June 15, 2018, Dr Chee L Khoo
The most recent stats tell us that antibiotics prescription for viral URTIs have come down. It certainly gives us that warm and fuzzy feel good feeling that finally, the message is getting through in primary care. Well, are antibiotic prescription rates for influenza infections really coming down? How come I still come across many of patients being prescribed antibiotics for the “flu” after they were seen on the weekend.…
June 1, 2018, Dr Chee L Khoo
Source: SENSIMED
We are all familiar with 24-hour BP monitor. We are also familiar with 24-hour Holter monitor and continuous glucose monitoring. We now have 24-hour intraocular pressure monitor. It doesn’t actually monitor intraocular pressure but the effects of it (a bit later). A recent study has now confirmed the association between the intraocular pressure monitoring and progression of glaucoma in older adults.…
May 15, 2018, Dr Chee L Khoo
You probably think that insulin pump (so-called continuous subcutaneous insulin infusion or CSII) and continuous glucose monitoring (CGM) are all to do with Type 1 diabetes (T1D) in diabetes centres and you probably don’t need to know about it, you are probably right. Well, almost. I mean, how often do you come across CGM and CSII in general practice?…
May 15, 2018, Dr Ahmed Mayat (Medical Imaging Campbelltown)
Gold standard for diagnosis and staging of liver fibrosis is liver biopsy. This is, however an invasive procedure with its associated complications.
Liver Elastography is a simple non-invasive method to assess liver fibrosis. A special ultrasound pulse measures the propagation speed of sound waves through the liver parenchyma. This data can be acquired during the normal liver ultrasound examination. …
May 15, 2018, Dr Chee L Khoo
Kylie was known to have chronic hepatitis c infection for many years. She had been busy for the last 2-3 years being pregnant. We talked about anti-viral treatment as soon as she finished with breast feeding her last baby. She had heard about these wonder drugs curing her hepatitis C infection.
When Kylie was ready, we went through the motions:
Pre-treatment Asssessment – the 6 Cs
May1, 2018, Dr Chee L Khoo
We all know that smoking and alcohol are associated with increased risk of oesophageal cancer. A recent large study from China looked at 456,155 people and found 1731 esophageal cancers over 9.2 years. They noticed that there was an interaction of hot tea with smoking. Smokers who drank burning hot tea daily had double the risk of oesophageal cancer compared with non-smokers who only occasionally drank tea.…
May 1, 2018 Dr Chee L Khoo
When I wrote the article last fortnight about new SLT2 inhibitor/DPP4 inhibitor combo now on the PBS, the situation was still very confused. Since that article, more information has come to light. Yes, we are allowed to use both DPP4 inhibitors (DPP4i) and SLGT2 inhibitors (SGLT2i) together when patients with type 2 diabetes (T2D) if the HbA1c is >7.0%.…
April 15, 2018, Dr Chee L Khoo
To get our patients with type 2 diabetes (T2D) to glycaemic target using oral agents, you can either use an SGLT2 inhibitor (SGLT2i) or a DPP4 inhibitor DPP4i) after metformin (with or without a sulphonylurea) but not both. If you stop a DPP4 inhibitor to start a SGLT2ior vice versa, in general, the HbA1c remain unchanged.…
April 2018, Dr Chee L Khoo
The term complementary medicine refers to a group of diagnostic and therapeutic disciplines that exist largely outside the institutions where conventional health care is provided and taught. The wide range of disciplines classified as complementary medicine makes it difficult to find defining criteria that are common to all.
In Germany, a significant proportion of doctors have additional qualifications in chiropractic, homeopathy and naturopathy.…
April 2018, Dr Chee L Khoo
Multi-disciplinary care (MDC) is often hailed as THE comprehensive management for patients with type 2 diabetes (T2D). We refer these patients to podiatrists, exercise physios, dietitians, diabetes educators and sometimes, endocrinologists. Now, that is MDC, isn’t it? We are part of the MDC team. Do we see the benefit that is often hailed from MDC?…
April 2018, Dr Chee L Khoo
Ketogenesis is the production of ketone bodies (KB) when glucose levels decline and the glucagon:insulin ratio is high. When the body is deprived of glucose, KB act as an alternative fuel source for brain, heart, kidneys and skeletal muscles. KB have also been shown to have other physiological functions including lower glucose levels.
To understand the potential therapeutic implications of KB, we need to revise our knowledge about KB metabolism.…
A 60 year old man presents with a rising PSA despite several previously negative transrectal prostate biopsies. A prostate MRI demonstrates a circumscribed small region of low T2 signal intensity within the left lateral peripheral zone at the gland base. This region demonstrates moderately restricted water diffusion and avid early enhancement after intravenous contrast. This appearance is consistent with a region of high grade prostate cancer.…