Pomegranate Health

• Ep138: Amyloid busters- the benefit and the burden

  Australia has just approved a second amyloid-targeting therapy for patients with incipient Alzheimer’s dementia. Lecanemab (Leqembi) now joins donanemab (Kisunla) on the Australian Registry of Therapeutic Goods but the impact of both has been modest in Phase III trials to date. After 18 months of therapy they delay progression of disease, as quantified on neurocognitive tests, by around 5 months on average.  For some, the prolonged independence and dignity will justify the $60,000 to $80,000 a year price tag for the drugs. But for the Pharmaceutical Benefits Advisory Committee “the high burden of [donanemab] treatment on both patients and the health system, combined with the risks and modest clinical impact, makes the drug unsuitable for PBS subsidy”. This burden includes specialist consults, gene screening, multiple MRI and PET brain scans, and delivery of monthly or fortnightly infusions, adding up to another $20,000 in costs. Even before considering these logistical requirements, Australian memory clinics don’t have anywhere near the capacity to address the 245,000 new cases of early dementia or mild cognitive impairment every year. Advocates see these disease-modifying therapies as a turning point for dementia research and argue for further investment in the systems infrastructure needed to roll them out. Sceptics argue that the available evidence instead questions the importance of amyloidosis in the Alzheimer’s disease cascade.GuestsProfessor Michael Woodward AM FRACP FANZSGM FAAG FAWMA (Austin Health, Melbourne; University of Melbourne) Dr Chrysanth Pulle FRACP (Prince Charles Hospital, Brisbane)  Chapters 13:16 Time Saved16:18 Costs of treatment 26:44 IMJ paper on resourcing 39:10 Scepticism and stagingProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘RGBA’ and ‘Pulse Voyage’ by Chill Cole, ‘A Forest Melody’ by Tellsonic, ‘Axon Terminal’ by Out to the World, ‘Organic Textures 2’ by Johannes Bornlof and ‘Fugent’ by Lupus Nocte. Image courtesy of Wikimedia Commons and University of Pittsburgh. Editorial feedback kindly provided by physicians of the podcast editorial group Ronaldo Piovezan, Aidan Tan, Hugh Murray, Joseph Lee, Rahul Barmanray, Simeon Wong and Sebastian Lambooy. Thanks also to Profs Bruce Campbell, Mike Parsons and Amy Brodtmann and registrars Jamie Bellinge and Karan Singh for additional insights into research methods. 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.

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• [Case Report] 27yo with left limb weakness and a mediastinal mass

  A 27-year-old male wakes up with weakness in the left arm and leg and gets himself admitted at Royal Adelaide Hospital. Shockingly, for an otherwise well young man with no significant medical history, a right middle cerebral artery acute ischaemic stroke is identified by CT angiogram. His condition deteriorates in hospital, and a mediastinal mass is discovered on review which gives a lead as to the distal cause. This conversation describes the expedient workup and methodical consideration of some rarer causes of ischaemic stroke.Guest Dr Rudy Goh FRACP (Lyell McEwin Hospital, University of Adelaide) HostAssociate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide)ProductionProduced 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.Key Reference (Spoiler Alert)*****Disseminated Aspergillosis with Mediastinal Invasion Causing Fatal Stroke in an Immunocompetent Young Man [Case Rep Neurol. 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.

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• [IMJ On-Air] DKA and insulin infusion protocols

  Diabetic ketoacidosis can be life-threatening but there’s some variability in the way it’s managed between health settings. Intervention involves intravenous insulin administration, hydration, electrolyte replacement and treatment of the underlying precipitant. In a survey of practitioners from 31 different hospitals in Australia there was an even split between those organisations which followed a fixed rate insulin infusion protocol, usually based on bodyweight, or a variable rate infusion protocol, titrated against blood glucose concentration. Three quarters of survey respondents had worked at another hospital that had different DKA management protocols raising concerns about the cognitive load on junior health staff moving between institutions. In Europe there has been some normalisation towards fixed rate protocols, despite there being no good quality evidence for superiority. In this podcast we hear some theories from two of the authors of the study published recently in the Internal Medicine Journal.12:40 SGLT2 inhbitor-associated ketoacidosis17:26 The cognitive burden of variation across settings25:11 the challenges of researching this questionsGuestsDr Lisa Raven FRACP PhD (St Vincent's Hospital, Sydney)Dr Mahesh Umapathysivam FRACP DPhil (Southern Adelaide Diabetes and Endocrine Service; Royal Adelaide Hospital) Guest HostDr Mervyn Kyi FRACP PhD (Royal Melbourne Hospital; Northern Hospital)ProductionProduced by Dr Mervyn Kyi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan, Hugh Murray, Stephen Bacchi and Aafreen Khalid. Key Reference“Heterogeneity in the management of diabetic ketoacidosis in Australia: a national survey”  [IMJ. 2025]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.

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• Ep135: “Wherefore a Pomegranate?” and other classics from the last ten years

  Pomegranate Health has been streaming since June 2015, so we’re going to share a few more classic eps from the last ten years. First up, presenter Mic Cavazzini digs deep to find the origins of the pomegranate, featured not just on this podcast but on the crest of the RACP. The journey starts 500 years ago at an unlikely place, the marriage of Henry VIII and the first of his six wives. You’ll find much of the pageantry reproduced at the web page. We then hear from the wonderful staff at Marrabinya, a support service in western NSW that helps connect Aboriginal patients to specialist consultations. As heard in episode 53, and a handful of others, healthy equity for First Nations people is a value embedded in the mission of the RACP. At Pomegranate Health we also try to support physician wellbeing and career development. One podcast towards that end was Episode 55: Starting out in Private Practice. We hear a pep talk from veteran rheumatologist Louis McGuigan about when and how to back yourself in such a business venture. Another episode with a practical theme was number 56 titled “Billing in Byzantium” where we heard how it is that a few billion dollars are inappropriately leaked from Medicare every year. Finally, in a sample from Episode 69. we hear about some of the structural bias in the health system that results in a gendered understanding of drug effects. All of these episodes and more, are now available on YouTube, as well as all the usual podcast browsing apps. Sampled in this retrospective episode: Desley Mason, Possum Swinton and Kym Lees from Ep53: Marrabinya Dr Louis McGuigan from Ep55: Starting out in private practice Margaret Faux PhD from  Ep56: Billing in ByzantiumProfessor Zoe Wainer from Ep69: Gendered Medicine 2- Funding and Research Production CreditsProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Fair Game’ by Mizlo, ‘Salat Alsabah’ by Feras Charestan, ‘Your Wave’ by Cospe, ‘Dusty Delta Day’ by Lennon Hutton, ‘Corn Candy’ by Guustavv and ‘After the Freak Show’ by Luella Gren. Music courtesy of FreeMusicArchive includes JS Bach's ‘March Fur Die Arche’ performed by The United States Army Old Guard Fife and Drum Corps and ‘Notre Dame’ by Jahzarr. Allegri’s ‘Miserere’ performed by Trinity College under Creative Commons licence from archive.org.  Editorial feedback kindly provided by RACP staff Kathryn Smith, Arnika Martus and Ruby Nelson.  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 

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• [IMJ On-Air] Microbleeds and Memory

  Cerebral microbleeds are a finding on MRI that are usually asymptomatic. There are two main aetiological pathways, one occurring as a result of uncontrolled hypertension and the other from the accumulation of amyloid-beta peptide. The link between cerebral amyloid angiopathy and Alzheimer’s Disease is not understood and even the impact that cerebral microbleeds more generally have on cognition. For the study discussed today, clients of an Australian memory clinic were retrospectively assessed for prevalence of cerebral microbleeds and how this correlates to performance on cognitive tests and formal diagnosis categories. Prevalence of multiple cerebral microbleeds was associated with poorer cognitive performance and more severe diagnoses. And there are suggestions of a shared instigator between Alzheimer’s Disease cerebral amyloid angiopathy. But novel anti-amyloid therapies can also cause increased bleeding risk, meaning that multiple microbleeds are a contraindication for these drugs. We hear how clinicians in the memory clinic balance therapeutic outcomes and potential risks.  Guest Associate Professor Paul Yates FRACP PhD (Austin Health; University of Melbourne) Co-HostDr Duncan Austin FRACP PhD (Alfred Health; Cabrini Health)ProductionProduced by Dr Duncan Austin and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Joseph Lee and Aidan Tan.Key ReferencePrevalence and Associations of Cerebral Microbleeds in an Australian Memory Clinic Cohort [IMJ. 2025]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.

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