For an MD and DM level paediatricist regarding the breastfeeding topic for National Breastfeeding Day. It is an, uh, national level quiz program for MD and DM level paediatricians. What are all the topics should I cover completely regarding paediatrics, uh, in breastfeeding topic?

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National Breastfeeding Day quiz topics MD DM paediatrician India 2024 2025

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breastfeeding pediatrics evidence benefits recommendations

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breastfeeding quiz topics MD DM paediatricians IAP NNF advanced clinical questions 2025

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breastfeeding advanced topics paediatrician quiz IAP NNF breast milk immunology drugs contraindications neonatal

I now have comprehensive information to build a thorough, MD/DM-level topic map for a National Breastfeeding Day quiz. Let me compile this into a structured, high-yield syllabus.

Breastfeeding Quiz Topics for MD/DM Paediatricians - National Level

Here is a complete, exam-grade topic map organized by domain, pitched at MD/DM level with the depth and nuance expected at a national quiz for senior paediatricians.

1. Anatomy & Physiology of Lactation

Breast anatomy: Alveoli, lactiferous ducts, Montgomery glands, Cooper's ligaments
Milk synthesis: Prolactin receptor theory, autocrine regulation, Feedback Inhibitor of Lactation (FIL)
Milk ejection reflex: Oxytocin pathway, Ferguson reflex, let-down and its inhibition (stress, pain)
Hormonal cascade: Estrogen/progesterone withdrawal at delivery, prolactin surge, oxytocin release
Stages of lactogenesis:
- Lactogenesis I: 16 weeks gestation (colostrum secretion begins)
- Lactogenesis II: Day 2-3 postpartum ("milk coming in," progesterone withdrawal-driven)
- Lactogenesis III (Galactopoiesis): Demand-driven ongoing maintenance
Mammogenesis and influence of growth hormone, insulin, cortisol
Suckling stimulus: Afferent arc via nipple sensory fibers -> hypothalamus -> pituitary

2. Composition of Human Milk

Colostrum (Days 1-5)

Low volume (2-20 mL/feed), high protein, high IgA, low fat, laxative effect (meconium clearance)
Concentration: SIgA ~12 g/L (vs. mature milk ~1 g/L)
High leukocytes (1-3 million cells/mL), lactoferrin, growth factors

Transitional Milk (Days 6-14)

Increasing fat and lactose, decreasing protein and immunoglobulins

Mature Milk (After Day 14)

Macronutrients:
- Fat: 3.5-4.5 g/dL (accounts for ~50% of calories); rich in LCPUFA (DHA, ARA)
- Carbohydrates: Lactose 6.5-7 g/dL (main carbohydrate); Human Milk Oligosaccharides (HMOs) - prebiotic, anti-adhesin, brain development
- Protein: 0.9-1.2 g/dL; whey:casein ratio = 70:30 (vs. cow's milk 20:80); alpha-lactalbumin is dominant whey protein
Micronutrients:
- Vitamins: Rich in Vitamin A, C, E; relatively low in Vitamin D and K
- Minerals: Low iron (0.3 mg/L) but bioavailability is 50% (vs. 10% in formula); low in Vitamin K
- Zinc: High bioavailability
Foremilk vs. Hindmilk: Foremilk = watery, high lactose; Hindmilk = creamy, high fat (calorie-dense)
Bioactive factors: Lactoferrin, lysozyme, SIgA, IL-6, IL-10, TNF-alpha, EGF, IGF-1, leptin, adiponectin, stem cells
Human Milk Oligosaccharides (HMOs): Over 200 types; 2'-fucosyllactose is most abundant; bifidogenic, anti-infective, neurodevelopment

3. Immunological Components

SIgA: Secretory immunoglobulin A - primary mucosal defense; not absorbed but coats gut epithelium; entero-mammary pathway (MALT)
Lactoferrin: Iron-chelating, bacteriostatic, anti-inflammatory, promotes bifidobacterium growth
Lysozyme: Cleaves bacterial cell wall peptidoglycan; concentration increases over the first year
Leukocytes: Predominantly macrophages (>80%); also lymphocytes, neutrophils; produce IFN, cytokines
Complement: C3, C4 present in milk
Bifidus factor: Promotes Lactobacillus bifidus growth in infant gut
Entero-mammary axis: Maternal gut-associated lymphoid tissue (GALT) sensitized to antigens -> lymphocytes migrate to breast -> targeted SIgA in milk
Milk microbiome: >700 species; Staphylococcus, Streptococcus, Bifidobacterium; influences infant gut colonization

4. WHO/IAP/AAP Recommendations & Global Policy

WHO global target: Exclusive breastfeeding (EBF) for 6 months, then continued BF with complementary feeding up to 2 years or beyond
AAP 2022 updated policy (Meek & Noble): EBF for 6 months, continue for at least 2 years if mutually desired
IAP 2010 guidelines: EBF for 6 months; early initiation within 1 hour of birth
Early initiation: Within 1 hour - WHO standard; reduces neonatal mortality by 22%
Global breastfeeding rates: ~44% infants exclusively breastfed at 6 months globally (2023 WHO)
IYCF (Infant and Young Child Feeding) policy - 8 practices as per WHO
Baby-Friendly Hospital Initiative (BFHI): 10 steps to successful breastfeeding; "Ten Steps" - know all 10
World Breastfeeding Week: August 1-7 annually; 2025 theme: "Invest in Breastfeeding, Invest in the Future"
Sustainable Development Goals: BF linked to SDG 2 (Zero Hunger), SDG 3 (Good Health)
Millennium Breastfeeding Challenge - IAP initiative

5. Benefits of Breastfeeding

For the Infant

Infectious disease protection: 50% reduction in diarrhea, 72% reduction in hospitalization for lower respiratory tract infections; 50% reduction in otitis media
SIDS reduction: ~36-50% reduction with any breastfeeding; strongest for exclusive BF
Necrotizing enterocolitis (NEC): 58% reduction in NEC; 79% reduction in NEC-related death (especially preterm)
Neurodevelopment: 3-5 IQ point advantage; DHA/ARA, HMOs, and growth factors contribute
Obesity protection: 13-22% reduction in childhood obesity; dose-dependent
Diabetes (Type 1 & 2): 30% reduction in T1DM; 40% reduction in T2DM risk in adulthood
Celiac disease, IBD: Modest protective effects
Allergic disease: Atopic dermatitis reduction; effect on asthma more nuanced
Microbiome: Establishes healthier gut microbiome (bifidobacterium-dominant)

For the Mother

Postpartum hemorrhage: Oxytocin release promotes uterine involution
Amenorrhea / LAM (Lactational Amenorrhea Method): 98% effective contraception if EBF + amenorrheic + <6 months
Breast cancer: ~4% reduction per year of breastfeeding
Ovarian cancer: 30% reduction
Type 2 diabetes: Reduced incidence
Maternal mental health: Oxytocin reduces stress, cortisol; protects against postpartum depression (dose-dependent)

6. Contraindications to Breastfeeding

Absolute Contraindications (Infant)

Classic Galactosemia (Galactose-1-phosphate uridyl transferase deficiency) - must use galactose-free formula (e.g., Nutramigen, Pregestimil)
Maple Syrup Urine Disease (MSUD) - BF only partially possible with careful monitoring

Absolute Contraindications (Maternal)

HIV infection (in resource-rich settings per CDC; WHO recommends BF with ART in resource-limited settings)
HTLV-1 and HTLV-2 infection
Ebola virus disease (confirmed or suspected)
Active untreated tuberculosis (expressed milk can be given; direct feeding contraindicated until 2 weeks of treatment)
Herpes simplex lesions on the breast/nipple (avoid feeding from affected breast)

Temporary Contraindications

Maternal radioactive iodine/radiopharmaceuticals: Pause BF based on isotope half-life
- Gallium-67: 2 weeks
- I-125: 12 days
- I-131: 2 months
- Tc-99m: 24 hours
Active varicella (if lesions disseminated; expressed milk may be given if no lesion on breast)
Untreated brucellosis

NOT Contraindications (common myths):

Hepatitis B (vaccinate infant within 12 hours), Hepatitis C, CMV in term infants, mastitis, mild maternal illness, common medications

7. Drugs and Medications in Breastfeeding

Pharmacokinetics - Factors Governing Drug Transfer into Milk

Molecular weight (<200 Da: free transfer; >500 Da: poor transfer)
Protein binding (highly protein-bound drugs = less transfer)
Lipid solubility (lipophilic drugs concentrate in hindmilk)
Oral bioavailability in infant
pKa (basic drugs concentrate in milk - "ion trapping," milk pH 7.0 vs. plasma 7.4)
Relative Infant Dose (RID): >10% is threshold of concern

Contraindicated Drugs

Chemotherapy agents (cyclophosphamide, methotrexate, doxorubicin)
Radioactive compounds
Ergotamines
Amphetamines, cocaine, PCP
Statins
Lithium (borderline - only with rigorous monitoring)
Amiodarone (long half-life, contains iodine)
Gold salts
Retinoids (systemic)

Safe Drugs (common exam favorites)

Most antibiotics: penicillins, cephalosporins, macrolides, aminoglycosides (poorly absorbed orally)
NSAIDs: Ibuprofen preferred; avoid aspirin (Reye's syndrome risk)
Paracetamol/acetaminophen: Safe
SSRIs: Sertraline, paroxetine preferred (low RID); fluoxetine - use with caution (longer half-life)
Methadone and buprenorphine: Breastfeeding ENCOURAGED with stable maintenance therapy
Insulin: Safe (destroyed in GI tract)
Levothyroxine: Safe
Metronidazole: Safe (single dose - some advise 12-24 h pause)
Heparin/LMWH: Safe (too large to transfer)
Warfarin: Safe (heavily protein-bound)

AAP Categories of Drugs in Breastfeeding (2001/2013 update):

Know the classification system; LactMed database (NIH); Hale's Medications & Mothers' Milk (22nd edition, 2026)

8. Breastfeeding Technique & Support

Latch assessment: LATCH scoring tool (Latch, Audible swallowing, Type of nipple, Comfort, Hold) - 0-2 for each parameter, total 0-10
Positioning: Cradle, cross-cradle, football/clutch, side-lying, laid-back (biological nurturing)
Signs of correct latch: Wide open mouth, chin touching breast, lower lip flanged out, areola more visible above than below, no pain, audible swallow
Signs of effective feeding: 6-8 wet nappies/day after Day 5, pale yellow urine, regains birth weight by Day 10-14, adequate weight gain (20-30 g/day in first 3 months)
Feeding frequency: 8-12 times/24 hours in neonatal period; demand feeding (not scheduled)
Duration: Until breast is drained (not by clock); hindmilk is obtained only after adequate emptying

9. Common Breastfeeding Problems & Management

Problem	Key Points
Engorgement	Day 3-5; treat with frequent feeding, warm compresses, cold post-feed
Nipple pain/cracks	Poor latch is #1 cause; apply hindmilk/colostrum to heal; nipple shields (last resort)
Mastitis	Staphylococcus aureus most common; continue BF; antibiotics (dicloxacillin, cloxacillin); if abscess - surgical drainage
Low milk supply (perceived vs. real)	Assess latch/frequency first; galactagogues (domperidone, metoclopramide, fenugreek) if confirmed
Lactation failure	Primary vs. secondary; Sheehan's syndrome, IGT (insufficient glandular tissue)
Raynaud's of nipple	Vasospasm; nifedipine used in severe cases
Nipple confusion	Avoid bottles/pacifiers in first 4-6 weeks; use cup/spoon/SNS instead

10. Breastfeeding in Special Clinical Situations

Preterm and NICU Infants

Kangaroo Mother Care (KMC): Reduces mortality by 40% in LBW; WHO recommends immediate KMC even for unstable infants (2023 updated guidance)
Preterm milk: Higher protein, sodium, IgA, lactoferrin; lower lactose than term milk (lasts ~4 weeks)
Human Milk Fortifiers (HMF): Required for VLBW (<1500 g); bovine-derived vs. human-derived HMF
Donor Human Milk: For <32 weeks or <1500 g when maternal milk unavailable; pasteurization (Holder pasteurization 62.5°C x 30 min) destroys HIV, CMV, bacteria but reduces some bioactive factors
Late preterm (34-36+6 weeks): High risk of BF failure; sleepy, poor suck; requires close monitoring
NEC and breastfeeding: Human milk (maternal or donor) is the single most effective NEC prevention strategy

HIV and Breastfeeding

Developed countries (CDC 2025): Breastfeeding NOT recommended regardless of ART/viral load
Developing countries (WHO): BF recommended with ART (viral suppression); exclusive BF for 6 months reduces transmission more than mixed feeding; BF + ART reduces transmission to <1-2%
MTCT via breast milk: 5-20% additional risk without ART; 3-5% with mixed feeding (early introduction of other foods damages gut mucosa, increases transmission)

Maternal Infections

CMV: Reactivates in milk; risk to term infants negligible; VLBW preterm infants at risk - Holder pasteurization eliminates CMV
Hepatitis B: NOT a contraindication; give HBIG + vaccine within 12 hours; BF can begin immediately after immunoprophylaxis
Hepatitis C: NOT a contraindication (unless cracked/bleeding nipples)
Tuberculosis: Active TB - isolate mother but expressed milk can be given; after 2 weeks of treatment, direct BF safe
COVID-19: BF encouraged; SARS-CoV-2 not detected in milk; protective antibodies present in milk; mother to wear mask during feeding

Infant Conditions

Neonatal jaundice:
- Breastfeeding jaundice (starvation jaundice): Days 2-5; inadequate intake/calories; increased enterohepatic circulation; treat by improving latch/frequency
- Breast milk jaundice: Day 7-14 onwards; prolonged (up to 12 weeks); caused by beta-glucuronidase, 3-alpha-20-beta-pregnanediol in milk; interruption test (48h pause causes 30-50% drop in bilirubin) confirms diagnosis; generally benign; no indication to stop BF
Infant with cleft lip/palate: Modified positions; use of supplemental nursing systems; Haberman feeder; cleft palate makes effective suckling difficult
Down syndrome (Trisomy 21): Low tone/hypotonia - challenges; support needed; beneficial
Congenital heart disease: Higher caloric need; may need higher calorie formula supplementation; increased effort of feeding

Maternal Conditions

Diabetes: BF reduces maternal T2DM risk; lower insulin requirement postpartum while BF; watch for hypoglycemia
Thyroid disease: Levothyroxine and carbimazole (low doses) are safe; propylthiouracil (PTU) preferred over methimazole in higher doses
Postpartum depression: BF protective; SSRIs safe (sertraline first choice)
Breast surgery: Augmentation (implants) - usually safe; reduction surgery - may impair milk ducts/nerve supply significantly
IGT (Insufficient Glandular Tissue): Primary lactation failure; tubular/asymmetric breasts; partial BF possible

11. Breastfeeding and Neonatal Metabolism

Hypoglycemia: At-risk groups (LGA, SGA, preterm, IDM); avoid unnecessary supplementation; skin-to-skin + frequent BF is first-line; buccal dextrose gel (40% dextrose, 0.5 mL/kg) before formula supplementation
Hypernatremic dehydration: Rare but serious BF complication; signs include lethargy, fever, brick-red urine crystals; serum Na >145 mEq/L; occurs with poor intake/poor latch
Weight loss: Normal up to 7-10% of birth weight; weight loss >10% requires evaluation; regain birth weight by Day 10-14
Bowel pattern: Breastfed stools - yellow, seedy, loose (3-8/day initially); by 6 weeks may have infrequent stools (every 7-10 days) - normal as long as soft (BF stool has minimal residue)
Vitamin D supplementation: 400 IU/day from Day 1 for all exclusively breastfed infants (AAP/IAP); maternal vitamin D does not adequately enrich milk
Iron supplementation: Exclusively BF term infants - iron-rich foods from 6 months; if not starting complementary foods, supplement 1 mg/kg/day from 4 months (AAP); preterm/LBW infants: 2-4 mg/kg/day from 2-4 weeks
Vitamin K: Given prophylactically (IM preferred) at birth; breast milk is low in Vitamin K; late hemorrhagic disease of newborn (VKDB) is a BF-associated complication

12. Extended Breastfeeding, Weaning & Complementary Feeding

Complementary feeding initiation: 6 months (WHO) - not before 4 months
Signs of readiness: Head control, sitting with support, loss of extrusion reflex, showing interest in food
During complementary feeding: BF remains primary nutrition source until 12 months; continues as supplement thereafter
Extended/sustained BF: WHO recommends up to 2 years +; AAP 2022 - at least 2 years if mutually desired; no defined upper age limit medically
Weaning: Child-led vs. mother-led; abrupt weaning (cold turkey) increases engorgement/mastitis risk; gradual preferred

13. Breastfeeding and Infant Growth

WHO Growth Standards (2006): Based on exclusively breastfed infants from 6 countries as the gold standard; BF infants gain weight faster in first 3 months, then slower than formula-fed infants - NOT a reason to supplement
Growth faltering: Defined as weight for age <-2SD or crossing two major centile lines; requires systematic evaluation
Normal BF weight gain: 20-30 g/day (0-3 months); 15-20 g/day (3-6 months); 10-15 g/day (6-12 months)

14. Expressed Breast Milk (EBM) - Storage and Handling

Location	Temperature	Duration
Room temperature	25°C	4 hours
Refrigerator	4°C	4 days
Freezer compartment	-15°C	2 weeks
Deep freeze	-18 to -20°C	6 months
Deep freeze	-80°C	12 months

Thawing: Refrigerator overnight or warm water (not microwave - destroys enzymes, creates hot spots)
Once thawed: Use within 24 hours; do not refreeze
Lipase activity: Some infants reject EBM due to high lipase (rancid taste); scald at 72°C before storage

15. Galactagogues

Pharmacological: Domperidone (preferred; less CNS side effects), Metoclopramide (extrapyramidal risk), Oxytocin (intranasal - no longer recommended)
Herbal: Fenugreek (most evidence), Shatavari (Asparagus racemosus - used in India), blessed thistle, moringa
Evidence base for all is weak/moderate; mechanical measures (frequent feeding, pumping) are first-line
Domperidone caution: Risk of QTc prolongation and cardiac arrhythmias; contraindicated with CYP3A4 inhibitors

16. Legal, Ethical & Policy Frameworks

International Code of Marketing of Breast-milk Substitutes (WHO, 1981): Prohibits advertising of formula; no free samples in health facilities; labels must not idealize formula
Maternity Protection Convention (ILO): Maternity leave, paid breastfeeding breaks
POCSO/Maternity Benefit Act (India): 26 weeks paid maternity leave; creche facilities
Right to breastfeed in public: Legal in most countries

High-Yield Quiz Topics to Focus On (MD/DM Level)

These are the areas where nuanced, MCQ-style questions are set at national level:

Breast milk jaundice vs. breastfeeding jaundice - pathophysiology distinction
RID >10% drugs - lithium, amiodarone; drugs safe vs. unsafe
HIV and breastfeeding - WHO vs. CDC discordant guidelines (resource-rich vs. limited)
Galactosemia - absolute contraindication; which enzyme is deficient
Preterm milk composition - higher protein/Na, lower lactose vs. term
HMOs - 2'-fucosyllactose, prebiotic, anti-adhesion mechanism
Entero-mammary axis - mechanism of targeted SIgA
Domperidone vs. metoclopramide as galactagogue
Lactogenesis staging - timing, hormonal drivers
KMC evidence - 40% mortality reduction; now recommended for unstable infants (2023 WHO)
WHO growth standards origin - based on EBF infants; why BF infants appear to "slow down" after 3 months
Vitamin D/K/Iron supplementation timelines
Late preterm BF challenges
Buccal dextrose gel - 40% dextrose, 0.5 mL/kg for hypoglycemia before formula
Holder pasteurization parameters for donor milk banks
LATCH score components
Radioactive isotopes and breastfeeding pause durations
AAP 2022 updated recommendation - 2 years of BF; change from previous 1-year recommendation

Recent supporting evidence (for quiz context):

An umbrella review in Am J Clin Nutr (2025) confirms breastfeeding associations with lower childhood obesity, infection, NEC, and maternal cancer (PMID 40754214)
A systematic review in Front Public Health (2024) confirms breastfeeding improves neurodevelopmental outcomes in preterm infants (PMID 39639909)
WHO 2023 guidelines updated to recommend immediate KMC even for clinically unstable LBW newborns

This covers every domain an MD/DM-level paediatrician could be tested on at a national quiz. Prioritize sections 6, 7, 10, and 11 for the highest-yield MCQ material - these are where the tricky, high-discrimination questions tend to appear.

Create a PowerPoint presentation summarizing these 16 topics with key clinical points

Reading File

Running Command

ls -la /tmp/workspace/ 2>/dev/null || echo "workspace does not exist"

Running Command

mkdir -p /tmp/workspace/breastfeeding-quiz-pptx

Writing File

~/breastfeeding-quiz-pptx/create_pptx.py

from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
from io import BytesIO

# ── Colour palette ────────────────────────────────────────────────────────────
NAVY       = RGBColor(0x00, 0x33, 0x66)   # dark navy – header bars
TEAL       = RGBColor(0x00, 0x7B, 0x8A)   # teal accent
AMBER      = RGBColor(0xFF, 0xA5, 0x00)   # amber highlight
WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_GREY = RGBColor(0xF2, 0xF5, 0xF7)
DARK_TEXT  = RGBColor(0x1A, 0x1A, 0x2E)
MID_GREY   = RGBColor(0x55, 0x65, 0x75)
RED_WARN   = RGBColor(0xC0, 0x39, 0x2B)
GREEN_OK   = RGBColor(0x1A, 0x7A, 0x4A)

W = Inches(13.333)
H = Inches(7.5)

prs = Presentation()
prs.slide_width  = W
prs.slide_height = H
blank = prs.slide_layouts[6]   # fully blank

# ─────────────────────────────────────────────────────────────────────────────
# Helper functions
# ─────────────────────────────────────────────────────────────────────────────

def add_rect(slide, x, y, w, h, fill_color, line_color=None, line_width=Pt(0)):
    from pptx.enum.shapes import MSO_SHAPE
    shp = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, x, y, w, h)
    shp.fill.solid()
    shp.fill.fore_color.rgb = fill_color
    if line_color:
        shp.line.color.rgb = line_color
        shp.line.width = line_width
    else:
        shp.line.fill.background()
    shp.shadow.inherit = False
    return shp

def add_textbox(slide, x, y, w, h, text, font_size=Pt(14), bold=False,
                color=DARK_TEXT, align=PP_ALIGN.LEFT, italic=False,
                wrap=True, v_anchor=MSO_ANCHOR.TOP,
                margin_l=Inches(0.1), margin_t=Inches(0.05)):
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.vertical_anchor = v_anchor
    tf.margin_left   = margin_l
    tf.margin_right  = Inches(0.05)
    tf.margin_top    = margin_t
    tf.margin_bottom = Inches(0.05)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size  = font_size
    run.font.bold  = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name  = "Calibri"
    return tb

def add_bullet_block(slide, x, y, w, h, items, font_size=Pt(13),
                     bullet_color=TEAL, text_color=DARK_TEXT,
                     line_spacing=1.15):
    """Adds a textbox with bulleted items using layout placeholder style."""
    from pptx.oxml.ns import qn
    from lxml import etree
    import copy

    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = True
    tf.vertical_anchor = MSO_ANCHOR.TOP
    tf.margin_left   = Inches(0.1)
    tf.margin_right  = Inches(0.1)
    tf.margin_top    = Inches(0.05)
    tf.margin_bottom = Inches(0.05)

    for i, item in enumerate(items):
        if i == 0:
            p = tf.paragraphs[0]
        else:
            p = tf.add_paragraph()
        # indent via space prefix to mimic bullet
        run = p.add_run()
        level = 0
        prefix = "  " * level
        if isinstance(item, tuple):
            text, level = item
            prefix = "    " * level
        else:
            text = item
        run.text = prefix + "\u25CF  " + text
        run.font.size = font_size
        run.font.color.rgb = text_color
        run.font.name = "Calibri"
        p.alignment = PP_ALIGN.LEFT
        # space between paragraphs
        pPr = p._p.get_or_add_pPr()
        spcBef = etree.SubElement(pPr, qn('a:spcBef'))
        spcPts = etree.SubElement(spcBef, qn('a:spcPts'))
        spcPts.set('val', '80')   # 8 pt before each bullet

    return tb

def slide_header(slide, topic_num, title, subtitle=None):
    """Draw the standard header bar used on topic slides."""
    # Full-width navy bar at top
    add_rect(slide, 0, 0, W, Inches(1.15), NAVY)
    # Teal accent strip
    add_rect(slide, 0, Inches(1.15), W, Inches(0.07), TEAL)

    # Topic number badge
    badge = add_rect(slide, Inches(0.3), Inches(0.1), Inches(0.75), Inches(0.75), AMBER)
    add_textbox(slide, Inches(0.3), Inches(0.1), Inches(0.75), Inches(0.75),
                str(topic_num), font_size=Pt(22), bold=True,
                color=NAVY, align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0), margin_t=Inches(0))

    # Title text
    add_textbox(slide, Inches(1.25), Inches(0.1), Inches(11.5), Inches(0.65),
                title, font_size=Pt(28), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))

    # Subtitle line if provided
    if subtitle:
        add_textbox(slide, Inches(1.25), Inches(0.72), Inches(11.5), Inches(0.38),
                    subtitle, font_size=Pt(14), bold=False,
                    color=RGBColor(0xCC, 0xE5, 0xFF), align=PP_ALIGN.LEFT,
                    v_anchor=MSO_ANCHOR.TOP,
                    margin_l=Inches(0.1), margin_t=Inches(0))

def slide_footer(slide, tag="National Breastfeeding Day Quiz  |  MD/DM Paediatrics"):
    """Bottom footer bar."""
    add_rect(slide, 0, Inches(7.2), W, Inches(0.3), NAVY)
    add_textbox(slide, Inches(0.3), Inches(7.2), Inches(12.7), Inches(0.3),
                tag, font_size=Pt(9), bold=False,
                color=RGBColor(0xCC, 0xE5, 0xFF), align=PP_ALIGN.LEFT,
                v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))

def key_point_box(slide, x, y, w, h, label, value,
                  label_color=WHITE, value_color=WHITE,
                  box_color=TEAL):
    add_rect(slide, x, y, w, h, box_color)
    add_textbox(slide, x, y, w, Inches(0.32),
                label, font_size=Pt(10), bold=True,
                color=label_color, align=PP_ALIGN.CENTER,
                v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.05), margin_t=Inches(0))
    add_textbox(slide, x, y+Inches(0.32), w, h-Inches(0.32),
                value, font_size=Pt(12), bold=False,
                color=value_color, align=PP_ALIGN.CENTER,
                v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.05), margin_t=Inches(0))

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 1 – Title / Cover
# ─────────────────────────────────────────────────────────────────────────────
def make_title_slide(prs):
    slide = prs.slides.add_slide(blank)
    # Deep navy background
    add_rect(slide, 0, 0, W, H, NAVY)
    # Teal decorative band
    add_rect(slide, 0, Inches(2.6), W, Inches(0.12), TEAL)
    add_rect(slide, 0, Inches(5.1), W, Inches(0.12), AMBER)

    # Main title
    add_textbox(slide, Inches(0.8), Inches(0.7), Inches(11.7), Inches(1.4),
                "BREASTFEEDING IN PAEDIATRICS",
                font_size=Pt(42), bold=True,
                color=WHITE, align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0), margin_t=Inches(0))

    add_textbox(slide, Inches(0.8), Inches(2.1), Inches(11.7), Inches(0.6),
                "A Comprehensive Clinical Quiz Guide",
                font_size=Pt(20), bold=False,
                color=RGBColor(0xCC, 0xE5, 0xFF), align=PP_ALIGN.CENTER,
                v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0), margin_t=Inches(0))

    # 16 Topics badge area
    add_rect(slide, Inches(4.5), Inches(3.0), Inches(4.3), Inches(1.3), TEAL)
    add_textbox(slide, Inches(4.5), Inches(3.0), Inches(4.3), Inches(0.55),
                "16 TOPICS COVERED",
                font_size=Pt(18), bold=True,
                color=WHITE, align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0), margin_t=Inches(0))
    add_textbox(slide, Inches(4.5), Inches(3.55), Inches(4.3), Inches(0.75),
                "MD & DM Level Paediatricians",
                font_size=Pt(14), bold=False,
                color=RGBColor(0xCC, 0xF2, 0xF5), align=PP_ALIGN.CENTER,
                v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0), margin_t=Inches(0))

    add_textbox(slide, Inches(0.8), Inches(5.4), Inches(11.7), Inches(0.5),
                "National Breastfeeding Day  |  August 2025",
                font_size=Pt(15), bold=False,
                color=AMBER, align=PP_ALIGN.CENTER,
                v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0), margin_t=Inches(0))

    add_textbox(slide, Inches(0.8), Inches(6.1), Inches(11.7), Inches(0.9),
                "Anatomy & Physiology  •  Milk Composition  •  Immunology  •  WHO/IAP/AAP Guidelines\n"
                "Benefits  •  Contraindications  •  Drugs  •  Technique  •  Neonatal Problems\n"
                "Special Situations  •  Metabolism  •  Galactagogues  •  EBM  •  Policy",
                font_size=Pt(11), bold=False,
                color=RGBColor(0xAA, 0xCC, 0xEE), align=PP_ALIGN.CENTER,
                v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0), margin_t=Inches(0))

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 2 – Topic 1: Anatomy & Physiology
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_01(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 1, "Anatomy & Physiology of Lactation",
                 "Structures, hormones, and lactogenesis stages")

    # Two columns
    # Left column – Lactogenesis stages
    add_rect(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.35), Inches(1.35), Inches(6.0), Inches(0.35),
                "STAGES OF LACTOGENESIS", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))

    lg_items = [
        "Lactogenesis I – 16 wks gestation; colostrum secretion begins; inhibited by progesterone",
        "Lactogenesis II – Day 2-3 postpartum; 'milk coming in'; driven by progesterone withdrawal",
        "Lactogenesis III (Galactopoiesis) – ongoing; demand-driven; autocrine regulation via FIL",
        "Milk Ejection Reflex – Oxytocin released from posterior pituitary; let-down; inhibited by stress/pain",
        "Prolactin – secreted by anterior pituitary; drives milk synthesis; elevated by suckling",
        "Feedback Inhibitor of Lactation (FIL) – whey protein; autocrine suppressor; removal = more milk",
        "Entero-mammary axis – MALT-sensitised lymphocytes migrate to breast → targeted SIgA in milk",
    ]
    add_bullet_block(slide, Inches(0.4), Inches(1.75), Inches(5.9), Inches(5.1),
                     lg_items, font_size=Pt(12))

    # Right column – Key structures + hormonal cascade
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(0.35), NAVY)
    add_textbox(slide, Inches(6.75), Inches(1.35), Inches(6.2), Inches(0.35),
                "KEY STRUCTURES & HORMONAL CASCADE", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))

    r_items = [
        "Alveoli → lactiferous ducts → lactiferous sinuses → nipple",
        "Montgomery glands – sebaceous; lubricate areola",
        "Cooper's ligaments – suspensory ligaments of breast",
        "Mammogenesis: estrogen (ductal), progesterone (lobular), prolactin + insulin + cortisol + GH",
        "Suckling reflex arc: nipple sensory fibres → hypothalamus → ↑PRL + oxytocin",
        "Oxytocin (Ferguson reflex): myoepithelial cells contract → milk ejection",
        "Progesterone withdrawal at delivery → Lactogenesis II trigger",
        "Prolactin receptor theory: suckling frequency determines receptor density",
    ]
    add_bullet_block(slide, Inches(6.8), Inches(1.75), Inches(6.1), Inches(5.1),
                     r_items, font_size=Pt(12))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 3 – Topic 2: Composition of Human Milk
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_02(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 2, "Composition of Human Milk",
                 "Colostrum → Transitional → Mature milk; Foremilk vs. Hindmilk")

    # Three phase boxes at top
    phases = [
        ("COLOSTRUM\n(Days 1–5)", "Low vol (2–20 mL/feed)\nHigh SIgA (~12 g/L)\nHigh protein, low fat\nLeukocytes: 1–3 M cells/mL\nLaxative – clears meconium"),
        ("TRANSITIONAL MILK\n(Days 6–14)", "↑ Fat & lactose\n↓ Protein & immunoglobulins\nGradual transition to mature"),
        ("MATURE MILK\n(After Day 14)", "Protein: 0.9–1.2 g/dL\nFat: 3.5–4.5 g/dL (~50% kcal)\nLactose: 6.5–7 g/dL\nWhey:Casein = 70:30"),
    ]
    box_w = Inches(4.0)
    colors = [TEAL, NAVY, RGBColor(0x2C, 0x5F, 0x8A)]
    for i, (ph, desc) in enumerate(phases):
        x = Inches(0.3) + i * (box_w + Inches(0.22))
        add_rect(slide, x, Inches(1.35), box_w, Inches(2.55),
                 colors[i])
        add_textbox(slide, x, Inches(1.38), box_w, Inches(0.55),
                    ph, font_size=Pt(12), bold=True, color=WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0.1), margin_t=Inches(0))
        add_textbox(slide, x + Inches(0.1), Inches(1.93), box_w - Inches(0.2), Inches(1.9),
                    desc, font_size=Pt(11), bold=False, color=WHITE,
                    align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.TOP,
                    margin_l=Inches(0.1), margin_t=Inches(0.05))

    # Lower two columns
    add_rect(slide, Inches(0.3), Inches(4.05), Inches(6.1), Inches(2.9), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.3), Inches(4.05), Inches(6.1), Inches(0.32), AMBER)
    add_textbox(slide, Inches(0.35), Inches(4.05), Inches(6.0), Inches(0.32),
                "BIOACTIVE COMPONENTS", font_size=Pt(11), bold=True,
                color=NAVY, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    bio = [
        "HMOs (>200 types): 2'-fucosyllactose most abundant; prebiotic, anti-adhesin, neuro-dev",
        "Lactoferrin: iron-chelating, bacteriostatic, bifidogenic",
        "Lysozyme: cleaves bacterial peptidoglycan; ↑ over 1st year",
        "SIgA: mucosal defence; coats gut epithelium; not absorbed",
        "Growth factors: EGF, IGF-1; gut maturation",
        "Stem cells, leptin, adiponectin, IL-6, IL-10, TNF-α",
    ]
    add_bullet_block(slide, Inches(0.4), Inches(4.42), Inches(5.9), Inches(2.4),
                     bio, font_size=Pt(11))

    add_rect(slide, Inches(6.7), Inches(4.05), Inches(6.3), Inches(2.9), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(6.7), Inches(4.05), Inches(6.3), Inches(0.32), AMBER)
    add_textbox(slide, Inches(6.75), Inches(4.05), Inches(6.2), Inches(0.32),
                "FOREMILK vs HINDMILK  |  MICRONUTRIENTS", font_size=Pt(11), bold=True,
                color=NAVY, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    micro = [
        "Foremilk: watery, high lactose (thirst) | Hindmilk: creamy, high fat (energy)",
        "Vit D & K: LOW in breast milk → supplementation needed",
        "Iron: 0.3 mg/L but 50% bioavailability (vs 10% in formula)",
        "Zinc: high bioavailability",
        "Alpha-lactalbumin: dominant whey protein (vs β-lactoglobulin in cow)",
        "Cow milk whey:casein = 20:80 vs human 70:30 → easier digestion",
    ]
    add_bullet_block(slide, Inches(6.8), Inches(4.42), Inches(6.1), Inches(2.4),
                     micro, font_size=Pt(11))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 4 – Topic 3: Immunological Components
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_03(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 3, "Immunological Components of Breast Milk",
                 "Passive immunity, cellular defence, and entero-mammary axis")

    # 3 columns
    cols = [
        ("HUMORAL FACTORS", TEAL, [
            "SIgA – primary defence; targets ingested pathogens; entero-mammary axis delivers targeted antibodies",
            "IgM, IgG also present (lower levels)",
            "Complement: C3, C4 present",
            "Lysozyme – cleaves bacterial peptidoglycan; concentration INCREASES over 1st year",
            "Lactoferrin – iron-chelating, bacteriostatic; promotes Bifidobacterium growth",
            "Bifidus factor – promotes Lactobacillus bifidus growth",
        ]),
        ("CELLULAR COMPONENTS", NAVY, [
            "Leukocytes: 1–3 million cells/mL in colostrum",
            "Macrophages >80% – produce IFN, cytokines, complement",
            "Lymphocytes: T cells (memory) + B cells",
            "Neutrophils: minority",
            "Cytokines: IL-6, IL-10, TNF-α, TGF-β – immune modulation",
            "Stem cells: multi-potent; developmental role",
        ]),
        ("ENTERO-MAMMARY AXIS", RGBColor(0x1A, 0x5F, 0x7A), [
            "Maternal gut/respiratory MALT exposed to pathogens",
            "Sensitised lymphocytes migrate via bloodstream to breast",
            "Breast produces targeted SIgA against those specific pathogens",
            "Protects infant from same organisms in shared environment",
            "Milk microbiome (>700 species): Staph, Strep, Bifidobacterium",
            "Establishes infant gut microbiome; reduces dysbiosis",
        ]),
    ]
    col_w = Inches(4.1)
    for i, (title, color, items) in enumerate(cols):
        x = Inches(0.25) + i * (col_w + Inches(0.18))
        add_rect(slide, x, Inches(1.35), col_w, Inches(5.6), WHITE,
                 line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
        add_rect(slide, x, Inches(1.35), col_w, Inches(0.35), color)
        add_textbox(slide, x+Inches(0.1), Inches(1.35), col_w-Inches(0.2), Inches(0.35),
                    title, font_size=Pt(11), bold=True, color=WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0), margin_t=Inches(0))
        add_bullet_block(slide, x+Inches(0.1), Inches(1.75), col_w-Inches(0.2), Inches(5.05),
                         items, font_size=Pt(11.5))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 5 – Topic 4: WHO/IAP/AAP Guidelines
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_04(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 4, "WHO / IAP / AAP Recommendations & Global Policy",
                 "Ten Steps, BFHI, IYCF, and global breastfeeding targets")

    # Recommendation boxes at top
    recs = [
        ("WHO", "EBF for 6 months\nContinue BF + complementary\nfeeding up to 2 years or beyond"),
        ("AAP 2022", "EBF for 6 months\nContinue BF at least 2 years\n(updated from 1 year)"),
        ("IAP 2010", "EBF for 6 months\nInitiation within 1 hour of birth\nContinue to 2 years+"),
    ]
    box_w = Inches(3.9)
    for i, (org, rec) in enumerate(recs):
        x = Inches(0.3) + i * (box_w + Inches(0.28))
        add_rect(slide, x, Inches(1.35), box_w, Inches(1.65), NAVY)
        add_textbox(slide, x, Inches(1.35), box_w, Inches(0.38),
                    org, font_size=Pt(16), bold=True, color=AMBER,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0), margin_t=Inches(0))
        add_textbox(slide, x+Inches(0.1), Inches(1.73), box_w-Inches(0.2), Inches(1.2),
                    rec, font_size=Pt(12), bold=False, color=WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0.05), margin_t=Inches(0))

    # Ten Steps box (left)
    add_rect(slide, Inches(0.3), Inches(3.15), Inches(6.1), Inches(3.8), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.3), Inches(3.15), Inches(6.1), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.35), Inches(3.15), Inches(6.0), Inches(0.35),
                "TEN STEPS TO SUCCESSFUL BREASTFEEDING (BFHI)", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    steps = [
        "1. Written breastfeeding policy communicated to all staff",
        "2. Staff trained in skills to implement policy",
        "3. Ante-natal BF counselling to all pregnant women",
        "4. Initiate BF within 1 hour of birth (skin-to-skin)",
        "5. Show mothers how to BF and maintain lactation if separated",
        "6. Give newborns no food or drink other than BM (unless medically indicated)",
        "7. Practice rooming-in (mother and infant together 24h)",
        "8. Encourage breastfeeding on demand",
        "9. Give no artificial teats or pacifiers to BF infants",
        "10. Promote BF support groups on discharge",
    ]
    add_bullet_block(slide, Inches(0.4), Inches(3.55), Inches(5.9), Inches(3.35),
                     steps, font_size=Pt(10.5))

    # Right column – policy facts
    add_rect(slide, Inches(6.7), Inches(3.15), Inches(6.3), Inches(3.8), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(6.7), Inches(3.15), Inches(6.3), Inches(0.35), NAVY)
    add_textbox(slide, Inches(6.75), Inches(3.15), Inches(6.2), Inches(0.35),
                "KEY POLICY FACTS", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    pfacts = [
        "Early initiation within 1 hour reduces neonatal mortality by 22%",
        "WHO Code (1981): bans formula advertising; no free samples in health facilities",
        "World Breastfeeding Week: August 1–7; 2025 theme: 'Invest in Breastfeeding'",
        "Global EBF rate at 6 months: ~44% (WHO 2023)",
        "LAM (Lactational Amenorrhea Method): 98% effective if EBF + amenorrheic + <6 months",
        "IYCF: 8 recommended practices (WHO)",
        "SDG 2 (Zero Hunger) + SDG 3 (Good Health) linked to BF targets",
        "India Maternity Benefit Act: 26 weeks paid maternity leave",
    ]
    add_bullet_block(slide, Inches(6.8), Inches(3.55), Inches(6.1), Inches(3.35),
                     pfacts, font_size=Pt(11))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 6 – Topic 5: Benefits
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_05(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 5, "Benefits of Breastfeeding",
                 "Infant benefits • Maternal benefits • Evidence-based data")

    # Left: infant
    add_rect(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.35), Inches(1.35), Inches(6.0), Inches(0.35),
                "INFANT BENEFITS (WITH EFFECT SIZES)", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    ibens = [
        "Diarrhoea hospitalisation: ↓50%",
        "LRTI hospitalisation: ↓72%",
        "Otitis media: ↓50%",
        "SIDS: ↓36–50%",
        "NEC: ↓58% (preterm); NEC death ↓79%",
        "Childhood obesity: ↓13–22% (dose-dependent)",
        "Type 1 DM: ↓30%  |  Type 2 DM: ↓40%",
        "IQ advantage: 3–5 points (DHA/ARA/HMOs)",
        "Healthier gut microbiome (Bifidobacterium-dominant)",
        "Reduced risk of coeliac disease, IBD",
        "Atopic dermatitis: ↓ (asthma: nuanced evidence)",
    ]
    add_bullet_block(slide, Inches(0.4), Inches(1.75), Inches(5.9), Inches(5.1),
                     ibens, font_size=Pt(12))

    # Right: maternal
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(0.35), NAVY)
    add_textbox(slide, Inches(6.75), Inches(1.35), Inches(6.2), Inches(0.35),
                "MATERNAL BENEFITS", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    mbens = [
        "PPH prevention: oxytocin → uterine involution",
        "LAM contraception: 98% effective (EBF + amenorrhoea + <6 months)",
        "Breast cancer: ↓4% per year of breastfeeding",
        "Ovarian cancer: ↓30%",
        "Type 2 DM: reduced incidence",
        "Postpartum depression: oxytocin ↓ cortisol; protective (dose-dependent)",
        "Faster return to pre-pregnancy weight",
        "Osteoporosis: possibly protective (debated)",
        "Bonding: oxytocin-mediated maternal-infant attachment",
        "Economic benefit: formula costs avoided",
    ]
    add_bullet_block(slide, Inches(6.8), Inches(1.75), Inches(6.1), Inches(5.1),
                     mbens, font_size=Pt(12))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 7 – Topic 6: Contraindications
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_06(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 6, "Contraindications to Breastfeeding",
                 "Absolute • Temporary • Common myths debunked")

    # Absolute contraindications
    add_rect(slide, Inches(0.3), Inches(1.35), Inches(5.5), Inches(2.85), WHITE,
             line_color=RED_WARN, line_width=Pt(1.0))
    add_rect(slide, Inches(0.3), Inches(1.35), Inches(5.5), Inches(0.35), RED_WARN)
    add_textbox(slide, Inches(0.35), Inches(1.35), Inches(5.4), Inches(0.35),
                "ABSOLUTE CONTRAINDICATIONS", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    abs_ci = [
        "Classic GALACTOSEMIA – must use galactose-free formula (Nutramigen)",
        "MSUD – partial BF only with strict monitoring",
        "HIV (resource-rich settings per CDC) – not recommended",
        "HTLV-1 / HTLV-2 infection",
        "EBOLA – confirmed or suspected",
        "HSV lesions on breast/nipple (that specific breast)",
    ]
    add_bullet_block(slide, Inches(0.4), Inches(1.75), Inches(5.3), Inches(2.3),
                     abs_ci, font_size=Pt(11), bullet_color=RED_WARN, text_color=DARK_TEXT)

    # Temporary
    add_rect(slide, Inches(6.1), Inches(1.35), Inches(6.9), Inches(2.85), WHITE,
             line_color=AMBER, line_width=Pt(1.0))
    add_rect(slide, Inches(6.1), Inches(1.35), Inches(6.9), Inches(0.35), AMBER)
    add_textbox(slide, Inches(6.15), Inches(1.35), Inches(6.8), Inches(0.35),
                "TEMPORARY CONTRAINDICATIONS & PAUSE DURATIONS", font_size=Pt(11), bold=True,
                color=NAVY, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    temp_ci = [
        "Radioactive isotopes – pause per half-life:",
        "  Tc-99m: 24 hrs  |  Ga-67: 2 weeks",
        "  I-131: 2 months  |  I-125: 12 days",
        "Active varicella with disseminated lesions (expressed milk OK if no breast lesion)",
        "Untreated brucellosis",
        "Active untreated TB – direct feeding; expressed milk can be given",
        "Certain chemotherapy / cytotoxic agents",
    ]
    add_bullet_block(slide, Inches(6.2), Inches(1.75), Inches(6.7), Inches(2.3),
                     temp_ci, font_size=Pt(11))

    # NOT contraindications
    add_rect(slide, Inches(0.3), Inches(4.35), Inches(12.7), Inches(2.6), WHITE,
             line_color=GREEN_OK, line_width=Pt(1.0))
    add_rect(slide, Inches(0.3), Inches(4.35), Inches(12.7), Inches(0.35), GREEN_OK)
    add_textbox(slide, Inches(0.35), Inches(4.35), Inches(12.6), Inches(0.35),
                "NOT CONTRAINDICATIONS (Common Exam Myths)", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    not_ci = [
        "Hepatitis B (vaccinate + HBIG within 12 h → BF safe)",
        "Hepatitis C (unless cracked/bleeding nipples)",
        "CMV in term infants (negligible risk; concern only in VLBW preterm)",
        "Mastitis (continue feeding – promotes resolution)",
        "Mild maternal illness (cold, flu)",
        "Jaundice in infant (unless severe – see Topic 11)",
        "Most common medications (antibiotics, paracetamol, LMWH, levothyroxine)",
        "HIV in resource-limited settings WITH effective ART (WHO recommends EBF)",
    ]
    # Two-row display
    half = len(not_ci) // 2
    add_bullet_block(slide, Inches(0.4), Inches(4.75), Inches(6.0), Inches(2.1),
                     not_ci[:half], font_size=Pt(11), text_color=DARK_TEXT)
    add_bullet_block(slide, Inches(6.7), Inches(4.75), Inches(6.2), Inches(2.1),
                     not_ci[half:], font_size=Pt(11), text_color=DARK_TEXT)

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 8 – Topic 7: Drugs
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_07(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 7, "Drugs & Medications in Breastfeeding",
                 "Pharmacokinetics of transfer • RID >10% threshold • Safe vs. contraindicated")

    # PK factors box
    add_rect(slide, Inches(0.3), Inches(1.35), Inches(4.2), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.3), Inches(1.35), Inches(4.2), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.35), Inches(1.35), Inches(4.1), Inches(0.35),
                "PK FACTORS GOVERNING TRANSFER", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    pk = [
        "Mol. weight: <200 Da free transfer; >500 Da poor transfer",
        "Protein binding: highly bound = less transfer",
        "Lipid solubility: lipophilic drugs concentrate in hindmilk",
        "pKa / ion-trapping: basic drugs accumulate (milk pH 7.0 < plasma 7.4)",
        "RID (Relative Infant Dose): ≥10% = threshold of concern",
        "Oral bioavailability in infant",
        "Infant age: neonates <2 months highest risk; >6 months low risk",
        "Preterm infants: immature hepatic/renal clearance → higher risk",
        "Milk volume: ~150 mL/kg/day (EBF)",
        "Reference: Hale's Medications & Mothers' Milk 22nd Ed (2026)",
    ]
    add_bullet_block(slide, Inches(0.4), Inches(1.75), Inches(4.0), Inches(5.1),
                     pk, font_size=Pt(11))

    # Contraindicated
    add_rect(slide, Inches(4.7), Inches(1.35), Inches(4.0), Inches(2.75), WHITE,
             line_color=RED_WARN, line_width=Pt(0.8))
    add_rect(slide, Inches(4.7), Inches(1.35), Inches(4.0), Inches(0.35), RED_WARN)
    add_textbox(slide, Inches(4.75), Inches(1.35), Inches(3.9), Inches(0.35),
                "CONTRAINDICATED", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    ci_drugs = [
        "Chemotherapy (cyclophosphamide, MTX, doxorubicin)",
        "Radioactive compounds",
        "Ergotamines | Statins",
        "Amphetamines, cocaine, PCP",
        "Amiodarone (long t½, iodine-containing)",
        "Oral retinoids | Gold salts",
        "Lithium (only with rigorous monitoring)",
    ]
    add_bullet_block(slide, Inches(4.8), Inches(1.75), Inches(3.8), Inches(2.3),
                     ci_drugs, font_size=Pt(11))

    # Safe drugs
    add_rect(slide, Inches(4.7), Inches(4.25), Inches(4.0), Inches(2.7), WHITE,
             line_color=GREEN_OK, line_width=Pt(0.8))
    add_rect(slide, Inches(4.7), Inches(4.25), Inches(4.0), Inches(0.35), GREEN_OK)
    add_textbox(slide, Inches(4.75), Inches(4.25), Inches(3.9), Inches(0.35),
                "GENERALLY SAFE", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    safe_drugs = [
        "Penicillins, cephalosporins, macrolides",
        "Aminoglycosides (poor oral absorption in infant)",
        "Paracetamol/acetaminophen",
        "Ibuprofen (preferred NSAID; avoid aspirin – Reye's risk)",
        "Insulin, levothyroxine (destroyed in GI)",
        "LMWH, warfarin (large/protein-bound)",
        "Sertraline, paroxetine (low RID SSRIs)",
        "Methadone/buprenorphine (ENCOURAGE BF with stable therapy)",
    ]
    add_bullet_block(slide, Inches(4.8), Inches(4.65), Inches(3.8), Inches(2.2),
                     safe_drugs, font_size=Pt(11))

    # Right col
    add_rect(slide, Inches(8.9), Inches(1.35), Inches(4.1), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(8.9), Inches(1.35), Inches(4.1), Inches(0.35), NAVY)
    add_textbox(slide, Inches(8.95), Inches(1.35), Inches(4.0), Inches(0.35),
                "SPECIAL DRUG NOTES", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    spec = [
        "Fluoxetine: longer half-life → use sertraline/paroxetine instead",
        "Metronidazole: single dose – some advise 12–24 h pump-and-discard",
        "Carbimazole/PTU: low doses safe; PTU preferred for hyperthyroidism",
        "Antiepileptics: most safe; lamotrigine monitor infant levels",
        "Codeine: AVOID – risk of neonatal opioid toxicity (CYP2D6 ultra-metabolisers)",
        "Domperidone as galactagogue: QTc prolongation risk; avoid with CYP3A4 inhibitors",
        "Antibiotics in nursing: watch for GI effects in infant (diarrhoea, thrush)",
        "LactMed (NIH database) + Hale's = standard references",
        "RID >10%: lithium, iodine, amiodarone – re-evaluate BF",
    ]
    add_bullet_block(slide, Inches(9.0), Inches(1.75), Inches(3.9), Inches(5.1),
                     spec, font_size=Pt(11))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 9 – Topic 8: Technique & Support
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_08(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 8, "Breastfeeding Technique & Support",
                 "Latch, positions, LATCH score, adequacy indicators")

    add_rect(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.35), Inches(1.35), Inches(6.0), Inches(0.35),
                "LATCH SCORING TOOL  (0–10 total)", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    latch = [
        "L – Latch: 0=unable | 1=with assistance | 2=independent",
        "A – Audible swallowing: 0=none | 1=occasional | 2=spontaneous",
        "T – Type of nipple: 0=inverted | 1=flat | 2=everted",
        "C – Comfort (breast/nipple): 0=engorged/cracked | 1=filling/red | 2=soft/no tenderness",
        "H – Hold (positioning): 0=full assist | 1=minimal assist | 2=no assist",
        "Score 7–10: satisfactory latch | <7: needs intervention",
    ]
    add_bullet_block(slide, Inches(0.4), Inches(1.75), Inches(5.9), Inches(2.6),
                     latch, font_size=Pt(12))

    add_rect(slide, Inches(0.3), Inches(4.5), Inches(6.1), Inches(2.3), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.3), Inches(4.5), Inches(6.1), Inches(0.32), NAVY)
    add_textbox(slide, Inches(0.35), Inches(4.5), Inches(6.0), Inches(0.32),
                "SIGNS OF ADEQUATE FEEDING", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    adeq = [
        "6–8 wet nappies/day (after Day 5); pale yellow urine",
        "Regains birth weight by Day 10–14",
        "Weight gain: 20–30 g/day (0–3 months)",
        "8–12 feeds/24 hours in neonatal period",
        "Audible swallowing; slow steady jaw movements",
    ]
    add_bullet_block(slide, Inches(0.4), Inches(4.87), Inches(5.9), Inches(1.8),
                     adeq, font_size=Pt(12))

    # Right: Positions + correct latch signs
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(0.35), NAVY)
    add_textbox(slide, Inches(6.75), Inches(1.35), Inches(6.2), Inches(0.35),
                "POSITIONS & CORRECT LATCH SIGNS", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    pos = [
        "POSITIONS: Cradle | Cross-cradle | Football/clutch | Side-lying | Laid-back (biological nurturing)",
        "Correct latch – wide open mouth (>140°)",
        "Chin touching breast; nose free",
        "Lower lip flanged outward",
        "More areola visible above than below",
        "No pain; audible swallowing",
        "Slow steady jaw movement (not rapid suckling)",
        "FEEDING FREQUENCY: 8–12 times/24 h; demand (not scheduled)",
        "DURATION: Until breast drained; hindmilk obtained after adequate emptying",
        "Common error: timing feeds by clock → hindmilk deprivation",
        "Nipple confusion: avoid bottles/pacifiers for first 4–6 weeks; use cup/spoon/SNS",
    ]
    add_bullet_block(slide, Inches(6.8), Inches(1.75), Inches(6.1), Inches(5.1),
                     pos, font_size=Pt(12))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 10 – Topic 9: Common Problems
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_09(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 9, "Common Breastfeeding Problems & Management",
                 "Engorgement, mastitis, low supply, nipple issues")

    problems = [
        ("ENGORGEMENT", TEAL,
         ["Days 3–5 postpartum",
          "Treat: frequent feeding + warm compresses pre-feed, cold post-feed",
          "Avoid pumping excessively (worsens supply mismatch)",
          "Cabbage leaves: anecdotal, not evidence-based"]),
        ("NIPPLE PAIN / CRACKS", NAVY,
         ["Poor latch is #1 cause – correct first",
          "Apply hindmilk/colostrum to heal",
          "Nipple shields: last resort only; monitor adequacy",
          "Rule out thrush (burning pain, satellite lesions)",
          "Raynaud's of nipple: vasospasm → nifedipine for severe cases"]),
        ("MASTITIS", RED_WARN,
         ["Staphylococcus aureus most common",
          "CONTINUE breastfeeding (promotes resolution)",
          "Antibiotics: dicloxacillin/cloxacillin 10 days",
          "If abscess: surgical drainage + continue BF from other breast",
          "Recurrent mastitis: rule out ductal anomaly"]),
        ("LOW MILK SUPPLY", RGBColor(0x5D, 0x4E, 0x75),
         ["Perceived vs. real – assess latch and frequency first",
          "Galactagogues: domperidone (preferred), metoclopramide",
          "Primary causes: IGT, Sheehan's syndrome, breast surgery",
          "Mechanical: frequent feeding + pumping is first-line"]),
        ("BREAST MILK JAUNDICE vs BF JAUNDICE", RGBColor(0x2E, 0x6D, 0x4B),
         ["BF jaundice (starvation): Days 2–5; poor intake; treat by improving latch",
          "Breast milk jaundice: Day 7–14 onwards; β-glucuronidase in milk",
          "Interruption test: 48 h pause → 30–50% bilirubin drop confirms diagnosis",
          "Benign; no indication to stop BF long-term"]),
        ("OTHER PROBLEMS", RGBColor(0x5A, 0x62, 0x71),
         ["Nipple confusion: avoid bottles/pacifiers first 4–6 wks",
          "Lipase activity in EBM: rancid taste → scald at 72°C before storage",
          "Flat/inverted nipples: most resolve with correct latch technique",
          "Lactation failure (primary/secondary): rule out systemic causes"]),
    ]

    col_w = Inches(4.0)
    col_h = Inches(2.55)
    for i, (title, color, items) in enumerate(problems):
        col = i % 3
        row = i // 3
        x = Inches(0.25) + col * (col_w + Inches(0.27))
        y = Inches(1.35) + row * (col_h + Inches(0.15))
        add_rect(slide, x, y, col_w, col_h, WHITE,
                 line_color=color, line_width=Pt(1.0))
        add_rect(slide, x, y, col_w, Inches(0.33), color)
        add_textbox(slide, x+Inches(0.1), y, col_w-Inches(0.2), Inches(0.33),
                    title, font_size=Pt(10), bold=True, color=WHITE,
                    align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0), margin_t=Inches(0))
        add_bullet_block(slide, x+Inches(0.1), y+Inches(0.37), col_w-Inches(0.2), col_h-Inches(0.42),
                         items, font_size=Pt(10.5))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 11 – Topic 10: Special Clinical Situations
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_10(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 10, "Breastfeeding in Special Clinical Situations",
                 "Preterm/NICU • HIV • Maternal infections • Infant conditions")

    # Left column
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(6.2), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(6.2), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(0.35),
                "PRETERM & NICU", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    nicu = [
        "KMC (Kangaroo Mother Care): ↓mortality 40% in LBW; WHO 2023 – immediate KMC even for UNSTABLE infants",
        "Preterm milk (first ~4 wks): ↑ protein, Na, IgA, lactoferrin; ↓ lactose vs. term",
        "HMF (Human Milk Fortifier): required for VLBW (<1500 g)",
        "Donor Human Milk: for <32 wks or <1500 g; Holder pasteurisation (62.5°C × 30 min)",
        "Holder pasteurisation destroys HIV, CMV, bacteria but ↓ some bioactive factors",
        "NEC prevention: human milk (maternal/donor) is most effective single strategy",
        "Late preterm (34–36+6 wks): sleepy, poor suck; high BF failure risk; close monitoring",
        "Preterm BF guided by infant competence/stability – NOT gestational age alone",
    ]
    add_bullet_block(slide, Inches(0.35), Inches(1.75), Inches(6.0), Inches(3.2), nicu, font_size=Pt(11))

    add_rect(slide, Inches(0.25), Inches(5.1), Inches(6.2), Inches(1.85), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.25), Inches(5.1), Inches(6.2), Inches(0.32), NAVY)
    add_textbox(slide, Inches(0.3), Inches(5.1), Inches(6.1), Inches(0.32),
                "HIV & BREASTFEEDING", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    hiv = [
        "CDC (resource-rich): BF NOT recommended regardless of ART/viral load",
        "WHO (resource-limited): BF + ART recommended; EBF for 6 months reduces MTCT",
        "MTCT via milk: 5–20% without ART; <1–2% with ART + viral suppression",
        "Mixed feeding > exclusive BF for MTCT risk (gut mucosal damage)",
    ]
    add_bullet_block(slide, Inches(0.35), Inches(5.47), Inches(6.0), Inches(1.42), hiv, font_size=Pt(11))

    # Right column
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(0.35), NAVY)
    add_textbox(slide, Inches(6.75), Inches(1.35), Inches(6.2), Inches(0.35),
                "MATERNAL INFECTIONS & INFANT CONDITIONS", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    spec_sit = [
        "CMV: reactivates in milk; term infants – negligible risk; VLBW preterm – risk; Holder pasteurisation eliminates",
        "Hep B: NOT CI; HBIG + vaccine within 12 h; BF begins immediately after immunoprophylaxis",
        "Hep C: NOT CI (unless cracked/bleeding nipples)",
        "TB: active – isolate mother; expressed milk can be given; after 2 wks treatment, direct BF safe",
        "COVID-19: BF encouraged; SARS-CoV-2 not in milk; protective Ab in milk; wear mask during feed",
        "Cleft lip/palate: Haberman feeder; supplemental nursing systems; cleft palate = BF difficult",
        "Down syndrome: hypotonia challenges; BF beneficial; intensive support needed",
        "CHD: ↑caloric need; may need high-cal supplement; BF reduces stress of feeding when possible",
        "Diabetes (maternal): ↓insulin requirement while BF; watch for hypoglycaemia",
        "Breast surgery: augmentation – usually safe; reduction – may impair milk ducts significantly",
        "IGT (Insufficient Glandular Tissue): primary lactation failure; partial BF possible",
        "Postpartum depression: BF protective; sertraline first-choice SSRI",
    ]
    add_bullet_block(slide, Inches(6.8), Inches(1.75), Inches(6.1), Inches(5.1), spec_sit, font_size=Pt(11))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 12 – Topic 11: Neonatal Metabolism
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_11(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 11, "Breastfeeding & Neonatal Metabolism",
                 "Hypoglycaemia, jaundice, weight loss, vitamins, iron supplementation")

    # Left col
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(6.2), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(6.2), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(0.35),
                "NEONATAL HYPOGLYCAEMIA & WEIGHT", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    hypo = [
        "At-risk groups: LGA, SGA, preterm, IDM",
        "First-line: skin-to-skin + frequent BF",
        "Buccal dextrose gel: 40% dextrose, 0.5 mL/kg → before formula supplementation",
        "Normal weight loss: up to 7–10% of birth weight (>10% = evaluate)",
        "Regain birth weight by Day 10–14",
        "Weight gain: 20–30 g/day (0–3 m) | 15–20 g/day (3–6 m) | 10–15 g/day (6–12 m)",
        "Hypernatraemic dehydration: lethargy, fever, brick-red urine crystals; serum Na >145",
        "BF stools: yellow, seedy, loose (3–8/day early); by 6 wks may be every 7–10 days – NORMAL",
    ]
    add_bullet_block(slide, Inches(0.35), Inches(1.75), Inches(6.0), Inches(3.1), hypo, font_size=Pt(11.5))

    add_rect(slide, Inches(0.25), Inches(5.0), Inches(6.2), Inches(1.95), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.25), Inches(5.0), Inches(6.2), Inches(0.32), NAVY)
    add_textbox(slide, Inches(0.3), Inches(5.0), Inches(6.1), Inches(0.32),
                "JAUNDICE – BF vs. BREAST MILK (KEY DISTINCTION)", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    jaundice = [
        "BF JAUNDICE (starvation, Days 2–5): poor intake; treat by improving latch/frequency",
        "BREAST MILK JAUNDICE (Days 7–14+): β-glucuronidase + pregnanediol in milk",
        "Interruption test: 48 h pause → 30–50% bilirubin drop confirms; restart BF safe",
        "Benign; may persist up to 12 weeks; no indication to permanently stop BF",
    ]
    add_bullet_block(slide, Inches(0.35), Inches(5.37), Inches(6.0), Inches(1.5), jaundice, font_size=Pt(11))

    # Right col – vitamins, iron, VKDB
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(0.35), NAVY)
    add_textbox(slide, Inches(6.75), Inches(1.35), Inches(6.2), Inches(0.35),
                "SUPPLEMENTATION IN BREASTFED INFANTS", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    supp = [
        "VITAMIN D: 400 IU/day from Day 1 (AAP/IAP) – maternal Vit D does not adequately enrich milk",
        "VITAMIN K: IM at birth (prophylaxis); breast milk is LOW in Vit K",
        "Late VKDB (Haemorrhagic disease of newborn): BF-associated complication – life-threatening intracranial bleed",
        "IRON – Term EBF infants: iron-rich foods from 6 months; if not, supplement 1 mg/kg/day from 4 months (AAP)",
        "IRON – Preterm/LBW: 2–4 mg/kg/day from 2–4 weeks of life",
        "FLUORIDE: not before 6 months; supplement only if water <0.3 ppm",
        "WHO growth standards (2006): based on EBF infants as gold standard",
        "BF infants gain faster 0–3 months then SLOWER than formula-fed → normal, not inadequate",
        "Growth faltering: weight-for-age <-2SD or crossing ≥2 major centile lines",
    ]
    add_bullet_block(slide, Inches(6.8), Inches(1.75), Inches(6.1), Inches(5.1), supp, font_size=Pt(11.5))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 13 – Topic 12: Complementary Feeding / Extended BF
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_12(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 12, "Complementary Feeding, Weaning & Extended Breastfeeding",
                 "Timing • Readiness signs • WHO/AAP recommendations")

    add_rect(slide, Inches(0.25), Inches(1.35), Inches(6.2), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(6.2), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(0.35),
                "COMPLEMENTARY FEEDING", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    cf = [
        "Initiate at 6 months (WHO) – NOT before 4 months (risk of allergy, obesity, infection)",
        "SIGNS OF READINESS: head control, sits with support, loss of extrusion reflex, interest in food",
        "BF remains PRIMARY nutrition until 12 months; supplement thereafter",
        "AAP 2022: introduce allergenic foods (peanut, egg) early – reduces allergy risk",
        "IYCF: age-appropriate food consistency, frequency, amount",
        "Continued BF during illness: preferred (maintains hydration + immunity)",
        "Avoid honey before 1 year (botulism risk)",
        "Avoid cow's milk as main drink before 1 year",
        "Iron-rich first foods recommended: meat, lentils, fortified cereals",
    ]
    add_bullet_block(slide, Inches(0.35), Inches(1.75), Inches(6.0), Inches(5.1), cf, font_size=Pt(12))

    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(0.35), NAVY)
    add_textbox(slide, Inches(6.75), Inches(1.35), Inches(6.2), Inches(0.35),
                "EXTENDED BF & WEANING", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    wean = [
        "WHO: continue BF to 2 years or beyond; no defined upper age limit medically",
        "AAP 2022 (updated): at least 2 years of BF if mutually desired",
        "Previous AAP: until at least 1 year – note the CHANGE for quiz purposes",
        "Extended BF: non-nutritive benefits (comfort, immunity) predominate after 2 years",
        "Weaning – GRADUAL preferred over abrupt (avoids engorgement, mastitis)",
        "Child-led weaning: follows infant's developmental readiness",
        "Mother-led weaning: drop one feed at a time over weeks",
        "Abrupt weaning: risk of engorgement, mastitis, maternal mood changes",
        "Sage tea, pseudoephedrine used to suppress lactation (anecdotal/limited evidence)",
        "Cabergoline: effective pharmacological suppression of lactation if needed",
    ]
    add_bullet_block(slide, Inches(6.8), Inches(1.75), Inches(6.1), Inches(5.1), wean, font_size=Pt(12))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 14 – Topic 13: Infant Growth
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_13(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 13, "Breastfeeding & Infant Growth",
                 "WHO Growth Standards • Weight gain norms • Growth faltering")

    # Centre content with wide panels
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(12.8), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))

    # Sub headers and content
    # Row 1: WHO standards
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(12.8), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.3), Inches(1.35), Inches(12.7), Inches(0.35),
                "WHO GROWTH STANDARDS (2006) & NORMAL BF GROWTH PATTERN", font_size=Pt(12), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))

    who_items = [
        "WHO 2006 standards were developed specifically from healthy EBF infants in 6 countries (Brazil, Ghana, India, Norway, Oman, USA)",
        "BF infants gain weight FASTER in first 3 months, then SLOWER than formula-fed infants after 3 months",
        "This divergence is normal and is NOT an indication to supplement with formula",
        "Weight-for-age z-scores based on BF infants – formula-fed infants may falsely appear 'overweight' on these charts",
    ]
    add_bullet_block(slide, Inches(0.35), Inches(1.75), Inches(12.5), Inches(1.55), who_items, font_size=Pt(12))

    # Weight gain norms boxes
    gain_data = [
        ("0–3 months", "20–30 g/day"),
        ("3–6 months", "15–20 g/day"),
        ("6–12 months", "10–15 g/day"),
        ("Birth weight doubled", "~4–5 months"),
        ("Birth weight tripled", "~12 months"),
    ]
    box_w2 = Inches(2.4)
    for i, (period, gain) in enumerate(gain_data):
        x2 = Inches(0.35) + i * (box_w2 + Inches(0.13))
        add_rect(slide, x2, Inches(3.42), box_w2, Inches(0.95),
                 NAVY if i % 2 == 0 else TEAL)
        add_textbox(slide, x2, Inches(3.42), box_w2, Inches(0.42),
                    period, font_size=Pt(11), bold=True, color=WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0), margin_t=Inches(0))
        add_textbox(slide, x2, Inches(3.84), box_w2, Inches(0.53),
                    gain, font_size=Pt(14), bold=True, color=AMBER,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0), margin_t=Inches(0))

    # Growth faltering
    add_rect(slide, Inches(0.25), Inches(4.5), Inches(12.8), Inches(0.32), NAVY)
    add_textbox(slide, Inches(0.3), Inches(4.5), Inches(12.7), Inches(0.32),
                "GROWTH FALTERING DEFINITION & MANAGEMENT", font_size=Pt(12), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    gf = [
        "Weight for age <-2 SD (z-score) OR crossing ≥2 major centile lines downward",
        "Assessment: latch, frequency, foremilk/hindmilk balance, maternal milk supply, infant illness",
        "Primary BF problem: correct latch; ensure hindmilk delivery; consider galactagogue if supply confirmed low",
        "Organic causes to exclude: metabolic disorders, structural anomalies (cardiac, palate), neuromuscular conditions",
        "Supplementation: use donor human milk > formula if supplementation unavoidable in NICU settings",
    ]
    add_bullet_block(slide, Inches(0.35), Inches(4.87), Inches(12.5), Inches(2.0), gf, font_size=Pt(12))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 15 – Topic 14: Expressed Breast Milk
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_14(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 14, "Expressed Breast Milk (EBM) – Storage & Handling",
                 "Storage durations • Thawing • Human Milk Banks")

    # Storage table
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(12.8), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.3), Inches(1.35), Inches(12.7), Inches(0.35),
                "EBM STORAGE GUIDELINES", font_size=Pt(12), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))

    storage = [
        ("Room temperature", "25°C", "4 hours", TEAL),
        ("Refrigerator", "4°C", "4 days", NAVY),
        ("Freezer compartment (inside fridge)", "-15°C", "2 weeks", RGBColor(0x2E, 0x6D, 0x8A)),
        ("Deep freeze (separate door)", "-18 to -20°C", "6 months", RGBColor(0x1A, 0x4F, 0x7A)),
        ("Ultra-low deep freeze", "-80°C", "12 months", RGBColor(0x0F, 0x2D, 0x5A)),
    ]
    row_h = Inches(0.72)
    headers = ["LOCATION", "TEMPERATURE", "DURATION"]
    header_x = [Inches(0.25), Inches(4.8), Inches(9.0)]
    header_w = [Inches(4.5), Inches(4.15), Inches(3.85)]
    for j, (hdr, hx, hw) in enumerate(zip(headers, header_x, header_w)):
        add_rect(slide, hx, Inches(1.75), hw, Inches(0.35), NAVY)
        add_textbox(slide, hx, Inches(1.75), hw, Inches(0.35),
                    hdr, font_size=Pt(11), bold=True, color=WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0), margin_t=Inches(0))

    for ri, (loc, temp, dur, col) in enumerate(storage):
        ry = Inches(2.13) + ri * row_h
        bg = WHITE if ri % 2 == 0 else LIGHT_GREY
        add_rect(slide, Inches(0.25), ry, Inches(13.0), row_h, bg)
        add_textbox(slide, Inches(0.35), ry, Inches(4.35), row_h,
                    loc, font_size=Pt(12), bold=False, color=DARK_TEXT,
                    align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0.1), margin_t=Inches(0))
        add_rect(slide, Inches(4.8), ry+Inches(0.17), Inches(4.15), row_h-Inches(0.34), col)
        add_textbox(slide, Inches(4.8), ry, Inches(4.15), row_h,
                    temp, font_size=Pt(13), bold=True, color=WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0), margin_t=Inches(0))
        add_rect(slide, Inches(9.0), ry+Inches(0.17), Inches(3.85), row_h-Inches(0.34), col)
        add_textbox(slide, Inches(9.0), ry, Inches(3.85), row_h,
                    dur, font_size=Pt(14), bold=True, color=WHITE,
                    align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                    margin_l=Inches(0), margin_t=Inches(0))

    # Notes below
    add_rect(slide, Inches(0.25), Inches(5.7), Inches(12.8), Inches(1.25), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    notes = [
        "Thawing: refrigerator overnight OR warm water (NOT microwave – destroys enzymes, creates hot spots)",
        "Once thawed: use within 24 hours; do NOT refreeze",
        "Lipase activity: some infants reject EBM (rancid taste) → scald at 72°C before storage to inactivate",
        "Holder Pasteurisation (for Milk Banks): 62.5°C × 30 min; eliminates HIV, CMV, bacteria",
    ]
    add_bullet_block(slide, Inches(0.35), Inches(5.75), Inches(12.5), Inches(1.1),
                     notes, font_size=Pt(11.5))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 16 – Topic 15: Galactagogues
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_15(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 15, "Galactagogues",
                 "Pharmacological • Herbal • Evidence & Safety")

    # Pharmacological
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(6.2), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(6.2), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(0.35),
                "PHARMACOLOGICAL GALACTAGOGUES", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    pharm = [
        "DOMPERIDONE (preferred):",
        "  Dopamine antagonist → ↑ prolactin",
        "  Less CNS side effects than metoclopramide",
        "  CAUTION: QTc prolongation; cardiac arrhythmia risk",
        "  CONTRAINDICATED with CYP3A4 inhibitors (azoles, erythromycin)",
        "",
        "METOCLOPRAMIDE:",
        "  Also dopamine antagonist → ↑ prolactin",
        "  Crosses BBB → extrapyramidal reactions (tardive dyskinesia risk)",
        "  Second-line; short courses only",
        "",
        "OXYTOCIN (intranasal): no longer routinely recommended",
        "",
        "FIRST-LINE APPROACH: frequent feeding + pumping",
        "Evidence base for all galactagogues is weak to moderate",
    ]
    add_bullet_block(slide, Inches(0.35), Inches(1.75), Inches(6.0), Inches(5.1), pharm, font_size=Pt(12))

    # Herbal + principles
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(0.35), NAVY)
    add_textbox(slide, Inches(6.75), Inches(1.35), Inches(6.2), Inches(0.35),
                "HERBAL GALACTAGOGUES & PRINCIPLES", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    herbal = [
        "FENUGREEK: most studied herbal; phytoestrogens → ↑ prolactin; caution – lowers blood glucose (diabetics)",
        "SHATAVARI (Asparagus racemosus): widely used in India; phytoestrogenic; limited RCT data",
        "Blessed thistle, moringa: used traditionally; limited evidence",
        "",
        "KEY PRINCIPLES FOR GALACTAGOGUE USE:",
        "Rule out modifiable causes first: poor latch, infrequent feeds, stress, pain, retained placenta",
        "Correct the cause → often resolves without drugs",
        "Assess actual supply vs. perceived insufficient milk",
        "Cabergoline: for SUPPRESSION of lactation (not stimulation); very effective",
        "Bromocriptine (Parlodel): suppresses lactation – NOT a galactagogue; no longer used for suppression due to CVA risk",
        "",
        "PERCEIVED vs. REAL LOW SUPPLY:",
        "Most mothers have sufficient milk; perceived insufficiency is #1 reason for early cessation",
        "True primary lactation failure: IGT, Sheehan's syndrome, breast surgery",
    ]
    add_bullet_block(slide, Inches(6.8), Inches(1.75), Inches(6.1), Inches(5.1), herbal, font_size=Pt(11.5))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 17 – Topic 16: Legal, Ethical & Policy Frameworks
# ─────────────────────────────────────────────────────────────────────────────
def make_slide_16(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, LIGHT_GREY)
    slide_header(slide, 16, "Legal, Ethical & Policy Frameworks",
                 "WHO Code • ILO • India legislation • Rights")

    add_rect(slide, Inches(0.25), Inches(1.35), Inches(6.2), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(0.25), Inches(1.35), Inches(6.2), Inches(0.35), TEAL)
    add_textbox(slide, Inches(0.3), Inches(1.35), Inches(6.1), Inches(0.35),
                "INTERNATIONAL CODE & POLICY", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    intl = [
        "WHO International Code of Marketing of Breast-milk Substitutes (1981):",
        "  No advertising of formula to the public",
        "  No free samples in health facilities or to mothers",
        "  Labels must not idealise formula feeding",
        "  No promotion of bottles, teats, or dummies",
        "",
        "ILO Maternity Protection Convention:",
        "  Paid maternity leave entitlement",
        "  Paid breastfeeding breaks during work hours",
        "",
        "BFHI (Baby-Friendly Hospital Initiative): WHO + UNICEF; Ten Steps",
        "Sustainable Development Goals: SDG 2 (Zero Hunger) + SDG 3 linked to BF",
        "Global Nutrition Targets 2030: ≥70% EBF rate target (from current ~44%)",
    ]
    add_bullet_block(slide, Inches(0.35), Inches(1.75), Inches(6.0), Inches(5.1), intl, font_size=Pt(12))

    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(5.6), WHITE,
             line_color=RGBColor(0xCC,0xCC,0xCC), line_width=Pt(0.5))
    add_rect(slide, Inches(6.7), Inches(1.35), Inches(6.3), Inches(0.35), NAVY)
    add_textbox(slide, Inches(6.75), Inches(1.35), Inches(6.2), Inches(0.35),
                "INDIA-SPECIFIC LEGISLATION & QUIZ HIGH-YIELD FACTS", font_size=Pt(11), bold=True,
                color=WHITE, align=PP_ALIGN.LEFT, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0.1), margin_t=Inches(0))
    india = [
        "Maternity Benefit (Amendment) Act 2017: 26 weeks paid maternity leave (previously 12 weeks)",
        "Creche facilities mandatory for establishments with ≥50 employees",
        "IMS Act 1992 (India): restricts promotion of infant formula",
        "Right to breastfeed in public: legally protected in most countries",
        "",
        "HIGH-YIELD QUIZ DISTINCTIONS:",
        "AAP 2022 update: 2 years of BF (changed from 1 year) – know this!",
        "Galactosemia = ONLY absolute metabolic CI to BF",
        "HIV – two answers (WHO vs CDC) depending on resource setting",
        "KMC 2023 update: IMMEDIATE even for UNSTABLE infants",
        "Breast milk jaundice ≠ breastfeeding jaundice (key distinction)",
        "Buccal dextrose gel: 40% concentration, 0.5 mL/kg",
        "Holder pasteurisation: 62.5°C × 30 min",
        "RID >10% = threshold of concern (lithium, amiodarone, iodine)",
    ]
    add_bullet_block(slide, Inches(6.8), Inches(1.75), Inches(6.1), Inches(5.1), india, font_size=Pt(11.5))

    slide_footer(slide)

# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 18 – Summary / High-Yield Recap
# ─────────────────────────────────────────────────────────────────────────────
def make_summary_slide(prs):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, W, H, NAVY)
    add_rect(slide, 0, Inches(1.2), W, Inches(0.08), AMBER)
    add_rect(slide, 0, Inches(6.85), W, Inches(0.08), TEAL)

    add_textbox(slide, Inches(0.5), Inches(0.15), Inches(12.3), Inches(1.0),
                "HIGH-YIELD RECAP  –  18 Points Every MD/DM Must Know",
                font_size=Pt(26), bold=True, color=WHITE,
                align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0), margin_t=Inches(0))

    # Two columns
    left_points = [
        "1. Lactogenesis II trigger: progesterone withdrawal (not prolactin rise)",
        "2. Foremilk = high lactose; Hindmilk = high fat (don't time-limit feeds!)",
        "3. SIgA in colostrum: ~12 g/L (vs. 1 g/L in mature milk)",
        "4. AAP 2022: BF until ≥2 years (updated from 1 year)",
        "5. Early initiation within 1 hour: ↓ neonatal mortality 22%",
        "6. Galactosemia: ONLY absolute metabolic CI to breastfeeding",
        "7. HIV: CDC = no BF; WHO = BF + ART in resource-limited settings",
        "8. RID >10%: lithium, amiodarone, iodine – reassess breastfeeding",
        "9. Codeine: AVOID in BF mothers (CYP2D6 ultra-metaboliser risk)",
    ]
    right_points = [
        "10. Buccal dextrose gel: 40%, 0.5 mL/kg before formula supplementation",
        "11. KMC 2023 (WHO): immediate KMC even for unstable LBW infants",
        "12. Holder pasteurisation: 62.5°C × 30 min (destroys HIV, CMV)",
        "13. Breast milk jaundice (Day 7+) vs. BF jaundice (Day 2–5, starvation)",
        "14. Vitamin D: 400 IU/day from Day 1 for all EBF infants",
        "15. Late VKDB: BF-associated; life-threatening if Vit K prophylaxis missed",
        "16. WHO growth standards = based on EBF infants; slower gain 3–12 m is normal",
        "17. Domperidone: preferred galactagogue; risk QTc prolongation",
        "18. Entero-mammary axis: MALT → targeted maternal SIgA against shared pathogens",
    ]
    add_bullet_block(slide, Inches(0.4), Inches(1.4), Inches(6.2), Inches(5.35),
                     left_points, font_size=Pt(12), text_color=WHITE)
    add_bullet_block(slide, Inches(6.9), Inches(1.4), Inches(6.1), Inches(5.35),
                     right_points, font_size=Pt(12), text_color=WHITE)

    add_textbox(slide, Inches(0.5), Inches(6.85), Inches(12.3), Inches(0.55),
                "National Breastfeeding Day  |  MD/DM Paediatrics Quiz  |  August 2025  |  16 Topics • 18 High-Yield Facts",
                font_size=Pt(10), bold=False, color=RGBColor(0xAA,0xCC,0xEE),
                align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE,
                margin_l=Inches(0), margin_t=Inches(0))

# ─────────────────────────────────────────────────────────────────────────────
# BUILD ALL SLIDES
# ─────────────────────────────────────────────────────────────────────────────
make_title_slide(prs)
make_slide_01(prs)
make_slide_02(prs)
make_slide_03(prs)
make_slide_04(prs)
make_slide_05(prs)
make_slide_06(prs)
make_slide_07(prs)
make_slide_08(prs)
make_slide_09(prs)
make_slide_10(prs)
make_slide_11(prs)
make_slide_12(prs)
make_slide_13(prs)
make_slide_14(prs)
make_slide_15(prs)
make_slide_16(prs)
make_summary_slide(prs)

# ─────────────────────────────────────────────────────────────────────────────
# SAVE
# ─────────────────────────────────────────────────────────────────────────────
output_path = "/tmp/workspace/breastfeeding-quiz-pptx/Breastfeeding_MD_DM_Paediatrics_Quiz.pptx"
buf = BytesIO()
prs.save(buf)
with open(output_path, "wb") as f:
    f.write(buf.getvalue())

print(f"Saved: {output_path}")
print(f"Slides: {len(prs.slides)}")

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