Pomegranate Health

A 72-year-old female presents to an Adelaide emergency department with bilateral eye pain and redness lasting several days. She has a history of hypertension, hypercholesterolemia and age-related macular degeneration for which she has received a range of medications. Anterior uveitis is identified as the proximal cause of the ocular pain but there are many possible aetiologies that require careful consideration. Pomegranate [Case Reports] have been developed to help Trainees rehearse diagnostic problem solving and case presentation.
 
Guests
Associate Professor Jagjit Singh Gilhotra ,FRANZCO (Queen Elizabeth Hospital; University of Adelaide)
Dr Yong Min (Shane) Lee FRACP (Royal Adelaide Hospital)
 

Host
Associate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes  ‘Desert Whispers’ by Tellsonic  and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. 

Key Reference (Spoiler Alert)

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Bilateral occlusive retinal vasculitis secondary to intravitreal faricimab injection: a case report and review of literature [Lee, Eye Vis. 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.

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.

Guests
Professor Michael Woodward AM FRACP FANZSGM FAAG FAWMA (Austin Health, Melbourne; University of Melbourne)
Dr Chrysanth Pulle FRACP (Prince Charles Hospital, Brisbane) 

Chapters
13:18 Time Saved
16:20 Costs of treatment
26:45 Resourcing systems to deliver amyloid therapies
39:11 Scepticism about the amyloid hypothesis and staging options

Production
Produced 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.

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)
 
Host
Associate Professor Stephen Bacchi FRACP (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.

Key Reference (Spoiler Alert)

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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.

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 ketoacidosis
17:26 The cognitive burden of variation across settings
25:11 the challenges of researching this questions

Guests
Dr Lisa Raven FRACP PhD (St Vincent's Hospital, Sydney)
Dr Mahesh Umapathysivam FRACP DPhil (Southern Adelaide Diabetes and Endocrine Service; Royal Adelaide Hospital) 

Guest Host
Dr Mervyn Kyi FRACP PhD (Royal Melbourne Hospital; Northern Hospital)

Production
Produced 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.

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 Byzantium
Professor Zoe Wainer from Ep69: Gendered Medicine - Funding and Research 

Production Credits
Produced 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 acti<

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-Host
Dr Duncan Austin FRACP PhD (Alfred Health; Cabrini Health)

Production
Produced 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 Reference
Prevalence 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.

A 46-year old man is admitted to hospital following a first time presentation of psychosis that involved barricading himself inside a neighbour’s home. At admission he appears disorganised with slow movements and speech. His rambling reveals bizarre delusional beliefs of a paranoid and persecutory nature. At moments he shows aggression towards staff but when examines reports occasional dizziness and an intolerance of cold. Physical examination reveals cool peripheries, sparse axillary and pubic hair, and soft adult-sized testicles. The investigating team suspect hypothyroidism and a complex series of investigations and therapies follows.

Guests
Dr Peak Man Mah FRACP  (Lyell McEwin Hospital, University of Adelaide)
Dr Malcolm Borg (Royal Adelaide Hospital)
 
Hosts
Associate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide)
Mic Cavazzini DPhil

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 Simeon Wong and medical student Cindy Shi. 
 

Key Reference (Spoiler Alert)

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Panhypopituitarism and psychosis in a male patient [Aust N Z J Psychiatry. 2010]

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 Health marks ten years of podcasting since its launch in June 2015. This episode will be one of two samplers that dip into the back catalogue of 131 episodes to showcase some of the most compelling stories. You’ll hear how podcast themes are identified from all the domains of medicine and professionalism. And a little bit about the motivations of long-time producer and presenter, Mic Cavazzini.

Pomegranate Health has several thousand listeners in over 150 countries. Three quarters of listeners are, predictably, in Australia and Aotearoa-New Zealand, but a full 14 per cent are located outside the traditional anglosphere. RACP is proud to provide this platform to showcase the great work and dedication of its members. It’s also a place where physicians can learn from the other professionals and patient advocates that make up the health system.

Sampled in this retrospective episode:
Prof Meera Agar from ​Ep33: Early days for medicinal cannabis
Dr Paul Drury and Prof Sophia Zoungas from Ep41: Targeting Diabetes
Prof Rinaldo Bellomo from Ep70: Zeroing in on “the renal troponin”
Dr Nic Szecket and Dr Art Nahill from Ep32: Cognitive biases in diagnostic thinking
Prof Ian Harris and Assoc Prof Louise Stone from Ep25: Dealing with Uncertainty Part 1
Dr Danielle Ofri from Ep38: Making a Connection
Michael Pooley as Dr David Hilfiker from Ep75: Feeling guilty- Medical Injury Part 2 

Credits
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Le Hustle’ by Polyrhythmics, ‘Your Wave’ by Cospe, ‘Soul Single Serenade’ by Dusty Decks, ‘Hollow Head’ by Kenzo Almond, ‘Illusory Motion’ by Gavin Luke and 'Let Us Overcome' by Tayler Watts Music courtesy of FreeMusicArchive includes ‘I got 99 broadswords but this one isn't one’ and ‘Friends’ by Komiku and ‘Cree’ by Satellite Ensemble. Thumbnail image is the copyright of RACP. 

Editorial feedback kindly provided by RACP physicians Zac Fuller and Simeon Wong. Thanks also to RACP staff Kathryn Smith, Michael Davidson and Anne Fredrickson.
 Please visit the Pomegranate Health web page for a list of thankyous over the ten years. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.

In this podcast we discuss low-value care that has emerged from a decay in the specificity of the terms “cardiac arrest” and “cardiopulmonary resuscitation.” Patients who experience cardiac arrest in hospital are rarely more than a minute or two away from defibrillation. But the proportion of shockable rhythms in these patients is low as the heart has typically stopped after the decline of other systems. In such conditions, chest compressions are more likely to cause unnecessary trauma than improve survival outcomes. 

As retired UK palliative care physician Kathryn Mannix explains, “cardiac arrest” was originally reserved for unexpected events in relatively healthy individuals in the community. She says we need to separate this from the more progressive phenomenon that is better described as “natural dying”.
 
There is also a semantic breakdown in the understanding of what “cardiopulmonary resuscitation” entails. Surveys of Australasian medical practitioners show that the majority consider CPR to include defibrillation and drugs not just chest compressions and ventilation. As a result, Do Not Attempt CPR orders get perceived as being “a stop sign” to other treatments that may be beneficial. We hear from the NZ-based authors of that research, cardiologist Dr Tammy Pegg, intensivist Dr Alex Psirides and palliative care physician Dr Kate Grundy. 

Chapters
4:00 CPR for out-of-hospital cardiac arrest
8:43 Overuse of CPR in hospitalised patients
20:08 Crude algorithms and failed conversations
40:17 Semantic confusion around what CPR entails
48:13 The midwifing of natural dying

Guests
Dr Kathryn Mannix (www.kathrynmannix.com)
Dr Tammy Pegg MRCP FRACP FC CANZ DPhil (Nelson Marlborough Hospital cardiology department)
Dr Alex Psirides FCICM (Wellington Regional Hospital intensive care unit)
Dr Kate Grundy FAChPM FRACP (Christchurch Hospital palliative care service; University of Otago)

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Awash’ by Gavin Luke, ‘Fields 3’ by Gunnar Johnsén, ‘RGBA’ by Chill Cole and ‘Til All that’s Left is Ash’ by Ludlow.

Music courtesy of FreeMusicArchive includes ‘New Times’ by 4T Thieves and ‘Secret Place’ by Alex Fitch. Image by Yuichiro Chino licenced through Getty Images. Football commentary courtesy of UEFA Euro 2021. 

Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Fionnuala Fagan, Simeon Wong, Hugh Murray and Aidan Tan. Thanks also to RACP staff Arnika Martus and Kathryn Smith. 

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

Despite filling more than half of places in Australian medical schools, women represent 45 per cent of all medical practitioners and just 36 per cent of specialists. Female representation dwindles further in many areas of clinical leadership, prompting what has been termed a “leaky pipeline”. It has been reported that women would progress at similar rates to men, and achieve similar remuneration, were it not for the time taken out from the profession to raise children. In this podcast we discuss what it would take to mitigate this so-called “motherhood penalty” through policy, workplace culture and better distribution of labour in the home. This discussion is important because it relates not just to the wellbeing and rights of individual medics, but also to the depth and diversity of the workforce.a

Chapters
1:38 Better support for return to work
9:09 Workforce effects and workplace flexibility
19:56 The “motherhood penalty” on career progression
33:52 Broader societal biases

Guests
Associate Professor Kara Allen FANZCA (Royal Melbourne Hospital; University of Melbourne)
Dr Jenny Proimos FRACP (Royal Children's Hospital Melbourne; Monash Centre for Health Research and Innovation;

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Melting Places’ by Andres Cantú, ‘Not Blue’ by Kylie Dailey. Music courtesy of Free Music Archive includes ‘Good Days’ by Cody Francis, ‘Planting Flags’ by Blue Dot Sessions,  ‘Helice’ by Monplaisir, ‘Feeling Minnesota by Gavin Luke, and ‘Maybe This Time’ by Major Tweaks. Image by George Peters licenced through Getty Images. 

Editorial feedback kindly provided by RACP physicians Zac Fuller, Aidan Tan, Joseph Lee, David Skalicky, and Stella Sarlos. Thanks also to RACP staff Arnika Martus and Kathryn Smith and also to Sarah Anderson of La Trobe University for guiding me through some of the AIHW data.

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.