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)?…

Stopping statins in the “elderly” – are you sure?

12th August 2019, Dr Chee L Khoo

We are often reminded to review statins prescriptions for primary prevention in the “elderly” because the evidence of benefit of statins in this group of patients is often “lacking”. Lacking doesn’t mean it there is no benefit. It may mean there are no or limited studies done in that age group.…

Curing Hepatitis C – are you the stumbling block?

28th July 2019, Dr Chee L Khoo

It’s not often that we cure anyone of any disease. Hepatitis C is one of those exceptions to the rule. The World Health Organization (WHO) set the ambitious target of eliminating hepatitis C as a public health threat by 2030 [1]. Australia is one of the very first countries in the world to have made the direct acting anti-viral (DAA) agents available on the PBS.…

QT interval – how long is too long? Is it relevant in GP?

26th July 2019, Dr Chee L Khoo

All of us remember the association of QT prolongation with the dramatic Torsale de Pointes (TdP) and sudden cardiac death (SCD) from medical school. Fortunately, both are relatively rare in general practice and we really don’t need to know much about QT prolongation in general practice as it belongs to the hospital people and the cardiologists, right?…

Cardiovascular health – are eggs in or out?

13th July 2019, Dr Chee L Khoo

First, it’s not good, then it’s Ok and now we are not sure. Maybe it is, maybe it isn’t. We are talking about eggs and the association with cardiovascular disease and mortality. It’s stuck in many of our and our patients’ minds that eggs are no good. It doesn’t help when the 2015-2020 Dietary Guidelines for Americans came out with somewhat contradictory recommendations: “ (1) Cholesterol is not a nutrient of concern for overconsumption” and (2) “Individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern” (1).…

Early diagnosis, prevention and treatment of Alzheimer Disease – where are we at now?

12th July 2019, Dr Chee L Khoo 

When we think about Alzheimer disease (AD) we think about the two classes of abnormal structures, extracellular amyloid plaques and intraneuronal neurofibrillary tangles. The soluble building blocks of these structures are amyloid-β (Aβ) peptides for plaques and tau for tangles. We have known about the association between Aβ and tau and AD for some time yet the only therapies available for patients with AD are the cholinesterase inhibitors and memantine which only target the symptoms of the disease.…

Fasting or non-fasting lipid levels – doesn’t it really matter?

22nd June 2019, Dr Chee L Khoo

It is standard to measure blood lipids after an 8-12 hour fast. Pretty much all our guidelines for management of cardiometabolic conditions are based on these fasting blood levels. The actual reading is important because it guides us to determine whether a patient is commenced on a statin or not. Do meals affect lipid levels?…

Diabetic peripheral neuropathy and serum cholesterol– is lower necessarily better?

22nd June 2019, Dr Chee L Khoo

Distal polyneuropathy (DPN) is one of the more severe complications of diabetes. The exact pathologic metabolic process of DPN is still uncertain but it is more common in patients with type 2 diabetes (T2DM) than in patients with type 1 diabetes (T1DM) even after adjusting for glucose levels. Thus, in addition to hyperglycaemia, other factors could be involved in the development of DPN such as obesity, hypertension, dyslipidaemia and renal impairment. …

Montelukast and neuropsychiatric events in kids with asthma – is there a link?

10th June 2019, Dr Chee L Khoo

Children with moderate to severe asthma often needs more than the usual bronchodilators. Even the newer long acting beta agonists (LABA) or long acting muscarinic antagonists (LAMA) may not be enough to control the symptoms and reduce exacerbations and inhaled corticosteroids (ICS) are often needed. But we are careful to keep the total daily dose of corticosteroids to a minimum.…

Checkpoint inhibitor-induced T1D – a newly emerging syndrome

8th June 2019, Dr Chee L Khoo

Checkpoint inhibitors are monoclonal antibodies that block checkpoint molecules, cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed death-1 (PD-1) and PD-1 ligand 1 (PD – L1). They have revolutionised cancer treatment because of their ability to improve survival in a growing number of cancers. Some of the cancers that have been successfully treated include melanoma, lung cancer, kidney cancer, bladder cancer, head and neck cancer, and Hodgkin’s lymphoma.…