from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER
from reportlab.lib.units import cm
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, PageBreak, KeepTogether
from reportlab.pdfbase.pdfmetrics import stringWidth
from reportlab.pdfbase.ttfonts import TTFont
from reportlab.pdfbase import pdfmetrics
from reportlab.lib.colors import HexColor
from reportlab.pdfgen import canvas
import os

OUT='/tmp/workspace/ntep_tb_guides/output'
os.makedirs(OUT,exist_ok=True)

OFFICIAL = [
 ('National Guidelines for Management of DR-TB, Central TB Division/NTEP, 2025', 'https://tbcindia.mohfw.gov.in/wp-content/uploads/2025/03/National-Guidelines-for-Management-of-DR-TB_27-3-2025.pdf'),
 ('Guidelines for Programmatic Management of DR-TB in India, Central TB Division/NTEP, 2021', 'https://tbcindia.mohfw.gov.in/wp-content/uploads/2023/05/8368587497Guidelines-for-PMDT-in-India.pdf'),
 ('Guidelines for Programmatic Management of TB Preventive Treatment in India, Central TB Division/NTEP, 2021', 'https://tbcindia.mohfw.gov.in/wp-content/uploads/2023/05/Guidelines-for-Programmatic-Management-of-Tuberculosis-Preventive-Treatment-in-India.pdf'),
 ('Index-TB Guidelines: Extra-pulmonary TB for India, Central TB Division', 'https://tbcindia.mohfw.gov.in/wp-content/uploads/2023/05/5585665076Index-TB-Guidelines.pdf')]

styles=getSampleStyleSheet()
styles.add(ParagraphStyle(name='Title2',parent=styles['Title'],fontName='Helvetica-Bold',fontSize=20,leading=25,textColor=HexColor('#073B4C'),alignment=TA_CENTER,spaceAfter=10))
styles.add(ParagraphStyle(name='Sub',parent=styles['Normal'],fontSize=9,leading=12,textColor=HexColor('#455A64'),alignment=TA_CENTER,spaceAfter=15))
styles.add(ParagraphStyle(name='H1x',parent=styles['Heading1'],fontSize=14,leading=17,textColor=HexColor('#006D77'),spaceBefore=12,spaceAfter=6))
styles.add(ParagraphStyle(name='H2x',parent=styles['Heading2'],fontSize=11,leading=14,textColor=HexColor('#9B2226'),spaceBefore=8,spaceAfter=4))
styles.add(ParagraphStyle(name='Bodyx',parent=styles['BodyText'],fontSize=9.2,leading=12.4,spaceAfter=5))
styles.add(ParagraphStyle(name='Small',parent=styles['BodyText'],fontSize=7.5,leading=9.5,spaceAfter=3))
styles.add(ParagraphStyle(name='Box',parent=styles['BodyText'],fontSize=9,leading=12,backColor=HexColor('#E9F5F6'),borderColor=HexColor('#83C5BE'),borderWidth=.5,borderPadding=7,spaceBefore=5,spaceAfter=8))

def P(s,sty='Bodyx'): return Paragraph(s,styles[sty])
def bullet(s): return P('• '+s)
def tbl(rows, widths=None, small=False):
    data=[]
    for r,row in enumerate(rows): data.append([P(str(x), 'Small' if small else 'Bodyx') for x in row])
    t=Table(data,colWidths=widths,repeatRows=1,hAlign='LEFT')
    t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),HexColor('#006D77')),('TEXTCOLOR',(0,0),(-1,0),colors.white),('FONTNAME',(0,0),(-1,0),'Helvetica-Bold'),('VALIGN',(0,0),(-1,-1),'TOP'),('GRID',(0,0),(-1,-1),.35,HexColor('#A7C7C8')),('ROWBACKGROUNDS',(0,1),(-1,-1),[colors.white,HexColor('#F4FAFA')]),('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4)]))
    return t
class NumberedCanvas(canvas.Canvas):
 def __init__(self,*a,**kw): canvas.Canvas.__init__(self,*a,**kw); self.pages=[]
 def showPage(self): self.pages.append(dict(self.__dict__)); self._startPage()
 def save(self):
  n=len(self.pages)
  for state in self.pages:
   self.__dict__.update(state); self.setFont('Helvetica',7.5); self.setFillColor(HexColor('#607D8B')); self.drawString(1.6*cm,.9*cm,'Educational guide | Verify against the latest NTEP circular and patient-specific DST'); self.drawRightString(19.4*cm,.9*cm,f'Page {self._pageNumber} of {n}'); canvas.Canvas.showPage(self)
  canvas.Canvas.save(self)
def build(filename,title,subtitle,story):
 doc=SimpleDocTemplate(os.path.join(OUT,filename),pagesize=A4,rightMargin=1.55*cm,leftMargin=1.55*cm,topMargin=1.35*cm,bottomMargin=1.45*cm,title=title,author='Orris')
 first=[P(title,'Title2'),P(subtitle,'Sub'),P('<b>Clinical safety note.</b> This study guide summarizes national programme materials. TB treatment must be prescribed, weight-banded, and monitored by an NTEP-linked clinician. Do not start, stop, substitute, or dose drugs from this document alone.','Box')]
 doc.build(first+story,canvasmaker=NumberedCanvas)
def refs():
 s=[P('Official NTEP / Central TB Division source PDFs','H1x')]
 for name,url in OFFICIAL: s.append(P(f'<b>{name}.</b> <link href="{url}" color="#006D77">Open official PDF</link>','Small'))
 s.append(P('Source status: DR-TB recommendations below are based principally on the March 2025 national DR-TB guideline. Drug-sensitive TB operational documents remain programme documents and local NTEP circulars may change implementation details. Accessed 22 September 2026.','Small'))
 return s

# 1 diagnosis
s=[]
s += [P('1. Programme approach and diagnosis','H1x'),P('NTEP aims to identify TB promptly, establish bacteriological confirmation where possible, test for drug resistance early, notify the person in Nikshay, start an appropriate all-oral regimen, support adherence, and document outcomes.'),P('<b>Mnemonic: “TEST TB”.</b> <b>T</b>riage symptoms/risk, <b>E</b>xamine and collect specimen, <b>S</b>eek molecular confirmation and resistance result, <b>T</b>reat under NTEP, <b>T</b>rack adherence/results, <b>B</b>ring contacts for evaluation.','Box'),P('Initial evaluation','H2x'),tbl([['Step','Practical NTEP-oriented action'],['1. Identify','Cough, fever, weight loss, night sweats, hemoptysis; assess contact, prior TB, HIV, diabetes, undernutrition, tobacco, occupational and congregate-setting risks.'],['2. Test','Obtain a quality respiratory specimen for a WHO-recommended rapid molecular test / NAAT where available. Extrapulmonary disease needs site-specific specimen, imaging and/or histopathology as clinically indicated.'],['3. Resist','Perform universal drug-susceptibility testing at least for rifampicin; expand DST as guided by result/history before or during DR-TB treatment.'],['4. Assess','Weight, pregnancy status, HIV and ART, diabetes, liver/renal disease, prior drugs, ECG and laboratory baseline appropriate to chosen regimen.'],['5. Notify/support','Nikshay notification, counselling, infection-control advice, contact investigation, nutritional and social support.']], [2.8*cm,14.8*cm]),P('Specimen and diagnostic principles','H2x'),bullet('Do not use chest radiography alone to confirm or exclude TB. A radiograph supports clinical assessment but microbiology or tissue diagnosis should be pursued whenever feasible.'),bullet('If the rapid molecular test detects rifampicin resistance, urgently link to a DR-TB centre for regimen eligibility review and baseline DST. Do not improvise a first-line regimen.'),bullet('For extrapulmonary TB, obtain aspirate, biopsy, cerebrospinal fluid or other relevant specimen when safely possible. The disease site and severity determine duration and referral decisions.'),P('Clinical prioritisation','H2x'),tbl([['Situation','Action'],['Severe illness / danger signs','Urgent hospital assessment: respiratory distress, massive hemoptysis, altered sensorium, suspected meningitis, spinal cord compression, pericardial tamponade, severe hypoxia or inability to take medicines.'],['Possible CNS or spinal TB','Urgent specialist evaluation. Regimen duration and use of corticosteroids are site-specific; do not assume routine 6-month pulmonary-TB management.'],['HIV / immunosuppression','Offer HIV testing and coordinated TB-HIV care. Review antiretroviral interactions, particularly rifamycins.'],['Household contact','Screen for active TB first. If disease is excluded, assess eligibility for TB preventive treatment.']], [4.4*cm,13.2*cm]),P('TB preventive treatment (TPT)','H1x'),P('After <b>active TB has been excluded</b>, NTEP 2021 TPT guidance includes 6H or 3HP for specified contacts/people living with HIV, subject to age, weight, drug availability and interactions. 6H: daily isoniazid, usually 6 months. 3HP: once-weekly isoniazid plus rifapentine for 12 doses in eligible persons aged over 2 years.'),tbl([['Regimen','Frequency','Key dose principle from NTEP TPT guide'],['6H','Daily for 6 months','Age ≥10 years: H 5 mg/kg/day; age <10 years: 10 mg/kg/day (range 7-15); maximum daily H 300 mg.'],['3HP','Once weekly for 12 doses','Weight-banded isoniazid plus rifapentine. For adults >14 years, the guide lists H 900 mg plus rifapentine 900 mg weekly in the adult weight bands shown.'],['DR-TB contact TPT','Only after expert assessment','For contacts of rifampicin-resistant, fluoroquinolone-sensitive index TB: 6 months daily levofloxacin. Age >14 years: <45 kg 750 mg/day, ≥45 kg 1,000 mg/day.']], [3.4*cm,3.4*cm,10.8*cm], True),P('<b>Mnemonic: “Rule OUT before TPT”.</b> <b>O</b>bserve symptoms, <b>U</b>ndergo evaluation/testing as indicated, <b>T</b>reat active disease instead if present.','Box')]
s+=refs(); build('01_NTEP_TB_Diagnosis_TPT.pdf','NTEP Tuberculosis Guide 1','Diagnosis, notification, triage and TB preventive treatment',s)

# DS
s=[]
s += [P('2. Drug-susceptible TB (DS-TB)','H1x'),P('For drug-susceptible TB, India moved to daily, weight-banded fixed-dose combinations (FDCs). The usual programme regimen for new DS-TB disease is <b>2 months HRZE followed by 4 months HRE</b>, given daily. Confirm local NTEP instructions for site-specific disease and patient exceptions.'),P('<b>Mnemonic: “2 HRZE, 4 HRE: Hit Rapidly, then Hold Relapse away.”</b> H = isoniazid, R = rifampicin, Z = pyrazinamide, E = ethambutol.','Box'),P('Standard adult DS-TB FDC schedule','H2x'),tbl([['Phase','Daily medicines','Duration','Purpose'],['Intensive phase','HRZE','2 months','Rapidly reduces bacillary burden and resistance selection.'],['Continuation phase','HRE','4 months','Clears remaining organisms and prevents relapse.']], [3*cm,4*cm,3*cm,7*cm]),P('Common adult FDC tablet strengths and weight-band tablet counts','H2x'),P('The table is a commonly used NTEP daily adult FDC schedule. Ensure the pack strength and patient weight agree with the prescription and current local stock. Re-weigh monthly and adjust after a meaningful weight-band change.'),tbl([['Body weight','HRZE FDC 75/150/400/275 mg','HRE FDC 75/150/275 mg','Frequency'],['25-39 kg','2 tablets','2 tablets','Once daily'],['40-54 kg','3 tablets','3 tablets','Once daily'],['55-69 kg','4 tablets','4 tablets','Once daily'],['≥70 kg','5 tablets','5 tablets','Once daily']], [3.5*cm,5.1*cm,5.1*cm,3.9*cm]),P('The listed FDC order is H/R/Z/E. Individual formulations and special dosing may be needed for children, very low body weight, pregnancy, organ dysfunction, intolerance, or drug resistance. Use the current NTEP weight-band chart, not adult tablet counts, for children.'),P('Administration and follow-up','H2x'),bullet('Give treatment daily, supported by the treatment supporter and NTEP recording system. Counsel not to split, skip, or double doses without advice.'),bullet('Record weight, symptoms, adherence, adverse effects, diabetes/HIV care and microbiological follow-up according to NTEP schedule. Persistently positive test results, clinical deterioration or missed doses need prompt reassessment and DST review.'),bullet('In pulmonary TB, obtain bacteriological follow-up as programme guidance directs. Do not label failure from one result without quality, timing and DST review.'),P('Special clinical situations','H2x'),tbl([['Situation','Key point'],['Pregnancy','First-line H, R and E are generally used when TB disease needs treatment. Avoid assuming Z is contraindicated; use NTEP/specialist protocol. Avoid streptomycin/aminoglycosides because of fetal ototoxicity risk.'],['HIV and ART','Treat TB promptly and coordinate ART. Rifampicin has major interactions with several antiretrovirals, so ART selection/dosing needs TB-HIV expertise.'],['Liver disease','Baseline and symptom-triggered liver assessment. H, R and Z may cause hepatotoxicity; do not simply stop all therapy without clinician direction unless severe reaction is suspected.'],['Renal impairment','H and R commonly remain daily; Z and E may require interval adjustment in significant renal impairment. Specialist/NTEP review is needed.'],['TB meningitis / bone / other EPTB','Duration and adjunct treatment may differ. Refer to NTEP/Index-TB guidance rather than applying the pulmonary schedule mechanically.']], [4*cm,13.6*cm],True),P('When to urgently review','H2x'),P('<b>Mnemonic: “YELLOW”.</b> <b>Y</b>ellow eyes/urine, <b>E</b>ye blur or color change, <b>L</b>oss of hearing/balance (if injectable exposure), <b>L</b>imb tingling/weakness, <b>O</b>ngoing vomiting/severe rash, <b>W</b>orsening breathlessness or hemoptysis. Stop only the medicines specifically directed by the treating team, except seek emergency care for severe allergy or severe illness.','Box')]
s+=refs(); build('02_NTEP_DS_TB_Management.pdf','NTEP Tuberculosis Guide 2','Drug-susceptible TB: daily FDC regimen, dosing and follow-up',s)

# DR
s=[]
s += [P('3. Drug-resistant TB (DR-TB)','H1x'),P('<b>Definition:</b> Rifampicin-resistant TB (RR-TB) has resistance to rifampicin. MDR-TB has at least isoniazid and rifampicin resistance. Regimen selection depends on DST, prior exposure, disease extent, age, pregnancy and tolerability. Management belongs with an NTEP DR-TB centre.'),P('<b>Mnemonic: “DST drives DR-TB.”</b> <b>D</b>etect resistance, <b>S</b>elect a regimen, <b>T</b>rack toxicity and response.','Box'),P('BPaLM: preferred first choice for eligible patients','H2x'),P('The March 2025 national guideline states BPaLM should be the first treatment choice in eligible patients aged <b>14 years or older</b> with MDR/RR-TB, irrespective of fluoroquinolone resistance or HIV status, after programme eligibility assessment. It is all oral and ordinarily 26 weeks, with extension only under defined criteria.'),tbl([['Medicine','Dose / frequency in national guideline','Main safety focus'],['Bedaquiline (Bdq)','400 mg once daily weeks 1-2, then 200 mg three times weekly to week 26 (or 39 if extended)','QT prolongation, hepatotoxicity; ECG and interaction review.'],['Pretomanid (Pa)','200 mg once daily to week 26 (or 39)','Hepatotoxicity, GI effects, neuropathy risk; avoid unapproved use in pregnancy.'],['Linezolid (Lzd)','600 mg once daily to week 26 (or 39); dose modification only per guideline/clinical review','Myelosuppression, peripheral/optic neuropathy, lactic acidosis, serotonin interactions.'],['Moxifloxacin (Mfx)','400 mg once daily to week 26 (or 39)','QT prolongation, tendinopathy, dysglycaemia; avoid Mg/Al antacids around dose.'],['Pyridoxine','16-29 kg: 50 mg daily; >30 kg: 100 mg daily','Neuropathy prevention.']], [3*cm,7.3*cm,7.3*cm],True),P('BPaLM exclusions and modifications are not a self-selection exercise. The treating centre checks age, pregnancy/breastfeeding, prior medicines, baseline resistance to regimen drugs, cardiac risk/QT interval, severe comorbidity, drug interactions and ability to monitor. If baseline DST reveals bedaquiline, pretomanid or linezolid resistance, the guideline directs a regimen change and expert review.'),P('Other national regimen pathways','H2x'),tbl([['Pathway','Typical composition / duration','Who decides'],['9-11 month shorter oral MDR/RR-TB regimen','Usually a 4-6 month core phase containing Bdq, Lfx, Cfz, Z, E, high-dose H and Eto, followed by 5 months Lfx, Cfz, Z, E. Exact eligibility and dosing are weight-banded.','NTEP DR-TB centre after DST/eligibility assessment.'],['18-20 month longer all-oral M/XDR-TB regimen','Individualised longer regimen using WHO/NTEP group medicines, often a fluoroquinolone where active, Bdq, Lzd, Cfz and Cs, then continuation components.','NTEP DR-TB centre based on resistance pattern.'],['H mono/poly DR-TB','6 months R-E-Z-Lfx daily for suitable H-resistant, R-susceptible disease; regimen can need modification.','NTEP clinician after DST and clinical assessment.']], [4.3*cm,8.5*cm,4.8*cm],True),P('H mono/poly DR-TB daily adult doses from 2025 guideline','H2x'),tbl([['Weight','R','E','Z','Lfx'],['16-29 kg','300 mg','400 mg','750 mg','250 mg'],['30-45 kg','450 mg','800 mg','1,250 mg','750 mg'],['46-70 kg','600 mg','1,200 mg','1,750 mg','1,000 mg'],['>70 kg','750 mg','1,600 mg','2,000 mg','1,000 mg']], [3.2*cm,3.6*cm,3.6*cm,3.6*cm,3.6*cm]),P('Monitoring','H2x'),bullet('<b>Before treatment:</b> history of prior TB drugs and adverse effects, weight, pregnancy status, DST, ECG when QT-active drugs used, blood count for linezolid, liver and renal assessment, glucose/electrolytes and targeted tests as regimen requires.'),bullet('<b>During treatment:</b> symptom/adherence review, weight, ECG and labs per regimen schedule, neuropathy/vision review for linezolid, mental-health review for cycloserine, and culture/bacteriological monitoring as required.'),P('<b>Mnemonic: “BPaLM watch: Heart, Hepatic, Hemogram, Hands and Eyes.”</b> Heart = QT/ECG; Hepatic = liver symptoms/tests; Hemogram = linezolid cytopenia; Hands = neuropathy; Eyes = optic neuropathy.','Box')]
s+=refs(); build('03_NTEP_DR_TB_Management.pdf','NTEP Tuberculosis Guide 3','Drug-resistant TB: BPaLM, alternatives, dosage and monitoring',s)

# drugs
s=[]
s += [P('4. TB medicines, adverse effects and mnemonics','H1x'),P('This guide lists high-yield toxicities and practical monitoring cues. It is not a substitute for regimen-specific NTEP adverse-drug-reaction algorithms. Evaluate severity, competing diagnoses and interactions before withholding or reintroducing a drug.'),P('First-line drugs: “RIPE”','H2x'),tbl([['Drug','Usual role / frequency','Major adverse effects','Memory cue and practical action'],['Isoniazid (H)','Daily in DS-TB and selected TPT/DR regimens','Hepatitis, peripheral neuropathy, rash; inhibits metabolism of some drugs.','<b>H = Hepatitis + Hand/foot numbness.</b> Give pyridoxine when indicated; investigate jaundice, persistent vomiting or neuropathy.'],['Rifampicin (R)','Daily in DS-TB; key rifamycin','Hepatitis, GI upset, thrombocytopenia (rare), orange-red body fluids; many drug interactions.','<b>R = Red secretions + Rx interactions.</b> Check ART, anticoagulants, contraceptives and other drugs.'],['Pyrazinamide (Z)','Daily, usually intensive phase','Hepatotoxicity, hyperuricaemia/arthralgia, GI upset, photosensitivity.','<b>Z = Zore joints.</b> Do not treat an isolated uric-acid rise alone without clinical review.'],['Ethambutol (E)','Daily in DS-TB / selected DR regimens','Optic neuritis, decreased visual acuity, red-green color impairment.','<b>E = Eyes.</b> Baseline and symptom-triggered acuity/color assessment; report visual change immediately.']], [2.6*cm,3.6*cm,5.6*cm,6.2*cm],True),P('<b>RIPE mnemonic:</b> <b>R</b>ed-orange fluids and interactions, <b>I</b>njured liver/neuropathy, <b>P</b>ainful joints, <b>E</b>ye toxicity.','Box'),P('Core DR-TB medicines','H2x'),tbl([['Drug','Major adverse effects','Monitoring / memory'],['Bedaquiline','QT prolongation, hepatotoxicity, arthralgia.','ECG and interaction review. <b>“Bedaquiline: beat delay.”</b> Avoid unreviewed QT-prolonging combinations.'],['Linezolid','Anaemia, leukopenia/thrombocytopenia, peripheral and optic neuropathy, lactic acidosis, serotonin syndrome risk.','CBC, neuropathy and vision assessment. <b>“Linezolid draws a LINE through marrow and nerves.”</b>'],['Pretomanid','Hepatotoxicity, GI symptoms, neuropathy, possible myelosuppression with combination therapy.','Liver symptoms/tests and neuropathy surveillance. <b>“Pa: pay attention to liver.”</b>'],['Levofloxacin / moxifloxacin','QT prolongation (more with Mfx), tendinopathy, neuropathy, dysglycaemia, CNS effects.','ECG and glucose where appropriate. Separate from Mg/Al antacids by at least 2 hours before/after. <b>“FQ: Feet, QT, sugar.”</b>'],['Clofazimine','Skin discoloration/dryness, GI effects, QT prolongation.','Counsel discoloration before starting. <b>“Clofazimine colors.”</b>'],['Cycloserine','Depression, psychosis, seizures, neuropathy.','Mental-health and neurologic assessment; pyridoxine. <b>“Cycloserine circles the CNS.”</b>'],['Ethionamide','GI intolerance, hypothyroidism, hepatotoxicity, neuropathy.','Thyroid/liver assessment if used. <b>“Eto: endocrine + emesis.”</b>']], [3.2*cm,7*cm,7.8*cm],True),P('High-risk symptom response','H2x'),tbl([['Finding','Immediate safe response'],['Severe rash, facial swelling, mucosal lesions, wheeze, syncope','Emergency assessment. Potential severe hypersensitivity.'],['Jaundice, dark urine, severe abdominal pain, persistent vomiting','Urgent liver-toxicity assessment. Bring all medicine packs; clinician determines interruption/rechallenge.'],['New blurred vision, reduced color vision','Stop driving and urgently assess vision; ethambutol or linezolid toxicity must be considered.'],['Palpitations, fainting, seizure, severe depression/suicidal thoughts','Urgent assessment. Consider QT-active medicines, cycloserine or metabolic causes.'],['Numbness/burning or weakness','Assess neuropathy early; review H, linezolid, cycloserine and diabetes, and ensure prescribed pyridoxine.']], [6.3*cm,11.3*cm]),P('Adherence tools','H2x'),bullet('Use a fixed daily routine, phone reminder, calendar/blister pack and treatment-supporter contact. Record every missed dose and tell the NTEP team early.'),bullet('Do not double the next dose after vomiting or a missed dose unless the clinician tells you to. Report vomiting timing and visible tablets.'),bullet('Avoid alcohol during hepatotoxic TB regimens. Bring every prescription, OTC medicine, antacid and supplement to visits for interaction screening.'),P('<b>One-line revision:</b> “RIPE treats DS-TB; BPaLM treats eligible MDR/RR-TB; eyes, liver, nerves, marrow and QT are the toxicity checkpoints.”','Box')]
s+=refs(); build('04_NTEP_TB_Drugs_Adverse_Effects_Mnemonics.pdf','NTEP Tuberculosis Guide 4','Medicines, adverse effects, interactions and memory aids',s)
print('created',sorted(os.listdir(OUT)))

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER
from reportlab.lib.units import cm
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, PageBreak
from reportlab.lib.colors import HexColor
from reportlab.pdfbase.pdfmetrics import stringWidth
import os
OUT='/tmp/workspace/ntep_tb_guides/output_updated_2026'
os.makedirs(OUT,exist_ok=True)
styles=getSampleStyleSheet()
styles.add(ParagraphStyle(name='T',parent=styles['Title'],fontName='Helvetica-Bold',fontSize=19,leading=23,textColor=HexColor('#083344'),alignment=TA_CENTER,spaceAfter=9))
styles.add(ParagraphStyle(name='S',parent=styles['Normal'],fontSize=8.5,leading=11,alignment=TA_CENTER,textColor=HexColor('#44546A'),spaceAfter=10))
styles.add(ParagraphStyle(name='H1x',parent=styles['Heading1'],fontSize=13,leading=16,textColor=HexColor('#006B6B'),spaceBefore=10,spaceAfter=5))
styles.add(ParagraphStyle(name='H2x',parent=styles['Heading2'],fontSize=10.5,leading=13,textColor=HexColor('#8B2635'),spaceBefore=7,spaceAfter=3))
styles.add(ParagraphStyle(name='B',parent=styles['BodyText'],fontSize=8.8,leading=11.5,spaceAfter=4))
styles.add(ParagraphStyle(name='SM',parent=styles['BodyText'],fontSize=7.2,leading=9,spaceAfter=2))
styles.add(ParagraphStyle(name='Alert',parent=styles['BodyText'],fontSize=8.6,leading=11,backColor=HexColor('#FFF4D6'),borderColor=HexColor('#E0A100'),borderWidth=.5,borderPadding=6,spaceBefore=4,spaceAfter=7))
def P(x,s='B'): return Paragraph(x,styles[s])
def bullets(items): return [P('• '+x) for x in items]
def table(rows,widths):
 d=[[P(str(x),'SM') for x in r] for r in rows]
 t=Table(d,colWidths=widths,repeatRows=1,hAlign='LEFT')
 t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),HexColor('#006B6B')),('TEXTCOLOR',(0,0),(-1,0),colors.white),('FONTNAME',(0,0),(-1,0),'Helvetica-Bold'),('VALIGN',(0,0),(-1,-1),'TOP'),('GRID',(0,0),(-1,-1),.3,HexColor('#B7C9CC')),('ROWBACKGROUNDS',(0,1),(-1,-1),[colors.white,HexColor('#F3F8F8')]),('LEFTPADDING',(0,0),(-1,-1),4),('RIGHTPADDING',(0,0),(-1,-1),4),('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3)]))
 return t
SOURCES=[
('NTEP Central source index (checked 22 Sep 2026)','https://tbcindia.mohfw.gov.in/guidelines'),
('National Guidelines for Management of Drug-Resistant TB, final published 27 Mar 2025','https://tbcindia.mohfw.gov.in/wp-content/uploads/2025/03/National-Guidelines-for-Management-of-DR-TB_27-3-2025.pdf'),
('NTEP PMTPT page, including later 1HP and 3RH addenda','https://tbcindia.mohfw.gov.in/pmtpt'),
('PMTPT guideline, 2021','https://tbcindia.mohfw.gov.in/wp-content/uploads/2023/05/Guidelines-for-Programmatic-Management-of-Tuberculosis-Preventive-Treatment-in-India.pdf'),
('1HP technical and operational addendum, implementation age >=13 years','https://tbcindia.nikshay.in/wp-content/uploads/2024/12/Technical-and-Operational-Guidance-on-1HP-TPT-regimen_addendum-to-National-PMTPT-guidelines.pdf'),
('3RH technical and operational addendum, implementation age 0-15 years','https://tbcindia.nikshay.in/wp-content/uploads/2024/12/Technical-and-Operational-Guidance-on-3RH-TPT-regimen_addendum-to-national-PMTPT-guidelines.pdf'),
('NACO revised TPT guidance for PLHIV, 20 May 2024','https://tbcindia.nikshay.in/wp-content/uploads/2024/12/Guidance-from-NACO-on-1HP-as-a-TPT-regimen-in-PLHIV.pdf'),
('National Guidance on Differentiated TB Care, March 2025','https://tbcindia.mohfw.gov.in/wp-content/uploads/2025/07/National-Guidance-on-Differential-TB-Care_Final_March-2025-3.pdf'),
('National airborne infection prevention and control guideline, 2026','https://tbcindia.mohfw.gov.in/wp-content/uploads/2026/03/National-AIC-Guidelines-2026.pdf')]
def footer(c,doc):
 c.saveState(); c.setFont('Helvetica',7); c.setFillColor(HexColor('#566573')); c.drawString(1.5*cm,.8*cm,'NTEP study summary | verified source set checked 22 September 2026 | not a prescription'); c.drawRightString(19.5*cm,.8*cm,f'Page {doc.page}'); c.restoreState()
def make(name,title,subtitle,story,used):
 story=[P(title,'T'),P(subtitle,'S'),P('<b>Scope and safety.</b> This educational summary is based on the official source hierarchy listed below. It is not a substitute for NTEP case-based decisions, state circulars, product strength verification, DST, or clinician review. Do not calculate a patient dose from this document alone.','Alert')]+story
 story += [P('Verified official-source hierarchy','H1x')]
 for label,url in used: story.append(P('• <b>'+label+'</b><br/><font color="#305E77">'+url+'</font>','SM'))
 doc=SimpleDocTemplate(os.path.join(OUT,name),pagesize=A4,rightMargin=1.35*cm,leftMargin=1.35*cm,topMargin=1.25*cm,bottomMargin=1.3*cm,title=title,author='Orris - source-verified study summary')
 doc.build(story,onFirstPage=footer,onLaterPages=footer)
# 1
st=[P('What is current versus historical','H1x'),P('The NTEP guidelines index lists the 2025 DR-TB guideline, 2025 differentiated-care guidance, 2021 PMTPT guideline, and the newer 1HP/3RH addenda on its PMTPT page. The 2016 Technical and Operational Guidelines and older Index-TB guideline remain listed, but are historical references and do not override later regimen-specific documents.','B'),P('TB disease: initial pathway','H1x')]+bullets(['Assess symptoms and obtain appropriate specimen. NTEP uses upfront molecular testing/NAAT where indicated; confirm rifampicin resistance and arrange universal DST pathway before selecting a DR-TB regimen.','Notify and link every person with TB to NTEP/Nikshay; assess HIV, diabetes, nutrition, pregnancy, liver/renal disease, and risk of poor outcome.','Use the 2025 differentiated-care guidance to identify high-risk patients and arrange referral, follow-up, and adverse-event support.'])+[P('TB preventive treatment: current source set','H1x'),table([['Regimen','Who / implementation','Dose & frequency confirmed in source'],['1HP','NTEP addendum: age >=13 years after active TB is ruled out','Isoniazid 300 mg + rifapentine 600 mg once daily for 28 doses. ART interactions apply.'],['3RH','NTEP addendum: age 0-15 years after active TB is ruled out','Daily x 84 doses. INH: <10 yr 10 mg/kg/day, >=10 yr 5 mg/kg/day. R: <10 yr 15 mg/kg/day, >=10 yr 10 mg/kg/day. Use specified FDC weight bands.'],['3HP','Base 2021 PMTPT guideline','Weekly isoniazid + rifapentine for 12 doses in eligible people older than 2 years.'],['6H','Base 2021 PMTPT guideline','Daily isoniazid for 6 months. >=10 yr 5 mg/kg/day; <10 yr 10 mg/kg/day (range 7-15); maximum daily H 300 mg.'],['DR-TB contacts','Base guideline and NACO PLHIV guidance','4R for contacts of H mono/poly-resistant, R-susceptible index TB; 6Lfx for contacts of MDR/RR-TB with FQ-susceptible index strain, after eligibility assessment.']], [3.2*cm,5.0*cm,8.6*cm]),P('Memory aid','H1x'),P('<b>“1HP = 1 month, H + P daily; 3RH = 3 months, R + H daily; 3HP = 3 months, H + P weekly.”</b> Always rule out TB disease first.','Alert'),P('PLHIV caution','H2x'),P('NACO guidance dated 20 May 2024 identifies 1HP as preferred for PLHIV age >=13 years, but 6H for PLHIV <13 years, pregnancy/breastfeeding, and PI-based ART. Rifamycin interactions must be checked against the current ART regimen.','B')]
make('01_UPDATED_NTEP_Diagnosis_TPT.pdf','NTEP Tuberculosis: Diagnosis, Care Pathway and TPT','Updated with 2025 DR-TB source hierarchy and 2024 NTEP/NACO TPT addenda',st,[SOURCES[i] for i in [0,2,3,4,5,6,7]])
# 2
st=[P('Drug-susceptible TB (DS-TB)','H1x'),P('The current NTEP material referenced in the 2025 DR-TB guideline describes standard DS-TB care as <b>6 months</b>: 2 months initiation phase HRZE, followed by 4 months HRE. Drugs are daily, normally supplied as weight-band FDCs under NTEP.','B'),P('Important update boundary','Alert'),P('The official NTEP index continues to list the 2016 Technical and Operational Guidelines as the core broad operational source. I did not locate a later national, publicly posted DS-TB FDC tablet-count chart that supersedes it. Therefore, this update intentionally does <b>not</b> reproduce tablet counts. Verify the current NTEP-issued FDC pack, body-weight band, and state circular at treatment initiation.','Alert'),P('Practical care sequence','H1x')]+bullets(['Confirm TB and assess rifampicin resistance using NTEP diagnostic pathway. If resistance is detected or suspected, do not manage as routine DS-TB: refer into DR-TB/DST pathway.','Record baseline weight and comorbidities. Reassess weight and issue the correct weight-band pack; review adherence and adverse effects at every visit.','Test for HIV and diabetes; assess liver and renal status when clinically indicated. Provide counselling, nutrition/social support, and Nikshay-linked follow-up.','If high-risk, severe, or clinically deteriorating, follow the March 2025 differentiated-care referral and reassessment framework.']),P('First-line drug safety screen','H1x'),table([['Drug','Key adverse effect / action'],['H isoniazid','Hepatotoxicity; peripheral neuropathy. Give pyridoxine where indicated and evaluate symptoms promptly.'],['R rifampicin','Hepatotoxicity; major drug interactions; orange body fluids. Check ART and other medicines.'],['Z pyrazinamide','Hepatotoxicity; arthralgia/hyperuricaemia.'],['E ethambutol','Optic neuritis, reduced visual acuity/red-green discrimination. Urgent review for visual symptoms.']], [3.4*cm,13.4*cm]),P('Mnemonic','H1x'),P('<b>“HRZE: Hepatitis, Red-orange, Z = joints, Eyes.”</b> It is a memory prompt, not an adverse-event rule. Stop/rechallenge decisions require the treating clinician/NTEP guidance.','Alert'),P('EPTB note','H2x'),P('The older Index-TB guideline is still an official reference for EPTB diagnostic principles but is not used here as a current standalone dosing authority. Site-specific disease, especially CNS TB, needs specialist and NTEP review.','B')]
make('02_UPDATED_NTEP_DS_TB_Management.pdf','NTEP Drug-Susceptible TB Management','Updated source hierarchy, with non-verified tablet-count tables intentionally removed',st,[SOURCES[i] for i in [0,1,7,8]])
# 3
st=[P('Primary current source','H1x'),P('The <b>National Guidelines for Management of Drug-Resistant TB, final published 27 March 2025</b> is the controlling NTEP regimen source in this guide. The former 2021 PMDT guideline is background only and must not override 2025 recommendations.','B'),P('BPaLM: first-choice regimen when eligible','H1x'),P('For eligible MDR/RR-TB patients aged >=14 years, including irrespective of FQ resistance or HIV status as specified in the 2025 guideline, BPaLM is the first choice. Eligibility/exclusion criteria, baseline DST, pregnancy status, disease severity/site, and monitoring must be checked in the full guideline.','B'),table([['Medicine','2025 NTEP BPaLM dose / frequency'],['Bedaquiline','400 mg once daily in weeks 1-2, then 200 mg three times weekly through week 26 (or extension as directed).'],['Pretomanid','200 mg once daily through week 26 (or extension as directed).'],['Linezolid','600 mg once daily through week 26 (or extension as directed).'],['Moxifloxacin','400 mg once daily through week 26 (or extension as directed).'],['Pyridoxine','16-29 kg: 50 mg; >30 kg: 100 mg, per guideline.']], [3.4*cm,13.4*cm]),P('Monitoring and response','H1x')]+bullets(['Obtain pretreatment evaluation and DST as defined by NTEP. The guideline permits BPaLM initiation in eligible MDR-TB while baseline DST for bedaquiline, pretomanid and linezolid is awaited, then requires regimen change if resistance is detected.','Monitor ECG/QT-risk and medicines that prolong QT; monitor CBC and symptoms/signs of linezolid neuropathy, optic toxicity and myelosuppression; monitor liver/renal function and clinical response as directed.','Avoid magnesium supplements or magnesium-containing antacids for 2 hours before and after fluoroquinolones, because they reduce FQ absorption.','If severe toxicity or ineligibility arises, use the guideline-directed 9-11 month shorter oral MDR/RR-TB regimen or 18-20 month longer oral M/XDR-TB regimen through N/DDR-TB centre. Do not invent substitutions.']),P('Mnemonic','H1x'),P('<b>“BPaLM: Bedaquiline, Pretomanid, Linezolid, Moxifloxacin. L = Look at nerves, eyes and blood; B/M = mind the QT.”</b>','Alert')]
make('03_UPDATED_NTEP_DR_TB_Management.pdf','NTEP Drug-Resistant TB Management','Current 2025 national DR-TB guideline: BPaLM, safety and referral framework',st,[SOURCES[i] for i in [0,1,7]])
#4
st=[P('How this guide changed','H1x'),P('Adverse-effect recognition is retained for learning, but medication changes are now explicitly tied to the 2025 NTEP DR-TB guideline and the 2025 differentiated-care guidance. Do not use mnemonics to decide drug cessation or rechallenge.','B'),P('Adverse-effect recognition table','H1x'),table([['Drug / group','Recognise','Immediate response'],['H/R/Z','Anorexia, nausea/vomiting, jaundice, dark urine, fatigue: possible liver injury','Urgent clinical assessment; NTEP clinician decides interruption and reintroduction.'],['Ethambutol','Blurred vision, reduced acuity or red-green colour change','Urgent ophthalmic/clinical review.'],['Linezolid','Tingling/burning pain, weakness, visual change; anaemia/infection symptoms','Urgent review, CBC and toxicity-directed decision.'],['Bedaquiline / clofazimine / FQ','Syncope, palpitations, dizziness: QT-risk signal','Urgent ECG/electrolyte/medicine review.'],['Fluoroquinolone','Tendon pain/swelling, neuropathic symptoms','Stop exertion and obtain clinical review.'],['Rifamycins','Orange tears/urine expected; rash, fever or jaundice needs assessment','Check interactions and assess severity.']], [3.5*cm,6.0*cm,7.3*cm]),P('Current TPT safety and interactions','H1x')]+bullets(['1HP (>=13 years): H 300 mg plus rifapentine 600 mg daily x 28. Addendum lists hepatotoxicity, hypersensitivity, rash, GI upset and orange body fluids. It lists contraindication with all PIs, nevirapine/NNRTIs and TAF; verify ART regimen in real time.','3RH (0-15 years): daily R + H x 84. The addendum identifies hypersensitivity, hepatotoxicity, rash, GI symptoms, hypoprothrombinaemia and orange fluids.','NACO 2024: for PLHIV <13 years, pregnancy/breastfeeding, or PI-based ART, 6H is listed rather than 1HP.']),P('Mnemonics','H1x'),table([['Mnemonic','Meaning'],['“HRZE = Hepatitis, Red-orange, Z-joints, Eyes”','Recall major first-line warnings.'],['“BPaLM = Blood, Peripheral nerves, Look at eyes, Monitor QT”','BPaLM toxicity monitoring prompt: LZD affects blood/nerves/eyes; Bdq/Mfx contribute QT risk.'],['“TPT before treatment? No: rule out TB disease first.”','Prevents monotherapy for unrecognised active TB.']], [5.4*cm,11.4*cm]),P('When to urgently refer','H1x'),P('Jaundice, severe rash/mucosal involvement, visual loss, syncope/palpitations, severe neuropathy, breathlessness, altered sensorium, or inability to eat/drink require urgent assessment. Use NTEP referral pathways and the differentiated-care guidance for high-risk people with TB.','Alert')]
make('04_UPDATED_NTEP_TB_Drugs_Adverse_Effects_Mnemonics.pdf','NTEP TB Drugs: Safety, Interactions and Mnemonics','Updated adverse-effect and TPT interaction notes linked to verified NTEP sources',st,[SOURCES[i] for i in [0,1,2,4,5,6,7]])
print('created',OUT)

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.colors import HexColor, white
from reportlab.lib.units import cm
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle
import os
OUT='/tmp/workspace/ntep_tb_guides/output_updated_2026'; os.makedirs(OUT,exist_ok=True)
ss=getSampleStyleSheet()
ss.add(ParagraphStyle(name='TitleX',parent=ss['Title'],fontSize=18,leading=22,textColor=HexColor('#073B4C'),alignment=1,spaceAfter=7))
ss.add(ParagraphStyle(name='SubX',parent=ss['Normal'],fontSize=8.5,leading=10,alignment=1,textColor=HexColor('#52616B'),spaceAfter=9))
ss.add(ParagraphStyle(name='H',parent=ss['Heading1'],fontSize=13,leading=16,textColor=HexColor('#006D77'),spaceBefore=9,spaceAfter=4))
ss.add(ParagraphStyle(name='B',parent=ss['BodyText'],fontSize=8.8,leading=11.4,spaceAfter=4))
ss.add(ParagraphStyle(name='S',parent=ss['BodyText'],fontSize=7.2,leading=8.8,spaceAfter=2))
ss.add(ParagraphStyle(name='A',parent=ss['BodyText'],fontSize=8.5,leading=11,backColor=HexColor('#FFF3CD'),borderColor=HexColor('#D69E2E'),borderWidth=.5,borderPadding=6,spaceBefore=4,spaceAfter=7))
def p(t,s='B'): return Paragraph(t,ss[s])
def bs(xs): return [p('• '+x) for x in xs]
def tab(rows,widths):
    t=Table([[p(str(c),'S') for c in row] for row in rows],colWidths=widths,repeatRows=1)
    t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),HexColor('#006D77')),('TEXTCOLOR',(0,0),(-1,0),white),('FONTNAME',(0,0),(-1,0),'Helvetica-Bold'),('GRID',(0,0),(-1,-1),.3,HexColor('#B6C8CC')),('VALIGN',(0,0),(-1,-1),'TOP'),('ROWBACKGROUNDS',(0,1),(-1,-1),[white,HexColor('#F1F7F7')]),('LEFTPADDING',(0,0),(-1,-1),4),('RIGHTPADDING',(0,0),(-1,-1),4),('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3)])); return t
sources={
'Index':'https://tbcindia.mohfw.gov.in/guidelines',
'DR2025':'https://tbcindia.mohfw.gov.in/wp-content/uploads/2025/03/National-Guidelines-for-Management-of-DR-TB_27-3-2025.pdf',
'PMTPT':'https://tbcindia.mohfw.gov.in/pmtpt',
'TPT2021':'https://tbcindia.mohfw.gov.in/wp-content/uploads/2023/05/Guidelines-for-Programmatic-Management-of-Tuberculosis-Preventive-Treatment-in-India.pdf',
'1HP':'https://tbcindia.nikshay.in/wp-content/uploads/2024/12/Technical-and-Operational-Guidance-on-1HP-TPT-regimen_addendum-to-National-PMTPT-guidelines.pdf',
'3RH':'https://tbcindia.nikshay.in/wp-content/uploads/2024/12/Technical-and-Operational-Guidance-on-3RH-TPT-regimen_addendum-to-national-PMTPT-guidelines.pdf',
'PLHIV':'https://tbcindia.nikshay.in/wp-content/uploads/2024/12/Guidance-from-NACO-on-1HP-as-a-TPT-regimen-in-PLHIV.pdf',
'Diff':'https://tbcindia.mohfw.gov.in/wp-content/uploads/2025/07/National-Guidance-on-Differential-TB-Care_Final_March-2025-3.pdf'}
def foot(c,d):
 c.saveState();c.setFont('Helvetica',7);c.setFillColor(HexColor('#566573'));c.drawString(1.3*cm,.75*cm,'NTEP learning summary | sources checked 22 Sep 2026 | not a prescription');c.drawRightString(19.5*cm,.75*cm,'Page %d'%d.page);c.restoreState()
def build(fn,title,sub,items,keys):
 st=[p(title,'TitleX'),p(sub,'SubX'),p('<b>Safety:</b> Educational summary only. Confirm current state circular, product strength, weight band, DST, comorbidities, pregnancy and drug interactions with the treating NTEP clinician.','A')]+items+[p('Verified official NTEP/NACO sources','H')]
 for k in keys: st.append(p('• <font color="#1E5A7A">'+sources[k]+'</font>','S'))
 SimpleDocTemplate(os.path.join(OUT,fn),pagesize=A4,leftMargin=1.3*cm,rightMargin=1.3*cm,topMargin=1.2*cm,bottomMargin=1.2*cm).build(st,onFirstPage=foot,onLaterPages=foot)
# 1
x=[]
x += [p('Current source hierarchy','H'),p('The official NTEP index lists the 2025 DR-TB guideline and the 2021 PMTPT guideline. The PMTPT page additionally lists later 1HP and 3RH technical addenda. These later regimen-specific addenda supplement the 2021 PMTPT document.','B')]
x += [p('Initial pathway','H')] + bs(['Assess presumptive TB and collect an appropriate specimen. Use NTEP molecular testing/DST pathway and establish rifampicin resistance before choosing DR-TB treatment.','Notify and link to NTEP/Nikshay. Assess HIV, diabetes, nutrition, pregnancy, liver/renal disease and risk of adverse outcomes.','Use the March 2025 differentiated-care guidance for high-risk patients, referral and follow-up.'])
x += [p('TB preventive treatment after active TB is ruled out','H'),tab([['Regimen','Current NTEP source and dose'],['1HP, age >=13 years','Isoniazid 300 mg + rifapentine 600 mg daily for 28 doses. Check ART interactions.'],['3RH, age 0-15 years','Daily 84 doses. H: <10 y 10 mg/kg/day; >=10 y 5 mg/kg/day. R: <10 y 15 mg/kg/day; >=10 y 10 mg/kg/day. Use specified FDC weight bands.'],['3HP','Base 2021 PMTPT guideline: weekly H + rifapentine for 12 doses in eligible persons >2 years.'],['6H','Daily H for 6 months. >=10 y 5 mg/kg/day; <10 y 10 mg/kg/day, maximum daily H 300 mg.'],['DR-TB contacts','4R for H mono/poly-resistant, R-susceptible index TB; 6Lfx for MDR/RR-TB contact with FQ-susceptible index strain, after eligibility assessment.']],[3.2*cm,13.5*cm]),p('<b>Mnemonic:</b> 1HP = 1 month H+P daily. 3RH = 3 months R+H daily. 3HP = 3 months H+P weekly. Rule out active TB first.','A'),p('PLHIV: NACO 20 May 2024 lists 1HP for PLHIV >=13 years; 6H for PLHIV <13 years, pregnancy/breastfeeding and PI-based ART.','B')]
build('01_UPDATED_NTEP_Diagnosis_TPT.pdf','NTEP TB: Diagnosis, Care Pathway and TPT','Updated with verified NTEP 2025 and TPT addendum sources',x,['Index','PMTPT','TPT2021','1HP','3RH','PLHIV','Diff'])
#2
x=[]
x += [p('Drug-susceptible TB regimen','H'),p('The 2025 NTEP DR-TB guideline describes standard DS-TB care as 6 months: 2 months HRZE initiation phase followed by 4 months HRE. Treatment is daily and normally issued as NTEP weight-band FDCs.','B'),p('<b>Update boundary:</b> I did not identify a newer publicly posted nationwide DS-TB FDC tablet-count chart. Tablet counts are intentionally omitted. Verify the currently issued NTEP pack, body-weight band and state instruction at initiation and when weight changes.','A')]
x += [p('Care sequence','H')] + bs(['Confirm TB and assess rifampicin resistance. Resistance detected/suspected means referral into the DR-TB and DST pathway, not routine DS-TB treatment.','Review weight, adherence and adverse effects at every contact. Screen HIV and diabetes and assess liver/renal status where indicated.','Provide counselling, nutrition/social support and Nikshay follow-up. Refer high-risk/deteriorating patients using 2025 differentiated-care pathways.'])
x += [p('First-line safety recall','H'),tab([['Drug','Main warning signs'],['Isoniazid','Hepatotoxicity; peripheral neuropathy. Pyridoxine where indicated.'],['Rifampicin','Hepatotoxicity; major drug interactions; orange body fluids.'],['Pyrazinamide','Hepatotoxicity; arthralgia/hyperuricaemia.'],['Ethambutol','Optic neuritis, visual acuity or red-green colour change.']],[3.3*cm,13.4*cm]),p('<b>Mnemonic:</b> HRZE = Hepatitis, Red-orange, Z-joints, Eyes. This is a recall prompt, not a stop/rechallenge algorithm.','A'),p('Older Index-TB guidance is useful for EPTB principles but is not a current standalone dosing authority. CNS and complex EPTB require specialist/NTEP review.','B')]
build('02_UPDATED_NTEP_DS_TB_Management.pdf','NTEP Drug-Susceptible TB Management','Verified current-source hierarchy, without unverified FDC tablet-count tables',x,['Index','DR2025','Diff'])
#3
x=[]
x += [p('Current controlling source','H'),p('Use the National Guidelines for Management of Drug-Resistant TB, final published 27 March 2025. The 2021 PMDT guideline is historical background where it conflicts with the 2025 document.','B'),p('BPaLM','H'),p('For eligible MDR/RR-TB patients aged >=14 years, BPaLM is the NTEP first-choice regimen, subject to full eligibility, site/severity, pregnancy, DST and safety assessment.','B'),tab([['Medicine','2025 NTEP dose/frequency'],['Bedaquiline','400 mg daily weeks 1-2, then 200 mg three times weekly through week 26 or directed extension.'],['Pretomanid','200 mg daily through week 26 or directed extension.'],['Linezolid','600 mg daily through week 26 or directed extension.'],['Moxifloxacin','400 mg daily through week 26 or directed extension.'],['Pyridoxine','16-29 kg: 50 mg; >30 kg: 100 mg.']],[3.5*cm,13.2*cm])]
x += [p('Monitoring and decision points','H')] + bs(['Perform pretreatment evaluation and DST. The guideline permits BPaLM in eligible MDR-TB while baseline Bdq/Pa/Lzd DST is awaited, but requires regimen change if resistance is found.','Monitor ECG/QT risk, CBC, linezolid neuropathy/optic symptoms, liver/renal status and clinical response as specified in the full guideline.','Avoid magnesium supplements or magnesium-containing antacids for 2 hours before and after fluoroquinolones.','For toxicity or BPaLM ineligibility, select 9-11 month shorter oral MDR/RR-TB or 18-20 month longer oral M/XDR-TB regimen only via N/DDR-TB centre and the 2025 guideline.'])
x += [p('<b>Mnemonic:</b> BPaLM = Bedaquiline, Pretomanid, Linezolid, Moxifloxacin. L: look at blood, nerves and eyes. B/M: mind QT.','A')]
build('03_UPDATED_NTEP_DR_TB_Management.pdf','NTEP Drug-Resistant TB Management','Updated to the verified National DR-TB Guideline published 27 March 2025',x,['Index','DR2025','Diff'])
#4
x=[]
x += [p('Safety recognition, not self-management','H'),p('The 2025 NTEP DR-TB guideline and differentiated-care guidance should govern adverse-event management. Do not use this mnemonic sheet to stop, restart, replace or rechallenge medicines.','A'),p('Key warning signals','H'),tab([['Drug/group','Recognise and refer'],['H/R/Z','Nausea, vomiting, jaundice, dark urine or marked fatigue: possible liver injury.'],['Ethambutol','Blurred vision, reduced acuity or red-green colour change.'],['Linezolid','Neuropathic pain, weakness, visual symptoms, anaemia/infection symptoms.'],['Bedaquiline/FQ/clofazimine','Palpitations, syncope, dizziness: QT-risk signal, needs ECG/electrolyte/medicine review.'],['Fluoroquinolone','Tendon pain/swelling or neuropathic symptoms.'],['Rifamycins','Orange tears/urine is expected; rash, fever or jaundice needs assessment.']],[3.6*cm,13.1*cm])]
x += [p('Current TPT safety','H')] + bs(['1HP age >=13: H 300 mg + rifapentine 600 mg daily x28. Monitor for hepatotoxicity, hypersensitivity, rash and GI symptoms. ART interaction checks are mandatory.','3RH age 0-15: R+H daily x84. Risks include hypersensitivity, hepatotoxicity, rash, GI symptoms and orange body fluids.','NACO 2024: 6H rather than 1HP for PLHIV <13 years, pregnancy/breastfeeding and PI-based ART.'])
x += [p('Memory prompts','H'),tab([['Prompt','Meaning'],['HRZE','Hepatitis, Red-orange, Z-joints, Eyes.'],['BPaLM','Blood, Peripheral nerves, Look at eyes, Monitor QT.'],['TPT rule','Rule out active TB disease before preventive treatment.']],[5*cm,11.7*cm]),p('Urgent assessment: jaundice, severe rash/mucosal involvement, visual loss, syncope/palpitations, severe neuropathy, altered sensorium, breathlessness or inability to eat/drink.','A')]
build('04_UPDATED_NTEP_TB_Drugs_Adverse_Effects_Mnemonics.pdf','NTEP TB Drugs: Safety, Interactions and Mnemonics','Updated adverse-effect and TPT interaction notes using verified sources',x,['Index','DR2025','PMTPT','1HP','3RH','PLHIV','Diff'])
print(OUT)

from pptx import Presentation
from pptx.util import Inches, Pt
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.dml.color import RGBColor
from pptx.enum.dml import MSO_LINE_DASH_STYLE
import os

OUT='/tmp/workspace/ntep_tb_guides/output_updated_2026/NTEP_Tuberculosis_Updated_Verified_Black_White.pptx'
prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5)
BLANK=prs.slide_layouts[6]
BLACK=RGBColor(0,0,0); WHITE=RGBColor(255,255,255); GREY=RGBColor(90,90,90)

def add_text(slide,text,x,y,w,h,size=22,bold=False,align=PP_ALIGN.LEFT,color=BLACK):
    box=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h))
    tf=box.text_frame; tf.clear(); tf.word_wrap=True; tf.vertical_anchor=MSO_ANCHOR.TOP
    tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0
    p=tf.paragraphs[0]; p.alignment=align
    r=p.add_run(); r.text=text; r.font.name='Arial'; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color
    return box

def rule(slide,y=1.12):
    sh=slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(.55), Inches(y), Inches(12.2), Inches(.018))
    sh.fill.solid(); sh.fill.fore_color.rgb=BLACK; sh.line.fill.background()

def footer(slide,n):
    add_text(slide,'NTEP tuberculosis learning summary | verified source hierarchy | not a prescription',.55,7.08,10.5,.18,8,color=GREY)
    add_text(slide,str(n),12.3,7.05,.45,.2,9,align=PP_ALIGN.RIGHT,color=GREY)

def base(title,n):
    s=prs.slides.add_slide(BLANK)
    bg=s.background.fill; bg.solid(); bg.fore_color.rgb=WHITE
    add_text(s,title,.55,.34,12.1,.5,26,True)
    rule(s); footer(s,n); return s

def bullets(slide, items, x=.75,y=1.45,w=11.8,size=19,space=.58):
    for i,t in enumerate(items):
        add_text(slide,'• '+t,x,y+i*space,w,space-.08,size)

def table(slide, headers, rows, x,y,w,h, font=13):
    cols=len(headers); colw=w/cols
    allrows=[headers]+rows; rh=h/len(allrows)
    for r,row in enumerate(allrows):
        for c,val in enumerate(row):
            shp=slide.shapes.add_shape(MSO_SHAPE.RECTANGLE,Inches(x+c*colw),Inches(y+r*rh),Inches(colw),Inches(rh))
            shp.fill.solid(); shp.fill.fore_color.rgb=BLACK if r==0 else WHITE
            shp.line.color.rgb=BLACK; shp.line.width=Pt(.8)
            add_text(slide,str(val),x+c*colw+.08,y+r*rh+.07,colw-.16,rh-.14,font,r==0,color=WHITE if r==0 else BLACK)

# 1
s=prs.slides.add_slide(BLANK); s.background.fill.solid(); s.background.fill.fore_color.rgb=WHITE
add_text(s,'TUBERCULOSIS',.6,1.7,12.1,.65,36,True,PP_ALIGN.CENTER)
add_text(s,'Updated NTEP management summary',.6,2.55,12.1,.45,24,False,PP_ALIGN.CENTER)
rule(s,3.25)
add_text(s,'Black-and-white teaching deck based on verified official NTEP/NACO sources',.6,3.55,12.1,.3,15,False,PP_ALIGN.CENTER,color=GREY)
add_text(s,'Source check: 22 September 2026',.6,4.02,12.1,.25,12,False,PP_ALIGN.CENTER,color=GREY)
footer(s,1)
#2
s=base('Source hierarchy and updates',2)
bullets(s,['Primary DR-TB treatment authority: National Guidelines for Management of DR-TB, published 27 March 2025.','TPT base document: Programmatic Management of TB Preventive Treatment, 2021.','TPT updates: 1HP and 3RH technical/operational addenda; NACO PLHIV guidance dated 20 May 2024.','2025 Differentiated TB Care guidance: risk stratification, referral, follow-up and high-risk care.','2016 technical guidance, 2021 PMDT and Index-TB are historical/reference sources where later documents differ.'],size=17,space=.74)
#3
s=base('Initial NTEP pathway',3)
bullets(s,['Identify presumptive TB and obtain an appropriate specimen.','Use NTEP molecular testing and drug-susceptibility pathway. Establish rifampicin resistance early.','Notify and link the person with TB to NTEP/Nikshay.','Assess HIV, diabetes, nutrition, pregnancy, liver/renal disease and risk of poor outcome.','If rifampicin resistance is detected or suspected, enter the DR-TB pathway and obtain expert/NTEP assessment.'],size=19,space=.74)
#4
s=base('Drug-susceptible TB: standard framework',4)
add_text(s,'Daily treatment: 2 months HRZE followed by 4 months HRE',.75,1.45,11.8,.45,24,True)
bullets(s,['H = isoniazid, R = rifampicin, Z = pyrazinamide, E = ethambutol.','NTEP usually issues daily weight-band fixed-dose combinations (FDCs).','Do not use a generic tablet count from a teaching sheet. Confirm the current NTEP pack strength, body-weight band and state instruction.','At each visit: review weight, adherence, symptoms and adverse effects.','Screen HIV and diabetes; arrange support, counselling and Nikshay-linked follow-up.'],y=2.15,size=17,space=.67)
#5
s=base('First-line adverse-effect recall',5)
table(s,['Drug','Key concern'],[['Isoniazid','Hepatotoxicity; peripheral neuropathy. Pyridoxine where indicated.'],['Rifampicin','Hepatotoxicity; major drug interactions; orange body fluids.'],['Pyrazinamide','Hepatotoxicity; arthralgia and hyperuricaemia.'],['Ethambutol','Optic neuritis, blurred vision, red-green colour disturbance.']],.75,1.45,11.8,3.4,font=16)
add_text(s,'Mnemonic: HRZE = Hepatitis, Red-orange, Z-joints, Eyes',.75,5.35,11.5,.35,20,True)
add_text(s,'A memory aid only. Drug interruption, rechallenge and substitution require clinician/NTEP guidance.',.75,5.88,11.7,.35,14,color=GREY)
#6
s=base('TB preventive treatment: current options',6)
table(s,['Regimen','Who','Frequency / duration'],[['1HP','Age >=13 years, eligible after active TB excluded','H 300 mg + rifapentine 600 mg daily x 28 doses'],['3RH','Age 0-15 years, eligible after active TB excluded','R + H daily x 84 doses; weight/age dosing'],['3HP','Eligible people >2 years','H + rifapentine weekly x 12 doses'],['6H','Eligible people','Isoniazid daily x 6 months']],.55,1.35,12.2,4.0,font=13)
add_text(s,'Rule: Exclude active TB before starting preventive treatment.',.75,5.75,11.5,.35,19,True)
#7
s=base('TPT doses and mnemonic',7)
table(s,['Regimen','Verified dose'],[['1HP, age >=13','Isoniazid 300 mg + rifapentine 600 mg once daily for 28 doses.'],['3RH, age 0-15','H: <10 y 10 mg/kg/day; >=10 y 5 mg/kg/day. R: <10 y 15 mg/kg/day; >=10 y 10 mg/kg/day.'],['6H','>=10 y 5 mg/kg/day; <10 y 10 mg/kg/day; maximum H 300 mg/day.']],.75,1.45,11.8,3.3,font=14)
add_text(s,'Mnemonic: 1HP = 1 month H+P daily | 3RH = 3 months R+H daily | 3HP = 3 months H+P weekly',.75,5.2,11.6,.58,17,True)
#8
s=base('PLHIV and TB preventive treatment',8)
bullets(s,['NACO guidance: for PLHIV aged >=13 years, 1HP is preferred when eligible.','Use 6H for PLHIV under 13 years, pregnancy/breastfeeding, and people on protease-inhibitor-based ART.','Check all rifamycin-ART interactions before selection.','For DR-TB contacts: 4R may be used with H mono/poly-resistant, rifampicin-susceptible index TB; 6Lfx may be used for eligible MDR/RR-TB contacts with FQ-susceptible index strain.'],size=18,space=.86)
#9
s=base('DR-TB: BPaLM regimen',9)
add_text(s,'First-choice regimen for eligible MDR/RR-TB patients aged >=14 years',.75,1.35,11.7,.35,20,True)
table(s,['Medicine','NTEP 2025 dose/frequency'],[['Bedaquiline','400 mg daily in weeks 1-2, then 200 mg three times weekly through week 26 or directed extension.'],['Pretomanid','200 mg daily through week 26 or directed extension.'],['Linezolid','600 mg daily through week 26 or directed extension.'],['Moxifloxacin','400 mg daily through week 26 or directed extension.'],['Pyridoxine','16-29 kg: 50 mg; >30 kg: 100 mg.']],.65,1.95,12.0,3.6,font=13)
#10
s=base('DR-TB monitoring and safety',10)
bullets(s,['Perform baseline evaluation and DST. Regimen choice requires eligibility, disease-site/severity, pregnancy, safety and drug-interaction assessment.','Monitor ECG/QT risk, blood count, neuropathy, visual symptoms, liver/renal status and treatment response as specified in the full guideline.','Avoid magnesium-containing antacids/supplements for 2 hours before and after a fluoroquinolone.','If BPaLM is ineligible or toxicity/resistance occurs, select shorter or longer all-oral regimen only through the N/DDR-TB centre and 2025 guideline.'],size=18,space=.82)
add_text(s,'Mnemonic: BPaLM = Bedaquiline, Pretomanid, Linezolid, Moxifloxacin',.75,5.7,11.7,.35,19,True)
#11
s=base('When to seek urgent review',11)
bullets(s,['Jaundice, dark urine, persistent vomiting or severe fatigue.','Severe rash, fever, mucosal involvement or facial swelling.','Blurred vision, loss of colour vision or visual decline.','Syncope, palpitations, severe dizziness or chest symptoms.','Severe neuropathic pain, weakness, anaemia/infection symptoms while on linezolid.','Altered sensorium, breathlessness, inability to eat/drink, or clinical deterioration.'],size=18,space=.67)
#12
s=base('Official sources',12)
urls=['NTEP guideline index: https://tbcindia.mohfw.gov.in/guidelines','NTEP DR-TB guideline 2025: https://tbcindia.mohfw.gov.in/wp-content/uploads/2025/03/National-Guidelines-for-Management-of-DR-TB_27-3-2025.pdf','NTEP PMTPT page: https://tbcindia.mohfw.gov.in/pmtpt','NTEP 1HP and 3RH TPT addenda: listed on PMTPT page','NACO PLHIV TPT guidance, 20 May 2024: listed on PMTPT page','National Guidance on Differentiated TB Care, March 2025: listed on NTEP guideline index']
bullets(s,urls,size=14,space=.68)
add_text(s,'This deck is for learning. Use the complete official guideline and local NTEP instructions for patient care.',.75,6.0,11.7,.35,15,True)
prs.save(OUT)
print(OUT)

from pptx import Presentation
from pptx.util import Inches, Pt
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.dml.color import RGBColor
from pptx.enum.dml import MSO_LINE
import os

OUT='/tmp/workspace/ntep_tb_guides/output_updated_2026'
os.makedirs(OUT,exist_ok=True)
FILE=os.path.join(OUT,'NTEP_TB_India_2025_2026_Detailed_Guidelines.pptx')
prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5)
WHITE=RGBColor(255,255,255); BLACK=RGBColor(0,0,0); GRAY=RGBColor(90,90,90); LGRAY=RGBColor(238,238,238)

# ---------- helpers ----------
def textbox(slide,x,y,w,h,text,size=18,bold=False,align=PP_ALIGN.LEFT,color=BLACK,margin=.06):
    sh=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=sh.text_frame
    tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(margin); tf.margin_top=tf.margin_bottom=Inches(margin)
    for i,line in enumerate(text.split('\n')):
        p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=line; p.alignment=align
        p.space_after=Pt(0); p.space_before=Pt(0)
        for r in p.runs:
            r.font.name='Arial'; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color
    return sh

def base(title,section='NTEP TB INDIA | 2025-2026'):
    s=prs.slides.add_slide(prs.slide_layouts[6]); bg=s.background.fill; bg.solid(); bg.fore_color.rgb=WHITE
    line=s.shapes.add_shape(MSO_SHAPE.RECTANGLE,0,0,prs.slide_width,Inches(.11)); line.fill.solid(); line.fill.fore_color.rgb=BLACK; line.line.fill.background()
    textbox(s,.45,.28,12.35,.48,title,26,True)
    textbox(s,.48,7.08,6.5,.18,section,7,False,color=GRAY)
    n=len(prs.slides); textbox(s,12.1,7.03,.55,.23,str(n),8,True,align=PP_ALIGN.RIGHT,color=GRAY)
    return s

def bullets(slide, items, x=.65,y=1.15,w=12,h=5.55,size=18):
    sh=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=sh.text_frame; tf.clear(); tf.word_wrap=True
    tf.margin_left=tf.margin_right=Inches(.08); tf.margin_top=tf.margin_bottom=Inches(.05)
    for i,item in enumerate(items):
        p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=item; p.level=0; p.font.size=Pt(size); p.font.name='Arial'; p.font.color.rgb=BLACK; p.space_after=Pt(10); p.bullet=True
    return sh

def note(slide,text):
    sh=slide.shapes.add_shape(MSO_SHAPE.RECTANGLE,Inches(.62),Inches(6.42),Inches(12.1),Inches(.45)); sh.fill.solid(); sh.fill.fore_color.rgb=LGRAY; sh.line.color.rgb=BLACK
    textbox(slide,.76,6.51,11.8,.18,text,8,False,color=GRAY)

def table(slide,headers,rows,widths,y=1.25,fs=12):
    x=.55; h=.45; total=sum(widths)
    for j,hdr in enumerate(headers):
        xx=x+sum(widths[:j]); sh=slide.shapes.add_shape(MSO_SHAPE.RECTANGLE,Inches(xx),Inches(y),Inches(widths[j]),Inches(h)); sh.fill.solid(); sh.fill.fore_color.rgb=BLACK; sh.line.color.rgb=BLACK
        textbox(slide,xx+.04,y+.05,widths[j]-.08,h-.07,hdr,fs,True,color=WHITE)
    rowh=(5.85-y)/max(1,len(rows))
    for i,row in enumerate(rows):
        yy=y+h+i*rowh
        for j,val in enumerate(row):
            xx=x+sum(widths[:j]); sh=slide.shapes.add_shape(MSO_SHAPE.RECTANGLE,Inches(xx),Inches(yy),Inches(widths[j]),Inches(rowh)); sh.fill.solid(); sh.fill.fore_color.rgb=WHITE if i%2==0 else LGRAY; sh.line.color.rgb=BLACK
            textbox(slide,xx+.05,yy+.05,widths[j]-.1,rowh-.08,val,fs,False)

def section_slide(title,sub):
    s=prs.slides.add_slide(prs.slide_layouts[6]); s.background.fill.solid(); s.background.fill.fore_color.rgb=BLACK
    textbox(s,.7,2.45,11.9,.75,title,36,True,align=PP_ALIGN.CENTER,color=WHITE)
    textbox(s,1.2,3.35,10.9,.5,sub,18,False,align=PP_ALIGN.CENTER,color=WHITE)
    textbox(s,.5,7.0,12.3,.22,'NTEP TB INDIA | 2025-2026',8,False,align=PP_ALIGN.CENTER,color=WHITE)

# ---------- slides ----------
s=prs.slides.add_slide(prs.slide_layouts[6]); s.background.fill.solid(); s.background.fill.fore_color.rgb=WHITE
textbox(s,.8,1.55,11.7,1.1,'Tuberculosis in India',42,True,align=PP_ALIGN.CENTER)
textbox(s,.8,2.72,11.7,.55,'Detailed NTEP teaching deck: 2025 and 2026 official guidance',22,False,align=PP_ALIGN.CENTER)
textbox(s,1.35,4.05,10.6,.65,'Regimens | indications | adverse effects | interactions | special populations',19,False,align=PP_ALIGN.CENTER)
textbox(s,.8,6.45,11.7,.3,'Prepared from official Central TB Division / NTEP sources. Educational material, not a patient-specific prescription.',10,False,align=PP_ALIGN.CENTER,color=GRAY)

s=base('Scope and source hierarchy')
bullets(s,[
'2025 National Guidelines for Management of Drug-Resistant TB: the controlling national source for MDR/RR-TB regimen selection, BPaLM, shorter oral and longer oral regimens, monitoring and special situations.',
'2025 National Guidance on Differentiated TB Care: triage, high-risk assessment, referral, monitoring and mortality reduction.',
'2026 National Guidelines on Prevention and Control of Airborne Infections Including TB: facility, household and community infection prevention and control.',
'TPT uses the NTEP PMTPT 2021 guideline plus its later 1HP and 3RH implementation addenda and NACO 2024 PLHIV guidance.'
],size=16); note(s,'Important: the 2026 guideline is an airborne infection-control guideline. It does not replace 2025 DR-TB treatment regimens.')

s=base('Core NTEP management pathway')
bullets(s,['Identify presumptive TB, collect appropriate respiratory or extrapulmonary specimen, and use NTEP molecular testing pathway.', 'Establish rifampicin resistance status and arrange DST. Regimen choice depends on DST, prior treatment, severity/site of disease and adverse-event risk.', 'Notify/link to NTEP and Ni-kshay. Screen for HIV, diabetes, nutrition and high-risk clinical features.', 'Start the appropriate regimen promptly through the NTEP treatment system. Counselling, adherence support, active drug-safety monitoring and scheduled follow-up are treatment components.'],size=17)

s=base('2025 differentiated TB care: who needs escalation?')
bullets(s,['High-risk features include severe undernutrition, anaemia, HIV, diabetes, liver or renal complications, mental illness, haemoptysis, severe lung disease, pregnancy, elderly age, EPTB complications and drug adverse effects.', 'Urgent clinical triggers include SpO2 <94%, breathlessness at rest, altered consciousness/convulsions, shock, recurrent vomiting/diarrhoea, serious bleeding, jaundice, severe pain or respiratory failure.', 'Assess vitals, CBC, HIV/ART status, glycaemia, liver and renal function; investigate according to the treating clinician.', 'Use structured referral, discharge planning and close follow-up.'],size=16); note(s,'Source: NTEP National Guidance on Differentiated TB Care, March 2025.')

section_slide('Drug-susceptible TB','Standard framework, first-line drugs and common safety problems')
s=base('Drug-susceptible TB: standard regimen framework')
table(s,['Phase','Drugs','Frequency / duration','Practical points'],[
['Initiation phase','H + R + Z + E (HRZE)','Daily for 2 months','Use NTEP weight-band FDC pack; check weight, adherence and toxicity.'],
['Continuation phase','H + R + E (HRE)','Daily for 4 months','Continue clinical and bacteriological follow-up as indicated.'],
['Total','2HRZE / 4HRE','6 months','Confirm susceptibility pathway; do not use routine DS-TB regimen when DR-TB is detected/suspected.'],
], [2.2,3.25,2.35,4.4],fs=14); note(s,'Do not use this slide to calculate tablet numbers. Verify the current NTEP-issued FDC pack and state weight-band instruction at prescribing.')

s=base('First-line drugs: indications and adverse effects')
table(s,['Drug','Role','Important adverse effects','Key action'],[
['Isoniazid (H)','Core bactericidal drug','Hepatitis; peripheral neuropathy','Ask about tingling/numbness; provide pyridoxine when indicated.'],
['Rifampicin (R)','Core sterilising drug','Hepatitis; orange body fluids; hypersensitivity','Review interacting medicines, especially ART and anticoagulants.'],
['Pyrazinamide (Z)','Early intensive-phase sterilising drug','Hepatitis; hyperuricaemia/arthralgia','Assess liver symptoms and troublesome joint pain.'],
['Ethambutol (E)','Protects regimen until susceptibility is known','Optic neuritis; reduced acuity/red-green discrimination','Document/report visual symptoms urgently.'],
], [2.0,2.7,4.15,3.35],fs=12); note(s,'Memory aid: “Hepatitis - Red-orange - Z joints - Eyes” = H/R/Z/E safety recall.')

s=base('First-line drug interactions and practical precautions')
table(s,['Medicine','Interaction / precaution','Clinical implication'],[
['Rifampicin','Potent enzyme induction; interacts with many ARVs, anticoagulants, hormonal contraception and other drugs','Reconcile all drugs before starting; coordinate ART/other medicine changes with specialist programme.'],
['Isoniazid','Neuropathy risk rises with malnutrition, diabetes, HIV, alcohol use and pregnancy/postpartum; hepatotoxicity risk with alcohol/liver disease','Pyridoxine and symptom surveillance when indicated.'],
['Rifampicin + isoniazid / pyrazinamide','Additive hepatotoxicity','Evaluate anorexia, nausea/vomiting, jaundice, dark urine or marked fatigue promptly.'],
['Ethambutol','Renal clearance and vision toxicity concern','Specialist dose adjustment/monitoring in renal impairment; urgent assessment for visual change.'],
], [2.7,5.0,4.5],fs=13)

section_slide('Tuberculosis preventive treatment','Current TPT regimen set: 1HP and 3RH addenda plus base PMTPT guidance')
s=base('TPT: principles and indications')
bullets(s,['Exclude active TB disease before TPT. Selection is based on contact status, age, TB infection testing where applicable, index-case drug resistance and programme eligibility.', 'Priority groups include PLHIV, household contacts of pulmonary TB, and specified clinical risk groups such as people initiating immunosuppression/anti-TNF therapy, silicosis, dialysis and transplant candidates.', 'Household contacts of DR-TB require index-case DST-informed selection. TPT is not a substitute for active TB evaluation.', 'Counsel regarding adherence, hepatotoxicity symptoms, rash and medicine interactions.'],size=17); note(s,'Current addenda: 1HP for age >=13 years and 3RH for age 0-15 years, in their specified implementation contexts.')

s=base('TPT regimen comparison')
table(s,['Regimen','Population / indication','Dose frequency & duration','Major caution'],[
['1HP','NTEP addendum: age >=13 years','Isoniazid 300 mg + rifapentine 600 mg daily x 28 doses','Major rifamycin-ART interactions; pregnancy safety not established in addendum.'],
['3RH','NTEP addendum: age 0-15 years','Daily rifampicin + isoniazid x 84 doses; weight/age based','Rifampicin interactions; check ART.'],
['3HP','Base PMTPT guideline: eligible people >2 years','Weekly isoniazid + rifapentine x 12 doses','ART interactions; verify current programme eligibility.'],
['6H','Base PMTPT guideline','Daily isoniazid x 6 months','Neuropathy/hepatotoxicity; maximum adult daily H 300 mg.'],
], [1.35,3.25,4.1,3.5],fs=12)

s=base('TPT doses: 1HP and 3RH')
table(s,['Regimen','Exact regimen','Dose detail','Reminder'],[
['1HP','Daily x 28 doses; age >=13 years','Isoniazid 300 mg/day + rifapentine 600 mg/day, regardless of weight band per addendum','Take interaction history, including ARVs.'],
['3RH','Daily x 84 doses; age 0-15 years','INH: <10 y 10 mg/kg/day; >=10 y 5 mg/kg/day. R: <10 y 15 mg/kg/day; >=10 y 10 mg/kg/day. Use stated FDC bands.','4-7 kg: 1, 8-11: 2, 12-15: 3, 16-24: 4 RH 75/50 mg FDC tablets; >=25 kg adult formulation.'],
], [1.35,2.85,4.5,3.5],fs=13); note(s,'Mnemonic: “1HP daily for 1 month; 3RH daily for 3 months; 3HP weekly for 3 months.”')

s=base('TPT in PLHIV and pregnancy')
table(s,['Situation','Preferred NACO/NTEP guidance','Important interaction / caution'],[
['PLHIV >=13 years','1HP daily for 28 days','No dolutegravir dose change required per NACO 20 May 2024 guidance; check complete ART regimen.'],
['PLHIV <13 years','6H daily x 6 months','Use paediatric programme guidance.'],
['Pregnant or breastfeeding woman living with HIV','6H daily x 6 months','1HP not recommended here by the cited NACO guidance.'],
['PI-based ARV regimen','6H daily x 6 months','Avoid 1HP due to rifapentine interaction.'],
['DR-TB contact with PLHIV','4R for H-resistant/R-susceptible index case OR 6Lfx for MDR/RR-TB with FQ-susceptible index case','Requires index DST, active TB exclusion and programme assessment.'],
], [3.0,4.0,4.7],fs=12)

section_slide('Drug-resistant TB','2025 NTEP guideline: regimen selection must be DST- and eligibility-based')
s=base('DR-TB: 2025 regimen selection')
bullets(s,['Nodal/district DR-TB centres and their committees select BPaLM, 9-11 month shorter oral MDR/RR-TB regimen or 18-20 month longer oral M/XDR-TB regimen based on molecular and/or phenotypic DST plus eligibility.', 'BPaLM is the first-choice regimen for eligible persons aged >=14 years with MDR/RR-TB, irrespective of fluoroquinolone resistance or HIV status, as stated in the guideline.', 'Do not select a regimen from a slide alone. Consider prior drug exposure, severity, site of disease, QT risk, neuropathy, blood counts, renal/hepatic status, pregnancy and concomitant medicines.', 'All DR-TB care includes counselling, informed decision-making, aDSM, clinical/laboratory monitoring and follow-up.'],size=16)

s=base('BPaLM: indication, schedule and duration')
table(s,['Drug','Dose & frequency','Duration','Why it matters'],[
['Bedaquiline (Bdq)','400 mg once daily in weeks 1-2; then 200 mg three times weekly','Through week 26; extension 27-39 weeks if criteria met','QT prolongation risk and drug-interaction review.'],
['Pretomanid (Pa)','200 mg once daily','Week 1 through 26/39','Part of BPaLM; avoid use outside eligibility framework.'],
['Linezolid (Lzd)','600 mg once daily','Week 1 through 26/39; modification possible for toxicity','Neuropathy, myelosuppression and optic toxicity require monitoring.'],
['Moxifloxacin (Mfx)','400 mg once daily','Week 1 through 26/39','QT risk; avoid magnesium/antacids 2 h before/after FQ dose.'],
], [2.0,3.55,2.1,4.1],fs=12); note(s,'BPaLM uses pyridoxine throughout: 50 mg/day at 16-29 kg; 100 mg/day at >30 kg, per 2025 guideline.')

s=base('BPaLM eligibility and important exclusions')
bullets(s,['Eligible: MDR/RR-TB age >=14 years after NTEP clinical and DST assessment. The guideline permits initiation in eligible patients while baseline Bdq/Pa/Lzd DST is awaited because resistance levels are low, with regimen change if resistance is found.', 'Major reasons for ineligibility / caution include exposure or resistance to regimen drugs, QT-risk conditions or interacting medicines, serious baseline blood-count abnormality, severe renal failure, severe grade 3-4 neuropathy, pregnancy/breastfeeding and other protocol-defined conditions.', 'Children under 14 years: BPaLM is not the routine regimen because pretomanid evidence/use is limited below 14 years. NTEP committee selects another appropriate regimen.', 'Women of reproductive age need counselling regarding family planning before DR-TB therapy.'],size=16); note(s,'Exact eligibility/exclusion list and exceptions are in Chapter 3 of the 2025 national DR-TB guideline.')

s=base('BPaLM adverse effects and response')
table(s,['Drug','High-yield adverse effects','Response / monitoring'],[
['Bedaquiline','QTc prolongation; hepatotoxicity','Baseline and follow-up ECG/electrolytes; review all QT-prolonging drugs.'],
['Pretomanid','Hepatotoxicity; GI symptoms; possible neuropathy with regimen','Clinical/LFT review and protocol-directed action.'],
['Linezolid','Peripheral/optic neuropathy; anaemia, thrombocytopenia, neutropenia; lactic acidosis','CBC and neuropathy/vision surveillance; dose interruption/reduction only under protocol.'],
['Moxifloxacin','QT prolongation, dysglycaemia, tendinopathy, CNS effects','ECG/electrolyte review; check diabetes; separate from polyvalent cations.'],
], [2.0,4.6,5.15],fs=12); note(s,'A severe linezolid toxicity requiring permanent discontinuation may mean BPaLM cannot continue: change regimen through the N/DDR-TBC pathway.')

s=base('DR-TB: interactions that matter')
table(s,['Issue','What to check','Action'],[
['QT prolongation','Bdq, Mfx, clofazimine, delamanid and non-TB QT-prolonging drugs; electrolytes','Baseline/follow-up ECG and electrolyte correction. Avoid unnecessary QT-active combinations.'],
['Fluoroquinolone absorption','Magnesium supplements or magnesium-containing antacids','Avoid for 2 hours before and 2 hours after FQ administration.'],
['Rifamycins and ART','Rifampicin/rifapentine have major ARV interactions','Select/adjust with NTEP and ART centre, never independently.'],
['Linezolid','Drugs with serotonergic/adrenergic effect and marrow-toxic medicines','Medication reconciliation and clinical monitoring.'],
['Alcohol/hepatotoxic medicines','H, R, Z, Eto, PAS, Bdq, Pa can contribute to hepatotoxicity','Counsel avoidance and promptly evaluate symptoms/LFT abnormalities.'],
], [2.3,5.0,4.45],fs=12)

s=base('Shorter oral and longer oral DR-TB regimens')
table(s,['Regimen pathway','When considered','Core principle'],[
['9-11 month shorter oral MDR/RR-TB regimen','For people who are not suitable for BPaLM but meet shorter-regimen eligibility','2025 guideline updates the all-oral pathway; exact composition and dosage are committee/DST based. Do not substitute old injectable regimen charts.'],
['18-20 month longer oral M/XDR-TB regimen','For ineligible patients, resistance/previous exposure patterns or regimen modification needs','Construct an effective regimen using DST, history and safety constraints under N/DDR-TBC guidance.'],
['H mono/poly DR-TB regimen','Isoniazid mono/poly resistance with rifampicin susceptibility','2025 guideline provides 6-month R-E-Z-Lfx approach with weight-band dosing and modification sequence.'],
], [3.1,3.8,4.85],fs=13); note(s,'The 2021 PMDT document is historical where it conflicts with the 2025 DR-TB guideline.')

s=base('H mono/poly DR-TB: 2025 regimen and adult doses')
table(s,['Drug','16-29 kg','30-45 kg','46-70 kg','>70 kg'],[
['Rifampicin (daily)','300 mg','450 mg','600 mg','750 mg'],
['Ethambutol (daily)','400 mg','800 mg','1200 mg','1600 mg'],
['Pyrazinamide (daily)','750 mg','1250 mg','1750 mg','2000 mg'],
['Levofloxacin (daily)','250 mg','750 mg','1000 mg','1000 mg'],
], [2.5,2.3,2.3,2.3,2.3],fs=13); note(s,'Indication: H mono/poly DR-TB after DST-based assessment. 2025 guideline: 6 months R-E-Z-Lfx; substitutions require the stated NTEP sequence.')

section_slide('Special populations','The regimen is not “one-size-fits-all”: use NTEP committee and speciality support')
s=base('Children and adolescents')
bullets(s,['Children require age- and weight-band formulations and specialist/NTEP assessment. BPaLM is routinely considered from age >=14 years only; below this, pretomanid limitation means another suitable regimen is selected.', 'The 2025 DR-TB guideline notes bedaquiline availability/use constraints in children below 5 years and requires regimen selection by the DR-TB centre.', 'For TPT: 3RH addendum applies to age 0-15 years; 1HP addendum applies to age >=13 years. Check overlap/eligibility before choosing.', 'Assess nutrition, growth, adherence support and caregiver education at each visit.'],size=16)

s=base('Pregnancy and breastfeeding')
bullets(s,['TB disease requires prompt evaluation and treatment coordination: untreated TB can be dangerous to mother and fetus. Refer through NTEP and obstetric care.', 'In 2025 DR-TB care, pregnancy/breastfeeding is a key regimen-selection issue. BPaLM eligibility must be determined by the DR-TB committee, not assumed.', 'For PLHIV who are pregnant/breastfeeding, NACO 2024 guidance lists 6H daily for 6 months rather than 1HP.', 'Counsel about contraception/family planning for DR-TB treatment and check all drug interactions before use.'],size=16)

s=base('HIV and TB')
bullets(s,['Test every person with TB for HIV and link promptly to ART services. Review ART adherence, CD4 status, viral suppression context and drug interactions.', 'Rifampicin/rifapentine interactions can require ART selection or adjustment. Do not interrupt or modify ART without ART-centre involvement.', '2025 DR-TB guideline states BPaLM may be used in eligible MDR/RR-TB patients irrespective of HIV status, but concurrent medicine and adverse-event review remain essential.', 'Watch for IRIS, severe immunosuppression, drug toxicity and adherence barriers; differentiated TB care flags HIV as a high-risk condition.'],size=16)

s=base('Liver disease, alcohol use and malnutrition')
bullets(s,['Potentially hepatotoxic DR-TB medicines cited in the 2025 guideline: R, H, Z, PAS, Eto, Bdq and Pa. Hepatitis is less common with fluoroquinolones.', 'Higher risk: older age, alcohol use, malnutrition and pre-existing liver disease. Obtain baseline clinical/laboratory assessment and follow the regimen-specific monitoring plan.', 'Symptoms needing urgent review: anorexia, persistent nausea/vomiting, abdominal pain, marked fatigue, dark urine, jaundice or altered sensorium.', 'Do not stop/rechallenge or redesign a TB regimen from memory: consult NTEP/DR-TB team.'],size=16)

s=base('Renal impairment and dialysis')
bullets(s,['Evaluate renal insufficiency before MDR/RR-TB regimen selection. The 2025 guideline urges caution in severe renal failure because experience with some regimens is limited.', 'Avoid nephrotoxic medicines where possible and use protocol/specialist adjustments for renally cleared drugs. In older EPTB teaching material, aminoglycosides are specifically high risk in CKD.', 'For haemodialysis, timing and dosing require nephrology/NTEP coordination. Do not apply standard weight-band dosing unchanged.', 'Monitor renal function, electrolytes and ECG when QT-active drugs are used.'],size=16)

s=base('Diabetes, elderly persons and other vulnerable groups')
bullets(s,['Diabetes raises risk of poor outcomes and can be worsened by fluoroquinolone dysglycaemia. Screen glucose and ensure diabetes management is integrated with TB care.', 'Elderly persons may have polypharmacy, hepatic/renal impairment, frailty and QT risk: review medicines and monitor more closely.', 'Mental illness, substance use, homelessness/migration, poverty and stigma can impair adherence. Provide counselling, treatment support, nutritional/social support and referral.', 'NTEP differentiated care specifically flags severe anaemia, diabetes, mental illness, COPD/restrictive disease and special populations for intensified assessment.'],size=16)

section_slide('2026 airborne infection control','Prevent transmission at home, in facilities and during patient movement')
s=base('2026 AIC-IPC: FAST and hierarchy of controls')
bullets(s,['FAST: Find TB cases actively, Separate safely and Treat effectively. Prompt diagnosis and treatment reduce infectiousness.', 'Administrative controls: triage, early testing, separation, cough etiquette, appointment flow, staff training and monitoring.', 'Environmental controls: optimize ventilation; use designated well-ventilated spaces. Where feasible, airborne isolation rooms have >=12 air changes/hour and controlled airflow.', 'Personal protection: source control mask for patient during transport outside isolation; particulate respirator such as N95 for healthcare workers when indicated.'],size=16); note(s,'Source: National Guidelines on Prevention and Control of Airborne Infections Including Tuberculosis, 2026.')

s=base('Home, community and facility implementation')
bullets(s,['Teach patient and household: cough etiquette, no spitting, open windows/ventilation where possible, reduce crowding around infectious respiratory cases and attend follow-up.', 'At facility: separate coughing/infectious patients promptly, designate well-ventilated waiting/clinical areas, and provide respiratory hygiene education.', 'NTEP workers should support household education before discharge/referral and throughout treatment and follow-up.', 'Infection control complements, but never delays, diagnostic testing and effective treatment.'],size=17)

s=base('Adverse-effect red flags: same-day escalation')
table(s,['System','Warning signs','Possible issue'],[
['Hepatic','Jaundice, dark urine, persistent vomiting, severe fatigue','Drug-induced liver injury'],
['Cardiac','Syncope, palpitations, severe dizziness','QT prolongation/arrhythmia'],
['Neurologic / eye','Painful tingling, weakness, new visual change, confusion, seizures','Lzd/INH neuropathy, optic toxicity or severe illness'],
['Haematologic','Marked pallor, fever/infection, bleeding/bruising','Linezolid marrow toxicity'],
['Respiratory','SpO2 <94%, breathlessness at rest, haemoptysis, chest pain','Severe TB complication / respiratory failure'],
], [2.4,5.3,4.05],fs=13); note(s,'This is an escalation checklist, not a diagnostic tool. Contact the NTEP/DR-TB centre or emergency service as clinically indicated.')

s=base('High-yield mnemonics')
table(s,['Topic','Mnemonic','Meaning'],[
['DS-TB','HRZE = “Hepatitis, Red-orange, Z joints, Eyes”','Recall major first-line adverse effects.'],
['TPT','“1HP daily 1 month; 3RH daily 3 months; 3HP weekly 3 months”','Duration and frequency recall.'],
['BPaLM','“B-Pa-L-M: QT, liver, lines, muscle/nerve”','Bdq: QT; Pa: liver/GI; Lzd: blood/nerve/eye; Mfx: QT/tendon/dysglycaemia.'],
['AIC','FAST','Find actively, Separate safely, Treat effectively.'],
], [2.1,4.7,4.95],fs=14); note(s,'Mnemonics support recall only. Always use the official guideline for dose, eligibility and adverse-event management.')

s=base('Official sources and closing checklist')
bullets(s,['2025 National Guidelines for Management of Drug Resistant TB: https://tbcindia.mohfw.gov.in/wp-content/uploads/2025/03/National-Guidelines-for-Management-of-DR-TB_27-3-2025.pdf', '2025 National Guidance on Differentiated TB Care: https://tbcindia.mohfw.gov.in/wp-content/uploads/2025/07/National-Guidance-on-Differential-TB-Care_Final_March-2025-3.pdf', '2026 National Guidelines on Prevention and Control of Airborne Infections Including TB: https://tbcindia.mohfw.gov.in/wp-content/uploads/2026/03/National-AIC-Guidelines-2026.pdf', 'NTEP PMTPT document page: https://tbcindia.mohfw.gov.in/pmtpt', 'NTEP guidelines index: https://tbcindia.mohfw.gov.in/guidelines'],size=13)
note(s,'Before prescribing: confirm DST, body weight/available FDC, pregnancy and breastfeeding status, HIV/ART, liver/renal function, ECG/QT risk, drug interactions and current state/NTEP circular.')

prs.save(FILE)
print(FILE, len(prs.slides))

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/ntep_tb_guides/src/create_2025_2026_detailed_ppt.py'

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/ntep_tb_guides/src/create_2025_2026_detailed_ppt.py'