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).…

SGLT2 inhibitors and hospitalisation for heart failure – finally a real trial!

12th December 2019, Dr Chee L Khoo

EMPA-REG, CANVAS, DECLARE-TIMI 58 and VERTIS-CV are cardiovascular outcome trials (CVOTs) originally designed to demonstrate non-inferiority of SGLT2 inhibitors versus placebo on major adverse cardiovascular events (MACE). These clinical trials involving a total of > 36,000 patients with type 2 diabetes (T2D) followed for 2–5 years. Patients treated with a SGLT2 inhibitor experienced a 25–35% lower risk of hospitalisation for heart failure (HHF).

Anaemia management in chronic kidney disease – a new approach coming real soon!

8th December 2019, Dr Chee L Khoo

Anaemia is quite common in patients with chronic kidney disease (CKD). Disruption in the production of erythropoietin is not the only cause. Iron deficiency, uremia, chronic inflammation and gastrointestinal (G) loss are the common the other causes of anaemia in these patients. After excluding GI losses, current treatment consists of iron replacement and the use of erythropoietin stimulating agents (ESA).…

Osteomyelitis – diagnosis is not always straight forward

26th November 2019

The symptoms of acute osteomyelitis include pain, swelling, warmth and redness over the affected part. Sometimes, there are systemic signs of fever and fatigue. Plain xrays may review osteolytic lesions, periosteal reaction or may be totally normal. Sometimes, we may need to resort to MRI to clinch the diagnosis. This month’s case illustrate the difficulty with diagnosis when the symptoms and signs are not straight forward.…

Vitamin D and Omega 3 Oils – do they have a role in diabetic kidney disease?

24th November 2019, Dr Chee L Khoo

It’s not often that we report on trials with negative results but this trial attracted my attention because of many issues it raised when the top-line results were announced in the Journal of American Medical Association a fortnight ago. The conclusion states “supplementation with vitamin D3 or omega-3 fatty acids, compared with placebo, resulted in no significant difference in change in eGFR at 5 years.

Helicobacter pylori and gastric cancer – is there a point of no return?

23rd November 2019, Dr Chee L Khoo

Treatment of helicobacter pylori infection (HPi) has been shown to reduce the incidence of gastric cancer (GC) worldwide (1,2). HPi may cause chronic inflammation which can lead to precancerous conditions. Since HPi is not always symptomatic and many patients may have untreated HPi for decades. Surely, if you have untreated HPi for decades, you might still be at risk of GC years down the track despite eradication of the infection.…