mkdir -p /home/daytona/workspace/dvt-ppt && ls /home/daytona/workspace/dvt-ppt

~/dvt-ppt/dvt.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Deep Vein Thrombosis (DVT) - Clinical Overview";
pres.author = "Clinical Presentation";

// ─── COLOR PALETTE ───────────────────────────────────────────────
const NAVY    = "0D2B55";   // dominant dark
const STEEL   = "1A4A7A";   // secondary
const ACCENT  = "E8A020";   // amber accent
const WHITE   = "FFFFFF";
const OFFWHITE= "F4F7FB";
const GRAY    = "6B7A8D";
const LGRAY   = "CBD5E0";
const DARKTEXT= "1C2833";
const LIGHTBG = "EAF1FA";

// ─── HELPER: Dark slide header ────────────────────────────────────
function addDarkSlide(slide, title, subtitle) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY } });
  // Accent bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 4.7, w: 10, h: 0.15, fill: { color: ACCENT } });
  slide.addText(title, {
    x: 0.6, y: 1.6, w: 8.8, h: 1.4,
    fontSize: 44, bold: true, color: WHITE, align: "center", fontFace: "Calibri"
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.6, y: 3.2, w: 8.8, h: 0.7,
      fontSize: 18, color: LGRAY, align: "center", fontFace: "Calibri", italic: true
    });
  }
}

// ─── HELPER: Section header (dark strip top) ──────────────────────
function addSectionHeader(slide, sectionTitle) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: NAVY } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.75, w: 10, h: 0.06, fill: { color: ACCENT } });
  slide.addText(sectionTitle, {
    x: 0.3, y: 0.1, w: 9.4, h: 0.55,
    fontSize: 20, bold: true, color: WHITE, fontFace: "Calibri", valign: "middle"
  });
}

// ─── HELPER: bullet list ─────────────────────────────────────────
function makeBullets(items, opts = {}) {
  return items.map((item, i) => ({
    text: item,
    options: {
      bullet: { type: "bullet", characterCode: "25A0", color: ACCENT },
      fontSize: opts.fontSize || 15,
      color: opts.color || DARKTEXT,
      fontFace: "Calibri",
      breakLine: i < items.length - 1
    }
  }));
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addDarkSlide(s,
    "Deep Vein Thrombosis",
    "Clinical Assessment, Diagnosis & Management"
  );
  s.addText("A clinical reference for physicians & hospitalists", {
    x: 0.6, y: 4.1, w: 8.8, h: 0.4,
    fontSize: 13, color: LGRAY, align: "center", fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 2 – DEFINITION & EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "Definition & Epidemiology");

  // Left panel – definition box
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.0, w: 4.5, h: 4.2, fill: { color: NAVY }, line: { color: NAVY } });
  s.addText("What is DVT?", {
    x: 0.3, y: 1.05, w: 4.5, h: 0.5,
    fontSize: 16, bold: true, color: ACCENT, fontFace: "Calibri", align: "center"
  });
  s.addText([
    { text: "Formation of a blood clot (thrombus) within the deep venous system, most commonly the lower extremities.", options: { breakLine: true } },
    { text: " ", options: { breakLine: true } },
    { text: "Part of the spectrum of Venous Thromboembolism (VTE) — which also includes Pulmonary Embolism (PE).", options: { breakLine: true } },
    { text: " ", options: { breakLine: true } },
    { text: "Proximal DVT (femoral, popliteal, iliac) carries higher PE risk than isolated distal (calf) DVT.", options: {} }
  ], {
    x: 0.4, y: 1.65, w: 4.3, h: 3.3,
    fontSize: 13, color: WHITE, fontFace: "Calibri", valign: "top"
  });

  // Right panel – epidemiology stats
  s.addText("Epidemiology", {
    x: 5.1, y: 1.05, w: 4.5, h: 0.4,
    fontSize: 16, bold: true, color: NAVY, fontFace: "Calibri"
  });

  const stats = [
    ["~1–2", "cases per 1,000 persons/year"],
    [">50%", "of untreated proximal DVT leads to PE"],
    ["<10%", "of ED DVT cases are bilateral"],
    ["~25%", "of suspected DVTs confirmed on imaging"],
  ];

  stats.forEach(([num, label], i) => {
    const y = 1.55 + i * 0.95;
    s.addShape(pres.ShapeType.rect, { x: 5.1, y, w: 4.4, h: 0.8, fill: { color: LIGHTBG }, line: { color: LGRAY, pt: 1 } });
    s.addText(num, { x: 5.15, y: y + 0.05, w: 1.1, h: 0.7, fontSize: 22, bold: true, color: ACCENT, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(label, { x: 6.35, y: y + 0.12, w: 3.1, h: 0.55, fontSize: 12, color: DARKTEXT, fontFace: "Calibri", valign: "middle" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 3 – PATHOPHYSIOLOGY (VIRCHOW'S TRIAD)
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "Pathophysiology – Virchow's Triad");

  const triad = [
    {
      label: "Venous Stasis",
      icon: "S",
      color: NAVY,
      points: ["Immobility, bed rest", "Long-haul travel (>4 hrs)", "Heart failure", "Pregnancy"]
    },
    {
      label: "Endothelial Injury",
      icon: "E",
      color: STEEL,
      points: ["Surgery / trauma", "Central venous catheters", "Prior DVT", "Inflammation"]
    },
    {
      label: "Hypercoagulability",
      icon: "H",
      color: "1A6B5A",
      points: ["Active malignancy", "Thrombophilia (Factor V Leiden, Protein C/S deficiency)", "Oral contraceptives / HRT", "Pregnancy / postpartum"]
    }
  ];

  triad.forEach((t, i) => {
    const x = 0.25 + i * 3.25;
    // Card background
    s.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 3.05, h: 4.25, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
    // Top color bar
    s.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 3.05, h: 0.55, fill: { color: t.color } });
    s.addText(t.label, { x, y: 1.02, w: 3.05, h: 0.5, fontSize: 14, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    // Icon circle
    s.addShape(pres.ShapeType.ellipse, { x: x + 1.15, y: 1.45, w: 0.75, h: 0.75, fill: { color: ACCENT } });
    s.addText(t.icon, { x: x + 1.15, y: 1.47, w: 0.75, h: 0.72, fontSize: 22, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });

    s.addText(makeBullets(t.points, { fontSize: 12, color: DARKTEXT }), {
      x: x + 0.1, y: 2.3, w: 2.85, h: 2.8, fontFace: "Calibri"
    });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 4 – RISK FACTORS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "Risk Factors");

  const categories = [
    {
      title: "Patient Factors",
      items: ["Age >60 years", "Prior VTE history", "Obesity (BMI >30)", "Thrombophilia", "Pregnancy / postpartum", "Varicose veins"]
    },
    {
      title: "Acquired / Situational",
      items: ["Major surgery (esp. orthopaedic)", "Active malignancy", "Trauma / fractures", "Prolonged immobility", "Long-haul travel", "Central venous catheter"]
    },
    {
      title: "Drug / Hormonal",
      items: ["Combined oral contraceptives", "Hormone replacement therapy", "Antipsychotics (clozapine)", "Tamoxifen / chemotherapy", "Erythropoiesis-stimulating agents"]
    }
  ];

  categories.forEach((cat, i) => {
    const x = 0.25 + i * 3.25;
    s.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 3.05, h: 4.25, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
    s.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 3.05, h: 0.5, fill: { color: STEEL } });
    s.addText(cat.title, { x, y: 1.02, w: 3.05, h: 0.45, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    s.addText(makeBullets(cat.items, { fontSize: 12 }), { x: x + 0.1, y: 1.6, w: 2.85, h: 3.4 });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 5 – CLINICAL PRESENTATION
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "Clinical Presentation");

  // Left column – symptoms & signs
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.95, w: 4.4, h: 4.3, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.95, w: 4.4, h: 0.45, fill: { color: NAVY } });
  s.addText("Symptoms & Signs", { x: 0.3, y: 0.97, w: 4.4, h: 0.4, fontSize: 14, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
  s.addText(makeBullets([
    "Unilateral limb pain and swelling",
    "Calf pain / cramping or sense of fullness",
    "Erythema, warmth, tenderness along deep veins",
    "Dilation of superficial collateral veins",
    "Palpable venous cord (rare)",
    "Homans' sign - calf pain on dorsiflexion (neither sensitive nor specific)",
    "Majority have no / subtle physical signs"
  ], { fontSize: 12 }), { x: 0.4, y: 1.5, w: 4.2, h: 3.5 });

  // Right column – special populations + upper limb
  s.addShape(pres.ShapeType.rect, { x: 5.0, y: 0.95, w: 4.6, h: 4.3, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 5.0, y: 0.95, w: 4.6, h: 0.45, fill: { color: STEEL } });
  s.addText("Special Considerations", { x: 5.0, y: 0.97, w: 4.6, h: 0.4, fontSize: 14, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });

  s.addText("Upper Extremity DVT", { x: 5.1, y: 1.5, w: 4.3, h: 0.35, fontSize: 13, bold: true, color: NAVY, fontFace: "Calibri" });
  s.addText(makeBullets([
    ">90% associated with indwelling catheter / pacemaker wire",
    "Paget-Schroetter syndrome: dominant arm in young athletes (effort-induced thoracic outlet syndrome)"
  ], { fontSize: 11 }), { x: 5.1, y: 1.9, w: 4.3, h: 1.0 });

  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 2.95, w: 4.3, h: 0.04, fill: { color: ACCENT } });

  s.addText("Left Leg Predominance", { x: 5.1, y: 3.05, w: 4.3, h: 0.35, fontSize: 13, bold: true, color: NAVY, fontFace: "Calibri" });
  s.addText("May-Thurner Syndrome: left iliac vein compression by left iliac artery increases left-sided DVT frequency.", {
    x: 5.1, y: 3.45, w: 4.3, h: 0.65, fontSize: 11, color: DARKTEXT, fontFace: "Calibri"
  });

  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 4.15, w: 4.3, h: 0.04, fill: { color: ACCENT } });
  s.addText("Bilateral DVT in <10% of ED patients with DVT", {
    x: 5.1, y: 4.25, w: 4.3, h: 0.5, fontSize: 11, color: DARKTEXT, fontFace: "Calibri", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 6 – DIFFERENTIAL DIAGNOSIS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "Differential Diagnosis");

  const ddx = [
    { title: "Venous Insufficiency", body: "Congestion & inflammation; common in older patients. Note: venous insufficiency itself increases DVT risk." },
    { title: "Cellulitis", body: "Localised skin infection. Concurrent DVT in only ~3% of cellulitis patients. Fever favours cellulitis." },
    { title: "Baker Cyst / Rupture", body: "Popliteal mass or ruptured cyst causing calf inflammation - clinically indistinguishable from DVT." },
    { title: "Muscle / Tendon Injury", body: "Gastrocnemius tear or Achilles tendon injury - pain/swelling; distinguished by mechanism of injury." },
    { title: "Spontaneous Calf Hematoma", body: "Especially in anticoagulated patients; inflammatory changes mimic DVT." },
    { title: "Systemic Edema", body: "CHF, liver disease, hypoalbuminaemia - may cause asymmetrical swelling raising DVT concern." }
  ];

  ddx.forEach((item, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.85;
    const y = 1.0 + row * 1.55;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 1.4, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.12, h: 1.4, fill: { color: ACCENT } });
    s.addText(item.title, { x: x + 0.2, y: y + 0.08, w: 4.3, h: 0.35, fontSize: 13, bold: true, color: NAVY, fontFace: "Calibri" });
    s.addText(item.body, { x: x + 0.2, y: y + 0.45, w: 4.3, h: 0.85, fontSize: 11, color: DARKTEXT, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 7 – WELLS SCORE
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "Pre-test Probability – Wells DVT Score");

  const wellsRows = [
    ["Active cancer (treatment within 6 months or palliative)", "+1"],
    ["Paralysis, paresis, or recent lower extremity plaster immobilisation", "+1"],
    ["Bedridden ≥3 days OR major surgery within 12 weeks (GA/RA)", "+1"],
    ["Localised tenderness along deep venous system distribution", "+1"],
    ["Entire leg swollen", "+1"],
    ["Calf swelling ≥3 cm more than asymptomatic side (10 cm below tibial tuberosity)", "+1"],
    ["Pitting oedema confined to symptomatic leg", "+1"],
    ["Collateral superficial veins (non-varicose)", "+1"],
    ["Previously documented DVT", "+1"],
    ["Alternative diagnosis at least as likely as DVT", "−2"],
  ];

  // Table header
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.0, w: 7.8, h: 0.38, fill: { color: NAVY } });
  s.addText("Clinical Feature", { x: 0.35, y: 1.03, w: 6.8, h: 0.32, fontSize: 12, bold: true, color: WHITE, fontFace: "Calibri" });
  s.addText("Score", { x: 7.4, y: 1.03, w: 0.7, h: 0.32, fontSize: 12, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });

  wellsRows.forEach((row, i) => {
    const y = 1.38 + i * 0.36;
    const bg = i % 2 === 0 ? WHITE : LIGHTBG;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 7.8, h: 0.35, fill: { color: bg } });
    const scoreColor = row[1] === "−2" ? "C0392B" : "1A6B5A";
    s.addText(row[0], { x: 0.4, y: y + 0.03, w: 6.7, h: 0.28, fontSize: 10.5, color: DARKTEXT, fontFace: "Calibri" });
    s.addText(row[1], { x: 7.4, y: y + 0.03, w: 0.7, h: 0.28, fontSize: 12, bold: true, color: scoreColor, fontFace: "Calibri", align: "center" });
  });

  // Interpretation box
  s.addShape(pres.ShapeType.rect, { x: 8.25, y: 1.0, w: 1.45, h: 4.3, fill: { color: NAVY } });
  s.addText("Interpretation", { x: 8.28, y: 1.05, w: 1.4, h: 0.4, fontSize: 10, bold: true, color: ACCENT, fontFace: "Calibri", align: "center" });
  s.addText([
    { text: "Score <2", options: { bold: true, breakLine: true, color: ACCENT } },
    { text: "Low probability", options: { breakLine: true, color: WHITE } },
    { text: " ", options: { breakLine: true } },
    { text: "Score ≥2", options: { bold: true, breakLine: true, color: ACCENT } },
    { text: "High probability", options: { breakLine: true, color: WHITE } },
    { text: " ", options: { breakLine: true } },
    { text: "Combine with D-dimer for low PTP; proceed to USS for high PTP", options: { color: LGRAY, italic: true } }
  ], { x: 8.28, y: 1.5, w: 1.4, h: 3.6, fontSize: 10, fontFace: "Calibri" });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 8 – DIAGNOSTIC WORK-UP
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "Diagnostic Work-Up");

  // D-dimer box
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.95, w: 4.5, h: 2.25, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.95, w: 4.5, h: 0.45, fill: { color: NAVY } });
  s.addText("D-Dimer", { x: 0.3, y: 0.97, w: 4.5, h: 0.4, fontSize: 15, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
  s.addText(makeBullets([
    "Measures enzymatic breakdown of cross-linked fibrin",
    "Sensitivity ~92%, Specificity ~45% (cutoff >500 ng/mL)",
    "Age-adjusted threshold: age × 10 ng/mL (e.g. 80 yrs → 800 ng/mL)",
    "FALSE POSITIVE: malignancy, pregnancy, surgery, infection, age",
    "FALSE NEGATIVE: warfarin use"
  ], { fontSize: 11 }), { x: 0.4, y: 1.5, w: 4.3, h: 1.6 });

  // USS box
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 0.95, w: 4.5, h: 2.25, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 0.95, w: 4.5, h: 0.45, fill: { color: STEEL } });
  s.addText("Compression Ultrasonography (USS)", { x: 5.1, y: 0.97, w: 4.5, h: 0.4, fontSize: 14, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
  s.addText(makeBullets([
    "Most widely used non-invasive test for proximal DVT",
    "Non-compressibility of vein = diagnostic criterion",
    "High accuracy for proximal DVT; less accurate for distal",
    "3-point scan: common femoral, femoral, popliteal veins",
    "Whole-leg scan adds posterior tibial, peroneal, saphenous"
  ], { fontSize: 11 }), { x: 5.2, y: 1.5, w: 4.3, h: 1.6 });

  // Diagnostic algorithm
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.35, w: 9.4, h: 1.95, fill: { color: LIGHTBG }, line: { color: LGRAY, pt: 1 } });
  s.addText("Diagnostic Algorithm", { x: 0.4, y: 3.42, w: 4.0, h: 0.35, fontSize: 13, bold: true, color: NAVY, fontFace: "Calibri" });

  const steps = [
    { label: "Low PTP\n(Wells <2)", action: "D-Dimer\n→ If negative: DVT excluded\n→ If positive: USS" },
    { label: "High PTP\n(Wells ≥2)", action: "USS\n→ If positive: treat\n→ If negative: D-dimer + follow-up USS at 1 week" }
  ];

  steps.forEach((step, i) => {
    const x = 0.4 + i * 4.7;
    s.addShape(pres.ShapeType.rect, { x, y: 3.85, w: 2.2, h: 1.25, fill: { color: NAVY }, line: { color: NAVY } });
    s.addText(step.label, { x, y: 3.88, w: 2.2, h: 1.2, fontSize: 11, bold: true, color: ACCENT, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x: x + 2.25, y: 3.85, w: 2.2, h: 1.25, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
    s.addText(step.action, { x: x + 2.3, y: 3.88, w: 2.1, h: 1.2, fontSize: 10, color: DARKTEXT, fontFace: "Calibri", valign: "middle" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 9 – TREATMENT: ANTICOAGULATION
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "Treatment – Anticoagulation");

  // Title note
  s.addText("Anticoagulation should be initiated at time of diagnosis (or when imaging is delayed) unless contraindicated.", {
    x: 0.3, y: 0.88, w: 9.4, h: 0.4, fontSize: 11, italic: true, color: GRAY, fontFace: "Calibri"
  });

  const drugs = [
    {
      drug: "Rivaroxaban (Xarelto)",
      class: "DOAC – Direct Xa inhibitor",
      dose: "15 mg BD x 21 days → 20 mg OD",
      notes: "No LMWH bridging required. First-choice for most patients.",
      highlight: true
    },
    {
      drug: "Apixaban (Eliquis)",
      class: "DOAC – Direct Xa inhibitor",
      dose: "10 mg BD x 7 days → 5 mg BD",
      notes: "No bridging required. First-choice; preferred in renal impairment.",
      highlight: true
    },
    {
      drug: "Dabigatran (Pradaxa)",
      class: "DOAC – Direct thrombin inhibitor",
      dose: "5–10 days LMWH first → 150 mg BD",
      notes: "Requires initial parenteral bridging.",
      highlight: false
    },
    {
      drug: "LMWH (e.g. Enoxaparin)",
      class: "Low Molecular Weight Heparin",
      dose: "1 mg/kg SC BD or 1.5 mg/kg OD",
      notes: "Preferred in cancer (lower recurrence than warfarin). Also use in pregnancy.",
      highlight: false
    },
    {
      drug: "Warfarin",
      class: "Vitamin K Antagonist",
      dose: "Target INR 2.0–3.0 (bridge with LMWH)",
      notes: "Requires regular INR monitoring. Second-line to DOACs.",
      highlight: false
    }
  ];

  drugs.forEach((d, i) => {
    const col = i < 3 ? 0 : 1;
    const row = i < 3 ? i : i - 3;
    const x = 0.25 + col * 5.0;
    const y = 1.45 + row * 1.35;
    const h = 1.2;
    const bgColor = d.highlight ? "E8F4E8" : WHITE;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h, fill: { color: bgColor }, line: { color: LGRAY, pt: 1 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.1, h, fill: { color: d.highlight ? "1A6B5A" : GRAY } });
    s.addText(d.drug, { x: x + 0.18, y: y + 0.07, w: 4.3, h: 0.3, fontSize: 13, bold: true, color: NAVY, fontFace: "Calibri" });
    s.addText(d.class, { x: x + 0.18, y: y + 0.37, w: 4.3, h: 0.22, fontSize: 10, color: GRAY, fontFace: "Calibri", italic: true });
    s.addText("Dose: " + d.dose, { x: x + 0.18, y: y + 0.6, w: 4.3, h: 0.22, fontSize: 10, color: DARKTEXT, fontFace: "Calibri" });
    s.addText(d.notes, { x: x + 0.18, y: y + 0.85, w: 4.3, h: 0.28, fontSize: 10, color: STEEL, fontFace: "Calibri", italic: true });
  });

  // Contraindications note
  s.addShape(pres.ShapeType.rect, { x: 5.25, y: 4.15, w: 4.45, h: 1.2, fill: { color: "FFF3CD" }, line: { color: ACCENT, pt: 1 } });
  s.addText("DOACs are contraindicated / not studied in:", { x: 5.35, y: 4.22, w: 4.2, h: 0.3, fontSize: 11, bold: true, color: "7D4E00", fontFace: "Calibri" });
  s.addText("Pregnancy • Severe renal/hepatic failure • Antiphospholipid syndrome • High-risk PE", {
    x: 5.35, y: 4.52, w: 4.2, h: 0.6, fontSize: 10, color: "7D4E00", fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 10 – DURATION OF TREATMENT
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "Duration of Anticoagulation");

  const durations = [
    {
      category: "Provoked DVT",
      subtitle: "(Transient risk factor – surgery, immobility, trauma)",
      duration: "3 Months",
      color: "1A6B5A",
      notes: "Lower recurrence risk after provoking factor resolves. Minimum 3 months for proximal DVT."
    },
    {
      category: "Unprovoked DVT",
      subtitle: "(No identifiable cause)",
      duration: "3–6 Months\n+/- Extended",
      color: STEEL,
      notes: "Consider extended therapy based on bleeding risk vs. recurrence risk. Annual recurrence ~10% without anticoagulation."
    },
    {
      category: "Cancer-Associated DVT",
      subtitle: "(Active malignancy)",
      duration: "Until cancer\nresolved / inactive",
      color: "8B2020",
      notes: "LMWH or DOAC (edoxaban, rivaroxaban). Duration guided by ongoing cancer activity and bleeding risk."
    },
    {
      category: "Isolated Distal DVT",
      subtitle: "(Below-knee calf veins only)",
      duration: "3 Months\nor Surveillance",
      color: NAVY,
      notes: "Anticoagulate if symptomatic, high recurrence risk, or clot >5 cm. Otherwise serial USS at 1 week to check propagation."
    }
  ];

  durations.forEach((d, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 4.9;
    const y = 1.0 + row * 2.25;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 2.1, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 0.5, fill: { color: d.color } });
    s.addText(d.category, { x, y: y + 0.05, w: 4.6, h: 0.4, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    s.addText(d.subtitle, { x: x + 0.2, y: y + 0.55, w: 4.2, h: 0.3, fontSize: 10, color: GRAY, fontFace: "Calibri", italic: true });
    s.addShape(pres.ShapeType.rect, { x: x + 1.2, y: y + 0.9, w: 2.2, h: 0.55, fill: { color: ACCENT } });
    s.addText(d.duration, { x: x + 1.2, y: y + 0.92, w: 2.2, h: 0.52, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(d.notes, { x: x + 0.15, y: y + 1.55, w: 4.3, h: 0.5, fontSize: 10, color: DARKTEXT, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 11 – COMPLICATIONS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "Complications");

  const comps = [
    {
      title: "Pulmonary Embolism (PE)",
      severity: "LIFE-THREATENING",
      sevColor: "C0392B",
      points: [
        ">50% of untreated proximal DVT → PE",
        "Symptoms: pleuritic chest pain, dyspnoea, haemoptysis, hypotension",
        "Right ventricular strain, hypoxaemia, death in massive PE",
        "CTPA is diagnostic gold standard"
      ]
    },
    {
      title: "Post-Thrombotic Syndrome (PTS)",
      severity: "CHRONIC MORBIDITY",
      sevColor: "E8A020",
      points: [
        "20–50% of patients with proximal DVT",
        "Chronic venous hypertension from valve damage",
        "Symptoms: leg pain, swelling, hyperpigmentation, venous ulcers",
        "Risk factors: iliofemoral DVT, recurrent ipsilateral DVT, subtherapeutic anticoagulation"
      ]
    },
    {
      title: "Recurrent DVT / VTE",
      severity: "SIGNIFICANT RISK",
      sevColor: STEEL,
      points: [
        "~10% annual risk after unprovoked DVT without anticoagulation",
        "Higher with thrombophilia, malignancy, antiphospholipid syndrome",
        "Consider extended anticoagulation in unprovoked cases",
        "Thrombophilia screening after first unprovoked VTE"
      ]
    }
  ];

  comps.forEach((c, i) => {
    const x = 0.25 + i * 3.25;
    s.addShape(pres.ShapeType.rect, { x, y: 0.95, w: 3.05, h: 4.35, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
    s.addShape(pres.ShapeType.rect, { x, y: 0.95, w: 3.05, h: 0.5, fill: { color: NAVY } });
    s.addText(c.title, { x: x + 0.05, y: 0.97, w: 2.95, h: 0.45, fontSize: 12, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });
    // Severity badge
    s.addShape(pres.ShapeType.rect, { x: x + 0.4, y: 1.52, w: 2.25, h: 0.3, fill: { color: c.sevColor } });
    s.addText(c.severity, { x: x + 0.4, y: 1.53, w: 2.25, h: 0.28, fontSize: 9, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    s.addText(makeBullets(c.points, { fontSize: 11 }), { x: x + 0.1, y: 1.9, w: 2.85, h: 3.15 });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 12 – PROPHYLAXIS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "DVT Prophylaxis");

  // Subheading
  s.addText("Risk stratification and prophylaxis should be assessed within 24 hours of hospital admission and reviewed when clinical status changes.", {
    x: 0.3, y: 0.87, w: 9.4, h: 0.4, fontSize: 10.5, italic: true, color: GRAY, fontFace: "Calibri"
  });

  // Risk table
  const riskRows = [
    { risk: "Low", example: "Maxillofacial, neurosurgery, cardiothoracic", measure: "Early mobilisation" },
    { risk: "Medium", example: "Inguinal hernia, abdominal, gynaecological, urological surgery", measure: "Compression stockings + LMWH" },
    { risk: "High", example: "Pelvic surgery, total hip/knee replacement, major trauma", measure: "LMWH + mechanical compression devices" }
  ];

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.38, w: 9.4, h: 0.38, fill: { color: NAVY } });
  s.addText("Risk Level", { x: 0.35, y: 1.41, w: 2.0, h: 0.32, fontSize: 11, bold: true, color: WHITE, fontFace: "Calibri" });
  s.addText("Surgical Examples", { x: 2.4, y: 1.41, w: 4.5, h: 0.32, fontSize: 11, bold: true, color: WHITE, fontFace: "Calibri" });
  s.addText("Prophylaxis", { x: 6.95, y: 1.41, w: 2.7, h: 0.32, fontSize: 11, bold: true, color: WHITE, fontFace: "Calibri" });

  const rowColors = [LIGHTBG, WHITE, LIGHTBG];
  riskRows.forEach((row, i) => {
    const y = 1.76 + i * 0.5;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 9.4, h: 0.48, fill: { color: rowColors[i] } });
    const riskColor = row.risk === "High" ? "C0392B" : row.risk === "Medium" ? STEEL : "1A6B5A";
    s.addText(row.risk, { x: 0.35, y: y + 0.08, w: 2.0, h: 0.32, fontSize: 12, bold: true, color: riskColor, fontFace: "Calibri" });
    s.addText(row.example, { x: 2.4, y: y + 0.08, w: 4.5, h: 0.32, fontSize: 10.5, color: DARKTEXT, fontFace: "Calibri" });
    s.addText(row.measure, { x: 6.95, y: y + 0.08, w: 2.7, h: 0.32, fontSize: 10.5, color: DARKTEXT, fontFace: "Calibri", bold: true });
  });

  // Mechanical & pharmacological notes
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.1, w: 4.5, h: 2.2, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.1, w: 4.5, h: 0.4, fill: { color: STEEL } });
  s.addText("Mechanical Methods", { x: 0.3, y: 3.12, w: 4.5, h: 0.35, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
  s.addText(makeBullets([
    "Graduated compression stockings (GCS) - avoid in suspected/known PAD, neuropathy, severe leg oedema",
    "Pneumatic calf compression devices (IPC)",
    "Early mobilisation post-surgery"
  ], { fontSize: 11 }), { x: 0.4, y: 3.58, w: 4.3, h: 1.6 });

  s.addShape(pres.ShapeType.rect, { x: 5.15, y: 3.1, w: 4.55, h: 2.2, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 5.15, y: 3.1, w: 4.55, h: 0.4, fill: { color: NAVY } });
  s.addText("Pharmacological Prophylaxis", { x: 5.15, y: 3.12, w: 4.55, h: 0.35, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
  s.addText(makeBullets([
    "LMWH (e.g. enoxaparin 40 mg SC OD) - most widely used",
    "Fondaparinux - alternative in HIT",
    "DOACs post-arthroplasty (rivaroxaban 10 mg OD x 35 days)",
    "Aspirin 81 mg BD for selected orthopaedic patients"
  ], { fontSize: 11 }), { x: 5.25, y: 3.58, w: 4.35, h: 1.6 });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 13 – SPECIAL POPULATIONS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
  addSectionHeader(s, "DVT in Special Populations");

  const pops = [
    {
      title: "Pregnancy",
      points: [
        "Wells score not validated – use LEFt score (Left leg, Edema, first Trimester)",
        "DOACs are contraindicated – use LMWH throughout pregnancy",
        "Avoid warfarin in first trimester (teratogenic)",
        "USS is first imaging test; MRI for pelvic vein DVT"
      ]
    },
    {
      title: "Malignancy",
      points: [
        "Cancer is major prothrombotic state – Trousseau syndrome",
        "LMWH preferred (lower VTE recurrence than warfarin)",
        "DOACs (edoxaban, rivaroxaban) are alternative in low GI bleed risk",
        "Duration: until cancer resolved or patient no longer benefits"
      ]
    },
    {
      title: "Upper Extremity DVT",
      points: [
        ">90% catheter-related; anticoagulate for 3 months",
        "If catheter functioning and needed, keep in situ – anticoagulate while catheter in place",
        "Paget-Schroetter: consider thrombolysis + surgical decompression",
        "Same anticoagulation agents as lower limb DVT"
      ]
    },
    {
      title: "Renal / Hepatic Impairment",
      points: [
        "Severe CKD (eGFR <30): avoid rivaroxaban, edoxaban; apixaban may be used cautiously",
        "LMWH requires dose adjustment or switch to UFH in severe renal failure",
        "Hepatic impairment: avoid DOACs; LMWH is preferred",
        "Monitor anti-Xa levels if LMWH used in renal impairment"
      ]
    }
  ];

  pops.forEach((pop, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 4.9;
    const y = 0.95 + row * 2.3;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 2.15, fill: { color: WHITE }, line: { color: LGRAY, pt: 1 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 0.45, fill: { color: NAVY } });
    s.addText(pop.title, { x, y: y + 0.03, w: 4.6, h: 0.38, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    s.addText(makeBullets(pop.points, { fontSize: 11 }), { x: x + 0.1, y: y + 0.55, w: 4.4, h: 1.5 });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 14 – KEY TAKE-AWAYS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.75, w: 10, h: 0.08, fill: { color: ACCENT } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.3, w: 10, h: 0.08, fill: { color: ACCENT } });

  s.addText("Key Clinical Take-Aways", {
    x: 0.5, y: 0.12, w: 9, h: 0.55,
    fontSize: 24, bold: true, color: WHITE, fontFace: "Calibri", align: "center"
  });

  const points = [
    "Clinical diagnosis is unreliable — always use pretest probability (Wells Score) + D-dimer and/or USS.",
    "DOACs (rivaroxaban, apixaban) are first-line for most DVT — no bridging, no INR monitoring, less intracranial bleeding than warfarin.",
    "D-dimer is highly sensitive but non-specific; age-adjust the threshold (age × 10 ng/mL) to reduce unnecessary imaging.",
    "Minimum anticoagulation duration is 3 months for provoked DVT; consider extended therapy for unprovoked DVT.",
    "Cancer-associated DVT: use LMWH or DOAC; anticoagulate until cancer resolves.",
    "Prevent PE and Post-Thrombotic Syndrome — the two major complications of untreated/undertreated DVT.",
    "Prophylaxis must be assessed in ALL admitted surgical patients within 24 hours of admission."
  ];

  points.forEach((pt, i) => {
    const y = 0.95 + i * 0.67;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 0.35, h: 0.35, fill: { color: ACCENT } });
    s.addText(`${i + 1}`, { x: 0.3, y, w: 0.35, h: 0.35, fontSize: 12, bold: true, color: NAVY, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(pt, { x: 0.8, y: y + 0.02, w: 8.9, h: 0.35, fontSize: 12, color: WHITE, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SAVE
// ═══════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/dvt-ppt/DVT_Clinical_Presentation.pptx" })
  .then(() => console.log("SUCCESS: /home/daytona/workspace/dvt-ppt/DVT_Clinical_Presentation.pptx"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/dvt-ppt && node dvt.js