Chronic Suppurative Otitis Media (CSOM)

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Chronic Suppurative Otitis Media (CSOM)";
pres.author = "Orris Medical";

// ─── COLOR PALETTE ───────────────────────────────────────────────
// Deep teal (dominant), pale mist (bg), gold accent, white text
const C = {
  dark:    "0A2E3D",   // deep navy-teal (title bg, header bars)
  mid:     "0E5B73",   // mid teal (section headers)
  accent:  "F0A500",   // amber/gold accent
  light:   "E8F4F8",   // very pale teal bg
  white:   "FFFFFF",
  body:    "1A3A4A",   // dark teal for body text
  muted:   "5A7F8E",   // muted teal for subtext
  red:     "C0392B",   // danger / complication red
  green:   "1A7A4A",   // safe/tubotympanic green
  orange:  "E67E22",   // unsafe/atticoantral orange
};

// ─── HELPERS ─────────────────────────────────────────────────────
function darkSlide(slide) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 5.625,
    fill: { color: C.dark }, line: { color: C.dark }
  });
}

function lightSlide(slide) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 5.625,
    fill: { color: C.light }, line: { color: C.light }
  });
}

function accentBar(slide, w = 10, h = 0.06, x = 0, y = 5.565) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x, y, w, h, fill: { color: C.accent }, line: { color: C.accent }
  });
}

function sectionLabel(slide, text, x = 0.4, y = 0.22) {
  slide.addText(text, {
    x, y, w: 9.2, h: 0.32,
    fontSize: 9, bold: true, color: C.accent, charSpacing: 2,
    fontFace: "Calibri", margin: 0
  });
}

function slideTitle(slide, title, x = 0.4, y = 0.55) {
  slide.addText(title, {
    x, y, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.dark,
    fontFace: "Calibri", margin: 0
  });
}

function headerBar(slide, title) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 1.1,
    fill: { color: C.dark }, line: { color: C.dark }
  });
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 1.05, w: 10, h: 0.06,
    fill: { color: C.accent }, line: { color: C.accent }
  });
  slide.addText(title, {
    x: 0.4, y: 0.15, w: 9.2, h: 0.8,
    fontSize: 24, bold: true, color: C.white,
    fontFace: "Calibri", margin: 0
  });
}

function card(slide, x, y, w, h, fillColor, shadowOn = true) {
  slide.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x, y, w, h,
    fill: { color: fillColor },
    line: { color: fillColor },
    rectRadius: 0.12,
    shadow: shadowOn ? { type: "outer", color: "000000", blur: 8, offset: 2, angle: 135, opacity: 0.12 } : undefined
  });
}

function bullet(text, sub = false) {
  return {
    text,
    options: {
      bullet: sub ? { indent: 20 } : true,
      fontSize: sub ? 12 : 13.5,
      color: C.body,
      bold: false,
      breakLine: true
    }
  };
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE SLIDE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);

  // Gold left strip
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 0.18, h: 5.625,
    fill: { color: C.accent }, line: { color: C.accent }
  });

  // Ear icon silhouette area (decorative circle)
  s.addShape(pres.shapes.OVAL, {
    x: 7.2, y: 0.5, w: 2.5, h: 2.5,
    fill: { color: C.mid }, line: { color: C.mid }
  });
  s.addText("👂", {
    x: 7.4, y: 0.7, w: 2.1, h: 2.1,
    fontSize: 68, align: "center", valign: "middle"
  });

  s.addText("CHRONIC SUPPURATIVE", {
    x: 0.5, y: 1.0, w: 6.5, h: 0.55,
    fontSize: 13, bold: true, color: C.accent,
    charSpacing: 4, fontFace: "Calibri", margin: 0
  });
  s.addText("Otitis Media", {
    x: 0.5, y: 1.5, w: 6.5, h: 1.1,
    fontSize: 52, bold: true, color: C.white,
    fontFace: "Calibri", margin: 0
  });
  s.addText("CSOM", {
    x: 0.5, y: 2.55, w: 6.5, h: 0.65,
    fontSize: 36, bold: true, color: C.accent,
    fontFace: "Calibri", margin: 0
  });
  s.addText("Definition · Pathophysiology · Diagnosis · Management · Complications", {
    x: 0.5, y: 3.35, w: 6.5, h: 0.45,
    fontSize: 11, color: C.muted, italic: true,
    fontFace: "Calibri", margin: 0
  });

  // Sources credit
  s.addText("Sources: Cummings Otolaryngology · KJ Lee's Essential Otolaryngology · Shambaugh Surgery of the Ear · Cochrane 2025", {
    x: 0.5, y: 5.1, w: 9.2, h: 0.35,
    fontSize: 8, color: C.muted, italic: true,
    fontFace: "Calibri", margin: 0
  });
  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 — DEFINITION & OVERVIEW
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  headerBar(s, "Definition & Overview");

  // Definition card
  card(s, 0.35, 1.25, 9.3, 1.2, C.white);
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.35, y: 1.25, w: 0.12, h: 1.2,
    fill: { color: C.accent }, line: { color: C.accent }
  });
  s.addText("CSOM is a persistent chronic inflammation of the middle ear and mastoid, characterized by a perforated tympanic membrane with recurrent or continuous mucopurulent otorrhea lasting > 2–6 weeks.", {
    x: 0.6, y: 1.32, w: 8.9, h: 1.05,
    fontSize: 13.5, color: C.body, italic: true,
    fontFace: "Calibri", valign: "middle"
  });

  // Key facts row
  const facts = [
    { icon: "🌍", val: "Leading cause", sub: "of preventable\nhearing loss" },
    { icon: "👶", val: "Peak: < 2 yrs", sub: "Most common in\nyoung children" },
    { icon: "⚠️", val: "> 2–6 weeks", sub: "Duration of\notorrhea" },
    { icon: "🕳️", val: "TM Perforation", sub: "Hallmark\nfinding" },
  ];
  facts.forEach((f, i) => {
    const x = 0.35 + i * 2.35;
    card(s, x, 2.65, 2.15, 2.55, C.white);
    s.addShape(pres.shapes.RECTANGLE, {
      x, y: 2.65, w: 2.15, h: 0.08,
      fill: { color: C.mid }, line: { color: C.mid }
    });
    s.addText(f.icon, { x, y: 2.7, w: 2.15, h: 0.7, fontSize: 28, align: "center" });
    s.addText(f.val, {
      x, y: 3.42, w: 2.15, h: 0.4,
      fontSize: 12.5, bold: true, color: C.dark, align: "center", fontFace: "Calibri"
    });
    s.addText(f.sub, {
      x, y: 3.82, w: 2.15, h: 0.65,
      fontSize: 10, color: C.muted, align: "center", fontFace: "Calibri"
    });
  });
  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 3 — TYPES / CLASSIFICATION
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  headerBar(s, "Classification of CSOM");

  // Tubotympanic
  card(s, 0.35, 1.25, 4.45, 3.9, "EBF5FB");
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.35, y: 1.25, w: 4.45, h: 0.45,
    fill: { color: C.green }, line: { color: C.green }
  });
  s.addText("TUBOTYMPANIC  (Safe)", {
    x: 0.4, y: 1.27, w: 4.3, h: 0.42,
    fontSize: 13, bold: true, color: C.white, align: "center",
    fontFace: "Calibri", margin: 0
  });
  s.addText([
    { text: "Synonyms: Benign / Mucosal type", options: { bold: true, breakLine: true, color: C.body } },
    { text: " ", options: { breakLine: true } },
    { text: "• Central (pars tensa) perforation", options: { breakLine: true, color: C.body } },
    { text: "• Mucopurulent / mucoid otorrhea", options: { breakLine: true, color: C.body } },
    { text: "• No cholesteatoma", options: { breakLine: true, color: C.body } },
    { text: "• Conductive hearing loss", options: { breakLine: true, color: C.body } },
    { text: "• ET dysfunction is key driver", options: { breakLine: true, color: C.body } },
    { text: " ", options: { breakLine: true } },
    { text: "Prognosis: Generally favorable with treatment", options: { color: C.green, bold: true, breakLine: false } },
  ], {
    x: 0.5, y: 1.75, w: 4.1, h: 3.2,
    fontSize: 12.5, fontFace: "Calibri", valign: "top"
  });

  // Atticoantral
  card(s, 5.2, 1.25, 4.45, 3.9, "FDF3E7");
  s.addShape(pres.shapes.RECTANGLE, {
    x: 5.2, y: 1.25, w: 4.45, h: 0.45,
    fill: { color: C.orange }, line: { color: C.orange }
  });
  s.addText("ATTICOANTRAL  (Unsafe)", {
    x: 5.25, y: 1.27, w: 4.3, h: 0.42,
    fontSize: 13, bold: true, color: C.white, align: "center",
    fontFace: "Calibri", margin: 0
  });
  s.addText([
    { text: "Synonyms: Dangerous / Squamous type", options: { bold: true, breakLine: true, color: C.body } },
    { text: " ", options: { breakLine: true } },
    { text: "• Marginal / attic perforation", options: { breakLine: true, color: C.body } },
    { text: "• Foul-smelling, scanty otorrhea", options: { breakLine: true, color: C.body } },
    { text: "• Cholesteatoma commonly present", options: { breakLine: true, color: C.orange, bold: true } },
    { text: "• Ossicular erosion common", options: { breakLine: true, color: C.body } },
    { text: "• High risk of complications", options: { breakLine: true, color: C.body } },
    { text: " ", options: { breakLine: true } },
    { text: "Prognosis: Requires surgery", options: { color: C.red, bold: true, breakLine: false } },
  ], {
    x: 5.35, y: 1.75, w: 4.1, h: 3.2,
    fontSize: 12.5, fontFace: "Calibri", valign: "top"
  });

  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 4 — EPIDEMIOLOGY & RISK FACTORS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  headerBar(s, "Epidemiology & Risk Factors");

  // Epidemiology left column
  card(s, 0.35, 1.25, 4.45, 3.9, C.white);
  s.addText("EPIDEMIOLOGY", {
    x: 0.5, y: 1.32, w: 4.1, h: 0.38,
    fontSize: 11, bold: true, color: C.mid, charSpacing: 2,
    fontFace: "Calibri", margin: 0
  });
  s.addText([
    bullet("Most common in children < 2 years old"),
    bullet("Prevalent in low-resource settings"),
    bullet("Leading preventable cause of hearing loss worldwide"),
    bullet("High-risk populations:"),
    bullet("Native Americans, Inuit, Aboriginal Australians, Māori", true),
    bullet("Genetic predisposition suspected", true),
    bullet("Strong association with multiple prior AOM episodes"),
  ], {
    x: 0.5, y: 1.72, w: 4.1, h: 3.3,
    fontFace: "Calibri", valign: "top"
  });

  // Risk factors right column
  card(s, 5.2, 1.25, 4.45, 3.9, C.white);
  s.addText("RISK FACTORS", {
    x: 5.35, y: 1.32, w: 4.1, h: 0.38,
    fontSize: 11, bold: true, color: C.mid, charSpacing: 2,
    fontFace: "Calibri", margin: 0
  });
  const risks = [
    "🔴  Recurrent acute otitis media (AOM)",
    "🔴  AOM in first few months of life",
    "🔴  Chronic secretory otitis media",
    "🔴  Eustachian tube dysfunction",
    "🔴  Craniofacial abnormalities (cleft palate)",
    "🔴  Poor nutrition / overcrowded living",
    "🔴  Lack of breastfeeding",
    "🔴  Immunodeficiency states",
  ];
  s.addText(risks.map((r, i) => ({
    text: r,
    options: { breakLine: i < risks.length - 1, color: C.body, fontSize: 12.5 }
  })), {
    x: 5.35, y: 1.72, w: 4.1, h: 3.3,
    fontFace: "Calibri", valign: "top"
  });

  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 5 — PATHOPHYSIOLOGY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  headerBar(s, "Pathophysiology");

  const steps = [
    { n: "1", title: "ET Dysfunction", desc: "Negative ME pressure\n→ TM retraction" },
    { n: "2", title: "Effusion", desc: "Serous → purulent\nmiddle ear effusion" },
    { n: "3", title: "Infection", desc: "Bacterial biofilms;\nchronic inflammation" },
    { n: "4", title: "Mucosal Change", desc: "Submucosal glands;\nsecretory mucosa" },
    { n: "5", title: "TM Weakening", desc: "Enzyme degradation\nof collagen skeleton" },
    { n: "6", title: "Perforation", desc: "Retraction pockets\n→ TM perforation" },
    { n: "7", title: "Cholesteatoma", desc: "Deep pockets +\nsquamous migration" },
  ];

  // Draw cascade boxes
  steps.forEach((st, i) => {
    const x = 0.28 + i * 1.35;
    const y = 1.25;
    // circle number
    s.addShape(pres.shapes.OVAL, {
      x: x + 0.27, y: y, w: 0.52, h: 0.52,
      fill: { color: C.mid }, line: { color: C.mid }
    });
    s.addText(st.n, {
      x: x + 0.27, y: y, w: 0.52, h: 0.52,
      fontSize: 14, bold: true, color: C.white,
      align: "center", valign: "middle", margin: 0
    });
    // Card
    card(s, x, y + 0.58, 1.2, 2.4, C.white);
    s.addShape(pres.shapes.RECTANGLE, {
      x, y: y + 0.58, w: 1.2, h: 0.06,
      fill: { color: C.mid }, line: { color: C.mid }
    });
    s.addText(st.title, {
      x, y: y + 0.66, w: 1.2, h: 0.48,
      fontSize: 10.5, bold: true, color: C.dark,
      align: "center", fontFace: "Calibri"
    });
    s.addText(st.desc, {
      x, y: y + 1.15, w: 1.2, h: 1.7,
      fontSize: 9.5, color: C.muted, align: "center",
      fontFace: "Calibri", valign: "top"
    });
    // Arrow
    if (i < steps.length - 1) {
      s.addShape(pres.shapes.RECTANGLE, {
        x: x + 1.2, y: y + 1.48, w: 0.14, h: 0.06,
        fill: { color: C.accent }, line: { color: C.accent }
      });
    }
  });

  // Biofilm callout
  card(s, 0.35, 4.22, 9.3, 1.0, "FFF8E7");
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.35, y: 4.22, w: 0.1, h: 1.0,
    fill: { color: C.accent }, line: { color: C.accent }
  });
  s.addText("⚗️  BIOFILM KEY CONCEPT: ", {
    x: 0.55, y: 4.3, w: 2.2, h: 0.4,
    fontSize: 11, bold: true, color: C.orange, fontFace: "Calibri", margin: 0
  });
  s.addText("Sessile bacteria encased in oligopolysaccharide matrix escape phagocytosis, show up to 1000× antibiotic resistance, produce efflux pumps, and are often polymicrobial — making CSOM notoriously difficult to eradicate medically.", {
    x: 2.7, y: 4.3, w: 6.7, h: 0.75,
    fontSize: 10.5, color: C.body, fontFace: "Calibri"
  });

  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 6 — MICROBIOLOGY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  headerBar(s, "Microbiology");

  const bugs = [
    { org: "Pseudomonas aeruginosa", note: "Most common in chronic CSOM", color: C.red, pct: "38%" },
    { org: "Staphylococcus aureus", note: "Including MRSA strains", color: C.orange, pct: "30%" },
    { org: "Streptococcus pneumoniae", note: "More common in AOM-associated", color: C.mid, pct: "12%" },
    { org: "H. influenzae / M. catarrhalis", note: "Acute-on-chronic exacerbations", color: C.muted, pct: "10%" },
    { org: "Anaerobes", note: "Bacteroides, Peptostreptococcus", color: "6A4C93", pct: "6%" },
    { org: "Candida / Fungal", note: "35% after topical ciprofloxacin × 3 wks", color: "2E7D32", pct: "4%" },
  ];

  bugs.forEach((b, i) => {
    const col = i < 3 ? 0 : 1;
    const row = i < 3 ? i : i - 3;
    const x = col === 0 ? 0.35 : 5.2;
    const y = 1.3 + row * 1.32;
    card(s, x, y, 4.45, 1.15, C.white);
    s.addShape(pres.shapes.RECTANGLE, {
      x, y, w: 0.08, h: 1.15,
      fill: { color: b.color }, line: { color: b.color }
    });
    // Percentage badge
    s.addShape(pres.shapes.OVAL, {
      x: x + 3.8, y: y + 0.1, w: 0.5, h: 0.5,
      fill: { color: b.color }, line: { color: b.color }
    });
    s.addText(b.pct, {
      x: x + 3.8, y: y + 0.1, w: 0.5, h: 0.5,
      fontSize: 8.5, bold: true, color: C.white,
      align: "center", valign: "middle", margin: 0
    });
    s.addText(b.org, {
      x: x + 0.2, y: y + 0.1, w: 3.5, h: 0.45,
      fontSize: 12, bold: true, color: b.color,
      fontFace: "Calibri", margin: 0, italic: true
    });
    s.addText(b.note, {
      x: x + 0.2, y: y + 0.57, w: 3.5, h: 0.45,
      fontSize: 10.5, color: C.body, fontFace: "Calibri", margin: 0
    });
  });

  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 7 — CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  headerBar(s, "Clinical Features");

  // Symptoms left
  card(s, 0.35, 1.25, 4.3, 3.9, C.white);
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.35, y: 1.25, w: 4.3, h: 0.42,
    fill: { color: C.mid }, line: { color: C.mid }
  });
  s.addText("SYMPTOMS", {
    x: 0.4, y: 1.27, w: 4.2, h: 0.38,
    fontSize: 13, bold: true, color: C.white, fontFace: "Calibri",
    align: "center", margin: 0
  });
  s.addText([
    { text: "✅  Intermittent / continuous otorrhea", options: { color: C.body, breakLine: true } },
    { text: "      (may be foul-smelling)", options: { color: C.muted, italic: true, fontSize: 11, breakLine: true } },
    { text: "✅  Hearing loss (conductive > SNHL)", options: { color: C.body, breakLine: true } },
    { text: " ", options: { breakLine: true } },
    { text: "⚠️  Otalgia / headache = RED FLAG", options: { color: C.red, bold: true, breakLine: true } },
    { text: "      (suspect intracranial complication)", options: { color: C.muted, italic: true, fontSize: 11, breakLine: true } },
    { text: "⚠️  Vertigo = RED FLAG", options: { color: C.red, bold: true, breakLine: true } },
    { text: "      (suspect labyrinthitis / fistula)", options: { color: C.muted, italic: true, fontSize: 11, breakLine: true } },
    { text: " ", options: { breakLine: true } },
    { text: "❌  No fever typically (unlike AOM)", options: { color: C.body, breakLine: false } },
  ], {
    x: 0.5, y: 1.72, w: 4.0, h: 3.35,
    fontSize: 12.5, fontFace: "Calibri", valign: "top"
  });

  // Signs right
  card(s, 4.85, 1.25, 4.8, 3.9, C.white);
  s.addShape(pres.shapes.RECTANGLE, {
    x: 4.85, y: 1.25, w: 4.8, h: 0.42,
    fill: { color: C.mid }, line: { color: C.mid }
  });
  s.addText("SIGNS (Otomicroscopy)", {
    x: 4.9, y: 1.27, w: 4.7, h: 0.38,
    fontSize: 13, bold: true, color: C.white, fontFace: "Calibri",
    align: "center", margin: 0
  });
  s.addText([
    { text: "🔬  TM perforation (central = tubotympanic;\n        attic/marginal = atticoantral)", options: { color: C.body, breakLine: true } },
    { text: "🔬  Mucopurulent discharge in EAC", options: { color: C.body, breakLine: true } },
    { text: "🔬  Granulation tissue / polyps", options: { color: C.body, breakLine: true } },
    { text: "🔬  Ossicular / scutal erosion", options: { color: C.body, breakLine: true } },
    { text: "🔬  Pearly white debris = cholesteatoma", options: { color: C.orange, bold: true, breakLine: true } },
    { text: "🔬  TM retraction pockets", options: { color: C.body, breakLine: true } },
    { text: " ", options: { breakLine: true } },
    { text: "Audiometry mandatory in all patients!", options: { color: C.mid, bold: true, breakLine: false } },
  ], {
    x: 5.0, y: 1.72, w: 4.5, h: 3.35,
    fontSize: 12.5, fontFace: "Calibri", valign: "top"
  });

  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 8 — AUDIOLOGICAL ASSESSMENT
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  headerBar(s, "Audiological Assessment");

  const items = [
    { icon: "🎧", title: "Pure Tone Audiometry (PTA)", desc: "Mandatory in ALL patients.\nDocuments degree & type of hearing loss before any treatment.", color: C.mid },
    { icon: "📉", title: "Conductive Hearing Loss", desc: "Most common finding.\n>30 dB air–bone gap suggests ossicular chain erosion.", color: C.orange },
    { icon: "🌀", title: "Sensorineural Hearing Loss", desc: "SNHL of 5–33 dB may co-exist.\nDocument preoperatively — important for surgical consent.", color: C.red },
    { icon: "🦴", title: "Ossicular Erosion Clue", desc: "Hearing may be preserved even with ossicular erosion if cholesteatoma directly transmits sound to oval window.", color: "6A4C93" },
    { icon: "📊", title: "Tympanometry", desc: "Type B flat curve = perforation or effusion.\nHelps differentiate from intact TM with effusion (AOM).", color: C.green },
    { icon: "🎤", title: "Speech Discrimination", desc: "Useful in children to quantify functional impact.\nPoor scores may indicate cochlear involvement.", color: C.muted },
  ];

  items.forEach((item, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.35 + col * 3.12;
    const y = 1.28 + row * 1.98;
    card(s, x, y, 3.0, 1.82, C.white);
    s.addShape(pres.shapes.RECTANGLE, {
      x, y, w: 3.0, h: 0.06,
      fill: { color: item.color }, line: { color: item.color }
    });
    s.addText(item.icon, { x, y: y + 0.06, w: 3.0, h: 0.55, fontSize: 22, align: "center" });
    s.addText(item.title, {
      x: x + 0.1, y: y + 0.6, w: 2.8, h: 0.42,
      fontSize: 11, bold: true, color: item.color,
      fontFace: "Calibri", align: "center"
    });
    s.addText(item.desc, {
      x: x + 0.1, y: y + 1.0, w: 2.8, h: 0.75,
      fontSize: 9.5, color: C.body,
      fontFace: "Calibri", align: "center"
    });
  });

  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 9 — MANAGEMENT: MEDICAL
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  headerBar(s, "Management — Medical Treatment");

  const steps = [
    {
      num: "1",
      title: "Aural Toilet",
      bullets: [
        "Microsuction / dry mopping to clear discharge",
        "Removes debris → improves topical drug penetration",
        "Acetic acid 1:1 (white vinegar : distilled water) for antisepsis",
        "Cornerstone of all medical management"
      ],
      color: C.mid,
    },
    {
      num: "2",
      title: "Topical Fluoroquinolones",
      bullets: [
        "FIRST-LINE: ciprofloxacin / ofloxacin otic drops",
        "Superior to systemic antibiotics (Cochrane 2025)",
        "Safe for middle ear use — no ototoxicity",
        "Cover Pseudomonas & S. aureus",
        "Avoid aminoglycosides (ototoxic risk)"
      ],
      color: C.green,
    },
    {
      num: "3",
      title: "Systemic Antibiotics",
      bullets: [
        "Reserved for: severe cases, copious drainage,\nor failed topical treatment",
        "Cover Pseudomonas (ciprofloxacin oral)",
        "IV antibiotics if systemic sepsis signs",
        "Culture & sensitivity guides selection"
      ],
      color: C.orange,
    },
  ];

  steps.forEach((st, i) => {
    const x = 0.3 + i * 3.22;
    card(s, x, 1.22, 3.1, 3.98, C.white);
    s.addShape(pres.shapes.RECTANGLE, {
      x, y: 1.22, w: 3.1, h: 0.5,
      fill: { color: st.color }, line: { color: st.color }
    });
    s.addShape(pres.shapes.OVAL, {
      x: x + 0.1, y: 1.22, w: 0.5, h: 0.5,
      fill: { color: C.white }, line: { color: C.white }
    });
    s.addText(st.num, {
      x: x + 0.1, y: 1.22, w: 0.5, h: 0.5,
      fontSize: 16, bold: true, color: st.color,
      align: "center", valign: "middle", margin: 0
    });
    s.addText(st.title, {
      x: x + 0.65, y: 1.29, w: 2.35, h: 0.4,
      fontSize: 13, bold: true, color: C.white,
      fontFace: "Calibri", margin: 0, valign: "middle"
    });
    s.addText(st.bullets.map((b, bi) => ({
      text: "• " + b,
      options: { breakLine: bi < st.bullets.length - 1, color: C.body, fontSize: 12 }
    })), {
      x: x + 0.15, y: 1.8, w: 2.85, h: 3.3,
      fontFace: "Calibri", valign: "top"
    });
  });

  // Note bar
  card(s, 0.35, 5.22, 9.3, 0.28, "E8F4F8");
  s.addText("📌  Cochrane 2025 (3 Systematic Reviews): Topical antibiotics > systemic antibiotics for CSOM. Topical quinolones are safe and effective first-line therapy.", {
    x: 0.5, y: 5.24, w: 9.1, h: 0.25,
    fontSize: 9.5, color: C.mid, italic: true, fontFace: "Calibri"
  });

  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 10 — MANAGEMENT: SURGICAL
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  headerBar(s, "Management — Surgical Treatment");

  // Indications
  card(s, 0.35, 1.22, 9.3, 1.0, "FFF3E0");
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.35, y: 1.22, w: 0.1, h: 1.0,
    fill: { color: C.orange }, line: { color: C.orange }
  });
  s.addText("SURGICAL INDICATIONS: ", {
    x: 0.55, y: 1.28, w: 2.0, h: 0.4,
    fontSize: 11, bold: true, color: C.orange, fontFace: "Calibri", margin: 0
  });
  s.addText("Cholesteatoma (near-absolute)  |  Failed medical therapy  |  Complications (vertigo, facial palsy, headache)  |  Persistent TM perforation after infection resolves", {
    x: 2.5, y: 1.28, w: 7.0, h: 0.75,
    fontSize: 11, color: C.body, fontFace: "Calibri"
  });

  // Three priorities
  const prios = ["1  Eradicate disease", "2  Prevent recurrence", "3  Restore hearing"];
  prios.forEach((p, i) => {
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x: 0.35 + i * 3.12, y: 2.35, w: 3.0, h: 0.52,
      fill: { color: C.dark }, line: { color: C.dark }, rectRadius: 0.1
    });
    s.addText(p, {
      x: 0.35 + i * 3.12, y: 2.35, w: 3.0, h: 0.52,
      fontSize: 13, bold: true, color: C.white,
      align: "center", valign: "middle", fontFace: "Calibri"
    });
  });
  s.addText("Surgical Priorities:", {
    x: 9.4, y: 2.4, w: 0.5, h: 0.45,
    fontSize: 9, color: C.muted, italic: true, fontFace: "Calibri"
  });

  // Procedures
  const procs = [
    {
      title: "Myringoplasty\n/ Tympanoplasty",
      bullets: [
        "TM repair — ear dry ≥3–4 wks pre-op",
        ">90% success for TM perforation",
        "Ossiculoplasty if ossicular damage",
        "May be staged procedure"
      ],
      color: C.green
    },
    {
      title: "Canal Wall-Up\nMastoidectomy (CWU)",
      bullets: [
        "Preserves posterior EAC wall",
        "Easier aftercare, no restrictions",
        "Risk: residual cholesteatoma",
        "May need planned 2nd-look surgery"
      ],
      color: C.mid
    },
    {
      title: "Canal Wall-Down\nMastoidectomy (CWD)",
      bullets: [
        "Removes posterior canal wall",
        "Better exposure, lower recurrence",
        "Open cavity: lifetime monitoring",
        "Used for extensive cholesteatoma"
      ],
      color: C.orange
    },
  ];

  procs.forEach((pr, i) => {
    const x = 0.35 + i * 3.12;
    card(s, x, 3.0, 3.0, 2.3, C.white);
    s.addShape(pres.shapes.RECTANGLE, {
      x, y: 3.0, w: 3.0, h: 0.45,
      fill: { color: pr.color }, line: { color: pr.color }
    });
    s.addText(pr.title, {
      x, y: 3.0, w: 3.0, h: 0.45,
      fontSize: 11, bold: true, color: C.white,
      align: "center", valign: "middle", fontFace: "Calibri"
    });
    s.addText(pr.bullets.map((b, bi) => ({
      text: "• " + b,
      options: { breakLine: bi < pr.bullets.length - 1, color: C.body, fontSize: 11 }
    })), {
      x: x + 0.12, y: 3.5, w: 2.75, h: 1.72,
      fontFace: "Calibri", valign: "top"
    });
  });

  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 11 — COMPLICATIONS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  headerBar(s, "Complications of CSOM");

  // Intratemporal
  card(s, 0.35, 1.25, 4.45, 3.95, C.white);
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.35, y: 1.25, w: 4.45, h: 0.45,
    fill: { color: C.orange }, line: { color: C.orange }
  });
  s.addText("INTRATEMPORAL", {
    x: 0.4, y: 1.27, w: 4.35, h: 0.42,
    fontSize: 14, bold: true, color: C.white,
    align: "center", fontFace: "Calibri", margin: 0
  });
  const intra = [
    "🦻  Conductive Hearing Loss",
    "🌀  Acute / Coalescent Mastoiditis",
    "😵  Labyrinthitis / SNHL",
    "💉  Labyrinthine Fistula",
    "😶  Facial Nerve Paralysis",
    "🦠  Subperiosteal Abscess",
    "💎  Cholesteatoma Formation",
    "👁️  Petrositis (Gradenigo Syndrome)",
  ];
  s.addText(intra.map((t, i) => ({
    text: t,
    options: { breakLine: i < intra.length - 1, color: C.body, fontSize: 12.5 }
  })), {
    x: 0.55, y: 1.78, w: 4.1, h: 3.35,
    fontFace: "Calibri", valign: "top"
  });

  // Intracranial
  card(s, 5.2, 1.25, 4.45, 3.95, C.white);
  s.addShape(pres.shapes.RECTANGLE, {
    x: 5.2, y: 1.25, w: 4.45, h: 0.45,
    fill: { color: C.red }, line: { color: C.red }
  });
  s.addText("INTRACRANIAL  ⚠️", {
    x: 5.25, y: 1.27, w: 4.35, h: 0.42,
    fontSize: 14, bold: true, color: C.white,
    align: "center", fontFace: "Calibri", margin: 0
  });
  const intra2 = [
    "🧠  Meningitis",
    "🧠  Brain Abscess",
    "🩸  Epidural Abscess",
    "🩸  Subdural Abscess",
    "🩸  Sigmoid Sinus Thrombophlebitis",
    "💀  Otitic Hydrocephalus",
    " ",
    "⚡  Otalgia + Headache = RED FLAG\n       → Immediate investigation",
  ];
  s.addText(intra2.map((t, i) => ({
    text: t,
    options: {
      breakLine: i < intra2.length - 1,
      color: i === intra2.length - 1 ? C.red : C.body,
      fontSize: 12.5,
      bold: i === intra2.length - 1
    }
  })), {
    x: 5.35, y: 1.78, w: 4.15, h: 3.35,
    fontFace: "Calibri", valign: "top"
  });

  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 12 — SUMMARY / KEY POINTS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);

  // Gold accent strip
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 0.08,
    fill: { color: C.accent }, line: { color: C.accent }
  });

  s.addText("KEY TAKEAWAYS", {
    x: 0.5, y: 0.2, w: 9, h: 0.4,
    fontSize: 11, bold: true, color: C.accent, charSpacing: 4,
    fontFace: "Calibri", margin: 0
  });
  s.addText("CSOM — Clinical Pearls", {
    x: 0.5, y: 0.6, w: 9, h: 0.65,
    fontSize: 28, bold: true, color: C.white,
    fontFace: "Calibri", margin: 0
  });

  const points = [
    { n: "01", text: "CSOM = TM perforation + mucopurulent otorrhea > 2–6 weeks", col: C.accent },
    { n: "02", text: "Tubotympanic (safe): central perforation, no cholesteatoma", col: C.green },
    { n: "03", text: "Atticoantral (unsafe): attic/marginal perforation + cholesteatoma → surgery", col: C.orange },
    { n: "04", text: "Key pathogen: Pseudomonas aeruginosa; biofilms drive antibiotic resistance", col: C.red },
    { n: "05", text: "First-line: Aural toilet + topical fluoroquinolone (ciprofloxacin/ofloxacin)", col: C.mid },
    { n: "06", text: "Otalgia/headache/vertigo = RED FLAGS → suspect complications", col: C.red },
    { n: "07", text: "Cochrane 2025: Topical > systemic antibiotics for CSOM", col: C.accent },
    { n: "08", text: "Surgery for cholesteatoma, failed medical treatment, or complications", col: "A0CFDD" },
  ];

  points.forEach((p, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.35 : 5.2;
    const y = 1.38 + row * 1.02;
    s.addShape(pres.shapes.RECTANGLE, {
      x, y, w: 0.5, h: 0.82,
      fill: { color: p.col }, line: { color: p.col }
    });
    s.addText(p.n, {
      x, y, w: 0.5, h: 0.82,
      fontSize: 13, bold: true, color: C.dark,
      align: "center", valign: "middle", margin: 0
    });
    s.addShape(pres.shapes.RECTANGLE, {
      x: x + 0.5, y, w: 4.3, h: 0.82,
      fill: { color: "132E3D" }, line: { color: "132E3D" }
    });
    s.addText(p.text, {
      x: x + 0.6, y, w: 4.1, h: 0.82,
      fontSize: 11.5, color: C.white,
      fontFace: "Calibri", valign: "middle"
    });
  });

  accentBar(s);
}

// ══════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/csom-ppt/CSOM_Presentation.pptx" })
  .then(() => console.log("✅  CSOM_Presentation.pptx created successfully"))
  .catch(err => { console.error("❌  Error:", err); process.exit(1); });