Percutaneous Coronary Intervention after STEMI – stent one or stent all?

27th October 2019. Dr Chee L Khoo

Imagine you are the interventional cardiologist. You are asked to perform a percutaneous coronary intervention for a symptomatic coronary artery stenosis with a view of inserting a stent for the tight stenotic lesion. As the coronary angiogram is being performed, you discover that there are more than one stenotic lesion. Do you stent the symptomatic lesion alone as was originally intended or do you stent all the other incidentally found stenotic lesions?…

Does bariatric surgery reduce major adverse cardiovascular events?

27th October 2019. Dr Chee L Khoo

We often hear about cardiovascular outcomes trials (COVT) involving the new anti-diabetic agents – the SGLT2 inhibitors, the DPP4 inhibitors and the GLP1-RAs. The CVOTs were meant to ensure that the agents do not have significant major adverse cardiovascular outcomes (MACE) when we prescribed them for patients with type 2 diabetes (T2D). All make sense as we need to make sure that post Phase 2 trials when these agents are used in hundreds of thousands of patients, they don’t cause more harm that good.…

Nut consumption and weight change – is it positive or negative?

11th October 2019. Dr Chee L Khoo

We all know that weight management is not as simple as a calories in calories out equation. Increasing nut consumption in particular, in theory, can cause weight gain because of nuts’ energy density but it doesn’t always translate to weight gain. In fact, a recent study showed the opposite – increased nut consumption actually is associated with reduced long term weight gain.…

Anti-coagulant related nephropathy – do you know who is at risk?

6th October 2019. Dr Chee L Khoo

Traditionally, warfarin was the main anticoagulant for stroke prevention in patients with atrial fibrillation and in patients with significant valvular disease. The newer direct oral anti-coagulants (DOACs) are now the main anti-coagulants used instead of warfarin. However, a common limiting factor in the use of the DOACs is renal impairment. We still have come back to good old warfarin in patients whose eGFR is near 30 mL/min/1.73 m2.…

Pancreatic cancer and T2D – how are they related?

6th October 2019. Dr Chee L Khoo

Last month we looked at the state of play with screening for the deadly disease, pancreatic ductal adenocarcinoma (PDAC). We saw how it may not be useful to screen the general population with the technology that we have but there are select higher risk groups where screening may be useful. Long standing type 2 diabetes (T2DM) is a modest risk factor for PDAC.…

Diagnosis of breast invasive ductal carcinoma – a case study

26th September 2019. Spectrum Medical Imaging

Breast cancer is the most common cancer affecting women. In 2019, it is estimated that 19,535 Australians will be diagnosed with breast cancer. However it is important to remember that most women survive breast cancer. Diagnosis of breast cancer patients in early stages is one of important aspects of breast cancer treatment. Among of many diagnostic platforms, imaging techniques are main diagnostic approaches which could provide valuable data on patients with breast cancer.…

Breast cancer – should we offer risk reducing medications?

26th September 2019. Dr Chee L Khoo

We put patients at high risk of cardiovascular events on statins as primary prevention. We sometimes put patients with high risk of cerebrovascular disease on aspirin to prevent strokes. What about patients who are at high risk of breast cancer? Now, these are not patients who already had breast cancer. We are talking about patients who have not had cancer but are at higher than average risk of developing breast cancer.…

Is the incidence of Coeliac Disease really increasing?

26th September 2019. Dr Chee L Khoo

Everyone seems to be worried about coeliac disease (CD) these days. Everyone else is on a gluten free diet anyway. The naturopaths are also homing in on this bandwagon. How accurate are those blood tests? Or to be specific, what is the specificity and sensitivity of the serological screening tests? Why do we still need a duodenal biopsy?…

Immune check point inhibitors, microbiome and antibiotics

13th September, 2019. Dr Chee L Khoo

Checkpoint molecules are key regulators of the immune system. These checkpoint molecules are expressed by T cells and are essential for maintenance of immunological tolerance by preventing the unimpeded activation of T cells. Tumour cells capitalise on these checkpoint molecules to protect themselves from attacks by the immune system. Checkpoint therapy block inhibitory checkpoints, restoring immune system function.…

Pancreatic cancer screening – why are we not there yet?

10th September, 2019. Dr Chee L Khoo

Let’s face it. We all dread the diagnosis of pancreatic cancer in any of our patients. There aren’t too many red flags that we can rely on to warn us that something is not right with this deep seated abdominal organ. Many of the symptoms are either subtle or non-specific like nausea, intermittent epigastric pain, nausea, weight loss, loss of appetite or back pain.…

Lipid guidelines – what’s new in 2019?

23rd August 2019, Dr Chee L Khoo

Remember we used to have lipid targets for patients with diabetes and patients with cardiovascular disease. Life was simple then. Just follow those numbers. Then the 2013 ACC/AHA guidelines told us to throw away those targets and put everyone with cardiovascular (CV) risk above a certain figure on maximally tolerated statins. It’s kind of set and forget strategy.…

Adding ezetimibe to statins in the elderly – should we bother?

13th August 2019, Dr Chee L Khoo

Although persons 75 years or older account for 6% of the population, they account for more than 65%of all deaths due to cardiovascular disease (CVD) (1). We know from numerous trials that intensive treatment to reduce lipid levels reduces CV events in patients after they have an ACS (2). What about elderly patients (>75 years old)?…