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.util import Inches, Pt
import copy
from lxml import etree

# ── Palette ──────────────────────────────────────────────────────────────────
DARK_BLUE   = RGBColor(0x0D, 0x2E, 0x5A)   # header / title bg
MID_BLUE    = RGBColor(0x1A, 0x5F, 0x9E)   # accent bar
LIGHT_BLUE  = RGBColor(0xD6, 0xE8, 0xF7)   # light bg
RED_ACCENT  = RGBColor(0xC0, 0x20, 0x2A)   # emergency / highlight
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
DARK_GREY   = RGBColor(0x2B, 0x2B, 0x2B)
LIGHT_GREY  = RGBColor(0xF2, 0xF4, 0xF7)
GOLD        = RGBColor(0xE8, 0xA0, 0x1E)

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

# ── Helpers ───────────────────────────────────────────────────────────────────
def add_rect(slide, x, y, w, h, color, alpha=None):
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = color
    shape.line.fill.background()
    return shape

def add_text(slide, text, x, y, w, h, size=18, bold=False, color=WHITE,
             align=PP_ALIGN.LEFT, wrap=True, italic=False, anchor=MSO_ANCHOR.TOP):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.vertical_anchor = anchor
    tf.margin_left = Inches(0.05)
    tf.margin_right = Inches(0.05)
    tf.margin_top = Inches(0.03)
    tf.margin_bottom = Inches(0.03)
    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_multiline(slide, lines, x, y, w, h, size=16, color=DARK_GREY,
                  bold_first=False, bullet=True, line_spacing=1.15):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Inches(0.1)
    tf.margin_right = Inches(0.05)
    tf.margin_top = Inches(0.05)
    tf.margin_bottom = Inches(0.05)
    for i, line in enumerate(lines):
        if i == 0:
            p = tf.paragraphs[0]
        else:
            p = tf.add_paragraph()
        p.alignment = PP_ALIGN.LEFT
        from pptx.util import Pt as Pt2
        from pptx.oxml.ns import qn
        pPr = p._pPr
        if pPr is None:
            pPr = p._p.get_or_add_pPr()
        # line spacing
        lnSpc = etree.SubElement(pPr, qn('a:lnSpc'))
        spcPct = etree.SubElement(lnSpc, qn('a:spcPct'))
        spcPct.set('val', str(int(line_spacing * 100000)))

        run = p.add_run()
        bullet_prefix = "• " if bullet else ""
        run.text = bullet_prefix + line
        run.font.size = Pt(size)
        run.font.color.rgb = color
        run.font.name = "Calibri"
        if bold_first and i == 0:
            run.font.bold = True
    return tb

def header_bar(slide, title, subtitle=None):
    """Dark blue header bar at top"""
    add_rect(slide, 0, 0, 13.333, 1.15, DARK_BLUE)
    add_rect(slide, 0, 1.15, 13.333, 0.07, MID_BLUE)
    add_text(slide, title, 0.3, 0.1, 12.5, 0.8,
             size=28, bold=True, color=WHITE, align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.MIDDLE)
    if subtitle:
        add_text(slide, subtitle, 0.3, 0.82, 12.5, 0.35,
                 size=14, bold=False, color=LIGHT_BLUE, align=PP_ALIGN.LEFT)

def footer(slide, text="Chowdhury R et al. J Otorhinolaryngol Hear Balance Med 2024;5(2):21"):
    add_rect(slide, 0, 7.2, 13.333, 0.3, DARK_BLUE)
    add_text(slide, text, 0.2, 7.2, 13.0, 0.3,
             size=9, bold=False, color=RGBColor(0xBB, 0xCC, 0xDD),
             align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)

def section_card(slide, title, items, x, y, w, h, header_color=MID_BLUE, text_size=15):
    add_rect(slide, x, y, w, 0.4, header_color)
    add_text(slide, title, x+0.08, y+0.02, w-0.15, 0.38,
             size=14, bold=True, color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, x, y+0.4, w, h-0.4, LIGHT_GREY)
    add_multiline(slide, items, x+0.1, y+0.42, w-0.2, h-0.5,
                  size=text_size, color=DARK_GREY)

# =============================================================================
# SLIDE 1 – TITLE
# =============================================================================
slide = prs.slides.add_slide(blank)
# Full dark bg
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
# Accent strip
add_rect(slide, 0, 3.5, 13.333, 0.08, RED_ACCENT)
add_rect(slide, 0, 5.7, 13.333, 0.08, GOLD)

# Title
add_text(slide, "APPROACH TO EPISTAXIS", 1.0, 1.2, 11.5, 1.5,
         size=44, bold=True, color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
add_text(slide, "Guidelines | Journal of Otorhinolaryngology, Hearing and Balance Medicine",
         1.0, 2.7, 11.5, 0.5, size=17, bold=False,
         color=LIGHT_BLUE, align=PP_ALIGN.CENTER)
add_text(slide, "Chowdhury R, Turkdogan S, Silver JA, Hier J, Bursey S, Quttaineh D, Khoury M, Himdi L",
         1.0, 3.7, 11.5, 0.5, size=14, bold=False,
         color=RGBColor(0xDD, 0xEE, 0xFF), align=PP_ALIGN.CENTER)
add_text(slide, "Published: December 23, 2024  •  DOI: 10.3390/ohbm5020021",
         1.0, 4.25, 11.5, 0.4, size=13, bold=False,
         color=GOLD, align=PP_ALIGN.CENTER)
add_text(slide, "Journal Club Presentation  •  Postgraduate ENT",
         1.0, 5.9, 11.5, 0.5, size=15, bold=True,
         color=WHITE, align=PP_ALIGN.CENTER)

# =============================================================================
# SLIDE 2 – OVERVIEW / OUTLINE
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Presentation Outline")
footer(slide)

outline = [
    ("1", "Introduction & Epidemiology"),
    ("2", "Anatomy of Nasal Vasculature"),
    ("3", "Etiology & Risk Factors"),
    ("4", "Classification of Epistaxis"),
    ("5", "Clinical Assessment & History"),
    ("6", "Initial Management"),
    ("7", "Stepwise Treatment Algorithm"),
    ("8", "Advanced Interventions"),
    ("9", "Special Populations & Recurrence"),
    ("10", "Patient Education & Prevention"),
    ("11", "Key Takeaways & Summary"),
]

for i, (num, title) in enumerate(outline):
    col = i % 2
    row = i // 2
    x = 0.5 + col * 6.4
    y = 1.4 + row * 1.0
    add_rect(slide, x, y, 0.45, 0.62, MID_BLUE)
    add_text(slide, num, x, y, 0.45, 0.62, size=20, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, x+0.45, y, 5.7, 0.62, WHITE)
    add_text(slide, title, x+0.55, y+0.06, 5.5, 0.5,
             size=16, bold=False, color=DARK_GREY, anchor=MSO_ANCHOR.MIDDLE)

# =============================================================================
# SLIDE 3 – INTRODUCTION & EPIDEMIOLOGY
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Introduction & Epidemiology")
footer(slide)

# Left panel – definition
add_rect(slide, 0.3, 1.4, 6.0, 0.38, MID_BLUE)
add_text(slide, "What is Epistaxis?", 0.4, 1.4, 5.8, 0.38,
         size=14, bold=True, color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 0.3, 1.78, 6.0, 2.6, WHITE)
add_multiline(slide,
    ["Epistaxis (nosebleed) = bleeding from the nasal cavity or nasopharynx",
     "One of the most common ENT emergencies worldwide",
     "Bimodal age distribution: children (<16 yrs) and adults (>40 yrs, peaks in 6th decade)",
     "60% of the general population experience at least one episode in their lifetime",
     "Only ~6% require medical attention; <0.1% are life-threatening",
     "Etiologies span local trauma, systemic disease, and medications"],
    0.4, 1.82, 5.7, 2.5, size=14, color=DARK_GREY)

# Right panel – key stats
add_rect(slide, 6.8, 1.4, 6.2, 0.38, RED_ACCENT)
add_text(slide, "Key Epidemiological Facts", 6.9, 1.4, 6.0, 0.38,
         size=14, bold=True, color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
stats = [
    ("~60%", "lifetime prevalence in general population"),
    ("2x peak", "children and 6th decade adults"),
    ("80%", "cases are anterior (Little's area / Kiesselbach's plexus)"),
    ("70–80%", "are idiopathic (primary epistaxis)"),
    ("20%", "are posterior – higher morbidity, hospitalization"),
]
for i, (val, desc) in enumerate(stats):
    y_pos = 1.82 + i * 0.9
    add_rect(slide, 6.8, y_pos, 1.3, 0.7, MID_BLUE)
    add_text(slide, val, 6.8, y_pos, 1.3, 0.7, size=17, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, 8.1, y_pos, 4.9, 0.7, WHITE)
    add_text(slide, desc, 8.18, y_pos+0.06, 4.7, 0.58,
             size=13, color=DARK_GREY, anchor=MSO_ANCHOR.MIDDLE)

# =============================================================================
# SLIDE 4 – ANATOMY OF NASAL VASCULATURE
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Anatomy of Nasal Vasculature", "Understanding the blood supply is key to localizing and managing epistaxis")
footer(slide)

add_rect(slide, 0.3, 1.38, 12.7, 0.38, MID_BLUE)
add_text(slide, "Dual Blood Supply to the Nasal Cavity", 0.45, 1.38, 12.5, 0.38,
         size=15, bold=True, color=WHITE, anchor=MSO_ANCHOR.MIDDLE)

# ECA column
section_card(slide, "External Carotid Artery (ECA)",
    ["Facial artery → Superior labial artery → septal branches",
     "Internal maxillary artery → Sphenopalatine artery (SPA)",
     "SPA = posterior septum & lateral wall (MOST COMMON source of posterior epistaxis)",
     "Greater palatine artery → incisive foramen → anterior septum",
     "SPA ligation / embolization = mainstay of surgical tx"],
    0.3, 1.85, 6.1, 2.6, header_color=MID_BLUE, text_size=14)

# ICA column
section_card(slide, "Internal Carotid Artery (ICA)",
    ["Ophthalmic artery → Anterior ethmoidal artery",
     "Anterior ethmoidal artery → anterior upper septum & roof",
     "Posterior ethmoidal artery → posterior superior septum",
     "Anterior ethmoidal ligation needed for refractory anterior-superior bleeds",
     "ICA bleeds less common but more difficult to control"],
    6.55, 1.85, 6.1, 2.6, header_color=DARK_BLUE, text_size=14)

# Kiesselbach / Little's area
add_rect(slide, 0.3, 4.6, 12.7, 0.38, GOLD)
add_text(slide, "Kiesselbach's Plexus (Little's Area) — Anterior Inferior Nasal Septum",
         0.4, 4.6, 12.5, 0.38, size=14, bold=True, color=DARK_GREY, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 0.3, 4.98, 12.7, 1.2, WHITE)
add_multiline(slide,
    ["Anastomosis of: SPA + Greater palatine + Superior labial + Anterior ethmoidal arteries",
     "Responsible for ~80% of all anterior epistaxis episodes — the most common bleeding site",
     "Woodruff's plexus (posterior nasal floor / inferior meatus) = posterior counterpart"],
    0.45, 5.0, 12.4, 1.1, size=14, color=DARK_GREY, bullet=True)

# =============================================================================
# SLIDE 5 – ETIOLOGY & RISK FACTORS
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Etiology & Risk Factors")
footer(slide)

local_causes = [
    "Trauma (nose picking, facial fractures, foreign bodies)",
    "Nasal surgery or procedures",
    "Septal perforation / deviated septum",
    "Rhinitis (allergic, infective, atrophic)",
    "Nasal tumors (benign: juvenile angiofibroma; malignant)",
    "Hereditary Hemorrhagic Telangiectasia (HHT / Osler-Weber-Rendu)",
    "Topical medications (decongestants, steroids – chronic use)",
    "Dry air / low humidity – mucosal desiccation",
    "Intranasal illicit drugs (cocaine – septal damage)",
]
systemic_causes = [
    "Hypertension (does not cause epistaxis but worsens severity/duration)",
    "Anticoagulants: warfarin, heparin, DOACs",
    "Antiplatelet agents: aspirin, clopidogrel, NSAIDs",
    "Coagulopathies: von Willebrand disease, haemophilia, thrombocytopenia",
    "Hepatic disease (coagulation factor deficiency)",
    "Renal failure (uraemic platelet dysfunction)",
    "Systemic infections (influenza, COVID-19 – mucosal inflammation)",
    "Pregnancy (increased nasal vascularity + hormonal effects)",
]
section_card(slide, "LOCAL CAUSES", local_causes,
    0.3, 1.38, 6.1, 5.5, header_color=MID_BLUE, text_size=13)
section_card(slide, "SYSTEMIC / DRUG-RELATED CAUSES", systemic_causes,
    6.55, 1.38, 6.4, 5.5, header_color=RED_ACCENT, text_size=13)

# =============================================================================
# SLIDE 6 – CLASSIFICATION
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Classification of Epistaxis", "Scott-Brown / Clinical Classification")
footer(slide)

# Row 1: Primary vs Secondary
add_rect(slide, 0.3, 1.38, 6.0, 0.4, MID_BLUE)
add_text(slide, "Primary (Idiopathic)", 0.4, 1.38, 5.8, 0.4, size=14, bold=True,
         color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 0.3, 1.78, 6.0, 1.3, WHITE)
add_multiline(slide,
    ["70–80% of all cases — no proven precipitant",
     "Spontaneous bleeds; most common in Little's area",
     "Typically mild, recurrent, responds to first-line tx"],
    0.4, 1.82, 5.7, 1.2, size=14, color=DARK_GREY, bullet=True)

add_rect(slide, 6.8, 1.38, 6.2, 0.4, RED_ACCENT)
add_text(slide, "Secondary (Identifiable Cause)", 6.9, 1.38, 6.0, 0.4, size=14, bold=True,
         color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 6.8, 1.78, 6.2, 1.3, WHITE)
add_multiline(slide,
    ["20–30%: clear cause (trauma, surgery, anticoagulation, tumor)",
     "Requires specific management of underlying etiology",
     "Standard hemostatic techniques may be insufficient"],
    6.9, 1.82, 6.0, 1.2, size=14, color=DARK_GREY, bullet=True)

# Row 2: Anterior vs Posterior
add_rect(slide, 0.3, 3.25, 6.0, 0.4, DARK_BLUE)
add_text(slide, "Anterior Epistaxis (~80%)", 0.4, 3.25, 5.8, 0.4, size=14, bold=True,
         color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 0.3, 3.65, 6.0, 1.5, WHITE)
add_multiline(slide,
    ["Source: Kiesselbach's plexus (Little's area)",
     "Visible on anterior rhinoscopy",
     "Most self-limiting; managed with pressure ± cautery",
     "Better prognosis; rarely life-threatening"],
    0.4, 3.68, 5.7, 1.4, size=14, color=DARK_GREY, bullet=True)

add_rect(slide, 6.8, 3.25, 6.2, 0.4, DARK_BLUE)
add_text(slide, "Posterior Epistaxis (~20%)", 6.9, 3.25, 6.0, 0.4, size=14, bold=True,
         color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 6.8, 3.65, 6.2, 1.5, WHITE)
add_multiline(slide,
    ["Source: posterior to piriform aperture (SPA, Woodruff's plexus)",
     "Often cannot be located on anterior examination",
     "Requires nasal endoscopy for localization",
     "Higher morbidity; may require packing, surgery, or embolization"],
    6.9, 3.68, 6.0, 1.4, size=14, color=DARK_GREY, bullet=True)

# Row 3: Age / Severity
add_rect(slide, 0.3, 5.3, 6.0, 0.4, GOLD)
add_text(slide, "By Age", 0.4, 5.3, 5.8, 0.4, size=14, bold=True,
         color=DARK_GREY, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 0.3, 5.7, 6.0, 1.0, WHITE)
add_multiline(slide,
    ["Childhood (<16 yrs): usually anterior, Kiesselbach's, responds to simple measures",
     "Adult (>16 yrs): bimodal; older adults more likely posterior, systemic factors"],
    0.4, 5.73, 5.7, 0.9, size=14, color=DARK_GREY, bullet=True)

add_rect(slide, 6.8, 5.3, 6.2, 0.4, GOLD)
add_text(slide, "By Severity / Frequency", 6.9, 5.3, 6.0, 0.4, size=14, bold=True,
         color=DARK_GREY, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 6.8, 5.7, 6.2, 1.0, WHITE)
add_multiline(slide,
    ["Recurrent minor: inversely proportional to severity; easily managed",
     "Acute severe: often single episode, hospitalization, high morbidity"],
    6.9, 5.73, 6.0, 0.9, size=14, color=DARK_GREY, bullet=True)

# =============================================================================
# SLIDE 7 – CLINICAL ASSESSMENT
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Clinical Assessment", "History, Examination & Investigations")
footer(slide)

# History
section_card(slide, "HISTORY",
    ["Frequency, duration, severity, side, volume of blood",
     "Precipitating factors: trauma, nose blowing, sneezing, surgery",
     "Associated symptoms: nasal obstruction, facial pain, visual changes",
     "Drug history: anticoagulants, antiplatelets, NSAIDs, nasal sprays, illicit drugs",
     "PMH: hypertension, coagulopathy, liver/renal disease, HHT family history",
     "Prior treatments: packing, cautery, surgical procedures"],
    0.3, 1.38, 6.0, 3.0, header_color=MID_BLUE, text_size=13)

# Examination
section_card(slide, "EXAMINATION",
    ["Vital signs: BP, HR, SpO2 (assess hemodynamic stability)",
     "Anterior rhinoscopy: Thudichum or otoscope; identify Kiesselbach's plexus bleeding",
     "Flexible/rigid nasal endoscopy: gold standard for posterior localization",
     "Oropharynx: check for blood trickling down posterior pharynx",
     "Neck: lymphadenopathy (malignancy?); facial exam for trauma",
     "Look for stigmata of HHT: telangiectasias on lips/tongue/fingers"],
    6.55, 1.38, 6.4, 3.0, header_color=DARK_BLUE, text_size=13)

# Investigations
add_rect(slide, 0.3, 4.55, 12.7, 0.38, RED_ACCENT)
add_text(slide, "INVESTIGATIONS", 0.4, 4.55, 12.5, 0.38,
         size=14, bold=True, color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 0.3, 4.93, 12.7, 1.75, WHITE)
invest_left = [
    "FBC: Hb (anemia), platelets (thrombocytopenia?)",
    "Coagulation screen: PT/INR, aPTT (especially if on anticoagulants)",
    "Group & Save / Crossmatch (if severe/life-threatening bleed)",
]
invest_right = [
    "Renal/liver function: uremia, coagulopathy of liver disease",
    "Imaging: CT angiography if tumor/vascular lesion suspected",
    "DUCG (Dynamic Uncertain Causality Graph): emerging AI-aided diagnostic tool",
]
add_multiline(slide, invest_left, 0.5, 4.97, 6.1, 1.65, size=13, color=DARK_GREY, bullet=True)
add_multiline(slide, invest_right, 6.8, 4.97, 6.1, 1.65, size=13, color=DARK_GREY, bullet=True)

# =============================================================================
# SLIDE 8 – INITIAL MANAGEMENT
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Initial (First-Line) Management", "First-aid & Emergency Department Approach")
footer(slide)

steps = [
    ("STEP 1", "Resuscitation & Stabilization",
     ["Airway, Breathing, Circulation — large bore IV access if haemodynamically compromised",
      "Position: sit upright, lean forward (prevents swallowing blood)",
      "Supplemental oxygen if SpO2 <94% or ongoing blood loss"],
     MID_BLUE),
    ("STEP 2", "Direct Pressure",
     ["Compress the soft cartilaginous (anterior) part of the nose",
      "Sustained pressure for 10–20 minutes — the single most effective first-line measure",
      "Pinch below the bony bridge; ice over nose/neck may reduce bleeding",
      "Instruct patient NOT to blow nose or swallow blood"],
     MID_BLUE),
    ("STEP 3", "Topical Vasoconstrictors / Anaesthesia",
     ["Oxymetazoline 0.05%, xylometazoline, or 1:1000 adrenaline-soaked pledgets",
      "Reduces mucosal bleeding and improves visualization",
      "Lignocaine (lidocaine) 4% or co-phenylcaine spray for anaesthesia prior to examination",
      "Topical tranexamic acid (1g/5mL) – emerging evidence for efficacy"],
     RED_ACCENT),
    ("STEP 4", "Chemical Cautery",
     ["Silver nitrate sticks – preferred method for visible anterior bleeds",
      "Apply to BLEEDING point (not the whole septum)",
      "Do NOT cauterize both sides of the septum simultaneously → perforation risk",
      "Electrocautery (bipolar): reserved for larger/persistent vessels"],
     RED_ACCENT),
]

for i, (step, title, items, color) in enumerate(steps):
    col = i % 2
    row = i // 2
    x = 0.3 + col * 6.5
    y = 1.4 + row * 2.6
    add_rect(slide, x, y, 1.1, 0.5, color)
    add_text(slide, step, x, y, 1.1, 0.5, size=13, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, x+1.1, y, 5.0, 0.5, DARK_BLUE if color == MID_BLUE else RGBColor(0x8B, 0x10, 0x15))
    add_text(slide, title, x+1.15, y, 4.9, 0.5, size=14, bold=True,
             color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, x, y+0.5, 6.1, 2.0, WHITE)
    add_multiline(slide, items, x+0.12, y+0.53, 5.85, 1.9, size=13, color=DARK_GREY, bullet=True)

# =============================================================================
# SLIDE 9 – TREATMENT ALGORITHM / STEPWISE APPROACH
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Stepwise Treatment Algorithm", "Escalating management based on response")
footer(slide)

# Draw algorithm boxes
def algo_box(slide, text, x, y, w=3.8, h=0.65, bg=MID_BLUE, fg=WHITE, size=13):
    add_rect(slide, x, y, w, h, bg)
    add_text(slide, text, x+0.05, y+0.05, w-0.1, h-0.1, size=size, bold=True,
             color=fg, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)

def arrow_down(slide, x, y):
    """Small downward arrow text"""
    add_text(slide, "▼", x, y, 0.4, 0.3, size=14, color=DARK_GREY,
             align=PP_ALIGN.CENTER)

algo_items = [
    (0.5, 1.4, "1. Direct Pressure × 20 min + Vasoconstrictor", MID_BLUE, WHITE),
    (0.5, 2.2, "2. Anterior Rhinoscopy / Nasendoscopy → Identify bleeding point", MID_BLUE, WHITE),
    (0.5, 3.0, "3. Topical Tranexamic Acid / Silver Nitrate Cautery", RGBColor(0x14, 0x75, 0xBB), WHITE),
    (0.5, 3.8, "4. Anterior Nasal Packing (Bismuth-iodoform or Rapid Rhino)", DARK_BLUE, WHITE),
    (0.5, 4.6, "5. Posterior Packing / Foley Catheter Balloon (if posterior bleed)", RED_ACCENT, WHITE),
    (0.5, 5.4, "6. Nasal Endoscopy + Electrocautery of SPA / Anterior Ethmoidal Artery", RED_ACCENT, WHITE),
    (0.5, 6.2, "7. Surgical Ligation (SPA) or Interventional Radiology Embolization", RGBColor(0x80, 0x00, 0x00), WHITE),
]
for x, y, text, bg, fg in algo_items:
    algo_box(slide, text, x, y, w=8.0, h=0.62, bg=bg, fg=fg, size=13)
    if y < 6.2:
        add_text(slide, "▼", 4.1, y+0.62, 0.5, 0.35, size=16, color=DARK_GREY, align=PP_ALIGN.CENTER)

# Side notes
add_rect(slide, 9.0, 1.38, 4.0, 5.5, WHITE)
add_rect(slide, 9.0, 1.38, 4.0, 0.4, GOLD)
add_text(slide, "Key Considerations", 9.05, 1.38, 3.9, 0.4, size=13, bold=True,
         color=DARK_GREY, anchor=MSO_ANCHOR.MIDDLE)
notes = [
    "Always reassess after each step",
    "Haemodynamic instability → resuscitate first",
    "Bilateral simultaneous cautery is CONTRAINDICATED",
    "Packing → prophylactic antibiotics (staph coverage)",
    "Anticoagulants: reverse if life-threatening; bridge therapy decisions are individualized",
    "Coagulopathy: correct before invasive procedures",
    "For HHT: laser, embolization, bevacizumab are options",
    "Paediatric: avoid posterior packing; ENT + PICU involvement",
    "Record all bleeding points and interventions meticulously",
]
add_multiline(slide, notes, 9.08, 1.82, 3.85, 5.0, size=12, color=DARK_GREY, bullet=True, line_spacing=1.2)

# =============================================================================
# SLIDE 10 – PACKING TECHNIQUES
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Nasal Packing Techniques", "Anterior & Posterior Packing — Indications and Methods")
footer(slide)

section_card(slide, "ANTERIOR NASAL PACKING",
    ["Indication: anterior bleed not controlled by cautery",
     "BIPP (Bismuth Iodoform Paraffin Paste) ribbon gauze — traditional",
     "Rapid Rhino / Merocel expandable sponge — easy insertion, less trauma",
     "Inflatable balloon catheters (e.g. Epistat dual balloon)",
     "Duration: typically 24–48 hours; remove in daylight",
     "Complications: sinusitis, toxic shock syndrome (TSS), pressure necrosis",
     "Antibiotics: not universally recommended; consider if prolonged packing"],
    0.3, 1.38, 6.0, 5.5, header_color=MID_BLUE, text_size=13)

section_card(slide, "POSTERIOR NASAL PACKING",
    ["Indication: posterior bleed not amenable to cautery",
     "Traditional: posterior gauze pack + anterior pack → hospital admission mandatory",
     "Foley catheter balloon (14–16 Fr, 10–30 mL) — widely available, rapid",
     "Brighton balloon / Epistat: dual balloon for simultaneous anterior + posterior tamponade",
     "Requires admission, monitoring (hypoxia risk, vasovagal episodes)",
     "Supplemental O2; pulse oximetry monitoring during packing",
     "Consider antibiotics (TSS prophylaxis); remove within 48–72 hours",
     "Failure → escalate to surgical/endovascular intervention"],
    6.55, 1.38, 6.4, 5.5, header_color=DARK_BLUE, text_size=13)

# =============================================================================
# SLIDE 11 – SURGICAL & INTERVENTIONAL OPTIONS
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Advanced Interventions", "Surgical & Endovascular Options")
footer(slide)

section_card(slide, "ENDOSCOPIC CAUTERY / LIGATION",
    ["Endoscopic SPA ligation: gold standard surgical treatment for posterior epistaxis",
     "Success rate: 87–100% for posterior refractory epistaxis",
     "Performed under general or local anaesthesia",
     "Anterior ethmoidal artery ligation: for refractory anterior-superior bleeds",
     "External ethmoidectomy approach or endoscopic depending on anatomy"],
    0.3, 1.38, 6.0, 2.7, header_color=MID_BLUE, text_size=13)

section_card(slide, "INTERVENTIONAL RADIOLOGY (IR) EMBOLIZATION",
    ["Embolization of SPA or internal maxillary artery branches",
     "Indicated for: failed packing + failed/unsuitable surgery; life-threatening bleeds",
     "Requires collaboration with IR team; performed under local anaesthesia",
     "Success rate: ~80–90%; risk of facial/scalp necrosis, CVA (<1%)",
     "Particularly useful in HHT and post-traumatic pseudoaneurysm"],
    6.55, 1.38, 6.4, 2.7, header_color=RED_ACCENT, text_size=13)

section_card(slide, "HEMOSTATIC AGENTS & EMERGING THERAPIES",
    ["Fibrin glue / oxidized cellulose (Surgicel) — topical hemostasis",
     "Tranexamic acid (topical & IV): effective in reducing rebleeding",
     "Bevacizumab (anti-VEGF): for HHT-related recurrent epistaxis",
     "Systemic antifibrinolytics: tranexamic acid PO — first-line for coagulopathic bleeds",
     "Platelet transfusion / FFP: correct specific coagulopathy",
     "Desmopressin (DDAVP): for von Willebrand disease or platelet dysfunction"],
    0.3, 4.25, 6.0, 2.6, header_color=DARK_BLUE, text_size=13)

section_card(slide, "ANTICOAGULATION MANAGEMENT",
    ["Risk-benefit discussion: continuing vs. reversing anticoagulation",
     "Warfarin: vitamin K ± PCC (Prothrombin Complex Concentrate) for major bleed",
     "DOACs (rivaroxaban, apixaban, dabigatran): specific reversal agents available",
     "Aspirin/clopidogrel: generally continue unless bleed is life-threatening",
     "Always involve haematology / cardiology for complex cases",
     "Restart anticoagulation within 7–14 days after control to prevent thromboembolism"],
    6.55, 4.25, 6.4, 2.6, header_color=GOLD, text_size=13)

# =============================================================================
# SLIDE 12 – SPECIAL POPULATIONS
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Special Populations & Recurrence", "Pediatric, HHT, Hypertension, Recurrence Risk")
footer(slide)

section_card(slide, "PAEDIATRIC EPISTAXIS",
    ["Most are anterior / Kiesselbach's; usually idiopathic",
     "First-line: saline irrigation, petroleum jelly moisturisation, avoid nose-picking",
     "Silver nitrate cautery safe in children; unilateral only",
     "Juvenile Nasopharyngeal Angiofibroma: vascular tumor in adolescent males — do NOT pack; refer",
     "Avoid posterior packing in children where possible"],
    0.3, 1.38, 6.0, 3.0, header_color=MID_BLUE, text_size=13)

section_card(slide, "HHT (Hereditary Haemorrhagic Telangiectasia)",
    ["Autosomal dominant; telangiectasias of mucosa, skin, viscera",
     "Recurrent bilateral epistaxis — standard packing often ineffective",
     "Options: laser photocoagulation (KTP, Nd:YAG), topical oestrogen, bevacizumab",
     "Embolization may provide temporary relief",
     "Refer to HHT specialist centre; genetic counselling recommended"],
    6.55, 1.38, 6.4, 3.0, header_color=MID_BLUE, text_size=13)

section_card(slide, "HYPERTENSION & EPISTAXIS",
    ["HTN does NOT cause epistaxis directly but prolongs/worsens bleeding",
     "Treat elevated BP during acute episode (IV labetalol if severely elevated)",
     "Long-term BP control reduces recurrence",
     "Epistaxis itself may temporarily elevate BP (pain, anxiety)"],
    0.3, 4.55, 6.0, 2.3, header_color=RED_ACCENT, text_size=13)

section_card(slide, "RECURRENCE & RISK STRATIFICATION",
    ["Early recurrence (within 30 days) vs. late recurrence (31 days–3 years)",
     "Risk factors for recurrence: anticoagulation, HHT, posterior source, uncontrolled HTN",
     "Written discharge instructions reduce re-attendance rates significantly",
     "Follow-up endoscopy if suspected underlying pathology",
     "Screen for coagulopathy in recurrent childhood epistaxis"],
    6.55, 4.55, 6.4, 2.3, header_color=RED_ACCENT, text_size=13)

# =============================================================================
# SLIDE 13 – PATIENT EDUCATION & PREVENTION
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Patient Education & Prevention", "Reducing Recurrence and Re-attendance")
footer(slide)

# First aid instructions
section_card(slide, "FIRST-AID INSTRUCTIONS (Give verbally AND in writing)",
    ["Sit upright and lean slightly forward",
     "Pinch the soft part of the nose continuously for 10–20 minutes (use a timer)",
     "Breathe through the mouth; spit out any blood",
     "Apply ice pack to nose/back of neck",
     "Do NOT tilt head back — blood may be swallowed or aspirated",
     "Do NOT remove clots prematurely; avoid nose blowing for 24 hours",
     "If bleeding persists after 20 minutes or recurs → attend emergency department"],
    0.3, 1.38, 6.0, 4.0, header_color=RED_ACCENT, text_size=13)

# Prevention
section_card(slide, "PREVENTIVE MEASURES",
    ["Nasal moisturisation: saline sprays, nasal gel (petroleum jelly), humidifier",
     "Avoid nose-picking and trauma; trim fingernails in children",
     "Review all anticoagulant/antiplatelet medications with prescribing physician",
     "Manage underlying conditions: HTN, allergic rhinitis, coagulopathies",
     "Avoid dry environments; increase indoor humidity",
     "Regular follow-up for recurrent epistaxis to identify treatable cause",
     "In HHT: genetic counselling; screen family members",
     "Reduce triggers: smoking cessation (impairs mucosal integrity)"],
    6.55, 1.38, 6.4, 4.0, header_color=MID_BLUE, text_size=13)

# Discharge checklist
add_rect(slide, 0.3, 5.55, 12.7, 0.38, GOLD)
add_text(slide, "Discharge Checklist", 0.4, 5.55, 12.5, 0.38,
         size=14, bold=True, color=DARK_GREY, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 0.3, 5.93, 12.7, 1.25, WHITE)
discharge = [
    "Verbal + written instructions given",
    "Underlying cause identified and addressed",
    "Anticoagulation plan documented",
    "ENT follow-up arranged if recurrent / posterior / unexplained bleed",
    "Emergency re-attendance threshold clearly communicated to patient",
]
add_multiline(slide, discharge, 0.45, 5.96, 12.5, 1.15, size=13, color=DARK_GREY, bullet=True)

# =============================================================================
# SLIDE 14 – KEY TAKEAWAYS
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Key Takeaways & Clinical Pearls")
footer(slide)

takeaways = [
    ("1", "80% anterior (Kiesselbach's plexus); 20% posterior (SPA/Woodruff's) — localize first"),
    ("2", "Direct pressure for 20 minutes is the single most effective first-line intervention"),
    ("3", "70–80% are idiopathic (primary); always exclude secondary causes in recurrent/severe cases"),
    ("4", "Nasendoscopy is the gold standard to localize posterior bleeds — do not rely on palpation"),
    ("5", "Cauterize only the identified bleeding point; NEVER both sides of septum simultaneously"),
    ("6", "Posterior packing requires hospital admission with O2 monitoring — vasovagal/hypoxia risk"),
    ("7", "Endoscopic SPA ligation: gold standard surgical option — 87–100% success for posterior bleeds"),
    ("8", "Always individualize anticoagulation reversal: balance bleeding risk vs. thrombosis risk"),
    ("9", "HHT: standard packing often fails; bevacizumab and laser are evidence-based options"),
    ("10", "Written patient education at discharge significantly reduces re-attendance rates"),
]

for i, (num, text) in enumerate(takeaways):
    y_pos = 1.42 + i * 0.57
    add_rect(slide, 0.3, y_pos, 0.55, 0.48, MID_BLUE if i % 2 == 0 else DARK_BLUE)
    add_text(slide, num, 0.3, y_pos, 0.55, 0.48, size=16, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    bg_col = WHITE if i % 2 == 0 else LIGHT_GREY
    add_rect(slide, 0.85, y_pos, 12.2, 0.48, bg_col)
    add_text(slide, text, 0.95, y_pos+0.04, 12.0, 0.42,
             size=14, color=DARK_GREY, anchor=MSO_ANCHOR.MIDDLE)

# =============================================================================
# SLIDE 15 – CONCLUSION & REFERENCES
# =============================================================================
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
add_rect(slide, 0, 1.3, 13.333, 0.07, RED_ACCENT)
add_rect(slide, 0, 6.2, 13.333, 0.07, GOLD)

add_text(slide, "Conclusion", 1.0, 0.2, 11.5, 0.9,
         size=32, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

conclusions = [
    "Epistaxis is common but management requires a systematic, stepwise approach",
    "Accurate anatomical knowledge (ECA/ICA, Kiesselbach's, SPA) guides targeted intervention",
    "Patient education with verbal AND written instructions is essential at every encounter",
    "Most cases resolve with conservative measures; escalate judiciously",
    "Interdisciplinary collaboration (ENT, IR, haematology) is key in complex cases",
]
add_multiline(slide, conclusions, 1.0, 1.5, 11.2, 3.5, size=16,
              color=RGBColor(0xDD, 0xEE, 0xFF), bullet=True, line_spacing=1.3)

add_rect(slide, 0.5, 5.1, 12.5, 0.38, MID_BLUE)
add_text(slide, "Source Article", 0.6, 5.1, 12.3, 0.38, size=13, bold=True,
         color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
add_rect(slide, 0.5, 5.48, 12.5, 1.5, RGBColor(0x0A, 0x1F, 0x40))
refs = [
    "Chowdhury R, Turkdogan S, Silver JA, Hier J, Bursey S, Quttaineh D, Khoury M, Himdi L.",
    "Approach to Epistaxis. J Otorhinolaryngol Hear Balance Med. 2024;5(2):21.",
    "DOI: 10.3390/ohbm5020021 | Published: 23 December 2024",
    "",
    "Additional sources: Scott-Brown's Otorhinolaryngology HNS (8th ed.), Cummings Otolaryngology (7th ed.)",
]
add_multiline(slide, refs, 0.6, 5.5, 12.3, 1.4, size=12,
              color=RGBColor(0xAA, 0xCC, 0xEE), bullet=False, line_spacing=1.15)

# =============================================================================
# SAVE
# =============================================================================
from io import BytesIO
buf = BytesIO()
prs.save(buf)
with open("/tmp/workspace/epistaxis-ppt/Approach_to_Epistaxis_Journal_PPT.pptx", "wb") as f:
    f.write(buf.getvalue())

print("DONE — saved to /tmp/workspace/epistaxis-ppt/Approach_to_Epistaxis_Journal_PPT.pptx")