cd /home/daytona/workspace/attachments/45647221-a27f-4095-97de-cc68528610d1/ && python3 -c " import pdfplumber for fname in ['Research Question Worksheet Complete.pdf', 'Research Question CMCH.pdf']: print(f'\n\n===== {fname} =====') with pdfplumber.open(fname) as pdf: for i, page in enumerate(pdf.pages): print(f'--- Page {i+1} ---') print(page.extract_text()) "

fever thrombocytopenia association

high grade fever platelet count hospitalized patients

dengue fever thrombocytopenia platelet

fever thrombocytopenia mechanism pathophysiology inflammatory

febrile illness thrombocytopenia hospitalized adults India

PMID: 39397710

PMID: 34819445

PMID: 34027810

malaria thrombocytopenia platelet count severity

sepsis fever thrombocytopenia platelet destruction inflammatory cytokines

ls /home/daytona/workspace/ 2>/dev/null && ls /home/daytona/skills/docx/scripts/office/ 2>/dev/null

mkdir -p /home/daytona/workspace/fever-thrombocytopenia && cat > /home/daytona/workspace/fever-thrombocytopenia/generate.js << 'EOF' const { Document, Packer, Paragraph, TextRun, HeadingLevel, AlignmentType, BorderStyle, UnderlineType, ShadingType, WidthType, PageNumber, Header, Footer, NumberFormat, convertInchesToTwip, LineRuleType } = require('docx'); const fs = require('fs'); const doc = new Document({ numbering: { config: [ { reference: "ref-list", levels: [ { level: 0, format: "decimal", text: "%1.", alignment: AlignmentType.LEFT, style: { paragraph: { indent: { left: convertInchesToTwip(0.3), hanging: convertInchesToTwip(0.3) } } } } ] } ] }, styles: { default: { document: { run: { font: "Times New Roman", size: 24 }, paragraph: { spacing: { line: 360, lineRule: LineRuleType.AUTO } } } }, paragraphStyles: [ { id: "heading1", name: "Heading 1", basedOn: "Normal", next: "Normal", run: { font: "Times New Roman", size: 28, bold: true, color: "2E4057" }, paragraph: { spacing: { before: 240, after: 120 } } }, { id: "heading2", name: "Heading 2", basedOn: "Normal", next: "Normal", run: { font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" }, paragraph: { spacing: { before: 200, after: 80 } } } ] }, sections: [ { properties: { page: { margin: { top: convertInchesToTwip(1), right: convertInchesToTwip(1), bottom: convertInchesToTwip(1), left: convertInchesToTwip(1.25) } } }, headers: { default: new Header({ children: [ new Paragraph({ alignment: AlignmentType.RIGHT, children: [ new TextRun({ text: "Hypothesis 101: Research Question Competition | CMCH", font: "Times New Roman", size: 18, color: "888888", italics: true }) ] }) ] }) }, footers: { default: new Footer({ children: [ new Paragraph({ alignment: AlignmentType.CENTER, children: [ new TextRun({ text: "Page ", font: "Times New Roman", size: 18, color: "888888" }), new TextRun({ children: [PageNumber.CURRENT], font: "Times New Roman", size: 18, color: "888888" }), new TextRun({ text: " of ", font: "Times New Roman", size: 18, color: "888888" }), new TextRun({ children: [PageNumber.TOTAL_PAGES], font: "Times New Roman", size: 18, color: "888888" }) ] }) ] }) }, children: [ // ── TITLE ── new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 200 }, children: [ new TextRun({ text: "Incidence of Thrombocytopenia in Patients with High-Grade Fever (≥39°C) Compared to Low-Grade Fever (<39°C) in a Tertiary Care Hospital", font: "Times New Roman", size: 32, bold: true, color: "2E4057" }) ] }), new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 60 }, children: [ new TextRun({ text: "Hypothesis 101: Research Question Competition", font: "Times New Roman", size: 22, italics: true, color: "555555" }) ] }), new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 60 }, children: [ new TextRun({ text: "Chirayu Medical College and Hospital", font: "Times New Roman", size: 22, italics: true, color: "555555" }) ] }), new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 400 }, children: [ new TextRun({ text: "Category: Clinical Medicine and Surgery – General Medicine", font: "Times New Roman", size: 20, color: "777777" }) ] }), // ── SECTION: PICOT FRAMEWORK ── new Paragraph({ heading: HeadingLevel.HEADING_1, children: [new TextRun({ text: "PICOT Framework", font: "Times New Roman", size: 28, bold: true, color: "2E4057" })] }), // P new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "P — Population", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 200, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "Adult patients aged 18 years and above admitted to the General Medicine ward of a tertiary care hospital presenting with fever of any grade (axillary temperature ≥ 37.2°C / ≥ 99°F). Patients will be divided into two groups based on their peak recorded axillary temperature during the first 48 hours of admission. Patients with a pre-existing diagnosis of any haematological disorder (ITP, aplastic anaemia, leukaemia), those currently on anticoagulants, cytotoxic, or immunosuppressive therapy, and pregnant women will be excluded to prevent confounding of platelet counts.", font: "Times New Roman", size: 24 })] }), // I new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "I — Intervention / Exposure", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 200, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "High-grade fever, defined as an axillary temperature of ≥ 39°C (≥ 102.2°F), recorded at the time of admission and monitored every 8 hours during the hospital stay. Peak temperature over the first 48 hours will be used as the defining exposure. A complete blood count including platelet count will be performed at admission, at 48 hours (day 2), and at day 7 or discharge, whichever is earlier. Fever aetiology will be investigated using dengue NS1 antigen and serology (IgM/IgG), malaria peripheral smear and rapid diagnostic test, blood culture and sensitivity, scrub typhus IgM ELISA, Widal test, and urine routine examination as clinically indicated. Fever grade, duration, and pattern will be systematically recorded.", font: "Times New Roman", size: 24 })] }), // C new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "C — Comparison / Control", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 200, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "Adult febrile patients admitted during the same period with low-grade fever, defined as an axillary temperature between 37.2°C and < 39°C, serving as the comparison group. These patients will be matched for age and sex and will undergo identical serial platelet count monitoring and haematological workup over the same time intervals under the same clinical setting.", font: "Times New Roman", size: 24 })] }), // O new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "O — Outcome", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 200, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "The primary outcome is the incidence of thrombocytopenia, defined as a platelet count below 1,50,000/mm³, in the high-grade fever group compared to the low-grade fever group. Secondary outcomes include: (a) degree of thrombocytopenia — mild (1,00,000–1,49,999/mm³), moderate (50,000–99,999/mm³), and severe (< 50,000/mm³); (b) correlation between peak recorded temperature and nadir platelet count; (c) need for platelet transfusion; (d) bleeding manifestations; and (e) in-hospital mortality.", font: "Times New Roman", size: 24 })] }), // T new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "T — Time Frame", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 200, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "Over a period of 6 months.", font: "Times New Roman", size: 24 })] }), // Final Research Question box new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 200, after: 400, line: 360, lineRule: LineRuleType.AUTO }, border: { top: { style: BorderStyle.SINGLE, size: 6, color: "2E4057" }, bottom: { style: BorderStyle.SINGLE, size: 6, color: "2E4057" }, left: { style: BorderStyle.THICK, size: 12, color: "1A6B3C" }, right: { style: BorderStyle.SINGLE, size: 6, color: "2E4057" } }, shading: { type: ShadingType.SOLID, color: "F0F7F4" }, children: [ new TextRun({ text: "Final PICOT Research Question: ", font: "Times New Roman", size: 24, bold: true, color: "2E4057" }), new TextRun({ text: '"Is the incidence of thrombocytopenia higher in patients with high-grade fever (≥39°C) compared to low-grade fever (<39°C) admitted to a tertiary care hospital, as assessed by serial platelet counts over a period of 6 months?"', font: "Times New Roman", size: 24, italics: true, color: "1A3A2A" }) ] }), // ── SECTION: ABSTRACT ── new Paragraph({ heading: HeadingLevel.HEADING_1, children: [new TextRun({ text: "Abstract", font: "Times New Roman", size: 28, bold: true, color: "2E4057" })] }), // Research Question new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "Research Question", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 200, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "Is the incidence of thrombocytopenia higher in patients with high-grade fever (≥39°C) compared to low-grade fever (<39°C) in a tertiary care hospital?", font: "Times New Roman", size: 24 })] }), // Population new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "Population", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 200, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "Adult patients (≥ 18 years) admitted to the General Medicine ward of a tertiary care hospital presenting with fever will be enrolled. Patients will be divided into two groups based on their peak recorded axillary temperature: Group A (high-grade fever, ≥39°C) and Group B (low-grade fever, 37.2°C to <39°C). Patients with known haematological malignancies, chronic liver disease, chronic immune thrombocytopenia, ongoing cytotoxic or anticoagulant therapy, and pregnant women will be excluded. A minimum sample size will be calculated based on expected prevalence from existing literature.", font: "Times New Roman", size: 24 })] }), // Intervention new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "Intervention", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 200, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "The exposure under investigation is high-grade fever (≥39°C). Peak axillary temperature during the first 48 hours of admission will be the defining exposure variable. All enrolled patients will undergo complete blood count with platelet count at three time points: on admission (day 0), at 48 hours (day 2), and at day 7 or the day of discharge, whichever comes first. Fever aetiology will be determined through standardized investigations including dengue NS1 antigen and serology, malaria peripheral smear, blood cultures, scrub typhus IgM ELISA, and Widal test. Fever grade, duration, and pattern will be systematically recorded. High-grade fever promotes platelet destruction through multiple mechanisms — direct thermal suppression of megakaryopoiesis, cytokine-mediated platelet consumption (via TNF-α, IL-6, and IL-1β), immune complex deposition on platelet surfaces, and splenic sequestration — all of which are more pronounced at higher temperatures.", font: "Times New Roman", size: 24 })] }), // Control new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "Control", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 200, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "Patients with low-grade fever (37.2°C to <39°C) admitted during the same study period will form the control group, matched for age and sex. Identical haematological monitoring and aetiological workup will be performed in this group to ensure comparability.", font: "Times New Roman", size: 24 })] }), // Outcome new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "Outcome", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 200, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "The primary outcome is the incidence of thrombocytopenia (platelet count < 1,50,000/mm³) in Group A compared to Group B. Prior studies confirm that acute febrile illnesses — particularly dengue, malaria, scrub typhus, leptospirosis, and sepsis — are strongly associated with thrombocytopenia, and the severity of platelet fall has been shown to correlate with disease severity and mortality. This study aims to establish whether fever grade alone, independent of aetiology, is a predictor of thrombocytopenia, which would have direct implications for early monitoring and clinical decision-making in febrile inpatients.", font: "Times New Roman", size: 24 })] }), // Time Frame new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 80 }, children: [new TextRun({ text: "Time Frame", font: "Times New Roman", size: 26, bold: true, color: "1A6B3C" })] }), new Paragraph({ alignment: AlignmentType.JUSTIFIED, spacing: { before: 0, after: 400, line: 360, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: "The study will be conducted over a period of 6 months.", font: "Times New Roman", size: 24 })] }), // ── SECTION: REFERENCES ── new Paragraph({ heading: HeadingLevel.HEADING_1, children: [new TextRun({ text: "References (Vancouver Style)", font: "Times New Roman", size: 28, bold: true, color: "2E4057" })] }), ...[ "Dhunputh P, Acharya R, Umakanth S, Shetty SM, Mohammed AP, Saraswat PP. Clinical profile of thrombocytopenia in acute febrile illnesses; a hospital-based study. Kathmandu Univ Med J (KUMJ). 2021 Apr-Jun;19(74):168-173. PMID: 34819445.", "Khazali AS, Hadrawi WH, Ibrahim F, Othman S, Nor Rashid N. Thrombocytopenia in dengue infection: mechanisms and a potential application. Expert Rev Mol Med. 2024 Oct 14;26:e18. doi:10.1017/erm.2024.18. PMID: 39397710.", "Quirino-Teixeira AC, Andrade FB, Pinheiro MBM, Rozini SV, Hottz ED. Platelets in dengue infection: more than a numbers game. Platelets. 2022 Feb 17;33(2):200-207. doi:10.1080/09537104.2021.1921722. PMID: 34027810.", "Tiiba JI, Ahmadu PU, Naamawu A. Thrombocytopenia a predictor of malaria: how far? J Parasit Dis. 2023 Mar;47(1):1-9. PMID: 37187502.", "Bayleyegn B, Asrie F, Yalew A. Role of platelet indices as a potential marker for malaria severity. J Parasitol Res. 2021;2021:6671577. doi:10.1155/2021/6671577. PMID: 37601293.", "Mahittikorn A, Masangkay FR, Kotepui KU, et al. Alteration of platelet count in patients with severe non-Plasmodium falciparum malaria: a systematic review and meta-analysis. Biology (Basel). 2021 Dec 5;10(12):1298. doi:10.3390/biology10121298. PMID: 34943190." ].map((ref, i) => new Paragraph({ numbering: { reference: "ref-list", level: 0 }, alignment: AlignmentType.JUSTIFIED, spacing: { before: 80, after: 80, line: 320, lineRule: LineRuleType.AUTO }, children: [new TextRun({ text: ref, font: "Times New Roman", size: 22 })] }) ) ] } ] }); Packer.toBuffer(doc).then(buffer => { fs.writeFileSync("/home/daytona/workspace/fever-thrombocytopenia/Fever_Thrombocytopenia_PICOT_Abstract.docx", buffer); console.log("Done"); }); EOF node /home/daytona/workspace/fever-thrombocytopenia/generate.js

ls -lh /home/daytona/workspace/fever-thrombocytopenia/

python3 /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/workspace/fever-thrombocytopenia/Fever_Thrombocytopenia_PICOT_Abstract.docx

# Verify the docx is a valid ZIP and has expected structure python3 -c " import zipfile, sys path = '/home/daytona/workspace/fever-thrombocytopenia/Fever_Thrombocytopenia_PICOT_Abstract.docx' with zipfile.ZipFile(path) as z: names = z.namelist() print('Valid ZIP. Contents:') for n in names: print(' ', n) "