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

// ─── COLOUR PALETTE ────────────────────────────────────────────────────────────
const C = {
  darkBg:    "0D1B2A",  // deep navy – title/section slides
  midBg:     "1B3A5C",  // mid-navy – accent bars
  accent:    "E94F37",  // vibrant red-orange (surgical/alert)
  accentSoft:"F5A623",  // amber – highlights
  light:     "F0F4F8",  // near-white content bg
  white:     "FFFFFF",
  textDark:  "1A1A2E",
  textMid:   "2C4A70",
  textLight: "D4E4F7",
  subtext:   "5A7FA8",
  green:     "27AE60",
  red:       "C0392B",
};

// ─── HELPER – section-divider slide ─────────────────────────────────────────
function sectionSlide(title, subtitle) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 2.6, w: 10, h: 0.06, fill: { color: C.accent } });
  s.addText(title, { x: 0.6, y: 1.8, w: 8.8, h: 0.9, fontSize: 40, bold: true, color: C.white, fontFace: "Calibri" });
  if (subtitle) {
    s.addText(subtitle, { x: 0.6, y: 2.8, w: 8.8, h: 0.7, fontSize: 18, color: C.textLight, fontFace: "Calibri" });
  }
  return s;
}

// ─── HELPER – content slide template ────────────────────────────────────────
function contentSlide(heading, accent = C.accent) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  // left accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: accent } });
  // header strip
  s.addShape(pres.ShapeType.rect, { x: 0.12, y: 0, w: 9.88, h: 0.85, fill: { color: C.midBg } });
  s.addText(heading, { x: 0.3, y: 0.08, w: 9.4, h: 0.7, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  return s;
}

// ─── HELPER – bullet block ───────────────────────────────────────────────────
function addBullets(slide, items, x, y, w, h, opts = {}) {
  const rows = items.map((item, i) => ({
    text: item,
    options: {
      bullet: { code: "25B6", indent: 12 },
      breakLine: i < items.length - 1,
      fontSize: opts.fontSize || 14,
      color: opts.color || C.textDark,
      fontFace: "Calibri",
      paraSpaceAfter: 4,
      bold: false,
    },
  }));
  slide.addText(rows, { x, y, w, h, valign: "top", margin: [4, 8, 4, 8] });
}

// ─── HELPER – stat box ───────────────────────────────────────────────────────
function statBox(slide, x, y, w, h, value, label, bg = C.accent) {
  slide.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill: { color: bg }, rectRadius: 0.1, line: { color: bg } });
  slide.addText(value, { x, y: y + 0.07, w, h: h * 0.52, fontSize: 24, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  slide.addText(label, { x, y: y + h * 0.52, w, h: h * 0.45, fontSize: 10, color: C.white, align: "center", valign: "top", fontFace: "Calibri", wrap: true });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1 – TITLE
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkBg } });
  // diagonal accent shape
  s.addShape(pres.ShapeType.rect, { x: 6.8, y: 0, w: 3.2, h: 5.625, fill: { color: C.midBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.6, w: 10, h: 0.1, fill: { color: C.accent } });
  s.addText("ACUTE APPENDICITIS", {
    x: 0.5, y: 1.0, w: 6.0, h: 1.0,
    fontSize: 38, bold: true, color: C.white, fontFace: "Calibri",
    charSpacing: 2,
  });
  s.addText("A Comprehensive Clinical Overview", {
    x: 0.5, y: 2.15, w: 6.0, h: 0.5,
    fontSize: 17, color: C.accentSoft, fontFace: "Calibri", italic: true,
  });
  s.addText([
    { text: "Anatomy  |  Pathophysiology  |  Diagnosis  |  Management", options: { breakLine: true } },
    { text: "Source: Current Surgical Therapy 14e, Mulholland & Greenfield Surgery 7e, Rosen's Emergency Medicine" },
  ], {
    x: 0.5, y: 2.9, w: 6.0, h: 0.9,
    fontSize: 11, color: C.textLight, fontFace: "Calibri",
  });
  // RLQ icon area (text-art placeholder)
  s.addText("⚕", { x: 7.3, y: 1.5, w: 2, h: 2, fontSize: 90, align: "center", color: C.accentSoft });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2 – OVERVIEW / EPIDEMIOLOGY
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Overview & Epidemiology", C.accent);
  // stat boxes
  statBox(s, 0.3,  1.1, 2.1, 1.3, "7–10%",   "Lifetime risk",        C.accent);
  statBox(s, 2.6,  1.1, 2.1, 1.3, "400,000", "US cases/year",        C.midBg);
  statBox(s, 4.9,  1.1, 2.1, 1.3, "100–150", "per 100,000/yr (global)", C.accentSoft);
  statBox(s, 7.2,  1.1, 2.1, 1.3, "16–40%",  "Present perforated",   C.red);

  addBullets(s, [
    "Most common cause of acute surgical abdomen worldwide",
    "Peak incidence: 10–30 years of age; slight male predominance",
    "Mortality <1% for simple appendicitis; rises sharply with perforation",
    "Negative appendectomy rate ~7% with CT-guided diagnosis",
    "Increasing incidence in developing countries parallels Western diet adoption",
  ], 0.3, 2.65, 9.4, 2.6);
}

// ─────────────────────────────────────────────────────────────────────────────
// SECTION DIVIDER – Anatomy
// ─────────────────────────────────────────────────────────────────────────────
sectionSlide("01  Anatomy", "Structure, location, and blood supply of the vermiform appendix");

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 3 – ANATOMY
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Anatomy of the Appendix", C.midBg);
  // left column bullets
  addBullets(s, [
    "~9 cm long, ~0.6 cm wide vermiform (worm-shaped) hollow viscus",
    "Originates from the terminal cecum where the three taenia coli converge",
    "Normally located in the right lower quadrant (RLQ) after normal intestinal rotation",
    "Tip position is variable: retrocecal (most common ~65%), subcecal, pelvic, preileal, postileal",
    "Blood supply: appendiceal artery – a branch of the ileocolic artery",
    "Lymphoid tissue is abundant (MALT); peaks in the second decade of life",
  ], 0.25, 1.0, 5.3, 4.4);

  // right panel – position labels
  s.addShape(pres.ShapeType.rect, { x: 5.8, y: 0.95, w: 3.9, h: 4.4, fill: { color: C.midBg }, rectRadius: 0.08, line: { color: C.midBg } });
  s.addText("Tip Positions & Frequency", { x: 5.85, y: 1.0, w: 3.8, h: 0.4, fontSize: 13, bold: true, color: C.accentSoft, fontFace: "Calibri", align: "center" });

  const positions = [
    ["Retrocecal",  "~65%",  C.accent],
    ["Pelvic",      "~30%",  C.accentSoft],
    ["Subcecal",    "~2%",   C.subtext],
    ["Pre-ileal",   "~1%",   C.subtext],
    ["Post-ileal",  "~0.5%", C.subtext],
  ];
  positions.forEach(([pos, pct, col], i) => {
    const y = 1.55 + i * 0.68;
    s.addShape(pres.ShapeType.roundRect, { x: 5.95, y, w: 3.7, h: 0.52, fill: { color: "1C3A5A" }, rectRadius: 0.06, line: { color: "1C3A5A" } });
    s.addText(pos, { x: 6.1, y: y + 0.05, w: 2.4, h: 0.42, fontSize: 12, color: C.white, fontFace: "Calibri", valign: "middle" });
    s.addText(pct, { x: 8.3, y: y + 0.05, w: 1.2, h: 0.42, fontSize: 13, bold: true, color: col, fontFace: "Calibri", valign: "middle", align: "right" });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SECTION DIVIDER – Pathophysiology
// ─────────────────────────────────────────────────────────────────────────────
sectionSlide("02  Pathophysiology", "Mechanism of obstruction, bacterial overgrowth, and perforation");

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 4 – PATHOPHYSIOLOGY
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Pathophysiology – Cascade of Events", C.accent);

  const steps = [
    ["1", "Luminal Obstruction",         "Fecalith / appendicolith (most common), lymphoid hyperplasia, neoplasm, foreign body, parasites"],
    ["2", "Bacterial Overgrowth",        "Mucus accumulation → distension → venous congestion → bacterial proliferation"],
    ["3", "Visceral Pain",               "Stretching of afferent nerve fibers → vague periumbilical / epigastric pain"],
    ["4", "Arterial Ischemia",           "Progressive congestion obstructs arterial inflow → ischemia → necrosis → gangrene"],
    ["5", "Perforation / Abscess",       "Untreated: wall necrosis → perforation → localised abscess OR generalised peritonitis"],
  ];

  steps.forEach(([num, title, desc], i) => {
    const y = 1.0 + i * 0.88;
    // number circle
    s.addShape(pres.ShapeType.ellipse, { x: 0.22, y: y + 0.08, w: 0.48, h: 0.48, fill: { color: C.accent }, line: { color: C.accent } });
    s.addText(num, { x: 0.22, y: y + 0.08, w: 0.48, h: 0.48, fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    // connector (except last)
    if (i < steps.length - 1) {
      s.addShape(pres.ShapeType.rect, { x: 0.43, y: y + 0.56, w: 0.06, h: 0.34, fill: { color: C.accent }, line: { color: C.accent } });
    }
    s.addText(title, { x: 0.85, y: y + 0.02, w: 3.3, h: 0.28, fontSize: 13, bold: true, color: C.accent, fontFace: "Calibri" });
    s.addText(desc,  { x: 0.85, y: y + 0.3,  w: 8.8, h: 0.46, fontSize: 11, color: C.textDark, fontFace: "Calibri", wrap: true });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 5 – ORGANISMS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Causative Organisms", C.red);

  addBullets(s, [
    "Escherichia coli – most common Gram-negative; isolated in majority of perforated cases",
    "Bacteroides fragilis – dominant anaerobe in perforated/gangrenous appendicitis",
    "Klebsiella pneumoniae",
    "Streptococcus spp.",
    "Enterococcus spp.",
    "Pseudomonas aeruginosa",
  ], 0.3, 1.1, 5.5, 4.2);

  // right info box
  s.addShape(pres.ShapeType.rect, { x: 6.0, y: 1.0, w: 3.7, h: 4.3, fill: { color: C.midBg }, line: { color: C.midBg } });
  s.addText("Clinical Significance", { x: 6.1, y: 1.1, w: 3.5, h: 0.4, fontSize: 13, bold: true, color: C.accentSoft, fontFace: "Calibri" });
  const items = [
    "Guides empirical antibiotic selection",
    "Simple appendicitis: 2nd-gen cephalosporin or amox-clav",
    "Perforated: broad-spectrum coverage (pip/tazo, carbapenems) targeting E. coli + anaerobes",
    "Cefoxitin or ertapenem used in APPAC trial",
  ];
  items.forEach((txt, i) => {
    s.addText("• " + txt, { x: 6.1, y: 1.65 + i * 0.82, w: 3.5, h: 0.75, fontSize: 11, color: C.textLight, fontFace: "Calibri", wrap: true });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SECTION DIVIDER – Clinical Presentation
// ─────────────────────────────────────────────────────────────────────────────
sectionSlide("03  Clinical Presentation", "History, physical signs, and scoring systems");

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 6 – SYMPTOMS / SIGNS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Clinical Presentation", C.accent);

  // Column headings
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.0, w: 4.55, h: 0.38, fill: { color: C.midBg }, line: { color: C.midBg } });
  s.addText("SYMPTOMS", { x: 0.25, y: 1.0, w: 4.55, h: 0.38, fontSize: 13, bold: true, color: C.accentSoft, align: "center", fontFace: "Calibri" });

  s.addShape(pres.ShapeType.rect, { x: 5.2, y: 1.0, w: 4.55, h: 0.38, fill: { color: C.midBg }, line: { color: C.midBg } });
  s.addText("SIGNS", { x: 5.2, y: 1.0, w: 4.55, h: 0.38, fontSize: 13, bold: true, color: C.accentSoft, align: "center", fontFace: "Calibri" });

  addBullets(s, [
    "Vague periumbilical / epigastric pain (early)",
    "Pain migrates to RLQ within 12–24 h",
    "Anorexia (nearly universal)",
    "Nausea and vomiting",
    "Low-grade fever",
    "Malaise",
  ], 0.3, 1.45, 4.5, 3.8);

  addBullets(s, [
    "RLQ tenderness at McBurney's point",
    "Rebound tenderness / guarding",
    "Rovsing's sign (LLQ pressure → RLQ pain)",
    "Psoas sign (retrocecal appendix)",
    "Obturator sign (pelvic appendix)",
    "Tachycardia; voluntary/involuntary guarding",
  ], 5.25, 1.45, 4.5, 3.8);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 7 – ALVARADO SCORE
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Alvarado Scoring System (MANTRELS)", C.accentSoft);

  s.addText("A practical bedside tool to risk-stratify suspected appendicitis (max score: 10)", {
    x: 0.25, y: 1.0, w: 9.5, h: 0.32, fontSize: 12, color: C.textMid, fontFace: "Calibri", italic: true,
  });

  const rows = [
    ["Feature",                                      "Points", true],
    ["Migration of pain to RLQ",                     "1",      false],
    ["Anorexia",                                     "1",      false],
    ["Nausea / Vomiting",                            "1",      false],
    ["RLQ tenderness on exam",                       "2",      false],
    ["Rebound tenderness",                           "1",      false],
    ["Elevated temperature (>37.3°C / 99.1°F)",     "1",      false],
    ["Leukocytosis (WBC >10,000)",                   "2",      false],
    ["Left shift (neutrophilia)",                    "1",      false],
  ];

  rows.forEach(([feat, pts, isHeader], i) => {
    const y = 1.42 + i * 0.44;
    const bg = isHeader ? C.midBg : (i % 2 === 0 ? "E8EEF4" : C.white);
    s.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 7.8, h: 0.43, fill: { color: bg }, line: { color: "C5D3E0" } });
    s.addShape(pres.ShapeType.rect, { x: 8.05, y, w: 1.65, h: 0.43, fill: { color: isHeader ? C.accent : bg }, line: { color: "C5D3E0" } });
    s.addText(feat, { x: 0.35, y: y + 0.04, w: 7.6, h: 0.35, fontSize: isHeader ? 12 : 11, bold: isHeader, color: isHeader ? C.white : C.textDark, fontFace: "Calibri" });
    s.addText(pts,  { x: 8.05, y: y + 0.04, w: 1.65, h: 0.35, fontSize: isHeader ? 12 : 13, bold: true, color: isHeader ? C.white : C.accent, align: "center", fontFace: "Calibri" });
  });

  // legend
  const legend = [
    ["1–4", "Low risk – discharge / observation", C.green],
    ["5–6", "Equivocal – imaging / surgical consult", C.accentSoft],
    ["7–10", "High risk – surgical intervention", C.red],
  ];
  legend.forEach(([score, txt, col], i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.25, y: 5.3 - 0.0 + i * 0, w: 0, h: 0 }); // spacer
    // small badge row below table but abbreviated – fit within slide
  });
  // Single legend line to keep layout clean
  s.addText("Score: 1–4 = low risk  |  5–6 = equivocal  |  7–10 = high risk → surgery", {
    x: 0.25, y: 5.25, w: 9.5, h: 0.3, fontSize: 10.5, color: C.textMid, fontFace: "Calibri",
    bold: true,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SECTION DIVIDER – Investigations
// ─────────────────────────────────────────────────────────────────────────────
sectionSlide("04  Investigations", "Laboratory tests and imaging modalities");

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 8 – LABS + IMAGING
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Laboratory & Imaging Workup", C.midBg);

  // Labs column
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.0, w: 4.3, h: 0.38, fill: { color: C.accent }, line: { color: C.accent } });
  s.addText("LABORATORY", { x: 0.25, y: 1.0, w: 4.3, h: 0.38, fontSize: 12, bold: true, color: C.white, align: "center", fontFace: "Calibri" });

  addBullets(s, [
    "WBC: leukocytosis (>10,000); neutrophilia with left shift",
    "CRP: elevated; correlates with severity",
    "Urinalysis: sterile pyuria in 40% (proximity to ureter) – NOT diagnostic of UTI",
    "β-hCG: rule out ectopic pregnancy in females of childbearing age",
    "BMP / LFTs: baseline before surgery",
  ], 0.3, 1.45, 4.2, 3.8, { fontSize: 12 });

  // Imaging column
  s.addShape(pres.ShapeType.rect, { x: 5.2, y: 1.0, w: 4.55, h: 0.38, fill: { color: C.accent }, line: { color: C.accent } });
  s.addText("IMAGING", { x: 5.2, y: 1.0, w: 4.55, h: 0.38, fontSize: 12, bold: true, color: C.white, align: "center", fontFace: "Calibri" });

  const imaging = [
    ["CT Abdomen/Pelvis", "Gold standard. Sensitivity ~94%, specificity ~95%. Appendix >6 mm, periappendiceal fat stranding, fecalith."],
    ["Ultrasound (US)", "First-line in children & pregnant patients. Avoids radiation. Sensitivity ~75–90%. Non-compressible appendix >6 mm."],
    ["MRI", "Preferred in pregnancy when US is inconclusive. No radiation. Sensitivity ~96%."],
    ["Plain X-ray", "Limited utility. May show appendicolith (~10%), air-fluid levels."],
  ];
  imaging.forEach(([mod, desc], i) => {
    const y = 1.45 + i * 1.02;
    s.addText(mod, { x: 5.3, y, w: 4.3, h: 0.28, fontSize: 12, bold: true, color: C.midBg, fontFace: "Calibri" });
    s.addText(desc, { x: 5.3, y: y + 0.28, w: 4.3, h: 0.65, fontSize: 10.5, color: C.textDark, fontFace: "Calibri", wrap: true });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SECTION DIVIDER – Differential Diagnosis
// ─────────────────────────────────────────────────────────────────────────────
sectionSlide("05  Differential Diagnosis", "Conditions mimicking acute appendicitis");

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 9 – DIFFERENTIAL DIAGNOSIS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Differential Diagnosis", C.red);

  const diffs = [
    { group: "GI",           items: ["Mesenteric adenitis", "Meckel's diverticulitis", "Crohn's disease (terminal ileitis)", "Cecal diverticulitis", "Bowel obstruction"] },
    { group: "Gynaecological", items: ["Ectopic pregnancy", "Ovarian torsion", "Ruptured ovarian cyst", "PID / Tubo-ovarian abscess", "Mittelschmerz"] },
    { group: "Urological",   items: ["Ureteral / renal colic", "Right-sided pyelonephritis", "Cystitis"] },
    { group: "Other",        items: ["Psoas abscess", "Right-sided hernia", "Rectus sheath haematoma"] },
  ];

  const cols = [
    { x: 0.25, y: 1.05 },
    { x: 5.15, y: 1.05 },
  ];
  diffs.forEach((d, idx) => {
    const col = idx < 2 ? cols[0] : cols[1];
    const offset = idx < 2 ? idx : idx - 2;
    const startY = col.y + offset * 2.2;
    const startX = (idx < 2) ? 0.25 : 5.15;

    s.addShape(pres.ShapeType.rect, { x: startX, y: startY, w: 4.6, h: 0.35, fill: { color: C.midBg }, line: { color: C.midBg } });
    s.addText(d.group, { x: startX + 0.1, y: startY, w: 4.4, h: 0.35, fontSize: 12, bold: true, color: C.accentSoft, fontFace: "Calibri", valign: "middle" });
    addBullets(s, d.items, startX + 0.05, startY + 0.38, 4.5, 1.78, { fontSize: 11 });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SECTION DIVIDER – Management
// ─────────────────────────────────────────────────────────────────────────────
sectionSlide("06  Management", "Non-operative and operative approaches");

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 10 – MANAGEMENT OVERVIEW
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Management Overview", C.accent);

  // Decision tree style – 3 boxes
  const boxData = [
    { label: "Uncomplicated\nAppendicitis", x: 0.3,  col: C.green,    w: 2.9 },
    { label: "Perforated /\nAbscess",       x: 3.55, col: C.red,      w: 2.9 },
    { label: "Interval / Elective\n(after non-op)", x: 6.8, col: C.midBg, w: 2.9 },
  ];
  boxData.forEach(b => {
    s.addShape(pres.ShapeType.roundRect, { x: b.x, y: 1.05, w: b.w, h: 0.72, fill: { color: b.col }, rectRadius: 0.08, line: { color: b.col } });
    s.addText(b.label, { x: b.x, y: 1.05, w: b.w, h: 0.72, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  });

  const optionsLeft = [
    "Laparoscopic appendectomy (standard of care)",
    "Open appendectomy (when laparoscopy unavailable/contraindicated)",
    "Antibiotics-only (alternative for select patients – no fecalith, no perforation)",
  ];
  const optionsMid = [
    "IV fluid resuscitation + broad-spectrum antibiotics",
    "If free perforation: emergency surgery",
    "If abscess: IR drain + antibiotics → interval appendectomy 6–8 wk",
    "Oral antibiotics on discharge for 7–10 days",
  ];
  const optionsRight = [
    "Elective laparoscopic appendectomy after non-op success",
    "Colonoscopy in older patients (rule out neoplasm)",
    "Recurrence rate after antibiotics-alone: ~14–40% at 5 yr",
  ];

  addBullets(s, optionsLeft,  0.3,  1.95, 2.85, 3.4, { fontSize: 11 });
  addBullets(s, optionsMid,   3.55, 1.95, 2.85, 3.4, { fontSize: 11 });
  addBullets(s, optionsRight, 6.8,  1.95, 2.85, 3.4, { fontSize: 11 });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 11 – ANTIBIOTICS vs APPENDECTOMY (EVIDENCE)
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Antibiotics vs Appendectomy – Key Evidence", C.accentSoft);

  const trials = [
    { name: "APPAC Trial\n(Finland, 2015/2020)", result: "72.7% no appendectomy at 1 yr; 60.9% at 5 yr; long-term QoL similar", color: C.midBg },
    { name: "CODA Trial\n(USA, 2020)", result: "n=1,552; Antibiotics non-inferior at 30 days for Alvarado ≤7; patient-preference driven", color: C.midBg },
    { name: "Cochrane Meta-analysis\n(6 RCTs)", result: "73.4% antibiotic vs 97.4% surgery cured at 2 wks; complications lower with antibiotics", color: C.midBg },
    { name: "Meta-analysis\n(11 trials, n=2,751)", result: "Non-op: fewer complications, shorter stay; lower efficacy, higher relapse", color: C.midBg },
  ];

  trials.forEach((t, i) => {
    const y = 1.05 + i * 1.12;
    s.addShape(pres.ShapeType.roundRect, { x: 0.25, y, w: 9.5, h: 1.0, fill: { color: i % 2 === 0 ? "E8EEF4" : C.white }, line: { color: "C5D3E0" }, rectRadius: 0.06 });
    s.addText(t.name, { x: 0.35, y: y + 0.08, w: 3.0, h: 0.82, fontSize: 11, bold: true, color: C.midBg, fontFace: "Calibri", valign: "top" });
    s.addShape(pres.ShapeType.rect, { x: 3.35, y: y + 0.18, w: 0.04, h: 0.64, fill: { color: C.accent }, line: { color: C.accent } });
    s.addText(t.result, { x: 3.5, y: y + 0.08, w: 6.1, h: 0.82, fontSize: 11, color: C.textDark, fontFace: "Calibri", valign: "top", wrap: true });
  });

  s.addText("Current standard: Appendectomy. Antibiotics-only is an accepted alternative in uncomplicated cases without fecalith.", {
    x: 0.25, y: 5.28, w: 9.5, h: 0.28, fontSize: 10, bold: true, color: C.accent, fontFace: "Calibri",
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 12 – SPECIAL POPULATIONS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Special Populations", C.midBg);

  const pops = [
    {
      title: "Paediatric",
      color: C.accentSoft,
      points: [
        "Most common acute surgical problem in children",
        "Children <6 yr frequently present perforated",
        "US or MRI preferred to avoid radiation",
        "Laparoscopic appendectomy is standard; non-op viable (80–90% respond at 24–48 h)",
        "Fecalith → NOT suitable for non-operative management",
      ]
    },
    {
      title: "Pregnancy",
      color: C.accent,
      points: [
        "Most common surgical emergency in pregnant patients",
        "Same incidence as non-pregnant; higher perforation rate due to diagnostic delays",
        "Appendix displaced only in <25% at 3rd trimester – typical RLQ pain still valid",
        "MRI preferred when US inconclusive; CT if MRI unavailable and high clinical suspicion",
        "Risk: fetal mortality, maternal sepsis, preterm labour",
      ]
    },
  ];

  pops.forEach((p, idx) => {
    const xStart = idx === 0 ? 0.25 : 5.15;
    s.addShape(pres.ShapeType.rect, { x: xStart, y: 1.0, w: 4.6, h: 0.38, fill: { color: p.color }, line: { color: p.color } });
    s.addText(p.title, { x: xStart, y: 1.0, w: 4.6, h: 0.38, fontSize: 13, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
    addBullets(s, p.points, xStart + 0.1, 1.45, 4.4, 3.9, { fontSize: 11.5 });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 13 – COMPLICATIONS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = contentSlide("Complications of Appendicitis", C.red);

  const comps = [
    { title: "Perforation", desc: "16–40% of all cases; risk increases >24–36 h from symptom onset; leads to peritonitis or abscess formation", col: C.red },
    { title: "Peritonitis", desc: "Generalised soiling of peritoneal cavity; sepsis, multi-organ failure; requires emergency surgery", col: C.red },
    { title: "Appendiceal Abscess / Phlegmon", desc: "Walled-off perforation; managed with IR drainage + antibiotics → interval appendectomy", col: C.accentSoft },
    { title: "Wound Infection / SSI", desc: "More common after open vs laparoscopic surgery; risk higher in perforated disease", col: C.accentSoft },
    { title: "Enterocutaneous Fistula", desc: "Rare; may occur after antibiotic-only management failure or complicated perforation", col: C.subtext },
    { title: "Missed Neoplasm", desc: "Colonoscopy after non-operative treatment in older patients; carcinoid tumour most common appendiceal neoplasm", col: C.subtext },
  ];

  comps.forEach((c, i) => {
    const col = i % 2 === 0 ? 0 : 1;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.25 : 5.15;
    const y = 1.05 + row * 1.48;
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    s.addShape(pres.ShapeType.rect, { x, y, w: 0.18, h: 1.38, fill: { color: c.col }, line: { color: c.col } });
    s.addText(c.title, { x: x + 0.26, y: y + 0.07, w: 4.2, h: 0.32, fontSize: 12, bold: true, color: C.textDark, fontFace: "Calibri" });
    s.addText(c.desc,  { x: x + 0.26, y: y + 0.42, w: 4.2, h: 0.88, fontSize: 10.5, color: C.textDark, fontFace: "Calibri", wrap: true });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 14 – SUMMARY / KEY TAKEAWAYS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: 10, h: 0.06, fill: { color: C.accent } });

  s.addText("Key Takeaways", { x: 0.4, y: 0.15, w: 9.2, h: 0.65, fontSize: 28, bold: true, color: C.white, fontFace: "Calibri" });

  const takes = [
    "Appendicitis is the most common surgical emergency with a 7–10% lifetime risk",
    "Obstruction → bacterial overgrowth → ischaemia → perforation is the classic cascade",
    "McBurney's point tenderness + migration of periumbilical pain to RLQ is the hallmark presentation",
    "Alvarado score ≥7 warrants surgical consultation; CT is gold-standard imaging",
    "Laparoscopic appendectomy remains the standard treatment; antibiotics-only is viable for uncomplicated disease without fecalith",
    "Perforated appendicitis: emergency surgery or IR drainage + antibiotics → interval appendectomy",
    "Always consider special populations: paediatric (prefer US/MRI), pregnant (diagnostic delay = higher perforation risk)",
    "Post-treatment: colonoscopy for older patients to exclude neoplasm",
  ];

  takes.forEach((t, i) => {
    const y = 1.05 + i * 0.55;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: y + 0.08, w: 0.32, h: 0.32, fill: { color: C.accent }, line: { color: C.accent } });
    s.addText((i + 1).toString(), { x: 0.3, y: y + 0.08, w: 0.32, h: 0.32, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(t, { x: 0.72, y, w: 9.0, h: 0.52, fontSize: 12, color: C.textLight, fontFace: "Calibri", valign: "middle" });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/appendicitis-ppt/Acute_Appendicitis.pptx" })
  .then(() => console.log("Done: Acute_Appendicitis.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

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