const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Myxoedema";
pres.author = "Emergency Medicine – 3rd Year";

// ─── COLOUR PALETTE ────────────────────────────────────────────────────────
const DARK      = "0D1B2A";   // deep navy   (dominant, ~65%)
const MID       = "1B4965";   // steel blue  (supporting)
const ACCENT    = "5FA8D3";   // sky blue    (accent)
const LIGHT     = "BEE9E8";   // pale mint   (light accent / dividers)
const WHITE     = "FFFFFF";
const OFFWHITE  = "F0F4F8";
const RED_ACC   = "E63946";   // danger / warning accent
const YELLOW    = "FFD166";   // highlight

// ─── FONT ───────────────────────────────────────────────────────────────────
const TITLE_FONT   = "Calibri";
const BODY_FONT    = "Calibri";

// ─── HELPER: Section-header slide ───────────────────────────────────────────
function sectionSlide(title, subtitle) {
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}

// ─── HELPER: Bullet body slide ───────────────────────────────────────────────
function bulletSlide(heading, items, opts = {}) {
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// ─── HELPER: Two-column slide ────────────────────────────────────────────────
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}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
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  });
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  sl.addText([
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    { text: "30%", options: { color: YELLOW, fontSize: 16, bold: true, fontFace: BODY_FONT } },
    { text: " with treatment  |  ", options: { color: OFFWHITE, fontSize: 14, fontFace: BODY_FONT } },
    { text: "~100%", options: { color: RED_ACC, fontSize: 16, bold: true, fontFace: BODY_FONT } },
    { text: " without", options: { color: OFFWHITE, fontSize: 14, fontFace: BODY_FONT } },
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  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 — SECTION: WHAT IS MYXOEDEMA?
// ═══════════════════════════════════════════════════════════════════════════
sectionSlide("01  WHAT IS MYXOEDEMA?", "Definition & Pathophysiology");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — DEFINITION
// ═══════════════════════════════════════════════════════════════════════════
bulletSlide("Definition", [
  { text: "Hypothyroidism is failure of the thyroid gland to produce or secrete sufficient thyroid hormone to meet peripheral tissue needs.", bold: false },
  { text: "", bullet: false, size: 6 },
  { text: "Myxoedema = severe, decompensated hypothyroidism that progresses to a life-threatening state.", bold: true, color: MID, size: 18 },
  { text: "", bullet: false, size: 6 },
  { text: "Myxoedema COMA: altered mental status + hypothermia + precipitating event — a medical emergency.", bold: true, color: RED_ACC, size: 18 },
  { text: "", bullet: false, size: 6 },
  { text: "The name 'myxoedema' derives from the characteristic non-pitting, mucin-rich oedema deposited in skin and tissues.", bold: false },
  { text: "It is the MOST COMMON functional disorder of the thyroid gland.", bold: false },
]);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — PATHOPHYSIOLOGY
// ═══════════════════════════════════════════════════════════════════════════
bulletSlide("Pathophysiology", [
  { text: "PRIMARY hypothyroidism (99% of cases): intrinsic gland failure", bold: true, color: MID, size: 18 },
  { text: "Autoimmune destruction, surgery, radiotherapy, infiltrative disease, drugs", indent: 1 },
  { text: "", bullet: false, size: 5 },
  { text: "CENTRAL (secondary) hypothyroidism (<1%): lack of TSH/TRH stimulation", bold: true, color: MID, size: 18 },
  { text: "Pituitary / hypothalamic disease", indent: 1 },
  { text: "", bullet: false, size: 5 },
  { text: "Thyroid hormone (T3/T4) deficiency leads to:", bold: true },
  { text: "Slowed metabolic rate in ALL body systems", indent: 1 },
  { text: "Accumulation of glycosaminoglycans in tissues → myxoedematous changes", indent: 1 },
  { text: "Impaired cardiovascular, respiratory, neurological, and thermoregulatory function", indent: 1 },
]);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — SECTION: CAUSES
// ═══════════════════════════════════════════════════════════════════════════
sectionSlide("02  CAUSES", "Aetiology of Hypothyroidism & Precipitants of Myxoedema Coma");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — CAUSES OF HYPOTHYROIDISM
// ═══════════════════════════════════════════════════════════════════════════
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    fontFace: TITLE_FONT, fontSize: 26, bold: true, color: WHITE, valign: "middle", margin: 6
  });

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    { cat: "Autoimmune", detail: "Hashimoto's thyroiditis (most common cause)", color: MID },
    { cat: "Iatrogenic", detail: "Thyroidectomy, radioactive iodine therapy", color: MID },
    { cat: "Medications", detail: "Amiodarone, lithium, antithyroid drugs, iodides", color: MID },
    { cat: "Congenital", detail: "Thyroid agenesis / dysgenesis, enzyme defects", color: MID },
    { cat: "Infiltrative", detail: "Amyloidosis, sarcoidosis, haemochromatosis", color: MID },
    { cat: "Iodine deficiency", detail: "Worldwide leading cause of hypothyroidism", color: MID },
    { cat: "Central", detail: "Pituitary / hypothalamic disease (secondary)", color: MID },
    { cat: "Transient", detail: "Post-partum thyroiditis, silent thyroiditis", color: MID },
  ];

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}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — PRECIPITATING FACTORS OF MYXOEDEMA COMA
// ═══════════════════════════════════════════════════════════════════════════
twoColSlide(
  "Precipitating / Aggravating Factors of Myxoedema Coma",
  "Common Triggers",
  [
    "Infection / sepsis (esp. pneumonia)",
    "Exposure to cold",
    "Myocardial infarction",
    "Gastrointestinal bleeding",
    "Cerebrovascular accident",
    "Trauma / burns",
    "Hypoxia / hypercapnia",
  ],
  "Metabolic & Drug Triggers",
  [
    "Sedatives, narcotics, anaesthesia, neuroleptics",
    "Amiodarone, lithium, iodides (↓ T4/T3 release)",
    "Phenytoin, rifampin (↑ T4/T3 elimination)",
    "Hyponatraemia, hypoglycaemia",
    "Diabetic ketoacidosis",
    "Congestive heart failure",
    "Non-compliance with thyroid hormone replacement",
  ]
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — SECTION: SIGNS & SYMPTOMS
// ═══════════════════════════════════════════════════════════════════════════
sectionSlide("03  SIGNS & SYMPTOMS", "The Clinical Spectrum of Hypothyroidism");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — VITAL SIGNS & HYPOMETABOLIC FEATURES
// ═══════════════════════════════════════════════════════════════════════════
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    { title: "Hypometabolic", icon: "🌡", items: ["Cold intolerance", "Fatigue", "Weight gain (despite ↓ appetite)", "Constipation", "Decreased exercise capacity"], color: MID, textColor: WHITE },
    { title: "Cutaneous", icon: "🩺", items: ["Dry, coarse, rough skin", "Coarse/brittle hair, alopecia", "Lateral eyebrow thinning", "Periorbital oedema (puffy eyelids)", "Yellow tinge (carotenaemia)"], color: ACCENT, textColor: DARK },
    { title: "Gastrointestinal", icon: "⚕", items: ["Constipation", "Ascites", "Abnormal LFTs", "Ileus (in severe cases)"], color: "4A7C59", textColor: WHITE },
  ];

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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — NEUROLOGICAL, MUSCULAR, CARDIAC SYMPTOMS
// ═══════════════════════════════════════════════════════════════════════════
twoColSlide(
  "Signs & Symptoms — Neurological, Muscular & Cardiac",
  "Neurological",
  [
    "Slow mentation and speech",
    "Impaired concentration / memory",
    "Lethargy, agitation, psychosis",
    "Seizures",
    "Ataxia, dysmetria",
    "Peripheral neuropathy, paraesthesiae",
    "Carpal tunnel syndrome",
    "Sensorineural hearing loss",
  ],
  "Muscular & Cardiac",
  [
    "Proximal myopathy",
    "Pseudohypertrophy",
    "Delayed tendon reflex relaxation (hung-up reflex)",
    "Sinus bradycardia",
    "Long QT + ventricular arrhythmias",
    "Diastolic heart failure (delayed ventricular relaxation)",
    "Pericardial effusion",
    "Elevated CK, LDH, AST",
  ]
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — REPRODUCTIVE, RHEUMATIC, HEENT
// ═══════════════════════════════════════════════════════════════════════════
twoColSlide(
  "Signs & Symptoms — Reproductive, Rheumatic & HEENT",
  "Reproductive & Rheumatic",
  [
    "Menorrhagia → amenorrhoea",
    "Infertility, miscarriage",
    "Decreased libido, erectile dysfunction",
    "Hyperprolactinaemia, galactorrhoea",
    "Polyarthralgias",
    "Joint effusions",
    "Acute gout / pseudogout",
  ],
  "HEENT & Respiratory",
  [
    "Macroglossia",
    "Hoarseness, deep husky voice",
    "Periorbital swelling",
    "Hearing loss",
    "Goitre",
    "Broad nose, swollen lips",
    "Pulmonary hypoventilation / hypercapnia",
    "Pleural effusion",
  ]
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 12 — SECTION: CLINICAL FEATURES
// ═══════════════════════════════════════════════════════════════════════════
sectionSlide("04  CLINICAL FEATURES", "Recognition of Myxoedema Coma");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 13 — RECOGNITION OF MYXOEDEMA COMA (Box 117.7)
// ═══════════════════════════════════════════════════════════════════════════
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    { label: "Patient Profile", detail: "Older woman presenting in winter months", icon: "👤" },
    { label: "Known Hypothyroidism", detail: "History of thyroid disease; thyroidectomy scar", icon: "📋" },
    { label: "Hypothermia", detail: "Temp usually <36°C; <32°C is a poor prognostic sign; as low as 24°C reported", icon: "🌡" },
    { label: "Altered Mental Status", detail: "Lethargy → confusion → stupor → coma; agitation, psychosis, seizures ('myxoedema madness')", icon: "🧠" },
    { label: "Hypotension", detail: "Often refractory to fluids & pressors unless thyroid hormone given", icon: "💉" },
    { label: "Respirations", detail: "Slow, shallow; hypercapnia + hypoxia; high risk of respiratory failure", icon: "💨" },
    { label: "Bradycardia", detail: "Sinus bradycardia; long QT; ventricular arrhythmias", icon: "❤" },
    { label: "Myxoedema Facies", detail: "Puffy eyelids, macroglossia, periorbital oedema, non-pitting oedema", icon: "😶" },
  ];

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  const startY = 1.06;
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      { text: f.label + ": ", options: { bold: true, color: RED_ACC, fontSize: 13, fontFace: TITLE_FONT } },
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  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 14 — DIAGNOSTIC TESTS
// ═══════════════════════════════════════════════════════════════════════════
bulletSlide("Diagnostic Investigations", [
  { text: "THYROID FUNCTION TESTS — cornerstone of diagnosis", bold: true, color: MID, size: 18 },
  { text: "TSH: elevated in primary hypothyroidism (most sensitive)", indent: 1 },
  { text: "Free T4 (fT4): low — confirms hypothyroidism", indent: 1 },
  { text: "T3: low (less reliable in isolation)", indent: 1 },
  { text: "", bullet: false, size: 5 },
  { text: "OTHER LABS", bold: true, color: MID, size: 18 },
  { text: "↑ CK, LDH, AST (muscle involvement)", indent: 1 },
  { text: "Hyponatraemia (associated with ↑ mortality)", indent: 1 },
  { text: "Hypoglycaemia", indent: 1 },
  { text: "↑ Cholesterol, triglycerides", indent: 1 },
  { text: "", bullet: false, size: 5 },
  { text: "ECG: sinus bradycardia, low-voltage complexes, long QT, T-wave changes", bold: false },
  { text: "CXR / Echo: cardiomegaly, pericardial/pleural effusion", bold: false },
  { text: "Cortisol: rule out concomitant adrenal insufficiency (often coexists)", bold: true, color: RED_ACC },
]);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 15 — SECTION: MANAGEMENT
// ═══════════════════════════════════════════════════════════════════════════
sectionSlide("05  MANAGEMENT", "Emergency Treatment of Myxoedema Coma");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 16 — IMMEDIATE RESUSCITATION
// ═══════════════════════════════════════════════════════════════════════════
bulletSlide("Management — Immediate Resuscitation", [
  { text: "AIRWAY & BREATHING", bold: true, color: RED_ACC, size: 18 },
  { text: "Secure airway if GCS low / respiratory failure anticipated", indent: 1 },
  { text: "Assisted ventilation for hypoventilation / hypercapnia", indent: 1 },
  { text: "", bullet: false, size: 5 },
  { text: "CIRCULATION", bold: true, color: RED_ACC, size: 18 },
  { text: "Hypotension: IV crystalloid (0.9 NS or D5/0.9 NS if hypoglycaemic)", indent: 1 },
  { text: "Vasopressors if refractory — but thyroid hormone replacement itself may restore BP", indent: 1 },
  { text: "", bullet: false, size: 5 },
  { text: "TEMPERATURE", bold: true, color: RED_ACC, size: 18 },
  { text: "Passive rewarming with blankets — active rewarming rarely needed", indent: 1 },
  { text: "If heating blankets used: pre-load with IV fluids + monitor BP closely", indent: 1 },
  { text: "", bullet: false, size: 5 },
  { text: "GLUCOSE: check and correct hypoglycaemia promptly", bold: false },
  { text: "SEDATIVES / NARCOTICS: reduce dosing — metabolism slowed in hypothyroidism", bold: false, color: YELLOW },
]);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 17 — THYROID HORMONE REPLACEMENT (Box 117.8)
// ═══════════════════════════════════════════════════════════════════════════
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        "Stress-dose steroid — ALWAYS give alongside thyroid hormone",
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 18 — DISPOSITION & SPECIAL POPULATIONS
// ═══════════════════════════════════════════════════════════════════════════
bulletSlide("Disposition & Special Considerations", [
  { text: "DISPOSITION", bold: true, color: MID, size: 18 },
  { text: "Mild/moderate hypothyroidism → outpatient management", indent: 1 },
  { text: "Severe hypothyroidism or myxoedema coma → INPATIENT (ICU)", indent: 1 },
  { text: "Higher mortality with: requirement for steroids, mechanical ventilation, vasopressors", indent: 1, color: RED_ACC },
  { text: "", bullet: false, size: 6 },
  { text: "SPECIAL POPULATIONS", bold: true, color: MID, size: 18 },
  { text: "Pregnancy: hypothyroidism often subtle; T4 replacement → normal maternal/fetal outcome", indent: 1 },
  { text: "Children: impaired growth, development, and cognition; T4 replacement → rapid growth spurt", indent: 1 },
  { text: "Elderly: higher risk; atypical presentation; lower replacement doses required", indent: 1 },
  { text: "", bullet: false, size: 6 },
  { text: "KEY PRINCIPLE: Identify and treat the precipitating event (infection most common)", bold: true, color: RED_ACC, size: 18 },
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]);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 19 — SUMMARY / TAKE-HOME
// ═══════════════════════════════════════════════════════════════════════════
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    { num: "2", text: "Mortality approaches 100% untreated; up to 30% even with optimal therapy." },
    { num: "3", text: "Classic patient: older woman, winter presentation, known thyroid disease." },
    { num: "4", text: "T4 loading dose 200–400 μg IV is the cornerstone treatment — give immediately." },
    { num: "5", text: "ALWAYS add hydrocortisone 100 mg IV — concomitant adrenal insufficiency is common." },
    { num: "6", text: "Treat the precipitating event (sepsis most frequent trigger)." },
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// ─── WRITE FILE ──────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/myxoedema-ppt/Myxoedema_3rdYear.pptx" })
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  .catch(err => { console.error("ERROR:", err); process.exit(1); });

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/myxoedema-ppt/myxoedema.js'