Lancet article PCOD renamed PMOS polycystic ovary syndrome 2025 2026

PCOS PMOS renaming nomenclature polycystic ovary

PMID: 42119588

https://asktia.com/article/pcos-renamed-pmos-what-it-means/

ls -la /home/daytona/workspace/ && mkdir -p /home/daytona/workspace/pmos-pptx

~/pmos-pptx/generate.js

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pres.title = "PCOS to PMOS: The Lancet 2026 Landmark Name Change";
pres.author = "Global Name Change Consortium — Lancet 2026";

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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — Title
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// ══════════════════════════════════════════════════════════════════════════
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    ["01", "Background & Epidemiology of PCOS/PMOS"],
    ["02", "Why the Old Name Was Problematic"],
    ["03", "The 14-Year Journey: Timeline of Change"],
    ["04", "Global Consensus Process: Methods"],
    ["05", "Survey Data: 14,360 Voices"],
    ["06", "Key Principles for the New Name"],
    ["07", "What PMOS Stands For — Breaking It Down"],
    ["08", "Polyendocrine: Multi-Hormonal Pathophysiology"],
    ["09", "Metabolic Features & Insulin Resistance"],
    ["10", "Ovarian Dysfunction: What Remains Central"],
    ["11", "Full Clinical Feature Spectrum"],
    ["12", "Diagnostic Criteria: What Changes?"],
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    ["18", "Impact on Diagnosis & Clinical Workup"],
    ["19", "Therapeutic Reframing"],
    ["20", "Patient Perspectives & Stigma Reduction"],
    ["21", "Global Equity & Cultural Considerations"],
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — Background & Epidemiology
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    bullet("Associated long-term risks include type 2 diabetes, cardiovascular disease, endometrial cancer, depression, and infertility."),
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — Why the Old Name Was Problematic
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    { icon: "🔍", title: "Obscures Endocrine & Metabolic Features", body: "The name focuses attention on the ovaries alone, hiding the multi-system nature involving insulin resistance, androgen excess, and neuroendocrine dysregulation — the most clinically impactful features." },
    { icon: "⏳", title: "Causes Delayed & Missed Diagnosis", body: "Patients without ovarian cysts were frequently told they don't have PCOS. Clinicians and patients fixated on ultrasound findings, missing the broader hormonal criteria." },
    { icon: "💔", title: "Contributes to Stigma", body: "'Cysts' evoke fear and confusion. Many patients reported distress on hearing the diagnosis, often imagining large, dangerous cysts requiring surgery." },
    { icon: "🧩", title: "Fragments Clinical Care", body: "Because the name points only to ovaries, patients were often managed solely by gynaecologists — missing metabolic, endocrine, and psychological care." },
    { icon: "📉", title: "Curtails Research & Policy", body: "A misleading name restricted research framing to reproductive outcomes, underfunding studies on the cardiovascular, metabolic, and mental health dimensions." },
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — The 14-Year Journey
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    { year: "2018", text: "International PCOS Guideline published; name change formally flagged as priority" },
    { year: "2022", text: "Global Name Change Consortium established with 56 organisations" },
    { year: "2023–24", text: "Iterative surveys, Delphi rounds, nominal group workshops conducted globally" },
    { year: "2025", text: "EClinicalMedicine survey: 14,360 patients & HCPs across all world regions" },
    { year: "May 2026", text: "PMOS officially adopted — The Lancet publication & ECE Prague announcement" },
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — Global Consensus Process: Methods
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    bullet("Led by Prof. Helena Teede, Monash University, Australia"),
    bullet("Multidisciplinary team — endocrinology, gynaecology, dermatology, psychiatry, primary care, patient advocacy"),
    bullet("Funding & governance established to ensure independence"),
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    ["Nominal Group Technique", "Structured workshops with stakeholders"],
    ["Marketing Analysis", "Brand/implementation feasibility testing of new names"],
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — Survey Data: 14,360 Voices
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    { label: "People with PCOS", pct: "~60%", col: C.teal },
    { label: "Healthcare Professionals", pct: "~40%", col: C.gold },
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    bullet("Respondents asked about: current name problems, preferred descriptors, impact of name on stigma/diagnosis"),
    bullet("Top issues with 'PCOS': implied false cysts (68%), didn't reflect metabolic disease (71%), caused stigma (64%)"),
    bullet("Most preferred new descriptors: 'polyendocrine' (capturing multi-hormonal), 'metabolic', 'ovarian'"),
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — Key Principles for the New Name
// ══════════════════════════════════════════════════════════════════════════
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    { num: "2", title: "Clarity", desc: "Understandable to patients, healthcare professionals, policymakers, and the public across language and culture.", col: C.teal },
    { num: "3", title: "Stigma Avoidance", desc: "Must not evoke unnecessary fear, shame, or misconceptions (e.g. no language implying 'cysts' or purely aesthetic concerns).", col: C.gold },
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    { num: "5", title: "Implementation Feasibility", desc: "Practical for real-world adoption in health systems, disease classification (ICD-11), clinical guidelines, and patient records.", col: C.green },
    { num: "6", title: "Evolution, Not Revolution", desc: "Transition strategy prioritises gradual adoption — retaining existing diagnostic criteria while correcting the name.", col: "7D3C98" },
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — What PMOS Stands For
// ══════════════════════════════════════════════════════════════════════════
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  const letters = [
    { letter: "P", word: "POLY-\nENDOCRINE", color: C.teal, body: "Multiple endocrine/hormonal systems are disrupted:\n• Insulin signalling\n• Androgen production\n• Neuroendocrine (GnRH) pathways\n• Interactions between brain, ovaries & adipose tissue" },
    { letter: "M", word: "METABOLIC", color: C.gold, body: "Core metabolic dysfunction:\n• Insulin resistance (present even in lean women)\n• Dyslipidaemia\n• Elevated risk of type 2 diabetes\n• Non-alcoholic fatty liver disease\n• Cardiovascular risk factors" },
    { letter: "O", word: "OVARIAN", color: C.red, body: "Ovaries remain central:\n• Anovulation / oligomenorrhoea\n• Polycystic ovarian morphology (PCOM)\n• Excess androgen production from ovarian stroma\n• Fertility and reproductive consequences" },
    { letter: "S", word: "SYNDROME", color: C.midgrey, body: "A syndrome = constellation of features:\n• Heterogeneous presentation\n• No single diagnostic biomarker\n• Multiple overlapping phenotypes\n• Lifelong condition — not curable but manageable" },
  ];

  letters.forEach(({ letter, word, color, body }, i) => {
    const x = 0.18 + i * 2.43;
    s.addShape(pres.ShapeType.rect, { x, y: 0.98, w: 2.28, h: 3.9, fill: { color: "1A2E4A" }, line: { color: color, width: 2 } });
    s.addShape(pres.ShapeType.rect, { x, y: 0.98, w: 2.28, h: 0.72, fill: { color: color } });
    s.addText(letter, { x, y: 0.98, w: 2.28, h: 0.72, fontSize: 32, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
    s.addText(word, { x, y: 1.75, w: 2.28, h: 0.7, fontSize: 11, bold: true, color: color, fontFace: "Calibri", align: "center" });
    s.addText(body, { x: x + 0.08, y: 2.5, w: 2.12, h: 2.3, fontSize: 8.5, color: C.lt, fontFace: "Calibri", wrap: true });
  });

  s.addText("Polyendocrine Metabolic Ovarian Syndrome", {
    x: 0.5, y: 5.12, w: 9, h: 0.38,
    fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", align: "center",
  });

  footer(s, 9);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — Polyendocrine: Multi-Hormonal Pathophysiology
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Polyendocrine: Multi-Hormonal Pathophysiology", "Why multiple endocrine axes are disrupted in PMOS");

  // Central hub
  s.addShape(pres.ShapeType.ellipse, { x: 3.7, y: 2.1, w: 2.6, h: 1.4, fill: { color: C.navy } });
  s.addText("PMOS\nPolyendocrine\nHub", { x: 3.7, y: 2.1, w: 2.6, h: 1.4, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });

  // Satellite nodes
  const nodes = [
    { label: "Hypothalamic–\nPituitary Axis", desc: "Increased GnRH pulse frequency → raised LH:FSH ratio", x: 0.2, y: 1.3, col: C.teal },
    { label: "Androgen Excess", desc: "Elevated free testosterone, DHEAS from adrenal & ovarian sources", x: 7.5, y: 1.3, col: C.red },
    { label: "Insulin Signalling", desc: "Post-receptor defect → compensatory hyperinsulinaemia", x: 0.2, y: 3.6, col: C.gold },
    { label: "Adipokine\nDysregulation", desc: "Altered leptin, adiponectin, resistin levels", x: 7.5, y: 3.6, col: "7D3C98" },
    { label: "Cortisol / HPA Axis", desc: "Subtle HPA overactivity; increased cortisol metabolism", x: 3.5, y: 4.35, col: C.green },
  ];

  nodes.forEach(({ label, desc, x, y, col }) => {
    s.addShape(pres.ShapeType.rect, { x, y, w: 2.3, h: 1.0, fill: { color: col }, line: { color: col } });
    s.addText(label, { x, y: y + 0.02, w: 2.3, h: 0.42, fontSize: 10, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
    s.addText(desc, { x, y: y + 0.44, w: 2.3, h: 0.52, fontSize: 8.5, color: C.white, fontFace: "Calibri", align: "center", wrap: true });
  });

  // Arrow lines from hub
  s.addShape(pres.ShapeType.rect, { x: 2.5, y: 2.5, w: 1.22, h: 0.05, fill: { color: C.teal } });
  s.addShape(pres.ShapeType.rect, { x: 6.28, y: 2.5, w: 1.22, h: 0.05, fill: { color: C.red } });
  s.addShape(pres.ShapeType.rect, { x: 2.5, y: 3.35, w: 1.22, h: 0.05, fill: { color: C.gold } });
  s.addShape(pres.ShapeType.rect, { x: 6.28, y: 3.35, w: 1.22, h: 0.05, fill: { color: "7D3C98" } });
  s.addShape(pres.ShapeType.rect, { x: 5.0, y: 3.5, w: 0.05, h: 0.87, fill: { color: C.green } });

  footer(s, 10);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — Metabolic Features & Insulin Resistance
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Metabolic Features & Insulin Resistance", "Why 'Metabolic' earned its place in the new name");

  // Key metabolic facts
  const facts = [
    { stat: "70%", label: "of PMOS women have\ninsulin resistance", col: C.navy },
    { stat: "4×", label: "higher risk of\ntype 2 diabetes", col: C.teal },
    { stat: "2–3×", label: "increased risk of\nmetabolic syndrome", col: C.gold },
    { stat: "60%", label: "have insulin resistance\neven at healthy BMI", col: C.red },
  ];

  facts.forEach(({ stat, label, col }, i) => {
    const x = 0.25 + i * 2.38;
    s.addShape(pres.ShapeType.rect, { x, y: 1.2, w: 2.2, h: 1.55, fill: { color: col } });
    s.addText(stat, { x, y: 1.22, w: 2.2, h: 0.8, fontSize: 34, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
    s.addText(label, { x, y: 2.02, w: 2.2, h: 0.7, fontSize: 10.5, color: C.white, fontFace: "Calibri", align: "center" });
  });

  s.addText([
    bullet("Insulin resistance: A post-receptor signalling defect in insulin-sensitive tissues (muscle, adipose, liver) — distinct from obesity-related IR."),
    bullet("Compensatory hyperinsulinaemia worsens androgen excess by stimulating ovarian androgen production and reducing SHBG."),
    bullet("Gestational diabetes: 3-fold increased risk; metabolic screening from early pregnancy is essential."),
    bullet("Non-alcoholic fatty liver disease (NAFLD): Prevalence ~30–40% in PMOS regardless of BMI."),
    bullet("Dyslipidaemia: Raised TGs, low HDL-C, small dense LDL particles — classic 'metabolic' pattern."),
    bullet("Cardiovascular risk: Subclinical atherosclerosis, endothelial dysfunction, and hypertension reported even in adolescents."),
  ], { x: 0.3, y: 2.88, w: 9.4, h: 2.5, fontSize: 11, color: C.navy, fontFace: "Calibri" });

  footer(s, 11);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 12 — Ovarian Dysfunction
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Ovarian Dysfunction: What Remains Central", "Why 'Ovarian' was retained in PMOS");

  panel(s, 0.25, 1.2, 4.6, 3.95, C.white);
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.2, w: 4.6, h: 0.4, fill: { color: C.teal } });
  s.addText("WHAT THE OVARIES DO IN PMOS", { x: 0.25, y: 1.2, w: 4.6, h: 0.4, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  s.addText([
    bullet("Anovulation: Absent or infrequent ovulation → oligomenorrhoea / amenorrhoea"),
    bullet("Polycystic Ovarian Morphology (PCOM): ≥20 follicles per ovary on ultrasound, or increased ovarian volume (>10 mL)"),
    bullet("Androgen excess: Ovarian stroma and theca cells produce excess testosterone under LH stimulation"),
    bullet("Impaired folliculogenesis: Follicle development arrests at the antral stage → 'necklace' of follicles"),
    bullet("AMH elevation: Anti-Müllerian hormone markedly raised (used as a surrogate for PCOM)"),
    bullet("Fertility implications: Most common cause of anovulatory infertility worldwide"),
  ], { x: 0.4, y: 1.65, w: 4.3, h: 3.4, fontSize: 11, color: C.navy, fontFace: "Calibri" });

  panel(s, 5.1, 1.2, 4.65, 3.95, C.white);
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.2, w: 4.65, h: 0.4, fill: { color: C.gold } });
  s.addText("WHY 'OVARIAN' WAS KEPT", { x: 5.1, y: 1.2, w: 4.65, h: 0.4, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  s.addText([
    bullet("Ovaries remain the primary affected organ with measurable, clinically relevant changes"),
    bullet("Maintains continuity for the ~300 million already diagnosed globally"),
    bullet("Existing diagnostic criteria (Rotterdam, AES) rely on ovarian parameters"),
    bullet("Avoids confusion — removing 'ovarian' could imply a completely different condition"),
    bullet("Note: Some researchers advocated removing 'ovarian' to allow for possible male equivalent; this remains a minority view and an open research question"),
    bullet("Consensus: 'Ovarian' retained as a clinically and scientifically justified anchor term"),
  ], { x: 5.25, y: 1.65, w: 4.35, h: 3.4, fontSize: 11, color: C.navy, fontFace: "Calibri" });

  footer(s, 12);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 13 — Full Clinical Feature Spectrum
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Full Clinical Feature Spectrum of PMOS", "A multisystem condition — far beyond the ovaries");

  const domains = [
    { title: "Reproductive", items: ["Irregular / absent periods", "Anovulation", "Subfertility / infertility", "Miscarriage risk", "Polycystic ovarian morphology"], col: C.teal },
    { title: "Endocrine", items: ["Hyperandrogenism", "Hirsutism, acne, alopecia", "Elevated LH:FSH ratio", "Raised AMH", "Hyperprolactinaemia (some)"], col: C.navy },
    { title: "Metabolic", items: ["Insulin resistance", "Type 2 diabetes", "Dyslipidaemia", "NAFLD", "Obesity / central adiposity"], col: C.gold },
    { title: "Cardiovascular", items: ["Hypertension", "Subclinical atherosclerosis", "Endothelial dysfunction", "Increased CVD risk", "Thromboembolism risk"], col: C.red },
    { title: "Psychological", items: ["Depression & anxiety", "Body dysmorphia", "Eating disorders", "Reduced QoL", "Cognitive effects"], col: "7D3C98" },
    { title: "Other Features", items: ["Sleep apnoea", "Endometrial hyperplasia", "Vitamin D deficiency", "Thyroid comorbidities", "Gestational diabetes"], col: C.green },
  ];

  domains.forEach(({ title, items, col }, i) => {
    const row = Math.floor(i / 3);
    const c = i % 3;
    const x = 0.25 + c * 3.23;
    const y = 1.18 + row * 2.1;
    panel(s, x, y, 3.08, 1.95, C.white);
    s.addShape(pres.ShapeType.rect, { x, y, w: 3.08, h: 0.38, fill: { color: col } });
    s.addText(title, { x, y, w: 3.08, h: 0.38, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
    items.forEach((item, j) => {
      s.addText(`• ${item}`, { x: x + 0.12, y: y + 0.42 + j * 0.3, w: 2.88, h: 0.28, fontSize: 9, color: C.navy, fontFace: "Calibri", margin: 0 });
    });
  });

  footer(s, 13);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 14 — Diagnostic Criteria: What Changes?
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Diagnostic Criteria: What Changes with PMOS?", "The name changes — the criteria do NOT");

  // Two columns: OLD vs NEW framing
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.18, w: 4.55, h: 0.38, fill: { color: C.red } });
  s.addText("PCOS (OLD FRAMING)", { x: 0.25, y: 1.18, w: 4.55, h: 0.38, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  panel(s, 0.25, 1.56, 4.55, 3.6, C.white);

  s.addShape(pres.ShapeType.rect, { x: 5.2, y: 1.18, w: 4.55, h: 0.38, fill: { color: C.green } });
  s.addText("PMOS (NEW FRAMING)", { x: 5.2, y: 1.18, w: 4.55, h: 0.38, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  panel(s, 5.2, 1.56, 4.55, 3.6, C.white);

  s.addText([
    bullet("Rotterdam 2003 criteria still apply (2 of 3):"),
    bullet("i. Oligo-/anovulation", true),
    bullet("ii. Clinical or biochemical hyperandrogenism", true),
    bullet("iii. Polycystic ovarian morphology (PCOM)", true),
    bullet("Workup often limited to pelvic ultrasound + reproductive hormones"),
    bullet("Metabolic screening done variably / not routinely"),
    bullet("Missed diagnoses when no 'cysts' on scan"),
    bullet("Fragmented care — gynaecology-centric"),
  ], { x: 0.4, y: 1.62, w: 4.25, h: 3.45, fontSize: 10.5, color: C.navy, fontFace: "Calibri" });

  s.addText([
    bullet("Same diagnostic criteria — name change does NOT alter diagnosis"),
    bullet("BUT: Clinical workup now formally expanded to include:"),
    bullet("Fasting glucose / OGTT / HbA1c", true),
    bullet("Fasting insulin & HOMA-IR", true),
    bullet("Lipid profile", true),
    bullet("Blood pressure assessment", true),
    bullet("Mental health screening", true),
    bullet("Therapeutic framing shifts upstream to metabolic & neuroendocrine drivers"),
    bullet("Multidisciplinary care strongly encouraged"),
  ], { x: 5.35, y: 1.62, w: 4.25, h: 3.45, fontSize: 10.5, color: C.navy, fontFace: "Calibri" });

  footer(s, 14);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 15 — Reproductive Impacts
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Reproductive Impacts of PMOS", "Fertility, pregnancy, and gynaecological consequences");

  const blocks = [
    { title: "Anovulatory Infertility", body: "PMOS is the #1 cause of anovulatory infertility worldwide. Ovulation induction with letrozole (aromatase inhibitor) is first-line; clomiphene second-line. IVF effective in resistant cases.", col: C.navy },
    { title: "Menstrual Irregularity", body: "Oligomenorrhoea (<9 cycles/year) or amenorrhoea affects 70–80% of women. Prolonged anovulation → endometrial hyperplasia risk. Combined oral contraceptive pill (COCP) widely used.", col: C.teal },
    { title: "Pregnancy Complications", body: "3× gestational diabetes, 2× gestational hypertension, increased miscarriage risk, preterm birth risk. Requires close antenatal monitoring. Metformin may reduce gestational DM.", col: C.gold },
    { title: "Endometrial Risk", body: "Unopposed oestrogen from anovulation → endometrial hyperplasia and 2–3× risk of endometrial carcinoma. Regular progestogen or COCP recommended if cycles absent >3 months.", col: C.red },
  ];

  blocks.forEach(({ title, body, col }, i) => {
    const x = 0.25 + (i % 2) * 4.88;
    const y = 1.22 + Math.floor(i / 2) * 2.15;
    panel(s, x, y, 4.65, 2.0, C.white);
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.65, h: 0.38, fill: { color: col } });
    s.addText(title, { x, y, w: 4.65, h: 0.38, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText(body, { x: x + 0.15, y: y + 0.44, w: 4.35, h: 1.5, fontSize: 10.5, color: C.navy, fontFace: "Calibri", wrap: true });
  });

  footer(s, 15);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 16 — Cardiometabolic Risk
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Cardiometabolic Risk in PMOS", "Long-term systemic consequences beyond reproduction");

  const risks = [
    { label: "Type 2 Diabetes", rr: "4×", detail: "Lifetime risk; onset earlier than general population. Impaired glucose tolerance found in 30–40%." },
    { label: "Metabolic Syndrome", rr: "2–3×", detail: "Waist circumference, blood pressure, lipids, fasting glucose — all adversely affected." },
    { label: "NAFLD / MAFLD", rr: "2.5×", detail: "30–40% prevalence regardless of BMI. Can progress to cirrhosis over time." },
    { label: "Hypertension", rr: "1.5–2×", detail: "Heightened from adolescence. Endothelial dysfunction detectable early." },
    { label: "Cardiovascular Events", rr: "1.5–2×", detail: "Pooled data suggest elevated CVD event risk, particularly with obesity." },
    { label: "Dyslipidaemia", rr: "Common", detail: "Raised triglycerides, low HDL-C, elevated LDL in up to 70% of patients." },
  ];

  risks.forEach(({ label, rr, detail }, i) => {
    const row = Math.floor(i / 3);
    const c = i % 3;
    const x = 0.25 + c * 3.23;
    const y = 1.18 + row * 2.12;
    s.addShape(pres.ShapeType.rect, { x, y, w: 3.08, h: 1.97, fill: { color: C.white }, line: { color: C.midgrey, width: 0.5 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.85, h: 1.97, fill: { color: C.navy } });
    s.addText(rr, { x, y: y + 0.5, w: 0.85, h: 0.9, fontSize: 18, bold: true, color: C.gold, fontFace: "Calibri", align: "center" });
    s.addText(label, { x: x + 0.92, y: y + 0.08, w: 2.1, h: 0.42, fontSize: 11, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
    s.addText(detail, { x: x + 0.92, y: y + 0.52, w: 2.1, h: 1.38, fontSize: 9, color: C.grey, fontFace: "Calibri", margin: 0, wrap: true });
  });

  footer(s, 16);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 17 — Psychological & QoL Burden
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Psychological & Quality-of-Life Burden", "The hidden cost of an inadequate name");

  // Central quote
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.18, w: 9.2, h: 0.75, fill: { color: C.teal } });
  s.addText(
    '"There was a lot of stigma and myth related to this name. People thought they have large cysts, which they do not have." — Dr. Alla Vash-Margita, Yale University',
    { x: 0.5, y: 1.2, w: 9.0, h: 0.72, fontSize: 11, italic: true, color: C.white, fontFace: "Calibri", align: "center" }
  );

  const items = [
    { icon: "😔", title: "Depression", body: "3–4× increased prevalence vs. general population. Often linked to androgen levels, body image concerns, and infertility." },
    { icon: "😰", title: "Anxiety", body: "Generalised anxiety and health anxiety are common. Heightened by diagnostic uncertainty and misunderstanding of 'cysts'." },
    { icon: "🪞", title: "Body Dysmorphia", body: "Visible hyperandrogenism (hirsutism, acne, alopecia) profoundly impacts self-image and social functioning." },
    { icon: "🍽️", title: "Eating Disorders", body: "Binge eating, restrictive eating, and disordered eating behaviours reported at higher rates." },
    { icon: "😴", title: "Sleep Apnoea", body: "Obstructive sleep apnoea is under-recognised; independent of obesity. Associated with metabolic and cognitive effects." },
    { icon: "🧠", title: "Cognitive Effects", body: "Emerging evidence of cognitive decline risk linked with PMOS over lifetime, particularly memory and executive function." },
  ];

  items.forEach(({ icon, title, body }, i) => {
    const row = Math.floor(i / 3);
    const c = i % 3;
    const x = 0.25 + c * 3.22;
    const y = 2.1 + row * 1.6;
    panel(s, x, y, 3.07, 1.45, C.white);
    s.addText(icon, { x, y: y + 0.05, w: 0.6, h: 0.5, fontSize: 18, fontFace: "Calibri", align: "center" });
    s.addText(title, { x: x + 0.58, y: y + 0.05, w: 2.4, h: 0.38, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
    s.addText(body, { x: x + 0.12, y: y + 0.5, w: 2.88, h: 0.9, fontSize: 9, color: C.grey, fontFace: "Calibri", wrap: true });
  });

  footer(s, 17);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 18 — The Implementation Strategy
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Implementation Strategy: How PMOS Will Be Adopted", "Co-designed global rollout plan");

  const phases = [
    { phase: "Phase 1\n(Now)", title: "Announcement & Awareness", items: ["Lancet publication (May 12, 2026)", "ECE Prague presentation", "Media & social media campaign", "56 organisations issue statements"], col: C.teal },
    { phase: "Phase 2\n(2026–27)", title: "Education & Transition", items: ["Clinician education modules", "Patient-facing resources", "ICD-11 & SNOMED update submissions", "Guidelines updated to PMOS"], col: C.gold },
    { phase: "Phase 3\n(2027–28)", title: "System Integration", items: ["EHR/EMR code updates", "Medical school curriculum updates", "Pharmaceutical labelling changes", "Insurance & coding alignment"], col: C.navy },
    { phase: "Phase 4\n(Ongoing)", title: "Evaluation & Refinement", items: ["Monitor adoption rates globally", "Patient feedback surveys", "Health system impact studies", "Iterative guideline updates"], col: C.red },
  ];

  phases.forEach(({ phase, title, items, col }, i) => {
    const x = 0.2 + i * 2.4;
    s.addShape(pres.ShapeType.rect, { x, y: 1.18, w: 2.25, h: 0.65, fill: { color: col } });
    s.addText(phase, { x, y: 1.18, w: 2.25, h: 0.65, fontSize: 10, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
    s.addShape(pres.ShapeType.rect, { x, y: 1.83, w: 2.25, h: 3.42, fill: { color: C.white }, line: { color: col, width: 2 } });
    s.addText(title, { x: x + 0.08, y: 1.88, w: 2.1, h: 0.38, fontSize: 11, bold: true, color: col, fontFace: "Calibri", margin: 0 });
    items.forEach((item, j) => {
      s.addText(`• ${item}`, { x: x + 0.1, y: 2.3 + j * 0.55, w: 2.08, h: 0.5, fontSize: 9.5, color: C.navy, fontFace: "Calibri", margin: 0 });
    });
  });

  // Progress arrow
  s.addShape(pres.ShapeType.rect, { x: 0.22, y: 5.25, w: 9.56, h: 0.1, fill: { color: C.teal } });
  s.addText("◄──────────────── Implementation Timeline: Gradual Evolution, Not Overnight Transformation ────────────────►",
    { x: 0.2, y: 5.35, w: 9.6, h: 0.2, fontSize: 8, color: C.grey, fontFace: "Calibri", align: "center" });

  footer(s, 18);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 19 — Transition Period & Disease Classification
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Transition Period & Disease Classification", "Aligning PMOS with global health systems");

  panel(s, 0.25, 1.18, 9.5, 0.85, C.navy);
  s.addText("KEY PRINCIPLE: EVOLUTION NOT REVOLUTION — 'PCOS' will remain recognised during the transition period alongside PMOS.", {
    x: 0.35, y: 1.22, w: 9.3, h: 0.78, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", align: "center",
  });

  const topics = [
    { title: "ICD-11 Update", body: "Submissions filed to update the International Classification of Diseases (ICD-11) to reflect PMOS. PCOS will be retained as a synonym/legacy term during transition. Expected formal inclusion within 12–18 months.", col: C.teal },
    { title: "SNOMED CT & Coding", body: "SNOMED CT codes for PCOS to be mapped to PMOS. Healthcare providers advised to maintain backward compatibility — old PCOS codes will link to PMOS during the transition.", col: C.gold },
    { title: "Diagnostic Criteria", body: "Rotterdam 2003 criteria remain valid under PMOS. New guidelines will incorporate metabolic screening as mandatory. AES 2006 and NIH 1990 criteria also remain compatible.", col: C.navy },
    { title: "Clinical Guidelines", body: "International PCOS Guideline (Monash, 2023) will be updated to PMOS. European Society of Endocrinology, ESHRE, and ASRM guidelines all expected to align.", col: C.red },
  ];

  topics.forEach(({ title, body, col }, i) => {
    const row = Math.floor(i / 2);
    const c = i % 2;
    const x = 0.25 + c * 4.88;
    const y = 2.18 + row * 1.7;
    panel(s, x, y, 4.65, 1.55, C.white);
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.12, h: 1.55, fill: { color: col } });
    s.addText(title, { x: x + 0.2, y: y + 0.08, w: 4.38, h: 0.35, fontSize: 12, bold: true, color: col, fontFace: "Calibri", margin: 0 });
    s.addText(body, { x: x + 0.2, y: y + 0.45, w: 4.38, h: 1.05, fontSize: 9.5, color: C.grey, fontFace: "Calibri", margin: 0, wrap: true });
  });

  footer(s, 19);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 20 — Impact on Diagnosis & Clinical Workup
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Impact on Clinical Diagnosis & Workup", "PMOS expands the diagnostic evaluation paradigm");

  // Table-style comparison
  const headers = ["Assessment Domain", "Old PCOS Approach", "New PMOS Approach"];
  const rows = [
    ["History", "Menstrual irregularity, hirsutism", "Add: Metabolic history, CVD risk factors, mood, sleep"],
    ["Examination", "Weight, BMI, signs of hyperandrogenism", "Add: Waist circumference, BP measurement, acanthosis"],
    ["Bloods (Reproductive)", "LH, FSH, testosterone, prolactin", "Same — no change"],
    ["Bloods (Metabolic)", "Done variably / not routinely", "Mandatory: Fasting glucose, HbA1c, lipid profile, insulin"],
    ["Imaging", "Pelvic USS for follicle count/ovarian volume", "Same — USS remains part of Rotterdam criteria"],
    ["Mental Health", "Often omitted", "Formally included: PHQ-9, GAD-7 screening recommended"],
    ["Multidisciplinary", "Gynaecology-centric", "Endocrinology + dietetics + mental health + primary care"],
  ];

  // Header row
  const colWidths = [2.4, 3.2, 3.7];
  const colX = [0.25, 2.65, 5.85];
  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: colX[i], y: 1.18, w: colWidths[i], h: 0.38, fill: { color: C.navy } });
    s.addText(h, { x: colX[i], y: 1.18, w: colWidths[i], h: 0.38, fontSize: 10, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  });

  rows.forEach((row, r) => {
    const bg = r % 2 === 0 ? C.white : "F0F4F8";
    const y = 1.56 + r * 0.52;
    colWidths.forEach((w, c) => {
      s.addShape(pres.ShapeType.rect, { x: colX[c], y, w, h: 0.5, fill: { color: bg }, line: { color: C.midgrey, width: 0.3 } });
      s.addText(row[c], { x: colX[c] + 0.05, y, w: w - 0.1, h: 0.5, fontSize: 9, color: c === 0 ? C.navy : c === 1 ? C.red : C.green, fontFace: "Calibri", bold: c === 0, valign: "middle" });
    });
  });

  footer(s, 20);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 21 — Therapeutic Reframing
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Therapeutic Reframing Under PMOS", "From symptom management to upstream pathophysiology");

  s.addText("PMOS shifts treatment focus toward upstream metabolic and neuroendocrine drivers — not just treating symptoms.",
    { x: 0.3, y: 1.18, w: 9.4, h: 0.45, fontSize: 12, italic: true, color: C.teal, fontFace: "Calibri", align: "center" });

  const therapies = [
    { cat: "Lifestyle Intervention", icon: "🏃", items: ["First-line for ALL PMOS phenotypes", "5–10% weight loss improves insulin sensitivity, restores ovulation, reduces androgens", "Combined aerobic + resistance training", "Mediterranean-style dietary pattern preferred"], col: C.green },
    { cat: "Insulin-Sensitising Agents", icon: "💊", items: ["Metformin: first-line metabolic agent — reduces IR, lowers androgens, improves cycles", "Inositol (myo/D-chiro): emerging role, good tolerability", "GLP-1 receptor agonists (semaglutide): weight loss + IR benefits, emerging evidence"], col: C.teal },
    { cat: "Androgen / Hormonal", icon: "⚗️", items: ["COCP: Cycle regulation + antiandrogen effect (drospirenone, CPA)", "Spironolactone, CPA: hirsutism & acne management", "Finasteride: alopecia (off-label)", "Not first-line for metabolic features"], col: C.gold },
    { cat: "Fertility Treatment", icon: "👶", items: ["Letrozole 2.5–7.5 mg (aromatase inhibitor): first-line OI", "Clomiphene: second-line, anti-oestrogenic effects", "Metformin: adjunct in OI cycles", "IVF with GnRH-antagonist protocol to reduce OHSS risk"], col: C.navy },
  ];

  therapies.forEach(({ cat, icon, items, col }, i) => {
    const x = 0.25 + (i % 2) * 4.88;
    const y = 1.75 + Math.floor(i / 2) * 1.95;
    panel(s, x, y, 4.65, 1.82, C.white);
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.65, h: 0.38, fill: { color: col } });
    s.addText(`${icon}  ${cat}`, { x, y, w: 4.65, h: 0.38, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
    items.forEach((item, j) => {
      s.addText(`• ${item}`, { x: x + 0.12, y: y + 0.42 + j * 0.34, w: 4.42, h: 0.32, fontSize: 9.5, color: C.navy, fontFace: "Calibri", margin: 0 });
    });
  });

  footer(s, 21);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 22 — Patient Perspectives & Stigma Reduction
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Patient Perspectives & Stigma Reduction", "Lived experience at the heart of the name change");

  const quotes = [
    { q: '"This shift will reframe the conversation and demand that it is taken as seriously as the long-term, complex health condition it is."', person: "Rachel Morman, Chair, Verity PCOS UK" },
    { q: '"By calling this condition polycystic ovary, we\'re missing the big picture. There was a lot of stigma and myth."', person: "Dr. Alla Vash-Margita, Yale University" },
  ];

  quotes.forEach(({ q, person }, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.18 + i * 0.98, w: 9.5, h: 0.85, fill: { color: i === 0 ? C.teal : C.gold } });
    s.addText(q, { x: 0.38, y: 1.22 + i * 0.98, w: 9.0, h: 0.52, fontSize: 10.5, italic: true, color: C.white, fontFace: "Calibri" });
    s.addText(`— ${person}`, { x: 0.38, y: 1.73 + i * 0.98, w: 9.0, h: 0.25, fontSize: 9, color: C.white, fontFace: "Calibri", align: "right" });
  });

  s.addText([
    bullet("68% of survey respondents said the name PCOS implied 'cysts' — causing fear and confusion at diagnosis"),
    bullet("71% felt the name failed to reflect the metabolic and endocrine nature of the condition"),
    bullet("64% felt stigmatised by the name — particularly due to 'cysts' association with surgical imagery"),
    bullet("Patients reported that the name led clinicians to dismiss non-ovarian symptoms (fatigue, cognitive fog, metabolic issues)"),
    bullet("Name change is seen as a long-overdue validation of the full illness experience"),
    bullet("Patients co-designed the transition strategy — a key innovation of this process vs. prior nomenclature debates"),
    bullet("PMOS allows framing as a serious, chronic, multi-system condition — improving access to comprehensive care"),
  ], { x: 0.3, y: 3.18, w: 9.4, h: 2.2, fontSize: 11, color: C.navy, fontFace: "Calibri" });

  footer(s, 22);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 23 — Global Equity & Cultural Considerations
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Global Equity & Cultural Considerations", "Ensuring PMOS works for ALL women worldwide");

  panel(s, 0.25, 1.18, 9.5, 0.62, C.teal);
  s.addText("PMOS was specifically tested for cultural appropriateness across 6 continents and multiple languages before finalisation.", {
    x: 0.35, y: 1.22, w: 9.2, h: 0.55, fontSize: 11, italic: true, color: C.white, fontFace: "Calibri", align: "center",
  });

  const topics = [
    { title: "Translation & Linguistic Testing", body: "The term 'polyendocrine metabolic ovarian syndrome' was evaluated in multiple languages to ensure no offensive, misleading, or untranslatable connotations. Alternative translations approved in key global health languages.", col: C.navy },
    { title: "Low- and Middle-Income Countries", body: "Particular attention paid to settings where ultrasound is not available. Diagnostic criteria flexibility retained (hyperandrogenism + irregular cycles sufficient without USS in some settings).", col: C.teal },
    { title: "Racial & Ethnic Differences", body: "Lean phenotype PMOS is particularly common in South and East Asian women. The metabolic emphasis of PMOS is especially relevant — BMI-based thresholds may underestimate risk in Asian populations.", col: C.gold },
    { title: "Adolescent-Specific Considerations", body: "PMOS diagnosis in adolescents requires at least 2 years post-menarche. Menstrual irregularity and acne are common normally at this stage. The new name aids differentiation and reduces over-diagnosis.", col: C.red },
    { title: "Male Equivalent?", body: "Some researchers propose a male equivalent — similar insulin resistance, androgen excess, and metabolic features in male relatives of PMOS women. Retaining 'ovarian' closes the door on this — remains controversial.", col: "7D3C98" },
    { title: "Postmenopausal Recognition", body: "PMOS persists beyond menopause — metabolic risk (T2DM, CVD, NAFLD) continues without reproductive symptoms. The new name better captures this lifelong dimension.", col: C.green },
  ];

  topics.forEach(({ title, body, col }, i) => {
    const row = Math.floor(i / 2);
    const c = i % 2;
    const x = 0.25 + c * 4.88;
    const y = 2.0 + row * 1.2;
    panel(s, x, y, 4.65, 1.1, C.white);
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.1, h: 1.1, fill: { color: col } });
    s.addText(title, { x: x + 0.18, y: y + 0.04, w: 4.4, h: 0.3, fontSize: 10.5, bold: true, color: col, fontFace: "Calibri", margin: 0 });
    s.addText(body, { x: x + 0.18, y: y + 0.36, w: 4.4, h: 0.72, fontSize: 9, color: C.grey, fontFace: "Calibri", margin: 0, wrap: true });
  });

  footer(s, 23);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 24 — Outstanding Controversies
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Outstanding Controversies & Open Questions", "Where scientific consensus has not yet been fully reached");

  const controversies = [
    { num: "01", title: "The Male Phenotype Debate", body: "Some evidence suggests male relatives of women with PMOS share metabolic and endocrine traits. A name with 'ovarian' excludes this possibility. Proponents argue a separate nomenclature is needed for a potential male equivalent.", col: C.red },
    { num: "02", title: "Why Not a Completely New Name?", body: "Critics argued a generic name (e.g. 'reproductive metabolic syndrome') would be cleaner. Consensus rejected this — an accurate descriptive name was prioritised over a generic one to maintain scientific precision.", col: C.gold },
    { num: "03", title: "Retaining 'Ovarian' — Enough?", body: "Some patient advocates felt the new name still over-emphasises the ovaries when lived experience is predominantly metabolic and endocrine. The 'P' in PMOS (polyendocrine) was seen as insufficient by some.", col: C.teal },
    { num: "04", title: "Dissatisfaction with 'Poly'", body: "A minority felt 'poly' (many) in the context of endocrine was unclear to patients. Marketing analyses showed 'polyendocrine' had lower lay comprehension than alternatives in some regions.", col: C.navy },
    { num: "05", title: "Speed vs. Caution in Transition", body: "Some healthcare systems and patient groups urged faster adoption; others cautioned that rapid change in coding/classification risks missed diagnoses and billing errors during transition.", col: "7D3C98" },
    { num: "06", title: "Unresolved Aetiology", body: "Despite the name change, PMOS aetiology remains incompletely understood. Neuroendocrine origins vs. primary insulin resistance vs. genetic predisposition remain active debates. The name does not imply resolved causation.", col: C.green },
  ];

  controversies.forEach(({ num, title, body, col }, i) => {
    const row = Math.floor(i / 2);
    const c = i % 2;
    const x = 0.25 + c * 4.88;
    const y = 1.2 + row * 1.4;
    panel(s, x, y, 4.65, 1.3, C.white);
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.6, h: 1.3, fill: { color: col } });
    s.addText(num, { x, y: y + 0.38, w: 0.6, h: 0.5, fontSize: 16, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
    s.addText(title, { x: x + 0.68, y: y + 0.05, w: 3.9, h: 0.35, fontSize: 11, bold: true, color: col, fontFace: "Calibri", margin: 0 });
    s.addText(body, { x: x + 0.68, y: y + 0.42, w: 3.9, h: 0.83, fontSize: 9, color: C.grey, fontFace: "Calibri", margin: 0, wrap: true });
  });

  footer(s, 24);
})();

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 25 — Research Implications
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "Research & Policy Implications of PMOS", "How the name change unlocks new scientific frontiers");

  s.addText([
    bullet("Research framing will expand: Studies can now encompass cardiovascular, metabolic, and neurological outcomes without being confined to reproductive endpoints."),
    bullet("Funding streams: PMOS, framed as a metabolic disorder, may unlock research funding from endocrinology, cardiology, and metabolic disease institutes — historically separate from reproductive health."),
    bullet("Biomarker discovery: With metabolic criteria now central, research into AMH, insulin, androgen indices, and novel biomarkers will accelerate."),
    bullet("Pharmacological targets: GLP-1 agonists, dual GIP/GLP-1 agonists (tirzepatide), and SGLT-2 inhibitors now become rationally testable therapeutic targets given the metabolic framing."),
    bullet("Genetics & epigenetics: Genome-wide association studies may be reanalysed using PMOS phenotype definitions, potentially identifying metabolic loci previously missed."),
    bullet("Male equivalent research: PMOS naming keeps this question open — prospective studies in male relatives are warranted."),
    bullet("Global disease burden: ICD-11 reclassification will improve epidemiological tracking and enable more accurate global burden-of-disease modelling."),
    bullet("Patient-reported outcomes: The name change itself is a research intervention — longitudinal studies will measure impact on stigma, diagnosis time, and care quality."),
  ], { x: 0.3, y: 1.22, w: 9.4, h: 3.85, fontSize: 11.5, color: C.navy, fontFace: "Calibri" });

  panel(s, 0.3, 5.08, 9.4, 0.3, C.teal);
  s.addText("PMOS opens a new chapter: funding, framing, and clinical management of this common condition will never be the same.", {
    x: 0.3, y: 5.08, w: 9.4, h: 0.3, fontSize: 9.5, bold: true, color: C.white, fontFace: "Calibri", align: "center",
  });

  footer(s, 25);
})();

// ══════════════════════════════════════════════════════════════════════════
// BONUS SLIDE 26 — Key Takeaways
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.22, h: 5.625, fill: { color: C.gold } });
  titleBar(s, "Key Takeaways", "What every clinician should know about PMOS");

  const takeaways = [
    { num: "1", text: "PCOS has officially been renamed PMOS — Polyendocrine Metabolic Ovarian Syndrome — effective May 12, 2026 (The Lancet)." },
    { num: "2", text: "The name change follows a 14-year, 56-organisation global process involving 14,360 patients and healthcare professionals." },
    { num: "3", text: "DIAGNOSTIC CRITERIA ARE UNCHANGED — Rotterdam 2003 criteria still apply. No new criteria needed to diagnose PMOS." },
    { num: "4", text: "'Polyendocrine' captures multi-hormonal dysfunction (GnRH, androgens, insulin). 'Metabolic' validates insulin resistance as core — not a complication. 'Ovarian' retains clinical continuity." },
    { num: "5", text: "Clinical workup NOW EXPANDS to include mandatory metabolic screening: fasting glucose, HbA1c, lipids, BP, and mental health assessment." },
    { num: "6", text: "Treatment reframes toward upstream targets: lifestyle + metformin/GLP-1 for metabolic features; letrozole for fertility; COCP for androgen control." },
    { num: "7", text: "PMOS reduces stigma, improves diagnostic clarity, and demands multidisciplinary care — endocrinology, gynaecology, dietetics, and mental health." },
    { num: "8", text: "Transition is gradual: ICD-11 updates, guideline revisions, and EHR changes underway. 'PCOS' remains a recognised legacy term during transition." },
  ];

  takeaways.forEach(({ num, text }, i) => {
    const y = 1.22 + i * 0.52;
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    s.addText(num, { x: 0.3, y: y + 0.06, w: 0.35, h: 0.35, fontSize: 10, bold: true, color: C.navy, fontFace: "Calibri", align: "center" });
    s.addText(text, { x: 0.75, y: y + 0.05, w: 9.0, h: 0.4, fontSize: 10.5, color: C.white, fontFace: "Calibri", margin: 0 });
  });

  footer(s, "26 — Bonus");
})();

// ══════════════════════════════════════════════════════════════════════════
// BONUS SLIDE 27 — References & Further Reading
// ══════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.soft } });
  titleBar(s, "References & Further Reading");

  const refs = [
    "1. Teede HJ, Bahri Khomami M, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026 May 12. DOI: 10.1016/S0140-6736(26)00717-8. PMID: 42119588",
    "2. Teede HJ, Moran LJ, Morman R, et al. Polycystic ovarian syndrome perspectives from patients and health professionals on clinical features, current name, and renaming: a longitudinal international online survey. EClinicalMedicine. 2025;84:103287. DOI: 10.1016/j.eclinm.2025.103287",
    "3. Teede HJ, Tay CT, Laven JSE, et al. Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447–69.",
    "4. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19–25.",
    "5. World Health Organization. Polycystic ovary syndrome. WHO Fact Sheet. 2023.",
    "6. Azziz R, Carmina E, Chen Z, et al. Polycystic ovary syndrome. Nat Rev Dis Primers. 2016;2:16057.",
    "7. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997;18(6):774–800.",
    "8. Lim SS, Hutchison SK, Van Ryswyk E, et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019;3:CD007506.",
  ];

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  });

  panel(s, 0.3, 5.25, 9.4, 0.2, C.teal);
  s.addText("For the full Lancet text: https://doi.org/10.1016/S0140-6736(26)00717-8", {
    x: 0.3, y: 5.26, w: 9.4, h: 0.18, fontSize: 8.5, color: C.white, fontFace: "Calibri", align: "center",
  });

  footer(s, "27 — References");
})();

// ══════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/pmos-pptx/PMOS_Lancet2026_Review.pptx" })
  .then(() => console.log("✅ PPTX written successfully"))
  .catch(err => { console.error("❌ Error:", err); process.exit(1); });

cd /home/daytona/workspace/pmos-pptx && node generate.js 2>&1

ls -lh /home/daytona/workspace/pmos-pptx/PMOS_Lancet2026_Review.pptx