13th July 2019, Dr Chee L Khoo
New anti-diabetic agents are coming thick and fast. It is easy to get confused as to which agent to use. For injectables, there are currently at least a dozen different insulin preparations and 5 GLP1 -Receptor Analogues (GLP1-RAs) available in Australia. Some are on the Pharmaceutical Benefits Scheme (PBS), some not. It is easy to put them all in the too hard basket.…
13th July 2019, Dr Chee L Khoo
First, it’s not good, then it’s Ok and now we are not sure. Maybe it is, maybe it isn’t. We are talking about eggs and the association with cardiovascular disease and mortality. It’s stuck in many of our and our patients’ minds that eggs are no good. It doesn’t help when the 2015-2020 Dietary Guidelines for Americans came out with somewhat contradictory recommendations: “ (1) Cholesterol is not a nutrient of concern for overconsumption” and (2) “Individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern” (1).…
12th July 2019, Dr Chee L Khoo 
When we think about Alzheimer disease (AD) we think about the two classes of abnormal structures, extracellular amyloid plaques and intraneuronal neurofibrillary tangles. The soluble building blocks of these structures are amyloid-β (Aβ) peptides for plaques and tau for tangles. We have known about the association between Aβ and tau and AD for some time yet the only therapies available for patients with AD are the cholinesterase inhibitors and memantine which only target the symptoms of the disease.…
22nd June 2019, Dr Chee L Khoo
Screening mammography has been shown in many prospective, randomised, clinical trials to reduce breast cancer deaths by between 25-40% (1-4). Unfortunately, small but high-grade cancers can be masked by the presence of dense breast tissues or may be confused as benign breast disease in mammograms. In fact, in countries that have national breast screening mammography programs, advanced breast cancers have not decreased (5,6).…
22nd June 2019, Spectrum Medical Imaging
Dynamic contrast enhanced breast – MRI must contain a minimal number of MRI sequences that is necessary to detect small enhancing breast lesions. What if we cut down the number of sequences but yet have enough accuracy to detect small early cancers? That’s what AB-MRI is – less number of sequences but yet enough to detect small lesions. …
22nd June 2019, Dr Chee L Khoo
It is standard to measure blood lipids after an 8-12 hour fast. Pretty much all our guidelines for management of cardiometabolic conditions are based on these fasting blood levels. The actual reading is important because it guides us to determine whether a patient is commenced on a statin or not. Do meals affect lipid levels?…
22nd June 2019, Dr Chee L Khoo
Distal polyneuropathy (DPN) is one of the more severe complications of diabetes. The exact pathologic metabolic process of DPN is still uncertain but it is more common in patients with type 2 diabetes (T2DM) than in patients with type 1 diabetes (T1DM) even after adjusting for glucose levels. Thus, in addition to hyperglycaemia, other factors could be involved in the development of DPN such as obesity, hypertension, dyslipidaemia and renal impairment. …
10th June 2019, Dr Chee L Khoo
Children with moderate to severe asthma often needs more than the usual bronchodilators. Even the newer long acting beta agonists (LABA) or long acting muscarinic antagonists (LAMA) may not be enough to control the symptoms and reduce exacerbations and inhaled corticosteroids (ICS) are often needed. But we are careful to keep the total daily dose of corticosteroids to a minimum.…
8th June 2019, Dr Chee L Khoo
Checkpoint inhibitors are monoclonal antibodies that block checkpoint molecules, cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed death-1 (PD-1) and PD-1 ligand 1 (PD – L1). They have revolutionised cancer treatment because of their ability to improve survival in a growing number of cancers. Some of the cancers that have been successfully treated include melanoma, lung cancer, kidney cancer, bladder cancer, head and neck cancer, and Hodgkin’s lymphoma.…
8th June 2019, Dr Chee L Khoo
The majority of patients with type 2 diabetes (T2DM) are diagnosed and managed in primary in the early years. We know from the UKPDS that early tight glycaemic control have enduring legacy effects on cardiovascular morbidity and mortality. We also know from the DiRECT trials that significant weight loss when the diabetes duration is short can lead to diabetes remission (1,2).…
6th June 2019, Dr Chee L Khoo
I thought short acting insulin was fast acting until fast acting insulin came along. Just when you think fast acting is truly fast acting, along came faster acting. So, what is this faster acting insulin aspart (fiasp)? Is it just another play with semantics? Or is it just another attempt in extending a patent?…
A meningioma is a benign tumour that arises from the meninges. Meningiomas are often slow-growing, however in some instances, they may be fast-growing and their effects on 
adjacent brain tissue, nerves or vessels may cause serious disability. Timely access to a Bulk Billable MRI scan can enable a quick diagnosis and appropriate referral for neurosurgery without the patient requiring a CT scan with the associated ionizing radiation, especially relevant given the patient’s age.…