12th September 2023, NIA Diagnostic Imaging
Back pain has to be one of the most common ailments we see in general practice. Pain may originate from nerve root irritation, facet joint dysfunction, degenerative disc disease or poor muscle function or even osteoporotic fractures. There has been numerous systematic reviews and meta-analyses and most have highlighted how ineffective cortisone injections are in relieving the symptoms in the medium and long term.…
12th September 2023, Dr Chee L Khoo
We have a number of drug classes that are helpful in reducing mortality in patients with heart failure with reduced ejection fraction. But when it comes to heart failure with preserved ejection fraction, SGLT2 inhibitors are the only class that have shown to be of use. ARNI, MRA or betablockers helps with HFrEF but in HFpEF?…
10th September 2023, Dr Chee L Khoo
We looked at the new understanding of the pathophysiology of COPD last fortnight. Armed with that information, we may be able to make sense of which puffer to use for which patient and what to escalate during their exacerbations. We already do that but, I must admit, rather haphazardly. It, kind of, depends on what samples I have in the drug cupboard or when the last pharma rep came to sell their ware.…
30th August 2023, Spectrum Medical Imaging
68yo female patient sustained a fall on an outstretched hand. Plain x-rays revealed a closed fracture to the right distal radius and ulna. This was reduced by the orthopaedic surgeon and held in a forearm plaster of Paris. Post op x-rays showed satisfactory alignment and she was discharged to see her GP with follow up with the orthopaedic team at a later date.…
27th August 2023, Dr Chee L Khoo
I thought I knew how to diagnose COPD when I see one. I thought I knew everything I need to know as a GP in managing COPD. I mean, how hard can it be? LABA, LAMA +/- ICS. If in doubt, put them on a triple puffer. Might be a bit of an overkill but what is the harm?…
27th August 2023, Dr Chee L Khoo
We talked about a number of monoclonal antibody (-mab) treatment for Alzheimer Dementia (AD) that have made headlines recently. We explore how (non) exciting the results of the clinical trials were including adverse effects. We also touched on how similar in efficacy the new wonder drugs are when compared with older existing anti-cholinesterases.…
13th August 2023, NIA Diagnostic Imaging
A 49-year-old lady presented with pain in her right breast. There is a strong family history of breast cancer. Breast examination was difficult because of “lumpiness” of the breasts. She was referred for a breast ultrasound at NIA. Ultrasound showed two lesions in the right breast – one at 3 o’clock, 2cm from the nipple and another at 7 o’clock, 2cm from the nipple.…
13th August 2023, Dr Chee L Khoo
Over the last 2 decades we have seen a number of new classes of glucose-lowering agents in the management of patients with type 2 diabetes (T2D). It was quite a few years after the introduction of the thiazolidinediones (pio- and rosiglitazones) that the DPP4 inhibitors, the GLP1- RA and then SGLT2 inhibitors came along and now changed the way we manage T2D.…
13th August 2023, Dr Chee L Khoo
Many of the male doctors are slowly losing the battle against male pattern alopecia. It’s either thinning or receding. For those who are not there yet, it’s coming. We are also seeing women joining the club. Androgenetic alopecia (AGA) is the most common form of hair loss in humans affecting 80% of Caucasian men and 50% of Caucasian women.[1].…
28th July 2023, Spectrum Medical Imaging
I couldn’t never work out the work flow of electronic referrals (e-referrals) for patients whom I refer for imaging. We are so used to having a piece of paper in our hand to make an appointment. You will be surprised how many patients look at you wondering what to do with that piece of paper.…
26th July 2023, Dr Chee L Khoo
It is coming up to 10 years now when we, as GPs, were suddenly not allowed to prescribe TRT for our patients with low serum testosterone levels. The rationale cited at the time was that testosterone replacement therapy (TRT) was potentially harmful because we were told that TRT is associated with increased cardiovascular risk in men with hypogonadism.…
26th July 2023, Dr Chee L Khoo
First it was aducanumab then lecanemab. Now it’s donanemab. All of them purportedly showed statistically significant improvement in clinical outcomes although the “significance” is hotly debated. Although aducanumab was the first to be approved by FDA (June 2021), the limited clinical improvement together with the increased risk of severe adverse effects meant that aducanumab is no longer used these days.…