Aspirin – which cancers will it benefit?

The US Preventive Services Task Force (USPSTF) recommends low-dose aspirin use for the prevention of cardiovascular disease among average-risk individuals aged 50 to 59 years with a 10% or greater 10-year risk of cardiovascular disease (1). Long-term regular aspirin use is also associated with reduced risk of obesity- and inflammation-associated cancers, particularly colorectal cancer (CRC) (2,3). Numerous follow up trials have consistently demonstrated significant reductions in risk in GI cancers – the NIH-AARP (4), the Nurses Health Study (5) and the Health Professionals Follow-up study (6,7).…

Heart Failure in diabetes – getting more complicated?

10th February 2020, Dr Chee L Khoo

Diabetes can either be the sole perpetrator of the heart failure or be an accomplice to other cardiac disease such as coronary artery disease or myocarditis. Diabetic cardiomyopathy can manifest itself either as a restrictive cardiomyopathy with heart failure with preserved ejection fraction (HFpEF) or as a dilated cardiomyopathy with heart failure wth reduced ejection fraction (HFrEF).…

Workers comp referrals – one-stop shop

Work related or motor vehicle injuries can often be tricky to manage. One not only have to look into the mechanisms of injury to assist in the diagnosis but one needs to consider the return to work schedule and restrictions. Often we need radiological investigations. That usually require approval from the insurer and that can be quite tedious. Wouldn’t it be great if someone can do the running around on our behalf.…

Diabetes risk according to family history – can we quantify the risk?

29th January 2020, Dr Chee L Khoo

If you have someone in the family with type 2 diabetes (T2D), then your risk of developing diabetes significantly increases. How much is “significant” though? Is it 2 times, 3 times or is it 10 times? Does it matter how many members in the family have diabetes? Is paternal diabetes important too? Do we know the numbers?…

New T2D hyperglycaemia management guidelines 2019 – what is new?

29th January 2020, Dr Chee L Khoo

The major difference between the 2018 American Diabetes Association/ European Association for the Study of Diabetes (ADA/EASD) consensus guidelines compared to previous guidelines were that they were less glucose centric in determining which agent to use after metformin. We used to use the most potent agent to get the sugars to target but increasingly, we are now looking at what other benefits the next agent has in addition to lowering glucose.…

Coronary artery calcification among endurance athletes – do we need to worry?

5th January 2020, Dr Chee L Khoo

Athletes and highly active people are not immune to coronary artery disease. There are some studies which suggest that despite the high levels of physical activity, these individuals have a higher prevalence of coronary artery calcification (CAC) compared with controls with low atherosclerotic risks (1,2). Is this increased level of CAC associated with increased mortality?…

Ubrogepant – the first of the gepants is out now

5th January 2020, Dr Chee L Khoo

Last week, we explore the updated pathophysiology of migraine and foreshadow the arrivals of the gepants and the “mabs”  As the article went to press, the FDA approved the first of the gepants, ubrogepant for the acute (immediate) treatment of migraine with or without aura (in adults. It is not indicated for the preventive treatment of migraine.…

Pet ownership and cardiovascular mortality – is it the ownership or the walking?

4th January 2020, Dr Chee L Khoo

Anecdotal evidence suggests that having a pet reduces cardiovascular mortality. Does it? You can imagine that trying to conduct a randomised control trial can be difficult. One has to consider the pre-existing risks profile of the pet owner, physical activity pre and post pet ownership, marital status of the owner and whether pet ownership benefits men or women more.…

Pregnancy Medical Imaging – A personalised one stop shop for pregnant women

Pregnancy medical imaging can provide vital diagnostic information about a developing baby including gestational age, checking for multiple pregnancies, congenital anomalies and/or problems with the placenta, monitoring foetal position and growth, and the level of amniotic fluid.

Who would have thought that the radiologist is now a friend of GPs when we look after pregnant women. Radiologists are key members of clinical teams who frequently make the first diagnosis of many medical conditions in children, adults and often the unborn baby.…

Paediatric Acute-Onset Neuropsychiatric Syndrome (PANS) – Is it real?

25th December 2019, Dr Chee L Khoo

They used to call it “Paediatric Infection Triggered Autoimmune Neuropsychiatric Disorders” (PITANDS)(1). Sounds terrible, doesn’t it? They were referring to children with obsessive-compulsive disorder (OCD) who had a sudden onset of their psychiatric symptoms, typically following infection with a variety of agents, including group A streptococcus (pyogenes), varicella and mycoplasma pneumoniae. The subgroup specifically associated with group A streptococcus (GAS) was called “Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections” (PANDAS).…

New migraine therapy – the battle of mabs vs gepants

22nd December 2019, Dr Chee L Khoo

There have been no new advances in acute migraine management since the introduction of the triptans in the early 1990s. There have been no advances in migraine prophylaxis since that time either. Over the last decade, there have been two emerging migraine therapies that are in advanced Phase 2 and Phase 3 trials. They are ready to hit the market anytime soon.…

Heart failure in type 2 diabetes – who is most at risk?

12th December 2019, Dr Chee L Khoo

Type 2 diabetes (T2D) and heart failure (HF) are common diseases with significant morbidity and mortality. Two out of three patients with T2D have evidence of ventricular dysfunction within 5 years of diabetes diagnosis (1). Data from both observational studies and clinical trial cohorts suggest that the development of HF in patients with T2DM is associated with anywhere from a 4- to 10-fold increase in mortality risk (2,3).…