Hepatitis C (HCV) - Comprehensive Overview

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

// Helper: fetch one image as base64
function fetchImg(url) {
  try {
    const result = execSync(
      `node /home/daytona/skills/shared/scripts/fetch_images.js "${url}"`,
      { timeout: 40000 }
    ).toString();
    const parsed = JSON.parse(result);
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    console.warn("Image fetch failed:", url, e.message);
    return null;
  }
}

// Fetch images
console.log("Fetching images...");
const imgEM = fetchImg("https://upload.wikimedia.org/wikipedia/commons/3/3b/HCV_EM_picture_2.png");
console.log("EM image:", imgEM ? "OK" : "FAIL");
const imgDiagram = fetchImg("https://upload.wikimedia.org/wikipedia/commons/thumb/3/3e/HCV.png/960px-HCV.png");
console.log("Diagram image:", imgDiagram ? "OK" : "FAIL");
const imgHisto = fetchImg("https://upload.wikimedia.org/wikipedia/commons/e/e6/Histopathology_of_acute_hepatitis.jpg");
console.log("Histo image:", imgHisto ? "OK" : "FAIL");

// ─── COLORS ─────────────────────────────────────────────────────────────────
const C = {
  darkBg:    "0B1E2D",   // deep navy
  midBg:     "102A3F",   // mid navy
  accent:    "E84855",   // vivid red (HCV danger feel)
  accentSoft:"C0392B",   // darker red
  gold:      "F5A623",   // warm gold accent
  white:     "FFFFFF",
  lightGray: "D6DDE8",
  textMid:   "8DA4BF",
  cardBg:    "153248",   // card panels
};

// ─── HELPERS ────────────────────────────────────────────────────────────────
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// ─── PRES ────────────────────────────────────────────────────────────────────
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Hepatitis C – A Comprehensive Clinical Review";
pres.author = "Orris Medical";

// ══════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
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  // Full-width red bar at top
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.55, fill:{ color: C.accent }, line:{color:C.accent} });
  s.addText("HEPATITIS C", {
    x:0, y:0.04, w:10, h:0.47, align:"center",
    fontSize:18, bold:true, color:C.white, charSpacing:8, margin:0
  });
  // Virus EM image
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  // Main title
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  s.addText("Virology  ·  Epidemiology  ·  Pathogenesis  ·  Diagnosis  ·  Treatment", {
    x:0.5, y:2.9, w:5.8, h:0.4, fontSize:11, color:C.textMid, italic:true, margin:0
  });
  s.addText("June 2026  |  Sources: Jawetz Microbiology · Henry's Lab Methods · Sleisenger & Fordtran's GI", {
    x:0.5, y:5.1, w:9, h:0.35, fontSize:8, color:C.textMid, italic:true, margin:0
  });
}

// ══════════════════════════════════════════════════════
// SLIDE 2 – OVERVIEW / KEY FACTS
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midSlide(s);
  addSectionLabel(s, "Overview");
  addSlideTitle(s, "What is Hepatitis C?");

  const facts = [
    ["RNA Virus", "Flaviviridae family\nPositive-sense ssRNA genome\nEnters hepatocytes via CD81 receptor"],
    ["Global Burden", "~70 million chronic carriers worldwide\n~3 million in the United States\nLeading cause of liver cirrhosis & HCC"],
    ["Chronicity", "~75% of acute infections\nbecome chronic\n(vs. 5-10% for HBV)"],
    ["Cure Rate", "Direct-acting antivirals (DAAs)\nachieve >95% cure (SVR)\nacross all genotypes"],
  ];
  const cols = [[0.3,1.4,4.5,3.8],[5.0,1.4,4.5,3.8],[0.3,3.45,4.5,1.9],[5.0,3.45,4.5,1.9]];
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}

// ══════════════════════════════════════════════════════
// SLIDE 3 – VIROLOGY
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midSlide(s);
  addSectionLabel(s, "Virology");
  addSlideTitle(s, "HCV Structure & Proteins");

  if (imgDiagram) {
    s.addImage({ data: imgDiagram, x:5.9, y:1.35, w:3.8, h:3.8 });
    s.addText("HCV viral structure diagram", {
      x:5.9,y:5.2,w:3.8,h:0.25,fontSize:7,color:C.textMid,align:"center",italic:true,margin:0
    });
  }

  const proteins = [
    { name:"Core / E1 / E2", role:"Structural proteins; E2 binds CD81 receptor" },
    { name:"NS2", role:"Transmembrane protein" },
    { name:"NS3", role:"Protease + RNA helicase — key DAA target" },
    { name:"NS4A/B", role:"NS3 cofactors" },
    { name:"NS5A", role:"Interferon-resistance protein — DAA target" },
    { name:"NS5B", role:"RNA-dependent RNA polymerase (replication)" },
  ];
  proteins.forEach((p, i) => {
    const y = 1.38 + i * 0.64;
    s.addShape(pres.shapes.RECTANGLE, { x:0.3,y,w:5.3,h:0.55, fill:{color:C.cardBg} });
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  s.addText("High mutation rate (no proofreading by NS5B) → 6 genotypes, multiple subtypes", {
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  });
}

// ══════════════════════════════════════════════════════
// SLIDE 4 – GENOTYPES
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midSlide(s);
  addSectionLabel(s, "Virology");
  addSlideTitle(s, "HCV Genotypes & Geographic Distribution");

  const genos = [
    { g:"1a", region:"North America (dominant)", note:"Most resistant to IFN-based therapy (48 wk)" },
    { g:"1b", region:"Europe (dominant)", note:"Most resistant; genotype 1b linked to severe post-LT recurrence" },
    { g:"2",  region:"USA, Japan, Europe", note:"Better IFN response (24 wk)" },
    { g:"3",  region:"South Asia, Australia", note:"Associated with steatosis; IFN-sensitive" },
    { g:"4",  region:"Africa, Middle East", note:"Unique to Africa; IFN-resistant (48 wk)" },
    { g:"5",  region:"South Africa", note:"Unique to Africa" },
    { g:"6",  region:"Southeast Asia", note:"IFN-sensitive" },
  ];
  genos.forEach((g, i) => {
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  s.addShape(pres.shapes.RECTANGLE, { x:5.2,y:4.28,w:4.5,h:0.82, fill:{color:"1A3A52"} });
  s.addText("Pan-genotypic DAAs (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir)\nnow eliminate the need for genotyping in most settings", {
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  });
}

// ══════════════════════════════════════════════════════
// SLIDE 5 – EPIDEMIOLOGY & TRANSMISSION
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midSlide(s);
  addSectionLabel(s, "Epidemiology");
  addSlideTitle(s, "Transmission & Risk Factors");

  // Left column: transmission
  addCard(s, 0.3, 1.38, 4.55, 3.95, "Transmission Routes", [
    "Injection drug use — ~80% of new cases",
    "Blood transfusions / transplants (pre-1990)",
    "Hemodialysis patients (~10%)",
    "Sexual transmission (~10% of cases)",
    "Mother-to-child vertical: 3-10%",
    "Needlestick / healthcare workers (~1%)",
    "No transmission via breastfeeding",
    "Tattoos, folk medicine (some countries)",
  ]);

  // Right column: global burden
  addCard(s, 5.1, 1.38, 4.55, 1.85, "Global Burden", [
    "~1% world population infected",
    "Africa subgroups up to 10% prevalence",
    "Egypt ~20% (schistosomiasis campaign 1950s-80s)",
    "South America & Asia: high prevalence areas",
  ]);

  // Right bottom: incubation
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  s.addText("Incubation & Seroconversion", { x:5.25,y:3.5,w:4.3,h:0.32, fontSize:11,bold:true,color:C.gold,margin:0 });
  const timeline = [
    ["Incubation period", "avg. 6-7 weeks"],
    ["Exposure → seroconversion", "avg. 8-9 weeks"],
    ["Anti-HCV positive (90%)", "within 5 months"],
    ["Source unknown in", "10-50% of cases"],
  ];
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// ══════════════════════════════════════════════════════
// SLIDE 6 – PATHOGENESIS & NATURAL HISTORY
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midSlide(s);
  addSectionLabel(s, "Pathogenesis");
  addSlideTitle(s, "Natural History of HCV Infection");

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    s.addText("Liver histopathology in acute hepatitis (H&E stain)", {
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    });
  }

  // Flowchart steps
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    { label:"Acute Infection", pct:"100%", detail:"80% asymptomatic; 20-30% jaundice; 10-20% nonspecific symptoms", color: C.gold },
    { label:"Chronic Infection", pct:"~75%", detail:"Persistent viremia; elevated ALT in ~50%; symptoms absent for first 2 decades", color: C.accent },
    { label:"Cirrhosis", pct:"~20%", detail:"Of chronic cases; progressive inflammation → fibrosis → cirrhosis", color: "E05C67" },
    { label:"HCC / Liver Failure", pct:"1-5%/yr", detail:"HCC risk 1-5% per year in cirrhosis; HCC ONLY in cirrhotic patients", color: "C0392B" },
  ];
  steps.forEach((st, i) => {
    const y = 1.38 + i * 0.95;
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  });
}

// ══════════════════════════════════════════════════════
// SLIDE 7 – DIAGNOSIS
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midSlide(s);
  addSectionLabel(s, "Diagnosis");
  addSlideTitle(s, "Laboratory Diagnosis of HCV");

  const tests = [
    { name:"Anti-HCV EIA\n(2nd generation)", use:"Screening; detects antibodies to Core, E1/E2, NS3/NS4",
      note:"Does NOT distinguish acute / chronic / resolved\n50-70% positive at symptom onset; rest by 3-6 wks\nWindow period: avg. 10-12 weeks", color:C.gold },
    { name:"HCV RNA\n(RT-PCR)", use:"Confirms active infection; monitors therapy; diagnoses acute infection early",
      note:"Undetectable RNA = Sustained Virological Response (SVR)\nLTT tubes give higher readings than PPT tubes", color:C.accent },
    { name:"HCV Genotyping", use:"Determines genotype 1-6 for treatment planning",
      note:"Guides regimen selection and duration\nGenotypes 1 & 4: more resistant to IFN (48 wk)\nLess critical with pan-genotypic DAAs", color:"5DADE2" },
    { name:"HCV Core Antigen", use:"Detects core protein; alternative to RNA",
      note:"Less sensitive than HCV RNA assays\nUseful when molecular testing unavailable", color:C.textMid },
  ];

  tests.forEach((t, i) => {
    const x = i % 2 === 0 ? 0.3 : 5.2;
    const y = i < 2 ? 1.38 : 3.55;
    const w = 4.6;
    s.addShape(pres.shapes.RECTANGLE, { x,y,w,h:1.85, fill:{color:C.cardBg},
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// ══════════════════════════════════════════════════════
// SLIDE 8 – TREATMENT: DAAs
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midSlide(s);
  addSectionLabel(s, "Treatment");
  addSlideTitle(s, "Direct-Acting Antivirals (DAAs)");

  // Three DAA classes
  const classes = [
    { cls:"NS3/4A\nProtease Inhibitors", drugs:"Boceprevir, Telaprevir\nSimeprevir, Glecaprevir\nVoxilaprevir", mech:"Block viral protease → prevent\nprocessing of HCV polyprotein", color:C.accent },
    { cls:"NS5A\nInhibitors", drugs:"Ledipasvir\nPibrentasvir\nVelpatasvir", mech:"Inhibit NS5A replication\ncomplex assembly", color:C.gold },
    { cls:"NS5B\nPolymerase Inhibitors", drugs:"Sofosbuvir\n(nucleotide analogue)", mech:"Block RNA-dependent RNA\npolymerase → stop replication", color:"5DADE2" },
  ];
  classes.forEach((c, i) => {
    const x = 0.3 + i * 3.23;
    s.addShape(pres.shapes.RECTANGLE, { x,y:1.38,w:3.05,h:3.9, fill:{color:C.cardBg},
      shadow:{type:"outer",color:"000000",blur:10,offset:4,angle:135,opacity:0.25} });
    s.addShape(pres.shapes.RECTANGLE, { x,y:1.38,w:3.05,h:0.06, fill:{color:c.color},line:{color:c.color} });
    s.addText(c.cls, { x:x+0.15,y:1.48,w:2.75,h:0.65, fontSize:12,bold:true,color:c.color,margin:0 });
    s.addShape(pres.shapes.RECTANGLE, { x:x+0.15,y:2.2,w:2.75,h:0.04, fill:{color:"1A3A52"},line:{color:"1A3A52"} });
    s.addText("Mechanism", { x:x+0.15,y:2.3,w:2.75,h:0.24, fontSize:9,bold:true,color:C.textMid,charSpacing:2,margin:0 });
    s.addText(c.mech, { x:x+0.15,y:2.58,w:2.75,h:0.7, fontSize:9,color:C.lightGray,margin:0 });
    s.addText("Key Drugs", { x:x+0.15,y:3.35,w:2.75,h:0.24, fontSize:9,bold:true,color:C.textMid,charSpacing:2,margin:0 });
    s.addText(c.drugs, { x:x+0.15,y:3.63,w:2.75,h:0.85, fontSize:9,color:C.lightGray,margin:0 });
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  // Bottom banner: outcomes
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}

// ══════════════════════════════════════════════════════
// SLIDE 9 – KEY REGIMENS & OUTCOMES
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midSlide(s);
  addSectionLabel(s, "Treatment");
  addSlideTitle(s, "Key Regimens & Clinical Outcomes");

  const regimens = [
    { name:"Sofosbuvir /\nVelpatasvir\n(Epclusa)", detail:"Pan-genotypic\n12 weeks\nAll genotypes 1-6", color:C.accent },
    { name:"Glecaprevir /\nPibrentasvir\n(Maviret)", detail:"Pan-genotypic\n8 weeks (treatment-naive)\nAcute HCV: FDA-approved 2025", color:C.gold },
    { name:"SOF / VEL /\nVoxilaprevir\n(Vosevi)", detail:"Pan-genotypic\n12 weeks\nFor DAA-experienced patients", color:"5DADE2" },
  ];
  regimens.forEach((r, i) => {
    const x = 0.3 + i * 3.2;
    s.addShape(pres.shapes.RECTANGLE, { x,y:1.38,w:3.0,h:2.6, fill:{color:C.cardBg} });
    s.addShape(pres.shapes.RECTANGLE, { x,y:1.38,w:3.0,h:0.06, fill:{color:r.color},line:{color:r.color} });
    s.addText(r.name, { x:x+0.15,y:1.48,w:2.7,h:0.75, fontSize:11.5,bold:true,color:r.color,margin:0 });
    s.addText(r.detail, { x:x+0.15,y:2.28,w:2.7,h:1.0, fontSize:9.5,color:C.lightGray,margin:0 });
  });

  // SVR outcomes
  s.addText("Outcomes with DAA Therapy — Sustained Virological Response (SVR)", {
    x:0.3,y:4.12,w:9.4,h:0.35, fontSize:12,bold:true,color:C.white,margin:0
  });
  const outcomes = [
    { stat:">95%", label:"SVR rate\n(all genotypes)" },
    { stat:"0.27", label:"Hazard ratio for\nmortality reduction" },
    { stat:"0.26", label:"HR for decreased\nhepatic decompensation" },
    { stat:"0.29", label:"HR for reduced\nHCC incidence" },
  ];
  outcomes.forEach((o, i) => {
    const x = 0.3 + i * 2.38;
    s.addShape(pres.shapes.RECTANGLE, { x,y:4.55,w:2.2,h:0.9, fill:{color:C.cardBg} });
    s.addText(o.stat, { x,y:4.57,w:2.2,h:0.45, fontSize:20,bold:true,color:C.gold,align:"center",margin:0 });
    s.addText(o.label, { x,y:4.99,w:2.2,h:0.42, fontSize:8,color:C.textMid,align:"center",margin:0 });
  });
}

// ══════════════════════════════════════════════════════
// SLIDE 10 – COMPLICATIONS
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midSlide(s);
  addSectionLabel(s, "Complications");
  addSlideTitle(s, "Complications of Chronic HCV");

  const comps = [
    { title:"Liver Cirrhosis", pct:"~20%", desc:"Of chronic cases; over 20+ years of infection\nPredictors: genotype 1b, high viral load, alcohol use, HIV co-infection", color:C.accent },
    { title:"Hepatocellular\nCarcinoma (HCC)", pct:"1-5%/yr", desc:"Occurs almost exclusively in cirrhotic patients\nHCV achieving SVR reduces HCC risk (HR 0.29)", color:"C0392B" },
    { title:"Cryoglobulinemia", pct:"~50%", desc:"Mixed type II/III cryoglobulinemia\nManifests as purpura, vasculitis, glomerulonephritis", color:C.gold },
    { title:"Fibrosing Cholestatic\nHepatitis (post-LT)", pct:"5-10%", desc:"Dense portal fibrosis, cholestasis in liver transplant patients\nTreatment: reduce immunosuppression + start DAA", color:"5DADE2" },
  ];
  comps.forEach((c, i) => {
    const x = i % 2 === 0 ? 0.3 : 5.2;
    const y = i < 2 ? 1.38 : 3.5;
    s.addShape(pres.shapes.RECTANGLE, { x,y,w:4.55,h:1.82, fill:{color:C.cardBg},
      shadow:{type:"outer",color:"000000",blur:8,offset:3,angle:135,opacity:0.2} });
    s.addShape(pres.shapes.RECTANGLE, { x,y,w:4.55,h:0.05, fill:{color:c.color},line:{color:c.color} });
    s.addShape(pres.shapes.RECTANGLE, { x:x+3.3,y:y+0.12,w:1.1,h:0.55, fill:{color:"0E2235"} });
    s.addText(c.pct, { x:x+3.3,y:y+0.12,w:1.1,h:0.55, fontSize:14,bold:true,color:c.color,align:"center",valign:"middle",margin:0 });
    s.addText(c.title, { x:x+0.15,y:y+0.1,w:3.1,h:0.55, fontSize:11,bold:true,color:C.white,margin:0 });
    s.addText(c.desc, { x:x+0.15,y:y+0.72,w:4.2,h:0.9, fontSize:8.8,color:C.textMid,margin:0 });
  });
}

// ══════════════════════════════════════════════════════
// SLIDE 11 – CONCLUSION
// ══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:10,h:0.55, fill:{color:C.accent},line:{color:C.accent} });
  s.addText("KEY TAKEAWAYS", {
    x:0,y:0.04,w:10,h:0.47,align:"center",fontSize:16,bold:true,color:C.white,charSpacing:6,margin:0
  });

  if (imgEM) {
    s.addImage({ data: imgEM, x:7.0,y:0.7,w:2.7,h:2.7, rounding:true, transparency:20 });
  }

  const points = [
    "HCV is a single-stranded RNA Flavivirus with 6 genotypes; high mutation rate creates treatment challenges",
    "~75% of acute infections become chronic — the highest chronicity rate of all hepatitis viruses",
    "~70 million chronic carriers globally; leading infectious cause of cirrhosis and HCC worldwide",
    "Diagnosis: anti-HCV EIA for screening, HCV RNA (RT-PCR) for confirmation and monitoring",
    "Pan-genotypic DAAs (Epclusa, Maviret, Vosevi) achieve >95% SVR — HCV is now curable",
    "SVR significantly reduces mortality (HR 0.27), liver decompensation (HR 0.26), and HCC (HR 0.29)",
    "2025 update: Glecaprevir/pibrentasvir FDA-approved for acute HCV (8 wks, 96% cure rate)",
    "No vaccine exists — prevention relies on harm reduction and blood safety",
  ];

  points.forEach((pt, i) => {
    const y = 0.72 + i * 0.58;
    s.addShape(pres.shapes.RECTANGLE, { x:0.3,y,w:0.3,h:0.38, fill:{color:C.accent},line:{color:C.accent} });
    s.addText(`${i+1}`, { x:0.3,y,w:0.3,h:0.38, fontSize:10,bold:true,color:C.white,align:"center",valign:"middle",margin:0 });
    s.addText(pt, { x:0.72,y:y+0.02,w:6.1,h:0.38, fontSize:9.5,color:C.lightGray,valign:"middle",margin:0 });
  });

  s.addText("Sources: Jawetz Microbiology 28e · Henry's Lab Methods · Sleisenger & Fordtran's GI & Liver Disease · FDA / EMA 2025-26", {
    x:0.3,y:5.28,w:9.4,h:0.28, fontSize:7,color:C.textMid,italic:true,margin:0
  });
}

// ─── WRITE FILE ──────────────────────────────────────────────────────────────
const outPath = "/home/daytona/workspace/hcv-presentation/Hepatitis_C_Presentation.pptx";
pres.writeFile({ fileName: outPath })
  .then(() => console.log("SUCCESS:", outPath))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });