SHORT CASES - GYNAECOLOGY: Diagnosis, Workup & Management

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether, PageBreak
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import Frame, PageTemplate
from reportlab.pdfgen import canvas
from datetime import date

OUTPUT = "/tmp/workspace/gynae-rounds-pdf/Gynae_Short_Cases_Quick_Reference.pdf"

# ── Colour palette ──────────────────────────────────────────────────────────
NAVY      = colors.HexColor("#1B3A6B")
TEAL      = colors.HexColor("#007F8B")
SAGE      = colors.HexColor("#E8F5F7")
ACCENT    = colors.HexColor("#D94F4F")
GOLD      = colors.HexColor("#F0A500")
LIGHT_GRY = colors.HexColor("#F5F5F5")
MID_GRY   = colors.HexColor("#CCCCCC")
WHITE     = colors.white
BLACK     = colors.black

# ── Styles ──────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def S(name, **kw):
    """Quick style builder."""
    return ParagraphStyle(name, **kw)

TITLE_STYLE = S("Title", fontSize=20, textColor=WHITE, alignment=TA_CENTER,
                fontName="Helvetica-Bold", spaceAfter=2)
SUBTITLE_STYLE = S("Sub", fontSize=11, textColor=colors.HexColor("#B0D8E0"),
                   alignment=TA_CENTER, fontName="Helvetica", spaceAfter=4)
CASE_HEADER = S("CaseH", fontSize=13, textColor=WHITE, fontName="Helvetica-Bold",
                alignment=TA_LEFT, leading=16)
SECTION_LABEL = S("SecL", fontSize=8, textColor=TEAL, fontName="Helvetica-Bold",
                  spaceAfter=1, spaceBefore=4)
BODY = S("Body", fontSize=8.5, textColor=BLACK, fontName="Helvetica",
         leading=12, spaceAfter=1)
BULLET = S("Bul", fontSize=8.5, textColor=BLACK, fontName="Helvetica",
           leading=12, leftIndent=10, bulletIndent=0, spaceAfter=1)
DIAG_STYLE = S("Diag", fontSize=10, textColor=NAVY, fontName="Helvetica-Bold",
               spaceAfter=2)
SMALL = S("Sm", fontSize=7.5, textColor=colors.HexColor("#555555"),
          fontName="Helvetica", leading=10)
TABLE_HDR = S("TH", fontSize=8, textColor=WHITE, fontName="Helvetica-Bold",
              alignment=TA_CENTER, leading=10)
TABLE_CELL = S("TC", fontSize=8, textColor=BLACK, fontName="Helvetica",
               alignment=TA_LEFT, leading=10)

# ── Header/Footer canvas callback ───────────────────────────────────────────
def header_footer(canvas_obj, doc):
    canvas_obj.saveState()
    W, H = A4
    # Footer
    canvas_obj.setFont("Helvetica", 7)
    canvas_obj.setFillColor(colors.HexColor("#888888"))
    canvas_obj.drawString(1.5*cm, 0.8*cm,
        f"Gynaecology Short Cases | Quick Reference | {date.today().strftime('%B %Y')}")
    canvas_obj.drawRightString(W - 1.5*cm, 0.8*cm,
        f"Page {doc.page}")
    canvas_obj.setStrokeColor(MID_GRY)
    canvas_obj.setLineWidth(0.3)
    canvas_obj.line(1.5*cm, 1.0*cm, W - 1.5*cm, 1.0*cm)
    canvas_obj.restoreState()

# ── Helper: coloured banner row for a case ──────────────────────────────────
def case_banner(case_num, title, diagnosis):
    data = [[
        Paragraph(f"CASE {case_num}", CASE_HEADER),
        Paragraph(title, CASE_HEADER),
        Paragraph(f"Dx: {diagnosis}", S("DxBan", fontSize=9.5, textColor=GOLD,
                  fontName="Helvetica-Bold", alignment=TA_LEFT, leading=13)),
    ]]
    col_widths = [2.0*cm, 8.0*cm, 7.5*cm]
    t = Table(data, colWidths=col_widths)
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), NAVY),
        ("TOPPADDING",   (0,0), (-1,-1), 6),
        ("BOTTOMPADDING",(0,0), (-1,-1), 6),
        ("LEFTPADDING",  (0,0), (-1,-1), 8),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("VALIGN",       (0,0), (-1,-1), "MIDDLE"),
        ("LINEBELOW", (0,0), (-1,-1), 1, TEAL),
    ]))
    return t

# ── Helper: two-column workup + management table ────────────────────────────
def workup_mgmt_table(inv_rows, mgmt_bullets):
    """inv_rows: list of (Investigation, Purpose)  |  mgmt_bullets: list of strings"""
    left_data = [[
        Paragraph("INVESTIGATIONS / WORKUP", TABLE_HDR),
        Paragraph("PURPOSE", TABLE_HDR),
    ]]
    for inv, pur in inv_rows:
        left_data.append([
            Paragraph(inv, S("TCI", fontSize=8, fontName="Helvetica-Bold",
                             textColor=NAVY, leading=10)),
            Paragraph(pur, TABLE_CELL),
        ])

    right_data = [[Paragraph("MANAGEMENT", TABLE_HDR)]]
    for b in mgmt_bullets:
        right_data.append([Paragraph(f"\u2022  {b}", BULLET)])

    # Build left table
    lt = Table(left_data, colWidths=[4.5*cm, 5.5*cm])
    lt.setStyle(TableStyle([
        ("BACKGROUND",   (0,0), (-1,0), TEAL),
        ("BACKGROUND",   (0,1), (-1,-1), LIGHT_GRY),
        ("ROWBACKGROUNDS",(0,1),(-1,-1),[WHITE, LIGHT_GRY]),
        ("GRID",         (0,0), (-1,-1), 0.3, MID_GRY),
        ("TOPPADDING",   (0,0), (-1,-1), 3),
        ("BOTTOMPADDING",(0,0), (-1,-1), 3),
        ("LEFTPADDING",  (0,0), (-1,-1), 5),
        ("RIGHTPADDING", (0,0), (-1,-1), 4),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
    ]))

    # Build right table
    rt = Table(right_data, colWidths=[7.0*cm])
    rt.setStyle(TableStyle([
        ("BACKGROUND",   (0,0), (-1,0), ACCENT),
        ("BACKGROUND",   (0,1), (-1,-1), colors.HexColor("#FFF5F5")),
        ("ROWBACKGROUNDS",(0,1),(-1,-1),[WHITE, colors.HexColor("#FFF5F5")]),
        ("GRID",         (0,0), (-1,-1), 0.3, MID_GRY),
        ("TOPPADDING",   (0,0), (-1,-1), 3),
        ("BOTTOMPADDING",(0,0), (-1,-1), 3),
        ("LEFTPADDING",  (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 4),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
    ]))

    combined = Table([[lt, Spacer(0.3*cm,0), rt]], colWidths=[10.2*cm, 0.3*cm, 7.2*cm])
    combined.setStyle(TableStyle([
        ("VALIGN", (0,0), (-1,-1), "TOP"),
        ("LEFTPADDING", (0,0), (-1,-1), 0),
        ("RIGHTPADDING", (0,0), (-1,-1), 0),
        ("TOPPADDING", (0,0), (-1,-1), 0),
        ("BOTTOMPADDING", (0,0), (-1,-1), 0),
    ]))
    return combined

# ── Helper: key facts ribbon ────────────────────────────────────────────────
def facts_ribbon(facts):
    """facts: list of (label, value)"""
    cells = []
    for label, val in facts:
        cells.append(Paragraph(
            f'<font color="#007F8B"><b>{label}:</b></font> {val}',
            S("FR", fontSize=8, fontName="Helvetica", leading=10, textColor=BLACK)
        ))
    t = Table([cells], colWidths=[17.7*cm/len(facts)]*len(facts))
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), SAGE),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0),(-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING",(0,0),(-1,-1), 6),
        ("BOX", (0,0),(-1,-1), 0.5, TEAL),
        ("INNERGRID", (0,0),(-1,-1), 0.3, MID_GRY),
        ("VALIGN", (0,0),(-1,-1), "MIDDLE"),
    ]))
    return t

# ── Case data ────────────────────────────────────────────────────────────────
CASES = [

    # ── CASE 1 ──────────────────────────────────────────────────────────────
    dict(
        num=1, short="65F | DM 30y | Postmenopausal 18y | PMB 4 months | Uterus 8wks",
        diagnosis="Endometrial Carcinoma (Type I Endometrioid)",
        facts=[("Age","65F"), ("Key Sx","Postmenopausal bleeding"), ("Risk","DM + HTN"),
               ("FIGO","Confirm by MRI + biopsy"), ("Stage clue","Ut enlarged 8wks")],
        inv=[
            ("Endometrial Biopsy (Pipelle)", "Gold standard tissue diagnosis"),
            ("TVUS endometrial thickness", ">4 mm in PMB is significant"),
            ("Fractional D&C", "If biopsy inconclusive / Cx involvement"),
            ("MRI Pelvis", "Myometrial invasion depth, Cx spread, staging"),
            ("CT Chest/Abdomen/Pelvis", "Lymph nodes, distant mets"),
            ("CA-125", "Baseline; elevated in advanced disease"),
            ("CBC, LFT, RFT, HbA1c", "Preop + DM assessment"),
        ],
        mgmt=[
            "TAH + BSO + pelvic & para-aortic lymph node dissection",
            "Adjuvant vaginal brachytherapy: Stage IB (deep invasion)",
            "Pelvic EBRT: Stage II-III disease",
            "Chemotherapy (advanced/recurrent): Carboplatin + Paclitaxel",
            "Hormonal therapy: MPA/Megace for Grade 1 unfit for surgery",
            "Optimize DM and HTN preoperatively",
        ],
    ),

    # ── CASE 2 ──────────────────────────────────────────────────────────────
    dict(
        num=2, short="30F | Nullipara | Menorrhagia 4y | Dysmenorrhoea | Uterus 10wks symmetrical",
        diagnosis="Fibroid Uterus (Leiomyoma) - Submucosal/Intramural",
        facts=[("Age","30F"), ("Parity","Nulliparous"), ("Key Sx","Menorrhagia + dysmenorrhoea"),
               ("Uterus","10 wks, symmetrical"), ("Pallor","++")],
        inv=[
            ("Transvaginal USG", "Fibroid number, size, subtype"),
            ("CBC + Iron studies", "Degree of iron-deficiency anaemia"),
            ("Hysteroscopy", "Gold standard submucosal fibroids"),
            ("MRI pelvis", "Mapping before myomectomy/UAE"),
            ("TSH", "Rule out hypothyroidism"),
            ("Endometrial biopsy", "Abnormal bleeding pattern workup"),
            ("Coagulation profile", "Rule out bleeding disorder"),
        ],
        mgmt=[
            "MEDICAL: Iron supplementation, Tranexamic acid, NSAIDs",
            "OCP or LNG-IUS (Mirena) to reduce menstrual flow",
            "GnRH agonist (Leuprolide) x3-6 months preop - shrinks fibroid",
            "SURGICAL: Myomectomy (fertility-preserving) - laparoscopic/hysteroscopic",
            "Hysteroscopic myomectomy for submucosal fibroids",
            "UAE (Uterine Artery Embolisation) - minimally invasive option",
        ],
    ),

    # ── CASE 3 ──────────────────────────────────────────────────────────────
    dict(
        num=3, short="64F | Postmenopausal 20y | P3L3 | Pelvic mass + gross ascites | Left ovarian complex mass 10x8x9 cm",
        diagnosis="Carcinoma Ovary - Epithelial (HGSC), Stage IIIC",
        facts=[("Age","64F"), ("Triad","PM + Adnexal mass + Ascites"), ("Mass","Left ovary 10x8x9 cm complex"),
               ("Stage","IIIC - peritoneal spread"), ("Marker","CA-125 + HE4/ROMA")],
        inv=[
            ("CA-125 + HE4 / ROMA score", "Malignancy risk stratification"),
            ("CEA, CA 19-9", "Rule out GI primary"),
            ("Contrast CT abdomen/pelvis", "Extent, nodes, peritoneal deposits"),
            ("MRI pelvis", "Ovarian mass characterisation"),
            ("Diagnostic paracentesis", "Cytology for malignant cells"),
            ("BRCA1/BRCA2 gene testing", "Treatment + genetic implications"),
            ("CBC, LFT, albumin, RFT", "Nutritional/preop status"),
            ("CXR / CT chest", "Pleural effusion, Stage IV"),
        ],
        mgmt=[
            "Optimal cytoreductive surgery: TAH + BSO + omentectomy + peritoneal stripping",
            "Aim for no residual disease (<1 cm) - key prognostic factor",
            "Chemotherapy: Carboplatin AUC5 + Paclitaxel 175 mg/m², 6 cycles",
            "Bevacizumab add-on for high-risk Stage III/IV",
            "PARP inhibitors (Olaparib/Niraparib) maintenance if BRCA-mutated",
            "NACT + interval debulking if unresectable / poor performance status",
            "Symptomatic ascites: serial paracentesis / PleurX catheter",
        ],
    ),

    # ── CASE 4 ──────────────────────────────────────────────────────────────
    dict(
        num=4, short="30F | P2 | LCB 3y | Menorrhagia + pelvic pain 6m | Uterus 16wks irregular",
        diagnosis="Fibroid Uterus - Multiple (Family Complete)",
        facts=[("Age","30F"), ("Parity","Para 2 - family complete"), ("Uterus","16 wks, irregular"),
               ("Key Sx","Menorrhagia + dysmenorrhoea"), ("Plan","Hysterectomy preferred")],
        inv=[
            ("Transvaginal/Abdominal USG", "Fibroid mapping, number, size"),
            ("MRI pelvis", "Preoperative planning"),
            ("Pap smear", "Cervical cytology - standard of care"),
            ("CBC + iron studies", "Severity of anaemia"),
            ("HbA1c, blood group", "Preoperative workup"),
            ("Coagulation profile", "Rule out bleeding disorder"),
        ],
        mgmt=[
            "Definitive: Total abdominal hysterectomy (TAH) - family complete",
            "Laparoscopic hysterectomy if surgical expertise available",
            "GnRH agonist preop: shrink fibroid, correct anaemia",
            "Iron + Folic acid supplementation preoperatively",
            "Target Hb >10 g/dL before surgery",
            "If fertility desired: Myomectomy (high recurrence risk at 16 wks size)",
        ],
    ),

    # ── CASE 5 ──────────────────────────────────────────────────────────────
    dict(
        num=5, short="35F | DM Type 2 | P2 | Perineal itching | Curdy discharge | White flakes with oozing spots",
        diagnosis="Vulvovaginal Candidiasis (Complicated - Diabetic Patient)",
        facts=[("Age","35F"), ("Risk","DM Type 2 - poor glucose control"), ("D/C","Thick curdy/cottage-cheese"),
               ("Sign","White flakes; bleed on removal"), ("pH","<4.5 (normal)")],
        inv=[
            ("Wet mount + KOH prep", "Budding yeast + pseudohyphae - POC diagnosis"),
            ("HVS culture + sensitivity", "Speciation (C. glabrata = azole-resistant)"),
            ("Vaginal pH", "<4.5 in VVC; >4.5 in BV/Trichomonas"),
            ("Fasting glucose + HbA1c", "Assess diabetic control"),
            ("Urine R/E", "Glucosuria"),
            ("HIV serology", "Immunocompromise if recurrent VVC"),
        ],
        mgmt=[
            "Local: Clotrimazole 500 mg pessary single dose OR 100 mg x7d",
            "Miconazole cream for external vulval involvement",
            "Systemic: Fluconazole 150 mg oral single dose (1st line)",
            "Severe/complicated: Fluconazole 150 mg q72h x 3 doses",
            "Recurrent VVC (≥4 episodes/yr): Fluconazole 150 mg weekly x 6 months",
            "STRICT glycaemic control (HbA1c target <7%) - prevent recurrence",
            "Avoid tight synthetic clothing, local irritants",
        ],
    ),

    # ── CASE 6 ──────────────────────────────────────────────────────────────
    dict(
        num=6, short="58F | P7 | Low SES | Irregular PVB 1y | Foul discharge | Fungating Cx | Bilateral parametrium to lateral wall",
        diagnosis="Carcinoma Cervix - Stage IIIB",
        facts=[("Age","58F"), ("Parity","P7 - multipara"), ("Stage","IIIB - parametrium bilateral to lat wall"),
               ("Cx","Fungating, bleeds on touch"), ("Rectum","Free (not IVA)")],
        inv=[
            ("Cervical punch biopsy", "Histopath confirmation (SCC 80%)"),
            ("MRI pelvis", "Parametrial invasion, nodal involvement"),
            ("CT chest/abdomen/pelvis", "Nodal mets, distant spread"),
            ("Cystoscopy", "Rule out bladder = Stage IVA"),
            ("Proctosigmoidoscopy", "Rule out rectal involvement"),
            ("IVU / CT urography", "Hydronephrosis = Stage IIIB criterion"),
            ("CBC, LFT, RFT", "Anaemia +++, organ function"),
            ("Blood group + cross-match", "May need transfusion preRT"),
        ],
        mgmt=[
            "Stage IIIB: NOT operable - Concurrent Chemoradiation (CCRT)",
            "EBRT to pelvis: 45-50 Gy in 25 fractions over 5 weeks",
            "Intracavitary brachytherapy (ICBT): central disease boost",
            "Cisplatin 40 mg/m² IV weekly concurrent (radiosensitiser)",
            "Correct anaemia to Hb >10 g/dL BEFORE radiotherapy",
            "Ureteric obstruction: stenting or nephrostomy",
            "Nutritional support + palliative care team involvement",
        ],
    ),

    # ── CASE 7 ──────────────────────────────────────────────────────────────
    dict(
        num=7, short="50F | Menopausal 1y | P4 | Chronic cough | Cystocele + Rectocele | Cervix outside introitus | Decubitus ulcers",
        diagnosis="3rd Degree Uterovaginal Prolapse + Cystocele + Rectocele",
        facts=[("Age","50F"), ("Parity","P4 - rapid succession"), ("Grade","3rd degree / Complete prolapse"),
               ("Complication","Decubitus ulcers on Cx lips"), ("RF","Cough + Menopause + Prolonged labour")],
        inv=[
            ("POP-Q assessment", "Objective staging of prolapse"),
            ("Biopsy of decubitus ulcer", "MUST rule out carcinomatous change"),
            ("Pap smear + colposcopy", "Cervical cytology"),
            ("Urodynamics", "If stress incontinence; pre-surgical planning"),
            ("Urine R/E + C&S", "Associated UTI"),
            ("USG pelvis", "Uterine/adnexal pathology"),
            ("CXR + spirometry", "Chronic cough - preop chest assessment"),
            ("CBC, blood sugar, ECG", "Preoperative assessment"),
        ],
        mgmt=[
            "PRE-OP: Local oestrogen + saline soaks + ring pessary x 4-6 wks to heal ulcers",
            "DEFINITIVE SURGICAL: Vaginal hysterectomy (procedure of choice)",
            "Anterior colporrhaphy: cystocele repair",
            "Posterior colpoperineorrhaphy: rectocele repair",
            "Pelvic floor repair at same sitting",
            "CONSERVATIVE (unfit): Ring pessary + pelvic floor exercises",
            "Treat chronic cough (bronchodilators) to prevent recurrence",
        ],
    ),

    # ── CASE 8 ──────────────────────────────────────────────────────────────
    dict(
        num=8, short="28F | P2 | LCB 3y | Post-coital bleeding 2m | Fungating growth post lip Cx 3cm | Parametrium free",
        diagnosis="Carcinoma Cervix - Stage IB1 (Lesion ≤4 cm, confined to cervix)",
        facts=[("Age","28F"), ("Stage","IB1 - visible lesion ≤4 cm"), ("Growth","3 cm post lip"),
               ("Parametrium","Free"), ("Preference","Surgery - young patient, preserve ovaries")],
        inv=[
            ("Cervical punch biopsy", "Histopath confirmation"),
            ("Colposcopy + directed biopsy", "Map lesion extent"),
            ("MRI pelvis", "Tumour size, stroma, nodes, parametrium"),
            ("PET-CT", "Nodal staging - surgical candidate"),
            ("Cystoscopy + Proctoscopy", "Rule out Stage IVA"),
            ("HPV DNA genotyping", "Documentation (HPV 16/18)"),
            ("CBC, LFT, RFT, CXR", "Preoperative workup"),
        ],
        mgmt=[
            "Stage IB1: SURGICAL preferred in young patient",
            "Wertheim's Radical Hysterectomy: uterus + upper vaginal cuff + parametria + PLND",
            "Advantage over CCRT: ovaries preserved, no RT vaginal stenosis",
            "Adjuvant CCRT post-surgery if: +ve nodes, +ve margins, parametrial involvement",
            "Alternative: CCRT (equivalent oncological outcome if surgery contraindicated)",
            "Fertility-sparing: Radical trachelectomy if lesion ≤2 cm (this lesion 3 cm - MDT decision)",
        ],
    ),

    # ── CASE 9 ──────────────────────────────────────────────────────────────
    dict(
        num=9, short="26F | Recently married | Burning micturition + Foul discharge 10d | Frothy greenish D/C | Punctate haemorrhagic spots vaginal walls",
        diagnosis="Trichomoniasis (Trichomonas vaginalis)",
        facts=[("Age","26F"), ("Discharge","Thin, frothy, greenish-yellow, foul"), ("Sign","Strawberry cervix/vagina"),
               ("pH","Elevated >4.5 (alkaline)"), ("STI","Screen for coinfections")],
        inv=[
            ("Wet mount microscopy", "Motile pear-shaped flagellated trichomonads - POC"),
            ("Vaginal pH", ">4.5 alkaline in Trichomonas"),
            ("NAAT (gold standard)", "Highest sensitivity ~98%"),
            ("HVS culture (Diamond's medium)", "If wet mount negative"),
            ("Gram stain", "Rule out concurrent BV"),
            ("HIV, VDRL, Chlamydia, GC NAAT", "Full STI screen - coinfections common"),
            ("Partner testing", "Essential for eradication"),
        ],
        mgmt=[
            "Metronidazole 2 g orally, SINGLE DOSE (1st line)",
            "Tinidazole 2 g single dose (alternative, better GI tolerance)",
            "If failure: Metronidazole 400-500 mg BD x 7 days",
            "TREAT SEXUAL PARTNER SIMULTANEOUSLY (prevent reinfection)",
            "Avoid alcohol during + 48h after metronidazole (disulfiram reaction)",
            "Retest at 3 months; safe sex counselling",
            "Notify STI contacts",
        ],
    ),

    # ── CASE 10 ─────────────────────────────────────────────────────────────
    dict(
        num=10, short="30F | Vaginal delivery 7m ago (home, forceps, 2-day labour, stillbirth 3.5kg) | Continuous dribbling urine 7m | Hole 0.5x1 cm vesico-cervical junction",
        diagnosis="Vesico-Vaginal Fistula (VVF) - Obstetric / Iatrogenic",
        facts=[("Age","30F"), ("Cause","Obstructed labour + forceps"), ("Fistula","0.5x1 cm vesico-cervical jn."),
               ("Symptom","Continuous urine dribbling"), ("Wait","Repair after 3 months")],
        inv=[
            ("Dye test (methylene blue)", "200 mL in bladder → blue seen vaginally = VVF"),
            ("Three-swab test", "Differentiate VVF vs ureterovaginal fistula"),
            ("Cystoscopy + vaginoscopy", "Site, size, distance from ureteric orifices"),
            ("IVU / CT urography", "Rule out ureterovaginal fistula; upper tracts"),
            ("MRI pelvis", "Complex fistulas, tissue necrosis extent"),
            ("Urine R/E + C&S", "Treat UTI before surgery"),
            ("RFT + CBC", "Renal function + preoperative status"),
            ("Biopsy fistula edge", "Rule out malignancy (if radiation-related)"),
        ],
        mgmt=[
            "CONSERVATIVE (small fresh <72h or <3mm): Foley catheter x 4-6 wks",
            "Antibiotics + anticholinergics during conservative management",
            "SURGICAL: WAIT 3 MONTHS for oedema/inflammation to resolve",
            "Transvaginal layered repair (1st line for obstetric VVF)",
            "Latzko operation for post-hysterectomy VVF",
            "Transabdominal (O'Connor) for complex/recurrent VVF",
            "Principles: wide mobilisation, tension-free closure, layered repair",
            "Post-repair: Foley catheter x 14-21 days + anticholinergics + pelvic rest",
        ],
    ),
]

# ── Summary table data ───────────────────────────────────────────────────────
SUMMARY_ROWS = [
    ["Case", "Diagnosis", "Key Investigation", "Management"],
    ["1", "Endometrial Carcinoma", "Endometrial Biopsy + MRI Pelvis", "TAH+BSO+LND ± RT/Chemo"],
    ["2", "Fibroid Uterus (Nullipara)", "TVUS + Hysteroscopy", "Myomectomy (fertility-preserving)"],
    ["3", "Carcinoma Ovary Stage IIIC", "CA-125 + CT Abdomen/Pelvis", "Debulking + Carbo/Taxol"],
    ["4", "Fibroid Uterus (P2, family complete)", "TVUS + MRI", "TAH (abdominal hysterectomy)"],
    ["5", "Vulvovaginal Candidiasis (DM)", "KOH Wet Mount + HVS Culture", "Fluconazole 150 mg + glycaemic control"],
    ["6", "Ca Cervix Stage IIIB", "Cervical Biopsy + MRI + Cystoscopy", "CCRT (Cisplatin + EBRT + ICBT)"],
    ["7", "3° Uterovaginal Prolapse", "POP-Q + Ulcer Biopsy + Urodynamics", "Vaginal Hyst. + Colporrhaphy"],
    ["8", "Ca Cervix Stage IB1", "Cervical Biopsy + MRI + PET-CT", "Wertheim's Radical Hysterectomy"],
    ["9", "Trichomoniasis", "Wet Mount + NAAT + STI Screen", "Metronidazole 2 g stat + treat partner"],
    ["10", "Vesico-Vaginal Fistula (Obstetric)", "Dye Test + Cystoscopy + IVU", "Transvaginal fistula repair (after 3 mths)"],
]

# ── Build PDF ────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    leftMargin=1.3*cm, rightMargin=1.3*cm,
    topMargin=1.8*cm, bottomMargin=1.8*cm,
)

story = []

# ── Cover band ───────────────────────────────────────────────────────────────
cover_data = [[
    Paragraph("GYNAECOLOGY SHORT CASES", TITLE_STYLE),
]]
cover_sub = [[
    Paragraph("Clinical Summary for Quick Reference During Rounds", SUBTITLE_STYLE),
]]
for d in [cover_data, cover_sub]:
    t = Table(d, colWidths=[17.7*cm])
    bg = NAVY if d is cover_data else TEAL
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0),(-1,-1), bg),
        ("TOPPADDING", (0,0),(-1,-1), 10 if d is cover_data else 6),
        ("BOTTOMPADDING",(0,0),(-1,-1), 10 if d is cover_data else 6),
        ("LEFTPADDING", (0,0),(-1,-1), 10),
        ("RIGHTPADDING",(0,0),(-1,-1), 10),
    ]))
    story.append(t)

story.append(Spacer(1, 0.25*cm))

# meta line
meta = Table([[
    Paragraph("10 Clinical Cases  |  Diagnosis + Workup + Management", SMALL),
    Paragraph(f"Date: {date.today().strftime('%d %B %Y')}", S("MR", fontSize=7.5,
              textColor=colors.HexColor("#555555"), alignment=TA_LEFT, fontName="Helvetica")),
]], colWidths=[13*cm, 4.7*cm])
meta.setStyle(TableStyle([
    ("TOPPADDING",(0,0),(-1,-1),2), ("BOTTOMPADDING",(0,0),(-1,-1),2),
    ("LEFTPADDING",(0,0),(-1,-1),2), ("RIGHTPADDING",(0,0),(-1,-1),2),
]))
story.append(meta)
story.append(HRFlowable(width="100%", thickness=0.5, color=TEAL, spaceAfter=6))

# ── Individual cases ─────────────────────────────────────────────────────────
for c in CASES:
    block = []
    block.append(case_banner(c["num"], c["short"], c["diagnosis"]))
    block.append(Spacer(1, 0.2*cm))
    block.append(facts_ribbon(c["facts"]))
    block.append(Spacer(1, 0.2*cm))
    block.append(workup_mgmt_table(c["inv"], c["mgmt"]))
    block.append(Spacer(1, 0.4*cm))
    story.append(KeepTogether(block[:3]))  # banner + facts together
    story.extend(block[3:])               # table can flow

# ── Summary table ────────────────────────────────────────────────────────────
story.append(PageBreak())
story.append(Paragraph("QUICK REFERENCE SUMMARY TABLE", S("ST", fontSize=13,
             textColor=NAVY, fontName="Helvetica-Bold", spaceAfter=8)))
story.append(HRFlowable(width="100%", thickness=1, color=TEAL, spaceAfter=8))

sm_data = []
for i, row in enumerate(SUMMARY_ROWS):
    if i == 0:
        sm_data.append([Paragraph(c, TABLE_HDR) for c in row])
    else:
        styled = [
            Paragraph(row[0], S("SN", fontSize=8.5, fontName="Helvetica-Bold",
                                 textColor=WHITE, alignment=TA_CENTER)),
            Paragraph(row[1], S("SD", fontSize=8, fontName="Helvetica-Bold", textColor=NAVY)),
            Paragraph(row[2], S("SI", fontSize=8, fontName="Helvetica", textColor=BLACK)),
            Paragraph(row[3], S("SM", fontSize=8, fontName="Helvetica", textColor=BLACK)),
        ]
        sm_data.append(styled)

sm_table = Table(sm_data, colWidths=[1.1*cm, 5.2*cm, 5.7*cm, 5.7*cm])
row_bgs = []
for i in range(1, len(SUMMARY_ROWS)):
    bg = LIGHT_GRY if i % 2 == 0 else WHITE
    row_bgs.append(("BACKGROUND", (0,i), (-1,i), bg))
    if i % 2 == 1:
        row_bgs.append(("BACKGROUND", (0,i), (0,i), NAVY))  # case number cell NAVY
    else:
        row_bgs.append(("BACKGROUND", (0,i), (0,i), TEAL))  # case number cell TEAL

sm_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), NAVY),
    *row_bgs,
    ("GRID", (0,0), (-1,-1), 0.4, MID_GRY),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING",(0,0),(-1,-1), 4),
    ("LEFTPADDING", (0,0), (-1,-1), 5),
    ("RIGHTPADDING",(0,0),(-1,-1), 5),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
    ("ALIGN", (0,0), (0,-1), "CENTER"),
    ("FONTNAME", (0,1),(0,-1), "Helvetica-Bold"),
    ("TEXTCOLOR", (0,0),(-1,0), WHITE),
    ("TEXTCOLOR", (0,1),(0,-1), WHITE),
]))
story.append(sm_table)

story.append(Spacer(1, 0.5*cm))
story.append(HRFlowable(width="100%", thickness=0.3, color=MID_GRY, spaceAfter=4))
story.append(Paragraph(
    "Reference: Berek & Novak's Gynecology | Robbins Pathology | Campbell-Walsh Urology | Harrison's Internal Medicine",
    S("Ref", fontSize=7, textColor=colors.HexColor("#888888"), fontName="Helvetica-Oblique",
      alignment=TA_CENTER)
))

# ── Build ─────────────────────────────────────────────────────────────────────
doc.build(story, onFirstPage=header_footer, onLaterPages=header_footer)
print(f"PDF created: {OUTPUT}")