Hydatid Cyst (Echinococcosis) - Surgical Residency Final Exam Notes

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm, cm
from reportlab.lib.styles import ParagraphStyle, getSampleStyleSheet
from reportlab.lib.enums import TA_LEFT, TA_CENTER
from reportlab.platypus import (
    BaseDocTemplate, Frame, PageTemplate, Paragraph,
    Table, TableStyle, Spacer, HRFlowable, KeepTogether
)
from reportlab.platypus.flowables import BalancedColumns
from reportlab.pdfbase import pdfmetrics
from reportlab.pdfbase.ttfonts import TTFont
import os

OUTPUT = "/home/daytona/workspace/hydatid-cyst/Hydatid_Cyst_Quick_Reference.pdf"

# ─── Colour palette ───────────────────────────────────────────────────────────
NAVY    = colors.HexColor("#1a3a5c")
TEAL    = colors.HexColor("#0d7377")
AMBER   = colors.HexColor("#e8a020")
RED     = colors.HexColor("#c0392b")
LGRAY   = colors.HexColor("#f0f4f8")
MGRAY   = colors.HexColor("#d0d8e4")
WHITE   = colors.white
BLACK   = colors.HexColor("#1a1a1a")
GREEN   = colors.HexColor("#1a7a4a")

# ─── Page setup ───────────────────────────────────────────────────────────────
PAGE_W, PAGE_H = A4           # 210 × 297 mm
MARGIN_T = 22*mm
MARGIN_B = 16*mm
MARGIN_L = 12*mm
MARGIN_R = 12*mm
COL_GAP  = 5*mm
COL_W    = (PAGE_W - MARGIN_L - MARGIN_R - COL_GAP) / 2

# ─── Styles ───────────────────────────────────────────────────────────────────
def make_styles():
    S = {}
    base = dict(fontName="Helvetica", fontSize=7, leading=9.5, textColor=BLACK)

    S["h_section"] = ParagraphStyle("h_section",
        fontName="Helvetica-Bold", fontSize=8, leading=10,
        textColor=WHITE, spaceAfter=2)

    S["h_sub"] = ParagraphStyle("h_sub",
        fontName="Helvetica-Bold", fontSize=7, leading=9,
        textColor=NAVY, spaceBefore=3, spaceAfter=1)

    S["body"] = ParagraphStyle("body", **base)

    S["bullet"] = ParagraphStyle("bullet",
        fontName="Helvetica", fontSize=7, leading=9.5,
        textColor=BLACK, leftIndent=8, firstLineIndent=-6)

    S["key"] = ParagraphStyle("key",
        fontName="Helvetica-Bold", fontSize=7, leading=9.5, textColor=NAVY)

    S["warn"] = ParagraphStyle("warn",
        fontName="Helvetica-Bold", fontSize=6.5, leading=8.5,
        textColor=RED, spaceBefore=2)

    S["small"] = ParagraphStyle("small",
        fontName="Helvetica", fontSize=6, leading=8, textColor=colors.HexColor("#555555"))

    S["title"] = ParagraphStyle("title",
        fontName="Helvetica-Bold", fontSize=14, leading=17,
        textColor=WHITE, alignment=TA_CENTER)

    S["subtitle"] = ParagraphStyle("subtitle",
        fontName="Helvetica", fontSize=8, leading=10,
        textColor=colors.HexColor("#c8d8e8"), alignment=TA_CENTER)

    S["tbl_hdr"] = ParagraphStyle("tbl_hdr",
        fontName="Helvetica-Bold", fontSize=6.5, leading=8, textColor=WHITE)

    S["tbl_body"] = ParagraphStyle("tbl_body",
        fontName="Helvetica", fontSize=6.5, leading=8, textColor=BLACK)

    S["tbl_key"] = ParagraphStyle("tbl_key",
        fontName="Helvetica-Bold", fontSize=6.5, leading=8, textColor=NAVY)

    return S

S = make_styles()

# ─── Helper builders ──────────────────────────────────────────────────────────
def section_header(title, color=NAVY):
    """Coloured banner for a section."""
    tbl = Table([[Paragraph(f"  {title}", S["h_section"])]],
                colWidths=[COL_W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("LEFTPADDING",  (0,0), (-1,-1), 4),
        ("RIGHTPADDING", (0,0), (-1,-1), 4),
        ("TOPPADDING",   (0,0), (-1,-1), 3),
        ("BOTTOMPADDING",(0,0), (-1,-1), 3),
        ("ROUNDEDCORNERS", [3]),
    ]))
    return tbl

def bullet(text, bold_part=None):
    if bold_part:
        text = text.replace(bold_part, f"<b>{bold_part}</b>", 1)
    return Paragraph(f"<bullet>&bull;</bullet> {text}", S["bullet"])

def kv(key, value):
    return Paragraph(f"<b>{key}:</b> {value}", S["body"])

def sp(h=2):
    return Spacer(1, h*mm)

def mini_table(headers, rows, col_widths, hdr_color=NAVY):
    data = [[Paragraph(h, S["tbl_hdr"]) for h in headers]]
    for row in rows:
        data.append([Paragraph(str(c), S["tbl_body"]) for c in row])
    t = Table(data, colWidths=col_widths)
    style = [
        ("BACKGROUND",   (0,0), (-1,0),  hdr_color),
        ("BACKGROUND",   (0,1), (-1,-1), LGRAY),
        ("ROWBACKGROUNDS",(0,1),(-1,-1), [WHITE, LGRAY]),
        ("GRID",         (0,0), (-1,-1), 0.3, MGRAY),
        ("LEFTPADDING",  (0,0), (-1,-1), 3),
        ("RIGHTPADDING", (0,0), (-1,-1), 3),
        ("TOPPADDING",   (0,0), (-1,-1), 2),
        ("BOTTOMPADDING",(0,0), (-1,-1), 2),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
    ]
    t.setStyle(TableStyle(style))
    return t

def highlight_box(text, bg=colors.HexColor("#fff3cd"), border=AMBER):
    inner = Paragraph(text, ParagraphStyle("hi", fontName="Helvetica-Bold",
                      fontSize=6.5, leading=8.5, textColor=BLACK))
    t = Table([[inner]], colWidths=[COL_W - 4])
    t.setStyle(TableStyle([
        ("BACKGROUND",   (0,0), (-1,-1), bg),
        ("BOX",          (0,0), (-1,-1), 1, border),
        ("LEFTPADDING",  (0,0), (-1,-1), 5),
        ("RIGHTPADDING", (0,0), (-1,-1), 5),
        ("TOPPADDING",   (0,0), (-1,-1), 3),
        ("BOTTOMPADDING",(0,0), (-1,-1), 3),
    ]))
    return t

def red_box(text):
    return highlight_box(f"⚠ {text}", bg=colors.HexColor("#fdecea"), border=RED)

def green_box(text):
    return highlight_box(f"✓ {text}", bg=colors.HexColor("#e8f5e9"), border=GREEN)

# ─── Content builders ──────────────────────────────────────────────────────────
def left_column():
    items = []

    # ── OVERVIEW ──────────────────────────────────────────────────────────────
    items += [section_header("OVERVIEW  |  AETIOLOGY", NAVY), sp(1)]
    items += [
        kv("Disease", "Echinococcosis / Hydatid disease (Zoonosis)"),
        kv("Organism", "<i>E. granulosus</i> (most common) | <i>E. multilocularis</i> (alveolar/lethal) | <i>E. ligartus</i>"),
        kv("Definitive host", "Dog (tapeworm in proximal small bowel)"),
        kv("Intermediate host", "Sheep (natural) | Humans (accidental, end-stage)"),
        kv("Transmission", "Ingestion of ova from dog feces; contaminated water/vegetables; NO human-to-human"),
        kv("Endemic", "Mediterranean, Middle East, Far East, S. America, Australia, NZ, E. Africa"),
        sp(1),
    ]

    # ── LIFE CYCLE ────────────────────────────────────────────────────────────
    items += [section_header("LIFE CYCLE", TEAL), sp(1)]
    lc = [
        "Dog excretes ova in feces (thousands/day)",
        "Human ingests ova → duodenum → oncosphere released",
        "Oncosphere penetrates mucosa → portal blood",
        "Lodges in liver (1st filter) or lungs → larval stage = Hydatid cyst",
        "Cyst grows 1 cm/first 6 months, then 2–3 cm/year",
    ]
    for i, step in enumerate(lc, 1):
        items.append(Paragraph(f"<b>{i}.</b> {step}", S["bullet"]))
    items.append(sp(1))

    # ── CYST STRUCTURE ────────────────────────────────────────────────────────
    items += [section_header("CYST WALL STRUCTURE  (3 Layers)", colors.HexColor("#5b2d8e")), sp(1)]
    rows = [
        ["<b>Pericyst</b> (outermost)", "Host-derived fibrous capsule; bile ducts + vessels incorporated; calcifies over time"],
        ["<b>Ectocyst</b> (middle)", "Bluish-white chitinous laminated membrane, ~0.5 cm; bacterial barrier; no nuclei"],
        ["<b>Endocyst</b> (inner)", "Germinal layer (10–25 µm); produces fluid, brood capsules, scoleces, daughter cysts"],
    ]
    items += [mini_table(["Layer", "Description"], rows, [COL_W*0.32, COL_W*0.68], colors.HexColor("#5b2d8e")), sp(1)]
    items += [
        Paragraph("<b>Hydatid sand</b> = brood capsules + protoscoleces + calcareous bodies (~400,000 scoleces/mL)", S["body"]),
        Paragraph("<b>Daughter cysts</b> = replicas of mother cyst (endogenic vesiculation)", S["body"]),
        Paragraph("<b>E. multilocularis</b>: ectogenic vesiculation → invasive, multilocular, necrotic centre, often lethal", S["warn"]),
        sp(1),
    ]

    # ── DISTRIBUTION ──────────────────────────────────────────────────────────
    items += [section_header("DISTRIBUTION", colors.HexColor("#2e7d32")), sp(1)]
    rows2 = [
        ["Liver", "50–75%", "Right lobe 75% | Solitary 75%"],
        ["Lungs", "20–25%", "Second most common"],
        ["Other (kidney, spleen, brain, bone)", "5–10%", "—"],
    ]
    items += [mini_table(["Site", "Frequency", "Notes"], rows2,
                         [COL_W*0.45, COL_W*0.2, COL_W*0.35], colors.HexColor("#2e7d32")), sp(1)]
    items += [green_box("Most common cause of liver cysts worldwide"), sp(1)]

    # ── CLINICAL FEATURES ─────────────────────────────────────────────────────
    items += [section_header("CLINICAL FEATURES", colors.HexColor("#b71c1c")), sp(1)]
    items += [
        Paragraph("<b>Usually asymptomatic until complications occur</b>  |  Age ~45 yrs  |  Equal sex distribution", S["body"]),
        sp(1),
        Paragraph("<b>Elective presentation:</b>", S["h_sub"]),
        bullet("Abdominal pain (most common symptom)"),
        bullet("Dyspepsia, vomiting"),
        bullet("Hepatomegaly (most frequent sign)"),
        bullet("Jaundice ~8%  |  Fever ~8%"),
        sp(1),
        Paragraph("<b>Emergency presentations:</b>", S["h_sub"]),
        bullet("Anaphylactic shock from cyst rupture (potentially fatal)"),
        bullet("Coughing white material (scoleces) from hepato-bronchial rupture"),
        bullet("Severe abdominal pain after minor trauma"),
        sp(1),
        Paragraph("<b>Complications:</b>", S["h_sub"]),
        bullet("Biliary rupture → biliary colic, jaundice, cholangitis"),
        bullet("Bronchial rupture → haemoptysis, cough"),
        bullet("Peritoneal/pleural/pericardial rupture → disseminated echinococcosis"),
        bullet("Bacterial superinfection → mimics pyogenic abscess"),
        bullet("Calcification (does NOT always = dead cyst)"),
        sp(1),
    ]

    return items


def right_column():
    items = []

    # ── INVESTIGATIONS ────────────────────────────────────────────────────────
    items += [section_header("INVESTIGATIONS", TEAL), sp(1)]
    items += [
        Paragraph("<b>Blood:</b> Eosinophilia | ELISA | Immunoelectrophoresis (low sensitivity/specificity)", S["body"]),
        sp(1),
        Paragraph("<b>USG</b> (1st choice worldwide — ~90% specificity):", S["h_sub"]),
        bullet("Hydatid sand (free-floating hyperechogenic foci)"),
        bullet('"Water lily sign" = floating detached laminated membrane'),
        bullet("Rosette / honeycomb / cartwheel = daughter cysts"),
        bullet("Eggshell calcification"),
        sp(1),
    ]

    # ── USG STAGING TABLE ─────────────────────────────────────────────────────
    items += [Paragraph("<b>WHO/Gharbi USG Staging (CE Classification):</b>", S["h_sub"])]
    stg_rows = [
        ["CL", "Unilocular anechoic, no septations"],
        ["CE1", "Fine internal echoes — hydatid sand"],
        ["CE2", "Septations — honeycomb/rosette (daughter cysts)"],
        ["CE3a", "Detached laminated membrane (water lily)"],
        ["CE3b", "Daughter cysts in solid matrix"],
        ["CE4", '"Bag of wool" — inactive, no daughter cysts'],
        ["CE5", "Partial/complete calcification — inactive"],
    ]
    items += [mini_table(["Stage", "USG Description"], stg_rows,
                         [COL_W*0.18, COL_W*0.82], TEAL), sp(1)]

    items += [
        Paragraph("<b>CT</b> (best for planning): smooth SOL + septa; daughter cysts; depth/location; calcification", S["body"]),
        Paragraph("<b>MRI/MRCP</b>: biliary communication; daughter cysts communicating with biliary tree", S["body"]),
        Paragraph("<b>ERCP</b>: delineate biliary anatomy; drain biliary tree pre-op", S["body"]),
        sp(1),
    ]

    # ── DIFF DIAGNOSIS TABLE ──────────────────────────────────────────────────
    items += [section_header("DIFF Dx — LIVER CYSTS", colors.HexColor("#4a148c")), sp(1)]
    dd_rows = [
        ["<b>Hydatid</b>", "Thick", "Clear/bilious; daughter cysts; 50% calcified"],
        ["Pyogenic", "Thick", "Pus with blood; single/multiple"],
        ["Amebic", "Thick", "Anchovy paste (red-brown)"],
        ["Congenital", "Thin", "Clear, water density"],
        ["Cystadenoma", "Variable", "Green-brown mucinous; septations"],
    ]
    items += [mini_table(["Type", "Wall", "Contents/Features"], dd_rows,
                         [COL_W*0.28, COL_W*0.15, COL_W*0.57], colors.HexColor("#4a148c")), sp(1)]

    # ── TREATMENT ─────────────────────────────────────────────────────────────
    items += [section_header("TREATMENT ALGORITHM", RED), sp(1)]
    items += [
        Paragraph("<b>Inactive cysts (CE4/CE5) or small &lt;4 cm, deep, asymptomatic</b> → Monitor with USG", S["body"]),
        Paragraph("<b>Active cysts</b> → Albendazole (≥3 months pre-op) → PAIR or Surgery", S["body"]),
        Paragraph("<b>Elderly + densely calcified + asymptomatic</b> → Conservative management", S["body"]),
        sp(1),
    ]

    # PAIR
    items += [Paragraph("<b>PAIR</b> (Puncture, Aspiration, Injection, Re-aspiration):", S["h_sub"])]
    items += [
        bullet("USG/CT-guided puncture → aspirate contents → inject contrast → infuse scolicidal agent → re-aspirate"),
        bullet("Scolicidal agents: 15–20% hypertonic saline (most common) | 95% ethanol | 5% povidone-iodine"),
        red_box("CONTRAINDICATED if biliary communication present → risk of sclerosing cholangitis"),
        sp(1),
    ]

    # Surgery
    items += [Paragraph("<b>Surgical Treatment:</b>", S["h_sub"])]
    surg_rows = [
        ["Conservative (drainage)", "Marsupialization/deroofing + omentoplasty; evacuation + drainage; laparoscopic deroofing"],
        ["Radical (resection)", "Total/partial pericystectomy; hepatic segmentectomy; partial hepatectomy"],
    ]
    items += [mini_table(["Approach", "Procedures"], surg_rows,
                         [COL_W*0.3, COL_W*0.7], RED), sp(1)]

    items += [
        Paragraph("<b>Operative principles:</b>", S["h_sub"]),
        bullet("Pack off abdomen before opening cyst (anaphylaxis + seeding risk)"),
        bullet("Aspiration via closed suction → scolicidal flush (hypertonic saline 15–20%)"),
        bullet("Epinephrine + steroids on standby for anaphylaxis"),
        bullet("Biliary communication: suture repair ± ERCP post-op ± common bile duct approach"),
        bullet("Laparoscopic approach increasingly used — CT mandatory for planning"),
        Paragraph("<b>Recurrence:</b> 1–20%; &lt;5% in expert centres", S["body"]),
        sp(1),
    ]

    # ── MEDICAL THERAPY ───────────────────────────────────────────────────────
    items += [section_header("MEDICAL THERAPY  &  SCOLICIDAL AGENTS", colors.HexColor("#01579b")), sp(1)]
    med_rows = [
        ["<b>Albendazole</b>", "Drug of choice", "Well absorbed; liver-activated; ≥3 mo pre-op; ≥1 mo post-op if spillage"],
        ["Mebendazole", "2nd choice", "Poorly absorbed; liver-inactivated"],
        ["Praziquantel", "Adjunct", "Named-patient basis"],
    ]
    items += [mini_table(["Drug", "Role", "Notes"], med_rows,
                         [COL_W*0.28, COL_W*0.2, COL_W*0.52], colors.HexColor("#01579b")), sp(1)]
    items += [Paragraph("<b>Alone: only ~30% successful</b> — always combine with definitive treatment", S["warn"]), sp(1)]

    # ── HIGH YIELD ────────────────────────────────────────────────────────────
    items += [section_header("HIGH-YIELD EXAM FACTS  🎯", AMBER), sp(1)]
    hy = [
        ("<b>Definitive host</b>", "Dog"),
        ("<b>Accidental intermediate host</b>", "Humans"),
        ("<b>#1 organ affected</b>", "Liver (right lobe 75%)"),
        ("<b>#2 organ</b>", "Lungs"),
        ("<b>Most common cause of liver cysts worldwide</b>", "Echinococcal infection"),
        ("<b>Pathognomonic USG sign</b>", "Daughter cysts / rosette / water lily sign"),
        ("<b>Calcification</b>", "Does NOT always = dead cyst"),
        ("<b>Drug of choice</b>", "Albendazole"),
        ("<b>Best scolicidal agent</b>", "Hypertonic saline 15–20%"),
        ("<b>PAIR contraindication</b>", "Biliary communication"),
        ("<b>Emergency presentation</b>", "Anaphylactic shock from rupture"),
        ("<b>Hydatid sand</b>", "~400,000 scoleces/mL"),
        ("<b>CE4 USG</b>", '"Bag of wool" = inactive'),
        ("<b>E. multilocularis</b>", "Ectogenic vesiculation; invasive; often lethal"),
    ]
    hy_data = [[Paragraph(k, S["tbl_key"]), Paragraph(v, S["tbl_body"])] for k, v in hy]
    hy_tbl = Table(hy_data, colWidths=[COL_W*0.45, COL_W*0.55])
    hy_tbl.setStyle(TableStyle([
        ("ROWBACKGROUNDS", (0,0), (-1,-1), [WHITE, LGRAY]),
        ("GRID",          (0,0), (-1,-1), 0.3, MGRAY),
        ("LEFTPADDING",   (0,0), (-1,-1), 3),
        ("RIGHTPADDING",  (0,0), (-1,-1), 3),
        ("TOPPADDING",    (0,0), (-1,-1), 2),
        ("BOTTOMPADDING", (0,0), (-1,-1), 2),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    items.append(hy_tbl)
    items.append(sp(1))

    # ── PREVENTION ────────────────────────────────────────────────────────────
    items += [section_header("PREVENTION", colors.HexColor("#2e7d32")), sp(1)]
    items += [
        bullet("Wash hands after contact with dogs"),
        bullet("Avoid vegetables grown at ground level in endemic areas"),
        bullet("Do NOT feed animal entrails to dogs (breaks life cycle)"),
    ]

    return items


# ─── Document assembly ────────────────────────────────────────────────────────
def build_header(canvas, doc):
    canvas.saveState()
    # Header banner
    canvas.setFillColor(NAVY)
    canvas.rect(0, PAGE_H - 18*mm, PAGE_W, 18*mm, fill=1, stroke=0)

    canvas.setFillColor(AMBER)
    canvas.rect(0, PAGE_H - 20*mm, PAGE_W, 2*mm, fill=1, stroke=0)

    canvas.setFont("Helvetica-Bold", 14)
    canvas.setFillColor(WHITE)
    canvas.drawCentredString(PAGE_W/2, PAGE_H - 10*mm, "HYDATID CYST  |  Quick Reference Card")

    canvas.setFont("Helvetica", 7.5)
    canvas.setFillColor(colors.HexColor("#a0c4e0"))
    canvas.drawCentredString(PAGE_W/2, PAGE_H - 15*mm,
        "Surgical Residency Final Exam  •  Echinococcosis / Hydatid Disease  •  Sources: Sabiston | Bailey & Love | Maingot's")

    # Footer
    canvas.setFillColor(NAVY)
    canvas.rect(0, 0, PAGE_W, 10*mm, fill=1, stroke=0)
    canvas.setFont("Helvetica", 6)
    canvas.setFillColor(colors.HexColor("#a0c4e0"))
    canvas.drawString(MARGIN_L, 3.5*mm, "Orris Medical  •  For educational use only  •  Verify all doses/guidelines with current references")
    canvas.drawRightString(PAGE_W - MARGIN_R, 3.5*mm, "July 2026")

    # Vertical divider
    canvas.setStrokeColor(MGRAY)
    canvas.setLineWidth(0.5)
    mid_x = MARGIN_L + COL_W + COL_GAP/2
    canvas.line(mid_x, MARGIN_B + 2*mm, mid_x, PAGE_H - MARGIN_T - 2*mm)

    canvas.restoreState()


def main():
    doc = BaseDocTemplate(OUTPUT,
                          pagesize=A4,
                          leftMargin=MARGIN_L,
                          rightMargin=MARGIN_R,
                          topMargin=MARGIN_T,
                          bottomMargin=MARGIN_B)

    left_frame  = Frame(MARGIN_L, MARGIN_B,
                        COL_W, PAGE_H - MARGIN_T - MARGIN_B,
                        leftPadding=0, rightPadding=0,
                        topPadding=0, bottomPadding=0,
                        id="left")

    right_frame = Frame(MARGIN_L + COL_W + COL_GAP, MARGIN_B,
                        COL_W, PAGE_H - MARGIN_T - MARGIN_B,
                        leftPadding=0, rightPadding=0,
                        topPadding=0, bottomPadding=0,
                        id="right")

    doc.addPageTemplates([PageTemplate(id="two_col",
                                       frames=[left_frame, right_frame],
                                       onPage=build_header)])

    story = left_column()
    # Signal column break (FrameBreak equivalent via empty frame usage)
    from reportlab.platypus import FrameBreak
    story.append(FrameBreak())
    story += right_column()

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


if __name__ == "__main__":
    main()

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.lib.styles import ParagraphStyle
from reportlab.lib.enums import TA_CENTER
from reportlab.platypus import (
    BaseDocTemplate, Frame, PageTemplate, Paragraph,
    Table, TableStyle, Spacer, FrameBreak
)

OUTPUT = "/home/daytona/workspace/hydatid-cyst/Hydatid_Cyst_Quick_Reference.pdf"

# ── Colour palette ─────────────────────────────────────────────────────────────
NAVY   = colors.HexColor("#1a3a5c")
TEAL   = colors.HexColor("#0d7377")
AMBER  = colors.HexColor("#c8860e")
RED    = colors.HexColor("#b71c1c")
PURPLE = colors.HexColor("#4a148c")
DGREEN = colors.HexColor("#1b5e20")
BLUE   = colors.HexColor("#01579b")
LGRAY  = colors.HexColor("#f2f5f9")
MGRAY  = colors.HexColor("#ccd5e0")
WHITE  = colors.white
BLACK  = colors.HexColor("#111111")
WARN   = colors.HexColor("#fdecea")
WARNB  = colors.HexColor("#b71c1c")
HILY   = colors.HexColor("#fff8e1")

# ── Page geometry ──────────────────────────────────────────────────────────────
PAGE_W, PAGE_H = A4
MT = 18*mm   # top margin (under header)
MB = 9*mm    # bottom margin (above footer)
ML = 10*mm
MR = 10*mm
GAP = 4*mm
COL_W = (PAGE_W - ML - MR - GAP) / 2

# ── Styles ─────────────────────────────────────────────────────────────────────
def S(name, **kw):
    defaults = dict(fontName="Helvetica", fontSize=6.4, leading=8.2, textColor=BLACK)
    defaults.update(kw)
    return ParagraphStyle(name, **defaults)

s_body   = S("body")
s_bullet = S("bullet", leftIndent=7, firstLineIndent=-5)
s_bold   = S("bold",   fontName="Helvetica-Bold")
s_hdr    = S("hdr",    fontName="Helvetica-Bold", fontSize=7.2, leading=9, textColor=WHITE)
s_sub    = S("sub",    fontName="Helvetica-Bold", fontSize=6.5, leading=8, textColor=NAVY, spaceBefore=2, spaceAfter=1)
s_warn   = S("warn",   fontName="Helvetica-Bold", fontSize=6.2, leading=7.8, textColor=RED)
s_th     = S("th",     fontName="Helvetica-Bold", fontSize=6.2, leading=7.5, textColor=WHITE)
s_td     = S("td",     fontName="Helvetica",      fontSize=6.2, leading=7.5, textColor=BLACK)
s_tdkey  = S("tdkey",  fontName="Helvetica-Bold", fontSize=6.2, leading=7.5, textColor=NAVY)

def sp(h=1.5):  return Spacer(1, h*mm)

def sec(title, color=NAVY):
    t = Table([[Paragraph(f"  {title}", s_hdr)]], colWidths=[COL_W])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0),(-1,-1), color),
        ("LEFTPADDING",   (0,0),(-1,-1), 3),
        ("RIGHTPADDING",  (0,0),(-1,-1), 3),
        ("TOPPADDING",    (0,0),(-1,-1), 2),
        ("BOTTOMPADDING", (0,0),(-1,-1), 2),
    ]))
    return t

def tbl(headers, rows, widths, hcolor=NAVY):
    data = [[Paragraph(h, s_th) for h in headers]]
    for r in rows:
        data.append([Paragraph(str(c), s_td) for c in r])
    t = Table(data, colWidths=widths)
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1, 0), hcolor),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, LGRAY]),
        ("GRID",          (0,0), (-1,-1), 0.25, MGRAY),
        ("LEFTPADDING",   (0,0), (-1,-1), 2),
        ("RIGHTPADDING",  (0,0), (-1,-1), 2),
        ("TOPPADDING",    (0,0), (-1,-1), 1.5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 1.5),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    return t

def kv_tbl(rows, c1w=0.42):
    data = [[Paragraph(k, s_tdkey), Paragraph(v, s_td)] for k,v in rows]
    t = Table(data, colWidths=[COL_W*c1w, COL_W*(1-c1w)])
    t.setStyle(TableStyle([
        ("ROWBACKGROUNDS",(0,0),(-1,-1),[WHITE,LGRAY]),
        ("GRID",         (0,0),(-1,-1), 0.25, MGRAY),
        ("LEFTPADDING",  (0,0),(-1,-1), 2),
        ("RIGHTPADDING", (0,0),(-1,-1), 2),
        ("TOPPADDING",   (0,0),(-1,-1), 1.5),
        ("BOTTOMPADDING",(0,0),(-1,-1), 1.5),
        ("VALIGN",       (0,0),(-1,-1), "TOP"),
    ]))
    return t

def box(text, bg=HILY, bc=AMBER, style=None):
    st = style or S("bx", fontName="Helvetica-Bold", fontSize=6.2, leading=7.8, textColor=BLACK)
    inner = Table([[Paragraph(text, st)]], colWidths=[COL_W - 6])
    inner.setStyle(TableStyle([
        ("BACKGROUND",   (0,0),(-1,-1), bg),
        ("BOX",          (0,0),(-1,-1), 0.8, bc),
        ("LEFTPADDING",  (0,0),(-1,-1), 4),
        ("RIGHTPADDING", (0,0),(-1,-1), 4),
        ("TOPPADDING",   (0,0),(-1,-1), 2),
        ("BOTTOMPADDING",(0,0),(-1,-1), 2),
    ]))
    return inner

def rbox(text): return box(f"⚠  {text}", bg=WARN, bc=WARNB,
                            style=S("rb", fontName="Helvetica-Bold", fontSize=6.2, leading=7.8, textColor=RED))

def b(text):   return Paragraph(f"• {text}", s_bullet)
def p(text):   return Paragraph(text, s_body)

# ── Left column ────────────────────────────────────────────────────────────────
def left_col():
    items = []

    # OVERVIEW
    items += [sec("OVERVIEW  |  AETIOLOGY", NAVY), sp(1)]
    items += [kv_tbl([
        ("<b>Disease</b>",         "Echinococcosis / Hydatid disease (Zoonosis)"),
        ("<b>Organism</b>",        "<i>E. granulosus</i> (most common) | <i>E. multilocularis</i> (alveolar, lethal) | <i>E. ligartus</i>"),
        ("<b>Definitive host</b>", "Dog — adult tapeworm in proximal small bowel; thousands of ova/day"),
        ("<b>Intermediate host</b>","Sheep (natural) | Humans (accidental, end-stage — no human-to-human transmission)"),
        ("<b>Transmission</b>",    "Ingestion of ova from dog feces; contaminated water/vegetables"),
        ("<b>Endemic regions</b>", "Mediterranean, Middle East, Far East, S. America, Australia, NZ, E. Africa"),
    ]), sp(1)]

    # LIFE CYCLE
    items += [sec("LIFE CYCLE", TEAL), sp(1)]
    for i, step in enumerate([
        "Dog excretes ova in feces",
        "Human ingests ova → duodenum → oncosphere released",
        "Oncosphere penetrates mucosa → portal blood",
        "Lodges in liver (1st filter) or lungs → larval stage = Hydatid cyst",
        "Grows 1 cm/first 6 months, then 2–3 cm/year thereafter",
    ], 1):
        items.append(Paragraph(f"<b>{i}.</b> {step}", s_bullet))
    items.append(sp(1))

    # CYST STRUCTURE
    items += [sec("CYST WALL — 3 LAYERS", PURPLE), sp(1)]
    items += [tbl(["Layer", "Description"],
        [["<b>Pericyst</b> (outermost — host)", "Fibrous adventitial reaction; bile ducts + vessels incorporated; calcifies over time"],
         ["<b>Ectocyst</b> (middle)", "Chitinous laminated membrane ~0.5 cm; bluish-white; bacterial barrier; no nuclei"],
         ["<b>Endocyst</b> (inner — parasite)", "Germinal layer 10–25 µm; produces fluid, brood capsules, scoleces, daughter cysts"]],
        [COL_W*0.32, COL_W*0.68], PURPLE), sp(0.8)]
    items += [
        p("• <b>Hydatid sand</b> = brood capsules + protoscoleces + calcareous bodies (~400,000 scoleces/mL)"),
        p("• <b>Daughter cysts</b> = replicas of mother cyst (endogenic vesiculation from germinal layer)"),
        p("• <b>E. multilocularis</b>: ectogenic vesiculation → invasive, multilocular, necrotic centre, often lethal"),
        sp(1),
    ]

    # DISTRIBUTION
    items += [sec("DISTRIBUTION", DGREEN), sp(1)]
    items += [tbl(["Site", "Freq.", "Notes"],
        [["Liver", "50–75%", "Right lobe 75% | Solitary 75% | 50% of solitary have daughter cysts"],
         ["Lungs", "20–25%", "2nd most common"],
         ["Other (kidney, spleen, brain, bone)", "5–10%", "—"]],
        [COL_W*0.42, COL_W*0.14, COL_W*0.44], DGREEN), sp(0.8)]
    items += [box("<b>Most common cause of liver cysts worldwide</b>  •  Echinococcal infection"), sp(1)]

    # CLINICAL FEATURES
    items += [sec("CLINICAL FEATURES", RED), sp(1)]
    items += [p("<b>Usually asymptomatic until complications</b>  |  Age ~45 yrs  |  Equal M:F"), sp(0.5)]
    items += [p("<b>Elective:</b> Abdominal pain (most common) • Dyspepsia/vomiting • Hepatomegaly (most frequent sign) • Jaundice ~8% • Fever ~8%")]
    items += [sp(0.5), p("<b>Emergency:</b> Anaphylactic shock from rupture (potentially fatal) • Coughing scoleces from hepato-bronchial rupture • Severe pain after minor trauma")]
    items += [sp(0.5), p("<b>Complications:</b> Biliary rupture → jaundice/cholangitis • Bronchial rupture → haemoptysis • Peritoneal rupture → disseminated disease • Bacterial superinfection (mimics pyogenic abscess) • Calcification (does NOT always = dead cyst)")]
    items.append(sp(1))

    return items

# ── Right column ───────────────────────────────────────────────────────────────
def right_col():
    items = []

    # INVESTIGATIONS
    items += [sec("INVESTIGATIONS", TEAL), sp(1)]
    items += [p("<b>Blood:</b> Eosinophilia | ELISA | Immunoelectrophoresis (limited sensitivity/specificity)"), sp(0.5)]
    items += [p("<b>USG</b> (1st choice worldwide, ~90% specificity): hydatid sand (hyperechoic foci) • 'Water lily sign' (floating membrane) • Rosette/honeycomb/cartwheel (daughter cysts) • Eggshell calcification"), sp(0.8)]

    # USG STAGING
    items += [p("<b>WHO/Gharbi CE Staging:</b>")]
    items += [tbl(["Stage", "USG Description", "Status"],
        [["CL",   "Unilocular anechoic, no septations", "Active"],
         ["CE1",  "Fine echoes — hydatid sand", "Active"],
         ["CE2",  "Honeycomb/rosette — daughter cysts", "Active"],
         ["CE3a", "Detached laminated membrane (water lily)", "Transitional"],
         ["CE3b", "Daughter cysts in solid matrix", "Transitional"],
         ["CE4",  '"Bag of wool" — no daughter cysts', "Inactive"],
         ["CE5",  "Partial/complete calcification", "Inactive"]],
        [COL_W*0.15, COL_W*0.63, COL_W*0.22], TEAL), sp(0.8)]
    items += [
        p("<b>CT</b> (best for planning): smooth SOL + septa; daughter cysts; calcification; depth/location"),
        p("<b>MRCP</b>: biliary communication • <b>ERCP</b>: delineate + drain biliary tree pre-op"),
        sp(1),
    ]

    # DIFF Dx
    items += [sec("DIFF Dx — LIVER CYSTS", PURPLE), sp(1)]
    items += [tbl(["Type", "Wall", "Contents / Key Feature"],
        [["<b>Hydatid</b>",  "Thick", "Clear/bilious; daughter cysts; 50% calcified"],
         ["Pyogenic",        "Thick", "Pus + blood; single/multiple; fever, ↑WCC"],
         ["Amebic",          "Thick", "Anchovy paste (red-brown); travel Hx"],
         ["Congenital",      "Thin",  "Clear, water density; smooth"],
         ["Cystadenoma",     "Variable", "Green-brown mucinous; irregular septations"]],
        [COL_W*0.26, COL_W*0.14, COL_W*0.60], PURPLE), sp(1)]

    # TREATMENT
    items += [sec("TREATMENT ALGORITHM", RED), sp(1)]
    items += [
        p("<b>Inactive (CE4/CE5) or small &lt;4 cm deep asymptomatic</b> → Watchful waiting + USG monitoring"),
        p("<b>Elderly + densely calcified + asymptomatic</b> → Conservative"),
        p("<b>Active cysts</b> → <b>Albendazole ≥3 months pre-op</b> → PAIR or Surgery"),
        sp(0.8),
        p("<b>PAIR</b> (Puncture, Aspiration, Injection, Re-aspiration):"),
        b("USG/CT-guided • Puncture → Aspirate → Inject contrast (check biliary comm.) → Scolicidal agent → Re-aspirate"),
        b("Scolicidal agents: 15–20% hypertonic saline (1st choice) | 95% ethanol | 5% povidone-iodine"),
        rbox("CONTRAINDICATED if biliary communication — risk of sclerosing cholangitis"),
        sp(0.8),
    ]
    items += [p("<b>Surgical options:</b>")]
    items += [tbl(["Approach", "Procedures"],
        [["Conservative (drainage)", "Marsupialization/deroofing + omentoplasty; laparoscopic deroofing; external drainage"],
         ["Radical (resection)",    "Total/partial pericystectomy; hepatic segmentectomy; partial hepatectomy"]],
        [COL_W*0.3, COL_W*0.7], RED), sp(0.8)]
    items += [
        p("<b>Operative principles:</b> Pack off abdomen before opening cyst (anaphylaxis + seeding) • Aspiration via closed suction • Scolicidal flush • Epinephrine + steroids on standby • Biliary communication → suture repair ± ERCP"),
        p("<b>Recurrence:</b> 1–20%; &lt;5% in expert centres"),
        sp(1),
    ]

    # MEDICAL THERAPY
    items += [sec("MEDICAL THERAPY", BLUE), sp(1)]
    items += [tbl(["Drug", "Notes"],
        [["<b>Albendazole</b> (1st choice)", "Well absorbed; liver-activated to active metabolite; given ≥3 mo pre-op; ≥1 mo post-op if spillage/biliary rupture"],
         ["Mebendazole (2nd choice)",        "Poorly absorbed; liver-inactivated; less effective"],
         ["Praziquantel (adjunct)",           "Named-patient basis; combined with albendazole in some protocols"]],
        [COL_W*0.32, COL_W*0.68], BLUE), sp(0.5)]
    items += [rbox("Alone only ~30% successful — always combine with PAIR or surgery"), sp(1)]

    # HIGH YIELD
    items += [sec("HIGH-YIELD EXAM FACTS  🎯", colors.HexColor("#7b5800")), sp(1)]
    items += [kv_tbl([
        ("<b>Definitive host</b>",              "Dog"),
        ("<b>Accidental intermediate host</b>", "Humans (end-stage — no H-to-H transmission)"),
        ("<b>#1 organ affected</b>",            "Liver — right lobe 75% | solitary 75%"),
        ("<b>#2 organ</b>",                     "Lungs (20–25%)"),
        ("<b>Pathognomonic USG</b>",            "Daughter cysts / rosette / water lily sign"),
        ("<b>Calcification</b>",               "Does NOT always mean dead cyst"),
        ("<b>Drug of choice</b>",              "Albendazole"),
        ("<b>Best scolicidal agent</b>",        "Hypertonic saline 15–20%"),
        ("<b>PAIR contraindication</b>",        "Biliary communication"),
        ("<b>Emergency presentation</b>",       "Anaphylactic shock from rupture"),
        ("<b>CE4 appearance</b>",              '"Bag of wool" = inactive stage'),
        ("<b>E. multilocularis</b>",           "Ectogenic vesiculation; invasive; no sequestration; often lethal"),
        ("<b>Prevention</b>",                  "Handwashing; no ground vegetables in endemic areas; don't feed entrails to dogs"),
    ], 0.44), sp(1)]

    return items

# ── Page decorations ───────────────────────────────────────────────────────────
def draw_page(canvas, doc):
    canvas.saveState()
    # Header
    canvas.setFillColor(NAVY)
    canvas.rect(0, PAGE_H - 15*mm, PAGE_W, 15*mm, fill=1, stroke=0)
    canvas.setFillColor(AMBER)
    canvas.rect(0, PAGE_H - 16.5*mm, PAGE_W, 1.5*mm, fill=1, stroke=0)
    canvas.setFont("Helvetica-Bold", 13)
    canvas.setFillColor(WHITE)
    canvas.drawCentredString(PAGE_W/2, PAGE_H - 8.5*mm, "HYDATID CYST  |  Quick Reference Card")
    canvas.setFont("Helvetica", 6.8)
    canvas.setFillColor(colors.HexColor("#90bcd8"))
    canvas.drawCentredString(PAGE_W/2, PAGE_H - 13*mm,
        "Surgical Residency Final Exam  •  Echinococcosis  •  Sabiston | Bailey & Love | Maingot's")
    # Footer
    canvas.setFillColor(NAVY)
    canvas.rect(0, 0, PAGE_W, 8*mm, fill=1, stroke=0)
    canvas.setFont("Helvetica", 5.8)
    canvas.setFillColor(colors.HexColor("#90bcd8"))
    canvas.drawString(ML, 2.8*mm, "Orris Medical  •  For educational use only  •  Verify all clinical details with current references")
    canvas.drawRightString(PAGE_W - MR, 2.8*mm, "July 2026")
    # Divider
    mid_x = ML + COL_W + GAP/2
    canvas.setStrokeColor(MGRAY)
    canvas.setLineWidth(0.4)
    canvas.line(mid_x, MB, mid_x, PAGE_H - MT)
    canvas.restoreState()

# ── Build PDF ──────────────────────────────────────────────────────────────────
def main():
    doc = BaseDocTemplate(OUTPUT, pagesize=A4,
                          leftMargin=ML, rightMargin=MR,
                          topMargin=MT, bottomMargin=MB)

    f_left  = Frame(ML,          MB, COL_W, PAGE_H - MT - MB,
                    leftPadding=0, rightPadding=0, topPadding=0, bottomPadding=0, id="left")
    f_right = Frame(ML+COL_W+GAP, MB, COL_W, PAGE_H - MT - MB,
                    leftPadding=0, rightPadding=0, topPadding=0, bottomPadding=0, id="right")

    doc.addPageTemplates([PageTemplate(id="two_col",
                                       frames=[f_left, f_right],
                                       onPage=draw_page)])

    story = left_col() + [FrameBreak()] + right_col()
    doc.build(story)
    print(f"Done: {OUTPUT}")

if __name__ == "__main__":
    main()

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/hydatid-cyst/make_card.py'