mkdir -p /home/daytona/workspace/ra-pptx && ls /home/daytona/workspace/ra-pptx/

~/ra-pptx/build_ra.js

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

// ─────────────────────────────────────────────
// FETCH IMAGES
// ─────────────────────────────────────────────
const imageUrls = [
  // Robbins Basic Pathology Fig 19.33 – RA vs OA comparison diagram
  "https://cdn.orris.care/cdss_images/d37d990e5c309c374da36de8355091f0de550873793358421ff5f7a1e533c9c5.png",
  // Robbins Basic Pathology – RA pathogenesis figure (Fig 19.34) – from block7 line 4248-4261 area
  // We'll use the OA histology + RA comparison from block12
  "https://cdn.orris.care/cdss_images/672400bf5065286b7cada905052378ec6cbc6784f00493aef922f889a39c3983.png",
];

let imgs = {};
try {
  const raw = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`
  ).toString();
  const arr = JSON.parse(raw);
  arr.forEach((item, i) => {
    imgs[i] = item.error ? null : item.base64;
  });
  console.log("Images fetched:", arr.map(a => a.error ? "ERROR: "+a.error : "OK"));
} catch(e) {
  console.log("Image fetch error:", e.message);
}

// ─────────────────────────────────────────────
// DESIGN CONSTANTS
// ─────────────────────────────────────────────
const DARK_BG   = "1A2B4A";   // deep navy
const MED_BLUE  = "2E4A7A";   // medium navy
const ACCENT    = "E63946";   // crimson red
const WHITE     = "FFFFFF";
const LIGHT_GRAY = "F0F4F8";
const GOLD      = "F4A261";
const TEAL      = "2A9D8F";
const TITLE_FONT = "Calibri";
const BODY_FONT  = "Arial";

function makeTitleSlide(pres, title, subtitle, badge) {
  let s = pres.addSlide();
  s.background = { color: DARK_BG };
  // Accent bar left
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.18, h:5.625, fill:{color: ACCENT} });
  // Gold top bar
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.08, fill:{color: GOLD} });
  // Badge
  if(badge) {
    s.addShape(pres.ShapeType.roundRect, { x:0.35, y:0.18, w:2.0, h:0.38, rectRadius:0.15, fill:{color: ACCENT} });
    s.addText(badge, { x:0.35, y:0.18, w:2.0, h:0.38, fontSize:12, color: WHITE, bold:true, align:"center", valign:"middle", fontFace: BODY_FONT });
  }
  s.addText(title, { x:0.4, y:1.1, w:9.2, h:2.2, fontSize:42, color: WHITE, bold:true, fontFace: TITLE_FONT, align:"left", valign:"middle", charSpacing:1 });
  if(subtitle) {
    s.addShape(pres.ShapeType.rect, { x:0.4, y:3.45, w:9.0, h:0.04, fill:{color: GOLD} });
    s.addText(subtitle, { x:0.4, y:3.6, w:9.0, h:0.9, fontSize:20, color: GOLD, fontFace: BODY_FONT, italic:true, align:"left" });
  }
  return s;
}

function makeContentSlide(pres, title, bullets, colorScheme) {
  let s = pres.addSlide();
  const isDark = colorScheme === "dark";
  const bg = isDark ? DARK_BG : WHITE;
  const titleColor = isDark ? WHITE : DARK_BG;
  const bulletColor = isDark ? "D0E4FF" : "1A2B4A";
  const accentBar = isDark ? ACCENT : MED_BLUE;

  s.background = { color: bg };
  // Top accent strip
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.1, fill:{color: accentBar} });
  // Title
  s.addShape(pres.ShapeType.rect, { x:0, y:0.1, w:10, h:0.72, fill:{color: isDark ? MED_BLUE : LIGHT_GRAY} });
  s.addText(title, { x:0.4, y:0.1, w:9.2, h:0.72, fontSize:34, color: isDark ? WHITE : DARK_BG, bold:true, fontFace: TITLE_FONT, valign:"middle" });

  // Bullets
  const bulletItems = bullets.map((b, i) => ({
    text: b,
    options: { bullet: { type: "bullet", indent: 10 }, fontSize: 24, color: bulletColor, breakLine: i < bullets.length-1, fontFace: BODY_FONT, paraSpaceBefore:4 }
  }));
  s.addText(bulletItems, { x:0.4, y:1.0, w:9.2, h:4.3, valign:"top", wrap:true });
  return s;
}

function makeSplitSlide(pres, title, bullets, imgBase64, imgCaption, colorScheme) {
  let s = pres.addSlide();
  const isDark = colorScheme === "dark";
  const bg = isDark ? DARK_BG : WHITE;
  const titleColor = isDark ? WHITE : DARK_BG;
  const bulletColor = isDark ? "D0E4FF" : "1A2B4A";

  s.background = { color: bg };
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.1, fill:{color: isDark ? ACCENT : MED_BLUE} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.1, w:10, h:0.72, fill:{color: isDark ? MED_BLUE : LIGHT_GRAY} });
  s.addText(title, { x:0.4, y:0.1, w:9.2, h:0.72, fontSize:34, color: isDark ? WHITE : DARK_BG, bold:true, fontFace: TITLE_FONT, valign:"middle" });

  const bulletItems = bullets.map((b, i) => ({
    text: b,
    options: { bullet: { type:"bullet", indent:10 }, fontSize:24, color: bulletColor, breakLine: i < bullets.length-1, fontFace: BODY_FONT, paraSpaceBefore:4 }
  }));
  s.addText(bulletItems, { x:0.3, y:1.0, w:4.9, h:4.3, valign:"top", wrap:true });

  if(imgBase64) {
    s.addImage({ data: imgBase64, x:5.4, y:1.0, w:4.3, h:3.5, sizing:{type:"contain"} });
    if(imgCaption) {
      s.addText(imgCaption, { x:5.4, y:4.55, w:4.3, h:0.5, fontSize:11, color: isDark ? "AAAAAA" : "555555", italic:true, align:"center", fontFace: BODY_FONT });
    }
  }
  return s;
}

function makeFlowchartSlide(pres, title, steps, colorScheme) {
  let s = pres.addSlide();
  const isDark = colorScheme === "dark";
  s.background = { color: isDark ? DARK_BG : WHITE };
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.1, fill:{color: isDark ? ACCENT : MED_BLUE} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.1, w:10, h:0.72, fill:{color: isDark ? MED_BLUE : LIGHT_GRAY} });
  s.addText(title, { x:0.4, y:0.1, w:9.2, h:0.72, fontSize:34, color: isDark ? WHITE : DARK_BG, bold:true, fontFace: TITLE_FONT, valign:"middle" });

  const colors = [ACCENT, MED_BLUE, TEAL, "7B2D8B", "E07800", "1A7A4A", ACCENT];
  const boxW = 1.3, boxH = 0.56;
  const startX = 0.25;
  const y = 2.2;
  steps.forEach((step, i) => {
    const x = startX + i * 1.4;
    s.addShape(pres.ShapeType.roundRect, { x, y: y-0.28, w: boxW, h: boxH, rectRadius:0.1, fill:{color: colors[i % colors.length]}, line:{color: WHITE, width:1.5} });
    s.addText(step, { x, y: y-0.28, w: boxW, h: boxH, fontSize:12, color: WHITE, bold:true, align:"center", valign:"middle", fontFace: BODY_FONT, wrap:true });
    if(i < steps.length-1) {
      s.addShape(pres.ShapeType.chevron, { x: x+boxW+0.01, y: y-0.15, w:0.22, h:0.3, fill:{color: GOLD} });
    }
  });
  return s;
}

function makeMnemonicSlide(pres, title, mnemonic, items) {
  let s = pres.addSlide();
  s.background = { color: DARK_BG };
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.1, fill:{color: GOLD} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.1, w:10, h:0.72, fill:{color: MED_BLUE} });
  s.addText(title, { x:0.4, y:0.1, w:9.2, h:0.72, fontSize:34, color: WHITE, bold:true, fontFace: TITLE_FONT, valign:"middle" });

  // Mnemonic highlight box
  s.addShape(pres.ShapeType.roundRect, { x:0.3, y:1.0, w:9.4, h:0.65, rectRadius:0.12, fill:{color: ACCENT} });
  s.addText("🧠  " + mnemonic, { x:0.3, y:1.0, w:9.4, h:0.65, fontSize:26, color: WHITE, bold:true, align:"center", valign:"middle", fontFace: TITLE_FONT });

  const bulletItems = items.map((b, i) => ({
    text: b,
    options: { bullet:{ type:"bullet", indent:10 }, fontSize:22, color:"D0E4FF", breakLine: i < items.length-1, fontFace: BODY_FONT, paraSpaceBefore:5 }
  }));
  s.addText(bulletItems, { x:0.5, y:1.8, w:9.0, h:3.4, valign:"top", wrap:true });
  return s;
}

function makeCaseSlide(pres) {
  let s = pres.addSlide();
  s.background = { color: LIGHT_GRAY };
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.1, fill:{color: ACCENT} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.1, w:10, h:0.72, fill:{color: DARK_BG} });
  s.addText("📋  CASE SCENARIO", { x:0.4, y:0.1, w:9.2, h:0.72, fontSize:34, color: WHITE, bold:true, fontFace: TITLE_FONT, valign:"middle" });

  const caseText = "Mrs. Rekha, 42F • 8-month Hx of bilateral hand swelling\n" +
    "• Morning stiffness >1 hr • Symmetrical MCP + PIP joint involvement\n" +
    "• ESR 78 mm/hr • RF +ve, Anti-CCP +ve\n" +
    "• X-ray: Periarticular osteopenia + erosions at MCP joints";
  s.addShape(pres.ShapeType.roundRect, { x:0.3, y:0.98, w:9.4, h:1.55, rectRadius:0.12, fill:{color: WHITE}, line:{color: MED_BLUE, width:2} });
  s.addText(caseText, { x:0.5, y:1.02, w:9.0, h:1.45, fontSize:20, color: DARK_BG, fontFace: BODY_FONT, valign:"top", wrap:true });

  s.addText("Sub-Questions:", { x:0.4, y:2.65, w:9.2, h:0.35, fontSize:22, color: DARK_BG, bold:true, fontFace: TITLE_FONT });
  const qs = [
    "Q1: Which autoantibody is most specific for RA?  (a) RF  (b) ANA  (c) Anti-CCP  (d) Anti-dsDNA",
    "Q2: The pannus invades cartilage via which mechanism primarily?",
    "Q3: What histologic hallmark would a synovial biopsy show?",
  ];
  const qItems = qs.map((q, i) => ({
    text: q,
    options: { bullet:{ type:"number", numberStartAt:1, indent:10 }, fontSize:19, color: DARK_BG, breakLine: i<qs.length-1, fontFace: BODY_FONT, paraSpaceBefore:6 }
  }));
  s.addText(qItems, { x:0.4, y:3.05, w:9.2, h:2.2, valign:"top", wrap:true });
  return s;
}

function makeMCQSlide(pres, qNum, question, options, answer, explanation) {
  let s = pres.addSlide();
  s.background = { color: WHITE };
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.1, fill:{color: TEAL} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.1, w:10, h:0.72, fill:{color: DARK_BG} });
  s.addText(`MCQ ${qNum}`, { x:0.4, y:0.1, w:9.2, h:0.72, fontSize:34, color: WHITE, bold:true, fontFace: TITLE_FONT, valign:"middle" });

  s.addShape(pres.ShapeType.roundRect, { x:0.3, y:0.95, w:9.4, h:0.9, rectRadius:0.1, fill:{color: LIGHT_GRAY}, line:{color: MED_BLUE, width:1.5} });
  s.addText(question, { x:0.5, y:0.95, w:9.0, h:0.9, fontSize:22, color: DARK_BG, bold:true, fontFace: TITLE_FONT, valign:"middle", wrap:true });

  options.forEach((opt, i) => {
    const isAnswer = opt.startsWith(answer);
    s.addShape(pres.ShapeType.roundRect, {
      x:0.3, y:2.0+i*0.62, w:9.4, h:0.55, rectRadius:0.08,
      fill:{ color: isAnswer ? "D4EDDA" : LIGHT_GRAY },
      line:{ color: isAnswer ? TEAL : "CCCCCC", width: isAnswer ? 2 : 1 }
    });
    s.addText((isAnswer ? "✓ " : "") + opt, {
      x:0.5, y:2.0+i*0.62, w:9.0, h:0.55, fontSize:20,
      color: isAnswer ? "155724" : DARK_BG, bold: isAnswer,
      fontFace: BODY_FONT, valign:"middle"
    });
  });

  s.addShape(pres.ShapeType.roundRect, { x:0.3, y:4.55, w:9.4, h:0.75, rectRadius:0.1, fill:{color: "FFF3CD"}, line:{color: GOLD, width:1.5} });
  s.addText("💡 " + explanation, { x:0.5, y:4.55, w:9.0, h:0.75, fontSize:17, color:"856404", fontFace: BODY_FONT, valign:"middle", wrap:true, italic:true });
  return s;
}

function makeThankYouSlide(pres) {
  let s = pres.addSlide();
  s.background = { color: DARK_BG };
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.08, fill:{color: GOLD} });
  s.addShape(pres.ShapeType.rect, { x:0, y:5.545, w:10, h:0.08, fill:{color: GOLD} });
  s.addText("THANK YOU", { x:1, y:1.5, w:8, h:1.5, fontSize:60, color: WHITE, bold:true, fontFace: TITLE_FONT, align:"center", valign:"middle", charSpacing:8 });
  s.addShape(pres.ShapeType.rect, { x:2.5, y:3.15, w:5.0, h:0.05, fill:{color: ACCENT} });
  s.addText("Robbins & Cotran Pathologic Basis of Disease, 10th Ed.\nRobbins & Kumar Basic Pathology, 11th Ed.", {
    x:1, y:3.3, w:8, h:0.9, fontSize:16, color: GOLD, italic:true, align:"center", fontFace: BODY_FONT
  });
  s.addText("Questions are welcome!", { x:1, y:4.3, w:8, h:0.6, fontSize:22, color:"AAAAAA", italic:true, align:"center", fontFace: BODY_FONT });
  return s;
}

// ─────────────────────────────────────────────
// BUILD PRESENTATION
// ─────────────────────────────────────────────
let pres = new pptxgen();
pres.layout = 'LAYOUT_16x9';
pres.title = 'Rheumatoid Arthritis – Pathology';
pres.author = 'Pathology Department';

// ── SLIDE 1 – SET INDUCTION (TITLE) ─────────────────────────────
makeTitleSlide(pres,
  "Rheumatoid Arthritis",
  "Etiology • Pathogenesis • Manifestations\nRadiology • Lab Features • Diagnostic Criteria • Complications",
  "PATHOLOGY"
);

// ── SLIDE 2 – SET INDUCTION (HOOK) ──────────────────────────────
{
  let s = pres.addSlide();
  s.background = { color: DARK_BG };
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.1, fill:{color: ACCENT} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.1, w:10, h:0.72, fill:{color: MED_BLUE} });
  s.addText("Why Does This Matter?", { x:0.4, y:0.1, w:9.2, h:0.72, fontSize:34, color: WHITE, bold:true, fontFace: TITLE_FONT, valign:"middle" });
  const statsItems = [
    { text:"RA affects ~1% of global population", options:{ bullet:{type:"bullet"}, fontSize:26, color:"D0E4FF", breakLine:true, fontFace:BODY_FONT } },
    { text:"3× more common in females", options:{ bullet:{type:"bullet"}, fontSize:26, color:"D0E4FF", breakLine:true, fontFace:BODY_FONT } },
    { text:"Peak onset: 3rd–5th decade of life", options:{ bullet:{type:"bullet"}, fontSize:26, color:"D0E4FF", breakLine:true, fontFace:BODY_FONT } },
    { text:"Leading cause of inflammatory joint disability", options:{ bullet:{type:"bullet"}, fontSize:26, color:GOLD, bold:true, breakLine:true, fontFace:BODY_FONT } },
    { text:"Systemic disease: skin, heart, lungs, vessels", options:{ bullet:{type:"bullet"}, fontSize:26, color:"D0E4FF", fontFace:BODY_FONT } },
  ];
  s.addText(statsItems, { x:0.4, y:1.05, w:9.2, h:4.2, valign:"top", wrap:true });
  s.addText("Source: Robbins & Cotran Pathologic Basis of Disease, 10th Ed.", { x:0.4, y:5.2, w:9.2, h:0.3, fontSize:11, color:"666666", italic:true, fontFace:BODY_FONT });
}

// ── SLIDE 3 – ETIOLOGY ──────────────────────────────────────────
makeSplitSlide(pres,
  "Etiology of Rheumatoid Arthritis",
  [
    "Chronic autoimmune disease of synovial joints",
    "CD4+ T cells react against joint antigens",
    "HLA-DR4 allele — strongest genetic risk factor",
    "Smoking promotes citrullination of self-proteins",
    "Periodontitis and infections may trigger onset",
    "50% risk attributed to genetic susceptibility",
  ],
  imgs[0],
  "RA vs OA comparison (Robbins Basic Pathology, Fig 19.33)",
  "light"
);

// ── SLIDE 4 – GENETIC & ENVIRONMENTAL FACTORS ───────────────────
makeContentSlide(pres,
  "Risk Factors – Genetic & Environmental",
  [
    "HLA-DR4 (class II MHC): molecular mimicry with microbial peptides",
    "Anti-CCP antibodies (ACPA) – detected in 70% of RA patients",
    "Rheumatoid factor (IgM anti-IgG) – present in ~80% of patients",
    "Smoking: induces citrullination → triggers immune response",
    "Periodontitis (Porphyromonas gingivalis): citrullinates host proteins",
    "Female sex hormones: estrogen promotes Th2/autoimmune shift",
  ],
  "dark"
);

// ── SLIDE 5 – PATHOGENESIS OVERVIEW (FLOWCHART) ─────────────────
makeFlowchartSlide(pres,
  "Pathogenesis – Step-by-Step",
  [
    "Genetic\nPredisposition\n(HLA-DR4)",
    "Environmental\nTrigger\n(Smoking/\nInfection)",
    "Citrullination\nof Self-Proteins",
    "CD4+ T Cell\nActivation",
    "Cytokine\nRelease\n(TNF, IL-1,\nIL-6, IL-17)",
    "Pannus\nFormation",
    "Cartilage &\nBone\nDestruction",
  ],
  "light"
);

// ── SLIDE 6 – CYTOKINES IN PATHOGENESIS ─────────────────────────
makeContentSlide(pres,
  "Key Cytokines in RA Pathogenesis",
  [
    "TNF + IL-1 + IL-6: macrophage-derived → activate leukocytes",
    "TNF: KEY mediator — basis of anti-TNF therapy (biologics)",
    "IL-17 (Th17 cells): recruits neutrophils + monocytes to synovium",
    "RANKL (activated T cells): stimulates osteoclasts → bone resorption",
    "IFN-γ (Th1 cells): activates macrophages + synovial fibroblasts",
    "IL-6: stimulates hepatic acute phase reactants (CRP, ESR ↑)",
  ],
  "dark"
);

// ── SLIDE 7 – MORPHOLOGY: GROSS + MICROSCOPY ────────────────────
makeSplitSlide(pres,
  "Morphology of RA – Synovium",
  [
    "Synovium: edematous, thickened, hyperplastic with bulbous villi",
    "Synoviocyte hyperplasia + proliferation",
    "Dense CD4+ T cells, B cells (lymphoid follicles), plasma cells",
    "Increased vascularity (angiogenesis)",
    "Fibrin-rich exudate with neutrophils on joint surfaces",
    "Osteoclastic erosion of subchondral bone → periarticular erosions",
  ],
  imgs[1],
  "Histology comparison OA vs RA (Robbins & Cotran, Fig 26.32)",
  "light"
);

// ── SLIDE 8 – PANNUS FORMATION ───────────────────────────────────
makeContentSlide(pres,
  "Pannus – The Hallmark Lesion of RA",
  [
    "Pannus = mass of edematous synovium + inflammatory cells + granulation tissue + fibroblasts",
    "Grows over articular cartilage → enzymatic erosion",
    "Proteases destroy hyaline cartilage (TNF/IL-1 mediated)",
    "Pannus bridges apposing bones → fibrous ankylosis",
    "Fibrous ankylosis ossifies → bony ankylosis (fusion)",
    "Source: Robbins & Cotran Pathologic Basis of Disease, p.1106",
  ],
  "dark"
);

// ── SLIDE 9 – RHEUMATOID NODULE ──────────────────────────────────
makeContentSlide(pres,
  "Rheumatoid Nodule – Extraarticular Lesion",
  [
    "Occur in subcutaneous tissue: forearm, elbows, occiput, lumbosacral",
    "Small, firm, nontender, oval subcutaneous masses",
    "Histology: Central zone of FIBRINOID NECROSIS",
    "Surrounded by palisading activated macrophages",
    "Outer layer of lymphocytes and plasma cells",
    "Leukocytoclastic vasculitis in severe RA",
  ],
  "light"
);

// ── SLIDE 10 – MNEMONIC: ETIOLOGY ────────────────────────────────
makeMnemonicSlide(pres,
  "Mnemonic: RA Etiology – 'CHASTE'",
  "C-H-A-S-T-E",
  [
    "C — Citrullinated peptides trigger immune response (ACPA)",
    "H — HLA-DR4 (major genetic predisposition)",
    "A — Autoimmune CD4+ T cell activation against joint antigens",
    "S — Smoking & Stress (environmental triggers)",
    "T — T cells (Th1/Th17) + TNF, IL-1, IL-6 cytokines",
    "E — Estrogen (female sex: 3× more common in women)",
  ]
);

// ── SLIDE 11 – CLINICAL MANIFESTATIONS ───────────────────────────
makeContentSlide(pres,
  "Clinical Manifestations of RA",
  [
    "Insidious onset: malaise, fatigue, generalized myalgia (50%)",
    "Symmetrical polyarthritis: MCP + PIP joints (hands first)",
    "Morning stiffness > 1 hour (key differentiator from OA)",
    "Swollen, warm, tender joints + limited range of motion",
    "Progression: wrists → ankles → elbows → knees",
    "Deformities: ulnar deviation, swan-neck, boutonnière",
  ],
  "light"
);

// ── SLIDE 12 – EXTRAARTICULAR MANIFESTATIONS ─────────────────────
makeContentSlide(pres,
  "Extraarticular Manifestations",
  [
    "Skin: rheumatoid nodules (subcutaneous, non-tender)",
    "Eyes: keratoconjunctivitis sicca, episcleritis, uveitis",
    "Heart: pericarditis, accelerated atherosclerosis",
    "Lungs: pleuritis, interstitial fibrosis, nodules",
    "Vessels: leukocytoclastic vasculitis in severe disease",
    "Felty syndrome: RA + splenomegaly + neutropenia",
  ],
  "dark"
);

// ── SLIDE 13 – MNEMONIC: MANIFESTATIONS ──────────────────────────
makeMnemonicSlide(pres,
  "Mnemonic: Extraarticular Features – 'PEARL'",
  "P-E-A-R-L",
  [
    "P — Pericarditis / Pleuritis / Pulmonary fibrosis",
    "E — Eyes (keratoconjunctivitis, uveitis, episcleritis)",
    "A — Amyloidosis (secondary AA type) – long-standing RA",
    "R — Rheumatoid nodules (fibrinoid necrosis + palisading macrophages)",
    "L — Leukocytoclastic vasculitis / Felty syndrome (RA+splenomeg+neutropenia)",
  ]
);

// ── SLIDE 14 – LABORATORY FEATURES ───────────────────────────────
makeContentSlide(pres,
  "Laboratory Features of RA",
  [
    "Rheumatoid Factor (RF): IgM anti-IgG — +ve in 80%; non-specific",
    "Anti-CCP (ACPA): 70% sensitivity; MOST SPECIFIC (97%) for RA",
    "ESR + CRP markedly elevated (acute phase reactants)",
    "ANA weakly +ve in 30%; CBC: normocytic anaemia of chronic disease",
    "Synovial fluid: turbid, inflammatory (WBC 5000–50,000), low glucose",
    "Complement levels (C3, C4) reduced in active synovitis",
  ],
  "light"
);

// ── SLIDE 15 – RADIOLOGIC FEATURES ───────────────────────────────
makeContentSlide(pres,
  "Radiologic Features of RA",
  [
    "Early: periarticular osteopenia (juxtaarticular bone demineralization)",
    "Soft tissue swelling around affected joints",
    "Uniform joint space narrowing (pannus destruction of cartilage)",
    "Bony erosions (marginal erosions at MCP/PIP joints)",
    "Subchondral cysts (geodes) in advanced disease",
    "Late: fibrous or bony ankylosis; subluxation and deformity",
  ],
  "dark"
);

// ── SLIDE 16 – 2010 ACR/EULAR DIAGNOSTIC CRITERIA ───────────────
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  });
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    ["", "1–3 small joints", "2"],
    ["", "4–10 small joints", "3"],
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}

// ── SLIDE 17 – COMPLICATIONS ─────────────────────────────────────
makeContentSlide(pres,
  "Complications of Rheumatoid Arthritis",
  [
    "Joint destruction → fibrous/bony ankylosis → permanent deformity",
    "Atlantoaxial subluxation → spinal cord compression risk",
    "Secondary (AA) amyloidosis in longstanding RA → renal failure",
    "Iatrogenic: NSAID gastropathy, steroid osteoporosis, infection",
    "Cardiovascular disease: accelerated atherosclerosis (major cause of death)",
    "Lymphoma risk increased (Sjögren overlap, chronic inflammation)",
  ],
  "dark"
);

// ── SLIDE 18 – CASE SCENARIO ─────────────────────────────────────
makeCaseSlide(pres);

// ── SLIDE 19 – MCQ 1 ─────────────────────────────────────────────
makeMCQSlide(pres, 1,
  "Which cytokine is considered the KEY mediator of joint damage in RA, and is the target of biologic therapy?",
  [
    "A) IL-17",
    "B) TNF (Tumor Necrosis Factor)",
    "C) IFN-γ",
    "D) IL-10",
  ],
  "B)",
  "TNF antagonists (e.g., infliximab, etanercept) are highly effective in RA, confirming TNF as the key mediator. (Robbins & Kumar Basic Pathology, p.792)"
);

// ── SLIDE 20 – MCQ 2 ─────────────────────────────────────────────
makeMCQSlide(pres, 2,
  "The MOST SPECIFIC serological marker for Rheumatoid Arthritis is:",
  [
    "A) Rheumatoid Factor (RF)",
    "B) ANA (anti-nuclear antibody)",
    "C) Anti-CCP / ACPA (anti-citrullinated peptide antibody)",
    "D) Anti-dsDNA",
  ],
  "C)",
  "Anti-CCP (ACPA) has specificity ~97% for RA vs 80% for RF. It can be positive years before symptoms. (Robbins & Cotran, 10th Ed., p.1106)"
);

// ── SLIDE 21 – MCQ 3 ─────────────────────────────────────────────
makeMCQSlide(pres, 3,
  "Rheumatoid nodule histology classically shows:",
  [
    "A) Caseating granuloma with Langhans giant cells",
    "B) Central fibrinoid necrosis surrounded by palisading macrophages",
    "C) Amyloid deposits with apple-green birefringence (Congo red stain)",
    "D) Urate crystals with neutrophilic infiltrate",
  ],
  "B)",
  "Rheumatoid nodule = central fibrinoid necrosis + palisading activated macrophages + peripheral lymphocytes/plasma cells. (Robbins & Cotran, 10th Ed., p.1106)"
);

// ── SLIDE 22 – THANK YOU ─────────────────────────────────────────
makeThankYouSlide(pres);

// ─────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────
const outPath = "/home/daytona/workspace/ra-pptx/Rheumatoid_Arthritis_Pathology.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
  console.log("SUCCESS: File written to " + outPath);
}).catch(err => {
  console.error("ERROR writing file:", err);
});

cd /home/daytona/workspace/ra-pptx && node build_ra.js 2>&1

cd /home/daytona/workspace/ra-pptx && node -e " const {execSync} = require('chil…

cd /home/daytona/workspace/ra-pptx && curl -s -o img0.png "https://cdn.orris.car…

cd /home/daytona/workspace/ra-pptx && node -e " const fs = require('fs'); const …

~/ra-pptx/build_ra_v2.js

const pptxgen = require("pptxgenjs");
const fs = require("fs");

const img0 = fs.readFileSync("/home/daytona/workspace/ra-pptx/img0.b64","utf8");
const img1 = fs.readFileSync("/home/daytona/workspace/ra-pptx/img1.b64","utf8");
const imgs = [img0, img1];

const DARK_BG="1A2B4A", MED_BLUE="2E4A7A", ACCENT="E63946", WHITE="FFFFFF", LIGHT_GRAY="F0F4F8", GOLD="F4A261", TEAL="2A9D8F";
const TITLE_FONT="Calibri", BODY_FONT="Arial";

function makeTitleSlide(pres,title,subtitle,badge){
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}

function makeContentSlide(pres,title,bullets,colorScheme){
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function makeSplitSlide(pres,title,bullets,imgData,imgCaption,colorScheme){
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}

function makeFlowchartSlide(pres,title,steps,colorScheme){
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}

function makeMnemonicSlide(pres,title,mnemonic,items){
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function makeCaseSlide(pres){
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  const caseText="Mrs. Rekha, 42F | 8-month Hx: bilateral hand swelling\nMorning stiffness > 1 hour | Symmetrical MCP + PIP involvement\nESR 78 mm/hr | RF +ve | Anti-CCP +ve\nX-ray: Periarticular osteopenia + marginal erosions at MCP joints";
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  const qs=[
    "Q1: Which autoantibody is most SPECIFIC for RA?  (a) RF  (b) ANA  (c) Anti-CCP  (d) Anti-dsDNA",
    "Q2: Name the hallmark erosive lesion of RA that destroys articular cartilage.",
    "Q3: What histology would synovial biopsy show?  Which cytokine is targeted by biologic therapy?",
  ];
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function makeMCQSlide(pres,qNum,question,options,answer,explanation){
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  s.addShape(pres.ShapeType.rect,{x:0,y:0.1,w:10,h:0.72,fill:{color:DARK_BG}});
  s.addText("MCQ "+qNum,{x:0.4,y:0.1,w:9.2,h:0.72,fontSize:34,color:WHITE,bold:true,fontFace:TITLE_FONT,valign:"middle"});
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}

function makeThankYouSlide(pres){
  let s=pres.addSlide();
  s.background={color:DARK_BG};
  s.addShape(pres.ShapeType.rect,{x:0,y:0,w:10,h:0.08,fill:{color:GOLD}});
  s.addShape(pres.ShapeType.rect,{x:0,y:5.545,w:10,h:0.08,fill:{color:GOLD}});
  s.addText("THANK YOU",{x:1,y:1.4,w:8,h:1.5,fontSize:60,color:WHITE,bold:true,fontFace:TITLE_FONT,align:"center",valign:"middle",charSpacing:8});
  s.addShape(pres.ShapeType.rect,{x:2.5,y:3.1,w:5.0,h:0.05,fill:{color:ACCENT}});
  s.addText("Robbins & Cotran Pathologic Basis of Disease, 10th Ed.\nRobbins & Kumar Basic Pathology, 11th Ed.",{x:1,y:3.2,w:8,h:0.9,fontSize:16,color:GOLD,italic:true,align:"center",fontFace:BODY_FONT});
  s.addText("Questions are welcome!",{x:1,y:4.3,w:8,h:0.6,fontSize:22,color:"AAAAAA",italic:true,align:"center",fontFace:BODY_FONT});
}

// ─── BUILD ───────────────────────────────────────────────────────
let pres=new pptxgen();
pres.layout="LAYOUT_16x9";
pres.title="Rheumatoid Arthritis – Pathology";
pres.author="Pathology Department";

// SLIDE 1 – TITLE
makeTitleSlide(pres,"Rheumatoid Arthritis",
  "Etiology  •  Pathogenesis  •  Manifestations  •  Radiology  •  Lab Features  •  Diagnostic Criteria  •  Complications",
  "PATHOLOGY");

// SLIDE 2 – SET INDUCTION
{
  let s=pres.addSlide();
  s.background={color:DARK_BG};
  s.addShape(pres.ShapeType.rect,{x:0,y:0,w:10,h:0.1,fill:{color:ACCENT}});
  s.addShape(pres.ShapeType.rect,{x:0,y:0.1,w:10,h:0.72,fill:{color:MED_BLUE}});
  s.addText("Why Should We Learn About RA?",{x:0.4,y:0.1,w:9.2,h:0.72,fontSize:34,color:WHITE,bold:true,fontFace:TITLE_FONT,valign:"middle"});
  const si=[
    {text:"~1% of global population affected by RA",options:{bullet:{type:"bullet"},fontSize:26,color:"D0E4FF",breakLine:true,fontFace:BODY_FONT}},
    {text:"3x more common in females than males",options:{bullet:{type:"bullet"},fontSize:26,color:"D0E4FF",breakLine:true,fontFace:BODY_FONT}},
    {text:"Peak onset: 3rd to 5th decade of life",options:{bullet:{type:"bullet"},fontSize:26,color:"D0E4FF",breakLine:true,fontFace:BODY_FONT}},
    {text:"Leading cause of inflammatory joint disability worldwide",options:{bullet:{type:"bullet"},fontSize:26,color:GOLD,bold:true,breakLine:true,fontFace:BODY_FONT}},
    {text:"Systemic disease: skin, heart, lungs, vessels involved",options:{bullet:{type:"bullet"},fontSize:26,color:"D0E4FF",fontFace:BODY_FONT}},
  ];
  s.addText(si,{x:0.4,y:1.05,w:9.2,h:4.2,valign:"top",wrap:true});
}

// SLIDE 3 – ETIOLOGY WITH IMAGE (RA vs OA comparison)
makeSplitSlide(pres,"Etiology of Rheumatoid Arthritis",[
  "Chronic autoimmune disorder of synovial joints",
  "CD4+ T cells react against joint antigens",
  "Antigens: collagen + citrullinated peptides",
  "HLA-DR4: strongest genetic risk (molecular mimicry)",
  "Smoking promotes citrullination of self-proteins",
  "50% of RA risk is genetically determined",
],imgs[0],"Fig. 19.33 – RA vs OA comparison\n(Robbins Basic Pathology)","light");

// SLIDE 4 – GENETIC & ENVIRONMENTAL RISK
makeContentSlide(pres,"Risk Factors: Genetic & Environmental",[
  "HLA-DR4 class II MHC — ACPA-positive RA association",
  "Anti-CCP (ACPA): detected in 70% of RA patients",
  "Rheumatoid factor (IgM anti-IgG): present in 80% of patients",
  "Smoking induces citrullination → creates neo-antigens",
  "Female sex (estrogen promotes autoimmune shift) — 3:1 F:M ratio",
  "Periodontitis (P. gingivalis): may trigger molecular mimicry",
],"dark");

// SLIDE 5 – PATHOGENESIS FLOWCHART
makeFlowchartSlide(pres,"Pathogenesis Overview — Sequence of Events",[
  "Genetic Susceptibility (HLA-DR4)",
  "Environmental Trigger (Smoking/ Infection)",
  "Citrullination of Self-Proteins",
  "CD4+ T Cell Activation",
  "Cytokine Storm (TNF, IL-1, IL-6, IL-17)",
  "Pannus Formation",
  "Cartilage & Bone Destruction",
],"light");

// SLIDE 6 – CYTOKINES
makeContentSlide(pres,"Cytokines Driving RA Pathogenesis",[
  "TNF + IL-1 + IL-6: macrophage-derived; activate leukocytes + proteases",
  "TNF = KEY mediator; basis of anti-TNF biologic therapy",
  "IL-17 (Th17 cells): recruits neutrophils + monocytes into synovium",
  "RANKL (T cells): stimulates osteoclasts — bone resorption",
  "IFN-gamma (Th1): activates macrophages + synovial fibroblasts",
  "IL-6: stimulates hepatic acute phase reactants (CRP, ESR elevated)",
],"dark");

// SLIDE 7 – MORPHOLOGY WITH IMAGE
makeSplitSlide(pres,"Morphology: Synovial Changes in RA",[
  "Synovium: edematous, thickened with bulbous villi",
  "Synoviocyte hyperplasia and proliferation",
  "Dense infiltrate: CD4+ T cells, B cells, plasma cells",
  "Lymphoid follicles (germinal centers) in synovium",
  "Increased vascularity (angiogenesis)",
  "Fibrin-rich neutrophilic exudate on joint surfaces",
],imgs[1],"Histology: RA synovitis\n(Robbins & Cotran, Fig 26.32/26.34)","light");

// SLIDE 8 – PANNUS
makeContentSlide(pres,"Pannus: The Hallmark of Destructive RA",[
  "Pannus = edematous synovium + inflammatory cells + granulation tissue + fibroblasts",
  "Grows over articular cartilage; erodes it enzymatically",
  "Proteases (MMPs) destroy hyaline cartilage (TNF/IL-1 mediated)",
  "Pannus bridges apposing bones — fibrous ankylosis",
  "Fibrous ankylosis ossifies — BONY ANKYLOSIS (permanent fusion)",
  "Source: Robbins & Cotran, 10th Ed., p.1106",
],"dark");

// SLIDE 9 – RHEUMATOID NODULE
makeContentSlide(pres,"Rheumatoid Nodule — Extraarticular Pathology",[
  "Sites: forearm (extensor surface), elbows, occiput, lumbosacral area",
  "Gross: small, firm, nontender, oval subcutaneous masses",
  "Histology: Central zone of FIBRINOID NECROSIS",
  "Surrounded by palisading activated macrophages",
  "Peripheral rim of lymphocytes and plasma cells",
  "Severe RA: leukocytoclastic vasculitis of small/large arteries",
],"light");

// SLIDE 10 – MNEMONIC ETIOLOGY
makeMnemonicSlide(pres,"Mnemonic for RA Etiology","C-H-A-S-T-E",[
  "C — Citrullinated peptides (ACPA/Anti-CCP targets)",
  "H — HLA-DR4 (key genetic predisposition; molecular mimicry)",
  "A — Autoimmune CD4+ T-cell attack on joint antigens",
  "S — Smoking + Stress (environmental triggers of autoimmunity)",
  "T — TNF/IL-1/IL-6/IL-17 — cytokine-driven joint destruction",
  "E — Estrogen dominance (Female:Male = 3:1)",
]);

// SLIDE 11 – CLINICAL MANIFESTATIONS
makeContentSlide(pres,"Clinical Manifestations of RA",[
  "Insidious onset: malaise, fatigue, generalized myalgia (50%)",
  "Symmetrical polyarthritis: MCP + PIP joints (hands and feet first)",
  "Morning stiffness > 1 hour — KEY differentiator from OA",
  "Joints: swollen, warm, tender + restricted range of motion",
  "Deformities: ulnar deviation, swan-neck, boutonniere fingers",
  "Progression: wrists then ankles then elbows then knees",
],"light");

// SLIDE 12 – EXTRAARTICULAR MANIFESTATIONS
makeContentSlide(pres,"Extraarticular Manifestations (PEARL)",[
  "Pericarditis, pleuritis, pulmonary interstitial fibrosis",
  "Eyes: keratoconjunctivitis sicca, episcleritis, uveitis",
  "Amyloidosis (secondary AA type) — longstanding RA — renal failure",
  "Rheumatoid nodules: subcutaneous non-tender (fibrinoid necrosis)",
  "Leukocytoclastic vasculitis in severe disease",
  "Felty syndrome: RA + splenomegaly + neutropenia",
],"dark");

// SLIDE 13 – MNEMONIC MANIFESTATIONS
makeMnemonicSlide(pres,"Mnemonic: Extraarticular Features","P-E-A-R-L",[
  "P — Pericarditis / Pleuritis / Pulmonary fibrosis",
  "E — Eyes (keratoconjunctivitis, uveitis, episcleritis)",
  "A — Amyloidosis (secondary AA type) — renal failure risk",
  "R — Rheumatoid nodules (fibrinoid necrosis + palisading macrophages)",
  "L — Leukocytoclastic vasculitis + Lymphoma risk + Felty syndrome",
]);

// SLIDE 14 – LABORATORY FEATURES
makeContentSlide(pres,"Laboratory Features of RA",[
  "RF (IgM anti-IgG): +ve in 80%; NOT specific (also in SLE, Sjogren)",
  "Anti-CCP (ACPA): 70% sensitivity — ~97% SPECIFICITY — most useful",
  "ESR + CRP: markedly elevated (reflects disease activity)",
  "ANA weakly +ve in ~30%; CBC: normocytic anaemia of chronic disease",
  "Synovial fluid: turbid, WBC 5,000-50,000/mm3, low glucose",
  "Complement (C3/C4) reduced in active synovitis",
],"light");

// SLIDE 15 – RADIOLOGIC FEATURES
makeContentSlide(pres,"Radiologic Features of RA",[
  "Early: periarticular osteopenia (juxtaarticular demineralization)",
  "Soft tissue swelling around MCP, PIP joints",
  "Uniform joint space narrowing (pannus destroys cartilage)",
  "Marginal bony erosions at MCP/PIP joints — pathognomonic",
  "Subchondral cysts (geodes) — late disease",
  "Advanced: fibrous/bony ankylosis, subluxation, joint deformity",
],"dark");

// SLIDE 16 – 2010 ACR/EULAR DIAGNOSTIC CRITERIA
{
  let s=pres.addSlide();
  s.background={color:WHITE};
  s.addShape(pres.ShapeType.rect,{x:0,y:0,w:10,h:0.1,fill:{color:ACCENT}});
  s.addShape(pres.ShapeType.rect,{x:0,y:0.1,w:10,h:0.72,fill:{color:DARK_BG}});
  s.addText("2010 ACR/EULAR Criteria  (Score >= 6/10 = Definite RA)",{x:0.4,y:0.1,w:9.2,h:0.72,fontSize:26,color:WHITE,bold:true,fontFace:TITLE_FONT,valign:"middle"});
  const rows=[
    ["Domain","Finding","Score"],
    ["Joint involvement","1 large joint","0"],
    ["","2-10 large joints","1"],
    ["","1-3 small joints","2"],
    ["","4-10 small joints","3"],
    ["",">10 joints (including small)","5"],
    ["Serology","RF-ve AND ACPA-ve","0"],
    ["","Low +ve RF or ACPA","2"],
    ["","High +ve RF or ACPA (>3x ULN)","3"],
    ["Acute Phase Reactants","Normal CRP and ESR","0"],
    ["","Abnormal CRP or ESR","1"],
    ["Symptom Duration","< 6 weeks","0"],
    ["",">= 6 weeks","1"],
  ];
  s.addTable(rows,{x:0.2,y:0.98,w:9.6,h:4.3,colW:[2.8,4.9,1.4],fontSize:15,fontFace:BODY_FONT,border:{type:"solid",color:"DDDDDD",pt:1},fill:WHITE,color:DARK_BG,autoPage:false});
  s.addText("Score >= 6/10 = Definite RA  |  Requires exclusion of other diagnoses  |  Robbins & Cotran, 10th Ed.",{x:0.4,y:5.35,w:9.2,h:0.22,fontSize:10,color:"666666",italic:true,fontFace:BODY_FONT});
}

// SLIDE 17 – COMPLICATIONS
makeContentSlide(pres,"Complications of Rheumatoid Arthritis",[
  "Joint destruction — fibrous/bony ankylosis — permanent deformity",
  "Atlantoaxial subluxation — risk of spinal cord compression",
  "Secondary (AA) amyloidosis in long-standing RA — renal failure",
  "Cardiovascular: accelerated atherosclerosis (leading cause of death)",
  "Iatrogenic: NSAID gastropathy, steroid osteoporosis, infections",
  "Lymphoma risk increased (chronic inflammation, Sjogren overlap)",
],"light");

// SLIDE 18 – CASE SCENARIO
makeCaseSlide(pres);

// SLIDE 19 – MCQ 1
makeMCQSlide(pres,1,
  "Which cytokine is the KEY mediator of joint damage in RA and the primary target of biologic therapy?",
  ["A) IL-17","B) TNF (Tumor Necrosis Factor)","C) IFN-gamma","D) IL-10"],
  "B)",
  "TNF antagonists (infliximab, etanercept) are highly effective in RA, confirming TNF as the master inflammatory mediator. (Robbins Basic Pathology, p.792)"
);

// SLIDE 20 – MCQ 2
makeMCQSlide(pres,2,
  "The MOST SPECIFIC serological test for Rheumatoid Arthritis is:",
  ["A) Rheumatoid Factor (RF)","B) ANA (anti-nuclear antibody)","C) Anti-CCP / ACPA (anti-citrullinated peptide antibody)","D) Anti-dsDNA"],
  "C)",
  "Anti-CCP (ACPA) has specificity ~97% for RA vs ~80% for RF. It can be positive years before symptom onset. (Robbins & Cotran, 10th Ed., p.1106)"
);

// SLIDE 21 – MCQ 3
makeMCQSlide(pres,3,
  "Rheumatoid nodule histology classically demonstrates:",
  ["A) Caseating granuloma with Langhans giant cells","B) Central fibrinoid necrosis + palisading macrophages","C) Amyloid deposits with apple-green birefringence (Congo red stain)","D) Urate crystals with neutrophilic infiltrate (gout)"],
  "B)",
  "Rheumatoid nodule = central FIBRINOID NECROSIS + palisading activated macrophages + peripheral lymphocytes/plasma cells. (Robbins & Cotran, 10th Ed., p.1106)"
);

// SLIDE 22 – THANK YOU
makeThankYouSlide(pres);

// ─── WRITE FILE ──────────────────────────────────────────────────
const outPath="/home/daytona/workspace/ra-pptx/Rheumatoid_Arthritis_Pathology.pptx";
pres.writeFile({fileName:outPath}).then(()=>{
  console.log("SUCCESS: File written to "+outPath);
  // Check file size
  const stat=fs.statSync(outPath);
  console.log("File size: "+Math.round(stat.size/1024)+" KB, Slides: 22");
}).catch(e=>console.error("ERROR:",e));

cd /home/daytona/workspace/ra-pptx && node build_ra_v2.js 2>&1