const pptxgen = require("pptxgenjs");
const pres = new pptxgen();

pres.layout = 'LAYOUT_WIDE';
pres.title = 'Viral Hepatitis';
pres.author = 'Harrison\'s Principles of Internal Medicine 22E';

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const C = {
  bg_dark:    '0D1B2A',   // deep navy
  bg_mid:     '1B2E44',   // medium navy
  accent:     'E8A020',   // amber/gold
  accent2:    '3AAFA9',   // teal
  accent3:    'E05A3A',   // coral/red
  accent4:    '4CAF79',   // green
  white:      'FFFFFF',
  light_gray: 'D0D8E4',
  text_dark:  '1A1A2E',
  subtitle:   'A8C0D6',
  card_bg:    '162236',
  card_bg2:   '0F2435',
};

// ─── HELPER FUNCTIONS ─────────────────────────────────────────────────────────
function addSlide(bg) {
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: '100%', h: '100%', fill: { color: bg || C.bg_dark } });
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}

function slideHeader(slide, title, subtitle, accentColor) {
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    fontSize: 28, bold: true, color: C.white, fontFace: 'Calibri', margin: 0
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      fontSize: 13, color: C.subtitle, fontFace: 'Calibri', italic: true, margin: 0
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function bullet(text, options) {
  return { text, options: { bullet: { type: 'bullet', code: '25B6' }, fontSize: 14, color: C.white, fontFace: 'Calibri', breakLine: true, ...options } };
}

function bulletDot(text, options) {
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}

function card(slide, x, y, w, h, title, titleColor, bodyItems, bgColor) {
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  slide.addText(bodyItems, { x: x + 0.15, y: y + 0.5, w: w - 0.3, h: h - 0.6, fontSize: 12, color: C.white, fontFace: 'Calibri', valign: 'top', margin: 0 });
}


// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.bg_dark);
  // large accent rect left
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.4, h: '100%', fill: { color: C.accent } });
  // subtle mid panel
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.8, w: 12.9, h: 3.5, fill: { color: C.bg_mid } });
  s.addText('VIRAL HEPATITIS', {
    x: 0.7, y: 2.0, w: 12, h: 1.2,
    fontSize: 52, bold: true, color: C.white, fontFace: 'Calibri', margin: 0, charSpacing: 3
  });
  s.addText('A Comprehensive Overview', {
    x: 0.7, y: 3.2, w: 10, h: 0.5,
    fontSize: 22, color: C.accent, fontFace: 'Calibri', italic: true, margin: 0
  });
  s.addShape(pres.ShapeType.rect, { x: 0.7, y: 3.85, w: 4, h: 0.05, fill: { color: C.accent2 } });
  s.addText("Harrison's Principles of Internal Medicine, 22nd Edition (2025)", {
    x: 0.7, y: 4.0, w: 10, h: 0.4,
    fontSize: 14, color: C.subtitle, fontFace: 'Calibri', margin: 0
  });
  s.addText('Chapter 350 & 352 | Schaefer, Chung, Dienstag', {
    x: 0.7, y: 4.5, w: 10, h: 0.35,
    fontSize: 12, color: C.light_gray, fontFace: 'Calibri', margin: 0, italic: true
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  // decorative circles
  s.addShape(pres.ShapeType.ellipse, { x: 11.0, y: 0.3, w: 2.5, h: 2.5, fill: { color: C.accent, alpha: 85 } });
  s.addShape(pres.ShapeType.ellipse, { x: 11.8, y: 1.2, w: 1.4, h: 1.4, fill: { color: C.accent2, alpha: 80 } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW OUTLINE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.bg_dark);
  slideHeader(s, 'PRESENTATION OUTLINE', 'Topics covered in this presentation', C.accent);

  const topics = [
    { num: '01', title: 'Introduction & Virology', desc: 'HAV, HBV, HCV, HDV, HEV — structure, epidemiology, pathogenesis' },
    { num: '02', title: 'Clinical Features & Diagnosis', desc: 'Symptoms, signs, incubation, lab findings, serologic markers' },
    { num: '03', title: 'Approach to Management', desc: 'General measures, indications for hospitalization, monitoring' },
    { num: '04', title: 'Treatment with Doses', desc: 'Antivirals for HBV and HCV — regimens, doses, duration' },
    { num: '05', title: 'Complications', desc: 'Fulminant hepatitis, chronicity, cirrhosis, HCC, extrahepatic' },
  ];

  const colors = [C.accent, C.accent2, C.accent3, C.accent4, 'B07FD4'];
  topics.forEach((t, i) => {
    const col = i < 3 ? 0 : (i === 3 ? 0 : 0);
    const x = 0.5 + (i % 3) * 4.3;
    const y = i < 3 ? 1.55 : 3.45;
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    s.addText(t.desc, { x: xOff + 0.15, y: yOff + 1.0, w: 3.6, h: 0.5, fontSize: 11, color: C.subtitle, fontFace: 'Calibri', margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — INTRODUCTION (ETIOLOGY)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.bg_dark);
  slideHeader(s, 'INTRODUCTION — VIROLOGY & ETIOLOGY', 'Five primary hepatotropic viruses', C.accent);

  const viruses = [
    { name: 'HAV', color: C.accent,  type: 'RNA', family: 'Picornavirus / Hepatovirus', genome: 'ssRNA (+), 7500 nt', route: 'Fecal-oral', incub: '15–45 days (mean 4 wks)', chronic: 'No' },
    { name: 'HBV', color: C.accent2, type: 'DNA', family: 'Hepadnavirus', genome: 'Partially dsDNA', route: 'Parenteral / Sexual / Perinatal', incub: '30–180 days (mean 8–12 wks)', chronic: 'Yes (1–90%)' },
    { name: 'HCV', color: C.accent3, type: 'RNA', family: 'Flavivirus / Hepacivirus', genome: 'ssRNA (+), 6 genotypes', route: 'Parenteral (IDU)', incub: '15–160 days (mean 7 wks)', chronic: 'Yes (~80%)' },
    { name: 'HDV', color: 'B07FD4', type: 'RNA', family: 'Deltavirus (satellite)', genome: 'Circular ssRNA, HDV Ag', route: 'Co-/Super-infection with HBV', incub: '30–60 days', chronic: 'If superinfection: 70–80%' },
    { name: 'HEV', color: C.accent4, type: 'RNA', family: 'Hepeviridae', genome: 'ssRNA (+), 4 genotypes', route: 'Fecal-oral (waterborne)', incub: '14–60 days (mean 5–6 wks)', chronic: 'Rare (immunosuppressed)' },
  ];

  viruses.forEach((v, i) => {
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    const y = 1.55;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 2.45, h: 4.0, fill: { color: C.card_bg }, line: { color: v.color, width: 2 }, rectRadius: 0.1 });
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    s.addText(v.name, { x: x + 0.05, y: y + 0.08, w: 2.35, h: 0.5, fontSize: 22, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', margin: 0 });

    const rows = [
      [v.type + ' virus', v.family],
      ['Incubation:', v.incub],
      ['Route:', v.route],
      ['Chronicity:', v.chronic],
    ];
    rows.forEach((r, ri) => {
      s.addText(r[0], { x: x + 0.1, y: y + 0.8 + ri * 0.78, w: 2.25, h: 0.32, fontSize: 10.5, bold: true, color: v.color, fontFace: 'Calibri', margin: 0 });
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  s.addText('* HBV is the only DNA virus; replicates like a retrovirus. All others are RNA viruses. HAV/HEV = enteric; HBV/HCV/HDV = parenteral transmission.', {
    x: 0.3, y: 5.65, w: 12.9, h: 0.3, fontSize: 10, color: C.subtitle, fontFace: 'Calibri', italic: true, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.bg_dark);
  slideHeader(s, 'CLINICAL FEATURES & DIAGNOSIS', 'Symptoms, signs, and serologic markers', C.accent2);

  // Left column – Phases
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 1.55, w: 4.0, h: 4.1, fill: { color: C.card_bg }, line: { color: C.accent2, width: 1.5 }, rectRadius: 0.08 });
  s.addText('CLINICAL PHASES', { x: 0.55, y: 1.65, w: 3.7, h: 0.4, fontSize: 14, bold: true, color: C.accent2, fontFace: 'Calibri', margin: 0 });

  const phases = [
    ['Incubation', 'Asymptomatic; viremia present'],
    ['Prodrome\n(pre-icteric)', 'Anorexia, nausea, vomiting, fatigue, myalgia, fever 38–39°C, RUQ pain, aversion to cigarettes/alcohol'],
    ['Icteric Phase', 'Jaundice, dark urine, pale stools, hepatomegaly, splenomegaly (~20%), pruritus'],
    ['Recovery', 'Fatigue may persist weeks to months'],
  ];
  const phaseColors = [C.accent, C.accent2, C.accent3, C.accent4];
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    s.addShape(pres.ShapeType.rect, { x: 0.55, y: 2.1 + i * 0.88, w: 0.1, h: 0.7, fill: { color: phaseColors[i] } });
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    s.addText(p[1], { x: 0.75, y: 2.38 + i * 0.88, w: 3.5, h: 0.4, fontSize: 10.5, color: C.white, fontFace: 'Calibri', margin: 0, wrap: true });
  });

  // Middle column – Labs
  s.addShape(pres.ShapeType.roundRect, { x: 4.7, y: 1.55, w: 4.0, h: 4.1, fill: { color: C.card_bg }, line: { color: C.accent, width: 1.5 }, rectRadius: 0.08 });
  s.addText('LABORATORY FINDINGS', { x: 4.85, y: 1.65, w: 3.7, h: 0.4, fontSize: 14, bold: true, color: C.accent, fontFace: 'Calibri', margin: 0 });

  const labs = [
    ['ALT / AST', 'Elevated 400–4000 IU/L; ALT > AST in viral hepatitis'],
    ['Bilirubin', 'Total Tbili >3 mg/dL with jaundice; both conjugated & unconjugated'],
    ['PT / INR', 'Prolonged in severe disease; best indicator of hepatic synthesis'],
    ['Alkaline\nPhosphatase', 'Modestly elevated; >3× normal suggests cholestasis'],
    ['CBC', 'Atypical lymphocytes; relative leukopenia'],
    ['Serology', 'Type-specific markers (see next column)'],
  ];
  labs.forEach((l, i) => {
    s.addText('▸  ' + l[0], { x: 4.85, y: 2.12 + i * 0.57, w: 3.7, h: 0.25, fontSize: 12, bold: true, color: C.accent, fontFace: 'Calibri', margin: 0 });
    s.addText(l[1], { x: 4.85, y: 2.37 + i * 0.57, w: 3.7, h: 0.22, fontSize: 10.5, color: C.white, fontFace: 'Calibri', margin: 0, wrap: true });
  });

  // Right column – Serologic markers
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  s.addText('KEY SEROLOGIC MARKERS', { x: 9.15, y: 1.65, w: 3.9, h: 0.4, fontSize: 14, bold: true, color: C.accent3, fontFace: 'Calibri', margin: 0 });

  const sero = [
    ['HAV', 'IgM anti-HAV = acute; IgG anti-HAV = past/immunity'],
    ['HBV acute', 'HBsAg (+), IgM anti-HBc (+), HBeAg reflects high replication'],
    ['HBV window', 'HBsAg(-), anti-HBs(-) → only IgM anti-HBc (+)'],
    ['HBV chronic', 'HBsAg >6 months; HBV DNA, HBeAg/anti-HBe, LFTs'],
    ['HCV', 'Anti-HCV ± HCV RNA (RNA confirms viremia)'],
    ['HDV', 'HDAg, anti-HDV; only in HBsAg(+) patients'],
    ['HEV', 'IgM/IgG anti-HEV; HEV RNA in stool/serum'],
  ];
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  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — APPROACH TO MANAGEMENT (ACUTE)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.bg_dark);
  slideHeader(s, 'APPROACH TO MANAGEMENT', 'Acute viral hepatitis — general principles', C.accent4);

  // Box: General measures
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 1.55, w: 6.1, h: 4.1, fill: { color: C.card_bg }, line: { color: C.accent4, width: 1.5 }, rectRadius: 0.08 });
  s.addText('GENERAL MEASURES', { x: 0.55, y: 1.65, w: 5.8, h: 0.4, fontSize: 15, bold: true, color: C.accent4, fontFace: 'Calibri', margin: 0 });

  const general = [
    ['Activity', 'Rest as needed; bed rest is not essential. Restrict strenuous physical activity. Resume activity as tolerated.'],
    ['Diet', 'High-calorie diet preferred. Nausea often worst in afternoon, so major caloric intake in morning. IV fluids if persistent vomiting.'],
    ['Drugs to Avoid', 'All drugs metabolized by liver; hepatotoxic agents; cholestatic drugs. Glucocorticoids have NO role — may worsen chronicity.'],
    ['Pruritus', 'Cholestyramine (bile salt resin) for severe pruritus.'],
    ['Alcohol', 'Abstain completely during acute illness.'],
    ['Isolation', 'No isolation needed for bloodborne types (HBV/HCV/HDV). Enteric precautions for HAV/HEV (hand hygiene, gloves for stool).'],
  ];
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    s.addText('▸  ' + g[0], { x: 0.55, y: 2.12 + i * 0.57, w: 5.8, h: 0.24, fontSize: 12.5, bold: true, color: C.accent4, fontFace: 'Calibri', margin: 0 });
    s.addText(g[1], { x: 0.55, y: 2.36 + i * 0.57, w: 5.8, h: 0.22, fontSize: 10.5, color: C.white, fontFace: 'Calibri', margin: 0, wrap: true });
  });

  // Box: Hospitalization indications
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  s.addText('INDICATIONS FOR HOSPITALIZATION', { x: 6.95, y: 1.65, w: 5.8, h: 0.4, fontSize: 13, bold: true, color: C.accent3, fontFace: 'Calibri', margin: 0 });
  const hosp = ['Prolonged PT / coagulopathy', 'Encephalopathy / altered sensorium', 'Hypoglycemia', 'Persistent vomiting / inability to maintain hydration', 'Serum bilirubin >10 mg/dL or rapidly rising', 'Elderly or immunocompromised patient'];
  s.addText(hosp.map(h => '• ' + h).join('\n'), { x: 6.95, y: 2.1, w: 5.8, h: 1.35, fontSize: 11.5, color: C.white, fontFace: 'Calibri', valign: 'top', margin: 0 });

  // Box: Monitoring
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  s.addText('MONITORING PARAMETERS', { x: 6.95, y: 3.85, w: 5.8, h: 0.4, fontSize: 13, bold: true, color: C.accent, fontFace: 'Calibri', margin: 0 });
  const monitor = ['LFTs (ALT/AST) every 1–2 weeks until normalization', 'PT/INR — key marker of hepatic synthetic function', 'Serum bilirubin (total + direct)', 'Serology: HBsAg, HBeAg, anti-HBe, HBV DNA', 'Abdominal ultrasound if prolonged jaundice or fever'];
  s.addText(monitor.map(m => '• ' + m).join('\n'), { x: 6.95, y: 4.28, w: 5.8, h: 1.3, fontSize: 11.5, color: C.white, fontFace: 'Calibri', valign: 'top', margin: 0 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — MANAGEMENT: SPECIFIC ANTIVIRALS (HBV)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.bg_dark);
  slideHeader(s, 'TREATMENT — CHRONIC HEPATITIS B', 'Eight approved agents: goals and first-line recommendations', C.accent2);

  // Header bar
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.55, w: 12.5, h: 0.45, fill: { color: C.bg_mid } });
  ['Drug', 'Route & Dose', 'Resistance', 'Key Points'].forEach((h, i) => {
    const xs = [0.5, 3.0, 6.7, 9.3];
    s.addText(h, { x: xs[i], y: 1.6, w: i === 0 ? 2.4 : (i === 1 ? 3.5 : (i === 2 ? 2.5 : 3.5)), h: 0.35, fontSize: 12.5, bold: true, color: C.accent2, fontFace: 'Calibri', margin: 0 });
  });

  const drugs = [
    ['PEG-IFN α-2a\n(First-line)', 'SC 100 µg/week × 48 wks', 'Not described', 'Finite duration; response better in Genotype A/B; avoid in decompensated cirrhosis & pregnancy'],
    ['Entecavir\n★ First-line', 'Oral 0.5 mg/day\n(1 mg/day if LAM-R)', '1–2% @ 5 yr (naïve)\n50% @ 5 yr (LAM-R)', 'High potency, high barrier to resistance; preferred oral agent'],
    ['Tenofovir DF\n★ First-line', 'Oral 300 mg/day', 'None reported', 'Potent; preferred in pregnancy (Category B); monitor renal function & bone density'],
    ['Tenofovir AF\n★ First-line', 'Oral 25 mg/day', 'None reported', 'Renal/bone-safer TAF formulation; not for CrCl <15 mL/min'],
    ['Lamivudine\n(Historical)', 'Oral 100 mg/day', '23% @ 1 yr; 70% @ 5 yr', 'High resistance; only for prophylaxis if short course needed'],
    ['Adefovir\n(Historical)', 'Oral 10 mg/day', '20–29% @ 5 yr', 'Renal toxicity at higher doses; active against LAM-R strains'],
    ['Telbivudine\n(Historical)', 'Oral 600 mg/day', '11–25% @ 2 yr', 'Cross-resistance with lamivudine; myopathy risk'],
  ];

  const rowColors = [C.bg_mid, C.card_bg];
  drugs.forEach((d, i) => {
    const y = 2.1 + i * 0.5;
    s.addShape(pres.ShapeType.rect, { x: 0.4, y, w: 12.5, h: 0.48, fill: { color: rowColors[i % 2] } });
    s.addText(d[0], { x: 0.5, y: y + 0.05, w: 2.4, h: 0.38, fontSize: 11, bold: true, color: d[0].includes('★') ? C.accent4 : C.white, fontFace: 'Calibri', margin: 0, wrap: true });
    s.addText(d[1], { x: 3.0, y: y + 0.05, w: 3.5, h: 0.38, fontSize: 11, color: C.accent, fontFace: 'Calibri', margin: 0, wrap: true });
    s.addText(d[2], { x: 6.7, y: y + 0.05, w: 2.5, h: 0.38, fontSize: 10.5, color: C.white, fontFace: 'Calibri', margin: 0, wrap: true });
    s.addText(d[3], { x: 9.3, y: y + 0.05, w: 3.5, h: 0.38, fontSize: 10, color: C.light_gray, fontFace: 'Calibri', margin: 0, wrap: true });
  });

  s.addText('Treatment endpoint: HBsAg seroconversion OR HBeAg seroconversion (continue 6 months after). In acute severe HBV: entecavir or TDF until 3 months after HBsAg loss.', {
    x: 0.4, y: 5.6, w: 12.5, h: 0.35, fontSize: 10.5, color: C.subtitle, fontFace: 'Calibri', italic: true, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — TREATMENT: CHRONIC HEPATITIS C (DAA REGIMENS)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.bg_dark);
  slideHeader(s, 'TREATMENT — CHRONIC HEPATITIS C', 'Direct-acting antivirals (DAAs) — current first-line combinations', C.accent3);

  // Mechanism bar
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 1.55, w: 12.5, h: 0.55, fill: { color: C.card_bg }, line: { color: C.accent3, width: 1 }, rectRadius: 0.06 });
  s.addText('DAA Classes: NS3/4A Protease inhibitors ("-previr") | NS5A inhibitors ("-asvir") | NS5B Polymerase inhibitors ("-buvir") | Goal: SVR12 (undetectable HCV RNA 12 wks post-treatment) ≥ 95–99%', {
    x: 0.55, y: 1.62, w: 12.2, h: 0.42, fontSize: 11.5, color: C.white, fontFace: 'Calibri', margin: 0
  });

  // Table header
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 2.2, w: 12.5, h: 0.4, fill: { color: C.bg_mid } });
  ['Regimen (Brand)', 'Dose', 'Duration', 'Genotype', 'SVR12 / Notes'].forEach((h, i) => {
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    ['Sofosbuvir/Ledipasvir\n(Harvoni)', '90/400 mg once daily', '8–12 wks', '1, 4, 5, 6', '95–99% SVR12; 8 wks if treatment-naïve, no cirrhosis, VL <6M IU/mL'],
    ['Sofosbuvir/Velpatasvir\n(Epclusa)', '400/100 mg once daily', '12 wks', 'Pangenotypic\n1–6', '95–99%; ribavirin added for compensated cirrhosis GT3'],
    ['Glecaprevir/Pibrentasvir\n(Mavyret) ★', '300/120 mg once daily', '8 wks (naïve, no cirr.)\n12 wks (cirrhosis)', 'Pangenotypic', '97–99%; approved 8 wks for all genotypes; CONTRAINDICATED in decompensated cirrhosis'],
    ['Sofosbuvir/Velpatasvir/\nVoxilaprevir (Vosevi)', '400/100/100 mg once daily', '12 wks', 'Pangenotypic\n(salvage)', 'For DAA-experienced or NS5A-resistant patients; CONTRAINDICATED in decompensated cirrhosis'],
    ['Elbasvir/Grazoprevir\n(Zepatier)', '50/100 mg once daily', '12–16 wks', '1a, 1b, 4', '95–99%; add ribavirin for GT1a with NS5A RAVs; avoid in decompensated cirrhosis'],
  ];

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    const xs = [0.5, 4.3, 6.4, 7.9, 9.3];
    const ws = [3.7, 2.0, 1.4, 1.3, 3.5];
    const colors = [C.white, C.accent, C.white, C.white, C.light_gray];
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    });
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — COMPLICATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.bg_dark);
  slideHeader(s, 'COMPLICATIONS OF VIRAL HEPATITIS', 'Acute and chronic sequelae', C.accent3);

  const comps = [
    {
      title: 'Fulminant Hepatic\nFailure (FHF)',
      color: C.accent3,
      icon: '⚡',
      items: [
        'Rare but life-threatening (<1% acute HBV; HEV in pregnancy up to 20–25%)',
        'Massive hepatic necrosis → hepatic encephalopathy within 2 weeks of jaundice',
        'Features: shrinking liver, coagulopathy, hypoglycemia, ascites, cerebral edema',
        'HBV: treat with entecavir/TDF; refer for liver transplantation',
      ]
    },
    {
      title: 'Chronic Hepatitis\n& Chronicity',
      color: C.accent2,
      icon: '🔄',
      items: [
        'HAV/HEV: no chronicity (self-limited)',
        'HBV: 1% (adult); 90% (neonatal); 25–30% (age 1–5 yrs)',
        'HCV: ~75–85% progress to chronic infection',
        'HDV superinfection: 70–80% chronic; co-infection 1–3%',
      ]
    },
    {
      title: 'Cirrhosis',
      color: C.accent,
      icon: '🫀',
      items: [
        'End-stage of chronic HBV and HCV',
        'Characterized by fibrosis, regenerative nodules, portal hypertension',
        'Complications: variceal bleeding, ascites, SBP, hepatic encephalopathy',
        'HBV cirrhosis: antiviral therapy shown to cause fibrosis regression',
      ]
    },
    {
      title: 'Hepatocellular\nCarcinoma (HCC)',
      color: 'B07FD4',
      icon: '🔴',
      items: [
        'HBV: independent risk even without cirrhosis; HBsAg(+) = 100× risk',
        'HCV: HCC occurs almost exclusively in setting of cirrhosis',
        'Surveillance: AFP + ultrasound every 6 months in high-risk groups',
        'HBV treatment reduces but does not eliminate HCC risk',
      ]
    },
    {
      title: 'Extrahepatic\nManifestations',
      color: C.accent4,
      icon: '🌐',
      items: [
        'HBV: serum-sickness–like illness, polyarteritis nodosa, membranous GN, essential mixed cryoglobulinemia',
        'HCV: Mixed cryoglobulinemia, membranoproliferative GN, lichen planus, porphyria cutanea tarda, non-Hodgkin lymphoma',
        'HAV: Relapsing hepatitis (rare), cholestatic hepatitis, autoimmune hepatitis trigger',
        'HEV: Neurologic complications — Guillain-Barré, Bell palsy, encephalitis',
      ]
    },
    {
      title: 'Cholestatic &\nOther Variants',
      color: 'F0A500',
      icon: '💛',
      items: [
        'Cholestatic hepatitis A: prolonged jaundice + pruritis, intense but self-limited',
        'Relapsing hepatitis A: 2–3 relapses before final recovery; ~10–20%',
        'HBV reactivation: in immunosuppressed — can be fulminant; prophylaxis required',
        'HEV in immunocompromised (transplant recipients): chronic HEV infection with rapid fibrosis',
      ]
    },
  ];

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      fontSize: 9.5, color: C.white, fontFace: 'Calibri', valign: 'top', margin: 0, wrap: true
    });
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — PREVENTION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.bg_dark);
  slideHeader(s, 'PREVENTION & PROPHYLAXIS', 'Vaccines, passive immunity, and public health measures', C.accent4);

  const prevData = [
    {
      title: 'HAV Prevention',
      color: C.accent,
      lines: [
        'Active: Inactivated HAV vaccine (Havrix, Vaqta) — 2 doses at 0 & 6–12 months → 95–100% protection',
        'Passive: IG 0.02 mL/kg within 2 weeks of exposure (pre-exposure travel)',
        'HAV immune globulin + vaccine for post-exposure prophylaxis',
        'Environmental: hand hygiene, safe water & food handling',
      ]
    },
    {
      title: 'HBV Prevention',
      color: C.accent2,
      lines: [
        'Active: Recombinant HBsAg vaccine — 3 doses (0, 1, 6 months); >90% seroconversion',
        'Perinatal: Newborns of HBsAg(+) mothers: vaccine + HBIG (0.5 mL) within 12 h of birth → 85–90% prevention',
        'Post-exposure (needle-stick): HBIG (0.06 mL/kg) + vaccine series within 24 h',
        'Universal precautions, safe injection practices',
      ]
    },
    {
      title: 'HCV Prevention',
      color: C.accent3,
      lines: [
        'No vaccine available',
        'Reduce needle sharing; harm reduction programs for IDUs',
        'Blood product screening (anti-HCV + HCV RNA)',
        'No effective post-exposure prophylaxis — monitor HCV RNA at 4–6 weeks',
      ]
    },
    {
      title: 'HEV Prevention',
      color: C.accent4,
      lines: [
        'HEV 239 vaccine (Hecolin) — approved in China; 3 doses, 95.5% efficacy',
        'Not widely available outside China',
        'Safe water supply; sanitation infrastructure; avoid raw pork in endemic areas',
        'High-risk group: pregnant women (mortality 15–25% in endemic areas)',
      ]
    },
  ];

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      fontSize: 10.5, color: C.white, fontFace: 'Calibri', valign: 'top', margin: 0, wrap: true
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  s.addText('HDV: No specific HDV vaccine — HBV vaccination prevents HDV co-infection. For chronic HDV: Bulevirtide (approved in EU 2020) — 2 mg SC daily; PEG-IFN α as alternative.', {
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — SPECIAL SITUATIONS / MANAGEMENT ALGORITHM
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide(C.bg_dark);
  slideHeader(s, 'MANAGEMENT ALGORITHM — SPECIAL SITUATIONS', 'Pregnancy, immunosuppression, decompensated cirrhosis', C.accent);

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    {
      title: 'HBV in Pregnancy',
      color: 'F9A8D4',
      content: [
        'Screen all pregnant women for HBsAg',
        'TDF (Tenofovir DF) — safest antiviral in pregnancy (Cat. B)',
        'High viral load (HBV DNA >200,000 IU/mL): start TDF at 28–32 wks to prevent MTCT',
        'Newborn: HBV vaccine + HBIG within 12 hours',
        'Avoid entecavir, PEG-IFN in pregnancy',
      ]
    },
    {
      title: 'HBV Reactivation\n(Immunosuppression)',
      color: 'FCA5A5',
      content: [
        'Risk: chemotherapy, biologics (anti-TNF, rituximab), steroids, transplant',
        'Screen all patients for HBsAg and anti-HBc before immunosuppression',
        'HBsAg(+): start prophylactic entecavir or TDF before chemotherapy',
        'Anti-HBc(+)/HBsAg(-): monitor HBV DNA monthly; treat if DNA detectable',
        'Prophylaxis duration: until 6–12 months post-immunosuppression',
      ]
    },
    {
      title: 'Decompensated\nCirrhosis (HBV)',
      color: C.accent3,
      content: [
        'Entecavir 1 mg/day or TDF — even in compensated cirrhosis',
        'Avoid PEG-IFN (risk of decompensation)',
        'Refer for liver transplantation evaluation',
        'Continuous viral suppression indefinitely',
        'Monitor MELD score, serum albumin, PT/INR',
      ]
    },
    {
      title: 'Decompensated\nCirrhosis (HCV)',
      color: 'FBBF24',
      content: [
        'CONTRAINDICATED: all protease inhibitors (glecaprevir, grazoprevir, voxilaprevir)',
        'Use: Sofosbuvir/Velpatasvir ± ribavirin for 24 weeks',
        'Ribavirin: weight-based (600–1200 mg/day); reduce dose per Hb',
        'Sustained virologic response may allow downlisting from transplant waitlist',
        'Monitor for HCV reinfection post-transplant',
      ]
    },
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  s.addText("Source: Harrison's Principles of Internal Medicine 22E (2025) | Chapters 350 & 352", {
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — SUMMARY / KEY TAKEAWAYS
// ══════════════════════════════════════════════════════════════════════════════
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    { num: '2', color: C.accent2, text: 'Most acute hepatitis is self-limited. General supportive care is the cornerstone; avoid hepatotoxic drugs & glucocorticoids.' },
    { num: '3', color: C.accent3, text: 'Severe acute HBV (fulminant or prolonged >4 wks): treat with entecavir or TDF until 3–6 months after seroconversion.' },
    { num: '4', color: C.accent4, text: 'Acute HCV: initiate full 8–12 week DAA therapy early (no longer wait for spontaneous resolution).' },
    { num: '5', color: 'B07FD4', text: 'Chronic HBV: first-line = Entecavir 0.5 mg/day, TDF 300 mg/day, or TAF 25 mg/day. Lifelong therapy often required. Goal: undetectable HBV DNA.' },
    { num: '6', color: C.accent, text: 'Chronic HCV: pangenotypic DAAs (glecaprevir/pibrentasvir or sofosbuvir/velpatasvir) achieve SVR12 >95–99% in 8–12 weeks.' },
    { num: '7', color: C.accent3, text: 'Complications: fulminant hepatic failure, chronicity, cirrhosis, HCC, and extrahepatic manifestations (cryoglobulinemia, GN, lymphoma).' },
    { num: '8', color: C.accent2, text: 'Prevention: HBV vaccine is highly effective. No HCV or HDV vaccine — harm reduction key. HAV/HEV: sanitation + HAV vaccine.' },
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// ═══════════════════════════════════════
// WRITE FILE
// ═══════════════════════════════════════
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