#!/usr/bin/env python3
"""
DENOS-HYPOCA — Denosumab-associated hypocalcemia risk-context stratification.

Transparent clinical skill for estimating concern before or during denosumab therapy.

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 DenosHypocaInput:
    age: int
    indication: str
    current_or_planned_denosumab: bool = True
    advanced_ckd_egfr_below_30: bool = False
    dialysis: bool = False
    baseline_corrected_calcium_low_or_low_normal: bool = False
    vitamin_d_deficiency_or_unknown: bool = False
    elevated_pth_or_ckd_mbd: bool = False
    no_recent_calcium_vitamin_d_supplementation: bool = False
    malabsorption_or_bariatric_history: bool = False
    loop_diuretic_use: bool = False
    prior_bisphosphonate_failure_or_high_turnover_bone_state: bool = False
    symptoms_of_hypocalcemia: bool = False
    prolonged_qt_or_seizure_or_tetany: bool = False


def exposure_component(inp: DenosHypocaInput) -> float:
    score = 0.0
    if inp.current_or_planned_denosumab:
        score += 1.2
    if inp.prior_bisphosphonate_failure_or_high_turnover_bone_state:
        score += 0.6
    return score


def renal_mineral_component(inp: DenosHypocaInput) -> float:
    score = 0.0
    if inp.advanced_ckd_egfr_below_30:
        score += 2.4
    if inp.dialysis:
        score += 2.8
    if inp.baseline_corrected_calcium_low_or_low_normal:
        score += 1.8
    if inp.vitamin_d_deficiency_or_unknown:
        score += 1.4
    if inp.elevated_pth_or_ckd_mbd:
        score += 1.4
    if inp.age >= 75:
        score += 0.4
    return score


def cofactor_component(inp: DenosHypocaInput) -> float:
    score = 0.0
    if inp.no_recent_calcium_vitamin_d_supplementation:
        score += 1.2
    if inp.malabsorption_or_bariatric_history:
        score += 1.0
    if inp.loop_diuretic_use:
        score += 0.8
    return score


def danger_signal_component(inp: DenosHypocaInput) -> float:
    score = 0.0
    if inp.symptoms_of_hypocalcemia:
        score += 2.6
    if inp.prolonged_qt_or_seizure_or_tetany:
        score += 3.0
    return score


def total_score(inp: DenosHypocaInput) -> float:
    score = (
        exposure_component(inp)
        + renal_mineral_component(inp)
        + cofactor_component(inp)
        + danger_signal_component(inp)
    )
    if inp.current_or_planned_denosumab and inp.advanced_ckd_egfr_below_30:
        score += 1.8
    if inp.current_or_planned_denosumab and inp.dialysis:
        score += 1.6
    if inp.baseline_corrected_calcium_low_or_low_normal and inp.vitamin_d_deficiency_or_unknown:
        score += 1.4
    if inp.advanced_ckd_egfr_below_30 and inp.elevated_pth_or_ckd_mbd:
        score += 1.2
    if inp.symptoms_of_hypocalcemia and inp.prolonged_qt_or_seizure_or_tetany:
        score += 2.0
    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: DenosHypocaInput, score: float) -> List[str]:
    out: List[str] = []
    if score < 20:
        out.append('Risk context is low enough for denosumab use with routine calcium, vitamin D, and adherence checks if clinically indicated.')
    elif score < 40:
        out.append('High-risk context: verify corrected calcium, 25-OH vitamin D, renal function, and supplementation before denosumab is given.')
    elif score < 70:
        out.append('Very high concern: defer denosumab until calcium and vitamin D abnormalities are corrected and CKD-mineral bone disorder issues are reviewed.')
    else:
        out.append('Denosumab exposure is contraindicated or clinically critical until hypocalcemia is excluded, stabilized, or treated.')
        out.append('Arrange urgent clinician-level evaluation with ECG review, repeat calcium panel, magnesium/phosphate review, and targeted treatment.')

    if inp.advanced_ckd_egfr_below_30 or inp.dialysis:
        out.append('Advanced CKD markedly increases denosumab-related hypocalcemia risk and warrants intensified post-dose monitoring.')
    if inp.no_recent_calcium_vitamin_d_supplementation:
        out.append('Lack of calcium and vitamin D supplementation is a modifiable risk amplifier.')
    if inp.vitamin_d_deficiency_or_unknown:
        out.append('Vitamin D status should be checked and corrected before treatment whenever possible.')
    return out


def alerts(inp: DenosHypocaInput, score: float) -> List[str]:
    out: List[str] = []
    if inp.symptoms_of_hypocalcemia:
        out.append('Paresthesias, cramps, or other hypocalcemic symptoms after denosumab should be treated as true safety signals, not minor side effects.')
    if inp.prolonged_qt_or_seizure_or_tetany:
        out.append('QT prolongation, tetany, or seizure features imply immediate danger from severe hypocalcemia.')
    if inp.dialysis:
        out.append('Dialysis patients may develop profound or prolonged post-denosumab calcium decline.')
    if score >= 40:
        out.append('This tool supports transparent triage only; definitive diagnosis and treatment require direct clinical evaluation and laboratory confirmation.')
    return out


def run_denos_hypoca(inp: DenosHypocaInput) -> Dict[str, Any]:
    score = total_score(inp)
    return {
        'input_summary': asdict(inp),
        'exposure_component': round(exposure_component(inp), 2),
        'renal_mineral_component': round(renal_mineral_component(inp), 2),
        'cofactor_component': round(cofactor_component(inp), 2),
        'danger_signal_component': round(danger_signal_component(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 prospectively calibrated probability calculator for denosumab-associated hypocalcemia.',
            'Weights are derived from mechanism, CKD-focused observational reports, and bedside safety logic rather than regression derivation in a single cohort.',
            'The tool does not replace direct measurement of corrected or ionized calcium, magnesium, phosphate, and vitamin D.',
            'Oncologic denosumab dosing, parathyroid disorders, and evolving CKD-mineral bone disease may change true risk beyond this simplified model.',
            'Use only as a transparent clinical decision-support aid alongside clinician judgment and urgent treatment when severe hypocalcemia is suspected.'
        ]
    }


if __name__ == '__main__':
    demos = [
        (
            'Osteoporosis patient with preserved renal function and supplementation',
            DenosHypocaInput(age=66, indication='Glucocorticoid-induced osteoporosis'),
        ),
        (
            'Advanced CKD patient with low-normal calcium and no supplementation before denosumab',
            DenosHypocaInput(
                age=74,
                indication='Osteoporosis with fracture risk',
                advanced_ckd_egfr_below_30=True,
                baseline_corrected_calcium_low_or_low_normal=True,
                vitamin_d_deficiency_or_unknown=True,
                no_recent_calcium_vitamin_d_supplementation=True,
            ),
        ),
        (
            'Dialysis patient with symptoms and QT concern after denosumab',
            DenosHypocaInput(
                age=71,
                indication='Fracture prevention',
                advanced_ckd_egfr_below_30=True,
                dialysis=True,
                baseline_corrected_calcium_low_or_low_normal=True,
                vitamin_d_deficiency_or_unknown=True,
                elevated_pth_or_ckd_mbd=True,
                no_recent_calcium_vitamin_d_supplementation=True,
                malabsorption_or_bariatric_history=True,
                loop_diuretic_use=True,
                symptoms_of_hypocalcemia=True,
                prolonged_qt_or_seizure_or_tetany=True,
            ),
        ),
    ]

    print('=' * 78)
    print('DENOS-HYPOCA — Denosumab-Associated Hypocalcemia Risk-Context Stratification')
    print('Authors: Dr. Erick Zamora-Tehozol, DNAI, RheumaAI')
    print('=' * 78)
    for label, demo in demos:
        result = run_denos_hypoca(demo)
        print(f'\n--- {label} ---')
        print(json.dumps(result, indent=2))