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Getting T2D to target – two heads better than one

April 15, 2018, Dr Chee L Khoo

To get our patients with type 2 diabetes (T2D) to glycaemic target using oral agents,  you can either use an SGLT2 inhibitor (SGLT2i) or a DPP4 inhibitor DPP4i) after metformin (with or without a sulphonylurea) but not both. If you stop a DPP4 inhibitor to start a SGLT2ior vice versa, in general, the HbA1c remain unchanged.…

Complementary vs Conventional Medicine – it doesn’t have to be like that!

April 2018, Dr Chee L Khoo

The term complementary medicine refers to a group of diagnostic and therapeutic disciplines that exist largely outside the institutions where conventional health care is provided and taught. The wide range of disciplines classified as complementary medicine makes it difficult to find defining criteria that are common to all.

In Germany, a significant proportion of doctors have additional qualifications in chiropractic, homeopathy and naturopathy.…

Multi-disciplinary care of T2D – does it work in primary care?

April 2018, Dr Chee L Khoo

Multi-disciplinary care (MDC) is often hailed as THE comprehensive management for patients with type 2 diabetes (T2D). We refer these patients to podiatrists, exercise physios, dietitians, diabetes educators and sometimes, endocrinologists. Now, that is MDC, isn’t it? We are part of the MDC team. Do we see the benefit that is often hailed from MDC?…

Ketosis may improve glycaemic control – can we use it in T2D therapy?

April 2018, Dr Chee L Khoo

Ketogenesis is the production of ketone bodies (KB) when glucose levels decline and the glucagon:insulin ratio is high. When the body is deprived of glucose, KB act as an alternative fuel source for brain, heart, kidneys and skeletal muscles. KB have also been shown to have other physiological functions including lower glucose levels.

To understand the potential therapeutic implications of KB, we need to revise our knowledge about KB metabolism.…

Prostate MRI – A case study

A 60 year old man presents with a rising PSA despite several previously negative transrectal prostate biopsies. A prostate MRI demonstrates a circumscribed small region of low T2 signal intensity within the left lateral peripheral zone at the gland base. This region demonstrates moderately restricted water diffusion and avid early enhancement after intravenous contrast. This appearance is consistent with a region of high grade prostate cancer.…

A GP guide to understanding prostate MRI – the PI-RADS scoring system

April 2018, Dr Chee L Khoo

Forget about whether PSA screening saves lives or not. What is the next step when a PSA level comes back elevated. Obviously if the PSA is >10 or much higher, they need referral to a urologist for biopsies. What if it is trending high or is significantly higher than the age related reference range? Patients are increasingly having prostate MRIs performed the results are reported as PI-RADS scores.…

Statins and Muscles – worse than we think

March 15, 2018,  Dr Chee L Khoo

“Doc, my muscles feels tired every time I try to exercise”. Are these patients just unfit or is it the statin or is that just another excuse? Between 7-29% of patients on statins report muscle complaints (depending on who reports them). Often these symptoms are exacerbated with physical activity and exercises. Muscle soreness, muscle pains and muscle tenderness are probably relatively easier to quantify in patients but non-specific muscle fatigue are much harder to pin down.…

Metformin during pregnancy – Goldilocks principle strikes again!

March 15, 2018 Dr Chee L Khoo

Hyperglycaemia during pregnancy has significant metabolic consequences for the mother, the pregnancy as well as for the offspring’s future health. It is tempting to assume that keeping the glucose lower during pregnancy must be beneficial for both parties. Metformin has been used in women with PCOS, GDM and obesity during pregnancy in an attempt to improve pregnancy and foetal outcomes but this practice is not based on solid scientific evidence.…

INTERIM OPIOID TREATMENT ACCREDITATION COURSE

March 15, 2018
Dr Jenny James
General Practice Drug and Alcohol Advice and Support Service

The Opioid Treatment Accreditation Course is currently being restructured by the University of Sydney, Discipline of Addiction Medicine. The new format training is expected to commence by 1 June 2018.

As a measure to manage the waiting list for accreditation training,  an interim course is being be offered.…

VLCD may cause initial reduction in cardiac function

March 2018, Dr Chee L Khoo

Several meta-analyses of randomised clinical trials showed that ketogenic diets induce a long-term significant improvement in body weight, diastolic blood pressure, triglycerides and HDL-cholesterol, when compared to low fat diets. However, rapid weight loss may cause a transient rise in plasma triglycerides which can contribute to impairment in cardiac function in the short term.

The heart has a very high energy demand, which is met almost entirely by the mitochondrial oxidation of fatty acids and carbohydrates.…

D-dimer – how to use it correctly in general practice

March 2018, Dr Chee L Khoo

We all know a bit about d-dimer. We all know that it can be a useful marker for the diagnosis of venous thromboembolism (VTE). It can be used to guide the optimal duration of anti-coagulation in VTE. It is also useful in assessing the risk of recurrence in patients who already had a VTE event especially in patients with cancer.…

CancerSEEK test – not another screening test for cancer

February 2018, Dr Chee L Khoo

“Doc, is there a test for cancer?” I’m sure you have many a patient asking for a blood test to screen for cancer. Some of you may be tempted to order a CEA or a CA-125 without being familiar with their sensitivities and specificities (that’s another story on another day). An international group of researchers recently described a blood test, called CancerSEEK which purportedly can detect eight common cancers.…

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