mkdir -p /home/daytona/workspace/appendicitis-ppt && ls /home/daytona/workspace/…

~/appendicitis-ppt/create_ppt.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Acute Appendicitis";
pres.author = "Orris Medical";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const C = {
  darkBg:   "0D1B2A",   // deep navy  (dominates ~65%)
  midBg:    "1B3A5C",   // mid-blue
  accent:   "E84855",   // vivid crimson-red
  accentSoft:"FF8C94",  // soft coral
  light:    "FFFFFF",   // white text
  bodyText: "D0E4F5",   // pale blue-white
  subHead:  "7FBCD2",   // sky blue
  cardBg:   "14304F",   // dark card
  lineColor:"E84855",
  gold:     "F5A623",   // highlight / warning
  greenSafe:"4CAF82",   // safe/good
};

// ─── HELPERS ─────────────────────────────────────────────────────────────────
function addSectionHeader(pres, title, subtitle) {
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };
  // left accent bar
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.accent } });
  sl.addText(title.toUpperCase(), {
    x: 0.45, y: 2.1, w: 9.3, h: 0.9,
    fontSize: 38, bold: true, color: C.light,
    fontFace: "Calibri", charSpacing: 4
  });
  if (subtitle) {
    sl.addText(subtitle, {
      x: 0.45, y: 3.1, w: 9.3, h: 0.6,
      fontSize: 18, color: C.subHead, fontFace: "Calibri", italic: true
    });
  }
  return sl;
}

function accentLine(sl, x, y, w) {
  sl.addShape("rect", { x, y, w, h: 0.04, fill: { color: C.accent } });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  // large diagonal decorative block
  sl.addShape("rect", { x: 6.8, y: 0, w: 3.2, h: 5.625, fill: { color: C.midBg } });
  sl.addShape("rect", { x: 7.2, y: 0, w: 0.22, h: 5.625, fill: { color: C.accent } });

  // TITLE
  sl.addText("ACUTE", {
    x: 0.5, y: 1.0, w: 7, h: 0.85,
    fontSize: 56, bold: true, color: C.accent,
    fontFace: "Calibri", charSpacing: 8
  });
  sl.addText("APPENDICITIS", {
    x: 0.5, y: 1.85, w: 7, h: 0.85,
    fontSize: 56, bold: true, color: C.light,
    fontFace: "Calibri", charSpacing: 4
  });

  accentLine(sl, 0.5, 2.85, 5.5);

  sl.addText("Pathophysiology · Diagnosis · Management", {
    x: 0.5, y: 3.0, w: 7, h: 0.5,
    fontSize: 18, color: C.subHead, fontFace: "Calibri", italic: true
  });

  sl.addText([
    { text: "Sources: ", options: { bold: true, color: C.gold } },
    { text: "Fischer's Mastery of Surgery • Tintinalli's Emergency Medicine\nSabiston Textbook of Surgery • Goldman-Cecil Medicine\nBailey & Love's Short Practice of Surgery", options: { color: C.bodyText } }
  ], { x: 0.5, y: 4.3, w: 6.5, h: 1.1, fontSize: 11, fontFace: "Calibri" });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW & EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  sl.addText("OVERVIEW & EPIDEMIOLOGY", {
    x: 0.4, y: 0.2, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.light, fontFace: "Calibri", charSpacing: 2
  });
  accentLine(sl, 0.4, 0.78, 9.2);

  // Stat cards  (3 across)
  const cards = [
    { icon: "🏥", val: "#1", label: "Most common surgical\nemergency worldwide", sub: "" },
    { icon: "📊", val: "8.7% / 6.9%", label: "Lifetime prevalence\nMen / Women", sub: "" },
    { icon: "🎯", val: "10–19 yrs", label: "Peak incidence\nage group", sub: "" },
  ];
  cards.forEach((c, i) => {
    const x = 0.35 + i * 3.2;
    sl.addShape("rect", { x, y: 1.0, w: 2.9, h: 1.65, fill: { color: C.cardBg }, line: { color: C.accent, width: 1.5 } });
    sl.addText(c.icon + "  " + c.val, { x: x+0.12, y: 1.08, w: 2.66, h: 0.55, fontSize: 18, bold: true, color: C.gold, fontFace: "Calibri" });
    sl.addText(c.label, { x: x+0.12, y: 1.65, w: 2.66, h: 0.75, fontSize: 12, color: C.bodyText, fontFace: "Calibri" });
  });

  // Bullet list
  const bullets = [
    "250,000–300,000 appendectomies/year in the US; ~700,000 affected in Europe annually",
    "Lifetime risk: 12% males, 25% females (Tintinalli's — higher in females due to diagnostic uncertainty)",
    "Most common atraumatic abdominal pain requiring surgery in children >1 year old",
    "Most frequent non-obstetric surgical emergency in pregnancy (1 in 1,500 pregnancies)",
    "Gangrenous appendicitis almost always associated with luminal obstruction",
    "Lifetime appendectomy rates higher than true prevalence: 12% men, 23% women",
  ];
  sl.addText(bullets.map((b, i) => ({
    text: b, options: { bullet: { type: "bullet" }, color: C.bodyText, breakLine: i < bullets.length - 1 }
  })), {
    x: 0.4, y: 2.8, w: 9.2, h: 2.6,
    fontSize: 13.5, fontFace: "Calibri", lineSpacingMultiple: 1.25
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 3 — ANATOMY & PATHOPHYSIOLOGY
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  sl.addText("PATHOPHYSIOLOGY", {
    x: 0.4, y: 0.2, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.light, fontFace: "Calibri", charSpacing: 2
  });
  accentLine(sl, 0.4, 0.78, 9.2);

  // Left column — anatomy note
  sl.addText("Anatomy", { x: 0.4, y: 0.95, w: 4.5, h: 0.4, fontSize: 16, bold: true, color: C.accent, fontFace: "Calibri" });
  const anatBullets = [
    "True diverticulum of the cecum (all 3 intestinal layers)",
    "Contains gut-associated lymphoid tissue (GALT) — immunologically active",
    "Lymphoid tissue peaks in children → obstructs lumen via hyperplasia",
    "Appendiceal lumen obliterates with age → lower incidence in elderly",
  ];
  sl.addText(anatBullets.map((b,i) => ({
    text: b, options: { bullet: { type: "bullet" }, color: C.bodyText, breakLine: i < anatBullets.length - 1 }
  })), { x: 0.4, y: 1.38, w: 4.4, h: 1.95, fontSize: 12.5, fontFace: "Calibri", lineSpacingMultiple: 1.3 });

  // Right column — cascade
  sl.addText("Pathophysiology Cascade", { x: 5.1, y: 0.95, w: 4.7, h: 0.4, fontSize: 16, bold: true, color: C.accent, fontFace: "Calibri" });

  const steps = [
    { n: "1", t: "Luminal Obstruction", d: "Fecalith (most common), lymphoid hyperplasia, tumor, parasites" },
    { n: "2", t: "↑ Intraluminal Pressure", d: "Continued mucosal secretion → Law of Laplace: ↑ wall tension → ↓ venous return" },
    { n: "3", t: "Vascular Insufficiency", d: "Venous & lymphatic outflow obstruction → ischemia, bacterial translocation" },
    { n: "4", t: "Transmural Necrosis", d: "Inflammation → necrosis → perforation → abscess or diffuse peritonitis / sepsis" },
  ];
  steps.forEach((s, i) => {
    const y = 1.38 + i * 0.95;
    sl.addShape("rect", { x: 5.1, y, w: 4.7, h: 0.82, fill: { color: C.cardBg }, line: { color: C.midBg, width: 1 } });
    sl.addShape("rect", { x: 5.1, y, w: 0.32, h: 0.82, fill: { color: C.accent } });
    sl.addText(s.n, { x: 5.11, y: y+0.17, w: 0.3, h: 0.4, fontSize: 16, bold: true, color: C.light, fontFace: "Calibri", align: "center" });
    sl.addText(s.t, { x: 5.5, y: y+0.04, w: 4.2, h: 0.3, fontSize: 12.5, bold: true, color: C.subHead, fontFace: "Calibri" });
    sl.addText(s.d, { x: 5.5, y: y+0.37, w: 4.2, h: 0.38, fontSize: 11, color: C.bodyText, fontFace: "Calibri" });
  });

  // Pain migration note
  sl.addShape("rect", { x: 0.4, y: 3.45, w: 4.4, h: 1.95, fill: { color: C.cardBg }, line: { color: C.gold, width: 1.5 } });
  sl.addText("Pain Migration Mechanism", { x: 0.55, y: 3.55, w: 4.1, h: 0.35, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri" });
  sl.addText([
    { text: "Early: ", options: { bold: true, color: C.accentSoft } },
    { text: "Visceral (T10–T11) → vague periumbilical pain\n", options: { color: C.bodyText } },
    { text: "Late: ", options: { bold: true, color: C.accentSoft } },
    { text: "Parietal peritoneum irritation → RLQ pain at McBurney's point\n(1/3 from ASIS to umbilicus)\n", options: { color: C.bodyText } },
    { text: "Variants: ", options: { bold: true, color: C.accentSoft } },
    { text: "Retrocecal → flank/back pain; Pelvic → groin pain;\nMalrotation → LUQ pain; Pregnancy → RUQ pain", options: { color: C.bodyText } },
  ], { x: 0.55, y: 3.95, w: 4.1, h: 1.35, fontSize: 11.5, fontFace: "Calibri", lineSpacingMultiple: 1.2 });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 4 — CLINICAL FEATURES
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  sl.addText("CLINICAL FEATURES", {
    x: 0.4, y: 0.2, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.light, fontFace: "Calibri", charSpacing: 2
  });
  accentLine(sl, 0.4, 0.78, 9.2);

  // SYMPTOMS column
  sl.addText("Symptoms", { x: 0.4, y: 0.95, w: 4.5, h: 0.38, fontSize: 16, bold: true, color: C.accent, fontFace: "Calibri" });
  const symptoms = [
    ["Periumbilical pain", "migrates to RLQ over hours"],
    ["Anorexia", "common but not universal"],
    ["Nausea/vomiting", "follows onset of pain"],
    ["Low-grade fever", "subjective or objective"],
    ["Bowel changes", "constipation, diarrhea, or obstruction"],
    ["Dysuria/hematuria", "from proximity to urinary tract"],
  ];
  symptoms.forEach(([s, d], i) => {
    const y = 1.4 + i * 0.65;
    sl.addShape("rect", { x: 0.4, y, w: 0.1, h: 0.42, fill: { color: C.accent } });
    sl.addText(s, { x: 0.62, y, w: 2.3, h: 0.25, fontSize: 12.5, bold: true, color: C.subHead, fontFace: "Calibri" });
    sl.addText(d, { x: 0.62, y: y+0.25, w: 4.1, h: 0.22, fontSize: 11, color: C.bodyText, fontFace: "Calibri" });
  });

  // SIGNS column
  sl.addText("Signs & Eponyms", { x: 5.1, y: 0.95, w: 4.7, h: 0.38, fontSize: 16, bold: true, color: C.accent, fontFace: "Calibri" });
  const signs = [
    ["McBurney's Point Tenderness", "RLQ point, 1/3 ASIS to umbilicus"],
    ["Rovsing's Sign", "RLQ pain on LLQ palpation (peritoneal stretch)"],
    ["Psoas Sign", "RLQ pain on extension of right hip (retrocecal)"],
    ["Obturator Sign", "Pain on internal rotation of right hip (pelvic appendix)"],
    ["Rebound Tenderness", "Pain worse on release — peritoneal irritation"],
    ["Dunphy's Sign", "Pain on coughing — peritoneal involvement"],
  ];
  signs.forEach(([s, d], i) => {
    const y = 1.4 + i * 0.65;
    sl.addShape("rect", { x: 5.1, y, w: 0.1, h: 0.42, fill: { color: C.gold } });
    sl.addText(s, { x: 5.32, y, w: 4.4, h: 0.25, fontSize: 12.5, bold: true, color: C.gold, fontFace: "Calibri" });
    sl.addText(d, { x: 5.32, y: y+0.25, w: 4.4, h: 0.22, fontSize: 11, color: C.bodyText, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 5 — DIAGNOSIS & SCORING
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  sl.addText("DIAGNOSIS & SCORING SYSTEMS", {
    x: 0.4, y: 0.2, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.light, fontFace: "Calibri", charSpacing: 2
  });
  accentLine(sl, 0.4, 0.78, 9.2);

  // Alvarado Score Table
  sl.addText("Modified Alvarado Score (MANTRELS)", {
    x: 0.4, y: 0.9, w: 5.5, h: 0.38, fontSize: 15, bold: true, color: C.accent, fontFace: "Calibri"
  });

  const tRows = [
    ["Feature", "Points"],
    ["Migration of pain to RLQ", "1"],
    ["Anorexia / urinary acetone", "1"],
    ["Nausea / Vomiting", "1"],
    ["RLQ tenderness", "2"],
    ["Rebound tenderness", "1"],
    ["Fever (>37.3°C)", "1"],
    ["WBC > 10,000/mm³", "2"],
    ["TOTAL", "10"],
  ];
  const tH = 0.34, tW1 = 3.6, tW2 = 0.9, tX = 0.4, tY0 = 1.32;
  tRows.forEach((row, i) => {
    const y = tY0 + i * tH;
    const bg = i === 0 ? C.accent : (i === tRows.length - 1 ? C.midBg : (i % 2 === 0 ? C.cardBg : C.darkBg));
    sl.addShape("rect", { x: tX, y, w: tW1, h: tH, fill: { color: bg }, line: { color: C.midBg, width: 0.5 } });
    sl.addShape("rect", { x: tX + tW1, y, w: tW2, h: tH, fill: { color: bg }, line: { color: C.midBg, width: 0.5 } });
    sl.addText(row[0], { x: tX + 0.1, y: y+0.05, w: tW1 - 0.15, h: tH - 0.08, fontSize: 11.5,
      bold: i === 0 || i === tRows.length - 1,
      color: i === 0 ? C.light : (i === tRows.length - 1 ? C.gold : C.bodyText), fontFace: "Calibri" });
    sl.addText(row[1], { x: tX + tW1, y: y+0.05, w: tW2 - 0.05, h: tH - 0.08, fontSize: 12,
      bold: true, align: "center",
      color: i === 0 ? C.light : (i === tRows.length - 1 ? C.gold : C.accentSoft), fontFace: "Calibri" });
  });

  // Score interpretation
  const interp = [
    { score: "1–4", label: "Low risk", color: C.greenSafe, note: "Appendicitis unlikely — observe" },
    { score: "5–6", label: "Equivocal", color: C.gold, note: "Imaging recommended" },
    { score: "7–9", label: "Probable", color: C.accent, note: "Surgical consultation" },
    { score: "10",  label: "Certain", color: "FF3333", note: "Emergent surgery" },
  ];
  sl.addText("Score Interpretation", { x: 0.4, y: 4.5, w: 5.5, h: 0.35, fontSize: 13, bold: true, color: C.subHead, fontFace: "Calibri" });
  interp.forEach((r, i) => {
    const x = 0.4 + i * 1.28;
    sl.addShape("rect", { x, y: 4.88, w: 1.18, h: 0.6, fill: { color: r.color }, line: { color: C.darkBg, width: 1 } });
    sl.addText(r.score, { x, y: 4.9, w: 1.18, h: 0.25, fontSize: 14, bold: true, color: C.light, align: "center", fontFace: "Calibri" });
    sl.addText(r.label, { x, y: 5.15, w: 1.18, h: 0.25, fontSize: 10, color: C.light, align: "center", fontFace: "Calibri" });
  });

  // Right column — lab tests
  sl.addText("Laboratory & Biomarkers", {
    x: 5.3, y: 0.9, w: 4.5, h: 0.38, fontSize: 15, bold: true, color: C.accent, fontFace: "Calibri"
  });
  const labs = [
    ["WBC", "Elevated in 90%; typically 10,000–18,000/μL; normal in 10% → don't use alone"],
    ["CRP", ">10 mg/L in children <6 yr predictive; combined WBC+CRP sensitivity up to 98%"],
    ["Procalcitonin", "Elevated; supports diagnosis but not specific"],
    ["Urinalysis", "Trace pyuria/hematuria possible even in true appendicitis — not excluder"],
    ["β-hCG", "Mandatory in females of reproductive age — exclude ectopic pregnancy"],
    ["AIR / AAS Score", "Current guidelines recommend AIR or Adult Appendicitis Score over Alvarado"],
  ];
  labs.forEach(([lab, note], i) => {
    const y = 1.35 + i * 0.69;
    sl.addShape("rect", { x: 5.3, y, w: 4.45, h: 0.58, fill: { color: C.cardBg }, line: { color: C.midBg, width: 0.75 } });
    sl.addText(lab, { x: 5.42, y: y+0.04, w: 1.5, h: 0.26, fontSize: 12.5, bold: true, color: C.gold, fontFace: "Calibri" });
    sl.addText(note, { x: 5.42, y: y+0.3, w: 4.2, h: 0.26, fontSize: 10.5, color: C.bodyText, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 6 — IMAGING
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  sl.addText("IMAGING IN APPENDICITIS", {
    x: 0.4, y: 0.2, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.light, fontFace: "Calibri", charSpacing: 2
  });
  accentLine(sl, 0.4, 0.78, 9.2);

  // CT image from Bailey & Love textbook
  const ctImgUrl = "https://cdn.orris.care/cdss_images/078c8e56593eeea35b80a2fdd2066f7087ad312748e9cd6806c66f6d1ad7b305.png";
  const images = JSON.parse(require("child_process").execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js "${ctImgUrl}"`
  ).toString());

  if (images[0] && !images[0].error) {
    sl.addImage({ data: images[0].base64, x: 0.4, y: 0.95, w: 3.4, h: 4.4 });
    sl.addText("CT: Thickened appendix with periappendiceal fat stranding (arrow)\n– Bailey & Love's Surgery", {
      x: 0.4, y: 5.25, w: 3.4, h: 0.28,
      fontSize: 9, color: C.subHead, fontFace: "Calibri", italic: true, align: "center"
    });
  }

  // Right column imaging modalities
  const modalities = [
    {
      name: "Plain X-Ray",
      icon: "🔲",
      sensitivity: "Low",
      notes: "Calcified appendicolith visible in only ~5% cases. Not recommended routinely.",
      color: C.midBg
    },
    {
      name: "Ultrasound (US)",
      icon: "📡",
      sensitivity: "Sensitivity 71–94%\nSpecificity 81–98%",
      notes: "First line in children & pregnant women (no radiation). Inflamed appendix: enlarged, non-compressible, >6mm diameter. Operator-dependent. Retrocecal appendix may be missed.",
      color: C.cardBg
    },
    {
      name: "CT Scan",
      icon: "💻",
      sensitivity: "Sensitivity & Specificity ≥94%",
      notes: "Gold standard in adults. Criteria: appendix >7 mm, periappendiceal fat stranding, free fluid. Can detect perforation, abscess. Low-dose (2 mSv) preferred.",
      color: C.cardBg
    },
    {
      name: "MRI",
      icon: "🧲",
      sensitivity: "Comparable to CT",
      notes: "Preferred alternative for pregnant women when US is inconclusive. No ionizing radiation. Not better than CT but safe in pregnancy.",
      color: C.cardBg
    },
  ];

  modalities.forEach((m, i) => {
    const y = 0.95 + i * 1.15;
    sl.addShape("rect", { x: 4.05, y, w: 5.6, h: 1.05, fill: { color: m.color }, line: { color: C.midBg, width: 1 } });
    sl.addShape("rect", { x: 4.05, y, w: 0.12, h: 1.05, fill: { color: C.accent } });
    sl.addText(m.icon + " " + m.name, { x: 4.28, y: y+0.05, w: 3.0, h: 0.32, fontSize: 13.5, bold: true, color: C.light, fontFace: "Calibri" });
    sl.addText(m.sensitivity, { x: 7.3, y: y+0.05, w: 2.2, h: 0.32, fontSize: 10, bold: true, color: C.gold, fontFace: "Calibri", align: "right" });
    sl.addText(m.notes, { x: 4.28, y: y+0.38, w: 5.25, h: 0.62, fontSize: 10.5, color: C.bodyText, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 7 — DIFFERENTIAL DIAGNOSIS
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  sl.addText("DIFFERENTIAL DIAGNOSIS", {
    x: 0.4, y: 0.2, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.light, fontFace: "Calibri", charSpacing: 2
  });
  accentLine(sl, 0.4, 0.78, 9.2);

  const ddx = [
    {
      cat: "Surgical",
      color: C.accent,
      items: ["Meckel's diverticulitis", "Perforated peptic ulcer", "Intestinal obstruction", "Intussusception (children)", "Ileocecal Crohn's disease", "Cecal carcinoma / carcinoid"]
    },
    {
      cat: "Urological / Gynaecological",
      color: C.gold,
      items: ["Ectopic pregnancy", "Ovarian torsion / cyst", "Tubo-ovarian abscess", "Mittelschmerz", "Ureteric colic (renal stone)", "Pelvic inflammatory disease"]
    },
    {
      cat: "Medical / Infectious",
      color: C.greenSafe,
      items: ["Mesenteric lymphadenitis", "Gastroenteritis", "Yersinia / Salmonella ileitis", "Pyelonephritis / UTI", "Psoas abscess", "Diabetic ketoacidosis"]
    },
  ];

  ddx.forEach((col, i) => {
    const x = 0.35 + i * 3.2;
    sl.addShape("rect", { x, y: 0.95, w: 0.12, h: 0.36, fill: { color: col.color } });
    sl.addText(col.cat, { x: x+0.2, y: 0.95, w: 2.9, h: 0.36, fontSize: 13.5, bold: true, color: col.color, fontFace: "Calibri" });
    sl.addText(col.items.map((item, j) => ({
      text: item,
      options: { bullet: { type: "bullet" }, color: C.bodyText, breakLine: j < col.items.length - 1 }
    })), {
      x: x, y: 1.4, w: 3.0, h: 3.6,
      fontSize: 12.5, fontFace: "Calibri", lineSpacingMultiple: 1.4
    });
  });

  // Key note
  sl.addShape("rect", { x: 0.35, y: 5.0, w: 9.3, h: 0.48, fill: { color: C.midBg }, line: { color: C.accent, width: 1.2 } });
  sl.addText("⚠  Consider appendicitis in ANY patient with atraumatic abdominal pain without prior appendectomy — Tintinalli's Emergency Medicine", {
    x: 0.5, y: 5.05, w: 9.0, h: 0.38, fontSize: 11.5, color: C.gold, fontFace: "Calibri", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 8 — MANAGEMENT
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  sl.addText("MANAGEMENT", {
    x: 0.4, y: 0.2, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.light, fontFace: "Calibri", charSpacing: 2
  });
  accentLine(sl, 0.4, 0.78, 9.2);

  // Pre-op
  sl.addShape("rect", { x: 0.4, y: 0.95, w: 4.45, h: 0.38, fill: { color: C.accent } });
  sl.addText("Pre-operative Management", { x: 0.5, y: 0.98, w: 4.25, h: 0.3, fontSize: 13.5, bold: true, color: C.light, fontFace: "Calibri" });
  const preop = [
    "IV fluid resuscitation — correct dehydration from fever and vomiting",
    "NPO status",
    "Pre-operative antibiotics: Cefotetan 2 g IV, or Cefoxitin 2 g IV (± 3 post-op doses)",
    "Alternative: Ticarcillin-clavulanic acid",
    "Antibiotics reduce infectious complications even in uncomplicated cases",
  ];
  sl.addText(preop.map((b,i) => ({ text: b, options: { bullet: { type: "bullet" }, color: C.bodyText, breakLine: i<preop.length-1 } })),
    { x: 0.4, y: 1.38, w: 4.45, h: 2.0, fontSize: 12, fontFace: "Calibri", lineSpacingMultiple: 1.3 });

  // Surgical
  sl.addShape("rect", { x: 0.4, y: 3.45, w: 4.45, h: 0.38, fill: { color: C.midBg } });
  sl.addText("Surgical Treatment — Appendectomy", { x: 0.5, y: 3.48, w: 4.25, h: 0.3, fontSize: 13.5, bold: true, color: C.gold, fontFace: "Calibri" });
  const surg = [
    "Laparoscopic appendectomy preferred — lower complication rates, faster recovery",
    "3 incisions: umbilical + 2 lower abdominal",
    "Open approach preferred when perforation is evident",
    "Resume liquids shortly after uncomplicated laparoscopic surgery; solid diet next day",
    "Full recovery in 2–3 weeks; older patients require longer recovery",
  ];
  sl.addText(surg.map((b,i) => ({ text: b, options: { bullet: { type: "bullet" }, color: C.bodyText, breakLine: i<surg.length-1 } })),
    { x: 0.4, y: 3.88, w: 4.45, h: 1.65, fontSize: 12, fontFace: "Calibri", lineSpacingMultiple: 1.3 });

  // Outcomes / Perforation impact
  sl.addShape("rect", { x: 5.1, y: 0.95, w: 4.65, h: 0.38, fill: { color: C.accent } });
  sl.addText("Impact of Perforation", { x: 5.2, y: 0.98, w: 4.45, h: 0.3, fontSize: 13.5, bold: true, color: C.light, fontFace: "Calibri" });

  const perfStats = [
    { label: "Mortality (uncomplicated)", val: "0.0002%" },
    { label: "Mortality (perforated)", val: "3%" },
    { label: "Morbidity (uncomplicated)", val: "3%" },
    { label: "Morbidity (perforated)", val: "47%" },
  ];
  perfStats.forEach((s, i) => {
    const y = 1.42 + i * 0.65;
    sl.addShape("rect", { x: 5.1, y, w: 4.65, h: 0.55, fill: { color: C.cardBg }, line: { color: C.midBg, width: 0.75 } });
    sl.addText(s.label, { x: 5.22, y: y+0.1, w: 3.0, h: 0.35, fontSize: 12, color: C.bodyText, fontFace: "Calibri" });
    sl.addText(s.val, { x: 8.1, y: y+0.08, w: 1.5, h: 0.38, fontSize: 14, bold: true, color: i >= 2 ? C.accent : C.greenSafe, fontFace: "Calibri", align: "right" });
  });

  // Non-operative management box
  sl.addShape("rect", { x: 5.1, y: 3.15, w: 4.65, h: 2.3, fill: { color: C.cardBg }, line: { color: C.gold, width: 1.5 } });
  sl.addText("Non-operative (Antibiotic) Management", { x: 5.2, y: 3.22, w: 4.4, h: 0.38, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri" });
  const nonop = [
    "Effective in ~80% of uncomplicated appendicitis cases",
    "Failure rate remains unacceptably high for many patients",
    "Perforated / peritonitis / obstruction: surgery mandatory",
    "Abscess: image-guided percutaneous drainage + antibiotics → interval appendectomy at 6–8 weeks",
    "Not standard; RCTs ongoing (NCT02800785)",
  ];
  sl.addText(nonop.map((b,i) => ({ text: b, options: { bullet: { type: "bullet" }, color: C.bodyText, breakLine: i<nonop.length-1 } })),
    { x: 5.2, y: 3.65, w: 4.4, h: 1.7, fontSize: 11, fontFace: "Calibri", lineSpacingMultiple: 1.25 });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 9 — SPECIAL POPULATIONS
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  sl.addText("SPECIAL POPULATIONS", {
    x: 0.4, y: 0.2, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.light, fontFace: "Calibri", charSpacing: 2
  });
  accentLine(sl, 0.4, 0.78, 9.2);

  const pops = [
    {
      title: "Children",
      icon: "👶",
      color: C.gold,
      items: [
        "Most common atraumatic abdominal surgical emergency in children >1 yr",
        "Young children (<5 yrs) often present WITH perforation — unable to localize pain",
        "Diagnosis remains largely clinical; CT/US/MRI as adjuncts",
        "Girls: US first to exclude ovarian pathology",
        "Diagnostic laparoscopy if all studies negative but pain persists",
        "Remove appendix even if normal unless other cause definitively identified",
      ]
    },
    {
      title: "Pregnancy",
      icon: "🤰",
      color: C.accentSoft,
      items: [
        "Most common non-obstetric surgical emergency in pregnancy (1 in 1,500)",
        "Same incidence as non-pregnant — but perforation rate higher due to diagnostic delay",
        "2× risk of sepsis, septic shock, bowel obstruction vs. non-pregnant",
        "Classic RLQ pain still most common even in 3rd trimester",
        "Imaging: US first; MRI if US inconclusive; CT only when MRI not available",
        "Physiologic leukocytosis and elevated ESR in pregnancy — confounds diagnosis",
      ]
    },
    {
      title: "Elderly",
      icon: "👴",
      color: C.subHead,
      items: [
        "Lower overall incidence (appendiceal lumen obliterates with age)",
        "Higher mortality — comorbidities + delayed presentation",
        "Atypical presentation common — diagnosis frequently delayed",
        "Perforation and abscess more likely at presentation",
        "Longer recovery period post-operatively",
      ]
    },
  ];

  pops.forEach((p, i) => {
    const x = 0.35 + i * 3.2;
    sl.addShape("rect", { x, y: 0.93, w: 3.0, h: 4.55, fill: { color: C.cardBg }, line: { color: p.color, width: 1.5 } });
    sl.addText(p.icon + "  " + p.title, { x: x+0.15, y: 1.0, w: 2.7, h: 0.42, fontSize: 15, bold: true, color: p.color, fontFace: "Calibri" });
    sl.addShape("rect", { x: x+0.15, y: 1.44, w: 2.7, h: 0.03, fill: { color: p.color } });
    sl.addText(p.items.map((b,j) => ({ text: b, options: { bullet: { type: "bullet" }, color: C.bodyText, breakLine: j < p.items.length - 1 } })),
      { x: x+0.1, y: 1.52, w: 2.8, h: 3.8, fontSize: 11, fontFace: "Calibri", lineSpacingMultiple: 1.3 });
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 10 — COMPLICATIONS
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  sl.addText("COMPLICATIONS OF APPENDICITIS", {
    x: 0.4, y: 0.2, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.light, fontFace: "Calibri", charSpacing: 2
  });
  accentLine(sl, 0.4, 0.78, 9.2);

  const comps = [
    { title: "Perforation", color: C.accent, icon: "💥",
      text: "Mortality rises from 0.0002% → 3%. Morbidity 3% → 47%. Classic sudden pain relief followed by diffuse peritonitis. Extraluminal fecalith may propagate sepsis." },
    { title: "Peritonitis", color: "FF5555", icon: "⚠️",
      text: "Diffuse bacterial peritonitis from free perforation. Requires urgent laparotomy with broad-spectrum antibiotics and peritoneal lavage." },
    { title: "Appendiceal Abscess / Phlegmon", color: C.gold, icon: "🔴",
      text: "Localized collection after contained perforation. Management: percutaneous image-guided drainage + IV antibiotics → interval appendectomy at 6–8 weeks." },
    { title: "Pylephlebitis", color: C.subHead, icon: "🩸",
      text: "Septic thrombophlebitis of portal vein — rare but life-threatening. Fever, jaundice, RUQ pain. Requires antibiotics ± anticoagulation." },
    { title: "Adhesions / Bowel Obstruction", color: C.greenSafe, icon: "🔗",
      text: "Late complication. Post-inflammatory adhesions may cause small bowel obstruction requiring future surgical intervention." },
    { title: "Negative Appendectomy", color: C.bodyText, icon: "🔍",
      text: "Histologically normal appendix removed. Rate up to 15% without imaging. Reduces with CT use. Balance against risk of perforation from observation delay." },
  ];

  comps.forEach((c, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.35 + col * 4.75;
    const y = 0.95 + row * 1.6;
    sl.addShape("rect", { x, y, w: 4.45, h: 1.45, fill: { color: C.cardBg }, line: { color: c.color, width: 1.5 } });
    sl.addShape("rect", { x, y, w: 0.12, h: 1.45, fill: { color: c.color } });
    sl.addText(c.icon + "  " + c.title, { x: x+0.22, y: y+0.07, w: 4.1, h: 0.35, fontSize: 13, bold: true, color: c.color, fontFace: "Calibri" });
    sl.addText(c.text, { x: x+0.22, y: y+0.45, w: 4.1, h: 0.92, fontSize: 11, color: C.bodyText, fontFace: "Calibri", lineSpacingMultiple: 1.2 });
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 11 — KEY TAKEAWAYS
// ═══════════════════════════════════════════════════════════════════
{
  let sl = pres.addSlide();
  sl.background = { color: C.darkBg };

  // Decorative right panel
  sl.addShape("rect", { x: 7.2, y: 0, w: 2.8, h: 5.625, fill: { color: C.midBg } });
  sl.addShape("rect", { x: 7.2, y: 0, w: 0.18, h: 5.625, fill: { color: C.accent } });

  sl.addText("KEY TAKEAWAYS", {
    x: 0.4, y: 0.25, w: 6.5, h: 0.55,
    fontSize: 26, bold: true, color: C.light, fontFace: "Calibri", charSpacing: 3
  });
  accentLine(sl, 0.4, 0.82, 6.5);

  const takeaways = [
    { n: "01", t: "Most common surgical emergency", d: "Affects ~1/1,000 adults/year; lifetime risk 8.7% M / 6.9% F" },
    { n: "02", t: "Pathophysiology: luminal obstruction", d: "Fecalith or lymphoid hyperplasia → ischemia → necrosis → perforation" },
    { n: "03", t: "Classic triad", d: "Periumbilical pain migrating to RLQ + nausea + fever — but 50% are atypical" },
    { n: "04", t: "CT is gold standard", d: "Sensitivity/specificity ≥94%; US first in children and pregnant women" },
    { n: "05", t: "Laparoscopic appendectomy preferred", d: "Unless perforation present; preoperative antibiotics mandatory" },
    { n: "06", t: "Perforation = major risk", d: "Mortality ×15,000; morbidity ×16 — early diagnosis prevents perforation" },
  ];

  takeaways.forEach((t, i) => {
    const y = 1.0 + i * 0.75;
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    sl.addText(t.t, { x: 1.05, y: y+0.02, w: 5.9, h: 0.28, fontSize: 13.5, bold: true, color: C.light, fontFace: "Calibri" });
    sl.addText(t.d, { x: 1.05, y: y+0.3, w: 5.9, h: 0.25, fontSize: 11.5, color: C.bodyText, fontFace: "Calibri" });
    if (i < takeaways.length - 1)
      sl.addShape("rect", { x: 0.4, y: y+0.63, w: 6.5, h: 0.025, fill: { color: C.midBg } });
  });

  sl.addText("Sources: Fischer's Mastery of Surgery 8e • Tintinalli's Emergency Medicine 9e\nSabiston Textbook of Surgery • Goldman-Cecil Medicine • Bailey & Love 28e", {
    x: 7.4, y: 3.5, w: 2.3, h: 1.5,
    fontSize: 9.5, color: C.subHead, fontFace: "Calibri", align: "center", lineSpacingMultiple: 1.4
  });
}

// ═══════════════════════════════════════════════════════════════════
// WRITE FILE
// ═══════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/appendicitis-ppt/Acute_Appendicitis.pptx" })
  .then(() => console.log("✅ Presentation saved to /home/daytona/workspace/appendicitis-ppt/Acute_Appendicitis.pptx"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

cd /home/daytona/workspace/appendicitis-ppt && node create_ppt.js 2>&1

cd /home/daytona/workspace/appendicitis-ppt && node /home/daytona/skills/shared/…

~/appendicitis-ppt/create_ppt.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/appendicitis-ppt/create_ppt.js'

cd /home/daytona/workspace/appendicitis-ppt && node create_ppt.js 2>&1

ls -lh /home/daytona/workspace/appendicitis-ppt/Acute_Appendicitis.pptx