Sex hormones and eye abnormalities – how are they related?

11th January 2021, Dr Chee L Khoo

Sex hormones are not just responsible for the function of the reproductive system. They are also responsible for bone and cardiovascular health. Interestingly, they are produced, not only by the gonads, but also by other organs (1,2) including the central nervous system (CNS). Well, the eye is a neural structure and there is increasing evidence that oestrogens exert a neuro-protective role (3,4).…

Angiopoeitin-like 3 inhibitors – new therapy for hypercholesterolaemia

27th December 2020, Dr Chee L Khoo

Every time we come across some rare genetic disorder, we learn more about the intricacies of metabolism. Nothing is more true when it comes to lipid and lipoprotein metabolism. Familial combined hypolipidemia (FCHL) is a relatively recently recognised autosomal recessive disorder characterised by globally reduced levels of LDL and HDL cholesterol and triglyceride, with no apparent adverse effects.…

PCSK9 inhibitors on PBS – who can be on it?

24th December 2020, Dr Chee L Khoo

PBS Authority

It’s been a couple of years since we first previewed the PCSK9 inhibitors (PCSK9i) on the PBS for patients with dyslipidaemia despite maximal statins and ezetimibe. Since then PCSK9i have been demonstrated in many trials of its efficacy in patients with high cardiovascular risk with dyslipidaemia despite maximally tolerated statins. The qualifying criteria  under the PBS has significantly loosened and suddenly we all have a number of patients who will meet those PBS criteria.…

Stroke prevention – are two agents better than one?

13th December 2020, Dr Chee L Khoo

Stroke prevention

If you have been following GPVoice over the years, you would have realised that I am easily confused. I am confused again. Why are some patients who has had a TIA or minor stroke on aspirin and some on dual antiplatelet therapy (DAPT)? With supplies of some of these agents interrupted during the pandemic, can we swab one anti-platelet agent for another?…

Aortic aneurysm and fluoroquinolones don’t mix well – do they?

13th October 2020, Dr Chee L Khoo

Aortic aneurysm (AA) and aortic dissection (AD) are potentially fatal conditions. Without treatment, ruptured AA/AD carries a mortality rate of up to 90%. Population-based studies estimated the annual incidence to be 2.4 to 14.8 per 100 000 persons for AA (1-4) and 3.8 to 8.8 per 100 000 persons for AD (3,5-7). Although the incidence varied across countries, the number has universally increased over time (1-5,7).…

Temporal arteritis – which features help with the diagnosis?

11th October 2020, Dr Chee L Khoo

There are a few “rare” medical diagnoses that are stuck in our minds since medical school days. They may be rare but it’s important not to miss them. Temporal arteritis, also known as giant cell arteritis (GCA) is one of those not so common conditions. It is actually not that rare. It is the most frequent primary systemic vasculitis with an annual incidence rate of 15–25 per 100,000 in Caucasians ≥50 years of age and it primarily affects medium- and large-sized vessels (1,2).  When do you suspect GCA?…

Hypoglycaemia in non-diabetics – is it a problem?


27th September 2020, Dr Chee L Khoo

We know that hyperglycaemia is associated with increased cardiovascular mortality. We also know that in patients with diabetes, hypoglycaemia is also associated with increased cardiovascular morbidity and mortality. What about patients who don’t have diabetes and have low blood glucose (<4.0 mmol/L)? I am sure we all have patients who do not have diabetes but on screening blood tests, have BSL lower than 4.0 mmol/L.…

Refining cardiovascular risk stratification – can troponin help?

13th August 2020, Dr Chee L Khoo

We all know the usefulness of highly sensitive troponin (hsTn) in diagnosing acute myocardial infarction in daily practice. hsTn has also been demonstrated to be strongly associated with recurrent events in patients with stable atherosclerotic cardiovascular disease (ASCVD) (1-7). However, hsTn is not routinely used in clinical practice in this population of patients.…

Deleting ECG item numbers in primary care – whose idea was it?

27th July 2020, Dr Chee L Khoo

GP: the brains behind ECGs

Just pause and think for just one minute. Over the last 12 months, how many atrial fibrillations have you picked up incidentally on ECG? How many silent old acute myocardial infarct have you seen on ECG in a patient with diabetes? How many ST and T wave changes have you seen on ECG which suggest ischaemia which requires further investigations?…

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


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.…