GP Voice

voice of general practice

Knee OA – A GP’s perspective

12th October 2018, Dr Chee L Khoo

Imagine a 55 year gentleman come in with right knee pain. He was an active football player from years gone by and suffered the usual meniscal tears here and there over the years. He is now a storeman in the local factory and takes his dog for a walk most days. Yes, he’s put on some weight over the years and he has usual mild hypertension, mild hypercholesterolaemia and maybe borderline glucose.…

Finally, what comes after metformin – the latest ADA/EASD guidelines made easy

11th October 2018, Dr Chee L Khoo

Over the last 20 years, 5 classes of anti-diabetic agents are now available to choose from. This is great but which do you use after metformin? Guidelines after guidelines in Australia and internationally leave that decision up to us to make the choice on behalf of our patients. They all have different mechanisms of action but pretty much all of them have similar efficacy, reducing HbA1c by about 1.0%.…

PCOS diagnosis – an end to the dog breakfast?

11th October, 2018, Dr Chee L Khoo

The original diagnostic criteria for polycystic ovary syndrome (PCOS) put forward after the first international conference on PCOS in 1990 was oligo-anovulation and hyperandrogenism or hyperandrogenaemia in the absence of all other endocrinopathies. This was based on expert consensus rather than clinical research data. The Rotterdam criteria 2003 added ultrasound as a third diagnostic marker and to allow for a diagnosis of PCOS if two of the three criteria were met.…

Prenatal programming – can it affect offspring mental outcomes?

11th October 2018, Dr Chee L Khoo

Epigenetics is the modification of the DNA that changes a gene’s expression without altering the nucleotide sequence. DNA methylation and histone modifications are the most commonly studied epigenetic mechanisms by which cell structure and function can be altered during embryogenesis. The in-utero environment can lead to prenatal programming by which genes are activated or deactivated.…

Guidelines, guidelines and guidelines – the secret to keeping up to date

30th September, 2018, Dr Chee L Khoo

One of the many challenges in general practice is keeping up with new management guidelines. Another week another guideline somewhere. Even if you are made aware of the existence of those guidelines and have access to them, the guidelines are usually 150-200 pages long. Even the executive summary runs into half a dozen pages.…

3D Mammogram – is there a role in clinical practice?

30th September, 2018, Dr Chee L Khoo

There is no question that screening mammograms have led to a decline in late stage breast cancers. There have been a gradual decrease in breast cancer mortality, at least partly, due to the introduction of screening mammograms over the last 25 years. But screening mammograms are not perfect. In women with dense breast tissue, the sensitivity of mammogram decreases.…

Psoriatic Arthropathy & Metabolic Syndrome – the role of the GP

30th September 2018, Dr Chee L Khoo

10-40% of patients with psoriasis have joint manifestations as part of a multi-system inflammatory disease (1). There is a strong association between psoriasis and elements of metabolic syndrome. Recent evidence suggests that patients with psoriasis have increased cardio-metabolic morbidity and mortality. Like other auto-immune collagen diseases, psoriatic arthropathy (PsA) often necessitate a referral to the specialists to manage the systemic and joint disease.…

Sulfonylureas – the bad guy again!

30th September 2018, Dr Chee L Khoo

Sulfonylurea (SU) is still one of the most commonly prescribed anti-diabetic agent for type 2 diabetes (T2D)1. These patients may have put on a few kilograms of weight over the years but then they are overweight anyway. Weight gain when one gets older is pretty much expected anyway. They may have a few cardiovascular events here and there but then patients with T2D are known to have a higher risk of CV events.…

Aspirin use prevents serious CV events in diabetes but…

15th September, 2018, Dr Chee L Khoo

There is definitely a role for aspirin in preventing cardiovascular (CV) events in patients who already had a CV event (secondary prevention).  There is always a risk of gastrointestinal and intracranial bleeding.  Because the risk of another event after the first is often significantly higher, when one works out the risk benefit ratio, the benefits of aspirin use usually wins.…

Ondansetron – is it safe in pregnancy?

15th September, 2018, Dr Chee L Khoo

Nausea and vomiting affects up to 80% of pregnancies but severe nausea and vomiting in early pregnancy or hyperemesis gravidarum (HG) can affect up to 1% of pregnancy. As GPs, we are often the first port of call for these women. We know how debilitating it is to those women. There is also an significant economic impact not just because of many of these women ended up in hospital on more than one occasion before 20 weeks of gestation but many (and often their partners) can’t go to work during this period.…

Diabetic Nephropathy – time for a new strategy

15th September 2018, Dr Chee L Khoo

Glomerular Hyperfiltration

Although the physiological factors that cause early diabetic renal injury remain incompletely understood, glomerular hyperfiltration (GH) has been associated with the development of diabetic nephropathy (DN). GH leads to renin-angiotensin-aldosterone system (RAAS) activation which in turn leads to systemic vascular and endothelial abnormalities. DN not only lead to dialysis and ultimately, renal transplantation in some, it is a leading cause of mortality in patients with diabetes.…

Meet your noxious cousins from the Nox family

15th September 2018, Dr Chee L Khoo

Nox family
Noxious family members?

When phagocytes engulf microorganisms, intracellular phagasome bound NADPH oxidase catalysed the production of reactive oxygen species (ROS) like superoxide and hydrogen perixoide which kills the microorganism. NADPH oxidase is also expressed on membranes of many other non-phagocytic cells. ROS play a pivotal role in many physiological processes including host defence, hormone biosynthesis, fertilisation and cellular signalling.…

Medical Imaging Campbelltown

GPs wanted

Healthpathways seeking GP Editors. Click here for more details

Spectrum Radiology

Articles by Categories

Copyright © 2018 GP Voice