Collaborator: Dr Katherine JohnsIf you don't need to put it in your body, don't put it in your body.These cases are patients who I, or my colleagues have seen. They are de-identified and many instances have been presented in more depth in an academic setting. These videos are not individual medical advice and are for general educational purposes only. I do not give medical advice over the internet.References:A family cluster of nitrite poisoning, Suzhou City, 2013. Western Pac Surveill Response J. 2013 Jul 30;4(3):33-6. https://pmc.ncbi.nlm.nih.gov/articles/PMC3854094/Human safety controversies surrounding nitrate and nitrite in the diet. https://pubmed.ncbi.nlm.nih.gov/22487433/A mitochondrial superoxide theory for oxidative stress diseases and aging. https://pmc.ncbi.nlm.nih.gov/articles/PMC4306659/Proposed mechanism of nitrite-induced methemoglobinemia. https://pubmed.ncbi.nlm.nih.gov/15892615/Methylene Blue. https://www.ncbi.nlm.nih.gov/books/NBK557593/Methemoglobinemia. https://www.ncbi.nlm.nih.gov/books/NBK537317/Methylene Blue in Goldfrank's ToxicologyPriapism. https://www.ncbi.nlm.nih.gov/books/NBK459178/Methylene blue as a means of treatment for priapism caused by intracavernous injection to combat erectile dysfunction. https://pubmed.ncbi.nlm.nih.gov/15198160/Pharmacologically-induced Recreational Priapism: Case Report and Review. https://pmc.ncbi.nlm.nih.gov/articles/PMC7676772/PharmGKB summary very important pharmacogene information for G6PD. https://journals.lww.com/jpharmacogenetics/citation/2012/03000/pharmgkb_summary__very_important_pharmacogene.8.aspxThe Methylene Blue Baby. N Engl J Med 1989;320:1756-1757. Methylene blue as an antidote for poisoning. J Lab Clin Med. 1933;19:166–71.Methylene blue for distributive shock: a potential new use of an old antidote. J Med Toxicol. 2013;9:242–9.A review of methylene blue treatment for cardiovascular collapse. J Emerg Med. 2014;46:670–9.The role of monoamine oxidase inhibitors in depression treatment guidelines. https://pubmed.ncbi.nlm.nih.gov/22951237/FDA to Revoke Authorization for the Use of Red No. 3 in Food and Ingested Drugs. https://www.fda.gov/food/hfp-constituent-updates/fda-revoke-authorization-use-red-no-3-food-and-ingested-drugsMethylene Blue in the Treatment of Poisonings Associated with Methemoglobinemia. https://www.nejm.org/doi/abs/10.1056/NEJM193306012082205Lawmakers Press Amazon on Sales of Chemical. https://www.nytimes.com/2022/02/04/technology/amazon-suicide-poison-preservative.html

Original Report: https://www.nejm.org/doi/abs/10.1056/NEJMc2500231

References:Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins. https://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/Establishment of the Nichols strain as the type strain of Treponema pallidum. https://pmc.ncbi.nlm.nih.gov/articles/PMC11868658/In vitro assay to demonstrate high-level erythromycin resistance of a clinical isolate of Treponema pallidum.. https://pmc.ncbi.nlm.nih.gov/articles/PMC172128/Phylogenetic and genetic characterization of Treponema pallidum strains from syphilis patients in Japan by whole-genome sequence analysis from global perspectives. https://pmc.ncbi.nlm.nih.gov/articles/PMC7862685/ Global phylogeny of Treponema pallidum lineages reveals recent expansion and spread of contemporary syphilis. https://pmc.ncbi.nlm.nih.gov/articles/PMC8612932/Near-Universal Resistance to Macrolides of Treponema pallidum in North America. https://www.nejm.org/doi/full/10.1056/NEJMc2314441

Chubbyemu video: https://open.spotify.com/episode/5BXEnVu8h0UWvlfmkwy3Xv?si=1XFT34Q9Q06okvMB2UgNKg

Selected References:

Intravenous mushroom poisoning. https://pubmed.ncbi.nlm.nih.gov/4025991/

The inhibition of mitochondrial cytochrome oxidase by the gases carbon monoxide, nitric oxide, hydrogen cyanide and hydrogen sulfide: chemical mechanism and physiological significance. https://pubmed.ncbi.nlm.nih.gov/18839291/

Clinical toxicology of cyanide. https://pubmed.ncbi.nlm.nih.gov/3526995/

Probing the oxygen binding site of cytochrome c oxidase by cyanide. https://pubmed.ncbi.nlm.nih.gov/7929065/

Colchicine Gout Approval 2009 https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=022351

Chubbyemu is on Spotify now!

Chubbyemu Licorice Video: https://open.spotify.com/episode/77z8mZGbmBI4E2JtA8GXsh?si=k_qV_IkrQiqTGpn8EXK61Q

References:

A bradykinin-potentiating factor (bpf) present in the venom of bothrops jararaca. https://pmc.ncbi.nlm.nih.gov/articles/PMC1704050/

UpToDate, Choice of drug therapy in primary (essential) hypertension.

Primary Hyperaldosteronism. https://www.ncbi.nlm.nih.gov/books/NBK539779/

NEJM Case 24-1992.

Dr Pavlos Msaouel: https://faculty.mdanderson.org/profiles/pavlos_msaouel.html 0:00 Pretext and context MD Anderson Cancer Center 1:42 The Early Experiences That Shaped Dr Msaouel 3:39 The System of Cancer Research In the United States 5:25 FDA Drug Approvals and Special Designations For Oncology 11:09 A trade-off in our current system 12:35 Whoops 😞 I misspoke 14:35 Randomized trials are not supposed to be representative of a population 18:10 Inference for the treatment of Katie Coleman (metastatic oncocytoma) 25:12 It is much more valuable to refute hypotheses than to confirm them 28:05 All Models Are Wrong, But Some Are Useful 30:05 Recasting the Bias-Variance Trade-off as the Patient Relevance-Robustness Trade-off 33:38 High Relevance, Low Robustness: Subjective Bayes 34:46 High Robustness, Low Relevance: Pure Randomization 41:47 Signal To Noise Ratio 45:49 The Big Data Paradox 53:41 How the Big Data Paradox fits in with Katie Coleman's case 54:33 How the Big Data Paradox fits in with other branches of medicine 57:54 How do we rectify subjectivity in The Truth? 01:00:43 How do we address the problems introduced by the Big Data Paradox? 01:04:21 Duality in nature and a Twitter argument re: the Evidence-Based Deep Medicine Iceberg 01:07:03 Why the ideas coming from MD Anderson are coming from MD Anderson 01:09:39 Where you can find Dr Msaouel Dr Msaouel: https://twitter.com/PavlosMsaouel Heme Review: https://twitter.com/HemeReview

Produced by ⁠ @chubbyemu ⁠ Production Assistant: Nick Brown Secret channel:  @BigEmus  Cancer Patient Speaks With Her Oncologist ► https://youtu.be/Nddft_nc3Yc A Woman Had A Headache Lasting 3 Days (Katie's case) ► https://www.youtu.be/i9fLEvgZzRE References: Stephen Senn. Statistical Issues in Drug Development. Why representativeness should be avoided. https://academic.oup.com/ije/article/42/4/1012/656034 Commentary: Representativeness is usually not necessary and often should be avoided. https://academic.oup.com/ije/article/42/4/1018/658638 Impervious to Randomness: Confounding and Selection Biases in Randomized Clinical Trials. https://www.tandfonline.com/doi/full/10.1080/07357907.2021.1974030 A Causal Framework for Making Individualized Treatment Decisions in Oncology. https://www.mdpi.com/2072-6694/14/16/3923 Causal Diagram Techniques for Urologic Oncology Research. https://www.sciencedirect.com/science/article/pii/S1558767320301932 Causal inference and the data-fusion problem. https://www.pnas.org/doi/10.1073/pnas.1510507113 Causal Inference: What If. Miguel A Hernán and James M. Robins. https://www.hsph.harvard.edu/miguel-hernan/wp-content/uploads/sites/1268/2023/04/hernanrobins_WhatIf_31mar23.pdf There is Individualized Treatment. Why Not Individualized Inference? https://arxiv.org/abs/1510.08539 Unrepresentative big surveys significantly overestimated US vaccine uptake. https://www.nature.com/articles/s41586-021-04198-4 Unrepresentative Big Surveys Significantly Overestimate US Uptake https://arxiv.org/pdf/2106.05818.pdf Statistical Modeling: The Three Cultures. https://hdsr.mitpress.mit.edu/pub/uo4hjcx6/release/1 How “centaur AI” will radically reshape the future of healthcare. https://bigthink.com/health/how-centaur-ai-will-radically-reshape-the-future-of-healthcare/

Mug is here 😳 ► https://crowdmade.com/collections/chubbyemu

 @chubbyemu  energy drink video ► https://youtu.be/tAtaIZD0Ebs

A Student Ate Only Chips And Fries For 10 Years ► https://youtu.be/VINtwoyaF_8

A Mom Ate 5 Day Old Sushi 🍣 ► https://youtu.be/R0d6Dpx2li4

Vitamin B12 deficiency can cause neurologic problems. It's stored in the liver and isn't made in humans. It needs to be sourced via diet.

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Daddy Longlegs by Vengolis

Loxosceles gaucho by Halies

Some images by Getty Images

References:

CMS Malaque, RS Vetter, M Entres. Loxosceles spiders. Critical Care toxicology. https://link.springer.com/referenceworkentry/10.1007/978-3-319-17900-1_119

Myth: Idiopathic wounds are often due to brown recluse or other spider bites throughout the United States https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071166/

Correspondance: Bites of the Brown Recluse Spider. https://www.nejm.org/doi/full/10.1056/nejm200505123521922

Spider Bites: Part 1. https://lacerationrepair.com/wound-blog/spider-bites/

Brown Recluse Pest Management Tips for The Spider That's Not As Common As You Think. https://entomologytoday.org/2018/01/29/brown-recluse-pest-management-tips-for-the-spider-thats-not-as-common-as-you-think/brown-recluse-range-map/

The Chilean Recluse. https://www.fdacs.gov/content/download/68159/file/Pest_Alert_-_Loxosceles_laeta,_The_Chilean_Recluse.pdf

Brown recluse spider (Loxosceles reclusa) envenomation leading to acute hemolytic anemia in six adolescents. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902007/

Acute kidney injury and dermonecrosis after Loxosceles reclusa envenomation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119339/

Bites of Brown Recluse Spiders and Suspected Necrotic Arachnidism. https://www.nejm.org/doi/full/10.1056/NEJMra041184

Caffeine Dry Scoop: https://youtu.be/sylqJ0NEVJw

Happened while filming this video: https://youtu.be/LKNfFm0QDXQ

Music by Lifeformed: https://lifeformed.bandcamp.com

References:

The Signaling Pathways Involved in the Anticonvulsive Effects of the Adenosine A1 Receptor. https://www.mdpi.com/1422-0067/22/1/320

Caffeine Withdrawal. https://www.ncbi.nlm.nih.gov/books/NBK430790/

A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. https://pubmed.ncbi.nlm.nih.gov/15448977/

Caffeine (1, 3, 7-trimethylxanthine) in foods: a comprehensive review on consumption, functionality, safety, and regulatory matters. https://pubmed.ncbi.nlm.nih.gov/20492310/

Coffee, CYP1A2 genotype, and risk of myocardial infarction. https://pubmed.ncbi.nlm.nih.gov/16522833/

In 2015, a boy rubbed an entire tube of minty pain relief cream in-between his legs, and it caused his organs to shut down. Majority of modern men I believe are familiar with this action-- you may have accidentally applied it to the area yourself, or to the eyes, where it will hurt for a time that feels like an eternity.

Chubbyemu video: https://open.spotify.com/episode/2ul5F6qQn8KoHlqfFFsXDz?si=u72E79cMSGaaSQIlaDEWEw

Boy Drinking his mom's essential oils: https://open.spotify.com/episode/4dmWDzHXAElQbsRuxN9roQ?si=LOXnN_FpTleDu83whkkJDQ

References:

Salicylate Toxicity from Exposure to a Methylsalicylate-Containing Rubefacient. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786239/

Regional variation in percutaneous penetration of 14C cortisol in man. https://www.jidonline.org/article/S0022-202X(15)47268-9/pdf

Anatomy and physiology of chronic s pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503924/

Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. https://pubmed.ncbi.nlm.nih.gov/10634967/

ISPAD Clinical Practice Consensus Guidelines 2018: DKA and the hyperglycemic hyperosmolar state. https://pubmed.ncbi.nlm.nih.gov/29900641/

Guidance Document: Management Priorities in Salicylate Toxicity.  https://www.acmt.net/_Library/Position_Drafts/Management_Priorities_in_Salicylate_Toxicity_APPROVED_03_13_13.pdf

Tox and Hound – Unconscious Uncoupling – Managing pH in Salicylate Overdoses. https://toxandhound.com/toxhound/phinasa/

Salicylates. Goldfrank, Lewis R, and Neal Flomenbaum. Goldfrank's Toxicologic Emergencies. New York: McGraw-Hill, 2006.

Unconscious Uncoupling – Managing pH in Salicylate. Tox and Hound. https://toxandhound.com/toxhound/phinasa/

Counterproductive effects of sodium bicarbonate in DKA. https://pubmed.ncbi.nlm.nih.gov/8550770/

Peptic ulcer disease and non-steroidal anti-inflammatory drugs https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478398

Role of the mitochondrial permeability transition in salicylate toxicity to cultured rat hepatocytes: implications for the pathogenesis of Reye’s syndrome. Toxicol Appl Pharmacol. 1997;147:431–41. https://pubmed.ncbi.nlm.nih.gov/9439738/

Aspirin, acetaminophen and proton transport through phospholipid bilayers and mitochondrial membranes. https://pubmed.ncbi.nlm.nih.gov/1334228/

Fasting can be an effective tool for weight loss. However if used inappropriately, can result in some not good situations. The patient's situation in this case isn't quite like the intermittent fasting schedules that are popular today.

Chubbyemu video: https://open.spotify.com/episode/7zeoihTgEj0pEWIkRvDKIt?si=8YBaRCtkT1m6j9aJZeen2A

Music by Lifeformed

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References:

Mechanism of hypokalemia in magnesium deficiency. Huang CL, Kuo E. J Am Soc Nephrol. 2007;18:2649–2652. https://pubmed.ncbi.nlm.nih.gov/17804670/

Hypophosphatemia and Rhabdomyolysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC371889/

A Case of Hemodynamically Unstable Sick Sinus Syndrome Secondary to Refeeding Syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8148626

Review of the Refeeding Syndrome. January 2006 Nutrition in Clinical Practice 20(6):625-33. 

EMCrit Refeeding Syndrome https://emcrit.org/ibcc/refeeding/

Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008 Jun 28; 336(7659): 1495–1498. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440847/

Video version of this podcast: https://youtu.be/bq1kwlGhPyE

Original Chubbyemu video: https://youtu.be/5ujTYLV2Qo4

Tweet me: https://twitter.com/hemereview

IG me: https://instagram.com/hemereview

Music by Lifeformed

References:

Fulminant Liver Failure in Association with the Emetic Toxin of Bacillus cereus. https://www.nejm.org/doi/full/10.1056/NEJM199704173361604

Sudden Death of a Young Adult Associated with Bacillus cereus Food Poisoning. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232990/

Acute Liver Failure after Ingestion of Fried Rice Balls: A Case Series of Bacillus cereus Food Poisonings. https://doi.org/10.3390/toxins14010012

Fatal Family Outbreak of Bacillus cereus-Associated Food Poisoning. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1233987/

Bacillus cereus and its food poisoning toxins. https://pubmed.ncbi.nlm.nih.gov/9435100/

Liver Zonation – Revisiting Old Questions With New Technologies. https://www.frontiersin.org/articles/10.3389/fphys.2021.732929/full

Bacillus cereus food poisoning. https://www.nejm.org/doi/full/10.1056/NEJM197801192980306

Tox and Hound: D and Toxin-Induced Hepatic Microvesicular Steatosis https://toxandhound.com/toxhound/ff-microvesicular-steatosis/

ENCEPHALOPATHY AND FATTY DEGENERATION OF THE VISCERA. A DISEASE ENTITY IN CHILDHOOD. https://pubmed.ncbi.nlm.nih.gov/14055046/

Whatever happened to Reye’s syndrome? Did it ever really exist? https://pubmed.ncbi.nlm.nih.gov/10470768/

Regulation of the structure and activity of pyruvate carboxylase by acetyl CoA. https://pubmed.ncbi.nlm.nih.gov/22120519/

Prevalence of Alcoholic Fatty Liver Disease Among Adults in the United States, 2001-2016. https://pubmed.ncbi.nlm.nih.gov/31063562/

Goldfrank's Toxicologic Emergencies 11th ed.