Pediatric emergency

[drd64640-glitch]

"""
generate_pdf.py
Creates a PDF file "Pediatric_Disease_Notes.pdf" from the pediatric content.
Requires: pip install fpdf2
"""

from fpdf import FPDF

class PediatricPDF(FPDF):
def header(self):
# No automatic header, manual titles handled in body
pass

def footer(self):
    # Page number
    self.set_y(-15)
    self.set_font("DejaVu", "I", 8)
    self.cell(0, 10, f"Page {self.page_no()}", align="C")

def add_section_title(self, title: str):
    self.set_font("DejaVu", "B", 14)
    self.set_text_color(0, 51, 102)  # dark blue
    self.multi_cell(0, 8, title)
    self.ln(2)

def add_body_text(self, text: str):
    self.set_font("DejaVu", "", 11)
    self.set_text_color(0, 0, 0)
    self.multi_cell(0, 6, text)
    self.ln(1)

def add_bullet_list(self, items: list):
    self.set_font("DejaVu", "", 11)
    for item in items:
        self.cell(5)  # indent
        self.cell(5, 6, "•")
        self.multi_cell(0, 6, item)
    self.ln(1)

def add_definition(self, term: str, definition: str):
    self.set_font("DejaVu", "B", 11)
    self.cell(0, 6, f"{term}: ", new_x="LMARGIN", new_y="NEXT")
    self.set_font("DejaVu", "", 11)
    self.multi_cell(0, 6, definition)
    self.ln(1)

def create_pdf():
pdf = PediatricPDF()
pdf.add_page()
pdf.set_auto_page_break(auto=True, margin=20)
# Add Unicode font (DejaVu) – fpdf2 includes it
pdf.add_font("DejaVu", "", "DejaVuSans.ttf", uni=True)
pdf.add_font("DejaVu", "B", "DejaVuSans-Bold.ttf", uni=True)
pdf.add_font("DejaVu", "I", "DejaVuSans-Oblique.ttf", uni=True)

# Title page
pdf.set_font("DejaVu", "B", 22)
pdf.set_text_color(0, 51, 102)
pdf.cell(0, 15, "Pediatric Disease – Comprehensive Notes", align="C", new_x="LMARGIN", new_y="NEXT")
pdf.ln(10)
pdf.set_font("DejaVu", "I", 12)
pdf.set_text_color(80, 80, 80)
pdf.cell(0, 8, "Exam-oriented quick-reference guide", align="C", new_x="LMARGIN", new_y="NEXT")
pdf.ln(20)

# ===================== CONTENT =====================
sections = [
    ("Functional Constipation",
     "- Difficulty/delay in passing stools for ≥2 weeks, no organic cause.\n"
     "- Rome IV: ≤2 defecations/week, stool retention, painful hard stools, large fecal mass; post-toilet-training incontinence may be present.\n"
     "- Management: Disimpaction (oral PEG/enemas), maintenance osmotic laxatives (lactulose, PEG), dietary fiber, hydration, behavioral toilet sits after meals."),

    ("Methods to Perform Inspection of the Abdominal Cavity",
     "- Position child supine, expose from xiphoid to pubis, good lighting.\n"
     "- Look for symmetry, contour (scaphoid/distended), visible peristalsis (obstruction), masses, hernias (umbilical, inguinal), scars, dilated veins (portal HTN), skin changes (bruises, striae).\n"
     "- Observe thoracoabdominal movement; absent movement suggests peritonitis."),

    ("Instrumental Methods of Diagnosis of GIT",
     "- Imaging: Plain X-ray, contrast studies (barium), ultrasound (appendicitis, intussusception, pyloric stenosis), CT/MRI.\n"
     "- Endoscopy: Upper GI endoscopy, colonoscopy, capsule endoscopy.\n"
     "- Functional: Esophageal/anorectal manometry, pH/impedance (GERD).\n"
     "- Lab: Fecal calprotectin, H. pylori breath test, stool cultures."),

    ("Appendicitis",
     "- Definition: Inflammation of vermiform appendix; most common pediatric surgical emergency.\n"
     "- Symptoms: Periumbilical pain → RLQ, anorexia, nausea, vomiting, low fever.\n"
     "- Signs: McBurney’s point tenderness, guarding, rebound, Rovsing’s, psoas/obturator.\n"
     "- Diagnosis: Alvarado score, ultrasound (non-compressible >6 mm), CT if unclear, WBC/CRP.\n"
     "- Treatment: Appendectomy (laparoscopic/open) + preoperative antibiotics."),

    ("GERD (Gastroesophageal Reflux Disease)",
     "- Definition: Pathologic reflux causing troublesome symptoms/complications.\n"
     "- Manifestation: Infancy (physiological up to 18 months); pathological at any age.\n"
     "- Symptoms: Infants – irritability, regurgitation, feeding refusal, FTT, apnea; Older – heartburn, epigastric pain, dysphagia, chronic cough, dental erosions.\n"
     "- Diagnosis: Clinical, trial of PPI, pH/impedance, endoscopy with biopsies.\n"
     "- Treatment: Thickened feeds, upright positioning, PPIs/H2 blockers; rarely fundoplication."),

    ("Functional Abdominal Pain",
     "- Definition: Recurrent abdominal pain without organic cause; periumbilical, not interfering with nutrition. Rome IV subtypes: functional dyspepsia, IBS, abdominal migraine, FAP-NOS.\n"
     "- Features: Normal growth/exam/labs, pain does not wake from sleep, stress link.\n"
     "- Management: Reassurance, biopsychosocial approach, diet (low FODMAP in IBS), CBT, antispasmodics if needed."),

    ("Diarrhea in Childhood",
     "- Acute: Infectious (viral: rotavirus, norovirus; bacterial: Salmonella, Shigella, Campylobacter, E. coli; parasitic: Giardia). Watery vs bloody. Manage ORS, zinc, continue feeding.\n"
     "- Persistent (>14 days): Post-infectious, parasites, or chronic disorders.\n"
     "- Chronic: Malabsorption (celiac, CF), food allergy, IBD, congenital diarrheas, toddler’s diarrhea.\n"
     "- Diagnosis: Stool pH, reducing substances, fat, culture, calprotectin; serology; endoscopy."),

    ("Crohn’s Disease in Childhood",
     "- Definition: Chronic transmural granulomatous IBD, mouth to anus, skip lesions.\n"
     "- Symptoms: Abdominal pain, diarrhea (often non-bloody), weight loss, growth failure, delayed puberty, perianal disease (fistulas, tags), extraintestinal (arthritis, erythema nodosum, uveitis).\n"
     "- Diagnosis: Elevated CRP/ESR, fecal calprotectin, endoscopy + granulomas, MRE/small bowel follow-through.\n"
     "- Treatment: Exclusive enteral nutrition (induction), steroids, immunomodulators (azathioprine), biologics (anti-TNF), surgery."),

    ("Ulcerative Colitis",
     "- Definition: Chronic mucosal inflammation limited to colon, continuous from rectum.\n"
     "- Symptoms: Bloody diarrhea + mucus, tenesmus, urgency, cramps, weight loss. Extraintestinal: PSC, arthropathy.\n"
     "- Diagnosis: Colonoscopy (crypt distortion, crypt abscesses, mucosal inflammation), negative stool cultures.\n"
     "- Treatment: 5-ASA for mild-moderate, steroids for flares, immunomodulators/biologics (anti-TNF, anti-integrin), colectomy if fulminant."),

    ("Allergy – Definition, Atopy Meaning",
     "- Allergy: Immune-mediated hypersensitivity to harmless allergen (IgE/non-IgE/mixed).\n"
     "- Atopy: Personal/familial tendency to produce IgE against low-dose allergens → atopic dermatitis, allergic rhinitis, asthma, food allergy."),

    ("Etiology of Atopic Dermatitis",
     "- Multifactorial: Filaggrin gene mutations (impaired skin barrier), Th2-skewed immune dysregulation, environmental triggers (allergens, irritants, microbes, stress). Barrier defect → increased water loss and allergen entry."),

    ("Skin Prick Test",
     "- Method: Allergen drops on forearm, lancet prick. Positive (histamine) and negative controls. Read at 15–20 min.\n"
     "- Positive: Wheal ≥3 mm above negative control. Shows IgE sensitization; must correlate with clinical history."),

    ("Types of Allergic Reaction (Gell & Coombs)",
     "- Type I: Immediate IgE-mediated (mast cell degranulation → anaphylaxis, urticaria, allergic rhinitis).\n"
     "- Type II: Cytotoxic IgG/IgM (cell destruction, e.g., hemolytic anemia).\n"
     "- Type III: Immune complex deposition (serum sickness, HSP).\n"
     "- Type IV: Delayed T-cell mediated (contact dermatitis, tuberculin reaction)."),

    ("Allergic Rhinitis",
     "- Definition: IgE-mediated nasal mucosal inflammation; sneezing, rhinorrhea, congestion, itching.\n"
     "- Classification: Intermittent (<4 days/week or <4 weeks) vs persistent; mild vs moderate-severe.\n"
     "- Diagnosis: History, skin prick test/specific IgE.\n"
     "- Treatment: Allergen avoidance, intranasal corticosteroids (1st line), antihistamines, LTRA, immunotherapy."),

    ("Apgar Scale",
     "- Rapid newborn assessment at 1 & 5 min. Score 0–2: Appearance (color), Pulse, Grimace (reflex), Activity (tone), Respiration.\n"
     "- Scores: 7–10 normal, 4–6 moderately depressed, 0–3 severely depressed."),

    ("Neonatal Jaundice",
     "- Definition: Yellow skin/sclera from elevated bilirubin (total >5 mg/dL). May be unconjugated or conjugated.\n"
     "- Causes: Hemolysis, G6PD deficiency, immaturity, sepsis, metabolic disorders, biliary atresia."),

    ("Neonatal Sepsis",
     "- Definition: Systemic infection in first 28 days with positive blood culture (or clinical sepsis) and SIRS signs.\n"
     "- Classification: Early-onset (<72 h, vertical transmission: GBS, E. coli, Listeria); Late-onset (≥72 h, nosocomial/community: CoNS, S. aureus, Gram-negatives).\n"
     "- Symptoms: Temperature instability, lethargy, poor feeding, respiratory distress, apnea, jaundice, shock."),

    ("Transient Conditions of Newborns",
     "- Physiological self-limited: physiological jaundice, erythema toxicum, milia, neonatal acne, breast engorgement, vaginal withdrawal bleeding, transitional stool, initial weight loss (<10%), irregular respiratory rate, caput succedaneum."),

    ("Early Neonatal Sepsis – Definition, Symptoms, Causes, Treatment",
     "- Definition: Sepsis within first 72 hours.\n"
     "- Causes: GBS, E. coli, Listeria; risk factors: prematurity, PROM, maternal chorioamnionitis.\n"
     "- Symptoms: Same as neonatal sepsis.\n"
     "- Treatment: Empiric IV ampicillin + gentamicin/cefotaxime; supportive care (ventilation, fluids, inotropes)."),

    ("Breastfeeding",
     "- Exclusive breastfeeding for first 6 months, early initiation within 1 h, on demand 8–12 feeds/day. Benefits: optimal nutrition, immunoprotection, bonding, reduced SIDS/NEC/infections.\n"
     "- Technique: Proper latch (wide mouth, chin touching breast), effective suckling with pauses.\n"
     "- Contraindications: Galactosemia, maternal HIV (high-resource settings), active untreated TB, certain drugs."),

    ("Physiological Jaundice",
     "- Onset >24 h, peak day 3–5 (term), later in preterm. Unconjugated. Declines by day 7–10.\n"
     "- Mechanism: Immature UGT1A1, high red cell mass, increased enterohepatic circulation.\n"
     "- Usually <15 mg/dL, no treatment needed, no underlying pathology."),

    ("Colostrum, Definition and Features",
     "- First milk (late pregnancy to 2–5 days postpartum).\n"
     "- Features: Thick, yellowish, rich in sIgA, lactoferrin, leukocytes, growth factors. High protein, lower fat/lactose. Laxative effect clears meconium."),

    ("Kramer Scale",
     "- Clinical staging of jaundice by dermal zones (head-to-toe progression): Zone 1 face (~5–6 mg/dL), Zone 2 upper trunk (~8–10), Zone 3 lower trunk/thighs (~10–12), Zone 4 arms/legs (~12–14), Zone 5 palms/soles (≥15). Confirm by TcB/serum bilirubin."),

    ("Methods Diagnosis of Jaundice",
     "- Transcutaneous bilirubinometry (TcB): screening.\n"
     "- Serum total & direct bilirubin: gold standard. Conjugated >20% or >1 mg/dL with total >5 indicates conjugated hyperbilirubinemia.\n"
     "- Workup: Blood group, Coombs, G6PD, Hb/Hct, LFTs, sepsis workup, ultrasound for biliary atresia."),

    ("Bilirubin Metabolism",
     "- Heme → biliverdin → unconjugated bilirubin (bound to albumin) → liver.\n"
     "- Hepatocyte: Uptake → conjugation by UGT1A1 to conjugated bilirubin → bile.\n"
     "- Intestine: gut flora deconjugate to urobilinogen → stercobilin; enterohepatic reabsorption. In newborns, immature UGT1A1 and increased reabsorption cause physiological jaundice."),

    ("Pathological Jaundice",
     "- Onset <24 h, conjugated hyperbilirubinemia, rapid rise (>0.5 mg/dL/h or >5 mg/dL/day), above phototherapy threshold, prolonged (>2 weeks term, >3 weeks preterm), anemia, hepatosplenomegaly, poor feeding, encephalopathy signs."),

    ("Meconium Aspiration Syndrome (MAS)",
     "- Definition: Respiratory distress in neonate with meconium-stained fluid → airway obstruction, chemical pneumonitis, surfactant inactivation, risk PPHN.\n"
     "- Presentation: Post-term/term, meconium staining, barrel chest, rales, severe hypoxemia.\n"
     "- Management: Suction non-vigorous infants at birth, ventilation, surfactant, iNO for PPHN, antibiotics if pneumonia suspected."),

    ("Apnea of Prematurity",
     "- Definition: Cessation of breathing >20 sec, or shorter with bradycardia/cyanosis in <37 weeks, due to immature respiratory control.\n"
     "- Types: Central, obstructive, mixed.\n"
     "- Management: Caffeine citrate (1st line), CPAP, monitor until 34–36 weeks corrected without events."),

    ("Food Allergy, Diagnosis",
     "- Definition: Adverse immune response to food protein (IgE or non-IgE).\n"
     "- Diagnosis: History, food diary, skin prick/specific IgE (for IgE-mediated), elimination diet + oral food challenge (gold standard), sigmoidoscopy for non-IgE forms (proctocolitis)."),

    ("Crigler-Najjar Syndrome",
     "- Type I: Absent UGT1A1 activity; severe unconjugated hyperbilirubinemia, kernicterus risk. Requires lifelong phototherapy, liver transplant.\n"
     "- Type II: Reduced UGT1A1 (<10%); responds to phenobarbital, milder course."),

    ("Atopic Dermatitis (Eczema)",
     "- Diagnosis: Pruritic lesions, infant face/extensor, older child flexural, chronic relapsing, xerosis, personal/family atopy.\n"
     "- Treatment: Emollients (liberal), topical corticosteroids, calcineurin inhibitors, antihistamines, trigger avoidance, wet wraps for severe flares."),

    ("Neonate Care in OPD",
     "- Follow-up: Weight gain, feeding support, jaundice, cord care.\n"
     "- Screening: Metabolic screen, hearing, pulse oximetry (CCHD).\n"
     "- Education: Immunization schedule, safe sleep (supine), car seat, danger signs (lethargy, poor feeding, fever/hypothermia).\n"
     "- Exam: Growth, CVS, musculoskeletal (DDH), reflexes, red reflex."),

    ("Management of Pediatric Asthma",
     "- Diagnosis: Recurrent wheeze, cough, breathlessness, variable airflow obstruction (PEF/FEV1), bronchodilator response.\n"
     "- Stepwise therapy (GINA): Step 1 SABA PRN; Step 2 low-dose ICS; Step 3 low-dose ICS/LABA; Step 4 medium-dose ICS/LABA + LTRA/tiotropium; Step 5 high-dose + biologics (anti-IgE, anti-IL5).\n"
     "- Acute exacerbation: SABA, O₂, systemic steroids, ipratropium if severe.\n"
     "- Education: Inhaler technique, asthma action plan, trigger avoidance."),

    ("Respiratory Distress Syndrome (RDS)",
     "- Definition: Surfactant deficiency in preterm → alveolar collapse, V/Q mismatch, hypoxemia.\n"
     "- Symptoms: Onset within minutes–hours: tachypnea, grunting, nasal flaring, retractions, cyanosis.\n"
     "- Diagnosis: Clinical + CXR (ground-glass, air bronchograms, low volumes).\n"
     "- Treatment: Antenatal corticosteroids, surfactant replacement, CPAP/ventilation, supportive care."),

    ("Liver Function Test (LFT)",
     "- Hepatocellular injury: ALT, AST (elevated in hepatitis).\n"
     "- Cholestasis: ALP, GGT (elevated in biliary obstruction/atresia).\n"
     "- Synthetic function: Albumin, PT/INR.\n"
     "- Excretory function: Conjugated bilirubin.\n"
     "- Pediatric interpretation: hepatitis pattern (transaminase rise) vs cholestatic pattern (conjugated hyperbilirubinemia, high GGT)."),
]

for title, body in sections:
    pdf.add_section_title(title)
    # Split body into lines for proper formatting
    lines = body.split("\n")
    for line in lines:
        if line.startswith("- "):
            pdf.add_bullet_list([line[2:]])
        else:
            pdf.add_body_text(line)

pdf.output("Pediatric_Disease_Notes.pdf")
print("PDF created: Pediatric_Disease_Notes.pdf")

if name == "main":
create_pdf()