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

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)

blank_layout = prs.slide_layouts[6]

# ─── Color Palette ───────────────────────────────────────────────────────────
DARK_BLUE   = RGBColor(0x12, 0x35, 0x6B)   # deep navy
MED_BLUE    = RGBColor(0x1A, 0x73, 0xAA)   # medium blue
ACCENT_TEAL = RGBColor(0x00, 0xAA, 0xAA)   # teal accent
LIGHT_BLUE  = RGBColor(0xD6, 0xEA, 0xF8)   # very light blue bg
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
OFF_WHITE   = RGBColor(0xF7, 0xF9, 0xFC)
TEXT_DARK   = RGBColor(0x1C, 0x1C, 0x2E)
TEXT_MID    = RGBColor(0x3A, 0x3A, 0x5C)
GOLD        = RGBColor(0xE8, 0xA0, 0x00)
GREEN       = RGBColor(0x1A, 0x8A, 0x4A)
RED_SOFT    = RGBColor(0xCC, 0x33, 0x33)
GRAY_LIGHT  = RGBColor(0xEB, 0xEE, 0xF5)


def add_rect(slide, left, top, width, height, fill_color, alpha=None):
    shape = slide.shapes.add_shape(
        1,  # MSO_SHAPE_TYPE.RECTANGLE
        Inches(left), Inches(top), Inches(width), Inches(height)
    )
    shape.line.fill.background()
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    return shape


def add_text(slide, text, left, top, width, height,
             font_size=18, bold=False, color=TEXT_DARK,
             align=PP_ALIGN.LEFT, italic=False, wrap=True):
    tb = slide.shapes.add_textbox(
        Inches(left), Inches(top), Inches(width), Inches(height)
    )
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Inches(0.05)
    tf.margin_right = Inches(0.05)
    tf.margin_top = Inches(0.03)
    tf.margin_bottom = Inches(0.03)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(font_size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = "Calibri"
    return tb


def add_bullet_text(slide, bullets, left, top, width, height,
                    font_size=16, title=None, title_size=18,
                    title_color=DARK_BLUE, bullet_color=TEXT_DARK,
                    bg_color=None, padding=0.15):
    if bg_color:
        add_rect(slide, left, top, width, height, bg_color)
    tb = slide.shapes.add_textbox(
        Inches(left + padding), Inches(top + padding),
        Inches(width - padding*2), Inches(height - padding*2)
    )
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = 0
    tf.margin_right = 0
    tf.margin_top = 0
    tf.margin_bottom = 0
    first = True
    if title:
        p = tf.paragraphs[0]
        p.alignment = PP_ALIGN.LEFT
        r = p.add_run()
        r.text = title
        r.font.size = Pt(title_size)
        r.font.bold = True
        r.font.color.rgb = title_color
        r.font.name = "Calibri"
        first = False
    for bullet in bullets:
        p = tf.add_paragraph() if not first else tf.paragraphs[0]
        first = False
        p.alignment = PP_ALIGN.LEFT
        p.space_before = Pt(3)
        r = p.add_run()
        r.text = bullet
        r.font.size = Pt(font_size)
        r.font.color.rgb = bullet_color
        r.font.name = "Calibri"
    return tb


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 1 — TITLE SLIDE
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
# Full background
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
# Accent bar
add_rect(slide, 0, 5.8, 13.333, 0.08, GOLD)
# Side accent
add_rect(slide, 0, 0, 0.35, 7.5, MED_BLUE)

add_text(slide, "PRINCIPLES OF GENERAL SURGERY",
         0.7, 1.3, 12.2, 1.4, font_size=40, bold=True,
         color=WHITE, align=PP_ALIGN.CENTER)
add_text(slide, "A Comprehensive Overview from Recent Editions",
         0.7, 2.85, 12.2, 0.7, font_size=22, bold=False,
         color=ACCENT_TEAL, align=PP_ALIGN.CENTER)
add_text(slide, "Bailey & Love's Short Practice of Surgery (28th Ed)  |  Sabiston Textbook of Surgery",
         0.7, 3.6, 12.2, 0.6, font_size=16, bold=False,
         color=RGBColor(0xCC, 0xDD, 0xEE), align=PP_ALIGN.CENTER)
add_text(slide, "General Surgery  •  Perioperative Care  •  Surgical Science",
         0.7, 4.3, 12.2, 0.5, font_size=14, bold=False,
         color=RGBColor(0xAA, 0xBB, 0xCC), align=PP_ALIGN.CENTER)
add_text(slide, "2026",
         5.5, 6.2, 2.3, 0.5, font_size=18, bold=True,
         color=GOLD, align=PP_ALIGN.CENTER)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 2 — TABLE OF CONTENTS
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, DARK_BLUE)
add_rect(slide, 0, 1.1, 0.08, 6.4, GOLD)

add_text(slide, "TABLE OF CONTENTS", 0.3, 0.2, 12.5, 0.75,
         font_size=28, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

topics = [
    ("01", "Metabolic Response to Injury & Homeostasis"),
    ("02", "Mediators: Neuroendocrine & Inflammatory Response"),
    ("03", "Wound Healing: Phases, Factors & Management"),
    ("04", "Surgical Infection, Sepsis & Antibiotics"),
    ("05", "Fluid, Electrolytes & Blood Transfusion"),
    ("06", "Shock: Classification, Pathophysiology & Treatment"),
    ("07", "Preoperative Assessment & Risk Stratification"),
    ("08", "Perioperative Care & Enhanced Recovery"),
    ("09", "Principles of Surgical Oncology"),
    ("10", "Surgical Ethics, Education & Patient Safety"),
]

col_w = 6.0
for i, (num, topic) in enumerate(topics):
    row = i % 5
    col = i // 5
    x = 0.4 + col * 6.5
    y = 1.35 + row * 1.1

    add_rect(slide, x, y, col_w, 0.9, LIGHT_BLUE if i % 2 == 0 else GRAY_LIGHT)
    add_rect(slide, x, y, 0.55, 0.9, MED_BLUE)
    add_text(slide, num, x + 0.05, y + 0.1, 0.5, 0.7, font_size=18,
             bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_text(slide, topic, x + 0.65, y + 0.12, col_w - 0.75, 0.7,
             font_size=14, bold=False, color=TEXT_DARK)

add_text(slide, "Source: Bailey & Love 28th Ed | Sabiston Textbook of Surgery",
         0.3, 7.1, 12.7, 0.35, font_size=10, italic=True,
         color=RGBColor(0x88, 0x88, 0x99), align=PP_ALIGN.CENTER)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 3 — METABOLIC RESPONSE TO INJURY
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, DARK_BLUE)
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "1. METABOLIC RESPONSE TO INJURY & HOMEOSTASIS", 0.3, 0.2, 12.7, 0.75,
         font_size=24, bold=True, color=WHITE)

# Left column
add_bullet_text(slide,
    title="Homeostasis",
    bullets=[
        "• Maintaining a constant internal environment for optimal cellular function",
        "• Divided into CATABOLIC phase (early) and ANABOLIC phase (recovery)",
        "• Catabolic phase: hypovolaemia, reduced cardiac output, hypothermia, lactic acidosis",
        "• Anabolic phase: rebuilding begins after ~3-5 days; nitrogen retained",
    ],
    left=0.25, top=1.3, width=6.0, height=2.5,
    font_size=13, bg_color=LIGHT_BLUE)

add_bullet_text(slide,
    title="Magnitude of Injury Response",
    bullets=[
        "• Graded: more severe injury = greater metabolic response",
        "• Minor surgery: modest transient rise in HR, temp, WBC",
        "• Major trauma/sepsis/burns: SIRS, hypermetabolism, MODS",
        "• Genetic variability modulates individual response intensity",
    ],
    left=0.25, top=3.95, width=6.0, height=2.55,
    font_size=13, bg_color=GRAY_LIGHT)

# Right column
add_bullet_text(slide,
    title="Key Phases Summary (Bailey & Love, Ch. 1)",
    bullets=[
        "EBB PHASE (0-24 hrs)",
        "  → Hypovolaemia, hypothermia, reduced BMR",
        "  → Goal: preserve circulating volume & energy",
        "",
        "FLOW PHASE (days 1-5)",
        "  → SIRS, hypermetabolism, muscle proteolysis",
        "  → Insulin resistance, hyperglycaemia",
        "  → Increased cardiac output, O₂ consumption",
        "",
        "ANABOLIC PHASE (days 5+)",
        "  → Protein synthesis resumes",
        "  → Gradual restoration of lean body mass",
    ],
    left=6.55, top=1.3, width=6.55, height=5.1,
    font_size=12.5, bg_color=LIGHT_BLUE, title_color=MED_BLUE)

add_text(slide, "Bailey & Love's Short Practice of Surgery, 28th Ed, Ch. 1", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 4 — MEDIATORS OF METABOLIC RESPONSE
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, MED_BLUE)
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "2. MEDIATORS: NEUROENDOCRINE & INFLAMMATORY RESPONSE", 0.3, 0.2, 12.7, 0.75,
         font_size=22, bold=True, color=WHITE)

# Inflammatory mediators
add_bullet_text(slide,
    title="Inflammatory Pathway",
    bullets=[
        "• Tissue injury releases DAMPs (damage-associated molecular patterns)",
        "• DAMPs sensed by PRRs: Toll-like receptors, NOD-like receptors",
        "• Activates macrophages, neutrophils, dendritic cells",
        "• Inflammasome formation → Caspase activation",
        "• Key cytokines released: IL-1, IL-6, TNF-alpha, interferons",
        "• Sterile SIRS initiated → local inflammation and systemic effects",
    ],
    left=0.25, top=1.3, width=6.2, height=2.8,
    font_size=13, bg_color=LIGHT_BLUE)

# Neuroendocrine
add_bullet_text(slide,
    title="Neuroendocrine Response",
    bullets=[
        "• Hypothalamic-pituitary-adrenal (HPA) axis activation",
        "• Cortisol ↑: promotes gluconeogenesis, anti-inflammatory",
        "• Catecholamines (Adr, NA) ↑: tachycardia, ↑ glycogenolysis",
        "• ADH (vasopressin) ↑: water retention, oliguria post-op",
        "• Aldosterone ↑: Na+ & water reabsorption",
        "• GH ↑ but IGF-1 ↓ = peripheral resistance",
        "• Insulin resistance → hyperglycaemia (risk of sepsis)",
    ],
    left=6.55, top=1.3, width=6.55, height=2.8,
    font_size=13, bg_color=GRAY_LIGHT)

# Bottom summary row
add_bullet_text(slide,
    title="Consequences of Uncontrolled Inflammatory Response",
    bullets=[
        "• Capillary leak → tissue oedema, visceral oedema, impaired organ perfusion",
        "• Acute Kidney Injury (AKI) and Acute Lung Injury (ALI)",
        "• Coagulopathy → DIC risk",
        "• Multiple Organ Dysfunction Syndrome (MODS) in severe cases",
        "• MODS mortality: up to 50-80% in full organ failure",
    ],
    left=0.25, top=4.3, width=12.85, height=2.55,
    font_size=13, bg_color=RGBColor(0xFF, 0xF3, 0xD0), title_color=RED_SOFT)

add_text(slide, "Bailey & Love 28th Ed, Ch. 1 | Sabiston Textbook of Surgery", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 5 — WOUND HEALING
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, RGBColor(0x12, 0x6D, 0x40))
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "3. WOUND HEALING: PHASES, FACTORS & MANAGEMENT", 0.3, 0.2, 12.7, 0.75,
         font_size=24, bold=True, color=WHITE)

phases = [
    ("Haemostasis\n(0-24 hrs)", [
        "Platelet aggregation",
        "Fibrin clot formation",
        "Vasoconstriction",
        "Growth factor release",
    ], MED_BLUE),
    ("Inflammation\n(1-4 days)", [
        "Neutrophil infiltration",
        "Macrophage activity",
        "Debridement of debris",
        "Cytokine release",
    ], RGBColor(0xCC, 0x55, 0x00)),
    ("Proliferation\n(4-21 days)", [
        "Fibroblast migration",
        "Collagen synthesis (Type III)",
        "Angiogenesis (VEGF)",
        "Granulation tissue",
    ], RGBColor(0x1A, 0x7A, 0x4A)),
    ("Remodelling\n(21d - 2yr)", [
        "Type III → Type I collagen",
        "Scar contraction",
        "Max tensile strength: 80%",
        "Myofibroblast action",
    ], RGBColor(0x6A, 0x1A, 0x8A)),
]

for i, (phase, pts, color) in enumerate(phases):
    x = 0.25 + i * 3.2
    add_rect(slide, x, 1.3, 3.05, 3.8, color)
    add_text(slide, phase, x + 0.1, 1.35, 2.85, 0.9, font_size=14,
             bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    for j, pt in enumerate(pts):
        add_text(slide, "• " + pt, x + 0.12, 2.35 + j*0.65, 2.82, 0.65,
                 font_size=12.5, color=RGBColor(0xEE, 0xFF, 0xEE))

# Factors affecting wound healing
add_bullet_text(slide,
    title="Factors Affecting Wound Healing",
    bullets=[
        "LOCAL: wound tension, haematoma, infection, foreign body, ischaemia, radiation",
        "SYSTEMIC: malnutrition (↓ Vit C, Zn, protein), diabetes, steroid use, immunosuppression, old age, anaemia",
    ],
    left=0.25, top=5.35, width=8.5, height=1.85,
    font_size=13, bg_color=LIGHT_BLUE, title_color=MED_BLUE)

add_bullet_text(slide,
    title="Closure Types",
    bullets=[
        "Primary: direct apposition",
        "Secondary: granulation",
        "Tertiary: delayed primary",
    ],
    left=9.0, top=5.35, width=4.1, height=1.85,
    font_size=13, bg_color=GRAY_LIGHT, title_color=MED_BLUE)

add_text(slide, "Bailey & Love 28th Ed | Sabiston Textbook of Surgery", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 6 — SURGICAL INFECTION, SEPSIS & ANTIBIOTICS
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, RGBColor(0x7D, 0x1A, 0x1A))
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "4. SURGICAL INFECTION, SEPSIS & ANTIMICROBIAL PRINCIPLES", 0.3, 0.2, 12.7, 0.75,
         font_size=22, bold=True, color=WHITE)

add_bullet_text(slide,
    title="Surgical Site Infection (SSI) - Classification",
    bullets=[
        "Superficial incisional: skin and subcutaneous tissue only",
        "Deep incisional: fascia and muscle layers",
        "Organ/space SSI: any anatomical structure opened during surgery",
        "Risk factors: obesity, DM, immunosuppression, prolonged OR time, contaminated wound",
    ],
    left=0.25, top=1.3, width=6.2, height=2.5,
    font_size=13, bg_color=LIGHT_BLUE, title_color=RGBColor(0x7D, 0x1A, 0x1A))

add_bullet_text(slide,
    title="Sepsis (Sepsis-3 Definition)",
    bullets=[
        "Life-threatening organ dysfunction due to dysregulated host response to infection",
        "SOFA score ≥ 2 (or qSOFA: RR≥22, altered mentation, SBP≤100)",
        "Septic shock: sepsis + vasopressor needed + lactate > 2 mmol/L",
        "Management: 1-hr bundle — cultures, IV antibiotics, IV fluids, lactate",
    ],
    left=6.55, top=1.3, width=6.55, height=2.5,
    font_size=13, bg_color=GRAY_LIGHT, title_color=RGBColor(0x7D, 0x1A, 0x1A))

add_bullet_text(slide,
    title="Antibiotic Prophylaxis Principles",
    bullets=[
        "• Given within 60 minutes before skin incision (or 2 hrs for vancomycin/fluoroquinolones)",
        "• Covers likely pathogens at surgical site (e.g., cefazolin for skin/GI flora)",
        "• Re-dose for procedures >4 hrs or major blood loss (>1500 mL)",
        "• Stop within 24 hours post-operatively (24-48 hrs for cardiac surgery)",
        "• Overuse drives antibiotic resistance — adhere to stewardship protocols",
    ],
    left=0.25, top=4.0, width=12.85, height=2.85,
    font_size=13, bg_color=RGBColor(0xFF, 0xF0, 0xE0), title_color=RGBColor(0x7D, 0x1A, 0x1A))

add_text(slide, "Bailey & Love 28th Ed | Sabiston Textbook of Surgery | NICE Guidelines", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 7 — FLUID, ELECTROLYTES & BLOOD
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, RGBColor(0x1A, 0x5C, 0x8A))
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "5. FLUID, ELECTROLYTES & BLOOD TRANSFUSION", 0.3, 0.2, 12.7, 0.75,
         font_size=24, bold=True, color=WHITE)

add_bullet_text(slide,
    title="Body Fluid Compartments",
    bullets=[
        "Total Body Water (TBW): ~60% body weight in males; ~55% in females",
        "Intracellular Fluid (ICF): 2/3 of TBW; K+, Mg2+, PO₄ dominant",
        "Extracellular Fluid (ECF): 1/3 of TBW = Interstitial (3/4) + Intravascular (1/4)",
        "Daily requirement: ~35 mL/kg water; Na+ 1-2 mmol/kg; K+ 0.5-1 mmol/kg",
    ],
    left=0.25, top=1.3, width=6.2, height=2.5,
    font_size=13, bg_color=LIGHT_BLUE)

add_bullet_text(slide,
    title="Crystalloids vs Colloids",
    bullets=[
        "Normal Saline (0.9%): hyperchloraemic acidosis risk; avoid large volumes",
        "Hartmann's/Ringer's Lactate: balanced; preferred for resuscitation",
        "Colloids (albumin, gelatin): expand intravascular volume; costly",
        "Hypertonic saline: used in traumatic brain injury (↓ ICP)",
    ],
    left=6.55, top=1.3, width=6.55, height=2.5,
    font_size=13, bg_color=GRAY_LIGHT)

add_bullet_text(slide,
    title="Blood Transfusion Principles (Bailey & Love, Ch. 2)",
    bullets=[
        "Restrictive strategy: transfuse when Hb < 7 g/dL (8 g/dL in cardiac surgery)",
        "Each unit pRBC raises Hb by ~1 g/dL",
        "Massive transfusion (>10 units): use 1:1:1 ratio pRBC:FFP:Platelets",
        "Complications: TRALI, TACO, transfusion reactions, hypothermia, hypocalcaemia, CMV transmission",
        "Cell salvage preferred in elective surgery to minimise allogeneic transfusion",
    ],
    left=0.25, top=4.0, width=12.85, height=2.85,
    font_size=13, bg_color=RGBColor(0xE8, 0xF4, 0xFF), title_color=RGBColor(0x1A, 0x5C, 0x8A))

add_text(slide, "Bailey & Love 28th Ed, Ch. 2 | Sabiston Textbook of Surgery", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 8 — SHOCK
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, RGBColor(0x5A, 0x1A, 0x5A))
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "6. SHOCK: CLASSIFICATION, PATHOPHYSIOLOGY & TREATMENT", 0.3, 0.2, 12.7, 0.75,
         font_size=22, bold=True, color=WHITE)

shock_types = [
    ("HYPOVOLAEMIC", ["• Blood/fluid loss", "• Haemorrhage, burns, vomiting", "• HR↑, BP↓, cold clammy skin", "• Rx: IV fluids, blood"], RGBColor(0xCC, 0x33, 0x33)),
    ("CARDIOGENIC", ["• Pump failure", "• MI, arrhythmia, tamponade", "• Raised JVP, S3, crackles", "• Rx: inotropes, IABP"], RGBColor(0x1A, 0x5C, 0x8A)),
    ("DISTRIBUTIVE", ["• Vasodilation/maldistribution", "• Septic, anaphylactic, neurogenic", "• Warm skin (septic), hypotension", "• Rx: vasopressors, fluids"], RGBColor(0x7D, 0x5A, 0x00)),
    ("OBSTRUCTIVE", ["• Mechanical obstruction", "• PE, tension PTX, cardiac tamponade", "• Absent breath sounds/raised JVP", "• Rx: treat cause urgently"], RGBColor(0x1A, 0x6A, 0x3A)),
]

for i, (stype, pts, color) in enumerate(shock_types):
    x = 0.25 + i * 3.26
    add_rect(slide, x, 1.3, 3.1, 4.2, color)
    add_text(slide, stype, x + 0.1, 1.35, 2.9, 0.65, font_size=13,
             bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    for j, pt in enumerate(pts):
        add_text(slide, pt, x + 0.12, 2.1 + j * 0.72, 2.86, 0.7,
                 font_size=12, color=WHITE)

# ATLS Classification
add_bullet_text(slide,
    title="ATLS Haemorrhagic Shock Classification",
    bullets=[
        "Class I: <750 mL (<15%) | HR <100, BP normal | Minimal symptoms",
        "Class II: 750-1500 mL (15-30%) | HR 100-120, BP ↓ slightly | Anxiety",
        "Class III: 1500-2000 mL (30-40%) | HR 120-140, BP ↓↓ | Confusion",
        "Class IV: >2000 mL (>40%) | HR >140, BP markedly ↓ | Lethargy, anuria",
    ],
    left=0.25, top=5.65, width=12.85, height=1.65,
    font_size=12.5, bg_color=GRAY_LIGHT, title_color=RGBColor(0x5A, 0x1A, 0x5A))

add_text(slide, "Bailey & Love 28th Ed, Ch. 2 | ATLS 10th Ed | Sabiston Textbook", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 9 — PREOPERATIVE ASSESSMENT
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, DARK_BLUE)
add_rect(slide, 0, 1.1, 13.333, 0.06, ACCENT_TEAL)

add_text(slide, "7. PREOPERATIVE ASSESSMENT & RISK STRATIFICATION", 0.3, 0.2, 12.7, 0.75,
         font_size=24, bold=True, color=WHITE)

add_bullet_text(slide,
    title="ASA Physical Status Classification",
    bullets=[
        "ASA I: Normal healthy patient",
        "ASA II: Mild systemic disease (e.g., well-controlled DM, mild HTN)",
        "ASA III: Severe systemic disease (e.g., COPD, heart failure, CKD)",
        "ASA IV: Severe systemic disease with constant life threat",
        "ASA V: Moribund; not expected to survive without surgery",
        "ASA VI: Brain-dead; organ donation",
        "Suffix 'E' added for emergency procedures",
    ],
    left=0.25, top=1.3, width=6.0, height=3.4,
    font_size=13, bg_color=LIGHT_BLUE, title_color=DARK_BLUE)

add_bullet_text(slide,
    title="Cardiac Risk Assessment (Lee's Revised Cardiac Risk Index)",
    bullets=[
        "1. High-risk surgery (intrathoracic, intraabdominal, suprainguinal vascular)",
        "2. Ischaemic heart disease (prior MI, +ve stress test, angina)",
        "3. Congestive heart failure history",
        "4. Cerebrovascular disease (TIA/stroke history)",
        "5. Insulin-dependent diabetes mellitus",
        "6. Serum creatinine > 177 μmol/L (> 2 mg/dL)",
        "Score 0-1: low risk | Score ≥ 3: major cardiac event risk ~11%",
    ],
    left=6.55, top=1.3, width=6.55, height=3.4,
    font_size=12.5, bg_color=GRAY_LIGHT, title_color=DARK_BLUE)

add_bullet_text(slide,
    title="Key Preoperative Investigations & Optimisation",
    bullets=[
        "Bloods: FBC, U&E, LFTs, coagulation, group & save, glucose, HbA1c",
        "ECG: all patients >40 yrs or known cardiac disease",
        "Optimise: hypertension, DM, anaemia, malnutrition, bronchospasm",
        "Medication review: stop anticoagulants, NSAIDs; continue beta-blockers, antihypertensives",
        "Nutritional support if BMI <18.5 or significant weight loss pre-surgery",
    ],
    left=0.25, top=4.85, width=12.85, height=2.45,
    font_size=13, bg_color=RGBColor(0xE0, 0xF7, 0xEA), title_color=GREEN)

add_text(slide, "Bailey & Love 28th Ed | Sabiston Textbook | ACC/AHA 2014 Guidelines", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 10 — PERIOPERATIVE CARE & ERAS
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, RGBColor(0x0A, 0x6A, 0x5A))
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "8. PERIOPERATIVE CARE & ENHANCED RECOVERY AFTER SURGERY (ERAS)", 0.3, 0.2, 12.7, 0.75,
         font_size=21, bold=True, color=WHITE)

add_bullet_text(slide,
    title="PRE-OPERATIVE (ERAS)",
    bullets=[
        "• Patient education & shared decision making",
        "• Carbohydrate loading (drink) 2 hrs pre-op",
        "• Prehabilitation: exercise, nutrition optimisation",
        "• Avoid prolonged preoperative fasting",
        "• Anaemia correction (iron/EPO if needed)",
        "• DVT prophylaxis counselling",
    ],
    left=0.25, top=1.3, width=4.1, height=5.55,
    font_size=12, bg_color=RGBColor(0xD0, 0xF0, 0xE8), title_color=RGBColor(0x0A, 0x6A, 0x5A))

add_bullet_text(slide,
    title="INTRA-OPERATIVE (ERAS)",
    bullets=[
        "• Minimally invasive surgery preferred",
        "• Short-acting anaesthetic agents",
        "• Goal-directed fluid therapy (avoid over/under-hydration)",
        "• Maintain normothermia (forced-air warming)",
        "• Epidural or regional analgesia",
        "• Avoid nasogastric tubes unless essential",
        "• Selective use of drains",
    ],
    left=4.6, top=1.3, width=4.1, height=5.55,
    font_size=12, bg_color=RGBColor(0xE8, 0xF4, 0xFF), title_color=RGBColor(0x0A, 0x6A, 0x5A))

add_bullet_text(slide,
    title="POST-OPERATIVE (ERAS)",
    bullets=[
        "• Early oral feeding within 4-6 hrs",
        "• Multimodal analgesia (minimise opioids)",
        "• Early mobilisation (Day 0 or Day 1)",
        "• Remove urinary catheter early",
        "• Prophylactic antiemetics",
        "• VTE prophylaxis (LMWH + TED stockings)",
        "• Audit outcomes; readmission monitoring",
    ],
    left=9.1, top=1.3, width=4.0, height=5.55,
    font_size=12, bg_color=RGBColor(0xFFF8, 0xE8, 0xD0), title_color=RGBColor(0x0A, 0x6A, 0x5A))

add_text(slide, "Bailey & Love 28th Ed, Ch. 1 | ERAS Society Guidelines | Sabiston Textbook", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 11 — SURGICAL ONCOLOGY
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, RGBColor(0x4A, 0x1A, 0x6A))
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "9. PRINCIPLES OF SURGICAL ONCOLOGY", 0.3, 0.2, 12.7, 0.75,
         font_size=26, bold=True, color=WHITE)

add_bullet_text(slide,
    title="Surgical Goals in Cancer Treatment",
    bullets=[
        "• Curative resection: complete removal with adequate margins (R0 resection)",
        "• Cytoreductive/debulking surgery: reduce tumour bulk for adjuvant therapy",
        "• Palliation: relieve obstruction, bleeding, pain without cure intent",
        "• Diagnosis/staging: biopsy, sentinel node biopsy",
        "• Reconstruction: restore function/appearance after ablation",
    ],
    left=0.25, top=1.3, width=6.2, height=2.7,
    font_size=13, bg_color=LIGHT_BLUE, title_color=RGBColor(0x4A, 0x1A, 0x6A))

add_bullet_text(slide,
    title="Principles of Resection (Bailey & Love, Ch. 12)",
    bullets=[
        "• En-bloc resection: remove tumour with surrounding tissues/organs",
        "• Wide local excision: margin >1 cm for soft tissue sarcoma",
        "• Lymph node dissection: regional nodes removed based on staging",
        "• Microscopic margin clearance (R0) vs. positive margins (R1/R2)",
        "• 'No-touch' technique: ligate vessels before mobilising tumour",
    ],
    left=6.55, top=1.3, width=6.55, height=2.7,
    font_size=13, bg_color=GRAY_LIGHT, title_color=RGBColor(0x4A, 0x1A, 0x6A))

add_bullet_text(slide,
    title="Multimodal Oncological Approach",
    bullets=[
        "Neoadjuvant therapy: chemotherapy/radiotherapy BEFORE surgery to downsize tumour, improve resectability",
        "Adjuvant therapy: treatment AFTER surgery to eliminate residual disease and micrometastases",
        "Targeted therapy & immunotherapy: increasingly integrated with surgery in modern oncology",
        "Tumour board/MDT decision: mandatory for all cancer management planning",
        "Prognostic staging: TNM system (T=primary tumour, N=nodes, M=metastasis) guides treatment",
    ],
    left=0.25, top=4.2, width=12.85, height=2.65,
    font_size=13, bg_color=RGBColor(0xF0, 0xE8, 0xFF), title_color=RGBColor(0x4A, 0x1A, 0x6A))

add_text(slide, "Bailey & Love 28th Ed, Ch. 12 | Sabiston Textbook of Surgery", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 12 — SURGICAL ETHICS, EDUCATION & PATIENT SAFETY
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, RGBColor(0x2A, 0x4A, 0x2A))
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "10. SURGICAL ETHICS, EDUCATION & PATIENT SAFETY", 0.3, 0.2, 12.7, 0.75,
         font_size=24, bold=True, color=WHITE)

add_bullet_text(slide,
    title="Ethical Principles in Surgery (Sabiston, Ch. 1)",
    bullets=[
        "Autonomy: respect patient's right to make informed decisions",
        "Beneficence: act in patient's best interest; balance risks vs. benefits",
        "Non-maleficence: avoid harm; primum non nocere",
        "Justice: equitable access to surgical care regardless of background",
        "Informed consent: patient must understand risks, benefits, alternatives",
        "Confidentiality & truth-telling essential to therapeutic relationship",
    ],
    left=0.25, top=1.3, width=6.0, height=3.3,
    font_size=13, bg_color=LIGHT_BLUE, title_color=RGBColor(0x2A, 0x4A, 0x2A))

add_bullet_text(slide,
    title="Patient Safety & Surgical Checklists",
    bullets=[
        "WHO Surgical Safety Checklist: Sign In, Time Out, Sign Out",
        "Reduces surgical mortality by ~47% and complication rates significantly",
        "Never Events: wrong-site surgery, retained instruments, wrong-patient procedures",
        "Surgeon fatigue: duty hour reforms; 80-hour week limits",
        "Simulation training: reduces technical errors in real OR",
        "Morbidity & Mortality conferences: reflective learning culture",
    ],
    left=6.55, top=1.3, width=6.55, height=3.3,
    font_size=13, bg_color=GRAY_LIGHT, title_color=RGBColor(0x2A, 0x4A, 0x2A))

add_bullet_text(slide,
    title="Modern Surgical Education (Sabiston, Ch. 1)",
    bullets=[
        "Competency-based training replacing time-based apprenticeship",
        "Milestones and entrustable professional activities (EPAs) for assessment",
        "Evidence-based medicine integrated at all levels",
        "Diversity, equity and inclusion as core values in surgery",
        "Resident well-being: addressing burnout, mistreatment, mental health",
    ],
    left=0.25, top=4.75, width=12.85, height=2.05,
    font_size=13, bg_color=RGBColor(0xE0, 0xF0, 0xE0), title_color=RGBColor(0x2A, 0x4A, 0x2A))

add_text(slide, "Sabiston Textbook of Surgery | Bailey & Love 28th Ed | WHO Surgical Safety Checklist", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 13 — NUTRITION IN SURGICAL PATIENTS
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, RGBColor(0x5A, 0x3A, 0x00))
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "SURGICAL NUTRITION & METABOLIC SUPPORT", 0.3, 0.2, 12.7, 0.75,
         font_size=26, bold=True, color=WHITE)

add_bullet_text(slide,
    title="Assessment of Nutritional Status",
    bullets=[
        "BMI <18.5 OR unintentional weight loss >10% OR poor intake >5 days = high risk",
        "Tools: NRS-2002, MUST score, SGA (Subjective Global Assessment)",
        "Biochemical markers: albumin <30 g/L (chronic); prealbumin (acute)",
        "Anthropometry: MUAC, triceps skinfold, handgrip strength",
    ],
    left=0.25, top=1.3, width=6.2, height=2.6,
    font_size=13, bg_color=LIGHT_BLUE, title_color=RGBColor(0x5A, 0x3A, 0x00))

add_bullet_text(slide,
    title="Routes of Nutritional Support",
    bullets=[
        "Enteral (preferred): NG/NJ tube, PEG; preserves gut integrity and immunity",
        "Parenteral: TPN via central line when gut non-functional (>7 days)",
        "Immunonutrition: arginine, omega-3, glutamine; evidence in major surgery",
        "Key: 'If the gut works, use it!' - enteral always preferred over parenteral",
    ],
    left=6.55, top=1.3, width=6.55, height=2.6,
    font_size=13, bg_color=GRAY_LIGHT, title_color=RGBColor(0x5A, 0x3A, 0x00))

add_bullet_text(slide,
    title="Macronutrient Requirements in Surgical Patients",
    bullets=[
        "ENERGY: 25-30 kcal/kg/day (critically ill: 20-25 kcal/kg); indirect calorimetry is gold standard",
        "PROTEIN: 1.2-2.0 g/kg/day (higher in burns, critical illness); essential for wound healing",
        "GLUCOSE: max oxidation rate ~5 mg/kg/min; avoid hyperglycaemia (target 6-10 mmol/L)",
        "LIPIDS: 0.7-1.5 g/kg/day; MCT/LCT mixtures preferred; caution in pancreatitis",
        "VITAMINS & TRACE ELEMENTS: Vit C (collagen synthesis), Zn (immunity), Vit D, B-complex",
    ],
    left=0.25, top=4.1, width=12.85, height=2.7,
    font_size=13, bg_color=RGBColor(0xFFF8, 0xF0, 0xD8), title_color=RGBColor(0x5A, 0x3A, 0x00))

add_text(slide, "Bailey & Love 28th Ed, Ch. 2 | Sabiston Textbook | ESPEN Guidelines 2019", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 14 — VTE PROPHYLAXIS
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, OFF_WHITE)
add_rect(slide, 0, 0, 13.333, 1.1, RGBColor(0x1A, 0x3A, 0x7A))
add_rect(slide, 0, 1.1, 13.333, 0.06, GOLD)

add_text(slide, "VTE PROPHYLAXIS IN SURGICAL PATIENTS", 0.3, 0.2, 12.7, 0.75,
         font_size=26, bold=True, color=WHITE)

add_bullet_text(slide,
    title="Virchow's Triad",
    bullets=[
        "1. STASIS: immobility, paralysis, prolonged anaesthesia",
        "2. HYPERCOAGULABILITY: cancer, OCP, thrombophilia, pregnancy",
        "3. ENDOTHELIAL DAMAGE: trauma, surgery, burns, IV catheters",
        "All three factors commonly present post-operatively",
    ],
    left=0.25, top=1.3, width=4.2, height=2.7,
    font_size=13, bg_color=LIGHT_BLUE, title_color=RGBColor(0x1A, 0x3A, 0x7A))

add_bullet_text(slide,
    title="Risk Stratification (Caprini Score)",
    bullets=[
        "Low risk (score 0-2): early mobilisation, TED stockings",
        "Moderate risk (score 3-4): LMWH + mechanical prophylaxis",
        "High risk (score ≥ 5): LMWH + mechanical; extended prophylaxis 28 days in cancer surgery",
        "Very high risk (cancer + surgery + VTE history): extended course mandatory",
    ],
    left=4.7, top=1.3, width=4.2, height=2.7,
    font_size=13, bg_color=GRAY_LIGHT, title_color=RGBColor(0x1A, 0x3A, 0x7A))

add_bullet_text(slide,
    title="Pharmacological Prophylaxis",
    bullets=[
        "LMWH: enoxaparin 40 mg SC daily (standard dose) - start 12 hrs post-op",
        "UFH: 5000 IU SC TDS - used in renal impairment (GFR <30)",
        "DOACs: rivaroxaban/apixaban increasingly used in orthopaedic surgery",
        "Fondaparinux: used in heparin-induced thrombocytopaenia (HIT)",
    ],
    left=9.1, top=1.3, width=4.0, height=2.7,
    font_size=12, bg_color=RGBColor(0xE8, 0xF4, 0xFF), title_color=RGBColor(0x1A, 0x3A, 0x7A))

add_bullet_text(slide,
    title="Treatment of Established VTE (DVT/PE)",
    bullets=[
        "DVT: therapeutic anticoagulation for minimum 3 months; DOAC preferred (rivaroxaban, apixaban)",
        "PE: haemodynamically stable → DOAC anticoagulation; massive PE → thrombolysis (tPA) or surgical embolectomy",
        "IVC filter: if anticoagulation contraindicated or recurrent PE despite treatment",
        "Cancer-associated VTE: LMWH or DOAC; higher recurrence risk requires longer treatment (6+ months)",
    ],
    left=0.25, top=4.2, width=12.85, height=2.65,
    font_size=13, bg_color=RGBColor(0xE0, 0xF0, 0xFF), title_color=RGBColor(0x1A, 0x3A, 0x7A))

add_text(slide, "Bailey & Love 28th Ed | NICE NG89 | Sabiston Textbook of Surgery", 0.3, 7.1, 12.7, 0.35,
         font_size=10, italic=True, color=RGBColor(0x88, 0x88, 0x99))


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 15 — FINAL SUMMARY / CLOSING SLIDE
# ═══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
add_rect(slide, 0, 5.8, 13.333, 0.08, GOLD)
add_rect(slide, 0, 0, 0.35, 7.5, MED_BLUE)

add_text(slide, "KEY TAKEAWAYS", 0.7, 0.5, 12.2, 0.8,
         font_size=30, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

key_points = [
    "Metabolic response to injury is GRADED — the severity of response mirrors injury severity",
    "Cytokines (IL-1, IL-6, TNF-alpha) and neuroendocrine axis mediate the systemic response",
    "Wound healing progresses through haemostasis → inflammation → proliferation → remodelling",
    "Sepsis-3 requires SOFA ≥2; 1-hr bundle (cultures, antibiotics, fluids, lactate) is standard",
    "Goal-directed fluid therapy and balanced crystalloids form the cornerstone of fluid management",
    "ERAS protocols reduce hospital stay, complications and costs across all surgical disciplines",
    "Preoperative optimisation (anaemia, DM, nutrition) is as important as the surgery itself",
    "WHO Surgical Safety Checklist reduces surgical mortality by ~47%",
    "Oncological surgery demands R0 resection with MDT-guided multimodal approach",
]

for i, pt in enumerate(key_points):
    y = 1.5 + i * 0.62
    add_rect(slide, 0.6, y, 0.45, 0.45, ACCENT_TEAL)
    add_text(slide, str(i+1), 0.6, y + 0.02, 0.45, 0.45, font_size=14,
             bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_text(slide, pt, 1.15, y + 0.03, 11.8, 0.48, font_size=13,
             color=RGBColor(0xDD, 0xEE, 0xFF))

add_text(slide, "Sources: Bailey & Love's Short Practice of Surgery 28th Ed | Sabiston Textbook of Surgery (Latest Ed)",
         0.7, 6.9, 12.2, 0.45, font_size=11, italic=True,
         color=RGBColor(0x88, 0xAA, 0xCC), align=PP_ALIGN.CENTER)


# ─── SAVE ────────────────────────────────────────────────────────────────────
out_path = "/tmp/workspace/general-surgery-ppt/Principles_of_General_Surgery.pptx"
from io import BytesIO
buf = BytesIO()
prs.save(buf)
with open(out_path, "wb") as f:
    f.write(buf.getvalue())

print(f"Saved: {out_path}")
print(f"Slides: {len(prs.slides)}")

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/general-surgery-ppt/create_ppt.py'

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/general-surgery-ppt/create_ppt.py'