The first time most of us heard of monkeypox was in May 2022. The smallpox-like infection appeared to spring from nowhere and make its way through Europe then the Americas, largely within the gay and bisexual community. But the first documented human case of mpox actually occurred in 1970 in Central Africa and it’s been endemic ever since.  Last year’s mpox outbreak eclipsed prior case numbers in just a few months thanks to a newly evolved strain. The count of confirmed cases totalled over 86,000 all around the world and it’s a testament to well-coordinated community health in the developed world that the outbreak was reigned in within a few months of the index case in Europe. 

But alongside this success story, there’s also a cautionary tale about global health strategy. Because mpox wasn't taken seriously in endemic countries, an incubator was created for this new strain to emerge. We also discuss the stigma associated with sexually transmitted infections and the pros and cons of applying this label.  
Guests
Dr Vincent Cornelisse FRACGP FAChSHM PhD (Royal Prince Alfred Hospital, Royal North Shore Hospital, Sydney; Kirby Institute, UNSW)
Dr Massimo Giola FRACP FAChSHM PhD (Te Whatu Ora, Tauranga, Rotorua) Production
Produced by Mic Cavazzini DPhil. Recording assistance in Tauranga from Melissa Cox, Mockingbird Music Studios. Editorial feedback kindly provided by Dr Aidan Tan and Dr David Arroyo. 

Music licenced from Epidemic Sound includes ‘Cocktail by Major Tweaks, ‘Broke No More’ by Cushy, ‘Temple of Ruhnha’ by ELFL and ‘Razzamatazz’ by Jules Gaia. Music courtesy of Free Music Archive includes ‘Out of the Skies, Under the Earth’ by Chris Zabriskie, Image by Flashpop licenced from Getty Images. 

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



Ep93: The rise and fall of mpox

Pomegranate Health is an award-winning podcast about the culture of medicine, from the Royal Australasian College of Physicians. We ask how doctors make difficult clinical and ethical decisions, how doctor-patient communication can be improved, and how healthcare delivery can be made more equitable.&nbsp;

This is also the home of [IMJ On-Air], a podcast to accompany the RACP's Internal Medicine Journal.&nbsp; Interviews with authors are conducted by specialist section editors. Find out more at the website www.racp.edu.au/podcast and get in touch via the address podcast@racp.edu.au

Medicine

Science & Medicine

Health & Fitness

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 other auto-immune diseases without generating intolerable side effects. Teplizumab is an antibody to CD3 which was presented to the world in 2019 as delaying the onset of type 1 diabetes in high-risk individuals thanks to its protective effect on pancreatic β-cells. It has not yet been registered by the Therapeutic Goods Administration but another immunomodulatory drug called baricitinib has. Baricitinib is an inhibitor of Janus Kinases indicated for the for the treatment of rheumatoid arthritis, alopecia areata, atopic dermatitis and even COVID-19. 
 
In December of last year the results of a Phase 2 trial in patients with new-onset type 1 diabetes were published in the New England Journal of Medicine. After almost a year of taking the oral therapy, patients were found to have better glycaemic control and evoked C-peptide levels than those taking placebo, indicating a preserved ability to secrete insulin. In today’s episode, Pomegranate’s in-house endocrinologist interviews two of the study authors.   

Key Reference
Baricitinib and β-Cell Function in Patients with New-Onset Type 1 Diabetes [NEJM. 2023. 7;389(23)] Guests
Prof Jenny Couper FRACP FAHMS (Women's and Children's Hospital, University of Adelaide)
 Dr Michelle So FRACP (Royal Melbourne Hospital, Northern Hospital)
 
 Guest Host
Dr Rahul Barmanray FRACP (Royal Melbourne Hospital) Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Things to Sort out’ and ‘Quiet Waters’ by Walt Adams and ‘The Appalachian Trail’ by Hunter Quinn. Music courtesy of FreeMusic Archive includes ‘I am a Man Who Will Fight For Your Honor’ by Chris Zabriskie. Image produced and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Amy Hughes, Stephen Bacchi, Fionnuala Fagan and Aidan Tan.   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.

[Journal Club] Baricitinib immune therapy for new onset type 1 diabetes

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 tale of how the pomegranate made its way from ancient myth onto this podcast by way of Henry VIII and some mystical symbolism. Guests Dr Travis Brown MBBS, FRCPA (ClinPath Pathology)
 Steve Davis MBA FAMI CPM (Talked About Marketing)
 
Production
Produced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes ‘Mendo Mulcher’ by Polyrhytmiques, ‘Bach’s March fur die Arche’ by The United States Army old Fife and Drum Corps and ‘Notre Dame’ by Jahzzar. Music licenced from Epidemic Sound includes ‘Salat Alsabah’ by Feras Charestan and ‘Savannah Nights 1’ by Martin Gauffin. Image courtesy of Wikimedia Commons. Recording of Allegri’s Miserere from Trinity College under Creative Commons licence from archive.org. Editorial feedback kindly provided by RACP physicians Chris Leung, Aidan Tan, David Arroyo, Ronaldo Piovezan, Rahul Barmanray and Ian Woolley.  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.

Ep106: The whiskey fix and the apple of Granada

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 the day that Indi was to be extubated.  Conflicts over care have always existed but their frequency has increased as medicinal advances present more options for intervention even in the sickest patients. Added to that, the online media environment allows advocacy campaigns to grow until they spill onto the streets outside hospitals and courtrooms.  This heightened tension causes moral injury both to parents and healthcare staff looking after child patients. The Medical Mediation Foundation has developed a conflict management framework to help avoid or de-escalate such disputes and keep attention focused on the best interests of the patient. In this podcast we hear from the director of the foundation, as well as three staff from the Starship Hospital, Auckland who have undertaken this training. 

Guests
Sarah Barclay (Director, the Medical Mediation Foundation)
Dr Louise Webster MBChB RANZCP FRACP (Paediatric Consult Liaison Team, Starship Hospital)
Dr Fiona Miles FRACP FFICANZCA (Paediatric Intensivist, Starship Hospital)
Fiona McIver (nurse specialist, Starship Hospital) Production
Produced by Mic Cavazzini DPhil. Recording assistance in Auckland from Dinesh Kumar. Music courtesy of FreeMusic Archive includes ‘December’ by Kai Engel. Music licenced from Epidemic Sound includes ‘Ikigai’ by Twelwe and ‘Pulse Voyage by Chill Cole. Image by Photodisc licenced from Getty Images.

Editorial feedback kindly provided by RACP physicians Michael Herd, Rosalynn Pszczola, Rachel Murdoch, Sasha Taylor, Zac Fuller, Rahul Barmanray, David Arroyo, Rachel Bowden, Chris Leung, Fionnuala Fagan, Thazin Thazin and Aidan Tan.  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.

Ep105: When parents and paediatrics clash

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 found in their tissues along with much lower levels of pre-β-lipoprotein and plasma-triglycerides when compared to controls. 
 
 That association between a fishy diet and lowered cardiovascular risk has been replicated in multiple population studies since then and there are several ways omega-3 fatty acids could mediate the effect. They have anti-inflammatory and antithrombotic properties, lower circulating triglyceride concentrations and keep vessels impermeable to plaque forming lipoproteins. For many years now clinical guidelines like those of the American Heart Association and the National Heart Foundation of Australia have explicitly encouraged dietary intake of omega-3s fatty acids for those at high cardiovascular risk. But such recommendations come despite considerable inconsistency in the outcomes from intervention studies on omega-3 supplementation over the past 25 years. From several large RCTs there have been just as many negative or neutral associations as there have been positive ones. Professor Christian Hamilton-Craig has published a viewpoint review in the December edition of the Internal Medicine Journal attempting to explain these inconsistencies. 

Guests
Dr Paul Bridgman MB ChB MD FRACP FCSANZ FASE (Christchurch Hospital; St George Hospital; University of Otago)

Prof Christian Hamilton-Craig MBBS PhD FRACP FCSANZ FSCCT FSCMR FACC (Director, Noosa Hearts Cardiology; Noosa Hospital; Griffith University; University of Queensland)
 
​Declarations of interest: nil

Key Reference  ·         Christian Hamilton-Craig, Karam Kostner, David Colquhoun, Stephen J Nicholls. Omega-3 fatty acids and cardiovascular prevention: is the jury still out? IMJ. 2023 Dec;53(12):2330-2335 Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Niagara’ by Chris Shards and ‘Hollow Head’ by Kenzo Almond.  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.

[IMJ On-Air] Is the jury still out on omega-3 supplementation?

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 life.
 
 To try and reduce barriers to referral, clinicians at Royal Brisbane Hospital developed a model called Hepatocare. They adapted a palliative care referral algorithm to include cirrhosis specific markers and continuity of care between the teams was provided by a clinical nurse consultant. The model was piloted model in 30 consecutive patients to the liver clinic, and its impact was assessed on rate of referrals, incidence of unplanned admissions, length of patient stay and rates of polypharmacy. 

Guests
Professor James O’Beirne FRCP FRACP (Sunshine Coast Hospital and Health Service; University of the Sunshine Coast)
Dr Richard Skoien MBBS FRACP (Royal Brisbane and Women’s Hospital; University of Queensland)
Dr Alison Kearney FRACP MRCP (Royal Brisbane and Women’s Hospital; University of Queensland)
Olivia Cullen (Royal Brisbane and Women’s Hospital) Key Reference Alison Kearney, Neha Tiwari, Olivia Cullen, Amy Legg, Ismail Arbi, Carol Douglas, Barbara Leggett, Mary Fenech, Joanne Mina, Paris Hoey, Richard Skoien. Improving palliative and supportive care in advanced cirrhosis: the HepatoCare model of integrated collaborative care. Intern Medicine Journal. 2023 Nov;53(11):1963-1971Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘After the Freak Show’ by Luella Gren and ‘The Cold Shoulder’ by Kylie Dailey.  Editorial feedback kindly provided by RACP physicians Aidan Tan 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.



Ep93: The rise and fall of mpox

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