cd /home/daytona/workspace/attachments/7790bf41-717f-4366-8c37-9b7cb7a0c3fb && p…

cd /home/daytona/workspace/attachments/7790bf41-717f-4366-8c37-9b7cb7a0c3fb && p…

cd /home/daytona/workspace/attachments/7790bf41-717f-4366-8c37-9b7cb7a0c3fb && p…

python3 -c " import olefile, sys f = '/home/daytona/workspace/attachments/7790bf…

python3 -c " # Try LibreOffice conversion to extract text from old .ppt files im…

mkdir -p /home/daytona/workspace/ppt_convert && cp "/home/daytona/workspace/atta…

mkdir -p /home/daytona/workspace/uterine-ppt && ls /home/daytona/workspace/uteri…

~/uterine-ppt/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Uterine Stimulants & Relaxants";
pres.author = "Pharmacology Department";

// ─── THEME ────────────────────────────────────────────────────────────────
const C = {
  darkBg:    "0D1B2A",   // deep navy
  accentRed: "C0392B",   // crimson (stimulants)
  accentGreen:"1A6B3C",  // forest green (relaxants)
  accentGold:"E8A020",   // gold
  white:     "FFFFFF",
  lightGray: "ECF0F1",
  midGray:   "7F8C8D",
  textDark:  "1A252F",
  teal:      "0E6655",
  blue:      "154360",
  boxBlue:   "1B4F72",
  boxTeal:   "0E6655",
  boxPurple: "512E5F",
  slideRed:  "7B241C",
  sectionBg: "1A1A2E",
};

// ─── HELPERS ──────────────────────────────────────────────────────────────
function addBg(slide, color) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color } });
}
function addAccentBar(slide, color, height = 0.08) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: height, fill: { color } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.545, w: "100%", h: height, fill: { color } });
}
function addSectionHeader(slide, title, subtitle, bgColor, accentColor) {
  addBg(slide, bgColor);
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 2.0, w: "100%", h: 1.6, fill: { color: accentColor } });
  slide.addText(title, { x: 0.5, y: 2.1, w: 9, h: 0.8, fontSize: 38, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
  if (subtitle) slide.addText(subtitle, { x: 0.5, y: 2.95, w: 9, h: 0.5, fontSize: 18, color: C.white, align: "center", fontFace: "Calibri", italic: true });
}

function titleSlide(slide, title, subtitle) {
  addBg(slide, C.darkBg);
  // gradient overlay strip
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 1.8, w: "100%", h: 2.2, fill: { color: C.accentRed, transparency: 20 } });
  slide.addText(title, {
    x: 0.4, y: 1.85, w: 9.2, h: 1.5, fontSize: 40, bold: true, color: C.white,
    align: "center", fontFace: "Calibri", valign: "middle"
  });
  slide.addText(subtitle, {
    x: 0.4, y: 3.3, w: 9.2, h: 0.7, fontSize: 20, color: C.accentGold,
    align: "center", fontFace: "Calibri", italic: true
  });
  slide.addText("Ref: KD Tripathi | Satoskar & Bhandarkar | DC Dutta's Textbook of Obstetrics", {
    x: 0.4, y: 4.8, w: 9.2, h: 0.4, fontSize: 13, color: C.midGray, align: "center", fontFace: "Calibri"
  });
}

function contentSlide(slide, title, bullets, accentColor = C.accentRed, iconChar = "●") {
  addBg(slide, C.darkBg);
  addAccentBar(slide, accentColor);
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.08, w: "100%", h: 0.82, fill: { color: C.blue } });
  slide.addText(title, {
    x: 0.3, y: 0.12, w: 9.4, h: 0.75, fontSize: 24, bold: true, color: C.white,
    fontFace: "Calibri", valign: "middle"
  });
  const items = bullets.map((b, i) => {
    if (typeof b === "string") {
      return [
        { text: b, options: { fontSize: 16, color: C.white, bullet: { type: "char", code: "2022" }, breakLine: true, fontFace: "Calibri" } }
      ];
    }
    return [
      { text: b.h + " ", options: { fontSize: 17, color: C.accentGold, bold: true, breakLine: false, fontFace: "Calibri" } },
      { text: b.t, options: { fontSize: 15, color: C.lightGray, breakLine: true, fontFace: "Calibri" } }
    ];
  });
  slide.addText(items.flat(), { x: 0.4, y: 1.1, w: 9.2, h: 4.2, fontFace: "Calibri", valign: "top" });
}

function twoColSlide(slide, title, leftTitle, leftItems, rightTitle, rightItems, leftColor = C.boxBlue, rightColor = C.boxTeal) {
  addBg(slide, C.darkBg);
  addAccentBar(slide, C.accentRed);
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.08, w: "100%", h: 0.82, fill: { color: C.blue } });
  slide.addText(title, { x: 0.3, y: 0.12, w: 9.4, h: 0.75, fontSize: 23, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
  // left box
  slide.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.05, w: 4.3, h: 4.35, fill: { color: leftColor }, line: { color: C.accentGold, width: 1.5 } });
  slide.addText(leftTitle, { x: 0.3, y: 1.05, w: 4.3, h: 0.45, fontSize: 16, bold: true, color: C.accentGold, align: "center", fontFace: "Calibri", valign: "middle" });
  const lItems = leftItems.map(t => ({ text: t, options: { fontSize: 14, color: C.white, bullet: { type: "char", code: "2022" }, breakLine: true, fontFace: "Calibri" } }));
  slide.addText(lItems, { x: 0.4, y: 1.55, w: 4.1, h: 3.7, fontFace: "Calibri", valign: "top" });
  // right box
  slide.addShape(pres.ShapeType.rect, { x: 5.0, y: 1.05, w: 4.3, h: 4.35, fill: { color: rightColor }, line: { color: C.accentGold, width: 1.5 } });
  slide.addText(rightTitle, { x: 5.0, y: 1.05, w: 4.3, h: 0.45, fontSize: 16, bold: true, color: C.accentGold, align: "center", fontFace: "Calibri", valign: "middle" });
  const rItems = rightItems.map(t => ({ text: t, options: { fontSize: 14, color: C.white, bullet: { type: "char", code: "2022" }, breakLine: true, fontFace: "Calibri" } }));
  slide.addText(rItems, { x: 5.1, y: 1.55, w: 4.1, h: 3.7, fontFace: "Calibri", valign: "top" });
}

function tableSlide(slide, title, headers, rows, accentColor = C.accentRed) {
  addBg(slide, C.darkBg);
  addAccentBar(slide, accentColor);
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.08, w: "100%", h: 0.82, fill: { color: C.blue } });
  slide.addText(title, { x: 0.3, y: 0.12, w: 9.4, h: 0.75, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
  const tableData = [
    headers.map(h => ({ text: h, options: { bold: true, color: C.white, fill: { color: C.accentRed }, fontSize: 13, align: "center" } })),
    ...rows.map((row, ri) => row.map(cell => ({
      text: cell,
      options: { color: C.textDark, fill: { color: ri % 2 === 0 ? "D6E4F0" : C.white }, fontSize: 12, align: "center" }
    })))
  ];
  const colW = 9.4 / headers.length;
  slide.addTable(tableData, { x: 0.3, y: 1.05, w: 9.4, colW: Array(headers.length).fill(colW), border: { pt: 0.5, color: C.midGray }, fontFace: "Calibri" });
}

function diagramSlide(slide, title, boxes, accentColor = C.accentRed) {
  addBg(slide, C.darkBg);
  addAccentBar(slide, accentColor);
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.08, w: "100%", h: 0.82, fill: { color: C.blue } });
  slide.addText(title, { x: 0.3, y: 0.12, w: 9.4, h: 0.75, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
  boxes.forEach(b => {
    slide.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: b.fill || C.boxBlue }, line: { color: b.border || C.accentGold, width: 1.5 }, rounding: 0.1 });
    slide.addText(b.text, { x: b.x, y: b.y, w: b.w, h: b.h, fontSize: b.fs || 14, bold: b.bold || false, color: b.color || C.white, align: "center", valign: "middle", fontFace: "Calibri", wrap: true });
    if (b.arrow) {
      slide.addShape(pres.ShapeType.line, { x: b.arrow.x1, y: b.arrow.y1, w: b.arrow.x2 - b.arrow.x1, h: b.arrow.y2 - b.arrow.y1, line: { color: C.accentGold, width: 2 } });
    }
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════
let s = pres.addSlide();
titleSlide(s, "UTERINE STIMULANTS & RELAXANTS", "Comprehensive Pharmacology of the Myometrium");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 — Contents / Overview
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
addBg(s, C.darkBg);
addAccentBar(s, C.accentRed);
s.addShape(pres.ShapeType.rect, { x: 0, y: 0.08, w: "100%", h: 0.82, fill: { color: C.blue } });
s.addText("Contents", { x: 0.3, y: 0.12, w: 9.4, h: 0.75, fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
const contentsLeft = ["UTERINE STIMULANTS (Oxytocics)", "• Oxytocin", "• Ergot Alkaloids (Ergometrine, Methylergometrine)", "• Prostaglandins (PGE₂, PGF₂α, Misoprostol, Carboprost)", "• Quinine", "• Sparteine", "• Clinical Uses: IOL, PPH, Abortion"];
const contentsRight = ["UTERINE RELAXANTS (Tocolytics)", "• β₂ Agonists (Ritodrine, Terbutaline)", "• Calcium Channel Blockers (Nifedipine)", "• Oxytocin Antagonists (Atosiban)", "• NSAIDs (Indomethacin)", "• Magnesium Sulfate", "• Clinical Uses: Preterm Labor, Dysmenorrhea"];
s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.05, w: 4.3, h: 4.35, fill: { color: C.slideRed }, line: { color: C.accentGold, width: 1.5 } });
s.addText("PART 1\nUterine STIMULANTS\n(30 Slides)", { x: 0.3, y: 1.05, w: 4.3, h: 0.7, fontSize: 15, bold: true, color: C.accentGold, align: "center", fontFace: "Calibri", valign: "middle" });
const li = contentsLeft.map(t => ({ text: t, options: { fontSize: 13, color: t.startsWith("•") ? C.lightGray : C.accentGold, bold: !t.startsWith("•"), breakLine: true, fontFace: "Calibri" } }));
s.addText(li, { x: 0.4, y: 1.8, w: 4.1, h: 3.4, fontFace: "Calibri", valign: "top" });
s.addShape(pres.ShapeType.rect, { x: 5.0, y: 1.05, w: 4.3, h: 4.35, fill: { color: C.accentGreen }, line: { color: C.accentGold, width: 1.5 } });
s.addText("PART 2\nUterine RELAXANTS\n(10 Slides)", { x: 5.0, y: 1.05, w: 4.3, h: 0.7, fontSize: 15, bold: true, color: C.accentGold, align: "center", fontFace: "Calibri", valign: "middle" });
const ri2 = contentsRight.map(t => ({ text: t, options: { fontSize: 13, color: t.startsWith("•") ? C.lightGray : C.accentGold, bold: !t.startsWith("•"), breakLine: true, fontFace: "Calibri" } }));
s.addText(ri2, { x: 5.1, y: 1.8, w: 4.1, h: 3.4, fontFace: "Calibri", valign: "top" });

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — Classification of Uterine Stimulants
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
addBg(s, C.darkBg);
addAccentBar(s, C.accentRed);
s.addShape(pres.ShapeType.rect, { x: 0, y: 0.08, w: "100%", h: 0.82, fill: { color: C.blue } });
s.addText("Classification of Uterine Stimulants (Oxytocics)", { x: 0.3, y: 0.12, w: 9.4, h: 0.75, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
const classData = [
  ["Class", "Drugs", "Mechanism"],
  ["Posterior Pituitary Hormone", "Oxytocin", "OT receptor → IP₃/DAG → ↑Ca²⁺"],
  ["Ergot Alkaloids", "Ergometrine, Methylergometrine", "α-adrenergic + serotonin receptors"],
  ["Prostaglandins", "PGE₂ (Dinoprostone), PGF₂α (Carboprost), PGE₁ (Misoprostol)", "EP/FP receptors → ↑Ca²⁺ + PKC"],
  ["Oxytocin Analogue", "Carbetocin", "Long-acting OT receptor agonist"],
  ["Alkaloids", "Quinine, Sparteine", "Direct myometrial stimulation"],
  ["Others", "Oestrogens (high dose)", "Sensitize uterus to oxytocin"],
];
const cw = [2.2, 3.8, 3.2];
s.addTable(classData.map((row, ri) => row.map((cell, ci) => ({
  text: cell, options: { bold: ri===0||ci===0, color: ri===0 ? C.white : C.textDark, fill: { color: ri===0 ? C.accentRed : ri%2===0 ? "D6EAF8" : C.white }, fontSize: ri===0 ? 13 : 12, align: "center" }
}))), { x: 0.3, y: 1.05, w: 9.4, colW: cw, border: { pt: 0.5, color: C.midGray }, fontFace: "Calibri" });

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — Uterine Physiology: Myometrial Contraction
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
diagramSlide(s, "Myometrial Contraction — Cellular Mechanism", [
  { x: 0.3, y: 1.1, w: 2.5, h: 0.65, text: "Receptor Activation\n(OT, PG, α-adrenoceptor)", fill: C.boxBlue, fs: 12, bold: true },
  { x: 0.3, y: 2.1, w: 2.5, h: 0.65, text: "Gq protein activation\n→ PLC stimulation", fill: C.boxBlue, fs: 12 },
  { x: 0.3, y: 3.1, w: 2.5, h: 0.65, text: "IP₃ + DAG formed", fill: C.boxTeal, fs: 12 },
  { x: 0.3, y: 4.1, w: 2.5, h: 0.65, text: "↑ Intracellular Ca²⁺\n(SR release + influx)", fill: "8E44AD", fs: 12 },
  { x: 3.5, y: 1.1, w: 2.6, h: 0.65, text: "Ca²⁺ binds Calmodulin", fill: "8E44AD", fs: 12 },
  { x: 3.5, y: 2.1, w: 2.6, h: 0.65, text: "Activates MLCK\n(Myosin Light Chain Kinase)", fill: "8E44AD", fs: 12 },
  { x: 3.5, y: 3.1, w: 2.6, h: 0.65, text: "Myosin phosphorylation", fill: C.boxTeal, fs: 12 },
  { x: 3.5, y: 4.1, w: 2.6, h: 0.65, text: "Actin–Myosin Cross-bridge\n→ CONTRACTION", fill: C.accentRed, fs: 13, bold: true },
  { x: 6.8, y: 1.1, w: 2.8, h: 3.65, text: "KEY MODULATORS\n\n↑ Estrogen: sensitizes\n↑ Oxytocin receptors at term\nProgesterone: inhibits\nPGE₂/PGF₂α: stimulate\nβ₂ agonists: relax\nCa²⁺ channel blockers: relax\nMgSO₄: competes with Ca²⁺", fill: C.boxPurple, fs: 12, color: C.white },
]);
// Arrows
s.addShape(pres.ShapeType.line, { x: 1.55, y: 1.75, w: 0, h: 0.35, line: { color: C.accentGold, width: 2 } });
s.addShape(pres.ShapeType.line, { x: 1.55, y: 2.75, w: 0, h: 0.35, line: { color: C.accentGold, width: 2 } });
s.addShape(pres.ShapeType.line, { x: 1.55, y: 3.75, w: 0, h: 0.35, line: { color: C.accentGold, width: 2 } });
s.addShape(pres.ShapeType.line, { x: 4.8, y: 1.75, w: 0, h: 0.35, line: { color: C.accentGold, width: 2 } });
s.addShape(pres.ShapeType.line, { x: 4.8, y: 2.75, w: 0, h: 0.35, line: { color: C.accentGold, width: 2 } });
s.addShape(pres.ShapeType.line, { x: 4.8, y: 3.75, w: 0, h: 0.35, line: { color: C.accentGold, width: 2 } });

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — Section Header: OXYTOCIN
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
addSectionHeader(s, "OXYTOCIN", "The Primary Uterine Stimulant", C.darkBg, C.accentRed);
s.addText("Posterior pituitary nonapeptide | First uterotonic of choice in obstetrics", {
  x: 0.5, y: 3.6, w: 9, h: 0.5, fontSize: 16, color: C.lightGray, align: "center", fontFace: "Calibri"
});
s.addText("KD Tripathi, 8e • Satoskar & Bhandarkar • DC Dutta's Obstetrics", {
  x: 0.5, y: 4.5, w: 9, h: 0.4, fontSize: 13, color: C.midGray, align: "center", fontFace: "Calibri", italic: true
});

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — Oxytocin: Source & Structure
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Oxytocin — Source, Structure & Pharmacokinetics", [
  { h: "Source:", t: "Synthesized in hypothalamic paraventricular & supraoptic nuclei; stored & released from posterior pituitary" },
  { h: "Structure:", t: "Nonapeptide (9 amino acids) — Cys-Tyr-Ile-Gln-Asn-Cys-Pro-Leu-Gly-NH₂; disulfide bond (Cys¹—Cys⁶)" },
  { h: "Preparation:", t: "Synthetic oxytocin (identical to natural); 1 USP unit = 2 μg; available as 5 IU/mL & 10 IU/mL injections" },
  { h: "Route:", t: "IV infusion (most common), IM, intranasal; NOT oral (destroyed by GI peptidases)" },
  { h: "Onset:", t: "IV: immediate (1–2 min); IM: 3–5 min" },
  { h: "Half-life:", t: "3–20 minutes (oxytocinase in plasma/placenta degrades it rapidly)" },
  { h: "Receptor:", t: "Gq-coupled oxytocin receptor (OTR) — density ↑ 100–200× during pregnancy under estrogen influence" },
], C.accentRed);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — Oxytocin: Mechanism of Action
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
diagramSlide(s, "Oxytocin — Mechanism of Action", [
  { x: 0.3, y: 1.05, w: 2.8, h: 0.75, text: "OXYTOCIN", fill: C.accentRed, fs: 16, bold: true, color: C.white },
  { x: 0.3, y: 2.1, w: 2.8, h: 0.75, text: "Binds OTR (Gq PCR)\non myometrial cell", fill: C.boxBlue, fs: 13 },
  { x: 0.3, y: 3.2, w: 2.8, h: 0.75, text: "↑ PLC activity\n→ IP₃ + DAG", fill: C.boxBlue, fs: 13 },
  { x: 0.3, y: 4.3, w: 2.8, h: 0.75, text: "↑ Ca²⁺ from SR\n+ VOC opening", fill: "8E44AD", fs: 13 },
  { x: 4.0, y: 1.05, w: 2.8, h: 0.75, text: "Also activates PLA₂\n→ ↑ PGE/PGF synthesis", fill: C.boxTeal, fs: 12 },
  { x: 4.0, y: 2.1, w: 2.8, h: 0.75, text: "DAG → PKC activation\n→ ↑ sensitivity", fill: C.boxTeal, fs: 12 },
  { x: 4.0, y: 3.2, w: 2.8, h: 0.75, text: "↑ Gap junctions\n(connexin-43)", fill: "B9770E", fs: 13 },
  { x: 4.0, y: 4.3, w: 2.8, h: 0.75, text: "↑ OTR expression\n(positive feedback)", fill: "8E44AD", fs: 12 },
  { x: 7.4, y: 1.05, w: 2.3, h: 4.0, text: "NET EFFECT\n\nRhythmic uterine contractions\n\nFrequency ↑\nAmplitude ↑\nResting tone ↑\n(dose-dependent)\n\nSensitivity ↑\nat term > mid-pregnancy > non-pregnant", fill: C.accentRed, fs: 12, bold: false },
]);
s.addShape(pres.ShapeType.line, { x: 1.7, y: 1.8, w: 0, h: 0.3, line: { color: C.accentGold, width: 2 } });
s.addShape(pres.ShapeType.line, { x: 1.7, y: 2.85, w: 0, h: 0.35, line: { color: C.accentGold, width: 2 } });
s.addShape(pres.ShapeType.line, { x: 1.7, y: 3.95, w: 0, h: 0.35, line: { color: C.accentGold, width: 2 } });

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — Oxytocin: Pharmacological Actions
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Oxytocin — Pharmacological Actions",
  "Uterine Effects",
  ["Stimulates rhythmic uterine contractions", "Sensitivity greatest at term (high OTR)", "Low doses → frequency ↑ (physiological)", "High doses → sustained tetanic contraction", "Fundus > body > cervix (gradient effect)", "Also softens & effaces cervix"],
  "Extra-uterine Effects",
  ["Milk ejection (myoepithelial cells)", "Mild antidiuretic effect (ADH-like)", "↓ BP at high doses (vascular smooth muscle relaxation)", "Positive chronotropic effect (reflex)", "Uterine blood flow ↑", "Nasal route → milk letdown, breast engorgement"],
  C.slideRed, C.boxTeal
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — Oxytocin: Therapeutic Uses
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Oxytocin — Therapeutic Uses (DC Dutta / KDT)", [
  { h: "1. Induction of Labour:", t: "Cervical ripening, PROM, post-dates pregnancy, IUGR, PIH — IV infusion 1–2 mU/min, titrated up" },
  { h: "2. Augmentation of Labour:", t: "Hypotonic uterine dysfunction, prolonged labour — after assessing CPD" },
  { h: "3. Prevention of PPH:", t: "10 IU IM (WHO-recommended) OR 5 IU slow IV after delivery of anterior shoulder" },
  { h: "4. Treatment of PPH:", t: "20–40 IU in 1 L saline IV infusion; oxytocin + ergometrine (Syntometrine)" },
  { h: "5. Missed/Incomplete Abortion:", t: "After 16 weeks — IV oxytocin to expel retained products" },
  { h: "6. Post C-section:", t: "IV/IM to contract uterus and reduce haemorrhage" },
  { h: "7. Oxytocin Challenge Test (OCT):", t: "Assess uteroplacental reserve (fetal distress test)" },
], C.accentRed);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — Oxytocin: Dosage Regimens (Table)
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Oxytocin — Dosage & Administration (KDT / DC Dutta)",
  ["Indication", "Route", "Dose", "Notes"],
  [
    ["IOL / Augmentation", "IV infusion", "0.5–2 mU/min → ↑ by 1–2 mU/min q 20 min\n(max 20–40 mU/min)", "Use infusion pump; CTG monitoring"],
    ["PPH Prevention", "IM", "10 IU after delivery", "WHO 1st choice"],
    ["PPH Prevention", "Slow IV", "5 IU (bolus avoided)", "Avoid rapid IV bolus"],
    ["PPH Treatment", "IV infusion", "20–40 IU in 1 L NS\nat 250 mL/hr", "Can combine with ergometrine"],
    ["Incomplete Abortion", "IV infusion", "10–20 IU/L", "After ≥ 16 weeks"],
    ["Post-op (C-section)", "IM/IV", "5–10 IU", "Surgeon administers at delivery"],
  ],
  C.accentRed
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — Oxytocin ADRs & Contraindications
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Oxytocin — Adverse Effects & Contraindications",
  "Adverse Effects",
  ["Uterine hyperstimulation → fetal distress", "Uterine rupture (especially scarred uterus)", "Fetal bradycardia, hypoxia, asphyxia", "Water intoxication (ADH-like, high prolonged dose)", "Hyponatremia → seizures/coma (rare)", "Hypotension, tachycardia (IV bolus)", "Nausea, vomiting"],
  "Contraindications",
  ["Cephalopelvic disproportion (CPD)", "Abnormal foetal presentation", "Previous uterine scar (relative CI)", "Grand multipara (relative CI)", "Foetal distress / cord prolapse", "Placenta praevia", "Hypertonic uterine contractions"],
  C.slideRed, "6E2F0B"
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 12 — Carbetocin (Long-acting OT Analogue)
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Carbetocin — Long-acting Oxytocin Analogue", [
  { h: "Chemical nature:", t: "Synthetic analogue of oxytocin — deamino-1-monocarba analogue (1-butanoic acid substitution)" },
  { h: "Mechanism:", t: "OTR agonist; longer t½ due to resistance to oxytocinase and aminopeptidase" },
  { h: "t½:", t: "~40 minutes (vs 3–20 min for oxytocin)" },
  { h: "Dose:", t: "100 μg IM single dose (WHO heat-stable formulation) or 100 μg IV slow injection" },
  { h: "Indication:", t: "Prevention of PPH — preferred in Caesarean section; WHO Thermoreg trial supports it in resource-limited settings" },
  { h: "Advantage:", t: "Single dose; no refrigeration needed (heat-stable at 30°C for ≥3 years); no repeat infusion" },
  { h: "Adverse effects:", t: "Nausea, flushing, headache, hypotension (less than oxytocin bolus)" },
], C.accentRed);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 13 — Section Header: ERGOT ALKALOIDS
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
addSectionHeader(s, "ERGOT ALKALOIDS", "Ergometrine & Methylergometrine", C.darkBg, "8B0000");
s.addText("Derived from Claviceps purpurea (a fungus on rye) — powerful uterotonics", {
  x: 0.5, y: 3.6, w: 9, h: 0.5, fontSize: 16, color: C.lightGray, align: "center", fontFace: "Calibri"
});
s.addText("Ref: KD Tripathi Ch.17 | Satoskar & Bhandarkar | DC Dutta Obstetrics", {
  x: 0.5, y: 4.5, w: 9, h: 0.4, fontSize: 13, color: C.midGray, align: "center", fontFace: "Calibri", italic: true
});

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 14 — Ergot Alkaloids: Classification & Chemistry
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Ergot Alkaloids — Classification (KDT Table 17.2)",
  ["Drug", "Chemical Type", "Route", "Onset", "Duration", "Main Use"],
  [
    ["Ergotamine", "Natural amino acid alkaloid", "Oral/SC/IM", "Slow", "Long", "Migraine (not uterine)"],
    ["Ergometrine\n(Ergonovine)", "Natural amine alkaloid", "IV/IM/Oral", "IV: 1 min\nIM: 2–3 min", "45–60 min\n(IV); 3 hr (IM)", "PPH, PPH Prophylaxis"],
    ["Methylergometrine\n(Methergine)", "Semi-synthetic amine", "IV/IM/Oral", "IV: 1 min\nIM: 2–3 min", "~3 hours", "PPH (most used)"],
    ["Bromocriptine", "Semi-synthetic", "Oral", "1–2 hr", "8–12 hr", "Hyperprolactinaemia"],
    ["Dihydroergotamine", "Dihydrogenated", "IM/IV", "30 min", "3–4 hr", "Migraine, orthostatic hypotension"],
  ],
  "8B0000"
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 15 — Ergometrine: Mechanism & Actions
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Ergometrine / Methylergometrine — Mechanism & Effects",
  "Mechanism of Action",
  ["Partial agonist at α-adrenoceptors → vasoconstriction", "Serotonin (5-HT) receptor agonism", "Weak dopamine receptor affinity", "Directly stimulates uterine smooth muscle", "No oxytocin receptor involvement", "Produces sustained tonic contraction (unlike oxytocin's rhythmic effect)"],
  "Pharmacological Effects",
  ["Powerful uterine stimulation — tonic sustained tetanic contraction", "Fundus contracts more than cervix — important for PPH", "Vasoconstriction of peripheral vessels (↑ BP)", "Nausea, vomiting (CTZ stimulation)", "Coronary artery vasospasm (high doses)", "Ergotism with chronic use"],
  "8B0000", C.boxBlue
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 16 — Ergometrine: Clinical Uses & Dosage
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Ergometrine / Methylergometrine — Clinical Uses & Doses",
  ["Indication", "Drug", "Route", "Dose"],
  [
    ["PPH Treatment (1st/2nd line)", "Methylergometrine", "IM", "0.2 mg — repeated q2–4h prn"],
    ["PPH Prophylaxis", "Ergometrine", "IM/IV", "0.2–0.5 mg after placenta delivery"],
    ["PPH (combined)", "Syntometrine\n(Ergometrine 0.5 mg + Oxytocin 5 IU)", "IM", "Single IM injection at crowning of head"],
    ["Subinvolution of uterus", "Methylergometrine", "Oral", "0.2 mg TDS × 3–5 days"],
    ["Uterine atony (ongoing)", "Methylergometrine", "IV slow", "0.1–0.2 mg (diluted) over 60 sec"],
    ["Lochia control", "Ergometrine", "Oral", "0.5–1 mg BD–TDS"],
  ],
  "8B0000"
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 17 — Ergometrine ADRs & Contraindications
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Ergometrine — Adverse Effects & Contraindications",
  "Adverse Effects",
  ["Hypertension (↑ BP) — risk of stroke/seizures", "Coronary artery spasm → angina/MI", "Nausea, vomiting (CTZ stimulation)", "Headache, dizziness", "Raynaud's phenomenon", "Ergotism (chronic): gangrene, ischaemia", "Anaphylaxis (rare)"],
  "Contraindications",
  ["Hypertension / pre-eclampsia / eclampsia", "Cardiac disease (IHD, valvular disease)", "Obliterative vascular disease", "Renal / hepatic impairment", "Sepsis / pyrexia", "Active labour (cervix not fully dilated)", "NOT for IOL or augmentation (tetanic contraction)"],
  "8B0000", C.boxPurple
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 18 — Section Header: PROSTAGLANDINS
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
addSectionHeader(s, "PROSTAGLANDINS", "PGE₂ • PGF₂α • Misoprostol • Carboprost", C.darkBg, C.teal);
s.addText("Locally acting lipid mediators — powerful uterotonics used in IOL, PPH & termination of pregnancy", {
  x: 0.5, y: 3.6, w: 9, h: 0.5, fontSize: 15, color: C.lightGray, align: "center", fontFace: "Calibri"
});

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 19 — Prostaglandins: Classification Table
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Prostaglandins Used in Obstetrics — Classification (KDT)",
  ["Drug", "Type", "Route", "Indication", "Dose"],
  [
    ["Dinoprostone\n(Prostaglandin E₂)", "PGE₂", "Vaginal gel, pessary, extra-amniotic", "Cervical ripening, IOL", "0.5 mg intra-cervical\n1–2 mg vaginal gel"],
    ["Carboprost\n(15-methyl PGF₂α)", "PGF₂α analogue", "IM deep", "Refractory PPH\n(3rd line)", "250 μg q15–90 min\n(max 8 doses)"],
    ["Misoprostol\n(PGE₁ analogue)", "PGE₁", "Oral/Sublingual/Vaginal/Rectal", "IOL, PPH prophylaxis, abortion", "25–50 μg (IOL)\n400–800 μg (PPH)"],
    ["Gemeprost", "PGE₁ analogue", "Vaginal pessary", "Medical termination", "1 mg q3h × 5 doses"],
    ["Sulprostone", "PGE₂ analogue", "IV", "Severe PPH", "500 μg/500 mL IV"],
  ],
  C.teal
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 20 — Misoprostol: Detailed Pharmacology
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Misoprostol — Detailed Pharmacology (KDT / Satoskar)", [
  { h: "Class:", t: "Synthetic PGE₁ analogue; also cytoprotective (gastric mucosa)" },
  { h: "Mechanism:", t: "Binds EP2/EP3/EP4 receptors on myometrium → ↑ IP₃ → ↑Ca²⁺ → contraction; softens cervix (cervical ripening)" },
  { h: "Routes & Bioavailability:", t: "Oral (bioavail 80%); SL (faster onset, 15–30 min); Vaginal (slower but prolonged); Rectal (PPH)" },
  { h: "Advantages:", t: "Cheap, thermostable (no cold chain needed), oral route possible, WHO Essential Medicines List" },
  { h: "Obstetric doses:", t: "IOL: 25 μg vaginally q4–6h OR 50 μg SL; PPH prevention: 600 μg oral; PPH treatment: 800 μg SL/rectal; MTP: 800 μg (with mifepristone)" },
  { h: "Adverse effects:", t: "Shivering (most common), fever, diarrhoea, nausea; uterine hyperstimulation (excessive dose)" },
  { h: "CI:", t: "Prior uterine scar (relative), allergy to PGs; caution in asthma" },
], C.teal);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 21 — Carboprost (15-methyl PGF₂α)
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Carboprost (15-Methyl PGF₂α) — Refractory PPH", [
  { h: "Chemical:", t: "15-methyl analogue of PGF₂α — more potent (10–30×) and longer acting than PGF₂α due to resistance to 15-PGDH" },
  { h: "Mechanism:", t: "FP receptor agonist → ↑IP₃/Ca²⁺ → strong myometrial contraction; also ↑bronchial smooth muscle tone" },
  { h: "Pharmacokinetics:", t: "IM route; onset 15–20 min; duration 1.5–2 hrs; metabolized hepatically" },
  { h: "Indications:", t: "Refractory PPH unresponsive to oxytocin + ergometrine (3rd-line uterotonic); MTP (2nd trimester)" },
  { h: "Dose (PPH):", t: "250 μg IM deep, q15–90 min intervals; max cumulative dose 2 mg (8 doses)" },
  { h: "Adverse effects:", t: "Bronchospasm (major — avoid in asthma!), diarrhoea (most common), vomiting, flushing, fever, transient ↑BP" },
  { h: "Contraindications:", t: "Asthma (absolute), hepatic/renal/cardiac disease, active PID" },
], C.teal);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 22 — Dinoprostone (PGE₂)
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Dinoprostone (PGE₂) — Cervical Ripening & IOL", [
  { h: "Source:", t: "Naturally occurring PGE₂; produced locally in decidua, amnion, chorion at term" },
  { h: "Mechanism:", t: "EP receptor activation → myometrial contraction + collagen remodelling in cervix (cervical ripening via matrix metalloproteinases)" },
  { h: "Preparations:", t: "(1) Prepidil gel 0.5 mg intra-cervical; (2) Cervidil 10 mg vaginal insert (slow-release, retrievable); (3) Prostin E₂ vaginal gel 1–2 mg" },
  { h: "Bishop score:", t: "Used to assess cervical favourability before IOL — PGE₂ used when Bishop score < 6" },
  { h: "Advantages:", t: "Cervical ripening + IOL in one agent; slow-release form allows removal if hyperstimulation occurs" },
  { h: "Adverse effects:", t: "Uterine hyperstimulation (most important), fetal distress, GI effects, fever" },
  { h: "Contraindications:", t: "Active labour, > 6 previous term pregnancies, previous C-section/uterine surgery (relative), asthma, glaucoma" },
], C.teal);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 23 — Comparison Table: Oxytocin vs Ergometrine vs Prostaglandins
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Comparison: Oxytocin vs Ergometrine vs Prostaglandins (KDT Table)",
  ["Feature", "Oxytocin", "Ergometrine", "PGs (Misoprostol)"],
  [
    ["Contraction type", "Rhythmic (physiological)", "Sustained tonic (tetanic)", "Rhythmic/sustained (dose-dep.)"],
    ["Onset (IV/IM)", "Immediate / 3–5 min", "1 min / 2–3 min", "15–30 min (oral/SL)"],
    ["Duration", "Short (20–60 min infusion)", "3–6 hours", "2–6 hours"],
    ["BP effect", "↓ (vasodilation)", "↑ (vasoconstriction)", "Variable"],
    ["Use in IOL", "Yes — 1st choice", "NO (tetanic contraction)", "Yes (PGE₂, misoprostol)"],
    ["Use in PPH", "Yes — 1st line", "Yes — 2nd line", "Yes — adjunct/resource-limited"],
    ["Cold chain needed?", "Yes", "Yes", "No (misoprostol)"],
    ["Breastfeeding", "Stimulates milk ejection", "↓ Prolactin (ergometrine)", "Compatible"],
    ["CI in HTN", "No", "YES — contraindicated", "Caution (PGF₂α ↑ BP)"],
  ],
  C.accentRed
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 24 — Management of PPH: Stepwise Uterotonic Use
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
diagramSlide(s, "Stepwise Management of PPH — Uterotonic Protocol (DC Dutta / WHO)", [
  { x: 0.3, y: 1.1, w: 9.1, h: 0.65, text: "STEP 1 — FIRST LINE: Oxytocin 10 IU IM (prevention) OR 20–40 IU IV infusion (treatment)", fill: C.accentRed, fs: 14, bold: true },
  { x: 0.3, y: 1.95, w: 9.1, h: 0.65, text: "STEP 2 — ADD: Ergometrine 0.2 mg IM (if BP normal) OR Syntometrine IM (Erg 0.5 mg + Oxytocin 5 IU)", fill: "8B0000", fs: 13 },
  { x: 0.3, y: 2.8, w: 9.1, h: 0.65, text: "STEP 3 — ADD: Carboprost (15-methyl PGF₂α) 250 μg IM q15 min (max 8 doses) [Avoid in asthma]", fill: C.teal, fs: 13 },
  { x: 0.3, y: 3.65, w: 9.1, h: 0.65, text: "STEP 4 — ADD: Misoprostol 800 μg SL/rectal if injectable uterotonics unavailable", fill: "27AE60", fs: 13 },
  { x: 0.3, y: 4.5, w: 9.1, h: 0.65, text: "STEP 5 — SURGICAL: Uterine compression sutures | Vessel ligation | Uterine artery embolisation | Hysterectomy", fill: C.boxPurple, fs: 12 },
]);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 25 — Induction of Labour: Drug Protocol
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Induction of Labour — Drug Selection Protocol (DC Dutta)",
  ["Bishop Score", "Cervical Status", "Drug of Choice", "Regimen"],
  [
    ["< 4 (Unfavorable)", "Unripe cervix", "Dinoprostone PGE₂\nOR Misoprostol", "PGE₂ 0.5 mg intra-cervical\n(Prepidil); repeat q6h × 3"],
    ["4–6 (Partial ripening)", "Partially favorable", "Misoprostol or Dinoprostone vaginal", "Misoprostol 25 μg vaginally q4–6h\n(max 6 doses)"],
    ["≥ 7 (Favorable)", "Ripe/favorable cervix", "Oxytocin IV infusion\n(1st choice)", "Start 1–2 mU/min; ↑ by 1–2 mU/min q30 min; max 32–40 mU/min"],
    ["Any", "PROM (≥34 weeks)", "Oxytocin IV\n(proceed without ripening)", "Standard oxytocin protocol if cx already favorable"],
    ["Any", "Post-dates ≥42 wks", "Misoprostol SL or PGE₂ gel\nthen oxytocin", "Combined 2-step protocol"],
  ],
  C.accentRed
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 26 — Medical Termination of Pregnancy (MTP) Drugs
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Medical Termination of Pregnancy — Drug Regimens",
  ["Gestational Age", "Regimen", "Drug & Dose", "Efficacy"],
  [
    ["Up to 63 days\n(≤9 weeks)", "Combination (WHO preferred)", "Mifepristone 200 mg oral + Misoprostol 800 μg SL/vaginal 24–48h later", ">95%"],
    ["Up to 63 days", "Misoprostol alone\n(if mifepristone unavailable)", "Misoprostol 800 μg vaginal × 3 doses q3h", "80–85%"],
    ["13–24 weeks", "Medical method", "Mifepristone 200 mg D1 + Misoprostol 400 μg SL q3h from D2 (max 5 doses)", "90–95%"],
    ["2nd trimester\n(alternative)", "Carboprost", "Carboprost 250 μg IM q90 min", "Reliable"],
    ["Any trimester\n(old method)", "Intra-amniotic", "Hypertonic saline / urea (largely abandoned)", "Historical"],
  ],
  C.teal
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 27 — Mifepristone (Anti-progestogen)
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Mifepristone — Anti-progestogen Priming Agent", [
  { h: "Class:", t: "Competitive progesterone receptor antagonist (also anti-glucocorticoid at high doses)" },
  { h: "Mechanism:", t: "Blocks PR → decidual breakdown → cervical softening & uterine sensitization to prostaglandins; ↑ oxytocin receptors" },
  { h: "Used with:", t: "Always combined with misoprostol (or gemeprost) for MTP — synergistic effect; mifepristone alone only 50–80% effective" },
  { h: "Dose:", t: "200 mg oral (single dose) — same efficacy as 600 mg; given 24–48 hrs before misoprostol" },
  { h: "Indications:", t: "MTP up to 9 weeks (with misoprostol); cervical ripening before surgical termination; Cushing's syndrome (anti-GC dose 300–1200 mg/day)" },
  { h: "Adverse effects:", t: "Nausea, abdominal cramps, incomplete abortion (need surgical completion ~5%), heavy bleeding" },
  { h: "CI:", t: "Ectopic pregnancy (must exclude), adrenal insufficiency, chronic corticosteroid use, IUD in situ (remove first)" },
], C.accentRed);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 28 — Quinine & Sparteine
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Quinine & Sparteine as Uterine Stimulants",
  "Quinine",
  ["Cinchona alkaloid — primarily antimalarial", "Direct stimulant effect on uterine muscle", "Rarely used as oxytocic today (dangerous)", "Doses needed for uterotonic effect overlap toxic doses", "Can cause abortion but also fetal eighth nerve damage (irreversible deafness)", "Historical: used illegally for criminal abortion", "Teratogenic — not for use in pregnancy except malaria treatment (benefit >> risk)"],
  "Sparteine",
  ["Lupine alkaloid (from Sarothamnus scoparius)", "Weak oxytocic action — stimulates uterine contractions", "Used in late 1900s for IOL (sulfate salt)", "Replaced by safer agents — no longer recommended", "Side effects: arrhythmias, conduction defects", "Historical significance: first 'synthetic-like' oxytocic tried for IOL", "Mainly of academic/historical interest now"],
  "7D6608", "7B5C08"
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 29 — Active Management of 3rd Stage of Labour (AMTSL)
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
diagramSlide(s, "Active Management of Third Stage of Labour (AMTSL) — DC Dutta", [
  { x: 0.3, y: 1.1, w: 9.1, h: 0.75, text: "AMTSL = 3-STEP PROTOCOL (WHO/FIGO/DC Dutta)", fill: C.accentRed, fs: 16, bold: true },
  { x: 0.3, y: 2.05, w: 2.8, h: 1.8, text: "STEP 1\nUterotonic\n\nOxytocin 10 IU IM\nwithin 1 minute of\nbirth\n(or Carbetocin 100 μg IM)", fill: C.boxBlue, fs: 12 },
  { x: 3.5, y: 2.05, w: 2.8, h: 1.8, text: "STEP 2\nControlled Cord\nTraction (CCT)\n\nBrandt–Andrews method\nwhile uterus contracted\n(DO NOT pull until uterus firm)", fill: C.boxTeal, fs: 12 },
  { x: 6.6, y: 2.05, w: 2.8, h: 1.8, text: "STEP 3\nUterine Massage\n\nFundal massage\nafter placenta\ndelivered\n(confirm uterus contracted)", fill: "8E44AD", fs: 12 },
  { x: 0.3, y: 4.1, w: 9.1, h: 1.1, text: "KEY POINTS: AMTSL reduces PPH by 60–70% | Oxytocin preferred over ergometrine (fewer side effects) | Carbetocin preferred in C-section | Misoprostol when injectables unavailable (resource-limited settings)", fill: C.textDark, fs: 12, color: C.white, bold: false },
]);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 30 — Oxytocin Challenge Test & Role of Oxytocin in Breast
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Other Uses of Oxytocin: OCT & Lactation",
  "Oxytocin Challenge Test (OCT)",
  ["Purpose: Assess uteroplacental reserve / fetal well-being", "Method: IV oxytocin infusion at 0.5 mU/min, doubled q15 min until 3 contractions/10 min", "Negative OCT = reassuring (no late decelerations)", "Positive OCT = Late decelerations with ≥50% contractions (fetal compromise)", "Hyperstimulation test/NST + OCT = comprehensive assessment", "Now largely replaced by BPP (biophysical profile) + Doppler"],
  "Oxytocin in Lactation",
  ["Milk letdown / milk ejection reflex", "Baby suckling → neurohypophysis → oxytocin release", "Oxytocin → myoepithelial cells contract → milk ejection", "Also ↓ uterine involution time postpartum", "Intranasal oxytocin used for breast engorgement / difficult letdown", "Positive feedback loop: Suckling → oxytocin → more milk"],
  C.boxBlue, C.boxTeal
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 31 — Summary: Uterine Stimulants
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Summary — Uterine Stimulants at a Glance",
  ["Drug", "1st Line Use", "Key Advantage", "Key CI/Caution"],
  [
    ["Oxytocin", "IOL, Augmentation, PPH prevention", "Physiological, short-acting, titratable", "Uterine scar, CPD, fetal distress"],
    ["Carbetocin", "PPH prevention (C-section)", "Single dose, no cold chain", "Avoid in severe cardiovascular disease"],
    ["Ergometrine", "PPH treatment (IM/IV)", "Fast, long-lasting tonic contraction", "Hypertension, cardiac disease, PVC"],
    ["Methylergometrine", "PPH, subinvolution", "Reliable tonic effect, oral possible", "Same as ergometrine"],
    ["Dinoprostone (PGE₂)", "Cervical ripening, IOL", "Slow-release form, retrievable", "Previous scar (relative), asthma"],
    ["Misoprostol", "IOL, MTP, PPH (resource-limited)", "Oral/SL, cheap, thermostable", "Avoid excessive dosing — uterine rupture risk"],
    ["Carboprost", "Refractory PPH (3rd line)", "Very potent uterotonic", "Asthma (absolute CI)"],
    ["Mifepristone", "MTP priming + cervical ripening", "Sensitizes uterus to PGs", "Ectopic pregnancy (must exclude first)"],
  ],
  C.accentRed
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 32 — SECTION BREAK: UTERINE RELAXANTS
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
addSectionHeader(s, "PART II: UTERINE RELAXANTS", "Tocolytics — Management of Preterm Labour", C.darkBg, C.accentGreen);
s.addText("Preterm birth (<37 weeks) accounts for ~75% of neonatal mortality — tocolysis buys time", {
  x: 0.5, y: 3.6, w: 9, h: 0.5, fontSize: 15, color: C.lightGray, align: "center", fontFace: "Calibri"
});
s.addText("Ref: KD Tripathi • Satoskar & Bhandarkar • Creasy & Resnik MFM", {
  x: 0.5, y: 4.5, w: 9, h: 0.4, fontSize: 13, color: C.midGray, align: "center", fontFace: "Calibri", italic: true
});

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 33 — Classification of Tocolytics
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s = pres.addSlide();
tableSlide(s, "Classification of Uterine Relaxants (Tocolytics) — KDT",
  ["Class", "Drug(s)", "Mechanism"],
  [
    ["β₂ Adrenoceptor Agonists", "Ritodrine, Terbutaline, Salbutamol, Isoxsuprine", "β₂ → ↑cAMP → PKA → MLCK ↓ activity → relaxation"],
    ["Oxytocin Receptor Antagonists", "Atosiban", "Competitive OTR block → ↓ IP₃ → ↓ Ca²⁺ → relaxation"],
    ["Calcium Channel Blockers", "Nifedipine (preferred)", "Block VOC L-type Ca²⁺ channels → ↓ Ca²⁺ → relaxation"],
    ["COX Inhibitors (NSAIDs)", "Indomethacin, Sulindac", "↓ PG synthesis → ↓ uterine stimulation"],
    ["Magnesium Sulfate", "MgSO₄", "Competes with Ca²⁺ at MLCK; stabilizes membrane"],
    ["Nitric Oxide Donors", "GTN (glyceryl trinitrate)", "↑ cGMP → smooth muscle relaxation"],
    ["Progesterone", "Natural P4, Hydroxyprogesterone", "Reduces OTR & gap junctions; anti-inflammatory"],
    ["CNS Depressants (old)", "Ethanol (IV)", "↓ Oxytocin release; historical — abandoned"],
  ],
  C.accentGreen
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 34 — β₂ Agonists as Tocolytics
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s = pres.addSlide();
twoColSlide(s, "β₂ Agonists — Tocolytics (Ritodrine, Terbutaline)",
  "Mechanism & Pharmacology",
  ["β₂ receptor → Gs protein → ↑adenylyl cyclase → ↑cAMP", "PKA activation → phosphorylates MLCK → inactivation", "↓ Myosin phosphorylation → smooth muscle relaxation", "Also: Ca²⁺ re-uptake into SR; K⁺ channel opening → hyperpolarization", "Ritodrine — only FDA-approved tocolytic (now withdrawn)", "Terbutaline: subcutaneous 0.25 mg q20 min × 3 doses"],
  "Adverse Effects",
  ["Tachycardia (maternal & fetal)", "Hypokalemia (→ arrhythmias)", "Hyperglycemia (avoid in GDM)", "Pulmonary oedema (most serious — fluid overload)", "Tremor, headache, nervousness", "CI: Cardiac arrhythmia, thyrotoxicosis, DM, haemorrhage, IUGR"],
  C.accentGreen, "0A4F2E"
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 35 — Nifedipine & Atosiban
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Nifedipine & Atosiban — Preferred Modern Tocolytics",
  "Nifedipine (CCB)",
  ["Dihydropyridine L-type Ca²⁺ channel blocker", "↓ Ca²⁺ influx → ↓ MLCK activation → uterine relaxation", "Dose: 20–30 mg oral loading → 10–20 mg q4–6h (slow release)", "Preferred first-line tocolytic in many guidelines (simple oral, cheap)", "Adverse: headache, flushing, hypotension, tachycardia", "CI: Hypotension, combination with MgSO₄ (risk of cardiac block)", "Evidence: ↓ delivery <37wks, ↓ neonatal morbidity vs ritodrine"],
  "Atosiban (OTR Antagonist)",
  ["Competitive oxytocin + AVP receptor antagonist", "Blocks OTR → ↓IP₃/DAG → ↓Ca²⁺ → relaxation", "Dose: IV bolus 6.75 mg → infusion 18 mg/hr × 3h → 6 mg/hr × 45h", "Highly selective — fewer side effects than β₂ agonists", "Safe in patients with cardiac disease, diabetes, hyperthyroidism", "Adverse: nausea, vomiting, headache, hyperglycaemia (mild)", "1st line in European guidelines; expensive (limits use in LMICs)"],
  C.accentGreen, C.boxTeal
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 36 — Magnesium Sulfate: Tocolytic & Neuroprotection
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Magnesium Sulfate — Tocolytic & Fetal Neuroprotection", [
  { h: "Mechanism:", t: "Mg²⁺ competes with Ca²⁺ at MLCK & voltage-gated Ca²⁺ channels → ↓ Ca²⁺ dependent myometrial contraction; also blocks NMDA receptors" },
  { h: "Tocolytic use:", t: "4–6 g IV loading dose → 1–3 g/hr maintenance; less effective than nifedipine/atosiban as pure tocolytic; use mainly with indomethacin when CCBs contraindicated" },
  { h: "Neuroprotection (key use):", t: "WHO/ACOG: MgSO₄ given <32 weeks for fetal neuroprotection — reduces risk of cerebral palsy by ~30% (Cochrane evidence)" },
  { h: "Pre-eclampsia:", t: "4–6 g loading + 1–2 g/hr; prevents eclamptic seizures (mechanism: vasodilation of cerebral vasospasm + Ca²⁺ antagonism)" },
  { h: "Monitoring:", t: "UO ≥25 mL/hr; respiratory rate ≥12/min; patellar reflex present (lost at 7–10 mEq/L = first sign of toxicity)" },
  { h: "Toxicity:", t: "Therapeutic: 4–7 mEq/L; Patellar reflex lost: 7–10; Resp. paralysis: >10; Cardiac arrest: >15 mEq/L" },
  { h: "Antidote:", t: "Calcium gluconate 1 g (10 mL of 10%) IV slowly over 10 min" },
], C.accentGreen);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 37 — Indomethacin & NSAIDs as Tocolytics
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Indomethacin — COX Inhibitor Tocolytic", [
  { h: "Mechanism:", t: "Non-selective COX-1/COX-2 inhibitor → ↓ Prostaglandin synthesis → reduced uterine stimulation + cervical ripening inhibition" },
  { h: "Dose:", t: "50–100 mg rectal/oral loading → 25–50 mg q4–6h; max 48–72 hr course (to limit fetal effects)" },
  { h: "Efficacy:", t: "Comparable to other tocolytics in RCTs; particularly effective when PGs are driving preterm labour" },
  { h: "Gestational age limit:", t: "Use ONLY <32 weeks gestation (ideally <30 weeks) — fetal concerns after this" },
  { h: "Fetal risks:", t: "Premature closure of ductus arteriosus (most feared — monitor with fetal echo), ↓ fetal urine output → oligohydramnios, NEC (controversial)" },
  { h: "Maternal ADRs:", t: "GI irritation, nausea, platelet dysfunction, hepatitis (rare)" },
  { h: "CI:", t: "≥32 weeks, renal impairment, peptic ulcer, platelet disorders, oligohydramnios, ductal-dependent cardiac lesions" },
], C.accentGreen);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 38 — Progesterone in Preterm Labour Prevention
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Progesterone — Prevention of Preterm Birth", [
  { h: "Mechanism:", t: "↓ OTR expression; ↓ gap junctions (connexin-43); anti-inflammatory (NF-κB inhibition); ↓ cervical ripening (anti-PG effect); maintains uterine quiescence" },
  { h: "Formulations:", t: "(1) 17α-Hydroxyprogesterone caproate (17-OHPC) 250 mg IM weekly; (2) Vaginal progesterone 100–200 mg/night (suppository or gel)" },
  { h: "Indication:", t: "Singleton pregnancy with prior spontaneous preterm birth (<34 wks) → 17-OHPC weekly from 16–20 wks until 36 wks; Short cervix (<25 mm on TVS) → vaginal progesterone" },
  { h: "Evidence:", t: "ACOG/RCOG supported; vaginal progesterone reduces preterm birth in short cervix patients (Romero meta-analysis)" },
  { h: "NOT for acute tocolysis:", t: "Progesterone does not stop active preterm labour — it is PREVENTIVE only" },
  { h: "Adverse effects:", t: "Injection site pain (17-OHPC), vaginal irritation, bloating; teratogenicity not confirmed at therapeutic doses" },
  { h: "Note:", t: "EPPROMS trial (2019) showed 17-OHPC was NOT superior to placebo in twin pregnancies" },
], C.accentGreen);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 39 — Comparison of Tocolytics (Table)
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Comparison of Tocolytics — Key Features",
  ["Drug", "Mechanism", "Preferred Setting", "Key Advantage", "Major Risk"],
  [
    ["Nifedipine", "L-type Ca²⁺ block", "1st line (most guidelines)", "Oral, cheap, effective", "Hypotension, avoid with MgSO₄"],
    ["Atosiban", "OTR antagonist", "1st line (Europe)", "Selective, fewer SE", "Expensive"],
    ["Terbutaline", "β₂ agonist", "Acute intrapartum use", "SC route fast onset", "Pulmonary oedema, tachycardia"],
    ["Indomethacin", "COX inhibitor", "<28 weeks, adjunct", "Oral/rectal, effective", "Ductus arteriosus constriction"],
    ["MgSO₄", "Ca²⁺ antagonism", "Neuroprotection <32 wks", "Dual tocolytic + neuroprotection", "Respiratory depression, toxicity"],
    ["Progesterone", "Uterine quiescence", "Prevention (not acute)", "Safe, preventive", "Only for high-risk prophylaxis"],
    ["GTN patch", "↑cGMP (NO donor)", "Acute relaxation", "Rapid cervical + uterine relaxation", "Headache, hypotension"],
  ],
  C.accentGreen
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 40 — Final Summary Slide
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
addBg(s, C.darkBg);
addAccentBar(s, C.accentGold);
s.addShape(pres.ShapeType.rect, { x: 0, y: 0.08, w: "100%", h: 0.82, fill: { color: C.blue } });
s.addText("Key Clinical Pearls — Uterine Stimulants & Relaxants", {
  x: 0.3, y: 0.12, w: 9.4, h: 0.75, fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
});
// Left column (stimulants)
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.05, w: 4.4, h: 4.35, fill: { color: C.slideRed }, line: { color: C.accentGold, width: 1 } });
s.addText("STIMULANTS (Oxytocics)", { x: 0.2, y: 1.05, w: 4.4, h: 0.45, fontSize: 14, bold: true, color: C.accentGold, align: "center", fontFace: "Calibri", valign: "middle" });
const pearls1 = [
  "Oxytocin = 1st choice IOL, augmentation, PPH",
  "Ergometrine = CI in HTN/PEC; not for IOL",
  "Carboprost = CI in asthma; 3rd line PPH",
  "Misoprostol = thermostable; WHO essential drug",
  "Mifepristone always before misoprostol for MTP",
  "AMTSL = oxytocin 10 IU IM within 1 min of birth",
  "Carbetocin = single-dose; C-section PPH prevention",
  "Syntometrine = erg+OT combination; avoid in HTN",
].map(t => ({ text: t, options: { fontSize: 12, color: C.white, bullet: { type: "char", code: "2713" }, breakLine: true, fontFace: "Calibri" } }));
s.addText(pearls1, { x: 0.3, y: 1.55, w: 4.2, h: 3.7, fontFace: "Calibri", valign: "top" });
// Right column (relaxants)
s.addShape(pres.ShapeType.rect, { x: 5.0, y: 1.05, w: 4.4, h: 4.35, fill: { color: C.accentGreen }, line: { color: C.accentGold, width: 1 } });
s.addText("RELAXANTS (Tocolytics)", { x: 5.0, y: 1.05, w: 4.4, h: 0.45, fontSize: 14, bold: true, color: C.accentGold, align: "center", fontFace: "Calibri", valign: "middle" });
const pearls2 = [
  "Nifedipine = 1st line oral tocolytic worldwide",
  "Atosiban = 1st line in European guidelines (expensive)",
  "MgSO₄ = neuroprotection <32 wks + pre-eclampsia",
  "Indomethacin = limit to <32 wks; monitor ductus",
  "Terbutaline = avoid prolonged use (cardiovascular SE)",
  "Progesterone = PREVENTION only; not acute tocolysis",
  "Ca gluconate = antidote for MgSO₄ toxicity",
  "GTN patch = acute cervical relaxation (ECV, cord prolapse)",
].map(t => ({ text: t, options: { fontSize: 12, color: C.white, bullet: { type: "char", code: "2713" }, breakLine: true, fontFace: "Calibri" } }));
s.addText(pearls2, { x: 5.1, y: 1.55, w: 4.2, h: 3.7, fontFace: "Calibri", valign: "top" });

// ─── WRITE FILE ───────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/uterine-ppt/Uterine_Stimulants_Relaxants.pptx" }).then(() => {
  console.log("✅ PPT created successfully!");
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  process.exit(1);
});