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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).…

Fasting or non-fasting lipid levels – doesn’t it really matter?

22nd June 2019, Dr Chee L Khoo

It is standard to measure blood lipids after an 8-12 hour fast. Pretty much all our guidelines for management of cardiometabolic conditions are based on these fasting blood levels. The actual reading is important because it guides us to determine whether a patient is commenced on a statin or not. Do meals affect lipid levels?…

Diabetic peripheral neuropathy and serum cholesterol– is lower necessarily better?

22nd June 2019, Dr Chee L Khoo

Distal polyneuropathy (DPN) is one of the more severe complications of diabetes. The exact pathologic metabolic process of DPN is still uncertain but it is more common in patients with type 2 diabetes (T2DM) than in patients with type 1 diabetes (T1DM) even after adjusting for glucose levels. Thus, in addition to hyperglycaemia, other factors could be involved in the development of DPN such as obesity, hypertension, dyslipidaemia and renal impairment. …

Montelukast and neuropsychiatric events in kids with asthma – is there a link?

10th June 2019, Dr Chee L Khoo

Children with moderate to severe asthma often needs more than the usual bronchodilators. Even the newer long acting beta agonists (LABA) or long acting muscarinic antagonists (LAMA) may not be enough to control the symptoms and reduce exacerbations and inhaled corticosteroids (ICS) are often needed. But we are careful to keep the total daily dose of corticosteroids to a minimum.…

Early weight loss following T2DM diagnosis – does the body remember?

8th June 2019, Dr Chee L Khoo

The majority of patients with type 2 diabetes (T2DM) are diagnosed and managed in primary in the early years. We know from the UKPDS that early tight glycaemic control have enduring legacy effects on cardiovascular morbidity and mortality. We also know from the DiRECT trials that significant weight loss when the diabetes duration is short can lead to diabetes remission (1,2).…

New faster acting insulin – how fast is faster?

6th June 2019, Dr Chee L Khoo

I thought short acting insulin was fast acting until fast acting insulin came along. Just when you think fast acting is truly fast acting, along came faster acting. So, what is this faster acting insulin aspart (fiasp)? Is it just another play with semantics? Or is it just another attempt in extending a patent?…

SGLT2 inhibitors and the diabetic kidney – friend or foe?

26th May 2019, Dr Chee L Khoo

Sometimes when a drug is contraindicated for patients with low eGFR, it may mean that usage of the drug may further damage the kidneys or increase the risk of certain adverse events. For example, the use of metformin in patients with eGFR <30 significantly increase the risk of lactic acidosis. Usage of lithium in patients with impaired renal function (low eGFR) may further damage the kidneys.…

GP: The centre of type 2 diabetes care – are you up to the task?

26th May 2019, Dr Chee L Khoo

GPs in south west Dydney (SWS) are increasingly overwhelmed by the numbers of patients with type 2 diabetes (T2DM) coming through the doors. We know that this cohort have a more “aggressive” disease and much higher and earlier complication rates. T2DM continues to be strongly associated with numerous cardiovascular and renal complications.…

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