CTPA – the key to diagnosing pulmonary emboli

11th March 2024, NIA Diagnostic Imaging

It is actually not that difficult to diagnose pulmonary embolism. Patients with chest pains, shortness of breath, tachycardia and perhaps, light headedness might suggest pulmonary embolism. However, on their own, those symptoms may be from a number of medical conditions. Only with a high index of suspicion would you consider ordering more investigations looking for pulmonary emboli.…

MINOCA – an increasing cause of MI

10th March 2024, A/Prof Chee L Khoo

Acute MI

Myocardial infarction in a patient with minimal coronary artery disease (stenosis <50%) is increasingly being recognised in patients with myocardial injury but no significant coronary obstruction is demonstrated. Myocardial Infarction in Non-Obstructive Coronary Arteries (MINOCA) accounts for approximately 5-10% of all myocardial infarction. The precise pathogenesis is poorly understood. Diagnosing MINOCA is not straightforward and identifying the aetiologies and ongoing management can be challenging.…

Lean body mass loss – can we prevent it?

7th March 2024, A/Prof Chee L Khoo

Total body weight loss

There was some kerfuffle recently in the lay press about muscle loss with semaglutide. Great horror? Well, it doesn’t matter how you lose the weight. Any significant body weight loss will incur lean body mass loss (LBM). It’s not unique to GLP1-RA injections. Weight loss from bariatric surgery, dietary restrictions or just healthier eating will do the same.…

Obstetric ultrasound – the importance of consistent quality

29th February 2024, South West Radiology

We all know how important quality and consistency is when we choose where our patients go to for their ultrasound scans. It is even more important when we choose where they go to for their follow up scans to compare with the last scan. This is particularly important when we look at serial ultrasounds during pregnancy.…

BP control – a novel way to address medication adherence?

24th February 2024, A/Prof Chee L Khoo

BP Control

We all know how important it is for BP control in prevention cardiovascular, cerebrovascular and renal complications. We are also aware of the difficulty is improving medication adherence. We have a broad range of effective BP lowering medications covering diverse classes of medications. Anti-hypertensives work only if our patients take them regularly.…

Patients with high lipoprotein a – should they be on aspirin?

24th February 2024, A/Prof Chee L Khoo

Primary CVD prevention

In May 2022, the US Preventative Services Task Force (USPSTF) recommended that we avoid routine aspirin for primary prevention of CVD for anyone at all (1). In particular, for those between 40–59-year-old with a 10-year CVD risk 10%, the decision to initiate aspirin for the primary prevention should be an individual one as the evidence of the net benefit of aspirin use in this group is small.…

Uterine artery doppler – when would you order one?

13th February 2024, NIA Diagnostic Imaging

Uterine Artery

Commonly, uterine artery doppler ultrasound is conducted to measure the blood flow in the uterine arteries. This specific ultrasound allows for qualitative information to be gathered on the presence/absence of flow, the direction of flow, the quality of flow, to determine if the flow is laminar or turbulent and to distinguish waveform shape (low resistance, high resistance, early diastolic notch) (Naguib et al.,2012).…

T2D remission: can it happen in real world in primary care?

11th February 2024, A/Prof Chee L Khoo

Significant weight loss of >10% body weight has been associated with remission of type 2 diabetes. It’s not surprising, really, is it? The DiRECT trial which reported in 2018 demonstrated that early in T2D, significant weight loss can lead to remission of T2D (1). Importantly, DiRECT showed that weight loss of >10% can be achieved in primary with minimal support.…

Hypertriglyceridaemia – the forgotten villain?

11th February 2024, A/Prof Chee L Khoo

hypertriglyceridaemia

Hypertriglyceridaemia (HTG) often accompanies hypercholesterolaemia but that is often ignored as it is considered to be a minor villain. Older clinical trials on lipid lowering agents excluded subjects with HTG and that is partly why the significance of HTG is often ignored. The interplay between HTG and atherosclerotic cardiovascular disease (ASCVD) is real but extremely complicated.…

Intracranial haemorrhage – management in primary care

27th January 2024, NIA Diagnostic Imaging

Intracranial haemorrhage

Intracranial haemorrhage (ICH) is defined as any bleeding within the intracranial vault, which includes the brain parenchyma and the surrounding meningeal spaces. ICH is associated with severe outcomes, including a 30-day mortality rate of 35–52%, with only 20% of survivors expected to fully recover within 6 months. Hence, ICHs are classified as medical emergencies, requiring immediate diagnosis and treatment to ensure the highest possible survival chances.…

Salpingectomy to prevent ovarian cancer?

27th January 2024, A/Prof Chee L Khoo

Ovaries

The World Health Organisation classifies epithelial ovarian carcinomas into several morphological categories according to cell type: serous carcinomas (SC), mucinous carcinomas, endometrioid carcinomas, and clear-cell carcinomas, transitional-cell Brenner tumours, mixed, and undifferentiated type [1]. SC account for 75-80% of epithelial carcinomas and are subdivided into high-grade SC (HGSC) and low-grade SC (LGSC). Like any other cancers, early diagnosis would be important to improve the prognosis but often when diagnosed, ovarian cancer is in its advanced stages.…

Weekly insulin and weekly GLP1-RA – ideal partners?

27th January 2024, A/Prof Chee L Khoo

Weekly combo

We are all pretty much used to weekly GLP1-RA injections for our patients with type 2 diabetes (T2D). Certainly, a lot less needles compared with the once daily or twice daily GLP1-RA injections and therefore more acceptable to patients (including those without diabetes!). Weekly GLP-1 are efficacious in reducing fasting as well as postprandial glucose.…