.color.rgb=GOLD rect(s,1.72,3.08,1.02,1.55,GOLD,None,True); text(s,1.05,5.12,2.3,.6,'Middle-aged woman\\nwith unexplained ALP rise',16,INK,True,PP_ALIGN.CENTER) for x,y,w,h,head,body,col in [(4.15,1.65,3.8,1.5,'Early / common','Asymptomatic ALP elevation\\nFatigue and pruritus',TEAL),(8.25,1.65,3.8,1.5,'Cholestatic features','Jaundice is late\\nHyperpigmentation, xanthelasma',GOLD),(4.15,3.55,3.8,1.5,'Malabsorption effects','Steatorrhea; fat-soluble vitamin deficiency\\nOsteopenia/osteoporosis',RED),(8.25,3.55,3.8,1.5,'Autoimmune associations','Sjögren syndrome, thyroid disease\\nRaynaud phenomenon, celiac disease',TEAL)]: rect(s,x,y,w,h,PALE,LIGHT,True); rect(s,x,y,.11,h,col); text(s,x+.28,y+.25,w-.45,.25,head,16,NAVY,True); text(s,x+.28,y+.7,w-.45,.55,body,13,INK) text(s,4.15,5.82,8.1,.28,'Fatigue severity does not necessarily reflect hepatic disease stage.',15,GREY,False,PP_ALIGN.CENTER) footer(s,'Sources: Goldman-Cecil Medicine, pp. 1645-1646; Robbins Basic Pathology, pp. 622-623.') # Slide 5 s=prs.slides.add_slide(blank); title(s,5,'Diagnosis: meet 2 of 3, after excluding extrahepatic obstruction') # 3 criteria criteria=[('1','Cholestasis','ALP elevation\\n± GGT elevation',TEAL),('2','Serology','AMA positive\\nPBC-specific ANA if AMA negative',GOLD),('3','Histology','Nonsuppurative destructive cholangitis\\n/florid duct lesion',RED)] for i,(num,h,b,c) in enumerate(criteria): x=.75+i*4.18; rect(s,x,1.7,3.55,1.9,PALE,LIGHT,True); rect(s,x+.15,1.88,.46,.46,c,None,True); text(s,x+.15,1.98,.46,.2,num,13,WHITE,True,PP_ALIGN.CENTER); text(s,x+.75,1.92,2.55,.3,h,18,NAVY,True); text(s,x+.38,2.58,2.85,.55,b,14,INK,False,PP_ALIGN.CENTER) text(s,1.05,4.05,11.15,.35,'Diagnosis is made when any 2 of the 3 criteria are present.',21,NAVY,True,PP_ALIGN.CENTER) # workflow for i,(h,b) in enumerate([('Cholestatic LFTs','ALP predominant pattern'),('Ultrasound','Exclude biliary obstruction'),('AMA','High diagnostic specificity'),('Biopsy?','Atypical, AMA-negative, overlap/staging')]): x=.72+i*3.16; rect(s,x,4.8,2.55,1.05,WHITE,LIGHT,True); text(s,x+.12,5.03,2.3,.22,h,15,TEAL,True,PP_ALIGN.CENTER); text(s,x+.12,5.42,2.3,.19,b,10,GREY,False,PP_ALIGN.CENTER) if i<3: arrow(s,x+2.58,5.3,x+3.04,5.3,TEAL,2) text(s,.78,6.35,11.8,.25,'Supportive labs: raised IgM; bilirubin elevation is usually late and has prognostic importance.',13,GREY,False,PP_ALIGN.CENTER) footer(s,'Sources: AASLD PBC Guidance (2021); Goldman-Cecil Medicine, p. 1646.') # Slide 6 s=prs.slides.add_slide(blank); title(s,6,'Investigations and staging','Test purposefully: establish diagnosis, assess fibrosis, detect complications.') cols=[('Confirm cholestasis',['ALP, GGT','Bilirubin','AST/ALT','Albumin, INR'],TEAL),('Establish cause',['AMA','IgM','ANA: gp210/sp100 if needed','Viral/drug screen'],GOLD),('Define anatomy',['Ultrasound first','MRCP if obstruction/PSC suspected','Do not use ERCP routinely'],RED),('Stage & surveil',['Elastography','Platelets, portal HTN signs','DEXA and fat-soluble vitamins'],GREEN)] for i,(h,arr,c) in enumerate(cols): x=.62+i*3.14; rect(s,x,1.55,2.75,4.65,PALE,LIGHT,True); rect(s,x,1.55,2.75,.5,c); text(s,x+.12,1.69,2.5,.2,h,15,WHITE,True,PP_ALIGN.CENTER); bullet(s,x+.26,2.35,2.25,arr,14,c) text(s,.85,6.52,11.6,.28,'Biopsy is not routine when cholestasis + AMA are typical; use it for diagnostic uncertainty or suspected PBC-AIH overlap.',15,NAVY,True,PP_ALIGN.CENTER) footer(s,'Sources: AASLD PBC Guidance (2021); EASL PBC CPG (2017).') # Slide 7 s=prs.slides.add_slide(blank); title(s,7,'Histology and natural history') # histology drawing rect(s,.7,1.48,5.25,4.9,PALE,None,True); text(s,1.0,1.75,4.65,.3,'Florid duct lesion (schematic)',19,NAVY,True,PP_ALIGN.CENTER) # portal circle and duct s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(2.18),Inches(2.45),Inches(2.25),Inches(2.25)).fill.solid(); s.shapes[-1].fill.fore_color.rgb=RGBColor(220,233,216); s.shapes[-1].line.color.rgb=GREEN s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(2.8),Inches(3.04),Inches(1.0),Inches(.85)).fill.solid(); s.shapes[-1].fill.fore_color.rgb=WHITE; s.shapes[-1].line.color.rgb=RED for x,y in [(2.4,2.8),(3.95,2.82),(2.45,4.05),(4.1,3.95),(2.2,3.58)]: s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y),Inches(.18),Inches(.18)).fill.solid(); s.shapes[-1].fill.fore_color.rgb=RED; s.shapes[-1].line.color.rgb=RED text(s,1.3,5.18,4.1,.55,'Portal lymphoplasmacytic inflammation ± granulomas surrounding and destroying a small bile duct.',13,INK,False,PP_ALIGN.CENTER) # progression stages=[('Portal inflammation','Stage I'),('Periportal fibrosis','Stage II'),('Bridging fibrosis','Stage III'),('Cirrhosis','Stage IV')] for i,(h,b) in enumerate(stages): x=6.55+i*1.6; rect(s,x,2.35,1.35,2.0,WHITE,LIGHT,True); text(s,x+.08,2.73,1.18,.35,b,13,TEAL,True,PP_ALIGN.CENTER); text(s,x+.08,3.27,1.18,.48,h,11,INK,False,PP_ALIGN.CENTER) if i<3: arrow(s,x+1.37,3.34,x+1.56,3.34,GOLD,2) text(s,6.65,5.15,5.7,.7,'Progression results from duct loss and chronic cholestasis. Fibrosis stage, bilirubin, albumin and treatment response inform prognosis.',16,NAVY,True,PP_ALIGN.CENTER) footer(s,'Sources: Robbins Basic Pathology, pp. 622-623; AASLD PBC Guidance (2021).') # Slide 8 s=prs.slides.add_slide(blank); title(s,8,'Management: treat the disease and the patient') rect(s,.7,1.45,12.0,.6,NAVY,None,True); text(s,.9,1.62,11.6,.22,'First-line for all patients with abnormal liver enzymes: ursodeoxycholic acid (UDCA) 13-15 mg/kg/day, lifelong',18,WHITE,True,PP_ALIGN.CENTER) # pathway for x,h,b,c in [(1.0,'Start UDCA','Assess adherence & tolerance',TEAL),(4.4,'Reassess at 12 months','Biochemical response, especially ALP and bilirubin',GOLD),(8.0,'Inadequate response','Refer/hepatology-directed second-line therapy',RED)]: rect(s,x,2.55,3.0,1.5,PALE,LIGHT,True); rect(s,x,2.55,3.0,.12,c); text(s,x+.25,2.89,2.5,.28,h,17,NAVY,True,PP_ALIGN.CENTER); text(s,x+.25,3.38,2.5,.3,b,12,INK,False,PP_ALIGN.CENTER) arrow(s,4.02,3.3,4.32,3.3,TEAL,2); arrow(s,7.42,3.3,7.92,3.3,TEAL,2) rect(s,.9,4.75,5.55,1.25,AQUA,None,True); text(s,1.18,5.0,5.0,.24,'Second-line: specialist decision',16,NAVY,True); text(s,1.18,5.37,5.0,.35,'Fibrates are used in some regions. Drug availability and contraindications vary.',12,INK) rect(s,6.85,4.75,5.55,1.25,RGBColor(253,242,219),None,True); text(s,7.13,5.0,5.0,.24,'Current caution',16,NAVY,True); text(s,7.13,5.37,5.0,.35,'Obeticholic acid was withdrawn from the US market in Nov 2025. Check local guidance.',12,INK) text(s,.95,6.45,11.6,.25,'Avoid routine corticosteroids, azathioprine, colchicine, or methotrexate for isolated PBC.',14,GREY,False,PP_ALIGN.CENTER) footer(s,'Sources: AASLD PBC Guidance (2021); FDA Ocaliva withdrawal listing, 2025. Educational only: follow local hepatology guidance.') # Slide 9 s=prs.slides.add_slide(blank); title(s,9,'Symptom control, prevention and surveillance') items=[('Pruritus','Cholestyramine first-line. If refractory: rifampicin, naltrexone or sertraline under specialist supervision.'),(('Sicca symptoms'),'Artificial tears/saliva; evaluate for Sjögren syndrome.'),(('Bone disease'),'DEXA at baseline and periodically; calcium/vitamin D. Treat osteoporosis by standard indications.'),(('Nutrition'),'Replace fat-soluble vitamins when deficient; assess steatorrhea and weight loss.'),(('Cirrhosis care'),'Screen/manage portal hypertension. HCC surveillance if cirrhosis, per local guideline.')] for i,(h,b) in enumerate(items): y=1.48+i*1.0; rect(s,.7,y,11.95,.77,PALE,LIGHT,True); rect(s,.7,y,.18,.77,[TEAL,GOLD,RED,GREEN,TEAL][i]); text(s,1.1,y+.17,2.2,.24,h,16,NAVY,True); text(s,3.15,y+.13,8.95,.38,b,13,INK) footer(s,'Sources: AASLD PBC Guidance (2021); EASL PBC CPG (2017).') # Slide 10 s=prs.slides.add_slide(blank); title(s,10,'PBC-AIH overlap: when should you suspect it?') rect(s,.75,1.45,3.65,4.8,PALE,None,True); text(s,1.0,1.78,3.15,.32,'Think overlap when',19,NAVY,True,PP_ALIGN.CENTER) bullet(s,1.05,2.5,2.9,['Marked ALT/AST elevation','High IgG rather than isolated IgM','Interface hepatitis on biopsy','Autoimmune hepatitis serology/features'],15,RED) rect(s,4.85,1.45,3.65,4.8,AQUA,None,True); text(s,5.1,1.78,3.15,.32,'Why it matters',19,NAVY,True,PP_ALIGN.CENTER) bullet(s,5.15,2.5,2.9,['Diagnosis needs expert assessment','Biopsy is particularly helpful','Immunosuppression may be needed in addition to UDCA'],15,TEAL) rect(s,8.95,1.45,3.65,4.8,RGBColor(253,242,219),None,True); text(s,9.2,1.78,3.15,.32,'Do not confuse with',19,NAVY,True,PP_ALIGN.CENTER) bullet(s,9.25,2.5,2.9,['Primary sclerosing cholangitis','Drug-induced cholestasis','Extrahepatic obstruction','IgG4-related disease'],15,GOLD) text(s,.95,6.55,11.5,.26,'Exam point: disproportionate hepatitic enzymes in PBC should prompt evaluation for overlap rather than reflex escalation of PBC treatment.',14,GREY,False,PP_ALIGN.CENTER) footer(s,'Sources: AASLD PBC Guidance (2021); EASL PBC CPG (2017).') # Slide 11 case s=prs.slides.add_slide(blank); title(s,11,'Case-based application','A 48-year-old woman has 6 months of pruritus and fatigue.') rect(s,.72,1.5,4.0,4.9,NAVY,None,True); text(s,1.05,1.9,3.35,.3,'Key data',20,WHITE,True) text(s,1.05,2.55,3.15,1.9,'ALP: 3× ULN\\nGGT elevated\\nBilirubin: normal\\nAMA: positive 1:160\\nUltrasound: no duct dilation',18,WHITE) text(s,1.05,5.5,3.2,.35,'What is the next best step?',14,AQUA,True) # answer steps for i,(h,b) in enumerate([('Diagnosis','PBC: cholestasis + AMA, after normal ultrasound.'),('Initial treatment','Start UDCA 13-15 mg/kg/day.'),('Baseline evaluation','Elastography, albumin/INR/platelets, bone health and symptom burden.'),('Follow-up','Assess biochemical response after 12 months; continue lifelong monitoring.')]): y=1.52+i*1.18; rect(s,5.2,y,7.1,.88,PALE,LIGHT,True); text(s,5.48,y+.17,1.8,.24,h,15,TEAL,True); text(s,7.25,y+.13,4.7,.35,b,13,INK) footer(s,'Sources: AASLD PBC Guidance (2021).') # Slide 12 s=prs.slides.add_slide(blank); title(s,12,'Take-home messages') for i,(h,b,c) in enumerate([('Recognize','Persistent ALP-predominant cholestasis in a middle-aged woman is a classic trigger to test for PBC.',TEAL),('Confirm','Diagnosis usually rests on cholestatic liver tests + AMA, after ultrasound excludes obstruction.',GOLD),('Treat early','UDCA 13-15 mg/kg/day is first-line and lifelong. Assess biochemical response at 12 months.',RED),('Follow long term','Manage pruritus, bone disease and nutritional deficiency; monitor fibrosis and cirrhotic complications.',GREEN)]): y=1.45+i*1.18; rect(s,.85,y,11.7,.9,PALE,LIGHT,True); rect(s,.85,y,.23,.9,c); text(s,1.35,y+.18,2.0,.27,h,17,NAVY,True); text(s,3.28,y+.16,8.65,.34,b,14,INK) text(s,.85,6.38,11.65,.3,'Remember: bilirubin elevation is late and signals worse prognosis.',17,NAVY,True,PP_ALIGN.CENTER) footer(s,'Core sources: AASLD 2021, EASL 2017, Goldman-Cecil, Robbins, Tietz.') # Slide 13 references s=prs.slides.add_slide(blank); title(s,13,'References and selected reading') refs=[ '1. Bowlus CL, et al. AASLD Practice Guidance on Primary Biliary Cholangitis: 2021 Practice Guidance Update. Hepatology. 2021.', '2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: diagnosis and management of primary biliary cholangitis. J Hepatol. 2017;67:145-172.', '3. Goldman-Cecil Medicine. Primary Biliary Cholangitis, pp. 1645-1646.', '4. Robbins & Kumar Basic Pathology. Primary Biliary Cholangitis, pp. 622-623.', '5. Tietz Textbook of Laboratory Medicine, 7th ed. Primary Biliary Cholangitis section.', '6. US Food and Drug Administration. Withdrawn accelerated approval indications: Ocaliva (obeticholic acid), withdrawal date 24 Nov 2025. Accessed Oct 2026.', '7. Martins AA, et al. Comparative effectiveness of PPAR agonists as second-line therapies for PBC: systematic review and network meta-analysis. Hepatology. 2026. PMID: 41052304.' ] text(s,.8,1.48,11.7,.4,'Use national and local hepatology guidance for contemporary prescribing and referral pathways.',16,NAVY,True) y=2.15 for r in refs: rect(s,.88,y,.12,.12,TEAL); text(s,1.18,y-.08,11.2,.43,r,13,INK); y+=.62 text(s,.9,6.8,11.55,.22,'Prepared for educational use. This deck is not a substitute for clinical supervision or local protocol.',10,GREY,False,PP_ALIGN.CENTER) footer(s,'Primary Biliary Cholangitis | Final-year MBBS') prs.save(OUT) print(OUT) ''')) PY python "/tmp/workspace/pbc-mbbs-presentation/src/create_pbc_ppt.py"

~/pbc-mbbs-presentation/output

python - <<'PY' from pptx import Presentation p='/tmp/workspace/pbc-mbbs-presentation/output/Primary_Biliary_Cholangitis_MBBS_Final_Year.pptx' prs=Presentation(p) print('slides:',len(prs.slides)) for i,s in enumerate(prs.slides,1): texts=[] for sh in s.shapes: if hasattr(sh,'text') and sh.text.strip(): texts.append(sh.text.replace('\n',' | ')) print(i, ' :: ', texts[0][:100] if texts else '[NO TEXT]') PY

python - <<'PY' from zipfile import ZipFile p='/tmp/workspace/pbc-mbbs-presentation/output/Primary_Biliary_Cholangitis_MBBS_Final_Year.pptx' with ZipFile(p) as z: print('zip test:', z.testzip()) print('slide xml:',len([n for n in z.namelist() if n.startswith('ppt/slides/slide') and n.endswith('.xml')])) PY