Vitamins and Minerals - Complete Clinical Reference

ls -la /tmp/workspace/ 2>/dev/null || mkdir -p /tmp/workspace && echo "created"

mkdir -p /tmp/workspace/vitamins-minerals && cat > /tmp/workspace/vitamins-minerals/make_pdf.py << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.platypus import ( SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, KeepTogether, PageBreak ) from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY from reportlab.platypus import Flowable OUTPUT = "/tmp/workspace/vitamins-minerals/Vitamins_and_Minerals_Reference.pdf" doc = SimpleDocTemplate( OUTPUT, pagesize=A4, rightMargin=1.8*cm, leftMargin=1.8*cm, topMargin=2*cm, bottomMargin=2*cm, title="Vitamins & Minerals - Complete Clinical Reference", author="Orris Medical" ) W = A4[0] - 3.6*cm # usable width # ── Colour palette ──────────────────────────────────────────────────────────── C_NAVY = colors.HexColor("#1A3A5C") C_TEAL = colors.HexColor("#1B6B8A") C_TEAL2 = colors.HexColor("#2596be") C_GOLD = colors.HexColor("#D4A017") C_GREEN = colors.HexColor("#2E7D32") C_RED = colors.HexColor("#C62828") C_ORANGE = colors.HexColor("#E65100") C_PURPLE = colors.HexColor("#6A1B9A") C_LBLUE = colors.HexColor("#E3F2FD") C_LGREEN = colors.HexColor("#E8F5E9") C_LPUR = colors.HexColor("#F3E5F5") C_LORANGE = colors.HexColor("#FFF3E0") C_LYELLOW = colors.HexColor("#FFFDE7") C_LGRAY = colors.HexColor("#F5F5F5") C_TH_BG = colors.HexColor("#1A3A5C") C_TH2_BG = colors.HexColor("#1B6B8A") C_STRIPE = colors.HexColor("#EEF4FB") C_BORDER = colors.HexColor("#B0BEC5") styles = getSampleStyleSheet() # ── Custom paragraph styles ─────────────────────────────────────────────────── def S(name, **kw): base = kw.pop("parent", "Normal") s = ParagraphStyle(name, parent=styles[base], **kw) return s ST = { "title": S("T_title", fontSize=22, textColor=C_NAVY, leading=28, alignment=TA_CENTER, spaceAfter=4, fontName="Helvetica-Bold"), "subtitle": S("T_sub", fontSize=10, textColor=C_TEAL, leading=14, alignment=TA_CENTER, spaceAfter=2, fontName="Helvetica"), "h1": S("T_h1", fontSize=14, textColor=colors.white, leading=18, fontName="Helvetica-Bold", spaceAfter=0, spaceBefore=4), "h2": S("T_h2", fontSize=11, textColor=C_NAVY, leading=15, fontName="Helvetica-Bold", spaceBefore=8, spaceAfter=2), "h3": S("T_h3", fontSize=9.5,textColor=C_TEAL, leading=13, fontName="Helvetica-Bold", spaceBefore=5, spaceAfter=2), "body": S("T_body", fontSize=8.5,textColor=colors.black, leading=12, fontName="Helvetica", spaceAfter=2), "bullet": S("T_bullet", fontSize=8.5,textColor=colors.black, leading=12, fontName="Helvetica", spaceAfter=1, leftIndent=10, bulletIndent=0), "note": S("T_note", fontSize=8, textColor=C_TEAL, leading=11, fontName="Helvetica-Oblique", spaceAfter=2), "th": S("T_th", fontSize=8.5,textColor=colors.white, leading=11, fontName="Helvetica-Bold", alignment=TA_CENTER), "td": S("T_td", fontSize=8, textColor=colors.black, leading=11, fontName="Helvetica"), "tdg": S("T_tdg", fontSize=8, textColor=C_GREEN, leading=11, fontName="Helvetica-Bold"), "tdr": S("T_tdr", fontSize=8, textColor=C_RED, leading=11, fontName="Helvetica-Bold"), "footer": S("T_foot", fontSize=7, textColor=colors.grey, leading=9, alignment=TA_CENTER), "tag_fat": S("T_fat", fontSize=8, textColor=colors.white, leading=10, fontName="Helvetica-Bold", alignment=TA_CENTER), "tag_water":S("T_water", fontSize=8, textColor=colors.white, leading=10, fontName="Helvetica-Bold", alignment=TA_CENTER), "tag_min": S("T_min", fontSize=8, textColor=colors.white, leading=10, fontName="Helvetica-Bold", alignment=TA_CENTER), "callout": S("T_callout",fontSize=8.5,textColor=C_NAVY, leading=12, fontName="Helvetica", spaceAfter=2, leftIndent=8), } def p(text, style="body"): return Paragraph(text, ST[style]) def bp(text): return Paragraph(f"• {text}", ST["bullet"]) def hr(color=C_BORDER, thickness=0.5): return HRFlowable(width="100%", thickness=thickness, color=color, spaceAfter=4, spaceBefore=4) # ── Section header band ──────────────────────────────────────────────────────── def section_header(title, bg=C_NAVY): tbl = Table([[Paragraph(title, ST["h1"])]], colWidths=[W]) tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), bg), ("TOPPADDING", (0,0),(-1,-1), 6), ("BOTTOMPADDING", (0,0),(-1,-1), 6), ("LEFTPADDING", (0,0),(-1,-1), 10), ("RIGHTPADDING", (0,0),(-1,-1), 10), ("ROUNDEDCORNERS",(0,0),(-1,-1), [4,4,4,4]), ])) return tbl # ── Vitamin card builder ─────────────────────────────────────────────────────── def vit_card(name, tag_label, tag_color, rda, ul, sources, functions, deficiency_items, deficiency_label="Deficiency Signs", toxicity_items=None, key_points=None, at_risk=None, bg=C_LGRAY): elems = [] # Title row title_row = [ [Paragraph(name, S("vt_name", parent="Normal", fontSize=11, fontName="Helvetica-Bold", textColor=C_NAVY, leading=14)), Table([[Paragraph(tag_label, ST["tag_fat"])]], colWidths=[2*cm], style=TableStyle([("BACKGROUND",(0,0),(-1,-1),tag_color), ("TOPPADDING",(0,0),(-1,-1),3), ("BOTTOMPADDING",(0,0),(-1,-1),3), ("LEFTPADDING",(0,0),(-1,-1),4), ("RIGHTPADDING",(0,0),(-1,-1),4), ])) ] ] hdr = Table(title_row, colWidths=[W - 2.3*cm, 2.3*cm]) hdr.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,-1), bg), ("TOPPADDING",(0,0),(-1,-1), 6), ("BOTTOMPADDING",(0,0),(-1,-1), 4), ("LEFTPADDING",(0,0),(-1,-1), 8), ("RIGHTPADDING",(0,0),(-1,-1), 6), ("VALIGN",(0,0),(-1,-1),"MIDDLE"), ])) elems.append(hdr) # Info table info_rows = [ [p("<b>RDA/AI:</b>","body"), p(rda,"body")], ] if ul: info_rows.append([p("<b>UL:</b>","body"), p(ul,"body")]) info_rows.append([p("<b>Sources:</b>","body"), p(sources,"body")]) info_rows.append([p("<b>Functions:</b>","body"), p(functions,"body")]) if at_risk: info_rows.append([p("<b>At-risk:</b>","body"), p(at_risk,"body")]) info = Table(info_rows, colWidths=[2.2*cm, W-2.4*cm]) info.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,-1), colors.white), ("TOPPADDING",(0,0),(-1,-1), 3), ("BOTTOMPADDING",(0,0),(-1,-1), 3), ("LEFTPADDING",(0,0),(-1,-1), 8), ("RIGHTPADDING",(0,0),(-1,-1), 6), ("VALIGN",(0,0),(-1,-1),"TOP"), ("LINEBELOW",(0,-1),(-1,-1), 0.3, C_BORDER), ])) elems.append(info) # Deficiency / Toxicity / Key points columns def_items_p = [bp(i) for i in deficiency_items] tox_items_p = [bp(i) for i in toxicity_items] if toxicity_items else [p("Not established / minimal","note")] kp_items_p = [bp(i) for i in key_points] if key_points else [] # Deficiency box def_header = Table([[p(f"<b>⚠ {deficiency_label}</b>","body")]], colWidths=[W]) def_header.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,-1), colors.HexColor("#FFEBEE")), ("TOPPADDING",(0,0),(-1,-1), 3),("BOTTOMPADDING",(0,0),(-1,-1), 3), ("LEFTPADDING",(0,0),(-1,-1), 8),("RIGHTPADDING",(0,0),(-1,-1), 6), ])) tox_header = Table([[p("<b>☠ Toxicity</b>","body")]], colWidths=[W]) tox_header.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,-1), colors.HexColor("#FFF3E0")), ("TOPPADDING",(0,0),(-1,-1), 3),("BOTTOMPADDING",(0,0),(-1,-1), 3), ("LEFTPADDING",(0,0),(-1,-1), 8),("RIGHTPADDING",(0,0),(-1,-1), 6), ])) # Two-column layout for deficiency + toxicity if toxicity_items: col_w = (W - 0.3*cm) / 2 def_cell = [def_header] + def_items_p tox_cell = [tox_header] + tox_items_p two_col = Table([[def_cell, tox_cell]], colWidths=[col_w, col_w]) two_col.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), ])) elems.append(two_col) else: elems.append(def_header) for i in def_items_p: elems.append(i) if kp_items_p: kp_header = Table([[p("<b>★ Key Points</b>","body")]], colWidths=[W]) kp_header.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,-1), colors.HexColor("#E8F5E9")), ("TOPPADDING",(0,0),(-1,-1), 3),("BOTTOMPADDING",(0,0),(-1,-1), 3), ("LEFTPADDING",(0,0),(-1,-1), 8),("RIGHTPADDING",(0,0),(-1,-1), 6), ])) kp_items_wrap = Table([[kp_header] + kp_items_p], colWidths=[W]) kp_items_wrap.setStyle(TableStyle([ ("LEFTPADDING",(0,0),(-1,-1), 0), ("RIGHTPADDING",(0,0),(-1,-1), 0), ("TOPPADDING",(0,0),(-1,-1), 0), ("BOTTOMPADDING",(0,0),(-1,-1), 0), ])) elems.append(kp_header) for i in kp_items_p: elems.append(i) # Wrap all in a border box card_inner = [[e] for e in elems] card = Table(card_inner, colWidths=[W]) card.setStyle(TableStyle([ ("BOX",(0,0),(-1,-1), 0.8, C_TEAL2), ("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 KeepTogether([card, Spacer(1, 0.25*cm)]) # ── Simple table helper ──────────────────────────────────────────────────────── def simple_table(headers, rows, col_widths=None, stripe=True): header_row = [Paragraph(h, ST["th"]) for h in headers] data = [header_row] for i, row in enumerate(rows): bg = C_STRIPE if (stripe and i % 2 == 0) else colors.white data.append([Paragraph(str(c), ST["td"]) for c in row]) if col_widths is None: col_widths = [W / len(headers)] * len(headers) tbl = Table(data, colWidths=col_widths, repeatRows=1) style = [ ("BACKGROUND", (0,0), (-1,0), C_TH_BG), ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (-1,0), 8.5), ("TEXTCOLOR", (0,0), (-1,0), colors.white), ("ALIGN", (0,0), (-1,0), "CENTER"), ("VALIGN", (0,0), (-1,-1), "TOP"), ("FONTSIZE", (0,1), (-1,-1), 8), ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_STRIPE, colors.white]), ("GRID", (0,0), (-1,-1), 0.3, C_BORDER), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4), ("LEFTPADDING", (0,0), (-1,-1), 5), ("RIGHTPADDING", (0,0), (-1,-1), 5), ] tbl.setStyle(TableStyle(style)) return tbl # ══════════════════════════════════════════════════════════════════════════════ # BUILD CONTENT # ══════════════════════════════════════════════════════════════════════════════ story = [] # ── Cover / Title ───────────────────────────────────────────────────────────── story.append(Spacer(1, 0.5*cm)) story.append(p("Vitamins & Minerals", "title")) story.append(p("Complete Clinical Reference — Important Points to Remember", "subtitle")) story.append(p("Sources: Goldman-Cecil Medicine · Basic Medical Biochemistry · Washington Manual · Costanzo Physiology", "footer")) story.append(hr(C_TEAL2, 2)) story.append(Spacer(1, 0.3*cm)) # Key principle box kp_box_data = [[ Paragraph("KEY PRINCIPLES", S("kp_hdr", parent="Normal", fontSize=9, fontName="Helvetica-Bold", textColor=colors.white, leading=12)), Paragraph( "<b>Fat-soluble vitamins (A, D, E, K):</b> absorbed via micellar phase; stored in body; " "any fat malabsorption causes simultaneous deficiency; toxicity possible with excess.<br/>" "<b>Water-soluble vitamins (B-complex, C):</b> excess excreted in urine; limited storage; " "deficiency develops faster; most act as coenzymes.<br/>" "<b>Minerals:</b> essential for enzyme cofactors, structural roles, fluid balance, and signalling.", S("kp_body", parent="Normal", fontSize=8, fontName="Helvetica", textColor=colors.black, leading=12) ) ]] kp_box = Table(kp_box_data, colWidths=[2.5*cm, W-2.5*cm]) kp_box.setStyle(TableStyle([ ("BACKGROUND", (0,0), (0,0), C_NAVY), ("BACKGROUND", (1,0), (1,0), C_LYELLOW), ("VALIGN", (0,0), (-1,-1), "MIDDLE"), ("TOPPADDING", (0,0), (-1,-1), 8), ("BOTTOMPADDING",(0,0),(-1,-1), 8), ("LEFTPADDING",(0,0),(-1,-1), 8), ("RIGHTPADDING",(0,0),(-1,-1), 8), ("BOX", (0,0),(-1,-1), 1, C_NAVY), ])) story.append(kp_box) story.append(Spacer(1, 0.4*cm)) # ══════════════════════════════════════════════════════════════════════════════ # FAT-SOLUBLE VITAMINS # ══════════════════════════════════════════════════════════════════════════════ story.append(section_header("FAT-SOLUBLE VITAMINS (A · D · E · K)", C_NAVY)) story.append(Spacer(1, 0.2*cm)) story.append(vit_card( name="Vitamin A (Retinol / Retinoic Acid)", tag_label="FAT-SOLUBLE", tag_color=C_TEAL, rda="Women: 700 µg RAE/day | Men: 900 µg RAE/day", ul="3,000 µg/day (teratogenic in excess)", sources="Liver, dairy, eggs (preformed retinol); dark orange/yellow & leafy green vegetables (β-carotene provitamin)", functions="Vision (rhodopsin synthesis - retinal); Epithelial differentiation (retinoic acid - gene regulation); Immune function; Reproduction; Bone growth", deficiency_items=[ "Night blindness — earliest sign", "Bitot's spots (foamy white plaques on conjunctiva)", "Xerophthalmia (dry eyes) → Keratomalacia (corneal ulceration/blindness)", "Follicular hyperkeratosis ('toad skin')", "Increased susceptibility to infection (especially measles, diarrhea in children)", ], toxicity_items=[ "Acute: headache, vomiting, blurred vision, skin peeling", "Chronic: alopecia, dry skin, hepatotoxicity, pseudotumor cerebri", "TERATOGENIC — isotretinoin causes birth defects", "Hypercalcemia with chronic excess", ], key_points=[ "Progression: Night blindness → Bitot spots → Xerophthalmia → Keratomalacia", "Retinoic acid regulates gene transcription → growth and differentiation", "At-risk: fat malabsorption, chronic liver disease, strict vegetarians", ], at_risk="Malabsorptive states (proximal small bowel disease), chronic liver disease, strict vegetarians", bg=colors.HexColor("#FFF8E1") )) story.append(vit_card( name="Vitamin D (Calciferol — the 'Sunshine Vitamin')", tag_label="FAT-SOLUBLE", tag_color=C_TEAL, rda="600 IU (15 µg) under age 70; 800 IU over age 70", ul="4,000 IU/day", sources="Skin synthesis (UV + 7-dehydrocholesterol); fatty fish, fortified dairy/OJ, egg yolk", functions="Increases intestinal Ca²⁺ & phosphate absorption; bone mineralization; immune modulation; cell differentiation", deficiency_items=[ "Children: RICKETS — soft/bowed bones, craniotabes, rachitic rosary, widened epiphyseal plates", "Adults: OSTEOMALACIA — bone pain, pathologic fractures, proximal muscle weakness, waddling gait", "Hypocalcemia → tetany, seizures", ], toxicity_items=[ "Hypercalcemia: nausea, vomiting, polyuria, polydipsia, constipation, confusion", "Metastatic calcifications (kidneys, vessels, soft tissue)", "Nephrolithiasis and nephrocalcinosis", ], key_points=[ "Metabolism: Skin (D3) → Liver (25-OH) → Kidney (1,25-OH₂ = calcitriol) — PTH stimulates 1α-hydroxylation", "25(OH)D is the BEST serum marker of Vitamin D status (half-life ~3 weeks)", "At-risk: dark skin, exclusively breastfed infants, elderly/institutionalized, obesity, chronic liver/kidney disease", ], at_risk="Dark-skinned individuals, exclusively breastfed infants, limited sun exposure, obesity, malabsorptive states, chronic liver/kidney disease", bg=colors.HexColor("#FFF8E1") )) story.append(vit_card( name="Vitamin E (Tocopherol)", tag_label="FAT-SOLUBLE", tag_color=C_TEAL, rda="15 mg α-tocopherol/day", ul="1,000 mg/day", sources="Vegetable oils, wheat germ, nuts, seeds, green leafy vegetables", functions="Major lipid-soluble ANTIOXIDANT; protects cell membranes from peroxidation; RBC integrity; normal neurologic function", deficiency_items=[ "Hemolytic anemia — especially in premature infants (primary risk group)", "Spinocerebellar ataxia (progressive neurologic degeneration)", "Peripheral neuropathy (demyelination — posterior columns + spinocerebellar tracts)", "Ophthalmoplegia, areflexia, retinopathy in premature infants", ], toxicity_items=[ "Inhibits platelet aggregation → bleeding tendency", "Antagonizes Vitamin K → risk of hemorrhage at very high doses", ], key_points=[ "Works synergistically with selenium (both antioxidants)", "Abetalipoproteinemia → profound Vit E deficiency (no chylomicron/VLDL transport)", "At-risk: premature neonates, fat malabsorption syndromes", ], at_risk="Premature neonates, fat malabsorption syndromes, abetalipoproteinemia", bg=colors.HexColor("#FFF8E1") )) story.append(vit_card( name="Vitamin K (Phylloquinone K1 / Menaquinone K2)", tag_label="FAT-SOLUBLE", tag_color=C_TEAL, rda="Women: 90 µg/day | Men: 120 µg/day (AI — no UL established)", ul="No established UL (K1/K2 essentially non-toxic; K3 menadione toxic)", sources="K1: leafy green vegetables; K2: gut bacteria + fermented foods; K3: synthetic form", functions="Cofactor for γ-carboxylation: Clotting factors II, VII, IX, X + Proteins C, S, Z; Osteocalcin synthesis (bone mineralization)", deficiency_items=[ "Bleeding diathesis — elevated PT/INR (prolonged clotting time)", "HEMORRHAGIC DISEASE OF NEWBORN (HDN) — no gut bacteria, little placental transfer → prophylactic K injection at birth", "Spontaneous bruising, hematuria, GI bleeding", ], toxicity_items=[ "K1/K2: essentially non-toxic even in large amounts", "Synthetic K3 (menadione): hemolytic anemia and kernicterus in infants", ], key_points=[ "Warfarin antagonizes Vitamin K (blocks VKOR enzyme)", "Proteins C and S are anticoagulant and ALSO require Vitamin K — warfarin initially procoagulant", "All newborns receive prophylactic IM Vitamin K injection at birth", "At-risk: newborns, broad-spectrum antibiotics, fat malabsorption, warfarin therapy", ], at_risk="Newborns, broad-spectrum antibiotic use, fat malabsorption, warfarin therapy", bg=colors.HexColor("#FFF8E1") )) # ══════════════════════════════════════════════════════════════════════════════ # WATER-SOLUBLE VITAMINS # ══════════════════════════════════════════════════════════════════════════════ story.append(PageBreak()) story.append(section_header("WATER-SOLUBLE VITAMINS (B-Complex · Vitamin C)", C_TEAL)) story.append(Spacer(1, 0.2*cm)) story.append(vit_card( name="Vitamin B1 — Thiamine", tag_label="WATER-SOLUBLE", tag_color=C_GREEN, rda="Women: 1.1 mg/day | Men: 1.2 mg/day", ul="No UL established", sources="Whole grains, enriched cereals, legumes, pork, nuts, seeds", functions="As TPP: Pyruvate dehydrogenase (pyruvate→acetyl-CoA); α-ketoglutarate dehydrogenase (TCA); Transketolase (pentose phosphate pathway); Branched-chain AA catabolism", deficiency_items=[ "WET BERIBERI — high-output cardiac failure, dilated cardiomyopathy, edema", "DRY BERIBERI — peripheral neuropathy (distal sensorimotor polyneuropathy, legs > arms)", "WERNICKE'S ENCEPHALOPATHY (triad): Confusion + Ophthalmoplegia + Ataxia — acute, reversible", "KORSAKOFF'S SYNDROME: anterograde amnesia + confabulation — chronic, often irreversible", ], toxicity_items=[ "No known toxicity — excess excreted in urine", ], key_points=[ "ALWAYS give thiamine BEFORE glucose in suspected deficiency (glucose worsens Wernicke's)", "Primary risk group: ALCOHOLICS (reduced intake + impaired absorption + impaired utilization)", "Also at-risk: prolonged IV glucose without thiamine, dialysis, hyperemesis gravidarum, gastric bypass", "Most sensitive test: RBC transketolase activity", ], at_risk="Alcoholics, malnutrition, prolonged IV glucose without thiamine, dialysis, hyperemesis gravidarum, gastric bypass", bg=C_LGREEN )) story.append(vit_card( name="Vitamin B2 — Riboflavin", tag_label="WATER-SOLUBLE", tag_color=C_GREEN, rda="Women: 1.1 mg/day | Men: 1.3 mg/day", ul="No UL established", sources="Dairy products, lean meats, enriched cereals, eggs, leafy vegetables", functions="As FMN/FAD: electron carrier in redox reactions (ETC); fatty acid β-oxidation; glutathione reductase (antioxidant); required for B6 and folate activation", deficiency_items=[ "ARIBOFLAVINOSIS: Cheilosis + angular stomatitis (cracking at corners of mouth)", "Glossitis — magenta tongue", "Seborrheic dermatitis (scrotum, vulva, nasolabial folds)", "Corneal vascularization, photophobia", "Normochromic normocytic anemia", ], toxicity_items=[ "No known significant toxicity", "Urine turns yellow-green (fluorescent) on supplementation", ], key_points=[ "Required for activation of Vitamin B6 and Folate", "Phenothiazines, tricyclics, and probenecid impair riboflavin absorption", ], at_risk="Alcoholics, malabsorption, elderly on poor diets", bg=C_LGREEN )) story.append(vit_card( name="Vitamin B3 — Niacin / Nicotinamide", tag_label="WATER-SOLUBLE", tag_color=C_GREEN, rda="Women: 14 mg NE/day | Men: 16 mg NE/day", ul="35 mg/day (supplemental)", sources="Meat, poultry, fish, peanuts, enriched cereals; also synthesized from tryptophan (60 mg Trp = 1 mg niacin)", functions="As NAD⁺/NADH and NADP⁺/NADPH: central coenzyme in redox reactions — glycolysis, TCA cycle, fatty acid synthesis/oxidation, oxidative phosphorylation", deficiency_items=[ "PELLAGRA — The 4 Ds: Dermatitis + Diarrhea + Dementia + Death", "Casal's necklace — hyperpigmented rash on sun-exposed skin (neck, dorsum of hands)", "Bright red tongue, confusion, neuropsychiatric symptoms", ], toxicity_items=[ "Pharmacologic doses (1-3g): FLUSHING (prostaglandin-mediated → prevent with aspirin)", "Hepatotoxicity (esp. sustained-release forms)", "Hyperglycemia, hyperuricemia (at high therapeutic doses)", ], key_points=[ "Pellagra-causing conditions: Corn-based diets (niacytin form of niacin unabsorbable), ALCOHOLICS", "Hartnup disease: defective neutral AA transport → low tryptophan → pellagra-like symptoms", "Carcinoid syndrome: tryptophan diverted to serotonin → pellagra", "Isoniazid (INH) impairs tryptophan → niacin conversion (give B6 with INH)", "High-dose niacin: best agent for RAISING HDL-C", ], at_risk="Corn-based diets, alcoholics, Hartnup disease, carcinoid syndrome, INH therapy", bg=C_LGREEN )) story.append(vit_card( name="Vitamin B5 — Pantothenic Acid", tag_label="WATER-SOLUBLE", tag_color=C_GREEN, rda="AI: 5 mg/day (both sexes)", ul="No UL established", sources="Ubiquitous in all foods (Greek: pantos = 'everywhere'); liver, egg yolk, avocado are richest sources", functions="As Coenzyme A (CoA): central to ALL CoA-dependent reactions — fatty acid synthesis & oxidation, TCA cycle (acetyl-CoA, succinyl-CoA), steroid synthesis, heme synthesis, acetylcholine synthesis", deficiency_items=[ "Extremely rare due to ubiquitous distribution", "'Burning feet syndrome' — painful paresthesias and burning of feet", "Irritability, fatigue, headache, nausea in severe malnutrition", ], key_points=[ "Backbone of Coenzyme A — essential for ALL acyl-group transfer reactions", "Almost never seen in clinical practice except in extreme starvation", ], bg=C_LGREEN )) story.append(PageBreak()) story.append(vit_card( name="Vitamin B6 — Pyridoxine", tag_label="WATER-SOLUBLE", tag_color=C_GREEN, rda="1.3 mg/day (adults)", ul="100 mg/day", sources="Meat, poultry, fish, potatoes, bananas, fortified cereals", functions="As PLP (Pyridoxal Phosphate): Transamination (ALT, AST); Decarboxylation → neurotransmitters (serotonin, dopamine, GABA, histamine); Heme synthesis (ALA synthase); Glycogenolysis; Cystathionine synthesis (homocysteine→cysteine)", deficiency_items=[ "Seborrheic dermatitis, cheilosis, glossitis (similar to B2 deficiency)", "MICROCYTIC SIDEROBLASTIC ANEMIA — impaired heme synthesis; ring sideroblasts on bone marrow", "PERIPHERAL NEUROPATHY", "CONVULSIONS/SEIZURES — decreased GABA synthesis", "Depression, confusion; elevated homocysteine (cardiovascular risk)", ], toxicity_items=[ "SENSORY NEUROPATHY at >200 mg/day — only B vitamin with significant neurotoxicity", "Ataxia, proprioception loss, irreversible nerve damage with megadose use", ], key_points=[ "Isoniazid (INH) binds and inactivates PLP → give B6 (25-50 mg/day) prophylactically with INH", "Penicillamine and oral contraceptives also deplete B6", "Key memory: B6 needed for EVERY step of neurotransmitter and heme biosynthesis", ], at_risk="Alcoholics, isoniazid therapy, penicillamine, oral contraceptives", bg=C_LGREEN )) story.append(vit_card( name="Vitamin B7 — Biotin", tag_label="WATER-SOLUBLE", tag_color=C_GREEN, rda="AI: 30 µg/day", ul="No UL established", sources="Liver, egg yolk (cooked), nuts, legumes; gut bacteria produce some", functions="Cofactor for carboxylation reactions (CO₂ fixation): Pyruvate carboxylase (pyruvate→OAA); Acetyl-CoA carboxylase (acetyl-CoA→malonyl-CoA, fatty acid synthesis); Propionyl-CoA carboxylase; β-methylcrotonyl-CoA carboxylase", deficiency_items=[ "ALOPECIA (hair loss) — hallmark sign", "PERIORIFICIAL DERMATITIS — scaly rash around eyes, nose, mouth, genitals", "Conjunctivitis", "CNS abnormalities: lethargy, depression, hallucinations", ], key_points=[ "RAW EGG WHITES contain AVIDIN — binds biotin irreversibly → biotin deficiency (cooking denatures avidin)", "Biotinidase deficiency — inherited disorder causing biotin deficiency in infants", "Prolonged TPN without biotin supplementation is a risk", ], at_risk="Raw egg white consumption, prolonged TPN, biotinidase deficiency", bg=C_LGREEN )) story.append(vit_card( name="Vitamin B9 — Folate / Folic Acid", tag_label="WATER-SOLUBLE", tag_color=C_GREEN, rda="400 µg DFE/day; 600 µg in PREGNANCY; 500 µg lactation", ul="1,000 µg/day (supplemental folate only)", sources="Leafy green vegetables (spinach, asparagus), legumes, fortified cereals, citrus fruits, liver", functions="As THF (Tetrahydrofolate): One-carbon transfer reactions — purine synthesis, thymidylate synthesis (dTMP from dUMP), homocysteine→methionine (requires B12)", deficiency_items=[ "MEGALOBLASTIC MACROCYTIC ANEMIA — impaired DNA synthesis; large hypersegmented neutrophils + oval macrocytes", "NEURAL TUBE DEFECTS (spina bifida, anencephaly) — critical in first 4 weeks of pregnancy", "Elevated homocysteine → cardiovascular risk", "NO NEUROLOGIC SYMPTOMS (key difference from B12 deficiency)", ], toxicity_items=[ "Can MASK B12 deficiency (corrects anemia but not neurologic damage)", "Seizure threshold may be lowered at very high doses", ], key_points=[ "400-800 µg/day recommended for ALL women of childbearing age (pre-conceptionally)", "METHYLFOLATE TRAP: B12 deficiency → folate accumulates as inactive N5-methyl-THF", "Drug interactions: Methotrexate, trimethoprim, pyrimethamine → inhibit DHFR", "Phenytoin and sulfasalazine impair folate absorption", ], at_risk="Pregnancy, alcoholics, elderly, methotrexate/TMP use, celiac disease, Crohn's disease", bg=C_LGREEN )) story.append(vit_card( name="Vitamin B12 — Cobalamin", tag_label="WATER-SOLUBLE", tag_color=C_GREEN, rda="2.4 µg/day", ul="No UL established", sources="EXCLUSIVELY animal products (meat, fish, dairy, eggs) — vegans MUST supplement", functions="Methylcobalamin: methionine synthase (homocysteine→methionine, regenerates THF); Adenosylcobalamin: methylmalonyl-CoA mutase (methylmalonyl-CoA→succinyl-CoA)", deficiency_items=[ "MEGALOBLASTIC MACROCYTIC ANEMIA (same as folate)", "SUBACUTE COMBINED DEGENERATION OF SPINAL CORD: posterior columns (↓vibration/proprioception) + lateral corticospinal tracts (UMN signs) + peripheral neuropathy", "Glossitis — beefy red, smooth tongue", "Elevated METHYLMALONIC ACID (MMA) + elevated homocysteine (both elevated vs. folate only homocysteine)", "Neuropsychiatric symptoms: dementia, depression, psychosis", ], toxicity_items=[ "No known toxicity — water soluble, excess excreted", ], key_points=[ "Absorption: B12 + Intrinsic Factor (parietal cells) → ILEUM (terminal ileum is exclusive absorption site)", "PERNICIOUS ANEMIA: autoimmune parietal cell destruction → no IF → B12 malabsorption", "MMA elevated ONLY in B12 deficiency (not folate) — use to distinguish the two", "Metformin impairs B12 absorption — monitor B12 in long-term metformin users", "Other causes: gastrectomy, ileal disease/resection, bacterial overgrowth, D. latum tapeworm", ], at_risk="Strict vegans, pernicious anemia, gastrectomy, ileal resection, bacterial overgrowth, metformin use, elderly", bg=C_LGREEN )) story.append(PageBreak()) story.append(vit_card( name="Vitamin C — Ascorbic Acid", tag_label="WATER-SOLUBLE", tag_color=C_GREEN, rda="Women: 75 mg/day | Men: 90 mg/day | Smokers +35 mg/day", ul="2,000 mg/day", sources="Citrus fruits, strawberries, kiwi, bell peppers, broccoli, potatoes", functions="Cofactor for prolyl/lysyl hydroxylase (collagen synthesis); Iron absorption enhancer (Fe³⁺→Fe²⁺); Antioxidant (regenerates Vitamin E); Dopamine-β-hydroxylase (dopamine→norepinephrine); Carnitine synthesis", deficiency_items=[ "SCURVY — defective collagen → vascular/tissue fragility", "PERIFOLLICULAR HEMORRHAGES + CORKSCREW HAIRS (pathognomonic)", "Gingival bleeding and gingivitis (swollen, spongy, bleeding gums)", "Poor wound healing", "Petechiae and ecchymoses (bruising)", "Infants: Frankel's sign (corner fractures of long bones), Pelkan spurs", ], toxicity_items=[ "GI upset (diarrhea) at >2 g/day", "Oxalate kidney stones with chronic very high intake", "Hemolysis in G6PD-deficient individuals", ], key_points=[ "Corkscrew hairs are PATHOGNOMONIC for scurvy", "Vitamin C enhances non-heme iron absorption — take together", "Does NOT prevent the common cold (evidence does not support this)", "At-risk: elderly on restricted diets, alcoholics, smokers, food insecurity", ], at_risk="Elderly on restricted diets, alcoholics, smokers, food insecurity", bg=C_LGREEN )) # ══════════════════════════════════════════════════════════════════════════════ # MINERALS # ══════════════════════════════════════════════════════════════════════════════ story.append(section_header("MINERALS (Macro & Trace)", colors.HexColor("#4A148C"))) story.append(Spacer(1, 0.2*cm)) PURPLE = colors.HexColor("#F3E5F5") story.append(vit_card( name="Calcium (Ca²⁺)", tag_label="MACROMINERAL", tag_color=C_PURPLE, rda="1,000 mg/day (adults 19-50); 1,200 mg (women >50, all >70)", ul="2,500 mg/day", sources="Dairy products, fortified foods, leafy greens (kale, bok choy), sardines (with bones)", functions="Bone & teeth structure (99% in skeleton as hydroxyapatite); muscle contraction; nerve transmission; coagulation (factor activation); second messenger signalling (Ca²⁺-calmodulin)", deficiency_items=[ "HYPOCALCEMIA: Tetany — Chvostek's sign (tap facial nerve → facial twitch) + Trousseau's sign (BP cuff → carpal spasm)", "Seizures, perioral/digital paresthesias", "Prolonged QT interval → cardiac arrhythmias", "Chronic inadequate intake → OSTEOPOROSIS", ], toxicity_items=[ "'Bones, Stones, Groans, Psychic Moans' (Hypercalcemia mnemonic)", "Kidney stones (nephrolithiasis), constipation, nausea", "Bone pain, confusion, depression, psychosis", "Hypercalcemia causes: primary hyperparathyroidism (most common outpatient), malignancy (most common inpatient)", ], key_points=[ "Absorption requires calcitriol (active Vitamin D) — Vitamin D deficiency → secondary hypocalcemia", "PTH and Vitamin D are the major regulators of calcium homeostasis", "Refractory hypocalcemia → always check and correct MAGNESIUM first", ], at_risk="Postmenopausal women, elderly, low dairy intake, Vitamin D deficiency", bg=PURPLE )) story.append(vit_card( name="Magnesium (Mg²⁺)", tag_label="MACROMINERAL", tag_color=C_PURPLE, rda="Women: 310-320 mg/day | Men: 400-420 mg/day", ul="350 mg/day (supplemental only)", sources="Nuts, seeds, whole grains, leafy greens (spinach), legumes, dark chocolate", functions="Cofactor for >300 enzymes; ATP stabilization (Mg-ATP complex); protein synthesis; DNA replication; muscle relaxation; neuromuscular junction function", deficiency_items=[ "HYPOCALCEMIA refractory to calcium replacement (Mg required for PTH secretion and action)", "HYPOKALEMIA (renal K⁺ wasting — cannot correct K⁺ without first correcting Mg²⁺)", "Muscle cramps, tremors, tetany", "TORSADES DE POINTES and other cardiac arrhythmias", "Personality changes, nystagmus, seizures", ], toxicity_items=[ "Respiratory depression (used therapeutically: IV Mg for eclampsia — monitor respiratory rate)", "Hypotension, cardiac arrest at very high IV levels", "Diarrhea with oral high-dose Mg (osmotic effect)", ], key_points=[ "Most common cause of hypomagnesemia: ALCOHOLISM", "Also: loop/thiazide diuretics, PPIs (chronic use), diarrhea, Gitelman syndrome, DM", "IV Magnesium Sulfate: treatment of eclampsia seizures AND torsades de pointes", "Patellar reflex is clinical monitor for Mg toxicity during IV infusion", ], at_risk="Alcoholics, diuretics (loop/thiazide), chronic PPI use, diarrhea, diabetes", bg=PURPLE )) story.append(vit_card( name="Phosphorus", tag_label="MACROMINERAL", tag_color=C_PURPLE, rda="700 mg/day", ul="4,000 mg/day", sources="Widely distributed; dairy, meat, fish, nuts, legumes, cola drinks (phosphoric acid)", functions="Bone mineralization (hydroxyapatite); ATP (energy currency); phospholipids (cell membranes); DNA/RNA backbone; enzyme regulation via phosphorylation/dephosphorylation", deficiency_items=[ "Muscle weakness, bone pain, hemolytic anemia", "Respiratory failure (ATP depletion → diaphragm failure)", "REFEEDING SYNDROME — dramatic phosphate fall after carbohydrate refeeding of malnourished patients → cardiac arrest, seizures, respiratory failure", ], key_points=[ "Refeeding syndrome triad: Hypophosphatemia + Hypokalemia + Hypomagnesemia", "Prevention: start refeeding slowly; monitor and supplement phosphate", "Hyperphosphatemia in chronic kidney disease → secondary hyperparathyroidism and renal osteodystrophy", ], bg=PURPLE )) story.append(PageBreak()) story.append(vit_card( name="Iron (Fe²⁺/Fe³⁺)", tag_label="TRACE MINERAL", tag_color=colors.HexColor("#B71C1C"), rda="Women 19-50: 18 mg; Men: 8 mg; Pregnancy: 27 mg", ul="45 mg/day", sources="Heme iron (red meat, organ meats — 15-35% absorbed); Non-heme iron (legumes, fortified cereals, spinach — 2-10% absorbed); Vitamin C enhances non-heme absorption", functions="Hemoglobin (O₂ transport), myoglobin (muscle O₂ storage), cytochromes (electron transport chain), catalase/peroxidase enzymes", deficiency_items=[ "MICROCYTIC HYPOCHROMIC ANEMIA — fatigue, pallor, decreased exercise tolerance", "KOILONYCHIA (spoon-shaped nails)", "PICA (craving ice, clay, starch)", "PLUMMER-VINSON SYNDROME: iron deficiency + dysphagia + esophageal web", "Glossitis, angular stomatitis, restless leg syndrome", "Labs: low ferritin (best marker), low serum iron, high TIBC, low transferrin saturation", ], toxicity_items=[ "HEREDITARY HEMOCHROMATOSIS: HFE gene (C282Y mutation) — 'bronze diabetes' triad (cirrhosis + diabetes + bronze skin)", "Also: cardiac failure, hypogonadism, arthropathy, hepatocellular carcinoma risk", "Acute poisoning (children): gastroenteritis → shock → hepatic failure", "Treatment: phlebotomy (hereditary); deferoxamine (acute toxicity)", ], key_points=[ "Most common nutritional deficiency worldwide", "Heme iron absorbed 5-10x better than non-heme iron", "Serum ferritin is the BEST marker of iron stores (acute phase reactant — falsely elevated in inflammation)", "At-risk: reproductive-age females, pregnancy, infants, vegetarians, GI bleeding, post-gastric bypass, celiac", ], at_risk="Reproductive-age females, pregnancy, infants/children, vegetarians, post-gastric bypass, celiac disease, chronic GI bleeding", bg=colors.HexColor("#FFEBEE") )) story.append(vit_card( name="Zinc (Zn²⁺)", tag_label="TRACE MINERAL", tag_color=colors.HexColor("#B71C1C"), rda="Women: 8 mg/day | Men: 11 mg/day", ul="40 mg/day", sources="Oysters (richest source), red meat, poultry, beans, nuts, fortified cereals", functions="Cofactor for >100 enzymes (DNA polymerase, RNA polymerase, carbonic anhydrase); zinc finger transcription factors; wound healing; taste/smell; immune function; spermatogenesis; Vitamin A mobilization from liver", deficiency_items=[ "ACRODERMATITIS ENTEROPATHICA — periorificial and acral rash (around mouth, eyes, genitals, hands/feet)", "ALOPECIA (hair loss)", "HYPOGONADISM + growth retardation in children", "DYSGEUSIA/DYSOSMIA (impaired taste and smell)", "Poor wound healing; impaired immune function", "Night blindness (zinc needed to mobilize Vitamin A from liver)", ], toxicity_items=[ "High-dose zinc COMPETITIVELY INHIBITS copper absorption → copper deficiency (anemia + neutropenia)", "Nausea, vomiting, diarrhea, gastric irritation", ], key_points=[ "Acrodermatitis enteropathica = inherited zinc malabsorption (SLC39A4 mutation)", "High-phytate diets (cereals, legumes) chelate zinc → reduced absorption", "Chronic diarrhea and fistulas are major risk factors", ], at_risk="Alcoholics, chronic diarrhea, high-phytate diets, malabsorptive states, nephrotic syndrome, pregnancy, post-gastric bypass, HIV, sickle cell", bg=colors.HexColor("#FFEBEE") )) story.append(vit_card( name="Copper (Cu²⁺)", tag_label="TRACE MINERAL", tag_color=colors.HexColor("#B71C1C"), rda="900 µg/day", ul="10,000 µg/day", sources="Liver, shellfish (oysters), nuts, seeds, dark chocolate, whole grains", functions="Ceruloplasmin (iron oxidation/transport); Cytochrome c oxidase (ETC complex IV); Superoxide dismutase (antioxidant); Dopamine-β-hydroxylase; Lysyl oxidase (collagen/elastin cross-linking); Tyrosinase (melanin synthesis)", deficiency_items=[ "HYPOCHROMIC NORMOCYTIC OR MACROCYTIC ANEMIA + NEUTROPENIA + thrombocytopenia (mimics B12/folate hematologically)", "Osteoporosis, pathologic fractures", "Depigmentation of skin and hair", "Myelopathy resembling subacute combined degeneration", ], toxicity_items=[ "WILSON'S DISEASE (ATP7B mutation): copper accumulation → liver disease + Kayser-Fleischer rings + neuropsychiatric symptoms", "Nausea, vomiting, hemolytic anemia, liver failure", ], key_points=[ "MENKES DISEASE (X-linked, ATP7A mutation): impaired copper transport → kinky hair + neurodegeneration + connective tissue fragility (defective lysyl oxidase)", "Excess zinc intake → copper deficiency (competitive inhibition of absorption)", "Ceruloplasmin is the main copper-carrying protein (also an acute-phase reactant — low in Wilson's)", ], at_risk="Excessive zinc intake, chronic diarrhea, Menkes disease, high-protein infant formula", bg=colors.HexColor("#FFEBEE") )) story.append(vit_card( name="Iodine (I⁻)", tag_label="TRACE MINERAL", tag_color=colors.HexColor("#B71C1C"), rda="150 µg/day; 220 µg pregnancy; 290 µg lactation", ul="1,100 µg/day", sources="Iodized salt (most important source), seafood, dairy, seaweed", functions="Required EXCLUSIVELY for thyroid hormone synthesis (T3/T4)", deficiency_items=[ "GOITER — thyroid hyperplasia due to chronically elevated TSH", "HYPOTHYROIDISM: fatigue, cold intolerance, constipation, weight gain, myxedema", "CRETINISM (in utero deficiency): irreversible intellectual disability, short stature, deafness, hypothyroidism (myxedematous vs. neurological cretinism)", ], toxicity_items=[ "Paradoxical HYPOTHYROIDISM via Wolff-Chaikoff effect (excess I⁻ transiently inhibits thyroid peroxidase)", "Jod-Basedow effect: iodine loading → HYPERTHYROIDISM in previously iodine-deficient glands", ], key_points=[ "Iodine deficiency is the leading preventable cause of intellectual disability worldwide", "Universal salt iodization is the primary prevention strategy", "At-risk: inland/mountainous populations ('goiter belt') without access to iodized salt", ], at_risk="Inland/mountainous populations without iodized salt, pregnancy", bg=colors.HexColor("#FFEBEE") )) story.append(PageBreak()) story.append(vit_card( name="Selenium (Se)", tag_label="TRACE MINERAL", tag_color=colors.HexColor("#B71C1C"), rda="55 µg/day", ul="400 µg/day", sources="Brazil nuts (single highest food source), seafood, meat, cereals (soil-dependent content)", functions="Component of selenoproteins: glutathione peroxidase (antioxidant); thioredoxin reductase; iodothyronine deiodinase (T4 → T3 conversion — works with Vitamin E/iodine)", deficiency_items=[ "KESHAN DISEASE — endemic cardiomyopathy in selenium-deficient areas of China", "KASHIN-BECK DISEASE — endemic osteoarthropathy", "Myopathy, muscle pain", "Hypothyroidism (impaired T4→T3 conversion)", ], toxicity_items=[ "SELENOSIS: garlic-breath odor (selenide compounds in breath/urine)", "Alopecia, nail brittleness/changes, peripheral neuropathy", "Nausea, diarrhea, fatigue", ], key_points=[ "Works synergistically with Vitamin E (both antioxidants)", "At-risk: TPN without selenium supplementation, Crohn's disease, renal dialysis, endemic low-soil areas (China, New Zealand)", ], at_risk="TPN without selenium, Crohn's disease, renal dialysis, selenium-depleted soil regions", bg=colors.HexColor("#FFEBEE") )) story.append(vit_card( name="Fluoride (F⁻)", tag_label="TRACE MINERAL", tag_color=colors.HexColor("#B71C1C"), rda="AI: Women 3 mg/day | Men 4 mg/day", ul="10 mg/day", sources="Fluoridated water (main source), toothpaste, tea, seafood", functions="Incorporated into hydroxyapatite (bone and teeth) → resistance to acid dissolution and caries prevention", deficiency_items=[ "Increased dental caries (tooth decay)", ], toxicity_items=[ "DENTAL FLUOROSIS: mottled/pitted enamel, white spots (chronic mild excess during tooth development)", "SKELETAL FLUOROSIS: osteosclerosis, joint stiffness (chronic high exposure)", "Acute (rare): nausea, vomiting, hypocalcemia, cardiac arrhythmias", ], key_points=[ "Optimal water fluoridation: 0.7 mg/L (US recommendation)", "Benefit (caries prevention) occurs at low levels; toxicity only with excess", ], bg=colors.HexColor("#FFEBEE") )) story.append(vit_card( name="Chromium (Cr³⁺) · Manganese (Mn²⁺) · Molybdenum", tag_label="TRACE MINERAL", tag_color=colors.HexColor("#B71C1C"), rda="Chromium: AI 25-35 µg/day | Manganese: AI Women 1.8 mg, Men 2.3 mg | Molybdenum: RDA 45 µg/day", ul="Cr: not established | Mn: 11 mg/day | Mo: 2,000 µg/day", sources="Chromium: whole grains, broccoli, nuts; Manganese: whole grains, nuts, legumes, tea; Molybdenum: legumes, whole grains, nuts", functions="Chromium: potentiates insulin signaling ('glucose tolerance factor'); Manganese: cofactor for SOD, arginase, pyruvate carboxylase, glycosyltransferases; Molybdenum: cofactor for xanthine oxidase, sulfite oxidase, aldehyde oxidase", deficiency_items=[ "Chromium: glucose intolerance, insulin resistance, peripheral neuropathy (mainly TPN-related)", "Manganese: hypercholesterolemia, dermatitis, weight loss (very rare)", "Molybdenum: neurologic symptoms, accumulation of sulfite/xanthine (very rare — seen with TPN)", ], toxicity_items=[ "Manganese INHALATION toxicity: MANGANISM — Parkinson's-like syndrome (tremor, rigidity, behavioral changes) seen in miners/welders", "Chromium Cr⁶⁺ (hexavalent, industrial): lung cancer risk by inhalation", ], key_points=[ "Manganism is the main clinically important toxicity in this group", "These deficiencies are almost exclusively seen in prolonged TPN without trace element supplementation", ], bg=colors.HexColor("#FFEBEE") )) # ══════════════════════════════════════════════════════════════════════════════ # QUICK REFERENCE SUMMARY TABLES # ══════════════════════════════════════════════════════════════════════════════ story.append(PageBreak()) story.append(section_header("QUICK REFERENCE SUMMARY TABLES", colors.HexColor("#1A237E"))) story.append(Spacer(1, 0.3*cm)) # ── Vitamin deficiency buzzwords ────────────────────────────────────────────── story.append(p("<b>Vitamin Deficiency — Classic Signs & Buzzwords</b>", "h2")) vit_rows = [ ["Vitamin A", "Night blindness → Bitot's spots → Xerophthalmia → Keratomalacia"], ["Vitamin D", "Rickets (children) — bowed legs, rachitic rosary; Osteomalacia (adults) — bone pain, proximal weakness"], ["Vitamin E", "Hemolytic anemia in premature infants; Spinocerebellar ataxia; Peripheral neuropathy"], ["Vitamin K", "Bleeding diathesis (elevated PT/INR); Hemorrhagic disease of the newborn (HDN)"], ["B1 Thiamine", "WET Beriberi (cardiac failure/edema); DRY Beriberi (peripheral neuropathy); Wernicke-Korsakoff (alcoholics)"], ["B2 Riboflavin", "Ariboflavinosis: Cheilosis, Angular stomatitis, Magenta tongue, Seborrheic dermatitis"], ["B3 Niacin", "PELLAGRA — 4 Ds: Dermatitis (Casal's necklace), Diarrhea, Dementia, Death"], ["B5 Pantothenic acid", "Burning feet syndrome (rare — seen in severe malnutrition only)"], ["B6 Pyridoxine", "Microcytic sideroblastic anemia; Peripheral neuropathy; Seizures (low GABA); Elevated homocysteine"], ["B7 Biotin", "Alopecia + Periorificial dermatitis + CNS symptoms (raw egg white / avidin)"], ["B9 Folate", "Megaloblastic macrocytic anemia; Neural tube defects (pregnancy); NO neurologic symptoms"], ["B12 Cobalamin", "Megaloblastic anemia + SUBACUTE COMBINED DEGENERATION (posterior & lateral columns) + elevated MMA"], ["Vitamin C", "SCURVY: Perifollicular hemorrhages, Corkscrew hairs (pathognomonic), Gingival bleeding, Poor wound healing"], ] story.append(simple_table( ["Vitamin", "Classic Deficiency Findings"], vit_rows, col_widths=[2.5*cm, W-2.5*cm] )) story.append(Spacer(1, 0.4*cm)) # ── Mineral deficiency buzzwords ────────────────────────────────────────────── story.append(p("<b>Mineral Deficiency — Classic Signs & Buzzwords</b>", "h2")) min_rows = [ ["Calcium", "Tetany (Chvostek/Trousseau signs), Seizures, Prolonged QT; Chronic → Osteoporosis"], ["Magnesium", "Refractory hypokalemia/hypocalcemia; Torsades de pointes; Seizures (most common cause: alcoholism)"], ["Phosphorus", "Refeeding syndrome (hypophosphatemia after refeeding malnourished patients → cardiac arrest, respiratory failure)"], ["Iron", "Microcytic hypochromic anemia; Koilonychia (spoon nails); Pica; Plummer-Vinson syndrome"], ["Zinc", "Acrodermatitis enteropathica (periorificial rash); Alopecia; Hypogonadism; Poor wound healing; Dysgeusia"], ["Copper", "Normocytic/macrocytic anemia + NEUTROPENIA (mimics B12/folate); Osteoporosis; Myelopathy"], ["Iodine", "Goiter; Hypothyroidism; Cretinism (irreversible intellectual disability if in utero deficiency)"], ["Selenium", "Keshan disease (endemic cardiomyopathy); Kashin-Beck disease (osteoarthropathy); Hypothyroidism"], ["Fluoride", "DEFICIENCY: Dental caries; EXCESS: Dental/Skeletal fluorosis"], ["Manganese", "TOXICITY (inhalation): Manganism — Parkinson's-like syndrome (miners, welders)"], ["Chromium", "Glucose intolerance (mainly in TPN patients); Cr⁶⁺ toxicity → lung cancer risk"], ] story.append(simple_table( ["Mineral", "Classic Deficiency/Toxicity Findings"], min_rows, col_widths=[2.5*cm, W-2.5*cm] )) story.append(Spacer(1, 0.4*cm)) # ── B12 vs Folate table ──────────────────────────────────────────────────────── story.append(p("<b>B12 Deficiency vs. Folate Deficiency — Key Differences</b>", "h2")) bf_rows = [ ["Megaloblastic macrocytic anemia", "✓ YES", "✓ YES"], ["Neurologic symptoms (subacute combined degeneration)", "✓ YES", "✗ NO"], ["Elevated homocysteine", "✓ YES", "✓ YES"], ["Elevated methylmalonic acid (MMA)", "✓ YES", "✗ NO"], ["Responds to folate supplementation", "Partially (corrects anemia only; NOT neuro)", "✓ YES"], ["Neural tube defect risk in pregnancy", "✗ NO", "✓ YES"], ] story.append(simple_table( ["Feature", "B12 Deficiency", "Folate Deficiency"], bf_rows, col_widths=[W*0.55, W*0.22, W*0.23] )) story.append(Spacer(1, 0.4*cm)) # ── "Only" facts ────────────────────────────────────────────────────────────── story.append(p("<b>High-Yield 'Only' Facts</b>", "h2")) only_rows = [ ["Only vitamin synthesized by the skin", "Vitamin D"], ["Only vitamin found exclusively in animal products", "Vitamin B12"], ["Only B vitamin with significant neurotoxicity in excess", "Vitamin B6 (pyridoxine) — sensory neuropathy >200 mg/day"], ["Only fat-soluble vitamins", "A, D, E, K (mnemonic: ADEK / 'Fat DEKA')"], ["Only antidote/reversal for warfarin", "Vitamin K"], ["Most common nutritional deficiency worldwide", "Iron deficiency anemia"], ["Only vitamin to treat eclampsia / torsades de pointes", "Magnesium sulfate (IV)"], ["Coenzyme A backbone vitamin", "Vitamin B5 (Pantothenic acid)"], ["Elevated MMA = diagnostic of", "Vitamin B12 deficiency ONLY (not folate) — key distinguishing marker"], ["Methylfolate trap caused by", "Vitamin B12 deficiency → folate accumulates as inactive N5-methyl-THF"], ["Corkscrew hairs = pathognomonic for", "Scurvy (Vitamin C deficiency)"], ["Excess zinc → causes deficiency of", "Copper (competitive absorption inhibition → anemia + neutropenia)"], ["'Give thiamine BEFORE glucose' rule", "Suspected Wernicke's encephalopathy — glucose alone worsens the condition"], ["Iodine: leading cause of preventable intellectual disability", "Iodine deficiency → cretinism (in utero)"], ["Refeeding syndrome: watch for", "Severe hypophosphatemia + hypokalemia + hypomagnesemia"], ] story.append(simple_table( ["Key Fact", "Answer"], only_rows, col_widths=[W*0.5, W*0.5] )) # ── Footer ──────────────────────────────────────────────────────────────────── story.append(Spacer(1, 0.5*cm)) story.append(hr(C_TEAL2)) story.append(p("Sources: Goldman-Cecil Medicine (Vol.2 Ch.199) · Basic Medical Biochemistry 6e · Washington Manual of Medical Therapeutics · Costanzo Physiology 7e", "footer")) story.append(p("Generated by Orris Medical AI · For educational purposes only", "footer")) # ── BUILD ───────────────────────────────────────────────────────────────────── doc.build(story) print(f"PDF saved: {OUTPUT}") PYEOF echo "Script written"

cd /tmp/workspace/vitamins-minerals && python make_pdf.py 2>&1

ls -lh /tmp/workspace/vitamins-minerals/Vitamins_and_Minerals_Reference.pdf

cat > /tmp/workspace/vitamins-minerals/make_concise_pdf.py << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.platypus import ( SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak, KeepTogether ) from reportlab.lib.styles import ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT OUTPUT = "/tmp/workspace/vitamins-minerals/Vitamins_Minerals_Quick_Reference.pdf" PAGE_W, PAGE_H = A4 L_MARGIN = R_MARGIN = 1.5*cm T_MARGIN = B_MARGIN = 1.8*cm USABLE_W = PAGE_W - L_MARGIN - R_MARGIN # ~17.7 cm doc = SimpleDocTemplate( OUTPUT, pagesize=A4, leftMargin=L_MARGIN, rightMargin=R_MARGIN, topMargin=T_MARGIN, bottomMargin=B_MARGIN, title="Vitamins & Minerals Quick Reference" ) # ── Colours ──────────────────────────────────────────────────────────────────── NAVY = colors.HexColor("#1A3A5C") TEAL = colors.HexColor("#1B6B8A") GREEN = colors.HexColor("#2E7D32") RED = colors.HexColor("#B71C1C") PURPLE = colors.HexColor("#4A148C") ORANGE = colors.HexColor("#E65100") GOLD = colors.HexColor("#F57F17") LBLUE = colors.HexColor("#E3F2FD") LGREEN = colors.HexColor("#E8F5E9") LRED = colors.HexColor("#FFEBEE") LPURP = colors.HexColor("#F3E5F5") LYELL = colors.HexColor("#FFFDE7") LGRAY = colors.HexColor("#F5F5F5") STRIPE = colors.HexColor("#EEF4FB") BORDER = colors.HexColor("#90A4AE") WHITE = colors.white # ── Styles ───────────────────────────────────────────────────────────────────── def S(name, **kw): return ParagraphStyle(name, **kw) TH = S("th", fontName="Helvetica-Bold", fontSize=7.5, textColor=WHITE, leading=10, alignment=TA_CENTER) TH2 = S("th2", fontName="Helvetica-Bold", fontSize=7, textColor=WHITE, leading=9, alignment=TA_CENTER) TD = S("td", fontName="Helvetica", fontSize=7, textColor=colors.black, leading=9, alignment=TA_LEFT) TDB = S("tdb", fontName="Helvetica-Bold", fontSize=7, textColor=colors.black, leading=9, alignment=TA_LEFT) TDR = S("tdr", fontName="Helvetica-Bold", fontSize=7, textColor=RED, leading=9, alignment=TA_LEFT) TDG = S("tdg", fontName="Helvetica-Bold", fontSize=7, textColor=GREEN, leading=9, alignment=TA_LEFT) H1 = S("h1", fontName="Helvetica-Bold", fontSize=11, textColor=WHITE, leading=14, alignment=TA_LEFT) H2 = S("h2", fontName="Helvetica-Bold", fontSize=9, textColor=NAVY, leading=12, alignment=TA_LEFT) TTL = S("ttl", fontName="Helvetica-Bold", fontSize=18, textColor=NAVY, leading=22, alignment=TA_CENTER) SUB = S("sub", fontName="Helvetica", fontSize=9, textColor=TEAL, leading=12, alignment=TA_CENTER) FTR = S("ftr", fontName="Helvetica", fontSize=6.5, textColor=colors.grey, leading=9, alignment=TA_CENTER) NOTE= S("note",fontName="Helvetica-Oblique",fontSize=7, textColor=TEAL, leading=9, alignment=TA_LEFT) def p(txt, style=TD): return Paragraph(txt, style) def pb(txt): return Paragraph(txt, TDB) def pr(txt): return Paragraph(txt, TDR) def pg(txt): return Paragraph(txt, TDG) def hr(col=BORDER, t=0.5): return HRFlowable(width="100%", thickness=t, color=col, spaceAfter=3, spaceBefore=3) # ── Section banner ───────────────────────────────────────────────────────────── def banner(title, bg=NAVY): t = Table([[Paragraph(title, H1)]], colWidths=[USABLE_W]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), bg), ("TOPPADDING", (0,0),(-1,-1), 5), ("BOTTOMPADDING", (0,0),(-1,-1), 5), ("LEFTPADDING", (0,0),(-1,-1), 8), ("RIGHTPADDING", (0,0),(-1,-1), 8), ])) return t # ── Generic table builder with fixed total width = USABLE_W ─────────────────── def make_table(headers, rows, col_fracs, header_bg=NAVY, row_bgs=None): """ col_fracs: list of fractions that sum to 1.0 Guarantees total width == USABLE_W so nothing bleeds off-page. """ col_widths = [USABLE_W * f for f in col_fracs] header_row = [p(h, TH) for h in headers] data = [header_row] for row in rows: data.append([p(str(c), TD) if not isinstance(c, Paragraph) else c for c in row]) if row_bgs is None: row_bgs = [STRIPE, WHITE] tbl = Table(data, colWidths=col_widths, repeatRows=1) style = TableStyle([ ("BACKGROUND", (0,0), (-1,0), header_bg), ("ROWBACKGROUNDS",(0,1), (-1,-1), row_bgs), ("GRID", (0,0), (-1,-1), 0.3, BORDER), ("VALIGN", (0,0), (-1,-1), "TOP"), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ("LEFTPADDING", (0,0), (-1,-1), 4), ("RIGHTPADDING", (0,0), (-1,-1), 4), ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (-1,0), 7.5), ("TEXTCOLOR", (0,0), (-1,0), WHITE), ("FONTSIZE", (0,1), (-1,-1), 7), ]) tbl.setStyle(style) return tbl # ══════════════════════════════════════════════════════════════════════════════ # DATA # ══════════════════════════════════════════════════════════════════════════════ # FAT-SOLUBLE VITAMINS TABLE # Cols: Vitamin | RDA | Key Sources | Functions | Deficiency | Toxicity | High-Yield Note fat_sol_rows = [ ["A (Retinol)", "M: 900 µg\nF: 700 µg\nUL: 3000 µg", "Liver, dairy, eggs;\nβ-carotene from dark veg", "Vision (rhodopsin); epithelial differentiation; immune function; reproduction", "Night blindness (1st sign); Bitot's spots; Xerophthalmia; Keratomalacia; follicular hyperkeratosis", "Acute: headache, vomiting\nChronic: alopecia, hepatotoxicity, pseudotumor cerebri\nTERATOGENIC", "Progression: Night blindness→Bitot spots→Xerophthalmia→Keratomalacia"], ["D (Calciferol)", "< 70 yr: 600 IU\n> 70 yr: 800 IU\nUL: 4000 IU", "Sunlight (skin); fatty fish; fortified dairy", "Ca²⁺/PO₄ absorption; bone mineralisation; immune modulation", "Children: RICKETS (bowed legs, rachitic rosary)\nAdults: OSTEOMALACIA (bone pain, proximal weakness, waddling gait)", "Hypercalcaemia (polyuria, constipation, confusion); nephrolithiasis; metastatic calcification", "25(OH)D = best serum marker\nPTH stimulates 1α-hydroxylation in kidney\nOnly vitamin made by skin"], ["E (Tocopherol)", "15 mg/day\nUL: 1000 mg", "Veg oils, wheat germ, nuts, seeds, leafy greens", "Lipid-soluble antioxidant; protects RBC membranes; neurological function", "Premature infants: HAEMOLYTIC ANAEMIA\nSpinoc. ataxia; peripheral neuropathy (posterior columns); ophthalmoplegia", "Inhibits platelets → bleeding risk\nAntagonises Vitamin K", "Works synergistically with selenium\nAbetalipoproteinaemia → severe deficiency"], ["K (Phylloquinone)", "M: 120 µg (AI)\nF: 90 µg (AI)\nNo UL", "K1: leafy greens\nK2: gut bacteria, fermented food", "γ-carboxylation: clotting factors II, VII, IX, X; Proteins C, S, Z; osteocalcin", "Bleeding (elevated PT/INR); HAEMORRHAGIC DISEASE OF NEWBORN (HDN); bruising, haematuria, GI bleed", "K1/K2: essentially non-toxic\nK3 (menadione-synthetic): haemolytic anaemia, kernicterus in infants", "Warfarin blocks VKOR enzyme\nAll newborns receive prophylactic IM Vit K\nProteins C & S also need Vit K → warfarin initially procoagulant"], ] # WATER-SOLUBLE VITAMINS TABLE water_sol_rows = [ ["B1\nThiamine", "M: 1.2 mg\nF: 1.1 mg\nNo UL", "Whole grains, pork, legumes, nuts", "TPP cofactor: pyruvate DH; α-KG DH; transketolase (PPP); BCAA catabolism", "WET BERIBERI: cardiomyopathy, high-output failure, oedema\nDRY BERIBERI: peripheral neuropathy\nWERNICKE'S: confusion + ophthalmoplegia + ataxia\nKORSAKOFF'S: amnesia + confabulation", "None known", "Give THIAMINE BEFORE glucose in suspected deficiency\nPrimary risk: alcoholics\nBest test: RBC transketolase"], ["B2\nRiboflavin", "M: 1.3 mg\nF: 1.1 mg\nNo UL", "Dairy, meats, enriched cereals, eggs", "FMN/FAD: redox reactions, ETC; fatty acid β-oxidation; activates B6 & folate", "ARIBOFLAVINOSIS:\nCheilosis + angular stomatitis\nMagenta tongue (glossitis)\nSeborrhoeic dermatitis\nCorneal vascularisation", "None known\n(Urine turns yellow-green)", "Required to activate B6 and folate\nPhenothiazines impair absorption"], ["B3\nNiacin", "M: 16 mg NE\nF: 14 mg NE\nUL: 35 mg", "Meat, fish, peanuts; made from tryptophan (60 mg Trp = 1 mg niacin)", "NAD⁺/NADH, NADP⁺/NADPH: central coenzyme in glycolysis, TCA, FAO, OXPHOS", "PELLAGRA — 4 Ds:\nDermatitis (Casal's necklace)\nDiarrhoea\nDementia\nDeath", "Pharmacologic doses:\nFlushing (give aspirin to prevent)\nHepatotoxicity\nHyperglycaemia, hyperuricaemia", "Pellagra causes: corn diet, alcoholism, Hartnup disease, carcinoid syndrome, INH therapy\nHigh-dose niacin = best HDL-raising agent"], ["B5\nPantothenic acid", "AI: 5 mg\nNo UL", "Ubiquitous (liver, egg yolk, avocado are richest)", "Coenzyme A backbone: ALL acyl-transfer reactions — FA synthesis/oxidation, TCA, steroid synthesis", "RARE: burning feet syndrome\nIrritability, fatigue (severe malnutrition only)", "None known", "Deficiency almost never seen clinically\nGreek: pantos = 'everywhere'"], ["B6\nPyridoxine", "1.3 mg/day\nUL: 100 mg", "Meat, fish, potatoes, bananas, fortified cereals", "PLP cofactor: transamination (ALT/AST); neurotransmitter synthesis (serotonin, dopamine, GABA); heme synthesis (ALA synthase); cystathionine synthesis", "Microcytic SIDEROBLASTIC anaemia (ring sideroblasts)\nPeripheral neuropathy\nSEIZURES (↓GABA)\nDermatitis; ↑homocysteine", "SENSORY NEUROPATHY at >200 mg/day\n(Only B vitamin with significant neurotoxicity)", "INH inactivates PLP → give B6 with INH\nB6 needed for EVERY neurotransmitter biosynthesis step"], ["B7\nBiotin", "AI: 30 µg\nNo UL", "Liver, cooked egg yolk, nuts, legumes", "Carboxylation cofactor: pyruvate carboxylase; acetyl-CoA carboxylase; propionyl-CoA carboxylase", "ALOPECIA (hallmark)\nPeriorificial dermatitis (around mouth, eyes, genitals)\nConjunctivitis; CNS abnormalities", "None known", "Raw egg white AVIDIN binds biotin irreversibly → cooking destroys avidin\nBiotinidase deficiency in infants"], ["B9\nFolate", "400 µg DFE\nPregnancy: 600 µg\nUL: 1000 µg", "Leafy greens, legumes, fortified cereals, citrus, liver", "THF: one-carbon transfers — purine & thymidylate synthesis; homocysteine→methionine", "MEGALOBLASTIC MACROCYTIC anaemia\nNEURAL TUBE DEFECTS (spina bifida, anencephaly)\n↑Homocysteine\nNO neurologic symptoms", "Masks B12 deficiency (corrects anaemia but not neuro damage)", "400-800 µg/day for ALL women of childbearing age\nMETHYLFOLATE TRAP (B12 deficiency)\nMTX/TMP inhibit DHFR"], ["B12\nCobalamin", "2.4 µg/day\nNo UL", "ONLY animal products (meat, fish, dairy, eggs)\nVegans must supplement", "Methionine synthase (methylcobalamin); methylmalonyl-CoA mutase (adenosylcobalamin)", "MEGALOBLASTIC MACROCYTIC anaemia\nSUBACUTE COMBINED DEGENERATION (posterior + lateral columns)\n↑MMA + ↑homocysteine\nGlossitis; neuropsychiatric symptoms", "None known", "Absorbed ONLY in terminal ileum (needs intrinsic factor)\nPernicious anaemia = anti-IF antibodies\nElevated MMA = B12 only (not folate)\nMetformin impairs B12 absorption"], ["C\nAscorbic acid", "M: 90 mg\nF: 75 mg\nSmokers +35 mg\nUL: 2000 mg", "Citrus, kiwi, strawberries, bell peppers, broccoli", "Prolyl/lysyl hydroxylase (collagen); Fe³⁺→Fe²⁺ (iron absorption); antioxidant; dopamine-β-hydroxylase; carnitine synthesis", "SCURVY:\nCorkscrew hairs (PATHOGNOMONIC)\nPerifollicular haemorrhages\nGingival bleeding\nPoor wound healing\nPetechiae, ecchymoses", "GI upset (>2 g/day)\nOxalate kidney stones\nHaemolysis in G6PD deficiency", "Corkscrew hairs = pathognomonic for scurvy\nVit C enhances non-heme iron absorption\nDoes NOT prevent common cold"], ] # MINERALS TABLE mineral_rows = [ # Macrominerals ["CALCIUM\nCa²⁺", "19-50 yr: 1000 mg\n>50F/>70 all: 1200 mg\nUL: 2500 mg", "Dairy, fortified foods, leafy greens (kale), sardines", "Bone structure (99% in skeleton); muscle contraction; nerve transmission; coagulation; 2nd messenger", "HYPOCALCAEMIA:\nChvostek's sign (facial tap → twitch)\nTrousseau's sign (BP cuff → carpal spasm)\nProlonged QT; seizures\nChronic: OSTEOPOROSIS", "HYPERCALCAEMIA ('Bones Stones Groans Moans'):\nKidney stones; bone pain\nConstipation, nausea\nConfusion, depression", "Refractory hypocalcaemia → check Mg first\nVit D required for absorption\nCauses: hyperPTH (outpatient), malignancy (inpatient)"], ["MAGNESIUM\nMg²⁺", "M: 400-420 mg\nF: 310-320 mg\nUL: 350 mg (suppl)", "Nuts, seeds, whole grains, spinach, legumes, dark chocolate", "Cofactor for >300 enzymes; ATP stabilisation; protein/DNA synthesis; muscle relaxation", "Refractory HYPOKALAEMIA\nRefractory HYPOCALCAEMIA\nTORSADES DE POINTES\nSeizures; tetany; personality changes", "IV: respiratory depression, hypotension, cardiac arrest\nOral: diarrhoea (osmotic)", "Most common cause: ALCOHOLISM\nAlso: loop/thiazide diuretics, PPIs, Gitelman syndrome\nIV MgSO₄ = treatment for ECLAMPSIA and torsades\nMonitor patellar reflex during IV infusion"], ["PHOSPHORUS", "700 mg/day\nUL: 4000 mg", "Dairy, meat, fish, nuts, legumes, cola drinks", "Bone mineralisation; ATP; phospholipids; DNA/RNA; enzyme phosphorylation", "REFEEDING SYNDROME:\nhypophosphataemia after re-feeding malnourished patient → cardiac arrest, respiratory failure, seizures", "Hyperphosphataemia in CKD → secondary hyperPTH, renal osteodystrophy", "Refeeding syndrome triad: ↓PO₄ + ↓K⁺ + ↓Mg²⁺\nPrevent: refeed slowly + supplement PO₄"], # Trace minerals ["IRON\nFe²⁺/³⁺", "M: 8 mg\nF 19-50: 18 mg\nPregnancy: 27 mg\nUL: 45 mg", "Heme iron: red meat (15-35% absorbed)\nNon-heme: legumes, fortified cereals (2-10%)\nVit C enhances absorption", "Haemoglobin; myoglobin; cytochromes (ETC); catalase/peroxidase", "MICROCYTIC HYPOCHROMIC ANAEMIA\nKOILONYCHIA (spoon nails)\nPICA (craving ice, clay)\nPLUMMER-VINSON: Fe def + dysphagia + oesophageal web\nGlossitis; restless legs", "HAEMOCHROMATOSIS (HFE, C282Y): 'Bronze diabetes' (cirrhosis + DM + bronze skin)\nCardiac failure; hypogonadism; arthropathy\nAcute ingestion (children): GE → shock → liver failure", "Most common nutritional deficiency worldwide\nFerritin = BEST marker of iron stores (↑ in inflammation)\nTx: phlebotomy (hereditary); deferoxamine (acute toxicity)"], ["ZINC\nZn²⁺", "M: 11 mg\nF: 8 mg\nUL: 40 mg", "Oysters (richest), red meat, beans, nuts, fortified cereals", "Cofactor for >100 enzymes (DNA/RNA pol, carbonic anhydrase); zinc finger TFs; wound healing; taste/smell; spermatogenesis", "ACRODERMATITIS ENTEROPATHICA (periorificial + acral rash)\nALOPECIA\nHYPOGONADISM + growth retardation\nDysgeusia/dysosmia\nPoor wound healing; night blindness", "High-dose Zn → COPPER DEFICIENCY (competitive inhibition → anaemia + neutropenia)\nNausea, vomiting, GI irritation", "AE = inherited Zn malabsorption (SLC39A4 mutation)\nPhytate in cereals/legumes chelates zinc\nHigh-phytate diets and chronic diarrhoea = major risk factors"], ["COPPER\nCu²⁺", "900 µg/day\nUL: 10,000 µg", "Liver, oysters, nuts, seeds, dark chocolate, whole grains", "Ceruloplasmin (Fe transport); cytochrome c oxidase (ETC IV); SOD; dopamine-β-hydroxylase; lysyl oxidase (collagen/elastin cross-linking); tyrosinase (melanin)", "NORMOCYTIC/MACROCYTIC ANAEMIA + NEUTROPENIA + thrombocytopenia (mimics B12/folate)\nOsteoporosis; pathological fractures\nMyelopathy (like SCD); depigmentation", "WILSON'S DISEASE (ATP7B mutation): liver disease + KAYSER-FLEISCHER rings + neuropsychiatric symptoms", "MENKES DISEASE (X-linked, ATP7A): kinky hair + neurodegeneration + connective tissue fragility\nExcess Zn → Cu deficiency\nCeruloplasmin: main Cu-carrying protein (LOW in Wilson's)"], ["IODINE\nI⁻", "150 µg/day\nPregnancy: 220 µg\nLactation: 290 µg\nUL: 1100 µg", "Iodised salt (most important), seafood, dairy, seaweed", "Required EXCLUSIVELY for thyroid hormone synthesis (T3, T4)", "GOITRE (thyroid hyperplasia, ↑TSH)\nHYPOTHYROIDISM\nCRETINISM (in utero): irreversible intellectual disability, short stature, deafness", "Wolff-Chaikoff: excess I⁻ → paradoxical HYPOTHYROIDISM\nJod-Basedow: I⁻ loading → HYPERTHYROIDISM", "Leading preventable cause of intellectual disability worldwide\nUniversal salt iodisation = primary prevention\nAt-risk: inland/mountainous regions"], ["SELENIUM\nSe", "55 µg/day\nUL: 400 µg", "Brazil nuts (highest), seafood, meat, cereals (soil-dependent)", "Glutathione peroxidase (antioxidant); iodothyronine deiodinase (T4→T3 conversion); thioredoxin reductase", "KESHAN DISEASE (endemic cardiomyopathy, China)\nKASHIN-BECK DISEASE (osteoarthropathy)\nMyopathy; hypothyroidism", "SELENOSIS: garlic-breath odour, alopecia, nail changes, peripheral neuropathy, nausea", "Synergistic with Vitamin E (both antioxidants)\nAt-risk: TPN without Se, Crohn's, renal dialysis, low-selenium soil areas"], ["FLUORIDE\nF⁻", "M: 4 mg (AI)\nF: 3 mg (AI)\nUL: 10 mg", "Fluoridated water (main source), toothpaste, tea, seafood", "Incorporated into hydroxyapatite → resistance to acid dissolution; dental caries prevention", "DEFICIENCY: Increased dental caries", "DENTAL FLUOROSIS: mottled enamel (chronic mild excess in childhood)\nSKELETAL FLUOROSIS: osteosclerosis, joint stiffness\nAcute: hypocalcaemia, cardiac arrhythmia", "Optimal water fluoridation: 0.7 mg/L\nBenefit at low levels; toxicity only with excess"], ["CHROMIUM\nCr³⁺", "AI: 25-35 µg\nNo UL", "Whole grains, broccoli, nuts, meat", "Potentiates insulin signalling ('glucose tolerance factor')", "Glucose intolerance (insulin resistance)\nPeripheral neuropathy\n(Mainly TPN-related — rare otherwise)", "Cr⁶⁺ (hexavalent, industrial): LUNG CANCER risk by inhalation", "Deficiency almost exclusively in prolonged TPN\nCr³⁺ is dietary form (safe); Cr⁶⁺ is industrial toxin"], ["MANGANESE\nMn²⁺", "M: 2.3 mg (AI)\nF: 1.8 mg (AI)\nUL: 11 mg", "Whole grains, nuts, legumes, tea, leafy veg", "Cofactor: Mn-SOD; arginase; pyruvate carboxylase; glycosyltransferases", "Hypercholesterolaemia, dermatitis, weight loss (very rare — TPN)", "MANGANISM (inhalation): Parkinson's-like syndrome — tremor, rigidity, behavioural changes (miners/welders)", "Toxicity more clinically relevant than deficiency\nManganism occurs with chronic Mn INHALATION"], ["MOLYBDENUM", "RDA: 45 µg\nUL: 2000 µg", "Legumes, whole grains, nuts", "Cofactor: xanthine oxidase (purine catabolism); sulfite oxidase; aldehyde oxidase", "Neurologic symptoms; sulfite/xanthine accumulation\n(Only in prolonged TPN without trace elements)", "Gout-like symptoms at very high intake (↑xanthine oxidase → ↑uric acid)", "Clinically rare — almost exclusively TPN-related"], ] # HIGH-YIELD SUMMARY summary_rows = [ ["Only vitamin made by the skin", "Vitamin D"], ["Only vitamin EXCLUSIVELY in animal products", "Vitamin B12"], ["Fat-soluble vitamins (mnemonic)", "A, D, E, K — 'ADEK'"], ["Only B vitamin neurotoxic in excess", "B6 pyridoxine (sensory neuropathy >200 mg/day)"], ["Give THIAMINE before glucose — why?", "Glucose alone worsens Wernicke's encephalopathy"], ["Corkscrew hairs = pathognomonic for", "Scurvy (Vitamin C deficiency)"], ["Elevated MMA = diagnostic of", "Vitamin B12 deficiency ONLY (not folate)"], ["Methylfolate trap caused by", "B12 deficiency → folate trapped as inactive N5-methyl-THF"], ["B12 vs folate: key neuro difference", "B12 → subacute combined degeneration of spinal cord; Folate → NO neuro symptoms"], ["Antidote / reversal for warfarin", "Vitamin K"], ["Most common nutritional deficiency worldwide", "Iron deficiency anaemia"], ["Refractory hypoK + hypoCa → check first", "Magnesium (must correct Mg before K or Ca will respond)"], ["IV MgSO₄ used to treat", "Eclampsia (seizures) AND torsades de pointes"], ["Refeeding syndrome triad", "↓Phosphate + ↓Potassium + ↓Magnesium"], ["Excess zinc → causes deficiency of", "Copper → normocytic anaemia + neutropenia"], ["Acrodermatitis enteropathica", "Inherited zinc malabsorption (SLC39A4 mutation)"], ["Menkes disease", "X-linked Cu transport defect (ATP7A) → kinky hair + neurodegeneration"], ["Wilson's disease", "Cu excretion defect (ATP7B) → Kayser-Fleischer rings + liver disease"], ["Pernicious anaemia", "Anti-intrinsic factor antibodies → B12 malabsorption"], ["Iodine deficiency: leading cause of", "Preventable intellectual disability worldwide (cretinism)"], ["Pellagra: 4 Ds", "Dermatitis (Casal's necklace), Diarrhoea, Dementia, Death"], ["Keshan disease", "Selenium deficiency → endemic cardiomyopathy (China)"], ["Manganism (Mn inhalation toxicity)", "Parkinson's-like syndrome (miners, welders)"], ["Raw egg white causes deficiency of", "Biotin (avidin binds irreversibly; destroyed by cooking)"], ["Vitamin needed for GABA synthesis", "Vitamin B6 (PLP — decarboxylation of glutamate)"], ["Neural tube defect prevention", "Folic acid 400-800 µg/day pre-conceptionally"], ["Ferritin: clinical note", "BEST marker of iron stores; falsely elevated in inflammation (acute-phase reactant)"], ["Hartnup disease → pellagra-like symptoms", "Defective tryptophan absorption → can't synthesise niacin"], ["Carcinoid syndrome → pellagra", "Tryptophan diverted to serotonin → niacin deficiency"], ["INH therapy: give prophylactic", "Vitamin B6 (INH binds/inactivates PLP)"], ] # B12 vs Folate comparison b12_vs_fol_rows = [ ["Megaloblastic macrocytic anaemia", "YES", "YES"], ["Neurologic symptoms (SCD of cord)","YES", "NO"], ["Elevated homocysteine", "YES", "YES"], ["Elevated methylmalonic acid (MMA)","YES", "NO"], ["Neural tube defect risk", "NO", "YES"], ["Source", "Only animal products", "Green veg, fortified grains"], ["Absorption site", "Terminal ileum (needs IF)", "Proximal small intestine"], ["Key drug interactions", "Metformin (↓absorption)", "Methotrexate, TMP (inhibit DHFR)"], ] # ══════════════════════════════════════════════════════════════════════════════ # BUILD STORY # ══════════════════════════════════════════════════════════════════════════════ story = [] # ── Title ────────────────────────────────────────────────────────────────────── story.append(Spacer(1, 0.3*cm)) story.append(Paragraph("Vitamins & Minerals", TTL)) story.append(Paragraph("Quick Reference — Important Points for Rapid Learning", SUB)) story.append(hr(TEAL, 2)) story.append(Spacer(1, 0.2*cm)) # Key principle box (compact) kp = Table([[ Paragraph("<b>FAT-SOLUBLE (A,D,E,K):</b> stored in body; absorbed via micellar phase; fat malabsorption → all 4 deficient simultaneously; toxicity possible.<br/>" "<b>WATER-SOLUBLE (B1-B12, C):</b> limited storage; excess excreted; deficiency faster; most are coenzymes.<br/>" "<b>MINERALS:</b> enzyme cofactors, structural (bone/teeth), fluid balance, signalling.", S("kpb", fontName="Helvetica", fontSize=7.5, textColor=colors.black, leading=11)) ]], colWidths=[USABLE_W]) kp.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), LYELL), ("BOX", (0,0),(-1,-1), 1, GOLD), ("TOPPADDING", (0,0),(-1,-1), 6), ("BOTTOMPADDING", (0,0),(-1,-1), 6), ("LEFTPADDING", (0,0),(-1,-1), 8), ("RIGHTPADDING", (0,0),(-1,-1), 8), ])) story.append(kp) story.append(Spacer(1, 0.3*cm)) # ── FAT-SOLUBLE VITAMINS ─────────────────────────────────────────────────────── story.append(banner("FAT-SOLUBLE VITAMINS (A · D · E · K)", NAVY)) story.append(Spacer(1, 0.15*cm)) fat_headers = ["Vitamin", "RDA / UL", "Key Sources", "Functions", "Deficiency Signs", "Toxicity", "High-Yield Notes"] fat_fracs = [0.08, 0.09, 0.12, 0.15, 0.21, 0.17, 0.18] # sums to 1.0 story.append(make_table(fat_headers, fat_sol_rows, fat_fracs, header_bg=NAVY, row_bgs=[LBLUE, WHITE])) story.append(Spacer(1, 0.35*cm)) # ── WATER-SOLUBLE VITAMINS ───────────────────────────────────────────────────── story.append(PageBreak()) story.append(banner("WATER-SOLUBLE VITAMINS (B1 · B2 · B3 · B5 · B6 · B7 · B9 · B12 · Vitamin C)", TEAL)) story.append(Spacer(1, 0.15*cm)) ws_headers = ["Vitamin", "RDA / UL", "Key Sources", "Functions", "Deficiency Signs", "Toxicity", "High-Yield Notes"] ws_fracs = [0.07, 0.09, 0.12, 0.17, 0.21, 0.14, 0.20] story.append(make_table(ws_headers, water_sol_rows, ws_fracs, header_bg=TEAL, row_bgs=[LGREEN, WHITE])) story.append(Spacer(1, 0.35*cm)) # ── B12 vs FOLATE ────────────────────────────────────────────────────────────── story.append(banner("B12 vs FOLATE DEFICIENCY — Key Differences", colors.HexColor("#2E7D32"))) story.append(Spacer(1, 0.15*cm)) story.append(make_table( ["Feature", "B12 (Cobalamin)", "Folate (B9)"], b12_vs_fol_rows, [0.42, 0.29, 0.29], header_bg=GREEN )) story.append(Spacer(1, 0.35*cm)) # ── MINERALS ─────────────────────────────────────────────────────────────────── story.append(PageBreak()) story.append(banner("MINERALS (Macrominerals: Ca · Mg · P | Trace: Fe · Zn · Cu · I · Se · F · Cr · Mn · Mo)", PURPLE)) story.append(Spacer(1, 0.15*cm)) min_headers = ["Mineral", "RDA / UL", "Key Sources", "Functions", "Deficiency Signs", "Toxicity", "High-Yield Notes"] min_fracs = [0.08, 0.09, 0.12, 0.15, 0.21, 0.17, 0.18] story.append(make_table(min_headers, mineral_rows, min_fracs, header_bg=PURPLE, row_bgs=[LPURP, WHITE])) story.append(Spacer(1, 0.35*cm)) # ── HIGH-YIELD SUMMARY ───────────────────────────────────────────────────────── story.append(PageBreak()) story.append(banner("HIGH-YIELD SUMMARY — Must-Know Facts", colors.HexColor("#BF360C"))) story.append(Spacer(1, 0.15*cm)) story.append(make_table( ["Key Fact / Question", "Answer"], summary_rows, [0.44, 0.56], header_bg=ORANGE, row_bgs=[LRED, WHITE] )) story.append(Spacer(1, 0.4*cm)) # Footer story.append(hr(TEAL, 1)) story.append(Paragraph( "Sources: Goldman-Cecil Medicine · Basic Medical Biochemistry 6e · Washington Manual of Medical Therapeutics · Costanzo Physiology 7e | Generated by Orris Medical AI · For educational use only", FTR )) doc.build(story) print(f"PDF saved: {OUTPUT}") PYEOF echo "Script written"

cd /tmp/workspace/vitamins-minerals && python make_concise_pdf.py 2>&1

ls -lh /tmp/workspace/vitamins-minerals/Vitamins_Minerals_Quick_Reference.pdf

cat > /tmp/workspace/vitamins-minerals/make_mixed_pdf.py << 'PYEOF' """ Build a multi-page PDF where: • Page 1 = LANDSCAPE (fat-soluble vitamins table) • Pages 2+ = PORTRAIT (water-soluble, minerals, B12vsFolate, summary) Strategy: build two separate PDFs with ReportLab, then merge with pypdf. """ from reportlab.lib.pagesizes import A4, landscape from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.platypus import ( SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak ) from reportlab.lib.styles import ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT from pypdf import PdfWriter, PdfReader import io # ── Page sizes ───────────────────────────────────────────────────────────────── PORT_W, PORT_H = A4 # 595 x 842 pt LAND_W, LAND_H = landscape(A4) # 842 x 595 pt L_MAR = R_MAR = 1.5*cm T_MAR = B_MAR = 1.6*cm # ── Colours ──────────────────────────────────────────────────────────────────── NAVY = colors.HexColor("#1A3A5C") TEAL = colors.HexColor("#1B6B8A") GREEN = colors.HexColor("#2E7D32") RED = colors.HexColor("#B71C1C") PURPLE = colors.HexColor("#4A148C") ORANGE = colors.HexColor("#E65100") GOLD = colors.HexColor("#F57F17") LBLUE = colors.HexColor("#E3F2FD") LGREEN = colors.HexColor("#E8F5E9") LRED = colors.HexColor("#FFEBEE") LPURP = colors.HexColor("#F3E5F5") LYELL = colors.HexColor("#FFFDE7") STRIPE = colors.HexColor("#EEF4FB") BORDER = colors.HexColor("#90A4AE") WHITE = colors.white # ── Styles ───────────────────────────────────────────────────────────────────── def S(name, **kw): return ParagraphStyle(name, **kw) TH = S("th", fontName="Helvetica-Bold", fontSize=8, textColor=WHITE, leading=10, alignment=TA_CENTER) TD = S("td", fontName="Helvetica", fontSize=7.5, textColor=colors.black, leading=10, alignment=TA_LEFT) TDB = S("tdb", fontName="Helvetica-Bold", fontSize=7.5, textColor=colors.black, leading=10, alignment=TA_LEFT) H1 = S("h1", fontName="Helvetica-Bold", fontSize=12, textColor=WHITE, leading=15, alignment=TA_LEFT) TTL = S("ttl", fontName="Helvetica-Bold", fontSize=20, textColor=NAVY, leading=24, alignment=TA_CENTER) SUB = S("sub", fontName="Helvetica", fontSize=9, textColor=TEAL, leading=12, alignment=TA_CENTER) FTR = S("ftr", fontName="Helvetica", fontSize=6.5, textColor=colors.grey, leading=9, alignment=TA_CENTER) def p(txt, style=TD): return Paragraph(txt, style) def pb(txt): return Paragraph(txt, TDB) def hr(col=BORDER, t=0.5): return HRFlowable(width="100%", thickness=t, color=col, spaceAfter=3, spaceBefore=3) def banner(title, usable_w, bg=NAVY): t = Table([[Paragraph(title, H1)]], colWidths=[usable_w]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), bg), ("TOPPADDING", (0,0),(-1,-1), 5), ("BOTTOMPADDING", (0,0),(-1,-1), 5), ("LEFTPADDING", (0,0),(-1,-1), 8), ("RIGHTPADDING", (0,0),(-1,-1), 8), ])) return t def make_table(headers, rows, col_fracs, usable_w, header_bg=NAVY, row_bgs=None): col_widths = [usable_w * f for f in col_fracs] if row_bgs is None: row_bgs = [STRIPE, WHITE] header_row = [p(h, TH) for h in headers] data = [header_row] for row in rows: data.append([p(str(c), TD) if not isinstance(c, Paragraph) else c for c in row]) tbl = Table(data, colWidths=col_widths, repeatRows=1) tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), header_bg), ("ROWBACKGROUNDS",(0,1), (-1,-1), row_bgs), ("GRID", (0,0), (-1,-1), 0.3, BORDER), ("VALIGN", (0,0), (-1,-1), "TOP"), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ("LEFTPADDING", (0,0), (-1,-1), 4), ("RIGHTPADDING", (0,0), (-1,-1), 4), ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (-1,0), 8), ("TEXTCOLOR", (0,0), (-1,0), WHITE), ("FONTSIZE", (0,1), (-1,-1), 7.5), ])) return tbl # ══════════════════════════════════════════════════════════════════════════════ # DATA — same as before # ══════════════════════════════════════════════════════════════════════════════ fat_sol_rows = [ ["A\n(Retinol)", "M: 900 µg\nF: 700 µg\nUL: 3000 µg", "Liver, dairy, eggs\n(preformed);\nβ-carotene from dark\norange/green veg", "Vision (rhodopsin — retinal);\nepithelial differentiation\n(retinoic acid);\nimmune function;\nreproduction; bone growth", "Night blindness (1st sign)\nBitot's spots (conjunctiva)\nXerophthalmia (dry eyes)\nKeratomalacia (corneal ulcer/blindness)\nFollicular hyperkeratosis ('toad skin')\nIncreased infection susceptibility", "Acute: headache, vomiting, skin peeling\nChronic: alopecia, hepatotoxicity,\npseudotumour cerebri\nTERATOGENIC (isotretinoin)\nHypercalcaemia", "Progression: Night blindness → Bitot spots → Xerophthalmia → Keratomalacia\nAt-risk: fat malabsorption, chronic liver disease, strict vegetarians\nRetinoic acid regulates gene transcription"], ["D\n(Calciferol)", "<70 yr: 600 IU\n>70 yr: 800 IU\nUL: 4000 IU", "Skin + UV light\n(main source);\nFatty fish;\nFortified dairy/OJ;\nEgg yolk", "Increases intestinal Ca²⁺ & PO₄\nabsorption; bone mineralisation;\nimmune modulation;\ncell differentiation", "Children: RICKETS\n(bowed legs, rachitic rosary,\ncraniotabes, widened epiphysis)\nAdults: OSTEOMALACIA\n(bone pain, pathological fractures,\nproximal muscle weakness,\nwaddling gait)\nHypocalcaemia → tetany, seizures", "HYPERCALCAEMIA:\nnausea, vomiting, polyuria,\npolydipsia, constipation, confusion\nNephrolithiasis\nMetastatic calcifications", "ONLY vitamin synthesised by skin\nMetabolism: Skin (D3) → Liver (25-OH) → Kidney (1,25-OH₂ = calcitriol)\nPTH stimulates 1α-hydroxylation in kidney\n25(OH)D = BEST serum marker\nAt-risk: dark skin, exclusively breastfed infants, elderly, obesity"], ["E\n(Tocopherol)", "15 mg/day\nUL: 1000 mg", "Vegetable oils,\nwheat germ,\nnuts, seeds,\nleafy greens", "Major lipid-soluble ANTIOXIDANT;\nprotects cell membranes from\nlipid peroxidation;\nRBC integrity;\nnormal neurological function", "Premature infants: HAEMOLYTIC ANAEMIA\nSpinocerebellar ataxia\n(progressive neurodegeneration)\nPeripheral neuropathy\n(posterior columns + spinocerebellar)\nOphthalmoplegia; areflexia", "Inhibits platelet aggregation\n→ bleeding tendency\nAntagonises Vitamin K\n→ haemorrhage risk", "Works synergistically with selenium (both antioxidants)\nAbetalipoproteinaemia → profound Vit E deficiency\n(no chylomicron/VLDL transport)\nAt-risk: premature neonates, fat malabsorption"], ["K\n(Phylloquinone\n/Menaquinone)", "M: 120 µg AI\nF: 90 µg AI\nNo UL", "K1: leafy green veg\nK2: gut bacteria,\nfermented foods\nK3: synthetic\n(menadione)", "γ-carboxylation cofactor:\nClotting factors II,VII,IX,X;\nProteins C, S, Z;\nOsteocalcin (bone mineralisation)", "BLEEDING DIATHESIS\n(elevated PT/INR)\nHAEMORRHAGIC DISEASE OF NEWBORN\n(HDN) — no gut bacteria, minimal\nplacental transfer\nSpontaneous bruising,\nhaematuria, GI bleed", "K1/K2: essentially non-toxic\nK3 (menadione-synthetic):\nhaemolytic anaemia,\nkernicterus in infants", "Warfarin blocks VKOR enzyme (antagonises Vit K)\nAll newborns receive prophylactic IM Vit K injection\nProteins C & S also need Vit K → warfarin initially PROCOAGULANT\nAt-risk: newborns, broad-spectrum antibiotics, fat malabsorption"], ] water_sol_rows = [ ["B1\nThiamine", "M: 1.2 mg\nF: 1.1 mg", "Whole grains, pork, legumes, nuts", "TPP cofactor: pyruvate DH; α-KG DH; transketolase (PPP); BCAA catabolism", "WET BERIBERI: cardiomyopathy, high-output failure, oedema\nDRY BERIBERI: peripheral neuropathy\nWERNICKE'S: confusion + ophthalmoplegia + ataxia\nKORSAKOFF'S: amnesia + confabulation", "None known", "Give THIAMINE BEFORE glucose (prevents Wernicke's worsening)\nPrimary risk: alcoholics\nBest test: RBC transketolase activity"], ["B2\nRiboflavin", "M: 1.3 mg\nF: 1.1 mg", "Dairy, meats, enriched cereals, eggs", "FMN/FAD: redox reactions, ETC; fatty acid β-oxidation; activates B6 & folate", "ARIBOFLAVINOSIS:\nCheilosis + angular stomatitis\nMagenta tongue (glossitis)\nSeborrhoeic dermatitis\nCorneal vascularisation", "None known\n(Urine turns yellow-green)", "Required to activate Vitamins B6 and Folate\nPhenothiazines impair absorption"], ["B3\nNiacin", "M: 16 mg NE\nF: 14 mg NE\nUL: 35 mg", "Meat, fish, peanuts;\nmade from tryptophan\n(60 mg Trp = 1 mg niacin)", "NAD⁺/NADH, NADP⁺/NADPH: glycolysis, TCA, FA oxidation, OXPHOS", "PELLAGRA — 4 Ds:\nDermatitis (Casal's necklace)\nDiarrhoea\nDementia\nDeath", "Pharmacologic doses:\nFlushing (give aspirin)\nHepatotoxicity\nHyperglycaemia, hyperuricaemia", "Pellagra: corn diets, alcoholism, Hartnup disease, carcinoid syndrome, INH\nHigh-dose niacin = best HDL-raising agent"], ["B5\nPantothenic\nacid", "AI: 5 mg\nNo UL", "Ubiquitous (liver, egg yolk, avocado richest)", "Coenzyme A backbone: ALL acyl-transfer reactions — FA synthesis/oxidation, TCA, steroids", "RARE: burning feet syndrome\nIrritability, fatigue\n(severe malnutrition only)", "None known", "Greek pantos = 'everywhere' — deficiency almost never seen clinically"], ["B6\nPyridoxine", "1.3 mg/day\nUL: 100 mg", "Meat, fish, potatoes, bananas, fortified cereals", "PLP cofactor: transamination (ALT/AST); neurotransmitter synthesis (5-HT, DA, GABA); heme synthesis; cystathionine synthesis", "Microcytic SIDEROBLASTIC anaemia\n(ring sideroblasts on BM)\nPeripheral neuropathy\nSEIZURES (↓GABA)\nDermatitis; ↑homocysteine", "SENSORY NEUROPATHY\n>200 mg/day\n(Only B vitamin with neurotoxicity)", "INH inactivates PLP → give B6 prophylactically with INH\nB6 needed for every neurotransmitter biosynthesis step"], ["B7\nBiotin", "AI: 30 µg\nNo UL", "Liver, cooked egg yolk, nuts, legumes", "Carboxylation cofactor: pyruvate carboxylase; acetyl-CoA carboxylase; propionyl-CoA carboxylase", "ALOPECIA (hallmark)\nPeriorificial dermatitis\n(around mouth, eyes, genitals)\nConjunctivitis; CNS abnormalities", "None known", "Raw egg white AVIDIN binds biotin irreversibly → cooking destroys avidin\nBiotinidase deficiency in infants"], ["B9\nFolate", "400 µg DFE\nPregnancy: 600 µg\nUL: 1000 µg", "Leafy greens, legumes, fortified cereals, citrus, liver", "THF: one-carbon transfers — purine & thymidylate synthesis; homocysteine→methionine", "MEGALOBLASTIC MACROCYTIC anaemia\nNEURAL TUBE DEFECTS\n(spina bifida, anencephaly)\n↑Homocysteine\nNO neurologic symptoms", "Masks B12 deficiency\n(corrects anaemia not neuro damage)", "400-800 µg/day for ALL women of childbearing age\nMETHYLFOLATE TRAP (caused by B12 deficiency)\nMTX/TMP inhibit DHFR"], ["B12\nCobalamin", "2.4 µg/day\nNo UL", "ONLY animal products\n(meat, fish, dairy, eggs)\nVegans must supplement", "Methionine synthase (methylcobalamin); methylmalonyl-CoA mutase (adenosylcobalamin)", "MEGALOBLASTIC MACROCYTIC anaemia\nSUBACUTE COMBINED DEGENERATION\n(posterior + lateral columns)\n↑MMA + ↑homocysteine\nGlossitis; neuropsychiatric symptoms", "None known", "Absorbed ONLY in terminal ileum (needs intrinsic factor)\nPernicious anaemia = anti-IF antibodies\nElevated MMA = B12 ONLY (not folate)\nMetformin impairs B12 absorption"], ["C\nAscorbic acid", "M: 90 mg\nF: 75 mg\n+35 mg smokers\nUL: 2000 mg", "Citrus, kiwi, strawberries, bell peppers, broccoli", "Prolyl/lysyl hydroxylase (collagen); Fe³⁺→Fe²⁺; antioxidant; dopamine-β-hydroxylase; carnitine synthesis", "SCURVY:\nCorkscrew hairs (PATHOGNOMONIC)\nPerifollicular haemorrhages\nGingival bleeding\nPoor wound healing\nPetechiae, ecchymoses", "GI upset >2 g/day\nOxalate kidney stones\nHaemolysis in G6PD deficiency", "Corkscrew hairs = pathognomonic for scurvy\nVit C enhances non-heme iron absorption\nDoes NOT prevent common cold"], ] mineral_rows = [ ["CALCIUM\nCa²⁺", "19-50: 1000 mg\n>50F/>70: 1200 mg\nUL: 2500 mg", "Dairy, fortified foods, leafy greens (kale), sardines", "Bone structure (99% in skeleton); muscle contraction; nerve transmission; coagulation; 2nd messenger", "HYPOCALCAEMIA:\nChvostek's sign (facial tap→twitch)\nTrousseau's sign (BP cuff→carpal spasm)\nProlonged QT; seizures\nChronic: OSTEOPOROSIS", "HYPERCALCAEMIA\n('Bones Stones Groans Moans'):\nKidney stones; bone pain\nConstipation, nausea\nConfusion, depression", "Refractory hypoCa → check Mg first\nVit D required for absorption\nCauses: hyperPTH (outpatient), malignancy (inpatient)"], ["MAGNESIUM\nMg²⁺", "M: 400-420 mg\nF: 310-320 mg\nUL: 350 mg (suppl)", "Nuts, seeds, whole grains, spinach, legumes, dark chocolate", "Cofactor for >300 enzymes; ATP stabilisation; protein/DNA synthesis; muscle relaxation", "Refractory HYPOKALAEMIA\nRefractory HYPOCALCAEMIA\nTORSADES DE POINTES\nSeizures; tetany; personality changes", "IV: respiratory depression,\nhypotension, cardiac arrest\nOral: diarrhoea (osmotic)", "Most common cause: ALCOHOLISM\nAlso: loop/thiazide diuretics, PPIs, Gitelman\nIV MgSO₄ = ECLAMPSIA + torsades\nMonitor patellar reflex during IV infusion"], ["PHOSPHORUS", "700 mg/day\nUL: 4000 mg", "Dairy, meat, fish, nuts, legumes, cola drinks", "Bone mineralisation; ATP; phospholipids; DNA/RNA; enzyme phosphorylation", "REFEEDING SYNDROME:\nDramatic ↓PO₄ after refeeding malnourished patient → cardiac arrest, respiratory failure, seizures", "Hyperphosphataemia in CKD\n→ secondary hyperPTH\n→ renal osteodystrophy", "Refeeding triad: ↓PO₄ + ↓K⁺ + ↓Mg²⁺\nRefeed slowly + supplement PO₄"], ["IRON\nFe²⁺/³⁺", "M: 8 mg\nF 19-50: 18 mg\nPregnancy: 27 mg\nUL: 45 mg", "Heme iron: red meat\n(15-35% absorbed)\nNon-heme: legumes,\nfortified cereals\n(2-10%)\nVit C enhances absorption", "Haemoglobin; myoglobin; cytochromes (ETC); catalase/peroxidase", "MICROCYTIC HYPOCHROMIC ANAEMIA\nKOILONYCHIA (spoon nails)\nPICA (craving ice, clay)\nPLUMMER-VINSON:\n(Fe def + dysphagia + oesophageal web)\nGlossitis; restless legs", "HAEMOCHROMATOSIS (HFE/C282Y):\n'Bronze diabetes'\n(cirrhosis + DM + bronze skin)\nCardiac failure; hypogonadism\nAcute (children): GE→shock→liver failure", "Most common nutritional deficiency worldwide\nFerritin = BEST stores marker (↑ in inflammation)\nTx: phlebotomy (hereditary); deferoxamine (acute)"], ["ZINC\nZn²⁺", "M: 11 mg\nF: 8 mg\nUL: 40 mg", "Oysters (richest), red meat, beans, nuts, fortified cereals", "Cofactor for >100 enzymes; zinc finger TFs; wound healing; taste/smell; spermatogenesis; Vit A mobilisation", "ACRODERMATITIS ENTEROPATHICA\n(periorificial + acral rash)\nALOPECIA\nHYPOGONADISM + growth retardation\nDysgeusia/dysosmia\nPoor wound healing; night blindness", "High-dose Zn → COPPER DEFICIENCY\n(competitive inhibition)\n→ anaemia + neutropenia\nNausea, vomiting, GI irritation", "AE = inherited Zn malabsorption (SLC39A4 mutation)\nPhytate chelates zinc → high-phytate diets = risk\nHigh dose zinc supplementation causes Cu deficiency"], ["COPPER\nCu²⁺", "900 µg/day\nUL: 10,000 µg", "Liver, oysters, nuts, seeds, dark chocolate, whole grains", "Ceruloplasmin (Fe transport); cytochrome c oxidase (ETC IV); SOD; dopamine-β-hydroxylase; lysyl oxidase; tyrosinase", "NORMOCYTIC/MACROCYTIC ANAEMIA\n+ NEUTROPENIA\n(mimics B12/folate!)\nOsteoporosis; myelopathy;\ndepigmentation", "WILSON'S DISEASE (ATP7B):\nliver disease + Kayser-Fleischer\nrings + neuropsychiatric symptoms", "MENKES DISEASE (X-linked, ATP7A): kinky hair + neurodegeneration + connective tissue fragility\nExcess Zn → Cu deficiency\nCeruloplasmin LOW in Wilson's disease"], ["IODINE\nI⁻", "150 µg/day\nPregnancy: 220 µg\nLactation: 290 µg\nUL: 1100 µg", "Iodised salt (most important), seafood, dairy, seaweed", "Required EXCLUSIVELY for thyroid hormone synthesis (T3, T4)", "GOITRE (thyroid hyperplasia, ↑TSH)\nHYPOTHYROIDISM\nCRETINISM (in utero):\nirreversible intellectual disability,\nshort stature, deafness", "Wolff-Chaikoff:\nexcess I⁻ → paradoxical HYPOTHYROIDISM\nJod-Basedow:\nI⁻ loading → HYPERTHYROIDISM", "Leading preventable cause of intellectual disability worldwide\nUniversal salt iodisation = primary prevention"], ["SELENIUM\nSe", "55 µg/day\nUL: 400 µg", "Brazil nuts (highest), seafood, meat, cereals (soil-dependent)", "Glutathione peroxidase (antioxidant); iodothyronine deiodinase (T4→T3 conversion); thioredoxin reductase", "KESHAN DISEASE\n(endemic cardiomyopathy — China)\nKASHIN-BECK DISEASE (osteoarthropathy)\nMyopathy; hypothyroidism", "SELENOSIS:\nGarlic-breath odour\nAlopecia; nail changes\nPeripheral neuropathy; nausea", "Synergistic with Vitamin E\nAt-risk: TPN without Se, Crohn's, renal dialysis, low-selenium soil regions"], ["FLUORIDE\nF⁻", "M: 4 mg AI\nF: 3 mg AI\nUL: 10 mg", "Fluoridated water (main), toothpaste, tea, seafood", "Incorporated into hydroxyapatite → resistance to acid dissolution; dental caries prevention", "DEFICIENCY: Increased dental caries", "Dental fluorosis: mottled enamel\nSkeletal fluorosis: osteosclerosis\nAcute: hypocalcaemia, arrhythmia", "Optimal water fluoridation: 0.7 mg/L\nBenefit at low levels; toxicity only with excess"], ["CHROMIUM Cr³⁺\nMANGANESE Mn²⁺\nMOLYBDENUM", "Cr: AI 25-35 µg\nMn: AI 1.8-2.3 mg\nMo: RDA 45 µg", "Cr: whole grains, broccoli\nMn: whole grains, nuts, tea\nMo: legumes, whole grains", "Cr: insulin signalling (glucose tolerance factor)\nMn: Mn-SOD, arginase, pyruvate carboxylase\nMo: xanthine oxidase, sulfite oxidase", "Cr: glucose intolerance (TPN)\nMn: hypercholesterolaemia, dermatitis (rare)\nMo: neurologic symptoms (TPN only)", "Mn INHALATION: MANGANISM\n(Parkinson's-like: tremor, rigidity)\n— miners/welders\nCr⁶⁺: lung cancer (industrial)", "Deficiencies almost exclusively in prolonged TPN without trace elements\nManganism is the main clinical toxicity in this group"], ] b12_vs_fol_rows = [ ["Megaloblastic macrocytic anaemia", "YES", "YES"], ["Neurologic symptoms (SCD of cord)", "YES", "NO"], ["Elevated homocysteine", "YES", "YES"], ["Elevated methylmalonic acid (MMA)", "YES — diagnostic", "NO"], ["Neural tube defect risk in pregnancy", "NO", "YES"], ["Source", "Only animal products", "Green veg, fortified grains"], ["Absorption site", "Terminal ileum (needs IF)", "Proximal small intestine"], ["Key drug interactions", "Metformin (↓absorption)", "Methotrexate, TMP (inhibit DHFR)"], ] summary_rows = [ ["Only vitamin made by the skin", "Vitamin D"], ["Only vitamin exclusively in animal products", "Vitamin B12"], ["Fat-soluble vitamins mnemonic", "A, D, E, K — 'ADEK'"], ["Only B vitamin neurotoxic in excess", "B6 pyridoxine (sensory neuropathy >200 mg/day)"], ["Give THIAMINE before glucose — why?", "Glucose alone worsens Wernicke's encephalopathy"], ["Corkscrew hairs = pathognomonic for", "Scurvy (Vitamin C deficiency)"], ["Elevated MMA = diagnostic of", "Vitamin B12 deficiency ONLY (not folate)"], ["Methylfolate trap caused by", "B12 deficiency → folate trapped as inactive N5-methyl-THF"], ["B12 vs folate: neurological difference", "B12 → subacute combined degeneration of spinal cord; Folate → NO neuro symptoms"], ["Antidote / reversal for warfarin", "Vitamin K"], ["Most common nutritional deficiency worldwide", "Iron deficiency anaemia"], ["Refractory hypoK + hypoCa → check first", "Magnesium (must correct Mg first)"], ["IV MgSO₄ used to treat", "Eclampsia (seizures) AND torsades de pointes"], ["Refeeding syndrome triad", "↓Phosphate + ↓Potassium + ↓Magnesium"], ["Excess zinc → causes deficiency of", "Copper → normocytic anaemia + neutropenia"], ["Acrodermatitis enteropathica", "Inherited zinc malabsorption (SLC39A4 mutation)"], ["Menkes disease", "X-linked Cu transport defect (ATP7A) → kinky hair + neurodegeneration"], ["Wilson's disease", "Cu excretion defect (ATP7B) → Kayser-Fleischer rings + liver disease"], ["Pernicious anaemia", "Anti-intrinsic factor antibodies → B12 malabsorption"], ["Iodine deficiency: leading cause of", "Preventable intellectual disability worldwide (cretinism)"], ["Pellagra 4 Ds", "Dermatitis (Casal's necklace), Diarrhoea, Dementia, Death"], ["Keshan disease", "Selenium deficiency → endemic cardiomyopathy (China)"], ["Manganism", "Mn inhalation toxicity → Parkinson's-like syndrome (miners, welders)"], ["Raw egg white causes deficiency of", "Biotin (avidin binds irreversibly; destroyed by cooking)"], ["Neural tube defect prevention", "Folic acid 400-800 µg/day pre-conceptionally"], ["Ferritin: clinical note", "BEST iron stores marker; falsely elevated in inflammation"], ["Hartnup disease → pellagra-like", "Defective tryptophan absorption → can't synthesise niacin"], ["Carcinoid syndrome → pellagra", "Tryptophan diverted to serotonin → niacin deficiency"], ["INH therapy: give prophylactic", "Vitamin B6 (INH inactivates PLP)"], ["Vitamin needed for GABA synthesis", "Vitamin B6 (PLP — decarboxylation of glutamate)"], ] # ══════════════════════════════════════════════════════════════════════════════ # BUILD LANDSCAPE PAGE 1 (fat-soluble vitamins) # ══════════════════════════════════════════════════════════════════════════════ LAND_UW = LAND_W - L_MAR - R_MAR def build_landscape_page(): buf = io.BytesIO() doc = SimpleDocTemplate(buf, pagesize=landscape(A4), leftMargin=L_MAR, rightMargin=R_MAR, topMargin=T_MAR, bottomMargin=B_MAR) story = [] story.append(Paragraph("Vitamins & Minerals — Quick Reference", TTL)) story.append(Paragraph("Page 1 of 4 | Fat-Soluble Vitamins (A · D · E · K)", SUB)) story.append(hr(TEAL, 1.5)) # Key principle strip kp = Table([[Paragraph( "<b>FAT-SOLUBLE (A,D,E,K):</b> stored in body; absorbed via micellar phase; " "any fat malabsorption → all 4 deficient simultaneously; toxicity possible with excess. " " <b>WATER-SOLUBLE:</b> limited storage; excess excreted; deficiency develops faster; most act as coenzymes.", S("kpb", fontName="Helvetica", fontSize=8, textColor=colors.black, leading=11)) ]], colWidths=[LAND_UW]) kp.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), LYELL), ("BOX", (0,0),(-1,-1), 1, GOLD), ("TOPPADDING", (0,0),(-1,-1), 5), ("BOTTOMPADDING", (0,0),(-1,-1), 5), ("LEFTPADDING", (0,0),(-1,-1), 8), ("RIGHTPADDING", (0,0),(-1,-1), 8), ])) story.append(kp) story.append(Spacer(1, 0.2*cm)) story.append(banner("FAT-SOLUBLE VITAMINS (A · D · E · K)", LAND_UW, NAVY)) story.append(Spacer(1, 0.1*cm)) fat_headers = ["Vitamin", "RDA / UL", "Key Sources", "Functions", "Deficiency Signs", "Toxicity", "High-Yield Notes"] # Wider columns thanks to landscape fat_fracs = [0.06, 0.09, 0.12, 0.15, 0.22, 0.17, 0.19] # sum = 1.0 story.append(make_table(fat_headers, fat_sol_rows, fat_fracs, LAND_UW, header_bg=NAVY, row_bgs=[LBLUE, WHITE])) story.append(Spacer(1, 0.3*cm)) story.append(hr(TEAL, 0.5)) story.append(Paragraph( "Sources: Goldman-Cecil Medicine · Basic Medical Biochemistry 6e · Washington Manual · Costanzo Physiology 7e | Orris Medical AI", FTR)) doc.build(story) buf.seek(0) return buf # ══════════════════════════════════════════════════════════════════════════════ # BUILD PORTRAIT PAGES 2-4 # ══════════════════════════════════════════════════════════════════════════════ PORT_UW = PORT_W - L_MAR - R_MAR def build_portrait_pages(): buf = io.BytesIO() doc = SimpleDocTemplate(buf, pagesize=A4, leftMargin=L_MAR, rightMargin=R_MAR, topMargin=T_MAR, bottomMargin=B_MAR) story = [] # ── Page 2: Water-soluble vitamins ───────────────────────────────────────── story.append(banner("WATER-SOLUBLE VITAMINS (B1 · B2 · B3 · B5 · B6 · B7 · B9 · B12 · Vitamin C)", PORT_UW, TEAL)) story.append(Spacer(1, 0.1*cm)) ws_headers = ["Vitamin", "RDA / UL", "Key Sources", "Functions", "Deficiency Signs", "Toxicity", "High-Yield Notes"] ws_fracs = [0.07, 0.09, 0.12, 0.17, 0.21, 0.14, 0.20] story.append(make_table(ws_headers, water_sol_rows, ws_fracs, PORT_UW, header_bg=TEAL, row_bgs=[LGREEN, WHITE])) story.append(Spacer(1, 0.3*cm)) # B12 vs Folate story.append(banner("B12 vs FOLATE DEFICIENCY — Key Differences", PORT_UW, GREEN)) story.append(Spacer(1, 0.1*cm)) story.append(make_table( ["Feature", "B12 (Cobalamin)", "Folate (B9)"], b12_vs_fol_rows, [0.44, 0.28, 0.28], PORT_UW, header_bg=GREEN )) # ── Page 3: Minerals ─────────────────────────────────────────────────────── story.append(PageBreak()) story.append(banner("MINERALS (Ca · Mg · P | Fe · Zn · Cu · I · Se · F · Cr · Mn · Mo)", PORT_UW, PURPLE)) story.append(Spacer(1, 0.1*cm)) min_headers = ["Mineral", "RDA / UL", "Key Sources", "Functions", "Deficiency Signs", "Toxicity", "High-Yield Notes"] min_fracs = [0.08, 0.09, 0.12, 0.15, 0.21, 0.17, 0.18] story.append(make_table(min_headers, mineral_rows, min_fracs, PORT_UW, header_bg=PURPLE, row_bgs=[LPURP, WHITE])) # ── Page 4: High-yield summary ───────────────────────────────────────────── story.append(PageBreak()) story.append(banner("HIGH-YIELD SUMMARY — Must-Know Facts", PORT_UW, colors.HexColor("#BF360C"))) story.append(Spacer(1, 0.1*cm)) story.append(make_table( ["Key Fact / Question", "Answer"], summary_rows, [0.44, 0.56], PORT_UW, header_bg=ORANGE, row_bgs=[LRED, WHITE] )) story.append(Spacer(1, 0.3*cm)) story.append(hr(TEAL, 1)) story.append(Paragraph( "Sources: Goldman-Cecil Medicine · Basic Medical Biochemistry 6e · Washington Manual of Medical Therapeutics · Costanzo Physiology 7e | Orris Medical AI · Educational use only", FTR)) doc.build(story) buf.seek(0) return buf # ══════════════════════════════════════════════════════════════════════════════ # MERGE both PDFs # ══════════════════════════════════════════════════════════════════════════════ print("Building landscape page 1...") land_buf = build_landscape_page() print("Building portrait pages 2-4...") port_buf = build_portrait_pages() print("Merging...") writer = PdfWriter() reader1 = PdfReader(land_buf) for page in reader1.pages: writer.add_page(page) reader2 = PdfReader(port_buf) for page in reader2.pages: writer.add_page(page) OUTPUT = "/tmp/workspace/vitamins-minerals/Vitamins_Minerals_Mixed_Orientation.pdf" with open(OUTPUT, "wb") as f: writer.write(f) import os size_kb = os.path.getsize(OUTPUT) / 1024 print(f"Done! PDF saved: {OUTPUT} ({size_kb:.1f} KB, {len(writer.pages)} pages)") PYEOF echo "Script written."

cd /tmp/workspace/vitamins-minerals && python make_mixed_pdf.py 2>&1

cat > /tmp/workspace/vitamins-minerals/make_final_pdf.py << 'PYEOF' """ Final PDF: Page 1 = LANDSCAPE — Fat-Soluble Vitamins Pages 2-4 = PORTRAIT — Water-soluble, Minerals, Summary Page 5 = PORTRAIT — Marasmus vs Kwashiorkor (new) """ from reportlab.lib.pagesizes import A4, landscape from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.platypus import ( SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak ) from reportlab.lib.styles import ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY from pypdf import PdfWriter, PdfReader import io PORT_W, PORT_H = A4 LAND_W, LAND_H = landscape(A4) L = R = 1.5*cm T = B = 1.6*cm LAND_UW = LAND_W - L - R PORT_UW = PORT_W - L - R # ── Colours ──────────────────────────────────────────────────────────────────── NAVY = colors.HexColor("#1A3A5C") TEAL = colors.HexColor("#1B6B8A") GREEN = colors.HexColor("#2E7D32") RED = colors.HexColor("#B71C1C") PURPLE = colors.HexColor("#4A148C") ORANGE = colors.HexColor("#E65100") GOLD = colors.HexColor("#F57F17") DKRED = colors.HexColor("#7B1FA2") LBLUE = colors.HexColor("#E3F2FD") LGREEN = colors.HexColor("#E8F5E9") LRED = colors.HexColor("#FFEBEE") LPURP = colors.HexColor("#F3E5F5") LYELL = colors.HexColor("#FFFDE7") LORANGE= colors.HexColor("#FFF3E0") STRIPE = colors.HexColor("#EEF4FB") BORDER = colors.HexColor("#90A4AE") WHITE = colors.white def S(name, **kw): return ParagraphStyle(name, **kw) TH = S("th", fontName="Helvetica-Bold", fontSize=8, textColor=WHITE, leading=10, alignment=TA_CENTER) TD = S("td", fontName="Helvetica", fontSize=7.5, textColor=colors.black, leading=10, alignment=TA_LEFT) TDB = S("tdb", fontName="Helvetica-Bold", fontSize=7.5, textColor=colors.black, leading=10, alignment=TA_LEFT) H1 = S("h1", fontName="Helvetica-Bold", fontSize=12, textColor=WHITE, leading=15, alignment=TA_LEFT) TTL = S("ttl", fontName="Helvetica-Bold", fontSize=20, textColor=NAVY, leading=24, alignment=TA_CENTER) SUB = S("sub", fontName="Helvetica", fontSize=9, textColor=TEAL, leading=12, alignment=TA_CENTER) FTR = S("ftr", fontName="Helvetica", fontSize=6.5, textColor=colors.grey, leading=9, alignment=TA_CENTER) H2S = S("h2s", fontName="Helvetica-Bold", fontSize=10, textColor=WHITE, leading=13, alignment=TA_LEFT) NRM = S("nrm", fontName="Helvetica", fontSize=8, textColor=colors.black, leading=11, alignment=TA_LEFT) def p(txt, style=TD): return Paragraph(txt, style) def pb(txt): return Paragraph(txt, TDB) def pn(txt): return Paragraph(txt, NRM) def hr(col=BORDER, t=0.5): return HRFlowable(width="100%", thickness=t, color=col, spaceAfter=3, spaceBefore=3) def banner(title, uw, bg=NAVY, style=H1): t = Table([[Paragraph(title, style)]], colWidths=[uw]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), bg), ("TOPPADDING", (0,0),(-1,-1), 5), ("BOTTOMPADDING", (0,0),(-1,-1), 5), ("LEFTPADDING", (0,0),(-1,-1), 8), ("RIGHTPADDING", (0,0),(-1,-1), 8), ])) return t def make_table(headers, rows, col_fracs, uw, header_bg=NAVY, row_bgs=None): col_widths = [uw * f for f in col_fracs] if row_bgs is None: row_bgs = [STRIPE, WHITE] data = [[p(h, TH) for h in headers]] for row in rows: data.append([p(str(c), TD) if not isinstance(c, Paragraph) else c for c in row]) tbl = Table(data, colWidths=col_widths, repeatRows=1) tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,0), header_bg), ("ROWBACKGROUNDS",(0,1),(-1,-1), row_bgs), ("GRID", (0,0),(-1,-1), 0.3, BORDER), ("VALIGN", (0,0),(-1,-1), "TOP"), ("TOPPADDING", (0,0),(-1,-1), 3), ("BOTTOMPADDING", (0,0),(-1,-1), 3), ("LEFTPADDING", (0,0),(-1,-1), 4), ("RIGHTPADDING", (0,0),(-1,-1), 4), ("FONTSIZE", (0,0),(-1,0), 8), ("FONTNAME", (0,0),(-1,0), "Helvetica-Bold"), ("TEXTCOLOR", (0,0),(-1,0), WHITE), ("FONTSIZE", (0,1),(-1,-1), 7.5), ])) return tbl # ═══════════════════════════════════════════════════════════════════ # ALL DATA (reused from previous script) # ═══════════════════════════════════════════════════════════════════ fat_sol_rows = [ ["A\n(Retinol)","M: 900 µg\nF: 700 µg\nUL: 3000 µg", "Liver, dairy, eggs\n(preformed);\nβ-carotene from dark\norange/green veg", "Vision (rhodopsin — retinal);\nepithelial differentiation\n(retinoic acid);\nimmune function;\nreproduction; bone growth", "Night blindness (1st sign)\nBitot's spots (conjunctiva)\nXerophthalmia (dry eyes)\nKeratomalacia (corneal ulcer/blindness)\nFollicular hyperkeratosis ('toad skin')\nIncreased infection susceptibility", "Acute: headache, vomiting, skin peeling\nChronic: alopecia, hepatotoxicity,\npseudotumour cerebri\nTERATOGENIC (isotretinoin)\nHypercalcaemia", "Progression: Night blindness→Bitot spots→Xerophthalmia→Keratomalacia\nAt-risk: fat malabsorption, chronic liver disease, strict vegetarians"], ["D\n(Calciferol)","<70 yr: 600 IU\n>70 yr: 800 IU\nUL: 4000 IU", "Skin + UV light\n(main source);\nFatty fish;\nFortified dairy/OJ;\nEgg yolk", "Increases intestinal Ca²⁺ & PO₄\nabsorption; bone mineralisation;\nimmune modulation;\ncell differentiation", "Children: RICKETS\n(bowed legs, rachitic rosary,\ncraniotabes, widened epiphysis)\nAdults: OSTEOMALACIA\n(bone pain, pathological fractures,\nproximal muscle weakness,\nwaddling gait)\nHypocalcaemia → tetany, seizures", "HYPERCALCAEMIA: nausea, vomiting,\npolyuria, polydipsia, constipation,\nconfusion; nephrolithiasis;\nmetastatic calcifications", "ONLY vitamin synthesised by skin\nMetabolism: Skin (D3)→Liver (25-OH)→Kidney (1,25-OH₂ calcitriol)\nPTH stimulates 1α-hydroxylation\n25(OH)D = BEST serum marker"], ["E\n(Tocopherol)","15 mg/day\nUL: 1000 mg", "Vegetable oils,\nwheat germ,\nnuts, seeds,\nleafy greens", "Major lipid-soluble ANTIOXIDANT;\nprotects cell membranes from\nlipid peroxidation;\nRBC integrity;\nnormal neurological function", "Premature infants: HAEMOLYTIC ANAEMIA\nSpinocerebellar ataxia\nPeripheral neuropathy\n(posterior columns + spinocerebellar)\nOphthalmoplegia; areflexia", "Inhibits platelet aggregation\n→ bleeding tendency\nAntagonises Vitamin K\n→ haemorrhage risk", "Synergistic with selenium (both antioxidants)\nAbetalipoproteinaemia → profound Vit E deficiency\nAt-risk: premature neonates, fat malabsorption"], ["K\n(Phylloquinone\n/Menaquinone)","M: 120 µg AI\nF: 90 µg AI\nNo UL", "K1: leafy green veg\nK2: gut bacteria,\nfermented foods\nK3: synthetic\n(menadione)", "γ-carboxylation cofactor:\nClotting factors II,VII,IX,X;\nProteins C, S, Z;\nOsteocalcin (bone)", "BLEEDING DIATHESIS\n(elevated PT/INR)\nHAEMORRHAGIC DISEASE OF NEWBORN\n(no gut bacteria, low placental transfer)\nSpontaneous bruising,\nhaematuria, GI bleed", "K1/K2: essentially non-toxic\nK3 (menadione-synthetic):\nhaemolytic anaemia,\nkernicterus in infants", "Warfarin blocks VKOR (antagonises Vit K)\nAll newborns receive prophylactic IM Vit K\nProteins C & S need Vit K → warfarin initially procoagulant\nAt-risk: newborns, broad-spectrum ABx, fat malabsorption"], ] water_sol_rows = [ ["B1\nThiamine","M: 1.2 mg\nF: 1.1 mg", "Whole grains, pork, legumes, nuts", "TPP cofactor: pyruvate DH; α-KG DH; transketolase (PPP); BCAA catabolism", "WET BERIBERI: cardiomyopathy, high-output failure, oedema\nDRY BERIBERI: peripheral neuropathy\nWERNICKE'S: confusion + ophthalmoplegia + ataxia\nKORSAKOFF'S: amnesia + confabulation", "None known","Give THIAMINE BEFORE glucose (prevents Wernicke's worsening)\nPrimary risk: ALCOHOLICS\nBest test: RBC transketolase activity"], ["B2\nRiboflavin","M: 1.3 mg\nF: 1.1 mg", "Dairy, meats, enriched cereals, eggs", "FMN/FAD: redox reactions, ETC; FA β-oxidation; activates B6 & folate", "ARIBOFLAVINOSIS:\nCheilosis + angular stomatitis\nMagenta tongue (glossitis)\nSeborrhoeic dermatitis\nCorneal vascularisation", "None known\n(Urine turns yellow-green)","Required to activate B6 and folate\nPhenothiazines impair absorption"], ["B3\nNiacin","M: 16 mg NE\nF: 14 mg NE\nUL: 35 mg", "Meat, fish, peanuts;\nmade from tryptophan\n(60 mg Trp = 1 mg niacin)", "NAD⁺/NADH, NADP⁺/NADPH: glycolysis, TCA, FA oxidation, OXPHOS", "PELLAGRA — 4 Ds:\nDermatitis (Casal's necklace)\nDiarrhoea\nDementia\nDeath", "Pharmacologic doses:\nFlushing (give aspirin)\nHepatotoxicity\nHyperglycaemia, hyperuricaemia", "Causes: corn diet, alcoholism, Hartnup disease, carcinoid, INH\nHigh-dose niacin = best HDL-raising agent"], ["B5\nPantothenic\nacid","AI: 5 mg\nNo UL", "Ubiquitous (liver, egg yolk, avocado richest)", "Coenzyme A backbone: ALL acyl-transfer reactions — FA synthesis/oxidation, TCA, steroids", "RARE: burning feet syndrome\nIrritability, fatigue\n(severe malnutrition only)", "None known","Greek pantos = 'everywhere' — deficiency almost never seen clinically"], ["B6\nPyridoxine","1.3 mg/day\nUL: 100 mg", "Meat, fish, potatoes, bananas, fortified cereals", "PLP cofactor: transamination (ALT/AST); neurotransmitter synthesis (5-HT, DA, GABA); heme synthesis (ALA synthase); cystathionine synthesis", "Microcytic SIDEROBLASTIC anaemia\n(ring sideroblasts on BM)\nPeripheral neuropathy\nSEIZURES (↓GABA)\nDermatitis; ↑homocysteine", "SENSORY NEUROPATHY\n>200 mg/day\n(Only B vitamin with neurotoxicity)", "INH inactivates PLP → give B6 prophylactically with INH\nB6 needed for every neurotransmitter biosynthesis step"], ["B7\nBiotin","AI: 30 µg\nNo UL", "Liver, cooked egg yolk, nuts, legumes", "Carboxylation cofactor: pyruvate carboxylase; acetyl-CoA carboxylase; propionyl-CoA carboxylase", "ALOPECIA (hallmark)\nPeriorificial dermatitis\n(around mouth, eyes, genitals)\nConjunctivitis; CNS abnormalities", "None known", "Raw egg white AVIDIN binds biotin irreversibly → cooking destroys avidin\nBiotinidase deficiency in infants"], ["B9\nFolate","400 µg DFE\nPregnancy: 600 µg\nUL: 1000 µg", "Leafy greens, legumes, fortified cereals, citrus, liver", "THF: one-carbon transfers — purine & thymidylate synthesis; homocysteine→methionine", "MEGALOBLASTIC MACROCYTIC anaemia\nNEURAL TUBE DEFECTS\n(spina bifida, anencephaly)\n↑Homocysteine\nNO neurologic symptoms", "Masks B12 deficiency\n(corrects anaemia not neuro damage)", "400-800 µg/day for ALL women of childbearing age\nMETHYLFOLATE TRAP (caused by B12 deficiency)\nMTX/TMP inhibit DHFR"], ["B12\nCobalamin","2.4 µg/day\nNo UL", "ONLY animal products\n(meat, fish, dairy, eggs)\nVegans must supplement", "Methionine synthase (methylcobalamin); methylmalonyl-CoA mutase (adenosylcobalamin)", "MEGALOBLASTIC MACROCYTIC anaemia\nSUBACUTE COMBINED DEGENERATION\n(posterior + lateral columns)\n↑MMA + ↑homocysteine\nGlossitis; neuropsychiatric symptoms", "None known", "Absorbed ONLY in terminal ileum (needs intrinsic factor)\nPernicious anaemia = anti-IF antibodies\nElevated MMA = B12 ONLY (not folate)\nMetformin impairs B12 absorption"], ["C\nAscorbic acid","M: 90 mg\nF: 75 mg\n+35 mg smokers\nUL: 2000 mg", "Citrus, kiwi, strawberries, bell peppers, broccoli", "Prolyl/lysyl hydroxylase (collagen); Fe³⁺→Fe²⁺; antioxidant; dopamine-β-hydroxylase; carnitine synthesis", "SCURVY:\nCorkscrew hairs (PATHOGNOMONIC)\nPerifollicular haemorrhages\nGingival bleeding\nPoor wound healing\nPetechiae, ecchymoses", "GI upset >2 g/day\nOxalate kidney stones\nHaemolysis in G6PD deficiency", "Corkscrew hairs = pathognomonic for scurvy\nVit C enhances non-heme iron absorption\nDoes NOT prevent common cold"], ] mineral_rows = [ ["CALCIUM\nCa²⁺","19-50: 1000 mg\n>50F/>70: 1200 mg\nUL: 2500 mg", "Dairy, fortified foods, leafy greens (kale), sardines", "Bone structure (99% in skeleton); muscle contraction; nerve transmission; coagulation; 2nd messenger", "HYPOCALCAEMIA:\nChvostek's + Trousseau's signs\nProlonged QT; seizures\nChronic: OSTEOPOROSIS", "HYPERCALCAEMIA ('Bones Stones Groans Moans'):\nKidney stones; bone pain\nConstipation; confusion, depression", "Refractory hypoCa → check Mg first\nVit D required for absorption\nCauses: hyperPTH (outpatient), malignancy (inpatient)"], ["MAGNESIUM\nMg²⁺","M: 400-420 mg\nF: 310-320 mg\nUL: 350 mg (suppl)", "Nuts, seeds, whole grains, spinach, legumes, dark chocolate", "Cofactor for >300 enzymes; ATP stabilisation; protein/DNA synthesis; muscle relaxation", "Refractory HYPOKALAEMIA\nRefractory HYPOCALCAEMIA\nTORSADES DE POINTES\nSeizures; tetany; personality changes", "IV: respiratory depression,\nhypotension, cardiac arrest\nOral: diarrhoea (osmotic)", "Most common cause: ALCOHOLISM\nAlso: loop/thiazide diuretics, PPIs, Gitelman\nIV MgSO₄ = ECLAMPSIA + torsades\nMonitor patellar reflex during IV infusion"], ["PHOSPHORUS","700 mg/day\nUL: 4000 mg", "Dairy, meat, fish, nuts, legumes, cola drinks", "Bone mineralisation; ATP; phospholipids; DNA/RNA; enzyme phosphorylation", "REFEEDING SYNDROME:\n↓PO₄ after refeeding malnourished patient → cardiac arrest, respiratory failure, seizures", "Hyperphosphataemia in CKD\n→ secondary hyperPTH\n→ renal osteodystrophy", "Refeeding triad: ↓PO₄ + ↓K⁺ + ↓Mg²⁺\nRefeed slowly + supplement PO₄"], ["IRON\nFe²⁺/³⁺","M: 8 mg\nF 19-50: 18 mg\nPregnancy: 27 mg\nUL: 45 mg", "Heme iron: red meat\n(15-35% absorbed)\nNon-heme: legumes,\nfortified cereals\n(2-10%)\nVit C enhances absorption", "Haemoglobin; myoglobin; cytochromes (ETC); catalase/peroxidase", "MICROCYTIC HYPOCHROMIC ANAEMIA\nKOILONYCHIA (spoon nails)\nPICA (craving ice, clay)\nPLUMMER-VINSON: Fe def + dysphagia + oesophageal web\nGlossitis; restless legs", "HAEMOCHROMATOSIS (HFE/C282Y):\n'Bronze diabetes'\n(cirrhosis + DM + bronze skin)\nCardiac failure; hypogonadism\nAcute (children): GE→shock→liver failure", "Most common nutritional deficiency worldwide\nFerritin = BEST stores marker\nTx: phlebotomy (hereditary); deferoxamine (acute)"], ["ZINC\nZn²⁺","M: 11 mg\nF: 8 mg\nUL: 40 mg", "Oysters (richest), red meat, beans, nuts, fortified cereals", "Cofactor for >100 enzymes; zinc finger TFs; wound healing; taste/smell; spermatogenesis; Vit A mobilisation", "ACRODERMATITIS ENTEROPATHICA\n(periorificial + acral rash)\nALOPECIA\nHYPOGONADISM + growth retardation\nDysgeusia/dysosmia\nPoor wound healing; night blindness", "High-dose Zn → COPPER DEFICIENCY\n→ anaemia + neutropenia\nNausea, vomiting, GI irritation", "AE = inherited Zn malabsorption (SLC39A4 mutation)\nPhytate chelates zinc\nHigh-dose zinc supplementation causes Cu deficiency"], ["COPPER\nCu²⁺","900 µg/day\nUL: 10,000 µg", "Liver, oysters, nuts, seeds, dark chocolate, whole grains", "Ceruloplasmin (Fe transport); cytochrome c oxidase (ETC IV); SOD; dopamine-β-hydroxylase; lysyl oxidase; tyrosinase", "NORMOCYTIC/MACROCYTIC ANAEMIA\n+ NEUTROPENIA\n(mimics B12/folate!)\nOsteoporosis; myelopathy;\ndepigmentation", "WILSON'S DISEASE (ATP7B):\nliver disease + Kayser-Fleischer\nrings + neuropsychiatric symptoms", "MENKES DISEASE (X-linked, ATP7A): kinky hair + neurodegeneration\nExcess Zn → Cu deficiency\nCeruloplasmin LOW in Wilson's disease"], ["IODINE\nI⁻","150 µg/day\nPregnancy: 220 µg\nLactation: 290 µg\nUL: 1100 µg", "Iodised salt (most important), seafood, dairy, seaweed", "Required EXCLUSIVELY for thyroid hormone synthesis (T3, T4)", "GOITRE (thyroid hyperplasia, ↑TSH)\nHYPOTHYROIDISM\nCRETINISM (in utero):\nirreversible intellectual disability,\nshort stature, deafness", "Wolff-Chaikoff:\nexcess I⁻ → paradoxical HYPOTHYROIDISM\nJod-Basedow:\nI⁻ loading → HYPERTHYROIDISM", "Leading preventable cause of intellectual disability worldwide\nUniversal salt iodisation = primary prevention"], ["SELENIUM\nSe","55 µg/day\nUL: 400 µg", "Brazil nuts (highest), seafood, meat, cereals (soil-dependent)", "Glutathione peroxidase (antioxidant); iodothyronine deiodinase (T4→T3 conversion); thioredoxin reductase", "KESHAN DISEASE\n(endemic cardiomyopathy — China)\nKASHIN-BECK DISEASE (osteoarthropathy)\nMyopathy; hypothyroidism", "SELENOSIS:\nGarlic-breath odour\nAlopecia; nail changes\nPeripheral neuropathy; nausea", "Synergistic with Vitamin E\nAt-risk: TPN without Se, Crohn's, renal dialysis, low-selenium soil regions"], ["FLUORIDE\nF⁻","M: 4 mg AI\nF: 3 mg AI\nUL: 10 mg", "Fluoridated water (main), toothpaste, tea, seafood", "Incorporated into hydroxyapatite → resistance to acid dissolution; dental caries prevention", "DEFICIENCY: Increased dental caries", "Dental fluorosis: mottled enamel\nSkeletal fluorosis: osteosclerosis\nAcute: hypocalcaemia, arrhythmia", "Optimal water fluoridation: 0.7 mg/L\nBenefit at low levels; toxicity only with excess"], ["CHROMIUM\nMANGANESE\nMOLYBDENUM","Cr: AI 25-35 µg\nMn: AI 1.8-2.3 mg\nMo: RDA 45 µg", "Cr: whole grains, broccoli\nMn: whole grains, nuts, tea\nMo: legumes, whole grains", "Cr: insulin signalling (glucose tolerance factor)\nMn: Mn-SOD, arginase, pyruvate carboxylase\nMo: xanthine oxidase, sulfite oxidase", "Cr: glucose intolerance (TPN)\nMn: hypercholesterolaemia, dermatitis (rare)\nMo: neurologic symptoms (TPN only)", "Mn INHALATION: MANGANISM\n(Parkinson's-like: tremor, rigidity)\n— miners/welders\nCr⁶⁺: lung cancer (industrial)", "Deficiencies almost exclusively in prolonged TPN\nManganism = main clinical toxicity in this group"], ] b12_fol_rows = [ ["Megaloblastic macrocytic anaemia", "YES", "YES"], ["Neurologic symptoms (SCD of cord)", "YES", "NO"], ["Elevated homocysteine", "YES", "YES"], ["Elevated methylmalonic acid (MMA)", "YES — diagnostic", "NO"], ["Neural tube defect risk in pregnancy", "NO", "YES"], ["Source", "Only animal products", "Green veg, fortified grains"], ["Absorption site", "Terminal ileum (needs IF)", "Proximal small intestine"], ["Key drug interactions", "Metformin (↓absorption)", "Methotrexate, TMP (inhibit DHFR)"], ] summary_rows = [ ["Only vitamin made by the skin", "Vitamin D"], ["Only vitamin exclusively in animal products", "Vitamin B12"], ["Fat-soluble vitamins mnemonic", "A, D, E, K — 'ADEK'"], ["Only B vitamin neurotoxic in excess", "B6 pyridoxine (sensory neuropathy >200 mg/day)"], ["Give THIAMINE before glucose — why?", "Glucose alone worsens Wernicke's encephalopathy"], ["Corkscrew hairs = pathognomonic for", "Scurvy (Vitamin C deficiency)"], ["Elevated MMA = diagnostic of", "Vitamin B12 deficiency ONLY (not folate)"], ["Methylfolate trap caused by", "B12 deficiency → folate trapped as inactive N5-methyl-THF"], ["B12 vs folate: neurological difference", "B12 → subacute combined degeneration of spinal cord; Folate → NO neuro symptoms"], ["Antidote / reversal for warfarin", "Vitamin K"], ["Most common nutritional deficiency worldwide", "Iron deficiency anaemia"], ["Refractory hypoK + hypoCa → check first", "Magnesium (must correct Mg first)"], ["IV MgSO₄ used to treat", "Eclampsia (seizures) AND torsades de pointes"], ["Refeeding syndrome triad", "↓Phosphate + ↓Potassium + ↓Magnesium"], ["Excess zinc → causes deficiency of", "Copper → normocytic anaemia + neutropenia"], ["Acrodermatitis enteropathica", "Inherited zinc malabsorption (SLC39A4 mutation)"], ["Menkes disease", "X-linked Cu transport defect (ATP7A) → kinky hair + neurodegeneration"], ["Wilson's disease", "Cu excretion defect (ATP7B) → Kayser-Fleischer rings + liver disease"], ["Pernicious anaemia", "Anti-intrinsic factor antibodies → B12 malabsorption"], ["Iodine deficiency: leading cause of", "Preventable intellectual disability worldwide (cretinism)"], ["Pellagra 4 Ds", "Dermatitis (Casal's necklace), Diarrhoea, Dementia, Death"], ["Keshan disease", "Selenium deficiency → endemic cardiomyopathy (China)"], ["Manganism", "Mn inhalation toxicity → Parkinson's-like syndrome (miners, welders)"], ["Raw egg white causes deficiency of", "Biotin (avidin binds irreversibly; destroyed by cooking)"], ["Neural tube defect prevention", "Folic acid 400-800 µg/day pre-conceptionally"], ["Ferritin: clinical note", "BEST iron stores marker; falsely elevated in inflammation"], ["Hartnup disease → pellagra-like", "Defective tryptophan absorption → can't synthesise niacin"], ["Carcinoid syndrome → pellagra", "Tryptophan diverted to serotonin → niacin deficiency"], ["INH therapy: give prophylactic", "Vitamin B6 (INH inactivates PLP)"], ["Vitamin needed for GABA synthesis", "Vitamin B6 (PLP — decarboxylation of glutamate)"], ] # ═══════════════════════════════════════════════════════════════════ # MARASMUS vs KWASHIORKOR DATA # ═══════════════════════════════════════════════════════════════════ mkw_comparison = [ ["Definition / Aetiology", "Severe global calorie (protein + energy) deficiency\n< 60% expected weight for age", "Protein deficiency disproportionate to calorie deficiency\n60-80% expected weight (masked by oedema)"], ["Pathophysiology", "Adaptive response: somatic protein (muscle) catabolised to provide amino acids for energy\nVisceral protein largely PRESERVED\nHigh cortisol → lipolysis of subcutaneous fat", "Non-adaptive: visceral protein compartment severely DEPLETED\nHypoalbuminaemia → generalised oedema\nRelative preservation of muscle and subcutaneous fat"], ["Oedema", "ABSENT — hallmark of marasmus", "PRESENT (generalised/dependent) — hallmark of kwashiorkor\nAscites; puffiness of face, hands, legs"], ["Body weight appearance", "Grossly underweight\nExtremes of wasting — 'skin and bones'\nHead appears too large for emaciated body", "Weight may appear near-normal (masked by oedema)\nPot-belly (ascites) common"], ["Muscle wasting", "SEVERE — generalised atrophy of skeletal muscle\nSpindly limbs; prominent ribs", "LESS SEVERE — partially masked by oedema"], ["Subcutaneous fat", "SEVERELY DEPLETED — loss of buccal fat pad ('old man face')\nLoss of perirenal and abdominal fat", "RELATIVELY PRESERVED (masked by oedema)"], ["Serum albumin", "Normal or MILDLY reduced\n(visceral protein largely spared)", "SEVERELY reduced (< 2.8 g/dL)\n→ oncotic pressure ↓ → oedema"], ["Skin changes", "Thin, wrinkled, lax skin\nNo typical rash", "'Flaky paint' dermatosis:\nAlternating zones of hyperpigmentation, desquamation, and hypopigmentation"], ["Hair changes", "Sparse, thin, brittle hair\n(less specific)", "Flag sign (alternating bands of light and dark pigmentation)\nEasy pluckability; straightening; depigmentation (reddish-yellow)"], ["Liver", "NOT enlarged\nNo fatty change", "ENLARGED, FATTY LIVER (hepatic steatosis)\nCaused by ↓apoprotein synthesis → impaired VLDL export → fat accumulates"], ["Mental / behaviour", "Alert, wide-eyed, hungry (though weak)", "Apathetic, listless, irritable, anorexic\nMiserable expression ('kwashi' face)"], ["Immunity / infections", "IMPAIRED (esp. T-cell mediated)\nConcurrent infections common", "IMPAIRED (similar defects)\nConcurrent infections common"], ["Anaemia", "Present (multifactorial: iron, folate, B12 deficiency)", "Present (multifactorial)\n+/- haemolytic anaemia"], ["GI changes", "Villous atrophy → malabsorption\n(worsens nutritional state)", "Villous atrophy → malabsorption\nAlso seen"], ["Age group / typical setting", "Infants < 1 year; severe food shortage/famine\nWasting in older children with chronic illness", "Children 1-4 years after early weaning onto carbohydrate diet\nClassic: weaned child displaced by new baby"], ["Origin of term", "Greek: marasmos = 'wasting'", "Ga language (Ghana): 'disease of the displaced/deposed child'"], ] # Treatment comparison mkw_tx = [ ["Acute stabilisation (Phase 1)", "Treat hypoglycaemia, hypothermia, dehydration\nTreat infections (amoxicillin)\nCorrect electrolytes (avoid IV fluids if possible — risk of heart failure)\nStart F-75 therapeutic milk (75 kcal/100 mL)", "SAME — treat hypoglycaemia, infections\nAVOID aggressive fluid resuscitation (oedema worsens)\nCorrect electrolytes; do NOT give IV albumin"], ["Transition / catch-up growth (Phase 2)", "Gradually increase to F-100 (100 kcal/100 mL)\nOr RUTF (Ready-to-Use Therapeutic Food)\nHigh protein + energy", "Reduce oedema first, then increase protein intake\nF-100 / RUTF once oedema resolving"], ["Micronutrient supplementation", "Vitamins A, D, folate, zinc, copper\n(Give on day 2, after initial stabilisation)", "Same micronutrients\n(Avoid excess vitamin A on day 1 — risk of toxicity)"], ["Monitoring", "Weight gain, mid-upper arm circumference (MUAC)\nTarget: >5 g/kg/day weight gain", "Monitor oedema resolution\nBilateral pitting oedema + MUAC for discharge criteria"], ["Discharge criteria", "MUAC ≥ 12.5 cm\nNo oedema, no acute illness\nEating well", "MUAC ≥ 12.5 cm + oedema resolved\nNo acute illness"], ] # Key distinguishing features box mkw_key_facts = [ ["Key distinguishing feature", "WASTING without oedema", "OEDEMA is the cardinal sign"], ["Mnemonic", "'MAR-ASMUS = Marked wasting, No Oedema'", "'KWAshiorkor = K-WAter = Wet = Oedema'"], ["Serum albumin", "Normal / mildly ↓", "Severely ↓ (< 2.8 g/dL)"], ["Liver", "Normal", "Enlarged + fatty"], ["'Flaky paint' skin", "Absent", "PRESENT"], ["'Flag sign' of hair", "Absent", "PRESENT"], ["Behaviour", "Alert but weak", "Apathetic, miserable, anorexic"], ["WHO weight-for-height", "< -3 SD (severe wasting)", "Oedema present regardless of weight"], ["Visceral protein", "PRESERVED", "SEVERELY DEPLETED"], ["Somatic protein (muscle)", "SEVERELY DEPLETED", "Relatively preserved"], ] # ═══════════════════════════════════════════════════════════════════ # BUILD PAGE 1 — LANDSCAPE # ═══════════════════════════════════════════════════════════════════ def build_page1(): buf = io.BytesIO() doc = SimpleDocTemplate(buf, pagesize=landscape(A4), leftMargin=L, rightMargin=R, topMargin=T, bottomMargin=B) story = [] story.append(Paragraph("Vitamins & Minerals — Quick Reference", TTL)) story.append(Paragraph("Page 1 of 5 | Fat-Soluble Vitamins (A · D · E · K)", SUB)) story.append(hr(TEAL, 1.5)) kp = Table([[Paragraph( "<b>FAT-SOLUBLE (A,D,E,K):</b> stored in body; absorbed via micellar phase; any fat malabsorption → all 4 deficient simultaneously; toxicity possible. " "<b>WATER-SOLUBLE (B1-B12, C):</b> limited storage; excess excreted in urine; deficiency develops faster; most act as coenzymes.", S("kpb", fontName="Helvetica", fontSize=8, textColor=colors.black, leading=11)) ]], colWidths=[LAND_UW]) kp.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,-1),LYELL), ("BOX",(0,0),(-1,-1),1,GOLD), ("TOPPADDING",(0,0),(-1,-1),5), ("BOTTOMPADDING",(0,0),(-1,-1),5), ("LEFTPADDING",(0,0),(-1,-1),8), ("RIGHTPADDING",(0,0),(-1,-1),8), ])) story.append(kp) story.append(Spacer(1, 0.2*cm)) story.append(banner("FAT-SOLUBLE VITAMINS (A · D · E · K)", LAND_UW, NAVY)) story.append(Spacer(1, 0.1*cm)) story.append(make_table( ["Vitamin", "RDA / UL", "Key Sources", "Functions", "Deficiency Signs", "Toxicity", "High-Yield Notes"], fat_sol_rows, [0.06, 0.09, 0.12, 0.15, 0.22, 0.17, 0.19], LAND_UW, header_bg=NAVY, row_bgs=[LBLUE, WHITE] )) story.append(Spacer(1, 0.3*cm)) story.append(hr(TEAL, 0.5)) story.append(Paragraph("Sources: Goldman-Cecil Medicine · Basic Medical Biochemistry 6e · Washington Manual · Costanzo Physiology 7e | Orris Medical AI", FTR)) doc.build(story) buf.seek(0) return buf # ═══════════════════════════════════════════════════════════════════ # BUILD PAGES 2-4 — PORTRAIT # ═══════════════════════════════════════════════════════════════════ def build_pages2_4(): buf = io.BytesIO() doc = SimpleDocTemplate(buf, pagesize=A4, leftMargin=L, rightMargin=R, topMargin=T, bottomMargin=B) story = [] # Page 2 story.append(banner("WATER-SOLUBLE VITAMINS (B1 · B2 · B3 · B5 · B6 · B7 · B9 · B12 · Vitamin C)", PORT_UW, TEAL)) story.append(Spacer(1, 0.1*cm)) story.append(make_table( ["Vitamin", "RDA / UL", "Key Sources", "Functions", "Deficiency Signs", "Toxicity", "High-Yield Notes"], water_sol_rows, [0.07, 0.09, 0.12, 0.17, 0.21, 0.14, 0.20], PORT_UW, header_bg=TEAL, row_bgs=[LGREEN, WHITE] )) story.append(Spacer(1, 0.25*cm)) story.append(banner("B12 vs FOLATE DEFICIENCY — Key Differences", PORT_UW, GREEN)) story.append(Spacer(1, 0.1*cm)) story.append(make_table( ["Feature", "B12 (Cobalamin)", "Folate (B9)"], b12_fol_rows, [0.44, 0.28, 0.28], PORT_UW, header_bg=GREEN )) # Page 3 story.append(PageBreak()) story.append(banner("MINERALS (Ca · Mg · P | Fe · Zn · Cu · I · Se · F · Cr · Mn · Mo)", PORT_UW, PURPLE)) story.append(Spacer(1, 0.1*cm)) story.append(make_table( ["Mineral", "RDA / UL", "Key Sources", "Functions", "Deficiency Signs", "Toxicity", "High-Yield Notes"], mineral_rows, [0.08, 0.09, 0.12, 0.15, 0.21, 0.17, 0.18], PORT_UW, header_bg=PURPLE, row_bgs=[LPURP, WHITE] )) # Page 4 story.append(PageBreak()) story.append(banner("HIGH-YIELD SUMMARY — Must-Know Facts", PORT_UW, colors.HexColor("#BF360C"))) story.append(Spacer(1, 0.1*cm)) story.append(make_table( ["Key Fact / Question", "Answer"], summary_rows, [0.44, 0.56], PORT_UW, header_bg=ORANGE, row_bgs=[LRED, WHITE] )) story.append(Spacer(1, 0.3*cm)) story.append(hr(TEAL, 1)) story.append(Paragraph( "Sources: Goldman-Cecil Medicine · Basic Medical Biochemistry 6e · Washington Manual · Costanzo Physiology 7e | Orris Medical AI · Educational use only", FTR)) doc.build(story) buf.seek(0) return buf # ═══════════════════════════════════════════════════════════════════ # BUILD PAGE 5 — MARASMUS vs KWASHIORKOR (PORTRAIT) # ═══════════════════════════════════════════════════════════════════ def build_page5(): buf = io.BytesIO() doc = SimpleDocTemplate(buf, pagesize=A4, leftMargin=L, rightMargin=R, topMargin=T, bottomMargin=B) story = [] # Title banner story.append(banner("PROTEIN-ENERGY MALNUTRITION | Marasmus vs Kwashiorkor", PORT_UW, colors.HexColor("#4E342E"))) story.append(Spacer(1, 0.15*cm)) # Intro note intro = Table([[Paragraph( "<b>Protein-Energy Malnutrition (PEM)</b> encompasses a spectrum from <b>marasmus</b> (global calorie starvation) to " "<b>kwashiorkor</b> (predominantly protein deficiency). Both are forms of severe acute malnutrition (SAM) and carry high mortality. " "The key clinical distinction is <b>oedema</b> — present in kwashiorkor, absent in marasmus. " "<i>Source: Robbins & Cotran Pathologic Basis of Disease; Park's Preventive & Social Medicine</i>", S("intro", fontName="Helvetica", fontSize=7.5, textColor=colors.black, leading=11)) ]], colWidths=[PORT_UW]) intro.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,-1), colors.HexColor("#EFEBE9")), ("BOX",(0,0),(-1,-1), 0.8, colors.HexColor("#4E342E")), ("TOPPADDING",(0,0),(-1,-1), 5), ("BOTTOMPADDING",(0,0),(-1,-1), 5), ("LEFTPADDING",(0,0),(-1,-1), 8), ("RIGHTPADDING",(0,0),(-1,-1), 8), ])) story.append(intro) story.append(Spacer(1, 0.2*cm)) # KEY DISTINGUISHING FEATURES (compact at top) story.append(Paragraph( Paragraph("KEY DISTINGUISHING FEATURES AT A GLANCE", H2S), H2S) if False else None) key_banner = Table([[Paragraph("KEY DISTINGUISHING FEATURES AT A GLANCE", H2S)]], colWidths=[PORT_UW]) key_banner.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,-1), colors.HexColor("#BF360C")), ("TOPPADDING",(0,0),(-1,-1), 4), ("BOTTOMPADDING",(0,0),(-1,-1), 4), ("LEFTPADDING",(0,0),(-1,-1), 8), ("RIGHTPADDING",(0,0),(-1,-1), 8), ])) story.append(key_banner) story.append(Spacer(1, 0.05*cm)) # Key features table (3 cols) TH_MK = S("thmk", fontName="Helvetica-Bold", fontSize=8, textColor=WHITE, leading=10, alignment=TA_CENTER) TDM = S("tdm", fontName="Helvetica", fontSize=7.5, textColor=colors.black, leading=10, alignment=TA_LEFT) TDB_M = S("tdbm", fontName="Helvetica-Bold", fontSize=7.5, textColor=colors.HexColor("#1A237E"), leading=10, alignment=TA_LEFT) TDB_K = S("tdbk", fontName="Helvetica-Bold", fontSize=7.5, textColor=colors.HexColor("#B71C1C"), leading=10, alignment=TA_LEFT) kf_header = [p("Feature", TH_MK), p("MARASMUS", TH_MK), p("KWASHIORKOR", TH_MK)] kf_data = [kf_header] kf_row_bgs = [colors.HexColor("#EFEBE9"), WHITE] M_COL = colors.HexColor("#E3F2FD") K_COL = colors.HexColor("#FCE4EC") for i, row in enumerate(mkw_key_facts): bg_m = M_COL if i % 2 == 0 else colors.HexColor("#BBDEFB") bg_k = K_COL if i % 2 == 0 else colors.HexColor("#F8BBD0") kf_data.append([ Paragraph(row[0], TDB_M), Paragraph(row[1], TDM), Paragraph(row[2], TDM), ]) kf_fracs = [0.30, 0.35, 0.35] kf_col_w = [PORT_UW * f for f in kf_fracs] kf_tbl = Table(kf_data, colWidths=kf_col_w) kf_style = [ ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#BF360C")), ("BACKGROUND", (1,1), (1,-1), M_COL), ("BACKGROUND", (2,1), (2,-1), K_COL), ("ROWBACKGROUNDS",(0,1), (0,-1), [colors.HexColor("#EFEBE9"), WHITE]), ("GRID", (0,0), (-1,-1), 0.3, BORDER), ("VALIGN", (0,0), (-1,-1), "TOP"), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ("LEFTPADDING", (0,0), (-1,-1), 4), ("RIGHTPADDING", (0,0), (-1,-1), 4), ] kf_tbl.setStyle(TableStyle(kf_style)) story.append(kf_tbl) story.append(Spacer(1, 0.2*cm)) # DETAILED COMPARISON TABLE det_banner = Table([[Paragraph("DETAILED CLINICAL COMPARISON", H2S)]], colWidths=[PORT_UW]) det_banner.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,-1), colors.HexColor("#4E342E")), ("TOPPADDING",(0,0),(-1,-1), 4), ("BOTTOMPADDING",(0,0),(-1,-1), 4), ("LEFTPADDING",(0,0),(-1,-1), 8), ("RIGHTPADDING",(0,0),(-1,-1), 8), ])) story.append(det_banner) story.append(Spacer(1, 0.05*cm)) det_header = [p("Feature", TH_MK), p("MARASMUS", TH_MK), p("KWASHIORKOR", TH_MK)] det_data = [det_header] for row in mkw_comparison: det_data.append([Paragraph(row[0], TDB_M), Paragraph(row[1], TDM), Paragraph(row[2], TDM)]) det_col_w = [PORT_UW * f for f in [0.22, 0.39, 0.39]] det_tbl = Table(det_data, colWidths=det_col_w, repeatRows=1) det_tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#4E342E")), ("BACKGROUND", (1,1), (1,-1), M_COL), ("BACKGROUND", (2,1), (2,-1), K_COL), ("ROWBACKGROUNDS",(0,1), (0,-1), [colors.HexColor("#EFEBE9"), WHITE]), ("GRID", (0,0), (-1,-1), 0.3, BORDER), ("VALIGN", (0,0), (-1,-1), "TOP"), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ("LEFTPADDING", (0,0), (-1,-1), 4), ("RIGHTPADDING", (0,0), (-1,-1), 4), ])) story.append(det_tbl) story.append(Spacer(1, 0.2*cm)) # MANAGEMENT TABLE tx_banner = Table([[Paragraph("MANAGEMENT PRINCIPLES (WHO SAM Protocol)", H2S)]], colWidths=[PORT_UW]) tx_banner.setStyle(TableStyle([ ("BACKGROUND",(0,0),(-1,-1), GREEN), ("TOPPADDING",(0,0),(-1,-1), 4), ("BOTTOMPADDING",(0,0),(-1,-1), 4), ("LEFTPADDING",(0,0),(-1,-1), 8), ("RIGHTPADDING",(0,0),(-1,-1), 8), ])) story.append(tx_banner) story.append(Spacer(1, 0.05*cm)) tx_header = [p("Phase", TH_MK), p("MARASMUS", TH_MK), p("KWASHIORKOR", TH_MK)] tx_data = [tx_header] for row in mkw_tx: tx_data.append([Paragraph(row[0], TDB_M), Paragraph(row[1], TDM), Paragraph(row[2], TDM)]) tx_col_w = [PORT_UW * f for f in [0.22, 0.39, 0.39]] tx_tbl = Table(tx_data, colWidths=tx_col_w, repeatRows=1) tx_tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), GREEN), ("ROWBACKGROUNDS",(0,1), (-1,-1), [LGREEN, WHITE]), ("GRID", (0,0), (-1,-1), 0.3, BORDER), ("VALIGN", (0,0), (-1,-1), "TOP"), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ("LEFTPADDING", (0,0), (-1,-1), 4), ("RIGHTPADDING", (0,0), (-1,-1), 4), ])) story.append(tx_tbl) story.append(Spacer(1, 0.25*cm)) story.append(hr(colors.HexColor("#4E342E"), 1)) story.append(Paragraph( "Sources: Robbins & Cotran Pathologic Basis of Disease (10e) · Robbins & Kumar Basic Pathology · Park's Preventive & Social Medicine · WHO Guidelines for SAM Management | Orris Medical AI · Educational use only", FTR)) doc.build(story) buf.seek(0) return buf # ═══════════════════════════════════════════════════════════════════ # MERGE ALL # ═══════════════════════════════════════════════════════════════════ print("Building page 1 (landscape)...") buf1 = build_page1() print("Building pages 2-4 (portrait)...") buf24 = build_pages2_4() print("Building page 5 (marasmus vs kwashiorkor)...") buf5 = build_page5() print("Merging...") writer = PdfWriter() for buf in [buf1, buf24, buf5]: reader = PdfReader(buf) for page in reader.pages: writer.add_page(page) OUTPUT = "/tmp/workspace/vitamins-minerals/Vitamins_Minerals_Final.pdf" with open(OUTPUT, "wb") as f: writer.write(f) import os sz = os.path.getsize(OUTPUT) / 1024 npg = sum(1 for _ in writer.pages) print(f"Done! {OUTPUT} ({sz:.1f} KB, {npg} pages)") PYEOF echo "Script written."

cd /tmp/workspace/vitamins-minerals && python make_final_pdf.py 2>&1