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).…

Vitamin D and Omega 3 Oils – do they have a role in diabetic kidney disease?

24th November 2019, Dr Chee L Khoo

It’s not often that we report on trials with negative results but this trial attracted my attention because of many issues it raised when the top-line results were announced in the Journal of American Medical Association a fortnight ago. The conclusion states “supplementation with vitamin D3 or omega-3 fatty acids, compared with placebo, resulted in no significant difference in change in eGFR at 5 years.

Helicobacter pylori and gastric cancer – is there a point of no return?

23rd November 2019, Dr Chee L Khoo

Treatment of helicobacter pylori infection (HPi) has been shown to reduce the incidence of gastric cancer (GC) worldwide (1,2). HPi may cause chronic inflammation which can lead to precancerous conditions. Since HPi is not always symptomatic and many patients may have untreated HPi for decades. Surely, if you have untreated HPi for decades, you might still be at risk of GC years down the track despite eradication of the infection.…

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.…