A 75 year-old man with severe aortic stenosis is deemed unsuitable for surgery on the basis of a porcelain aorta detected with cross-sectional imaging. The patient had, a decade earlier, been diagnosed with hypertrophic cardiomyopathy after presenting with cardiac arrhythmia. A dual chamber ICD was implanted at the time for secondary prevention and other comorbidities were managed.

The patient is now being considered for staged alcohol septal ablation (for the HCM) and transcatheter aortic valve replacement (for the aortic stenosis), however, additional complications force an experimental two-in-one procedure.

Guest
Professor Ross Roberts-Thomson FRACP (Central Adelaide Local Health Network; University of Adelaide)

Hosts
Associate Professor Stephen Bacchi FRACP (Northern Adelaide Local Health Network; University of Adelaide)
Dr Alistair Leslie (Central Adelaide Local Health Network;)

Key Reference (Spoiler Alert)

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Two-in-one: Combined transcatheter therapy for hypertrophic cardiomyopathy and aortic stenosis [IHJ Cardiovascular Case Reports (CVCR). 2020]

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

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPDto 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.

The record for the longest space-flight is held by physician-cosmonaut Valeri Polyakov. Back in 1994-95, he spent 437 days on the Mir space station and grew 4 centimetres in height through elongation of his spine in micro-gravity. Polyakov had an uncomfortable ride back to Earth in the very precisely customised descent module.

Microgravity also causes demineralization of weight-bearing bones that is faster than age-related decline. But the cosmonaut had worked out religiously for the entire mission and after his capsule parachuted to the ground he made a point of walking from it relatively unassisted. One of the main objectives of the marathon flight had been to prove that walking proudly onto the Martian surface after a 9-month journey might be possible, given it only has 37 percent the gravitational force that Earth does.

Microgravity additionally results in adaptive plasticity of the vestibular and sensorimotor networks and deconditioning of the cardiovascular system. Indeed, several years ago there was a medical emergency aboard the international space station when an ultrasound investigation revealed thrombosis of the internal jugular vein in one astronaut. In this podcast we discuss how management of cases like this has many parallels with remote medicine on earth. Part 1 of this series examined the risks of cosmic radiation and spaceflight-associated neuro-ocular syndrome among other things.

Guests
Professor Gordon Cable (Australian National University; Co-founder, Human Aerospace)
Dr Alicia Tucker FACEM, FAWM (Royal Hobart Hospital; University of Tasmania)
Dr John Cherry PhD FACRRM (Deputy CMO, Australian Antarctic Division)

Chapters
1:08 Bone mineral density
15:35 Circulation and a case study in remote medicine
35:04 Historic medevacs from space

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Spring Water’ By Chill Cole, ‘At the End of Nothing’ by Silver Maple and ‘Mega Woman IV’ by ELFL. Music courtesy of Free Music Archive includes ‘Snowfall’ by Kai Engel. Graphic is AI-generated and shared online with a Creative Commons licence.

Editorial feedback kindly provided by members of the podcast editorial group Paul Cooper PhD, Dr Aidan Tan, Dr Rahul Barmanray, Dr Simeon Wong, Dr Fionnuala Fagan, Dr Maansi Arora, Dr Jia-Wen Chong, Dr Aafreen Khalid and Associate Professor Dr 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. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

In 2027, NASA’s is planning to land astronauts on the moon for the first time in 53 years with the expectation that there will be a permanent base there by the early 2030s. And the ever-humble Elon Musk reckons he’ll be sending people to Mars by then too.

This has prompted a renewed interest in the prolonged effects of space travel on the human body, and a lot of fascinating research has been conducted aboard the International Space Station over the last two decades.

The main objective risk to astronauts is exposure to galactic cosmic radiation. This can be reduced to some degree by shielding of space habitats, however, the impacts of microgravity are much harder to engineer away. In part 1 we’ll discuss spaceflight associated neuro-ocular syndrome and other sensorimotor impacts. In part 2 we’ll focus on the effects of microgravity on bone density and the circulatory system.

We’ll also talk through the management of a cases of suspected thrombosis on the international space station from a few years ago. Medical care on orbit has many parallels with the remote medicine you’re already familiar with.

Guests
Professor Gordon Cable (Australian National University; Co-founder, Human Aerospace)
Dr Alicia Tucker FACEM, FAWM (Royal Hobart Hospital; University of Tasmania)
Dr John Cherry PhD FACRRM (Deputy CMO, Australian Antarctic Division)

Chapters
4:55 Cosmic Radiation
18:34 Spaceflight Associated Neuro-ocular Syndrome
33:01 Occupational Hazards

Production
Produced by Mic Cavazzini DPhil. Recording of ‘Also Sprach Zarathustra’ by Richard Strauss, licenced under Creative Commons from the Lud and Schlatts Musical Emporium Conducted by Philip Milman. Music licenced from Epidemic Sound includes ‘Orthosie’ by Ben Elson, ‘Spring Water’ By Chill Cole and ‘Temple of Runha’ by ELFL. Music courtesy of Free Music Archive includes ‘The Undertake’ and ‘Operation A’ by Borttex. NASA audio downloaded from SPACE.com YouTube channel. Image courtesy of NASA and WikiCommons. Image of first US moonwalk by Ed White courtesy of NASA and WikiCommons.

Editorial feedback kindly provided by members of the podcast editorial group Paul Cooper PhD, Dr Aidan Tan, Dr Rahul Barmanray, Dr Simeon Wong, Dr Fionnuala Fagan, Dr Maansi Arora, Dr Jia-Wen Chong, Dr Aafreen Khalid and Associate Professor Dr 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. 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
13:16 Time Saved
16:18 Costs of treatment
26:44 IMJ paper on resourcing
39:10 Scepticism and staging

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.

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.