GP Voice

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Another successful injectable workshop – DOMTRU at your service!

13th December 2018, Dr Chee L Khoo

Three weeks ago, 25 of our GP and allied health professional (AHP) colleagues sacrificed their valuable Saturday and became engaged in a highly interactive session exploring the use of injectables in the management of our patients with type 2 diabetes. Evaluation, comments and suggestions from the participants have just been collated and here at the Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU) we are just absolutely delighted about the results.…

Ertugliflozin – now we are three again

13th December 2018, Dr Chee L Khoo

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the latest therapeutic strategy in the treatment of type 2 diabetes mellitus (T2DM). They feature prominently in the latest international diabetes management guidelines. They not only improve glycaemic control but recent clinical trials demonstrated cardiovascular protection, combined with a reduction in body weight and blood pressure. There used to be three SGLT2 inhibitors, dapagliflozin, empagliflozin and canagliflozin until canagliflozin withdrew from the Australian market.…

High dose fish oil and CV outcomes – another fishy tale?

10th December, 2018, Dr Chee L Khoo

Elevated triglyceride  (TG) level serves as an independent marker for an increased risk of ischaemic events, as shown in epidemiologic and mendelian randomisation studies (1-5). However, in most of the statin trials, patients with high TG are generally excluded. There is confusion out there as to whether fish oils is useful or not for cardiovascular protection.…

Refractory depression – does adding mirtazapine help?

10th December 2018, Dr Chee L Khoo

Treatment resistant depression is not that uncommon in general practice. We have quite a few patients that don’t respond to maximal dose of our usual SSRI or SNRIs. Naturally, we need to check adherence to medications and alcohol intake. A review of the history is important as there may be hidden skeletons unresolved (including sexual abuse).…

The Diabetic Heart – the dawn of the myocardium

27th November, 2018, Dr Chee L Khoo

Of the patients with type 2 diabetes (T2D) who die from cardiovascular (CV) disease, 40% die from IHD, 15% die from heart failure and 15% die from strokes. Patients with T2D have greater atherosclerotic plaque burden, higher atheroma volume, and smaller coronary artery lumen diameter than persons without diabetes. Numerous processes contribute to atherosclerotic cardiovascular disease (ASCVD) in diabetes including (but not limited to) hyperglycaemia, insulin resistance and/or hyperinsulinemia, dyslipidaemia, inflammation, reactive oxygen species, endothelial dysfunction, hypercoagulability, and vascular calcification.…

Anti-phospholipid antibodies – how much do you know?

27th November 2018, Dr Chee L Khoo

I recently saw a young lady whose mother had anti-phospholipid syndrome (APL) . She is now worried whether she has the same problem and request some blood tests. She is otherwise fit and healthy. Sure, among other things, I ordered APL antibodies hoping that the pathologist will know what I was looking for. Pretty straight forward so far until the results of her tests came back.…

Diabetes Management – GPs as good as Diabetes Centres!

13th November 2018, Dr Chee L Khoo

70-80% of patients with type 2 diabetes (T2D) are managed in primary care in Australia. Patients managed in hospital based outpatients have the advantage of multi-disciplinary team care. They have dietitians, credentialled diabetes educator (CDE), physiotherapists and of course, the endocrinologist in the team. On the other hand, we, as GPs, have the advantage of knowing our patients and their families’ social environment.…

Dapagliflozin more than DECLARE its CV benefits

13th November 2018, Dr Chee L Khoo

It’s finally here. The Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE–TIMI 58) trial finally released their results this week at the American Heart Association (AHA) Scientific Sessions 2018. The results were most impressive but this was not just another CV outcome trial of another SGLT2 inhibitors. The results have major implications in the way we treat patients with type 2 diabetes (T2D) in general practice.…

Floppy Iris Syndrome – is your patient at risk?

12th November 2018, Dr Chee L Khoo

Intraoperative floppy iris syndrome (IFIS) was first described by Chang and Campbell. It is characterised by floppiness of the iris, miosis and ultimately, iris prolapse through the surgical wounds. It can occur during surgery for cataract and if not anticipated, it increases the risk of posterior capsule rupture, vitreous loss, retained nuclear fragments, post op intraocular pressure spikes, irido-dialysis, hyphema and corneal endothelial loss.…

GDM Diagnosis & Management – SWS leading the way

8th November 2018, Dr Chee L Khoo

When there is so much talk about gestational diabetes (GDM), you can’t help but think that just about every pregnant woman has GDM in south west Sydney (SWS). After all, if you look at the “high risk” group that you ought to be screening for GDM, there is hardly any woman in SWS that is not in the high risk category.…

Twincretins – are two incretins better than one?

29th October 2018, Dr Chee L Khoo

Incretins are hormones released when we eat. They augment the release of insulin from pancreatic beta cells. They not only lead to reduction in blood glucose levels via the secretion of insulin, they also inhibit glucagon release thereby stemming further hyperglycaemia, slow the absorption of nutrients by slowing gastric emptying and increase satiety. The two main incretin hormones are glucagon like peptide -1 (GLP1) and gastric inhibitory peptides (GIP).…

Metallic implants/prosthesis – are they MRI safe?

28th October 2018, Dr Chee L Khoo

Metallic objects, implants or prosthesis can render magnetic resonance imaging (MRI) unsafe or affect the quality of the images. Our patients who have metallic joint prosthesis in-situ not uncommonly require further imaging. This can pose a bit of a challenge as many of the same patient population who require the joint replacement are the same population of patient that require further imaging.…

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