25th December 2018, Dr Chee L Khoo
After the acute management of an ischaemic stroke, what follows is the diagnostic process to find the underlying cause and secondary prevention of further strokes. In younger patients and in patients whose atherosclerotic burden is low, the search for a cause can be challenging. Some of the rarer causes of stroke and cardioembolic causes (including atrial fibrillation) needs to be excluded.…
24th December 2018, Dr Chee L Khoo
Losing weight is the second hardest thing to do. The hardest is keeping that weight off. With weight loss, hunger increases and energy expenditure decreases as the body adapts physiologically to the weight loss. The kilogram loss is not all fat loss. Some of the losses are muscles and with less muscle bulk, basal metabolic rate also decreases adding further to the decrease in energy expenditure. …
22nd December 2018, Dr Chee L Khoo
Patients with active cancers are at an increased risk of DVTs and pulmonary embolism. Some patients are at higher risk than others. Thromboembolic prophylaxis could reduce that risk but is not routinely recommended in practice guidelines because the absolute risk is modest and of course, there are potential major bleeding risk. With the introduction of the new oral anti-coagulants (NOACs), the equation might be different.…
10th December, 2018, Dr Chee L Khoo
Elevated triglyceride (TG) level serves as an independent marker for an increased risk of ischaemic events, as shown in epidemiologic and mendelian randomisation studies (1-5). However, in most of the statin trials, patients with high TG are generally excluded. There is confusion out there as to whether fish oils is useful or not for cardiovascular protection.…
27th November, 2018, Dr Chee L Khoo
Of the patients with type 2 diabetes (T2D) who die from cardiovascular (CV) disease, 40% die from IHD, 15% die from heart failure and 15% die from strokes. Patients with T2D have greater atherosclerotic plaque burden, higher atheroma volume, and smaller coronary artery lumen diameter than persons without diabetes. Numerous processes contribute to atherosclerotic cardiovascular disease (ASCVD) in diabetes including (but not limited to) hyperglycaemia, insulin resistance and/or hyperinsulinemia, dyslipidaemia, inflammation, reactive oxygen species, endothelial dysfunction, hypercoagulability, and vascular calcification.…
27th November 2018, Dr Chee L Khoo
I recently saw a young lady whose mother had anti-phospholipid syndrome (APL) . She is now worried whether she has the same problem and request some blood tests. She is otherwise fit and healthy. Sure, among other things, I ordered APL antibodies hoping that the pathologist will know what I was looking for. Pretty straight forward so far until the results of her tests came back.…
13th November 2018, Dr Chee L Khoo
It’s finally here. The Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE–TIMI 58) trial finally released their results this week at the American Heart Association (AHA) Scientific Sessions 2018. The results were most impressive but this was not just another CV outcome trial of another SGLT2 inhibitors. The results have major implications in the way we treat patients with type 2 diabetes (T2D) in general practice.…
12th November 2018, Dr Chee L Khoo
Intraoperative floppy iris syndrome (IFIS) was first described by Chang and Campbell. It is characterised by floppiness of the iris, miosis and ultimately, iris prolapse through the surgical wounds. It can occur during surgery for cataract and if not anticipated, it increases the risk of posterior capsule rupture, vitreous loss, retained nuclear fragments, post op intraocular pressure spikes, irido-dialysis, hyphema and corneal endothelial loss.…
28th October 2018, Dr Chee L Khoo
Metallic objects, implants or prosthesis can render magnetic resonance imaging (MRI) unsafe or affect the quality of the images. Our patients who have metallic joint prosthesis in-situ not uncommonly require further imaging. This can pose a bit of a challenge as many of the same patient population who require the joint replacement are the same population of patient that require further imaging.…
28th October 2018, Dr Chee L Khoo
There are now 7 glucagon like peptide 1 (GLP 1) injectable analogues used to control hyperglycaemia in patients with type 2 diabetes (T2D). An eighth GLP1 analogue is now available as an oral form. Only four of them are available in Australia of which three are on the PBS under authority prescription (Byetta, Bydureon, Trulicity).…
28th October 2018, Dr Chee L Khoo
Most of you would have read about the recent study linking angiotensin converting enzymes inhibitors (ACEI) to the risk of lung cancer. This was published in the BMJ last week. it was a bit of a surprise to some extent although once the dust settled, it wasn’t that surprising after all. ACEI causes a build-up of bradykinin in the lungs and bradykinin has been reported to stimulate growth of lung cancers.…
11th October 2018, Dr Chee L Khoo
Over the last 20 years, 5 classes of anti-diabetic agents are now available to choose from. This is great but which do you use after metformin? Guidelines after guidelines in Australia and internationally leave that decision up to us to make the choice on behalf of our patients. They all have different mechanisms of action but pretty much all of them have similar efficacy, reducing HbA1c by about 1.0%.…