acute lymphoblastic leukemia histology microscopy images ALL pathology

acute lymphoblastic leukemia clinical features child petechiae lymphadenopathy image site:wikipedia.org OR site:wikimedia.org

mkdir -p /home/daytona/workspace/ALL-presentation && ls /home/daytona/workspace/…

~/ALL-presentation/create_ppt.js

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

// ── colour palette (deep navy + crimson accent + white) ──────────────────────
const NAVY     = "0D2B55";
const NAVY_MID = "16407A";
const CRIMSON  = "C0392B";
const GOLD     = "E8A838";
const LIGHT_BG = "EBF2FA";
const WHITE    = "FFFFFF";
const DARK_TXT = "1A1A2E";
const GREY_TXT = "4A4A6A";

// ── download images as base64 ────────────────────────────────────────────────
const imgUrls = [
  "https://www.rarediseaseadvisor.com/wp-content/uploads/sites/25/2024/03/Acute-lymphoblastic-leukemia-histology_G_1394232965.jpg",
  "https://www.pathologyoutlines.com/imgau/lymphnodesALLTsang12.jpg",
  "https://www.pathologyoutlines.com/imgau/lymphnodesALLTsang02.jpg",
  "https://www.pathologyoutlines.com/imgau/lymphnodesALLTsang10.jpg",
  "https://cdn.orris.care/cdss_images/fdb5c8fe71e065c39b004c65cbed67f5cf283716771ad3ff5c3803b9d3115fb5.png"
];

console.log("Fetching images...");
const imgs = JSON.parse(
  execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imgUrls.map(u => `"${u}"`).join(" ")}`,
    { maxBuffer: 50 * 1024 * 1024 }
  ).toString()
);
console.log("Image fetch results:", imgs.map(i => ({ url: i.url.slice(-40), error: i.error, hasData: !!i.base64 })));

const [imgBloodSmearColor, imgHistoHE, imgHistoLN, imgBloodSmearMono, imgDiagram] = imgs;

// ── helpers ──────────────────────────────────────────────────────────────────
function navBar(slide, title) {
  // top accent bar
  slide.addShape("rect", { x: 0, y: 0, w: 10, h: 0.12, fill: { color: CRIMSON }, line: { color: CRIMSON } });
  // navy header band
  slide.addShape("rect", { x: 0, y: 0.12, w: 10, h: 0.72, fill: { color: NAVY }, line: { color: NAVY } });
  slide.addText(title, {
    x: 0.3, y: 0.12, w: 9.4, h: 0.72,
    fontSize: 18, bold: true, color: WHITE,
    fontFace: "Calibri", valign: "middle", margin: 0
  });
}

function footerBar(slide, tag) {
  slide.addShape("rect", { x: 0, y: 5.37, w: 10, h: 0.25, fill: { color: NAVY }, line: { color: NAVY } });
  slide.addText(`Acute Lymphocytic Leukaemia  |  3rd BDS  |  ${tag}`, {
    x: 0.2, y: 5.37, w: 9.6, h: 0.25,
    fontSize: 7.5, color: "AABBDD", fontFace: "Calibri", valign: "middle", margin: 0
  });
}

function sectionCard(slide, x, y, w, h, titleText, bullets, accentColor = CRIMSON) {
  slide.addShape("rect", { x, y, w, h, fill: { color: WHITE }, line: { color: accentColor, pt: 1.5 },
    shadow: { type: "outer", color: "000000", blur: 5, offset: 2, angle: 135, opacity: 0.1 }
  });
  slide.addShape("rect", { x, y, w, h: 0.34, fill: { color: accentColor }, line: { color: accentColor } });
  slide.addText(titleText, {
    x: x + 0.1, y, w: w - 0.2, h: 0.34,
    fontSize: 9.5, bold: true, color: WHITE, fontFace: "Calibri", valign: "middle", margin: 0
  });
  const bulletItems = bullets.map((b, i) => ({
    text: b,
    options: { bullet: { type: "bullet" }, breakLine: i < bullets.length - 1, fontSize: 8.5, color: DARK_TXT, fontFace: "Calibri" }
  }));
  slide.addText(bulletItems, { x: x + 0.12, y: y + 0.38, w: w - 0.24, h: h - 0.44, valign: "top" });
}

// ── presentation ─────────────────────────────────────────────────────────────
let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author  = "3rd BDS Oral Pathology";
pres.title   = "Acute Lymphocytic Leukaemia";

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — Title slide
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:NAVY }, line:{ color:NAVY } });
  // diagonal crimson accent
  s.addShape("rect", { x:6.8, y:0, w:3.2, h:5.625, fill:{ color:NAVY_MID }, line:{ color:NAVY_MID } });
  // gold top bar
  s.addShape("rect", { x:0, y:0, w:10, h:0.1, fill:{ color:GOLD }, line:{ color:GOLD } });
  // crimson vertical accent
  s.addShape("rect", { x:6.75, y:0.1, w:0.06, h:5.525, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });

  // blood smear image on the right half
  if (imgBloodSmearColor.base64) {
    s.addImage({ data: imgBloodSmearColor.base64, x:6.85, y:0.15, w:3.05, h:5.45, transparency:25 });
  }

  // main text block
  s.addText("ACUTE LYMPHOCYTIC", {
    x:0.5, y:1.1, w:6.0, h:0.75,
    fontSize:30, bold:true, color:WHITE, fontFace:"Calibri", charSpacing:2
  });
  s.addText("LEUKAEMIA", {
    x:0.5, y:1.85, w:6.0, h:0.75,
    fontSize:36, bold:true, color:GOLD, fontFace:"Calibri", charSpacing:3
  });
  s.addShape("rect", { x:0.5, y:2.65, w:3.5, h:0.05, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });
  s.addText("(ALL / Acute Lymphoblastic Leukemia)", {
    x:0.5, y:2.75, w:6.0, h:0.4,
    fontSize:12, italic:true, color:"AABBDD", fontFace:"Calibri"
  });
  s.addText([
    { text:"Presented for: ", options:{ bold:false } },
    { text:"3rd BDS Students", options:{ bold:true } }
  ], { x:0.5, y:3.3, w:6.0, h:0.35, fontSize:12, color:WHITE, fontFace:"Calibri" });
  s.addText("Oral & General Pathology", {
    x:0.5, y:3.7, w:6.0, h:0.35,
    fontSize:11, italic:true, color:"88AACC", fontFace:"Calibri"
  });

  // badge
  s.addShape("rect", { x:0.5, y:4.6, w:2.2, h:0.6, fill:{ color:CRIMSON }, line:{ color:CRIMSON },
    shadow:{ type:"outer", color:"000000", blur:6, offset:2, angle:135, opacity:0.3 }
  });
  s.addText("ORAL PATHOLOGY", { x:0.5, y:4.6, w:2.2, h:0.6,
    fontSize:9, bold:true, color:WHITE, fontFace:"Calibri", align:"center", valign:"middle"
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — Overview / Introduction
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:LIGHT_BG }, line:{ color:LIGHT_BG } });
  navBar(s, "Overview & Introduction");
  footerBar(s, "Introduction");

  // left big text block
  s.addShape("rect", { x:0.3, y:1.0, w:5.6, h:4.1, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 },
    shadow:{ type:"outer", color:"000000", blur:5, offset:2, angle:135, opacity:0.08 }
  });
  s.addShape("rect", { x:0.3, y:1.0, w:5.6, h:0.4, fill:{ color:NAVY }, line:{ color:NAVY } });
  s.addText("What is ALL?", { x:0.4, y:1.0, w:5.4, h:0.4,
    fontSize:13, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0
  });

  const defBullets = [
    "Neoplasm of immature B (pre-B) or T (pre-T) lymphoid cells called LYMPHOBLASTS",
    "Most common cancer of children — ~2500 new cases/year in USA",
    "85% are B-ALL; 15% are T-ALL",
    "B-ALL peaks at ~3 years of age; T-ALL peaks in adolescence",
    "Slightly more frequent in boys; highest incidence in Hispanic/Latino children",
    "Diagnosis requires ≥20% blasts of lymphoid origin in bone marrow",
    "Classified as Acute Lymphoblastic Leukemia/Lymphoma (ALL/LBL)"
  ];
  const defItems = defBullets.map((b,i) => ({
    text: b,
    options: { bullet:{ type:"bullet" }, breakLine: i < defBullets.length-1,
               fontSize:9, color:DARK_TXT, fontFace:"Calibri" }
  }));
  s.addText(defItems, { x:0.45, y:1.45, w:5.35, h:3.5, valign:"top" });

  // right: 3 stat cards
  const cards = [
    { label:"Most Common\nChildhood Cancer", val:"#1", col:CRIMSON },
    { label:"5-year Survival\n(Children)", val:"~90%", col:NAVY },
    { label:"B-ALL\nProportion", val:"85%", col:"1E7A4C" }
  ];
  cards.forEach((c,i) => {
    const cx = 6.2, cy = 1.0 + i*1.35;
    s.addShape("rect", { x:cx, y:cy, w:3.5, h:1.2, fill:{ color:c.col }, line:{ color:c.col },
      shadow:{ type:"outer", color:"000000", blur:6, offset:2, angle:135, opacity:0.2 }
    });
    s.addText(c.val, { x:cx, y:cy+0.05, w:3.5, h:0.65,
      fontSize:26, bold:true, color:GOLD, fontFace:"Calibri", align:"center", valign:"bottom"
    });
    s.addText(c.label, { x:cx, y:cy+0.7, w:3.5, h:0.45,
      fontSize:9, color:WHITE, fontFace:"Calibri", align:"center", valign:"top"
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — Classification (FAB + Immunophenotypic)
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:"F5F8FC" }, line:{ color:"F5F8FC" } });
  navBar(s, "Classification of ALL");
  footerBar(s, "Classification");

  // FAB table card
  s.addShape("rect", { x:0.3, y:1.0, w:4.5, h:4.1, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
  s.addShape("rect", { x:0.3, y:1.0, w:4.5, h:0.38, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });
  s.addText("FAB Morphological Classification", { x:0.4, y:1.0, w:4.3, h:0.38,
    fontSize:11, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0
  });

  const fabRows = [
    ["Type","Cell Size","Nucleus","Nucleoli","Cytoplasm"],
    ["L1","Small","Regular","Indistinct","Scant"],
    ["L2","Large","Irregular","Prominent","Moderate"],
    ["L3\n(Burkitt)","Large","Oval","Prominent","Vacuolated"]
  ];
  const colW = [0.6, 0.9, 0.9, 0.9, 0.9];
  fabRows.forEach((row, ri) => {
    const ry = 1.42 + ri * 0.7;
    const isHeader = ri === 0;
    row.forEach((cell, ci) => {
      const cx = 0.35 + colW.slice(0,ci).reduce((a,b)=>a+b,0);
      if(isHeader){
        s.addShape("rect", { x:cx, y:ry-0.04, w:colW[ci]-0.02, h:0.36,
          fill:{ color:NAVY }, line:{ color:NAVY }
        });
      }
      s.addText(cell, { x:cx+0.02, y:ry, w:colW[ci]-0.06, h:0.28,
        fontSize: isHeader ? 7.5 : 8, bold: isHeader, color: isHeader ? WHITE : DARK_TXT,
        fontFace:"Calibri", align:"center", valign:"middle"
      });
    });
  });

  s.addText("* L1 is most common in children\n* L2 is most common in adults\n* L3 is Burkitt-type (rare)", {
    x:0.35, y:4.3, w:4.3, h:0.7,
    fontSize:7.5, italic:true, color:GREY_TXT, fontFace:"Calibri"
  });

  // Immunophenotypic card
  s.addShape("rect", { x:5.1, y:1.0, w:4.6, h:4.1, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
  s.addShape("rect", { x:5.1, y:1.0, w:4.6, h:0.38, fill:{ color:NAVY }, line:{ color:NAVY } });
  s.addText("Immunophenotypic Classification", { x:5.2, y:1.0, w:4.4, h:0.38,
    fontSize:11, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0
  });

  const immunoBlocks = [
    { type:"Pre-B ALL (B-ALL)", color:CRIMSON, markers:"TdT+, HLA-DR+, CD19+, CD10+/-, CD34+\nSurface Ig absent" },
    { type:"T-ALL", color:"1E6B8C", markers:"TdT+, CD7+, CD3+\nHLA-DR-, CD19-, CD10-" },
    { type:"Common ALL", color:"1E7A4C", markers:"CD10+ (CALLA)\nMost favorable prognosis in children" }
  ];
  immunoBlocks.forEach((blk, i) => {
    const by = 1.48 + i * 1.2;
    s.addShape("rect", { x:5.2, y:by, w:4.3, h:1.1, fill:{ color:blk.color+"22" }, line:{ color:blk.color, pt:1.5 } });
    s.addShape("rect", { x:5.2, y:by, w:0.08, h:1.1, fill:{ color:blk.color }, line:{ color:blk.color } });
    s.addText(blk.type, { x:5.35, y:by+0.05, w:4.0, h:0.28,
      fontSize:9.5, bold:true, color:blk.color, fontFace:"Calibri"
    });
    s.addText(blk.markers, { x:5.35, y:by+0.35, w:4.0, h:0.68,
      fontSize:8, color:DARK_TXT, fontFace:"Calibri"
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — Etiology & Pathogenesis
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:LIGHT_BG }, line:{ color:LIGHT_BG } });
  navBar(s, "Etiology & Pathogenesis");
  footerBar(s, "Etiology & Pathogenesis");

  // Diagram image on right
  if (imgDiagram.base64) {
    s.addShape("rect", { x:5.7, y:0.95, w:4.0, h:3.8, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
    s.addImage({ data: imgDiagram.base64, x:5.75, y:1.0, w:3.9, h:3.7 });
    s.addText("Origin of lymphoid neoplasms (Robbins, 2024)", {
      x:5.7, y:4.75, w:4.0, h:0.28,
      fontSize:6.5, italic:true, color:GREY_TXT, fontFace:"Calibri", align:"center"
    });
  }

  sectionCard(s, 0.3, 1.0, 5.1, 1.65, "Predisposing Factors", [
    "Ionizing radiation (prenatal X-ray exposure, nuclear fallout)",
    "Chemical exposure — benzene, alkylating agents",
    "Viral association — HTLV-1 (T-ALL)",
    "Immunodeficiency syndromes (Wiskott-Aldrich, ataxia-telangiectasia)",
    "Down syndrome — 20x increased risk"
  ], CRIMSON);

  sectionCard(s, 0.3, 2.75, 5.1, 1.65, "Key Molecular Mechanisms", [
    "B-ALL: mutations in PAX5, TCF3, ETV6, RUNX1 (transcription factors)",
    "T-ALL: NOTCH1 mutations (50-70% of cases)",
    "t(9;22) Philadelphia chromosome → BCR-ABL fusion (25% adults, 3% children)",
    "t(12;21) ETV6-RUNX1 — most common translocation in children (25%), GOOD prognosis",
    "Hyperdiploidy (>50 chr) — good prognosis; Hypodiploidy — poor prognosis",
    "Mutations cause maturation arrest + increased self-renewal of blast cells"
  ], NAVY);

  s.addShape("rect", { x:0.3, y:4.5, w:5.1, h:0.7, fill:{ color:GOLD+"33" }, line:{ color:GOLD, pt:1 } });
  s.addText("Key concept: <10 mutations are sufficient to produce full-blown ALL (deep sequencing data)", {
    x:0.4, y:4.5, w:4.9, h:0.7,
    fontSize:8.5, italic:true, color:"6A4000", fontFace:"Calibri", valign:"middle"
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — Clinical Features
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:"F5F8FC" }, line:{ color:"F5F8FC" } });
  navBar(s, "Clinical Features");
  footerBar(s, "Clinical Features");

  // Blood smear image on left
  if (imgBloodSmearMono.base64) {
    s.addShape("rect", { x:0.3, y:1.0, w:3.2, h:2.6,
      fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 },
      shadow:{ type:"outer", color:"000000", blur:5, offset:2, angle:135, opacity:0.1 }
    });
    s.addImage({ data: imgBloodSmearMono.base64, x:0.35, y:1.05, w:3.1, h:2.3 });
    s.addText("Peripheral blood smear — lymphoblasts (Giemsa)", {
      x:0.3, y:3.32, w:3.2, h:0.28, fontSize:6.5, italic:true, color:GREY_TXT,
      fontFace:"Calibri", align:"center"
    });
  }

  // Feature cards
  const features = [
    {
      title:"Due to Bone Marrow Failure",
      items:["Anaemia → pallor, fatigue, exertional dyspnoea","Thrombocytopenia → petechiae, purpura, bleeding","Neutropenia → recurrent infections, fever","Pancytopenia on CBC"]
    },
    {
      title:"Organ Infiltration Signs",
      items:["Lymphadenopathy (generalised, non-tender)","Hepatosplenomegaly","Bone pain & tenderness (expansion of marrow)","Thymic enlargement/mediastinal mass (T-ALL)"]
    },
    {
      title:"CNS Involvement",
      items:["Headache, nausea, vomiting","Cranial nerve palsies","CNS is a sanctuary site — needs prophylaxis","Meningeal infiltration on CSF exam"]
    },
    {
      title:"Other Features",
      items:["Testicular enlargement (boys) — another sanctuary site","Weight loss, malaise, night sweats","Oral manifestations: gingival bleeding, mucosal pallor","Hyperleukocytosis → leucostasis in severe cases"]
    }
  ];

  const startX = [3.7, 6.85, 3.7, 6.85];
  const startY = [1.0, 1.0, 3.05, 3.05];
  const colors = [CRIMSON, NAVY, "1E7A4C", "7B3FA0"];
  features.forEach((f, i) => {
    sectionCard(s, startX[i], startY[i], 2.9, 1.95, f.title, f.items, colors[i]);
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — Histological Features (MAIN SLIDE)
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:LIGHT_BG }, line:{ color:LIGHT_BG } });
  navBar(s, "Histological & Morphological Features");
  footerBar(s, "Histology");

  // Left: histology images stacked
  if (imgHistoHE.base64) {
    s.addShape("rect", { x:0.25, y:1.0, w:3.2, h:2.5, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
    s.addImage({ data: imgHistoHE.base64, x:0.3, y:1.05, w:3.1, h:2.2 });
    s.addText("H&E: Bone marrow — sheets of lymphoblasts (small, uniform)", {
      x:0.25, y:3.25, w:3.2, h:0.28, fontSize:6.5, italic:true, color:GREY_TXT,
      fontFace:"Calibri", align:"center"
    });
  }
  if (imgHistoLN.base64) {
    s.addShape("rect", { x:0.25, y:3.6, w:3.2, h:1.7, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
    s.addImage({ data: imgHistoLN.base64, x:0.3, y:3.65, w:3.1, h:1.4 });
    s.addText("H&E: Lymph node — diffuse infiltration by blasts", {
      x:0.25, y:5.07, w:3.2, h:0.25, fontSize:6.5, italic:true, color:GREY_TXT,
      fontFace:"Calibri", align:"center"
    });
  }

  // Right: histological features text blocks
  const histo1 = [
    "Small to medium-sized cells (10-20 μm)",
    "HIGH nuclear-to-cytoplasmic (N:C) ratio",
    "Round to slightly irregular nuclear contour",
    "Finely stippled (salt-and-pepper) chromatin",
    "Nucleoli: absent/indistinct (L1) or prominent (L2/L3)",
    "Scant pale cytoplasm — NO granules",
    "Delicate nuclear membrane"
  ];
  const histo2 = [
    "Bone marrow: hypercellular — blasts >20% nucleated cells",
    "Diffuse effacement of normal marrow architecture",
    "Starry-sky pattern may occur (like Burkitt lymphoma in L3)",
    "Lymph nodes: diffuse paracortical/cortical obliteration",
    "Spleen: diffuse white pulp expansion",
    "Thymus: cortical infiltration (T-ALL)",
    "Mitotic figures frequently seen"
  ];

  sectionCard(s, 3.7, 1.0, 2.95, 2.6, "Lymphoblast Cytology", histo1, CRIMSON);
  sectionCard(s, 6.75, 1.0, 2.95, 2.6, "Tissue Architecture", histo2, NAVY);

  // Special stains bar
  s.addShape("rect", { x:3.7, y:3.7, w:6.0, h:1.6, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
  s.addShape("rect", { x:3.7, y:3.7, w:6.0, h:0.36, fill:{ color:"7B3FA0" }, line:{ color:"7B3FA0" } });
  s.addText("Special Stains & Immunohistochemistry", { x:3.8, y:3.7, w:5.8, h:0.36,
    fontSize:10, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0
  });
  const stainRows = [
    ["PAS (Periodic Acid-Schiff)", "Coarse block positivity (CHARACTERISTIC of ALL)"],
    ["Sudan Black B / MPO", "NEGATIVE (distinguishes from AML)"],
    ["TdT (Terminal Deoxynucleotidyl Transferase)", "Nuclear positivity — hallmark marker"],
    ["CD10 (CALLA)", "Positive in most B-ALL — good prognostic marker"],
    ["CD19, CD22 (B-ALL) | CD7, CD3 (T-ALL)", "Lineage-specific markers on flow cytometry"]
  ];
  stainRows.forEach((row, i) => {
    const ry = 4.1 + i * 0.22;
    s.addText("• " + row[0], { x:3.8, y:ry, w:3.1, h:0.2, fontSize:7.5, bold:true, color:DARK_TXT, fontFace:"Calibri" });
    s.addText(row[1], { x:6.95, y:ry, w:2.7, h:0.2, fontSize:7.5, color:GREY_TXT, fontFace:"Calibri" });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — Peripheral Blood Smear (dedicated image slide)
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:DARK_TXT }, line:{ color:DARK_TXT } });
  navBar(s, "Peripheral Blood Smear — Microscopic Appearance");
  footerBar(s, "Peripheral Blood Smear");

  if (imgBloodSmearColor.base64) {
    s.addImage({ data: imgBloodSmearColor.base64, x:0.3, y:0.95, w:5.5, h:4.3,
      shadow:{ type:"outer", color:"000000", blur:8, offset:3, angle:135, opacity:0.5 }
    });
  }

  // annotation callouts
  const callouts = [
    { label:"Large lymphoblast", desc:"High N:C ratio, irregular nucleus", y:1.15 },
    { label:"Small lymphoblast", desc:"Round nucleus, scant cytoplasm", y:1.95 },
    { label:"Normal neutrophil", desc:"For size comparison — multilobed", y:2.75 },
    { label:"Erythrocytes", desc:"Normal red cells — anemia evident", y:3.55 },
    { label:"PAS positivity", desc:"Not shown here — see bone marrow", y:4.35 }
  ];
  callouts.forEach(c => {
    s.addShape("rect", { x:6.0, y:c.y, w:3.7, h:0.68, fill:{ color:WHITE+"22" }, line:{ color:WHITE+"55", pt:0.5 } });
    s.addText(c.label, { x:6.1, y:c.y+0.04, w:3.5, h:0.24,
      fontSize:9.5, bold:true, color:GOLD, fontFace:"Calibri"
    });
    s.addText(c.desc, { x:6.1, y:c.y+0.3, w:3.5, h:0.32,
      fontSize:8, color:WHITE, fontFace:"Calibri"
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — Investigations & Diagnosis
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:"F5F8FC" }, line:{ color:"F5F8FC" } });
  navBar(s, "Investigations & Diagnosis");
  footerBar(s, "Investigations");

  const invGroups = [
    {
      title:"Complete Blood Count (CBC)",
      col:CRIMSON,
      items:["WBC: variable (may be very high, normal or low)","Anaemia (normocytic, normochromic)","Thrombocytopenia (<100,000/μL in most)","Peripheral smear: lymphoblasts present"]
    },
    {
      title:"Bone Marrow Aspiration & Biopsy",
      col:NAVY,
      items:["GOLD STANDARD for diagnosis","Blasts ≥20% of nucleated cells (WHO 2022)","Hypercellular marrow with sheets of blasts","Trephine biopsy for architecture"]
    },
    {
      title:"Immunophenotyping (Flow Cytometry)",
      col:"1E7A4C",
      items:["Distinguishes B-ALL from T-ALL","Panel: TdT, CD19, CD10, CD7, CD3","Essential for lineage assignment","Identifies aberrant antigen expression"]
    },
    {
      title:"Cytogenetics & Molecular Studies",
      col:"7B3FA0",
      items:["Karyotype: hyperdiploidy / hypodiploidy / translocations","FISH / PCR: detect t(9;22), t(12;21), KMT2A","Minimal residual disease (MRD) monitoring","Next generation sequencing in select cases"]
    },
    {
      title:"CSF Analysis (Lumbar Puncture)",
      col:"B05A00",
      items:["CNS involvement in ~5% at diagnosis","Blasts in CSF = CNS leukemia","Performed after platelet correction","Intrathecal chemotherapy given prophylactically"]
    },
    {
      title:"Imaging Studies",
      col:"1E5E7A",
      items:["CXR / CT chest: mediastinal widening (T-ALL)","Ultrasound abdomen: hepatosplenomegaly","Skeletal survey: osteopenia, lytic lesions","MRI: CNS / spinal cord involvement"]
    }
  ];

  const colX = [0.25, 3.45, 6.65];
  const rowY = [1.0, 3.1];
  invGroups.forEach((g, i) => {
    const xi = i % 3, yi = Math.floor(i / 3);
    sectionCard(s, colX[xi], rowY[yi], 2.95, 1.95, g.title, g.items, g.col);
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — Treatment & Prognosis
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:LIGHT_BG }, line:{ color:LIGHT_BG } });
  navBar(s, "Treatment & Prognosis");
  footerBar(s, "Treatment & Prognosis");

  sectionCard(s, 0.25, 1.0, 3.0, 2.7, "Chemotherapy Phases", [
    "1. INDUCTION (4-6 weeks): VCR + Pred + Asparaginase ± Daunorubicin → CR in >95% children",
    "2. CNS PROPHYLAXIS: Intrathecal MTX / CNS irradiation",
    "3. CONSOLIDATION: High-dose MTX, 6-MP",
    "4. MAINTENANCE (2-3 years): Daily 6-MP + weekly MTX",
    "Total duration: ~2-3 years"
  ], NAVY);

  sectionCard(s, 0.25, 3.8, 3.0, 1.5, "Targeted Therapy", [
    "Imatinib / Dasatinib: BCR-ABL+ (Ph+ ALL)",
    "CD19-directed CAR-T cell therapy (Tisagenlecleucel)",
    "Blinatumomab: bispecific T-cell engager (anti-CD3/CD19)"
  ], CRIMSON);

  // Prognostic factors table
  s.addShape("rect", { x:3.5, y:1.0, w:6.2, h:4.3, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
  s.addShape("rect", { x:3.5, y:1.0, w:6.2, h:0.38, fill:{ color:"1E7A4C" }, line:{ color:"1E7A4C" } });
  s.addText("Prognostic Factors", { x:3.6, y:1.0, w:6.0, h:0.38,
    fontSize:12, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0
  });

  const progTable = [
    ["Factor","Favorable","Unfavorable"],
    ["Age","1-10 years","<1 yr or >10 yrs"],
    ["WBC at diagnosis","<50,000/μL",">50,000/μL"],
    ["Cytogenetics","Hyperdiploidy, t(12;21)","Hypodiploidy, t(9;22)"],
    ["Response to Rx","Early CR","Slow/no response"],
    ["MRD at end induction","MRD negative","MRD positive"],
    ["Immunophenotype","B-ALL (common)","T-ALL, Pro-B ALL"],
    ["5-yr survival (children)","~90%","~40-60%"]
  ];

  progTable.forEach((row, ri) => {
    const ry = 1.43 + ri * 0.43;
    const isH = ri === 0;
    const fills = ["F0F8FF","E8F5E9","FFF3E0"];
    const bgCol = isH ? "E8F0FB" : fills[(ri-1)%3];
    s.addShape("rect", { x:3.55, y:ry-0.02, w:6.0, h:0.42, fill:{ color:bgCol }, line:{ color:"DDDDDD", pt:0.5 } });
    const cws = [1.8, 2.0, 2.1];
    const cxs = [3.6, 5.45, 7.5];
    row.forEach((cell, ci) => {
      s.addText(cell, { x:cxs[ci], y:ry, w:cws[ci], h:0.38,
        fontSize: isH ? 8.5 : 8,
        bold: isH || ci===0,
        color: isH ? NAVY : (ci===1 ? "1E7A4C" : (ci===2 ? CRIMSON : DARK_TXT)),
        fontFace:"Calibri", valign:"middle"
      });
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — Dental / Oral Significance for BDS Students
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:"F5F8FC" }, line:{ color:"F5F8FC" } });
  navBar(s, "Oral & Dental Significance — BDS Perspective");
  footerBar(s, "Dental Significance");

  // Left column
  sectionCard(s, 0.25, 1.0, 4.7, 2.0, "Oral Manifestations of ALL", [
    "Gingival bleeding — due to thrombocytopenia",
    "Mucosal pallor — due to anaemia",
    "Oral ulceration / mucositis — post-chemotherapy",
    "Gingival hypertrophy / infiltration by leukemic cells",
    "Petechiae on oral mucosa and soft palate",
    "Opportunistic infections: candidiasis, HSV, CMV",
    "Toothache / bone pain — marrow infiltration"
  ], CRIMSON);

  sectionCard(s, 0.25, 3.1, 4.7, 2.2, "Dental Management Considerations", [
    "Medical clearance BEFORE any dental procedure",
    "Check CBC: delay if platelets <50,000/μL or ANC <1000/μL",
    "Avoid elective extractions during active leukemia",
    "Antibiotic prophylaxis for invasive procedures if immunocompromised",
    "Fluoride supplements — prevent rampant caries during chemo",
    "Coordinate with haematologist for timing of dental work",
    "Patient/parent counselling on oral hygiene during chemotherapy"
  ], NAVY);

  // Right: high yield facts for exam
  s.addShape("rect", { x:5.2, y:1.0, w:4.5, h:4.3, fill:{ color:NAVY }, line:{ color:NAVY },
    shadow:{ type:"outer", color:"000000", blur:6, offset:2, angle:135, opacity:0.3 }
  });
  s.addShape("rect", { x:5.2, y:1.0, w:4.5, h:0.42, fill:{ color:GOLD }, line:{ color:GOLD } });
  s.addText("HIGH YIELD EXAM POINTS", { x:5.3, y:1.0, w:4.3, h:0.42,
    fontSize:11, bold:true, color:NAVY, fontFace:"Calibri", valign:"middle", align:"center", margin:0
  });
  const examPoints = [
    "ALL = most common childhood cancer",
    "85% B-ALL | 15% T-ALL",
    "PAS: coarse block positivity (ALL)",
    "TdT: nuclear+, hallmark of ALL",
    "MPO / Sudan Black B: NEGATIVE (vs AML)",
    "t(12;21) = best prognosis in children",
    "t(9;22) = Ph chromosome, worst prognosis",
    "Diagnosis: ≥20% blasts in bone marrow",
    "Starry-sky pattern: ALL-L3 (Burkitt type)",
    "CR rate in children: >95%",
    "CNS + testes = sanctuary sites",
    "CAR-T (Tisagenlecleucel) approved for B-ALL"
  ];
  const examItems = examPoints.map((p,i) => ({
    text: p,
    options: { bullet:{ type:"bullet" }, breakLine: i < examPoints.length-1,
               fontSize:8.5, color:i%2===0 ? WHITE : GOLD, fontFace:"Calibri" }
  }));
  s.addText(examItems, { x:5.3, y:1.48, w:4.2, h:3.7, valign:"top" });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — Summary & Thank You
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:NAVY }, line:{ color:NAVY } });
  s.addShape("rect", { x:0, y:0, w:10, h:0.12, fill:{ color:GOLD }, line:{ color:GOLD } });
  s.addShape("rect", { x:0, y:5.5, w:10, h:0.125, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });

  // Big summary grid
  const summaryItems = [
    { icon:"🔬", head:"Definition", body:"Neoplasm of immature B/T lymphoblasts\n#1 childhood cancer" },
    { icon:"🧬", head:"Pathogenesis", body:"Transcription factor mutations\nChromosomal translocations" },
    { icon:"🩺", head:"Clinical", body:"Pallor, petechiae, lymphadenopathy\nHepatosplenomegaly, bone pain" },
    { icon:"🔎", head:"Histology", body:"High N:C ratio, scant cytoplasm\nFine chromatin, PAS+ blocks" },
    { icon:"💉", head:"Diagnosis", body:"BM biopsy ≥20% blasts\nTdT+, flow cytometry" },
    { icon:"💊", head:"Treatment", body:"Induction → CNS prophylaxis\n→ Consolidation → Maintenance" }
  ];
  summaryItems.forEach((item, i) => {
    const xi = (i % 3) * 3.2 + 0.2;
    const yi = Math.floor(i / 3) * 2.1 + 0.7;
    s.addShape("rect", { x:xi, y:yi, w:3.0, h:1.9, fill:{ color:NAVY_MID }, line:{ color:WHITE+"44", pt:1 } });
    s.addShape("rect", { x:xi, y:yi, w:3.0, h:0.45, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });
    s.addText(item.icon + "  " + item.head, { x:xi+0.05, y:yi, w:2.9, h:0.45,
      fontSize:11, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0
    });
    s.addText(item.body, { x:xi+0.1, y:yi+0.5, w:2.8, h:1.3,
      fontSize:9, color:"CCDDFF", fontFace:"Calibri"
    });
  });

  s.addShape("rect", { x:1.5, y:5.1, w:7.0, h:0.38, fill:{ color:GOLD+"44" }, line:{ color:GOLD, pt:1 } });
  s.addText("Thank You — Questions Welcome", {
    x:1.5, y:5.1, w:7.0, h:0.38,
    fontSize:12, bold:true, color:GOLD, fontFace:"Calibri", align:"center", valign:"middle"
  });
}

// ── write file ──────────────────────────────────────────────────────────────
const outPath = "/home/daytona/workspace/ALL-presentation/Acute_Lymphocytic_Leukaemia_3BDS.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
  console.log("✅  PPTX written to:", outPath);
}).catch(err => {
  console.error("❌  Error:", err);
  process.exit(1);
});

cd /home/daytona/workspace/ALL-presentation && node create_ppt.js 2>&1

sed -i \ 's/"C0392B22"/"FDECEA"/g; s/"1E6B8C22"/"E3F2FD"/g; s/"1E7A4C22"/"E8F5…

ls -lh /home/daytona/workspace/ALL-presentation/Acute_Lymphocytic_Leukaemia_3BDS…

~/ALL-presentation/create_ppt_4slides.js

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

const NAVY     = "0D2B55";
const NAVY_MID = "16407A";
const CRIMSON  = "C0392B";
const GOLD     = "E8A838";
const LIGHT_BG = "EBF2FA";
const WHITE    = "FFFFFF";
const DARK_TXT = "1A1A2E";
const GREY_TXT = "4A4A6A";

// Fetch images
const imgUrls = [
  "https://www.pathologyoutlines.com/imgau/lymphnodesALLTsang12.jpg",
  "https://www.pathologyoutlines.com/imgau/lymphnodesALLTsang02.jpg",
  "https://www.pathologyoutlines.com/imgau/lymphnodesALLTsang10.jpg",
  "https://cdn.orris.care/cdss_images/fdb5c8fe71e065c39b004c65cbed67f5cf283716771ad3ff5c3803b9d3115fb5.png"
];

console.log("Fetching images...");
const imgs = JSON.parse(
  execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imgUrls.map(u => `"${u}"`).join(" ")}`,
    { maxBuffer: 50 * 1024 * 1024 }
  ).toString()
);
console.log("Images:", imgs.map(i => ({ ok: !!i.base64, err: i.error })));

const [imgHistoHE, imgHistoLN, imgBloodSmear, imgDiagram] = imgs;

// ── helpers ──────────────────────────────────────────────────────────────────
function navBar(slide, title) {
  slide.addShape("rect", { x:0, y:0, w:10, h:0.1, fill:{ color:GOLD }, line:{ color:GOLD } });
  slide.addShape("rect", { x:0, y:0.1, w:10, h:0.68, fill:{ color:NAVY }, line:{ color:NAVY } });
  slide.addShape("rect", { x:0, y:0.1, w:0.06, h:0.68, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });
  slide.addText(title, {
    x:0.18, y:0.1, w:9.6, h:0.68,
    fontSize:18, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0
  });
}

function footer(slide, pg) {
  slide.addShape("rect", { x:0, y:5.38, w:10, h:0.245, fill:{ color:NAVY }, line:{ color:NAVY } });
  slide.addText(`Acute Lymphocytic Leukaemia  |  3rd BDS  |  ${pg}  |  Oral Pathology`, {
    x:0.2, y:5.38, w:9.6, h:0.245,
    fontSize:7, color:"AABBDD", fontFace:"Calibri", valign:"middle", margin:0
  });
}

function card(slide, x, y, w, h, title, bullets, accentCol) {
  slide.addShape("rect", { x, y, w, h, fill:{ color:WHITE }, line:{ color:accentCol, pt:1.5 },
    shadow:{ type:"outer", color:"888888", blur:5, offset:2, angle:135, opacity:0.12 }
  });
  slide.addShape("rect", { x, y, w, h:0.33, fill:{ color:accentCol }, line:{ color:accentCol } });
  slide.addText(title, { x:x+0.1, y, w:w-0.2, h:0.33,
    fontSize:9, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0
  });
  const items = bullets.map((b,i) => ({
    text: b,
    options:{ bullet:{ type:"bullet" }, breakLine: i < bullets.length-1,
              fontSize:8, color:DARK_TXT, fontFace:"Calibri" }
  }));
  slide.addText(items, { x:x+0.12, y:y+0.36, w:w-0.24, h:h-0.42, valign:"top" });
}

// ── build presentation ────────────────────────────────────────────────────────
let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title  = "Acute Lymphocytic Leukaemia — 3rd BDS";

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — Title + Overview
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  // Full navy bg
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:NAVY }, line:{ color:NAVY } });
  // Right panel lighter
  s.addShape("rect", { x:5.8, y:0, w:4.2, h:5.625, fill:{ color:NAVY_MID }, line:{ color:NAVY_MID } });
  // Gold top bar
  s.addShape("rect", { x:0, y:0, w:10, h:0.09, fill:{ color:GOLD }, line:{ color:GOLD } });
  // Crimson divider
  s.addShape("rect", { x:5.75, y:0, w:0.06, h:5.625, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });
  // Bottom bar
  s.addShape("rect", { x:0, y:5.53, w:10, h:0.095, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });

  // Image on right
  if (imgHistoHE.base64) {
    s.addImage({ data:imgHistoHE.base64, x:5.85, y:0.12, w:4.05, h:5.35, transparency:20 });
  }

  // Left: Title text
  s.addText("ACUTE", { x:0.5, y:0.7, w:5.1, h:0.65, fontSize:34, bold:true, color:WHITE, fontFace:"Calibri", charSpacing:5 });
  s.addText("LYMPHOCYTIC", { x:0.5, y:1.35, w:5.1, h:0.65, fontSize:34, bold:true, color:GOLD, fontFace:"Calibri", charSpacing:3 });
  s.addText("LEUKAEMIA", { x:0.5, y:2.0, w:5.1, h:0.65, fontSize:34, bold:true, color:WHITE, fontFace:"Calibri", charSpacing:3 });
  s.addShape("rect", { x:0.5, y:2.72, w:4.0, h:0.05, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });
  s.addText("(ALL / Acute Lymphoblastic Leukemia)", { x:0.5, y:2.82, w:5.0, h:0.35, fontSize:11, italic:true, color:"AABBDD", fontFace:"Calibri" });

  // Quick facts
  const facts = ["Most common childhood cancer", "85% B-ALL | 15% T-ALL", "Peak age: 3 years (B-ALL)", "5-yr survival: ~90% in children"];
  facts.forEach((f, i) => {
    s.addShape("rect", { x:0.5, y:3.35+i*0.47, w:0.06, h:0.28, fill:{ color:GOLD }, line:{ color:GOLD } });
    s.addText(f, { x:0.68, y:3.35+i*0.47, w:4.8, h:0.3, fontSize:10, color:WHITE, fontFace:"Calibri", valign:"middle" });
  });

  // Presented for badge
  s.addShape("rect", { x:0.5, y:5.1, w:3.5, h:0.38, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });
  s.addText("Presented for: 3rd BDS  |  Oral Pathology", { x:0.5, y:5.1, w:3.5, h:0.38,
    fontSize:9, bold:true, color:WHITE, fontFace:"Calibri", align:"center", valign:"middle"
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — Clinical Features + Etiology
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:LIGHT_BG }, line:{ color:LIGHT_BG } });
  navBar(s, "Etiology & Clinical Features");
  footer(s, "Slide 2/4");

  // Image (diagram) top right
  if (imgDiagram.base64) {
    s.addShape("rect", { x:6.9, y:0.9, w:2.85, h:2.5, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
    s.addImage({ data:imgDiagram.base64, x:6.95, y:0.95, w:2.75, h:2.25 });
    s.addText("Origin of lymphoid neoplasms (Robbins, 2024)", { x:6.9, y:3.22, w:2.85, h:0.22, fontSize:5.5, italic:true, color:GREY_TXT, fontFace:"Calibri", align:"center" });
  }

  // Etiology card — left top
  card(s, 0.25, 0.9, 3.3, 2.0, "Etiology / Predisposing Factors", [
    "Ionizing radiation (prenatal X-rays, fallout)",
    "Chemical exposure: benzene, alkylating agents",
    "HTLV-1 virus (T-ALL association)",
    "Down syndrome — 20x increased risk",
    "Immunodeficiency: Wiskott-Aldrich, AT",
    "t(9;22) Ph chromosome — 25% adults, 3% children"
  ], CRIMSON);

  // Pathogenesis card — left bottom
  card(s, 0.25, 2.98, 3.3, 2.0, "Pathogenesis (Key Mutations)", [
    "B-ALL: PAX5, TCF3, ETV6, RUNX1 mutations",
    "T-ALL: NOTCH1 mutations (50-70%)",
    "t(12;21) ETV6-RUNX1: best prognosis (25% children)",
    "Hyperdiploidy (>50 chr): good prognosis",
    "Hypodiploidy: poor prognosis",
    "Maturation arrest + increased self-renewal"
  ], NAVY);

  // Clinical features — middle
  card(s, 3.75, 0.9, 2.9, 2.0, "Due to Bone Marrow Failure", [
    "Anaemia → pallor, fatigue, dyspnoea",
    "Thrombocytopenia → petechiae, purpura",
    "Neutropenia → infections, fever",
    "Pancytopenia on CBC"
  ], "1E7A4C");

  card(s, 3.75, 2.98, 2.9, 2.0, "Organ Infiltration Signs", [
    "Generalised lymphadenopathy",
    "Hepatosplenomegaly",
    "Bone pain & tenderness",
    "Mediastinal mass (T-ALL)",
    "CNS: headache, cranial nerve palsies",
    "Testicular enlargement (boys)"
  ], "7B3FA0");
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — Histological Features (with images)
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:"F5F8FC" }, line:{ color:"F5F8FC" } });
  navBar(s, "Histological Features");
  footer(s, "Slide 3/4");

  // Image 1: bone marrow H&E
  if (imgHistoHE.base64) {
    s.addShape("rect", { x:0.25, y:0.9, w:3.0, h:2.2, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
    s.addImage({ data:imgHistoHE.base64, x:0.3, y:0.95, w:2.9, h:1.95 });
    s.addShape("rect", { x:0.25, y:2.9, w:3.0, h:0.3, fill:{ color:NAVY }, line:{ color:NAVY } });
    s.addText("H&E — Bone marrow: sheets of lymphoblasts", { x:0.3, y:2.91, w:2.9, h:0.28, fontSize:6.5, color:WHITE, fontFace:"Calibri", valign:"middle" });
  }

  // Image 2: lymph node
  if (imgHistoLN.base64) {
    s.addShape("rect", { x:0.25, y:3.28, w:3.0, h:1.85, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
    s.addImage({ data:imgHistoLN.base64, x:0.3, y:3.33, w:2.9, h:1.6 });
    s.addShape("rect", { x:0.25, y:4.93, w:3.0, h:0.3, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });
    s.addText("H&E — Lymph node: diffuse blast infiltration", { x:0.3, y:4.94, w:2.9, h:0.28, fontSize:6.5, color:WHITE, fontFace:"Calibri", valign:"middle" });
  }

  // Image 3: blood smear
  if (imgBloodSmear.base64) {
    s.addShape("rect", { x:3.45, y:0.9, w:2.8, h:2.2, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
    s.addImage({ data:imgBloodSmear.base64, x:3.5, y:0.95, w:2.7, h:1.95 });
    s.addShape("rect", { x:3.45, y:2.9, w:2.8, h:0.3, fill:{ color:"1E7A4C" }, line:{ color:"1E7A4C" } });
    s.addText("Peripheral smear — lymphoblasts circulating", { x:3.5, y:2.91, w:2.7, h:0.28, fontSize:6.5, color:WHITE, fontFace:"Calibri", valign:"middle" });
  }

  // Histological features text — right
  s.addShape("rect", { x:3.45, y:3.28, w:6.3, h:1.95, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
  s.addShape("rect", { x:3.45, y:3.28, w:6.3, h:0.33, fill:{ color:"7B3FA0" }, line:{ color:"7B3FA0" } });
  s.addText("Special Stains & Markers", { x:3.55, y:3.28, w:6.1, h:0.33, fontSize:9.5, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0 });
  const stains = [
    ["PAS stain","Coarse block positivity — CHARACTERISTIC of ALL"],
    ["Sudan Black B / MPO","NEGATIVE — distinguishes ALL from AML"],
    ["TdT (nuclear)","POSITIVE — hallmark marker of ALL (immature lymphoblasts)"],
    ["CD10 / CALLA","Positive in B-ALL — favourable prognostic marker"],
    ["CD19, CD22","B-ALL lineage | CD7, CD3 — T-ALL lineage (flow cytometry)"]
  ];
  stains.forEach((row, i) => {
    const ry = 3.65 + i * 0.3;
    s.addShape("rect", { x:3.55, y:ry, w:1.5, h:0.27, fill:{ color:"7B3FA022" }, line:{ color:"7B3FA0", pt:0.5 } });
    s.addText(row[0], { x:3.58, y:ry+0.03, w:1.44, h:0.22, fontSize:7.5, bold:true, color:"7B3FA0", fontFace:"Calibri", valign:"middle" });
    s.addText(row[1], { x:5.1, y:ry+0.03, w:4.55, h:0.22, fontSize:7.5, color:DARK_TXT, fontFace:"Calibri", valign:"middle" });
  });

  // Cytology features card — top right
  s.addShape("rect", { x:6.45, y:0.9, w:3.3, h:2.2, fill:{ color:WHITE }, line:{ color:CRIMSON, pt:1.5 } });
  s.addShape("rect", { x:6.45, y:0.9, w:3.3, h:0.33, fill:{ color:CRIMSON }, line:{ color:CRIMSON } });
  s.addText("Lymphoblast Cytology", { x:6.55, y:0.9, w:3.1, h:0.33, fontSize:9.5, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0 });
  const cytoItems = [
    "Small–medium cells (10–20 μm)",
    "HIGH nuclear-to-cytoplasmic ratio",
    "Round/irregular nuclear contour",
    "Finely stippled (salt-and-pepper) chromatin",
    "Nucleoli: indistinct (L1) / prominent (L2)",
    "Scant pale cytoplasm — NO granules",
    "Frequent mitotic figures"
  ].map((b,i) => ({ text:b, options:{ bullet:{ type:"bullet" }, breakLine: i<6, fontSize:7.5, color:DARK_TXT, fontFace:"Calibri" } }));
  s.addText(cytoItems, { x:6.58, y:1.27, w:3.1, h:1.78, valign:"top" });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — Investigations, Treatment & Dental Significance
// ════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape("rect", { x:0, y:0, w:10, h:5.625, fill:{ color:LIGHT_BG }, line:{ color:LIGHT_BG } });
  navBar(s, "Diagnosis, Treatment & Dental Significance");
  footer(s, "Slide 4/4");

  // Investigations
  card(s, 0.25, 0.9, 3.0, 2.35, "Investigations", [
    "CBC: anaemia, thrombocytopenia, variable WBC",
    "Peripheral smear: circulating blasts",
    "Bone marrow biopsy: GOLD STANDARD (≥20% blasts)",
    "Flow cytometry: TdT+, lineage markers",
    "Cytogenetics: t(9;22), t(12;21), hyperdiploidy",
    "CSF analysis: CNS involvement",
    "CXR/CT: mediastinal mass (T-ALL)"
  ], NAVY);

  // Treatment
  card(s, 0.25, 3.33, 3.0, 1.95, "Treatment", [
    "Induction: VCR + Pred + Asparaginase (CR >95%)",
    "CNS prophylaxis: intrathecal methotrexate",
    "Consolidation: high-dose MTX, 6-MP",
    "Maintenance: 2–3 years (6-MP + MTX)",
    "Ph+ ALL: imatinib/dasatinib added",
    "CAR-T (CD19): relapsed/refractory B-ALL"
  ], CRIMSON);

  // Prognosis table
  s.addShape("rect", { x:3.45, y:0.9, w:3.3, h:2.35, fill:{ color:WHITE }, line:{ color:"CCDDEE", pt:1 } });
  s.addShape("rect", { x:3.45, y:0.9, w:3.3, h:0.33, fill:{ color:"1E7A4C" }, line:{ color:"1E7A4C" } });
  s.addText("Prognostic Factors", { x:3.55, y:0.9, w:3.1, h:0.33, fontSize:9.5, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", margin:0 });
  const progRows = [
    ["Factor","Favorable","Unfavorable"],
    ["Age","1–10 yrs","<1 or >10 yrs"],
    ["WBC","<50,000","≥50,000/μL"],
    ["Cytogenetics","Hyperdiploidy\nt(12;21)","Hypodiploidy\nt(9;22)"],
    ["5-yr survival","~90% (child)","~40–60%"]
  ];
  progRows.forEach((row, ri) => {
    const ry = 1.27 + ri * 0.38;
    const isH = ri === 0;
    const bg = isH ? "E8F0FB" : (ri%2===0 ? "F7FBFF" : "FFFFFF");
    s.addShape("rect", { x:3.5, y:ry-0.02, w:3.2, h:0.38, fill:{ color:bg }, line:{ color:"DDDDDD", pt:0.5 } });
    const cws = [0.95, 1.0, 1.0]; const cxs = [3.55, 4.55, 5.6];
    row.forEach((cell, ci) => {
      s.addText(cell, { x:cxs[ci], y:ry, w:cws[ci], h:0.34,
        fontSize: isH ? 7.5 : 7, bold: isH || ci===0,
        color: isH ? NAVY : (ci===1 ? "1E7A4C" : (ci===2 ? CRIMSON : DARK_TXT)),
        fontFace:"Calibri", valign:"middle"
      });
    });
  });

  // Dental significance — high yield card (right)
  s.addShape("rect", { x:6.95, y:0.9, w:2.8, h:4.38, fill:{ color:NAVY }, line:{ color:NAVY },
    shadow:{ type:"outer", color:"333333", blur:6, offset:2, angle:135, opacity:0.3 }
  });
  s.addShape("rect", { x:6.95, y:0.9, w:2.8, h:0.38, fill:{ color:GOLD }, line:{ color:GOLD } });
  s.addText("HIGH YIELD — BDS", { x:6.95, y:0.9, w:2.8, h:0.38, fontSize:10, bold:true, color:NAVY, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
  const hySections = [
    { head:"Oral Manifestations", col:CRIMSON, pts:["Gingival bleeding (thrombocytopenia)","Mucosal pallor (anaemia)","Petechiae on soft palate","Gingival infiltration by blasts","Oral candidiasis (immunosuppressed)"] },
    { head:"Dental Management", col:GOLD, pts:["Check CBC before any procedure","Delay if plt <50,000 or ANC <1000","Antibiotic prophylaxis if neutropenic","Coordinate with haematologist","Fluoride for caries prevention"] }
  ];
  let ty = 1.35;
  hySections.forEach(sec => {
    s.addShape("rect", { x:7.05, y:ty, w:2.6, h:0.26, fill:{ color:sec.col }, line:{ color:sec.col } });
    s.addText(sec.head, { x:7.05, y:ty, w:2.6, h:0.26, fontSize:8, bold:true, color:NAVY, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    ty += 0.28;
    sec.pts.forEach(p => {
      s.addText("• " + p, { x:7.08, y:ty, w:2.55, h:0.28, fontSize:7, color:WHITE, fontFace:"Calibri", valign:"middle" });
      ty += 0.28;
    });
    ty += 0.1;
  });

  // Oral significance card below prognosis
  card(s, 3.45, 3.33, 3.3, 1.95, "Classification (FAB)", [
    "L1 — Small uniform blasts; most common in children",
    "L2 — Large irregular blasts; most common in adults",
    "L3 — Large vacuolated blasts; Burkitt-type (rare)",
    "WHO 2022: classification by immunophenotype preferred",
    "TdT+ (nuclear) differentiates ALL from mature NHL"
  ], "7B3FA0");
}

// ── write ─────────────────────────────────────────────────────────────────────
const out = "/home/daytona/workspace/ALL-presentation/ALL_4Slides_3BDS.pptx";
pres.writeFile({ fileName: out }).then(() => {
  console.log("✅  Written:", out);
}).catch(err => {
  console.error("❌", err); process.exit(1);
});

cd /home/daytona/workspace/ALL-presentation && node create_ppt_4slides.js 2>&1

ls -lh /home/daytona/workspace/ALL-presentation/ALL_4Slides_3BDS.pptx