#!/usr/bin/env python3
"""
COLCHI-MYO — Colchicine-associated neuromyopathy risk-context stratification.

Transparent clinical skill for estimating concern before or during colchicine
therapy in gout and other inflammatory conditions.

Authors: Dr. Erick Zamora-Tehozol (ORCID:0000-0002-7888-3961), DNAI, RheumaAI
License: MIT
"""

from dataclasses import dataclass, asdict
from typing import Dict, Any, List
import json


@dataclass
class ColchiMyoInput:
    age: int
    indication: str
    current_or_planned_colchicine: bool = True
    daily_dose_mg: float = 0.6
    therapy_duration_days: int = 7
    egfr_below_45: bool = False
    dialysis: bool = False
    hepatic_impairment: bool = False
    concurrent_statin: bool = False
    concurrent_macrolide_or_strong_cyp3a4_pgp_inhibitor: bool = False
    baseline_neuropathy_or_myopathy: bool = False
    frailty_or_low_body_mass: bool = False
    diabetes: bool = False
    proximal_weakness: bool = False
    myalgia: bool = False
    elevated_ck: bool = False
    neuropathic_symptoms_or_areflexia: bool = False
    dark_urine_or_aki: bool = False


def exposure_burden(inp: ColchiMyoInput) -> float:
    score = 0.0
    if inp.current_or_planned_colchicine:
        score += 1.0
    if inp.daily_dose_mg >= 1.2:
        score += 2.2
    elif inp.daily_dose_mg >= 0.9:
        score += 1.4
    elif inp.daily_dose_mg > 0.6:
        score += 0.8
    if inp.therapy_duration_days >= 90:
        score += 1.6
    elif inp.therapy_duration_days >= 30:
        score += 0.9
    elif inp.therapy_duration_days >= 14:
        score += 0.4
    return score


def clearance_vulnerability(inp: ColchiMyoInput) -> float:
    score = 0.0
    if inp.egfr_below_45:
        score += 2.4
    if inp.dialysis:
        score += 2.6
    if inp.hepatic_impairment:
        score += 1.6
    return score


def interaction_host_risk(inp: ColchiMyoInput) -> float:
    score = 0.0
    if inp.concurrent_statin:
        score += 1.4
    if inp.concurrent_macrolide_or_strong_cyp3a4_pgp_inhibitor:
        score += 3.0
    if inp.baseline_neuropathy_or_myopathy:
        score += 1.4
    if inp.frailty_or_low_body_mass:
        score += 1.2
    if inp.diabetes:
        score += 0.6
    if inp.age >= 75:
        score += 1.2
    elif inp.age >= 65:
        score += 0.6
    return score


def toxicity_signal(inp: ColchiMyoInput) -> float:
    score = 0.0
    if inp.proximal_weakness:
        score += 2.2
    if inp.myalgia:
        score += 1.0
    if inp.elevated_ck:
        score += 2.0
    if inp.neuropathic_symptoms_or_areflexia:
        score += 1.8
    if inp.dark_urine_or_aki:
        score += 2.2
    return score


def total_score(inp: ColchiMyoInput) -> float:
    score = (
        exposure_burden(inp)
        + clearance_vulnerability(inp)
        + interaction_host_risk(inp)
        + toxicity_signal(inp)
    )
    if inp.egfr_below_45 and inp.concurrent_macrolide_or_strong_cyp3a4_pgp_inhibitor:
        score += 2.2
    if inp.concurrent_statin and inp.elevated_ck:
        score += 1.4
    if inp.proximal_weakness and inp.elevated_ck:
        score += 1.6
    if inp.dialysis and inp.daily_dose_mg >= 0.9:
        score += 1.8
    if inp.therapy_duration_days <= 14 and not inp.egfr_below_45 and not inp.concurrent_macrolide_or_strong_cyp3a4_pgp_inhibitor:
        score -= 0.8
    return round(max(score, 0.0) * 5.0, 1)


def classify(score: float) -> str:
    if score >= 70:
        return "CONTRAINDICATED / CRITICAL"
    if score >= 40:
        return "VERY HIGH"
    if score >= 20:
        return "HIGH"
    return "LOW"


def recommendations(inp: ColchiMyoInput, score: float) -> List[str]:
    out: List[str] = []
    if score < 20:
        out.append("Risk context is low enough for cautious colchicine use if clinically indicated, with standard renal-dose review and symptom counseling.")
    elif score < 40:
        out.append("High-risk context: verify dose, indication, kidney function, and interacting drugs before continuing or escalating colchicine.")
    elif score < 70:
        out.append("Very high concern: strongly reconsider colchicine exposure, reduce or stop interacting medications when possible, and assess for emerging neuromuscular toxicity.")
    else:
        out.append("Colchicine use is contraindicated or the presentation is clinically critical until drug-induced neuromyopathy/rhabdomyolysis is excluded.")
        out.append("Stop colchicine immediately and arrange urgent clinician-level evaluation with CK, renal function, and medication reconciliation.")

    if inp.concurrent_macrolide_or_strong_cyp3a4_pgp_inhibitor:
        out.append("A strong CYP3A4/P-gp inhibitor markedly increases colchicine exposure and is a classic preventable toxicity trigger.")
    if inp.egfr_below_45 or inp.dialysis:
        out.append("Reduced renal clearance materially raises colchicine toxicity risk even at seemingly conventional doses.")
    return out


def alerts(inp: ColchiMyoInput, score: float) -> List[str]:
    out: List[str] = []
    if inp.concurrent_statin:
        out.append("Concomitant statin therapy can amplify diagnostic uncertainty because both agents may contribute to myotoxicity.")
    if inp.proximal_weakness or inp.neuropathic_symptoms_or_areflexia:
        out.append("Progressive proximal weakness or neuropathic symptoms should trigger active review for colchicine neuromyopathy, not simple watchful waiting.")
    if inp.dark_urine_or_aki:
        out.append("Dark urine or acute kidney injury raises concern for severe muscle injury and requires urgent assessment.")
    if score >= 40:
        out.append("This tool supports transparent triage only; definitive diagnosis requires direct clinical evaluation, laboratory confirmation, and medication review.")
    return out


def run_colchi_myo(inp: ColchiMyoInput) -> Dict[str, Any]:
    score = total_score(inp)
    return {
        "input_summary": asdict(inp),
        "exposure_burden": round(exposure_burden(inp), 2),
        "clearance_vulnerability": round(clearance_vulnerability(inp), 2),
        "interaction_host_risk": round(interaction_host_risk(inp), 2),
        "toxicity_signal": round(toxicity_signal(inp), 2),
        "total_score": score,
        "risk_class": classify(score),
        "recommended_actions": recommendations(inp, score),
        "alerts": alerts(inp, score),
        "limitations": [
            "Evidence-informed heuristic model, not a validated probability calculator for colchicine neuromyopathy.",
            "Weights are derived from case-based and observational clinical literature rather than prospective multivariable calibration.",
            "The tool cannot distinguish all alternative causes of weakness or CK elevation, including statin myopathy, inflammatory myositis, or critical illness.",
            "Drug-interaction burden may be underestimated if medication reconciliation is incomplete.",
            "Use only as a transparent decision-support aid alongside clinician judgment, medication review, and direct examination."
        ]
    }


if __name__ == '__main__':
    demos = [
        (
            'Short-course low-risk gout flare treatment',
            ColchiMyoInput(age=52, indication='Gout flare', daily_dose_mg=0.6, therapy_duration_days=5),
        ),
        (
            'CKD patient on statin with evolving weakness',
            ColchiMyoInput(age=71, indication='Gout prophylaxis', daily_dose_mg=0.9, therapy_duration_days=45, egfr_below_45=True, concurrent_statin=True, proximal_weakness=True, myalgia=True, elevated_ck=True),
        ),
        (
            'Dialysis patient with clarithromycin exposure and severe toxicity signs',
            ColchiMyoInput(age=68, indication='Familial Mediterranean fever', daily_dose_mg=1.2, therapy_duration_days=21, egfr_below_45=True, dialysis=True, concurrent_macrolide_or_strong_cyp3a4_pgp_inhibitor=True, frailty_or_low_body_mass=True, proximal_weakness=True, elevated_ck=True, neuropathic_symptoms_or_areflexia=True, dark_urine_or_aki=True),
        ),
    ]

    print('=' * 78)
    print('COLCHI-MYO — Colchicine Neuromyopathy Risk-Context Stratification')
    print('Authors: Dr. Erick Zamora-Tehozol, DNAI, RheumaAI')
    print('=' * 78)
    for label, demo in demos:
        result = run_colchi_myo(demo)
        print(f'\n--- {label} ---')
        print(json.dumps(result, indent=2))