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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 after the first is often significantly higher, when one works out the risk benefit ratio, the benefits of aspirin use usually wins.…

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 for these women. We know how debilitating it is to those women. There is also an significant economic impact not just because of many of these women ended up in hospital on more than one occasion before 20 weeks of gestation but many (and often their partners) can’t go to work during this period.…

Diabetic Nephropathy – time for a new strategy

15th September 2018, Dr Chee L Khoo

Glomerular Hyperfiltration

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 systemic vascular and endothelial abnormalities. DN not only lead to dialysis and ultimately, renal transplantation in some, it is a leading cause of mortality in patients with diabetes.…

Meet your noxious cousins from the Nox family

15th September 2018, Dr Chee L Khoo

Nox family
Noxious family members?

When phagocytes engulf microorganisms, intracellular phagasome bound NADPH oxidase catalysed the production of reactive oxygen species (ROS) like superoxide and hydrogen perixoide which kills the microorganism. NADPH oxidase is also expressed on membranes of many other non-phagocytic cells. ROS play a pivotal role in many physiological processes including host defence, hormone biosynthesis, fertilisation and cellular signalling.…

Idiopathic Pulmonary Fibrosis – is it still idiopathic?

1st August, 2018, Dr Chee L Khoo

When a diagnosis is idiopathic, it often means we don’t know its pathogenesis well. Often, a mixed bag of conditions is thrown in there because we are rather imprecise in defining them. Fibrosis is the final common pathway of lung injury and idiopathic pulmonary fibrosis used to have a mixture of fibrotic conditions lumped together under the umbrella diagnosis.…

Morton’s Neuroma – is it a neuroma?

1st September, 2018, Dr Chee L Khoo

It would seem to me that just about every doctor who graduated from Australian medical schools know about Morton’s neuroma. It’s part of the long list of differential diagnoses of forefoot pain but either I have missed many or it’s not that common. I’m also not sure what else to do once diagnosed apart from referring to an orthopaedic surgeon.…

“Trust me, I am a doctor” – don’t take that for granted!

15th August, 2018, Dr Chee L Khoo

Opinion article 

“Trust me, I’m a doctor” is so universally accepted that we don’t even have to say it. Patients know that they can trust us implicitly. What are we asking patients to trust us with though? The current debate or argument about the pros and cons of opt-in or opt-out with MyHealthRecord may endanger the trust patients have in their doctors.…

Oral glucose tolerance test – what should the 1 hour reading be?

15th August 2018, Dr Chee L Khoo

Diabetes can be diagnosed using a myriad of criteria – fasting glucose >7.0mmol/L, 2-hour post prandial  >11.0 mmol/L or HbA1c > 6.5%. There are limitations to each of those tests and it is not one size fits all. The myriad of diagnostic tests allows clinicians to choose the most appropriate test for our patients based on their individual characteristics.…

Stroke Prevention – are two agents better than one?

15th August 2018, Dr Chee L Khoo

Following an acute coronary event we know that two anti-platelets are better than aspirin alone in preventing further coronary events. What about a cerebro-vascular events? Following a mild CVA or a TIA, we would normally commenced aspirin to prevent another stroke especially in the first 90 days. Would adding another agent to aspirin be better in preventing further strokes?…

The many faces of hypoglycaemia

2nd August, 2018, Dr Chee L Khoo

I first met Jack 14 years ago when he was diagnosed with T2D from an OGTT in 2005. He was a 47 years old then.  He was a busy businessman with no time for exercise and eating out fairly regularly.  His BMI back then was 34.7. He was already on treatment for hypertension and dyslipidaemia.…

Prostatic arterial embolisation – another option for BPH

1st August, 2018, Dr Chee L Khoo

Benign prostatic hyperplasia (BPH) is increasingly more common when men gets older. Transurethral resection of prostate (TURP) is still the gold standard treatment for most patients. Since alpha-adrenergic antagonists (also called alpha blockers) came to market, TURP is performed a lot less often. 5-alpha reductase convert testosterone into 5-alpha-di-hydrotestosterone (DHT), which is responsible for prostate hypertrophy and blocking this enzyme prevents further prostate growth.…

Lynch Syndrome – what GPs need to know

1st August, 2018, Dr Chee L Khoo

Although one third of patients with colorectal cancer (CRC) have a family history of cancer, only 5% of all patients with CRC have an identifiable cause to their cancer predisposition. Most of these identifiable predispositions are inherited mutations in genes that regulate growth processes in colonic stem cells and/or genome caretakers which ensure the only good clean DNA is passed on to the next generation. …

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