Thrombectomy for acute ischaemic stroke has undergone great advances in the last decade, but the expertise and technology is restricted to tertiary hospitals. Outside of large metropolitan centres, thrombolytic treatment can buy a patient time, but for almost 30 years the first line agent has remained unchanged. 

Alteplase is an analog of the human tissue plasminogen activator which activates plasmin to dissolve fibrin blood clots. For many years it was assumed that alteplase should be administered within 3 hours of symptom onset, thus it was a big deal when in 2008, research showed that that window could be safely broadened out to four and a half hours.

Today’s guests have over the intervening years been pushing the envelope even further, in an effort to help the more than two thirds of stroke patients who present after that threshold. In this podcast, Professors Bruce Campbell and Mark Parsons discuss a trial of the relatively novel agent, tenecteplase. The publication in the New England Journal of Medicine showed that tenecteplase could improve patient outcomes even if administered up to 24 hours out from a large vessel occlusion. The researchers explain the steps that led up to their study, and the importance of perfusion imaging to identify candidates with salvageable brain tissue. 

Key Reference
Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy [NEJM. 2024]

Guests
Dr Duncan Austin PhD FRACP MRCP (Cabrini Health)
Professor Bruce Campbell PhD FRACP (Cabrini Health; Royal Melbourne Hospital; University of Melbourne)
Professor Mark Parsons PhD FRACP, FAAHMS (Sydney Neurointerventional Specialists; Consulting in Neurology, Maitland). 

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Things to Sort Out’ by Walt Adams and ‘the Appalachian Trail’ by Hunter Quinn. Image produced and copyrighted by RACP.

Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, Courtney Dowd, Saion Chaterjee and David Arroyo.  

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

This podcast follows the case of a 48-year-old male with a 3-month history of diarrhoea and associated lymphadenopathy. A complex constellation of symptoms accompanies this presenting complaint, along with a key radiological finding that enabled the treating team to arrive at the correct diagnosis. Can you arrive at the correct diagnosis before the treating team? This case was managed at the Queen Elizabeth Hospital and is presented by Dr Andrew Vanlint from the Northern Adelaide Local Health Network and University of Adelaide.

Credits
Dr Andrew Vanlint FRACP AFRACMA (Northern Adelaide Local Health Network and University of Adelaide
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
 
Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physician David Arroyo.

Key Reference (Spoiler Alert)
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Lessons from practice: Low attenuation lymphadenopathy on computed tomography leading to diagnosis of Whipple disease [Vanlint; Med J Aust. 2020] 

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

This recording comes from the launch of the 2nd Monitoring and Evaluation Report on Hepatitis C Elimination in NSW. The work was conducted through the Kirby Institute under the guidance of infectious diseases specialist, Professor Greg Dore. As presented in this seminar, data show that the state is on track to meet the 2025 target set by NSW Health, and the national target for 2030, but there have been surprises along the way that have required an adaptable approach to surveillance and intervention. 

This is particularly true in correctional settings which typically have high rates of hep C transmission due to the amount of injecting drug use that takes place coupled with an absence of needle exchange programs. Presenting on this theme was Colette McGrath, who is General Manager of Population and Preventative Health for Justice Health NSW. Her very pragmatic approach is informed by almost a decade of experience working with this population. 
 

Key Reference
Hepatitis C Elimination in NSW: Monitoring and Evaluation Report, 2024 [Kirby Institute]
Video Recording from launch event

Guests
Prof Greg Dore FRACP (Kirby Institute, Viral Hepatitis Clinical Research Program Head; St Vincent’s Hospital).
Colette McGrath (Population and Preventative Health, General Manager, Justice Health NSW)

Production
Recorded by Kirby Institute staff. Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Southern Sun’ and ‘Quiet Waters’ by Walt Adams, ‘Train Ride’ by Alex Kehm and ‘The Appalachian Trail’ by Hunter Quinn. Image produced and copyrighted by RACP.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app. 

Dr Karan Singh loves his job as a registrar in nuclear medicine but he thinks there isn’t enough exposure to the specialty during medical school and basic training. In this podcast we spend a day in his department at Prince of Wales Hospital Sydney and get a taste of the many different referrals that come his way; a bone scan for a young man experiencing leg spasms after recovering from a car crash; myocardial perfusion imaging for an elderly gentleman with coronary artery disease; staging for prostate and breast cancer; and radiation therapy for a toxic multinodular goiter. The “reality audio” format gives a good sense of the daily tasks and responsibilities involved in this career pathway.

Credits

Dr Karan Singh
Staff and patients at Prince of Wales Nuclear Medicine and PET Department

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Salty Sails’ and ‘Nuna’ by Sindrandi, ‘Between Four Eyes’ by Czar Donic, ‘Organic Textures 2’ by Johannes Bornlöf and ‘Punjabi Swag’ by Aks and Lakshmi. Image by JohnnyGreig licenced through Getty Images. 

Editorial feedback kindly provided by RACP physicians Jamie Bellinge, Joseph Lee, Sern Wei Yeoh, Zac Fuller and Stephen Bacchi.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. 

The LACE index is a prognostic algorithm for predicting the likelihood that a newly discharged patient will come back into hospital within 30 days because of complications. Today’s IMJ paper describes a validation of the LACE index in a regional Victorian setting. Identifying patients who are at risk could allow for better targeted care at the first admission, reducing harm to patients and inefficient use of healthcare resources. 
 
The researchers also tested a novel classification tool for scoring which readmissions are avoidable and which are just an unfortunate outcome of the patient’s illness. This could help more accurately track quality of care within and between healthcare service providers.

Guests
Prof Christian Gericke PhD FRACP FAFPHM AFRACMA FRCP Edin FEAN FAAN (Calvary Mater, Newcastle; University of Newcastle; University of Queensland)
Dr Reinhardt Dreyer (South West Medicine ; University of Stellenbosch)
Dr James Gome FRACP (South West Medicine, Clinical Director General Medicine)

Production
Produced by Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Treetops’ by Autohacker and ‘The Cold Shoulder’ by Kylie Dailey. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by RACP physicians Aidan Tan, Joseph Lee, David Arroyo and Stephen Bacchi.

Key Reference
Causes for 30-day readmissions and accuracy of the LACE index in regional Victoria, Australia [IMJ. 2024]

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

This podcast follows the case of a 58 year old man who presented to the haematology department at Flinders Medical Centre with intravascular coagulation and leukocytosis. He was diagnosed with acute myeloid leukaemia and treated on standard cytarabine and daunorubicin combination therapy. Nine days after initiation, the patient developed painless diplopia and ptosis, and the story is picked up with a referral to the neurology department. 

Guests
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
Dr James Triplett FRACP (Flinders Medical Centre, consultant neurologist)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Brandon Stretton.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.

Key Reference and Learning Points (Spoiler Alert)
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Painless progressive mononeuritis multiplex secondary to AML associated neuroleukemiosis [J Neuroimmunol. 2023]
 
(1) Chemotherapy can have neurological complications, including chemotherapy induced peripheral neuropathy (e.g., oxaliplatin).

(2) A third (oculomotor) cranial nerve palsy has multiple possible causes, which can be divided into painful vs painless causes, and compressive (classically with pupillary involvement) vs non-compressive (can spare pupil, as with microvascular insult) causes.

(3) Conduction block is shown by a significant reduction in compound muscle action potential, between proximal and distal stimulation, the criteria for which varies by nerve.

(4) Ascertaining whether conduction block occurs at compressible vs non-compressible sites can be a useful distinguishing feature for the various possible causes e.g. including compression, demyelination, and ischaemia, and 

(5) Mononeuritis multiplex, while classically associated with a vasculitic neuropathy, has a number of causes, including leukaemia. This is the very rare condition known as neuroleukemiosis.

The RACP Congress in May this year was opened by a fascinating lecture on mental health in the medical workforce, which has been trimmed down for audio. Professor Neil Greenberg is an occupational psychiatrist with more than 23 years in the UK Armed Forces. His extensive research within defence and health settings has informed a very pragmatic understanding of the impact of trauma and relationships in the workplace. Professor Greenberg overturns some entrenched beliefs we have about the presentation and management of mental illness, as does guest host Dr David Beaumont from the College Member Health and Wellbeing Committee. He reflects on the role of the Committee and how his own understanding of health has shifted in response to personal distress.

Guests
Professor Neil Greenberg FRCPsych, FHEA, MFMLM, MInstLM, MEWI, MFFLM (Kings College, London; March on Stress)
Dr David Beaumont FAFOEM (Positive Medicine, Director; RACP Member Health and Wellbeing Committee)

Production
Produced by Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Blacklight’ by John B. Lund and ‘Lukas Got Lucky’ by Rate 44. Image by Richard Drury licenced through Getty Images.

Editorial feedback kindly provided by RACP physicians David Arroyo, Stephen Bacchi, Nele Legge, Ronaldo Piovezan, Rachel Murdoch, Aidan Tan and Rachel Bowden.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Counselling Support
College EAP
Member service provided by TELUS Health
Australia: 1300 361 008
Aotearoa-NZ: 0800 155 318 (Aotearoa New Zealand).
See also the TELUS wellbeing app.

Doctor’s Health Advisory Service Helpline
Aotearoa-NZ:  800 471 2654
NSW/ACT: 02 9437 6552
VIC:      03 9280 8712
TAS:     03 9280 8712
SA:       08 8366 0250
NT:       08 8366 0250
QLD:    07 3833 4352
WA:     08 9321 3098
 
Lifeline
Australia: 13 11 14.
Aotearoa-NZ: 0800 54 33 54

From 2024, supervising has been recognised as a Category 2 CPD activity. This short and insightful episode focuses on recent updates to the 2024 MyCPD Framework, highlighting the recognition of supervisory activities as a critical element of Category 2 Reviewing Performance CPD. 

Please join Professor Martin Veysey, a renowned expert in supervision and medical education, and Associate Professor Kudzai Kanhutu, College Dean, as they delve into the practicalities and strategic benefits of integrating supervision into your CPD activities. This podcast offers guidance on planning and recording supervising activities, using MyCPD tools to streamline the process efficiently.

Guests
Associate Professor Kudzai Kanhutu FRACP GAICD (College Dean; Royal Melbourne Hospital; University of Melbourne)
Professor Martin Veysey FRACP, FRCP (Gastro Healthcare; Australian National University) 

Production
CPD OnDemand project production by Rebecca Lewis and David Tarr. Audio editing by Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Bookies’ by Jones Meadow and ‘Love Thing’ by Paisley Pink. Image created and copyrighted by RACP.

For more podcasts that you can credit to Category 1 CPD , please visit the Pomegranate Health web page. And there are many more educational videos and eLearning resources at RACP Online Learning.  
 
 

This case report has been developed by Trainees, to assist their peers with preparation of long-case presentations. It is not a fully-vetted Education resource but a “passion project” from editors of the Pomegranate Health podcasts.
 
The case is that of a 32-year-old woman presenting with constant and dull abdominal pain that had been sudden in onset. The pain is accompanied by nausea and vomiting but bowel habits were unchanged. The patient has a history of type 1 diabetes and a simultaneous pancreas-kidney transplant two years prior to the presentation. There is no history of rejection of pancreatitis and serum creatinine appears normal.
 
The attending nephrologist walks through the elimination of differential diagnoses typical of any patient and also of particular relevance to a transplant patient.  

Guests
Dr Chiang Sheng Lee FRACP (Lyell McEwin Hospital; University of Adelaide)
Dr Stephen Bacchi (Lyell McEwin Hospital)
Dr Amitjeet Singh (Lyell McEwin Hospital)

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.
 
Editorial feedback kindly provided by RACP physicians Aidan Tan, Brandon Stretton, David Arroyo, Keith Ooi and Fionnuala Fagan. Thanks also to Adelaide medical students Benjamin Cook, Srishti Sharma and Prakriti Sharma.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. 

Key Reference (Spoiler Alert)
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Gadolinium-Induced Acute Graft Pancreatitis in a Simultaneous Pancreas-Kidney Transplant Recipient [Case Rep Nephrol. 2022]

Australia is a big continent and sparsely populated continent. 28 percent of Australians live in areas classified regional, rural or remote and their access to health services is much more limited. It’s estimated that between 2009 and 2011 there were 19,000 excess deaths in regional and remote areas as compared to the major cities. No doubt, socioeconomic disadvantage is factor in that mortality gap, but inequitable access to healthcare is also a major driver. 

In this podcast we focus specifically on the shortage in health practitioners in the regions. Even in regional centres, the density of physicians by population count is two thirds what it is in the major cities. By the time you get to large rural towns it’s just over a third that baseline. In this podcast we discuss opportunities to lift recruitment and retention. This means improving the experience for trainees and the esteem for rural medicine in the eyes of the profession at large.

Guests
​Adjunct Professor Graeme Maguire PhD FRACP MHM MPHTM (President Adult Medicine Division, RACP and Director of Medical Education, WA Country Health Service)
Dr Sarah Straw FRACP (WACHS Kimberley Regional Physician Team; Northern Hospital, Melb; Rural, Regional and Remote Working Group, RACP)
​Associate Professor Matthew McGrail PhD (Head Regional Training Hub Research, University of Queensland)

Production
Produced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes ‘The Envelope’, ‘Cast in Wicker’ and ‘Planting Flags’ by Blue Dot Sessions. Music licenced from Epidemic Sound includes ‘The Mission’ by J. F. Gloss. Photo by Pearshop on behalf of RACP. 

Editorial feedback kindly provided by RACP physicians Steve Flecknoe-Brown, Zac Fuller, Aidan Tan, Sasha Taylor, Jia Wen Chong, Joseph Lee, Fionnuala Fagan, Stephen Bacchi, Chris Leung, David Arroyo, Nele Legge, Li-Zsa Tan and Thazin Thazin.

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Pomegranate [Case Report] is a Q&A style podcast developed by trainees, for trainees. In our debut episode, we hear about w a who man presented to the emergency department reporting sudden onset vision loss in his right eye lasting several hours. He was 68 year old with a history of type 2 diabetes mellitus. Three differential diagnoses being considered were optic neuropathy, vitreoretinal disease, or corneal oedema following from potential uveitis. In this podcast consultant ophthalmologist, Dr Sumu Simon, walks through an approach to this presentation and an exploratory therapy.

Guests
Dr Sumu Simon FRANZCO (Queen Elizabeth Hospital; Royal Adelaide Hospital)
Dr Brandon Stretton (Royal Adelaide Hospital)
Dr Stephen Bacchi (Lyell McEwin Hospital)

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Fionnuala Fagan. 

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. 

Learning points and Key Reference (spoiler alert)
 1.      This case underscores the critical nature of timely diagnosis and aggressive treatment in conditions like giant cell arteritis (GCA), where delayed treatment can lead to irreversible complications such as vision loss. Thorough history taking and clinical acumen are still key elements in establishing a diagnosis of GCA.
2.      The patient's initial response and subsequent decline in vision illustrate the need for ongoing monitoring and readiness to adapt the treatment approach. It also shows the necessity of close monitoring of inflammatory markers and clinical symptoms.
3.      Amaurosis fugax warrants urgent referral to an ophthalmologist.
4.      High index of suspicion for GCA and prompt referral of GCA suspects will ensure best outcome for patients.
5.      Progressive visual loss and elevated inflammatory markers should alert the clinician to glucocorticoid-resistant GCA.
6.      The effectiveness of tocilizumab in this case highlights its role as a valuable treatment option for refractory GCA, especially when traditional therapies are not sufficiently effective. Targeted biologic agents may open up new treatment approaches in the future particularly in patients with progressive visual loss despite administration of intravenous methylprednisolone.
7.      Managing complex cases like GCA often requires a collaborative approach involving rheumatologists, ophthalmologists, and other specialists to ensure comprehensive care and optimal outcomes.
8.      There is often value in case reports to start the evidence cascade that is required to bring new, life altering treatments to the forefront. 


The Role of Tocilizumab in Glucocorticoid Resistant Giant Cell Arteritis: A Case Series and Literature Review [J Neuroophthalmol. 2023;43(1)]