Telogen Effluvium (TE)

from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether, ListFlowable, ListItem, PageBreak
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import inch, mm
from reportlab.lib import colors
from reportlab.lib.pagesizes import A4
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
from reportlab.platypus.flowables import Flowable
import reportlab.rl_config

OUTPUT = "/tmp/workspace/telogen-effluvium/Telogen_Effluvium_Clinical_Reference.pdf"

# ── Colour palette ────────────────────────────────────────────────────────────
C_NAVY      = colors.HexColor("#1B3A5C")   # header / title bar
C_TEAL      = colors.HexColor("#1A7B8C")   # section heading bar
C_TEAL_LITE = colors.HexColor("#E8F5F7")   # section heading bar fill (light)
C_ACCENT    = colors.HexColor("#D4A843")   # gold accent line
C_RED       = colors.HexColor("#C0392B")   # alert / warning
C_GREEN     = colors.HexColor("#27AE60")   # positive/good
C_AMBER     = colors.HexColor("#E67E22")   # caution
C_BG_GREY   = colors.HexColor("#F4F6F8")   # table alt row
C_BG_BLUE   = colors.HexColor("#EBF4F8")   # info box
C_TEXT      = colors.HexColor("#2C3E50")   # body text
C_WHITE     = colors.white
C_HEADER_TXT= colors.HexColor("#E0EEF3")

# ── Page setup ─────────────────────────────────────────────────────────────────
PAGE_W, PAGE_H = A4
L_MARGIN = 18 * mm
R_MARGIN = 18 * mm
T_MARGIN = 20 * mm
B_MARGIN = 20 * mm

# ── Styles ─────────────────────────────────────────────────────────────────────
base = getSampleStyleSheet()

def make_style(name, parent="Normal", **kw):
    s = ParagraphStyle(name, parent=base[parent])
    for k, v in kw.items():
        setattr(s, k, v)
    return s

sTitle       = make_style("sTitle",      "Title",
                           fontName="Helvetica-Bold", fontSize=22,
                           textColor=C_WHITE, alignment=TA_CENTER,
                           spaceAfter=2, spaceBefore=0, leading=26)
sSubtitle    = make_style("sSubtitle",   "Normal",
                           fontName="Helvetica", fontSize=10,
                           textColor=C_HEADER_TXT, alignment=TA_CENTER,
                           spaceAfter=0, leading=14)
sSectionHdr  = make_style("sSectionHdr", "Normal",
                           fontName="Helvetica-Bold", fontSize=11,
                           textColor=C_WHITE, alignment=TA_LEFT,
                           spaceBefore=10, spaceAfter=4, leading=16)
sSubHdr      = make_style("sSubHdr",     "Normal",
                           fontName="Helvetica-Bold", fontSize=9.5,
                           textColor=C_NAVY, alignment=TA_LEFT,
                           spaceBefore=6, spaceAfter=2, leading=13)
sBody        = make_style("sBody",       "Normal",
                           fontName="Helvetica", fontSize=8.5,
                           textColor=C_TEXT, alignment=TA_JUSTIFY,
                           spaceAfter=4, leading=12)
sBodyBold    = make_style("sBodyBold",   "Normal",
                           fontName="Helvetica-Bold", fontSize=8.5,
                           textColor=C_TEXT, alignment=TA_LEFT,
                           spaceAfter=2, leading=12)
sBullet      = make_style("sBullet",     "Normal",
                           fontName="Helvetica", fontSize=8.2,
                           textColor=C_TEXT, alignment=TA_LEFT,
                           leftIndent=10, spaceAfter=2, leading=12)
sTableHdr    = make_style("sTableHdr",   "Normal",
                           fontName="Helvetica-Bold", fontSize=8,
                           textColor=C_WHITE, alignment=TA_CENTER,
                           leading=11)
sTableCell   = make_style("sTableCell",  "Normal",
                           fontName="Helvetica", fontSize=8,
                           textColor=C_TEXT, alignment=TA_LEFT,
                           leading=11)
sTableCellC  = make_style("sTableCellC", "Normal",
                           fontName="Helvetica", fontSize=8,
                           textColor=C_TEXT, alignment=TA_CENTER,
                           leading=11)
sTableCellB  = make_style("sTableCellB", "Normal",
                           fontName="Helvetica-Bold", fontSize=8,
                           textColor=C_TEXT, alignment=TA_LEFT,
                           leading=11)
sAlertRed    = make_style("sAlertRed",   "Normal",
                           fontName="Helvetica-Bold", fontSize=8.5,
                           textColor=C_RED, alignment=TA_LEFT,
                           spaceAfter=2, leading=12)
sFooter      = make_style("sFooter",     "Normal",
                           fontName="Helvetica", fontSize=7,
                           textColor=colors.HexColor("#7F8C8D"),
                           alignment=TA_CENTER, leading=10)
sCaption     = make_style("sCaption",    "Normal",
                           fontName="Helvetica-Oblique", fontSize=7.5,
                           textColor=colors.HexColor("#5D6D7E"),
                           alignment=TA_CENTER, spaceAfter=4, leading=11)
sDrug        = make_style("sDrug",       "Normal",
                           fontName="Helvetica", fontSize=8,
                           textColor=C_TEXT, alignment=TA_LEFT,
                           spaceAfter=2, leading=12)

# ── Helper flowables ────────────────────────────────────────────────────────────
def HR(color=C_ACCENT, width=1.2):
    return HRFlowable(width="100%", thickness=width, color=color, spaceAfter=4, spaceBefore=2)

def section_header(text):
    """Teal background bar with white text used for each major section."""
    tbl = Table([[Paragraph(text, sSectionHdr)]], colWidths=[PAGE_W - L_MARGIN - R_MARGIN])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0, 0), (-1, -1), C_TEAL),
        ("LEFTPADDING",  (0, 0), (-1, -1), 8),
        ("RIGHTPADDING", (0, 0), (-1, -1), 8),
        ("TOPPADDING",   (0, 0), (-1, -1), 5),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 5),
        ("ROUNDEDCORNERS", [4, 4, 4, 4]),
    ]))
    return tbl

def info_box(text, bg=C_BG_BLUE, border=C_TEAL):
    """Coloured info box."""
    tbl = Table([[Paragraph(text, sBody)]], colWidths=[PAGE_W - L_MARGIN - R_MARGIN])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",   (0, 0), (-1, -1), bg),
        ("BOX",          (0, 0), (-1, -1), 1, border),
        ("LEFTPADDING",  (0, 0), (-1, -1), 10),
        ("RIGHTPADDING", (0, 0), (-1, -1), 10),
        ("TOPPADDING",   (0, 0), (-1, -1), 6),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 6),
    ]))
    return tbl

def alert_box(text, bg=colors.HexColor("#FDEDEC"), border=C_RED):
    tbl = Table([[Paragraph(text, sAlertRed)]], colWidths=[PAGE_W - L_MARGIN - R_MARGIN])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",   (0, 0), (-1, -1), bg),
        ("BOX",          (0, 0), (-1, -1), 1, border),
        ("LEFTPADDING",  (0, 0), (-1, -1), 10),
        ("RIGHTPADDING", (0, 0), (-1, -1), 10),
        ("TOPPADDING",   (0, 0), (-1, -1), 6),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 6),
    ]))
    return tbl

def success_box(text, bg=colors.HexColor("#EAFAF1"), border=C_GREEN):
    tbl = Table([[Paragraph(text, sBody)]], colWidths=[PAGE_W - L_MARGIN - R_MARGIN])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",   (0, 0), (-1, -1), bg),
        ("BOX",          (0, 0), (-1, -1), 1, border),
        ("LEFTPADDING",  (0, 0), (-1, -1), 10),
        ("RIGHTPADDING", (0, 0), (-1, -1), 10),
        ("TOPPADDING",   (0, 0), (-1, -1), 6),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 6),
    ]))
    return tbl

def TC(text, style=None, bold=False):
    if style is None:
        style = sTableCellB if bold else sTableCell
    return Paragraph(text, style)

def TH(text):
    return Paragraph(text, sTableHdr)

def build_table(headers, rows, col_widths, alt=True, hdr_color=C_NAVY):
    data = [[TH(h) for h in headers]] + [[TC(c) for c in row] for row in rows]
    style = [
        ("BACKGROUND",    (0, 0), (-1, 0),  hdr_color),
        ("ROWBACKGROUNDS",(0, 1), (-1, -1), [C_WHITE, C_BG_GREY] if alt else [C_WHITE]),
        ("GRID",          (0, 0), (-1, -1), 0.4, colors.HexColor("#BDC3C7")),
        ("VALIGN",        (0, 0), (-1, -1), "TOP"),
        ("LEFTPADDING",   (0, 0), (-1, -1), 5),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 5),
        ("TOPPADDING",    (0, 0), (-1, -1), 4),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 4),
    ]
    t = Table(data, colWidths=col_widths)
    t.setStyle(TableStyle(style))
    return t

# ── Header / Footer callbacks ──────────────────────────────────────────────────
def on_first_page(canvas, doc):
    _draw_header(canvas, doc, first=True)
    _draw_footer(canvas, doc)

def on_later_pages(canvas, doc):
    _draw_header(canvas, doc, first=False)
    _draw_footer(canvas, doc)

def _draw_header(canvas, doc, first=False):
    canvas.saveState()
    if first:
        # Full navy title banner
        banner_h = 58
        canvas.setFillColor(C_NAVY)
        canvas.rect(0, PAGE_H - banner_h, PAGE_W, banner_h, fill=1, stroke=0)
        # Gold accent stripe
        canvas.setFillColor(C_ACCENT)
        canvas.rect(0, PAGE_H - banner_h - 3, PAGE_W, 3, fill=1, stroke=0)
    else:
        # Compact repeat header
        hdr_h = 22
        canvas.setFillColor(C_NAVY)
        canvas.rect(0, PAGE_H - hdr_h, PAGE_W, hdr_h, fill=1, stroke=0)
        canvas.setFillColor(C_ACCENT)
        canvas.rect(0, PAGE_H - hdr_h - 2, PAGE_W, 2, fill=1, stroke=0)
        canvas.setFont("Helvetica-Bold", 9)
        canvas.setFillColor(C_WHITE)
        canvas.drawString(L_MARGIN, PAGE_H - 15, "TELOGEN EFFLUVIUM — Clinical Reference")
        canvas.setFont("Helvetica", 8)
        canvas.setFillColor(C_HEADER_TXT)
        canvas.drawRightString(PAGE_W - R_MARGIN, PAGE_H - 15, f"Page {doc.page}")
    canvas.restoreState()

def _draw_footer(canvas, doc):
    canvas.saveState()
    canvas.setFillColor(colors.HexColor("#ECF0F1"))
    canvas.rect(0, 0, PAGE_W, 16, fill=1, stroke=0)
    canvas.setFillColor(C_ACCENT)
    canvas.rect(0, 16, PAGE_W, 1, fill=1, stroke=0)
    canvas.setFont("Helvetica", 6.5)
    canvas.setFillColor(colors.HexColor("#7F8C8D"))
    canvas.drawString(L_MARGIN, 5, "Sources: Fitzpatrick's Dermatology (9780071837781) | Andrews' Diseases of the Skin (9780323547536) | Dermatology 2-Volume Set 5e (9780702082252)")
    canvas.drawRightString(PAGE_W - R_MARGIN, 5, "For clinical use — verify with current guidelines")
    canvas.restoreState()

# ── Build document ─────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=L_MARGIN,
    rightMargin=R_MARGIN,
    topMargin=T_MARGIN + 45,   # extra top for banner
    bottomMargin=B_MARGIN + 16,
    title="Telogen Effluvium — Clinical Reference",
    author="Orris Medical AI",
    subject="Dermatology — Hair Loss",
)

story = []
SP = Spacer(1, 5)
SP8 = Spacer(1, 8)

# ═══════════════════════════════════════════════════════
# TITLE SECTION  (drawn in canvas; here we just add a spacer)
# ═══════════════════════════════════════════════════════
# We draw the title text directly in the first-page callback
# via a custom Flowable so it sits inside the banner
class TitleFlowable(Flowable):
    def __init__(self):
        Flowable.__init__(self)
        self.width  = PAGE_W - L_MARGIN - R_MARGIN
        self.height = 0  # zero height — rendered above in canvas callback

    def draw(self):
        pass   # actual drawing done in on_first_page

story.append(TitleFlowable())

# We add explicit title paragraphs as the very first story items,
# but place them INSIDE a table so they render nicely in the banner space.
# Actually simpler: just push them to a spacer + paragraphs aligned to top margin.
# The on_first_page callback draws the navy banner behind them.

# Because reportlab draws canvas decorations behind story items, we push
# the title text using normal paragraphs but with navy-background table so
# they visually merge with the canvas banner.
title_block = Table([
    [Paragraph("TELOGEN EFFLUVIUM", sTitle)],
    [Paragraph("Clinical Reference Guide  |  Diagnosis & Management", sSubtitle)],
    [Paragraph("Dermatology  ·  August 2026", sSubtitle)],
], colWidths=[PAGE_W - L_MARGIN - R_MARGIN])
title_block.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,-1), C_NAVY),
    ("TOPPADDING",    (0,0),(-1,-1), 4),
    ("BOTTOMPADDING", (0,0),(-1,-1), 4),
    ("LEFTPADDING",   (0,0),(-1,-1), 0),
    ("RIGHTPADDING",  (0,0),(-1,-1), 0),
]))
story.append(title_block)
story.append(Spacer(1, 10))

# ═══════════════════════════════════════════════════════
# 1 — DEFINITION & OVERVIEW
# ═══════════════════════════════════════════════════════
story.append(section_header("1.  DEFINITION & OVERVIEW"))
story.append(SP)
story.append(Paragraph(
    "<b>Telogen effluvium (TE)</b> is an acute or chronic diffuse, <b>non-scarring alopecia</b> caused by a premature or "
    "excessive shift of hair follicles from the <b>anagen</b> (growth) phase into the <b>telogen</b> (resting/shedding) phase, "
    "resulting in abnormal club-hair shedding across the entire scalp.",
    sBody))
story.append(SP)

# Key numbers box
story.append(info_box(
    "<b>Key numbers:</b>&nbsp; Normal scalp ~ 100,000 follicles &nbsp;|&nbsp; ~10% normally in telogen &nbsp;|&nbsp; "
    "Normal daily loss: 100–150 hairs &nbsp;|&nbsp; TE daily loss: 150–400+ hairs"))
story.append(SP8)

# ═══════════════════════════════════════════════════════
# 2 — PATHOPHYSIOLOGY
# ═══════════════════════════════════════════════════════
story.append(section_header("2.  PATHOPHYSIOLOGY — Five Mechanisms (Kligman)"))
story.append(SP)

path_data = [
    ["Mechanism", "Description", "Classic Example"],
    ["Immediate anagen release", "Abrupt premature conversion of anagen → telogen", "Febrile illness, surgery, childbirth"],
    ["Delayed anagen release",   "Prolonged anagen (e.g. pregnancy), mass release after trigger resolves", "Postpartum TE — shedding 2–3 months after delivery"],
    ["Short anagen",             "Intrinsically shortened anagen; more hairs cycling into telogen constantly", "Chronic TE, androgenetic alopecia"],
    ["Immediate telogen release","Premature exit from telogen to initiate anagen", "Topical minoxidil (transient early shedding)"],
    ["Delayed telogen release",  "Prolonged telogen; synchronous delayed shedding", "Seasonal shedding"],
]
story.append(build_table(path_data[0], [r for r in path_data[1:]], [85, 200, 190]))
story.append(SP8)

# ═══════════════════════════════════════════════════════
# 3 — ETIOLOGY & TRIGGERS
# ═══════════════════════════════════════════════════════
story.append(section_header("3.  ETIOLOGY & COMMON TRIGGERS"))
story.append(SP)

story.append(Paragraph("<b>A. Physiological</b>", sSubHdr))
phys = [
    ["Postpartum (Telogen Gravidarum)", "Most widely recognised TE. Anagen rate peaks ~94% in pregnancy; telogen rises ~25% by 6 weeks postpartum. Shedding peaks 2–3 months post-delivery."],
    ["Neonatal TE", "Telogen counts 60–80%; begins within 4 months of birth; resolves spontaneously by 6 months."],
]
story.append(build_table(["Trigger", "Notes"], phys, [130, 345]))
story.append(SP)

story.append(Paragraph("<b>B. Medical / Systemic</b>", sSubHdr))
med = [
    ["Febrile illness / sepsis",   "High fever stresses matrix cells → early anagen release. Post-COVID-19 TE is a current well-recognised example."],
    ["Major surgery",              "Surgery itself or accompanying factors (fever, anaesthesia, hormonal/cytokine changes, nutritional shifts). Rhytidectomy can cause localised TE."],
    ["Hypothyroidism",             "Well-established association. More often causes chronic diffuse telogen hair loss (CDTHL). Hair regrowth begins ~8 weeks after thyroid hormone replacement."],
    ["Iron deficiency",            "Low ferritin / iron saturation. Iron replacement alone may not resolve TE — likely a marker of overall nutritional status."],
    ["Other",                      "Renal dialysis with secondary hypervitaminosis A; allergic contact dermatitis to hair dyes; hyperthyroidism (less clear association)."],
]
story.append(build_table(["Trigger", "Notes"], med, [130, 345]))
story.append(SP)

story.append(Paragraph("<b>C. Nutritional</b>", sSubHdr))
nutr = [
    ["Crash diet / severe calorie restriction", "Weight loss ~12–25 kg over 3 weeks–3 months → telogen counts rise to 25–50%. Classic example shown in Fig 33.4 of Andrews'."],
    ["Protein deficiency",                      "Inadequate dietary protein reduces hair matrix cell proliferation."],
    ["Micronutrient deficiencies",              "Iron, zinc, biotin, vitamin D — assess and correct where identified."],
]
story.append(build_table(["Trigger", "Notes"], nutr, [175, 300]))
story.append(SP)

story.append(Paragraph("<b>D. Drug-induced TE</b>", sSubHdr))
story.append(Paragraph(
    "Aminosalicylic acid, amphetamines, bromocriptine, captopril, carbamazepine, cimetidine, "
    "coumarin, danazol, enalapril, etretinate, levodopa, lithium carbonate, metoprolol, metyrapone, "
    "pramipexole, propranolol, pyridostigmine, trimethadione.", sDrug))
story.append(alert_box("Drug-induced TE: Discontinue the offending agent — this is usually curative."))
story.append(SP8)

# ═══════════════════════════════════════════════════════
# 4 — CLINICAL FEATURES
# ═══════════════════════════════════════════════════════
story.append(section_header("4.  CLINICAL FEATURES"))
story.append(SP)

clin_data = [
    ["Feature", "Detail"],
    ["Pattern",                "Diffuse shedding across entire scalp — NOT patchy"],
    ["Timing",                 "Typically begins 3–5 months after precipitating event"],
    ["Shed hair morphology",   "Depigmented, club-shaped bulb; no root sheath (telogen club hair)"],
    ["Scalp appearance",       "Normal — no erythema, scaling, or scarring"],
    ["Bitemporal recession",   "Frequently noted, especially in chronic TE"],
    ["Trichodynia",            "Scalp pain/dysaesthesia — common; may coexist with anxiety or depression"],
    ["Severity",               "Patient may notice hair blocking shower drain; clumps of shed hair"],
    ["Duration",               "Acute TE: resolves within 3–6 months. Chronic TE: >6 months, fluctuating"],
]
story.append(build_table(clin_data[0], [r for r in clin_data[1:]], [150, 325]))
story.append(SP8)

# ═══════════════════════════════════════════════════════
# 5 — DIAGNOSIS
# ═══════════════════════════════════════════════════════
story.append(section_header("5.  DIAGNOSTIC APPROACH"))
story.append(SP)

story.append(Paragraph("<b>5.1  Clinical Tests</b>", sSubHdr))
diag_data = [
    ["Test", "Method", "Interpretation"],
    ["Pull Test",
     "Grasp ~40 hairs, apply slow firm traction",
     ">4–6 club hairs = abnormal (unshampooed scalp)\n>2–3 club hairs = abnormal (freshly shampooed scalp)"],
    ["Clip Test",
     "Cut 25–30 hairs just above scalp surface, mount",
     "Short, small-diameter hairs = indeterminate/telogen. Many such hairs in TE or pattern alopecia"],
    ["Trichogram",
     "Pluck 50 hairs with rubber-padded Kelly clamp",
     "Provides anagen:telogen ratio. Neonatal TE: telogen ~60–80%"],
    ["Hair Collection Count",
     "Patient collects all shed hairs for 24 h (bed, brush, shower)",
     ">100 hairs/day sustained over time = significant shedding"],
]
story.append(build_table(diag_data[0], [r for r in diag_data[1:]], [75, 165, 235]))
story.append(SP)

story.append(Paragraph("<b>5.2  Scalp Biopsy (4 mm punch, horizontal/transverse sections)</b>", sSubHdr))
bx_data = [
    ["Finding", "Significance"],
    [">12–15% terminal follicles in telogen", "Significant anagen-to-telogen shift — supports TE diagnosis"],
    ["Miniaturisation + variable shaft diameter", "Androgenetic alopecia (key differential)"],
    ["Pigment casts, trichomalacia, catagen hairs", "Traction alopecia / trichotillomania"],
    ["Normal follicle count in transverse section", "25–50 follicles expected per 4 mm punch"],
]
story.append(build_table(bx_data[0], [r for r in bx_data[1:]], [220, 255]))
story.append(SP)

story.append(Paragraph("<b>5.3  Laboratory Investigations</b>", sSubHdr))
lab_data = [
    ["Test", "Rationale"],
    ["Serum ferritin + iron saturation", "Iron deficiency — also a marker of overall nutritional status"],
    ["TSH ± free T4", "Hypothyroidism (most common thyroid cause); hyperthyroidism less clearly linked"],
    ["FBC / CBC",     "Anaemia, infection markers"],
    ["Metabolic panel", "Renal function, liver function"],
    ["Hormonal panel (if indicated)", "DHEAS, testosterone, prolactin — consider in women with signs of hyperandrogenaemia"],
    ["25-OH Vitamin D, zinc, B12", "Micronutrient deficiencies in prolonged or unexplained TE"],
]
story.append(build_table(lab_data[0], [r for r in lab_data[1:]], [175, 300]))
story.append(SP8)

# ═══════════════════════════════════════════════════════
# 6 — DIFFERENTIAL DIAGNOSIS
# ═══════════════════════════════════════════════════════
story.append(section_header("6.  DIFFERENTIAL DIAGNOSIS"))
story.append(SP)

diff_data = [
    ["Condition", "Key Distinguishing Features", "Biopsy Clue"],
    ["Androgenetic alopecia",         "Patterned (frontoparietal) distribution; miniaturisation",            "Miniaturised follicles; variable shaft diameter"],
    ["Diffuse alopecia areata",       "Personal/family hx of AA; nail changes (pitting); body hair loss",   "Peribulbar lymphocytic infiltrate ('swarm of bees')"],
    ["Central centrifugal cicatricial alopecia", "Vertex scarring; women of African descent; progressive", "Scarring; perifollicular fibrosis"],
    ["Frontal fibrosing alopecia",    "Band-like frontotemporal recession; eyebrow loss; perifollicular erythema", "Lymphocytic scarring alopecia"],
    ["Traction alopecia",             "History of tight braiding/tension; frontoparietal margin", "Increased catagen/telogen; no miniaturisation"],
    ["Tinea capitis",                 "Children; scaling; broken-off hairs; KOH positive",                  "Fungal hyphae"],
    ["Secondary syphilis",            "'Moth-eaten' patchy loss; systemic signs; RPR positive",              "Perivascular/lichenoid infiltrate"],
]
story.append(build_table(diff_data[0], [r for r in diff_data[1:]], [130, 215, 130]))
story.append(SP8)

# ═══════════════════════════════════════════════════════
# 7 — CHRONIC TELOGEN EFFLUVIUM
# ═══════════════════════════════════════════════════════
story.append(section_header("7.  CHRONIC TELOGEN EFFLUVIUM (CTE)"))
story.append(SP)
story.append(info_box(
    "<b>Definition:</b> Idiopathic diffuse club-hair loss lasting >6 months with fluctuating course. "
    "Described by Whiting in 355 patients (346 women, 9 men), predominantly aged 30–60 years."))
story.append(SP)

cte_data = [
    ["Feature", "Acute TE", "Chronic TE (CTE)"],
    ["Duration",          "<6 months, self-limiting",      ">6 months; fluctuating, may persist years"],
    ["Trigger",           "Identifiable precipitant",       "Idiopathic; no clear trigger"],
    ["Demographics",      "Any age, any gender",            "Women, 4th–6th decade predominantly"],
    ["Mechanism",         "Premature anagen release",       "Shortened anagen phase"],
    ["Hair density before onset", "Normal",                 "Often above average — very long hair in childhood"],
    ["Pull test",         "Diffusely positive scalp-wide",  "Positive at vertex and occiput"],
    ["Bitemporal recession", "Less prominent",              "Frequently marked"],
    ["Treatment",         "Treat cause; reassure",          "5% topical minoxidil; correct modifiable factors"],
    ["Prognosis",         "Excellent — full regrowth",      "Variable; may improve with minoxidil"],
]
hdr = cte_data[0]
rows = cte_data[1:]
# Build manually for coloured middle column
data_p = [[TH(h) for h in hdr]]
for r in rows:
    data_p.append([TC(r[0], sTableCellB), TC(r[1]), TC(r[2])])
cte_tbl = Table(data_p, colWidths=[130, 185, 160])
cte_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0, 0), (-1, 0),  C_NAVY),
    ("BACKGROUND",    (1, 1), (1, -1),  colors.HexColor("#EBF5FB")),
    ("BACKGROUND",    (2, 1), (2, -1),  colors.HexColor("#FEF9E7")),
    ("ROWBACKGROUNDS",(0, 1), (0, -1),  [C_WHITE, C_BG_GREY]),
    ("GRID",          (0, 0), (-1, -1), 0.4, colors.HexColor("#BDC3C7")),
    ("VALIGN",        (0, 0), (-1, -1), "TOP"),
    ("LEFTPADDING",   (0, 0), (-1, -1), 5),
    ("RIGHTPADDING",  (0, 0), (-1, -1), 5),
    ("TOPPADDING",    (0, 0), (-1, -1), 4),
    ("BOTTOMPADDING", (0, 0), (-1, -1), 4),
]))
story.append(cte_tbl)
story.append(SP8)

# ═══════════════════════════════════════════════════════
# 8 — MANAGEMENT
# ═══════════════════════════════════════════════════════
story.append(section_header("8.  MANAGEMENT"))
story.append(SP)

story.append(Paragraph("8.1  General Principles", sSubHdr))
story.append(success_box(
    "<b>Key principle:</b> No specific therapy is required for most cases of acute TE. "
    "The majority resolve spontaneously within 3–6 months once the precipitating trigger resolves. "
    "Follicles remain intact — full hair regrowth is expected."))
story.append(SP)

mgmt_data = [
    ["Scenario", "Management"],
    ["Drug-induced TE",           "Discontinue offending drug — usually curative. Hair regrowth in 3–6 months."],
    ["Nutritional deficiency",    "Correct identified deficiency. Encourage balanced diet. Investigate blood loss (menstrual, GI). Note: iron replacement alone may not resolve TE."],
    ["Postpartum TE",             "Reassurance — self-limiting. Full regrowth expected within 6–12 months post-delivery."],
    ["Hypothyroidism",            "Thyroid hormone replacement. Expect hair regrowth from ~8 weeks post-treatment."],
    ["Papulosquamous scalp disease", "Treat underlying condition (seborrhoeic dermatitis, psoriasis) — may precipitate TE."],
    ["Chronic TE (idiopathic)",   "5% topical minoxidil solution — may shorten telogen and trigger anagen. Address all modifiable factors."],
    ["Neonatal TE",               "No treatment. Spontaneous resolution by 6 months of age."],
]
story.append(build_table(mgmt_data[0], [r for r in mgmt_data[1:]], [145, 330]))
story.append(SP)

story.append(Paragraph("8.2  Patient Counselling Points", sSubHdr))
counsel = [
    "Follicles are intact and will regrow — TE does not cause permanent hair loss.",
    "Shedding peaks 3–5 months after the trigger, not immediately after it.",
    "Recovery is often slower than expected — allow 6–12 months after trigger resolution.",
    "Trichodynia (scalp tenderness) is common and does not indicate disease severity.",
    "Avoid unnecessary hair dye products or tight hairstyles during recovery.",
    "A balanced, protein-rich diet supports optimal hair re-growth.",
]
for pt in counsel:
    story.append(Paragraph(f"• {pt}", sBullet))
story.append(SP8)

# ═══════════════════════════════════════════════════════
# 9 — DIAGNOSTIC ALGORITHM
# ═══════════════════════════════════════════════════════
story.append(section_header("9.  DIAGNOSTIC ALGORITHM — Diffuse Hair Loss"))
story.append(SP)

algo_steps = [
    ("STEP 1", "History",
     "Duration of shedding | Precipitating event (illness, surgery, delivery, diet, drugs, stress) | "
     "Timing: 3–5 month lag after trigger | Drug history | Nutritional habits | Family history | Menstrual history"),
    ("STEP 2", "Examination",
     "Pull test (>4–6 club hairs = positive) | Scalp inspection (scarring? scaling? erythema?) | "
     "Distribution (diffuse vs patterned) | Nail changes | Body hair | Thyroid exam"),
    ("STEP 3", "Initial Labs",
     "Serum ferritin + iron saturation | TSH | FBC | If indicated: hormonal screen, metabolic panel, vitamin D, zinc"),
    ("STEP 4", "Trichoscopy (if available)",
     "Vacant follicular ostia (yellow dots) | Upright regrowing hairs | Diversity of hair shaft diameter"),
    ("STEP 5", "Scalp Biopsy (if diagnosis unclear)",
     "Horizontal sections | >12–15% terminal follicles in telogen confirms TE | Exclude scarring alopecias"),
    ("STEP 6", "Diagnosis & Management",
     "Acute TE with identifiable trigger → treat cause + reassure | Chronic TE (>6 months, idiopathic) → "
     "5% minoxidil + correct modifiable factors | Refer dermatology if uncertain or refractory"),
]

for step, title, desc in algo_steps:
    row = Table([[
        Paragraph(step, make_style(f"algo_{step}", "Normal",
                                   fontName="Helvetica-Bold", fontSize=8, textColor=C_WHITE,
                                   alignment=TA_CENTER, leading=11)),
        Paragraph(f"<b>{title}:</b> {desc}", sBody)
    ]], colWidths=[45, PAGE_W - L_MARGIN - R_MARGIN - 55])
    row.setStyle(TableStyle([
        ("BACKGROUND",   (0, 0), (0, 0), C_TEAL),
        ("BACKGROUND",   (1, 0), (1, 0), C_BG_BLUE),
        ("BOX",          (0, 0), (-1, -1), 0.5, C_TEAL),
        ("VALIGN",       (0, 0), (-1, -1), "MIDDLE"),
        ("LEFTPADDING",  (0, 0), (-1, -1), 6),
        ("RIGHTPADDING", (0, 0), (-1, -1), 6),
        ("TOPPADDING",   (0, 0), (-1, -1), 5),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 5),
    ]))
    story.append(row)
    story.append(Spacer(1, 2))

story.append(SP8)

# ═══════════════════════════════════════════════════════
# 10 — PROGNOSIS
# ═══════════════════════════════════════════════════════
story.append(section_header("10.  PROGNOSIS"))
story.append(SP)
story.append(success_box(
    "<b>Overall prognosis is excellent when a clear precipitating event is identified.</b> "
    "Full hair regrowth is the norm for acute TE. Neonatal TE always resolves by 6 months. "
    "Chronic idiopathic TE has a fluctuating course but is non-scarring and responds partially "
    "to 5% minoxidil. Female pattern hair loss must be excluded before diagnosing CTE."))
story.append(SP)

prog_data = [
    ["Type of TE", "Expected Outcome", "Timeframe"],
    ["Postpartum",              "Full regrowth",           "6–12 months post-delivery"],
    ["Post-febrile illness",    "Full regrowth",           "3–6 months after recovery"],
    ["Drug-induced",            "Full regrowth",           "3–6 months after stopping drug"],
    ["Post-surgical",           "Full regrowth",           "3–6 months post-operatively"],
    ["Nutritional/dietary",     "Full regrowth",           "After nutritional correction — 3–6 months"],
    ["Hypothyroid",             "Full regrowth",           "Begins ~8 weeks after treatment"],
    ["Neonatal",                "Full regrowth — always",  "By 6 months of age"],
    ["Chronic TE (idiopathic)", "Partial/variable",        "Fluctuating; may require long-term minoxidil"],
]
story.append(build_table(prog_data[0], [r for r in prog_data[1:]], [145, 200, 130]))
story.append(SP8)

# ═══════════════════════════════════════════════════════
# 11 — QUICK REFERENCE CARD
# ═══════════════════════════════════════════════════════
story.append(section_header("11.  QUICK REFERENCE — At a Glance"))
story.append(SP)

qr_left = [
    ("<b>Diagnose TE when:</b>", None),
    ("• Diffuse shedding, 3–5 months after trigger", sBody),
    ("• Pull test >4–6 club hairs positive", sBody),
    ("• Club-shaped, non-pigmented bulb on shed hair", sBody),
    ("• Normal scalp — no scarring, no erythema", sBody),
    ("• Ferritin, TSH normal (or abnormal — explains TE)", sBody),
    ("", None),
    ("<b>Exclude before diagnosing TE:</b>", None),
    ("• Androgenetic alopecia (patterned, miniaturisation)", sBody),
    ("• Alopecia areata (patches, nail changes)", sBody),
    ("• Scarring alopecia (permanent loss risk)", sBody),
    ("• Tinea capitis in children", sBody),
]
qr_right = [
    ("<b>Immediate action:</b>", None),
    ("• Identify and remove/treat the trigger", sBody),
    ("• Check ferritin + TSH in all cases", sBody),
    ("• Reassure — follicles intact, hair WILL regrow", sBody),
    ("", None),
    ("<b>Refer to Dermatology if:</b>", None),
    ("• Diagnosis unclear after workup", sBody),
    ("• Shedding >12 months without resolution", sBody),
    ("• Scalp biopsy required", sBody),
    ("• Suspected scarring alopecia", sBody),
    ("• Minoxidil not tolerated or ineffective", sBody),
]

def qr_paras(items):
    out = []
    for text, style in items:
        if style is None:
            out.append(Paragraph(text, sSubHdr if text else sBody))
        else:
            out.append(Paragraph(text, style))
    return out

qr_tbl = Table([[qr_paras(qr_left), qr_paras(qr_right)]],
               colWidths=[(PAGE_W - L_MARGIN - R_MARGIN) / 2 - 4,
                          (PAGE_W - L_MARGIN - R_MARGIN) / 2 - 4])
qr_tbl.setStyle(TableStyle([
    ("BACKGROUND",   (0, 0), (0, 0), colors.HexColor("#EBF4F8")),
    ("BACKGROUND",   (1, 0), (1, 0), colors.HexColor("#EAFAF1")),
    ("BOX",          (0, 0), (0, 0), 0.6, C_TEAL),
    ("BOX",          (1, 0), (1, 0), 0.6, C_GREEN),
    ("VALIGN",       (0, 0), (-1, -1), "TOP"),
    ("LEFTPADDING",  (0, 0), (-1, -1), 10),
    ("RIGHTPADDING", (0, 0), (-1, -1), 10),
    ("TOPPADDING",   (0, 0), (-1, -1), 8),
    ("BOTTOMPADDING",(0, 0), (-1, -1), 8),
]))
story.append(qr_tbl)
story.append(SP8)
story.append(HR())
story.append(Paragraph(
    "Sources: Fitzpatrick's Dermatology (9780071837781) | Andrews' Diseases of the Skin (9780323547536) | "
    "Dermatology 2-Volume Set 5e (9780702082252) | Compiled by Orris Medical AI, August 2026",
    sFooter))

# ── Build ──────────────────────────────────────────────────────────────────────
doc.build(story, onFirstPage=on_first_page, onLaterPages=on_later_pages)
print(f"PDF written to: {OUTPUT}")