Foot injuries – is that a Lisfranc injury?

Foot injury

30th November, Spectrum Medical Imaging

The midfoot consist of 5 bones, cuboid, navicular and three cuneiform bones. These bones articulate with the base of the five metatarsals. In the Lisfranc injuries, it is these articulations (and their ligamemts) that are damage. Sometimes, there are fractures easily seen on plain xrays. Sometimes, one can see separation of the bones on plain xrays.…

Acne – the ABC of management in primary care

27th November 2023, A/Prof Chee L Khoo

Although moderate to severe acne is pretty common in primary care, our management tends to be haphazard. We have our favourite topical and oral therapy but I am not sure that that is evidence-based nor pathophysiological in our approach. When all else fails, we refer on to our friendly dermatologist. I recently attended a brilliant lecture at the Melbourne GPCE presented by Dr Ryan de Cruz, a Melbournian dermatologist.…

Cervical screening – hands up who’s not here?

25th November 2023, A/Prof Chee L Khoo

Cervical screening for cervical cancer for the prevention of cervical cancer has to be one of the most successful campaigns in primary care. For most, instead of having an intimate check every two years, doing it every 5 years is such a relief. For others, it is still having to endure an insertion of a vaginal speculum.…

Genetic carrier screening on MBS now – what does that mean?

25th November 2023, A/Prof Chee L Khoo

genetic carrier screening

Reproductive genetic carrier screening for cystic fibrosis (CF), spinal muscular atrophy (SMA) and fragile X syndrome (FXS) has become available on the Medicare Benefits Scheme (MBS). Screening for those three conditions is recommended for all couples prior to, or in the early stages of pregnancy. Great but what is this genetic screening all about?…

GLP1RAs – do they reduce CV events?

14th November 2023, A/Prof Chee L Khoo

Cardiovascular Events

Obesity is a recognised risk factor for cardiovascular disease (CVD). We are all used to treating cardiovascular risk factors such as hypertension, dyslipidaemia and diabetes in an attempt to reduce CV events. We should also treat the obesity, shouldn’t we? Logically, weight reduction should lead to reduction in CV events but, unfortunately, lifestyle changes and pharmacological interventions to reduce obesity have not been shown to improve cardiovascular outcomes (1-5).…

Exacerbation of COPD – do oral steroids make any difference?

12th November 2023, Conjoint Assoc. Prof Chee L Khoo

It is pretty standard for us to treat an infective exacerbation of COPD with antibiotics and a shot of oral corticosteroids, usually oral prednisolone for 5-7 days. Almost all of them seems to get better with that regimen. Or do they? We explored when to use and when not to use inhaled corticosteroids (ICS) in COPD in the September 2023 issue.…

CT cholangiogram – when should we order one?

12th November 2023, NIA Diagnostic Imaging

epigastric pain

Epigastric pain has to be one of the most common presenting symptoms in primary care. The differential diagnoses include cholelithiasis and cholecystitis. With increasing prevalence of obesity and type 2 diabetes, the prevalence of gallbladder disease is also increasing. Often, abdominal ultrasound can confirm or exclude gallbladder disease but sometimes, the results are inconclusive or we suspect additional bile duct obstruction.…

High Resolution Chest CT

2nd November 2023, Spectrum Medical Imaging

HRCT

There is still many cases of Covid-19 infection sprouting here and there. We are now seeing patients with ongoing cough and we sometimes suspect long Covid amongst them. A high resolution CT (HRCT) of the chest is a CT technique in which thin-slice images of the chest are obtained and post-processed in a high-spatial-frequency reconstruction algorithm.…

Precision medicine in diabetes – are we there yet?

30th October 2023, Dr Chee L Khoo

Precision

When we think about precision medicine, we usually think about some fancy, expensive genetic tests that can help us determine ahead of time who is at risk of some serious diseases. This may allow us to target these patients early and reduce morbidity and mortality. There is connotation that only the rich in rich countries can afford these tests and once again, patients in low and middle income countries (LMIC) will miss out on these state of the art expensive tests.…

MAFLD to MASLD – another name change again?

28th October 2023, A/Prof Chee L Khoo

Steatosis

It’s all deja-vu again. In January, we discussed the name change from NAFLD to MAFLD. We also discussed how the metabolic dysfunction fatty liver disease (MAFLD) nomenclature and definition were not quite universally accepted internationally. Somehow, we knew that MAFLD was really a temporary placeholder. And indeed, it was and many international bodies have got together since then and put together a consensus nomenclature for metabolic dysfunction associated steatotic liver disease or MASLD (pronounced MASL-D).…

DVT – how does duplex US look for it?

11th October, 2023, NIA

DVT?

Deep vein thrombosis (DVT) is a medical condition associated with significant morbidity and mortality. It is vital that a rapid diagnosis can be acquired since DVT can result in severe complications including the development of pulmonary embolism (PE). The consequences of PE can be life-threatening. About 10% of PEs are fatal and 5% will cause death later despite diagnosis and treatment.…