python3 -c " import pdfplumber with pdfplumber.open('/tmp/workspace/attachments/e1e7d49f-3d80-436b-8e54-bdc0a262ede4/06.07.2026 - 1432 .pdf') as pdf: print(f'Total pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages): text = page.extract_text() print(f'--- PAGE {i+1} ---') print(text) print() "

python3 -c " from pypdf import PdfReader import base64 reader = PdfReader('/tmp/workspace/attachments/e1e7d49f-3d80-436b-8e54-bdc0a262ede4/06.07.2026 - 1432 .pdf') print(f'Pages: {len(reader.pages)}') print(f'Metadata: {reader.metadata}') # Check if there are images for i, page in enumerate(reader.pages): print(f'Page {i+1} resources: {list(page.get(\"/Resources\", {}).keys())}') try: imgs = list(page.images) print(f' Images: {len(imgs)}') except Exception as e: print(f' Image error: {e}') "

python3 -c " from pypdf import PdfReader import os os.makedirs('/tmp/workspace/exam_pages', exist_ok=True) reader = PdfReader('/tmp/workspace/attachments/e1e7d49f-3d80-436b-8e54-bdc0a262ede4/06.07.2026 - 1432 .pdf') for i, page in enumerate(reader.pages): for j, img in enumerate(page.images): ext = img.name.split('.')[-1] if '.' in img.name else 'png' path = f'/tmp/workspace/exam_pages/page_{i+1}_img{j}.{ext}' with open(path, 'wb') as f: f.write(img.data) print(f'Saved: {path} ({len(img.data)} bytes)') "

cd /tmp/workspace/exam_pages && python3 -m http.server 8765 & sleep 2 echo "Server started" curl -s -o /dev/null -w "%{http_code}" http://localhost:8765/page_1_img0.jpg

python3 -c " from PIL import Image import base64, io # Resize page 1 to be smaller and convert to base64 to check content img = Image.open('/tmp/workspace/exam_pages/page_1_img0.jpg') print(f'Size: {img.size}, Mode: {img.mode}') # Save a smaller version img_small = img.resize((800, int(800 * img.size[1] / img.size[0]))) img_small.save('/tmp/workspace/exam_pages/page_1_small.jpg', quality=85) print('Saved small version') "

python3 -c " from PIL import Image for i in range(2, 6): img = Image.open(f'/tmp/workspace/exam_pages/page_{i}_img0.jpg') img_small = img.resize((800, int(800 * img.size[1] / img.size[0]))) img_small.save(f'/tmp/workspace/exam_pages/page_{i}_small.jpg', quality=85) print(f'Page {i} saved') "

mkdir -p /tmp/workspace/exam-notes && ls /tmp/workspace/exam-notes/

cat << 'PYEOF' > /tmp/workspace/exam-notes/make_notes.py from docx import Document from docx.shared import Pt, Inches, RGBColor from docx.enum.text import WD_ALIGN_PARAGRAPH from docx.oxml.ns import qn from docx.oxml import OxmlElement doc = Document() # ---------- Styles ---------- normal = doc.styles["Normal"] normal.font.name = "Arial" normal.font.size = Pt(11) def add_title(doc, text): p = doc.add_heading(text, level=0) p.alignment = WD_ALIGN_PARAGRAPH.CENTER run = p.runs[0] run.font.color.rgb = RGBColor(0x1A, 0x53, 0x76) # dark blue def add_h1(doc, text): p = doc.add_heading(text, level=1) run = p.runs[0] run.font.color.rgb = RGBColor(0x1A, 0x53, 0x76) def add_h2(doc, text): p = doc.add_heading(text, level=2) run = p.runs[0] run.font.color.rgb = RGBColor(0xC0, 0x50, 0x00) # orange def add_h3(doc, text): p = doc.add_heading(text, level=3) def add_bullet(doc, text, bold_part=None): p = doc.add_paragraph(style="List Bullet") if bold_part and bold_part in text: idx = text.index(bold_part) if idx > 0: p.add_run(text[:idx]) r = p.add_run(bold_part) r.bold = True rest = text[idx+len(bold_part):] if rest: p.add_run(rest) else: p.add_run(text) def add_para(doc, text): doc.add_paragraph(text) def add_note(doc, text): p = doc.add_paragraph() run = p.add_run("📝 " + text) run.italic = True run.font.color.rgb = RGBColor(0x50, 0x50, 0x50) def add_table(doc, headers, rows): table = doc.add_table(rows=1+len(rows), cols=len(headers)) table.style = "Table Grid" hdr_cells = table.rows[0].cells for i, h in enumerate(headers): hdr_cells[i].text = h hdr_cells[i].paragraphs[0].runs[0].bold = True hdr_cells[i].paragraphs[0].runs[0].font.color.rgb = RGBColor(0xFF,0xFF,0xFF) tc = hdr_cells[i]._tc tcPr = tc.get_or_add_tcPr() shd = OxmlElement('w:shd') shd.set(qn('w:val'), 'clear') shd.set(qn('w:color'), 'auto') shd.set(qn('w:fill'), '1A5376') tcPr.append(shd) for row_data in rows: row_cells = table.add_row().cells for i, val in enumerate(row_data): row_cells[i].text = str(val) doc.add_paragraph() # ================================================ # COVER # ================================================ add_title(doc, "EXAM NOTES") p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER r = p.add_run("II Semester Nursing | Applied Biochemistry & Applied Nutrition and Dietetics") r.bold = True r.font.size = Pt(12) p2 = doc.add_paragraph() p2.alignment = WD_ALIGN_PARAGRAPH.CENTER p2.add_run("Ticked Topics — Important for Exam").italic = True doc.add_page_break() # ================================================ # PART 1: APPLIED BIOCHEMISTRY # ================================================ add_h1(doc, "PART 1: APPLIED BIOCHEMISTRY") # ----- UNIT I: CARBOHYDRATES ----- add_h2(doc, "UNIT I: Carbohydrates") add_h3(doc, "1. Digestion, Absorption & Metabolism of Carbohydrates") add_bullet(doc, "Digestion begins in the mouth — salivary amylase breaks starch → maltose") add_bullet(doc, "Pancreatic amylase continues in small intestine → dextrins, maltose, isomaltose") add_bullet(doc, "Brush border enzymes (maltase, sucrase, lactase) → monosaccharides (glucose, fructose, galactose)") add_bullet(doc, "Absorbed in small intestine via Na+-dependent active transport (SGLT1) and facilitated diffusion (GLUT2)") add_bullet(doc, "Transported to liver via portal vein") add_para(doc, "") add_bullet(doc, "Glycolysis: Glucose → Pyruvate (cytoplasm, 10 steps, net 2 ATP, 2 NADH)") add_bullet(doc, "Krebs / TCA Cycle: Pyruvate → Acetyl-CoA → CO2 + ATP + NADH + FADH2 (mitochondria)") add_bullet(doc, "Oxidative phosphorylation: NADH/FADH2 → ATP via ETC (36-38 ATP total from 1 glucose)") add_bullet(doc, "Glycogenesis: Glucose → Glycogen (storage in liver & muscle)") add_bullet(doc, "Glycogenolysis: Glycogen → Glucose (fasting/exercise)") add_bullet(doc, "Gluconeogenesis: Non-carbohydrate sources (amino acids, lactate, glycerol) → Glucose") add_bullet(doc, "Pentose phosphate pathway: Produces NADPH and ribose-5-phosphate") add_h3(doc, "Related Disorders") add_bullet(doc, "Galactosemia — deficiency of galactose-1-phosphate uridyl transferase") add_bullet(doc, "Fructosuria — fructose in urine due to fructokinase deficiency") add_bullet(doc, "Lactose intolerance — deficiency of lactase enzyme") add_bullet(doc, "Glycogen storage diseases (e.g., Von Gierke's — G6Pase deficiency)") add_h3(doc, "2. Diabetes Mellitus (DM)") add_bullet(doc, "Definition:", "Definition:") add_para(doc, " Chronic metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.") add_h3(doc, "Type 1 DM (Insulin-Dependent)") add_bullet(doc, "Autoimmune destruction of pancreatic beta cells") add_bullet(doc, "No insulin production → absolute insulin deficiency") add_bullet(doc, "Onset: usually in childhood/young adults (juvenile onset)") add_bullet(doc, "Thin body type; prone to DKA (Diabetic Ketoacidosis)") add_bullet(doc, "Treatment: Insulin injections mandatory") add_h3(doc, "Type 2 DM (Non-Insulin-Dependent)") add_bullet(doc, "Insulin resistance + relative insulin deficiency") add_bullet(doc, "Onset: usually adults, obese patients") add_bullet(doc, "Strong genetic component; associated with obesity") add_bullet(doc, "Treatment: Diet, exercise, oral hypoglycemics, insulin if needed") add_h3(doc, "Symptoms of DM") add_table(doc, ["Symptom", "Explanation"], [ ["Polyuria (excess urine)", "Osmotic diuresis due to glucosuria"], ["Polydipsia (excess thirst)", "Due to dehydration from polyuria"], ["Polyphagia (excess hunger)", "Cells starved despite high blood glucose"], ["Weight loss", "Fat and protein catabolism (esp. Type 1)"], ["Fatigue / weakness", "Cells cannot use glucose for energy"], ["Blurred vision", "Osmotic changes in lens"], ["Frequent infections", "Impaired immune function"], ["Slow wound healing", "Poor circulation and immune response"], ] ) add_h3(doc, "Complications of DM") add_bullet(doc, "Microvascular: Retinopathy, Nephropathy, Neuropathy (3 N's)") add_bullet(doc, "Macrovascular: Coronary artery disease, stroke, peripheral vascular disease") add_bullet(doc, "Acute: DKA (Type 1), HONK/HHNK (Type 2), Hypoglycemia") add_h3(doc, "3. Investigations of Diabetes Mellitus") add_h3(doc, "a. OGTT — Oral Glucose Tolerance Test") add_bullet(doc, "Indication: Suspected DM (fasting glucose borderline); gestational DM screening") add_bullet(doc, "Procedure:") add_bullet(doc, " Fast for 8-14 hours overnight") add_bullet(doc, " Fasting blood sample taken") add_bullet(doc, " Patient drinks 75g glucose in 250-300 mL water") add_bullet(doc, " Blood sample at 2 hours post-glucose load") add_table(doc, ["Result", "Fasting (mg/dL)", "2-Hour (mg/dL)"], [ ["Normal", "< 100", "< 140"], ["Impaired Fasting Glucose (IFG)", "100–125", "—"], ["Impaired Glucose Tolerance (IGT)", "—", "140–199"], ["Diabetes Mellitus", "≥ 126", "≥ 200"], ] ) add_h3(doc, "b. Types of GTT") add_bullet(doc, "Mini GTT: 50g glucose load — used for GDM screening (1-hour value ≥ 140 = abnormal)") add_bullet(doc, "Extended GTT: 3–5 hour test with multiple samples — used for reactive hypoglycemia") add_bullet(doc, "GCT (Glucose Challenge Test): 50g, non-fasting, 1-hour screen for GDM") add_bullet(doc, "IV GTT (Intravenous GTT): For patients with GI malabsorption; glucose given IV") add_h3(doc, "c. HbA1c (Glycated Hemoglobin)") add_bullet(doc, "Definition: Hemoglobin that has glucose irreversibly attached to it") add_bullet(doc, "Reflects average blood glucose over past 2-3 months (lifespan of RBC)") add_bullet(doc, "Normal: < 5.7%") add_bullet(doc, "Pre-diabetes: 5.7–6.4%") add_bullet(doc, "Diabetes: ≥ 6.5%") add_bullet(doc, "Target in treated DM: < 7%") add_note(doc, "HbA1c is NOT affected by recent meals — reflects long-term glucose control.") # ----- UNIT II: LIPIDS ----- add_h2(doc, "UNIT II: Lipids") add_h3(doc, "1. Fatty Acids — Definition & Classification") add_bullet(doc, "Definition: Fatty acids are long chain carboxylic acids (R-COOH) that are components of fats and oils.") add_h3(doc, "Classification") add_table(doc, ["Type", "Features", "Examples"], [ ["Saturated FA", "No double bonds; solid at room temp", "Palmitic acid (C16:0), Stearic acid (C18:0)"], ["Monounsaturated FA (MUFA)", "One double bond", "Oleic acid (C18:1) — olive oil"], ["Polyunsaturated FA (PUFA)", "Two or more double bonds", "Linoleic (C18:2), Linolenic (C18:3)"], ["Trans fatty acids", "Unsaturated FA with trans configuration", "Partially hydrogenated vegetable oils; harmful"], ["Essential FA", "Cannot be synthesized; must come from diet", "Linoleic (ω-6), α-Linolenic (ω-3)"], ] ) add_h3(doc, "2. Ketone Bodies") add_bullet(doc, "Definition: Water-soluble molecules produced in the liver from fatty acid oxidation during starvation or uncontrolled DM") add_bullet(doc, "Types (3):") add_bullet(doc, " 1. Acetoacetate (primary ketone body)") add_bullet(doc, " 2. Beta-hydroxybutyrate (most abundant in blood)") add_bullet(doc, " 3. Acetone (volatile; gives fruity breath in DKA)") add_bullet(doc, "Significance:") add_bullet(doc, " • Brain and heart use ketone bodies as fuel during starvation") add_bullet(doc, " • Excess production → Ketoacidosis (low blood pH)") add_bullet(doc, " • Ketonuria — ketones in urine (detected by Rothera's test)") add_note(doc, "In DKA: High glucose + high ketones + acidosis (pH < 7.3). Fruity breath = acetone.") # ----- UNIT III: PROTEINS ----- add_h2(doc, "UNIT III: Proteins") add_h3(doc, "1. Plasma Proteins — Types, Functions & Normal Values") add_table(doc, ["Protein", "Normal Value", "Functions"], [ ["Total Protein", "6.0–8.0 g/dL", "—"], ["Albumin", "3.5–5.0 g/dL", "Oncotic pressure, transport (bilirubin, Ca2+, drugs), nutrition"], ["Globulins", "2.0–3.5 g/dL", "Immune defense (gamma-globulins = antibodies), transport"], ["Fibrinogen", "200–400 mg/dL", "Coagulation — converted to fibrin"], ["Prothrombin", "Trace", "Coagulation factor II"], ["A/G Ratio", "1.2–2.2:1", "Albumin:Globulin ratio — reversed in liver disease, myeloma"], ["Alpha-1 globulins", "—", "Alpha-1 antitrypsin, HDL (high-density lipoprotein)"], ["Alpha-2 globulins", "—", "Ceruloplasmin (copper), Haptoglobin, Alpha-2 macroglobulin"], ["Beta globulins", "—", "Transferrin (iron transport), LDL, C3 complement"], ["Gamma globulins", "—", "IgG, IgA, IgM, IgE, IgD (antibodies / immunoglobulins)"], ] ) add_h3(doc, "Clinical Significance") add_bullet(doc, "Hypoalbuminemia: Liver disease, nephrotic syndrome, malnutrition → edema") add_bullet(doc, "Hyperproteinemia: Dehydration, multiple myeloma") add_bullet(doc, "Proteinuria: Kidney disease (nephrotic syndrome)") add_h3(doc, "2. Electrophoresis — Principle, Normal & Abnormal Patterns") add_para(doc, "Principle: Serum proteins are separated based on their electrical charge and size when placed in an electric field on a medium (cellulose acetate or agarose gel).") add_bullet(doc, "At pH 8.6 (alkaline buffer), all proteins carry negative charge and migrate toward anode (+)") add_bullet(doc, "Albumin — fastest, smallest, highest charge → migrates furthest") add_bullet(doc, "Globulins — migrate slower based on size/charge") add_h3(doc, "Normal Electrophoretic Pattern (5 bands — anode to cathode)") add_table(doc, ["Band", "Protein", "% of Total"], [ ["Albumin", "Albumin", "55–65%"], ["Alpha-1 (α1)", "Alpha-1 antitrypsin, lipoprotein", "2–4%"], ["Alpha-2 (α2)", "Haptoglobin, ceruloplasmin", "7–13%"], ["Beta (β)", "Transferrin, LDL, complement", "8–14%"], ["Gamma (γ)", "Immunoglobulins (IgG, IgA, IgM)", "10–21%"], ] ) add_h3(doc, "Abnormal Electrophoretic Patterns") add_table(doc, ["Condition", "Pattern Change"], [ ["Liver cirrhosis", "↓ Albumin; beta-gamma bridging (β-γ fusion)"], ["Multiple Myeloma", "Monoclonal spike (M band) in gamma region"], ["Nephrotic syndrome", "↓ Albumin, ↑ Alpha-2 globulin"], ["Chronic infection/inflammation", "↑ Gamma globulins (polyclonal)"], ["Alpha-1 antitrypsin deficiency", "Absent Alpha-1 band"], ] ) # ----- UNIT IV: CLINICAL ENZYMOLOGY ----- add_h2(doc, "UNIT IV: Clinical Enzymology") add_h3(doc, "Liver Disease Enzymes — ALT, AST, ALP, GGT") add_table(doc, ["Enzyme", "Full Name", "Normal Value", "Elevated In"], [ ["ALT", "Alanine Aminotransferase", "7–56 U/L", "Liver disease (most specific for liver)"], ["AST", "Aspartate Aminotransferase", "10–40 U/L", "Liver disease, MI, muscle disease"], ["ALP", "Alkaline Phosphatase", "44–147 U/L", "Cholestasis, bone disease, liver"], ["GGT", "Gamma-Glutamyl Transferase", "9–48 U/L", "Alcohol abuse, cholestasis, drug toxicity"], ] ) add_h3(doc, "Key Points") add_bullet(doc, "ALT is MORE specific for liver damage than AST") add_bullet(doc, "AST:ALT ratio > 2:1 suggests alcoholic liver disease") add_bullet(doc, "ALP + GGT elevated together → cholestatic liver disease (bile duct blockage)") add_bullet(doc, "ALP elevated alone (normal GGT) → bone disease (Paget's, bone metastases)") add_bullet(doc, "GGT is sensitive marker for alcohol consumption and microsomal enzyme induction") add_bullet(doc, "In viral hepatitis: ALT >> AST (ALT rises more)") add_note(doc, "Remember: ALT = Liver specific. AST = Also in heart & muscle. ALP = Liver + Bone. GGT = Alcohol marker.") # ----- UNIT V: ACID BASE MAINTENANCE ----- add_h2(doc, "UNIT V: Acid Base Maintenance") add_h3(doc, "1. Regulation of Blood pH — Blood Buffer, Respiratory & Renal") add_bullet(doc, "Normal blood pH: 7.35–7.45 (slightly alkaline)") add_bullet(doc, "Acidosis: pH < 7.35") add_bullet(doc, "Alkalosis: pH > 7.45") add_h3(doc, "Three Mechanisms of pH Regulation") add_table(doc, ["Mechanism", "How It Works", "Speed"], [ ["Blood Buffers", "Bicarbonate (HCO3-/H2CO3), Phosphate, Protein/Hb buffers — absorb H+ ions immediately", "Immediate (seconds)"], ["Respiratory", "Lungs control CO2 (H2CO3). Fast breathing expels CO2 → raises pH. Slow breathing retains CO2 → lowers pH", "Minutes"], ["Renal", "Kidneys excrete H+ and reabsorb HCO3-. Most powerful but slowest mechanism", "Hours–Days"], ] ) add_h3(doc, "Bicarbonate Buffer System") add_para(doc, "CO2 + H2O ⇌ H2CO3 ⇌ H+ + HCO3-") add_bullet(doc, "Henderson-Hasselbalch equation: pH = 6.1 + log [HCO3-] / [0.03 × PaCO2]") add_bullet(doc, "Normal ratio: HCO3- : H2CO3 = 20:1 → pH 7.4") add_h3(doc, "2. ABG (Arterial Blood Gas) — Normal Values") add_table(doc, ["Parameter", "Normal Value", "What it Measures"], [ ["pH", "7.35–7.45", "Acidity/alkalinity of blood"], ["PaCO2", "35–45 mmHg", "Partial pressure CO2 (respiratory component)"], ["PaO2", "80–100 mmHg", "Partial pressure O2"], ["HCO3-", "22–26 mEq/L", "Bicarbonate (metabolic component)"], ["SaO2", "95–100%", "Oxygen saturation of hemoglobin"], ["Base Excess (BE)", "-2 to +2", "Excess/deficit of base"], ] ) add_h3(doc, "Acid-Base Disorders Summary") add_table(doc, ["Disorder", "pH", "PaCO2", "HCO3-", "Cause"], [ ["Respiratory Acidosis", "↓ < 7.35", "↑ > 45", "Normal/↑ (compensated)", "COPD, respiratory failure, hypoventilation"], ["Respiratory Alkalosis", "↑ > 7.45", "↓ < 35", "Normal/↓ (compensated)", "Hyperventilation, anxiety, high altitude"], ["Metabolic Acidosis", "↓ < 7.35", "Normal/↓ (compensated)", "↓ < 22", "DKA, diarrhea, renal failure, lactic acidosis"], ["Metabolic Alkalosis", "↑ > 7.45", "Normal/↑ (compensated)", "↑ > 26", "Vomiting, diuretics, excess alkali intake"], ] ) # ----- UNIT VI: HEME CATABOLISM ----- add_h2(doc, "UNIT VI: Heme Catabolism") add_h3(doc, "Heme Degradation Pathway") add_para(doc, "Overview: Old/damaged RBCs (lifespan ~120 days) are broken down in the Reticuloendothelial System (RES) — mainly spleen, liver, bone marrow.") add_table(doc, ["Step", "Location", "Process / Product"], [ ["1", "Spleen (RES)", "RBC breakdown → Hemoglobin released"], ["2", "RES (Spleen/Liver)", "Hemoglobin → Heme + Globin. Globin → amino acids (recycled)"], ["3", "RES", "Heme → Biliverdin (green) + CO + Fe2+ by heme oxygenase. Iron recycled"], ["4", "RES", "Biliverdin → Unconjugated Bilirubin (UCB) = Free/Indirect bilirubin. Insoluble in water, bound to albumin"], ["5", "Blood", "UCB transported to liver bound to albumin"], ["6", "Liver (hepatocytes)", "UCB + 2 glucuronic acid (UDPGT enzyme) → Conjugated Bilirubin (CB) = Direct bilirubin. Now water-soluble"], ["7", "Bile", "CB excreted in bile → enters small intestine"], ["8", "Intestine", "CB → Urobilinogen by intestinal bacteria. Most urobilinogen → Stercobilin (brown color of feces)"], ["9", "Enterohepatic circulation", "Small amount urobilinogen reabsorbed → urine as urobilin (yellow color of urine)"], ] ) add_h3(doc, "Jaundice — Types, Causes, Urine & Blood Investigations") add_table(doc, ["Feature", "Prehepatic (Hemolytic)", "Hepatic (Hepatocellular)", "Post-hepatic (Obstructive)"], [ ["Cause", "Excess hemolysis (malaria, sickle cell)", "Liver disease (hepatitis, cirrhosis)", "Bile duct blockage (gallstone, cancer)"], ["UCB (Indirect)", "↑↑ High", "↑ Moderate", "Normal/slight ↑"], ["CB (Direct)", "Normal", "↑ Moderate", "↑↑ High"], ["Urine bilirubin", "Absent (UCB not filtered)", "Present", "Present ↑↑"], ["Urine urobilinogen", "↑↑ High", "↑ Increased", "Absent (no bile reaching gut)"], ["Stool color", "Dark (↑ stercobilin)", "Pale", "Clay/pale (no bile)"], ["Van den Berg test", "Indirect +ve", "Both +ve", "Direct +ve"], ] ) add_h3(doc, "Van den Berg Test") add_bullet(doc, "Tests: Direct reaction (CB) — reacts directly with diazo reagent") add_bullet(doc, "Indirect reaction (UCB) — needs alcohol to react") add_bullet(doc, "Biphasic reaction: Both fractions elevated (hepatic jaundice)") # ----- UNIT VII: ORGAN FUNCTION TESTS ----- add_h2(doc, "UNIT VII: Organ Function Tests (Biochemical Parameters & Normal Values)") add_h3(doc, "Renal Function Tests (RFT)") add_table(doc, ["Test", "Normal Value", "Elevated In"], [ ["Serum Creatinine", "0.6–1.2 mg/dL", "Renal failure, dehydration"], ["Blood Urea Nitrogen (BUN)", "7–20 mg/dL", "Renal failure, high protein intake"], ["Serum Uric Acid", "M: 3.5–7.2; F: 2.6–6.0 mg/dL", "Gout, renal failure, leukemia"], ["Serum Electrolytes", "Na+: 135–145, K+: 3.5–5.0 mEq/L", "Varies with disorder"], ["GFR (Glomerular Filtration Rate)", "90–120 mL/min/1.73m²", "CKD staging by GFR"], ["Creatinine Clearance", "85–135 mL/min (M)", "Reduced in renal impairment"], ["Urine Protein", "< 150 mg/24 hrs", "Nephrotic syndrome, nephritis"], ["Urine Creatinine", "1–2 g/24 hrs", "Reflects muscle mass and renal function"], ] ) add_bullet(doc, "BUN:Creatinine ratio > 20:1 = Pre-renal azotemia (dehydration, reduced renal perfusion)") add_bullet(doc, "BUN:Creatinine ratio 10-20:1 = Intrinsic renal disease") # ----- UNIT VIII: IMMUNOCHEMISTRY ----- add_h2(doc, "UNIT VIII: Immunochemistry") add_h3(doc, "1. Immunoglobulins — Structure & Functions") add_para(doc, "Immunoglobulins (Ig) = Antibodies. Glycoproteins produced by B lymphocytes/plasma cells in response to antigens.") add_h3(doc, "Basic Structure (Y-shaped)") add_bullet(doc, "2 Heavy chains (H) + 2 Light chains (L) — linked by disulfide bonds") add_bullet(doc, "Light chains: Kappa (κ) or Lambda (λ)") add_bullet(doc, "Heavy chains determine the class: IgG=γ, IgA=α, IgM=μ, IgD=δ, IgE=ε") add_bullet(doc, "Fab region (Fragment Antigen Binding): antigen-binding site (variable region)") add_bullet(doc, "Fc region (Fragment Crystallizable): Complement activation, binding to cells") add_table(doc, ["Immunoglobulin", "% in serum", "Features", "Functions"], [ ["IgG", "75–80%", "Most abundant; monomer; crosses placenta", "Secondary immune response; opsonization; complement"], ["IgA", "10–15%", "Dimer in secretions (saliva, breast milk, tears)", "Mucosal immunity; first line defense at mucous membranes"], ["IgM", "5–10%", "Pentamer; largest Ig; first to appear", "Primary immune response; ABO blood group antibodies; complement activation"], ["IgD", "< 1%", "Monomer on B cell surface", "B cell activation and maturation"], ["IgE", "Trace", "Monomer; binds mast cells", "Allergic reactions; defense against parasites"], ] ) add_h3(doc, "2. ELISA — Investigations & Interpretation") add_para(doc, "ELISA = Enzyme-Linked Immunosorbent Assay") add_para(doc, "Principle: An antigen-antibody reaction detected by an enzyme that converts colorless substrate to colored product. Color intensity is proportional to the amount of analyte.") add_h3(doc, "Types of ELISA") add_table(doc, ["Type", "How it Works", "Use"], [ ["Direct ELISA", "Antigen coated on plate → enzyme-labeled antibody → color reaction", "Detect antigen directly"], ["Indirect ELISA", "Antigen on plate → primary antibody → enzyme-labeled secondary antibody → color", "Detect antibody in patient sample (e.g., HIV test)"], ["Sandwich ELISA", "Capture antibody → antigen → detection antibody (enzyme-labeled) → color", "Detect antigen; most sensitive"], ["Competitive ELISA", "Known antigen competes with sample antigen for antibody", "Quantify small molecules/haptens"], ] ) add_h3(doc, "ELISA Procedure (General Steps)") add_bullet(doc, "1. Coat microplate wells with antigen or capture antibody") add_bullet(doc, "2. Block with BSA or casein to prevent non-specific binding") add_bullet(doc, "3. Add patient sample (serum) — incubate") add_bullet(doc, "4. Wash away unbound material") add_bullet(doc, "5. Add enzyme-conjugated antibody — incubate") add_bullet(doc, "6. Wash, then add substrate (TMB or OPD)") add_bullet(doc, "7. Color develops — stop reaction with acid") add_bullet(doc, "8. Read absorbance at 450 nm using spectrophotometer") add_h3(doc, "Interpretation") add_bullet(doc, "Positive result: Absorbance > cut-off value (color developed)") add_bullet(doc, "Negative result: Absorbance < cut-off value (no/minimal color)") add_bullet(doc, "Used for: HIV, Hepatitis B (HBsAg), Dengue NS1, TORCH infections, pregnancy test (beta-hCG), drug levels, allergen-specific IgE") add_note(doc, "ELISA is highly sensitive and specific. Used as screening AND confirmation test depending on format. HIV ELISA: 2 positive ELISAs → confirm by Western Blot.") doc.add_page_break() # ================================================ # PART 2: APPLIED NUTRITION AND DIETETICS # ================================================ add_h1(doc, "PART 2: APPLIED NUTRITION AND DIETETICS") # ----- UNIT V: VITAMINS ----- add_h2(doc, "UNIT V: Vitamins") add_h3(doc, "Classification of Vitamins") add_bullet(doc, "Fat-soluble: A, D, E, K — absorbed with dietary fat; stored in liver and adipose tissue") add_bullet(doc, "Water-soluble: B-complex vitamins + Vitamin C — not stored (excreted in urine); required daily") add_h3(doc, "FAT-SOLUBLE VITAMINS") add_table(doc, ["Vitamin", "RDA (Adults)", "Dietary Sources", "Functions", "Deficiency Disease"], [ ["Vitamin A\n(Retinol)", "700–900 µg RAE", "Liver, egg yolk, milk, butter;\nCarotenes: carrot, sweet potato, spinach, papaya", "Vision (rhodopsin formation)\nEpithelial integrity\nImmune function\nGrowth & reproduction", "Night blindness\nXerophthalmia\nKeratomalacia\nBitot's spots\nIncreased infection risk"], ["Vitamin D\n(Calciferol)", "600–800 IU (15–20 µg)", "Sunlight (skin synthesis — main source)\nFatty fish, egg yolk, fortified milk", "Ca2+ and PO4 absorption from gut\nBone mineralization\nCalcium homeostasis\nImmune function", "Children: Rickets (bowed legs, soft bones)\nAdults: Osteomalacia\nOsteoporosis"], ["Vitamin E\n(Tocopherol)", "15 mg", "Vegetable oils, nuts, seeds, wheat germ, green leafy vegetables", "Antioxidant (protects cell membranes)\nPrevents lipid peroxidation\nImmune function\nAnti-platelet", "Hemolytic anemia in premature infants\nNeuropathy\nMuscle weakness\nRetinopathy"], ["Vitamin K\n(Phylloquinone/Menaquinone)", "90–120 µg", "Green leafy vegetables (spinach, broccoli, cabbage)\nK2 from gut bacteria", "Blood coagulation (factors II, VII, IX, X, protein C, S)\nBone protein synthesis (osteocalcin)", "Prolonged PT/INR\nBleeding tendency\nHemorrhagic disease of newborn"], ] ) add_h3(doc, "WATER-SOLUBLE VITAMINS — B-Complex") add_table(doc, ["Vitamin", "RDA", "Sources", "Functions", "Deficiency"], [ ["B1 — Thiamine", "M: 1.2 mg\nF: 1.1 mg", "Whole grains, pork, legumes, nuts", "Coenzyme in carbohydrate metabolism (pyruvate dehydrogenase)", "Beriberi (Wet: cardiac; Dry: neurological)\nWernicke-Korsakoff (alcoholics)"], ["B2 — Riboflavin", "M: 1.3 mg\nF: 1.1 mg", "Dairy, meat, eggs, green vegetables", "FAD/FMN coenzymes in redox reactions; energy metabolism", "Ariboflavinosis: Cheilosis, angular stomatitis, glossitis, magenta tongue"], ["B3 — Niacin", "M: 16 mg NE\nF: 14 mg NE", "Meat, fish, peanuts, whole grains", "NAD/NADP coenzymes in redox reactions; energy metabolism", "Pellagra: Dermatitis, Diarrhea, Dementia, Death (4 D's)"], ["B5 — Pantothenic Acid", "5 mg (AI)", "Widely distributed; meat, eggs, legumes", "Part of Coenzyme A (CoA) — central to metabolism", "Very rare; burning feet syndrome"], ["B6 — Pyridoxine", "1.3–1.7 mg", "Meat, fish, poultry, potatoes, bananas", "Coenzyme in amino acid metabolism, neurotransmitter synthesis, heme synthesis", "Peripheral neuropathy, microcytic anemia, glossitis"], ["B7 — Biotin", "30 µg (AI)", "Eggs (raw egg white blocks), nuts, liver", "Coenzyme for carboxylation reactions; fatty acid synthesis", "Dermatitis, hair loss, neurological symptoms (rare)"], ["B9 — Folic Acid", "400 µg DFE\n(600 µg pregnant)", "Green leafy veg, legumes, fortified foods, liver", "DNA synthesis and repair; cell division; amino acid metabolism; neural tube formation", "Megaloblastic anemia; Neural tube defects (NTDs) in fetus"], ["B12 — Cobalamin", "2.4 µg", "Animal products only (meat, fish, dairy, eggs)", "DNA synthesis; myelin synthesis; conversion of homocysteine; folate metabolism", "Megaloblastic anemia; Subacute combined degeneration (spinal cord); glossitis"], ] ) add_h3(doc, "Vitamin C — Ascorbic Acid") add_table(doc, ["Aspect", "Details"], [ ["RDA", "M: 90 mg/day; F: 75 mg/day; Smokers: +35 mg"], ["Sources", "Citrus fruits, guava, amla (highest), strawberries, bell peppers, broccoli, tomatoes"], ["Functions", "Collagen synthesis (hydroxylation of proline/lysine)\nAntioxidant\nEnhances iron absorption (reduces Fe3+ to Fe2+)\nImmune function; wound healing\nNeurotransmitter synthesis"], ["Deficiency", "Scurvy: Perifollicular hemorrhage, bleeding gums, corkscrew hair, poor wound healing, subperiosteal hemorrhage"], ] ) # ----- UNIT VI: MINERALS ----- add_h2(doc, "UNIT VI: Minerals — Dietary Sources & RDA") add_h3(doc, "Major Minerals") add_table(doc, ["Mineral", "RDA", "Dietary Sources", "Functions", "Deficiency"], [ ["Calcium", "1000–1200 mg/day", "Milk, dairy, fish (sardines), tofu, fortified foods, green leafy veg", "Bone & teeth formation; muscle contraction; nerve transmission; blood clotting", "Osteoporosis, rickets, tetany, muscle cramps"], ["Phosphorus", "700 mg/day", "Meat, dairy, nuts, whole grains, legumes", "Bone & teeth (hydroxyapatite); ATP & nucleic acid formation; acid-base balance", "Rare; weakness, bone pain"], ["Sodium", "< 2300 mg/day", "Table salt, processed foods, bread, pickles", "Fluid balance; nerve transmission; muscle contraction", "Hyponatremia (lethargy, seizures); excess → hypertension"], ["Potassium", "4700 mg/day (AI)", "Bananas, potatoes, tomatoes, legumes, fish", "Fluid balance; nerve/muscle function; blood pressure regulation", "Hypokalemia: muscle weakness, cardiac arrhythmia"], ["Magnesium", "310–420 mg/day", "Whole grains, nuts, seeds, green leafy vegetables, legumes", "Enzyme cofactor (>300 enzymes); ATP synthesis; bone; muscle/nerve function", "Muscle cramps, arrhythmia, hypomagnesemia"], ] ) add_h3(doc, "Trace Minerals / Micronutrients") add_table(doc, ["Mineral", "RDA", "Sources", "Functions", "Deficiency"], [ ["Iron", "M: 8 mg\nF: 18 mg\nPregnant: 27 mg", "Red meat, liver, legumes, fortified cereals; spinach (non-heme)", "Hemoglobin (heme) synthesis; myoglobin; electron transport chain (cytochromes)", "Iron deficiency anemia: fatigue, pallor, koilonychia, pica"], ["Iodine", "150 µg/day\nPregnant: 220 µg", "Iodized salt, seafood, dairy", "Thyroid hormone (T3, T4) synthesis", "Goiter; Hypothyroidism; Cretinism (in newborns)"], ["Zinc", "M: 11 mg\nF: 8 mg", "Meat, shellfish, legumes, nuts, seeds", "Enzyme cofactor; wound healing; immune function; growth; taste & smell", "Growth retardation; delayed wound healing; hypogeusia; immune deficiency"], ["Fluoride", "M: 4 mg\nF: 3 mg", "Fluoridated water, seafood, tea", "Dental enamel and bone strengthening", "Dental caries; excess → fluorosis"], ["Selenium", "55 µg/day", "Brazil nuts, seafood, meat, grains", "Antioxidant (glutathione peroxidase); thyroid function", "Keshan disease (cardiomyopathy)"], ] ) # ----- UNIT IX: THERAPEUTIC DIETS ----- add_h2(doc, "UNIT IX: Therapeutic Diets") add_h3(doc, "1. Modifications — Consistency & Nutrients") add_h3(doc, "Consistency Modifications") add_table(doc, ["Diet Type", "Description", "Use"], [ ["Regular/Normal Diet", "No restrictions; adequate in all nutrients", "Healthy individuals"], ["Soft Diet", "Soft-textured, easy to chew; low in fiber and residue", "Post-surgery, dental problems, elderly"], ["Semi-solid/Pureed Diet", "Blended foods with sauce/gravy; no chunks", "Dysphagia (swallowing difficulty), stroke"], ["Liquid Diet (Clear)", "Clear fluids only: water, broth, juice, gelatin", "Pre/post surgery, severe GI upset"], ["Liquid Diet (Full)", "All liquids + milk, cream soups, ice cream, custard", "Post oral surgery, jaw wiring, severe dysphagia"], ["Tube Feed/Enteral Feed", "Liquid formula via nasogastric tube", "Unconscious patients, severe dysphagia, coma"], ] ) add_h3(doc, "Nutrient Modifications") add_table(doc, ["Modified Diet", "Change Made", "Indication"], [ ["High Protein Diet", "Protein: 100–150 g/day (1.5–2 g/kg/day)", "Burns, surgery, infection, PEM, dialysis"], ["Low Protein Diet", "Protein: 20–40 g/day", "Renal failure, hepatic encephalopathy"], ["High Calorie Diet", "Energy: 3000–5000 kcal/day", "Underweight, cancer, AIDS, recovery"], ["Low Calorie Diet", "Energy: 800–1200 kcal/day", "Obesity, metabolic syndrome"], ["Low Sodium Diet", "Na < 500–1000 mg/day", "Hypertension, heart failure, edema, renal disease"], ["Low Fat Diet", "Fat < 20–30% of calories", "Gallbladder disease, pancreatitis, hyperlipidemia"], ["High Fiber Diet", "Fiber: 25–38 g/day", "Constipation, IBS, diverticulosis, colon cancer prevention"], ["Low Fiber/Low Residue", "Fiber < 10 g/day", "IBD flare, bowel prep, post GI surgery"], ["Diabetic Diet", "Controlled carbohydrate; low GI foods; consistent meals", "Diabetes Mellitus"], ["Renal Diet", "Low protein, low K+, low PO4, low fluid", "CKD, dialysis patients"], ["Bland Diet", "Low fiber, non-irritating, no spices/acid", "Peptic ulcer, GERD"], ] ) # ----- UNIT X: COOKERY RULES ----- add_h2(doc, "UNIT X: Cookery Rules and Preservation of Nutrients") add_h3(doc, "1. Preservation of Nutrients During Cooking") add_table(doc, ["Nutrient", "Losses During Cooking", "How to Minimize Loss"], [ ["Water-soluble vitamins\n(C, B-complex)", "Leach into cooking water; destroyed by heat/oxidation", "Cook in minimal water; use cooking water in soup; avoid prolonged heat; steam/microwave"], ["Fat-soluble vitamins\n(A, D, E, K)", "Lost with fat; oxidized by air and light", "Avoid prolonged frying; store away from light"], ["Minerals", "Leach into cooking water", "Use cooking water; avoid excessive washing/soaking"], ["Proteins", "Denatured by heat (structure changes)", "Denaturation improves digestibility; avoid charring"], ["Carbohydrates", "Starch gelatinization on heating → more digestible", "Generally beneficial changes"], ] ) add_h3(doc, "Cooking Methods — Best to Worst for Nutrient Retention") add_bullet(doc, "Best: Steaming, microwaving, pressure cooking (short time)") add_bullet(doc, "Moderate: Boiling (if water is used in the meal), stir-frying") add_bullet(doc, "Worst: Deep frying (vitamin loss), prolonged boiling and discarding water, charbroiling") add_h3(doc, "2. Safe Food Handling and Storage of Foods") add_bullet(doc, "FIFO principle: First In First Out — use older stock first") add_bullet(doc, "Temperature control: Danger zone = 5°C–60°C (bacteria grow rapidly)") add_bullet(doc, "Cold storage: Refrigerator: 0–5°C; Freezer: -18°C or below") add_bullet(doc, "Separate raw meat from cooked/ready-to-eat foods (prevent cross-contamination)") add_bullet(doc, "Wash hands before and after handling food; use clean utensils") add_bullet(doc, "Use safe water for drinking and cooking") add_bullet(doc, "Cook food to safe internal temperatures (poultry: 74°C; beef: 71°C)") add_h3(doc, "3. Food Preservation Methods") add_table(doc, ["Method", "Principle", "Examples"], [ ["Refrigeration", "Low temp slows microbial growth", "Vegetables, dairy, meat (short term)"], ["Freezing", "Very low temp stops microbial growth", "Meat, fish, vegetables (long term)"], ["Drying/Dehydration", "Removes water (Aw < 0.6) → no microbial growth", "Sun-dried fruits, legumes, spices"], ["Canning", "Heat sterilization in sealed container", "Canned fruits, vegetables, fish"], ["Salting/Curing", "Salt draws out water, creates hostile environment for bacteria", "Pickles, salted fish, cured meats"], ["Sugar preservation", "High sugar lowers water activity", "Jams, jellies, candied fruits"], ["Fermentation", "Beneficial bacteria produce acid (low pH)", "Yogurt, cheese, idli, kimchi"], ["Pasteurization", "Heat at 72°C/15 sec (HTST) kills pathogens", "Milk, fruit juices"], ["Irradiation", "Gamma rays kill microbes and insects", "Spices, grains, some fruits"], ["Vacuum packing", "Removes oxygen — prevents aerobic microbial growth", "Packaged meats, snacks"], ] ) # ----- UNIT XIII: FOOD SAFETY ----- add_h2(doc, "UNIT XIII: Food Safety") add_h3(doc, "1. Food Safety — Definition & Considerations") add_para(doc, "Food safety: Conditions and practices that preserve the quality of food to prevent contamination and foodborne illness.") add_bullet(doc, "Foodborne illness caused by: bacteria (Salmonella, E. coli, Staphylococcus), viruses (Norovirus, Hepatitis A), parasites, toxins, allergens") add_bullet(doc, "Three types of food hazards:") add_bullet(doc, " 1. Biological: Bacteria, viruses, fungi, parasites") add_bullet(doc, " 2. Chemical: Pesticides, food additives, heavy metals, cleaning agents") add_bullet(doc, " 3. Physical: Glass, metal, stones, hair, plastic fragments") add_h3(doc, "2. Food Safety Regulatory Measures in India — Relevant Acts") add_table(doc, ["Act/Body", "Year", "Key Points"], [ ["Food Safety and Standards Act", "2006", "Consolidated all previous food laws; established FSSAI"], ["FSSAI (Food Safety and Standards Authority of India)", "Established 2008", "Apex regulatory body; sets food standards; licenses FBOs; enforces compliance"], ["Prevention of Food Adulteration Act (PFA)", "1954 (now superseded by FSS Act)", "Prevented adulteration of food; basis for FSSAI"], ["Consumer Protection Act", "2019", "Protects consumer rights including food safety"], ["Agmark", "—", "Grading and marking of agricultural produce (DACS)"], ["BIS (Bureau of Indian Standards)", "—", "ISI mark on processed food products"], ["Codex Alimentarius", "International", "WHO/FAO international food standards body"], ] ) add_note(doc, "FSSAI regulates: Food businesses (restaurants, manufacturers, importers); Sets standards for additives, contaminants, packaging, labeling.") add_h3(doc, "3. Five Keys to Safer Food (WHO)") add_table(doc, ["Key", "Principle", "Practice"], [ ["Key 1", "Keep CLEAN", "Wash hands; clean surfaces; protect from insects/pests"], ["Key 2", "Separate RAW and COOKED", "Use separate boards/utensils; store raw meat below cooked food"], ["Key 3", "Cook THOROUGHLY", "Cook to proper temp (74°C poultry); heat leftovers to boiling"], ["Key 4", "Keep food at SAFE TEMPERATURES", "Don't leave food at room temp > 2 hrs; refrigerate promptly; don't thaw at room temp"], ["Key 5", "Use SAFE WATER and RAW MATERIALS", "Use treated/boiled water; select safe processed foods; wash fruits and vegetables"], ] ) # ---------- Save ---------- out_path = "/tmp/workspace/exam-notes/Exam_Notes_Biochemistry_Nutrition.docx" doc.save(out_path) print(f"Saved: {out_path}") PYEOF python3 /tmp/workspace/exam-notes/make_notes.py