25th June 2023, Dr Chee L Khoo
A few weeks ago we explored familial hypercholesterolaemia (FH) primarily in adults. The issues we touched on were how not so rare FH really is and further, how aggressive we should target the LDL-Cholesterol (LDL-C). As we know, commencing lipid lowering agents is only the first step. The next step is to agree on what the LDL-C target should be in this patient based on the cardiovascular risk of the patient.…
11th June 2023, NIA Diagnostic Imaging
The incidence of pelvic organ prolapse is highly associated with increased age and vaginal childbirth (Weintraub et al., 2020). Majority of patients who present with POP may not report any symptoms. Patients who do present with symptoms, however, often describe a sense of feeling of a bulge protruding through the vaginal opening. In younger women, vaginal laxity is more commonly noticed and related to sexual dysfunction (Peter Dietz, 2015).…
11th June 2023, Dr Chee L Khoo
First, we have short acting GLP1-RA (exenatide) which requires twice a day injections. Then, we have once daily GLP1-RA injections (e.g. Exenatide ER, liraglutide, lixisenatide) which makes it more convenient for most patients. Of course, once daily injection is still too many. Once a week would be better, wouldn’t it? Of course, we now have weekly dulaglutide and semaglutide and patients love them.…
10th June 2023, Dr Chee L Khoo
It’s all very confusing, isn’t it? Low fat, low carbohydrate, Mediterranean diet, Paleo diet, Nordic diet or DASH diet. There are many other diets which we haven’t even heard of. Are they any good? Do they cause harm? How can we advise our patients if we don’t know what those diets are?…
30th May, 2023, Spectrum Medical Imaging
Knee injuries are one of the most common injuries we see in general practice. We always start with history to determine the mechanism of injury. Examination is not always straight forward especially, if there is severe pain and restriction of movement. MRI is an excellent tool for demonstrating injuries of the internal soft tissue structures in the joints.…
28th May 2023, Dr Chee L Khoo
Hypertriglyceridaemia has always played second fiddle to hypercholesterolaemia for a long time. Studies after studies have demonstrated the cardiovascular benefits of cholesterol lowering therapy. You might know that most of these clinical trials excluded patients with hypertriglyceridaemia. Does that mean that hypertriglyceridaemia doesn’t matter? We know hypertriglyceridaemia inflict oxidative damage to vital metabolic systems and organs.…
27th May 2023, Dr Chee L Khoo
The first GLP1- RA, exenatide was first isolated by John Eng in 1992 while working at the Veterans Administration Medical Center in the Bronx, New York.[1] It was made by Amylin Pharmaceuticals and commercialised by AstraZeneca. Exenatide was approved by the FDA on April 28, 2005, for people whose diabetes is not well controlled on other oral medications.…
14th May 2023, Dr Chee L Khoo
TOBOGM is the very first study to see if immediate treatment of early gestational diabetes mellitus (GDM) increases or reduces pregnancy complications among women with GDM diagnosed with OGTT before 20 weeks’ gestation. TOBOGM study results will significantly contribute to the management decisions of pregnant women with early GDM. Campbelltown Hospital was the lead recruiting centre with Professor David Simmons being the chief investigator of this international study.…
14th May 2023, Dr Chee L Khoo
When we think about diabetic complications, we usually think about microvascular and macrovascular complications. We don’t often think about dementia as a diabetic complication. Diabetes has consistently been associated with an increased risk of dementia and its subtypes (Alzheimer’s disease and vascular dementia (1). As many with diabetes, especially T2D, are being diagnosed at a younger age, dementia relating to diabetes will increasingly be diagnosed and diagnosed at a younger age.…
30th April, Spectrum Medical Imaging
All medical students will remember Morton’s neuroma but they never tell us what to do after you suspect the foot symptoms are suggestive of Morton’s neuroma. It also known as inter-metatarsal neuroma. It is a focal area of perineural fibrosis around plantar digital nerves of the foot. It is thought to be due to chronic entrapment of the nerve by the inter-metatarsal ligament and can be a cause of metatarsalgia.…
29th April 2023, Dr Chee L Khoo
We have a increasing number of patients who has undergone a percutaneous coronary intervention (PCI). This could be in the acute setting of an acute coronary syndrome (ACS) or electively during an exploratory angiogram. Stents used to be bare metal. Then came the first-generation drug eluting stents. The latest generation drug eluting stents are better at reducing subsequent thrombosis of the stented and unstented coronary segments.…
25th April 2023, Dr Chee L Khoo
We may not have many patients with neuropathic pain but patients with neuropathic pain can be heartsinks. Most of the time, nothing seems to work. It can be quite frustrating when anti-depressants after anti-depressants don’t work. The old tricyclics often don’t work either. What about pregabalin? Nope. What about gabapentin? Nope. What about long-acting opioids or tramadol?…