June 15, 2018 Dr Chee L Khoo
Someone once said “If at the end of taking the history, you do not have the diagnosis, take the history again”. This is particularly relevant when we come to knee injuries. In 90% of the time, when I see someone with a knee injury, I have a fair idea what I am looking for in the examination before I even touch the patient.…
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.…
June 15, 2018, Dr Chee L Khoo 
Insulin secretion is augmented by incretins following oral glucose intake. In healthy individuals, incretins are responsible for 70% of insulin secretion. However, in patients with type 2 diabetes (T2D), the incretin effect is significantly blunted thereby affecting glucose control. Glucagon like peptide 1 (GLP1) and gastric inhibitory peptide (GIP)s are the most studied of the incretins.…
June 15, 2018, Dr Chee L Khoo
In primary care, we have to battle with the increasing incidence of obesity amongst our patients. We also have to battle with the patients with depression where anti-depressants are increasingly being prescribed. Obesity is associated with depression, which is particularly common in patients with severe obesity. Antidepressant treatment may also add on to our patients’ weight.…
May 15, 2018, Dr Chee L Khoo
Unless you have experienced a severe hypoglycaemia, you don’t actually appreciate the petrifying effects it has on your patients. In addition to increased morbidity and mortality, it is associated with a reduction in health-related quality of life, increased fear and anxiety, reduced productivity and increased healthcare costs through increased utilisation of healthcare resources and blood glucose monitoring.…
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?…
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
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.…
May 1, 2018 Dr Chee L Khoo
When I wrote the article last fortnight about new SLT2 inhibitor/DPP4 inhibitor combo now on the PBS, the situation was still very confused. Since that article, more information has come to light. Yes, we are allowed to use both DPP4 inhibitors (DPP4i) and SLGT2 inhibitors (SGLT2i) together when patients with type 2 diabetes (T2D) if the HbA1c is >7.0%.…
April 15, 2018, Dr Chee L Khoo
If it was a headline conclusion in any other medical publication, we would be combing the study looking for holes, validity, statistical significance and clinical relevance. We would be checking that the conclusions drawn were correct and valid conclusions that arose from the data. But when it was the Medical Board which released the headline, most of us, kind of, accepted the conclusions of the study without questions.…
April 15, 2018, Dr Chee L Khoo
Last fortnight we review the PI-RADS score in relation to prostate MRI and i thought we might go through a real case study and how it relates to general practice. Otherwise well 42 year old gentleman with no family history of prostate cancer or any other hormone related cancers presented for general check-up in 2011 in addition to the usual coughs and colds.…
April 15, 2018, Dr Chee L Khoo
To get our patients with type 2 diabetes (T2D) to glycaemic target using oral agents, you can either use an SGLT2 inhibitor (SGLT2i) or a DPP4 inhibitor DPP4i) after metformin (with or without a sulphonylurea) but not both. If you stop a DPP4 inhibitor to start a SGLT2ior vice versa, in general, the HbA1c remain unchanged.…