Episode 133. Ehlers-Danlos and Hypermobility Syndromes with Associate Professor Chris O'Callaghan
Hypermobile joints were noted by Hippocrates as long ago as 400 BCE and are common, occurring in about 10-25 % of the population. In a minority of patients’ pain and injury results suggest that the clinical findings may reflect a condition referred to as hypermobility spectrum disorder, a polygenic connective tissue syndrome affecting between 1:500 to 1:600 people. This syndrome involves extreme joint flexibility often associated with joint pains, tends to run in families and is more common amongst females. Hypermobility spectrum disorder has been redefined separately from the more stringent diagnostic criteria required for the diagnosis of more extreme hypermobility syndromes such as Ehlers-Danlos syndrome, Marfans disease, Loeys-Dietz or Osteogenesis imperfecta syndromes.
Hypermobile joints were noted by Hippocrates as long ago as 400 BCE and are common, occurring in about 10-25 % of the population. In a minority of patients’ pain and injury results suggest that the clinical findings may reflect a condition referred to as hypermobility spectrum disorder, a polygenic connective tissue syndrome affecting between 1:500 to 1:600 people. This syndrome involves extreme joint flexibility often associated with joint pains, tends to run in families and is more common amongst females. Hypermobility spectrum disorder has been redefined separately from the more stringent diagnostic criteria required for the diagnosis of more extreme hypermobility syndromes such as Ehlers-Danlos syndrome, Marfans disease, Loeys-Dietz or Osteogenesis imperfecta syndromes.
In relation to the above-mentioned syndromes in 1901 a Danish doctor, Dr Lauritz-Edvard Ehlers presented a case of hypermobility, and a similar case was subsequently presented by French physician Dr Henri-Alexandre Danlos in 1908. The name Ehlers-Danlos syndrome (EDS) wasn’t proposed until many years later in 1936 by Englishman Dr Parkes-Weber. We now recognize 13 types of Ehlers-Danlos syndrome with hypermobile EDS as the most common and myopathic EDS, Spondylodysplastic classical EDS and brittle cornea syndrome as just some of the others. About 1: 3500 to 1: 5000 people have EDS. Both dominant and recessive inheritance patterns are noted. Frequent joint and ligament injuries including sprains and dislocations may occur and joint stiffness, clumsiness, fatigue dizziness and associated bowel and bladder complaints are often cited.
Another well-known hypermobility disorder Marfans syndrome is rare affecting about 1 in 5000 and in three-quarters of cases, inheritance is autosomal dominant with the defective fibrillin gene resulting in tall individuals with slender limbs, fingers and toes, cardiac defects including aortic dissections, aortic root aneurysms and valvular incompetence, lens dislocations as well as the high arched palate, crowded teeth and abnormal sternum development (pectus excavatum or pectus carinatum ). A quarter of cases experience a new gene mutation with no family pedigree identified.
These hypermobility conditions have common abnormalities in collagen structure and function. Whilst genetic studies are available in some cases of hypermobility (but not hypermobility spectrum disorder), the criteria for diagnosis referred to as The Beighton criteria are essentially clinical and includes a Beighton score reflecting joint extensibility and mobility combined with arthralgia over 3 months, dislocations and subluxations, soft tissue lesions such as epicondylitis, tenosynovitis and bursitis, Marfanoid habitus and abnormal skin with striae, hyperextensibility, thin skin and papyraceous scarring.
No cure is currently known for these syndromes which are managed symptomatically. Fortunately, societies such as the Ehlers-Danlos Society and physicians such as Assoc Professor Chris O’Callaghan from Melbourne’s Austin Health are the most helpful resources and I welcome you to the interview with Chris to expand our understanding of this subject today.
References:
Assoc Professor Chris O’Callaghan: www.austin.org.au
The Ehlers Danlos Society: www.ehlers-danlos.com
Ehlers-Danlos syndromes: www.nhs.uk
Episode 132. Acid Base Balance with Associate Professor Adrian Regli (Part 2)
Acid-Base theory is often considered a difficult subject. As long ago as 1962, Creese et al wrote in the Lancet … “There is a bewildering variety of pseudoscientific jargon in medical writing on this subject “My suspicion is that some degree of confusion and thus avoidance of the subject continues to this day. Hopefully, this podcast conversation will resonate with some of our listeners and smooth out any misunderstandings should they exist.
Acid-Base theory is often considered a difficult subject. As long ago as 1962, Creese et al wrote in the Lancet … “There is a bewildering variety of pseudoscientific jargon in medical writing on this subject “My suspicion is that some degree of confusion and thus avoidance of the subject continues to this day. Hopefully, this podcast conversation will resonate with some of our listeners and smooth out any misunderstandings should they exist.
As a background, Bronsted and Lowrys definitions of acids and bases are as follows: A base is a substance that accepts a proton (a hydrogen ion) an acid is a compound that dissociates in water to release a proton. A strong acid is one that readily dissociates in water to release a proton (eg HCL), and a weak acid does not readily dissociate in water (uric acid). pH is the negative logarithm of the hydrogen ion concentration to the base 10. Thus, the negative logarithm of 0.0000001 which may be expressed as 10 to the power of -7 is 7.
The reason blood and cellular pH are so important is that their stability is essential to the integrity of enzymes, metabolic processes, and cell membrane potential. Homeostasis holds our blood pH tightly between 7.35 and 7.45 with an intracellular pH of 6.8.
Where does the acid come from?
Acid production results from the production of CO2 by metabolism of glucose, fatty acids, and amino acids. CO2 combines with water and is converted to carbonic acid -H2CO3 by carbonic anhydrase and then dissociates to H+ and HCO3-. That enzyme carbonic anhydrase pops up everywhere.
Acid production also results from anaerobic glucose metabolism whereby glucose is converted to H+ and lactate in ketogenesis as well as from the catabolism of the amino acids: methionine and cysteine.
Which organs play a major role in the maintenance of pH?
Both the lungs and kidneys play critical roles in acid-base balance. We exhale CO2 from the lungs effectively blowing off acid but may also retain CO 2 by underventilation.
The kidneys have the potential to excrete or absorb bicarbonate and to excrete or reabsorb protons (hydrogen ions) influencing and compensating for pH disturbance through an intricate juggling of these two. The excretion of protons is by combination with ammonia from the metabolism of muscle glutamine or in combination with monohydrogen phosphate. These ingenious biological systems may be influenced by multiple disease processes and respiratory forms of acidosis and alkalosis as well as metabolic processes leading to acidosis and alkalosis are well recognised.
Whilst arterial blood gas assessment is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body, arterial puncture may result in complications, and the difficulty in acquiring arterial blood may delay care. Venous blood gas (VBG) is a more accessible alternative to ABG sampling and correlates well with arterial sampling in pH measurement (slightly lower in venous sample) and HCO3 - (1.41 mmol/l higher in venous) with pCO2 approximately 5.6 mmHg higher in venous blood. These differences may be exaggerated however in circulatory failure.
In this podcast with ICU physician Associate Professor Adrian Regli, we will explore the subject further, delve into some of the typical metabolic and respiratory disturbances we are likely to encounter as clinicians and also review some handy rules of thumb to draw upon in practical acid-base interpretation. Currently, Adrian works as an ICU consultant at Fiona Stanley Hospital Perth. Please welcome Adrian to the Podcast.
References
Assoc Professor Adrian Regli - via Google
Oh’s Intensive Care Manual, Bersten et al 6 th ED, Butterworth
Medical Biochemistry at a Glance, Salway,3rd ED, Wiley-Blackwell
Acid-Base Disorders in the Critically Ill Patient, Achanti et al CJASN, Sept 2022
Episode 131. Acid Base Balance with Associate Professor Adrian Regli (Part 1)
Acid-Base theory is often considered a difficult subject. As long ago as 1962, Creese et al wrote in the Lancet … “There is a bewildering variety of pseudoscientific jargon in medical writing on this subject “My suspicion is that some degree of confusion and thus avoidance of the subject continues to this day. Hopefully, this podcast conversation will resonate with some of our listeners and smooth out any misunderstandings should they exist.
Acid-Base theory is often considered a difficult subject. As long ago as 1962, Creese et al wrote in the Lancet … “There is a bewildering variety of pseudoscientific jargon in medical writing on this subject “My suspicion is that some degree of confusion and thus avoidance of the subject continues to this day. Hopefully, this podcast conversation will resonate with some of our listeners and smooth out any misunderstandings should they exist.
As a background, Bronsted and Lowrys definitions of acids and bases are as follows: A base is a substance that accepts a proton (a hydrogen ion) an acid is a compound that dissociates in water to release a proton. A strong acid is one that readily dissociates in water to release a proton (eg HCL), and a weak acid does not readily dissociate in water (uric acid). pH is the negative logarithm of the hydrogen ion concentration to the base 10. Thus, the negative logarithm of 0.0000001 which may be expressed as 10 to the power of -7 is 7.
The reason blood and cellular pH are so important is that their stability is essential to the integrity of enzymes, metabolic processes, and cell membrane potential. Homeostasis holds our blood pH tightly between 7.35 and 7.45 with an intracellular pH of 6.8.
Where does the acid come from?
Acid production results from the production of CO2 by metabolism of glucose, fatty acids, and amino acids. CO2 combines with water and is converted to carbonic acid -H2CO3 by carbonic anhydrase and then dissociates to H+ and HCO3-. That enzyme carbonic anhydrase pops up everywhere.
Acid production also results from anaerobic glucose metabolism whereby glucose is converted to H+ and lactate in ketogenesis as well as from the catabolism of the amino acids: methionine and cysteine.
Which organs play a major role in the maintenance of pH?
Both the lungs and kidneys play critical roles in acid-base balance. We exhale CO2 from the lungs effectively blowing off acid but may also retain CO 2 by underventilation.
The kidneys have the potential to excrete or absorb bicarbonate and to excrete or reabsorb protons (hydrogen ions) influencing and compensating for pH disturbance through an intricate juggling of these two. The excretion of protons is by combination with ammonia from the metabolism of muscle glutamine or in combination with monohydrogen phosphate. These ingenious biological systems may be influenced by multiple disease processes and respiratory forms of acidosis and alkalosis as well as metabolic processes leading to acidosis and alkalosis are well recognised.
Whilst arterial blood gas assessment is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body, arterial puncture may result in complications, and the difficulty in acquiring arterial blood may delay care. Venous blood gas (VBG) is a more accessible alternative to ABG sampling and correlates well with arterial sampling in pH measurement (slightly lower in venous sample) and HCO3 - (1.41 mmol/l higher in venous) with pCO2 approximately 5.6 mmHg higher in venous blood. These differences may be exaggerated however in circulatory failure.
In this podcast with ICU physician Associate Professor Adrian Regli, we will explore the subject further, delve into some of the typical metabolic and respiratory disturbances we are likely to encounter as clinicians and also review some handy rules of thumb to draw upon in practical acid-base interpretation. Currently, Adrian works as an ICU consultant at Fiona Stanley Hospital Perth. Please welcome Adrian to the Podcast.
References
Assoc Professor Adrian Regli - via Google
Oh’s Intensive Care Manual, Bersten et al 6 th ED, Butterworth
Medical Biochemistry at a Glance, Salway,3rd ED, Wiley-Blackwell
Acid-Base Disorders in the Critically Ill Patient, Achanti et al CJASN, Sept 2022
Special Episode 15. Rheumatic Fever with Dr Alex Tai
Acute Rheumatic fever (ARF) is a multisystem disease caused by an immunological response to Group A streptococcal infection leading to Rheumatic heart disease (RHD) and is responsible for 250,000 deaths per year worldwide, predominantly in young people. It is estimated that 15 million people across the globe have evidence of Rheumatic heart disease. In Australia, the estimated incidence is reflective of ethnicity with 65 per 100 000 infections among Aboriginal and Torres Strait Islander people compared with 3 per 100 000 for other Australians. Consequently, 92% of the ARF reported is among Aboriginal and Torres Strait Islander people, mostly affecting children aged 5-14 years with rates of ARF and Rheumatic heart disease highest across northern and central Australia.
Acute Rheumatic fever (ARF) is a multisystem disease caused by an immunological response to Group A streptococcal infection leading to Rheumatic heart disease (RHD) and is responsible for 250,000 deaths per year worldwide, predominantly in young people. It is estimated that 15 million people across the globe have evidence of Rheumatic heart disease. In Australia, the estimated incidence is reflective of ethnicity with 65 per 100 000 infections among Aboriginal and Torres Strait Islander people compared with 3 per 100 000 for other Australians. Consequently, 92% of the ARF reported is among Aboriginal and Torres Strait Islander people, mostly affecting children aged 5-14 years with rates of ARF and Rheumatic heart disease highest across northern and central Australia.
Recent research has found that Aboriginal and or Torres Strait Islander people are ten times more likely and Pacific Islander people 82 times more likely to have an episode of ARF than other ethnicities.
Although more than 9000 people are on RHD registers across Australia currently very little is known about the epidemiology of ARF and RHD in southern regions of Australia despite an estimated 57% of the Aboriginal and Torres Strait Islander population living in these regions. Importantly on 31st July this year, acute rheumatic fever and rheumatic heart disease became routine notifiable conditions in Victoria with only Tasmania and the ACT left to enact this important policy.
A new case of ARF is recognised to be 10 times more common in an individual with a past episode of ARF than an individual from the same community without prior ARF underscoring how important disease notification is for secondary prevention. Presently 80 % of people diagnosed with ARF have no prior diagnosis registered.
It was a real honour to welcome back expert infectious diseases specialist Alex Tai who has been passionate about education and bringing forth new issues of an infectious nature for our understanding. It gives me great pleasure to welcome Alex back to Everyday Medicine to discuss this important topic further.
References:
Dr Alex Tai - Gippsland Region Public Health Unit - Monash University. - Baw Baw Physicianshttps://www.bawbawphysicians.com.au › ...Dr Alex Tai - Infectious Diseases Physician
Dr Alex Tai - LinkedIn
Notification of Rheumatic Heart Disease and Acute Rhematic Fever. https://www.health.vic.gov.au/health-advisories/notification-of-rheumatic-heart-disease-and-acute-rhematic-fever
National Treatment Guidelines - www.rhdaustralia.org.au/arf-rhd-guidelines
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 85. Pancreatic Cancer with Dr Michael Lee
Pancreatic cancer is the eighth most common cancer reported in Australia. In 2021, it is estimated that there will be 4261 new cases and 3391 deaths. The incidence has increased from 10 per 100,000 in 1982 -to 12 per 100,000 today with the average age of onset between 60 and 65 years. At the time of diagnosis, approximately one-third of patients already have advanced disease with a limited 3 to 4-month survival prognosis, overall, 1-year survival for pancreatic cancer is only 16% and 5-year survival of 3% despite new approaches to management.
Pancreatic cancer is the eighth most common cancer reported in Australia. In 2021, it is estimated that there will be 4261 new cases and 3391 deaths. The incidence has increased from 10 per 100,000 in 1982 -to 12 per 100,000 today with the average age of onset between 60 and 65 years. At the time of diagnosis, approximately one-third of patients already have advanced disease with a limited 3 to 4-month survival prognosis, overall, 1-year survival for pancreatic cancer is only 16% and 5-year survival of 3% despite new approaches to management.
Risk factors include obesity, smoking (fivefold increase risk) and type 2 diabetes mellitus which after cigarette smoking and obesity is likely the third most modifiable risk factor for pancreatic cancer.
Other risks include family history (7%) and autosomal dominant syndromes such as Hereditary pancreatitis, Peutz-Jeghers syndrome, Hereditary breast and ovarian cancer syndrome (BRCA 2 and 1 genes), and Lynch syndrome and the Familial atypical multiple mole melanoma syndromes.
Additionally, there is probably a risk associated with ongoing heavy alcohol consumption and subsequent chronic pancreatic inflammation.
After imaging and subsequent diagnosis, staging determines locally respectable, borderline respectable, locally advanced unresectable or metastatic disease, and guides the choice of surgery, chemotherapy, radiotherapy and or palliation.
It was a privilege to be joined in this conversation by Dr Michael Lee from the Peter McCallum Cancer Centre, an oncologist specialising in clinical translational genomic research and advanced cancers with a special focus on metastatic pancreatic cancer. Michael trained in Australia and subsequently worked in Vancouver at the BC Cancer and Michael Smith's Science Centre before returning to Melbourne where he is undertaking a PhD with the aim of developing a new novel therapy for pancreatic cancer. Michael’s motto is to provide holistic oncology care with an honest conversation, supported by the latest research from the bench side to the bedside and tailoring it to his patient’s goals and wishes.
References:
www.petermac.org
canceraustralia.gov.au
www.cancer.org.au
www1.racgp.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 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.
Episode 80. Endometriosis with Dr Mei Cheah
Endometriosis is the presence of endometrial tissue outside the uterus or embedded within its muscular wall. This unusual condition is known to induce a chronic inflammatory reaction that may be associated with pelvic pain and infertility. In women of reproductive age the estimated prevalence is 7 to 10% and up to one third of women undergoing laparoscopy for pelvic pain are diagnosed with endometriosis. Endometrial deposits may be deeply infiltrating, found in the abdomen and pelvic region may be invading the ovary but also found in the lungs, pleura and on the diaphragm. Ectopic endometrial tissue within the uterine myometrium is referred to as adenomyosis and may be responsible for heavy menstrual bleeding, some estimates place adenomyosis with a prevalence of 20 to 28%.
Endometriosis is the presence of endometrial tissue outside the uterus or embedded within its muscular wall. This unusual condition is known to induce a chronic inflammatory reaction that may be associated with pelvic pain and infertility. In women of reproductive age the estimated prevalence is 7 to 10% and up to one third of women undergoing laparoscopy for pelvic pain are diagnosed with endometriosis. Endometrial deposits may be deeply infiltrating, found in the abdomen and pelvic region may be invading the ovary but also found in the lungs, pleura and on the diaphragm. Ectopic endometrial tissue within the uterine myometrium is referred to as adenomyosis and may be responsible for heavy menstrual bleeding, some estimates place adenomyosis with a prevalence of 20 to 28%.
Pathogenetic mechanisms including retrograde menstruation and coelomic metaplasia as well as the induction theory have been proposed. In this podcast we have a conversation with obstetrician and gynaecologist Dr Mei Cheah founder of Create Health a leading group of specialists in women's health creating visions for a healthy future, better well being and more informed patient's. Create Health aims to deliver exceptional care across obstetrics, gynaecology, reproductive endocrinology, minimally invasive surgery, fertility and IVF plus allied and complimentary health services. We look forward to exploring the practical aspects of this diagnosis further with you.
References:
Dr Mei Cheah -create-health.com.au
www.endometriosisaustralia.org
www.ncbi.nlm.nig.gov
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 79. Investigations in Rheumatology with Dr Andrew Teichtahl
In this episode we explore investigations in rheumatology - What is helpful and what is not?A clinician faced with a patient complaining of myalgias and generalised rheumatic aches may be tempted to order a host of immunological and inflammatory tests whilst also assessing multiple other differential diagnoses that need considering. There are a host of serological tests available each with different degrees of sensitivity and specificity for rheumatological conditions, furthermore it is important to understand the sensitivity (ability to rule out condition) and specificity (ability to rule condition in) is applied to such tests. Fortunately, we had the opportunity to have a conversation with Dr Andrew Teichtahl who provides excellent clarification on the subject.
In this episode we explore investigations in rheumatology - What is helpful and what is not?
A clinician faced with a patient complaining of myalgias and generalised rheumatic aches may be tempted to order a host of immunological and inflammatory tests whilst also assessing multiple other differential diagnoses that need considering. There are a host of serological tests available each with different degrees of sensitivity and specificity for rheumatological conditions, furthermore it is important to understand the sensitivity (ability to rule out condition) and specificity (ability to rule condition in) is applied to such tests. Fortunately, we had the opportunity to have a conversation with Dr Andrew Teichtahl who provides excellent clarification on the subject.
Andrew is a senior staff specialist at the Alfred Hospital and the National Health and Medical Research Council Fellow at the Baker International Diabetes Institute. He is a chief investigator on two clinical trials funded by the National Health and Medical Research Council (NHMRC) and has authored over 75 publications in internationally peer reviewed journals. In his former life he was also a physiotherapist (a degree he attained with honours) and is passionate in his practice of rheumatology with expertise across rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.
References:
Dr Andrew Teichtahl: www.arthritiscentre.com.au
www.racp.edu.au Investigations: In Medicine-Rheumatology-RACP
www.ncbi.nlm.nih.gov : Common Laboratory Tests for Rheumatological Disorders, ED Gupta 2009
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 78. New Agents in Rheumatology with Dr Andrew Teichtahl
The past two decades have witnessed dramatic changes in the approach to managing rheumatologic conditions, born of a wider understanding of cellular biology, immunology, and the pathophysiology of inflammation we have consequently seen an explosion in the development and availability of both Biologic medications and small molecules for medical applications.
The past two decades have witnessed dramatic changes in the approach to managing rheumatologic conditions, born of a wider understanding of cellular biology, immunology, and the pathophysiology of inflammation we have consequently seen an explosion in the development and availability of both Biologic medications and small molecules for medical applications.
Some of these products are designed to interfere with cytokine function or production and include:
· TNF inhibitors
· TNF receptor fusion proteins
· IL6 inhibitors
· IL-17 inhibitors
· IL-12/23 inhibitors
· T-cell modulators
· B cell modulators
In addition, the development of small molecules as Janus kinase inhibitors has opened up new channels for inflammatory modulation.
It was a great privilege to welcome rheumatologist Dr Andrew Teichtahl to this podcast to help us understand how to apply this new age of science to the practice of rheumatology. Andrew is a senior staff specialist at the Alfred Hospital and the National Health and Medical Research Council Fellow at the Baker International Diabetes Institute. He is a chief investigator on two clinical trials funded by the National Health and Medical Research Council (NHMRC) and has authored over 75 publications in internationally peer reviewed journals. In his former life he was also a physiotherapist (a degree he attained with honours) and is passionate in his practice of rheumatology with expertise across rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.
References:
Dr Andrew Teichtahl: www.arthritiscentre.com.au
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911251/ New era of treatment with biologics in rheumatology – is it time to shift paradigms in treatment with biologics? Anna Felis-Giemza
www.nature.com/articles/nrrheum.2009.197, Are new agents needed to treat RA ?
https://arthritis-research.biomedcentral.com/articles/10.1186/1478-6354-13-S1-S5 Advances in rheumatology: new targeted therapeutics
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 9. New Vaccines with Professor Dale Godfrey
The Peter Doherty Institute was the first Australian laboratory to establish a Covid 19 PCR test and diagnose the first SARS- Cov 2 infection on Australian shores, its research scientist is heavily involved in developing novel diagnostic tools applied across many areas of medical science and the institute plays a key leadership role in advising state and federal government on best medical practice. It’s no great surprise therefore that we have learned of their ground-breaking development of a new subunit Covid 19 vaccine utilising the receptor binding domain at the tip of the virus’s spike proteins. This is the region responsible for virus attachment and infection and for eliciting over 90% of neutralising antibodies following SARS Cov-2 infection. Parallel with the subunit vaccine development, another Melbourne group – the Monash Institute of Pharmaceutical Sciences has developed a similar vaccine but using mRNA technology copying the virus’s genetic sequence that codes for the receptor binding domain.
The Peter Doherty Institute was the first Australian laboratory to establish a Covid 19 PCR test and diagnose the first SARS- Cov 2 infection on Australian shores, its research scientist is heavily involved in developing novel diagnostic tools applied across many areas of medical science and the institute plays a key leadership role in advising state and federal government on best medical practice. It’s no great surprise therefore that we have learned of their ground-breaking development of a new subunit Covid 19 vaccine utilising the receptor binding domain at the tip of the virus’s spike proteins. This is the region responsible for virus attachment and infection and for eliciting over 90% of neutralising antibodies following SARS Cov-2 infection. Parallel with the subunit vaccine development, another Melbourne group – the Monash Institute of Pharmaceutical Sciences has developed a similar vaccine but using mRNA technology copying the virus’s genetic sequence that codes for the receptor binding domain.
These vaccines enter the pantheon of other existing mRNA/viral vector/and subunit protein vaccines already available offering protection against Covid 19 but are different as they focus the immune response to the tip of the spike protein – the important receptor binding domain.
Both new Melbourne developed vaccines are entering phase 1 trials and results will be eagerly awaited.
Professor Dale Godfrey is a senior principal research fellow and immunology theme leader at the Doherty Institute and has played a major role in RBD subunit protein vaccine development.
Please join this conversation where Dale discusses the new vaccine development, their efficacy, and the phase 1 clinical trials evaluating the vaccines further.
References:
Professor Dale Godfrey: godfrey@unimelb.edu.au
doherty.edu.au
Phone: 83449325 for further trial information or at virgo-studies@unimelb.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.