const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3 x 7.5 inches
pres.title = "Anemia - Clinical Guide for Intern Doctors";
pres.author = "Orris Medical";

// ─── COLOUR PALETTE ───────────────────────────────────────────────────────────
const C = {
  darkBg:    "0D1B2A",   // near-black navy  (title / section slides)
  navyMid:   "1B3A5C",   // deep navy
  royalBlue: "1565C0",   // dominant blue
  skyBlue:   "42A5F5",   // light accent
  redAccent: "E53935",   // danger / important
  orange:    "FB8C00",   // warm accent
  green:     "2E7D32",   // positive / treatment
  lightGreen:"43A047",
  teal:      "00838F",
  yellow:    "F9A825",
  purple:    "6A1B9A",
  lightPurp: "AB47BC",
  pink:      "E91E63",
  white:     "FFFFFF",
  offWhite:  "F5F7FA",
  lightGrey: "E3E8F0",
  grey:      "90A4AE",
  darkText:  "1A237E",
};

// ─── HELPER FUNCTIONS ─────────────────────────────────────────────────────────
function addSlide(bgColor) {
  const s = pres.addSlide();
  s.background = { color: bgColor || C.offWhite };
  return s;
}

function header(s, title, subtitle, bgColor) {
  // top colour bar
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  s.addText(title, { x: 0.25, y: 0.06, w: 12.8, h: 0.42, fontSize: 18, bold: true, color: C.white, valign: "middle", margin: 0 });
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}

function card(s, x, y, w, h, fillColor, text, textOpts) {
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x, y, w, h,
    fill: { color: fillColor },
    line: { color: fillColor },
    rectRadius: 0.12,
    shadow: { type: "outer", color: "000000", blur: 8, offset: 2, angle: 135, opacity: 0.13 }
  });
  if (text) {
    s.addText(text, Object.assign({ x: x + 0.1, y, w: w - 0.2, h, valign: "middle", margin: 4 }, textOpts));
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}

function sectionDivider(s, icon, title, subtitle, accentColor) {
  // Left accent stripe
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  // Big icon circle
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  s.addText(icon, { x: 1.2, y: 2.5, w: 2.4, h: 2.4, fontSize: 72, align: "center", valign: "middle" });
  s.addText(title, { x: 4.2, y: 2.6, w: 8.6, h: 1, fontSize: 38, bold: true, color: accentColor });
  if (subtitle) s.addText(subtitle, { x: 4.2, y: 3.7, w: 8.6, h: 0.7, fontSize: 17, italic: true, color: C.grey });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 - TITLE SLIDE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.darkBg);
  // Decorative circles
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  s.addShape(pres.shapes.OVAL, { x: 11, y: 3.5, w: 4, h: 4, fill: { color: C.skyBlue, transparency: 80 }, line: { color: C.skyBlue, transparency: 80 } });
  s.addShape(pres.shapes.OVAL, { x: -1, y: 4, w: 3.5, h: 3.5, fill: { color: C.teal, transparency: 80 }, line: { color: C.teal, transparency: 80 } });

  // Red blood cell icon representation
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  s.addShape(pres.shapes.OVAL, { x: 0.85, y: 1.5, w: 1.1, h: 0.9, fill: { color: C.darkBg }, line: { color: C.darkBg } });

  s.addText("🩸 ANEMIA", { x: 1, y: 1.0, w: 11, h: 1.4, fontSize: 62, bold: true, color: C.white, align: "center", charSpacing: 8 });
  s.addText("Complete Clinical Guide for the Intern Doctor", {
    x: 1, y: 2.55, w: 11, h: 0.65, fontSize: 22, color: C.skyBlue, align: "center", italic: true
  });

  // Divider line
  s.addShape(pres.shapes.RECTANGLE, { x: 3.5, y: 3.35, w: 6.3, h: 0.04, fill: { color: C.orange }, line: { color: C.orange } });

  // Topic chips
  const chips = ["Definition","Classification","Pathophysiology","Investigations","Iron Deficiency","Megaloblastic","Hemolysis","Aplastic","Treatment","Mnemonics"];
  const chipColors = [C.royalBlue, C.teal, C.purple, C.green, C.redAccent, C.orange, C.pink, C.navyMid, C.lightGreen, C.yellow];
  chips.forEach((chip, i) => {
    const col = i % 5;
    const row = Math.floor(i / 5);
    const cx = 1.2 + col * 2.2;
    const cy = 3.7 + row * 0.62;
    card(s, cx, cy, 2.0, 0.45, chipColors[i], chip, { fontSize: 10, bold: true, color: C.white, align: "center" });
  });

  s.addText("Harrison's 22E  •  Tintinalli  •  Family Medicine 9E", {
    x: 0, y: 7.1, w: 13.3, h: 0.35, fontSize: 10, color: C.grey, align: "center", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 - DEFINITION & WHO CRITERIA
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.offWhite);
  header(s, "DEFINITION & WHO DIAGNOSTIC CRITERIA", "What exactly is Anemia?", C.royalBlue);

  // Definition box
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 0.95, w: 12.7, h: 0.85, fill: { color: C.darkBg }, line: { color: C.darkBg }, rectRadius: 0.1 });
  s.addText([
    { text: "📖  Anemia  ", options: { bold: true, color: C.yellow, fontSize: 16 } },
    { text: "= Hemoglobin below normal for age & sex-matched population  |  \"Not just a number — it's reduced O₂ delivery to tissues\"", options: { color: C.white, fontSize: 13 } }
  ], { x: 0.3, y: 0.95, w: 12.7, h: 0.85, valign: "middle", margin: 8 });

  // WHO table header
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 1.95, w: 12.7, h: 0.38, fill: { color: C.royalBlue }, line: { color: C.royalBlue } });
  s.addText("WHO HAEMOGLOBIN THRESHOLDS (g/dL)", { x: 0.3, y: 1.95, w: 12.7, h: 0.38, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle" });

  const rows = [
    ["👨 Adult Men", "< 13.0", C.royalBlue],
    ["👩 Adult Women (non-pregnant)", "< 12.0", C.teal],
    ["🤰 Pregnant Women", "< 11.0", C.pink],
    ["👶 Children 6m–6 yrs", "< 11.0", C.orange],
    ["🧒 Children 6–14 yrs", "< 12.0", C.purple],
  ];
  rows.forEach(([label, val, col], i) => {
    const bg = i % 2 === 0 ? C.white : C.lightGrey;
    s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 2.33 + i * 0.47, w: 12.7, h: 0.47, fill: { color: bg }, line: { color: bg } });
    s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 2.33 + i * 0.47, w: 0.08, h: 0.47, fill: { color: col }, line: { color: col } });
    s.addText(label, { x: 0.55, y: 2.33 + i * 0.47, w: 8.5, h: 0.47, fontSize: 13, color: C.darkText, valign: "middle" });
    // value badge
    card(s, 10.0, 2.38 + i * 0.47, 1.9, 0.36, col, val, { fontSize: 14, bold: true, color: C.white, align: "center" });
  });

  // intern tip
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 4.65, w: 12.7, h: 0.65, fill: { color: C.yellow, transparency: 15 }, line: { color: C.yellow }, rectRadius: 0.1 });
  s.addText([
    { text: "⚡ INTERN TIP:  ", options: { bold: true, color: C.darkBg, fontSize: 13 } },
    { text: "Always check the FULL CBC — not Hb alone. MCV + RDW + Reticulocyte count together tell the whole story!", options: { color: C.darkBg, fontSize: 12 } }
  ], { x: 0.5, y: 4.65, w: 12.4, h: 0.65, valign: "middle", margin: 4 });

  // Severity scale
  s.addText("SEVERITY SCALE:", { x: 0.3, y: 5.45, w: 3, h: 0.35, fontSize: 12, bold: true, color: C.darkText });
  const sev = [["Mild","10–13 (M) / 10–12 (F)", C.lightGreen], ["Moderate","7–10",C.orange],["Severe","4–7",C.redAccent],["Very Severe","< 4",C.darkBg]];
  sev.forEach(([label, val, col], i) => {
    card(s, 0.3 + i * 3.22, 5.85, 3.0, 0.75, col, "", {});
    s.addText(label, { x: 0.3 + i * 3.22, y: 5.85, w: 3.0, h: 0.38, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(val + " g/dL", { x: 0.3 + i * 3.22, y: 6.23, w: 3.0, h: 0.37, fontSize: 10, color: C.white, align: "center", valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 - CLASSIFICATION BY MCV
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.darkBg);
  header(s, "CLASSIFICATION BY MCV — Wintrobe's System", "Your first step: look at the MCV!", C.skyBlue);

  // Three columns
  const cols = [
    {
      label: "MICROCYTIC", mv: "MCV < 80 fL", emoji: "🔴", color: C.redAccent, x: 0.25,
      items: ["🔑 TAILS Mnemonic:", "T - Thalassemia", "A - Anemia of inflammation", "I - Iron deficiency (most common!)", "L - Lead poisoning", "S - Sideroblastic anemia", "", "📌 Key fact: Less Hb → smaller cells", "Interference with Hb production"]
    },
    {
      label: "NORMOCYTIC", mv: "MCV 80–100 fL", emoji: "🟡", color: C.orange, x: 4.55,
      items: ["Use RETICULOCYTE to split:", "", "HIGH retic → LOSS/DESTRUCTION", "• Acute blood loss", "• Hemolysis", "", "LOW retic → UNDERPRODUCTION", "• Aplastic anemia", "• CKD (↓ EPO)", "• Endocrinopathies", "• Bone marrow infiltration"]
    },
    {
      label: "MACROCYTIC", mv: "MCV > 100 fL", emoji: "🔵", color: C.royalBlue, x: 8.85,
      items: ["OVAL macros (DNA defect):", "• B12 deficiency", "• Folate deficiency", "• Methotrexate / Hydroxyurea", "• MDS", "", "ROUND macros (membrane):", "• Alcohol 🍺 (MOST COMMON!)", "• Liver disease", "• Hypothyroidism", "• Reticulocytosis"]
    }
  ];

  cols.forEach(col => {
    // Column header card
    card(s, col.x, 0.6, 4.1, 0.95, col.color, "", {});
    s.addText(col.emoji, { x: col.x, y: 0.6, w: 0.9, h: 0.95, fontSize: 28, align: "center", valign: "middle" });
    s.addText(col.label, { x: col.x + 0.85, y: 0.6, w: 3.2, h: 0.5, fontSize: 15, bold: true, color: C.white, valign: "middle" });
    s.addText(col.mv, { x: col.x + 0.85, y: 1.1, w: 3.2, h: 0.45, fontSize: 11, color: C.white, italic: true, valign: "middle" });
    // Content box
    s.addShape(pres.shapes.RECTANGLE, { x: col.x, y: 1.6, w: 4.1, h: 5.45, fill: { color: C.navyMid }, line: { color: col.color, pt: 1.5 } });
    const textItems = col.items.map((item, idx) => ({
      text: item + (idx < col.items.length - 1 ? "\n" : ""),
      options: {
        color: item.startsWith("🔑") || item.startsWith("📌") || item.includes("OVAL") || item.includes("ROUND") || item.includes("HIGH") || item.includes("LOW") || item.includes("Use ") ? C.yellow : C.white,
        fontSize: item.startsWith("🔑") || item.includes("OVAL") || item.includes("ROUND") || item.includes("Use ") || item.includes("HIGH") || item.includes("LOW") ? 12 : 11,
        bold: item.startsWith("🔑") || item.includes("OVAL") || item.includes("ROUND") || item.includes("Use ") || item.includes("HIGH") || item.includes("LOW"),
        breakLine: true
      }
    }));
    s.addText(textItems, { x: col.x + 0.15, y: 1.65, w: 3.8, h: 5.3, valign: "top", margin: 6 });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 - PATHOPHYSIOLOGY & COMPENSATION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.offWhite);
  header(s, "PATHOPHYSIOLOGY — How the Body Compensates", "3 brilliant compensatory mechanisms", C.teal);

  // Arrow flow: Anemia → 3 mechanisms → Outcome
  // Central "Anemia" node
  s.addShape(pres.shapes.OVAL, { x: 5.4, y: 1.0, w: 2.5, h: 1.0, fill: { color: C.redAccent }, line: { color: C.redAccent } });
  s.addText("⬇️ Hb Falls", { x: 5.4, y: 1.0, w: 2.5, h: 1.0, fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle" });

  // 3 Mechanism cards
  const mechs = [
    {
      x: 0.2, y: 2.4, color: C.royalBlue,
      num: "①", title: "↑ Cardiac Output",
      time: "⏱️ Minutes",
      body: "If Hb↓, CO↑ to maintain O₂ delivery\n→ Tachycardia is the first sign!\n⚠️ Patients with IHD / HF decompensate at higher Hb — treat them at >8-9 g/dL"
    },
    {
      x: 4.7, y: 2.4, color: C.teal,
      num: "②", title: "↑ 2,3-DPG",
      time: "⏱️ Hours to Days",
      body: "Shifts O₂-Hb dissociation curve RIGHT\n→ Hb releases O₂ more easily to tissues\nSeems paradoxical but lung PO₂ still fully saturates Hb\n📌 Classic exam fact!"
    },
    {
      x: 9.2, y: 2.4, color: C.purple,
      num: "③", title: "↑ Plasma Volume",
      time: "⏱️ Weeks",
      body: "Maintains cardiac output & BP\n⚠️ Over-expansion → fluid overload / HF\n→ Transfuse chronic severe anemia SLOWLY\nGive furosemide between units!"
    }
  ];

  mechs.forEach(m => {
    // Arrow from top
    s.addShape(pres.shapes.RECTANGLE, { x: m.x + 1.7, y: 1.95, w: 0.08, h: 0.45, fill: { color: m.color }, line: { color: m.color } });
    // Card
    card(s, m.x, 2.4, 3.9, 4.2, m.color, "", {});
    // num circle
    s.addShape(pres.shapes.OVAL, { x: m.x + 0.1, y: 2.45, w: 0.6, h: 0.6, fill: { color: C.white }, line: { color: C.white } });
    s.addText(m.num, { x: m.x + 0.1, y: 2.45, w: 0.6, h: 0.6, fontSize: 16, bold: true, color: m.color, align: "center", valign: "middle" });
    s.addText(m.title, { x: m.x + 0.8, y: 2.47, w: 2.9, h: 0.55, fontSize: 14, bold: true, color: C.white, valign: "middle" });
    s.addText(m.time, { x: m.x + 0.1, y: 3.1, w: 3.7, h: 0.38, fontSize: 11, color: C.yellow, italic: true, valign: "middle" });
    // divider
    s.addShape(pres.shapes.RECTANGLE, { x: m.x + 0.1, y: 3.5, w: 3.7, h: 0.04, fill: { color: C.white, transparency: 60 }, line: { color: C.white, transparency: 60 } });
    s.addText(m.body, { x: m.x + 0.1, y: 3.55, w: 3.7, h: 2.9, fontSize: 11, color: C.white, valign: "top", margin: 4 });
  });

  // Clinical Signs box
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 6.75, w: 12.9, h: 0.6, fill: { color: C.yellow, transparency: 10 }, line: { color: C.yellow }, rectRadius: 0.1 });
  s.addText([
    { text: "🩺 SIGNS FROM COMPENSATION:  ", options: { bold: true, color: C.darkBg, fontSize: 12 } },
    { text: "Tachycardia  |  Wide pulse pressure  |  Systolic flow murmur  |  Bounding pulse  |  Ankle oedema (late, in HF)", options: { color: C.darkBg, fontSize: 11 } }
  ], { x: 0.4, y: 6.75, w: 12.7, h: 0.6, valign: "middle", margin: 4 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 - CLINICAL FEATURES & DISEASE-SPECIFIC SIGNS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.darkBg);
  header(s, "CLINICAL FEATURES — What to Look for at the Bedside", "Symptoms + Signs + Disease-Specific Clues", C.orange);

  // Left: General S&S
  card(s, 0.2, 0.65, 5.8, 3.3, C.navyMid, "", {});
  s.addText("🧠 GENERAL SYMPTOMS", { x: 0.3, y: 0.68, w: 5.6, h: 0.45, fontSize: 13, bold: true, color: C.orange, valign: "middle" });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 1.12, w: 5.6, h: 0.03, fill: { color: C.orange, transparency: 50 }, line: { color: C.orange, transparency: 50 } });
  const symptoms = ["😴 Fatigue, lethargy, weakness (most common)","😮‍💨 Dyspnoea on exertion (at rest if severe)","💓 Palpitations, tachycardia","😵 Dizziness, lightheadedness, syncope","🤕 Headache, poor concentration","❤️‍🩹 Worsening angina / claudication (elderly)"];
  s.addText(symptoms.join("\n"), { x: 0.35, y: 1.18, w: 5.55, h: 2.65, fontSize: 11.5, color: C.white, valign: "top", margin: 5 });

  // Right: General signs
  card(s, 6.2, 0.65, 6.9, 3.3, C.navyMid, "", {});
  s.addText("👁️ GENERAL SIGNS (Examination)", { x: 6.3, y: 0.68, w: 6.7, h: 0.45, fontSize: 13, bold: true, color: C.skyBlue, valign: "middle" });
  s.addShape(pres.shapes.RECTANGLE, { x: 6.3, y: 1.12, w: 6.7, h: 0.03, fill: { color: C.skyBlue, transparency: 50 }, line: { color: C.skyBlue, transparency: 50 } });
  const signs = ["👁️ Pallor — PALPEBRAL CONJUNCTIVA most reliable!","💅 Pallor of palms, mucous membranes","❤️ Tachycardia at rest","🔊 Systolic flow murmur (hyperdynamic)","🦶 Ankle oedema (if cardiac decompensation)"];
  s.addText(signs.join("\n"), { x: 6.35, y: 1.18, w: 6.65, h: 2.65, fontSize: 11.5, color: C.white, valign: "top", margin: 5 });

  // Disease-specific signs
  s.addText("🔍 DISEASE-SPECIFIC SIGNS — Know These Cold!", { x: 0.2, y: 4.05, w: 12.9, h: 0.4, fontSize: 13, bold: true, color: C.yellow });

  const dxSigns = [
    { dx: "Iron Deficiency", signs: "Pica 🍦 • Koilonychia (spoon nails) • Angular cheilitis • Glossitis • Dysphagia (Plummer-Vinson)", color: C.redAccent },
    { dx: "B12 Deficiency", signs: "Peripheral neuropathy • SACD (dorsal + lateral columns) • Dementia • Glossitis • Lemon-yellow tinge", color: C.orange },
    { dx: "Hemolytic Anemia", signs: "Jaundice + Pallor + Splenomegaly (classic triad) • Dark urine (intravascular)", color: C.yellow },
    { dx: "Aplastic Anemia", signs: "Pancytopenia signs: Petechiae + Gum bleeding + Recurrent infections + Pallor", color: C.lightGreen },
    { dx: "Thalassemia", signs: "Frontal bossing • Chipmunk facies • Hepatosplenomegaly • Growth retardation", color: C.skyBlue },
  ];

  dxSigns.forEach((item, i) => {
    const y = 4.5 + i * 0.54;
    s.addShape(pres.shapes.RECTANGLE, { x: 0.2, y, w: 0.06, h: 0.46, fill: { color: item.color }, line: { color: item.color } });
    s.addShape(pres.shapes.RECTANGLE, { x: 0.26, y, w: 12.84, h: 0.46, fill: { color: C.navyMid, transparency: 30 }, line: { color: C.navyMid, transparency: 30 } });
    s.addText(item.dx + ":", { x: 0.35, y, w: 2.2, h: 0.46, fontSize: 11, bold: true, color: item.color, valign: "middle" });
    s.addText(item.signs, { x: 2.6, y, w: 10.35, h: 0.46, fontSize: 10.5, color: C.white, valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 - INVESTIGATIONS ALGORITHM
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.offWhite);
  header(s, "INVESTIGATION ALGORITHM — Step by Step", "Start with CBC → Reticulocyte → Smear → Targeted tests", C.green);

  // Flowchart boxes
  // Step 1
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 4.5, y: 0.65, w: 4.3, h: 0.65, fill: { color: C.darkBg }, line: { color: C.darkBg }, rectRadius: 0.15 });
  s.addText("STEP 1️⃣  CBC + Reticulocyte Count", { x: 4.5, y: 0.65, w: 4.3, h: 0.65, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle" });

  // Arrow down
  s.addShape(pres.shapes.RECTANGLE, { x: 6.6, y: 1.3, w: 0.1, h: 0.35, fill: { color: C.darkBg }, line: { color: C.darkBg } });

  // Reticulocyte split
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 4.5, y: 1.65, w: 4.3, h: 0.55, fill: { color: C.navyMid }, line: { color: C.navyMid }, rectRadius: 0.12 });
  s.addText("RETICULOCYTE COUNT", { x: 4.5, y: 1.65, w: 4.3, h: 0.55, fontSize: 12, bold: true, color: C.yellow, align: "center", valign: "middle" });

  // Arrows to HIGH / LOW
  s.addShape(pres.shapes.RECTANGLE, { x: 3.8, y: 2.2, w: 2.8, h: 0.07, fill: { color: C.redAccent }, line: { color: C.redAccent } });
  s.addShape(pres.shapes.RECTANGLE, { x: 6.7, y: 2.2, w: 2.8, h: 0.07, fill: { color: C.royalBlue }, line: { color: C.royalBlue } });

  card(s, 0.2, 2.27, 3.6, 2.5, C.redAccent, "", {});
  s.addText("🔴 HIGH Retic (>2%)", { x: 0.25, y: 2.27, w: 3.5, h: 0.5, fontSize: 12, bold: true, color: C.white, valign: "middle" });
  s.addText("= Loss / Destruction\n\n• Check for BLEEDING\n• If no bleed → HEMOLYSIS\n  ↳ LDH ↑, Haptoglobin ↓\n  ↳ Unconjugated bili ↑\n  ↳ Peripheral smear\n  ↳ DAT/Coombs test", { x: 0.3, y: 2.77, w: 3.4, h: 2.0, fontSize: 11, color: C.white, valign: "top", margin: 4 });

  card(s, 9.5, 2.27, 3.6, 2.5, C.royalBlue, "", {});
  s.addText("🔵 LOW Retic (<2%)", { x: 9.55, y: 2.27, w: 3.5, h: 0.5, fontSize: 12, bold: true, color: C.white, valign: "middle" });
  s.addText("= Underproduction\n\n→ Go to STEP 2: Check MCV\n• Low MCV → Iron studies\n• Normal MCV → Renal fn, EPO\n• High MCV → B12/Folate,\n  Smear for hyperseg PMNs\n  TSH, LFTs", { x: 9.55, y: 2.77, w: 3.45, h: 2.0, fontSize: 11, color: C.white, valign: "top", margin: 4 });

  // Middle: Peripheral Smear box
  card(s, 3.95, 2.27, 5.4, 2.5, C.teal, "", {});
  s.addText("🔬 PERIPHERAL SMEAR — Always Order!", { x: 4.0, y: 2.27, w: 5.3, h: 0.5, fontSize: 11.5, bold: true, color: C.white, valign: "middle" });
  const smearFindings = [
    "Pencil cells + microcytic hypochromic → IDA",
    "Macro-ovalocytes + hyperseg PMNs → Megaloblastic",
    "Spherocytes → Spherocytosis / AIHA",
    "Schistocytes → TTP / HUS / DIC / Valve",
    "Target cells → Thalassemia / Liver dz",
    "Sickle cells → Sickle cell disease",
    "Tear drop + nucleated RBCs → Myelofibrosis",
  ];
  s.addText(smearFindings.join("\n"), { x: 4.05, y: 2.82, w: 5.2, h: 1.9, fontSize: 10, color: C.white, valign: "top", margin: 4 });

  // Iron panel comparison table
  s.addText("⚗️ IRON PANEL — The Critical Differentiator:", { x: 0.2, y: 5.0, w: 6.0, h: 0.35, fontSize: 12, bold: true, color: C.darkText });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.2, y: 5.38, w: 12.9, h: 0.37, fill: { color: C.darkBg }, line: { color: C.darkBg } });
  ["Parameter","Iron Deficiency","Anemia of Inflammation","Thalassemia Trait"].forEach((h, i) => {
    s.addText(h, { x: 0.2 + i * 3.22, y: 5.38, w: 3.2, h: 0.37, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
  });
  const ironRows = [
    ["Ferritin", "⬇️ LOW", "⬆️ HIGH (acute phase!)", "Normal"],
    ["Serum Iron", "⬇️ Low", "⬇️ Low", "Normal"],
    ["TIBC", "⬆️ HIGH", "⬇️ Low", "Normal"],
    ["RDW", "⬆️ HIGH", "Normal", "Normal / Low"],
  ];
  ironRows.forEach((row, ri) => {
    const bg = ri % 2 === 0 ? C.lightGrey : C.white;
    s.addShape(pres.shapes.RECTANGLE, { x: 0.2, y: 5.75 + ri * 0.38, w: 12.9, h: 0.38, fill: { color: bg }, line: { color: bg } });
    const rowColors = [C.darkText, C.redAccent, C.orange, C.teal];
    row.forEach((cell, ci) => {
      s.addText(cell, { x: 0.2 + ci * 3.22, y: 5.75 + ri * 0.38, w: 3.2, h: 0.38, fontSize: 11, color: ci === 0 ? C.darkText : rowColors[ci], align: "center", valign: "middle", bold: ci !== 0 });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 - IRON DEFICIENCY ANEMIA
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.offWhite);
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: C.offWhite }, line: { color: C.offWhite } });
  header(s, "IRON DEFICIENCY ANEMIA (IDA)", "Most common anemia worldwide — Every intern must know this cold!", C.redAccent);

  // Left column — Causes
  card(s, 0.2, 0.65, 4.1, 4.2, C.navyMid, "", {});
  s.addText("🩸 CAUSES", { x: 0.3, y: 0.68, w: 3.9, h: 0.45, fontSize: 13, bold: true, color: C.redAccent, valign: "middle" });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 1.12, w: 3.9, h: 0.03, fill: { color: C.redAccent, transparency: 50 }, line: { color: C.redAccent, transparency: 50 } });
  s.addText([
    { text: "1. BLOOD LOSS (most common in adults)\n", options: { bold: true, color: C.yellow, breakLine: false } },
    { text: "   GI bleeding (peptic ulcer, cancer)\n   Menorrhagia 👩\n   NSAIDs-induced gastritis\n\n", options: { color: C.white } },
    { text: "2. POOR INTAKE\n", options: { bold: true, color: C.yellow } },
    { text: "   Malnutrition, strict vegetarian diet\n\n", options: { color: C.white } },
    { text: "3. MALABSORPTION\n", options: { bold: true, color: C.yellow } },
    { text: "   Celiac disease, post-gastrectomy\n   H. pylori infection\n\n", options: { color: C.white } },
    { text: "4. INCREASED DEMAND\n", options: { bold: true, color: C.yellow } },
    { text: "   Pregnancy 🤰, rapid growth", options: { color: C.white } },
  ], { x: 0.3, y: 1.2, w: 3.95, h: 3.6, valign: "top", margin: 4 });

  // Middle column — Clinical features
  card(s, 4.5, 0.65, 4.1, 4.2, C.navyMid, "", {});
  s.addText("🔍 CLINICAL FEATURES", { x: 4.6, y: 0.68, w: 3.9, h: 0.45, fontSize: 12, bold: true, color: C.orange, valign: "middle" });
  s.addShape(pres.shapes.RECTANGLE, { x: 4.6, y: 1.12, w: 3.9, h: 0.03, fill: { color: C.orange, transparency: 50 }, line: { color: C.orange, transparency: 50 } });
  s.addText([
    { text: "General anemia symptoms PLUS:\n\n", options: { color: C.grey } },
    { text: "💅 Koilonychia\n", options: { color: C.white } },
    { text: "👄 Angular cheilitis & glossitis\n", options: { color: C.white } },
    { text: "🍦 Pica (craving ice/clay/dirt)\n", options: { color: C.white } },
    { text: "😮 Dysphagia (Plummer-Vinson)\n", options: { color: C.white } },
    { text: "👶 In kids: Developmental delay\n\n", options: { color: C.white } },
    { text: "📌 INTERN ALERT:\n", options: { bold: true, color: C.yellow } },
    { text: "IDA in adult male or post-\nmenopausal female = GI scope\nto EXCLUDE MALIGNANCY!", options: { color: C.redAccent, bold: true } },
  ], { x: 4.6, y: 1.2, w: 3.95, h: 3.6, valign: "top", margin: 4 });

  // Right column — Treatment
  card(s, 8.8, 0.65, 4.3, 4.2, C.navyMid, "", {});
  s.addText("💊 TREATMENT", { x: 8.9, y: 0.68, w: 4.1, h: 0.45, fontSize: 13, bold: true, color: C.lightGreen, valign: "middle" });
  s.addShape(pres.shapes.RECTANGLE, { x: 8.9, y: 1.12, w: 4.1, h: 0.03, fill: { color: C.lightGreen, transparency: 50 }, line: { color: C.lightGreen, transparency: 50 } });
  s.addText([
    { text: "ORAL IRON (first-line):\n", options: { bold: true, color: C.yellow } },
    { text: "Ferrous sulphate 200mg TDS\n(= 65mg elemental iron)\n", options: { color: C.white } },
    { text: "• Empty stomach + Vit C for absorption\n• Avoid: tea, calcium, antacids\n\n", options: { color: C.grey } },
    { text: "RESPONSE TIMELINE:\n", options: { bold: true, color: C.yellow } },
    { text: "⏱️ 7-10 days → Reticulocytosis\n📈 ~1-2 g/dL Hb rise/week\n⏱️ 3 months AFTER Hb normalises\n→ to replenish stores!\n\n", options: { color: C.white } },
    { text: "IV IRON (select cases):\n", options: { bold: true, color: C.yellow } },
    { text: "Ferric carboxymaltose when:\n• Oral intolerance\n• Malabsorption / IBD\n• Pre-operative", options: { color: C.white } },
  ], { x: 8.9, y: 1.2, w: 4.1, h: 3.6, valign: "top", margin: 4 });

  // Red flag box
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 4.95, w: 12.9, h: 0.7, fill: { color: C.redAccent, transparency: 10 }, line: { color: C.redAccent }, rectRadius: 0.1 });
  s.addText("🚨 RED FLAG:  Adult male OR post-menopausal woman with IDA = COLONOSCOPY + OGD to exclude colorectal/gastric cancer. NEVER attribute to diet without investigation!", {
    x: 0.4, y: 4.95, w: 12.7, h: 0.7, fontSize: 12, bold: true, color: C.white, valign: "middle", margin: 6
  });

  // Ferritin trap box
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 5.75, w: 12.9, h: 0.65, fill: { color: C.yellow, transparency: 15 }, line: { color: C.yellow }, rectRadius: 0.1 });
  s.addText("⚡ FERRITIN TRAP:  Ferritin is an ACUTE-PHASE REACTANT. It can be falsely normal/high in inflamed patients even with true iron deficiency. In those cases → check Transferrin Saturation (<15% confirms IDA).", {
    x: 0.4, y: 5.75, w: 12.7, h: 0.65, fontSize: 11, color: C.darkBg, valign: "middle", margin: 4
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 - MEGALOBLASTIC ANEMIA
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.darkBg);
  header(s, "MEGALOBLASTIC ANEMIA — B12 & Folate Deficiency", "DNA synthesis defect → big cells, big consequences", C.orange);

  // Mechanism strip
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 0.65, w: 12.9, h: 0.7, fill: { color: C.navyMid }, line: { color: C.orange }, rectRadius: 0.1 });
  s.addText("🔬 MECHANISM:  B12 + Folate both needed for dUMP → dTMP conversion → DNA synthesis fails → Cells grow but CAN'T DIVIDE → Megaloblasts\n    → Affects ALL rapidly dividing cells → Pancytopenia possible", {
    x: 0.4, y: 0.65, w: 12.6, h: 0.7, fontSize: 11, color: C.white, valign: "middle", margin: 4
  });

  // Two columns B12 vs Folate
  const cols_mega = [
    {
      x: 0.2, color: C.orange, title: "🅱️ VITAMIN B12 DEFICIENCY",
      causes: "• Pernicious anaemia (Anti-IF antibodies) 🏆 Most common in adults\n• Strict veganism (B12 only in animal products)\n• Gastrectomy / terminal ileal disease (Crohn's)\n• Metformin long-term use ⚠️\n• Fish tapeworm (D. latum)",
      neuro: "NEUROLOGICAL (B12 ONLY ⚠️):\n• Subacute combined degeneration (SACD)\n  → Dorsal columns: loss vibration/proprioception\n  → Lateral corticospinal: UMN signs\n• Peripheral neuropathy\n• Dementia, cognitive decline\n• Glossitis, lemon-yellow skin",
      tx: "💊 Rx: IM hydroxocobalamin 1000µg daily ×7d,\nthen weekly ×4, then every 3 months (LIFE)"
    },
    {
      x: 6.85, color: C.teal, title: "🍃 FOLATE DEFICIENCY",
      causes: "• Poor diet (alcoholics 🍺, elderly, homeless)\n• Pregnancy (increased demand — supplement early!)\n• Malabsorption (coeliac disease)\n• Drugs: Methotrexate, Phenytoin, Trimethoprim\n  (all inhibit dihydrofolate reductase)",
      neuro: "NO NEUROLOGICAL FEATURES\n\n⚠️ CRITICAL DANGER:\nNever give FOLATE alone without\nfirst checking B12!\n\nIf undiagnosed B12 deficiency:\n→ Folate corrects blood count\n→ But WORSENS NEURO damage!\n→ Classic exam + clinical TRAP",
      tx: "💊 Rx: Folic acid 5mg/day oral\n(Always check B12 first!)"
    }
  ];

  cols_mega.forEach(col => {
    card(s, col.x, 1.5, 6.35, 5.2, C.navyMid, "", {});
    // header bar
    s.addShape(pres.shapes.RECTANGLE, { x: col.x, y: 1.5, w: 6.35, h: 0.45, fill: { color: col.color }, line: { color: col.color } });
    s.addText(col.title, { x: col.x + 0.1, y: 1.5, w: 6.15, h: 0.45, fontSize: 13, bold: true, color: C.white, valign: "middle" });
    // Causes
    s.addText("📋 CAUSES:", { x: col.x + 0.15, y: 2.02, w: 6.1, h: 0.3, fontSize: 11, bold: true, color: col.color, valign: "middle" });
    s.addText(col.causes, { x: col.x + 0.15, y: 2.33, w: 6.1, h: 1.55, fontSize: 10.5, color: C.white, valign: "top", margin: 2 });
    s.addShape(pres.shapes.RECTANGLE, { x: col.x + 0.15, y: 3.9, w: 6.05, h: 0.03, fill: { color: C.white, transparency: 70 }, line: { color: C.white, transparency: 70 } });
    s.addText(col.neuro, { x: col.x + 0.15, y: 3.95, w: 6.1, h: 2.0, fontSize: 10.5, color: C.white, valign: "top", margin: 2 });
    s.addShape(pres.shapes.RECTANGLE, { x: col.x + 0.15, y: 5.96, w: 6.05, h: 0.03, fill: { color: col.color, transparency: 50 }, line: { color: col.color, transparency: 50 } });
    s.addText(col.tx, { x: col.x + 0.15, y: 6.0, w: 6.1, h: 0.65, fontSize: 10.5, color: C.yellow, bold: true, valign: "top", margin: 2 });
  });

  // Distinguishing MMA/Homocysteine
  card(s, 6.75, 1.5, 0.1, 5.2, C.orange, "", {});

  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 6.72, w: 12.9, h: 0.7, fill: { color: C.redAccent, transparency: 5 }, line: { color: C.redAccent }, rectRadius: 0.1 });
  s.addText("🧪 B12 vs FOLATE — KEY LAB TRICK:  Homocysteine ↑ in BOTH  |  Methylmalonic acid (MMA) ↑ in B12 ONLY  →  Use MMA to confirm B12 deficiency!", {
    x: 0.4, y: 6.72, w: 12.7, h: 0.7, fontSize: 12, color: C.white, bold: true, valign: "middle", margin: 4
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 - ANEMIA OF INFLAMMATION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.offWhite);
  header(s, "ANEMIA OF INFLAMMATION (ACD)", "Most common anemia in HOSPITALISED patients — multifactorial cytokine-driven", C.teal);

  // 3 mechanism cards
  const mechs_ai = [
    { emoji: "🦠", title: "IL-6 → Hepcidin", body: "Hepcidin causes macrophage iron sequestration → Hypoferremia. Iron locked in stores, unavailable for erythropoiesis (\"functional iron deficiency\")", color: C.teal },
    { emoji: "🫘", title: "TNF-α + IL-1β → ↓EPO", body: "Suppress erythropoietin production from the kidney → Less stimulus for RBC production. Key mechanism in CKD.", color: C.purple },
    { emoji: "⚡", title: "IFN-γ → Blunts EPO Response", body: "Erythroid progenitors respond poorly to EPO. Also shifts progenitor commitment → myelopoiesis (emergency myelopoiesis in sepsis)", color: C.orange },
  ];

  mechs_ai.forEach((m, i) => {
    card(s, 0.2 + i * 4.37, 0.65, 4.15, 2.5, m.color, "", {});
    s.addText(m.emoji, { x: 0.2 + i * 4.37, y: 0.68, w: 0.8, h: 0.6, fontSize: 24, align: "center", valign: "middle" });
    s.addText(m.title, { x: 0.9 + i * 4.37, y: 0.68, w: 3.35, h: 0.6, fontSize: 12, bold: true, color: C.white, valign: "middle" });
    s.addShape(pres.shapes.RECTANGLE, { x: 0.3 + i * 4.37, y: 1.28, w: 3.95, h: 0.03, fill: { color: C.white, transparency: 70 }, line: { color: C.white, transparency: 70 } });
    s.addText(m.body, { x: 0.3 + i * 4.37, y: 1.35, w: 3.95, h: 1.75, fontSize: 11, color: C.white, valign: "top", margin: 4 });
  });

  // The image from Harrison's
  s.addImage({
    path: "https://cdn.orris.care/cdss_images/eb7630bf3cc9b9b18d432fed65234846f52a204db471ad98bf49f7fa060d21af.png",
    x: 0.2, y: 3.3, w: 5.0, h: 2.9
  });
  s.addText("Harrison's 22E Fig. 102-3", { x: 0.2, y: 6.22, w: 5.0, h: 0.25, fontSize: 9, color: C.grey, align: "center", italic: true });

  // Right: Diagnosis and treatment
  card(s, 5.45, 3.3, 7.65, 4.1, C.navyMid, "", {});
  s.addText("🔍 DIAGNOSIS", { x: 5.55, y: 3.33, w: 7.45, h: 0.4, fontSize: 12, bold: true, color: C.teal, valign: "middle" });
  s.addText([
    { text: "Type: ", options: { bold: true, color: C.yellow } },
    { text: "Mild-moderate, normocytic-normochromic, low reticulocyte count\n", options: { color: C.white } },
    { text: "Ferritin: ", options: { bold: true, color: C.yellow } },
    { text: "HIGH (acute phase reactant) — cannot use alone!\n", options: { color: C.white } },
    { text: "Iron: ", options: { bold: true, color: C.yellow } },
    { text: "LOW serum iron + LOW TIBC + HIGH ferritin = hallmark pattern\n", options: { color: C.white } },
    { text: "\"Functional iron deficiency\" ", options: { bold: true, color: C.orange } },
    { text: "= iron in stores but NOT available to erythroid precursors\n\n", options: { color: C.white } },
    { text: "Conditions: ", options: { bold: true, color: C.yellow } },
    { text: "Infections, autoimmune (RA, SLE, IBD), malignancy, CKD, CHF, sepsis", options: { color: C.white } },
  ], { x: 5.55, y: 3.78, w: 7.35, h: 1.9, valign: "top", margin: 4, fontSize: 11 });

  s.addShape(pres.shapes.RECTANGLE, { x: 5.55, y: 5.7, w: 7.35, h: 0.04, fill: { color: C.teal, transparency: 50 }, line: { color: C.teal, transparency: 50 } });
  s.addText("💊 TREATMENT", { x: 5.55, y: 5.75, w: 7.45, h: 0.38, fontSize: 12, bold: true, color: C.lightGreen, valign: "middle" });
  s.addText("Primary: Treat the UNDERLYING DISEASE\nIV iron: In CKD, IBD, pre-operative, CHF when absolute iron deficiency coexists\nEPO agents (erythropoiesis-stimulating agents): CKD on dialysis, chemotherapy patients\n— Target Hb 10-12 g/dL (higher targets increase thrombosis risk!)", {
    x: 5.55, y: 6.18, w: 7.35, h: 1.1, fontSize: 11, color: C.white, valign: "top", margin: 4
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 - HEMOLYTIC ANEMIAS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.darkBg);
  header(s, "HEMOLYTIC ANEMIAS", "RBC destruction before 120 days — HIGH reticulocyte count is the KEY!", C.yellow);

  // Classic triad badge
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 0.65, w: 12.9, h: 0.6, fill: { color: C.yellow, transparency: 10 }, line: { color: C.yellow }, rectRadius: 0.1 });
  s.addText("⚡ CLASSIC HEMOLYSIS LABS:  LDH ↑  +  Haptoglobin ↓  +  Unconjugated Bilirubin ↑  +  High Reticulocyte Count  +  Jaundice + Pallor + Splenomegaly", {
    x: 0.4, y: 0.65, w: 12.7, h: 0.6, fontSize: 12, bold: true, color: C.darkBg, valign: "middle", margin: 4
  });

  // Two main types: Intravascular vs Extravascular
  card(s, 0.2, 1.38, 6.2, 5.75, C.navyMid, "", {});
  s.addShape(pres.shapes.RECTANGLE, { x: 0.2, y: 1.38, w: 6.2, h: 0.45, fill: { color: C.redAccent }, line: { color: C.redAccent } });
  s.addText("🔴 INTRAVASCULAR HEMOLYSIS", { x: 0.3, y: 1.38, w: 6.0, h: 0.45, fontSize: 12, bold: true, color: C.white, valign: "middle" });
  s.addText([
    { text: "RBCs destroyed IN blood vessels\n\n", options: { color: C.grey, italic: true } },
    { text: "Causes:\n", options: { bold: true, color: C.yellow } },
    { text: "• TTP / HUS (SCHISTOCYTES on smear!)\n• DIC\n• G6PD deficiency + oxidative stress\n  (drugs: primaquine, dapsone; fava beans)\n• Prosthetic heart valves\n• March / exertional hemoglobinuria\n• PNH (paroxysmal nocturnal hemoglobinuria)\n\n", options: { color: C.white } },
    { text: "Hallmark Lab:\n", options: { bold: true, color: C.yellow } },
    { text: "HEMOGLOBINURIA — dark red/brown urine\nVery low haptoglobin\nSchistocytes on smear", options: { color: C.white } },
  ], { x: 0.3, y: 1.88, w: 6.0, h: 5.1, valign: "top", margin: 4, fontSize: 11 });

  card(s, 6.7, 1.38, 6.4, 5.75, C.navyMid, "", {});
  s.addShape(pres.shapes.RECTANGLE, { x: 6.7, y: 1.38, w: 6.4, h: 0.45, fill: { color: C.teal }, line: { color: C.teal } });
  s.addText("🟢 EXTRAVASCULAR HEMOLYSIS", { x: 6.8, y: 1.38, w: 6.2, h: 0.45, fontSize: 12, bold: true, color: C.white, valign: "middle" });
  s.addText([
    { text: "RBCs destroyed by macrophages in SPLEEN/LIVER\n\n", options: { color: C.grey, italic: true } },
    { text: "Causes:\n", options: { bold: true, color: C.yellow } },
    { text: "• Hereditary spherocytosis (spherocytes)\n• Autoimmune HA (AIHA) — most common\n• Sickle cell disease\n• Thalassemia major\n• G6PD (partly extravascular)\n\n", options: { color: C.white } },
    { text: "AIHA — MUST KNOW:\n", options: { bold: true, color: C.yellow } },
    { text: "WARM AIHA (IgG, 37°C): SLE, CLL, lymphoma, methyldopa\n→ Rx: Steroids → Rituximab → Splenectomy\n\n", options: { color: C.white } },
    { text: "COLD AIHA (IgM, <37°C): Mycoplasma, EBV, lymphoma\n→ Rx: Keep WARM, avoid cold exposure\n\n", options: { color: C.white } },
    { text: "KEY TEST: Direct Antiglobulin Test (DAT/COOMBS)", options: { bold: true, color: C.yellow } },
  ], { x: 6.8, y: 1.88, w: 6.2, h: 5.1, valign: "top", margin: 4, fontSize: 11 });

  // G6PD tip
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 7.18, w: 12.9, h: 0.25, fill: { color: C.orange, transparency: 20 }, line: { color: C.orange }, rectRadius: 0.08 });
  s.addText("⚡ G6PD: X-linked | Mediterranean/African/Asian | Heinz bodies + bite cells | Avoid oxidant drugs (primaquine, dapsone) + fava beans", {
    x: 0.4, y: 7.18, w: 12.7, h: 0.25, fontSize: 9.5, color: C.white, valign: "middle"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 - APLASTIC ANEMIA
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.offWhite);
  header(s, "APLASTIC ANEMIA — Bone Marrow Failure", "Pancytopenia + Hypocellular marrow — ALWAYS refer to haematology", C.purple);

  // Definition
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 0.65, w: 12.9, h: 0.65, fill: { color: C.darkBg }, line: { color: C.purple }, rectRadius: 0.1 });
  s.addText("📖 DEFINITION:  Pancytopenia + Bone marrow hypocellularity (fatty replacement). Low RBCs + Low WBCs + Low Platelets. Reticulocyte count is VERY LOW.", {
    x: 0.4, y: 0.65, w: 12.7, h: 0.65, fontSize: 12, color: C.white, bold: false, valign: "middle", margin: 4
  });

  // Causes and Clinical
  card(s, 0.2, 1.45, 4.1, 5.2, C.navyMid, "", {});
  s.addText("🧪 CAUSES", { x: 0.3, y: 1.48, w: 3.9, h: 0.4, fontSize: 12, bold: true, color: C.purple, valign: "middle" });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 1.88, w: 3.9, h: 0.03, fill: { color: C.purple, transparency: 60 }, line: { color: C.purple, transparency: 60 } });
  s.addText([
    { text: "ACQUIRED (most common):\n", options: { bold: true, color: C.yellow } },
    { text: "• Immune-mediated T-cell destruction\n  of haematopoietic stem cells\n• Idiopathic (majority)\n• Post-hepatitis (seronegative)\n• Drugs: Chloramphenicol, NSAIDs, gold\n• Toxins: Benzene ☠️, radiation\n\n", options: { color: C.white } },
    { text: "CONSTITUTIONAL (inherited):\n", options: { bold: true, color: C.yellow } },
    { text: "• Fanconi anaemia\n• Dyskeratosis congenita\n• Diamond-Blackfan anaemia\n• Telomere biology disorders", options: { color: C.white } },
  ], { x: 0.3, y: 1.95, w: 3.9, h: 4.6, valign: "top", margin: 4, fontSize: 11 });

  card(s, 4.5, 1.45, 4.1, 5.2, C.navyMid, "", {});
  s.addText("🩺 CLINICAL FEATURES", { x: 4.6, y: 1.48, w: 3.9, h: 0.4, fontSize: 12, bold: true, color: C.orange, valign: "middle" });
  s.addShape(pres.shapes.RECTANGLE, { x: 4.6, y: 1.88, w: 3.9, h: 0.03, fill: { color: C.orange, transparency: 60 }, line: { color: C.orange, transparency: 60 } });
  s.addText([
    { text: "Triad of PANCYTOPENIA:\n\n", options: { bold: true, color: C.yellow } },
    { text: "🔴 ANEMIA:\n", options: { bold: true, color: C.redAccent } },
    { text: "Pallor, fatigue, dyspnoea\n\n", options: { color: C.white } },
    { text: "🟡 THROMBOCYTOPENIA:\n", options: { bold: true, color: C.yellow } },
    { text: "Petechiae, gum bleeding,\nspontaneous bruising,\nmenorrhagia\n\n", options: { color: C.white } },
    { text: "🟢 NEUTROPENIA:\n", options: { bold: true, color: C.lightGreen } },
    { text: "Recurrent/severe infections\n(bacteria + fungi)\nFever without source\n\n", options: { color: C.white } },
    { text: "⚠️ NO lymphadenopathy,\nNO splenomegaly\n(unlike leukemia!)", options: { bold: true, color: C.yellow } },
  ], { x: 4.6, y: 1.95, w: 3.9, h: 4.6, valign: "top", margin: 4, fontSize: 11 });

  card(s, 8.8, 1.45, 4.3, 5.2, C.navyMid, "", {});
  s.addText("💊 TREATMENT", { x: 8.9, y: 1.48, w: 4.1, h: 0.4, fontSize: 12, bold: true, color: C.lightGreen, valign: "middle" });
  s.addShape(pres.shapes.RECTANGLE, { x: 8.9, y: 1.88, w: 4.1, h: 0.03, fill: { color: C.lightGreen, transparency: 60 }, line: { color: C.lightGreen, transparency: 60 } });
  s.addText([
    { text: "SEVERITY (Camitta Criteria):\n", options: { bold: true, color: C.yellow } },
    { text: "Severe: ≥2 of:\n• PMNs <0.5 ×10⁹/L\n• Platelets <20 ×10⁹/L\n• Retics <20 ×10⁹/L\nVery severe: PMNs <0.2 ×10⁹/L\n\n", options: { color: C.white } },
    { text: "DEFINITIVE Rx:\n", options: { bold: true, color: C.yellow } },
    { text: "🏆 Age <40 + HLA sibling donor:\nAllogeneic STEM CELL TRANSPLANT\n(CURATIVE)\n\n", options: { color: C.white } },
    { text: "No donor / older:\n", options: { bold: true, color: C.yellow } },
    { text: "ATG + Cyclosporine + Eltrombopag\n\n", options: { color: C.white } },
    { text: "SUPPORTIVE:\n", options: { bold: true, color: C.yellow } },
    { text: "Transfusions, G-CSF,\naggressive infection Rx", options: { color: C.white } },
  ], { x: 8.9, y: 1.95, w: 4.1, h: 4.6, valign: "top", margin: 4, fontSize: 11 });

  // Diagnosis strip
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 6.75, w: 12.9, h: 0.65, fill: { color: C.purple, transparency: 10 }, line: { color: C.purple }, rectRadius: 0.1 });
  s.addText("🔬 DIAGNOSIS:  Bone marrow BIOPSY = hypocellular marrow with >70% fat (gold standard). BM trephine biopsy — NOT aspirate alone!", {
    x: 0.4, y: 6.75, w: 12.7, h: 0.65, fontSize: 12, bold: true, color: C.white, valign: "middle", margin: 4
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 - MNEMONICS MEGA SLIDE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.darkBg);
  header(s, "MNEMONICS MASTER SLIDE 🧠", "Remember these and you'll never forget Anemia!", C.yellow);

  const mnemonics = [
    {
      x: 0.2, y: 0.65, w: 4.25, h: 2.05, color: C.redAccent,
      title: "🔴 MICROCYTIC = TAILS",
      items: ["T - Thalassemia","A - Anemia of chronic disease","I - Iron deficiency","L - Lead poisoning","S - Sideroblastic anemia"]
    },
    {
      x: 4.55, y: 0.65, w: 4.25, h: 2.05, color: C.orange,
      title: "🔵 MACROCYTIC = HAMILT",
      items: ["H - Hypothyroidism","A - Alcohol / liver disease","M - Myelodysplasia","I - Ineffective erythropoiesis (B12/Folate)","L - Liver disease","T - Treatment drugs (MTX, hydroxyurea)"]
    },
    {
      x: 8.85, y: 0.65, w: 4.25, h: 2.05, color: C.teal,
      title: "💊 IDA SYMPTOMS = PAGED",
      items: ["P - Pica","A - Angular cheilitis","G - Glossitis","E - Epithelial changes (koilonychia)","D - Dysphagia (Plummer-Vinson)"]
    },
    {
      x: 0.2, y: 2.85, w: 4.25, h: 2.25, color: C.purple,
      title: "🔬 HEMOLYSIS LABS = HHU",
      items: ["H - Haptoglobin ↓","H - High LDH","U - Unconjugated bili ↑","+ High reticulocyte count","+ Peripheral smear: spherocytes/schistocytes"]
    },
    {
      x: 4.55, y: 2.85, w: 4.25, h: 2.25, color: C.green,
      title: "⚠️ APLASTIC Rx = SAVE",
      items: ["S - Stem cell transplant (if donor)","A - ATG (anti-thymocyte globulin)","V - Vitamin K / transfusions support","E - Eltrombopag (+ cyclosporine)"]
    },
    {
      x: 8.85, y: 2.85, w: 4.25, h: 2.25, color: C.pink,
      title: "🔴 COOMBS AIHA = WISE",
      items: ["W - Warm (IgG) = SLE/CLL/lymphoma","I - Immune drugs (methyldopa)","S - Splenectomy if refractory","E - Extravascular hemolysis pattern"]
    },
  ];

  mnemonics.forEach(m => {
    card(s, m.x, m.y, m.w, m.h, C.navyMid, "", {});
    s.addShape(pres.shapes.RECTANGLE, { x: m.x, y: m.y, w: m.w, h: 0.42, fill: { color: m.color }, line: { color: m.color } });
    s.addText(m.title, { x: m.x + 0.08, y: m.y, w: m.w - 0.16, h: 0.42, fontSize: 11.5, bold: true, color: C.white, valign: "middle" });
    const textItems = m.items.map((item, idx) => ({
      text: item,
      options: { color: item[0] >= "A" && item[0] <= "Z" && item[1] === " " && item[2] === "-" ? C.yellow : C.white, fontSize: 11, bold: item[1] === " " && item[2] === "-", breakLine: idx < m.items.length - 1 }
    }));
    s.addText(textItems, { x: m.x + 0.12, y: m.y + 0.47, w: m.w - 0.2, h: m.h - 0.52, valign: "top", margin: 4 });
  });

  // Quick CLINICAL RULES box
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 5.22, w: 12.9, h: 2.1, fill: { color: C.navyMid }, line: { color: C.yellow }, rectRadius: 0.12 });
  s.addText("⚡ QUICK CLINICAL RULES — Burn These In!", { x: 0.4, y: 5.25, w: 12.5, h: 0.38, fontSize: 13, bold: true, color: C.yellow, valign: "middle" });
  const rules = [
    "🔑 Retic HIGH = LOSS/DESTRUCTION  |  Retic LOW = UNDERPRODUCTION",
    "🔑 RDW HIGH + MCV low = Iron deficiency  |  RDW normal + MCV low = Thalassemia",
    "🔑 NEVER give folate without checking B12 first — can mask anemia but destroy spinal cord!",
    "🔑 IDA in adult male / post-menopausal female = SCOPE to rule out GI malignancy",
  ];
  s.addText(rules.join("\n"), { x: 0.4, y: 5.65, w: 12.7, h: 1.62, fontSize: 11.5, color: C.white, valign: "top", margin: 4 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 - TREATMENT & TRANSFUSION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.offWhite);
  header(s, "TREATMENT OVERVIEW & TRANSFUSION GUIDELINES", "When to treat what — and when to transfuse", C.green);

  // Treatment table
  const txRows = [
    { dx: "Iron Deficiency", rx: "Oral ferrous sulphate 200mg TDS × 3 months after Hb normalises. IV iron if oral fails.", color: C.redAccent },
    { dx: "B12 Deficiency", rx: "IM hydroxocobalamin 1000µg daily ×7d → weekly ×4 → every 3 months lifelong", color: C.orange },
    { dx: "Folate Deficiency", rx: "Folic acid 5mg/day oral (after B12 excluded). Supplement in pregnancy.", color: C.teal },
    { dx: "Anemia of Inflammation", rx: "Treat underlying disease. IV iron / ESAs in CKD, cancer chemo.", color: C.purple },
    { dx: "Hemolytic (AIHA)", rx: "Steroids first-line → Rituximab → Splenectomy. Keep warm for cold AIHA.", color: C.pink },
    { dx: "Aplastic Anemia", rx: "Allo-SCT (young, matched donor) or ATG + Cyclosporine + Eltrombopag", color: C.lightPurp },
  ];

  s.addShape(pres.shapes.RECTANGLE, { x: 0.2, y: 0.65, w: 12.9, h: 0.4, fill: { color: C.darkBg }, line: { color: C.darkBg } });
  s.addText("DIAGNOSIS", { x: 0.2, y: 0.65, w: 3.5, h: 0.4, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });
  s.addText("TREATMENT", { x: 3.7, y: 0.65, w: 9.4, h: 0.4, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });

  txRows.forEach((row, i) => {
    const bg = i % 2 === 0 ? C.white : C.lightGrey;
    s.addShape(pres.shapes.RECTANGLE, { x: 0.2, y: 1.05 + i * 0.48, w: 12.9, h: 0.48, fill: { color: bg }, line: { color: bg } });
    s.addShape(pres.shapes.RECTANGLE, { x: 0.2, y: 1.05 + i * 0.48, w: 0.07, h: 0.48, fill: { color: row.color }, line: { color: row.color } });
    s.addText(row.dx, { x: 0.35, y: 1.05 + i * 0.48, w: 3.25, h: 0.48, fontSize: 12, bold: true, color: C.darkText, valign: "middle" });
    s.addText(row.rx, { x: 3.7, y: 1.05 + i * 0.48, w: 9.25, h: 0.48, fontSize: 11.5, color: C.darkText, valign: "middle" });
  });

  // Transfusion section
  s.addText("🩸 TRANSFUSION THRESHOLDS", { x: 0.2, y: 4.0, w: 6.5, h: 0.38, fontSize: 13, bold: true, color: C.royalBlue });

  const transRows = [
    { label: "Stable patient (general)", thresh: "Hb < 7 g/dL", color: C.royalBlue },
    { label: "Cardiovascular disease", thresh: "Hb < 8 g/dL", color: C.redAccent },
    { label: "Active bleeding / haemodynamic instability", thresh: "IMMEDIATE regardless of Hb", color: C.redAccent },
    { label: "Pre-operative", thresh: "Hb target > 8 g/dL", color: C.teal },
    { label: "Bone marrow failure (aplastic, MDS)", thresh: "Hb < 8 g/dL or symptomatic", color: C.purple },
  ];

  transRows.forEach((row, i) => {
    s.addShape(pres.shapes.RECTANGLE, { x: 0.2, y: 4.42 + i * 0.46, w: 12.9, h: 0.46, fill: { color: i % 2 === 0 ? C.lightGrey : C.white }, line: { color: i % 2 === 0 ? C.lightGrey : C.white } });
    s.addText(row.label, { x: 0.3, y: 4.42 + i * 0.46, w: 8.5, h: 0.46, fontSize: 12, color: C.darkText, valign: "middle" });
    card(s, 9.2, 4.46 + i * 0.46, 3.7, 0.36, row.color, row.thresh, { fontSize: 11, bold: true, color: C.white, align: "center" });
  });

  // TACO warning
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 6.75, w: 12.9, h: 0.65, fill: { color: C.redAccent, transparency: 10 }, line: { color: C.redAccent }, rectRadius: 0.1 });
  s.addText("🚨 TACO WARNING:  Chronic severe anemia = compensated with ↑plasma volume. Transfuse SLOWLY (over 4h). Give Furosemide between units. Risk = acute pulmonary oedema!", {
    x: 0.4, y: 6.75, w: 12.7, h: 0.65, fontSize: 11.5, bold: true, color: C.white, valign: "middle", margin: 4
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 - TOP 10 CLINICAL PEARLS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.darkBg);
  header(s, "TOP 10 CLINICAL PEARLS FOR WARD ROUNDS 🏆", "Things attendings will ask you — know these cold!", C.yellow);

  const pearls = [
    { num: "01", text: "Normocytic anemia + pancytopenia = APLASTIC ANEMIA until proven otherwise → BM biopsy urgently!", color: C.redAccent },
    { num: "02", text: "NEVER treat macrocytic anemia with folate before checking B12 — you'll fix the blood but destroy the spinal cord!", color: C.orange },
    { num: "03", text: "IDA in adult male or post-menopausal woman = GI malignancy until proven otherwise → scope both ends!", color: C.yellow },
    { num: "04", text: "Ferritin is an acute-phase reactant — 'normal' ferritin in inflamed patient does NOT exclude iron deficiency!", color: C.teal },
    { num: "05", text: "Reticulocyte count is your diagnostic compass — HIGH = loss/destruction, LOW = underproduction. Check it first!", color: C.skyBlue },
    { num: "06", text: "Peripheral smear is FREE and invaluable — always order it with anemia workup. The machine can't see everything.", color: C.lightGreen },
    { num: "07", text: "Signs & symptoms of anemia are UNRELIABLE — Hb 5 g/dL can walk, Hb 8 g/dL can be in heart failure!", color: C.purple },
    { num: "08", text: "Metformin long-term → B12 deficiency → check annually, especially if peripheral neuropathy develops!", color: C.pink },
    { num: "09", text: "Splenomegaly + anemia → think hemolysis, portal hypertension, or bone marrow infiltration.", color: C.orange },
    { num: "10", text: "Hypersegmented neutrophil (>5 lobes) on smear = MEGALOBLASTIC process until proven otherwise!", color: C.royalBlue },
  ];

  pearls.forEach((p, i) => {
    const col = Math.floor(i / 5);
    const row = i % 5;
    const x = 0.2 + col * 6.55;
    const y = 0.65 + row * 1.32;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y, w: 6.35, h: 1.2, fill: { color: C.navyMid }, line: { color: p.color, pt: 1.5 }, rectRadius: 0.1 });
    // num badge
    s.addShape(pres.shapes.OVAL, { x: x + 0.08, y: y + 0.1, w: 0.7, h: 0.7, fill: { color: p.color }, line: { color: p.color } });
    s.addText(p.num, { x: x + 0.08, y: y + 0.1, w: 0.7, h: 0.7, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(p.text, { x: x + 0.85, y, w: 5.4, h: 1.2, fontSize: 11, color: C.white, valign: "middle", margin: 4 });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 - CLOSING SLIDE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.darkBg);
  s.addShape(pres.shapes.OVAL, { x: 8.5, y: -2.5, w: 7, h: 7, fill: { color: C.royalBlue, transparency: 80 }, line: { color: C.royalBlue, transparency: 80 } });
  s.addShape(pres.shapes.OVAL, { x: -2, y: 3, w: 5, h: 5, fill: { color: C.teal, transparency: 85 }, line: { color: C.teal, transparency: 85 } });
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.35, h: 7.5, fill: { color: C.redAccent }, line: { color: C.redAccent } });

  s.addText("🩸", { x: 5.5, y: 0.8, w: 2.3, h: 1.8, fontSize: 80, align: "center", valign: "middle" });
  s.addText("YOU'VE GOT THIS.", { x: 1, y: 2.6, w: 11.3, h: 0.95, fontSize: 40, bold: true, color: C.white, align: "center", charSpacing: 4 });
  s.addText("Anemia — Complete. Organised. Clinical.", { x: 1, y: 3.65, w: 11.3, h: 0.55, fontSize: 20, color: C.skyBlue, align: "center", italic: true });
  s.addShape(pres.shapes.RECTANGLE, { x: 3.5, y: 4.35, w: 6.3, h: 0.04, fill: { color: C.orange }, line: { color: C.orange } });

  const summary = ["Definition & WHO criteria","MCV Classification (TAILS)","3 Compensation Mechanisms","Clinical Features & Exam Signs","Investigation Algorithm + Smear","Iron Deficiency → Megaloblastic → ACI → Hemolytic → Aplastic","Treatment + Transfusion Thresholds","10 Clinical Pearls + Mnemonics"];
  s.addText(summary.map(x => "✓  " + x).join("     "), {
    x: 0.5, y: 4.55, w: 12.3, h: 1.4, fontSize: 11, color: C.grey, align: "center", valign: "top", margin: 4
  });

  s.addText("Source: Harrison's Principles of Internal Medicine 22E (2025)  •  Tintinalli's Emergency Medicine  •  Textbook of Family Medicine 9E", {
    x: 0.5, y: 7.1, w: 12.3, h: 0.3, fontSize: 9.5, color: C.grey, align: "center", italic: true
  });
}

// ─── WRITE FILE ──────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/anemia-pptx/Anemia_Clinical_Guide.pptx" })
  .then(() => console.log("✅ DONE: /home/daytona/workspace/anemia-pptx/Anemia_Clinical_Guide.pptx"))
  .catch(err => { console.error("❌ ERROR:", err); process.exit(1); });

import cv2
import numpy as np
from PIL import Image, ImageDraw, ImageFont
import os
import glob

# ── CONFIG ──────────────────────────────────────────────────────────────────
W, H = 1280, 720          # output resolution
FPS = 30
SLIDE_HOLD  = 4.5         # seconds each slide is held
TRANS_SECS  = 0.7         # transition duration
ZOOM_SECS   = 4.5         # ken-burns zoom over the hold period
FONT_PATH   = "/usr/share/fonts/truetype/dejavu/DejaVuSans-Bold.ttf"
FONT_SM     = "/usr/share/fonts/truetype/dejavu/DejaVuSans.ttf"
OUTPUT      = "/home/daytona/workspace/anemia-pptx/Anemia_Walkthrough.mp4"
SLIDES_DIR  = "/home/daytona/workspace/anemia-pptx"

# slide titles for lower-third banner
TITLES = [
    "🩸 ANEMIA — Complete Clinical Guide",
    "📋 Definition & WHO Diagnostic Criteria",
    "🔬 MCV Classification — Wintrobe's System",
    "⚙️ Pathophysiology & Compensatory Mechanisms",
    "🩺 Clinical Features — Symptoms & Signs",
    "🧪 Investigation Algorithm — Step by Step",
    "🔴 Iron Deficiency Anemia (IDA)",
    "🅱️ Megaloblastic Anemia — B12 & Folate",
    "🦠 Anemia of Inflammation (ACD)",
    "💥 Hemolytic Anemias",
    "💀 Aplastic Anemia — Bone Marrow Failure",
    "🧠 Mnemonics Master Slide",
    "💊 Treatment Overview & Transfusion Guidelines",
    "🏆 Top 10 Clinical Pearls for Ward Rounds",
    "✅ Summary — You've Got This!",
]

# accent colours per slide (BGR for OpenCV)
ACCENT_COLORS = [
    (26,  101, 193),   # 1 - royal blue
    (26,  101, 193),   # 2
    (39,   69, 227),   # 3 - red
    (143,  83,  21),   # 4 - teal
    (39,  140, 251),   # 5 - orange
    (56,  142,  60),   # 6 - green
    (39,   69, 227),   # 7 - red
    (39,  140, 251),   # 8 - orange
    (143,  83,  21),   # 9 - teal
    (39,  140, 251),   # 10 - orange
    (154,  27, 106),   # 11 - purple
    (39,  140, 251),   # 12 - orange
    (56,  142,  60),   # 13 - green
    (39,  140, 251),   # 14 - orange
    (26,  101, 193),   # 15 - blue
]

# ── HELPERS ──────────────────────────────────────────────────────────────────
def load_slide(path):
    img = Image.open(path).convert("RGB")
    img = img.resize((W, H), Image.LANCZOS)
    return np.array(img)[:, :, ::-1].copy()   # RGB→BGR

def add_lower_third(frame, title, color_bgr, alpha=1.0):
    """Draws a translucent lower-third bar with slide title."""
    overlay = frame.copy()
    bar_h = 58
    y0 = H - bar_h
    # dark background bar
    cv2.rectangle(overlay, (0, y0), (W, H), (15, 25, 40), -1)
    # colour accent stripe on left
    cv2.rectangle(overlay, (0, y0), (8, H), color_bgr, -1)
    cv2.addWeighted(overlay, 0.82, frame, 0.18, 0, frame)
    # text  (use PIL for emoji + unicode support)
    pil = Image.fromarray(frame[:, :, ::-1])
    draw = ImageDraw.Draw(pil)
    try:
        fnt = ImageFont.truetype(FONT_PATH, 22)
    except:
        fnt = ImageFont.load_default()
    draw.text((22, y0 + 16), title, font=fnt, fill=(255, 255, 255))
    return np.array(pil)[:, :, ::-1].copy()

def add_slide_number(frame, n, total):
    """Small slide counter top-right."""
    pil = Image.fromarray(frame[:, :, ::-1])
    draw = ImageDraw.Draw(pil)
    try:
        fnt = ImageFont.truetype(FONT_SM, 16)
    except:
        fnt = ImageFont.load_default()
    txt = f"{n}/{total}"
    draw.text((W - 60, 10), txt, font=fnt, fill=(200, 200, 200))
    return np.array(pil)[:, :, ::-1].copy()

def ken_burns(slide, t, duration, zoom_factor=1.06):
    """Slow zoom-in ken-burns effect. t=0..1 over the slide hold."""
    scale = 1.0 + (zoom_factor - 1.0) * t
    new_w = int(W * scale)
    new_h = int(H * scale)
    resized = cv2.resize(slide, (new_w, new_h), interpolation=cv2.INTER_LINEAR)
    x0 = (new_w - W) // 2
    y0 = (new_h - H) // 2
    return resized[y0:y0+H, x0:x0+W]

def cross_dissolve(a, b, t):
    """Simple cross-dissolve blend. t=0→a, t=1→b."""
    return cv2.addWeighted(a, 1.0 - t, b, t, 0)

def slide_wipe(a, b, t, direction="left"):
    """Wipe transition: slide b comes in from the right."""
    x = int(W * t)
    out = a.copy()
    if direction == "left":
        out[:, :x] = b[:, :x]
    else:
        out[:, W-x:] = b[:, W-x:]
    return out

def zoom_push(a, b, t):
    """Zoom the outgoing slide while bringing in the new one."""
    scale = 1.0 + 0.12 * t
    new_w = int(W * scale)
    new_h = int(H * scale)
    zoomed = cv2.resize(a, (new_w, new_h))
    x0 = (new_w - W) // 2
    y0 = (new_h - H) // 2
    zoomed = zoomed[y0:y0+H, x0:x0+W]
    alpha = t
    return cv2.addWeighted(zoomed, 1.0 - alpha, b, alpha, 0)

# ── LOAD SLIDES ───────────────────────────────────────────────────────────────
slide_paths = sorted(glob.glob(os.path.join(SLIDES_DIR, "slide-*.png")))
print(f"Found {len(slide_paths)} slides")
slides = [load_slide(p) for p in slide_paths]
N = len(slides)

# ── VIDEO WRITER ──────────────────────────────────────────────────────────────
fourcc = cv2.VideoWriter_fourcc(*"mp4v")
out = cv2.VideoWriter(OUTPUT, fourcc, FPS, (W, H))

trans_frames = int(TRANS_SECS * FPS)
hold_frames  = int(SLIDE_HOLD  * FPS)
zoom_frames  = hold_frames

TRANSITIONS = ["zoom_push", "dissolve", "wipe_left", "dissolve",
               "zoom_push", "wipe_left", "dissolve", "zoom_push",
               "dissolve", "wipe_left", "zoom_push", "dissolve",
               "wipe_left", "dissolve"]   # 14 transitions between 15 slides

total_frames = N * hold_frames + (N - 1) * trans_frames
print(f"Total frames: {total_frames} ({total_frames/FPS:.1f}s)")

for i, slide in enumerate(slides):
    print(f"  Rendering slide {i+1}/{N}: {TITLES[i][:40]}")
    color = ACCENT_COLORS[i]

    # ── HOLD with Ken-Burns ──────────────────────────────────────────────────
    for f in range(hold_frames):
        t = f / max(hold_frames - 1, 1)
        frame = ken_burns(slide, t, SLIDE_HOLD)
        frame = add_lower_third(frame, TITLES[i], color)
        frame = add_slide_number(frame, i + 1, N)
        out.write(frame)

    # ── TRANSITION to next slide ────────────────────────────────────────────
    if i < N - 1:
        next_slide = slides[i + 1]
        next_color = ACCENT_COLORS[i + 1]
        tr_type = TRANSITIONS[i % len(TRANSITIONS)]

        for f in range(trans_frames):
            t = f / max(trans_frames - 1, 1)
            # easing: smoothstep
            t_ease = t * t * (3 - 2 * t)

            # current slide at end of ken-burns
            cur = ken_burns(slide, 1.0, SLIDE_HOLD)
            nxt = next_slide.copy()

            if tr_type == "dissolve":
                frame = cross_dissolve(cur, nxt, t_ease)
            elif tr_type == "wipe_left":
                frame = slide_wipe(cur, nxt, t_ease, "left")
            elif tr_type == "zoom_push":
                frame = zoom_push(cur, nxt, t_ease)
            else:
                frame = cross_dissolve(cur, nxt, t_ease)

            # blend lower thirds
            frame = add_lower_third(frame, TITLES[i] if t < 0.5 else TITLES[i+1],
                                    color if t < 0.5 else next_color)
            frame = add_slide_number(frame, i + 1 if t < 0.5 else i + 2, N)
            out.write(frame)

out.release()
print(f"✅ Video saved: {OUTPUT}")
print(f"   Size: {os.path.getsize(OUTPUT)/1024/1024:.1f} MB")

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/anemia-pptx/make_video.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/anemia-pptx/make_video.py'

from gtts import gTTS
import os

# Full narration script for intern doctors - conversational, easy to follow
script = """
Welcome to your complete clinical guide on Anemia — designed specifically for intern doctors like you.
This audio walkthrough covers everything from definition to treatment, with mnemonics to help you remember it all.
Let's get started.

--- Slide 1 ---

The topic today is Anemia. 
Think of anemia not just as a low number on a blood report — but as reduced oxygen delivery to your patient's tissues.
That's what causes every single symptom and sign you will see at the bedside.
We will cover definition, classification, pathophysiology, clinical features, investigations, specific types, treatment, mnemonics, and top clinical pearls.
All of this is based on Harrison's Principles of Internal Medicine, 22nd Edition, 2025.

--- Slide 2 — Definition and WHO Criteria ---

So what exactly is anemia?
Anemia is defined as hemoglobin below normal for a given age and sex-matched population.

The World Health Organization gives us specific cutoffs:
Adult men — hemoglobin less than 13 grams per deciliter.
Adult women who are not pregnant — less than 12 grams per deciliter.
Pregnant women — less than 11 grams per deciliter.
Children aged 6 months to 6 years — less than 11 grams per deciliter.
Children aged 6 to 14 years — less than 12 grams per deciliter.

Intern tip — always check the full blood count, not just the hemoglobin alone.
You need the MCV, the RDW, and the reticulocyte count together to solve the puzzle.

Severity-wise:
Mild anemia is hemoglobin between 10 and 13 in men, or 10 and 12 in women.
Moderate is 7 to 10.
Severe is 4 to 7.
And very severe is below 4 grams per deciliter — this patient is in danger.

--- Slide 3 — Classification by MCV ---

Now let's classify anemia. There are two main ways — by the size of red cells, which is the MCV, and by mechanism.

Start with MCV because your blood count machine gives it to you automatically.

First — MICROCYTIC anemia, where MCV is less than 80.
Remember this with the mnemonic TAILS.
T for Thalassemia.
A for Anemia of chronic disease or inflammation.
I for Iron deficiency — the most common cause of anemia worldwide!
L for Lead poisoning.
S for Sideroblastic anemia.

The reason these are all microcytic is simple — any process that interferes with hemoglobin production leads to less hemoglobin, which means smaller red cells.

Second — MACROCYTIC anemia, where MCV is above 100.
There are two subtypes:
Oval macrocytes happen because of a DNA synthesis defect — think Vitamin B12 deficiency, folate deficiency, methotrexate, hydroxyurea, and myelodysplastic syndrome.
Round macrocytes happen because of membrane defects — think alcohol, liver disease, hypothyroidism, and reticulocytosis from hemolysis.

The most common cause of macrocytosis in clinical practice is actually alcohol — not B12 deficiency. Keep that in mind!

Third — NORMOCYTIC anemia, where MCV is 80 to 100.
Here, the reticulocyte count is your best friend. It tells you the mechanism.
High reticulocyte count means the marrow is trying hard — there is loss or destruction.
Low reticulocyte count means underproduction — the marrow is failing.

--- Slide 4 — Pathophysiology and Compensatory Mechanisms ---

When hemoglobin falls, the body does three things to compensate. Understanding these mechanisms explains every clinical sign you will see.

Mechanism One — Increased cardiac output. This happens within minutes.
Oxygen delivery equals cardiac output multiplied by hemoglobin. So if hemoglobin drops, cardiac output rises to compensate.
This is why anemic patients are tachycardic.
Patients with pre-existing heart disease or coronary artery disease cannot increase their cardiac output well — so they decompensate at higher hemoglobin levels. Treat them when hemoglobin is below 8 or 9 grams per deciliter.

Mechanism Two — Increased 2-3 DPG, or 2-3 diphosphoglycerate. This takes hours to days.
2-3 DPG shifts the oxygen-hemoglobin dissociation curve to the right. This means hemoglobin releases oxygen more easily to the tissues.
It sounds paradoxical at first — why decrease hemoglobin's affinity for oxygen? But the key is that in the lungs, the high oxygen pressure still fully saturates hemoglobin. And in the tissues, more oxygen gets offloaded. Net result — tissues get more oxygen. This is a classic exam question!

Mechanism Three — Increased plasma volume. This takes weeks.
The body expands plasma volume to maintain cardiac output and blood pressure.
Warning — if a patient has had very severe chronic anemia for a long time, they have compensated with a lot of extra plasma volume. If you transfuse them too fast, this can cause fluid overload and pulmonary edema. Always transfuse slowly over 4 hours, and give furosemide between units.

The clinical signs from these compensatory mechanisms are: tachycardia, wide pulse pressure, a systolic flow murmur from hyperdynamic circulation, bounding pulse, and in late stages, ankle edema from heart failure.

--- Slide 5 — Clinical Features ---

Let's talk about what you will actually find when you see an anemic patient.

General symptoms include fatigue and lethargy — the most common complaint, dyspnea on exertion, palpitations, dizziness and lightheadedness, headache, poor concentration, and in older patients, worsening of angina or claudication.

On examination, look for:
Pallor — and the most RELIABLE place to check is the palpebral conjunctiva — the inner lower eyelid. Pull it down and look. If it's pale, that's real pallor.
Also check palmar pallor and mucosal pallor.
Tachycardia at rest.
Systolic flow murmur from the hyperdynamic state.
Ankle edema if cardiac decompensation has occurred.

Now the disease-specific signs — these are what will impress your attending:

Iron deficiency — look for pica, which is craving for non-food items like ice, clay, or dirt. Also koilonychia or spoon-shaped nails, angular cheilitis at the corners of the mouth, glossitis or a sore smooth tongue, and in severe cases, dysphagia from a post-cricoid web — this is called Plummer-Vinson syndrome.

B12 deficiency — peripheral neuropathy, subacute combined degeneration of the spinal cord with loss of vibration and proprioception, dementia, glossitis, and a lemon-yellow tinge to the skin from mild jaundice plus pallor together.

Hemolytic anemia — the classic triad is jaundice PLUS pallor PLUS splenomegaly. If you see all three together, think hemolysis immediately.

Aplastic anemia — think of the pancytopenia triad: petechiae and gum bleeding from low platelets, recurrent infections from low white cells, and pallor and fatigue from low red cells.

Thalassemia — frontal bossing, chipmunk facies, hepatosplenomegaly, and growth retardation in children.

--- Slide 6 — Investigation Algorithm ---

Here is your step-by-step approach to investigating anemia. Follow this every time and you will not miss anything.

Step 1 — Full blood count plus reticulocyte count. Always together.

Look at the reticulocyte count first. It is your diagnostic compass.

If reticulocyte count is HIGH — above 2 percent — the mechanism is LOSS or DESTRUCTION.
First rule out bleeding. If there is no bleeding, then test for hemolysis:
LDH will be elevated.
Haptoglobin will be low.
Unconjugated bilirubin will be elevated.
Order a peripheral blood smear.
Do a Direct Antiglobulin Test, also called the Coombs test.

If reticulocyte count is LOW — below 2 percent — the mechanism is UNDERPRODUCTION.
Now look at MCV.
Low MCV — check iron studies — ferritin, serum iron, TIBC.
Normal MCV — check renal function, EPO levels, look for endocrinopathy.
High MCV — look at the peripheral smear for hypersegmented neutrophils and macro-ovalocytes. Check B12 and folate. Also check TSH and liver function tests.

Step 2 — ALWAYS order a peripheral blood smear. It is free and tells you what the machine cannot.

Here is what smear findings tell you:
Microcytic hypochromic cells with pencil cells — iron deficiency anemia.
Macro-ovalocytes with hypersegmented neutrophils — megaloblastic anemia.
Spherocytes — hereditary spherocytosis or autoimmune hemolytic anemia.
Schistocytes or fragmented red cells — microangiopathic hemolytic anemia — think TTP, HUS, DIC, or prosthetic heart valves.
Target cells — thalassemia or liver disease.
Sickle cells — sickle cell disease.
Tear drop cells with nucleated red cells — myelofibrosis or marrow infiltration.

The critical iron panel comparison:
In iron deficiency — ferritin is LOW, serum iron is low, TIBC is HIGH, and RDW is HIGH because cells are anisocytic.
In anemia of inflammation — ferritin is HIGH because it is an acute phase reactant, serum iron is low, and TIBC is low to normal.
In thalassemia trait — ferritin, serum iron, and TIBC are all normal. The MCV is low but the RDW is usually normal because the cells are uniformly small.

This RDW trick is key — high RDW with low MCV means iron deficiency. Normal RDW with low MCV means thalassemia.

--- Slide 7 — Iron Deficiency Anemia ---

Iron deficiency anemia is the most common anemia worldwide. Every intern must know this inside out.

Causes — think in four categories:
1. Blood loss — this is the most common cause in adults. GI bleeding from peptic ulcers or colon cancer. Menorrhagia in women. NSAIDs-induced gastritis.
2. Poor intake — malnutrition, strict vegetarian diet.
3. Malabsorption — celiac disease, post-gastrectomy, Helicobacter pylori infection.
4. Increased demand — pregnancy and rapid growth in children.

Red flag alert — if you find iron deficiency anemia in an adult male or a post-menopausal woman, you MUST investigate for gastrointestinal malignancy. Do a colonoscopy AND an upper GI endoscopy. Never attribute it to diet alone without ruling out cancer.

Clinical features on top of general anemia symptoms:
Koilonychia — spoon-shaped nails.
Angular cheilitis — cracks at the corners of the mouth.
Pica — craving for ice, clay, or dirt.
Glossitis — smooth, sore tongue.
Dysphagia from Plummer-Vinson syndrome in severe longstanding cases.
In children — developmental delay.

Treatment:
First line is oral iron — ferrous sulphate 200 milligrams three times a day, which gives 65 milligrams of elemental iron per tablet.
Take it on an empty stomach with Vitamin C, which enhances absorption.
Avoid taking it with tea, calcium supplements, or antacids.

The response timeline is important — reticulocytosis happens within 7 to 10 days. Hemoglobin rises about 1 to 2 grams per deciliter per week. Continue for 3 months AFTER hemoglobin normalizes to replenish body stores. Many interns stop too early — don't!

IV iron — ferric carboxymaltose — is used when oral iron is not tolerated, when there is malabsorption, active inflammatory bowel disease, or as pre-operative optimization.

Ferritin trap — remember, ferritin is an acute phase reactant. In an inflamed or infected patient, ferritin can be falsely normal or even high, even when the patient has true iron deficiency. In those cases, check transferrin saturation — less than 15% confirms iron deficiency.

--- Slide 8 — Megaloblastic Anemia ---

Megaloblastic anemia is caused by a defect in DNA synthesis that affects all rapidly dividing cells in the bone marrow.

The mechanism — both B12 and folate are needed for the conversion of deoxyuridine monophosphate to deoxythymidine monophosphate — a key step in DNA synthesis. When this fails, cells grow in size but cannot divide properly — creating megaloblasts. Because ALL rapidly dividing cells are affected, you can get pancytopenia, not just anemia.

Vitamin B12 deficiency:
The most common cause in adults is pernicious anemia — an autoimmune condition where the body makes antibodies against intrinsic factor, which is made by gastric parietal cells. Without intrinsic factor, B12 cannot be absorbed in the terminal ileum.
Other causes — strict veganism, since B12 is only found in animal products, gastrectomy, terminal ileal disease like Crohn's, metformin long-term use, and rarely, fish tapeworm.

B12 deficiency has neurological features that folate deficiency does NOT have.
These include subacute combined degeneration of the spinal cord, affecting the dorsal columns causing loss of vibration and proprioception, and the lateral corticospinal tracts causing upper motor neuron signs.
Also peripheral neuropathy and dementia.

Folate deficiency:
Causes include poor diet especially in alcoholics and the elderly, pregnancy which increases demand — this is why we give folic acid supplements in early pregnancy, malabsorption from celiac disease, and drugs like methotrexate, phenytoin, and trimethoprim, which all inhibit dihydrofolate reductase.

CRITICAL DANGER — never treat macrocytic anemia with folate alone without first checking B12.
If the patient has undiagnosed B12 deficiency, giving folate will correct the blood count and make the anemia look better, but it will allow the neurological damage to continue and worsen. This is a classic clinical and exam trap. Always check B12 first.

Treatment:
B12 deficiency — intramuscular hydroxocobalamin 1000 micrograms daily for one week, then weekly for four weeks, then every three months for life in pernicious anemia.
Folate deficiency — folic acid 5 milligrams per day orally, after B12 has been excluded.

Lab trick to distinguish B12 from folate — both cause elevated homocysteine. But only B12 deficiency causes elevated methylmalonic acid. So if homocysteine is up and methylmalonic acid is up — it's B12. If homocysteine is up but methylmalonic acid is normal — it's folate.

--- Slide 9 — Anemia of Inflammation ---

Anemia of inflammation, previously called anemia of chronic disease, is the most common anemia in hospitalized patients.

It occurs in infections, autoimmune diseases like rheumatoid arthritis and lupus, malignancies, inflammatory bowel disease, chronic kidney disease, congestive heart failure, and sepsis.

There are three cytokine-driven mechanisms:
First — Interleukin-6 stimulates hepcidin production. Hepcidin causes macrophages to sequester iron, leading to hypoferremia. Iron is locked in the body's stores and is unavailable for red cell production. This is called "functional iron deficiency."

Second — tumor necrosis factor alpha and interleukin 1 beta suppress erythropoietin production from the kidney. Less erythropoietin means less stimulus to make red cells.

Third — interferon gamma blunts the response of erythroid progenitors to erythropoietin. Even when erythropoietin is present, the bone marrow doesn't respond well.

The result is a mild to moderate, normocytic, normochromic anemia with a low reticulocyte count.

The hallmark lab pattern is: low serum iron, low TIBC, but HIGH ferritin. This combination tells you functional iron deficiency.

Treatment — primarily treat the underlying disease. In chronic kidney disease, erythropoiesis-stimulating agents like epoetin are used, targeting hemoglobin 10 to 12. In selected patients with absolute iron deficiency on top, IV iron is given.

--- Slide 10 — Hemolytic Anemias ---

Hemolytic anemia is premature destruction of red blood cells before their normal lifespan of 120 days.

The classic hemolysis labs are: elevated LDH, low haptoglobin, elevated unconjugated bilirubin, and a high reticulocyte count. At the bedside, look for jaundice plus pallor plus splenomegaly — that classic triad should immediately make you think hemolysis.

There are two types based on where destruction happens:

Intravascular hemolysis — red cells are destroyed inside blood vessels.
Causes include TTP and HUS — look for schistocytes on the smear, DIC, G6PD deficiency triggered by oxidative stress from drugs like primaquine or dapsone or from fava beans, prosthetic heart valves, and march hemoglobinuria from prolonged running.
The hallmark of intravascular hemolysis is hemoglobinuria — the urine turns dark red or brown because free hemoglobin is being filtered by the kidneys.

Extravascular hemolysis — red cells are destroyed by macrophages in the spleen and liver.
Causes include hereditary spherocytosis, autoimmune hemolytic anemia, sickle cell disease, and thalassemia major.

Autoimmune hemolytic anemia — there are two types:
Warm AIHA — mediated by IgG antibodies that react at 37 degrees. Associated with lupus, chronic lymphocytic leukemia, lymphomas, and drugs like methyldopa. Treatment is steroids first, then rituximab, then splenectomy.
Cold AIHA — mediated by IgM antibodies that react below 37 degrees — cold agglutinin disease. Associated with Mycoplasma pneumoniae, Epstein-Barr virus, and lymphoma. Treatment involves keeping the patient warm and avoiding cold exposure.

The key diagnostic test for AIHA is the Direct Antiglobulin Test — also called the Coombs test. If it is positive, you have confirmed immune-mediated hemolysis.

G6PD deficiency — X-linked, common in Mediterranean, African, and Asian populations. Oxidative stress triggers hemolysis. Heinz bodies and bite cells are seen on smear. Avoid precipitant drugs.

--- Slide 11 — Aplastic Anemia ---

Aplastic anemia is defined as pancytopenia with bone marrow hypocellularity — the marrow is replaced by fat.

The key distinction from leukemia — in aplastic anemia, you get pancytopenia but there is NO lymphadenopathy and NO splenomegaly. In leukemia, you often have both. This is an important clinical differentiator.

Causes:
Acquired — the most common. Usually immune-mediated destruction of hematopoietic stem cells by T cells. Most are idiopathic. Others follow seronegative hepatitis, drugs like chloramphenicol, NSAIDs, and gold, or toxins like benzene and radiation.
Constitutional — inherited syndromes like Fanconi anemia, dyskeratosis congenita, and Diamond-Blackfan anemia.

Clinical features are the triad of pancytopenia:
From low red cells — pallor, fatigue, dyspnea.
From low platelets — petechiae, gum bleeding, spontaneous bruising, menorrhagia.
From low white cells — recurrent and severe bacterial and fungal infections, fever without a source.

Diagnosis — bone marrow biopsy showing hypocellular marrow with greater than 70 percent fat. This is the gold standard. Note — you need a trephine biopsy, not just an aspirate.

Severity — the Camitta criteria. Severe aplastic anemia requires two or more of: neutrophil count below 0.5, platelets below 20, reticulocytes below 20, all times 10 to the 9 per liter. Very severe is neutrophils below 0.2.

Treatment:
For young patients under 40 with an HLA-matched sibling donor — allogeneic stem cell transplant. This is curative.
For patients without a donor or older patients — immunosuppression with anti-thymocyte globulin, cyclosporine, and eltrombopag.
Supportive care — blood and platelet transfusions, G-CSF, and aggressive treatment of infections.

--- Slide 12 — Mnemonics Master Slide ---

Now let's nail the mnemonics so you never forget these in the ward.

For microcytic anemia — TAILS.
T — Thalassemia.
A — Anemia of chronic disease.
I — Iron deficiency — the most common.
L — Lead poisoning.
S — Sideroblastic anemia.

For macrocytic anemia — HAMILT.
H — Hypothyroidism.
A — Alcohol and liver disease.
M — Myelodysplasia.
I — Ineffective erythropoiesis from B12 and folate deficiency.
L — Liver disease.
T — Treatment drugs like methotrexate and hydroxyurea.

For iron deficiency specific symptoms — PAGED.
P — Pica.
A — Angular cheilitis.
G — Glossitis.
E — Epithelial changes like koilonychia.
D — Dysphagia from Plummer-Vinson syndrome.

For hemolysis labs — HHU.
H — Haptoglobin down.
H — High LDH.
U — Unconjugated bilirubin up.
Plus high reticulocyte count.

For aplastic anemia treatment — SAVE.
S — Stem cell transplant if a donor is available.
A — Anti-thymocyte globulin.
V — Various blood product support and transfusions.
E — Eltrombopag plus cyclosporine.

For autoimmune hemolytic anemia — WISE.
W — Warm AIHA is IgG, associated with SLE, CLL, and lymphoma.
I — Immune drugs like methyldopa can cause it.
S — Splenectomy if refractory.
E — Extravascular hemolysis is the pattern.

Quick clinical rules to burn into your memory:
Reticulocyte HIGH means loss or destruction. Reticulocyte LOW means underproduction.
RDW high with low MCV means iron deficiency. RDW normal with low MCV means thalassemia.
Never give folate without checking B12 first.
IDA in adult male or post-menopausal female means scope both ends to rule out GI malignancy.

--- Slide 13 — Treatment Overview and Transfusion Guidelines ---

Quick treatment summary for all types:

Iron deficiency — oral ferrous sulphate 200 milligrams three times a day for 3 months after hemoglobin normalizes. IV iron if oral fails.

B12 deficiency — intramuscular hydroxocobalamin 1000 micrograms daily for 7 days, then weekly for 4 doses, then every 3 months for life.

Folate deficiency — folic acid 5 milligrams daily orally, after B12 has been excluded.

Anemia of inflammation — treat the underlying disease. IV iron or erythropoiesis-stimulating agents in CKD and chemotherapy patients.

Autoimmune hemolytic anemia — steroids first, then rituximab, then splenectomy. Keep the patient warm for cold AIHA.

Aplastic anemia — allogeneic stem cell transplant for young patients with a donor. Anti-thymocyte globulin, cyclosporine, and eltrombopag for others.

Transfusion thresholds — know these:
Stable general patient — transfuse when hemoglobin falls below 7 grams per deciliter.
Cardiovascular disease — transfuse when below 8 grams per deciliter.
Active bleeding with hemodynamic instability — transfuse immediately regardless of the hemoglobin.
Pre-operative — target hemoglobin above 8 grams per deciliter.
Bone marrow failure patients — transfuse when below 8 or when symptomatic.

TACO warning — Transfusion-Associated Circulatory Overload. Patients with chronic severe anemia have compensated with increased plasma volume. If you transfuse too quickly, you risk acute pulmonary edema. Transfuse slowly over 4 hours. Give furosemide between units if the patient has poor cardiac reserve or signs of fluid overload.

--- Slide 14 — Top 10 Clinical Pearls for Ward Rounds ---

These are the 10 things your attending will ask you. Know them cold.

Pearl 1 — Normocytic anemia plus pancytopenia equals aplastic anemia until proven otherwise. Get a bone marrow biopsy urgently.

Pearl 2 — Never treat macrocytic anemia with folate before checking B12. You will fix the blood count but allow the spinal cord damage to continue. This can be catastrophic.

Pearl 3 — Iron deficiency anemia in an adult male or post-menopausal woman means GI malignancy until proven otherwise. Scope both ends.

Pearl 4 — Ferritin is an acute phase reactant. A normal ferritin in an inflamed patient does NOT exclude iron deficiency. Check transferrin saturation.

Pearl 5 — The reticulocyte count is your diagnostic compass. Check it first before anything else in an anemic patient.

Pearl 6 — Peripheral blood smear is free and invaluable. Always order it with the blood count. The machine cannot see schistocytes, Heinz bodies, or hypersegmented neutrophils.

Pearl 7 — Signs and symptoms of anemia are unreliable. A patient with hemoglobin of 5 grams per deciliter can walk into clinic. Another with 8 grams per deciliter can be in heart failure. It depends on acuity and cardiac reserve.

Pearl 8 — Metformin long-term use causes B12 deficiency. Check B12 annually in patients on long-term metformin, especially if they develop peripheral neuropathy.

Pearl 9 — Splenomegaly plus anemia makes you think hemolysis, portal hypertension, or bone marrow infiltration by lymphoma or leukemia.

Pearl 10 — A hypersegmented neutrophil with more than 5 lobes on the peripheral smear means a megaloblastic process until proven otherwise. This is one of the most specific findings in hematology.

--- Summary ---

You have just covered the complete clinical picture of anemia — from the WHO definition, through classification by MCV, the three compensatory mechanisms your patient's body uses, the bedside signs and disease-specific clues, the step-by-step investigation algorithm, iron deficiency, megaloblastic anemia, anemia of inflammation, hemolytic anemias, aplastic anemia, all the mnemonics, treatment guidelines, transfusion thresholds, and the top 10 clinical pearls.

Remember these key points:
Always start with the full blood count and reticulocyte count together.
The reticulocyte count tells you the mechanism.
The peripheral smear tells you the diagnosis.
And NEVER give folate before checking B12.

You are now ready for ward rounds. Good luck, doctor. You have got this!
"""

print("Generating MP3 with gTTS...")
tts = gTTS(text=script, lang='en', slow=False, tld='com')

output_path = "/home/daytona/workspace/anemia-pptx/Anemia_Audio_Guide.mp3"
tts.save(output_path)

size_mb = os.path.getsize(output_path) / 1024 / 1024
print(f"✅ MP3 saved: {output_path}")
print(f"   File size: {size_mb:.1f} MB")

from gtts import gTTS
from pydub import AudioSegment
import os, sys

OUT_DIR = "/home/daytona/workspace/anemia-pptx/audio_parts"
os.makedirs(OUT_DIR, exist_ok=True)

FINAL = "/home/daytona/workspace/anemia-pptx/Anemia_Audio_Guide.mp3"

# Split into manageable sections — one per slide cluster
sections = {
    "00_intro": """
Welcome to your complete clinical guide on Anemia, designed specifically for intern doctors.
This audio walkthrough covers everything from definition to treatment, with mnemonics to help you remember.
Let's get started.
""",

    "01_definition": """
Slide 1 and 2. Definition and WHO Criteria.

Think of anemia not just as a low number on a blood report, but as reduced oxygen delivery to your patient's tissues.
That's what causes every single symptom and sign you will see at the bedside.

The World Health Organization gives us specific cutoffs.
Adult men — hemoglobin less than 13 grams per deciliter.
Adult women who are not pregnant — less than 12.
Pregnant women — less than 11.
Children aged 6 months to 6 years — less than 11.
Children aged 6 to 14 years — less than 12 grams per deciliter.

Intern tip — always check the FULL blood count, not just hemoglobin alone.
You need the MCV, the RDW, and the reticulocyte count together to solve the puzzle.

Severity scale — mild is 10 to 13. Moderate is 7 to 10. Severe is 4 to 7. Very severe is below 4 grams per deciliter.
""",

    "02_classification": """
Slide 3. Classification by MCV — Wintrobe's System.

Start with MCV because your blood count machine gives it to you automatically.

First — MICROCYTIC anemia, MCV less than 80.
Remember with the mnemonic TAILS.
T for Thalassemia.
A for Anemia of chronic disease or inflammation.
I for Iron deficiency — the most common cause of anemia worldwide.
L for Lead poisoning.
S for Sideroblastic anemia.
All microcytic because less hemoglobin means smaller red cells.

Second — MACROCYTIC anemia, MCV above 100.
Two subtypes.
Oval macrocytes — DNA synthesis defect — think B12 deficiency, folate deficiency, methotrexate, and myelodysplastic syndrome.
Round macrocytes — membrane defects — think alcohol, liver disease, and hypothyroidism.
Important — the most common cause of macrocytosis in clinical practice is alcohol, not B12. Keep that in mind!

Third — NORMOCYTIC anemia, MCV 80 to 100.
Here, the reticulocyte count is your best friend.
High reticulocyte count means loss or destruction.
Low reticulocyte count means underproduction — the marrow is failing.
""",

    "03_pathophysiology": """
Slide 4. Pathophysiology and Compensatory Mechanisms.

When hemoglobin falls, the body does three things to compensate.

Mechanism One — Increased cardiac output. This happens within minutes.
Oxygen delivery equals cardiac output times hemoglobin. If hemoglobin drops, cardiac output rises.
This is why anemic patients are tachycardic.
Patients with heart disease cannot increase cardiac output well — treat them at hemoglobin below 8 to 9.

Mechanism Two — Increased 2-3 DPG. This takes hours to days.
It shifts the oxygen-hemoglobin dissociation curve to the RIGHT.
Hemoglobin releases oxygen more easily to tissues — a classic exam fact!

Mechanism Three — Increased plasma volume. This takes weeks.
Maintains cardiac output and blood pressure.
Warning — if you transfuse a patient with chronic severe anemia too fast, you cause fluid overload.
Always transfuse slowly over 4 hours and give furosemide between units.

Signs from compensation — tachycardia, wide pulse pressure, systolic flow murmur, bounding pulse, and ankle edema in late stages.
""",

    "04_clinical_features": """
Slide 5. Clinical Features.

General symptoms — fatigue and lethargy (most common), dyspnea on exertion, palpitations, dizziness, headache, and in older patients, worsening angina or claudication.

On examination — check the palpebral conjunctiva — pull down the lower eyelid. This is the most reliable place to check pallor.
Also check palmar pallor, tachycardia, systolic flow murmur, and ankle edema.

Disease-specific signs — these will impress your attending.

Iron deficiency — pica, koilonychia (spoon nails), angular cheilitis, glossitis, and Plummer-Vinson syndrome (dysphagia).

B12 deficiency — peripheral neuropathy, subacute combined degeneration of the spinal cord, dementia, and glossitis.

Hemolytic anemia — the classic triad — jaundice PLUS pallor PLUS splenomegaly. See all three? Think hemolysis.

Aplastic anemia — petechiae and gum bleeding, plus recurrent infections, plus pallor — the pancytopenia triad.

Thalassemia — frontal bossing, chipmunk facies, hepatosplenomegaly.
""",

    "05_investigations": """
Slide 6. Investigation Algorithm.

Step by step — do this every time.

Step 1 — Full blood count plus reticulocyte count. Always order together.

If reticulocyte count is HIGH — loss or destruction.
Rule out bleeding first. If no bleeding, test for hemolysis.
LDH will be up. Haptoglobin will be down. Unconjugated bilirubin up.
Order peripheral smear and Direct Antiglobulin Test — Coombs test.

If reticulocyte count is LOW — underproduction.
Check MCV.
Low MCV — check ferritin, serum iron, TIBC.
Normal MCV — check renal function and EPO.
High MCV — check B12, folate, TSH, liver function.

Step 2 — Always order peripheral blood smear.
Pencil cells and microcytic cells — iron deficiency.
Macro-ovalocytes with hypersegmented neutrophils — megaloblastic anemia.
Spherocytes — hereditary spherocytosis or autoimmune hemolytic anemia.
Schistocytes — TTP, HUS, DIC, or prosthetic valves.
Target cells — thalassemia or liver disease.
Sickle cells — sickle cell disease.

The iron panel comparison — memorize this.
Iron deficiency — ferritin LOW, iron low, TIBC HIGH, RDW HIGH.
Anemia of inflammation — ferritin HIGH, iron low, TIBC low.
Thalassemia trait — all iron studies normal.

The RDW trick — high RDW with low MCV equals iron deficiency. Normal RDW with low MCV equals thalassemia. This single trick saves you time every day.
""",

    "06_ida": """
Slide 7. Iron Deficiency Anemia.

The most common anemia worldwide. Know this inside out.

Causes — four categories.
1. Blood loss — most common in adults. GI bleeding, menorrhagia, NSAID gastritis.
2. Poor intake — malnutrition and veganism.
3. Malabsorption — celiac disease, post-gastrectomy, H. pylori.
4. Increased demand — pregnancy and growth in children.

Red flag — IDA in an adult male or post-menopausal woman demands a colonoscopy AND upper GI endoscopy to exclude cancer. Never say it's dietary without scoping.

Treatment — oral ferrous sulphate 200 milligrams three times a day. Take on empty stomach with Vitamin C. Avoid tea, calcium, and antacids.

Response timeline — reticulocytosis in 7 to 10 days. Hemoglobin rises 1 to 2 grams per deciliter per week. Continue for 3 months AFTER hemoglobin normalizes to replenish stores. Most interns stop too early.

Ferritin trap — ferritin is an acute phase reactant. Normal ferritin in an inflamed patient does NOT exclude iron deficiency. Check transferrin saturation — less than 15% confirms it.
""",

    "07_megaloblastic": """
Slide 8. Megaloblastic Anemia — B12 and Folate Deficiency.

Mechanism — both B12 and folate are needed for DNA synthesis. When this fails, cells grow but cannot divide — creating megaloblasts. All rapidly dividing cells are affected — so pancytopenia is possible.

B12 deficiency causes — pernicious anemia (most common in adults, anti-intrinsic factor antibodies), strict veganism, gastrectomy, Crohn's of the terminal ileum, long-term metformin, and fish tapeworm.

B12 deficiency has NEUROLOGICAL features — subacute combined degeneration of the spinal cord, peripheral neuropathy, and dementia.

Folate deficiency causes — poor diet especially in alcoholics and elderly, pregnancy (increased demand), celiac disease, and drugs like methotrexate, phenytoin, and trimethoprim.

CRITICAL WARNING — never give folate without checking B12 first!
If there is undiagnosed B12 deficiency, folate will correct the blood count but allow neurological damage to continue. This is a catastrophic mistake.

Treatment — B12 deficiency: intramuscular hydroxocobalamin 1000 micrograms daily for 1 week, then weekly for 4, then every 3 months for life.
Folate — folic acid 5 milligrams daily after B12 is excluded.

Lab trick — both cause high homocysteine. Only B12 deficiency causes high methylmalonic acid. Use methylmalonic acid to distinguish them.
""",

    "08_inflammation": """
Slide 9. Anemia of Inflammation.

The most common anemia in hospitalized patients.

Three cytokine-driven mechanisms.

First — Interleukin-6 stimulates hepcidin, which causes iron sequestration in macrophages. Iron is locked in stores — this is called functional iron deficiency.

Second — TNF alpha and IL-1 beta suppress erythropoietin from the kidney.

Third — Interferon gamma blunts the erythroid progenitor response to erythropoietin.

Result — mild to moderate, normocytic, normochromic anemia with low reticulocyte count.

Hallmark labs — low serum iron, low TIBC, but HIGH ferritin. The ferritin is high because it is an acute phase reactant, not because iron stores are genuinely high.

Treatment — treat the underlying disease. IV iron or erythropoiesis-stimulating agents in chronic kidney disease. Target hemoglobin 10 to 12 — higher targets increase thrombosis risk.
""",

    "09_hemolytic": """
Slide 10. Hemolytic Anemias.

Classic hemolysis labs — LDH up, haptoglobin down, unconjugated bilirubin up, high reticulocyte count.
At the bedside — jaundice plus pallor plus splenomegaly.

Intravascular hemolysis — red cells destroyed inside blood vessels.
Causes — TTP, HUS with schistocytes on smear, DIC, G6PD deficiency, prosthetic heart valves, march hemoglobinuria.
Hallmark — hemoglobinuria, dark red or brown urine.

Extravascular hemolysis — red cells destroyed by macrophages in the spleen and liver.
Causes — hereditary spherocytosis, autoimmune hemolytic anemia, sickle cell disease, thalassemia major.

Autoimmune hemolytic anemia — two types.
Warm AIHA — IgG, at 37 degrees. Associated with lupus, CLL, lymphoma, methyldopa. Treatment — steroids, then rituximab, then splenectomy.
Cold AIHA — IgM, below 37 degrees. Associated with Mycoplasma and EBV. Treatment — keep the patient warm.

Key test — Direct Antiglobulin Test, or Coombs test. Positive means immune-mediated hemolysis.
G6PD — X-linked, Mediterranean and African populations, Heinz bodies and bite cells on smear, avoid oxidant drugs.
""",

    "10_aplastic": """
Slide 11. Aplastic Anemia.

Pancytopenia plus bone marrow hypocellularity — the marrow is replaced by fat.

Key point — NO lymphadenopathy and NO splenomegaly. This distinguishes it from leukemia where you often have both.

Causes — acquired (most common): immune-mediated T-cell destruction of stem cells, idiopathic, post-hepatitis, drugs like chloramphenicol and NSAIDs, toxins like benzene and radiation.
Constitutional — Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan anemia.

Clinical features — the pancytopenia triad.
Low red cells — pallor, fatigue, dyspnea.
Low platelets — petechiae, gum bleeding, spontaneous bruising.
Low white cells — recurrent severe infections, fever without a source.

Diagnosis — bone marrow TREPHINE biopsy showing hypocellular marrow with more than 70 percent fat. Not just an aspirate.

Severity — Camitta criteria. Severe means two of: neutrophils below 0.5, platelets below 20, reticulocytes below 20, all per liter times 10 to the 9.

Treatment — young patient under 40 with HLA-matched sibling donor — allogeneic stem cell transplant — curative!
No donor or older — anti-thymocyte globulin plus cyclosporine plus eltrombopag.
Supportive — transfusions, G-CSF, treat infections aggressively.
""",

    "11_mnemonics_pearls": """
Slides 12, 13, and 14. Mnemonics, Treatment, and Clinical Pearls.

Mnemonics to remember forever.

Microcytic — TAILS. Thalassemia, Anemia of chronic disease, Iron deficiency, Lead poisoning, Sideroblastic.

Macrocytic — HAMILT. Hypothyroidism, Alcohol and liver, Myelodysplasia, Ineffective erythropoiesis from B12 and folate, Liver disease, Treatment drugs.

IDA symptoms — PAGED. Pica, Angular cheilitis, Glossitis, Epithelial changes (koilonychia), Dysphagia.

Hemolysis labs — HHU. Haptoglobin down, High LDH, Unconjugated bilirubin up.

Aplastic treatment — SAVE. Stem cell transplant, Anti-thymocyte globulin, Various blood products, Eltrombopag.

Treatment summary —
Iron deficiency — oral ferrous sulphate for 3 months after normalization.
B12 — hydroxocobalamin intramuscular, every 3 months lifelong.
Folate — folic acid 5 milligrams daily.
Anemia of inflammation — treat the underlying cause.
AIHA — steroids, then rituximab, then splenectomy.
Aplastic — stem cell transplant or immunosuppression.

Transfusion thresholds —
Stable patient — below 7.
Cardiovascular disease — below 8.
Active bleeding — immediate regardless of number.

Top 10 clinical pearls —
1. Normocytic anemia plus pancytopenia equals aplastic anemia — bone marrow biopsy urgently.
2. Never give folate without checking B12. You risk destroying the spinal cord.
3. IDA in adult male or post-menopausal woman — scope both ends for cancer.
4. Normal ferritin in inflamed patient does not exclude iron deficiency.
5. Reticulocyte count first — it is your diagnostic compass.
6. Always order peripheral blood smear.
7. Signs of anemia are unreliable — a patient with hemoglobin 5 can walk; at 8 they can be in heart failure.
8. Check B12 annually in patients on long-term metformin.
9. Splenomegaly plus anemia — think hemolysis, portal hypertension, or bone marrow infiltration.
10. Hypersegmented neutrophil with more than 5 lobes on smear — megaloblastic process until proven otherwise.
""",

    "12_summary": """
Final summary.

You have just completed the full clinical guide to Anemia for intern doctors.

Remember these five golden rules:
One — always start with full blood count and reticulocyte count together.
Two — the reticulocyte count tells you the mechanism — high means destruction, low means underproduction.
Three — always order a peripheral blood smear.
Four — never give folate before checking B12.
Five — IDA in a middle-aged man or post-menopausal woman means scope both ends.

You have covered definition, WHO criteria, MCV classification with the TAILS mnemonic, the three compensatory mechanisms, bedside clinical features, investigation algorithm, iron deficiency anemia, megaloblastic anemia, anemia of inflammation, hemolytic anemias, aplastic anemia, all mnemonics, treatment guidelines, transfusion thresholds, and 10 clinical pearls for ward rounds.

You are now ready for ward rounds, doctor. Go and ace it. You have got this!
"""
}

print(f"Generating {len(sections)} audio sections...")

parts = []
for i, (name, text) in enumerate(sections.items()):
    part_path = os.path.join(OUT_DIR, f"{name}.mp3")
    print(f"  [{i+1}/{len(sections)}] {name}...")
    tts = gTTS(text=text.strip(), lang='en', slow=False, tld='co.uk')
    tts.save(part_path)
    parts.append(part_path)

print("Merging all parts with pydub...")
combined = AudioSegment.empty()
pause = AudioSegment.silent(duration=800)  # 0.8s pause between sections

for path in parts:
    seg = AudioSegment.from_mp3(path)
    combined += seg + pause

combined.export(FINAL, format="mp3", bitrate="128k")
size_mb = os.path.getsize(FINAL) / 1024 / 1024
print(f"✅ MP3 saved: {FINAL}")
print(f"   Duration: {len(combined)/1000/60:.1f} minutes")
print(f"   File size: {size_mb:.1f} MB")