hepatitis B serological markers timeline acute infection

hepatitis C virus liver histology cirrhosis

hepatitis A virus transmission fecal oral epidemiology

hepatitis treatment algorithm antiviral therapy DAA

mkdir -p /home/daytona/workspace/viral-hepatitis-pptx && ls /home/daytona/worksp…

~/viral-hepatitis-pptx/build.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ─── Fetch images as base64 ───────────────────────────────────────────────────
const imageUrls = [
  "https://cdn.orris.care/cdss_images/HARRISON_1763033460065_c3d3e24a-7619-4eff-a877-88960cb74c8e.png",   // 0 - Acute HBV serology timeline
  "https://cdn.orris.care/cdss_images/GLGCA_2558842_1766507565974_8efea364-b689-40e6-b608-5553ff2978a1_478aea1c-31e7-4a47-8b7f-8b864093fd55.png",  // 1 - Acute vs Chronic HBV
  "https://cdn.orris.care/cdss_images/HARRISON_1763031941963_b8714721-0c5c-4031-a531-da171f3c8e24.png",   // 2 - Chronic HBV timeline
  "https://cdn.orris.care/cdss_images/bf0678a73add35492ce7b8b1bd9f9c4bfb1d7de22918f4b6fd9b9493980b2ce7.png", // 3 - HCV serology
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_c6e8860216024ad472b39587963637caf7249be8157e8dbd71023629c946faec.jpg", // 4 - HCV-HCC progression
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_44b28c54ef7dd2682a3553293b44b3f4cdb793661e768ea60186a75dc545305e.jpg", // 5 - HCV cirrhosis mechanism
  "https://cdn.orris.care/cdss_images/e8dc7b1c3a4f58dba10a352069391d2d9844c2a7afaf35c4362002f4f68fd37f.png",  // 6 - HAV serology
];

console.log("Fetching images...");
let images = [];
try {
  const result = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
    { maxBuffer: 50 * 1024 * 1024 }
  ).toString();
  images = JSON.parse(result);
  console.log("Images fetched:", images.map((img, i) => `${i}: ${img.error ? 'ERROR: ' + img.error : 'OK'}`));
} catch (e) {
  console.error("Image fetch error:", e.message);
  images = imageUrls.map(() => ({ base64: null, error: "fetch failed" }));
}

// ─── Color Palette ────────────────────────────────────────────────────────────
const C = {
  navy:      "0D2B45",   // deep navy - dominant background
  teal:      "1A7A7A",   // teal accent
  gold:      "E8A020",   // amber/gold highlight
  white:     "FFFFFF",
  offwhite:  "F0F4F7",
  lightgray: "D0DBE5",
  slate:     "3A5068",
  red:       "C0392B",
  green:     "1E8449",
  light_teal:"2AADAD",
  pale_teal: "A8DDDD",
};

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Viral Hepatitis";
pres.author = "Internal Medicine";

// ─── Helper functions ─────────────────────────────────────────────────────────
function navyBg(slide) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy }, line: { color: C.navy }
  });
}
function tealBar(slide, h = 0.06) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 5.625 - h, w: 10, h, fill: { color: C.teal }, line: { color: C.teal }
  });
}
function sectionHeader(slide, title, subtitle = "") {
  navyBg(slide);
  // Teal accent left strip
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.teal }, line: { color: C.teal } });
  slide.addText(title, {
    x: 0.3, y: 2.1, w: 9.4, h: 1.0,
    fontSize: 36, bold: true, color: C.white, fontFace: "Calibri", align: "center"
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.3, y: 3.2, w: 9.4, h: 0.5,
      fontSize: 18, color: C.pale_teal, fontFace: "Calibri", align: "center", italic: true
    });
  }
  tealBar(slide);
}

function contentSlide(slide) {
  // White content area on navy
  navyBg(slide);
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0.35, y: 0.9, w: 9.3, h: 4.4,
    fill: { color: C.offwhite }, line: { color: C.lightgray, pt: 0.5 },
    shadow: { type: "outer", color: "000000", blur: 8, offset: 3, angle: 135, opacity: 0.2 }
  });
}

function slideTitle(slide, text) {
  // Title bar
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.85, fill: { color: C.teal }, line: { color: C.teal } });
  slide.addText(text, {
    x: 0.25, y: 0.0, w: 9.5, h: 0.85,
    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0
  });
  tealBar(slide);
}

function bulletBlock(slide, items, opts = {}) {
  const { x = 0.55, y = 1.0, w = 8.9, h = 4.1, fontSize = 14, color = C.navy } = opts;
  const textArr = items.map((item, i) => {
    const isLast = i === items.length - 1;
    if (typeof item === "string") {
      return { text: item, options: { bullet: { indent: 15 }, breakLine: !isLast, fontSize, color, fontFace: "Calibri", paraSpaceAfter: 4 } };
    }
    return item;
  });
  slide.addText(textArr, { x, y, w, h, valign: "top" });
}

function addImg(slide, imgObj, x, y, w, h, caption = "") {
  if (imgObj && imgObj.base64 && !imgObj.error) {
    slide.addImage({ data: imgObj.base64, x, y, w, h });
  } else {
    slide.addShape(pres.shapes.RECTANGLE, { x, y, w, h, fill: { color: C.lightgray }, line: { color: C.slate, pt: 1 } });
    slide.addText("[Image unavailable]", { x, y, w, h, fontSize: 10, color: C.slate, align: "center", valign: "middle" });
  }
  if (caption) {
    slide.addText(caption, { x, y: y + h + 0.02, w, h: 0.2, fontSize: 8, color: C.slate, italic: true, align: "center" });
  }
}

// ─── SLIDE 1: Title ───────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  // Bold teal accent top bar
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.12, fill: { color: C.teal }, line: { color: C.teal } });
  // Gold bottom bar
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.46, w: 10, h: 0.165, fill: { color: C.gold }, line: { color: C.gold } });

  // Centered main title
  s.addText("VIRAL HEPATITIS", {
    x: 0.5, y: 1.3, w: 9, h: 1.1,
    fontSize: 48, bold: true, color: C.white, fontFace: "Calibri",
    align: "center", charSpacing: 4
  });
  s.addShape(pres.shapes.RECTANGLE, { x: 2.5, y: 2.5, w: 5, h: 0.04, fill: { color: C.teal }, line: { color: C.teal } });
  s.addText("An Internal Medicine Comprehensive Review", {
    x: 0.5, y: 2.65, w: 9, h: 0.55,
    fontSize: 20, color: C.pale_teal, fontFace: "Calibri", align: "center", italic: true
  });

  // Info row
  s.addText([
    { text: "HEPATITIS A  •  B  •  C  •  D  •  E", options: { fontSize: 13, color: C.gold, bold: true, charSpacing: 1 } },
  ], { x: 0.5, y: 3.45, w: 9, h: 0.35, align: "center" });

  s.addText("Epidemiology  |  Pathology  |  Serology  |  Treatment  |  Complications", {
    x: 0.5, y: 3.9, w: 9, h: 0.3,
    fontSize: 12, color: C.lightgray, fontFace: "Calibri", align: "center"
  });

  // Source badge
  s.addText("Based on Robbins Basic Pathology • Harrison's Principles of Internal Medicine", {
    x: 0.5, y: 5.0, w: 9, h: 0.25,
    fontSize: 9, color: C.slate, fontFace: "Calibri", align: "center", italic: true
  });
}

// ─── SLIDE 2: Overview / Table of Contents ────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Lecture Overview");

  const topics = [
    { num: "01", text: "Introduction & Classification of Hepatitis Viruses", col: C.teal },
    { num: "02", text: "Hepatitis A (HAV) — Epidemiology & Clinical Features", col: C.teal },
    { num: "03", text: "Hepatitis B (HBV) — Virology, Serology & Outcomes", col: C.gold },
    { num: "04", text: "Hepatitis C (HCV) — Chronic Disease & Treatment", col: C.gold },
    { num: "05", text: "Hepatitis D & E — Special Considerations", col: C.light_teal },
    { num: "06", text: "Acute Hepatitis — Pathology & Clinical Presentation", col: C.light_teal },
    { num: "07", text: "Chronic Hepatitis — Progression to Cirrhosis & HCC", col: C.red },
    { num: "08", text: "Management & Prevention", col: C.red },
  ];

  topics.forEach((t, i) => {
    const col = i % 2 === 0 ? 0 : 5;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.35 : 5.15;
    const y = 0.95 + row * 1.0;
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 4.6, h: 0.82, fill: { color: C.slate }, line: { color: t.col, pt: 1.5 } });
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 0.55, h: 0.82, fill: { color: t.col }, line: { color: t.col } });
    s.addText(t.num, { x, y, w: 0.55, h: 0.82, fontSize: 16, bold: true, color: C.navy, align: "center", valign: "middle" });
    s.addText(t.text, { x: x + 0.65, y, w: 3.85, h: 0.82, fontSize: 11, color: C.white, valign: "middle", fontFace: "Calibri" });
  });
}

// ─── SLIDE 3: Classification Table ───────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Classification of Hepatotropic Viruses");

  const rows = [
    ["Feature", "HAV", "HBV", "HCV", "HDV", "HEV"],
    ["Genome", "ssRNA", "Partial dsDNA", "ssRNA", "Circular ssRNA", "ssRNA"],
    ["Family", "Hepatovirus", "Hepadnavirus", "Flaviviridae", "Deltaviridae", "Hepeviridae"],
    ["Transmission", "Fecal-oral", "Parenteral/ sexual/ perinatal", "Parenteral", "Parenteral", "Fecal-oral"],
    ["Incubation", "2–6 wks", "2–26 wks", "4–26 wks", "Same as HBV", "4–5 wks"],
    ["Chronicity", "Never", "5–10%", ">80%", "10–100%*", "Rare†"],
    ["Carrier state", "No", "Yes", "Yes", "Depends on HBV", "No"],
    ["Vaccine", "✓ Available", "✓ Available", "✗ None", "✗ (HBV vaccine)", "✗ None"],
  ];

  const colW = [1.7, 1.35, 1.35, 1.35, 1.35, 1.35];
  const colX = [0.3];
  for (let i = 1; i < colW.length; i++) colX.push(colX[i-1] + colW[i-1]);

  rows.forEach((row, ri) => {
    const isHeader = ri === 0;
    const y = 0.92 + ri * 0.57;
    row.forEach((cell, ci) => {
      const bgColor = isHeader ? C.teal : (ri % 2 === 0 ? C.slate : C.navy);
      const txtColor = isHeader ? C.white : (ci === 0 ? C.pale_teal : C.white);
      s.addShape(pres.shapes.RECTANGLE, {
        x: colX[ci], y, w: colW[ci], h: 0.55,
        fill: { color: bgColor }, line: { color: C.navy, pt: 0.5 }
      });
      s.addText(cell, {
        x: colX[ci], y, w: colW[ci], h: 0.55,
        fontSize: isHeader ? 11 : 10, bold: isHeader || ci === 0, color: txtColor,
        align: "center", valign: "middle", fontFace: "Calibri"
      });
    });
  });

  s.addText("*10% coinfection; 90–100% superinfection   †Only in immunocompromised hosts", {
    x: 0.3, y: 5.3, w: 9.4, h: 0.2,
    fontSize: 8, color: C.lightgray, italic: true
  });
}

// ─── SLIDE 4: HAV ─────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Hepatitis A Virus (HAV)");

  // Left panel - text
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 0.92, w: 5.1, h: 4.35, fill: { color: C.slate }, line: { color: C.teal, pt: 1 } });

  const bullets = [
    [{ text: "Epidemiology & Virology", options: { bold: true, fontSize: 13, color: C.gold, breakLine: true } }],
    "Nonenveloped, positive-strand RNA picornavirus (Hepatovirus genus)",
    "Accounts for ~25% of acute hepatitis worldwide",
    "Endemic in resource-limited countries; ~2,800 cases/yr in USA (post-vaccine)",
    "Spread fecal-oral: contaminated water, food (shellfish), person-to-person",
    [{ text: "\nClinical Features", options: { bold: true, fontSize: 13, color: C.gold, breakLine: true } }],
    "Incubation 2–6 weeks; self-limited febrile illness with jaundice",
    "HAV does NOT cause chronic hepatitis; fulminant rare (<0.1%)",
    "Fecal shedding 2–3 wks before + 1 wk after jaundice onset",
    [{ text: "\nDiagnosis & Prevention", options: { bold: true, fontSize: 13, color: C.gold, breakLine: true } }],
    "IgM anti-HAV — diagnostic marker of acute infection",
    "IgG anti-HAV — appears after recovery; confers lifelong immunity",
    "Vaccine available since 1995 (>95% reduction in US cases)",
  ];

  const textArr = [];
  bullets.forEach((b, i) => {
    const isLast = i === bullets.length - 1;
    if (Array.isArray(b)) {
      textArr.push(...b);
    } else {
      textArr.push({ text: b, options: { bullet: { indent: 12 }, breakLine: !isLast, fontSize: 11, color: C.white, fontFace: "Calibri", paraSpaceAfter: 2 } });
    }
  });
  s.addText(textArr, { x: 0.45, y: 0.98, w: 4.85, h: 4.15, valign: "top" });

  // Right panel - serology image
  s.addShape(pres.shapes.RECTANGLE, { x: 5.55, y: 0.92, w: 4.15, h: 2.5, fill: { color: C.offwhite }, line: { color: C.teal, pt: 1 } });
  addImg(s, images[6], 5.6, 0.97, 4.05, 2.35, "HAV Serological Markers Over Time");

  // Key concept box
  s.addShape(pres.shapes.RECTANGLE, { x: 5.55, y: 3.55, w: 4.15, h: 1.72, fill: { color: C.navy }, line: { color: C.gold, pt: 1.5 } });
  s.addText([
    { text: "Key Pathogenesis Point\n", options: { bold: true, fontSize: 12, color: C.gold, breakLine: true } },
    { text: "HAV is NOT directly cytopathic. Hepatocellular injury is immune-mediated via cytotoxic CD8+ T cells. Viremia is transient → blood screening not required.", options: { fontSize: 11, color: C.white } }
  ], { x: 5.65, y: 3.62, w: 3.95, h: 1.58, valign: "top", fontFace: "Calibri" });
}

// ─── SLIDE 5: HBV Virology & Epidemiology ────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Hepatitis B Virus (HBV) — Virology & Epidemiology");

  // Top stats row
  const stats = [
    { val: "2 Billion", label: "Ever infected worldwide" },
    { val: "250 M", label: "Chronic carriers globally" },
    { val: "75%", label: "Carriers in Asia & Pacific" },
    { val: "5–10%", label: "Acute → Chronic (adults)" },
  ];
  stats.forEach((st, i) => {
    const x = 0.3 + i * 2.35;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y: 0.92, w: 2.2, h: 1.05, fill: { color: C.slate }, line: { color: C.teal, pt: 1 }, rectRadius: 0.08 });
    s.addText(st.val, { x, y: 0.95, w: 2.2, h: 0.55, fontSize: 20, bold: true, color: C.gold, align: "center", fontFace: "Calibri" });
    s.addText(st.label, { x, y: 1.5, w: 2.2, h: 0.42, fontSize: 10, color: C.pale_teal, align: "center", fontFace: "Calibri" });
  });

  // Left: Virology
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 2.1, w: 4.5, h: 3.18, fill: { color: C.slate }, line: { color: C.teal, pt: 1 } });
  s.addText("Virology", { x: 0.35, y: 2.15, w: 4.4, h: 0.35, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri" });
  const virItems = [
    "Partially double-stranded DNA virus — Hepadnaviridae family",
    "4 overlapping ORFs: S (surface), C (core), P (polymerase), X (regulatory)",
    "3 surface particles: Dane particle (complete virion), spherical & filamentous HBsAg",
    "HBcAg (core) — intracellular only",
    "HBeAg — soluble marker of active replication",
    "Integrates into host genome → risk of HCC even without cirrhosis",
    "Transmitted: parenteral, sexual, perinatal (vertical in endemic areas)",
  ];
  s.addText(virItems.map((t, i) => ({
    text: t, options: { bullet: { indent: 12 }, breakLine: i < virItems.length - 1, fontSize: 11, color: C.white, fontFace: "Calibri", paraSpaceAfter: 3 }
  })), { x: 0.45, y: 2.55, w: 4.25, h: 2.65, valign: "top" });

  // Right: Outcomes spectrum
  s.addShape(pres.shapes.RECTANGLE, { x: 4.95, y: 2.1, w: 4.75, h: 3.18, fill: { color: C.slate }, line: { color: C.gold, pt: 1 } });
  s.addText("Clinical Outcomes of HBV Infection", { x: 5.0, y: 2.15, w: 4.65, h: 0.35, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri" });
  const outcomes = [
    ["Acute hepatitis + recovery", C.green, "Most common in immunocompetent adults"],
    ["Fulminant hepatitis", C.red, "Massive necrosis; rare but life-threatening"],
    ["Healthy carrier state", C.light_teal, "HBsAg+ with normal liver histology"],
    ["Nonprogressive chronic hepatitis", C.light_teal, "Mild inflammation, no fibrosis"],
    ["Progressive chronic hepatitis", C.red, "→ Cirrhosis → HCC"],
  ];
  outcomes.forEach((o, i) => {
    const y = 2.58 + i * 0.58;
    s.addShape(pres.shapes.RECTANGLE, { x: 5.05, y, w: 0.06, h: 0.44, fill: { color: o[1] }, line: { color: o[1] } });
    s.addText([
      { text: o[0] + "\n", options: { bold: true, fontSize: 11, color: C.white } },
      { text: o[2], options: { fontSize: 10, color: C.pale_teal } }
    ], { x: 5.18, y, w: 4.45, h: 0.48, valign: "middle", fontFace: "Calibri" });
  });
}

// ─── SLIDE 6: HBV Serology ────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Hepatitis B — Serological Markers");

  // Serology table
  const serRows = [
    ["Marker", "Significance", "Acute Inf.", "Recovery", "Chronic", "Immunity"],
    ["HBsAg", "Active infection (surface antigen)", "✓", "↓ clears", "✓ persist", "✗"],
    ["Anti-HBs", "Immunity (vaccine or recovery)", "✗", "✓ late", "✗", "✓"],
    ["HBcAg", "Core antigen — intrahepatic only", "—", "—", "—", "—"],
    ["IgM Anti-HBc", "Acute/recent infection marker", "✓", "↓", "✗/low", "✗"],
    ["IgG Anti-HBc", "Prior exposure (past or chronic)", "✓ late", "✓", "✓", "✗"],
    ["HBeAg", "Active replication, high infectivity", "✓", "↓", "Variable", "✗"],
    ["Anti-HBe", "Seroconversion — low replication", "✗", "✓", "Variable", "✗"],
    ["HBV DNA", "Active replication — gold standard", "✓ High", "↓ zero", "Variable", "✗"],
  ];

  const sColW = [1.55, 2.85, 0.95, 0.95, 0.95, 0.95];
  const sColX = [0.25]; for (let i = 1; i < sColW.length; i++) sColX.push(sColX[i-1] + sColW[i-1]);

  serRows.forEach((row, ri) => {
    const isH = ri === 0;
    const y = 0.88 + ri * 0.52;
    row.forEach((cell, ci) => {
      const bg = isH ? C.teal : (ri % 2 === 0 ? C.slate : C.navy);
      const fc = isH ? C.white : (ci <= 1 ? C.pale_teal : (cell === "✓" ? C.green : cell === "✗" ? C.red : C.white));
      s.addShape(pres.shapes.RECTANGLE, { x: sColX[ci], y, w: sColW[ci], h: 0.5, fill: { color: bg }, line: { color: C.navy, pt: 0.5 } });
      s.addText(cell, { x: sColX[ci], y, w: sColW[ci], h: 0.5, fontSize: isH ? 10 : 10, bold: isH || ci <= 1, color: fc, align: "center", valign: "middle", fontFace: "Calibri" });
    });
  });

  // Window period note
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.25, y: 5.2, w: 9.5, h: 0.28, fill: { color: C.gold }, line: { color: C.gold }, rectRadius: 0.05 });
  s.addText("⚠ Window Period: HBsAg cleared but Anti-HBs not yet detectable — IgM Anti-HBc is the ONLY positive marker during this interval", {
    x: 0.3, y: 5.2, w: 9.4, h: 0.28, fontSize: 10, bold: true, color: C.navy, align: "center", valign: "middle"
  });
}

// ─── SLIDE 7: HBV Serology Image ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "HBV — Acute vs. Chronic Serological Course");

  // Acute image left
  s.addShape(pres.shapes.RECTANGLE, { x: 0.25, y: 0.92, w: 4.65, h: 3.5, fill: { color: C.offwhite }, line: { color: C.teal, pt: 1 } });
  addImg(s, images[0], 0.3, 0.97, 4.55, 3.35, "Acute HBV — resolution & seroconversion");

  // Chronic image right
  s.addShape(pres.shapes.RECTANGLE, { x: 5.1, y: 0.92, w: 4.65, h: 3.5, fill: { color: C.offwhite }, line: { color: C.gold, pt: 1 } });
  addImg(s, images[2], 5.15, 0.97, 4.55, 3.35, "Chronic HBV — persistent HBsAg, HBV DNA");

  // Bottom comparison
  s.addShape(pres.shapes.RECTANGLE, { x: 0.25, y: 4.55, w: 9.5, h: 0.92, fill: { color: C.slate }, line: { color: C.lightgray, pt: 0.5 } });
  s.addText([
    { text: "ACUTE HBV (Recovery): ", options: { bold: true, color: C.teal, fontSize: 11 } },
    { text: "HBsAg clears within 6 months → Anti-HBs appears → IgM Anti-HBc transient   |   ", options: { color: C.white, fontSize: 11 } },
    { text: "CHRONIC HBV: ", options: { bold: true, color: C.gold, fontSize: 11 } },
    { text: "HBsAg persists >6 months → IgM Anti-HBc disappears → IgG Anti-HBc + HBsAg remain", options: { color: C.white, fontSize: 11 } }
  ], { x: 0.35, y: 4.58, w: 9.3, h: 0.86, valign: "middle", fontFace: "Calibri" });
}

// ─── SLIDE 8: HBV Treatment ───────────────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Hepatitis B — Treatment & Management");

  // Treatment indications box
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 0.92, w: 4.5, h: 2.25, fill: { color: C.slate }, line: { color: C.teal, pt: 1.5 } });
  s.addText("Treatment Indications", { x: 0.35, y: 0.96, w: 4.4, h: 0.3, fontSize: 13, bold: true, color: C.gold });
  const indications = [
    "HBV DNA >2,000 IU/mL + elevated ALT",
    "Any HBV DNA with significant fibrosis (F2+)",
    "Cirrhosis regardless of HBV DNA level",
    "HBeAg+ with high viral load",
    "Pre-immunosuppression (HBsAg+ or anti-HBc+)",
  ];
  s.addText(indications.map((t, i) => ({
    text: t, options: { bullet: { indent: 12 }, breakLine: i < indications.length - 1, fontSize: 11, color: C.white, fontFace: "Calibri", paraSpaceAfter: 3 }
  })), { x: 0.45, y: 1.3, w: 4.25, h: 1.75, valign: "top" });

  // Drugs box
  s.addShape(pres.shapes.RECTANGLE, { x: 4.95, y: 0.92, w: 4.75, h: 2.25, fill: { color: C.slate }, line: { color: C.gold, pt: 1.5 } });
  s.addText("Antiviral Agents", { x: 5.0, y: 0.96, w: 4.65, h: 0.3, fontSize: 13, bold: true, color: C.gold });
  const drugs = [
    { drug: "Tenofovir (TDF/TAF)", detail: "1st-line; high barrier to resistance; preferred" },
    { drug: "Entecavir", detail: "1st-line; high efficacy; avoid in lamivudine-resistant" },
    { drug: "Pegylated IFN-α", detail: "Finite duration (48 wks); seroconversion advantage" },
    { drug: "Lamivudine / Adefovir", detail: "Older agents; high resistance rates — not preferred" },
  ];
  drugs.forEach((d, i) => {
    const y = 1.32 + i * 0.44;
    s.addText([
      { text: d.drug + "  ", options: { bold: true, fontSize: 11, color: C.light_teal } },
      { text: d.detail, options: { fontSize: 10, color: C.white } }
    ], { x: 5.1, y, w: 4.5, h: 0.4, valign: "middle", fontFace: "Calibri" });
    if (i < drugs.length - 1) s.addShape(pres.shapes.RECTANGLE, { x: 5.1, y: y + 0.38, w: 4.5, h: 0.02, fill: { color: C.navy }, line: { color: C.navy } });
  });

  // Goals & monitoring
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 3.3, w: 9.4, h: 1.98, fill: { color: C.navy }, line: { color: C.teal, pt: 1 } });
  s.addText("Treatment Goals & Monitoring", { x: 0.4, y: 3.35, w: 9.2, h: 0.3, fontSize: 13, bold: true, color: C.gold });
  const goals = [
    "Suppress HBV DNA to undetectable — primary endpoint",
    "HBeAg seroconversion (loss of HBeAg, gain of anti-HBe) — indicates immune control",
    "HBsAg loss (functional cure) — rare but achievable; HBsAg seroconversion = complete cure",
    "Monitor: HBV DNA q3–6 months, LFTs, AFP (HCC surveillance), fibroscan/imaging",
    "Screen ALL HBsAg+ patients for HCC with ultrasound ± AFP every 6 months",
  ];
  s.addText(goals.map((t, i) => ({
    text: t, options: { bullet: { indent: 12 }, breakLine: i < goals.length - 1, fontSize: 11, color: C.white, fontFace: "Calibri", paraSpaceAfter: 2 }
  })), { x: 0.45, y: 3.68, w: 9.1, h: 1.52, valign: "top" });
}

// ─── SLIDE 9: HCV ─────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Hepatitis C Virus (HCV) — Epidemiology & Virology");

  // Left stats
  const hcvStats = [
    { val: ">170M", label: "Chronic HCV worldwide" },
    { val: ">80%", label: "Acute → Chronic" },
    { val: "95%+", label: "Cure rate with DAAs" },
    { val: "6+", label: "Genotypes (1–6)" },
  ];
  hcvStats.forEach((st, i) => {
    const x = 0.3 + i * 2.35;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y: 0.92, w: 2.2, h: 1.05, fill: { color: C.slate }, line: { color: C.gold, pt: 1.2 }, rectRadius: 0.08 });
    s.addText(st.val, { x, y: 0.94, w: 2.2, h: 0.55, fontSize: 20, bold: true, color: C.gold, align: "center", fontFace: "Calibri" });
    s.addText(st.label, { x, y: 1.5, w: 2.2, h: 0.42, fontSize: 10, color: C.pale_teal, align: "center", fontFace: "Calibri" });
  });

  // Virology panel
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 2.1, w: 4.5, h: 3.18, fill: { color: C.slate }, line: { color: C.gold, pt: 1 } });
  s.addText("Virology & Pathogenesis", { x: 0.35, y: 2.15, w: 4.4, h: 0.32, fontSize: 13, bold: true, color: C.gold });
  const virHCV = [
    "Positive-sense ssRNA flavivirus; 6 major genotypes",
    "No proofreading → hypermutation → quasispecies formation",
    "Quasispecies → immune evasion → chronicity (>80%)",
    "Replicates in ER-derived membranous webs",
    "NS3 (protease), NS5A, NS5B (RNA polymerase) — DAA targets",
    "NOT directly cytopathic — T-cell mediated injury",
    "Risk factors: IVDU, transfusion pre-1992, hemodialysis, tattoos",
    "Sexual/perinatal transmission possible but less efficient",
  ];
  s.addText(virHCV.map((t, i) => ({
    text: t, options: { bullet: { indent: 12 }, breakLine: i < virHCV.length - 1, fontSize: 11, color: C.white, fontFace: "Calibri", paraSpaceAfter: 2 }
  })), { x: 0.45, y: 2.5, w: 4.25, h: 2.65, valign: "top" });

  // Serology image
  s.addShape(pres.shapes.RECTANGLE, { x: 4.95, y: 2.1, w: 4.75, h: 3.18, fill: { color: C.offwhite }, line: { color: C.teal, pt: 1 } });
  addImg(s, images[3], 5.0, 2.15, 4.65, 2.85, "HCV serological markers — acute and chronic disease");
  s.addText("Diagnosis: Anti-HCV ELISA (screening) → HCV RNA PCR (confirmation) → Genotyping (guides therapy)", {
    x: 5.0, y: 5.05, w: 4.65, h: 0.2, fontSize: 9, color: C.slate, italic: true, align: "center"
  });
}

// ─── SLIDE 10: HCV Treatment (DAAs) ──────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Hepatitis C — Direct-Acting Antivirals (DAAs)");

  // DAA classes
  const daaClasses = [
    { cls: "NS3/4A Protease Inhibitors", suffix: "-previr", examples: "Glecaprevir, Grazoprevir, Voxilaprevir", color: C.teal },
    { cls: "NS5A Inhibitors", suffix: "-asvir", examples: "Elbasvir, Ledipasvir, Pibrentasvir, Velpatasvir", color: C.gold },
    { cls: "NS5B Nucleoside Inhibitors", suffix: "-buvir", examples: "Sofosbuvir (pangenotypic backbone)", color: C.light_teal },
  ];

  daaClasses.forEach((d, i) => {
    const y = 0.92 + i * 1.2;
    s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y, w: 5.9, h: 1.1, fill: { color: C.slate }, line: { color: d.color, pt: 1.5 } });
    s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y, w: 0.1, h: 1.1, fill: { color: d.color }, line: { color: d.color } });
    s.addText([
      { text: d.cls + "\n", options: { bold: true, fontSize: 13, color: d.color, breakLine: true } },
      { text: "Suffix: " + d.suffix + "   |   ", options: { fontSize: 10, color: C.lightgray, italic: true } },
      { text: d.examples, options: { fontSize: 11, color: C.white } }
    ], { x: 0.5, y: y + 0.05, w: 5.6, h: 1.0, valign: "middle", fontFace: "Calibri" });
  });

  // First-line regimens box
  s.addShape(pres.shapes.RECTANGLE, { x: 6.35, y: 0.92, w: 3.35, h: 3.65, fill: { color: C.navy }, line: { color: C.gold, pt: 1.5 } });
  s.addText("Preferred Regimens", { x: 6.4, y: 0.97, w: 3.25, h: 0.32, fontSize: 13, bold: true, color: C.gold, align: "center" });
  const regimens = [
    { name: "Sofosbuvir/Velpatasvir", detail: "Pangenotypic (G1–6); 12 wks" },
    { name: "Glecaprevir/Pibrentasvir", detail: "Pangenotypic; 8 wks (no cirrhosis)" },
    { name: "Ledipasvir/Sofosbuvir", detail: "Genotype 1, 4, 5, 6; 8–12 wks" },
    { name: "Elbasvir/Grazoprevir", detail: "Genotype 1, 4; 12 wks" },
  ];
  regimens.forEach((r, i) => {
    const y = 1.38 + i * 0.8;
    s.addShape(pres.shapes.RECTANGLE, { x: 6.45, y, w: 3.15, h: 0.72, fill: { color: C.slate }, line: { color: C.teal, pt: 0.5 } });
    s.addText([
      { text: r.name + "\n", options: { bold: true, fontSize: 11, color: C.light_teal, breakLine: true } },
      { text: r.detail, options: { fontSize: 10, color: C.white } }
    ], { x: 6.5, y: y + 0.05, w: 3.05, h: 0.62, valign: "middle", fontFace: "Calibri" });
  });

  // SVR info
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 4.68, w: 9.4, h: 0.72, fill: { color: C.teal }, line: { color: C.teal } });
  s.addText([
    { text: "SVR12 (Sustained Virologic Response at 12 weeks post-treatment) = CURE   ", options: { bold: true, fontSize: 13, color: C.white } },
    { text: "Achieved in >95% of patients with current DAA regimens regardless of genotype", options: { fontSize: 12, color: C.offwhite } }
  ], { x: 0.4, y: 4.72, w: 9.2, h: 0.62, valign: "middle", fontFace: "Calibri", align: "center" });
}

// ─── SLIDE 11: HDV & HEV ─────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Hepatitis D & E — Special Considerations");

  // HDV panel
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 0.92, w: 4.5, h: 4.35, fill: { color: C.slate }, line: { color: C.teal, pt: 1.5 } });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 0.92, w: 4.5, h: 0.4, fill: { color: C.teal }, line: { color: C.teal } });
  s.addText("Hepatitis D Virus (HDV) — Delta Agent", { x: 0.35, y: 0.92, w: 4.4, h: 0.4, fontSize: 13, bold: true, color: C.white, valign: "middle" });

  const hdvItems = [
    "Defective RNA virus — REQUIRES HBV (HBsAg) for envelope",
    "Prevents HDV with HBV vaccination",
    "~15 million infected worldwide (5% of HBV carriers)",
    "Endemic: Amazon basin, Africa, Middle East, S. Italy",
    "",
    "Coinfection (HDV + HBV simultaneously):",
    "  → Usually self-limited, similar to acute HBV",
    "  → Higher risk of fulminant hepatitis (in IVDU)",
    "",
    "Superinfection (HDV infects chronic HBV carrier):",
    "  → Chronic HDV in >80% of cases",
    "  → Rapid progression to cirrhosis",
    "  → Higher HCC risk",
    "",
    "Treatment: Pegylated interferon-α (limited efficacy)",
    "Bulevirtide — novel entry inhibitor (EU approved 2020)",
  ];
  s.addText(hdvItems.map((t, i) => ({
    text: t, options: {
      bullet: t && !t.startsWith("  ") && !t.startsWith("Co") && !t.startsWith("Su") && !t.startsWith("Tr") && !t.startsWith("Bu") ? false : (t ? { indent: 12 } : false),
      breakLine: i < hdvItems.length - 1, fontSize: 10.5, color: t.startsWith("  ") ? C.pale_teal : C.white, fontFace: "Calibri", paraSpaceAfter: 1
    }
  })), { x: 0.42, y: 1.38, w: 4.28, h: 3.75, valign: "top" });

  // HEV panel
  s.addShape(pres.shapes.RECTANGLE, { x: 4.95, y: 0.92, w: 4.75, h: 4.35, fill: { color: C.slate }, line: { color: C.gold, pt: 1.5 } });
  s.addShape(pres.shapes.RECTANGLE, { x: 4.95, y: 0.92, w: 4.75, h: 0.4, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText("Hepatitis E Virus (HEV)", { x: 5.0, y: 0.92, w: 4.65, h: 0.4, fontSize: 13, bold: true, color: C.navy, valign: "middle" });

  const hevItems = [
    "ssRNA, Hepeviridae; 4 main genotypes (1–4)",
    "Genotypes 1 & 2: human-only, epidemic in Asia/Africa",
    "Genotypes 3 & 4: zoonotic (pigs, deer); sporadic in developed countries",
    "Transmission: fecal-oral, waterborne (large epidemics in South Asia)",
    "Self-limited in immunocompetent individuals",
    "Does NOT cause chronic hepatitis (except in immunocompromised)",
    "",
    "⚠ Pregnant women (HEV G1):",
    "  → Fulminant hepatic failure in 20% of cases in 3rd trimester",
    "  → Maternal mortality 15–25%",
    "  → Vertical transmission risk",
    "",
    "Diagnosis: IgM/IgG anti-HEV; HEV RNA (PCR)",
    "Treatment: Supportive; Ribavirin for immunocompromised",
    "Vaccine (HEV 239) approved in China; not globally available",
  ];
  s.addText(hevItems.map((t, i) => ({
    text: t, options: {
      bullet: t ? { indent: 12 } : false,
      breakLine: i < hevItems.length - 1, fontSize: 10.5, color: t.startsWith("  ") ? C.pale_teal : (t.startsWith("⚠") ? C.gold : C.white), fontFace: "Calibri", paraSpaceAfter: 1
    }
  })), { x: 5.05, y: 1.38, w: 4.55, h: 3.75, valign: "top" });
}

// ─── SLIDE 12: Acute Hepatitis — Pathology ────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Acute Viral Hepatitis — Pathology & Clinical Presentation");

  // Left: pathological features
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 0.92, w: 4.5, h: 4.35, fill: { color: C.slate }, line: { color: C.teal, pt: 1 } });
  s.addText("Histopathological Features", { x: 0.35, y: 0.97, w: 4.4, h: 0.32, fontSize: 13, bold: true, color: C.gold });

  const histoItems = [
    { heading: "Hepatocyte Injury:", bullets: ["Ballooning degeneration", "Acidophil bodies (Councilman bodies) — apoptotic hepatocytes", "Spotty (focal) hepatocyte necrosis"] },
    { heading: "Inflammation:", bullets: ["Portal tract expansion with mononuclear infiltrate", "Lobular disarray — loss of normal plate architecture", "Kupffer cell hypertrophy and hyperplasia"] },
    { heading: "Cholestasis (variable):", bullets: ["Bile plugs in canaliculi", "Bilirubin in hepatocytes"] },
    { heading: "Fulminant:", bullets: ["Massive or submassive hepatic necrosis", "Panacinar necrosis with collapse of reticulin framework"] },
  ];

  let yOff = 1.38;
  histoItems.forEach(item => {
    s.addText(item.heading, { x: 0.42, y: yOff, w: 4.28, h: 0.25, fontSize: 11, bold: true, color: C.light_teal, fontFace: "Calibri" });
    yOff += 0.26;
    item.bullets.forEach(b => {
      s.addText("• " + b, { x: 0.55, y: yOff, w: 4.1, h: 0.22, fontSize: 10.5, color: C.white, fontFace: "Calibri" });
      yOff += 0.22;
    });
    yOff += 0.08;
  });

  // Right: clinical presentation
  s.addShape(pres.shapes.RECTANGLE, { x: 4.95, y: 0.92, w: 4.75, h: 4.35, fill: { color: C.slate }, line: { color: C.gold, pt: 1 } });
  s.addText("Clinical Presentation", { x: 5.0, y: 0.97, w: 4.65, h: 0.32, fontSize: 13, bold: true, color: C.gold });

  const phases = [
    { phase: "Prodromal Phase (1–2 weeks)", sx: ["Malaise, fatigue, anorexia", "Nausea, vomiting, RUQ discomfort", "Fever, arthralgias, myalgias", "Dark urine (bilirubinuria)"] },
    { phase: "Icteric Phase (2–6 weeks)", sx: ["Jaundice + scleral icterus", "Tender hepatomegaly", "Pruritus (cholestasis)", "LFTs peak: ALT/AST often >1000"] },
    { phase: "Recovery Phase", sx: ["Symptoms resolve over weeks", "LFTs normalize (except HCV→chronic)", "Fatigue may persist months"] },
  ];

  let yR = 1.35;
  phases.forEach(p => {
    s.addShape(pres.shapes.RECTANGLE, { x: 5.05, y: yR, w: 0.08, h: 0.28, fill: { color: C.gold }, line: { color: C.gold } });
    s.addText(p.phase, { x: 5.2, y: yR, w: 4.4, h: 0.28, fontSize: 11, bold: true, color: C.light_teal, fontFace: "Calibri", valign: "middle" });
    yR += 0.3;
    p.sx.forEach(sx => {
      s.addText("• " + sx, { x: 5.2, y: yR, w: 4.4, h: 0.22, fontSize: 10.5, color: C.white, fontFace: "Calibri" });
      yR += 0.22;
    });
    yR += 0.15;
  });

  // Lab values box
  s.addShape(pres.shapes.RECTANGLE, { x: 4.95, y: 4.45, w: 4.75, h: 0.82, fill: { color: C.navy }, line: { color: C.red, pt: 1.5 } });
  s.addText([
    { text: "⚠ Alarm Features → Fulminant Hepatic Failure:\n", options: { bold: true, fontSize: 11, color: C.red, breakLine: true } },
    { text: "PT/INR >1.5  |  Encephalopathy  |  Rapidly shrinking liver  |  Hypoglycemia  |  Ascites", options: { fontSize: 10.5, color: C.white } }
  ], { x: 5.05, y: 4.5, w: 4.55, h: 0.72, valign: "middle", fontFace: "Calibri" });
}

// ─── SLIDE 13: Chronic Hepatitis Progression ──────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Chronic Hepatitis — Progression & Staging");

  // METAVIR scheme
  s.addText("METAVIR Fibrosis Staging (Liver Biopsy)", {
    x: 0.3, y: 0.93, w: 9.4, h: 0.32, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri"
  });

  const stages = [
    { stage: "F0", label: "No Fibrosis", color: C.green, detail: "Normal portal tracts" },
    { stage: "F1", label: "Portal Fibrosis", color: "#7FBA00", detail: "Expanded portal tracts, no septa" },
    { stage: "F2", label: "Periportal", color: C.gold, detail: "Few septa / portal-portal bridging" },
    { stage: "F3", label: "Bridging Fibrosis", color: "#E67E22", detail: "Numerous septa without cirrhosis" },
    { stage: "F4", label: "Cirrhosis", color: C.red, detail: "Complete distortion + regenerative nodules" },
  ];

  stages.forEach((st, i) => {
    const x = 0.3 + i * 1.88;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y: 1.32, w: 1.75, h: 0.55, fill: { color: st.color }, line: { color: st.color }, rectRadius: 0.08 });
    s.addText(st.stage, { x, y: 1.32, w: 1.75, h: 0.55, fontSize: 22, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(st.label, { x, y: 1.9, w: 1.75, h: 0.25, fontSize: 10, bold: true, color: C.lightgray, align: "center" });
    s.addText(st.detail, { x, y: 2.18, w: 1.75, h: 0.4, fontSize: 9, color: C.pale_teal, align: "center", fontFace: "Calibri" });
    if (i < stages.length - 1) {
      s.addText("→", { x: x + 1.76, y: 1.45, w: 0.12, h: 0.3, fontSize: 16, color: C.lightgray, align: "center" });
    }
  });

  // Progression image
  s.addShape(pres.shapes.RECTANGLE, { x: 5.1, y: 2.65, w: 4.6, h: 2.6, fill: { color: C.offwhite }, line: { color: C.teal, pt: 1 } });
  addImg(s, images[4], 5.15, 2.7, 4.5, 2.4, "HCV-related HCC progression: Normal → Chronic Hepatitis → Cirrhosis → HCC");

  // Left panel complications
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 2.65, w: 4.65, h: 2.6, fill: { color: C.slate }, line: { color: C.red, pt: 1 } });
  s.addText("Complications of Cirrhosis", { x: 0.35, y: 2.7, w: 4.55, h: 0.32, fontSize: 13, bold: true, color: C.red, fontFace: "Calibri" });
  const complications = [
    "Portal hypertension → varices (esophageal/gastric)",
    "Ascites → risk of SBP (spontaneous bacterial peritonitis)",
    "Hepatic encephalopathy (↑ ammonia)",
    "Hepatorenal syndrome",
    "Coagulopathy (↓ factor synthesis)",
    "Hepatocellular carcinoma (HCC)",
    "  → HBV: HCC even WITHOUT cirrhosis possible",
    "  → HCV: requires cirrhosis in most cases",
  ];
  s.addText(complications.map((t, i) => ({
    text: t, options: { bullet: { indent: 12 }, breakLine: i < complications.length - 1, fontSize: 10.5, color: t.startsWith("  ") ? C.pale_teal : C.white, fontFace: "Calibri", paraSpaceAfter: 2 }
  })), { x: 0.42, y: 3.06, w: 4.45, h: 2.12, valign: "top" });
}

// ─── SLIDE 14: HCC Surveillance & Prevention ─────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Complications — HCC Surveillance & Prevention");

  // HCC risk factors box
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 0.92, w: 4.5, h: 2.5, fill: { color: C.slate }, line: { color: C.red, pt: 1.5 } });
  s.addText("HCC Risk Factors", { x: 0.35, y: 0.97, w: 4.4, h: 0.3, fontSize: 13, bold: true, color: C.red });
  const hccRisk = [
    "HBV: cirrhosis, HBeAg+, high HBV DNA, HBV genotype C, co-infection",
    "HCV: cirrhosis (primary risk), co-infection with HBV/HIV, alcohol",
    "HDV superinfection amplifies HCC risk",
    "Male sex, older age, alcohol, aflatoxin exposure, NAFLD",
    "HBV can cause HCC WITHOUT cirrhosis (viral DNA integration)",
  ];
  s.addText(hccRisk.map((t, i) => ({
    text: t, options: { bullet: { indent: 12 }, breakLine: i < hccRisk.length - 1, fontSize: 11, color: C.white, fontFace: "Calibri", paraSpaceAfter: 3 }
  })), { x: 0.42, y: 1.32, w: 4.3, h: 1.98, valign: "top" });

  // Surveillance box
  s.addShape(pres.shapes.RECTANGLE, { x: 4.95, y: 0.92, w: 4.75, h: 2.5, fill: { color: C.slate }, line: { color: C.gold, pt: 1.5 } });
  s.addText("HCC Surveillance Protocol", { x: 5.0, y: 0.97, w: 4.65, h: 0.3, fontSize: 13, bold: true, color: C.gold });
  const surv = [
    "Ultrasound ± AFP every 6 months for HIGH-RISK patients:",
    "  • All HBsAg+ patients (with/without cirrhosis)",
    "  • All HCV cirrhosis patients (even after SVR)",
    "  • Any hepatitis-related cirrhosis",
    "AFP >20 ng/mL or suspicious lesion → CT/MRI (LI-RADS system)",
    "Nodule >1 cm meeting LI-RADS-5 criteria = diagnose HCC",
  ];
  s.addText(surv.map((t, i) => ({
    text: t, options: { bullet: t.startsWith("  ") ? { indent: 22 } : { indent: 12 }, breakLine: i < surv.length - 1, fontSize: 11, color: t.startsWith("  ") ? C.pale_teal : C.white, fontFace: "Calibri", paraSpaceAfter: 2 }
  })), { x: 5.05, y: 1.32, w: 4.55, h: 1.98, valign: "top" });

  // Prevention section
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  s.addText("Prevention Strategies", { x: 0.4, y: 3.6, w: 9.2, h: 0.32, fontSize: 13, bold: true, color: C.gold, align: "center" });

  const preventCols = [
    { title: "HAV Vaccine", items: ["2-dose series", "Travelers to endemic areas", "MSM, IVDU, chronic liver disease"] },
    { title: "HBV Vaccine", items: ["3-dose series (0, 1, 6 months)", "Universal infant vaccination", "Healthcare workers", "Anti-HBs ≥10 mIU/mL = protected"] },
    { title: "Post-Exposure (HBV)", items: ["HBIG + HBV vaccine", "Given to unvaccinated contacts", "Needle-stick, newborns of HBsAg+"] },
    { title: "HCV Prevention", items: ["No vaccine available", "Harm reduction (IVDU programs)", "Safe injection practices", "DAA therapy prevents transmission"] },
  ];

  preventCols.forEach((col, i) => {
    const x = 0.35 + i * 2.35;
    s.addShape(pres.shapes.RECTANGLE, { x, y: 4.0, w: 2.25, h: 1.2, fill: { color: C.slate }, line: { color: C.teal, pt: 0.5 } });
    s.addText(col.title, { x, y: 4.03, w: 2.25, h: 0.28, fontSize: 11, bold: true, color: C.light_teal, align: "center" });
    s.addText(col.items.join("\n"), { x: x + 0.05, y: 4.33, w: 2.15, h: 0.85, fontSize: 9, color: C.white, fontFace: "Calibri", valign: "top" });
  });
}

// ─── SLIDE 15: Diagnostic Algorithm ──────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Diagnostic Approach to Suspected Viral Hepatitis");

  // Step boxes
  const steps = [
    { step: "1", title: "Initial Workup", items: ["LFTs (ALT, AST, ALP, GGT, bilirubin)", "PT/INR, albumin", "CBC, metabolic panel", "Hepatitis serology panel"] },
    { step: "2", title: "Serology Panel", items: ["Anti-HAV IgM (acute HAV)", "HBsAg + IgM anti-HBc (acute HBV)", "Anti-HCV ELISA (HCV screening)", "Anti-HEV IgM (if travel history)"] },
    { step: "3", title: "Confirmatory Testing", items: ["HCV RNA PCR if anti-HCV+", "HBV DNA if HBsAg+", "HCV genotype (guides therapy)", "HDV serology if HBsAg+"] },
  ];

  steps.forEach((st, i) => {
    const x = 0.3 + i * 3.2;
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    s.addText(st.step, { x: x + 0.1, y: 0.98, w: 0.55, h: 0.55, fontSize: 18, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(st.title, { x: x + 0.75, y: 1.0, w: 2.2, h: 0.5, fontSize: 13, bold: true, color: C.gold, valign: "middle" });
    s.addText(st.items.map((t, i2) => ({
      text: t, options: { bullet: { indent: 12 }, breakLine: i2 < st.items.length - 1, fontSize: 11, color: C.white, fontFace: "Calibri", paraSpaceAfter: 3 }
    })), { x: x + 0.15, y: 1.6, w: 2.8, h: 1.96, valign: "top" });
    if (i < steps.length - 1) s.addText("→", { x: x + 3.06, y: 1.5, w: 0.18, h: 0.5, fontSize: 22, color: C.teal, align: "center" });
  });

  // Acute hepatitis panel info
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 3.88, w: 9.4, h: 0.6, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText("ACUTE HEPATITIS PANEL (CPT 80074): IgM Anti-HAV  +  IgM Anti-HBc  +  HBsAg  +  Anti-HCV", {
    x: 0.35, y: 3.91, w: 9.3, h: 0.55, fontSize: 12, bold: true, color: C.navy, align: "center", valign: "middle"
  });

  // Clinical clues
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  const clues = [
    { label: "HAV", hint: "Recent travel / shellfish / daycare cluster → fecal-oral" },
    { label: "HBV", hint: "IVDU, MSM, healthcare worker, neonatal exposure" },
    { label: "HCV", hint: "IVDU (major), pre-1992 transfusion, hemodialysis" },
    { label: "HEV", hint: "Pregnancy + fulminant hepatitis + travel to South Asia" },
  ];
  clues.forEach((c, i) => {
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    s.addText([
      { text: c.label + ": ", options: { bold: true, color: C.gold, fontSize: 10 } },
      { text: c.hint, options: { color: C.white, fontSize: 10 } }
    ], { x, y: 4.58, w: 2.3, h: 0.76, valign: "middle", fontFace: "Calibri" });
  });
}

// ─── SLIDE 16: Extrahepatic Manifestations ────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Extrahepatic Manifestations of Viral Hepatitis");

  const conditions = [
    { virus: "HBV", manifestations: ["Polyarteritis nodosa (PAN)", "Membranous nephropathy (HBsAg deposits)", "Mixed cryoglobulinemia (rare)", "Aplastic anemia (rare)", "Serum sickness-like (prodrome)"], color: C.teal },
    { virus: "HCV", manifestations: ["Mixed cryoglobulinemia (vasculitis)", "Membranoproliferative GN (MPGN)", "Porphyria cutanea tarda", "Lichen planus", "B-cell non-Hodgkin lymphoma", "Sjögren's-like syndrome", "Thyroid disorders"], color: C.gold },
    { virus: "HAV/HEV", manifestations: ["Cholestatic jaundice (prolonged)", "Relapsing hepatitis (HAV)", "Acute kidney injury (HEV in pregnancy)", "Neurological manifestations (rare)"], color: C.light_teal },
  ];

  conditions.forEach((c, i) => {
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    s.addShape(pres.shapes.RECTANGLE, { x, y: 0.92, w: 3.1, h: 0.42, fill: { color: c.color }, line: { color: c.color } });
    s.addText(c.virus, { x, y: 0.92, w: 3.1, h: 0.42, fontSize: 18, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(c.manifestations.map((t, i2) => ({
      text: t, options: { bullet: { indent: 12 }, breakLine: i2 < c.manifestations.length - 1, fontSize: 12, color: C.white, fontFace: "Calibri", paraSpaceAfter: 4 }
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  });

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  s.addText("HCV has the BROADEST extrahepatic manifestations — cryoglobulinemia is the hallmark immune-complex disease of HCV", {
    x: 0.3, y: 5.3, w: 9.4, h: 0.22, fontSize: 9, color: C.lightgray, italic: true, align: "center"
  });
}

// ─── SLIDE 17: Summary ────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  navyBg(s);
  slideTitle(s, "Summary — High-Yield Points for Internal Medicine");

  const highYield = [
    { icon: "🅰", text: "HAV: Self-limited, fecal-oral, NO chronicity, NO blood screening needed. IgM anti-HAV = acute; IgG = immunity. Vaccine available.", color: C.teal },
    { icon: "🅱", text: "HBV: Partial dsDNA; 5–10% chronicity in adults. Window period → IgM anti-HBc only positive. Treat: TDF/TAF or Entecavir. HCC without cirrhosis possible.", color: C.gold },
    { icon: "🆈", text: "HCV: ssRNA flavivirus; >80% chronicity; quasispecies → immune evasion. DAAs (SOF-based) cure >95%. SVR12 = cure. Screen all adults born 1945–1965 (CDC).", color: C.light_teal },
    { icon: "🅳", text: "HDV: Defective RNA — needs HBV. Superinfection = worse prognosis. HBV vaccine prevents HDV. Bulevirtide = new treatment.", color: C.pale_teal },
    { icon: "🅴", text: "HEV: Fecal-oral zoonotic; self-limited EXCEPT in pregnancy (20% fulminant) and immunocompromised (chronic). No global vaccine.", color: C.lightgray },
    { icon: "⚡", text: "ALL hepatitis viruses: Monitor for HCC (HBsAg+ and HCV cirrhosis). Screen with US ± AFP q6 months. Cirrhosis staging = METAVIR F0–F4.", color: C.red },
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}

// ─── Write file ───────────────────────────────────────────────────────────────
const outPath = "/home/daytona/workspace/viral-hepatitis-pptx/Viral_Hepatitis_Internal_Medicine.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
  console.log("✅ Presentation saved:", outPath);
}).catch(err => {
  console.error("Error writing file:", err);
});