We read last fortnight about cerebral amyloid angiopathy (CAA). I am not sure that I can pick up a CAA when I see one. I mean, we are not experts in CT or MRI of the brain. A fairly obvious, bit chunk of an infarct is easy to spot. I can also pick up any asymmetry in the scan. Any more than that, i will have reached out to the printed report.…
GPvoice
Fournier’s gangrene & SGLT2i – how rare is it?
23rd March 2019, Dr Chee L Khoo
You may remember receiving warnings recently from the Therapeutics Goods Administration (TGA) about a serious “rare” infection, called necrotising fasciitis of the perineum, also referred to as Fournier’s gangrene (FG). FG is reported to be associated with the use of SGLT2 inhibitors in patients with type 2 diabetes (T2D). The warning came on the back of similar warnings by the US Food and Drug Authority (FDA) in August 2018.…
Insulin-GLP1 agonist combo – two heads better than one
23rd March 2019, Dr Chee L Khoo
American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) suggest that if HbA1c targets are not achieved despite the addition of basal insulin in type 2 diabetes (T2D), treatment could also be further advanced by the addition of a glucagon-like peptide-1 receptor agonist (GLP-1 RA). The addition of a GLP1-RA has been shown to be as efficacious as the addition of a prandial insulin in patients with T2D who is not at glycaemic target despite the addition of basal insulin therapy (1).…
Diabetes management after bariatric surgery – which medication to continue
14th March 2018, Dr Chee L Khoo
Bariatric/metabolic surgery is an effective strategy to attain diabetes remission in obese patients. Significant and rapid weight loss by any means will improve insulin sensitivity, the internal glucotoxicity and lipotoxicity. Bariatric surgery, in particular, is thought to also lead to changes in gut incretins and neurotransmitters, improvement of hepatic and peripheral insulin sensitivity, altered bile acid metabolism and gut microbiota that are independent of weight loss.…
Can drugs and supplements improve sperm quality?
12th March 2019, Dr Chee L Khoo
When couples present for investigations of infertility, semen analysis is one of the earliest investigations we order. Every so often, the results come back with reduced sperm numbers, motility or normal forms. It is frustrating as a GP when we are unable to advise them what they can take to improve their sperm parameters.…
Haemorrhagic stroke – is that cerebral amyloid angiopathy?
10th March 2019, Dr Chee L Khoo
About 10% of all strokes are haemorrhagic strokes. In about 10% of cases of primary intracerebral haemorrhage (ICH), cerebral amyloid angiopathy (CAA) is regarded as a possible cause. The recurrence rate of ICH is significantly higher in patients with CAA. With improvements in MRI technology, CAA is increasingly recognised as a cause of ICH.…
Continuous glucose monitoring FREE for T1D but not FREELY available
10th March 2019, Dr Chee L Khoo
It makes sense that patients with type 1 diabetes (T1D) on insulin pump be fitted with continuous glucose monitoring (CGM) which facilitate insulin titration. It’s even better if the CGM sensor directly “talks” to the pump and adjust the basal insulin rate with an algorithm based on the blood glucose levels. There are ample studies demonstrating better glycaemic control when you use both pump and CGM for management of patients with T1D.…
How long does a knee replacement last?
23rd February 2019, Dr Chee L Khoo
Joint replacement is the mainstay treatment for advanced arthritis. Unfortunately, almost all joint replacements fail over time. We are frequently asked by patients “how long does the replacement last?”. It’s important to know how long a joint is supposed to last because it determines the “ideal” age to have the first knee replacement. Further, we can anticipate when symptoms will be coming up and start exploring the feasibility of the next joint replacement.…
Can Vitamin C reduce plasma glucose?
22nd February 2019, Dr Chee L Khoo
Increased oxidative stress appears to be a significant factor leading to insulin resistance, dyslipidaemia, β-cell dysfunction, impaired glucose tolerance and ultimately leading to type 2 diabetes (T2D). Ascorbic acid (AA) is a water soluble anti-oxidant that reduces oxidative damage at the cellular and tissue level. So, logically, AA supplementation should therefore reduce oxidate stress and lead to improvement in glycaemic control in patients with diabetes.…
Pavements and Medicare – what do they share in common?
13th February 2019, Dr Chee L Khoo
One of the great advantage of being a runner is that wherever you go, all you have to do is pack a pair of running shoes and the world is your oyster. During a recent visit to Kuala Lumpur, Malaysia, I went out running on the local streets. It was 6am and still pitch dark.…
Anti-depressants – what to do when it comes time to discontinue
13th February 2019, Dr Chee L Khoo
The bulk of patients with depression is managed in primary care. A significant proportion of these patients do well with the usual anti-depressants. At some point in time, many will no longer need their medications and we usually wean them off their drugs. Why do we need to wean them off? How do we wean them off?…
Congenital nasolacrimal duct obstruction – when to probe?
13th February 2019, Dr Chee L Khoo
Nasolacrimal duct obstruction in infants is not uncommon. Up to 10% of infants will present with watery, teary eyes which sometimes become purulent necessitating antibiotic drops. We know that “most” spontaneously resolve as the infant grows older. In the meantime, we generally recommend massaging of the duct and topical antibiotics when required. Up to 1 in 4 congenital nasolacrimal duct obstruction (CNLDO) does not resolve spontaneously.…