24th December 2018, Dr Chee L Khoo
Losing weight is the second hardest thing to do. The hardest is keeping that weight off. With weight loss, hunger increases and energy expenditure decreases as the body adapts physiologically to the weight loss. The kilogram loss is not all fat loss. Some of the losses are muscles and with less muscle bulk, basal metabolic rate also decreases adding further to the decrease in energy expenditure. …
22nd December 2018, Dr Chee L Khoo
Endometriosis is the most frequently diagnosed condition in women with chronic pelvic pain. What if they can’t find endometriosis on laparoscopy? In 60% of women with chronic pelvic pain, the cause remained unknown. A significant proportion of these women may suffer from pelvic congestion syndrome (PVC). Is this one of those “idiopathic” type condition which is diagnosed when all tests are negative?…
22nd December 2018, Dr Chee L Khoo
Patients with active cancers are at an increased risk of DVTs and pulmonary embolism. Some patients are at higher risk than others. Thromboembolic prophylaxis could reduce that risk but is not routinely recommended in practice guidelines because the absolute risk is modest and of course, there are potential major bleeding risk. With the introduction of the new oral anti-coagulants (NOACs), the equation might be different.…
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.…
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.…
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.…
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).…
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.…
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.…
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.…
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.…
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.…