import json, base64
from io import BytesIO
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.enum.shapes import MSO_SHAPE

# ---------- Colors ----------
NAVY = RGBColor(0x0B, 0x2C, 0x4D)
TEAL = RGBColor(0x0E, 0x7C, 0x7B)
LIGHT = RGBColor(0xF4, 0xF7, 0xF9)
WHITE = RGBColor(0xFF, 0xFF, 0xFF)
DARK = RGBColor(0x22, 0x28, 0x2E)
ACCENT = RGBColor(0xE0, 0x7A, 0x2C)
GREY = RGBColor(0x5A, 0x63, 0x6B)

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)
BLANK = prs.slide_layouts[6]
SW, SH = prs.slide_width, prs.slide_height

# ---------- Load images ----------
imgs = json.load(open('/tmp/workspace/laryngectomy-voice-ppt/assets/images.json'))
img_bytes = {}
names = ['blom_singer', 'provox', 'electrolarynx', 'esophageal_speech']
for n, im in zip(names, imgs):
    img_bytes[n] = BytesIO(base64.b64decode(im['base64'].split(',', 1)[1]))

def add_bg(slide, color=WHITE):
    rect = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, 0, 0, SW, SH)
    rect.fill.solid(); rect.fill.fore_color.rgb = color
    rect.line.fill.background()
    rect.shadow.inherit = False
    slide.shapes._spTree.remove(rect._element)
    slide.shapes._spTree.insert(2, rect._element)
    return rect

def add_textbox(slide, left, top, width, height, text, size=18, bold=False, color=DARK,
                 align=PP_ALIGN.LEFT, font='Calibri', italic=False, line_spacing=1.0):
    tb = slide.shapes.add_textbox(left, top, width, height)
    tf = tb.text_frame
    tf.word_wrap = True
    lines = text.split('\n')
    for i, line in enumerate(lines):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.text = line
        p.alignment = align
        p.line_spacing = line_spacing
        r = p.runs[0] if p.runs else p.add_run()
        r.font.size = Pt(size)
        r.font.bold = bold
        r.font.italic = italic
        r.font.name = font
        r.font.color.rgb = color
    return tb

def add_bullets(slide, left, top, width, height, items, size=15, color=DARK, bold_first=False,
                 space_after=8, font='Calibri', bullet_color=TEAL):
    tb = slide.shapes.add_textbox(left, top, width, height)
    tf = tb.text_frame
    tf.word_wrap = True
    for i, item in enumerate(items):
        level = 0
        txt = item
        if isinstance(item, tuple):
            txt, level = item
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        prefix = ('•  ' if level == 0 else '   -  ')
        p.text = prefix + txt
        p.space_after = Pt(space_after)
        p.line_spacing = 1.05
        r = p.runs[0]
        r.font.size = Pt(size - (2 if level else 0))
        r.font.color.rgb = color
        r.font.name = font
        r.font.bold = False
    return tb

def header(slide, title, subtitle=None, num=None, total=None):
    add_bg(slide, WHITE)
    bar = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, 0, 0, SW, Inches(1.15))
    bar.fill.solid(); bar.fill.fore_color.rgb = NAVY
    bar.line.fill.background(); bar.shadow.inherit = False
    accent = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, 0, Inches(1.15), SW, Pt(4))
    accent.fill.solid(); accent.fill.fore_color.rgb = ACCENT
    accent.line.fill.background(); accent.shadow.inherit = False
    add_textbox(slide, Inches(0.5), Inches(0.18), Inches(11.5), Inches(0.6), title,
                size=26, bold=True, color=WHITE, font='Calibri')
    if subtitle:
        add_textbox(slide, Inches(0.5), Inches(0.68), Inches(11.5), Inches(0.4), subtitle,
                     size=13, italic=True, color=RGBColor(0xC9, 0xD8, 0xE4))
    if num:
        add_textbox(slide, SW - Inches(1.1), Inches(0.35), Inches(0.7), Inches(0.4), f"{num}/{total}",
                     size=12, color=RGBColor(0xC9,0xD8,0xE4), align=PP_ALIGN.RIGHT)

def add_picture_boxed(slide, img_key, left, top, width, height, caption=None):
    pic = slide.shapes.add_picture(img_bytes[img_key], left, top, height=height)
    # center horizontally within given width if picture narrower
    if pic.width > width:
        pic.width = width
        pic.left = left
    else:
        pic.left = left + int((width - pic.width) / 2)
    img_bytes[img_key].seek(0)
    if caption:
        add_textbox(slide, left, top + height + Pt(4), width, Inches(0.35), caption,
                    size=11, italic=True, color=GREY, align=PP_ALIGN.CENTER)

TOTAL = 13

# ================= SLIDE 1: TITLE =================
s = prs.slides.add_slide(BLANK)
add_bg(s, NAVY)
band = s.shapes.add_shape(MSO_SHAPE.RECTANGLE, 0, Inches(4.7), SW, Pt(4))
band.fill.solid(); band.fill.fore_color.rgb = ACCENT; band.line.fill.background(); band.shadow.inherit=False
add_textbox(s, Inches(1), Inches(2.3), Inches(11.3), Inches(1.4),
            "Voice Rehabilitation in Laryngectomy", size=44, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
add_textbox(s, Inches(1), Inches(3.55), Inches(11.3), Inches(0.7),
            "Restoring communication after total laryngectomy", size=20, italic=True,
            color=RGBColor(0xC9,0xD8,0xE4))
add_textbox(s, Inches(1), Inches(4.95), Inches(11.3), Inches(0.5),
            "MBBS Final Professional Part I - ENT (Otorhinolaryngology)", size=16, color=WHITE)
add_textbox(s, Inches(1), Inches(5.4), Inches(11.3), Inches(0.5),
            "Reference: Dhingra's Diseases of Ear, Nose and Throat & Head and Neck Surgery", size=14, color=RGBColor(0xC9,0xD8,0xE4))

# ================= SLIDE 2: LEARNING OBJECTIVES =================
s = prs.slides.add_slide(BLANK)
header(s, "Learning Objectives", num=2, total=TOTAL)
add_bullets(s, Inches(0.7), Inches(1.5), Inches(11.9), Inches(5.2), [
    "Recall why total laryngectomy abolishes normal (laryngeal) voice production",
    "Classify the methods available for post-laryngectomy voice rehabilitation",
    "Describe the mechanism, technique, advantages and limitations of oesophageal speech",
    "Describe the artificial larynx (electrolarynx) - types and use",
    "Explain tracheo-oesophageal (TE) speech with a voice prosthesis (Blom-Singer / Provox)",
    "Outline surgical methods of voice restoration (neoglottic reconstruction)",
    "List complications of voice prostheses and their management",
    "Appreciate the multidisciplinary approach to rehabilitation of a laryngectomee",
], size=17, space_after=14)

# ================= SLIDE 3: WHY VOICE REHAB NEEDED =================
s = prs.slides.add_slide(BLANK)
header(s, "Total Laryngectomy: The Problem", num=3, total=TOTAL)
add_bullets(s, Inches(0.6), Inches(1.5), Inches(6.6), Inches(5.2), [
    "Total laryngectomy = complete removal of the larynx, done for advanced (T3/T4) laryngeal or hypopharyngeal cancer, or as salvage after failed radiotherapy/chemoradiation",
    "The airway is permanently separated from the digestive tract:",
    ("Trachea is brought out as a separate end tracheostome on the neck (permanent 'neck breather')", 1),
    ("Pharynx/oesophagus is repaired to restore swallowing", 1),
    "Consequences for voice:",
    ("The vibratory sound source (vocal cords) is lost", 1),
    ("Expired lung air no longer passes through the pharynx/mouth, so it cannot power speech", 1),
    "Voice rehabilitation aims to give the patient a new sound source and a way to direct air/vibration into the vocal tract for articulation",
], size=15.5, space_after=10)
add_picture_boxed(s, 'esophageal_speech', Inches(7.6), Inches(1.6), Inches(4.9), Inches(3.6))
add_textbox(s, Inches(7.6), Inches(5.35), Inches(4.9), Inches(1.3),
            "Goal of rehabilitation:\nAudible, intelligible, hands-free speech + preserved swallowing, smell and quality of life",
            size=13.5, bold=True, color=TEAL, align=PP_ALIGN.CENTER)

# ================= SLIDE 4: CLASSIFICATION =================
s = prs.slides.add_slide(BLANK)
header(s, "Methods of Voice Rehabilitation - Overview", num=4, total=TOTAL)
add_textbox(s, Inches(0.6), Inches(1.4), Inches(11.5), Inches(0.5), "Three broad approaches:", size=18, bold=True, color=NAVY)

cols = [
    ("A. Non-surgical /\nAlaryngeal speech", ["Oesophageal speech", "Pharyngeal/buccal speech (rare)"]),
    ("B. Mechanical / Electronic\ndevices", ["Artificial larynx - Electronic (electrolarynx)", "Pneumatic (Tokyo-type) artificial larynx"]),
    ("C. Surgical voice\nrestoration", ["Tracheo-oesophageal (TE) puncture + voice prosthesis (Blom-Singer, Provox)", "Neoglottic reconstruction (Asai, Staffieri, Amatsu techniques)"]),
]
x = Inches(0.6); w = Inches(3.95); gap = Inches(0.15)
for title, items in cols:
    box = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, x, Inches(2.1), w, Inches(4.6))
    box.fill.solid(); box.fill.fore_color.rgb = LIGHT
    box.line.color.rgb = TEAL; box.line.width = Pt(1.25)
    box.shadow.inherit = False
    hd = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, x, Inches(2.1), w, Inches(1.0))
    hd.fill.solid(); hd.fill.fore_color.rgb = NAVY
    hd.line.fill.background(); hd.shadow.inherit=False
    tf = hd.text_frame; tf.word_wrap = True
    tf.margin_left=Pt(6); tf.margin_right=Pt(6)
    p = tf.paragraphs[0]; p.text = title; p.alignment = PP_ALIGN.CENTER
    r = p.runs[0]; r.font.size = Pt(16); r.font.bold = True; r.font.color.rgb = WHITE
    add_bullets(s, x + Inches(0.2), Inches(3.25), w - Inches(0.4), Inches(3.3), items, size=13.5, space_after=10)
    x = x + w + gap

# ================= SLIDE 5: OESOPHAGEAL SPEECH =================
s = prs.slides.add_slide(BLANK)
header(s, "Oesophageal Speech", num=5, total=TOTAL)
add_bullets(s, Inches(0.6), Inches(1.5), Inches(7.0), Inches(5.2), [
    "Oldest and simplest method - requires no device or surgery",
    "Mechanism:",
    ("Air is injected/swallowed into the upper oesophagus (by tongue-pumping or gulping)", 1),
    ("Air is then belched back (regurgitated) in a controlled way", 1),
    ("The vibrating pharyngo-oesophageal (PE) segment mucosa acts as the new 'neo-glottis' / sound source", 1),
    ("Sound is articulated into speech by tongue, lips, palate as usual", 1),
    "Advantages: no device, no cost, hands-free, no surgery",
    "Disadvantages:",
    ("Difficult and slow to learn (needs speech therapy, weeks-months)", 1),
    ("Only a small volume of air can be trapped - short phrases, low volume, low pitch", 1),
    ("Only 25-50% of patients achieve useful fluency", 1),
], size=14.5, space_after=7)
add_picture_boxed(s, 'esophageal_speech', Inches(7.9), Inches(1.6), Inches(4.6), Inches(3.4),
                   caption="Production of oesophageal speech (Bailey & Love, Fig. 52.62)")
box = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(7.9), Inches(5.4), Inches(4.6), Inches(1.3))
box.fill.solid(); box.fill.fore_color.rgb = LIGHT; box.line.color.rgb=ACCENT; box.shadow.inherit=False
tf = box.text_frame; tf.word_wrap=True; tf.margin_left=Pt(8); tf.margin_top=Pt(6)
p = tf.paragraphs[0]; p.text = "Clinical pearl:"; p.runs[0].font.bold=True; p.runs[0].font.size=Pt(13); p.runs[0].font.color.rgb=NAVY
p2 = tf.add_paragraph(); p2.text = "Often taught first by a speech-language therapist before offering TEP/electrolarynx."
p2.runs[0].font.size = Pt(12.5); p2.runs[0].font.color.rgb = DARK

# ================= SLIDE 6: ARTIFICIAL LARYNX / ELECTROLARYNX =================
s = prs.slides.add_slide(BLANK)
header(s, "Artificial Larynx (Electrolarynx)", num=6, total=TOTAL)
add_bullets(s, Inches(0.6), Inches(1.5), Inches(6.9), Inches(5.2), [
    "External mechanical/electronic device used when surgery/TEP is not possible or as an early aid",
    "Two main types:",
    ("Electronic (transcervical / neck-type): battery-powered vibrating diaphragm held against the neck (or an intra-oral tube). Vibration is transmitted through soft tissues into the pharynx and shaped into speech by the tongue, lips and palate", 1),
    ("Pneumatic type: uses the patient's own pulmonary air, directed from the tracheostome through a tube with a reed, into the mouth", 1),
    "Advantages:",
    ("Easy and quick to learn, usable within days of surgery", 1),
    ("Reliable, works even with poor pharyngeal mucosa/after radiotherapy", 1),
    "Disadvantages:",
    ("Sound is monotonous and mechanical/robotic", 1),
    ("Needs a free hand to hold the device against the neck", 1),
    ("Ongoing battery/device cost", 1),
], size=14, space_after=7)
add_picture_boxed(s, 'electrolarynx', Inches(8.0), Inches(1.8), Inches(4.4), Inches(3.2),
                   caption="Electrolarynx device (Bailey & Love, Fig. 52.61)")

# ================= SLIDE 7: TE PUNCTURE / VOICE PROSTHESIS =================
s = prs.slides.add_slide(BLANK)
header(s, "Tracheo-oesophageal (TE) Speech: Voice Prosthesis", num=7, total=TOTAL)
add_bullets(s, Inches(0.6), Inches(1.5), Inches(7.0), Inches(5.3), [
    "Currently the gold standard for post-laryngectomy voice restoration",
    "Principle: a surgically created tracheo-oesophageal fistula (TE puncture, TEP) allows pulmonary air to be shunted from the trachea into the oesophagus, driving vibration of the PE segment (neoglottis) for louder, more fluent, near-normal-sounding speech",
    "A one-way silicone voice prosthesis is placed in the puncture tract:",
    ("Allows air trachea -> oesophagus during expiration (occlude stoma with finger/valve)", 1),
    ("Closes automatically to prevent aspiration of food/fluid oesophagus -> trachea", 1),
    "Can be done as primary TEP (at the time of laryngectomy) or secondary TEP (later)",
    "Common devices: Blom-Singer prosthesis, Provox (indwelling, low-resistance) prosthesis",
    "Advantages: best voice quality, fluent, loud, near-normal intonation, learned quickly",
    "Disadvantages: device cost, needs periodic replacement, risk of leakage/aspiration if valve fails",
], size=14, space_after=7)
add_picture_boxed(s, 'blom_singer', Inches(7.9), Inches(1.55), Inches(4.6), Inches(3.3),
                   caption="Blom-Singer valve in a TE fistula with stoma valve (Fig. 52.59)")
add_picture_boxed(s, 'provox', Inches(9.1), Inches(5.05), Inches(2.3), Inches(1.75),
                   caption="Provox prosthesis in situ")

# ================= SLIDE 8: SURGICAL NEOGLOTTIS RECONSTRUCTION =================
s = prs.slides.add_slide(BLANK)
header(s, "Surgical Voice Restoration (Historical / Alternative Techniques)", num=8, total=TOTAL)
add_bullets(s, Inches(0.6), Inches(1.5), Inches(11.9), Inches(5.3), [
    "Before modern voice prostheses, several surgical shunt/neoglottis techniques were devised to create a permanent tracheo-pharyngeal air channel:",
    ("Asai's technique - a skin/mucosal tube fashioned as a permanent tracheo-pharyngeal shunt for TE voicing", 1),
    ("Staffieri's operation (phonatory neoglottis) - creation of a neoglottis from residual mucosa to permit voicing", 1),
    ("Amatsu's technique - single-stage tracheo-oesophageal shunt operation", 1),
    "Popular in the late 1970s-80s, but largely abandoned because of a difficult trade-off: good voice quality was associated with troublesome aspiration, whereas an aspiration-free shunt often gave poor or absent voice",
    "Superseded in most centres by voice-prosthesis-based TEP (Singer-Blom, 1980 onward), which uses a one-way valve to solve the aspiration problem while retaining good voice",
    "Still occasionally relevant in patients unsuitable for a prosthesis or where prostheses are unavailable/unaffordable",
], size=15.5, space_after=12)

# ================= SLIDE 9: COMPARISON TABLE =================
s = prs.slides.add_slide(BLANK)
header(s, "Comparison of Voice Rehabilitation Methods", num=9, total=TOTAL)
rows = [
    ["Feature", "Oesophageal speech", "Electrolarynx", "TE speech (prosthesis)"],
    ["Sound source", "PE segment mucosa", "Mechanical vibrator", "PE segment (pulmonary air driven)"],
    ["Ease of learning", "Difficult, slow", "Easy, quick", "Easy-moderate, quick"],
    ["Voice quality", "Low pitch, limited volume", "Monotonous, robotic", "Best - fluent, louder"],
    ["Hands-free", "Yes", "No (device held to neck)", "Mostly yes (with auto valve)"],
    ["Cost", "None", "Device + batteries", "Prosthesis + replacement"],
    ["Main drawback", "Low success rate", "Mechanical sound", "Device care, leakage risk"],
]
tbl_left, tbl_top, tbl_w, tbl_h = Inches(0.6), Inches(1.6), Inches(12.1), Inches(4.9)
gtable = s.shapes.add_table(len(rows), 4, tbl_left, tbl_top, tbl_w, tbl_h).table
colw = [Inches(2.6), Inches(3.2), Inches(3.1), Inches(3.2)]
for i, w_ in enumerate(colw):
    gtable.columns[i].width = w_
for r_i, row in enumerate(rows):
    for c_i, val in enumerate(row):
        cell = gtable.cell(r_i, c_i)
        cell.text = val
        cell.vertical_anchor = MSO_ANCHOR.MIDDLE
        cell.margin_left = Pt(6); cell.margin_right = Pt(6)
        para = cell.text_frame.paragraphs[0]
        para.font.size = Pt(13 if r_i else 14)
        para.font.bold = (r_i == 0)
        para.font.color.rgb = WHITE if r_i == 0 else DARK
        cell.fill.solid()
        cell.fill.fore_color.rgb = NAVY if r_i == 0 else (LIGHT if r_i % 2 == 0 else WHITE)

# ================= SLIDE 10: COMPLICATIONS =================
s = prs.slides.add_slide(BLANK)
header(s, "Complications of Voice Prosthesis / TEP", num=10, total=TOTAL)
add_bullets(s, Inches(0.6), Inches(1.5), Inches(5.9), Inches(5.2), [
    "Device-related:",
    ("Leakage through the valve (candida biofilm degrading the silicone) - most common cause of replacement", 1),
    ("Leakage around the prosthesis - fistula tract widening/hypotonicity of PE segment", 1),
    ("Granulation tissue at the puncture site", 1),
    ("Dislodgement or accidental removal", 1),
], size=14.5, space_after=8)
add_bullets(s, Inches(6.9), Inches(1.5), Inches(5.9), Inches(5.2), [
    "General surgical complications:",
    ("Pharyngocutaneous fistula (higher risk after prior radiotherapy)", 1),
    ("Stomal stenosis - may need a laryngectomy tube/appliance", 1),
    ("Aspiration pneumonia (if valve incompetent)", 1),
    "Management principles:",
    ("Regular follow-up, antifungal (nystatin) rinses to reduce candida colonisation", 1),
    ("Timely prosthesis replacement (can be an outpatient/bedside procedure)", 1),
], size=14.5, space_after=8)

# ================= SLIDE 11: HOLISTIC REHABILITATION =================
s = prs.slides.add_slide(BLANK)
header(s, "Beyond Voice: Holistic Rehabilitation of the Laryngectomee", num=11, total=TOTAL)
add_bullets(s, Inches(0.6), Inches(1.5), Inches(11.9), Inches(5.3), [
    "Voice rehabilitation is only one part of comprehensive laryngectomee care - a multidisciplinary team approach is essential:",
    ("Speech-language therapist - trains oesophageal/TE speech, counsels on device use", 1),
    ("ENT/Head-neck surgeon - performs TEP, manages stoma and prosthesis issues", 1),
    ("Heat and moisture exchanger (HME) - improves pulmonary humidification and can improve TE speech", 1),
    ("Olfaction rehabilitation - 'polite yawning' / nasal-airflow-inducing manoeuvre helps restore smell (lost due to diverted airflow)", 1),
    ("Stoma care and education - lifelong neck-breather precautions (showering, swimming, emergency resuscitation via stoma)", 1),
    ("Psychological support and laryngectomy support groups - address anxiety, depression and body-image concerns", 1),
    ("Dietitian - for swallowing and nutrition once oral intake resumes", 1),
], size=16, space_after=12)

# ================= SLIDE 12: RECENT EVIDENCE =================
s = prs.slides.add_slide(BLANK)
header(s, "Recent Evidence & Quality of Life", num=12, total=TOTAL)
add_bullets(s, Inches(0.6), Inches(1.5), Inches(11.9), Inches(4.6), [
    "Tracheoesophageal (prosthetic) speech consistently shows the best voice-related quality of life scores compared with oesophageal speech and electrolarynx across recent systematic reviews and meta-analyses",
    "Provox and Blom-Singer indwelling prostheses show comparable long-term functional outcomes; device choice is often guided by local expertise and patient factors",
    "Early involvement of speech-language pathology and structured voice/swallow rehabilitation protocols improve overall communication and quality-of-life outcomes after total laryngectomy and after chemoradiation-related voice dysfunction",
], size=16, space_after=14)
note = s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE, Inches(0.6), Inches(5.5), Inches(11.9), Inches(1.4))
note.fill.solid(); note.fill.fore_color.rgb = LIGHT; note.line.color.rgb = TEAL; note.shadow.inherit=False
tf = note.text_frame; tf.word_wrap = True; tf.margin_left=Pt(10); tf.margin_top=Pt(8)
p = tf.paragraphs[0]; p.text = "Supporting literature (PubMed):"
p.runs[0].font.bold = True; p.runs[0].font.size = Pt(13); p.runs[0].font.color.rgb = NAVY
p2 = tf.add_paragraph()
p2.text = ("Maniaci A et al. Voice-Related Quality of Life After Total Laryngectomy: Systematic Review and Meta-Analysis. "
           "J Voice. 2024. PMID 34763996  |  Zhao M et al. Rehabilitation training on radiotherapy-related voice abnormalities: "
           "SR & meta-analysis. PLoS One 2025. PMID 40063657")
p2.runs[0].font.size = Pt(12); p2.runs[0].font.color.rgb = DARK

# ================= SLIDE 13: SUMMARY / REFERENCES =================
s = prs.slides.add_slide(BLANK)
header(s, "Summary & References", num=13, total=TOTAL)
add_textbox(s, Inches(0.6), Inches(1.4), Inches(11.9), Inches(0.4), "Key take-home points", size=18, bold=True, color=NAVY)
add_bullets(s, Inches(0.6), Inches(1.85), Inches(11.9), Inches(2.5), [
    "Total laryngectomy removes the sound source and separates the airway from the vocal tract",
    "Three rehabilitation pathways: oesophageal speech, artificial larynx (electrolarynx), and tracheo-oesophageal speech with a voice prosthesis (TEP)",
    "TEP with an indwelling voice prosthesis (Blom-Singer/Provox) gives the best voice outcomes and is now the standard of care",
    "Rehabilitation is multidisciplinary - surgeon, speech therapist, and long-term stoma/device care are all essential",
], size=15.5, space_after=8)
add_textbox(s, Inches(0.6), Inches(4.55), Inches(11.9), Inches(0.4), "References", size=18, bold=True, color=NAVY)
add_bullets(s, Inches(0.6), Inches(5.0), Inches(11.9), Inches(2.0), [
    "Dhingra PL, Dhingra S. Diseases of Ear, Nose and Throat & Head and Neck Surgery (as per MBBS curriculum) - Larynx / Laryngectomy chapter",
    "Bailey BJ, Love RJ. Bailey & Love's Short Practice of Surgery, 28th ed. - 'Voice rehabilitation' section",
    "Flint PW et al. Cummings Otolaryngology - Head and Neck Surgery - Chapter on Alaryngeal Voice and Speech Rehabilitation",
    "Maniaci A et al. J Voice 2024 (PMID 34763996); Zhao M et al. PLoS One 2025 (PMID 40063657)",
], size=13.5, space_after=6)

prs.save('/tmp/workspace/laryngectomy-voice-ppt/Voice_Rehabilitation_in_Laryngectomy.pptx')
print("Saved.")