27th February 2019, Dr Chee L Khoo
Primum non nocere (first do no harm) is quite an appropriate term when is comes to managing pregnant women who either have dysglycaemia or are at risk of dysglycaemia. While there is no question that hyperglycaemia during pregnancy is associated with both poor maternal and foetal outcomes as well as epigenetic changes which can affect the next generation, who and how to treat is still debatable.…
23rd February 2019, Dr Chee L Khoo
Joint replacement is the mainstay treatment for advanced arthritis. Unfortunately, almost all joint replacements fail over time. We are frequently asked by patients “how long does the replacement last?”. It’s important to know how long a joint is supposed to last because it determines the “ideal” age to have the first knee replacement. Further, we can anticipate when symptoms will be coming up and start exploring the feasibility of the next joint replacement.…
22nd February 2019, Dr Chee L Khoo
Increased oxidative stress appears to be a significant factor leading to insulin resistance, dyslipidaemia, β-cell dysfunction, impaired glucose tolerance and ultimately leading to type 2 diabetes (T2D). Ascorbic acid (AA) is a water soluble anti-oxidant that reduces oxidative damage at the cellular and tissue level. So, logically, AA supplementation should therefore reduce oxidate stress and lead to improvement in glycaemic control in patients with diabetes.…
13th February 2019, Dr Chee L Khoo
One of the great advantage of being a runner is that wherever you go, all you have to do is pack a pair of running shoes and the world is your oyster. During a recent visit to Kuala Lumpur, Malaysia, I went out running on the local streets. It was 6am and still pitch dark.…
13th February 2019, Dr Chee L Khoo
The bulk of patients with depression is managed in primary care. A significant proportion of these patients do well with the usual anti-depressants. At some point in time, many will no longer need their medications and we usually wean them off their drugs. Why do we need to wean them off? How do we wean them off?…
13th February 2019, Dr Chee L Khoo
Nasolacrimal duct obstruction in infants is not uncommon. Up to 10% of infants will present with watery, teary eyes which sometimes become purulent necessitating antibiotic drops. We know that “most” spontaneously resolve as the infant grows older. In the meantime, we generally recommend massaging of the duct and topical antibiotics when required. Up to 1 in 4 congenital nasolacrimal duct obstruction (CNLDO) does not resolve spontaneously.…
13th February 2019, Dr Chee L Khoo
It’s all too confusing. It used to be low fat diet. It’s now low carbohydrate (carb) diet. Some studies show that low carb diet loses more weight than low fat diet while others show the opposite. Yet, other studies show no significant difference between the diets. So, which is it then? Have you wondered that perhaps, we are looking at different patients responding to different diets.…
44-year-old male with 1 month of increasing neck pain was referred for a cervical spine injection. A CT scan of the cervical spine two weeks prior (Figure A), revealed foraminal narrowing at the C5-6 level. There was a significant difference between the new scan and the previous scan. There was severe destruction of the C5-6 disc and of the adjacent C5 and C6 vertebral end plates with retrolisthesis of C5 on C6.…
27th January 2019, Dr Chee L Khoo
Energy consumption, regulation and storage vital for the survival of the organism. We have specialised cells that manages the above but often, the cells do a bit of each depending on the energy needs of the organism at the time. When you think about it, the most effective cell to do all of the above is actually the adipocyte.…
27th January 2019, Dr Chee L Khoo
As GPs we often see little kids already carrying extra weight and we know that many of these will go on to become overweight or obese adults. Many overweight kids and overweight adults will go on to develop type 2 diabetes. Interestingly, some obese kids don’t go on to become diabetic. Which subsets of these overweight kids don’t go on to develop diabetes?…
27th January 2019, Dr Chee L Khoo
It’s tempting to rely too much on HbA1c when managing our patients with type 2 diabetes (T2D). It is not uncommon to come across patients with pretty optimal HbA1c (under 6.5-7.0%) and we pat them on the back with the message “well done”. Often, the fasting glucose levels is just glossed over. Should we even bother with the fasting glucose levels at all these days?…
9th January 2019, Dr John Goswell
According to a recent article in JAMA, in flight emergencies occur in about 1:600 flights. This comforting statistic should allow doctors to relax and enjoy their holidays. Not so for me. I have answered the call “Is there a doctor on the plane” twice now, even though I am not a “frequent flier”. …