mkdir -p /home/daytona/workspace/giardia-answersheet && ls /home/daytona/workspa…

~/giardia-answersheet/create_answersheet.js

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

// Fetch images
const imgUrls = [
  "https://cdn.orris.care/cdss_images/48077f2c40ac32cc5088a4cd97cd3e6419578c74651161c54ff74c5c5bb6f8a2.png",
  "https://cdn.orris.care/cdss_images/c4507cbfcbe41284b03a7d4c5a04e6eaa677bc3bdf025c3d497bcddc21605afd.png",
  "https://cdn.orris.care/cdss_images/0f12bd2b1ed4d3f7b0ab2ffb4c8e16350716c6d42580ab173bfbf35dafefe556.png"
];

let imgData = [];
try {
  const result = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imgUrls.map(u => `"${u}"`).join(" ")}`
  ).toString();
  imgData = JSON.parse(result);
  console.log("Images fetched:", imgData.map(i => i.error ? "ERROR:" + i.error : "OK"));
} catch(e) {
  console.log("Image fetch failed:", e.message);
}

let pres = new pptxgen();
pres.layout = 'LAYOUT_WIDE'; // 13.3 x 7.5 inches - wider for answer sheet format
pres.title = 'Giardia lamblia - Microbiology Answer Sheet';

// COLORS
const BG = "FFFDF5";        // warm white like paper
const DARK_BLUE = "0D3B66"; // header dark blue
const ACCENT = "1A6B3A";    // section green
const GOLD = "C9952A";      // highlight gold
const LINE_COLOR = "1A6B3A";
const TEXT_DARK = "1C1C1C";
const TEXT_BODY = "2D2D2D";
const LIGHT_BOX = "E8F4F0";
const HEADING_BG = "0D3B66";
const SUBHEAD_BG = "1A6B3A";
const WHITE = "FFFFFF";
const NOTE_BG = "FFF3CD";

// Helper: add slide with background
function newSlide(bgColor) {
  let slide = pres.addSlide();
  slide.background = { color: bgColor || BG };
  return slide;
}

// Helper: section heading bar
function addSectionBar(slide, text, y, color) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0.2, y: y, w: 12.9, h: 0.38,
    fill: { color: color || HEADING_BG }
  });
  slide.addText(text, {
    x: 0.3, y: y + 0.02, w: 12.7, h: 0.34,
    fontSize: 13, bold: true, color: WHITE,
    fontFace: "Arial", valign: "middle", margin: 4
  });
}

// Helper: sub-section bar
function addSubBar(slide, text, y) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0.2, y: y, w: 12.9, h: 0.30,
    fill: { color: SUBHEAD_BG }
  });
  slide.addText(text, {
    x: 0.3, y: y + 0.01, w: 12.7, h: 0.28,
    fontSize: 11, bold: true, color: WHITE,
    fontFace: "Arial", valign: "middle", margin: 3
  });
}

// Helper: body text box
function addBody(slide, textArr, x, y, w, h, fontSize) {
  slide.addText(textArr, {
    x, y, w, h,
    fontSize: fontSize || 9.5,
    color: TEXT_BODY,
    fontFace: "Arial",
    valign: "top",
    margin: 4,
    wrap: true
  });
}

// ============================================================
// SLIDE 1: COVER / TITLE
// ============================================================
{
  let slide = pres.addSlide();
  slide.background = { color: DARK_BLUE };

  // decorative top bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.25, fill: { color: GOLD } });

  // Title
  slide.addText("GIARDIA LAMBLIA", {
    x: 0.5, y: 0.8, w: 12.3, h: 1.2,
    fontSize: 44, bold: true, color: GOLD,
    fontFace: "Arial", align: "center", charSpacing: 4
  });

  slide.addText("(Giardia intestinalis | Giardia duodenalis)", {
    x: 0.5, y: 2.0, w: 12.3, h: 0.5,
    fontSize: 18, color: "C8E6FA", fontFace: "Arial", align: "center", italic: true
  });

  // horizontal line
  slide.addShape(pres.ShapeType.line, {
    x: 1.5, y: 2.65, w: 10.3, h: 0,
    line: { color: GOLD, width: 2 }
  });

  slide.addText("MICROBIOLOGY IA — ANSWER SHEET", {
    x: 0.5, y: 2.8, w: 12.3, h: 0.45,
    fontSize: 14, color: WHITE, fontFace: "Arial", align: "center", bold: true
  });

  slide.addText([
    { text: "Kingdom: ", options: { bold: true, color: GOLD } },
    { text: "Protista  ", options: { color: WHITE } },
    { text: "  |  Phylum: ", options: { bold: true, color: GOLD } },
    { text: "Metamonada  ", options: { color: WHITE } },
    { text: "  |  Class: ", options: { bold: true, color: GOLD } },
    { text: "Trepomonadea  ", options: { color: WHITE } },
    { text: "  |  Type: ", options: { bold: true, color: GOLD } },
    { text: "Flagellated Protozoan", options: { color: WHITE } },
  ], {
    x: 0.5, y: 3.4, w: 12.3, h: 0.4,
    fontSize: 10, fontFace: "Arial", align: "center"
  });

  // Index
  slide.addShape(pres.ShapeType.rect, {
    x: 0.5, y: 4.0, w: 12.3, h: 2.8,
    fill: { color: "0A2E52" }, line: { color: GOLD, width: 1 }
  });

  slide.addText("CONTENTS:", {
    x: 0.7, y: 4.1, w: 11.9, h: 0.35,
    fontSize: 12, bold: true, color: GOLD, fontFace: "Arial"
  });

  const contents = [
    "1. Classification & Nomenclature",
    "2. Morphology — Trophozoite & Cyst",
    "3. Life Cycle",
    "4. Antigenic Structure & Pathogenesis",
    "5. Disease Caused — Giardiasis: Clinical Features",
    "6. Laboratory Diagnosis (Stool Microscopy, Culture, Antigen, NAAT)",
    "7. Treatment & Prevention",
    "8. Key Points for 20-Mark Essay & 6-Mark SAQ"
  ];

  contents.forEach((c, i) => {
    const col = i < 4 ? 0 : 1;
    const row = i < 4 ? i : i - 4;
    slide.addText(c, {
      x: 0.8 + col * 6.2,
      y: 4.55 + row * 0.45,
      w: 6.0, h: 0.4,
      fontSize: 10, color: "C8E6FA", fontFace: "Arial"
    });
  });

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 7.25, w: 13.3, h: 0.25, fill: { color: GOLD } });
}

// ============================================================
// SLIDE 2: CLASSIFICATION + MORPHOLOGY (TROPHOZOITE)
// ============================================================
{
  let slide = newSlide(BG);

  // Top band
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.45, fill: { color: DARK_BLUE } });
  slide.addText("GIARDIA LAMBLIA — CLASSIFICATION & MORPHOLOGY", {
    x: 0.2, y: 0.03, w: 12.9, h: 0.4,
    fontSize: 14, bold: true, color: WHITE, fontFace: "Arial", valign: "middle"
  });
  slide.addText("Slide 2 of 7", {
    x: 10.5, y: 0.03, w: 2.6, h: 0.4,
    fontSize: 9, color: GOLD, fontFace: "Arial", align: "right", valign: "middle"
  });

  // LEFT COLUMN
  addSectionBar(slide, "CLASSIFICATION", 0.55);
  const classData = [
    [{ text: "Kingdom: ", options: { bold: true }}, { text: "Protista" }],
    [{ text: "Sub-kingdom: ", options: { bold: true }}, { text: "Protozoa" }],
    [{ text: "Phylum: ", options: { bold: true }}, { text: "Metamonada" }],
    [{ text: "Order: ", options: { bold: true }}, { text: "Diplomonadida" }],
    [{ text: "Genus: ", options: { bold: true }}, { text: "Giardia" }],
    [{ text: "Species: ", options: { bold: true }}, { text: "lamblia (= intestinalis = duodenalis)" }],
    [{ text: "Type: ", options: { bold: true }}, { text: "Flagellated protozoan (Intestinal)" }],
    [{ text: "First described: ", options: { bold: true }}, { text: "Van Leeuwenhoek (1681), Stiles named it (1915)" }],
    [{ text: "Infective dose: ", options: { bold: true }}, { text: "As few as 10–25 cysts" }],
    [{ text: "Assemblages: ", options: { bold: true }}, { text: "A–H; A & B infect humans" }],
  ];
  classData.forEach((row, i) => {
    slide.addText(row, {
      x: 0.25, y: 0.98 + i * 0.32,
      w: 5.9, h: 0.30,
      fontSize: 9.5, color: TEXT_BODY, fontFace: "Arial", margin: 2
    });
  });

  // TROPHOZOITE
  addSectionBar(slide, "MORPHOLOGY — TROPHOZOITE (Vegetative form / Active form)", 4.3, SUBHEAD_BG);

  slide.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 4.7, w: 5.9, h: 2.55,
    fill: { color: LIGHT_BOX }, line: { color: LINE_COLOR, width: 0.5 }
  });

  const trophoData = [
    "• Shape: Pear-shaped (pyriform) with tapered posterior end",
    "• Size: 10–20 μm long × 7–10 μm wide",
    "• Nuclei: 2 nuclei (bilateral symmetry)",
    "• Flagella: 8 total — 4 lateral, 2 ventral, 2 caudal",
    "• Sucking disc: Ventral concave disc — used to adhere to duodenal enterocytes",
    "• Median bodies: 2 curved structures — give 'smiling face' / 'monkey face' / 'old man face' appearance",
    "• Axonemes (longitudinal fibrils): Present",
    "• Movement: Tumbling / falling leaf motility",
    "• Replication: Binary fission",
    "• Habitat: Duodenum and upper jejunum",
    "• DOES NOT invade mucosa — remains luminal",
  ];
  trophoData.forEach((t, i) => {
    slide.addText(t, {
      x: 0.35, y: 4.75 + i * 0.225,
      w: 5.7, h: 0.22,
      fontSize: 9, color: TEXT_BODY, fontFace: "Arial"
    });
  });

  // RIGHT COLUMN — CYST
  addSectionBar(slide, "MORPHOLOGY — CYST (Infective form / Diagnostic stage)", 0.55, ACCENT);

  slide.addShape(pres.ShapeType.rect, {
    x: 6.6, y: 0.98, w: 6.45, h: 3.1,
    fill: { color: LIGHT_BOX }, line: { color: ACCENT, width: 0.5 }
  });

  const cystData = [
    "• Shape: Oval / ellipsoidal",
    "• Size: 8–12 μm long × 7–10 μm wide",
    "• Nuclei: 2 nuclei (immature cyst) → 4 nuclei (mature cyst)",
    "• Wall: Rigid, thick outer wall — resistant to dehydration, temperature extremes, and chlorination",
    "• Survival: Survives in cold water for several weeks",
    "• Median bodies: Dark-staining curved bodies cross axonemes — appear as 'smiling mouth'",
    "• Cytoplasm: May be retracted from cyst wall",
    "• Role: INFECTIVE stage — ingested by new host",
    "• Staining: Well visualized on iodine stain, trichrome stain",
    "• Excystation: Each cyst → 2 trophozoites (triggered by gastric acid + intestinal proteases)",
  ];
  cystData.forEach((t, i) => {
    slide.addText(t, {
      x: 6.7, y: 1.02 + i * 0.3,
      w: 6.25, h: 0.28,
      fontSize: 9, color: TEXT_BODY, fontFace: "Arial"
    });
  });

  // COMPARISON TABLE
  addSubBar(slide, "TROPHOZOITE vs CYST — COMPARISON AT A GLANCE", 4.18);

  const tableRows = [
    ["Feature", "Trophozoite", "Cyst"],
    ["Shape", "Pear-shaped", "Oval"],
    ["Size", "10–20 × 7–10 μm", "8–12 × 7–10 μm"],
    ["Nuclei", "2", "2 (immature) / 4 (mature)"],
    ["Flagella", "8 (active)", "Absent"],
    ["Role", "Pathogenic form", "Infective form (diagnostic)"],
    ["Found in stool", "Diarrheic stool", "Formed stool"],
    ["Motility", "Tumbling (falling leaf)", "None"],
  ];

  slide.addTable(tableRows, {
    x: 6.6, y: 4.55, w: 6.45, h: 2.7,
    fontSize: 8.5,
    fontFace: "Arial",
    border: { pt: 0.5, color: "CCCCCC" },
    rowH: 0.32,
    align: "center",
    color: TEXT_BODY,
    fill: WHITE,
    colW: [1.5, 2.5, 2.45],
    thead: {
      fill: { color: DARK_BLUE },
      color: WHITE,
      bold: true,
      fontSize: 9
    }
  });

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.2, fill: { color: DARK_BLUE } });
}

// ============================================================
// SLIDE 3: LIFE CYCLE + EPIDEMIOLOGY
// ============================================================
{
  let slide = newSlide(BG);

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.45, fill: { color: DARK_BLUE } });
  slide.addText("GIARDIA LAMBLIA — LIFE CYCLE & EPIDEMIOLOGY", {
    x: 0.2, y: 0.03, w: 12.9, h: 0.4,
    fontSize: 14, bold: true, color: WHITE, fontFace: "Arial", valign: "middle"
  });
  slide.addText("Slide 3 of 7", {
    x: 10.5, y: 0.03, w: 2.6, h: 0.4,
    fontSize: 9, color: GOLD, fontFace: "Arial", align: "right", valign: "middle"
  });

  // LIFE CYCLE image
  addSectionBar(slide, "LIFE CYCLE DIAGRAM (CDC)", 0.55);
  if (imgData[0] && !imgData[0].error) {
    slide.addImage({
      data: imgData[0].base64,
      x: 0.2, y: 0.98, w: 4.8, h: 5.9
    });
  } else {
    slide.addShape(pres.ShapeType.rect, {
      x: 0.2, y: 0.98, w: 4.8, h: 5.9,
      fill: { color: "DDDDDD" }
    });
    slide.addText("Life Cycle Diagram\n(See CDC / Apurba Shastry Fig.)", {
      x: 0.2, y: 3.0, w: 4.8, h: 1,
      fontSize: 11, color: "555555", align: "center"
    });
  }

  // LIFE CYCLE STEPS - TEXT
  addSectionBar(slide, "LIFE CYCLE — STEP BY STEP", 0.55, ACCENT);
  // reposition - right of image
  slide.addShape(pres.ShapeType.rect, {
    x: 0.2, y: 0.55, w: 4.8, h: 0.4,
    fill: { color: ACCENT }
  }); // overlaps, intentional

  const lcSteps = [
    { step: "STEP 1", text: "INGESTION — Human ingests as few as 10–25 infective CYSTS via contaminated water, food, or fecal-oral route" },
    { step: "STEP 2", text: "EXCYSTATION — Cysts reach stomach; gastric acid + intestinal proteases trigger excystation. Each cyst → 2 trophozoites" },
    { step: "STEP 3", text: "COLONIZATION — Trophozoites multiply by binary fission in the duodenum & upper jejunum; attach to enterocytes via ventral sucking disc" },
    { step: "STEP 4", text: "ENCYSTATION — As trophozoites move to lower intestine, exposure to alkaline pH or bile salts triggers encystation → Cysts formed" },
    { step: "STEP 5", text: "EXCRETION — Cysts (and sometimes trophozoites in diarrheic stools) are passed in feces → contaminate environment → infect next host" },
  ];

  addSectionBar(slide, "LIFE CYCLE — STEPS", 0.55, ACCENT);
  lcSteps.forEach((item, i) => {
    slide.addShape(pres.ShapeType.rect, {
      x: 5.2, y: 1.02 + i * 1.05, w: 1.1, h: 0.9,
      fill: { color: i % 2 === 0 ? ACCENT : DARK_BLUE }
    });
    slide.addText(item.step, {
      x: 5.2, y: 1.02 + i * 1.05, w: 1.1, h: 0.9,
      fontSize: 9, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Arial"
    });
    slide.addShape(pres.ShapeType.rect, {
      x: 6.35, y: 1.02 + i * 1.05, w: 6.75, h: 0.9,
      fill: { color: i % 2 === 0 ? LIGHT_BOX : "FFFFFF" },
      line: { color: LINE_COLOR, width: 0.3 }
    });
    slide.addText(item.text, {
      x: 6.45, y: 1.08 + i * 1.05, w: 6.5, h: 0.78,
      fontSize: 9.5, color: TEXT_BODY, fontFace: "Arial", valign: "middle", wrap: true
    });
  });

  // EPIDEMIOLOGY
  addSectionBar(slide, "EPIDEMIOLOGY", 6.3, DARK_BLUE);
  const epiPoints = [
    "• Giardia is the MOST COMMON intestinal protozoan parasite worldwide & in the USA",
    "• 5–6 cases/100,000 in USA; ~1.2 million cases/year estimated",
    "• Worldwide: Children more commonly infected — essentially all children in highly endemic areas infected by age 2–3 years",
    "• High-risk groups: Travellers, campers, children in daycare, homosexual men, immunocompromised (esp. IgA deficiency)",
    "• Reservoir: Humans, cats, dogs (assemblage A & B), beavers ('beaver fever')",
    "• Mode of transmission: Waterborne (main route), foodborne, fecal-oral (person-to-person)",
  ];
  epiPoints.forEach((t, i) => {
    slide.addText(t, {
      x: 0.3, y: 6.68 + i * 0.1,
      w: 12.9, h: 0.12,
      fontSize: 8.5, color: TEXT_BODY, fontFace: "Arial"
    });
  });

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.2, fill: { color: DARK_BLUE } });
}

// ============================================================
// SLIDE 4: PATHOGENESIS + ANTIGENIC STRUCTURE + DISEASE / CLINICAL FEATURES
// ============================================================
{
  let slide = newSlide(BG);

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.45, fill: { color: DARK_BLUE } });
  slide.addText("GIARDIA LAMBLIA — PATHOGENESIS, ANTIGENIC STRUCTURE & DISEASE", {
    x: 0.2, y: 0.03, w: 12.9, h: 0.4,
    fontSize: 14, bold: true, color: WHITE, fontFace: "Arial", valign: "middle"
  });
  slide.addText("Slide 4 of 7", {
    x: 10.5, y: 0.03, w: 2.6, h: 0.4,
    fontSize: 9, color: GOLD, fontFace: "Arial", align: "right", valign: "middle"
  });

  // PATHOGENESIS — LEFT
  addSectionBar(slide, "PATHOGENESIS", 0.55);
  const pathoPoints = [
    "• Trophozoites adhere to duodenal/jejunal epithelium via ventral sucking disc — NO TISSUE INVASION",
    "• Damages brush border → disaccharidase deficiency (especially lactase) → malabsorption",
    "• Villus atrophy (in severe cases) — resembles celiac sprue histologically",
    "• Biopsy: Ranges from near-normal mucosa (96% of cases) to severe villus atrophy with mononuclear infiltrate",
    "• Steatorrhea occurs due to fat malabsorption (bile salt interference)",
    "• Motility disruption by adhering trophozoites → altered gut transit",
    "• Immune evasion: Antigenic variation (VSP switching) every ~2 weeks",
    "• Severity correlates with degree of histopathological change",
  ];
  pathoPoints.forEach((t, i) => {
    slide.addText(t, {
      x: 0.25, y: 0.98 + i * 0.32,
      w: 6.2, h: 0.30,
      fontSize: 9, color: TEXT_BODY, fontFace: "Arial"
    });
  });

  // ANTIGENIC STRUCTURE
  addSectionBar(slide, "ANTIGENIC STRUCTURE", 3.62, SUBHEAD_BG);
  slide.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 4.02, w: 6.2, h: 2.15,
    fill: { color: LIGHT_BOX }, line: { color: ACCENT, width: 0.5 }
  });
  const antigPoints = [
    "• Variant Surface Proteins (VSPs): ~200 cysteine-rich surface proteins expressed by trophozoites",
    "• Antigenic variation: Giardia switches its predominant VSP approximately every 2 weeks — coinciding with peak antibody response — allowing IMMUNE EVASION",
    "• Immune response: Host mounts anti-Giardia IgM, IgG, IgA (serum); secretory IgA in saliva and breast milk of infected mothers",
    "• Breast milk IgA: Protective — may partly explain why breastfed infants have less severe giardiasis",
    "• IL-6 and mast cells: Important in early immune response (animal models)",
    "• Humoral immunity: Essential for clearance — B-cell-deficient mice cannot clear Giardia infection",
    "• Immunodeficiency risk: Patients with common variable immunodeficiency (CVID) / IgA deficiency develop severe, protracted disease",
  ];
  antigPoints.forEach((t, i) => {
    slide.addText(t, {
      x: 0.35, y: 4.07 + i * 0.29,
      w: 6.0, h: 0.27,
      fontSize: 8.5, color: TEXT_BODY, fontFace: "Arial"
    });
  });

  // DISEASE / CLINICAL FEATURES — RIGHT
  addSectionBar(slide, "DISEASE CAUSED — GIARDIASIS: CLINICAL FEATURES", 0.55, ACCENT);

  // Incubation
  slide.addShape(pres.ShapeType.rect, {
    x: 6.7, y: 0.98, w: 6.35, h: 0.28,
    fill: { color: NOTE_BG }, line: { color: GOLD, width: 0.5 }
  });
  slide.addText("Incubation period: 1–3 weeks (average 7–10 days)  |  Infective dose: 10–25 cysts", {
    x: 6.7, y: 0.98, w: 6.35, h: 0.28,
    fontSize: 9, bold: true, color: "7A5000", fontFace: "Arial", valign: "middle", align: "center"
  });

  const clinFeatures = [
    { head: "1. ASYMPTOMATIC", body: "~50–75% of infections are asymptomatic cyst passers. Important reservoir for transmission." },
    { head: "2. ACUTE GIARDIASIS", body: "Sudden onset diarrhea (watery/greasy, foul-smelling, frothy), abdominal cramps, bloating, flatulence, nausea, low-grade fever. Duration: up to 2 weeks." },
    { head: "3. CHRONIC GIARDIASIS", body: "Persistent/intermittent diarrhea (>10 days), malabsorption, steatorrhea, weight loss, anorexia, fatigue. Resembles celiac sprue. Associated with impaired growth in children." },
    { head: "4. MALABSORPTION SYNDROME", body: "Fat, fat-soluble vitamins (A, D, E, K), B12 malabsorption. Disaccharidase (lactase) deficiency → lactose intolerance. Similar to Celiac / Tropical sprue." },
    { head: "5. EXTRA-INTESTINAL", body: "Urticaria (acute & chronic), angioedema, arthritis, cholangitis (rare). Eye manifestations (uveitis) — rare." },
    { head: "6. IMMUNOCOMPROMISED", body: "Severe protracted diarrhea with sprue-like pathology in CVID / IgA deficiency patients." },
  ];

  clinFeatures.forEach((item, i) => {
    const bg = i % 2 === 0 ? LIGHT_BOX : WHITE;
    slide.addShape(pres.ShapeType.rect, {
      x: 6.7, y: 1.3 + i * 1.02, w: 6.35, h: 0.97,
      fill: { color: bg }, line: { color: LINE_COLOR, width: 0.3 }
    });
    slide.addShape(pres.ShapeType.rect, {
      x: 6.7, y: 1.3 + i * 1.02, w: 2.0, h: 0.97,
      fill: { color: DARK_BLUE }
    });
    slide.addText(item.head, {
      x: 6.72, y: 1.3 + i * 1.02, w: 1.96, h: 0.97,
      fontSize: 8.5, bold: true, color: WHITE, fontFace: "Arial", align: "center", valign: "middle", wrap: true
    });
    slide.addText(item.body, {
      x: 8.75, y: 1.35 + i * 1.02, w: 4.2, h: 0.87,
      fontSize: 8.5, color: TEXT_BODY, fontFace: "Arial", valign: "middle", wrap: true
    });
  });

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.2, fill: { color: DARK_BLUE } });
}

// ============================================================
// SLIDE 5: LABORATORY DIAGNOSIS
// ============================================================
{
  let slide = newSlide(BG);

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.45, fill: { color: DARK_BLUE } });
  slide.addText("GIARDIA LAMBLIA — LABORATORY DIAGNOSIS", {
    x: 0.2, y: 0.03, w: 12.9, h: 0.4,
    fontSize: 14, bold: true, color: WHITE, fontFace: "Arial", valign: "middle"
  });
  slide.addText("Slide 5 of 7", {
    x: 10.5, y: 0.03, w: 2.6, h: 0.4,
    fontSize: 9, color: GOLD, fontFace: "Arial", align: "right", valign: "middle"
  });

  // Specimen
  addSectionBar(slide, "SPECIMENS", 0.55, ACCENT);
  slide.addText([
    { text: "• Stool (main): ", options: { bold: true } },
    { text: "Fresh stool — MUST be examined within 30 min (trophozoites) OR preserved in PVA/formalin fixative for later.  " },
    { text: "• Duodenal contents: ", options: { bold: true } },
    { text: "Duodenal aspirate (Enterotest / string test / Beal's string test) — if stool negative.  " },
    { text: "• Duodenal biopsy: ", options: { bold: true } },
    { text: "Gold standard when stool repeatedly negative — shows trophozoites attached to mucosa." }
  ], {
    x: 0.25, y: 0.98, w: 12.9, h: 0.55,
    fontSize: 9.5, color: TEXT_BODY, fontFace: "Arial", wrap: true
  });

  // TABLE of lab methods
  addSectionBar(slide, "DIAGNOSTIC METHODS — DETAILED", 1.6);

  const labMethods = [
    ["Method", "Specimen", "Findings / Notes", "Sensitivity"],
    ["Direct Wet Mount\n(Saline + Iodine)", "Fresh stool", "Saline: Trophozoite motility ('tumbling/falling leaf')\nIodine: Cysts stain golden-brown; 4 nuclei visible", "Low (single specimen)"],
    ["Formal-ether\nConcentration", "Stool", "Concentrates cysts; enhances detection.\nMost common routine method", "Moderate"],
    ["Permanent Stain\n(Trichrome / Iron-hematoxylin)", "Stool", "Best morphological detail of trophozoites & cysts.\nTrophozoite: 2 nuclei + median bodies ('smiling face')\nCysts: 4 nuclei, curved median bodies", "Moderate–High"],
    ["String Test\n(Enterotest)", "Duodenal contents", "Patient swallows gelatin capsule with nylon string.\nString retrieved after 4h — bile-stained section examined.\nTrophozoites found when stool negative", "High (2nd choice)"],
    ["Duodenal Biopsy\n(Endoscopy)", "Duodenal tissue", "Histology shows trophozoites adherent to villi on Giemsa stain.\nGold standard for diagnosis", "Highest"],
    ["Antigen Detection\n(DFA / EIA / ICT)", "Stool", "Detects Giardia-specific antigens (GSA65 antigen).\nHigher sensitivity than O&P.\nCommercially available kits; often combined with Cryptosporidium test", "High"],
    ["NAAT / PCR\n(Multiplex)", "Stool", "FDA-approved multiplex panels (FilmArray GI, Luminex xTAG)\nHighest sensitivity & specificity; detects multiple GI pathogens", "Highest"],
    ["ELISA\n(Serology)", "Serum", "Anti-Giardia IgM, IgG, IgA detectable.\nNot used routinely for clinical diagnosis; more for research/epidemiology", "Variable"],
  ];

  slide.addTable(labMethods, {
    x: 0.2, y: 2.05, w: 13.0, h: 4.8,
    fontSize: 8.5,
    fontFace: "Arial",
    border: { pt: 0.5, color: "CCCCCC" },
    rowH: 0.58,
    align: "left",
    color: TEXT_BODY,
    fill: WHITE,
    colW: [2.2, 2.0, 5.8, 3.0],
    thead: {
      fill: { color: DARK_BLUE },
      color: WHITE,
      bold: true,
      fontSize: 9.5,
      align: "center"
    }
  });

  // Note box
  slide.addShape(pres.ShapeType.rect, {
    x: 0.2, y: 7.0, w: 13.0, h: 0.28,
    fill: { color: NOTE_BG }, line: { color: GOLD, width: 0.5 }
  });
  slide.addText("★ EXAM TIP: 'Stool examination for ova & parasites (O&P) ×3 specimens on alternate days' is the classic recommendation. Sensitivity of a single specimen ~50–70%; 3 specimens increases sensitivity to ~90%.", {
    x: 0.3, y: 7.02, w: 12.8, h: 0.24,
    fontSize: 8.5, color: "7A5000", fontFace: "Arial", valign: "middle", bold: false
  });

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.2, fill: { color: DARK_BLUE } });
}

// ============================================================
// SLIDE 6: MICROSCOPY IMAGES + CULTURE / TRANSPORT MEDIA
// ============================================================
{
  let slide = newSlide(BG);

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.45, fill: { color: DARK_BLUE } });
  slide.addText("GIARDIA LAMBLIA — MICROSCOPY, CULTURE MEDIA & TRANSPORT", {
    x: 0.2, y: 0.03, w: 12.9, h: 0.4,
    fontSize: 14, bold: true, color: WHITE, fontFace: "Arial", valign: "middle"
  });
  slide.addText("Slide 6 of 7", {
    x: 10.5, y: 0.03, w: 2.6, h: 0.4,
    fontSize: 9, color: GOLD, fontFace: "Arial", align: "right", valign: "middle"
  });

  // IMAGES
  addSectionBar(slide, "MICROSCOPY IMAGES", 0.55, ACCENT);

  // Biopsy + cyst image
  if (imgData[1] && !imgData[1].error) {
    slide.addImage({ data: imgData[1].base64, x: 0.2, y: 0.98, w: 4.1, h: 3.2 });
  }
  slide.addText("Fig A: Duodenal biopsy (H&E) — Trophozoites between villi\nFig B: Giardia cyst in stool (Giemsa stain, 400×)", {
    x: 0.2, y: 4.22, w: 4.1, h: 0.5,
    fontSize: 8, color: "555555", fontFace: "Arial", italic: true, align: "center"
  });

  // Trophozoite/cyst stained
  if (imgData[2] && !imgData[2].error) {
    slide.addImage({ data: imgData[2].base64, x: 4.5, y: 0.98, w: 4.1, h: 3.2 });
  }
  slide.addText("Fig A: Trophozoites (trichrome, 1000×)  Fig B: Cysts (trichrome)\nFig C: Duodenal biopsy — trophozoites ventral view (arrow)", {
    x: 4.5, y: 4.22, w: 4.1, h: 0.5,
    fontSize: 8, color: "555555", fontFace: "Arial", italic: true, align: "center"
  });

  // CULTURE MEDIA
  addSectionBar(slide, "CULTURE MEDIA (In Vitro Cultivation)", 4.8);
  slide.addShape(pres.ShapeType.rect, {
    x: 0.2, y: 5.22, w: 8.5, h: 2.0,
    fill: { color: LIGHT_BOX }, line: { color: LINE_COLOR, width: 0.5 }
  });

  const cultureData = [
    [{ text: "TYI-S-33 Medium", options: { bold: true }}, { text: " (Trypticase-Yeast Extract-Iron-Serum) — Most widely used axenic culture medium for Giardia trophozoites" }],
    [{ text: "Keister's modified TYI-S-33", options: { bold: true }}, { text: " — Modified version with increased sensitivity" }],
    [{ text: "Diamond's TYM medium", options: { bold: true }}, { text: " — Used for Entamoeba; less common for Giardia" }],
    [{ text: "Importance:", options: { bold: true, color: ACCENT }}, { text: " Culture mainly used for research and drug sensitivity testing; NOT routinely done for diagnosis" }],
    [{ text: "Growth conditions:", options: { bold: true }}, { text: " 37°C, microaerophilic conditions, pH 7.0–7.2" }],
    [{ text: "Encystation medium:", options: { bold: true }}, { text: " Alkaline media (pH 7.8) + bile — induces cyst formation in vitro for research" }],
  ];

  cultureData.forEach((row, i) => {
    slide.addText(row, {
      x: 0.35, y: 5.28 + i * 0.31,
      w: 8.2, h: 0.28,
      fontSize: 9, color: TEXT_BODY, fontFace: "Arial"
    });
  });

  // TRANSPORT MEDIA
  addSectionBar(slide, "TRANSPORT MEDIA & PRESERVATION", 4.8, ACCENT);
  // reposition right
  slide.addShape(pres.ShapeType.rect, {
    x: 8.85, y: 0.98, w: 4.25, h: 6.25,
    fill: { color: LIGHT_BOX }, line: { color: ACCENT, width: 0.5 }
  });

  slide.addText("TRANSPORT MEDIA", {
    x: 8.95, y: 1.02, w: 4.05, h: 0.3,
    fontSize: 10, bold: true, color: DARK_BLUE, fontFace: "Arial"
  });

  const transportMedia = [
    { name: "PVA Fixative\n(Polyvinyl Alcohol)", use: "Preserves trophozoites & cysts for morphology; allows permanent staining. GOLD STANDARD transport medium" },
    { name: "10% Formalin\n(Formal Saline)", use: "Preserves cysts only. Good for concentration methods (formal-ether). Cannot be used for permanent stains" },
    { name: "SAF\n(Sodium Acetate-Acetic Acid-Formalin)", use: "Preserves both trophozoites & cysts; allows permanent staining + concentration. Better alternative to PVA" },
    { name: "MIF\n(Merthiolate-Iodine-Formalin)", use: "Trophozoites + cysts preserved; directly readable with iodine staining. Quick method" },
    { name: "Schaudinn's Fixative", use: "Used for immediate fixation of fresh stool smears for permanent staining" },
    { name: "Cary-Blair Medium", use: "For bacteria; NOT recommended for protozoa" },
    { name: "Fresh Examination", use: "Ideal: examine within 30 min (trophozoite motility). If >30 min, must use fixative" },
  ];

  transportMedia.forEach((item, i) => {
    slide.addShape(pres.ShapeType.rect, {
      x: 8.87, y: 1.36 + i * 0.73, w: 4.18, h: 0.68,
      fill: { color: i % 2 === 0 ? WHITE : LIGHT_BOX },
      line: { color: "CCCCCC", width: 0.3 }
    });
    slide.addText(item.name, {
      x: 8.9, y: 1.38 + i * 0.73, w: 1.5, h: 0.62,
      fontSize: 8, bold: true, color: DARK_BLUE, fontFace: "Arial", valign: "middle", align: "center", wrap: true
    });
    slide.addShape(pres.ShapeType.line, {
      x: 10.42, y: 1.38 + i * 0.73, w: 0, h: 0.62,
      line: { color: "AAAAAA", width: 0.5 }
    });
    slide.addText(item.use, {
      x: 10.47, y: 1.38 + i * 0.73, w: 2.52, h: 0.62,
      fontSize: 7.5, color: TEXT_BODY, fontFace: "Arial", valign: "middle", wrap: true
    });
  });

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.2, fill: { color: DARK_BLUE } });
}

// ============================================================
// SLIDE 7: TREATMENT + KEY EXAM POINTS
// ============================================================
{
  let slide = newSlide(BG);

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.45, fill: { color: DARK_BLUE } });
  slide.addText("GIARDIA LAMBLIA — TREATMENT, PREVENTION & EXAM KEY POINTS", {
    x: 0.2, y: 0.03, w: 12.9, h: 0.4,
    fontSize: 14, bold: true, color: WHITE, fontFace: "Arial", valign: "middle"
  });
  slide.addText("Slide 7 of 7", {
    x: 10.5, y: 0.03, w: 2.6, h: 0.4,
    fontSize: 9, color: GOLD, fontFace: "Arial", align: "right", valign: "middle"
  });

  // TREATMENT TABLE
  addSectionBar(slide, "TREATMENT OF GIARDIASIS", 0.55);
  const treatTable = [
    ["Drug", "Dose (Adult)", "Duration", "Notes"],
    ["Tinidazole\n(DRUG OF CHOICE)", "2g single dose", "Single dose", "Most effective; best cure rate (~90%). Single dose advantage. Category C in pregnancy"],
    ["Metronidazole\n(Flagyl)", "250mg TDS or 400mg TDS", "5–7 days", "Widely used; most available. Avoid alcohol. Category B in pregnancy after 1st trimester"],
    ["Nitazoxanide", "500mg BD", "3 days", "FDA-approved; good for children (liquid form available). Effective & safe in HIV patients"],
    ["Albendazole", "400mg OD", "5 days", "Alternative; also treats helminths. Less efficacious than metronidazole"],
    ["Paromomycin", "25–30 mg/kg/day in 3 doses", "5–10 days", "Drug of choice in PREGNANCY (not absorbed systemically). Aminoglycoside"],
    ["Quinacrine", "100mg TDS", "5 days", "Older drug; no longer easily available. High efficacy"],
    ["Furazolidone", "100mg QID", "7–10 days", "Liquid form available for children. Limited availability"],
    ["Mebendazole", "200mg TDS", "5 days", "Alternative; less commonly used"],
  ];

  slide.addTable(treatTable, {
    x: 0.2, y: 0.98, w: 12.9, h: 3.2,
    fontSize: 8.5,
    fontFace: "Arial",
    border: { pt: 0.5, color: "CCCCCC" },
    rowH: 0.36,
    align: "left",
    color: TEXT_BODY,
    fill: WHITE,
    colW: [2.5, 2.3, 1.8, 6.3],
    thead: {
      fill: { color: DARK_BLUE },
      color: WHITE,
      bold: true,
      fontSize: 9.5
    }
  });

  // Special situations
  addSectionBar(slide, "TREATMENT IN SPECIAL SITUATIONS", 4.25, ACCENT);
  slide.addShape(pres.ShapeType.rect, {
    x: 0.2, y: 4.65, w: 6.3, h: 1.25,
    fill: { color: LIGHT_BOX }, line: { color: ACCENT, width: 0.5 }
  });
  const specPoints = [
    "• PREGNANCY: Paromomycin (non-absorbed); if unavailable, delay treatment to 2nd trimester then use metronidazole",
    "• CHILDREN: Nitazoxanide (liquid), Tinidazole, Metronidazole (syrup)",
    "• IMMUNOCOMPROMISED: Prolonged/combination therapy often needed. Nitazoxanide useful in HIV",
    "• TREATMENT FAILURE: Combination therapy (e.g., metronidazole + albendazole)",
    "• ASYMPTOMATIC CYST PASSERS: Generally treated to prevent transmission (paromomycin in pregnancy)",
  ];
  specPoints.forEach((t, i) => {
    slide.addText(t, {
      x: 0.35, y: 4.7 + i * 0.235,
      w: 6.1, h: 0.22,
      fontSize: 8.5, color: TEXT_BODY, fontFace: "Arial"
    });
  });

  // PREVENTION
  addSectionBar(slide, "PREVENTION & CONTROL", 4.25, DARK_BLUE);
  slide.addShape(pres.ShapeType.rect, {
    x: 6.7, y: 4.65, w: 6.35, h: 1.25,
    fill: { color: NOTE_BG }, line: { color: GOLD, width: 0.5 }
  });
  const prevPoints = [
    "• Water purification: Boiling (most reliable), filtration with 1μm absolute filter (chlorination ALONE does NOT kill cysts)",
    "• Hand hygiene: Thorough washing with soap before meals and after toilet",
    "• Safe food handling: Avoid raw vegetables washed with contaminated water",
    "• Avoid swimming in untreated freshwater (lakes, streams)",
    "• Treat infected individuals (including asymptomatic carriers in high-risk settings)",
    "• Screen children in daycare settings; exclude symptomatic children",
    "• No vaccine currently available",
  ];
  prevPoints.forEach((t, i) => {
    slide.addText(t, {
      x: 6.85, y: 4.7 + i * 0.175,
      w: 6.1, h: 0.17,
      fontSize: 8.5, color: "7A5000", fontFace: "Arial"
    });
  });

  // KEY EXAM POINTS
  addSectionBar(slide, "⭐ KEY EXAM POINTS — 20-MARK ESSAY & 6-MARK SAQ", 6.0, GOLD);
  slide.addShape(pres.ShapeType.rect, {
    x: 0.2, y: 6.42, w: 12.9, h: 0.82,
    fill: { color: "FFF8E1" }, line: { color: GOLD, width: 1 }
  });

  const keyPoints = [
    "1. Giardia = most common intestinal protozoan worldwide  |  2. CYST = infective form (10–25 cysts sufficient)  |  3. TROPHOZOITE = pathogenic/vegetative form",
    "4. Trophozoite: pear-shaped, 2 nuclei, 8 flagella, sucking disc, 'falling leaf motility', 'smiling face' appearance  |  5. Cyst: oval, 4 nuclei (mature)",
    "6. Diagnosis: Stool O&P × 3 specimens | String test | Biopsy | Antigen EIA | Multiplex NAAT  |  7. Drug of choice: Tinidazole (single dose) / Metronidazole  |  Pregnancy: Paromomycin",
    "8. Mechanism of diarrhea: Brush border damage → disaccharidase deficiency → malabsorption (NOT invasive)  |  9. Culture medium: TYI-S-33  |  10. Transport: PVA fixative",
  ];

  keyPoints.forEach((t, i) => {
    slide.addText(t, {
      x: 0.35, y: 6.46 + i * 0.19,
      w: 12.6, h: 0.18,
      fontSize: 8, color: "5D4000", fontFace: "Arial", bold: i === 0
    });
  });

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.2, fill: { color: DARK_BLUE } });
}

// WRITE FILE
pres.writeFile({ fileName: "/home/daytona/workspace/giardia-answersheet/Giardia_lamblia_Answer_Sheet.pptx" })
  .then(() => {
    console.log("SUCCESS: Giardia_lamblia_Answer_Sheet.pptx created!");
  })
  .catch(err => {
    console.error("ERROR:", err);
    process.exit(1);
  });

cd /home/daytona/workspace/giardia-answersheet && node create_answersheet.js 2>&…

cd /home/daytona/workspace/giardia-answersheet && curl -s -o lifecycle.png "http…

~/giardia-answersheet/create_answersheet.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/giardia-answersheet/create_answersheet.js'

~/giardia-answersheet/create_answersheet.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/giardia-answersheet/create_answersheet.js'

cd /home/daytona/workspace/giardia-answersheet && node create_answersheet.js 2>&…

ls -lh /home/daytona/workspace/giardia-answersheet/Giardia_lamblia_Answer_Sheet.…