from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
import os

ASSETS = "/tmp/workspace/sarcoidosis-ppt/assets"

# Color palette (clinical navy / teal)
NAVY = RGBColor(0x0B, 0x2E, 0x4E)
TEAL = RGBColor(0x0E, 0x7C, 0x86)
LIGHT_TEAL = RGBColor(0xE6, 0xF3, 0xF3)
DARK = RGBColor(0x27, 0x2B, 0x30)
GREY = RGBColor(0x5A, 0x63, 0x6B)
WHITE = RGBColor(0xFF, 0xFF, 0xFF)
ACCENT = RGBColor(0xC0, 0x6A, 0x2E)  # amber accent for emphasis

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)
BLANK = prs.slide_layouts[6]
SW, SH = prs.slide_width, prs.slide_height


def add_slide():
    return prs.slides.add_slide(BLANK)


def add_bg(slide, color=WHITE):
    rect = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, 0, 0, SW, SH)
    rect.fill.solid()
    rect.fill.fore_color.rgb = color
    rect.line.fill.background()
    rect.shadow.inherit = False
    slide.shapes._spTree.remove(rect._element)
    slide.shapes._spTree.insert(2, rect._element)
    return rect


def add_textbox(slide, l, t, w, h, text, size=18, color=DARK, bold=False,
                 align=PP_ALIGN.LEFT, font="Calibri", anchor=None, italic=False):
    tb = slide.shapes.add_textbox(l, t, w, h)
    tf = tb.text_frame
    tf.word_wrap = True
    if anchor:
        tf.vertical_anchor = anchor
    p = tf.paragraphs[0]
    p.text = text
    p.alignment = align
    r = p.runs[0]
    r.font.size = Pt(size)
    r.font.bold = bold
    r.font.italic = italic
    r.font.color.rgb = color
    r.font.name = font
    return tb


def add_bullets(slide, l, t, w, h, items, size=15, color=DARK, font="Calibri",
                 line_spacing=1.15, space_after=8):
    tb = slide.shapes.add_textbox(l, t, w, h)
    tf = tb.text_frame
    tf.word_wrap = True
    first = True
    for item in items:
        if isinstance(item, tuple):
            text, level, kwargs = item[0], item[1], (item[2] if len(item) > 2 else {})
        else:
            text, level, kwargs = item, 0, {}
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first = False
        bullet_char = "\u25AA " if level == 0 else "\u2013 "
        indent = "" if level == 0 else "    "
        p.text = indent + bullet_char + text
        p.level = 0
        p.space_after = Pt(space_after)
        p.line_spacing = line_spacing
        r = p.runs[0]
        r.font.size = Pt(size - (2 if level else 0))
        r.font.color.rgb = kwargs.get("color", color)
        r.font.bold = kwargs.get("bold", False)
        r.font.name = font
    return tb


def header(slide, kicker, title, num, total):
    add_bg(slide, WHITE)
    bar = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, 0, 0, SW, Inches(1.15))
    bar.fill.solid()
    bar.fill.fore_color.rgb = NAVY
    bar.line.fill.background()
    bar.shadow.inherit = False
    add_textbox(slide, Inches(0.55), Inches(0.10), Inches(11), Inches(0.35),
                kicker.upper(), size=12, color=RGBColor(0xB9, 0xD6, 0xDC), bold=True, font="Calibri")
    add_textbox(slide, Inches(0.55), Inches(0.40), Inches(11.5), Inches(0.7),
                title, size=26, color=WHITE, bold=True, font="Calibri")
    accent = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(0.55), Inches(1.15), Inches(1.3), Pt(4))
    accent.fill.solid()
    accent.fill.fore_color.rgb = ACCENT
    accent.line.fill.background()
    accent.shadow.inherit = False
    # footer
    add_textbox(slide, Inches(0.55), Inches(7.12), Inches(6), Inches(0.3),
                "Sarcoidosis \u2014 Registrar Teaching Session", size=9, color=GREY)
    add_textbox(slide, Inches(11.6), Inches(7.12), Inches(1.2), Inches(0.3),
                f"{num} / {total}", size=9, color=GREY, align=PP_ALIGN.RIGHT)


TOTAL = 17

# ---------- SLIDE 1: TITLE ----------
s = add_slide()
add_bg(s, NAVY)
band = s.shapes.add_shape(MSO_SHAPE.RECTANGLE, 0, Inches(4.9), SW, Inches(2.6))
band.fill.solid(); band.fill.fore_color.rgb = RGBColor(0x08, 0x22, 0x38); band.line.fill.background(); band.shadow.inherit = False
line = s.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(0.7), Inches(3.55), Inches(1.6), Pt(5))
line.fill.solid(); line.fill.fore_color.rgb = ACCENT; line.line.fill.background(); line.shadow.inherit = False
add_textbox(s, Inches(0.7), Inches(2.5), Inches(11.5), Inches(1.0), "SARCOIDOSIS", size=54, color=WHITE, bold=True)
add_textbox(s, Inches(0.7), Inches(3.7), Inches(11), Inches(0.6),
            "A Multisystem Granulomatous Disease: Recognition, Work-up & Management", size=20, color=RGBColor(0xCF, 0xE3, 0xE7))
add_textbox(s, Inches(0.7), Inches(5.25), Inches(10), Inches(0.5), "Teaching Session for Medical Registrars", size=18, color=RGBColor(0xB9, 0xD6, 0xDC), bold=True)
add_textbox(s, Inches(0.7), Inches(5.75), Inches(10), Inches(0.5), "Internal Medicine / Respiratory Rotation", size=14, color=GREY)

# ---------- SLIDE 2: OBJECTIVES ----------
s = add_slide(); header(s, "Introduction", "Learning Objectives", 2, TOTAL)
add_bullets(s, Inches(0.7), Inches(1.6), Inches(11.8), Inches(5),
    ["Define sarcoidosis and summarise its epidemiology and proposed pathogenesis",
     "Recognise the pulmonary and key extrapulmonary presentations, including sight- and life-threatening forms",
     "Apply a structured diagnostic approach: compatible clinical picture + non-caseating granulomas + exclusion of alternatives",
     "Interpret radiographic (Scadding) staging and relevant investigations (bloods, HRCT, BAL, biopsy)",
     "Formulate an evidence-based management plan, including when to observe vs. treat, and escalation pathways",
     "Identify red flags requiring urgent specialist referral (cardiac, neuro, ocular sarcoidosis)"],
    size=17, space_after=14)

# ---------- SLIDE 3: DEFINITION & EPIDEMIOLOGY ----------
s = add_slide(); header(s, "Background", "Definition & Epidemiology", 3, TOTAL)
add_textbox(s, Inches(0.7), Inches(1.5), Inches(5.9), Inches(0.4), "What is it?", size=16, color=TEAL, bold=True)
add_bullets(s, Inches(0.7), Inches(1.95), Inches(5.9), Inches(2.2),
    ["Multisystem disease of unknown cause characterised by non-caseating granulomatous inflammation",
     "Most commonly affects the lungs and mediastinal/hilar lymph nodes, but can involve any organ",
     "Diagnosis of exclusion \u2014 no single confirmatory test"], size=14, space_after=10)
add_textbox(s, Inches(6.9), Inches(1.5), Inches(5.7), Inches(0.4), "Epidemiology", size=16, color=TEAL, bold=True)
add_bullets(s, Inches(6.9), Inches(1.95), Inches(5.7), Inches(4.5),
    ["Highest incidence: African Americans (~35.5/100,000) and Northern Europeans (~24/100,000)",
     "Female predominance (up to 2:1 in most cohorts); US Black Women's Health Study: incidence 71/100,000, prevalence ~2%",
     "Peak age 35\u201345 years; a significant proportion present after age 55",
     "Risk factors: certain occupational/environmental exposures, raised BMI; smoking is associated with reduced incidence",
     "Seasonal clustering \u2014 more diagnoses in spring",
     "Black and female patients tend to have more severe / extrapulmonary disease; higher mortality reported in women and African Americans (pulmonary fibrosis is the leading cause of death)"],
    size=13.5, space_after=9)
add_textbox(s, Inches(0.7), Inches(4.4), Inches(5.9), Inches(2.4), "", size=10)
box = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(0.7), Inches(4.4), Inches(5.9), Inches(2.3))
box.fill.solid(); box.fill.fore_color.rgb = LIGHT_TEAL; box.line.color.rgb = TEAL; box.line.width = Pt(0.75); box.shadow.inherit = False
tf = box.text_frame; tf.word_wrap = True; tf.margin_left = Inches(0.2); tf.margin_top = Inches(0.15)
p = tf.paragraphs[0]; p.text = "Population variation in phenotype"; p.runs[0].font.bold = True; p.runs[0].font.size = Pt(14); p.runs[0].font.color.rgb = NAVY
for line_txt in ["Japanese patients: more cardiac & ocular involvement",
                  "Europeans: more erythema nodosum (uncommon in Black/Japanese patients)",
                  "Japan: lower overall mortality, but cardiac sarcoidosis is the leading cause of death there"]:
    pp = tf.add_paragraph(); pp.text = "\u25AA " + line_txt; pp.space_before = Pt(6)
    pp.runs[0].font.size = Pt(12.5); pp.runs[0].font.color.rgb = DARK

# ---------- SLIDE 4: PATHOGENESIS ----------
s = add_slide(); header(s, "Background", "Aetiology & Pathogenesis", 4, TOTAL)
add_bullets(s, Inches(0.7), Inches(1.6), Inches(11.8), Inches(3.2),
    ["Cause remains unknown \u2014 leading model: exaggerated / dysregulated host immune (Th1-driven) response to an unidentified environmental antigen in a genetically susceptible host",
     "Historic evidence for a transmissible antigen: the Kveim-Siltzbach test (splenic homogenate from sarcoidosis patients) induced granulomas when injected into early-disease patients; sarcoid-like reactions reported after solid organ transplant from a donor with sarcoidosis",
     "Candidate antigens studied because they produce similar granulomatous histology: beryllium, mycobacteria, and fungi",
     "Mycobacterial proteins (mKatG, ESAT-6, superoxide dismutase A, antigen 85A, heat-shock proteins) are disproportionately represented in sarcoid granulomas, but no organism has been proven causal",
     "End result: activated macrophages/CD4+ T-cells aggregate and organise into non-caseating granulomas, which may resolve spontaneously or progress to fibrosis"],
    size=15.5, space_after=12)
box = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(0.7), Inches(5.3), Inches(11.8), Inches(1.35))
box.fill.solid(); box.fill.fore_color.rgb = RGBColor(0xFB, 0xF0, 0xE3); box.line.color.rgb = ACCENT; box.line.width = Pt(0.75); box.shadow.inherit = False
tf = box.text_frame; tf.word_wrap = True; tf.margin_left = Inches(0.25); tf.margin_top = Inches(0.12); tf.vertical_anchor = MSO_ANCHOR.MIDDLE
p = tf.paragraphs[0]; p.text = "Registrar pearl: think of sarcoidosis as a diagnosis of pattern + exclusion \u2014 always rule out TB, fungal infection, berylliosis and lymphoma before committing to the label."
p.runs[0].font.size = Pt(14); p.runs[0].font.italic = True; p.runs[0].font.color.rgb = NAVY; p.runs[0].font.bold = True

# ---------- SLIDE 5: CLINICAL - PULMONARY ----------
s = add_slide(); header(s, "Clinical Features", "Pulmonary Manifestations", 5, TOTAL)
add_bullets(s, Inches(0.7), Inches(1.55), Inches(11.8), Inches(3.2),
    ["Present in ~90% of patients; accounts for most morbidity and mortality",
     "Symptoms: dry cough, dyspnoea, chest discomfort \u2014 often insidious; up to a third are asymptomatic and detected incidentally",
     "Bilateral hilar and/or mediastinal lymphadenopathy \u00b1 parenchymal infiltrates on imaging",
     "Chronic disease may progress to pulmonary fibrosis, traction bronchiectasis, and honeycombing (advanced Stage IV)",
     "Pulmonary function tests: may be normal, or show a restrictive pattern with reduced DLCO; obstruction can occur from airway granulomas/distortion",
     "Complications: pulmonary hypertension, mycetoma within fibrotic cavities, respiratory failure"],
    size=15.5, space_after=11)
box = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(0.7), Inches(5.15), Inches(11.8), Inches(1.55))
box.fill.solid(); box.fill.fore_color.rgb = LIGHT_TEAL; box.line.color.rgb = TEAL; box.line.width = Pt(0.75); box.shadow.inherit = False
tf = box.text_frame; tf.word_wrap = True; tf.margin_left = Inches(0.25); tf.margin_top = Inches(0.12)
p = tf.paragraphs[0]; p.text = "Lofgren syndrome (acute presentation, good prognosis)"; p.runs[0].font.bold = True; p.runs[0].font.size = Pt(14.5); p.runs[0].font.color.rgb = NAVY
pp = tf.add_paragraph(); pp.text = "Bilateral hilar lymphadenopathy + erythema nodosum + polyarthralgia (ankles) \u00b1 fever \u2014 often self-limiting, resolves within 2 years in >80%"
pp.runs[0].font.size = Pt(13.5); pp.runs[0].font.color.rgb = DARK; pp.space_before = Pt(6)

# ---------- SLIDE 6: CLINICAL - EXTRAPULMONARY ----------
s = add_slide(); header(s, "Clinical Features", "Extrapulmonary Manifestations", 6, TOTAL)
cols = [
    ("Skin (~25%)", ["Erythema nodosum", "Lupus pernio (chronic, disfiguring, associated with pulmonary fibrosis)", "Scar infiltration, plaques, subcutaneous nodules"]),
    ("Eye (~20-30%)", ["Anterior/posterior uveitis", "Keratoconjunctivitis sicca", "Can cause blindness if untreated \u2014 needs prompt ophthalmology review"]),
    ("Cardiac (~5% clinical, higher on imaging)", ["Conduction block, ventricular arrhythmia", "Cardiomyopathy, sudden cardiac death", "Higher prevalence & mortality impact in Japanese cohorts"]),
    ("Neurological (~5-10%)", ["Cranial neuropathy (esp. facial nerve palsy)", "Basal meningitis, hypothalamic-pituitary involvement", "Peripheral neuropathy, myelopathy"]),
    ("Musculoskeletal / Renal / Other", ["Arthralgia, dactylitis, myopathy", "Hypercalcaemia / hypercalciuria \u2192 nephrocalcinosis, nephrolithiasis", "Hepatosplenomegaly; peripheral lymphadenopathy; parotid/lacrimal gland enlargement"]),
]
x_positions = [Inches(0.55), Inches(4.75), Inches(8.95)]
y_positions = [Inches(1.45), Inches(4.1)]
positions = [(x_positions[0], y_positions[0]), (x_positions[1], y_positions[0]), (x_positions[2], y_positions[0]),
             (x_positions[0], y_positions[1]), (x_positions[1], y_positions[1])]
box_w, box_h = Inches(4.0), Inches(2.5)
for (title, items), (x, y) in zip(cols, positions):
    card = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, x, y, box_w, box_h)
    card.fill.solid(); card.fill.fore_color.rgb = WHITE
    card.line.color.rgb = RGBColor(0xD8, 0xDE, 0xE2); card.line.width = Pt(1); card.shadow.inherit = False
    hd = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, x, y, box_w, Inches(0.5))
    hd.fill.solid(); hd.fill.fore_color.rgb = NAVY; hd.line.fill.background(); hd.shadow.inherit = False
    tf = hd.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    p = tf.paragraphs[0]; p.text = title; p.alignment = PP_ALIGN.CENTER
    p.runs[0].font.size = Pt(13); p.runs[0].font.bold = True; p.runs[0].font.color.rgb = WHITE
    tb = s.shapes.add_textbox(x + Inches(0.15), y + Inches(0.58), box_w - Inches(0.3), box_h - Inches(0.68))
    tf2 = tb.text_frame; tf2.word_wrap = True
    first = True
    for it in items:
        p2 = tf2.paragraphs[0] if first else tf2.add_paragraph(); first = False
        p2.text = "\u25AA " + it
        p2.space_after = Pt(5); p2.line_spacing = 1.05
        p2.runs[0].font.size = Pt(11); p2.runs[0].font.color.rgb = DARK

# ---------- SLIDE 7: IMAGE - CUTANEOUS SARCOIDOSIS ----------
s = add_slide(); header(s, "Clinical Features", "Cutaneous Sarcoidosis \u2014 Visual Recognition", 7, TOTAL)
img1 = os.path.join(ASSETS, "skin_lesions1.jpg")
img2 = os.path.join(ASSETS, "skin_lesions2.jpg")
if os.path.exists(img1):
    s.shapes.add_picture(img1, Inches(0.6), Inches(1.55), height=Inches(3.7))
if os.path.exists(img2):
    s.shapes.add_picture(img2, Inches(6.6), Inches(1.55), height=Inches(3.7))
add_textbox(s, Inches(0.6), Inches(5.35), Inches(5.6), Inches(0.9),
            "Left: Erythema nodosum (pretibial, acute, non-specific) and lupus pernio (violaceous nasal plaque, chronic).",
            size=12.5, color=GREY, italic=True)
add_textbox(s, Inches(6.6), Inches(5.35), Inches(5.9), Inches(0.9),
            "Right: Lupus pernio with facial/periorbital plaques and sarcoid dactylitis (\u2018sausage digits\u2019) of the hands.",
            size=12.5, color=GREY, italic=True)
box = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(0.6), Inches(6.35), Inches(11.9), Inches(0.65))
box.fill.solid(); box.fill.fore_color.rgb = RGBColor(0xFB, 0xF0, 0xE3); box.line.color.rgb = ACCENT; box.line.width = Pt(0.75); box.shadow.inherit = False
tf = box.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE; tf.margin_left = Inches(0.2)
p = tf.paragraphs[0]; p.text = "Lupus pernio is strongly associated with chronic fibrotic pulmonary disease \u2014 a visual cue to look harder at the chest."
p.runs[0].font.size = Pt(13); p.runs[0].font.bold = True; p.runs[0].font.color.rgb = NAVY

# ---------- SLIDE 8: DIAGNOSTIC APPROACH ----------
s = add_slide(); header(s, "Diagnosis", "Diagnostic Approach", 8, TOTAL)
box = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(0.7), Inches(1.5), Inches(11.8), Inches(1.1))
box.fill.solid(); box.fill.fore_color.rgb = NAVY; box.line.fill.background(); box.shadow.inherit = False
tf = box.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE; tf.margin_left = Inches(0.3); tf.margin_right = Inches(0.3)
p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER
p.text = "Diagnosis requires ALL three: (1) a compatible clinical & radiological picture, (2) histological demonstration of non-caseating granulomas, and (3) exclusion of alternative causes of granulomatous disease"
p.runs[0].font.size = Pt(16); p.runs[0].font.bold = True; p.runs[0].font.color.rgb = WHITE
add_bullets(s, Inches(0.7), Inches(2.9), Inches(11.8), Inches(3.8),
    ["No single test is diagnostic \u2014 sarcoidosis is a pattern-recognition + exclusion diagnosis",
     "Tissue is usually required except in classic Lofgren syndrome, where a confident clinical diagnosis is often accepted without biopsy",
     "Key differentials to exclude before labelling as sarcoidosis:", ], size=16, space_after=10)
add_bullets(s, Inches(1.1), Inches(4.15), Inches(11.2), Inches(1.0),
    [("Tuberculosis and other mycobacterial infection", 1),
     ("Fungal infection (histoplasmosis, coccidioidomycosis)", 1),
     ("Chronic beryllium disease (identical histology \u2014 needs occupational history \u00b1 beryllium lymphocyte proliferation test)", 1),
     ("Lymphoma, other malignancy; hypersensitivity pneumonitis; granulomatosis with polyangiitis", 1)],
    size=13.5, space_after=6)
add_textbox(s, Inches(0.7), Inches(5.7), Inches(11.8), Inches(1.0),
            "Biopsy site chosen by accessibility/yield: skin lesion, peripheral/mediastinal lymph node, conjunctiva, or minor salivary gland; endobronchial ultrasound-guided TBNA of mediastinal nodes is now a preferred first-line tissue route.",
            size=13.5, color=GREY, italic=True)

# ---------- SLIDE 9: INVESTIGATIONS ----------
s = add_slide(); header(s, "Diagnosis", "Investigations & Work-up", 9, TOTAL)
left_items = ["FBC (anaemia/lymphopenia), U&E, LFTs, corrected calcium (hypercalcaemia)",
              "Serum ACE \u2014 supportive but neither sensitive nor specific; not for screening alone",
              "24h urinary calcium (hypercalciuria)",
              "ECG in every patient \u2014 screen for conduction disease; further cardiac MRI/PET if abnormal or symptomatic",
              "Ophthalmology review (slit-lamp) even if asymptomatic",
              "Pulmonary function tests (spirometry + DLCO)"]
right_items = ["HRCT chest: bilateral hilar/mediastinal lymphadenopathy, perilymphatic nodules, upper-lobe predominant fibrosis in advanced disease",
               "Bronchoscopy with BAL and biopsy (endobronchial + transbronchial) \u00b1 EBUS-TBNA of mediastinal nodes",
               "BAL lymphocytosis with CD4:CD8 ratio > 3.5 supports the diagnosis (not fully specific)",
               "Tissue biopsy: non-caseating (\u2018naked\u2019) granulomas with epithelioid histiocytes and multinucleated giant cells; stains (AFB, fungal) and cultures to exclude infection",
               "Tuberculin skin test / IGRA to help exclude TB before immunosuppression"]
add_textbox(s, Inches(0.65), Inches(1.45), Inches(5.9), Inches(0.4), "Bloods & Screening", size=15.5, color=TEAL, bold=True)
add_bullets(s, Inches(0.65), Inches(1.9), Inches(5.9), Inches(4.8), left_items, size=13.5, space_after=9)
add_textbox(s, Inches(6.85), Inches(1.45), Inches(5.9), Inches(0.4), "Imaging, Endoscopy & Histology", size=15.5, color=TEAL, bold=True)
add_bullets(s, Inches(6.85), Inches(1.9), Inches(5.9), Inches(4.8), right_items, size=13.5, space_after=9)

# ---------- SLIDE 10: HISTOLOGY IMAGE ----------
s = add_slide(); header(s, "Diagnosis", "Histopathology \u2014 Non-caseating Granuloma", 10, TOTAL)
imgh = os.path.join(ASSETS, "granuloma.jpg")
if os.path.exists(imgh):
    s.shapes.add_picture(imgh, Inches(0.8), Inches(1.5), height=Inches(4.6))
add_textbox(s, Inches(7.1), Inches(1.6), Inches(5.4), Inches(0.4), "Key features", size=16, color=TEAL, bold=True)
add_bullets(s, Inches(7.1), Inches(2.1), Inches(5.4), Inches(3.2),
    ["Well-circumscribed, compact ('naked') granulomas of epithelioid histiocytes \u00b1 multinucleated giant cells",
     "Tight lymphocytic cuff, minimal surrounding inflammation",
     "No central caseating necrosis (unlike TB) \u2014 subtle fibrinoid necrosis can occasionally occur",
     "Occasional inclusions: Schaumann bodies, asteroid bodies (not specific)",
     "Always correlate with AFB/fungal stains and cultures to exclude infectious granulomas before confirming sarcoidosis"],
    size=14, space_after=10)
add_textbox(s, Inches(0.8), Inches(6.25), Inches(6.5), Inches(0.6),
            "H&E, low power: discrete non-caseating granuloma with epithelioid macrophages and a lymphocytic rim.",
            size=11.5, color=GREY, italic=True)

# ---------- SLIDE 11: RADIOGRAPHIC STAGING ----------
s = add_slide(); header(s, "Diagnosis", "Radiographic (Scadding) Staging \u2014 Chest X-ray", 11, TOTAL)
stages = [
    ("Stage 0", "Normal chest radiograph", "~10-15%"),
    ("Stage I", "Bilateral hilar \u00b1 paratracheal lymphadenopathy alone", "~30-50%"),
    ("Stage II", "Lymphadenopathy + parenchymal infiltrates", "~40-60%"),
    ("Stage III", "Parenchymal infiltrates without lymphadenopathy", "~10-15%"),
    ("Stage IV", "Pulmonary fibrosis (honeycombing, traction bronchiectasis, hilar retraction)", "~5-10%"),
]
y = Inches(1.55)
colors = [RGBColor(0x1B, 0x5E, 0x77), RGBColor(0x15, 0x74, 0x7A), RGBColor(0x0E, 0x7C, 0x86), RGBColor(0xB0, 0x7A, 0x2E), RGBColor(0x9C, 0x3B, 0x2E)]
for (stage, desc, freq), col in zip(stages, colors):
    row = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(0.7), y, Inches(11.8), Inches(0.85))
    row.fill.solid(); row.fill.fore_color.rgb = WHITE; row.line.color.rgb = RGBColor(0xD8,0xDE,0xE2); row.line.width = Pt(1); row.shadow.inherit = False
    tag = s.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(0.7), y, Inches(1.7), Inches(0.85))
    tag.fill.solid(); tag.fill.fore_color.rgb = col; tag.line.fill.background(); tag.shadow.inherit = False
    tf = tag.text_frame; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER; p.text = stage
    p.runs[0].font.size = Pt(15); p.runs[0].font.bold = True; p.runs[0].font.color.rgb = WHITE
    tb = s.shapes.add_textbox(Inches(2.55), y, Inches(7.7), Inches(0.85))
    tf2 = tb.text_frame; tf2.vertical_anchor = MSO_ANCHOR.MIDDLE; tf2.word_wrap = True
    p2 = tf2.paragraphs[0]; p2.text = desc; p2.runs[0].font.size = Pt(14.5); p2.runs[0].font.color.rgb = DARK
    tb2 = s.shapes.add_textbox(Inches(10.4), y, Inches(2.0), Inches(0.85))
    tf3 = tb2.text_frame; tf3.vertical_anchor = MSO_ANCHOR.MIDDLE
    p3 = tf3.paragraphs[0]; p3.alignment = PP_ALIGN.CENTER; p3.text = freq
    p3.runs[0].font.size = Pt(13); p3.runs[0].font.italic = True; p3.runs[0].font.color.rgb = GREY
    y += Inches(0.98)
add_textbox(s, Inches(0.7), Inches(6.55), Inches(11.8), Inches(0.5),
            "Higher stage broadly correlates with lower spontaneous remission and worse prognosis, but does not replace clinical/physiological assessment.",
            size=12.5, color=GREY, italic=True)

# ---------- SLIDE 12: DIFFERENTIAL DIAGNOSIS ----------
s = add_slide(); header(s, "Diagnosis", "Key Differential Diagnoses", 12, TOTAL)
diffs = [
    ("Infectious", "TB & atypical mycobacteria, histoplasmosis, coccidioidomycosis, cat-scratch disease"),
    ("Occupational", "Chronic beryllium disease (histologically identical \u2014 needs exposure history & BeLPT)"),
    ("Malignancy", "Lymphoma, metastatic carcinoma with granulomatous reaction"),
    ("Autoimmune / Vasculitic", "Granulomatosis with polyangiitis, hypersensitivity pneumonitis, Crohn's disease"),
    ("Drug-induced", "Interferon-alpha, immune checkpoint inhibitors, anti-TNF therapy (paradoxical sarcoid-like reactions)"),
]
y = Inches(1.55)
for name, desc in diffs:
    row = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(0.7), y, Inches(11.8), Inches(0.92))
    row.fill.solid(); row.fill.fore_color.rgb = LIGHT_TEAL if diffs.index((name,desc)) % 2 == 0 else WHITE
    row.line.color.rgb = RGBColor(0xD8,0xDE,0xE2); row.line.width = Pt(0.75); row.shadow.inherit = False
    tb = s.shapes.add_textbox(Inches(0.95), y, Inches(2.6), Inches(0.92))
    tf = tb.text_frame; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    p = tf.paragraphs[0]; p.text = name; p.runs[0].font.bold = True; p.runs[0].font.size = Pt(15); p.runs[0].font.color.rgb = NAVY
    tb2 = s.shapes.add_textbox(Inches(3.65), y, Inches(8.65), Inches(0.92))
    tf2 = tb2.text_frame; tf2.word_wrap = True; tf2.vertical_anchor = MSO_ANCHOR.MIDDLE
    p2 = tf2.paragraphs[0]; p2.text = desc; p2.runs[0].font.size = Pt(14); p2.runs[0].font.color.rgb = DARK
    y += Inches(1.02)

# ---------- SLIDE 13: WHEN TO TREAT ----------
s = add_slide(); header(s, "Management", "When to Treat vs. Observe", 13, TOTAL)
add_textbox(s, Inches(0.7), Inches(1.45), Inches(11.8), Inches(0.6),
            "Not every patient with sarcoidosis needs treatment \u2014 many cases (especially Stage I / Lofgren syndrome) remit spontaneously.",
            size=15.5, color=NAVY, bold=True)
add_textbox(s, Inches(0.7), Inches(2.15), Inches(5.7), Inches(0.4), "Observe / no treatment", size=15.5, color=TEAL, bold=True)
add_bullets(s, Inches(0.7), Inches(2.6), Inches(5.7), Inches(3.6),
    ["Asymptomatic Stage 0-I disease with normal/stable lung function",
     "Lofgren syndrome \u2014 usually self-limiting; NSAIDs for symptomatic arthralgia",
     "Isolated asymptomatic skin or lymph node disease",
     "Plan: clinical, radiographic and PFT surveillance (e.g. every 3-6 months initially)"],
    size=14, space_after=10)
add_textbox(s, Inches(6.9), Inches(2.15), Inches(5.7), Inches(0.4), "Treat", size=15.5, color=ACCENT, bold=True)
add_bullets(s, Inches(6.9), Inches(2.6), Inches(5.7), Inches(4.0),
    ["Progressive or symptomatic pulmonary disease with declining PFTs",
     "Cardiac involvement (arrhythmia, conduction disease, cardiomyopathy)",
     "Neurosarcoidosis (CNS/PNS involvement)",
     "Ocular disease not controlled with topical therapy",
     "Hypercalcaemia / hypercalciuria with renal impairment",
     "Disfiguring or functionally limiting cutaneous disease (e.g. lupus pernio)",
     "Significant constitutional symptoms / disabling fatigue"],
    size=14, space_after=8, color=DARK)

# ---------- SLIDE 14: PHARMACOTHERAPY ----------
s = add_slide(); header(s, "Management", "Pharmacological Management", 14, TOTAL)
tiers = [
    ("1st line", "Oral corticosteroids", "Prednisone/prednisolone (typically ~20-40 mg/day, tapered over months) remain first-line for organ-threatening or progressive disease. Topical/inhaled steroids for isolated skin or airway disease.", NAVY),
    ("2nd line", "Steroid-sparing agents", "Methotrexate is the most widely used; azathioprine, mycophenolate, leflunomide, and hydroxychloroquine (especially cutaneous disease) are alternatives, used for steroid-refractory disease, relapse, or to limit cumulative steroid toxicity.", TEAL),
    ("3rd line", "Biologic therapy", "Anti-TNF agents (infliximab has the best evidence; adalimumab also used) for refractory, severe, or multi-organ disease unresponsive to steroids and steroid-sparing agents. Etanercept has NOT shown efficacy.", ACCENT),
]
y = Inches(1.5)
for tag, name, desc, col in tiers:
    card = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(0.7), y, Inches(11.8), Inches(1.55))
    card.fill.solid(); card.fill.fore_color.rgb = WHITE; card.line.color.rgb = RGBColor(0xD8,0xDE,0xE2); card.line.width = Pt(1); card.shadow.inherit = False
    tagbox = s.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(0.7), y, Inches(1.5), Inches(1.55))
    tagbox.fill.solid(); tagbox.fill.fore_color.rgb = col; tagbox.line.fill.background(); tagbox.shadow.inherit = False
    tf = tagbox.text_frame; tf.vertical_anchor = MSO_ANCHOR.MIDDLE; tf.word_wrap = True
    p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER; p.text = tag
    p.runs[0].font.size = Pt(14); p.runs[0].font.bold = True; p.runs[0].font.color.rgb = WHITE
    tb = s.shapes.add_textbox(Inches(2.35), y + Inches(0.08), Inches(10.0), Inches(1.4))
    tf2 = tb.text_frame; tf2.word_wrap = True
    p2 = tf2.paragraphs[0]; p2.text = name; p2.runs[0].font.size = Pt(15.5); p2.runs[0].font.bold = True; p2.runs[0].font.color.rgb = NAVY
    p3 = tf2.add_paragraph(); p3.text = desc; p3.space_before = Pt(3); p3.runs[0].font.size = Pt(12.5); p3.runs[0].font.color.rgb = DARK
    y += Inches(1.7)
add_textbox(s, Inches(0.7), Inches(6.65), Inches(11.8), Inches(0.5),
            "Recent systematic review/meta-analysis (Thorax, 2025, PMID 40393718) supports biologic/targeted synthetic therapy efficacy in refractory sarcoidosis \u2014 check current evidence before escalation.",
            size=11.5, color=GREY, italic=True)

# ---------- SLIDE 15: COMPLICATIONS & PROGNOSIS ----------
s = add_slide(); header(s, "Outcomes", "Complications & Prognosis", 15, TOTAL)
add_textbox(s, Inches(0.7), Inches(1.5), Inches(5.9), Inches(0.4), "Prognosis", size=16, color=TEAL, bold=True)
add_bullets(s, Inches(0.7), Inches(1.95), Inches(5.9), Inches(3.6),
    ["~60-70% of patients (especially Stage 0-I) undergo spontaneous remission within 2-5 years",
     "Chronic/progressive disease more likely with Stage III-IV, Black race, and multi-organ involvement",
     "Overall mortality is low (~1-5%) but higher in advanced pulmonary fibrosis, and in Black patients and women",
     "Cardiac and neurosarcoidosis carry disproportionate morbidity/mortality risk"], size=14.5, space_after=11)
add_textbox(s, Inches(6.9), Inches(1.5), Inches(5.7), Inches(0.4), "Key complications", size=16, color=TEAL, bold=True)
add_bullets(s, Inches(6.9), Inches(1.95), Inches(5.7), Inches(4.0),
    ["Pulmonary fibrosis, pulmonary hypertension, mycetoma", "Fatal arrhythmia / sudden cardiac death",
     "Blindness from untreated uveitis", "Nephrocalcinosis / renal impairment from hypercalcaemia",
     "Hypothalamic-pituitary dysfunction (rare)", "Chronic corticosteroid toxicity from prolonged treatment"],
    size=14.5, space_after=10)

# ---------- SLIDE 16: TAKE-HOME / RED FLAGS ----------
s = add_slide(); header(s, "Summary", "Key Take-Home Points for Registrars", 16, TOTAL)
add_bullets(s, Inches(0.7), Inches(1.5), Inches(11.8), Inches(2.6),
    ["Sarcoidosis is a clinicopathologic diagnosis of exclusion \u2014 always exclude infection, malignancy and beryllium exposure",
     "Screen every patient for cardiac (ECG), ocular (slit-lamp) and hypercalcaemic complications regardless of pulmonary status",
     "Treatment is reserved for organ-threatening, progressive or significantly symptomatic disease \u2014 many patients need only surveillance",
     "Corticosteroids remain first-line; escalate to methotrexate or anti-TNF biologics (infliximab) for refractory disease"],
    size=16.5, space_after=12)
box = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(0.7), Inches(4.5), Inches(11.8), Inches(2.1))
box.fill.solid(); box.fill.fore_color.rgb = RGBColor(0x8B, 0x1E, 0x1E); box.line.fill.background(); box.shadow.inherit = False
tf = box.text_frame; tf.word_wrap = True; tf.margin_left = Inches(0.3); tf.margin_top = Inches(0.15); tf.margin_right = Inches(0.3)
p = tf.paragraphs[0]; p.text = "\u26A0 Red flags \u2014 urgent specialist referral"; p.runs[0].font.bold = True; p.runs[0].font.size = Pt(17); p.runs[0].font.color.rgb = WHITE
for t in ["New arrhythmia, syncope, or heart block \u2192 urgent cardiology (risk of sudden death)",
          "Visual loss, floaters, painful red eye \u2192 same-day ophthalmology",
          "Focal neurology, cranial nerve palsy, or altered consciousness \u2192 neurology / neuroimaging",
          "Severe hypercalcaemia or acute kidney injury \u2192 urgent medical admission"]:
    pp = tf.add_paragraph(); pp.text = "\u25AA " + t; pp.space_before = Pt(6)
    pp.runs[0].font.size = Pt(14); pp.runs[0].font.color.rgb = WHITE

# ---------- SLIDE 17: REFERENCES ----------
s = add_slide(); header(s, "Appendix", "References", 17, TOTAL)
refs = [
    "Harrison's Principles of Internal Medicine, 22nd Edition (2025) \u2014 Sarcoidosis chapter",
    "Fitzpatrick's Dermatology, 9th Edition \u2014 Sarcoidosis / cutaneous manifestations",
    "Murray & Nadel's Textbook of Respiratory Medicine, 7th Edition \u2014 Sarcoidosis diagnosis & treatment",
    "Firestein & Kelley's Textbook of Rheumatology \u2014 Musculoskeletal sarcoidosis, diagnostic tests",
    "Andrews' Diseases of the Skin, 13th Edition \u2014 Systemic & cutaneous sarcoidosis, staging & treatment",
    "Fishman's Pulmonary Diseases and Disorders \u2014 Chest imaging & staging, BAL findings",
    "Grainger & Allison's Diagnostic Radiology \u2014 Scadding staging system",
    "Bechman K, Biddle K, Miracle A, et al. Systematic review and meta-analysis of the efficacy of biologic and targeted synthetic therapies in sarcoidosis. Thorax. 2025. PMID: 40393718",
    "Bouadi N, Rijal H, Sood S, et al. Use of Biologics for Cutaneous Sarcoidosis: A Systematic Review. J Cutan Med Surg. 2024. PMID: 38404164",
]
add_bullets(s, Inches(0.7), Inches(1.5), Inches(11.8), Inches(5.3), refs, size=13.5, space_after=12)

prs.save("/tmp/workspace/sarcoidosis-ppt/Sarcoidosis_Registrar_Teaching.pptx")
print("Saved.")
print("Slides:", len(prs.slides.__iter__.__self__._sldIdLst))

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