28th October 2018, Dr Chee L Khoo
There are now 7 glucagon like peptide 1 (GLP 1) injectable analogues used to control hyperglycaemia in patients with type 2 diabetes (T2D). An eighth GLP1 analogue is now available as an oral form. Only four of them are available in Australia of which three are on the PBS under authority prescription (Byetta, Bydureon, Trulicity).…
28th October 2018, Dr Chee L Khoo
Most of you would have read about the recent study linking angiotensin converting enzymes inhibitors (ACEI) to the risk of lung cancer. This was published in the BMJ last week. it was a bit of a surprise to some extent although once the dust settled, it wasn’t that surprising after all. ACEI causes a build-up of bradykinin in the lungs and bradykinin has been reported to stimulate growth of lung cancers.…
11th October 2018, Dr Chee L Khoo
Over the last 20 years, 5 classes of anti-diabetic agents are now available to choose from. This is great but which do you use after metformin? Guidelines after guidelines in Australia and internationally leave that decision up to us to make the choice on behalf of our patients. They all have different mechanisms of action but pretty much all of them have similar efficacy, reducing HbA1c by about 1.0%.…
30th September, 2018, Dr Chee L Khoo
One of the many challenges in general practice is keeping up with new management guidelines. Another week another guideline somewhere. Even if you are made aware of the existence of those guidelines and have access to them, the guidelines are usually 150-200 pages long. Even the executive summary runs into half a dozen pages.…
30th September 2018, Dr Chee L Khoo
10-40% of patients with psoriasis have joint manifestations as part of a multi-system inflammatory disease (1). There is a strong association between psoriasis and elements of metabolic syndrome. Recent evidence suggests that patients with psoriasis have increased cardio-metabolic morbidity and mortality. Like other auto-immune collagen diseases, psoriatic arthropathy (PsA) often necessitate a referral to the specialists to manage the systemic and joint disease.…
30th September 2018, Dr Chee L Khoo
Sulfonylurea (SU) is still one of the most commonly prescribed anti-diabetic agent for type 2 diabetes (T2D)1. These patients may have put on a few kilograms of weight over the years but then they are overweight anyway. Weight gain when one gets older is pretty much expected anyway. They may have a few cardiovascular events here and there but then patients with T2D are known to have a higher risk of CV events.…
15th September, 2018, Dr Chee L Khoo
There is definitely a role for aspirin in preventing cardiovascular (CV) events in patients who already had a CV event (secondary prevention). There is always a risk of gastrointestinal and intracranial bleeding. Because the risk of another event after the first is often significantly higher, when one works out the risk benefit ratio, the benefits of aspirin use usually wins.…
15th September, 2018, Dr Chee L Khoo
Nausea and vomiting affects up to 80% of pregnancies but severe nausea and vomiting in early pregnancy or hyperemesis gravidarum (HG) can affect up to 1% of pregnancy. As GPs, we are often the first port of call for these women. We know how debilitating it is to those women. There is also an significant economic impact not just because of many of these women ended up in hospital on more than one occasion before 20 weeks of gestation but many (and often their partners) can’t go to work during this period.…
15th September 2018, Dr Chee L Khoo
Glomerular Hyperfiltration
Although the physiological factors that cause early diabetic renal injury remain incompletely understood, glomerular hyperfiltration (GH) has been associated with the development of diabetic nephropathy (DN). GH leads to renin-angiotensin-aldosterone system (RAAS) activation which in turn leads to systemic vascular and endothelial abnormalities. DN not only lead to dialysis and ultimately, renal transplantation in some, it is a leading cause of mortality in patients with diabetes.…
15th September 2018, Dr Chee L Khoo
Noxious family members?
When phagocytes engulf microorganisms, intracellular phagasome bound NADPH oxidase catalysed the production of reactive oxygen species (ROS) like superoxide and hydrogen perixoide which kills the microorganism. NADPH oxidase is also expressed on membranes of many other non-phagocytic cells. ROS play a pivotal role in many physiological processes including host defence, hormone biosynthesis, fertilisation and cellular signalling.…
1st August, 2018, Dr Chee L Khoo
When a diagnosis is idiopathic, it often means we don’t know its pathogenesis well. Often, a mixed bag of conditions is thrown in there because we are rather imprecise in defining them. Fibrosis is the final common pathway of lung injury and idiopathic pulmonary fibrosis used to have a mixture of fibrotic conditions lumped together under the umbrella diagnosis.…
15th August 2018, Dr Chee L Khoo
Diabetes can be diagnosed using a myriad of criteria – fasting glucose >7.0mmol/L, 2-hour post prandial >11.0 mmol/L or HbA1c > 6.5%. There are limitations to each of those tests and it is not one size fits all. The myriad of diagnostic tests allows clinicians to choose the most appropriate test for our patients based on their individual characteristics.…