from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.enum.style import WD_STYLE_TYPE
from docx.oxml.ns import qn

doc = Document()

# Compact page setup to fit content on ~2 A4 sheets
section = doc.sections[0]
section.page_height = Inches(11.69)
section.page_width = Inches(8.27)
section.top_margin = Inches(0.5)
section.bottom_margin = Inches(0.5)
section.left_margin = Inches(0.6)
section.right_margin = Inches(0.6)

# Base style
normal = doc.styles["Normal"]
normal.font.name = "Calibri"
normal.font.size = Pt(10)
normal.paragraph_format.space_after = Pt(2)
normal.paragraph_format.space_before = Pt(0)
normal.paragraph_format.line_spacing = 1.0

def set_font_east_asian(style):
    rpr = style.element.get_or_add_rPr()
    rFonts = rpr.find(qn('w:rFonts'))
    if rFonts is None:
        rFonts = rpr.makeelement(qn('w:rFonts'), {})
        rpr.append(rFonts)
    rFonts.set(qn('w:eastAsia'), 'Calibri')

set_font_east_asian(normal)

# Title
title = doc.add_paragraph()
title.alignment = WD_ALIGN_PARAGRAPH.CENTER
run = title.add_run("GENERAL SURGERY / GENERAL MEDICINE - SHORT NOTES\n(For BPT / Physiotherapy Students)")
run.bold = True
run.font.size = Pt(13)
title.paragraph_format.space_after = Pt(6)

topics = doc.add_paragraph()
run = topics.add_run("Topics: COPD | Chronic Bronchitis | Bronchiectasis | Leprosy | Dermatitis | Psoriasis")
run.italic = True
run.font.size = Pt(9)
topics.alignment = WD_ALIGN_PARAGRAPH.CENTER
topics.paragraph_format.space_after = Pt(8)

def add_heading(text):
    p = doc.add_paragraph()
    p.paragraph_format.space_before = Pt(6)
    p.paragraph_format.space_after = Pt(2)
    run = p.add_run(text)
    run.bold = True
    run.font.size = Pt(12)
    run.font.color.rgb = RGBColor(0x1F, 0x3D, 0x7A)
    # bottom border
    pPr = p._p.get_or_add_pPr()
    pBdr = pPr.makeelement(qn('w:pBdr'), {})
    bottom = pPr.makeelement(qn('w:bottom'), {qn('w:val'): 'single', qn('w:sz'): '4', qn('w:space'): '1', qn('w:color'): '1F3D7A'})
    pBdr.append(bottom)
    pPr.append(pBdr)
    return p

def add_sub(text):
    p = doc.add_paragraph()
    p.paragraph_format.space_before = Pt(2)
    p.paragraph_format.space_after = Pt(1)
    run = p.add_run(text)
    run.bold = True
    run.underline = True
    run.font.size = Pt(10)
    return p

def add_bullet(text, bold_lead=None):
    p = doc.add_paragraph(style="List Bullet")
    p.paragraph_format.space_after = Pt(1)
    p.paragraph_format.left_indent = Inches(0.15)
    pf = p.paragraph_format
    pf.line_spacing = 1.0
    if bold_lead:
        r = p.add_run(bold_lead)
        r.bold = True
        r.font.size = Pt(9.5)
        r2 = p.add_run(text)
        r2.font.size = Pt(9.5)
    else:
        r = p.add_run(text)
        r.font.size = Pt(9.5)
    return p

# Tighten bullet list style spacing
try:
    bullet_style = doc.styles["List Bullet"]
    bullet_style.font.size = Pt(9.5)
    bullet_style.paragraph_format.space_after = Pt(1)
except KeyError:
    pass

# ------------------ 1. COPD ------------------
add_heading("1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)")
add_bullet(" A progressive disease of persistent airflow limitation, usually combining chronic bronchitis + emphysema; largely irreversible.", "Definition: ")
add_bullet(" Cigarette smoking (major cause), air pollution, occupational dust/chemicals, alpha-1 antitrypsin deficiency (panacinar emphysema), recurrent infections.", "Etiology: ")
add_bullet(" Exertional dyspnea, chronic cough with sputum, wheeze, barrel-shaped chest, use of accessory muscles, pursed-lip breathing, cyanosis, clubbing (late), cor pulmonale/right heart failure in advanced disease.", "Clinical features: ")
add_bullet(" Spirometry - reduced FEV1/FVC ratio (<0.7, poorly reversible); CXR - hyperinflation, flattened diaphragm; ABG - hypoxemia +/- hypercapnia; raised Hb (polycythemia).", "Investigations: ")
add_bullet(" Smoking cessation, bronchodilators (SABA/LABA), inhaled corticosteroids, oxygen therapy, vaccination, pulmonary rehabilitation; surgery (bullectomy, lung volume reduction, transplant) in select cases.", "Management: ")
add_bullet(" Pursed-lip & diaphragmatic breathing, active cycle of breathing technique, airway clearance (postural drainage, percussion, vibration, huffing), graded exercise/pulmonary rehab, energy conservation, patient education on inhaler technique.", "Physiotherapy role: ")

# ------------------ 2. Chronic Bronchitis ------------------
add_heading("2. CHRONIC BRONCHITIS")
add_bullet(" Persistent productive cough for at least 3 consecutive months in at least 2 consecutive years (clinical diagnosis).", "Definition: ")
add_bullet(" Cigarette smoking (chief cause), air pollutants (SO2, NO2), recurrent infection, occupational irritants.", "Etiology: ")
add_bullet(" Hyperplasia of mucous glands + goblet cell metaplasia in large airways -> mucus hypersecretion; small airway inflammation (chronic bronchiolitis) -> airflow obstruction. \"Blue bloater\" picture - cyanosis, hypoxemia, hypercapnia, may progress to cor pulmonale.", "Pathogenesis/Features: ")
add_bullet(" Productive cough, wheeze, dyspnea, recurrent chest infections, cyanosis; CXR may show increased bronchovascular markings.", "Clinical features/Investigations: ")
add_bullet(" Stop smoking, bronchodilators, mucolytics, antibiotics for infective exacerbations, oxygen if hypoxemic.", "Management: ")
add_bullet(" Chest physiotherapy for secretion clearance (postural drainage, percussion/vibration, forced expiration technique/huffing), breathing exercises, incentive spirometry, exercise training.", "Physiotherapy role: ")

# ------------------ 3. Bronchiectasis ------------------
add_heading("3. BRONCHIECTASIS")
add_bullet(" Permanent, abnormal dilatation of bronchi/bronchioles with destruction of elastic and muscular wall components, causing chronic productive cough and recurrent infections.", "Definition: ")
add_bullet(" Post-infective (necrotizing pneumonia, TB, whooping cough, measles), cystic fibrosis, ciliary dyskinesia, immunodeficiency, allergic bronchopulmonary aspergillosis, bronchial obstruction (tumour, foreign body).", "Causes: ")
add_bullet(" Chronic cough with copious foul-smelling mucopurulent sputum, hemoptysis, recurrent chest infections, clubbing, coarse crackles on auscultation, dyspnea; can be cylindrical, varicose, or cystic/saccular on imaging.", "Clinical features: ")
add_bullet(" High-resolution CT chest (investigation of choice) - bronchial wall thickening and dilatation ('signet ring' sign); sputum culture; CBC; immunoglobulins; sweat chloride test if cystic fibrosis suspected.", "Investigations: ")
add_bullet(" Antibiotics for exacerbations, bronchodilators, mucolytics, annual vaccination; surgical resection of localized diseased lung segment/lobe if medically refractory and localized; no medical cure otherwise.", "Management: ")
add_bullet(" Cornerstone of treatment - postural drainage in specific positions per affected lobe, percussion and vibration, active cycle of breathing technique, autogenic drainage, forced expiration/huffing, PEP devices (flutter/acapella), regular exercise.", "Physiotherapy role: ")

# ------------------ 4. Leprosy ------------------
add_heading("4. LEPROSY (HANSEN'S DISEASE)")
add_bullet(" A chronic granulomatous infectious disease caused by Mycobacterium leprae (acid-fast bacillus), primarily affecting skin, peripheral nerves and upper respiratory tract; endemic in India, Brazil, and parts of Africa/Asia.", "Definition: ")
add_bullet(" Prolonged close contact; nasal secretions are the main source; incubation period of several years; bacillus favours cooler body parts (skin, ears, superficial nerves).", "Transmission: ")
add_bullet(" Tuberculoid (strong immunity, few bacilli, localized well-defined anesthetic hypopigmented macules, thickened tender nerve); Lepromatous (poor immunity, abundant bacilli, symmetrical widespread nodules/plaques - 'lepromas', leonine facies); Borderline/dimorphous forms between the two. WHO classifies as Paucibacillary (PB, <=5 lesions) or Multibacillary (MB, >5 lesions).", "Classification: ")
add_bullet(" Hypopigmented/erythematous anesthetic skin patches; thickened peripheral nerves (ulnar, median, lateral popliteal, posterior tibial, facial); claw hand (ulnar+median nerve palsy), foot drop (lateral popliteal nerve), facial palsy/lagophthalmos, trophic ulcers, absorption/autoamputation of digits due to anesthesia and repeated trauma, madarosis (loss of eyebrows), collapsed nasal bridge, gynaecomastia (testicular atrophy).", "Clinical features: ")
add_bullet(" Slit-skin smear for bacilli (AFB), skin biopsy showing granulomas, lepromin skin test (indicates immune status, not diagnostic).", "Diagnosis: ")
add_bullet(" WHO Multidrug Therapy (MDT) - PB: Rifampicin + Dapsone for 6 months; MB: Rifampicin + Dapsone + Clofazimine for 12 months. Reconstructive surgery for established deformities (tendon transfers for claw hand/foot drop, nerve decompression, ptosis correction).", "Treatment: ")
add_bullet(" Central to Disability Prevention and Medical Rehabilitation (DPMR): protective sensation education and self-care to prevent trophic ulcers, splinting to prevent/correct deformity (e.g., for claw hand, foot drop), passive and active exercises to maintain joint range and muscle power, pre- and post-operative rehabilitation after reconstructive surgery, gait training with appropriate footwear.", "Physiotherapy role: ")

# ------------------ 5. Dermatitis ------------------
add_heading("5. DERMATITIS (ECZEMA)")
add_bullet(" An inflammatory skin condition (used interchangeably with eczema) characterized by erythema, itching, vesiculation/weeping, and scaling; may be acute, subacute or chronic.", "Definition: ")
add_bullet(" Atopic dermatitis (genetic/allergic predisposition), contact dermatitis (irritant or allergic - e.g., to plaster/resins, chemicals, metals), seborrheic dermatitis, stasis dermatitis (venous insufficiency), drug reactions.", "Types/Causes: ")
add_bullet(" Pruritic erythematous papules/vesicles, weeping/oozing in acute stage, lichenification and scaling in chronic stage; secondary infection from scratching may occur; contact dermatitis is localized to the site of exposure (e.g., under a cast/splint).", "Clinical features: ")
add_bullet(" Clinical examination; patch testing for allergic contact dermatitis; skin biopsy if diagnosis unclear.", "Investigations: ")
add_bullet(" Avoid/remove offending agent, emollients, topical corticosteroids, antihistamines for itching, antibiotics if secondarily infected.", "Management: ")
add_bullet(" Awareness during splinting/casting/orthotic fitting (padding, avoiding irritant materials), advice on skin hygiene and moisturizing, monitoring skin under orthoses/prosthetics and during electrotherapy, patient education to avoid scratching and known triggers.", "Physiotherapy relevance: ")

# ------------------ 6. Psoriasis ------------------
add_heading("6. PSORIASIS")
add_bullet(" A chronic, immune-mediated, papulosquamous skin disorder marked by well-demarcated erythematous plaques with thick silvery-white scales, due to hyperproliferation of keratinocytes.", "Definition: ")
add_bullet(" Genetic predisposition (positive family history in ~30%), immune dysregulation (T-cell mediated); triggers include stress, infection (streptococcal pharyngitis -> guttate psoriasis), trauma (Koebner phenomenon), drugs, alcohol, and steroid withdrawal.", "Etiology: ")
add_bullet(" Plaque (most common, ~80-90%), guttate, inverse, palmoplantar, pustular, erythrodermic, nail psoriasis (pitting, onycholysis), and psoriatic arthritis (affecting hands, feet, knees, spine).", "Types: ")
add_bullet(" Symmetrical plaques over extensor surfaces - elbows, knees, scalp, lower back, nails; Auspitz sign (pinpoint bleeding on scale removal); associated joint pain/stiffness in psoriatic arthritis.", "Clinical features: ")
add_bullet(" Mainly clinical; skin biopsy if atypical; assess joints for psoriatic arthritis.", "Investigations: ")
add_bullet(" Topical corticosteroids, vitamin D analogues (calcipotriene), tar preparations, phototherapy (narrow-band UVB), systemic agents (methotrexate, acitretin, cyclosporine) and biologics (etanercept, adalimumab, ustekinumab) for moderate-severe disease/psoriatic arthritis.", "Management: ")
add_bullet(" Joint protection and mobility exercises for psoriatic arthritis, gentle skin care during exercise/hydrotherapy (avoid excess friction/trauma - Koebner phenomenon), patient education, and supervised exercise/physical activity to reduce stress (a known trigger).", "Physiotherapy relevance: ")

# Footer note
foot = doc.add_paragraph()
foot.paragraph_format.space_before = Pt(6)
r = foot.add_run("Source: Robbins Basic Pathology; Robbins & Cotran Pathologic Basis of Disease; Bailey & Love's Short Practice of Surgery (28th ed.); Textbook of Family Medicine (9th ed.); Fitzpatrick's Dermatology; supplemented with current physiotherapy practice references.")
r.italic = True
r.font.size = Pt(7.5)

doc.save("/tmp/workspace/gs-notes/General_Surgery_Notes_COPD_Leprosy_Dermatitis_Psoriasis_Bronchitis_Bronchiectasis.docx")
print("saved")