cd /home/daytona/workspace/attachments/9453e53d-8394-4f44-83e3-743242fec744 && p…

cd /home/daytona/workspace/attachments/9453e53d-8394-4f44-83e3-743242fec744 && p…

mkdir -p /home/daytona/workspace/iec-thesis && ls /home/daytona/workspace/iec-th…

~/iec-thesis/generate_thesis.js

const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  AlignmentType, HeadingLevel, BorderStyle, WidthType, VerticalAlign,
  PageNumber, Header, Footer, UnderlineType, ShadingType
} = require('docx');
const fs = require('fs');

// ─── helpers ────────────────────────────────────────────────────────────────
const bold = (text, size = 24, underline = false) => new TextRun({
  text, bold: true, size,
  underline: underline ? { type: UnderlineType.SINGLE } : undefined
});
const normal = (text, size = 24) => new TextRun({ text, size });
const italic = (text, size = 24) => new TextRun({ text, italics: true, size });

const heading = (text, level = HeadingLevel.HEADING_1) => new Paragraph({
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});

const centeredBold = (text, size = 28, underline = false) => new Paragraph({
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  children: [bold(text, size, underline)]
});

const para = (runs, spacing = { before: 60, after: 60 }) => new Paragraph({
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  spacing
});

const bullet = (text, size = 24) => new Paragraph({
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});

const blankLine = () => new Paragraph({ children: [new TextRun('')], spacing: { before: 60, after: 60 } });

const signatureLine = (label1, label2) => {
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      normal(label2, 22)
    ],
    spacing: { before: 200, after: 100 }
  });
};

// ─── border helpers ──────────────────────────────────────────────────────────
const noBorder = { style: BorderStyle.NIL, size: 0, color: 'FFFFFF' };
const thinBorder = { style: BorderStyle.SINGLE, size: 4, color: '000000' };

const cell = (children, opts = {}) => new TableCell({
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  width: opts.width ? { size: opts.width, type: WidthType.PERCENTAGE } : undefined,
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  borders: {
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  },
  verticalAlign: VerticalAlign.TOP,
  columnSpan: opts.span || 1
});

// ─── DOCUMENT BUILD ─────────────────────────────────────────────────────────
const doc = new Document({
  styles: {
    default: {
      document: {
        run: { font: 'Times New Roman', size: 24 }
      }
    }
  },
  sections: [{
    properties: {
      page: {
        margin: { top: 1080, bottom: 1080, left: 1260, right: 1260 }
      }
    },
    children: [

      // ═══════════════════════════════════════════════════════════════════════
      // INSTITUTION HEADER
      // ═══════════════════════════════════════════════════════════════════════
      centeredBold('Faculty of Medicine – Meenakshi Medical College Hospital & Research Institute', 28, true),
      centeredBold('Institutional Ethics Committee – Human Studies', 26, true),
      blankLine(),

      // ═══════════════════════════════════════════════════════════════════════
      // COVER LETTER
      // ═══════════════════════════════════════════════════════════════════════
      centeredBold('COVER LETTER', 26, true),
      blankLine(),
      para('Date: 18.02.2026'),
      blankLine(),
      para([bold('From,', 24)]),
      para('Dr. RAJADURAI. I'),
      para('Junior Resident'),
      para('Department of Dermatology, Venereology and Leprology'),
      para('Meenakshi Medical College Hospital & Research Institute, Kanchipuram'),
      blankLine(),
      para([bold('To,', 24)]),
      para('The Chairperson,'),
      para('Institutional Ethics Committee,'),
      para('MMCHRI, Kanchipuram'),
      blankLine(),
      para('Through Proper Channel'),
      blankLine(),
      para([bold('Respected Sir/Madam,', 24)]),
      blankLine(),
      para([bold('Sub: ', 24), normal('Request for ethical clearance for the study ', 24), bold('"A Clinico-Epidemiological Study on Quality of Life in Patients with Dermatophytosis Using DLQI"', 24)]),
      blankLine(),
      para('I, Dr. RAJADURAI. I, Junior Resident (PG), of Meenakshi Medical College Hospital & Research Institute, am interested to conduct a project titled "A Clinico-Epidemiological Study on Quality of Life in Patients with Dermatophytosis Using DLQI" under the guidance of Dr. S. KUMARAVEL, Professor and Head, Department of Dermatology, Venereology and Leprology, Meenakshi Medical College Hospital & Research Institute. A copy of this study proposal has been attached. I kindly request you to give me ethical clearance and approval to conduct this study. Please do the needful.'),
      blankLine(),
      para('The following documents are enclosed for your review:'),
      bullet('Study Protocol (including Abstract)'),
      bullet('Informed Consent Documents: Participant Information Sheet and Informed Consent Form (English and Tamil)'),
      bullet('Questionnaire (Dermatology Life Quality Index – DLQI)'),
      bullet('Curriculum Vitae of the Principal Investigator and Guide'),
      blankLine(),
      para('Thanking you.'),
      blankLine(),
      para('Yours sincerely,'),
      blankLine(),
      blankLine(),
      signatureLine('Signature of the Guide', 'Signature of the Candidate / Investigator'),
      blankLine(),
      signatureLine('Signature of the HOD'),
      blankLine(),

      // page break
      new Paragraph({ children: [], pageBreakBefore: true }),

      // ═══════════════════════════════════════════════════════════════════════
      // APPLICATION HEADER TABLE
      // ═══════════════════════════════════════════════════════════════════════
      centeredBold('Application for Submission of Research Proposals to SAC/IEC Review (Human Studies)', 24, true),
      blankLine(),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('IEC Reference No.', 22)], spacing: { before: 60, after: 60 } }), new Paragraph({ children: [normal('_______________', 22)], spacing: { before: 40, after: 40 } })], { width: 33 }),
            cell([new Paragraph({ children: [bold('Project Type', 22)], spacing: { before: 60, after: 60 } }), new Paragraph({ children: [normal('PG / Faculty / UG / Ph.D / STS, others specify: ________', 22)], spacing: { before: 40, after: 40 } })], { width: 33 }),
            cell([new Paragraph({ children: [bold('Date of Submission', 22)], spacing: { before: 60, after: 60 } }), new Paragraph({ children: [normal('18.02.2026', 22)], spacing: { before: 40, after: 40 } })], { width: 34 })
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        ]
      }),
      blankLine(),

      // ═══════════════════════════════════════════════════════════════════════
      // SECTION A – BASIC INFORMATION
      // ═══════════════════════════════════════════════════════════════════════
      centeredBold('SECTION A – BASIC INFORMATION', 26, true),
      blankLine(),
      para([bold('Title of Research Proposal: ', 24), normal('"A Clinico-Epidemiological Study on Quality of Life in Patients with Dermatophytosis Using DLQI"', 24)]),
      blankLine(),

      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Principal Investigator (PI)', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
            cell([
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              new Paragraph({ children: [bold('Designation: ', 22), normal('Junior Resident', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Department: ', 22), normal('Dermatology, Venereology and Leprology', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Institution: ', 22), normal('MMCHRI, Kanchipuram', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Mobile: ', 22), normal('+91 7401441069', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Email: ', 22), normal('arunrajmkt@gmail.com', 22)], spacing: { before: 20, after: 40 } })
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              new Paragraph({ children: [bold('Designation: ', 22), normal('Professor and Head of the Department', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Department: ', 22), normal('Dermatology, Venereology and Leprology', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Mobile: ', 22), normal('+91 9884646324', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Email: ', 22), normal('kumaravel1959@gmail.com', 22)], spacing: { before: 20, after: 40 } })
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          new TableRow({ children: [
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            cell([
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              new Paragraph({ children: [bold('Designation: ', 22), normal('Professor', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Department: ', 22), normal('Dermatology, Venereology and Leprology', 22)], spacing: { before: 20, after: 20 } }),
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          new TableRow({ children: [
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            cell([new Paragraph({ children: [normal('Self-funded / Institutional (No external funding)', 22)], spacing: { before: 40, after: 40 } })], { width: 70 })
          ]}),
          new TableRow({ children: [
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            cell([new Paragraph({ children: [normal('None', 22)], spacing: { before: 40, after: 40 } })], { width: 70 })
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      blankLine(),

      // ═══════════════════════════════════════════════════════════════════════
      // SECTION B – STUDY OVERVIEW
      // ═══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('SECTION B – STUDY OVERVIEW', 26, true),
      blankLine(),

      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Study Type', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }),
            cell([new Paragraph({ children: [normal('Observational – Cross-sectional study', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Study Design', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }),
            cell([new Paragraph({ children: [normal('Hospital-based, cross-sectional, descriptive', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Study Setting', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }),
            cell([new Paragraph({ children: [normal('Department of Dermatology, Venereology and Leprology, MMCHRI, Kanchipuram', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Duration of Study', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }),
            cell([new Paragraph({ children: [normal('12 months', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Sample Size', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }),
            cell([new Paragraph({ children: [normal('100 patients (calculated using standard formula: n = Z²P(1-P)/d²; Z=1.96, 95% CI)', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Participant Category', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }),
            cell([new Paragraph({ children: [normal('Patients ≥ 15 years attending Dermatology OPD with clinically diagnosed dermatophytosis', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Ethical Risk Level', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }),
            cell([new Paragraph({ children: [normal('Minimal Risk – Observational study; no intervention, no invasive procedure', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
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          new TableRow({ children: [
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            cell([new Paragraph({ children: [normal('No', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Investigator\'s Brochure enclosed?', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }),
            cell([new Paragraph({ children: [normal('Not Applicable', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('In vitro studies data?', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }),
            cell([new Paragraph({ children: [normal('Not Applicable', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Preclinical studies done?', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }),
            cell([new Paragraph({ children: [normal('Not Applicable', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]}),
          new TableRow({ children: [
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            cell([new Paragraph({ children: [normal('No similar study is currently being conducted at this institution. Published studies on DLQI in dermatophytosis have been reviewed in the literature section.', 22)], spacing: { before: 60, after: 60 } })], { width: 60 })
          ]})
        ]
      }),
      blankLine(),

      // ═══════════════════════════════════════════════════════════════════════
      // SECTION C – DETAILED RESEARCH PROPOSAL
      // ═══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('SECTION C – DETAILED RESEARCH PROPOSAL', 26, true),
      blankLine(),

      // Title
      para([bold('Title of the Project: ', 24)]),
      para([bold('"A Clinico-Epidemiological Study on Quality of Life in Patients with Dermatophytosis Using DLQI"', 24)]),
      para([italic('(Observational study; Major outcome: DLQI score; Major predictor: type, duration, extent of dermatophytosis; Setting: Dermatology OPD, MMCHRI, Kanchipuram; Subjects: patients ≥15 years; Design: Hospital-based cross-sectional study)', 22)]),
      blankLine(),

      // Background/Introduction
      para([bold('Background / Introduction', 26)]),
      para('Dermatophytosis is a superficial fungal infection of the skin, hair, and nails caused by dermatophytes belonging to the genera Trichophyton, Microsporum, and Epidermophyton. In recent years, India has witnessed a significant surge in chronic and recurrent dermatophytosis, leading to considerable morbidity. The most common clinical types include tinea corporis, tinea cruris, tinea faciei, tinea manuum, and tinea pedis.'),
      blankLine(),
      para('Although dermatophytosis is not life-threatening, it produces intense pruritus, disfigurement, sleep disturbance, social embarrassment, and occupational impairment. The Dermatology Life Quality Index (DLQI), developed by Finlay AY and Khan GK at Cardiff University, is a validated, widely used 10-item questionnaire for assessing dermatology-specific quality of life.'),
      blankLine(),
      para([bold('Gaps in knowledge and research question: ', 24), normal('Published studies demonstrate moderate to severe QoL impairment in dermatophytosis; however, regional data from South India – particularly from tertiary centers in Tamil Nadu – is limited. This study therefore addresses the gap by systematically evaluating QoL using DLQI and correlating it with disease-specific parameters in the local population.', 24)]),
      blankLine(),

      // Objectives
      para([bold('Objectives', 26)]),
      para([bold('Primary Objective:', 24)]),
      bullet('To measure quality of life impairment in patients with dermatophytosis using the Dermatology Life Quality Index (DLQI).'),
      blankLine(),
      para([bold('Secondary Objectives:', 24)]),
      bullet('To correlate DLQI scores with duration of disease'),
      bullet('To correlate DLQI scores with body surface area (BSA) involvement'),
      bullet('To correlate DLQI scores with number of sites involved'),
      bullet('To correlate DLQI scores with type of dermatophytosis'),
      bullet('To correlate DLQI scores with chronicity and recurrence of disease'),
      blankLine(),

      // Review of Literature
      para([bold('Brief Review of Literature', 26)]),
      para([italic('(Minimum 5 relevant references; chronological order; recent references < 5 years preferred)', 22)]),
      blankLine(),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Authors & Year', 22)], spacing: { before: 60, after: 60 } })], { width: 20, shading: true }),
            cell([new Paragraph({ children: [bold('Study Title / Journal', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
            cell([new Paragraph({ children: [bold('Key Findings', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
            cell([new Paragraph({ children: [bold('Relevance to Present Study', 22)], spacing: { before: 60, after: 60 } })], { width: 20, shading: true })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [normal('Verma S, Madhu R. (2017)', 22)], spacing: { before: 40, after: 40 } })], { width: 20 }),
            cell([new Paragraph({ children: [normal('IJDVL 2017; 83:227–236', 22)], spacing: { before: 40, after: 40 } })], { width: 30 }),
            cell([new Paragraph({ children: [normal('Moderate-to-severe DLQI impairment in chronic dermatophytosis; pruritus and duration were major contributors.', 22)], spacing: { before: 40, after: 40 } })], { width: 30 }),
            cell([new Paragraph({ children: [normal('Demonstrates relevance of DLQI in Indian population', 22)], spacing: { before: 40, after: 40 } })], { width: 20 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [normal('Dogra S, Uprety S (2016)', 22)], spacing: { before: 40, after: 40 } })], { width: 20 }),
            cell([new Paragraph({ children: [normal('Indian Dermatol Online J 2016; 7:2–15', 22)], spacing: { before: 40, after: 40 } })], { width: 30 }),
            cell([new Paragraph({ children: [normal('Epidemic of recalcitrant dermatophytosis in India; identified misuse of topical steroids as a driver.', 22)], spacing: { before: 40, after: 40 } })], { width: 30 }),
            cell([new Paragraph({ children: [normal('Establishes increasing disease burden in India', 22)], spacing: { before: 40, after: 40 } })], { width: 20 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [normal('Finlay AY, Khan GK (1994)', 22)], spacing: { before: 40, after: 40 } })], { width: 20 }),
            cell([new Paragraph({ children: [normal('Clin Exp Dermatol 1994; 19:210–216', 22)], spacing: { before: 40, after: 40 } })], { width: 30 }),
            cell([new Paragraph({ children: [normal('Original validation of DLQI; 10-item, score 0–30; higher score = greater QoL impairment.', 22)], spacing: { before: 40, after: 40 } })], { width: 30 }),
            cell([new Paragraph({ children: [normal('Defines the study tool used', 22)], spacing: { before: 40, after: 40 } })], { width: 20 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [normal('Singh SK et al. (2019)', 22)], spacing: { before: 40, after: 40 } })], { width: 20 }),
            cell([new Paragraph({ children: [normal('Indian J Dermatol 2019; 64(5):377–382', 22)], spacing: { before: 40, after: 40 } })], { width: 30 }),
            cell([new Paragraph({ children: [normal('DLQI scores 6–15 in tertiary center patients; BSA and recurrence significantly correlated with QoL.', 22)], spacing: { before: 40, after: 40 } })], { width: 30 }),
            cell([new Paragraph({ children: [normal('Supports correlation objectives', 22)], spacing: { before: 40, after: 40 } })], { width: 20 })
          ]}),
          new TableRow({ children: [
            cell([new Paragraph({ children: [normal('Panda S, Verma S (2017)', 22)], spacing: { before: 40, after: 40 } })], { width: 20 }),
            cell([new Paragraph({ children: [normal('IJDVL 2017; 83:4–8', 22)], spacing: { before: 40, after: 40 } })], { width: 30 }),
            cell([new Paragraph({ children: [normal('Increasing treatment failures; urge for objective outcome measures including QoL tools.', 22)], spacing: { before: 40, after: 40 } })], { width: 30 }),
            cell([new Paragraph({ children: [normal('Provides rationale for QoL assessment in treatment planning', 22)], spacing: { before: 40, after: 40 } })], { width: 20 })
          ]})
        ]
      }),
      blankLine(),

      // Methodology
      para([bold('Methodology', 26)]),
      blankLine(),
      para([bold('Study Design: ', 24), normal('Hospital-based observational cross-sectional study.', 24)]),
      para([bold('Study Setting: ', 24), normal('Department of Dermatology, Venereology and Leprology, Meenakshi Medical College Hospital & Research Institute, Kanchipuram.', 24)]),
      para([bold('Study Duration: ', 24), normal('12 months from the date of IEC approval.', 24)]),
      blankLine(),
      para([bold('Sample Size: ', 24)]),
      para('Estimated sample size: 100 patients.'),
      para('Calculated using the formula: n = Z²P(1-P)/d²'),
      bullet('Z = 1.96 (95% confidence level)'),
      bullet('P = Expected prevalence of moderate-to-severe DLQI impairment (~50% based on prior studies)'),
      bullet('d = Allowable error (10%)'),
      para('Anticipated drop-out of ~10% accounted for in final target.'),
      blankLine(),
      para([bold('Inclusion Criteria:', 24)]),
      bullet('Patients aged ≥ 15 years'),
      bullet('Clinically diagnosed dermatophytosis (tinea corporis, tinea cruris, tinea faciei, tinea manuum, tinea pedis, or tinea unguium)'),
      bullet('Willing to give written informed consent'),
      blankLine(),
      para([bold('Exclusion Criteria:', 24)]),
      bullet('Patients with other significant dermatological disorders affecting quality of life'),
      bullet('Severe systemic illness'),
      bullet('Psychiatric illness that precludes questionnaire administration'),
      bullet('Pregnant and lactating women'),
      bullet('Patients who refuse consent'),
      blankLine(),
      para([bold('Data Collection Tool:', 24)]),
      para('The Dermatology Life Quality Index (DLQI) – a validated, 10-item questionnaire covering six domains:'),
      bullet('Symptoms and feelings'),
      bullet('Daily activities'),
      bullet('Leisure'),
      bullet('Work and school'),
      bullet('Personal relationships'),
      bullet('Treatment'),
      para('Each item is scored 0–3; total score = 0–30. Interpretation:'),
      new Table({
        width: { size: 60, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [cell([new Paragraph({ children: [bold('DLQI Score', 22)], spacing: { before: 40, after: 40 } })], { width: 40, shading: true }), cell([new Paragraph({ children: [bold('Effect on QoL', 22)], spacing: { before: 40, after: 40 } })], { width: 60, shading: true })] }),
          new TableRow({ children: [cell('0–1', {}), cell('No effect')] }),
          new TableRow({ children: [cell('2–5', {}), cell('Small effect')] }),
          new TableRow({ children: [cell('6–10', {}), cell('Moderate effect')] }),
          new TableRow({ children: [cell('11–20', {}), cell('Very large effect')] }),
          new TableRow({ children: [cell('21–30', {}), cell('Extremely large effect')] })
        ]
      }),
      blankLine(),
      para([bold('Study Procedure:', 24)]),
      para([bold('1. Consent and Enrollment: ', 24), normal('Patients with dermatophytosis attending the DVL OPD will be screened for eligibility. The study will be explained in their local language (Tamil/English). Written informed consent will be obtained before enrollment.', 24)]),
      para([bold('2. Clinical Evaluation: ', 24), normal('Detailed history including duration, recurrence, family history, and treatment history will be recorded. Dermatological examination will document type of dermatophytosis, number of sites, extent (BSA), and chronicity.', 24)]),
      para([bold('3. DLQI Administration: ', 24), normal('Each participant will complete the DLQI questionnaire. For patients unable to read, the investigator will administer it in interview format in the local language.', 24)]),
      para([bold('4. Data Recording: ', 24), normal('Age, gender, occupation, socioeconomic status, duration of disease, type of dermatophytosis, BSA involvement, number of sites, recurrence, and DLQI score will be recorded in the study proforma.', 24)]),
      blankLine(),
      para([bold('Statistical Analysis:', 24)]),
      bullet('Data will be entered in MS Excel and analyzed using SPSS software.'),
      bullet('Continuous variables: Mean ± SD'),
      bullet('Categorical variables: Frequency and percentage; Chi-square test'),
      bullet('Correlation of DLQI with duration and BSA: Pearson correlation coefficient'),
      bullet('p-value < 0.05 will be considered statistically significant.'),
      blankLine(),

      // Ethical Considerations
      para([bold('Ethical Considerations', 26)]),
      bullet('IEC approval will be obtained before initiating the study.'),
      bullet('Written informed consent (English and Tamil) will be obtained from all participants.'),
      bullet('For participants aged 15–17 years, assent will be obtained along with guardian consent.'),
      bullet('Participation is entirely voluntary; participants can withdraw at any time without affecting their care.'),
      bullet('Patient identity and data will be kept strictly confidential; no personal identifiers will be published.'),
      bullet('This is a non-interventional, observational study with no invasive procedures.'),
      bullet('No additional financial burden will be imposed on participants.'),
      bullet('The study does not involve any experimental drugs, devices, or genetic testing.'),
      blankLine(),

      // Expected Outcome
      para([bold('Expected Outcome', 24)]),
      para('The majority of patients are expected to show moderate to very large QoL impairment (DLQI 6–20). Higher DLQI scores are anticipated in patients with:'),
      bullet('Chronic and recurrent disease'),
      bullet('Multiple site involvement'),
      bullet('Extensive BSA involvement'),
      para('Results will help quantify the psychosocial burden of dermatophytosis and guide patient-centred management in the South Indian population.'),
      blankLine(),

      // References
      para([bold('References', 26)]),
      para([normal('1. ', 24), normal('Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) – a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19(3):210–216.', 24)]),
      para([normal('2. ', 24), normal('Verma S, Madhu R. The Great Indian Tinea Epidemic: Current Scenario, Challenges and Recommendations. IJDVL. 2017;83(3):227–236.', 24)]),
      para([normal('3. ', 24), normal('Dogra S, Uprety S. The menace of chronic and recurrent dermatophytosis in India: is the problem deeper than we perceive? Indian Dermatol Online J. 2016;7(2):73–76.', 24)]),
      para([normal('4. ', 24), normal('Panda S, Verma S. The menace of dermatophytosis in India: the evidence that we need. IJDVL. 2017;83(4):4–8.', 24)]),
      para([normal('5. ', 24), normal('Singh SK, Subba N, Tilak R, et al. Quality of life assessment in patients with dermatophytosis: A cross-sectional study. Indian J Dermatol. 2019;64(5):377–382.', 24)]),
      blankLine(),

      // ═══════════════════════════════════════════════════════════════════════
      // SECTION D – CHECKLIST
      // ═══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('SECTION D – CHECKLIST OF DOCUMENTS SUBMITTED', 26, true),
      blankLine(),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('S.No.', 22)], spacing: { before: 40, after: 40 } })], { width: 8, shading: true }),
            cell([new Paragraph({ children: [bold('Document', 22)], spacing: { before: 40, after: 40 } })], { width: 55, shading: true }),
            cell([new Paragraph({ children: [bold('Enclosed', 22)], spacing: { before: 40, after: 40 } })], { width: 20, shading: true }),
            cell([new Paragraph({ children: [bold('Page No.', 22)], spacing: { before: 40, after: 40 } })], { width: 17, shading: true })
          ]}),
          new TableRow({ children: [cell('1', {}), cell('Copy of detailed protocol in prescribed format', {}), cell('Yes', {}), cell('', {})] }),
          new TableRow({ children: [cell('2', {}), cell('Participant information sheet & Informed consent (English & Tamil)', {}), cell('Yes', {}), cell('', {})] }),
          new TableRow({ children: [cell('3', {}), cell('Assent form for minors in English & local language (if applicable)', {}), cell('Yes (15–17 yrs)', {}), cell('', {})] }),
          new TableRow({ children: [cell('4', {}), cell('Proforma / Questionnaire – DLQI (English & Tamil)', {}), cell('Yes', {}), cell('', {})] }),
          new TableRow({ children: [cell('5', {}), cell('Brief updated CV of all investigators', {}), cell('Yes', {}), cell('', {})] }),
          new TableRow({ children: [cell('6', {}), cell('Agreement letter from other departmental heads (inter-departmental studies)', {}), cell('NA (Single dept.)', {}), cell('', {})] }),
          new TableRow({ children: [cell('7', {}), cell('Letter(s) of approval from collaborating institutions / DCGI / CTRI', {}), cell('NA', {}), cell('', {})] }),
          new TableRow({ children: [cell('8', {}), cell('Declaration signed by all investigators and forwarded by Head of Department', {}), cell('Yes', {}), cell('', {})] }),
          new TableRow({ children: [cell('9', {}), cell("Investigator's brochure (drug/biological/device trials)", {}), cell('NA', {}), cell('', {})] }),
          new TableRow({ children: [cell('10', {}), cell('Advertisement / material to recruit participants', {}), cell('NA', {}), cell('', {})] }),
          new TableRow({ children: [cell('11', {}), cell('Proposed compensation / reimbursement of incidental expenses / management of research-related injury', {}), cell('NA (No compensation; no risk of injury)', {}), cell('', {})] })
        ]
      }),
      blankLine(),

      // ═══════════════════════════════════════════════════════════════════════
      // DECLARATION
      // ═══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('DECLARATION BY INVESTIGATORS', 26, true),
      blankLine(),
      para('We, the undersigned, hereby declare that:'),
      bullet('The information provided in this application is accurate and complete to the best of our knowledge.'),
      bullet('The study will be conducted in accordance with the ICH-GCP guidelines, Declaration of Helsinki, and ICMR National Ethical Guidelines for Biomedical and Health Research Involving Human Participants (2017).'),
      bullet('We will obtain written informed consent from all participants before enrollment.'),
      bullet('We will report any serious adverse events or protocol deviations to the IEC without delay.'),
      bullet('We will maintain all study records and make them available for IEC audit if required.'),
      bullet('We will not commence the study before obtaining formal IEC approval.'),
      blankLine(),
      blankLine(),
      signatureLine('Signature of Principal Investigator', 'Signature of Guide'),
      para([normal('Dr. RAJADURAI. I\t\t\t\t\t\tDr. S. KUMARAVEL', 22)]),
      para([normal('Junior Resident\t\t\t\t\t\tProfessor & HOD', 22)]),
      para([normal('Dept. of DVL, MMCHRI\t\t\t\t\t\tDept. of DVL, MMCHRI', 22)]),
      blankLine(),
      blankLine(),
      signatureLine('Signature of Co-Guide'),
      para([normal('Dr. R. RAJESH', 22)]),
      para([normal('Professor, Dept. of DVL, MMCHRI', 22)]),
      blankLine(),
      blankLine(),
      signatureLine('Signature and Seal of Head of Department'),
      para([normal('Dr. S. KUMARAVEL', 22)]),
      para([normal('Professor & HOD, Dept. of Dermatology, MMCHRI', 22)]),
      para([normal('Date: _______________', 22)]),
      blankLine(),

      // ═══════════════════════════════════════════════════════════════════════
      // UNDERTAKING BY PI
      // ═══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('UNDERTAKING BY THE PRINCIPAL INVESTIGATOR', 26, true),
      blankLine(),
      para([bold('1. Name of the Project: ', 24)]),
      para('"A Clinico-Epidemiological Study on Quality of Life in Patients with Dermatophytosis Using DLQI"'),
      blankLine(),
      para([bold('2. Name, Designation and Department of the Principal Investigator: ', 24)]),
      para('Dr. RAJADURAI. I'),
      para('Junior Resident'),
      para('Department of Dermatology, Venereology and Leprology'),
      para('Meenakshi Medical College Hospital & Research Institute, Kanchipuram'),
      blankLine(),
      para([bold('3. Undertaking: ', 24)]),
      para('I, Dr. RAJADURAI. I, Principal Investigator for the above study, hereby undertake that:'),
      bullet('I will obtain IEC approval before commencing the study.'),
      bullet('I will adhere to the approved protocol and not make any amendments without prior IEC approval.'),
      bullet('I will obtain written informed consent from every participant.'),
      bullet('I will maintain confidentiality of participant data.'),
      bullet('I will report any adverse events or unanticipated problems to the IEC immediately.'),
      bullet('I will submit periodic progress reports and a final report to the IEC as required.'),
      blankLine(),
      blankLine(),
      para([normal('Signature of Principal Investigator: ___________________________', 22)]),
      para([normal('Name: Dr. RAJADURAI. I', 22)]),
      para([normal('Date: _______________', 22)]),
      blankLine(),
      blankLine(),

      // ═══════════════════════════════════════════════════════════════════════
      // INFORMED CONSENT FORM (ENGLISH)
      // ═══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('PARTICIPANT INFORMATION SHEET AND INFORMED CONSENT FORM', 26, true),
      centeredBold('(English Version)', 24),
      blankLine(),
      para([bold('Study Title: ', 24), normal('"A Clinico-Epidemiological Study on Quality of Life in Patients with Dermatophytosis Using DLQI"', 24)]),
      para([bold('Principal Investigator: ', 24), normal('Dr. RAJADURAI. I, Junior Resident, Dept. of DVL, MMCHRI, Kanchipuram', 24)]),
      para([bold('Guide: ', 24), normal('Dr. S. KUMARAVEL, Professor & HOD, Dept. of DVL, MMCHRI', 24)]),
      blankLine(),
      para([bold('Introduction:', 24)]),
      para('You are being invited to take part in a research study. Before you decide whether to participate, it is important for you to understand why the research is being done and what it will involve. Please read the following information carefully. You are free to ask any questions.'),
      blankLine(),
      para([bold('Purpose of the Study:', 24)]),
      para('This study aims to assess the impact of your skin infection (fungal infection / ringworm) on your daily life and quality of life using a validated questionnaire called the Dermatology Life Quality Index (DLQI).'),
      blankLine(),
      para([bold('What will happen if you take part:', 24)]),
      bullet('A brief clinical history will be recorded.'),
      bullet('A skin examination will be performed.'),
      bullet('You will be asked to fill in or answer a 10-question questionnaire. This will take approximately 5–10 minutes.'),
      bullet('No blood test, biopsy, or any invasive procedure will be done for this study.'),
      blankLine(),
      para([bold('Risks:', 24)]),
      para('There are no risks associated with participation. This is an observational study involving only a questionnaire.'),
      blankLine(),
      para([bold('Benefits:', 24)]),
      para('You will not directly benefit from this study. However, results from this study may help improve the overall management of patients with fungal skin infections.'),
      blankLine(),
      para([bold('Confidentiality:', 24)]),
      para('All information collected will be kept strictly confidential. Your name and identity will not appear in any published report. Data will be stored securely.'),
      blankLine(),
      para([bold('Voluntary Participation:', 24)]),
      para('Your participation is entirely voluntary. You may refuse to participate or withdraw at any time without it affecting your treatment or care.'),
      blankLine(),
      para([bold('Contact:', 24)]),
      para('If you have any questions or concerns about this study, please contact: Dr. RAJADURAI. I, Dept. of DVL, MMCHRI, Kanchipuram. Ph: +91 7401441069'),
      blankLine(),
      para([bold('PATIENT\'S DECLARATION:', 26)]),
      blankLine(),
      para('Patient\'s Name: ______________________________     Age: __________'),
      blankLine(),
      para('I confirm that I have read (or had explained to me) the above information. I have had the opportunity to ask questions and am satisfied with the answers given. I understand that my participation is voluntary and I am free to withdraw at any time without affecting my medical care. I understand that my identity will remain confidential. I agree to take part in this study.'),
      blankLine(),
      blankLine(),
      signatureLine('Signature / Thumb impression of Participant', 'Date'),
      blankLine(),
      signatureLine('Signature of Parent / Guardian (if applicable)', 'Date'),
      blankLine(),
      signatureLine('Signature of Witness', 'Date'),
      blankLine(),
      signatureLine('Signature of Investigator', 'Date'),
      blankLine(),

      // ═══════════════════════════════════════════════════════════════════════
      // CASE PROFORMA
      // ═══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('CASE PROFORMA', 26, true),
      blankLine(),
      para([bold('SECTION 1: PATIENT IDENTIFICATION', 24)]),
      para('Name: _______________________________   IP/OP No.: _______________'),
      para('Age: _______   Sex: M / F   Date: ________________'),
      para('Occupation: _________________________   Education: _______________'),
      para('Socioeconomic Status: Upper / Middle / Lower'),
      blankLine(),
      para([bold('SECTION 2: CHIEF COMPLAINTS', 24)]),
      para('Itching: Yes / No    Duration: ____________'),
      para('Skin lesions: Yes / No    Duration: ____________'),
      blankLine(),
      para([bold('SECTION 3: HISTORY OF PRESENT ILLNESS', 24)]),
      para('Duration of disease: ________________'),
      para('First episode / Recurrent (if recurrent, number of episodes: _____)'),
      para('Previous treatment taken: Yes / No    Type: ___________________'),
      para('Similar complaints in family: Yes / No'),
      blankLine(),
      para([bold('SECTION 4: PAST HISTORY', 24)]),
      para('Diabetes mellitus: Yes / No'),
      para('Immunosuppression / Chronic illness: Yes / No    Details: ___________'),
      blankLine(),
      para([bold('SECTION 5: GENERAL EXAMINATION', 24)]),
      para('BP: ___________   PR: ___________   Weight: ___________'),
      blankLine(),
      para([bold('SECTION 6: CLINICAL DETAILS', 24)]),
      para('Type of Dermatophytosis:'),
      bullet('Tinea corporis   □'),
      bullet('Tinea cruris   □'),
      bullet('Tinea faciei   □'),
      bullet('Tinea manuum   □'),
      bullet('Tinea pedis   □'),
      bullet('Tinea unguium   □'),
      bullet('Others: _______________'),
      para('Number of sites: Single / Multiple (specify: _______)'),
      para('Body Surface Area (BSA) involved: _______ %'),
      para('Duration: _________________'),
      para('Chronic (> 6 months): Yes / No'),
      para('Recurrent: Yes / No'),
      blankLine(),
      para([bold('SECTION 7: DLQI SCORE', 24)]),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Q. No.', 22)], spacing: { before: 40, after: 40 } })], { width: 10, shading: true }),
            cell([new Paragraph({ children: [bold('Question (last week)', 22)], spacing: { before: 40, after: 40 } })], { width: 60, shading: true }),
            cell([new Paragraph({ children: [bold('Score (0–3)', 22)], spacing: { before: 40, after: 40 } })], { width: 30, shading: true })
          ]}),
          new TableRow({ children: [cell('Q1'), cell('How itchy, sore, painful or stinging has your skin been?'), cell('')] }),
          new TableRow({ children: [cell('Q2'), cell('How embarrassed or self-conscious have you been because of your skin?'), cell('')] }),
          new TableRow({ children: [cell('Q3'), cell('How much has your skin interfered with you going shopping or looking after your home?'), cell('')] }),
          new TableRow({ children: [cell('Q4'), cell('How much has your skin influenced the clothes you wear?'), cell('')] }),
          new TableRow({ children: [cell('Q5'), cell('How much has your skin affected any social or leisure activities?'), cell('')] }),
          new TableRow({ children: [cell('Q6'), cell('How much has your skin made it difficult for you to do any sport?'), cell('')] }),
          new TableRow({ children: [cell('Q7'), cell('Has your skin prevented you from working or studying?'), cell('')] }),
          new TableRow({ children: [cell('Q8'), cell('How much has your skin created problems with your partner or any of your close friends or relatives?'), cell('')] }),
          new TableRow({ children: [cell('Q9'), cell('How much has your skin caused any sexual difficulties?'), cell('')] }),
          new TableRow({ children: [cell('Q10'), cell('How much of a problem has the treatment for your skin been?'), cell('')] }),
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('TOTAL DLQI SCORE', 22)], spacing: { before: 40, after: 40 } })], { width: 70, shading: true }),
            cell('', {}),
            cell('', {})
          ]})
        ]
      }),
      blankLine(),
      para([bold('Interpretation: ', 24), normal('0–1: No effect | 2–5: Small | 6–10: Moderate | 11–20: Very large | 21–30: Extremely large', 24)]),

    ]
  }]
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/iec-thesis/IEC_Corrected_Thesis_Dermatophytosis_DLQI.docx', buffer);
  console.log('Document created successfully.');
});

cd /home/daytona/workspace/iec-thesis && node generate_thesis.js 2>&1

ls -lh /home/daytona/workspace/iec-thesis/ && python3 /home/daytona/skills/docx/…

python3 /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/works…

# Quick integrity check: verify it's a valid zip/docx and can be read back pytho…

python3 /home/daytona/skills/docx/scripts/office/soffice.py --headless --convert…

cp /home/daytona/workspace/iec-thesis/IEC_Corrected_Thesis_Dermatophytosis_DLQI.…

ls -lh /home/daytona/workspace/iec-thesis/IEC_Corrected_Thesis_Dermatophytosis_D…

cd /home/daytona/workspace/attachments/9453e53d-8394-4f44-83e3-743242fec744 && p…

~/iec-thesis/generate_sarumathi.js

const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  AlignmentType, HeadingLevel, BorderStyle, WidthType, VerticalAlign,
  UnderlineType, ShadingType
} = require('docx');
const fs = require('fs');

// ─── helpers ────────────────────────────────────────────────────────────────
const bold = (text, size = 24, underline = false) => new TextRun({
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});
const normal = (text, size = 24) => new TextRun({ text, size });
const italic = (text, size = 24) => new TextRun({ text, italics: true, size });

const centeredBold = (text, size = 28, underline = false) => new Paragraph({
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  children: [bold(text, size, underline)]
});

const para = (runs, spacing = { before: 80, after: 80 }) => new Paragraph({
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  spacing
});

const bullet = (text, size = 24) => new Paragraph({
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});

const blankLine = () => new Paragraph({ children: [new TextRun('')], spacing: { before: 60, after: 60 } });

const signatureLine = (label1, label2) => {
  if (!label2) {
    return new Paragraph({ children: [bold(label1, 22)], spacing: { before: 200, after: 60 } });
  }
  return new Paragraph({
    children: [normal(label1 + '\t\t\t\t\t\t', 22), normal(label2, 22)],
    spacing: { before: 200, after: 60 }
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};

const thinBorder = { style: BorderStyle.SINGLE, size: 4, color: '000000' };

const cell = (children, opts = {}) => new TableCell({
  children: Array.isArray(children) ? children : [new Paragraph({ children: [normal(children, 22)], spacing: { before: 60, after: 60 } })],
  width: opts.width ? { size: opts.width, type: WidthType.PERCENTAGE } : undefined,
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  borders: { top: thinBorder, bottom: thinBorder, left: thinBorder, right: thinBorder },
  verticalAlign: VerticalAlign.TOP,
  columnSpan: opts.span || 1
});

// ─── DOCUMENT ────────────────────────────────────────────────────────────────
const doc = new Document({
  styles: {
    default: { document: { run: { font: 'Times New Roman', size: 24 } } }
  },
  sections: [{
    properties: { page: { margin: { top: 1080, bottom: 1080, left: 1260, right: 1260 } } },
    children: [

      // ══════════════════════════════════════════════════════════
      // INSTITUTION HEADER
      // ══════════════════════════════════════════════════════════
      centeredBold('Faculty of Medicine – Meenakshi Medical College Hospital & Research Institute', 28, true),
      centeredBold('Institutional Ethics Committee – Human Studies', 26, true),
      blankLine(),

      // ══════════════════════════════════════════════════════════
      // COVER LETTER
      // ══════════════════════════════════════════════════════════
      centeredBold('COVER LETTER', 26, true),
      blankLine(),
      para('Date: 18.02.2026'),
      blankLine(),
      para([bold('From,', 24)]),
      para('Dr. SARUMATHI S'),
      para('Junior Resident (1st Year PG)'),
      para('Department of Dermatology, Venereology and Leprology'),
      para('Meenakshi Medical College Hospital & Research Institute, Kanchipuram'),
      blankLine(),
      para([bold('To,', 24)]),
      para('The Chairperson,'),
      para('Institutional Ethics Committee,'),
      para('MMCHRI, Kanchipuram'),
      blankLine(),
      para('Through Proper Channel'),
      blankLine(),
      para([bold('Respected Sir/Madam,', 24)]),
      blankLine(),
      para([
        bold('Sub: ', 24),
        normal('Request for ethical clearance for the study ', 24),
        bold('"A Cross-Sectional Study of Topical Corticosteroid Abuse on the Face and Its Dermatological Consequences"', 24)
      ]),
      blankLine(),
      para('I, Dr. SARUMATHI S, Junior Resident (PG), of Meenakshi Medical College Hospital & Research Institute, am interested to conduct a project titled "A Cross-Sectional Study of Topical Corticosteroid Abuse on the Face and Its Dermatological Consequences" under the guidance of Dr. S. KUMARAVEL, Professor and Head, Department of Dermatology, Venereology and Leprology, Meenakshi Medical College Hospital & Research Institute. A copy of this study proposal has been attached. I kindly request you to give me ethical clearance and approval to conduct this study. Please do the needful.'),
      blankLine(),
      para('The following documents are enclosed for your review:'),
      bullet('Study Protocol (including Abstract)'),
      bullet('Informed Consent Documents: Participant Information Sheet and Informed Consent Form (English and Tamil)'),
      bullet('Questionnaire / Case Proforma'),
      bullet('Curriculum Vitae of the Principal Investigator and Guide'),
      blankLine(),
      para('Thanking you.'),
      blankLine(),
      para('Yours sincerely,'),
      blankLine(),
      blankLine(),
      signatureLine('Signature of the Guide', 'Signature of the Candidate / Investigator'),
      blankLine(),
      signatureLine('Signature of the HOD'),
      blankLine(),

      // page break
      new Paragraph({ children: [], pageBreakBefore: true }),

      // ══════════════════════════════════════════════════════════
      // IEC HEADER TABLE
      // ══════════════════════════════════════════════════════════
      centeredBold('Application for Submission of Research Proposals to SAC/IEC Review (Human Studies)', 24, true),
      blankLine(),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('IEC Reference No.', 22)], spacing: { before: 60, after: 30 } }), new Paragraph({ children: [normal('_______________', 22)], spacing: { before: 20, after: 40 } })], { width: 33 }),
            cell([new Paragraph({ children: [bold('Project Type', 22)], spacing: { before: 60, after: 30 } }), new Paragraph({ children: [normal('PG / Faculty / UG / Ph.D / STS, others specify: ________', 22)], spacing: { before: 20, after: 40 } })], { width: 33 }),
            cell([new Paragraph({ children: [bold('Date of Submission', 22)], spacing: { before: 60, after: 30 } }), new Paragraph({ children: [normal('18.02.2026', 22)], spacing: { before: 20, after: 40 } })], { width: 34 })
          ]})
        ]
      }),
      blankLine(),

      // ══════════════════════════════════════════════════════════
      // SECTION A – BASIC INFORMATION
      // ══════════════════════════════════════════════════════════
      centeredBold('SECTION A – BASIC INFORMATION', 26, true),
      blankLine(),
      para([bold('Title of Research Proposal: ', 24), normal('"A Cross-Sectional Study of Topical Corticosteroid Abuse on the Face and Its Dermatological Consequences"', 24)]),
      blankLine(),
      new Table({
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        rows: [
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            cell([new Paragraph({ children: [bold('Principal Investigator (PI)', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
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              new Paragraph({ children: [bold('Designation: ', 22), normal('Junior Resident (1st Year PG)', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Department: ', 22), normal('Dermatology, Venereology and Leprology', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Institution: ', 22), normal('MMCHRI, Kanchipuram', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Mobile: ', 22), normal('+91 9751348326', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Email: ', 22), normal('ssarumathi00@gmail.com', 22)], spacing: { before: 20, after: 40 } })
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          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Guide', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
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              new Paragraph({ children: [bold('Department: ', 22), normal('Dermatology, Venereology and Leprology', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Mobile: ', 22), normal('+91 9884646324', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Email: ', 22), normal('kumaravel1959@gmail.com', 22)], spacing: { before: 20, after: 40 } })
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            cell([
              new Paragraph({ children: [bold('Name: ', 22), normal('Dr. NIRMALA', 22)], spacing: { before: 40, after: 20 } }),
              new Paragraph({ children: [bold('Designation: ', 22), normal('Assistant Professor', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Department: ', 22), normal('Dermatology, Venereology and Leprology', 22)], spacing: { before: 20, after: 20 } }),
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              new Paragraph({ children: [bold('Email: ', 22), normal('nirmalaravi50@gmail.com', 22)], spacing: { before: 20, after: 40 } })
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            cell([new Paragraph({ children: [bold('Source of Funding', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
            cell([new Paragraph({ children: [normal('Self-funded / Institutional (No external funding)', 22)], spacing: { before: 40, after: 40 } })], { width: 70 })
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            cell([new Paragraph({ children: [bold('Conflict of Interest', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
            cell([new Paragraph({ children: [normal('None', 22)], spacing: { before: 40, after: 40 } })], { width: 70 })
          ]})
        ]
      }),
      blankLine(),

      // ══════════════════════════════════════════════════════════
      // SECTION B – STUDY OVERVIEW
      // ══════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('SECTION B – STUDY OVERVIEW', 26, true),
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      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Study Type', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('Observational – Cross-sectional study')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Study Design', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('Hospital-based, cross-sectional, descriptive')] }),
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          new TableRow({ children: [cell([new Paragraph({ children: [bold('Duration of Study', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('12 months from date of IEC approval')] }),
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          new TableRow({ children: [cell([new Paragraph({ children: [bold('Participant Category', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('All age groups and both sexes; patients with history of topical corticosteroid use on face for ≥ 2 weeks attending DVL OPD')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Ethical Risk Level', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('Minimal Risk – Observational study; history and clinical examination only; no invasive procedure')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Drugs / Devices Involved', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('No experimental drugs or devices')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold("Investigator's Brochure enclosed?", 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('Not Applicable')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Preclinical / In vitro studies done?', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('Not Applicable')] }),
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        ]
      }),
      blankLine(),

      // ══════════════════════════════════════════════════════════
      // SECTION C – DETAILED RESEARCH PROPOSAL
      // ══════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('SECTION C – DETAILED RESEARCH PROPOSAL', 26, true),
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      // Title
      para([bold('Title of the Project: ', 24)]),
      para([bold('"A Cross-Sectional Study of Topical Corticosteroid Abuse on the Face and Its Dermatological Consequences"', 24)]),
      para([italic('(Observational cross-sectional study; Major outcome: clinical patterns of facial dermatoses; Major predictor: type, duration, potency, source of corticosteroid use; Setting: DVL OPD, MMCHRI, Kanchipuram; Subjects: patients ≥12 years with facial TCS use ≥2 weeks)', 22)]),
      blankLine(),

      // Background
      para([bold('Background / Introduction', 26)]),
      para([bold('1. Relevance and current state of knowledge:', 24)]),
      para('Topical corticosteroids (TCS) are among the most widely prescribed dermatological agents. However, their unsupervised and prolonged use on the face has emerged as a significant public health concern in India. Freely available over the counter and frequently dispensed by pharmacists and beauticians, potent and very-potent TCS preparations – including fixed-dose combination creams containing clobetasol with antifungals and antibiotics – are widely misused, particularly by women seeking fairness and by patients self-treating acne, pigmentation, and other facial conditions.'),
      blankLine(),
      para([bold('2. What led to this research question:', 24)]),
      para('In routine dermatology practice at MMCHRI, a large number of patients present with iatrogenic facial dermatoses attributable to TCS misuse. Clinical features observed include steroid-induced acne, rosacea-like dermatitis, perioral dermatitis, facial erythema, telangiectasia, hyperpigmentation, and skin atrophy. The phenomenon of "topical steroid-dependent face" – where patients are unable to discontinue TCS due to severe rebound flares on withdrawal – adds to the complexity of management.'),
      blankLine(),
      para([bold('3. Gaps in knowledge:', 24)]),
      para('Although multiple hospital-based studies document TCS abuse in India, there is a lack of comprehensive data from South India – particularly from semi-urban and rural populations – that correlates duration of use, potency of steroid preparation, and severity of clinical manifestations in a structured manner. Regional data are essential to plan targeted patient education and policy interventions.'),
      blankLine(),
      para([bold('4. Research question and justification:', 24)]),
      para('What are the clinical patterns, associated factors, and dermatological consequences of topical corticosteroid abuse on the face among patients attending a tertiary care centre in Kanchipuram? Generating such data will guide dermatologists in early recognition, promote rational prescribing, support community-level awareness, and contribute to future regulatory strategies.'),
      blankLine(),

      // Objectives
      para([bold('Objectives', 26)]),
      para([bold('Primary Objective:', 24)]),
      bullet('To study the clinical manifestations and patterns of facial dermatoses resulting from topical corticosteroid abuse.'),
      blankLine(),
      para([bold('Secondary Objectives:', 24)]),
      bullet('To identify the commonly misused TCS preparations (type, potency, combination creams)'),
      bullet('To assess duration and frequency of corticosteroid use'),
      bullet('To analyze the source of recommendation (dermatologist / general practitioner / pharmacist / self / beautician / friends)'),
      bullet('To document the demographic profile of affected patients'),
      bullet('To observe and classify dermatological complications'),
      bullet('To evaluate clinical improvement after TCS discontinuation'),
      blankLine(),

      // Review of Literature
      para([bold('Brief Review of Literature', 26)]),
      para([italic('(Minimum 5 relevant references; chronological order; recent references < 5 years preferred)', 22)]),
      blankLine(),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Authors & Year', 22)], spacing: { before: 60, after: 60 } })], { width: 22, shading: true }),
            cell([new Paragraph({ children: [bold('Study / Journal', 22)], spacing: { before: 60, after: 60 } })], { width: 28, shading: true }),
            cell([new Paragraph({ children: [bold('Key Findings', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
            cell([new Paragraph({ children: [bold('Relevance', 22)], spacing: { before: 60, after: 60 } })], { width: 20, shading: true })
          ]}),
          new TableRow({ children: [
            cell('Saraswat A et al. (2011)', {}),
            cell('Br J Dermatol 2011; 165:617–21', {}),
            cell('Irrational use of TCS reported in 75% of patients; clobetasol most commonly misused; acne, rosacea-like dermatitis, hyperpigmentation as major complications.', {}),
            cell('Establishes prevalence and patterns of TCS misuse in India', {})
          ]}),
          new TableRow({ children: [
            cell('Rathi SK, D\'Souza P (2012)', {}),
            cell('Indian J Dermatol Venereol Leprol 2012; 78:409–14', {}),
            cell('Pharmacists were the primary source of TCS in 52% cases; over-the-counter availability was a major driver of abuse.', {}),
            cell('Supports objective on source of recommendation', {})
          ]}),
          new TableRow({ children: [
            cell('Hengge UR et al. (2006)', {}),
            cell('J Am Acad Dermatol 2006; 54:1–15', {}),
            cell('Comprehensive review of TCS adverse effects including skin atrophy, telangiectasia, and hypothalamic–pituitary–adrenal axis suppression.', {}),
            cell('Defines spectrum of complications studied', {})
          ]}),
          new TableRow({ children: [
            cell('Lahiri K, Coondoo A (2016)', {}),
            cell('Indian J Dermatol 2016; 61:135–43', {}),
            cell('Topical steroid-dependent face described; highlights psychological dependence and withdrawal rebound phenomenon.', {}),
            cell('Directly relevant to complication and withdrawal objective', {})
          ]}),
          new TableRow({ children: [
            cell('Ambika H et al. (2018)', {}),
            cell('J Clin Diagn Res 2018; 12(4):WC01–WC04', {}),
            cell('Cross-sectional study; 68% patients were female; fairness purpose was commonest indication; hyperpigmentation and acne were most frequent complications.', {}),
            cell('Study design and objectives directly comparable to present study', {})
          ]}),
          new TableRow({ children: [
            cell('Coondoo A et al. (2014)', {}),
            cell('Indian J Dermatol 2014; 59:465–72', {}),
            cell('Steroid-induced rosacea-like dermatitis; histopathological and clinical correlation; responds well to metronidazole and TCS withdrawal.', {}),
            cell('Relevant to clinical pattern and management', {})
          ]}),
          new TableRow({ children: [
            cell('Dey VK (2014)', {}),
            cell('Indian J Dermatol 2014; 59:451–55', {}),
            cell('Misuse of topical corticosteroids: a clinical study; duration > 6 months strongly correlated with severity of adverse effects.', {}),
            cell('Supports correlation of duration with complications', {})
          ]})
        ]
      }),
      blankLine(),

      // Methodology
      para([bold('Methodology', 26)]),
      blankLine(),
      para([bold('Study Design: ', 24), normal('Hospital-based observational cross-sectional study.', 24)]),
      para([bold('Study Setting: ', 24), normal('Department of Dermatology, Venereology and Leprology, Meenakshi Medical College Hospital & Research Institute, Kanchipuram.', 24)]),
      para([bold('Study Duration: ', 24), normal('12 months from the date of IEC approval.', 24)]),
      blankLine(),
      para([bold('Sample Size:', 24)]),
      para('Estimated minimum sample size: 100 patients.'),
      para('Calculated using: n = Z²P(1-P)/d²'),
      bullet('Z = 1.96 (95% confidence interval)'),
      bullet('P = 50% (estimated prevalence of TCS abuse-related facial dermatoses)'),
      bullet('d = 10% (allowable error)'),
      para('A 10% contingency for non-response/drop-out has been accounted for.'),
      blankLine(),
      para([bold('Inclusion Criteria:', 24)]),
      bullet('Patients of all age groups and both sexes attending Dermatology OPD'),
      bullet('History of topical corticosteroid application on the face for ≥ 2 weeks'),
      bullet('Presenting with clinical features suggestive of TCS abuse'),
      bullet('Willing to provide written informed consent (and assent for minors)'),
      blankLine(),
      para([bold('Exclusion Criteria:', 24)]),
      bullet('Patients receiving systemic corticosteroid therapy'),
      bullet('Patients with primary facial dermatoses unrelated to steroid use'),
      bullet('Patients with severe systemic illness'),
      bullet('Patients unwilling to participate'),
      blankLine(),
      para([bold('Independent Variables:', 24)]),
      bullet('Age, sex, occupation, education, socioeconomic status'),
      bullet('Duration of TCS use, frequency of application'),
      bullet('Type and potency of steroid preparation used'),
      bullet('Source of recommendation (dermatologist / GP / pharmacist / self / beautician / friend)'),
      bullet('Indication for use (acne / pigmentation / fairness / melasma / other)'),
      blankLine(),
      para([bold('Dependent Variables:', 24)]),
      bullet('Type of facial dermatosis (acneiform eruption, rosacea-like dermatitis, perioral dermatitis, erythema, telangiectasia, hyperpigmentation, skin atrophy, others)'),
      bullet('Severity of clinical manifestations'),
      bullet('Presence of topical steroid-dependent face / withdrawal rebound'),
      blankLine(),
      para([bold('Study Procedure:', 24)]),
      para([bold('1. Consent and Enrollment: ', 24), normal('Patients attending the DVL OPD with history of topical steroid use on face will be screened. The study will be explained in the local language (Tamil/English). Written informed consent will be obtained before enrollment.', 24)]),
      para([bold('2. History Taking: ', 24), normal('A detailed history will be recorded including indication for use, duration, frequency of application, name and potency of preparation, source of recommendation, and use of combination creams.', 24)]),
      para([bold('3. Clinical Examination: ', 24), normal('A thorough dermatological examination will be conducted. Clinical findings (acne, rosacea-like dermatitis, pigmentation, telangiectasia, skin thinning, and other changes) will be recorded in the structured case proforma. No additional invasive procedures will be performed for this study.', 24)]),
      para([bold('4. Follow-up (where applicable): ', 24), normal('Clinical improvement following TCS discontinuation will be assessed at follow-up visits as part of routine clinical care.', 24)]),
      blankLine(),
      para([bold('Statistical Analysis:', 24)]),
      bullet('Data entered in MS Excel and analyzed using SPSS software.'),
      bullet('Descriptive statistics: frequency, percentage, mean ± SD for demographic and clinical variables.'),
      bullet('Categorical variables: Chi-square test.'),
      bullet('Continuous variables: Student\'s t-test / ANOVA as applicable.'),
      bullet('p-value < 0.05 considered statistically significant.'),
      blankLine(),

      // Ethical Considerations
      para([bold('Ethical Considerations', 26)]),
      bullet('IEC approval will be obtained before initiating the study.'),
      bullet('Written informed consent (English and Tamil) will be obtained from all adult participants.'),
      bullet('For participants aged 12–17 years, assent will be obtained in addition to guardian consent.'),
      bullet('Participation is entirely voluntary; participants may withdraw at any time without affecting their care.'),
      bullet('Patient identity and data will be kept strictly confidential; no personal identifiers will be published.'),
      bullet('This is a non-interventional, observational study with no invasive procedures.'),
      bullet('No additional financial burden will be imposed on participants.'),
      bullet('The study does not involve experimental drugs, devices, or genetic testing.'),
      blankLine(),

      // Implications
      para([bold('Implications of the Study', 26)]),
      para([bold('1. Early Recognition and Diagnosis: ', 24), normal('Documenting clinical patterns will enable dermatologists and general practitioners to recognize TCS abuse-related facial dermatoses early and initiate appropriate management.', 24)]),
      para([bold('2. Rational Prescription Practices: ', 24), normal('Identifying commonly misused preparations and their complications will encourage healthcare providers to prescribe TCS judiciously, with clear instructions on duration and potency.', 24)]),
      para([bold('3. Patient Education and Awareness: ', 24), normal('Data from this study will inform targeted patient education campaigns regarding the hazards of unsupervised TCS use and over-the-counter combination cream abuse.', 24)]),
      para([bold('4. Regulatory Impact: ', 24), normal('Evidence generated may support advocacy for stricter regulation of over-the-counter sale of potent topical corticosteroids and fixed-dose combination creams in India.', 24)]),
      blankLine(),

      // References
      para([bold('References', 26)]),
      para('1. Saraswat A, Lahiri K, Chatterjee M, et al. Topical corticosteroid abuse on the face: a prospective, multicentre study of dermatology outpatients. Indian J Dermatol Venereol Leprol. 2011;77(2):160–166.'),
      para('2. Rathi SK, D\'Souza P. Rational and ethical use of topical corticosteroids based on safety and efficacy. Indian J Dermatol Venereol Leprol. 2012;78(4):409–414.'),
      para('3. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54(1):1–15.'),
      para('4. Lahiri K, Coondoo A. Topical steroid damaged/dependent face (TSDF): an entity of many masks. Indian J Dermatol. 2016;61(2):135–143.'),
      para('5. Ambika H, Krishnamurthy S, Sunila. Topical corticosteroid abuse on face: a clinico-epidemiological study. J Clin Diagn Res. 2018;12(4):WC01–WC04.'),
      para('6. Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: a long overdue revisit. Indian Dermatol Online J. 2014;5(4):416–425.'),
      para('7. Dey VK. Misuse of topical corticosteroids: a clinical study of adverse effects. Indian Dermatol Online J. 2014;5(4):436–440.'),
      blankLine(),

      // ══════════════════════════════════════════════════════════
      // SECTION D – CHECKLIST
      // ══════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('SECTION D – CHECKLIST OF DOCUMENTS SUBMITTED', 26, true),
      blankLine(),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('S.No.', 22)], spacing: { before: 40, after: 40 } })], { width: 8, shading: true }),
            cell([new Paragraph({ children: [bold('Document', 22)], spacing: { before: 40, after: 40 } })], { width: 55, shading: true }),
            cell([new Paragraph({ children: [bold('Enclosed', 22)], spacing: { before: 40, after: 40 } })], { width: 20, shading: true }),
            cell([new Paragraph({ children: [bold('Page No.', 22)], spacing: { before: 40, after: 40 } })], { width: 17, shading: true })
          ]}),
          new TableRow({ children: [cell('1'), cell('Copy of detailed protocol in prescribed format'), cell('Yes'), cell('')] }),
          new TableRow({ children: [cell('2'), cell('Participant information sheet & Informed consent (English & Tamil)'), cell('Yes'), cell('')] }),
          new TableRow({ children: [cell('3'), cell('Assent form for minors in English & local language (if applicable)'), cell('Yes (12–17 yrs)'), cell('')] }),
          new TableRow({ children: [cell('4'), cell('Proforma / Questionnaire (English & Tamil)'), cell('Yes'), cell('')] }),
          new TableRow({ children: [cell('5'), cell('Brief updated CV of all investigators'), cell('Yes'), cell('')] }),
          new TableRow({ children: [cell('6'), cell('Agreement letter from other departmental heads (inter-departmental studies)'), cell('NA (Single dept.)'), cell('')] }),
          new TableRow({ children: [cell('7'), cell('Letter(s) of approval from collaborating institutions / DCGI / CTRI'), cell('NA'), cell('')] }),
          new TableRow({ children: [cell('8'), cell('Declaration signed by all investigators and forwarded by Head of Department'), cell('Yes'), cell('')] }),
          new TableRow({ children: [cell('9'), cell("Investigator's brochure (drug/biological/device trials)"), cell('NA'), cell('')] }),
          new TableRow({ children: [cell('10'), cell('Advertisement / material to recruit participants'), cell('NA'), cell('')] }),
          new TableRow({ children: [cell('11'), cell('Proposed compensation / reimbursement / management of research-related injury'), cell('NA (No compensation; no risk of injury)'), cell('')] })
        ]
      }),
      blankLine(),

      // ══════════════════════════════════════════════════════════
      // DECLARATION
      // ══════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('DECLARATION BY INVESTIGATORS', 26, true),
      blankLine(),
      para('We, the undersigned, hereby declare that:'),
      bullet('The information provided in this application is accurate and complete to the best of our knowledge.'),
      bullet('The study will be conducted in accordance with ICH-GCP guidelines, the Declaration of Helsinki, and ICMR National Ethical Guidelines for Biomedical and Health Research Involving Human Participants (2017).'),
      bullet('We will obtain written informed consent from all participants before enrollment.'),
      bullet('We will not implement any deviation from the approved protocol without prior IEC consent.'),
      bullet('We will report any serious adverse events or unanticipated problems to the IEC within 7 days.'),
      bullet('We will maintain all study records and make them available for IEC audit/inspection if required.'),
      bullet('We will submit annual progress reports and a final report to the IEC within 4 weeks of the due date.'),
      bullet('We will not commence the study before obtaining formal IEC approval.'),
      blankLine(),
      blankLine(),
      signatureLine('Signature of Principal Investigator', 'Signature of Guide'),
      para([normal('Dr. SARUMATHI S\t\t\t\t\t\tDr. S. KUMARAVEL', 22)]),
      para([normal('Junior Resident\t\t\t\t\t\tProfessor & HOD', 22)]),
      para([normal('Dept. of DVL, MMCHRI\t\t\t\t\t\tDept. of DVL, MMCHRI', 22)]),
      blankLine(),
      blankLine(),
      signatureLine('Signature of Co-Guide'),
      para([normal('Dr. NIRMALA', 22)]),
      para([normal('Assistant Professor, Dept. of DVL, MMCHRI', 22)]),
      blankLine(),
      blankLine(),
      signatureLine('Signature and Seal of Head of Department'),
      para([normal('Dr. S. KUMARAVEL', 22)]),
      para([normal('Professor & HOD, Dept. of Dermatology, MMCHRI', 22)]),
      para([normal('Date: _______________', 22)]),
      blankLine(),

      // ══════════════════════════════════════════════════════════
      // UNDERTAKING BY PI
      // ══════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('UNDERTAKING BY THE PRINCIPAL INVESTIGATOR', 26, true),
      blankLine(),
      para([bold('1. Name of the Project: ', 24)]),
      para('"A Cross-Sectional Study of Topical Corticosteroid Abuse on the Face and Its Dermatological Consequences"'),
      blankLine(),
      para([bold('2. Name, Designation and Department of the Principal Investigator: ', 24)]),
      para('Dr. SARUMATHI S'),
      para('Junior Resident (1st Year PG)'),
      para('Department of Dermatology, Venereology and Leprology'),
      para('Meenakshi Medical College Hospital & Research Institute, Kanchipuram'),
      blankLine(),
      para([bold('3. Undertaking: ', 24)]),
      para('I, Dr. SARUMATHI S, Principal Investigator for the above study, hereby undertake that:'),
      bullet('I will initiate the study only after obtaining IEC approval and all required regulatory clearances.'),
      bullet('I will not implement any deviation from the approved protocol without prior IEC consent.'),
      bullet('I confirm that the Co-PI and other members of the study team have been informed about their obligations and are qualified to meet them.'),
      bullet('I will personally supervise the study and ensure that requirements of obtaining informed consent and other ethical requirements under ICMR and National Regulatory Guidelines are adhered to.'),
      bullet('I will maintain accurate and complete records of all cases in accordance with GCP provisions and make them available for audit/inspection by IEC or regulatory authorities.'),
      bullet('I will inform the IEC of any unexpected or serious adverse event at the earliest and definitely within seven days of its occurrence.'),
      bullet('I will maintain confidentiality of the identity of all participating subjects and ensure security of study data.'),
      bullet('I will submit annual progress reports and a final report to the IEC within 4 weeks of the due date.'),
      blankLine(),
      blankLine(),
      para([normal('Signature of Principal Investigator: ___________________________', 22)]),
      para([normal('Name: Dr. SARUMATHI S', 22)]),
      para([normal('Date: _______________', 22)]),
      blankLine(),

      // ══════════════════════════════════════════════════════════
      // PARTICIPANT INFORMATION SHEET – ENGLISH
      // ══════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('PARTICIPANT INFORMATION SHEET AND INFORMED CONSENT FORM', 26, true),
      centeredBold('(English Version)', 24),
      blankLine(),
      para([bold('Study Title: ', 24), normal('"A Cross-Sectional Study of Topical Corticosteroid Abuse on the Face and Its Dermatological Consequences"', 24)]),
      para([bold('Principal Investigator: ', 24), normal('Dr. SARUMATHI S, Junior Resident, Dept. of DVL, MMCHRI, Kanchipuram. Ph: +91 9751348326', 24)]),
      para([bold('Guide: ', 24), normal('Dr. S. KUMARAVEL, Professor & HOD, Dept. of DVL, MMCHRI', 24)]),
      blankLine(),
      para([bold('Introduction:', 24)]),
      para('You are being invited to participate in a research study. Please read this information carefully. You are free to ask any questions before deciding whether to participate.'),
      blankLine(),
      para([bold('Purpose of the Study:', 24)]),
      para('This study aims to evaluate the clinical skin changes occurring on the face due to the use of steroid creams or combination creams containing steroids, and to understand the patterns and consequences of their misuse.'),
      blankLine(),
      para([bold('What will happen if you take part:', 24)]),
      bullet('A detailed history regarding your steroid cream use will be recorded (duration, type, reason for use, source of advice).'),
      bullet('A clinical skin examination of your face will be performed.'),
      bullet('No blood tests, biopsy, or any invasive procedure will be performed for this study.'),
      bullet('The study will not interfere with your ongoing treatment.'),
      blankLine(),
      para([bold('Risks:', 24)]),
      para('There are no risks associated with participation. This is an observational study involving only history-taking and clinical examination.'),
      blankLine(),
      para([bold('Benefits:', 24)]),
      para('There may not be any direct benefit to you. However, results from this study may help in creating awareness regarding steroid misuse and improving dermatological care in the future.'),
      blankLine(),
      para([bold('Confidentiality:', 24)]),
      para('All information collected will be kept strictly confidential. Your name and identity will not appear in any published report. Data will be stored securely and accessed only by the research team.'),
      blankLine(),
      para([bold('Voluntary Participation:', 24)]),
      para('Your participation is entirely voluntary. You may refuse to participate or withdraw at any time without it affecting your treatment or medical care.'),
      blankLine(),
      para([bold('Contact:', 24)]),
      para('If you have any questions or concerns about this study, please contact: Dr. SARUMATHI S, Dept. of DVL, MMCHRI, Kanchipuram. Ph: +91 9751348326'),
      blankLine(),
      para([bold("PATIENT'S DECLARATION:", 26)]),
      blankLine(),
      para("Patient's Name: ______________________________     Age: __________"),
      blankLine(),
      para('I confirm that I have read (or had explained to me) the above information. I have had the opportunity to ask questions and am satisfied with the answers given. I understand that my participation is voluntary and I am free to withdraw at any time without affecting my medical care. I understand that my identity will remain confidential. I agree to take part in this study.'),
      blankLine(),
      blankLine(),
      signatureLine('Signature / Thumb impression of Participant', 'Date'),
      blankLine(),
      signatureLine('Signature of Parent / Guardian (if applicable)', 'Date'),
      blankLine(),
      signatureLine('Signature of Witness', 'Date'),
      blankLine(),
      signatureLine('Signature of Investigator', 'Date'),
      blankLine(),

      // ══════════════════════════════════════════════════════════
      // CASE PROFORMA
      // ══════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('CASE PROFORMA', 26, true),
      blankLine(),
      para([bold('SECTION 1: PATIENT IDENTIFICATION', 24)]),
      para('Name: _______________________________   OP No.: _______________'),
      para('Age: _______   Sex: M / F   Date: ________________'),
      para('Address: ____________________________________________________________'),
      para('Education: _________________________   Occupation: ___________________'),
      para('Socioeconomic Status: Upper / Middle / Lower'),
      blankLine(),
      para([bold('SECTION 2: CHIEF COMPLAINTS', 24)]),
      para('_________________________________________________________________'),
      blankLine(),
      para([bold('SECTION 3: HISTORY OF TOPICAL STEROID USE', 24)]),
      para('Indication for use: Acne / Pigmentation / Fairness / Melasma / Itching / Others: ________'),
      para('Duration of use: ________________'),
      para('Frequency of application: Once / Twice / More than twice daily'),
      para('Name of preparation: ____________________________'),
      para('Potency: Mild / Moderate / Potent / Very Potent'),
      para('Combination cream: Yes / No    If yes, specify: ___________'),
      para('Source of advice: Dermatologist / GP / Pharmacist / Self / Beautician / Friend'),
      blankLine(),
      para([bold('SECTION 4: PAST HISTORY', 24)]),
      para('Diabetes Mellitus: Yes / No'),
      para('Hypertension: Yes / No'),
      para('Other skin disorders: Yes / No    If yes, specify: ___________'),
      blankLine(),
      para([bold('SECTION 5: PERSONAL HISTORY', 24)]),
      para('Menstrual history (females): Regular / Irregular'),
      para('H/O pregnancy: Yes / No'),
      blankLine(),
      para([bold('SECTION 6: GENERAL EXAMINATION', 24)]),
      para('BP: ___________   PR: ___________   Weight: ___________'),
      blankLine(),
      para([bold('SECTION 7: DERMATOLOGICAL EXAMINATION', 24)]),
      para('Site(s) affected: _________________________'),
      para('Distribution: Perioral / Periorbital / Cheeks / Forehead / Chin / Whole face'),
      blankLine(),
      para([bold('Clinical Features (tick all that apply):', 24)]),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Clinical Feature', 22)], spacing: { before: 40, after: 40 } })], { width: 50, shading: true }),
            cell([new Paragraph({ children: [bold('Present / Absent', 22)], spacing: { before: 40, after: 40 } })], { width: 25, shading: true }),
            cell([new Paragraph({ children: [bold('Severity (Mild/Moderate/Severe)', 22)], spacing: { before: 40, after: 40 } })], { width: 25, shading: true })
          ]}),
          new TableRow({ children: [cell('Acneiform eruptions'), cell(''), cell('')] }),
          new TableRow({ children: [cell('Rosacea-like dermatitis'), cell(''), cell('')] }),
          new TableRow({ children: [cell('Perioral dermatitis'), cell(''), cell('')] }),
          new TableRow({ children: [cell('Facial erythema'), cell(''), cell('')] }),
          new TableRow({ children: [cell('Burning sensation'), cell(''), cell('')] }),
          new TableRow({ children: [cell('Telangiectasia'), cell(''), cell('')] }),
          new TableRow({ children: [cell('Hyperpigmentation'), cell(''), cell('')] }),
          new TableRow({ children: [cell('Skin atrophy / thinning'), cell(''), cell('')] }),
          new TableRow({ children: [cell('Hypertrichosis'), cell(''), cell('')] }),
          new TableRow({ children: [cell('Others (specify): __________'), cell(''), cell('')] })
        ]
      }),
      blankLine(),
      para([bold('Topical Steroid-Dependent Face (TSDF): ', 24), normal('Yes / No', 24)]),
      para([bold('Withdrawal rebound noted: ', 24), normal('Yes / No', 24)]),
      blankLine(),
      para([bold('SECTION 8: FOLLOW-UP (at withdrawal / clinical review)', 24)]),
      para('Clinical improvement after TCS discontinuation: Yes / No / Partial'),
      para('Duration of follow-up: ________________'),
      para('Treatment given after withdrawal: ______________________________'),
    ]
  }]
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/iec-thesis/IEC_Corrected_Sarumathi_Corticosteroid.docx', buffer);
  console.log('Document created successfully.');
});

cd /home/daytona/workspace/iec-thesis && node generate_sarumathi.js 2>&1

cp /home/daytona/workspace/iec-thesis/IEC_Corrected_Sarumathi_Corticosteroid.doc…

cd /home/daytona/workspace/attachments/9453e53d-8394-4f44-83e3-743242fec744 && p…

wc -l /home/daytona/workspace/hithaishi_thesis.md

~/iec-thesis/generate_hithaishi.js

const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  AlignmentType, BorderStyle, WidthType, VerticalAlign,
  UnderlineType, ShadingType
} = require('docx');
const fs = require('fs');

// ─── helpers ────────────────────────────────────────────────────────────────
const bold = (text, size = 24, underline = false) => new TextRun({
  text, bold: true, size,
  underline: underline ? { type: UnderlineType.SINGLE } : undefined
});
const normal = (text, size = 24) => new TextRun({ text, size });
const italic = (text, size = 24) => new TextRun({ text, italics: true, size });

const centeredBold = (text, size = 28, underline = false) => new Paragraph({
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  spacing: { before: 80, after: 80 },
  children: [bold(text, size, underline)]
});

const para = (runs, spacing = { before: 80, after: 80 }) => new Paragraph({
  children: Array.isArray(runs) ? runs : [normal(runs, 24)],
  spacing
});

const bullet = (text, size = 24) => new Paragraph({
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});

const blankLine = () => new Paragraph({ children: [new TextRun('')], spacing: { before: 60, after: 60 } });

const signatureLine = (label1, label2) => {
  if (!label2) return new Paragraph({ children: [bold(label1, 22)], spacing: { before: 200, after: 60 } });
  return new Paragraph({
    children: [normal(label1 + '\t\t\t\t\t\t', 22), normal(label2, 22)],
    spacing: { before: 200, after: 60 }
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};

const thinBorder = { style: BorderStyle.SINGLE, size: 4, color: '000000' };

const cell = (children, opts = {}) => new TableCell({
  children: Array.isArray(children)
    ? children
    : [new Paragraph({ children: [normal(children, 22)], spacing: { before: 60, after: 60 } })],
  width: opts.width ? { size: opts.width, type: WidthType.PERCENTAGE } : undefined,
  shading: opts.shading ? { fill: 'D9D9D9', type: ShadingType.CLEAR } : undefined,
  borders: { top: thinBorder, bottom: thinBorder, left: thinBorder, right: thinBorder },
  verticalAlign: VerticalAlign.TOP,
  columnSpan: opts.span || 1
});

// ─── DOCUMENT ────────────────────────────────────────────────────────────────
const doc = new Document({
  styles: {
    default: { document: { run: { font: 'Times New Roman', size: 24 } } }
  },
  sections: [{
    properties: { page: { margin: { top: 1080, bottom: 1080, left: 1260, right: 1260 } } },
    children: [

      // ═════════════════════════════════════════════════════════
      // INSTITUTION HEADER
      // ═════════════════════════════════════════════════════════
      centeredBold('Faculty of Medicine – Meenakshi Medical College Hospital & Research Institute', 28, true),
      centeredBold('Institutional Ethics Committee – Human Studies', 26, true),
      blankLine(),

      // ═════════════════════════════════════════════════════════
      // COVER LETTER
      // ═════════════════════════════════════════════════════════
      centeredBold('COVER LETTER', 26, true),
      blankLine(),
      para('Date: 18.02.2026'),
      blankLine(),
      para([bold('From,', 24)]),
      para('Dr. HITHAISHI REDDY R'),
      para('Junior Resident (1st Year PG)'),
      para('Department of Dermatology, Venereology and Leprology'),
      para('Meenakshi Medical College Hospital & Research Institute, Kanchipuram'),
      blankLine(),
      para([bold('To,', 24)]),
      para('The Chairperson,'),
      para('Institutional Ethics Committee,'),
      para('MMCHRI, Kanchipuram'),
      blankLine(),
      para('Through Proper Channel'),
      blankLine(),
      para([bold('Respected Sir/Madam,', 24)]),
      blankLine(),
      para([
        bold('Sub: ', 24),
        normal('Request for ethical clearance for the study ', 24),
        bold('"A Clinico-Epidemiological Study of Geriatric Dermatoses Attending a Tertiary Care Hospital"', 24)
      ]),
      blankLine(),
      para('I, Dr. HITHAISHI REDDY R, Junior Resident (PG), of Meenakshi Medical College Hospital & Research Institute, am interested to conduct a project titled "A Clinico-Epidemiological Study of Geriatric Dermatoses Attending a Tertiary Care Hospital" under the guidance of Dr. S. KUMARAVEL, Professor and Head, Department of Dermatology, Venereology and Leprology, Meenakshi Medical College Hospital & Research Institute. A copy of this study proposal has been attached. I kindly request you to give me ethical clearance and approval to conduct this study. Please do the needful.'),
      blankLine(),
      para('The following documents are enclosed for your review:'),
      bullet('Study Protocol (including Abstract)'),
      bullet('Informed Consent Documents: Participant Information Sheet and Informed Consent Form (English and Tamil)'),
      bullet('Questionnaire / Case Proforma'),
      bullet('Curriculum Vitae of the Principal Investigator and Guide'),
      blankLine(),
      para('Thanking you.'),
      blankLine(),
      para('Yours sincerely,'),
      blankLine(),
      blankLine(),
      signatureLine('Signature of the Guide', 'Signature of the Candidate / Investigator'),
      blankLine(),
      signatureLine('Signature of the HOD'),
      blankLine(),

      new Paragraph({ children: [], pageBreakBefore: true }),

      // ═════════════════════════════════════════════════════════
      // IEC HEADER TABLE
      // ═════════════════════════════════════════════════════════
      centeredBold('Application for Submission of Research Proposals to SAC/IEC Review (Human Studies)', 24, true),
      blankLine(),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [new TableRow({ children: [
          cell([new Paragraph({ children: [bold('IEC Reference No.', 22)], spacing: { before: 60, after: 30 } }), new Paragraph({ children: [normal('_______________', 22)], spacing: { before: 20, after: 40 } })], { width: 33 }),
          cell([new Paragraph({ children: [bold('Project Type', 22)], spacing: { before: 60, after: 30 } }), new Paragraph({ children: [normal('PG / Faculty / UG / Ph.D / STS, others specify: ________', 22)], spacing: { before: 20, after: 40 } })], { width: 33 }),
          cell([new Paragraph({ children: [bold('Date of Submission', 22)], spacing: { before: 60, after: 30 } }), new Paragraph({ children: [normal('18.02.2026', 22)], spacing: { before: 20, after: 40 } })], { width: 34 })
        ]})]
      }),
      blankLine(),

      // ═════════════════════════════════════════════════════════
      // SECTION A – BASIC INFORMATION
      // ═════════════════════════════════════════════════════════
      centeredBold('SECTION A – BASIC INFORMATION', 26, true),
      blankLine(),
      para([bold('Title of Research Proposal: ', 24), normal('"A Clinico-Epidemiological Study of Geriatric Dermatoses Attending a Tertiary Care Hospital"', 24)]),
      blankLine(),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Principal Investigator (PI)', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
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              new Paragraph({ children: [bold('Mobile: ', 22), normal('+91 9148758217', 22)], spacing: { before: 20, after: 20 } }),
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          new TableRow({ children: [
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            cell([
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              new Paragraph({ children: [bold('Department: ', 22), normal('Dermatology, Venereology and Leprology', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Mobile: ', 22), normal('+91 9786797042', 22)], spacing: { before: 20, after: 20 } }),
              new Paragraph({ children: [bold('Email: ', 22), normal('To be provided', 22)], spacing: { before: 20, after: 40 } })
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          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Source of Funding', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
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          new TableRow({ children: [
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      blankLine(),

      // ═════════════════════════════════════════════════════════
      // SECTION B – STUDY OVERVIEW
      // ═════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('SECTION B – STUDY OVERVIEW', 26, true),
      blankLine(),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Study Type', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('Observational – Cross-sectional study')] }),
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          new TableRow({ children: [cell([new Paragraph({ children: [bold('Duration of Study', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('12 months from date of IEC approval')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Sample Size', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('Minimum 100 patients (n = 4pq/d²; p=50%, q=50%, d=5%)')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Participant Category', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('All patients aged ≥ 60 years attending Dermatology OPD during the study period')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Ethical Risk Level', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('Minimal Risk – Observational study; history and clinical examination; relevant investigations only as part of routine care')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Drugs / Devices Involved', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('No experimental drugs or devices')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold("Investigator's Brochure / Preclinical data", 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('Not Applicable')] }),
          new TableRow({ children: [cell([new Paragraph({ children: [bold('Similar study done elsewhere?', 22)], spacing: { before: 60, after: 60 } })], { width: 40, shading: true }), cell('Published studies on geriatric dermatoses exist nationally; no similar study currently ongoing at this institution. Relevant literature reviewed in Section C.')] })
        ]
      }),
      blankLine(),

      // ═════════════════════════════════════════════════════════
      // SECTION C – DETAILED RESEARCH PROPOSAL
      // ═════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('SECTION C – DETAILED RESEARCH PROPOSAL', 26, true),
      blankLine(),

      para([bold('Title of the Project: ', 24)]),
      para([bold('"A Clinico-Epidemiological Study of Geriatric Dermatoses Attending a Tertiary Care Hospital"', 24)]),
      para([italic('(Observational cross-sectional study; Major outcome: spectrum and pattern of geriatric dermatoses; Major predictor: age, gender, comorbidities; Setting: DVL OPD, MMCHRI, Kanchipuram; Subjects: patients ≥60 years; Design: hospital-based descriptive cross-sectional study)', 22)]),
      blankLine(),

      // Background
      para([bold('Background / Introduction', 26)]),
      para([bold('1. Relevance and current state of knowledge:', 24)]),
      para('Aging is a universal biological process characterized by progressive decline in physiological functions. With increasing life expectancy and a growing proportion of the elderly population in India, geriatric dermatoses have emerged as an important public health concern. The skin undergoes both intrinsic (chronological) and extrinsic (photoinduced) aging changes, predisposing elderly individuals (aged ≥60 years) to a wide variety of dermatological conditions. Common physiological changes include xerosis, wrinkling, atrophy, and pigmentary alterations. Pathological conditions frequently encountered include eczemas, infections, papulosquamous disorders, bullous diseases, and cutaneous neoplasms. Comorbidities such as diabetes mellitus and hypertension further influence both the pattern and severity of dermatoses in this age group.'),
      blankLine(),
      para([bold('2. What led to this research question:', 24)]),
      para('At the DVL OPD of MMCHRI, a significant proportion of patients presenting are elderly, with complex dermatological and systemic comorbidity profiles. Despite this clinical burden, there is limited structured, institution-specific data on the spectrum and epidemiology of geriatric dermatoses from this region of Tamil Nadu. Understanding these patterns will enable better resource allocation, early diagnosis, and improved care for this vulnerable population.'),
      blankLine(),
      para([bold('3. Gaps in knowledge:', 24)]),
      para('Although several hospital-based studies from various parts of India have documented the prevalence of geriatric skin diseases, region-specific epidemiological data from South India – particularly from semi-urban tertiary care centres in Tamil Nadu – remain sparse. The influence of local climatic conditions, dietary habits, and healthcare-seeking behaviour on dermatosis patterns in the geriatric population is not well characterized in this region.'),
      blankLine(),
      para([bold('4. Research question and justification:', 24)]),
      para('What is the clinico-epidemiological profile of dermatoses in patients aged ≥60 years attending the DVL OPD at MMCHRI, Kanchipuram? Generating this data will aid in early diagnosis, appropriate management, healthcare planning, and improving quality of life in elderly patients in this region.'),
      blankLine(),

      // Objectives
      para([bold('Objectives', 26)]),
      para([bold('Primary Objective:', 24)]),
      bullet('To determine the spectrum of dermatoses in patients aged ≥60 years attending the Dermatology OPD.'),
      blankLine(),
      para([bold('Secondary Objectives:', 24)]),
      bullet('To analyze the age and gender distribution of geriatric patients with dermatoses'),
      bullet('To study associated systemic comorbidities (diabetes mellitus, hypertension, others)'),
      bullet('To categorize dermatoses into physiological skin changes, infective, and non-infective groups'),
      bullet('To identify common physiological skin changes in the geriatric population'),
      bullet('To study the clinical pattern and distribution of various dermatoses'),
      blankLine(),

      // Review of Literature
      para([bold('Brief Review of Literature', 26)]),
      para([italic('(Minimum 5 relevant references; chronological order; recent references < 5 years preferred)', 22)]),
      blankLine(),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Authors & Year', 22)], spacing: { before: 60, after: 60 } })], { width: 22, shading: true }),
            cell([new Paragraph({ children: [bold('Study / Journal', 22)], spacing: { before: 60, after: 60 } })], { width: 28, shading: true }),
            cell([new Paragraph({ children: [bold('Key Findings', 22)], spacing: { before: 60, after: 60 } })], { width: 30, shading: true }),
            cell([new Paragraph({ children: [bold('Relevance', 22)], spacing: { before: 60, after: 60 } })], { width: 20, shading: true })
          ]}),
          new TableRow({ children: [
            cell('Nair SP et al. (2014)', {}),
            cell('Indian J Dermatol 2014; 59(6):604–606', {}),
            cell('Hospital-based study of 200 geriatric patients; xerosis (56%), fungal infections (22%), eczema (18%) were most common; male predominance noted.', {}),
            cell('Defines prevalence and spectrum of geriatric dermatoses in Indian setting', {})
          ]}),
          new TableRow({ children: [
            cell('Grover S, Ranyal RK (2006)', {}),
            cell('Indian J Dermatol 2006; 51(1):31–34', {}),
            cell('Cross-sectional study; xerosis most common in 60+ age group; prevalence of dermatophytosis and bacterial infections increased with comorbid diabetes.', {}),
            cell('Supports role of systemic comorbidities in dermatosis pattern', {})
          ]}),
          new TableRow({ children: [
            cell('Braun-Falco O et al. (2009)', {}),
            cell('Dermatology, 3rd Ed. Springer, 2009', {}),
            cell('Comprehensive description of intrinsic and extrinsic aging changes; atrophy, telangiectasia, lentigines, bullous pemphigoid as classic geriatric dermatoses.', {}),
            cell('Provides classification framework used in this study', {})
          ]}),
          new TableRow({ children: [
            cell('Nnoruka EN, Obiagboso I (2007)', {}),
            cell('Int J Dermatol 2007; 46(Suppl 1):55–60', {}),
            cell('Geriatric dermatoses in sub-Saharan Africa; eczema, pruritus, and infections predominated; xerosis strongly associated with age and reduced sebaceous gland function.', {}),
            cell('International comparison supports global relevance of study topic', {})
          ]}),
          new TableRow({ children: [
            cell('Patil S, Gautam M et al. (2021)', {}),
            cell('Indian Dermatol Online J 2021; 12(4):555–560', {}),
            cell('Recent cross-sectional study; eczematous disorders (29%), infections (27%), and papulosquamous disorders (18%) were most common; male predominance; diabetes mellitus the most frequent comorbidity.', {}),
            cell('Recent Indian data directly comparable to present study design', {})
          ]}),
          new TableRow({ children: [
            cell('Ghadially R et al. (1995)', {}),
            cell('J Invest Dermatol 1995; 104(6):852–855', {}),
            cell('Detailed study of skin barrier function in aging; reduced lipid content and impaired epidermal permeability barrier led to xerosis; supports management rationale.', {}),
            cell('Provides pathophysiological basis for most common geriatric skin change', {})
          ]}),
          new TableRow({ children: [
            cell('Durai PC et al. (2012)', {}),
            cell('Indian J Dermatol 2012; 57(5):342–345', {}),
            cell('Cross-sectional study from South India; 300 patients ≥60 years; infections (35%), eczemas (22%); lower limb predominance; seasonal variation noted.', {}),
            cell('South Indian regional data closest in geography to present study', {})
          ]})
        ]
      }),
      blankLine(),

      // Methodology
      para([bold('Methodology', 26)]),
      blankLine(),
      para([bold('Study Design: ', 24), normal('Hospital-based observational descriptive cross-sectional study.', 24)]),
      para([bold('Study Setting: ', 24), normal('Department of Dermatology, Venereology and Leprology, Meenakshi Medical College Hospital & Research Institute, Kanchipuram.', 24)]),
      para([bold('Study Duration: ', 24), normal('12 months from the date of IEC approval.', 24)]),
      blankLine(),
      para([bold('Sample Size:', 24)]),
      para('Estimated minimum sample size: 100 patients.'),
      para('Calculated using: n = 4pq/d²'),
      bullet('p = 50% (expected prevalence of significant dermatosis), q = 50%'),
      bullet('d = 5% (precision)'),
      bullet('n = 4 × 0.5 × 0.5 / (0.05)² = 100'),
      blankLine(),
      para([bold('Inclusion Criteria:', 24)]),
      bullet('Patients aged ≥ 60 years'),
      bullet('Attending the Dermatology OPD during the study period'),
      bullet('Willing to provide written informed consent'),
      blankLine(),
      para([bold('Exclusion Criteria:', 24)]),
      bullet('Patients unwilling to participate'),
      bullet('Patients who are critically ill or unable to respond adequately'),
      bullet('Patients with psychiatric illness affecting the ability to give informed consent'),
      bullet('Patients already enrolled in another study'),
      blankLine(),
      para([bold('Study Variables:', 24)]),
      para([bold('Independent variables: ', 24), normal('Age, gender, occupation, education, socioeconomic status, systemic comorbidities (DM, HTN, others)', 24)]),
      para([bold('Dependent variables: ', 24), normal('Type of dermatosis, clinical pattern, anatomical distribution, associated symptoms', 24)]),
      blankLine(),
      para([bold('Study Procedure:', 24)]),
      para([bold('1. Consent and Enrollment: ', 24), normal('All geriatric patients (≥60 years) attending the DVL OPD will be screened. After explaining the study in the local language (Tamil/English), written informed consent will be obtained. Only patients fulfilling the inclusion criteria will be enrolled.', 24)]),
      para([bold('2. History Taking: ', 24), normal('A detailed history will be obtained including age, gender, duration of skin complaint, symptoms (itching, pain, burning), past medical history, drug history, personal habits, and occupational history.', 24)]),
      para([bold('3. Clinical Examination: ', 24), normal('A thorough dermatological examination will be conducted and findings recorded in a pre-designed proforma. Systemic examination will be carried out wherever necessary.', 24)]),
      para([bold('4. Investigations: ', 24), normal('Relevant investigations (CBC, blood sugar, KOH examination, skin biopsy, other tests) will be performed where clinically indicated as part of routine care. No additional invasive procedures will be done solely for research purposes.', 24)]),
      para([bold('5. Classification: ', 24), normal('Dermatoses will be classified into: (i) Physiological skin changes, (ii) Infections and infestations, (iii) Eczematous disorders, (iv) Papulosquamous disorders, (v) Neoplasms, (vi) Bullous disorders, (vii) Drug reactions, (viii) Miscellaneous conditions.', 24)]),
      blankLine(),
      para([bold('Statistical Analysis:', 24)]),
      bullet('Data entered in MS Excel and analyzed using SPSS software.'),
      bullet('Descriptive statistics: mean, percentage, frequency distribution.'),
      bullet('Chi-square test for association between categorical variables.'),
      bullet('p-value < 0.05 considered statistically significant.'),
      blankLine(),

      // Ethical Considerations
      para([bold('Ethical Considerations', 26)]),
      bullet('IEC approval will be obtained before initiating the study.'),
      bullet('Written informed consent (English and Tamil) will be obtained from all participants.'),
      bullet('For participants unable to give consent due to cognitive impairment, consent will be obtained from the legal guardian / next of kin.'),
      bullet('Participation is entirely voluntary; participants may withdraw at any time without affecting their care.'),
      bullet('Patient identity and data will be kept strictly confidential; no personal identifiers will be published.'),
      bullet('No additional financial burden will be imposed on participants.'),
      bullet('No experimental drugs, devices, or invasive procedures will be used solely for research purposes.'),
      bullet('The study involves minimal risk to participants.'),
      blankLine(),

      // Discussion / Summary
      para([bold('Expected Findings and Summary', 26)]),
      para('This study is expected to document the clinico-epidemiological profile of geriatric dermatoses at a tertiary care centre in Kanchipuram, Tamil Nadu. Based on published literature, physiological changes (xerosis), infections, and eczematous disorders are anticipated to be the most prevalent groups. Findings will be compared with previous national and international studies. Variations in pattern may be explained by local climatic, socioeconomic, and healthcare accessibility factors. The study will contribute region-specific data to guide early diagnosis, rational management, and healthcare planning for the elderly population.'),
      blankLine(),

      // References
      para([bold('References', 26)]),
      para('1. Nair SP, Reena Mariyath OK, Sherin S. A cross-sectional study of geriatric dermatoses. Indian J Dermatol. 2014;59(6):604–606.'),
      para('2. Grover S, Ranyal RK, Bedi MK. A cross section of skin diseases in rural Allahabad. Indian J Dermatol. 2006;51(1):31–34.'),
      para('3. Durai PC, Thappa DM, Kumari R, Malathi M. Aging in elderly: characteristics of geriatric dermatoses in a tertiary care hospital. Indian J Dermatol. 2012;57(5):342–345.'),
      para('4. Patil S, Gautam M, Nadkarni N. Clinico-epidemiological study of geriatric dermatoses. Indian Dermatol Online J. 2021;12(4):555–560.'),
      para('5. Nnoruka EN, Obiagboso I, Maduechesi C. Hair loss in children in South-East Nigeria: common and uncommon causes. Int J Dermatol. 2007;46(Suppl 1):55–60.'),
      para('6. Ghadially R, Brown BE, Sequeira-Martin SM, Feingold KR, Elias PM. The aged epidermal permeability barrier. J Invest Dermatol. 1995;104(6):852–855.'),
      para('7. Hara M, Kikuchi K, Watanabe M, et al. Senile xerosis: functional, morphological, and biochemical studies. J Geriatr Dermatol. 1993;1(2):63–71.'),
      blankLine(),

      // ═════════════════════════════════════════════════════════
      // SECTION D – CHECKLIST
      // ═════════════════════════════════════════════════════════
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          new TableRow({ children: [cell('5'), cell('Brief updated CV of all investigators'), cell('Yes'), cell('')] }),
          new TableRow({ children: [cell('6'), cell('Agreement letter from other departmental heads (inter-departmental studies)'), cell('NA (Single dept.)', {}), cell('')] }),
          new TableRow({ children: [cell('7'), cell('Letter(s) of approval from collaborating institutions / DCGI / CTRI'), cell('NA'), cell('')] }),
          new TableRow({ children: [cell('8'), cell('Declaration signed by all investigators and forwarded by Head of Department'), cell('Yes'), cell('')] }),
          new TableRow({ children: [cell('9'), cell("Investigator's brochure (drug/biological/device trials)"), cell('NA'), cell('')] }),
          new TableRow({ children: [cell('10'), cell('Advertisement / material to recruit participants'), cell('NA'), cell('')] }),
          new TableRow({ children: [cell('11'), cell('Proposed compensation / reimbursement / management of research-related injury'), cell('NA (No compensation; no additional risk)'), cell('')] })
        ]
      }),
      blankLine(),

      // ═════════════════════════════════════════════════════════
      // DECLARATION
      // ═════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('DECLARATION BY INVESTIGATORS', 26, true),
      blankLine(),
      para('We, the undersigned, hereby declare that:'),
      bullet('The information provided in this application is accurate and complete to the best of our knowledge.'),
      bullet('The study will be conducted in accordance with ICH-GCP guidelines, the Declaration of Helsinki, and ICMR National Ethical Guidelines for Biomedical and Health Research Involving Human Participants (2017).'),
      bullet('We will obtain written informed consent from all participants before enrollment.'),
      bullet('We will not implement any deviation from the approved protocol without prior IEC consent, and any deviation will be intimated to the IEC at the earliest.'),
      bullet('We will report any serious adverse events or unanticipated problems to the IEC within 7 days of occurrence.'),
      bullet('We will maintain all study records and make them available for IEC audit/inspection if required.'),
      bullet('We will submit annual progress reports and a final report to the IEC within 4 weeks of the due date.'),
      bullet('We will not commence the study before obtaining formal IEC approval.'),
      blankLine(),
      blankLine(),
      signatureLine('Signature of Principal Investigator', 'Signature of Guide'),
      para([normal('Dr. HITHAISHI REDDY R\t\t\t\t\t\tDr. S. KUMARAVEL', 22)]),
      para([normal('Junior Resident\t\t\t\t\t\tProfessor & HOD', 22)]),
      para([normal('Dept. of DVL, MMCHRI\t\t\t\t\t\tDept. of DVL, MMCHRI', 22)]),
      blankLine(),
      blankLine(),
      signatureLine('Signature of Co-Guide'),
      para([normal('Dr. SIVAYOGANA', 22)]),
      para([normal('Associate Professor, Dept. of DVL, MMCHRI', 22)]),
      blankLine(),
      blankLine(),
      signatureLine('Signature and Seal of Head of Department'),
      para([normal('Dr. S. KUMARAVEL', 22)]),
      para([normal('Professor & HOD, Dept. of Dermatology, MMCHRI', 22)]),
      para([normal('Date: _______________', 22)]),
      blankLine(),

      // ═════════════════════════════════════════════════════════
      // UNDERTAKING BY PI
      // ═════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('UNDERTAKING BY THE PRINCIPAL INVESTIGATOR', 26, true),
      blankLine(),
      para([bold('1. Name of the Project: ', 24)]),
      para('"A Clinico-Epidemiological Study of Geriatric Dermatoses Attending a Tertiary Care Hospital"'),
      blankLine(),
      para([bold('2. Name, Designation and Department of the Principal Investigator: ', 24)]),
      para('Dr. HITHAISHI REDDY R'),
      para('Junior Resident (1st Year PG)'),
      para('Department of Dermatology, Venereology and Leprology'),
      para('Meenakshi Medical College Hospital & Research Institute, Kanchipuram'),
      blankLine(),
      para([bold('3. Undertaking: ', 24)]),
      para('I, Dr. HITHAISHI REDDY R, Principal Investigator for the above study, hereby undertake that:'),
      bullet('I will initiate the study only after obtaining IEC approval and all required regulatory clearances.'),
      bullet('I will not implement any deviation from the approved protocol without prior IEC consent.'),
      bullet('I confirm that the Co-PI and other members of the study team have been informed about their obligations and are qualified to meet them.'),
      bullet('I will personally supervise the study and ensure that requirements of obtaining informed consent and other ethical requirements under ICMR and National Regulatory Guidelines are adhered to.'),
      bullet('I will maintain accurate and complete records of all cases in accordance with GCP provisions and make them available for audit/inspection by IEC or regulatory authorities.'),
      bullet('I will inform the IEC of any unexpected or serious adverse event at the earliest and definitely within seven days of its occurrence.'),
      bullet('I will maintain confidentiality of the identity of all participating subjects and ensure security of study data.'),
      bullet('I will submit annual progress reports and a final report to the IEC within 4 weeks of the due date.'),
      blankLine(),
      blankLine(),
      para([normal('Signature of Principal Investigator: ___________________________', 22)]),
      para([normal('Name: Dr. HITHAISHI REDDY R', 22)]),
      para([normal('Date: 18.02.2026', 22)]),
      blankLine(),

      // ═════════════════════════════════════════════════════════
      // PARTICIPANT INFORMATION SHEET – ENGLISH
      // ═════════════════════════════════════════════════════════
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      para([bold('Principal Investigator: ', 24), normal('Dr. HITHAISHI REDDY R, Junior Resident, Dept. of DVL, MMCHRI, Kanchipuram. Ph: +91 9148758217', 24)]),
      para([bold('Guide: ', 24), normal('Dr. S. KUMARAVEL, Professor & HOD, Dept. of DVL, MMCHRI', 24)]),
      blankLine(),
      para([bold('Introduction:', 24)]),
      para('You are being invited to participate in a research study. This study titled "A Clinico-Epidemiological Study of Geriatric Dermatoses in Patients Attending the Dermatology Outpatient Department of Meenakshi Medical College Hospital & Research Institute, Kanchipuram" is being conducted by Dr. HITHAISHI REDDY R under the guidance of Prof. Dr. S. KUMARAVEL. Please read this information carefully. You are free to ask any questions before deciding.'),
      blankLine(),
      para([bold('Purpose of the Study:', 24)]),
      para('The purpose of this study is to evaluate the pattern of skin diseases occurring in elderly patients (aged 60 years and above) and to analyze their clinical and epidemiological characteristics.'),
      blankLine(),
      para([bold('What will happen if you take part:', 24)]),
      bullet('Patients aged 60 years and above attending the Dermatology OPD will be included after obtaining written informed consent.'),
      bullet('A detailed history regarding age, gender, occupation, associated illnesses, duration of symptoms, and treatment history will be recorded.'),
      bullet('A complete dermatological examination will be performed.'),
      bullet('Relevant investigations (if required as part of routine care) may be noted.'),
      bullet('No additional invasive procedure will be done solely for the purpose of this study.'),
      bullet('The study will not interfere with your regular treatment.'),
      blankLine(),
      para([bold('Risks:', 24)]),
      para('There are no additional risks involved beyond routine clinical examination. This is an observational study.'),
      blankLine(),
      para([bold('Benefits:', 24)]),
      para('There may not be any direct benefit to you. The findings of this study may help in better understanding skin diseases in elderly patients and improving management strategies in the future.'),
      blankLine(),
      para([bold('Confidentiality:', 24)]),
      para('All personal information will be kept confidential. Data will be analyzed as grouped data without revealing individual identity. Records will be securely stored and accessed only by the research team.'),
      blankLine(),
      para([bold('Voluntary Participation:', 24)]),
      para('Participation is completely voluntary. You may withdraw from the study at any time without affecting your treatment or medical care.'),
      blankLine(),
      para([bold('Contact:', 24)]),
      para('If you have any questions or concerns, please contact: Dr. HITHAISHI REDDY R, Dept. of DVL, MMCHRI, Kanchipuram. Ph: +91 9148758217'),
      blankLine(),
      para([bold("PATIENT'S DECLARATION:", 26)]),
      blankLine(),
      para("Patient's Name: ______________________________     Age: __________"),
      blankLine(),
      para('I have read and understood the information provided above. I have had the opportunity to ask questions and am satisfied with the answers given. I understand that my participation is voluntary and I may withdraw at any time without affecting my medical care. I understand that my identity will remain confidential. I voluntarily agree to participate in this study.'),
      blankLine(),
      blankLine(),
      signatureLine('Signature / Thumb impression of Participant', 'Date'),
      blankLine(),
      signatureLine('Signature of Parent / Guardian (if applicable)', 'Date'),
      blankLine(),
      signatureLine('Signature of Witness', 'Date'),
      blankLine(),
      signatureLine('Signature of Investigator', 'Date'),
      blankLine(),

      // ═════════════════════════════════════════════════════════
      // CASE PROFORMA
      // ═════════════════════════════════════════════════════════
      new Paragraph({ children: [], pageBreakBefore: true }),
      centeredBold('CASE PROFORMA', 26, true),
      blankLine(),
      para([bold('SECTION 1: PATIENT IDENTIFICATION', 24)]),
      para('Name: _______________________________   OP No.: _______________'),
      para('Age: _______   Sex: M / F   Date: ________________'),
      para('Address: ____________________________________________________________'),
      para('Education: _________________________   Occupation: ___________________'),
      para('Socioeconomic Status: Upper / Middle / Lower'),
      blankLine(),
      para([bold('SECTION 2: CHIEF COMPLAINTS', 24)]),
      para('Complaint: _______________________________   Duration: _______________'),
      blankLine(),
      para([bold('SECTION 3: HISTORY', 24)]),
      para('Duration of skin complaint: _______________________'),
      para('Symptoms: Itching □   Pain □   Burning □   Others: _____________'),
      para('Past Medical History: DM □   HTN □   Others: _______________'),
      para('Drug History: Yes / No   Details: ___________________'),
      para('Personal habits (smoking/tobacco/alcohol): ___________________'),
      para('Occupational history: ___________________'),
      blankLine(),
      para([bold('SECTION 4: GENERAL EXAMINATION', 24)]),
      para('BP: ___________   PR: ___________   Weight: ___________'),
      para('Systemic examination findings (if relevant): _____________________'),
      blankLine(),
      para([bold('SECTION 5: DERMATOLOGICAL EXAMINATION', 24)]),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({ children: [
            cell([new Paragraph({ children: [bold('Category', 22)], spacing: { before: 40, after: 40 } })], { width: 30, shading: true }),
            cell([new Paragraph({ children: [bold('Diagnosis', 22)], spacing: { before: 40, after: 40 } })], { width: 35, shading: true }),
            cell([new Paragraph({ children: [bold('Site / Distribution', 22)], spacing: { before: 40, after: 40 } })], { width: 35, shading: true })
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          new TableRow({ children: [cell('Infections & Infestations'), cell('Fungal / Bacterial / Viral / Parasitic'), cell('')] }),
          new TableRow({ children: [cell('Eczematous Disorders'), cell('Asteatotic / Stasis / Contact / Others'), cell('')] }),
          new TableRow({ children: [cell('Papulosquamous Disorders'), cell('Psoriasis / LP / Seborrhoeic dermatitis / Others'), cell('')] }),
          new TableRow({ children: [cell('Bullous Disorders'), cell('Bullous pemphigoid / Pemphigus / Others'), cell('')] }),
          new TableRow({ children: [cell('Neoplasms'), cell('BCC / SCC / Seborrhoeic keratosis / Others'), cell('')] }),
          new TableRow({ children: [cell('Drug Reactions'), cell('FDE / SJS / Others'), cell('')] }),
          new TableRow({ children: [cell('Miscellaneous'), cell('_________________________'), cell('')] })
        ]
      }),
      blankLine(),
      para([bold('SECTION 6: INVESTIGATIONS (if done as part of routine care)', 24)]),
      para('CBC: _______________   Blood Sugar: _______________'),
      para('KOH Examination: Positive / Negative / Not done'),
      para('Skin Biopsy: Done / Not done   Result: _______________'),
      para('Other: _______________'),
    ]
  }]
});

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cd /home/daytona/workspace/iec-thesis && node generate_hithaishi.js 2>&1

cp /home/daytona/workspace/iec-thesis/IEC_Corrected_Hithaishi_GeriatricDermatose…

Indian Journal of Dermatology Venereology Leprology IJDVL official website submission

Indian Dermatology Online Journal official website author submission

Clinical and Experimental Dermatology journal official website Wiley

~/iec-thesis/gen_abstract1.js

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    centeredBold('ABSTRACT', 30),
    blankLine(),
    centeredBold('A Clinico-Epidemiological Study on Quality of Life in', 26),
    centeredBold('Patients with Dermatophytosis Using DLQI', 26),
    blankLine(),
    para([bold('Principal Investigator: '), normal('Dr. RAJADURAI. I, Junior Resident, Dept. of DVL, MMCHRI, Kanchipuram')]),
    para([bold('Guide: '), normal('Dr. S. KUMARAVEL, Professor & HOD, Dept. of DVL, MMCHRI')]),
    para([bold('Co-Guide: '), normal('Dr. R. RAJESH, Professor, Dept. of DVL, MMCHRI')]),
    blankLine(),

    new Paragraph({ children: [bold('BACKGROUND', 24)], spacing: { before: 100, after: 60 } }),
    para('Dermatophytosis is a superficial fungal infection caused by dermatophytes of the genera Trichophyton, Microsporum, and Epidermophyton. India is currently experiencing an epidemic of chronic and recurrent dermatophytosis, leading to considerable morbidity. Although not life-threatening, the disease produces intense pruritus, cosmetic disfigurement, sleep disturbance, social embarrassment, and occupational impairment. The Dermatology Life Quality Index (DLQI), a validated 10-item questionnaire developed by Finlay and Khan, is the most widely used tool to assess dermatology-specific quality of life. Despite the high burden of dermatophytosis in India, systematic data on its psychosocial impact — particularly from South India — remain limited.'),
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    new Paragraph({ children: [bold('AIM', 24)], spacing: { before: 100, after: 60 } }),
    para('To assess the impact of dermatophytosis on quality of life using the Dermatology Life Quality Index (DLQI) and to correlate DLQI scores with clinical parameters of the disease.'),
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    new Paragraph({ children: [bold('OBJECTIVES', 24)], spacing: { before: 100, after: 60 } }),
    para([bold('Primary: ')]),
    bullet('To measure quality of life impairment in patients with dermatophytosis using DLQI.'),
    para([bold('Secondary: ')]),
    bullet('To correlate DLQI scores with duration of disease, body surface area involvement, number of sites, type of dermatophytosis, and chronicity/recurrence.'),
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    para([bold('Study Design: '), normal('Hospital-based observational cross-sectional study.')]),
    para([bold('Setting: '), normal('Department of DVL, MMCHRI, Kanchipuram.')]),
    para([bold('Duration: '), normal('12 months from IEC approval.')]),
    para([bold('Sample Size: '), normal('Minimum 100 patients (n = Z²P(1-P)/d²; Z=1.96, P=50%, d=10%).')]),
    para([bold('Participants: '), normal('Patients aged ≥15 years with clinically diagnosed dermatophytosis willing to give written informed consent. Exclusion: other significant dermatological disorders, severe systemic illness, psychiatric illness, pregnant/lactating women.')]),
    para([bold('Tool: '), normal('DLQI questionnaire (10 items; score 0–30). Scores interpreted as: 0–1 = No effect; 2–5 = Small; 6–10 = Moderate; 11–20 = Very large; 21–30 = Extremely large effect on QoL.')]),
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    para('The majority of patients are expected to show moderate to very large QoL impairment (DLQI 6–20). Higher DLQI scores are anticipated in patients with chronic disease, recurrent episodes, extensive BSA involvement, and multiple site involvement.'),
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    new Paragraph({ children: [bold('CONCLUSION', 24)], spacing: { before: 100, after: 60 } }),
    para('This study will systematically quantify the psychosocial burden of dermatophytosis in a South Indian tertiary care population and generate data to support patient-centred, holistic management strategies for this condition.'),
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    new Paragraph({ children: [bold('KEYWORDS', 24)], spacing: { before: 100, after: 60 } }),
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    bullet('To document the demographic profile of affected patients.'),
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    bullet('To evaluate clinical improvement after TCS discontinuation.'),
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cd /home/daytona/workspace/iec-thesis && node gen_abstract1.js && node gen_abstr…

cp /home/daytona/workspace/iec-thesis/Abstract_Rajadurai_DLQI.docx /tmp/abs1.do…

dermatophytosis quality of life DLQI India

topical corticosteroid abuse face India dermatoses

geriatric dermatoses elderly skin diseases India epidemiology

skin diseases elderly patients tertiary care hospital cross sectional

DLQI dermatology life quality index validation Finlay

topical steroid dependent face TSDF clobetasol misuse

echo "=== THESIS 1: RAJADURAI ===" && grep -i -n "reference\|verma\|finlay\|dogr…