PCOS polycystic ovary syndrome teenagers clinical features symptoms complications prevention 2024

https://pmc.ncbi.nlm.nih.gov/articles/PMC9951123

mkdir -p /home/daytona/workspace/pcos-pmos-ppt && ls /home/daytona/workspace/pco…

~/pcos-pmos-ppt/create_pcos_ppt.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "PMOS / PCOS - Understanding Your Body";
pres.author = "Health Education";

// ─────────────────────────────────────────────
// COLOR PALETTE
// Primary bg dark: #1A0A2E (deep purple)
// Secondary dark: #2D1B4E
// Accent teal: #00C9A7
// Accent pink: #FF6B9D
// Accent yellow: #FFD166
// Light text: #F0EAF8
// Card bg: #2D1B4E
// Highlight box: #3D2461
// ─────────────────────────────────────────────

const C = {
  bg: "1A0A2E",
  bgCard: "2D1B4E",
  bgHighlight: "3D2461",
  teal: "00C9A7",
  pink: "FF6B9D",
  yellow: "FFD166",
  lavender: "C4A8FF",
  white: "F0EAF8",
  subtext: "B8A8D8",
  darkText: "1A0A2E",
};

// ─── helper: slide background ───────────────
function bgSlide(slide) {
  slide.background = { color: C.bg };
}

// ─── helper: decorative top bar ─────────────
function topBar(slide, color1, color2) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.07, fill: { color: color1 } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.07, w: 10, h: 0.04, fill: { color: color2 } });
}

// ─── helper: section pill tag ───────────────
function pill(slide, label, x, y, color) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w: label.length * 0.12 + 0.4, h: 0.3,
    fill: { color },
    rectRadius: 0.15,
  });
  slide.addText(label, {
    x, y, w: label.length * 0.12 + 0.4, h: 0.3,
    fontSize: 9, bold: true, color: C.darkText, align: "center", valign: "middle", margin: 0,
  });
}

// ─── helper: card box ────────────────────────
function card(slide, x, y, w, h, fillColor) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h,
    fill: { color: fillColor || C.bgCard },
    rectRadius: 0.12,
    line: { color: C.bgHighlight, width: 1 },
  });
}

// ─── helper: icon circle ─────────────────────
function iconCircle(slide, emoji, x, y, size, bgColor) {
  slide.addShape(pres.ShapeType.ellipse, {
    x: x - size / 2, y: y - size / 2, w: size, h: size,
    fill: { color: bgColor || C.bgHighlight },
  });
  slide.addText(emoji, {
    x: x - size / 2, y: y - size / 2, w: size, h: size,
    fontSize: size * 14, align: "center", valign: "middle", margin: 0,
  });
}

// ─────────────────────────────────────────────
// SLIDE 1 — TITLE SLIDE
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);

  // gradient-feel diagonal shape
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 3.5, h: 5.625, fill: { color: "110720" } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 3.5, h: 0.07, fill: { color: C.teal } });

  // Big emoji side panel
  s.addText("🌸", { x: 0, y: 0.6, w: 3.5, h: 2.5, fontSize: 120, align: "center", valign: "middle" });

  // Right side content
  s.addText("PMOS", {
    x: 3.8, y: 0.5, w: 6, h: 1.4,
    fontSize: 80, bold: true, color: C.teal,
    charSpacing: 8, align: "left",
  });

  s.addText("Polyendocrine Metabolic Ovarian Syndrome", {
    x: 3.8, y: 1.85, w: 6, h: 0.6,
    fontSize: 14, bold: true, color: C.pink, align: "left",
    italic: true,
  });

  s.addText("(formerly known as PCOS)", {
    x: 3.8, y: 2.42, w: 5.5, h: 0.35,
    fontSize: 11, color: C.subtext, align: "left",
  });

  // Divider
  s.addShape(pres.ShapeType.rect, { x: 3.8, y: 2.9, w: 5.5, h: 0.03, fill: { color: C.lavender } });

  s.addText("A Guide for Teenagers", {
    x: 3.8, y: 3.05, w: 6, h: 0.5,
    fontSize: 22, bold: true, color: C.white, align: "left",
  });

  s.addText("Understanding your hormones, your body, and how to thrive 💜", {
    x: 3.8, y: 3.65, w: 6, h: 0.5,
    fontSize: 11.5, color: C.subtext, align: "left",
  });

  // Bottom tag
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.3, w: 10, h: 0.325, fill: { color: "110720" } });
  s.addText("Health Education  •  Teen Wellness Series  •  2026", {
    x: 0, y: 5.3, w: 10, h: 0.325,
    fontSize: 9, color: C.subtext, align: "center", valign: "middle",
  });
}

// ─────────────────────────────────────────────
// SLIDE 2 — WHAT IS PMOS/PCOS?
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);
  topBar(s, C.teal, C.pink);

  pill(s, "WHAT IS IT?", 0.35, 0.18, C.teal);

  s.addText("So... What Exactly IS PMOS?", {
    x: 0.35, y: 0.55, w: 9.3, h: 0.7,
    fontSize: 30, bold: true, color: C.white,
  });

  // Main definition card
  card(s, 0.3, 1.3, 9.4, 1.3, "221440");
  s.addText([
    { text: "PMOS", options: { bold: true, color: C.teal } },
    { text: " (Polyendocrine Metabolic Ovarian Syndrome) — previously called ", options: { color: C.white } },
    { text: "PCOS", options: { bold: true, color: C.pink } },
    { text: " — is a hormonal condition that affects girls and women during their reproductive years. It involves a mix of hormonal imbalance, metabolism changes, and ovarian function.", options: { color: C.white } },
  ], {
    x: 0.55, y: 1.35, w: 9.0, h: 1.2,
    fontSize: 13.5, valign: "middle", lineSpacingMultiple: 1.4,
  });

  // Why renamed box
  card(s, 0.3, 2.75, 9.4, 0.85, "1A0A2E");
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 2.75, w: 0.07, h: 0.85, fill: { color: C.yellow } });
  s.addText("🔄  Why the name change?", {
    x: 0.55, y: 2.78, w: 4, h: 0.35,
    fontSize: 12, bold: true, color: C.yellow,
  });
  s.addText("'PMOS' better captures the full picture — it's not just about cysts on ovaries. It's about hormones, metabolism, and multiple body systems working together (or not!).", {
    x: 0.55, y: 3.1, w: 8.9, h: 0.45,
    fontSize: 11, color: C.subtext,
  });

  // 3 key stats
  const stats = [
    { icon: "1 in 10", label: "girls/women\naffected worldwide", color: C.teal },
    { icon: "puberty", label: "symptoms often\nstart in teenage years", color: C.pink },
    { icon: "#1", label: "most common hormonal\ndisorder in young women", color: C.yellow },
  ];
  stats.forEach((st, i) => {
    const x = 0.35 + i * 3.2;
    card(s, x, 3.72, 3.0, 1.6, C.bgCard);
    s.addText(st.icon, {
      x, y: 3.78, w: 3.0, h: 0.6,
      fontSize: 20, bold: true, color: st.color, align: "center",
    });
    s.addText(st.label, {
      x, y: 4.36, w: 3.0, h: 0.85,
      fontSize: 10.5, color: C.subtext, align: "center",
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 3 — HOW DOES IT HAPPEN? (Pathophysiology)
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);
  topBar(s, C.pink, C.lavender);

  pill(s, "HOW IT HAPPENS", 0.35, 0.18, C.pink);

  s.addText("What's Going On Inside Your Body?", {
    x: 0.35, y: 0.55, w: 9.3, h: 0.65,
    fontSize: 28, bold: true, color: C.white,
  });

  // Flow diagram - 4 boxes with arrows
  const steps = [
    { icon: "🧠", title: "Brain Signal Mix-Up", desc: "The brain (hypothalamus & pituitary) sends uneven signals — too much LH, not enough FSH", color: C.teal },
    { icon: "🔥", title: "Too Many Androgens", desc: "Ovaries make excess 'male hormones' (androgens like testosterone) causing acne, hair growth", color: C.pink },
    { icon: "📉", title: "Insulin Resistance", desc: "Cells don't respond well to insulin → pancreas makes more → worsens androgen overload", color: C.yellow },
    { icon: "🥚", title: "Eggs Don't Mature", desc: "Follicles start growing but don't release eggs — they collect as small cysts on ovaries", color: C.lavender },
  ];

  steps.forEach((st, i) => {
    const x = 0.3 + i * 2.4;
    card(s, x, 1.35, 2.1, 3.7, C.bgCard);
    s.addText(st.icon, {
      x, y: 1.45, w: 2.1, h: 0.7,
      fontSize: 30, align: "center",
    });
    s.addText(st.title, {
      x: x + 0.1, y: 2.2, w: 1.9, h: 0.55,
      fontSize: 11.5, bold: true, color: st.color, align: "center",
    });
    s.addText(st.desc, {
      x: x + 0.1, y: 2.8, w: 1.9, h: 1.95,
      fontSize: 10, color: C.subtext, align: "center", lineSpacingMultiple: 1.3,
    });
    // Arrow between boxes
    if (i < 3) {
      s.addText("→", {
        x: x + 2.1, y: 2.4, w: 0.3, h: 0.5,
        fontSize: 22, color: C.lavender, align: "center", bold: true,
      });
    }
  });

  // Bottom note
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 5.1, w: 9.4, h: 0.03, fill: { color: C.bgHighlight } });
  s.addText("💡  Think of it like a domino effect — one hormonal hiccup triggers many others!", {
    x: 0.35, y: 5.17, w: 9.3, h: 0.35,
    fontSize: 11, color: C.lavender, italic: true,
  });
}

// ─────────────────────────────────────────────
// SLIDE 4 — CLINICAL FEATURES
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);
  topBar(s, C.yellow, C.teal);

  pill(s, "CLINICAL FEATURES", 0.35, 0.18, C.yellow);

  s.addText("Signs & Symptoms to Watch For", {
    x: 0.35, y: 0.55, w: 9.3, h: 0.65,
    fontSize: 28, bold: true, color: C.white,
  });

  const features = [
    { icon: "📅", title: "Irregular Periods", desc: "Periods that are too far apart, too close, very heavy, or missing altogether (< 8 periods/year)", color: C.pink },
    { icon: "🧴", title: "Acne", desc: "Stubborn acne on face, chest, or back that doesn't respond to usual treatments", color: C.teal },
    { icon: "🪒", title: "Hirsutism", desc: "Extra hair growth on face, chin, chest, belly — caused by high androgens (~70% of PMOS)", color: C.yellow },
    { icon: "💇", title: "Hair Thinning", desc: "Hair loss from the scalp (male-pattern baldness look) while body hair increases", color: C.lavender },
    { icon: "⚖️", title: "Weight Gain", desc: "Especially around the belly — hard to lose weight due to insulin resistance", color: C.pink },
    { icon: "🌑", title: "Dark Patches", desc: "Acanthosis nigricans — dark, velvety skin patches on neck, armpits, groin (sign of insulin resistance)", color: C.teal },
    { icon: "😓", title: "Mood Changes", desc: "Anxiety, depression, mood swings — hormonal imbalance directly affects mental health", color: C.yellow },
    { icon: "🔵", title: "Ovarian Cysts", desc: "Multiple small fluid-filled follicles on ovaries seen on ultrasound (12+ follicles per ovary)", color: C.lavender },
  ];

  features.forEach((f, i) => {
    const col = i % 4;
    const row = Math.floor(i / 4);
    const x = 0.25 + col * 2.4;
    const y = 1.38 + row * 1.9;

    card(s, x, y, 2.2, 1.75, C.bgCard);
    s.addText(f.icon, {
      x, y: y + 0.1, w: 2.2, h: 0.5,
      fontSize: 22, align: "center",
    });
    s.addText(f.title, {
      x: x + 0.08, y: y + 0.6, w: 2.05, h: 0.38,
      fontSize: 11, bold: true, color: f.color, align: "center",
    });
    s.addText(f.desc, {
      x: x + 0.08, y: y + 0.98, w: 2.05, h: 0.72,
      fontSize: 9, color: C.subtext, align: "center", lineSpacingMultiple: 1.2,
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 5 — DIAGNOSIS
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);
  topBar(s, C.lavender, C.pink);

  pill(s, "DIAGNOSIS", 0.35, 0.18, C.lavender);

  s.addText("How is PMOS Diagnosed?", {
    x: 0.35, y: 0.55, w: 9.3, h: 0.65,
    fontSize: 28, bold: true, color: C.white,
  });

  // Rotterdam Criteria box
  card(s, 0.3, 1.28, 4.5, 2.8, "221440");
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.28, w: 4.5, h: 0.07, fill: { color: C.lavender } });
  s.addText("Rotterdam Criteria (2 of 3 needed):", {
    x: 0.5, y: 1.35, w: 4.1, h: 0.45,
    fontSize: 13, bold: true, color: C.lavender,
  });

  const criteria = [
    "1️⃣  Irregular or absent ovulation (oligo/anovulation)",
    "2️⃣  Signs of excess male hormones (hyperandrogenism)",
    "3️⃣  Polycystic ovaries on ultrasound",
  ];
  criteria.forEach((c, i) => {
    s.addText(c, {
      x: 0.5, y: 1.85 + i * 0.58, w: 4.1, h: 0.5,
      fontSize: 11, color: C.white, lineSpacingMultiple: 1.2,
    });
  });

  s.addText("⚠️  In teenagers: diagnosis needs\npersistent symptoms (≥2 yrs after first period)\nbefore confirming PMOS", {
    x: 0.5, y: 3.55, w: 4.1, h: 0.48,
    fontSize: 10, color: C.yellow, italic: true,
  });

  // Tests box
  card(s, 5.1, 1.28, 4.6, 2.8, C.bgCard);
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.28, w: 4.6, h: 0.07, fill: { color: C.teal } });
  s.addText("Tests Your Doctor May Order:", {
    x: 5.3, y: 1.35, w: 4.2, h: 0.45,
    fontSize: 13, bold: true, color: C.teal,
  });

  const tests = [
    { t: "🩸 Blood Tests", d: "LH, FSH, testosterone, insulin, glucose, thyroid (TSH), prolactin" },
    { t: "🖥️ Pelvic Ultrasound", d: "Checks ovaries for follicle count and size" },
    { t: "📏 BMI & Waist", d: "Measures metabolic risk factors" },
    { t: "🔬 AMH Level", d: "Anti-Mullerian hormone — newer marker (2023 update)" },
  ];
  tests.forEach((t, i) => {
    s.addText(t.t, {
      x: 5.3, y: 1.85 + i * 0.57, w: 4.2, h: 0.25,
      fontSize: 11, bold: true, color: C.white,
    });
    s.addText(t.d, {
      x: 5.3, y: 2.08 + i * 0.57, w: 4.2, h: 0.3,
      fontSize: 9.5, color: C.subtext,
    });
  });

  // Exclusion note
  card(s, 0.3, 4.18, 9.4, 1.05, "110720");
  s.addText("🚫  Must RULE OUT first: Cushing syndrome • Congenital adrenal hyperplasia • Thyroid disorders • Androgen-secreting tumors • Hyperprolactinemia", {
    x: 0.5, y: 4.28, w: 9.0, h: 0.85,
    fontSize: 11, color: C.subtext, lineSpacingMultiple: 1.3,
  });
}

// ─────────────────────────────────────────────
// SLIDE 6 — COMPLICATIONS
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);
  topBar(s, C.pink, C.yellow);

  pill(s, "COMPLICATIONS", 0.35, 0.18, C.pink);

  s.addText("Why Does It Matter Long-Term?", {
    x: 0.35, y: 0.55, w: 9.3, h: 0.65,
    fontSize: 28, bold: true, color: C.white,
  });

  s.addText("Left untreated, PMOS can lead to serious health issues. Catching it early PROTECTS your future.", {
    x: 0.35, y: 1.15, w: 9.3, h: 0.4,
    fontSize: 12, color: C.subtext, italic: true,
  });

  const comps = [
    { icon: "🍬", title: "Type 2 Diabetes", detail: "50%+ develop T2DM by age 40 due to chronic insulin resistance", severity: "HIGH", sColor: "FF4757" },
    { icon: "❤️", title: "Heart Disease", detail: "Higher risk of high blood pressure, high cholesterol, cardiovascular events", severity: "HIGH", sColor: "FF4757" },
    { icon: "🧴", title: "Endometrial Cancer", detail: "Unopposed estrogen from lack of ovulation raises uterine lining cancer risk", severity: "MOD", sColor: C.yellow },
    { icon: "😢", title: "Depression & Anxiety", detail: "4x more likely. Hormonal imbalance + body image issues = real mental health toll", severity: "HIGH", sColor: "FF4757" },
    { icon: "🤰", title: "Fertility Issues", detail: "Irregular ovulation makes conception harder — but not impossible with treatment!", severity: "MOD", sColor: C.yellow },
    { icon: "😴", title: "Sleep Apnea", detail: "5-10x higher risk, even in lean women — breathing interruptions during sleep", severity: "MOD", sColor: C.yellow },
    { icon: "🧠", title: "Metabolic Syndrome", detail: "Cluster of abdominal obesity + insulin resistance + high BP + abnormal cholesterol", severity: "HIGH", sColor: "FF4757" },
    { icon: "🌒", title: "Non-alcoholic Fatty Liver", detail: "Insulin resistance drives fat accumulation in liver cells (NAFLD)", severity: "MOD", sColor: C.yellow },
  ];

  comps.forEach((c, i) => {
    const col = i % 4;
    const row = Math.floor(i / 4);
    const x = 0.25 + col * 2.4;
    const y = 1.65 + row * 1.92;

    card(s, x, y, 2.2, 1.78, C.bgCard);

    // Severity badge
    s.addShape(pres.ShapeType.roundRect, {
      x: x + 1.55, y: y + 0.08, w: 0.58, h: 0.25,
      fill: { color: c.sColor },
      rectRadius: 0.08,
    });
    s.addText(c.severity, {
      x: x + 1.55, y: y + 0.08, w: 0.58, h: 0.25,
      fontSize: 8, bold: true, color: C.darkText, align: "center", valign: "middle", margin: 0,
    });

    s.addText(c.icon, {
      x, y: y + 0.12, w: 1.5, h: 0.5,
      fontSize: 22, align: "center",
    });
    s.addText(c.title, {
      x: x + 0.08, y: y + 0.62, w: 2.05, h: 0.38,
      fontSize: 11, bold: true, color: C.pink, align: "center",
    });
    s.addText(c.detail, {
      x: x + 0.08, y: y + 0.98, w: 2.05, h: 0.72,
      fontSize: 9, color: C.subtext, align: "center", lineSpacingMultiple: 1.2,
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 7 — PREVENTION & LIFESTYLE
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);
  topBar(s, C.teal, C.lavender);

  pill(s, "PREVENTION & LIFESTYLE", 0.35, 0.18, C.teal);

  s.addText("You Have More Power Than You Think! 💪", {
    x: 0.35, y: 0.55, w: 9.3, h: 0.65,
    fontSize: 28, bold: true, color: C.white,
  });

  s.addText("While PMOS can't always be prevented (genetics play a role), these habits significantly reduce symptoms and long-term risks:", {
    x: 0.35, y: 1.15, w: 9.3, h: 0.4,
    fontSize: 12, color: C.subtext,
  });

  const habits = [
    {
      icon: "🥗",
      title: "Eat Smart",
      points: ["Low glycemic index foods (whole grains, veggies, legumes)", "Reduce sugar, white bread, and processed foods", "Anti-inflammatory foods: fish, nuts, berries", "Eat regular meals — don't skip!"],
      color: C.teal,
    },
    {
      icon: "🏃",
      title: "Stay Active",
      points: ["30 mins moderate exercise 5x/week", "Even walking helps insulin sensitivity", "Resistance training builds muscle (helps metabolism)", "Avoid a completely sedentary lifestyle"],
      color: C.pink,
    },
    {
      icon: "🧘",
      title: "Manage Stress",
      points: ["Chronic stress spikes cortisol → worsens hormones", "Try yoga, meditation, journaling", "Get 8-9 hours of sleep every night", "Talk to someone — therapy is strong, not weak"],
      color: C.yellow,
    },
    {
      icon: "🩺",
      title: "Regular Check-ups",
      points: ["Annual period tracking + hormone checks", "Monitor blood sugar & cholesterol", "See a gynecologist or endocrinologist", "Don't wait for symptoms to spiral"],
      color: C.lavender,
    },
  ];

  habits.forEach((h, i) => {
    const x = 0.25 + i * 2.42;
    card(s, x, 1.65, 2.25, 3.7, C.bgCard);
    s.addShape(pres.ShapeType.rect, { x, y: 1.65, w: 2.25, h: 0.06, fill: { color: h.color } });

    s.addText(h.icon, {
      x, y: 1.72, w: 2.25, h: 0.55,
      fontSize: 26, align: "center",
    });
    s.addText(h.title, {
      x: x + 0.1, y: 2.3, w: 2.05, h: 0.4,
      fontSize: 13, bold: true, color: h.color, align: "center",
    });

    h.points.forEach((p, j) => {
      s.addText([
        { text: "✓ ", options: { color: h.color, bold: true } },
        { text: p, options: { color: C.subtext } },
      ], {
        x: x + 0.12, y: 2.73 + j * 0.55, w: 2.0, h: 0.52,
        fontSize: 9.5, lineSpacingMultiple: 1.2,
      });
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 8 — TREATMENT OPTIONS
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);
  topBar(s, C.yellow, C.pink);

  pill(s, "TREATMENT", 0.35, 0.18, C.yellow);

  s.addText("How is PMOS Treated?", {
    x: 0.35, y: 0.55, w: 9.3, h: 0.65,
    fontSize: 28, bold: true, color: C.white,
  });

  s.addText("Treatment is personalised — there is no one-size-fits-all! Goals are: regulate periods, manage symptoms, protect long-term health.", {
    x: 0.35, y: 1.15, w: 9.3, h: 0.4,
    fontSize: 12, color: C.subtext,
  });

  // Two-column layout
  const leftTreatments = [
    {
      cat: "💊 Hormonal Therapy",
      catColor: C.pink,
      items: [
        "Combined oral contraceptive pills (COCPs) — regulate periods + reduce androgens",
        "Progestin-only therapy to induce withdrawal bleed",
        "Reduces acne, hirsutism, and risk of endometrial cancer",
      ],
    },
    {
      cat: "🍃 Metformin",
      catColor: C.teal,
      items: [
        "Insulin-sensitizing drug — reduces insulin resistance",
        "Improves ovulation and menstrual regularity",
        "Lowers risk of developing Type 2 Diabetes",
      ],
    },
    {
      cat: "🧴 Skin & Hair Treatments",
      catColor: C.yellow,
      items: [
        "Anti-androgens (spironolactone) for hirsutism & acne",
        "Topical retinoids or antibiotics for acne",
        "Laser hair removal is an option",
      ],
    },
  ];

  leftTreatments.forEach((t, i) => {
    card(s, 0.3, 1.65 + i * 1.3, 4.6, 1.2, C.bgCard);
    s.addText(t.cat, {
      x: 0.5, y: 1.7 + i * 1.3, w: 4.2, h: 0.38,
      fontSize: 12.5, bold: true, color: t.catColor,
    });
    t.items.forEach((item, j) => {
      s.addText("• " + item, {
        x: 0.5, y: 2.06 + i * 1.3 + j * 0.0, w: 4.2,
        fontSize: 9.5, color: C.subtext, bullet: false,
        h: 0.3,
      });
    });
  });

  // Right side: lifestyle again + mental health
  const rightTreatments = [
    {
      cat: "🏃 Lifestyle Medicine (FIRST LINE)",
      catColor: C.teal,
      items: [
        "Even 5-10% weight loss can restore ovulation",
        "Diet + exercise is the most evidence-based treatment",
        "Often enough on its own for mild PMOS",
      ],
    },
    {
      cat: "🧠 Mental Health Support",
      catColor: C.lavender,
      items: [
        "CBT (Cognitive Behavioural Therapy) for anxiety/depression",
        "Body image counselling",
        "Peer support groups — you are NOT alone",
      ],
    },
    {
      cat: "🤰 For Future Fertility",
      catColor: C.pink,
      items: [
        "Clomiphene (ovulation induction)",
        "Letrozole — now preferred ovulation agent",
        "IVF if needed — PMOS does NOT mean infertility",
      ],
    },
  ];

  rightTreatments.forEach((t, i) => {
    card(s, 5.1, 1.65 + i * 1.3, 4.6, 1.2, C.bgCard);
    s.addText(t.cat, {
      x: 5.3, y: 1.7 + i * 1.3, w: 4.2, h: 0.38,
      fontSize: 12.5, bold: true, color: t.catColor,
    });
    t.items.forEach((item, j) => {
      s.addText("• " + item, {
        x: 5.3, y: 2.06 + i * 1.3 + j * 0.0, w: 4.2,
        fontSize: 9.5, color: C.subtext,
        h: 0.3,
      });
    });
  });

  // Bottom note
  card(s, 0.3, 5.15, 9.4, 0.35, "110720");
  s.addText("⚠️  In teenagers, treatment focuses on SYMPTOM MANAGEMENT first, not fertility — personalised care is key.", {
    x: 0.5, y: 5.17, w: 9.0, h: 0.33,
    fontSize: 10.5, color: C.yellow, italic: true, valign: "middle",
  });
}

// ─────────────────────────────────────────────
// SLIDE 9 — MENTAL HEALTH & SELF-CARE
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);
  topBar(s, C.lavender, C.teal);

  pill(s, "MENTAL HEALTH", 0.35, 0.18, C.lavender);

  s.addText("PMOS & Your Mind 🧠💜", {
    x: 0.35, y: 0.55, w: 9.3, h: 0.65,
    fontSize: 28, bold: true, color: C.white,
  });

  // Left column - emotional impact
  card(s, 0.3, 1.28, 4.4, 4.1, C.bgCard);
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.28, w: 4.4, h: 0.06, fill: { color: C.lavender } });
  s.addText("The Emotional Side of PMOS", {
    x: 0.5, y: 1.36, w: 4.0, h: 0.45,
    fontSize: 14, bold: true, color: C.lavender,
  });

  const emotional = [
    { icon: "😰", text: "4x higher risk of depression and anxiety compared to peers" },
    { icon: "🪞", text: "Body image struggles due to acne, weight gain, and hair changes" },
    { icon: "😤", text: "Frustration from chronic symptoms that feel 'invisible' to others" },
    { icon: "😔", text: "Social withdrawal — skipping events due to appearance concerns" },
    { icon: "🤯", text: "Mood swings driven by hormonal fluctuations" },
    { icon: "💔", text: "Grief around fertility uncertainty for the future" },
  ];
  emotional.forEach((e, i) => {
    s.addText(e.icon + "  " + e.text, {
      x: 0.5, y: 1.9 + i * 0.54, w: 4.0, h: 0.5,
      fontSize: 10.5, color: C.white, lineSpacingMultiple: 1.2,
    });
  });

  // Right column - support strategies
  card(s, 5.0, 1.28, 4.7, 4.1, "221440");
  s.addShape(pres.ShapeType.rect, { x: 5.0, y: 1.28, w: 4.7, h: 0.06, fill: { color: C.teal } });
  s.addText("Building Your Support System", {
    x: 5.2, y: 1.36, w: 4.3, h: 0.45,
    fontSize: 14, bold: true, color: C.teal,
  });

  const support = [
    { icon: "🗣️", title: "Talk About It", text: "Speak with friends, family, or a counsellor — keeping it inside makes it heavier" },
    { icon: "📓", title: "Journal Your Journey", text: "Track symptoms, moods, food, sleep — awareness is your first step to control" },
    { icon: "🧘", title: "Mindfulness", text: "Just 10 mins of deep breathing/meditation daily lowers cortisol levels" },
    { icon: "👯", title: "Find Your Tribe", text: "Online communities (e.g. PCOS Challenge) connect millions of people like you" },
    { icon: "🏥", title: "Seek Professional Help", text: "Therapy (especially CBT) is proven to help anxiety & depression in PMOS" },
  ];
  support.forEach((sp, i) => {
    s.addText(sp.icon + "  " + sp.title, {
      x: 5.2, y: 1.9 + i * 0.62, w: 4.3, h: 0.28,
      fontSize: 11.5, bold: true, color: C.teal,
    });
    s.addText("  " + sp.text, {
      x: 5.2, y: 2.17 + i * 0.62, w: 4.3, h: 0.32,
      fontSize: 10, color: C.subtext,
    });
  });

  // Bottom quote
  card(s, 0.3, 5.48, 9.4, 0.0, "110720");
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.3, y: 5.48, w: 9.4, h: 0.42,
    fill: { color: "110720" },
    rectRadius: 0.1,
  });
  s.addText('"Having PMOS does not define you — it is just one part of your story. You are so much more." 💜', {
    x: 0.5, y: 5.5, w: 9.0, h: 0.38,
    fontSize: 11, color: C.lavender, italic: true, align: "center",
  });
}

// ─────────────────────────────────────────────
// SLIDE 10 — MYTH BUSTERS
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);
  topBar(s, C.pink, C.teal);

  pill(s, "MYTH BUSTERS", 0.35, 0.18, C.pink);

  s.addText("Let's Bust Some PMOS Myths! 🔍", {
    x: 0.35, y: 0.55, w: 9.3, h: 0.65,
    fontSize: 28, bold: true, color: C.white,
  });

  const myths = [
    {
      myth: "Myth: You MUST have cysts to have PMOS",
      fact: "Fact: 'Cysts' are actually immature follicles. You can have PMOS without visible cysts on ultrasound!",
    },
    {
      myth: "Myth: PMOS means you can never get pregnant",
      fact: "Fact: Most women with PMOS CAN conceive — often with treatment. PMOS is a leading cause of treatable infertility.",
    },
    {
      myth: "Myth: Only overweight people get PMOS",
      fact: "Fact: Lean women get PMOS too (20-30% of cases). Weight is a risk factor, not a requirement.",
    },
    {
      myth: "Myth: Birth control pills cure PMOS",
      fact: "Fact: Pills manage symptoms, but PMOS doesn't disappear. Symptoms return when pills stop.",
    },
    {
      myth: "Myth: Irregular periods as a teen = definitely PMOS",
      fact: "Fact: Irregular periods are NORMAL for 2+ years after your first period. Diagnosis needs time & full evaluation.",
    },
    {
      myth: "Myth: PMOS is rare",
      fact: "Fact: PMOS affects 1 in 10 women worldwide — it's one of the most common endocrine disorders!",
    },
  ];

  myths.forEach((m, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.85;
    const y = 1.3 + row * 1.42;

    card(s, x, y, 4.6, 1.3, C.bgCard);

    // Red myth bar
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 0.07, fill: { color: "FF4757" } });

    s.addText("❌  " + m.myth, {
      x: x + 0.15, y: y + 0.12, w: 4.3, h: 0.42,
      fontSize: 10.5, bold: true, color: "FF6B6B", lineSpacingMultiple: 1.1,
    });
    s.addText("✅  " + m.fact, {
      x: x + 0.15, y: y + 0.6, w: 4.3, h: 0.65,
      fontSize: 10, color: C.white, lineSpacingMultiple: 1.2,
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 11 — WHEN TO SEE A DOCTOR
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);
  topBar(s, C.yellow, C.teal);

  pill(s, "WHEN TO SEE A DOCTOR", 0.35, 0.18, C.yellow);

  s.addText("When Should You Talk to a Doctor? 🩺", {
    x: 0.35, y: 0.55, w: 9.3, h: 0.65,
    fontSize: 28, bold: true, color: C.white,
  });

  s.addText("You know your body best. If something feels off — speak up. Here are clear signals to see a healthcare provider:", {
    x: 0.35, y: 1.15, w: 9.3, h: 0.4,
    fontSize: 12, color: C.subtext,
  });

  const redFlags = [
    { icon: "🗓️", text: "Periods more than 45 days apart OR fewer than 8 per year (2+ years after first period)" },
    { icon: "🧴", text: "Severe acne not responding to any skincare treatment" },
    { icon: "🪒", text: "Noticeable facial/body hair growth in a male pattern" },
    { icon: "⚖️", text: "Unexplained rapid weight gain, especially around the waist" },
    { icon: "🌑", text: "Dark patches of skin on neck, underarms, or groin (acanthosis nigricans)" },
    { icon: "😢", text: "Persistent low mood, anxiety, or depression affecting daily life" },
    { icon: "💇", text: "Thinning hair on scalp / noticeable hair loss" },
    { icon: "📊", text: "Family history of PCOS, diabetes, or heart disease" },
  ];

  redFlags.forEach((rf, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.85;
    const y = 1.65 + row * 0.9;

    card(s, x, y, 4.6, 0.82, "221440");
    s.addText(rf.icon + "  " + rf.text, {
      x: x + 0.18, y: y + 0.1, w: 4.25, h: 0.62,
      fontSize: 10.5, color: C.white, lineSpacingMultiple: 1.2, valign: "middle",
    });
  });

  // Bottom card
  card(s, 0.3, 5.28, 9.4, 0.2, "00C9A7");
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.3, y: 5.28, w: 9.4, h: 0.28,
    fill: { color: "003D33" },
    rectRadius: 0.08,
  });
  s.addText("💬  Remember: Your symptoms are REAL. You deserve to be heard and helped. Ask for a referral to a gynecologist or endocrinologist!", {
    x: 0.5, y: 5.3, w: 9.0, h: 0.26,
    fontSize: 10.5, color: C.teal, valign: "middle", align: "center",
  });
}

// ─────────────────────────────────────────────
// SLIDE 12 — KEY TAKEAWAYS / CLOSING
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgSlide(s);

  // Large decorative background shapes
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.bg } });
  s.addShape(pres.ShapeType.ellipse, {
    x: 6.5, y: -1, w: 5, h: 5,
    fill: { color: "220A3D" },
    line: { color: "220A3D" },
  });
  s.addShape(pres.ShapeType.ellipse, {
    x: -1.5, y: 3, w: 4.5, h: 4.5,
    fill: { color: "1A0535" },
    line: { color: "1A0535" },
  });

  s.addText("Key Takeaways 💜", {
    x: 0.5, y: 0.2, w: 9, h: 0.7,
    fontSize: 32, bold: true, color: C.white, align: "center",
  });

  const takeaways = [
    { icon: "🌸", text: "PMOS = PCOS rebranded — a hormonal + metabolic condition, not just an ovarian issue" },
    { icon: "📅", text: "Key signs: irregular periods, acne, hair growth, weight gain, mood changes" },
    { icon: "⚡", text: "Insulin resistance is a central driver — lifestyle changes make a REAL difference" },
    { icon: "🔬", text: "Diagnosed by Rotterdam criteria (2 of 3) — but teenagers need extra time before confirming" },
    { icon: "⚠️", text: "Long-term risks: diabetes, heart disease, mental health, fertility — all preventable with early care" },
    { icon: "💊", text: "Treatment: lifestyle first, then medications (COCPs, metformin, anti-androgens) as needed" },
    { icon: "💬", text: "Mental health matters — anxiety, depression are real complications. Seek support!" },
    { icon: "🌟", text: "You are MORE than your diagnosis. With the right support, you can absolutely thrive!" },
  ];

  takeaways.forEach((t, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.35 + col * 4.9;
    const y = 1.05 + row * 1.05;

    s.addShape(pres.ShapeType.roundRect, {
      x, y, w: 4.65, h: 0.92,
      fill: { color: i % 2 === 0 ? "221440" : "2D1B4E" },
      rectRadius: 0.1,
      line: { color: C.bgHighlight, width: 0.5 },
    });
    s.addText(t.icon + "  " + t.text, {
      x: x + 0.15, y: y + 0.1, w: 4.35, h: 0.72,
      fontSize: 10.5, color: C.white, lineSpacingMultiple: 1.25, valign: "middle",
    });
  });

  // Bottom bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.24, w: 10, h: 0.385, fill: { color: C.teal } });
  s.addText("You got this! 💜  Talk to someone you trust. Your health is worth fighting for.", {
    x: 0, y: 5.24, w: 10, h: 0.385,
    fontSize: 13, bold: true, color: C.darkText, align: "center", valign: "middle",
  });
}

// ─────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────
const outputPath = "/home/daytona/workspace/pcos-pmos-ppt/PMOS_PCOS_Teen_Guide.pptx";
pres.writeFile({ fileName: outputPath })
  .then(() => console.log("SUCCESS: " + outputPath))
  .catch(e => console.error("ERROR:", e));

cd /home/daytona/workspace/pcos-pmos-ppt && node create_pcos_ppt.js 2>&1

ls -lh /home/daytona/workspace/pcos-pmos-ppt/PMOS_PCOS_Teen_Guide.pptx

ls -lh /home/daytona/workspace/pcos-pmos-ppt/ && file /home/daytona/workspace/pc…

cd /home/daytona/workspace/pcos-pmos-ppt && libreoffice --headless --convert-to …

cp /home/daytona/workspace/pcos-pmos-ppt/PMOS_PCOS_Teen_Guide.pptx /home/daytona…

cp /tmp/PMOS_PCOS_Teen_Guide_copy.pdf /home/daytona/workspace/pcos-pmos-ppt/PMOS…