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
from pptx.oxml.ns import qn
from pptx.oxml import parse_xml
from lxml import etree
import copy
from io import BytesIO

# ─────────────────────────────────────────
# CONSTANTS
# ─────────────────────────────────────────
SLIDE_W = Inches(13.333)
SLIDE_H = Inches(7.5)

# Color palette
C_DARK_BLUE  = RGBColor(0x0D, 0x3B, 0x6E)   # deep navy – header bg
C_ACCENT     = RGBColor(0x1A, 0x78, 0xC2)   # bright blue – title text / bullets
C_LIGHT_BG   = RGBColor(0xF0, 0xF6, 0xFF)   # very light blue – slide bg
C_WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
C_BLACK      = RGBColor(0x1A, 0x1A, 0x1A)
C_GOLD       = RGBColor(0xD4, 0xA0, 0x17)   # gold accent for title slide
C_BOX_BG     = RGBColor(0xE8, 0xF2, 0xFF)   # light blue box background
C_BOX_BORDER = RGBColor(0x1A, 0x78, 0xC2)   # box border
C_HEADER_TXT = RGBColor(0xFF, 0xFF, 0xFF)   # white text on dark header

FONT = "Times New Roman"
BODY_SIZE = Pt(23)
TITLE_SIZE = Pt(28)
HEADER_SIZE = Pt(30)
SMALL_SIZE = Pt(20)

prs = Presentation()
prs.slide_width = SLIDE_W
prs.slide_height = SLIDE_H
blank_layout = prs.slide_layouts[6]

# ─────────────────────────────────────────
# HELPER FUNCTIONS
# ─────────────────────────────────────────

def add_rect(slide, x, y, w, h, fill_rgb=None, border_rgb=None, border_pt=1.5):
    shape = slide.shapes.add_shape(1, x, y, w, h)  # MSO_SHAPE_TYPE.RECTANGLE = 1
    fill = shape.fill
    if fill_rgb:
        fill.solid()
        fill.fore_color.rgb = fill_rgb
    else:
        fill.background()
    line = shape.line
    if border_rgb:
        line.color.rgb = border_rgb
        line.width = Pt(border_pt)
    else:
        line.fill.background()
    return shape

def add_textbox(slide, x, y, w, h, text, font_size=BODY_SIZE, bold=False,
                color=C_BLACK, align=PP_ALIGN.LEFT, word_wrap=True,
                v_anchor=MSO_ANCHOR.TOP):
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = word_wrap
    tf.vertical_anchor = v_anchor
    tf.margin_left = Inches(0.05)
    tf.margin_right = Inches(0.05)
    tf.margin_top = Inches(0.05)
    tf.margin_bottom = Inches(0.05)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.name = FONT
    run.font.size = font_size
    run.font.bold = bold
    run.font.color.rgb = color
    return tb

def add_slide_background(slide, color=C_LIGHT_BG):
    bg = add_rect(slide, 0, 0, SLIDE_W, SLIDE_H, fill_rgb=color)

def add_header_bar(slide, title_text):
    """Dark blue header bar with white title text."""
    bar = add_rect(slide, 0, 0, SLIDE_W, Inches(1.1), fill_rgb=C_DARK_BLUE)
    tb = slide.shapes.add_textbox(Inches(0.3), Inches(0.05), Inches(12.5), Inches(1.0))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    p = tf.paragraphs[0]
    p.alignment = PP_ALIGN.LEFT
    run = p.add_run()
    run.text = title_text
    run.font.name = FONT
    run.font.size = TITLE_SIZE
    run.font.bold = True
    run.font.color.rgb = C_WHITE

def add_slide_number(slide, num):
    """Slide number bottom right."""
    tb = slide.shapes.add_textbox(Inches(12.5), Inches(7.1), Inches(0.8), Inches(0.35))
    tf = tb.text_frame
    p = tf.paragraphs[0]
    p.alignment = PP_ALIGN.RIGHT
    run = p.add_run()
    run.text = str(num)
    run.font.name = FONT
    run.font.size = Pt(18)
    run.font.bold = False
    run.font.color.rgb = C_DARK_BLUE

def add_bullet_textbox(slide, x, y, w, h, bullets, font_size=BODY_SIZE,
                       color=C_BLACK, bold_first=False, indent=False):
    """Add a textbox with multiple bullet lines."""
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = True
    tf.vertical_anchor = MSO_ANCHOR.TOP
    tf.margin_left = Inches(0.08)
    tf.margin_right = Inches(0.05)
    tf.margin_top = Inches(0.05)
    tf.margin_bottom = Inches(0.05)
    for i, bullet in enumerate(bullets):
        if i == 0:
            p = tf.paragraphs[0]
        else:
            p = tf.add_paragraph()
        p.alignment = PP_ALIGN.LEFT
        p.space_before = Pt(4)
        if indent:
            p.level = 1
        run = p.add_run()
        run.text = bullet
        run.font.name = FONT
        run.font.size = font_size
        run.font.bold = (bold_first and i == 0)
        run.font.color.rgb = color
    return tb

def add_boxed_section(slide, x, y, w, h, title, bullets, title_color=C_WHITE,
                       box_fill=C_BOX_BG, title_fill=C_ACCENT, font_size=BODY_SIZE):
    """Titled box with bullet points inside."""
    # Title bar
    add_rect(slide, x, y, w, Inches(0.42), fill_rgb=title_fill)
    tb_title = slide.shapes.add_textbox(x + Inches(0.1), y + Inches(0.02),
                                         w - Inches(0.2), Inches(0.4))
    tf = tb_title.text_frame
    p = tf.paragraphs[0]
    run = p.add_run()
    run.text = title
    run.font.name = FONT
    run.font.size = Pt(22)
    run.font.bold = True
    run.font.color.rgb = title_color
    # Content box
    content_h = h - Inches(0.42)
    add_rect(slide, x, y + Inches(0.42), w, content_h,
              fill_rgb=box_fill, border_rgb=C_BOX_BORDER, border_pt=1.0)
    add_bullet_textbox(slide, x + Inches(0.15), y + Inches(0.48),
                        w - Inches(0.25), content_h - Inches(0.1),
                        bullets, font_size=font_size)

def add_image(slide, img_path, x, y, w, h):
    try:
        slide.shapes.add_picture(img_path, x, y, w, h)
    except Exception as e:
        print(f"Image error: {e}")

def make_slide(num, header_title, content_fn):
    slide = prs.slides.add_slide(blank_layout)
    add_slide_background(slide)
    add_header_bar(slide, header_title)
    content_fn(slide)
    add_slide_number(slide, num)
    return slide

# ─────────────────────────────────────────────────────────────
# SLIDE 1 – TITLE / JOURNAL CLUB INFO
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout)
# Full dark background
add_rect(slide, 0, 0, SLIDE_W, SLIDE_H, fill_rgb=C_DARK_BLUE)
# Gold accent strip
add_rect(slide, 0, Inches(1.9), SLIDE_W, Inches(0.06), fill_rgb=C_GOLD)
add_rect(slide, 0, Inches(5.7), SLIDE_W, Inches(0.06), fill_rgb=C_GOLD)

# JOURNAL CLUB header
tb = slide.shapes.add_textbox(Inches(0.5), Inches(0.2), Inches(12.3), Inches(0.55))
tf = tb.text_frame; p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER
run = p.add_run(); run.text = "JOURNAL CLUB PRESENTATION"
run.font.name = FONT; run.font.size = Pt(24); run.font.bold = True; run.font.color.rgb = C_GOLD

# Main title
tb2 = slide.shapes.add_textbox(Inches(0.4), Inches(2.05), Inches(12.5), Inches(1.7))
tf2 = tb2.text_frame; tf2.word_wrap = True; p2 = tf2.paragraphs[0]
p2.alignment = PP_ALIGN.CENTER
run2 = p2.add_run()
run2.text = "Efficacy of Intralesional Platelet-Rich Plasma in Treatment of Fingernail Onychomycosis:"
run2.font.name = FONT; run2.font.size = Pt(30); run2.font.bold = True; run2.font.color.rgb = C_WHITE
p2b = tf2.add_paragraph(); p2b.alignment = PP_ALIGN.CENTER
run2b = p2b.add_run(); run2b.text = "A Randomized Controlled Trial"
run2b.font.name = FONT; run2b.font.size = Pt(30); run2b.font.bold = True; run2b.font.color.rgb = C_GOLD

# Article details box
details = [
    ("Authors:", "Reem E. Ali, Mohammed Abu El-Hamd, Amr Abdelhamed, Mohamad A. Elsuity, Ramadan Saleh"),
    ("Journal:", "Dermatology Practical & Conceptual | Volume 16(2) | 2026"),
    ("Place of Study:", "Sohag University, Sohag, Egypt"),
    ("Type of Study:", "Single-blind Randomized Controlled Trial (RCT)"),
    ("DOI:", "10.5826/dpc.1602a6129"),
]
y_pos = Inches(3.85)
for label, value in details:
    tb_l = slide.shapes.add_textbox(Inches(1.0), y_pos, Inches(2.5), Inches(0.38))
    tf_l = tb_l.text_frame; p_l = tf_l.paragraphs[0]
    run_l = p_l.add_run(); run_l.text = label
    run_l.font.name = FONT; run_l.font.size = Pt(21); run_l.font.bold = True; run_l.font.color.rgb = C_GOLD

    tb_v = slide.shapes.add_textbox(Inches(3.6), y_pos, Inches(9.0), Inches(0.38))
    tf_v = tb_v.text_frame; tf_v.word_wrap = True; p_v = tf_v.paragraphs[0]
    run_v = p_v.add_run(); run_v.text = value
    run_v.font.name = FONT; run_v.font.size = Pt(21); run_v.font.bold = False; run_v.font.color.rgb = C_WHITE
    y_pos += Inches(0.42)

# Presenter / Moderator
add_rect(slide, Inches(0.5), Inches(5.85), Inches(5.8), Inches(1.35), fill_rgb=RGBColor(0x1A, 0x4A, 0x8C))
add_rect(slide, Inches(7.0), Inches(5.85), Inches(5.8), Inches(1.35), fill_rgb=RGBColor(0x1A, 0x4A, 0x8C))

for box_x, role, name in [(Inches(0.5), "PRESENTER", "Dr. Anuj Jain"), (Inches(7.0), "MODERATOR", "Dr. K.S. Dhillon")]:
    tb_r = slide.shapes.add_textbox(box_x + Inches(0.15), Inches(5.92), Inches(5.5), Inches(0.4))
    tf_r = tb_r.text_frame; p_r = tf_r.paragraphs[0]; p_r.alignment = PP_ALIGN.CENTER
    run_r = p_r.add_run(); run_r.text = role
    run_r.font.name = FONT; run_r.font.size = Pt(20); run_r.font.bold = True; run_r.font.color.rgb = C_GOLD
    tb_n = slide.shapes.add_textbox(box_x + Inches(0.15), Inches(6.38), Inches(5.5), Inches(0.45))
    tf_n = tb_n.text_frame; p_n = tf_n.paragraphs[0]; p_n.alignment = PP_ALIGN.CENTER
    run_n = p_n.add_run(); run_n.text = name
    run_n.font.name = FONT; run_n.font.size = Pt(24); run_n.font.bold = True; run_n.font.color.rgb = C_WHITE

add_slide_number(slide, 1)

# ─────────────────────────────────────────────────────────────
# SLIDE 2 – TABLE OF CONTENTS / OVERVIEW
# ─────────────────────────────────────────────────────────────
def s2(slide):
    toc = [
        "1.  Introduction",
        "2.  Objectives",
        "3.  Patients & Methods  (Ethical Considerations, Study Design, Sample Size,",
        "    Randomization, Pre-intervention Evaluation, Intervention, Follow-up, Statistics)",
        "4.  EDC Exposure Characteristics",
        "5.  Results  (Study Population, Baseline, Nail Characteristics, OSI,",
        "    Paronychia, Dermoscopy, KOH/Culture, Cure Rates, Adverse Outcomes, Predictors)",
        "6.  Discussion",
        "7.  Conclusions",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.6), Inches(6.1),
                        toc, font_size=Pt(24), color=C_BLACK)
make_slide(2, "Overview / Table of Contents", s2)

# ─────────────────────────────────────────────────────────────
# SLIDE 3 – INTRODUCTION (1)
# ─────────────────────────────────────────────────────────────
def s3(slide):
    pts = [
        "• Onychomycosis is the most common nail disorder worldwide",
        "• Prevalence ~5.5%; responsible for up to 50% of all nail diseases",
        "• Causative organisms: dermatophytes, non-dermatophyte molds (NDMs), yeasts",
        "• Mixed infections increasingly detected in recent studies",
        "• Treatment is challenging: lengthy, expensive, and often unsuccessful",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.6), Inches(5.8),
                        pts, font_size=BODY_SIZE)
make_slide(3, "Introduction", s3)

# ─────────────────────────────────────────────────────────────
# SLIDE 4 – INTRODUCTION (2) – Challenges of Treatment
# ─────────────────────────────────────────────────────────────
def s4(slide):
    pts = [
        "• Relapse rate of onychomycosis ranges from 10% to 53%",
        "• Systemic antifungal side effects include:",
        "   – GI upset (7–17.7%), dermatological rashes (4–9.5%)",
        "   – Headache (7.2–12.9%), asymptomatic liver enzyme elevation (3.3%)",
        "   – Significant drug-drug interactions",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.6), Inches(3.5),
                        pts, font_size=BODY_SIZE)
    # Box for treatment need
    add_boxed_section(slide, Inches(0.5), Inches(4.8), Inches(12.0), Inches(2.35),
                      "Clinical Need",
                      ["There is a clear need for alternative, effective, safe treatment options",
                       "for patients who fail or cannot tolerate oral antifungals"])
make_slide(4, "Introduction (contd.)", s4)

# ─────────────────────────────────────────────────────────────
# SLIDE 5 – INTRODUCTION (3) – PRP Background
# ─────────────────────────────────────────────────────────────
def s5(slide):
    pts = [
        "• PRP = portion of plasma with higher platelet concentration after centrifugation",
        "• Platelets play a fundamental role in antimicrobial host defense mechanisms:",
        "   – Chemotactic responses to inflammatory mediators",
        "   – Express immunological receptors for antibodies and complement proteins",
        "   – Generate oxygen metabolites with antimicrobial properties",
        "• PRP contains high concentration of neutrophils → release myeloperoxidase",
        "   (antibacterial and antifungal properties)",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.6), Inches(5.8),
                        pts, font_size=BODY_SIZE)
make_slide(5, "Introduction – PRP & Antimicrobial Properties", s5)

# ─────────────────────────────────────────────────────────────
# SLIDE 6 – INTRODUCTION (4) – Prior PRP Antifungal Evidence
# ─────────────────────────────────────────────────────────────
def s6(slide):
    # Flow showing prior evidence
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.45),
                "Prior Evidence for Antifungal Role of PRP:", font_size=Pt(25), bold=True, color=C_ACCENT)

    boxes = [
        ("In vitro / Animal",   "Antifungal activity against lymphocutaneous sporotrichosis"),
        ("Periodontal",         "Inhibited C. albicans periodontal infections"),
        ("Wound Healing",       "Promoted healing of C. albicans-infected burn wounds"),
        ("Warts",               "Successfully used in recalcitrant plane & plantar warts"),
    ]
    x_starts = [Inches(0.4), Inches(3.6), Inches(6.8), Inches(10.0)]
    for i, (title, desc) in enumerate(boxes):
        bx = x_starts[i]
        add_rect(slide, bx, Inches(1.85), Inches(3.0), Inches(0.45), fill_rgb=C_ACCENT)
        add_textbox(slide, bx + Inches(0.05), Inches(1.88), Inches(2.9), Inches(0.42),
                    title, font_size=Pt(21), bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)
        add_rect(slide, bx, Inches(2.3), Inches(3.0), Inches(1.5), fill_rgb=C_BOX_BG, border_rgb=C_BOX_BORDER)
        add_textbox(slide, bx + Inches(0.08), Inches(2.38), Inches(2.84), Inches(1.35),
                    desc, font_size=Pt(21), color=C_BLACK)

    add_textbox(slide, Inches(0.5), Inches(4.05), Inches(12.3), Inches(0.45),
                "Gap in Evidence:", font_size=Pt(25), bold=True, color=C_ACCENT)
    pts = [
        "• Only a FEW studies have explored the antifungal role of PRP in nail disease",
        "• No prior RCT investigating intralesional PRP for fingernail onychomycosis",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(4.6), Inches(12.3), Inches(1.5),
                        pts, font_size=BODY_SIZE)
make_slide(6, "Introduction – Prior Evidence", s6)

# ─────────────────────────────────────────────────────────────
# SLIDE 7 – OBJECTIVE
# ─────────────────────────────────────────────────────────────
def s7(slide):
    add_rect(slide, Inches(1.5), Inches(1.5), Inches(10.3), Inches(1.5), fill_rgb=C_ACCENT)
    add_textbox(slide, Inches(1.6), Inches(1.55), Inches(10.1), Inches(1.4),
                "To investigate the efficacy of intralesional PRP in the treatment\nof fingernail onychomycosis as compared to oral terbinafine",
                font_size=Pt(26), bold=True, color=C_WHITE, align=PP_ALIGN.CENTER,
                v_anchor=MSO_ANCHOR.MIDDLE)

    add_textbox(slide, Inches(0.5), Inches(3.2), Inches(12.3), Inches(0.42),
                "Secondary Aims:", font_size=Pt(25), bold=True, color=C_ACCENT)
    sec = [
        "• Assess whether combination of PRP + terbinafine is superior to either alone",
        "• Evaluate improvement in dermoscopic features, paronychia, and mycological cure",
        "• Identify predictors of OSI improvement",
        "• Clarify the potential antifungal role of PRP in clinical practice",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(3.7), Inches(12.3), Inches(3.3),
                        sec, font_size=BODY_SIZE)
make_slide(7, "Objectives", s7)

# ─────────────────────────────────────────────────────────────
# SLIDE 8 – ETHICAL CONSIDERATIONS
# ─────────────────────────────────────────────────────────────
def s8(slide):
    pts = [
        "• Approved by Research Ethics Committee, Faculty of Medicine, Sohag University",
        "   IRB Number: Soh-Med-21-11-21",
        "• Prospectively registered at ClinicalTrials.gov",
        "   Registration Number: NCT05128916",
        "• Written informed consent obtained from ALL participants",
        "• Study ethical guidance compatible with Declaration of Helsinki",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.6), Inches(5.8),
                        pts, font_size=BODY_SIZE)
make_slide(8, "Ethical Considerations", s8)

# ─────────────────────────────────────────────────────────────
# SLIDE 9 – STUDY DESIGN & INCLUSION CRITERIA
# ─────────────────────────────────────────────────────────────
def s9(slide):
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Study Design:", font_size=Pt(25), bold=True, color=C_ACCENT)
    add_textbox(slide, Inches(0.5), Inches(1.65), Inches(12.3), Inches(0.42),
                "Single-blind Randomized Controlled Clinical Trial (RCT) — Dermatology outpatient clinic",
                font_size=BODY_SIZE)

    add_textbox(slide, Inches(0.5), Inches(2.15), Inches(5.9), Inches(0.42),
                "Inclusion Criteria:", font_size=Pt(25), bold=True, color=C_ACCENT)
    inc = [
        "• Adults aged ≥18 years",
        "• Fingernail onychomycosis confirmed by:",
        "   – Dermoscopy",
        "   – Direct KOH microscopic exam",
        "   – Positive fungal culture",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(2.6), Inches(5.9), Inches(3.5),
                        inc, font_size=BODY_SIZE)

    add_textbox(slide, Inches(6.8), Inches(2.15), Inches(6.0), Inches(0.42),
                "Exclusion Criteria:", font_size=Pt(25), bold=True, color=C_ACCENT)
    exc = [
        "• Pregnant / lactating females",
        "• Antifungal therapy in prior 3 months",
        "• Impaired liver or renal functions",
        "• Anemia (Hb <10 mg/dl)",
        "• Thrombocytopenia (<100,000/μL)",
        "• Coagulopathies / anticoagulant therapy",
        "• Iron deficiency",
    ]
    add_bullet_textbox(slide, Inches(6.8), Inches(2.6), Inches(6.0), Inches(4.0),
                        exc, font_size=BODY_SIZE)
make_slide(9, "Study Design & Inclusion / Exclusion Criteria", s9)

# ─────────────────────────────────────────────────────────────
# SLIDE 10 – SAMPLE SIZE
# ─────────────────────────────────────────────────────────────
def s10(slide):
    pts = [
        "• Software: G*Power version 3.1.9.6 (Heinrich Heine University, Düsseldorf, Germany)",
        "• Effect size: 0.5 (moderate) between three study groups",
        "• Confidence Interval: 95%",
        "• Power: 90%",
        "• Minimum required sample size: 54 participants",
        "• Planned recruitment: ≥70 patients (accounting for ~30% expected dropout rate)",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.6), Inches(5.6),
                        pts, font_size=BODY_SIZE)
make_slide(10, "Sample Size Calculation", s10)

# ─────────────────────────────────────────────────────────────
# SLIDE 11 – STUDY GROUPS, RANDOMIZATION & BLINDING
# ─────────────────────────────────────────────────────────────
def s11(slide):
    # 3 group boxes
    groups = [
        ("Group 1\nTerbinafine", "Oral terbinafine\n250 mg daily\nfor 3 months\n(Control group)"),
        ("Group 2\nPRP", "Intralesional PRP\n6 sessions\nevery 2 weeks\n(3 months)"),
        ("Group 3\nPRP + Terbinafine", "Intralesional PRP\n+\nOral terbinafine\n250 mg daily"),
    ]
    for i, (title, desc) in enumerate(groups):
        bx = Inches(0.5 + i * 4.2)
        add_rect(slide, bx, Inches(1.3), Inches(3.8), Inches(0.52), fill_rgb=C_DARK_BLUE)
        add_textbox(slide, bx + Inches(0.05), Inches(1.32), Inches(3.7), Inches(0.5),
                    title, font_size=Pt(23), bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)
        add_rect(slide, bx, Inches(1.82), Inches(3.8), Inches(1.9), fill_rgb=C_BOX_BG, border_rgb=C_BOX_BORDER)
        add_textbox(slide, bx + Inches(0.1), Inches(1.9), Inches(3.6), Inches(1.8),
                    desc, font_size=Pt(22), color=C_BLACK, align=PP_ALIGN.CENTER)

    add_textbox(slide, Inches(0.5), Inches(3.85), Inches(12.3), Inches(0.42),
                "Randomization:", font_size=Pt(25), bold=True, color=C_ACCENT)
    rand_pts = [
        "• 1:1:1 allocation ratio via computer-generated list (permuted block size 15)",
        "• Generated at: www.sealedenvelope.com",
        "• Results sealed in opaque envelopes labelled with unique random codes",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(4.35), Inches(12.3), Inches(1.4),
                        rand_pts, font_size=BODY_SIZE)

    add_textbox(slide, Inches(0.5), Inches(5.85), Inches(12.3), Inches(0.42),
                "Blinding:  Single-blind — Outcome assessed by 2 blinded investigators (A & B); patient & treating investigator NOT blinded (nature of intervention)",
                font_size=Pt(22), color=C_BLACK)
make_slide(11, "Study Groups, Randomization & Blinding", s11)

# ─────────────────────────────────────────────────────────────
# SLIDE 12 – PRE-INTERVENTION EVALUATION (1)
# ─────────────────────────────────────────────────────────────
def s12(slide):
    items = [
        ("Medical History", "Detailed history including duration, previous treatments, family history, comorbidities"),
        ("Physical Examination", "No. of affected fingers; type of onychomycosis; extent of nail affection; nail changes: thickening, discoloration, deformity, pain, onycholysis; periungual tissue for paronychia"),
        ("OSI Score", "Onychomycosis Severity Index for each nail:\n  Area score (0–5) × Proximity to matrix (1–5)\n  +10 if longitudinal streak/patch or >2mm subungual hyperkeratosis\n  Mild: 1–5 | Moderate: 6–15 | Severe: 16–35"),
    ]
    y = Inches(1.2)
    for title, desc in items:
        add_rect(slide, Inches(0.4), y, Inches(2.5), Inches(1.1), fill_rgb=C_ACCENT)
        add_textbox(slide, Inches(0.45), y + Inches(0.1), Inches(2.4), Inches(1.0),
                    title, font_size=Pt(23), bold=True, color=C_WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
        add_rect(slide, Inches(2.9), y, Inches(10.0), Inches(1.1), fill_rgb=C_BOX_BG, border_rgb=C_BOX_BORDER)
        add_textbox(slide, Inches(3.0), y + Inches(0.08), Inches(9.8), Inches(1.0),
                    desc, font_size=Pt(22), color=C_BLACK)
        y += Inches(1.2)
make_slide(12, "Pre-Intervention Patient Evaluation", s12)

# ─────────────────────────────────────────────────────────────
# SLIDE 13 – PRE-INTERVENTION EVALUATION (2) – Dermoscopy & KOH
# ─────────────────────────────────────────────────────────────
def s13(slide):
    items = [
        ("Dermoscopic Evaluation",
         "Contact, polarized, non-immersion dermoscopy (DermLite DL4, FotoFinder, Germany)\n"
         "Signs assessed: fringing at proximal border of onycholysis, longitudinal striae\n"
         "of yellow-orange-brown discoloration, subungual hyperkeratosis in ruin-like appearance"),
        ("Direct KOH Microscopy",
         "Nail scrapings collected, placed on glass slide\n"
         "3 drops of 10% KOH + 40% DMSO added\n"
         "Positive: round-to-oval budding cells, septate or aseptate hyphae"),
        ("Fungal Culture",
         "Nail specimens inoculated in Sabouraud dextrose agar:\n"
         "  (1) With 5% chloramphenicol alone\n"
         "  (2) With cycloheximide (Microxpress, Verna, India)\n"
         "Purpose: Organism identification"),
    ]
    y = Inches(1.2)
    for title, desc in items:
        add_rect(slide, Inches(0.4), y, Inches(2.9), Inches(1.3), fill_rgb=C_ACCENT)
        add_textbox(slide, Inches(0.45), y + Inches(0.1), Inches(2.8), Inches(1.2),
                    title, font_size=Pt(22), bold=True, color=C_WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
        add_rect(slide, Inches(3.35), y, Inches(9.65), Inches(1.3), fill_rgb=C_BOX_BG, border_rgb=C_BOX_BORDER)
        add_textbox(slide, Inches(3.45), y + Inches(0.08), Inches(9.45), Inches(1.2),
                    desc, font_size=Pt(22), color=C_BLACK)
        y += Inches(1.45)
make_slide(13, "Pre-Intervention Evaluation – Dermoscopy, KOH & Culture", s13)

# ─────────────────────────────────────────────────────────────
# SLIDE 14 – INTERVENTION & PROCEDURES
# ─────────────────────────────────────────────────────────────
def s14(slide):
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "PRP Preparation:", font_size=Pt(25), bold=True, color=C_ACCENT)
    prp_pts = [
        "• 2 mL of blood per nail drawn → evacuated into Prothrombin time tubes (3.2% sodium citrate)",
        "• Centrifuged at 300 G-force (~1500 RPM) for 10 minutes",
        "• Supernatant (upper third) removed → middle third (PRP) aspirated for injection",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.65), Inches(12.3), Inches(1.7),
                        prp_pts, font_size=BODY_SIZE)

    add_textbox(slide, Inches(0.5), Inches(3.45), Inches(12.3), Inches(0.42),
                "PRP Injection Protocol:", font_size=Pt(25), bold=True, color=C_ACCENT)
    inj_pts = [
        "• Proximal nerve block: 2 mL mepivacaine HCl 3% per finger",
        "• 6 PRP injections per session (0.1 mL each):",
        "   – 1 at proximal nail fold, 1 at hyponychium, 2 at each lateral nail fold",
        "• Sessions: every 2 weeks × 6 sessions = 12 weeks (3 months) total",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(3.9), Inches(12.3), Inches(2.1),
                        inj_pts, font_size=BODY_SIZE)

    add_textbox(slide, Inches(0.5), Inches(6.1), Inches(12.3), Inches(0.42),
                "Oral Terbinafine (terbinafine & PRP+terbinafine groups): 250 mg daily immediately after fatty meal for 3 months",
                font_size=BODY_SIZE, color=C_BLACK)
make_slide(14, "Intervention & Procedures", s14)

# ─────────────────────────────────────────────────────────────
# SLIDE 15 – FOLLOW UP
# ─────────────────────────────────────────────────────────────
def s15(slide):
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Follow-up Duration: 3 months treatment + 3 months follow-up = 6 months total",
                font_size=Pt(25), bold=True, color=C_ACCENT)

    # Timeline
    months = ["Month 1", "Month 2", "Month 3\n(End Tx)", "Month 4", "Month 5", "Month 6\n(End F/U)"]
    for i, m in enumerate(months):
        bx = Inches(0.5 + i * 2.05)
        col = C_DARK_BLUE if i in [2, 5] else C_ACCENT
        add_rect(slide, bx, Inches(1.85), Inches(1.85), Inches(0.62), fill_rgb=col)
        add_textbox(slide, bx + Inches(0.05), Inches(1.87), Inches(1.75), Inches(0.6),
                    m, font_size=Pt(20), bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)
        if i < 5:
            add_textbox(slide, bx + Inches(1.85), Inches(2.0), Inches(0.25), Inches(0.35),
                        "→", font_size=Pt(24), bold=True, color=C_ACCENT)

    add_textbox(slide, Inches(0.5), Inches(2.7), Inches(12.3), Inches(0.42),
                "Assessment Tools:", font_size=Pt(25), bold=True, color=C_ACCENT)
    assess = [
        "• PRIMARY OUTCOME: Improvement in OSI score at end of treatment and end of follow-up (per affected nail)",
        "• Clinical cure: >90% clearance of previously affected nail plate",
        "• Mycological cure: Negative KOH examination + negative culture",
        "• Complete cure: Clinical cure + mycological cure",
        "• Safety: Patient-Reported Adverse Outcomes (PRAO); pain assessed by Numerical Rating Scale (NRS 0–10)",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(3.2), Inches(12.3), Inches(3.8),
                        assess, font_size=BODY_SIZE)
make_slide(15, "Follow-Up & Assessment", s15)

# ─────────────────────────────────────────────────────────────
# SLIDE 16 – STATISTICAL ANALYSIS
# ─────────────────────────────────────────────────────────────
def s16(slide):
    rows = [
        ("Data Recording", "Microsoft 365 Excel (Microsoft Co., Massachusetts, USA)"),
        ("Statistical Software", "Posit Cloud R program (Posit PBC, Boston, USA)"),
        ("Continuous Variables", "Presented as median ± IQR; compared using Kruskal-Wallis rank sum test (non-normal distribution)"),
        ("Categorical Variables", "Presented as frequencies & percentages; compared by Pearson chi-square or Fisher's exact test"),
        ("Regression Analysis", "Univariate & multivariate generalized linear regression to identify predictors of primary outcome"),
        ("Significance", "p-value <0.05 considered statistically significant"),
    ]
    y = Inches(1.2)
    for label, val in rows:
        add_rect(slide, Inches(0.4), y, Inches(3.2), Inches(0.62), fill_rgb=C_DARK_BLUE)
        add_textbox(slide, Inches(0.45), y + Inches(0.04), Inches(3.1), Inches(0.56),
                    label, font_size=Pt(22), bold=True, color=C_WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
        add_rect(slide, Inches(3.65), y, Inches(9.3), Inches(0.62), fill_rgb=C_BOX_BG, border_rgb=C_BOX_BORDER)
        add_textbox(slide, Inches(3.75), y + Inches(0.04), Inches(9.1), Inches(0.58),
                    val, font_size=Pt(22), color=C_BLACK, v_anchor=MSO_ANCHOR.MIDDLE)
        y += Inches(0.72)
make_slide(16, "Statistical Analysis", s16)

# ─────────────────────────────────────────────────────────────
# SLIDE 17 – EDC EXPOSURE CHARACTERISTICS (Main characteristics)
# ─────────────────────────────────────────────────────────────
def s17(slide):
    add_textbox(slide, Inches(0.5), Inches(1.15), Inches(12.3), Inches(0.45),
                "Main Characteristics on Exposure to Onychomycosis Risk Factors (EDC Proxy):",
                font_size=Pt(25), bold=True, color=C_ACCENT)
    pts = [
        "• Most patients were housewives (61%) — prolonged exposure to water & detergents",
        "• Bilateral nail involvement in 51% of patients",
        "• 74% had received prior treatment without improvement",
        "• Median duration of onychomycosis: 2 years (IQR: 1–3 years)",
        "• C. albicans predominated (61.7%) — common in chronic wet-work exposure (housewives)",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.7), Inches(12.3), Inches(3.2),
                        pts, font_size=BODY_SIZE)

    occupations = ["Housewife\n61%", "Nurse\n11%", "Student\n11%", "Cook/Farmer\n6.6%", "Other\n10.4%"]
    cols = [C_DARK_BLUE, C_ACCENT, RGBColor(0x2E, 0x86, 0xC1), RGBColor(0x5D, 0xAD, 0xE8), RGBColor(0xAE, 0xD6, 0xF1)]
    x = Inches(0.4)
    for i, (label, col) in enumerate(zip(occupations, cols)):
        add_rect(slide, x, Inches(5.1), Inches(2.4), Inches(1.0), fill_rgb=col)
        add_textbox(slide, x + Inches(0.05), Inches(5.15), Inches(2.3), Inches(0.92),
                    label, font_size=Pt(21), bold=True, color=C_WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
        x += Inches(2.55)
    add_textbox(slide, Inches(0.5), Inches(6.25), Inches(12.3), Inches(0.42),
                "Occupation Distribution of Study Participants",
                font_size=Pt(20), color=C_DARK_BLUE, align=PP_ALIGN.CENTER, bold=True)
make_slide(17, "Main Characteristics — Exposure Risk Factors", s17)

# ─────────────────────────────────────────────────────────────
# SLIDE 18 – STUDY POPULATION (Figure 1 – CONSORT)
# ─────────────────────────────────────────────────────────────
def s18(slide):
    pts = [
        "• 113 patients screened; 75 randomized (25 per group)",
        "• Losses: 5 (terbinafine), 5 (PRP), 1 (PRP+terbinafine) lost to follow-up",
        "• Discontinuation: 2 (PRP) + 1 (PRP+terbinafine) due to injection pain",
        "• Final analysis: 20 (terbinafine) | 18 (PRP) | 23 (PRP+terbinafine)",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(6.0), Inches(3.2),
                        pts, font_size=BODY_SIZE)
    add_image(slide, "/tmp/workspace/journal-club/figures/fig1.jpg",
              Inches(6.3), Inches(1.15), Inches(6.7), Inches(5.8))
    add_textbox(slide, Inches(6.3), Inches(7.0), Inches(6.7), Inches(0.4),
                "Figure 1: CONSORT flowchart of study design",
                font_size=Pt(18), color=C_DARK_BLUE, align=PP_ALIGN.CENTER, bold=True)
make_slide(18, "Results – Study Population", s18)

# ─────────────────────────────────────────────────────────────
# SLIDE 19 – BASELINE CHARACTERISTICS
# ─────────────────────────────────────────────────────────────
def s19(slide):
    rows = [
        ("Age (median)", "Terbinafine: 36 yrs | PRP: 36 yrs | PRP+T: 35 yrs | p=0.9"),
        ("Sex", "Female: 90% overall (Terbinafine 85% | PRP 94% | PRP+T 91%) | p=0.7"),
        ("Occupation", "Housewife 61%, Nurse 11%, Student 11% — comparable across groups | p>0.9"),
        ("Residence", "Rural 74%, Urban 23%, Suburban 3.3% | p=0.3"),
        ("Duration", "Median 2 years (IQR: 1–3) | No significant difference | p=0.2"),
        ("Prior Treatment", "74% had received prior treatment without improvement | p=0.2"),
        ("Laterality", "Bilateral 51%, Unilateral 49% | p=0.2"),
        ("Nails/patient", "Median 2 fingers per patient (IQR: 1–3) | p=0.2"),
    ]
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.38),
                "All groups were comparable at baseline (no statistically significant differences):",
                font_size=Pt(23), bold=True, color=C_ACCENT)
    y = Inches(1.68)
    for label, val in rows:
        add_rect(slide, Inches(0.4), y, Inches(2.6), Inches(0.5), fill_rgb=C_DARK_BLUE)
        add_textbox(slide, Inches(0.45), y + Inches(0.03), Inches(2.5), Inches(0.46),
                    label, font_size=Pt(21), bold=True, color=C_WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
        add_rect(slide, Inches(3.05), y, Inches(9.9), Inches(0.5), fill_rgb=C_BOX_BG, border_rgb=C_BOX_BORDER)
        add_textbox(slide, Inches(3.15), y + Inches(0.03), Inches(9.7), Inches(0.46),
                    val, font_size=Pt(21), color=C_BLACK, v_anchor=MSO_ANCHOR.MIDDLE)
        y += Inches(0.58)
make_slide(19, "Results – Baseline Characteristics of Treated Patients", s19)

# ─────────────────────────────────────────────────────────────
# SLIDE 20 – CLINICAL CHARACTERISTICS OF AFFECTED NAILS
# ─────────────────────────────────────────────────────────────
def s20(slide):
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Total nails treated: 40 (terbinafine) | 51 (PRP) | 50 (PRP + terbinafine)",
                font_size=Pt(25), bold=True, color=C_ACCENT)

    types = [
        ("Lateral\nOnychomycosis", "39%", "Most common type"),
        ("Distal Subungual\nOnychomycosis", "Common", "Classic DLSO pattern"),
        ("Total Dystrophic\nOnychomycosis", "Present", "Severe disease subgroup"),
    ]
    x = Inches(0.4)
    for label, pct, note in types:
        add_rect(slide, x, Inches(1.85), Inches(4.0), Inches(1.5), fill_rgb=C_DARK_BLUE)
        add_textbox(slide, x + Inches(0.1), Inches(1.9), Inches(3.8), Inches(1.4),
                    f"{label}\n{pct}", font_size=Pt(24), bold=True, color=C_WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
        x += Inches(4.3)

    add_textbox(slide, Inches(0.5), Inches(3.55), Inches(12.3), Inches(0.42),
                "OSI Severity Distribution (overall):", font_size=Pt(25), bold=True, color=C_ACCENT)

    sev_data = [("Mild (OSI 1–5)", "21%", C_ACCENT), ("Moderate (OSI 6–15)", "48%", C_DARK_BLUE), ("Severe (OSI 16–35)", "32%", RGBColor(0x8B, 0x00, 0x00))]
    x = Inches(0.4)
    for label, pct, col in sev_data:
        add_rect(slide, x, Inches(4.1), Inches(4.0), Inches(1.2), fill_rgb=col)
        add_textbox(slide, x + Inches(0.1), Inches(4.15), Inches(3.8), Inches(1.1),
                    f"{label}\n{pct}", font_size=Pt(24), bold=True, color=C_WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
        x += Inches(4.3)

    pts = [
        "• All groups were comparable regarding type and distribution of affected nails",
        "• PRP group had significantly higher baseline OSI vs. other groups (p=0.004 Inv A; p=0.015 Inv B)",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(5.5), Inches(12.3), Inches(1.55),
                        pts, font_size=BODY_SIZE)
make_slide(20, "Results – Clinical Characteristics of Affected Nails", s20)

# ─────────────────────────────────────────────────────────────
# SLIDE 21 – IMPROVEMENT IN OSI (1)
# ─────────────────────────────────────────────────────────────
def s21(slide):
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Two blinded investigators showed strong agreement in OSI assessment (r > 0.8)",
                font_size=Pt(24), bold=True, color=C_ACCENT)
    rows = [
        ("Timepoint", "Terbinafine (n=40)", "PRP (n=51)", "PRP+Terbinafine (n=50)", "p-value"),
        ("Baseline", "8 (IQR: 4,17)", "15 (IQR: 8,24)", "9 (IQR: 4,15)", "0.004*"),
        ("After Treatment", "5 (IQR: 4,13)", "8 (IQR: 4,16)", "6 (IQR: 3,12)", "0.088"),
        ("At Follow-up", "4 (IQR: 4,9)", "6 (IQR: 2,12)", "5 (IQR: 3,8)", ">0.9"),
    ]
    y = Inches(1.75)
    for i, row in enumerate(rows):
        bg = C_DARK_BLUE if i == 0 else (C_BOX_BG if i % 2 == 0 else C_WHITE)
        txt_col = C_WHITE if i == 0 else C_BLACK
        add_rect(slide, Inches(0.3), y, Inches(12.5), Inches(0.7), fill_rgb=bg, border_rgb=C_BOX_BORDER, border_pt=0.5)
        widths = [Inches(2.0), Inches(2.6), Inches(2.5), Inches(3.2), Inches(2.0)]
        x = Inches(0.35)
        for j, (cell, w) in enumerate(zip(row, widths)):
            add_textbox(slide, x, y + Inches(0.05), w - Inches(0.1), Inches(0.6),
                        cell, font_size=Pt(21), bold=(i == 0), color=txt_col,
                        align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
            x += w
        y += Inches(0.72)

    pts = [
        "• All groups showed SIGNIFICANT within-group reduction in OSI (p<0.001 before vs. after; p<0.001 before vs. follow-up)",
        "• PRP group: greatest absolute reduction (~9 points at follow-up) but started from higher baseline",
        "• Groups comparable at end of treatment and end of follow-up",
    ]
    add_bullet_textbox(slide, Inches(0.3), Inches(4.85), Inches(12.7), Inches(2.2),
                        pts, font_size=BODY_SIZE)
make_slide(21, "Results – Improvement in OSI", s21)

# ─────────────────────────────────────────────────────────────
# SLIDE 22 – IMPROVEMENT IN OSI (2) – Investigator B + key points
# ─────────────────────────────────────────────────────────────
def s22(slide):
    rows = [
        ("Timepoint", "Terbinafine (n=40)", "PRP (n=51)", "PRP+Terbinafine (n=50)", "p-value"),
        ("Baseline", "8 (IQR: 6,19)", "16 (IQR: 8,26)", "9 (IQR: 4,15)", "0.015*"),
        ("After Treatment", "6 (IQR: 4,13)", "8 (IQR: 4,16)", "7 (IQR: 3,12)", "0.2"),
        ("At Follow-up", "4 (IQR: 3,10)", "6 (IQR: 4,10)", "6 (IQR: 3,12)", ">0.9"),
    ]
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Investigator B Assessment (median OSI per affected nail):",
                font_size=Pt(24), bold=True, color=C_ACCENT)
    y = Inches(1.7)
    for i, row in enumerate(rows):
        bg = C_DARK_BLUE if i == 0 else (C_BOX_BG if i % 2 == 0 else C_WHITE)
        txt_col = C_WHITE if i == 0 else C_BLACK
        add_rect(slide, Inches(0.3), y, Inches(12.5), Inches(0.7), fill_rgb=bg, border_rgb=C_BOX_BORDER, border_pt=0.5)
        widths = [Inches(2.0), Inches(2.6), Inches(2.5), Inches(3.2), Inches(2.0)]
        x = Inches(0.35)
        for cell, w in zip(row, widths):
            add_textbox(slide, x, y + Inches(0.05), w - Inches(0.1), Inches(0.6),
                        cell, font_size=Pt(21), bold=(i == 0), color=txt_col,
                        align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
            x += w
        y += Inches(0.72)

    boxes_content = [
        ("Key Finding", "PRP alone achieved a 9-point OSI reduction — comparable to terbinafine and combination therapy at follow-up"),
        ("Clinical Implication", "PRP is a viable standalone therapy when terbinafine is contraindicated or not tolerated"),
    ]
    bx = Inches(0.4)
    for title, body in boxes_content:
        add_boxed_section(slide, bx, Inches(4.8), Inches(6.1), Inches(1.8), title, [body], font_size=Pt(22))
        bx += Inches(6.5)
make_slide(22, "Results – OSI (Investigator B)", s22)

# ─────────────────────────────────────────────────────────────
# SLIDE 23 – IMPROVEMENT IN PARONYCHIA
# ─────────────────────────────────────────────────────────────
def s23(slide):
    pts = [
        "• Strong inter-observer agreement between blinded investigators (weighted kappa >0.8)",
        "• At baseline: 75% (Inv A) and 77% (Inv B) of treated nails had paronychia",
        "• All groups showed improvement in paronychia after treatment and at follow-up",
        "• Groups were comparable in paronychia improvement across all time points",
        "• Paronychia was assessed per affected nail (not per patient)",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(3.8),
                        pts, font_size=BODY_SIZE)
    add_boxed_section(slide, Inches(0.5), Inches(5.15), Inches(12.0), Inches(1.95),
                      "Clinical Significance",
                      ["Improvement in paronychia indicates broader anti-inflammatory and antimicrobial effects of PRP",
                       "Comparable improvement across all 3 treatment groups"])
make_slide(23, "Results – Improvement in Paronychia", s23)

# ─────────────────────────────────────────────────────────────
# SLIDE 24 – IMPROVEMENT IN DERMOSCOPIC CHARACTERISTICS (with Fig 2)
# ─────────────────────────────────────────────────────────────
def s24(slide):
    findings = [
        ("Chromonychia", "Most prevalent: 88–92% across groups at baseline; No significant change after treatment in any group"),
        ("Subungual Hyperkeratosis", "Present in 41–63% at baseline; Significant reduction in PRP group after treatment (p=0.022)"),
        ("Other Features", "Fringing at proximal border, longitudinal striae, ruin-like hyperkeratosis — all assessed at each visit"),
    ]
    y = Inches(1.2)
    for title, desc in findings:
        add_rect(slide, Inches(0.4), y, Inches(2.9), Inches(0.88), fill_rgb=C_ACCENT)
        add_textbox(slide, Inches(0.45), y + Inches(0.05), Inches(2.8), Inches(0.8),
                    title, font_size=Pt(22), bold=True, color=C_WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
        add_rect(slide, Inches(3.35), y, Inches(6.0), Inches(0.88), fill_rgb=C_BOX_BG, border_rgb=C_BOX_BORDER)
        add_textbox(slide, Inches(3.45), y + Inches(0.05), Inches(5.8), Inches(0.8),
                    desc, font_size=Pt(21), color=C_BLACK, v_anchor=MSO_ANCHOR.MIDDLE)
        y += Inches(1.0)

    add_image(slide, "/tmp/workspace/journal-club/figures/fig2.jpg",
              Inches(9.4), Inches(1.2), Inches(3.7), Inches(5.3))
    add_textbox(slide, Inches(9.4), Inches(6.55), Inches(3.7), Inches(0.4),
                "Figure 2: Dermoscopic findings",
                font_size=Pt(17), color=C_DARK_BLUE, align=PP_ALIGN.CENTER, bold=True)
make_slide(24, "Results – Improvement in Dermoscopic Characteristics", s24)

# ─────────────────────────────────────────────────────────────
# SLIDE 25 – KOH AND FUNGAL CULTURE FINDINGS
# ─────────────────────────────────────────────────────────────
def s25(slide):
    pts = [
        "• KOH examination: Comparable among all groups at all time points (p>0.05)",
        "• All treated nails had positive fungal culture before treatment (no statistical difference)",
        "• All groups showed significant reduction in culture positivity:",
        "   – After treatment: p<0.05 in all groups",
        "   – After follow-up: p<0.05 in all groups",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(3.1),
                        pts, font_size=BODY_SIZE)

    add_textbox(slide, Inches(0.5), Inches(4.4), Inches(12.3), Inches(0.42),
                "Fungal Species Distribution (overall):", font_size=Pt(25), bold=True, color=C_ACCENT)
    species = [
        ("C. albicans", "61.7%", C_DARK_BLUE),
        ("A. flavus", "18.4%", C_ACCENT),
        ("Mucormycosis", "14.2%", RGBColor(0x2E, 0x86, 0xC1)),
        ("T. rubrum", "3.5%", RGBColor(0x5D, 0xAD, 0xE8)),
        ("Others", "2.1%", RGBColor(0xAE, 0xD6, 0xF1)),
    ]
    x = Inches(0.4)
    for name, pct, col in species:
        add_rect(slide, x, Inches(5.0), Inches(2.4), Inches(1.05), fill_rgb=col)
        add_textbox(slide, x + Inches(0.05), Inches(5.05), Inches(2.3), Inches(0.98),
                    f"{name}\n{pct}", font_size=Pt(21), bold=True, color=C_WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
        x += Inches(2.55)
    add_textbox(slide, Inches(0.5), Inches(6.2), Inches(12.3), Inches(0.5),
                "NOTE: C. albicans predominance linked to demographic profile (housewives — chronic wet-work exposure); explains lower terbinafine cure rates",
                font_size=Pt(21), color=C_DARK_BLUE, bold=True)
make_slide(25, "Results – KOH and Fungal Culture Findings", s25)

# ─────────────────────────────────────────────────────────────
# SLIDE 26 – CURE RATES (with Fig 3)
# ─────────────────────────────────────────────────────────────
def s26(slide):
    cure_rows = [
        ("Cure Type", "Terbinafine", "PRP", "PRP+Terbinafine", "p-value"),
        ("Mycological Cure\n(end of treatment)", "20%", "35%", "34%", "p=0.23"),
        ("Clinical Cure — Inv A\n(end of follow-up)", "23%", "27%", "32%", "p=0.61"),
        ("Complete Cure — Inv A\n(end of follow-up)", "20%", "27%", "28%", "p=0.64"),
    ]
    y = Inches(1.2)
    for i, row in enumerate(cure_rows):
        bg = C_DARK_BLUE if i == 0 else (C_BOX_BG if i % 2 == 0 else C_WHITE)
        txt_col = C_WHITE if i == 0 else C_BLACK
        add_rect(slide, Inches(0.3), y, Inches(8.5), Inches(0.75), fill_rgb=bg, border_rgb=C_BOX_BORDER, border_pt=0.5)
        widths = [Inches(2.8), Inches(1.4), Inches(1.3), Inches(1.8), Inches(1.1)]
        x = Inches(0.35)
        for cell, w in zip(row, widths):
            add_textbox(slide, x, y + Inches(0.04), w - Inches(0.05), Inches(0.68),
                        cell, font_size=Pt(20), bold=(i == 0), color=txt_col,
                        align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
            x += w
        y += Inches(0.82)

    add_image(slide, "/tmp/workspace/journal-club/figures/fig3.jpg",
              Inches(9.0), Inches(1.2), Inches(4.1), Inches(3.8))
    add_textbox(slide, Inches(9.0), Inches(5.05), Inches(4.1), Inches(0.4),
                "Figure 3: Mycological cure rates",
                font_size=Pt(17), color=C_DARK_BLUE, align=PP_ALIGN.CENTER, bold=True)

    pts = [
        "• Overall mycological cure at follow-up: 30.4% of treated nails",
        "• Overall clinical cure at follow-up: 27.6% (Inv A), 26.2% (Inv B)",
        "• Overall complete cure at follow-up: 25.5% (Inv A), 24.1% (Inv B)",
    ]
    add_bullet_textbox(slide, Inches(0.3), Inches(5.55), Inches(8.5), Inches(1.8),
                        pts, font_size=BODY_SIZE)
make_slide(26, "Results – Cure Rates", s26)

# ─────────────────────────────────────────────────────────────
# SLIDE 27 – CURE RATES (2) – Fig 4
# ─────────────────────────────────────────────────────────────
def s27(slide):
    pts = [
        "• No statistically significant difference in any cure type between the 3 groups",
        "• PRP alone achieved numerically higher mycological cure (35%) vs. terbinafine (20%)",
        "• Further increase in mycological cure observed from end-of-treatment to follow-up:",
        "   – PRP: 18% → 35%  |  PRP+Terbinafine: 22% → 34%  |  Terbinafine: 20% → 20%",
        "• Delayed improvement in PRP group possibly related to nail growth dynamics",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(6.8), Inches(4.0),
                        pts, font_size=BODY_SIZE)
    add_image(slide, "/tmp/workspace/journal-club/figures/fig4.jpg",
              Inches(7.3), Inches(1.15), Inches(5.7), Inches(5.8))
    add_textbox(slide, Inches(7.3), Inches(7.0), Inches(5.7), Inches(0.4),
                "Figure 4: Clinical & complete cure rates (Inv A & B)",
                font_size=Pt(17), color=C_DARK_BLUE, align=PP_ALIGN.CENTER, bold=True)
make_slide(27, "Results – Cure Rates (contd.)", s27)

# ─────────────────────────────────────────────────────────────
# SLIDE 28 – PATIENT-REPORTED ADVERSE OUTCOMES (PRAO)
# ─────────────────────────────────────────────────────────────
def s28(slide):
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Safety assessed by Patient-Reported Adverse Outcomes (PRAO):",
                font_size=Pt(25), bold=True, color=C_ACCENT)

    adverse = [
        ("Pain (NRS 0–10)", "PRP: 6 (IQR: 6,7) | PRP+Terbinafine: 6 (IQR: 6,7) | p=0.8 (no difference)"),
        ("Bruising", "PRP: 61% | PRP+Terbinafine: 57% | p=0.9 (comparable)"),
        ("Discontinuation\ndue to pain", "2 patients in PRP group, 1 patient in PRP+Terbinafine group discontinued sessions"),
        ("Terbinafine\nSide Effects", "Assessed clinically; no serious hepatic events reported in this study"),
    ]
    y = Inches(1.75)
    for label, val in adverse:
        add_rect(slide, Inches(0.4), y, Inches(2.5), Inches(0.82), fill_rgb=C_DARK_BLUE)
        add_textbox(slide, Inches(0.45), y + Inches(0.05), Inches(2.4), Inches(0.75),
                    label, font_size=Pt(22), bold=True, color=C_WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
        add_rect(slide, Inches(2.95), y, Inches(10.0), Inches(0.82), fill_rgb=C_BOX_BG, border_rgb=C_BOX_BORDER)
        add_textbox(slide, Inches(3.05), y + Inches(0.05), Inches(9.8), Inches(0.75),
                    val, font_size=Pt(22), color=C_BLACK, v_anchor=MSO_ANCHOR.MIDDLE)
        y += Inches(0.95)

    add_boxed_section(slide, Inches(0.5), Inches(5.75), Inches(12.0), Inches(1.4),
                      "Key Safety Takeaway",
                      ["Intralesional PRP is associated with moderate injection-related pain (NRS 6/10)",
                       "More suitable for patients with few affected nails; pain limits extensive use"])
make_slide(28, "Results – Patient-Reported Adverse Outcomes", s28)

# ─────────────────────────────────────────────────────────────
# SLIDE 29 – PREDICTORS OF OSI IMPROVEMENT
# ─────────────────────────────────────────────────────────────
def s29(slide):
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Univariate & Multivariate Generalized Linear Regression Analysis:",
                font_size=Pt(25), bold=True, color=C_ACCENT)
    rows = [
        ("Variable", "Univariate OR (95% CI)", "p-value", "Multivariate aOR (95% CI)", "p-value"),
        ("Older Patient Age", "OR=1.34 (1.14–1.57)", "<0.001", "aOR=1.31 (1.04–1.66)", "0.025"),
        ("TDO (Total Dystrophic\nOnychomycosis)", "OR=20.7 (5.53–77.2)", "<0.001", "aOR=4.24 (1.14–15.7)", "0.033"),
        ("Intervention Type\n(PRP vs. Terbinafine)", "Not significant", ">0.05", "Not significant", ">0.05"),
    ]
    y = Inches(1.75)
    for i, row in enumerate(rows):
        bg = C_DARK_BLUE if i == 0 else (C_BOX_BG if i % 2 == 0 else C_WHITE)
        txt_col = C_WHITE if i == 0 else C_BLACK
        add_rect(slide, Inches(0.3), y, Inches(12.5), Inches(0.82), fill_rgb=bg, border_rgb=C_BOX_BORDER, border_pt=0.5)
        widths = [Inches(2.6), Inches(2.5), Inches(1.2), Inches(2.5), Inches(1.2) ]
        # Adjust: total = 10, with the last column spanning to end
        widths = [Inches(2.8), Inches(2.5), Inches(1.2), Inches(3.2), Inches(2.5)]
        x = Inches(0.35)
        for cell, w in zip(row, widths):
            add_textbox(slide, x, y + Inches(0.05), w - Inches(0.08), Inches(0.72),
                        cell, font_size=Pt(20), bold=(i == 0), color=txt_col,
                        align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
            x += w
        y += Inches(0.92)

    pts = [
        "• Older age = predictor of WORSE OSI improvement (higher residual score)",
        "• TDO = strong predictor of worse outcome (4× worse odds in multivariate model)",
        "• Type of intervention was NOT a significant predictor — reinforces comparable efficacy",
    ]
    add_bullet_textbox(slide, Inches(0.3), Inches(5.55), Inches(12.7), Inches(1.8),
                        pts, font_size=BODY_SIZE)
make_slide(29, "Results – Predictors of OSI Improvement", s29)

# ─────────────────────────────────────────────────────────────
# SLIDE 30 – DISCUSSION (1) – Treatment Challenge & PRP Rationale
# ─────────────────────────────────────────────────────────────
def s30(slide):
    pts = [
        "• Treatment of onychomycosis is challenging due to:",
        "   – Rising prevalence of mixed infections",
        "   – Suboptimal cure rates and side effects of systemic antifungals",
        "   – High relapse rates (10–53%)",
        "• PRP α-granules release high concentrations of antimicrobial peptides after platelet aggregation",
        "• PRP contains 2–4× higher WBC concentration than whole blood:",
        "   – Neutrophils: release myeloperoxidase (antifungal + antibacterial)",
        "   – Lymphocytes & monocytes: immunogenic cells",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(5.8),
                        pts, font_size=BODY_SIZE)
make_slide(30, "Discussion – Treatment Challenges & PRP Rationale", s30)

# ─────────────────────────────────────────────────────────────
# SLIDE 31 – DISCUSSION (2) – Key Findings
# ─────────────────────────────────────────────────────────────
def s31(slide):
    pts = [
        "• Significant OSI improvement in ALL groups after treatment and follow-up",
        "• PRP group: 9-point OSI reduction at follow-up vs. 4-point in terbinafine & combination groups",
        "• However, all groups were statistically COMPARABLE in post-treatment and follow-up OSI",
        "• Multivariate analysis confirmed: intervention type NOT a significant predictor of OSI improvement",
        "• Delayed mycological cure improvement in PRP group (18% → 35%) possibly due to nail growth dynamics",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(4.0),
                        pts, font_size=BODY_SIZE)
    add_boxed_section(slide, Inches(0.5), Inches(5.35), Inches(12.0), Inches(1.85),
                      "Interpretation",
                      ["PRP could be a promising therapeutic option when systemic antifungals are contraindicated",
                       "Combining PRP + terbinafine did NOT provide additive benefit — combination not superior"])
make_slide(31, "Discussion – Key Findings Interpretation", s31)

# ─────────────────────────────────────────────────────────────
# SLIDE 32 – DISCUSSION (3) – C. albicans & Terbinafine Efficacy
# ─────────────────────────────────────────────────────────────
def s32(slide):
    pts = [
        "• Recent network meta-analysis reported mycological cure 66.3% and complete cure 45.6%",
        "   for terbinafine 250 mg/day for 12 weeks (literature standard)",
        "• This study: terbinafine mycological cure only 20% — significantly lower",
        "• Reason: C. albicans (yeast) was predominant (61.7%) — terbinafine has INFERIOR efficacy against yeasts",
        "• Triazole antifungals (fluconazole, itraconazole) are superior for C. albicans",
        "• Studies from Africa, Middle East, Egypt: higher prevalence of yeasts vs. dermatophytes",
        "   (unlike northern hemisphere where dermatophytes predominate)",
        "• Predominance of housewives explains C. albicans prevalence (wet-work exposure)",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(6.0),
                        pts, font_size=BODY_SIZE)
make_slide(32, "Discussion – C. albicans & Terbinafine Efficacy", s32)

# ─────────────────────────────────────────────────────────────
# SLIDE 33 – DISCUSSION (4) – Limitations
# ─────────────────────────────────────────────────────────────
def s33(slide):
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Study Limitations:", font_size=Pt(25), bold=True, color=C_ACCENT)
    limitations = [
        ("Sample Size", "Powered for moderate effect size (0.5); larger sample needed for subtle differences"),
        ("Per-nail Analysis", "Provides precise tracking but biological/patient factors may confound results"),
        ("Unequal Groups", "Different dropout rates → unequal final group sizes (20, 18, 23) despite block randomization"),
        ("Per-protocol Analysis", "May overestimate treatment effect if dropouts were related to side effects or lack of efficacy"),
        ("Fingernails Only", "Results cannot be generalized to toenail onychomycosis (more challenging)"),
        ("PRP Baseline Bias", "PRP group had significantly higher baseline OSI — may bias impression of improvement"),
        ("Comparator Choice", "Terbinafine inferior vs. triazoles for C. albicans; results should be interpreted with caution"),
        ("Follow-up Duration", "3-month follow-up insufficient to assess long-term efficacy and relapse rates"),
    ]
    y = Inches(1.72)
    for i, (label, desc) in enumerate(limitations):
        bg = C_BOX_BG if i % 2 == 0 else C_WHITE
        add_rect(slide, Inches(0.3), y, Inches(12.5), Inches(0.6), fill_rgb=bg, border_rgb=C_BOX_BORDER, border_pt=0.5)
        add_textbox(slide, Inches(0.4), y + Inches(0.04), Inches(2.5), Inches(0.52),
                    label, font_size=Pt(21), bold=True, color=C_DARK_BLUE, v_anchor=MSO_ANCHOR.MIDDLE)
        add_textbox(slide, Inches(2.95), y + Inches(0.04), Inches(9.7), Inches(0.52),
                    desc, font_size=Pt(21), color=C_BLACK, v_anchor=MSO_ANCHOR.MIDDLE)
        y += Inches(0.65)
make_slide(33, "Discussion – Limitations", s33)

# ─────────────────────────────────────────────────────────────
# SLIDE 34 – DISCUSSION (5) – Future Directions
# ─────────────────────────────────────────────────────────────
def s34(slide):
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Future Research Directions:", font_size=Pt(25), bold=True, color=C_ACCENT)
    future = [
        "• Larger RCTs to confirm comparable efficacy of PRP vs. systemic antifungals",
        "• Studies exploring different PRP preparation protocols and concentrations",
        "• Varying administration schedules (more frequent / fewer sessions)",
        "• Combining PRP with TOPICAL antifungals (rather than systemic) to minimize side effects",
        "• Extending follow-up to ≥12 months to capture long-term outcomes and relapse rates",
        "• Studies in toenail onychomycosis and in immunocompromised patients",
        "• Comparison with triazole antifungals (more appropriate comparator for C. albicans infections)",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.75), Inches(12.3), Inches(5.4),
                        future, font_size=BODY_SIZE)
make_slide(34, "Discussion – Future Directions", s34)

# ─────────────────────────────────────────────────────────────
# SLIDE 35 – CONCLUSIONS (1)
# ─────────────────────────────────────────────────────────────
def s35(slide):
    conclusions = [
        "1. Intralesional PRP was effective in the treatment of fingernail onychomycosis",
        "2. Efficacy of PRP (6 sessions over 3 months) was COMPARABLE to oral terbinafine",
        "3. Combination of PRP + terbinafine did NOT provide superior results over either alone",
        "4. PRP may constitute a second-line treatment option for patients with:",
        "   • Resistance to oral antifungals",
        "   • Contraindications to systemic antifungal therapy",
        "5. PRP is best suited for patients with FEW affected nails due to injection-related pain",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(5.8),
                        conclusions, font_size=BODY_SIZE)
make_slide(35, "Conclusions", s35)

# ─────────────────────────────────────────────────────────────
# SLIDE 36 – CONCLUSIONS (2) – Summary box
# ─────────────────────────────────────────────────────────────
def s36(slide):
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Additional Conclusions:", font_size=Pt(25), bold=True, color=C_ACCENT)
    pts = [
        "• Older age and Total Dystrophic Onychomycosis (TDO) were independent predictors of worse outcome",
        "• C. albicans was the predominant organism (61.7%) — uncommonly high; linked to wet-work occupations",
        "• Topical antifungals remain a valuable option for patients in whom systemic antifungals are contraindicated",
        "• Further large-scale clinical studies are required to confirm these findings",
    ]
    add_bullet_textbox(slide, Inches(0.5), Inches(1.72), Inches(12.3), Inches(3.2),
                        pts, font_size=BODY_SIZE)

    # Take-home message
    add_rect(slide, Inches(0.5), Inches(5.1), Inches(12.3), Inches(2.05), fill_rgb=C_DARK_BLUE)
    add_textbox(slide, Inches(0.7), Inches(5.18), Inches(11.9), Inches(0.42),
                "TAKE-HOME MESSAGE FOR DERMATOLOGISTS:", font_size=Pt(25), bold=True, color=C_GOLD)
    add_textbox(slide, Inches(0.7), Inches(5.65), Inches(11.9), Inches(1.4),
                "Intralesional PRP offers a promising, safe, needle-based alternative for fingernail "
                "onychomycosis — particularly useful in patients who cannot tolerate systemic antifungals. "
                "Pain and limited number of nails treatable per session are the key practical constraints.",
                font_size=Pt(23), color=C_WHITE)
make_slide(36, "Conclusions (contd.)", s36)

# ─────────────────────────────────────────────────────────────
# SLIDE 37 – CLINICAL PEARLS FOR DERMATOLOGISTS
# ─────────────────────────────────────────────────────────────
def s37(slide):
    pearls = [
        ("OSI Scoring", "Use OSI to quantify severity: Area (0–5) × Proximity to matrix (1–5) + 10 for dermatophytoma\nMild ≤5 | Moderate 6–15 | Severe ≥16"),
        ("Dermoscopy", "Look for: fringing at proximal border, longitudinal brown-yellow striae, ruin-like subungual hyperkeratosis — all diagnostic of onychomycosis"),
        ("Confirm Before Treating", "Always confirm with KOH microscopy + fungal culture before starting treatment — organism identity changes management"),
        ("Yeast vs. Dermatophyte", "In patients with wet-work (housewives, nurses, cooks): suspect yeasts (C. albicans) — choose triazoles over terbinafine"),
        ("PRP Candidacy", "Ideal PRP candidate: 1–3 nails affected, failed/intolerant to oral antifungals, no thrombocytopenia/coagulopathy, motivated patient"),
    ]
    y = Inches(1.2)
    for title, desc in pearls:
        add_rect(slide, Inches(0.4), y, Inches(2.5), Inches(0.95), fill_rgb=C_ACCENT)
        add_textbox(slide, Inches(0.45), y + Inches(0.05), Inches(2.4), Inches(0.88),
                    title, font_size=Pt(22), bold=True, color=C_WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
        add_rect(slide, Inches(2.95), y, Inches(10.0), Inches(0.95), fill_rgb=C_BOX_BG, border_rgb=C_BOX_BORDER)
        add_textbox(slide, Inches(3.05), y + Inches(0.05), Inches(9.8), Inches(0.88),
                    desc, font_size=Pt(21), color=C_BLACK, v_anchor=MSO_ANCHOR.MIDDLE)
        y += Inches(1.08)
make_slide(37, "Clinical Pearls for Dermatologists", s37)

# ─────────────────────────────────────────────────────────────
# SLIDE 38 – COMPARISON TABLE: PRP vs. TERBINAFINE vs. COMBINATION
# ─────────────────────────────────────────────────────────────
def s38(slide):
    rows = [
        ("Parameter", "Terbinafine\n(n=40 nails)", "PRP\n(n=51 nails)", "PRP + Terbinafine\n(n=50 nails)"),
        ("OSI at Baseline\n(Inv A)", "8 (4,17)", "15 (8,24)*", "9 (4,15)"),
        ("OSI at Follow-up\n(Inv A)", "4 (4,9)", "6 (2,12)", "5 (3,8)"),
        ("OSI Reduction", "~4 points", "~9 points", "~4 points"),
        ("Mycological Cure\n(Follow-up)", "20%", "35%", "34%"),
        ("Clinical Cure\n(Follow-up, Inv A)", "23%", "27%", "32%"),
        ("Complete Cure\n(Follow-up, Inv A)", "20%", "27%", "28%"),
        ("Pain (NRS)", "N/A", "6/10", "6/10"),
        ("Bruising", "N/A", "61%", "57%"),
    ]
    y = Inches(1.2)
    col_widths = [Inches(2.9), Inches(3.1), Inches(3.0), Inches(3.8)]
    for i, row in enumerate(rows):
        bg = C_DARK_BLUE if i == 0 else (C_BOX_BG if i % 2 == 0 else C_WHITE)
        txt_col = C_WHITE if i == 0 else C_BLACK
        add_rect(slide, Inches(0.3), y, Inches(12.5), Inches(0.66), fill_rgb=bg, border_rgb=C_BOX_BORDER, border_pt=0.5)
        x = Inches(0.35)
        for cell, w in zip(row, col_widths):
            add_textbox(slide, x, y + Inches(0.04), w - Inches(0.08), Inches(0.58),
                        cell, font_size=Pt(20), bold=(i == 0), color=txt_col,
                        align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
            x += w
        y += Inches(0.7)
    add_textbox(slide, Inches(0.3), y + Inches(0.05), Inches(12.5), Inches(0.35),
                "* PRP group had significantly higher baseline OSI (p=0.004). All groups comparable at end of treatment and follow-up.",
                font_size=Pt(18), color=C_DARK_BLUE)
make_slide(38, "Summary Comparison: Terbinafine vs. PRP vs. Combination", s38)

# ─────────────────────────────────────────────────────────────
# SLIDE 39 – STUDY STRENGTHS
# ─────────────────────────────────────────────────────────────
def s39(slide):
    strengths = [
        "• First RCT to evaluate intralesional PRP for fingernail onychomycosis",
        "• Prospectively registered (ClinicalTrials.gov: NCT05128916)",
        "• IRB-approved; conducted as per Declaration of Helsinki",
        "• Two independent blinded outcome assessors — strong inter-rater reliability (r>0.8)",
        "• Per-nail assessment (not per-patient) — more precise tracking of outcomes",
        "• Multiple outcome measures: OSI, clinical cure, mycological cure, complete cure, PRAO",
        "• Both treatment efficacy AND safety comprehensively assessed",
        "• Dermoscopic, KOH, and culture confirmed diagnosis at baseline",
    ]
    add_textbox(slide, Inches(0.5), Inches(1.2), Inches(12.3), Inches(0.42),
                "Study Strengths:", font_size=Pt(25), bold=True, color=C_ACCENT)
    add_bullet_textbox(slide, Inches(0.5), Inches(1.72), Inches(12.3), Inches(5.4),
                        strengths, font_size=BODY_SIZE)
make_slide(39, "Study Strengths", s39)

# ─────────────────────────────────────────────────────────────
# SLIDE 40 – REFERENCES & THANK YOU
# ─────────────────────────────────────────────────────────────
slide40 = prs.slides.add_slide(blank_layout)
add_rect(slide40, 0, 0, SLIDE_W, SLIDE_H, fill_rgb=C_DARK_BLUE)
add_rect(slide40, 0, Inches(1.9), SLIDE_W, Inches(0.06), fill_rgb=C_GOLD)

tb_ty = slide40.shapes.add_textbox(Inches(0.5), Inches(0.2), Inches(12.3), Inches(0.7))
tf_ty = tb_ty.text_frame; p_ty = tf_ty.paragraphs[0]; p_ty.alignment = PP_ALIGN.CENTER
run_ty = p_ty.add_run(); run_ty.text = "References & Acknowledgement"
run_ty.font.name = FONT; run_ty.font.size = Pt(28); run_ty.font.bold = True; run_ty.font.color.rgb = C_GOLD

refs = [
    "1.  Ali RE et al. Efficacy of Intralesional PRP in Treatment of Fingernail Onychomycosis: A RCT.",
    "    Dermatol Pract Concept. 2026;16(2):6129. DOI: 10.5826/dpc.1602a6129. PMID: 42190181",
    "2.  Abu El-Hamd M et al. In vitro antifungal susceptibility in onychomycosis. Dermatol Ther. 2020.",
    "3.  Gupta AK, Shear NH. Risk-benefit of newer oral antifungals for onychomycosis. Drug Saf. 2000.",
    "4.  Piraccini BM et al. Long-term follow-up of toenail onychomycosis. J Am Acad Dermatol. 2010.",
    "5.  Tang YQ et al. Antimicrobial peptides from human platelets. Infect Immun. 2002.",
    "6.  Badade PS et al. Antimicrobial effect of PRP and PRF. Indian J Dent Res. 2016.",
]
add_bullet_textbox(slide40, Inches(0.5), Inches(2.1), Inches(12.3), Inches(3.8),
                    refs, font_size=Pt(20), color=C_WHITE)

# Thank you
add_rect(slide40, Inches(3.0), Inches(5.9), Inches(7.3), Inches(1.35), fill_rgb=RGBColor(0x1A, 0x4A, 0x8C))
tb_t = slide40.shapes.add_textbox(Inches(3.1), Inches(5.95), Inches(7.1), Inches(0.55))
tf_t = tb_t.text_frame; p_t = tf_t.paragraphs[0]; p_t.alignment = PP_ALIGN.CENTER
run_t = p_t.add_run(); run_t.text = "Thank You"
run_t.font.name = FONT; run_t.font.size = Pt(34); run_t.font.bold = True; run_t.font.color.rgb = C_GOLD

tb_t2 = slide40.shapes.add_textbox(Inches(3.1), Inches(6.6), Inches(7.1), Inches(0.5))
tf_t2 = tb_t2.text_frame; p_t2 = tf_t2.paragraphs[0]; p_t2.alignment = PP_ALIGN.CENTER
run_t2 = p_t2.add_run(); run_t2.text = "Presenter: Dr. Anuj Jain  |  Moderator: Dr. K.S. Dhillon"
run_t2.font.name = FONT; run_t2.font.size = Pt(21); run_t2.font.bold = False; run_t2.font.color.rgb = C_WHITE

add_slide_number(slide40, 40)

# ─────────────────────────────────────────────────────────────
# SAVE
# ─────────────────────────────────────────────────────────────
out_path = "/tmp/workspace/journal-club/PRP_Onychomycosis_JournalClub.pptx"
prs.save(out_path)
print(f"Saved: {out_path}")
print(f"Total slides: {len(prs.slides)}")