python3 << 'EOF' import pdfplumber files = { "Clinical Summary": "/tmp/workspace/attachments/3bd3769d-5aac-4188-b3c8-84f85812ea20/Clinical_Summary_Pre_Apollo_Admission.pdf", "Discharge Summary": "/tmp/workspace/attachments/3bd3769d-5aac-4188-b3c8-84f85812ea20/DischargeSummaryDyncPrint zaitoon.pdf" } for name, path in files.items(): print(f"\n{'='*60}") print(f"FILE: {name}") print('='*60) with pdfplumber.open(path) as pdf: for i, page in enumerate(pdf.pages): text = page.extract_text() if text: print(f"\n--- Page {i+1} ---\n{text}") EOF

mkdir -p /tmp/workspace/tbm-case && python3 << 'PYEOF' from docx import Document from docx.shared import Pt, Inches, RGBColor, Cm from docx.enum.text import WD_ALIGN_PARAGRAPH from docx.enum.table import WD_TABLE_ALIGNMENT, WD_ALIGN_VERTICAL from docx.oxml.ns import qn from docx.oxml import OxmlElement import copy doc = Document() # ── Page margins ────────────────────────────────────────────────────────────── section = doc.sections[0] section.top_margin = Cm(2.0) section.bottom_margin = Cm(2.0) section.left_margin = Cm(2.2) section.right_margin = Cm(2.2) # ── Default style ───────────────────────────────────────────────────────────── normal = doc.styles["Normal"] normal.font.name = "Calibri" normal.font.size = Pt(10.5) # ── Helper: set cell shading ────────────────────────────────────────────────── def shade_cell(cell, fill_hex): tc = cell._tc tcPr = tc.get_or_add_tcPr() shd = OxmlElement("w:shd") shd.set(qn("w:val"), "clear") shd.set(qn("w:color"), "auto") shd.set(qn("w:fill"), fill_hex) tcPr.append(shd) def set_cell_border(cell, **kwargs): tc = cell._tc tcPr = tc.get_or_add_tcPr() tcBorders = OxmlElement("w:tcBorders") for edge in ("top","left","bottom","right","insideH","insideV"): if edge in kwargs: tag = OxmlElement(f"w:{edge}") tag.set(qn("w:val"), kwargs[edge].get("val","single")) tag.set(qn("w:sz"), kwargs[edge].get("sz","4")) tag.set(qn("w:space"), "0") tag.set(qn("w:color"), kwargs[edge].get("color","auto")) tcBorders.append(tag) tcPr.append(tcBorders) def add_table_header_row(table, headers, fill="1F4E79"): row = table.rows[0] for i, h in enumerate(headers): cell = row.cells[i] cell.text = "" p = cell.paragraphs[0] run = p.add_run(h) run.bold = True run.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF) run.font.size = Pt(10) p.alignment = WD_ALIGN_PARAGRAPH.CENTER shade_cell(cell, fill) def add_data_row(table, values, shade=None, bold_first=False): row = table.add_row() for i, v in enumerate(values): cell = row.cells[i] p = cell.paragraphs[0] run = p.add_run(str(v)) run.font.size = Pt(10) if bold_first and i == 0: run.bold = True if shade: shade_cell(cell, shade) return row # ══════════════════════════════════════════════════════════════════════════════ # HEADER BANNER # ══════════════════════════════════════════════════════════════════════════════ banner_tbl = doc.add_table(rows=1, cols=1) banner_tbl.alignment = WD_TABLE_ALIGNMENT.CENTER banner_cell = banner_tbl.cell(0, 0) shade_cell(banner_cell, "1F4E79") bp = banner_cell.paragraphs[0] bp.alignment = WD_ALIGN_PARAGRAPH.CENTER r1 = bp.add_run("CLINICAL CASE SUMMARY") r1.bold = True r1.font.size = Pt(16) r1.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF) bp.add_run("\n") r2 = bp.add_run("Tuberculous Meningoencephalitis with Communicating Hydrocephalus") r2.font.size = Pt(11) r2.font.color.rgb = RGBColor(0xBD, 0xD7, 0xEE) doc.add_paragraph() # spacer # ══════════════════════════════════════════════════════════════════════════════ # SECTION HELPER # ══════════════════════════════════════════════════════════════════════════════ def section_heading(text, color_hex="1F4E79"): p = doc.add_paragraph() p.paragraph_format.space_before = Pt(10) p.paragraph_format.space_after = Pt(2) run = p.add_run(f" {text} ") run.bold = True run.font.size = Pt(11) run.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF) # paragraph shading pPr = p._p.get_or_add_pPr() shd = OxmlElement("w:shd") shd.set(qn("w:val"), "clear") shd.set(qn("w:color"), "auto") shd.set(qn("w:fill"), color_hex) pPr.append(shd) return p def sub_heading(text): p = doc.add_paragraph() p.paragraph_format.space_before = Pt(6) p.paragraph_format.space_after = Pt(1) run = p.add_run(text) run.bold = True run.font.size = Pt(10.5) run.font.color.rgb = RGBColor(0x1F, 0x4E, 0x79) return p def body_para(text, italic=False, bullet=False): p = doc.add_paragraph() p.paragraph_format.space_after = Pt(2) if bullet: p.style = doc.styles["List Bullet"] run = p.add_run(text) run.font.size = Pt(10.5) run.italic = italic return p def kv_pair(label, value): p = doc.add_paragraph() p.paragraph_format.space_after = Pt(1) r1 = p.add_run(f"{label}: ") r1.bold = True r1.font.size = Pt(10.5) r2 = p.add_run(value) r2.font.size = Pt(10.5) return p # ══════════════════════════════════════════════════════════════════════════════ # 1. PATIENT INFORMATION # ══════════════════════════════════════════════════════════════════════════════ section_heading("1. PATIENT INFORMATION") doc.add_paragraph() pt_tbl = doc.add_table(rows=1, cols=4) pt_tbl.style = "Table Grid" add_table_header_row(pt_tbl, ["Field", "Details", "Field", "Details"], fill="2E75B6") rows_data = [ ("Name", "Mrs. J. Saithoon Benazir", "UHID", "AC01.0005824403"), ("Age / Sex", "41 years, Female", "Patient ID", "CMHIP525038"), ("Date of Admission", "28 May 2026", "Date of Discharge", "20 July 2026"), ("Duration of Stay", "~53 days", "Ward", "1st Floor, Transit, TR122"), ("Primary Consultant","Dr. Dhanaraj M, MD, DM (Neurology)","Hospital", "Apollo Hospital, Chennai"), ("Blood Group", "O Positive", "Allergies", "Not known"), ] for i, (f1, v1, f2, v2) in enumerate(rows_data): row = pt_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([f1, v1, f2, v2]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(10) if ci in (0, 2): run.bold = True shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 2. FINAL DIAGNOSES # ══════════════════════════════════════════════════════════════════════════════ section_heading("2. FINAL DIAGNOSES") doc.add_paragraph() dx_tbl = doc.add_table(rows=1, cols=2) dx_tbl.style = "Table Grid" add_table_header_row(dx_tbl, ["#", "Diagnosis"], fill="2E75B6") dx_list = [ ("1 (PRIMARY)", "Tuberculous Meningitis with Arachnoiditis and Communicating Ventriculomegaly\n" " • Status post Right VP Shunt (30 May 2026)\n" " • Status post Tracheostomy (8 June 2026)"), ("2", "Aspiration Pneumonitis with Right Lower Zone Opacity"), ("3", "Urosepsis with Septic Shock and Septicemia"), ("4", "Tracheitis"), ("5", "Old Healed Rib Fractures"), ("6", "Systemic Hypertension"), ("7", "Diabetes Mellitus"), ("8", "Dyslipidemia"), ] for i, (num, diag) in enumerate(dx_list): row = dx_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" c0 = row.cells[0] c1 = row.cells[1] p0 = c0.paragraphs[0] run0 = p0.add_run(num) run0.bold = True run0.font.size = Pt(10) p1 = c1.paragraphs[0] run1 = p1.add_run(diag) run1.font.size = Pt(10) if i == 0: run1.bold = True shade_cell(c0, fill) shade_cell(c1, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 3. PRESENTING COMPLAINT & BACKGROUND # ══════════════════════════════════════════════════════════════════════════════ section_heading("3. PRESENTING COMPLAINTS & BACKGROUND") doc.add_paragraph() kv_pair("Presenting Complaints", "Fever with headache (on and off, 1 month); Decreased responsiveness (on and off, 1 month)") kv_pair("Co-morbidities", "Diabetes Mellitus, Systemic Hypertension") kv_pair("Smoking / Alcohol", "None") kv_pair("Surgical History", "Nil prior to this admission") kv_pair("Family History", "Nil significant") doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 4. TIMELINE OF ILLNESS # ══════════════════════════════════════════════════════════════════════════════ section_heading("4. TIMELINE OF ILLNESS (PRE-APOLLO)") doc.add_paragraph() tl_tbl = doc.add_table(rows=1, cols=3) tl_tbl.style = "Table Grid" add_table_header_row(tl_tbl, ["Period", "Phase", "Key Events"], fill="2E75B6") tl_data = [ ("20 – 30 Apr 2026", "Prodromal", "Intermittent headache + neck stiffness; treated at local clinic as viral illness; sudden severe headache night of 30 Apr"), ("1 – 6 May 2026", "1st Admission\n(Murugan Hospital)", "Altered sensorium; elective intubation for MRI; MRI: small right putamen infarct; CSF: all causes negative; treated empirically for meningoencephalitis; discharged GCS 15/15"), ("7 – 12 May 2026", "Home Course", "Intermittent fever, persistent headache, restlessness; blurred/misty vision left eye (10–11 May)"), ("13 – 20 May 2026", "2nd Admission\n(Murugan Hospital)", "MRI: demyelination pattern; IV methylprednisolone; CSF repeated; improved; discharged on oral steroids"), ("20 – 27 May 2026", "Progressive\nDeterioration", "Increasing confusion, drowsiness, inability to stand; MRI: progressive ventriculomegaly/hydrocephalus; intubated 27 May; TB meningitis suspected"), ("28 May 2026", "Transfer", "Transferred to Apollo Hospital for advanced neurological care; CSF Xpert MTB detected (trace positive); ATT commenced 29 May"), ] for i, (period, phase, events) in enumerate(tl_data): row = tl_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([period, phase, events]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(10) if ci < 2: run.bold = True shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 5. EXAMINATION AT APOLLO ADMISSION # ══════════════════════════════════════════════════════════════════════════════ section_heading("5. EXAMINATION AT APOLLO ADMISSION") doc.add_paragraph() ex_tbl = doc.add_table(rows=1, cols=4) ex_tbl.style = "Table Grid" add_table_header_row(ex_tbl, ["Parameter", "Finding", "Parameter", "Finding"], fill="2E75B6") ex_data = [ ("Pulse", "83/min", "BP", "168/100 mmHg"), ("Temperature", "Febrile", "Sensorium", "Altered (intubated/ventilated)"), ("CVS", "S1 S2 heard", "Respiratory", "Bilateral vesicular breath sounds"), ("Abdomen", "Soft, BS present", "Pallor/Icterus", "Nil"), ("Oedema", "Nil", "Lymphadenopathy","Nil"), ("Functional", "Fully dependent", "Cyanosis/Clubbing","Nil"), ] for i, (f1, v1, f2, v2) in enumerate(ex_data): row = ex_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([f1, v1, f2, v2]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(10) if ci in (0, 2): run.bold = True shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 6. KEY INVESTIGATIONS # ══════════════════════════════════════════════════════════════════════════════ section_heading("6. KEY INVESTIGATIONS") doc.add_paragraph() # 6A CSF sub_heading("A. CSF Analysis (Apollo Admission — 28–29 May 2026)") csf_tbl = doc.add_table(rows=1, cols=3) csf_tbl.style = "Table Grid" add_table_header_row(csf_tbl, ["Parameter", "Result", "Significance"], fill="2E75B6") csf_data = [ ("Opening Pressure", "25 cmH₂O", "Raised (normal <20)"), ("Protein", "152.5 mg/dL", "Markedly raised (normal 15–45)"), ("Glucose", "35 mg/dL (blood glucose ~178)","Low CSF:blood ratio (<0.5)"), ("WBC count", "225 cells/µL", "Pleocytosis"), ("Cell differential","74% lymphocytes, 26% neutrophils","Lymphocytic predominance"), ("RBC", "100 cells", "Traumatic tap vs. haemorrhage"), ("CSF Xpert MTB", "DETECTED (trace positive)", "Confirms TBM — KEY finding"), ("AFB smear", "No AFB seen", "Expected in TBM (low sensitivity)"), ("Cryptococcus", "Negative", "Alternate excluded"), ("Autoimmune panel", "Negative (CSF + serum)", "Autoimmune encephalitis excluded"), ("HSV 1&2 PCR", "Not detected", "Viral encephalitis excluded"), ("Meningoencephalitis panel", "Not detected", "Bacterial/viral causes excluded"), ("Malignant cells", "Negative", "Leptomeningeal carcinomatosis excluded"), ("Culture", "No growth", "Awaiting AFB/fungal culture"), ] for i, (p, r, s) in enumerate(csf_data): row = csf_tbl.add_row() fill = "FFF2CC" if p == "CSF Xpert MTB" else ("EBF3FB" if i % 2 == 0 else "FFFFFF") for ci, txt in enumerate([p, r, s]): cell = row.cells[ci] para = cell.paragraphs[0] run = para.add_run(txt) run.font.size = Pt(10) if ci == 0 or p == "CSF Xpert MTB": run.bold = True shade_cell(cell, fill) doc.add_paragraph() # 6B Haematology sub_heading("B. Haematology — Key Values") hb_tbl = doc.add_table(rows=1, cols=4) hb_tbl.style = "Table Grid" add_table_header_row(hb_tbl, ["Parameter", "Admission", "Nadir / Peak", "Trend"], fill="2E75B6") hb_data = [ ("Haemoglobin (g/dL)", "8.7", "6.1 (6/6/26)", "Improved to 10–11 with transfusion"), ("PCV (%)", "31", "21 (6/6/26)", "Improved with PRBC"), ("WBC (×10³/mm³)", "14.31","13.66 (leukocytosis persisted)", "Persistent leukocytosis"), ("Platelets (×10³/mm³)", "Normal","90 (8/6/26) — thrombocytopenia", "Recovered to 110–132"), ] for i, row_data in enumerate(hb_data): row = hb_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate(row_data): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(10) if ci == 0: run.bold = True shade_cell(cell, fill) doc.add_paragraph() # 6C Biochemistry sub_heading("C. Biochemistry — Selected Values") bio_tbl = doc.add_table(rows=1, cols=3) bio_tbl.style = "Table Grid" add_table_header_row(bio_tbl, ["Parameter", "Notable Value", "Comment"], fill="2E75B6") bio_data = [ ("Serum Sodium", "128 mEq/L", "Hyponatremia — common in TBM (SIADH)"), ("Serum Calcium", "8.2 mg/dL", "Hypocalcemia"), ("Random Blood Sugar", "178 mg/dL", "Raised; HbA1c 6.5%"), ("Serum Albumin", "2.55 g/dL (nadir)", "Severe hypoalbuminemia"), ("SGPT", "150 U/L (peak 18/6)", "ATT hepatotoxicity — PZA dose reduced"), ("SGOT", "85 U/L", "ATT hepatotoxicity"), ("Alkaline Phosphatase","154 U/L", "Raised"), ("Total Bilirubin", "2.03 mg/dL", "Raised transiently"), ("LDL", "104 mg/dL", "Raised — dyslipidemia"), ("Triglycerides", "233 mg/dL", "Raised"), ("TSH", "0.128 µIU/mL", "Low — sick euthyroid / subclinical hyperthyroid"), ("BD-Glucan", "19.3 pg/mL", "Raised — fungal screen; antifungal added"), ("INR", "1.46 (6/6/26)", "Coagulopathy during septic phase"), ] for i, (p, v, c) in enumerate(bio_data): row = bio_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([p, v, c]): cell = row.cells[ci] para = cell.paragraphs[0] run = para.add_run(txt) run.font.size = Pt(10) if ci == 0: run.bold = True shade_cell(cell, fill) doc.add_paragraph() # 6D Microbiology sub_heading("D. Microbiology / Culture Results") mic_tbl = doc.add_table(rows=1, cols=3) mic_tbl.style = "Table Grid" add_table_header_row(mic_tbl, ["Sample (Date)", "Organism", "Significance"], fill="2E75B6") mic_data = [ ("Blood culture (admission)", "No growth", "—"), ("Urine culture (admission)", "Insignificant Enterococci", "—"), ("ET culture (3/6/26)", "Pseudomonas aeruginosa + Klebsiella pneumoniae (both pan-sensitive)", "VAP pathogens"), ("Urine culture (3/6/26)", "Candida albicans", "Fungal UTI — antifungal initiated"), ("Blood culture (5/6/26)", "Pseudomonas aeruginosa (pan-sensitive)","Bacteraemia / septic shock"), ] for i, (s, o, sig) in enumerate(mic_data): row = mic_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([s, o, sig]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(10) shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 7. IMAGING SUMMARY # ══════════════════════════════════════════════════════════════════════════════ section_heading("7. IMAGING SUMMARY") doc.add_paragraph() img_tbl = doc.add_table(rows=1, cols=3) img_tbl.style = "Table Grid" add_table_header_row(img_tbl, ["Study & Date", "Key Findings", "Action Taken"], fill="2E75B6") img_data = [ ("MRI Brain\n1 May 2026\n(Murugan Hospital)", "Small acute infarct right putamen", "Empirical meningoencephalitis treatment"), ("MRI Brain\n14 May 2026\n(2nd admission)", "Suggested demyelination pattern", "IV methylprednisolone commenced"), ("CT Brain with contrast\n28–29 May 2026\n(Apollo)", "Leptomeningeal enhancement (Sylvian fissures, perimesencephalic, ventral medulla); " "bilateral periventricular white matter hypodensities; communicating ventriculomegaly (Evans index 0.35)", "Neurosurgery consulted; VP Shunt planned"), ("CT Brain\n1 June 2026\n(Post-shunt day 2)", "Evans index 0.32 (from 0.35); new minimal intraventricular haemorrhage", "Monitored; no intervention"), ("MRI Brain + Whole Spine with contrast\n6 June 2026", "FLAIR hyperintensities basal cisterns; dilated ventricles + subependymal oedema; " "diffuse smooth leptomeningeal/dural enhancement cervical-dorsal-lumbar spine; " "cauda equina thickening and enhancement — PAN-SPINAL ARACHNOIDITIS", "Confirmed spinal involvement; continued ATT + steroids"), ("CT Brain\n13 June 2026", "Mild increase in hydrocephalus; VP shunt in situ", "Neurosurgery review; abdominal US for shunt tip"), ("CT Brain\n17 June 2026", "Evans index 0.31; decrease in hydrocephalus; bilateral subcortical frontoparietal hypodense areas", "Improvement confirmed"), ("MRI Brain with contrast\n20 June 2026", "Persisting meningitis; reduction in hydrocephalus; NEW microhemorrhages in hypothalamus and right cerebral peduncle", "Monitored; no new intervention"), ("CT Brain plain\n4 July 2026", "Significant reduction of ventricular dilatation; VP shunt in situ; no haemorrhage", "Discharge planning initiated"), ("MRI Brain + Cervical/Whole Spine\n17 July 2026\n(Pre-discharge)", "Mild patchy leptomeningeal enhancement dorsal/lumbar spine; cauda equina clumping (adhesive arachnoiditis); " "no acute infarct; no new intracranial abnormality", "Discharge planned; physiotherapy and rehabilitation advised"), ("VEP\n(Pre-discharge)", "Right: non-recordable. Left: moderate anterior visual pathway dysfunction", "Optic pathway involvement confirmed; ophthalmology follow-up"), ("EEG (serial)", "Admission: bilateral diffuse dysfunction. 12/6: metabolic encephalopathy (triphasic waves). 20/6: moderate bilateral diffuse dysfunction", "Levetiracetam escalated; metabolic correction"), ("Echo / ECG", "Normal LV function; EF 60%", "No cardiac intervention needed"), ("Chest X-ray", "Cardiomegaly; bilateral apical pleural thickening; lower zone infiltrates; bilateral pleural effusion; old rib fractures", "Pulmonology consulted; CT chest advised"), ("USG Abdomen", "Grade 1 fatty liver; cholelithiasis; minimal pleural effusion; shunt tip in right iliac fossa with 4cc pericatheter collection", "Monitored; GI consult for elevated enzymes"), ] for i, (study, findings, action) in enumerate(img_data): row = img_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([study, findings, action]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(9.5) if ci == 0: run.bold = True shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 8. PROCEDURES PERFORMED # ══════════════════════════════════════════════════════════════════════════════ section_heading("8. PROCEDURES PERFORMED") doc.add_paragraph() proc_tbl = doc.add_table(rows=1, cols=3) proc_tbl.style = "Table Grid" add_table_header_row(proc_tbl, ["Procedure", "Date", "Details / Outcome"], fill="2E75B6") proc_data = [ ("Lumbar Puncture", "28–29 May 2026", "CSF Xpert MTB detected (trace positive); high opening pressure 25 cmH₂O; confirmed TBM"), ("Right VP Shunt\n(Surgilinear dome valve, medium pressure)", "30 May 2026", "For communicating hydrocephalus (Evans index 0.35); ETGA; right Keen's point approach; " "subcutaneous tunnelling to right hypochondrium; high pressure CSF; post-op uneventful; " "Evans index improved to 0.31 by 17/6/26"), ("Tracheostomy", "8 June 2026", "For prolonged ventilator dependence; by ENT surgeon; uneventful; " "downsized 8→6 on 9/7/26; decannulated 13/7/26"), ("PRBC Transfusion\n(2 units)", "6 June 2026", "For symptomatic anaemia (Hb nadir 6.1 g/dL)"), ] for i, (proc, date, details) in enumerate(proc_data): row = proc_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([proc, date, details]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(10) if ci == 0: run.bold = True shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 9. HOSPITAL COURSE SUMMARY # ══════════════════════════════════════════════════════════════════════════════ section_heading("9. HOSPITAL COURSE — SUMMARY") doc.add_paragraph() hc_tbl = doc.add_table(rows=1, cols=3) hc_tbl.style = "Table Grid" add_table_header_row(hc_tbl, ["Phase", "Period", "Key Events & Management"], fill="2E75B6") hc_data = [ ("Phase 1\nStabilization", "28 May – 30 May", "ATT initiated (HRZE + Dexamethasone); VP Shunt 30/5; Meropenem empirically; Levetiracetam for seizure prophylaxis; " "Noradrenaline for haemodynamic support"), ("Phase 2\nSeptic Complications", "1 – 10 June", "Pseudomonas bacteraemia + Candida UTI + VAP; septic shock 5/6; Targocid + Tigecycline + Caspofungin + vasopressors; " "hydrocortisone stress protocol; 2u PRBC; tracheostomy 8/6; shifted to tracheostomy ward 10/6"), ("Phase 3\nNeurological & Hepatic", "11 – 20 June", "Metabolic encephalopathy (triphasic EEG); electrolyte correction; Levetiracetam escalated; " "ATT hepatotoxicity — PZA reduced 1750→1250 mg; Udiliv added; " "Dexa changed from hydrocort per ID team (arachnoiditis); microhemorrhages on MRI 20/6"), ("Phase 4\nRehabilitation & Decannulation", "21 June – 20 July", "Physiotherapy; glycemic optimization; intertrigo treated; Dexa tapered to OD then switched to oral Wysolone; " "VEP: anterior visual pathway dysfunction bilaterally; tracheostomy decannulation 13/7; " "CT Brain 4/7: significant ventricular reduction; MRI Spine 17/7: persisting arachnoiditis; discharged 20/7"), ] for i, (phase, period, events) in enumerate(hc_data): row = hc_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([phase, period, events]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(10) if ci < 2: run.bold = True shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 10. DISCHARGE MEDICATIONS # ══════════════════════════════════════════════════════════════════════════════ section_heading("10. DISCHARGE MEDICATIONS") doc.add_paragraph() med_tbl = doc.add_table(rows=1, cols=4) med_tbl.style = "Table Grid" add_table_header_row(med_tbl, ["Category", "Drug", "Dose / Frequency", "Duration"], fill="2E75B6") med_data = [ ("Anti-TB", "Tab. R-Cinex (Rifampicin/Isoniazid 600/300 mg)", "OD (morning)", "Till 28/7/26"), ("Anti-TB", "Tab. Combutol (Ethambutol 1 g)", "OD", "Till 28/7/26"), ("Anti-TB", "Tab. Pyzina (Pyrazinamide 1250 mg)", "OD", "Till 28/7/26"), ("Anti-TB", "Tab. Benadon (Pyridoxine B6 40 mg)", "OD", "Till review"), ("Steroid taper","Tab. Wysolone (Prednisolone)", "30 mg×1wk → 20 mg×3d → 10 mg×2d → 5 mg×2d → stop", "Tapering"), ("Anticonvulsant","Tab. Levipil (Levetiracetam 500 mg)", "BD", "Till review — do NOT stop without Neurologist advice"), ("Antihypertensive","Tab. Telma (Telmisartan 40 mg)", "OD", "Till review"), ("Anticoagulation","Inj. Clexane (Enoxaparin 40 mg) SC", "OD", "Till review"), ("Antidiabetic", "Inj. Lupisulin 30/70 SC 6 units", "Before breakfast","Monitor for hypoglycemia"), ("Hepatoprotective","Tab. Udiliv (UDCA 300 mg)", "BD", "Till review"), ("Gastroprotection","Tab. Pan (Pantoprazole 40 mg)", "BD", "Till review"), ("Calcium", "Tab. Shelcal 500 mg", "OD", "Till review"), ("CNS stimulant", "Tab. Modalert (Modafinil 200 mg)", "OD", "Till review — for hypersomnolence"), ("Nutrition", "NoviMeal High Protein Powder", "1 scoop in 100 mL TDS", "Till review"), ("Laxative", "Syp. Cremafin 15 mL", "BD", "Till review"), ("Skin (intertrigo)","Fusidic acid cream (local)", "BD", "Till review"), ("Skin (intertrigo)","Tab. Dazit (Desloratadine 10 mg)", "BD", "Till review"), ("Multivitamin", "Cap. Becozymes", "OD", "Till review"), ] for i, (cat, drug, dose, dur) in enumerate(med_data): row = med_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([cat, drug, dose, dur]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(9.5) if ci == 0: run.bold = True shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 11. CONDITION AT DISCHARGE # ══════════════════════════════════════════════════════════════════════════════ section_heading("11. CONDITION AT DISCHARGE") doc.add_paragraph() disch_tbl = doc.add_table(rows=1, cols=2) disch_tbl.style = "Table Grid" add_table_header_row(disch_tbl, ["Parameter", "Status at Discharge"], fill="2E75B6") disch_data = [ ("Vitals", "Stable, afebrile, haemodynamically stable"), ("GCS", "15/15"), ("Upper limb power", "4/5 bilaterally"), ("Lower limb power", "1–2/5 bilaterally (residual weakness — arachnoiditis)"), ("Tracheostomy", "Decannulated and closed (13 July 2026)"), ("VP Shunt", "In situ and functioning; Evans index reduced to 0.31"), ("Vision", "Impaired — VEP: non-recordable right, moderate dysfunction left (optic pathway involvement)"), ("Higher functions", "Status quo — no acute deterioration"), ("Respiratory", "Room air, no ventilatory support"), ("Nutrition", "Via Ryle's tube (RT feeds at 50 mL/hr); 1800 kcal/day"), ] for i, (param, status) in enumerate(disch_data): row = disch_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([param, status]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(10) if ci == 0: run.bold = True shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 12. FOLLOW-UP PLAN # ══════════════════════════════════════════════════════════════════════════════ section_heading("12. FOLLOW-UP PLAN") doc.add_paragraph() fu_tbl = doc.add_table(rows=1, cols=3) fu_tbl.style = "Table Grid" add_table_header_row(fu_tbl, ["Team / Specialist", "Timeframe", "Purpose"], fill="2E75B6") fu_data = [ ("Neurology — Dr. Dhanaraj M", "15 days (with prior appointment)", "ATT monitoring, seizure review, neurological status"), ("Cardiology — Dr. K.P. Pramodkumar", "15 days", "BP management, cardiac monitoring"), ("Diabetology — Dr. Shantharam", "3 days (with FBS + PPBS reports)", "Glycemic optimization"), ("Infectious Diseases — Dr. Senthur Nambi","28 July 2026", "ATT continuation, liver function monitoring"), ("ENT", "If stridor/breathing difficulty", "Tracheostomy closure site care (alt. day dressing ×3 weeks)"), ("Neurosurgery", "2 weeks", "VP shunt check (2×daily pumping — 20 pumps/session)"), ("Physiotherapy", "Ongoing", "Intensive chest + limb rehab; aspiration precautions"), ("Ophthalmology", "As required", "Visual pathway dysfunction — VEP follow-up"), ] for i, (team, time, purpose) in enumerate(fu_data): row = fu_tbl.add_row() fill = "EBF3FB" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([team, time, purpose]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(10) if ci == 0: run.bold = True shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 13. TEACHING POINTS # ══════════════════════════════════════════════════════════════════════════════ section_heading("13. KEY TEACHING POINTS", color_hex="833C00") doc.add_paragraph() teaching_points = [ ("Diagnostic challenge of TBM", "This patient was treated for presumed viral meningoencephalitis and then demyelination across two prior hospital admissions. " "TBM was only confirmed on CSF Xpert MTB at the tertiary centre. This highlights how TBM can mimic both inflammatory/autoimmune " "and demyelinating disease, and the low sensitivity of AFB smear mandates molecular testing (Xpert MTB/RIF) early in the diagnostic workup."), ("Steroid paradox", "IV methylprednisolone given for presumed demyelination temporarily improved symptoms before the correct diagnosis was established. " "Steroids do have a role in TBM (dexamethasone reduces mortality in confirmed TBM), but empirical use for misdiagnosed TBM " "delays appropriate ATT and may mask clinical signs."), ("Communicating hydrocephalus in TBM", "Hydrocephalus is a common and serious complication of TBM, resulting from basal exudates blocking CSF resorption. " "This case required a VP shunt (Evans index 0.35 at presentation), with gradual improvement to 0.31 on serial CT. " "Acetazolamide (Diamox) was initially added but stopped due to respiratory alkalosis — an important drug interaction to remember."), ("Pan-spinal arachnoiditis", "MRI on 6 June demonstrated leptomeningeal and dural enhancement from cervical to lumbar levels with cauda equina clumping — " "a finding that explains the severe lower limb weakness (1–2/5) at discharge. Adhesive arachnoiditis is a recognized complication " "of TBM and portends a difficult rehabilitation course."), ("ATT hepatotoxicity", "Raised transaminases (SGPT peak 150 U/L) were attributed to pyrazinamide. The Infectious Disease team recommended dose reduction " "(1750→1250 mg) and ursodeoxycholic acid (Udiliv). Isoniazid and rifampicin were continued. Regular LFT monitoring during ATT is essential."), ("Anterior visual pathway involvement", "Absent menace reflexes noted at 22 June; VEP pre-discharge confirmed non-recordable responses on the right and moderate dysfunction " "on the left — consistent with optic chiasm/nerve involvement by basal meningeal exudates. This is a recognized but often under-appreciated " "complication of TBM."), ("Hospital-acquired infections (HAI) in intubated TBM", "The patient developed VAP (Pseudomonas + Klebsiella), Candida UTI, and Pseudomonas bacteraemia with septic shock — all superimposed " "on severe TBM. Management required broad-spectrum antibiotics (Tigecycline, Ceftazidime) and antifungals (Caspofungin). " "HAI surveillance and early tracheostomy (to facilitate ventilator weaning) are critical in prolonged TBM admissions."), ("Multidisciplinary care is non-negotiable", "Nine specialties were actively involved (Neurology, Neurosurgery, Pulmonology, Infectious Diseases, Gastroenterology, " "Gynaecology, Diabetology, Cardiology, ENT, Ophthalmology, Dermatology). This case illustrates the systemic complexity of severe TBM " "in a patient with diabetes and hypertension and the importance of protocolised multi-team collaboration."), ("Modafinil in TBM-related hypersomnia", "The patient had persistent drowsiness throughout the admission. Modafinil (Modalert 100 mg then 200 mg OD) was added as a " "wake-promoting agent — a pragmatic intervention in TBM with diffuse cortical dysfunction, though evidence is extrapolated from " "TBI/encephalopathy literature."), ] tp_tbl = doc.add_table(rows=1, cols=3) tp_tbl.style = "Table Grid" add_table_header_row(tp_tbl, ["#", "Point", "Clinical Lesson"], fill="833C00") for i, (point, lesson) in enumerate(teaching_points): row = tp_tbl.add_row() fill = "FFF2E8" if i % 2 == 0 else "FFFFFF" for ci, txt in enumerate([str(i+1), point, lesson]): cell = row.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.font.size = Pt(9.5) if ci == 1: run.bold = True shade_cell(cell, fill) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # 14. RED FLAG SYMPTOMS FOR EMERGENCY # ══════════════════════════════════════════════════════════════════════════════ section_heading("14. RED FLAG SYMPTOMS — SEEK IMMEDIATE CARE", color_hex="C00000") doc.add_paragraph() rf_tbl = doc.add_table(rows=2, cols=3) rf_tbl.style = "Table Grid" rf_items = ["Fever >101°F", "New or worsening headache", "Seizures", "Altered level of consciousness", "Breathing difficulty / stridor", "New neurological deficit or weakness"] r0 = rf_tbl.rows[0] r1 = rf_tbl.rows[1] for ci, txt in enumerate(rf_items[:3]): cell = r0.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.bold = True run.font.size = Pt(10) shade_cell(cell, "FFE6E6") for ci, txt in enumerate(rf_items[3:]): cell = r1.cells[ci] p = cell.paragraphs[0] run = p.add_run(txt) run.bold = True run.font.size = Pt(10) shade_cell(cell, "FFE6E6") doc.add_paragraph() p = doc.add_paragraph() run = p.add_run("Emergency Contact: Apollo Hospitals — 1066 | Enquiry & Appointment: 044-28293333") run.bold = True run.font.size = Pt(10.5) run.font.color.rgb = RGBColor(0xC0, 0x00, 0x00) p.alignment = WD_ALIGN_PARAGRAPH.CENTER doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # FOOTER NOTE # ══════════════════════════════════════════════════════════════════════════════ footer_tbl = doc.add_table(rows=1, cols=1) footer_cell = footer_tbl.cell(0, 0) shade_cell(footer_cell, "EBF3FB") fp = footer_cell.paragraphs[0] fp.alignment = WD_ALIGN_PARAGRAPH.CENTER r = fp.add_run( "Document prepared for referral / teaching purposes | Apollo Hospital, Chennai | " "Compiled: August 2026 | Primary Consultant: Dr. Dhanaraj M, MD, DM (Neurology)" ) r.italic = True r.font.size = Pt(9) r.font.color.rgb = RGBColor(0x44, 0x44, 0x44) # ── Save ────────────────────────────────────────────────────────────────────── output_path = "/tmp/workspace/tbm-case/TBM_Clinical_Summary_Saithoon_Benazir.docx" doc.save(output_path) print(f"Saved: {output_path}") PYEOF

python3 -c " from docx import Document doc = Document('/tmp/workspace/tbm-case/TBM_Clinical_Summary_Saithoon_Benazir.docx') print(f'Pages/paragraphs: {len(doc.paragraphs)}, Tables: {len(doc.tables)}') # Verify key sections present text_sample = ' '.join([p.text for p in doc.paragraphs[:30]]) print(text_sample[:500]) "