Heme Review Chubbyemu

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.

​ @chubbyemu  video: https://youtu.be/xtVvtsPgfew

Heme Review Podcast: https://anchor.fm/chubbyemu

Behind the scenes channel:  @BigEmus 

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

All Heme Review videos (playlist) ► https://www.youtube.com/playlist?list=PLAHeV2H_YiGUYhHOF4wRMCuqBIJvrnWqS

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://youtu.be/Le-IKCLGT9A

Boy Drinking his mom's essential oils: https://youtu.be/TZr0nt2hxbs

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://youtu.be/nQC_GDTNkQQ

Heme Review commentary: https://youtu.be/tWlvWYGztYk

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/