cd /home/daytona/workspace/attachments/e8f54e84-e639-4040-b589-bd4760523213 && p…

cd /home/daytona/workspace/attachments/e8f54e84-e639-4040-b589-bd4760523213 && p…

python3 -c " from pptx import Presentation prs = Presentation('/home/daytona/wor…

pip install python-pptx --quiet 2>&1 | tail -3

python3 -c " from pptx import Presentation prs = Presentation('/home/daytona/wor…

mkdir -p /home/daytona/workspace/sports_physio_ppt && ls /home/daytona/workspace…

~/sports_physio_ppt/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Sports Medicine: Pharmacology, Doping & Physiotherapy";
pres.author = "Sports Medicine & Physiotherapy";

// ─── COLOR PALETTE ───────────────────────────────────────────────
const C = {
  navyDark:  "0D1B2A",   // dominant dark background
  navy:      "1B2A4A",   // secondary dark
  teal:      "00B4D8",   // accent teal
  tealLight: "90E0EF",   // light teal
  white:     "FFFFFF",
  offWhite:  "E8F4FD",
  red:       "E63946",
  amber:     "F4A261",
  green:     "2DC653",
  gray:      "8B9DB0",
  grayLight: "CCD6E0",
};

// ─── HELPER: accent bar at top ───────────────────────────────────
function topBar(slide, color) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 0.12, fill: { color: color || C.teal }, line: { color: color || C.teal }
  });
}

// ─── HELPER: section badge ────────────────────────────────────────
function badge(slide, label, x, y, bgColor) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w: 2.1, h: 0.32, fill: { color: bgColor || C.teal }, line: { color: bgColor || C.teal }, rectRadius: 0.05
  });
  slide.addText(label, {
    x, y, w: 2.1, h: 0.32, fontSize: 8, bold: true, color: C.navyDark, align: "center", valign: "middle", margin: 0
  });
}

// ─── HELPER: dark bg slide ────────────────────────────────────────
function darkBg(slide) {
  slide.background = { color: C.navyDark };
}

// ─── HELPER: info card ────────────────────────────────────────────
function infoCard(slide, x, y, w, h, title, lines, accentColor) {
  const ac = accentColor || C.teal;
  slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: C.navy }, line: { color: ac, pt: 1.5 } });
  slide.addShape(pres.ShapeType.rect, { x, y, w, h: 0.04, fill: { color: ac }, line: { color: ac } });
  slide.addText(title, { x: x+0.12, y: y+0.06, w: w-0.24, h: 0.3, fontSize: 9.5, bold: true, color: ac, margin: 0 });
  const bullets = lines.map((t, i) => ({
    text: t,
    options: { bullet: { type: "bullet" }, fontSize: 7.8, color: C.offWhite, breakLine: i < lines.length - 1, paraSpaceBefore: 2 }
  }));
  slide.addText(bullets, { x: x+0.12, y: y+0.42, w: w-0.24, h: h-0.52, valign: "top", margin: 0 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE SLIDE
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  darkBg(sl);

  // gradient-like side stripe
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.08, h: 5.625, fill: { color: C.teal }, line: { color: C.teal } });
  sl.addShape(pres.ShapeType.rect, { x: 0.08, y: 0, w: 0.08, h: 5.625, fill: { color: "007EA7" }, line: { color: "007EA7" } });

  sl.addText("SPORTS MEDICINE", {
    x: 0.5, y: 1.0, w: 9, h: 0.65, fontSize: 38, bold: true, color: C.teal, charSpacing: 5, align: "left", margin: 0
  });
  sl.addText("Pharmacology of Doping, Prohibited Substances & the Physiotherapist's Role", {
    x: 0.5, y: 1.75, w: 8.8, h: 0.85, fontSize: 16, color: C.offWhite, align: "left", margin: 0
  });

  sl.addShape(pres.ShapeType.line, { x: 0.5, y: 2.72, w: 5.5, h: 0, line: { color: C.teal, pt: 1.5 } });

  sl.addText([
    { text: "Based on: ", options: { bold: false, color: C.gray } },
    { text: "KD Tripathi's Essentials of Medical Pharmacology (8e) • WADA 2024 Prohibited List • Tietz Laboratory Medicine (7e) • Bailey & Love's Surgery (28e) • Miller's Orthopaedics (9e)", options: { bold: false, color: C.tealLight } }
  ], { x: 0.5, y: 2.9, w: 9, h: 0.7, fontSize: 8.5, align: "left", margin: 0 });

  sl.addText("Pharmacology for Medical & Physiotherapy Students", {
    x: 0.5, y: 4.6, w: 9, h: 0.4, fontSize: 10, italic: true, color: C.gray, align: "left", margin: 0
  });

  // decorative circles
  sl.addShape(pres.ShapeType.ellipse, { x: 8.2, y: 0.3, w: 2.5, h: 2.5, fill: { color: C.navy }, line: { color: C.teal, pt: 2 } });
  sl.addShape(pres.ShapeType.ellipse, { x: 8.6, y: 0.7, w: 1.6, h: 1.6, fill: { color: "007EA7" }, line: { color: C.tealLight, pt: 1 } });
  sl.addText("2024\nWADA", { x: 8.6, y: 0.85, w: 1.6, h: 1.2, fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 — INTRODUCTION TO DOPING
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  darkBg(sl);
  topBar(sl);

  badge(sl, "INTRODUCTION", 0.4, 0.2);

  sl.addText("Doping in Sports: Definitions, Governance & Ethics", {
    x: 0.4, y: 0.6, w: 9.2, h: 0.6, fontSize: 22, bold: true, color: C.white, margin: 0
  });

  // Two-column layout
  // Left: key definitions
  sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.35, w: 4.5, h: 3.7, fill: { color: C.navy }, line: { color: C.teal, pt: 1 } });
  sl.addText("What is Doping?", { x: 0.45, y: 1.45, w: 4.2, h: 0.35, fontSize: 11, bold: true, color: C.teal, margin: 0 });
  sl.addText([
    { text: "WADA Definition: ", options: { bold: true, color: C.tealLight, breakLine: false } },
    { text: "Use of substances or methods on the Prohibited List that violate the spirit of sport — regardless of intent.\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Three-Criterion Rule\n", options: { bold: true, color: C.amber, breakLine: true } },
    { text: "A substance/method is prohibited if it satisfies ≥2 of:\n", options: { color: C.offWhite, breakLine: true } },
    { text: "① Performance-enhancing potential\n② Risk to athlete health\n③ Against the spirit of sport\n", options: { color: C.tealLight, breakLine: true } },
    { text: "\nStrict Liability: ", options: { bold: true, color: C.red, breakLine: false } },
    { text: "Athletes bear full responsibility for any substance detected in their biological samples, regardless of route of exposure (WADA Code 2021, Art. 2.1).", options: { color: C.offWhite } }
  ], { x: 0.45, y: 1.9, w: 4.2, h: 2.9, fontSize: 8.8, valign: "top", margin: 0 });

  // Right: Timeline & key facts
  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.35, w: 4.5, h: 3.7, fill: { color: C.navy }, line: { color: C.amber, pt: 1 } });
  sl.addText("Historical Milestones", { x: 5.25, y: 1.45, w: 4.2, h: 0.35, fontSize: 11, bold: true, color: C.amber, margin: 0 });
  sl.addText([
    { text: "1960 Rome Olympics", options: { bold: true, color: C.amber, breakLine: true } },
    { text: "Death of Knud Jensen (DEN cyclist) — first doping fatality at Olympics\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "1967", options: { bold: true, color: C.amber, breakLine: false } },
    { text: " — IOC Medical Commission established\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "1999", options: { bold: true, color: C.amber, breakLine: false } },
    { text: " — WADA founded (Lausanne)\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "2004", options: { bold: true, color: C.amber, breakLine: false } },
    { text: " — WADA Code adopted by NADA India\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "2021 WADA Code", options: { bold: true, color: C.tealLight, breakLine: false } },
    { text: " — Added 'non-analytical anti-doping rule violations' (trafficking, complicity)", options: { color: C.offWhite } }
  ], { x: 5.25, y: 1.9, w: 4.2, h: 2.9, fontSize: 8.8, valign: "top", margin: 0 });

  // Source note
  sl.addText("Source: Tietz Textbook of Laboratory Medicine 7e; WADA Code 2021", {
    x: 0.4, y: 5.25, w: 9.2, h: 0.25, fontSize: 7, italic: true, color: C.gray, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 3 — ANABOLIC ANDROGENIC STEROIDS (AAS) - MECHANISM
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  darkBg(sl);
  topBar(sl);

  badge(sl, "CLASS I — ANABOLIC STEROIDS", 0.4, 0.2, C.red);

  sl.addText("Anabolic Androgenic Steroids (AAS): Mechanisms & Pharmacology", {
    x: 0.4, y: 0.6, w: 9.2, h: 0.55, fontSize: 20, bold: true, color: C.white, margin: 0
  });

  // Mechanism box
  sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.3, w: 9.4, h: 1.55, fill: { color: "1A0A1A" }, line: { color: C.red, pt: 1.5 } });
  sl.addText("MOLECULAR MECHANISM", { x: 0.45, y: 1.38, w: 4, h: 0.28, fontSize: 8.5, bold: true, color: C.red, margin: 0, charSpacing: 2 });
  sl.addText([
    { text: "AAS diffuse across the cell membrane → bind cytoplasmic ", options: { color: C.offWhite } },
    { text: "androgen receptors (AR)", options: { bold: true, color: C.tealLight } },
    { text: " → AAS-AR complex translocates to nucleus → binds ", options: { color: C.offWhite } },
    { text: "androgen response elements (AREs)", options: { bold: true, color: C.tealLight } },
    { text: " on DNA → ↑ transcription of ", options: { color: C.offWhite } },
    { text: "IGF-1, myosin heavy chain, satellite cell activation genes", options: { bold: true, color: C.amber } },
    { text: " → hypertrophy & anti-catabolic effects (↓ glucocorticoid-mediated catabolism via competitive AR binding).", options: { color: C.offWhite } }
  ], { x: 0.45, y: 1.7, w: 9, h: 0.95, fontSize: 8.8, valign: "middle", margin: 0 });

  // Three columns: Examples | Performance Effects | Detection
  infoCard(sl, 0.3, 3.05, 3.0, 2.35, "Common AAS & Schedule",
    [
      "Testosterone (esters: cypionate, enanthate)",
      "Nandrolone decanoate (19-nortestosterone)",
      "Stanozolol — 17α-alkylated oral",
      "Trenbolone — veterinary origin",
      "DHEA — precursor; Schedule III (US)",
      "SARMS (LGD-4033, Ostarine) — selective AR modulators; WADA-banned since 2008"
    ], C.red);

  infoCard(sl, 3.55, 3.05, 3.0, 2.35, "Performance Effects (Evidence-Based)",
    [
      "↑ Fat-free mass: +2–5 kg over 10–12 wks (meta-analysis, JAMA 1996)",
      "↑ Muscle fiber cross-sectional area (Type II > Type I)",
      "↑ Erythropoiesis via ↑ EPO secretion → ↑ VO₂max",
      "Anti-catabolic: blocks cortisol-mediated proteolysis",
      "↑ Aggression & competitiveness (CNS androgenic effect)",
      "Recovery time ↓; training volume ↑"
    ], C.amber);

  infoCard(sl, 6.8, 3.05, 3.0, 2.35, "Detection & Analysis",
    [
      "GC-MS / LC-MS/MS: gold standard (urine & blood)",
      "Testosterone/Epitestosterone (T/E) ratio: normal ≤4:1; >4:1 triggers CIR",
      "Carbon Isotope Ratio (CIR/GC-C-IRMS): detects synthetic T",
      "Longitudinal Athlete Biological Passport (ABP)",
      "Hair analysis: retrospective window up to 12 months",
      "Window: oral forms 3 wks; injectable esters 4–6 months"
    ], C.teal);

  sl.addText("Ref: KD Tripathi Essentials of Medical Pharmacology 8e, Ch.20 | Tietz Lab Medicine 7e | WADA TD2024AAS", {
    x: 0.4, y: 5.3, w: 9.2, h: 0.22, fontSize: 6.8, italic: true, color: C.gray, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 4 — AAS ADVERSE EFFECTS (MALE)
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  darkBg(sl);
  topBar(sl, C.red);

  badge(sl, "AAS ADVERSE EFFECTS — MALE", 0.4, 0.2, C.red);

  sl.addText("AAS in Males: Systemic Adverse Effects", {
    x: 0.4, y: 0.6, w: 9.2, h: 0.55, fontSize: 22, bold: true, color: C.white, margin: 0
  });

  // 4 system cards
  const cards = [
    { x: 0.3,  y: 1.3,  title: "HPGA Suppression", color: C.red, lines: [
      "↓ GnRH pulsatility → ↓ LH & FSH → testicular atrophy (Leydig cell suppression)",
      "Oligospermia → azoospermia (dose & duration dependent)",
      "Recovery: 3–12 months post-cessation; may be permanent with chronic use",
      "Hypogonadism post-cycle: requires PCT (Clomiphene, Tamoxifen, hCG)"
    ]},
    { x: 5.1,  y: 1.3,  title: "Cardiovascular Effects", color: C.amber, lines: [
      "↓ HDL-C (up to 50%) + ↑ LDL-C → accelerated atherosclerosis",
      "LV concentric hypertrophy → diastolic dysfunction (echocardiographic evidence)",
      "Hypertension: ↑ Na⁺/H₂O retention (mineralocorticoid effect of some AAS)",
      "Fatal arrhythmias; AAS-associated sudden cardiac death in athletes <35 yrs"
    ]},
    { x: 0.3,  y: 3.2,  title: "Dermatological & Hepatic", color: C.teal, lines: [
      "Severe cystic acne: ↑ sebaceous gland activity via 5α-dihydrotestosterone",
      "Androgenic alopecia (male-pattern baldness)",
      "Gynecomastia: peripheral aromatization of AAS → ↑ estradiol",
      "Oral 17α-alkylated AAS (Stanozolol, Oxymethalone): hepatotoxicity, peliosis hepatis, hepatocellular carcinoma"
    ]},
    { x: 5.1,  y: 3.2,  title: "Psychological & Musculoskeletal", color: "B5179E", lines: [
      "'Roid rage': irritability, aggression, hypomania (dose-dependent CNS AR activation)",
      "AAS dependence syndrome: reported in ~30% of long-term users",
      "Tendon rupture risk ↑: muscle hypertrophy disproportionate to tendon adaptation",
      "Premature epiphyseal closure in adolescent athletes (growth stunting)"
    ]},
  ];

  cards.forEach(c => {
    sl.addShape(pres.ShapeType.rect, { x: c.x, y: c.y, w: 4.5, h: 2.15, fill: { color: C.navy }, line: { color: c.color, pt: 1.5 } });
    sl.addShape(pres.ShapeType.rect, { x: c.x, y: c.y, w: 4.5, h: 0.04, fill: { color: c.color }, line: { color: c.color } });
    sl.addText(c.title, { x: c.x+0.12, y: c.y+0.07, w: 4.3, h: 0.28, fontSize: 9.5, bold: true, color: c.color, margin: 0 });
    const bullets = c.lines.map((t, i) => ({
      text: t,
      options: { bullet: { type: "bullet" }, fontSize: 8, color: C.offWhite, breakLine: i < c.lines.length-1, paraSpaceBefore: 2 }
    }));
    sl.addText(bullets, { x: c.x+0.12, y: c.y+0.4, w: 4.3, h: 1.65, valign: "top", margin: 0 });
  });

  sl.addText("Ref: KD Tripathi 8e Ch.20 | Braunwald's Heart Disease 12e | Andrews' Diseases of the Skin 2e", {
    x: 0.4, y: 5.35, w: 9.2, h: 0.2, fontSize: 6.8, italic: true, color: C.gray, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 5 — AAS ADVERSE EFFECTS (FEMALE)
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  darkBg(sl);
  topBar(sl, C.red);

  badge(sl, "AAS ADVERSE EFFECTS — FEMALE", 0.4, 0.2, "B5179E");

  sl.addText("AAS in Females: Virilization, Hormonal & Systemic Toxicity", {
    x: 0.4, y: 0.6, w: 9.2, h: 0.55, fontSize: 20, bold: true, color: C.white, margin: 0
  });

  // Key alert box
  sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.25, w: 9.4, h: 0.82, fill: { color: "2D0A0A" }, line: { color: C.red, pt: 1.5 } });
  sl.addText("⚠  CLINICAL ALERT — IRREVERSIBILITY", { x: 0.45, y: 1.3, w: 5, h: 0.28, fontSize: 9, bold: true, color: C.red, margin: 0, charSpacing: 1 });
  sl.addText("Several virilizing effects of AAS in females are IRREVERSIBLE even after cessation: clitoromegaly, voice deepening (permanent laryngeal cartilage hypertrophy), and androgenic alopecia. Early detection by physiotherapists and team clinicians is critical.", {
    x: 0.45, y: 1.58, w: 9, h: 0.42, fontSize: 8.5, color: C.offWhite, margin: 0
  });

  // Three columns
  infoCard(sl, 0.3, 2.2, 3.0, 3.0, "Virilization (Androgenic)",
    [
      "Hirsutism: ↑ terminal hair growth (face, chest, abdomen)",
      "Clitoromegaly — partially/fully irreversible",
      "Voice deepening: laryngeal hypertrophy (irreversible)",
      "Male-pattern androgenic alopecia",
      "Acne vulgaris / cystic acne",
      "Increased muscle bulk with masculine habitus"
    ], "B5179E");

  infoCard(sl, 3.55, 2.2, 3.0, 3.0, "Reproductive & Endocrine",
    [
      "Amenorrhea / oligomenorrhea: ↓ GnRH-LH-FSH axis",
      "Anovulation → infertility (reversible if short-term use)",
      "Polycystic-like ovarian changes on ultrasound",
      "↓ estrogen levels: risk of bone mineral density loss",
      "Premature epiphyseal closure in adolescent females",
      "Post-cycle: delayed return of menstrual function"
    ], C.amber);

  infoCard(sl, 6.8, 2.2, 3.0, 3.0, "Cardiovascular & Hepatic",
    [
      "↓ HDL-C more pronounced in females than males",
      "Hypertension: mineralocorticoid effect",
      "Oral 17α-alkylated AAS: hepatocellular damage (↑ ALT/AST)",
      "Peliosis hepatis: blood-filled hepatic cavities",
      "Risk of hepatocellular carcinoma with prolonged use",
      "LV dysfunction (cardiomyopathy — smaller absolute doses than males)"
    ], C.red);

  sl.addText("Ref: KD Tripathi 8e | Andrews' Skin Dermatology | Bailey & Love's Surgery 28e, Ch.36", {
    x: 0.4, y: 5.35, w: 9.2, h: 0.22, fontSize: 6.8, italic: true, color: C.gray, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 6 — PEPTIDE HORMONES: EPO & hGH
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  darkBg(sl);
  topBar(sl, C.teal);

  badge(sl, "CLASS II — PEPTIDE HORMONES", 0.4, 0.2, C.teal);

  sl.addText("Erythropoietin (EPO) & Human Growth Hormone (hGH)", {
    x: 0.4, y: 0.6, w: 9.2, h: 0.55, fontSize: 21, bold: true, color: C.white, margin: 0
  });

  // EPO LEFT column
  sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.28, w: 4.55, h: 4.05, fill: { color: C.navy }, line: { color: C.teal, pt: 1.5 } });
  sl.addText("Erythropoietin (EPO)", { x: 0.45, y: 1.36, w: 4.2, h: 0.32, fontSize: 12, bold: true, color: C.teal, margin: 0 });

  sl.addText([
    { text: "Mechanism: ", options: { bold: true, color: C.tealLight, breakLine: false } },
    { text: "Binds EPO-R on erythroid progenitors → JAK2/STAT5 signalling → ↑ RBC production → ↑ haematocrit & ↑ O₂-carrying capacity\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Performance Gain: ", options: { bold: true, color: C.tealLight, breakLine: false } },
    { text: "↑ VO₂max 5–10%; ↑ time-to-exhaustion in endurance events\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Risks:\n", options: { bold: true, color: C.red, breakLine: true } },
    { text: "• ↑ Blood viscosity → thrombosis, stroke, pulmonary embolism\n• Nocturnal bradycardia → sudden death (documented in cyclists)\n• Polycythaemia vera-like state if haematocrit >50%\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Detection (Tietz 7e): ", options: { bold: true, color: C.tealLight, breakLine: false } },
    { text: "Isoelectric focusing + SDS-PAGE ('double blotting') since Salt Lake City 2002; recombinant EPO has altered glycosylation pattern distinguishable from endogenous EPO. ABP tracks reticulocyte% and haemoglobin over career.", options: { color: C.offWhite } }
  ], { x: 0.45, y: 1.75, w: 4.2, h: 3.3, fontSize: 8.7, valign: "top", margin: 0 });

  // hGH RIGHT column
  sl.addShape(pres.ShapeType.rect, { x: 5.15, y: 1.28, w: 4.55, h: 4.05, fill: { color: C.navy }, line: { color: C.amber, pt: 1.5 } });
  sl.addText("Human Growth Hormone (hGH / Somatropin)", { x: 5.3, y: 1.36, w: 4.2, h: 0.32, fontSize: 11, bold: true, color: C.amber, margin: 0 });

  sl.addText([
    { text: "Mechanism: ", options: { bold: true, color: C.amber, breakLine: false } },
    { text: "Binds GHR → JAK2 → STAT5b → ↑ hepatic IGF-1 synthesis → promotes protein anabolism, lipolysis & bone growth\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Performance Claim: ", options: { bold: true, color: C.amber, breakLine: false } },
    { text: "↑ lean body mass, ↓ fat mass; minimal documented strength gain in controlled trials\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Adverse Effects:\n", options: { bold: true, color: C.red, breakLine: true } },
    { text: "• Acromegalic features with chronic use (jaw protrusion, hand/foot enlargement)\n• Insulin resistance → Type 2 Diabetes Mellitus\n• Cardiomegaly, visceromegaly\n• CTS (carpal tunnel syndrome) — common\n• Joint & muscle pain (sodium/water retention)\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Detection: ", options: { bold: true, color: C.amber, breakLine: false } },
    { text: "Isoform test (pituitary hGH isoforms 22 kDa vs recombinant) + Biomarker test (IGF-1, P-III-NP). Window <72 hrs (isoform); months (biomarker).", options: { color: C.offWhite } }
  ], { x: 5.3, y: 1.75, w: 4.2, h: 3.3, fontSize: 8.7, valign: "top", margin: 0 });

  sl.addText("Ref: Tietz Laboratory Medicine 7e, Athletes & Drug Testing | KD Tripathi 8e Ch.20 | WADA Technical Document 2024", {
    x: 0.4, y: 5.35, w: 9.2, h: 0.22, fontSize: 6.8, italic: true, color: C.gray, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 7 — STIMULANTS
// ══════════════════════════════════════════════════════════════════
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  const sl = pres.addSlide();
  darkBg(sl);
  topBar(sl, C.amber);

  badge(sl, "CLASS III — STIMULANTS", 0.4, 0.2, C.amber);

  sl.addText("Stimulants in Sport: Pharmacology, Risks & Detection", {
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  });

  // Table-like cards for each stimulant class
  const stims = [
    { name: "Amphetamines\n(Dexamphetamine, Methylphenidate)", mech: "Block DA/NE reuptake + promote release (monoamine transporters)", perf: "↑ Alertness, ↑ aggression, ↓ fatigue perception, ↑ pain threshold", adr: "Tachycardia, hypertension, hyperthermia, arrhythmia, stroke, sudden death", det: "Urine GC-MS; ~48–72 hrs; urine pH dependent" },
    { name: "Ephedrine / Pseudoephedrine", mech: "Indirect sympathomimetic — releases NE from synaptic vesicles; partial α/β agonist", perf: "↑ Bronchodilation, mild ↑ strength; thermogenic; threshold dose-dependent", adr: "Hypertension, tachycardia, anxiety; cardiac events reported", det: "Threshold: 10 μg/mL (urine); monitored not prohibited below threshold (WADA 2024)" },
    { name: "Caffeine", mech: "Non-selective adenosine receptor (A₁/A₂A) antagonist → ↑ cAMP; CNS stimulation", perf: "↑ Endurance (meta-analyses confirm ~1–3% VO₂max benefit); ↓ perceived effort (Borg scale)", adr: "Insomnia, tremor, GI upset; at >9 mg/kg: arrhythmia risk; removed from WADA list 2004", det: "Monitored (not prohibited); urine threshold was 12 μg/mL historically" },
  ];

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    // Mech
    sl.addText("Mechanism", { x: 2.8, y: y+0.04, w: 2.0, h: 0.22, fontSize: 7, bold: true, color: C.tealLight, margin: 0 });
    sl.addText(s.mech, { x: 2.8, y: y+0.25, w: 2.1, h: 0.82, fontSize: 7.5, color: C.offWhite, margin: 0 });
    // Performance
    sl.addText("Performance", { x: 5.0, y: y+0.04, w: 2.0, h: 0.22, fontSize: 7, bold: true, color: C.green, margin: 0 });
    sl.addText(s.perf, { x: 5.0, y: y+0.25, w: 2.1, h: 0.82, fontSize: 7.5, color: C.offWhite, margin: 0 });
    // ADR
    sl.addText("Adverse Effects", { x: 7.2, y: y+0.04, w: 2.0, h: 0.22, fontSize: 7, bold: true, color: C.red, margin: 0 });
    sl.addText(s.adr, { x: 7.2, y: y+0.25, w: 2.15, h: 0.82, fontSize: 7.5, color: C.offWhite, margin: 0 });
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    sl.addShape(pres.ShapeType.line, { x: 7.15, y: y+0.05, w: 0, h: 1.1, line: { color: C.gray, pt: 0.5 } });
  });

  sl.addText("Indian Context: Pre-workout supplements commonly contaminated with undeclared ephedrine alkaloids & AMP analogues — physiotherapists must screen supplement labels.", {
    x: 0.4, y: 5.12, w: 9.2, h: 0.22, fontSize: 7.5, bold: true, color: C.amber, margin: 0
  });

  sl.addText("Ref: KD Tripathi 8e Ch.11 | Tietz Lab Medicine 7e | WADA 2024 Monitoring Program", {
    x: 0.4, y: 5.37, w: 9.2, h: 0.2, fontSize: 6.8, italic: true, color: C.gray, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 8 — DIURETICS & BETA-BLOCKERS
// ══════════════════════════════════════════════════════════════════
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  const sl = pres.addSlide();
  darkBg(sl);
  topBar(sl);

  badge(sl, "CLASS IV — DIURETICS & BETA-BLOCKERS", 0.4, 0.2, C.teal);

  sl.addText("Diuretics & Beta-Blockers: Mechanisms, Uses & Risks", {
    x: 0.4, y: 0.6, w: 9.2, h: 0.55, fontSize: 21, bold: true, color: C.white, margin: 0
  });

  // Diuretics left
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  sl.addText("Diuretics", { x: 0.45, y: 1.36, w: 2, h: 0.32, fontSize: 13, bold: true, color: C.teal, margin: 0 });

  sl.addText([
    { text: "Examples: ", options: { bold: true, color: C.tealLight, breakLine: false } },
    { text: "Furosemide (loop), Hydrochlorothiazide, Acetazolamide, Spironolactone\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Why Banned?\n", options: { bold: true, color: C.amber, breakLine: true } },
    { text: "① Rapid weight loss: wrestlers, boxers, rowers — make lower weight class\n② Masking agents: ↑ urine flow dilutes AAS metabolites below detection threshold\n③ False negatives for AAS/stimulants in urine\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Mechanisms:\n", options: { bold: true, color: C.tealLight, breakLine: true } },
    { text: "• Furosemide: blocks NKCC2 transporter, thick ascending loop of Henle\n• Thiazides: inhibit NCC co-transporter, distal tubule\n• Spironolactone: aldosterone antagonist (also used as AAS masking agent — prohibited at all times)\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Health Risks: ", options: { bold: true, color: C.red, breakLine: false } },
    { text: "Severe hypokalemia (arrhythmia risk), dehydration, hypotension, muscle cramps, hyponatraemia; fatalities documented in combat sports", options: { color: C.offWhite } }
  ], { x: 0.45, y: 1.75, w: 4.2, h: 3.3, fontSize: 8.6, valign: "top", margin: 0 });

  // Beta-blockers right
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  sl.addText("Beta-Adrenoceptor Antagonists (Beta-Blockers)", { x: 5.3, y: 1.36, w: 4.2, h: 0.32, fontSize: 11, bold: true, color: C.green, margin: 0 });

  sl.addText([
    { text: "Examples: ", options: { bold: true, color: C.tealLight, breakLine: false } },
    { text: "Propranolol (non-selective), Atenolol (β₁-selective), Metoprolol, Nebivolol\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "Why Used in Sport?\n", options: { bold: true, color: C.amber, breakLine: true } },
    { text: "• Competitive archery, shooting, golf, billiards, darts\n• ↓ Heart rate → ↓ tremor → improved precision aim\n• ↓ Sympathetic 'stage fright' / performance anxiety\n• ↓ Systolic BP → steadier hand (β₁/β₂ blockade)\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "WADA Status (2024):\n", options: { bold: true, color: C.tealLight, breakLine: true } },
    { text: "Prohibited IN-COMPETITION ONLY in: Archery, Shooting, Golf, Motorcycle racing, Billiards, Darts, Skiing\nNOT prohibited in other sports\n\n", options: { color: C.offWhite, breakLine: true } },
    { text: "KDT Reference: ", options: { bold: true, color: C.green, breakLine: false } },
    { text: "Propranolol — first beta-blocker (Sir James Black, Nobel 1988); blocks β₁ > β₂ at higher doses; lipophilic — better CNS penetration for anxiety reduction vs hydrophilic atenolol.", options: { color: C.offWhite } }
  ], { x: 5.3, y: 1.75, w: 4.2, h: 3.3, fontSize: 8.6, valign: "top", margin: 0 });

  sl.addText("Ref: KD Tripathi 8e Ch.10 (Beta-Blockers), Ch.14 (Diuretics) | WADA 2024 Prohibited List Section S5 & S6", {
    x: 0.4, y: 5.35, w: 9.2, h: 0.22, fontSize: 6.8, italic: true, color: C.gray, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 9 — THERAPEUTIC USE EXEMPTION (TUE)
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  darkBg(sl);
  topBar(sl, C.green);

  badge(sl, "THERAPEUTIC USE EXEMPTION", 0.4, 0.2, C.green);

  sl.addText("Therapeutic Use Exemption (TUE): Criteria, Process & Clinical Examples", {
    x: 0.4, y: 0.6, w: 9.2, h: 0.55, fontSize: 19, bold: true, color: C.white, margin: 0
  });

  // TUE criteria box
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  sl.addText("WADA TUE CRITERIA (WADC Article 4.4 — All FOUR must be met):", { x: 0.45, y: 1.34, w: 9, h: 0.28, fontSize: 9, bold: true, color: C.green, margin: 0 });
  sl.addText([
    { text: "①  ", options: { bold: true, color: C.green } }, { text: "Significant health risk if substance is withheld   ", options: { color: C.offWhite } },
    { text: "②  ", options: { bold: true, color: C.green } }, { text: "No reasonable therapeutic alternative exists   ", options: { color: C.offWhite } },
    { text: "③  ", options: { bold: true, color: C.green } }, { text: "No additional performance enhancement beyond returning to normal health   ", options: { color: C.offWhite } },
    { text: "④  ", options: { bold: true, color: C.green } }, { text: "Medical condition not caused by prior doping", options: { color: C.offWhite } },
  ], { x: 0.45, y: 1.64, w: 9, h: 0.7, fontSize: 8.8, valign: "middle", margin: 0 });

  // Three clinical examples
  const tues = [
    { title: "Asthma — Inhaled Glucocorticoids & SABAs", color: C.teal, lines: [
      "Salbutamol (albuterol) — SABA: max 1600 μg/24h inhaled; no TUE required below threshold",
      "Formoterol — LABA: max 54 μg/24h; above threshold requires TUE",
      "Inhaled ICS (Budesonide, Fluticasone): permitted without TUE at therapeutic doses",
      "Systemic corticosteroids (oral/IV): prohibited IN-COMPETITION; always require TUE",
      "Evidence: prevalence of asthma in elite athletes 8–17% (higher in endurance sports)"
    ]},
    { title: "ADHD — Methylphenidate & Amphetamine Salts", color: C.amber, lines: [
      "Both prohibited stimulants under WADA S6a",
      "TUE required: comprehensive ADHD diagnosis documentation mandatory",
      "Acceptable: neuropsychological testing, DSM-5 criteria fulfilment",
      "Controversy: TUE prevalence in elite athletes high (~1–2% in Olympic sports)",
      "Alternative strategies (non-stimulant atomoxetine) considered first"
    ]},
    { title: "Diabetes — Insulin & Glucose Regulation", color: C.green, lines: [
      "Insulin: prohibited S4 (peptide hormone) — always requires TUE for T1DM athletes",
      "Clinical evidence required: HbA1c, C-peptide level, endocrinology confirmation",
      "T1DM athletes: UK Athletics, IAAF allow with strict glycaemic monitoring protocols",
      "Continuous Glucose Monitors (CGMs) now accepted during competition",
      "Risk without TUE: athlete forced to choose health vs competition eligibility"
    ]},
  ];

  tues.forEach((t, i) => {
    const x = 0.3 + i * 3.22;
    sl.addShape(pres.ShapeType.rect, { x, y: 2.55, w: 3.05, h: 2.8, fill: { color: C.navy }, line: { color: t.color, pt: 1.5 } });
    sl.addShape(pres.ShapeType.rect, { x, y: 2.55, w: 3.05, h: 0.04, fill: { color: t.color }, line: { color: t.color } });
    sl.addText(t.title, { x: x+0.1, y: 2.62, w: 2.85, h: 0.42, fontSize: 8.5, bold: true, color: t.color, margin: 0 });
    const bullets = t.lines.map((l, j) => ({
      text: l,
      options: { bullet: { type: "bullet" }, fontSize: 7.8, color: C.offWhite, breakLine: j < t.lines.length-1, paraSpaceBefore: 2 }
    }));
    sl.addText(bullets, { x: x+0.1, y: 3.1, w: 2.85, h: 2.1, valign: "top", margin: 0 });
  });

  sl.addText("Ref: WADA International Standard for TUE (ISTUE 2024) | KD Tripathi 8e | NADA India TUE Guidelines", {
    x: 0.4, y: 5.35, w: 9.2, h: 0.22, fontSize: 6.8, italic: true, color: C.gray, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 10 — ROLE OF THE PHYSIOTHERAPIST
// ══════════════════════════════════════════════════════════════════
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  const sl = pres.addSlide();
  darkBg(sl);
  topBar(sl, C.teal);

  badge(sl, "PHYSIOTHERAPIST'S ROLE", 0.4, 0.2, C.teal);

  sl.addText("The Sports Physiotherapist & Anti-Doping: Clinical Responsibilities", {
    x: 0.4, y: 0.6, w: 9.2, h: 0.55, fontSize: 20, bold: true, color: C.white, margin: 0
  });

  // 6-cell grid
  const roles = [
    { icon: "🔍", title: "Supplement Screening", color: C.amber, lines: [
      "Screen all supplements for WADA-prohibited contaminants",
      "Use Informed-Sport / NSF Certified databases",
      "India: FSSAI-approved supplements do NOT guarantee WADA compliance",
      "Advise athletes against 'natural' bodybuilding supplements"
    ]},
    { icon: "⚠️", title: "Clinical Surveillance", color: C.red, lines: [
      "Recognize 'steroid rage' behavioural changes",
      "Note unexplained muscle hypertrophy, acne, voice changes",
      "Monitor unexplained rise in haematocrit (EPO suspicion)",
      "Facilitate early referral — physio has daily athlete access"
    ]},
    { icon: "🩺", title: "Topical Medications", color: C.teal, lines: [
      "Topical corticosteroids: NOT prohibited (no TUE needed)",
      "BUT verify formulation — some compounded creams contain prohibited AAS",
      "Lidocaine & corticosteroid injections: route matters (local joint OK; IV = prohibited in-competition)",
      "NSAIDs: not prohibited; counsel on overuse masking injury"
    ]},
    { icon: "🏋️", title: "Natural Recovery Protocols", color: C.green, lines: [
      "Periodised ice bath / contrast hydrotherapy",
      "Compression therapy + sleep quality (↑ endogenous GH release during SWS)",
      "Periodised nutrition: protein timing (0.3 g/kg/meal, leucine-rich) — evidence-based muscle repair",
      "Promote legal ergogenics: creatine monohydrate (evidence grade A)"
    ]},
    { icon: "📋", title: "TUE Documentation Support", color: C.tealLight, lines: [
      "Assist physician with collecting sport-specific clinical evidence",
      "Document functional limitations due to condition (e.g., asthma FEV₁, ADHD behavioural impact)",
      "Ensure timely submission (retroactive TUE valid only in emergencies)",
      "NADA India: TUE applications submitted via ADAMS platform"
    ]},
    { icon: "🎓", title: "Athlete Education", color: "B5179E", lines: [
      "Include anti-doping in pre-season team education sessions",
      "WADA 'Play True' online education program (free, multilingual)",
      "Teach athletes how to verify supplement labels (lot number traceability)",
      "Indian context: no strict supplement regulation = higher contamination risk"
    ]},
  ];

  roles.forEach((r, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.3 + col * 3.22;
    const y = 1.28 + row * 2.15;
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    sl.addShape(pres.ShapeType.rect, { x, y, w: 3.0, h: 0.04, fill: { color: r.color }, line: { color: r.color } });
    sl.addText(`${r.icon}  ${r.title}`, { x: x+0.1, y: y+0.07, w: 2.8, h: 0.3, fontSize: 9, bold: true, color: r.color, margin: 0 });
    const bullets = r.lines.map((l, j) => ({
      text: l,
      options: { bullet: { type: "bullet" }, fontSize: 7.5, color: C.offWhite, breakLine: j < r.lines.length-1, paraSpaceBefore: 2 }
    }));
    sl.addText(bullets, { x: x+0.1, y: y+0.43, w: 2.8, h: 1.45, valign: "top", margin: 0 });
  });

  sl.addText("Ref: Bailey & Love's Surgery 28e, Diagnosis of Sports Injuries | Miller's Orthopaedics 9e | WADA Athlete Support Personnel Guidelines 2024", {
    x: 0.4, y: 5.35, w: 9.2, h: 0.22, fontSize: 6.8, italic: true, color: C.gray, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 11 — SUMMARY, KEY TAKEAWAYS & REFERENCES
// ══════════════════════════════════════════════════════════════════
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  badge(sl, "SUMMARY & REFERENCES", 0.4, 0.2, C.teal);

  sl.addText("Key Takeaways & Evidence-Based References", {
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  // Left: key takeaways
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  sl.addText("CLINICAL SUMMARY", { x: 0.45, y: 1.28, w: 5.2, h: 0.28, fontSize: 10, bold: true, color: C.teal, charSpacing: 2, margin: 0 });
  const takeaways = [
    { text: "AAS act via genomic AR-mediated pathways → irreversible organ toxicity (HPGA suppression, cardiotoxicity, hepatotoxicity); detection window months via GC-MS/IRMS.", color: C.offWhite },
    { text: "EPO → ↑ VO₂max via ↑ haematocrit; nocturnal cardiac events documented; detected by isoelectric focusing (Tietz 7e).", color: C.offWhite },
    { text: "hGH detected by 22 kDa isoform test (<72 hrs) and biomarker panel (IGF-1/P-III-NP) — months retrospectively.", color: C.offWhite },
    { text: "Beta-blockers are sport-specific: prohibited in archery/shooting only; propranolol remains reference compound (KDT Ch.10).", color: C.offWhite },
    { text: "TUE framework (WADC Art. 4.4): ≥2 of 3 criteria for prohibition; all 4 TUE criteria required; NADA India via ADAMS.", color: C.offWhite },
    { text: "Physiotherapist = FIRST LINE of anti-doping: supplement screening, behavioural surveillance, natural recovery, athlete education.", color: C.tealLight },
    { text: "India-specific: FSSAI certification ≠ WADA compliance; supplement contamination remains significant risk.", color: C.amber },
  ];
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    sl.addText([
      { text: `${i+1}.  `, options: { bold: true, color: C.teal } },
      { text: t.text, options: { color: t.color } }
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    if (i < takeaways.length-1) {
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  // Right: References
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  sl.addText("REFERENCES", { x: 6.2, y: 1.28, w: 3.4, h: 0.28, fontSize: 10, bold: true, color: C.grayLight, charSpacing: 2, margin: 0 });

  const refs = [
    "KD Tripathi. Essentials of Medical Pharmacology, 8th Ed. Jaypee Brothers, 2019.",
    "Tietz Textbook of Laboratory Medicine, 7th Ed. Elsevier, 2022. [Athletes & Drug Testing, p.827–833]",
    "Bailey & Love's Short Practice of Surgery, 28th Ed. CRC Press, 2023. [Diagnosis of Sports Injuries, Ch.36]",
    "Miller's Review of Orthopaedics, 9th Ed. Elsevier, 2023.",
    "WADA. World Anti-Doping Code 2021. Montreal: WADA, 2021.",
    "WADA. Prohibited List 2024. International Standard. Montreal: WADA, 2024.",
    "WADA. International Standard for TUE (ISTUE), 2024.",
    "NADA India. Anti-Doping Rules 2021. New Delhi: NADA, 2021.",
    "Tietz (Ref 899): WADA established 1999 — only ISO-accredited labs authorized for doping detection.",
  ];

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  });
}

// ══════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/sports_physio_ppt/Sports_Medicine_Doping_Enhanced.pptx" })
  .then(() => console.log("✅ Saved: Sports_Medicine_Doping_Enhanced.pptx"))
  .catch(err => console.error("❌ Error:", err));

cd /home/daytona/workspace/sports_physio_ppt && node build.js 2>&1