Covid-19 – to ACEi or not to ACEi?

10th April 2020, Dr Chee L Khoo

It’s amazing how quickly news travel during a pandemic. A bit of information came out a few weeks ago that suggests SARS-CoV-2 enters the body via the angiotensin converting enzyme receptor 2 (ACE2) present in abundance in pulmonary tissues. Initial reports out of Wuhan found that patients with chronic obstructive pulmonary disease (COPD), diabetes and hypertension were at higher risks of getting the infection as well as developing the severe form of Covid-19 if they do get the infection.…

Fighting Covid-19 – do you want to be a hero?

We all have that warm fussy feeling inside every time they talk about the frontline “heroes”. You say “that’s me”. We all contribute towards the fight against the Covid-19 pandemic. The UK recently acknowledge the hardworking frontline health care workers (HCWs) with the “clap hands for frontline workers” campaign to acknowledge the dangerous work that we do. That’s what we sign up for – to save human lives.…

Covid-19 – can’t swab? Can xrays help?

We all know how restricted the criteria for swabbing patients for Covid-19. You may consider perhaps, a chest rays may help. Although there are lots of studies describing the “classic” ground glass appearance on CXR or Chest CT, Unfortunately, in practical terms, they are not useful. It may actually endanger your radiology colleagues and their staff unless we work as a team during this difficult period.…

Covid-19 treatment – why chloroquine?

28th March 2020, Dr Chee L Khoo

Covid-19 belong to the subfamily Coronavirinae in the family of Coronaviridae of the order Nidovirales, and this subfamily includes four genera: α-coronavirus, β-coronavirus, γ-coronavirus, and δ-coronavirus. The new 2019 nCoV (or Covid-19), which belongs to β-coronavirus can infect the lower respiratory tract and cause pneumonia in humans, but it seems that the symptoms are milder than SARS and MERS.…

Covid-19 – who should we swab?

25th March 2020, Dr Chee L Khoo

They tell us that patients need to have 1) returned from overseas (any country will do now) OR been in contact with someone confirmed to have coronavirus infection AND 2) Flu symptoms with FEVER before we swab for Covid-19. Otherwise, we just reassure the patient that no they can’t have the swab and yes, they probably don’t have coronavirus infection.…

Covid-19 – reporting from primary care frontline

I told you last week that I am no expert and despite that I did write an article about the coronavirus. Well, I am doing that again this week but this time with a little more information and little bit more “expertise”. We have been getting oodles of feeds from many sources and I don’t know about you, but, all these bulletins really don’t help us working at the frontline.…

Coronavirus disaster plan – is there one?

14th March 2020, Dr Chee L Khoo

I have been holding off writing about the coronavirus so far as I didn’t think that I have the expertise. I would be out of my depth. It’s been coming up to three months since the world woke up to Wuhan. It’s been 6 weeks since Australia banned all flights from China. It was only a matter of time before the virus run rampant in Australia causing mayhem.…

Preventing type 1 diabetes – where are we at?

14th March 2020, Dr Chee L Khoo

It’s more than 100 years since insulin was first use for patients with type 1 diabetes (T1D). It’s been many decades now since we discovered that autoantibodies pre-dates the development of hyperglycaemia and theoretically, we should be able stop destruction of the beta cells before the onset of hyperglycaemia and “prevent” T1D. Unfortunately, strategies from preclinical and clinical studies thus fat, have not met their primary end points.…

Stroke prevention in T2D – REWINDing the clock?

14th March 2020, Dr Chee L Khoo

Despite significant reduction in cardiovascular events over the last 20 years in the general population, patients with diabetes still has 1.5-2 times the risk of cardiovascular events and cardiovascular mortality compared with the general population. It was pretty exciting when two classes of the new anti-diabetic medications have been shown in a number of landmark trials to reduce composite cardiovascular events patients with type 2 diabetes (T2D) and previous cardiovascular disease or patients with T2D with multiple cardiovascular risks.…

Time in Range in CGM – new metric on the block?

The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive glucose lowering in patients with type 1 diabetes (T1D) reduce the risk of long term diabetes complications (1). Similar results were demonstrated in patients with type 2 diabetes (T2D) in the UK Prospective Diabetes Study (UKPDS). But intensive glucose control involves finger pricks at least 4-8 times a day and is not sustainable in the medium to long term in most patients.…