fever differential diagnosis CBC interpretation treatment guidelines general practice 2024

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace dir does not exis…

mkdir -p /home/daytona/workspace/fever-quickref && python3 -c "import reportlab;…

~/fever-quickref/build_pdf.py

#!/usr/bin/env python3
"""
Fever Quick Reference Card - GP Edition
Generates a professional multi-page PDF with:
  - Page 1: Cover + Fever DDx (Infectious & Non-Infectious)
  - Page 2: CBC Interpretation
  - Page 3: Treatment Flowchart + Treatment Table
  - Page 4: Red Flags + Investigations
"""

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm, cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether, PageBreak
)
from reportlab.platypus.flowables import Flowable
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT
from reportlab.graphics.shapes import Drawing, Rect, String, Line, Arrow
from reportlab.graphics import renderPDF
from reportlab.graphics.shapes import Drawing, Rect, String, Line, Polygon
from reportlab.pdfgen import canvas

# ── Colour Palette ──────────────────────────────────────────────────────────
NAVY        = colors.HexColor("#1A2E4A")
TEAL        = colors.HexColor("#00838F")
TEAL_LIGHT  = colors.HexColor("#E0F4F5")
RED         = colors.HexColor("#C62828")
RED_LIGHT   = colors.HexColor("#FFEBEE")
ORANGE      = colors.HexColor("#E65100")
ORANGE_LIGHT= colors.HexColor("#FFF3E0")
GREEN       = colors.HexColor("#2E7D32")
GREEN_LIGHT = colors.HexColor("#E8F5E9")
YELLOW_LIGHT= colors.HexColor("#FFFDE7")
GREY        = colors.HexColor("#546E7A")
GREY_LIGHT  = colors.HexColor("#ECEFF1")
WHITE       = colors.white
BLACK       = colors.black

W, H = A4  # 595.27 x 841.89 pts

OUTPUT = "/home/daytona/workspace/fever-quickref/Fever_Quick_Reference_GP.pdf"

# ── Custom Flowables ─────────────────────────────────────────────────────────

class ColorBar(Flowable):
    """A thin horizontal colour bar used as section divider."""
    def __init__(self, width, height=3, color=TEAL):
        Flowable.__init__(self)
        self.bar_width = width
        self.bar_height = height
        self.color = color

    def draw(self):
        self.canv.setFillColor(self.color)
        self.canv.rect(0, 0, self.bar_width, self.bar_height, fill=1, stroke=0)

    def wrap(self, aw, ah):
        return (self.bar_width, self.bar_height)


class SectionHeader(Flowable):
    """Coloured section header banner."""
    def __init__(self, text, width, bg=NAVY, fg=WHITE, fontsize=13):
        Flowable.__init__(self)
        self.text = text
        self.w = width
        self.bg = bg
        self.fg = fg
        self.fontsize = fontsize
        self.h = fontsize + 10

    def draw(self):
        c = self.canv
        c.setFillColor(self.bg)
        c.roundRect(0, 0, self.w, self.h, 4, fill=1, stroke=0)
        c.setFillColor(self.fg)
        c.setFont("Helvetica-Bold", self.fontsize)
        c.drawString(8, 4, self.text)

    def wrap(self, aw, ah):
        return (self.w, self.h)


class FlowchartBox(Flowable):
    """Simple flowchart for the treatment decision flow."""
    def __init__(self, width=500):
        Flowable.__init__(self)
        self.w = width
        self.h = 340

    def draw(self):
        c = self.canv
        bw = self.w

        def box(x, y, w, h, text, bg, fg=WHITE, fontsize=8.5, radius=6):
            c.setFillColor(bg)
            c.roundRect(x, y, w, h, radius, fill=1, stroke=0)
            c.setFillColor(fg)
            c.setFont("Helvetica-Bold", fontsize)
            lines = text.split("\n")
            total_h = len(lines) * (fontsize + 3)
            start_y = y + (h - total_h) / 2 + (fontsize + 3) * (len(lines) - 1)
            for line in lines:
                c.drawCentredString(x + w / 2, start_y, line)
                start_y -= (fontsize + 3)

        def arrow(x1, y1, x2, y2):
            c.setStrokeColor(GREY)
            c.setLineWidth(1.2)
            c.line(x1, y1, x2, y2)
            # arrowhead
            import math
            angle = math.atan2(y2 - y1, x2 - x1)
            aw = 6
            c.setFillColor(GREY)
            c.beginPath()
            c.moveTo(x2, y2)
            c.lineTo(x2 - aw * math.cos(angle - 0.4), y2 - aw * math.sin(angle - 0.4))
            c.lineTo(x2 - aw * math.cos(angle + 0.4), y2 - aw * math.sin(angle + 0.4))
            c.closePath()
            c.fill()

        def label(x, y, text, color=ORANGE, fontsize=7.5):
            c.setFillColor(color)
            c.setFont("Helvetica-Bold", fontsize)
            c.drawString(x, y, text)

        # Node positions (x, y, w, h)
        cx = bw / 2
        # Row 1 - Start
        box(cx-90, 305, 180, 28, "FEBRILE PATIENT AT GP\n(Temp > 38.0 C)", NAVY, WHITE, 8)
        arrow(cx, 305, cx, 278)

        # Row 2 - History & Exam
        box(cx-110, 250, 220, 26, "History + Physical Examination\nLocalise source; assess severity", TEAL, WHITE, 8)
        arrow(cx, 250, cx, 223)

        # Row 3 - Red flags
        box(cx-100, 195, 200, 26, "RED FLAGS present?\n(see Page 4)", RED, WHITE, 8)
        # Yes branch - right
        arrow(cx+100, 208, cx+160, 208)
        box(cx+160, 195, 115, 26, "EMERGENCY\nReferral / 999", RED, WHITE, 7.5)
        label(cx+105, 211, "YES", RED)
        # No branch - down
        arrow(cx, 195, cx, 168)
        label(cx+4, 180, "NO", GREEN)

        # Row 4 - CBC + Markers
        box(cx-120, 140, 240, 26, "Order: CBC + CRP/PCT + ESR\n+ Targeted tests (urine/CXR/swab)", TEAL, WHITE, 8)
        arrow(cx, 140, cx, 113)

        # Row 5 - Decision split
        box(cx-80, 85, 160, 26, "CBC Result + Clinical Picture", NAVY, WHITE, 8)

        # Branch left - Bacterial
        arrow(cx-40, 85, cx-120, 60)
        box(cx-195, 35, 140, 26, "Neutrophilia\n+ High CRP/PCT", RED_LIGHT, RED, 8)
        arrow(cx-125, 35, cx-125, 10)
        box(cx-195, -15, 140, 26, "BACTERIAL\nAntibiotics", RED, WHITE, 8)
        label(cx-165, 63, "Bacterial", RED, 7)

        # Branch right - Viral
        arrow(cx+40, 85, cx+120, 60)
        box(cx+55, 35, 140, 26, "Lymphocytosis\n+ Normal/Low WBC", GREEN_LIGHT, GREEN, 8)
        arrow(cx+125, 35, cx+125, 10)
        box(cx+55, -15, 140, 26, "VIRAL\nSupportive Care", GREEN, WHITE, 8)
        label(cx+75, 63, "Viral", GREEN, 7)

        # Label
        c.setFillColor(GREY)
        c.setFont("Helvetica-Oblique", 7)
        c.drawCentredString(cx, -30, "Review in 48-72 hrs if not improving | Consider FUO workup if fever > 7 days")


# ── Styles ───────────────────────────────────────────────────────────────────

styles = getSampleStyleSheet()

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

title_style    = S("Title2", fontSize=22, textColor=WHITE, alignment=TA_CENTER, fontName="Helvetica-Bold", leading=28)
subtitle_style = S("Sub2",  fontSize=11, textColor=TEAL_LIGHT, alignment=TA_CENTER, fontName="Helvetica-Oblique")
body_style     = S("Body2", fontSize=8.5, textColor=BLACK, leading=13)
bold_style     = S("Bold2", fontSize=8.5, textColor=BLACK, fontName="Helvetica-Bold", leading=13)
small_style    = S("Small2", fontSize=7.5, textColor=GREY, leading=11)
heading_style  = S("H3", fontSize=10, textColor=NAVY, fontName="Helvetica-Bold", leading=14, spaceAfter=2)
red_style      = S("Red2", fontSize=8.5, textColor=RED, fontName="Helvetica-Bold", leading=13)

# ── Helper Functions ──────────────────────────────────────────────────────────

def tbl(data, col_widths, style_cmds, row_heights=None):
    t = Table(data, colWidths=col_widths, rowHeights=row_heights)
    t.setStyle(TableStyle([
        ("FONTNAME", (0,0), (-1,-1), "Helvetica"),
        ("FONTSIZE", (0,0), (-1,-1), 8),
        ("VALIGN",  (0,0), (-1,-1), "MIDDLE"),
        ("GRID",    (0,0), (-1,-1), 0.3, colors.HexColor("#B0BEC5")),
        ("ROWBACKGROUNDS", (0,0), (-1,-1), [WHITE, GREY_LIGHT]),
        ("TOPPADDING",  (0,0), (-1,-1), 3),
        ("BOTTOMPADDING",(0,0), (-1,-1), 3),
        ("LEFTPADDING", (0,0), (-1,-1), 5),
    ] + style_cmds))
    return t

# ── Page background callback ──────────────────────────────────────────────────

def on_first_page(canvas_obj, doc):
    canvas_obj.saveState()
    # Navy gradient-style header block
    canvas_obj.setFillColor(NAVY)
    canvas_obj.rect(0, H - 110, W, 110, fill=1, stroke=0)
    # Teal accent strip
    canvas_obj.setFillColor(TEAL)
    canvas_obj.rect(0, H - 113, W, 3, fill=1, stroke=0)
    # Footer
    canvas_obj.setFillColor(GREY_LIGHT)
    canvas_obj.rect(0, 0, W, 20, fill=1, stroke=0)
    canvas_obj.setFillColor(GREY)
    canvas_obj.setFont("Helvetica", 7)
    canvas_obj.drawCentredString(W/2, 6, "Fever Quick Reference for General Practice  |  Sources: Harrison's 22E, ROSEN's EM, Robbins Pathology, Goldman-Cecil Medicine  |  For clinical guidance only")
    canvas_obj.restoreState()

def on_later_pages(canvas_obj, doc):
    canvas_obj.saveState()
    # Thin top bar
    canvas_obj.setFillColor(NAVY)
    canvas_obj.rect(0, H - 22, W, 22, fill=1, stroke=0)
    canvas_obj.setFillColor(WHITE)
    canvas_obj.setFont("Helvetica-Bold", 8)
    canvas_obj.drawString(15, H - 14, "FEVER QUICK REFERENCE  |  GP EDITION")
    canvas_obj.setFont("Helvetica", 8)
    canvas_obj.drawRightString(W - 15, H - 14, f"Page {doc.page}")
    # Footer
    canvas_obj.setFillColor(GREY_LIGHT)
    canvas_obj.rect(0, 0, W, 20, fill=1, stroke=0)
    canvas_obj.setFillColor(GREY)
    canvas_obj.setFont("Helvetica", 7)
    canvas_obj.drawCentredString(W/2, 6, "Fever Quick Reference for General Practice  |  Sources: Harrison's 22E, ROSEN's EM, Robbins Pathology, Goldman-Cecil Medicine  |  For clinical guidance only")
    canvas_obj.restoreState()


# ── Build Content ─────────────────────────────────────────────────────────────

def build():
    doc = SimpleDocTemplate(
        OUTPUT,
        pagesize=A4,
        leftMargin=18*mm, rightMargin=18*mm,
        topMargin=28*mm, bottomMargin=22*mm,
        title="Fever Quick Reference - GP Edition",
        author="Orris Clinical Assistant",
        subject="Fever DDx, CBC Interpretation, Treatment",
    )

    story = []
    UW = W - 36*mm  # usable width

    # ════════════════════════════════════════════════════════════════════
    # PAGE 1: COVER HEADER + FEVER DDx
    # ════════════════════════════════════════════════════════════════════

    # Cover header (sits over the painted navy rectangle)
    story.append(Spacer(1, 14))
    story.append(Paragraph("FEVER", title_style))
    story.append(Paragraph("Quick Reference Card for General Practice", subtitle_style))
    story.append(Spacer(1, 6))
    story.append(Paragraph("Differential Diagnosis  |  CBC Analysis  |  Treatment Guide  |  Red Flags", subtitle_style))
    story.append(Spacer(1, 22))

    # ── Section 1: Definition ────────────────────────────────────────────
    story.append(SectionHeader("  DEFINITION & PATHOPHYSIOLOGY", UW, NAVY))
    story.append(Spacer(1, 5))

    def_data = [
        [Paragraph("<b>Fever</b>", bold_style),
         Paragraph("Core temperature <b>&gt;38.0°C (100.4°F)</b>. Hyperpyrexia = &gt;41°C (neural tissue damage risk)", body_style)],
        [Paragraph("<b>Mechanism</b>", bold_style),
         Paragraph("Pyrogenic cytokines (IL-1, IL-6, TNF) → PGE2 → hypothalamic set point ↑ → chills → fever → sweating", body_style)],
        [Paragraph("<b>Antipyresis</b>", bold_style),
         Paragraph("NSAIDs/Paracetamol inhibit COX → block PGE2 synthesis → set point normalises", body_style)],
        [Paragraph("<b>Treat if</b>", bold_style),
         Paragraph("Temp &gt;41°C (mandatory); symptomatic relief for moderate fever; paediatric febrile seizure risk", body_style)],
    ]
    t_def = tbl(def_data, [38*mm, UW - 38*mm], [
        ("BACKGROUND", (0,0), (-1,-1), TEAL_LIGHT),
        ("FONTNAME", (0,0), (0,-1), "Helvetica-Bold"),
        ("GRID", (0,0), (-1,-1), 0.3, TEAL),
    ])
    story.append(t_def)
    story.append(Spacer(1, 10))

    # ── Section 2: Infectious DDx ────────────────────────────────────────
    story.append(SectionHeader("  INFECTIOUS CAUSES BY SYSTEM", UW, TEAL))
    story.append(Spacer(1, 5))

    inf_header = [
        Paragraph("<b>System</b>", bold_style),
        Paragraph("<b>Common / Nonemergent</b>", bold_style),
        Paragraph("<b>Urgent / Emergent</b>", bold_style),
        Paragraph("<b>Life-Threatening</b>", bold_style),
    ]
    inf_rows = [
        ["Respiratory", "Pharyngitis, sinusitis, otitis media, bronchitis, influenza, COVID-19, TB", "Bacterial pneumonia, peritonsillar abscess, epiglottitis, retropharyngeal abscess", "Pneumonia + respiratory failure"],
        ["GI / Abdominal", "Gastroenteritis, colitis", "Appendicitis, cholecystitis, diverticulitis, intra-abdominal abscess", "Peritonitis"],
        ["Genitourinary", "Cystitis, prostatitis, epididymitis", "Pyelonephritis, PID, tubo-ovarian abscess", "-"],
        ["Neurological", "-", "Encephalitis, brain abscess", "Meningitis, cavernous sinus thrombosis"],
        ["Skin / Soft Tissue", "-", "Cellulitis, soft tissue abscess, infected decubitus ulcer", "Necrotizing fasciitis"],
        ["Cardiovascular", "-", "Endocarditis, pericarditis, myocarditis", "-"],
        ["Systemic", "-", "Influenza, COVID-19, malaria, dengue, typhoid", "Sepsis / septic shock, meningococcemia"],
    ]

    inf_data = [inf_header]
    for row in inf_rows:
        inf_data.append([Paragraph(c, body_style) for c in row])

    t_inf = tbl(inf_data,
        [28*mm, 58*mm, 62*mm, 48*mm],
        [
            ("BACKGROUND", (0,0), (-1,0), TEAL),
            ("TEXTCOLOR", (0,0), (-1,0), WHITE),
            ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
            ("BACKGROUND", (3,1), (3,-1), RED_LIGHT),
            ("TEXTCOLOR", (3,1), (3,-1), RED),
            ("FONTNAME", (3,1), (3,-1), "Helvetica-Bold"),
        ])
    story.append(t_inf)
    story.append(Spacer(1, 10))

    # ── Section 3: Non-Infectious DDx ─────────────────────────────────────
    story.append(SectionHeader("  NON-INFECTIOUS CAUSES  (Always Consider!)", UW, ORANGE))
    story.append(Spacer(1, 5))

    ni_data = [
        [Paragraph("<b>Critical</b>", S("x", fontSize=8, textColor=RED, fontName="Helvetica-Bold")),
         Paragraph("Acute MI, Pulmonary embolism, Intracranial haemorrhage/stroke, Neuroleptic malignant syndrome, Thyroid storm, Adrenal insufficiency, Transfusion reaction", body_style)],
        [Paragraph("<b>Emergent</b>", S("x", fontSize=8, textColor=ORANGE, fontName="Helvetica-Bold")),
         Paragraph("CHF, Dehydration, Post-seizure, Sickle cell crisis, Pancreatitis, DVT, Transplant rejection", body_style)],
        [Paragraph("<b>Non-urgent</b>", S("x", fontSize=8, textColor=GREEN, fontName="Helvetica-Bold")),
         Paragraph("Drug fever, Malignancy (lymphoma/leukaemia), Gout, Sarcoidosis, Crohn's disease, SLE, RA, Adult-onset Still's disease", body_style)],
    ]
    t_ni = tbl(ni_data, [22*mm, UW - 22*mm], [
        ("BACKGROUND", (0,0), (0,0), RED_LIGHT),
        ("BACKGROUND", (0,1), (0,1), ORANGE_LIGHT),
        ("BACKGROUND", (0,2), (0,2), GREEN_LIGHT),
    ])
    story.append(t_ni)
    story.append(Spacer(1, 10))

    # ── Section 4: Common GP Presentations ──────────────────────────────
    story.append(SectionHeader("  COMMON GP PRESENTATIONS", UW, NAVY))
    story.append(Spacer(1, 5))

    gp_header = [Paragraph("<b>Diagnosis</b>", bold_style),
                 Paragraph("<b>Typical Fever</b>", bold_style),
                 Paragraph("<b>Key Complaints</b>", bold_style),
                 Paragraph("<b>Distinguishing Feature</b>", bold_style)]
    gp_rows = [
        ["Viral URTI", "38-38.5°C", "Sore throat, runny nose, nasal congestion, mild cough", "Self-limiting; no exudate unless Strep"],
        ["Influenza", "39-40°C", "Abrupt myalgia, headache, dry cough, fatigue", "\"Hit by a truck\"; systemic > nasal"],
        ["COVID-19", "38-39°C", "Fever, dry cough, fatigue, anosmia/ageusia", "Loss of smell/taste; SpO2 monitoring"],
        ["Strep Pharyngitis", "38.5-40°C", "Severe sore throat, odynophagia, no cough", "Exudate + tender anterior cervical LN"],
        ["UTI / Cystitis", "Low-grade/none", "Dysuria, frequency, urgency, suprapubic pain", "Usually afebrile; dipstick nitrites/LE +ve"],
        ["Pyelonephritis", "38.5-40°C + rigors", "Flank/loin pain, nausea, vomiting, dysuria", "CVA tenderness; systemic illness"],
        ["Pneumonia (CAP)", "38.5-40°C", "Productive cough, pleuritic pain, dyspnoea", "Bronchial breath sounds; CXR consolidation"],
        ["Dengue Fever", "39-40°C abrupt", "Retro-orbital pain, severe myalgia, rash", "\"Breakbone fever\"; thrombocytopenia"],
        ["Malaria", "Cyclical", "Rigors, sweating, headache, hepatosplenomegaly", "P.vivax 48h / P.malariae 72h cycles"],
        ["Typhoid", "Stepwise rise", "Headache, relative bradycardia, abdo pain, rose spots", "Blood culture positive in week 1"],
        ["Cellulitis", "38-39°C", "Red, warm, swollen, tender skin + systemic fever", "No fluctuance (unlike abscess)"],
        ["Gastroenteritis", "38-39°C", "Nausea, vomiting, diarrhoea, abdo cramps", "Viral = watery; Bacterial = may be bloody"],
    ]
    gp_data = [gp_header]
    for row in gp_rows:
        gp_data.append([Paragraph(c, body_style) for c in row])

    t_gp = tbl(gp_data, [32*mm, 26*mm, 65*mm, 73*mm], [
        ("BACKGROUND", (0,0), (-1,0), NAVY),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTNAME", (0,1), (0,-1), "Helvetica-Bold"),
        ("TEXTCOLOR", (0,1), (0,-1), TEAL),
    ])
    story.append(t_gp)

    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════
    # PAGE 2: CBC INTERPRETATION
    # ════════════════════════════════════════════════════════════════════
    story.append(Spacer(1, 6))
    story.append(SectionHeader("  CBC INTERPRETATION IN FEVER", UW, NAVY, fontsize=13))
    story.append(Spacer(1, 6))

    # WBC
    story.append(Paragraph("WHITE BLOOD CELL COUNT (Normal: 4,000 - 11,000 /µL)", heading_style))
    wbc_data = [
        [Paragraph("<b>Finding</b>", bold_style), Paragraph("<b>Value</b>", bold_style),
         Paragraph("<b>Interpretation</b>", bold_style), Paragraph("<b>Common Causes</b>", bold_style)],
        ["Leukocytosis", "> 11,000 /µL", "Active infection / inflammation / stress",
         "Bacterial infection, acute inflammation, steroid use, physiological stress"],
        ["Extreme leukocytosis", "> 40,000-100,000 /µL", "Leukemoid reaction (vs leukaemia - distinguish!)",
         "Severe bacterial sepsis, pertussis, TB; rule out CML"],
        ["Leukopenia", "< 4,000 /µL", "Viral infection OR overwhelming bacterial sepsis",
         "Dengue, typhoid, viral hepatitis, HIV, protozoa, drug toxicity"],
        ["Normal WBC", "4,000-11,000 /µL", "Does NOT exclude infection",
         "Early bacterial infection, atypical organisms, viral illness"],
    ]
    t_wbc = tbl(wbc_data, [30*mm, 28*mm, 60*mm, UW-118*mm], [
        ("BACKGROUND", (0,0), (-1,0), TEAL),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("BACKGROUND", (0,2), (-1,2), RED_LIGHT),
    ], row_heights=[None,None,None,None,None])
    story.append(t_wbc)
    story.append(Spacer(1, 8))

    # Differential
    story.append(Paragraph("DIFFERENTIAL COUNT - What Each Cell Tells You", heading_style))
    diff_data = [
        [Paragraph("<b>Cell</b>", bold_style), Paragraph("<b>Normal %</b>", bold_style),
         Paragraph("<b>Elevation (↑) Suggests</b>", bold_style), Paragraph("<b>Decrease (↓) Suggests</b>", bold_style),
         Paragraph("<b>Key Point</b>", bold_style)],
        ["Neutrophils", "50-70%", "Bacterial infection, acute inflammation, stress", "Viral infection, typhoid, chemotherapy, drug toxicity", "SHIFT TO LEFT = band cells = active bacterial infection"],
        ["Lymphocytes", "20-40%", "Viral infection (EBV, CMV, rubella, HIV)", "HIV/AIDS, immunosuppression, sepsis, steroids", "Atypical lymphocytes in EBV mononucleosis"],
        ["Monocytes", "2-8%", "Chronic infection (TB, Brucella), malaria, EBV, CMV", "Rarely clinically significant", "Monocytosis in prolonged/granulomatous infection"],
        ["Eosinophils", "1-4%", "Parasitic/helminth infections, allergies, drugs", "Acute bacterial infection, corticosteroids, Cushing's", "Eosinopenia in acute severe infection = poor sign"],
        ["Basophils", "0-1%", "Myeloproliferative disease (rare)", "Usually not significant", "Basophilia rare; think CML if marked"],
        ["Band Cells", "< 5%", "> 5% = 'left shift' = active bacterial infection", "N/A", "Indicates high demand for neutrophils from marrow"],
    ]
    t_diff = tbl(diff_data, [22*mm, 18*mm, 52*mm, 52*mm, 52*mm], [
        ("BACKGROUND", (0,0), (-1,0), NAVY),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTNAME", (0,1), (0,-1), "Helvetica-Bold"),
        ("TEXTCOLOR", (0,1), (0,-1), TEAL),
        ("BACKGROUND", (0,1), (-1,1), YELLOW_LIGHT),  # Neutrophils highlighted
        ("BACKGROUND", (0,6), (-1,6), ORANGE_LIGHT),  # Bands highlighted
    ])
    story.append(t_diff)
    story.append(Spacer(1, 8))

    # RBC + Platelets
    story.append(Paragraph("RED CELLS, HAEMOGLOBIN & PLATELETS", heading_style))
    rbc_data = [
        [Paragraph("<b>Parameter</b>", bold_style), Paragraph("<b>Abnormality</b>", bold_style),
         Paragraph("<b>Clinical Interpretation</b>", bold_style)],
        ["Haemoglobin (Hb)", "Low (Anaemia)", "Chronic infection/inflammation, haemolysis (malaria), iron deficiency"],
        ["MCV", "Low (< 80 fL) = Microcytic", "Iron deficiency anaemia (chronic disease/blood loss)"],
        ["MCV", "High (> 100 fL) = Macrocytic", "B12/folate deficiency, liver disease, hypothyroidism, alcoholism"],
        ["MCV", "Normal = Normocytic anaemia", "Acute blood loss, haemolysis, anaemia of chronic disease"],
        ["Platelets", "Low (< 150,000/µL) THROMBOCYTOPENIA", "DENGUE (hallmark), malaria, sepsis, ITP, drug-induced - RED FLAG"],
        ["Platelets", "High (> 400,000/µL) Thrombocytosis", "Reactive (infection, inflammation, iron deficiency) or essential thrombocythaemia"],
    ]
    t_rbc = tbl(rbc_data, [30*mm, 48*mm, UW - 78*mm], [
        ("BACKGROUND", (0,0), (-1,0), TEAL),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("BACKGROUND", (0,5), (-1,5), RED_LIGHT),
        ("TEXTCOLOR", (1,5), (1,5), RED),
        ("FONTNAME", (1,5), (1,5), "Helvetica-Bold"),
    ])
    story.append(t_rbc)
    story.append(Spacer(1, 8))

    # Inflammatory markers
    story.append(SectionHeader("  INFLAMMATORY MARKERS & INTERPRETATION", UW, TEAL, fontsize=11))
    story.append(Spacer(1, 5))
    im_data = [
        [Paragraph("<b>Marker</b>", bold_style), Paragraph("<b>Normal</b>", bold_style),
         Paragraph("<b>Bacterial Infection</b>", bold_style), Paragraph("<b>Viral Infection</b>", bold_style),
         Paragraph("<b>Clinical Notes</b>", bold_style)],
        ["CRP", "< 10 mg/L", "> 100 mg/L (often)", "Mildly elevated (10-50)", "Rises within 6 hrs; best acute marker; produced in liver (IL-6 stimulus)"],
        ["ESR", "M: <20 / F: <30 mm/hr", "Elevated (non-specific)", "Elevated (non-specific)", "Slow to rise/fall; use for monitoring TB, arteritis, chronic disease"],
        ["Procalcitonin (PCT)", "< 0.1 ng/mL", "> 0.5 ng/mL strongly suggests bacterial; >2 = sepsis probable", "Usually <0.25 ng/mL", "More specific than CRP for bacterial vs viral; guides antibiotic stewardship"],
        ["Ferritin", "M: 20-500 / F: 12-300 µg/L", "Elevated (acute phase)", "May be very high in EBV, CMV", "Extreme elevation (>10,000) = haemophagocytic lymphohistiocytosis (HLH) or Adult Still's"],
        ["LDH", "140-280 U/L", "Elevated in tissue destruction", "Elevated in EBV, haemolysis", "High in haematological malignancy, haemolysis, liver disease"],
    ]
    t_im = tbl(im_data, [22*mm, 28*mm, 44*mm, 38*mm, UW - 132*mm], [
        ("BACKGROUND", (0,0), (-1,0), TEAL),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTNAME", (0,1), (0,-1), "Helvetica-Bold"),
        ("TEXTCOLOR", (0,1), (0,-1), NAVY),
        ("BACKGROUND", (0,3), (-1,3), YELLOW_LIGHT),
    ])
    story.append(t_im)
    story.append(Spacer(1, 8))

    # Pattern recognition box
    story.append(Paragraph("CBC PATTERN RECOGNITION AT A GLANCE", heading_style))
    pat_data = [
        [Paragraph("<b>CBC Pattern</b>", bold_style), Paragraph("<b>Think...</b>", bold_style)],
        ["Neutrophilia + high CRP + high PCT", "Bacterial infection - start targeted antibiotics"],
        ["Lymphocytosis + atypical lymphocytes + normal/low WBC", "Viral infection (EBV/CMV) - supportive care"],
        ["Leukopenia + thrombocytopenia + normal/low Hb", "Dengue fever - no NSAIDs, IV fluids, monitor"],
        ["Leukopenia + relative lymphocytosis + normal platelets", "Typhoid - blood cultures, azithromycin"],
        ["Neutrophilia + anaemia + thrombocytopenia", "Malaria (esp. falciparum) - blood film urgently"],
        ["Very high WBC (> 50,000) + all cell lines affected", "Rule out leukaemia - haematology referral"],
        ["Eosinophilia + fever + travel history", "Parasitic/helminth infection - serology, stool O&P"],
        ["Normal CBC + fever >38.5°C + no source", "Consider blood cultures, procalcitonin, urine MC&S"],
    ]
    t_pat = tbl(pat_data, [75*mm, UW-75*mm], [
        ("BACKGROUND", (0,0), (-1,0), NAVY),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTNAME", (0,1), (0,-1), "Helvetica-Bold"),
        ("TEXTCOLOR", (0,1), (0,-1), NAVY),
    ])
    story.append(t_pat)

    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════
    # PAGE 3: TREATMENT FLOWCHART + TREATMENT TABLE
    # ════════════════════════════════════════════════════════════════════
    story.append(Spacer(1, 4))
    story.append(SectionHeader("  CLINICAL DECISION FLOWCHART", UW, NAVY, fontsize=13))
    story.append(Spacer(1, 8))
    story.append(FlowchartBox(UW))
    story.append(Spacer(1, 55))  # space for flowchart height

    # Antipyretics
    story.append(SectionHeader("  ANTIPYRETIC TREATMENT", UW, TEAL, fontsize=11))
    story.append(Spacer(1, 5))
    ap_data = [
        [Paragraph("<b>Drug</b>", bold_style), Paragraph("<b>Adult Dose</b>", bold_style),
         Paragraph("<b>Mechanism</b>", bold_style), Paragraph("<b>Precautions / Notes</b>", bold_style)],
        ["Paracetamol\n(Acetaminophen)", "500-1000 mg q4-6h\n(max 4g/day)", "Inhibits PGE2 centrally; weak peripheral COX inhibition",
         "FIRST-LINE. Safe in pregnancy, elderly. Caution: hepatic impairment. Do NOT exceed 4g/day."],
        ["Ibuprofen\n(NSAID)", "400 mg q6-8h\n(max 1200 mg/day OTC)", "COX-1/COX-2 inhibitor → blocks prostaglandin synthesis",
         "Anti-inflammatory benefit. AVOID: renal disease, GI ulcers, pregnancy (3rd trimester), dengue, dehydration."],
        ["Aspirin", "325-650 mg q4-6h", "COX inhibitor; decreases PGE2", "AVOID in children <16 yrs (Reye syndrome risk). AVOID in dengue (bleeding risk)."],
        ["Tepid sponging\n+ cooling blanket", "For temp > 41°C", "Physical heat dissipation (conduction/evaporation)", "Use alongside antipyretics for hyperpyrexia. Fan + misting also effective."],
    ]
    t_ap = tbl(ap_data, [30*mm, 32*mm, 52*mm, UW-114*mm], [
        ("BACKGROUND", (0,0), (-1,0), TEAL),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("BACKGROUND", (0,1), (-1,1), GREEN_LIGHT),
    ])
    story.append(t_ap)
    story.append(Spacer(1, 8))

    # Specific treatments
    story.append(SectionHeader("  SPECIFIC TREATMENT BY DIAGNOSIS", UW, NAVY, fontsize=11))
    story.append(Spacer(1, 5))
    tx_data = [
        [Paragraph("<b>Diagnosis</b>", bold_style), Paragraph("<b>First-Line Treatment</b>", bold_style),
         Paragraph("<b>Duration / Notes</b>", bold_style)],
        ["Viral URTI", "Supportive: rest, hydration, paracetamol/ibuprofen", "No antibiotics. Zinc lozenges may shorten duration."],
        ["Strep Pharyngitis (GAS)", "Amoxicillin 500 mg TID OR Penicillin V 500 mg BD", "10 days. Prevents rheumatic fever & peritonsillar abscess."],
        ["Influenza", "Oseltamivir (Tamiflu) 75 mg BD x 5 days (within 48 hrs)", "Prioritise: elderly, immunocompromised, pregnancy, comorbidities."],
        ["COVID-19 (high-risk)", "Nirmatrelvir/ritonavir (Paxlovid) within 5 days of symptoms", "Check drug interactions. Supportive care for mild/low-risk."],
        ["UTI (Cystitis)", "Trimethoprim 200 mg BD x 3-7d OR Nitrofurantoin 100 mg BD x 5-7d", "Send MSU for MC&S first. Adjust per sensitivity."],
        ["Pyelonephritis", "Co-amoxiclav 625 mg TID x 14d OR Ciprofloxacin 500 mg BD x 7-10d", "IV antibiotics if vomiting/severe. Admit if systemic sepsis."],
        ["CAP (mild)", "Amoxicillin 500 mg TID x 5d (+ Clarithromycin if atypical)", "CURB-65 score: 0-1 = community; 2+ = hospital consider."],
        ["Gastroenteritis (bacterial)", "Rehydration (ORS). Azithromycin/Ciprofloxacin if severe/bloody", "Most self-limiting. Bloody + systemic = treat. Avoid loperamide."],
        ["Malaria (P. falciparum)", "Artemether-lumefantrine (Coartem) x 3 days", "URGENT. Admit if severe. P. vivax: Chloroquine + Primaquine."],
        ["Dengue", "Supportive ONLY: IV fluids, paracetamol (strictly)", "NO NSAIDs/aspirin (bleeding risk). Monitor platelets daily."],
        ["Typhoid", "Azithromycin 500 mg OD x 7d (mild/outpatient)", "Ceftriaxone IV for severe. Based on local resistance patterns."],
        ["Cellulitis", "Flucloxacillin 500 mg QID x 5-7d (Clarithromycin if pen-allergic)", "Mark border with pen. IV if systemically unwell or spreading."],
        ["Sepsis (empirical)", "IV Piperacillin-tazobactam OR Meropenem + source control", "SEPSIS 6 bundle: cultures, lactate, fluids, abx, O2, urine output."],
        ["Meningitis (empirical)", "Ceftriaxone 2g IV + Dexamethasone IV immediately", "Do NOT delay for LP if clinically suspected."],
    ]
    t_tx = tbl(tx_data, [35*mm, 73*mm, UW-108*mm], [
        ("BACKGROUND", (0,0), (-1,0), NAVY),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTNAME", (0,1), (0,-1), "Helvetica-Bold"),
        ("TEXTCOLOR", (0,1), (0,-1), TEAL),
        ("BACKGROUND", (0,13), (-1,13), RED_LIGHT),
        ("BACKGROUND", (0,14), (-1,14), RED_LIGHT),
        ("TEXTCOLOR", (0,13), (0,14), RED),
    ])
    story.append(t_tx)

    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════
    # PAGE 4: INVESTIGATIONS + RED FLAGS + FUO
    # ════════════════════════════════════════════════════════════════════
    story.append(Spacer(1, 4))
    story.append(SectionHeader("  INVESTIGATIONS TO ORDER BY SUSPECTED DIAGNOSIS", UW, NAVY, fontsize=12))
    story.append(Spacer(1, 5))

    inv_data = [
        [Paragraph("<b>Suspected Diagnosis</b>", bold_style), Paragraph("<b>First-Line Investigations</b>", bold_style),
         Paragraph("<b>Additional / Confirmatory Tests</b>", bold_style)],
        ["All febrile patients", "CBC + differential, CRP, ESR, temperature chart", "Add procalcitonin if bacterial vs viral unclear"],
        ["UTI / Pyelonephritis", "Urine dipstick, urinalysis (microscopy)", "Urine MC&S (mid-stream); renal USS if pyelonephritis"],
        ["Pneumonia (CAP)", "Chest X-ray (CXR), pulse oximetry", "Sputum culture + sensitivity, blood cultures (if severe), CURB-65"],
        ["Sepsis (any source)", "Blood cultures x 2 (before antibiotics), serum lactate", "CXR, urinalysis, CBC, LFTs, coagulation, ECG"],
        ["Malaria", "Thick + thin blood film (gold standard)", "Rapid antigen test (RDT); repeat film if first negative"],
        ["Dengue", "CBC (thrombocytopenia!), dengue NS1 antigen (days 1-5)", "IgM/IgG serology after day 5; LFTs"],
        ["Typhoid", "Blood cultures (most sensitive week 1)", "Widal test (limited specificity); stool culture week 2-3"],
        ["Influenza / COVID-19", "Rapid antigen test (nasopharyngeal swab)", "PCR (more sensitive); CXR if lower respiratory symptoms"],
        ["EBV (Mono)", "CBC (lymphocytosis, atypical lymphs), Monospot test", "EBV IgM/IgG, LFTs, throat swab"],
        ["TB (suspected)", "CXR (apical cavitation), sputum AFB smear x 3", "Sputum culture (6-8 wks), IGRA/Mantoux, NAAT (GeneXpert)"],
        ["Endocarditis", "Blood cultures x 3 (different sites, before abx)", "Echocardiogram (TTE first, then TEE), ESR, CRP"],
        ["Meningitis", "Blood cultures, blood glucose", "LP (CSF: microscopy, culture, glucose, protein, PCR); CT first if focal neuro signs"],
        ["SLE / Autoimmune", "ANA (screening), full CBC, ESR, CRP, urinalysis", "Anti-dsDNA, complement (C3/C4), RF, anti-CCP; renal function"],
        ["Malignancy (FUO)", "CBC, LDH, ferritin, protein electrophoresis, LFTs", "CT chest/abdomen/pelvis, PET scan, bone marrow biopsy"],
    ]
    t_inv = tbl(inv_data, [38*mm, 68*mm, UW-106*mm], [
        ("BACKGROUND", (0,0), (-1,0), NAVY),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTNAME", (0,1), (0,-1), "Helvetica-Bold"),
        ("TEXTCOLOR", (0,1), (0,-1), TEAL),
        ("BACKGROUND", (0,1), (-1,1), TEAL_LIGHT),
    ])
    story.append(t_inv)
    story.append(Spacer(1, 10))

    # RED FLAGS
    story.append(SectionHeader("  RED FLAG FEATURES - IMMEDIATE ESCALATION / 999", UW, RED, fontsize=12))
    story.append(Spacer(1, 5))

    rf_left = [
        "Temperature > 41°C (hyperpyrexia)",
        "Petechiae or purpuric rash (meningococcemia?)",
        "Neck stiffness, photophobia, altered GCS (meningitis)",
        "Severe tachycardia (>120 bpm), hypotension, SBP <90",
        "Respiratory distress, SpO2 < 94% on air",
        "Rigors + high fever in returning traveller (malaria)",
    ]
    rf_right = [
        "Thrombocytopenia + rash + fever (dengue, RMSF)",
        "Immunocompromised patient with ANY fever",
        "Elderly + fever + new confusion (delirium = sepsis until proven otherwise)",
        "Fever + focal neurological signs",
        "Newborn / infant < 3 months with any fever",
        "Fever > 7 days without a clear source (FUO - investigate)",
    ]

    rf_data = []
    for i in range(len(rf_left)):
        rf_data.append([
            Paragraph(f"<b>&#9658;</b> {rf_left[i]}", S("rf", fontSize=8.5, textColor=RED, fontName="Helvetica")),
            Paragraph(f"<b>&#9658;</b> {rf_right[i]}", S("rf2", fontSize=8.5, textColor=RED, fontName="Helvetica")),
        ])
    t_rf = Table(rf_data, colWidths=[UW/2 - 3*mm, UW/2 - 3*mm])
    t_rf.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), RED_LIGHT),
        ("TOPPADDING",  (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("LINEBELOW", (0,0), (-1,-2), 0.3, colors.HexColor("#FFCDD2")),
        ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
    ]))
    story.append(t_rf)
    story.append(Spacer(1, 10))

    # FUO
    story.append(SectionHeader("  FEVER OF UNKNOWN ORIGIN (FUO)", UW, GREY, fontsize=11))
    story.append(Spacer(1, 5))
    fuo_def = Paragraph(
        "<b>Definition:</b> Temperature &gt;38.3°C on &gt;3 occasions, lasting &gt;3 weeks, not diagnosed after 1 week of thorough investigation.",
        S("fuodef", fontSize=8.5, textColor=NAVY, fontName="Helvetica")
    )
    story.append(fuo_def)
    story.append(Spacer(1, 5))
    fuo_data = [
        [Paragraph("<b>Category</b>", bold_style), Paragraph("<b>Frequency</b>", bold_style),
         Paragraph("<b>Examples</b>", bold_style), Paragraph("<b>Key Investigations</b>", bold_style)],
        ["Infectious", "30-40%", "TB (most common), infective endocarditis, intra-abdominal abscess, CMV, EBV, brucellosis",
         "Blood cultures, IGRA, ECHO, CT abdomen, serology"],
        ["Malignancy", "20-30%", "Hodgkin's lymphoma, Non-Hodgkin's lymphoma, leukaemia, renal cell carcinoma, hepatoma",
         "LDH, ferritin, CT chest/abdomen/pelvis, PET scan, bone marrow biopsy"],
        ["Autoimmune / Inflammatory", "10-20%", "Adult-onset Still's disease, SLE, giant cell arteritis, vasculitis, RA, sarcoidosis, IBD",
         "ANA, ANCA, ferritin (very high in Still's), ESR, CRP, temporal artery biopsy"],
        ["Miscellaneous / Undiagnosed", "Up to 25%", "Drug fever, factitious fever, periodic fever syndromes, Kikuchi disease",
         "Medication review, genetic testing for periodic syndromes"],
    ]
    t_fuo = tbl(fuo_data, [30*mm, 20*mm, 78*mm, UW-128*mm], [
        ("BACKGROUND", (0,0), (-1,0), GREY),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTNAME", (0,1), (0,-1), "Helvetica-Bold"),
        ("TEXTCOLOR", (0,1), (0,-1), NAVY),
    ])
    story.append(t_fuo)
    story.append(Spacer(1, 8))

    # GP Quick Reminder
    story.append(SectionHeader("  GP QUICK REMINDER", UW, GREEN, fontsize=11))
    story.append(Spacer(1, 5))
    reminder_data = [
        ["1.", "Always take travel history, medication history, immunosuppression status, vaccination history, and TB contacts."],
        ["2.", "Blood cultures MUST be drawn BEFORE starting antibiotics in any severe/undiagnosed fever."],
        ["3.", "A normal CBC does NOT exclude serious infection - clinical picture is paramount."],
        ["4.", "In dengue and malaria, avoid NSAIDs and aspirin - use paracetamol only."],
        ["5.", "Children < 3 months with any fever (> 38.0°C) need urgent assessment."],
        ["6.", "Fever + petechiae = meningococcemia until proven otherwise - treat empirically and call 999."],
        ["7.", "Review all febrile patients who do not improve within 48-72 hours."],
        ["8.", "In elderly patients, fever may be absent or blunted despite serious infection - have a low threshold."],
    ]
    for row in reminder_data:
        reminder_data_row = [
            Paragraph(f"<b>{row[0]}</b>", S("rn", fontSize=9, textColor=GREEN, fontName="Helvetica-Bold")),
            Paragraph(row[1], S("rb", fontSize=8.5, textColor=BLACK))
        ]
    t_rem = Table([[
        Paragraph(f"<b>{row[0]}</b>", S(f"rn{i}", fontSize=9, textColor=GREEN, fontName="Helvetica-Bold")),
        Paragraph(row[1], S(f"rb{i}", fontSize=8.5, textColor=BLACK))
    ] for i, row in enumerate(reminder_data)], colWidths=[8*mm, UW-8*mm])
    t_rem.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), GREEN_LIGHT),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 5),
        ("LINEBELOW", (0,0), (-1,-2), 0.3, colors.HexColor("#C8E6C9")),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))
    story.append(t_rem)

    # Build PDF
    doc.build(story, onFirstPage=on_first_page, onLaterPages=on_later_pages)
    print(f"PDF saved to: {OUTPUT}")

if __name__ == "__main__":
    build()

cd /home/daytona/workspace/fever-quickref && python3 build_pdf.py 2>&1

~/fever-quickref/build_pdf.py

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/fever-quickref/build_pdf.py'

cd /home/daytona/workspace/fever-quickref && python3 build_pdf.py 2>&1

~/fever-quickref/build_pdf.py

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/fever-quickref/build_pdf.py'

cd /home/daytona/workspace/fever-quickref && python3 build_pdf.py 2>&1

ls -lh /home/daytona/workspace/fever-quickref/Fever_Quick_Reference_GP.pdf

ls /home/daytona/skills/docx/scripts/office/ && node --version && npm list -g do…

~/fever-quickref/build_checklist.js

// Fever Treatment Protocol Checklist - GP Practice Wall Display
// A4 Landscape, 2-column layout, colour-coded sections

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

// ── Colour Palette ──────────────────────────────────────────────────────────
const NAVY        = "1A2E4A";
const TEAL        = "00838F";
const TEAL_LIGHT  = "E0F4F5";
const RED         = "C62828";
const RED_LIGHT   = "FFEBEE";
const ORANGE      = "E65100";
const ORANGE_LIGHT= "FFF3E0";
const GREEN       = "2E7D32";
const GREEN_LIGHT = "E8F5E9";
const YELLOW_LIGHT= "FFFDE7";
const GREY        = "546E7A";
const GREY_LIGHT  = "ECEFF1";
const WHITE       = "FFFFFF";
const BLACK       = "000000";

// ── Helpers ─────────────────────────────────────────────────────────────────

const NO_BORDER = { style: BorderStyle.NONE, size: 0, color: "FFFFFF" };
const THIN_BORDER = (col) => ({ style: BorderStyle.SINGLE, size: 4, color: col || "B0BEC5" });

function shading(fill, type = ShadingType.CLEAR) {
  return { type, fill, color: "auto" };
}

function bold(text, color = BLACK, size = 18) {
  return new TextRun({ text, bold: true, color, size });
}

function run(text, opts = {}) {
  return new TextRun({ text, size: opts.size || 17, color: opts.color || BLACK,
    bold: opts.bold || false, italics: opts.italics || false });
}

function cell(children, opts = {}) {
  return new TableCell({
    children: Array.isArray(children) ? children : [
      new Paragraph({
        children: Array.isArray(children[0]) ? children[0] : children,
        alignment: opts.align || AlignmentType.LEFT,
        spacing: { before: 30, after: 30 },
      })
    ],
    shading: opts.bg ? shading(opts.bg) : undefined,
    verticalAlign: VerticalAlign.CENTER,
    margins: { top: 60, bottom: 60, left: 80, right: 80 },
    borders: opts.borders || {
      top: THIN_BORDER(opts.borderColor),
      bottom: THIN_BORDER(opts.borderColor),
      left: THIN_BORDER(opts.borderColor),
      right: THIN_BORDER(opts.borderColor),
    },
    columnSpan: opts.span,
    width: opts.width ? { size: opts.width, type: WidthType.DXA } : undefined,
  });
}

function para(children, opts = {}) {
  return new Paragraph({
    children: Array.isArray(children) ? children : [children],
    alignment: opts.align || AlignmentType.LEFT,
    spacing: { before: opts.before || 40, after: opts.after || 40 },
    indent: opts.indent ? { left: opts.indent } : undefined,
  });
}

function hdr(text, bg = NAVY, fg = WHITE, size = 20) {
  return new TableRow({
    children: [
      new TableCell({
        children: [new Paragraph({
          children: [new TextRun({ text: `  ${text}`, bold: true, color: fg, size, allCaps: false })],
          alignment: AlignmentType.LEFT,
          spacing: { before: 60, after: 60 },
        })],
        shading: shading(bg),
        columnSpan: 99,
        borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER },
        margins: { top: 60, bottom: 60, left: 120, right: 80 },
      })
    ],
    tableHeader: true,
  });
}

// Checkbox character (unicode ballot box)
const CHK = "\u2610";   // empty checkbox
const BULL = "\u25BA";  // filled bullet

// ── Section builder: numbered checklist rows ─────────────────────────────────
function checkRow(number, action, detail, bg = WHITE, bold_action = true) {
  return new TableRow({
    children: [
      cell(
        [new TextRun({ text: ` ${CHK}`, size: 20, color: TEAL, bold: true })],
        { bg, width: 400, borders: { top: NO_BORDER, bottom: THIN_BORDER("E0F4F5"), left: NO_BORDER, right: NO_BORDER } }
      ),
      cell(
        [new TextRun({ text: `${number}. `, bold: true, size: 17, color: GREY }),
         new TextRun({ text: action, bold: bold_action, size: 17, color: NAVY })],
        { bg, width: 2500, borders: { top: NO_BORDER, bottom: THIN_BORDER("E0F4F5"), left: NO_BORDER, right: NO_BORDER } }
      ),
      cell(
        [new TextRun({ text: detail, size: 16, color: BLACK })],
        { bg, borders: { top: NO_BORDER, bottom: THIN_BORDER("E0F4F5"), left: NO_BORDER, right: NO_BORDER } }
      ),
    ],
  });
}

function diagRow(diagnosis, treatment, dose, notes, rowBg = WHITE) {
  return new TableRow({
    children: [
      cell([bold(`${CHK}  `, TEAL, 18), bold(diagnosis, NAVY, 17)],
        { bg: rowBg, borderColor: "CFD8DC" }),
      cell([run(treatment, { bold: true, color: TEAL, size: 17 })],
        { bg: rowBg, borderColor: "CFD8DC" }),
      cell([run(dose, { size: 16, color: "37474F" })],
        { bg: rowBg, borderColor: "CFD8DC" }),
      cell([run(notes, { size: 15, color: GREY, italics: true })],
        { bg: rowBg, borderColor: "CFD8DC" }),
    ],
  });
}

function redFlagRow(text) {
  return new TableRow({
    children: [
      cell(
        [new TextRun({ text: "  ! ", bold: true, color: RED, size: 20 }),
         new TextRun({ text, size: 17, color: RED, bold: true })],
        { bg: RED_LIGHT, borders: { top: NO_BORDER, bottom: THIN_BORDER("FFCDD2"), left: THIN_BORDER(RED), right: NO_BORDER } }
      )
    ]
  });
}

// ── Page-width table wrapper (for 2-column look per section) ──────────────────
function sectionTable(rows, widths) {
  return new Table({
    rows,
    width: { size: 100, type: WidthType.PERCENTAGE },
    columnWidths: widths,
    layout: TableLayoutType.FIXED,
    borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER,
                insideH: NO_BORDER, insideV: NO_BORDER },
  });
}

// ════════════════════════════════════════════════════════════════════════════
// BUILD DOCUMENT
// ════════════════════════════════════════════════════════════════════════════

const children = [];

// ── BANNER / TITLE ────────────────────────────────────────────────────────────
children.push(new Table({
  rows: [
    new TableRow({ children: [
      new TableCell({
        children: [
          new Paragraph({ children: [new TextRun({ text: "FEVER TREATMENT PROTOCOL CHECKLIST", bold: true, color: WHITE, size: 40, allCaps: true })], alignment: AlignmentType.CENTER, spacing: { before: 80, after: 20 } }),
          new Paragraph({ children: [new TextRun({ text: "General Practice  |  Wall Display Reference  |  Updated 2025/26", color: "B2EBF2", size: 18, italics: true })], alignment: AlignmentType.CENTER, spacing: { before: 0, after: 80 } }),
        ],
        shading: shading(NAVY),
        borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER },
        margins: { top: 120, bottom: 120, left: 200, right: 200 },
      })
    ]})
  ],
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER },
}));

children.push(para([new TextRun({ text: "", size: 8 })], { before: 100, after: 0 }));

// ── TEAL INFO STRIP ────────────────────────────────────────────────────────────
children.push(new Table({
  rows: [new TableRow({ children: [
    cell([bold("DEFINITION:", TEAL, 16), run("  Fever = Core Temp > 38.0°C  |  Hyperpyrexia = > 41°C (treat urgently)", { size: 16 })],
      { bg: TEAL_LIGHT }),
    cell([bold("TREAT FEVER IF:", TEAL, 16), run("  > 41°C (mandatory)  |  Patient discomfort  |  Paediatric seizure risk", { size: 16 })],
      { bg: TEAL_LIGHT }),
  ]})],
  width: { size: 100, type: WidthType.PERCENTAGE },
  columnWidths: [7000, 7000],
  borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER },
}));

children.push(para([new TextRun({ text: "", size: 8 })], { before: 60, after: 0 }));

// ════════════════════════════════════════════════════════════════════════════
// SECTION A: INITIAL ASSESSMENT CHECKLIST
// ════════════════════════════════════════════════════════════════════════════
const assessRows = [
  hdr("SECTION A  |  INITIAL ASSESSMENT - DO FIRST", NAVY, WHITE, 19),
  checkRow(1, "Measure temperature", "Oral/tympanic preferred. Temp > 41°C = hyperpyrexia - act immediately", GREY_LIGHT),
  checkRow(2, "Vital signs", "HR, BP, RR, SpO2, GCS. Tachycardia >120 + hypotension = SEPSIS - escalate", WHITE),
  checkRow(3, "Full history", "Onset, duration, pattern, associated symptoms, travel, sick contacts, medications, immunocompromise", GREY_LIGHT),
  checkRow(4, "Targeted examination", "Throat, ears, chest, abdomen, skin, lymph nodes, neuro, CVA tenderness", WHITE),
  checkRow(5, "Red flags screen", "See RED FLAGS panel below - if ANY present, escalate immediately", GREY_LIGHT),
  checkRow(6, "Age & comorbidities", "Elderly (blunted fever), immunocompromised, pregnancy, <3 months - all need lower threshold", WHITE),
];

children.push(new Table({
  rows: assessRows,
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER },
}));

children.push(para([new TextRun({ text: "", size: 8 })], { before: 80, after: 0 }));

// ════════════════════════════════════════════════════════════════════════════
// SECTION B: INVESTIGATIONS CHECKLIST  |  RED FLAGS  (2-column)
// ════════════════════════════════════════════════════════════════════════════

const invRows = [
  hdr("SECTION B  |  INVESTIGATIONS TO ORDER", TEAL, WHITE, 18),
  checkRow(1, "CBC with differential", "WBC, neutrophils, lymphocytes, bands, Hb, platelets"),
  checkRow(2, "CRP + ESR + Procalcitonin", "CRP >100 = bacterial likely | PCT >0.5 = bacterial | PCT >2 = sepsis probable", GREY_LIGHT),
  checkRow(3, "Urine dipstick + MC&S", "Order if any urinary symptoms OR fever without clear source", WHITE),
  checkRow(4, "Chest X-ray", "If cough, dyspnoea, pleuritic pain, SpO2 low, elderly with fever", GREY_LIGHT),
  checkRow(5, "Blood cultures x2", "MUST be drawn BEFORE antibiotics in any severe or undiagnosed fever", WHITE),
  checkRow(6, "Blood film (malaria)", "Any fever + travel to endemic region - urgent", GREY_LIGHT),
  checkRow(7, "Dengue NS1/IgM/IgG", "If dengue suspected (thrombocytopenia + retro-orbital pain + rash)", WHITE),
  checkRow(8, "Rapid Ag test", "Influenza / COVID-19 NP swab - guide isolation and antiviral use", GREY_LIGHT),
  checkRow(9, "LFTs + serum lactate", "If hepatitis suspected, jaundice, or sepsis (lactate >2 = organ dysfunction)", WHITE),
  checkRow(10, "Further targeted tests", "ANA/dsDNA (autoimmune) | LDH/ferritin (malignancy/HLH) | IGRA/CXR (TB)", GREY_LIGHT),
];

const rfRows = [
  hdr("RED FLAGS  |  IMMEDIATE ESCALATION / 999", RED, WHITE, 18),
  redFlagRow("Temperature > 41°C (hyperpyrexia)"),
  redFlagRow("Petechiae or purpuric rash - meningococcemia?"),
  redFlagRow("Neck stiffness + photophobia + altered GCS"),
  redFlagRow("Severe tachycardia / hypotension (septic shock)"),
  redFlagRow("SpO2 < 94% on air / respiratory distress"),
  redFlagRow("Rigors + fever in returning traveller (malaria)"),
  redFlagRow("Thrombocytopenia + rash + fever"),
  redFlagRow("Immunocompromised + ANY fever"),
  redFlagRow("Elderly + fever + new confusion"),
  redFlagRow("Infant < 3 months with any fever (> 38.0°C)"),
];

children.push(new Table({
  rows: [new TableRow({ children: [
    new TableCell({
      children: [new Table({ rows: invRows, width: { size: 100, type: WidthType.PERCENTAGE },
        borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER } })],
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: THIN_BORDER("E0E0E0"), right: NO_BORDER },
      margins: { right: 200 },
    }),
    new TableCell({
      children: [new Table({ rows: rfRows, width: { size: 100, type: WidthType.PERCENTAGE },
        borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER } })],
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: THIN_BORDER("E0E0E0"), right: NO_BORDER },
      margins: { left: 200 },
    }),
  ]})],
  width: { size: 100, type: WidthType.PERCENTAGE },
  columnWidths: [7200, 6800],
  borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER },
}));

children.push(para([new TextRun({ text: "", size: 8 })], { before: 80, after: 0 }));

// ════════════════════════════════════════════════════════════════════════════
// SECTION C: CBC QUICK INTERPRETATION
// ════════════════════════════════════════════════════════════════════════════
const cbcData = [
  hdr("SECTION C  |  CBC QUICK INTERPRETATION", NAVY, WHITE, 18),
  new TableRow({ children: [
    cell([bold("CBC Finding", WHITE, 16)], { bg: TEAL }),
    cell([bold("Pattern", WHITE, 16)], { bg: TEAL }),
    cell([bold("Interpretation", WHITE, 16)], { bg: TEAL }),
    cell([bold("Action", WHITE, 16)], { bg: TEAL }),
  ]}),
  new TableRow({ children: [
    cell([bold("Neutrophilia", NAVY, 16), run(" (WBC > 11k, Neut > 70%)", { size: 15 })], { bg: YELLOW_LIGHT }),
    cell([run("+ High CRP/PCT", { bold: true, color: ORANGE, size: 16 })], { bg: YELLOW_LIGHT }),
    cell([run("Bacterial infection / acute inflammation / stress", { size: 16 })], { bg: YELLOW_LIGHT }),
    cell([run("Target antibiotics; blood cultures before Rx", { bold: true, size: 16 })], { bg: YELLOW_LIGHT }),
  ]}),
  new TableRow({ children: [
    cell([bold("Lymphocytosis", NAVY, 16), run(" (Lymph > 40%)", { size: 15 })], { bg: WHITE }),
    cell([run("Normal/Low WBC", { bold: true, color: GREEN, size: 16 })], { bg: WHITE }),
    cell([run("Viral infection (EBV, CMV, rubella, influenza)", { size: 16 })], { bg: WHITE }),
    cell([run("Supportive care; antivirals if indicated", { bold: true, size: 16 })], { bg: WHITE }),
  ]}),
  new TableRow({ children: [
    cell([bold("Leukopenia", NAVY, 16), run(" (WBC < 4k)", { size: 15 })], { bg: GREY_LIGHT }),
    cell([run("Low platelets too", { bold: true, color: RED, size: 16 })], { bg: GREY_LIGHT }),
    cell([run("Dengue fever (hallmark: WBC + platelets both low)", { size: 16 })], { bg: GREY_LIGHT }),
    cell([run("No NSAIDs/aspirin - paracetamol + IV fluids only", { bold: true, color: RED, size: 16 })], { bg: GREY_LIGHT }),
  ]}),
  new TableRow({ children: [
    cell([bold("Leukopenia", NAVY, 16), run(" (WBC < 4k)", { size: 15 })], { bg: WHITE }),
    cell([run("Relative lymphocytosis", { bold: true, color: GREY, size: 16 })], { bg: WHITE }),
    cell([run("Typhoid (Salmonella typhi - week 1)", { size: 16 })], { bg: WHITE }),
    cell([run("Blood cultures (gold standard); azithromycin", { bold: true, size: 16 })], { bg: WHITE }),
  ]}),
  new TableRow({ children: [
    cell([bold("Bands > 5%", NAVY, 16), run(" ('Shift to Left')", { size: 15 })], { bg: YELLOW_LIGHT }),
    cell([run("+ Neutrophilia", { bold: true, color: ORANGE, size: 16 })], { bg: YELLOW_LIGHT }),
    cell([run("Active bacterial infection - immature neutrophils released from marrow", { size: 16 })], { bg: YELLOW_LIGHT }),
    cell([run("Start empirical antibiotics; identify source", { bold: true, size: 16 })], { bg: YELLOW_LIGHT }),
  ]}),
  new TableRow({ children: [
    cell([bold("Thrombocytopenia", RED, 16), run(" (Plt < 150k)", { size: 15 })], { bg: RED_LIGHT }),
    cell([run("+ Fever + rash", { bold: true, color: RED, size: 16 })], { bg: RED_LIGHT }),
    cell([run("Dengue, malaria, ITP, meningococcemia, HUS - RED FLAG", { size: 16, color: RED })], { bg: RED_LIGHT }),
    cell([run("Urgent - hospital referral; avoid NSAIDs", { bold: true, color: RED, size: 16 })], { bg: RED_LIGHT }),
  ]}),
  new TableRow({ children: [
    cell([bold("Eosinophilia", NAVY, 16), run(" (> 4%)", { size: 15 })], { bg: WHITE }),
    cell([run("+ Travel history", { bold: true, color: GREY, size: 16 })], { bg: WHITE }),
    cell([run("Parasitic/helminth infection, schistosomiasis, strongyloides", { size: 16 })], { bg: WHITE }),
    cell([run("Stool O&P, serology; antiparasitic treatment", { bold: true, size: 16 })], { bg: WHITE }),
  ]}),
  new TableRow({ children: [
    cell([bold("WBC > 50k", RED, 16), run(" (extreme)", { size: 15 })], { bg: RED_LIGHT }),
    cell([run("All cell lines abnormal", { bold: true, color: RED, size: 16 })], { bg: RED_LIGHT }),
    cell([run("Rule out leukaemia (leukemoid reaction vs leukaemia)", { size: 16, color: RED })], { bg: RED_LIGHT }),
    cell([run("URGENT haematology referral + peripheral blood film", { bold: true, color: RED, size: 16 })], { bg: RED_LIGHT }),
  ]}),
];

children.push(new Table({
  rows: cbcData,
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER },
}));

children.push(para([new TextRun({ text: "", size: 8 })], { before: 80, after: 0 }));

// ════════════════════════════════════════════════════════════════════════════
// SECTION D: TREATMENT PROTOCOL BY DIAGNOSIS
// ════════════════════════════════════════════════════════════════════════════

const txRows = [
  hdr("SECTION D  |  TREATMENT PROTOCOL BY DIAGNOSIS", NAVY, WHITE, 18),
  new TableRow({ children: [
    cell([bold("  Diagnosis", WHITE, 16)], { bg: TEAL }),
    cell([bold("First-Line Treatment", WHITE, 16)], { bg: TEAL }),
    cell([bold("Dose / Duration", WHITE, 16)], { bg: TEAL }),
    cell([bold("Key Notes", WHITE, 16)], { bg: TEAL }),
  ]}),

  // ANTIPYRETICS
  new TableRow({ children: [
    new TableCell({
      children: [new Paragraph({ children: [new TextRun({ text: "ANTIPYRETICS", bold: true, color: WHITE, size: 16 })], spacing: { before: 40, after: 40 } })],
      shading: shading(TEAL),
      columnSpan: 4,
      margins: { left: 120 },
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER },
    })
  ]}),
  diagRow("Paracetamol", "FIRST-LINE antipyretic", "500-1000 mg q4-6h (max 4g/day)", "Safe in pregnancy, elderly. Caution: hepatic impairment", GREEN_LIGHT),
  diagRow("Ibuprofen", "Second-line / anti-inflammatory", "400 mg q6-8h (max 1200 mg/day)", "Avoid: renal disease, GI ulcers, pregnancy 3rd trim, dengue, dehydration"),
  diagRow("Aspirin", "Avoid in most febrile patients", "325-650 mg q4-6h if used", "NEVER in children <16 (Reye syndrome). NEVER in dengue (bleeding risk)", RED_LIGHT),

  // RESPIRATORY
  new TableRow({ children: [
    new TableCell({
      children: [new Paragraph({ children: [new TextRun({ text: "RESPIRATORY INFECTIONS", bold: true, color: WHITE, size: 16 })], spacing: { before: 40, after: 40 } })],
      shading: shading(TEAL),
      columnSpan: 4,
      margins: { left: 120 },
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER },
    })
  ]}),
  diagRow("Viral URTI", "SUPPORTIVE CARE ONLY", "Rest, fluids, paracetamol/ibuprofen", "No antibiotics. Zinc lozenges may shorten duration", GREY_LIGHT),
  diagRow("Strep Pharyngitis (GAS)", "Amoxicillin", "500 mg TID x 10 days (or Penicillin V 500 mg BD)", "Prevents rheumatic fever. Clarithromycin if penicillin-allergic"),
  diagRow("Influenza", "Oseltamivir (Tamiflu)", "75 mg BD x 5 days (start within 48 hrs)", "Prioritise: elderly, immunocompromised, pregnant, comorbidities", GREY_LIGHT),
  diagRow("COVID-19 (high risk)", "Nirmatrelvir/Ritonavir (Paxlovid)", "Within 5 days of symptom onset", "Check drug interactions. Supportive Rx for low-risk/mild."),
  diagRow("CAP - Mild", "Amoxicillin", "500 mg TID x 5 days + Clarithromycin if atypical", "CURB-65: 0-1 = community; 2+ = consider hospital", GREY_LIGHT),
  diagRow("CAP - Moderate/Severe", "Amoxicillin-clavulanate + Clarithromycin", "625 mg TID + 500 mg BD x 7-10 days", "ADMIT if CURB-65 >= 2, SpO2 <94%, elderly, no improvement in 48h"),

  // URINARY
  new TableRow({ children: [
    new TableCell({
      children: [new Paragraph({ children: [new TextRun({ text: "URINARY TRACT INFECTIONS", bold: true, color: WHITE, size: 16 })], spacing: { before: 40, after: 40 } })],
      shading: shading(TEAL),
      columnSpan: 4,
      margins: { left: 120 },
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER },
    })
  ]}),
  diagRow("UTI - Cystitis (women)", "Trimethoprim OR Nitrofurantoin", "200 mg BD x 3-7d / 100 mg BD x 5-7d", "Send MSU before Rx. Adjust per sensitivity. Avoid Nitrofurantoin in pyelonephritis", GREY_LIGHT),
  diagRow("UTI - Cystitis (men)", "Trimethoprim", "200 mg BD x 7 days", "Always culture. MSU needed. Longer course than women."),
  diagRow("Pyelonephritis", "Co-amoxiclav OR Ciprofloxacin", "625 mg TID x 14d / 500 mg BD x 7-10d", "IV antibiotics if vomiting/severe. Admit if systemically unwell", GREY_LIGHT),

  // GI
  new TableRow({ children: [
    new TableCell({
      children: [new Paragraph({ children: [new TextRun({ text: "GASTROINTESTINAL INFECTIONS", bold: true, color: WHITE, size: 16 })], spacing: { before: 40, after: 40 } })],
      shading: shading(TEAL),
      columnSpan: 4,
      margins: { left: 120 },
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER },
    })
  ]}),
  diagRow("Viral Gastroenteritis", "SUPPORTIVE - ORS rehydration", "ORS 200-400 mL after each loose stool", "Most self-limiting 3-5 days. Avoid loperamide in bloody diarrhoea", GREY_LIGHT),
  diagRow("Bacterial Gastroenteritis", "Azithromycin OR Ciprofloxacin", "500 mg OD x 3d / 500 mg BD x 3d (if severe/bloody)", "Stool culture first. Not all need antibiotics."),
  diagRow("Typhoid (mild/outpatient)", "Azithromycin", "500 mg OD x 7 days", "Ceftriaxone IV for severe. Base on local resistance patterns", GREY_LIGHT),

  // TROPICAL
  new TableRow({ children: [
    new TableCell({
      children: [new Paragraph({ children: [new TextRun({ text: "TROPICAL & VECTOR-BORNE INFECTIONS", bold: true, color: WHITE, size: 16 })], spacing: { before: 40, after: 40 } })],
      shading: shading(TEAL),
      columnSpan: 4,
      margins: { left: 120 },
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER },
    })
  ]}),
  diagRow("Malaria - P. falciparum", "Artemether-Lumefantrine (Coartem)", "Weight-based dosing x 3 days (6 doses)", "URGENT. Admit if severe. IV artesunate for severe malaria", GREY_LIGHT),
  diagRow("Malaria - P. vivax/ovale", "Chloroquine + Primaquine", "Chloroquine 25 mg/kg over 3 days; Primaquine 15 mg OD x 14d", "Check G6PD before primaquine (haemolysis risk)"),
  diagRow("Dengue Fever", "SUPPORTIVE ONLY", "Paracetamol + IV fluids. Strict fluid balance.", "NO NSAIDs/aspirin. Monitor platelets daily. Admit if platelets <100k or warning signs", RED_LIGHT),

  // SKIN
  new TableRow({ children: [
    new TableCell({
      children: [new Paragraph({ children: [new TextRun({ text: "SKIN & SOFT TISSUE INFECTIONS", bold: true, color: WHITE, size: 16 })], spacing: { before: 40, after: 40 } })],
      shading: shading(TEAL),
      columnSpan: 4,
      margins: { left: 120 },
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER },
    })
  ]}),
  diagRow("Cellulitis", "Flucloxacillin", "500 mg QID x 5-7 days (Clarithromycin if pen-allergic)", "Mark border with pen. IV if spreading, systemically unwell, or facial", GREY_LIGHT),
  diagRow("Soft Tissue Abscess", "Incision & Drainage (I&D)", "Antibiotics: Flucloxacillin 500 mg QID if systemically unwell", "Most abscesses heal with I&D alone. Consider MRSA risk."),

  // EMERGENCIES
  new TableRow({ children: [
    new TableCell({
      children: [new Paragraph({ children: [new TextRun({ text: "EMERGENCIES (START IMMEDIATELY - DO NOT DELAY)", bold: true, color: WHITE, size: 16 })], spacing: { before: 40, after: 40 } })],
      shading: shading(RED),
      columnSpan: 4,
      margins: { left: 120 },
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER },
    })
  ]}),
  diagRow("Bacterial Meningitis", "Ceftriaxone 2g IV + Dexamethasone IV", "IMMEDIATELY. Do NOT wait for LP.", "Call 999. Do NOT delay treatment for imaging.", RED_LIGHT),
  diagRow("Sepsis", "IV Piperacillin-Tazobactam OR Meropenem", "Pip-taz 4.5g IV q8h / Meropenem 1g IV q8h", "SEPSIS 6: cultures, lactate, fluids (30mL/kg), O2, urine output, abx within 1 hr", RED_LIGHT),
  diagRow("Meningococcemia", "Benzylpenicillin IM/IV + 999", "1.2g IM immediately then transfer", "Do NOT wait. Give antibiotics in GP before ambulance arrives", RED_LIGHT),
];

children.push(new Table({
  rows: txRows,
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER },
}));

children.push(para([new TextRun({ text: "", size: 8 })], { before: 80, after: 0 }));

// ════════════════════════════════════════════════════════════════════════════
// SECTION E: FUO + SPECIAL POPULATIONS  (2-column)
// ════════════════════════════════════════════════════════════════════════════

const fuoRows = [
  hdr("FEVER OF UNKNOWN ORIGIN (FUO)", GREY, WHITE, 17),
  new TableRow({ children: [
    cell([bold("Definition:", NAVY, 16), run(" Fever >38.3°C on >3 occasions, >3 weeks, undiagnosed after 1 week investigation", { size: 16 })],
      { bg: GREY_LIGHT, borderColor: "B0BEC5" })
  ]}),
  new TableRow({ children: [
    cell([bold("Infections (30-40%): ", TEAL, 16), run("TB, endocarditis, intra-abdominal abscess, CMV, EBV, brucellosis", { size: 16 })],
      { bg: WHITE, borderColor: "B0BEC5" })
  ]}),
  new TableRow({ children: [
    cell([bold("Malignancy (20-30%): ", NAVY, 16), run("Lymphoma (Hodgkin's/NHL), leukaemia, RCC, hepatoma", { size: 16 })],
      { bg: GREY_LIGHT, borderColor: "B0BEC5" })
  ]}),
  new TableRow({ children: [
    cell([bold("Autoimmune (10-20%): ", ORANGE, 16), run("Adult Still's disease (ferritin >10k!), SLE, GCA, vasculitis, RA, sarcoidosis", { size: 16 })],
      { bg: WHITE, borderColor: "B0BEC5" })
  ]}),
  new TableRow({ children: [
    cell([bold("Misc/Undiagnosed (25%): ", GREY, 16), run("Drug fever, factitious, periodic fever syndromes - review ALL medications", { size: 16 })],
      { bg: GREY_LIGHT, borderColor: "B0BEC5" })
  ]}),
  new TableRow({ children: [
    cell([bold("FUO Workup: ", TEAL, 16), run("CT C/A/P, PET scan, echocardiogram, bone marrow biopsy, ANA/ANCA, LDH, ferritin, IGRA", { size: 16 })],
      { bg: TEAL_LIGHT, borderColor: "B0BEC5" })
  ]}),
];

const remRows = [
  hdr("GP QUICK REMINDERS", GREEN, WHITE, 17),
  new TableRow({ children: [
    cell([new TextRun({ text: `${CHK}  `, color: GREEN, bold: true, size: 18 }), run("Blood cultures BEFORE antibiotics in any severe fever", { bold: true, size: 16 })],
      { bg: GREEN_LIGHT, borderColor: "C8E6C9" })
  ]}),
  new TableRow({ children: [
    cell([new TextRun({ text: `${CHK}  `, color: GREEN, bold: true, size: 18 }), run("Normal CBC does NOT exclude serious infection", { bold: true, size: 16 })],
      { bg: WHITE, borderColor: "C8E6C9" })
  ]}),
  new TableRow({ children: [
    cell([new TextRun({ text: `${CHK}  `, color: GREEN, bold: true, size: 18 }), run("NEVER give NSAIDs/aspirin in dengue or malaria", { bold: true, size: 16, color: RED })],
      { bg: GREEN_LIGHT, borderColor: "C8E6C9" })
  ]}),
  new TableRow({ children: [
    cell([new TextRun({ text: `${CHK}  `, color: GREEN, bold: true, size: 18 }), run("Fever + petechiae = meningococcemia until proven otherwise", { bold: true, size: 16, color: RED })],
      { bg: WHITE, borderColor: "C8E6C9" })
  ]}),
  new TableRow({ children: [
    cell([new TextRun({ text: `${CHK}  `, color: GREEN, bold: true, size: 18 }), run("Infants <3 months: any fever >38.0°C = urgent assessment", { bold: true, size: 16 })],
      { bg: GREEN_LIGHT, borderColor: "C8E6C9" })
  ]}),
  new TableRow({ children: [
    cell([new TextRun({ text: `${CHK}  `, color: GREEN, bold: true, size: 18 }), run("Elderly: fever may be blunted - use lower threshold (>37.8°C)", { bold: true, size: 16 })],
      { bg: WHITE, borderColor: "C8E6C9" })
  ]}),
  new TableRow({ children: [
    cell([new TextRun({ text: `${CHK}  `, color: GREEN, bold: true, size: 18 }), run("Review all febrile patients not improving within 48-72 hours", { bold: true, size: 16 })],
      { bg: GREEN_LIGHT, borderColor: "C8E6C9" })
  ]}),
  new TableRow({ children: [
    cell([new TextRun({ text: `${CHK}  `, color: GREEN, bold: true, size: 18 }), run("Always take: travel, medication, TB contact, immunisation history", { bold: true, size: 16 })],
      { bg: WHITE, borderColor: "C8E6C9" })
  ]}),
];

children.push(new Table({
  rows: [new TableRow({ children: [
    new TableCell({
      children: [new Table({ rows: fuoRows, width: { size: 100, type: WidthType.PERCENTAGE },
        borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER } })],
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: THIN_BORDER("E0E0E0") },
      margins: { right: 200 },
    }),
    new TableCell({
      children: [new Table({ rows: remRows, width: { size: 100, type: WidthType.PERCENTAGE },
        borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER } })],
      borders: { top: NO_BORDER, bottom: NO_BORDER, left: THIN_BORDER("E0E0E0"), right: NO_BORDER },
      margins: { left: 200 },
    }),
  ]})],
  width: { size: 100, type: WidthType.PERCENTAGE },
  columnWidths: [7200, 6800],
  borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER },
}));

// ── FOOTER NOTE ───────────────────────────────────────────────────────────────
children.push(para([new TextRun({ text: "", size: 6 })], { before: 100, after: 0 }));
children.push(new Table({
  rows: [new TableRow({ children: [
    new TableCell({
      children: [new Paragraph({
        children: [
          new TextRun({ text: "Sources: Harrison's Principles of Internal Medicine 22E (2025)  |  ROSEN's Emergency Medicine  |  Robbins & Kumar Pathologic Basis of Disease  |  Goldman-Cecil Medicine  ", size: 14, color: GREY, italics: true }),
          new TextRun({ text: "  |  For clinical guidance use only - verify doses with local formulary and BNF  |  Prepared 2025/26", size: 14, color: GREY, italics: true }),
        ],
        alignment: AlignmentType.CENTER,
        spacing: { before: 60, after: 60 },
      })],
      shading: shading(GREY_LIGHT),
      borders: { top: THIN_BORDER(TEAL), bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER },
      margins: { left: 120, right: 120 },
    })
  ]})],
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: { top: NO_BORDER, bottom: NO_BORDER, left: NO_BORDER, right: NO_BORDER, insideH: NO_BORDER, insideV: NO_BORDER },
}));

// ════════════════════════════════════════════════════════════════════════════
// ASSEMBLE DOCUMENT
// ════════════════════════════════════════════════════════════════════════════

const doc = new Document({
  creator: "Orris Clinical Assistant",
  title: "Fever Treatment Protocol Checklist - GP Wall Display",
  description: "Quick reference protocol for fever management in general practice",
  styles: {
    default: {
      document: {
        run: { font: "Calibri", size: 17 },
      },
    },
  },
  sections: [{
    properties: {
      page: {
        size: { orientation: PageOrientation.LANDSCAPE, width: 16838, height: 11906 },
        margin: { top: 500, bottom: 500, left: 600, right: 600 },
      },
    },
    headers: {
      default: new Header({
        children: [new Paragraph({
          children: [
            new TextRun({ text: "FEVER TREATMENT PROTOCOL  |  GP PRACTICE WALL DISPLAY", bold: true, color: WHITE, size: 16 }),
            new TextRun({ text: "                                                                For clinical guidance only - verify with BNF", color: "B2EBF2", size: 14, italics: true }),
          ],
          alignment: AlignmentType.LEFT,
          shading: shading(NAVY),
          spacing: { before: 80, after: 80 },
          indent: { left: 200 },
        })]
      })
    },
    children,
  }],
});

const OUTPUT = "/home/daytona/workspace/fever-quickref/Fever_Treatment_Protocol_Checklist.docx";
Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync(OUTPUT, buffer);
  console.log(`DOCX saved to: ${OUTPUT}`);
}).catch(err => {
  console.error("Error:", err);
  process.exit(1);
});

cd /home/daytona/workspace/fever-quickref && node build_checklist.js 2>&1

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

ls -lh /home/daytona/workspace/fever-quickref/Fever_Treatment_Protocol_Checklist…