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

// ── Fetch images ──────────────────────────────────────────────────────────────
const imageUrls = [
  "https://cdn.orris.care/cdss_images/4cbf3e40cfeca1d676b99941ed523c302ddaa0049dbd1ed7f4f9efaae5e4e567.png", // Diagnostic flowchart
  "https://cdn.orris.care/cdss_images/3d8594fc54984e5ddfa52b10416171ab5e1f193f1af29fcf8d096368096b40d2.png", // Management flowchart
];

let imgDiag = null, imgMgmt = null;
try {
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} catch (e) {
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}

// ── Color palette ─────────────────────────────────────────────────────────────
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  red:     "C0392B",
  green:   "1E8449",
  gray:    "6B7C93",
  lightgray:"D6DCE5",
};

// ── Helpers ───────────────────────────────────────────────────────────────────
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// ═══════════════════════════════════════════════════════════════
// BUILD PRESENTATION
// ═══════════════════════════════════════════════════════════════
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Hypersensitivity Pneumonitis";
pres.author = "Pulmonology Education";

// ── SLIDE 1: Title ────────────────────────────────────────────
titleSlide(pres,
  "Hypersensitivity\nPneumonitis",
  "A Comprehensive Guide for Budding Pulmonologists  |  2026"
);

// ── SLIDE 2: Section – Overview ───────────────────────────────
sectionDivider(pres, "01  Overview & Classification", "What is HP and how do we classify it?");

// ── SLIDE 3: Definition ───────────────────────────────────────
contentSlide(pres, "What is Hypersensitivity Pneumonitis?", [
  { type: "bullet", text: "Complex inflammatory and/or fibrotic interstitial lung disease (ILD) in susceptible individuals" },
  { type: "bullet", text: "Caused by immunologically mediated reaction to inhaled organic or low-molecular-weight antigens" },
  { type: "bullet", text: "Also called Extrinsic Allergic Alveolitis (EAA)" },
  { type: "bullet", text: "Exposures: occupational, avocational, residential, or environmental settings" },
  { type: "bullet", text: "Overlap with other ILDs makes diagnosis and management challenging" },
  { type: "bullet", text: "High index of suspicion required — always consider HP in any ILD workup" },
  { type: "header", text: "KEY CONCEPT" },
  { type: "bullet", text: "HP is diagnosed by integration of clinical + radiologic + histopathologic findings in Multidisciplinary Discussion (MDD)" },
], { footnote: "Murray & Nadel's Textbook of Respiratory Medicine, Chapter 91" });

// ── SLIDE 4: Classification ───────────────────────────────────
twoColSlide(pres,
  "Current Classification: Nonfibrotic vs Fibrotic HP",
  [
    "Nonfibrotic HP (= Acute/Subacute HP)",
    "Predominantly inflammatory pattern",
    "Reversible with antigen avoidance",
    "Ground-glass opacity, centrilobular nodules on HRCT",
    "Better prognosis",
    "Responds to corticosteroids",
    "Cluster analysis shows majority of HP fits this two-cluster model",
  ],
  [
    "Fibrotic HP (= Chronic HP)",
    "Irreversible fibrosis present",
    "May mimic UIP or NSIP pattern on HRCT",
    "Higher mortality rate",
    "Antigen identification may be impossible in up to 50% of cases",
    "Can progress even after antigen removal",
    "May require antifibrotics or transplant evaluation",
  ],
  { leftTitle: "NONFIBROTIC (Inflammatory)", rightTitle: "FIBROTIC (Chronic)" }
);

// ── SLIDE 5: Section – Etiology ───────────────────────────────
sectionDivider(pres, "02  Etiology & Antigens", "Know your triggers — >200 sources implicated");

// ── SLIDE 6: Antigen Table ────────────────────────────────────
const hdrStyle = { bold: true, color: C.white, fill: { color: C.slate }, align: "center" };
tableSlide(pres,
  "Common Causes of Hypersensitivity Pneumonitis",
  [
    [
      { text: "Disease Name", options: hdrStyle },
      { text: "Source of Antigen", options: hdrStyle },
      { text: "Antigen", options: hdrStyle },
    ],
    [{ text: "Farmer's Lung" }, { text: "Moldy hay / grain (thermophilic actinomycetes)" }, { text: "Saccharopolyspora rectivirgula" }],
    [{ text: "Bird Breeder's Lung" }, { text: "Pigeons, doves, parakeets (feathers, droppings)" }, { text: "Avian proteins, IgA" }],
    [{ text: "Hot Tub Lung" }, { text: "Contaminated hot tubs / saunas" }, { text: "Mycobacterium avium complex (MAC)" }],
    [{ text: "Humidifier Lung" }, { text: "Contaminated water in humidifiers, HVAC" }, { text: "Fungi, bacteria, protozoa" }],
    [{ text: "Cheese Washer's Lung" }, { text: "Moldy cheese rinds" }, { text: "Penicillium casei" }],
    [{ text: "Metalworking Fluid HP" }, { text: "Contaminated metalworking fluids" }, { text: "MAC, fungi" }],
    [{ text: "Chemical HP" }, { text: "Auto-painting, spray foam insulation" }, { text: "Isocyanates (TDI, MDI)" }],
    [{ text: "Summer-type HP (Japan)" }, { text: "Seasonal, humid environments" }, { text: "Trichosporon species" }],
  ],
  [2.5, 4.0, 2.9],
  C.slate
);

// ── SLIDE 7: Section – Immunopathogenesis ─────────────────────
sectionDivider(pres, "03  Immunopathogenesis", "Type III and IV hypersensitivity — a dual mechanism");

// ── SLIDE 8: Pathogenesis ─────────────────────────────────────
twoColSlide(pres,
  "Immunopathogenesis: Dual Mechanism",
  [
    "Type III (Immune Complex-mediated)",
    "Inhaled antigens → serum IgG precipitins formed",
    "Antigen-antibody immune complexes deposit in alveolar walls",
    "Complement activation → acute inflammation",
    "Occurs within hours of exposure",
    "Explains acute febrile illness pattern",
  ],
  [
    "Type IV (Cell-mediated / Delayed)",
    "T-lymphocyte sensitization to inhaled antigens",
    "CD4+ and CD8+ T cells infiltrate lung",
    "BAL shows markedly elevated CD8+ (low CD4:CD8 ratio)",
    "Granuloma formation — epithelioid macrophages + giant cells",
    "Explains chronic progressive fibrotic disease",
  ],
  { leftTitle: "TYPE III — Immune Complex", rightTitle: "TYPE IV — Cell-Mediated" }
);

// ── SLIDE 9: Histopathology ───────────────────────────────────
contentSlide(pres, "Histopathology", [
  { type: "header", text: "CLASSIC TRIAD (nonfibrotic HP)" },
  { type: "bullet", text: "1.  Peribronchiolar mononuclear cell infiltrate (lymphocytes predominate)" },
  { type: "bullet", text: "2.  Poorly formed (noncohesive) noncaseating granulomas — 2/3 of cases, peribronchiolar" },
  { type: "bullet", text: "3.  Cellular bronchiolitis" },
  { type: "header", text: "GRANULOMA FEATURES" },
  { type: "bullet", text: "Epithelioid macrophages + multinucleated giant cells" },
  { type: "bullet", text: "Giant cells may contain cholesterol clefts (Schaumann bodies)" },
  { type: "bullet", text: "Bronchiolocentric distribution — key to distinguishing from sarcoid" },
  { type: "header", text: "FIBROTIC HP" },
  { type: "bullet", text: "Bilateral upper-lobe-dominant interstitial fibrosis (UIP pattern in advanced cases)" },
  { type: "bullet", text: "May overlap with NSIP or UIP — bronchiolocentric accentuation helpful clue" },
], { footnote: "Murray & Nadel's Respiratory Medicine; Robbins & Kumar Basic Pathology" });

// ── SLIDE 10: Section – Diagnosis ────────────────────────────
sectionDivider(pres, "04  Clinical Features & Diagnosis", "Recognize the syndrome, find the antigen");

// ── SLIDE 11: Clinical Features ───────────────────────────────
twoColSlide(pres,
  "Clinical Presentations",
  [
    "Nonfibrotic / Acute HP",
    "Onset 4–8 hours after antigen exposure",
    "Fever, chills, myalgia",
    "Cough and dyspnea",
    "No eosinophilia; wheeze uncommon",
    "Resolves days after antigen removal",
    "Temporal relationship to exposure is diagnostic clue",
  ],
  [
    "Fibrotic / Chronic HP",
    "Insidious onset — weeks to months",
    "Progressive dyspnea, dry cough",
    "Malaise, weight loss",
    "Bibasilar crackles on auscultation",
    "Clubbing (in ~50% of fibrotic cases)",
    "Irreversible if antigen not removed early",
    "May progress even with antigen avoidance",
  ],
  { leftTitle: "NONFIBROTIC (Acute/Subacute)", rightTitle: "FIBROTIC (Chronic)" }
);

// ── SLIDE 12: HRCT Findings ───────────────────────────────────
contentSlide(pres, "HRCT Findings", [
  { type: "header", text: "NONFIBROTIC / SUBACUTE HP" },
  { type: "bullet", text: "Centrilobular poorly-defined nodules (~5 mm) — mid/lower zones" },
  { type: "bullet", text: "Ground-glass opacity (GGO) — especially with ongoing exposure" },
  { type: "bullet", text: "Mosaic attenuation + air trapping on expiratory CT (lobular air trapping = coexisting bronchiolitis)" },
  { type: "bullet", text: "Thin-walled cysts (3–25 mm) in subacute phase" },
  { type: "header", text: "FIBROTIC / CHRONIC HP" },
  { type: "bullet", text: "Intralobular and interlobular septal thickening" },
  { type: "bullet", text: "Traction bronchiectasis, honeycombing" },
  { type: "bullet", text: "Mid-zone or upper-lobe predominance (vs lower-zone in IPF)" },
  { type: "header", text: "HP vs IPF on HRCT — Features Favoring HP" },
  { type: "bullet", text: "Upper/mid-zone predominance, GGO, centrilobular nodules, bronchocentric distribution, air trapping" },
], { footnote: "Grainger & Allison's Diagnostic Radiology; Semin Roentgenol 2026 PMID:41513513" });

// ── SLIDE 13: Diagnostic Flowchart ───────────────────────────
if (imgDiag) {
  imageSlide(pres,
    "Diagnostic Approach to HP",
    imgDiag,
    "Fig 91.2 — Approach to HP diagnosis: exposure assessment → HRCT pattern → diagnostic certainty → MDD. (Murray & Nadel's Respiratory Medicine)",
    { iy: 1.18, ih: 3.9, cy: 5.18 }
  );
} else {
  contentSlide(pres, "Diagnostic Approach to HP", [
    { type: "header", text: "STEP 1 — Exposure Assessment" },
    { type: "bullet", text: "Comprehensive occupational, residential & avocational history" },
    { type: "bullet", text: "Consider referral to occupational medicine / industrial hygienist" },
    { type: "header", text: "STEP 2 — HRCT Pattern" },
    { type: "bullet", text: "Nonfibrotic (typical HP pattern) vs fibrotic (UIP-like/NSIP-like)" },
    { type: "bullet", text: "Air trapping on expiratory HRCT is a key clue" },
    { type: "header", text: "STEP 3 — Diagnostic Certainty" },
    { type: "bullet", text: "Confident diagnosis → exposure + typical HRCT + known antigen" },
    { type: "bullet", text: "Working diagnosis → BAL ± transbronchial biopsy considered" },
    { type: "bullet", text: "Surgical lung biopsy when diagnosis remains uncertain after MDD" },
  ]);
}

// ── SLIDE 14: Diagnostic Tests ────────────────────────────────
contentSlide(pres, "Investigations in HP", [
  { type: "header", text: "PULMONARY FUNCTION TESTS" },
  { type: "bullet", text: "Predominantly restrictive pattern (reduced TLC, FVC, compliance)" },
  { type: "bullet", text: "Reduced DLCO — important marker of severity and prognosis" },
  { type: "bullet", text: "Airflow obstruction may be present in smokers / chronic forms" },
  { type: "header", text: "SEROLOGY — Serum Precipitins / Specific IgG" },
  { type: "bullet", text: "Neither sensitive nor specific — high false-positive rate in exposed, asymptomatic individuals" },
  { type: "bullet", text: "92% of bird breeder HP had positive antibodies BUT so did 87% of asymptomatic controls" },
  { type: "bullet", text: "Can wane over time with reduced exposure" },
  { type: "header", text: "BAL" },
  { type: "bullet", text: "Lymphocytosis (>30%) with low CD4:CD8 ratio (<1) — classic finding" },
  { type: "bullet", text: "Most sensitive test but not diagnostic alone" },
  { type: "header", text: "BIOPSY" },
  { type: "bullet", text: "Transbronchial biopsy may suffice for nonfibrotic HP" },
  { type: "bullet", text: "Surgical lung biopsy (VATS) for indeterminate cases" },
], { footnote: "Murray & Nadel's Respiratory Medicine, Chapter 91" });

// ── SLIDE 15: Prognostic Factors ──────────────────────────────
tableSlide(pres,
  "Prognostic Indicators of Mortality in HP",
  [
    [
      { text: "Domain", options: { bold: true, color: C.white, fill: { color: C.slate }, align: "center" } },
      { text: "Adverse Prognostic Factors", options: { bold: true, color: C.white, fill: { color: C.slate }, align: "center" } },
    ],
    [{ text: "Demographics" }, { text: "Male sex, older age" }],
    [{ text: "Physical Exam" }, { text: "Auscultatory crackles" }],
    [{ text: "Lung Function" }, { text: "Low FVC%, low DLCO%" }],
    [{ text: "HRCT" }, { text: "Increased fibrosis, honeycombing, traction bronchiectasis, mosaic attenuation, increased PA:Ao ratio" }],
    [{ text: "Histology" }, { text: "Increased fibrosis, fibroblast foci" }],
    [{ text: "Genetics" }, { text: "MUC5B rs35705950 SNP, shorter telomere length (<10th percentile)" }],
    [{ text: "Composite" }, { text: "Abnormal ILD-GAP index" }],
    [{ text: "Other" }, { text: "No identified antigen, smoking, acute exacerbation, pulmonary hypertension" }],
  ],
  [2.8, 6.6],
  C.slate
);

// ── SLIDE 16: Section – Management ───────────────────────────
sectionDivider(pres, "05  Management", "Antigen avoidance is the cornerstone of treatment");

// ── SLIDE 17: Management Overview ────────────────────────────
contentSlide(pres, "Management: Key Pillars", [
  { type: "header", text: "1.  ANTIGEN AVOIDANCE (Most Important)" },
  { type: "bullet", text: "Complete removal from exposure environment is first-line treatment" },
  { type: "bullet", text: "Even partial reduction of exposure may slow progression" },
  { type: "bullet", text: "Environmental remediation (HEPA filtration, dehumidification) where relocation is not possible" },
  { type: "bullet", text: "Occupational counselling — may require change of occupation" },
  { type: "header", text: "2.  PHARMACOLOGIC THERAPY" },
  { type: "bullet", text: "Initiated when clinically significant disease progression despite antigen avoidance" },
  { type: "bullet", text: "Systemic corticosteroids (Prednisone) — initial treatment, tapering schedule" },
  { type: "bullet", text: "Corticosteroid-sparing agents: Azathioprine (AZA), Mycophenolate mofetil (MMF)" },
  { type: "bullet", text: "Antifibrotic therapy (Nintedanib) — emerging role in fibrotic HP progression" },
  { type: "header", text: "3.  SUPPORTIVE CARE" },
  { type: "bullet", text: "Supplemental O2, pulmonary rehabilitation, smoking cessation, vaccinations" },
], { footnote: "Murray & Nadel's Respiratory Medicine, Chapter 91 | German S2k Guideline 2025 (PMID:39870058)" });

// ── SLIDE 18: Management Flowchart ───────────────────────────
if (imgMgmt) {
  imageSlide(pres,
    "Management Algorithm for HP",
    imgMgmt,
    "Fig 91.6 — HP management approach: antigen avoidance → steroid response assessment → corticosteroid-sparing / antifibrotic agents → lung transplant evaluation. (Murray & Nadel's Respiratory Medicine)",
    { iy: 1.18, ih: 3.9, cy: 5.18 }
  );
} else {
  contentSlide(pres, "Management Algorithm", [
    { type: "bullet", text: "Antigen avoidance → monitor for response at 6–12 weeks" },
    { type: "bullet", text: "Ongoing symptoms/progression → add systemic steroids" },
    { type: "bullet", text: "Steroid response? → Taper and monitor" },
    { type: "bullet", text: "No response / steroid-dependent → AZA or MMF" },
    { type: "bullet", text: "Fibrotic HP progression → consider nintedanib" },
    { type: "bullet", text: "End-stage disease → lung transplant evaluation" },
  ]);
}

// ── SLIDE 19: Lung Transplant ─────────────────────────────────
contentSlide(pres, "Advanced Disease & Lung Transplantation", [
  { type: "header", text: "WHEN TO CONSIDER TRANSPLANT EVALUATION" },
  { type: "bullet", text: "Continued disease progression despite antigen avoidance + pharmacotherapy" },
  { type: "bullet", text: "FVC <50% predicted or DLCO <40% predicted" },
  { type: "bullet", text: "Resting or exertional hypoxemia" },
  { type: "bullet", text: "6MWT distance <250 m or >50 m decline in 12 months" },
  { type: "header", text: "OUTCOMES" },
  { type: "bullet", text: "HP mortality increases with age — age-adjusted mortality rose from 0.1 → 0.7 per million (1988–2016)" },
  { type: "bullet", text: "Average annual percentage increase in mortality: 5.6%" },
  { type: "bullet", text: "Fibrotic HP: 56–68% of HP cases; prevalence 0.9–1.7 per 100,000" },
  { type: "bullet", text: "Acute exacerbations of fibrotic HP carry high mortality — early recognition essential" },
  { type: "header", text: "PREVENTION" },
  { type: "bullet", text: "Occupational health monitoring, protective equipment, engineering controls" },
  { type: "bullet", text: "Outbreak investigation when occupational cluster is identified" },
], { footnote: "Murray & Nadel's Respiratory Medicine, Chapter 91" });

// ── SLIDE 20: Section – Differentials ────────────────────────
sectionDivider(pres, "06  Differential Diagnosis", "HP mimics — don't be fooled");

// ── SLIDE 21: Differentials ───────────────────────────────────
twoColSlide(pres,
  "Differential Diagnosis",
  [
    "Idiopathic Pulmonary Fibrosis (IPF)",
    "Lower-lobe honeycomb dominant UIP",
    "No causative antigen",
    "No GGO, no air trapping",
    "MUC5B SNP association similar",
    "Sarcoidosis",
    "Well-formed granulomas (vs HP: poorly-formed)",
    "Lymphangitic distribution on HRCT",
    "Bilateral hilar adenopathy",
  ],
  [
    "NSIP (Nonspecific Interstitial Pneumonia)",
    "Bilateral symmetric GGO with basal predominance",
    "May occur in CTD — check ANA, anti-Scl70",
    "RB-ILD / DIP",
    "Smoking history key differentiator",
    "Centrilobular GGO similar to HP",
    "Acute Eosinophilic Pneumonia",
    "Peripheral eosinophilia present (unlike HP)",
    "Responds rapidly to steroids",
  ],
  { leftTitle: "KEY DIFFERENTIALS — LEFT", rightTitle: "KEY DIFFERENTIALS — RIGHT" }
);

// ── SLIDE 22: Mnemonics / Pearls ──────────────────────────────
contentSlide(pres, "Clinical Pearls for the Pulmonologist", [
  { type: "header", text: "DIAGNOSIS PEARLS" },
  { type: "bullet", text: "Always take a detailed exposure history — occupational, home, hobbies (birds, hot tubs, farming)" },
  { type: "bullet", text: "Air trapping on expiratory HRCT + GGO = HP until proven otherwise" },
  { type: "bullet", text: "BAL lymphocytosis with CD4:CD8 < 1 strongly suggests HP" },
  { type: "bullet", text: "Positive serum precipitins = exposure, NOT disease — must correlate clinically" },
  { type: "bullet", text: "In 50% of chronic HP — no antigen ever found" },
  { type: "header", text: "MANAGEMENT PEARLS" },
  { type: "bullet", text: "Antigen removal FIRST — steroids are adjunctive, not primary" },
  { type: "bullet", text: "Fibrotic HP progresses like IPF — consider antifibrotics if rapid decline" },
  { type: "bullet", text: "Refer early for lung transplant in deteriorating fibrotic HP" },
  { type: "bullet", text: "MUC5B SNP and telomere shortening = poor prognosis markers" },
  { type: "header", text: "DO NOT MISS" },
  { type: "bullet", text: "Acute exacerbation of fibrotic HP = medical emergency — high mortality" },
], { footnote: "Murray & Nadel's Respiratory Medicine; German S2k Guideline 2025; Am J Respir Crit Care Med 2025" });

// ── SLIDE 23: Key References ──────────────────────────────────
contentSlide(pres, "Key References", [
  { type: "bullet", text: "Murray & Nadel's Textbook of Respiratory Medicine, 7th Ed. — Chapter 91 (Johannson & Fernandez Perez)" },
  { type: "bullet", text: "Robbins & Kumar Basic Pathology, 11th Ed. — Chapter 11" },
  { type: "bullet", text: "Grainger & Allison's Diagnostic Radiology — Chapter 9" },
  { type: "bullet", text: "Koschel D et al. Diagnosis and Treatment of HP: S2k Guideline (German Respiratory Society). Respiration 2025. PMID: 39870058" },
  { type: "bullet", text: "Ryerson CJ et al. Outcomes of Atypical Fibrotic HP Pattern on CT. Am J Respir Crit Care Med 2025. PMID: 40505139" },
  { type: "bullet", text: "Sellers T et al. HP: Imaging Findings and Patterns. Semin Roentgenol 2026. PMID: 41513513" },
  { type: "bullet", text: "Carroll MB et al. Update on Interstitial Pneumonias. Clin Chest Med 2024. PMID: 38816097" },
  { type: "header", text: "INTERNATIONAL GUIDELINES" },
  { type: "bullet", text: "ATS/JRS/ALAT Clinical Practice Guidelines for HP Diagnosis (2020) — Raghu G et al. Am J Respir Crit Care Med" },
  { type: "bullet", text: "Fernandez Perez ER et al. Diagnosis and Evaluation of HP. CHEST Guideline 2021" },
], { footnote: "Prepared for: Pulmonology Residency Education | July 2026" });

// ── SLIDE 24: Closing ─────────────────────────────────────────
const closing = pres.addSlide();
closing.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
closing.addShape(pres.ShapeType.rect, { x: 0, y: 2.5, w: 10, h: 0.12, fill: { color: C.teal } });
closing.addShape(pres.ShapeType.ellipse, { x: -1, y: 3.5, w: 5, h: 5,
  fill: { color: C.teal, transparency: 88 }, line: { color: C.teal, transparency: 88 } });
closing.addText("Key Take-Home Message", {
  x: 1.0, y: 0.7, w: 8, h: 0.6,
  fontSize: 18, color: C.sky, fontFace: "Calibri", align: "center", bold: true, margin: 0,
});
closing.addText([
  { text: "Hypersensitivity Pneumonitis is a clinician's diagnosis.\n", options: { bold: true, color: C.white, fontSize: 22, breakLine: true } },
  { text: "Ask about the environment. Find the antigen. Remove it early.\n", options: { color: C.sky, fontSize: 17, breakLine: true } },
  { text: "When fibrosis sets in, act fast — the window is narrow.", options: { color: C.lightgray, fontSize: 15 } },
], {
  x: 0.8, y: 2.8, w: 8.4, h: 2.3,
  fontFace: "Calibri", align: "center", valign: "middle", margin: 0,
});
closing.addText("Based on Murray & Nadel's Respiratory Medicine | Robbins Pathology | Current Guidelines 2025–2026", {
  x: 0.5, y: 5.28, w: 9, h: 0.28,
  fontSize: 8, color: C.gray, fontFace: "Calibri", align: "center", margin: 0,
});

// ── WRITE FILE ────────────────────────────────────────────────
const outPath = "/home/daytona/workspace/hp-presentation/Hypersensitivity_Pneumonitis.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
  console.log("SUCCESS:", outPath);
}).catch(e => {
  console.error("ERROR:", e.message);
  process.exit(1);
});

#!/usr/bin/env python3
"""
HP Diagnosis Criteria – 1-Page Cheat Sheet
Uses ReportLab for precise, dense, colour-coded layout.
"""
from reportlab.lib.pagesizes import A4
from reportlab.lib.units import mm
from reportlab.lib import colors
from reportlab.platypus import (
    SimpleDocTemplate, Table, TableStyle, Paragraph, Spacer, HRFlowable
)
from reportlab.lib.styles import ParagraphStyle
from reportlab.lib.enums import TA_LEFT, TA_CENTER
from reportlab.pdfbase import pdfmetrics
from reportlab.pdfbase.ttfonts import TTFont

# ── Colours ───────────────────────────────────────────────────────────────────
NAVY    = colors.HexColor("#0A1628")
TEAL    = colors.HexColor("#0D7377")
SKY     = colors.HexColor("#14BDCC")
AMBER   = colors.HexColor("#E67E22")
RED     = colors.HexColor("#C0392B")
GREEN   = colors.HexColor("#1E8449")
WHITE   = colors.white
OFFWHT  = colors.HexColor("#F5F8FA")
LGRAY   = colors.HexColor("#D6DCE5")
DGRAY   = colors.HexColor("#4A5568")
SLATE   = colors.HexColor("#2D4059")
YELLOW  = colors.HexColor("#FFF3CD")
YELBORD = colors.HexColor("#F5A623")

# ── Styles ────────────────────────────────────────────────────────────────────
def S(name, **kw):
    defaults = dict(fontName="Helvetica", fontSize=7.5, leading=10,
                    textColor=NAVY, spaceAfter=0, spaceBefore=0)
    defaults.update(kw)
    return ParagraphStyle(name, **defaults)

TITLE   = S("title", fontName="Helvetica-Bold", fontSize=16, leading=20,
            textColor=WHITE, alignment=TA_CENTER, spaceAfter=0)
SHEAD   = S("shead", fontName="Helvetica-Bold", fontSize=7.8, leading=10,
            textColor=WHITE, alignment=TA_CENTER)
LABEL   = S("label", fontName="Helvetica-Bold", fontSize=7, leading=9,
            textColor=NAVY)
BODY    = S("body", fontName="Helvetica", fontSize=7, leading=9.5,
            textColor=NAVY)
BODY_WH = S("body_wh", fontName="Helvetica", fontSize=7, leading=9.5,
            textColor=WHITE)
BOLD_WH = S("bold_wh", fontName="Helvetica-Bold", fontSize=7, leading=9.5,
            textColor=WHITE)
SMALL   = S("small", fontName="Helvetica", fontSize=5.8, leading=7.5,
            textColor=DGRAY)
SMALL_C = S("small_c", fontName="Helvetica", fontSize=5.8, leading=7.5,
            textColor=DGRAY, alignment=TA_CENTER)
FOOT    = S("foot", fontName="Helvetica-Oblique", fontSize=5.5, leading=7,
            textColor=DGRAY, alignment=TA_CENTER)
ALERT   = S("alert", fontName="Helvetica-Bold", fontSize=7.2, leading=9.5,
            textColor=colors.HexColor("#7D3C00"))

# helper: cell with a Paragraph
def P(text, style=None):
    if style is None: style = BODY
    return Paragraph(text, style)

def PB(text, col=None):
    c = col or NAVY
    st = S("pb", fontName="Helvetica-Bold", fontSize=7, leading=9.5, textColor=c)
    return Paragraph(text, st)

def bullet(text, indent=0, bold_start=None):
    prefix = " " * (indent * 4) + "• "
    if bold_start:
        return P(f"{prefix}<b>{bold_start}</b> {text}")
    return P(prefix + text)

W = A4[0]  # page width = 210 mm
H = A4[1]

OUT = "/home/daytona/workspace/hp-presentation/HP_Diagnosis_Cheatsheet.pdf"

doc = SimpleDocTemplate(
    OUT,
    pagesize=A4,
    topMargin=6*mm,
    bottomMargin=5*mm,
    leftMargin=7*mm,
    rightMargin=7*mm,
)

PW = doc.width  # usable width

# ═══════════════════════════════════════════════════════════════
# HEADER ROW
# ═══════════════════════════════════════════════════════════════
header_data = [[
    P("<b><font size=15 color='#FFFFFF'>Hypersensitivity Pneumonitis</font></b> "
      "<font size=9 color='#14BDCC'> — Diagnosis Quick Reference</font>",
      S("hdr", fontName="Helvetica-Bold", fontSize=15, leading=18, textColor=WHITE)),
    P("<font color='#14BDCC'><b>ATS/JRS/ALAT 2020 · Murray &amp; Nadel 7e · S2k Guideline 2025</b></font>",
      S("hdr2", fontName="Helvetica", fontSize=7, leading=9, textColor=WHITE,
        alignment=TA_CENTER)),
    P("<font color='#AAAAAA'>Pulmonology Quick Ref | July 2026</font>",
      S("hdr3", fontName="Helvetica-Oblique", fontSize=6.5, leading=8,
        textColor=DGRAY, alignment=TA_CENTER)),
]]
header_tbl = Table(header_data, colWidths=[PW*0.55, PW*0.28, PW*0.17])
header_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), NAVY),
    ("ROWBACKGROUNDS", (0,0), (-1,-1), [NAVY]),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
    ("LEFTPADDING",  (0,0), (-1,-1), 6),
    ("RIGHTPADDING", (0,0), (-1,-1), 4),
    ("TOPPADDING",   (0,0), (-1,-1), 5),
    ("BOTTOMPADDING",(0,0), (-1,-1), 5),
]))

# ═══════════════════════════════════════════════════════════════
# SECTION HEADER helper
# ═══════════════════════════════════════════════════════════════
def sec_hdr(text, bg=TEAL, fg=WHITE, size=8):
    st = S("sh", fontName="Helvetica-Bold", fontSize=size, leading=11,
           textColor=fg, alignment=TA_CENTER)
    t = Table([[P(text, st)]], colWidths=[PW])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0),(-1,-1), bg),
        ("TOPPADDING",    (0,0),(-1,-1), 3),
        ("BOTTOMPADDING", (0,0),(-1,-1), 3),
        ("LEFTPADDING",   (0,0),(-1,-1), 4),
        ("RIGHTPADDING",  (0,0),(-1,-1), 4),
    ]))
    return t

def mini_hdr(text, bg=SLATE, w=None):
    cw = [w or PW]
    st = S("mh", fontName="Helvetica-Bold", fontSize=7, leading=9,
           textColor=WHITE, alignment=TA_CENTER)
    t = Table([[P(text, st)]], colWidths=cw)
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0),(-1,-1), bg),
        ("TOPPADDING",    (0,0),(-1,-1), 2),
        ("BOTTOMPADDING", (0,0),(-1,-1), 2),
        ("LEFTPADDING",   (0,0),(-1,-1), 4),
        ("RIGHTPADDING",  (0,0),(-1,-1), 4),
    ]))
    return t

# ─────────────────────────────────────────────────────────────────────────────
# ROW 1: Classification | Diagnostic Certainty
# ─────────────────────────────────────────────────────────────────────────────
CW1 = PW * 0.38
CW2 = PW * 0.62

classif_rows = [
    [P("<b>NONFIBROTIC HP</b> (Acute/Subacute)", S("c1", fontName="Helvetica-Bold",
       fontSize=7.5, leading=9.5, textColor=WHITE)),
     P("<b>FIBROTIC HP</b> (Chronic)", S("c2", fontName="Helvetica-Bold",
       fontSize=7.5, leading=9.5, textColor=WHITE))],
    [bullet("Acute onset 4–8 h post-exposure"),
     bullet("Insidious, progressive dyspnea/cough")],
    [bullet("Fever, chills, myalgia, cough"),
     bullet("Velcro crackles ± clubbing (~50%)")],
    [bullet("Resolves with antigen removal"),
     bullet("May progress despite removal")],
    [bullet("HRCT: GGO + centrilobular nodules + air trapping"),
     bullet("HRCT: Fibrosis, traction bronchiectasis, honeycombing")],
    [bullet("BAL: lymphocytosis >50% typical"),
     bullet("BAL: lymphocytosis less prominent (often 20–40%)")],
    [bullet("Histology: poorly-formed granulomas + bronchiolitis"),
     bullet("Histology: fibrosis ± granulomas; may mimic UIP/NSIP")],
]
classif_tbl = Table(classif_rows, colWidths=[PW/2, PW/2])
classif_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), TEAL),
    ("BACKGROUND", (1,0),(1,0), SLATE),
    ("BACKGROUND", (0,1),(-1,-1), OFFWHT),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [OFFWHT, WHITE]),
    ("GRID",       (0,0),(-1,-1), 0.3, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
]))

# ─────────────────────────────────────────────────────────────────────────────
# ROW 2: Diagnostic Certainty (ATS 2020 framework)
# ─────────────────────────────────────────────────────────────────────────────
cert_data = [
    [P("<b>CONFIDENT DIAGNOSIS</b>", S("cd", fontName="Helvetica-Bold", fontSize=7,
       textColor=GREEN)),
     P("<b>WORKING DIAGNOSIS</b>", S("wd", fontName="Helvetica-Bold", fontSize=7,
       textColor=AMBER)),
     P("<b>UNLIKELY HP</b>", S("ud", fontName="Helvetica-Bold", fontSize=7,
       textColor=RED))],
    [P("✓ Known antigen exposure<br/>"
       "✓ Typical HRCT for HP<br/>"
       "✓ Consistent exposure history<br/>"
       "→ <i>MDD can diagnose without biopsy</i>", BODY),
     P("✓ Suspected but unconfirmed antigen<br/>"
       "✓ Atypical HRCT features<br/>"
       "→ <i>BAL / TBBx / SLB may be needed</i><br/>"
       "→ <i>MDD review required</i>", BODY),
     P("✗ No antigen identified<br/>"
       "✗ HRCT strongly favours alternative<br/>"
       "✗ Histology inconsistent<br/>"
       "→ <i>Reconsider alternative ILD</i>", BODY)],
]
cert_tbl = Table(cert_data, colWidths=[PW/3, PW/3, PW/3])
cert_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), colors.HexColor("#D5F5E3")),
    ("BACKGROUND", (1,0),(1,0), colors.HexColor("#FEF9E7")),
    ("BACKGROUND", (2,0),(2,0), colors.HexColor("#FADBD8")),
    ("BACKGROUND", (0,1),(0,1), colors.HexColor("#EAFAF1")),
    ("BACKGROUND", (1,1),(1,1), colors.HexColor("#FDFEFE")),
    ("BACKGROUND", (2,1),(2,1), colors.HexColor("#FDEDEC")),
    ("GRID",       (0,0),(-1,-1), 0.4, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 5),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 3),
    ("BOTTOMPADDING",(0,0),(-1,-1), 3),
]))

# ─────────────────────────────────────────────────────────────────────────────
# ROW 3: HRCT criteria | BAL | Histology  (3 columns)
# ─────────────────────────────────────────────────────────────────────────────
C3 = PW / 3

hrct_rows = [
    [P("<b>NONFIBROTIC HRCT</b>", S("h1", fontName="Helvetica-Bold", fontSize=7,
       textColor=TEAL)), P("<b>FIBROTIC HRCT</b>", S("h2", fontName="Helvetica-Bold",
       fontSize=7, textColor=SLATE))],
    [bullet("Centrilobular nodules (≤5 mm, GGO halo)"),
     bullet("Reticulation + traction bronchiectasis")],
    [bullet("Diffuse GGO — bilateral, mid-lower zones"),
     bullet("Honeycombing (HP vs UIP overlap)")],
    [bullet("Mosaic attenuation (lobular)"),
     bullet("Mid/upper zone predominance (vs IPF: lower)")],
    [bullet("Air trapping on expiratory CT ← KEY"),
     bullet("Coexisting GGO + air trapping = strong clue")],
    [bullet('"Headcheese sign": mixed GGO + mosaic'),
     bullet("Increased PA:Ao ratio if PH present")],
    [P("<i>Typical HP HRCT = GGO + centrilobular nodules + air trapping</i>",
       S("tip", fontName="Helvetica-Oblique", fontSize=6.5, textColor=TEAL)),
     P("<i>Upper/mid-zone + GGO + air trapping favours HP over IPF</i>",
       S("tip2", fontName="Helvetica-Oblique", fontSize=6.5, textColor=SLATE))],
]
hrct_tbl = Table(hrct_rows, colWidths=[C3, C3])
hrct_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), colors.HexColor("#E8F8F5")),
    ("BACKGROUND", (1,0),(1,0), colors.HexColor("#EBF5FB")),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [colors.HexColor("#F5FFFD"), WHITE]),
    ("GRID",       (0,0),(-1,-1), 0.3, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
]))

bal_rows = [
    [P("<b>BAL FINDINGS</b>", S("bh", fontName="Helvetica-Bold", fontSize=7,
       textColor=TEAL))],
    [bullet("Lymphocytosis >20% supports HP")],
    [bullet(">50% lymphocytes: highly suggestive")],
    [bullet("CD4:CD8 ratio <1 (reversed) — classic")],
    [bullet("Fibrotic HP: lymphocyte % lower (median ~24%)")],
    [bullet("BAL lymphocytosis also in: COP, NSIP, sarcoid")],
    [bullet("Normal BAL does NOT exclude HP")],
    [P("<i>Optimal threshold >20%; Sn 68%, Sp 65%</i>",
       S("t", fontName="Helvetica-Oblique", fontSize=6.5, textColor=TEAL))],
]
bal_tbl = Table(bal_rows, colWidths=[C3])
bal_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), colors.HexColor("#E8F8F5")),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [colors.HexColor("#F5FFFD"), WHITE]),
    ("GRID",       (0,0),(-1,-1), 0.3, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
]))

histo_rows = [
    [P("<b>HISTOPATHOLOGY</b>", S("hh", fontName="Helvetica-Bold", fontSize=7,
       textColor=TEAL))],
    [bullet("Bronchiolocentric mononuclear infiltrate")],
    [bullet("Poorly-formed noncaseating granulomas (2/3 cases)")],
    [bullet("Lymphocytic bronchiolitis")],
    [bullet("Giant cells: cholesterol clefts, Schaumann bodies")],
    [bullet("Fibrotic HP: UIP or NSIP-like pattern")],
    [bullet("Bronchiolocentric fibrosis = key HP clue vs IPF")],
    [P("<i>SLB required if MDD indeterminate after BAL</i>",
       S("t2", fontName="Helvetica-Oblique", fontSize=6.5, textColor=TEAL))],
]
histo_tbl = Table(histo_rows, colWidths=[C3])
histo_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), colors.HexColor("#E8F8F5")),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [colors.HexColor("#F5FFFD"), WHITE]),
    ("GRID",       (0,0),(-1,-1), 0.3, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
]))

# combine BAL + histo side by side with HRCT
row3_data = [[hrct_tbl, bal_tbl, histo_tbl]]
row3_tbl = Table(row3_data, colWidths=[C3, C3, C3])
row3_tbl.setStyle(TableStyle([
    ("VALIGN", (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 0),
    ("RIGHTPADDING", (0,0),(-1,-1), 0),
    ("TOPPADDING",   (0,0),(-1,-1), 0),
    ("BOTTOMPADDING",(0,0),(-1,-1), 0),
]))

# ─────────────────────────────────────────────────────────────────────────────
# ROW 4: Exposure Assessment | Serology | Investigations
# ─────────────────────────────────────────────────────────────────────────────
C4a = PW * 0.38
C4b = PW * 0.32
C4c = PW * 0.30

exp_rows = [
    [P("<b>ASK ABOUT (Exposure History)</b>", S("ea", fontName="Helvetica-Bold",
       fontSize=7, textColor=NAVY)), ""],
    [bullet("Birds — pigeons, parakeets, doves; down bedding"), ""],
    [bullet("Occupation — farmers, metalworkers, painters, cheese"), ""],
    [bullet("Home — mold, musty odors, water damage, humidifiers"), ""],
    [bullet("Hobbies — woodworking, spray painting, hot tubs"), ""],
    [bullet("Summer-type HP (Japan) — Trichosporon spp."), ""],
    [P("<b>⚠ No identified antigen does NOT rule out HP</b>",
       S("warn", fontName="Helvetica-Bold", fontSize=6.5,
         textColor=colors.HexColor("#7D3C00"))), ""],
    [P("<i>(50% of chronic HP: antigen never found)</i>",
       S("wi", fontName="Helvetica-Oblique", fontSize=6.5,
         textColor=colors.HexColor("#7D3C00"))), ""],
]
exp_tbl = Table(exp_rows, colWidths=[C4a, 0.1])
exp_tbl.setStyle(TableStyle([
    ("SPAN",       (0,0),(1,0)),
    ("SPAN",       (0,6),(1,6)),
    ("SPAN",       (0,7),(1,7)),
    ("BACKGROUND", (0,0),(1,0), colors.HexColor("#EBF5FB")),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [WHITE, colors.HexColor("#F8FAFC")]),
    ("GRID",       (0,0),(-1,-1), 0.3, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
]))

sero_rows = [
    [P("<b>SEROLOGY — Specific IgG</b>", S("se", fontName="Helvetica-Bold",
       fontSize=7, textColor=NAVY))],
    [bullet("Qualitative: double diffusion (precipitins)")],
    [bullet("Quantitative: ELISA (preferred)")],
    [bullet("Positive = exposure, NOT disease causation")],
    [bullet("False-positive rate very high (87% controls)")],
    [bullet("Can wane with reduced exposure")],
    [P("<b>NOT recommended as screening test</b>",
       S("ns", fontName="Helvetica-Bold", fontSize=6.5,
         textColor=RED))],
    [P("Inhalational challenge (SIC): rarely available;<br/>not routinely recommended",
       S("sic", fontName="Helvetica", fontSize=6.3, leading=8, textColor=DGRAY))],
]
sero_tbl = Table(sero_rows, colWidths=[C4b])
sero_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), colors.HexColor("#EBF5FB")),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [WHITE, colors.HexColor("#F8FAFC")]),
    ("GRID",       (0,0),(-1,-1), 0.3, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
]))

inv_rows = [
    [P("<b>PFTs / OTHER TESTS</b>", S("pf", fontName="Helvetica-Bold",
       fontSize=7, textColor=NAVY))],
    [bullet("PFTs: restrictive pattern (reduced TLC, FVC)")],
    [bullet("DLCO: reduced — correlates with severity/prognosis")],
    [bullet("Mixed obstructive-restrictive in some")],
    [bullet("Isolated low DLCO (early disease)")],
    [bullet("Exercise SpO₂: may desaturate on exertion only")],
    [bullet("Methacholine challenge: non-specific BHR possible")],
    [P("<i>Serial PFTs every 3–6 months to track progression</i>",
       S("sp", fontName="Helvetica-Oblique", fontSize=6.3, textColor=TEAL))],
]
inv_tbl = Table(inv_rows, colWidths=[C4c])
inv_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), colors.HexColor("#EBF5FB")),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [WHITE, colors.HexColor("#F8FAFC")]),
    ("GRID",       (0,0),(-1,-1), 0.3, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
]))

row4_data = [[exp_tbl, sero_tbl, inv_tbl]]
row4_tbl = Table(row4_data, colWidths=[C4a + 0.1, C4b, C4c])
row4_tbl.setStyle(TableStyle([
    ("VALIGN", (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 0),
    ("RIGHTPADDING", (0,0),(-1,-1), 0),
    ("TOPPADDING",   (0,0),(-1,-1), 0),
    ("BOTTOMPADDING",(0,0),(-1,-1), 0),
]))

# ─────────────────────────────────────────────────────────────────────────────
# ROW 5: Differential Diagnosis | Prognosis red flags | Pearls
# ─────────────────────────────────────────────────────────────────────────────
C5a = PW * 0.36
C5b = PW * 0.32
C5c = PW * 0.32

diff_rows = [
    [P("<b>DIFFERENTIAL DIAGNOSIS</b>", S("dd", fontName="Helvetica-Bold",
       fontSize=7, textColor=NAVY)), ""],
    [P("<b>IPF/UIP</b> — lower zone honeycombing, no GGO, no air trapping, older male", BODY), ""],
    [P("<b>Sarcoidosis</b> — well-formed granulomas, bilat hilar LAD, lymphangitic distribution", BODY), ""],
    [P("<b>NSIP</b> — bilateral subpleural GGO, CTD association (check ANA/anti-Scl70)", BODY), ""],
    [P("<b>COP</b> — BAL lymphocytosis similar; consolidation pattern on CT", BODY), ""],
    [P("<b>RB-ILD/DIP</b> — smoking history; centrilobular GGO overlaps with HP", BODY), ""],
    [P("<b>Eosinophilic pneumonia</b> — eosinophilia present; prompt steroid response", BODY), ""],
]
diff_tbl = Table(diff_rows, colWidths=[C5a, 0.1])
diff_tbl.setStyle(TableStyle([
    ("SPAN",       (0,0),(1,0)),
    ("BACKGROUND", (0,0),(1,0), colors.HexColor("#FDFEFE")),
    ("BACKGROUND", (0,1),(-1,1), colors.HexColor("#FDEDEC")),
    ("BACKGROUND", (0,2),(-1,2), colors.HexColor("#FEF9E7")),
    ("BACKGROUND", (0,3),(-1,3), colors.HexColor("#EBF5FB")),
    ("BACKGROUND", (0,4),(-1,4), colors.HexColor("#F0FFF4")),
    ("BACKGROUND", (0,5),(-1,5), colors.HexColor("#F5EEF8")),
    ("BACKGROUND", (0,6),(-1,6), colors.HexColor("#FFF9F0")),
    ("GRID",       (0,0),(-1,-1), 0.3, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
]))

prog_rows = [
    [P("<b>POOR PROGNOSIS FLAGS ⚠</b>", S("pp", fontName="Helvetica-Bold",
       fontSize=7, textColor=RED))],
    [bullet("Male sex, older age")],
    [bullet("Low FVC% or DLCO% at baseline")],
    [bullet("Honeycombing / traction bronchiectasis on HRCT")],
    [bullet("Pulmonary hypertension (PA:Ao ratio ↑)")],
    [bullet("Fibroblast foci on histology")],
    [bullet("MUC5B rs35705950 SNP / telomere shortening")],
    [bullet("No identified antigen; active smoking")],
    [bullet("Acute exacerbation — VERY high mortality")],
]
prog_tbl = Table(prog_rows, colWidths=[C5b])
prog_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), colors.HexColor("#FADBD8")),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [colors.HexColor("#FEF0EE"), WHITE]),
    ("GRID",       (0,0),(-1,-1), 0.3, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
]))

pearl_rows = [
    [P("<b>CLINICAL PEARLS ★</b>", S("cp", fontName="Helvetica-Bold",
       fontSize=7, textColor=colors.HexColor("#7D6608")))],
    [P("Temporal exposure-symptom link = biggest clue", BODY)],
    [P("Air trapping on expiratory CT = classic HP sign", BODY)],
    [P("CD4:CD8 &lt;1 on BAL — reversed ratio typical", BODY)],
    [P("Precipitins = exposure, not disease. Don't over-interpret.", BODY)],
    [P("Normal BAL/CXR does NOT exclude HP", BODY)],
    [P("Fibrotic HP: manage like IPF if rapid decline", BODY)],
    [P("Refer for transplant: FVC &lt;50% or DLCO &lt;40%", BODY)],
    [P("Acute exacerbation = emergency. Act fast.", 
       S("ae", fontName="Helvetica-Bold", fontSize=6.8, textColor=RED))],
]
pearl_tbl = Table(pearl_rows, colWidths=[C5c])
pearl_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), colors.HexColor("#FEF9E7")),
    ("ROWBACKGROUNDS", (0,1),(-1,-1), [colors.HexColor("#FEFDF5"), WHITE]),
    ("GRID",       (0,0),(-1,-1), 0.3, LGRAY),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
]))

row5_data = [[diff_tbl, prog_tbl, pearl_tbl]]
row5_tbl = Table(row5_data, colWidths=[C5a + 0.1, C5b, C5c])
row5_tbl.setStyle(TableStyle([
    ("VALIGN", (0,0),(-1,-1), "TOP"),
    ("LEFTPADDING",  (0,0),(-1,-1), 0),
    ("RIGHTPADDING", (0,0),(-1,-1), 0),
    ("TOPPADDING",   (0,0),(-1,-1), 0),
    ("BOTTOMPADDING",(0,0),(-1,-1), 0),
]))

# ─────────────────────────────────────────────────────────────────────────────
# FOOTER
# ─────────────────────────────────────────────────────────────────────────────
footer = Table(
    [[P("Sources: Murray &amp; Nadel's Textbook of Respiratory Medicine 7e (Ch.91) · "
        "Robbins &amp; Kumar Basic Pathology · Grainger &amp; Allison's Diagnostic Radiology · "
        "ATS/JRS/ALAT HP Guideline 2020 (Am J Respir Crit Care Med) · "
        "S2k Guideline German Respiratory Society 2025 (PMID:39870058) · "
        "Semin Roentgenol 2026 (PMID:41513513)",
        FOOT)]],
    colWidths=[PW]
)
footer.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(-1,-1), NAVY),
    ("TOPPADDING",    (0,0),(-1,-1), 3),
    ("BOTTOMPADDING", (0,0),(-1,-1), 3),
    ("LEFTPADDING",   (0,0),(-1,-1), 6),
    ("RIGHTPADDING",  (0,0),(-1,-1), 6),
]))

# ─────────────────────────────────────────────────────────────────────────────
# ASSEMBLE
# ─────────────────────────────────────────────────────────────────────────────
SP = lambda h: Spacer(1, h*mm)

story = [
    header_tbl,
    SP(0.8),
    sec_hdr("CLASSIFICATION"),
    classif_tbl,
    SP(0.8),
    sec_hdr("DIAGNOSTIC CERTAINTY (ATS/JRS/ALAT 2020 Framework)"),
    cert_tbl,
    SP(0.8),
    sec_hdr("HRCT CRITERIA                    BAL ANALYSIS                    HISTOPATHOLOGY"),
    row3_tbl,
    SP(0.8),
    sec_hdr("EXPOSURE HISTORY                                                  SEROLOGY                    PFTs"),
    row4_tbl,
    SP(0.8),
    sec_hdr("DIFFERENTIAL DIAGNOSIS                    POOR PROGNOSIS FLAGS                    CLINICAL PEARLS"),
    row5_tbl,
    SP(0.8),
    footer,
]

doc.build(story)
print(f"PDF created: {OUT}")

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

// ── Fetch textbook images ────────────────────────────────────────────────────
const imageUrls = [
  "https://cdn.orris.care/cdss_images/4cbf3e40cfeca1d676b99941ed523c302ddaa0049dbd1ed7f4f9efaae5e4e567.png", // Dx flowchart
  "https://cdn.orris.care/cdss_images/3d8594fc54984e5ddfa52b10416171ab5e1f193f1af29fcf8d096368096b40d2.png", // Mgmt flowchart
];
let imgDiag = null, imgMgmt = null;
try {
  const r = JSON.parse(execSync(`node /home/daytona/skills/shared/scripts/fetch_images.js "${imageUrls[0]}" "${imageUrls[1]}"`, { timeout: 30000 }).toString());
  if (r[0] && !r[0].error) imgDiag = r[0].base64;
  if (r[1] && !r[1].error) imgMgmt = r[1].base64;
} catch(e) { console.warn("Image fetch:", e.message); }

// ── Palette ──────────────────────────────────────────────────────────────────
const C = {
  midnight: "0D0D2B",   // dominant dark (richer than navy)
  indigo:   "1A1A6C",
  teal:     "0D9488",
  sky:      "22D3EE",
  lime:     "A3E635",
  amber:    "F59E0B",
  red:      "EF4444",
  green:    "22C55E",
  white:    "FFFFFF",
  offwht:   "F1F5F9",
  slate:    "334155",
  lgray:    "CBD5E1",
  dgray:    "64748B",
  gold:     "EAB308",
  purple:   "7C3AED",
};

// ── Helpers ──────────────────────────────────────────────────────────────────
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title  = "Hypersensitivity Pneumonitis: Senior Pulmonologist Update 2026";
pres.author = "Pulmonology Advanced Education";

// TITLE SLIDE
function titleSlide(title, subtitle, tag) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.midnight} });
  // gradient band
  s.addShape(pres.ShapeType.rect, { x:0,y:3.8,w:10,h:0.22, fill:{color:C.teal} });
  s.addShape(pres.ShapeType.rect, { x:0,y:4.02,w:10,h:0.06, fill:{color:C.sky} });
  // decorative circles
  s.addShape(pres.ShapeType.ellipse, { x:7.5,y:-1.5,w:5,h:5, fill:{color:C.teal, transparency:85}, line:{color:C.teal,transparency:85} });
  s.addShape(pres.ShapeType.ellipse, { x:8.5,y:2.5,w:3,h:3,  fill:{color:C.purple, transparency:88}, line:{color:C.purple,transparency:88} });
  s.addText(title, { x:0.55,y:0.8,w:8.5,h:2.2, fontSize:36,bold:true,color:C.white,fontFace:"Calibri",align:"left",valign:"middle",margin:0 });
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  if(tag){ s.addText(tag, { x:0.55,y:3.55,w:7,h:0.3, fontSize:10,color:C.amber,fontFace:"Calibri",bold:true,align:"left",margin:0 }); }
  s.addText("Murray & Nadel's Respiratory Medicine 7e  ·  Am J Respir Crit Care Med  ·  JAMA  ·  ERJ  ·  Lancet Respir Med", {
    x:0.55,y:5.28,w:9,h:0.28, fontSize:8,color:C.dgray,fontFace:"Calibri",align:"left",margin:0
  });
}

// SECTION DIVIDER
function secDiv(num, title, subtitle) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.slate} });
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  s.addShape(pres.ShapeType.ellipse, { x:6.2,y:2.0,w:5.5,h:5.5, fill:{color:C.teal,transparency:90}, line:{color:C.teal,transparency:90} });
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}

// CONTENT SLIDE – heading bar + bullets, optional evidence badge
function cSlide(heading, items, opts={}) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.offwht} });
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:1.05, fill:{color:C.midnight} });
  s.addShape(pres.ShapeType.rect, { x:0,y:1.05,w:10,h:0.07, fill:{color:C.teal} });
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  if(opts.badge){
    s.addShape(pres.ShapeType.roundRect, { x:7.8,y:0.1,w:1.9,h:0.38, fill:{color:C.teal}, rectRadius:0.04, line:{color:C.teal} });
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  // source tag
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  const flat = items.map((b,i)=>{
    if(b.type==="h"){ return [{ text:b.text, options:{bold:true,color:C.teal,fontSize:b.fs||14,breakLine:true} }]; }
    if(b.type==="sub"){ return [{ text:"    – "+b.text, options:{color:C.slate,fontSize:11,breakLine:true} }]; }
    if(b.type==="ref"){ return [{ text:"  → "+b.text, options:{color:C.purple,fontSize:10,italic:true,breakLine:true} }]; }
    if(b.type==="warn"){ return [{ text:"⚠  "+b.text, options:{color:C.red,fontSize:b.fs||12,bold:true,breakLine:true} }]; }
    if(b.type==="key"){ return [{ text:"★  "+b.text, options:{color:C.gold,fontSize:b.fs||12.5,bold:true,breakLine:true} }]; }
    return [{ text:"●  "+b.text, options:{color:C.midnight,fontSize:b.fs||12.5,bold:b.bold||false,breakLine:true} }];
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    s.addText(opts.foot, { x:0.35,y:5.3,w:9.3,h:0.28, fontSize:7.5,color:C.dgray,fontFace:"Calibri",italic:true,align:"left",margin:0 });
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}

// TWO-COL SLIDE
function twoCol(heading, leftT, left, rightT, right, opts={}) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.offwht} });
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:1.05, fill:{color:C.midnight} });
  s.addShape(pres.ShapeType.rect, { x:0,y:1.05,w:10,h:0.07, fill:{color:C.teal} });
  s.addShape(pres.ShapeType.line, { x:5.1,y:1.2,w:0,h:4.1, line:{color:C.lgray,width:1.2} });
  s.addText(heading, { x:0.35,y:0.05,w:9.4,h:0.95, fontSize:21,bold:true,color:C.white,fontFace:"Calibri",align:"left",valign:"middle",margin:0 });
  if(opts.badge){
    s.addShape(pres.ShapeType.roundRect, { x:7.8,y:0.1,w:1.9,h:0.38, fill:{color:C.teal}, rectRadius:0.04, line:{color:C.teal} });
    s.addText(opts.badge, { x:7.8,y:0.1,w:1.9,h:0.38, fontSize:7,color:C.white,fontFace:"Calibri",bold:true,align:"center",valign:"middle",margin:0 });
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    const f = arr.map(b=>{
      if(b.type==="h"){ return [{ text:b.text, options:{bold:true,color:C.teal,fontSize:b.fs||12.5,breakLine:true} }]; }
      if(b.type==="sub"){ return [{ text:"    – "+b.text, options:{color:C.slate,fontSize:10.5,breakLine:true} }]; }
      if(b.type==="ref"){ return [{ text:"→ "+b.text, options:{color:C.purple,fontSize:10,italic:true,breakLine:true} }]; }
      if(b.type==="warn"){ return [{ text:"⚠  "+b.text, options:{color:C.red,fontSize:11,bold:true,breakLine:true} }]; }
      if(b.type==="key"){ return [{ text:"★  "+b.text, options:{color:C.gold,fontSize:11.5,bold:true,breakLine:true} }]; }
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}

// IMAGE SLIDE
function imgSlide(heading, imgData, caption, iy=1.18, ih=3.9) {
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// TABLE SLIDE
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// EVIDENCE SLIDE – highlighted citation box
function evidSlide(heading, citationText, summaryItems, opts={}) {
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// CLOSING SLIDE
function closingSlide() {
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  s.addText("Where are we headed?", { x:1,y:0.5,w:8,h:0.55, fontSize:16,color:C.sky,fontFace:"Calibri",bold:true,align:"center",margin:0 });
  s.addText([
    { text:"The future of HP management lies at the intersection of\n", options:{color:C.white,fontSize:20,bold:true,breakLine:true} },
    { text:"precision immunology, genomics, and antifibrotic biology.\n", options:{color:C.sky,fontSize:17,breakLine:true} },
    { text:"Single-cell transcriptomics is redefining disease endotypes.\n", options:{color:C.lgray,fontSize:14,breakLine:true} },
    { text:"Telomere-guided immunosuppression is already changing practice.\n", options:{color:C.lgray,fontSize:14,breakLine:true} },
    { text:"The antifibrotic era has arrived — clinical trial data are accumulating fast.", options:{color:C.amber,fontSize:14,bold:true} },
  ], { x:0.8,y:2.75,w:8.4,h:2.4,fontFace:"Calibri",align:"center",valign:"middle",margin:0 });
  s.addText("Based on Murray & Nadel 7e · Am J Respir Crit Care Med 2024–2025 · Lancet Respir Med 2025 · ERJ 2023 · Expert Rev Clin Immunol 2025 · PMC Open Access 2025", {
    x:0.5,y:5.3,w:9,h:0.26, fontSize:7,color:C.dgray,fontFace:"Calibri",align:"center",margin:0
  });
}

// ═══════════════════════════════════════════════════════════════════════════
//  BUILD SLIDES
// ═══════════════════════════════════════════════════════════════════════════

// ── SLIDE 1: Title ───────────────────────────────────────────────────────────
titleSlide(
  "Hypersensitivity Pneumonitis\nAdvanced Update 2026",
  "For Senior Pulmonologists: Pathogenesis, Diagnostics & Emerging Therapies",
  "● Includes data from AJRCCM 2024 · ERJ 2023 · Expert Rev Clin Immunol 2025 · PMC Open Access 2025"
);

// ── SLIDE 2: Agenda / What's New ─────────────────────────────────────────────
cSlide("Agenda: What Has Changed in HP?", [
  { type:"h",  text:"1.  Redefined Classification — Fibrotic vs Nonfibrotic Endotypes" },
  { text:"Shift from time-based (acute/subacute/chronic) to biology-based classification" },
  { type:"h",  text:"2.  Updated Diagnostic Framework (ATS 2020 + Post-2020 Evidence)" },
  { text:"HRCT certainty model, MDD role, antigen indeterminate status outcomes" },
  { type:"h",  text:"3.  Single-Cell Immunology — Novel Disease Mechanisms Uncovered" },
  { text:"GZMhi cytotoxic T cells, SPP1hi macrophages, CCL3/CCL4 monocytes — AJRCCM 2024" },
  { type:"h",  text:"4.  Genomics & Biomarkers — Precision Medicine Era Begins" },
  { text:"Telomere length as treatment decision tool; MUC5B SNP; KL-6; SP-D" },
  { type:"h",  text:"5.  Antifibrotic Therapy — Evidence From RCTs" },
  { text:"Nintedanib in PPF (INBUILD); Pirfenidone in fibrotic HP — 2025 NMA + meta-analysis" },
  { type:"h",  text:"6.  Practical Challenges — CT Overlap, CTD Mimicry, Acute Exacerbations" },
  { text:"14% of 'typical fHP pattern' on CT eventually develop CTD — AJRCCM 2025" },
], { foot:"Sources: Murray & Nadel 7e; AJRCCM 2024–2025; ERJ 2023; Expert Rev Clin Immunol 2025; PMC 2025" });

// ── SLIDE 3: Section – New Classification ────────────────────────────────────
secDiv("01", "Updated Classification &\nDisease Endotypes", "From time-based to biology-based — why it matters clinically");

// ── SLIDE 4: Classification in Detail ────────────────────────────────────────
twoCol(
  "Nonfibrotic vs Fibrotic HP: Key Differences",
  "NONFIBROTIC HP", [
    { text:"Predominantly inflammatory — lymphocytic alveolitis" },
    { text:"Acute onset 4–8 h post-exposure: fever, chills, dyspnea" },
    { text:"HRCT: GGO, centrilobular nodules, air trapping" },
    { text:"BAL: lymphocytosis >50%, reversed CD4:CD8 ratio" },
    { text:"Histology: poorly-formed granulomas + bronchiolitis" },
    { text:"Reversible with complete antigen avoidance" },
    { text:"PFTs: restriction + low DLCO; may fully normalise" },
    { type:"key", text:"Antigen identification = excellent prognosis" },
  ],
  "FIBROTIC HP", [
    { text:"Inflammatory + fibrotic — mixed mechanism" },
    { text:"Insidious onset; antigen link often unclear" },
    { text:"HRCT: traction bronchiectasis, honeycombing, mid-zone" },
    { text:"BAL lymphocytosis reduced (median 24%); often <30%" },
    { text:"Histology: UIP or NSIP-like + bronchiolocentric clue" },
    { text:"Progresses even after antigen removal in many" },
    { text:"PFTs: low FVC%, low DLCO% — serial decline" },
    { type:"warn", text:"Mortality approaches IPF in advanced fibrotic HP" },
  ],
  { badge:"CLASSIFICATION 2020+", foot:"Murray & Nadel 7e, Chapter 91; ATS/JRS/ALAT 2020 HP Guideline" }
);

// ── SLIDE 5: Section – New Pathogenesis ──────────────────────────────────────
secDiv("02", "Immunopathogenesis:\nSingle-Cell Revolution", "What scRNA-seq is teaching us about fibrotic HP");

// ── SLIDE 6: Single-Cell Evidence ───────────────────────────────────────────
evidSlide(
  "Single-Cell Transcriptomics in Fibrotic HP",
  "Zhao AY, Unterman A, et al. "Single-Cell Analysis Reveals Novel Immune Perturbations in Fibrotic Hypersensitivity Pneumonitis." Am J Respir Crit Care Med. 2024 Nov;210(9). PMID: 38924775",
  [
    { type:"h", text:"Study Design" },
    { text:"5' scRNA-seq on PBMCs + BAL from 45 FHP, 63 IPF, 4 nonfibrotic HP, 36 healthy controls (US + Mexico)" },
    { text:"501,534 PBMCs and 88,336 BAL cells profiled" },
    { type:"h", text:"Key Findings — Unique to FHP" },
    { type:"key", text:"GZMhi cytotoxic CD4+ AND CD8+ T cells — elevated vs both IPF and controls" },
    { text:"TF activities: TGFβ, TNFα, and NFκB pathways in these T cells" },
    { type:"key", text:"CCL3hi/CCL4hi and S100Ahi classical monocytes → differentiate into SPP1hi fibrotic macrophages" },
    { text:"SPP1hi macrophages are shared with IPF — converging downstream fibrotic mechanism" },
    { type:"h", text:"Clinical Implication" },
    { text:"GZMhi T cells and SPP1+ macrophages = potential novel therapeutic targets" },
    { text:"Data publicly available: http://ildimmunecellatlas.com" },
  ],
  { badge:"AJRCCM 2024 · scRNA-seq", foot:"PMID 38924775 | DOI: 10.1164/rccm.202401-0078OC" }
);

// ── SLIDE 7: Classical Immunopathogenesis ────────────────────────────────────
twoCol(
  "Classical Immunopathogenesis: Dual Mechanism (Updated View)",
  "TYPE III — Immune Complex", [
    { text:"Inhaled antigens → specific serum IgG (precipitins)" },
    { text:"Antigen-antibody complexes → complement activation" },
    { text:"Acute neutrophilic alveolitis within hours" },
    { text:"Explains acute febrile HP presentation" },
    { type:"h", text:"Histology" },
    { text:"Peribronchiolar mononuclear infiltrate" },
    { text:"Poorly-formed noncaseating granulomas (2/3 cases)" },
    { text:"Cholesterol clefts, Schaumann bodies in giant cells" },
  ],
  "TYPE IV — Cell-Mediated (New Insights)", [
    { text:"CD4+ and CD8+ T cells — sensitised to antigen" },
    { type:"key", text:"NEW: GZMhi cytotoxic T cells — unique to FHP (not seen in IPF)" },
    { text:"TGFβ + TNFα + NFκB pathway activation" },
    { type:"key", text:"NEW: S100Ahi monocytes → SPP1hi fibrotic macrophages (shared with IPF)" },
    { type:"h", text:"Fibrosis Pathway" },
    { text:"SPP1+ macrophages drive myofibroblast activation" },
    { text:"Telomere shortening accelerates fibroblast senescence" },
    { text:"TGFβ1 → collagen deposition → irreversible fibrosis" },
  ],
  { badge:"UPDATED PATHOGENESIS", foot:"Murray & Nadel 7e; Zhao et al. AJRCCM 2024 (PMID:38924775)" }
);

// ── SLIDE 8: Section – Diagnosis ─────────────────────────────────────────────
secDiv("03", "Diagnostics: Evolving\nEvidence & Pitfalls", "CT overlap, CTD mimicry, and the antigen-indeterminate problem");

// ── SLIDE 9: CT Overlap Evidence ─────────────────────────────────────────────
evidSlide(
  "The 'Typical fHP Pattern' CT Trap",
  "Ryerson CJ, Marinescu DC, Muller NL, et al. "Outcomes of a Typical Fibrotic Hypersensitivity Pneumonitis Pattern on Chest CT." Am J Respir Crit Care Med. 2025 Oct. PMID: 40505139",
  [
    { type:"h", text:"Study: Prospective Registry — 164 patients with CT pattern of 'typical fHP'" },
    { text:"Multidisciplinary diagnoses established by consensus (structured MDD)" },
    { type:"h", text:"The Diagnosis Distribution Was Striking:" },
    { text:"fHP with exposure identified: 49 patients (30%)" },
    { text:"fHP without exposure identified: 56 patients (34%)" },
    { type:"key", text:"CTD-ILD: 36 patients (22%) — most common non-HP diagnosis" },
    { text:"Other MDD diagnoses: 23 patients (14%)" },
    { type:"h", text:"Outcome Differences" },
    { text:"fHP without exposure: WORSE lung function decline and higher mortality/transplant rate" },
    { type:"warn", text:"14% of 'antigen-negative fHP' developed CTD features (new autoimmune serology or rheumatologist-confirmed CTD) during follow-up" },
    { type:"key", text:"Conclusion: Always screen for CTD in antigen-negative fHP. Order ANA, anti-CCP, anti-Scl70, myositis panel." },
  ],
  { badge:"AJRCCM 2025 · Prospective", foot:"PMID 40505139 | DOI: 10.1164/rccm.202411-2215OC" }
);

// ── SLIDE 10: Diagnostic Algorithm ───────────────────────────────────────────
if (imgDiag) {
  imgSlide("Diagnostic Algorithm for HP (Murray & Nadel Fig 91.2)", imgDiag,
    "Fig 91.2 — Integrated HP diagnostic approach: exposure assessment → HRCT certainty → MDD → biopsy when needed. (Murray & Nadel's Respiratory Medicine, Chapter 91)");
}

// ── SLIDE 11: Diagnostic Certainty Framework ──────────────────────────────────
const hdr = (txt, bg) => ({ text: txt, options: { bold:true, color:"FFFFFF", fill:{color:bg}, align:"center", fontSize:10.5 }});
tableSlide(
  "ATS 2020 Diagnostic Certainty Framework — Annotated for Senior Practice",
  [
    [hdr("Domain", C.midnight), hdr("CONFIDENT Dx", C.teal), hdr("WORKING Dx", C.slate), hdr("UNLIKELY HP", "991B1B")],
    [
      { text:"Antigen Exposure", options:{bold:true, fontSize:10} },
      { text:"Known exposure + positive history or serology" },
      { text:"Suspected but unconfirmed; antigen indeterminate" },
      { text:"No relevant exposure despite exhaustive search" },
    ],
    [
      { text:"HRCT Pattern", options:{bold:true, fontSize:10} },
      { text:"Typical HP: GGO + centrilobular nodules + air trapping" },
      { text:"Compatible but atypical; mid-upper fibrosis possible" },
      { text:"Clearly favours IPF/UIP, NSIP without HP features" },
    ],
    [
      { text:"BAL", options:{bold:true, fontSize:10} },
      { text:"Supports but not required; lymphocytosis >30%" },
      { text:"Borderline lymphocytosis (20–30%); may guide biopsy" },
      { text:"Normal BAL or neutrophilia only — does not exclude" },
    ],
    [
      { text:"Biopsy", options:{bold:true, fontSize:10} },
      { text:"Not required if Confident Dx on MDD" },
      { text:"TBBx ± Cryo/SLB; aim to improve certainty at MDD" },
      { text:"SLB may redirect to IPF, CTD-ILD or other diagnosis" },
    ],
    [
      { text:"★ Senior Pearl", options:{bold:true, fontSize:10, color:"92400E"} },
      { text:"22% of typical fHP CT = CTD-ILD (Ryerson 2025)", options:{italic:true, fontSize:9.5} },
      { text:"Check autoimmune serology in ALL antigen-negative patients", options:{italic:true, fontSize:9.5} },
      { text:"Reconsider HP if no antigen + atypical HRCT + ANA+", options:{italic:true, fontSize:9.5} },
    ],
  ],
  [2.0, 2.5, 2.5, 2.4],
  { foot:"ATS/JRS/ALAT 2020 HP Guidelines; Ryerson CJ et al. AJRCCM 2025 (PMID:40505139)" }
);

// ── SLIDE 12: Section – Genomics & Biomarkers ────────────────────────────────
secDiv("04", "Genomics, Telomeres\n& Biomarkers", "Precision medicine is no longer theoretical in HP");

// ── SLIDE 13: Telomere Evidence ───────────────────────────────────────────────
evidSlide(
  "Telomere Length: Rethinking Immunosuppression",
  "Zhang D, Adegunsoye A, Oldham JM, et al. "Telomere length and immunosuppression in non-IPF interstitial lung disease." Eur Respir J. 2023 Nov. PMID: 37591536",
  [
    { type:"h", text:"Study Design" },
    { text:"Retrospective multicentre cohort: 613 (discovery) + 325 (replication) patients" },
    { text:"Populations: fibrotic HP (fHP), unclassifiable ILD, CTD-ILD across 5 centres" },
    { text:"LTL measured by qPCR; outcome: 2-year transplant-free survival" },
    { type:"h", text:"Key Findings — Practice-Changing" },
    { type:"key", text:"fHP + LTL <10th percentile + immunosuppression (AZA or MMF): HR 4.97 (CI 2.26–10.92, p<0.001)" },
    { text:"Replication cohort confirmed: HR 4.90 (CI 1.74–13.77, p=0.003)" },
    { text:"Significant interaction between telomere shortening and immunosuppressant exposure" },
    { text:"Patients with normal LTL: no differential survival with immunosuppression" },
    { type:"h", text:"Clinical Practice Implication" },
    { type:"warn", text:"CHECK TELOMERE LENGTH before starting AZA/MMF in fibrotic HP patients" },
    { text:"Short telomeres → AVOID immunosuppression → consider antifibrotics or transplant" },
  ],
  { badge:"ERJ 2023 · PRACTICE-CHANGING", foot:"PMID 37591536 | DOI: 10.1183/13993003.00441-2023 | Open Access via PMC10695771" }
);

// ── SLIDE 14: Genomics & Biomarkers Overview ──────────────────────────────────
cSlide("Genomics & Biomarkers in Fibrotic HP: Current Evidence", [
  { type:"h", text:"GENETIC RISK MARKERS" },
  { text:"MUC5B rs35705950 promoter SNP — associated with susceptibility AND worse prognosis in fibrotic HP" },
  { text:"Telomere gene mutations (TERT, TERC, RTEL1, PARN) — telomeropathy as HP substrate" },
  { text:"Short telomeres (<10th percentile) in ~22% of fibrotic ILD patients; modify treatment decisions" },
  { type:"h", text:"SERUM BIOMARKERS (Research / Emerging)" },
  { text:"KL-6 (Krebs von den Lungen 6): elevated in active fibrotic HP; tracks disease activity over time" },
  { text:"SP-D (surfactant protein D): correlates with alveolar epithelial injury" },
  { text:"CCL18: elevated in progressive fibrosis; prognostic marker across ILDs" },
  { text:"YKL-40 / CHI3L1: chitinase marker of macrophage activation" },
  { type:"h", text:"BAL IMMUNE PHENOTYPING (Research)" },
  { text:"SPP1+ macrophage enrichment: fibrotic trajectory marker (Zhao et al. 2024)" },
  { type:"key", text:"GZMhi cytotoxic T cell expansion in BAL = unique FHP signature vs IPF" },
], { badge:"PRECISION MEDICINE", foot:"Murray & Nadel 7e; Zhao et al. AJRCCM 2024; Zhang et al. ERJ 2023; D'Alessandro et al. Panminerva Med 2022" });

// ── SLIDE 15: Section – Antifibrotic Therapy ──────────────────────────────────
secDiv("05", "Antifibrotic Therapy\nin HP", "From IPF to progressive pulmonary fibrosis — what's the evidence?");

// ── SLIDE 16: Nintedanib / INBUILD NMA Evidence ───────────────────────────────
evidSlide(
  "Antifibrotics in Progressive HP: Network Meta-Analysis",
  "Singh P, Thampi G, Gupta K, et al. "Clinical efficacy and safety evaluation of drug therapies for PF-ILDs: a network meta-analysis of RCTs." Expert Rev Clin Immunol. 2025 Aug. PMID: 40754799",
  [
    { type:"h", text:"Study: NMA of 65 RCTs (13,521 patients); 4 studies (259 patients) specifically in chronic HP (CHP)" },
    { type:"h", text:"Findings for CHP:" },
    { text:"Pirfenidone + prednisolone showed benefit in CHP in the available (limited) RCT data" },
    { text:"Nintedanib: established in IPF and PPF (INBUILD trial); HP patients included via PPF criterion" },
    { type:"h", text:"Network Evidence: Drugs effective across PF-ILDs" },
    { text:"Pirfenidone: slows FVC decline, reduces mortality in IPF; promising in fibrotic HP" },
    { text:"Nintedanib: effective in IPF + PPF (including HP with progressive phenotype)" },
    { type:"key", text:"Conclusion: Pirfenidone and nintedanib are the most evidence-supported agents for PF-ILDs including progressive HP" },
    { type:"warn", text:"High-quality RCT data specific to HP remain scarce — only 4 HP-specific RCTs in this NMA" },
  ],
  { badge:"NMA · Systematic Review 2025", foot:"PMID 40754799 | DOI: 10.1080/1744666X.2025.2543473" }
);

// ── SLIDE 17: Pirfenidone in Fibrotic HP Meta-Analysis ───────────────────────
evidSlide(
  "Pirfenidone in Fibrotic HP: Meta-Analysis (2025)",
  "Giri B et al. "Efficacy of pirfenidone in fibrotic hypersensitivity pneumonitis: a systematic review and meta-analysis of RCTs." Open Access. PMC 2025. PMID: 41377281",
  [
    { type:"h", text:"Study: Systematic review + meta-analysis of RCTs on pirfenidone in fibrotic HP" },
    { type:"h", text:"Primary Outcomes:" },
    { text:"% predicted FVC: Non-significant increase [MD: +3.65; 95% CI: −1.63 to +8.94; p=0.18]" },
    { text:"% predicted DLCO: Non-significant [MD: +7.64; 95% CI: −1.46 to +16.74; p=0.10]" },
    { type:"h", text:"Secondary Outcome — Quality of Life:" },
    { type:"key", text:"SGRQ score: Significant improvement [MD: −5.0; 95% CI: −6.88 to −3.12; p<0.00001]" },
    { type:"h", text:"Interpretation" },
    { text:"Pirfenidone does NOT significantly improve objective lung function metrics in fibrotic HP" },
    { text:"BUT significantly improves quality of life (SGRQ) — clinically meaningful" },
    { type:"warn", text:"Important caveat: Very limited HP-specific RCT data; results driven by small trial pool" },
    { text:"Pathophysiological overlap with IPF supports continued investigation in HP" },
  ],
  { badge:"META-ANALYSIS 2025 · Open Access", foot:"PMID 41377281 | PMC12689064 | Free full text available" }
);

// ── SLIDE 18: Management Algorithm Image ─────────────────────────────────────
if (imgMgmt) {
  imgSlide("HP Management Algorithm (Murray & Nadel Fig 91.6)", imgMgmt,
    "Fig 91.6 — HP management: antigen avoidance → corticosteroids → corticosteroid-sparing (AZA/MMF) → antifibrotics → transplant evaluation. (Murray & Nadel 7e, Ch.91)");
}

// ── SLIDE 19: Comprehensive Management Ladder ─────────────────────────────────
cSlide("Management: Evidence-Graded Treatment Ladder", [
  { type:"h", text:"STEP 1 — Antigen Avoidance (ALL patients; first-line)" },
  { text:"Complete removal is most effective intervention; even partial avoidance slows progression" },
  { text:"Occupational counselling; environmental remediation; HEPA filtration; industrial hygienist referral" },
  { type:"h", text:"STEP 2 — Corticosteroids (Inflammatory / Symptomatic disease)" },
  { text:"Prednisone 0.5 mg/kg/day → taper over 4–6 weeks; limited evidence base" },
  { text:"Monitoring: bone density, glycaemia, infection risk; plan exit strategy early" },
  { type:"h", text:"STEP 3 — Steroid-Sparing Immunosuppression (Fibrotic HP — with caution)" },
  { type:"warn", text:"CHECK TELOMERE LENGTH first — LTL <10th percentile + AZA/MMF = 5x mortality HR (ERJ 2023)" },
  { text:"If LTL normal: AZA (2–3 mg/kg/day) or MMF (1–3 g/day)" },
  { type:"h", text:"STEP 4 — Antifibrotic Therapy (Progressive Fibrotic HP)" },
  { text:"Nintedanib: FDA-approved for PPF (INBUILD 2020); use if FVC declining ≥5–10%/yr despite Steps 1–3" },
  { text:"Pirfenidone: improves QoL (SGRQ) in fibrotic HP; consider for progressive disease" },
  { type:"h", text:"STEP 5 — Lung Transplantation" },
  { text:"Refer: FVC <50%, DLCO <40%, resting/exertional hypoxemia, rapid decline despite therapy" },
], { foot:"Murray & Nadel 7e; Zhang et al. ERJ 2023 (PMID:37591536); Giri et al. PMC 2025 (PMID:41377281); Singh et al. 2025 (PMID:40754799)" });

// ── SLIDE 20: Section – Acute Exacerbations ───────────────────────────────────
secDiv("06", "Acute Exacerbations of\nFibrotic HP", "A medical emergency — recognition and management");

// ── SLIDE 21: Acute Exacerbation ──────────────────────────────────────────────
twoCol(
  "Acute Exacerbation of Fibrotic HP (AE-fHP)",
  "RECOGNITION", [
    { text:"Rapid worsening of dyspnea within 30 days" },
    { text:"New bilateral GGO on HRCT superimposed on fibrotic background" },
    { text:"Exclude: infection, pulmonary embolism, cardiac failure" },
    { text:"Triggers: infection, surgical procedures, inhalation events" },
    { text:"May occur without identifiable trigger (idiopathic AE)" },
    { type:"warn", text:"Mortality of AE-fHP: 50–80% in-hospital" },
    { text:"Similar mechanism to AE-IPF: epithelial injury + macrophage storm" },
  ],
  "MANAGEMENT", [
    { type:"h", text:"Evidence-Based Steps" },
    { text:"High-dose IV methylprednisolone 500–1000 mg x 3 days" },
    { text:"Broad-spectrum antibiotics (exclude infection)" },
    { text:"Prophylactic anticoagulation if no contraindication" },
    { text:"Supplemental O2 + NIV / HFNO for respiratory support" },
    { text:"Continue antifibrotic if patient tolerating" },
    { type:"h", text:"ICU Considerations" },
    { text:"Intubation and mechanical ventilation: very poor outcomes; discuss goals of care early" },
    { type:"key", text:"Palliative/comfort care discussion ESSENTIAL at AE presentation" },
  ],
  { badge:"HIGH MORTALITY — EMERGENCY", foot:"Murray & Nadel 7e; analogous to AE-IPF evidence (Collard et al. AJRCCM)" }
);

// ── SLIDE 22: Section – Emerging & Future Therapies ──────────────────────────
secDiv("07", "Emerging & Future\nTherapies", "What to watch in the next 2–3 years");

// ── SLIDE 23: Pipeline ─────────────────────────────────────────────────────────
cSlide("Emerging Therapeutic Targets in HP / Fibrotic ILD", [
  { type:"h", text:"IN CLINICAL TRIALS" },
  { text:"Nerandomilast (BI 1015550) — PDE4B inhibitor; Phase III in IPF/PPF — includes HP with progressive phenotype" },
  { text:"MTX-463 — anti-WISP1 mAb; Phase 2 ongoing in PPF (NCT in progress); IPF/HP eligible" },
  { text:"Inhaled treprostinil (TETON-2): met primary endpoint (+95.6 mL FVC vs placebo); TETON-1 results expected mid-2026" },
  { text:"AI-designed drugs: Insilico Medicine's INS018_055 (IPF) — first AI-designed drug in Phase II; signals for HP pipeline" },
  { type:"h", text:"MECHANISTICALLY COMPELLING (Pre-Clinical / Early Phase)" },
  { text:"Anti-CCL3/CCL4 and anti-S100A8/9: targeting monocyte recruitment to lung (Zhao 2024 scRNA-seq rationale)" },
  { text:"GZMhi cytotoxic T cell blockade: novel in FHP; no clinical agents yet but clear target from AJRCCM 2024" },
  { text:"SPP1+ macrophage inhibition: shared IPF-HP target; galectin-3 inhibitors under investigation" },
  { type:"h", text:"SUPPORTIVE / ADJUNCT" },
  { text:"Inhaled N-acetylcysteine, antioxidant strategies in oxidative-stress driven HP" },
  { text:"Pulmonary hypertension in HP: mosliciguat (Phase 2 NCT06635850) — now recruiting" },
], { badge:"PIPELINE 2025–2026", foot:"Pulm Ther 2026 (Springer); Pulmonary Fibrosis Foundation Clinical Trials 2025–2026; PMID:40754799" });

// ── SLIDE 24: Section – Surveillance & Monitoring ────────────────────────────
secDiv("08", "Monitoring &\nSurveillance Strategy", "Tracking progression in the clinic");

// ── SLIDE 25: Monitoring Table ─────────────────────────────────────────────────
tableSlide(
  "Structured Monitoring Protocol for Fibrotic HP",
  [
    [
      { text:"Assessment", options:{bold:true,color:"FFFFFF",fill:{color:C.midnight},align:"center"} },
      { text:"Frequency", options:{bold:true,color:"FFFFFF",fill:{color:C.midnight},align:"center"} },
      { text:"Threshold for Action", options:{bold:true,color:"FFFFFF",fill:{color:C.midnight},align:"center"} },
      { text:"Evidence Level", options:{bold:true,color:"FFFFFF",fill:{color:C.midnight},align:"center"} },
    ],
    [{ text:"PFTs (FVC + DLCO)" },{ text:"Every 3–6 months" },{ text:"FVC decline ≥5–10% in 6–12 months → escalate therapy / add antifibrotic" },{ text:"Expert consensus; INBUILD trial" }],
    [{ text:"HRCT chest" },{ text:"At diagnosis; then annually or with clinical worsening" },{ text:"New/worsening fibrosis, new GGO (AE?), PA enlargement (PH?)" },{ text:"ATS 2020 Guideline" }],
    [{ text:"6MWT + SpO2" },{ text:"Every 3–6 months" },{ text:">50 m decline or new exertional desaturation → transplant workup" },{ text:"ILD-GAP index" }],
    [{ text:"Leukocyte Telomere Length" },{ text:"Once at diagnosis" },{ text:"LTL <10th percentile → avoid AZA/MMF (HR ~5x mortality)" },{ text:"Zhang et al. ERJ 2023" }],
    [{ text:"Autoimmune serology (ANA, anti-CCP, myositis, Scl70)" },{ text:"At Dx + annually if antigen-negative" },{ text:"New positivity → rheumatology referral; reconsider CTD-ILD vs HP" },{ text:"Ryerson AJRCCM 2025" }],
    [{ text:"Echocardiography" },{ text:"At Dx; repeat if SpO2 low or DLCO drop" },{ text:"PA systolic pressure >40 mmHg → PH evaluation; consider treprostinil" },{ text:"Murray & Nadel 7e" }],
    [{ text:"Antigen reassessment" },{ text:"Each clinic visit" },{ text:"Any new exposure? Ongoing low-level exposure? Occupational hygienist if needed" },{ text:"ATS 2020 Guideline" }],
  ],
  [2.5, 1.8, 3.2, 1.9],
  { foot:"Murray & Nadel 7e Ch.91; Zhang ERJ 2023 (PMID:37591536); Ryerson AJRCCM 2025 (PMID:40505139); ATS/JRS/ALAT 2020" }
);

// ── SLIDE 26: Prognostic Scoring ──────────────────────────────────────────────
cSlide("Prognostic Markers & Risk Stratification", [
  { type:"h", text:"ILD-GAP INDEX (Validated in fHP)" },
  { text:"Gender (Male=1) + Age (>65=1–2) + Physiology (FVC <70% + DLCO <40%) → total score 0–8" },
  { text:"Higher GAP score = higher 1-year mortality; guides transplant listing priority" },
  { type:"h", text:"HIGH-RISK FEATURES (Murray & Nadel, Table 91.1)" },
  { text:"Male sex + older age + bibasilar Velcro crackles" },
  { text:"FVC <70% predicted at baseline; DLCO <40% predicted" },
  { text:"Honeycombing, traction bronchiectasis, elevated PA:Ao ratio on HRCT" },
  { text:"Fibroblast foci on histology; fibrotic pattern on biopsy" },
  { text:"MUC5B risk allele + shorter telomere length (<10th percentile)" },
  { text:"No identified antigen; smoking; prior acute exacerbation; pulmonary hypertension" },
  { type:"h", text:"BIOMARKERS UNDER INVESTIGATION" },
  { text:"KL-6 serial trend: rising levels = disease activity; use for monitoring response" },
  { text:"SP-D: alveolar epithelial injury marker" },
  { type:"key", text:"GZMhi T cell and SPP1+ macrophage signatures may become prognostic endotype markers" },
], { foot:"Murray & Nadel 7e Table 91.1; Zhao et al. AJRCCM 2024; D'Alessandro et al. Panminerva 2022" });

// ── SLIDE 27: Lung Transplant ─────────────────────────────────────────────────
cSlide("Lung Transplant in HP: Indications & Outcomes", [
  { type:"h", text:"REFERRAL CRITERIA (per ATS / ISHLT)" },
  { text:"FVC <50% predicted OR DLCO <40% predicted at any time point" },
  { text:"Decline in FVC ≥10% (absolute) in 12 months" },
  { text:"Resting SpO2 <88% or significant exertional desaturation" },
  { text:"6MWT <250 m or >50 m decline in 12 months" },
  { text:"Pulmonary hypertension on echo or right heart catheterisation" },
  { text:"Refractory disease despite antigen avoidance + pharmacotherapy" },
  { type:"h", text:"OUTCOMES" },
  { text:"Bilateral lung transplant preferred over single-lung in younger patients" },
  { text:"Post-transplant survival in HP comparable to other non-IPF ILD" },
  { text:"Age-adjusted HP mortality rising: 0.1 → 0.7 per million (1988–2016); +5.6%/year (Murray & Nadel 7e)" },
  { type:"h", text:"TIMING MATTERS" },
  { type:"warn", text:"Refer EARLY — waitlist mortality in fibrotic HP is significant; do not wait for 'end-stage'" },
  { text:"Early referral ≠ immediate listing; allows time for transplant workup & optimisation" },
], { foot:"Murray & Nadel 7e Ch.91; ISHLT Guidelines; ATS 2020 HP Guidelines" });

// ── SLIDE 28: Surveillance in Special Situations ─────────────────────────────
cSlide("Special Situations in Senior Practice", [
  { type:"h", text:"WIND INSTRUMENT / MUSICAL INSTRUMENT HP" },
  { text:"Trombone player's lung, saxophone lung, bagpipe lung — increasingly recognised" },
  { text:"Fungi (Fusarium, Penicillium), MAC, Candida in contaminated instruments" },
  { text:"Ask about musical hobbies in ALL unexplained ILD" },
  { type:"h", text:"HP IN PATIENTS WITH AUTOIMMUNE FEATURES" },
  { text:"HP can coexist with CTD; autoimmune serology does NOT exclude HP" },
  { text:"Beware: antigen-negative fHP → 14% develop confirmed CTD (Ryerson 2025)" },
  { text:"MDD should include rheumatology for complex cases" },
  { type:"h", text:"HP IN THE IMMUNOCOMPROMISED HOST" },
  { text:"PCP, atypical infections can mimic HP on HRCT (GGO + diffuse infiltrates)" },
  { text:"BAL culture and metagenomic sequencing essential in immunocompromised" },
  { type:"h", text:"OCCUPATIONAL HP OUTBREAKS" },
  { text:"Report to occupational health authorities; systematic workplace assessment mandatory" },
  { text:"Engineering controls and surveillance spirometry for co-workers" },
], { foot:"Murray & Nadel 7e; Spagnolo et al. J Intern Med 2023 (PMID:37535448); ATS 2020 Guidelines" });

// ── SLIDE 29: Evidence Summary Table ─────────────────────────────────────────
tableSlide(
  "Key Evidence Summary: HP 2023–2026",
  [
    [
      { text:"Study / Guideline", options:{bold:true,color:"FFFFFF",fill:{color:C.midnight},align:"center"} },
      { text:"Year / Journal", options:{bold:true,color:"FFFFFF",fill:{color:C.midnight},align:"center"} },
      { text:"Key Finding", options:{bold:true,color:"FFFFFF",fill:{color:C.midnight},align:"center"} },
      { text:"PMID", options:{bold:true,color:"FFFFFF",fill:{color:C.midnight},align:"center"} },
    ],
    [{ text:"Zhao AY et al. scRNA-seq FHP" },{ text:"AJRCCM 2024" },{ text:"GZMhi cytotoxic T cells + SPP1+ macrophages unique to FHP; novel therapeutic targets" },{ text:"38924775" }],
    [{ text:"Ryerson CJ et al. fHP CT patterns" },{ text:"AJRCCM 2025" },{ text:"22% of 'typical fHP CT' = CTD-ILD; 14% antigen-neg fHP → CTD over follow-up" },{ text:"40505139" }],
    [{ text:"Zhang D et al. Telomere + immunosuppression" },{ text:"ERJ 2023" },{ text:"LTL <10th%ile + AZA/MMF: HR 4.97 mortality in fHP; avoid immunosuppression in short-telomere patients" },{ text:"37591536" }],
    [{ text:"Giri B et al. Pirfenidone meta-analysis" },{ text:"PMC 2025 (Open)" },{ text:"Pirfenidone improves QoL (SGRQ ↓5 pts) but not FVC/DLCO in fibrotic HP" },{ text:"41377281" }],
    [{ text:"Singh P et al. NMA PF-ILDs" },{ text:"Expert Rev Clin Immunol 2025" },{ text:"Pirfenidone + prednisolone benefit in CHP; nintedanib effective for PPF including HP" },{ text:"40754799" }],
    [{ text:"Koschel D et al. S2k Guideline" },{ text:"Respiration 2025" },{ text:"German national guideline: HP diagnosis, antifibrotic use, monitoring framework" },{ text:"39870058" }],
    [{ text:"Yanagawa M et al. ILD Imaging Advances" },{ text:"Radiology 2025" },{ text:"AI-based quantitative CT analysis for progressive ILD monitoring; emerging role in HP" },{ text:"40358445" }],
  ],
  [3.0, 1.7, 3.3, 1.4],
  { foot:"All PMIDs verified on PubMed. Open access papers: PMID 41377281 (PMC12689064), PMID 37591536 (PMC10695771)" }
);

// ── SLIDE 30: Closing ─────────────────────────────────────────────────────────
closingSlide();

// ── WRITE ──────────────────────────────────────────────────────────────────
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