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Smart intraocular pressure sensors – coming to a centre near you

June 1, 2018, Dr Chee L Khoo

Source: SENSIMED

We are all familiar with 24-hour BP monitor. We are also familiar with 24-hour Holter monitor and continuous glucose monitoring. We now have 24-hour intraocular pressure monitor. It doesn’t actually monitor intraocular pressure but the effects of it (a bit later). A recent study has now confirmed the association of between the intraocular pressure monitoring and progression of glaucoma in older adults.…

ACL tears – do they all need reconstruction?

June 1, 2018, Dr Chee L Khoo

Anterior Cruciate Ligament Tear

For patients with anterior cruciate ligament (ACL) tears, it used to be that conservative treatment is tried first and if the knee joint is symptomatic and/or unstable, then surgery can be considered. But have you noticed that patients are now routinely heading for surgery without a trial of conservative treatment and irrespective of what future demands on their joints may be?…

Different types of type 2 diabetes – the more the merrier?

June 1, 2018, Dr Chee L Khoo

Different categories of type 2 diabetes

Have you noticed that your patients with type 2 diabetes (T2D) are a heterogeneous group? Some T2D patients are more insulin resistant than others. Some T2D patients are more insulin deficient than others. These tend to be the younger T2D. Some patients are obese and some are not.…

Hypoglycaemia is more than just an inconvenience

May 15, 2018, Dr Chee L Khoo

Unless you have experienced a severe hypoglycaemia, you don’t actually appreciate the petrifying effects it has on your patients. In addition to increased morbidity and mortality, it is associated with a reduction in health-related quality of life, increased fear and anxiety, reduced productivity and increased healthcare costs through increased utilisation of healthcare resources and blood glucose monitoring.…

Continuous Glucose Monitoring coming to general practice – are you ready?

May 15, 2018, Dr Chee L  Khoo

You probably think that insulin pump (so-called continuous subcutaneous insulin infusion or CSII) and continuous glucose monitoring (CGM) are all to do with Type 1 diabetes (T1D) in diabetes centres and you probably don’t need to know about it, you are probably right. Well, almost. I mean, how often do you come across CGM and CSII in general practice?…

Non-invasive liver elastography – a new era in liver disease assessment

May 15, 2018, Dr Ahmed Mayat (Medical Imaging Campbelltown)

Gold standard for diagnosis and staging of liver fibrosis is liver biopsy.  This is, however an invasive procedure with its associated complications.

Liver Elastography is a simple non-invasive method to assess liver fibrosis.  A special ultrasound pulse measures the propagation speed of sound waves through the liver parenchyma.  This data can be acquired during the normal liver ultrasound examination. …

Hepatitis C treatment in general practice – my first case

May 15, 2018, Dr Chee L Khoo

Kylie was known to have chronic hepatitis c infection for many years. She had been busy for the last 2-3 years being pregnant. We talked about anti-viral treatment as soon as she finished with breast feeding her last baby. She had heard about these wonder drugs curing her hepatitis C infection.

When Kylie was ready, we went through the motions:

Pre-treatment Asssessment – the 6 Cs

  1. Complications of liver disease
  • Co-factors for liver disease progression
  • Signs of liver disease
  • Presence of cirrhosis -consider Fibroscan for any patient with hepatitis C.

CT and US Guided Injections – what goes where for what conditions

Interventional procedures have evolved and improved over time since epidural injection was first introduced for low back pain and sciatica in 1901. One of the major contributors in the improvement of these interventions is the advancement of imaging guidance technologies. The utilisation of image guidance has dramatically improved the accuracy and safety of these interventions.

It is sometimes confusing to know what injections go where for what conditions?…

Opioids or codeine not recommended? What do we do with patients with severe back and leg pains?

May 1, 2018 Dr Chee L Khoo

Chronic, persistent low back, lower extremity pain, and radicular pain may be secondary to disc herniation, disc disruption, disc degeneration, facet joint disease, spinal stenosis, or post lumbar surgery syndrome resulting in disc-related pain with or without radiculitis. The specificity and sensitivity of the symptoms and signs are low and therefore, not as reliable as we think in getting to the precise diagnosis.…

Smoking, alcohol, hot tea and oesophageal cancer – how are they related?

May1, 2018, Dr Chee L Khoo

We all know that smoking and alcohol are associated with increased risk of oesophageal cancer. A recent large study from China looked at 456,155 people and found 1731 esophageal cancers over 9.2 years. They noticed that there was an interaction of hot tea with smoking. Smokers who drank burning hot tea daily had double the risk of oesophageal cancer compared with non-smokers who only occasionally drank tea.…

SGLT2 inhibitor/DPP4 inhibitor combo under PBS – sorting out the confusion

May 1, 2018 Dr Chee L Khoo

When I wrote the article last fortnight about new SLT2 inhibitor/DPP4 inhibitor combo now on the PBS, the situation was still very confused. Since that article, more information has  come to light. Yes, we are allowed to use both DPP4 inhibitors (DPP4i) and SLGT2 inhibitors (SGLT2i) together when patients with type 2 diabetes (T2D) if the HbA1c is >7.0%.…

“Health, performance and conduct concerns among older doctors” – A set up in progress?

April 15, 2018,  Dr Chee L Khoo

If it was a headline conclusion in any other medical publication, we would be combing the study looking for holes, validity, statistical significance and clinical relevance. We would be checking that the conclusions drawn were correct and valid conclusions that arose from the data. But when it was the Medical Board which released the headline, most of us, kind of, accepted the conclusions of the study without questions.…

Spectrum Radiology

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