const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3" × 7.5"
pres.title = "Clinical Decision Flowchart: Anti-Cytokine Therapies";
pres.author = "Orris Medical AI";

// ─── Colour Palette ───────────────────────────────────────────────
const C = {
  navy:    "0D1F3C",
  teal:    "0B7285",
  tealLt:  "1A9BAF",
  amber:   "E67700",
  green:   "2E7D32",
  purple:  "6A1E8F",
  red:     "B71C1C",
  orange:  "E65100",
  steel:   "37474F",
  white:   "FFFFFF",
  offWhite:"F4F6F9",
  ltGray:  "E8ECF0",
  midGray: "9EA9B0",
  gold:    "F59F00",
  lime:    "558B2F",
};

// ─── Helpers ──────────────────────────────────────────────────────
function box(slide, opts) {
  const {
    x, y, w, h,
    fill = C.white, line = C.steel, lineW = 1.5,
    text, fontSize = 11, bold = false, color = C.steel,
    align = "center", valign = "middle",
    radius, textArr,
  } = opts;

  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h,
    fill: { color: fill },
    line: { color: line, width: lineW },
    rectRadius: radius !== undefined ? radius : 0.12,
  });

  if (textArr) {
    slide.addText(textArr, { x, y, w, h, align, valign, fontSize, color, margin: 4 });
  } else if (text) {
    slide.addText(text, { x, y, w, h, align, valign, fontSize, bold, color, margin: 4 });
  }
}

function diamond(slide, opts) {
  const { x, y, w, h, fill, line = C.steel, text, fontSize = 10, color = C.white, bold = true } = opts;
  slide.addShape(pres.ShapeType.diamond, {
    x, y, w, h,
    fill: { color: fill },
    line: { color: line, width: 1.5 },
  });
  slide.addText(text, { x, y, w, h, align: "center", valign: "middle", fontSize, bold, color, margin: 4 });
}

function arrow(slide, x1, y1, x2, y2, color = C.steel) {
  slide.addShape(pres.ShapeType.line, {
    x: x1, y: y1, w: x2 - x1, h: y2 - y1,
    line: { color, width: 1.5, endArrowType: "triangle" },
  });
}

function label(slide, x, y, text, fontSize = 8.5, color = C.amber, bold = true) {
  slide.addText(text, { x, y, w: 0.7, h: 0.22, fontSize, bold, color, align: "center" });
}

function sectionHeader(slide, x, y, w, text, fill, textColor = C.white) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h: 0.38,
    fill: { color: fill },
    line: { color: fill },
    rectRadius: 0.1,
  });
  slide.addText(text, { x, y, w, h: 0.38, align: "center", valign: "middle", fontSize: 10, bold: true, color: textColor, margin: 0 });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 1 — Title / Overview
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();

  // Dark background
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: C.navy }, line: { color: C.navy } });

  // Accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 7.5, fill: { color: C.tealLt }, line: { color: C.tealLt } });

  // Title
  s.addText("Clinical Decision Flowchart", {
    x: 0.5, y: 1.4, w: 12.3, h: 0.85,
    fontSize: 36, bold: true, color: C.white, align: "center",
  });
  s.addText("Anti-Cytokine Therapy Selection by Disease", {
    x: 0.5, y: 2.3, w: 12.3, h: 0.55,
    fontSize: 22, bold: false, color: C.tealLt, align: "center",
  });
  s.addText("For Medical Students & Trainees", {
    x: 0.5, y: 2.9, w: 12.3, h: 0.35,
    fontSize: 14, bold: false, color: C.midGray, align: "center",
  });

  // Disease area pills
  const pills = [
    { label: "Rheumatic Diseases", fill: C.teal },
    { label: "GI / IBD", fill: C.green },
    { label: "Respiratory / Allergy", fill: C.purple },
    { label: "Oncology / CRS", fill: C.red },
    { label: "Emergency / Sepsis", fill: C.orange },
  ];
  const pillW = 2.2, gap = 0.2;
  const totalW = pills.length * pillW + (pills.length - 1) * gap;
  let px = (13.3 - totalW) / 2;
  pills.forEach(p => {
    s.addShape(pres.ShapeType.roundRect, { x: px, y: 3.65, w: pillW, h: 0.38, fill: { color: p.fill }, line: { color: p.fill }, rectRadius: 0.19 });
    s.addText(p.label, { x: px, y: 3.65, w: pillW, h: 0.38, align: "center", valign: "middle", fontSize: 9.5, bold: true, color: C.white, margin: 0 });
    px += pillW + gap;
  });

  // Legend
  s.addText("How to use this flowchart:", { x: 1.5, y: 4.35, w: 10.3, h: 0.3, fontSize: 11, bold: true, color: C.gold, align: "center" });
  s.addText([
    { text: "1. Identify the patient's primary diagnosis    ", options: {} },
    { text: "2. Navigate to the relevant slide    ", options: {} },
    { text: "3. Follow the decision nodes (diamonds) to select the appropriate biologic or JAK inhibitor", options: {} },
  ], { x: 1.5, y: 4.65, w: 10.3, h: 0.5, fontSize: 10, color: C.ltGray, align: "center", margin: 0 });

  // Note
  s.addText("⚠  Always individualise therapy. Check contraindications, TB screening, and local formulary before prescribing.", {
    x: 1.0, y: 5.45, w: 11.3, h: 0.45,
    fontSize: 9.5, italic: true, color: C.midGray, align: "center",
  });

  // Footer
  s.addText("Sources: Firestein & Kelley's Rheumatology | Goodman & Gilman's Pharmacology | Cellular & Molecular Immunology", {
    x: 0.4, y: 7.1, w: 12.5, h: 0.25, fontSize: 7.5, color: C.midGray, align: "center",
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 2 — Rheumatic Diseases
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: C.offWhite }, line: { color: C.offWhite } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.52, fill: { color: C.navy }, line: { color: C.navy } });
  s.addText("RHEUMATIC DISEASES — Anti-Cytokine Therapy Flowchart", {
    x: 0.2, y: 0, w: 12.9, h: 0.52, fontSize: 13, bold: true, color: C.white, valign: "middle",
  });

  // ── START BOX ──
  box(s, { x: 5.4, y: 0.7, w: 2.5, h: 0.45, fill: C.navy, line: C.navy, text: "Inflammatory Arthritis / Connective Tissue Disease", fontSize: 8.5, color: C.white, bold: true });
  arrow(s, 6.65, 1.15, 6.65, 1.42);

  // ── Q1: Diagnosis ──
  diamond(s, { x: 5.2, y: 1.42, w: 2.9, h: 0.7, fill: C.teal, text: "Primary Diagnosis?", fontSize: 10 });

  // ─ Branch arrows from diamond center (6.65, 1.77)
  // Left → RA
  arrow(s, 5.2, 1.77, 2.55, 1.77);
  label(s, 4.0, 1.6, "RA / JIA");
  // Right → SpA/PsA
  arrow(s, 8.1, 1.77, 10.25, 1.77);
  label(s, 8.9, 1.6, "PsA / AS");
  // Down → SLE / other
  arrow(s, 6.65, 2.12, 6.65, 2.38);
  label(s, 6.75, 2.15, "SLE / PMR / GCA");

  // ─── RA branch ───
  diamond(s, { x: 0.7, y: 1.42, w: 2.5, h: 0.7, fill: C.tealLt, text: "Adequate response to MTX / csDMARD?", fontSize: 9 });
  // Yes → continue MTX
  arrow(s, 1.95, 1.42, 1.95, 0.95);
  label(s, 2.0, 1.05, "YES");
  box(s, { x: 0.7, y: 0.55, w: 2.5, h: 0.38, fill: C.lime, line: C.lime, text: "Continue csDMARD (MTX) + monitor", fontSize: 8, color: C.white });
  // No → next q
  arrow(s, 1.95, 2.12, 1.95, 2.4);
  label(s, 2.05, 2.2, "NO");
  diamond(s, { x: 0.7, y: 2.4, w: 2.5, h: 0.7, fill: C.tealLt, text: "High disease activity or poor prognosis?", fontSize: 9 });
  // → bDMARD
  arrow(s, 1.95, 3.1, 1.95, 3.38);
  box(s, { x: 0.25, y: 3.38, w: 3.4, h: 1.1, fill: C.white, line: C.teal,
    textArr: [
      { text: "Anti-TNF (1st line bDMARD)\n", options: { bold: true, color: C.teal, fontSize: 10, breakLine: false } },
      { text: "Infliximab, Adalimumab,\nEtanercept, Certolizumab\n", options: { color: C.steel, fontSize: 9, breakLine: false } },
      { text: "Baricitinib / Tofacitinib (JAKi)\n", options: { bold: true, color: C.purple, fontSize: 9, breakLine: false } },
      { text: "if anti-TNF fails or contraindicated", options: { color: C.midGray, fontSize: 8 } },
    ],
    align: "left", valign: "top",
  });
  // IL-6R if anti-TNF fails
  arrow(s, 1.95, 4.48, 1.95, 4.75);
  box(s, { x: 0.25, y: 4.75, w: 3.4, h: 0.65, fill: C.white, line: C.purple,
    textArr: [
      { text: "Anti-TNF failure?  →  ", options: { bold: true, color: C.steel, fontSize: 9 } },
      { text: "Tocilizumab (anti-IL-6R)\nor Sarilumab / Abatacept / Rituximab", options: { color: C.purple, fontSize: 9 } },
    ],
    align: "left", valign: "middle",
  });
  // IL-1RA for Still's
  arrow(s, 1.95, 5.4, 1.95, 5.65);
  box(s, { x: 0.25, y: 5.65, w: 3.4, h: 0.5, fill: C.white, line: C.orange,
    textArr: [
      { text: "Still's Disease / Autoinflammatory:  ", options: { bold: true, color: C.steel, fontSize: 9 } },
      { text: "Anakinra (IL-1RA) or Canakinumab", options: { color: C.orange, fontSize: 9 } },
    ],
    align: "left", valign: "middle",
  });

  // ─── PsA / AS branch ───
  diamond(s, { x: 9.5, y: 1.42, w: 2.8, h: 0.7, fill: C.tealLt, text: "Prominent skin disease (psoriasis)?", fontSize: 9 });
  // YES →
  arrow(s, 10.9, 1.42, 10.9, 0.92);
  label(s, 10.98, 1.1, "YES");
  box(s, { x: 9.5, y: 0.55, w: 2.8, h: 0.35, fill: C.purple, line: C.purple, text: "IL-17A inhibitor: Secukinumab / Ixekizumab", fontSize: 8.5, color: C.white });
  // NO → anti-TNF preferred
  arrow(s, 12.3, 1.77, 12.6, 1.77);
  label(s, 12.35, 1.6, "NO");
  box(s, { x: 12.6, y: 1.6, w: 0.65, h: 0.35, fill: C.teal, line: C.teal, text: "Anti-TNF", fontSize: 8, color: C.white });

  arrow(s, 10.9, 2.12, 10.9, 2.38);
  diamond(s, { x: 9.5, y: 2.38, w: 2.8, h: 0.7, fill: C.tealLt, text: "Predominant axial disease (AS)?", fontSize: 9 });
  arrow(s, 10.9, 3.08, 10.9, 3.38);
  box(s, { x: 9.5, y: 3.38, w: 2.8, h: 0.95, fill: C.white, line: C.teal,
    textArr: [
      { text: "Anti-TNF (1st line):\n", options: { bold: true, color: C.teal, fontSize: 9, breakLine: false } },
      { text: "Adalimumab, Certolizumab,\nEtanercept\n", options: { color: C.steel, fontSize: 8.5, breakLine: false } },
      { text: "OR  IL-17A inhibitor (secukinumab)\nif anti-TNF contraindicated", options: { color: C.purple, fontSize: 8.5 } },
    ],
    align: "left", valign: "top",
  });

  arrow(s, 10.9, 4.33, 10.9, 4.6);
  box(s, { x: 9.5, y: 4.6, w: 2.8, h: 0.65, fill: C.white, line: C.purple,
    textArr: [
      { text: "Skin + joints (PsA):  ", options: { bold: true, color: C.steel, fontSize: 9 } },
      { text: "IL-23 inhibitor\n(Guselkumab, Risankizumab)", options: { color: C.purple, fontSize: 9 } },
    ],
    align: "left", valign: "middle",
  });

  // ─── SLE / PMR / GCA branch ───
  diamond(s, { x: 5.2, y: 2.38, w: 2.9, h: 0.7, fill: C.tealLt, text: "Specific diagnosis?", fontSize: 10 });
  // GCA
  arrow(s, 7.5, 2.73, 8.5, 3.5);
  label(s, 7.8, 2.8, "GCA/PMR");
  box(s, { x: 7.8, y: 3.5, w: 2.1, h: 0.55, fill: C.white, line: C.teal, text: "Tocilizumab (IL-6R)\n+ steroids taper", fontSize: 8.5, color: C.steel });
  // SLE
  arrow(s, 6.65, 3.08, 6.65, 3.38);
  label(s, 6.75, 3.15, "SLE");
  box(s, { x: 5.2, y: 3.38, w: 2.9, h: 0.8, fill: C.white, line: C.teal,
    textArr: [
      { text: "Anifrolumab (anti-IFN-α receptor)\n", options: { bold: true, color: C.teal, fontSize: 9, breakLine: false } },
      { text: "Belimumab (anti-BLyS)\n", options: { color: C.steel, fontSize: 8.5, breakLine: false } },
      { text: "Baricitinib (JAKi – lupus nephritis)", options: { color: C.purple, fontSize: 8.5 } },
    ],
    align: "left", valign: "top",
  });

  // Key box
  s.addShape(pres.ShapeType.roundRect, { x: 3.7, y: 5.6, w: 5.9, h: 1.65, fill: { color: C.ltGray }, line: { color: C.midGray, width: 1 }, rectRadius: 0.1 });
  s.addText("📋  Screen before any biologic:", { x: 3.8, y: 5.65, w: 5.7, h: 0.28, fontSize: 9.5, bold: true, color: C.navy });
  s.addText([
    { text: "• TB (Quantiferon/TST)  •  Hepatitis B & C serology  •  Varicella immunity\n", options: { fontSize: 8.5, color: C.steel, breakLine: false } },
    { text: "• Pregnancy / breastfeeding  •  Live vaccine history  •  Renal/hepatic function\n", options: { fontSize: 8.5, color: C.steel, breakLine: false } },
    { text: "• Active infection = HOLD biologic  •  Heart failure (NYHA III/IV) = avoid anti-TNF", options: { fontSize: 8.5, color: C.red, bold: true } },
  ], { x: 3.8, y: 5.95, w: 5.7, h: 1.2, margin: 0 });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 3 — GI / Respiratory / Oncology / Emergency
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: C.offWhite }, line: { color: C.offWhite } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.52, fill: { color: C.navy }, line: { color: C.navy } });
  s.addText("GI · RESPIRATORY · ONCOLOGY · EMERGENCY — Anti-Cytokine Therapy Flowchart", {
    x: 0.2, y: 0, w: 12.9, h: 0.52, fontSize: 12, bold: true, color: C.white, valign: "middle",
  });

  // ── Column dividers ──
  s.addShape(pres.ShapeType.line, { x: 3.3, y: 0.6, w: 0, h: 6.7, line: { color: C.ltGray, width: 1.5 } });
  s.addShape(pres.ShapeType.line, { x: 6.65, y: 0.6, w: 0, h: 6.7, line: { color: C.ltGray, width: 1.5 } });
  s.addShape(pres.ShapeType.line, { x: 9.95, y: 0.6, w: 0, h: 6.7, line: { color: C.ltGray, width: 1.5 } });

  // Column headers
  sectionHeader(s, 0.1, 0.58, 3.1, "🩺  GI / IBD", C.green);
  sectionHeader(s, 3.4, 0.58, 3.15, "🫁  Respiratory / Allergy", C.purple);
  sectionHeader(s, 6.75, 0.58, 3.1, "🔬  Oncology / CAR-T", C.red);
  sectionHeader(s, 10.05, 0.58, 3.15, "🚨  Emergency / Critical Care", C.orange);

  // ── GI / IBD ──
  diamond(s, { x: 0.3, y: 1.1, w: 2.7, h: 0.65, fill: C.green, text: "IBD Subtype?", fontSize: 10 });
  // Crohn's
  arrow(s, 1.65, 1.1, 1.65, 0.85);
  s.addText("Crohn's", { x: 0.3, y: 0.64, w: 1.1, h: 0.2, fontSize: 8, color: C.amber, bold: true });
  box(s, { x: 0.1, y: 0.15, w: 1.5, h: 0.5, fill: C.white, line: C.green,
    text: "Anti-TNF\n(Infliximab /\nAdalimumab)", fontSize: 7.5, color: C.steel });
  // UC / both
  arrow(s, 1.65, 1.75, 1.65, 2.05);
  s.addText("UC / Both", { x: 1.8, y: 1.55, w: 0.9, h: 0.2, fontSize: 8, color: C.amber, bold: true });
  box(s, { x: 0.1, y: 2.05, w: 3.1, h: 1.0, fill: C.white, line: C.green,
    textArr: [
      { text: "Vedolizumab (anti-α4β7 integrin)\n", options: { bold: true, color: C.green, fontSize: 9, breakLine: false } },
      { text: "Ustekinumab (anti-IL-12/23 p40)\n", options: { color: C.steel, fontSize: 8.5, breakLine: false } },
      { text: "Risankizumab (anti-IL-23 p19)\n", options: { color: C.steel, fontSize: 8.5, breakLine: false } },
      { text: "Tofacitinib / Upadacitinib (JAKi – UC)\n", options: { color: C.purple, fontSize: 8.5, breakLine: false } },
      { text: "Anti-TNF: if above fail or severe flare", options: { color: C.midGray, fontSize: 8 } },
    ],
    align: "left", valign: "top",
  });
  arrow(s, 1.65, 3.05, 1.65, 3.3);
  diamond(s, { x: 0.3, y: 3.3, w: 2.7, h: 0.65, fill: C.green, text: "Steroid-dependent?", fontSize: 9.5 });
  arrow(s, 1.65, 3.95, 1.65, 4.2);
  box(s, { x: 0.1, y: 4.2, w: 3.1, h: 0.55, fill: C.white, line: C.green,
    text: "Escalate to biologic + step-up steroid-free maintenance protocol", fontSize: 8.5, color: C.steel });
  arrow(s, 1.65, 4.75, 1.65, 5.0);
  box(s, { x: 0.1, y: 5.0, w: 3.1, h: 0.7, fill: C.white, line: C.orange,
    textArr: [
      { text: "Peri-operative / fistulising Crohn's:\n", options: { bold: true, color: C.orange, fontSize: 9, breakLine: false } },
      { text: "Infliximab (induction) + consider\ncombination therapy with MTX/AZA", options: { color: C.steel, fontSize: 8.5 } },
    ],
    align: "left", valign: "top",
  });

  // ── Respiratory / Allergy ──
  diamond(s, { x: 3.5, y: 1.1, w: 3.0, h: 0.65, fill: C.purple, text: "Respiratory / Allergic Condition?", fontSize: 9 });
  // Severe asthma branch
  arrow(s, 5.0, 1.75, 5.0, 2.05);
  s.addText("Severe asthma", { x: 5.1, y: 1.77, w: 1.3, h: 0.2, fontSize: 8, color: C.amber, bold: true });
  diamond(s, { x: 3.5, y: 2.05, w: 3.0, h: 0.65, fill: C.purple, text: "Eosinophilic phenotype\n(eos ≥ 300)?", fontSize: 9 });
  arrow(s, 5.0, 2.7, 5.0, 2.98);
  s.addText("YES", { x: 5.1, y: 2.75, w: 0.5, h: 0.2, fontSize: 8, color: C.amber, bold: true });
  box(s, { x: 3.5, y: 2.98, w: 3.0, h: 0.75, fill: C.white, line: C.purple,
    textArr: [
      { text: "Anti-IL-5: Mepolizumab / Reslizumab\n", options: { bold: true, color: C.purple, fontSize: 9, breakLine: false } },
      { text: "Anti-IL-5Rα: Benralizumab\n", options: { color: C.steel, fontSize: 8.5, breakLine: false } },
      { text: "Anti-IL-4Rα: Dupilumab (IL-4 + IL-13)\nif atopic + eosinophilic", options: { color: C.steel, fontSize: 8.5 } },
    ],
    align: "left", valign: "top",
  });
  arrow(s, 3.5, 2.37, 3.2, 2.37);
  s.addText("NO", { x: 3.0, y: 2.2, w: 0.5, h: 0.2, fontSize: 8, color: C.amber, bold: true });
  box(s, { x: 3.4, y: 3.85, w: 3.0, h: 0.55, fill: C.white, line: C.purple,
    text: "Tezepelumab (anti-TSLP)\nfor uncontrolled severe asthma, any phenotype", fontSize: 8.5, color: C.steel });
  arrow(s, 5.0, 3.73, 5.0, 3.85);
  // Atopic derm
  arrow(s, 5.0, 4.4, 5.0, 4.65);
  s.addText("Atopic dermatitis /\nChronic urticaria", { x: 5.1, y: 4.35, w: 1.8, h: 0.28, fontSize: 8, color: C.amber, bold: true });
  box(s, { x: 3.5, y: 4.65, w: 3.0, h: 0.65, fill: C.white, line: C.purple,
    textArr: [
      { text: "Dupilumab (anti-IL-4Rα, blocks IL-4 + IL-13)\n", options: { bold: true, color: C.purple, fontSize: 9, breakLine: false } },
      { text: "Tralokinumab (anti-IL-13)\n", options: { color: C.steel, fontSize: 8.5, breakLine: false } },
      { text: "Omalizumab (anti-IgE) for urticaria / allergic asthma", options: { color: C.steel, fontSize: 8.5 } },
    ],
    align: "left", valign: "top",
  });

  // ── Oncology / CAR-T ──
  diamond(s, { x: 6.85, y: 1.1, w: 2.95, h: 0.65, fill: C.red, text: "Oncology Indication?", fontSize: 9.5 });
  // Cytokine release syndrome (CRS)
  arrow(s, 8.32, 1.75, 8.32, 2.05);
  s.addText("CAR-T CRS\n/ immune effector\ncell toxicity", { x: 8.4, y: 1.6, w: 1.5, h: 0.45, fontSize: 7.5, color: C.amber, bold: true });
  diamond(s, { x: 6.85, y: 2.05, w: 2.95, h: 0.65, fill: C.red, text: "CRS Grade?", fontSize: 10 });
  arrow(s, 8.32, 2.7, 8.32, 2.98);
  s.addText("Grade ≥2", { x: 8.4, y: 2.72, w: 0.9, h: 0.2, fontSize: 8, color: C.amber, bold: true });
  box(s, { x: 6.85, y: 2.98, w: 2.95, h: 0.7, fill: C.white, line: C.red,
    textArr: [
      { text: "Tocilizumab (anti-IL-6R) — FIRST LINE\n", options: { bold: true, color: C.red, fontSize: 9, breakLine: false } },
      { text: "± Corticosteroids\n", options: { color: C.steel, fontSize: 8.5, breakLine: false } },
      { text: "Grade 3–4: ICU support; repeat tocilizumab\nor siltuximab if refractory", options: { color: C.orange, fontSize: 8.5 } },
    ],
    align: "left", valign: "top",
  });
  // Grade 1
  arrow(s, 6.85, 2.37, 6.65, 2.37);
  s.addText("Grade 1", { x: 6.5, y: 2.18, w: 0.7, h: 0.2, fontSize: 8, color: C.amber, bold: true });
  box(s, { x: 6.0, y: 2.25, w: 0.6, h: 0.28, fill: C.lime, line: C.lime, text: "Supportive", fontSize: 7.5, color: C.white });
  // Immunotherapy checkpoint
  arrow(s, 8.32, 3.68, 8.32, 3.95);
  s.addText("Checkpoint\ninhibitor irAEs", { x: 8.4, y: 3.58, w: 1.2, h: 0.35, fontSize: 7.5, color: C.amber, bold: true });
  box(s, { x: 6.85, y: 3.95, w: 2.95, h: 0.7, fill: C.white, line: C.red,
    textArr: [
      { text: "Steroids (1st line for most irAEs)\n", options: { bold: true, color: C.steel, fontSize: 9, breakLine: false } },
      { text: "Infliximab: colitis grades 3–4\n", options: { color: C.red, fontSize: 8.5, breakLine: false } },
      { text: "Tocilizumab: myocarditis / pneumonitis\nBaricitinib: steroid-refractory", options: { color: C.red, fontSize: 8.5 } },
    ],
    align: "left", valign: "top",
  });
  // Cancer with IL-2
  arrow(s, 8.32, 4.65, 8.32, 4.9);
  box(s, { x: 6.85, y: 4.9, w: 2.95, h: 0.65, fill: C.white, line: C.orange,
    textArr: [
      { text: "Cancer immunotherapy (adjuvant):\n", options: { bold: true, color: C.orange, fontSize: 9, breakLine: false } },
      { text: "High-dose IL-2 (metastatic melanoma / RCC)\nIFN-α (hairy cell leukaemia)", options: { color: C.steel, fontSize: 8.5 } },
    ],
    align: "left", valign: "top",
  });

  // ── Emergency / Critical Care ──
  diamond(s, { x: 10.15, y: 1.1, w: 3.0, h: 0.65, fill: C.orange, text: "Emergency Condition?", fontSize: 9.5 });
  // Sepsis / septic shock
  arrow(s, 11.65, 1.75, 11.65, 2.05);
  box(s, { x: 10.15, y: 2.05, w: 3.0, h: 1.0, fill: C.white, line: C.orange,
    textArr: [
      { text: "Sepsis / Septic Shock\n", options: { bold: true, color: C.orange, fontSize: 9, breakLine: false } },
      { text: "No cytokine-targeted biologic approved\nas standard of care for sepsis.\n", options: { color: C.steel, fontSize: 8.5, breakLine: false } },
      { text: "Anakinra (IL-1RA): emerging evidence in\nmacrophage activation syndrome (MAS/HLH)\nand sHLH complicating sepsis", options: { color: C.red, fontSize: 8.5, bold: true } },
    ],
    align: "left", valign: "top",
  });
  // HLH / MAS
  arrow(s, 11.65, 3.05, 11.65, 3.3);
  diamond(s, { x: 10.15, y: 3.3, w: 3.0, h: 0.65, fill: C.orange, text: "Macrophage Activation\nSyndrome (MAS/HLH)?", fontSize: 9 });
  arrow(s, 11.65, 3.95, 11.65, 4.22);
  box(s, { x: 10.15, y: 4.22, w: 3.0, h: 0.8, fill: C.white, line: C.red,
    textArr: [
      { text: "Anakinra (IL-1RA) — first line\n", options: { bold: true, color: C.red, fontSize: 9, breakLine: false } },
      { text: "Tocilizumab (anti-IL-6R) — 2nd line\n", options: { color: C.steel, fontSize: 8.5, breakLine: false } },
      { text: "Emapalumab (anti-IFN-γ) for primary HLH\nin children", options: { color: C.steel, fontSize: 8.5 } },
    ],
    align: "left", valign: "top",
  });
  // COVID-19 CRS
  arrow(s, 11.65, 5.02, 11.65, 5.28);
  box(s, { x: 10.15, y: 5.28, w: 3.0, h: 0.9, fill: C.white, line: C.orange,
    textArr: [
      { text: "Severe COVID-19 / viral CRS:\n", options: { bold: true, color: C.orange, fontSize: 9, breakLine: false } },
      { text: "Baricitinib (JAKi) — WHO strong recommendation\nTocilizumab — hospitalised, requiring O₂\nDexamethasone — all hospitalised requiring O₂", options: { color: C.steel, fontSize: 8.5 } },
    ],
    align: "left", valign: "top",
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 4 — Quick Reference Table
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: C.navy }, line: { color: C.navy } });
  s.addText("Quick Reference — Anti-Cytokine Drugs at a Glance", {
    x: 0.3, y: 0.12, w: 12.7, h: 0.45, fontSize: 15, bold: true, color: C.white, align: "center",
  });

  const rows = [
    // [Drug, Target, Disease Use, Class]
    ["Drug / Class", "Target", "Key Indication(s)", "Monitoring"],
    ["Infliximab / Adalimumab\nEtanercept / Certolizumab", "TNF-α", "RA, PsA, AS, IBD, Psoriasis", "TB screen, LFTs, HBsAg"],
    ["Tocilizumab / Sarilumab", "IL-6 receptor", "RA, GCA, CAR-T CRS, COVID-19", "Neutrophil count, LFTs"],
    ["Anakinra / Canakinumab", "IL-1 / IL-1β", "RA, Still's, gout, MAS/HLH, FMF", "Injection site, neutropenia"],
    ["Ustekinumab", "IL-12/23 (p40)", "Psoriasis, PsA, Crohn's", "Infections, TB screen"],
    ["Secukinumab / Ixekizumab", "IL-17A", "Psoriasis, PsA, AS", "IBD caution, candida"],
    ["Guselkumab / Risankizumab", "IL-23 (p19)", "Psoriasis, PsA, Crohn's (ris.)", "Infections"],
    ["Dupilumab", "IL-4Rα (IL-4+IL-13)", "Atopic dermatitis, asthma, CRSwNP", "Eosinophilia (transient)"],
    ["Mepolizumab / Benralizumab", "IL-5 / IL-5Rα", "Severe eosinophilic asthma, EGPA", "Eosinophil count, parasites"],
    ["Tofacitinib / Baricitinib\nUpadacitinib", "JAK 1/2/3", "RA, PsA, UC, COVID-19, AD", "VTE risk, CBC, lipids, malignancy"],
    ["Anifrolumab", "IFN-α/β receptor", "Systemic lupus erythematosus", "Infections, herpes zoster"],
    ["Emapalumab", "IFN-γ", "Primary HLH (paediatric)", "Infections (prophylaxis needed)"],
  ];

  const colW = [2.7, 1.8, 4.4, 3.8];
  const colX = [0.15, 2.85, 4.65, 9.05];
  const rowH = 0.53;
  const startY = 0.65;

  rows.forEach((row, ri) => {
    const isHeader = ri === 0;
    const fillColor = isHeader ? C.teal : (ri % 2 === 0 ? "182D4A" : "152540");
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, {
        x: colX[ci], y: startY + ri * rowH, w: colW[ci], h: rowH,
        fill: { color: fillColor }, line: { color: "1A3A5C", width: 0.5 },
      });
      s.addText(cell, {
        x: colX[ci] + 0.07, y: startY + ri * rowH, w: colW[ci] - 0.12, h: rowH,
        fontSize: isHeader ? 9.5 : 8.5, bold: isHeader, color: isHeader ? C.white : C.offWhite,
        valign: "middle", align: "left", margin: 2,
      });
    });
  });

  // Footer note
  s.addText("⚠  Check for active infection, TB, hepatitis B, pregnancy, and cardiovascular risk before initiating any biologic or JAK inhibitor.", {
    x: 0.2, y: 7.18, w: 12.9, h: 0.25, fontSize: 8.5, color: C.gold, italic: true, align: "center",
  });
}

// ─── Write file ───────────────────────────────────────────────────
const outPath = "/home/daytona/workspace/anti-cytokine-flowchart/Anti_Cytokine_Therapy_Flowchart.pptx";
pres.writeFile({ fileName: outPath })
  .then(() => console.log("SUCCESS: " + outPath))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3 × 7.5 inches
pres.title = "Anaesthetic Management in Laparoscopic Surgery";
pres.author = "Orris Medical AI";

// ── Palette ──────────────────────────────────────────────────────
const C = {
  navy:    "0A1628",
  teal:    "0E7490",
  tealLt:  "22D3EE",
  tealDk:  "164E63",
  amber:   "D97706",
  amberLt: "FCD34D",
  red:     "B91C1C",
  redLt:   "FCA5A5",
  green:   "166534",
  greenLt: "86EFAC",
  purple:  "6D28D9",
  purpleLt:"C4B5FD",
  orange:  "C2410C",
  slate:   "334155",
  white:   "FFFFFF",
  offWhite:"F8FAFC",
  ltGray:  "E2E8F0",
  midGray: "94A3B8",
  gold:    "F59E0B",
  lime:    "15803D",
};

// ── Helpers ───────────────────────────────────────────────────────
function bg(s, color) {
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color}, line:{color} });
}
function headerBar(s, text, sub) {
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:1.1, fill:{color:C.navy}, line:{color:C.navy} });
  s.addShape(pres.ShapeType.rect, { x:0, y:1.1, w:13.3, h:0.06, fill:{color:C.teal}, line:{color:C.teal} });
  s.addText(text, { x:0.35, y:0.1, w:12.6, h:0.6, fontSize:22, bold:true, color:C.white });
  if (sub) s.addText(sub, { x:0.35, y:0.68, w:12.6, h:0.38, fontSize:12, color:C.tealLt });
}
function card(s, x, y, w, h, title, items, titleColor, accentColor) {
  s.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill:{color:C.white}, line:{color:accentColor||C.teal, width:1.8}, rectRadius:0.14 });
  s.addShape(pres.ShapeType.roundRect, { x, y, w, h:0.36, fill:{color:accentColor||C.teal}, line:{color:accentColor||C.teal}, rectRadius:0.14 });
  // cover bottom corners of top bar
  s.addShape(pres.ShapeType.rect, { x, y:y+0.22, w, h:0.14, fill:{color:accentColor||C.teal}, line:{color:accentColor||C.teal} });
  s.addText(title, { x:x+0.1, y:y+0.02, w:w-0.2, h:0.32, fontSize:10, bold:true, color:C.white, valign:"middle" });
  const bulletArr = items.map((t,i)=>({
    text: t,
    options:{ bullet:true, color:C.slate, fontSize:9, breakLine: i<items.length-1 }
  }));
  s.addText(bulletArr, { x:x+0.12, y:y+0.4, w:w-0.22, h:h-0.48, valign:"top", margin:2 });
}
function badge(s, x, y, text, fill, textColor=C.white) {
  s.addShape(pres.ShapeType.roundRect, { x, y, w:2.5, h:0.34, fill:{color:fill}, line:{color:fill}, rectRadius:0.1 });
  s.addText(text, { x, y, w:2.5, h:0.34, fontSize:10, bold:true, color:textColor, align:"center", valign:"middle" });
}
function sectionPill(s, x, y, text, fill) {
  s.addShape(pres.ShapeType.roundRect, { x, y, w:12.6, h:0.38, fill:{color:fill}, line:{color:fill}, rectRadius:0.1 });
  s.addText(text, { x:x+0.15, y, w:12.3, h:0.38, fontSize:11, bold:true, color:C.white, valign:"middle" });
}
function twoCol(s, leftCards, rightCards, startY, cardW=6.1, gap=0.3) {
  leftCards.forEach(c => card(s, 0.35, c.y, cardW, c.h, c.title, c.items, C.white, c.color||C.teal));
  rightCards.forEach(c => card(s, 0.35+cardW+gap, c.y, cardW, c.h, c.title, c.items, C.white, c.color||C.teal));
}
function footer(s, text=`Source: Barash, Cullen & Stoelting's Clinical Anesthesia 9e | Miller's Anesthesia 10e`) {
  s.addShape(pres.ShapeType.rect, { x:0, y:7.28, w:13.3, h:0.22, fill:{color:C.navy}, line:{color:C.navy} });
  s.addText(text, { x:0.3, y:7.28, w:12.7, h:0.22, fontSize:7.5, color:C.midGray, align:"center", valign:"middle" });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  // Deep gradient-like background
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color:C.navy}, line:{color:C.navy} });
  s.addShape(pres.ShapeType.rect, { x:0, y:4.5, w:13.3, h:3.0, fill:{color:C.tealDk}, line:{color:C.tealDk} });
  // Accent lines
  s.addShape(pres.ShapeType.rect, { x:0, y:4.48, w:13.3, h:0.05, fill:{color:C.tealLt}, line:{color:C.tealLt} });
  s.addShape(pres.ShapeType.rect, { x:0.35, y:1.8, w:0.07, h:1.8, fill:{color:C.tealLt}, line:{color:C.tealLt} });

  s.addText("Anaesthetic Management in", { x:0.6, y:1.3, w:12.1, h:0.65, fontSize:28, bold:false, color:C.tealLt });
  s.addText("Laparoscopic Surgery", { x:0.6, y:1.9, w:12.1, h:0.9, fontSize:42, bold:true, color:C.white });
  s.addText("A comprehensive clinical overview for anaesthesiologists", {
    x:0.6, y:2.88, w:12.1, h:0.4, fontSize:14, color:C.midGray, italic:true
  });

  // Topic pills
  const topics = [
    {t:"Physiology of Pneumoperitoneum", c:C.teal},
    {t:"Preoperative Assessment", c:C.purple},
    {t:"Intraoperative Management", c:C.orange},
    {t:"Complications & Recovery", c:C.red},
  ];
  let px = 0.6;
  topics.forEach(tp => {
    const w = 2.85;
    s.addShape(pres.ShapeType.roundRect, { x:px, y:4.9, w, h:0.42, fill:{color:tp.c}, line:{color:tp.c}, rectRadius:0.1 });
    s.addText(tp.t, { x:px, y:4.9, w, h:0.42, fontSize:9.5, bold:true, color:C.white, align:"center", valign:"middle" });
    px += w + 0.25;
  });

  // Bottom info
  s.addText([
    {text:"Reference: ", options:{bold:true, color:C.amberLt, fontSize:10}},
    {text:"Barash, Cullen & Stoelting's Clinical Anesthesia, 9e (Chapter 44)  |  Miller's Anesthesia, 10e (Chapter 50)", options:{color:C.midGray, fontSize:10}},
  ], { x:0.6, y:5.62, w:12.1, h:0.35, margin:0 });
  s.addText([
    {text:"Key principle: ", options:{bold:true, color:C.amberLt, fontSize:10}},
    {text:"General endotracheal anaesthesia (GETA) with muscle relaxation and controlled mechanical ventilation is the preferred technique for laparoscopic surgery.", options:{color:C.ltGray, fontSize:10}},
  ], { x:0.6, y:5.95, w:12.1, h:0.42, margin:0 });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 2 — ADVANTAGES & BASICS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.offWhite);
  headerBar(s, "Overview & Advantages of Laparoscopy", "Minimally invasive technique — key concepts for the anaesthesiologist");

  card(s, 0.35, 1.3, 5.9, 2.2, "Advantages Over Open Surgery", [
    "Small (~1 cm) skin incisions — reduced postoperative pain",
    "Lower wound infection rates & blood loss",
    "Faster recovery and shorter hospital stay",
    "Equivalent oncological outcomes (colorectal, urologic)",
    "Better visualisation with magnified camera view",
    "NICE recommends laparoscopic colorectal surgery for suitable patients",
  ], C.white, C.teal);

  card(s, 6.55, 1.3, 6.4, 2.2, "Disadvantages & Anaesthetic Challenges", [
    "Physiologic derangements from pneumoperitoneum",
    "Extreme patient positioning required",
    "Longer operative times vs. open surgery",
    "Higher equipment costs",
    "Limited patient access in robotic surgery",
    "Cardiopulmonary instability — especially in high-risk patients",
  ], C.white, C.orange);

  card(s, 0.35, 3.65, 5.9, 1.85, "Pneumoperitoneum: How it Works", [
    "CO₂ insufflation via Veress needle → intraperitoneal pressure",
    "Target IAP: 12–15 mmHg (max 15 mmHg)",
    "CO₂ preferred: highly soluble in blood, non-flammable, safe with diathermy",
    "Automated insufflator maintains preset IAP",
    "Alternative: gasless abdominal wall lift (rarely used)",
  ], C.white, C.purple);

  card(s, 6.55, 3.65, 6.4, 1.85, "Patient Positioning Used", [
    "Trendelenburg (head-down): pelvic / lower abdominal surgery",
    "Reverse Trendelenburg (head-up): upper abdominal / bariatric",
    "Lateral decubitus: nephrectomy, adrenalectomy",
    "Lithotomy + Trendelenburg: gynaecology, robotic prostatectomy",
    "Combination positions worsen physiologic derangements",
  ], C.white, C.purple);

  // Why CO2?
  s.addShape(pres.ShapeType.roundRect, { x:0.35, y:5.65, w:12.6, h:1.4, fill:{color:C.navy}, line:{color:C.navy}, rectRadius:0.12 });
  s.addText("Why CO₂ for Insufflation?", { x:0.55, y:5.7, w:5, h:0.3, fontSize:11, bold:true, color:C.amberLt });
  const co2 = [
    ["Highly blood-soluble","Rapid pulmonary clearance if vascular embolism occurs"],
    ["Non-flammable","Safe with electrocautery — no fire/explosion risk"],
    ["Non-oxidising","Does not support combustion"],
    ["Rapidly absorbed","Metabolised/excreted quickly reducing anaesthesia duration"],
  ];
  co2.forEach((row, i) => {
    const cx = 0.55 + i * 3.1;
    s.addText("✓ " + row[0], { x:cx, y:6.05, w:3.0, h:0.25, fontSize:9.5, bold:true, color:C.tealLt });
    s.addText(row[1], { x:cx, y:6.3, w:3.0, h:0.5, fontSize:8.5, color:C.ltGray });
  });
  footer(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 3 — CARDIOVASCULAR PHYSIOLOGY
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.offWhite);
  headerBar(s, "Cardiovascular Physiology of Pneumoperitoneum", "CO₂ insufflation + positioning cause predictable, manageable haemodynamic changes");

  // Central diagram concept
  s.addShape(pres.ShapeType.roundRect, { x:4.8, y:1.25, w:3.7, h:1.0, fill:{color:C.navy}, line:{color:C.tealLt, width:2}, rectRadius:0.14 });
  s.addText("CO₂ Pneumoperitoneum\n+ Patient Position", { x:4.8, y:1.25, w:3.7, h:1.0, fontSize:12, bold:true, color:C.white, align:"center", valign:"middle" });

  // Left effects
  const leftEff = [
    {t:"↑ SVR (Systemic Vascular Resistance)", c:C.red, y:1.25},
    {t:"↑ MAP (Mean Arterial Pressure)", c:C.red, y:1.72},
    {t:"↑ Myocardial O₂ Consumption", c:C.orange, y:2.19},
    {t:"↓ Venous Return (IVC compression)", c:C.red, y:2.66},
  ];
  leftEff.forEach(e => {
    s.addShape(pres.ShapeType.roundRect, { x:0.35, y:e.y, w:4.25, h:0.38, fill:{color:e.c}, line:{color:e.c}, rectRadius:0.08 });
    s.addText(e.t, { x:0.4, y:e.y, w:4.15, h:0.38, fontSize:9.5, bold:true, color:C.white, valign:"middle" });
    // Arrow
    s.addShape(pres.ShapeType.line, { x:4.6, y:e.y+0.19, w:0.2, h:0, line:{color:C.slate, width:1.5, endArrowType:"triangle"} });
  });
  // Right effects
  const rightEff = [
    {t:"Dysrhythmias (CO₂ / vagal)", c:C.red, y:1.25},
    {t:"Reduced Cardiac Output", c:C.orange, y:1.72},
    {t:"↓ Renal / Portal / Splanchnic Flow", c:C.orange, y:2.19},
    {t:"VTE risk ↑ (femoral vein stasis)", c:C.orange, y:2.66},
  ];
  rightEff.forEach(e => {
    s.addShape(pres.ShapeType.roundRect, { x:8.7, y:e.y, w:4.25, h:0.38, fill:{color:e.c}, line:{color:e.c}, rectRadius:0.08 });
    s.addText(e.t, { x:8.75, y:e.y, w:4.15, h:0.38, fontSize:9.5, bold:true, color:C.white, valign:"middle" });
    s.addShape(pres.ShapeType.line, { x:8.5, y:e.y+0.19, w:0.2, h:0, line:{color:C.slate, width:1.5, endArrowType:"triangle"} });
  });

  // IAP mechanism
  sectionPill(s, 0.35, 3.22, "Mechanism: Intra-Abdominal Pressure (IAP) Effects on Heart", C.tealDk);
  card(s, 0.35, 3.68, 3.9, 2.0, "Low IAP (< 10 mmHg)", [
    "IVC compression minimal",
    "Venous return maintained or slightly ↑",
    "CO relatively preserved",
    "Preferred target in high-risk patients",
  ], C.white, C.green);
  card(s, 4.45, 3.68, 4.3, 2.0, "High IAP (> 15 mmHg)", [
    "IVC compressed — venous return ↓↓",
    "Cardiac filling ↓ → CO ↓",
    "Combined with hypovolaemia = cardiovascular collapse",
    "Associated with postoperative AKI",
    "AVOID IAP > 15 mmHg",
  ], C.white, C.red);
  card(s, 8.95, 3.68, 3.9, 2.0, "Hypercarbia (absorbed CO₂)", [
    "Acidosis → ↓ myocardial contractility",
    "Dysrhythmias",
    "Arterial vasodilation (paradoxical hypotension)",
    "↑ Catecholamine release",
    "Monitor ETCO₂ continuously",
  ], C.white, C.orange);

  // Bottom warning
  s.addShape(pres.ShapeType.roundRect, { x:0.35, y:5.85, w:12.6, h:1.15, fill:{color:"FFF7ED"}, line:{color:C.amber, width:1.5}, rectRadius:0.1 });
  s.addText("⚠  Clinical Pearls", { x:0.55, y:5.9, w:3, h:0.3, fontSize:11, bold:true, color:C.amber });
  s.addText([
    {text:"• Severe hypotension during pneumoperitoneum → desufflate immediately; may require conversion to open procedure\n", options:{color:C.slate, fontSize:9, breakLine:false}},
    {text:"• High IAP + hypovolaemia = severe cardiac failure risk • Position Trendelenburg initially improves venous return, but impairs respiratory mechanics\n", options:{color:C.slate, fontSize:9, breakLine:false}},
    {text:"• Cardiac ischaemia can develop in patients with coronary artery disease — have vasopressors and inotropes available", options:{color:C.red, fontSize:9, bold:true}},
  ], { x:0.55, y:6.2, w:12.2, h:0.72, margin:0, valign:"top" });
  footer(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 4 — RESPIRATORY PHYSIOLOGY
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.offWhite);
  headerBar(s, "Respiratory Physiology of Pneumoperitoneum", "Ventilatory management is critical — understand the mechanical and metabolic effects");

  sectionPill(s, 0.35, 1.22, "Mechanical Effects (Pneumoperitoneum + Trendelenburg)", C.tealDk);
  const mechCards = [
    {title:"↓ FRC & Vital Capacity", items:["Diaphragm displaced cephalad","Reduced lung volume available for ventilation","Basal atelectasis — especially in obese patients","Worsened in Trendelenburg position"], color:C.red, y:1.68},
    {title:"↓ Pulmonary Compliance", items:["Stiff lungs = higher peak airway pressure needed","↑ Peak inspiratory pressure (PIP)","Risk of barotrauma at high pressures","V/Q mismatch → hypoxaemia"], color:C.orange, y:1.68},
    {title:"ETT Migration Risk", items:["Diaphragm pushed up into thorax","ETT may advance into right main bronchus","Check bilateral breath sounds after position change","Confirm tube position after insufflation"], color:C.red, y:1.68},
  ];
  const mW = 4.0;
  mechCards.forEach((c, i) => {
    card(s, 0.35 + i*(mW+0.22), 1.68, mW, 2.2, c.title, c.items, C.white, c.color);
  });

  sectionPill(s, 0.35, 4.0, "Metabolic Effect: CO₂ Absorption & Respiratory Acidosis", C.tealDk);
  card(s, 0.35, 4.46, 5.9, 2.0, "CO₂ Absorption Pathway", [
    "CO₂ absorbed from peritoneal surface into bloodstream",
    "↑ PaCO₂ and ↑ ETCO₂",
    "Respiratory acidosis if ventilation not adjusted",
    "Require ↑ minute ventilation to maintain normocapnia",
    "Rate of absorption varies with IAP and vascularity",
    "Subcutaneous emphysema = massive CO₂ absorption",
  ], C.white, C.teal);
  card(s, 6.55, 4.46, 6.4, 2.0, "Ventilatory Strategy", [
    "Increase tidal volume or RR to compensate for CO₂",
    "Target ETCO₂ 35–45 mmHg (higher acceptable if needed)",
    "PEEP (5–8 cmH₂O): reduces atelectasis, improves oxygenation",
    "Low tidal volumes (6–8 mL/kg IBW) — lung-protective",
    "Recruitment manoeuvres for refractory hypoxaemia",
    "FiO₂ titrated to SpO₂ > 95%",
  ], C.white, C.green);

  // key note
  s.addShape(pres.ShapeType.roundRect, { x:0.35, y:6.6, w:12.6, h:0.58, fill:{color:C.navy}, line:{color:C.navy}, rectRadius:0.1 });
  s.addText([
    {text:"Key: ", options:{bold:true, color:C.amberLt, fontSize:10}},
    {text:"Reductions in pulmonary compliance and FRC, combined with CO₂ absorption, often cause respiratory acidosis. Cephalad displacement of abdominal contents — particularly in obese patients — adds atelectasis and V/Q mismatch. ETCO₂ monitoring is mandatory.", options:{color:C.ltGray, fontSize:9.5}},
  ], { x:0.55, y:6.62, w:12.2, h:0.52, valign:"middle", margin:0 });
  footer(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 5 — REGIONAL PERFUSION & CNS EFFECTS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.offWhite);
  headerBar(s, "Regional Perfusion & CNS/Ocular Effects", "Pneumoperitoneum reduces splanchnic and renal perfusion; raises ICP and IOP");

  card(s, 0.35, 1.28, 3.85, 2.7, "Renal Effects", [
    "↓ Renal blood flow due to direct compression",
    "↓ GFR and urine output during pneumoperitoneum",
    "↑ Vasopressin → reduced free-water excretion",
    "Activation of renin–angiotensin system",
    "IAP >15 mmHg → postoperative AKI risk",
    "Oliguria may persist post-nephrectomy despite haemodynamic stability (self-limited)",
    "Preoperative renal impairment, HTN = increased risk",
    "Hydration + limiting IAP <12 mmHg — protective strategy",
  ], C.white, C.teal);

  card(s, 4.4, 1.28, 4.15, 2.7, "Splanchnic/Hepatic Effects", [
    "↓ Intestinal blood flow (compression + vasoconstriction)",
    "Hypercapnia-driven mesenteric vasodilatation (partially offsets)",
    "↓ Hepatic arterial and portal flow",
    "Bowel ischaemia risk in prolonged procedures",
    "↓ Splanchnic flow → reduced drug hepatic clearance",
    "Relevant in bariatric surgery (already altered liver function)",
  ], C.white, C.orange);

  card(s, 8.75, 1.28, 4.2, 2.7, "Femoral/IVC Effects", [
    "IVC compressed by IAP → femoral vein stasis",
    "↓ Femoral venous blood flow",
    "↑ DVT / VTE risk — particularly in long procedures",
    "Pneumatic compression stockings mandatory",
    "Early mobilisation postoperatively",
    "Pharmacological thromboprophylaxis as indicated",
  ], C.white, C.purple);

  sectionPill(s, 0.35, 4.15, "CNS & Ocular Effects (Critical in Steep Trendelenburg / Robotic Surgery)", C.tealDk);

  card(s, 0.35, 4.62, 5.9, 2.3, "Intracranial Pressure (ICP) Effects", [
    "Both pneumoperitoneum AND Trendelenburg ↑ ICP",
    "Mechanism: ↓ cerebral venous outflow + hypercarbia → cerebral hyperperfusion",
    "↑ Cerebral blood flow & ↑ cerebral perfusion pressure",
    "Regional cerebral O₂ saturation is increased (usually well-tolerated)",
    "Prolonged steep Trendelenburg → acute postoperative cerebral oedema",
    "Contraindicated/extreme caution: known intracranial pathology, raised ICP, cerebrovascular disease",
    "Catecholamine release adds to systemic haemodynamic effects",
  ], C.white, C.red);

  card(s, 6.55, 4.62, 6.4, 2.3, "Intraocular Pressure (IOP) Effects", [
    "IOP ↑ significantly during robotic prostatectomy (steep Trendelenburg)",
    "Mechanism: ↑ CVP from Trendelenburg + ↑ choroidal blood volume from hypercarbia",
    "Rare: postoperative blindness (ischaemic optic neuropathy) reported",
    "Risk factors: glaucoma, diabetes, atherosclerosis, anaemia",
    "Keep ETCO₂ within normal range to limit hypercarbia contribution",
    "Limit total duration of steep Trendelenburg where possible",
    "Ophthalmology review if visual symptoms postoperatively",
  ], C.white, C.orange);
  footer(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 6 — PREOPERATIVE ASSESSMENT
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.offWhite);
  headerBar(s, "Preoperative Assessment & Patient Selection", "Identify high-risk patients — comorbidities amplify pneumoperitoneum-related derangements");

  card(s, 0.35, 1.28, 5.9, 2.35, "Cardiovascular Assessment", [
    "History of IHD, HF, valvular disease — cardiology review",
    "Uncontrolled hypertension — optimise before elective surgery",
    "Cardiac disease → ECG, ECHO if indicated",
    "High risk: may require arterial line, invasive monitoring",
    "Poor LV function: pneumoperitoneum may not be tolerated",
    "NYHA Class III–IV: discuss risks/benefits; consider open approach",
    "Antiplatelet and anticoagulant management plan",
  ], C.white, C.red);

  card(s, 6.55, 1.28, 6.4, 2.35, "Respiratory Assessment", [
    "Severe COPD / asthma: may not tolerate CO₂ retention",
    "Obesity: ↑ risk of hypoxaemia, atelectasis, difficult airway",
    "OSA: CPAP continuation, post-op monitoring required",
    "Pulmonary HTN: elevated IAP may critically ↓ RV output",
    "Spirometry / ABG if significant respiratory compromise",
    "CXR if new or unexplained symptoms",
    "Optimise inhalers before elective surgery",
  ], C.white, C.teal);

  card(s, 0.35, 3.75, 3.85, 2.35, "High-Risk Groups", [
    "BMI >40 with obesity comorbidities → ↑ perioperative complications",
    "Elderly patients: reduced cardiorespiratory reserve",
    "Renal impairment: AKI risk with high IAP",
    "Diabetes: AKI risk in bariatric surgery",
    "Cerebrovascular disease: ICP concerns in Trendelenburg",
    "Previous abdominal surgery: adhesions, trocar injury risk",
  ], C.white, C.orange);

  card(s, 4.4, 3.75, 4.15, 2.35, "Airway Assessment", [
    "Obesity: predict difficult laryngoscopy",
    "Mallampati, thyromental distance, neck mobility",
    "Consider awake FOB in difficult airway",
    "RSI for high aspiration risk (obese, hiatus hernia)",
    "Confirm ETT position after insufflation and positioning",
    "Have airway adjuncts immediately available",
  ], C.white, C.purple);

  card(s, 8.75, 3.75, 4.2, 2.35, "Preoperative Preparation", [
    "NBM fasting: solids 6h, clear fluids 2h (ERAS protocol)",
    "Continue antihypertensives (hold ACEi/ARB morning of surgery per local policy)",
    "DVT prophylaxis: TED stockings + LMWH",
    "Pre-oxygenation: 3 min tidal breathing or 8 deep breaths in 60s",
    "Antacid premedication for aspiration risk",
    "Inform patient: shoulder-tip pain from diaphragmatic irritation",
  ], C.white, C.green);
  footer(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 7 — INTRAOPERATIVE MANAGEMENT
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.offWhite);
  headerBar(s, "Intraoperative Anaesthetic Management", "GETA with muscle relaxation and controlled ventilation — standard of care");

  sectionPill(s, 0.35, 1.22, "Anaesthetic Technique: General Endotracheal Anaesthesia (GETA) — Preferred Approach", C.tealDk);

  card(s, 0.35, 1.68, 3.85, 2.0, "Induction", [
    "Standard IV induction: propofol + fentanyl/remifentanil",
    "RSI (suxamethonium or high-dose rocuronium) if aspiration risk",
    "Cuffed ETT — LMA acceptable only for brief, minor cases",
    "Confirm ETT position — bilateral air entry",
    "Secure ETT well — position changes may displace tube",
  ], C.white, C.navy);

  card(s, 4.4, 1.68, 4.15, 2.0, "Maintenance", [
    "Volatile agent (sevoflurane/desflurane) or TIVA (propofol)",
    "TIVA preferred: ↓ PONV, avoids N₂O (distends bowel)",
    "Remifentanil infusion for analgesia during laparoscopy",
    "Avoid N₂O — increases bowel distension & PONV risk",
    "Depth-of-anaesthesia monitoring (BIS) optional",
  ], C.white, C.navy);

  card(s, 8.75, 1.68, 4.2, 2.0, "Muscle Relaxation", [
    "Deep NMB improves surgical access",
    "Lower IAP required = less physiological derangement",
    "Allows ↓ insufflation pressure while maintaining exposure",
    "Monitor with TOF or PTC",
    "Reverse fully before extubation (sugammadex preferred)",
    "Assessment can be highly subjective — use nerve stimulator",
  ], C.white, C.purple);

  sectionPill(s, 0.35, 3.82, "Monitoring — Mandatory & Optional", C.tealDk);

  card(s, 0.35, 4.28, 5.9, 2.65, "Mandatory Monitoring", [
    "ECG — detect dysrhythmias from hypercarbia/vagal stimulation",
    "Non-invasive blood pressure (NIBP) — or arterial line in high-risk",
    "Capnography (ETCO₂) — essential: CO₂ absorption monitoring",
    "Pulse oximetry (SpO₂)",
    "Temperature — gas insufflation causes heat loss",
    "Airway pressure monitoring — detect tube migration, bronchospasm",
    "Urine output (catheter) — monitor renal perfusion",
  ], C.white, C.teal);

  card(s, 6.55, 4.28, 6.4, 2.65, "Situational / High-Risk Monitoring", [
    "Arterial line (A-line): high-risk cardiac/respiratory disease",
    "Central venous line: major blood loss risk, vasopressor infusions",
    "Cardiac output monitoring: FloTrac, TOE — cardiac surgery risk",
    "Neuromuscular blockade monitor (TOF, PTC) — mandatory NMB cases",
    "Depth-of-anaesthesia (BIS/entropy) — TIVA cases",
    "Near-infrared cerebral oximetry (rSO₂) — prolonged steep Trendelenburg",
    "Intraocular pressure monitoring — not routine; at-risk patients",
  ], C.white, C.purple);
  footer(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 8 — VENTILATION & FLUID MANAGEMENT
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.offWhite);
  headerBar(s, "Mechanical Ventilation & Fluid Management", "Lung-protective ventilation + goal-directed fluid therapy = key ERAS components");

  sectionPill(s, 0.35, 1.22, "Ventilation Strategy: Lung-Protective Approach", C.tealDk);
  card(s, 0.35, 1.68, 5.9, 2.4, "Ventilatory Parameters", [
    "Tidal volume (TV): 6–8 mL/kg Ideal Body Weight (IBW)",
    "PEEP: 5–8 cmH₂O — reduces atelectasis, improves oxygenation",
    "Respiratory rate: adjust to maintain ETCO₂ 35–45 mmHg",
    "FiO₂: minimum required to maintain SpO₂ >95%",
    "Pressure-controlled ventilation (PCV) preferred in obese patients",
    "Inspiration:expiration ratio 1:2 — may need adjustment",
    "Peak airway pressure target <30 cmH₂O",
  ], C.white, C.teal);

  card(s, 6.55, 1.68, 6.4, 2.4, "Managing CO₂ Accumulation", [
    "ETCO₂ rises after insufflation — increase minute ventilation",
    "ETCO₂ spike: consider subcutaneous emphysema, gas embolism",
    "PaCO₂ / ETCO₂ gradient widens in V/Q mismatch (obesity, COPD)",
    "Consider ABG if ETCO₂ unreliable (severe cardiorespiratory disease)",
    "Severe hypercarbia + acidosis → reduce IAP, increase ventilation",
    "Recruitment manoeuvres: 30–40 cmH₂O for 30s for refractory hypoxaemia",
    "At end of procedure: hand-ventilate to expel residual CO₂",
  ], C.white, C.orange);

  sectionPill(s, 0.35, 4.22, "Fluid Management (ERAS Goal-Directed Approach)", C.tealDk);
  card(s, 0.35, 4.68, 3.85, 2.15, "Principles", [
    "Avoid over-hydration — worsens airway oedema",
    "Goal-directed fluid therapy (GDFT) based on flow parameters",
    "Maintain urine output >0.5 mL/kg/hr (target >2 mL/kg/hr reassuring)",
    "No evidence for furosemide / mannitol / 'renal-dose' dopamine in AKI prevention",
  ], C.white, C.teal);

  card(s, 4.4, 4.68, 4.15, 2.15, "Warming", [
    "CO₂ gas causes significant heat loss",
    "Active patient warming (forced-air blanket) mandatory",
    "Warm IV fluids and blood products",
    "Heated and humidified CO₂ insufflation where available",
    "Target normothermia (36–37.5°C) — reduces PONV, infection, coagulopathy",
  ], C.white, C.purple);

  card(s, 8.75, 4.68, 4.2, 2.15, "Vasopressors & Inotropes", [
    "Phenylephrine (pure vasoconstrictor) for low SVR",
    "Vasopressin: adjunct in refractory hypotension",
    "Ephedrine for hypotension with bradycardia",
    "Dopamine/noradrenaline: if haemodynamic collapse",
    "Inotropes (dobutamine/adrenaline) if cardiac dysfunction",
    "Have vasopressors drawn up before insufflation",
  ], C.white, C.red);
  footer(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 9 — COMPLICATIONS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.offWhite);
  headerBar(s, "Intraoperative & Postoperative Complications", "Recognition and management of life-threatening events");

  sectionPill(s, 0.35, 1.22, "⚠  Intraoperative Complications", C.red);

  const compLeft = [
    {title:"Venous Gas Embolism (VGE)", color:C.red, y:1.68, h:1.85, items:[
      "CO₂ enters venous system via open vessel during insufflation",
      "Signs: ↓ ETCO₂ (large embolus), 'mill-wheel' murmur, ↓ SpO₂, cardiovascular collapse",
      "Management: desufflate immediately, left lateral Trendelenburg, 100% O₂, aspirate via CVP line, CPR if arrest",
    ]},
    {title:"Major Vascular Injury", color:C.red, y:3.62, h:1.5, items:[
      "Trocar/Veress needle injury — rare (~0.5%) but high mortality",
      "Sudden haemodynamic collapse, distended abdomen, visible haematoma",
      "Immediate conversion to open; call for help; blood products",
    ]},
  ];
  compLeft.forEach(c => card(s, 0.35, c.y, 5.9, c.h, c.title, c.items, C.white, c.color));

  const compRight = [
    {title:"Haemodynamic Instability", color:C.orange, y:1.68, h:1.85, items:[
      "Hypotension: reduce IAP, fluid bolus, vasopressor",
      "Hypertension: deepen anaesthesia, antihypertensives",
      "Dysrhythmias: hypercarbia correction, atropine for bradycardia",
      "Severe hypotension = consider desufflation + open conversion",
    ]},
    {title:"Airway Emergencies", color:C.orange, y:3.62, h:1.5, items:[
      "ETT migration into bronchus → reconfirm position",
      "↑ Airway pressure → check tube, bronchospasm, pneumothorax",
      "Tension pneumothorax: immediate chest decompression",
    ]},
  ];
  compRight.forEach(c => card(s, 6.55, c.y, 6.4, c.h, c.title, c.items, C.white, c.color));

  sectionPill(s, 0.35, 5.25, "Postoperative Complications", C.tealDk);
  const postops = [
    {title:"Respiratory Dysfunction", items:["Atelectasis, pneumonia","Residual diaphragmatic splinting","SpO₂ monitoring in recovery","O₂ supplementation as needed"], color:C.teal},
    {title:"PONV", items:["Very common — TIVA + multimodal antiemetics","Ondansetron + dexamethasone + droperidol","Avoid N₂O; minimise opioids","Adequate hydration"], color:C.purple},
    {title:"Shoulder-Tip Pain", items:["Referred pain from residual CO₂ irritating diaphragm","NSAIDs + paracetamol effective","Explain to patient pre-operatively","Resolves within 24–48h"], color:C.orange},
    {title:"DVT / VTE", items:["↑ Risk from femoral vein stasis","TED stockings + LMWH","Early mobilisation","Hydration"], color:C.red},
  ];
  const pcW = 2.9;
  postops.forEach((c, i) => card(s, 0.35 + i*(pcW+0.22), 5.7, pcW, 1.57, c.title, c.items, C.white, c.color));
  footer(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 10 — PAIN & PONV / ERAS / SPECIAL GROUPS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.offWhite);
  headerBar(s, "Postoperative Pain, PONV & Special Considerations", "Multimodal analgesia + ERAS protocols + high-risk populations");

  sectionPill(s, 0.35, 1.22, "Postoperative Analgesia (Multimodal — Opioid-Sparing)", C.tealDk);
  card(s, 0.35, 1.68, 5.9, 2.3, "Multimodal Analgesia Protocol", [
    "Regular paracetamol 1g QDS — baseline",
    "NSAIDs (ibuprofen/diclofenac/ketorolac) — add unless contraindicated",
    "Wound infiltration with LA (bupivacaine/levobupivacaine) at port sites",
    "TAP block (Transversus Abdominis Plane) for larger laparoscopic incisions",
    "Intraperitoneal LA instillation (controversial but low risk)",
    "Low-dose IV ketamine infusion (0.1–0.3 mg/kg/hr) — reduces opioid requirement",
    "Minimise systemic opioids — ↑ PONV, ileus, respiratory depression",
    "Remifentanil infusion intraoperatively (ultra-short acting)",
  ], C.white, C.teal);

  card(s, 6.55, 1.68, 6.4, 2.3, "PONV Prevention (APFEL Score-Based)", [
    "APFEL risk factors: female sex, non-smoker, Hx motion sickness, opioid use",
    "≥2 risk factors → dual/triple prophylaxis",
    "Ondansetron 4 mg IV at end of surgery",
    "Dexamethasone 4–8 mg IV at induction (potent antiemetic + analgesic)",
    "Droperidol 0.625–1.25 mg IV",
    "Scopolamine transdermal patch for high risk",
    "TIVA (propofol) — significantly ↓ PONV vs. volatile agents",
    "Minimise opioids; use regional where possible",
  ], C.white, C.purple);

  sectionPill(s, 0.35, 4.12, "Special Considerations", C.tealDk);

  card(s, 0.35, 4.58, 3.85, 2.25, "Ambulatory Laparoscopy", [
    "Short-acting agents: propofol TIVA, desflurane",
    "Multimodal analgesia — avoid opioid-heavy regimens",
    "Strict PONV prophylaxis before discharge",
    "Discharge criteria: Aldrete score ≥9, VAS pain ≤4",
    "Instructions re: CO₂ shoulder-tip pain",
  ], C.white, C.teal);

  card(s, 4.4, 4.58, 4.15, 2.25, "Robotic-Assisted Laparoscopy", [
    "Prolonged steep Trendelenburg = ↑ physiological derangement",
    "Limited patient access during robotic surgery — EMERGENCY PLAN essential",
    "Airway oedema post-long Trendelenburg — consider extubation in theatre",
    "Cerebral oedema, ↑ IOP — limit duration where possible",
    "Pre-agree undocking protocol for emergencies",
  ], C.white, C.orange);

  card(s, 8.75, 4.58, 4.2, 2.25, "Obese Patients (BMI >40)", [
    "↑ Risk of hypoxaemia, atelectasis, difficult airway",
    "Ramped position for induction (ear–sternal notch alignment)",
    "RSI routine — aspiration risk ↑",
    "Pressure-controlled ventilation preferred",
    "PEEP 10+ cmH₂O may be needed",
    "BMI >40 + comorbidities → ↑ laparoscopic complications",
    "Reverse Trendelenburg for upper abdominal work",
  ], C.white, C.red);
  footer(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 11 — SUMMARY TABLE
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.navy);
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:0.9, fill:{color:C.tealDk}, line:{color:C.tealDk} });
  s.addText("Summary: Physiologic Effects of CO₂ Pneumoperitoneum — At a Glance", {
    x:0.3, y:0.07, w:12.7, h:0.76, fontSize:16, bold:true, color:C.white, valign:"middle",
  });

  const rows = [
    ["System","Effect","Clinical Implication","Management Strategy"],
    ["Cardiovascular","↑ SVR, ↑ MAP, ↓ venous return (IVC compression), dysrhythmias","↓ Cardiac output; ischaemia in at-risk patients","Limit IAP ≤15 mmHg; vasopressors available; A-line in high-risk"],
    ["Respiratory","↓ FRC/VC, ↓ compliance, ↑ peak airway pressure, hypercarbia","Atelectasis, V/Q mismatch, respiratory acidosis, ETT migration","↑ Minute ventilation, PEEP 5–8, TV 6–8 mL/kg, lung-protective"],
    ["Renal","↓ RBF, ↓ GFR, ↑ vasopressin, renin–angiotensin activation","Oliguria; AKI risk especially IAP >15 mmHg","Hydration, limit IAP, avoid nephrotoxins"],
    ["Splanchnic","↓ Hepatic and intestinal flow (compression)","Bowel ischaemia risk in prolonged cases; ↓ drug clearance","Minimise IAP; avoid excessive Trendelenburg duration"],
    ["CNS","↑ ICP, ↑ CBF (Trendelenburg + hypercarbia)","Cerebral oedema; risk in cerebrovascular disease","Avoid prolonged steep Trendelenburg; normocapnia"],
    ["Ocular","↑ IOP (Trendelenburg + hypercarbia)","Rare: ischaemic optic neuropathy, postoperative blindness","Normocapnia; limit Trendelenburg time; ophthalmology if visual Sx"],
    ["Endocrine","Renin–angiotensin activation, vasopressin release","Fluid/electrolyte disturbance; oliguria","Monitor urine output; goal-directed fluid therapy"],
    ["Temperature","Heat loss from CO₂ gas","Hypothermia → ↑ coagulopathy, PONV, infection","Active warming, heated CO₂ where available"],
  ];

  const colW = [1.6, 3.2, 3.85, 4.25];
  const colX = [0.2, 1.8, 5.0, 8.85];
  const rowH = 0.58;
  const startY = 1.05;

  rows.forEach((row, ri) => {
    const isH = ri === 0;
    const fill = isH ? C.teal : (ri % 2 === 0 ? "112340" : "0D1F3C");
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x:colX[ci], y:startY+ri*rowH, w:colW[ci], h:rowH, fill:{color:fill}, line:{color:"1A3A5C", width:0.4} });
      s.addText(cell, { x:colX[ci]+0.06, y:startY+ri*rowH, w:colW[ci]-0.1, h:rowH, fontSize:isH?9.5:8.2, bold:isH, color:isH?C.white:C.offWhite, valign:"middle", align:"left", margin:2 });
    });
  });

  s.addText("⚠  Severe hypotension during pneumoperitoneum: DESUFFLATE immediately. Consider open conversion. | CO₂ gas embolism: left lateral Trendelenburg + 100% O₂ + aspirate CVP.", {
    x:0.2, y:6.3, w:12.9, h:0.38, fontSize:9, bold:true, color:C.amberLt, align:"center",
  });
  footer(s, "Source: Barash, Cullen & Stoelting's Clinical Anesthesia 9e (Ch.44) | Miller's Anesthesia 10e (Ch.50) | Bailey & Love's Surgery 28e");
}

// ─── Write file ───────────────────────────────────────────────
const outPath = "/home/daytona/workspace/laparoscopic-anaesthesia-ppt/Anaesthetic_Management_Laparoscopic_Surgery.pptx";
pres.writeFile({ fileName: outPath })
  .then(() => console.log("SUCCESS: " + outPath))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });