Stopping statins in the “elderly” – are you sure?

12th August 2019, Dr Chee L Khoo

We are often reminded to review statins prescriptions for primary prevention in the “elderly” because the evidence of benefit of statins in this group of patients is often “lacking”. Lacking doesn’t mean it there is no benefit. It may mean there are no or limited studies done in that age group.…

SGLT2i, GLP1-RA and CVOTs – sorting out the confusion

11th August 2019, Dr Chee L Khoo

All new anti-diabetic agents since 2008 have been mandated by the US FDA to conduct cardiovascular outcome trials (CVOT) to ensure that they are safe, or in statistical jargon, “non-inferior” to placebo in relation to major adverse cardiovascular events (MACE). 15 CVOTs assessing DPP‐4 inhibitors, GLP‐1 receptor agonists and SGLT‐2 inhibitors have been completed by the end of 2018 with several others to come yet.…

Bone density testing in general practice

An estimated 4.7 million Australians over the age of 50 currently have osteoporosis or osteopenia, with over 144,000 associated fractures (2013). Without major improvements in diagnosis and management, the rate of osteoporotic fracture will be around 30% higher by 2022, costing an estimated $33.6 billion over the next decade. In general practice, early detection can prevent a first fracture. For patients who have already fractured, investigation and initiation of osteoporosis medication is crucial to reduce the very high risk of subsequent fractures.…

Visceral fat deposits – not all fat deposits carry the same risk

28th July 2018, Dr Chee L Khoo

Visceral obesity is a better correlate with cardiometabolic risk, morbidity and mortality than general obesity. However, not all visceral fat depositions are the same. Some visceral fat depositions are worse than others in their contribution to atherosclerosis and cardiometabolic risk. The development of new imaging techniques has revolutionised the study of human body composition including measures of visceral fat.…

Curing Hepatitis C – are you the stumbling block?

28th July 2019, Dr Chee L Khoo

It’s not often that we cure anyone of any disease. Hepatitis C is one of those exceptions to the rule. The World Health Organization (WHO) set the ambitious target of eliminating hepatitis C as a public health threat by 2030 [1]. Australia is one of the very first countries in the world to have made the direct acting anti-viral (DAA) agents available on the PBS.…

QT interval – how long is too long? Is it relevant in GP?

26th July 2019, Dr Chee L Khoo

All of us remember the association of QT prolongation with the dramatic Torsale de Pointes (TdP) and sudden cardiac death (SCD) from medical school. Fortunately, both are relatively rare in general practice and we really don’t need to know much about QT prolongation in general practice as it belongs to the hospital people and the cardiologists, right?…

Acid suppression in infants – 2 questions to ponder before prescribing

13th July 2019, Dr Chee L Khoo

Gastroesophageal acid reflux disease in babies is a common presentation in general practice. Crying, frequent vomiting or regurgitation and sometimes poor weight gain can transform a lovely and cute baby into a monster. Acid suppressants, including proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs) are increasingly being prescribed for this debilitating (to both baby and parents) condition.…

At least 3 other reasons why you should use GLP1-RAs early in diabetes management

13th July 2019, Dr Chee L Khoo

New anti-diabetic agents are coming thick and fast. It is easy to get confused as to which agent to use. For injectables, there are currently at least a dozen different insulin preparations and 5 GLP1 -Receptor Analogues (GLP1-RAs) available in Australia. Some are on the Pharmaceutical Benefits Scheme (PBS), some not. It is easy to put them all in the too hard basket.…

Cardiovascular health – are eggs in or out?

13th July 2019, Dr Chee L Khoo

First, it’s not good, then it’s Ok and now we are not sure. Maybe it is, maybe it isn’t. We are talking about eggs and the association with cardiovascular disease and mortality. It’s stuck in many of our and our patients’ minds that eggs are no good. It doesn’t help when the 2015-2020 Dietary Guidelines for Americans came out with somewhat contradictory recommendations: “ (1) Cholesterol is not a nutrient of concern for overconsumption” and (2) “Individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern” (1).…

Early diagnosis, prevention and treatment of Alzheimer Disease – where are we at now?

12th July 2019, Dr Chee L Khoo 

When we think about Alzheimer disease (AD) we think about the two classes of abnormal structures, extracellular amyloid plaques and intraneuronal neurofibrillary tangles. The soluble building blocks of these structures are amyloid-β (Aβ) peptides for plaques and tau for tangles. We have known about the association between Aβ and tau and AD for some time yet the only therapies available for patients with AD are the cholinesterase inhibitors and memantine which only target the symptoms of the disease.…

Changing paradigms in breast cancer screening – the arrival of Abbreviated breast MRI

22nd June 2019, Dr Chee L Khoo

Screening mammography has been shown in many prospective, randomised, clinical trials to reduce breast cancer deaths by between 25-40% (1-4). Unfortunately, small but high-grade cancers can be masked by the presence of dense breast tissues or may be confused as benign breast disease in mammograms. In fact, in countries that have national breast screening mammography programs, advanced breast cancers have not decreased (5,6).…

Abbreviated breast MRI – what is it?

22nd June 2019, Spectrum Medical Imaging

Dynamic contrast enhanced breast – MRI must contain a minimal number of MRI sequences that is necessary to detect small enhancing breast lesions. What if we cut down the number of sequences but yet have enough accuracy to detect small early cancers? That’s what AB-MRI is – less number of sequences but yet enough to detect small lesions. …