cd "/tmp/workspace/attachments/9894628b-77c1-4c12-a08c-e65a7c350f53/" && python3 -c " import pdfplumber, os files = [ 'progress note.pdf', 'examintion.pdf', 'discharge summary.pdf', '31st july.pdf', '3rd aug.pdf' ] for f in files: print(f'\n\n========== FILE: {f} ==========') try: with pdfplumber.open(f) as pdf: for i, page in enumerate(pdf.pages): print(f'--- Page {i+1} ---') text = page.extract_text() if text: print(text) else: print('[No text extracted]') except Exception as e: print(f'ERROR: {e}') "

mkdir -p /tmp/workspace/case-discussion && python3 << 'PYEOF' from pptx import Presentation from pptx.util import Inches, Pt, Emu from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.util import Inches, Pt from io import BytesIO import copy prs = Presentation() prs.slide_width = Inches(13.333) prs.slide_height = Inches(7.5) blank = prs.slide_layouts[6] # ─── COLOUR PALETTE ──────────────────────────────────────────────── TEAL = RGBColor(0x00, 0x7B, 0x8A) # header / accent TEAL_DARK = RGBColor(0x00, 0x55, 0x62) TEAL_LIGHT= RGBColor(0xE0, 0xF4, 0xF7) # card backgrounds ORANGE = RGBColor(0xE8, 0x6B, 0x1A) # highlight accent ORANGE_LT = RGBColor(0xFF, 0xF0, 0xE3) RED_WARN = RGBColor(0xCC, 0x22, 0x22) GREEN = RGBColor(0x21, 0x8A, 0x38) GREEN_LT = RGBColor(0xE6, 0xF6, 0xE9) YELLOW = RGBColor(0xFF, 0xD7, 0x00) YELLOW_LT = RGBColor(0xFF, 0xFB, 0xE5) WHITE = RGBColor(0xFF, 0xFF, 0xFF) GREY_BG = RGBColor(0xF5, 0xF6, 0xFA) GREY_TEXT = RGBColor(0x55, 0x55, 0x66) DARK = RGBColor(0x1A, 0x1A, 0x2E) SLATE = RGBColor(0x2C, 0x3E, 0x50) # ─── HELPERS ─────────────────────────────────────────────────────── def add_rect(slide, x, y, w, h, fill=None, line=None, line_w=None): shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h)) shape.shadow.inherit = False if fill: shape.fill.solid(); shape.fill.fore_color.rgb = fill else: shape.fill.background() if line: shape.line.color.rgb = line if line_w: shape.line.width = line_w else: shape.line.fill.background() return shape def add_text(slide, text, x, y, w, h, size=18, bold=False, color=DARK, align=PP_ALIGN.LEFT, italic=False, wrap=True, font="Calibri", va=MSO_ANCHOR.TOP): tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)) tf = tb.text_frame tf.word_wrap = wrap tf.vertical_anchor = va tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0 p = tf.paragraphs[0] p.alignment = align r = p.add_run() r.text = text r.font.name = font r.font.size = Pt(size) r.font.bold = bold r.font.italic = italic r.font.color.rgb = color return tb def add_multiline(slide, lines, x, y, w, h, size=16, bold_first=False, color=DARK, font="Calibri", spacing=1.15, align=PP_ALIGN.LEFT, va=MSO_ANCHOR.TOP): """lines = list of (text, bold, color) or just strings.""" tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)) tf = tb.text_frame tf.word_wrap = True tf.vertical_anchor = va tf.margin_left = tf.margin_right = Inches(0.05) tf.margin_top = tf.margin_bottom = 0 first = True for item in lines: if isinstance(item, str): txt, bd, col = item, (bold_first and first), color else: txt, bd, col = item[0], item[1], item[2] if len(item)>2 else color if first: p = tf.paragraphs[0] else: p = tf.add_paragraph() p.alignment = align p.space_after = Pt(2) r = p.add_run() r.text = txt r.font.name = font r.font.size = Pt(size) r.font.bold = bd r.font.color.rgb = col first = False return tb def header_bar(slide, title, subtitle=None): """Standard top header bar for content slides.""" add_rect(slide, 0, 0, 13.333, 1.1, fill=TEAL) add_text(slide, title, 0.35, 0.05, 12.5, 0.65, size=30, bold=True, color=WHITE, font="Calibri", va=MSO_ANCHOR.MIDDLE) if subtitle: add_text(slide, subtitle, 0.35, 0.72, 12.5, 0.35, size=14, color=RGBColor(0xC8,0xED,0xF3), font="Calibri") # bottom accent line add_rect(slide, 0, 1.1, 13.333, 0.06, fill=ORANGE) def slide_bg(slide, color=GREY_BG): add_rect(slide, 0, 0, 13.333, 7.5, fill=color) def card(slide, x, y, w, h, fill=WHITE, border=None): s = add_rect(slide, x, y, w, h, fill=fill, line=border or TEAL, line_w=Pt(1.2)) return s # ────────────────────────────────────────────────────────────────── # SLIDE 1 – TITLE SLIDE # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) # Full bg gradient via two overlapping rects add_rect(sl, 0, 0, 13.333, 7.5, fill=TEAL_DARK) add_rect(sl, 0, 0, 13.333, 7.5, fill=SLATE) # Decorative accent bars add_rect(sl, 0, 6.7, 13.333, 0.8, fill=TEAL) add_rect(sl, 0, 6.7, 4, 0.8, fill=ORANGE) add_rect(sl, 0, 0, 0.18, 7.5, fill=ORANGE) add_rect(sl, 13.15, 0, 0.18, 7.5, fill=TEAL) # Large circle ornament circ = sl.shapes.add_shape(9, Inches(9.5), Inches(-0.5), Inches(4.5), Inches(4.5)) circ.fill.solid(); circ.fill.fore_color.rgb = RGBColor(0x00,0x8A,0x9C) circ.line.fill.background() circ2 = sl.shapes.add_shape(9, Inches(10.5), Inches(0.5), Inches(2.5), Inches(2.5)) circ2.fill.solid(); circ2.fill.fore_color.rgb = RGBColor(0xE8,0x6B,0x1A) circ2.line.fill.background() # Tag label add_rect(sl, 0.45, 1.0, 3.2, 0.45, fill=ORANGE) add_text(sl, "CASE DISCUSSION", 0.45, 1.0, 3.2, 0.45, size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER, va=MSO_ANCHOR.MIDDLE, font="Calibri") # Main title add_text(sl, "MYXOID NEUROFIBROMA", 0.45, 1.6, 9.5, 1.2, size=44, bold=True, color=WHITE, font="Calibri") add_text(sl, "OF THE NAPE OF NECK", 0.45, 2.7, 9.5, 0.9, size=38, bold=True, color=RGBColor(0xFF,0xD0,0x90), font="Calibri") # Subtitle add_text(sl, "A Deceptive Presentation | Surgical Oncology", 0.45, 3.75, 9.5, 0.55, size=18, color=RGBColor(0xB0,0xE0,0xE8), font="Calibri", italic=True) # Divider add_rect(sl, 0.45, 4.42, 7, 0.05, fill=ORANGE) # Info box add_multiline(sl, [ ("Patient: Gowramma | 56 Years / Female", True, WHITE), ("VYDEHI Institute of Medical Sciences & Research Centre, Bangalore", False, RGBColor(0xA0,0xD8,0xE0)), ("Dept. of Surgical Oncology | July – August 2026", False, RGBColor(0xA0,0xD8,0xE0)), ], 0.45, 4.6, 9.5, 1.6, size=16, font="Calibri") # ────────────────────────────────────────────────────────────────── # SLIDE 2 – CASE AT A GLANCE # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) slide_bg(sl, GREY_BG) header_bar(sl, "CASE AT A GLANCE", "Quick summary before we dive in") # 4 cards cards_data = [ (TEAL_LIGHT, TEAL, "👤 PATIENT", ["56-year-old female", "Housewife, non-smoker", "H/O paan chewing (unquantified)", "No comorbidities, no prior surgery"]), (ORANGE_LT, ORANGE, "🔍 PRESENTATION", ["Swelling: nape of neck × 40 years", "Slow, progressive growth", "Painless, no discharge, no fever", "Stretch veins visible on surface"]), (YELLOW_LT, RGBColor(0xCC,0x99,0x00), "⚙️ PROCEDURE", ["Excision biopsy under LA", "Prone position, elliptical incision", "Polyp excised in toto", "Skin closed in 2 layers"]), (GREEN_LT, GREEN, "🏁 OUTCOME", ["HPE: Myxoid Neurofibroma", "Post-op wound infection managed", "Healthy granulation at Day 19", "Plan: secondary suturing"]), ] cx = 0.3 for fill, border, title_txt, bullets in cards_data: card(sl, cx, 1.35, 3.1, 5.8, fill=fill, border=border) add_rect(sl, cx, 1.35, 3.1, 0.55, fill=border) add_text(sl, title_txt, cx+0.1, 1.35, 2.9, 0.55, size=14, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) for i, b in enumerate(bullets): add_text(sl, f"• {b}", cx+0.12, 2.0+i*0.7, 2.85, 0.65, size=13.5, color=DARK, wrap=True) cx += 3.26 # ────────────────────────────────────────────────────────────────── # SLIDE 3 – CHIEF COMPLAINT & HISTORY # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) slide_bg(sl, GREY_BG) header_bar(sl, "CHIEF COMPLAINT & HISTORY", "") # LEFT column card(sl, 0.3, 1.3, 5.8, 5.8, fill=WHITE, border=TEAL) add_rect(sl, 0.3, 1.3, 5.8, 0.55, fill=TEAL) add_text(sl, "📋 CHIEF COMPLAINT", 0.4, 1.3, 5.6, 0.55, size=15, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) add_text(sl, '"Swelling over the nape of the neck for the last 40 years"', 0.45, 1.97, 5.6, 0.75, size=15, italic=True, color=TEAL_DARK, wrap=True) add_rect(sl, 0.3, 2.82, 5.8, 0.45, fill=TEAL_LIGHT) add_text(sl, "HISTORY OF PRESENT ILLNESS", 0.4, 2.82, 5.6, 0.45, size=13, bold=True, color=TEAL, va=MSO_ANCHOR.MIDDLE) hpi = [ "• Swelling first noticed ~40 years ago as a small nodule", "• Gradual, progressive enlargement over years", "• NO pain, NO bleeding, NO discharge", "• No restriction in neck movements", "• No fever, no constitutional symptoms", ] for i, line in enumerate(hpi): add_text(sl, line, 0.45, 3.35+i*0.47, 5.6, 0.44, size=13.5, color=DARK) # RIGHT column card(sl, 6.4, 1.3, 6.6, 2.7, fill=WHITE, border=ORANGE) add_rect(sl, 6.4, 1.3, 6.6, 0.5, fill=ORANGE) add_text(sl, "🔬 SOCIAL & RISK HISTORY", 6.5, 1.3, 6.4, 0.5, size=14, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) socials = [ ("Paan Chewing", "Unquantified duration"), ("Comorbidities", "None"), ("Past Surgeries", "None"), ("Family Hx Malignancy", "Negative"), ("Drug / Food Allergy", "NKDA"), ] for i, (k, v) in enumerate(socials): add_text(sl, k+":", 6.5, 1.9+i*0.41, 2.5, 0.38, size=13, bold=True, color=SLATE) add_text(sl, v, 9.1, 1.9+i*0.41, 3.7, 0.38, size=13, color=DARK) card(sl, 6.4, 4.15, 6.6, 2.95, fill=WHITE, border=TEAL) add_rect(sl, 6.4, 4.15, 6.6, 0.5, fill=TEAL) add_text(sl, "📊 ECOG PERFORMANCE STATUS", 6.5, 4.15, 6.4, 0.5, size=14, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) add_text(sl, "ECOG 1", 6.5, 4.78, 3, 0.7, size=40, bold=True, color=GREEN) add_text(sl, "Fully ambulatory\nRestricted in strenuous activity only\nCapable of light work", 9.7, 4.78, 3.1, 1.3, size=13, color=DARK) add_rect(sl, 6.5, 5.6, 6.2, 0.05, fill=TEAL_LIGHT) add_text(sl, "ICD Code: L98.9 – Disorder of skin and subcutaneous tissue (initial) → revised to Q85.00 Neurofibromatosis", 6.5, 5.72, 6.2, 0.85, size=11.5, color=GREY_TEXT, italic=True, wrap=True) # ────────────────────────────────────────────────────────────────── # SLIDE 4 – CLINICAL EXAMINATION # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) slide_bg(sl, GREY_BG) header_bar(sl, "CLINICAL EXAMINATION", "Findings at presentation – 15 July 2026") # Vitals strip add_rect(sl, 0.3, 1.25, 12.73, 1.35, fill=TEAL_DARK) vitals = [ ("BP", "150/80", "mmHg"), ("Pulse", "73", "bpm"), ("RR", "12", "/min"), ("Temp", "97°F", "36°C"), ("SpO₂", "98%", ""), ] vx = 0.55 for label, val, unit in vitals: add_text(sl, label, vx, 1.3, 2.3, 0.35, size=12, color=RGBColor(0xA0,0xD8,0xE0), bold=True, align=PP_ALIGN.CENTER) add_text(sl, val, vx, 1.62, 2.3, 0.55, size=22, bold=True, color=WHITE, align=PP_ALIGN.CENTER) if unit: add_text(sl, unit, vx, 2.14, 2.3, 0.3, size=11, color=RGBColor(0xA0,0xD8,0xE0), align=PP_ALIGN.CENTER) vx += 2.5 # Systemic exam card card(sl, 0.3, 2.75, 4.5, 4.35, fill=WHITE, border=TEAL) add_rect(sl, 0.3, 2.75, 4.5, 0.5, fill=TEAL) add_text(sl, "🩺 SYSTEMIC EXAMINATION", 0.4, 2.75, 4.3, 0.5, size=14, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) sys_items = [ ("CNS", "Conscious & oriented"), ("CVS", "S1 S2 heard, no murmur"), ("RS", "B/L air entry present, chest clear"), ("Abdomen", "Soft, bowel sounds present"), ("ECOG", "Grade 1 – Ambulatory"), ] for i, (organ, finding) in enumerate(sys_items): add_rect(sl, 0.4, 3.35+i*0.66, 1.2, 0.52, fill=TEAL_LIGHT) add_text(sl, organ, 0.4, 3.35+i*0.66, 1.2, 0.52, size=13, bold=True, color=TEAL, align=PP_ALIGN.CENTER, va=MSO_ANCHOR.MIDDLE) add_text(sl, finding, 1.65, 3.35+i*0.66, 2.95, 0.52, size=12.5, color=DARK, wrap=True) # Swelling card card(sl, 5.1, 2.75, 7.93, 4.35, fill=WHITE, border=ORANGE) add_rect(sl, 5.1, 2.75, 7.93, 0.5, fill=ORANGE) add_text(sl, "🔴 LOCAL EXAMINATION – THE SWELLING", 5.2, 2.75, 7.73, 0.5, size=14, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) features = [ ("📍 Site", "Posterior nape of neck"), ("📏 Size", "6 × 6 cm (globular mass)"), ("🔗 Stalk", "Pedunculated, stalk ~1 cm"), ("👁 Surface", "Multiple nodular projections; stretched veins"), ("🤚 Consistency","Firm-hard on palpation"), ("💊 Tenderness", "Non-tender"), ("🔄 Mobility", "Mobile, no restriction of neck movement"), ("🩸 Discharge", "Nil"), ] for i, (feat, detail) in enumerate(features): row_y = 3.35 + i * 0.43 add_rect(sl, 5.15, row_y, 2.5, 0.39, fill=ORANGE_LT) add_text(sl, feat, 5.2, row_y, 2.4, 0.39, size=12.5, bold=True, color=ORANGE, va=MSO_ANCHOR.MIDDLE) add_text(sl, detail, 7.7, row_y, 5.1, 0.39, size=12.5, color=DARK, va=MSO_ANCHOR.MIDDLE) # ────────────────────────────────────────────────────────────────── # SLIDE 5 – INVESTIGATIONS # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) slide_bg(sl, GREY_BG) header_bar(sl, "INVESTIGATIONS", "Pre-operative workup – 15 July 2026") # CBC table card(sl, 0.3, 1.3, 7.5, 5.85, fill=WHITE, border=TEAL) add_rect(sl, 0.3, 1.3, 7.5, 0.5, fill=TEAL) add_text(sl, "🩸 COMPLETE BLOOD COUNT", 0.4, 1.3, 7.3, 0.5, size=14, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) cbc_headers = ["Parameter", "Value", "Normal", "Flag"] cbc_data = [ ("WBC", "6.19 × 10³/µL", "4.0–11.0", ""), ("RBC", "3.00 × 10⁶/µL", "3.8–4.8", "↓ LOW"), ("Haemoglobin", "12.3 g/dL", "11.5–15.0", ""), ("HCT/PCV", "34.3 %", "36.0–46.0", "↓ LOW"), ("MCV", "114.3 fL", "83–101", "↑ HIGH"), ("MCH", "41.0 pg", "27.0–32.0", "↑ HIGH"), ("MCHC", "35.9 %", "31.5–34.5", "↑ HIGH"), ("RDW-CV", "15.6 %", "12.0–15.0", "↑ HIGH"), ("Platelets", "265 × 10³/µL", "150–410", ""), ("PT", "11.5 sec", "10.5–13.2", ""), ("INR", "0.96", "0.8–1.2", ""), ("APTT", "29.5 sec", "24.3–35.0", ""), ] col_x = [0.4, 3.0, 5.1, 6.7] col_w = [2.5, 2.0, 1.55, 1.0] # Header row add_rect(sl, 0.3, 1.8, 7.5, 0.38, fill=TEAL_LIGHT) for j, (hdr, cx_val, cw) in enumerate(zip(cbc_headers, col_x, col_w)): add_text(sl, hdr, cx_val, 1.8, cw, 0.38, size=12, bold=True, color=TEAL, va=MSO_ANCHOR.MIDDLE) for i, row in enumerate(cbc_data): row_y = 2.22 + i*0.38 bg = GREY_BG if i%2==0 else WHITE add_rect(sl, 0.31, row_y, 7.48, 0.37, fill=bg) for j, (val, cx_val, cw) in enumerate(zip(row, col_x, col_w)): flag_col = RED_WARN if "HIGH" in val or "LOW" in val else DARK bd = "HIGH" in val or "LOW" in val add_text(sl, val, cx_val, row_y+0.01, cw, 0.35, size=12, color=flag_col, bold=bd, va=MSO_ANCHOR.MIDDLE) # Right: serology + key takeaway card(sl, 8.1, 1.3, 5.0, 2.5, fill=WHITE, border=GREEN) add_rect(sl, 8.1, 1.3, 5.0, 0.5, fill=GREEN) add_text(sl, "🧪 SEROLOGY", 8.2, 1.3, 4.8, 0.5, size=14, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) add_text(sl, "HIV Ag/Ab (CLIA):", 8.2, 1.9, 2.4, 0.4, size=13, bold=True, color=SLATE) add_rect(sl, 10.75, 1.87, 2.1, 0.44, fill=GREEN_LT) add_text(sl, "NON-REACTIVE ✓", 10.75, 1.87, 2.1, 0.44, size=13, bold=True, color=GREEN, align=PP_ALIGN.CENTER, va=MSO_ANCHOR.MIDDLE) add_text(sl, "Pre-op coagulation profile within normal limits.\nPatient cleared for surgery under local anaesthesia.", 8.2, 2.45, 4.8, 0.9, size=12.5, color=GREY_TEXT, italic=True, wrap=True) # Key finding box card(sl, 8.1, 4.0, 5.0, 3.15, fill=ORANGE_LT, border=ORANGE) add_rect(sl, 8.1, 4.0, 5.0, 0.52, fill=ORANGE) add_text(sl, "⚠️ KEY HAEMATOLOGICAL FINDING", 8.2, 4.0, 4.8, 0.52, size=13.5, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) add_text(sl, "MACROCYTIC ANAEMIA\n\n" "• MCV 114.3 fL (HIGH)\n" "• MCH 41.0 pg (HIGH)\n" "• RBC 3.00 × 10⁶/µL (LOW)\n" "• HCT 34.3% (LOW)\n\n" "Possible B12/Folate deficiency\n" "— warranting nutritional evaluation", 8.2, 4.6, 4.75, 2.4, size=12.5, color=DARK, wrap=True) # ────────────────────────────────────────────────────────────────── # SLIDE 6 – DIFFERENTIAL DIAGNOSIS # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) slide_bg(sl, GREY_BG) header_bar(sl, "DIFFERENTIAL DIAGNOSIS", "What were we thinking before HPE?") diffs = [ (ORANGE, "1ST", "Fibroepithelial Polyp", "Most common pedunculated soft-tissue lesion of the neck.\nSlow-growing, painless, flesh-colored; often on stalk.\n→ Favoured clinically on admission.", True), (TEAL, "2ND", "Papilloma / Skin Tag", "Benign epithelial overgrowth.\nSmaller, softer, typically sessile or thin stalk.\n→ Less likely given firm consistency & 6 cm size.", False), (RGBColor(0x6A,0x1A,0xB2), "3RD", "Lipoma / Fibrolipoma", "Soft, compressible subcutaneous fat tumour.\n→ Inconsistent with firm-hard consistency.", False), (RED_WARN, "4TH", "Neurofibroma / NF-1 Associated", "Nerve sheath tumour; can be pedunculated at unusual sites.\nMyxoid change gives soft/gelatinous core.\n→ FINAL HPE DIAGNOSIS ✓", True), ] dx = 0.3 for fill, rank, name, desc, highlight in diffs: bg = fill if highlight else WHITE bdr = fill card(sl, dx, 1.35, 3.06, 5.75, fill=bg if not highlight else RGBColor(*(max(c-20,0) for c in fill)) , border=bdr) # rank bubble bubble = sl.shapes.add_shape(9, Inches(dx+0.1), Inches(1.4), Inches(0.7), Inches(0.7)) bubble.fill.solid(); bubble.fill.fore_color.rgb = fill bubble.line.fill.background() add_text(sl, rank, dx+0.1, 1.4, 0.7, 0.7, size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER, va=MSO_ANCHOR.MIDDLE) name_col = WHITE if highlight else DARK add_text(sl, name, dx+0.9, 1.42, 2.1, 0.65, size=15, bold=True, color=name_col, wrap=True) add_rect(sl, dx+0.1, 2.18, 2.8, 0.05, fill=fill) add_text(sl, desc, dx+0.1, 2.3, 2.85, 4.5, size=12.5, color=WHITE if highlight else GREY_TEXT, wrap=True) if highlight: add_rect(sl, dx+0.1, 6.6, 2.85, 0.35, fill=fill) add_text(sl, "✅ CONFIRMED" if "FINAL" in desc else "⭐ INITIAL DIAGNOSIS", dx+0.1, 6.6, 2.85, 0.35, size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER, va=MSO_ANCHOR.MIDDLE) dx += 3.26 # ────────────────────────────────────────────────────────────────── # SLIDE 7 – OPERATIVE DETAILS # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) slide_bg(sl, GREY_BG) header_bar(sl, "OPERATIVE DETAILS", "Excision Biopsy Under Local Anaesthesia – 15 July 2026") # Steps timeline (vertical) steps = [ (TEAL, "POSITIONING", "Patient placed in prone position on OT table."), (ORANGE, "PREPARATION", "Parts painted with betadine, sterile draping done."), (TEAL, "INCISION", "Elliptical incision including stalk → deepened to subcutaneous plane."), (ORANGE, "DISSECTION", "Dissection carried to deep plane; polyp excised in toto."), (TEAL, "HAEMOSTASIS", "Haemostasis verified; no active bleed."), (ORANGE, "CLOSURE", "Skin closed in 2 layers; dressing applied."), (GREEN, "SPECIMEN", "Excised tissue sent for Histopathological Examination (HPE)."), ] for i, (col, step_title, detail) in enumerate(steps): yy = 1.35 + i * 0.84 add_rect(sl, 0.3, yy, 0.6, 0.65, fill=col) add_text(sl, str(i+1), 0.3, yy, 0.6, 0.65, size=18, bold=True, color=WHITE, align=PP_ALIGN.CENTER, va=MSO_ANCHOR.MIDDLE) add_rect(sl, 0.9, yy, 12.1, 0.65, fill=TEAL_LIGHT if col==TEAL else ORANGE_LT) add_text(sl, step_title, 1.0, yy, 2.8, 0.65, size=14, bold=True, color=col, va=MSO_ANCHOR.MIDDLE) add_text(sl, detail, 3.85, yy, 9.0, 0.65, size=13.5, color=DARK, va=MSO_ANCHOR.MIDDLE) if i < len(steps)-1: add_rect(sl, 0.53, yy+0.65, 0.04, 0.19, fill=GREY_TEXT) # Surgeon info add_rect(sl, 0.3, 7.1, 12.73, 0.02, fill=TEAL) add_text(sl, "Surgical Team: Dr. Sunayana | Dr. Prasanna • Anaesthesia: Local • Duration: Day Care", 0.3, 7.15, 12.73, 0.3, size=12.5, color=GREY_TEXT, align=PP_ALIGN.CENTER) # ────────────────────────────────────────────────────────────────── # SLIDE 8 – HPE RESULT: MYXOID NEUROFIBROMA # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) slide_bg(sl, GREY_BG) header_bar(sl, "HISTOPATHOLOGICAL EXAMINATION", "The Diagnostic Reveal") # Big HPE result box add_rect(sl, 0.3, 1.3, 12.73, 1.55, fill=SLATE) add_rect(sl, 0.3, 1.3, 0.25, 1.55, fill=ORANGE) add_text(sl, "HPE DIAGNOSIS:", 0.65, 1.35, 3.5, 0.55, size=16, bold=True, color=RGBColor(0xA0,0xD8,0xE0), va=MSO_ANCHOR.MIDDLE) add_text(sl, "MYXOID NEUROFIBROMA", 4.3, 1.28, 8.5, 1.0, size=42, bold=True, color=YELLOW, align=PP_ALIGN.LEFT) add_text(sl, "ICD Q85.00 – Neurofibromatosis | Peripheral nerve sheath tumour with myxoid stroma", 0.65, 2.1, 12.2, 0.65, size=14, color=RGBColor(0xB0,0xE0,0xE8), italic=True, wrap=True) # Feature cards features_hpe = [ (TEAL, "🔬 Tumour Type", "Benign peripheral nerve sheath tumour\nArising from Schwann cells and perineural fibroblasts"), (ORANGE, "🧬 Myxoid Stroma", "Abundant loose myxoid (mucoid) extracellular matrix\nGives gelatinous gross appearance"), (RGBColor(0x6A,0x1A,0xB2), "🧩 Histology", "Wavy spindle cells in myxoid background\nNeurofibroma lacks Antoni A/B zones (unlike schwannoma)"), (GREEN, "🔗 Association", "Sporadic OR NF-1 (von Recklinghausen)\nMultiple lesions → evaluate for NF-1 syndrome"), ] fx = 0.3 for col, title_txt, body in features_hpe: card(sl, fx, 3.0, 3.0, 4.15, fill=WHITE, border=col) add_rect(sl, fx, 3.0, 3.0, 0.52, fill=col) add_text(sl, title_txt, fx+0.1, 3.0, 2.8, 0.52, size=13.5, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) add_text(sl, body, fx+0.12, 3.6, 2.76, 3.4, size=13, color=DARK, wrap=True) fx += 3.26 # ────────────────────────────────────────────────────────────────── # SLIDE 9 – POST-OP COURSE & FOLLOW-UP # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) slide_bg(sl, GREY_BG) header_bar(sl, "POST-OPERATIVE COURSE & FOLLOW-UP", "Timeline of recovery") # Timeline timeline = [ ("15 Jul 2026", "DAY 0 – SURGERY", TEAL, "Excision biopsy done under LA. Post-procedure: patient recovered well, no soakage. Discharged same day (Day Care).\nDischarge Rx: Vit C 500mg, Ultracet, Pan-D; wound hygiene instructions.", "✅ Uncomplicated"), ("31 Jul 2026", "DAY 16 – REVIEW", ORANGE, "Came for wound review. Discharge from wound significantly reduced.\nL/E: 3 × 3 cm raw area, healthy granulating wound, minimal slough – debrided.\nDiagnosis revised: ICD D36.10 (Benign neoplasm of peripheral nerves).", "⚠️ Raw area, healing"), ("03 Aug 2026", "DAY 19 – REVIEW", RED_WARN, "Wound infection over suture site noted; daily C&D done.\nL/E: 3 × 3 cm ulcer with HEALTHY granulation tissue; upper edge mild slough – excised.\nFinal ICD: Q85.00 Neurofibromatosis.", "🔄 Infection resolved"), ] for i, (date, event, col, desc, status) in enumerate(timeline): yy = 1.35 + i * 1.98 # date banner add_rect(sl, 0.3, yy, 2.5, 0.52, fill=col) add_text(sl, date, 0.3, yy, 2.5, 0.52, size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER, va=MSO_ANCHOR.MIDDLE) # event title add_rect(sl, 2.8, yy, 9.93, 0.52, fill=TEAL_LIGHT if col==TEAL else (ORANGE_LT if col==ORANGE else RGBColor(0xFF,0xEB,0xEB))) add_text(sl, event, 2.9, yy, 9.73, 0.52, size=14, bold=True, color=col, va=MSO_ANCHOR.MIDDLE) # status badge add_rect(sl, 10.9, yy, 2.13, 0.52, fill=col) add_text(sl, status, 10.9, yy, 2.13, 0.52, size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER, va=MSO_ANCHOR.MIDDLE) # description card(sl, 0.3, yy+0.52, 12.73, 1.35, fill=WHITE, border=col) add_text(sl, desc, 0.45, yy+0.6, 12.35, 1.2, size=13, color=DARK, wrap=True) if i < len(timeline)-1: # connector add_rect(sl, 1.35, yy+1.87, 0.05, 0.11, fill=GREY_TEXT) # Future plan box add_rect(sl, 0.3, 7.12, 12.73, 0.32, fill=GREEN_LT) add_rect(sl, 0.3, 7.12, 0.15, 0.32, fill=GREEN) add_text(sl, "📅 NEXT STEP: Review in 3 days → If wound healthy, plan SECONDARY SUTURING under Local Anaesthesia", 0.5, 7.12, 12.5, 0.32, size=13, bold=True, color=GREEN, va=MSO_ANCHOR.MIDDLE, wrap=True) # ────────────────────────────────────────────────────────────────── # SLIDE 10 – NEUROFIBROMA: ACADEMIC DISCUSSION # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) slide_bg(sl, GREY_BG) header_bar(sl, "ABOUT MYXOID NEUROFIBROMA", "Academic Deep Dive") left_items = [ ("Definition", "Benign peripheral nerve sheath tumour composed of Schwann cells, perineural cells, and fibroblasts set in a myxoid stroma."), ("Incidence", "Most common benign soft-tissue tumour of peripheral nerves. Sporadic > NF-1 associated."), ("Location", "Skin & subcutaneous tissue; any site. Head/neck presentations are relatively rare."), ("Growth pattern", "Typically slow, insidious. A 40-year history is consistent with benign biology."), ("Malignant potential", "Very low in sporadic form. NF-1 associated: 8–13% lifetime risk of MPNST."), ] card(sl, 0.3, 1.3, 6.5, 5.8, fill=WHITE, border=TEAL) add_rect(sl, 0.3, 1.3, 6.5, 0.52, fill=TEAL) add_text(sl, "📚 KEY FACTS", 0.4, 1.3, 6.3, 0.52, size=15, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) for i, (label, body) in enumerate(left_items): yy = 1.95 + i * 1.0 add_rect(sl, 0.4, yy, 6.2, 0.38, fill=TEAL_LIGHT) add_text(sl, label, 0.45, yy, 6.1, 0.38, size=13, bold=True, color=TEAL, va=MSO_ANCHOR.MIDDLE) add_text(sl, body, 0.45, yy+0.38, 6.1, 0.58, size=12.5, color=DARK, wrap=True) # Right: NF-1 criteria card(sl, 7.1, 1.3, 5.9, 3.0, fill=WHITE, border=ORANGE) add_rect(sl, 7.1, 1.3, 5.9, 0.52, fill=ORANGE) add_text(sl, "🧬 NF-1 DIAGNOSTIC CRITERIA (≥2 of 7)", 7.2, 1.3, 5.7, 0.52, size=13, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) nf1 = [ "≥ 6 café-au-lait macules", "≥ 2 neurofibromas or 1 plexiform neurofibroma", "Axillary / inguinal freckling", "Optic glioma", "≥ 2 Lisch nodules (iris hamartomas)", "Distinctive bony lesion", "First-degree relative with NF-1", ] for i, item in enumerate(nf1): add_text(sl, f"{'✅' if i<2 else '⬜'} {item}", 7.2, 1.92+i*0.37, 5.7, 0.35, size=12.5, color=DARK if i<2 else GREY_TEXT, bold=(i<2)) # Differential Histo comparison card(sl, 7.1, 4.45, 5.9, 2.65, fill=WHITE, border=TEAL) add_rect(sl, 7.1, 4.45, 5.9, 0.52, fill=TEAL) add_text(sl, "⚖️ NEUROFIBROMA vs SCHWANNOMA", 7.2, 4.45, 5.7, 0.52, size=13, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) rows = [ ("Feature", "Neurofibroma", "Schwannoma"), ("Capsule", "Absent", "Present"), ("Stroma", "Myxoid common", "Antoni A+B"), ("NF-1 risk", "Yes", "No"), ("Malignant Tx", "Yes (MPNST)", "Very rare"), ] for i, (f, n, s) in enumerate(rows): row_y = 5.05 + i * 0.38 bg = TEAL_LIGHT if i==0 else (GREY_BG if i%2 else WHITE) add_rect(sl, 7.1, row_y, 5.9, 0.37, fill=bg) add_text(sl, f, 7.15, row_y, 2.0, 0.37, size=12, bold=(i==0), color=TEAL if i==0 else DARK, va=MSO_ANCHOR.MIDDLE) add_text(sl, n, 9.2, row_y, 1.85, 0.37, size=12, bold=(i==0), color=TEAL if i==0 else DARK, va=MSO_ANCHOR.MIDDLE, align=PP_ALIGN.CENTER) add_text(sl, s, 11.1, row_y, 1.8, 0.37, size=12, bold=(i==0), color=TEAL if i==0 else DARK, va=MSO_ANCHOR.MIDDLE, align=PP_ALIGN.CENTER) # ────────────────────────────────────────────────────────────────── # SLIDE 11 – LEARNING POINTS & DISCUSSION # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) slide_bg(sl, GREY_BG) header_bar(sl, "LEARNING POINTS & DISCUSSION", "What makes this case educational?") points = [ (ORANGE, "1", "CLINICAL vs HPE DISCORDANCE", "Initial clinical impression was fibroepithelial polyp. HPE revealed myxoid neurofibroma — highlighting that benign-appearing pedunculated lesions MUST always be sent for histopathology."), (TEAL, "2", "LONG DURATION ≠ BENIGN NEGLECT", "40 years of swelling reflects patient delay. Any long-standing lesion warrants formal evaluation — delay creates diagnostic uncertainty and may mask malignant transformation."), (RGBColor(0x6A,0x1A,0xB2), "3", "MACROCYTIC ANAEMIA – INCIDENTAL BUT IMPORTANT", "MCV 114.3 fL and MCH 41.0 pg suggest B12/Folate deficiency — unrelated to the primary diagnosis but an incidental finding requiring nutritional work-up and supplementation."), (RED_WARN, "4", "PAAN CHEWING & ONCOLOGICAL SURVEILLANCE", "H/O paan chewing is a known risk factor for oral submucous fibrosis and oral SCC. Though not directly relevant here, it warrants oral mucosal examination and counselling."), (GREEN, "5", "WOUND MANAGEMENT IN DAY-CARE ONCOLOGY", "Post-op wound infection after a minor LA procedure underlines importance of wound hygiene instructions, timely review, and secondary suturing when healing is delayed."), (ORANGE, "6", "NF-1 SCREENING CONSIDERATION", "Myxoid neurofibroma at an unusual site in a 56-year-old — evaluate clinically for café-au-lait spots, axillary freckling, and family history to rule out NF-1 syndrome."), ] lx, ly = 0.3, 1.3 col_pts = [points[:3], points[3:]] for ci, col_group in enumerate(col_pts): cx_val = lx + ci * 6.5 for i, (col, num, title_txt, body) in enumerate(col_group): yy = ly + i * 1.97 add_rect(sl, cx_val, yy, 0.52, 1.65, fill=col) add_text(sl, num, cx_val, yy+0.55, 0.52, 0.55, size=22, bold=True, color=WHITE, align=PP_ALIGN.CENTER, va=MSO_ANCHOR.MIDDLE) card(sl, cx_val+0.52, yy, 5.7, 1.65, fill=WHITE, border=col) add_text(sl, title_txt, cx_val+0.65, yy+0.08, 5.45, 0.52, size=13.5, bold=True, color=col, wrap=True) add_rect(sl, cx_val+0.52, yy+0.6, 5.7, 0.04, fill=col) add_text(sl, body, cx_val+0.65, yy+0.7, 5.45, 0.88, size=12, color=DARK, wrap=True) # ────────────────────────────────────────────────────────────────── # SLIDE 12 – CONCLUSION & TAKE-HOME # ────────────────────────────────────────────────────────────────── sl = prs.slides.add_slide(blank) # BG add_rect(sl, 0, 0, 13.333, 7.5, fill=SLATE) add_rect(sl, 0, 0, 0.2, 7.5, fill=ORANGE) add_rect(sl, 13.13, 0, 0.2, 7.5, fill=TEAL) add_rect(sl, 0, 7.1, 13.333, 0.4, fill=TEAL) # Title add_rect(sl, 0.3, 0.2, 12.73, 0.62, fill=RGBColor(0x00,0x55,0x62)) add_rect(sl, 0.3, 0.2, 0.18, 0.62, fill=ORANGE) add_text(sl, "CONCLUSION & TAKE-HOME MESSAGES", 0.55, 0.2, 12.5, 0.62, size=22, bold=True, color=WHITE, va=MSO_ANCHOR.MIDDLE) take_homes = [ ("🔬", "Always send excised tissue for HPE", "Even 'obvious' benign-looking pedunculated lesions can surprise you — this case was Myxoid Neurofibroma, not a simple polyp."), ("🩺", "Thorough post-op surveillance is non-negotiable", "Day-care minor surgery still carries infection risk. Structured follow-up at Day 3, 16, and 19 caught and managed wound infection promptly."), ("🧬", "Screen for NF-1 in confirmed neurofibromas", "Use NIH diagnostic criteria: ≥6 café-au-lait macules, axillary/inguinal freckling, Lisch nodules, and family history."), ("🩸", "Treat incidental macrocytic anaemia", "MCV 114.3 fL signals B12/Folate deficiency — a modifiable risk factor that impacts perioperative and long-term health."), ("💬", "Patient education matters", "A 40-year delay in seeking care is avoidable. Counsel patients on early presentation, especially those with behavioural risk factors like paan chewing."), ] for i, (icon, title_txt, body) in enumerate(take_homes): yy = 1.0 + i * 1.25 add_rect(sl, 0.3, yy, 0.6, 1.1, fill=TEAL if i%2==0 else ORANGE) add_text(sl, icon, 0.3, yy+0.2, 0.6, 0.7, size=22, color=WHITE, align=PP_ALIGN.CENTER, va=MSO_ANCHOR.MIDDLE) add_rect(sl, 0.9, yy, 12.13, 1.1, fill=RGBColor(0x1E,0x2D,0x3E)) add_text(sl, title_txt, 1.05, yy+0.08, 12.0, 0.45, size=15, bold=True, color=YELLOW if i%2==0 else RGBColor(0xFF,0xD0,0x80)) add_text(sl, body, 1.05, yy+0.55, 12.0, 0.48, size=12.5, color=RGBColor(0xCC,0xDD,0xEE), wrap=True) add_text(sl, "Vydehi Institute of Medical Sciences & Research Centre, Bangalore | Surgical Oncology | 2026", 0.3, 7.15, 12.73, 0.3, size=11, color=RGBColor(0xA0,0xD8,0xE0), align=PP_ALIGN.CENTER) # ────────────────────────────────────────────────────────────────── # SAVE # ────────────────────────────────────────────────────────────────── out_path = "/tmp/workspace/case-discussion/Myxoid_Neurofibroma_Case_Discussion.pptx" buf = BytesIO() prs.save(buf) with open(out_path, "wb") as f: f.write(buf.getvalue()) print(f"Saved: {out_path}") PYEOF

ls -lh /tmp/workspace/case-discussion/