from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.platypus.flowables import HRFlowable
from reportlab.pdfbase import pdfmetrics
from reportlab.pdfbase.ttfonts import TTFont
import urllib.request
import io
from reportlab.platypus import Image as RLImage
import os

OUTPUT = "/home/daytona/workspace/medical-notes/Medical_Notes_Hemorrhage_HydatidiformMole.pdf"

# ── page geometry ──────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2.2*cm, bottomMargin=2.2*cm,
    title="Medical Notes: Hemorrhage & Hydatidiform Mole",
    author="Orris Medical Assistant"
)

W = A4[0] - 4*cm   # usable width

# ── colour palette ─────────────────────────────────────────────────────────
DARK_BLUE   = colors.HexColor("#1a3a5c")
MED_BLUE    = colors.HexColor("#2563a8")
LIGHT_BLUE  = colors.HexColor("#dbeafe")
ACCENT      = colors.HexColor("#dc2626")
SOFT_GRAY   = colors.HexColor("#f3f4f6")
MED_GRAY    = colors.HexColor("#6b7280")
TABLE_HDR   = colors.HexColor("#1e3a5f")
TABLE_ALT   = colors.HexColor("#eef4fb")

# ── styles ─────────────────────────────────────────────────────────────────
base = getSampleStyleSheet()

def S(name, parent="Normal", **kw):
    return ParagraphStyle(name, parent=base[parent], **kw)

TITLE   = S("TITLE",   "Title",   fontSize=22, textColor=DARK_BLUE,
            spaceAfter=4, alignment=TA_CENTER, fontName="Helvetica-Bold")
SUBTITLE= S("SUBTITLE","Normal",  fontSize=11, textColor=MED_GRAY,
            spaceAfter=2, alignment=TA_CENTER)
H1      = S("H1",      "Heading1",fontSize=15, textColor=colors.white,
            spaceBefore=10, spaceAfter=4, fontName="Helvetica-Bold",
            backColor=DARK_BLUE, leftIndent=-2, rightIndent=-2,
            borderPad=5)
H2      = S("H2",      "Heading2",fontSize=12, textColor=DARK_BLUE,
            spaceBefore=8, spaceAfter=3, fontName="Helvetica-Bold",
            borderPad=3)
H3      = S("H3",      "Heading3",fontSize=11, textColor=MED_BLUE,
            spaceBefore=6, spaceAfter=2, fontName="Helvetica-BoldOblique")
BODY    = S("BODY",    "Normal",  fontSize=10, leading=15,
            spaceAfter=5, alignment=TA_JUSTIFY)
BULLET  = S("BULLET",  "Normal",  fontSize=10, leading=14,
            spaceAfter=3, leftIndent=14, bulletIndent=4)
CAPTION = S("CAPTION", "Normal",  fontSize=8.5, textColor=MED_GRAY,
            alignment=TA_CENTER, spaceAfter=6, fontName="Helvetica-Oblique")
NOTE    = S("NOTE",    "Normal",  fontSize=9,  textColor=MED_GRAY,
            spaceAfter=4, fontName="Helvetica-Oblique")
QBOX    = S("QBOX",    "Normal",  fontSize=10, textColor=DARK_BLUE,
            spaceAfter=2, fontName="Helvetica-BoldOblique",
            backColor=LIGHT_BLUE, borderPad=8, leftIndent=6)

# ── helpers ────────────────────────────────────────────────────────────────
def hr(color=MED_BLUE, thickness=0.8):
    return HRFlowable(width="100%", thickness=thickness,
                      color=color, spaceAfter=4, spaceBefore=2)

def sp(h=6):
    return Spacer(1, h)

def bullet(text):
    return Paragraph(f"• {text}", BULLET)

def body(text):
    return Paragraph(text, BODY)

def h1(text):
    return Paragraph(text, H1)

def h2(text):
    return Paragraph(text, H2)

def h3(text):
    return Paragraph(text, H3)

def note(text):
    return Paragraph(f"<i>{text}</i>", NOTE)

def qbox(text):
    return Paragraph(text, QBOX)

def make_table(headers, rows, col_widths=None, alt=True):
    """Build a styled table."""
    data = [headers] + rows
    if col_widths is None:
        n = len(headers)
        col_widths = [W / n] * n

    style = TableStyle([
        # header
        ("BACKGROUND",   (0,0), (-1,0),  TABLE_HDR),
        ("TEXTCOLOR",    (0,0), (-1,0),  colors.white),
        ("FONTNAME",     (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",     (0,0), (-1,0),  9.5),
        ("ALIGN",        (0,0), (-1,0),  "CENTER"),
        ("VALIGN",       (0,0), (-1,-1), "MIDDLE"),
        # body
        ("FONTNAME",     (0,1), (-1,-1), "Helvetica"),
        ("FONTSIZE",     (0,1), (-1,-1), 9),
        ("ALIGN",        (0,1), (0,-1),  "LEFT"),
        ("ALIGN",        (1,1), (-1,-1), "CENTER"),
        ("LEADING",      (0,1), (-1,-1), 13),
        # grid
        ("GRID",         (0,0), (-1,-1), 0.4, colors.HexColor("#cbd5e1")),
        ("LINEBELOW",    (0,0), (-1,0),  1.2, MED_BLUE),
        ("TOPPADDING",   (0,0), (-1,-1), 5),
        ("BOTTOMPADDING",(0,0), (-1,-1), 5),
        ("LEFTPADDING",  (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("ROWBACKGROUNDS",(0,1),(-1,-1), [colors.white, TABLE_ALT] if alt else [colors.white]),
    ])
    return Table(data, colWidths=col_widths, style=style, repeatRows=1)

def fetch_img(url, width, caption=None):
    """Download image and return [RLImage, caption_para] or []."""
    try:
        req = urllib.request.Request(url, headers={"User-Agent": "Mozilla/5.0"})
        data = urllib.request.urlopen(req, timeout=10).read()
        img = RLImage(io.BytesIO(data), width=width)
        img.hAlign = "CENTER"
        result = [sp(4), img]
        if caption:
            result.append(Paragraph(caption, CAPTION))
        result.append(sp(4))
        return result
    except Exception as e:
        print(f"  [img skip] {url[:60]}… → {e}")
        return []

# ══════════════════════════════════════════════════════════════════════════
# BUILD STORY
# ══════════════════════════════════════════════════════════════════════════
story = []

# ── COVER ──────────────────────────────────────────────────────────────────
story += [
    sp(60),
    Paragraph("Medical Pathology Notes", TITLE),
    hr(DARK_BLUE, 2),
    sp(6),
    Paragraph("Hemorrhage — Overview &amp; Classification", SUBTITLE),
    Paragraph("Hydatidiform Mole — Diagnosis, Cytogenetics &amp; Morphology", SUBTITLE),
    sp(8),
    hr(MED_GRAY, 0.5),
    sp(4),
    Paragraph("Source: Robbins &amp; Kumar Basic Pathology · Robbins, Cotran &amp; Kumar PBD · Berek &amp; Novak's Gynecology · Goldman-Cecil Medicine", NOTE),
    Paragraph("Compiled by Orris Medical Assistant · June 2026", NOTE),
    PageBreak(),
]

# ══════════════════════════════════════════════════════════════════════════
# QUESTION 1 — HEMORRHAGE
# ══════════════════════════════════════════════════════════════════════════
story += [
    h1("QUESTION 1   |   Hemorrhage — Overview & Classification"),
    sp(4),
]

# Definition
story += [
    h2("Definition"),
    body("Hemorrhage is defined as the <b>extravasation (escape) of blood from vessels</b>. "
         "It results from vessel wall damage and may be worsened by defects in coagulation. "
         "Capillary bleeding can occur in chronically congested tissues; trauma, atherosclerosis, "
         "or inflammatory/neoplastic erosion of a vessel wall can also lead to hemorrhage, which "
         "may be massive if the affected vessel is a large vein or artery."),
    sp(4),
]

# Causes
story += [
    h2("Causes"),
    bullet("Trauma (most common)"),
    bullet("Atherosclerosis — vessel wall weakening"),
    bullet("Inflammatory or neoplastic erosion of vessel wall"),
    bullet("Chronic congestion — capillary bleeding"),
    bullet("<b>Hemorrhagic diatheses</b> — inherited/acquired defects in vessel walls, "
           "platelets, or coagulation factors (increased risk after even trivial injury)"),
    sp(6),
]

# Morphological classification
story += [
    h2("Morphological Classification (by Size and Location)"),
    sp(4),
]

morph_headers = [
    Paragraph("<b>Type</b>", CAPTION),
    Paragraph("<b>Size</b>", CAPTION),
    Paragraph("<b>Features & Causes</b>", CAPTION),
]
morph_rows = [
    [Paragraph("<b>Petechiae</b>", BODY),
     "1–2 mm",
     "Minute skin/mucosal/serosal bleeds; causes: thrombocytopenia, platelet dysfunction, scurvy"],
    [Paragraph("<b>Purpura</b>", BODY),
     "3–5 mm",
     "Slightly larger; causes: same as petechiae + trauma, vasculitis, vascular fragility"],
    [Paragraph("<b>Ecchymoses</b>", BODY),
     "1–2 cm",
     "Subcutaneous hematomas (bruises); colour: red-blue → blue-green (bilirubin) → golden-brown (hemosiderin)"],
    [Paragraph("<b>Hematoma</b>", BODY),
     "Variable",
     "Localised blood accumulation in tissue; trivial (bruise) to fatal (retroperitoneal hematoma from aortic dissection)"],
]
story.append(make_table(morph_headers, morph_rows, col_widths=[3.2*cm, 2*cm, W-5.2*cm]))
story.append(sp(4))

# Body cavity locations
story += [
    h3("Hemorrhage by Body Cavity Location"),
    bullet("<b>Hemothorax</b> — blood in pleural space"),
    bullet("<b>Hemopericardium</b> — blood in pericardial sac"),
    bullet("<b>Hemoperitoneum</b> — blood in peritoneal cavity"),
    bullet("<b>Hemarthrosis</b> — blood in a joint"),
    sp(6),
]

# Images
story += fetch_img(
    "https://cdn.orris.care/cdss_images/e976d793a8221880bbc57745cd7fe84eb05cd52d1e5b7e2b9d553a5533fa867f.png",
    12*cm,
    "Fig 1A. Punctate petechial hemorrhages of the colonic mucosa (thrombocytopenia). "
    "[Robbins & Kumar Basic Pathology, Fig. 3.4A]"
)
story += fetch_img(
    "https://cdn.orris.care/cdss_images/1791cf07ee5ff6fd0fe73838de40edd1e6eadd474289feca54396e812547a802.png",
    12*cm,
    "Fig 1B. Fatal intracerebral hemorrhage — large hematoma in right hemisphere with surrounding oedema. "
    "[Robbins & Kumar Basic Pathology, Fig. 3.4B]"
)

# ATLS Hemorrhagic Shock Classification
story += [
    h2("Hemorrhagic Shock Classification (ATLS — American College of Surgeons)"),
    body("When blood loss is large enough to cause hemodynamic instability, it produces "
         "<b>hemorrhagic shock</b>. The ATLS system classifies it into 4 classes "
         "(estimates for a 70-kg patient):"),
    sp(4),
]

shock_headers = [
    Paragraph("<b>Parameter</b>", CAPTION),
    Paragraph("<b>Class I</b>", CAPTION),
    Paragraph("<b>Class II</b>", CAPTION),
    Paragraph("<b>Class III</b>", CAPTION),
    Paragraph("<b>Class IV</b>", CAPTION),
]
shock_rows = [
    ["Blood loss (mL)",       "Up to 750",   "750–1500",  "1500–2000",  ">2000"],
    ["% Blood volume",        "Up to 15%",   "15–30%",    "30–40%",     ">40%"],
    ["Heart rate (bpm)",      "<100",        ">100",      ">120",       ">140"],
    ["Blood pressure",        "Normal",      "Normal",    "Decreased",  "Decreased"],
    ["Pulse pressure",        "Normal/↑",    "Decreased", "Decreased",  "Decreased"],
    ["Resp. rate (per min)",  "14–20",       "20–30",     "30–40",      ">35"],
    ["Urine output (mL/hr)", ">30",          "20–30",     "5–15",       "Negligible"],
    ["Mental status",         "Sl. anxious", "Mildly anxious", "Anxious, confused", "Confused, lethargic"],
    ["Fluid replacement",     "Crystalloid", "Crystalloid","Crystalloid + blood","Crystalloid + blood"],
]
cw_s = [4.2*cm, 2.5*cm, 2.5*cm, 2.5*cm, 2.8*cm]
story.append(make_table(shock_headers, shock_rows, col_widths=cw_s))
story += [
    sp(4),
    note("Source: Goldman-Cecil Medicine; ATLS, American College of Surgeons (estimates based on a 70-kg patient)."),
    sp(6),
]

# Clinical impact
story += [
    h2("Clinical Impact — Key Determinants"),
    body("The severity of hemorrhage depends on four factors:"),
    bullet("<b>Volume of blood lost</b> — loss of >20% of blood volume causes hemodynamic compromise"),
    bullet("<b>Rate of bleeding</b> — rapid losses are less tolerated than slow, gradual losses"),
    bullet("<b>Location of the bleed</b> — bleeding into a confined space (skull, pericardium) "
           "can be fatal even at small volumes"),
    bullet("<b>Patient's baseline status</b> — pre-existing anaemia, cardiovascular disease, and "
           "advanced age worsen tolerance"),
    sp(4),
]

story += [
    h2("Consequences"),
    bullet("Large hemorrhages may cause <b>jaundice</b> — red cells broken down by macrophages release bilirubin"),
    bullet("Chronic slow bleeding → <b>iron-deficiency anaemia</b>"),
    bullet("Acute large-volume loss → <b>hypovolemic/hemorrhagic shock</b> and end-organ ischaemia"),
    bullet("Intracerebral or pericardial hemorrhage can be fatal at relatively small volumes due to "
           "space constraints"),
    sp(4),
    note("Sources: Robbins & Kumar Basic Pathology; Goldman-Cecil Medicine, 2-Volume Set."),
    PageBreak(),
]

# ══════════════════════════════════════════════════════════════════════════
# QUESTION 2 — HYDATIDIFORM MOLE
# ══════════════════════════════════════════════════════════════════════════
story += [
    h1("QUESTION 2   |   Hydatidiform Mole — GTD"),
    sp(4),
    qbox("30-year-old female · First trimester · Spontaneous bleeding PV + passage of vesicles · "
         "Excessive vomiting · Serum β-HCG markedly elevated"),
    sp(8),
]

# Part a
story += [
    h2("(a)  Most Likely Diagnosis with Reasons   [2 marks]"),
    body("<b>Diagnosis: Complete Hydatidiform Mole</b> (Gestational Trophoblastic Disease)"),
    sp(4),
]

diag_headers = [
    Paragraph("<b>Clinical Feature</b>", CAPTION),
    Paragraph("<b>Significance / Reason</b>", CAPTION),
]
diag_rows = [
    ["First-trimester bleeding PV",
     "Trophoblastic tissue erodes uterine vessels"],
    ["Passage of vesicles (grape-like structures)",
     "Pathognomonic — hydropic, cystically swollen chorionic villi"],
    ["Excessive vomiting (hyperemesis)",
     "Markedly elevated β-HCG stimulates the vomiting centre"],
    ["Markedly elevated serum β-HCG",
     "Massive trophoblastic proliferation; complete moles can exceed 100,000 IU/L — "
     "far higher than a normal pregnancy of the same gestational age"],
    ["First-trimester presentation",
     "Average detection at ~9 weeks gestation"],
]
story.append(make_table(diag_headers, diag_rows,
             col_widths=[5.5*cm, W-5.5*cm]))
story += [
    sp(6),
    body("The combination of these findings points specifically to a <b>complete mole</b> rather "
         "than a partial mole because: (i) partial moles present more like a missed abortion with "
         "less dramatic vesicle passage; (ii) β-HCG is only modestly elevated in partial moles; "
         "(iii) hyperemesis is characteristic of the extreme HCG elevation seen in complete moles."),
    sp(8),
]

# Part b
story += [
    h2("(b)  Cytogenetic Abnormalities   [4 marks]"),
    sp(4),
]

story += fetch_img(
    "https://cdn.orris.care/cdss_images/5b100d661f3d0a955a5efdead149e770a2a2bcb7b996b33f86b90506cf37df1b.png",
    13*cm,
    "Fig 2. Origin of complete and partial hydatidiform moles — cytogenetic diagram. "
    "(A) Monospermic complete mole — endoreduplication. "
    "(B) Dispermic complete mole — empty ovum + two sperm. "
    "(C) Partial mole — dispermy into normal ovum producing triploid karyotype. "
    "[Robbins, Cotran & Kumar Pathologic Basis of Disease, Fig. 22.53]"
)

story += [
    h3("Complete Mole — Cytogenetics"),
    body("Key concept: <b>all nuclear genetic material is of paternal origin (androgenesis)</b>. "
         "The ovum's nuclear DNA is absent or inactivated; mitochondrial DNA remains maternal."),
    sp(4),
    bullet("<b>Mechanism 1 — Monospermic (90% of cases):</b> An empty ovum (enucleated/inactive "
           "egg) fertilised by a <i>single haploid sperm (23X)</i>. The sperm undergoes "
           "<b>endoreduplication</b> (chromosome duplication) within the egg. Result: "
           "<b>46,XX</b> — homozygous, entirely paternal."),
    bullet("<b>Mechanism 2 — Dispermic (10% of cases):</b> Empty ovum fertilised by two separate "
           "sperm simultaneously. Produces <b>46,XX</b> (two X sperm) or <b>46,XY</b> (X + Y). "
           "Note: 46,YY is non-viable and never found. Result: heterozygous complete mole."),
    sp(4),
    note("Diagnostic key: Complete moles are p57-NEGATIVE (p57 is a paternally imprinted, "
         "maternally expressed gene product — absent when there are no maternal chromosomes)."),
    sp(6),
    h3("Partial Mole — Cytogenetics"),
    body("Mechanism: <b>dispermic fertilisation of a normal ovum.</b>"),
    bullet("A normal ovum (23X) is fertilised by two sperm (two X, or X + Y)"),
    bullet("Result: <b>triploid</b> (69 chromosomes) — two paternal haploid sets + one maternal set"),
    bullet("Possible karyotypes: <b>69,XXX</b> · <b>69,XXY</b> (most common) · <b>69,XYY</b> (rare)"),
    bullet("Occasional tetraploid forms (92,XXXY) have been reported"),
    sp(4),
    note("Diagnostic key: Partial moles are p57-POSITIVE (maternal chromosomes present). "
         "The extra paternal set still drives trophoblastic proliferation."),
    sp(6),
]

cyto_headers = [
    Paragraph("<b>Feature</b>", CAPTION),
    Paragraph("<b>Complete Mole</b>", CAPTION),
    Paragraph("<b>Partial Mole</b>", CAPTION),
]
cyto_rows = [
    ["Ploidy",               "Diploid",                      "Triploid (occasionally tetraploid)"],
    ["Karyotype",            "46,XX (90%) · 46,XY (10%)",    "69,XXX · 69,XXY · 69,XYY"],
    ["Mechanism",            "Monospermy + endoreduplication\nor dispermy → empty ovum",
                             "Dispermy → normal ovum"],
    ["Chromosome origin",    "Entirely paternal (androgenesis)","2 paternal + 1 maternal set"],
    ["p57 immunostaining",   "Negative",                     "Positive"],
]
story.append(make_table(cyto_headers, cyto_rows,
             col_widths=[4.5*cm, 6*cm, 6*cm]))
story += [sp(8)]

# Part c
story += [
    h2("(c)  Differentiating Features — Complete vs Partial Mole   [4 marks]"),
    sp(4),
]

diff_headers = [
    Paragraph("<b>Feature</b>", CAPTION),
    Paragraph("<b>Complete Mole</b>", CAPTION),
    Paragraph("<b>Partial Mole</b>", CAPTION),
]
diff_rows = [
    ["Karyotype",              "46,XX or 46,XY (diploid)",
                               "69,XXX / 69,XXY / 69,XYY (triploid)"],
    ["Gross appearance",       "Uterus distended by grape-like vesicles; NO fetal parts",
                               "Smaller vesicles mixed with normal villi; fetal parts may be present"],
    ["Villous oedema",         "ALL villi affected (diffuse/global)",
                               "Only SOME villi affected (focal)"],
    ["Villous outline",        "Smooth, round, regular",
                               "Irregular / scalloped outline"],
    ["Trophoblast hyperplasia","Diffuse, circumferential\n(cyto + syncytiotrophoblast)",
                               "Focal, slight\n(syncytiotrophoblast only)"],
    ["Cistern formation",      "Prominent central cisternae",
                               "Present but less prominent"],
    ["Trophoblastic inclusions","Absent",
                                "Prominent stromal inclusions"],
    ["Embryo / fetal tissue",  "ABSENT",
                               "May be present (growth-restricted; syndactyly, hydrocephaly)"],
    ["Serum β-HCG",            "Markedly elevated (>100,000 IU/L)",
                               "Less elevated or near-normal for dates"],
    ["Tissue β-HCG",           "++++",
                               "+"],
    ["Uterine size",           "Larger than dates",
                               "Normal or small for dates"],
    ["Clinical presentation",  "Bleeding + vesicle passage + hyperemesis + high HCG",
                               "Often presents as missed/incomplete abortion"],
    ["Risk: invasive mole",    "~15%",
                               "Low"],
    ["Risk: choriocarcinoma",  "~2.5%",
                               "Rare (not typically associated)"],
    ["p57 immunostaining",     "Negative",
                               "Positive"],
]
story.append(make_table(diff_headers, diff_rows,
             col_widths=[4.5*cm, 6.2*cm, 5.8*cm]))
story += [sp(6)]

# Gross + Histology images
story += fetch_img(
    "https://cdn.orris.care/cdss_images/8ad2ac1dd8c114feff8d1111cbcd6822388a702aeceebadb995a1dc39ee05aec.png",
    14*cm,
    "Fig 3. Complete hydatidiform mole. (A) Gross — uterine cavity distended by grape-like vesicular villi. "
    "(B) Histology — diffuse villous oedema, prominent central cisternae, and circumferential "
    "trophoblastic proliferation involving both cyto- and syncytiotrophoblast. "
    "[Robbins, Cotran & Kumar PBD, Fig. 22.54]"
)

story += fetch_img(
    "https://cdn.orris.care/cdss_images/943a8773800f1e01bcffd0109f904156a0841d7fbd06cc35d5d1dc03c680847d.png",
    12*cm,
    "Fig 4. Partial hydatidiform mole — histology. Mixture of large and small villi; large villi have "
    "irregular/scalloped outlines and prominent syncytiotrophoblastic inclusions; trophoblastic "
    "hyperplasia is focal and involves only syncytiotrophoblasts. This mole was triploid. "
    "[Robbins, Cotran & Kumar PBD, Fig. 22.55]"
)

# Follow-up
story += [
    h2("Follow-up After Mole Evacuation"),
    bullet("Serial serum β-HCG monitoring for <b>6–12 months</b> after uterine evacuation"),
    bullet("Persistent or rising HCG → invasive mole or choriocarcinoma → chemotherapy "
           "(methotrexate or actinomycin-D)"),
    bullet("Lung metastases occur in ~5% of complete moles; lesions <2 cm usually regress "
           "spontaneously"),
    sp(6),
    hr(MED_GRAY, 0.5),
    note("Sources: Robbins, Cotran & Kumar Pathologic Basis of Disease · "
         "Robbins & Kumar Basic Pathology · Berek & Novak's Gynecology · "
         "Goldman-Cecil Medicine, 2-Volume Set."),
]

# ── BUILD ──────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF written → {OUTPUT}")

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/medical-notes/generate_pdf.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/medical-notes/generate_pdf.py'