Our job just got harder. The bureaucrats keep changing the ground rules. We are expected to know who qualifies for what every so often. But here it is for your reference.
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…Author: adminwp
The Diabetic Heart – the dawn of the myocardium
27th November, 2018, Dr Chee L Khoo
Of the patients with type 2 diabetes (T2D) who die from cardiovascular (CV) disease, 40% die from IHD, 15% die from heart failure and 15% die from strokes. Patients with T2D have greater atherosclerotic plaque burden, higher atheroma volume, and smaller coronary artery lumen diameter than persons without diabetes. Numerous processes contribute to atherosclerotic cardiovascular disease (ASCVD) in diabetes including (but not limited to) hyperglycaemia, insulin resistance and/or hyperinsulinemia, dyslipidaemia, inflammation, reactive oxygen species, endothelial dysfunction, hypercoagulability, and vascular calcification.…
Anti-phospholipid antibodies – how much do you know?
27th November 2018, Dr Chee L Khoo
I recently saw a young lady whose mother had anti-phospholipid syndrome (APL) . She is now worried whether she has the same problem and request some blood tests. She is otherwise fit and healthy. Sure, among other things, I ordered APL antibodies hoping that the pathologist will know what I was looking for. Pretty straight forward so far until the results of her tests came back.…
Sitting on a pot of gold in general practice
26th November 2018, Dr Chee L Khoo
We sit on a large repository of data in general practice. A small subset of the data that can be useful is the individual patient data that can facilitate patient care. This subset (in the right set up) is what the myhealthrecord is hoping to host in the cloud but that is another story for another day.…
Diabetes Management – GPs as good as Diabetes Centres!
13th November 2018, Dr Chee L Khoo
70-80% of patients with type 2 diabetes (T2D) are managed in primary care in Australia. Patients managed in hospital based outpatients have the advantage of multi-disciplinary team care. They have dietitians, credentialled diabetes educator (CDE), physiotherapists and of course, the endocrinologist in the team. On the other hand, we, as GPs, have the advantage of knowing our patients and their families’ social environment.…
Dapagliflozin more than DECLARE its CV benefits
13th November 2018, Dr Chee L Khoo
It’s finally here. The Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE–TIMI 58) trial finally released their results this week at the American Heart Association (AHA) Scientific Sessions 2018. The results were most impressive but this was not just another CV outcome trial of another SGLT2 inhibitors. The results have major implications in the way we treat patients with type 2 diabetes (T2D) in general practice.…
Floppy Iris Syndrome – is your patient at risk?
12th November 2018, Dr Chee L Khoo
Intraoperative floppy iris syndrome (IFIS) was first described by Chang and Campbell. It is characterised by floppiness of the iris, miosis and ultimately, iris prolapse through the surgical wounds. It can occur during surgery for cataract and if not anticipated, it increases the risk of posterior capsule rupture, vitreous loss, retained nuclear fragments, post op intraocular pressure spikes, irido-dialysis, hyphema and corneal endothelial loss.…
GDM Diagnosis & Management – SWS leading the way
8th November 2018, Dr Chee L Khoo
When there is so much talk about gestational diabetes (GDM), you can’t help but think that just about every pregnant woman has GDM in south west Sydney (SWS). After all, if you look at the “high risk” group that you ought to be screening for GDM, there is hardly any woman in SWS that is not in the high risk category.…
Twincretins – are two incretins better than one?
29th October 2018, Dr Chee L Khoo
Incretins are hormones released when we eat. They augment the release of insulin from pancreatic beta cells. They not only lead to reduction in blood glucose levels via the secretion of insulin, they also inhibit glucagon release thereby stemming further hyperglycaemia, slow the absorption of nutrients by slowing gastric emptying and increase satiety. The two main incretin hormones are glucagon like peptide -1 (GLP1) and gastric inhibitory peptides (GIP).…
Metallic implants/prosthesis – are they MRI safe?
28th October 2018, Dr Chee L Khoo
Metallic objects, implants or prosthesis can render magnetic resonance imaging (MRI) unsafe or affect the quality of the images. Our patients who have metallic joint prosthesis in-situ not uncommonly require further imaging. This can pose a bit of a challenge as many of the same patient population who require the joint replacement are the same population of patient that require further imaging.…
GLP1 agonists – are you up-to-date with them?
28th October 2018, Dr Chee L Khoo
There are now 7 glucagon like peptide 1 (GLP 1) injectable analogues used to control hyperglycaemia in patients with type 2 diabetes (T2D). An eighth GLP1 analogue is now available as an oral form. Only four of them are available in Australia of which three are on the PBS under authority prescription (Byetta, Bydureon, Trulicity).…
ACE Inhibitors & Lung Cancer – is it for real?
28th October 2018, Dr Chee L Khoo
Most of you would have read about the recent study linking angiotensin converting enzymes inhibitors (ACEI) to the risk of lung cancer. This was published in the BMJ last week. it was a bit of a surprise to some extent although once the dust settled, it wasn’t that surprising after all. ACEI causes a build-up of bradykinin in the lungs and bradykinin has been reported to stimulate growth of lung cancers.…