In this episode of The Good GP, host Dr Tim Koh is joined once again by Dr Linny Kimly Phuong, a paediatric infectious diseases physician, researcher, and academic tutor, to discuss Pneumococcal Disease. Being the subject of her PhD, Dr Phuong brings her extensive knowledge and experience on this topic.

Dr Phuong outlines the different clinical manifestations of Pneumococcal Disease, dividing them into invasive and non-invasive categories. Non-invasive diseases include otitis media and sinusitis, while invasive diseases can result in conditions like complicated pneumonia, meningitis, bacteremia, bone and joint infections, endocarditis, and peritonitis.

Discussing the significance of the strep pneumoniae bacteria, which is commonly found in the nasopharynx of healthy individuals. Dr Phuong explains the switch from carriage to disease manifestation and highlights the risk factors for invasive Pneumococcal Disease, including extremes of age, immunocompromise, chronic health conditions, and certain lifestyle factors.

They then turn to pneumococcal vaccines, and the differences between conjugate and polysaccharide vaccines, their valencies, and their impact on clinical practice. Dr Phuong emphasises the importance of vaccination in reducing morbidity and mortality related to Pneumococcal Disease, particularly in young children and older adults.

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

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Mentioned in this episode:

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In this episode of The Good GP, Dr Tim Koh is joined by Dr Linny Kimly Phuong, a paediatric infectious diseases physician, researcher, and academic tutor, to discuss Kawasaki disease.

They began by explaining Kawasaki disease as an inflammatory vasculitis with potential long-term cardiac consequences. Dr Phuong notes that one child is diagnosed with Kawasaki disease every day. While the disease is more common in children under the age of five, it can present at any age and across all ethnic groups, with a higher incidence in children of Asian ethnicity.

They discussed the clinical picture of Kawasaki disease, commonly remembered by the mnemonic "CRASH and burn." This includes Conjunctivitis, Rash, Adenopathy, Strawberry tongue, and Hand/feet changes—all accompanying a prolonged fever. Dr Phuong emphasises the importance of recognising these symptoms even if they do not manifest simultaneously.

They move onto diagnosis, highlighting the absence of diagnostic tests and the reliance on clinical evaluation supported by laboratory tests such as full blood count, inflammatory markers, and liver function tests. Dr Phuong also elaborates on differential diagnoses, including both infectious (e.g., scarlet fever, adenovirus) and non-infectious conditions (e.g., drug hypersensitivity, systemic juvenile idiopathic arthritis).

Finally, outlining the long-term clinical impact of Kawasaki disease, emphasising the importance of treatment with intravenous immunoglobulin and low-dose aspirin to reduce the risk of coronary artery aneurysms. Highlighting the necessity for long-term cardiology follow-up due to the potential for severe complications like coronary artery stenosis and myocardial infarction.

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at Talking HealthTech.

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com

Mentioned in this episode:

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Unlock a 10% discount on Lyrebird Health by using the code GOODGP and discover how this AI scribe can transform your practice by saving you time and ensuring your documentation sounds just like you: www.thegoodgp.com.au/lyrebird

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In this episode, Dr Krystyna de Lange hosts Associate Professor Dr Alireza Ahmadvand, a practising GP with a special interest in gastroenterology at the Princess Alexandra Hospital in Brisbane, to discuss disorders of gut-brain interaction (DGBI).

Dr Ahmadvand elaborates on what DGBIs are and provides the latest insights into the pathophysiology, mentioning conditions such as irritable bowel syndrome and functional dyspepsia. He explains the diagnostic criteria and the importance of recognising these conditions in general practice, and highlights the role of GPs in identifying and ruling out structural abnormalities before considering a DGBI diagnosis.

They also covered the multifactorial nature of these disorders, including the impact of psychological and psychosocial factors, such as stress, anxiety, and depression, and the interactions between gut microbiome and gut function. Dr Ahmadvand outlines when GPs should consider DGBIs and what red flags to watch for, emphasising the importance of comprehensive evaluations and specialist collaboration.

For management, Dr Ahmadvand advocates for a multidisciplinary approach involving dietitians, psychologists, exercise physiologists, and gastroenterologists to provide holistic care. Pharmacological treatments, diet modifications, and psychological interventions, such as Cognitive Behaviour Therapy, are also mentioned as part of a comprehensive management plan.

Lastly, Dr Ahmadvand points GPs towards the Rome Foundation's criteria, the Gastroenterological Society of Australia, and patient-focused platforms like Gut Foundation Australia and the IBS Network. He also encourages keeping alongside of the latest research through journals like Neurogastroenterology and Motility.

Links & Resources:

Rome Iv Diagnostic Criteria For Fgids

• https://theromefoundation.org/rome-iv/rome-iv-criteria/
• https://theromefoundation.org/resources/rome-iv-criteria-booklet/ (downloadable booklet in PDF)

Patient Education Material

Irritable Bowel Syndrome (IBS)

• https://dietitiansaustralia.org.au/health-advice/irritable-bowel-syndrome-ibs
• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/irritable-bowel-syndrome-ibs
• https://www.healthdirect.gov.au/irritable-bowel-syndrome-ibs

Resources From The Australian Journal Of General Practice

The lived experience of irritable bowel syndrome: A focus on dietary management

• https://www1.racgp.org.au/ajgp/2022/june/the-lived-experience-of-irritable-bowel-syndrome

Research Instruments/Projects

Valid Instrument for Evaluating Symptoms in the Clinical Setting - Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS)