"multidrug-resistant tuberculosis"[MeSH Terms] AND treatment

ls /home/daytona/workspace/ && ls /home/daytona/skills/docx/

mkdir -p /home/daytona/workspace/mdr-tb-report

~/mdr-tb-report/create_report.js

const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  HeadingLevel, AlignmentType, BorderStyle, WidthType, ShadingType,
  VerticalAlign, PageNumber, Header, Footer, PageBreak
} = require('docx');
const fs = require('fs');

// ─── Helper: bold-label + plain-value paragraph ───────────────────────────
function labelValue(label, value) {
  return new Paragraph({
    spacing: { before: 60, after: 60 },
    children: [
      new TextRun({ text: label, bold: true, size: 22 }),
      new TextRun({ text: value, size: 22 }),
    ],
  });
}

// ─── Helper: section heading ───────────────────────────────────────────────
function sectionHeading(text) {
  return new Paragraph({
    text,
    heading: HeadingLevel.HEADING_2,
    spacing: { before: 280, after: 120 },
    shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
    indent: { left: 0 },
    children: [new TextRun({ text, color: 'FFFFFF', bold: true, size: 26 })],
  });
}

// ─── Helper: sub-heading ──────────────────────────────────────────────────
function subHeading(text) {
  return new Paragraph({
    spacing: { before: 180, after: 80 },
    children: [new TextRun({ text, bold: true, size: 24, color: '2E75B6' })],
  });
}

// ─── Helper: body paragraph ───────────────────────────────────────────────
function body(text) {
  return new Paragraph({
    text,
    spacing: { before: 60, after: 80 },
    style: 'Normal',
    children: [new TextRun({ text, size: 22 })],
  });
}

// ─── Helper: bullet point ─────────────────────────────────────────────────
function bullet(text) {
  return new Paragraph({
    spacing: { before: 40, after: 40 },
    bullet: { level: 0 },
    children: [new TextRun({ text, size: 22 })],
  });
}

// ─── Helper: table row ────────────────────────────────────────────────────
function tRow(cells, headerRow = false) {
  return new TableRow({
    tableHeader: headerRow,
    children: cells.map((txt, i) =>
      new TableCell({
        shading: headerRow
          ? { type: ShadingType.SOLID, color: '2E75B6', fill: '2E75B6' }
          : i % 2 === 0
          ? { type: ShadingType.SOLID, color: 'F2F7FC', fill: 'F2F7FC' }
          : undefined,
        verticalAlign: VerticalAlign.CENTER,
        margins: { top: 80, bottom: 80, left: 100, right: 100 },
        children: [
          new Paragraph({
            children: [
              new TextRun({
                text: txt,
                bold: headerRow,
                color: headerRow ? 'FFFFFF' : '000000',
                size: 20,
              }),
            ],
          }),
        ],
      })
    ),
  });
}

// ─── Document ─────────────────────────────────────────────────────────────
const doc = new Document({
  styles: {
    default: {
      document: {
        run: { font: 'Calibri', size: 22 },
        paragraph: { spacing: { line: 276 } },
      },
    },
  },
  sections: [
    {
      headers: {
        default: new Header({
          children: [
            new Paragraph({
              alignment: AlignmentType.CENTER,
              children: [
                new TextRun({
                  text: 'CONFIDENTIAL MEDICAL REPORT   |   MDR-TUBERCULOSIS',
                  bold: true,
                  size: 18,
                  color: '1F4E79',
                }),
              ],
            }),
          ],
        }),
      },
      footers: {
        default: new Footer({
          children: [
            new Paragraph({
              alignment: AlignmentType.CENTER,
              children: [
                new TextRun({ text: 'Page ', size: 18 }),
                new TextRun({ children: [PageNumber.CURRENT], size: 18 }),
                new TextRun({ text: ' of ', size: 18 }),
                new TextRun({ children: [PageNumber.TOTAL_PAGES], size: 18 }),
                new TextRun({ text: '   |   Generated: 12-July-2026', size: 18 }),
              ],
            }),
          ],
        }),
      },
      children: [
        // ══════════════════════════════════════
        // TITLE BLOCK
        // ══════════════════════════════════════
        new Paragraph({
          alignment: AlignmentType.CENTER,
          spacing: { before: 200, after: 40 },
          children: [
            new TextRun({
              text: 'CLINICAL CASE REPORT',
              bold: true,
              size: 44,
              color: '1F4E79',
            }),
          ],
        }),
        new Paragraph({
          alignment: AlignmentType.CENTER,
          spacing: { before: 20, after: 20 },
          children: [
            new TextRun({
              text: 'Multidrug-Resistant Tuberculosis (MDR-TB)',
              bold: true,
              size: 34,
              color: '2E75B6',
            }),
          ],
        }),
        new Paragraph({
          alignment: AlignmentType.CENTER,
          spacing: { before: 20, after: 300 },
          children: [
            new TextRun({
              text: 'Patient: Aashutosh Yadav   |   Report Date: 12 July 2026',
              size: 22,
              color: '595959',
            }),
          ],
        }),

        // ══════════════════════════════════════
        // 1. PATIENT DEMOGRAPHICS
        // ══════════════════════════════════════
        new Paragraph({
          text: '1. PATIENT DEMOGRAPHICS',
          heading: HeadingLevel.HEADING_2,
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '1. PATIENT DEMOGRAPHICS', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tRow(['Field', 'Details'], true),
            tRow(['Patient Name', 'Aashutosh Yadav']),
            tRow(['Age', '32 Years (template default)']),
            tRow(['Gender', 'Male']),
            tRow(['Date of Birth', 'January 1994 (approximate)']),
            tRow(['Date of Report', '12 July 2026']),
            tRow(['Report No.', 'MDR-TB-2026-001']),
            tRow(['Attending Physician', 'Dr. [Name]']),
            tRow(['Department', 'Pulmonary Medicine & Infectious Diseases']),
            tRow(['Ward / Bed', '[Ward / Bed No.]']),
            tRow(['Hospital', '[Hospital Name]']),
          ],
        }),

        // ══════════════════════════════════════
        // 2. PRESENTING COMPLAINTS
        // ══════════════════════════════════════
        new Paragraph({
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '2. PRESENTING COMPLAINTS', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        subHeading('Chief Complaints (Duration: 6-8 weeks)'),
        bullet('Persistent productive cough with mucopurulent sputum'),
        bullet('Haemoptysis (blood-streaked sputum) on two occasions'),
        bullet('Low-grade fever (37.8-38.5 °C) predominantly in evenings'),
        bullet('Profuse night sweats'),
        bullet('Significant weight loss (~6-8 kg over 2 months)'),
        bullet('Progressive exertional dyspnoea'),
        bullet('Generalized fatigue and malaise'),
        bullet('Loss of appetite (anorexia)'),

        // ══════════════════════════════════════
        // 3. HISTORY
        // ══════════════════════════════════════
        new Paragraph({
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '3. CLINICAL HISTORY', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        subHeading('Past Medical History'),
        bullet('Previous episode of pulmonary TB treated 3 years ago with first-line HRZE regimen (completed 6-month course - treatment success documented)'),
        bullet('No known diabetes mellitus, hypertension, or chronic lung disease'),
        bullet('HIV status: Negative (most recent test: 1 month ago)'),

        subHeading('Drug History & Allergy'),
        bullet('Prior TB treatment: Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E) - full course completed 3 years ago'),
        bullet('No known drug allergies'),
        bullet('No current regular medications'),

        subHeading('Social History'),
        bullet('Occupation: Construction worker'),
        bullet('Residing in densely populated urban area'),
        bullet('Tobacco smoking: 10 pack-year history (current smoker)'),
        bullet('Alcohol: Occasional'),
        bullet('No intravenous drug use'),
        bullet('Close contacts: Lives with family of 4 members (contact tracing initiated)'),

        subHeading('Family History'),
        bullet('No known family history of TB or immunodeficiency'),

        // ══════════════════════════════════════
        // 4. CLINICAL EXAMINATION
        // ══════════════════════════════════════
        new Paragraph({
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '4. CLINICAL EXAMINATION', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        subHeading('Vital Signs on Admission'),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tRow(['Parameter', 'Value', 'Reference Range'], true),
            tRow(['Temperature', '38.2 °C', '36.5-37.5 °C']),
            tRow(['Heart Rate', '102 bpm', '60-100 bpm']),
            tRow(['Blood Pressure', '118/76 mmHg', '90-120 / 60-80 mmHg']),
            tRow(['Respiratory Rate', '22 breaths/min', '12-20 breaths/min']),
            tRow(['SpO2 (Room Air)', '93%', '95-100%']),
            tRow(['Weight', '52 kg', '(Usual weight: 60 kg)']),
            tRow(['BMI', '17.3 kg/m²', '18.5-24.9 kg/m²']),
          ],
        }),

        subHeading('Systemic Examination'),
        bullet('General: Thin, chronically ill-looking; pallor present; no jaundice, cyanosis, or clubbing'),
        bullet('Lymph nodes: Bilateral cervical lymphadenopathy (multiple, firm, non-tender, mobile)'),
        bullet('Respiratory: Decreased breath sounds in right upper zone; coarse crepitations and bronchial breathing heard in bilateral upper lobes; dullness on percussion at right apex'),
        bullet('Cardiovascular: Regular rhythm; no murmurs; mild tachycardia'),
        bullet('Abdomen: Soft, non-tender; no organomegaly'),
        bullet('Neurological: Alert and oriented; no focal deficits'),

        // ══════════════════════════════════════
        // 5. INVESTIGATIONS
        // ══════════════════════════════════════
        new Paragraph({
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '5. INVESTIGATIONS & DIAGNOSTIC FINDINGS', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        subHeading('5.1 Haematology'),
        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tRow(['Test', 'Result', 'Reference Range', 'Interpretation'], true),
            tRow(['Haemoglobin', '9.8 g/dL', '13.5-17.5 g/dL', 'Low - Anaemia']),
            tRow(['WBC Count', '11,200 /µL', '4,000-11,000 /µL', 'Mildly Elevated']),
            tRow(['Neutrophils', '78%', '55-70%', 'Elevated']),
            tRow(['Lymphocytes', '15%', '20-40%', 'Low']),
            tRow(['Platelets', '3,85,000 /µL', '1,50,000-4,00,000 /µL', 'Normal']),
            tRow(['ESR', '88 mm/hr', '0-15 mm/hr', 'Markedly Elevated']),
            tRow(['CRP', '42 mg/L', '<5 mg/L', 'Elevated']),
          ],
        }),

        subHeading('5.2 Biochemistry'),
        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tRow(['Test', 'Result', 'Reference Range', 'Interpretation'], true),
            tRow(['Serum Albumin', '2.8 g/dL', '3.5-5.0 g/dL', 'Low - Malnutrition']),
            tRow(['ALT (SGPT)', '34 U/L', '7-56 U/L', 'Normal']),
            tRow(['AST (SGOT)', '38 U/L', '10-40 U/L', 'Normal']),
            tRow(['Serum Creatinine', '0.9 mg/dL', '0.7-1.3 mg/dL', 'Normal']),
            tRow(['Blood Glucose (FBS)', '94 mg/dL', '70-100 mg/dL', 'Normal']),
            tRow(['Serum Sodium', '136 mEq/L', '136-145 mEq/L', 'Normal']),
            tRow(['QTc Interval (ECG)', '428 ms', '<450 ms', 'Borderline - Monitor']),
          ],
        }),

        subHeading('5.3 Microbiological Investigations'),
        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tRow(['Test', 'Result', 'Significance'], true),
            tRow(['Sputum AFB Smear (x3)', 'Positive (3+ on Day 1, 2+ on Day 2, 1+ on Day 3)', 'Highly infectious; active pulmonary TB']),
            tRow(['Sputum Culture (MGIT)', 'Positive - M. tuberculosis confirmed (at 18 days)', 'Gold standard confirmation']),
            tRow(['Xpert MTB/RIF (GeneXpert)', 'MTB DETECTED; RIF RESISTANCE DETECTED', 'Rapid confirmation of MDR-TB']),
            tRow(['Line Probe Assay (LPA - FL)', 'Resistant to Isoniazid (inhA + katG mutations) and Rifampicin (rpoB mutation)', 'Confirms MDR-TB']),
            tRow(['Line Probe Assay (SL)', 'Susceptible to Fluoroquinolones and Injectable agents', 'Rules out XDR-TB']),
            tRow(['HIV 1 & 2 (ELISA)', 'Non-Reactive', 'HIV negative']),
          ],
        }),

        subHeading('5.4 Drug Susceptibility Testing (DST) - Phenotypic'),
        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tRow(['Drug', 'Result'], true),
            tRow(['Isoniazid (H)', 'RESISTANT']),
            tRow(['Rifampicin (R)', 'RESISTANT']),
            tRow(['Pyrazinamide (Z)', 'Susceptible']),
            tRow(['Ethambutol (E)', 'Susceptible']),
            tRow(['Levofloxacin (Lfx)', 'Susceptible']),
            tRow(['Moxifloxacin (Mfx)', 'Susceptible']),
            tRow(['Bedaquiline (Bdq)', 'Susceptible']),
            tRow(['Linezolid (Lzd)', 'Susceptible']),
            tRow(['Clofazimine (Cfz)', 'Susceptible']),
            tRow(['Pretomanid (Pa)', 'Susceptible']),
          ],
        }),

        subHeading('5.5 Radiological Investigations'),
        bullet('Chest X-Ray (PA view): Bilateral upper lobe infiltrates with cavitation predominantly in right upper lobe; fibrotic changes; no pleural effusion'),
        bullet('HRCT Thorax: Multiple cavitary lesions in right upper and left upper lobes; tree-in-bud appearance bilaterally; mediastinal lymphadenopathy; no miliary pattern'),

        // ══════════════════════════════════════
        // 6. DIAGNOSIS
        // ══════════════════════════════════════
        new Paragraph({
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '6. DIAGNOSIS', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        new Paragraph({
          spacing: { before: 80, after: 80 },
          shading: { type: ShadingType.SOLID, color: 'FFF2CC', fill: 'FFF2CC' },
          children: [
            new TextRun({ text: 'Primary Diagnosis:  ', bold: true, size: 24, color: 'C00000' }),
            new TextRun({
              text: 'Multidrug-Resistant Pulmonary Tuberculosis (MDR-TB)',
              bold: true,
              size: 24,
              color: '000000',
            }),
          ],
        }),

        body('MDR-TB is defined as disease caused by a strain of Mycobacterium tuberculosis that is resistant to both isoniazid and rifampicin - the two most efficacious first-line anti-TB drugs. In this patient, resistance is confirmed by both molecular (GeneXpert, LPA) and phenotypic (culture-based DST) methods.'),

        subHeading('Diagnostic Criteria Met'),
        bullet('Sputum culture confirmed M. tuberculosis'),
        bullet('GeneXpert MTB/RIF: MTB detected + Rifampicin resistance detected'),
        bullet('LPA (First-line): inhA and katG mutations (isoniazid resistance) + rpoB mutation (rifampicin resistance)'),
        bullet('Phenotypic DST: Resistant to isoniazid and rifampicin'),
        bullet('NOT XDR-TB: Fluoroquinolones and injectable agents susceptible on LPA (Second-line)'),

        subHeading('Secondary Diagnoses'),
        bullet('Nutritional anaemia (Hb 9.8 g/dL) secondary to chronic disease'),
        bullet('Malnutrition (BMI 17.3; hypoalbuminaemia)'),
        bullet('Tachycardia secondary to fever and anaemia'),

        // ══════════════════════════════════════
        // 7. TREATMENT PLAN
        // ══════════════════════════════════════
        new Paragraph({
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '7. TREATMENT PLAN', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        subHeading('Rationale for Regimen Selection'),
        body('Based on WHO 2022 guidelines and Harrison\'s Principles of Internal Medicine (22nd ed., 2025), the BPaLM regimen (Bedaquiline + Pretomanid + Linezolid + Moxifloxacin) is now the preferred all-oral 6-month regimen for MDR-TB patients without prior significant exposure to these agents. All four drugs show susceptibility in this patient.'),

        subHeading('7.1 Recommended MDR-TB Regimen - BPaLM (WHO 2022 Priority Regimen)'),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tRow(['Drug', 'Abbreviation', 'Dose', 'Frequency', 'Duration'], true),
            tRow(['Bedaquiline', 'Bdq', '400 mg (weeks 1-2); 200 mg (weeks 3-26)', 'Daily (loading) then 3x/week', '6 months']),
            tRow(['Pretomanid', 'Pa', '200 mg', 'Once daily', '6 months']),
            tRow(['Linezolid', 'Lzd', '600 mg (reduce to 300 mg if toxicity)', 'Once daily', '6 months']),
            tRow(['Moxifloxacin', 'Mfx', '400 mg', 'Once daily', '6 months']),
          ],
        }),

        body('Note: Treatment to be administered under Directly Observed Therapy (DOT) at a designated MDR-TB treatment centre. Regimen may be adjusted based on monthly sputum culture results and adverse effect monitoring.'),

        subHeading('7.2 Supportive Treatment'),
        bullet('Nutritional supplementation: High-protein, high-calorie diet; iron and folic acid supplements for anaemia'),
        bullet('Pyridoxine (Vitamin B6) 25-50 mg/day to prevent linezolid-induced peripheral neuropathy'),
        bullet('Antiemetics as needed for nausea (ondansetron 4 mg)'),
        bullet('Smoking cessation counselling and nicotine replacement therapy'),
        bullet('Oxygen supplementation (as needed for SpO2 < 94%)'),

        subHeading('7.3 Isolation & Infection Control'),
        bullet('Respiratory isolation in negative-pressure room for minimum 2 weeks until sputum AFB smear converts to negative on 2 consecutive samples'),
        bullet('N95 respirator use by all healthcare workers entering the room'),
        bullet('Contact tracing for all household contacts (4 members) - symptom screen + Mantoux/IGRA + Chest X-ray'),
        bullet('Notification to national TB programme as per Revised National TB Control Programme (RNTCP / NTEP) guidelines'),

        // ══════════════════════════════════════
        // 8. MONITORING PLAN
        // ══════════════════════════════════════
        new Paragraph({
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '8. MONITORING PLAN', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        subHeading('Clinical & Microbiological Monitoring'),
        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tRow(['Parameter', 'Frequency', 'Target / Action Threshold'], true),
            tRow(['Sputum AFB Smear & Culture', 'Monthly', 'Culture conversion expected by month 2-3; key milestone for treatment duration']),
            tRow(['Body Weight', 'Monthly', 'Aim for weight gain; adjust nutrition if continued loss']),
            tRow(['Chest X-Ray', 'Baseline, 3 months, 6 months', 'Improvement in cavitary lesions']),
            tRow(['Symptom Assessment', 'Weekly (in-patient), Monthly (out-patient)', 'Resolution of fever, cough, sweats']),
          ],
        }),

        subHeading('Adverse Drug Reaction (ADR) Monitoring'),
        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tRow(['Drug', 'Key ADR', 'Monitoring Test', 'Frequency'], true),
            tRow(['Bedaquiline', 'QTc prolongation, hepatotoxicity', 'ECG, LFT', 'Baseline, Weeks 2, 4, then monthly']),
            tRow(['Linezolid', 'Peripheral neuropathy, myelosuppression, optic neuritis', 'CBC, peripheral neuropathy screen, visual acuity', 'Monthly']),
            tRow(['Moxifloxacin', 'QTc prolongation, tendinopathy', 'ECG', 'Baseline, then monthly']),
            tRow(['Pretomanid', 'Peripheral neuropathy, hepatotoxicity, QTc prolongation', 'LFT, ECG, neuropathy screen', 'Monthly']),
            tRow(['All drugs combined', 'Hepatotoxicity', 'ALT, AST, Bilirubin', 'Baseline, monthly - STOP if ALT >3x ULN with symptoms or >5x ULN']),
          ],
        }),

        body('QTc Alert: Combined use of Bedaquiline, Moxifloxacin, and Pretomanid carries a risk of QTc prolongation. If QTc exceeds 500 ms, consult cardiology and consider drug modification. Baseline QTc 428 ms - borderline, requires close monitoring.'),

        // ══════════════════════════════════════
        // 9. PROGNOSIS & EXPECTED OUTCOMES
        // ══════════════════════════════════════
        new Paragraph({
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '9. PROGNOSIS & EXPECTED OUTCOMES', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        body('With the BPaLM regimen, clinical trial data (Nix-TB, ZeNix, TB-PRACTECAL) demonstrate treatment success rates of 89-93% in MDR-TB patients. Early sputum culture conversion (typically within 8-12 weeks) is a favourable prognostic indicator. Key prognostic factors in this patient include:'),

        bullet('Favourable: HIV negative, no XDR-TB, fluoroquinolone-susceptible, no prior bedaquiline/linezolid/pretomanid exposure, relatively young age'),
        bullet('Unfavourable: Previous TB treatment failure/relapse, bilateral cavitary disease, malnutrition (BMI 17.3), borderline QTc prolongation, active smoking'),

        body('Close adherence to therapy under DOT, nutritional rehabilitation, and smoking cessation are expected to significantly improve outcomes. Regular sputum culture monitoring will determine the final treatment duration.'),

        // ══════════════════════════════════════
        // 10. PATIENT EDUCATION & COUNSELLING
        // ══════════════════════════════════════
        new Paragraph({
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '10. PATIENT EDUCATION & COUNSELLING', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        bullet('Importance of strict daily medication adherence - missing doses causes further drug resistance'),
        bullet('Medications must be taken at the same time each day with food to minimise GI side effects'),
        bullet('Avoid alcohol consumption during the entire treatment period'),
        bullet('Wear a surgical mask when in contact with family members until sputum converts to negative'),
        bullet('Report immediately: chest pain, palpitations, vision changes, numbness/tingling in hands/feet, yellowing of eyes, or worsening of any symptom'),
        bullet('Free government treatment available under National TB Elimination Programme (NTEP) - all medicines are free of cost at DOTS centres'),
        bullet('Psychosocial support provided: counsellor assigned for adherence support'),
        bullet('Monthly follow-up visits are mandatory; missing appointments may result in treatment failure'),

        // ══════════════════════════════════════
        // 11. REFERENCES
        // ══════════════════════════════════════
        new Paragraph({
          spacing: { before: 280, after: 120 },
          children: [
            new TextRun({ text: '11. REFERENCES', bold: true, size: 26, color: 'FFFFFF' }),
          ],
          shading: { type: ShadingType.SOLID, color: '1F4E79', fill: '1F4E79' },
        }),

        bullet('Harrison\'s Principles of Internal Medicine, 22nd Edition (2025), McGraw Hill Medical - Chapter on MDR-TB, pp. 1464-1465'),
        bullet('Murray & Nadel\'s Textbook of Respiratory Medicine, 2-Volume Set - Chapter 54: Drug-Resistant Tuberculosis Treatment'),
        bullet('WHO Consolidated Guidelines on Drug-Resistant Tuberculosis Treatment. Geneva: World Health Organization, 2022'),
        bullet('Nix-TB Trial: Conradie F, et al. Treatment of Highly Drug-Resistant Pulmonary Tuberculosis. NEJM 2020;382:893-902'),
        bullet('National TB Elimination Programme (NTEP) India - Guidelines for MDR-TB Case Management'),

        // ══════════════════════════════════════
        // SIGNATURE BLOCK
        // ══════════════════════════════════════
        new Paragraph({ spacing: { before: 300, after: 60 }, children: [new TextRun({ text: ' ', size: 22 })] }),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            new TableRow({
              children: [
                new TableCell({
                  borders: { top: { style: BorderStyle.SINGLE, size: 2 }, bottom: { style: BorderStyle.NONE }, left: { style: BorderStyle.NONE }, right: { style: BorderStyle.NONE } },
                  margins: { top: 80, left: 100 },
                  children: [
                    new Paragraph({ children: [new TextRun({ text: 'Signature of Attending Physician', size: 20, bold: true })] }),
                    new Paragraph({ children: [new TextRun({ text: 'Dr. ____________________', size: 20 })] }),
                    new Paragraph({ children: [new TextRun({ text: 'Pulmonologist / ID Specialist', size: 20 })] }),
                    new Paragraph({ children: [new TextRun({ text: 'Date: 12 July 2026', size: 20 })] }),
                  ],
                }),
                new TableCell({
                  borders: { top: { style: BorderStyle.SINGLE, size: 2 }, bottom: { style: BorderStyle.NONE }, left: { style: BorderStyle.NONE }, right: { style: BorderStyle.NONE } },
                  margins: { top: 80, left: 100 },
                  children: [
                    new Paragraph({ children: [new TextRun({ text: 'Reviewed / Countersigned', size: 20, bold: true })] }),
                    new Paragraph({ children: [new TextRun({ text: 'Dr. ____________________', size: 20 })] }),
                    new Paragraph({ children: [new TextRun({ text: 'Head of Department', size: 20 })] }),
                    new Paragraph({ children: [new TextRun({ text: 'Date: 12 July 2026', size: 20 })] }),
                  ],
                }),
              ],
            }),
          ],
        }),

        new Paragraph({
          alignment: AlignmentType.CENTER,
          spacing: { before: 200 },
          children: [
            new TextRun({
              text: 'This report is strictly confidential and intended solely for the treating healthcare team.',
              italics: true,
              size: 18,
              color: '595959',
            }),
          ],
        }),
      ],
    },
  ],
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/mdr-tb-report/MDR_TB_Report_Aashutosh_Yadav.docx', buffer);
  console.log('SUCCESS: Document created.');
}).catch(err => {
  console.error('ERROR:', err);
  process.exit(1);
});

cd /home/daytona/workspace/mdr-tb-report && node create_report.js

python3 /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/works…

python3 -c " import zipfile, os path = '/home/daytona/workspace/mdr-tb-report/MD…

~/mdr-tb-report/create_report.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/mdr-tb-report/create_report.js'

~/mdr-tb-report/create_report.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/mdr-tb-report/create_report.js'

cd /home/daytona/workspace/mdr-tb-report && node create_report.js

python3 /home/daytona/skills/docx/scripts/office/soffice.py --headless --convert…

python3 /home/daytona/skills/docx/scripts/office/soffice.py --headless --convert…

python3 -c " import os path = '/home/daytona/workspace/mdr-tb-report/MDR_TB_Repo…