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Internal Medicine

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…

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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…

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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…

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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…

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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…

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Finally, what comes after metformin – the latest ADA/EASD guidelines made easy

11th October 2018, Dr Chee L Khoo Over the last 20 years, 5 classes of anti-diabetic agents are now available to choose from. This is great but which do you use after metformin? Guidelines after guidelines in Australia and internationally leave that decision up to…

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Guidelines, guidelines and guidelines – the secret to keeping up to date

30th September, 2018, Dr Chee L Khoo One of the many challenges in general practice is keeping up with new management guidelines. Another week another guideline somewhere. Even if you are made aware of the existence of those guidelines and have access to them, the…

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Psoriatic Arthropathy & Metabolic Syndrome – the role of the GP

30th September 2018, Dr Chee L Khoo 10-40% of patients with psoriasis have joint manifestations as part of a multi-system inflammatory disease (1). There is a strong association between psoriasis and elements of metabolic syndrome. Recent evidence suggests that patients with psoriasis have increased cardio-metabolic…

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Sulfonylureas – the bad guy again!

30th September 2018, Dr Chee L Khoo Sulfonylurea (SU) is still one of the most commonly prescribed anti-diabetic agent for type 2 diabetes (T2D)1. These patients may have put on a few kilograms of weight over the years but then they are overweight anyway. Weight…

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Aspirin use prevents serious CV events in diabetes but…

15th September, 2018, Dr Chee L Khoo There is definitely a role for aspirin in preventing cardiovascular (CV) events in patients who already had a CV event (secondary prevention).  There is always a risk of gastrointestinal and intracranial bleeding.  Because the risk of another event…

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Ondansetron – is it safe in pregnancy?

15th September, 2018, Dr Chee L Khoo Nausea and vomiting affects up to 80% of pregnancies but severe nausea and vomiting in early pregnancy or hyperemesis gravidarum (HG) can affect up to 1% of pregnancy. As GPs, we are often the first port of call…

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Diabetic Nephropathy – time for a new strategy

15th September 2018, Dr Chee L Khoo Although the physiological factors that cause early diabetic renal injury remain incompletely understood, glomerular hyperfiltration (GH) has been associated with the development of diabetic nephropathy (DN). GH leads to renin-angiotensin-aldosterone system (RAAS) activation which in turn leads to…

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