Dapagliflozin Product Information – why a tiny omission means a lot?

25th September 2021, Dr Chee L Khoo

small omission

SGLT2 inhibitors (SGLT2i) have been shown to improve outcomes in patients with type 2 diabetes (T2D) and high cardiovascular risks as well as in patients with chronic kidney disease and heart failure regardless of diabetes status and independently of blood glucose levels or HbA1c. There is a little bit of a “catch” though, the eGFR.…

CT Angiogram – who does Medicare cover?

23rd September, Spectrum Medical Imaging

CT angiogram

We all know the restrictions we all have in who we can order an ECG, stress test or stress echocardiogram for since the change in Medicare rebates some months ago. I am confused about the various eligibility criteria. You know what happens when are all confused? We stop ordering them to the detriment to patient care.…

Covid-19 vaccination booster – why, when, what?

23rd September 2021, Dr Chee L Khoo

Booster anybody?

You have to agree that the covid-19 vaccines have been pretty effective in reducing the case numbers of covid-19 worldwide. However, over the last few months, with the emergence of the delta variant, there have been resurgence of the virus. Is it because delta variant is more contagious? Perhaps, the efficacy of the vaccines has waned as it’s coming up to 6 months for those who had their vaccines earlier in the year.…

Comirnaty vaccine – how safe is it? What about myocarditis?

13th September 2021, Dr Chee L Khoo

mRNA covid-19 vaccines

Phase 3 trials have inherent limitations in assessing vaccine safety because of the small number of participants and the sample population is generally reasonably young and healthy. They are often underpowered to identify less common adverse events. For example, the AZ interventional arm had about 11,000 participants and the interventional arm of the Pfizer Comirnaty vaccine had about 23,000 participants.…

DOAC for valvular AF – is that allowed?

11th September 2021, Dr Chee L Khoo

stroke prevention in AF

You may recall when direct acting oral anti-coagulants (DOAC) first came out for treatment of atrial fibrillation (AF). Upon diagnosis of new AF, some GPs were hesitant to initiate a DOAC for the AF but instead refer patients to a cardiologist. There is a danger while waiting to see the cardiologist that the patient may incur a cerebrovascular accident (CVA).…

Heart failure with preserved ejection fraction – do SGLT2 inhibitors help?

9th September 2021, Dr Chee L Khoo

heart failure and SGLT2 inhibitors

You already know that SGLT2 inhibitors, as a class, have been shown to reduce the development and progression of heart failure in patients with diabetes (1-3). Incidentally, it has also been shown to do the same in patients with heart failure but without diabetes. Life used to be simple.…

Delta variant – are the vaccines any good?

real world data

26th August 2021, Dr Chee L Khoo

The Delta variant, first identified in India in December 2020, spread rapidly throughout a mostly unvaccinated country and caused massive numbers of cases, hospitalisations, and deaths. It’s now responsible for the outbreaks spreading across the world. This includes countries that have high vaccination rates. In the UK, the Delta variant has spread rapidly.…

Reducing retinopathy progression – how does fenofibrate work?

21st August 2021, Dr Chee L Khoo

Retinopathy progression

Nothing scares patients with diabetes more than blindness. Although we have many treatment options available for proliferative diabetic retinopathy and macular oedema, diabetes remains the leading cause of severe visual impairment in working-aged adults. Diabetic retinopathy affects one in three people with diabetes. Risk factor control and screening are the cornerstones for retinopathy prevention.…

Pregnancy and Pelvic Imaging – who can you trust?

18th August 2021, Spectrum Medical Imaging

We were all taught that we should always see it for ourselves and trust no one when it comes to history and examination. We cannot rely on third party information but sometimes, we have to. When we have to refer patient for imaging, we need to ensure that we can trust the provider and have faith in their experience and quality of reporting.…

Rotator cuff tears – do steroid injections work?

14th August 2021, Dr Chee L Khoo

Shoulder pain has to be one of the most common musculoskeletal complaints in general practice. Rotator cuff pathology makes up at least 70% of those cases (1). It is commonly very debilitating, causing pain the whole night, causing significant reduction in function and often last for years. Apart from rest, analgesia, non-steroidal anti-inflammatory drugs, treatment options include physiotherapy, corticosteroid injections and surgical repair.…

Covid-19 vaccines – can we mix and match yet?

8th August 2021, Dr Chee L Khoo

Mix/Match?

We know that the incidence of thrombocytopaenic thrombosis syndrome (TTS) can occur with the AstraZeneca (AZ) Covid-19 vaccines although it is pretty uncommon. What do you do with patients who had TTS with the first jab and it’s now ready for the next jab? Obviously, they can’t have the second jab with AZ.…

Covid-19 and pregnancy outcomes

7th August 2021, Dr Chee L Khoo

It is always difficult for pregnant women to decide whether to have the Covid-19 vaccine during pregnancy. Understandably, they are concerned about the safety of the vaccine administered during pregnancy. When the pandemic started last year, there were some studies which suggest that Covid-19 during pregnancy is associated with “significantly” poor maternal and offspring outcomes.…