Episode 135. Headaches with Dr Michael Eller
In my conversation with expert headache and movement disorder specialist Dr. Michael Eller from Richmond Neurology, I was keen to delve deeper into the realm of chronic primary headaches—specifically, migraine and cluster types. The evolving understanding of the pathophysiology of these headaches and the developing treatment approaches, focusing on inhibiting the neurotransmitter called Calcitonin gene-related peptide, is fascinating. This peptide is inhibited by the 5-HT1D and 1B receptor agonist effect of the triptans, as well as by a new family of CGRP-targeting drugs and monoclonal antibodies developed for the preventive treatment of migraine.
Headache is an extremely common symptom, and collectively, headache disorders rank among the most prevalent nervous system disorders. Approximately 95% of the general population have experienced a headache at some point in their lives, with a one-year prevalence rate of about one in every two adults. Headache accounts for up to 1 in 10 general practitioner consultations, remains a frequent reason for neurology referrals, and in Europe, constitutes up to 4% of emergency department visits, with migraine being the most common type.
The World Health Organization includes headache among the top ten causes of disability. While the impact on the economy and an individual’s quality of life may be challenging to quantify, in the case of migraine, up to 75% of patients report functional disability during an attack, and about 50% require the assistance of family and friends. Headaches do not discriminate; they affect people of all ages, races, and socioeconomic statuses, but they are more common in women.
Headaches are generally categorized as acute or chronic. Acute headaches may be new and severe, potentially indicating critical intracranial pathology like an aneurysm or meningitis. Chronic headaches are typically classified into primary types such as migraine, cluster, and tension-type, or secondary, which could reflect intracranial pathology or result from conditions like cervical spondylosis, dental and ocular disorders, sinusitis, hypertension, depression, TMJ dysfunction, temporal arteritis, medication side effects, and others.
When consulting with patients, inquiring about the onset of the headache, its frequency and type, duration, recent changes in characteristics, intensity, location, pain quality, associated symptoms like nausea and vomiting, factors that worsen or alleviate it, as well as the presence of neurological symptoms such as visual and sensory changes or alterations in speech, can all aid in establishing a diagnosis.
Migraine often demonstrates a complex polygenic pattern of inheritance, and in the case of familial hemiplegic migraine, it exhibits an autosomal dominant pattern of inheritance.
In my conversation with expert headache and movement disorder specialist Dr. Michael Eller from Richmond Neurology, I was keen to delve deeper into the realm of chronic primary headaches—specifically, migraine and cluster types. The evolving understanding of the pathophysiology of these headaches and the developing treatment approaches, focusing on inhibiting the neurotransmitter called Calcitonin gene-related peptide, is fascinating. This peptide is inhibited by the 5-HT1D and 1B receptor agonist effect of the triptans, as well as by a new family of CGRP-targeting drugs and monoclonal antibodies developed for the preventive treatment of migraine.
Michael completed his medical degree at the University of Sydney in 2003 following a Bachelor of Science and Arts. He has interests in archaeology, neuroscience, infectious disease, and indigenous health. Additionally, he has volunteered as an aid worker in remote locations, including PNG, and underwent training from 2012 to 2014 at The University of California, San Francisco, under Professor Peter Goadsby. I believe you will find this conversation quite engaging. Please welcome Michael to the podcast.
References:
Dr. Michael Eller: Richmond Neurology - richmondneurology.com.au
Headache disorders: differentiating and managing the common subtypes, Ahmed - ncbi.nlm.nih.gov
Current Medical Diagnosis and Treatment.2019: Papadakis, McPhee et al, McGraw Hill Education, Lange
Episode 134. Health Impacts on Climate Change with Professor Richard
The World Health Organisation estimates that between 2030 and 2050, climate change is anticipated to result in approximately 250,000 additional deaths annually. These fatalities may arise from issues such as malnutrition, and heat stress, as well as diseases like malaria and infectious diarrhea. The impact of a planet warming at a recorded rate of 0.08 degrees centigrade per decade since 1880, accelerating to 0.18 degrees centigrade since 1981, poses threats to human lives and health across multiple dimensions. It's important to note that this statement does not delve into the detrimental potential such warming has on other species. Factors crucial to human survival—such as clean air, safe drinking water, a nutritious food supply, and secure shelter—are all imperilled in a world grappling with climate change. In this podcast, my intention was not to focus on the specific science of global warming and subsequent climate change, but rather on the associated health consequences.
The World Health Organisation estimates that between 2030 and 2050, climate change is anticipated to result in approximately 250,000 additional deaths annually. These fatalities may arise from issues such as malnutrition, and heat stress, as well as diseases like malaria and infectious diarrhoea. The impact of a planet warming at a recorded rate of 0.08 degrees centigrade per decade since 1880, accelerating to 0.18 degrees centigrade since 1981, poses threats to human lives and health across multiple dimensions. It's important to note that this statement does not delve into the detrimental potential such warming has on other species. Factors crucial to human survival—such as clean air, safe drinking water, a nutritious food supply, and secure shelter—are all imperilled in a world grappling with climate change. In this podcast, my intention was not to focus on the specific science of global warming and subsequent climate change, but rather on the associated health consequences.
Despite the numerous pledges made by countries in various climate forums, global emissions in 2022 are projected to reach an unprecedented peak. However, there is a positive note to highlight—Australia managed to reduce its emissions by 1.9% in 2021. The historical responsibility for emissions lies significantly with the United States, followed by China, Russia, and Brazil.
Undoubtedly intertwined with atmospheric emissions and consequent climate change is the world's population, which is growing at an alarming rate. Thomas Malthus, in his Essay on 'the principle of population' in the 1800s, once predicted its unsustainability. Today, with a population exceeding 8 billion, the United Nations forecasts a peak population of about 10.4 billion by the 2080s, noting that the "peak baby" phase has already been reached, leading to a measurable slowdown in population growth. Time will undoubtedly affirm the accuracy of these figures in history. It's crucial to mention that an expanding population, particularly a growing wealthier middle class in many countries worldwide, is likely to result in increased greenhouse gas emissions, heightened resource consumption, and will test humanity's capacity to solve ecological problems arising from the collective global burden we carry.
My curiosity to delve deeper into this subject led me to invite Professor Richard Eckard to join the podcast and further enrich the discussion. Richard, a Professor of Sustainable Agriculture at The University of Melbourne and Director of The Primary Industries Climate Challenges Centre is a globally recognised authority on sustainable agricultural production. His focus includes carbon-neutral agriculture and agricultural adaptation to climate change. Richard's significant contributions encompass developing the initial greenhouse gas accounting tools for agriculture. Moreover, his research forms the scientific foundation for six carbon offset methods currently employed in Australia. Serving as a science advisor to various governments and international organisations such as the Australian, New Zealand, and UK governments, the International Livestock Research Institute, the Food and Agriculture Organisation of the United Nations, and the European Union, Richard provides invaluable counsel on climate change adaptation and mitigation in agriculture. Additionally, he represents Australia in the Global Research Alliance on Agricultural Greenhouse Gases.
Please welcome Richard to the podcast.
References:
• Professor Richard Eckard: rjeckard@unimelb.edu.au
• www.who.int/health-topics/climate-change
• "The Weather Makers" by Tim Flannery, Text Publishing
• National Geographic (multiple references)
Episode 99. Radiation Oncology with Dr Marcus Foo (Part 2)
Radiation oncology occupies a very important place in cancer therapy as an essential member of the multidisciplinary approach to cancer treatment . Of the near 146 000 Australians diagnosed with cancer each year is estimated that about half would benefit from radiation therapy as part of their overall cancer treatment.
Radiation therapy is a highly cost-effective cancer therapy contributing only about 10% of each healthcare dollar spent on treating cancer overall yet vital in about 40% or cancers that are cured. The technology employs ionising radiation that causes the ejection of an orbital electron which is the molecular event leading to damage and eventually cell death. The radiation used may be either electromagnetic in nature using photons or gamma rays or particulate- directing a stream of electrons, protons or other atomic particles to the target and causing DNA damage to both normal tissue and tumour cells. Cells are most susceptible in the G1 and G2 phases which represent growth and preparation for mitosis as well as the mitosis phase referred to as the M phase. Additionally, hypoxic cells are thought to be less susceptible to radiation than well-oxygenated cells as free radicals formed by ionising radiation are more easily repaired in the absence of oxygen.
Radiation oncology occupies a very important place in cancer therapy as an essential member of the multidisciplinary approach to cancer treatment . Of the near 146 000 Australians diagnosed with cancer each year is estimated that about half would benefit from radiation therapy as part of their overall cancer treatment.
Radiation therapy is a highly cost-effective cancer therapy contributing only about 10% of each healthcare dollar spent on treating cancer overall yet vital in about 40% or cancers that are cured. The technology employs ionising radiation that causes the ejection of an orbital electron which is the molecular event leading to damage and eventually cell death. The radiation used may be either electromagnetic in nature using photons or gamma rays or particulate- directing a stream of electrons, protons or other atomic particles to the target and causing DNA damage to both normal tissue and tumour cells. Cells are most susceptible in the G1 and G2 phases which represent growth and preparation for mitosis as well as the mitosis phase referred to as the M phase. Additionally, hypoxic cells are thought to be less susceptible to radiation than well-oxygenated cells as free radicals formed by ionising radiation are more easily repaired in the absence of oxygen.
Photon therapy is interesting in allowing delivery of energy to internal malignancies with relative tolerance at the level of the skin.
Radiation dose is measured as energy per unit mass -where 1 J/kg is 1 Gray.
In this podcast I was joined by Dr Marcus Foo who is a radiation oncologist with Genesis Care. Marcus graduated from the University of Melbourne in 2000 and trained in radiation oncology at the Peter MacCallum Cancer Centre before undertaking a clinical and research fellowship at the BC Cancer Agency in Vancouver, Canada focusing on gastrointestinal, breast and genitourinary oncology. He has strong interest in stereotactic radiation therapy and image-guided radiation therapy. I was keen to discuss with Marcus the principles of radiation oncology in more depth and understand much of the terminology used such as ‘fractionated radiotherapy’, ‘external beam’, ‘brachytherapy’, ‘stereotactic’ and ‘palliative therapy'. This conversation is covered across two very interesting episodes. I hope you enjoy the interview and I am pleased you have joined us.
References:
Dr Marcus Foo: www.genesiscare.com
Introduction to Radiation Oncology: www.astro.org
Introduction to Radiation Oncology : Apicelli, Parikh and Zoberi, Haematology and Oncology Subspecialty Consult, 4th Ed,Wolters Kluwer
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 98. Radiation Oncology with Dr Marcus Foo (Part 1)
Radiation oncology occupies a very important place in cancer therapy as an essential member of the multidisciplinary approach to cancer treatment . Of the near 146 000 Australians diagnosed with cancer each year is estimated that about half would benefit from radiation therapy as part of their overall cancer treatment.
Radiation oncology occupies a very important place in cancer therapy as an essential member of the multidisciplinary approach to cancer treatment . Of the near 146 000 Australians diagnosed with cancer each year is estimated that about half would benefit from radiation therapy as part of their overall cancer treatment.
Radiation therapy is a highly cost-effective cancer therapy contributing only about 10% of each healthcare dollar spent on treating cancer overall yet vital in about 40% or cancers that are cured. The technology employs ionising radiation that causes the ejection of an orbital electron which is the molecular event leading to damage and eventually cell death. The radiation used may be either electromagnetic in nature using photons or gamma rays or particulate- directing a stream of electrons, protons or other atomic particles to the target and causing DNA damage to both normal tissue and tumour cells. Cells are most susceptible in the G1 and G2 phases which represent growth and preparation for mitosis as well as the mitosis phase referred to as the M phase. Additionally, hypoxic cells are thought to be less susceptible to radiation than well-oxygenated cells as free radicals formed by ionising radiation are more easily repaired in the absence of oxygen.
Photon therapy is interesting in allowing the delivery of energy to internal malignancies with relative tolerance at the level of the skin.
Radiation dose is measured as energy per unit mass -where 1 J/kg is 1 Gray.
In this podcast, I was joined by Dr Marcus Foo who is a radiation oncologist with Genesis Care. Marcus graduated from the University of Melbourne in 2000 and trained in radiation oncology at the Peter MacCallum Cancer Centre before undertaking a clinical and research fellowship at the BC Cancer Agency in Vancouver, Canada focusing on gastrointestinal, breast and genitourinary oncology. He has a strong interest in stereotactic radiation therapy and image-guided radiation therapy. I was keen to discuss with Marcus the principles of radiation oncology in more depth and understand much of the terminology used such as ‘fractionated radiotherapy’, ‘external beam’, ‘brachytherapy’, ‘stereotactic’ and ‘palliative therapy'. This conversation is covered across two very interesting episodes. I hope you enjoy the interview and I am pleased you have joined us.
References:
Dr Marcus Foo :www.genesiscare.com
Introduction to Radiation Oncology: www.astro.org
Introduction to Radiation Oncology : Apicelli, Parikh and Zoberi, Haematology and Oncology Subspecialty Consult, 4th Ed,Wolters Kluwer
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 97. Hippocrasy with Dr Rachelle Buchbinder
In the September 25-26 edition of the weekend Australian magazine, I was drawn to a very interesting feature article reviewing the book Hippocrasy co-written by Professor Rachelle Buchbinder who is a rheumatologist as well as director of the Monash Cabrini Department of musculoskeletal health and clinical epidemiology at Cabrini Hospital and Professor of clinical epidemiology at Monash University with Ian Harris who is an orthopaedic surgeon at Liverpool St George and Sutherland hospitals and Professor of Orthopaedic surgery at the University of New South Wales Sydney and Honorary Professor at University of Sydney. The article was confronting in that it raised concerns that many of the medical procedures and treatments we are engaged with as clinicians may not help patients and that over diagnosis and the “medicalisation of normal” may be leading to a medical system failure.
In the September 25-26 edition of the weekend Australian magazine, I was drawn to a very interesting feature article reviewing the book Hippocrasy co-written by Professor Rachelle Buchbinder who is a rheumatologist as well as director of the Monash Cabrini Department of musculoskeletal health and clinical epidemiology at Cabrini Hospital and Professor of clinical epidemiology at Monash University with Ian Harris who is an orthopaedic surgeon at Liverpool St George and Sutherland hospitals and Professor of Orthopaedic surgery at the University of New South Wales Sydney and Honorary Professor at University of Sydney. The article was confronting in that it raised concerns that many of the medical procedures and treatments we are engaged with as clinicians may not help patients and that over diagnosis and the “medicalisation of normal” may be leading to a medical system failure.
The question the authors ask us to consider is whether doing a specific medical procedure or intervention is better for the patient than not doing it and they set the context of this question by drawing from a wide review of studies within the framework and reflecting of the Hippocratic oath. I subsequently purchased and read Hippocrasy which was as illuminating as it was confronting and would strongly recommend this book as essential reading for all doctors both graduated and training and hope it becomes a staple for medical students everywhere. Hippocrasy asks us to question the true value of specific medical practice, to choose wisely and to recognise cognitive dissonance and confirmation bias noting that up to a third of medical care may be of no value and that up to 10% of treatments and interventions may be harmful with medical error the third leading cause of death in the United States. We should all strive to practice evidence-based medicine when possible and there are many organisations such as the United Kingdom National Institute for Health and Care Excellence, Cochrane Collaboration and the United States Preventative Services Task force to guide us.
In this podcast with Rachelle Buchbinder, we discuss Hippocrasy in more detail including how the problem of the medicalisation of normal has arisen and what needs to change. Please join me on this interesting conversation.
References :
Prof Rachelle Buchbinder:www.malvernrheumatology.com
Hippocrasy: Buchbinder and Harris, NewSouth Publishing, 2021
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 96. Regenerative Medicine with Dr Kiryu Yap
The field of regenerative medicine is likely to significantly change how we practice medicine in the future with some amazing capabilities -harnessing the power of stem cells to restore form and function of damaged tissue. The potential of regenerative medicine has already being recognised in the areas of immunotherapy and bone marrow transplantation however the future is likely to see many further shining examples of its promise ,application and capability. Consider the possibility of injecting cardiac stem cells into the surrounding viable ventricular myocardium adjacent to an acute myocardial infarction providing functioning myocardial cells to restore cardiac output or indeed replacing a damaged organ such as a cirrhotic liver allowing restored hepatic synthetic function.
The field of regenerative medicine is likely to significantly change how we practice medicine in the future with some amazing capabilities -harnessing the power of stem cells to restore form and function of damaged tissue. The potential of regenerative medicine has already being recognised in the areas of immunotherapy and bone marrow transplantation however the future is likely to see many further shining examples of its promise ,application and capability. Consider the possibility of injecting cardiac stem cells into the surrounding viable ventricular myocardium adjacent to an acute myocardial infarction providing functioning myocardial cells to restore cardiac output or indeed replacing a damaged organ such as a cirrhotic liver allowing restored hepatic synthetic function.
A group of scientists at St Vincent's Institute of Medical Research in Melbourne with co lead researcher Kiryu Yap are attempting to do just that. Following a breakthrough over 4 years ago their team has the aim of growing entire lobes of the liver by taking patients’ blood and carefully reprogramming cells to become stem cells .This technology became available after the amazing techniques described by Sir John Gurdon and Shinya Yamanaka who discovered that mature cells can be reprogrammed to become pluripotent leading to their 2012 Nobel Prize in Physiology and Medicine.
It is known that about 7000 Australians die each year from chronic liver disease and that 260 livers are transplanted each year between Australia and New Zealand so if this bold project is successful, it will provide significant value to patients suffering with advanced and deteriorating liver disease. After genetically reprogramming cells to become pluripotent stem cells the application of very specific nutrients exerts the appropriate epigenetic effect to induce tiny liver cells. The plan is to implant these into the groin of patients where the small liver buds will be supported by the patient's blood vessels before the liver lobe is eventually harvested and transplanted to replace the diseased organ. Please join this fascinating discussion with Kiryu.
References:
Dr Kiryu Yap-School of Biomedical Sciences-University of Melbourne
www.svi.edu.au- Vacular biology-St Vincents Institiue of Medical Research-Dr Kiryu Yap
www.nobelprize.org- The 2012 Nobel Prize in Physiology or Medicine
https:/transplant.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 95. Remote and Rural Medicine with Dr Etienne Cawood
The Doctors, nurses, paramedics and hospital staff working at remote locations must be capable of dealing with a wide range of medical, surgical, obstetric, paediatric and psychiatric conditions that may present as emergencies. Where support help such as tertiary transfer may be hours or days away it takes a special team to come together to manage such difficulties. It was a great pleasure to interview Etienne Cawood who has spent the majority of his medical career working in rural and remote locations throughout the length and breadth of Australia and we him great debt gratitude for his services.
About 7 million Australians, around 28% of our population, live in rural and remote areas encompassing many diverse locations and communities that in some instances have poor access to the medical services we may take for granted in metropolitan centres. Higher rates of hospitalisations, deaths and injury are reported from remote and rural areas and statistics show that remote and very remote areas experience a greater burden of disease and injury compared to major city populations (about 1.4 times). The practice of medicine in such communities requires a higher level of medical literacy.
On average, people living in remote and very remote areas are younger than those in major cities and 18% of people living in remote and 47% in very remote areas are indigenous (aboriginal or Torres Strait Islander people) compared to 1.7% in major cities. Health risk factors such as smoking overweight and obesity, diet, high blood pressure, alcohol consumption and physical activity are just some of the factors influencing health outcomes.
The Doctors, nurses, paramedics and hospital staff working at remote locations must be capable of dealing with a wide range of medical, surgical, obstetric, paediatric and psychiatric conditions that may present as emergencies. Where support help such as tertiary transfer may be hours or days away it takes a special team to come together to manage such difficulties. It was a great pleasure to interview Etienne Cawood who has spent the majority of his medical career working in rural and remote locations throughout the length and breadth of Australia and we him great debt gratitude for his services.
References:
Etienne Cawood :ejcawood@gmail.com
Rural and remote health. aihw.gov.au
Australian College of rural and remote medicine. mycollege.acrrm.org.au
www.jcu.edu.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 94. Being an intern during COVID with Dr Nick Shearer
The journey from the VCE student to University and medical studies is highly competitive and never easy and for those undertaking a postgraduate degree in medicine, the graduate medical school admissions test-GAMSAT-designed to assess the capacity to undertake high-level intellectual studies in the medical and health professional programmes provides yet a further hurdle. Dr Nick Shearer completed his postgraduate medical studies at Deakin University before choosing and being accepted as an intern at the Northern Hospital Epping. In his dream of becoming a doctor he was immediately thrust into the incredible difficulty of not only managing the brutal responsibilities of internship but even more the harsh reality of coping with the COVID-19 pandemic at the very interface between disease and treatment in a hospital tasked with frontline COVID-19 responsibilities. Donning personal protective equipment for the entire year and honing his communication skills with often frustrated and frightened patients and their relatives Nick has become a shining example of how good our medical personnel and profession can function and be in a time of deep crisis.For his insights please welcome Dr Nick Shearer to the conversation.
The journey from the VCE student to University and medical studies is highly competitive and never easy and for those undertaking a postgraduate degree in medicine, the graduate medical school admissions test-GAMSAT-designed to assess the capacity to undertake high-level intellectual studies in the medical and health professional programmes provides yet a further hurdle. Dr Nick Shearer completed his postgraduate medical studies at Deakin University before choosing and being accepted as an intern at the Northern Hospital Epping. In his dream of becoming a doctor he was immediately thrust into the incredible difficulty of not only managing the brutal responsibilities of internship but even more the harsh reality of coping with the COVID-19 pandemic at the very interface between disease and treatment in a hospital tasked with frontline COVID-19 responsibilities. Donning personal protective equipment for the entire year and honing his communication skills with often frustrated and frightened patients and their relatives Nick has become a shining example of how good our medical personnel and profession can function and be in a time of deep crisis.
For his insights please welcome Dr Nick Shearer to the conversation.
References :
gamsat.acer.org
www.deakin.edu.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 93. Haemotology with Dr Thomas Lew (Part 3)
In this three-part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Observed abnormalities in the full blood count are not uncommon, they may be transient and mild, often involving one cell lineage and most likely benign, or progressive involving more than one cell lineage and pointing us toward a condition requiring further investigation, possible referral and treatment.
In foetal life, haemopoiesis occurs in the yolk sac and later in the liver and spleen. After birth normal haemopoiesis is restricted to the bone marrow. Infants have haemopoietic marrow in all bones but in adults, haemopoietic marrow is found in the central skeleton and proximal ends of long bones. Expansion of haemopoiesis down the long bones may occur in bone marrow malignancy such as with leukaemia or when there is increased demand such as with chronic haemolytic anaemias. Both the liver and spleen can resume extra medullary haematopoiesis when there is marrow replacement such as in myelofibrosis or when there is excessive demand for example in severe haemolytic anaemia such as thalassaemia major. Incredibly the bone marrow produces more than 1 million red cells per second in addition to similar numbers of white cells and platelets .Common primitive stem cells in the marrow have the capacity to self replicate and give rise to increasingly specialised and committed progenitor cells. Myeloid progenitors differentiate into platelets, red blood cells, eosinophils neutrophils, basophils, macrophages, mast cells and dendritic cells. Lymphoid precursors differentiate into T cells (CD4 helper and CD8 suppressor) B cells (plasma cells and memory cells) and natural killer cells.
In conditions of disease or physiologic stress, there may be a reduced number of cells in the full blood count assessment suggesting decreased production or loss (e.g. bleeding), sequestration (spleen, lymph nodes), or peripheral destruction. Elevated counts suggest an excess production which may be reactive (physiologic stress) or reflective of a primary abnormality of the bone marrow or other haemopoietic organs.
In this three-part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Please join these interesting conversations with Dr Thomas Lew - haematology advanced trainee at the Peter MacCallum Cancer Centre with special interest in novel therapies for haematological disorders.
References:
Dr Thomas Lew: petermac.org
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 92. Haemotology with Dr Thomas Lew (Part 2)
In this three-part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Observed abnormalities in the full blood count are not uncommon, they may be transient and mild, often involving one cell lineage and most likely benign, or progressive involving more than one cell lineage and pointing us toward a condition requiring further investigation, possible referral and treatment.
In foetal life, haemopoiesis occurs in the yolk sac and later in the liver and spleen. After birth normal haemopoiesis is restricted to the bone marrow. Infants have haemopoietic marrow in all bones but in adults, haemopoietic marrow is found in the central skeleton and proximal ends of long bones. Expansion of haemopoiesis down the long bones may occur in bone marrow malignancy such as with leukaemia or when there is increased demand such as with chronic haemolytic anaemias . Both the liver and spleen can resume extra medullary haematopoiesis when there is marrow replacement such as in myelofibrosis or when there is excessive demand for example in severe haemolytic anaemia such as thalassaemia major. Incredibly the bone marrow produces more than 1 million red cells per second in addition to similar numbers of white cells and platelets .Common primitive stem cells in the marrow have the capacity to self replicate and give rise to increasingly specialised and committed progenitor cells. Myeloid progenitors differentiate into platelets, red blood cells, eosinophils neutrophils, basophils, macrophages, mast cells and dendritic cells. Lymphoid precursors differentiate into T cells (CD4 helper and CD8 suppressor) B cells (plasma cells and memory cells) and natural killer cells.
In conditions of disease or physiologic stress there may be a reduced number of cells in the full blood count assessment suggesting decreased production or loss (e.g. bleeding), sequestration (spleen, lymph nodes), or peripheral destruction. Elevated counts suggest an excess production which may be reactive (physiologic stress) or reflective of a primary abnormality of the bone marrow or other haemopoietic organs.
In this three part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Please join these interesting conversations with Dr Thomas Lew - haematology advanced trainee at the Peter MacCallum Cancer Centre with special interests in novel therapies for haematological disorders.
References:
Dr Thomas Lew: petermac.org
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 91. Haemotology with Dr Thomas Lew (Part 1)
In this three-part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Observed abnormalities in the full blood count are not uncommon, they may be transient and mild, often involving one cell lineage and most likely benign, or progressive involving more than one cell lineage and pointing us toward a condition requiring further investigation, possible referral and treatment.
In foetal life, haemopoiesis occurs in the yolk sac and later in the liver and spleen. After birth normal haemopoiesis is restricted to the bone marrow. Infants have haemopoietic marrow in all bones but in adults, haemopoietic marrow is found in the central skeleton and proximal ends of long bones. Expansion of haemopoiesis down the long bones may occur in bone marrow malignancy such as with leukaemia or when there is increased demand such as with chronic haemolytic anaemias . Both the liver and spleen can resume extra medullary haematopoiesis when there is marrow replacement such as in myelofibrosis or when there is excessive demand for example in severe haemolytic anaemia such as thalassaemia major. Incredibly the bone marrow produces more than 1 million red cells per second in addition to similar numbers of white cells and platelets .Common primitive stem cells in the marrow have the capacity to self replicate and give rise to increasingly specialised and committed progenitor cells. Myeloid progenitors differentiate into platelets, red blood cells, eosinophils neutrophils, basophils, macrophages, mast cells and dendritic cells. Lymphoid precursors differentiate into T cells (CD4 helper and CD8 suppressor) B cells (plasma cells and memory cells) and natural killer cells.
In conditions of disease or physiologic stress there may be a reduced number of cells in the full blood count assessment suggesting decreased production or loss (e.g. bleeding), sequestration (spleen, lymph nodes), or peripheral destruction. Elevated counts suggest an excess production which may be reactive (physiologic stress) or reflective of a primary abnormality of the bone marrow or other haemopoietic organs.
In this three part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Please join these interesting conversations with Dr Thomas Lew - haematology advanced trainee at the Peter MacCallum Cancer Centre with special interests in novel therapies for haematological disorders.
References:
Dr Thomas Lew: petermac.org
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 90. Venous Thromboembolism with Dr Sanjeev Chunilal
Venous thrombosis affects more than 30,000 Australians each year and is responsible for over 5000 deaths per annum, this is more than the number of Australians who die from motor vehicle accidents annually. VTE is the third leading cause of death amongst hospitalised patients and patients admitted to hospital are at least 100 times more likely of developing a clot compared to being active in the community-a risk that may be assessed by the modified Wells criteria.
Venous thrombosis affects more than 30,000 Australians each year and is responsible for over 5000 deaths per annum, this is more than the number of Australians who die from motor vehicle accidents annually. VTE is the third leading cause of death amongst hospitalised patients and patients admitted to hospital are at least 100 times more likely of developing a clot compared to being active in the community-a risk that may be assessed by the modified Wells criteria.
Tellingly 60% of all venous thromboembolisms occur within 90 days of hospitalisation and importantly it is predicted that up to 70% are preventable.
It is also estimated that about 50% of patients with an untreated proximal deep vein thrombosis will develop a symptomatic pulmonary embolus within 3 months …half of these cases are asymptomatic, however, in 25% of cases sudden death is the first symptom.
Whilst 10% of clots form either in the upper limbs or mesenteric system, the vast majority of clots-90%- occur in the lower limbs. Although pulmonary emboli may include fat, amniotic fluid, may be septic or be formed from contaminants such as talc we will restrict discussions in this podcast to blood clots and focus on lower limb clots.
This is potentially a huge subject with multiple factors leading to abnormal clotting, excessive clotting, and subsequent potentially fatal thromboembolism. The more one considers coagulation in both the normal and pathophysiologic states the more fascinating the subject becomes. No wonder then that Associate Professor Sanjeev Chunilal from Monash Health has developed a deep interest and expertise in this subject. Sanjeev completed a clinical and research fellowship in venous thromboembolism at McMaster University Ontario Canada, has published widely and is a member of the International Society of Thrombosis and Haemostasis as well as the Australasian Society of Thrombosis and Haemostasis, please welcome Sanjeev to the podcast.
References:
Associate professor Sanjeev Chunilal: jessiemcpherson.org, monashpathology.org
www.ncbi.nlm.nih.gov: Deep venous Thrombosis: pathogenesis, diagnosis, and medical management,2017
Khan Academy-khanacademy.org
Australian Family Physician VOL 39, No 7 July 2010
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 89. Myasthenia Gravis and Gulian Barre Syndrome with Professor Ernest Butler
The Guillain Barre syndrome is an acute inflammatory demyelinating polyradiculopathy and although relatively rare (0.4-2 per 100,000) it is still the most common cause of acute flaccid neuromuscular paralysis worldwide. It famously affected Joseph Heller author of Catch-22 and more recently AFL football Legend Alexander Clarkson. It is an immune-mediated disorder that affects the peripheral nervous system and is another example of molecular mimicry, occurring 1 to 6 weeks after a respiratory infection, Campylobacter enterocolitis, and rarely after trauma or surgery. In 1 in a million cases, GB may develop after the influenza vaccine.
Myasthenia gravis is an autoimmune disorder most commonly observed in women under the age of 40 years and in men over the age of 60 years where antibodies form against the nicotinic acetylcholine receptor at the neuromuscular junction (85% of cases), muscle-specific tyrosine kinase (MuSK 7-10%) or low-density lipoprotein receptor-related protein 4 (LRP 4-5%)-the MuSK 7 and LRP4 are both important to the health of the neuromuscular junction. MG results in muscle fatigue especially of the eyes, facial muscles and bulbar muscles.
To discuss these two interesting conditions we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has major clinical expertise in the management of both acute and chronic neurological conditions, please join me in this conversation with Ernie.
The Guillain Barre syndrome is an acute inflammatory demyelinating polyradiculopathy and although relatively rare (0.4-2 per 100,000) it is still the most common cause of acute flaccid neuromuscular paralysis worldwide. It famously affected Joseph Heller author of Catch-22 and more recently AFL football Legend Alexander Clarkson. It is an immune-mediated disorder that affects the peripheral nervous system and is another example of molecular mimicry, occurring 1 to 6 weeks after a respiratory infection, Campylobacter enterocolitis, and rarely after trauma or surgery. In 1 in a million cases, GB may develop after the influenza vaccine.
Myasthenia gravis is an autoimmune disorder most commonly observed in women under the age of 40 years and in men over the age of 60 years where antibodies form against the nicotinic acetylcholine receptor at the neuromuscular junction (85% of cases), muscle-specific tyrosine kinase (MuSK 7-10%) or low-density lipoprotein receptor-related protein 4 (LRP 4-5%)-the MuSK 7 and LRP4 are both important to the health of the neuromuscular junction. MG results in muscle fatigue especially of the eyes, facial muscles and bulbar muscles.
To discuss these two interesting conditions we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has major clinical expertise in the management of both acute and chronic neurological conditions, please join me in this conversation with Ernie.
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 88. Multiple Sclerosis with Ernest Butler
Multiple sclerosis is an autoimmune neurodegenerative disease of the brain and spinal cord resulting in CNS demyelination affecting 2.8 million people worldwide and 23,000 Australians. There are about 1000 new cases diagnosed in Australia each year and the accumulation of disability can be devastating with an estimated 50 to 80% of patients ceasing full-time work within 10 years. The condition is 3 times more common in women and is most often seen between the ages of 20 and 40 years. The damage in multiple sclerosis is caused by a type IV hypersensitivity reaction and may reflect molecular mimicry with activated T cells crossing the blood-brain barrier and attacking CNS myelin which is produced by oligodendrocytes (myelin in the peripheral nervous system is made by Schwann cells).
Multiple sclerosis is an autoimmune neurodegenerative disease of the brain and spinal cord resulting in CNS demyelination affecting 2.8 million people worldwide and 23,000 Australians. There are about 1000 new cases diagnosed in Australia each year and the accumulation of disability can be devastating with an estimated 50 to 80% of patients ceasing full-time work within 10 years. The condition is 3 times more common in women and is most often seen between the ages of 20 and 40 years. The damage in multiple sclerosis is caused by a type IV hypersensitivity reaction and may reflect molecular mimicry with activated T cells crossing the blood-brain barrier and attacking CNS myelin which is produced by oligodendrocytes (myelin in the peripheral nervous system is made by Schwann cells).
Environmental and genetic factors play a role in the aetiology with a higher incidence of multiple sclerosis identified in patients living north of 40 degrees (north of Beijing and including much of Europe Russia the northern parts of the United States and Canada) or South of 40 degrees (Tasmania) raising speculation about the role of ultraviolet light and vitamin D. MS is 15 times more likely when a 1st-degree relative is affected and concordance with monozygotic twins is about 25%. Obesity, smoking, high intake of dietary saturated fats and Epstein-Barr virus have also been implicated.
Despite the distressing nature of this neurodegenerative condition many treatments are evolving to manage both acute episodes (steroids, plasmapheresis) and to prevent further damage (from Interferon beta and Glatiramer acetate to Ocrelizumab, Natalizumab and Stem cell therapy amongst others).
To guide us through this complex subject we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has a major clinical expertise in the management of multiple sclerosis amongst many other acute and chronic neurological conditions, please join me in this conversation with Ernie.
References:
Assoc professor Ernie Butler: Frankston neurology.com.au
www.ninds.nih.gov , Multiple sclerosis : Hope Through Research
www.sciencedirect.com , Multiple Sclerosis-an overview
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 87. Neuroendocrine tumours with Professor Rodney Hicks, Dr Michael Lee and Megan Rogers (Part 2)
Neuroendocrine tumours represent neoplasms of the diffuse neuroendocrine system (DNES) which is our body’s largest endocrine organ comprised of the fascinating amine precursor uptake and decarboxylase (APUD) cell series first described in the 1960s by British scientist A.G.E Pearse. These cells can produce numerous peptides and bioactive amines. Influenced by both the endocrine and nervous systems as well as by the chemistry in their local environment, neuroendocrine cells play a vital role in intracellular signalling and ensure the integrated functioning of many organs and systems within the human body working in both paracrine and endocrine fashion. The signalling molecules produced by the diffuse neuroendocrine system represent a universal chemical language, a vital contributor to the regulation of homeostasis. Cells of the DNES are found throughout the body and are present in almost every organ with well-known examples in the lining of the Gi tract, the lungs, pancreas, thymus, thyroid, brain, adrenal glands etc…
Neuroendocrine tumours represent neoplasms of the diffuse neuroendocrine system (DNES) which is our body’s largest endocrine organ comprised of the fascinating amine precursor uptake and decarboxylase (APUD) cell series first described in the 1960s by British scientist A.G.E Pearse. These cells can produce numerous peptides and bioactive amines. Influenced by both the endocrine and nervous systems as well as by the chemistry in their local environment, neuroendocrine cells play a vital role in intracellular signalling and ensure the integrated functioning of many organs and systems within the human body working in both paracrine and endocrine fashion. The signalling molecules produced by the diffuse neuroendocrine system represent a universal chemical language, a vital contributor to the regulation of homeostasis. Cells of the DNES are found throughout the body and are present in almost every organ with well-known examples in the lining of the Gi tract, the lungs, pancreas, thymus, thyroid, brain, adrenal glands etc…
Neoplastic transformation results in the development of neuroendocrine tumours (NET’S) most commonly in the small bowel (~60%) followed by the lungs (~27%) and pancreas.
Whilst considered rare more than 5000 diagnoses per year occur in Australia which is more than the combined number of annually reported pancreatic and gastric malignancies. Unfortunately, up to 60% of cases are advanced at the time of diagnosis with metastases and is not uncommon for patients to be misdiagnosed with irritable bowel syndrome. Neuroendocrine tumours may be functional or non-functional (the majority), they may be poorly or well-differentiated, low-grade or high-grade.
NET's have somatostatin receptors (there are 5 known receptors) on the cell surface and up to 80% of NET's express somatostatin receptor 2 which octreotide has a strong attraction for. The gallium dotatate scan exploits this fact by detecting the presence of the somatostatin 2 receptor.
Neuroendocrine cells also contain vesicles stacked with chromogranin which has been utilised as a relatively sensitive and specific marker for NET although elevated levels of this marker may be seen with proton pump inhibitors, renal impairment and atrophic gastritis. 24-hour measurement of urinary 5 hydroxy indole 3 acetic acids (5-HIAA), the degradation product of serotonin, is a useful laboratory marker for NETs producing serotonin.
I was particularly interested to explore this extensive subject further with Professor Rodney Hicks, Dr Michael Lee and Megan Rogers from the Peter MacCallum Cancer Centre all experts in managing neuroendocrine tumours and I was keen to discuss peptide receptor radionucleotide therapy (PRRT) which Professor Hicks whose expertise with this therapy is world renown. Please welcome them to this two-part podcast.
REFERENCES:
petermac.org
neuroendocrine.org.au
www.ncbi.nih.gov (Australian experience of peptide receptor radionuclide therapy in lung neuroendocrine tumours,2020)
www.sciencedirect.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 86. Neuroendocrine tumours with Professor Rodney Hicks, Dr Michael Lee and Megan Rogers (Part 1)
Neuroendocrine tumours represent neoplasms of the diffuse neuroendocrine system (DNES) which is our body’s largest endocrine organ comprised of the fascinating amine precursor uptake and decarboxylase (APUD) cell series first described in the 1960s by British scientist A.G.E Pearse. These cells can produce numerous peptides and bioactive amines. Influenced by both the endocrine and nervous systems as well as by the chemistry in their local environment, neuroendocrine cells play a vital role in intracellular signalling and ensure the integrated functioning of many organs and systems within the human body working in both paracrine and endocrine fashion. The signalling molecules produced by the diffuse neuroendocrine system represent a universal chemical language, a vital contributor to the regulation of homeostasis. Cells of the DNES are found throughout the body and are present in almost every organ with well-known examples in the lining of the Gi tract, the lungs, pancreas, thymus, thyroid, brain, adrenal glands etc…
Neuroendocrine tumours represent neoplasms of the diffuse neuroendocrine system (DNES) which is our body’s largest endocrine organ comprised of the fascinating amine precursor uptake and decarboxylase (APUD) cell series first described in the 1960s by British scientist A.G.E Pearse. These cells can produce numerous peptides and bioactive amines. Influenced by both the endocrine and nervous systems as well as by the chemistry in their local environment, neuroendocrine cells play a vital role in intracellular signalling and ensure the integrated functioning of many organs and systems within the human body working in both paracrine and endocrine fashion. The signalling molecules produced by the diffuse neuroendocrine system represent a universal chemical language, a vital contributor to the regulation of homeostasis. Cells of the DNES are found throughout the body and are present in almost every organ with well-known examples in the lining of the Gi tract, the lungs, pancreas, thymus, thyroid, brain, adrenal glands etc…
Neoplastic transformation results in the development of neuroendocrine tumours (NET’S) most commonly in the small bowel (~60%) followed by the lungs (~27%) and pancreas.
Whilst considered rare more than 5000 diagnoses per year occur in Australia which is more than the combined number of annually reported pancreatic and gastric malignancies. Unfortunately, up to 60% of cases are advanced at the time of diagnosis with metastases and is not uncommon for patients to be misdiagnosed with irritable bowel syndrome.
Neuroendocrine tumours may be functional or non-functional (the majority), they may be poorly or well-differentiated, low-grade or high-grade.
NET's have somatostatin receptors (there are 5 known receptors) on the cell surface and up to 80% of NET's express somatostatin receptor 2 which octreotide has a strong attraction for. The gallium dotatate scan exploits this fact by detecting the presence of the somatostatin 2 receptor.
Neuroendocrine cells also contain vesicles stacked with chromogranin which has been utilised as a relatively sensitive and specific marker for NET although elevated levels of this marker may be seen with proton pump inhibitors, renal impairment and atrophic gastritis. 24-hour measurement of urinary 5 hydroxy indole 3 acetic acids (5-HIAA), the degradation product of serotonin, is a useful laboratory marker for NETs producing serotonin.
I was particularly interested to explore this extensive subject further with Professor Rodney Hicks, Dr Michael Lee and Megan Rogers from the Peter MacCallum Cancer Centre all experts in managing neuroendocrine tumours and I was keen to discuss peptide receptor radionucleotide therapy (PRRT) which Professor Hicks whose expertise with this therapy is world renown.
Please welcome them to this two-part podcast.
REFERENCES:
petermac.org
neuroendocrine.org.au
www.ncbi.nih.gov (Australian experience of peptide receptor radionuclide therapy in lung neuroendocrine tumours,2020)
www.sciencedirect.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Special Episode 11. Anti Virals for COVID-19 with Dr Alex Tai
As case numbers and deaths continue to climb from Covid-19 infection and its many variants, two antiviral drugs have entered the market and are now available on the Australian PBS with specific prescription criteria to be met. So, what are they and what do they do?
As case numbers and deaths continue to climb from Covid 19 infection and its many variants, two antiviral drugs have entered the market and are now available on the Australian PBS with specific prescription criteria to be met. So, what are they and what do they do?
Molnupiravir - Made by Merck in collaboration with Ridgeback Biotherapeutics was the 1st to be introduced to Australia as a trade named Lagevrio available from March 1st. This drug is a polymerase inhibitor administered as four tablets twice daily for a five-day course and works by stopping Covid 19’s genetic material from being replicated accurately. By inhibiting the virus’s own polymerase, it induces replication errors so that ultimately the virus is unable to survive with these. This is the so-called catastrophe method. A question for our guest relates to this drug’s safety…. for example: Could this drug also affect host enzymes?
Paxlovid - takes a different approach the drug consists of Nirmatrevir, and an existing drug called Ritonavir. These are protease inhibitors affecting the viral proteases which cut apart long strands of non-functional viral protein into smaller functional proteins. Nirmatrevir is the drug working on this whilst Ritonavir prevents other enzymes from destroying Nirmatrevir. Ritonavir may be found elsewhere and used in anti-HIV cocktails. Paxlovid is also taken BD for five days.
These drugs are most effective when given early and the PBS criteria states these drugs are for adults who have mild to moderate COVID-19 confirmed by a PCR or medically verified RAT and who can start treatment within 5 days of symptom onset if:
o they are 65 years of age or older, with two other risk factors for severe disease (as increasing age is a risk factor, patients who are 75 years of age or older only need to have one other risk factor); or
o they identify as Aboriginal or Torres Strait Islander origin and are 50 years of age or older with two other risk factors for severe disease, or
o they are moderate to severely immunocompromised.
We should draw attention to:
Evushield (Tixagevimab+ Cilgavimab) and Sotrovimab
We need a primer on who should receive these and will discuss this with our guest shortly.
And what about other drugs that have at times perhaps controversially been recommended around the globe such as?:
Chloroquine and Ivermectin
And then is there an early place for steroid prescription?
To expand our knowledge on this emerging and complex subject please welcome to the podcast Dr Alex Tai Infectious Diseases specialist with a special interest in public health, tropical medicine, multi drug microbial resistance and travel medicine.
For more information on this episode please visit: https://www.gihealth.com.au/everyday-medicine-podcast-blog/special-episode-11-anti-virals-for-covid-19-with-dr-alex-tai
References:
Dr Alex Tai-Infectious Diseases Physician-
www.bawbawphysicians.com.au
What GPs need to know about the new Covid antivirals: www1.racgp.org.au
Antiviral treatments for Covid 19-NPS MedicineWise-www.nps.org.au
Liverpool COVID -19 Interactions : www.covid19-druginteractions.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 84. Lymphoma with Professor Stephen Opat (Part 2)
Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.
Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.
There are over 70 different types of lymphoma which are divided into 2 main groups: Hodgkin's lymphoma accounts for 10% of cases and non-Hodgkin's lymphoma accounts for 90% of cases.
Hodgkin's lymphoma named after Thomas Hodgkin (1832) is more common in men, and tends to occur at a younger age than non-Hodgkin's lymphoma with a bimodal age distribution but the average age at diagnosis of 39 years and involves lymph nodes frequently on just one side of the body usually above the diaphragm. The tumour cell is referred to as the Reed Sternberg cell which is a bi or multi-nucleated B cell comprising characteristically just 1% of the lymphoma mass. Just to make this nomenclature interesting there is classic Hodgkins which make up about 95 % of cases and of which nodular sclerosing comprises about 70 % and mixed cellularity 20-25 % and non-classic Hodgkins is characterised by nodular lymphocytic predominant pathology.
Non-Hodgkin's lymphoma can occur at any age and although the median age at diagnosis is 67 years it is one of the more common cancers among children, teens and young adults, none the less the risk of developing NHL increases throughout life and more than half the patients with NHL are 65 years or older at diagnosis. It is also more common amongst men and those with autoimmune diseases or a family history of hematologic malignancies. Presentations often involve the finding of involved lymph nodes on either side of the diaphragm. 85% of non-Hodgkin lymphomas are B cells in origin, and 15% are T cells. The most common the B cell non-Hodgkin lymphomas are diffuse large B cells -accounting for 37% of NHL cases, followed by follicular 29%, Malt 9% and Mantle cells 7%.
This is a complex and vast subject with a number of environmental factors and associated diseases influencing the fascinating pathogenesis of lymphoma which goes to the heart of B cell biology and our immune systems’ task of fighting for our lives against antigen invaders. There are a host of treatment options available with new emerging therapies at the cutting edge of medicine and it was a privilege to have a conversation with Professor Stephen OPAT -and to journey for a short time into his world of haematology. Stephen is the professor and director of clinical haematology at MMC and has a special interest in lymphoma, chronic leukaemia, cancer genomics and disorders of metabolism. I found Stevens’ conversation incredibly insightful and welcome you to this podcast:
References:
www.melbournehaematology.com.au
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 83. Lymphoma with Professor Stephen Opat (Part 1)
Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.
There are over 70 different types of lymphoma which are divided into 2 main groups: Hodgkin's lymphoma accounts for 10% of cases and non-Hodgkin's lymphoma accounts for 90% of cases.
Hodgkin's lymphoma named after Thomas Hodgkin (1832) is more common in men, and tends to occur at a younger age than non-Hodgkin's lymphoma with a bimodal age distribution but the average age at diagnosis of 39 years and involves lymph nodes frequently on just one side of the body usually above the diaphragm. The tumour cell is referred to as the Reed Sternberg cell which is a bi or multi-nucleated B cell comprising characteristically just 1% of the lymphoma mass. Just to make this nomenclature interesting there is classic Hodgkins which make up about 95 % of cases and of which nodular sclerosing comprises about 70 % and mixed cellularity 20-25 % and non-classic Hodgkins is characterised by nodular lymphocytic predominant pathology.
Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.
There are over 70 different types of lymphoma which are divided into 2 main groups: Hodgkin's lymphoma accounts for 10% of cases and non-Hodgkin's lymphoma accounts for 90% of cases.
Hodgkin's lymphoma named after Thomas Hodgkin (1832) is more common in men, and tends to occur at a younger age than non-Hodgkin's lymphoma with a bimodal age distribution but the average age at diagnosis of 39 years and involves lymph nodes frequently on just one side of the body usually above the diaphragm. The tumour cell is referred to as the Reed Sternberg cell which is a bi or multi-nucleated B cell comprising characteristically just 1% of the lymphoma mass. Just to make this nomenclature interesting there is classic Hodgkins which make up about 95 % of cases and of which nodular sclerosing comprises about 70 % and mixed cellularity 20-25 % and non-classic Hodgkins is characterised by nodular lymphocytic predominant pathology.
Non-Hodgkin's lymphoma can occur at any age and although the median age at diagnosis is 67 years it is one of the more common cancers among children, teens and young adults, none the less the risk of developing NHL increases throughout life and more than half the patients with NHL are 65 years or older at diagnosis. It is also more common amongst men and those with autoimmune diseases or a family history of hematologic malignancies. Presentations often involve the finding of involved lymph nodes on either side of the diaphragm. 85% of non-Hodgkin lymphomas are B cells in origin, and 15% are T cells. The most common the B cell non-Hodgkin lymphomas are diffuse large B cells -accounting for 37% of NHL cases, followed by follicular 29%, Malt 9% and Mantle cells 7%.
This is a complex and vast subject with a number of environmental factors and associated diseases influencing the fascinating pathogenesis of lymphoma which goes to the heart of B cell biology and our immune systems’ task of fighting for our lives against antigen invaders. There are a host of treatment options available with new emerging therapies at the cutting edge of medicine and it was a privilege to have a conversation with Professor Stephen OPAT -and to journey for a short time into his world of haematology. Stephen is the professor and director of clinical haematology at MMC and has a special interest in lymphoma, chronic leukaemia, cancer genomics and disorders of metabolism. I found Stevens’ conversation incredibly insightful and welcome you to this podcast:
References:
www.melbournehaematology.com.au
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Special Episode 10. Monkeypox and Japanese Encephalitis with Dr Alex Tai
In May this year, new cases of the rare infection-Monkey Pox - typically limited to Africa, began spreading within Europe and North America.
More than 780 cases have now been reported across 15 countries with Australia recently reporting 8 cases.
Monkeypox is a viral zoonotic disease, a member of the same family of viruses as smallpox and typically is spread through close physical contact with skin lesions, body fluids, respiratory droplets, and contaminated materials such as bedding and is much less infectious than respiratory illnesses such as Covid 19. Transmission of Monkey pox virus by respiratory droplets would normally require prolonged face-to-face contact, so the apparent rapid spread of the virus may signal a shift in its behaviour and some scientists have questioned if the virus may have mutated to become more transmissible. Two strains have been identified.
In May this year, new cases of the rare infection-Monkey Pox - typically limited to Africa, began spreading within Europe and North America.
More than 780 cases have now been reported across 15 countries with Australia recently reporting 8 cases.
Monkeypox is a viral zoonotic disease, a member of the same family of viruses as smallpox and typically is spread through close physical contact with skin lesions, body fluids, respiratory droplets, and contaminated materials such as bedding and is much less infectious than respiratory illnesses such as Covid 19. Transmission of Monkey pox virus by respiratory droplets would normally require prolonged face-to-face contact, so the apparent rapid spread of the virus may signal a shift in its behaviour and some scientists have questioned if the virus may have mutated to become more transmissible. Two strains have been identified.
The west African strain has a 1-3% mortality and is the strain currently spreading beyond Africa. The Central African strain is more deadly with a 10% mortality rate.
Infection is characterised by: Lymphadenopathy, muscle aches, fever, headache, and a pustular rash developing 1-3 days after the fever and typically starting on the face before spreading to other parts of the body.
It’s estimated that just 3% of close contacts of Monkeypox will become infected however asymptomatic spread is being postulated and another unusual feature of the current outbreak is the detection of cases through sexual health services and amongst same-sex men.
As smallpox was declared eradicated in 1980 the last mass vaccination against smallpox was in the 1970’s and it is speculated that declining herd levels of immunity against smallpox may be leading to the current propensity for transmission.
I thought it may also be interesting to expand the conversation with our guest beyond Monkeypox to discuss the recent spike in cases of Japanese encephalitis reported in Australia, noting that JEV is a mosquito-born presenting with fever, vomiting and headache and linked to piggeries as well as pig handling and abattoirs.
Please welcome Dr Alex Tai Infectious Diseases specialist with a special interest in public health, tropical medicine, multi-drug microbial resistance and travel medicine.
References:
Dr Alex Tai-Infectious Diseases Physician-www.bawbawphysicians.com.au
www1.racgp.org.au -Monkeypox exposure
Monkeypox-Fact sheets-NSW Health-www.health.nsw.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.