ls /home/daytona/workspace/ 2>/dev/null || echo "workspace empty or missing"

mkdir -p /home/daytona/workspace/ncd-questions && python3 -c "from reportlab.lib…

~/ncd-questions/generate_pdf.py

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

OUTPUT = "/home/daytona/workspace/ncd-questions/NCD_Epidemiology_University_Questions.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm,
    title="Epidemiology of NCDs - University Questions",
    author="Park's Textbook Reference"
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle(
    'CustomTitle', parent=styles['Title'],
    fontSize=18, textColor=colors.HexColor('#1a237e'),
    spaceAfter=6, spaceBefore=0, alignment=TA_CENTER
)
subtitle_style = ParagraphStyle(
    'Subtitle', parent=styles['Normal'],
    fontSize=11, textColor=colors.HexColor('#455a64'),
    spaceAfter=16, alignment=TA_CENTER, italic=True
)
section_style = ParagraphStyle(
    'Section', parent=styles['Heading1'],
    fontSize=13, textColor=colors.white,
    backColor=colors.HexColor('#1a237e'),
    spaceBefore=14, spaceAfter=4,
    leftIndent=-0.3*cm, rightIndent=-0.3*cm,
    borderPadding=(6, 8, 6, 8)
)
q_heading_style = ParagraphStyle(
    'QHeading', parent=styles['Heading2'],
    fontSize=11, textColor=colors.HexColor('#0d47a1'),
    spaceBefore=10, spaceAfter=3
)
body_style = ParagraphStyle(
    'Body', parent=styles['Normal'],
    fontSize=9.5, leading=14, spaceAfter=3,
    alignment=TA_JUSTIFY
)
bullet_style = ParagraphStyle(
    'Bullet', parent=styles['Normal'],
    fontSize=9.5, leading=13, leftIndent=16, spaceAfter=2,
    bulletIndent=4
)
sub_bullet_style = ParagraphStyle(
    'SubBullet', parent=styles['Normal'],
    fontSize=9, leading=13, leftIndent=30, spaceAfter=1,
    bulletIndent=18, textColor=colors.HexColor('#333333')
)
note_style = ParagraphStyle(
    'Note', parent=styles['Normal'],
    fontSize=9, leading=13, textColor=colors.HexColor('#e65100'),
    backColor=colors.HexColor('#fff3e0'),
    borderPadding=(5,6,5,6), spaceAfter=6, spaceBefore=4,
    leftIndent=4, rightIndent=4
)
label_style = ParagraphStyle(
    'Label', parent=styles['Normal'],
    fontSize=8.5, textColor=colors.white,
    backColor=colors.HexColor('#c62828'),
    alignment=TA_CENTER
)

story = []

# ── TITLE ──────────────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Important University Questions", title_style))
story.append(Paragraph("Epidemiology of Non-Communicable Diseases", title_style))
story.append(Paragraph("Based on Park's Textbook of Preventive and Social Medicine", subtitle_style))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1a237e'), spaceAfter=8))

# ── SECTION 1 : LONG QUESTIONS ─────────────────────────────────────────────
story.append(Paragraph("LONG QUESTIONS  (10–15 Marks)", section_style))
story.append(Spacer(1, 0.2*cm))

lqs = [
    {
        "num": "Q1.",
        "title": "Discuss the epidemiology, risk factors, and prevention of Coronary Heart Disease (CHD).",
        "points": [
            "Definition: 'Impairment of heart function due to inadequate blood flow caused by obstructive changes in the coronary circulation' (WHO calls it the modern epidemic)",
            "Presentations: Angina pectoris, Myocardial infarction, Arrhythmias, Cardiac failure, Sudden death",
            "Measuring burden: PMR, Loss of life expectancy, Incidence rate, Age-specific death rates, Prevalence rate",
            "Non-modifiable risk factors: Age, Male sex, Family history, Type A personality",
            "Modifiable risk factors: Hypertension, Hypercholesterolaemia, Smoking, Diabetes, Obesity, Sedentary lifestyle, Stress, Diet (saturated fat)",
            "Mention Framingham Heart Study (identified major CHD risk factors - prospective cohort)",
            "Primary, secondary, tertiary prevention"
        ]
    },
    {
        "num": "Q2.",
        "title": "Describe the epidemiology of Diabetes Mellitus with its classification, complications, and control measures.",
        "points": [
            "Definition: Group of metabolic disorders characterised by hyperglycaemia due to defects in insulin secretion, action or both",
            "WHO 2019 Classification: Type 1, Type 2, Hybrid forms (Slowly evolving immune-mediated / LADA; Ketosis-prone Type 2), Monogenic, Diseases of exocrine pancreas, Endocrine disorders, Drug-induced, Unclassified",
            "Complications: Retinopathy, Nephropathy, Neuropathy, CVD, Peripheral arterial disease, Cerebrovascular disease, Cataracts, Increased TB risk",
            "Screening: Urine sugar, fasting/post-prandial blood glucose, HbA1c",
            "NPCDCS - National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke",
            "Primary prevention: Lifestyle modification, weight control, diet"
        ]
    },
    {
        "num": "Q3.",
        "title": "Describe the epidemiology, risk factors, and control of Hypertension.",
        "points": [
            "Definition and JNC/WHO classification of blood pressure levels",
            "Risk factors: Age, obesity, excess salt intake, alcohol, physical inactivity, stress, family history",
            "Complications: Stroke (most common), CHD, Renal failure, Heart failure, Retinopathy",
            "Prevention: Sodium reduction (<5g/day), DASH diet, weight reduction, exercise, alcohol moderation",
            "Screening: Mass screening vs selective screening of high-risk groups",
            "Treatment: Lifestyle + pharmacotherapy (diuretics, beta-blockers, ACEi, CCBs, ARBs)"
        ]
    },
    {
        "num": "Q4.",
        "title": "Write in detail about the Epidemiology of Cancer with specific reference to India.",
        "points": [
            "Global burden: Leading causes of cancer death - lung, stomach, liver (males); breast, cervix, colorectum (females)",
            "India - ICMR National Cancer Registry data; Common cancers: oral cavity, cervix, breast, lung, oesophagus",
            "Risk factors: Tobacco (most important), alcohol, diet, infections (HPV → cervix, HBV → liver), occupational carcinogens, radiation",
            "Cancer patterns: Westernization trend - decline in infection-related cancers, rise in breast/prostate/colorectal",
            "Cancer control: Primary (avoid risk factors), Secondary (screening - Pap smear, mammography, oral exam), Tertiary (treatment/palliation)",
            "National Cancer Control Programme (NCCP) objectives"
        ]
    },
    {
        "num": "Q5.",
        "title": "Write in detail about Obesity - measurement, determinants, health hazards, and control.",
        "points": [
            "Definition: BMI ≥30 kg/m² (WHO); Asian cut-off ≥27.5 kg/m²",
            "Assessment methods: BMI (wt/ht²), Waist circumference, Waist-hip ratio, Skinfold thickness (Harpenden callipers)",
            "WHO BMI classification: Underweight <18.5, Normal 18.5–24.9, Overweight 25–29.9, Obese ≥30",
            "Determinants: Excess calorie intake, physical inactivity, genetic factors, endocrine (hypothyroidism, Cushing's), drugs",
            "Health hazards: T2DM, Hypertension, CHD, Dyslipidaemia, Osteoarthritis, Sleep apnoea, Cancers (breast, colon, endometrium), Psychological",
            "Control: Diet modification, physical activity, behaviour therapy, pharmacotherapy, bariatric surgery"
        ]
    }
]

for q in lqs:
    items = [
        Paragraph(f'<b>{q["num"]}</b> {q["title"]}', q_heading_style),
    ]
    items.append(Paragraph("<b>Key points to cover:</b>", body_style))
    for pt in q["points"]:
        items.append(Paragraph(f"\u2022 {pt}", bullet_style))
    items.append(Spacer(1, 0.2*cm))
    story.append(KeepTogether(items))

# ── SECTION 2 : SHORT QUESTIONS ────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("SHORT QUESTIONS  (5 Marks)", section_style))
story.append(Spacer(1, 0.2*cm))

sqs = [
    ("Q6.", "Risk factors of Coronary Heart Disease (CHD)", [
        "Non-modifiable: Age (>45 men, >55 women), Male sex, Family history, Type A personality",
        "Modifiable: Hypertension, Hypercholesterolaemia (LDL↑, HDL↓), Smoking, Diabetes mellitus, Obesity (BMI ≥30), Sedentary lifestyle, Diet rich in saturated fat",
        "Framingham study established smoking, hypertension, dyslipidaemia as the 'big three' risk factors"
    ]),
    ("Q7.", "Secondary Prevention of Rheumatic Fever", [
        "Benzathine benzyl penicillin IM every 3 weeks (21 days)",
        "Dose: Adults 1.2 million units; Children 600,000 units",
        "Duration: No carditis → 5 years or until 18 yrs; Mild carditis → 10 years or until 25 yrs; Severe/post-surgery → Life-long",
        "Alternative (penicillin allergy): Erythromycin / Sulfadiazine"
    ]),
    ("Q8.", "Stroke - Epidemiology and Control", [
        "Types: Ischaemic (80%) vs Haemorrhagic (20%)",
        "Most important risk factor: Hypertension",
        "Other risk factors: Diabetes, Smoking, Atrial fibrillation, Hyperlipidaemia, Obesity, Sedentary lifestyle",
        "Stroke control programme in India under NPCDCS",
        "Prevention: Control of hypertension, antiplatelet drugs, anticoagulation in AF"
    ]),
    ("Q9.", "BMI and Classification of Obesity", [
        "Formula: Weight (kg) ÷ Height² (m²)",
        "WHO: Underweight <18.5 | Normal 18.5–24.9 | Overweight 25–29.9 | Obese ≥30 | Morbidly obese ≥40",
        "Asian/Indian cut-offs: Overweight ≥23 | Obese ≥25",
        "Waist circumference risk threshold: Men >102 cm (WHO) / >90 cm (Asian); Women >88 cm / >80 cm (Asian)"
    ]),
    ("Q10.", "NPCDCS - National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke", [
        "Launched under 11th Five Year Plan; now continued under NHM",
        "Two sub-components: (A) Cancer; (B) Diabetes + CVD + Stroke",
        "Infrastructure: District NCD Clinic, CHC NCD Clinic, CHO-led primary care NCD screening",
        "Objectives: Health promotion, early diagnosis, treatment at primary level, referral system",
        "Population-based screening for hypertension, diabetes, 3 common cancers (oral, breast, cervix)"
    ]),
    ("Q11.", "Metabolic Syndrome", [
        "Also called Syndrome X / Insulin resistance syndrome",
        "IDF criteria: Central obesity (waist ≥90 cm men / ≥80 cm women for Asians) PLUS any 2 of:",
        "  – Raised triglycerides ≥150 mg/dL  |  Low HDL <40 (men) / <50 (women) mg/dL",
        "  – Hypertension ≥130/85 mmHg  |  Raised fasting glucose ≥100 mg/dL",
        "Significance: 5× increased risk of T2DM; 2× increased CVD risk",
        "Treatment: Lifestyle modification (cornerstone), treat individual components"
    ]),
    ("Q12.", "Epidemiology of Rheumatic Heart Disease (RHD) in India", [
        "Caused by Group A beta-haemolytic streptococcal pharyngitis → Acute Rheumatic Fever → RHD",
        "India prevalence: 5–7 per 1000 in 5–15 year age group; ~1 million RHD cases",
        "20–30% of all CVD hospital admissions in India are due to RHD",
        "High-risk groups: School-age children (5–15 yrs), slum dwellers, closed communities",
        "RF occurs in 1–3% of streptococcal infections; higher in poor socio-economic conditions",
        "Prevention: Primary (treat strep throat) + Secondary (benzathine penicillin prophylaxis)"
    ]),
]

for q in sqs:
    items = [Paragraph(f'<b>{q[0]}</b> {q[1]}', q_heading_style)]
    for pt in q[2]:
        indent = sub_bullet_style if pt.startswith("  –") else bullet_style
        items.append(Paragraph(f"\u2022 {pt.strip()}", indent))
    items.append(Spacer(1, 0.15*cm))
    story.append(KeepTogether(items))

# ── SECTION 3 : VERY SHORT / ONE-LINERS ───────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("VERY SHORT / ONE-LINER QUESTIONS  (2–3 Marks)", section_style))
story.append(Spacer(1, 0.3*cm))

table_data = [
    [Paragraph("<b>Question</b>", label_style), Paragraph("<b>Key Answer</b>", label_style)],
    ["Modern epidemic according to WHO", "Coronary Heart Disease (CHD)"],
    ["Most important modifiable risk factor for stroke", "Hypertension"],
    ["Drug for secondary prevention of Rheumatic Fever", "Benzathine benzyl penicillin IM (3-weekly)"],
    ["BMI formula", "Weight (kg) / Height² (m²)"],
    ["Global visually impaired (2010)", "285 million (39 million blind)"],
    ["Vision 2020 launched on", "18th February 1999 by WHO"],
    ["Four-tier structure under Vision 2020 (India)", "Centres of Excellence (20), Training (200), Service (2000), Vision Centres (20,000)"],
    ["Most common cancer in Indian females", "Cervix uteri / Breast"],
    ["Most common cancer in Indian males", "Oral cavity / Lung"],
    ["NPCDCS stands for", "National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke"],
    ["Iceberg phenomenon applicable to", "Diabetes, Hypertension (many undiagnosed cases)"],
    ["Framingham study design", "Prospective cohort study - identified major CHD risk factors"],
    ["Type A personality associated with", "Increased CHD risk"],
    ["WHO criterion: Obesity BMI", "≥ 30 kg/m²"],
    ["RF incidence in streptococcal infection", "1–3% of streptococcal pharyngitis cases"],
    ["Target for Global Eye Health Action Plan 2014-2019", "25% reduction in avoidable visual impairment by 2019 from 2010 baseline"],
]

col_widths = [9*cm, 8.5*cm]
tbl = Table(table_data, colWidths=col_widths, repeatRows=1)
tbl.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#c62828')),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE', (0,0), (-1,0), 9),
    ('FONTSIZE', (0,1), (-1,-1), 9),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.white, colors.HexColor('#fce4ec')]),
    ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#bdbdbd')),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 5),
    ('BOTTOMPADDING', (0,0), (-1,-1), 5),
    ('LEFTPADDING', (0,0), (-1,-1), 6),
    ('RIGHTPADDING', (0,0), (-1,-1), 6),
    ('WORDWRAP', (0,0), (-1,-1), True),
]))
story.append(tbl)

# ── SECTION 4 : SPECIAL TOPICS ─────────────────────────────────────────────
story.append(Spacer(1, 0.4*cm))
story.append(Paragraph("SPECIAL / FREQUENTLY ASKED TOPICS", section_style))
story.append(Spacer(1, 0.2*cm))

specials = [
    ("Q13.", "Levels of Prevention for NCDs (with examples)", [
        "Primordial: Prevent risk factors from emerging — healthy public policy, tobacco control legislation",
        "Primary: Health promotion + specific protection — diet counselling, exercise promotion, HBV/HPV vaccination",
        "Secondary: Early diagnosis and prompt treatment — screening for DM, HTN, breast/cervical cancer",
        "Tertiary: Disability limitation + Rehabilitation — cardiac rehab, diabetic foot care, stroke rehabilitation"
    ]),
    ("Q14.", "Tobacco and Non-Communicable Diseases", [
        "Tobacco linked to: Lung cancer (RR ~10×), oral cancer, CHD, COPD, stroke, peripheral vascular disease, bladder cancer",
        "COTPA 2003 (Cigarettes and Other Tobacco Products Act) - India's legislative framework",
        "WHO MPOWER package: Monitor, Protect, Offer cessation, Warn, Enforce bans, Raise taxes",
        "Smokeless tobacco (betel quid, khaini) strongly linked to oral cavity cancer in India"
    ]),
    ("Q15.", "Diet and NCDs", [
        "Saturated fat / trans fat → ↑LDL → CHD",
        "Excess dietary sodium → Hypertension",
        "Vitamin A deficiency → Xerophthalmia → Blindness (commonest preventable cause of childhood blindness)",
        "Dietary fibre deficiency → Colorectal cancer",
        "Excess calories / refined sugars → Obesity → Diabetes, HTN, CVD",
        "Alcohol → Liver cirrhosis, oral/oesophageal/hepatic cancer, hypertension, cardiomyopathy"
    ]),
    ("Q16.", "Vision 2020: The Right to Sight", [
        "Global initiative to eliminate avoidable blindness; launched by WHO on 18th February 1999",
        "Key concept: Sight as a fundamental HUMAN RIGHT",
        "Target diseases: Cataract, Xerophthalmia, Childhood blindness, Refractive errors, Trachoma, Corneal blindness",
        "India additionally includes: Glaucoma, Diabetic retinopathy",
        "Four-tier structure: Centres of Excellence (20), Training Centres (200), Service Centres (2000), Vision Centres (20,000)",
        "Global Eye Health Action Plan 2014–19: 25% reduction in avoidable VI from 2010 baseline"
    ]),
]

for q in specials:
    items = [Paragraph(f'<b>{q[0]}</b> {q[1]}', q_heading_style)]
    for pt in q[2]:
        items.append(Paragraph(f"\u2022 {pt}", bullet_style))
    items.append(Spacer(1, 0.15*cm))
    story.append(KeepTogether(items))

# ── EXAM TIP BOX ─────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#e65100'), spaceAfter=6))
story.append(Paragraph(
    "<b>Exam Tip:</b> University exams frequently combine two NCDs (e.g., 'Diabetes and Hypertension as "
    "risk factors for CHD'), or pair a disease with its national programme. Always structure answers as: "
    "Definition → Epidemiology/Burden → Risk Factors → Prevention → National Programme.",
    note_style
))
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#e65100'), spaceBefore=4))

# ── FOOTER NOTE ──────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "Source: Park's Textbook of Preventive and Social Medicine | Community Medicine Reference",
    ParagraphStyle('Footer', parent=styles['Normal'], fontSize=8,
                   textColor=colors.HexColor('#9e9e9e'), alignment=TA_CENTER)
))

doc.build(story)
print(f"PDF created: {OUTPUT}")

python3 /home/daytona/workspace/ncd-questions/generate_pdf.py