from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.graphics.shapes import Drawing, Rect, String
from reportlab.graphics import renderPDF
import os

OUTPUT = "/home/daytona/workspace/diaper-rash-pdf/Diaper_Rash_Quick_Reference.pdf"

# ── Colour palette ────────────────────────────────────────────────────────────
TEAL       = colors.HexColor("#0B6E8E")
TEAL_LIGHT = colors.HexColor("#D6EEF5")
TEAL_MID   = colors.HexColor("#6BB8CC")
ORANGE     = colors.HexColor("#E07B39")
ORANGE_LT  = colors.HexColor("#FDEBD9")
RED        = colors.HexColor("#C0392B")
RED_LT     = colors.HexColor("#FADBD8")
GREEN      = colors.HexColor("#1E8449")
GREEN_LT   = colors.HexColor("#D5F5E3")
YELLOW_LT  = colors.HexColor("#FEF9E7")
GREY_DARK  = colors.HexColor("#2C3E50")
GREY_MID   = colors.HexColor("#5D6D7E")
GREY_LIGHT = colors.HexColor("#EAF0FB")
WHITE      = colors.white

# ── Document ──────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    leftMargin=14*mm, rightMargin=14*mm,
    topMargin=14*mm, bottomMargin=14*mm,
    title="Diaper Rash Quick Reference",
    author="Orris Clinical Reference"
)
W = A4[0] - 28*mm   # usable width

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

def S(name, **kw):
    return ParagraphStyle(name, **kw)

TITLE = S("TITLE",
    fontName="Helvetica-Bold", fontSize=18, textColor=WHITE,
    alignment=TA_CENTER, spaceAfter=2)
SUBTITLE = S("SUBTITLE",
    fontName="Helvetica", fontSize=10, textColor=TEAL_LIGHT,
    alignment=TA_CENTER, spaceAfter=4)
SECTION = S("SECTION",
    fontName="Helvetica-Bold", fontSize=11, textColor=WHITE,
    alignment=TA_LEFT, spaceBefore=6, spaceAfter=3, leftIndent=4)
BODY = S("BODY",
    fontName="Helvetica", fontSize=8.5, textColor=GREY_DARK,
    leading=12, spaceAfter=3)
BODY_BOLD = S("BODY_BOLD",
    fontName="Helvetica-Bold", fontSize=8.5, textColor=GREY_DARK,
    leading=12, spaceAfter=2)
SMALL = S("SMALL",
    fontName="Helvetica", fontSize=7.5, textColor=GREY_MID,
    leading=11, spaceAfter=2)
SMALL_BOLD = S("SMALL_BOLD",
    fontName="Helvetica-Bold", fontSize=8, textColor=GREY_DARK,
    leading=11, spaceAfter=2)
CELL = S("CELL",
    fontName="Helvetica", fontSize=8, textColor=GREY_DARK, leading=11)
CELL_BOLD = S("CELL_BOLD",
    fontName="Helvetica-Bold", fontSize=8, textColor=GREY_DARK, leading=11)
CELL_HDR = S("CELL_HDR",
    fontName="Helvetica-Bold", fontSize=8, textColor=WHITE, leading=11)
NOTE = S("NOTE",
    fontName="Helvetica-Oblique", fontSize=7.5, textColor=GREY_MID,
    leading=10, spaceAfter=4)

# ── Helper builders ───────────────────────────────────────────────────────────
def section_header(text, bg=TEAL):
    t = Table([[Paragraph(text, SECTION)]], colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return t

def two_col_table(rows, col_widths, header=None, hdr_bg=TEAL, alt=GREY_LIGHT):
    data = []
    ts = [
        ("GRID",        (0,0), (-1,-1), 0.4, colors.HexColor("#CBD5E0")),
        ("LEFTPADDING",  (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("TOPPADDING",   (0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0), (-1,-1), 4),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
    ]
    start = 0
    if header:
        data.append([Paragraph(h, CELL_HDR) for h in header])
        ts += [
            ("BACKGROUND", (0,0), (-1,0), hdr_bg),
        ]
        start = 1
    for i, row in enumerate(rows):
        data.append([Paragraph(str(c), CELL) for c in row])
        if i % 2 == 1:
            ts.append(("BACKGROUND", (0, i+start), (-1, i+start), alt))
    t = Table(data, colWidths=col_widths)
    t.setStyle(TableStyle(ts))
    return t

def badge(text, bg, fg=WHITE, w=None):
    style = ParagraphStyle("badge",
        fontName="Helvetica-Bold", fontSize=8, textColor=fg,
        alignment=TA_CENTER, leading=11)
    inner = [[Paragraph(text, style)]]
    cw = [w] if w else [None]
    t = Table(inner, colWidths=cw)
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ]))
    return t

def info_box(text, bg=YELLOW_LT, border=ORANGE):
    t = Table([[Paragraph(text, BODY)]], colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND",   (0,0), (-1,-1), bg),
        ("LEFTPADDING",  (0,0), (-1,-1), 8),
        ("RIGHTPADDING", (0,0), (-1,-1), 8),
        ("TOPPADDING",   (0,0), (-1,-1), 5),
        ("BOTTOMPADDING",(0,0), (-1,-1), 5),
        ("BOX", (0,0), (-1,-1), 1.2, border),
    ]))
    return t

# ══════════════════════════════════════════════════════════════════════════════
# Build story
# ══════════════════════════════════════════════════════════════════════════════
story = []

# ── HEADER BANNER ─────────────────────────────────────────────────────────────
banner_data = [[
    Paragraph("DIAPER RASH (DIAPER DERMATITIS)", TITLE),
    Paragraph("QUICK REFERENCE: Assessment Criteria & Scoring Tools", SUBTITLE),
]]
banner = Table(banner_data, colWidths=[W])
banner.setStyle(TableStyle([
    ("BACKGROUND",   (0,0), (-1,-1), TEAL),
    ("TOPPADDING",   (0,0), (-1,-1), 10),
    ("BOTTOMPADDING",(0,0), (-1,-1), 10),
    ("LEFTPADDING",  (0,0), (-1,-1), 10),
    ("ROUNDEDCORNERS", [6]),
]))
story += [banner, Spacer(1, 6)]

# ── ROW 1: Epidemiology box + Skin pH box ─────────────────────────────────────
epi_rows = [
    ["Incidence (home/hospital)", "36–75% of infants"],
    ["Severe cases",              "1–24% of affected infants"],
    ["Peak incidence age",        "9–12 months"],
    ["Outpatient visits/year",    "~1 million (US)"],
    ["Breastfed vs formula-fed",  "Breastfed = lower risk (lower stool pH)"],
    ["Rash >3 days",              "40–75% colonised with Candida albicans"],
]
epi_tbl = two_col_table(epi_rows,
    col_widths=[W*0.47, W*0.47],
    header=["Epidemiology", "Value"],
    hdr_bg=TEAL_MID)

ph_rows = [
    ["Normal skin (non-diapered)", "4.5 – 5.5 (acid mantle)"],
    ["At birth (neonate)",         "~6.0 – 7.0 → acidifies over weeks"],
    ["Diapered area (healthy)",    "Slightly elevated vs. other sites"],
    ["Elevated pH triggers",       "Urine occlusion, urea→ammonia (fecal urease), prolonged contact"],
    ["Activated at alkaline pH",   "Fecal proteases & lipases → stratum corneum damage"],
    ["Microbial risk at high pH",  "Candida, Staphylococcus, Streptococcus"],
    ["Target for treatment",       "Restore pH to 4.5–5.5 with buffered wipes/diapers"],
]
ph_tbl = two_col_table(ph_rows,
    col_widths=[W*0.47, W*0.47],
    header=["Skin pH Parameter", "Value / Notes"],
    hdr_bg=ORANGE)

row1 = Table([[epi_tbl, ph_tbl]], colWidths=[W*0.49, W*0.49])
row1.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),
    ("INNERGRID", (0,0), (-1,-1), 0, WHITE),
    ("BOX",       (0,0), (-1,-1), 0, WHITE),
]))
story += [row1, Spacer(1, 5)]

# ── SECTION 2: Clinical Assessment Criteria ───────────────────────────────────
story += [section_header("1. CLINICAL ASSESSMENT CRITERIA"), Spacer(1, 3)]

assess_rows = [
    ["<b>Onset &amp; duration</b>",    "When did it start? Getting better or worse?",
     "<b>Diaper type</b>",             "Cloth vs. disposable; brand/buffering capacity"],
    ["<b>Change frequency</b>",        "Infrequent changes = prolonged urine/feces contact",
     "<b>Feeding type</b>",            "Breastfed (lower stool pH) vs. formula-fed"],
    ["<b>Antibiotic use</b>",          "Disrupts gut flora → Candida risk",
     "<b>Diarrhoea</b>",              "Major risk factor for candidal DD"],
    ["<b>Products used</b>",           "Wipes, creams, powders — potential allergens",
     "<b>Prior treatment</b>",         "What was tried? Did it help?"],
    ["<b>Family history</b>",          "Atopy (asthma, allergic rhinitis) — atopic DD overlap",
     "<b>Skin tone</b>",               "Evidence: darker-skinned infants may have lower DD severity"],
]

def four_col_table(rows, col_widths):
    data = []
    ts = [
        ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#CBD5E0")),
        ("LEFTPADDING",  (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("TOPPADDING",   (0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0), (-1,-1), 4),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
        ("BACKGROUND",   (0,0), (-1,0), TEAL_LIGHT),
    ]
    data.append([Paragraph("<b>History Domain</b>", CELL_BOLD),
                 Paragraph("<b>What to Assess</b>", CELL_BOLD),
                 Paragraph("<b>History Domain</b>", CELL_BOLD),
                 Paragraph("<b>What to Assess</b>", CELL_BOLD)])
    for i, row in enumerate(rows):
        data.append([Paragraph(str(c), CELL) for c in row])
        if i % 2 == 1:
            ts.append(("BACKGROUND", (0, i+1), (-1, i+1), GREY_LIGHT))
    t = Table(data, colWidths=col_widths)
    t.setStyle(TableStyle(ts))
    return t

story += [four_col_table(assess_rows,
    col_widths=[W*0.17, W*0.32, W*0.17, W*0.32]),
    Spacer(1, 5)]

# ── SECTION 3: Physical Examination ───────────────────────────────────────────
story += [section_header("2. PHYSICAL EXAMINATION — KEY FEATURES"), Spacer(1, 3)]

# Morphology table
morph_rows = [
    ["Erythema",          "Grade intensity: faint pink (mild) → bright/dark red (severe)"],
    ["Pattern",           "Shiny patches/plaques = irritant; scalloped border = candidal"],
    ["Scale",             "Present or absent; fine vs. thick"],
    ["Papules/vesicles",  "Count and distribution across anatomic sites"],
    ["Pustules",          "Number; culture if bacterial infection suspected"],
    ["Erosions/fissures/bullae", "Indicates severe irritant DD — infant may be in significant discomfort"],
    ["Satellite lesions", "<b>Pathognomonic for Candidal DD</b> — discrete papules/pustules distant from main eruption"],
    ["Border characteristics", "Sharply demarcated = candidal; ill-defined = irritant"],
    ["Skin fold involvement", "Spared = irritant DD; involved = candidal, seborrheic, intertrigo"],
]
story += [two_col_table(morph_rows,
    col_widths=[W*0.30, W*0.68],
    header=["Morphology Feature", "Description / Clinical Significance"],
    hdr_bg=TEAL),
    Spacer(1, 4)]

# Anatomic sites
sites_rows = [
    ["Buttocks", "Primary site; visible when prone; main site of irritant DD"],
    ["Perianal", "Along anal groove; high TEWL; first site to show erythema"],
    ["Genital area", "Scored separately; may be spared in irritant DD"],
    ["Intertriginous (leg folds)", "Spared in irritant DD; involved in candidal DD and intertrigo"],
    ["Lower abdomen / thighs", "Convex surface contact area; involved in irritant DD"],
]
story += [two_col_table(sites_rows,
    col_widths=[W*0.25, W*0.73],
    header=["Anatomic Site", "Clinical Notes"],
    hdr_bg=TEAL_MID),
    Spacer(1, 5)]

# ── SECTION 4: Severity Grading ───────────────────────────────────────────────
story += [section_header("3. SEVERITY GRADING", bg=ORANGE), Spacer(1, 4)]

# Bedside grades
grade_data = [
    [Paragraph("<b>GRADE</b>", CELL_HDR),
     Paragraph("<b>CLINICAL DESCRIPTION</b>", CELL_HDR),
     Paragraph("<b>KEY FEATURES</b>", CELL_HDR)],
    [badge("MILD", GREEN, w=W*0.12),
     Paragraph("Faint erythema, intact skin surface", CELL),
     Paragraph("No satellite lesions • Limited area • Minimal infant distress", CELL)],
    [badge("MODERATE", ORANGE, w=W*0.12),
     Paragraph("Bright erythema, papules, small erosions", CELL),
     Paragraph("Some confluence • Discomfort on diaper change • May have early satellite lesions", CELL)],
    [badge("SEVERE", RED, w=W*0.12),
     Paragraph("Intense erythema, extensive erosions, bullae, fissures", CELL),
     Paragraph("Ulceration possible • Significant infant distress • Secondary infection likely", CELL)],
]
grade_tbl = Table(grade_data, colWidths=[W*0.13, W*0.42, W*0.43])
grade_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), ORANGE),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#CBD5E0")),
    ("LEFTPADDING",  (0,0), (-1,-1), 6),
    ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ("TOPPADDING",   (0,0), (-1,-1), 5),
    ("BOTTOMPADDING",(0,0), (-1,-1), 5),
    ("VALIGN",       (0,0), (-1,-1), "MIDDLE"),
    ("BACKGROUND", (0,1), (-1,1), GREEN_LT),
    ("BACKGROUND", (0,2), (-1,2), ORANGE_LT),
    ("BACKGROUND", (0,3), (-1,3), RED_LT),
]))
story += [grade_tbl, Spacer(1, 5)]

# ── SECTION 5: Validated DD Scoring Tool ──────────────────────────────────────
story += [section_header("4. VALIDATED DIAPER DERMATITIS SCORING TOOL (Research/Clinical Trials)"), Spacer(1, 3)]

score_intro = ("The validated DD scale assesses <b>4 anatomic sites</b> (Buttocks, Genital, "
               "Intertriginous/leg folds, Perianal) independently. At each site, <b>4 skin attributes</b> "
               "are scored on a 0–3 scale. An integration algorithm produces a final <b>7-point DD score (0–3)</b>.")
story += [info_box(score_intro, bg=TEAL_LIGHT, border=TEAL), Spacer(1, 4)]

attr_rows = [
    ["1. Erythema intensity",    "0 = none  |  1 = mild/faint pink  |  2 = moderate red  |  3 = severe bright/dark red"],
    ["2. Erythema area (%)",     "0 = none  |  1 = <33%  |  2 = 33–66%  |  3 = >66% of site affected"],
    ["3. Number of papules",     "0 = none  |  1 = 1–3  |  2 = 4–9  |  3 = ≥10 papules at site"],
    ["4. Number of pustules",    "0 = none  |  1 = 1–2  |  2 = 3–5  |  3 = ≥6 pustules at site"],
]
attr_tbl = two_col_table(attr_rows,
    col_widths=[W*0.28, W*0.70],
    header=["Skin Attribute", "Scoring Anchors (0–3 per attribute)"],
    hdr_bg=TEAL)
story += [attr_tbl, Spacer(1,3)]

story += [Paragraph("Final score: Attributes at all 4 sites are integrated → <b>DD Score 0–3</b> "
    "(0 = no dermatitis; 3 = severe). Track score at each visit to monitor treatment response.", SMALL),
    Spacer(1, 4)]

# ── SECTION 6: Differential Diagnosis ────────────────────────────────────────
story += [section_header("5. DIFFERENTIAL DIAGNOSIS — KEY DISTINGUISHING FEATURES"), Spacer(1, 3)]

diff_rows = [
    ["<b>Irritant Contact DD (ICDD)</b>",
     "Erythematous, shiny patches/plaques; convex surfaces; <b>skin folds SPARED</b>; papulovesicular or bullous in severe cases",
     "Direct: high pH activates fecal proteases/lipases → stratum corneum damage",
     "Barrier cream + frequent diaper changes"],
    ["<b>Candidal DD</b>",
     "Confluent erythematous plaque; <b>scalloped border</b>; sharply demarcated edge; <b>SATELLITE LESIONS</b> (pathognomonic); folds INVOLVED",
     "High pH promotes Candida overgrowth; 40–75% of rashes >3 days colonised",
     "Topical antifungal (miconazole, clotrimazole, nystatin) ± low-potency steroid"],
    ["<b>Seborrheic DD</b>",
     "Dry, scaly, erythematous, papular; NOT pruritic; may involve face, neck, retroauricular, axillae; first 3 months of life",
     "Malassezia species; hormonal/genetic/fatty acid factors; less pH-dependent",
     "Usually self-limiting; low-dose hydrocortisone if persistent"],
    ["<b>Allergic Contact DD</b>",
     "Distribution matches allergen contact (elastic, dyes, fragrances, preservatives); clear demarcation at diaper edge",
     "Secondary barrier disruption; pH disruption possible",
     "Identify and remove allergen; patch testing if needed"],
    ["<b>Perianal Streptococcal</b>",
     "Bright red, well-demarcated perianal rash; tenderness; chronic perianal presentation",
     "Not primarily pH-driven; group A Strep",
     "Culture → oral amoxicillin"],
    ["<b>Intertrigo</b>",
     "Skin fold areas only; moisture-related; without satellite lesions",
     "Friction + occlusion + moisture",
     "Reduce moisture; may co-exist with candidal infection"],
]
diff_tbl_data = [[
    Paragraph("<b>Type</b>", CELL_HDR),
    Paragraph("<b>Clinical Features</b>", CELL_HDR),
    Paragraph("<b>pH / Pathophysiology</b>", CELL_HDR),
    Paragraph("<b>1st-Line Treatment</b>", CELL_HDR),
]]
for i, row in enumerate(diff_rows):
    diff_tbl_data.append([Paragraph(c, CELL) for c in row])

diff_tbl = Table(diff_tbl_data, colWidths=[W*0.19, W*0.34, W*0.26, W*0.19])
diff_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), TEAL),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#CBD5E0")),
    ("LEFTPADDING",  (0,0), (-1,-1), 5),
    ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ("TOPPADDING",   (0,0), (-1,-1), 4),
    ("BOTTOMPADDING",(0,0), (-1,-1), 4),
    ("VALIGN",       (0,0), (-1,-1), "TOP"),
    ("BACKGROUND", (0,2), (-1,2), GREY_LIGHT),
    ("BACKGROUND", (0,4), (-1,4), GREY_LIGHT),
    ("BACKGROUND", (0,6), (-1,6), GREY_LIGHT),
]))
story += [diff_tbl, Spacer(1, 5)]

# ── SECTION 7: Confirmatory Tests ────────────────────────────────────────────
story += [section_header("6. CONFIRMATORY TESTS & SKIN BARRIER PARAMETERS"), Spacer(1, 3)]

c1_rows = [
    ["KOH preparation",           "Suspected candidal DD; reveals pseudohyphae + spores"],
    ["Bacterial culture",         "Chronic perianal rash; suspected Streptococcal infection"],
    ["Patch testing",             "Suspected allergic contact DD (elastics, dyes, fragrances)"],
    ["Wood's lamp",               "Adjunct for fungal fluorescence in some infections"],
]
c2_rows = [
    ["Skin pH measurement", "Flat-tip electrode; normal 4.5–5.5; elevated in diaper area"],
    ["TEWL (transepidermal water loss)", "Elevated in diaper area even in healthy neonates; indicates barrier disruption"],
    ["Stratum corneum hydration", "Capacitance/conductance probe; overhydration = maceration risk"],
    ["Visual erythema grading",   "Using validated scale at standardised anatomic sites"],
]

test_left  = two_col_table(c1_rows,  col_widths=[W*0.24, W*0.24],
    header=["Clinical Test", "Indication"], hdr_bg=TEAL_MID)
test_right = two_col_table(c2_rows,  col_widths=[W*0.24, W*0.24],
    header=["Barrier Parameter", "Notes"], hdr_bg=ORANGE)

row_tests = Table([[test_left, test_right]], colWidths=[W*0.49, W*0.49])
row_tests.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),
]))
story += [row_tests, Spacer(1, 5)]

# ── SECTION 8: pH-Based Management ───────────────────────────────────────────
story += [section_header("7. SKIN pH — ASSESSMENT-DRIVEN MANAGEMENT"), Spacer(1, 3)]

mgmt_rows = [
    ["Mild irritant DD", "Frequent diaper changes (every 2 hrs or with each soiling); gentle cleansing; air dry",
     "Zinc oxide paste or petrolatum barrier cream at every change"],
    ["Elevated skin pH (>6.0)", "Switch to superabsorbent disposable diaper with buffering capacity",
     "Use acidic/pH-buffered wipes (pH 4.5–5.5); avoid alcohol-based wipes"],
    ["Persistent rash >3 days ±\nSatellite lesions", "Add topical antifungal BID: miconazole 2%, clotrimazole 1%, or nystatin",
     "Consider oral nystatin if concurrent oral thrush or recurrent infection"],
    ["Severe irritant DD with\nmarked inflammation", "Low-potency hydrocortisone 1% for 3–5 days maximum (avoid high-potency steroids — striae risk)",
     "If candidal DD co-exists: 50:50 mix of antifungal + hydrocortisone 1%"],
    ["Failed standard treatment", "Rule out: allergic contact DD (patch test) | Zinc deficiency (acrodermatitis enteropathica) | Streptococcal infection (culture)",
     "Consider dermatology referral if unresponsive after 2–4 weeks"],
]
mgmt_data = [[
    Paragraph("<b>Clinical Scenario</b>", CELL_HDR),
    Paragraph("<b>Non-Pharmacological Intervention</b>", CELL_HDR),
    Paragraph("<b>Pharmacological / Product Intervention</b>", CELL_HDR),
]]
for i, row in enumerate(mgmt_rows):
    mgmt_data.append([Paragraph(c, CELL) for c in row])
    
mgmt_tbl = Table(mgmt_data, colWidths=[W*0.22, W*0.39, W*0.37])
mgmt_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), ORANGE),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#CBD5E0")),
    ("LEFTPADDING",  (0,0), (-1,-1), 5),
    ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ("TOPPADDING",   (0,0), (-1,-1), 4),
    ("BOTTOMPADDING",(0,0), (-1,-1), 4),
    ("VALIGN",       (0,0), (-1,-1), "TOP"),
    ("BACKGROUND", (0,2), (-1,2), ORANGE_LT),
    ("BACKGROUND", (0,4), (-1,4), ORANGE_LT),
]))
story += [mgmt_tbl, Spacer(1, 5)]

# ── SECTION 9: Risk Factors ───────────────────────────────────────────────────
story += [section_header("8. RISK FACTORS AT A GLANCE"), Spacer(1, 3)]

risk_rows = [
    ["Infrequent diaper changes",   "↑ Urine/feces contact time → ↑ pH → enzyme activation"],
    ["Formula feeding (vs. breastfed)", "Higher stool pH → increased irritant enzyme activity"],
    ["Antibiotic use (oral or topical)", "Disrupts GI/skin microbiome → Candida overgrowth"],
    ["Diarrhoea / loose stools",    "Increased fecal enzyme load; reduced stool pH buffer"],
    ["Cloth diapers (non-superabsorbent)", "Less moisture wicking; higher skin wetness and maceration"],
    ["Prematurity",                 "Immature skin barrier; higher TEWL; reduced acid mantle"],
    ["Zinc deficiency",             "Impaired skin barrier; consider acrodermatitis enteropathica if refractory"],
    ["Immunodeficiency",            "Recurrent/severe candidal DD; consider underlying immunological cause"],
]
story += [two_col_table(risk_rows,
    col_widths=[W*0.36, W*0.62],
    header=["Risk Factor", "Mechanism / Implication"],
    hdr_bg=RED),
    Spacer(1, 4)]

# ── FOOTER NOTE ───────────────────────────────────────────────────────────────
story += [
    HRFlowable(width=W, thickness=0.5, color=TEAL_MID),
    Spacer(1, 3),
    Paragraph(
        "<b>Key References:</b> Swanson's Family Medicine Review, Ch.103 | Fitzpatrick's Dermatology, Neonatal Skin Physiology | "
        "Jaiyeoba &amp; Visscher. J Tissue Viability 2025 [PMID 40267862] | "
        "Gustin et al. Pediatr Dermatol 2021 [PMID 34060142] (RCT: pH-buffered wipes reduce diapered skin pH and erythema severity) | "
        "Consultant360: Diaper Dermatitis Review 2024",
        NOTE),
    Paragraph(
        "For clinical use as a quick reference only. Individual patient assessment and clinical judgement should guide all management decisions. "
        "Generated by Orris Clinical AI — June 2026.",
        NOTE),
]

# ── Build ─────────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {OUTPUT}")