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Omega 3 oils & CV disease – does it help?

July 15, 2018, Dr Chee L Khoo

I must declare my personal interest in this discussion. I have been taking omega-3 fish oil supplements for years to reduce my triglycerides. I am also on a statin for my hypercholesterolaemia and the fish oil is to treat the residual hypertriglyceridaemia. A recent study confirm the efficacy of this approach1. However, does the addition of fish oil and reduction of triglycerides translate to improvement in cardiovascular (CV) outcomes?…

Diagnosing Diabetes – is one reading enough?

July 15, 2018, Dr Chee L Khoo

Diabetes can be diagnosed if fasting glucose is >7.0 mmol/L, 2 hour post prandial > 11.0 mmol/L and/or HbA1c >6.5. However, clinical guidelines recommend that we repeat testing within a “short period of time” to reduce the possibility of a false positive result. Sometimes, repeat testing may not be possible or not uncommonly, patients may be lost to follow up.…

Gastrointestinal Malignancies in Cystic Fibrosis

July 15, 2018, Dr Chee L Khoo

It’s always sad to lose a patient due to complications of a disease. It’s even harder if the patient is another doctor especially if the disease has well recognised complications. Many of you may have read about the sad story of Dr Rana, known to have cystic fibrosis, who died of complications resulting from an unrecognised bowel obstruction.…

Tamsulosin for renal calculi – does it help?

July 15th 2018, Dr Chee L Khoo

Have you noticed that an increasing number of patients with renal stones discharged from emergency department are prescribed tamsulosin. It makes perfect sense, doesn’t it? Tamsulosin is an alpha blocker and by inhibiting the smooth muscles in the ureter, it facilitates the passage of stone into the bladder. Does it really? It’s logical but is there evidence that it works?…

Diabetes & Cancer – it’s a two way sword.

July 1st, 2018, Dr Chee L Khoo

With early diagnosis and improved treatment, many of our cancer patients have increased survival. You may already have noticed that many of our patients being managed in the multi-disciplinary oncology units are routinely promoting healthy lifestyles. Chronic co-morbidities including diabetes and cardiovascular diseases not only affect quality of life in these survivors but are the major cause of non-cancerous mortality in cancer patients.…

Tonsillectomy – do they affect future immunity?

July 1st, 2018, Dr Chee L Khoo

I am sure you have been asked by parents of young patients about to undergo tonsillectomy +/- adenoidectomy whether the removal of the tonsils will affect future immunity since the tonsils and adenoids are integral to the body’s immune response. I have had those questions asked of me and the answer used to be “Of course not.…

Prescribing antibiotics for influenza – are you one of them?

June 15, 2018, Dr Chee L Khoo

The most recent stats tell us that antibiotics prescription for viral URTIs have come down. It certainly gives us that warm and fuzzy feel good feeling that finally, the message is getting through in primary care. Well, are antibiotic prescription rates for influenza infections really coming down? How come I still come across many of patients being prescribed antibiotics for the “flu” after they were seen on the weekend.…

Smart intraocular pressure sensors – coming to a centre near you

June 1, 2018, Dr Chee L Khoo

Source: SENSIMED

We are all familiar with 24-hour BP monitor. We are also familiar with 24-hour Holter monitor and continuous glucose monitoring. We now have 24-hour intraocular pressure monitor. It doesn’t actually monitor intraocular pressure but the effects of it (a bit later). A recent study has now confirmed the association between the intraocular pressure monitoring and progression of glaucoma in older adults.…

Continuous Glucose Monitoring coming to general practice – are you ready?

May 15, 2018, Dr Chee L  Khoo

You probably think that insulin pump (so-called continuous subcutaneous insulin infusion or CSII) and continuous glucose monitoring (CGM) are all to do with Type 1 diabetes (T1D) in diabetes centres and you probably don’t need to know about it, you are probably right. Well, almost. I mean, how often do you come across CGM and CSII in general practice?…

Non-invasive liver elastography – a new era in liver disease assessment

May 15, 2018, Dr Ahmed Mayat (Medical Imaging Campbelltown)

Gold standard for diagnosis and staging of liver fibrosis is liver biopsy.  This is, however an invasive procedure with its associated complications.

Liver Elastography is a simple non-invasive method to assess liver fibrosis.  A special ultrasound pulse measures the propagation speed of sound waves through the liver parenchyma.  This data can be acquired during the normal liver ultrasound examination. …

Hepatitis C treatment in general practice – my first case

May 15, 2018, Dr Chee L Khoo

Kylie was known to have chronic hepatitis c infection for many years. She had been busy for the last 2-3 years being pregnant. We talked about anti-viral treatment as soon as she finished with breast feeding her last baby. She had heard about these wonder drugs curing her hepatitis C infection.

When Kylie was ready, we went through the motions:

Pre-treatment Asssessment – the 6 Cs

  1. Complications of liver disease
  • Co-factors for liver disease progression
  • Signs of liver disease
  • Presence of cirrhosis -consider Fibroscan for any patient with hepatitis C.

Smoking, alcohol, hot tea and oesophageal cancer – how are they related?

May1, 2018, Dr Chee L Khoo

We all know that smoking and alcohol are associated with increased risk of oesophageal cancer. A recent large study from China looked at 456,155 people and found 1731 esophageal cancers over 9.2 years. They noticed that there was an interaction of hot tea with smoking. Smokers who drank burning hot tea daily had double the risk of oesophageal cancer compared with non-smokers who only occasionally drank tea.…

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