Urticaria (Hives)

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pres.title = "Urticaria";
pres.author = "Medical Presentation";

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// ─── SLIDE 1: TITLE SLIDE ────────────────────────────────────────
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  slide.addText("Hives | Wheals | Skin Hypersensitivity", {
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  // Description
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  slide.addText("Source: The Anthology of Roga Nidāna and Vikṛti Vijñāna, Vol. 2", {
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// ─── SLIDE 2: INTRODUCTION ───────────────────────────────────────
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    { text: "What is Urticaria?", options: { bold: true, breakLine: true, fontSize: 13, color: ACCENT } },
    { text: "Also known as ", options: { fontSize: 11, color: WHITE } },
    { text: "hives or wheals", options: { fontSize: 11, color: ACCENT, bold: true } },
    { text: ", a skin condition characterised by the sudden onset of itchy, raised, and oedematous plaques or welts.", options: { fontSize: 11, color: WHITE } },
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    { text: "• Global prevalence (2017): ~86 million individuals (~1.1% worldwide)\n• India prevalence: ~0.1% population, incidence ~15%\n• Most prevalent: 20–40 years age group\n• Incidence higher in older age groups", options: { fontSize: 10.5, color: WHITE } }
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    { text: "Lesions", options: { bold: true, color: DARK_TEAL } },
    { text: ": Variable in size, shape & colour; typically resolve within 24 hours\n\n", options: { color: DARK_TEXT } },
    { text: "Triggers", options: { bold: true, color: DARK_TEAL } },
    { text: ": Allergic reactions, food, insect stings, medications, latex\n\n", options: { color: DARK_TEXT } },
    { text: "Hypersensitivity", options: { bold: true, color: DARK_TEAL } },
    { text: ": Type I (immediate) & Type IV (delayed)\n\n", options: { color: DARK_TEXT } },
    { text: "Other triggers", options: { bold: true, color: DARK_TEAL } },
    { text: ": Infections, autoimmune disorders (lupus, RA, thyroid disease), physical stimuli, stress, hormonal changes, medications", options: { color: DARK_TEXT } },
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// ─── SLIDE 3: DEFINITION ─────────────────────────────────────────
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    { text: "  is a cutaneous reaction pattern characterised by transient, pruritic, blanching wheals (raised plaques) arising from localised dermal oedema due to mast cell degranulation and vasoactive mediator release.", options: { color: WHITE, fontSize: 13 } }
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    { text: "Affects the superficial dermis. Presents as wheals with pale centres and red borders. Individual lesions last ", options: { fontSize: 11, color: DARK_TEXT } },
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    { text: "Angioedema", options: { bold: true, fontSize: 13, color: ACCENT, breakLine: true } },
    { text: "Affects the deeper dermis and subcutaneous tissues. Often accompanies urticaria (~40% of patients). Can affect face, lips, tongue, or throat.\nDuration: >24 hours.", options: { fontSize: 11, color: DARK_TEXT } }
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    { text: "Episodes < 6 weeks   ", options: { color: DARK_TEXT } },
    { text: " | ", options: { color: MED_TEAL } },
    { text: "  Chronic Urticaria: ", options: { bold: true, color: MED_TEAL } },
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    { text: " | ", options: { color: ACCENT } },
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// ─── SLIDE 4: CAUSES ─────────────────────────────────────────────
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// ─── SLIDE 5: TYPES & CLASSIFICATION ─────────────────────────────
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      body: "Duration: < 6 weeks\n\nOften due to allergic responses (food, insect stings, medications), infections (bacterial, viral, parasitic), stress, or environmental stimuli (cold, heat, sunlight).\n\nCharacterised by variable-sized wheals with a red flare, often with angioedema."
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      body: "Duration: > 6 weeks\n\nAssociated with autoimmune disorders (lupus, RA, SLE, Sjogren syndrome), thyroid dysfunction, elevated progesterone levels, genetic predisposition.\n\nManifests with recurring wheals, persistent itching, and discomfort."
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    { name: "Spontaneous", desc: "No identifiable cause (idiopathic); most common form of chronic urticaria", color: DARK_TEAL },
    { name: "Inducible", desc: "Triggered by specific stimuli: cold, heat, pressure, vibration, dermatographism, sunlight", color: MED_TEAL },
    { name: "Autoimmune", desc: "Associated with autoimmune disorders; IgG autoantibodies against IgE or FcεRI receptor", color: ACCENT },
    { name: "Allergic", desc: "IgE-mediated reaction triggered by specific allergens (food, drugs, latex, venom)", color: "5A7D6E" }
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// ─── SLIDE 6: PATHOPHYSIOLOGY ────────────────────────────────────
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    { label: "Trigger Exposure", desc: "Allergen, drug, infection, physical stimulus, autoantibody", color: DARK_TEAL },
    { label: "Mast Cell Activation", desc: "IgE binds to FcεRI on mast cells/basophils; crosslinking by antigen", color: MED_TEAL },
    { label: "Mediator Release", desc: "Histamine, bradykinin, kallikrein, slow-reacting substance of anaphylaxis (leukotrienes)", color: ACCENT },
    { label: "Vascular Changes", desc: "Vasodilation + increased vascular permeability → fluid leakage into dermis", color: "2A8A6A" },
    { label: "Wheal Formation", desc: "Raised, red, pruritic wheals — localised dermal oedema", color: "5A6D3E" }
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// ─── SLIDE 7: SYMPTOMS ───────────────────────────────────────────
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  const symptoms = [
    { icon: "🔴", title: "Pruritus", desc: "Intense itching or burning sensation — cardinal symptom" },
    { icon: "🔺", title: "Wheals", desc: "Raised, flat-topped plaques with pale centres and red borders; variable size" },
    { icon: "💧", title: "Swelling", desc: "Skin tenderness and redness; angioedema of face, lips, tongue, throat" },
    { icon: "🔄", title: "Transient Lesions", desc: "Individual wheals last <24 h; new lesions may continuously appear" },
    { icon: "⚡", title: "Dermatographism", desc: "Skin reacts to minor trauma with wheal formation" },
    { icon: "🌡️", title: "Flare Triggers", desc: "Flares triggered by stress, temperature changes, or physical activity" }
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// ─── SLIDE 8: CLINICAL FEATURES ──────────────────────────────────
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    { text: "• Raised, flat-topped wheals surrounded by red flare\n", options: {} },
    { text: "• Pale centre with erythematous margins\n", options: {} },
    { text: "• 'Wheal and flare' reaction — blanching on pressure\n", options: {} },
    { text: "• Variable size: mm to several cm in diameter\n", options: {} },
    { text: "• Angioedema: diffuse swelling of face, lips, tongue\n", options: {} },
    { text: "• Dermatographism in ~5% of population", options: {} }
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  slide.addText("• Systemic anaphylaxis (15–20% lifetime risk)\n• Nausea, abdominal cramps (cholinergic type)\n• Wheezing, dizziness (solar urticaria, extensive involvement)\n• Fever, lymphadenopathy (urticarial vasculitis)", {
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    fontSize: 10.5, color: DARK_TEXT, valign: "top", margin: 4
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  // Right column: Red flags
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  slide.addText("• Lesions lasting >36 hours\n• Painful rather than pruritic\n• Leaves bruising or scarring\n→ Biopsy to exclude urticarial vasculitis\n   (fibrinoid necrosis of venules on histology)", {
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  // Right: Locations
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  slide.addText("• Can occur anywhere on the body\n• Face, lips, tongue, throat (angioedema)\n• Pressure urticaria: belt/waistband areas\n• Solar urticaria: sun-exposed skin only\n• Cholinergic: trunk and upper limbs\n• Dermatographism: sites of friction/scratch", {
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// ─── SLIDE 9: DIAGNOSIS ──────────────────────────────────────────
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  addHeader(slide, "Diagnosis");

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        "Physical exam: skin lesion characteristics",
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        "Dermatographism testing",
        "Provocation/threshold testing for inducible urticaria"
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    {
      title: "Laboratory Tests", color: MED_TEAL,
      items: [
        "CBC with differential: eosinophilia, leukocytosis, anaemia, thrombocytosis",
        "ESR & CRP (elevated in systemic disease)",
        "Liver enzymes (hepatic involvement)",
        "Renal function tests",
        "Thyroid function (TSH)",
        "Stool: H. pylori, ova & parasites"
      ]
    },
    {
      title: "Immunological Tests", color: ACCENT,
      items: [
        "Antinuclear antibodies (ANA)",
        "Elevated IgE levels",
        "Anti-thyroid antibodies",
        "Skin prick testing (SPT)",
        "Radioallergosorbent test (RAST)",
        "Enzyme-linked immunosorbent assay (ELISA)"
      ]
    }
  ];

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    const x = 0.18 + i * 3.27;
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    fontSize: 10, color: MED_TEAL, italic: true, bold: false, align: "center"
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// ─── SLIDE 10: DIFFERENTIAL DIAGNOSIS TABLE ──────────────────────
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  addHeader(slide, "Differential Diagnosis");

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      { text: "Similarity to Urticaria", options: { bold: true, color: WHITE, fontSize: 12, fill: DARK_TEAL } },
      { text: "Key Distinguishing Features", options: { bold: true, color: WHITE, fontSize: 12, fill: DARK_TEAL } },
      { text: "Duration / Course", options: { bold: true, color: WHITE, fontSize: 12, fill: DARK_TEAL } }
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      { text: "Urticarial Vasculitis", options: { bold: true, color: DARK_TEAL } },
      { text: "Pruritic wheals with red borders, similar clinical appearance" },
      { text: "Lesions >36 h, PAINFUL not just itchy, leaves bruising/purpura, fibrinoid necrosis on biopsy, associated with SLE" },
      { text: "Chronic; may leave pigmentation" }
    ],
    [
      { text: "Angioedema (HAE)", options: { bold: true, color: DARK_TEAL } },
      { text: "Swelling of skin and subcutaneous tissues; may co-occur with urticaria" },
      { text: "NO urticaria or pruritus; GI involvement (colic); C1-INH deficiency; does NOT respond to antihistamines; family history common" },
      { text: "Attacks last 2–5 days; recurrent" }
    ],
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      { text: "Erythema Multiforme", options: { bold: true, color: DARK_TEAL } },
      { text: "Raised pruritic/tender plaques; skin redness; can follow drug exposure or infection" },
      { text: "TARGET lesions (2+ zones with dusky centre); fixed lesions that do NOT migrate; mucosal involvement; epidermal necrosis" },
      { text: "Persists >7 days; does not resolve in 24 h" }
    ],
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      { text: "Morbilliform Drug Eruption", options: { bold: true, color: DARK_TEAL } },
      { text: "Erythematous plaques after drug exposure; may itch; blanching" },
      { text: "Diffuse, SYMMETRIC maculopapular rash (not wheals); starts centrally; does NOT migrate within 24 h; no angioedema" },
      { text: "Days to weeks; resolves on drug withdrawal" }
    ]
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// ─── SLIDE 11: COMPLICATIONS ─────────────────────────────────────
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  addContentBg(slide);
  addHeader(slide, "Complications");

  const complications = [
    {
      title: "Anaphylaxis",
      severity: "LIFE-THREATENING",
      color: "C0392B",
      desc: "Severe systemic allergic reaction with urticaria + hypotension, bronchospasm, laryngeal oedema. Requires immediate epinephrine (adrenaline) injection. Risk highest with food/drug/venom triggers."
    },
    {
      title: "Angioedema of Airway",
      severity: "MEDICAL EMERGENCY",
      color: "E67E22",
      desc: "Swelling of tongue, pharynx, larynx causing airway obstruction. Presents with stridor, drooling, dysphagia. May require emergency intubation or tracheostomy."
    },
    {
      title: "Skin Infections",
      severity: "Secondary Bacterial",
      color: MED_TEAL,
      desc: "Intense scratching breaks the skin barrier, leading to secondary bacterial infections (impetigo, cellulitis, abscess). More common in chronic urticaria with persistent pruritus."
    },
    {
      title: "Psychological Impact",
      severity: "Chronic Burden",
      color: "7D6E9A",
      desc: "Chronic urticaria significantly impairs quality of life. Associated with anxiety, depression, sleep disturbance, and social isolation due to unpredictable outbreaks and visible skin changes."
    },
    {
      title: "Gastrointestinal Involvement",
      severity: "Systemic Spread",
      color: DARK_TEAL,
      desc: "Angioedema may extend to GI mucosa causing colic, nausea, vomiting, and diarrhoea. Particularly seen in hereditary angioedema (HAE) and severe allergic urticaria."
    },
    {
      title: "Urticarial Vasculitis",
      severity: "Chronic Complication",
      color: "5A7D6E",
      desc: "Progression to vessel wall inflammation. Persistent painful lesions >36 h, leaving bruising and pigmentation. Associated with SLE and other connective tissue diseases."
    }
  ];

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// ─── SLIDE 12: SUMMARY / CLOSING SLIDE ───────────────────────────
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  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.12, fill: { color: ACCENT } });
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    "Urticaria affects >20% of the population at some point — highly prevalent skin condition",
    "Mast cell degranulation and histamine release are central to ALL forms of urticaria",
    "Acute (<6 weeks) vs Chronic (≥6 weeks) — key clinical distinction for diagnosis & treatment",
    "4 types: Spontaneous, Inducible, Autoimmune, Allergic",
    "Diagnosis is primarily clinical; laboratory workup guided by history (most cases have no lab abnormality)",
    "Life-threatening complications: Anaphylaxis + Airway angioedema — must be recognised promptly",
  ];

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}

// ─── WRITE FILE ──────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/urticaria-ppt/Urticaria_Presentation.pptx" })
  .then(() => console.log("✅  Presentation saved successfully!"))
  .catch(err => console.error("❌  Error:", err));

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

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