cd /home/daytona/workspace && python3 -c " import pdfplumber with pdfplumber.open('attachments/265cc770-f782-4747-a3f9-fd435139ce6e/ORTHO LOGBOOK _260514_011322.pdf') as pdf: print(f'Total pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages): text = page.extract_text() print(f'--- PAGE {i+1} ---') print(text) print() "

ls /home/daytona/workspace/ && ls /home/daytona/skills/docx/scripts/office/ 2>/dev/null || echo "no scripts dir"

mkdir -p /home/daytona/workspace/ortho-logbook && cat > /home/daytona/workspace/ortho-logbook/case1.js << 'JSEOF' const { Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell, HeadingLevel, AlignmentType, BorderStyle, WidthType, VerticalAlign, PageNumber, Footer, ShadingType } = require('docx'); const fs = require('fs'); const BOLD = (text, size) => new TextRun({ text, bold: true, size: size || 22 }); const NORMAL = (text, size) => new TextRun({ text, size: size || 22 }); const ITALIC = (text) => new TextRun({ text, italics: true, size: 20 }); function heading1(text) { return new Paragraph({ children: [new TextRun({ text, bold: true, size: 28, color: "1F4E79" })], spacing: { before: 300, after: 100 }, border: { bottom: { color: "1F4E79", size: 6, style: BorderStyle.SINGLE } } }); } function heading2(text) { return new Paragraph({ children: [new TextRun({ text, bold: true, size: 24, color: "2E75B6" })], spacing: { before: 240, after: 80 } }); } function heading3(text) { return new Paragraph({ children: [new TextRun({ text, bold: true, size: 22, underline: {} })], spacing: { before: 160, after: 60 } }); } function para(text, italic) { return new Paragraph({ children: [italic ? ITALIC(text) : NORMAL(text)], spacing: { after: 80 } }); } function labelVal(label, value) { return new Paragraph({ children: [BOLD(label + ": "), NORMAL(value)], spacing: { after: 60 } }); } function bullet(text) { return new Paragraph({ children: [NORMAL(text)], bullet: { level: 0 }, spacing: { after: 40 } }); } function makeTable(headers, rows, colWidths) { return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows: [ new TableRow({ children: headers.map((h, i) => new TableCell({ children: [new Paragraph({ children: [BOLD(h, 20)], alignment: AlignmentType.CENTER })], width: colWidths ? { size: colWidths[i], type: WidthType.PERCENTAGE } : undefined, shading: { fill: "BDD7EE", type: ShadingType.CLEAR }, verticalAlign: VerticalAlign.CENTER })), tableHeader: true }), ...rows.map(row => new TableRow({ children: row.map((cell, i) => new TableCell({ children: [new Paragraph({ children: [NORMAL(cell || "", 20)], alignment: AlignmentType.LEFT })], width: colWidths ? { size: colWidths[i], type: WidthType.PERCENTAGE } : undefined, verticalAlign: VerticalAlign.CENTER })) })) ] }); } const doc = new Document({ styles: { default: { document: { run: { font: "Times New Roman", size: 22 } } } }, sections: [{ properties: { page: { margin: { top: 1080, bottom: 1080, left: 1080, right: 1080 } } }, footers: { default: new Footer({ children: [new Paragraph({ children: [NORMAL("AIMST University | Orthopaedics Logbook — Case 1 | Muhammad Danial Ikhwan", 18)], alignment: AlignmentType.CENTER })] }) }, children: [ // TITLE new Paragraph({ children: [new TextRun({ text: "AIMST UNIVERSITY", bold: true, size: 32, color: "1F4E79" })], alignment: AlignmentType.CENTER, spacing: { after: 60 } }), new Paragraph({ children: [new TextRun({ text: "FACULTY OF MEDICINE — UNIT OF ORTHOPAEDICS", bold: true, size: 26, color: "2E75B6" })], alignment: AlignmentType.CENTER, spacing: { after: 60 } }), new Paragraph({ children: [new TextRun({ text: "CLINICAL LOG BOOK — CASE 1", bold: true, size: 28 })], alignment: AlignmentType.CENTER, spacing: { after: 200 } }), // PATIENT DETAILS heading1("PATIENT DETAILS"), makeTable( ["Field", "Details"], [ ["Name", "Muhammad Danial Ikhwan bin Izham"], ["Age", "21 years old"], ["Date of Admission", "28/04/2026"], ["Date of Clerking", "28/04/2026"], ["Sex", "Male"], ["Occupation", "Assembler"], ["Race", "Malay"], ["Religion", "Islam"], ["Nationality", "Malaysian"], ["Place", "Kulim, Kedah (Hospital Kulim)"] ], [30, 70] ), // a heading1("a. Chief Complaints"), para("(Symptoms + duration + chronological order)"), bullet("Pain over the right thigh — since 28/04/2026 (day of admission)"), bullet("Swelling over the right thigh — since 28/04/2026"), bullet("Inability to bear weight on the right lower limb — since 28/04/2026"), // b heading1("b. History of Presenting Illness"), para("Mr. Muhammad Danial Ikhwan, a 21-year-old Malay Muslim male assembler and active smoker with no known medical illness or drug allergy (NKMI, NKDFA), presented to the Emergency Department of Hospital Kulim on 28/04/2026 at approximately 3:30 PM following an alleged motor vehicle accident (MVA) on the same day. He was a motorcyclist and was wearing a helmet at the time of the incident. The exact mechanism of injury (MOI) was unsure as documented."), para("Following the accident, he sustained trauma and complained of pain over the right thigh with associated swelling. He also experienced a transient loss of consciousness (LOC) and had road abrasion (RA) noted on examination. On review by the Orthopaedics team, the patient was alert with BP 116/89 mmHg, PR 84 bpm, and SpO₂ 98%."), para("He denied chest pain, abdominal pain, nausea, or vomiting. There was no ENT bleeding. He had no foot drop, and ROM of the ankle and toes was full. Distal pulses (DPA and PTA) were palpable with CRT < 2 seconds and intact sensation."), // c heading1("c. Past History"), para("No known previous fractures or musculoskeletal injuries. No prior hospitalizations or surgical history. No known chronic medical conditions (no diabetes mellitus, no hypertension, no bronchial asthma)."), // d heading1("d. Previous Treatment / Drug Intake / Drug Abuse / Drug Allergy"), labelVal("Previous treatment", "None"), labelVal("Regular medications", "None"), labelVal("Drug abuse", "Active smoker (documented)"), labelVal("Drug allergy", "No known drug allergy (NKDFA)"), labelVal("Food allergy", "No known food allergy (NKFA)"), // e heading1("e. Family History"), para("No family history of metabolic bone disease, malignancy, connective tissue disorders, or other hereditary conditions."), // f heading1("f. Occupational History"), para("Patient works as an assembler and has SOCSO (Social Security Organisation) coverage confirming active employment. His work involves repetitive manual tasks and possible prolonged standing. The injury was sustained during commute/travel and is not directly related to occupational activity. SOCSO claim may be applicable."), // g heading1("g. Menstrual History"), para("Not applicable — patient is male."), // h heading1("h. Personal and Social History"), bullet("Active smoker (documented in clerking sheet)"), bullet("SOCSO coverage available — gainfully employed"), bullet("No documented alcohol or recreational drug use"), bullet("Lives in Kulim, Kedah — working class socioeconomic background"), bullet("Marital status: not documented"), // i heading1("i. Systemic Enquiry"), makeTable( ["System", "Findings"], [ ["CNS", "Transient LOC post-accident; alert and GCS 15/15 on review"], ["CVS", "No chest pain; BP 116/89 mmHg, PR 84 bpm, regular"], ["Respiratory", "No shortness of breath; SpO₂ 98% on air"], ["GIT", "No abdominal pain, no nausea, no vomiting"], ["GUT", "No dysuria; urine output not documented"], ["ENT", "No ENT bleeding"], ["MSK", "Pain and swelling right thigh; no foot drop; full ROM at ankle and toes"], ["Skin", "Road abrasion over right thigh; no open wound"] ], [25, 75] ), // j heading1("j. Summary of History"), para("A 21-year-old Malay Muslim male assembler and active smoker, with no known medical illness or drug allergy, presented to Hospital Kulim on 28/04/2026 following a high-energy motor vehicle accident in which he was a motorcyclist wearing a helmet. He sustained trauma to the right lower limb with pain and swelling over the right thigh, transient loss of consciousness, and road abrasion. He denied chest pain, abdominal pain, and ENT bleeding. His vital signs were stable on review. This history is consistent with a traumatic injury to the right femur following a high-energy road traffic accident."), // k heading1("k. Provisional Diagnosis (Based on History)"), new Paragraph({ children: [BOLD("Provisional Diagnosis: "), NORMAL("Closed comminuted fracture of the right midshaft femur")], spacing: { after: 80 } }), heading3("Justification:"), bullet("Young male (21 years) involved in high-energy MVA (motorcycle accident)"), bullet("Immediate onset of right thigh pain and swelling following trauma"), bullet("Inability to weight bear on the right lower limb"), bullet("High-energy mechanism consistent with femoral shaft fracture (bending/direct force)"), bullet("Femoral shaft fractures in young males most commonly result from MVAs (Rockwood & Green's, 10th ed.)"), new Paragraph({ children: [BOLD("")], spacing: { after: 100 } }), heading3("Differential Diagnoses:"), makeTable( ["Differential Diagnosis", "Points in Favour", "Points Against"], [ ["Closed comminuted midshaft femur fracture", "Young male, MVA, thigh pain & swelling, X-ray confirmed, high energy", "—"], ["Distal femur fracture", "Thigh pain, high-energy MVA", "Pain localised to mid-thigh; X-ray shows midshaft involvement"], ["Proximal femur / hip fracture", "MVA, unable to weight bear", "Pain not at groin/hip; X-ray not consistent"], ["Soft tissue injury / contusion", "Swelling and pain post-trauma", "Degree of swelling + inability to weight bear + X-ray confirmation make isolated soft tissue injury unlikely"], ["Pathological fracture", "Fracture at young age", "Clear traumatic mechanism; no known malignancy or metabolic bone disease"] ], [30, 40, 30] ), // l heading1("l. Physical Examination"), heading2("General Examination (Head-to-Toe Inspection)"), heading3("Objectives:"), bullet("To assess the patient's general condition and level of consciousness"), bullet("To identify signs of haemodynamic compromise (tachycardia, hypotension, pallor)"), bullet("To detect associated injuries (head, chest, abdomen, pelvis, other limbs)"), bullet("To assess skin integrity (open wounds, abrasions, puncture marks)"), bullet("To note signs of anaemia suggesting acute haemorrhage"), heading3("Findings:"), bullet("Patient is alert and conscious, GCS 15/15"), bullet("Appears in pain but not in acute cardiorespiratory distress"), bullet("No pallor, no jaundice, no cyanosis, no clubbing, no peripheral lymphadenopathy"), bullet("Vital signs: BP 116/89 mmHg | PR 84 bpm | SpO₂ 98% on room air"), bullet("Road abrasion (RA) noted — skin intact at fracture site (confirms closed fracture)"), bullet("No obvious head injury; helmet was worn at time of accident"), bullet("No signs of thoracic or abdominal injury"), heading2("Local Examination"), heading3("1. Inspection"), bullet("Site: Right lower limb, mid-thigh region"), bullet("Swelling: Mild swelling over right mid-thigh"), bullet("Skin: Abrasion wound over distal right thigh; no open wound; no puncture marks"), bullet("Deformity: Deformity noted (as documented); limb in mild external rotation and shortening typical of femoral shaft fracture"), bullet("Colour: No gross bruising documented; mild erythema around abrasion site"), bullet("Muscle wasting: None (acute presentation)"), bullet("Foot drop: None — ROM of ankle and toes full"), heading3("2. Palpation"), bullet("Tenderness: Localised tenderness over right mid-thigh on palpation"), bullet("Swelling: Mild swelling palpable over mid-thigh region"), bullet("Temperature: Slightly warm over area of swelling (inflammatory response)"), bullet("Crepitus: May be elicited at fracture site (not routinely tested to avoid pain)"), bullet("Distal pulses: DPA (Dorsalis Pedis Artery) and PTA (Posterior Tibial Artery) — both palpable bilaterally"), bullet("Capillary Refill Time (CRT): < 2 seconds — adequate distal perfusion"), bullet("Sensation: Intact distally — no neurovascular deficit"), heading3("3. Range of Movements"), makeTable( ["Joint", "RIGHT Active", "RIGHT Passive", "LEFT Active", "LEFT Passive", "Remarks"], [ ["Hip: Flexion", "Limited — pain", "Limited — pain", "0–120°", "0–120°", "Right restricted due to femoral shaft pain"], ["Hip: Extension", "Limited — pain", "Limited", "0–20°", "0–20°", ""], ["Hip: Abduction", "Limited — pain", "Limited", "0–45°", "0–45°", ""], ["Knee: Flexion", "Limited ~0–90°", "Limited", "0–135°", "0–135°", "Right knee limited due to pain"], ["Ankle: Dorsiflexion", "Full (0–20°)", "Full", "Full", "Full", "No foot drop"], ["Ankle: Plantarflexion", "Full (0–50°)", "Full", "Full", "Full", ""], ["Toes", "Full", "Full", "Full", "Full", "Sensation intact"] ], [16, 12, 12, 12, 12, 36] ), heading3("4. Measurements"), makeTable( ["Measurement", "Right", "Left", "Difference"], [ ["Apparent limb length\n(Xiphisternum → medial malleolus)", "To be measured", "To be measured", "Likely shortened on right"], ["True limb length\n(ASIS → medial malleolus)", "Likely shortened", "Normal", "Shortened right (overriding fracture)"], ["Femur\n(ASIS → medial knee joint line)", "Shortened", "Normal", "Shortened"], ["Tibia\n(Medial knee joint line → medial malleolus)", "Normal", "Normal", "Nil"], ["Arm / Humerus", "N/A", "N/A", "N/A"], ["Forearm / Radius", "N/A", "N/A", "N/A"] ], [40, 20, 20, 20] ), para("Interpretation: Limb shortening on the right side is expected due to overriding of comminuted femoral fracture fragments by pull of thigh musculature. Exact measurements require bedside assessment with measuring tape.", true), heading3("5. Specific Tests"), bullet("Thomas test: Not performed acutely (pain-limiting)"), bullet("Straight leg raise (SLR): Unable to perform on right; normal on left"), bullet("Neurovascular assessment: CRT < 2 seconds, DPA and PTA palpable, sensation intact — no neurovascular compromise"), bullet("Bryant's triangle / Nelaton's line: Not assessed acutely"), // m heading1("m. Systemic Examination"), heading3("Cardiovascular:"), para("S1 and S2 heard, no murmurs. BP 116/89 mmHg, PR 84 bpm, regular. Peripheral pulses (DPA/PTA) palpable bilaterally in lower limbs."), heading3("Respiratory:"), para("Air entry equal bilaterally. No added sounds (no wheeze, no crepitations). SpO₂ 98% on room air. No respiratory distress. No chest wall tenderness."), heading3("Gastrointestinal:"), para("Abdomen soft, non-tender, non-distended. No guarding or rigidity. Bowel sounds present. No organomegaly."), heading3("Neurological:"), para("Alert, GCS 15/15. Pupils equal and reactive to light (PEARL). Sensation intact in bilateral lower limbs. No motor deficit distally. No foot drop."), heading3("Head and Neck:"), para("No facial lacerations. No cervical spine tenderness. Helmet was worn at time of accident."), // n heading1("n. Summary"), para("Mr. Muhammad Danial Ikhwan, a 21-year-old Malay Muslim male assembler and active smoker with no known medical illness or drug allergy, presented to Hospital Kulim on 28/04/2026 following a high-energy motor vehicle accident (motorcyclist, wearing helmet). He sustained a closed injury to the right lower limb with right mid-thigh pain, swelling, deformity, road abrasion, and transient loss of consciousness. Examination revealed mild swelling over the right mid-thigh, abrasion over the distal thigh, no open wound, limited ROM of right hip and knee due to pain, intact distal neurovascular status (palpable DPA/PTA, CRT < 2s, sensation intact), and stable vital signs. Blood investigations showed Hb 14.3 g/dL, TWC 24.2 × 10⁹/L (elevated, reactive), PLT 331, normal renal function, INR 1.08. X-ray confirmed a comminuted fracture of the right midshaft femur."), // o heading1("o. Provisional Diagnosis (Post-Examination)"), new Paragraph({ children: [BOLD("Closed comminuted fracture of the right midshaft femur")], spacing: { after: 80 } }), heading3("Points in Favour:"), bullet("21-year-old male, high-energy MVA (motorcycle accident)"), bullet("Localised right mid-thigh pain, swelling, deformity, and abrasion"), bullet("Limited ROM of right hip and knee due to pain"), bullet("No open wound — closed fracture confirmed"), bullet("Intact distal neurovascular status"), bullet("X-ray confirmed comminuted fracture at midshaft of right femur"), // p heading1("p. Investigations with Results"), makeTable( ["Investigation", "Patient's Result", "Normal Value", "Interpretation"], [ ["Haemoglobin (Hb)", "14.3 g/dL", "13–17 g/dL (male)", "Normal — no significant blood loss at time of testing"], ["Total White Cell Count (TWC)", "24.2 × 10⁹/L", "4–11 × 10⁹/L", "Elevated — reactive leukocytosis secondary to trauma/stress response"], ["Platelets (PLT)", "331 × 10⁹/L", "150–400 × 10⁹/L", "Normal"], ["Urea", "5.3 mmol/L", "2.5–6.7 mmol/L", "Normal"], ["Creatinine", "94 µmol/L", "62–115 µmol/L", "Normal — adequate renal function"], ["Sodium (Na)", "136 mmol/L", "135–145 mmol/L", "Normal"], ["Potassium (K)", "4.0 mmol/L", "3.5–5.0 mmol/L", "Normal"], ["Prothrombin Time (PT)", "14.2 seconds", "11–14 seconds", "Slightly prolonged — monitor coagulopathy"], ["APTT", "30.4 seconds", "25–35 seconds", "Normal"], ["INR", "1.08", "0.8–1.2", "Normal — no significant coagulopathy"], ["CT Brain", "Planned (pending)", "—", "To rule out intracranial injury given transient LOC"] ], [30, 18, 18, 34] ), heading2("Radiology"), makeTable( ["Type / Region / Date", "Findings"], [ ["X-ray Right Femur — AP View (28/04/2026)", "Comminuted fracture of the right midshaft femur"], ["X-ray Right Femur — Lateral View", "To be documented with actual radiograph"], ["Other views", "—"], ["Radiological Conclusion", "Closed comminuted fracture of the right midshaft femur (as documented in clerking sheet)"] ], [35, 65] ), // q heading1("q. Final Diagnosis"), new Paragraph({ children: [BOLD("Closed comminuted fracture of the right midshaft femur"), NORMAL(" — following high-energy motor vehicle accident (MVA) on 28/04/2026")], spacing: { after: 100 } }), // r heading1("r. Treatment"), heading3("Immediate / Emergency Management:"), bullet("IV access established — IV fluid 8 pint Normal Saline (NS) over 24 hours (fluid resuscitation)"), bullet("IV cannula insertion for right femur Intramedullary Locking Nail (IMLN) — after discussion with Orthopaedic Specialist"), bullet("Right skin traction applied — to maintain length and alignment, relieve pain, and stabilise fracture pending definitive fixation"), bullet("Watch for fat embolism syndrome and compartment syndrome"), bullet("SC Heparin commenced after review of CT brain results (DVT prophylaxis)"), bullet("Analgesia: Tramadol 50 mg TDS; Paracetamol (PCM) 1 g TDS"), bullet("Check SOCSO status — to facilitate work injury claim"), bullet("SIT Mr. Salman (Orthopaedic Specialist) — to call once patient admitted to ward"), heading3("Definitive Surgical Management:"), bullet("Closed or open reduction and Intramedullary Locking Nail (IMLN) of the right femur"), para("Gold standard for femoral shaft fractures in adults. Allows early mobilisation, restores length and alignment, and reduces risk of pulmonary complications including fat embolism. Reamed nailing is preferred as it improves union rates (Rockwood & Green's Fractures in Adults, 10th ed.).", true), // s heading1("s. Follow Up"), bullet("Post-operative wound review at 2 weeks"), bullet("Repeat X-ray right femur at 6 weeks post-operatively to assess fracture union"), bullet("Physiotherapy: quadriceps strengthening and progressive knee ROM exercises"), bullet("Weight-bearing protocol: Non-weight bearing → partial weight bearing → full weight bearing, based on radiological and clinical healing"), bullet("Monitor for complications: fat embolism syndrome, compartment syndrome, DVT, surgical site infection, delayed union, malunion, rotational deformity"), bullet("SOCSO documentation for work-related injury claim"), bullet("Smoking cessation counselling — active smoking impairs fracture healing"), // DISCUSSION heading1("DISCUSSION"), heading2("Closed Comminuted Fracture of the Right Midshaft Femur"), heading3("Definition and Epidemiology"), para("A femoral shaft fracture is defined as a fracture occurring between the subtrochanteric region proximally and the supracondylar flare distally. It is one of the most significant long bone injuries, accounting for 1–9% of all fractures, and is associated with significant morbidity and mortality due to associated injuries and complications."), para("Femoral shaft fractures show a bimodal age distribution. The first peak occurs in young males aged 15–25 years, predominantly from high-energy trauma such as motor vehicle accidents. The second peak occurs in elderly females over 75 years from low-energy falls due to osteoporosis. This patient (21-year-old male, MVA) fits the classic first-peak demographic."), heading3("Mechanism of Injury"), para("High-energy mechanisms (MVAs, motorcycle accidents, falls from heights, gunshot wounds) produce comminuted, displaced fractures due to significant forces applied to the femur. A bending force creates a transverse fracture; rotational forces produce spiral or oblique patterns; increasing energy creates increasing comminution. In this case, the comminuted pattern indicates a high-energy bending/torsional force."), heading3("Clinical Features"), bullet("Severe thigh pain, swelling, and deformity"), bullet("Inability to weight bear on affected limb"), bullet("Limb shortening (proximal fragment pulled into flexion, abduction, external rotation by iliopsoas, hip abductors, and short external rotators)"), bullet("Neurovascular assessment critical — sciatic nerve and femoral artery at risk"), para("Despite a normal Hb (14.3 g/dL) at presentation, the femur can harbour 500–1500 mL of blood within the thigh compartment. Serial monitoring of haemoglobin is essential."), heading3("Complications"), bullet("Fat embolism syndrome (first 24–72 hours): dyspnoea, confusion, petechiae"), bullet("Compartment syndrome: thigh compartment syndrome uncommon but life-threatening"), bullet("Deep vein thrombosis (DVT) / Pulmonary embolism (PE)"), bullet("Sciatic nerve injury"), bullet("Post-operative surgical site infection"), bullet("Delayed union / nonunion / malunion"), bullet("Rotational deformity"), bullet("Heterotopic ossification"), heading3("Management"), para("The gold standard treatment for femoral shaft fractures in adults is antegrade Intramedullary Locking Nail (IMLN). This provides rotational and axial stability, restores length and alignment, and allows early mobilisation. Early fixation (within 24 hours) reduces pulmonary complications in multiply-injured patients. Reamed nailing is preferred over unreamed as it improves union rates. Skin traction is used as a temporary measure prior to definitive fixation to maintain length and reduce pain."), // Signature line new Paragraph({ children: [NORMAL("")], spacing: { before: 400 } }), new Paragraph({ children: [BOLD("Signature of Faculty: "), NORMAL("_________________________________")], spacing: { after: 60 } }), new Paragraph({ children: [BOLD("Date: "), NORMAL("_____________")], spacing: { after: 60 } }) ] }] }); Packer.toBuffer(doc).then(buffer => { fs.writeFileSync("/home/daytona/workspace/ortho-logbook/Case1_Ortho_Logbook.docx", buffer); console.log("SUCCESS: File written."); }).catch(e => { console.error("ERROR:", e); }); JSEOF echo "Script written."

cd /home/daytona/workspace/ortho-logbook && node case1.js

python3 /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/workspace/ortho-logbook/Case1_Ortho_Logbook.docx

# Verify file exists and is a valid zip/docx ls -lh /home/daytona/workspace/ortho-logbook/Case1_Ortho_Logbook.docx python3 -c " import zipfile path = '/home/daytona/workspace/ortho-logbook/Case1_Ortho_Logbook.docx' with zipfile.ZipFile(path) as z: names = z.namelist() print('Valid DOCX. Contents:', names[:8]) "