BNP for heart failure now Medicare funded – who needs them?

27th October 2024, A/Prof Chee L Khoo

Patients with heart failure have high mortality and morbidity. Each time they are admitted into hospital with an exacerbation, their cardiac function deteriorate and usually do not return to pre hospital level when they are better. Many of these patients have other co-morbidities which can mask their symptoms or they are in and out of hospital with the other co-morbidities that the HF is overlooked.…

Cagrilintide for weight loss – another new kid on the block

24th October 2024, A/Prof Chee L Khoo

anti-obesity medication

We all know about how effective and potent the GLP1 agonists are in improving metabolic control in patients with T2D and obesity. We also know about how even more potent the new dual GIP/GLP1 agonist is in improving glycaemic control and losing body weight. There are further studies demonstrating their efficacy in reducing heart failure mortality, sleep quality in patients with obstructive sleep apnoea and liver fibrosis in patients with metabolic dysfunction associated fatty liver disease (MAFLD) (albeit in combination with other agents).…

The role of US in postmenopausal bleeding

13th October 2024, NIA Diagnostic Imaging

transvaginal US

Menopause is characterised by complete absence of menstrual cycle due to no ovarian follicles left in reserve and it is clinically diagnosed when a woman has amenorrhea for at least 1 year (Sung, 2023).
Any post-menopausal women with vaginal bleeding should be appropriately managed through comprehensive clinical examinations and diagnostic studies; these include diagnostic imaging and, in some cases, endometrial biopsies (Sung, 2023).…

MAFLD – how to safely monitor in primary care

13th October 2024, A/Prof Chee L Khoo

MAFLD

We dissected the latest consensus statement from GESA in the last issue of GPVoice when we looked at metabolic dysfunction related fatty liver disease (MAFLD). We highlighted the risk groups that are very likely to have MAFLD. Essentially, these are patients with metabolic syndrome (type 2 diabetes, obesity, hypertriglyceridaemia and hypertension). We looked at the recommendations of using ultrasonography as the first line investigation to diagnose MAFLD and not to rely on abnormal liver function tests (LFTs) to rule in or rule out MAFLD.…

MAFLD – Latest consensus statement for assessment in primary care

28th September 2024, A/Prof Chee L Khoo

MALFD

Patients are often given tacit recommendations about lifestyle changes for MAFLD because it’s “just a little fat in the liver”. For those of us who have that few patients with those liver as well as non-liver complications, we will remember how horrible these patients fare moving forward. Yet, we can’t refer all our patients with fatty liver to the hepatologist.…

Diabetic retinopathy – a new paradigm change in management coming…

28th September 2024, A/Prof Chee L Khoo

diabetic retinopathy (DR)

Diabetic retinopathy (DR) is the leading cause of new cases of blindness in patients with diabetes mellitus. In 2020, more than 103 million individuals with diabetes mellitus worldwide were affected by diabetic retinopathy and it is expected that this number will increase to 160 million by 2045 (1). We are all familiar with the association between poor glycaemic control and diabetic retinopathy development and progression.…

CKD – high protein intake or not?

12th September 2024, A/Prof Chee L Khoo

Protein

Inadequate protein intake in older adults may cause impairments of muscle mass and muscle function as well as impairment in immune function. Higher protein intake has been associated with increased muscle mass and strength, slower rate of bone loss, higher bone mineral density, lower risk of frailty, and improved cardiovascular function and recovery from illness (including wound healing) (1,2).…

Understanding radiation dose in CT scans

8th September 2024, NIA Diagnostic Imaging

CT

Computed tomography (CT) is widely recognised as the gold standard for detecting and diagnosing a broad range of pathologies due to its ability to provide detailed cross-sectional imaging. However, concerns about radiation exposure continue to be raised by both patients and clinicians. As a result, it is crucial to understand the impact of technological advancements in ensuring that radiation exposure is kept as low as reasonably achievable (ALARA) while still maintaining diagnostic accuracy.…

VLCD – does it work? Is it safe?

30th August 2024, A/Prof Chee L Khoo

Up until GLP1RAs +/- GIPs were shown to be efficacious in assisting patients lose weight and keeping the weight off, long term sustainable weight loss was practically unachievable. Not everyone wants to or is able to afford bariatric surgery to assist in weight loss. Even then, the weight loss is usually not sustainable. International guidelines (including Australian) include medical nutritional therapy in the management of obesity.…

Hypertriglyceridaemia – is fenofibrate all we have?

24th August 2024, A/Prof Chee L Khoo

Last fortnight we looked at the effects of hypertriglyceridaemia (HTG) on atherosclerosis. We explored the source and metabolism of triglycerides (TG). We saw how important lipoprotein lipase was in regulating plasma TG. Triglyceride levels are closely related to plasma triglycerides rich lipoprotein (TRL) and TRL remnants. All three components penetrate through the endothelium into the subendothelial space where atherosclerotic inflammation occur.…

Plasma glucose – how accurate is the reading?

24th August 2024, A/Prof Chee L Khoo

glucose analysis

Plasma glucose levels is such a simple test that we take for granted its reliability. The glucose level is absolutely critical in many of our clinical management. It governs whether we diagnose someone with diabetes or not and that have many regulatory implications. We have discussed the diagnosis and management of gestational diabetes mellitus (GDM) and how it affects maternal and offspring outcomes and future risks to both.…