const pptxgen = require("pptxgenjs");
const fs = require("fs");
const path = require("path");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Irritants, Counterirritants, Plasters, Poultice & Paste";
pres.author = "Pharmacology – Undergraduate Physiotherapy";

// ── Colour palette ──────────────────────────────────────────────────────────
const C = {
  navy:   "0B2D5E",  // dominant bg
  teal:   "1A7A8A",  // accent / section bar
  gold:   "F5A623",  // highlights
  white:  "FFFFFF",
  ltBlue: "D6EAF8",  // card bg
  slate:  "2C3E50",  // body text
  green:  "1E8449",  // table header
  red:    "C0392B",  // warning / contra
  cream:  "FEF9EF",  // light slide bg
};

// ── Helper functions ─────────────────────────────────────────────────────────
function addSlide(bg) {
  const sl = pres.addSlide();
  sl.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 5.625, fill: { color: bg || C.cream }, line: { color: bg || C.cream }
  });
  return sl;
}

function slideHeader(sl, title, barColor) {
  const bc = barColor || C.navy;
  sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.72, fill: { color: bc }, line: { color: bc } });
  sl.addText(title, { x: 0.25, y: 0.05, w: 9.5, h: 0.62, fontSize: 22, bold: true, color: C.white, valign: "middle", margin: 0 });
}

function footerRef(sl, ref) {
  sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.35, w: 10, h: 0.275, fill: { color: C.navy }, line: { color: C.navy } });
  sl.addText(ref || "Source: KD Tripathi, Goodman & Gilman, Katzung, Fitzpatrick's Dermatology", {
    x: 0.2, y: 5.36, w: 9.6, h: 0.24, fontSize: 8, color: C.gold, italic: true, valign: "middle", margin: 0
  });
}

function bulletBox(sl, items, x, y, w, h, fontSize, color) {
  const texts = items.map((t, i) => ({
    text: t,
    options: { bullet: { type: "bullet" }, breakLine: i < items.length - 1, fontSize: fontSize || 15, color: color || C.slate, paraSpaceBefore: 4 }
  }));
  sl.addText(texts, { x, y, w, h, valign: "top", margin: 6 });
}

function sectionDivider(title, subtitle) {
  const sl = addSlide(C.navy);
  sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 2.0, w: 10, h: 0.08, fill: { color: C.gold }, line: { color: C.gold } });
  sl.addText(title, { x: 0.5, y: 1.2, w: 9, h: 1.2, fontSize: 36, bold: true, color: C.white, align: "center", valign: "middle" });
  if (subtitle) sl.addText(subtitle, { x: 0.5, y: 2.5, w: 9, h: 0.8, fontSize: 18, color: C.gold, align: "center", italic: true });
  footerRef(sl);
  return sl;
}

function card(sl, x, y, w, h, title, body, titleColor, cardBg) {
  const tc = titleColor || C.navy;
  const cb = cardBg || C.ltBlue;
  sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y, w, h, fill: { color: cb }, line: { color: C.teal, width: 1 }, rectRadius: 0.08 });
  sl.addText(title, { x: x + 0.1, y: y + 0.06, w: w - 0.2, h: 0.38, fontSize: 13, bold: true, color: tc, margin: 0 });
  sl.addText(body, { x: x + 0.1, y: y + 0.44, w: w - 0.2, h: h - 0.52, fontSize: 11.5, color: C.slate, valign: "top", margin: 0, wrap: true });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE SLIDE
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.navy);
  sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 3.8, w: 10, h: 1.825, fill: { color: C.teal }, line: { color: C.teal } });
  sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.18, fill: { color: C.gold }, line: { color: C.gold } });
  sl.addText("Irritants, Counterirritants,", { x: 0.4, y: 0.55, w: 9.2, h: 0.9, fontSize: 32, bold: true, color: C.white, align: "center" });
  sl.addText("Plasters, Poultice & Paste", { x: 0.4, y: 1.4, w: 9.2, h: 0.9, fontSize: 32, bold: true, color: C.gold, align: "center" });
  sl.addShape(pres.shapes.RECTANGLE, { x: 3.5, y: 2.45, w: 3, h: 0.06, fill: { color: C.gold }, line: { color: C.gold } });
  sl.addText("Pharmacology for Undergraduate Physiotherapy Students", {
    x: 0.5, y: 2.65, w: 9, h: 0.5, fontSize: 16, color: C.ltBlue, align: "center", italic: true
  });
  sl.addText("Sources: KD Tripathi • Goodman & Gilman • Katzung • Fitzpatrick's Dermatology • Standard Physiotherapy & Orthopaedics Textbooks", {
    x: 0.4, y: 3.88, w: 9.2, h: 0.55, fontSize: 11, color: C.white, align: "center", italic: true
  });
  sl.addText("Undergraduate Physiotherapy Programme  |  2026", {
    x: 0.4, y: 4.55, w: 9.2, h: 0.4, fontSize: 13, color: C.gold, align: "center", bold: true
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – OVERVIEW / CONTENTS
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Contents at a Glance", C.navy);
  const topics = [
    ["01", "Introduction & Historical Perspective"],
    ["02", "Irritants – Definition, Classification, Mechanism"],
    ["03", "Counterirritants – Mechanism & Gate Control Theory"],
    ["04", "Specific Counterirritant Agents (Capsaicin, Menthol, Methyl Salicylate, Camphor, Turpentine)"],
    ["05", "Plasters – Types, Composition, Clinical Uses"],
    ["06", "Poultice – Definition, Types, Uses"],
    ["07", "Paste – Definition, Types (Zinc Oxide, Unna Boot), Uses"],
    ["08", "Physiotherapy Relevance & Clinical Applications"],
    ["09", "Adverse Effects, Contraindications & Precautions"],
    ["10", "Comparative Summary & Quick Review"],
  ];
  topics.forEach(([num, text], i) => {
    const row = Math.floor(i / 2);
    const col = i % 2;
    const x = 0.3 + col * 4.85;
    const y = 0.9 + row * 0.84;
    sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y, w: 4.6, h: 0.74, fill: { color: C.ltBlue }, line: { color: C.teal, width: 1 }, rectRadius: 0.07 });
    sl.addText(num, { x: x + 0.08, y: y + 0.12, w: 0.5, h: 0.5, fontSize: 16, bold: true, color: C.teal, margin: 0 });
    sl.addText(text, { x: x + 0.6, y: y + 0.08, w: 3.9, h: 0.58, fontSize: 11, color: C.slate, valign: "middle", margin: 0, wrap: true });
  });
  footerRef(sl);
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – SECTION DIVIDER: IRRITANTS
// ════════════════════════════════════════════════════════════════════════════
sectionDivider("IRRITANTS", "Definition • Classification • Mechanism of Action");

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – DEFINITION & CLASSIFICATION OF IRRITANTS
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Irritants – Definition & Classification");
  sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 0.82, w: 9.4, h: 0.72, fill: { color: C.navy }, line: { color: C.navy }, rectRadius: 0.08 });
  sl.addText("An irritant is a substance that, when applied topically or locally, causes a localised inflammatory reaction, stimulating sensory nerve endings and producing erythema, warmth, and mild inflammation without causing tissue destruction.", {
    x: 0.45, y: 0.87, w: 9.1, h: 0.62, fontSize: 12, color: C.white, italic: true, valign: "middle", margin: 0
  });

  sl.addText("CLASSIFICATION", { x: 0.3, y: 1.65, w: 4.0, h: 0.32, fontSize: 13, bold: true, color: C.teal });
  const classData = [
    ["By Intensity", "Mild (rubefacients) → local redness\nModerate → vesication\nSevere → ulceration/escharotics"],
    ["By Source", "Natural (plant-based): capsaicin, turpentine, mustard\nSynthetic: methyl salicylate, diclofenac gel"],
    ["By Mechanism", "TRPV1 agonists (capsaicin)\nCOX inhibitors (topical NSAIDs)\nNon-specific membrane effects (menthol, camphor)"],
    ["By Clinical Use", "Counterirritants, Rubefacients, Vesicants, Escharotics"],
  ];
  classData.forEach(([title, body], i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    card(sl, 0.3 + col * 4.7, 2.05 + row * 1.38, 4.5, 1.28, title, body, C.teal, C.ltBlue);
  });
  footerRef(sl);
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – RUBEFACIENTS vs VESICANTS vs ESCHAROTICS
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Types of Irritants – Spectrum of Action");
  const rows = [
    ["TYPE", "INTENSITY", "LOCAL EFFECT", "EXAMPLES", "USE IN PT"],
    ["Rubefacient", "Mild", "Redness, warmth, vasodilation", "Methyl salicylate, menthol, turpentine", "Muscle/joint pain relief"],
    ["Vesicant", "Moderate", "Blister/vesicle formation", "Cantharides (blister beetle)", "Historically for CRPS; now obsolete"],
    ["Pustulant", "Moderate-high", "Pus formation in skin", "Croton oil (historical)", "No current clinical role"],
    ["Escharotic", "Severe", "Tissue necrosis, eschar", "Trichloroacetic acid, phenol (high conc.)", "Wart/lesion removal only"],
  ];
  const colWidths = [1.5, 1.2, 2.2, 2.5, 2.0];
  const xs = [0.15, 1.65, 2.85, 5.05, 7.55];
  rows.forEach((row, ri) => {
    const y = 0.88 + ri * 0.82;
    const bg = ri === 0 ? C.navy : (ri % 2 === 0 ? C.ltBlue : "EBF5FB");
    const txtColor = ri === 0 ? C.white : C.slate;
    sl.addShape(pres.shapes.RECTANGLE, { x: 0.15, y, w: 9.7, h: 0.76, fill: { color: bg }, line: { color: bg } });
    row.forEach((cell, ci) => {
      sl.addText(cell, { x: xs[ci] + 0.05, y: y + 0.06, w: colWidths[ci] - 0.1, h: 0.64, fontSize: ri === 0 ? 11 : 10.5, bold: ri === 0, color: txtColor, valign: "middle", wrap: true, margin: 0 });
    });
  });
  footerRef(sl, "Source: KD Tripathi – Essentials of Medical Pharmacology; Goodman & Gilman's Pharmacological Basis");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – SECTION DIVIDER: COUNTERIRRITANTS
// ════════════════════════════════════════════════════════════════════════════
sectionDivider("COUNTERIRRITANTS", "Mechanism • Gate Control Theory • Clinical Rationale");

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – DEFINITION & MECHANISM OF COUNTERIRRITANTS
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Counterirritants – Definition & Mechanism");
  sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 0.82, w: 9.4, h: 0.68, fill: { color: C.navy }, line: { color: C.navy }, rectRadius: 0.08 });
  sl.addText("A counterirritant is a mild irritant applied to the skin to produce superficial inflammation, which in turn reduces or masks deeper visceral or musculoskeletal pain through neurological mechanisms.", {
    x: 0.45, y: 0.87, w: 9.1, h: 0.58, fontSize: 12, color: C.white, italic: true, valign: "middle", margin: 0
  });
  sl.addText("Mechanisms of Action", { x: 0.3, y: 1.62, w: 4.5, h: 0.32, fontSize: 14, bold: true, color: C.teal });
  const mechs = [
    ["1. Gate Control Theory (Melzack & Wall, 1965)", "Mild skin stimulation activates large-diameter Aβ afferent fibres, which activate inhibitory interneurons in the spinal cord dorsal horn (Substantia Gelatinosa). These interneurons inhibit pain transmission from small-diameter Aδ & C fibres → 'closing the gate' to pain signals."],
    ["2. Diffuse Noxious Inhibitory Control (DNIC)", "Activation of nociceptors at a distant site triggers endogenous opioid release and descending serotonergic/noradrenergic inhibition from the brainstem (PAG-RVM pathway), suppressing pain globally."],
    ["3. Local Vasodilation", "Increased cutaneous blood flow via axon reflex and release of vasoactive peptides (CGRP, Substance P) → warming effect → relieves muscle spasm and stiffness."],
    ["4. Substance P Depletion (Capsaicin)", "Repeated application of capsaicin stimulates, then depletes Substance P from C-fibre terminals → prolonged desensitisation of pain fibres (Goodman & Gilman 14e)."],
  ];
  mechs.forEach(([title, body], i) => {
    const y = 2.02 + i * 0.82;
    sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y, w: 9.4, h: 0.76, fill: { color: i % 2 === 0 ? C.ltBlue : "E8F8F5" }, line: { color: C.teal, width: 0.75 }, rectRadius: 0.07 });
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  });
  footerRef(sl);
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – GATE CONTROL THEORY (VISUAL)
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Gate Control Theory & Counterirritant Action");
  // Left: diagram image
  const img0 = fs.readFileSync("/home/daytona/workspace/physio-ppt/img0.jpg");
  sl.addImage({ data: "image/jpeg;base64," + img0.toString("base64"), x: 0.25, y: 0.85, w: 4.5, h: 3.5, altText: "Gate control spinal cord pain diagram" });
  // Right: key points
  sl.addShape(pres.shapes.RECTANGLE, { x: 4.95, y: 0.85, w: 4.8, h: 3.5, fill: { color: C.navy }, line: { color: C.navy } });
  const pts = [
    "Aβ fibres (touch/pressure) activate inhibitory interneurons in Substantia Gelatinosa",
    "Inhibitory interneurons block T-cells (transmission cells) → pain gate CLOSED",
    "Counterirritants mimic this by activating Aβ & Aδ fibres superficially",
    "Deep pain (muscle, joint) signal is effectively suppressed",
    "Clinically: explains why heat rubs, TENS, massage & topical agents reduce pain",
    "Melzack & Wall (1965) — foundational theory in pain physiology"
  ];
  pts.forEach((pt, i) => {
    sl.addText("• " + pt, { x: 5.08, y: 0.98 + i * 0.56, w: 4.5, h: 0.5, fontSize: 10.5, color: C.white, valign: "middle", margin: 0, wrap: true });
  });
  footerRef(sl);
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – CAPSAICIN
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Capsaicin – The Prototype Counterirritant");
  sl.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 0.82, w: 3.0, h: 0.38, fill: { color: C.teal }, line: { color: C.teal } });
  sl.addText("Source & Chemistry", { x: 0.35, y: 0.84, w: 2.9, h: 0.34, fontSize: 12, bold: true, color: C.white, margin: 0 });
  sl.addText("Alkaloid from Capsicum annuum (chilli peppers). Active pungent constituent. Fat-soluble vanilloid compound (trans-8-methyl-N-vanillyl-6-nonenamide).", {
    x: 0.3, y: 1.24, w: 4.3, h: 0.7, fontSize: 11, color: C.slate, wrap: true
  });
  sl.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 2.0, w: 3.0, h: 0.38, fill: { color: C.teal }, line: { color: C.teal } });
  sl.addText("Mechanism", { x: 0.35, y: 2.02, w: 2.9, h: 0.34, fontSize: 12, bold: true, color: C.white, margin: 0 });
  bulletBox(sl, [
    "Binds TRPV1 (Transient Receptor Potential Vanilloid 1) on C-fibres & Aδ fibres",
    "Initial application → burning sensation + erythema (Substance P release)",
    "Repeated use → Substance P DEPLETION → desensitization of nociceptors",
    "Long-term: nociceptor deactivation → pain relief (Goodman & Gilman 14e)"
  ], 0.3, 2.45, 4.4, 2.8, 11, C.slate);
  // Right panel – clinical info + image
  const img2 = fs.readFileSync("/home/daytona/workspace/physio-ppt/img2.jpg");
  sl.addImage({ data: "image/jpeg;base64," + img2.toString("base64"), x: 4.85, y: 0.82, w: 4.9, h: 2.7, altText: "Capsaicin 8% patch clinical application" });
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  sl.addText("Clinical Uses in Physiotherapy", { x: 4.95, y: 3.62, w: 4.6, h: 0.3, fontSize: 12, bold: true, color: C.navy, margin: 0 });
  bulletBox(sl, [
    "Osteoarthritis, rheumatoid arthritis (joint pain)",
    "Postherpetic neuralgia (PHN)",
    "Diabetic neuropathy",
    "Complex regional pain syndrome (CRPS)",
    "Low back pain, myofascial pain syndrome"
  ], 4.9, 3.95, 4.7, 1.2, 10.5, C.slate);
  footerRef(sl, "Source: Goodman & Gilman 14e; Dermatology 2-Volume Set 5e; Lippincott Pharmacology");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – CAPSAICIN: Doses, Formulations, ADRs
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Capsaicin – Formulations, Dosing & Adverse Effects");
  const img1 = fs.readFileSync("/home/daytona/workspace/physio-ppt/img1.jpg");
  sl.addImage({ data: "image/jpeg;base64," + img1.toString("base64"), x: 0.25, y: 0.82, w: 4.5, h: 2.6, altText: "Capsaicin pain NRS response and erythema" });
  const forms = [["Cream 0.025%", "Arthritis, general musculoskeletal pain"],["Cream 0.075%", "Neuropathic pain (PHN, diabetic neuropathy)"],["Patch 8% (Qutenza)", "Severe neuropathic pain; single-use clinic application"],["Gel / Roll-on", "Soft tissue sports injuries"],];
  sl.addText("Formulations", { x: 4.9, y: 0.85, w: 4.8, h: 0.3, fontSize: 13, bold: true, color: C.teal });
  forms.forEach(([form, use], i) => {
    const y = 1.2 + i * 0.64;
    sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 4.9, y, w: 4.8, h: 0.58, fill: { color: i%2===0?C.ltBlue:"E8F8F5" }, line: { color: C.teal, width: 0.75 }, rectRadius: 0.06 });
    sl.addText(form, { x: 5.0, y: y+0.04, w: 1.8, h: 0.25, fontSize: 11, bold: true, color: C.navy, margin: 0 });
    sl.addText(use, { x: 5.0, y: y+0.29, w: 4.5, h: 0.25, fontSize: 10.5, color: C.slate, margin: 0 });
  });
  // ADRs and precautions
  sl.addShape(pres.shapes.RECTANGLE, { x: 0.25, y: 3.5, w: 9.5, h: 1.7, fill: { color: "FEF0F0" }, line: { color: C.red, width: 1 } });
  sl.addText("⚠  Adverse Effects & Precautions", { x: 0.4, y: 3.55, w: 5, h: 0.3, fontSize: 13, bold: true, color: C.red, margin: 0 });
  bulletBox(sl, [
    "Initial burning/stinging sensation (subsides with repeated use – instruct patient)",
    "Erythema and local warmth (expected pharmacological response)",
    "Avoid eyes, mucous membranes, broken skin",
    "Wash hands after application (or use gloves)",
    "Use OTC concentrations 3–4× daily for minimum 4 weeks for efficacy",
    "8% patch: clinic use only under specialist supervision"
  ], 0.35, 3.88, 9.3, 1.25, 10.5, C.slate);
  footerRef(sl);
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – MENTHOL
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Menthol – Cooling Counterirritant");
  const cols = [
    { title: "Source & Chemistry", body: "Cyclic terpene alcohol obtained from Mentha piperita (peppermint). Available in levorotatory (natural) and racemic forms. Volatile, lipid-soluble." },
    { title: "Mechanism", body: "Activates TRPM8 (cold-sensitive) receptors on Aδ and C fibres → cool sensation overrides pain/itch signals. Acts as counterirritant via Gate Control – competing sensory input. Also mild local anaesthetic effect at high concentrations." },
    { title: "Concentrations & Formulations", body: "0.1–1%: antipruritic lotions, aftershaves\n1–3%: muscle/joint rubs (Sarna, Icy Hot)\n5–16%: topical analgesics for deep pain\nAvailable as cream, gel, spray, patches (Lidoderm+menthol)" },
    { title: "Clinical Uses (Physiotherapy)", body: "• Acute sprains & muscle soreness\n• Post-exercise recovery rubs\n• Counterirritant in neck/shoulder stiffness\n• Combined with methyl salicylate (BenGay, Icy Hot)\n• Itch/pruritus management in skin conditions" },
    { title: "Adverse Effects", body: "• Local irritation if > 16% concentration\n• Avoid in infants (mentholated nasal drops – respiratory risk)\n• Cold burn if left under occlusion\n• Allergy: rare contact dermatitis" },
    { title: "Key Reference", body: "Fitzpatrick's Dermatology 5e: 'Menthol is a counterirritant that, by induction of a cool sensation via TRPM8 receptors, overwhelms sensation of itch/pain.'" },
  ];
  cols.forEach((c, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    card(sl, 0.2 + col * 3.22, 0.88 + row * 2.22, 3.08, 2.1, c.title, c.body, C.navy, i % 2 === 0 ? C.ltBlue : "E8F8F5");
  });
  footerRef(sl, "Source: Fitzpatrick's Dermatology; Goodman & Gilman 14e; Tintinalli's Emergency Medicine");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 12 – METHYL SALICYLATE (Oil of Wintergreen)
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Methyl Salicylate (Oil of Wintergreen)");
  sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 0.84, w: 9.4, h: 0.62, fill: { color: C.navy }, line: { color: C.navy }, rectRadius: 0.07 });
  sl.addText("Methyl salicylate ('oil of wintergreen') is used externally as a cutaneous counterirritant in liniments such as arthritis creams and sports rubs. — Lippincott Illustrated Reviews: Pharmacology", {
    x: 0.45, y: 0.88, w: 9.1, h: 0.52, fontSize: 11.5, italic: true, color: C.white, valign: "middle", margin: 0
  });
  const pts = [
    ["Source", "Naturally in Gaultheria procumbens (wintergreen); also synthetically produced by esterification of salicylic acid with methanol."],
    ["Mechanism", "Acts as a local irritant/rubefacient → vasodilation, warmth, counterirritant effect. Also has weak COX inhibition → topical anti-inflammatory action. Strong, characteristic odour."],
    ["Formulations", "15–30%: Liniments (BenGay, Deep Heat, Tiger Balm, Moov)\nCombined with menthol, camphor, eucalyptus in most products. Available as cream, gel, ointment, spray."],
    ["Physiotherapy Uses", "Muscle soreness, sprains, ligament strains, arthritic joints, neck stiffness, pre-exercise warm-up, post-exercise recovery."],
    ["⚠ Toxicity Warning", "TOXIC IF SWALLOWED – salicylate poisoning. 1 tsp (~5 mL) methyl salicylate = ~7 adult aspirin tablets. Keep out of reach of children. Avoid mucous membranes. Do NOT use under occlusion/heating pads – enhances systemic absorption dangerously (Tintinalli EM)."],
  ];
  pts.forEach(([label, body], i) => {
    const y = 1.57 + i * 0.76;
    sl.addShape(pres.shapes.RECTANGLE, { x: 0.3, y, w: 1.9, h: 0.68, fill: { color: C.teal }, line: { color: C.teal } });
    sl.addText(label, { x: 0.35, y: y + 0.04, w: 1.8, h: 0.6, fontSize: 11, bold: true, color: C.white, valign: "middle", margin: 0, wrap: true });
    sl.addShape(pres.shapes.RECTANGLE, { x: 2.2, y, w: 7.5, h: 0.68, fill: { color: i % 2 === 0 ? C.ltBlue : "E8F8F5" }, line: { color: C.teal, width: 0.5 } });
    sl.addText(body, { x: 2.3, y: y + 0.06, w: 7.3, h: 0.56, fontSize: i === 4 ? 10 : 10.5, color: i === 4 ? C.red : C.slate, valign: "middle", margin: 0, wrap: true });
  });
  footerRef(sl, "Source: Lippincott Pharmacology; Tintinalli's Emergency Medicine; KD Tripathi");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – CAMPHOR & TURPENTINE OIL
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Camphor & Turpentine Oil");
  // Camphor
  sl.addShape(pres.shapes.RECTANGLE, { x: 0.25, y: 0.85, w: 4.7, h: 0.4, fill: { color: C.teal }, line: { color: C.teal } });
  sl.addText("CAMPHOR", { x: 0.3, y: 0.87, w: 4.5, h: 0.36, fontSize: 14, bold: true, color: C.white, margin: 0 });
  bulletBox(sl, [
    "Source: Cinnamomum camphora (camphor tree); also synthetic",
    "Mechanism: TRPM8 agonist (cooling) + TRPA1 activation at higher concentrations → counterirritant. Local anaesthetic effect at nerve endings",
    "Formulations: Camphorated oil 19–20%, in combination rubs (Vicks VapoRub, Icy Hot)",
    "Uses: Muscle aches, joint pain, itching, mild local anaesthesia",
    "Toxicity: Toxic if ingested – can cause seizures. Avoid applying near face of infants/toddlers. FDA recommends max 11% in topical products",
  ], 0.25, 1.32, 4.7, 3.8, 11, C.slate);

  // Turpentine
  sl.addShape(pres.shapes.RECTANGLE, { x: 5.2, y: 0.85, w: 4.5, h: 0.4, fill: { color: C.green }, line: { color: C.green } });
  sl.addText("TURPENTINE OIL", { x: 5.25, y: 0.87, w: 4.3, h: 0.36, fontSize: 14, bold: true, color: C.white, margin: 0 });
  bulletBox(sl, [
    "Source: Oleoresin from Pinus species (Pine trees); volatile oil obtained by distillation",
    "Chemical: Principally α-pinene and β-pinene (bicyclic monoterpenes)",
    "Mechanism: Rubefacient – direct skin irritation → erythema, vasodilation, warmth. Counterirritant by Gate Control mechanism",
    "Formulations: Turpentine liniment, compound liniment, combined ointments",
    "Historical/traditional use: Chest rubs for bronchitis, musculoskeletal pain (historical physiotherapy, now largely replaced)",
    "Adverse: Skin sensitisation, allergic dermatitis, renal irritation if absorbed in large amounts",
  ], 5.2, 1.32, 4.6, 3.8, 11, C.slate);
  footerRef(sl, "Source: KD Tripathi Essentials of Medical Pharmacology; Cummings Otolaryngology");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 14 – COUNTERIRRITANT AGENTS COMPARISON TABLE
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Counterirritants – Comparative Summary");
  const rows = [
    ["Agent", "Receptor / Target", "Key Effect", "Common Products", "PT Relevance"],
    ["Capsaicin", "TRPV1 (vanilloid)", "Substance P depletion, desensitisation", "Zostrix, Capsiderm, 8% patch", "Neuropathic pain, OA, CRPS"],
    ["Menthol", "TRPM8 (cold)", "Cooling, antipruritic, mild LA", "Icy Hot, Sarna, Deep Freeze", "Muscle rubs, sprains, itch"],
    ["Methyl Salicylate", "Local + COX-inhibition", "Warmth, rubefacient, anti-inflam.", "BenGay, Deep Heat, Tiger Balm", "Sports injuries, arthritis"],
    ["Camphor", "TRPM8 + TRPA1", "Cooling/warming dual effect", "Vicks VapoRub, camphor oil", "Muscle aches, itching"],
    ["Turpentine Oil", "Non-specific irritation", "Strong rubefacient, vasodilator", "Compound liniment", "Traditional use, historical"],
    ["Diclofenac (topical)", "COX-1/COX-2 inhibition", "Anti-inflammatory, analgesic", "Voltaren Gel, Diclac Gel", "OA knee/hand, soft tissue"],
  ];
  const cols = [1.5, 1.8, 2.1, 2.0, 2.1];
  const xs2 = [0.1, 1.6, 3.4, 5.5, 7.5];
  rows.forEach((row, ri) => {
    const y = 0.83 + ri * 0.66;
    const bg = ri === 0 ? C.navy : ri % 2 === 0 ? C.ltBlue : "F0FAF0";
    const tc = ri === 0 ? C.white : C.slate;
    sl.addShape(pres.shapes.RECTANGLE, { x: 0.1, y, w: 9.8, h: 0.6, fill: { color: bg }, line: { color: bg } });
    row.forEach((cell, ci) => {
      sl.addText(cell, { x: xs2[ci] + 0.05, y: y + 0.04, w: cols[ci] - 0.1, h: 0.52, fontSize: ri === 0 ? 10.5 : 10, bold: ri === 0, color: tc, valign: "middle", wrap: true, margin: 0 });
    });
  });
  footerRef(sl, "Source: Goodman & Gilman; Lippincott Pharmacology; Fitzpatrick's Dermatology; KD Tripathi");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 15 – SECTION DIVIDER: PLASTERS
// ════════════════════════════════════════════════════════════════════════════
sectionDivider("PLASTERS", "Types • Composition • Medicinal & Orthopaedic Uses");

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 16 – PLASTERS: Definition & Classification
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Plasters – Definition & Classification");
  sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 0.82, w: 9.4, h: 0.68, fill: { color: C.navy }, line: { color: C.navy }, rectRadius: 0.07 });
  sl.addText("A plaster is a solid or semisolid adhesive preparation applied to skin/mucous membranes, designed to remain in place and deliver local mechanical support or a medicinal agent percutaneously.", {
    x: 0.45, y: 0.87, w: 9.1, h: 0.56, fontSize: 12, italic: true, color: C.white, valign: "middle", margin: 0
  });
  const plasterTypes = [
    { title: "1. Adhesive / Strapping Plasters", body: "Plain adhesive plasters (band-aid type) and zinc oxide strapping tape for joint support, immobilisation, wound protection.\nMaterial: Cotton or non-woven fabric + rubber/acrylic adhesive. Used in PT for taping (McConnell, kinesio-taping)." },
    { title: "2. Medicated Plasters", body: "Contain pharmacological agents impregnated into the base:\n• Salicylic acid plaster (40%) – for corns and calluses\n• Capsaicin plaster/patch – neuropathic pain\n• Lidocaine patch (Lidoderm 5%) – postherpetic neuralgia\n• Diclofenac patch – musculoskeletal pain" },
    { title: "3. Mustard Plaster (Sinapism)", body: "Traditional plaster containing mustard (sinapis) powder and black mustard (Brassica nigra). Contains allyl isothiocyanate – a potent TRPA1 agonist and rubefacient. Applied to chest for bronchitis, musculoskeletal pain. Historical physiotherapy use. Rarely used now." },
    { title: "4. Plaster of Paris (CaSO₄·½H₂O)", body: "Calcium sulphate hemihydrate sets hard when water is added. Used for fracture immobilisation, orthopaedic casting. Sets in 3–5 min (extra-fast) to 20–30 min. Generates heat during setting – thermal burns possible if thick layers used (Roberts & Hedges)." },
  ];
  plasterTypes.forEach((p, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    card(sl, 0.25 + col * 4.75, 1.62 + row * 1.82, 4.55, 1.72, p.title, p.body, C.teal, i % 2 === 0 ? C.ltBlue : "E8F8F5");
  });
  footerRef(sl, "Source: Roberts & Hedges' Clinical Procedures in Emergency Medicine; KD Tripathi; Pfenninger & Fowler");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 17 – MEDICATED PLASTERS IN DETAIL
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Medicated Plasters – Physiotherapy Perspective");
  const items = [
    { label: "Salicylic Acid Plaster (40%)", col: C.teal, body: "Used for corn/callus removal, verrucae. Mechanism: Keratolytic – softens and dissolves keratin. Applied directly over lesion, replaced every 24–48 h. Avoid healthy surrounding skin – use protective ring pad. Relevant to physiotherapy as foot conditions affect gait and function." },
    { label: "Capsaicin 8% Patch (Qutenza)", col: C.green, body: "FDA-approved for postherpetic neuralgia, painful diabetic peripheral neuropathy. Single clinic-administered application (60–90 min). Pre-treat with topical anaesthetic. Effect lasts 3 months. Mechanism: High-dose TRPV1 desensitisation, IENFD (intra-epidermal nerve fibre density) reduction." },
    { label: "Lidocaine 5% Patch", col: C.navy, body: "FDA-approved for post-herpetic neuralgia. Up to 3 patches simultaneously for 12 h on / 12 h off. Minimal systemic absorption. Mechanism: Na⁺ channel blockade → local anaesthesia. Well-tolerated; skin reactions mild and transient." },
    { label: "Diclofenac Topical Patch/Gel", col: "#8E44AD", body: "1.3% diclofenac patch for acute pain in minor strains/sprains. Gel formulations for OA (knee, hands). Mechanism: COX-1/2 inhibition locally. Fewer GI adverse effects vs oral NSAIDs. Lippincott Pharmacology: 'Diclofenac is available in topical formulations (gel or solution) for treatment of osteoarthritis'." },
  ];
  items.forEach((item, i) => {
    const row = Math.floor(i / 2);
    const col = i % 2;
    const y = 0.9 + row * 2.3;
    const x = 0.25 + col * 4.8;
    sl.addShape(pres.shapes.RECTANGLE, { x, y, w: 4.6, h: 0.4, fill: { color: item.col }, line: { color: item.col } });
    sl.addText(item.label, { x: x + 0.08, y: y + 0.05, w: 4.44, h: 0.3, fontSize: 12, bold: true, color: C.white, margin: 0 });
    sl.addShape(pres.shapes.RECTANGLE, { x, y: y + 0.4, w: 4.6, h: 1.82, fill: { color: i % 2 === 0 ? C.ltBlue : "F0FAF0" }, line: { color: item.col, width: 0.75 } });
    sl.addText(item.body, { x: x + 0.1, y: y + 0.48, w: 4.4, h: 1.7, fontSize: 10.5, color: C.slate, valign: "top", wrap: true, margin: 0 });
  });
  footerRef(sl, "Source: Lippincott Illustrated Reviews: Pharmacology; Goodman & Gilman 14e");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 18 – PLASTER OF PARIS IN ORTHOPAEDICS
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Plaster of Paris – Orthopaedic Casting");
  sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 0.85, w: 9.4, h: 0.55, fill: { color: C.navy }, line: { color: C.navy }, rectRadius: 0.06 });
  sl.addText("CaSO₄·2H₂O (gypsum) → heat → CaSO₄·½H₂O (plaster of Paris) → add water → CaSO₄·2H₂O (rehydration/setting)", {
    x: 0.4, y: 0.89, w: 9.1, h: 0.45, fontSize: 12, bold: false, italic: true, color: C.gold, valign: "middle", margin: 0
  });
  const sections = [
    { title: "Composition", pts: ["Calcium sulphate hemihydrate impregnated into cotton/non-woven rolls or strips", "Pure POP bandages set in 3–5 min (extra-fast), 5–8 min (fast), 10–15 min (regular)", "Fiberglass splints: lighter, water-resistant, generate less heat – now preferred"] },
    { title: "Setting Process", pts: ["Water incorporated into crystalline lattice during setting (Roberts & Hedges)", "Exothermic reaction – generates HEAT during hardening", "Wet plaster: 2–4× weaker than dry – avoid weight bearing", "Full strength achieved in 24–48 h (POP) vs 30 min (fibreglass)"] },
    { title: "Clinical Application", pts: ["Padding (Webril/stockinette) applied first to protect skin", "POP rolls dipped in lukewarm water (slows setting, smoother mould)", "Mould with palm/flat fingers – avoid pressure ridges", "For fracture immobilisation, post-op casting, clubfoot correction (Ponseti)"] },
    { title: "Complications", pts: ["Thermal burn (plaster heat): use ≤8 layers, lukewarm water, avoid pillows/plastic under cast", "Cast syndrome (SMA): rare, with body/hip spica casts", "Pressure sores, compartment syndrome, stiffness, joint contracture", "POP is bulky, heavy, cannot get wet – limitation vs fibreglass"] },
  ];
  sections.forEach((sec, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.75;
    const y = 1.52 + row * 1.82;
    sl.addShape(pres.shapes.RECTANGLE, { x, y, w: 4.55, h: 0.36, fill: { color: i===0?C.navy:i===1?C.teal:i===2?C.green:C.red }, line: { color: C.navy } });
    sl.addText(sec.title, { x: x+0.08, y: y+0.04, w: 4.3, h: 0.28, fontSize: 12, bold: true, color: C.white, margin: 0 });
    sl.addShape(pres.shapes.RECTANGLE, { x, y: y+0.36, w: 4.55, h: 1.42, fill: { color: i%2===0?C.ltBlue:"F0FAF0" }, line: { color: C.teal, width: 0.5 } });
    bulletBox(sl, sec.pts, x+0.08, y+0.4, 4.35, 1.35, 10.5, C.slate);
  });
  footerRef(sl, "Source: Roberts & Hedges' Clinical Procedures in Emergency Medicine 8e");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 19 – SECTION DIVIDER: POULTICE
// ════════════════════════════════════════════════════════════════════════════
sectionDivider("POULTICE", "Cataplasm • Definition • Types • Physiotherapy Uses");

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 20 – POULTICE: Definition, Types, Uses
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Poultice (Cataplasm) – Definition, Types & Uses");
  sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 0.82, w: 9.4, h: 0.76, fill: { color: C.navy }, line: { color: C.navy }, rectRadius: 0.07 });
  sl.addText([
    { text: "Poultice (Cataplasm): ", options: { bold: true, color: C.gold } },
    { text: "A wet, soft, moist mass of material (solid particles in water base), sometimes heated, applied to diseased skin. Acts as a counterirritant, anti-inflammatory, drawing agent, and moisture-retaining dressing. — Fitzpatrick's Dermatology", options: { color: C.white } }
  ], { x: 0.45, y: 0.88, w: 9.1, h: 0.62, fontSize: 11.5, valign: "middle", margin: 0 });

  // Historical
  sl.addText("Historical Poultices", { x: 0.3, y: 1.72, w: 4.5, h: 0.3, fontSize: 13, bold: true, color: C.teal });
  bulletBox(sl, [
    "Linseed (flaxseed) poultice – anti-inflammatory, drawing",
    "Kaolin poultice – clay-based, still used for boils, abscess",
    "Mustard poultice (sinapism) – rubefacient/counterirritant",
    "Bread/milk poultice – traditional for skin infections",
    "Charcoal poultice – historically for septic wounds",
  ], 0.3, 2.05, 4.55, 2.8, 12, C.slate);

  // Modern
  sl.addText("Modern Poultices", { x: 5.1, y: 1.72, w: 4.5, h: 0.3, fontSize: 13, bold: true, color: C.green });
  bulletBox(sl, [
    "Dextranomer poultice (Debrisan) – porous beads absorb wound exudate in decubiti, leg ulcers",
    "Hydrogel sheets – moist wound healing poultice-type dressings",
    "Alginate dressings (seaweed-derived) – wound-cleansing effect",
    "Activated charcoal dressings – odour control in ulcers",
    "Medical-grade honey (Manuka) – antimicrobial poultice for chronic wounds",
  ], 5.1, 2.05, 4.6, 2.8, 12, C.slate);
  footerRef(sl, "Source: Fitzpatrick's Dermatology 5e; KD Tripathi; Sabiston Textbook of Surgery");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 21 – KAOLIN POULTICE (Most clinically used)
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Kaolin Poultice – Properties & Physiotherapy Relevance");
  const sections2 = [
    { label: "Composition", bg: C.navy, text: "Kaolin (hydrated aluminium silicate / china clay) 52.7%, boric acid 4.5%, peppermint oil, methyl salicylate 0.4%, glycerol, thymol – in a water-miscible base." },
    { label: "Properties", bg: C.teal, text: "Retains heat well (acts as a slow-release heat pack). Absorbs exudate from wounds. pH mildly acidic. Counterirritant effect from methyl salicylate content. Applied warm – pre-heat tin in hot water." },
    { label: "How Applied", bg: C.green, text: "Spread thickly (0.5–1 cm) on lint or flannel cloth. Heat to tolerable temperature (~40–42°C). Apply to skin – cover with another cloth to retain heat. Leave 20–30 min. Repeat 2–4× daily." },
    { label: "Physiotherapy Uses", bg: "#8E44AD", text: "• Boils, carbuncles – draws infection to surface\n• Rheumatic joints – heat therapy + counterirritant\n• Chest infections – traditional poultice on thorax\n• Sprained joints – warmth + anti-inflammatory\n• Post-injury stiffness – before exercise/mobilisation" },
    { label: "Contraindications", bg: C.red, text: "• Open wounds or broken skin\n• Peripheral vascular disease / impaired sensation\n• Acute inflammation (hot, red, swollen joint)\n• Malignancy over treatment area\n• Patient unable to report discomfort" },
    { label: "PT Precautions", bg: C.slate, text: "• Always test temperature before application\n• Do NOT microwave – uneven heating\n• Protect skin edges with petroleum jelly\n• Monitor skin every 5–10 min for burns\n• Never apply over areas with poor circulation" },
  ];
  sections2.forEach((sec, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.2 + col * 3.22;
    const y = 0.88 + row * 2.2;
    sl.addShape(pres.shapes.RECTANGLE, { x, y, w: 3.08, h: 0.36, fill: { color: sec.bg }, line: { color: sec.bg } });
    sl.addText(sec.label, { x: x+0.07, y: y+0.04, w: 2.94, h: 0.28, fontSize: 12, bold: true, color: C.white, margin: 0 });
    sl.addShape(pres.shapes.RECTANGLE, { x, y: y+0.36, w: 3.08, h: 1.76, fill: { color: i%2===0?C.ltBlue:"F0FAF0" }, line: { color: sec.bg, width: 0.75 } });
    sl.addText(sec.text, { x: x+0.08, y: y+0.4, w: 2.9, h: 1.68, fontSize: 10.5, color: C.slate, valign: "top", wrap: true, margin: 0 });
  });
  footerRef(sl, "Source: KD Tripathi; British National Formulary; Standard Physiotherapy Practice");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 22 – SECTION DIVIDER: PASTE
// ════════════════════════════════════════════════════════════════════════════
sectionDivider("PASTE", "Definition • Types • Zinc Oxide • Unna Boot");

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 23 – PASTE: Definition & Classification
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Paste – Definition, Properties & Classification");
  sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 0.82, w: 9.4, h: 0.7, fill: { color: C.navy }, line: { color: C.navy }, rectRadius: 0.07 });
  sl.addText("A paste is a stiff, semisolid preparation containing a HIGH proportion of finely powdered solid (>25%) dispersed in a fatty or aqueous base. Pastes are thicker than ointments, adhere well, and act as barriers/protectants. They are LESS occlusive than ointments (powder absorbs moisture).", {
    x: 0.44, y: 0.88, w: 9.1, h: 0.58, fontSize: 11.5, italic: true, color: C.white, valign: "middle", margin: 0
  });
  sl.addText("Key Properties of Pastes:", { x: 0.3, y: 1.65, w: 4.5, h: 0.3, fontSize: 13, bold: true, color: C.teal });
  bulletBox(sl, [
    "HIGH powder content (ZnO, starch, kaolin, calamine) – absorbs exudate",
    "Stiff consistency – stays in place, less prone to spreading",
    "Protective/barrier function – shields skin from irritants (urine, feces, wound exudate)",
    "Less occlusive than ointments → better for weeping/moist lesions",
    "Less absorption-enhancing than ointments → useful for avoiding systemic effects",
    "Applied with spatula or gloved finger – NOT rubbed in",
  ], 0.3, 1.98, 4.55, 3.2, 12, C.slate);

  sl.addText("Classification of Pastes:", { x: 5.05, y: 1.65, w: 4.5, h: 0.3, fontSize: 13, bold: true, color: C.teal });
  const pasteCats = [
    ["Protective pastes", "Zinc oxide paste, Lassar's paste – skin protection"],
    ["Medicated pastes", "Coal tar paste (psoriasis), Dithranol paste, Salicylic acid paste (keratolytic)"],
    ["Wound dressing pastes", "Unna boot (zinc oxide + gelatin + glycerin), Carboxymethylcellulose paste"],
    ["Dental pastes", "Zinc oxide eugenol (ZOE) paste – cavity filling, root canal"],
    ["Physiotherapy pastes", "Conducting gel (ultrasound), SRS paste, diclofenac gel"],
  ];
  pasteCats.forEach(([type, desc], i) => {
    const y = 2.0 + i * 0.64;
    sl.addShape(pres.shapes.RECTANGLE, { x: 5.05, y, w: 4.65, h: 0.58, fill: { color: i%2===0?C.ltBlue:"E8F8F5" }, line: { color: C.teal, width: 0.5 } });
    sl.addText(type, { x: 5.12, y: y+0.04, w: 2.2, h: 0.24, fontSize: 11, bold: true, color: C.navy, margin: 0 });
    sl.addText(desc, { x: 5.12, y: y+0.28, w: 4.48, h: 0.26, fontSize: 10.5, color: C.slate, margin: 0, wrap: true });
  });
  footerRef(sl, "Source: Fitzpatrick's Dermatology 5e; Sabiston Textbook of Surgery; KD Tripathi");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 24 – ZINC OXIDE PASTE
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Zinc Oxide Paste – The Cornerstone Protective Paste");
  sl.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 0.84, w: 4.55, h: 0.38, fill: { color: C.teal }, line: { color: C.teal } });
  sl.addText("Composition of Lassar's Paste (BP)", { x: 0.35, y: 0.86, w: 4.4, h: 0.34, fontSize: 12, bold: true, color: C.white, margin: 0 });
  const comp = [["Zinc oxide", "25%"], ["Starch", "25%"], ["White soft paraffin", "50%"]];
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  bulletBox(sl, [
    "Astringent: precipitates surface proteins → mild antiseptic",
    "Barrier function: physical protection against urine, feces, exudate",
    "Absorbs moisture from wound surface",
    "Mild anti-inflammatory effect (zinc ions)",
    "Promotes wound healing (zinc is essential for epithelialisation)",
  ], 0.3, 3.15, 4.55, 2.1, 11, C.slate);

  sl.addText("Clinical & Physiotherapy Uses", { x: 5.05, y: 0.84, w: 4.65, h: 0.3, fontSize: 13, bold: true, color: C.teal });
  bulletBox(sl, [
    "Nappy / diaper rash – primary first-line treatment",
    "Intertrigo – friction skin folds (groin, axilla, under breasts)",
    "Perianal skin protection in fistulae/continence disorders",
    "Stoma/ostomy skin protection",
    "Pressure sore prevention around wound edges",
    "Psoriasis plaques (combined with coal tar – Goeckerman therapy)",
    "Eczema maintenance therapy",
    "Unna Boot paste bandage (see next slide)",
    "Heel/elbow padding with zinc oxide strapping in athletes",
  ], 5.05, 1.2, 4.65, 3.25, 12, C.slate);
  footerRef(sl, "Source: Fitzpatrick's Dermatology; Tintinalli's EM; Sabiston Surgery; KD Tripathi");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 25 – UNNA BOOT
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Unna Boot – Zinc Oxide Paste Bandage");
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  sl.addText("The Unna Boot is a semi-rigid compression bandage originally consisting of cotton impregnated with zinc oxide, gelatin, and glycerin paste. It provides (semi-rigid) compression + moisture-retaining occlusive wound environment. — Fitzpatrick's Dermatology 5e", {
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  });
  const unnaInfo = [
    { title: "Composition", body: "Zinc oxide 10–15%, gelatin 15%, glycerin 40%, water. Impregnated into gauze rolls. Applied in layers with compression bandage overlay. Modern versions include Unna Flex, Primer, Vista Mesh." },
    { title: "Mechanism of Action", body: "• Compression reduces venous hypertension and oedema\n• Zinc oxide promotes healing & acts as mild astringent/antiseptic\n• Moist wound environment facilitates autolytic debridement\n• Semi-rigidity resists calf-muscle pump changes" },
    { title: "Application Technique", body: "1. Elevate limb → cleanse ulcer\n2. Apply Unna boot gauze (figure-8 spiral from toes to below knee)\n3. Overlap each layer 50%\n4. Cover with elastic bandage (Coban)\n5. Change every 5–7 days (or sooner if exudate heavy)" },
    { title: "Indications (Physiotherapy)", body: "• Venous stasis ulcers (primary indication)\n• Chronic venous insufficiency\n• Lymphoedema management\n• Oedematous lower limb in neurorehabilitation\n• Ankle sprains (acute immobilisation with compression)" },
    { title: "Contraindications", body: "• Arterial insufficiency (ABI < 0.8)\n• Infected, cellulitic leg\n• Allergy to zinc/gelatin\n• Acute DVT\n• Diabetes with neuropathy (caution – pressure risk)" },
    { title: "Physiotherapy Role", body: "Physiotherapists apply and monitor Unna boots, assess wound healing progress, educate patients on limb elevation and exercise, and integrate with compression hosiery and manual lymphatic drainage." },
  ];
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  });
  footerRef(sl, "Source: Fitzpatrick's Dermatology 5e; Pfenninger & Fowler's Procedures for Primary Care");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 26 – OTHER IMPORTANT PASTES
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Other Important Pastes in Clinical Practice");
  const pastes = [
    { name: "Coal Tar Paste", bg: C.slate, text: "2–10% coal tar in zinc oxide/starch base. Anti-proliferative, antipruritic, anti-inflammatory. Used in psoriasis (Goeckerman regimen), chronic eczema, seborrhoeic dermatitis. Applied overnight under occlusion. Malodorous; stains clothing." },
    { name: "Dithranol (Anthralin) Paste", bg: C.teal, text: "0.1–3% dithranol in yellow soft paraffin. Anti-mitotic – inhibits DNA synthesis in keratinocytes. Gold standard for chronic stable plaque psoriasis. Short contact therapy (30 min). Causes purple-brown staining of skin/clothing." },
    { name: "Salicylic Acid Paste", bg: C.green, text: "2–10% salicylic acid in appropriate base. Keratolytic – softens and removes hyperkeratotic skin. Used in psoriasis, hyperkeratosis, corns, calluses, plantar warts. Enhances penetration of co-applied drugs (e.g., corticosteroids)." },
    { name: "Compound Paste of Zinc & Salicylate (Lassar's)", bg: C.navy, text: "Zinc oxide 24% + salicylic acid 2% + starch 24% + white paraffin 50%. Combines barrier/astringent (ZnO), keratolytic (SA) and protectant (paraffin). Used in psoriasis, eczema, intertrigo. Standard physiotherapy skin preparation." },
    { name: "Ultrasound Coupling Gel", bg: "#2E86C1", text: "Not a medicinal paste per se, but a conductive gel-paste used in therapeutic ultrasound and electrotherapy in physiotherapy. Aqueous, non-irritating, easily removed. Optimises acoustic transmission. Also used for TENS, diathermy electrodes." },
    { name: "Zinc & Castor Oil Paste (BP)", bg: C.red, text: "Zinc oxide 7.5%, castor oil 50%, white beeswax 10%, arachis oil 30.5%. Used as nappy rash barrier, perianal skin protection, pressure sore prevention. Castor oil provides emollient effect; zinc oxide provides astringent/healing." },
  ];
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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 27 – PHYSIOTHERAPY RELEVANCE (COMBINED)
// ════════════════════════════════════════════════════════════════════════════
sectionDivider("Clinical Relevance in Physiotherapy", "Practical Application & Evidence-Based Use");

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 28 – PT CLINICAL APPLICATIONS TABLE
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Physiotherapy: When to Use Which Agent");
  const rows = [
    ["Clinical Condition", "Preferred Agent/Formulation", "Mechanism", "Precautions"],
    ["Acute muscle strain", "Menthol/methyl salicylate gel (cold)", "Counterirritant, TRPM8", "Avoid over broken skin"],
    ["Chronic joint pain (OA)", "Capsaicin 0.025–0.075% cream", "TRPV1, Substance P ↓", "4+ weeks for efficacy"],
    ["Post-exercise soreness", "Menthol + methyl salicylate rub", "Gate control, vasodilation", "Remove before hot bath"],
    ["Neuropathic pain", "Capsaicin 8% patch (clinic)", "TRPV1 desensitisation", "Clinic use; pre-anaesthesia"],
    ["Venous ulcer (leg)", "Unna Boot (ZnO paste + compression)", "Compression + ZnO healing", "Check ABI pre-application"],
    ["Pressure sore prevention", "Zinc oxide paste / barrier cream", "Barrier, astringent, healing", "Monitor q4h; reapply"],
    ["Acute sprain (immobilise)", "Plaster of Paris / fibreglass cast", "Rigid immobilisation", "Check circulation distal"],
    ["Boil / abscess (drawing)", "Kaolin poultice (warm)", "Heat + drawing + CI", "Test temp; avoid burns"],
  ];
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  });
  footerRef(sl, "Source: Standard Physiotherapy Practice; KD Tripathi; Goodman & Gilman");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 29 – ADVERSE EFFECTS, CONTRAINDICATIONS & PRECAUTIONS
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Adverse Effects, Contraindications & Precautions");
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    {
      title: "⚠ Counterirritants (General)", bg: C.red,
      pts: ["Contact dermatitis / sensitisation – especially to menthol, turpentine", "Excessive application → skin burns (especially with heat pads simultaneously)", "Systemic absorption with occlusion or large surface area – toxic with methyl salicylate", "Avoid use on inflamed, abraded, or broken skin", "Children and elderly: more permeable skin – lower concentrations"]
    },
    {
      title: "⚠ Capsaicin Specific", bg: "#8E44AD",
      pts: ["Initial burning/pain on application – warn patient, will subside in 2–4 weeks", "Eye/mucosa contact – severe burning; wear gloves", "8% patch: requires topical LA pre-treatment; clinic-only; skin blanching risk", "Do NOT use in DREZ lesions or central sensitisation without specialist guidance"]
    },
    {
      title: "⚠ Plasters & Casts", bg: C.teal,
      pts: ["POP cast: thermal burn during setting (use lukewarm water, ≤8 layers, no plastic backing)", "Pressure sores under cast – check circulation, sensation, and colour of digits", "Compartment syndrome – pain, paresthesia, pallor, paralysis, pulselessness", "Allergic contact dermatitis to adhesive plasters (latex, acrylate adhesive)"]
    },
    {
      title: "⚠ Poultices & Pastes", bg: C.navy,
      pts: ["Kaolin poultice burn – always test temperature; do not microwave", "Zinc oxide allergy – rare, but possible; test before extensive application", "Unna boot: constriction if oedema worsens; check distally; loosen/reapply if needed", "Coal tar paste: phototoxic – avoid UV exposure; carcinogenic risk with prolonged use", "Paste application around eyes or sensitive skin – irritation risk"]
    }
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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 30 – COMPARISON TABLE (MASTER SUMMARY)
// ════════════════════════════════════════════════════════════════════════════
{
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  slideHeader(sl, "Master Comparison – Irritants, Counterirritants, Plasters, Poultice & Paste");
  const rows = [
    ["Parameter", "Irritants/Counterirritants", "Plasters", "Poultice", "Paste"],
    ["Definition", "Agents producing local skin inflammation to relieve deep pain", "Adhesive/medicated solid preparations applied to skin", "Wet, soft, heated mass applied to skin", "Stiff semisolid with high powder content"],
    ["State", "Cream, gel, ointment, patch", "Solid/semi-solid adhesive", "Moist/wet solid mass", "Semisolid (very thick)"],
    ["Key agents", "Capsaicin, menthol, methyl salicylate, camphor", "ZnO strapping, salicylic acid, POP, capsaicin patch", "Kaolin, dextranomer, linseed, mustard", "Zinc oxide, coal tar, Unna boot, dithranol"],
    ["Mechanism", "TRPV1/TRPM8, Gate Control, Substance P ↓", "Local drug delivery / mechanical support", "Heat, drawing, absorption of exudate", "Barrier, astringent, drug delivery"],
    ["PT application", "Rubs, liniments, patches for pain", "Casting, taping, neuropathic pain", "Boils, joint warmth, chest physiotherapy", "Wound management, skin protection"],
    ["Onset", "Minutes to weeks (capsaicin)", "Immediate (mechanical) / variable (drug)", "30–60 min (heat effect)", "Immediate (barrier)"],
  ];
  const cw = [1.6, 2.0, 2.0, 2.0, 2.0];
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  footerRef(sl, "Compiled from: KD Tripathi; Goodman & Gilman; Katzung; Fitzpatrick's Dermatology; Roberts & Hedges");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 31 – QUICK REVIEW: KEY POINTS
// ════════════════════════════════════════════════════════════════════════════
{
  const sl = addSlide(C.cream);
  slideHeader(sl, "Quick Review – High-Yield Points for Examination");
  const qps = [
    ["Capsaicin Mechanism", "TRPV1 → Substance P release → depletion → analgesia. Concentration: 0.025–0.075% (OTC), 8% (specialist patch). Needs 4+ weeks."],
    ["Menthol Mechanism", "TRPM8 (cold receptor) agonist → cool sensation → Gate Control → pain/itch relief. Counterirritant."],
    ["Methyl Salicylate Toxicity", "Highly toxic if ingested – 1 tsp ≈ 7 aspirin tablets. Never use with heating pads or occlusion."],
    ["Gate Control Theory", "Aβ fibres → inhibitory interneurons → block Aδ/C fibre pain transmission. Basis of counterirritant therapy, TENS, massage."],
    ["Poultice = Cataplasm", "Wet solid mass; kaolin poultice: retains heat, drawing agent. Modern = dextranomer for wound exudate."],
    ["Paste vs Ointment", "Paste = >25% powder → less occlusive, better for moist/weeping lesions. Ointment = occlusive, better for dry skin."],
    ["Unna Boot", "Zinc oxide + gelatin + glycerin paste bandage for venous ulcers. Compression + moist healing. CI: ABI <0.8."],
    ["POP Setting", "Exothermic – generates heat! Use lukewarm water, ≤8 layers. Thermal burns reported (Roberts & Hedges)."],
    ["Kaolin Poultice", "Pre-heat in hot water to ~40–42°C. Apply on lint. Do NOT microwave. Cover and leave 20–30 min."],
    ["Zinc Oxide Paste (Lassar's)", "ZnO 25% + Starch 25% + White paraffin 50%. Barrier + astringent + promotes healing. Used in nappy rash, intertrigo, pressure sore prevention."],
  ];
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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 32 – REFERENCES & THANK YOU
// ════════════════════════════════════════════════════════════════════════════
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  const refs = [
    "1. Tripathi KD. Essentials of Medical Pharmacology. 8th ed. Jaypee Brothers Medical Publishers; 2019. Chapter: Drugs Acting on Skin and Mucous Membranes.",
    "2. Brunton LL, Hilal-Dandan R, Knollmann BC. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 14th ed. McGraw-Hill; 2023.",
    "3. Katzung BG, Trevor AJ. Basic and Clinical Pharmacology. 15th ed. McGraw-Hill; 2021.",
    "4. Lippincott Williams & Wilkins. Lippincott Illustrated Reviews: Pharmacology. 7th ed. Wolters Kluwer; 2020.",
    "5. Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 2-Volume Set, 5th ed. Elsevier; 2024. Chapter: Topical Therapy.",
    "6. Wolff K, Goldsmith LA, et al. Fitzpatrick's Dermatology in General Medicine. 8th ed. McGraw-Hill; 2019.",
    "7. Roberts JR, Hedges JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine. 7th ed. Elsevier; 2019. Chapter: Splinting Techniques.",
    "8. Pfenninger JL, Fowler GC. Pfenninger and Fowler's Procedures for Primary Care. 3rd ed. Elsevier; 2011.",
    "9. Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 7th ed. FA Davis; 2017.",
    "10. Magee DJ. Orthopedic Physical Assessment. 7th ed. Elsevier; 2021.",
  ];
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}

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