Homocysteine & MTHFR polymorphism – are they related?

12th June 2020, Dr Chee L Khoo

Like me, you probably have come across homocysteine, methionine and MTHFR gene polymorphism from time to time and are aware of some connection between those things and cardiovascular disease but not quite sure how to connect them together. Which patient should we be checking homocysteine levels in? What about the MTHFR gene polymorphism?…

Double thalassaemia – it’s more than double trouble

thalassaemia

22nd May 2020, Dr Chee L Khoo

Let’s imagine we have a pregnant woman who tested positive for β-thalassaemia trait (minor) on antenatal screening blood tests. If both partners carry the same thalassaemia trait, there is a 25% chance of having a baby with thalassaemia major. Thus, we are advised to screen her partner for thalassaemia as well. Say, the partner’s blood picture is normal with no microcytosis and high performance cation-exchange chromatography (HPLC) shows normal levels of HbA2 and HbF.…

Coronary revascularisations – do they save lives?

28th April 2020, Dr Chee L Khoo

The incidence and mortality from coronary artery disease in Australia continue to decline. Coronary revascularisation consisting of percutaneous coronary intervention and coronary artery bypass graft (CABG) is rapidly increasing as the standard of care for coronary artery disease. There have been numerous trials comparing CABG with percutaneous coronary intervention (PCI) and so far, no studies have convincingly shown any overall difference between the two revascularisation strategies.…

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.…

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.…

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.…

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).…

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.…