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).…

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).…