Enteric-coated aspirin – are they any better than plain aspirin?

11th October 2023, Dr Chee L Khoo

Antiplatelet therapy

Aspirin is commonly used as an anti-platelet agent for the prevention of acute coronary syndromes and cerebrovascular accidents. Its role in secondary prevention is well established but its role in primary prevention remains very complicated and very debatable. There is no question that aspirin is definitely beneficial in reducing events especially in patients at high risk of cardiovascular events.…

Omega-6 fatty acids – are they still the bad guys?

11th October 2023, Dr Chee L Khoo

Oils ain’t oils

Current U.S. dietary guidelines do recommend higher intake of omega-6 polyunsaturated fatty acids (n-6 PUFA) to reduce the risk of coronary heart disease (1,2). This pro-Omega-6 fatty acid stance remains rather contentious. While there is data supporting cholesterol benefits of linoleic acid (LA), the predominant dietary n-6 PUFA and higher dietary n-6 PUFA (predominantly LA) is associated with lower CHD risk in prospective cohort studies (3), not all cohort studies have confirmed these benefits (4).…

Amyand hernia – what is it?

28th September 2023, Spectrum Medical Imaging

A groin swelling has to be one of the most common pathology that affects the groin area. Of course, we will all be looking out for hernias. There are all sorts of hernia in the inguinal or groin area. This week, we explore the case of a Amyand Hernia. What is an amyand hernia?…

Tirzepatide is finally here – what’s the big deal?

28th September 2023, Dr Chee L Khoo

Five years ago, we previewed the arrival of the twincretins. These are agents which contain both incretins, GLP1 and GIP. Back then, agent LY3298176 was shown to cause significant weight loss and reduction in glucose. Two years ago, agent LY3298176 finally had a name – tirzepatide. Two years ago, we looked briefly at the clinical trials comparing tirzepatide with various glucose lowering agents.…

CT-guided spinal injections – what to order?

12th September 2023, NIA Diagnostic Imaging

Back pain has to be one of the most common ailments we see in general practice. Pain may originate from nerve root irritation, facet joint dysfunction, degenerative disc disease or poor muscle function or even osteoporotic fractures. There has been numerous systematic reviews and meta-analyses and most have highlighted how ineffective cortisone injections are in relieving the symptoms in the medium and long term.…

HFpEF – does semaglutide help?

12th September 2023, Dr Chee L Khoo

HF

We have a number of drug classes that are helpful in reducing mortality in patients with heart failure with reduced ejection fraction. But when it comes to heart failure with preserved ejection fraction, SGLT2 inhibitors are the only class that have shown to be of use. ARNI, MRA or betablockers helps with HFrEF but in HFpEF?…

COPD – which puffer/s?

10th September 2023, Dr Chee L Khoo

COPD

We looked at the new understanding of the pathophysiology of COPD last fortnight. Armed with that information, we may be able to make sense of which puffer to use for which patient and what to escalate during their exacerbations. We already do that but, I must admit, rather haphazardly. It, kind of, depends on what samples I have in the drug cupboard or when the last pharma rep came to sell their ware.…

Wrist fracture – a cautionary tale

30th August 2023, Spectrum Medical Imaging

wrist injury

68yo female patient sustained a fall on an outstretched hand. Plain x-rays revealed a closed fracture to the right distal radius and ulna. This was reduced by the orthopaedic surgeon and held in a forearm plaster of Paris. Post op x-rays showed satisfactory alignment and she was discharged to see her GP with follow up with the orthopaedic team at a later date.…

The GOLD guidelines – what do you need to know?

27th August 2023, Dr Chee L Khoo

SOBOE

I thought I knew how to diagnose COPD when I see one. I thought I knew everything I need to know as a GP in managing COPD. I mean, how hard can it be? LABA, LAMA +/- ICS. If in doubt, put them on a triple puffer. Might be a bit of an overkill but what is the harm?…

Alzheimer Dementia – do diets help?

27th August 2023, Dr Chee L Khoo

Alzheimer Dementia

We talked about a number of monoclonal antibody (-mab) treatment for Alzheimer Dementia (AD) that have made headlines recently. We explore how (non) exciting the results of the clinical trials were including adverse effects. We also touched on how similar in efficacy the new wonder drugs are when compared with older existing anti-cholinesterases.…

Early breast cancer – close collaboration between GP and radiologist.

13th August 2023, NIA Diagnostic Imaging

A 49-year-old lady presented with pain in her right breast. There is a strong family history of breast cancer. Breast examination was difficult because of “lumpiness” of the breasts. She was referred for a breast ultrasound at NIA. Ultrasound showed two lesions in the right breast – one at 3 o’clock, 2cm from the nipple and another at 7 o’clock, 2cm from the nipple.…