DEXA – the key to osteoporosis diagnosis

14th January 2025, NIA Diagnostic Imaging

It is usually not difficult to diagnose osteoporosis once a patient has fractured a bone or two. The key in primary care is to try to diagnose those at risk of osteoporosis and prevent a fracture, especially neck of femur fracture. The consequence of a neck of femur fracture is quite significant especially in elder patients.…

Obstructive Sleep Apnoea Rx – is CPAP all we have?

8th January 2025, A/Prof Chee L Khoo

CPAP

Obstructive sleep apnoea (OSA) often (but not always) lead to daytime sleepiness and suboptimal daytime performance (including driving performance). It can also have a major effect on the quality of life (QOL) of the patient and the family. OSA is associated with a number important metabolic and cardiovascular conditions in a multidirectional manner.…

Serum magnesium – what is normal and why the fuss?

23rd December 2024, A/Prof Chee L Khoo

Serum magnesium

The reference values for serum magnesium (Mg2+) have been proposed to be somewhere between ~0.6 and ~1.2 mmol/L in healthy humans. That is a pretty wide range. Have you noticed that every second person discharged from hospital is recommended to take some Mg2+ supplement. Serum Mg2+ is often (or always) checked in hospitalised patients.…

Anterior optic nerve neuropathy and semaglutide – are they related?

23rd December 2024, A/Prof Chee L Khoo

optic neuropathy

Is this one of those “adverse events” related to the GLP1 agonist your patient saw on google one day? I can see you roll your eyes and I thought that way too initially. But upon further research, it seems to be a real thing as there was a study published in the JAMA Ophthalmology recently.…

Icosapent ethyl for hypertriglyceridaemia – who is eligible?

12th December 2024, A/Prof Chee L Khoo

ASCVD

Back in August this year, when we last highlighted the benefits of the new pure eicosapentaenoic acid (EPA), icosapent ethyl (Vazkepa®), in reducing cardiovascular outcomes in patients with high triglycerides and high cardiovascular risk, we foreshadowed that it will be available on the PBS for patients with established cardiovascular disease. It is now on PBS Authority and there isn’t much of a launch of the drug which is a pity as many of our patients who may benefit from icosapent ethyl who should be on it aren’t because most of us (including me) are still confused as to who will benefit and who is eligible.…

3D Mammography – when should we order them?

12th December, NIA Diagnostic Imaging

Breast lump

We know that screening mammography is not perfect. This is particularly the case in breasts that are dense. Breast tissue density is a predictor of breast cancer (BC) risk (1-3). Pooled analyses have shown a fourfold to fivefold increase in BC risk for women with the highest breast tissue density compared with those classified in the lowest density category, independently of other risk factors for BC that may be present in women with high breast density (1,3).…

Early GDM – what happens post partum?

29th November 2024, A/Prof Chee L Khoo

We have written a bit on the paradigm change in our diagnosis and management of GDM over the last couple of years. We have looked at the TOBOGM study at length about early GDM (eGDM). This is GDM diagnosed before 24-week gestation. The TOBOGM study demonstrated that it is important to diagnosed early GDM as early treatment significantly improve neonatal and maternal outcomes.…

Tirzepatide – another kid on the block for HFpEF

18th November 2024, A/Prof Chee L Khoo

HFpEF

Amongst the many causes of heart failure with preserved ejection fraction (HFpEF) is obesity. This is not surprising because obesity is now considered an inflammatory chronic disease. Increase adiposity leads to increased released of pro-inflammatory cytokines which damages myocardial muscles. It would then follow that reducing that fat mass would reduce the pro-inflammatory environment and result in lower incidence of HFpEF as well as reducing complications of HF.…

Well controlled type 2 diabetes – can we stop metformin?

9th November 2024, A/Prof Chee L Khoo

Metformin

Metformin has been the first line treatment for patients with type diabetes for many years. It has many mechanisms of action with many more that we have yet to uncover. We know that it improves glucose control by improving insulin resistance. These days we have many other glucose lowering agents that are a lot more potent than metformin.…

Shoulder bursitis – diagnosis and management

9th November 2024, NIA Diagnostic Imaging

What is shoulder bursitis?

Shoulder bursitis is one of the most common causes of shoulder pain and is referred as an inflammatory disorder affecting the subacromial-subdeltoid bursa (Faruqi & Rizvi, 2023). The subacromial-subdeltoid bursa is a fluid-filled sac lined with synovium which separates the supraspinatus tendon from the acromion, coracoacromial ligament and deltoid and helps ease movement between the rotator cuff and other structures of the shoulder joint (MacMahon & Yablon, 2017).…

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).…