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

// ─── Helper functions ──────────────────────────────────────────────
function heading1(text) {
  return new Paragraph({
    text,
    heading: HeadingLevel.HEADING_1,
    spacing: { before: 300, after: 120 },
  });
}

function heading2(text) {
  return new Paragraph({
    text,
    heading: HeadingLevel.HEADING_2,
    spacing: { before: 200, after: 80 },
  });
}

function heading3(text) {
  return new Paragraph({
    text,
    heading: HeadingLevel.HEADING_3,
    spacing: { before: 160, after: 60 },
  });
}

function para(text, options = {}) {
  return new Paragraph({
    children: [new TextRun({ text, size: 22, font: 'Calibri', ...options })],
    spacing: { after: 100 },
    alignment: AlignmentType.JUSTIFIED,
  });
}

function boldPara(text) {
  return new Paragraph({
    children: [new TextRun({ text, bold: true, size: 22, font: 'Calibri' })],
    spacing: { after: 80 },
  });
}

function bullet(text, level = 0) {
  return new Paragraph({
    children: [new TextRun({ text, size: 22, font: 'Calibri' })],
    bullet: { level },
    spacing: { after: 60 },
  });
}

function emptyLine() {
  return new Paragraph({ children: [new TextRun('')], spacing: { after: 60 } });
}

function pageBreak() {
  return new Paragraph({ children: [new PageBreak()] });
}

// ─── Table builder ─────────────────────────────────────────────────
function makeTable(headers, rows, colWidths) {
  const headerRow = new TableRow({
    tableHeader: true,
    children: headers.map((h, i) =>
      new TableCell({
        children: [new Paragraph({
          children: [new TextRun({ text: h, bold: true, size: 20, font: 'Calibri', color: 'FFFFFF' })],
          alignment: AlignmentType.CENTER,
        })],
        width: { size: colWidths ? colWidths[i] : Math.floor(9000 / headers.length), type: WidthType.DXA },
        shading: { fill: '1F4E79', type: ShadingType.CLEAR, color: '1F4E79' },
        verticalAlign: VerticalAlign.CENTER,
        margins: { top: 80, bottom: 80, left: 100, right: 100 },
      })
    ),
  });

  const dataRows = rows.map((row, ri) =>
    new TableRow({
      children: row.map((cell, ci) =>
        new TableCell({
          children: [new Paragraph({
            children: [new TextRun({ text: String(cell), size: 20, font: 'Calibri' })],
            alignment: AlignmentType.LEFT,
          })],
          width: { size: colWidths ? colWidths[ci] : Math.floor(9000 / headers.length), type: WidthType.DXA },
          shading: { fill: ri % 2 === 0 ? 'DEEAF1' : 'FFFFFF', type: ShadingType.CLEAR },
          margins: { top: 80, bottom: 80, left: 100, right: 100 },
        })
      ),
    })
  );

  return new Table({
    rows: [headerRow, ...dataRows],
    width: { size: 9000, type: WidthType.DXA },
    borders: {
      top: { style: BorderStyle.SINGLE, size: 4, color: '1F4E79' },
      bottom: { style: BorderStyle.SINGLE, size: 4, color: '1F4E79' },
      left: { style: BorderStyle.SINGLE, size: 4, color: '1F4E79' },
      right: { style: BorderStyle.SINGLE, size: 4, color: '1F4E79' },
      insideH: { style: BorderStyle.SINGLE, size: 2, color: 'AED6F1' },
      insideV: { style: BorderStyle.SINGLE, size: 2, color: 'AED6F1' },
    },
  });
}

// ─── Title Page ────────────────────────────────────────────────────
const titlePage = [
  emptyLine(), emptyLine(), emptyLine(),
  new Paragraph({
    children: [new TextRun({ text: 'RESEARCH PROTOCOL', bold: true, size: 32, font: 'Calibri', color: '1F4E79', allCaps: true })],
    alignment: AlignmentType.CENTER, spacing: { after: 200 },
  }),
  new Paragraph({
    children: [new TextRun({ text: 'A Comparative Study of', size: 26, font: 'Calibri', color: '2E4057' })],
    alignment: AlignmentType.CENTER, spacing: { after: 100 },
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Intrathecal Dexmedetomidine vs Fentanyl', bold: true, size: 30, font: 'Calibri', color: '1F4E79' })],
    alignment: AlignmentType.CENTER, spacing: { after: 100 },
  }),
  new Paragraph({
    children: [new TextRun({ text: 'as Adjuvants to Hyperbaric Bupivacaine 0.5% for', size: 26, font: 'Calibri', color: '2E4057' })],
    alignment: AlignmentType.CENTER, spacing: { after: 100 },
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Spinal Anaesthesia in Lower Segment Caesarean Section (LSCS)', bold: true, size: 26, font: 'Calibri', color: '1F4E79' })],
    alignment: AlignmentType.CENTER, spacing: { after: 300 },
  }),
  new Paragraph({
    children: [new TextRun({ text: '─────────────────────────────────────', size: 22, font: 'Calibri', color: '1F4E79' })],
    alignment: AlignmentType.CENTER, spacing: { after: 200 },
  }),
  new Paragraph({
    children: [new TextRun({ text: 'A Double-Blind Randomized Controlled Trial', bold: true, size: 24, font: 'Calibri', color: '2E4057' })],
    alignment: AlignmentType.CENTER, spacing: { after: 400 },
  }),
  emptyLine(), emptyLine(),
  new Paragraph({
    children: [new TextRun({ text: 'Principal Investigator: ___________________________________', size: 22, font: 'Calibri' })],
    alignment: AlignmentType.CENTER, spacing: { after: 120 },
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Co-Investigator(s): ___________________________________', size: 22, font: 'Calibri' })],
    alignment: AlignmentType.CENTER, spacing: { after: 120 },
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Department of Anaesthesiology', size: 22, font: 'Calibri', bold: true })],
    alignment: AlignmentType.CENTER, spacing: { after: 80 },
  }),
  new Paragraph({
    children: [new TextRun({ text: '___________________________________  Hospital / Medical College', size: 22, font: 'Calibri' })],
    alignment: AlignmentType.CENTER, spacing: { after: 80 },
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Date: July 2026', size: 22, font: 'Calibri' })],
    alignment: AlignmentType.CENTER, spacing: { after: 80 },
  }),
  new Paragraph({
    children: [new TextRun({ text: 'EC/IEC Registration No.: ___________________________________', size: 22, font: 'Calibri' })],
    alignment: AlignmentType.CENTER, spacing: { after: 80 },
  }),
  new Paragraph({
    children: [new TextRun({ text: 'CTRI Registration No.: ___________________________________', size: 22, font: 'Calibri' })],
    alignment: AlignmentType.CENTER, spacing: { after: 80 },
  }),
  pageBreak(),
];

// ─── Section 1: Abbreviations ──────────────────────────────────────
const abbrevSection = [
  heading1('LIST OF ABBREVIATIONS'),
  makeTable(
    ['Abbreviation', 'Full Form'],
    [
      ['LSCS', 'Lower Segment Caesarean Section'],
      ['IT', 'Intrathecal'],
      ['SA', 'Spinal Anaesthesia'],
      ['Dex / Dexmed', 'Dexmedetomidine'],
      ['Fen / Fent', 'Fentanyl'],
      ['BPV', 'Bupivacaine'],
      ['HR', 'Heart Rate'],
      ['SBP', 'Systolic Blood Pressure'],
      ['DBP', 'Diastolic Blood Pressure'],
      ['MAP', 'Mean Arterial Pressure'],
      ['SpO2', 'Peripheral Oxygen Saturation'],
      ['NRS', 'Numeric Rating Scale'],
      ['VAS', 'Visual Analogue Scale'],
      ['PONV', 'Postoperative Nausea and Vomiting'],
      ['PACU', 'Post-Anaesthesia Care Unit'],
      ['ASA', 'American Society of Anesthesiologists'],
      ['RCT', 'Randomized Controlled Trial'],
      ['CSF', 'Cerebrospinal Fluid'],
      ['IEC', 'Institutional Ethics Committee'],
      ['CTRI', 'Clinical Trials Registry - India'],
      ['GA', 'General Anaesthesia'],
      ['BMI', 'Body Mass Index'],
      ['APGAR', 'Appearance, Pulse, Grimace, Activity, Respiration'],
    ],
    [2000, 7000]
  ),
  emptyLine(),
  pageBreak(),
];

// ─── Section 2: Background ─────────────────────────────────────────
const backgroundSection = [
  heading1('1. INTRODUCTION AND BACKGROUND'),
  heading2('1.1 Background'),
  para('Lower segment caesarean section (LSCS) is one of the most frequently performed major surgical procedures worldwide. Spinal anaesthesia (SA) is the preferred anaesthetic technique for LSCS due to its rapid onset, reliable block, avoidance of airway manipulation, and maternal awareness during delivery. However, single-shot spinal anaesthesia has inherent limitations including finite duration of block, postoperative pain, and side effects such as shivering, nausea, and vomiting in awake parturients.'),
  para('Adjuvants added to intrathecal local anaesthetics aim to prolong block duration, improve intraoperative analgesia, and reduce rescue analgesic requirements postoperatively. Intrathecal opioids - particularly fentanyl (10-25 mcg) - have been widely used for this purpose. While fentanyl reliably enhances spinal block, its opioid-related side effects including pruritus (30-50% incidence), nausea/vomiting, and occasional respiratory depression remain significant concerns, particularly in the awake obstetric patient.'),
  para('Dexmedetomidine (dexmed), a highly selective alpha-2 (α2) adrenergic agonist, has emerged as a promising non-opioid intrathecal adjuvant. It is approximately 10-fold more α2-selective than clonidine and acts on prejunctional and postjunctional α2 receptors in the dorsal horn of the spinal cord. Intrathecal dexmedetomidine in doses of 3-10 mcg has been shown to prolong sensory and motor block, improve postoperative analgesia, reduce shivering, and avoid opioid-related side effects.'),
  para('Several recent systematic reviews and meta-analyses have compared intrathecal dexmedetomidine with fentanyl in LSCS. A 2025 JBI systematic review (Boshoff et al., 15 studies, n=1098) demonstrated that dexmedetomidine prolongs duration of analgesia by approximately 93 minutes, reduces pruritus by 11%, shivering by 8%, and PONV by 7% compared to fentanyl - all with no significant difference in neonatal outcomes. A 2026 meta-analysis (Huda & Minhas, JCPSP) specific to LSCS confirmed faster sensory block onset and +81.74 minutes additional analgesia with dexmedetomidine over fentanyl.'),
  para('Despite this growing evidence, the optimal dose of intrathecal dexmedetomidine and its direct clinical comparison with fentanyl in a controlled local setting requires further study. The nipping/pinching test - a standard bedside assessment of dermatomal sensory block level - is used to confirm adequate block before surgical incision and to track block progression and regression.'),
  emptyLine(),
  heading2('1.2 Rationale'),
  para('A direct, double-blind, head-to-head comparison of intrathecal dexmedetomidine 5 mcg versus fentanyl 25 mcg in LSCS patients will provide local data on block quality (assessed by nipping test), analgesia duration, hemodynamic stability, and side effect profiles. This study will contribute to evidence-based selection of intrathecal adjuvants in obstetric anaesthesia practice.'),
  emptyLine(),
  pageBreak(),
];

// ─── Section 3: Aims & Objectives ─────────────────────────────────
const objectivesSection = [
  heading1('2. AIMS AND OBJECTIVES'),
  heading2('2.1 Primary Objectives'),
  bullet('To compare the duration of effective analgesia (time from intrathecal injection to first rescue analgesic request, NRS ≥4) between intrathecal dexmedetomidine 5 mcg and fentanyl 25 mcg as adjuvants to hyperbaric bupivacaine 0.5% in LSCS.'),
  bullet('To compare the duration of sensory block (time to two-dermatomal regression from maximum sensory level by nipping test) between the two groups.'),
  emptyLine(),
  heading2('2.2 Secondary Objectives'),
  bullet('To compare onset time of sensory block to T10 and T4 levels by nipping/pinching test.'),
  bullet('To compare maximum sensory level achieved by nipping test.'),
  bullet('To compare duration of motor block (Bromage scale).'),
  bullet('To assess intraoperative analgesia quality (NRS at incision, peritoneal handling, uterine closure).'),
  bullet('To compare postoperative pain scores (VAS/NRS at 0, 2, 4, 6, 12, 24 hours).'),
  bullet('To compare sedation level (Ramsay Sedation Scale).'),
  bullet('To compare incidence of shivering, pruritus, nausea/vomiting, hypotension, and bradycardia.'),
  bullet('To compare total rescue analgesic consumption in first 24 hours.'),
  bullet('To assess neonatal outcomes (APGAR score at 1 and 5 minutes, umbilical artery pH).'),
  emptyLine(),
  pageBreak(),
];

// ─── Section 4: Methodology ────────────────────────────────────────
const methodologySection = [
  heading1('3. METHODOLOGY'),
  heading2('3.1 Study Design'),
  para('Prospective, randomized, double-blind, parallel-group, active-controlled clinical trial.'),
  emptyLine(),
  heading2('3.2 Study Setting'),
  para('Department of Anaesthesiology and Department of Obstetrics & Gynaecology, [Name of Hospital / Medical College], [City].'),
  para('Duration of Study: [e.g., 12 months from date of IEC approval]'),
  emptyLine(),
  heading2('3.3 Eligibility Criteria'),
  heading3('Inclusion Criteria'),
  bullet('Parturients scheduled for elective or emergency LSCS under spinal anaesthesia'),
  bullet('ASA Physical Status I or II'),
  bullet('Age 18 to 40 years'),
  bullet('Term pregnancy (≥37 weeks of gestation)'),
  bullet('Singleton pregnancy, vertex presentation'),
  bullet('Weight 50-90 kg, BMI <40 kg/m²'),
  bullet('Willing to participate with written informed consent'),
  emptyLine(),
  heading3('Exclusion Criteria'),
  bullet('Patient refusal'),
  bullet('Contraindications to spinal anaesthesia: coagulopathy, local infection at site, raised intracranial pressure, severe hypovolemia'),
  bullet('Known allergy or hypersensitivity to any study drug'),
  bullet('Pre-existing neurological disease (peripheral neuropathy, spinal cord disorder)'),
  bullet('Severe cardiac disease (arrhythmia, pre-existing significant bradycardia HR <60, heart block)'),
  bullet('Severe preeclampsia or HELLP syndrome requiring immediate GA'),
  bullet('Fetal distress requiring crash LSCS under GA'),
  bullet('Height <150 cm'),
  bullet('Scheduled for combined spinal-epidural or epidural anaesthesia'),
  bullet('Failed spinal or conversion to GA'),
  emptyLine(),
  heading2('3.4 Sample Size Calculation'),
  para('Based on the meta-analysis by Boshoff et al. (2025), mean difference in duration of analgesia between dexmedetomidine and fentanyl groups was 93.3 minutes (SD approximately 120 minutes). Using the following parameters:'),
  bullet('Level of significance (α) = 0.05 (two-tailed)'),
  bullet('Power of study (1-β) = 80%'),
  bullet('Mean difference to detect = 90 minutes'),
  bullet('Standard deviation = 120 minutes (pooled from literature)'),
  bullet('Formula: n = 2 × [(Zα/2 + Zβ)² × σ²] / d²'),
  bullet('Calculated n = 28 per group → Rounded up to 35 per group to account for 20% dropouts'),
  boldPara('Total sample size: 70 patients (35 per group)'),
  emptyLine(),
  heading2('3.5 Randomization and Blinding'),
  heading3('Randomization'),
  para('Patients will be randomized using computer-generated random number table (www.random.org or SPSS random number generator). Block randomization with variable block sizes (4 and 6) will be used to ensure equal allocation.'),
  heading3('Allocation Concealment'),
  para('Sealed, sequentially numbered, opaque envelopes (SNOSEs) containing group allocation will be prepared and maintained by a designated pharmacist not involved in the study.'),
  heading3('Blinding'),
  bullet('Patient: Blinded to group allocation throughout.'),
  bullet('Assessor: The anaesthesiologist performing block assessment, nipping test, and recording outcomes will be blinded to group allocation.'),
  bullet('Drug preparation: A separate anaesthesiologist (non-blinded) will prepare the drug syringe and will not participate in patient assessment.'),
  bullet('Statistician: Data will be coded and analyzed in a blinded manner.'),
  emptyLine(),
  heading2('3.6 Study Groups and Drug Preparation'),
  makeTable(
    ['Group', 'Drug Combination', 'Volume', 'Baricity'],
    [
      ['Group D (Dexmedetomidine)', 'Hyperbaric Bupivacaine 0.5% 10 mg\n+ Dexmedetomidine 5 mcg\n(preservative-free)', '2.5 mL total\n(made up with NS to volume)', 'Hyperbaric'],
      ['Group F (Fentanyl)', 'Hyperbaric Bupivacaine 0.5% 10 mg\n+ Fentanyl 25 mcg\n(preservative-free)', '2.5 mL total\n(made up with NS to volume)', 'Hyperbaric'],
    ],
    [2500, 4000, 1500, 1000]
  ),
  emptyLine(),
  para('Drug preparation: Dexmedetomidine is available as 200 mcg/2mL (100 mcg/mL) ampoule. For 5 mcg: dilute 0.5 mL of dexmedetomidine in 9.5 mL normal saline to get 10 mcg/mL; draw 0.5 mL = 5 mcg. Fentanyl is available as 50 mcg/mL ampoule. For 25 mcg: draw 0.5 mL = 25 mcg. Both preparations must be preservative-free.'),
  emptyLine(),
  heading2('3.7 Anaesthetic Technique - Standard Protocol'),
  bullet('Pre-procedure: IV access (18G), preloading with Ringer\'s Lactate 500 mL over 15 minutes, baseline vitals recorded.'),
  bullet('Monitoring: Pulse oximetry (SpO2), non-invasive blood pressure (NIBP) every 2.5 minutes, continuous ECG.'),
  bullet('Position: Sitting or left lateral decubitus (standardized within institution).'),
  bullet('Level: L3-L4 or L2-L3 interspace under strict aseptic technique.'),
  bullet('Needle: 25G Quincke or 27G Whitacre (pencil-point) spinal needle - standardized within study.'),
  bullet('Confirm CSF: Free flow of clear CSF before injection.'),
  bullet('Injection: Drug injected over 15-20 seconds at rate of 0.2 mL/sec.'),
  bullet('Post-injection: Patient placed immediately supine with 15° left lateral tilt (wedge under right hip).'),
  bullet('Oxygen: 4-6 L/min via face mask or nasal prongs.'),
  bullet('Hypotension management: Phenylephrine 50 mcg IV bolus or Ephedrine 5 mg IV if SBP falls >20% from baseline or <90 mmHg.'),
  bullet('Bradycardia management: Atropine 0.6 mg IV if HR <50 bpm.'),
  bullet('Surgery start: Only after confirming T4 sensory block by nipping test.'),
  bullet('Intraoperative rescue: If NRS >4 despite T4 block: Inj. Ketamine 0.5 mg/kg IV or conversion to GA as per protocol.'),
  bullet('Postoperative analgesia: Inj. Diclofenac 75 mg IM every 8 hours as baseline. Rescue: Inj. Tramadol 50 mg IV if NRS ≥4 (first rescue analgesic request time = primary endpoint).'),
  emptyLine(),
  pageBreak(),
];

// ─── Section 5: Nipping Test ───────────────────────────────────────
const nippingSection = [
  heading1('4. NIPPING / PINCHING TEST - DETAILED PROTOCOL'),
  heading2('4.1 Method'),
  para('The nipping (pinching) test is the primary bedside method used to assess dermatomal sensory block level before and during surgery. It evaluates sharp pain sensation (A-delta fibre function) which corresponds to surgical anaesthesia level.'),
  heading3('Instrument'),
  para('Toothed Allis tissue forceps (toothed forceps) - standard technique. Alternatively, a firm fingernail pinch may be used. Pinprick with a sterile 23G needle is equivalent and may be used as per institutional practice.'),
  heading3('Procedure'),
  bullet('Begin testing 2 minutes after completion of intrathecal injection.'),
  bullet('Repeat every 2 minutes until T4 is achieved or 20 minutes have elapsed.'),
  bullet('Test bilaterally; record the higher level if asymmetric.'),
  bullet('Start at the foot (S1 level), move cephalad in dermatomal sequence.'),
  bullet('Apply firm nipping/pinching to skin at each dermatomal level.'),
  bullet('Ask patient: "Does this feel sharp like a pinch, or just pressure/dull?"'),
  bullet('Sharp = pain felt = block ABSENT at that level.'),
  bullet('Dull / Pressure only = no sharp pain = block PRESENT at that level.'),
  emptyLine(),
  heading2('4.2 Dermatomal Reference Chart'),
  makeTable(
    ['Dermatomal Level', 'Anatomical Landmark', 'Clinical Significance'],
    [
      ['T4', 'Nipple line (4th intercostal space)', 'MINIMUM level required for LSCS'],
      ['T5', 'Just below nipple line', 'Adequate for LSCS with margin'],
      ['T6', 'Xiphoid process', 'Adequate for uterine manipulation'],
      ['T8', 'Costal margin', 'Adequate for lower uterine incision'],
      ['T10', 'Umbilicus', 'Minimum for uterine incision (not sufficient for whole LSCS)'],
      ['T12', 'Inguinal ligament', 'Lower abdomen'],
      ['L1', 'Groin / Inguinal region', 'Groin sensation'],
      ['L2', 'Mid anterior thigh', 'Thigh sensation'],
      ['L3', 'Knee', 'Knee sensation'],
      ['S1', 'Lateral foot / Little toe', 'End of block recovery'],
    ],
    [1500, 3500, 4000]
  ),
  emptyLine(),
  heading2('4.3 Block Timing Parameters (Nipping Test)'),
  makeTable(
    ['Parameter', 'Definition', 'Measurement'],
    [
      ['Onset of sensory block (T10)', 'Time from injection to loss of nipping sensation at T10 bilaterally', 'Minutes from injection'],
      ['Time to T4 block', 'Time from injection to loss of nipping sensation at T4 (nipple line)', 'Minutes from injection'],
      ['Maximum sensory level', 'Highest dermatomal level where nipping sensation is absent', 'Dermatomal level (e.g., T4, T3)'],
      ['Time to maximum level', 'Time from injection to stabilization of maximum sensory level', 'Minutes from injection'],
      ['Two-dermatomal regression', 'Time from injection to fall of 2 dermatomes from peak level', 'Minutes from injection'],
      ['Complete sensory recovery (S1)', 'Return of normal sharp nipping sensation at S1 (lateral foot)', 'Minutes from injection'],
    ],
    [2500, 4000, 2500]
  ),
  emptyLine(),
  heading2('4.4 Motor Block Assessment (Bromage Scale)'),
  makeTable(
    ['Grade', 'Description', 'Interpretation'],
    [
      ['0', 'No paralysis - full flexion of knees and feet possible', 'No motor block'],
      ['1', 'Inability to raise extended leg; can flex knee', 'Partial motor block'],
      ['2', 'Inability to flex knee; can flex ankle/foot', 'Almost complete motor block'],
      ['3', 'Complete paralysis of foot and leg', 'Complete motor block'],
    ],
    [1000, 5000, 3000]
  ),
  emptyLine(),
  pageBreak(),
];

// ─── Section 6: Data Collection Form ───────────────────────────────
const dataFormSection = [
  heading1('5. CASE RECORD FORM (CRF) / DATA COLLECTION PROFORMA'),
  emptyLine(),
  heading2('5.1 Patient Identification'),
  makeTable(
    ['Field', 'Entry'],
    [
      ['Study ID (Randomization No.)', ''],
      ['Patient Name (initials only)', ''],
      ['Age (years)', ''],
      ['IP/OP Number', ''],
      ['Date of Surgery', ''],
      ['Group Allocated (D / F)', ''],
      ['Gravida / Para', ''],
      ['Gestational Age (weeks)', ''],
      ['Mode of LSCS (Elective / Emergency)', ''],
      ['Height (cm)', ''],
      ['Weight (kg)', ''],
      ['BMI (kg/m²)', ''],
      ['ASA Grade (I / II)', ''],
      ['Indication for LSCS', ''],
    ],
    [4000, 5000]
  ),
  emptyLine(),
  heading2('5.2 Preoperative Baseline Parameters'),
  makeTable(
    ['Parameter', 'Value'],
    [
      ['Baseline HR (bpm)', ''],
      ['Baseline SBP (mmHg)', ''],
      ['Baseline DBP (mmHg)', ''],
      ['Baseline MAP (mmHg)', ''],
      ['Baseline SpO2 (%)', ''],
      ['Baseline Temp (°C)', ''],
      ['IV fluid preloaded (mL)', ''],
      ['Spinal needle used (gauge/type)', ''],
      ['Level of spinal injection (L2-3 / L3-4)', ''],
      ['Position (sitting / left lateral)', ''],
      ['Time of injection (24h format)', ''],
      ['Any difficulty in spinal (Y/N) - details if Y', ''],
    ],
    [4000, 5000]
  ),
  emptyLine(),
  heading2('5.3 Block Assessment - Nipping Test + Motor Block'),
  makeTable(
    ['Time (min)', 'Sensory Level (Nipping)', 'Motor Block (Bromage 0-3)', 'HR (bpm)', 'SBP (mmHg)', 'MAP (mmHg)', 'SpO2 (%)'],
    [
      ['0 (Baseline)', '', '0', '', '', '', ''],
      ['2 min', '', '', '', '', '', ''],
      ['5 min', '', '', '', '', '', ''],
      ['8 min', '', '', '', '', '', ''],
      ['10 min', '', '', '', '', '', ''],
      ['12 min', '', '', '', '', '', ''],
      ['15 min', '', '', '', '', '', ''],
      ['20 min', '', '', '', '', '', ''],
      ['At Skin Incision', '', '', '', '', '', ''],
      ['At Baby Delivery', '', '', '', '', '', ''],
      ['At Uterine Closure', '', '', '', '', '', ''],
      ['At End of Surgery', '', '', '', '', '', ''],
    ],
    [1400, 1800, 1500, 1000, 1000, 1000, 1300]
  ),
  emptyLine(),
  heading2('5.4 Block Parameter Summary'),
  makeTable(
    ['Parameter', 'Time / Value'],
    [
      ['Onset of sensory block to T10 (min)', ''],
      ['Time to achieve T4 block (min)', ''],
      ['Maximum sensory level achieved (dermatomal level)', ''],
      ['Time to maximum sensory level (min)', ''],
      ['Two-dermatomal regression time from peak (min)', ''],
      ['Complete sensory recovery to S1 (min)', ''],
      ['Duration of motor block - Bromage 3 to 0 (min)', ''],
      ['Bromage 3 achieved at (min post-injection)', ''],
      ['Surgery start time (min post-injection)', ''],
      ['Surgery end time (min post-injection)', ''],
      ['Duration of surgery (min)', ''],
      ['Adequate surgical anaesthesia: Yes / No', ''],
      ['Intraoperative supplementation required: Yes / No', ''],
    ],
    [5000, 4000]
  ),
  emptyLine(),
  heading2('5.5 Intraoperative Pain / Discomfort'),
  makeTable(
    ['Time Point', 'NRS Score (0-10)', 'Pain / Discomfort Type', 'Intervention Required'],
    [
      ['At skin incision', '', '', ''],
      ['At peritoneal entry', '', '', ''],
      ['At uterine incision', '', '', ''],
      ['At baby delivery', '', '', ''],
      ['At uterine closure', '', '', ''],
      ['At skin closure', '', '', ''],
    ],
    [2500, 1500, 3000, 2000]
  ),
  emptyLine(),
  heading2('5.6 Intraoperative Events & Interventions'),
  makeTable(
    ['Event', 'Occurred (Y/N)', 'Time (min)', 'Intervention Given', 'Dose'],
    [
      ['Hypotension (SBP <90 or >20% fall)', '', '', '', ''],
      ['Bradycardia (HR <50 bpm)', '', '', '', ''],
      ['Nausea/Vomiting', '', '', '', ''],
      ['Shivering', '', '', '', ''],
      ['Pruritus', '', '', '', ''],
      ['Respiratory Depression (SpO2 <94%)', '', '', '', ''],
      ['High block (above T2)', '', '', '', ''],
      ['Conversion to GA', '', '', '', ''],
    ],
    [2500, 1200, 1200, 2500, 1600]
  ),
  emptyLine(),
  heading2('5.7 Postoperative Monitoring'),
  makeTable(
    ['Time Post-op', 'NRS / VAS (0-10)', 'Motor Block (Bromage)', 'Shivering (0-3)', 'Pruritus (0/1/2/3)', 'PONV (Y/N)', 'Sedation (Ramsay)', 'Rescue Analgesic (Y/N)'],
    [
      ['0 h (PACU arrival)', '', '', '', '', '', '', ''],
      ['30 min', '', '', '', '', '', '', ''],
      ['1 h', '', '', '', '', '', '', ''],
      ['2 h', '', '', '', '', '', '', ''],
      ['4 h', '', '', '', '', '', '', ''],
      ['6 h', '', '', '', '', '', '', ''],
      ['12 h', '', '', '', '', '', '', ''],
      ['24 h', '', '', '', '', '', '', ''],
    ],
    [1500, 1200, 1200, 1100, 1100, 900, 1100, 1500]
  ),
  emptyLine(),
  heading2('5.8 Analgesic Outcome Summary'),
  makeTable(
    ['Parameter', 'Value'],
    [
      ['Time to first rescue analgesic request (min from injection)', ''],
      ['NRS at time of rescue analgesic request', ''],
      ['Total diclofenac consumed in 24h (mg)', ''],
      ['Total tramadol consumed in 24h (mg)', ''],
      ['Patient satisfied: Yes / No / Partial', ''],
    ],
    [5500, 3500]
  ),
  emptyLine(),
  heading2('5.9 Neonatal Outcome'),
  makeTable(
    ['Parameter', 'Value'],
    [
      ['Baby weight (kg)', ''],
      ['APGAR Score at 1 minute (0-10)', ''],
      ['APGAR Score at 5 minutes (0-10)', ''],
      ['Umbilical artery pH', ''],
      ['NICU admission required: Yes / No', ''],
      ['If yes, reason', ''],
    ],
    [5000, 4000]
  ),
  emptyLine(),
  heading2('5.10 Side Effect Summary - Tick Sheet'),
  makeTable(
    ['Side Effect', 'Intraoperative', 'Postoperative (0-24h)', 'Treatment Given'],
    [
      ['Pruritus - Mild', '', '', ''],
      ['Pruritus - Moderate/Severe', '', '', ''],
      ['Shivering - Grade 1', '', '', ''],
      ['Shivering - Grade 2/3', '', '', ''],
      ['Nausea', '', '', ''],
      ['Vomiting', '', '', ''],
      ['Hypotension', '', '', ''],
      ['Bradycardia', '', '', ''],
      ['Excessive sedation', '', '', ''],
      ['Respiratory depression', '', '', ''],
      ['Any other adverse event', '', '', ''],
    ],
    [3000, 1800, 2200, 2000]
  ),
  emptyLine(),
  boldPara("Investigator's Signature: ____________________    Date: ____________"),
  emptyLine(),
  pageBreak(),
];

// ─── Section 7: Statistical Analysis ──────────────────────────────
const statsSection = [
  heading1('6. STATISTICAL ANALYSIS PLAN'),
  heading2('6.1 Software'),
  para('IBM SPSS Statistics version 26 or later, or GraphPad Prism 9.0 or equivalent. p value <0.05 considered statistically significant.'),
  emptyLine(),
  heading2('6.2 Analysis Tests'),
  makeTable(
    ['Data Type', 'Statistical Test'],
    [
      ['Normally distributed continuous data (HR, SBP, weight, height)', 'Unpaired Student\'s t-test; data presented as Mean ± SD'],
      ['Non-normally distributed continuous data (block onset times, pain scores, analgesic consumption)', 'Mann-Whitney U test; data presented as Median (IQR)'],
      ['Categorical/dichotomous data (incidence of PONV, pruritus, hypotension etc.)', 'Chi-square test or Fisher\'s Exact test; data as frequencies and percentages'],
      ['Repeated hemodynamic measurements over time', 'Repeated measures ANOVA with Bonferroni correction'],
      ['Normality testing', 'Shapiro-Wilk test (n<50 per group)'],
    ],
    [4500, 4500]
  ),
  emptyLine(),
  heading2('6.3 Primary Endpoints Analysis'),
  bullet('Duration of effective analgesia: Kaplan-Meier survival curve + Log-rank test (time-to-event analysis) or unpaired t-test if normally distributed.'),
  bullet('Duration of sensory block: Mann-Whitney U test or unpaired t-test.'),
  emptyLine(),
  pageBreak(),
];

// ─── Section 8: Ethical Considerations ────────────────────────────
const ethicsSection = [
  heading1('7. ETHICAL CONSIDERATIONS'),
  heading2('7.1 Ethics Approval'),
  para('This study will be conducted only after obtaining approval from the Institutional Ethics Committee (IEC). The trial will be registered with Clinical Trials Registry - India (CTRI) before commencement of enrolment.'),
  emptyLine(),
  heading2('7.2 Informed Consent'),
  para('Written informed consent will be obtained from all participants during the preanaesthetic visit (at least 24 hours before surgery). The consent form will be in English and the local language. Participants will be informed of their right to withdraw without affecting their medical care.'),
  emptyLine(),
  heading2('7.3 Patient Safety'),
  bullet('All intrathecal drugs will be preservative-free formulations.'),
  bullet('Resuscitation equipment (oxygen, suction, crash cart, intubation equipment) will be immediately available.'),
  bullet('Vasopressors (phenylephrine, ephedrine) and atropine will be drawn up before spinal injection.'),
  bullet('Neonatal resuscitation team will be present at delivery.'),
  bullet('Study will adhere to Declaration of Helsinki (2013 revision) and ICH-GCP guidelines.'),
  emptyLine(),
  heading2('7.4 Confidentiality'),
  para('All patient data will be coded. Name and identifying information will not be included in any publications. Data will be stored securely for 5 years after study completion.'),
  emptyLine(),
  pageBreak(),
];

// ─── Section 9: References ─────────────────────────────────────────
const referencesSection = [
  heading1('8. REFERENCES'),
  para('1. Boshoff J, Fourtounas M, Pegu K, McInerney P. Effectiveness of intrathecal dexmedetomidine versus fentanyl as additives to hyperbaric bupivacaine on postoperative analgesia in patients undergoing Cesarean section: a systematic review and meta-analysis. JBI Evid Synth. 2025. PMID: 41185983.'),
  para('2. Huda AU, Minhas MR. Intrathecal Dexmedetomidine versus Fentanyl for Improving the Quality of Spinal Block in Lower Segment Caesarean Section: A Meta-Analysis. J Coll Physicians Surg Pak. 2026;36(6):779. PMID: 42219838.'),
  para('3. Giaccari LG, Coppolino F, Aurilio C, Pace MC, Passavanti MB, Pota V. Is intrathecal bupivacaine plus dexmedetomidine superior to bupivacaine in spinal anesthesia for a cesarean section? A systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2024. PMID: 39194198.'),
  para('4. Ollosu M, Tripodi VF, Bonu A, et al. Efficacy and safety of intrathecal adjuvants for perioperative management of cesarean delivery: a systematic review and network meta-analysis of randomized controlled trials. Reg Anesth Pain Med. 2026. PMID: 40147822.'),
  para('5. Miller RD et al. Miller\'s Anesthesia. 10th ed. Elsevier; 2023. Chapter 41: Spinal Anaesthesia. pp. 6062-6063.'),
  para('6. Barash PG, Cullen BF, Stoelting RK et al. Clinical Anesthesia. 9th ed. Wolters Kluwer; 2022. Chapter 35: Spinal Anaesthesia - Adjuvants. p. 2843.'),
  emptyLine(),
  pageBreak(),
];

// ─── Section 10: Consent Form ──────────────────────────────────────
const consentSection = [
  heading1('APPENDIX A: PATIENT INFORMATION SHEET & INFORMED CONSENT FORM'),
  emptyLine(),
  boldPara('Study Title: A Comparative Study of Intrathecal Dexmedetomidine vs Fentanyl as Adjuvants to Hyperbaric Bupivacaine for Spinal Anaesthesia in LSCS'),
  emptyLine(),
  heading2('Patient Information Sheet'),
  para('You are being invited to take part in a research study. Before you decide, it is important for you to understand why the research is being done and what it will involve. Please read this information carefully and discuss it with your relatives if you wish. Ask us if there is anything that is not clear or if you would like more information.'),
  emptyLine(),
  heading3('Why is this study being done?'),
  para('When you have a caesarean section under spinal anaesthesia (injection in the back), your doctor gives you a painkilling drug along with the numbing medicine to help the anaesthesia work better and relieve pain after surgery. Two such drugs are commonly used: Dexmedetomidine and Fentanyl. We want to find out which drug is better in terms of pain relief, duration, and fewer side effects after your caesarean section.'),
  heading3('What will happen to me if I take part?'),
  para('If you agree to join the study, you will be assigned by chance (like tossing a coin) to receive either Dexmedetomidine or Fentanyl along with the spinal injection. Both drugs are approved and routinely used. You will not know which drug you receive. A doctor will check your pain level and feeling in your legs using a simple pinch test at regular intervals. We will record your pain scores, blood pressure, heart rate, and any side effects.'),
  heading3('What are the risks?'),
  para('Both drugs are safe and routinely used. Possible minor side effects of Dexmedetomidine include a slight slowing of heart rate or drop in blood pressure, which will be promptly treated. Fentanyl may cause itching or nausea, which are also treated. Your baby\'s condition will be carefully monitored. You and your baby\'s safety are our highest priority.'),
  heading3('Is participation voluntary?'),
  para('Yes. Your participation is entirely voluntary. Refusing to participate or withdrawing at any time will not affect the quality of care you receive.'),
  emptyLine(),
  heading2('Informed Consent'),
  para('I, ________________________________________ (Patient name), have read the above patient information sheet. The study has been explained to me in my own language. My questions have been answered satisfactorily. I voluntarily consent to participate in this study.'),
  emptyLine(),
  para('I understand that:'),
  bullet('I may withdraw from the study at any time without giving reasons.'),
  bullet('My medical care will not be affected if I withdraw.'),
  bullet('My personal information will remain confidential.'),
  bullet('My identity will not appear in any publications.'),
  emptyLine(),
  makeTable(
    ['', 'Patient', 'Witness', 'Principal Investigator'],
    [
      ['Name', '', '', ''],
      ['Signature / Thumb impression', '', '', ''],
      ['Date', '', '', ''],
      ['Relationship (for witness)', '-', '', '-'],
    ],
    [2000, 2000, 2500, 2500]
  ),
  emptyLine(),
];

// ─── Assemble document ─────────────────────────────────────────────
const doc = new Document({
  styles: {
    default: {
      document: {
        run: { font: 'Calibri', size: 22 },
      },
    },
    paragraphStyles: [
      {
        id: 'Heading1',
        name: 'Heading 1',
        basedOn: 'Normal',
        next: 'Normal',
        run: { font: 'Calibri', size: 28, bold: true, color: '1F4E79' },
        paragraph: {
          spacing: { before: 300, after: 120 },
          border: { bottom: { style: BorderStyle.SINGLE, size: 4, color: '1F4E79', space: 4 } },
        },
      },
      {
        id: 'Heading2',
        name: 'Heading 2',
        basedOn: 'Normal',
        next: 'Normal',
        run: { font: 'Calibri', size: 24, bold: true, color: '2E75B6' },
        paragraph: { spacing: { before: 200, after: 80 } },
      },
      {
        id: 'Heading3',
        name: 'Heading 3',
        basedOn: 'Normal',
        next: 'Normal',
        run: { font: 'Calibri', size: 22, bold: true, color: '2E4057', italics: true },
        paragraph: { spacing: { before: 160, after: 60 } },
      },
    ],
  },
  sections: [
    {
      headers: {
        default: new Header({
          children: [
            new Paragraph({
              children: [
                new TextRun({ text: 'Study Protocol: Intrathecal Dexmedetomidine vs Fentanyl in LSCS', size: 18, font: 'Calibri', color: '1F4E79', italics: true }),
              ],
              alignment: AlignmentType.RIGHT,
              border: { bottom: { style: BorderStyle.SINGLE, size: 2, color: '1F4E79', space: 4 } },
            }),
          ],
        }),
      },
      footers: {
        default: new Footer({
          children: [
            new Paragraph({
              children: [
                new TextRun({ text: 'Department of Anaesthesiology | Confidential Research Document | Page ', size: 18, font: 'Calibri', color: '888888' }),
                new TextRun({ children: [PageNumber.CURRENT], size: 18, font: 'Calibri', color: '888888' }),
                new TextRun({ text: ' of ', size: 18, font: 'Calibri', color: '888888' }),
                new TextRun({ children: [PageNumber.TOTAL_PAGES], size: 18, font: 'Calibri', color: '888888' }),
              ],
              alignment: AlignmentType.CENTER,
              border: { top: { style: BorderStyle.SINGLE, size: 2, color: '1F4E79', space: 4 } },
            }),
          ],
        }),
      },
      children: [
        ...titlePage,
        ...abbrevSection,
        ...backgroundSection,
        ...objectivesSection,
        ...methodologySection,
        ...nippingSection,
        ...dataFormSection,
        ...statsSection,
        ...ethicsSection,
        ...referencesSection,
        ...consentSection,
      ],
    },
  ],
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/dexmed-lscs-study/Dexmed_vs_Fentanyl_LSCS_Study_Protocol.docx', buffer);
  console.log('Document created successfully!');
}).catch(err => {
  console.error('Error:', err);
  process.exit(1);
});

import openpyxl
from openpyxl import Workbook
from openpyxl.styles import (
    PatternFill, Font, Alignment, Border, Side, GradientFill
)
from openpyxl.utils import get_column_letter
from openpyxl.worksheet.datavalidation import DataValidation

wb = Workbook()

# ── Colour palette ──────────────────────────────────────────────────
DARK_BLUE   = "1F4E79"
MED_BLUE    = "2E75B6"
LIGHT_BLUE  = "BDD7EE"
PALE_BLUE   = "DEEAF1"
HEADER_TXT  = "FFFFFF"
GREEN_FILL  = "E2EFDA"
YELLOW_FILL = "FFF2CC"
RED_FILL    = "FCE4D6"
GREY_FILL   = "F2F2F2"
WHITE       = "FFFFFF"

def hdr_font(sz=11, bold=True, color=HEADER_TXT):
    return Font(name="Calibri", size=sz, bold=bold, color=color)

def cell_font(sz=10, bold=False, color="000000"):
    return Font(name="Calibri", size=sz, bold=bold, color=color)

def fill(hex_col):
    return PatternFill("solid", fgColor=hex_col)

def center_align(wrap=True):
    return Alignment(horizontal="center", vertical="center", wrap_text=wrap)

def left_align(wrap=True):
    return Alignment(horizontal="left", vertical="center", wrap_text=wrap)

def thin_border():
    s = Side(border_style="thin", color="A6A6A6")
    return Border(left=s, right=s, top=s, bottom=s)

def thick_border():
    s = Side(border_style="medium", color=DARK_BLUE)
    return Border(left=s, right=s, top=s, bottom=s)

def set_row(ws, row, col_start, values, bg, font_obj, align_fn=center_align, border_fn=thin_border):
    for ci, val in enumerate(values, start=col_start):
        c = ws.cell(row=row, column=ci, value=val)
        c.fill = fill(bg)
        c.font = font_obj
        c.alignment = align_fn()
        c.border = border_fn()

def section_header(ws, row, col_start, col_end, text, bg=DARK_BLUE):
    ws.merge_cells(start_row=row, start_column=col_start,
                   end_row=row,   end_column=col_end)
    c = ws.cell(row=row, column=col_start, value=text)
    c.fill = fill(bg)
    c.font = Font(name="Calibri", size=12, bold=True, color=HEADER_TXT)
    c.alignment = center_align()
    c.border = thick_border()

# ════════════════════════════════════════════════════════════════════
# SHEET 1 – INSTRUCTIONS
# ════════════════════════════════════════════════════════════════════
ws_inst = wb.active
ws_inst.title = "INSTRUCTIONS"
ws_inst.sheet_view.showGridLines = False
ws_inst.column_dimensions["A"].width = 5
ws_inst.column_dimensions["B"].width = 60
ws_inst.column_dimensions["C"].width = 40

ws_inst.merge_cells("B2:C2")
c = ws_inst["B2"]
c.value = "DATA COLLECTION CHECKLIST — INSTRUCTIONS"
c.fill = fill(DARK_BLUE)
c.font = Font(name="Calibri", size=14, bold=True, color=HEADER_TXT)
c.alignment = center_align()
c.border = thick_border()
ws_inst.row_dimensions[2].height = 30

study_info = [
    ("Study Title:",  "Intrathecal Dexmedetomidine vs Fentanyl in LSCS (Spinal Anaesthesia)"),
    ("Study Design:", "Prospective Double-Blind RCT"),
    ("Groups:",       "Group D = Dexmedetomidine 5 mcg  |  Group F = Fentanyl 25 mcg"),
    ("Adjuvant:",     "Both added to Hyperbaric Bupivacaine 0.5% 10 mg"),
]
for ri, (label, val) in enumerate(study_info, start=4):
    ws_inst.cell(row=ri, column=2, value=label).font = Font(name="Calibri", size=10, bold=True)
    ws_inst.cell(row=ri, column=3, value=val).font   = Font(name="Calibri", size=10)
    ws_inst.row_dimensions[ri].height = 18

instructions = [
    ("SHEET 2 – PATIENT MASTER",   "Enter one row per patient. All demographic and basic data goes here."),
    ("SHEET 3 – BLOCK ASSESSMENT", "Record nipping test level + Bromage score + hemodynamics at every time point."),
    ("SHEET 4 – INTRAOP EVENTS",   "Record any intraoperative events (hypotension, bradycardia, PONV, shivering etc.)"),
    ("SHEET 5 – POSTOP MONITORING","Record pain scores (NRS/VAS), sedation, shivering, pruritus every 2-4-6-12-24h."),
    ("SHEET 6 – OUTCOMES SUMMARY", "Auto-populated outcome summary per patient for final analysis export."),
    ("SHEET 7 – NEONATAL",         "APGAR scores, birth weight, umbilical pH, NICU admission."),
]
ws_inst.cell(row=9, column=2, value="SHEET GUIDE").font = Font(name="Calibri", size=11, bold=True, color=DARK_BLUE)
ws_inst.cell(row=9, column=3, value="PURPOSE").font     = Font(name="Calibri", size=11, bold=True, color=DARK_BLUE)
for ri, (sheet, purpose) in enumerate(instructions, start=10):
    ws_inst.cell(row=ri, column=2, value=sheet).font = Font(name="Calibri", size=10, bold=True)
    c = ws_inst.cell(row=ri, column=3, value=purpose)
    c.font = Font(name="Calibri", size=10)
    c.alignment = left_align()
    ws_inst.row_dimensions[ri].height = 18

notes = [
    "HOW TO USE THIS CHECKLIST",
    "1.  Open the correct sheet for the time point you are recording.",
    "2.  Each patient has a unique Study ID (e.g., D-01, F-01).",
    "3.  Fill ALL fields. Leave blank only if data genuinely not available — write 'NA'.",
    "4.  Nipping test: Record dermatomal level where nipping = DULL (e.g., T4, T6, T10).",
    "5.  Bromage scale: 0 = No block, 1 = Cannot raise leg, 2 = Cannot flex knee, 3 = Complete paralysis.",
    "6.  Hypotension = SBP <90 mmHg OR >20% fall from baseline.",
    "7.  Bradycardia = HR <50 bpm.",
    "8.  NRS/VAS: 0 = No pain, 10 = Worst imaginable pain.",
    "9.  Shivering: 0=None, 1=Mild (not visible), 2=Moderate (muscle groups), 3=Severe (whole body).",
    "10. Pruritus: 0=None, 1=Mild, 2=Moderate, 3=Severe.",
    "11. Ramsay Sedation: 1=Anxious, 2=Cooperative calm, 3=Follows commands, 4=Brisk response, 5=Sluggish, 6=No response.",
    "12. First rescue analgesic request time = PRIMARY ENDPOINT. Record precisely in minutes.",
    "13. Do NOT alter Study ID or Group columns — these are locked for blinded analysis.",
]
for ri, note in enumerate(notes, start=18):
    c = ws_inst.cell(row=ri, column=2, value=note)
    c.font = Font(name="Calibri", size=10, bold=(ri == 18), color=DARK_BLUE if ri == 18 else "000000")
    c.fill = fill(PALE_BLUE if ri == 18 else (GREY_FILL if ri % 2 == 0 else WHITE))
    ws_inst.merge_cells(start_row=ri, start_column=2, end_row=ri, end_column=3)
    c.alignment = left_align()
    ws_inst.row_dimensions[ri].height = 18


# ════════════════════════════════════════════════════════════════════
# SHEET 2 – PATIENT MASTER
# ════════════════════════════════════════════════════════════════════
ws2 = wb.create_sheet("PATIENT MASTER")
ws2.sheet_view.showGridLines = False

master_headers = [
    "Study ID", "Group\n(D/F)", "Patient\nInitials", "Age\n(yrs)",
    "IP No.", "Date of\nSurgery", "ASA\nGrade",
    "Gravida", "Para", "Gest. Age\n(wks)",
    "Height\n(cm)", "Weight\n(kg)", "BMI\n(kg/m²)",
    "Type of LSCS\n(Elective/Emerg.)", "Indication\nfor LSCS",
    "Spinal\nNeedle (G)", "Level\n(L2-3/L3-4)",
    "Position\n(Sit/Lat)", "Time of\nInjection",
    "Baseline\nHR (bpm)", "Baseline\nSBP (mmHg)",
    "Baseline\nDBP (mmHg)", "Baseline\nMAP (mmHg)",
    "Baseline\nSpO2 (%)", "Baseline\nTemp (°C)",
    "IV Fluid\nPreloaded (mL)", "Any difficulty\nin spinal (Y/N)", "Remarks"
]
col_widths_m = [10,8,12,7,10,12,7,8,7,10,9,9,9,18,20,12,13,12,12,10,12,12,12,11,11,14,16,20]

section_header(ws2, 1, 1, len(master_headers), "SHEET 2 — PATIENT MASTER REGISTER")
set_row(ws2, 2, 1, master_headers, DARK_BLUE, hdr_font(10), center_align)
ws2.row_dimensions[1].height = 28
ws2.row_dimensions[2].height = 45

for ci, w in enumerate(col_widths_m, start=1):
    ws2.column_dimensions[get_column_letter(ci)].width = w

# Sample data rows + empty rows
sample_pts = [
    ["D-01","D","AB","28","IP-001","12-Jul-26","I","G2","P1","39","158","62","24.8","Elective","Previous LSCS","25G Whitacre","L3-4","Sitting","09:15","78","118","76","90","99","36.6","500","No",""],
    ["F-01","F","CD","32","IP-002","12-Jul-26","II","G3","P2","40","160","70","27.3","Elective","CPD","25G Whitacre","L3-4","Sitting","10:30","80","122","80","94","99","36.5","500","No",""],
]
for ri, row in enumerate(sample_pts, start=3):
    bg = PALE_BLUE if ri % 2 == 0 else WHITE
    for ci, val in enumerate(row, start=1):
        c = ws2.cell(row=ri, column=ci, value=val)
        c.font = cell_font()
        c.alignment = center_align()
        c.border = thin_border()
        c.fill = fill(bg)

for ri in range(5, 75):
    bg = PALE_BLUE if ri % 2 == 0 else WHITE
    for ci in range(1, len(master_headers)+1):
        c = ws2.cell(row=ri, column=ci, value="")
        c.fill = fill(bg)
        c.border = thin_border()
        c.alignment = center_align()
ws2.freeze_panes = "C3"


# ════════════════════════════════════════════════════════════════════
# SHEET 3 – BLOCK ASSESSMENT (Nipping Test + Hemodynamics)
# ════════════════════════════════════════════════════════════════════
ws3 = wb.create_sheet("BLOCK ASSESSMENT")
ws3.sheet_view.showGridLines = False

time_points = [
    "Baseline\n(T0)", "2 min", "5 min", "8 min", "10 min", "12 min",
    "15 min", "20 min", "Skin\nIncision", "Baby\nOut",
    "Uterine\nClosure", "End of\nSurgery"
]

# Row 1: Main header
section_header(ws3, 1, 1, 3 + len(time_points)*4 + 3,
               "SHEET 3 — BLOCK ASSESSMENT (Nipping Test + Motor Block + Hemodynamics)")
ws3.row_dimensions[1].height = 28

# Row 2: Column group headers
ws3.cell(row=2, column=1, value="Study\nID")
ws3.cell(row=2, column=2, value="Group\n(D/F)")
ws3.cell(row=2, column=3, value="Time of\nSpinal (hh:mm)")
for ci in [1,2,3]:
    c = ws3.cell(row=2, column=ci)
    c.fill = fill(DARK_BLUE); c.font = hdr_font(9); c.alignment = center_align(); c.border = thin_border()

col = 4
for tp in time_points:
    for sub in ["Sensory\n(Nipping)", "Bromage\n(0-3)", "HR\n(bpm)", "SBP\n(mmHg)"]:
        c = ws3.cell(row=2, column=col, value=sub)
        c.fill = fill(MED_BLUE); c.font = hdr_font(8); c.alignment = center_align(); c.border = thin_border()
        col += 1

# Row 3: time point labels merged
col = 4
for tp in time_points:
    ws3.merge_cells(start_row=3, start_column=col, end_row=3, end_column=col+3)
    c = ws3.cell(row=3, column=col, value=tp)
    c.fill = fill(LIGHT_BLUE); c.font = hdr_font(9, color=DARK_BLUE); c.alignment = center_align(); c.border = thin_border()
    col += 4

# Extra columns after time points
extras = ["Max Sensory\nLevel", "Time to T4\n(min)", "Time to\n2-derm regress (min)"]
for i, ex in enumerate(extras):
    c = ws3.cell(row=2, column=col+i, value=ex)
    c.fill = fill(DARK_BLUE); c.font = hdr_font(9); c.alignment = center_align(); c.border = thin_border()
ws3.row_dimensions[2].height = 45
ws3.row_dimensions[3].height = 40

# Set column widths
ws3.column_dimensions["A"].width = 9
ws3.column_dimensions["B"].width = 8
ws3.column_dimensions["C"].width = 14
col = 4
for _ in time_points:
    for sub_i in range(4):
        ws3.column_dimensions[get_column_letter(col)].width = 8
        col += 1
for i in range(3):
    ws3.column_dimensions[get_column_letter(col+i)].width = 14

# Data rows
for ri in range(4, 74):
    bg = PALE_BLUE if ri % 2 == 0 else WHITE
    for ci in range(1, 3 + len(time_points)*4 + 4):
        c = ws3.cell(row=ri, column=ci, value="")
        c.fill = fill(bg); c.border = thin_border(); c.alignment = center_align()

ws3.freeze_panes = "D4"


# ════════════════════════════════════════════════════════════════════
# SHEET 4 – INTRAOPERATIVE EVENTS
# ════════════════════════════════════════════════════════════════════
ws4 = wb.create_sheet("INTRAOP EVENTS")
ws4.sheet_view.showGridLines = False

section_header(ws4, 1, 1, 12, "SHEET 4 — INTRAOPERATIVE EVENTS & INTERVENTIONS")
ws4.row_dimensions[1].height = 28

intraop_hdrs = [
    "Study ID", "Group\n(D/F)",
    "Hypotension\n(Y/N)", "Episodes\n(n)", "Vasopressor\nUsed", "Total\nDose (mcg)",
    "Bradycardia\n(Y/N)", "Atropine\n(Y/N)", "Atropine\nDose (mg)",
    "Nausea\n(Y/N)", "Vomiting\n(Y/N)", "Ondansetron\n(Y/N)",
    "Shivering\n(Grade 0-3)", "Pruritus\n(Grade 0-3)",
    "Resp. Dep.\n(SpO2<94%)", "High Block\n(above T2)",
    "Intraop Rescue\nAnalgesia (Y/N)", "Rescue Drug\n& Dose",
    "Convert\nto GA (Y/N)", "Reason for\nConversion", "Remarks"
]
col_w4 = [9,8,11,9,12,10,11,9,11,9,9,12,13,12,12,12,14,15,12,18,20]

set_row(ws4, 2, 1, intraop_hdrs, DARK_BLUE, hdr_font(9), center_align)
ws4.row_dimensions[2].height = 50

for ci, w in enumerate(col_w4, start=1):
    ws4.column_dimensions[get_column_letter(ci)].width = w

for ri in range(3, 73):
    bg = PALE_BLUE if ri % 2 == 0 else WHITE
    for ci in range(1, len(intraop_hdrs)+1):
        c = ws4.cell(row=ri, column=ci, value="")
        c.fill = fill(bg); c.border = thin_border(); c.alignment = center_align()

# Data validation – Y/N dropdowns
dv_yn = DataValidation(type="list", formula1='"Y,N,NA"', allow_blank=True, showDropDown=False)
ws4.add_data_validation(dv_yn)
for col_i in [3,7,8,10,11,12,15,16,17,19]:
    for ri in range(3, 73):
        dv_yn.add(ws4.cell(row=ri, column=col_i))

ws4.freeze_panes = "C3"


# ════════════════════════════════════════════════════════════════════
# SHEET 5 – POSTOP MONITORING
# ════════════════════════════════════════════════════════════════════
ws5 = wb.create_sheet("POSTOP MONITORING")
ws5.sheet_view.showGridLines = False

postop_times = ["PACU\n0h", "30 min", "1h", "2h", "4h", "6h", "12h", "24h"]
postop_subs  = ["NRS\n(0-10)", "Motor\n(Bromage)", "Shiver\n(0-3)", "Pruritus\n(0-3)", "PONV\n(Y/N)", "Sedation\n(Ramsay)"]

section_header(ws5, 1, 1, 2 + len(postop_times)*len(postop_subs) + 4,
               "SHEET 5 — POSTOPERATIVE MONITORING (0 to 24 hours)")
ws5.row_dimensions[1].height = 28

ws5.cell(row=2, column=1, value="Study\nID"); ws5.cell(row=2, column=2, value="Group\n(D/F)")
for ci in [1,2]:
    c = ws5.cell(row=2, column=ci)
    c.fill = fill(DARK_BLUE); c.font = hdr_font(9); c.alignment = center_align(); c.border = thin_border()

col = 3
for tp in postop_times:
    for sub in postop_subs:
        c = ws5.cell(row=2, column=col, value=sub)
        c.fill = fill(MED_BLUE); c.font = hdr_font(8); c.alignment = center_align(); c.border = thin_border()
        col += 1

col = 3
for tp in postop_times:
    ws5.merge_cells(start_row=3, start_column=col, end_row=3, end_column=col+len(postop_subs)-1)
    c = ws5.cell(row=3, column=col, value=tp)
    c.fill = fill(LIGHT_BLUE); c.font = hdr_font(9, color=DARK_BLUE); c.alignment = center_align(); c.border = thin_border()
    col += len(postop_subs)

# Extra summary columns
extra_cols = ["Time to 1st\nRescue (min)", "Total Rescue\nAnalgesic (mg)", "Patient\nSatisfied (Y/N)", "Remarks"]
for i, ex in enumerate(extra_cols):
    c = ws5.cell(row=2, column=col+i, value=ex)
    c.fill = fill(DARK_BLUE); c.font = hdr_font(9); c.alignment = center_align(); c.border = thin_border()
ws5.row_dimensions[2].height = 45; ws5.row_dimensions[3].height = 40

ws5.column_dimensions["A"].width = 9; ws5.column_dimensions["B"].width = 8
col = 3
for _ in postop_times:
    for _ in postop_subs:
        ws5.column_dimensions[get_column_letter(col)].width = 8; col += 1
for i, w in enumerate([14,15,13,18]):
    ws5.column_dimensions[get_column_letter(col+i)].width = w

for ri in range(4, 74):
    bg = PALE_BLUE if ri % 2 == 0 else WHITE
    for ci in range(1, 2 + len(postop_times)*len(postop_subs) + 5):
        c = ws5.cell(row=ri, column=ci, value="")
        c.fill = fill(bg); c.border = thin_border(); c.alignment = center_align()

ws5.freeze_panes = "C4"


# ════════════════════════════════════════════════════════════════════
# SHEET 6 – OUTCOMES SUMMARY
# ════════════════════════════════════════════════════════════════════
ws6 = wb.create_sheet("OUTCOMES SUMMARY")
ws6.sheet_view.showGridLines = False

section_header(ws6, 1, 1, 20, "SHEET 6 — OUTCOMES SUMMARY (Per Patient — For Statistical Analysis)")
ws6.row_dimensions[1].height = 28

outcome_hdrs = [
    "Study ID", "Group\n(D/F)",
    "Onset to\nT10 (min)", "Time to\nT4 (min)",
    "Max Sensory\nLevel", "Motor Block\nDuration (min)",
    "Time to\n2-derm Regress (min)", "Duration of\nEffective Analgesia (min)",
    "Time to 1st\nRescue Analgesic (min)", "NRS at\nRescue",
    "Total Rescue\nDrug 24h (mg)",
    "Hypotension\n(Y/N)", "Bradycardia\n(Y/N)",
    "Pruritus\n(Max Grade)", "Shivering\n(Max Grade)",
    "PONV\n(Y/N)", "Sedation\n(Max Ramsay)",
    "APGAR\n1 min", "APGAR\n5 min", "Remarks"
]
col_w6 = [9,8,10,10,12,14,16,16,16,10,14,11,11,12,12,10,14,10,10,18]

set_row(ws6, 2, 1, outcome_hdrs, DARK_BLUE, hdr_font(9), center_align)
ws6.row_dimensions[2].height = 55

for ci, w in enumerate(col_w6, start=1):
    ws6.column_dimensions[get_column_letter(ci)].width = w

for ri in range(3, 73):
    bg = PALE_BLUE if ri % 2 == 0 else WHITE
    for ci in range(1, len(outcome_hdrs)+1):
        c = ws6.cell(row=ri, column=ci, value="")
        c.fill = fill(bg); c.border = thin_border(); c.alignment = center_align()

# Summary rows at bottom
for ri in range(73, 77):
    labels = {73: "GROUP D — Mean/Median", 74: "GROUP D — SD/IQR",
              75: "GROUP F — Mean/Median", 76: "GROUP F — SD/IQR"}
    ws6.merge_cells(start_row=ri, start_column=1, end_row=ri, end_column=2)
    c = ws6.cell(row=ri, column=1, value=labels[ri])
    c.fill = fill(YELLOW_FILL if ri < 75 else GREEN_FILL)
    c.font = Font(name="Calibri", size=10, bold=True)
    c.alignment = center_align()
    for ci in range(3, len(outcome_hdrs)+1):
        cc = ws6.cell(row=ri, column=ci, value="")
        cc.fill = fill(YELLOW_FILL if ri < 75 else GREEN_FILL)
        cc.border = thin_border()

ws6.freeze_panes = "C3"


# ════════════════════════════════════════════════════════════════════
# SHEET 7 – NEONATAL OUTCOMES
# ════════════════════════════════════════════════════════════════════
ws7 = wb.create_sheet("NEONATAL OUTCOMES")
ws7.sheet_view.showGridLines = False

section_header(ws7, 1, 1, 12, "SHEET 7 — NEONATAL OUTCOMES")
ws7.row_dimensions[1].height = 28

neo_hdrs = [
    "Study ID", "Group\n(D/F)",
    "Baby\nWeight (kg)", "APGAR\n1 min (0-10)", "APGAR\n5 min (0-10)",
    "Umbilical\nArtery pH", "Need for\nNICU (Y/N)", "NICU\nReason",
    "Neonatal\nResuscitation (Y/N)", "Details if\nResuscitation Done",
    "Paediatrician\nSign", "Remarks"
]
col_w7 = [9,8,12,14,14,13,12,20,16,22,14,18]

set_row(ws7, 2, 1, neo_hdrs, DARK_BLUE, hdr_font(9), center_align)
ws7.row_dimensions[2].height = 45

for ci, w in enumerate(col_w7, start=1):
    ws7.column_dimensions[get_column_letter(ci)].width = w

for ri in range(3, 73):
    bg = PALE_BLUE if ri % 2 == 0 else WHITE
    for ci in range(1, len(neo_hdrs)+1):
        c = ws7.cell(row=ri, column=ci, value="")
        c.fill = fill(bg); c.border = thin_border(); c.alignment = center_align()

ws7.freeze_panes = "C3"


# ════════════════════════════════════════════════════════════════════
# SHEET 8 – NIPPING TEST QUICK REFERENCE
# ════════════════════════════════════════════════════════════════════
ws8 = wb.create_sheet("NIPPING TEST REFERENCE")
ws8.sheet_view.showGridLines = False
ws8.column_dimensions["A"].width = 5
ws8.column_dimensions["B"].width = 16
ws8.column_dimensions["C"].width = 32
ws8.column_dimensions["D"].width = 30
ws8.column_dimensions["E"].width = 30

section_header(ws8, 1, 2, 5, "NIPPING / PINCHING TEST — QUICK REFERENCE CARD")
ws8.row_dimensions[1].height = 28

# Dermatomal table
derm_hdrs = ["Level", "Anatomical Landmark", "Clinical Meaning"]
set_row(ws8, 2, 2, derm_hdrs, DARK_BLUE, hdr_font(10), center_align)
ws8.row_dimensions[2].height = 25

derm_rows = [
    ("T4",  "Nipple line (4th ICS)",      "★ MINIMUM REQUIRED for LSCS — check before incision"),
    ("T5",  "Just below nipple",           "Adequate level with safety margin"),
    ("T6",  "Xiphoid process",             "Good level for uterine manipulation"),
    ("T8",  "Costal margin",               "Lower uterine incision adequate"),
    ("T10", "Umbilicus",                   "Adequate for skin incision; NOT enough for whole LSCS"),
    ("T12", "Inguinal ligament",           "Lower abdominal sensation"),
    ("L1",  "Groin",                       "Groin/inguinal region"),
    ("L2",  "Mid anterior thigh",          "Thigh sensation present"),
    ("L3",  "Knee",                        "Knee sensation present"),
    ("S1",  "Lateral foot / little toe",   "Last level to recover — marks end of block"),
]
for ri, (level, landmark, meaning) in enumerate(derm_rows, start=3):
    bg = RED_FILL if level == "T4" else (PALE_BLUE if ri % 2 == 0 else WHITE)
    bold = level == "T4"
    for ci, val in enumerate([level, landmark, meaning], start=2):
        c = ws8.cell(row=ri, column=ci, value=val)
        c.fill = fill(bg)
        c.font = Font(name="Calibri", size=10, bold=bold)
        c.alignment = left_align()
        c.border = thin_border()
    ws8.row_dimensions[ri].height = 18

# Bromage scale on same sheet
ws8.cell(row=14, column=2, value="BROMAGE SCALE — MOTOR BLOCK")
ws8.cell(row=14, column=2).font = Font(name="Calibri", size=11, bold=True, color=DARK_BLUE)
ws8.merge_cells("B14:E14")

brom_hdrs = ["Grade", "Description", "Motor Block Status"]
set_row(ws8, 15, 2, brom_hdrs, DARK_BLUE, hdr_font(10), center_align)
bromage_rows = [
    ("0", "Full movement — raises leg, flexes knee and foot", "NO motor block"),
    ("1", "Cannot raise extended leg; can flex knee", "Partial motor block"),
    ("2", "Cannot flex knee; can move ankle/foot only", "Almost complete motor block"),
    ("3", "Complete paralysis of leg and foot", "COMPLETE motor block"),
]
for ri, row in enumerate(bromage_rows, start=16):
    bg = PALE_BLUE if ri % 2 == 0 else WHITE
    for ci, val in enumerate(row, start=2):
        c = ws8.cell(row=ri, column=ci, value=val)
        c.fill = fill(bg); c.font = cell_font(10); c.alignment = left_align(); c.border = thin_border()
    ws8.row_dimensions[ri].height = 20

# Scoring scales
ws8.cell(row=21, column=2, value="QUICK SCORING SCALES").font = Font(name="Calibri", size=11, bold=True, color=DARK_BLUE)
ws8.merge_cells("B21:E21")

scales = [
    ("NRS/VAS Pain:",    "0 = No pain | 1-3 = Mild | 4-6 = Moderate | 7-10 = Severe"),
    ("Shivering:",       "0=None | 1=Mild/not visible | 2=Moderate (muscle groups) | 3=Severe (whole body)"),
    ("Pruritus:",        "0=None | 1=Mild | 2=Moderate | 3=Severe/unbearable"),
    ("Ramsay Sedation:", "1=Anxious | 2=Calm/cooperative | 3=Follows commands | 4=Brisk response | 5=Sluggish | 6=No response"),
    ("APGAR:",           "0-3=Severe depression | 4-6=Moderate | 7-10=Normal"),
]
for ri, (label, desc) in enumerate(scales, start=22):
    bg = PALE_BLUE if ri % 2 == 0 else WHITE
    c = ws8.cell(row=ri, column=2, value=label)
    c.fill = fill(bg); c.font = Font(name="Calibri", size=10, bold=True); c.alignment = left_align(); c.border = thin_border()
    ws8.merge_cells(start_row=ri, start_column=3, end_row=ri, end_column=5)
    cc = ws8.cell(row=ri, column=3, value=desc)
    cc.fill = fill(bg); cc.font = cell_font(10); cc.alignment = left_align(); cc.border = thin_border()
    ws8.row_dimensions[ri].height = 20


# ════════════════════════════════════════════════════════════════════
# Set tab colours
# ════════════════════════════════════════════════════════════════════
tab_colors = {
    "INSTRUCTIONS":         "1F4E79",
    "PATIENT MASTER":       "2E75B6",
    "BLOCK ASSESSMENT":     "00B050",
    "INTRAOP EVENTS":       "FF0000",
    "POSTOP MONITORING":    "FFC000",
    "OUTCOMES SUMMARY":     "7030A0",
    "NEONATAL OUTCOMES":    "00B0F0",
    "NIPPING TEST REFERENCE":"ED7D31",
}
for ws in wb.worksheets:
    if ws.title in tab_colors:
        ws.sheet_properties.tabColor = tab_colors[ws.title]

# Save
out = "/tmp/workspace/dexmed-lscs-study/Dexmed_vs_Fentanyl_DataCollection_Checklist.xlsx"
wb.save(out)
print(f"Saved: {out}")