Pomegranate Health

In Aotearoa-New Zealand, the proportion of doctors identifying as Māori has doubled from where it was a decade ago to over 5 percent. But there is still a long way to go before the workforce is representative of the broader population which is 17 percent Māori. The Auckland and Otago Medical Schools have in recent years turbocharged their intake of Māori and Pasifika students but these graduates d...

This case report comes to you from Brigham and Women’s Hospital in Boston, a huge teaching hospital that serves the Harvard Medical School. The 52-year-old female presented with clumsiness and paresthesia of the right hand that had persisted for several days. She also had a headache and three weeks prior to presentation had undergone a suboccipital craniotomy for a Chiari I malformation. To compli...

Professor Gary Lee established the first dedicated pleural service in the southern hemisphere in 2009, at the Sir Charles Gairdner Hospital in Perth. He says that pleural disease has finally come to be regarded as an area of subspeciality interest in its own right, not just a complication of other comorbidities. In this podcast he presents a potted history of key developments in the management of...

This case report describes a 42-year-old male from Arizona with a complex course characterised by fever following an orthotopic liver transplant. A general approach to fever in the post-transplant patient is discussed, along with specific considerations regarding travel in post-transplant patients or those on immunosuppressants for other indications. A/Prof Camille Kotton and Dr Simran Gupta from...

In the previous episode we heard how some rationally-designed therapies work on almost any cancer with the right molecular signature. Tumour-agnostic medications could be godsend for patients with rare cancers which have classically been overlooked by drug developers, and those with advanced cancers of unknown origin. 15,000 such patients have undergone comprehensive genome profiling of their tumo...

The genomic understanding of cancer has transformed a tissue-based classification model that had been dominant for 150 years or more. The last three decades have seen highly targeted therapies developed at blistering pace, and unprecedented improvements in patient outcomes.  To date, these advances have been focused on more common cancers. The financing model for drug development means that rare c...

This case report describes a 35-year-old Caucasian male presenting with 5 weeks of progressive weakness in the proximal limbs and trunk and associated changes to the skin. The man was previously well and not taking any regular medications. There are many pathways this undifferentiated patient could go down. Consultant physician, Professor Josephine Thomas demonstrates a systematic way to work thro...

In 2019 a man was referred to Royal Adelaide Hospital with worsening breathlessness and a productive cough. He was a 47 year old electrician with a history of tobacco smoking who’d been well before the onset of symptoms. Over a couple of admissions the patient’s condition progressed to type 2 respiratory failure. While the ultimate explanation for this presentation was a bit of a unicorn, the dram...

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 plas...

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...

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...

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 cras...

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 ineffic...

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 wit...

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 relationship...

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 Ku...

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 vomitin...

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 g...

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 dis...

Type 1 diabetes has a very high treatment burden in terms of direct costs, inconvenience and lost productivity for patients and their carers. Further, all the glucose checking, hormone replacement and consults don’t abolish the vascular complications associated with poor glycaemic control. Only in the last few years has it been possible to pharmacologically alter the course of type 1 diabetes and...

Today’s guests are the hosts of This Medical Life , a wonderful podcast that delves into the archives of medical history. Dr Travis Brown describes the period after World War I when the Spanish Flu was killing tens of millions around the world. In the USA, whiskey was thought to be a powerful prophylactic but distribution was not an easy thing. Later in the episode (22min) is the equally unlikely...

Last November an NHS Hospital Trust in Nottingham sought permission from the UK High Court to withdraw life support from a seven-month old girl called Indi Gregory. The devastated parents did not want to give up on her although they were advised there was no hope of treatment for her profound developmental disability. The family and the medical teams returned to court two more times, right up to t...

The theory that certain fatty acids are essential to the diet and associated with reduced cardiovascular risk has been controversial since it was floated in the 1950s.   In 1971 Danish researchers published the results from a cross-sectional study of Inuit people living on the west coast of Greenland . They ate a fish-based diet rich in polyunsaturated fatty acids known as omega-3s, which were fou...

Median survival for patients diagnosed with advanced cirrhosis is around 2 years and quality of life is poor. Fewer than a quarter of such patients receive referrals to palliative care and advanced care plans are also rare. Existing research from abroad suggests that hepatology staff aren’t familiar with referral criteria and assume that palliative services become involved only at the very end of...

Semaglutide, branded as Ozempic or Wegovy, is an analogue of glucagon-like peptide 1 which has glucose-dependent effects on insulin secretion. In this episode we discuss how semaglutide performs as an antihyperglycaemic agent compared to previous GLP-1 analogues and the soon-to-be launched tirzepatide. This dual agonist also binds receptors to glucose-dependent insulinotropic polypeptide, GIP. GLP...