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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.…

Non-invasive prenatal screening – A package deal

Increasingly, women are now requesting non invasive prenatal screening. Spectrum Medical Imaging now offers a comprehensive non-invasive prenatal screening at Liverpool.

For patient convenience, they provide pre-test discussion, a viability/dating scan, GeneStyle NIPS and 13 week structural scan. NIPS results are available within 5 days. Genetic counselling for NIPS if required post test.

Click here for more details.…

Oral steroids for glue ear?

1st September 2018, Dr Chee L Khoo

After acute otitis media, the middle ear effusion usually resolves within days although it may take up to 3 months in some children. However, in up to 8% of kids, the effusion persist beyond the 3 months and it becomes chronic otitis media with effusion (COME). Why these 8% is the key research question.…

Idiopathic Pulmonary Fibrosis – is it still idiopathic?

1st August, 2018, Dr Chee L Khoo

When a diagnosis is idiopathic, it often means we don’t know its pathogenesis well. Often, a mixed bag of conditions is thrown in there because we are rather imprecise in defining them. Fibrosis is the final common pathway of lung injury and idiopathic pulmonary fibrosis used to have a mixture of fibrotic conditions lumped together under the umbrella diagnosis.…

Morton’s Neuroma – is it a neuroma?

1st September, 2018, Dr Chee L Khoo

It would seem to me that just about every doctor who graduated from Australian medical schools know about Morton’s neuroma. It’s part of the long list of differential diagnoses of forefoot pain but either I have missed many or it’s not that common. I’m also not sure what else to do once diagnosed apart from referring to an orthopaedic surgeon.…

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