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.…

New migraine therapy – the battle of mabs vs gepants

22nd December 2019, Dr Chee L Khoo

There have been no new advances in acute migraine management since the introduction of the triptans in the early 1990s. There have been no advances in migraine prophylaxis since that time either. Over the last decade, there have been two emerging migraine therapies that are in advanced Phase 2 and Phase 3 trials. They are ready to hit the market anytime soon.…

SGLT2 inhibitors and hospitalisation for heart failure – finally a real trial!

12th December 2019, Dr Chee L Khoo

EMPA-REG, CANVAS, DECLARE-TIMI 58 and VERTIS-CV are cardiovascular outcome trials (CVOTs) originally designed to demonstrate non-inferiority of SGLT2 inhibitors versus placebo on major adverse cardiovascular events (MACE). These clinical trials involving a total of > 36,000 patients with type 2 diabetes (T2D) followed for 2–5 years. Patients treated with a SGLT2 inhibitor experienced a 25–35% lower risk of hospitalisation for heart failure (HHF).

Anaemia management in chronic kidney disease – a new approach coming real soon!

8th December 2019, Dr Chee L Khoo

Anaemia is quite common in patients with chronic kidney disease (CKD). Disruption in the production of erythropoietin is not the only cause. Iron deficiency, uremia, chronic inflammation and gastrointestinal (G) loss are the common the other causes of anaemia in these patients. After excluding GI losses, current treatment consists of iron replacement and the use of erythropoietin stimulating agents (ESA).…