13th February 2023, NIA Diagnostic Imaging
A 30 year old woman presented to her GP with a two-day history of right sided abdominal/pelvic pain. There was associated severe nausea. On examination, there was tenderness in the right lower quadrant with guarding. A pelvic ultrasound was requested.
With this request, differential diagnosis may include haemorrhagic cyst, dermoid cyst, ovarian torsion, ectopic pregnancy or endometriosis.…
13th February 2023, Dr Chee L Khoo
Now that I know how common metabolic-dysfunction associated fatty liver disease (MAFLD) is especially amongst those patients with elements of metabolic syndrome, it’s hard not to assume that every second patient have MAFLD. We also know that not all MAFLD has abnormal liver function tests (LFTs). So, if you only suspect or screen only those with abnormal LFts, then you are going to miss many MAFLD.…
29th January 2023, Dr Chee L Khoo
We have always regarded HDL-Cholesterol (HDL-C) as the good guys. In the 1970s, the Framingham Heart Study showed that HDL-C was negatively associated with the development of cardiovascular disease (CVD) (1). Thus, we have regarded HDL as anti-atherogenic lipoprotein and expected HDL-C-raising therapy to reduce CVD events. However, there have been recent reports of the associations of high HDL-C and osteoporosis and fractures in healthy older adults.…
29th January 2023, Spectrum Medical Imaging
Breasts not only come in different sizes and shapes but have different composition and densities. The breast density also changes with age, body composition and genetic factors. 50% of women in the US have dense breasts and dense breast tissue can camouflage early breast cancer. Yet, we only have standardised mammography and screening schedules. The Volpara is an AI software platform that provides an individualised risk assessment and screening recommendations based on the composition of the breast of the woman.…
29th January 2023, Dr Chee L Khoo
We looked at the difference in definitions between non-alcoholic and metabolic-dysfunction associated fatty liver disease (so-called NAFLD vs MAFLD) in the last issue of GPVoice. There are many similarities and overlap between the two entities. At the end of the day, does it really matter we call the diseases. Since writing the article, I have diagnosed quite a few MAFLD and taken the appropriate next steps in the management.…
14th January 2023, NIA Diagnostic Imaging
Despite the availability of modalities such as mammography, MRI and galactography, ultrasound still has a role in breast imaging. Ultrasound provides high resolution portrayal of normal and abnormal breast parenchyma as well as clear depiction of lactiferous ducts and the terminal duct-lobular unit where masses can form (4). This is particularly useful when investigating women presenting with a bloody nipple discharge.…
4th January 2023, Dr Chee L Khoo
The term non-alcoholic fatty liver disease (NAFLD) was first coined by Ludwig in 1980. It was rather an exclusive diagnostic term to exclude the other liver disease from being included in the definition. If your liver disease relates to excessive alcohol intake, drugs or autoimmune conditions, it cannot be included in the diagnosis.…
4th January 2023, Dr Chee L Khoo
The most recent US Prevention Services Task Force (USPSTF) recommendations pour cold water onto its use in primary prevention of CVD in April 2022 (1). We explored the details and rationale behind that turnaround recently. The recommendation for use of aspirin for prevention of colorectal cancer is lumped in together with the recommendation for CVD prevention.…
29th December 2022, Spectrum Medical Imaging
Last week we explored coronary artery calcium score and looked at how the score is really more than a score. There is a lot more details than just a number in the report. Spectrum also has a team of subspecialist Cardiac Radiologists and Cardiologists who are trained in cardiovascular imaging interpretation. The report has details that allows us to proceed to the next stage of the cardiovascular risk assessment.…
24th December 2022, Dr Chee L Khoo
There have been a number of contentious safety concerns regarding the prolonged used of denosumab. The original FREEDOM trial demonstrated efficacy in reducing vertebral, hip and femoral fractures over 3 years of denosumab therapy. There was a further 7 years extension to the original trial and the report was published last year. There were some suggestions a few years ago that patients might, perhaps, need a drug holiday after 5-10 years on denosumab but there is increasing evidence of rapid reduction in bone densitometry (BDM) after denosumab is stopped.…
18th December 2022, Dr Chee L Khoo
Making a decision whether to treat patients with lipid lowering agents is relatively easy in patients who either have symptomatic cardiovascular (CV) disease or have a very low risk according to our CV risk assessment. It is a bit more difficult in the intermediate CV risk group. We have to consider the cost and adverse effects of initiating lifelong preventive therapy versus the potential benefit to the patient.…
13th Decemer 2022, NIA Diagnostic Imaging
Pelvic pain is a common presentation in general practice. It becomes a little bit more complicated if that occurs during the first trimester of pregnancy. To the usual gynaecological and non-gynaecological causes, we have to add the other obstetric causes of pelvic pain. The obstetric causes during the 1st trimester can be a serious concern and should be treated as an urgent matter.…