const fs = require('fs');
const path = require('path');
const { Document, Packer, Paragraph, TextRun, HeadingLevel, AlignmentType, PageBreak } = require('docx');

const diseases = [
  {
    name: 'Acute Gastroenteritis (AGE)',
    findings: 'Watery diarrhea, vomiting, dehydration signs (dry mucosa, sunken eyes, decreased urine).',
    investigation: 'Primarily clinical. Stool exam/culture if blood in stool, severe disease, or prolonged illness. Serum electrolytes, blood gas in severe dehydration.',
    treatment: 'ORS for mild-moderate dehydration, IV fluids for severe dehydration/shock, zinc supplementation, continued feeding. Antibiotics only in select dysentery/cholera cases.',
    differential: 'Sepsis, UTI, appendicitis, intussusception, lactose intolerance, inflammatory bowel disease.',
    contraindication: 'Avoid routine antidiarrheals (e.g., loperamide) in young children; avoid unnecessary antibiotics.',
    ico: 'Integrated clinical observation: hydration assessment and danger signs triage.',
    management: 'Assess dehydration status, rehydrate, correct electrolytes, monitor urine output and clinical recovery.',
    opd: 'If no danger signs: ORS counseling, zinc, feeding advice, red-flag review in 24-48 h.',
    prescription: 'ORS 75 mL/kg over 4 hours (if some dehydration), Zinc 10 mg/day (<6 months) or 20 mg/day (>=6 months) for 14 days, Paracetamol PRN fever.'
  },
  {
    name: 'Bronchiolitis',
    findings: 'Coryza, cough, tachypnea, wheeze/crackles, chest retractions, feeding difficulty in infants.',
    investigation: 'Clinical diagnosis. Pulse oximetry essential. CXR only if severe/atypical. Viral testing selectively.',
    treatment: 'Supportive: oxygen if SpO2 persistently low, hydration (NG/IV if poor feeding), nasal suction.',
    differential: 'Asthma, pneumonia, foreign body aspiration, congenital heart disease with failure.',
    contraindication: 'Routine antibiotics, steroids, bronchodilators are generally not recommended in typical bronchiolitis.',
    ico: 'Respiratory distress scoring, oxygenation monitoring, feeding tolerance.',
    management: 'Admit if hypoxemia, apnea risk, severe distress, or dehydration; supportive care and monitoring.',
    opd: 'Mild cases: saline nasal drops, feeding support, warning signs education.',
    prescription: 'Normal saline nasal drops PRN, Paracetamol for fever/discomfort, frequent small feeds.'
  },
  {
    name: 'Community-Acquired Pneumonia',
    findings: 'Fever, cough, tachypnea, chest indrawing, crackles, decreased breath sounds.',
    investigation: 'Clinical + pulse oximetry. CBC/CRP optional. Chest X-ray in severe, complicated, or non-responding cases.',
    treatment: 'Oral amoxicillin for non-severe bacterial CAP. IV ampicillin/ceftriaxone in severe disease. Oxygen and fluids as needed.',
    differential: 'Bronchiolitis, asthma exacerbation, TB, aspiration, congenital lung malformations.',
    contraindication: 'Avoid cough suppressants and indiscriminate broad-spectrum antibiotics.',
    ico: 'WHO severity classification and hypoxemia screening.',
    management: 'Classify severity; outpatient oral therapy for non-severe; inpatient IV therapy/support for severe.',
    opd: 'Follow-up in 48-72 h; advise danger signs (fast breathing, poor feeding, lethargy, cyanosis).',
    prescription: 'Amoxicillin 40-50 mg/kg/dose PO q12h (as per local protocol), Paracetamol PRN, adequate fluids.'
  },
  {
    name: 'Asthma (Pediatric)',
    findings: 'Recurrent wheeze, cough (night/exercise-induced), breathlessness, variable airflow limitation.',
    investigation: 'Clinical history, trigger pattern, spirometry (>5-6 years), peak flow variability.',
    treatment: 'Reliever (SABA) plus controller (ICS) based on severity; acute exacerbation needs inhaled SABA +/- systemic steroids.',
    differential: 'Bronchiolitis, foreign body aspiration, GERD, vocal cord dysfunction, congenital airway lesions.',
    contraindication: 'Avoid LABA monotherapy without ICS; avoid overuse of SABA without controller step-up.',
    ico: 'Control assessment (day symptoms, night symptoms, reliever use, activity limitation).',
    management: 'Stepwise therapy, trigger avoidance, inhaler technique training, written action plan.',
    opd: 'Regular follow-up every 1-3 months initially; adjust step up/down per control.',
    prescription: 'Salbutamol inhaler 100 mcg/puff PRN via spacer; Budesonide inhaled maintenance as indicated.'
  },
  {
    name: 'Croup (Laryngotracheobronchitis)',
    findings: 'Barking cough, inspiratory stridor, hoarseness, worse at night.',
    investigation: 'Clinical diagnosis; no routine imaging. Pulse oximetry in moderate-severe disease.',
    treatment: 'Single-dose dexamethasone; nebulized epinephrine for moderate-severe stridor.',
    differential: 'Epiglottitis, bacterial tracheitis, foreign body, retropharyngeal abscess.',
    contraindication: 'Avoid agitating child and unnecessary throat examination in severe airway distress.',
    ico: 'Westley croup severity assessment and airway monitoring.',
    management: 'Mild outpatient care; observe after epinephrine in moderate-severe cases.',
    opd: 'Home care advice, humidified air comfort measures, emergency return if stridor at rest.',
    prescription: 'Dexamethasone 0.15-0.6 mg/kg single dose PO/IM; nebulized epinephrine in facility if indicated.'
  },
  {
    name: 'Acute Otitis Media',
    findings: 'Ear pain, fever, irritability, bulging erythematous tympanic membrane, reduced mobility.',
    investigation: 'Clinical with otoscopy/pneumatic otoscopy.',
    treatment: 'Analgesia first. Amoxicillin when indicated (young age, severe symptoms, bilateral disease, otorrhea).',
    differential: 'Otitis externa, referred pain (teeth/throat), viral URI without AOM.',
    contraindication: 'Avoid routine decongestants/antihistamines for AOM symptom relief.',
    ico: 'Assess severity, age, unilateral/bilateral disease, and follow-up feasibility.',
    management: 'Watchful waiting in selected non-severe cases; antibiotic if no improvement/worsening.',
    opd: 'Recheck if persistent fever/otalgia after 48 h.',
    prescription: 'Amoxicillin 80-90 mg/kg/day divided doses (if indicated), Ibuprofen/Paracetamol for pain.'
  },
  {
    name: 'Urinary Tract Infection',
    findings: 'Fever without source (infants), dysuria, frequency, abdominal/flank pain, vomiting.',
    investigation: 'Urinalysis + urine culture (clean catch/catheter/suprapubic based on age). Renal US in selected cases.',
    treatment: 'Age/severity-guided oral or IV antibiotics; ensure hydration; treat pyelonephritis adequately.',
    differential: 'Viral fever, vulvovaginitis, appendicitis, nephrolithiasis.',
    contraindication: 'Avoid diagnosing UTI from bag-collected urine culture due to contamination risk.',
    ico: 'Source-control evaluation, sepsis screen in toxic child, hydration monitoring.',
    management: 'Prompt antibiotics after urine sample collection; follow guideline-based imaging strategy.',
    opd: 'Review culture and tailor antibiotics; counsel on hydration and bowel/bladder habits.',
    prescription: 'Cephalexin or Cefixime as per local sensitivity; antipyretic PRN.'
  },
  {
    name: 'Iron Deficiency Anemia',
    findings: 'Pallor, fatigue, irritability, pica, microcytic hypochromic anemia.',
    investigation: 'CBC indices, peripheral smear, ferritin (with CRP if needed), reticulocyte count.',
    treatment: 'Oral elemental iron and dietary modification; treat underlying causes (blood loss, poor intake, helminths).',
    differential: 'Thalassemia trait, anemia of chronic disease, lead poisoning, sideroblastic anemia.',
    contraindication: 'Avoid unnecessary transfusion in stable chronic mild-moderate anemia.',
    ico: 'Nutritional risk and developmental impact assessment.',
    management: 'Confirm diagnosis, start iron, recheck Hb response in 2-4 weeks.',
    opd: 'Adherence counseling, iron with vitamin C-rich foods, avoid excess cow milk in toddlers.',
    prescription: 'Elemental iron 3-6 mg/kg/day PO in divided doses for ~3 months after Hb normalization.'
  },
  {
    name: 'Protein-Energy Malnutrition (SAM/MAM)',
    findings: 'Wasting, edema (kwashiorkor), poor weight gain, recurrent infections, micronutrient deficiencies.',
    investigation: 'Anthropometry (WFH, MUAC), glucose, electrolytes, CBC, infection screen as indicated.',
    treatment: 'WHO protocol: stabilize (hypoglycemia, hypothermia, infection), cautious feeds (F-75/F-100 or RUTF), micronutrients.',
    differential: 'Chronic systemic disease, congenital heart disease, malabsorption syndromes, TB/HIV.',
    contraindication: 'Avoid aggressive fluid boluses unless shock; avoid high-protein/high-sodium early feeding in unstable SAM.',
    ico: 'Appetite test, edema grading, complication screening.',
    management: 'Inpatient for complicated SAM; outpatient therapeutic feeding for uncomplicated cases.',
    opd: 'Growth monitoring, deworming, immunization catch-up, caregiver counseling.',
    prescription: 'RUTF as per weight, folic acid, multivitamins, antibiotics if indicated by protocol.'
  },
  {
    name: 'Neonatal Sepsis',
    findings: 'Poor feeding, lethargy, temperature instability, respiratory distress, apnea, shock.',
    investigation: 'Blood culture, CBC, CRP/procalcitonin, CSF (if stable and indicated), glucose, ABG.',
    treatment: 'Prompt empiric IV antibiotics, supportive NICU care, fluids and vasopressors if shock.',
    differential: 'Metabolic disorders, congenital heart disease, intracranial hemorrhage, hypoglycemia.',
    contraindication: 'Do not delay antibiotics in clinically suspected sepsis awaiting investigations.',
    ico: 'Early warning signs, organ dysfunction monitoring, sepsis bundle timing.',
    management: 'Culture before antibiotics when feasible, then timely broad-spectrum empiric therapy and de-escalation.',
    opd: 'Post-discharge neurodevelopment follow-up in high-risk infants.',
    prescription: 'Ampicillin + Gentamicin (or per local NICU antibiogram), adjust to culture.'
  },
  {
    name: 'Neonatal Jaundice',
    findings: 'Visible jaundice, bilirubin rise, poor feeding; risk of kernicterus if severe unconjugated hyperbilirubinemia.',
    investigation: 'Total/direct bilirubin, blood group/Coombs, CBC, retic count, G6PD in selected infants.',
    treatment: 'Phototherapy per nomogram; exchange transfusion in severe cases.',
    differential: 'Physiologic jaundice, hemolytic disease, sepsis, biliary atresia (conjugated jaundice).',
    contraindication: 'Avoid delaying treatment when bilirubin crosses threshold.',
    ico: 'Risk stratification by age in hours and bilirubin trend.',
    management: 'Use standardized nomograms; monitor hydration and bilirubin response.',
    opd: 'Early follow-up for high-risk newborns after discharge.',
    prescription: 'Phototherapy protocol; breastfeeding support; no routine medications for physiologic jaundice.'
  },
  {
    name: 'Acute Rheumatic Fever',
    findings: 'Fever, migratory polyarthritis, carditis, chorea, erythema marginatum, subcutaneous nodules.',
    investigation: 'Jones criteria, evidence of recent GAS infection (ASO/anti-DNase B), ECG, echo, CRP/ESR.',
    treatment: 'Eradicate streptococcus, anti-inflammatory therapy, manage carditis/heart failure, secondary prophylaxis.',
    differential: 'Juvenile idiopathic arthritis, viral arthritis, infective endocarditis, lupus.',
    contraindication: 'Do not stop secondary prophylaxis prematurely in established RHD risk.',
    ico: 'Carditis severity and long-term recurrence prevention focus.',
    management: 'Acute treatment + prolonged benzathine penicillin prophylaxis.',
    opd: 'Regular cardiology follow-up and adherence to prophylaxis schedule.',
    prescription: 'Benzathine penicillin G IM every 3-4 weeks; aspirin/naproxen as indicated.'
  },
  {
    name: 'Congenital Heart Disease (Acyanotic - VSD focus)',
    findings: 'Failure to thrive, recurrent respiratory infections, pansystolic murmur, tachypnea.',
    investigation: 'Echocardiography definitive; CXR/ECG supportive.',
    treatment: 'Medical treatment for heart failure; device/surgical closure for significant defects.',
    differential: 'PDA, ASD, AV canal defects, cardiomyopathy.',
    contraindication: 'Avoid delayed referral in pulmonary hypertension risk.',
    ico: 'Shunt size, heart failure severity, pulmonary pressure evaluation.',
    management: 'Nutritional support, anti-failure meds, timed intervention.',
    opd: 'Serial growth and echo follow-up.',
    prescription: 'Furosemide +/- ACE inhibitor in symptomatic infants (specialist guided).'
  },
  {
    name: 'Tetralogy of Fallot',
    findings: 'Cyanosis, tet spells, harsh ejection systolic murmur, clubbing in older children.',
    investigation: 'Echocardiography diagnostic; CXR may show boot-shaped heart.',
    treatment: 'Tet spell management (knee-chest, oxygen, morphine, beta-blocker), definitive surgical repair.',
    differential: 'Transposition of great arteries, tricuspid atresia, pulmonary atresia.',
    contraindication: 'Avoid dehydration and precipitating factors for hypercyanotic spells.',
    ico: 'Cyanotic spell recognition and emergency response preparedness.',
    management: 'Stabilize spells and plan corrective surgery.',
    opd: 'Cardiology and postoperative long-term follow-up.',
    prescription: 'Propranolol prophylaxis for spells in selected patients, iron if secondary polycythemia with deficiency.'
  },
  {
    name: 'Epilepsy (Pediatric)',
    findings: 'Recurrent unprovoked seizures, variable semiology, postictal phase.',
    investigation: 'Detailed seizure history, EEG, MRI when indicated, metabolic/genetic tests in selected cases.',
    treatment: 'Syndrome-specific antiseizure medication; rescue medication plan for prolonged seizures.',
    differential: 'Syncope, breath-holding spells, psychogenic nonepileptic events, movement disorders.',
    contraindication: 'Avoid abrupt withdrawal of antiepileptic drugs.',
    ico: 'Seizure type classification and developmental assessment.',
    management: 'Individualized ASM choice, adherence counseling, safety education.',
    opd: 'Regular dose titration, side-effect monitoring, school counseling.',
    prescription: 'Levetiracetam/Valproate/Carbamazepine depending on seizure type and age.'
  },
  {
    name: 'Febrile Seizure',
    findings: 'Seizure with fever in 6-60 months, no CNS infection or prior afebrile seizure disorder.',
    investigation: 'Mostly clinical; evaluate fever source. Lumbar puncture when meningitis suspected.',
    treatment: 'Acute seizure control if prolonged; antipyretics for comfort; parent reassurance.',
    differential: 'Meningitis/encephalitis, epilepsy, metabolic seizures.',
    contraindication: 'Avoid routine long-term antiepileptics for simple febrile seizures.',
    ico: 'Simple vs complex febrile seizure classification.',
    management: 'Treat cause of fever; educate caregivers on recurrence and first aid.',
    opd: 'Review if recurrent/complex episodes.',
    prescription: 'Paracetamol PRN; rescue buccal midazolam/rectal diazepam plan for prolonged recurrence risk.'
  },
  {
    name: 'Meningitis (Bacterial)',
    findings: 'Fever, headache, vomiting, altered sensorium, neck stiffness, seizures, bulging fontanelle in infants.',
    investigation: 'Blood culture, CSF analysis/culture (if no contraindication), CBC, CRP, neuroimaging when indicated.',
    treatment: 'Immediate empiric IV antibiotics + supportive care; dexamethasone in select settings.',
    differential: 'Viral meningoencephalitis, cerebral malaria, brain abscess, sepsis with encephalopathy.',
    contraindication: 'Avoid lumbar puncture in raised ICP/shock/focal deficits until stabilized.',
    ico: 'Neurologic status, ICP risk, sepsis severity monitoring.',
    management: 'Time-critical antibiotics and ICU-level support when needed.',
    opd: 'Hearing and neurodevelopment follow-up after recovery.',
    prescription: 'Ceftriaxone/Cefotaxime +/- Vancomycin based on age and local resistance.'
  },
  {
    name: 'Tuberculosis (Pediatric Pulmonary)',
    findings: 'Persistent cough, fever, weight loss/failure to thrive, TB contact history.',
    investigation: 'TST/IGRA, chest radiograph, gastric aspirate/sputum for GeneXpert/culture where possible.',
    treatment: 'Weight-based multidrug ATT per national program.',
    differential: 'Recurrent pneumonia, asthma, malignancy, chronic fungal disease.',
    contraindication: 'Avoid monotherapy and poor adherence due to resistance risk.',
    ico: 'Contact tracing, nutritional status, HIV screening.',
    management: 'Confirm probable/confirmed TB, start regimen, monitor adherence and toxicity.',
    opd: 'Monthly weight-based dose adjustment and response monitoring.',
    prescription: 'HRZE intensive phase then HR continuation phase (per guideline duration).'
  },
  {
    name: 'Dengue Fever',
    findings: 'Fever, myalgia, rash, thrombocytopenia, leukopenia; warning signs: abdominal pain, bleeding, lethargy.',
    investigation: 'CBC serial hematocrit/platelets, NS1/IgM based on illness day, LFT in severe disease.',
    treatment: 'Judicious fluids, monitoring for plasma leakage, manage shock/bleeding.',
    differential: 'Malaria, chikungunya, leptospirosis, typhoid, viral hemorrhagic fevers.',
    contraindication: 'Avoid NSAIDs (ibuprofen, aspirin) and unnecessary platelet transfusion without bleeding indications.',
    ico: 'Warning signs and critical phase timing assessment.',
    management: 'Classify severity, fluid protocol-based care, close hemodynamic monitoring.',
    opd: 'Stable non-warning cases with hydration and daily follow-up during critical period.',
    prescription: 'Oral fluids, Paracetamol only for fever, strict return precautions.'
  },
  {
    name: 'Malaria (Pediatric)',
    findings: 'Fever with chills, pallor, splenomegaly, vomiting; severe malaria with altered sensorium/anemia/shock.',
    investigation: 'Peripheral smear and/or rapid diagnostic test; CBC, glucose, renal/liver tests in severe cases.',
    treatment: 'ACT for uncomplicated malaria; IV artesunate for severe malaria.',
    differential: 'Dengue, typhoid, sepsis, viral fever.',
    contraindication: 'Avoid delayed treatment in severe malaria.',
    ico: 'Severity criteria screening and endemic exposure history.',
    management: 'Species/severity-based antimalarial regimen and supportive care.',
    opd: 'Ensure completion of therapy and fever reassessment.',
    prescription: 'Artemisinin-based combination therapy dose per weight/species; antipyretic support.'
  },
  {
    name: 'Typhoid Fever',
    findings: 'Prolonged fever, abdominal pain, coated tongue, hepatosplenomegaly, relative bradycardia occasionally.',
    investigation: 'Blood culture (early best), CBC, LFT; serology less specific.',
    treatment: 'Appropriate antibiotics per local sensitivity and supportive care.',
    differential: 'Dengue, malaria, TB, viral hepatitis, lymphoma.',
    contraindication: 'Avoid empirical repeated broad-spectrum changes without culture guidance.',
    ico: 'Toxicity, hydration, and complication surveillance (intestinal perforation/bleeding).',
    management: 'Targeted antibiotic therapy with monitoring for response and complications.',
    opd: 'Review in 48-72 h for defervescence and adherence.',
    prescription: 'Cefixime/Azithromycin/Ceftriaxone based on local resistance and severity.'
  },
  {
    name: 'Measles',
    findings: 'Fever, cough, coryza, conjunctivitis, Koplik spots, maculopapular rash.',
    investigation: 'Mostly clinical during outbreaks; measles IgM/PCR when needed.',
    treatment: 'Supportive care + vitamin A supplementation; treat complications (pneumonia, otitis).',
    differential: 'Rubella, roseola, scarlet fever, drug rash.',
    contraindication: 'Avoid delayed isolation in contagious phase.',
    ico: 'Complication risk (malnutrition/immunodeficiency) assessment.',
    management: 'Isolation, nutrition support, monitor for secondary infections.',
    opd: 'Follow-up for eye and respiratory complications.',
    prescription: 'Vitamin A age-specific dosing for 2 days, antipyretics, fluids.'
  },
  {
    name: 'Varicella (Chickenpox)',
    findings: 'Pruritic vesicular rash in crops with fever and malaise.',
    investigation: 'Clinical diagnosis; lab rarely needed.',
    treatment: 'Symptomatic care; acyclovir in high-risk/severe cases.',
    differential: 'Impetigo, scabies, hand-foot-mouth disease, disseminated HSV.',
    contraindication: 'Avoid aspirin due to Reye syndrome risk.',
    ico: 'Complication watch: secondary bacterial infection, pneumonia, encephalitis.',
    management: 'Isolation and skin care; antiviral for selected patients.',
    opd: 'Review if persistent fever, breathing issues, neurologic symptoms.',
    prescription: 'Calamine/lotion, antihistamine for itch, Paracetamol; acyclovir if indicated.'
  },
  {
    name: 'Atopic Dermatitis',
    findings: 'Chronic relapsing pruritic eczema, dry skin, flexural involvement.',
    investigation: 'Clinical diagnosis.',
    treatment: 'Emollients, trigger avoidance, topical corticosteroids/calcineurin inhibitors as needed.',
    differential: 'Scabies, seborrheic dermatitis, contact dermatitis, immunodeficiency dermatoses.',
    contraindication: 'Avoid prolonged unsupervised high-potency topical steroids on thin skin areas.',
    ico: 'Severity scoring and itch/sleep impact assessment.',
    management: 'Barrier repair and anti-inflammatory control of flares.',
    opd: 'Long-term skin care counseling and step-up/step-down therapy.',
    prescription: 'Frequent emollient application; low-medium potency topical steroid short course for flares.'
  },
  {
    name: 'Scabies',
    findings: 'Intense nocturnal pruritus, burrows/papules in web spaces, wrists, trunk; family clustering.',
    investigation: 'Clinical; dermoscopy/skin scraping in uncertain cases.',
    treatment: 'Permethrin 5% topical for patient and close contacts; decontaminate linens/clothes.',
    differential: 'Atopic dermatitis, papular urticaria, insect bites, impetigo.',
    contraindication: 'Avoid treating only index child while ignoring household contacts.',
    ico: 'Contact mapping and reinfestation risk assessment.',
    management: 'Simultaneous contact treatment and hygiene measures.',
    opd: 'Follow-up at 1-2 weeks for persistent itch vs treatment failure.',
    prescription: 'Permethrin 5% overnight application neck-down (repeat after 7 days), antihistamine PRN itch.'
  },
  {
    name: 'Nephrotic Syndrome (Minimal Change Common)',
    findings: 'Periorbital/generalized edema, proteinuria, hypoalbuminemia, hyperlipidemia.',
    investigation: 'Urinalysis/protein quantification, serum albumin/lipids/renal function; evaluate secondary causes if atypical.',
    treatment: 'Corticosteroids for first episode, edema control, infection/thrombosis vigilance.',
    differential: 'Acute glomerulonephritis, liver disease, heart failure, protein-losing enteropathy.',
    contraindication: 'Avoid live vaccines during high-dose immunosuppression.',
    ico: 'Relapse pattern and steroid response classification.',
    management: 'Induce remission, monitor urine protein, prevent/treat complications.',
    opd: 'Home urine protein monitoring, edema and BP checks.',
    prescription: 'Prednisolone regimen per pediatric nephrology guideline; salt restriction and diuretics when indicated.'
  },
  {
    name: 'Acute Post-Streptococcal Glomerulonephritis',
    findings: 'Hematuria (cola urine), edema, hypertension, reduced urine output after streptococcal infection.',
    investigation: 'Urinalysis, C3 low, ASO raised, renal function/electrolytes.',
    treatment: 'Supportive: fluid/salt restriction, antihypertensives, diuretics; antibiotics to eradicate streptococcus if active.',
    differential: 'IgA nephropathy, lupus nephritis, HUS, nephritic syndrome from other causes.',
    contraindication: 'Avoid overhydration in oliguric/hypertensive child.',
    ico: 'BP and fluid status monitoring priority.',
    management: 'Control BP/fluid overload and monitor renal recovery.',
    opd: 'Serial urine/BP follow-up until normalization.',
    prescription: 'Furosemide and antihypertensives as needed; penicillin if active streptococcal focus.'
  },
  {
    name: 'Type 1 Diabetes Mellitus',
    findings: 'Polyuria, polydipsia, weight loss, fatigue; may present as DKA.',
    investigation: 'Blood glucose, ketones, HbA1c, autoantibodies/C-peptide in selected cases.',
    treatment: 'Lifelong insulin therapy, nutrition planning, glucose monitoring, sick-day rules.',
    differential: 'Type 2 DM, MODY, diabetes secondary to pancreatitis/endocrinopathy.',
    contraindication: 'Avoid insulin omission; avoid unsupervised very-low-carb restrictions in growing child.',
    ico: 'Glycemic trends, hypoglycemia episodes, psychosocial and growth assessment.',
    management: 'Basal-bolus or pump regimen, education and complication prevention.',
    opd: 'Regular endocrinology follow-up with HbA1c and growth/puberty tracking.',
    prescription: 'Basal insulin + premeal rapid-acting insulin individualized by carbohydrate ratio/correction factors.'
  },
  {
    name: 'Diabetic Ketoacidosis (DKA)',
    findings: 'Vomiting, abdominal pain, dehydration, Kussmaul breathing, altered sensorium, hyperglycemia with ketonemia/acidosis.',
    investigation: 'Blood glucose, venous pH/HCO3, ketones, electrolytes, osmolality, ECG if potassium derangement.',
    treatment: 'Protocolized IV fluids, insulin infusion, electrolyte correction, cerebral edema monitoring.',
    differential: 'Sepsis with metabolic acidosis, acute abdomen, toxic ingestion.',
    contraindication: 'Avoid bicarbonate routinely; avoid rapid fluid shifts increasing cerebral edema risk.',
    ico: 'Hourly neuro checks, glucose/electrolyte monitoring.',
    management: 'PICU-level protocol adherence with careful rehydration and insulin therapy.',
    opd: 'Post-recovery diabetes education to prevent recurrence.',
    prescription: 'Insulin infusion 0.05-0.1 U/kg/h with fluid/electrolyte protocol (inpatient critical care).'
  },
  {
    name: 'Acute Lymphoblastic Leukemia (ALL)',
    findings: 'Pallor, fever, bleeding, bone pain, hepatosplenomegaly, lymphadenopathy.',
    investigation: 'CBC/peripheral smear, bone marrow examination, flow cytometry, cytogenetics, CSF evaluation.',
    treatment: 'Risk-stratified multiagent chemotherapy with supportive transfusion/infection care.',
    differential: 'Aplastic anemia, ITP, juvenile idiopathic arthritis, marrow infiltration by other malignancies.',
    contraindication: 'Avoid live vaccines and uncontrolled infection exposure during intensive chemotherapy.',
    ico: 'Risk stratification and treatment-phase toxicity surveillance.',
    management: 'Induction, consolidation, maintenance under pediatric oncology protocols.',
    opd: 'Strict follow-up for counts, infections, chemo adverse effects.',
    prescription: 'Protocol-based chemotherapy only under oncology center; supportive meds (TMP-SMX prophylaxis etc.) as protocol.'
  },
  {
    name: 'Intussusception',
    findings: 'Intermittent colicky pain, vomiting, red currant jelly stools, palpable sausage-shaped mass.',
    investigation: 'Ultrasound (target sign) diagnostic; contrast/air enema diagnostic and therapeutic in stable patients.',
    treatment: 'Resuscitation then pneumatic/hydrostatic reduction; surgery if perforation/peritonitis/failed reduction.',
    differential: 'Gastroenteritis, appendicitis, volvulus, incarcerated hernia.',
    contraindication: 'Avoid enema reduction in peritonitis, perforation, or unstable shock state.',
    ico: 'Hemodynamic stability and peritonitis assessment before reduction attempt.',
    management: 'Emergency diagnosis and timely reduction/surgery.',
    opd: 'Post-reduction recurrence watch and parental counseling.',
    prescription: 'NPO, IV fluids, analgesia, urgent surgical/pediatric referral (not routine OPD medication case).'
  }
];

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children.push(
  new Paragraph({ text: '30 Important Pediatric Diseases: Clinical Quick Reference', heading: HeadingLevel.TITLE, alignment: AlignmentType.CENTER }),
  new Paragraph({ text: 'Includes findings, investigations, treatment, differential diagnosis, contraindications, integrated care outline (ICO), management, OPD approach, and sample prescriptions.', alignment: AlignmentType.CENTER }),
  new Paragraph({ text: 'For educational use. Adapt to local/national guidelines and patient-specific context.', spacing: { after: 300 } })
);

diseases.forEach((d, idx) => {
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    new Paragraph({ children: [new TextRun({ text: 'Investigations: ', bold: true }), new TextRun(d.investigation)] }),
    new Paragraph({ children: [new TextRun({ text: 'Treatment: ', bold: true }), new TextRun(d.treatment)] }),
    new Paragraph({ children: [new TextRun({ text: 'Differential Diagnosis: ', bold: true }), new TextRun(d.differential)] }),
    new Paragraph({ children: [new TextRun({ text: 'Contraindications / Cautions: ', bold: true }), new TextRun(d.contraindication)] }),
    new Paragraph({ children: [new TextRun({ text: 'ICO: ', bold: true }), new TextRun(d.ico)] }),
    new Paragraph({ children: [new TextRun({ text: 'Management Plan: ', bold: true }), new TextRun(d.management)] }),
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children.push(
  new Paragraph({ text: 'References', heading: HeadingLevel.HEADING_1 }),
  new Paragraph('Harriet Lane Handbook, 23rd ed. (Pediatrics reference text).'),
  new Paragraph('AAP Red Book 2021 (Pediatric infectious diseases reference).')
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});

const outPath = '/home/daytona/workspace/pediatric-diseases/output';
if (!fs.existsSync(outPath)) fs.mkdirSync(outPath, { recursive: true });

Packer.toBuffer(doc).then((buffer) => {
  const file = path.join(outPath, '30_Important_Pediatric_Diseases.docx');
  fs.writeFileSync(file, buffer);
  console.log(file);
}).catch(err => {
  console.error(err);
  process.exit(1);
});