GP Voice

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Is there a doctor on the plane?

9th January 2019, Dr John Goswell

According to a recent article in JAMA, in flight emergencies occur in about 1:600 flights. This comforting statistic should allow doctors to relax and enjoy their holidays. Not so for me. I have answered the call “Is there a doctor on the plane” twice now, even though I am not a “frequent flier”. …

Investigating ischaemic stroke in a young patient

5th January, 2019, Dr Chee L Khoo

The incidence of ischaemic strokes in young adults is on the increase. Worldwide,  it has risen up to 40% over the past decades.  This contrasts with the decreasing incidence of stroke in older adults. It’s never a good time to have a stroke whatever the age of onset is but the socioeconomic costs are much higher in the younger.…

Cholecystokinin (CCK) – more than just a gallbladder hormone

4th January 2019, Dr Chee L Khoo

When you treat a medical condition with an agent with known intended effects, it is not uncommon that we come across some of the unintended effects of the agent. Glucagon-like peptide 1 receptor antagonists (GLP1-RAs) are very useful agents which not only improve glucose control via its known effects on insulin and glucagon but it is associated with modest weight loss.…

Management of Huntington’s Disease – where are we at?

4th January 2019, Dr Chee L Khoo

Huntington Disease (HD) was first described in 1872 by George Huntington, MD, in his paper “On Chorea”. HD is an autosomal-dominant, neurodegenerative disorder that is caused by expansion of a cytosine-adenine-guanine (CAG) triplet repeat in the huntingtin gene which is located on the short arm of chromosome 4 (1). The gene codes for the huntingtin protein.…

Patent foramen ovale – to close or not to close?

25th December 2018, Dr Chee L Khoo

After the acute management of an ischaemic stroke, what follows is the diagnostic process to find the underlying cause and secondary prevention of further strokes. In younger patients and in patients whose atherosclerotic burden is low, the search for a cause can be challenging.  Some of the rarer causes of stroke and cardioembolic causes (including atrial fibrillation) needs to be excluded.…

Weight loss – how to keep it off?

24th December 2018, Dr Chee L Khoo

Losing weight is the second hardest thing to do. The hardest is keeping that weight off. With weight loss, hunger increases and energy expenditure decreases as the body adapts physiologically to the weight loss. The kilogram loss is not all fat loss. Some of the losses are muscles and with less muscle bulk, basal metabolic rate also decreases adding further to the decrease in energy expenditure. …

Undiagnosed pelvic pain – is it pelvic congestion syndrome?

22nd December 2018, Dr Chee L Khoo

Endometriosis is the most frequently diagnosed condition in women with chronic pelvic pain. What if they can’t find endometriosis on laparoscopy? In 60% of women with chronic pelvic pain, the cause remained unknown. A significant proportion of these women may suffer from pelvic congestion syndrome (PVC). Is this one of those “idiopathic” type condition which is diagnosed when all tests are negative?…

Preventing thrombo-embolism in cancer patients – who should we target?

22nd December 2018, Dr Chee L Khoo

Patients with active cancers are at an increased risk of DVTs and pulmonary embolism. Some patients are at higher risk than others. Thromboembolic prophylaxis could reduce that risk but is not routinely recommended in practice guidelines because the absolute risk is modest and of course, there are potential major bleeding risk. With the introduction of the new oral anti-coagulants (NOACs), the equation might be different.…

Another successful injectable workshop – DOMTRU at your service!

13th December 2018, Dr Chee L Khoo

Three weeks ago, 25 of our GP and allied health professional (AHP) colleagues sacrificed their valuable Saturday and became engaged in a highly interactive session exploring the use of injectables in the management of our patients with type 2 diabetes. Evaluation, comments and suggestions from the participants have just been collated and here at the Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU) we are just absolutely delighted about the results.…

Ertugliflozin – now we are three again

13th December 2018, Dr Chee L Khoo

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the latest therapeutic strategy in the treatment of type 2 diabetes mellitus (T2DM). They feature prominently in the latest international diabetes management guidelines. They not only improve glycaemic control but recent clinical trials demonstrated cardiovascular protection, combined with a reduction in body weight and blood pressure. There used to be three SGLT2 inhibitors, dapagliflozin, empagliflozin and canagliflozin until canagliflozin withdrew from the Australian market.…

High dose fish oil and CV outcomes – another fishy tale?

10th December, 2018, Dr Chee L Khoo

Elevated triglyceride  (TG) level serves as an independent marker for an increased risk of ischaemic events, as shown in epidemiologic and mendelian randomisation studies (1-5). However, in most of the statin trials, patients with high TG are generally excluded. There is confusion out there as to whether fish oils is useful or not for cardiovascular protection.…

Refractory depression – does adding mirtazapine help?

10th December 2018, Dr Chee L Khoo

Treatment resistant depression is not that uncommon in general practice. We have quite a few patients that don’t respond to maximal dose of our usual SSRI or SNRIs. Naturally, we need to check adherence to medications and alcohol intake. A review of the history is important as there may be hidden skeletons unresolved (including sexual abuse).…

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