Newer anti-epileptic drugs in pregnancy – how safe are they?

12th June 2021, Dr Chee L Khoo

More than 50 years ago, there were reports of association between anti-epileptic drugs (AEDs) and birth defects (1). We now have newer AEDs including carbamazepine, lamotrigine, phenytoin and levetiracetam. In 2016, the UK banned valproate use in women who are not in a pregnancy prevention programme.  Despite that, sodium valproate is still widely prescribed in many countries to women of childbearing age.…

SGLT2 inhibitors in heart failure – it’s almost an emergency!

22nd May 2021, Dr Chee L Khoo

Emergency

Clinical inertia in heart failure (HF) treatment means deferred initiation of additional proven beneficial therapy, which ultimately leads to preventable adverse HF events. Hospitalisation for worsening HF is a prognostically significant event in the clinical course of a patient with chronic HF (1,2). Hospitalisation for HF (hHF) identifies patients who are at high risk for subsequent disease progression, requirement for advanced therapies, and cardiovascular death.…

Diabetes and dementia – who is at higher risk?

Dementia

9th May 2021, Dr Chee L Kho

When we think of diabetes-related complications, we usually think about microvascular and macrovascular complications. We don’t usually think about dementia. Type 2 diabetes (T2D) represents an increasing health burden world-wide and its prevalence in particularly higher in elderly population. While epidemiological evidence suggests an increased risk of vascular and Alzheimer’s dementia associated with T2D, the mechanisms underlying the association, however, remain unclear.…

Migraine prophylaxis – finally, something that works

22nd April 2021, Dr Chee L Khoo

migraines

We know migraines as recurrent episodes of headache, associated with symptoms such as nausea, photophobia and phonophobia. While we have agents that can treat acute migraine pretty effectively, many patients with migraines have frequent episodes. These patients with frequent migraines should be offered migraine prophylaxis. Unfortunately, amongst patients with frequent migraines, only 3–13% receive migraine preventive treatment [1,2].…

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).…

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.…

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.…

Carotid artery stenosis – should I have diagnosed it earlier?

11th February 2021, Dr Chee L Khoo

CVA

We all have come across this awful scenario. Patient was admitted to hospital with a TIA or a stroke due to significant carotid stenosis. As good caring GPs, we looked back and wonder whether we should have known about the stenosis. After all, these patients often have other hallmarks of atherosclerosis, coronary artery disease or peripheral arterial disease and the usual cardiovascular risk factors and we should have suspected carotid stenosis.…

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).…