#!/usr/bin/env python3
"""
Handwritten-style PDF notes: General Surgery - Principles & Instruments
Uses Caveat font (Google Fonts handwriting) + reportlab
"""

import os
from reportlab.lib.pagesizes import A4
from reportlab.lib.units import cm, mm
from reportlab.lib import colors
from reportlab.pdfgen import canvas
from reportlab.pdfbase import pdfmetrics
from reportlab.pdfbase.ttfonts import TTFont

# ── Paths ──────────────────────────────────────────────────────────────────
FONT_DIR   = "/home/daytona/workspace/fonts"
OUT_DIR    = "/home/daytona/workspace/surgery-notes"
OUT_FILE   = os.path.join(OUT_DIR, "General_Surgery_Principles_Instruments.pdf")
os.makedirs(OUT_DIR, exist_ok=True)

# ── Register Caveat ────────────────────────────────────────────────────────
pdfmetrics.registerFont(TTFont("Caveat",     os.path.join(FONT_DIR, "Caveat-Regular.ttf")))
pdfmetrics.registerFont(TTFont("CaveatBold", os.path.join(FONT_DIR, "Caveat-Bold.ttf")))

# ── Palette ────────────────────────────────────────────────────────────────
BG        = colors.HexColor("#FEFDF6")   # warm cream
LINE      = colors.HexColor("#C8D8E8")   # faint ruled-line blue
MARGIN_L  = colors.HexColor("#F5B8B8")   # red margin line
INK       = colors.HexColor("#1A1A2E")   # dark navy ink
HEADING   = colors.HexColor("#1B3A6B")   # deep blue heading
SUB_H     = colors.HexColor("#8B1A1A")   # dark-red subheading
BULLET    = colors.HexColor("#2E6B2E")   # green bullet
STAR      = colors.HexColor("#B8860B")   # gold star/key-point
HIGHLIGHT = colors.HexColor("#FFF176")   # yellow highlight
BOX_BG    = colors.HexColor("#EAF4FB")   # light blue box
BOX_BORD  = colors.HexColor("#2196F3")   # blue border

W, H = A4           # 595.27 x 841.89 pts
LM   = 2.5 * cm     # left margin  (after red line)
RM   = W - 1.6*cm   # right margin
TM   = H - 1.8*cm   # top margin
BM   = 1.5 * cm     # bottom margin

LINE_SPACING = 24   # pts between ruled lines
RED_X        = 1.8 * cm  # x of red margin line

# ── Canvas helper ──────────────────────────────────────────────────────────
class NoteWriter:
    def __init__(self, filename):
        self.c = canvas.Canvas(filename, pagesize=A4)
        self.page_num = 0
        self._new_page()

    # ── Background & ruled lines ─────────────────────────────────────────
    def _draw_bg(self):
        c = self.c
        # cream background
        c.setFillColor(BG)
        c.rect(0, 0, W, H, fill=1, stroke=0)
        # ruled lines
        c.setStrokeColor(LINE)
        c.setLineWidth(0.4)
        y = TM
        while y > BM:
            c.line(0, y, W, y)
            y -= LINE_SPACING
        # red margin line
        c.setStrokeColor(MARGIN_L)
        c.setLineWidth(1.0)
        c.line(RED_X, TM + 10, RED_X, BM - 5)
        # page number
        c.setFont("Caveat", 11)
        c.setFillColor(INK)
        c.drawCentredString(W/2, BM - 8, f"— {self.page_num} —")

    def _new_page(self):
        if self.page_num > 0:
            self.c.showPage()
        self.page_num += 1
        self.y = TM - 6
        self._draw_bg()

    def _check_space(self, needed=26):
        if self.y - needed < BM + 5:
            self._new_page()

    # ── Layout helpers ───────────────────────────────────────────────────
    def skip(self, pts=8):
        self.y -= pts
        if self.y < BM + 5:
            self._new_page()

    def draw_title(self, text):
        """Big centred title with underline box"""
        self._check_space(52)
        c = self.c
        # title box
        bh = 38
        c.setFillColor(HEADING)
        c.roundRect(LM - 4, self.y - bh + 6, RM - LM + 8, bh, 6, fill=1, stroke=0)
        c.setFillColor(colors.white)
        c.setFont("CaveatBold", 26)
        c.drawCentredString(W/2, self.y - 22, text)
        self.y -= bh + 8

    def draw_section(self, text, number=None):
        """Major section heading"""
        self._check_space(36)
        c = self.c
        self.y -= 6
        # underline bar
        c.setFillColor(HEADING)
        c.rect(LM - 4, self.y - 18, RM - LM + 8, 24, fill=1, stroke=0)
        label = f"  {number}  {text}" if number else f"  {text}"
        c.setFillColor(colors.white)
        c.setFont("CaveatBold", 18)
        c.drawString(LM + 2, self.y - 12, label)
        self.y -= 30

    def draw_subsection(self, text):
        """Sub-heading (dark red, underline)"""
        self._check_space(28)
        c = self.c
        self.y -= 4
        c.setFont("CaveatBold", 15)
        c.setFillColor(SUB_H)
        c.drawString(LM, self.y, text)
        # underline
        tw = c.stringWidth(text, "CaveatBold", 15)
        c.setStrokeColor(SUB_H)
        c.setLineWidth(1.0)
        c.line(LM, self.y - 2, LM + tw, self.y - 2)
        self.y -= 20

    def draw_para(self, text, indent=0, size=13, color=None):
        """Normal paragraph with auto-wrap"""
        c   = self.c
        col = color or INK
        c.setFont("Caveat", size)
        c.setFillColor(col)
        max_w = RM - LM - indent - 4
        # naive word-wrap
        words  = text.split()
        lines  = []
        cur    = ""
        for w in words:
            test = (cur + " " + w).strip()
            if c.stringWidth(test, "Caveat", size) <= max_w:
                cur = test
            else:
                if cur:
                    lines.append(cur)
                cur = w
        if cur:
            lines.append(cur)
        for line in lines:
            self._check_space(LINE_SPACING)
            c.drawString(LM + indent, self.y, line)
            self.y -= LINE_SPACING

    def draw_bullet(self, text, level=0, key=False):
        """Bullet point; key=True → gold star"""
        sym    = "★" if key else ("•" if level == 0 else "◦")
        sym_c  = STAR if key else BULLET
        indent = 18 + level * 14
        c = self.c
        c.setFont("CaveatBold" if key else "Caveat", 13 if not key else 13)
        c.setFillColor(sym_c)
        self._check_space(LINE_SPACING)
        c.drawString(LM + indent - 14, self.y, sym)
        c.setFillColor(INK)
        c.setFont("Caveat", 13)
        # wrap
        max_w = RM - LM - indent - 4
        words  = text.split()
        lines  = []
        cur    = ""
        for w in words:
            test = (cur + " " + w).strip()
            if c.stringWidth(test, "Caveat", 13) <= max_w:
                cur = test
            else:
                if cur:
                    lines.append(cur)
                cur = w
        if cur:
            lines.append(cur)
        for i, line in enumerate(lines):
            self._check_space(LINE_SPACING)
            x = LM + indent if i == 0 else LM + indent + 4
            c.drawString(x, self.y, line)
            self.y -= LINE_SPACING

    def draw_highlight_box(self, title, lines_list):
        """Highlighted blue info box"""
        c      = self.c
        nlines = len(lines_list) + 1
        bh     = 22 + nlines * LINE_SPACING
        self._check_space(bh + 10)
        # box
        c.setFillColor(BOX_BG)
        c.setStrokeColor(BOX_BORD)
        c.setLineWidth(1.5)
        c.roundRect(LM - 4, self.y - bh + 14, RM - LM + 8, bh, 5, fill=1, stroke=1)
        # title
        c.setFont("CaveatBold", 14)
        c.setFillColor(BOX_BORD)
        c.drawString(LM + 4, self.y + 2, title)
        self.y -= 18
        for line in lines_list:
            self._check_space(LINE_SPACING)
            c.setFont("Caveat", 12)
            c.setFillColor(INK)
            c.drawString(LM + 8, self.y, line)
            self.y -= LINE_SPACING
        self.y -= 8

    def draw_two_col_table(self, rows, col1w_frac=0.45):
        """Simple two-column table"""
        c  = self.c
        tw = RM - LM
        c1 = int(tw * col1w_frac)
        c2 = tw - c1
        row_h = LINE_SPACING + 4
        total_h = row_h * len(rows) + 10
        self._check_space(total_h + 20)
        # header bg
        hdr = rows[0]
        c.setFillColor(HEADING)
        c.rect(LM - 2, self.y - row_h + 8, tw + 4, row_h, fill=1, stroke=0)
        c.setFillColor(colors.white)
        c.setFont("CaveatBold", 13)
        c.drawString(LM + 4, self.y - 6, hdr[0])
        c.drawString(LM + c1 + 4, self.y - 6, hdr[1])
        self.y -= row_h
        # data rows
        for i, row in enumerate(rows[1:]):
            self._check_space(row_h + 4)
            bg = colors.HexColor("#EAF4FB") if i % 2 == 0 else colors.white
            c.setFillColor(bg)
            c.rect(LM - 2, self.y - row_h + 8, tw + 4, row_h, fill=1, stroke=0)
            c.setStrokeColor(LINE)
            c.setLineWidth(0.4)
            c.line(LM - 2, self.y - row_h + 8, RM + 2, self.y - row_h + 8)
            c.setFont("CaveatBold", 12)
            c.setFillColor(SUB_H)
            c.drawString(LM + 4, self.y - 6, str(row[0]))
            c.setFont("Caveat", 12)
            c.setFillColor(INK)
            # wrap col 2
            c.drawString(LM + c1 + 4, self.y - 6, str(row[1]))
            self.y -= row_h
        self.y -= 6

    def save(self):
        self.c.save()
        print(f"Saved → {OUT_FILE}")

# ═══════════════════════════════════════════════════════════════════════════
# CONTENT
# ═══════════════════════════════════════════════════════════════════════════
def build(nw: NoteWriter):

    # ── COVER / TITLE ────────────────────────────────────────────────────
    nw.skip(20)
    nw.draw_title("General Surgery")
    nw.draw_title("Principles & Instruments")
    nw.skip(4)
    nw.draw_para("★  Comprehensive Exam Notes  ★", color=STAR, size=14)
    nw.skip(6)
    nw.draw_para("Based on: Sabiston Textbook of Surgery • Schwartz's Principles of Surgery", size=11, color=colors.HexColor("#555555"))
    nw.skip(20)

    # ════════════════════════════════════════════════════════
    # SECTION 1 — ASEPSIS & STERILISATION
    # ════════════════════════════════════════════════════════
    nw.draw_section("ASEPSIS, STERILISATION & ANTISEPSIS", number="1")

    nw.draw_subsection("Key Definitions")
    nw.draw_bullet("Asepsis: absence of pathogenic micro-organisms from the surgical field")
    nw.draw_bullet("Antisepsis: killing/inhibiting micro-organisms on LIVING tissue")
    nw.draw_bullet("Disinfection: killing micro-organisms on INANIMATE surfaces (not all spores)")
    nw.draw_bullet("Sterilisation: destruction of ALL micro-organisms including spores")
    nw.skip(4)

    nw.draw_subsection("Methods of Sterilisation")
    nw.draw_two_col_table([
        ("Method", "Details / Used for"),
        ("Steam Autoclave (moist heat)", "121°C/15 psi × 15 min  OR  134°C × 3 min — GOLD standard"),
        ("Dry Heat",                    "170°C × 1 hr — glassware, oils, powders"),
        ("Ethylene Oxide (ETO)",         "Low temp; instruments damaged by heat/moisture"),
        ("Gamma / E-beam irradiation",   "Disposable items, sutures, implants"),
        ("Formaldehyde gas",             "Optical instruments"),
        ("Plasma (H₂O₂)",               "Endoscopes, electronic equipment — no toxic residue"),
    ])

    nw.draw_subsection("Common Antiseptics")
    nw.draw_bullet("Povidone-iodine (Betadine) — broad spectrum, bactericidal, sporicidal")
    nw.draw_bullet("Chlorhexidine gluconate — persistent residual activity, NOT sporicidal")
    nw.draw_bullet("Alcohol (70% isopropyl) — rapid action, no residual, flammable")
    nw.draw_bullet("Hydrogen peroxide 3% — wound irrigation, do NOT use in closed cavities")
    nw.draw_bullet("Hexachlorophene — gram-positive organisms; neurotoxic in infants", key=True)
    nw.skip(6)

    nw.draw_highlight_box("⚠ Key Principle",
        ["Surgical scrub = mechanical scrub (2-5 min) + antiseptic solution",
         "Chlorhexidine preferred over povidone-iodine for surgical hand rub",
         "Sterile gloves do NOT replace thorough scrub technique"])

    # ════════════════════════════════════════════════════════
    # SECTION 2 — WOUND HEALING
    # ════════════════════════════════════════════════════════
    nw.draw_section("WOUND HEALING", number="2")

    nw.draw_subsection("Phases of Wound Healing")
    nw.draw_bullet("① Haemostasis (0-minutes):", level=0, key=True)
    nw.draw_bullet("Platelet aggregation → thrombus; vascular spasm; coagulation cascade", level=1)
    nw.draw_bullet("② Inflammatory Phase (0-4 days):", level=0, key=True)
    nw.draw_bullet("Neutrophils (0-2 days) → débridement; Macrophages (2-4 days) → orchestrate repair", level=1)
    nw.draw_bullet("Growth factors: PDGF, TGF-β, EGF released by platelets & macrophages", level=1)
    nw.draw_bullet("③ Proliferative Phase (4-21 days):", level=0, key=True)
    nw.draw_bullet("Fibroblasts → collagen III synthesis; angiogenesis; re-epithelialisation", level=1)
    nw.draw_bullet("Wound contraction: myofibroblasts (peak day 10-14)", level=1)
    nw.draw_bullet("④ Remodelling / Maturation (21 days – 2 years):", level=0, key=True)
    nw.draw_bullet("Collagen III → Collagen I (type I = 80%); tensile strength increases", level=1)
    nw.draw_bullet("Max tensile strength = ~80% of original at ~6-12 months", level=1)
    nw.skip(4)

    nw.draw_subsection("Types of Wound Closure")
    nw.draw_two_col_table([
        ("Type", "Description"),
        ("Primary (1st intention)",  "Wound edges approximated immediately; minimal scar"),
        ("Secondary (2nd intention)", "Wound left open; heals by granulation/contraction; larger scar"),
        ("Tertiary / Delayed 1°",    "Wound left open 3-5 days then closed; contaminated wounds"),
    ])

    nw.draw_subsection("Factors Impairing Healing")
    nw.draw_bullet("Local: infection, ischaemia, foreign body, haematoma, dead space, radiation")
    nw.draw_bullet("Systemic: diabetes, malnutrition (esp. vitamin C, zinc, protein), steroids")
    nw.draw_bullet("Anaemia, uraemia, chemotherapy, jaundice")
    nw.draw_bullet("AGE: elderly → ↓ collagen synthesis, ↓ angiogenesis")
    nw.skip(4)

    nw.draw_subsection("Abnormal Scarring")
    nw.draw_bullet("Hypertrophic scar: raised, within wound boundary, regresses over time")
    nw.draw_bullet("Keloid: extends BEYOND wound boundaries; more common in dark-skinned individuals", key=True)
    nw.draw_bullet("Keloid Rx: intralesional triamcinolone, silicone gel, pressure, excision + adjuvant")

    # ════════════════════════════════════════════════════════
    # SECTION 3 — HAEMOSTASIS
    # ════════════════════════════════════════════════════════
    nw.draw_section("HAEMOSTASIS IN SURGERY", number="3")

    nw.draw_subsection("Mechanical Methods")
    nw.draw_bullet("Direct pressure — first line; most effective initial step")
    nw.draw_bullet("Ligature / suture ligation — vessels < 3 mm can be ligated")
    nw.draw_bullet("Clips (metal/titanium) — laparoscopic surgery; e.g. cystic duct")
    nw.draw_bullet("Tourniquet — limb surgery; max 2 hrs upper limb, 1.5 hrs lower limb")
    nw.draw_bullet("Packing — damage control surgery; large cavities (liver lacerations)")
    nw.skip(4)

    nw.draw_subsection("Thermal Methods")
    nw.draw_bullet("Monopolar diathermy: circuit passes through body → concentrate at tip; CAUTION near pacemakers")
    nw.draw_bullet("Bipolar diathermy: current only between two tips → safer near nerves & implants", key=True)
    nw.draw_bullet("Harmonic scalpel (ultrasonic): 55,500 Hz; coagulates & cuts; minimal lateral thermal spread")
    nw.draw_bullet("LigaSure (vessel sealing): fuses vessel walls with collagen/elastin; vessels up to 7 mm")
    nw.draw_bullet("Argon beam coagulator — superficial haemostasis; liver, spleen")
    nw.skip(4)

    nw.draw_subsection("Topical Haemostatic Agents")
    nw.draw_two_col_table([
        ("Agent",              "Mechanism / Notes"),
        ("Gelatin sponge (Gelfoam)", "Scaffold for clot; absorbed in 4-6 wks"),
        ("Oxidised cellulose",  "Lowers local pH → denatured Hb forms clot; bactericidal"),
        ("Thrombin (bovine/recombinant)", "Converts fibrinogen → fibrin; use with gelfoam"),
        ("Fibrin glue (sealant)", "Thrombin + fibrinogen; anastomotic leaks, parenchymal bleeding"),
        ("Bone wax",           "Mechanical occlusion; sternal / skull bleeding"),
        ("Chitosan dressings",  "Haemostatic; battlefield / trauma use"),
    ])

    # ════════════════════════════════════════════════════════
    # SECTION 4 — SUTURES & KNOTS
    # ════════════════════════════════════════════════════════
    nw.draw_section("SUTURES & KNOTS", number="4")

    nw.draw_subsection("Classification of Sutures")
    nw.draw_bullet("By absorption:")
    nw.draw_bullet("Absorbable — hydrolysis or proteolysis; e.g. Vicryl, PDS, Monocryl, catgut", level=1)
    nw.draw_bullet("Non-absorbable — permanent; e.g. Prolene, Nylon, Silk, Steel", level=1)
    nw.draw_bullet("By structure:")
    nw.draw_bullet("Monofilament — less bacteria harbourage, ↓ infection risk; e.g. PDS, Prolene", level=1)
    nw.draw_bullet("Multifilament (braided) — easier handling, ↑ tissue drag; e.g. Vicryl, Silk", level=1)
    nw.skip(4)

    nw.draw_two_col_table([
        ("Suture",       "Type / Key Property / Uses"),
        ("Catgut (plain)", "Absorbable; absorbed 5-7 days; rarely used now"),
        ("Chromic catgut", "Absorbable; absorbed 10-21 days; mucosa"),
        ("Vicryl (polyglactin 910)", "Braided absorbable; lost by 60 days; bowel, skin subcuticular"),
        ("Monocryl (poliglecaprone)", "Monofilament absorbable; 90-120 days; skin, bowel"),
        ("PDS (polydioxanone)", "Monofilament absorbable; 180 days; fascia, paediatric cardiac"),
        ("Prolene (polypropylene)", "Non-absorbable monofilament; vascular anastomosis"),
        ("Nylon (Ethilon)", "Non-absorbable monofilament; skin, tendons"),
        ("Silk",          "Non-absorbable braided; ties, bile duct"),
        ("Stainless steel", "Non-absorbable; sternal closure, orthopaedics"),
    ])

    nw.draw_subsection("Suture Sizes")
    nw.draw_bullet("USP scale: 10-0 (finest) → 5 (thickest)  [metric: 0.2 – 7 mm]")
    nw.draw_bullet("Skin: 2-0 to 3-0 (trunk) | 4-0 to 5-0 (face) | 0 (fascia)")
    nw.draw_bullet("Vascular: 4-0 (aorta) → 6-0 to 8-0 (coronary / micro)")
    nw.skip(4)

    nw.draw_subsection("Types of Suture Technique")
    nw.draw_bullet("Interrupted: each stitch tied separately; preferred for contaminated wounds")
    nw.draw_bullet("Continuous/running: quicker; even tension; anastomoses")
    nw.draw_bullet("Subcuticular: cosmetic closure; absorbable or non-absorbable pull-out")
    nw.draw_bullet("Mattress (horizontal/vertical): tension-relieving; everting skin edges")
    nw.draw_bullet("Purse-string: appendix stump, colostomy, trocar port sites")
    nw.skip(4)

    nw.draw_subsection("Surgical Knots")
    nw.draw_bullet("Square knot = 2 throws in opposite directions (1F-1B) — standard reef knot")
    nw.draw_bullet("Surgeon's knot: first throw x2 → extra friction; slips less during 2nd throw", key=True)
    nw.draw_bullet("Granny knot: both throws SAME direction — WEAK, avoid")
    nw.draw_bullet("Half-hitch: single throw; multiple half-hitches = slip knot risk")
    nw.draw_bullet("Aberdeen knot: finishing knot for continuous sutures")
    nw.draw_highlight_box("Remember!",
        ["Minimum 3 throws for monofilament sutures (PDS, Prolene, Nylon)",
         "Minimum 2 throws (square knot) sufficient for braided material",
         "Knot security: Vicryl > Silk > Prolene for synthetic sutures"])

    # ════════════════════════════════════════════════════════
    # SECTION 5 — SURGICAL INSTRUMENTS
    # ════════════════════════════════════════════════════════
    nw.draw_section("SURGICAL INSTRUMENTS", number="5")

    nw.draw_subsection("A. Cutting & Dissecting Instruments")
    nw.draw_two_col_table([
        ("Instrument",              "Use / Notes"),
        ("Scalpel (Bard-Parker)",   "#10 – large incisions | #11 – stab/abscess | #15 – delicate | #22 – large body"),
        ("Metzenbaum scissors",     "Tissue dissection — delicate; long handle, short blade"),
        ("Mayo scissors",           "Cutting sutures & fascia — robust, curved/straight"),
        ("Iris scissors",           "Fine ophthalmology / vascular work"),
        ("Tissue/Bandage scissors", "Cutting dressings"),
        ("Diathermy scissors",      "Combined cutting + coagulation"),
    ])

    nw.draw_subsection("B. Grasping & Holding Instruments")
    nw.draw_two_col_table([
        ("Instrument",               "Use / Notes"),
        ("Tissue forceps (toothed)", "Adson, rat-tooth — grip skin/tough tissue; traumatic"),
        ("Non-toothed (smooth)",     "Dissecting forceps — bowel, delicate tissue; less trauma"),
        ("Babcock forceps",          "Non-crushing; bowel, appendix, fallopian tube"),
        ("Allis forceps",            "Toothed; grasping fascia/tumour edge — slightly traumatic"),
        ("Kocher forceps",           "Toothed crushing clamp; thyroid, fascia"),
        ("Sponge-holding forceps",   "Ring forceps; hold swabs, apply antiseptic"),
    ])

    nw.draw_subsection("C. Haemostatic Clamps (Artery Forceps)")
    nw.draw_two_col_table([
        ("Instrument",           "Use / Notes"),
        ("Mosquito (Halstead)",  "Fine vessels; delicate tissue — curved/straight"),
        ("Crile forceps",        "Medium vessels"),
        ("Kelly forceps",        "Larger vessels, general clamping"),
        ("Rochester-Pean",       "Heavy clamping; large vascular pedicles"),
        ("Satinsky clamp",       "Partial occlusion of major vessels (aorta, IVC)"),
        ("Bulldog clamp",        "Temporary occlusion; vascular anastomosis"),
    ])

    nw.draw_subsection("D. Retractors")
    nw.draw_two_col_table([
        ("Retractor",            "Type / Use"),
        ("Langenbeck",           "Hand-held; laparotomy wound edges"),
        ("Deaver",               "Hand-held; deep retraction — liver, bile duct surgery"),
        ("Army-Navy (US Army)",  "Hand-held; superficial wound retraction"),
        ("Weitlaner",            "Self-retaining; small incisions"),
        ("Gelpi",                "Self-retaining; spinal, orthopaedic"),
        ("Balfour",              "Self-retaining; laparotomy — lateral blades + central blade"),
        ("Bookwalter",           "Self-retaining; versatile laparotomy system — fixed to table"),
        ("O'Sullivan-O'Connor",  "Self-retaining; gynaecological pelvic surgery"),
        ("Finochietto",          "Self-retaining; thoracotomy — rib spreader"),
    ])

    nw.draw_subsection("E. Needle Holders")
    nw.draw_bullet("Mayo-Hegar: most common; thick jaws — general closure")
    nw.draw_bullet("Crile-Wood: lighter; precision suturing")
    nw.draw_bullet("Castroviejo: ophthalmic / microsurgery — spring-loaded")
    nw.draw_bullet("Mathieu: ratchet with curved handle — perineal surgery")
    nw.skip(6)

    nw.draw_subsection("F. Bowel / GI Instruments")
    nw.draw_two_col_table([
        ("Instrument",            "Use"),
        ("Doyen intestinal clamp", "Non-crushing; occlude bowel lumen (soft jaws)"),
        ("Parker-Kerr clamp",     "Occlude colon — crushing"),
        ("GIA stapler",           "Gastrointestinal anastomosis — staple + cut simultaneously"),
        ("TA stapler",            "Thoraco-abdominal; staple without cutting"),
        ("EEA (circular)",        "End-to-end anastomosis — oesophagus, colon, rectum"),
        ("Ligaclip",              "Metal clip applicator — vessels, cystic duct"),
    ])

    nw.draw_subsection("G. Laparoscopic Instruments")
    nw.draw_bullet("Veress needle — closed pneumoperitoneum; angled bevel; spring-loaded safety tip")
    nw.draw_bullet("Trocar & cannula — ports (5, 10, 12 mm); bladed (sharp) or bladeless")
    nw.draw_bullet("Laparoscope — 0° (straight) or 30° (angled viewing)")
    nw.draw_bullet("Laparoscopic scissors, graspers, dissectors — same functions, longer shafts")
    nw.draw_bullet("Clip applicators — titanium or absorbable polymer (Hem-o-Lok)")
    nw.draw_bullet("Morcellator — tissue removal; endometriosis, myomata", key=True)
    nw.skip(6)

    nw.draw_subsection("H. Suction & Irrigation")
    nw.draw_bullet("Yankauer — oropharyngeal; large bore suction")
    nw.draw_bullet("Poole suction — abdominal cavity; fenestrated shield prevents clogging")
    nw.draw_bullet("Frazier — neurosurgery / ENT; angled fine suction")

    # ════════════════════════════════════════════════════════
    # SECTION 6 — ANAESTHESIA IN SURGERY (overview)
    # ════════════════════════════════════════════════════════
    nw.draw_section("ANAESTHESIA OVERVIEW", number="6")

    nw.draw_subsection("Types")
    nw.draw_bullet("General anaesthesia (GA): unconscious; airway secured (LMA / ETT)")
    nw.draw_bullet("Regional: spinal (subarachnoid), epidural, nerve blocks")
    nw.draw_bullet("Local infiltration: lidocaine, bupivacaine ± adrenaline")
    nw.draw_bullet("Monitored anaesthesia care (MAC): sedation + local")
    nw.skip(4)

    nw.draw_subsection("Local Anaesthetics — Key Facts")
    nw.draw_two_col_table([
        ("Agent",         "Max Dose (without / with adrenaline) | Duration"),
        ("Lidocaine",     "3 mg/kg  /  7 mg/kg | 1-2 hrs"),
        ("Bupivacaine",   "2 mg/kg  /  3 mg/kg | 4-8 hrs — cardiotoxic in excess"),
        ("Ropivacaine",   "3 mg/kg | 4-8 hrs — less cardiotoxic than bupivacaine"),
        ("Prilocaine",    "6 mg/kg  /  8.5 mg/kg | methaemoglobinaemia risk"),
        ("Cocaine",       "3 mg/kg — ENT only; vasoconstriction; ONLY LA that is vasoconstrictor"),
    ])
    nw.draw_bullet("Adrenaline (1:200,000) → vasoconstriction → prolongs LA + reduces systemic absorption")
    nw.draw_bullet("NEVER use adrenaline-containing LA in: fingers, toes, penis, nose, ears (end arteries!)", key=True)

    # ════════════════════════════════════════════════════════
    # SECTION 7 — SURGICAL INCISIONS
    # ════════════════════════════════════════════════════════
    nw.draw_section("SURGICAL INCISIONS", number="7")

    nw.draw_two_col_table([
        ("Incision",                   "Access / Use"),
        ("Midline (linea alba)",       "Universal access; fast; no muscle cut; most common laparotomy"),
        ("Paramedian",                 "One side of midline; stronger closure; less used now"),
        ("Kocher (right subcostal)",   "Biliary surgery: cholecystectomy, bile duct"),
        ("Rooftop (bilateral Kocher)", "Liver, pancreas, spleen, bariatric"),
        ("McBurney's (grid-iron)",     "Open appendicectomy — right iliac fossa"),
        ("Lanz incision",              "Cosmetic appendicectomy — Langer's lines"),
        ("Pfannenstiel",               "Pelvis — Caesarean section, hysterectomy; cosmetic (above pubis)"),
        ("Chevron",                    "Gastro-oesophageal junction, total gastrectomy"),
        ("Thoraco-abdominal",          "Oesophagus, stomach, left lobe liver"),
        ("Posterolateral thoracotomy", "Lung resections, oesophagus"),
    ])
    nw.skip(4)
    nw.draw_highlight_box("Incision Closure Principles (Jenkins Rule)",
        ["Mass closure: all layers in one continuous suture",
         "Suture length : wound length ratio = 4:1 (prevents dehiscence)",
         "Bites 1 cm from edge, 1 cm apart",
         "Use slowly absorbable (PDS) or non-absorbable for fascial closure"])

    # ════════════════════════════════════════════════════════
    # SECTION 8 — DRAINS
    # ════════════════════════════════════════════════════════
    nw.draw_section("SURGICAL DRAINS", number="8")

    nw.draw_subsection("Classification")
    nw.draw_bullet("Active (closed-suction): Redivac, Blake, Jackson-Pratt — negative pressure")
    nw.draw_bullet("Passive (open/gravity): Corrugated rubber/silicone, Penrose drain")
    nw.draw_bullet("Sump drain: double-lumen; irrigation + drainage simultaneously")
    nw.skip(4)

    nw.draw_subsection("Specific Drains")
    nw.draw_two_col_table([
        ("Drain",               "Use"),
        ("Redivac / Hemovac",   "Post-op wounds, haematoma prevention (breast, ortho)"),
        ("Jackson-Pratt (JP)",  "Abdominal, thoracic — bulb suction"),
        ("Intercostal drain",   "Pneumothorax, haemothorax, pleural effusion"),
        ("T-tube",              "Common bile duct post-choledochotomy; removed 6-8 wks"),
        ("Foley catheter",      "Urinary drainage; post-pelvic surgery"),
        ("Penrose",             "Passive; infections, abscess cavities"),
    ])

    nw.draw_subsection("When to Remove Drains")
    nw.draw_bullet("< 30–50 mL/day output (for serous/blood drainage)")
    nw.draw_bullet("No evidence of anastomotic leak (drain amylase if bowel anastomosis)")
    nw.draw_bullet("Typically 24-72 hrs post-op for prophylactic drains")
    nw.draw_bullet("Risks of prolonged drainage: infection, erosion into vessels, herniation")

    # ════════════════════════════════════════════════════════
    # SECTION 9 — DIATHERMY / ELECTROSURGERY
    # ════════════════════════════════════════════════════════
    nw.draw_section("DIATHERMY (ELECTROSURGERY)", number="9")

    nw.draw_subsection("Principles")
    nw.draw_bullet("High-frequency AC current (300 kHz – 3 MHz) → heat via electrical resistance")
    nw.draw_bullet("Frequency too high to stimulate nerves/muscles (tetany threshold ~100 kHz)")
    nw.draw_bullet("Two modes: CUT (continuous sine wave → vaporises cells) | COAGULATE (pulsed → desiccates)")
    nw.draw_bullet("BLEND = mix of cut + coag waveforms")
    nw.skip(4)

    nw.draw_subsection("Monopolar vs Bipolar")
    nw.draw_two_col_table([
        ("Feature",        "Monopolar",              ),
        ("Circuit",        "Tip → through patient → return plate"),
        ("Return plate",   "Needed; must have full contact → burns if poor contact"),
        ("Use",            "General cutting/coagulation; laparoscopic"),
        ("Hazards",        "Capacitance coupling, insulation failure, pacemaker interference"),
        ("",               ""),
        ("Feature",        "Bipolar"),
        ("Circuit",        "Current only between two forceps tips"),
        ("Return plate",   "NOT needed"),
        ("Use",            "Delicate work: nerves, vessels, eyes, pacemaker patients"),
        ("Hazards",        "Limited coagulation of large vessels"),
    ])
    nw.draw_bullet("Argon plasma coagulation (APC): non-contact; ionised argon gas conducts current → surface coag", key=True)
    nw.draw_bullet("Ultrasonic dissectors (CUSA, Harmonic): mechanical vibration 55.5 kHz; minimal thermal spread")

    # ════════════════════════════════════════════════════════
    # SECTION 10 — POST-OP COMPLICATIONS
    # ════════════════════════════════════════════════════════
    nw.draw_section("POST-OP COMPLICATIONS", number="10")

    nw.draw_subsection("Timing & Causes (the 5 W's of Fever)")
    nw.draw_two_col_table([
        ("Day Post-op",  "Cause"),
        ("1-2 (Wind)",   "Atelectasis, aspiration pneumonia — deep breathing, physiotherapy"),
        ("3-5 (Water)",  "Urinary tract infection — catheter-related"),
        ("5-7 (Wound)",  "Surgical site infection (SSI) — wound inspection, Abx"),
        ("5-7 (Walking)","DVT / Pulmonary embolism — anticoagulation, ambulation"),
        ("7+ (Wonder drug)", "Drug fever — review all medications"),
    ])

    nw.draw_subsection("Wound Complications")
    nw.draw_bullet("Haematoma: collection of blood; Rx — evacuation if tense/infected")
    nw.draw_bullet("Seroma: serous fluid; Rx — aspiration or observation")
    nw.draw_bullet("Dehiscence: partial wound breakdown; Rx — secondary closure")
    nw.draw_bullet("Burst abdomen (evisceration): complete dehiscence; bowels exposed → EMERGENCY", key=True)
    nw.draw_bullet("Incisional hernia: long-term complication; risk factors: obesity, infection, steroid use")
    nw.skip(4)

    nw.draw_subsection("Surgical Site Infection (SSI) Classification")
    nw.draw_bullet("Superficial incisional: skin/subcutaneous — within 30 days")
    nw.draw_bullet("Deep incisional: fascia/muscle — within 30 days (90 days if implant)")
    nw.draw_bullet("Organ/space SSI: cavity or organ involved — most serious")
    nw.draw_bullet("Prevention: prophylactic Abx within 60 min of incision; hair clipping (not shaving); normothermia", key=True)

    nw.draw_subsection("Wound Classification")
    nw.draw_two_col_table([
        ("Class", "Definition / SSI Rate"),
        ("I — Clean",          "No inflammation; no GI/GU/respiratory entry; elective → <2% SSI"),
        ("II — Clean-contaminated", "GI/respiratory/GU entry; no spillage → 2-10%"),
        ("III — Contaminated", "Gross spillage; open accidental wound; acute inflammation → 10-20%"),
        ("IV — Dirty/infected", "Old traumatic wound; pus/perforated viscus → >30% SSI"),
    ])

    # ════════════════════════════════════════════════════════
    # SECTION 11 — SURGICAL KNOT TYING SUMMARY
    # ════════════════════════════════════════════════════════
    nw.draw_section("QUICK REFERENCE SUMMARY", number="11")

    nw.draw_highlight_box("High-Yield Mnemonics",
        ["WOUNDS: Wound class, Open/closed, Undo haematoma, Nutrition, Drains, Skin closure",
         "HALVED: Haematoma, Anaemia, Ligation fail, Vasospasm, Electrolyte, Diathermy = intraop bleeding causes",
         "VICRYL: Very Important Closure Really Yet Lasts = braided absorbable suture",
         "5 W's of post-op fever: Wind, Water, Wound, Walking, Wonder drugs"])
    nw.skip(4)

    nw.draw_subsection("Instrument Identification Tips (OSCE)")
    nw.draw_bullet("Artery forceps: box joint, ratchet, transverse serrations on jaws")
    nw.draw_bullet("Tissue forceps: NO ratchet; sprung (tweezers design)")
    nw.draw_bullet("Needle holder: DIAMOND-jaw pattern for grip (cross-hatched)")
    nw.draw_bullet("Self-retaining retractor: has ratchet/locking mechanism")
    nw.draw_bullet("Name → function → usage (inspection, use, complications)")
    nw.skip(6)

    nw.draw_subsection("Scalpel Blade Numbers (must know!)")
    nw.draw_bullet("#10 — large curved; general skin incisions")
    nw.draw_bullet("#11 — triangular, pointed; stab incisions, abscess drainage, arterial cut-down")
    nw.draw_bullet("#12 — hooked; ENT, tonsillectomy")
    nw.draw_bullet("#15 — small curved; delicate/facial work, paediatrics")
    nw.draw_bullet("#22 — large curved; thoracic, large body incisions")
    nw.draw_bullet("Fit on: #3 handle (small blades) | #4 handle (large blades)")
    nw.skip(6)

    nw.draw_para("— End of Notes —  Good Luck! 🏆", color=HEADING, size=15)

# ═══════════════════════════════════════════════════════════════════════════
if __name__ == "__main__":
    nw = NoteWriter(OUT_FILE)
    build(nw)
    nw.save()
    print("Done.")