🦠 INFLUENZA - Complete Notes

mkdir -p /home/daytona/workspace/influenza-study-guide

~/influenza-study-guide/create_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import BaseDocTemplate, PageTemplate, Frame

# ── Colour palette ──────────────────────────────────────────────────────────
ORANGE      = colors.HexColor("#D9541E")
LIGHT_ORANGE= colors.HexColor("#FAD9C9")
DARK_ORANGE = colors.HexColor("#A33A0B")
BLUE        = colors.HexColor("#1A5276")
LIGHT_BLUE  = colors.HexColor("#D6EAF8")
GREEN       = colors.HexColor("#1E8449")
LIGHT_GREEN = colors.HexColor("#D5F5E3")
RED         = colors.HexColor("#C0392B")
LIGHT_RED   = colors.HexColor("#FADBD8")
YELLOW_BG   = colors.HexColor("#FEF9E7")
GREY_LIGHT  = colors.HexColor("#F2F3F4")
GREY_MID    = colors.HexColor("#BDC3C7")
WHITE       = colors.white
BLACK       = colors.black

# ── Styles ───────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def S(name, **kw):
    return ParagraphStyle(name, **kw)

COVER_TITLE = S("CoverTitle",
    fontSize=36, fontName="Helvetica-Bold",
    textColor=WHITE, alignment=TA_CENTER, leading=44)

COVER_SUB = S("CoverSub",
    fontSize=16, fontName="Helvetica",
    textColor=LIGHT_ORANGE, alignment=TA_CENTER, leading=22)

COVER_META = S("CoverMeta",
    fontSize=11, fontName="Helvetica",
    textColor=WHITE, alignment=TA_CENTER, leading=16)

SEC_HEADING = S("SecHeading",
    fontSize=15, fontName="Helvetica-Bold",
    textColor=WHITE, alignment=TA_LEFT, leading=20)

SUBSEC = S("SubSec",
    fontSize=12, fontName="Helvetica-Bold",
    textColor=ORANGE, alignment=TA_LEFT, leading=16)

BODY = S("Body",
    fontSize=10, fontName="Helvetica",
    textColor=BLACK, alignment=TA_JUSTIFY, leading=15)

BODY_BOLD = S("BodyBold",
    fontSize=10, fontName="Helvetica-Bold",
    textColor=BLACK, alignment=TA_LEFT, leading=15)

BULLET = S("Bullet",
    fontSize=10, fontName="Helvetica",
    textColor=BLACK, alignment=TA_LEFT, leading=15,
    leftIndent=14, bulletIndent=0)

SMALL = S("Small",
    fontSize=8.5, fontName="Helvetica",
    textColor=colors.HexColor("#555555"), alignment=TA_CENTER, leading=12)

MCQ_Q = S("MCQ_Q",
    fontSize=10, fontName="Helvetica-Bold",
    textColor=BLUE, alignment=TA_LEFT, leading=14)

MCQ_A = S("MCQ_A",
    fontSize=9.5, fontName="Helvetica",
    textColor=BLACK, alignment=TA_LEFT, leading=13, leftIndent=10)

MCQ_ANS = S("MCQ_ANS",
    fontSize=9.5, fontName="Helvetica-Bold",
    textColor=GREEN, alignment=TA_LEFT, leading=13, leftIndent=10)

TIP = S("Tip",
    fontSize=9.5, fontName="Helvetica-Oblique",
    textColor=BLUE, alignment=TA_LEFT, leading=13)

# ── Helper: section banner ───────────────────────────────────────────────────
def section_banner(title, color=ORANGE):
    data = [[Paragraph(title, SEC_HEADING)]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("TOPPADDING",    (0,0), (-1,-1), 7),
        ("BOTTOMPADDING", (0,0), (-1,-1), 7),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("ROUNDEDCORNERS", [4, 4, 4, 4]),
    ]))
    return t

def info_box(text, bg=LIGHT_BLUE, border=BLUE):
    data = [[Paragraph(text, BODY)]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
        ("BOX",           (0,0), (-1,-1), 1.5, border),
        ("ROUNDEDCORNERS",[4,4,4,4]),
    ]))
    return t

def bullet_table(items, bg=GREY_LIGHT):
    rows = [[Paragraph(f"• {i}", BULLET)] for i in items]
    t = Table(rows, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("LINEBELOW",     (0,0), (-1,-2), 0.3, GREY_MID),
    ]))
    return t

def two_col_table(rows, headers=None, col_widths=None):
    cw = col_widths or [6*cm, 11*cm]
    all_rows = []
    if headers:
        all_rows.append([Paragraph(f"<b>{headers[0]}</b>", BODY_BOLD),
                         Paragraph(f"<b>{headers[1]}</b>", BODY_BOLD)])
    for r in rows:
        all_rows.append([Paragraph(str(r[0]), BODY), Paragraph(str(r[1]), BODY)])
    t = Table(all_rows, colWidths=cw)
    style = [
        ("BACKGROUND",    (0,0), (-1,0), ORANGE if headers else LIGHT_ORANGE),
        ("TEXTCOLOR",     (0,0), (-1,0), WHITE if headers else BLACK),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, LIGHT_ORANGE]),
        ("GRID",          (0,0), (-1,-1), 0.5, GREY_MID),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 7),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]
    t.setStyle(TableStyle(style))
    return t

def sp(n=6):
    return Spacer(1, n)

# ── Build story ───────────────────────────────────────────────────────────────
story = []

# ══════════════════════════════════════════════════════════
#  COVER PAGE
# ══════════════════════════════════════════════════════════
cover_data = [[
    Paragraph("", SEC_HEADING),
    Paragraph("", SEC_HEADING),
    Paragraph("INFLUENZA", COVER_TITLE),
    Paragraph("Complete Exam Study Guide", COVER_SUB),
    Spacer(1, 12),
    Paragraph("Virology • Pathophysiology • Clinical Features • Diagnosis • Management", COVER_META),
    Spacer(1, 8),
    Paragraph("Prepared from: The Compendium of Kayacikitsa | July 2026", COVER_META),
]]
cover_tbl = Table([[story_item] for story_item in cover_data[0]], colWidths=[17*cm])
cover_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), ORANGE),
    ("TOPPADDING",    (0,0), (-1,-1), 14),
    ("BOTTOMPADDING", (0,0), (-1,-1), 14),
    ("LEFTPADDING",   (0,0), (-1,-1), 20),
    ("RIGHTPADDING",  (0,0), (-1,-1), 20),
]))
story.append(Spacer(1, 2*cm))
story.append(cover_tbl)
story.append(Spacer(1, 0.8*cm))

# Quick reference strip
qr_data = [
    [Paragraph("<b>Causative Agent</b>", BODY_BOLD), Paragraph("Influenza Virus A & B", BODY),
     Paragraph("<b>Incubation</b>", BODY_BOLD), Paragraph("1-4 days (avg 48 hrs)", BODY)],
    [Paragraph("<b>Transmission</b>", BODY_BOLD), Paragraph("Droplet infection", BODY),
     Paragraph("<b>Key Test</b>", BODY_BOLD), Paragraph("RT-PCR (gold standard)", BODY)],
]
qr_tbl = Table(qr_data, colWidths=[3.5*cm, 5*cm, 3.5*cm, 5*cm])
qr_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), LIGHT_ORANGE),
    ("GRID",          (0,0), (-1,-1), 0.4, ORANGE),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story.append(qr_tbl)
story.append(PageBreak())

# ══════════════════════════════════════════════════════════
#  1. INTRODUCTION
# ══════════════════════════════════════════════════════════
story.append(section_banner("1.  INTRODUCTION"))
story.append(sp(8))
story.append(Paragraph(
    "Influenza (flu) is an <b>acute viral infection of the respiratory tract</b> caused by "
    "<b>Influenza virus A and B</b>. It is one of the most significant global infectious diseases.", BODY))
story.append(sp())
story.append(two_col_table([
    ["Global cases/year",  "~1 billion seasonal cases documented"],
    ["Severe illnesses",   "3 to 5 million per year"],
    ["Respiratory deaths", "290,000 – 650,000 per year"],
], headers=["Epidemiology Fact", "Figure"]))
story.append(sp(8))
story.append(Paragraph("<b>High-Risk Groups:</b>", BODY_BOLD))
story.append(sp(4))
story.append(bullet_table([
    "Pregnant women",
    "Children under 5 years of age",
    "Older adults (elderly)",
    "Persons with chronic medical conditions (diabetes, heart disease, asthma, etc.)",
]))
story.append(sp(12))

# ══════════════════════════════════════════════════════════
#  2. BASIC PARAMETERS
# ══════════════════════════════════════════════════════════
story.append(section_banner("2.  BASIC PARAMETERS", BLUE))
story.append(sp(8))
params = [
    ["Incubation Period", "1 to 4 days | Average ~48 hours"],
    ["Mode of Transmission", "Droplet infection (cough / sneeze of infected person)"],
    ["Infectious Period", "1 day before symptoms to ~5-7 days after onset"],
    ["Viral Types", "Influenza A (most severe, pandemic risk) and B (seasonal)"],
]
story.append(two_col_table(params, headers=["Parameter", "Details"], col_widths=[5.5*cm, 11.5*cm]))
story.append(sp(12))

# ══════════════════════════════════════════════════════════
#  3. PATHOPHYSIOLOGY
# ══════════════════════════════════════════════════════════
story.append(section_banner("3.  PATHOPHYSIOLOGY"))
story.append(sp(8))
story.append(info_box(
    "<b>Key Concept:</b> Influenza pathophysiology is a multi-stage process involving viral entry, "
    "replication, immune activation, and tissue destruction.", LIGHT_ORANGE, ORANGE))
story.append(sp(8))

steps = [
    ["Step 1: Entry",
     "Virus enters via inhaled droplets into the respiratory tract epithelium"],
    ["Step 2: Attachment",
     "Hemagglutinin (HA) proteins on the viral surface attach to sialic acid receptors on epithelial cells"],
    ["Step 3: Replication",
     "Virus releases its RNA into the host cell; replicates and transcribes viral proteins using host cell machinery"],
    ["Step 4: Spread",
     "New viral particles assemble, bud off, and spread to adjacent epithelial cells"],
    ["Step 5: Immune Activation",
     "Infection triggers release of cytokines and interferons -> inflammation, fever, muscle pain, fatigue"],
    ["Step 6: Tissue Damage",
     "Virus-induced destruction of epithelial cells + immune-driven inflammation damages respiratory mucosal lining -> risk of secondary bacterial infections (e.g., pneumonia)"],
    ["Step 7: Systemic Effects",
     "Widespread inflammatory mediator release causes systemic symptoms: fever, chills, muscle aches, cough, sore throat"],
]
story.append(two_col_table(steps, headers=["Stage", "What Happens"], col_widths=[4*cm, 13*cm]))
story.append(sp(8))
story.append(info_box(
    "<b>Exam Tip:</b> The key attachment protein is <b>Hemagglutinin (HA)</b>. "
    "Neuraminidase (NA) helps viral release from cells. Both are targets for antiviral drugs (e.g., oseltamivir targets NA).",
    LIGHT_BLUE, BLUE))
story.append(sp(12))

# ══════════════════════════════════════════════════════════
#  4. CLINICAL FEATURES
# ══════════════════════════════════════════════════════════
story.append(section_banner("4.  CLINICAL FEATURES", DARK_ORANGE))
story.append(sp(8))
story.append(Paragraph(
    "Influenza classically presents with <b>sudden onset</b> of multiple symptoms:", BODY))
story.append(sp(6))

cf_data = [
    [Paragraph("<b>System</b>", BODY_BOLD), Paragraph("<b>Symptoms</b>", BODY_BOLD)],
    [Paragraph("Constitutional", BODY),
     Paragraph("Sudden high fever, chills, malaise, fatigue", BODY)],
    [Paragraph("Respiratory", BODY),
     Paragraph("Coryza (runny nose), sneezing, sore throat, dry and persistent cough, shortness of breath", BODY)],
    [Paragraph("Neurological", BODY),
     Paragraph("Headache, photophobia, pain in the eyes", BODY)],
    [Paragraph("Ocular", BODY),
     Paragraph("Mild conjunctivitis", BODY)],
    [Paragraph("Gastrointestinal", BODY),
     Paragraph("Nausea, vomiting, abdominal pain (more common in children)", BODY)],
    [Paragraph("Musculoskeletal", BODY),
     Paragraph("Myalgia (muscle pain) - a hallmark feature", BODY)],
]
cf_tbl = Table(cf_data, colWidths=[4.5*cm, 12.5*cm])
cf_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), ORANGE),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, LIGHT_ORANGE]),
    ("GRID",          (0,0), (-1,-1), 0.5, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 7),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(cf_tbl)
story.append(sp(8))
story.append(info_box(
    "<b>Memory Aid - FACTS:</b> Fever (sudden high) | Aches (myalgia) | Cough (dry) | "
    "Tiredness (malaise) | Sudden onset", LIGHT_GREEN, GREEN))
story.append(sp(12))

# ══════════════════════════════════════════════════════════
#  5. COMPLICATIONS
# ══════════════════════════════════════════════════════════
story.append(section_banner("5.  COMPLICATIONS", RED))
story.append(sp(8))

comp_data = [
    [Paragraph("<b>Type</b>", BODY_BOLD), Paragraph("<b>Complication</b>", BODY_BOLD), Paragraph("<b>Notes</b>", BODY_BOLD)],
    [Paragraph("MOST COMMON", BODY_BOLD),
     Paragraph("Bacterial Pneumonia", BODY),
     Paragraph("Secondary bacterial superinfection of damaged respiratory epithelium", BODY)],
    [Paragraph("Extra-pulmonary\n(Rare)", BODY),
     Paragraph("Myositis", BODY),
     Paragraph("Muscle inflammation", BODY)],
    [Paragraph("", BODY),
     Paragraph("Myocarditis", BODY),
     Paragraph("Inflammation of heart muscle", BODY)],
    [Paragraph("", BODY),
     Paragraph("Pericarditis", BODY),
     Paragraph("Inflammation of pericardial sac", BODY)],
    [Paragraph("", BODY),
     Paragraph("Encephalitis", BODY),
     Paragraph("Brain inflammation - serious neurological complication", BODY)],
    [Paragraph("", BODY),
     Paragraph("Reye Syndrome", BODY),
     Paragraph("Rare - seen in children given aspirin; liver failure + encephalopathy", BODY)],
]
comp_tbl = Table(comp_data, colWidths=[3.5*cm, 4.5*cm, 9*cm])
comp_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), RED),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("BACKGROUND",    (0,1), (-1,1), LIGHT_RED),
    ("ROWBACKGROUNDS",(0,2), (-1,-1), [WHITE, LIGHT_RED]),
    ("GRID",          (0,0), (-1,-1), 0.5, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 7),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ("SPAN",          (0,2), (0,-1)),
]))
story.append(comp_tbl)
story.append(sp(8))
story.append(info_box(
    "<b>Exam Alert:</b> Reye Syndrome = aspirin use in viral illness in children -> "
    "avoid aspirin in children with influenza! Use paracetamol instead.", LIGHT_RED, RED))
story.append(sp(12))
story.append(PageBreak())

# ══════════════════════════════════════════════════════════
#  6. DIAGNOSIS
# ══════════════════════════════════════════════════════════
story.append(section_banner("6.  DIAGNOSIS", BLUE))
story.append(sp(8))

diag_data = [
    ["Clinical Evaluation",       "First step; based on symptom history and physical examination"],
    ["Rapid Influenza Test",       "Quick bedside test; detects viral antigens; fast but lower sensitivity"],
    ["Naso-pharyngeal Swab Culture","Lab confirmation via viral culture; takes longer"],
    ["RT-PCR",                    "GOLD STANDARD - Reverse Transcriptase PCR; most sensitive and specific"],
    ["Pulse Oximetry",            "Rules out hypoxemia (low oxygen saturation)"],
    ["Chest X-ray",               "Imaging to diagnose pneumonia complication"],
    ["CT / MRI Chest",            "Advanced imaging for complex or severe pneumonia cases"],
]
story.append(two_col_table(diag_data, headers=["Diagnostic Method", "Purpose / Notes"],
                           col_widths=[5.5*cm, 11.5*cm]))
story.append(sp(8))
story.append(info_box(
    "<b>Exam Tip:</b> RT-PCR is the gold standard for confirming influenza. "
    "Rapid antigen tests are quick but less accurate (can miss cases). "
    "Pulse oximetry is used to check for hypoxemia, not to diagnose influenza.", LIGHT_BLUE, BLUE))
story.append(sp(12))

# ══════════════════════════════════════════════════════════
#  7. MANAGEMENT
# ══════════════════════════════════════════════════════════
story.append(section_banner("7.  MANAGEMENT & TREATMENT"))
story.append(sp(8))

story.append(Paragraph("<b>A. Supportive / General Care:</b>", SUBSEC))
story.append(sp(4))
story.append(bullet_table([
    "Oxygenation - maintain adequate oxygen levels",
    "Fluid balance - prevent dehydration",
    "Antipyretic therapy - reduce fever (paracetamol/acetaminophen)",
    "Analgesic therapy - relieve pain and headache",
    "Rest and adequate nutrition",
]))
story.append(sp(10))

story.append(Paragraph("<b>B. Specific Treatment (for high-risk patients):</b>", SUBSEC))
story.append(sp(4))
story.append(bullet_table([
    "Appropriate antibiotic therapy - for secondary bacterial infections",
    "Corticosteroids - sometimes required in severe/high-risk cases",
    "Antiviral therapy - for high-risk patients (e.g., oseltamivir/Tamiflu targets Neuraminidase)",
    "Ventilatory support - when respiratory failure occurs",
]))
story.append(sp(12))

# ══════════════════════════════════════════════════════════
#  8. PREVENTION / VACCINATION
# ══════════════════════════════════════════════════════════
story.append(section_banner("8.  PREVENTION & VACCINATION", GREEN))
story.append(sp(8))
story.append(Paragraph(
    "Annual vaccination is the primary prevention strategy for influenza.", BODY))
story.append(sp(6))

vax_data = [
    ["IIV",  "Inactivated Influenza Vaccine",    "Injection; suitable for all including immunocompromised"],
    ["RIV",  "Recombinant Influenza Vaccine",     "Egg-free; for egg-allergic individuals"],
    ["LAIV", "Live Attenuated Influenza Vaccine", "Nasal spray; for healthy non-pregnant adults 2-49 yrs"],
    ["TIV",  "Trivalent Influenza Vaccine",       "Covers 3 strains (2A + 1B)"],
    ["QIV",  "Quadrivalent Influenza Vaccine",    "Covers 4 strains (2A + 2B) - preferred"],
]
vax_tbl = Table(
    [[Paragraph("<b>Abbrev.</b>", BODY_BOLD), Paragraph("<b>Full Name</b>", BODY_BOLD), Paragraph("<b>Notes</b>", BODY_BOLD)]] +
    [[Paragraph(r[0], BODY), Paragraph(r[1], BODY), Paragraph(r[2], BODY)] for r in vax_data],
    colWidths=[2.5*cm, 7*cm, 7.5*cm]
)
vax_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), GREEN),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, LIGHT_GREEN]),
    ("GRID",          (0,0), (-1,-1), 0.5, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 7),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(vax_tbl)
story.append(sp(12))

# ══════════════════════════════════════════════════════════
#  9. AYURVEDIC PERSPECTIVE
# ══════════════════════════════════════════════════════════
story.append(section_banner("9.  AYURVEDIC PERSPECTIVE", colors.HexColor("#7D3C98")))
story.append(sp(8))
story.append(two_col_table([
    ["Disease Classification", "Janapadodhvamsa Vyadhi (epidemic/communicable disease)"],
    ["Treatment Principle",    "Slesmaka Jvara cikitsa (management of Kapha-dominant fever)"],
], headers=["Concept", "Ayurvedic Term"]))
story.append(sp(12))
story.append(PageBreak())

# ══════════════════════════════════════════════════════════
#  10. MCQ PRACTICE QUESTIONS
# ══════════════════════════════════════════════════════════
story.append(section_banner("10.  MCQ PRACTICE QUESTIONS", BLUE))
story.append(sp(8))

mcqs = [
    {
        "q": "Q1. What is the causative agent of influenza?",
        "opts": ["A) Influenza virus A only", "B) Influenza virus B only",
                 "C) Influenza virus A and B", "D) Influenza virus A, B, and C"],
        "ans": "C) Influenza virus A and B",
        "exp": "Influenza is caused by both virus A and B. Type A is responsible for most pandemics."
    },
    {
        "q": "Q2. What is the average incubation period of influenza?",
        "opts": ["A) 12 hours", "B) 24 hours", "C) 48 hours", "D) 72 hours"],
        "ans": "C) 48 hours",
        "exp": "Incubation period ranges from 1-4 days with an average of about 48 hours."
    },
    {
        "q": "Q3. Which protein does the influenza virus use to attach to host epithelial cells?",
        "opts": ["A) Neuraminidase (NA)", "B) Hemagglutinin (HA)",
                 "C) Matrix protein (M1)", "D) Nucleoprotein (NP)"],
        "ans": "B) Hemagglutinin (HA)",
        "exp": "HA proteins on the viral surface bind to sialic acid receptors on respiratory epithelial cells to initiate infection."
    },
    {
        "q": "Q4. What is the most common complication of influenza?",
        "opts": ["A) Myocarditis", "B) Encephalitis",
                 "C) Bacterial Pneumonia", "D) Reye Syndrome"],
        "ans": "C) Bacterial Pneumonia",
        "exp": "Bacterial pneumonia is the most common complication due to damaged mucosal defenses from viral infection."
    },
    {
        "q": "Q5. Which diagnostic test is considered the gold standard for confirming influenza?",
        "opts": ["A) Rapid influenza antigen test", "B) Chest X-ray",
                 "C) Pulse oximetry", "D) RT-PCR"],
        "ans": "D) RT-PCR",
        "exp": "Reverse Transcriptase-PCR (RT-PCR) is the most sensitive and specific test for confirming influenza infection."
    },
    {
        "q": "Q6. Reye syndrome as a complication of influenza is most commonly associated with:",
        "opts": ["A) Use of oseltamivir in adults", "B) Use of aspirin in children",
                 "C) Use of corticosteroids", "D) Secondary bacterial infection"],
        "ans": "B) Use of aspirin in children",
        "exp": "Reye syndrome = aspirin use during viral illness (influenza/varicella) in children. Always use paracetamol instead."
    },
    {
        "q": "Q7. Influenza is primarily transmitted by:",
        "opts": ["A) Fecal-oral route", "B) Contact with contaminated surfaces",
                 "C) Droplet infection", "D) Vector-borne transmission"],
        "ans": "C) Droplet infection",
        "exp": "Influenza spreads via respiratory droplets produced when an infected person coughs or sneezes."
    },
    {
        "q": "Q8. Which vaccine type is a nasal spray live vaccine for influenza?",
        "opts": ["A) IIV (Inactivated Influenza Vaccine)", "B) RIV (Recombinant Influenza Vaccine)",
                 "C) LAIV (Live Attenuated Influenza Vaccine)", "D) QIV (Quadrivalent Influenza Vaccine)"],
        "ans": "C) LAIV (Live Attenuated Influenza Vaccine)",
        "exp": "LAIV is administered as a nasal spray and contains live but weakened virus strains."
    },
]

for mcq in mcqs:
    story.append(KeepTogether([
        Paragraph(mcq["q"], MCQ_Q),
        sp(3),
        *[Paragraph(o, MCQ_A) for o in mcq["opts"]],
        sp(3),
        Paragraph(f"Answer: {mcq['ans']}", MCQ_ANS),
        Paragraph(f"Explanation: {mcq['exp']}", TIP),
        sp(10),
        HRFlowable(width="100%", thickness=0.5, color=GREY_MID),
        sp(8),
    ]))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════
#  11. QUICK REVISION TABLE (1-PAGE SUMMARY)
# ══════════════════════════════════════════════════════════
story.append(section_banner("11.  QUICK REVISION SUMMARY", DARK_ORANGE))
story.append(sp(8))

summary = [
    ["Causative Agent",    "Influenza Virus A & B"],
    ["Incubation",         "1-4 days (average 48 hours)"],
    ["Transmission",       "Droplet infection"],
    ["HA Protein Role",    "Attachment to host epithelial cells via sialic acid receptors"],
    ["Systemic Sx",        "Fever, chills, myalgia, malaise, headache"],
    ["Respiratory Sx",     "Coryza, sneeze, sore throat, dry cough, dyspnea"],
    ["Other Sx",           "Conjunctivitis, photophobia, eye pain, nausea, vomiting"],
    ["Main Complication",  "Bacterial Pneumonia"],
    ["Rare Complications", "Myositis, myocarditis, pericarditis, encephalitis, Reye syndrome"],
    ["Diagnosis",          "RT-PCR (gold standard), rapid antigen test, NP swab culture"],
    ["Imaging",            "Chest X-ray / CT to diagnose pneumonia"],
    ["Supportive Rx",      "O2, fluid balance, antipyretics, analgesics"],
    ["Specific Rx",        "Antivirals, antibiotics (if bacterial), corticosteroids, ventilation"],
    ["Prevention",         "Annual flu vaccine: IIV / RIV / LAIV / TIV / QIV"],
    ["Ayurveda",           "Janapadodhvamsa Vyadhi; Slesmaka Jvara cikitsa"],
]
story.append(two_col_table(summary, headers=["Topic", "Key Point"], col_widths=[5*cm, 12*cm]))
story.append(sp(10))

# Memory mnemonics box
story.append(info_box(
    "<b>MNEMONICS TO REMEMBER:</b><br/>"
    "• <b>FACTS</b> = Fever | Aches | Cough | Tiredness | Sudden onset (clinical features)<br/>"
    "• <b>Complications</b>: 'My Myo-Peri-Encephalo-Reye' = Myositis, Myocarditis, Pericarditis, Encephalitis, Reye syndrome<br/>"
    "• <b>Vaccines</b>: 'I Really Love Taking Quad' = IIV, RIV, LAIV, TIV, QIV<br/>"
    "• <b>Diagnosis</b>: 'Really Rapid Naso Pulse Chest' = RT-PCR, Rapid test, Naso swab, Pulse oximetry, Chest X-ray",
    YELLOW_BG, ORANGE))
story.append(sp(12))

# Footer note
story.append(HRFlowable(width="100%", thickness=1, color=ORANGE))
story.append(sp(4))
story.append(Paragraph(
    "Source: The Compendium of Kayacikitsa | Study Guide compiled for exam preparation | July 2026",
    SMALL))

# ── Build PDF ─────────────────────────────────────────────────────────────────
output_path = "/home/daytona/workspace/influenza-study-guide/Influenza_Study_Guide.pdf"
doc = SimpleDocTemplate(
    output_path,
    pagesize=A4,
    rightMargin=2*cm, leftMargin=2*cm,
    topMargin=2*cm,  bottomMargin=2*cm,
    title="Influenza - Complete Exam Study Guide",
    author="Orris AI",
    subject="Influenza Study Guide",
)
doc.build(story)
print(f"PDF created: {output_path}")

python /home/daytona/workspace/influenza-study-guide/create_pdf.py