~/

~/attachments/f9071c92-d4bf-4a4d-a442-9d0d1fd71d53

mkdir -p "/tmp/workspace/pdf-to-ppt/source" "/tmp/workspace/pdf-to-ppt/output" "/tmp/workspace/pdf-to-ppt/src" && python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/attachments/f9071c92-d4bf-4a4d-a442-9d0d1fd71d53/DocScanner 22-Sep-2026 04-29 PM.pdf' r=PdfReader(p) print('PAGES',len(r.pages)) for i,pg in enumerate(r.pages): t=pg.extract_text() or '' print('\n--- PAGE',i+1,'chars',len(t),'---\n',t[:3000]) PY

python - <<'PY' import fitz from PIL import Image, ImageDraw src='/tmp/workspace/attachments/f9071c92-d4bf-4a4d-a442-9d0d1fd71d53/DocScanner 22-Sep-2026 04-29 PM.pdf' doc=fitz.open(src) thumbs=[] for i,p in enumerate(doc): pix=p.get_pixmap(matrix=fitz.Matrix(1.2,1.2), alpha=False) fn=f'/tmp/workspace/pdf-to-ppt/source/page_{i+1:02d}.png' pix.save(fn) im=Image.open(fn).convert('RGB') im.thumbnail((220,310)) canvas=Image.new('RGB',(240,350),'white'); canvas.paste(im,((240-im.width)//2,25)); d=ImageDraw.Draw(canvas);d.text((10,5),f'Page {i+1}',fill='black') thumbs.append(canvas) for grp in range(0,len(thumbs),5): ims=thumbs[grp:grp+5] out=Image.new('RGB',(240*len(ims),350),'#dddddd') for j,im in enumerate(ims):out.paste(im,(j*240,0)) out.save(f'/tmp/workspace/pdf-to-ppt/source/contact_{grp//5+1}.jpg',quality=90) print('rendered',len(doc),'pages') PY

pip install --user PyMuPDF

python - <<'PY' import fitz from PIL import Image, ImageDraw src='/tmp/workspace/attachments/f9071c92-d4bf-4a4d-a442-9d0d1fd71d53/DocScanner 22-Sep-2026 04-29 PM.pdf' doc=fitz.open(src); thumbs=[] for i,p in enumerate(doc): pix=p.get_pixmap(matrix=fitz.Matrix(1.2,1.2), alpha=False) fn=f'/tmp/workspace/pdf-to-ppt/source/page_{i+1:02d}.png'; pix.save(fn) im=Image.open(fn).convert('RGB'); im.thumbnail((220,310)) canvas=Image.new('RGB',(240,350),'white'); canvas.paste(im,((240-im.width)//2,25)) ImageDraw.Draw(canvas).text((10,5),f'Page {i+1}',fill='black'); thumbs.append(canvas) for grp in range(0,len(thumbs),5): ims=thumbs[grp:grp+5]; out=Image.new('RGB',(240*len(ims),350),'#ddd') for j,im in enumerate(ims):out.paste(im,(j*240,0)) out.save(f'/tmp/workspace/pdf-to-ppt/source/contact_{grp//5+1}.jpg',quality=90) print('rendered',len(doc),'pages') PY

python - <<'PY' try: import pytesseract; print('pytesseract available'); print(pytesseract.get_tesseract_version()) except Exception as e: print('pytesseract',repr(e)) try: import easyocr; print('easyocr available') except Exception as e: print('easyocr',repr(e)) PY

pip install --user rapidocr_onnxruntime

pip install --user --no-deps rapidocr_onnxruntime && python - <<'PY' from rapidocr_onnxruntime import RapidOCR print('loaded') PY

pip install --user pyclipper && python - <<'PY' from rapidocr_onnxruntime import RapidOCR print('loaded') PY

python - <<'PY' from rapidocr_onnxruntime import RapidOCR import glob, os ocr=RapidOCR() files=sorted(glob.glob('/tmp/workspace/pdf-to-ppt/source/page_*.png')) out=[] for i,f in enumerate(files,1): r,_=ocr(f) lines=[] if r is None else [x[1] for x in r] out.append(f'\n\n===== PAGE {i} =====\n'+'\n'.join(lines)) print('page',i,'lines',len(lines)) open('/tmp/workspace/pdf-to-ppt/source/ocr.txt','w').write(''.join(out)) PY

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/pdf-to-ppt/source/ocr.txt') print(p.read_text()[7000:14000]) PY

tuberculosis treatment

WHO consolidated guidelines tuberculosis module 4 treatment drug resistant tuberculosis 2025

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python - <<'PY' from pptx import Presentation p=Presentation(); s=p.slides.add_slide(p.slide_layouts[6]); ns=s.notes_slide print(hasattr(ns,'notes_text_frame'), dir(ns)[:]) PY

python - <<'PY' from pathlib import Path from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE from pptx.enum.dml import MSO_THEME_COLOR out=Path('/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Revision_with_Notes.pptx') prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] NAVY=RGBColor(12,35,64); BLUE=RGBColor(28,94,145); TEAL=RGBColor(0,139,139); GOLD=RGBColor(227,168,50); PALE=RGBColor(239,246,250); DARK=RGBColor(32,41,52); WHITE=RGBColor(255,255,255); RED=RGBColor(170,54,54); GREY=RGBColor(96,110,124) def rect(slide,x,y,w,h,fill,line=None,radius=False): sh=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y),Inches(w),Inches(h)) sh.fill.solid(); sh.fill.fore_color.rgb=fill sh.line.color.rgb=line or fill return sh def textbox(slide,x,y,w,h,text,size=20,color=DARK,bold=False,align=PP_ALIGN.LEFT, valign=MSO_ANCHOR.TOP): tb=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame; tf.clear(); tf.word_wrap=True tf.margin_left=Inches(.08);tf.margin_right=Inches(.08);tf.margin_top=Inches(.04);tf.margin_bottom=Inches(.04);tf.vertical_anchor=valign for i,line in enumerate(text.split('\n')): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=line;p.alignment=align;p.space_after=Pt(4) for r in p.runs: r.font.name='Aptos';r.font.size=Pt(size);r.font.bold=bold;r.font.color.rgb=color return tb def add_notes(slide, notes): tf=slide.notes_slide.notes_text_frame; tf.text=notes def base(title,section,number): s=prs.slides.add_slide(blank); rect(s,0,0,13.333,.34,NAVY); rect(s,0,.34,13.333,.10,TEAL) textbox(s,.62,.68,11.9,.52,title,28,NAVY,True) textbox(s,.64,7.12,9,.20,section.upper(),9,GREY,True) textbox(s,12.3,7.05,.45,.24,f'{number:02}',10,TEAL,True,PP_ALIGN.RIGHT) return s def bullets(slide,items,x=.8,y=1.55,w=5.75,h=4.95,size=19): text='\n'.join('• '+i for i in items); return textbox(slide,x,y,w,h,text,size,DARK) def cards(slide,data,y=1.65,cols=3): gap=.24; total=11.75; cw=(total-gap*(cols-1))/cols for i,(head,body,accent) in enumerate(data): x=.78+i*(cw+gap); rect(slide,x,y,cw,4.55,WHITE,RGBColor(205,220,230),True); rect(slide,x,y,cw,.62,accent,accent,True) textbox(slide,x+.16,y+.11,cw-.32,.36,head,16,WHITE,True) textbox(slide,x+.18,y+.86,cw-.36,3.45,body,15,DARK) def flow(slide,items): x=.75; y=2.35; w=2.25; gap=.36 for i,(head,body,color) in enumerate(items): rect(slide,x+i*(w+gap),y,w,2.35,WHITE,RGBColor(195,215,226),True); rect(slide,x+i*(w+gap),y,w,.55,color,color,True) textbox(slide,x+i*(w+gap)+.12,y+.09,w-.24,.30,head,15,WHITE,True,PP_ALIGN.CENTER) textbox(slide,x+i*(w+gap)+.13,y+.75,w-.26,1.4,body,14,DARK,False,PP_ALIGN.CENTER,MSO_ANCHOR.MIDDLE) if i<len(items)-1: textbox(slide,x+i*(w+gap)+w+.05,y+.92,.26,.45,'→',24,TEAL,True,PP_ALIGN.CENTER) # 1 s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY);rect(s,0,0,13.333,.18,TEAL);rect(s,8.9,0,4.433,7.5,BLUE) textbox(s,.8,1.2,7.65,1.5,'MANAGEMENT OF\nTUBERCULOSIS',34,WHITE,True) textbox(s,.84,3.05,6.8,.6,'Academic + rapid-revision deck',21,RGBColor(204,227,239)) textbox(s,.84,4.0,6.75,1.4,'Based on the supplied 15-page class notes.\nIncludes high-yield speaker notes for each slide.',17,WHITE) textbox(s,9.45,1.25,3.2,1.15,'TB\nREVISION',33,WHITE,True,PP_ALIGN.CENTER) textbox(s,9.5,3.05,3.1,1.8,'Definitions\nRegimens\nLTBI\nSpecial situations',18,WHITE,False,PP_ALIGN.CENTER) textbox(s,.84,6.7,10.6,.25,'Educational material only: follow current national and WHO guidance for clinical decisions.',10,RGBColor(204,227,239)) add_notes(s,'High-yield orientation\nThis deck summarizes the supplied class notes, which cite PMDT 2021 and older WHO concepts. Drug-resistant TB regimens and definitions change frequently. Use this for exam revision, but verify local programme guidance before patient care.\n\nExam approach: first classify TB as drug-susceptible, isoniazid-resistant, rifampicin-resistant, or MDR/RR-TB. Then use DST, disease severity, prior drug exposure, age, pregnancy and comorbidities to select a regimen.') #2 s=base('The classification framework', 'Foundations',2) cards(s,[('Hr-TB','Isoniazid-resistant, rifampicin-susceptible TB. May be isoniazid mono- or poly-resistant.',BLUE),('MDR/RR-TB','MDR-TB = resistance to both isoniazid and rifampicin. RR-TB means rifampicin resistance, with or without other resistance.',TEAL),('pre-XDR / XDR','Modern definitions are regimen- and fluoroquinolone-focused. Always state the definition and guideline year used.',GOLD)]) textbox(s,.85,6.42,11.5,.36,'Exam anchor: MDR-TB is a subset of MDR/RR-TB; every MDR-TB has rifampicin resistance.',16,RED,True) add_notes(s,'High-yield explanation\nDo not confuse Hr-TB with MDR-TB. Hr-TB retains rifampicin susceptibility. MDR-TB requires resistance to both H and R. RR-TB is managed as drug-resistant TB until a full resistance profile is available.\n\nDefinitions have changed. The supplied notes define pre-XDR as MDR/RR-TB plus fluoroquinolone resistance and XDR as MDR/RR-TB plus fluoroquinolone resistance plus resistance to bedaquiline or linezolid. Because definitions and programme terminology are updated, quote the source year in written answers.\n\nMnemonic: H + R resistance = MDR.') #3 s=base('Treatment outcomes: know the wording', 'Programme concepts',3) cards(s,[('Cured','Completed recommended treatment with bacteriological evidence of response and no evidence of treatment failure.',TEAL),('Treatment completed','Completed recommended treatment but does not meet criteria for cure or treatment failure.',BLUE),('Treatment success','Cured + treatment completed.\n\nLoss to follow-up: did not start, or interruption for the specified programme-defined interval.',GOLD)]) textbox(s,.9,6.43,11.55,.36,'Treatment failure: regimen must be stopped or permanently changed because of poor response, ADRs, or additional resistance.',16,RED,True) add_notes(s,'High-yield explanation\nThe common exam trap is equating “treatment completed” with “cured.” Cure requires bacteriological evidence of response. Treatment success is the sum of cured and treatment completed.\n\nA failed regimen is not simply one with a positive symptom. It reflects the need to terminate or permanently change therapy, typically because of absent clinical or bacteriological response, serious toxicity, or additional resistance.\n\nLocal programme definitions specify the exact bacteriological and time criteria, so use those in clinical documentation.') #4 s=base('Second-line anti-TB medicines: exam grouping', 'Drug-resistant TB',4) cards(s,[('Group A','Levofloxacin or moxifloxacin\nBedaquiline\nLinezolid\n\nCore agents when an effective regimen can be built.',TEAL),('Group B','Clofazimine\nCycloserine / terizidone\n\nAdded to strengthen an all-oral regimen.',BLUE),('Group C','Examples in the notes: delamanid, amikacin, pyrazinamide, ethionamide, PAS, ethambutol, imipenem/meropenem.',GOLD)]) textbox(s,.85,6.4,11.6,.4,'Safety anchors: fluoroquinolones and bedaquiline can prolong QT; linezolid can cause myelosuppression and neuropathy.',16,RED,True) add_notes(s,'High-yield explanation\nThe supplied notes use the familiar A-B-C classification. In exam answers, list Group A first: fluoroquinolone, bedaquiline, linezolid. Bedaquiline and delamanid need attention to QT prolongation. Linezolid needs CBC and neuropathy monitoring.\n\nDo not memorise a drug list without the principle: construct a regimen from drugs likely to be effective, prioritising potent oral drugs and guided by DST, previous exposure, contraindications and tolerability.\n\nInjectables are no longer routine core drugs in most modern all-oral DR-TB approaches.') #5 s=base('Isoniazid mono/poly-resistant TB', 'Regimens',5) flow(s,[('Confirm pattern','Confirm H resistance and R susceptibility. Assess FQ and pyrazinamide susceptibility where indicated.',BLUE),('Core regimen','Supplied notes: levofloxacin + rifampicin + ethambutol + pyrazinamide (LfxREZ), usually 6 months.',TEAL),('Extend selectively','Notes allow extension to 9 months in extensive disease, uncontrolled comorbidity, EPTB or positive smear at month 4.',GOLD),('Escalate if R-resistant','If rifampicin resistance is detected, shift to the appropriate MDR/RR-TB pathway.',RED)]) textbox(s,.83,5.55,11.65,.55,'Source-note cautions: bedaquiline and delamanid are not recommended for H mono/poly-resistant TB in the supplied notes.',15,DARK,False,PP_ALIGN.CENTER) add_notes(s,'High-yield explanation\nThe key distinction is that rifampicin remains active in H mono/poly-resistant TB. The source notes use LfxREZ for 6 months, with selected extension to 9 months. If levofloxacin cannot be used, the notes advise considering moxifloxacin after appropriate molecular testing.\n\nDo not carry an Hr-TB regimen forward if rifampicin resistance appears. That converts the management problem to MDR/RR-TB.\n\nFor exams, mention DST and exclusion of rifampicin resistance before stating the regimen. Regimen durations and substitutions must follow current programme guidance.') #6 s=base('MDR/RR-TB: decision pathway', 'Drug-resistant TB',6) flow(s,[('Rifampicin resistance detected','Treat as DR-TB; obtain rapid molecular and phenotypic DST as available.',RED),('Map resistance','Assess isoniazid, fluoroquinolone and other relevant drug susceptibility plus prior exposure.',BLUE),('Check eligibility','Pregnancy, age, disease extent, EPTB/CNS disease, prior second-line exposure and safety factors matter.',GOLD),('Choose all-oral pathway','Use a shorter or longer oral bedaquiline-based regimen only when programme eligibility is met.',TEAL)]) textbox(s,.9,5.55,11.5,.55,'Never choose a DR-TB regimen from one result alone: DST, history, severity and safety monitoring determine the final plan.',16,NAVY,True,PP_ALIGN.CENTER) add_notes(s,'High-yield explanation\nRifampicin resistance is a management emergency, not a final full resistance profile. Begin the DR-TB work-up and use rapid DST to characterize fluoroquinolone resistance and other resistance.\n\nThe source notes divide patients into shorter oral bedaquiline-based and longer oral bedaquiline-based regimens. Eligibility excludes several high-risk groups, such as extensive disease, severe EPTB, pregnancy and substantial previous exposure to component drugs.\n\nCurrent WHO and national algorithms may offer additional regimens. Do not reproduce an older regimen in patient care without checking current programme instructions.') #7 s=base('Shorter oral MDR/RR-TB regimen: eligibility', 'Drug-resistant TB',7) bullets(s,['Rifampicin resistance detected or inferred.', 'No fluoroquinolone resistance detected.', 'No significant prior exposure to key second-line drugs in the regimen unless susceptibility is confirmed.', 'No extensive pulmonary disease: bilateral cavitation or extensive parenchymal damage in adults is an exclusion in the supplied notes.', 'No severe EPTB such as TB meningitis/CNS TB, spinal TB or miliary TB.', 'PLHIV may be eligible if severe pulmonary or extrapulmonary disease is absent.'],.8,1.55,6.35,4.95,18) rect(s,7.55,1.58,4.9,4.7,PALE,RGBColor(195,215,226),True) textbox(s,7.82,1.92,4.4,.5,'Why “eligibility” matters',21,NAVY,True,PP_ALIGN.CENTER) textbox(s,7.9,2.75,4.2,2.7,'A shorter regimen is not simply a convenience choice. It relies on a predictable susceptibility pattern and a disease form in which the regimen is expected to be adequate.',18,DARK,False,PP_ALIGN.CENTER,MSO_ANCHOR.MIDDLE) add_notes(s,'High-yield explanation\nThis is a high-yield list question. The source notes require FQ susceptibility, limited prior exposure to key drugs, and absence of extensive or severe extrapulmonary disease.\n\nRemember two molecular resistance patterns mentioned in the notes: inhA mutation is associated with ethionamide cross-resistance, while katG mutation confers higher-level isoniazid resistance and may preserve ethionamide susceptibility. This can influence regimen interpretation.\n\nAvoid listing a short regimen without documenting that FQ resistance has been excluded.') #8 s=base('Latent TB infection: who should be tested?', 'Prevention',8) cards(s,[('Recent exposure','Close or casual contacts of untreated active pulmonary TB and people with occupational or congregate-setting exposure.',BLUE),('High reactivation risk','HIV, anti-TNF treatment, certain malignancies, dialysis, silicosis, old fibronodular radiographic changes.',TEAL),('Moderate risk','Diabetes mellitus and prolonged systemic glucocorticoids are among the risks listed in the source notes.',GOLD)]) textbox(s,.85,6.38,11.6,.45,'Definition: immune evidence of M. tuberculosis infection in the absence of symptoms or signs of active TB disease.',16,NAVY,True,PP_ALIGN.CENTER) add_notes(s,'High-yield explanation\nLTBI is not “inactive active TB.” It is evidence of immune sensitization without clinical disease. Exclude active TB before preventive therapy.\n\nThe exam logic is risk based: test people with a high probability of infection after exposure or high risk of progression/reactivation if infected. Anti-TNF therapy is a classic trigger for LTBI screening.\n\nA positive test does not prove active disease. It only supports TB infection in the appropriate clinical context.') #9 s=base('TST versus IGRA', 'Diagnosis of LTBI',9) cards(s,[('TST','Uses PPD, usually RT23. High sensitivity, lower specificity in BCG-vaccinated people and in nontuberculous mycobacterial infection.',BLUE),('IGRA','Uses antigens such as ESAT-6 and CFP-10. Generally more specific in BCG-vaccinated populations.',TEAL),('False results','False negatives: recent infection, severe/disseminated TB, immunosuppression, infancy, technical error.\nFalse positives vary by test and mycobacteria.',GOLD)]) textbox(s,.85,6.38,11.65,.42,'Neither TST nor IGRA distinguishes latent infection from active TB. Clinical assessment and active-TB evaluation remain essential.',16,RED,True,PP_ALIGN.CENTER) add_notes(s,'High-yield explanation\nIGRA is often preferred when BCG vaccination may lower TST specificity, but both tests detect immunologic sensitization and neither confirms active disease.\n\nFor TST, interpret the induration threshold in relation to risk, not in isolation. The supplied notes list 5 mm for high-risk patients such as HIV, recent contacts and immunosuppressed patients; 10 mm for several risk groups; and 15 mm for those without risk factors.\n\nA negative test does not exclude TB in severe illness or immunosuppression because anergy can occur.') #10 s=base('TB preventive treatment: high-yield regimens', 'Prevention',10) # table rows=[('6H','Isoniazid daily','6 months'),('3HP','Isoniazid + rifapentine once weekly','3 months'),('4R','Rifampicin daily','4 months'),('3HR','Isoniazid + rifampicin daily','3 months'),('1HP','Isoniazid + rifapentine daily','1 month'),('9H / 36H','Isoniazid daily','9 / 36 months')] for j,(h,w) in enumerate([(.9,1.65),(2.0,5.6),(7.85,3.8)]): pass rect(s,.85,1.55,11.55,.55,NAVY,NAVY,True) for x,txt,w in [(1.05,'REGIMEN',1.5),(3.05,'DRUGS',5),(8.9,'DURATION',2.4)]:textbox(s,x,1.67,w,.22,txt,13,WHITE,True) for i,row in enumerate(rows): y=2.12+i*.60; fill=PALE if i%2==0 else WHITE; rect(s,.85,y,11.55,.56,fill,RGBColor(218,229,236));textbox(s,1.05,y+.13,1.5,.23,row[0],15,TEAL,True);textbox(s,3.05,y+.12,5.4,.25,row[1],15,DARK);textbox(s,8.9,y+.12,2.7,.25,row[2],15,DARK) textbox(s,.9,6.1,11.4,.6,'Regimen selection is patient- and programme-specific. Exclude active TB and review drug interactions, hepatotoxicity risk, pregnancy and HIV treatment interactions.',15,RED,True,PP_ALIGN.CENTER) add_notes(s,'High-yield explanation\nThe source notes list 6H, 3HP, 4R, 3HR, 1HP, 9H and 36H. Shorter rifamycin-based options are often preferred when appropriate because completion may be better, but eligibility and drug-drug interactions matter.\n\nBefore starting preventive treatment: exclude active TB, assess symptoms and investigations as indicated, consider HIV status and antiretroviral interactions, and counsel about adherence and toxicity.\n\nDoses and eligibility are not reproduced here because they vary by age, weight, country programme and co-medication.') #11 s=base('ATT in pregnancy: revision anchors', 'Special situations',11) cards(s,[('Avoid / restrict','Source notes: second-line injectables are contraindicated throughout pregnancy. Ethionamide is avoided early because of teratogenic concerns.',RED),('Regimen choice','The supplied notes exclude pregnant patients from the shorter oral MDR-TB regimen and use specialist-led longer-regimen decisions.',GOLD),('Monitoring','Obstetric follow-up, fetal assessment, toxicity surveillance, ECG/electrolytes/CBC as indicated; neonatal CBC/TSH considerations after relevant in-utero exposure.',TEAL)]) textbox(s,.86,6.37,11.55,.47,'Pregnancy + DR-TB requires multidisciplinary management with TB, obstetric and pediatric expertise. Check current local guidance.',16,NAVY,True,PP_ALIGN.CENTER) add_notes(s,'High-yield explanation\nPregnancy is an exam favourite because the answer must prioritise maternal control of TB while avoiding fetal toxicity. The source notes advise contraception counselling for women receiving DR-TB treatment, avoidance of injectables, and ethionamide avoidance in the first 32 weeks.\n\nThey also describe concerns about bedaquiline/delamanid during lactation and recommend specialist monitoring. Because safety evidence and policy evolve, this is not a self-management topic.\n\nState “multidisciplinary decision with obstetrics and TB specialist” in a case answer.') #12 s=base('Renal dysfunction and safety monitoring', 'Special situations',12) flow(s,[('Dose interval / adjustment','Source notes: pyrazinamide and ethambutol may be given every 48 h; levofloxacin needs adjustment; linezolid dose may need reduction with low clearance.',BLUE),('Baseline assessment','Renal function, CBC, LFTs, ECG when QT-prolonging agents are used, electrolytes and pregnancy testing when relevant.',TEAL),('Follow-up','Monitor symptoms, bacteriology, adherence, neuropathy, cytopenias, QTc and organ-specific toxicity.',GOLD),('Respond early','Investigate deterioration: resistance, poor absorption/adherence, drug interaction, paradoxical reaction or another diagnosis.',RED)]) textbox(s,.9,5.55,11.5,.58,'Dose changes must be calculated from current creatinine clearance and the active regimen. Do not use a generic “renal dose” across all TB drugs.',16,NAVY,True,PP_ALIGN.CENTER) add_notes(s,'High-yield explanation\nRenal impairment is not one adjustment for the whole regimen. In the supplied notes, pyrazinamide and ethambutol require extended interval dosing, levofloxacin needs adjustment, and linezolid dose reduction is mentioned with low creatinine clearance.\n\nThe safety-monitoring framework is more important than memorizing one list: drug-specific monitoring must match drug-specific toxicity. For example, linezolid: CBC and neuropathy; bedaquiline/fluoroquinolones: QTc and electrolytes; ethambutol: vision; aminoglycosides if used: renal and auditory toxicity.\n\nUse current programme dosing tables for any patient.') #13 s=base('One-minute recall', 'Rapid revision',13) qs=[('1','MDR-TB definition?','Resistance to H + R.'),('2','“Treatment success” equals?','Cured + treatment completed.'),('3','Does TST/IGRA diagnose active TB?','No. They indicate immune sensitization only.'),('4','Essential check before short DR-TB pathway?','DST, especially fluoroquinolone susceptibility, plus eligibility.'),('5','Pregnancy with DR-TB?','Specialist, multidisciplinary, guideline-led regimen selection.')] for i,(n,q,a) in enumerate(qs): x=.85+(i%2)*6.0;y=1.55+(i//2)*1.55 if i==4:x=3.85;y=4.65 rect(s,x,y,5.55,1.25,WHITE,RGBColor(195,215,226),True); rect(s,x,y,.65,1.25,TEAL,TEAL,True) textbox(s,x+.14,y+.37,.32,.4,n,18,WHITE,True,PP_ALIGN.CENTER);textbox(s,x+.85,y+.16,4.45,.32,q,15,NAVY,True);textbox(s,x+.85,y+.59,4.45,.42,a,14,DARK) textbox(s,.85,6.55,11.65,.32,'Source: uploaded class notes on Management of Tuberculosis. For clinical decisions, consult the latest national TB programme and WHO documents.',10,GREY,False,PP_ALIGN.CENTER) add_notes(s,'Use these as rapid oral-viva prompts.\n1. MDR means H and R resistance.\n2. Treatment success is cured plus treatment completed.\n3. TST and IGRA never distinguish latent from active TB by themselves.\n4. Shorter DR-TB treatment depends on DST and eligibility, not merely a positive rifampicin-resistance test.\n5. Pregnancy and renal dysfunction require specialist- and guideline-led individualisation.\n\nUpdate warning: current WHO and national TB programme guidance should supersede older class-note algorithms.') prs.save(out) print(out, out.stat().st_size) PY

python - <<'PY' from pptx import Presentation p='/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Revision_with_Notes.pptx' prs=Presentation(p) print('slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): txt=' | '.join(sh.text.replace('\n',' / ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()) note=s.notes_slide.notes_text_frame.text.strip() print(i, len(txt), 'notes',len(note), txt[:85]) assert note print('OK') PY

~/pdf-to-ppt/output

WHO tuberculosis treatment modules drug resistant tuberculosis latest guidance

python - <<'PY' from pathlib import Path from pptx import Presentation src=Path('/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Revision_with_Notes.pptx') out=Path('/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Revision_Viva_Notes.pptx') prs=Presentation(src) viva=[ '''VIVA OPENING\nIf asked to introduce the topic, say: “Tuberculosis management begins with confirming disease, assessing drug susceptibility, and selecting a patient-specific regimen with adherence and toxicity monitoring.”\n\nLikely examiner question: Why is this topic important?\nAnswer: Drug resistance, toxicity and variable disease severity mean that a one-size-fits-all approach is unsafe.\n\nTransition: I will first classify resistance, then discuss treatment pathways and prevention.''', '''VIVA QUESTION: Define Hr-TB, MDR-TB and RR-TB.\nModel answer: “Hr-TB is isoniazid-resistant but rifampicin-susceptible TB. MDR-TB is resistance to at least isoniazid and rifampicin. RR-TB is rifampicin-resistant TB, with or without resistance to other drugs.”\n\nFollow-up: Why is RR-TB important?\nAnswer: It is managed as DR-TB while the full DST profile is obtained.\n\nExam tip: Do not call isolated isoniazid resistance MDR-TB.''', '''VIVA QUESTION: Differentiate cure from treatment completion.\nModel answer: “Cure requires completing treatment with bacteriological evidence of response and no failure. Treatment completion means the regimen was completed but cure or failure criteria are not fulfilled.”\n\nFollow-up: Define treatment success.\nAnswer: “It is the sum of cured and treatment-completed outcomes.”\n\nTrap: Completion is not automatically cure.''', '''VIVA QUESTION: Name the Group A drugs for DR-TB.\nModel answer: “A fluoroquinolone such as levofloxacin or moxifloxacin, bedaquiline and linezolid.”\n\nFollow-up: Mention key toxicities.\nAnswer: “QT prolongation is relevant with bedaquiline and fluoroquinolones; linezolid can cause cytopenias and peripheral or optic neuropathy.”\n\nExam technique: State that drug selection is guided by DST, past exposure and tolerability.''', '''VIVA QUESTION: How would you manage isoniazid mono/poly-resistant TB?\nModel answer: “First confirm rifampicin susceptibility. The supplied notes use levofloxacin, rifampicin, ethambutol and pyrazinamide for 6 months, with selected extension in extensive or extrapulmonary disease.”\n\nFollow-up: What if rifampicin resistance is found?\nAnswer: “Shift to the MDR/RR-TB pathway.”\n\nSafety statement: Regimen selection and duration must follow current local TB programme guidance.''', '''VIVA QUESTION: A patient has rifampicin resistance on molecular testing. What is your next step?\nModel answer: “Treat this as DR-TB, promptly obtain a complete DST profile, especially fluoroquinolone susceptibility, review prior treatment exposure and assess disease severity and contraindications.”\n\nFollow-up: Can you choose a regimen from rifampicin resistance alone?\nAnswer: “No. DST, previous exposure, extent of disease, pregnancy, age and drug safety factors all determine eligibility.”''', '''VIVA QUESTION: Who is eligible for a shorter oral MDR/RR-TB regimen according to these notes?\nModel answer: “Patients should have rifampicin resistance, no detected fluoroquinolone resistance, no significant prior exposure to key regimen drugs without confirmed susceptibility, and no extensive pulmonary or severe extrapulmonary disease.”\n\nFollow-up: Why exclude CNS TB?\nAnswer: “It is severe extrapulmonary disease and needs an individualized, specialist-led approach.”\n\nTrap: Short regimen eligibility is not based only on a positive rifampicin-resistance test.''', '''VIVA QUESTION: Define latent TB infection and identify whom to screen.\nModel answer: “LTBI is immune evidence of M. tuberculosis infection without symptoms or signs of active disease. Screening targets contacts and people with high risk of progression, including HIV, anti-TNF therapy, dialysis and silicosis.”\n\nFollow-up: What must be excluded before preventive treatment?\nAnswer: “Active TB disease.”\n\nExam tip: A positive test alone does not prove active TB.''', '''VIVA QUESTION: Compare TST and IGRA.\nModel answer: “Both are immunologic tests for TB infection. TST uses PPD and may be less specific after BCG vaccination. IGRA uses antigens such as ESAT-6 and CFP-10 and is generally more specific in BCG-vaccinated populations.”\n\nFollow-up: Can either distinguish LTBI from active TB?\nAnswer: “No.”\n\nExtra point: A negative test can occur with immunosuppression or severe illness.''', '''VIVA QUESTION: List accepted preventive-treatment options in the supplied notes.\nModel answer: “6H, 3HP, 4R, 3HR, 1HP, and longer isoniazid regimens such as 9H or 36H.”\n\nFollow-up: What is your first step before starting one?\nAnswer: “Exclude active TB and review interactions, liver risk, pregnancy and HIV treatment.”\n\nDo not volunteer exact doses unless asked and you are using the current local table.''', '''VIVA QUESTION: How does pregnancy change DR-TB management?\nModel answer: “Management should be multidisciplinary. The supplied notes avoid second-line injectables throughout pregnancy and avoid ethionamide early in pregnancy. The shorter oral MDR-TB regimen is not used in pregnant patients in those notes.”\n\nFollow-up: What monitoring is important?\nAnswer: “Obstetric follow-up, fetal assessment and drug-specific safety monitoring, with pediatric planning for neonatal monitoring when relevant.”\n\nSafety phrase: Current national policy and specialist advice supersede older regimens.''', '''VIVA QUESTION: How will renal dysfunction alter ATT?\nModel answer: “I calculate creatinine clearance and adjust each drug individually. In the supplied notes, pyrazinamide and ethambutol may require 48-hourly dosing, levofloxacin requires adjustment, and linezolid may require reduction with low clearance.”\n\nFollow-up: Which monitoring will you perform?\nAnswer: “Renal function, CBC, ECG and electrolytes when QT-prolonging drugs are used, plus drug-specific monitoring.”\n\nTrap: Never apply one blanket renal dose to all ATT drugs.''', '''VIVA CLOSING\nIf asked for a summary, say: “Classify resistance correctly, obtain DST, choose the shortest effective guideline-supported regimen only when eligible, actively monitor toxicity and adherence, and individualize for pregnancy, renal dysfunction and severe extrapulmonary disease.”\n\nRapid-fire answers:\n• MDR-TB: H plus R resistance.\n• Treatment success: cure plus completion.\n• TST/IGRA: do not diagnose active TB.\n• Short DR-TB regimen: requires DST and eligibility.\n\nFinal safety point: Follow the latest WHO and national TB programme guidance.''' ] assert len(prs.slides)==len(viva) for slide,note in zip(prs.slides,viva): existing=slide.notes_slide.notes_text_frame.text.strip() slide.notes_slide.notes_text_frame.text = existing+'\n\n'+'='*48+'\nVIVA-STYLE PRESENTER NOTES\n'+'='*48+'\n'+note prs.save(out) print(out, out.stat().st_size) PY python - <<'PY' from pptx import Presentation p='/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Revision_Viva_Notes.pptx' prs=Presentation(p) print('slides:',len(prs.slides)) for i,s in enumerate(prs.slides,1): n=s.notes_slide.notes_text_frame.text assert 'VIVA-STYLE PRESENTER NOTES' in n print(i, 'notes chars',len(n)) print('verified') PY

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WHO consolidated guidelines tuberculosis module 4 treatment drug resistant tuberculosis 2022 update BPaLM official

python - <<'PY' from pathlib import Path from pptx import Presentation src=Path('/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Revision_with_Notes.pptx') out=Path('/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Detailed_Viva_Presenter_Notes.pptx') prs=Presentation(src) notes=[ '''DETAILED PRESENTER SCRIPT\nOpen with: “I will present a structured approach to tuberculosis management. The order is diagnosis and classification, drug-susceptibility testing, regimen selection, monitoring, and prevention.”\n\nViva framework: In every TB case, begin by deciding whether disease is active or latent, pulmonary or extrapulmonary, drug-susceptible or drug-resistant, and whether there are host factors such as HIV, pregnancy, renal dysfunction or previous treatment. Emphasize adherence support and public-health measures, including contact evaluation.\n\nIf asked why this matters: TB treatment is prolonged and multidrug based. Incorrect classification can expose the patient to ineffective drugs and amplify resistance.\n\nImportant qualifier: this deck reflects supplied class notes. For patient care, use the current national TB programme and WHO guidance because DR-TB definitions and regimens evolve.''', '''DETAILED VIVA EXPLANATION\nQuestion: Define the resistance categories.\nAnswer: “Hr-TB is isoniazid-resistant and rifampicin-susceptible TB. MDR-TB means resistance to at least isoniazid and rifampicin. RR-TB means rifampicin resistance with or without resistance to other anti-TB drugs.”\n\nExplain the significance: rifampicin resistance is a strong marker of a difficult resistance pattern and should trigger a DR-TB work-up and treatment pathway while complete DST is pursued.\n\nFollow-up: What is pre-XDR-TB? Answer using the definition adopted by the guideline or programme being examined. The supplied notes use MDR/RR-TB plus fluoroquinolone resistance. Definitions have been revised over time, so state the guideline year.\n\nCommon mistake: calling any H-resistant TB MDR-TB. It is MDR only if both H and R resistance are present.''', '''DETAILED VIVA EXPLANATION\nQuestion: Define treatment outcomes.\nAnswer: “Cure requires completion of recommended treatment with bacteriological evidence of response and no treatment failure. Treatment completion means treatment was completed but the patient does not meet criteria for cure or failure. Treatment success is cured plus treatment completed.”\n\nIf asked about failure: say, “Treatment failure indicates that the regimen must be stopped or permanently changed, usually because of absent clinical or bacteriological response, important adverse reactions, or additional drug resistance.”\n\nClinical reasoning: distinguish persistent symptoms from true programme-defined failure. Assess adherence, drug exposure, repeat microbiology, DST, alternative diagnoses and drug toxicity before concluding failure.\n\nExam trap: “Completed treatment” is not synonymous with “cured.”''', '''DETAILED VIVA EXPLANATION\nQuestion: Describe the A-B-C grouping of second-line medicines.\nAnswer: “The supplied notes place levofloxacin or moxifloxacin, bedaquiline and linezolid in Group A; clofazimine and cycloserine/terizidone in Group B; and other agents, including delamanid, pyrazinamide, ethionamide, PAS, ethambutol and carbapenems, among Group C options.”\n\nThen add the principle: “A regimen is built from drugs likely to be effective, guided by DST, previous exposure, contraindications and toxicity monitoring. Modern DR-TB care generally favors all-oral regimens.”\n\nSafety follow-up: bedaquiline and fluoroquinolones raise QT concerns; linezolid can cause anemia, thrombocytopenia and peripheral or optic neuropathy; cycloserine can cause neuropsychiatric toxicity.\n\nDo not promise a specific drug count without stating that local protocols determine the final regimen.''', '''DETAILED VIVA EXPLANATION\nQuestion: How will you manage isoniazid mono/poly-resistant TB?\nAnswer: “First, confirm rifampicin susceptibility and evaluate the relevant susceptibility profile. The supplied notes use levofloxacin, rifampicin, ethambutol and pyrazinamide, LfxREZ, generally for 6 months.”\n\nExtension described in the source notes: selected cases with extensive disease, uncontrolled comorbidity, extrapulmonary TB, or persistent smear positivity at four months may need longer treatment; CNS, skeletal and miliary disease are listed as situations where a longer duration may be used.\n\nIf levofloxacin cannot be used, do not improvise. Review molecular/phenotypic DST and consult a guideline-based alternative. If rifampicin resistance is identified, shift to an MDR/RR-TB pathway.\n\nExam pearl: InhA mutations can be associated with ethionamide cross-resistance, whereas katG-mediated isoniazid resistance may have different implications.''', '''DETAILED VIVA EXPLANATION\nQuestion: What will you do after detecting rifampicin resistance?\nAnswer: “I treat it as DR-TB, arrange rapid comprehensive DST, especially for fluoroquinolone resistance, review prior anti-TB exposure, determine extent and site of disease, and assess pregnancy, age, HIV status, comorbidities and baseline safety parameters.”\n\nExplain why: a molecular rifampicin-resistance result does not alone provide the complete regimen design. The final pathway depends on resistance pattern and eligibility.\n\nFollow-up: What baseline tests might you consider? Answer: microbiologic confirmation and DST, clinical severity assessment, CBC, renal and liver function, ECG and electrolytes when QT-prolonging drugs are planned, pregnancy assessment where relevant, and HIV testing/ART review according to programme policy.\n\nUpdate note: WHO 2022 guidance includes a 6-month BPaLM option for eligible MDR/RR-TB patients and a 9-month all-oral option when fluoroquinolone resistance is excluded. Local programme eligibility must be followed.''', '''DETAILED VIVA EXPLANATION\nQuestion: State eligibility for the shorter oral MDR/RR-TB regimen in these notes.\nAnswer: “There should be rifampicin resistance, no fluoroquinolone resistance detected, no important prior exposure to central second-line drugs unless susceptibility is confirmed, and no extensive pulmonary or severe extrapulmonary disease.”\n\nDefine extensive disease from the notes: bilateral cavitation or extensive parenchymal damage in adults; in children, cavitation or bilateral disease. Severe EPTB includes CNS/meningeal, spinal and miliary forms in the source material.\n\nWhy do these exclusions matter? They identify patients in whom a standardized short regimen may not provide sufficient confidence of efficacy or where penetration, severity and safety require individualized treatment.\n\nAnswer to the common follow-up “Can a person with HIV receive it?”: potentially, if severe PTB or EPTB is absent and all other eligibility criteria are met, following programme policy.''', '''DETAILED VIVA EXPLANATION\nQuestion: What is latent TB infection, and who should be screened?\nAnswer: “LTBI means immunologic evidence of infection with M. tuberculosis in a person without symptoms or signs of active TB disease.”\n\nScreening priorities from the notes: close contacts of untreated pulmonary TB, people with occupational or congregate-setting exposure, and those at high reactivation risk, including HIV, anti-TNF use, selected malignancies, dialysis, silicosis and old radiographic fibronodular changes. Diabetes and prolonged steroid use are also relevant risks.\n\nClinical sequence: first evaluate for active TB; then use an infection test; then offer preventive treatment to suitable candidates after considering interactions and toxicity.\n\nViva trap: do not say LTBI is diagnosed only by TST or only by IGRA. Both are options, and clinical exclusion of active disease is essential.''', '''DETAILED VIVA EXPLANATION\nQuestion: Compare TST and IGRA.\nAnswer: “TST uses intradermal PPD and is sensitive but less specific in BCG-vaccinated persons and in some nontuberculous mycobacterial exposures. IGRA measures response to TB-associated antigens such as ESAT-6 and CFP-10 and is generally more specific in BCG-vaccinated individuals.”\n\nImportant limitation: neither test can distinguish active TB from latent infection. A positive test means immune sensitization in the clinical context.\n\nTST interpretation: the supplied notes use lower thresholds for highest-risk groups, such as HIV, recent contacts and immunosuppression; intermediate thresholds for several other risk groups; and 15 mm for people without risk factors. State that exact thresholds should be applied according to local policy.\n\nFalse-negative causes include recent infection, severe/disseminated disease, immunosuppression, young age and technical issues. This is why a negative test cannot rule out active TB.''', '''DETAILED VIVA EXPLANATION\nQuestion: List preventive-treatment regimens in the notes.\nAnswer: “6H, 3HP, 4R, 3HR, 1HP, and longer isoniazid courses such as 9H and 36H.”\n\nExpand abbreviations if asked: H is isoniazid, R is rifampicin, and 3HP is weekly isoniazid plus rifapentine for three months in the source notes.\n\nBefore treatment: actively exclude TB disease, assess symptoms and investigations as clinically indicated, review hepatic risk, pregnancy, HIV status and antiretroviral interactions, and counsel about adherence and adverse effects.\n\nExam judgement: shorter rifamycin-containing regimens may improve completion in suitable patients, but regimen choice is not purely duration based. Drug interactions, age, weight and programme availability matter.''', '''DETAILED VIVA EXPLANATION\nQuestion: How does pregnancy change DR-TB management?\nAnswer: “It requires a multidisciplinary plan involving TB, obstetric and pediatric teams. The supplied notes contraindicate second-line injectables throughout pregnancy and avoid ethionamide in early pregnancy because of teratogenic concerns. They do not use the shorter oral MDR-TB regimen in pregnant patients.”\n\nMonitoring described in the source: regular antenatal review, fetal anomaly and growth assessment, and intensified drug-safety monitoring. CBC, thyroid assessment and neonatal evaluation may be relevant depending on maternal medicines, especially with linezolid or drugs associated with hypothyroidism.\n\nFollow-up: What is the goal? Answer: “Treat maternal disease effectively while minimizing fetal and neonatal toxicity. Untreated or poorly treated TB itself is hazardous.”\n\nAvoid memorizing a rigid pregnancy regimen from older notes. State that the latest programme policy and specialist consultation govern the choice.''', '''DETAILED VIVA EXPLANATION\nQuestion: How do you modify ATT in renal impairment?\nAnswer: “I calculate creatinine clearance, identify renally cleared drugs and make drug-specific interval or dose changes. The supplied notes state that pyrazinamide and ethambutol may be given every 48 hours, levofloxacin needs dose adjustment, and linezolid may require reduction with low creatinine clearance.”\n\nThen describe monitoring: serial renal function, CBC for linezolid, visual symptoms for ethambutol, ECG and electrolytes with QT-prolonging drugs, and neuropathy assessment where appropriate.\n\nClinical reasoning: distinguish chronic renal impairment from acute kidney injury and reassess doses as renal function changes. Concomitant nephrotoxins and dehydration may worsen toxicity.\n\nExam trap: do not apply the same renal adjustment to every anti-TB drug. Use current weight- and clearance-based programme tables.''', '''DETAILED VIVA CLOSING AND RAPID-FIRE PRACTICE\nSuggested summary: “Successful TB management is structured. Confirm the disease category, obtain DST, select an effective guideline-supported regimen, support adherence, monitor response and adverse effects, and individualize care for HIV, pregnancy, renal dysfunction and severe extrapulmonary disease.”\n\nRapid-fire questions with answers:\n1. MDR-TB? Resistance to isoniazid and rifampicin.\n2. Treatment success? Cure plus treatment completion.\n3. Can TST or IGRA diagnose active TB? No.\n4. First response to rifampicin resistance? DR-TB work-up and DST, especially fluoroquinolone susceptibility.\n5. Key risk before preventive therapy? Missing active TB.\n6. Key safety issue with bedaquiline? QT prolongation.\n\nFinish by stating that source algorithms are for revision; patient management requires current WHO and national TB programme guidance.''' ] assert len(notes)==len(prs.slides) for s,n in zip(prs.slides,notes): base=s.notes_slide.notes_text_frame.text.strip() s.notes_slide.notes_text_frame.text=base+'\n\n'+'='*60+'\nEXTENDED VIVA-STYLE PRESENTER NOTES\n'+'='*60+'\n'+n prs.save(out) print(out, out.stat().st_size) PY python - <<'PY' from pptx import Presentation p='/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Detailed_Viva_Presenter_Notes.pptx' prs=Presentation(p) assert len(prs.slides)==13 for i,s in enumerate(prs.slides,1): n=s.notes_slide.notes_text_frame.text assert 'EXTENDED VIVA-STYLE PRESENTER NOTES' in n and len(n)>1800 print(i,len(n)) print('All speaker notes verified.') PY

python - <<'PY' from pptx import Presentation p='/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Detailed_Viva_Presenter_Notes.pptx' prs=Presentation(p) print('slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): n=s.notes_slide.notes_text_frame.text print(i,len(n),'marker', 'EXTENDED VIVA-STYLE PRESENTER NOTES' in n) PY

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India National TB Elimination Programme 2025 drug sensitive TB treatment weight band dosage adults adverse drug reactions PDF

tuberculosis drug susceptibility testing

python - <<'PY' from pathlib import Path from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE src=Path('/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Detailed_Viva_Presenter_Notes.pptx') out=Path('/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Expanded_DST_Doses_ADRs_Special_Populations.pptx') prs=Presentation(src); blank=prs.slide_layouts[6] NAVY=RGBColor(12,35,64); TEAL=RGBColor(0,139,139); BLUE=RGBColor(28,94,145); GOLD=RGBColor(227,168,50); RED=RGBColor(170,54,54); DARK=RGBColor(32,41,52); WHITE=RGBColor(255,255,255); PALE=RGBColor(239,246,250); GREY=RGBColor(96,110,124) def rect(s,x,y,w,h,fill,line=None,round=False): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if round else MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h));sh.fill.solid();sh.fill.fore_color.rgb=fill;sh.line.color.rgb=line or fill;return sh def tb(s,x,y,w,h,text,size=18,color=DARK,bold=False,align=PP_ALIGN.LEFT): b=s.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h));f=b.text_frame;f.clear();f.word_wrap=True;f.margin_left=Inches(.07);f.margin_right=Inches(.07);f.margin_top=Inches(.03);f.margin_bottom=Inches(.03) for i,line in enumerate(text.split('\n')): p=f.paragraphs[0] if i==0 else f.add_paragraph();p.text=line;p.alignment=align;p.space_after=Pt(2) for r in p.runs:r.font.name='Aptos';r.font.size=Pt(size);r.font.bold=bold;r.font.color.rgb=color return b def base(title,section,num): s=prs.slides.add_slide(blank);rect(s,0,0,13.333,.34,NAVY);rect(s,0,.34,13.333,.1,TEAL);tb(s,.62,.68,11.9,.5,title,27,NAVY,True);tb(s,.64,7.12,9,.2,section.upper(),9,GREY,True);tb(s,12.3,7.05,.45,.24,str(num),10,TEAL,True,PP_ALIGN.RIGHT);return s def note(s,txt):s.notes_slide.notes_text_frame.text=txt def table(s, headers, rows, widths, y=1.45, font=13): x=.55; h=.48 for head,w in zip(headers,widths):rect(s,x,y,w,h,NAVY,NAVY,True);tb(s,x+.05,y+.11,w-.1,.22,head,font,WHITE,True,PP_ALIGN.CENTER);x+=w for i,row in enumerate(rows): x=.55; yy=y+h+i*.48; fill=PALE if i%2==0 else WHITE for val,w in zip(row,widths):rect(s,x,yy,w,.48,fill,RGBColor(210,225,234));tb(s,x+.05,yy+.07,w-.1,.34,val,font,DARK);x+=w #14 DST s=base('Drug-susceptibility testing (DST): what and why?', 'Diagnostics',14) for i,(h,b,c) in enumerate([('Purpose','Determines whether M. tuberculosis is susceptible or resistant to anti-TB drugs. It supports regimen selection and prevents ineffective therapy.',BLUE),('When','At diagnosis where available, especially in rifampicin resistance, prior TB treatment, contact with DR-TB, persistent positivity or clinical non-response.',TEAL),('How to use','Interpret with specimen quality, clinical context, prior drug exposure and programme algorithm. Do not delay urgent DR-TB action while completing the profile.',GOLD)]): x=.75+i*4.12;rect(s,x,1.55,3.8,3.8,WHITE,RGBColor(195,215,226),True);rect(s,x,1.55,3.8,.55,c,c,True);tb(s,x+.12,1.67,3.55,.25,h,16,WHITE,True,PP_ALIGN.CENTER);tb(s,x+.2,2.35,3.4,2.4,b,17,DARK,False,PP_ALIGN.CENTER) tb(s,.85,5.85,11.55,.55,'Key point: a molecular result may rapidly detect a resistance mutation; culture-based DST provides phenotypic susceptibility but takes longer.',16,RED,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: What is drug-susceptibility testing?\nModel answer: “DST assesses whether the patient’s M. tuberculosis isolate is susceptible or resistant to specific anti-TB medicines. It guides selection of an effective regimen, particularly in suspected or confirmed drug-resistant TB.”\n\nExplain the two broad approaches. Molecular DST detects resistance-associated genetic mutations and can provide rapid results, often within hours to days. Phenotypic DST tests whether the organism grows in the presence of a drug, but requires culture and therefore takes weeks. Molecular and phenotypic results complement each other.\n\nViva follow-up: Why not rely only on clinical response? Because poor response may arise from nonadherence, malabsorption, incorrect diagnosis, drug interactions or extensive disease. DST identifies resistance directly.\n\nTextbook support: Murray & Nadel states DST is clinically important and recommends it for initial M. tuberculosis isolates. Current programme protocols determine the exact testing sequence.') #15 algorithms s=base('DST methods and practical interpretation', 'Diagnostics',15) table(s,['METHOD','WHAT IT DETECTS','STRENGTH','LIMITATION'],[('Rapid molecular assay','M. tuberculosis DNA ± resistance mutations, commonly rifampicin; platforms vary.','Fast; supports early treatment decisions.','Only targets known mutations/drugs on its panel.'),('Line probe assay (LPA)','Specific resistance-associated mutations, including first-/second-line targets depending on assay.','Rapid resistance profiling.','Requires adequate specimen/DNA; mutation coverage is incomplete.'),('Culture + phenotypic DST','Growth of isolate in drug-containing system.','Broad phenotypic confirmation; can test additional drugs.','Slow; dependent on culture quality and laboratory capacity.'),('Sequencing','Resistance mutations across selected genes or genome.','Can clarify complex resistance patterns.','Expert interpretation and infrastructure required.')],[2.1,3.4,3.0,3.28],1.42,12) tb(s,.8,5.85,11.7,.7,'Interpretation rule: “resistant” means avoid relying on that drug. “No mutation detected” is not always proof of susceptibility: assay coverage and clinical context matter.',15,RED,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: Compare molecular and phenotypic DST.\nAnswer: “Molecular tests identify genetic mutations associated with resistance and are rapid. Phenotypic DST measures actual growth in the presence of drug and is slower because it depends on culture.”\n\nPractical sequence: obtain an appropriate respiratory or extrapulmonary specimen; confirm TB microbiologically; perform rapid molecular testing; send or arrange culture and further DST when indicated; then refine treatment when the complete profile returns.\n\nImportant caution: A negative molecular resistance marker does not guarantee susceptibility when the assay does not cover all resistance mechanisms. Conversely, a molecular resistance result must be interpreted in an approved programme algorithm.\n\nViva phrase: “I would not wait for a culture result to start the appropriate DR-TB pathway in a patient with confirmed rifampicin resistance, but I would use the expanded DST profile to optimize the regimen.”') #16 first line doses s=base('First-line drugs: usual adult daily doses', 'Dosage reference',16) table(s,['DRUG','USUAL DAILY DOSE','MAXIMUM','KEY REMARK'],[('Isoniazid (H)','5 mg/kg (range 4-6)','300 mg','Give pyridoxine in those at neuropathy risk; NTEP source notes 10 mg/day in DS-TB.'),('Rifampicin (R)','10 mg/kg (range 8-12)','600 mg','Major enzyme inducer; check antiretroviral and other interactions.'),('Pyrazinamide (Z)','25 mg/kg (range 20-30)','2,000 mg','Renal adjustment/interval change may be needed; monitor urate and liver toxicity.'),('Ethambutol (E)','15 mg/kg (range 12-18)','1,600 mg','Assess visual symptoms and color vision; adjust in renal dysfunction.'),('Streptomycin (S)','15 mg/kg (range 15-20)','Programme-specific','Reserved only for selected situations; renal and auditory toxicity.')],[2.1,2.6,1.25,5.83],1.42,12) tb(s,.72,5.75,11.9,.76,'Educational dosing reference only. Use current national weight-band tables, age-specific guidance, renal/hepatic adjustment and fixed-dose-combination policy for prescribing.',14,RED,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: State standard first-line adult daily doses.\nModel answer: “H 5 mg/kg to a maximum 300 mg; R 10 mg/kg to 600 mg; Z 25 mg/kg to 2 g; E 15 mg/kg to 1.6 g. Streptomycin, where used, is 15 mg/kg according to programme-specific guidance.”\n\nThese values are derived from NTEP material found in the supplied-source search and should be treated as an educational reference, not a prescription. Doses must be selected using the patient’s current weight band, formulation and local programme.\n\nViva follow-up: What is the usual DS-TB structure in the source notes? Two months HRZE followed by four months HRE, with longer continuation in selected CNS, skeletal or disseminated disease under programme advice.\n\nSafety: repeat weight measurement because FDC tablet count can need revision when weight changes significantly.') #17 DR dose s=base('Key DR-TB medicines: common adult doses', 'Dosage reference',17) table(s,['DRUG','COMMON ADULT DOSE','IMPORTANT LIMIT / NOTE','NOTABLE MONITORING'],[('Bedaquiline (Bdq)','400 mg daily for 2 weeks, then 200 mg three times weekly','NTEP 2025 regimen reference; regimen duration is protocol-specific.','ECG, QTc, electrolytes, liver tests.'),('Pretomanid (Pa)','200 mg daily','Used only in approved regimen and eligible patients.','Hepatic, GI and neuropathy assessment.'),('Linezolid (Lzd)','600 mg daily','Dose change/interruption may be needed with toxicity.','CBC, peripheral/optic neuropathy, lactic acidosis symptoms.'),('Moxifloxacin (Mfx)','400 mg daily','QT interaction review.','ECG/QTc, tendinopathy, dysglycemia symptoms.'),('Levofloxacin (Lfx)','Weight-banded; 1,000 mg daily in many adults >45 kg in NTEP tables','Reduce/adjust with renal impairment.','QTc, tendons, CNS effects, glucose.'),('Clofazimine (Cfz)','Weight-banded, often 100 mg daily in adults','Programme-specific.','Skin discoloration, QTc, GI symptoms.')],[2.1,3.25,3.0,3.43],1.25,11) tb(s,.72,5.85,11.9,.58,'Do not extrapolate DR-TB doses across age groups, weight bands or regimens. Confirm against the current NTEP/WHO protocol before prescribing.',14,RED,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: Give the standard BPaLM regimen doses for an eligible adult.\nAnswer: “Bedaquiline 400 mg daily for the first two weeks then 200 mg three times weekly; pretomanid 200 mg daily; linezolid 600 mg daily; and moxifloxacin 400 mg daily.”\n\nThe 2025 Indian DR-TB guideline found in the search presents these doses for patients 14 years and above in the relevant standardized regimen. Eligibility, duration and availability are programme specific.\n\nFor levofloxacin, the guideline tables use weight bands. Do not give a single universal dose in a viva unless the patient’s weight and programme are specified.\n\nHigh-yield safety: combining multiple QT-prolonging drugs requires ECG and electrolyte review. Linezolid toxicity commonly becomes the dose-limiting problem in prolonged use.') #18 ADRs firstline s=base('First-line drug ADRs: identify the culprit', 'Safety',18) table(s,['DRUG','HIGH-YIELD ADRs','VIVA CLUE / ACTION'],[('H','Hepatitis, peripheral neuropathy, rash, lupus-like syndrome.','Give pyridoxine in risk groups; evaluate hepatitis symptoms urgently.'),('R','Hepatitis, orange body fluids, flu-like syndrome, thrombocytopenia, major drug interactions.','Always ask about ART, anticoagulants, contraceptives and other interactions.'),('Z','Hepatotoxicity, hyperuricemia, arthralgia, GI upset.','Avoid/reassess in severe liver disease; distinguish asymptomatic hyperuricemia from gout.'),('E','Optic neuritis, reduced visual acuity, red-green color defect.','Stop and assess urgently if visual symptoms occur.'),('S','Ototoxicity, vestibular toxicity, nephrotoxicity.','Avoid in pregnancy and use caution/avoid in renal dysfunction.')],[1.0,5.2,5.58],1.42,13) tb(s,.8,5.6,11.7,.68,'Danger signs: jaundice, persistent vomiting, severe rash, visual change, hearing loss, syncope/palpitations or marked neuropathy require prompt clinical assessment.',15,RED,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: A patient on HRZE has blurred vision. Which drug is most likely responsible?\nAnswer: “Ethambutol until proven otherwise, due to optic neuritis. I would urgently assess visual acuity and color vision, stop or modify treatment under specialist/programme guidance, and exclude other causes.”\n\nQuestion: Which drug turns body fluids orange? Rifampicin. Explain that this is expected and benign, unlike jaundice which suggests possible hepatotoxicity.\n\nQuestion: Which drugs are hepatotoxic? H, R and Z are the classic first-line hepatotoxic drugs. In suspected drug-induced liver injury, evaluate severity and follow a formal programme reintroduction strategy, not a casual one-drug-at-a-time guess.\n\nQuestion: Why pyridoxine with H? It reduces risk of neuropathy, especially in malnutrition, diabetes, HIV, pregnancy, alcohol use, renal disease and pre-existing neuropathy.') #19 ADR DR s=base('DR-TB medicine ADRs and monitoring', 'Safety',19) table(s,['DRUG','HIGH-YIELD ADRs','MONITORING / RESPONSE'],[('Bdq / Dlm / FQ','QT prolongation, arrhythmia risk.','Baseline and follow-up ECG; correct K/Mg/Ca and review other QT drugs.'),('Lzd','Anemia, thrombocytopenia, peripheral/optic neuropathy, lactic acidosis.','CBC, neurologic and visual review; modify dose only per protocol.'),('Cfz','Skin discoloration, xerosis, GI effects, QT prolongation.','Counsel about cosmetic discoloration; ECG when combined QT risk.'),('Cs / Trd','Depression, psychosis, seizures, neuropathy.','Mental-health and neurologic review; pyridoxine and specialist support.'),('Eto / PAS','GI intolerance, hypothyroidism, hepatotoxicity.','TSH if prolonged/combined use; liver tests and symptom review.'),('Amikacin','Nephrotoxicity, hearing/vestibular loss.','Renal function and audiometry; avoid when safer oral alternatives apply.')],[1.75,4.7,5.33],1.25,11) tb(s,.75,5.9,11.85,.55,'ADR management follows three principles: recognize early, exclude other causes, and modify the regimen only with DST-aware specialist/programme support.',14,RED,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: What is the key adverse effect of bedaquiline?\nAnswer: “QT prolongation, so I obtain ECGs and correct electrolyte abnormalities while reviewing all QT-prolonging co-medications.”\n\nQuestion: What toxicity most limits linezolid?\nAnswer: “Myelosuppression and neuropathy. I monitor CBC and ask actively about paresthesia and visual symptoms. Dose interruption or reduction is protocol directed.”\n\nQuestion: Which DR-TB drugs cause hypothyroidism? Ethionamide and PAS are classic associations. TSH surveillance is particularly important when they are combined or in pregnancy as noted in the source material.\n\nQuestion: Which drug causes psychiatric toxicity? Cycloserine/terizidone. Screen for depression, psychosis and seizures before and during treatment.') #20 pregnancy s=base('Special population: pregnancy and lactation', 'Special populations',20) for i,(h,b,c) in enumerate([('Core approach','Treat active TB promptly. In DR-TB, involve TB specialist, obstetrician and pediatric team. Weigh maternal benefit against fetal risk.',BLUE),('Avoid / caution','Avoid second-line injectables in pregnancy. Source notes avoid ethionamide early in pregnancy and do not use shorter oral MDR-TB regimen in pregnancy.',RED),('Monitoring','Antenatal review, fetal assessment, maternal ECG/CBC/TSH when indicated, and neonatal planning where relevant. Discuss breastfeeding and drug-specific policy.',TEAL)]): x=.75+i*4.12;rect(s,x,1.45,3.8,4.2,WHITE,RGBColor(195,215,226),True);rect(s,x,1.45,3.8,.55,c,c,True);tb(s,x+.12,1.57,3.55,.25,h,16,WHITE,True,PP_ALIGN.CENTER);tb(s,x+.2,2.3,3.4,2.8,b,17,DARK,False,PP_ALIGN.CENTER) tb(s,.8,6.05,11.7,.42,'Viva phrase: “Untreated maternal TB is harmful; treatment should be individualized using current national guidance and multidisciplinary expertise.”',15,NAVY,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: How will you manage DR-TB in pregnancy?\nAnswer: “I will treat it as a multidisciplinary high-risk pregnancy. I will review the DST profile, maternal disease severity, gestational age, fetal risk and current national guidance. I will avoid second-line injectables and follow the programme’s approved pregnancy-specific regimen.”\n\nThe supplied notes specifically contraindicate second-line injectables throughout pregnancy, avoid ethionamide early in pregnancy, and exclude pregnancy from the shorter oral MDR-TB regimen. They also describe closer ECG, CBC and thyroid monitoring where relevant.\n\nLactation: do not give a blanket answer. Review each drug and current programme advice. The source notes caution about bedaquiline and delamanid during lactation.\n\nDo not advise treatment termination or regimen selection without specialist consultation.') #21 renal s=base('Special population: renal dysfunction / dialysis', 'Special populations',21) table(s,['STEP','PRACTICAL ACTION'],[('1. Define function','Calculate creatinine clearance/eGFR, distinguish stable CKD from acute kidney injury and identify dialysis schedule.'),('2. Adjust drug by drug','Source notes: pyrazinamide and ethambutol may need every-48-hour dosing; levofloxacin needs adjustment; linezolid reduction may be needed with low clearance.'),('3. Avoid toxicity','Avoid or strictly monitor injectables. Check concurrent nephrotoxins, hydration and electrolyte disturbances.'),('4. Monitor','Renal function, electrolytes, ECG when QT-risk drugs are used, CBC/neuropathy for linezolid, visual assessment for ethambutol.'),('5. Recalculate','Reassess after any meaningful renal-function or weight change; use a current programme dose table.')],[2.55,9.0],1.42,14) tb(s,.75,5.75,11.9,.68,'Do not use a generic “renal dose” for TB. Dose and interval depend on the individual drug, renal function and dialysis timing.',15,RED,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: Give your approach to TB in CKD.\nAnswer: “I calculate renal function, identify which drugs accumulate, adjust each medicine according to a current dosing table, and plan monitoring. I also coordinate dosing around dialysis where applicable.”\n\nSource-note examples: pyrazinamide and ethambutol may be changed to 48-hourly dosing; levofloxacin requires adjustment; linezolid may need reduction with low creatinine clearance.\n\nWhy are injectables problematic? Amikacin and related drugs can worsen nephrotoxicity and cause irreversible ototoxicity.\n\nViva trap: do not alter rifampicin or isoniazid automatically merely because a patient has CKD. Use drug-specific guidance.') #22 HIV s=base('Special population: HIV co-infection', 'Special populations',22) for i,(h,b,c) in enumerate([('Diagnosis','Use rapid molecular diagnosis and DST. Remember that smear-negative TB and extrapulmonary disease are more common in advanced immunosuppression.',BLUE),('Treatment integration','Start effective TB treatment promptly. Coordinate ART timing and regimen with TB team because rifampicin has major interactions.',TEAL),('Watch for','Drug interactions, overlapping hepatotoxicity, pill burden, adherence barriers and TB-associated immune reconstitution inflammatory syndrome (IRIS).',GOLD)]): x=.75+i*4.12;rect(s,x,1.55,3.8,3.95,WHITE,RGBColor(195,215,226),True);rect(s,x,1.55,3.8,.55,c,c,True);tb(s,x+.12,1.67,3.55,.25,h,16,WHITE,True,PP_ALIGN.CENTER);tb(s,x+.2,2.32,3.4,2.55,b,17,DARK,False,PP_ALIGN.CENTER) tb(s,.8,5.93,11.72,.58,'Viva phrase: “I will coordinate TB and HIV services early, check interactions before ART selection, and counsel the patient about adherence and IRIS.”',15,NAVY,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: What are the key principles in TB-HIV co-infection?\nAnswer: “Prompt TB diagnosis and effective treatment, early HIV care coordination, deliberate management of rifampicin-ART interactions, and surveillance for toxicity and IRIS.”\n\nExplain that rifampicin is a potent enzyme inducer and can lower concentrations of many medicines, including some antiretrovirals. ART selection and timing must follow the current national HIV/TB protocol.\n\nIf asked about IRIS: it is a paradoxical inflammatory deterioration after immune recovery, usually after ART initiation, but alternative explanations such as treatment failure, resistance, poor adherence or another infection must be excluded.\n\nLTBI prevention is particularly important in people living with HIV after active disease is excluded.') #23 pedi s=base('Special population: children and adolescents', 'Special populations',23) table(s,['PRINCIPLE','HIGH-YIELD POINT'],[('Weight-based dosing','Use pediatric weight-band tables and child formulations. Source search notes pediatric bands through <39 kg, while heavier adolescents use adult bands in NTEP material.'),('Disease pattern','Children may have paucibacillary disease, difficulty producing sputum and more extrapulmonary disease. Investigate contacts carefully.'),('Severity','CNS, miliary, spinal and severe disease need specialist-led duration/regimen decisions.'),('Safety','Ask caregivers about adherence, vomiting, visual symptoms, neuropathy and behavior change. Re-weigh often as the child grows.'),('Prevention','Assess household contacts promptly and consider preventive treatment after active disease is excluded.')],[2.7,8.85],1.42,14) tb(s,.75,5.75,11.9,.68,'Do not calculate pediatric doses by simply halving adult tablets. Use an approved pediatric formulation and current weight-band table.',15,RED,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: What are the practical differences in pediatric TB management?\nAnswer: “Diagnosis is often more difficult because disease can be paucibacillary and sputum may be unavailable. Dosing is strictly weight based with pediatric formulations, and contact tracing is especially important.”\n\nThe NTEP educational material found in the search states that children and adolescents under 18 years weighing less than 39 kg use pediatric weight bands, while those above 39 kg use adult bands. Confirm this against the currently active programme table.\n\nFollow-up: Which forms need longer or specialist treatment? CNS, skeletal, miliary and other severe extrapulmonary disease.\n\nViva pearl: Recalculate doses as the child gains or loses weight during treatment.') #24 liver s=base('Special population: liver disease / hepatotoxicity risk', 'Special populations',24) for i,(h,b,c) in enumerate([('Baseline','Document liver disease, alcohol use, pregnancy, viral hepatitis risk, co-medications and baseline liver tests when indicated.',BLUE),('Higher-risk drugs','H, R and Z are the main first-line hepatotoxic drugs. Ethionamide and PAS can also contribute in DR-TB regimens.',RED),('If symptoms occur','Stop and urgently assess according to severity and programme policy for jaundice, persistent vomiting, severe abdominal pain or marked transaminase elevation.',GOLD)]): x=.75+i*4.12;rect(s,x,1.55,3.8,3.9,WHITE,RGBColor(195,215,226),True);rect(s,x,1.55,3.8,.55,c,c,True);tb(s,x+.12,1.67,3.55,.25,h,16,WHITE,True,PP_ALIGN.CENTER);tb(s,x+.2,2.35,3.4,2.45,b,17,DARK,False,PP_ALIGN.CENTER) tb(s,.8,5.93,11.7,.58,'Never restart hepatotoxic TB drugs without a structured, protocol-guided plan once drug-induced liver injury is suspected.',15,NAVY,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: Which first-line drugs are hepatotoxic?\nAnswer: “Isoniazid, rifampicin and pyrazinamide are the classic drugs. Pyrazinamide is often the most difficult to reintroduce, but management must follow a formal protocol.”\n\nApproach: establish baseline liver risk, counsel regarding symptoms, monitor clinically and biochemically when indicated, stop suspected agents in significant injury, evaluate other causes such as viral hepatitis or biliary disease, and use a guideline-based reintroduction plan under specialist advice.\n\nExam trap: asymptomatic mild transaminase elevation is not automatically the same as severe drug-induced liver injury. Use symptoms, bilirubin, enzyme trends and programme thresholds.\n\nAlcohol cessation and review of other hepatotoxic medications are part of treatment, not optional counseling.') #25 elderly s=base('Special population: older adults and multimorbidity', 'Special populations',25) table(s,['RISK AREA','PRACTICAL MANAGEMENT'],[('Polypharmacy','Perform a medication reconciliation. Rifampicin interactions are especially important with anticoagulants, diabetes drugs, cardiovascular and psychotropic medicines.'),('Organ dysfunction','Assess renal, hepatic, cardiac and visual function before and during therapy; adjust using current tables.'),('Frailty/nutrition','Document weight, nutrition, swallowing and functional status. Support adherence with caregiver and social support.'),('Neurotoxicity','Ask about falls, dizziness, neuropathy, confusion, depression and visual/hearing change; risks are amplified by linezolid, cycloserine and injectables.'),('Monitoring','Use closer follow-up, not lower-quality treatment. Consider ECG, CBC and relevant organ monitoring based on the selected regimen.')],[2.7,8.85],1.42,14) tb(s,.75,5.75,11.9,.68,'Age alone does not determine the regimen. Functional status, comorbidities, interactions and treatment tolerance do.',15,RED,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nQuestion: How does TB management differ in an older person?\nAnswer: “The microbiologic principles are the same, but I give extra attention to drug interactions, organ dysfunction, frailty, nutrition, sensory impairment and adherence support.”\n\nRifampicin is a major interaction drug, so a full medication review is mandatory. Baseline visual function matters with ethambutol; renal function matters for several drugs; and neuropathy or psychiatric vulnerability matters with linezolid and cycloserine.\n\nViva point: do not undertreat because a patient is old. Instead, individualize monitoring and support while using an effective guideline-based regimen.') #26 summary s=base('Expanded revision checklist', 'Rapid revision',26) items=[('DST','Rapid molecular testing guides early action; phenotypic DST completes the profile.'),('Doses','Use current weight-band, age- and organ-function-specific programme tables.'),('ADRs','H/R/Z: liver; E: vision; S: kidney/hearing; Bdq/FQ: QT; Lzd: CBC/neuropathy.'),('Pregnancy','Multidisciplinary; avoid injectables; use current programme guidance.'),('Renal','Drug-specific adjustments, not one blanket dose.'),('HIV/children/elderly/liver','Coordinate care, assess interactions and use enhanced monitoring.')] for i,(h,b) in enumerate(items): x=.75+(i%2)*6.05;y=1.38+(i//2)*1.55;rect(s,x,y,5.7,1.22,WHITE,RGBColor(195,215,226),True);tb(s,x+.18,y+.18,1.25,.3,h,16,TEAL,True);tb(s,x+1.55,y+.14,3.95,.7,b,15,DARK) tb(s,.75,6.25,11.9,.5,'Safety footer: Doses and regimens in this deck are educational. Verify against the latest national TB programme and WHO documents before clinical use.',14,RED,True,PP_ALIGN.CENTER) note(s,'EXTENDED VIVA PRESENTER NOTES\nFinal viva summary: “I will use DST to classify resistance and build treatment around active drugs. I will dose by current weight band and organ function, identify predictable toxicities early, and individualize care for pregnancy, renal disease, HIV, children, liver disease and older adults.”\n\nRapid questions: What detects resistance rapidly? Molecular DST. What confirms broad phenotypic susceptibility? Culture-based DST. What must be checked with bedaquiline? ECG and electrolytes. What is the visual toxicity drug? Ethambutol. What is a key linezolid toxicity? Cytopenia or neuropathy.\n\nReference caveat: This deck incorporates uploaded class notes and current sources searched from official Indian NTEP and WHO material. Always follow the active local programme protocol.') prs.save(out);print(out,out.stat().st_size) PY python - <<'PY' from pptx import Presentation p='/tmp/workspace/pdf-to-ppt/output/Management_of_Tuberculosis_Expanded_DST_Doses_ADRs_Special_Populations.pptx' prs=Presentation(p) print('slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): n=s.notes_slide.notes_text_frame.text assert n.strip(),i print('notes all present, final title:',[sh.text for sh in prs.slides[-1].shapes if getattr(sh,'has_text_frame',False)][0]) PY