const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Gynecology Residency Program";
pres.title = "Uterine Fibroids: Impact on Women's Health and Quality of Life";

// ─── Color Palette ───
const C = {
  dark:    "1A2C42",   // deep navy – title/conclusion bg
  mid:     "234E72",   // medium navy – section headers
  accent:  "C0392B",   // crimson accent
  teal:    "1A7F7F",   // teal for callouts
  light:   "EAF2FB",   // near-white blue
  white:   "FFFFFF",
  text:    "1A2C42",
  subtext: "4A5568",
  gold:    "D4A017",
};

// ─── Helper ───
function sectionTag(slide, label, color) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.42, fill: { color }, line: { type: "none" } });
  slide.addText(label.toUpperCase(), {
    x: 0.35, y: 0.04, w: 9.3, h: 0.35,
    fontSize: 9, bold: true, color: C.white, charSpacing: 3, margin: 0,
  });
}

function bodyTitle(slide, text, color) {
  slide.addText(text, {
    x: 0.5, y: 0.52, w: 9, h: 0.65,
    fontSize: 22, bold: true, color: color || C.dark, fontFace: "Calibri",
  });
}

function addBullets(slide, items, opts) {
  const defaults = { x: 0.55, y: 1.25, w: 8.9, h: 3.9, fontSize: 14, color: C.text, fontFace: "Calibri" };
  const o = Object.assign({}, defaults, opts);
  slide.addText(items.map((item, i) => ({
    text: item,
    options: { bullet: { indent: 15 }, breakLine: i < items.length - 1 },
  })), o);
}

function divider(slide, y) {
  slide.addShape(pres.ShapeType.line, {
    x: 0.5, y: y || 1.18, w: 9, h: 0,
    line: { color: C.accent, width: 1.5 },
  });
}

// ═══════════════════════════════════════════
// SLIDE 1 – TITLE
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  // Full-slide dark background
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.dark }, line: { type: "none" } });
  // Red accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.6, w: 10, h: 0.08, fill: { color: C.accent }, line: { type: "none" } });
  // Left accent stripe
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.accent }, line: { type: "none" } });

  s.addText("UTERINE FIBROIDS", {
    x: 0.5, y: 0.8, w: 9.2, h: 1.0,
    fontSize: 40, bold: true, color: C.white, fontFace: "Calibri",
    align: "center", charSpacing: 2,
  });
  s.addText("Impact on Women's Health & Quality of Life", {
    x: 0.5, y: 1.85, w: 9.2, h: 0.7,
    fontSize: 22, color: "A8C6E8", fontFace: "Calibri", align: "center", italic: true,
  });
  s.addShape(pres.ShapeType.line, { x: 2.5, y: 2.7, w: 5, h: 0, line: { color: C.gold, width: 1.5 } });
  s.addText("Paper Presentation  |  Gynecology Residency", {
    x: 0.5, y: 2.85, w: 9.2, h: 0.4,
    fontSize: 13, color: "8FAFC8", fontFace: "Calibri", align: "center",
  });
  s.addText("May 2026", {
    x: 0.5, y: 3.3, w: 9.2, h: 0.35,
    fontSize: 12, color: "7A9BB8", fontFace: "Calibri", align: "center",
  });

  // Key stat boxes
  const stats = [
    { val: "40–89%", lbl: "Lifetime Prevalence" },
    { val: "#1", lbl: "Cause of Hysterectomy (US)" },
    { val: "$34B", lbl: "Annual Economic Burden" },
  ];
  stats.forEach((st, i) => {
    const x = 0.7 + i * 2.9;
    s.addShape(pres.ShapeType.roundRect, {
      x, y: 3.85, w: 2.5, h: 1.35,
      fill: { color: "22426A" }, line: { color: C.teal, width: 1 }, rectRadius: 0.1,
    });
    s.addText(st.val, { x, y: 3.9, w: 2.5, h: 0.65, fontSize: 22, bold: true, color: C.gold, align: "center", fontFace: "Calibri" });
    s.addText(st.lbl, { x, y: 4.55, w: 2.5, h: 0.5, fontSize: 9.5, color: "A8C6E8", align: "center", fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════
// SLIDE 2 – EPIDEMIOLOGY
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white }, line: { type: "none" } });
  sectionTag(s, "Epidemiology", C.mid);
  bodyTitle(s, "How Common Are Uterine Fibroids?");
  divider(s);

  // Left column – bullet facts
  addBullets(s, [
    "Most common pelvic neoplasm in reproductive-aged women",
    "Lifetime prevalence: 40–89% depending on detection method & population",
    "Cumulative incidence by age 50: ~70% in White women, >80% in Black women (US)",
    "Black women develop fibroids at younger ages with larger, more numerous tumors",
    "Detected in 3–4% of mid-trimester ultrasound evaluations in pregnancy",
    "Leading cause of hysterectomy in the United States",
    "Annual US economic burden: ~$34 billion (direct + indirect costs)",
  ], { x: 0.55, y: 1.25, w: 5.5, h: 4.0, fontSize: 13 });

  // Right info box
  s.addShape(pres.ShapeType.roundRect, {
    x: 6.3, y: 1.3, w: 3.45, h: 4.0,
    fill: { color: C.light }, line: { color: C.mid, width: 1 }, rectRadius: 0.12,
  });
  s.addText("RISK FACTORS", {
    x: 6.4, y: 1.4, w: 3.25, h: 0.4,
    fontSize: 12, bold: true, color: C.mid, align: "center", charSpacing: 1, fontFace: "Calibri",
  });
  const rf = ["Age (reproductive years peak)", "Black/African American race", "Nulliparity", "Obesity (BMI >30)", "Early menarche (<10 yrs)", "Family history", "Vitamin D deficiency", "Somatic MED12 gene mutations", "Germline FH gene mutations"];
  s.addText(rf.map((r, i) => ({ text: r, options: { bullet: { indent: 12 }, breakLine: i < rf.length - 1 } })), {
    x: 6.45, y: 1.85, w: 3.15, h: 3.3, fontSize: 11, color: C.text, fontFace: "Calibri",
  });
}

// ═══════════════════════════════════════════
// SLIDE 3 – PATHOPHYSIOLOGY & CLASSIFICATION
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white }, line: { type: "none" } });
  sectionTag(s, "Pathophysiology & Classification", C.mid);
  bodyTitle(s, "Pathogenesis & Fibroid Types");
  divider(s);

  // Pathogenesis box
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.4, y: 1.3, w: 4.5, h: 2.5,
    fill: { color: "F0F7FF" }, line: { color: C.mid, width: 0.8 }, rectRadius: 0.1,
  });
  s.addText("Pathogenesis", { x: 0.5, y: 1.38, w: 4.3, h: 0.38, fontSize: 13, bold: true, color: C.mid, fontFace: "Calibri" });
  s.addText([
    { text: "• Monoclonal smooth muscle tumors of myometrium", options: { breakLine: true } },
    { text: "• Growth driven by estrogen & progesterone", options: { breakLine: true } },
    { text: "• Regress after menopause (hormone-dependent)", options: { breakLine: true } },
    { text: "• MED12 mutation: ~70% of fibroids", options: { breakLine: true } },
    { text: "• Extracellular matrix (ECM) contributes ~50% of fibroid volume", options: { breakLine: true } },
    { text: "• Degeneration types: hyaline, cystic, calcific, red (carneous)" },
  ], { x: 0.55, y: 1.78, w: 4.2, h: 1.9, fontSize: 11.5, color: C.text, fontFace: "Calibri" });

  // FIGO classification
  s.addShape(pres.ShapeType.roundRect, {
    x: 5.1, y: 1.3, w: 4.65, h: 2.5,
    fill: { color: "FFF8F0" }, line: { color: C.accent, width: 0.8 }, rectRadius: 0.1,
  });
  s.addText("FIGO Classification (PALM-COEIN)", { x: 5.2, y: 1.38, w: 4.4, h: 0.38, fontSize: 13, bold: true, color: C.accent, fontFace: "Calibri" });
  const figo = [
    "Type 0 – Pedunculated submucosal",
    "Type 1 – <50% intramural (submucosal)",
    "Type 2 – ≥50% intramural (submucosal)",
    "Type 3 – Contacts endometrium, 100% intramural",
    "Type 4 – Intramural",
    "Type 5 – Subserosal, ≥50% intramural",
    "Type 6 – Subserosal, <50% intramural",
    "Type 7 – Pedunculated subserosal",
  ];
  s.addText(figo.map((f, i) => ({ text: f, options: { bullet: { indent: 12 }, breakLine: i < figo.length - 1 } })), {
    x: 5.2, y: 1.78, w: 4.35, h: 1.9, fontSize: 10.5, color: C.text, fontFace: "Calibri",
  });

  // Bottom note
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.4, y: 3.95, w: 9.2, h: 1.3,
    fill: { color: "E8F4EA" }, line: { color: C.teal, width: 0.8 }, rectRadius: 0.1,
  });
  s.addText("Clinical Pearl", { x: 0.6, y: 4.0, w: 3, h: 0.35, fontSize: 12, bold: true, color: C.teal, fontFace: "Calibri" });
  s.addText("Fibroids themselves are BENIGN and NOT premalignant. Risk of co-existing uterine sarcoma is ~1 in 1,100–1,500 women under 45 years. Concurrent leiomyosarcoma is often indistinguishable on imaging — diagnosis is histopathological.", {
    x: 0.6, y: 4.35, w: 8.9, h: 0.8, fontSize: 11, color: C.text, fontFace: "Calibri",
  });
}

// ═══════════════════════════════════════════
// SLIDE 4 – CLINICAL FEATURES
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white }, line: { type: "none" } });
  sectionTag(s, "Clinical Features", C.mid);
  bodyTitle(s, "Symptoms & Clinical Presentation");
  divider(s);

  const domains = [
    {
      title: "Abnormal Uterine Bleeding",
      color: C.accent,
      items: [
        "Heavy menstrual bleeding (HMB) — most common complaint",
        "Menorrhagia, metrorrhagia, intermenstrual spotting",
        "Iron-deficiency anaemia (fatigue, dyspnoea)",
        "More common with submucosal fibroids",
      ],
    },
    {
      title: "Bulk / Pressure Symptoms",
      color: C.mid,
      items: [
        "Pelvic heaviness, protuberant abdomen",
        "Urinary frequency, urgency, nocturia",
        "Constipation, incomplete evacuation",
        "Hydronephrosis (large fibroids)",
      ],
    },
    {
      title: "Pain",
      color: C.teal,
      items: [
        "Dysmenorrhoea, chronic pelvic pain",
        "Dyspareunia",
        "Acute pain: red degeneration (pregnancy), torsion of pedunculated fibroid",
      ],
    },
    {
      title: "Reproductive Morbidity",
      color: "8E44AD",
      items: [
        "Infertility (distortion of uterine cavity)",
        "Recurrent miscarriage",
        "Preterm labour, malpresentation",
        "Placenta praevia, placental abruption",
      ],
    },
  ];

  const colW = 4.55;
  domains.forEach((d, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.9;
    const y = 1.3 + row * 2.05;
    s.addShape(pres.ShapeType.roundRect, {
      x, y, w: colW, h: 1.9,
      fill: { color: C.light }, line: { color: d.color, width: 1.2 }, rectRadius: 0.1,
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    s.addText(d.title, { x: x + 0.1, y: y + 0.05, w: colW - 0.2, h: 0.38, fontSize: 12, bold: true, color: d.color, fontFace: "Calibri" });
    s.addText(d.items.map((it, ii) => ({ text: it, options: { bullet: { indent: 10 }, breakLine: ii < d.items.length - 1 } })), {
      x: x + 0.1, y: y + 0.42, w: colW - 0.2, h: 1.35, fontSize: 10.5, color: C.text, fontFace: "Calibri",
    });
  });
}

// ═══════════════════════════════════════════
// SLIDE 5 – IMPACT ON QUALITY OF LIFE
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white }, line: { type: "none" } });
  sectionTag(s, "Quality of Life", C.mid);
  bodyTitle(s, "Impact on Women's Quality of Life");
  divider(s);

  // Left text
  const leftItems = [
    "QoL significantly impaired across physical, emotional & social domains",
    "UFS-QoL (Uterine Fibroid Symptom–QoL): validated primary instrument for symptom severity + HR-QoL",
    "Sexual dysfunction: dyspareunia, reduced libido, negative body image",
    "Occupational impairment: absenteeism due to HMB & pain",
    "Social isolation: avoidance of activities during heavy periods",
    "Sleep disturbance from nocturia, pain, pad-changing",
    "Anxiety and depression: up to 30% of women with symptomatic fibroids",
    "Financial toxicity: missed workdays, treatment costs",
  ];
  addBullets(s, leftItems, { x: 0.5, y: 1.25, w: 5.7, h: 4.1, fontSize: 12.5 });

  // Right evidence box
  s.addShape(pres.ShapeType.roundRect, {
    x: 6.5, y: 1.3, w: 3.3, h: 4.0,
    fill: { color: "FFF0F0" }, line: { color: C.accent, width: 1 }, rectRadius: 0.12,
  });
  s.addText("EVIDENCE BASE", {
    x: 6.6, y: 1.4, w: 3.1, h: 0.38,
    fontSize: 11, bold: true, color: C.accent, align: "center", charSpacing: 1, fontFace: "Calibri",
  });
  const evid = [
    { t: "Neumann et al. (2024)", sub: "Fertil Steril — Systematic Review (67 studies). ALL interventions significantly improved fibroid-specific QoL & mental health." },
    { t: "Marsh et al. (2024)", sub: "JAMA — Racial disparities: Black women have higher morbidity, more hysterectomies, less access to minimally invasive procedures." },
    { t: "COMPARE-UF Study", sub: "Prospective cohort — substantial QoL improvement 1–3 years post-procedure; uterine-sparing and hysterectomy groups comparable at year 3." },
  ];
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    s.addText(e.sub, { x: 6.65, y: ey + 0.3, w: 3.05, h: 0.7, fontSize: 9.5, color: C.subtext, fontFace: "Calibri" });
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      s.addShape(pres.ShapeType.line, { x: 6.7, y: ey + 1.05, w: 2.9, h: 0, line: { color: "FFBBBB", width: 0.5 } });
    }
  });
}

// ═══════════════════════════════════════════
// SLIDE 6 – DIAGNOSIS
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white }, line: { type: "none" } });
  sectionTag(s, "Diagnosis & Evaluation", C.mid);
  bodyTitle(s, "Diagnostic Approach");
  divider(s);

  const steps = [
    {
      icon: "01",
      title: "History & Examination",
      points: [
        "Detailed menstrual & gynaecologic history",
        "Bimanual pelvic exam: enlarged/irregular uterus",
        "Signs of anaemia (pallor, tachycardia)",
      ],
      color: C.mid,
    },
    {
      icon: "02",
      title: "First-Line: Pelvic Ultrasound",
      points: [
        "Well-defined hypoechoic spherical mass",
        "Transvaginal USG: higher sensitivity for small/submucosal fibroids",
        "SIS (saline infusion sonography): cavity assessment",
      ],
      color: C.teal,
    },
    {
      icon: "03",
      title: "Second-Line: MRI Pelvis",
      points: [
        "Gold standard for fibroid mapping",
        "Differentiates leiomyoma from adenomyosis & sarcoma",
        "Essential pre-UAE / ablation planning",
      ],
      color: C.accent,
    },
    {
      icon: "04",
      title: "Hysteroscopy",
      points: [
        "Direct visualisation of cavity",
        "Diagnoses & treats submucosal fibroids (Type 0–2)",
        "Combined with endometrial biopsy if indicated",
      ],
      color: "8E44AD",
    },
  ];

  steps.forEach((st, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.9;
    const y = 1.3 + row * 2.05;

    s.addShape(pres.ShapeType.roundRect, {
      x, y, w: 4.55, h: 1.9,
      fill: { color: C.light }, line: { color: st.color, width: 1.2 }, rectRadius: 0.1,
    });
    s.addShape(pres.ShapeType.roundRect, {
      x: x + 0.08, y: y + 0.08, w: 0.55, h: 0.55,
      fill: { color: st.color }, line: { type: "none" }, rectRadius: 0.05,
    });
    s.addText(st.icon, { x: x + 0.08, y: y + 0.1, w: 0.55, h: 0.45, fontSize: 14, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
    s.addText(st.title, { x: x + 0.7, y: y + 0.1, w: 3.7, h: 0.42, fontSize: 12, bold: true, color: st.color, fontFace: "Calibri" });
    s.addText(st.points.map((p, ii) => ({ text: p, options: { bullet: { indent: 10 }, breakLine: ii < st.points.length - 1 } })), {
      x: x + 0.12, y: y + 0.62, w: 4.3, h: 1.2, fontSize: 10.5, color: C.text, fontFace: "Calibri",
    });
  });

  // Labs note
  s.addText("Laboratory: CBC (anaemia), serum ferritin, thyroid function (exclude AUB causes). CA-125 not specific; elevated in large fibroids.", {
    x: 0.4, y: 5.1, w: 9.2, h: 0.42, fontSize: 10, color: C.subtext, italic: true, fontFace: "Calibri",
  });
}

// ═══════════════════════════════════════════
// SLIDE 7 – MANAGEMENT: MEDICAL
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white }, line: { type: "none" } });
  sectionTag(s, "Management", C.mid);
  bodyTitle(s, "Medical (Non-Surgical) Treatment");
  divider(s);

  const rxGroups = [
    {
      label: "GnRH Agonists",
      eg: "Leuprolide, Goserelin",
      action: "Induce medical menopause; 35–60% fibroid shrinkage",
      use: "Pre-op priming (≤3–6 months); bridge to surgery",
      note: "SE: menopausal symptoms, bone loss. NOT long-term monotherapy",
      color: C.accent,
    },
    {
      label: "GnRH Antagonists",
      eg: "Elagolix + E2/NETA (Oriahnn), Relugolix combo",
      action: "Rapid oestrogen suppression; reduces HMB",
      use: "FDA-approved for fibroid-associated HMB",
      note: "Bone density preserved with add-back therapy (RCT: ELARIS, LIBERTY)",
      color: C.mid,
    },
    {
      label: "Progestin / SPRM",
      eg: "LNG-IUS, Ulipristal acetate, Mifepristone",
      action: "Reduces HMB; may stabilise/reduce fibroid size",
      use: "LNG-IUS: effective for HMB (submucosal excluded). Ulipristal: suspended in EU (liver injury signal)",
      note: "Mifepristone 5–10 mg/day: reduces symptoms transitionally",
      color: C.teal,
    },
    {
      label: "Symptomatic / Adjuncts",
      eg: "NSAIDs, TXA, CHCs, Iron",
      action: "Reduce bleeding & pain without fibroid regression",
      use: "Tranexamic acid: reduces MBL by ~50%. NSAIDs: dysmenorrhoea",
      note: "Combined hormonal contraceptives: modest benefit; may not shrink fibroids",
      color: "8E44AD",
    },
  ];

  rxGroups.forEach((g, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.85;
    const y = 1.3 + row * 2.0;

    s.addShape(pres.ShapeType.roundRect, {
      x, y, w: 4.5, h: 1.85,
      fill: { color: C.white }, line: { color: g.color, width: 1.2 }, rectRadius: 0.1,
    });
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.5, h: 0.38, fill: { color: g.color }, line: { type: "none" }, rectRadius: 0.1 });
    s.addText(g.label, { x: x + 0.1, y: y + 0.04, w: 4.3, h: 0.3, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri" });
    s.addText([
      { text: "Drugs: ", options: { bold: true, breakLine: false } },
      { text: g.eg + "\n", options: { breakLine: true } },
      { text: "Action: ", options: { bold: true, breakLine: false } },
      { text: g.action + "\n", options: { breakLine: true } },
      { text: "Use: ", options: { bold: true, breakLine: false } },
      { text: g.use + "\n", options: { breakLine: true } },
      { text: "Note: ", options: { bold: true, breakLine: false } },
      { text: g.note },
    ], { x: x + 0.12, y: y + 0.42, w: 4.25, h: 1.35, fontSize: 9.5, color: C.text, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════
// SLIDE 8 – MANAGEMENT: SURGICAL & INTERVENTIONAL
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white }, line: { type: "none" } });
  sectionTag(s, "Management", C.mid);
  bodyTitle(s, "Surgical & Interventional Procedures");
  divider(s);

  const procs = [
    {
      name: "Hysteroscopic Myomectomy",
      type: "Surgical — Uterine Sparing",
      color: C.teal,
      bullets: [
        "Submucosal fibroids (Type 0, 1, 2)",
        "Gold standard for cavity-distorting fibroids + infertility",
        "Outpatient; rapid recovery",
      ],
    },
    {
      name: "Laparoscopic / Abdominal Myomectomy",
      type: "Surgical — Uterine Sparing",
      color: C.teal,
      bullets: [
        "Intramural / subserosal fibroids",
        "Preserves uterus; allows future pregnancy",
        "Lower reintervention risk vs UAE (RR 0.32; Tzanis 2024)",
      ],
    },
    {
      name: "Uterine Artery Embolization (UAE)",
      type: "Interventional Radiology",
      color: C.mid,
      bullets: [
        "Embolic agents occlude uterine arteries → infarction",
        "QoL improvement comparable to myomectomy (RCT data)",
        "Higher reintervention rate (HR 0.41 vs myomectomy)",
        "Ovarian reserve concern; less preferred for fertility",
      ],
    },
    {
      name: "Hysterectomy",
      type: "Definitive — Uterine Removal",
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// ═══════════════════════════════════════════
// SLIDE 9 – RACIAL DISPARITIES & SPECIAL POPULATIONS
// ═══════════════════════════════════════════
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    "Red degeneration: acute pain, localised tenderness — managed conservatively",
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// ═══════════════════════════════════════════
// SLIDE 10 – KEY TAKEAWAYS & REFERENCES
// ═══════════════════════════════════════════
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    { num: "2", txt: "HMB, pelvic pain, bulk symptoms & reproductive morbidity form the core clinical triad — significantly impairing QoL and mental health." },
    { num: "3", txt: "UFS-QoL is the validated instrument; ALL treatment modalities improve it, though benefits of uterine-sparing procedures may decline by year 3." },
    { num: "4", txt: "Shared decision-making is central: weigh uterine preservation desire, fertility, fibroid location/number, and symptom severity." },
    { num: "5", txt: "Racial disparities are profound — Black women suffer greater disease burden and receive less equitable care. Advocacy and equity-focused practice are mandatory." },
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// ─── Write file ───
pres.writeFile({ fileName: "/home/daytona/workspace/uterine-fibroids-ppt/Uterine_Fibroids_Presentation.pptx" })
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const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Gynecology Residency Program";
pres.title = "Uterine Fibroids: Impact on Women's Health & Quality of Life";

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// ═══════════════════════════════════════════
// SLIDE 1 – TITLE
// ═══════════════════════════════════════════
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    { v:"$34B+",    l:"Annual US Economic Burden" },
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// ═══════════════════════════════════════════
// SLIDE 2 – OVERVIEW: SCOPE OF THE PROBLEM
// ═══════════════════════════════════════════
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    "Inpatient surgery alone costs $2.1 billion/year in the US; total annual burden ~$34 billion",
    "The burden is not just physical — it permeates every domain of a woman's life: physical health, mental health, reproductive health, sexuality, career, and social wellbeing",
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// ═══════════════════════════════════════════
// SLIDE 3 – PHYSICAL HEALTH IMPACT
// ═══════════════════════════════════════════
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        "Iron-deficiency anaemia → chronic fatigue, dyspnoea, poor exercise tolerance",
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        "Acute pain: red (carneous) degeneration in pregnancy; torsion of pedunculated fibroid",
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        "Recurrent miscarriage, especially with cavity-distorting fibroids",
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// ═══════════════════════════════════════════
// SLIDE 4 – MENTAL HEALTH & EMOTIONAL WELLBEING
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    "Constant pre-planning: avoidance of travel, social events, physical exercise, swimming",
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    "Grief and loss: infertility, miscarriage, or hysterectomy tied to identity and reproductive dreams",
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// ═══════════════════════════════════════════
// SLIDE 5 – SEXUAL HEALTH & BODY IMAGE
// ═══════════════════════════════════════════
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    "Fear of embarrassment during intimacy",
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    "Protuberant abdomen from large fibroids → distorted self-image",
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    "Self-consciousness subscale mean (UFS-QoL): 58.3–77.6 — highly variable",
    "Avoidance of form-fitting clothing, swimwear, social activities",
    "Negative body image persists regardless of objective fibroid size",
    "Shame and silence: many women do not discuss symptoms with partners or family",
    "~69% feel distress about having a 'growth' inside their body",
    "Cultural taboos worsen this in many low-resource settings (Sub-Saharan Africa, South Asia)",
  ];
  s.addText(body.map((t,i)=>({ text:t, options:{ bullet:{indent:12}, breakLine:i<body.length-1 } })), {
    x:5.27, y:1.78, w:4.25, h:3.35, fontSize:11, color:C.text, fontFace:"Calibri",
  });
}

// ═══════════════════════════════════════════
// SLIDE 6 – SOCIAL, OCCUPATIONAL & ECONOMIC IMPACT
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.white);
  topBar(s, "Social, Occupational & Economic Impact", C.blue);
  slideTitle(s, "The Hidden Costs: Work, Society & Economy");
  rule(s);

  // left bullets
  bullets(s, [
    "Work absenteeism: African American women are 77% more likely to miss work than White women due to fibroids",
    "25% of women with fibroids report that the condition prevented achieving full career potential",
    "Presenteeism (present but impaired): reduced productivity during symptomatic periods",
    "Healthcare workers with fibroids show significant functional work impairment (Sell et al., JOEM 2025)",
    "Repeated unplanned absences during heavy menstrual days create occupational instability",
    "Social isolation: avoidance of social events, exercise, travel during unpredictable heavy bleeding",
    "Financial toxicity: costs of pads/tampons, analgesics, multiple consultations, procedures",
    "Indirect costs (missed wages, carer time) add considerably to the direct $2.1B surgical cost",
    "Economic loss extends beyond individuals to employers, families, and healthcare systems",
  ], { x:0.5, y:1.3, w:5.9, h:4.1, fontSize:12.5 });

  // right callout column
  const cds = [
    { v:"77%",    l:"Higher work absenteeism — Black vs White women", c:C.amber },
    { v:"25%",    l:"Women say fibroids limited career potential", c:C.blue },
    { v:"$2.1B",  l:"Annual inpatient surgery cost (US alone)", c:C.red },
    { v:"240K",   l:"Hysterectomies/year in US for fibroids", c:C.teal },
  ];
  cds.forEach((cd,i) => {
    const y = 1.28 + i*1.06;
    s.addShape(pres.ShapeType.roundRect, {
      x:6.75, y, w:3.0, h:0.95,
      fill:{color:C.light}, line:{color:cd.c, width:1.2}, rectRadius:0.1,
    });
    s.addText(cd.v, { x:6.8, y:y+0.05, w:1.0, h:0.82, fontSize:22, bold:true, color:cd.c, align:"center", valign:"middle", fontFace:"Calibri" });
    s.addText(cd.l, { x:7.82, y:y+0.12, w:1.85, h:0.7, fontSize:10, color:C.text, fontFace:"Calibri", wrap:true });
  });
}

// ═══════════════════════════════════════════
// SLIDE 7 – REPRODUCTIVE HEALTH & FERTILITY QoL
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.white);
  topBar(s, "Reproductive Health & Fertility", C.blue);
  slideTitle(s, "Impact on Reproductive Goals & Fertility");
  rule(s);

  // intro sentence
  s.addText("Reproductive morbidity is a uniquely devastating dimension of fibroid-related QoL — especially for women who have not yet completed their families.", {
    x:0.5, y:1.25, w:9, h:0.6,
    fontSize:12.5, color:C.sub, italic:true, fontFace:"Calibri",
  });

  const rcards = [
    {
      title:"Infertility & Implantation",
      color:C.teal,
      fill:"F0FFF8",
      items:[
        "Submucosal fibroids: most harmful — distort endometrial cavity",
        "Decrease fertility; removal (hysteroscopic myomectomy) improves fertility rates",
        "Intramural fibroids may slightly decrease fertility",
        "Subserosal fibroids do not affect fertility (Berek & Novak)",
        "Altered endometrial receptivity: impaired implantation and early placentation",
      ],
    },
    {
      title:"Pregnancy Complications",
      color:C.amber,
      fill:"FFFAF0",
      items:[
        "Placenta praevia: OR 2.2",
        "Placental abruption: OR 2.6",
        "Preterm labour, malpresentation, caesarean section",
        "Postpartum haemorrhage",
        "Red (carneous) degeneration: acute severe pain in pregnancy",
      ],
    },
    {
      title:"Recurrent Pregnancy Loss",
      color:C.red,
      fill:"FFF4F4",
      items:[
        "Cavity-distorting fibroids strongly associated with recurrent miscarriage",
        "Emotional impact of repeated pregnancy loss on top of chronic fibroid disease is profound",
        "Fear of not being able to carry a pregnancy to term",
        "Reproductive grief: cycle of hope → loss → anxiety",
      ],
    },
    {
      title:"Psychological Dimension",
      color:C.amethyst,
      fill:"FBF0FF",
      items:[
        "Infertility diagnosis compounds existing anxiety and depression",
        "Hysterectomy feared particularly by women desiring future pregnancy",
        "Cultural stigma attached to infertility in many populations",
        "Loss of reproductive identity affects self-worth and marital relationships",
      ],
    },
  ];
  const rpos = [
    { x:0.28, y:1.92 }, { x:5.08, y:1.92 },
    { x:0.28, y:3.72 }, { x:5.08, y:3.72 },
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  rcards.forEach((c,i) => {
    const p = rpos[i];
    s.addShape(pres.ShapeType.roundRect, { x:p.x, y:p.y, w:4.62, h:1.7, fill:{color:c.fill}, line:{color:c.color, width:1.1}, rectRadius:0.1 });
    s.addText(c.title, { x:p.x+0.12, y:p.y+0.06, w:4.38, h:0.35, fontSize:12, bold:true, color:c.color, fontFace:"Calibri" });
    s.addText(c.items.map((t,i2)=>({ text:t, options:{ bullet:{indent:10}, breakLine:i2<c.items.length-1 } })), {
      x:p.x+0.14, y:p.y+0.42, w:4.32, h:1.2, fontSize:10, color:C.text, fontFace:"Calibri",
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  });
}

// ═══════════════════════════════════════════
// SLIDE 8 – RACIAL DISPARITIES IN QoL
// ═══════════════════════════════════════════
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  const s = pres.addSlide();
  bg(s, C.white);
  topBar(s, "Racial Disparities in QoL Burden", C.blue);
  slideTitle(s, "Racial Inequities: Who Bears the Greatest Burden?");
  rule(s);

  // left
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  s.addText("Black / African American Women", { x:0.4, y:1.36, w:4.4, h:0.38, fontSize:13, bold:true, color:C.red, fontFace:"Calibri" });
  const blk = [
    "Incidence 2.9× higher than White women (Berek & Novak)",
    "Cumulative incidence >80% by age 50",
    "Fibroids diagnosed at younger ages; larger and more numerous",
    "77% more likely to miss work due to fibroid symptoms",
    "Greater severity of HMB, pain, and anaemia",
    "Higher rates of hysterectomy despite comparable desire for fertility preservation",
    "Less access to minimally invasive and uterine-sparing procedures",
    "Healthcare access barriers, delayed diagnosis, implicit provider bias",
    "Cultural stigma and silence: reluctance to disclose symptoms",
    "Marsh et al. (JAMA 2024): racial disparities in treatment pathways are critical public health concern",
  ];
  s.addText(blk.map((t,i)=>({ text:t, options:{ bullet:{indent:12}, breakLine:i<blk.length-1 } })), {
    x:0.42, y:1.76, w:4.38, h:3.45, fontSize:11, color:C.text, fontFace:"Calibri",
  });

  // right
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  s.addText("Disparities in QoL Domains", { x:5.32, y:1.36, w:4.26, h:0.38, fontSize:13, bold:true, color:C.amber, fontFace:"Calibri" });
  const dispQol = [
    "Black women score consistently lower on ALL UFS-QoL subscales",
    "Greater impairment in Activities, Energy/Mood, Control, and Self-consciousness",
    "Higher symptom severity scores at time of presentation",
    "Larger fibroid burden = worse physical and psychological QoL",
    "Less timely treatment = longer duration of impaired QoL",
    "Post-procedure QoL recovery slower in Black women",
    "Patient-centred, culturally tailored approaches ESSENTIAL for equitable care",
    "Shared decision-making must account for cultural context and patient values",
  ];
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  });
}

// ═══════════════════════════════════════════
// SLIDE 9 – MEASURING QoL: INSTRUMENTS & DATA
// ═══════════════════════════════════════════
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  const s = pres.addSlide();
  bg(s, C.white);
  topBar(s, "Measuring Quality of Life", C.blue);
  slideTitle(s, "How We Measure QoL in Fibroids: Instruments & Evidence");
  rule(s);

  // UFS-QoL table layout
  s.addText("The UFS-QoL (37-item, validated) is the gold standard for measuring fibroid-specific HR-QoL. Higher SS score = worse symptoms; Higher HR-QoL score = better quality of life.", {
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    fontSize:11.5, color:C.sub, italic:true, fontFace:"Calibri",
  });

  // Subscale data table
  const rows = [
    ["Subscale",           "Mean Score (0–100)",  "What It Measures"],
    ["Symptom Severity",   "34.6 ± 13.6",         "Bleeding, pain, pressure, fatigue — higher = worse"],
    ["Concern",            "63.2 ± 18.3",          "Worry about health, fibroid growth, future complications"],
    ["Activities",         "62.9 ± 17.4",          "Impact on daily physical activities & exercise"],
    ["Energy / Mood",      "61.5 ± 15.5",          "Fatigue, sadness, hopelessness, emotional drain"],
    ["Control",            "58.7 ± 17.9",          "Sense of control over life despite symptoms"],
    ["Self-consciousness", "58.3 ± 20.1",          "Body image, embarrassment, physical appearance"],
    ["Sexual Function",    "61.4 ± 23.5",          "Dyspareunia, libido, intimacy & sexual satisfaction"],
  ];
  const tw = [2.7, 2.0, 4.8];
  const rowH = 0.41;
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    const y = 1.9 + ri * rowH;
    const fillC = ri === 0 ? C.blue : (ri%2===0 ? "EAF0FA" : C.white);
    const textC = ri === 0 ? C.white : C.text;
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  s.addText("Source: Sefogah et al., BMC Women's Health 2025 (Korle Bu Teaching Hospital, Ghana, n=163). 83.4% reported moderate-to-very important QoL impact.", {
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    fontSize:9, color:C.sub, italic:true, fontFace:"Calibri",
  });
}

// ═══════════════════════════════════════════
// SLIDE 10 – KEY TAKEAWAYS
// ═══════════════════════════════════════════
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  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.08, fill:{color:C.red}, line:{type:"none"} });
  s.addShape(pres.ShapeType.rect, { x:0, y:5.54, w:10, h:0.085, fill:{color:C.gold}, line:{type:"none"} });

  s.addText("KEY TAKEAWAYS", {
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    fontSize:18, bold:true, color:C.white, fontFace:"Calibri", align:"center", charSpacing:2,
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  const tks = [
    { n:"1", t:"Fibroids impair QoL across ALL domains — physical, mental, sexual, social, and occupational — not just heavy periods." },
    { n:"2", t:"The psychological burden is profound and under-recognised: >40% of women feel sad or discouraged; fear, anxiety, and depression are consistent findings." },
    { n:"3", t:"Sexual health and body image suffer significantly and must be actively explored in clinical consultations." },
    { n:"4", t:"Work absenteeism, career limitation, and economic toxicity are real consequences of symptomatic fibroid disease." },
    { n:"5", t:"Racial disparities are stark — Black women bear the greatest disease and QoL burden, compounded by inequitable access to care. Culturally tailored, patient-centred practice is not optional." },
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  s.addText("References: Marsh et al. JAMA 2024 | Neumann et al. Fertil Steril 2024 | Yang et al. BMC Women's Health 2025 | Sefogah et al. BMC Women's Health 2025 | Berek & Novak's Gynecology | Goldman-Cecil Medicine | UFS-QoL (Spies et al.)", {
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// ── Write ────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/uterine-fibroids-ppt/UF_QoL_Presentation.pptx" })
  .then(() => console.log("DONE"))
  .catch(err => { console.error(err); process.exit(1); });