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Fournier’s gangrene & SGLT2i – how rare is it?

23rd March 2019, Dr Chee L Khoo

You may remember receiving warnings recently from the Therapeutics Goods Administration (TGA) about a serious “rare” infection, called necrotising fasciitis of the perineum, also referred to as Fournier’s gangrene (FG). FG is reported to be associated with the use of SGLT2 inhibitors in patients with type 2 diabetes (T2D). The warning came on the back of similar warnings by the US Food and Drug Authority (FDA) in August 2018.…

Haemorrhagic stroke – is that cerebral amyloid angiopathy?

10th March 2019, Dr Chee L Khoo

About 10% of all strokes are haemorrhagic strokes. In about 10% of cases of primary intracerebral haemorrhage (ICH), cerebral amyloid angiopathy (CAA) is regarded as a possible cause. The recurrence rate of ICH is significantly higher in patients with CAA. With improvements in MRI technology, CAA is increasingly recognised as a cause of ICH.…

Can Vitamin C reduce plasma glucose?

22nd February 2019, Dr Chee L Khoo

Increased oxidative stress appears to be a significant factor leading to insulin resistance, dyslipidaemia, β-cell dysfunction, impaired glucose tolerance and ultimately leading to type 2 diabetes (T2D). Ascorbic acid (AA) is a water soluble anti-oxidant that reduces oxidative damage at the cellular and tissue level. So, logically, AA supplementation should therefore reduce oxidate stress and lead to improvement in glycaemic control in patients with diabetes.…

Losing weight: Different diets for different patients – are we there yet?

13th February 2019, Dr Chee L Khoo

It’s all too confusing. It used to be low fat diet. It’s now low carbohydrate (carb) diet. Some studies show that low carb diet loses more weight than low fat diet while others show the opposite. Yet, other studies show no significant difference between the diets. So, which is it then? Have you wondered that perhaps, we are looking at different patients responding to different diets.…

Case Study – man with increasing neck pain for one month

44-year-old male with 1 month of increasing neck pain was referred for a cervical spine injection. A CT scan of the cervical spine two weeks prior (Figure A), revealed foraminal narrowing at the C5-6 level. There was a significant difference between the new scan and the previous scan. There was severe destruction of the C5-6 disc and of the adjacent C5 and C6 vertebral end plates with retrolisthesis of C5 on C6.

The adipocyte – a very busy cell

27th January 2019, Dr Chee L Khoo

Energy consumption, regulation and storage vital for the survival of the organism. We have specialised cells that manages the above but often, the cells do a bit of each depending on the energy needs of the organism at the time. When you think about it, the most effective cell to do all of the above is actually the adipocyte.…

Do all fat kids develop diabetes? If not, who does?

27th January 2019, Dr Chee L Khoo

As GPs we often see little kids already carrying extra weight and we know that many of these will go on to become overweight or obese adults. Many overweight kids and overweight adults will go on to develop type 2 diabetes. Interestingly, some obese kids don’t go on to become diabetic. Which subsets of these overweight kids don’t go on to develop diabetes?…

Fasting glucose – is it still relevant when managing patients with T2D?

27th January 2019, Dr Chee L Khoo

It’s tempting to rely too much on HbA1c when managing our patients with type 2 diabetes (T2D). It is not uncommon to come across patients with pretty optimal HbA1c (under 6.5-7.0%) and we pat them on the back with the message “well done”. Often, the fasting glucose levels is just glossed over. Should we even bother with the fasting glucose levels at all these days?…

Is there a doctor on the plane?

9th January 2019, Dr John Goswell

According to a recent article in JAMA, in flight emergencies occur in about 1:600 flights. This comforting statistic should allow doctors to relax and enjoy their holidays. Not so for me. I have answered the call “Is there a doctor on the plane” twice now, even though I am not a “frequent flier”. …

Investigating ischaemic stroke in a young patient

5th January, 2019, Dr Chee L Khoo

The incidence of ischaemic strokes in young adults is on the increase. Worldwide,  it has risen up to 40% over the past decades.  This contrasts with the decreasing incidence of stroke in older adults. It’s never a good time to have a stroke whatever the age of onset is but the socioeconomic costs are much higher in the younger.…

Cholecystokinin (CCK) – more than just a gallbladder hormone

4th January 2019, Dr Chee L Khoo

When you treat a medical condition with an agent with known intended effects, it is not uncommon that we come across some of the unintended effects of the agent. Glucagon-like peptide 1 receptor antagonists (GLP1-RAs) are very useful agents which not only improve glucose control via its known effects on insulin and glucagon but it is associated with modest weight loss.…

Management of Huntington’s Disease – where are we at?

4th January 2019, Dr Chee L Khoo

Huntington Disease (HD) was first described in 1872 by George Huntington, MD, in his paper “On Chorea”. HD is an autosomal-dominant, neurodegenerative disorder that is caused by expansion of a cytosine-adenine-guanine (CAG) triplet repeat in the huntingtin gene which is located on the short arm of chromosome 4 (1). The gene codes for the huntingtin protein.…

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