from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm 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, PageBreak ) from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate from reportlab.lib.colors import HexColor # Color palette DARK_BLUE = HexColor("#1a3a5c") MED_BLUE = HexColor("#2563a8") LIGHT_BLUE = HexColor("#dbeafe") TEAL = HexColor("#0d7377") LIGHT_TEAL = HexColor("#d4f4f5") ORANGE = HexColor("#e05c00") LIGHT_ORANGE= HexColor("#fff3e0") GREEN = HexColor("#166534") LIGHT_GREEN = HexColor("#dcfce7") RED = HexColor("#991b1b") LIGHT_RED = HexColor("#fee2e2") GRAY_BG = HexColor("#f8fafc") GRAY_BORDER = HexColor("#cbd5e1") WHITE = colors.white BLACK = colors.black OUTPUT = "/home/daytona/workspace/opd-cases/OPD_Patient_Cases_Educational.pdf" doc = SimpleDocTemplate( OUTPUT, pagesize=A4, rightMargin=1.8*cm, leftMargin=1.8*cm, topMargin=2*cm, bottomMargin=2*cm, title="Medicine OPD Patient Cases – Educational Reference", author="Orris Medical Education" ) W = A4[0] - 3.6*cm # usable width styles = getSampleStyleSheet() # Custom styles title_style = ParagraphStyle( "MainTitle", parent=styles["Title"], fontSize=22, textColor=WHITE, spaceAfter=4, alignment=TA_CENTER, fontName="Helvetica-Bold" ) subtitle_style = ParagraphStyle( "SubTitle", parent=styles["Normal"], fontSize=11, textColor=LIGHT_BLUE, spaceAfter=2, alignment=TA_CENTER, fontName="Helvetica" ) case_title_style = ParagraphStyle( "CaseTitle", parent=styles["Normal"], fontSize=13, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_LEFT, spaceAfter=0, spaceBefore=0, leading=16 ) section_label = ParagraphStyle( "SectionLabel", parent=styles["Normal"], fontSize=8.5, textColor=MED_BLUE, fontName="Helvetica-Bold", spaceBefore=4, spaceAfter=1, textTransform="uppercase" ) body_style = ParagraphStyle( "Body", parent=styles["Normal"], fontSize=9.5, textColor=HexColor("#1e293b"), fontName="Helvetica", spaceAfter=2, leading=13 ) bullet_style = ParagraphStyle( "Bullet", parent=styles["Normal"], fontSize=9.5, textColor=HexColor("#1e293b"), fontName="Helvetica", spaceAfter=1, leading=13, leftIndent=12, bulletIndent=0 ) rx_drug_style = ParagraphStyle( "RxDrug", parent=styles["Normal"], fontSize=9.5, textColor=DARK_BLUE, fontName="Helvetica-Bold", spaceAfter=1, leading=13, leftIndent=10 ) reason_style = ParagraphStyle( "Reason", parent=styles["Normal"], fontSize=9, textColor=HexColor("#374151"), fontName="Helvetica-Oblique", spaceAfter=1, leading=12, leftIndent=22 ) footer_style = ParagraphStyle( "Footer", parent=styles["Normal"], fontSize=7.5, textColor=HexColor("#94a3b8"), fontName="Helvetica", alignment=TA_CENTER ) warning_style = ParagraphStyle( "Warning", parent=styles["Normal"], fontSize=8.5, textColor=RED, fontName="Helvetica-Bold", alignment=TA_CENTER ) # ─── DATA: 25 OPD Cases ──────────────────────────────────────────────────────── cases = [ # 1 { "num": 1, "title": "Hypertension (Primary/Essential)", "color": DARK_BLUE, "patient": "Mr. Ramesh Kumar | 52 yr | Male | Clerk", "cc": "Headache, dizziness, occasional blurred vision for 3 months", "vitals": "BP: 158/96 mmHg | PR: 82/min | Weight: 82 kg | BMI: 28.4", "history": "No known DM or heart disease. Smoker (10 cigarettes/day). Family history of HTN in father.", "exam": "S1 S2 normal, no murmurs. Fundus: Grade II hypertensive retinopathy.", "ix": "CBC, RFT, LFT, Lipid profile, ECG, Urine R/M – all normal. Serum creatinine 0.9 mg/dL.", "diagnosis": "Primary Hypertension (Stage 1)", "prescription": [ ("Tab. Amlodipine 5 mg", "1-0-0 (morning)", "Dihydropyridine CCB – first-line for primary HTN; lowers peripheral vascular resistance; well tolerated."), ("Tab. Telmisartan 40 mg", "0-0-1 (night)", "ARB – blocks AT1 receptors; renoprotective; preferred over ACEi due to better tolerability (no cough)."), ("Tab. Aspirin 75 mg (EC)", "1-0-0 after food", "Antiplatelet – indicated for primary prevention given his CV risk factors (smoking + HTN + age >45)."), ("Tab. Atorvastatin 10 mg", "0-0-1", "Statin – for dyslipidemia risk reduction; also pleiotropic vascular protection."), ], "advice": "Low-salt diet (<5g NaCl/day), stop smoking, 30 min brisk walk daily, weight reduction target BMI <25. Follow up in 4 weeks.", "tag_color": DARK_BLUE, }, # 2 { "num": 2, "title": "Type 2 Diabetes Mellitus", "color": HexColor("#7c3aed"), "patient": "Mrs. Sunita Devi | 48 yr | Female | Housewife", "cc": "Polyuria, polydipsia, weight loss for 2 months; fatigue", "vitals": "BP: 126/80 mmHg | PR: 76/min | Weight: 72 kg | BMI: 27.3", "history": "No previous diagnosis of DM. Family history: mother has T2DM. No known drug allergy.", "exam": "No pallor, no edema. Fundus normal. No peripheral neuropathy.", "ix": "FBS: 198 mg/dL | PPBS: 286 mg/dL | HbA1c: 8.4% | Lipids: mildly elevated TG. Urine: glucose 2+, no protein.", "diagnosis": "Type 2 Diabetes Mellitus (newly diagnosed)", "prescription": [ ("Tab. Metformin 500 mg", "1-0-1 with meals (titrate to 1g BD)", "Biguanide – first-line T2DM drug; reduces hepatic glucose output; weight-neutral; low hypoglycemia risk; cardioprotective."), ("Tab. Glimepiride 1 mg", "1-0-0 before breakfast", "Sulfonylurea – stimulates insulin secretion; used as add-on when metformin alone insufficient at HbA1c >8%."), ("Tab. Atorvastatin 10 mg", "0-0-1", "Diabetics have high CV risk; statin therapy reduces major adverse cardiac events."), ("Tab. Folic acid 5 mg", "1-0-0", "Metformin depletes B12/folate over time; prophylactic supplementation recommended."), ], "advice": "Diabetic diet (low glycemic index foods), portion control, 45 min walking 5 days/week. SMBG fasting and post-meal. HbA1c recheck in 3 months.", "tag_color": HexColor("#7c3aed"), }, # 3 { "num": 3, "title": "Community-Acquired Pneumonia (CAP)", "color": TEAL, "patient": "Mr. Anil Sharma | 34 yr | Male | Teacher", "cc": "High fever (102°F), productive cough with yellowish sputum, right-sided chest pain for 5 days", "vitals": "Temp: 38.9°C | PR: 104/min | RR: 22/min | SpO2: 96% RA | BP: 118/76", "history": "Previously healthy. No TB contact. No recent travel. Not vaccinated for pneumococcus.", "exam": "Dull percussion, increased vocal fremitus, crepitations right lower lobe. No wheeze.", "ix": "CXR: Right lower lobe consolidation. WBC: 14,200 (neutrophilia). CRP: 48. Sputum AFB: negative.", "diagnosis": "Community-Acquired Pneumonia (CURB-65 score: 1 – mild, outpatient eligible)", "prescription": [ ("Tab. Amoxicillin-Clavulanate 625 mg", "1-1-1 after food × 7 days", "Beta-lactam + beta-lactamase inhibitor; covers S. pneumoniae, H. influenzae, and atypicals; first-line for outpatient CAP."), ("Tab. Azithromycin 500 mg", "1-0-0 × 5 days", "Macrolide – covers atypical organisms (Mycoplasma, Chlamydophila, Legionella); synergistic with beta-lactam."), ("Tab. Paracetamol 650 mg", "1-1-1-1 SOS for fever/pain", "Antipyretic and analgesic for pleuritic chest pain and fever control."), ("Syp. Bromhexine 8 mg/5mL", "10 mL TID after food", "Mucolytic – reduces sputum viscosity; eases expectoration."), ], "advice": "Adequate hydration (>2L/day), steam inhalation, postural drainage. Return immediately if SpO2 <93%, worsening dyspnea, or no improvement in 48 hrs.", "tag_color": TEAL, }, # 4 { "num": 4, "title": "Iron Deficiency Anemia", "color": RED, "patient": "Ms. Priya Nair | 28 yr | Female | Nurse", "cc": "Fatigue, exertional breathlessness, pallor, hair fall for 3 months", "vitals": "BP: 108/70 mmHg | PR: 96/min | RR: 18/min | Temp: 37°C", "history": "Heavy menstrual bleeding (cycle 3/35 days, soaks 6 pads/day). Vegetarian. No GI symptoms.", "exam": "Pallor (conjunctival, palmar). Koilonychia. Angular stomatitis. No hepatosplenomegaly.", "ix": "Hb: 7.8 g/dL | MCV: 64 fL | MCH: 19 pg | Serum ferritin: 6 ng/mL | TIBC: elevated | S. iron: low. PBS: microcytic hypochromic.", "diagnosis": "Iron Deficiency Anemia (severe) secondary to menorrhagia", "prescription": [ ("Tab. Ferrous Sulfate 200 mg (elemental Fe 60 mg)", "1-0-1 on empty stomach", "Iron replacement – corrects iron deficit; taken between meals for maximum absorption (ascorbic acid enhances it)."), ("Tab. Vitamin C 500 mg", "1-0-1 (with iron tablet)", "Reduces Fe3+ to Fe2+ in gut; significantly increases non-heme iron absorption by 2-3×."), ("Tab. Folic Acid 5 mg", "1-0-0", "Folate supports RBC maturation; often co-deficient in nutritional anemia, especially in young women."), ("Tab. Tranexamic Acid 500 mg", "1-1-1 during menstruation (max 5 days)", "Antifibrinolytic – reduces menstrual blood loss; first-line non-hormonal treatment for menorrhagia."), ], "advice": "Iron-rich foods (green leafy vegetables, legumes, jaggery). Avoid tea/coffee with meals (tannins inhibit iron absorption). Gynaecology referral for menorrhagia evaluation. Repeat CBC in 4 weeks.", "tag_color": RED, }, # 5 { "num": 5, "title": "Acute Gastroenteritis", "color": ORANGE, "patient": "Master Ravi Singh | 8 yr | Male | Student", "cc": "Loose watery stools (8 episodes/day), vomiting (3×), mild crampy abdominal pain for 1 day", "vitals": "Temp: 38.2°C | PR: 110/min | BP: 100/66 mmHg | Weight: 24 kg", "history": "Ate outside food 12 hours ago. No blood in stools. No similar family members affected. Immunizations up to date.", "exam": "Mild dehydration: dry lips, slightly sunken eyes, skin turgor mildly decreased. Abdomen: soft, mild tenderness. No guarding.", "ix": "Stool R/M: no RBCs, few WBCs. No ova/cysts. Stool culture pending.", "diagnosis": "Acute Gastroenteritis with Mild Dehydration", "prescription": [ ("ORS (WHO formula)", "200 mL after each loose stool", "Oral rehydration – cornerstone of AGE management; replaces fluid and electrolytes lost; prevents severe dehydration."), ("Zinc Sulfate 20 mg dispersible tab", "1 tab OD × 14 days", "WHO recommendation – reduces stool frequency and duration; replenishes depleted zinc; decreases future diarrheal episodes."), ("Syp. Ondansetron 4 mg/5 mL", "4 mg (5 mL) TID SOS for vomiting", "5-HT3 antagonist antiemetic – controls vomiting, allowing oral rehydration to succeed; avoids IV fluids."), ("Probiotic (Saccharomyces boulardii 250 mg)", "1 cap BD × 5 days", "Restores gut flora; evidence supports reduction in duration of acute diarrhea in children."), ], "advice": "Continue breastfeeding/normal feeding. BRAT diet (banana, rice, apple, toast). Ensure hand hygiene. Return immediately if child becomes lethargic, unable to drink, or passes bloody stools.", "tag_color": ORANGE, }, # 6 { "num": 6, "title": "Bronchial Asthma (Mild Persistent)", "color": HexColor("#0891b2"), "patient": "Ms. Kavitha Reddy | 22 yr | Female | Student", "cc": "Recurrent episodes of wheeze, breathlessness, nocturnal cough 3-4 times/month; triggered by dust and cold", "vitals": "BP: 112/72 | PR: 82/min | RR: 18/min | SpO2: 98% | Temp: 37°C", "history": "Known atopy; allergic rhinitis. Sister has asthma. No current attack.", "exam": "Bilateral polyphonic expiratory wheeze. No accessory muscle use. PEFR: 68% predicted.", "ix": "Spirometry: FEV1/FVC = 0.68 (obstructive pattern); reversibility +18% post-bronchodilator. IgE elevated. Eosinophils: 7%.", "diagnosis": "Bronchial Asthma – Mild Persistent (GINA Step 2)", "prescription": [ ("Inhaler: Budesonide 200 mcg MDI (ICS)", "2 puffs BD (with spacer)", "Inhaled corticosteroid – reduces airway inflammation; cornerstone of persistent asthma control; prevents exacerbations."), ("Inhaler: Salbutamol 100 mcg MDI (SABA)", "2 puffs SOS (max 4× daily)", "Short-acting bronchodilator – rapid relief of acute bronchospasm; used as rescue inhaler only (not scheduled)."), ("Tab. Montelukast 10 mg", "0-0-1 at bedtime", "Leukotriene receptor antagonist – anti-inflammatory; effective for allergic asthma and associated rhinitis; additive to ICS."), ("Tab. Cetirizine 10 mg", "0-0-1", "Second-generation antihistamine – manages co-existing allergic rhinitis which can trigger/worsen asthma."), ], "advice": "Correct inhaler technique demonstration. Use spacer with MDI. Avoid dust, smoke, cold air. Asthma action plan provided. PEFR diary. Follow-up in 4-6 weeks.", "tag_color": HexColor("#0891b2"), }, # 7 { "num": 7, "title": "Acute Urinary Tract Infection (UTI)", "color": HexColor("#b45309"), "patient": "Mrs. Lalitha Menon | 35 yr | Female | Accountant", "cc": "Burning micturition, increased frequency, lower abdominal discomfort for 3 days. No fever.", "vitals": "BP: 118/76 | PR: 74/min | Temp: 37.1°C | No costovertebral angle tenderness", "history": "3rd episode in the past year. No catheter use. Not pregnant. No known drug allergy.", "exam": "Mild suprapubic tenderness on deep palpation. No renal angle tenderness. No vaginal discharge.", "ix": "Urine R/M: pus cells 20-25/HPF, RBC 3-4/HPF, bacteria (gram-negative rods). Urine culture pending.", "diagnosis": "Uncomplicated Acute Cystitis (Lower UTI)", "prescription": [ ("Tab. Nitrofurantoin 100 mg (modified release)", "1-0-1 after food × 5 days", "First-line for uncomplicated lower UTI; concentrated in urine; low resistance rates; not used for upper UTI."), ("Tab. Phenazopyridine 200 mg", "1-1-1 × 2 days (symptomatic)", "Urinary analgesic – quickly relieves burning micturition and frequency; warn patient urine turns orange."), ("Tab. Ibuprofen 400 mg", "1-1-1 SOS after food × 3 days", "NSAID for suprapubic discomfort and anti-inflammatory effect in lower urinary tract."), ], "advice": "Increase water intake to >2L/day. Void after intercourse. Front-to-back wiping. Cranberry juice may help. Urine culture and sensitivity report review in 48 hrs. If fever or loin pain develops – attend ER.", "tag_color": HexColor("#b45309"), }, # 8 { "num": 8, "title": "Hypothyroidism", "color": HexColor("#4f46e5"), "patient": "Mrs. Deepa Iyer | 42 yr | Female | Teacher", "cc": "Weight gain (6 kg in 4 months), cold intolerance, constipation, dry skin, fatigue, hair thinning", "vitals": "BP: 134/88 | PR: 58/min (bradycardia) | Weight: 78 kg | Temp: 36.5°C", "history": "Previously treated for postpartum thyroiditis 5 years ago. Family history: mother on levothyroxine.", "exam": "Dry, rough skin. Periorbital puffiness. Slow relaxing ankle reflexes. Non-pitting edema hands/face. Thyroid: mildly enlarged, firm.", "ix": "TSH: 18.4 mIU/L (high) | Free T4: 0.6 ng/dL (low) | Anti-TPO: 420 IU/mL (elevated). CBC: mild normocytic anemia. Lipids: LDL elevated.", "diagnosis": "Primary Hypothyroidism (Hashimoto's Thyroiditis)", "prescription": [ ("Tab. Levothyroxine (L-T4) 50 mcg", "1 tab empty stomach, 30 min before breakfast", "Synthetic T4 – hormone replacement; converts to active T3 peripherally; taken fasting for optimal absorption (not with calcium, iron, or antacids)."), ("Tab. Atorvastatin 10 mg", "0-0-1", "Hypothyroidism causes secondary dyslipidemia (elevated LDL/TG); statin needed while thyroid normalizes; recheck lipids after euthyroid state achieved."), ], "advice": "Recheck TSH + Free T4 after 6 weeks to titrate dose (target TSH 0.5-2.5 mIU/L). Do not take L-T4 with coffee, calcium, or iron supplements. No abrupt dose changes. Lifelong therapy.", "tag_color": HexColor("#4f46e5"), }, # 9 { "num": 9, "title": "Peptic Ulcer Disease (Duodenal Ulcer)", "color": HexColor("#be123c"), "patient": "Mr. Suresh Pillai | 44 yr | Male | Driver", "cc": "Epigastric pain relieved by food, nocturnal pain waking from sleep, heartburn for 6 weeks", "vitals": "BP: 120/80 | PR: 78/min | Weight: 68 kg | Temp: 37°C", "history": "Chronic NSAID use for back pain. H. pylori positive (Rapid Urease Test). Smoker. No hematemesis/melena.", "exam": "Mild epigastric tenderness. No guarding/rigidity. No hepatosplenomegaly.", "ix": "UGI Endoscopy: 0.8 cm duodenal ulcer. H. pylori RUT: positive. H. pylori serology: positive.", "diagnosis": "H. pylori-positive Duodenal Ulcer", "prescription": [ ("Tab. Omeprazole 20 mg", "1-0-1 (before meals) × 4 weeks, then OD × 4 weeks", "PPI – suppresses gastric acid by irreversibly inhibiting H+/K+ ATPase; heals ulcer; component of H. pylori triple therapy."), ("Tab. Clarithromycin 500 mg", "1-0-1 × 14 days", "Macrolide antibiotic – part of H. pylori triple therapy; inhibits bacterial protein synthesis."), ("Tab. Amoxicillin 1g", "1-0-1 × 14 days", "Penicillin antibiotic – synergistic with clarithromycin in H. pylori eradication; attacks cell wall."), ("Tab. Sucralfate 1g", "1-1-1-1 (1 hr before meals + bedtime) × 4 weeks", "Cytoprotective – forms gel over ulcer base; protects from acid/pepsin; promotes ulcer healing."), ], "advice": "Stop NSAIDs (switch to paracetamol). Stop smoking (delays ulcer healing). Avoid spicy foods, alcohol, caffeine. H. pylori eradication confirmed by urea breath test 4 weeks after completing antibiotics.", "tag_color": HexColor("#be123c"), }, # 10 { "num": 10, "title": "Acute Migraine", "color": HexColor("#7e22ce"), "patient": "Ms. Ananya Krishnan | 26 yr | Female | Software Engineer", "cc": "Severe throbbing unilateral headache (right side), nausea, vomiting, photophobia lasting 12-16 hours, 3-4 episodes/month", "vitals": "BP: 116/74 | PR: 78/min | Temp: 37°C | Neurological exam: normal", "history": "Headaches since age 18. Associated with menstrual cycle. Triggers: sleep deprivation, bright screens, stress. No aura.", "exam": "Photosensitive. No papilledema. No focal neurological deficits. Normal fundus.", "ix": "MRI brain: normal. No red flags.", "diagnosis": "Migraine without Aura (>4 attacks/month – needs prophylaxis)", "prescription": [ ("Tab. Sumatriptan 50 mg", "1 tab at headache onset; repeat after 2 hrs if needed (max 2 tabs/attack)", "5-HT1B/1D agonist (triptan) – causes vasoconstriction of dilated meningeal vessels; blocks CGRP release; specific migraine abortive treatment."), ("Tab. Naproxen 500 mg", "1-0-1 SOS during attack × 3 days", "NSAID – effective for acute migraine; can be used alone or with triptan for better response."), ("Tab. Metoclopramide 10 mg", "1 tab SOS during attack (before sumatriptan)", "Antiemetic + prokinetic – relieves nausea/vomiting; also enhances absorption of oral analgesics by improving gastric motility."), ("Tab. Propranolol 40 mg", "1-0-1 (prophylaxis – daily)", "Beta-blocker – first-line migraine prophylaxis; reduces frequency and severity; especially useful if no contraindication (asthma, diabetes)."), ], "advice": "Maintain migraine diary (triggers, frequency). Regular sleep schedule. Limit screen time. Avoid trigger foods (chocolate, cheese, wine). Reassess prophylaxis response at 8-12 weeks.", "tag_color": HexColor("#7e22ce"), }, # 11 { "num": 11, "title": "Rheumatoid Arthritis (Early)", "color": HexColor("#0f766e"), "patient": "Mrs. Rekha Joshi | 38 yr | Female | Bank Employee", "cc": "Bilateral symmetric swelling and pain in small joints of hands and feet, morning stiffness >1 hour for 3 months", "vitals": "BP: 120/78 | PR: 80/min | Temp: 37.2°C | Weight: 61 kg", "history": "No skin rash, no dry eyes/mouth, no photosensitivity. Family history: aunt with RA.", "exam": "Swelling, warmth, tenderness of bilateral MCP joints 2nd-4th, PIP joints, both wrists. No deformity yet.", "ix": "RF: 64 IU/mL (positive) | Anti-CCP: 180 U/mL (strongly positive) | ESR: 68 | CRP: 32 | CBC: mild normocytic anemia. X-ray hands: periarticular osteopenia, no erosions yet.", "diagnosis": "Rheumatoid Arthritis (Early, Seropositive – DAS28: 5.2 – Moderate Activity)", "prescription": [ ("Tab. Methotrexate (MTX) 7.5 mg", "Once weekly (Sunday) – escalate to 15-20 mg/week at 4 weeks", "DMARD – anchor drug for RA; inhibits dihydrofolate reductase; reduces joint inflammation and prevents erosions; disease-modifying effect."), ("Tab. Folic Acid 5 mg", "Daily (except MTX day)", "Given with MTX to reduce side effects (mucositis, hepatotoxicity, GI upset) by replenishing folate without reducing efficacy."), ("Tab. Hydroxychloroquine 200 mg", "1-0-1 (with meals)", "DMARD – anti-inflammatory; synergistic with MTX; used in combination DMARD therapy for moderate RA."), ("Tab. Prednisolone 10 mg", "1-0-0 × 4 weeks then taper", "Short-term bridge therapy while DMARDs take effect (onset 4-12 weeks); powerful anti-inflammatory."), ("Tab. Pantoprazole 40 mg", "1-0-0 before breakfast", "PPI gastroprotection during steroid therapy; prevents steroid-induced peptic ulcer."), ], "advice": "Monthly LFT + CBC during MTX therapy. Annual eye exam for hydroxychloroquine. Physiotherapy referral. Avoid live vaccines during immunosuppression. Rheumatology follow-up in 4 weeks.", "tag_color": HexColor("#0f766e"), }, # 12 { "num": 12, "title": "Depressive Disorder (Moderate)", "color": HexColor("#1d4ed8"), "patient": "Mr. Vikram Nair | 31 yr | Male | IT Professional", "cc": "Low mood, anhedonia, sleep disturbance (early morning awakening), poor concentration, loss of appetite for 6 weeks. PHQ-9 score: 14", "vitals": "BP: 114/76 | PR: 72/min | Temp: 37°C. No suicidal ideation at present.", "history": "No previous psychiatric history. Recent job loss. No substance use. No thyroid disease. No family psychiatric history.", "exam": "Unkempt appearance, poor eye contact, psychomotor retardation. No psychotic features. Cognitively intact.", "ix": "TFTs: normal. CBC: normal. Blood glucose: normal. PHQ-9: 14 (moderate depression).", "diagnosis": "Moderate Depressive Episode (ICD-11: 6A70.1)", "prescription": [ ("Tab. Sertraline 50 mg", "1-0-0 (morning) × 4 weeks, then review for dose increase", "SSRI – first-line antidepressant; inhibits serotonin reuptake; broad efficacy, good tolerability, low overdose risk; takes 2-4 weeks for effect."), ("Tab. Clonazepam 0.25 mg", "0-0-0.5 at bedtime × 2 weeks only", "Benzodiazepine – short-term use for insomnia and anxiety while waiting for SSRI to take effect; must avoid prolonged use due to dependence."), ("Tab. Melatonin 3 mg", "1 tab 30 min before bedtime", "Circadian regulator – helps restore sleep architecture; safe long-term; non-addictive alternative to maintain sleep."), ], "advice": "Psychiatric referral for CBT (Cognitive Behavioural Therapy). Antidepressants take 4-6 weeks for full effect. Do NOT stop abruptly. Safety plan discussed. Emergency contact provided. Follow-up in 2 weeks.", "tag_color": HexColor("#1d4ed8"), }, # 13 { "num": 13, "title": "Acute Gout Attack", "color": HexColor("#dc2626"), "patient": "Mr. Rajesh Mehta | 55 yr | Male | Business Owner", "cc": "Sudden onset severe pain, swelling, redness and warmth in right big toe since last night; unable to walk", "vitals": "BP: 148/92 | PR: 90/min | Temp: 38.0°C | Weight: 92 kg", "history": "History of similar attacks (3rd episode). Drinks alcohol regularly. On hydrochlorothiazide for hypertension.", "exam": "Right 1st MTP joint: hot, red, exquisitely tender, swollen. Tophi absent. No kidney stones.", "ix": "Serum uric acid: 9.8 mg/dL | WBC: 13,200 | CRP: 42 | Renal function: normal. Joint aspirate: monosodium urate crystals (needle-shaped, negatively birefringent).", "diagnosis": "Acute Gouty Arthritis – Right 1st MTP Joint", "prescription": [ ("Tab. Indomethacin 50 mg", "1-1-1 with food × 5 days (then reduce)", "NSAID – first-line acute gout treatment; potent anti-inflammatory; very effective for acute attack; take with food to reduce GI side effects."), ("Tab. Pantoprazole 40 mg", "1-0-0", "PPI – gastroprotection during NSAID use; prevents peptic ulcer."), ("Tab. Colchicine 0.5 mg", "1 tab every 8 hrs on day 1, then BD × 7 days", "Inhibits microtubule polymerization; blocks neutrophil migration to joint; most effective when started early in attack."), ("Tab. Allopurinol 100 mg", "1-0-0 (start AFTER acute attack resolves – at 2-4 weeks)", "Xanthine oxidase inhibitor – urate-lowering therapy; DO NOT start during acute attack (can worsen/prolong it); long-term prophylaxis."), ], "advice": "Rest and ice the affected joint. Avoid alcohol, red meat, seafood, fructose-rich drinks. Change diuretic from thiazide to alternative antihypertensive (thiazides raise uric acid). Target serum uric acid <6 mg/dL.", "tag_color": HexColor("#dc2626"), }, # 14 { "num": 14, "title": "COPD – Stable (Moderate)", "color": HexColor("#78350f"), "patient": "Mr. Balram Das | 62 yr | Male | Farmer", "cc": "Progressive breathlessness on exertion, chronic productive cough (white sputum), 2-3 acute exacerbations/year", "vitals": "BP: 138/86 | PR: 88/min | RR: 20/min | SpO2: 93% | Temp: 37°C", "history": "Smoker (40 pack-years). Currently smokes. No TB. No occupational dust exposure.", "exam": "Barrel chest, pursed-lip breathing. Hyper-resonant chest. Bilateral coarse crepitations. No clubbing.", "ix": "Spirometry: FEV1 58% predicted, FEV1/FVC 0.62 (post-bronchodilator – obstructive, not fully reversible). CXR: hyperinflation, flattened diaphragm. ABG: pH 7.38, pCO2 46, pO2 72.", "diagnosis": "COPD GOLD Group B (mMRC Grade 2, FEV1 50-80% – Moderate)", "prescription": [ ("Inhaler: Tiotropium 18 mcg Handihaler", "1 inhalation OD (morning)", "Long-acting muscarinic antagonist (LAMA) – bronchodilation via M3 blockade; reduces hyperinflation and exacerbation frequency; first-line COPD maintenance."), ("Inhaler: Formoterol 12 mcg MDI", "2 puffs BD", "Long-acting beta-2 agonist (LABA) – sustained bronchodilation; additive to LAMA; improves exercise tolerance."), ("Inhaler: Budesonide 200 mcg MDI (ICS)", "2 puffs BD", "Added as ICS/LABA combo in patients with frequent exacerbations; reduces airway inflammation."), ("Tab. Azithromycin 250 mg", "3 times weekly (prophylactic)", "Prophylactic macrolide in COPD with frequent exacerbations; anti-inflammatory and antibiotic effects; reduces exacerbation rate."), ("Tab. N-Acetylcysteine 600 mg", "1-0-1", "Mucolytic + antioxidant; reduces sputum viscosity and oxidative stress; evidence for reducing exacerbations."), ], "advice": "STOP SMOKING (most effective intervention – offer counselling + nicotine replacement). Pulmonary rehabilitation. Annual influenza and pneumococcal vaccination. Maintain SpO2 >92%. Oxygen therapy if SpO2 persistently <88%.", "tag_color": HexColor("#78350f"), }, # 15 { "num": 15, "title": "Urticaria (Acute Allergic)", "color": HexColor("#b45309"), "patient": "Ms. Fatima Begum | 24 yr | Female | Student", "cc": "Sudden onset widespread itchy wheals all over body, 2 hours after eating shrimp. No facial swelling or breathlessness.", "vitals": "BP: 118/76 | PR: 96/min | SpO2: 99% | Temp: 37.1°C | No stridor", "history": "No previous allergy history. No other medications. No angioedema family history.", "exam": "Multiple erythematous, raised, itchy wheals on trunk, arms, back. No angioedema. No wheeze. No rash on face.", "ix": "No investigations needed for acute urticaria. Advised serum IgE and skin prick test as outpatient later.", "diagnosis": "Acute Allergic Urticaria (food-triggered)", "prescription": [ ("Tab. Cetirizine 10 mg", "1-0-1 × 7 days (then OD if needed)", "Second-generation H1 antihistamine – first-line for urticaria; non-sedating; blocks histamine at H1 receptors; reduces itching and wheal formation."), ("Tab. Ranitidine 150 mg", "1-0-1 × 5 days", "H2 antihistamine – combined H1+H2 blockade more effective for urticaria than H1 alone; reduces refractory cases."), ("Tab. Prednisolone 20 mg", "1-0-0 × 3 days (tapering course)", "Oral corticosteroid – for moderate-severe acute urticaria; reduces mast cell mediator release; not for long-term use."), ("Inj. Chlorpheniramine 10 mg IM (if needed in clinic)", "Stat if severe itching at presentation", "Parenteral first-generation antihistamine – rapid onset; used for acute severe presentation."), ], "advice": "Strictly avoid shrimp and all shellfish. Carry antihistamine at all times. If throat swelling or breathing difficulty occurs - call emergency and use self-injectable epinephrine (Epipen) if available. Allergy specialist referral.", "tag_color": HexColor("#b45309"), }, # 16 { "num": 16, "title": "Pulmonary Tuberculosis (New Case)", "color": HexColor("#15803d"), "patient": "Mr. Dinesh Chauhan | 29 yr | Male | Construction Worker", "cc": "Cough >3 weeks (productive), evening fever, night sweats, weight loss 5 kg/3 months, occasional blood-tinged sputum", "vitals": "BP: 110/72 | PR: 96/min | RR: 20/min | Temp: 38.3°C (evening) | Weight: 52 kg", "history": "Close contact with TB patient (roommate). No prior TB treatment. Non-smoker. HIV status unknown.", "exam": "Wasted appearance. Left upper zone: dull percussion, bronchial breath sounds, crepitations.", "ix": "Sputum AFB (2 samples): 2+ | Sputum CBNAAT (GeneXpert): MTB detected, RIF susceptible | CXR: Left upper lobe cavity + infiltrates | HIV ELISA: Negative | LFT: Normal.", "diagnosis": "Pulmonary Tuberculosis – New Smear Positive (Drug Sensitive)", "prescription": [ ("HRZE Fixed-Dose Combination (FDC)", "2 tabs OD (Intensive Phase × 2 months): Isoniazid 75mg + Rifampicin 150mg + Pyrazinamide 400mg + Ethambutol 275mg per tab", "Standard RNTCP/NTEP first-line 4-drug intensive phase; kills actively dividing bacilli (H,R), eliminates semi-dormant bacilli (Z), prevents resistance."), ("HR FDC (Continuation Phase)", "2 tabs OD × 4 months: Isoniazid 75mg + Rifampicin 150mg per tab", "Continuation phase eliminates residual persisting organisms; prevents relapse."), ("Tab. Pyridoxine (B6) 10 mg", "1-0-0 daily throughout therapy", "Isoniazid depletes pyridoxine → peripheral neuropathy; B6 supplementation prevents INH-induced neuropathy."), ], "advice": "Register under NTEP/RNTCP. DOT (Directly Observed Treatment) mandatory. Notify contacts for screening. Rifampicin turns body fluids orange-red (normal). LFT monthly. Return immediately if jaundice occurs. Nutritional support.", "tag_color": HexColor("#15803d"), }, # 17 { "num": 17, "title": "Dengue Fever (Non-severe)", "color": HexColor("#b91c1c"), "patient": "Mr. Arun Pillai | 20 yr | Male | College Student", "cc": "High fever (104°F), severe headache, retro-orbital pain, bone/muscle ache, rash for 4 days. Lethargic.", "vitals": "BP: 108/68 | PR: 96/min | Temp: 39.5°C | SpO2: 98% | No bleeding", "history": "During dengue season. Mosquito exposure. No travel outside city. Dengue in locality.", "exam": "Flushed face. Petechial rash (scattered). Hepatomegaly (mild). No signs of plasma leakage. Tourniquet test: borderline.", "ix": "NS1 antigen: Positive | CBC: WBC 3,200 (leucopenia), Platelets: 95,000 (falling) | Hematocrit: 42% | Dengue IgM/IgG: Pending.", "diagnosis": "Dengue Fever (Group B – monitored outpatient)", "prescription": [ ("Tab. Paracetamol 500-1000 mg", "1-1-1-1 (max 4g/day) SOS for fever/pain", "ONLY safe antipyretic in dengue. NSAIDs (ibuprofen, aspirin, diclofenac) are ABSOLUTELY CONTRAINDICATED – increase bleeding risk and risk of Reye syndrome."), ("ORS / oral fluids", "2-3 L/day – coconut water, ORS, juice, soups", "Oral rehydration to prevent plasma volume depletion; crucial in febrile phase."), ("Tab. Vitamin C 500 mg", "1-0-1", "Antioxidant; some evidence for platelet support and reduction of oxidative stress in dengue; safe adjunct."), ], "advice": "STRICT WARNING: Do NOT give aspirin, ibuprofen, or diclofenac. Daily CBC monitoring (platelets + hematocrit). Return IMMEDIATELY if: warning signs (persistent vomiting, abdominal pain, bleeding, cold clammy skin, no urine >6 hrs). Hospitalize if platelets <50,000.", "tag_color": HexColor("#b91c1c"), }, # 18 { "num": 18, "title": "Chronic Kidney Disease – Stage 3", "color": HexColor("#1e40af"), "patient": "Mr. Subramaniam | 61 yr | Male | Retired", "cc": "Fatigue, ankle edema, decreased urine output, loss of appetite. Known DM + HTN for 10 years.", "vitals": "BP: 154/96 | PR: 84/min | Weight: 74 kg | No fever", "history": "DM on Metformin, HTN on Amlodipine. Poor medication compliance. Recent NSAID use for knee pain.", "exam": "Bilateral pitting pedal edema (2+). Pallor. No asterixis. No pericardial rub.", "ix": "S. Creatinine: 2.8 mg/dL | eGFR: 26 mL/min/1.73m² (CKD Stage 3b) | Urine protein:creatinine ratio: 0.65 | CBC: Hb 9.2 g/dL | S. K: 5.4 mEq/L | S. Bicarbonate: 18 mEq/L | S. Phosphate: 5.6 mg/dL.", "diagnosis": "Chronic Kidney Disease Stage 3b – Diabetic Nephropathy", "prescription": [ ("Tab. Telmisartan 40 mg", "0-0-1", "ARB – lowers intraglomerular pressure; reduces proteinuria; slows CKD progression in diabetic nephropathy; monitor K+ levels."), ("Tab. Furosemide 40 mg", "1-0-0", "Loop diuretic – manages fluid overload/edema; preferred over thiazides at eGFR <30; monitor electrolytes."), ("Tab. Sodium Bicarbonate 500 mg", "1-0-1", "Corrects metabolic acidosis (HCO3 <22); bicarbonate supplementation slows CKD progression."), ("Inj. Erythropoietin 4000 IU SC", "Once weekly", "ESA – corrects CKD-associated anemia (EPO deficiency); target Hb 10-12 g/dL; monitor BP."), ("Tab. Calcium Carbonate 500 mg (with meals)", "1-1-1", "Phosphate binder – binds dietary phosphate in gut; prevents hyperphosphatemia-induced renal osteodystrophy."), ], "advice": "STOP NSAIDs permanently (nephrotoxic). STOP Metformin (contraindicated eGFR <30 – risk of lactic acidosis). Switch diabetes management to Insulin. Protein restriction 0.8g/kg/day. Nephrology referral for dialysis planning. Avoid nephrotoxic drugs.", "tag_color": HexColor("#1e40af"), }, # 19 { "num": 19, "title": "Anxiety Disorder (Generalized Anxiety)", "color": HexColor("#6d28d9"), "patient": "Ms. Shalini Gupta | 33 yr | Female | Marketing Manager", "cc": "Excessive worry about multiple daily issues, restlessness, muscle tension, poor sleep, palpitations, difficulty concentrating for 6+ months. GAD-7: 16.", "vitals": "BP: 124/82 | PR: 96/min (sinus tachycardia) | Thyroid exam: normal", "history": "No panic attacks. No phobias. Stressful work environment. Coffee intake: 5 cups/day. No substance use. No cardiac disease.", "exam": "Mildly anxious. No tremor. No exophthalmos. Normal cardiovascular exam.", "ix": "TFTs: Normal | ECG: Sinus tachycardia | CBC, glucose: Normal | GAD-7: 16 (severe).", "diagnosis": "Generalized Anxiety Disorder (GAD-7 Severe)", "prescription": [ ("Tab. Escitalopram 10 mg", "1-0-0 (morning) × 6-12 months", "SSRI – first-line pharmacotherapy for GAD; anxiolytic and antidepressant; takes 4-6 weeks for full anxiolytic effect; reduces worry and physical anxiety symptoms."), ("Tab. Buspirone 5 mg", "1-0-1 (titrate to 10 mg BD over 2 weeks)", "Partial 5-HT1A agonist – non-benzodiazepine anxiolytic; no dependence/sedation risk; additive with SSRI; well-suited for chronic GAD."), ("Tab. Propranolol 10 mg", "1-0-1 SOS for palpitations/somatic anxiety", "Beta-blocker – manages somatic anxiety symptoms (tachycardia, tremor) without CNS sedation."), ], "advice": "Psychiatry/psychology referral for CBT (most effective long-term treatment for GAD). Cut caffeine to <1 cup/day. Regular aerobic exercise. Diaphragmatic breathing and progressive muscle relaxation. Follow-up in 3 weeks.", "tag_color": HexColor("#6d28d9"), }, # 20 { "num": 20, "title": "Acute Sinusitis (Bacterial)", "color": HexColor("#0369a1"), "patient": "Mr. Karthik Subramanian | 30 yr | Male | Sales Executive", "cc": "Facial pain/pressure (maxillary), nasal congestion, thick yellow-green nasal discharge, post-nasal drip, headache worsening on bending for 10 days", "vitals": "BP: 118/78 | PR: 80/min | Temp: 38.1°C", "history": "Upper respiratory tract infection 2 weeks ago. No asthma. No nasal polyps. First episode.", "exam": "Tenderness over bilateral maxillary sinuses. Nasal mucosa congested. Posterior pharynx: purulent drip. No orbital swelling.", "ix": "Clinical diagnosis. X-ray sinuses: bilateral maxillary opacification. No CT needed for uncomplicated case.", "diagnosis": "Acute Bacterial Rhinosinusitis (persisting >10 days with double-sickening pattern)", "prescription": [ ("Tab. Amoxicillin-Clavulanate 625 mg", "1-1-1 after food × 10-14 days", "First-line antibiotic for bacterial sinusitis; covers S. pneumoniae, H. influenzae, Moraxella catarrhalis; beta-lactamase resistant."), ("Nasal Spray: Mometasone Furoate 50 mcg", "2 sprays each nostril OD × 3 months", "Intranasal corticosteroid – reduces mucosal edema and inflammation; improves sinus drainage; evidence-based adjunct for sinusitis."), ("Tab. Levocetirizine 5 mg", "0-0-1 at bedtime", "Antihistamine – reduces allergic mucosal component if present; relieves post-nasal drip."), ("Steam inhalation with Menthol crystals", "3 × daily for 10 mins", "Warm steam loosens secretions and improves mucociliary clearance; relieves nasal congestion."), ], "advice": "Nasal saline irrigation (Jala Neti or NeilMed rinse) BD. Stay well hydrated. Elevate head of bed. If no improvement in 72 hrs or orbital/neurological symptoms develop – urgent ENT referral + CT sinuses.", "tag_color": HexColor("#0369a1"), }, # 21 { "num": 21, "title": "Osteoarthritis – Knee", "color": HexColor("#854d0e"), "patient": "Mrs. Meena Pillai | 64 yr | Female | Housewife", "cc": "Bilateral knee pain worse on walking and climbing stairs, joint stiffness <30 min on waking, crepitus, swelling for 2 years", "vitals": "BP: 146/88 | PR: 76/min | Weight: 80 kg | BMI: 32", "history": "No morning stiffness >30 min (rules out inflammatory arthritis). No fever. HTN on Amlodipine.", "exam": "Bilateral knee: bony enlargement, crepitus on movement, reduced flexion (110° bilaterally). No warmth or significant swelling.", "ix": "X-ray knees (standing): joint space narrowing, osteophytes, subchondral sclerosis (KL Grade II). RF: Negative. Anti-CCP: Negative. CRP: 8 (mildly elevated).", "diagnosis": "Bilateral Knee Osteoarthritis (KL Grade II)", "prescription": [ ("Tab. Paracetamol 500 mg", "1-1-1 (scheduled, not just SOS)", "First-line analgesic for OA – safest with regular use; avoids GI, renal, CV risks of NSAIDs especially in elderly HTN patient."), ("Tab. Celecoxib 200 mg", "1-0-0 after food SOS (not daily)", "COX-2 selective NSAID – better GI safety than non-selective NSAIDs; used when paracetamol insufficient; monitor BP and renal function."), ("Cap. Glucosamine 1500 mg + Chondroitin 1200 mg", "1-0-0", "Nutraceutical – modest evidence for symptom relief in knee OA; may have mild chondroprotective effect; well tolerated."), ("Topical Diclofenac 1% gel", "Apply to knees BD", "Topical NSAID – local anti-inflammatory effect with minimal systemic absorption; evidence-based for knee OA (NICE guidelines recommend)."), ], "advice": "Weight loss (target BMI <27) – every 1 kg lost reduces knee load by 4 kg. Physiotherapy (quadriceps strengthening). Avoid prolonged standing/squatting/stair climbing when possible. Knee support brace. Orthopedic referral if progressing to Grade III-IV.", "tag_color": HexColor("#854d0e"), }, # 22 { "num": 22, "title": "Atrial Fibrillation (Paroxysmal – New Onset)", "color": HexColor("#dc2626"), "patient": "Mr. Sudhir Lal | 67 yr | Male | Retired Officer", "cc": "Palpitations, mild breathlessness, light-headedness since this morning. No chest pain. No syncope.", "vitals": "BP: 144/90 | PR: 132/min (irregular) | RR: 20/min | SpO2: 96% | ECG: AF confirmed", "history": "Known HTN. Recently started thyroid medication. Alcohol use. No prior cardiac history.", "exam": "Irregularly irregular pulse. Soft S1. No signs of heart failure. JVP not elevated.", "ix": "ECG: Absent P waves, irregular RR intervals – confirmed AF | Echo: EF 58%, mild LA dilatation, no thrombus | TSH: 0.3 (borderline low) | CBC, electrolytes: normal. CHA2DS2-VASc: 3.", "diagnosis": "New-onset Paroxysmal Atrial Fibrillation (CHA2DS2-VASc 3 – anticoagulation indicated)", "prescription": [ ("Tab. Bisoprolol 2.5 mg", "1-0-1 (titrate to target HR <80/min)", "Beta-blocker – rate control strategy; reduces ventricular rate in AF; first-line for rate control in non-pre-excitation AF."), ("Tab. Rivaroxaban 20 mg", "0-0-1 with evening meal", "NOAC – oral anticoagulation (CHA2DS2-VASc ≥2 in men); prevents cardioembolic stroke; preferred over warfarin (no routine INR monitoring needed)."), ("Tab. Amiodarone 200 mg", "1-1-1 × 1 week (loading), then 1-0-0 (maintenance)", "Class III antiarrhythmic – for rhythm control (cardioversion and maintenance); effective if patient not spontaneously converting."), ], "advice": "Cardiology urgent referral. No alcohol (strong AF trigger). Treat subclinical thyroid. If on anticoagulation – avoid NSAIDs/aspirin (bleeding risk). Cardioversion may be considered if AF persists >48 hrs after adequate anticoagulation.", "tag_color": HexColor("#dc2626"), }, # 23 { "num": 23, "title": "Childhood Febrile Seizure", "color": HexColor("#d97706"), "patient": "Baby Arjun | 2.5 yr | Male | Child", "cc": "Generalized tonic-clonic seizure for 2 minutes (self-terminated) during fever. First episode.", "vitals": "Temp: 39.8°C | PR: 132/min | SpO2: 98% (post-ictal) | BP: 88/56 | RR: 28/min", "history": "Fever for 1 day (possible URTI). No prior seizure. Developmental milestones normal. Family history: uncle had childhood febrile seizures.", "exam": "Alert (post-ictal). No focal neurological signs. Mild pharyngeal congestion. No neck stiffness. No Kernig's sign.", "ix": "CBC: WBC 12,800 (viral pattern). CRP: 12. Blood glucose: 88 mg/dL. Urine: no infection. LP not indicated (no meningism).", "diagnosis": "Simple Febrile Seizure (duration <15 min, generalized, first episode)", "prescription": [ ("Syp. Paracetamol 15 mg/kg/dose", "Every 6 hours for fever (oral)", "First-line antipyretic – reduces fever to prevent recurrence of febrile seizure; paracetamol preferred over aspirin (Reye syndrome risk in children)."), ("Syp. Ibuprofen 10 mg/kg/dose", "Every 8 hours alternating with paracetamol", "NSAID antipyretic – alternating with paracetamol for sustained fever control; more effective fever reduction."), ("Rectal Diazepam 0.5 mg/kg", "Keep at home SOS – use if seizure recurs and lasts >3-5 min", "Benzodiazepine rescue – for seizure lasting >5 min or cluster seizures; rectal route convenient for home emergency use."), ], "advice": "Parent education: febrile seizures are common (3-5% children) and generally not dangerous for simple type. Place child on side during seizure (recovery position). Do NOT put anything in mouth. Do NOT restrain. Call emergency if seizure >5 mins. Reassure about good prognosis. No long-term anticonvulsant needed for simple febrile seizure.", "tag_color": HexColor("#d97706"), }, # 24 { "num": 24, "title": "Chronic Liver Disease / Liver Cirrhosis", "color": HexColor("#059669"), "patient": "Mr. Pramod Verma | 50 yr | Male | Businessman", "cc": "Abdominal distension (ascites), ankle edema, jaundice, fatigue for 2 months", "vitals": "BP: 100/64 | PR: 96/min | Weight: 68 kg | Temp: 37°C", "history": "Alcohol use disorder (750 mL whiskey/day for 15 years). Stopped 1 month ago. No IV drug use. No blood transfusion.", "exam": "Jaundice. Leukonychia. Palmar erythema. Spider angioma (×5 on trunk). Splenomegaly. Shifting dullness (ascites). No asterixis currently.", "ix": "LFT: Total bilirubin 4.2 mg/dL | AST/ALT: 120/58 (AST:ALT>2 – alcoholic pattern) | Albumin 2.6 g/dL | INR: 1.8 | Platelets: 88,000 | USG: Cirrhotic liver, moderate ascites, splenomegaly | Child-Pugh score: B (8 pts).", "diagnosis": "Liver Cirrhosis – Alcoholic – Child-Pugh B with Ascites", "prescription": [ ("Tab. Spironolactone 100 mg", "1-0-0 (morning)", "Aldosterone antagonist – first-line for cirrhotic ascites; blocks aldosterone-mediated Na/water retention; natriuretic; prevents diuretic-induced hypokalemia."), ("Tab. Furosemide 40 mg", "1-0-0 (morning)", "Loop diuretic – added to spironolactone for better ascites mobilization; maintain spironolactone:furosemide ratio 100:40 to balance potassium."), ("Tab. Propranolol 20 mg", "1-0-1", "Non-selective beta-blocker – reduces portal hypertension; primary prophylaxis of variceal bleeding; reduces risk of SBP and HE."), ("Tab. Rifaximin 400 mg", "1-1-1", "Non-absorbed gut antibiotic – reduces ammonia-producing gut bacteria; prevention of hepatic encephalopathy recurrence."), ("Tab. Zinc 50 mg", "1-0-0", "Cirrhosis causes zinc deficiency; zinc is a cofactor for urea cycle enzymes; supplementation reduces ammonia and HE risk."), ], "advice": "ABSOLUTE ALCOHOL ABSTINENCE. Hepatology referral for endoscopy (esophageal varices screening). Restrict sodium (<2g/day) and fluid. Daily weight monitoring. Drain ascites if tense (therapeutic paracentesis). HCC surveillance (USG + AFP every 6 months). Hepatitis B/C serology.", "tag_color": HexColor("#059669"), }, # 25 { "num": 25, "title": "Acute Pyelonephritis", "color": HexColor("#7c3aed"), "patient": "Mrs. Sheela Thomas | 32 yr | Female | Nurse", "cc": "High fever (103°F), rigors, right loin pain, nausea, vomiting, dysuria for 2 days", "vitals": "BP: 102/66 | PR: 112/min | Temp: 39.6°C | RR: 22/min", "history": "Recurrent UTIs. Currently 10 weeks pregnant (incidental finding). No known drug allergies.", "exam": "Right costovertebral angle tenderness (marked). Suprapubic tenderness. No peritoneal signs.", "ix": "Urine R/M: pus cells 50-60/HPF, bacteria (gram-negative). Urine culture: E. coli (pending sensitivity) | CBC: WBC 16,400 | CRP: 86 | S. Creatinine: 1.0 mg/dL | USG KUB: Right kidney echogenic with mild pyelectasis. No obstruction.", "diagnosis": "Acute Pyelonephritis (in Pregnancy – Outpatient-eligible after initial IV therapy)", "prescription": [ ("Inj. Ceftriaxone 1g IV", "BD × 48 hrs (in-clinic/hospital)", "Third-generation cephalosporin – safe in pregnancy; covers gram-negative uropathogens (E. coli, Klebsiella); parenteral for initial severe pyelonephritis treatment."), ("Tab. Cefixime 200 mg", "1-0-1 × 14 days (step-down after IV)", "Oral 3rd-gen cephalosporin – safe in pregnancy; continues coverage after parenteral therapy; completes 14-day course for pyelonephritis."), ("Tab. Paracetamol 500 mg", "1-1-1-1 SOS for fever/pain", "Safe antipyretic analgesic in pregnancy; NSAIDs CONTRAINDICATED in pregnancy (fetal renal toxicity, premature closure of ductus arteriosus)."), ("IV Fluid: Normal Saline 1L", "Over 6 hrs (dehydration management)", "Maintains hydration; flushes urinary tract; corrects hemodynamic instability from fever and vomiting."), ], "advice": "Obstetrics referral (pregnancy + UTI risk). Urine culture sensitivity review – adjust antibiotic if needed. Repeat urine culture 1 week after completing therapy. Monthly urine cultures for rest of pregnancy. Consider prophylactic nitrofurantoin after treatment (avoid in 3rd trimester).", "tag_color": HexColor("#7c3aed"), }, # 26 { "num": 26, "title": "Hypothyroidism in Pregnancy", "color": HexColor("#0891b2"), "patient": "Mrs. Divya Menon | 27 yr | Female | Teacher | 14 weeks pregnant", "cc": "Fatigue, constipation, cold intolerance, mild puffiness – routine antenatal labs revealed abnormal thyroid", "vitals": "BP: 110/72 | PR: 68/min | Weight: 61 kg | Temp: 36.8°C", "history": "G2P1A0. Previously had subclinical hypothyroidism; was not on treatment. No goitre.", "exam": "Mild periorbital puffiness. No goitre. Uterine size appropriate for dates. Fetal heart sounds present.", "ix": "TSH: 6.8 mIU/L (>2.5 is abnormal in T1-T2 pregnancy) | Free T4: 0.8 ng/dL (low-normal) | Anti-TPO: 312 IU/mL | Anomaly scan pending.", "diagnosis": "Overt Hypothyroidism in Pregnancy (Autoimmune – Hashimoto's)", "prescription": [ ("Tab. Levothyroxine 75 mcg", "1 tab empty stomach, 30 min before breakfast", "Thyroid hormone replacement – mandatory in pregnancy; untreated maternal hypothyroidism causes fetal neurodevelopmental impairment (IQ reduction, cretinism); target TSH <2.5 mIU/L in pregnancy."), ("Tab. Folic acid 5 mg", "1-0-0", "Mandatory supplementation in pregnancy; prevents neural tube defects; especially important in 1st trimester."), ("Iron + Folic acid antenatal tab", "1-0-0 (separate from LT4 by 4 hours)", "Iron can interfere with levothyroxine absorption – must be taken at least 4 hours apart; continued for anemia prevention."), ], "advice": "TSH recheck every 4 weeks throughout pregnancy. Post-delivery: reduce LT4 dose by 30% and recheck at 6 weeks postpartum. Obstetrics co-management. Take L-T4 NEVER with iron/calcium. Important: fetal thyroid development depends on adequate maternal T4 supply in first trimester.", "tag_color": HexColor("#0891b2"), }, # 27 – bonus { "num": 27, "title": "Scabies", "color": HexColor("#16a34a"), "patient": "Master Raju & Family | 6 yr + 4 family members", "cc": "Intensely itchy rash especially at night, spreading to family members over 3 weeks. Small bumps between fingers, wrist, axilla, groin.", "vitals": "Temp: 37°C | PR: 88/min | No fever", "history": "New housemaid joined 4 weeks ago. All family members affected. Several family members treated for 'allergy' elsewhere without relief.", "exam": "Linear burrows in finger webs, wrists. Papular rash on trunk, inner thighs. Excoriations. Secondary impetiginization on some lesions.", "ix": "Dermoscopy/skin scraping: Sarcoptes scabiei mites/eggs confirmed.", "diagnosis": "Scabies (with secondary bacterial infection) – Index case and contacts", "prescription": [ ("Cream: Permethrin 5%", "Apply from neck to toes at night; wash off after 8-12 hrs; REPEAT after 1 week", "Neurotoxin to mites – first-line scabicide; kills Sarcoptes scabiei and eggs; must treat ALL household contacts simultaneously on same night."), ("Syp./Tab. Ivermectin 200 mcg/kg single dose", "Single dose (weight-based), repeat after 2 weeks if needed", "Oral scabicide – alternative to permethrin or used in crusted/Norwegian scabies; systemic action; treat all contacts."), ("Calamine lotion + 1% Hydrocortisone cream", "Apply after permethrin wash-off, TID for itch", "Antipruritic – relieves post-scabies itch which can persist 2-4 weeks after successful treatment (hypersensitivity reaction)."), ("Tab. Cetirizine 5 mg (child dose)", "0-0-1 for itch", "Antihistamine – reduces itch; helps with sleep disrupted by nocturnal pruritus."), ("Tab. Amoxicillin-Clavulanate 312.5 mg (child dose)", "1-1-1 × 5 days", "For secondary impetiginization – treats S. aureus/Streptococcal superinfection of excoriated lesions."), ], "advice": "Treat ALL household contacts on the SAME night (even if asymptomatic). Wash all clothes, bedding, towels in hot water (>60°C) and sun-dry. Items that cannot be washed: seal in plastic bag for 1 week (mites die without host). Itch may persist 2-4 weeks after cure – does NOT mean treatment failure.", "tag_color": HexColor("#16a34a"), }, ] # ─── BUILD PDF ───────────────────────────────────────────────────────────────── story = [] # ── COVER HEADER ── cover_table = Table( [[Paragraph("Medicine OPD Patient Cases", title_style)], [Paragraph("25+ Clinical Cases with Prescriptions and Pharmacological Rationale", subtitle_style)], [Paragraph("For Medical Education & Practice Purposes Only", ParagraphStyle("sub2", parent=subtitle_style, fontSize=9, textColor=HexColor("#bfdbfe")))]], colWidths=[W] ) cover_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), DARK_BLUE), ("ROUNDEDCORNERS", [8]), ("TOPPADDING", (0,0), (-1,-1), 16), ("BOTTOMPADDING", (0,0), (-1,-1), 14), ("LEFTPADDING", (0,0), (-1,-1), 20), ("RIGHTPADDING", (0,0), (-1,-1), 20), ])) story.append(cover_table) story.append(Spacer(1, 0.35*cm)) # Disclaimer disclaimer_data = [[Paragraph( "EDUCATIONAL DISCLAIMER: These cases are hypothetical, constructed for undergraduate/postgraduate medical education. " "Prescriptions represent commonly accepted clinical practice and are NOT a substitute for individualized clinical judgment. " "Always verify drug doses, interactions, and contraindications before prescribing in real practice.", ParagraphStyle("disc", parent=styles["Normal"], fontSize=8, textColor=RED, fontName="Helvetica", alignment=TA_CENTER, leading=11) )]] disc_table = Table(disclaimer_data, colWidths=[W]) disc_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), LIGHT_RED), ("BOX", (0,0), (-1,-1), 1, RED), ("TOPPADDING", (0,0), (-1,-1), 8), ("BOTTOMPADDING", (0,0), (-1,-1), 8), ("LEFTPADDING", (0,0), (-1,-1), 12), ("RIGHTPADDING", (0,0), (-1,-1), 12), ("ROUNDEDCORNERS", [6]), ])) story.append(disc_table) story.append(Spacer(1, 0.3*cm)) # ── CASES ── for c in cases: col = c["tag_color"] light_col = LIGHT_BLUE # default background for content boxes # ---- Case Header bar ---- header_data = [[ Paragraph(f"Case {c['num']:02d}", ParagraphStyle("cnum", parent=styles["Normal"], fontSize=9, textColor=WHITE, fontName="Helvetica-Bold")), Paragraph(c["title"], case_title_style), ]] header_table = Table(header_data, colWidths=[1.5*cm, W-1.5*cm]) header_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), col), ("VALIGN", (0,0), (-1,-1), "MIDDLE"), ("TOPPADDING", (0,0), (-1,-1), 8), ("BOTTOMPADDING", (0,0), (-1,-1), 8), ("LEFTPADDING", (0,0), (-1,-1), 10), ("RIGHTPADDING", (0,0), (-1,-1), 10), ("ROUNDEDCORNERS", [6]), ])) # ---- Patient info row ---- info_data = [[ Paragraph(f"Patient: {c['patient']}", body_style), Paragraph(f"Chief Complaint: {c['cc']}", body_style), ]] info_table = Table(info_data, colWidths=[W*0.38, W*0.62]) info_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), GRAY_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), ("VALIGN", (0,0), (-1,-1), "TOP"), ("BOX", (0,0), (-1,-1), 0.5, GRAY_BORDER), ])) # ---- Vitals + History + Exam + Ix (2-col layout) ---- left_content = [ Paragraph("Vitals", section_label), Paragraph(c["vitals"], body_style), Paragraph("History", section_label), Paragraph(c["history"], body_style), ] right_content = [ Paragraph("Examination", section_label), Paragraph(c["exam"], body_style), Paragraph("Investigations", section_label), Paragraph(c["ix"], body_style), ] from reportlab.platypus import ListFlowable left_cell = left_content right_cell = right_content clincial_data = [[left_cell, right_cell]] clinical_table = Table(clincial_data, colWidths=[W*0.49, W*0.49]) clinical_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (0,-1), HexColor("#f0f4ff")), ("BACKGROUND", (1,0), (1,-1), HexColor("#f0fff4")), ("VALIGN", (0,0), (-1,-1), "TOP"), ("TOPPADDING", (0,0), (-1,-1), 6), ("BOTTOMPADDING", (0,0), (-1,-1), 4), ("LEFTPADDING", (0,0), (-1,-1), 8), ("RIGHTPADDING", (0,0), (-1,-1), 8), ("BOX", (0,0), (-1,-1), 0.5, GRAY_BORDER), ("INNERGRID", (0,0), (-1,-1), 0.3, GRAY_BORDER), ])) # ---- Diagnosis banner ---- diag_data = [[ Paragraph("DIAGNOSIS:", ParagraphStyle("dxlabel", parent=styles["Normal"], fontSize=9, textColor=col, fontName="Helvetica-Bold")), Paragraph(c["diagnosis"], ParagraphStyle("dxtxt", parent=styles["Normal"], fontSize=9.5, textColor=DARK_BLUE, fontName="Helvetica-Bold")), ]] diag_table = Table(diag_data, colWidths=[2.2*cm, W-2.2*cm]) diag_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), LIGHT_BLUE), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("LEFTPADDING", (0,0), (-1,-1), 8), ("RIGHTPADDING", (0,0), (-1,-1), 8), ("VALIGN", (0,0), (-1,-1), "MIDDLE"), ("BOX", (0,0), (-1,-1), 1, col), ])) # ---- Prescription ---- rx_header_data = [[Paragraph("Rx PRESCRIPTION & PHARMACOLOGICAL RATIONALE", ParagraphStyle("rxhdr", parent=styles["Normal"], fontSize=9, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_CENTER))]] rx_header_table = Table(rx_header_data, colWidths=[W]) rx_header_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), col), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("LEFTPADDING", (0,0), (-1,-1), 8), ("RIGHTPADDING", (0,0), (-1,-1), 8), ])) rx_rows = [] for i, (drug, dose, reason) in enumerate(c["prescription"]): bg = WHITE if i % 2 == 0 else HexColor("#f8f9ff") drug_cell = [ Paragraph(f"▶ {drug}", rx_drug_style), Paragraph(f" Dose: {dose}", ParagraphStyle("dose", parent=styles["Normal"], fontSize=8.5, textColor=HexColor("#64748b"), fontName="Helvetica-Oblique", leftIndent=22, spaceAfter=1)), Paragraph(f" Reason: {reason}", reason_style), ] row_table = Table([[drug_cell]], colWidths=[W]) row_table.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), 6), ("RIGHTPADDING", (0,0), (-1,-1), 6), ("BOX", (0,0), (-1,-1), 0.3, GRAY_BORDER), ])) rx_rows.append(row_table) # ---- Advice ---- advice_data = [[ Paragraph("ADVICE & FOLLOW-UP:", ParagraphStyle("advlbl", parent=styles["Normal"], fontSize=8.5, textColor=GREEN, fontName="Helvetica-Bold", leftIndent=0)), Paragraph(c["advice"], ParagraphStyle("advtxt", parent=styles["Normal"], fontSize=9, textColor=HexColor("#1e3a2f"), fontName="Helvetica", leading=12)) ]] advice_table = Table(advice_data, colWidths=[2.8*cm, W-2.8*cm]) advice_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), LIGHT_GREEN), ("TOPPADDING", (0,0), (-1,-1), 6), ("BOTTOMPADDING", (0,0), (-1,-1), 6), ("LEFTPADDING", (0,0), (-1,-1), 8), ("RIGHTPADDING", (0,0), (-1,-1), 8), ("VALIGN", (0,0), (-1,-1), "TOP"), ("BOX", (0,0), (-1,-1), 1, GREEN), ])) # ---- Assemble case block ---- case_elements = [ header_table, info_table, clinical_table, diag_table, rx_header_table, ] + rx_rows + [ advice_table, Spacer(1, 0.4*cm), ] # Wrap in KeepTogether to avoid splits, but allow page breaks between cases story.append(KeepTogether(case_elements[:6])) # header + first few elements together for el in case_elements[6:]: story.append(el) story.append(HRFlowable(width=W, thickness=1.5, color=col, spaceAfter=8, spaceBefore=4)) # ── FOOTER ── story.append(Spacer(1, 0.5*cm)) footer_data = [[ Paragraph( "This document is produced for educational and training purposes only. " "It does not constitute medical advice and must not be used as a clinical decision-making tool. " "Always consult current national guidelines and senior clinicians before prescribing. " "Drug doses and regimens may vary by institution, patient weight, renal/hepatic function, and local resistance patterns. " "Orris Medical Education | 2026", footer_style ) ]] footer_table = Table(footer_data, colWidths=[W]) footer_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), HexColor("#f1f5f9")), ("BOX", (0,0), (-1,-1), 0.5, GRAY_BORDER), ("TOPPADDING", (0,0), (-1,-1), 8), ("BOTTOMPADDING", (0,0), (-1,-1), 8), ("LEFTPADDING", (0,0), (-1,-1), 12), ("RIGHTPADDING", (0,0), (-1,-1), 12), ])) story.append(footer_table) # ── BUILD ── doc.build(story) print(f"PDF successfully generated: {OUTPUT}")