mkdir -p /home/daytona/workspace/nail-clubbing-ppt && ls /home/daytona/workspace…

~/nail-clubbing-ppt/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Medical Presentation";
pres.title = "Examination of Nails and Clubbing";

// ─── Color Palette ─────────────────────────────────────────────────────────
const C = {
  darkBg:    "1A2742",   // deep navy – title/section slides
  medBg:     "243352",   // slightly lighter navy – body bg
  accent1:   "2E86AB",   // steel blue – headers, highlights
  accent2:   "F4A261",   // warm amber – key terms
  accent3:   "52B788",   // teal green – sub-bullets / positive
  white:     "FFFFFF",
  lightGray: "D9E4F0",
  bodyText:  "E8EEF7",
  subText:   "B0C4DE",
  red:       "E05C5C",
  yellow:    "FFD166",
};

// ─── Helper: dark slide with gradient-like header strip ───────────────────
function addSectionSlide(title) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 2.0, w: 10, h: 1.5, fill: { color: C.accent1 } });
  s.addText(title, {
    x: 0.5, y: 2.05, w: 9, h: 1.4,
    fontSize: 36, bold: true, color: C.white, align: "center", valign: "middle",
    fontFace: "Calibri"
  });
  return s;
}

// ─── Helper: content slide ─────────────────────────────────────────────────
function addContentSlide(title, bullets, opts = {}) {
  const s = pres.addSlide();
  // bg
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.medBg } });
  // header strip
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.82, fill: { color: C.accent1 } });
  // left accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.82, w: 0.07, h: 4.8, fill: { color: C.accent2 } });
  // title
  s.addText(title, {
    x: 0.2, y: 0.06, w: 9.6, h: 0.7,
    fontSize: 22, bold: true, color: C.white, align: "left", valign: "middle",
    fontFace: "Calibri", margin: 0
  });

  const bx = opts.splitLeft ? 0.25 : 0.25;
  const bw = opts.splitLeft ? 4.5 : 9.4;
  const by = 1.0;
  const bh = 4.4;

  const items = bullets.map((b, i) => {
    if (b.isHeader) {
      return [
        { text: b.text, options: { bold: true, color: C.accent2, fontSize: 14, breakLine: true } }
      ];
    }
    if (b.isSub) {
      return [
        { text: "  • " + b.text, options: { color: C.subText, fontSize: 12.5, breakLine: true } }
      ];
    }
    return [
      { text: "• ", options: { bold: true, color: C.accent2, fontSize: 13, breakLine: false } },
      { text: b.text + (i < bullets.length - 1 ? "" : ""), options: { color: C.bodyText, fontSize: 13, breakLine: true } }
    ];
  }).flat();

  // remove last breakLine
  if (items.length > 0 && items[items.length - 1].options) {
    items[items.length - 1].options.breakLine = false;
  }

  s.addText(items, {
    x: bx, y: by, w: bw, h: bh,
    valign: "top", fontFace: "Calibri", paraSpaceAfter: 4
  });

  return s;
}

// ─── Helper: two-column content slide ─────────────────────────────────────
function addTwoColSlide(title, leftItems, rightItems, leftTitle = "", rightTitle = "") {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.medBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.82, fill: { color: C.accent1 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.82, w: 0.07, h: 4.8, fill: { color: C.accent2 } });
  s.addText(title, {
    x: 0.2, y: 0.06, w: 9.6, h: 0.7,
    fontSize: 22, bold: true, color: C.white, align: "left", valign: "middle",
    fontFace: "Calibri", margin: 0
  });

  // divider
  s.addShape(pres.ShapeType.line, {
    x: 5.05, y: 0.9, w: 0, h: 4.6,
    line: { color: C.accent1, width: 1, dashType: "dash" }
  });

  const buildItems = (arr) => arr.map((b, i) => {
    if (b.isHeader) return [{ text: b.text, options: { bold: true, color: C.accent2, fontSize: 13.5, breakLine: true } }];
    if (b.isSub)    return [{ text: "    – " + b.text, options: { color: C.subText, fontSize: 11.5, breakLine: true } }];
    return [
      { text: "• ", options: { bold: true, color: C.accent2, fontSize: 12.5 } },
      { text: b.text, options: { color: C.bodyText, fontSize: 12.5, breakLine: true } }
    ];
  }).flat();

  if (leftTitle) {
    s.addText(leftTitle, { x: 0.2, y: 0.85, w: 4.7, h: 0.35, fontSize: 13, bold: true, color: C.accent3, fontFace: "Calibri", margin: 0 });
  }
  if (rightTitle) {
    s.addText(rightTitle, { x: 5.2, y: 0.85, w: 4.6, h: 0.35, fontSize: 13, bold: true, color: C.accent3, fontFace: "Calibri", margin: 0 });
  }

  const ly = leftTitle ? 1.22 : 0.95;
  const lh = leftTitle ? 4.1 : 4.4;

  s.addText(buildItems(leftItems), { x: 0.18, y: ly, w: 4.7, h: lh, valign: "top", fontFace: "Calibri", paraSpaceAfter: 3 });
  s.addText(buildItems(rightItems), { x: 5.2, y: ly, w: 4.6, h: lh, valign: "top", fontFace: "Calibri", paraSpaceAfter: 3 });

  return s;
}

// ─── Helper: ref tag ───────────────────────────────────────────────────────
function refTag(slide, text) {
  slide.addText(text, {
    x: 0, y: 5.3, w: 10, h: 0.28,
    fontSize: 9, color: C.subText, italic: true, align: "right",
    fontFace: "Calibri", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 1: TITLE
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkBg } });
  // decorative top bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.18, fill: { color: C.accent2 } });
  // bottom bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.44, w: 10, h: 0.18, fill: { color: C.accent1 } });
  // big circle decoration
  s.addShape(pres.ShapeType.ellipse, { x: 7.5, y: -0.5, w: 3.5, h: 3.5, fill: { color: C.accent1, transparency: 85 }, line: { color: C.accent1, transparency: 60, width: 2 } });

  s.addText("EXAMINATION OF NAILS", {
    x: 0.6, y: 1.2, w: 8.5, h: 0.85,
    fontSize: 38, bold: true, color: C.white, align: "left",
    fontFace: "Calibri", charSpacing: 2
  });
  s.addText("& CLUBBING", {
    x: 0.6, y: 2.0, w: 8.5, h: 0.85,
    fontSize: 38, bold: true, color: C.accent2, align: "left",
    fontFace: "Calibri", charSpacing: 2
  });
  s.addText("A Clinical Approach", {
    x: 0.6, y: 2.9, w: 7, h: 0.45,
    fontSize: 18, italic: true, color: C.subText, align: "left", fontFace: "Calibri"
  });
  s.addShape(pres.ShapeType.line, { x: 0.6, y: 3.45, w: 5, h: 0, line: { color: C.accent2, width: 1.5 } });
  s.addText("References: Harrison's Principles of Internal Medicine 22e (2025)\nHutchinson's Clinical Methods | Alagappan's Manual of Practical Medicine", {
    x: 0.6, y: 3.6, w: 9, h: 0.7,
    fontSize: 11, color: C.subText, italic: true, align: "left", fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 2: OVERVIEW / OUTLINE
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.82, fill: { color: C.accent1 } });
  s.addText("OVERVIEW", {
    x: 0.3, y: 0.06, w: 9.4, h: 0.7,
    fontSize: 24, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  const topics = [
    "1.  Anatomy of the Nail Unit",
    "2.  Systematic Approach to Nail Examination",
    "3.  Normal vs. Abnormal Nail Findings",
    "4.  Clubbing – Definition & Anatomy",
    "5.  Grading of Clubbing",
    "6.  Pathophysiology of Clubbing",
    "7.  Causes of Clubbing",
    "8.  Clinical Tests for Clubbing",
    "9.  Hypertrophic Osteoarthropathy",
    "10. Important Nail Signs in Systemic Disease",
  ];

  const half = Math.ceil(topics.length / 2);
  const leftArr = topics.slice(0, half).map(t => ({ text: t }));
  const rightArr = topics.slice(half).map(t => ({ text: t }));

  const buildList = (arr) => arr.map((b, i) => [
    { text: b.text, options: { color: C.bodyText, fontSize: 13.5, breakLine: true, bold: false } }
  ]).flat();

  s.addText(buildList(leftArr), { x: 0.3, y: 0.95, w: 4.5, h: 4.5, valign: "top", fontFace: "Calibri", paraSpaceAfter: 6 });
  s.addText(buildList(rightArr), { x: 5.1, y: 0.95, w: 4.5, h: 4.5, valign: "top", fontFace: "Calibri", paraSpaceAfter: 6 });
}

// ══════════════════════════════════════════════════════════════════════════
// SECTION BREAK: NAIL ANATOMY
// ══════════════════════════════════════════════════════════════════════════
addSectionSlide("ANATOMY OF THE NAIL UNIT");

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 3: NAIL ANATOMY
// ══════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Components of the Nail Unit", [
    { text: "Nail Plate", isHeader: true },
    { text: "Keratinized structure produced by the nail matrix; hard, translucent", isSub: true },
    { text: "Nail Matrix", isHeader: true },
    { text: "Germinal layer beneath proximal nail fold – produces 90% of nail plate", isSub: true },
    { text: "Nail Bed", isHeader: true },
    { text: "Vascular dermis beneath nail plate; contributes to distal nail growth", isSub: true },
    { text: "Nail Folds", isHeader: true },
    { text: "Proximal (cuticle), lateral folds – seal the nail unit from environment", isSub: true },
    { text: "Lunula", isHeader: true },
    { text: "Visible portion of matrix – white crescent at proximal nail; most prominent in thumb", isSub: true },
    { text: "Hyponychium", isHeader: true },
    { text: "Junction between free nail edge and fingertip skin; barrier to infection", isSub: true },
  ]);
  refTag(s, "Hutchinson's Clinical Methods | Alagappan's Manual of Practical Medicine");
}

// ══════════════════════════════════════════════════════════════════════════
// SECTION BREAK: EXAMINATION
// ══════════════════════════════════════════════════════════════════════════
addSectionSlide("SYSTEMATIC NAIL EXAMINATION");

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 4: HOW TO EXAMINE NAILS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Approach to Nail Examination", [
    { text: "Patient Position", isHeader: true },
    { text: "Both hands extended at eye level; compare symmetric digits", isSub: true },
    { text: "Inspect All 20 Nails (fingers + toes)", isHeader: true },
    { text: "Assess shape, color, surface texture, consistency, and periungual tissue", isSub: true },
    { text: "Nail Plate", isHeader: true },
    { text: "Color (pink, white, yellow, brown/black) | Surface (ridges, pits, grooves)", isSub: true },
    { text: "Transparency, thickness, curvature (transverse & longitudinal)", isSub: true },
    { text: "Nail Folds", isHeader: true },
    { text: "Look for erythema, telangiectasia, ragged cuticles (CTD signs)", isSub: true },
    { text: "Nail Bed", isHeader: true },
    { text: "Blanching, capillary refill, subungual color changes, splinter hemorrhages", isSub: true },
    { text: "Angle Assessment", isHeader: true },
    { text: "Lovibond angle (normal <160°) | Schamroth window test", isSub: true },
  ]);
  refTag(s, "Hutchinson's Clinical Methods | Alagappan's Manual of Practical Medicine");
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 5: NORMAL NAIL PARAMETERS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = addTwoColSlide(
    "Normal Nail Parameters",
    [
      { text: "Growth Rate", isHeader: true },
      { text: "Fingernails: ~3 mm/month", isSub: true },
      { text: "Toenails: ~1.5 mm/month", isSub: true },
      { text: "Colour", isHeader: true },
      { text: "Pink (vascular bed) with white free edge", isSub: true },
      { text: "Surface", isHeader: true },
      { text: "Smooth; fine longitudinal striations may appear with age", isSub: true },
      { text: "Thickness", isHeader: true },
      { text: "0.3–0.65 mm (fingernails)", isSub: true },
    ],
    [
      { text: "Angles (Critical for Clubbing Assessment)", isHeader: true },
      { text: "Lovibond angle: <160° (nail plate to proximal nailfold)", isSub: true },
      { text: "Hyponychial angle: <180°", isSub: true },
      { text: "Profile sign (Lovibond): convex nail – abnormal if flattened", isSub: true },
      { text: "Schamroth Test", isHeader: true },
      { text: "Diamond window present when dorsal surfaces of same fingers opposed back-to-back", isSub: true },
      { text: "Absence = POSITIVE Schamroth sign (clubbing)", isSub: true },
    ],
    "Normal Values", "Key Angles"
  );
  refTag(s, "Harrison's 22e | Hutchinson's Clinical Methods");
}

// ══════════════════════════════════════════════════════════════════════════
// SECTION BREAK: CLUBBING
// ══════════════════════════════════════════════════════════════════════════
addSectionSlide("CLUBBING");

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 6: DEFINITION
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.medBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.82, fill: { color: C.accent1 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.82, w: 0.07, h: 4.8, fill: { color: C.accent2 } });
  s.addText("Definition of Clubbing", {
    x: 0.2, y: 0.06, w: 9.6, h: 0.7,
    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  // Quote box
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.0, w: 9.2, h: 1.3, fill: { color: "1D3461" }, line: { color: C.accent2, width: 1.5 } });
  s.addText('"The selective bulbous enlargement of the distal segments of the fingers and toes due to proliferation of connective tissue, particularly on the dorsal surface, with increased sponginess of the soft tissue at the base of the clubbed nail."', {
    x: 0.55, y: 1.05, w: 8.9, h: 1.2,
    fontSize: 13, italic: true, color: C.yellow, align: "center", valign: "middle", fontFace: "Calibri"
  });
  s.addText("— Harrison's Principles of Internal Medicine, 22nd Ed. (2025)", {
    x: 0.55, y: 2.28, w: 9, h: 0.25,
    fontSize: 10, color: C.subText, italic: true, align: "right", fontFace: "Calibri"
  });

  const pts = [
    { text: "First described by Hippocrates in association with empyema (Fishman's Pulmonary Medicine)" },
    { text: "The nail, especially the index finger, becomes abnormally curved in both longitudinal and coronal planes" },
    { text: "Hyponychial angle becomes blunted; nail base becomes soft and spongy" },
    { text: "Terminal phalanx is bulbous and fluctuant on palpation (Hutchinson's Clinical Methods)" },
  ];
  const items = pts.map((b, i) => [
    { text: "• ", options: { bold: true, color: C.accent2, fontSize: 13 } },
    { text: b.text, options: { color: C.bodyText, fontSize: 13, breakLine: true } }
  ]).flat();
  s.addText(items, { x: 0.25, y: 2.62, w: 9.4, h: 2.8, valign: "top", fontFace: "Calibri", paraSpaceAfter: 5 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 7: GRADING OF CLUBBING (Schamroth / Lovibond)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.medBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.82, fill: { color: C.accent1 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.82, w: 0.07, h: 4.8, fill: { color: C.accent2 } });
  s.addText("Grading of Clubbing – Schamroth's Classification", {
    x: 0.2, y: 0.06, w: 9.6, h: 0.7, fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  const grades = [
    ["Grade I", "Fluctuation & softening of nail bed (earliest sign); slight increase in convexity of nail", C.accent3],
    ["Grade II", "Obliteration of Lovibond angle (>180°); loss of diamond window (Schamroth positive)", C.accent2],
    ["Grade III", "Increase in AP diameter; drumstick / parrot beak appearance of finger", C.yellow],
    ["Grade IV", "Hypertrophic osteoarthropathy with periosteal new bone formation, painful joints", C.red],
  ];

  grades.forEach(([grade, desc, col], i) => {
    const y = 0.98 + i * 1.08;
    s.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 1.3, h: 0.82, fill: { color: col }, line: { color: col } });
    s.addText(grade, { x: 0.27, y: y + 0.05, w: 1.26, h: 0.72, fontSize: 13.5, bold: true, color: C.darkBg, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 });
    s.addShape(pres.ShapeType.rect, { x: 1.6, y, w: 8.1, h: 0.82, fill: { color: "1D3461" }, line: { color: col, width: 0.5 } });
    s.addText(desc, { x: 1.7, y: y + 0.05, w: 7.9, h: 0.72, fontSize: 12.5, color: C.bodyText, valign: "middle", fontFace: "Calibri", margin: 0 });
  });

  refTag(s, "Hutchinson's Clinical Methods | Alagappan's Manual of Practical Medicine");
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 8: SCHAMROTH & LOVIBOND TESTS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = addTwoColSlide(
    "Clinical Tests for Clubbing",
    [
      { text: "Schamroth Window Test", isHeader: true },
      { text: "Place dorsal surfaces of same digits (both index fingers) back to back", isSub: true },
      { text: "NORMAL: Diamond-shaped window (lozenge) visible at nail bases", isSub: true },
      { text: "CLUBBING: Window absent; angle between free nail margins >30°", isSub: true },
      { text: "Validated in JAMA 2010 (Pallares-Sanmartin et al.)", isSub: true },
      { text: "Profile Sign (Lovibond)", isHeader: true },
      { text: "View finger from the side", isSub: true },
      { text: "Normal: nail plate meets nailfold at <160°", isSub: true },
      { text: "Clubbing: angle ≥180° (angle obliterated)", isSub: true },
    ],
    [
      { text: "Palpation of Nail Bed", isHeader: true },
      { text: "Press nail plate toward proximal nailfold", isSub: true },
      { text: "POSITIVE: Spongy, fluctuant sensation = early clubbing", isSub: true },
      { text: "Crepitus Test", isHeader: true },
      { text: "Rock the nail – a 'clicking' sensation confirms sponginess", isSub: true },
      { text: "Hyponychial Angle (Curth)", isHeader: true },
      { text: "Angle between nail plate and the finger at the hyponychium", isSub: true },
      { text: "Normal <180°; Clubbing >195°", isSub: true },
      { text: "Digital Index (Turton et al.)", isHeader: true },
      { text: "Depth at distal phalanx / depth at distal interphalangeal joint", isSub: true },
      { text: "Ratio >1.0 indicates clubbing", isSub: true },
    ],
    "Schamroth & Lovibond", "Palpation & Measurements"
  );
  refTag(s, "Hutchinson's Clinical Methods | Andrews' Dermatology | Harrison's 22e");
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 9: PATHOPHYSIOLOGY
// ══════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Pathophysiology of Clubbing", [
    { text: "Prevailing Hypothesis – Megakaryocyte / Platelet Hypothesis", isHeader: true },
    { text: "Megakaryocytes NOT fully fragmented in diseased lungs → pass intact into systemic circulation", isSub: true },
    { text: "Strand in digital capillary network → disintegrate → release growth factors (PDGF, VEGF)", isSub: true },
    { text: "Promotes vascular proliferation and connective tissue hypertrophy in distal digits", isSub: true },
    { text: "Prostaglandin Pathway (Genetic Clubbing)", isHeader: true },
    { text: "Mutations in HPGD (15-hydroxyprostaglandin dehydrogenase) gene", isSub: true },
    { text: "Loss of PGE2 degradation → elevated PGE2 → vasodilation + tissue proliferation", isSub: true },
    { text: "Also: SLCO2A1 (prostaglandin transporter) mutations identified", isSub: true },
    { text: "Neural Hypothesis", isHeader: true },
    { text: "Vagal impulses from diseased lung may trigger digital vasodilation (vagotomy relieves clubbing)", isSub: true },
  ]);
  refTag(s, "Harrison's 22e (2025) | Andrews' Dermatology | Fishman's Pulmonary Medicine");
}

// ══════════════════════════════════════════════════════════════════════════
// SECTION BREAK: CAUSES
// ══════════════════════════════════════════════════════════════════════════
addSectionSlide("CAUSES OF CLUBBING");

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 10: TYPES & CAUSES
// ══════════════════════════════════════════════════════════════════════════
{
  const s = addTwoColSlide(
    "Types of Clubbing & Causes",
    [
      { text: "HEREDITARY / IDIOPATHIC", isHeader: true },
      { text: "Autosomal dominant – isolated type (HPGD mutations)", isSub: true },
      { text: "Pachydermoperiostosis (primary HOA)", isSub: true },
      { text: "PULMONARY (Most Common)", isHeader: true },
      { text: "Primary + metastatic lung carcinoma", isSub: true },
      { text: "Bronchiectasis, lung abscess, empyema", isSub: true },
      { text: "IPF, asbestosis, sarcoidosis", isSub: true },
      { text: "Cystic fibrosis, tuberculosis, mesothelioma", isSub: true },
      { text: "CARDIAC", isHeader: true },
      { text: "Cyanotic congenital heart disease", isSub: true },
      { text: "Infective endocarditis", isSub: true },
      { text: "Cor pulmonale, cardiac insufficiency", isSub: true },
    ],
    [
      { text: "HEPATIC & GI", isHeader: true },
      { text: "Hepatic cirrhosis", isSub: true },
      { text: "Inflammatory bowel disease (Crohn's, UC)", isSub: true },
      { text: "GI neoplasms, polyposis intestinalis", isSub: true },
      { text: "Bacillary and amoebic dysentery", isSub: true },
      { text: "INFECTIONS / OTHERS", isHeader: true },
      { text: "HIV infection (~36% of HIV+ patients)", isSub: true },
      { text: "Chronic methemoglobinaemia (heavy smokers)", isSub: true },
      { text: "UNILATERAL CLUBBING", isHeader: true },
      { text: "Arterial insufficiency (Takayasu arteritis)", isSub: true },
      { text: "Occupational (jackhammer operators)", isSub: true },
      { text: "Sarcoidosis (rarely unilateral)", isSub: true },
    ],
    "Hereditary, Pulmonary, Cardiac", "GI, Hepatic, Others"
  );
  refTag(s, "Harrison's 22e (2025) | Fitzpatrick's Dermatology | Andrews' Dermatology");
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 11: HYPERTROPHIC OSTEOARTHROPATHY
// ══════════════════════════════════════════════════════════════════════════
{
  const s = addContentSlide("Hypertrophic Osteoarthropathy (HOA)", [
    { text: "Definition", isHeader: true },
    { text: "Syndrome of clubbing + subperiosteal new bone formation + joint effusions", isSub: true },
    { text: "Most common with bronchogenic carcinoma (typically men)", isSub: true },
    { text: "Also: mesothelioma, bronchiectasis, hepatic cirrhosis", isSub: true },
    { text: "Clinical Features", isHeader: true },
    { text: "Painful clubbing with arthritis-like changes in shoulders, knees, ankles, wrists, elbows", isSub: true },
    { text: "Symmetric periosteal new bone formation in distal diaphyses of long bones", isSub: true },
    { text: "Diagnosis", isHeader: true },
    { text: "Confirmed by bone X-ray or MRI (periosteal reaction)", isSub: true },
    { text: "Reversibility", isHeader: true },
    { text: "Clubbing reversible after lung transplantation (e.g., cystic fibrosis) or resection of tumor", isSub: true },
    { text: "Primary HOA (Pachydermoperiostosis)", isHeader: true },
    { text: "HPGD or SLCO2A1 gene mutations; autosomal dominant/recessive", isSub: true },
  ]);
  refTag(s, "Harrison's 22e (2025)");
}

// ══════════════════════════════════════════════════════════════════════════
// SECTION BREAK: NAIL SIGNS IN SYSTEMIC DISEASE
// ══════════════════════════════════════════════════════════════════════════
addSectionSlide("NAIL SIGNS IN SYSTEMIC DISEASE");

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 12: NAIL SIGNS TABLE (part 1)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.medBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.82, fill: { color: C.accent1 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.82, w: 0.07, h: 4.8, fill: { color: C.accent2 } });
  s.addText("Nail Signs in Systemic Disease (Part 1)", {
    x: 0.2, y: 0.06, w: 9.6, h: 0.7, fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  const rows = [
    { sign: "Clubbing", disease: "Lung CA, bronchiectasis, cyanotic CHD, cirrhosis, IBD, endocarditis" },
    { sign: "Koilonychia (Spoon nails)", disease: "Iron deficiency anaemia, haemochromatosis, thyroid disease" },
    { sign: "Leukonychia (White nails)", disease: "Hypoalbuminaemia, liver disease, trauma, arsenic poisoning" },
    { sign: "Terry's Nails", disease: "Hepatic cirrhosis, CCF, diabetes – white nail, distal pink band" },
    { sign: "Muehrcke's Lines", disease: "Hypoalbuminaemia – paired transverse white bands, disappear on pressure" },
    { sign: "Lindsay's Nails (Half-and-half)", disease: "Chronic kidney disease – proximal white, distal red/brown band" },
  ];

  const rowH = 0.68;
  const startY = 0.9;
  const colW = [3.2, 6.4];
  const headers = ["Nail Sign", "Associated Disease / Significance"];
  // header row
  s.addShape(pres.ShapeType.rect, { x: 0.1, y: startY, w: colW[0], h: 0.38, fill: { color: C.accent1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.1 + colW[0], y: startY, w: colW[1] - 0.1, h: 0.38, fill: { color: C.accent1 } });
  s.addText(headers[0], { x: 0.15, y: startY + 0.03, w: colW[0] - 0.1, h: 0.32, fontSize: 11.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
  s.addText(headers[1], { x: 0.15 + colW[0], y: startY + 0.03, w: colW[1] - 0.2, h: 0.32, fontSize: 11.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });

  rows.forEach((row, i) => {
    const y = startY + 0.38 + i * rowH;
    const bg = i % 2 === 0 ? "1D3461" : "1A2F55";
    s.addShape(pres.ShapeType.rect, { x: 0.1, y, w: colW[0], h: rowH - 0.04, fill: { color: bg } });
    s.addShape(pres.ShapeType.rect, { x: 0.1 + colW[0], y, w: colW[1] - 0.1, h: rowH - 0.04, fill: { color: bg } });
    s.addText(row.sign, { x: 0.18, y: y + 0.04, w: colW[0] - 0.15, h: rowH - 0.12, fontSize: 12, bold: true, color: C.accent2, valign: "middle", fontFace: "Calibri", margin: 0 });
    s.addText(row.disease, { x: 0.18 + colW[0], y: y + 0.04, w: colW[1] - 0.25, h: rowH - 0.12, fontSize: 11.5, color: C.bodyText, valign: "middle", fontFace: "Calibri", margin: 0 });
  });

  refTag(s, "Hutchinson's Clinical Methods | Harrison's 22e | Alagappan's Manual");
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 13: NAIL SIGNS TABLE (part 2)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.medBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.82, fill: { color: C.accent1 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.82, w: 0.07, h: 4.8, fill: { color: C.accent2 } });
  s.addText("Nail Signs in Systemic Disease (Part 2)", {
    x: 0.2, y: 0.06, w: 9.6, h: 0.7, fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  const rows = [
    { sign: "Beau's Lines", disease: "Transverse grooves – systemic illness, chemotherapy, severe infection, MI" },
    { sign: "Mee's Lines", disease: "Transverse white lines – arsenic/heavy metal poisoning, severe illness" },
    { sign: "Onycholysis", disease: "Nail plate separation – psoriasis, thyrotoxicosis, trauma, fungal infection" },
    { sign: "Splinter Haemorrhages", disease: "Infective endocarditis, vasculitis, trauma, antiphospholipid syndrome" },
    { sign: "Yellow Nail Syndrome", disease: "Yellow thick nails + lymphoedema + bronchopulmonary disease (triad)" },
    { sign: "Pitting of Nails", disease: "Psoriasis (most common), alopecia areata, lichen planus, eczema" },
  ];

  const rowH = 0.68;
  const startY = 0.9;
  const colW = [3.2, 6.4];
  const headers = ["Nail Sign", "Associated Disease / Significance"];
  s.addShape(pres.ShapeType.rect, { x: 0.1, y: startY, w: colW[0], h: 0.38, fill: { color: C.accent1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.1 + colW[0], y: startY, w: colW[1] - 0.1, h: 0.38, fill: { color: C.accent1 } });
  s.addText(headers[0], { x: 0.15, y: startY + 0.03, w: colW[0] - 0.1, h: 0.32, fontSize: 11.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
  s.addText(headers[1], { x: 0.15 + colW[0], y: startY + 0.03, w: colW[1] - 0.2, h: 0.32, fontSize: 11.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });

  rows.forEach((row, i) => {
    const y = startY + 0.38 + i * rowH;
    const bg = i % 2 === 0 ? "1D3461" : "1A2F55";
    s.addShape(pres.ShapeType.rect, { x: 0.1, y, w: colW[0], h: rowH - 0.04, fill: { color: bg } });
    s.addShape(pres.ShapeType.rect, { x: 0.1 + colW[0], y, w: colW[1] - 0.1, h: rowH - 0.04, fill: { color: bg } });
    s.addText(row.sign, { x: 0.18, y: y + 0.04, w: colW[0] - 0.15, h: rowH - 0.12, fontSize: 12, bold: true, color: C.accent2, valign: "middle", fontFace: "Calibri", margin: 0 });
    s.addText(row.disease, { x: 0.18 + colW[0], y: y + 0.04, w: colW[1] - 0.25, h: rowH - 0.12, fontSize: 11.5, color: C.bodyText, valign: "middle", fontFace: "Calibri", margin: 0 });
  });

  refTag(s, "Hutchinson's Clinical Methods | Harrison's 22e | Alagappan's Manual");
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 14: NAIL IN SPECIFIC SYSTEMIC CONDITIONS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = addTwoColSlide(
    "Nails in Specific Systemic Conditions",
    [
      { text: "Liver Disease", isHeader: true },
      { text: "Terry's nails (white + distal pink band)", isSub: true },
      { text: "Muehrcke's lines (hypoalbuminaemia)", isSub: true },
      { text: "Leukonychia, koilonychia, clubbing, brittleness", isSub: true },
      { text: "Cardiovascular", isHeader: true },
      { text: "Clubbing – cyanotic CHD, cor pulmonale, IE", isSub: true },
      { text: "Splinter haemorrhages – IE, vasculitis", isSub: true },
      { text: "Cyanosis – peripheral/central", isSub: true },
      { text: "Connective Tissue Disease", isHeader: true },
      { text: "Periungual erythema + telangiectasia (SLE, dermatomyositis)", isSub: true },
      { text: "Ragged cuticles (scleroderma, dermatomyositis)", isSub: true },
    ],
    [
      { text: "Renal Disease", isHeader: true },
      { text: "Lindsay's half-and-half nails (CKD)", isSub: true },
      { text: "Mee's lines (uraemia, dialysis)", isSub: true },
      { text: "Respiratory Disease", isHeader: true },
      { text: "Clubbing – see causes slide", isSub: true },
      { text: "Yellow nail syndrome (sinopulmonary + oedema)", isSub: true },
      { text: "Anaemia", isHeader: true },
      { text: "Koilonychia (iron deficiency – most classic)", isSub: true },
      { text: "Thyroid Disease", isHeader: true },
      { text: "Onycholysis (thyrotoxicosis – Plummer's nails)", isSub: true },
      { text: "Brittle, dry nails (hypothyroidism)", isSub: true },
    ],
    "Liver, Cardiac, CTD", "Renal, Respiratory, Others"
  );
  refTag(s, "Hutchinson's Clinical Methods | Harrison's 22e | Fitzpatrick's Dermatology");
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 15: DIFFERENTIAL DIAGNOSIS OF CLUBBING
// ══════════════════════════════════════════════════════════════════════════
{
  const s = addTwoColSlide(
    "Differentiating Clubbing from Mimics",
    [
      { text: "True Clubbing", isHeader: true },
      { text: "Lovibond angle ≥180°", isSub: true },
      { text: "Schamroth sign POSITIVE (no window)", isSub: true },
      { text: "Spongy nail base on palpation", isSub: true },
      { text: "Bulbous fingertip, increased AP depth", isSub: true },
      { text: "Digital index (DPD/IPD) >1.0", isSub: true },
      { text: "Simple Nail Curvature (Normal Variant)", isHeader: true },
      { text: "Nail curves but Lovibond angle <180°", isSub: true },
      { text: "Schamroth window PRESENT", isSub: true },
      { text: "No sponginess of nail base", isSub: true },
    ],
    [
      { text: "Chronic Paronychia", isHeader: true },
      { text: "Inflammatory changes of nailfold", isSub: true },
      { text: "No change in Lovibond angle", isSub: true },
      { text: "Heberden Nodes (OA)", isHeader: true },
      { text: "Bony hard DIP joint swelling", isSub: true },
      { text: "No nail plate changes or angle change", isSub: true },
      { text: "Thyroid Acropachy", isHeader: true },
      { text: "Soft tissue swelling + periosteal reaction – Graves' disease", isSub: true },
      { text: "May resemble HOA; distinguish by context + TSH", isSub: true },
    ],
    "Clubbing vs. Normal", "vs. Other Mimics"
  );
  refTag(s, "Fishman's Pulmonary Medicine | Andrews' Dermatology | Hutchinson's");
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 16: CLINICAL PEARLS / KEY TAKEAWAYS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.82, fill: { color: C.accent1 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.82, w: 0.07, h: 4.8, fill: { color: C.accent2 } });
  s.addText("Clinical Pearls", {
    x: 0.2, y: 0.06, w: 9.6, h: 0.7, fontSize: 24, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  const pearls = [
    ["Always examine all 20 nails", "Asymmetric findings narrow the differential (unilateral = vascular cause)"],
    ["Earliest sign of clubbing", "Sponginess of nail base (before visible angle change)"],
    ["Schamroth test", "Quick bedside test – loss of diamond window = clubbing"],
    ["Lung CA is the most common cause", "Of acquired painful clubbing with HOA"],
    ["~36% of HIV+ patients", "Have clubbed nails – do not miss"],
    ["Clubbing can reverse", "After lung transplant or tumor resection – confirms pathophysiology"],
    ["Terry's vs. Muehrcke's", "Terry's: white + distal pink band (cirrhosis); Muehrcke's: paired white bands disappear on pressure (hypoalbuminaemia)"],
  ];

  pearls.forEach(([pearl, detail], i) => {
    const y = 0.95 + i * 0.65;
    s.addShape(pres.ShapeType.rect, { x: 0.18, y, w: 9.6, h: 0.57, fill: { color: "1A2F55" }, line: { color: C.accent1, width: 0.5 } });
    s.addShape(pres.ShapeType.rect, { x: 0.18, y, w: 0.1, h: 0.57, fill: { color: C.accent2 } });
    s.addText([
      { text: pearl + ": ", options: { bold: true, color: C.accent2, fontSize: 12 } },
      { text: detail, options: { color: C.bodyText, fontSize: 12 } }
    ], { x: 0.38, y: y + 0.05, w: 9.3, h: 0.47, valign: "middle", fontFace: "Calibri", margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 17: REFERENCES
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.82, fill: { color: C.accent1 } });
  s.addText("REFERENCES", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65, fontSize: 24, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  const refs = [
    "1. Loscalzo J, Fauci AS et al. Harrison's Principles of Internal Medicine, 22nd Edition (2025). McGraw-Hill Medical. [Chapters: Cyanosis, Clubbing, and Edema]",
    "2. Hutchinson's Clinical Methods, 24th Edition. Saunders/Elsevier. [Chapters: Examination of the Hands and Nails]",
    "3. Alagappan R. Manual of Practical Medicine, 6th Edition. Jaypee Brothers. [Chapter: Examination of Nails and Extremities]",
    "4. Andrews' Diseases of the Skin: Clinical Dermatology, 13th Edition. Elsevier (2020). [Chapter 33: Nail Disorders – Clubbing, p.898]",
    "5. Fishman's Pulmonary Diseases and Disorders, 5th Edition. McGraw-Hill (2015). [Chapter 27: Clubbing, p.447]",
    "6. Fitzpatrick's Dermatology, 9th Edition. McGraw-Hill. [Chapter 91: Nails in Cardiovascular Disease]",
    "7. Pallares-Sanmartin A et al. Validity and reliability of the Schamroth sign for diagnosis of digital clubbing. JAMA 2010;304:159.",
    "8. Essouma M et al. Epidemiology of digital clubbing and HOA: systematic review. J Clin Rheumatol 2022;28:104.",
  ];

  const items = refs.map((r, i) => [
    { text: r, options: { color: i === 0 ? C.accent2 : i <= 2 ? C.yellow : C.subText, fontSize: 11, breakLine: true } }
  ]).flat();

  s.addText(items, { x: 0.3, y: 0.9, w: 9.4, h: 4.5, valign: "top", fontFace: "Calibri", paraSpaceAfter: 5, margin: 0 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 18: THANK YOU
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.18, fill: { color: C.accent2 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.44, w: 10, h: 0.18, fill: { color: C.accent1 } });
  s.addShape(pres.ShapeType.ellipse, { x: -1.0, y: 2.5, w: 3.5, h: 3.5, fill: { color: C.accent1, transparency: 88 } });
  s.addShape(pres.ShapeType.ellipse, { x: 8.0, y: -0.5, w: 3.5, h: 3.5, fill: { color: C.accent2, transparency: 88 } });

  s.addText("THANK YOU", {
    x: 1, y: 1.6, w: 8, h: 1.0,
    fontSize: 48, bold: true, color: C.white, align: "center", fontFace: "Calibri", charSpacing: 5
  });
  s.addShape(pres.ShapeType.line, { x: 2.5, y: 2.75, w: 5, h: 0, line: { color: C.accent2, width: 2 } });
  s.addText("Examination of Nails and Clubbing", {
    x: 1, y: 2.9, w: 8, h: 0.5,
    fontSize: 18, italic: true, color: C.subText, align: "center", fontFace: "Calibri"
  });
  s.addText("References: Harrison's 22e | Hutchinson's Clinical Methods | Alagappan's Manual of Practical Medicine", {
    x: 0.5, y: 4.8, w: 9, h: 0.4,
    fontSize: 10, color: C.subText, italic: true, align: "center", fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/nail-clubbing-ppt/Examination_of_Nails_and_Clubbing.pptx" })
  .then(() => console.log("SUCCESS: PPT created"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

cd /home/daytona/workspace/nail-clubbing-ppt && node build.js 2>&1

ls -lh /home/daytona/workspace/nail-clubbing-ppt/