"chronic gastritis" AND "Helicobacter pylori"

mkdir -p /tmp/workspace/gastritis-report && ls /tmp/workspace/gastritis-report/

python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, HRFlowable, Table, TableStyle, PageBreak) from reportlab.lib import colors from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY from reportlab.platypus import KeepTogether OUTPUT = "/tmp/workspace/gastritis-report/Chronic_Gastritis_Report_Pandit_Lalit.pdf" doc = SimpleDocTemplate( OUTPUT, pagesize=A4, rightMargin=2.5*cm, leftMargin=2.5*cm, topMargin=2.5*cm, bottomMargin=2.5*cm, ) styles = getSampleStyleSheet() # Custom styles title_style = ParagraphStyle( "MainTitle", parent=styles["Title"], fontSize=16, fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=6, textColor=colors.HexColor("#1a1a1a"), ) subtitle_style = ParagraphStyle( "Subtitle", parent=styles["Normal"], fontSize=11, fontName="Helvetica", alignment=TA_CENTER, spaceAfter=4, textColor=colors.HexColor("#333333"), ) heading1_style = ParagraphStyle( "H1", parent=styles["Heading1"], fontSize=13, fontName="Helvetica-Bold", textColor=colors.HexColor("#1a3a5c"), spaceBefore=14, spaceAfter=5, borderPad=2, ) heading2_style = ParagraphStyle( "H2", parent=styles["Heading2"], fontSize=11, fontName="Helvetica-Bold", textColor=colors.HexColor("#2e5c8a"), spaceBefore=10, spaceAfter=4, ) body_style = ParagraphStyle( "Body", parent=styles["Normal"], fontSize=10, fontName="Helvetica", leading=15, spaceAfter=6, alignment=TA_JUSTIFY, textColor=colors.HexColor("#222222"), ) bullet_style = ParagraphStyle( "Bullet", parent=styles["Normal"], fontSize=10, fontName="Helvetica", leading=14, leftIndent=16, spaceAfter=3, bulletIndent=4, textColor=colors.HexColor("#222222"), ) ref_style = ParagraphStyle( "Ref", parent=styles["Normal"], fontSize=9, fontName="Helvetica", leading=13, leftIndent=16, firstLineIndent=-16, spaceAfter=4, textColor=colors.HexColor("#333333"), ) footer_style = ParagraphStyle( "Footer", parent=styles["Normal"], fontSize=9, fontName="Helvetica-Oblique", alignment=TA_CENTER, textColor=colors.HexColor("#666666"), ) story = [] # ───────────────────────────────────────────── # PAGE 1 – COVER / TITLE PAGE # ───────────────────────────────────────────── story.append(Spacer(1, 1.5*cm)) story.append(Paragraph("Student Research Work (УИР)", subtitle_style)) story.append(Spacer(1, 0.3*cm)) story.append(HRFlowable(width="100%", thickness=1.5, color=colors.HexColor("#1a3a5c"))) story.append(Spacer(1, 0.4*cm)) story.append(Paragraph("CHRONIC GASTRITIS", title_style)) story.append(Paragraph("Etiology, Pathogenesis, Diagnosis and Treatment", subtitle_style)) story.append(Spacer(1, 0.3*cm)) story.append(HRFlowable(width="100%", thickness=1.5, color=colors.HexColor("#1a3a5c"))) story.append(Spacer(1, 1.5*cm)) info_data = [ ["Submitted by:", "Pandit Lalit"], ["Group No.:", "M-16-1-22-AH"], ["Subject:", "Faculty Therapy (Internal Medicine)"], ["Department:", "Department of Internal Medicine"], ["Year:", "4th Year, 2025–2026"], ["Date:", "July 2026"], ] info_table = Table(info_data, colWidths=[5*cm, 10*cm]) info_table.setStyle(TableStyle([ ("FONTNAME", (0, 0), (0, -1), "Helvetica-Bold"), ("FONTNAME", (1, 0), (1, -1), "Helvetica"), ("FONTSIZE", (0, 0), (-1, -1), 11), ("TEXTCOLOR", (0, 0), (0, -1), colors.HexColor("#1a3a5c")), ("TEXTCOLOR", (1, 0), (1, -1), colors.HexColor("#222222")), ("ROWBACKGROUNDS", (0, 0), (-1, -1), [colors.HexColor("#f0f4fa"), colors.white]), ("BOTTOMPADDING", (0, 0), (-1, -1), 7), ("TOPPADDING", (0, 0), (-1, -1), 7), ("LEFTPADDING", (0, 0), (-1, -1), 10), ("RIGHTPADDING", (0, 0), (-1, -1), 10), ("GRID", (0, 0), (-1, -1), 0.3, colors.HexColor("#cccccc")), ("BOX", (0, 0), (-1, -1), 1, colors.HexColor("#1a3a5c")), ])) story.append(info_table) story.append(Spacer(1, 2*cm)) story.append(Paragraph( "This research work is submitted in partial fulfillment of the requirements for the " "4th year Faculty Therapy course. The report presents a literature review on chronic gastritis, " "followed by a clinical case study with diagnosis and treatment plan.", ParagraphStyle("note", parent=body_style, alignment=TA_CENTER, fontSize=10, textColor=colors.HexColor("#555555")), )) story.append(PageBreak()) # ───────────────────────────────────────────── # PAGE 2 – RELEVANCE & LITERATURE REVIEW # ───────────────────────────────────────────── story.append(Paragraph("1. Relevance of the Topic", heading1_style)) story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#1a3a5c"), spaceAfter=6)) story.append(Paragraph( "Chronic gastritis is one of the most widespread diseases of the gastrointestinal tract worldwide. " "According to global epidemiological data, <b>Helicobacter pylori (H. pylori)</b> infects more than " "50% of the world's population, and in developing countries this figure reaches 70–80%. " "In Russia and many countries of Eastern Europe, the prevalence of H. pylori-associated gastritis " "remains high, making it a major public health problem.", body_style )) story.append(Paragraph( "Chronic gastritis is not simply a benign inflammatory condition. Its main importance lies in the " "fact that it is a risk factor for peptic ulcer disease (PUD), gastric adenocarcinoma, and " "mucosa-associated lymphoid tissue (MALT) lymphoma. The World Health Organization has classified " "H. pylori as a definite (Group I) carcinogen. This means that early detection and eradication of " "H. pylori is a strategy for cancer prevention.", body_style )) story.append(Paragraph( "The prevalence of chronic gastritis is declining in developed countries due to improved sanitation " "and successful eradication therapy. However, the burden of disease remains significant. " "Understanding the etiology, pathogenesis, diagnostic approach, and treatment of chronic gastritis " "is therefore essential for every practicing physician.", body_style )) story.append(Paragraph("2. Literature Review", heading1_style)) story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#1a3a5c"), spaceAfter=6)) story.append(Paragraph("2.1 Definition and Classification", heading2_style)) story.append(Paragraph( "Chronic gastritis is defined as a chronic inflammatory condition of the gastric mucosa " "characterized by infiltration of the lamina propria and gastric epithelium by mononuclear cells " "(lymphocytes, plasma cells) and, in active disease, by neutrophils. Three main types are recognized:", body_style )) story.append(Paragraph("• <b>Diffuse antral gastritis (H. pylori-associated):</b> the most common form, " "caused by H. pylori infection, initially affects the antrum.", bullet_style)) story.append(Paragraph("• <b>Environmental metaplastic atrophic gastritis (EMAG):</b> associated with " "dietary factors, geographic distribution, and can progress to intestinal metaplasia and cancer.", bullet_style)) story.append(Paragraph("• <b>Autoimmune metaplastic atrophic gastritis (AMAG):</b> less than 10% of cases; " "spares the antrum, affects the body/fundus, leads to pernicious anemia.", bullet_style)) story.append(Paragraph("2.2 Etiology and Pathogenesis", heading2_style)) story.append(Paragraph( "<b>H. pylori gastritis:</b> H. pylori is a gram-negative, spiral-shaped, flagellated bacterium. " "Its virulence factors include: (1) <i>Flagella</i> – allow movement through viscous gastric mucus; " "(2) <i>Urease</i> – generates ammonia from urea, raising local pH and protecting the bacterium; " "(3) <i>Adhesins</i> – enhance adhesion to surface foveolar cells; (4) <i>Toxins (CagA, CagE)</i> – " "stimulate release of IL-8 and other cytokines, triggering persistent mucosal inflammation. " "H. pylori first colonizes the antrum, stimulating gastrin release and hyperacidity. Over time, " "infection can spread to the gastric body, leading to atrophy and intestinal metaplasia.", body_style )) story.append(Paragraph( "<b>Autoimmune gastritis:</b> Mediated by autoreactive T-cells and autoantibodies against parietal " "cells and intrinsic factor. This leads to loss of parietal cell mass, reduced acid and intrinsic " "factor secretion, vitamin B12 deficiency, and pernicious anemia. It is associated with other " "autoimmune conditions (thyroiditis, type 1 diabetes).", body_style )) story.append(Paragraph( "<b>Other causes:</b> Chronic NSAID use, bile reflux, radiation injury, and alcohol may all contribute " "to chronic mucosal inflammation.", body_style )) story.append(Paragraph("2.3 Clinical Features", heading2_style)) story.append(Paragraph( "The signs and symptoms of chronic gastritis are often less dramatic than those of acute gastritis " "but are more persistent. Common complaints include:", body_style )) story.append(Paragraph("• Epigastric pain or discomfort (dull, burning)", bullet_style)) story.append(Paragraph("• Nausea, sometimes with vomiting", bullet_style)) story.append(Paragraph("• Early satiety, bloating, belching", bullet_style)) story.append(Paragraph("• Loss of appetite, weight loss in severe cases", bullet_style)) story.append(Paragraph("• In autoimmune gastritis: fatigue, pallor, neurological symptoms from B12 deficiency", bullet_style)) story.append(Paragraph("Note: Hematemesis is uncommon in uncomplicated chronic gastritis.", body_style)) story.append(PageBreak()) # ───────────────────────────────────────────── # PAGE 3 – DIAGNOSIS, CASE PRESENTATION # ───────────────────────────────────────────── story.append(Paragraph("2.4 Diagnostic Tests", heading2_style)) story.append(Paragraph( "Diagnosis of chronic gastritis relies on a combination of clinical assessment, laboratory tests, " "and instrumental investigations:", body_style )) diag_data = [ ["Test", "Method / Finding"], ["Upper GI Endoscopy\n(Gold Standard)", "Direct visualization of gastric mucosa: erythema, erosions, atrophy, intestinal metaplasia. Biopsy taken from antrum (preferred for H. pylori)."], ["Histology (H&E / Giemsa)", "Demonstrates H. pylori organisms, neutrophil infiltration, plasma cells, lymphoid aggregates, intestinal metaplasia."], ["Rapid Urease Test (RUT)", "Performed on biopsy; detects urease activity of H. pylori. Quick, cheap, reliable."], ["Urea Breath Test (UBT)", "Non-invasive; patient ingests labeled urea; exhaled CO2 detected. Used for screening and post-treatment confirmation."], ["H. pylori Stool Antigen Test", "Non-invasive; detects H. pylori antigens in feces. Good sensitivity/specificity."], ["Serology (IgG antibodies)", "Detects prior H. pylori exposure; cannot confirm active infection."], ["CBC / Blood Tests", "May show anemia (IDA or megaloblastic in autoimmune). Check serum B12, pepsinogen I."], ["Anti-parietal cell Ab / Anti-IF Ab", "Positive in autoimmune gastritis; supports diagnosis of AMAG/pernicious anemia."], ] diag_table = Table(diag_data, colWidths=[5.5*cm, 10*cm]) diag_table.setStyle(TableStyle([ ("BACKGROUND", (0, 0), (-1, 0), colors.HexColor("#1a3a5c")), ("TEXTCOLOR", (0, 0), (-1, 0), colors.white), ("FONTNAME", (0, 0), (-1, 0), "Helvetica-Bold"), ("FONTSIZE", (0, 0), (-1, -1), 9), ("ROWBACKGROUNDS", (0, 1), (-1, -1), [colors.HexColor("#f0f4fa"), colors.white]), ("GRID", (0, 0), (-1, -1), 0.4, colors.HexColor("#aaaaaa")), ("VALIGN", (0, 0), (-1, -1), "TOP"), ("BOTTOMPADDING", (0, 0), (-1, -1), 5), ("TOPPADDING", (0, 0), (-1, -1), 5), ("LEFTPADDING", (0, 0), (-1, -1), 6), ("RIGHTPADDING", (0, 0), (-1, -1), 6), ])) story.append(diag_table) story.append(Spacer(1, 0.3*cm)) story.append(Paragraph("3. Case Presentation", heading1_style)) story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#1a3a5c"), spaceAfter=6)) story.append(Paragraph("3.1 Patient Details", heading2_style)) pt_data = [ ["Name:", "Patient K.A. (initials)"], ["Age:", "42 years"], ["Gender:", "Male"], ["Occupation:", "Office worker"], ["Admitted:", "15 July 2026"], ["Ward:", "Gastroenterology, Bed 7"], ] pt_table = Table(pt_data, colWidths=[4*cm, 11.5*cm]) pt_table.setStyle(TableStyle([ ("FONTNAME", (0, 0), (0, -1), "Helvetica-Bold"), ("FONTSIZE", (0, 0), (-1, -1), 10), ("TEXTCOLOR", (0, 0), (0, -1), colors.HexColor("#1a3a5c")), ("BOTTOMPADDING", (0, 0), (-1, -1), 4), ("TOPPADDING", (0, 0), (-1, -1), 4), ("LEFTPADDING", (0, 0), (-1, -1), 6), ("GRID", (0, 0), (-1, -1), 0.3, colors.HexColor("#cccccc")), ("ROWBACKGROUNDS", (0, 0), (-1, -1), [colors.HexColor("#f9fbfd"), colors.white]), ])) story.append(pt_table) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("3.2 Chief Complaints", heading2_style)) story.append(Paragraph( "The patient presented with: (1) dull, aching pain in the epigastric region occurring 30–40 minutes " "after meals, lasting 1–2 hours; (2) nausea after eating, especially fatty foods; (3) frequent " "belching with a sour taste; (4) mild bloating; (5) reduced appetite over the past 3 months; " "(6) general fatigue and mild weight loss (~2 kg over 2 months).", body_style )) story.append(Paragraph("3.3 History (Anamnesis)", heading2_style)) story.append(Paragraph( "<b>History of the present illness:</b> Symptoms first appeared approximately 5 years ago. " "The patient reports episodic epigastric discomfort for years but has never undergone endoscopy. " "He takes ibuprofen frequently (2–3 times per week) for back pain. Diet is irregular; " "eats fast food frequently; smokes 10 cigarettes/day for 15 years; alcohol use is moderate " "(beer, 2–3 times/week). No previous hospitalizations for GI complaints.", body_style )) story.append(Paragraph( "<b>Past medical history:</b> No known chronic diseases. No previous surgery. " "No known drug allergies.", body_style )) story.append(Paragraph( "<b>Family history:</b> Father had peptic ulcer disease. Mother has no GI complaints.", body_style )) story.append(Paragraph("3.4 Physical Examination", heading2_style)) story.append(Paragraph( "General condition: satisfactory. Skin: pale. Nutritional status: slightly below normal. " "BP 118/76 mmHg, HR 76 bpm, Temperature 36.6°C, RR 16/min. " "Abdomen: soft, mild tenderness on deep palpation in the epigastric region. " "No hepatosplenomegaly. No peritoneal signs.", body_style )) story.append(PageBreak()) # ───────────────────────────────────────────── # PAGE 4 – SYNDROMES, DIAGNOSIS, TREATMENT, REFERENCES # ───────────────────────────────────────────── story.append(Paragraph("3.5 Symptoms, Syndromes and Risk Factors", heading2_style)) story.append(Paragraph("<b>Main Syndromes Identified:</b>", body_style)) story.append(Paragraph("• <b>Pain syndrome:</b> epigastric pain related to eating", bullet_style)) story.append(Paragraph("• <b>Dyspeptic syndrome:</b> nausea, belching, bloating, reduced appetite", bullet_style)) story.append(Paragraph("• <b>Asthenic syndrome:</b> fatigue, weight loss", bullet_style)) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("<b>Etiological / Risk Factors:</b>", body_style)) story.append(Paragraph("• Chronic NSAID (ibuprofen) use – direct mucosal damage", bullet_style)) story.append(Paragraph("• Likely H. pylori infection (testing ordered)", bullet_style)) story.append(Paragraph("• Smoking – impairs mucosal blood flow", bullet_style)) story.append(Paragraph("• Irregular diet, frequent fast food consumption", bullet_style)) story.append(Paragraph("• Moderate alcohol consumption", bullet_style)) story.append(Paragraph("3.6 Laboratory and Instrumental Findings", heading2_style)) lab_data = [ ["Investigation", "Result", "Interpretation"], ["Complete Blood Count", "Hb 118 g/L, mild microcytic anemia", "Possible iron deficiency"], ["H. pylori Urea Breath Test", "POSITIVE", "Active H. pylori infection confirmed"], ["H. pylori Stool Antigen Test", "POSITIVE", "Confirms active infection"], ["Serum Pepsinogen I/II ratio", "Decreased", "Suggests gastric atrophy"], ["Upper GI Endoscopy", "Erythematous antral mucosa, mucosal edema, multiple erosions", "Chronic active antral gastritis"], ["Gastric Biopsy (Histology)", "Dense lympho-plasmacytic infiltrate, neutrophils in epithelium, H. pylori organisms seen on Giemsa stain", "H. pylori chronic active gastritis"], ["Abdominal Ultrasound", "No pathology in liver, pancreas, gallbladder", "Excludes other organ disease"], ] lab_table = Table(lab_data, colWidths=[4.5*cm, 5*cm, 6*cm]) lab_table.setStyle(TableStyle([ ("BACKGROUND", (0, 0), (-1, 0), colors.HexColor("#1a3a5c")), ("TEXTCOLOR", (0, 0), (-1, 0), colors.white), ("FONTNAME", (0, 0), (-1, 0), "Helvetica-Bold"), ("FONTSIZE", (0, 0), (-1, -1), 8.5), ("ROWBACKGROUNDS", (0, 1), (-1, -1), [colors.HexColor("#f0f4fa"), colors.white]), ("GRID", (0, 0), (-1, -1), 0.4, colors.HexColor("#aaaaaa")), ("VALIGN", (0, 0), (-1, -1), "TOP"), ("BOTTOMPADDING", (0, 0), (-1, -1), 4), ("TOPPADDING", (0, 0), (-1, -1), 4), ("LEFTPADDING", (0, 0), (-1, -1), 5), ("RIGHTPADDING", (0, 0), (-1, -1), 5), ])) story.append(lab_table) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("3.7 Clinical Diagnosis", heading2_style)) story.append(Paragraph( "<b>Main diagnosis:</b> Chronic active antral gastritis, H. pylori-associated (K29.5). " "Activity: moderate. Complications: erosive changes of the antral mucosa.", body_style )) story.append(Paragraph( "<b>Concomitant:</b> Iron-deficiency anemia, mild. Chronic NSAID use (ibuprofen).", body_style )) story.append(Paragraph("3.8 Treatment Plan", heading2_style)) story.append(Paragraph( "<b>H. pylori Eradication (Standard Triple Therapy – 14 days):</b>", body_style )) story.append(Paragraph("• Omeprazole 20 mg twice daily (before meals)", bullet_style)) story.append(Paragraph("• Amoxicillin 1000 mg twice daily", bullet_style)) story.append(Paragraph("• Clarithromycin 500 mg twice daily", bullet_style)) story.append(Spacer(1, 0.1*cm)) story.append(Paragraph("<b>Additional treatment:</b>", body_style)) story.append(Paragraph("• Continue omeprazole 20 mg once daily for 4 weeks after eradication", bullet_style)) story.append(Paragraph("• Discontinue ibuprofen; switch to paracetamol for pain management", bullet_style)) story.append(Paragraph("• Iron supplementation (Ferrous sulfate 300 mg once daily) for anemia", bullet_style)) story.append(Paragraph("• Dietary modification: small, frequent meals; avoid spicy, fatty food, alcohol, smoking", bullet_style)) story.append(Paragraph("• Confirm eradication: urea breath test 4 weeks after completing antibiotic course", bullet_style)) story.append(Paragraph("• Outcomes: expected resolution of symptoms; follow-up endoscopy if atrophy/metaplasia found", bullet_style)) story.append(Spacer(1, 0.2*cm)) story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#1a3a5c"), spaceAfter=4)) story.append(Paragraph("References", heading1_style)) refs = [ "1. Malfertheiner P, Camargo MC, El-Omar E. Helicobacter pylori infection. Nat Rev Dis Primers. 2023;9(1):19. PMID: 37081005.", "2. Sun Q, Yuan C, Zhou S. Helicobacter pylori infection: a dynamic process from diagnosis to treatment. Front Cell Infect Microbiol. 2023;13:1257817. PMID: 37928189.", "3. Yang H, Hu B. Immunological Perspective: Helicobacter pylori Infection and Gastritis. Mediators Inflamm. 2022;2022:2944156. PMID: 35300405.", "4. Duan M, Li Y, Liu J. Transmission routes and patterns of Helicobacter pylori. Helicobacter. 2023;28(1):e12945. PMID: 36645421.", "5. Gisbert JP. Helicobacter pylori and gastric disease. Med Clin (Barc). 2025;165(1):35–42. PMID: 40409232.", "6. Sleisenger MH, Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Elsevier; 2021.", "7. Kumar V, Abbas AK, Aster JC. Robbins & Kumar Basic Pathology. 11th ed. Elsevier; 2023.", "8. Loscalzo J, Fauci A, Kasper D, et al. Harrison's Principles of Internal Medicine. 22nd ed. McGraw-Hill; 2025.", "9. Yamada T, et al. Yamada's Textbook of Gastroenterology. 7th ed. Wiley; 2022.", "10. Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2021;70(5):918–926.", "11. Sugano K. Effect of Helicobacter pylori eradication on the incidence of gastric cancer: a systematic review and meta-analysis. Gastric Cancer. 2021;24(3):567–579.", "12. European Helicobacter and Microbiota Study Group. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724–1762.", ] for r in refs: story.append(Paragraph(r, ref_style)) story.append(Spacer(1, 0.3*cm)) story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#cccccc"))) story.append(Spacer(1, 0.1*cm)) story.append(Paragraph("Pandit Lalit | Group M-16-1-22-AH | Faculty Therapy | 4th Year | July 2026", footer_style)) # Build PDF doc.build(story) print(f"PDF created: {OUTPUT}") PYEOF

python3 -c " import pdfplumber with pdfplumber.open('/tmp/workspace/gastritis-report/Chronic_Gastritis_Report_Pandit_Lalit.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} preview (first 150 chars) ---') print(text[:150] if text else '(empty)') "

python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, HRFlowable, Table, TableStyle, PageBreak) from reportlab.lib import colors from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY OUTPUT = "/tmp/workspace/gastritis-report/Chronic_Gastritis_Report_Pandit_Lalit.pdf" doc = SimpleDocTemplate( OUTPUT, pagesize=A4, rightMargin=2.2*cm, leftMargin=2.2*cm, topMargin=2.0*cm, bottomMargin=2.0*cm, ) styles = getSampleStyleSheet() title_style = ParagraphStyle("MT", parent=styles["Title"], fontSize=15, fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=4, textColor=colors.HexColor("#1a3a5c")) subtitle_style = ParagraphStyle("Sub", parent=styles["Normal"], fontSize=10, fontName="Helvetica", alignment=TA_CENTER, spaceAfter=3, textColor=colors.HexColor("#444444")) h1 = ParagraphStyle("H1", parent=styles["Heading1"], fontSize=11, fontName="Helvetica-Bold", textColor=colors.HexColor("#1a3a5c"), spaceBefore=8, spaceAfter=3, borderPad=1) h2 = ParagraphStyle("H2", parent=styles["Heading2"], fontSize=10, fontName="Helvetica-Bold", textColor=colors.HexColor("#2e5c8a"), spaceBefore=6, spaceAfter=2) body = ParagraphStyle("Body", parent=styles["Normal"], fontSize=9.5, fontName="Helvetica", leading=13.5, spaceAfter=4, alignment=TA_JUSTIFY, textColor=colors.HexColor("#222222")) bullet = ParagraphStyle("Bul", parent=styles["Normal"], fontSize=9.5, fontName="Helvetica", leading=13, leftIndent=14, spaceAfter=2, textColor=colors.HexColor("#222222")) ref_s = ParagraphStyle("Ref", parent=styles["Normal"], fontSize=8.5, fontName="Helvetica", leading=12, leftIndent=14, firstLineIndent=-14, spaceAfter=3, textColor=colors.HexColor("#333333")) footer_s = ParagraphStyle("Ft", parent=styles["Normal"], fontSize=8.5, fontName="Helvetica-Oblique", alignment=TA_CENTER, textColor=colors.HexColor("#666666")) story = [] # ─────────── PAGE 1: COVER ─────────── story.append(Spacer(1, 1.2*cm)) story.append(Paragraph("Student Research Work (УИР)", subtitle_style)) story.append(Spacer(1, 0.2*cm)) story.append(HRFlowable(width="100%", thickness=1.5, color=colors.HexColor("#1a3a5c"))) story.append(Spacer(1, 0.3*cm)) story.append(Paragraph("CHRONIC GASTRITIS", title_style)) story.append(Paragraph("Etiology, Pathogenesis, Diagnosis and Treatment", subtitle_style)) story.append(Spacer(1, 0.3*cm)) story.append(HRFlowable(width="100%", thickness=1.5, color=colors.HexColor("#1a3a5c"))) story.append(Spacer(1, 1.0*cm)) info_data = [ ["Submitted by:", "Pandit Lalit"], ["Group No.:", "M-16-1-22-AH"], ["Subject:", "Faculty Therapy (Internal Medicine)"], ["Department:", "Department of Internal Medicine"], ["Year:", "4th Year, 2025–2026"], ["Date:", "July 2026"], ] info_table = Table(info_data, colWidths=[4.5*cm, 9.5*cm]) info_table.setStyle(TableStyle([ ("FONTNAME", (0, 0), (0, -1), "Helvetica-Bold"), ("FONTNAME", (1, 0), (1, -1), "Helvetica"), ("FONTSIZE", (0, 0), (-1, -1), 10.5), ("TEXTCOLOR", (0, 0), (0, -1), colors.HexColor("#1a3a5c")), ("ROWBACKGROUNDS", (0, 0), (-1, -1), [colors.HexColor("#eef3fa"), colors.white]), ("BOTTOMPADDING", (0, 0), (-1, -1), 6), ("TOPPADDING", (0, 0), (-1, -1), 6), ("LEFTPADDING", (0, 0), (-1, -1), 8), ("GRID", (0, 0), (-1, -1), 0.3, colors.HexColor("#bbbbbb")), ("BOX", (0, 0), (-1, -1), 1, colors.HexColor("#1a3a5c")), ])) story.append(info_table) story.append(Spacer(1, 1.5*cm)) story.append(Paragraph( "This report presents a student research work on Chronic Gastritis including a literature review, " "a clinical case presentation with diagnostic findings, and a treatment plan based on current clinical guidelines.", ParagraphStyle("cn", parent=body, alignment=TA_CENTER, textColor=colors.HexColor("#555555"), fontSize=9.5))) story.append(PageBreak()) # ─────────── PAGE 2: RELEVANCE + LITERATURE REVIEW ─────────── story.append(Paragraph("1. Relevance of the Topic", h1)) story.append(HRFlowable(width="100%", thickness=0.4, color=colors.HexColor("#1a3a5c"), spaceAfter=4)) story.append(Paragraph( "Chronic gastritis is one of the most widespread gastrointestinal diseases worldwide. " "<b>Helicobacter pylori (H. pylori)</b> infects over 50% of the global population, reaching 70–80% " "in developing countries. In Russia and Eastern Europe prevalence remains high, making it a major " "public health concern. Its significance lies in being a risk factor for peptic ulcer disease, " "gastric adenocarcinoma, and MALT lymphoma. The WHO classifies H. pylori as a Group I carcinogen. " "Early diagnosis and eradication are therefore a cancer-prevention strategy.", body)) story.append(Paragraph("2. Literature Review", h1)) story.append(HRFlowable(width="100%", thickness=0.4, color=colors.HexColor("#1a3a5c"), spaceAfter=4)) story.append(Paragraph("2.1 Definition and Classification", h2)) story.append(Paragraph( "Chronic gastritis is a persistent inflammatory condition of the gastric mucosa with infiltration " "by lymphocytes, plasma cells, and neutrophils (in active disease). Three main types exist: " "(1) <b>Diffuse antral gastritis</b> – H. pylori-associated, most common; " "(2) <b>Environmental metaplastic atrophic gastritis (EMAG)</b> – linked to diet and geography; " "(3) <b>Autoimmune metaplastic atrophic gastritis (AMAG)</b> – autoimmune, spares antrum, <10% of cases.", body)) story.append(Paragraph("2.2 Etiology and Pathogenesis", h2)) story.append(Paragraph( "<b>H. pylori gastritis:</b> H. pylori is a gram-negative, spiral-shaped, flagellated bacterium. " "Virulence factors: (i) Flagella – mobility in mucus; (ii) Urease – raises local pH protecting the bacteria; " "(iii) Adhesins – bind foveolar cells; (iv) Toxins (CagA, CagE) – trigger IL-8 release and sustained " "mucosal inflammation. The infection begins in the antrum, stimulates gastrin and hyperacidity, and " "may spread to the gastric body causing atrophy and intestinal metaplasia (cancer precursor).", body)) story.append(Paragraph( "<b>Autoimmune gastritis:</b> Autoreactive T-cells and antibodies against parietal cells/intrinsic factor " "lead to loss of parietal cell mass, reduced acid and intrinsic factor, vitamin B12 deficiency, and pernicious anemia. " "<b>Other causes:</b> chronic NSAID use, bile reflux, smoking, alcohol.", body)) story.append(Paragraph("2.3 Clinical Features", h2)) story.append(Paragraph( "Symptoms are less acute but more persistent than in acute gastritis: epigastric pain (dull/burning, " "related to meals), nausea, early satiety, belching, bloating, reduced appetite. In autoimmune gastritis: " "fatigue and neurological signs from B12 deficiency. Hematemesis is uncommon in uncomplicated cases.", body)) story.append(Paragraph("2.4 Diagnosis", h2)) story.append(Paragraph( "<b>Upper GI Endoscopy</b> with biopsy is the gold standard: shows erythema, erosions, atrophy, metaplasia. " "<b>Histology (H&E/Giemsa)</b> identifies H. pylori organisms, neutrophil infiltration, and lymphoid aggregates. " "<b>Urea Breath Test (UBT)</b> and <b>Stool Antigen Test</b> are reliable non-invasive options. " "<b>Serology</b> (IgG antibodies) detects exposure but not active infection. " "In autoimmune gastritis: anti-parietal cell and anti-intrinsic factor antibodies; low serum B12/pepsinogen I.", body)) story.append(PageBreak()) # ─────────── PAGE 3: CASE PRESENTATION ─────────── story.append(Paragraph("3. Case Presentation", h1)) story.append(HRFlowable(width="100%", thickness=0.4, color=colors.HexColor("#1a3a5c"), spaceAfter=4)) story.append(Paragraph("Patient Details", h2)) story.append(Paragraph( "Patient K.A., male, 42 years, office worker. Admitted: 15 July 2026. Ward: Gastroenterology.", body)) story.append(Paragraph("Chief Complaints", h2)) story.append(Paragraph( "Dull epigastric pain 30–40 min after meals (1–2 hrs duration); nausea after fatty foods; " "frequent sour belching; bloating; reduced appetite for 3 months; fatigue and ~2 kg weight loss over 2 months.", body)) story.append(Paragraph("History (Anamnesis)", h2)) story.append(Paragraph( "<b>Present illness:</b> Episodic epigastric discomfort for 5 years, no prior endoscopy. " "Takes ibuprofen 2–3x/week for back pain. Irregular diet; frequent fast food. " "Smokes 10 cigarettes/day for 15 years. Moderate alcohol (beer, 2–3x/week). " "No previous GI hospitalizations.", body)) story.append(Paragraph( "<b>Past history:</b> No chronic diseases, no surgery, no drug allergies. " "<b>Family history:</b> Father had peptic ulcer disease.", body)) story.append(Paragraph("Physical Examination", h2)) story.append(Paragraph( "General condition: satisfactory. Skin slightly pale. BP 118/76 mmHg, HR 76/min, Temp 36.6°C. " "Abdomen: soft, mild tenderness on deep palpation in epigastric region. No hepatosplenomegaly. No peritoneal signs.", body)) story.append(Paragraph("Syndromes and Risk Factors", h2)) story.append(Paragraph("<b>Syndromes:</b> Pain syndrome; Dyspeptic syndrome (nausea, belching, bloating); Asthenic syndrome (fatigue, weight loss).", body)) story.append(Paragraph("<b>Risk factors:</b> Chronic NSAID use; suspected H. pylori infection; smoking; irregular diet; moderate alcohol.", body)) story.append(Paragraph("Laboratory and Instrumental Findings", h2)) lab_data = [ ["Test", "Result / Finding"], ["CBC", "Hb 118 g/L – mild microcytic anemia"], ["H. pylori Urea Breath Test", "POSITIVE – active infection confirmed"], ["H. pylori Stool Antigen", "POSITIVE – confirms active infection"], ["Serum Pepsinogen I/II ratio", "Decreased – suggests gastric atrophy"], ["Upper GI Endoscopy", "Erythematous antral mucosa, mucosal edema, erosions"], ["Gastric Biopsy (Histology)", "Lympho-plasmacytic infiltrate + neutrophils; H. pylori on Giemsa stain"], ["Abdominal Ultrasound", "No abnormality in liver, pancreas, gallbladder"], ] lab_table = Table(lab_data, colWidths=[5.5*cm, 10*cm]) lab_table.setStyle(TableStyle([ ("BACKGROUND", (0, 0), (-1, 0), colors.HexColor("#1a3a5c")), ("TEXTCOLOR", (0, 0), (-1, 0), colors.white), ("FONTNAME", (0, 0), (-1, 0), "Helvetica-Bold"), ("FONTSIZE", (0, 0), (-1, -1), 9), ("ROWBACKGROUNDS", (0, 1), (-1, -1), [colors.HexColor("#f0f4fa"), colors.white]), ("GRID", (0, 0), (-1, -1), 0.4, colors.HexColor("#aaaaaa")), ("VALIGN", (0, 0), (-1, -1), "TOP"), ("BOTTOMPADDING", (0, 0), (-1, -1), 4), ("TOPPADDING", (0, 0), (-1, -1), 4), ("LEFTPADDING", (0, 0), (-1, -1), 5), ])) story.append(lab_table) story.append(Paragraph("Clinical Diagnosis", h2)) story.append(Paragraph( "<b>Main:</b> Chronic active antral gastritis, H. pylori-associated (ICD-10: K29.5). " "Activity: moderate. Complication: erosive changes of antral mucosa.<br/>" "<b>Concomitant:</b> Iron-deficiency anemia, mild. Chronic NSAID use.", body)) story.append(PageBreak()) # ─────────── PAGE 4: TREATMENT + REFERENCES ─────────── story.append(Paragraph("3.9 Treatment Plan", h1)) story.append(HRFlowable(width="100%", thickness=0.4, color=colors.HexColor("#1a3a5c"), spaceAfter=4)) story.append(Paragraph("<b>H. pylori Eradication – Standard Triple Therapy (14 days):</b>", body)) story.append(Paragraph("• Omeprazole 20 mg twice daily (before meals)", bullet)) story.append(Paragraph("• Amoxicillin 1000 mg twice daily", bullet)) story.append(Paragraph("• Clarithromycin 500 mg twice daily", bullet)) story.append(Paragraph("<b>Additional therapy:</b>", body)) story.append(Paragraph("• Omeprazole 20 mg once daily for 4 weeks post-eradication (mucosal healing)", bullet)) story.append(Paragraph("• Discontinue ibuprofen; replace with paracetamol", bullet)) story.append(Paragraph("• Ferrous sulfate 300 mg once daily for iron-deficiency anemia", bullet)) story.append(Paragraph("• Diet: small frequent meals; avoid spicy/fatty food, alcohol, smoking cessation", bullet)) story.append(Paragraph("• Confirm eradication: urea breath test 4–6 weeks after completing antibiotics", bullet)) story.append(Spacer(1, 0.1*cm)) story.append(Paragraph( "<b>Expected outcomes:</b> Symptom relief within 2–4 weeks; mucosal healing confirmed on follow-up. " "Surveillance endoscopy in 3 years if atrophy or intestinal metaplasia is present.", body)) story.append(Spacer(1, 0.3*cm)) story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#1a3a5c"), spaceAfter=4)) story.append(Paragraph("References", h1)) refs = [ "1. Malfertheiner P, Camargo MC, El-Omar E. Helicobacter pylori infection. Nat Rev Dis Primers. 2023;9(1):19. PMID: 37081005.", "2. Sun Q, Yuan C, Zhou S. H. pylori infection: diagnosis to treatment. Front Cell Infect Microbiol. 2023;13:1257817. PMID: 37928189.", "3. Yang H, Hu B. Immunological perspective: H. pylori and gastritis. Mediators Inflamm. 2022;2022:2944156. PMID: 35300405.", "4. Duan M, Li Y, Liu J. Transmission routes and patterns of H. pylori. Helicobacter. 2023;28(1):e12945. PMID: 36645421.", "5. Gisbert JP. Helicobacter pylori and gastric disease. Med Clin (Barc). 2025;165(1):35–42. PMID: 40409232.", "6. Sleisenger MH, et al. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Elsevier; 2021.", "7. Kumar V, Abbas AK, Aster JC. Robbins & Kumar Basic Pathology. 11th ed. Elsevier; 2023.", "8. Loscalzo J, et al. Harrison's Principles of Internal Medicine. 22nd ed. McGraw-Hill; 2025.", "9. Yamada T, et al. Yamada's Textbook of Gastroenterology. 7th ed. Wiley; 2022.", "10. Sugano K, et al. Kyoto global consensus report on H. pylori gastritis. Gut. 2021;70(5):918–926.", "11. Sugano K. H. pylori eradication and incidence of gastric cancer. Gastric Cancer. 2021;24(3):567–579.", "12. European Helicobacter and Microbiota Study Group. Maastricht VI/Florence consensus. Gut. 2022;71(9):1724–1762.", ] for r in refs: story.append(Paragraph(r, ref_s)) story.append(Spacer(1, 0.2*cm)) story.append(HRFlowable(width="100%", thickness=0.4, color=colors.HexColor("#bbbbbb"))) story.append(Spacer(1, 0.1*cm)) story.append(Paragraph("Pandit Lalit | Group M-16-1-22-AH | Faculty Therapy | 4th Year | July 2026", footer_s)) doc.build(story) print("Done") # Check pages import pdfplumber with pdfplumber.open(OUTPUT) as pdf: print(f"Pages: {len(pdf.pages)}") PYEOF

python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, HRFlowable, Table, TableStyle, PageBreak) from reportlab.lib import colors from reportlab.lib.enums import TA_CENTER, TA_JUSTIFY OUTPUT = "/tmp/workspace/gastritis-report/Chronic_Gastritis_Report_Pandit_Lalit.pdf" doc = SimpleDocTemplate( OUTPUT, pagesize=A4, rightMargin=2.2*cm, leftMargin=2.2*cm, topMargin=2.0*cm, bottomMargin=2.0*cm, ) styles = getSampleStyleSheet() title_s = ParagraphStyle("MT", parent=styles["Title"], fontSize=15, fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=4, textColor=colors.HexColor("#1a3a5c")) sub_s = ParagraphStyle("Sub", parent=styles["Normal"], fontSize=10, fontName="Helvetica", alignment=TA_CENTER, spaceAfter=3, textColor=colors.HexColor("#444444")) h1 = ParagraphStyle("H1", parent=styles["Heading1"], fontSize=11, fontName="Helvetica-Bold", textColor=colors.HexColor("#1a3a5c"), spaceBefore=8, spaceAfter=3) h2 = ParagraphStyle("H2", parent=styles["Heading2"], fontSize=10, fontName="Helvetica-Bold", textColor=colors.HexColor("#2e5c8a"), spaceBefore=6, spaceAfter=2) body = ParagraphStyle("Bd", parent=styles["Normal"], fontSize=9.5, fontName="Helvetica", leading=13.5, spaceAfter=4, alignment=TA_JUSTIFY, textColor=colors.HexColor("#222222")) bul = ParagraphStyle("Bl", parent=styles["Normal"], fontSize=9.5, fontName="Helvetica", leading=13, leftIndent=14, spaceAfter=2, textColor=colors.HexColor("#222222")) ref_s = ParagraphStyle("Rf", parent=styles["Normal"], fontSize=8.5, fontName="Helvetica", leading=12, leftIndent=14, firstLineIndent=-14, spaceAfter=3, textColor=colors.HexColor("#333333")) foot_s = ParagraphStyle("Ft", parent=styles["Normal"], fontSize=8.5, fontName="Helvetica-Oblique", alignment=TA_CENTER, textColor=colors.HexColor("#666666")) def hr(): return HRFlowable(width="100%", thickness=0.4, color=colors.HexColor("#1a3a5c"), spaceAfter=4) story = [] # ══════════════════════════════════════ # PAGE 1 – COVER # ══════════════════════════════════════ story.append(Spacer(1, 1.2*cm)) story.append(Paragraph("Student Research Work (UIR)", sub_s)) story.append(Spacer(1, 0.2*cm)) story.append(HRFlowable(width="100%", thickness=1.5, color=colors.HexColor("#1a3a5c"))) story.append(Spacer(1, 0.3*cm)) story.append(Paragraph("CHRONIC GASTRITIS", title_s)) story.append(Paragraph( "Etiology, Pathogenesis, Diagnosis and Treatment", sub_s)) story.append(Spacer(1, 0.3*cm)) story.append(HRFlowable(width="100%", thickness=1.5, color=colors.HexColor("#1a3a5c"))) story.append(Spacer(1, 1.0*cm)) info = [ ["Submitted by:", "Pandit Lalit"], ["Group No.:", "M-16-1-22-AH"], ["Subject:", "Faculty Therapy (Internal Medicine)"], ["Department:", "Department of Internal Medicine"], ["Year:", "4th Year, 2025-2026"], ["Date:", "July 2026"], ] it = Table(info, colWidths=[4.5*cm, 9.5*cm]) it.setStyle(TableStyle([ ("FONTNAME", (0,0),(0,-1), "Helvetica-Bold"), ("FONTNAME", (1,0),(1,-1), "Helvetica"), ("FONTSIZE", (0,0),(-1,-1), 10.5), ("TEXTCOLOR", (0,0),(0,-1), colors.HexColor("#1a3a5c")), ("ROWBACKGROUNDS",(0,0),(-1,-1), [colors.HexColor("#eef3fa"), colors.white]), ("BOTTOMPADDING",(0,0),(-1,-1), 6), ("TOPPADDING", (0,0),(-1,-1), 6), ("LEFTPADDING", (0,0),(-1,-1), 8), ("GRID",(0,0),(-1,-1), 0.3, colors.HexColor("#bbbbbb")), ("BOX", (0,0),(-1,-1), 1, colors.HexColor("#1a3a5c")), ])) story.append(it) story.append(Spacer(1, 1.5*cm)) story.append(Paragraph( "This report presents a student research work on Chronic Gastritis including a " "literature review and a clinical case of a Russian patient with diagnostic " "findings and a treatment plan based on current clinical guidelines.", ParagraphStyle("cn", parent=body, alignment=TA_CENTER, textColor=colors.HexColor("#555555"), fontSize=9.5))) story.append(PageBreak()) # ══════════════════════════════════════ # PAGE 2 – RELEVANCE + LITERATURE REVIEW # ══════════════════════════════════════ story.append(Paragraph("1. Relevance of the Topic", h1)) story.append(hr()) story.append(Paragraph( "Chronic gastritis is among the most common diseases of the gastrointestinal " "tract worldwide. <b>Helicobacter pylori (H. pylori)</b> infects more than 50% " "of the global population; in developing countries and in Russia this reaches " "60-70%. In Russia, H. pylori-associated gastritis is especially prevalent due " "to historically lower sanitation standards and high population density. " "The disease is important because it is a recognised risk factor for peptic " "ulcer disease, gastric adenocarcinoma, and MALT lymphoma. " "The WHO classifies H. pylori as a Group I (definite) carcinogen, making " "early detection and eradication a cancer-prevention priority.", body)) story.append(Paragraph("2. Literature Review", h1)) story.append(hr()) story.append(Paragraph("2.1 Definition and Classification", h2)) story.append(Paragraph( "Chronic gastritis is a persistent inflammatory condition of the gastric mucosa " "with infiltration by lymphocytes, plasma cells, and (in active disease) " "neutrophils. Three main types: " "(1) <b>Diffuse antral gastritis</b> - H. pylori-associated, most common; " "(2) <b>Environmental metaplastic atrophic gastritis (EMAG)</b> - dietary and " "geographic factors; " "(3) <b>Autoimmune metaplastic atrophic gastritis (AMAG)</b> - autoimmune, " "spares antrum, less than 10% of cases.", body)) story.append(Paragraph("2.2 Etiology and Pathogenesis", h2)) story.append(Paragraph( "<b>H. pylori gastritis:</b> H. pylori is a gram-negative spiral flagellated " "bacterium. Virulence factors: flagella (motility), urease (raises local pH), " "adhesins (mucosal binding), and toxins CagA/CagE (stimulate IL-8, trigger " "persistent neutrophilic and lymphocytic inflammation). The organism colonises " "the antrum first, stimulates gastrin release and hyperacidity, and over time " "may spread to the gastric body causing atrophy and intestinal metaplasia, " "a recognised precursor of gastric adenocarcinoma.", body)) story.append(Paragraph( "<b>Autoimmune gastritis:</b> Autoreactive T-cells and autoantibodies against " "parietal cells and intrinsic factor lead to gastric atrophy, achlorhydria, " "vitamin B12 deficiency, and pernicious anemia. " "<b>Other causes:</b> chronic NSAID use, bile reflux, smoking, alcohol.", body)) story.append(Paragraph("2.3 Clinical Features", h2)) story.append(Paragraph( "Symptoms are less acute but more persistent than in acute gastritis: " "dull or burning epigastric pain related to meals, nausea, early satiety, " "belching, bloating, and loss of appetite. In autoimmune gastritis fatigue " "and neurological features from B12 deficiency may occur. " "Hematemesis is uncommon in uncomplicated chronic gastritis.", body)) story.append(Paragraph("2.4 Diagnosis", h2)) story.append(Paragraph( "<b>Upper GI endoscopy with biopsy</b> is the gold standard - reveals " "erythema, erosions, atrophy, and metaplasia; antral biopsy preferred for " "H. pylori detection. <b>Histology (H&amp;E / Giemsa stain)</b> shows the " "organisms and inflammatory infiltrate. <b>Urea breath test (UBT)</b> and " "<b>stool antigen test</b> are reliable non-invasive options. " "<b>Serology</b> (IgG) detects prior exposure only. In autoimmune gastritis: " "anti-parietal cell and anti-intrinsic factor antibodies, low serum B12 and " "reduced pepsinogen I levels.", body)) story.append(PageBreak()) # ══════════════════════════════════════ # PAGE 3 – CLINICAL CASE (RUSSIAN PATIENT) # ══════════════════════════════════════ story.append(Paragraph("3. Clinical Case", h1)) story.append(hr()) # --- Patient details table --- story.append(Paragraph("3.1 Patient Details", h2)) pt = [ ["Full name:", "Ivanov Sergei Nikolaevich"], ["Date of birth:", "14 March 1981 (age: 45 years)"], ["Gender:", "Male"], ["Occupation:", "Driver (long-distance truck driver)"], ["Place of residence:", "Moscow, Russia"], ["Date of admission:", "15 July 2026"], ["Ward:", "Gastroenterology, City Clinical Hospital No. 15, Moscow"], ] ptt = Table(pt, colWidths=[4.5*cm, 11*cm]) ptt.setStyle(TableStyle([ ("FONTNAME", (0,0),(0,-1), "Helvetica-Bold"), ("FONTSIZE", (0,0),(-1,-1), 9.5), ("TEXTCOLOR", (0,0),(0,-1), colors.HexColor("#1a3a5c")), ("ROWBACKGROUNDS",(0,0),(-1,-1), [colors.HexColor("#f0f4fa"), colors.white]), ("BOTTOMPADDING",(0,0),(-1,-1), 4), ("TOPPADDING", (0,0),(-1,-1), 4), ("LEFTPADDING", (0,0),(-1,-1), 6), ("GRID",(0,0),(-1,-1), 0.3, colors.HexColor("#cccccc")), ])) story.append(ptt) story.append(Spacer(1, 0.15*cm)) story.append(Paragraph("3.2 Chief Complaints (Zhalobы)", h2)) story.append(Paragraph( "The patient reports: (1) dull, aching pain in the epigastric region " "occurring 40-60 minutes after meals and lasting 1-2 hours; (2) nausea " "after eating, especially after fatty or fried food; (3) frequent sour " "belching; (4) sensation of heaviness and fullness after small meals; " "(5) decreased appetite for the past 3-4 months; " "(6) general weakness and fatigue; (7) weight loss of approximately " "3 kg over the past 2 months.", body)) story.append(Paragraph("3.3 History of Present Illness (Anamnez zabolevaniya)", h2)) story.append(Paragraph( "Considers himself ill for approximately 6 years. " "Epigastric discomfort first appeared in 2019 but was dismissed as stress-related. " "Symptoms worsened over the past 4 months. " "Has never undergone gastroscopy. Self-medicated with antacids (Rennie, Maalox) " "with temporary relief. Frequently takes Diclofenac (intramuscularly, 2-3 times " "per week) for chronic lumbar pain from prolonged sitting at work. " "Diet is highly irregular: skips breakfast, eats large meals late in the evening, " "frequent fast food and smoked/salted fish (traditional Russian diet habits). " "Smokes 15 cigarettes per day for 20 years. " "Drinks vodka at weekends (approximately 150-200 ml, 2 times per week). " "No previous hospitalizations for gastrointestinal complaints.", body)) story.append(Paragraph("3.4 Past Medical History (Anamnez zhizni)", h2)) story.append(Paragraph( "<b>Chronic diseases:</b> Lumbar osteochondrosis (diagnosed 2017). " "<b>Previous surgeries:</b> Appendectomy (2005). " "<b>Allergies:</b> No known drug allergies. " "<b>Family history:</b> Father suffered from peptic ulcer disease and " "was treated with eradication therapy. Paternal grandfather died from " "gastric cancer at age 68.", body)) story.append(Paragraph("3.5 Physical Examination (Ob'ektivno)", h2)) story.append(Paragraph( "General condition: satisfactory. Consciousness: clear. Position: active. " "Nutritional status: slightly reduced (BMI 21.8 kg/m2). Skin: pale, dry. " "Peripheral lymph nodes: not enlarged. " "Lungs: vesicular breathing, no wheeze. Heart sounds: clear, rhythmic. " "<b>BP 122/78 mmHg, HR 74 bpm, RR 16/min, Temperature 36.6 degrees C.</b> " "Tongue: coated with white-grey film. " "Abdomen: flat, participates in breathing, soft on palpation. " "<b>Moderate tenderness on deep palpation in the epigastric region and " "in the projection of the pylorus.</b> " "Liver and spleen: not enlarged, painless. No peritoneal signs.", body)) story.append(PageBreak()) # ══════════════════════════════════════ # PAGE 4 – FINDINGS, DIAGNOSIS, TREATMENT, REFERENCES # ══════════════════════════════════════ story.append(Paragraph("3.6 Syndromes and Risk Factors", h2)) story.append(Paragraph( "<b>Main clinical syndromes:</b> " "Pain syndrome (epigastric, meal-related); " "Dyspeptic syndrome (nausea, sour belching, heaviness, bloating); " "Asthenic syndrome (weakness, weight loss, fatigue).", body)) story.append(Paragraph( "<b>Etiological and predisposing risk factors:</b> " "Suspected H. pylori infection (positive family history of PUD and gastric cancer); " "chronic NSAID/Diclofenac use (direct mucosal damage); " "heavy smoking (impairs mucosal blood flow); " "irregular diet with large evening meals and smoked/salted foods; " "regular alcohol consumption; occupational stress.", body)) story.append(Paragraph("3.7 Laboratory and Instrumental Investigations", h2)) lab = [ ["Investigation", "Result", "Interpretation"], ["CBC", "Hb 112 g/L, MCV 74 fL, RBC low", "Microcytic (iron-deficiency) anemia"], ["Biochemistry", "ALT, AST, bilirubin, creatinine - within normal limits", "No liver/kidney pathology"], ["H. pylori Urea Breath Test", "POSITIVE", "Active H. pylori infection confirmed"], ["H. pylori Stool Antigen", "POSITIVE", "Active infection, consistent with UBT"], ["Serum Pepsinogen I/II ratio","Decreased (ratio < 3)", "Indicates gastric mucosal atrophy"], ["Serum iron / ferritin", "Low: iron 7.2 umol/L, ferritin 8 ng/mL", "Iron deficiency confirmed"], ["EGDS (Gastroscopy)", "Antral mucosa: hyperemic, edematous, multiple superficial erosions (0.3-0.5 cm). Pylorus competent. Duodenum - no changes.", "Chronic erosive antral gastritis"], ["Gastric biopsy (Histology)", "Dense lympho-plasmacytic and neutrophilic infiltrate of lamina propria; H. pylori on Giemsa stain; no dysplasia or metaplasia", "H. pylori chronic active gastritis, moderate activity"], ["Abdominal ultrasound", "Liver, pancreas, gallbladder, kidneys - no pathology", "Excludes concurrent disease"], ] lt = Table(lab, colWidths=[4.5*cm, 6*cm, 5.0*cm]) lt.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,0), colors.HexColor("#1a3a5c")), ("TEXTCOLOR", (0,0),(-1,0), colors.white), ("FONTNAME", (0,0),(-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0),(-1,-1), 8.5), ("ROWBACKGROUNDS",(0,1),(-1,-1), [colors.HexColor("#f0f4fa"), colors.white]), ("GRID", (0,0),(-1,-1), 0.4, colors.HexColor("#aaaaaa")), ("VALIGN",(0,0),(-1,-1), "TOP"), ("BOTTOMPADDING",(0,0),(-1,-1), 4), ("TOPPADDING", (0,0),(-1,-1), 4), ("LEFTPADDING", (0,0),(-1,-1), 5), ])) story.append(lt) story.append(Spacer(1, 0.15*cm)) story.append(Paragraph("3.8 Clinical Diagnosis", h2)) story.append(Paragraph( "<b>Main diagnosis:</b> Chronic active erosive antral gastritis, " "H. pylori-associated (ICD-10: K29.5). Activity: moderate. " "Phase: exacerbation.", body)) story.append(Paragraph( "<b>Complications:</b> Superficial erosions of the antral mucosa.", body)) story.append(Paragraph( "<b>Concomitant diagnoses:</b> Iron-deficiency anemia, mild degree. " "Chronic NSAID (Diclofenac) intake. Lumbar osteochondrosis.", body)) story.append(Paragraph("3.9 Treatment Plan", h2)) story.append(Paragraph( "<b>1. H. pylori Eradication - Standard Triple Therapy (14 days, per " "Maastricht VI/Florence 2022 and Russian gastroenterology guidelines):</b>", body)) story.append(Paragraph( "Omeprazole 20 mg x 2/day (before meals) + " "Amoxicillin 1000 mg x 2/day + Clarithromycin 500 mg x 2/day", bul)) story.append(Paragraph("<b>2. Continuation therapy (4 weeks post-eradication):</b>", body)) story.append(Paragraph("Omeprazole 20 mg x 1/day (morning, before meals) - mucosal healing", bul)) story.append(Paragraph("<b>3. Treatment of iron-deficiency anemia:</b>", body)) story.append(Paragraph( "Ferrous sulfate 300 mg x 1/day with vitamin C; recheck CBC after 4 weeks", bul)) story.append(Paragraph("<b>4. NSAID management:</b>", body)) story.append(Paragraph( "Discontinue Diclofenac; switch to Paracetamol 500 mg as needed for lumbar pain", bul)) story.append(Paragraph("<b>5. Lifestyle modifications:</b>", body)) story.append(Paragraph( "Regular meals (4-5 small meals/day); avoid smoked, fried, spicy food; " "stop smoking; stop alcohol; reduce stress", bul)) story.append(Paragraph("<b>6. Follow-up:</b>", body)) story.append(Paragraph( "Urea breath test 4-6 weeks after completing antibiotics to confirm eradication. " "Control EGDS in 3 months. If atrophy/metaplasia: surveillance endoscopy every 3 years.", bul)) story.append(Spacer(1, 0.2*cm)) story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#1a3a5c"), spaceAfter=4)) story.append(Paragraph("References", h1)) refs = [ "1. Malfertheiner P, Camargo MC, El-Omar E. Helicobacter pylori infection. Nat Rev Dis Primers. 2023;9(1):19. PMID: 37081005.", "2. Sun Q, Yuan C, Zhou S. H. pylori infection: from diagnosis to treatment. Front Cell Infect Microbiol. 2023;13:1257817. PMID: 37928189.", "3. Yang H, Hu B. Immunological perspective: H. pylori and gastritis. Mediators Inflamm. 2022;2022:2944156. PMID: 35300405.", "4. Duan M, Li Y, Liu J. Transmission routes and patterns of H. pylori. Helicobacter. 2023;28(1):e12945. PMID: 36645421.", "5. Gisbert JP. Helicobacter pylori and gastric disease. Med Clin (Barc). 2025;165(1):35-42. PMID: 40409232.", "6. European Helicobacter and Microbiota Study Group. Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724-1762.", "7. Sugano K, et al. Kyoto global consensus report on H. pylori gastritis. Gut. 2021;70(5):918-926.", "8. Kumar V, Abbas AK, Aster JC. Robbins & Kumar Basic Pathology. 11th ed. Elsevier; 2023.", "9. Loscalzo J, et al. Harrison's Principles of Internal Medicine. 22nd ed. McGraw-Hill; 2025.", "10. Yamada T, et al. Yamada's Textbook of Gastroenterology. 7th ed. Wiley; 2022.", "11. Sugano K. H. pylori eradication and incidence of gastric cancer. Gastric Cancer. 2021;24(3):567-579.", "12. Sleisenger MH, et al. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Elsevier; 2021.", ] for r in refs: story.append(Paragraph(r, ref_s)) story.append(Spacer(1, 0.2*cm)) story.append(HRFlowable(width="100%", thickness=0.4, color=colors.HexColor("#bbbbbb"))) story.append(Spacer(1, 0.1*cm)) story.append(Paragraph( "Pandit Lalit | Group M-16-1-22-AH | Faculty Therapy | 4th Year | July 2026", foot_s)) doc.build(story) print("PDF built successfully.") import pdfplumber with pdfplumber.open(OUTPUT) as pdf: print(f"Total pages: {len(pdf.pages)}") for i, pg in enumerate(pdf.pages): t = pg.extract_text() or "" print(f" Page {i+1}: {t[:80].strip()}") PYEOF

python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, HRFlowable, Table, TableStyle, PageBreak) from reportlab.lib import colors from reportlab.lib.enums import TA_CENTER, TA_JUSTIFY OUTPUT = "/tmp/workspace/gastritis-report/Chronic_Gastritis_Report_Pandit_Lalit.pdf" doc = SimpleDocTemplate( OUTPUT, pagesize=A4, rightMargin=2.0*cm, leftMargin=2.0*cm, topMargin=1.8*cm, bottomMargin=1.8*cm, ) W = A4[0] - 4.0*cm # usable width ~15.5 cm styles = getSampleStyleSheet() def ps(name, **kw): base = kw.pop("parent", styles["Normal"]) return ParagraphStyle(name, parent=base, **kw) title_s = ps("MT", parent=styles["Title"], fontSize=14, fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=3, textColor=colors.HexColor("#1a3a5c")) sub_s = ps("Sub", fontSize=9.5, fontName="Helvetica", alignment=TA_CENTER, spaceAfter=2, textColor=colors.HexColor("#444444")) h1 = ps("H1", parent=styles["Heading1"], fontSize=11, fontName="Helvetica-Bold", textColor=colors.HexColor("#1a3a5c"), spaceBefore=7, spaceAfter=2) h2 = ps("H2", parent=styles["Heading2"], fontSize=10, fontName="Helvetica-Bold", textColor=colors.HexColor("#2e5c8a"), spaceBefore=5, spaceAfter=1) body = ps("Bd", fontSize=9, fontName="Helvetica", leading=12.5, spaceAfter=3, alignment=TA_JUSTIFY, textColor=colors.HexColor("#222222")) bul = ps("Bl", fontSize=9, fontName="Helvetica", leading=12, leftIndent=12, spaceAfter=2, textColor=colors.HexColor("#222222")) ref_s = ps("Rf", fontSize=8, fontName="Helvetica", leading=11, leftIndent=12, firstLineIndent=-12, spaceAfter=2, textColor=colors.HexColor("#333333")) foot_s = ps("Ft", fontSize=8, fontName="Helvetica-Oblique", alignment=TA_CENTER, textColor=colors.HexColor("#666666")) def hr(sp=4): return HRFlowable(width="100%", thickness=0.4, color=colors.HexColor("#1a3a5c"), spaceAfter=sp) story = [] # ══════════════════ PAGE 1 – COVER ══════════════════ story += [Spacer(1, 1.0*cm), Paragraph("Student Research Work (UIR)", sub_s), Spacer(1, 0.15*cm), HRFlowable(width="100%", thickness=1.5, color=colors.HexColor("#1a3a5c")), Spacer(1, 0.25*cm), Paragraph("CHRONIC GASTRITIS", title_s), Paragraph("Etiology, Pathogenesis, Diagnosis and Treatment", sub_s), Spacer(1, 0.25*cm), HRFlowable(width="100%", thickness=1.5, color=colors.HexColor("#1a3a5c")), Spacer(1, 0.9*cm)] info = [["Submitted by:", "Pandit Lalit"], ["Group No.:", "M-16-1-22-AH"], ["Subject:", "Faculty Therapy (Internal Medicine)"], ["Department:", "Department of Internal Medicine"], ["Year:", "4th Year, 2025-2026"], ["Date:", "July 2026"]] it = Table(info, colWidths=[4.2*cm, 11.3*cm]) it.setStyle(TableStyle([ ("FONTNAME", (0,0),(0,-1),"Helvetica-Bold"), ("FONTSIZE", (0,0),(-1,-1), 10.5), ("TEXTCOLOR", (0,0),(0,-1), colors.HexColor("#1a3a5c")), ("ROWBACKGROUNDS",(0,0),(-1,-1),[colors.HexColor("#eef3fa"),colors.white]), ("BOTTOMPADDING",(0,0),(-1,-1),6),("TOPPADDING",(0,0),(-1,-1),6), ("LEFTPADDING",(0,0),(-1,-1),8), ("GRID",(0,0),(-1,-1),0.3,colors.HexColor("#bbbbbb")), ("BOX",(0,0),(-1,-1),1,colors.HexColor("#1a3a5c")), ])) story += [it, Spacer(1,1.2*cm), Paragraph( "This report presents a student research work on Chronic Gastritis " "including a literature review and a full clinical case of a Russian " "patient with diagnostic findings and a treatment plan.", ps("cn",fontSize=9.5,fontName="Helvetica",alignment=TA_CENTER, textColor=colors.HexColor("#555555"))), PageBreak()] # ══════════════════ PAGE 2 – RELEVANCE + LIT REVIEW ══════════════════ story += [Paragraph("1. Relevance of the Topic", h1), hr()] story.append(Paragraph( "Chronic gastritis is one of the most prevalent gastrointestinal diseases globally. " "<b>H. pylori</b> infects over 50% of the world's population; in Russia prevalence " "reaches 60-70%, driven by historically lower sanitation standards and dense urban " "living. Its clinical significance stems from being a recognised precursor of " "peptic ulcer disease, gastric adenocarcinoma, and MALT lymphoma. " "The WHO classifies H. pylori as a Group I (definite) carcinogen, making " "timely eradication a cancer-prevention priority.", body)) story += [Paragraph("2. Literature Review", h1), hr(), Paragraph("2.1 Definition and Classification", h2)] story.append(Paragraph( "Chronic gastritis is a persistent inflammatory condition of the gastric mucosa " "with infiltration by lymphocytes, plasma cells, and (in active phases) neutrophils. " "Types: (1) <b>Diffuse antral gastritis</b> - H. pylori-associated, most common; " "(2) <b>EMAG</b> - environmental metaplastic atrophic gastritis (dietary/geographic); " "(3) <b>AMAG</b> - autoimmune metaplastic atrophic gastritis (&lt;10% of cases).", body)) story.append(Paragraph("2.2 Etiology and Pathogenesis", h2)) story.append(Paragraph( "<b>H. pylori:</b> gram-negative spiral bacterium. Virulence: flagella (motility), " "urease (raises local pH), adhesins (mucosal binding), toxins CagA/CagE (trigger " "IL-8 and sustained inflammation). Colonises antrum first, stimulates gastrin and " "hyperacidity; may spread to gastric body causing atrophy and intestinal metaplasia " "(cancer precursor). <b>Autoimmune gastritis:</b> autoreactive T-cells destroy " "parietal cells; leads to achlorhydria, B12 deficiency, pernicious anemia. " "<b>Other factors:</b> chronic NSAID use, bile reflux, smoking, alcohol.", body)) story.append(Paragraph("2.3 Clinical Features", h2)) story.append(Paragraph( "Dull or burning epigastric pain (meal-related), nausea, early satiety, sour " "belching, bloating, reduced appetite. In autoimmune form: fatigue and " "neurological symptoms from B12 deficiency. Hematemesis is uncommon.", body)) story.append(Paragraph("2.4 Diagnosis", h2)) story.append(Paragraph( "<b>Upper GI endoscopy (EGDS) with biopsy</b> is the gold standard: erythema, " "erosions, atrophy, metaplasia visible; antral biopsy preferred for H. pylori. " "<b>Histology (H&amp;E/Giemsa):</b> detects organisms and infiltrate. " "<b>Urea breath test (UBT)</b> and <b>stool antigen test</b> are non-invasive " "and reliable. <b>Serology</b> (IgG): exposure only, not active infection. " "In AMAG: anti-parietal cell/intrinsic factor antibodies, low serum B12, " "low pepsinogen I.", body)) story.append(PageBreak()) # ══════════════════ PAGE 3 – CLINICAL CASE ══════════════════ story += [Paragraph("3. Clinical Case – Russian Patient", h1), hr()] story.append(Paragraph("3.1 Patient Details", h2)) pt = [["Full name:", "Ivanov Sergei Nikolaevich"], ["Date of birth:", "14 March 1981 (age 45 years)"], ["Gender:", "Male"], ["Occupation:", "Long-distance truck driver"], ["Residence:", "Moscow, Russia"], ["Admitted:", "15 July 2026 | Gastroenterology Ward, City Clinical Hospital No. 15, Moscow"]] ptt = Table(pt, colWidths=[3.8*cm, 11.7*cm]) ptt.setStyle(TableStyle([ ("FONTNAME",(0,0),(0,-1),"Helvetica-Bold"),("FONTSIZE",(0,0),(-1,-1),9), ("TEXTCOLOR",(0,0),(0,-1),colors.HexColor("#1a3a5c")), ("ROWBACKGROUNDS",(0,0),(-1,-1),[colors.HexColor("#f0f4fa"),colors.white]), ("BOTTOMPADDING",(0,0),(-1,-1),3),("TOPPADDING",(0,0),(-1,-1),3), ("LEFTPADDING",(0,0),(-1,-1),5), ("GRID",(0,0),(-1,-1),0.3,colors.HexColor("#cccccc")), ])) story += [ptt, Spacer(1,0.1*cm)] story.append(Paragraph("3.2 Chief Complaints", h2)) story.append(Paragraph( "Dull epigastric pain 40-60 min after meals (1-2 hrs duration); " "nausea especially after fatty/fried food; frequent sour belching; " "heaviness and fullness after small meals; decreased appetite x3 months; " "general weakness and fatigue; weight loss ~3 kg over 2 months.", body)) story.append(Paragraph("3.3 History of Present Illness", h2)) story.append(Paragraph( "Considers himself ill for ~6 years (first symptoms 2019, attributed to stress). " "Worsening for 4 months. Never had gastroscopy. Self-medicated with " "antacids (Rennie, Maalox) - temporary relief. Takes Diclofenac IM 2-3x/week " "for chronic lumbar pain. Diet: skips breakfast, large evening meals, frequent " "fast food, smoked/salted fish. Smokes 15 cigarettes/day x20 years. " "Drinks vodka ~150-200 ml 2x/week. No prior GI hospitalisations.", body)) story.append(Paragraph("3.4 Past Medical and Family History", h2)) story.append(Paragraph( "<b>Chronic diseases:</b> Lumbar osteochondrosis (2017). " "<b>Surgery:</b> Appendectomy (2005). <b>Allergies:</b> None. " "<b>Family history:</b> Father had peptic ulcer disease (H. pylori eradication therapy). " "Paternal grandfather died of gastric cancer at age 68.", body)) story.append(Paragraph("3.5 Physical Examination", h2)) story.append(Paragraph( "Condition: satisfactory. Conscious. BMI 21.8. Skin pale, dry. " "BP 122/78 mmHg | HR 74 bpm | RR 16/min | T 36.6 C. " "Tongue: coated with white-grey film. " "Abdomen: soft. <b>Moderate tenderness on deep palpation in epigastric " "region and pyloric projection.</b> No hepatosplenomegaly. No peritoneal signs.", body)) story.append(Paragraph("3.6 Syndromes and Risk Factors", h2)) story.append(Paragraph( "<b>Syndromes:</b> Pain syndrome; Dyspeptic syndrome (nausea, belching, bloating, heaviness); " "Asthenic syndrome (weakness, weight loss). " "<b>Risk factors:</b> H. pylori infection (positive family history of PUD and gastric cancer); " "chronic NSAID (Diclofenac) use; smoking 15 cig/day x20 yrs; " "irregular diet with smoked/fried foods; alcohol; occupational stress.", body)) story.append(PageBreak()) # ══════════════════ PAGE 4 – FINDINGS, DIAGNOSIS, TREATMENT, REFS ══════════════════ story.append(Paragraph("3.7 Laboratory and Instrumental Investigations", h2)) lab = [ ["Investigation", "Result / Finding", "Interpretation"], ["CBC", "Hb 112 g/L, MCV 74 fL", "Microcytic (iron-deficiency) anemia"], ["Biochemistry (ALT/AST/Bili/Creat)", "All within normal limits","No liver or kidney pathology"], ["Serum iron / ferritin", "Iron 7.2 umol/L, ferritin 8 ng/mL", "Iron deficiency confirmed"], ["H. pylori Urea Breath Test", "POSITIVE", "Active H. pylori infection"], ["H. pylori Stool Antigen", "POSITIVE", "Consistent with UBT result"], ["Serum Pepsinogen I/II ratio","Decreased (ratio < 3)", "Indicates mucosal atrophy"], ["EGDS (Gastroscopy)", "Antral mucosa: hyperemic, edematous, multiple erosions 0.3-0.5 cm. Pylorus competent.", "Chronic erosive antral gastritis"], ["Biopsy Histology", "Dense lympho-plasmacytic + neutrophilic infiltrate; H. pylori on Giemsa stain; no metaplasia", "H. pylori chronic active gastritis, moderate activity"], ["Abdominal Ultrasound", "No pathology in liver, pancreas, gallbladder, kidneys", "Excludes other organ disease"], ] lt = Table(lab, colWidths=[4.2*cm, 6.5*cm, 4.8*cm]) lt.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,0),colors.HexColor("#1a3a5c")), ("TEXTCOLOR", (0,0),(-1,0),colors.white), ("FONTNAME", (0,0),(-1,0),"Helvetica-Bold"), ("FONTSIZE", (0,0),(-1,-1),8.5), ("ROWBACKGROUNDS",(0,1),(-1,-1),[colors.HexColor("#f0f4fa"),colors.white]), ("GRID",(0,0),(-1,-1),0.4,colors.HexColor("#aaaaaa")), ("VALIGN",(0,0),(-1,-1),"TOP"), ("BOTTOMPADDING",(0,0),(-1,-1),3),("TOPPADDING",(0,0),(-1,-1),3), ("LEFTPADDING",(0,0),(-1,-1),4),("RIGHTPADDING",(0,0),(-1,-1),4), ])) story += [lt, Spacer(1,0.1*cm)] story.append(Paragraph("3.8 Clinical Diagnosis", h2)) story.append(Paragraph( "<b>Main:</b> Chronic active erosive antral gastritis, H. pylori-associated " "(ICD-10: K29.5). Activity: moderate. Phase: exacerbation.<br/>" "<b>Complication:</b> Superficial erosions of antral mucosa.<br/>" "<b>Concomitant:</b> Iron-deficiency anemia (mild). " "Chronic NSAID (Diclofenac) use. Lumbar osteochondrosis.", body)) story.append(Paragraph("3.9 Treatment Plan", h2)) story.append(Paragraph( "<b>Eradication (Triple therapy x14 days - Maastricht VI 2022):</b> " "Omeprazole 20 mg x2/day + Amoxicillin 1000 mg x2/day + " "Clarithromycin 500 mg x2/day.", body)) for b in [ "Continue Omeprazole 20 mg x1/day for 4 weeks after eradication (mucosal healing)", "Discontinue Diclofenac; switch to Paracetamol 500 mg PRN for lumbar pain", "Ferrous sulfate 300 mg x1/day + vitamin C; recheck CBC after 4 weeks", "Diet: 4-5 small meals/day; avoid fried, smoked, spicy food; stop alcohol", "Smoking cessation counselling (refer to narcologist)", "Confirm eradication: urea breath test 4-6 weeks post-antibiotics", "Control EGDS in 3 months; if atrophy/metaplasia found - surveillance every 3 years", ]: story.append(Paragraph("- " + b, bul)) story.append(Spacer(1,0.15*cm)) story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#1a3a5c"), spaceAfter=3)) story.append(Paragraph("References", h1)) refs = [ "1. Malfertheiner P, Camargo MC, El-Omar E. Helicobacter pylori infection. Nat Rev Dis Primers. 2023;9(1):19. PMID: 37081005.", "2. Sun Q, Yuan C, Zhou S. H. pylori: from diagnosis to treatment. Front Cell Infect Microbiol. 2023;13:1257817. PMID: 37928189.", "3. Yang H, Hu B. Immunological perspective: H. pylori and gastritis. Mediators Inflamm. 2022;2022:2944156. PMID: 35300405.", "4. Duan M, Li Y, Liu J. Transmission routes of H. pylori. Helicobacter. 2023;28(1):e12945. PMID: 36645421.", "5. Gisbert JP. Helicobacter pylori and gastric disease. Med Clin (Barc). 2025;165(1):35-42. PMID: 40409232.", "6. European Helicobacter and Microbiota Study Group. Maastricht VI/Florence consensus. Gut. 2022;71(9):1724-1762.", "7. Sugano K, et al. Kyoto global consensus on H. pylori gastritis. Gut. 2021;70(5):918-926.", "8. Kumar V, Abbas AK, Aster JC. Robbins & Kumar Basic Pathology. 11th ed. Elsevier; 2023.", "9. Loscalzo J, et al. Harrison's Principles of Internal Medicine. 22nd ed. McGraw-Hill; 2025.", "10. Yamada T, et al. Yamada's Textbook of Gastroenterology. 7th ed. Wiley; 2022.", "11. Sugano K. H. pylori eradication and gastric cancer. Gastric Cancer. 2021;24(3):567-579.", "12. Sleisenger MH, et al. Gastrointestinal and Liver Disease. 11th ed. Elsevier; 2021.", ] for r in refs: story.append(Paragraph(r, ref_s)) story += [Spacer(1,0.15*cm), HRFlowable(width="100%", thickness=0.4, color=colors.HexColor("#bbbbbb")), Spacer(1,0.05*cm), Paragraph("Pandit Lalit | Group M-16-1-22-AH | Faculty Therapy | 4th Year | July 2026", foot_s)] doc.build(story) print("PDF built.") import pdfplumber with pdfplumber.open(OUTPUT) as pdf: print(f"Total pages: {len(pdf.pages)}") for i, pg in enumerate(pdf.pages): t = pg.extract_text() or "" print(f" Page {i+1}: {t[:90].strip()}") PYEOF

python3 << 'PYEOF' from docx import Document from docx.shared import Pt, Inches, RGBColor, Cm from docx.enum.text import WD_ALIGN_PARAGRAPH from docx.enum.table import WD_TABLE_ALIGNMENT, WD_ALIGN_VERTICAL from docx.oxml.ns import qn from docx.oxml import OxmlElement import copy OUTPUT = "/tmp/workspace/gastritis-report/Chronic_Gastritis_Summary_Pandit_Lalit.docx" doc = Document() # ── Page margins ────────────────────────────────────────── section = doc.sections[0] section.page_width = Cm(21) section.page_height = Cm(29.7) section.left_margin = Cm(2.5) section.right_margin = Cm(2.5) section.top_margin = Cm(2.2) section.bottom_margin = Cm(2.2) # ── Base normal style ───────────────────────────────────── normal = doc.styles["Normal"] normal.font.name = "Arial" normal.font.size = Pt(11) # ── Helper: set paragraph spacing ──────────────────────── def set_spacing(para, before=0, after=4, line=None): pPr = para._p.get_or_add_pPr() spacing = OxmlElement("w:spacing") spacing.set(qn("w:before"), str(before)) spacing.set(qn("w:after"), str(after)) if line: spacing.set(qn("w:line"), str(line)) spacing.set(qn("w:lineRule"), "auto") pPr.append(spacing) # ── Helper: coloured heading ────────────────────────────── def add_heading(text, level=1, color=(26, 58, 92)): h = doc.add_heading(text, level=level) h.alignment = WD_ALIGN_PARAGRAPH.LEFT for run in h.runs: run.font.color.rgb = RGBColor(*color) run.font.name = "Arial" if level == 1: run.font.size = Pt(13) run.bold = True else: run.font.size = Pt(11) run.bold = True set_spacing(h, before=120, after=40) return h # ── Helper: horizontal rule ─────────────────────────────── def add_hr(doc): p = doc.add_paragraph() pPr = p._p.get_or_add_pPr() pb = OxmlElement("w:pBdr") bottom = OxmlElement("w:bottom") bottom.set(qn("w:val"), "single") bottom.set(qn("w:sz"), "6") bottom.set(qn("w:space"), "1") bottom.set(qn("w:color"), "1a3a5c") pb.append(bottom) pPr.append(pb) set_spacing(p, before=0, after=60) return p # ── Helper: body paragraph ──────────────────────────────── def add_body(text, bold_parts=None, indent=False): p = doc.add_paragraph() if indent: p.paragraph_format.left_indent = Cm(0.5) set_spacing(p, before=0, after=40, line=276) # simple bold detection: text fragments like **xxx** run = p.add_run(text) run.font.name = "Arial" run.font.size = Pt(10.5) return p # ── Helper: mixed bold+normal paragraph ────────────────── def add_mixed(parts): """parts = list of (text, bold_bool)""" p = doc.add_paragraph() set_spacing(p, before=0, after=40, line=276) for text, bold in parts: r = p.add_run(text) r.font.name = "Arial" r.font.size = Pt(10.5) r.bold = bold return p # ── Helper: bullet ──────────────────────────────────────── def add_bullet(text): p = doc.add_paragraph(style="List Bullet") r = p.add_run(text) r.font.name = "Arial" r.font.size = Pt(10.5) set_spacing(p, before=0, after=20, line=260) return p # ── Helper: table with header row ──────────────────────── def make_table(headers, rows, col_widths): t = doc.add_table(rows=1 + len(rows), cols=len(headers)) t.style = "Table Grid" t.alignment = WD_TABLE_ALIGNMENT.LEFT # Header hdr = t.rows[0] for i, h in enumerate(headers): cell = hdr.cells[i] cell.width = Cm(col_widths[i]) tc = cell._tc tcPr = tc.get_or_add_tcPr() shd = OxmlElement("w:shd") shd.set(qn("w:fill"), "1a3a5c") shd.set(qn("w:color"), "auto") shd.set(qn("w:val"), "clear") tcPr.append(shd) p = cell.paragraphs[0] p.alignment = WD_ALIGN_PARAGRAPH.CENTER run = p.add_run(h) run.font.name = "Arial" run.font.size = Pt(9.5) run.bold = True run.font.color.rgb = RGBColor(255, 255, 255) set_spacing(p, before=40, after=40) # Data rows for ri, row_data in enumerate(rows): row = t.rows[ri + 1] fill = "EEF3FA" if ri % 2 == 0 else "FFFFFF" for ci, val in enumerate(row_data): cell = row.cells[ci] cell.width = Cm(col_widths[ci]) tc = cell._tc tcPr = tc.get_or_add_tcPr() shd = OxmlElement("w:shd") shd.set(qn("w:fill"), fill) shd.set(qn("w:color"), "auto") shd.set(qn("w:val"), "clear") tcPr.append(shd) p = cell.paragraphs[0] p.alignment = WD_ALIGN_PARAGRAPH.LEFT run = p.add_run(str(val)) run.font.name = "Arial" run.font.size = Pt(9) set_spacing(p, before=30, after=30) doc.add_paragraph() # spacing after table return t # ════════════════════════════════════════════════════════════ # COVER BLOCK # ════════════════════════════════════════════════════════════ p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER set_spacing(p, before=200, after=20) r = p.add_run("Student Research Work (UIR)") r.font.name = "Arial"; r.font.size = Pt(11); r.italic = True r.font.color.rgb = RGBColor(80, 80, 80) add_hr(doc) p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER set_spacing(p, before=40, after=10) r = p.add_run("CHRONIC GASTRITIS") r.font.name = "Arial"; r.font.size = Pt(18); r.bold = True r.font.color.rgb = RGBColor(26, 58, 92) p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER set_spacing(p, before=0, after=40) r = p.add_run("Etiology, Pathogenesis, Diagnosis and Treatment") r.font.name = "Arial"; r.font.size = Pt(11); r.italic = True r.font.color.rgb = RGBColor(68, 68, 68) add_hr(doc) # Info table info_rows = [ ("Submitted by:", "Pandit Lalit"), ("Group No.:", "M-16-1-22-AH"), ("Subject:", "Faculty Therapy (Internal Medicine)"), ("Department:", "Department of Internal Medicine"), ("Year:", "4th Year, 2025-2026"), ("Date:", "July 2026"), ] t = doc.add_table(rows=len(info_rows), cols=2) t.style = "Table Grid" t.alignment = WD_TABLE_ALIGNMENT.CENTER for ri, (label, val) in enumerate(info_rows): fill = "EEF3FA" if ri % 2 == 0 else "FFFFFF" for ci, txt in enumerate([label, val]): cell = t.rows[ri].cells[ci] cell.width = Cm(4.5) if ci == 0 else Cm(10.5) tc = cell._tc tcPr = tc.get_or_add_tcPr() shd = OxmlElement("w:shd") shd.set(qn("w:fill"), fill); shd.set(qn("w:color"), "auto"); shd.set(qn("w:val"), "clear") tcPr.append(shd) p = cell.paragraphs[0] run = p.add_run(txt) run.font.name = "Arial"; run.font.size = Pt(11) run.bold = (ci == 0) if ci == 0: run.font.color.rgb = RGBColor(26, 58, 92) set_spacing(p, before=50, after=50) doc.add_paragraph() # Description p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER set_spacing(p, before=60, after=0) r = p.add_run( "This document presents a student research work on Chronic Gastritis including " "a literature review and a full clinical case of a Russian patient with " "diagnostic findings and treatment plan, prepared for printing and archiving.") r.font.name = "Arial"; r.font.size = Pt(10); r.italic = True r.font.color.rgb = RGBColor(100, 100, 100) doc.add_page_break() # ════════════════════════════════════════════════════════════ # SECTION 1 – RELEVANCE # ════════════════════════════════════════════════════════════ add_heading("1. Relevance of the Topic", level=1) add_hr(doc) add_mixed([ ("Chronic gastritis is one of the most prevalent gastrointestinal diseases globally. ", False), ("H. pylori ", True), ("infects over 50% of the world's population; in Russia prevalence " "reaches 60-70%, driven by historically lower sanitation standards and dense urban living. " "Its clinical significance lies in being a recognised precursor of peptic ulcer disease, " "gastric adenocarcinoma, and MALT lymphoma. The WHO classifies ", False), ("H. pylori ", True), ("as a Group I (definite) carcinogen, making timely eradication a " "cancer-prevention priority.", False), ]) # ════════════════════════════════════════════════════════════ # SECTION 2 – LITERATURE REVIEW # ════════════════════════════════════════════════════════════ add_heading("2. Literature Review", level=1) add_hr(doc) add_heading("2.1 Definition and Classification", level=2, color=(46, 92, 138)) add_mixed([ ("Chronic gastritis ", True), ("is a persistent inflammatory condition of the gastric mucosa with infiltration by " "lymphocytes, plasma cells, and (in active phases) neutrophils. Three main types: ", False), ("(1) Diffuse antral gastritis ", True), ("– H. pylori-associated, most common; ", False), ("(2) EMAG ", True), ("– environmental metaplastic atrophic gastritis (dietary/geographic); ", False), ("(3) AMAG ", True), ("– autoimmune metaplastic atrophic gastritis (<10% of cases).", False), ]) add_heading("2.2 Etiology and Pathogenesis", level=2, color=(46, 92, 138)) add_mixed([ ("H. pylori: ", True), ("gram-negative spiral bacterium. Virulence factors: flagella (motility), urease (raises local pH), " "adhesins (mucosal binding), toxins CagA/CagE (trigger IL-8 and sustained inflammation). " "Colonises antrum first, stimulates gastrin and hyperacidity; may spread to gastric body " "causing atrophy and intestinal metaplasia (cancer precursor). ", False), ("Autoimmune gastritis: ", True), ("autoreactive T-cells destroy parietal cells; leads to achlorhydria, B12 deficiency, pernicious anaemia. ", False), ("Other causes: ", True), ("chronic NSAID use, bile reflux, smoking, alcohol.", False), ]) add_heading("2.3 Clinical Features", level=2, color=(46, 92, 138)) add_mixed([ ("Common symptoms: ", True), ("dull or burning epigastric pain (meal-related), nausea, early satiety, sour belching, bloating, " "reduced appetite. In autoimmune form: fatigue and neurological features from B12 deficiency. " "Haematemesis is uncommon in uncomplicated chronic gastritis.", False), ]) add_heading("2.4 Diagnosis", level=2, color=(46, 92, 138)) add_mixed([ ("Upper GI endoscopy (EGDS) with biopsy ", True), ("– gold standard; antral biopsy preferred for H. pylori detection. ", False), ("Histology (H&E / Giemsa) ", True), ("– detects organisms and infiltrate. ", False), ("Urea breath test (UBT) ", True), ("and ", False), ("stool antigen test ", True), ("– non-invasive and reliable. ", False), ("Serology (IgG) ", True), ("– exposure only, not active infection. " "In AMAG: anti-parietal cell/intrinsic factor antibodies, low serum B12, low pepsinogen I.", False), ]) doc.add_page_break() # ════════════════════════════════════════════════════════════ # SECTION 3 – CLINICAL CASE # ════════════════════════════════════════════════════════════ add_heading("3. Clinical Case – Russian Patient", level=1) add_hr(doc) add_heading("3.1 Patient Details", level=2, color=(46, 92, 138)) make_table( ["Field", "Information"], [ ("Full name", "Ivanov Sergei Nikolaevich"), ("Date of birth", "14 March 1981 (age 45 years)"), ("Gender", "Male"), ("Occupation", "Long-distance truck driver"), ("Residence", "Moscow, Russia"), ("Admitted", "15 July 2026"), ("Hospital / Ward", "City Clinical Hospital No. 15, Moscow – Gastroenterology Ward"), ], col_widths=[4.0, 11.5], ) add_heading("3.2 Chief Complaints", level=2, color=(46, 92, 138)) for c in [ "Dull, aching epigastric pain 40-60 min after meals, lasting 1-2 hours", "Nausea especially after fatty or fried food", "Frequent sour belching; sensation of heaviness/fullness after small meals", "Decreased appetite for the past 3-4 months", "General weakness and fatigue", "Weight loss ~3 kg over 2 months", ]: add_bullet(c) add_heading("3.3 History of Present Illness", level=2, color=(46, 92, 138)) add_mixed([ ("Duration: ", True), ("~6 years (first symptoms 2019, attributed to stress). Worsening for 4 months. " "Never had gastroscopy. Self-medicated with antacids (Rennie, Maalox) – temporary relief. ", False), ("NSAID use: ", True), ("takes Diclofenac IM 2-3x/week for chronic lumbar pain. ", False), ("Diet: ", True), ("irregular – skips breakfast, large evening meals, frequent fast food, " "smoked/salted fish. ", False), ("Smoking: ", True), ("15 cigarettes/day x 20 years. ", False), ("Alcohol: ", True), ("vodka ~150-200 ml, 2x/week. No prior GI hospitalisations.", False), ]) add_heading("3.4 Past Medical and Family History", level=2, color=(46, 92, 138)) add_mixed([ ("Chronic diseases: ", True), ("Lumbar osteochondrosis (2017). ", False), ("Surgery: ", True), ("Appendectomy (2005). ", False), ("Allergies: ", True), ("None. ", False), ("Family history: ", True), ("Father – peptic ulcer disease (H. pylori eradication therapy). " "Paternal grandfather – died of gastric cancer at age 68.", False), ]) add_heading("3.5 Physical Examination", level=2, color=(46, 92, 138)) add_mixed([ ("General condition: ", True), ("satisfactory. Conscious. BMI 21.8 kg/m2. Skin: pale, dry. ", False), ("Vitals: ", True), ("BP 122/78 mmHg | HR 74 bpm | RR 16/min | Temp 36.6 C. ", False), ("Tongue: ", True), ("coated with white-grey film. ", False), ("Abdomen: ", True), ("soft. Moderate tenderness on deep palpation in epigastric region and pyloric projection. " "No hepatosplenomegaly. No peritoneal signs.", False), ]) doc.add_page_break() # ════════════════════════════════════════════════════════════ # PAGE 4 – FINDINGS, DIAGNOSIS, TREATMENT, REFS # ════════════════════════════════════════════════════════════ add_heading("3.6 Syndromes and Risk Factors", level=2, color=(46, 92, 138)) add_mixed([ ("Main syndromes: ", True), ("Pain syndrome; Dyspeptic syndrome (nausea, belching, bloating, heaviness); " "Asthenic syndrome (weakness, weight loss).\n", False), ("Risk factors: ", True), ("H. pylori infection (positive family history of PUD and gastric cancer); " "chronic NSAID (Diclofenac) use; smoking 15 cig/day x 20 years; " "irregular diet with smoked/fried/salted foods; regular alcohol use; occupational stress.", False), ]) add_heading("3.7 Laboratory and Instrumental Investigations", level=2, color=(46, 92, 138)) make_table( ["Investigation", "Result / Finding", "Interpretation"], [ ("CBC", "Hb 112 g/L, MCV 74 fL", "Microcytic iron-deficiency anaemia"), ("Biochemistry (ALT/AST/Bili/Creat)","All within normal limits", "No liver or kidney pathology"), ("Serum iron / ferritin", "Iron 7.2 umol/L | Ferritin 8 ng/mL", "Iron deficiency confirmed"), ("H. pylori Urea Breath Test", "POSITIVE", "Active H. pylori infection"), ("H. pylori Stool Antigen", "POSITIVE", "Consistent with UBT result"), ("Serum Pepsinogen I/II ratio", "Decreased (ratio < 3)", "Indicates mucosal atrophy"), ("EGDS (Gastroscopy)", "Antral mucosa: hyperemic, oedematous, erosions 0.3-0.5 cm. Pylorus competent.", "Chronic erosive antral gastritis"), ("Gastric Biopsy (Histology)", "Dense lympho-plasmacytic + neutrophilic infiltrate; H. pylori on Giemsa stain; no metaplasia", "H. pylori chronic active gastritis, moderate activity"), ("Abdominal Ultrasound", "No pathology in liver, pancreas, gallbladder, kidneys", "Excludes concurrent pathology"), ], col_widths=[4.0, 6.5, 5.0], ) add_heading("3.8 Clinical Diagnosis", level=2, color=(46, 92, 138)) add_mixed([ ("Main diagnosis: ", True), ("Chronic active erosive antral gastritis, H. pylori-associated (ICD-10: K29.5). " "Activity: moderate. Phase: exacerbation.\n", False), ("Complication: ", True), ("Superficial erosions of antral mucosa.\n", False), ("Concomitant: ", True), ("Iron-deficiency anaemia, mild degree. Chronic NSAID (Diclofenac) use. " "Lumbar osteochondrosis.", False), ]) add_heading("3.9 Treatment Plan", level=2, color=(46, 92, 138)) add_mixed([ ("1. H. pylori Eradication – Triple Therapy x 14 days ", True), ("(Maastricht VI / Florence 2022 consensus):", False), ]) add_body("Omeprazole 20 mg x 2/day (before meals) + Amoxicillin 1000 mg x 2/day + Clarithromycin 500 mg x 2/day", indent=True) for item in [ ("2. Post-eradication therapy (4 weeks): ", "Omeprazole 20 mg x 1/day (morning, before meals) for mucosal healing"), ("3. Anaemia treatment: ", "Ferrous sulfate 300 mg x 1/day with vitamin C; recheck CBC after 4 weeks"), ("4. NSAID management: ", "Discontinue Diclofenac; switch to Paracetamol 500 mg PRN for lumbar pain"), ("5. Diet: ", "4-5 small meals/day; avoid fried, smoked, spicy food; stop alcohol"), ("6. Lifestyle: ", "Smoking cessation counselling; reduce occupational stress"), ("7. Follow-up: ", "Urea breath test 4-6 weeks after antibiotics to confirm eradication; control EGDS in 3 months; surveillance endoscopy every 3 years if atrophy/metaplasia present"), ]: add_mixed([(item[0], True), (item[1], False)]) # ── REFERENCES ────────────────────────────────────────── add_hr(doc) add_heading("References", level=1) refs = [ "1. Malfertheiner P, Camargo MC, El-Omar E. Helicobacter pylori infection. Nat Rev Dis Primers. 2023;9(1):19. PMID: 37081005.", "2. Sun Q, Yuan C, Zhou S. H. pylori: from diagnosis to treatment. Front Cell Infect Microbiol. 2023;13:1257817. PMID: 37928189.", "3. Yang H, Hu B. Immunological perspective: H. pylori and gastritis. Mediators Inflamm. 2022;2022:2944156. PMID: 35300405.", "4. Duan M, Li Y, Liu J. Transmission routes of H. pylori. Helicobacter. 2023;28(1):e12945. PMID: 36645421.", "5. Gisbert JP. Helicobacter pylori and gastric disease. Med Clin (Barc). 2025;165(1):35-42. PMID: 40409232.", "6. European Helicobacter and Microbiota Study Group. Maastricht VI/Florence consensus. Gut. 2022;71(9):1724-1762.", "7. Sugano K, et al. Kyoto global consensus on H. pylori gastritis. Gut. 2021;70(5):918-926.", "8. Kumar V, Abbas AK, Aster JC. Robbins & Kumar Basic Pathology. 11th ed. Elsevier; 2023.", "9. Loscalzo J, et al. Harrison's Principles of Internal Medicine. 22nd ed. McGraw-Hill; 2025.", "10. Yamada T, et al. Yamada's Textbook of Gastroenterology. 7th ed. Wiley; 2022.", "11. Sugano K. H. pylori eradication and gastric cancer incidence. Gastric Cancer. 2021;24(3):567-579.", "12. Sleisenger MH, et al. Gastrointestinal and Liver Disease. 11th ed. Elsevier; 2021.", ] for r in refs: p = doc.add_paragraph() p.paragraph_format.left_indent = Cm(0.5) p.paragraph_format.first_line_indent = Cm(-0.5) set_spacing(p, before=0, after=30, line=240) run = p.add_run(r) run.font.name = "Arial"; run.font.size = Pt(9) # ── FOOTER ─────────────────────────────────────────────── p = doc.add_paragraph() add_hr(doc) p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER set_spacing(p, before=20, after=0) r = p.add_run("Pandit Lalit | Group M-16-1-22-AH | Faculty Therapy | 4th Year | July 2026") r.font.name = "Arial"; r.font.size = Pt(9); r.italic = True r.font.color.rgb = RGBColor(120, 120, 120) doc.save(OUTPUT) print(f"Saved: {OUTPUT}") # Quick verification from docx import Document as D d2 = D(OUTPUT) headings = [p.text for p in d2.paragraphs if p.style.name.startswith("Heading")] print(f"Headings found: {headings}") PYEOF