AZ vaccine and clots – number crunching time

13th April 2021, Dr Chee L Khoo

Every time the government overpromise and underdeliver, we are the ones that have to deal with the public whose expectations have been led unnecessarily high for political reasons. With the issue of clots relating to the AZ vaccine on the front page over the last week or so, patients are now utterly confused and look to their GP for advice as to where and when to proceed.…

Quadruple therapy for heart failure – why is there treatment inertia?

9th April 2021, Dr Chee L Khoo

Quadruple therapy

We are all aware of the treatment inertia in the management of patients with diabetes. In patients with heart failure, several drug classes have demonstrated significant but independent survival benefit. Quadruple therapy with an angiotensin receptor–neprilsyin inhibitor (ARNI), evidence-based β-blocker, mineralo-corticoid receptor antagonist (MRA) and sodium glucose cotransporter 2 inhibitor (SGLT2i) can cumulatively reduce the risk of death by 73% over 2 years (1).…

Image guided injections – who gets what where and how?

30th March 2021, Spectrum Medical Imaging

image guided injections

We know that interventional radiologist can inject into practically anyway these days but sometimes it’s helpful to know what injections are for what conditions. Some injections are targeted at joints or near joints while others are injected into soft tissues like tendons or bursas. Sometimes we need ultrasound to guide the injections to the right place while other times, a CT scan required because we have bones in the way.…

White rice & T2D – both cause and effect?

29th March 2021, Dr Chee L Khoo

white rice and T2D

463 million adults  are living with diabetes globally, and this number is estimated to rise to 700 million by 2045. Interestingly, 60% of them live in Asia. By 2030, without intervention, both China and India combined will have almost half a billion of people with diabetics. While lifestyle issues and epigenetics play significant roles in the ever increasing prevalence of type 2 diabetes (T2D), white rice feature prominently in the Asian diet.…

AZ vaccine and clots – media hype?

27th March 2021, Dr Chee L Khoo

cerebral venous sinus thrombosis (CVST)

It all started when the Austrian regulatory authority suspended the use of a batch of AstraZeneca (AZ) vaccine on March 9th after a patient was diagnosed with multiple thrombosis and died 10 days after vaccination, and another was hospitalised with pulmonary embolism after being vaccinated. At least 16 other countries follow suit and suspended the use of AZ vaccine.…

New T2D treatment option – are you using it?

13th March 2021, Dr Chee L Khoo

diabetes treatment option

Medical treatment options for type 2 diabetes (T2D) have increased over the last decade and enhance the possibility of individualised treatment strategies where insulin is still one of them. In spite of the advancements in treatment options, less than one-third of the population with diabetes achieve their glycaemic target. What if I tell you that there is a new treatment option available that has been shown to significantly reduce HbA1c, hypoglycaemia, hospitalisation, complications and diabetic medications?…

Medicinal Cannabis – is it the wonder drug?

12th March 2021, Dr Chee L Khoo

Medicinal cannabis

I don’t about you but I seem to be bombarded by emails championing the wonderful things that cannabis oil can do. I even had a pharmaceutical rep swinging by to ask why I wasn’t prescribing cannabis oil for my patients. I even have a specialist (of sorts) that recommended that my patient come and discuss cannabis oil for his condition with me.…

Routine ECG in T2D – is it necessary?

!2th March 2021, Dr Chee L Khoo

Routine ECG

A substantial number of myocardial infarctions (MIs) are asymptomatic (silent MI (SMI)) or associated with minor and atypical symptoms and are found accidentally during routine electrocardiogram (ECG) examinations that reveal the existence of abnormal Q waves. The risk factors for occurrence of SMI are increasing age, hypertension, existing coronary artery disease and diabetes.…

Covid-19 vaccine roll out – time for some pre-planning

27th February 2021, Dr Chee L Khoo

time for panic yet?

Even though there should be no panic in the roll out, as more and more is being flashed across our TV screen, patients may start queuing up at the practice agitating to be first to be vaccinated. We all still have our normal patients to look after everyday and we need some pre-planning to avoid being snowed under and causing stress to GPs and their staff.…

Mortons Neuroma Case Study

27th February 2021, Spectrum Radiology

Anatomy of the nerve

We last reviewed Morton’s Neuroma here back in 2018. It is always refreshing to look a real case from the radiologist’s point of view. It does remind us to keep a look out for this relatively common condition which can be debilitating. The term neuroma is a misnomer because the lesion is not a neoplastic lesion such as a schwannoma or neurofibroma.…

Auto-immune arthropathy – understanding the IL-23/IL-17 pathway

26th February 2021, Dr Chee L Khoo

arthropathies

Back in medical school, we were taught that we have B-cells and T-cells. B-cells are responsible for humoral immunity and T-cells are responsible for cell-mediated immunity. T-cells could be killer cells or helper cells although we also have regulatory T-cells which tells the naïve T-cells how to behave. Of course, over the last 2-3 decades, we know more about what makes the regulatory T-cells decide what to tell these naïve cells.…