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

// Fetch images
const imageUrls = [
  "https://cdn.orris.care/cdss_images/BAILY_1760535777660_547912ec-2990-4df1-ab9a-1cd9b191ec81.png",   // fibroid types diagram
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_f14e8f4a8983c1ccd8db31ede8830cd29a192b309fea7118fd534975bc71cf2f.jpg", // FIGO classification
  "https://cdn.orris.care/cdss_images/Pathology_1760056828137_2c0ce550-3a56-45da-88a1-11386eda752f.jpg",  // gross pathology whorled
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_ea9f3abaf6cf16b3c23061bf65f1e3f00ebb08a6354a9567a0fc049bc514a2a1.jpg", // surgical specimen
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_e9d7e77a3f6f68d16b86b07372724968863fa45b027e3c0cabec50c0ed957c27.jpg", // MRI before/after treatment
];

console.log("Fetching images...");
let images;
try {
  images = JSON.parse(
    execSync(
      `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
      { maxBuffer: 50 * 1024 * 1024 }
    ).toString()
  );
  console.log("Images fetched:", images.map(i => i.error ? "ERROR: " + i.error : "OK"));
} catch (e) {
  console.error("Image fetch failed:", e.message);
  images = imageUrls.map(url => ({ url, base64: null, error: e.message }));
}

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Uterine Myoma (Leiomyoma)";
pres.author = "Orris Medical";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const C = {
  deep:    "1A2B4A",   // deep navy — dominant
  mid:     "2D5F8A",   // mid-blue accent
  accent:  "E8734A",   // warm orange accent
  light:   "EAF2FB",   // very light blue bg
  white:   "FFFFFF",
  subhead: "5A8CC2",   // muted blue for subheadings
  text:    "1E2D3D",   // dark navy text
  muted:   "6B7F94",
};

// ─── HELPER FUNCTIONS ────────────────────────────────────────────────────────
function addSlideHeader(slide, title, subtitle = "") {
  // Top bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: C.deep } });
  slide.addText(title, {
    x: 0.35, y: 0, w: 9.3, h: 0.75,
    fontSize: 22, bold: true, color: C.white, valign: "middle", margin: 0,
  });
  if (subtitle) {
    slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.75, w: 10, h: 0.35, fill: { color: C.mid } });
    slide.addText(subtitle, {
      x: 0.35, y: 0.75, w: 9.3, h: 0.35,
      fontSize: 12, color: C.white, valign: "middle", margin: 0, italic: true,
    });
  }
  // Bottom accent line
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.42, w: 10, h: 0.2, fill: { color: C.accent } });
}

function bulletItems(items) {
  return items.map((item, i) => [
    { text: item.text, options: { bold: item.bold || false, breakLine: false } },
    ...(i < items.length - 1 ? [{ text: "", options: { breakLine: true } }] : [])
  ]).flat();
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 1 — TITLE SLIDE
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  // Background gradient via shape
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.deep } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 3.5, w: 10, h: 2.125, fill: { color: C.mid } });
  // Decorative accent bar
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.6, w: 0.12, h: 2.4, fill: { color: C.accent } });
  // Title
  slide.addText("UTERINE MYOMA", {
    x: 0.8, y: 1.3, w: 8.5, h: 1.1,
    fontSize: 48, bold: true, color: C.white, charSpacing: 4,
  });
  // Subtitle
  slide.addText("Leiomyoma · Fibroid", {
    x: 0.8, y: 2.4, w: 6, h: 0.6,
    fontSize: 22, italic: true, color: "A8D4F5",
  });
  // Tagline
  slide.addText("Pathology · Classification · Clinical Features · Management", {
    x: 0.8, y: 3.1, w: 8, h: 0.45,
    fontSize: 13, color: "C5DCF0",
  });
  // Bottom box
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 4.9, w: 10, h: 0.7, fill: { color: "0E1C30" } });
  slide.addText("Gynecology & Obstetrics  |  Evidence-Based Review", {
    x: 0, y: 4.9, w: 10, h: 0.7,
    fontSize: 11, color: C.muted, align: "center", valign: "middle",
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 2 — OVERVIEW / TABLE OF CONTENTS
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addSlideHeader(slide, "Overview", "Topics Covered");

  const topics = [
    { num: "01", title: "Definition & Epidemiology" },
    { num: "02", title: "Pathogenesis & Etiology" },
    { num: "03", title: "Classification (FIGO)" },
    { num: "04", title: "Clinical Features & Symptoms" },
    { num: "05", title: "Diagnosis & Imaging" },
    { num: "06", title: "Gross & Histopathology" },
    { num: "07", title: "Complications" },
    { num: "08", title: "Management" },
    { num: "09", title: "Surgical Options" },
    { num: "10", title: "Uterine Artery Embolization" },
  ];

  const cols = [topics.slice(0, 5), topics.slice(5)];
  cols.forEach((col, ci) => {
    col.forEach((t, ri) => {
      const x = 0.5 + ci * 4.9;
      const y = 1.25 + ri * 0.77;
      slide.addShape(pres.ShapeType.rect, { x, y, w: 4.5, h: 0.65, fill: { color: C.mid }, line: { color: C.mid } });
      slide.addText([
        { text: t.num + "  ", options: { bold: true, color: C.accent } },
        { text: t.title, options: { color: C.white } },
      ], { x: x + 0.15, y, w: 4.2, h: 0.65, fontSize: 13, valign: "middle" });
    });
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 3 — DEFINITION & EPIDEMIOLOGY
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white } });
  addSlideHeader(slide, "Definition & Epidemiology");

  // Definition box
  slide.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.15, w: 9.2, h: 0.95, fill: { color: C.light }, line: { color: C.mid, pt: 1.5 } });
  slide.addText([
    { text: "Definition: ", options: { bold: true, color: C.accent } },
    { text: "A benign monoclonal smooth muscle tumor originating from the myometrium of the uterus. Also known as leiomyoma or fibroid.", options: { color: C.text } },
  ], { x: 0.6, y: 1.15, w: 8.8, h: 0.95, fontSize: 13.5, valign: "middle" });

  // Stats row
  const stats = [
    { val: "20–40%", label: "reproductive-age\nwomen affected" },
    { val: "50%", label: "Black women\nhave fibroids" },
    { val: "25%", label: "White women\nhave fibroids" },
    { val: "30%", label: "become\nsymptomatic" },
  ];
  stats.forEach((s, i) => {
    const x = 0.4 + i * 2.3;
    slide.addShape(pres.ShapeType.rect, { x, y: 2.3, w: 2.1, h: 1.15, fill: { color: C.deep }, line: { color: C.deep } });
    slide.addText(s.val, { x, y: 2.35, w: 2.1, h: 0.55, fontSize: 24, bold: true, color: C.accent, align: "center" });
    slide.addText(s.label, { x, y: 2.9, w: 2.1, h: 0.55, fontSize: 10, color: C.white, align: "center" });
  });

  // Key facts
  slide.addText("Key Facts", { x: 0.4, y: 3.65, w: 3, h: 0.3, fontSize: 13, bold: true, color: C.mid });
  const facts = [
    "Most common benign pelvic tumor in women",
    "Peak incidence: 30–40 years of age",
    "Detected in 3–4% of mid-trimester ultrasound evaluations",
    "Growth stimulated by estrogen & progesterone",
    "Rare before menarche; regress after menopause",
    "More prevalent and symptomatic in African-American women",
  ];
  slide.addText(
    facts.map((f, i) => [
      { text: f, options: { bullet: true, breakLine: i < facts.length - 1 } }
    ]).flat().flat(),
    { x: 0.4, y: 3.95, w: 9.2, h: 1.4, fontSize: 12, color: C.text }
  );
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 4 — PATHOGENESIS & ETIOLOGY
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white } });
  addSlideHeader(slide, "Pathogenesis & Etiology");

  // Two-column layout
  const leftItems = [
    { heading: "Origin", points: ["Monoclonal smooth muscle tumors from myometrium", "Single transformed myocyte with clonal expansion", "Multiple fibroids likely have different clonal origins"] },
    { heading: "Hormonal Drivers", points: ["Estrogen stimulates fibroid growth", "Progesterone promotes proliferation", "GnRH regulates; anti-hormonal therapy shrinks fibroids"] },
  ];

  const rightItems = [
    { heading: "Risk Factors", points: ["Early menarche", "Nulliparity", "Obesity / high BMI", "African-American ethnicity", "Family history", "Diet high in red meat; low in green vegetables", "Alcohol / caffeine use"] },
    { heading: "Protective Factors", points: ["Multiparity", "Oral contraceptive use (controversial)", "Physical activity"] },
  ];

  let y = 1.15;
  leftItems.forEach(item => {
    slide.addText(item.heading, { x: 0.4, y, w: 4.5, h: 0.28, fontSize: 13, bold: true, color: C.mid });
    y += 0.28;
    item.points.forEach(p => {
      slide.addText([{ text: p, options: { bullet: true } }], { x: 0.4, y, w: 4.5, h: 0.3, fontSize: 11, color: C.text });
      y += 0.3;
    });
    y += 0.12;
  });

  y = 1.15;
  rightItems.forEach(item => {
    slide.addText(item.heading, { x: 5.1, y, w: 4.5, h: 0.28, fontSize: 13, bold: true, color: C.mid });
    y += 0.28;
    item.points.forEach(p => {
      slide.addText([{ text: p, options: { bullet: true } }], { x: 5.1, y, w: 4.5, h: 0.3, fontSize: 11, color: C.text });
      y += 0.3;
    });
    y += 0.12;
  });

  // Vertical divider
  slide.addShape(pres.ShapeType.line, { x: 5.0, y: 1.1, w: 0, h: 4.1, line: { color: C.subhead, pt: 1, dashType: "dash" } });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 5 — CLASSIFICATION (FIGO) with image
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white } });
  addSlideHeader(slide, "Classification — FIGO System", "Location-based classification of uterine fibroids");

  const types = [
    { type: "Type 0", name: "Pedunculated Submucosal", desc: "Entirely within uterine cavity on a stalk" },
    { type: "Type 1", name: "Submucosal >50%", desc: ">50% protrudes into cavity" },
    { type: "Type 2", name: "Submucosal <50%", desc: "<50% protrudes into cavity (intramural portion dominant)" },
    { type: "Type 3", name: "Intramural (contact endometrium)", desc: "Entirely intramural, contacts endometrium" },
    { type: "Type 4", name: "Intramural", desc: "Entirely within myometrium" },
    { type: "Type 5", name: "Subserosal ≥50%", desc: "≥50% within myometrium" },
    { type: "Type 6", name: "Subserosal <50%", desc: "<50% within myometrium (serosal dominant)" },
    { type: "Type 7", name: "Pedunculated Subserosal", desc: "Attached by stalk to serosal surface" },
    { type: "Type 8", name: "Other", desc: "Cervical, parasitic, or distant location" },
  ];

  // Table
  const tblX = 0.35, tblY = 1.2;
  const rowH = 0.38;
  // Header row
  slide.addShape(pres.ShapeType.rect, { x: tblX, y: tblY, w: 9.3, h: 0.38, fill: { color: C.deep } });
  slide.addText("Type", { x: tblX + 0.05, y: tblY, w: 0.7, h: rowH, fontSize: 11, bold: true, color: C.white, valign: "middle" });
  slide.addText("Category", { x: tblX + 0.75, y: tblY, w: 2.2, h: rowH, fontSize: 11, bold: true, color: C.white, valign: "middle" });
  slide.addText("Description", { x: tblX + 2.95, y: tblY, w: 6.7, h: rowH, fontSize: 11, bold: true, color: C.white, valign: "middle" });

  types.forEach((t, i) => {
    const ry = tblY + rowH + i * rowH;
    const bg = i % 2 === 0 ? C.light : C.white;
    const typeColors = i < 3 ? "1A6B3C" : i < 5 ? "1A5B8A" : "8A3A1A";  // green=sub, blue=intra, brown=sub-serosal
    slide.addShape(pres.ShapeType.rect, { x: tblX, y: ry, w: 9.3, h: rowH, fill: { color: bg }, line: { color: "DDDDDD", pt: 0.5 } });
    slide.addText(t.type, { x: tblX + 0.05, y: ry, w: 0.7, h: rowH, fontSize: 10, bold: true, color: typeColors, valign: "middle" });
    slide.addText(t.name, { x: tblX + 0.75, y: ry, w: 2.2, h: rowH, fontSize: 10, color: C.text, valign: "middle" });
    slide.addText(t.desc, { x: tblX + 2.95, y: ry, w: 6.7, h: rowH, fontSize: 10, color: C.muted, valign: "middle" });
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 6 — FIBROID TYPES DIAGRAM (image slide)
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.deep } });
  addSlideHeader(slide, "Fibroid Locations — Anatomical Overview");

  // Left: image
  const img0 = images[0];  // Bailey anatomy diagram
  if (img0 && !img0.error && img0.base64) {
    slide.addImage({ data: img0.base64, x: 0.3, y: 0.95, w: 5.2, h: 4.4 });
  }

  // Right: legend
  const legends = [
    { color: "3498DB", label: "Intramural", desc: "Within the uterine muscular wall. Most common type." },
    { color: "27AE60", label: "Submucosal", desc: "Below the endometrial lining. Most symptomatic — causes heavy bleeding." },
    { color: "E67E22", label: "Subserosal", desc: "Beneath the serosal surface — causes pelvic bulk/pressure." },
    { color: "9B59B6", label: "Pedunculated", desc: "Attached by a stalk — can be submucosal or subserosal." },
  ];
  legends.forEach((l, i) => {
    const y = 1.35 + i * 0.9;
    slide.addShape(pres.ShapeType.rect, { x: 5.8, y, w: 0.18, h: 0.55, fill: { color: l.color } });
    slide.addText(l.label, { x: 6.1, y, w: 3.7, h: 0.28, fontSize: 13, bold: true, color: C.white });
    slide.addText(l.desc, { x: 6.1, y: y + 0.27, w: 3.7, h: 0.32, fontSize: 10.5, color: "C5DCF0" });
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 7 — CLINICAL FEATURES
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white } });
  addSlideHeader(slide, "Clinical Features", "Signs & Symptoms by Location");

  const boxes = [
    {
      title: "Menstrual Symptoms",
      color: C.deep,
      items: ["Menorrhagia (heavy menstrual bleeding)", "Dysmenorrhea (painful periods)", "Intermenstrual bleeding", "Iron-deficiency anemia (chronic)", "Dyspareunia"],
    },
    {
      title: "Bulk / Pressure Symptoms",
      color: "1A6B6B",
      items: ["Pelvic pressure or fullness", "Urinary frequency / retention", "Constipation", "Abdominal distension", "Enlarged uterus on exam"],
    },
    {
      title: "Reproductive Complications",
      color: "6B1A1A",
      items: ["Subfertility / infertility", "Recurrent pregnancy loss", "Preterm labor", "Placenta previa (OR 2.2)", "Placental abruption (OR 2.6)", "Fetal malpresentation"],
    },
    {
      title: "Acute Symptoms",
      color: C.accent,
      items: ["Red degeneration (pregnancy)", "Torsion of pedunculated fibroid", "Acute urinary retention", "Severe acute pelvic pain", "Fever & leukocytosis (degeneration)"],
    },
  ];

  boxes.forEach((box, i) => {
    const x = 0.3 + (i % 2) * 4.85;
    const y = 1.1 + Math.floor(i / 2) * 2.2;
    slide.addShape(pres.ShapeType.rect, { x, y, w: 4.55, h: 0.38, fill: { color: box.color } });
    slide.addText(box.title, { x: x + 0.1, y, w: 4.35, h: 0.38, fontSize: 12, bold: true, color: C.white, valign: "middle" });
    slide.addShape(pres.ShapeType.rect, { x, y: y + 0.38, w: 4.55, h: 1.72, fill: { color: C.light }, line: { color: box.color, pt: 1 } });
    slide.addText(
      box.items.map((item, idx) => [
        { text: item, options: { bullet: true, breakLine: idx < box.items.length - 1 } }
      ]).flat().flat(),
      { x: x + 0.1, y: y + 0.38, w: 4.35, h: 1.72, fontSize: 11, color: C.text, valign: "top" }
    );
  });

  // Note: 50% asymptomatic
  slide.addShape(pres.ShapeType.rect, { x: 0.3, y: 5.14, w: 9.4, h: 0.28, fill: { color: "FFF3E0" }, line: { color: C.accent, pt: 1 } });
  slide.addText("★  Note: ~50–70% of fibroids are asymptomatic and require no treatment", {
    x: 0.4, y: 5.14, w: 9.2, h: 0.28, fontSize: 10.5, color: C.accent, bold: true, valign: "middle",
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 8 — DIAGNOSIS & IMAGING
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white } });
  addSlideHeader(slide, "Diagnosis & Imaging");

  // Left column — modalities
  const modalities = [
    {
      icon: "🔬", title: "Pelvic Ultrasound (First-Line)",
      points: ["Sensitivity ≈ MRI for detecting fibroids", "Well-defined, hypoechoic spherical mass", "Doppler: peripheral blood flow pattern", "TVS better than TAS for small lesions"],
    },
    {
      icon: "🧲", title: "MRI Pelvis (Gold Standard)",
      points: ["Best for fibroid mapping before surgery", "T2: hypointense mass within myometrium", "Distinguishes fibroid subtypes accurately", "Evaluates degeneration types"],
    },
    {
      icon: "💧", title: "Saline Infusion Sonohysterography",
      points: ["Excellent for submucosal fibroids", "Evaluates cavity distortion", "Guides hysteroscopic planning"],
    },
    {
      icon: "🔭", title: "Hysteroscopy",
      points: ["Direct visualization of submucosal fibroids", "Simultaneous diagnostic & therapeutic"],
    },
  ];

  let y = 1.1;
  modalities.forEach(m => {
    slide.addText(`${m.icon}  ${m.title}`, { x: 0.35, y, w: 5.8, h: 0.32, fontSize: 12.5, bold: true, color: C.mid });
    y += 0.32;
    m.points.forEach(p => {
      slide.addText([{ text: p, options: { bullet: true } }], { x: 0.35, y, w: 5.8, h: 0.27, fontSize: 10.5, color: C.text });
      y += 0.27;
    });
    y += 0.12;
  });

  // Right column — MRI image
  const mriImg = images[4];
  if (mriImg && !mriImg.error && mriImg.base64) {
    slide.addImage({ data: mriImg.base64, x: 6.4, y: 1.05, w: 3.3, h: 3.0 });
    slide.addText("MRI pelvis: T2 sagittal views — before & after GnRH antagonist treatment", {
      x: 6.4, y: 4.05, w: 3.3, h: 0.55, fontSize: 9, italic: true, color: C.muted, align: "center",
    });
  }

  // Divider
  slide.addShape(pres.ShapeType.line, { x: 6.2, y: 1.1, w: 0, h: 4.1, line: { color: C.subhead, pt: 1, dashType: "dash" } });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 9 — GROSS & HISTOPATHOLOGY
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: "0E1C30" } });
  addSlideHeader(slide, "Gross Pathology & Histology");

  // Two gross pathology images
  const grossImg = images[2]; // whorled cut surface
  const specImg = images[3];  // surgical specimen
  if (grossImg && !grossImg.error && grossImg.base64) {
    slide.addImage({ data: grossImg.base64, x: 0.3, y: 0.95, w: 4.1, h: 3.0 });
    slide.addText("Classic whorled cut surface — intramural leiomyoma", {
      x: 0.3, y: 3.95, w: 4.1, h: 0.4, fontSize: 9.5, italic: true, color: "8DB4D4", align: "center",
    });
  }
  if (specImg && !specImg.error && specImg.base64) {
    slide.addImage({ data: specImg.base64, x: 4.7, y: 0.95, w: 4.1, h: 3.0 });
    slide.addText("Subserous leiomyoma surgical specimen — myomectomy", {
      x: 4.7, y: 3.95, w: 4.1, h: 0.4, fontSize: 9.5, italic: true, color: "8DB4D4", align: "center",
    });
  }

  // Histology bullets at bottom
  const histPoints = [
    "Well-circumscribed benign smooth muscle tumor; encapsulated by a fibrous pseudocapsule",
    "Intersecting bundles of smooth muscle fibers in a whorled pattern",
    "Uniform spindle cells with elongated nuclei and eosinophilic cytoplasm (no atypia)",
    "Degeneration types: hyaline (most common), cystic, red/carneous, calcific, myxoid",
  ];
  slide.addText(
    histPoints.map((p, i) => [
      { text: p, options: { bullet: true, breakLine: i < histPoints.length - 1 } }
    ]).flat().flat(),
    { x: 0.3, y: 4.45, w: 9.4, h: 1.0, fontSize: 10.5, color: "D0E8F5" }
  );
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 10 — DEGENERATION TYPES
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white } });
  addSlideHeader(slide, "Degeneration of Fibroids", "Occurs due to outgrowth of blood supply");

  const types = [
    { name: "Hyaline", pct: "65%", color: "5B8DB8", desc: "Most common. Collagen replacement. Firm, white on cut section." },
    { name: "Cystic", pct: "4%", color: "27AE60", desc: "Liquefaction of hyalinized areas. Fluid-filled spaces on imaging." },
    { name: "Red (Carneous)", pct: "3%", color: "E74C3C", desc: "Hemorrhagic infarction. Classic in pregnancy — acute pain, fever, leukocytosis." },
    { name: "Myxoid", pct: "~2%", color: "9B59B6", desc: "Myxoid matrix. Can mimic sarcoma — require careful histology." },
    { name: "Calcific", pct: "~4%", color: "95A5A6", desc: "Late stage. Calcium deposits. Post-menopausal. Visible on plain X-ray." },
    { name: "Sarcomatous", pct: "<1%", color: C.accent, desc: "Malignant transformation (leiomyosarcoma). Rare but serious." },
  ];

  types.forEach((t, i) => {
    const x = 0.3 + (i % 3) * 3.2;
    const y = 1.1 + Math.floor(i / 3) * 2.1;
    slide.addShape(pres.ShapeType.rect, { x, y, w: 3.0, h: 0.38, fill: { color: t.color } });
    slide.addText(`${t.name}  (${t.pct})`, { x: x + 0.1, y, w: 2.8, h: 0.38, fontSize: 12, bold: true, color: C.white, valign: "middle" });
    slide.addShape(pres.ShapeType.rect, { x, y: y + 0.38, w: 3.0, h: 1.6, fill: { color: C.light }, line: { color: t.color, pt: 1 } });
    slide.addText(t.desc, { x: x + 0.1, y: y + 0.45, w: 2.8, h: 1.45, fontSize: 11, color: C.text, valign: "top" });
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 11 — COMPLICATIONS
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white } });
  addSlideHeader(slide, "Complications");

  const comps = [
    { icon: "🩸", title: "Anemia", detail: "Chronic iron-deficiency anemia from menorrhagia. May require transfusion." },
    { icon: "🤰", title: "Infertility", detail: "Submucosal fibroids distort cavity; impair implantation and sperm migration." },
    { icon: "👶", title: "Obstetric Complications", detail: "Preterm labour, placenta previa (OR 2.2), abruption (OR 2.6), malpresentation." },
    { icon: "💊", title: "Red Degeneration", detail: "Hemorrhagic infarction in pregnancy — acute abdomen, fever, raised WBC." },
    { icon: "🔄", title: "Torsion", detail: "Pedunculated fibroids can twist on their pedicle — acute surgical emergency." },
    { icon: "⚠️", title: "Malignant Change", detail: "Leiomyosarcoma — rare (<1%). Suspect if rapid growth or post-menopausal growth." },
    { icon: "🚽", title: "Urinary Symptoms", detail: "Bladder compression → frequency, urgency, acute urinary retention." },
    { icon: "🔪", title: "Haemorrhage", detail: "Rare spontaneous rupture of surface vessel → haemoperitoneum." },
  ];

  comps.forEach((c, i) => {
    const x = 0.3 + (i % 4) * 2.35;
    const y = 1.1 + Math.floor(i / 4) * 2.15;
    slide.addShape(pres.ShapeType.rect, { x, y, w: 2.15, h: 2.0, fill: { color: C.light }, line: { color: C.mid, pt: 1.5 } });
    slide.addText(c.icon, { x, y: y + 0.12, w: 2.15, h: 0.45, fontSize: 22, align: "center" });
    slide.addText(c.title, { x: x + 0.05, y: y + 0.56, w: 2.05, h: 0.3, fontSize: 11, bold: true, color: C.mid, align: "center" });
    slide.addText(c.detail, { x: x + 0.1, y: y + 0.86, w: 1.95, h: 1.05, fontSize: 9.5, color: C.text, align: "center" });
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 12 — MANAGEMENT ALGORITHM
// ──────────────────────────────────────────────────────────────────────────────
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  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white } });
  addSlideHeader(slide, "Management Overview", "Tailored to symptoms, fertility desire, and fibroid characteristics");

  // Three pathways
  const paths = [
    {
      title: "Expectant Management",
      color: "27AE60",
      sub: "Asymptomatic fibroids",
      items: [
        "No treatment needed",
        "Regular surveillance (6–12 monthly US)",
        "Reassure patient",
        "Review if symptoms develop",
      ],
    },
    {
      title: "Medical Management",
      color: C.mid,
      sub: "Symptomatic — fertility-preserving or bridge therapy",
      items: [
        "GnRH agonists (leuprolide): shrink fibroid ≈50%; pre-op use",
        "GnRH antagonists (elagolix, linzagolix): oral, reduce HMB",
        "Levonorgestrel IUS: reduces HMB",
        "Combined OCP / progestins: cycle control",
        "Tranexamic acid / NSAIDs: symptomatic HMB relief",
        "Iron supplementation: correct anaemia",
      ],
    },
    {
      title: "Surgical / Interventional",
      color: C.accent,
      sub: "Definitive or fertility-preserving surgery",
      items: [
        "Myomectomy: fibroid removal, uterus preserved",
        "Hysteroscopic myomectomy: submucosal (Type 0–2)",
        "Hysterectomy: definitive cure — no desire for fertility",
        "Uterine Artery Embolization (UAE): non-surgical",
        "MRI-guided focused ultrasound (MRgFUS): non-invasive",
        "Endometrial ablation: for HMB (no submucosal fibroids)",
      ],
    },
  ];

  paths.forEach((p, i) => {
    const x = 0.25 + i * 3.2;
    const y = 1.1;
    slide.addShape(pres.ShapeType.rect, { x, y, w: 3.0, h: 0.42, fill: { color: p.color } });
    slide.addText(p.title, { x: x + 0.08, y, w: 2.85, h: 0.42, fontSize: 12.5, bold: true, color: C.white, valign: "middle" });
    slide.addShape(pres.ShapeType.rect, { x, y: y + 0.42, w: 3.0, h: 0.3, fill: { color: "E0ECF8" } });
    slide.addText(p.sub, { x: x + 0.08, y: y + 0.42, w: 2.85, h: 0.3, fontSize: 9, italic: true, color: C.muted, valign: "middle" });
    slide.addShape(pres.ShapeType.rect, { x, y: y + 0.72, w: 3.0, h: 3.78, fill: { color: C.light }, line: { color: p.color, pt: 1 } });
    slide.addText(
      p.items.map((item, idx) => [
        { text: item, options: { bullet: true, breakLine: idx < p.items.length - 1 } }
      ]).flat().flat(),
      { x: x + 0.1, y: y + 0.8, w: 2.8, h: 3.55, fontSize: 10.5, color: C.text, valign: "top" }
    );
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 13 — SURGICAL OPTIONS
// ──────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white } });
  addSlideHeader(slide, "Surgical Options in Detail");

  const surgeries = [
    {
      name: "Hysteroscopic Myomectomy",
      ind: "Submucosal (FIGO 0–2); HMB; infertility",
      approach: "Resectoscope via cervix — no incision",
      pros: "Day case; rapid recovery; uterus preserved",
      cons: "Limited to cavity lesions; fluid overload risk",
    },
    {
      name: "Laparoscopic Myomectomy",
      ind: "Intramural/subserosal ≤10 cm; limited number",
      approach: "Minimally invasive; laparoscopic dissection",
      pros: "Less blood loss; faster recovery vs open",
      cons: "Longer OR time; requires expertise; morcellation risk",
    },
    {
      name: "Open (Abdominal) Myomectomy",
      ind: "Multiple/large fibroids; complex anatomy",
      approach: "Laparotomy — Pfannenstiel or midline incision",
      pros: "Complete resection; any location/size",
      cons: "Longer recovery; adhesion risk; blood loss",
    },
    {
      name: "Hysterectomy",
      ind: "Completed family; failed conservative Rx; large/multiple fibroids",
      approach: "Vaginal / laparoscopic / open",
      pros: "Definitive cure; no recurrence",
      cons: "Loss of fertility; surgical risks; hormonal impact",
    },
  ];

  // Column headers
  const cols = ["Procedure", "Indication", "Approach", "Advantages", "Disadvantages"];
  const colW = [2.3, 2.1, 2.2, 1.7, 1.7];
  let cx = 0.2;
  slide.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.1, w: 9.6, h: 0.32, fill: { color: C.deep } });
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    cx += colW[i];
  });

  surgeries.forEach((s, ri) => {
    const ry = 1.42 + ri * 0.97;
    const bg = ri % 2 === 0 ? C.light : C.white;
    slide.addShape(pres.ShapeType.rect, { x: 0.2, y: ry, w: 9.6, h: 0.97, fill: { color: bg }, line: { color: "CCCCCC", pt: 0.5 } });
    const vals = [s.name, s.ind, s.approach, s.pros, s.cons];
    let vx = 0.2;
    vals.forEach((v, vi) => {
      slide.addText(v, {
        x: vx + 0.04, y: ry + 0.04, w: colW[vi] - 0.08, h: 0.88,
        fontSize: 9.5, color: vi === 0 ? C.mid : C.text, bold: vi === 0, valign: "middle",
      });
      vx += colW[vi];
    });
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 14 — UAE & NOVEL TREATMENTS
// ──────────────────────────────────────────────────────────────────────────────
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  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white } });
  addSlideHeader(slide, "Uterine Artery Embolization & Novel Therapies");

  // UAE box
  slide.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.15, w: 9.3, h: 0.38, fill: { color: C.mid } });
  slide.addText("Uterine Artery Embolization (UAE)", { x: 0.45, y: 1.15, w: 9.0, h: 0.38, fontSize: 14, bold: true, color: C.white, valign: "middle" });
  const uaeItems = [
    "Percutaneous fluoroscopic-guided embolization of uterine arteries via femoral access",
    "Polyvinyl alcohol (PVA) particles / microspheres used to occlude arterial supply to fibroids",
    "Fibroid volume reduction of 40–70% at 6 months; symptom improvement in 85–90%",
    "Ontario UFE Trial: significant reduction in bleeding, pain, and bulk symptoms",
    "Contraindicated: desire for future pregnancy (relative), infection, malignancy suspicion",
    "Complications: post-embolization syndrome (fever, pain), ovarian failure (rare), expulsion of fibroid",
  ];
  slide.addText(
    uaeItems.map((item, i) => [
      { text: item, options: { bullet: true, breakLine: i < uaeItems.length - 1 } }
    ]).flat().flat(),
    { x: 0.35, y: 1.53, w: 9.3, h: 1.9, fontSize: 11, color: C.text }
  );

  // Novel therapies
  slide.addShape(pres.ShapeType.rect, { x: 0.35, y: 3.55, w: 9.3, h: 0.35, fill: { color: C.accent } });
  slide.addText("Novel & Emerging Therapies", { x: 0.45, y: 3.55, w: 9.0, h: 0.35, fontSize: 13, bold: true, color: C.white, valign: "middle" });
  const novelItems = [
    { name: "MRI-guided Focused Ultrasound (MRgFUS / HIFU):", desc: "Non-invasive thermal ablation. FDA-approved. Best for ≤3 fibroids, anterior intramural." },
    { name: "Radiofrequency Ablation (Acessa™):", desc: "Laparoscopic US-guided probe. Reduces uterine volume. Fertility-preserving." },
    { name: "GnRH Antagonists (Linzagolix, Relugolix):", desc: "Oral, rapid onset. Approved for HMB associated with fibroids. Add-back HRT reduces bone loss." },
  ];
  novelItems.forEach((n, i) => {
    const y = 3.96 + i * 0.42;
    slide.addText([
      { text: n.name + "  ", options: { bold: true, color: C.mid } },
      { text: n.desc, options: { color: C.text } },
    ], { x: 0.35, y, w: 9.3, h: 0.4, fontSize: 10.5, valign: "middle" });
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// SLIDE 15 — KEY POINTS / SUMMARY
// ──────────────────────────────────────────────────────────────────────────────
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  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.deep } });
  addSlideHeader(slide, "Key Takeaways");

  const points = [
    { num: "1", text: "Uterine myomas are the most common benign pelvic tumors in women; ~20–40% of reproductive-age women are affected." },
    { num: "2", text: "Monoclonal smooth muscle tumors, hormonally driven by estrogen and progesterone." },
    { num: "3", text: "FIGO classification (Types 0–8) guides treatment approach — submucosal fibroids are most symptomatic." },
    { num: "4", text: "Most common symptoms: menorrhagia, dysmenorrhea, pelvic pressure, infertility." },
    { num: "5", text: "50–70% are asymptomatic — expectant management is appropriate for many patients." },
    { num: "6", text: "Ultrasound is first-line imaging; MRI is the gold standard for fibroid mapping pre-operatively." },
    { num: "7", text: "Medical options (GnRH agonists/antagonists, LNG-IUS) are temporizing; surgical options offer more durable relief." },
    { num: "8", text: "Myomectomy preserves fertility; hysterectomy is curative. UAE is an effective non-surgical option." },
  ];

  points.forEach((p, i) => {
    const y = 1.15 + i * 0.54;
    slide.addShape(pres.ShapeType.rect, { x: 0.35, y: y + 0.04, w: 0.42, h: 0.38, fill: { color: C.accent } });
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    slide.addText(p.text, { x: 0.87, y, w: 8.8, h: 0.52, fontSize: 11.5, color: "D0E8F5", valign: "middle" });
  });
}

// ──────────────────────────────────────────────────────────────────────────────
// WRITE FILE
// ──────────────────────────────────────────────────────────────────────────────
const outPath = "/home/daytona/workspace/uterine-myoma-ppt/Uterine_Myoma.pptx";
pres.writeFile({ fileName: outPath })
  .then(() => console.log("✅  Saved:", outPath))
  .catch(err => { console.error("❌  Error:", err); process.exit(1); });