Weekly insulin and weekly GLP1-RA – ideal partners?

27th January 2024, A/Prof Chee L Khoo

Weekly combo

We are all pretty much used to weekly GLP1-RA injections for our patients with type 2 diabetes (T2D). Certainly, a lot less needles compared with the once daily or twice daily GLP1-RA injections and therefore more acceptable to patients (including those without diabetes!). Weekly GLP-1 are efficacious in reducing fasting as well as postprandial glucose.…

Amiodarone toxicity – nastier than you think

13th January 2024, Conjoint A/Prof Chee L Khoo

Amiodarone toxicity

Amiodarone started life as an anti-angina drug but it’s used primarily for its anti-arrhythmic properties these days. That’s not because it is such a good anti-arrhythmic agent (AAD) but because there just aren’t that many good and safe anti-arrhythmic agents around. We are all aware of amiodarone’s thyroid effects (hypo or hyper) and we monitor them closely as long as they are on amiodarone.…

Marathon running – putting evidence into practice

13th January 2024, Conjoint A/Prof Chee L Khoo

Marathon running

When we think about extreme physical activity (EPA) such as marathon running, apart from the perceived issue of wearing out knee and hip joints (that’s another issue, another day), we think about the cardiovascular risks or benefits that comes with this intense physical activity. We explored the issue of marathon running and cardiovascular risks 9 months ago here.…

Marathon running – putting science into practice

27th December 2023, A/Prof Chee L Khoo

Endurance athlete

When we think about extreme physical activity (EPA) such as marathon running, apart from the perceived issue of wearing out knee and hip joints (that’s another issue, another day), we think about the cardiovascular risks or benefits that comes with this intense physical activity. We explored the issue of marathon running and cardiovascular risks 9 months ago here.…

CKD in T1D – any advances in management?

27th December 2023, A/Prof Chee L Khoo

CKD

Not surprisingly, if dysglycaemia is the major contributor to microvascular complications in type 2 diabetes (T2D), the same complications must plaque our patients with type 1 diabetes (T1D. However, we haven’t had many major advances in the management for chronic kidney disease (CKD) and cardiovascular disease (CVD) in patients with T1D for decades.…

Sarcopenia – can we measure it and how bad is it?

10th December 2023, A/Prof Chee L Khoo

Old and weak?

We don’t get old and weak. Actually, if we get weak, we become old. We all see that in practice. It doesn’t matter how old our patient is. When they become weak, they slow down. They can’t walk very far and they don’t. They become weaker and weaker. They have difficulty get off a chair.…

Foot injuries – is that a Lisfranc injury?

Foot injury

30th November, Spectrum Medical Imaging

The midfoot consist of 5 bones, cuboid, navicular and three cuneiform bones. These bones articulate with the base of the five metatarsals. In the Lisfranc injuries, it is these articulations (and their ligamemts) that are damage. Sometimes, there are fractures easily seen on plain xrays. Sometimes, one can see separation of the bones on plain xrays.…

Acne – the ABC of management in primary care

27th November 2023, A/Prof Chee L Khoo

Although moderate to severe acne is pretty common in primary care, our management tends to be haphazard. We have our favourite topical and oral therapy but I am not sure that that is evidence-based nor pathophysiological in our approach. When all else fails, we refer on to our friendly dermatologist. I recently attended a brilliant lecture at the Melbourne GPCE presented by Dr Ryan de Cruz, a Melbournian dermatologist.…

Cervical screening – hands up who’s not here?

25th November 2023, A/Prof Chee L Khoo

Cervical screening for cervical cancer for the prevention of cervical cancer has to be one of the most successful campaigns in primary care. For most, instead of having an intimate check every two years, doing it every 5 years is such a relief. For others, it is still having to endure an insertion of a vaginal speculum.…

GLP1RAs – do they reduce CV events?

14th November 2023, A/Prof Chee L Khoo

Cardiovascular Events

Obesity is a recognised risk factor for cardiovascular disease (CVD). We are all used to treating cardiovascular risk factors such as hypertension, dyslipidaemia and diabetes in an attempt to reduce CV events. We should also treat the obesity, shouldn’t we? Logically, weight reduction should lead to reduction in CV events but, unfortunately, lifestyle changes and pharmacological interventions to reduce obesity have not been shown to improve cardiovascular outcomes (1-5).…

Exacerbation of COPD – do oral steroids make any difference?

12th November 2023, Conjoint Assoc. Prof Chee L Khoo

It is pretty standard for us to treat an infective exacerbation of COPD with antibiotics and a shot of oral corticosteroids, usually oral prednisolone for 5-7 days. Almost all of them seems to get better with that regimen. Or do they? We explored when to use and when not to use inhaled corticosteroids (ICS) in COPD in the September 2023 issue.…

CT cholangiogram – when should we order one?

12th November 2023, NIA Diagnostic Imaging

epigastric pain

Epigastric pain has to be one of the most common presenting symptoms in primary care. The differential diagnoses include cholelithiasis and cholecystitis. With increasing prevalence of obesity and type 2 diabetes, the prevalence of gallbladder disease is also increasing. Often, abdominal ultrasound can confirm or exclude gallbladder disease but sometimes, the results are inconclusive or we suspect additional bile duct obstruction.…