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pres.author = "Gynecology Department";
pres.title = "Uterine Fibroids: Impact on Women's Health and Quality of Life";

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    "Uterine fibroids are the most common benign tumor in women, affecting up to 70-80% of women by age 50",
    "Symptomatic fibroids cause significant morbidity: heavy menstrual bleeding, pelvic pain, pressure symptoms, and impaired fertility",
    "Quality of life is severely impaired across physical, emotional, sexual, and social domains",
    "Racial disparities exist — Black women are 3x more likely to be affected and have more severe disease",
    "All treatment modalities (medical, surgical, radiological) significantly improve QOL scores",
    "Individualised management based on symptoms, size, location, fertility desires and patient preference is essential",
    "Early recognition and prompt intervention prevent long-term morbidity including iron-deficiency anaemia and infertility"
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — Title
// ═══════════════════════════════════════════════════════════════════════════
let s = pres.addSlide();
titleSlide(s,
  "Uterine Fibroids:\nImpact on Women's Health\nand Quality of Life",
  "A Comprehensive Review for the Gynecology Resident"
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 — Outline
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Presentation Outline", [
  "1.  Introduction & Definition",
  "2.  Epidemiology & Prevalence",
  "3.  Pathogenesis & Classification",
  "4.  Clinical Manifestations",
  "5.  Impact on Menstrual Health",
  "6.  Impact on Fertility & Reproductive Outcomes",
  "7.  Pelvic Pressure & Bladder/Bowel Symptoms",
  "8.  Pain — Dysmenorrhoea & Dyspareunia",
  "9.  Anaemia & Systemic Consequences",
  "10. Psychological Impact & Mental Health",
  "11. Sexual Health & Intimacy",
  "12. Impact on Work, Productivity & Social Life",
  "13. QOL Measurement Tools",
  "14. Racial & Socioeconomic Disparities",
  "15. Diagnosis",
  "16. Medical Management",
  "17. Surgical Management",
  "18. Minimally Invasive & Uterine-Preserving Procedures",
  "19. Treatment Impact on QOL — Evidence",
  "20. Shared Decision-Making",
  "21. Key Takeaways"
], null);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — Section: Introduction
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionDivider(s, "01", "Introduction & Definition", "Understanding the most common pelvic tumour in women");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — Definition
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Definition", [
  "A uterine myoma (fibroid, leiomyoma) is a benign smooth muscle neoplasm arising from the myometrium",
  "Synonyms: fibroid, uterine myoma, uterine leiomyoma — used interchangeably",
  "Monoclonal tumours: each fibroid arises from a single smooth muscle cell",
  "Hormone-dependent: growth stimulated by oestrogen and progesterone",
  "Most leiomyomas have normal karyotypes; ~40% have a simple chromosomal abnormality",
  "  Rearrangements of chromosomes 12q14 & 6p (HMGC and HMGIY genes)",
  "MED12 mutations found in approximately 70% of uterine leiomyomas",
  "  MED12 encodes a component of Mediator — a bridge between transcription factors and RNA polymerase",
  "Also associated with HLRCC syndrome (fumarate hydratase germline mutations)",
  "Rarely undergo malignant transformation to leiomyosarcoma"
], "Robbins, Cotran & Kumar Pathologic Basis of Disease | Creasy & Resnik's Maternal-Fetal Medicine");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — Epidemiology (Stat boxes)
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
calloutSlide(s, "Epidemiology & Prevalence", [
  { stat: "70-80%", label: "Women affected by fibroids by age 50", sub: "Lifetime prevalence" },
  { stat: "25-50%", label: "Women are symptomatic", sub: "Symptomatic prevalence" },
  { stat: "3-4%", label: "Detected on midtrimester ultrasound", sub: "Incidence in pregnancy" },
  { stat: "#1", label: "Most common indication for hysterectomy in the USA", sub: "~200,000/yr" }
], "Stewart et al. | Creasy & Resnik's Maternal-Fetal Medicine");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — Pathogenesis & Classification
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Pathogenesis & Classification (FIGO)",
  [
    "Monoclonal origin from uterine smooth muscle cells",
    "Oestrogen + progesterone drive growth",
    "MED12 mutations (~70%) — disrupts gene regulation",
    "HMGC / HMGIY rearrangements (~40%)",
    "Fumarate hydratase mutations (rare, HLRCC)",
    "Fibroid growth is usually slow; may regress post-menopause",
    "Rarely grow rapidly in pregnancy"
  ],
  [
    "Type 0  — Pedunculated, entirely intracavitary",
    "Type 1  — Submucosal, <50% intramural",
    "Type 2  — Submucosal, ≥50% intramural",
    "Type 3  — 100% intramural, contacts endometrium",
    "Type 4  — Intramural, no endometrial contact",
    "Type 5  — Subserosal, ≥50% intramural",
    "Type 6  — Subserosal, <50% intramural",
    "Type 7  — Pedunculated, subserosal",
    "Type 8  — Other (cervical, parasitic)"
  ],
  "Pathogenesis",
  "FIGO Classification"
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — Clinical Manifestations overview
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Clinical Manifestations — Overview", [
  "Many fibroids (especially small/intramural/subserosal) are ASYMPTOMATIC",
  "Symptoms depend on: number, size, location (submucosal most symptomatic), rate of growth",
  "There is NO correlation between degree of pain and fibroid volume or number",
  "Major symptom domains:",
  "  Abnormal uterine bleeding (most common) — menorrhagia, metrorrhagia",
  "  Pelvic pressure and bulk symptoms",
  "  Pelvic pain, dysmenorrhoea, dyspareunia",
  "  Urinary symptoms — frequency, urgency, incomplete emptying",
  "  Bowel symptoms — constipation, tenesmus",
  "  Reproductive dysfunction — infertility, recurrent pregnancy loss",
  "  Anaemia and systemic consequences",
  "  Psychological and QOL impairment"
], "Berek & Novak's Gynecology | Robbins Pathologic Basis of Disease");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — Section: Clinical Impact
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionDivider(s, "02", "Clinical Impact on Women's Health", "Bleeding, fertility, pain, pressure and systemic consequences");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — Menstrual Impact
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Impact on Menstrual Health", [
  "Heavy Menstrual Bleeding (HMB) is the cardinal symptom — most significant QOL driver",
  "  Submucosal fibroids most likely to cause HMB",
  "  Mechanism: increased endometrial surface area, abnormal vascularity, impaired haemostasis",
  "Blood loss: >80 mL per cycle (normal <35 mL)",
  "Causes iron-deficiency anaemia, fatigue, reduced work capacity",
  "Irregular bleeding (metrorrhagia, intermenstrual spotting)",
  "Bulk symptoms co-exist: uterine size > 12-week equivalent causes significant pelvic pressure",
  "Dysmenorrhoea: fibroids cause or worsen painful periods (especially submucosal)",
  "  Submucous fibroid expelling through cervix — labour-like pain with vaginal haemorrhage",
  "Impact on daily life: missed school/work, social withdrawal, constant fear of flooding"
], "Berek & Novak's Gynecology | Robbins Pathologic Basis of Disease");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — Fertility Impact
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Impact on Fertility & Reproductive Outcomes", [
  "Fibroids are found in ~5-10% of infertile women; may be the sole cause in 1-3%",
  "Submucosal fibroids most strongly associated with infertility",
  "Mechanisms of infertility:",
  "  Distortion of uterine cavity — impedes sperm transport and implantation",
  "  Altered endometrial receptivity — abnormal angiogenesis, altered cytokines",
  "  Tubal occlusion by large intramural fibroids",
  "Pregnancy complications (evidence from Creasy & Resnik):",
  "  Increased risk of spontaneous abortion",
  "  Fetal malpresentation",
  "  Uterine inertia (failure to contract adequately)",
  "  Postpartum haemorrhage",
  "  Preterm labour and delivery",
  "  Placenta previa (OR 2.2) and Placental abruption (OR 2.6)",
  "Psychosocial dimension: grief, loss of reproductive identity, relationship strain"
], "Creasy & Resnik's Maternal-Fetal Medicine | Berek & Novak's Gynecology");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — Pressure & Bladder/Bowel Symptoms
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Pelvic Pressure, Bladder & Bowel Symptoms",
  [
    "Urinary frequency — anterior fibroids compress bladder",
    "Urinary urgency and nocturia",
    "Incomplete bladder emptying / urinary retention",
    "Hydronephrosis — large posterior fibroids can compress ureters",
    "Stress urinary incontinence",
    "These symptoms disrupt sleep and daily activities significantly"
  ],
  [
    "Constipation — posterior fibroids compress rectum",
    "Tenesmus — sensation of incomplete defaecation",
    "Dyschezia — painful defaecation",
    "Abdominal distension causing visible bloating",
    "General abdominal discomfort — non-cyclic pressure",
    "Rarely: rectal obstruction with very large fibroids"
  ],
  "Bladder Symptoms",
  "Bowel Symptoms"
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 12 — Pain & Dyspareunia
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Pain — Dysmenorrhoea, Dyspareunia & Acute Pain", [
  "Dysmenorrhoea: cyclic pelvic pain worsened by submucosal or intramural fibroids",
  "  No direct correlation between fibroid size/number and pain severity",
  "Dyspareunia: deep pain during intercourse — affects sexual satisfaction and relationships",
  "Non-cyclic pelvic pressure or pain from bulk effect on adjacent structures",
  "Acute pain scenarios:",
  "  Torsion of pedunculated subserosal fibroid — ischaemic necrosis; mimics adnexal torsion",
  "  Red degeneration in pregnancy — sudden pain, fever, low-grade pyrexia; mimics acute abdomen",
  "  Submucous fibroid expelling through cervix — colicky labour-like pain",
  "  Degeneration misdiagnosed as subacute salpingo-oophoritis in non-pregnant women",
  "  Uterine rupture — extremely rare but documented; requires prompt treatment",
  "Diagnostic pearl: MRI more accurate than USS for characterising degeneration and differentiating from malignancy"
], "Berek & Novak's Gynecology");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 13 — Anaemia & Systemic Consequences
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
calloutSlide(s, "Anaemia & Systemic Consequences of HMB", [
  { stat: "Hb ↓", label: "Iron-deficiency anaemia from chronic blood loss", sub: "Most common systemic effect" },
  { stat: "↓ QOL", label: "Fatigue, weakness, dyspnoea, reduced exercise tolerance", sub: "Impairs all daily activities" },
  { stat: "↑ Cost", label: "Sanitary product cost, unplanned healthcare visits", sub: "Economic burden on women" },
  { stat: "Rare", label: "Polycythaemia from erythropoietin production by fibroid", sub: "Paraneoplastic phenomenon" }
], "Robbins, Cotran & Kumar Pathologic Basis of Disease");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 14 — Section: QOL
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionDivider(s, "03", "Quality of Life & Psychosocial Impact", "Beyond the physical: mental health, sexuality and social function");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 15 — Psychological Impact
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Psychological Impact & Mental Health", [
  "Fibroids significantly impact mental health — independent of physical symptom burden",
  "Evidence: Systematic review (Neumann et al., Fertil Steril 2024) — 67 studies, 18 RCTs",
  "  All interventions significantly improved mental health metrics alongside QOL scores",
  "Mental health consequences include:",
  "  Anxiety and depression — chronic unpredictable bleeding causes anticipatory anxiety",
  "  Body image disturbance — abdominal distension, bloating, weight gain",
  "  Loss of control and helplessness regarding menstrual cycle",
  "  Grief over fertility loss or reproductive choices limited by fibroids",
  "  Disrupted sleep from heavy bleeding and nocturia",
  "  Reduced self-confidence and social embarrassment",
  "Women often delay seeking care (normalise symptoms) — prolonging psychological burden",
  "Stigma around menstruation contributes to under-reporting and delayed diagnosis"
], "Neumann B et al. Fertil Steril 2024 [PMID: 38246400]");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 16 — Sexual Health & Social Impact
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Sexual Health, Intimacy & Social Function",
  [
    "Dyspareunia — deep pelvic pain during intercourse",
    "Reduced sexual desire (libido) from pain and HMB",
    "Decreased sexual satisfaction and frequency",
    "Embarrassment about heavy flow during intimacy",
    "Relationship strain — partner communication breakdown",
    "Impact on reproductive decision-making",
    "Fear of sexual activity exacerbating bleeding or pain"
  ],
  [
    "Absenteeism — 30-40% of women miss work due to HMB",
    "Presenteeism — reduced productivity while at work",
    "Social withdrawal — fear of flooding in public",
    "Limited participation in exercise and sports",
    "Restriction of travel and leisure activities",
    "Financial impact: treatment costs, productivity loss",
    "Negative impact on family and household function"
  ],
  "Sexual Health & Intimacy",
  "Social & Work Impact"
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 17 — QOL Measurement Tools
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "QOL Measurement Tools in Fibroid Research", [
  "Validated questionnaires are essential for objective QOL assessment and treatment comparison",
  "UFS-QOL (Uterine Fibroid Symptom and Quality of Life questionnaire) — most widely used",
  "  8-item Symptom Severity Score + 29-item HRQL subscales",
  "  Subscales: Concern, Activities, Energy/Mood, Control, Self-consciousness, Sexual Function",
  "SF-36 (Short Form 36) — generic HRQoL across 8 domains",
  "WHOQOL-BREF — WHO generic QOL instrument (physical, psychological, social, environmental)",
  "EQ-5D — generic health utility index (used in health economic analyses)",
  "Patient Global Impression of Change (PGIC) — patient-reported improvement score",
  "Pictorial Blood Loss Assessment Chart (PBAC) — quantify HMB",
  "PHQ-9 and GAD-7 — depression and anxiety screening",
  "Clinical note: Systematic review (Neumann 2024) found all interventions improved",
  "  UFS-QOL scores, symptom severity, and mental health metrics post-treatment"
], "Neumann B et al. Fertil Steril 2024 [PMID: 38246400]");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 18 — Racial & Socioeconomic Disparities
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Racial & Socioeconomic Disparities", [
  "Black women are disproportionately affected — a major health equity issue:",
  "  3x more likely to be diagnosed with uterine fibroids than white women",
  "  Earlier onset (younger age at diagnosis)",
  "  More numerous, larger, and more symptomatic fibroids",
  "  Higher rates of hospitalisation and hysterectomy",
  "  Greater anaemia burden and worse QOL scores",
  "Contributing factors:",
  "  Genetic predisposition",
  "  Hair relaxer / chemical exposure (emerging evidence)",
  "  Chronic stress and allostatic load",
  "  Vitamin D deficiency (more prevalent in darker-skinned populations)",
  "Healthcare access disparities:",
  "  Delays in diagnosis and referral",
  "  Differential access to uterine-preserving procedures (myomectomy, UAE)",
  "  Cultural and structural barriers to seeking care",
  "Evidence: Orellana et al. J Racial Ethn Health Disparities 2022 [PMID: 34013445]"
], "Orellana et al. 2022 | Neumann et al. 2024");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 19 — Section: Diagnosis & Management
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s = pres.addSlide();
sectionDivider(s, "04", "Diagnosis & Management", "From imaging to intervention — a structured approach");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 20 — Diagnosis
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s = pres.addSlide();
contentSlide(s, "Diagnosis of Uterine Fibroids", [
  "History: HMB, pelvic pain/pressure, urinary/bowel symptoms, infertility",
  "Examination: enlarged, irregular, firm uterus on bimanual pelvic examination",
  "Pelvic ultrasound — FIRST-LINE IMAGING",
  "  Sharply circumscribed, hypoechoic, well-defined masses within myometrium",
  "  Whorled internal texture; possible calcification",
  "  Saline infusion sonohysterography — best for submucosal fibroid mapping",
  "MRI Pelvis — GOLD STANDARD for fibroid mapping",
  "  Accurately classifies FIGO type, number, size, position",
  "  Distinguishes from adenomyosis and leiomyosarcoma",
  "  Essential before uterine artery embolisation or focused ultrasound",
  "Hysteroscopy: direct visualisation of submucosal fibroids (Type 0, 1, 2)",
  "Laboratory: FBC (assess anaemia), coagulation screen, thyroid function",
  "Endometrial biopsy: if atypical/intermenstrual bleeding to exclude pathology"
], "Berek & Novak's Gynecology | Creasy & Resnik's Maternal-Fetal Medicine");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 21 — Medical Management
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Medical Management", [
  "Goal: symptom control, QOL improvement, optimise for surgery if needed",
  "GnRH Agonists (e.g. Leuprolide, Goserelin):",
  "  Reduces fibroid volume by 35-65%; controls HMB pre-operatively",
  "  Use limited to 3-6 months — add-back therapy for bone protection",
  "GnRH Antagonists (e.g. Relugolix, Elagolix) — 2020+ approvals:",
  "  Oral, rapid onset; reduce HMB significantly; daily dosing",
  "  Relugolix + add-back: FDA/EMA approved for uterine fibroids",
  "Levonorgestrel IUS (Mirena): reduces HMB; does not reduce fibroid size",
  "Combined oral contraceptive pill / progestogens: symptom control (limited evidence)",
  "Ulipristal acetate (suspended in many markets due to hepatotoxicity)",
  "Tranexamic acid: antifibrinolytic for acute HMB control",
  "NSAIDs: dysmenorrhoea relief; modest reduction in blood loss",
  "Iron supplementation: correct pre-operative anaemia (oral or IV iron)",
  "Pre-operative medical therapy: Cochrane review 2025 (Puscasiu et al., PMID: 40183418)"
], "Singh S et al. Eur J Obstet Gynecol 2023 [PMID: 37385088] | Puscasiu et al. Cochrane 2025 [PMID: 40183418]");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 22 — Surgical & Minimally Invasive Management
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Surgical & Minimally Invasive Management",
  [
    "Hysterectomy: definitive cure — no recurrence",
    "  Most common indication in USA (~200,000/yr)",
    "  Abdominal, vaginal, laparoscopic routes",
    "  Preferred for completed family / severe symptoms",
    "Myomectomy: uterine-preserving option",
    "  Hysteroscopic (Types 0-2 submucosal)",
    "  Laparoscopic / robotic (subserosal, intramural)",
    "  Open abdominal (large/multiple fibroids)",
    "  Lower reintervention rate vs UAE at 4 years (meta-analysis 2024, PMID: 39164326)"
  ],
  [
    "Uterine Artery Embolisation (UAE):",
    "  Radiological; devascularises fibroids",
    "  Higher reintervention and hysterectomy rate vs myomectomy",
    "  Lower early complications vs surgery",
    "Radiofrequency Ablation (RFA):",
    "  Laparoscopic or transcervical Sonata device",
    "  AAGL meta-analysis 2025: safe, effective (PMID: 39277104)",
    "MR-guided Focused Ultrasound (MRgFUS):",
    "  Non-invasive, outpatient",
    "  Best for small number of fibroids",
    "Endometrial Ablation: for HMB with no future fertility intent"
  ],
  "Surgery (Hysterectomy & Myomectomy)",
  "Uterine-Preserving Procedures"
);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 23 — Treatment Impact on QOL
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Treatment Impact on QOL — Evidence Summary", [
  "Systematic review: Neumann et al. Fertil Steril 2024 (PMID: 38246400)",
  "  67 studies (18 RCTs + 49 observational); interventions Jan 1990 – Oct 2023",
  "  ALL interventions significantly improved UFS-QOL scores, mental health and symptom severity",
  "UAE vs Myomectomy (Meta-analysis, Peng et al. Sci Rep 2024 — PMID: 39164326):",
  "  Comparable improvement in QOL and AUB control",
  "  UAE: higher reintervention (OR 1.84) and hysterectomy (OR 4.04) rates at 4 years",
  "  Myomectomy: higher early complication rate but better long-term outcomes",
  "Radiofrequency Ablation (AAGL Meta-analysis, Chen et al. JMIG 2025 — PMID: 39277104):",
  "  Safe, effective with significant QOL improvement; uterine-preserving",
  "Preoperative medical therapy (Cochrane 2025 — PMID: 40183418):",
  "  GnRH agonists/antagonists pre-operatively reduce fibroid volume and blood loss",
  "Key message: Treatment choice should be individualised — all modalities improve QOL"
], "Neumann 2024 | Peng 2024 | Chen 2025 | Puscasiu 2025");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 24 — Shared Decision-Making
// ═══════════════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Shared Decision-Making Framework", [
  "No single 'best' treatment — decision is individualised and patient-centred",
  "Key factors to discuss with the patient:",
  "  Symptom severity and impact on QOL",
  "  Fertility wishes — present and future",
  "  Fibroid characteristics: size, number, FIGO classification",
  "  Uterine size and overall surgical risk",
  "  Patient's values regarding uterine preservation vs definitive cure",
  "  Comorbidities (anaemia, BMI, cardiovascular risk)",
  "  Access to specialist procedures (UAE, RFA, MRgFUS)",
  "Communication tools:",
  "  Validated patient decision aids (PDA)",
  "  UFS-QOL at baseline, 3 and 12 months post-treatment",
  "  Multidisciplinary approach: Gynecologist + Interventional Radiologist + Haematologist",
  "Equity considerations: ensure Black women are offered all uterine-preserving options equally"
], "Neumann B et al. Fertil Steril 2024");

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 25 — Key Takeaways / Conclusion
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s = pres.addSlide();
conclusionSlide(s);

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 26 — References
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const refs = [
  "1. Robbins, Cotran & Kumar. Pathologic Basis of Disease, 10th ed. Elsevier.",
  "2. Creasy & Resnik. Maternal-Fetal Medicine: Principles and Practice. Elsevier.",
  "3. Berek & Novak's Gynecology, 16th ed. Wolters Kluwer.",
  "4. Neumann B et al. The impact of fibroid treatments on quality of life and mental health. Fertil Steril. 2024;121(3). PMID: 38246400.",
  "5. Peng J et al. Systematic review and meta-analysis: UAE vs myomectomy for symptomatic uterine fibroids. Sci Rep. 2024. PMID: 39164326.",
  "6. Singh S et al. Contemporary approaches in management of uterine leiomyomas. Eur J Obstet Gynecol Reprod Biol. 2023. PMID: 37385088.",
  "7. Chen I et al. Radiofrequency Ablation for Uterine Fibroids: AAGL meta-analysis. J Minim Invasive Gynecol. 2025. PMID: 39277104.",
  "8. Puscasiu L et al. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev. 2025. PMID: 40183418.",
  "9. Orellana M et al. Ethnoracial factors in management of uterine fibroids. J Racial Ethn Health Disparities. 2022. PMID: 34013445.",
  "10. Amendola et al. MED-12 Gene and Uterine Fibroids: a Systematic Review. Reprod Sci. 2024. PMID: 37516697."
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