~/

python -c "from pypdf import PdfReader; p='/tmp/workspace/attachments/0c1775e5-430d-408d-8ff0-28955246be51/DOC-20260922-WA0013.pdf'; r=PdfReader(p); print('pages',len(r.pages)); print('metadata',r.metadata); [print('---PAGE',i+1,'---\n', (pg.extract_text() or '')[:6000]) for i,pg in enumerate(r.pages)]"

"Otitis Media"[MeSH Terms]

CDC ear infection otitis media treatment clinical guidelines antibiotic watchful waiting

mkdir -p "/tmp/workspace/otitis-handbook/src" "/tmp/workspace/otitis-handbook/output" && python - <<'PY' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT from reportlab.lib.units import cm from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, PageBreak, KeepTogether from reportlab.pdfbase.pdfmetrics import stringWidth from reportlab.pdfgen import canvas from reportlab.lib.colors import HexColor out='/tmp/workspace/otitis-handbook/output/Otitis_Media_English_Handbook.pdf' PAGE_W,PAGE_H=A4 navy=HexColor('#16324F'); teal=HexColor('#007C83'); aqua=HexColor('#EAF8F8'); blue=HexColor('#EAF2FB'); coral=HexColor('#E86F5B'); yellow=HexColor('#FFF4CE'); purple=HexColor('#5C4B8A'); grey=HexColor('#4A5568'); pale=HexColor('#F7FAFC'); green=HexColor('#DFF4EA') styles=getSampleStyleSheet() styles.add(ParagraphStyle(name='CoverTitle', fontName='Helvetica-Bold', fontSize=32, leading=37, textColor=colors.white, alignment=TA_LEFT, spaceAfter=10)) styles.add(ParagraphStyle(name='CoverSub', fontName='Helvetica', fontSize=14, leading=20, textColor=HexColor('#DCEFF3'))) styles.add(ParagraphStyle(name='H1x', fontName='Helvetica-Bold', fontSize=20, leading=25, textColor=navy, spaceBefore=4, spaceAfter=12)) styles.add(ParagraphStyle(name='H2x', fontName='Helvetica-Bold', fontSize=13, leading=16, textColor=teal, spaceBefore=9, spaceAfter=5)) styles.add(ParagraphStyle(name='Bodyx', fontName='Helvetica', fontSize=9.5, leading=14, textColor=HexColor('#253447'), spaceAfter=6)) styles.add(ParagraphStyle(name='Smallx', fontName='Helvetica', fontSize=8, leading=11, textColor=grey)) styles.add(ParagraphStyle(name='BoxHead', fontName='Helvetica-Bold', fontSize=10.5, leading=13, textColor=navy, spaceAfter=3)) styles.add(ParagraphStyle(name='BoxBody', fontName='Helvetica', fontSize=9, leading=12, textColor=HexColor('#253447'))) styles.add(ParagraphStyle(name='Bulletx', fontName='Helvetica', fontSize=9.5, leading=13, leftIndent=14, firstLineIndent=-9, textColor=HexColor('#253447'), spaceAfter=3)) def P(s, style='Bodyx'): return Paragraph(s, styles[style]) def bullets(items): return [P('&bull; '+x,'Bulletx') for x in items] def box(title, text, bg=aqua, accent=teal): t=Table([[P(title,'BoxHead')],[P(text,'BoxBody')]], colWidths=[16.3*cm]) t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,-1),bg),('LINEBEFORE',(0,0),(0,-1),4,accent),('BOX',(0,0),(-1,-1),0.25,HexColor('#C9DDE1')),('LEFTPADDING',(0,0),(-1,-1),9),('RIGHTPADDING',(0,0),(-1,-1),9),('TOPPADDING',(0,0),(-1,0),7),('BOTTOMPADDING',(0,-1),(-1,-1),7)])) return t def table(headers, rows, widths=None): data=[[P(h,'BoxHead') for h in headers]]+[[P(c,'BoxBody') for c in r] for r in rows] t=Table(data,colWidths=widths,repeatRows=1,hAlign='LEFT') t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),navy),('TEXTCOLOR',(0,0),(-1,0),colors.white),('VALIGN',(0,0),(-1,-1),'TOP'),('GRID',(0,0),(-1,-1),0.25,HexColor('#B7CBD2')),('ROWBACKGROUNDS',(0,1),(-1,-1),[colors.white,pale]),('LEFTPADDING',(0,0),(-1,-1),6),('RIGHTPADDING',(0,0),(-1,-1),6),('TOPPADDING',(0,0),(-1,-1),6),('BOTTOMPADDING',(0,0),(-1,-1),6)])) return t def header_footer(canv, doc): canv.saveState() canv.setFillColor(navy); canv.rect(0,PAGE_H-1.0*cm,PAGE_W,1.0*cm,fill=1,stroke=0) canv.setFillColor(colors.white); canv.setFont('Helvetica-Bold',8); canv.drawString(1.4*cm,PAGE_H-.63*cm,'OTITIS MEDIA | ENGLISH STUDY HANDBOOK') canv.setFillColor(grey); canv.setFont('Helvetica',8); canv.drawRightString(PAGE_W-1.4*cm,.65*cm,f'Page {doc.page}') canv.restoreState() def cover(canv,doc): canv.saveState() canv.setFillColor(navy);canv.rect(0,0,PAGE_W,PAGE_H,fill=1,stroke=0) canv.setFillColor(teal);canv.circle(PAGE_W-1.2*cm,PAGE_H-2*cm,4.8*cm,fill=1,stroke=0) canv.setFillColor(coral);canv.circle(PAGE_W-4.6*cm,2.3*cm,2.2*cm,fill=1,stroke=0) canv.setFillColor(HexColor('#275B7A'));canv.circle(2.1*cm,3*cm,2.7*cm,fill=1,stroke=0) canv.setFillColor(HexColor('#80D5D1'));canv.circle(PAGE_W-2.6*cm,PAGE_H-7.5*cm,.8*cm,fill=1,stroke=0) canv.restoreState() story=[] story += [Spacer(1,4.7*cm),P('OTITIS MEDIA','CoverTitle'),P('English Study Handbook','CoverTitle'),Spacer(1,.2*cm),P('A clear, structured English adaptation of the attached Russian lecture notes, with clinical terminology standardized for safe study use.','CoverSub'),Spacer(1,7.2*cm),P('<b>Scope:</b> middle-ear anatomy, Eustachian-tube function, otoscopy, effusion, acute otitis media, red flags and clinical reasoning.','CoverSub'),Spacer(1,.5*cm),P('Educational resource only. Diagnosis and treatment must be made by a qualified clinician.','CoverSub'),PageBreak()] story += [P('How to use this handbook','H1x'),P('The attached material was a set of lecture-style notes in Russian. This handbook translates the meaning and continues it in a logical learning order. Ambiguous or outdated statements have been labelled or standardized against current clinical concepts.'),box('Important terminology','The notes often contrast “catarrhal” and “inflammatory/bacterial” otitis. In current English-language practice, use clearer terms: <b>Eustachian-tube dysfunction</b>, <b>otitis media with effusion (OME)</b>, and <b>acute otitis media (AOM)</b>. A red or pink tympanic membrane alone does not diagnose bacterial AOM.',yellow,coral),Spacer(1,10),P('Contents','H2x'),table(['Section','What you will learn'],[['1. Foundations','Where the middle ear sits and why its pressure system matters'],['2. Otoscopy','Normal landmarks and a reproducible examination sequence'],['3. Pressure and effusion','How tube dysfunction changes the tympanic membrane'],['4. Inflammatory disease','How to distinguish OME from acute infection'],['5. Safety','Complications, red flags, and appropriate escalation'],['6. Review','A bedside checklist and high-yield summary']], [4.1*cm,12.2*cm]),Spacer(1,12),box('Source note','The handbook is an adaptation of “Otitis,” the 7-page uploaded PDF, dated 22 September 2026. It is not a word-for-word transcript, because the source uses fragmented lecture language and includes claims that need clinical context.',blue,navy),PageBreak()] story += [P('1. Middle-ear foundations','H1x'),P('The middle ear is an air-containing space behind the tympanic membrane (eardrum). It communicates with the nasopharynx through the Eustachian tube and with the mastoid air-cell system posteriorly.'),table(['Structure','Study point'],[['Tympanic membrane','Separates the external ear canal from the middle ear. It is oblique, not a flat vertical screen.'],['Tympanic cavity','Contains the ossicles: malleus, incus and stapes. Their role is sound transmission.'],['Eustachian tube','Ventilates the middle ear, equalizes pressure, clears secretions, and helps protect the middle ear from nasopharyngeal contents.'],['Mastoid air cells','Air-containing spaces in the temporal bone that communicate with the middle-ear system.']], [4.5*cm,11.8*cm]),Spacer(1,8),box('Clinical connection','Upper respiratory infections, allergic swelling, adenoid enlargement, and rapid altitude changes can impair Eustachian-tube opening. The result may be negative middle-ear pressure, a retracted membrane, a blocked-ear sensation, or fluid behind the membrane.',aqua,teal),Spacer(1,8),P('Why children are susceptible','H2x'),*bullets(['The Eustachian tube is shorter and more horizontal in young children.', 'Adenoid tissue lies near the pharyngeal opening of the tube and can contribute to obstruction.', 'Viral upper-respiratory infections commonly create mucosal swelling throughout the nose, nasopharynx and Eustachian tube.']),PageBreak()] story += [P('2. Otoscopy: normal findings','H1x'),P('Always compare both ears. A difference from the opposite side can be more informative than a single isolated feature.'),P('The key normal features are listed below. Pneumatic otoscopy, when available and performed correctly, assesses membrane mobility and is especially useful for detecting middle-ear effusion.'),table(['Feature','Typical normal appearance'],[['Colour','Pearly grey or grey-white. Mild pinkness can occur and is nonspecific.'],['Position','Neither distinctly retracted nor bulging.'],['Mobility','Moves with pressure change on pneumatic otoscopy.'],['Light reflex','A cone-shaped reflection in the anteroinferior quadrant: approximately 5 o’clock in the right ear and 7 o’clock in the left ear.'],['Malleus landmarks','Handle and short process are visible, but prominence varies between individuals.']], [4.1*cm,12.2*cm]),Spacer(1,10),box('A useful examination sequence','1. Inspect the pinna and external canal. 2. Insert the speculum gently with a view of the canal walls. 3. Identify membrane colour, translucency, position and landmarks. 4. Look for perforation or otorrhea. 5. Compare the other ear. 6. Test mobility if trained and equipped.',green,teal),Spacer(1,8),P('Referred ear pain','H2x'),P('Otalgia does not always arise in the ear. Dental disease and temporomandibular-joint disorders can refer pain to the ear, particularly when the ear examination is normal.'),PageBreak()] story += [P('3. Eustachian-tube dysfunction and effusion','H1x'),P('When the tube fails to ventilate the middle ear, gas is absorbed and middle-ear pressure may fall relative to atmospheric pressure. The membrane may retract inward and the malleus can appear unusually prominent.'),table(['Situation','Likely otoscopic and clinical pattern'],[['Negative pressure / tube dysfunction','Retracted membrane, altered light reflex, possible vascular injection or pinkness, ear fullness. Hearing may be normal early on.'],['Otitis media with effusion (OME)','Fluid behind an intact membrane, reduced mobility, conductive hearing loss or “blocked ear.” Acute systemic illness is usually absent.'],['Positive pressure or acute inflammation','Bulging membrane, loss of landmarks and reduced mobility. In the right clinical setting this supports AOM.']], [4.4*cm,11.9*cm]),Spacer(1,10),box('Do not overinterpret colour','Colour change by itself is not enough to diagnose acute bacterial infection. A pink membrane may follow crying, fever, upper-respiratory illness, pressure change, or vascular injection due to negative pressure. Position, mobility, symptoms and time course must be interpreted together.',yellow,coral),Spacer(1,8),P('The light reflex','H2x'),P('Its location and shape are determined by the membrane’s oblique position. A distorted, absent or diffuse light reflex may signal altered membrane contour, but it is a supporting observation, not a diagnosis by itself.'),PageBreak()] story += [P('4. Acute otitis media and OME','H1x'),P('AOM is an acute infection and inflammation of the middle ear. OME means middle-ear fluid without the acute infection syndrome. The distinction affects management and safety.'),table(['Feature','OME / tube dysfunction','Acute otitis media (AOM)'],[['Pain and fever','Often absent or mild','May be prominent, especially with acute onset'],['General illness','Usually none','May include irritability, fever or systemic symptoms'],['Tympanic membrane','Retracted or neutral; fluid signs; reduced mobility','Moderate to severe bulging, or new otorrhea not due to otitis externa, strongly supports diagnosis'],['Hearing','Conductive reduction may occur if fluid is present','May be reduced during the acute episode'],['Antibiotics','Not routinely indicated for OME alone','Use depends on age, severity, certainty of diagnosis and follow-up access']], [4.0*cm,6.15*cm,6.15*cm]),Spacer(1,10),P('Inflammation: the classic five signs','H2x'),table(['Latin term','Meaning'],[['Tumor','Swelling'],['Rubor','Redness'],['Calor','Heat'],['Dolor','Pain'],['Functio laesa','Loss of function']], [4.2*cm,12.1*cm]),Spacer(1,8),box('Medication safety','Do not translate the source notes as a rule that every inflammatory ear condition needs antibiotics. Current practice permits observation in selected uncomplicated AOM cases, while antibiotics are indicated in defined circumstances. OME alone is not an indication for antibiotics. Management should follow local guideline and clinician assessment.',aqua,teal),PageBreak()] story += [P('5. Clinical reasoning and safety','H1x'),P('Ask about the time course, pain, fever, drainage, hearing change, recent upper-respiratory illness, prior treatment and any neurological symptoms. If the examination is uncertain, reassessment and appropriate tests can be safer than forcing a diagnosis from colour alone.'),P('Historical clues from the notes','H2x'),*bullets(['Blocked ear but hearing still fairly good can occur with early Eustachian-tube dysfunction.', 'New reduction in hearing after a period of blockage can suggest middle-ear fluid.', 'Severe headache, fever, vomiting, neck stiffness, marked lethargy, or a worsening condition after ear infection needs urgent evaluation.']),Spacer(1,6),box('Urgent red flags','Seek urgent clinical assessment for severe or rapidly worsening illness; post-auricular swelling, redness or tenderness; facial weakness; severe headache, confusion, persistent vomiting, neck stiffness, seizure; or a very unwell infant/child. These symptoms can indicate complications and must not be managed as routine ear pain.',HexColor('#FDE7E5'),coral),Spacer(1,9),P('Why complications matter','H2x'),P('The middle ear and mastoid lie close to important cranial structures. Although complications are uncommon in the antibiotic era, mastoiditis and intracranial complications such as meningitis or venous sinus thrombosis are serious possibilities when a patient deteriorates or develops neurological signs.'),Spacer(1,6),P('Note on examination for meningism','H2x'),P('Signs such as neck stiffness, Kernig and Brudzinski signs are clinical examination findings that must be assessed by trained clinicians and interpreted in context. In infants, a tense or bulging fontanelle with systemic illness is an emergency feature.'),PageBreak()] story += [P('6. Bedside review checklist','H1x'),table(['Question','What it helps distinguish'],[['Is there acute ear pain, fever or systemic illness?','Acute infection versus noninfectious tube dysfunction/OME'],['Is the tympanic membrane bulging, retracted or neutral?','Pressure state and diagnostic certainty'],['Is mobility reduced?','Supports presence of middle-ear effusion'],['Is there new otorrhea?','May support AOM if not caused by otitis externa'],['Is hearing newly reduced?','May signal effusion and conductive hearing loss'],['How does the other ear look?','Provides an internal comparison'],['Are there red flags or deterioration?','Identifies need for urgent escalation']], [7.1*cm,9.2*cm]),Spacer(1,12),P('High-yield takeaways','H2x'),*bullets(['The Eustachian tube equalizes pressure and clears middle-ear secretions.', 'A red or pink membrane alone is not proof of bacterial otitis media.', 'Bulging of the tympanic membrane and reduced mobility carry more diagnostic weight than colour alone.', 'OME produces fluid and possible hearing loss, but is not synonymous with acute bacterial infection.', 'Always compare both ears and integrate history, otoscopy and the patient’s general condition.', 'Systemic toxicity or neurological symptoms after an ear infection require urgent assessment.']),Spacer(1,11),box('For study, not self-treatment','This document explains concepts and supports translation of the uploaded notes. It does not replace diagnosis, a local protocol, or individual treatment advice.',yellow,coral),PageBreak()] story += [P('References and translation notes','H1x'),P('Primary source','H2x'),P('Uploaded document: <i>Otitis</i>, 7 pages, Russian lecture-style text. English content was translated, reorganized and clinically standardized where the notes were fragmentary or used nonstandard categories.'),P('Clinical context used in standardization','H2x'),*bullets(['Centers for Disease Control and Prevention. <i>Ear Infection Basics</i>. Key point: some middle-ear infections improve without antibiotics; clinicians may recommend watchful waiting for selected cases.', 'Centers for Disease Control and Prevention. <i>Outpatient Clinical Care for Pediatric Populations</i>. Key point: definitive AOM diagnosis relies on acute findings such as moderate/severe tympanic-membrane bulging or new otorrhea not due to otitis externa.', 'Goldman-Cecil Medicine International Edition. Medical textbook library search for otitis media with effusion.']),Spacer(1,9),box('Recent-evidence note','Recent systematic reviews found by PubMed address the burden and developmental associations of otitis media, rather than changing the foundational diagnostic distinctions used here. PMIDs: 39823773, 38190644, 37984128.',blue,navy),Spacer(1,15),P('End of handbook','H2x'),P('Prepared 22 September 2026. Color-coded sections are designed for rapid revision and discussion with a qualified ENT or primary-care educator.','Bodyx')] doc=SimpleDocTemplate(out,pagesize=A4,rightMargin=1.4*cm,leftMargin=1.4*cm,topMargin=1.5*cm,bottomMargin=1.35*cm,title='Otitis Media English Study Handbook',author='English adaptation') doc.build(story,onFirstPage=cover,onLaterPages=header_footer) print(out) PY python -c "from pypdf import PdfReader; p='/tmp/workspace/otitis-handbook/output/Otitis_Media_English_Handbook.pdf'; r=PdfReader(p); print('pages',len(r.pages),'bytes',__import__('os').path.getsize(p)); print(r.pages[1].extract_text()[:500])"

python - <<'PY' import fitz, os from PIL import Image, ImageDraw p='/tmp/workspace/otitis-handbook/output/Otitis_Media_English_Handbook.pdf' doc=fitz.open(p) thumbs=[] for i,page in enumerate(doc): pix=page.get_pixmap(matrix=fitz.Matrix(0.65,0.65), alpha=False) im=Image.frombytes('RGB',[pix.width,pix.height],pix.samples) im.thumbnail((250,354)) canvas=Image.new('RGB',(270,390),'white'); canvas.paste(im,((270-im.width)//2,25)) d=ImageDraw.Draw(canvas); d.text((10,5),f'Page {i+1}',fill='black') thumbs.append(canvas) out=Image.new('RGB',(270*3,390*3),(220,225,230)) for i,im in enumerate(thumbs): out.paste(im,((i%3)*270,(i//3)*390)) out.save('/tmp/workspace/otitis-handbook/output/preview.png') print('rendered',len(doc),'pages') PY

~/otitis-handbook/output

python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/otitis-handbook/output/Otitis_Media_English_Handbook.pdf' r=PdfReader(p) print('pages:',len(r.pages)) for n, pg in enumerate(r.pages,1): t=pg.extract_text() or '' print(n, len(t), t.replace('\n',' ')[:100]) assert len(r.pages)==9 assert all((pg.extract_text() or '').strip() for pg in r.pages) print('PASS: readable text found on every page') PY