Pregnancy Medical Imaging – A personalised one stop shop for pregnant women

Pregnancy medical imaging can provide vital diagnostic information about a developing baby including gestational age, checking for multiple pregnancies, congenital anomalies and/or problems with the placenta, monitoring foetal position and growth, and the level of amniotic fluid.

Who would have thought that the radiologist is now a friend of GPs when we look after pregnant women. Radiologists are key members of clinical teams who frequently make the first diagnosis of many medical conditions in children, adults and often the unborn baby.…

Paediatric Acute-Onset Neuropsychiatric Syndrome (PANS) – Is it real?

25th December 2019, Dr Chee L Khoo

They used to call it “Paediatric Infection Triggered Autoimmune Neuropsychiatric Disorders” (PITANDS)(1). Sounds terrible, doesn’t it? They were referring to children with obsessive-compulsive disorder (OCD) who had a sudden onset of their psychiatric symptoms, typically following infection with a variety of agents, including group A streptococcus (pyogenes), varicella and mycoplasma pneumoniae. The subgroup specifically associated with group A streptococcus (GAS) was called “Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections” (PANDAS).…

New migraine therapy – the battle of mabs vs gepants

22nd December 2019, Dr Chee L Khoo

There have been no new advances in acute migraine management since the introduction of the triptans in the early 1990s. There have been no advances in migraine prophylaxis since that time either. Over the last decade, there have been two emerging migraine therapies that are in advanced Phase 2 and Phase 3 trials. They are ready to hit the market anytime soon.…

Heart failure in type 2 diabetes – who is most at risk?

12th December 2019, Dr Chee L Khoo

Type 2 diabetes (T2D) and heart failure (HF) are common diseases with significant morbidity and mortality. Two out of three patients with T2D have evidence of ventricular dysfunction within 5 years of diabetes diagnosis (1). Data from both observational studies and clinical trial cohorts suggest that the development of HF in patients with T2DM is associated with anywhere from a 4- to 10-fold increase in mortality risk (2,3).…

SGLT2 inhibitors and hospitalisation for heart failure – finally a real trial!

12th December 2019, Dr Chee L Khoo

EMPA-REG, CANVAS, DECLARE-TIMI 58 and VERTIS-CV are cardiovascular outcome trials (CVOTs) originally designed to demonstrate non-inferiority of SGLT2 inhibitors versus placebo on major adverse cardiovascular events (MACE). These clinical trials involving a total of > 36,000 patients with type 2 diabetes (T2D) followed for 2–5 years. Patients treated with a SGLT2 inhibitor experienced a 25–35% lower risk of hospitalisation for heart failure (HHF).

Anaemia management in chronic kidney disease – a new approach coming real soon!

8th December 2019, Dr Chee L Khoo

Anaemia is quite common in patients with chronic kidney disease (CKD). Disruption in the production of erythropoietin is not the only cause. Iron deficiency, uremia, chronic inflammation and gastrointestinal (G) loss are the common the other causes of anaemia in these patients. After excluding GI losses, current treatment consists of iron replacement and the use of erythropoietin stimulating agents (ESA).…

Osteomyelitis – diagnosis is not always straight forward

26th November 2019

The symptoms of acute osteomyelitis include pain, swelling, warmth and redness over the affected part. Sometimes, there are systemic signs of fever and fatigue. Plain xrays may review osteolytic lesions, periosteal reaction or may be totally normal. Sometimes, we may need to resort to MRI to clinch the diagnosis. This month’s case illustrate the difficulty with diagnosis when the symptoms and signs are not straight forward.…

Vitamin D and Omega 3 Oils – do they have a role in diabetic kidney disease?

24th November 2019, Dr Chee L Khoo

It’s not often that we report on trials with negative results but this trial attracted my attention because of many issues it raised when the top-line results were announced in the Journal of American Medical Association a fortnight ago. The conclusion states “supplementation with vitamin D3 or omega-3 fatty acids, compared with placebo, resulted in no significant difference in change in eGFR at 5 years.

Helicobacter pylori and gastric cancer – is there a point of no return?

23rd November 2019, Dr Chee L Khoo

Treatment of helicobacter pylori infection (HPi) has been shown to reduce the incidence of gastric cancer (GC) worldwide (1,2). HPi may cause chronic inflammation which can lead to precancerous conditions. Since HPi is not always symptomatic and many patients may have untreated HPi for decades. Surely, if you have untreated HPi for decades, you might still be at risk of GC years down the track despite eradication of the infection.…

Oral therapy in type 2 diabetes – navigating the PBS maze

14th November 2019, Dr Chee L Khoo

Oral therapy for T2D – navigating the PBS maze

During our recent GP Diabetes Injectable Masterclass Workshop, I noted that there was a lot of uncertainty and confusion in relation to what oral agents can be combined under the PBS. This uncertainty and confusion can only lead to hesitation to escalate treatment in patients whose glycaemic control is suboptimal.…

The complexity of managing T2D – a GP’s perspective

13th November 2019, Drs Chee Khoo & Sobhy Khalil

We have a contribution from our GP colleague this week. Dr Sobhy Hakeem KHALIL who thoroughly studied the ADA/EASD Management of Hyperglycaemia In Type 2 Diabetes, 2018 Consensus Report and provided his take on the guidelines. I have added my comments to his take (in blue):

  1. They emphasised the importance of life style changes such as weight reduction, physical activities (aerobic and high resistance activities) and smoking cessation.

Prostate Artery Embolisation

PAE is an embolisation procedure. It is a new application of a longstanding tried and tested technology. Embolisation is the deliberate occlusion of vessels in the body, in this case the arteries to the prostate.  The objective of PAE is to stem the blood flow to the prostate, targeting the enlarging tissue and rendering it ischaemic (reduced supply of oxygenated blood).…