const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Disseminated TB with Multiple Tuberculoma - Pediatric Radiology Case";
pres.author = "Department of Paediatrics";

// ─── COLOR PALETTE ───────────────────────────────────────────────
const C = {
  navy:    "1A2744",  // dominant dark navy
  teal:    "1D7874",  // accent teal
  amber:   "E8A838",  // highlight amber
  white:   "FFFFFF",
  lightBg: "F0F4F8",  // light slide background
  slate:   "334155",  // body text
  muted:   "94A3B8",  // muted/caption text
  red:     "DC2626",  // alert/abnormal
  green:   "16A34A",  // normal
};

// ─── HELPER: add a section header bar ────────────────────────────
function addSlideHeader(slide, title, subtitle = "") {
  // Top bar
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 0.85,
    fill: { color: C.navy },
    line: { color: C.navy },
  });
  slide.addText(title, {
    x: 0.2, y: 0, w: 9.6, h: 0.85,
    fontSize: 22, bold: true, color: C.white, valign: "middle", margin: 0,
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.2, y: 0.85, w: 9.6, h: 0.35,
      fontSize: 11, color: C.teal, italic: true, margin: 0,
    });
  }
  // Accent bar
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0.85, w: 10, h: 0.06,
    fill: { color: C.teal },
    line: { color: C.teal },
  });
}

function addFooter(slide, text = "Pediatric Radiology Meet | Department of Paediatrics") {
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    x: 0, y: 5.45, w: 10, h: 0.175,
    fill: { color: C.navy },
    line: { color: C.navy },
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  slide.addText(text, {
    x: 0.2, y: 5.45, w: 9.6, h: 0.175,
    fontSize: 9, color: C.muted, valign: "middle", margin: 0,
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 1 - TITLE SLIDE
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  // Full background
  s.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 5.625,
    fill: { color: C.navy }, line: { color: C.navy },
  });
  // Accent stripe
  s.addShape(pres.ShapeType.rect, {
    x: 0, y: 2.9, w: 10, h: 0.08,
    fill: { color: C.teal }, line: { color: C.teal },
  });
  s.addText("PEDIATRIC RADIOLOGY MEET", {
    x: 0.5, y: 0.5, w: 9, h: 0.5,
    fontSize: 13, bold: true, color: C.amber, align: "center", charSpacing: 4,
  });
  s.addText([
    { text: "Disseminated Tuberculosis\n", options: { bold: true, fontSize: 32 } },
    { text: "with Multiple Tuberculoma", options: { bold: true, fontSize: 32 } },
  ], {
    x: 0.5, y: 1.1, w: 9, h: 1.5,
    align: "center", color: C.white, valign: "middle",
  });
  s.addText("? Middle Ear TB  |  ? Pulmonary TB  |  TB Meningitis Stage 2", {
    x: 0.5, y: 2.65, w: 9, h: 0.35,
    fontSize: 13, color: C.teal, align: "center", italic: true,
  });
  s.addText([
    { text: "16-Year-Old Female  |  First Evaluation & Inpatient Course\n", options: { fontSize: 13 } },
    { text: "Admitted: 30 June 2026    Discharged: 09 July 2026", options: { fontSize: 12, color: C.muted } },
  ], {
    x: 0.5, y: 3.1, w: 9, h: 0.9,
    align: "center", color: C.white,
  });
  s.addText("Department of Paediatrics", {
    x: 0.5, y: 4.4, w: 9, h: 0.4,
    fontSize: 11, color: C.muted, align: "center",
  });
  s.addText("IP No: 26012063  |  OP No: 25048958", {
    x: 0.5, y: 4.9, w: 9, h: 0.3,
    fontSize: 10, color: C.muted, align: "center",
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 2 - PATIENT PROFILE & CHIEF COMPLAINTS
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.lightBg };
  addSlideHeader(s, "Patient Profile & Chief Complaints");
  addFooter(s);

  // Left box - demographics
  s.addShape(pres.ShapeType.rect, {
    x: 0.2, y: 1.1, w: 3.5, h: 3.8,
    fill: { color: C.navy }, line: { color: C.navy }, rounding: 0.08,
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  s.addText("DEMOGRAPHICS", {
    x: 0.2, y: 1.1, w: 3.5, h: 0.45,
    fontSize: 11, bold: true, color: C.amber, align: "center", valign: "middle",
  });

  const demoLines = [
    ["Name", "Ms. Hemasree"],
    ["Age / Sex", "16 Years / Female"],
    ["DOA", "30 June 2026"],
    ["DOD", "09 July 2026"],
    ["LOS", "10 Days"],
    ["IP No.", "26012063"],
    ["Allergies", "None"],
    ["Immunisation", "Last vax at 9 months"],
    ["Birth Wt.", "3.5 kg, Term NVD"],
  ];
  demoLines.forEach(([k, v], i) => {
    s.addText(k, {
      x: 0.3, y: 1.6 + i * 0.34, w: 1.5, h: 0.3,
      fontSize: 10, color: C.amber, bold: true, margin: 0,
    });
    s.addText(v, {
      x: 1.85, y: 1.6 + i * 0.34, w: 1.7, h: 0.3,
      fontSize: 10, color: C.white, margin: 0,
    });
  });

  // Right box - chief complaints
  s.addShape(pres.ShapeType.rect, {
    x: 4.0, y: 1.1, w: 5.75, h: 3.8,
    fill: { color: C.white }, line: { color: C.teal, pt: 1.5 }, rounding: 0.08,
  });
  s.addText("CHIEF COMPLAINTS", {
    x: 4.0, y: 1.1, w: 5.75, h: 0.45,
    fontSize: 11, bold: true, color: C.teal, align: "center", valign: "middle",
  });
  const complaints = [
    { text: "Right ear pain + tinnitus + discharge", sub: "3 months ago (1 month duration)" },
    { text: "Headache + photophobia", sub: "1 month duration; frontal → holocranial" },
    { text: "Diplopia (binocular, right lateral gaze)", sub: "1 month" },
    { text: "Vomiting", sub: "1 day" },
    { text: "Fever (high grade, intermittent)", sub: "1 day" },
    { text: "Weight loss", sub: "Not significant" },
    { text: "Imbalance on walking", sub: "Resolved after ear treatment" },
  ];
  complaints.forEach((c, i) => {
    s.addText([
      { text: `\u25CF  ${c.text}`, options: { bold: true, color: C.navy, fontSize: 11 } },
      { text: `\n     ${c.sub}`, options: { color: C.muted, fontSize: 9, italic: true } },
    ], {
      x: 4.2, y: 1.6 + i * 0.46, w: 5.3, h: 0.44,
      margin: 0,
    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 3 - HISTORY & RISK FACTORS
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.lightBg };
  addSlideHeader(s, "History & Risk Factors");
  addFooter(s);

  // Timeline of events
  s.addText("TIMELINE OF ILLNESS", {
    x: 0.2, y: 1.0, w: 9.6, h: 0.35,
    fontSize: 13, bold: true, color: C.navy,
  });

  const timeline = [
    { time: "3 months ago", event: "Rt ear pain, tinnitus, discharge, imbalance while walking" },
    { time: "2 months ago", event: "Admitted outside hospital → Dx: Disseminated TB + Stage 2 TBM + Spontaneous TM perforation + Middle ear TB\nEar culture: Staphylococcus aureus → Linezolid 2 weeks" },
    { time: "1 month ago", event: "MRI Brain (NIMHANS): Multiple ring-enhancing lesions → Multiple Tuberculoma\nHRCT Chest: Consolidation Lt lower lobe + Miliary infiltrates\nCSF: Cells 101, L 82%, N 11%, Protein 85.6, Glucose 40\nATT started" },
    { time: "30 Jun 2026", event: "Admitted here: persistent headache + diplopia + neck pain despite 1 month ATT" },
    { time: "Hospital course", event: "Steroid dose escalated → IV Dexamethasone → MRI repeated → Acetazolamide added\nOphthalmology: ocular exercises prescribed\nImproved, discharged 09 July 2026" },
  ];

  const dotX = 0.4;
  const lineX = 0.55;
  timeline.forEach((t, i) => {
    const y = 1.4 + i * 0.78;
    // Dot
    s.addShape(pres.ShapeType.ellipse, {
      x: dotX - 0.12, y: y - 0.04, w: 0.24, h: 0.24,
      fill: { color: C.teal }, line: { color: C.teal },
    });
    // Vertical line (except last)
    if (i < timeline.length - 1) {
      s.addShape(pres.ShapeType.rect, {
        x: dotX - 0.02, y: y + 0.2, w: 0.04, h: 0.58,
        fill: { color: C.muted }, line: { color: C.muted },
      });
    }
    // Time label
    s.addText(t.time, {
      x: 0.75, y: y - 0.04, w: 1.6, h: 0.24,
      fontSize: 10, bold: true, color: C.amber, valign: "middle", margin: 0,
    });
    // Event text
    s.addText(t.event, {
      x: 2.4, y: y - 0.06, w: 7.4, h: 0.7,
      fontSize: 9.5, color: C.slate, valign: "top", margin: 0,
    });
  });

  // Family history box
  s.addShape(pres.ShapeType.rect, {
    x: 0.2, y: 5.05, w: 9.6, h: 0.3,
    fill: { color: C.amber }, line: { color: C.amber }, rounding: 0.05,
  });
  s.addText("FAMILY HISTORY:  Paternal grandfather — Pulmonary TB (7 yrs ago, completed ATT)    |    Mother — TB Lymphadenitis (14 yrs ago, completed ATT)", {
    x: 0.2, y: 5.05, w: 9.6, h: 0.3,
    fontSize: 10, bold: true, color: C.navy, align: "center", valign: "middle", margin: 0,
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 4 - CLINICAL EXAMINATION
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.lightBg };
  addSlideHeader(s, "Clinical Examination");
  addFooter(s);

  // Vitals row
  const vitals = [
    { label: "Temp", val: "98°F", sub: "Afebrile" },
    { label: "SpO2", val: "98%", sub: "on 4L O2" },
    { label: "HR", val: "96/min", sub: "Regular" },
    { label: "RR", val: "24/min", sub: "" },
    { label: "BP", val: "120/80", sub: "mmHg" },
  ];
  vitals.forEach((v, i) => {
    const x = 0.2 + i * 1.92;
    s.addShape(pres.ShapeType.rect, {
      x, y: 1.0, w: 1.82, h: 0.85,
      fill: { color: C.navy }, line: { color: C.teal, pt: 1 }, rounding: 0.06,
    });
    s.addText(v.label, { x, y: 1.0, w: 1.82, h: 0.25, fontSize: 9, color: C.muted, align: "center", margin: 0 });
    s.addText(v.val, { x, y: 1.25, w: 1.82, h: 0.35, fontSize: 16, bold: true, color: C.amber, align: "center", margin: 0 });
    s.addText(v.sub, { x, y: 1.6, w: 1.82, h: 0.22, fontSize: 8.5, color: C.teal, align: "center", margin: 0 });
  });

  // Anthropometry
  s.addText("ANTHROPOMETRY", {
    x: 0.2, y: 1.95, w: 9.6, h: 0.3, fontSize: 11, bold: true, color: C.navy, margin: 0,
  });
  const anthro = [
    ["Parameter", "Observed", "Expected", "Centile"],
    ["Weight", "37.2 kg", "50 kg", "3rd–10th"],
    ["Height", "152 cm", "157 cm", "10th–25th"],
    ["BMI", "16.1", "20", "5th–10th"],
  ];
  anthro.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, {
        x: 0.2 + ci * 2.4, y: 2.25 + ri * 0.3, w: 2.38, h: 0.29,
        fill: { color: ri === 0 ? C.teal : (ri % 2 === 0 ? "E2EEF4" : C.white) },
        line: { color: "CBD5E1", pt: 0.5 },
      });
      s.addText(cell, {
        x: 0.2 + ci * 2.4, y: 2.25 + ri * 0.3, w: 2.38, h: 0.29,
        fontSize: 10, bold: ri === 0, color: ri === 0 ? C.white : C.slate,
        align: "center", valign: "middle", margin: 0,
      });
    });
  });

  // Key Neurological Findings
  s.addText("KEY NEUROLOGICAL FINDINGS", {
    x: 0.2, y: 3.47, w: 9.6, h: 0.3, fontSize: 11, bold: true, color: C.navy, margin: 0,
  });

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    ["6th CN Palsy", "Bilateral (R > L)  — Diplopia on right lateral gaze", C.red],
    ["Meningeal Signs", "Neck rigidity PRESENT; Kernig's –ve; Brudzinski's –ve", C.red],
    ["Weber Test", "Lateralised to RIGHT ear", C.red],
  ];
  const neuroRight = [
    ["Power", "4/5 all limbs (mild global reduction)", C.amber],
    ["Pallor", "Present", C.amber],
    ["Other CNs", "I, III, IV, V, VII, VIII–XII — Normal", C.green],
    ["Cerebellar", "No signs; Romberg absent", C.green],
  ];

  neuroLeft.forEach(([label, val, col], i) => {
    s.addShape(pres.ShapeType.rect, {
      x: 0.2, y: 3.83 + i * 0.38, w: 4.6, h: 0.35,
      fill: { color: C.white }, line: { color: col, pt: 1.5 }, rounding: 0.04,
    });
    s.addText([
      { text: label + ":  ", options: { bold: true, color: col, fontSize: 10 } },
      { text: val, options: { color: C.slate, fontSize: 10 } },
    ], { x: 0.2, y: 3.83 + i * 0.38, w: 4.6, h: 0.35, valign: "middle", margin: 6 });
  });
  neuroRight.forEach(([label, val, col], i) => {
    s.addShape(pres.ShapeType.rect, {
      x: 5.1, y: 3.83 + i * 0.38, w: 4.7, h: 0.35,
      fill: { color: C.white }, line: { color: col, pt: 1.5 }, rounding: 0.04,
    });
    s.addText([
      { text: label + ":  ", options: { bold: true, color: col, fontSize: 10 } },
      { text: val, options: { color: C.slate, fontSize: 10 } },
    ], { x: 5.1, y: 3.83 + i * 0.38, w: 4.7, h: 0.35, valign: "middle", margin: 6 });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 5 - CSF & LAB INVESTIGATIONS
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.lightBg };
  addSlideHeader(s, "Investigations — CSF Analysis & Microbiology");
  addFooter(s);

  // CSF table
  s.addText("CSF ANALYSIS (NIMHANS)", {
    x: 0.2, y: 1.05, w: 4.5, h: 0.3, fontSize: 11, bold: true, color: C.navy, margin: 0,
  });
  const csf = [
    ["Parameter", "Value", "Interpretation"],
    ["Total WBC", "101 cells", "Elevated (pleocytosis)"],
    ["Neutrophils", "11%", "Minor neutrophilia"],
    ["Lymphocytes", "82%", "Lymphocyte dominant"],
    ["Protein", "85.6 mg/dL", "Elevated"],
    ["Glucose (CSF)", "40 mg/dL", "Low"],
    ["Blood Sugar", "140 mg/dL", "CSF:BS ratio 0.28 (low)"],
    ["CBNAAT (CSF)", "Negative", ""],
    ["Culture (CSF)", "No growth", "Awaited from NIMHANS"],
  ];
  csf.forEach((row, ri) => {
    const cols = [0.2, 2.5, 3.8];
    const widths = [2.25, 1.25, 2.4];
    row.forEach((cell, ci) => {
      const isAbnormal = ri > 0 && (cell.includes("Elevated") || cell.includes("Low") || cell.includes("0.28"));
      s.addShape(pres.ShapeType.rect, {
        x: cols[ci], y: 1.38 + ri * 0.32, w: widths[ci], h: 0.31,
        fill: { color: ri === 0 ? C.navy : (ri % 2 === 0 ? "E8F4F8" : C.white) },
        line: { color: "CBD5E1", pt: 0.5 },
      });
      s.addText(cell, {
        x: cols[ci], y: 1.38 + ri * 0.32, w: widths[ci], h: 0.31,
        fontSize: ri === 0 ? 9.5 : 9,
        bold: ri === 0,
        color: ri === 0 ? C.white : (isAbnormal ? C.red : C.slate),
        valign: "middle", align: ci === 1 ? "center" : "left", margin: 4,
      });
    });
  });

  // Microbiology / other results
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    x: 5.0, y: 1.05, w: 4.75, h: 0.3, fontSize: 11, bold: true, color: C.navy, margin: 0,
  });

  const micro = [
    { label: "Ear Discharge C&S", val: "Staphylococcus aureus (+ve)\n→ Linezolid given (sensitivity)", color: C.red },
    { label: "Sputum CBNAAT", val: "Negative", color: C.amber },
    { label: "CSF CBNAAT", val: "Negative", color: C.amber },
    { label: "CSF Culture (NIMHANS)", val: "Processing — Awaited", color: C.muted },
    { label: "ENT Swab (our hospital)", val: "Scanty / Nil discharge — not done", color: C.amber },
  ];
  micro.forEach((m, i) => {
    s.addShape(pres.ShapeType.rect, {
      x: 5.0, y: 1.38 + i * 0.62, w: 4.75, h: 0.58,
      fill: { color: C.white }, line: { color: m.color, pt: 1.5 }, rounding: 0.05,
    });
    s.addText([
      { text: m.label + "\n", options: { bold: true, fontSize: 10, color: C.navy } },
      { text: m.val, options: { fontSize: 9.5, color: m.color } },
    ], { x: 5.1, y: 1.38 + i * 0.62, w: 4.55, h: 0.58, valign: "middle", margin: 0 });
  });

  // Nutritional status
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    x: 0.2, y: 4.52, w: 9.55, h: 0.72,
    fill: { color: "FEF3C7" }, line: { color: C.amber, pt: 1.5 }, rounding: 0.06,
  });
  s.addText("NUTRITIONAL ASSESSMENT", {
    x: 0.4, y: 4.55, w: 9.3, h: 0.28, fontSize: 10, bold: true, color: C.navy, margin: 0,
  });
  s.addText("Caloric intake: 1122 kcal/day (Expected: 1840 kcal) — Deficit: 718 kcal    |    Protein: 38.2 g/day (Expected: 40.2 g)    |    BMI: 16.1 (5th–10th centile)", {
    x: 0.4, y: 4.82, w: 9.3, h: 0.38, fontSize: 10, color: C.slate, margin: 0,
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 6 - MRI BRAIN FINDINGS (NIMHANS - prior imaging)
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.lightBg };
  addSlideHeader(s, "MRI Brain Findings — NIMHANS (Prior Imaging)", "Multiple Ring-Enhancing Lesions — Tuberculoma");
  addFooter(s);

  s.addText("IMAGING DETAILS", {
    x: 0.2, y: 1.25, w: 9.6, h: 0.28, fontSize: 11, bold: true, color: C.navy, margin: 0,
  });
  s.addText("Modality: MRI Brain with Contrast    |    Indication: Severe headache + raised ICP features    |    Institution: NIMHANS", {
    x: 0.2, y: 1.52, w: 9.6, h: 0.25, fontSize: 10, color: C.slate, margin: 0,
  });

  // Signal characteristics box
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    x: 0.2, y: 1.85, w: 4.5, h: 2.35,
    fill: { color: C.navy }, line: { color: C.navy }, rounding: 0.07,
  });
  s.addText("SIGNAL CHARACTERISTICS", {
    x: 0.2, y: 1.85, w: 4.5, h: 0.35, fontSize: 10, bold: true, color: C.amber, align: "center", valign: "middle",
  });
  const signals = [
    ["T1", "Isointense"],
    ["T2 / FLAIR", "Hypointense (target sign)"],
    ["Enhancement", "Ring-enhancing pattern"],
    ["Perilesional", "Vasogenic edema — present"],
  ];
  signals.forEach(([seq, finding], i) => {
    s.addText([
      { text: seq + ":  ", options: { bold: true, color: C.teal, fontSize: 11 } },
      { text: finding, options: { color: C.white, fontSize: 11 } },
    ], {
      x: 0.4, y: 2.3 + i * 0.42, w: 4.1, h: 0.38, valign: "middle", margin: 0,
    });
  });

  // Lesion locations
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    x: 4.9, y: 1.85, w: 4.9, h: 2.35,
    fill: { color: C.white }, line: { color: C.teal, pt: 1.5 }, rounding: 0.07,
  });
  s.addText("LESION LOCATIONS (Multiple Tuberculoma)", {
    x: 4.9, y: 1.85, w: 4.9, h: 0.35, fontSize: 10, bold: true, color: C.teal, align: "center", valign: "middle",
  });
  const locs = [
    "Right Frontal Lobe",
    "Right Parietal Lobe",
    "Right Occipital Lobe",
    "Left Periventricular Region",
    "Bilateral Basal Ganglia",
    "Thalamus",
    "Left Temporal Lobe",
    "Left Cerebellum",
  ];
  const col1 = locs.slice(0, 4);
  const col2 = locs.slice(4);
  col1.forEach((loc, i) => {
    s.addText("\u25BA  " + loc, {
      x: 5.0, y: 2.28 + i * 0.42, w: 2.35, h: 0.38,
      fontSize: 10, color: C.slate, valign: "middle", margin: 0,
    });
  });
  col2.forEach((loc, i) => {
    s.addText("\u25BA  " + loc, {
      x: 7.4, y: 2.28 + i * 0.42, w: 2.3, h: 0.38,
      fontSize: 10, color: C.slate, valign: "middle", margin: 0,
    });
  });

  // Impression
  s.addShape(pres.ShapeType.rect, {
    x: 0.2, y: 4.3, w: 9.55, h: 0.65,
    fill: { color: C.teal }, line: { color: C.teal }, rounding: 0.07,
  });
  s.addText("IMPRESSION:  Multiple ring-enhancing lesions with T2 hypointensity and perilesional vasogenic edema — distribution and characteristics consistent with GRANULOMATOUS ETIOLOGY (TUBERCULOMA)", {
    x: 0.35, y: 4.3, w: 9.3, h: 0.65,
    fontSize: 11, bold: true, color: C.white, valign: "middle", margin: 0,
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 7 - HRCT CHEST FINDINGS
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.lightBg };
  addSlideHeader(s, "HRCT Chest Findings — NIMHANS", "Disseminated Pulmonary TB");
  addFooter(s);

  // Left panel
  s.addShape(pres.ShapeType.rect, {
    x: 0.2, y: 1.15, w: 4.8, h: 3.9,
    fill: { color: C.navy }, line: { color: C.navy }, rounding: 0.08,
  });
  s.addText("HRCT CHEST FINDINGS", {
    x: 0.2, y: 1.15, w: 4.8, h: 0.38, fontSize: 11, bold: true, color: C.amber, align: "center", valign: "middle",
  });
  const hrct = [
    { finding: "Consolidation", detail: "Left lower lobe consolidation\nsuggesting active parenchymal disease" },
    { finding: "Miliary Pattern", detail: "Miliary infiltrates — bilateral\nconsistent with haematogenous dissemination" },
  ];
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    { icon: "►", label: "Dissemination route", val: "Haematogenous spread → simultaneous CNS + pulmonary + possible middle ear involvement" },
    { icon: "►", label: "Risk factor", val: "Strong family history of TB (grandfather: pulmonary TB; mother: TB lymphadenitis)" },
    { icon: "►", label: "Immunisation gap", val: "Not immunised after 9 months of age — BCG protection inadequate" },
    { icon: "►", label: "Nutritional status", val: "Caloric deficit (38% below expected) — contributes to susceptibility" },
    { icon: "►", label: "Sputum CBNAAT", val: "Negative — microbiological confirmation of pulmonary TB pending" },
  ];
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    }
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 8 - MRI BRAIN AT OUR HOSPITAL (REPEAT)
// ─────────────────────────────────────────────────────────────────
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  addSlideHeader(s, "Repeat MRI Brain — Our Hospital", "After 1 Month of ATT — Comparative Analysis");
  addFooter(s);

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        "T1 isointense / T2 hypointense",
        "Significant perilesional vasogenic edema",
        "8 sites involved (bilateral, multifocal)",
        "No basal leptomeningeal enhancement noted",
      ],
    },
    {
      title: "CURRENT MRI (OUR HOSPITAL)\nAfter 1 Month ATT",
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      items: [
        "NEW: Mild basal leptomeningeal enhancement",
        "Significant REDUCTION in lesion size",
        "Significant REDUCTION in perilesional edema",
        "Persistent ring-enhancing pattern",
        "No new lesions identified",
      ],
    },
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        bold: isNew, valign: "middle", margin: 0,
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    });
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    x: 0.2, y: 4.4, w: 9.55, h: 0.8,
    fill: { color: "F0FFF4" }, line: { color: C.green, pt: 1.5 }, rounding: 0.07,
  });
  s.addText([
    { text: "RADIOLOGICAL RESPONSE:  ", options: { bold: true, fontSize: 11, color: C.green } },
    { text: "Despite new basal leptomeningeal enhancement (possible paradoxical reaction or disease progression at CSF compartment), lesion size and vasogenic edema have significantly reduced — suggesting a PARTIAL RADIOLOGICAL RESPONSE to ATT.  ", options: { fontSize: 10.5, color: C.slate } },
    { text: "Steroid dose escalated accordingly.", options: { fontSize: 10.5, italic: true, color: C.navy } },
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}

// ─────────────────────────────────────────────────────────────────
// SLIDE 9 - MANAGEMENT OVERVIEW
// ─────────────────────────────────────────────────────────────────
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  addSlideHeader(s, "Management — Course in Hospital");
  addFooter(s);

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    { title: "2.  Anti-Edema / ICP", detail: "Tab. Acetazolamide 250mg Q6h × 9 days\n(for raised intracranial pressure)\nDiscontinued after symptom resolution", color: C.teal },
    { title: "3.  Anticonvulsant", detail: "Tab. Levetiracetam 500mg Q12h\n(prophylactic — no documented seizure)\nContinued on discharge", color: C.navy },
    { title: "4.  Ophthalmology Review", detail: "6th CN palsy → bilateral diplopia\nOcular movement exercises:\n15 repetitions × 3 sessions/day", color: C.navy },
    { title: "5.  ENT Evaluation", detail: "Middle ear TB suspected (NIMHANS)\nScanty/nil discharge here → biopsy/\nmicrobiological confirmation not feasible", color: C.amber },
    { title: "6.  Multidisciplinary", detail: "Paed. Neurologist: steroid protocol\nPaed. Endocrinologist: consulted\nGeneticist: consulted\nPaed. Surgeon: consulted", color: C.amber },
  ];
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// ─────────────────────────────────────────────────────────────────
// SLIDE 10 - DIFFERENTIAL DIAGNOSIS
// ─────────────────────────────────────────────────────────────────
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  s.background = { color: C.lightBg };
  addSlideHeader(s, "Differential Diagnosis — Ring-Enhancing Lesions in a Child");
  addFooter(s);

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      dx: "Tuberculoma ✓ (Favoured)",
      for_: "Multiple lesions, T2 hypointense, granulomatous pattern, miliary chest, strong TB contact history, CSF lymphocytosis, BCG gap, partial ATT response",
      against: "CBNAAT negative; Culture pending",
      likely: true,
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    {
      dx: "Pyogenic Brain Abscess",
      for_: "Ring-enhancing lesions",
      against: "No DWI restriction pattern reported; afebrile on admission; no source of pyogenic infection; no neutrophilic CSF predominance",
      likely: false,
    },
    {
      dx: "Neurocysticercosis",
      for_: "Ring-enhancing lesions, endemic region",
      against: "Multiple active lesions without calcification; T2 hypointensity not typical; no dietary risk; miliary chest pattern not explained",
      likely: false,
    },
    {
      dx: "Lymphoma (CNS)",
      for_: "Multiple periventricular lesions",
      against: "Child, immunocompetent; no systemic lymphoma features; pattern more granulomatous",
      likely: false,
    },
    {
      dx: "Toxoplasmosis",
      for_: "Ring-enhancing, basal ganglia involvement",
      against: "Immunocompetent child; no HIV risk; exposure history absent",
      likely: false,
    },
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}

// ─────────────────────────────────────────────────────────────────
// SLIDE 11 - DISCHARGE PLAN & FOLLOW-UP
// ─────────────────────────────────────────────────────────────────
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    ["Tab. Ethambutol", "200 mg", "Once daily", "1 month"],
    ["Tab. Levetiracetam", "500 mg", "BD (12-hrly)", "1 month"],
    ["Tab. Prednisolone", "20 mg", "2-0-2 (80mg/day)", "4 weeks then taper"],
    ["Tab. Pyridoxine", "40 mg", "BD", "4 weeks"],
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    { date: "25 Jul 2026", clinic: "Paed. Neurology OPD\n(Dr. Arathi)\n1st Floor" },
    { date: "31 Jul 2026", clinic: "ATT review\n(1-month course ends)" },
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// ─────────────────────────────────────────────────────────────────
// SLIDE 12 - SUMMARY & TEACHING POINTS
// ─────────────────────────────────────────────────────────────────
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    { num: "02", title: "Miliary TB — Haematogenous Dissemination", body: "Simultaneous involvement of brain (tuberculoma), lungs (miliary + consolidation), and possibly middle ear confirms haematogenous route. HRCT miliary pattern is pathognomonic." },
    { num: "03", title: "New Leptomeningeal Enhancement on Repeat MRI", body: "Basal leptomeningeal enhancement not seen on initial MRI — consider paradoxical reaction vs. true progression despite ATT. Steroid escalation is the correct response." },
    { num: "04", title: "Culture/CBNAAT Negativity is Common", body: "CSF CBNAAT sensitivity ~50–60% in TBM. Do not withhold treatment. Clinical + radiological + epidemiological diagnosis is sufficient in resource-limited settings." },
    { num: "05", title: "6th CN Palsy in TBM", body: "Long intracranial course of 6th CN makes it highly susceptible to raised ICP and basal meningitis. Its presence in TBM carries both localising and non-localising significance." },
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// ─────────────────────────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────────────────────────
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