ls /home/daytona/workspace/ 2>/dev/null && ls /home/daytona/skills/docx/scripts/…

mkdir -p /home/daytona/workspace/corrosive-poisoning && node -e "require('docx')…

~/corrosive-poisoning/create_doc.js

const {
  Document, Packer, Paragraph, TextRun, HeadingLevel,
  AlignmentType, BorderStyle, Table, TableRow, TableCell,
  WidthType, UnderlineType
} = require('docx');
const fs = require('fs');

function heading(text, level) {
  return new Paragraph({
    heading: level,
    children: [new TextRun({ text, bold: true })],
    spacing: { before: 240, after: 120 }
  });
}

function para(text, opts = {}) {
  return new Paragraph({
    children: [new TextRun({ text, ...opts })],
    spacing: { before: 60, after: 60 },
    indent: opts.indent ? { left: 360 } : undefined
  });
}

function bullet(text) {
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    spacing: { before: 40, after: 40 }
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}

function subBullet(text) {
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    spacing: { before: 30, after: 30 }
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}

function bold(text) {
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}

function tableRow(label, value) {
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    children: [
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      }),
    ]
  });
}

const doc = new Document({
  sections: [{
    children: [
      // Title
      new Paragraph({
        alignment: AlignmentType.CENTER,
        children: [new TextRun({ text: 'CORROSIVE POISONING IN CHILDREN', bold: true, size: 32, underline: { type: UnderlineType.SINGLE } })],
        spacing: { before: 0, after: 300 }
      }),

      // Definition
      heading('DEFINITION', HeadingLevel.HEADING_1),
      para('Corrosive poisoning refers to ingestion, inhalation, or skin/eye contact with substances that directly destroy or erode body tissues on contact. In children, this almost always occurs accidentally, most commonly in those under 5 years of age due to their natural curiosity and exploratory behavior.'),
      para('The word "corrosive" derives from the Latin corrodere - meaning "to gnaw through flesh." Caustic is a term often used synonymously, though strictly it refers to strong alkalis only.'),

      // Incidence
      heading('INCIDENCE AND EPIDEMIOLOGY', HeadingLevel.HEADING_1),
      bullet('Most common age group: under 5 years (especially 1-3 years of age)'),
      bullet('Boys are affected more commonly than girls'),
      bullet('Accidental ingestion is the overwhelming cause in children'),
      bullet('Alkalis account for the majority of childhood cases (~80%) as they are found in common household products'),
      bullet('Common household sources: drain cleaners, oven cleaners, dishwasher detergents, button batteries, hair relaxers'),

      // Classification
      heading('CLASSIFICATION OF CORROSIVE AGENTS', HeadingLevel.HEADING_1),

      new Paragraph({
        children: [bold('1. Strong Acids (pH < 7):')],
        spacing: { before: 80, after: 40 }
      }),
      new Paragraph({
        children: [new TextRun({ text: '   a. Inorganic (Mineral) acids: Sulphuric acid (H\u2082SO\u2084 - oil of vitriol), Hydrochloric acid (HCl), Nitric acid (HNO\u2083)' })],
        spacing: { before: 30, after: 30 }, indent: { left: 360 }
      }),
      new Paragraph({
        children: [new TextRun({ text: '   b. Organic acids: Carbolic acid (phenol), Oxalic acid, Acetylsalicylic acid, Formic acid, Acetic acid' })],
        spacing: { before: 30, after: 30 }, indent: { left: 360 }
      }),

      new Paragraph({
        children: [bold('2. Strong Alkalis / Bases (pH > 7):')],
        spacing: { before: 80, after: 40 }
      }),
      new Paragraph({
        children: [new TextRun({ text: '   Sodium hydroxide (NaOH / lye / caustic soda), Potassium hydroxide (KOH / caustic potash), Sodium carbonate (washing soda), Potassium carbonate, Ammonia, Ammonium carbonate' })],
        spacing: { before: 30, after: 30 }, indent: { left: 360 }
      }),

      new Paragraph({
        children: [bold('3. Other Corrosives:')],
        spacing: { before: 80, after: 40 }
      }),
      new Paragraph({
        children: [new TextRun({ text: '   Bleach / sodium hypochlorite (mild irritant, pH ~7), Battery fluids, Toilet/pool cleaners, Polyphosphates' })],
        spacing: { before: 30, after: 30 }, indent: { left: 360 }
      }),

      // Mechanism
      heading('PATHOPHYSIOLOGY / MECHANISM OF ACTION', HeadingLevel.HEADING_1),

      new Paragraph({
        children: [bold('A. Acids - Coagulation Necrosis:')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('Acids denature and precipitate tissue proteins, forming a hard eschar (coagulum)'),
      bullet('This coagulum acts as a protective barrier, limiting deeper penetration in the esophagus'),
      bullet('Acids extract water from tissues (dehydration necrosis)'),
      bullet('Convert haemoglobin to haematin'),
      bullet('The esophageal mucosa is relatively resistant to acids; the stomach (especially pyloric region) is more vulnerable'),
      bullet('Acids cause greater gastric injury, with risk of perforation and pyloric stricture'),

      new Paragraph({
        children: [bold('B. Alkalis - Liquefaction Necrosis:')],
        spacing: { before: 80, after: 60 }
      }),
      bullet('More dangerous than acids - cause deep, penetrating liquefaction necrosis'),
      bullet('Alkalis absorb water from tissues, precipitate proteins, and saponify fats (forming "soap")'),
      bullet('Saponification: tissue fats combine with lye to form a viscous liquid mass'),
      bullet('Thrombosis of blood vessels further compromises tissue blood supply'),
      bullet('No protective coagulum forms - penetration is deeper and more destructive'),
      bullet('Alkalis cause more severe esophageal injury; esophagus more commonly involved than stomach'),

      // Signs and Symptoms
      heading('CLINICAL FEATURES / SIGNS AND SYMPTOMS', HeadingLevel.HEADING_1),

      new Paragraph({
        children: [bold('Immediate Symptoms (within minutes to hours):')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('Severe burning pain in the mouth, throat, chest, and abdomen'),
      bullet('Excessive salivation (drooling)'),
      bullet('Dysphagia (difficulty swallowing) and odynophagia (painful swallowing)'),
      bullet('Refusal to eat or drink'),
      bullet('Nausea and vomiting (may be blood-stained - hematemesis)'),
      bullet('Hoarseness, stridor, and cough (laryngeal/epiglottic involvement)'),
      bullet('Respiratory distress - "chemical epiglottitis" if epiglottis is involved'),

      new Paragraph({
        children: [bold('Local Signs:')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('Lips, tongue, oral mucosa: burns, erythema, blistering, white/grey sloughing patches'),
      bullet('Acid burns: hard, dry, charred brown/black eschar'),
      bullet('Alkali burns: soft, oedematous, translucent, red-brownish, no charring'),
      bullet('Note: Absence of oral burns does NOT exclude esophageal injury (seen in ~12% of cases)'),

      new Paragraph({
        children: [bold('Systemic Signs:')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('Tachycardia and shock (from pain, blood loss, perforation)'),
      bullet('Metabolic acidosis (with acid ingestion)'),
      bullet('CNS effects (especially with detergent powders): lethargy, seizures, coma'),
      bullet('Fever (from infection, mediastinitis, peritonitis)'),

      // Grading
      heading('ENDOSCOPIC GRADING OF BURNS (Zargar Classification)', HeadingLevel.HEADING_1),

      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          tableRow('Grade 0', 'Normal mucosa - no injury'),
          tableRow('Grade I', 'Mucosal edema and hyperemia only'),
          tableRow('Grade IIa', 'Superficial, non-circumferential: whitish exudates, erosions, blisters'),
          tableRow('Grade IIb', 'Deep or circumferential Grade II lesions'),
          tableRow('Grade IIIa', 'Scattered areas of transmural necrosis'),
          tableRow('Grade IIIb', 'Extensive transmural necrosis'),
        ]
      }),
      new Paragraph({ spacing: { before: 120 } }),

      // Complications
      heading('COMPLICATIONS', HeadingLevel.HEADING_1),

      new Paragraph({
        children: [bold('Early (days to weeks):')],
        spacing: { before: 60, after: 40 }
      }),
      bullet('Oedema of glottis - may cause fatal airway obstruction'),
      bullet('Perforation of esophagus or stomach - leading to mediastinitis / peritonitis'),
      bullet('Aspiration pneumonia'),
      bullet('Septicemia and septic shock'),

      new Paragraph({
        children: [bold('Late (weeks to months/years):')],
        spacing: { before: 60, after: 40 }
      }),
      bullet('Esophageal stricture (most common late complication - from 3 weeks onwards)'),
      bullet('Pyloric stenosis / stricture'),
      bullet('Malnutrition and cachexia from inability to swallow'),
      bullet('Tracheoesophageal fistula'),
      bullet('Increased risk of esophageal carcinoma (long-term)'),

      // Causes of Death
      heading('CAUSES OF DEATH', HeadingLevel.HEADING_1),
      bullet('Within a few hours: Shock, spasm or oedema of glottis causing asphyxia'),
      bullet('Within 24 hours: Perforation of stomach leading to peritonitis and shock'),
      bullet('Within the first week: Septic absorption / septicemia'),
      bullet('After months to years: Exhaustion and malnutrition from esophageal or pyloric stricture'),

      // Management / Treatment
      heading('MANAGEMENT / TREATMENT', HeadingLevel.HEADING_1),

      new Paragraph({
        children: [bold('A. General / Emergency Measures:')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('DO NOT induce vomiting (risk of re-exposure and perforation)'),
      bullet('DO NOT perform gastric lavage (risk of perforation of already damaged esophagus/stomach)'),
      bullet('Exception: Levin tube may be used cautiously within 30 minutes if absolutely necessary'),
      bullet('Do NOT administer carbonates or bicarbonates (produce CO\u2082 gas causing distension and perforation)'),
      bullet('Secure airway - early intubation or tracheostomy if stridor/oedema of glottis is present'),
      bullet('Oxygen inhalation and assisted ventilation if needed'),
      bullet('IV access - correct shock with IV fluids and blood transfusion if required'),
      bullet('Place patient NPO (nil per os)'),

      new Paragraph({
        children: [bold('B. Neutralization:')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('For ACID ingestion: Dilute with water and alkaline substances (calcium oxide, magnesium oxide, aluminium hydroxide gel)'),
      bullet('Demulcents: Milk, vegetable oil, white of egg, barley water, olive oil'),
      bullet('For ALKALI ingestion: Neutralize with dilute vegetable acids and water; give demulcents'),

      new Paragraph({
        children: [bold('C. Pain Management:')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('Morphine 15 mg IM/IV or Meperidine (pethidine) HCl 50-150 mg orally/IV for severe pain'),
      bullet('IV Calcium gluconate (10 mL of 10% solution) if needed'),

      new Paragraph({
        children: [bold('D. Prevention of Strictures:')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('Corticosteroids: Traditionally used to prevent fibrosis and stricture formation, though recent evidence (meta-analysis of 10 studies, 572 patients) shows no clear benefit for Grade II lesions'),
      bullet('Nasogastric tube / long-term esophageal stenting for 6 weeks to maintain esophageal lumen'),
      bullet('Regular bougienage (esophageal dilation) - though carries perforation risk'),
      bullet('Antibiotics: Indicated for Grade III (transmural) injuries and known perforation to prevent mediastinitis/peritonitis'),

      new Paragraph({
        children: [bold('E. Investigations:')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('Endoscopy within 12-48 hours: Gold standard for assessing injury severity (Zargar grading)'),
      bullet('Flexible endoscopy preferred over rigid - allows inspection of stomach and duodenum'),
      bullet('Chest and abdominal X-ray: Look for free air under diaphragm (perforation)'),
      bullet('Barium/water-soluble contrast esophagram: Assess for strictures (if presenting > 48 hrs)'),

      new Paragraph({
        children: [bold('F. Skin and Eye Burns:')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('Skin burns: Copious water irrigation; sodium bicarbonate paste for acid burns'),
      bullet('Eye burns: Immediate irrigation with water for 10-15 minutes; treat symptomatically'),

      new Paragraph({
        children: [bold('G. Surgical Management:')],
        spacing: { before: 80, after: 40 }
      }),
      bullet('Grade IIIb/extensive injuries: May require esophageal resection and reconstruction'),
      bullet('Perforation: Requires urgent surgical repair (thoracotomy, esophagotomy, or laparotomy)'),
      bullet('Long-term stricture: Esophageal dilation or surgical reconstruction'),

      // Medicolegal
      heading('MEDICOLEGAL ASPECTS', HeadingLevel.HEADING_1),
      bullet('In children, corrosive poisoning is almost always ACCIDENTAL - household products within reach'),
      bullet('Products should be stored in original containers with child-proof caps out of reach of children'),
      bullet('Must be distinguished from: accidental vs. deliberate (homicidal poisoning by others - rare but occurs)'),
      bullet('Child abuse must be considered in unusual or recurrent presentations'),
      bullet('Button battery ingestion is a growing pediatric emergency - causes electrochemical liquefaction necrosis'),

      // Prevention
      heading('PREVENTION', HeadingLevel.HEADING_1),
      bullet('Store all household chemicals in original, labeled, child-proof containers'),
      bullet('Keep chemicals locked and out of reach of children'),
      bullet('Poison Control Centre numbers should be readily available'),
      bullet('Public education and product safety labeling'),
      bullet('Packaging regulations (child-resistant closures for hazardous household products)'),

      // Summary Box
      heading('KEY POINTS FOR EXAM', HeadingLevel.HEADING_1),
      bullet('Most common: Accidental alkali ingestion in children under 5 years'),
      bullet('Alkali = Liquefaction necrosis (deep, penetrating); Acid = Coagulation necrosis (superficial barrier forms)'),
      bullet('Never induce vomiting or give gastric lavage in corrosive poisoning'),
      bullet('Early endoscopy (12-48 hrs) is the gold standard for assessment'),
      bullet('Main late complication = Esophageal stricture'),
      bullet('Death can occur from: glottic oedema, perforation/peritonitis, septicemia, or chronic malnutrition'),
      bullet('Corticosteroids - controversial; no proven benefit for Grade II lesions per meta-analysis'),

      // References
      new Paragraph({ spacing: { before: 300 } }),
      new Paragraph({
        children: [new TextRun({ text: 'Sources:', bold: true, italics: true, size: 18 })],
      }),
      new Paragraph({ children: [new TextRun({ text: 'P.C. Dikshit, Textbook of Forensic Medicine and Toxicology', italics: true, size: 18 })] }),
      new Paragraph({ children: [new TextRun({ text: "Cummings Otolaryngology Head and Neck Surgery, Chapter 211: Caustic Ingestions", italics: true, size: 18 })] }),
      new Paragraph({ children: [new TextRun({ text: "Harrison's Principles of Internal Medicine, 22nd Edition", italics: true, size: 18 })] }),
      new Paragraph({ children: [new TextRun({ text: "Tintinalli's Emergency Medicine", italics: true, size: 18 })] }),
    ]
  }]
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/corrosive-poisoning/Corrosive_Poisoning_in_Children.docx', buffer);
  console.log('Document created successfully');
});

cd /home/daytona/workspace/corrosive-poisoning && node create_doc.js

python /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/worksp…

python3 -c " import zipfile z = zipfile.ZipFile('/home/daytona/workspace/corrosi…