Acute Achilles tendon rupture – is non-surgical treatment just as good?

11th May 2022, Dr Chee L Khoo

I was fortunate to have received ample orthopaedic experience in my training days. I was all destined to be an orthopaedic surgeon but changed my mind. I have seen a few complete Achilles tendon rupture and assisted in many successful surgical repair. Conceptually, you can’t imagine how anyone can plantar flex again if the tendon ends are not reattached surgically.…

GLP1-RAs and gallbladder diseases – is there a connection?

biliary system

12th April 2022, Dr Chee L Khoo

It’s almost close to a wonder drug. It is widely used in type 2 diabetes (T2D) for management of hyperglycaemia when the HbA1c is >7.0%. For that indication, it is pretty potent and in clinical trials, can reduce the HbA1c by 1-1.5%. It also assists in weight reduction and thence, reduce the core problem of insulin resistance in these patients.…

EGFR – not the renal one

1st January 2022, Dr Chee L Khoo

This definitely wasn’t in the curriculum when I left med school (alright, it was more than 30 years ago now) but I don’t remember being updated about its relevance. I am talking about the epidermal growth factor receptor (EGFR). It is not really in the realm of general practice as such but we do have patients coming back from the oncologist with a tumour bearing an EGFR gene mutation.…

Prostate cancer and statins – a complex relationship

25th December 2021, Dr Chee L Khoo

PSA screening

There is increasing evidence that supports an inverse association between statin use and cancer risk. The findings for prostate cancer, particularly advanced disease, are the most promising of all cancers studied. There are studies suggesting the usefulness of statins in secondary and tertiary prevention. For example, patients undergoing radiotherapy for prostate cancer improved their prostate specific survival if they are on statins.…

Cataract surgery delay – does it contribute to dementia risk?

11th December 2021, Dr Chee L Khoo


Cataract is a leading cause of blindness worldwide, affecting more than 35 million people globally and causing blindness in approximately 20 million. Visual impairment is an important dementia risk. Addressing sensory loss from visual impairment that affects older adults may be a potentially modifiable risk factor for dementia in late life (1,2) Because sensory impairments and dementia are both strongly associated with aging the link between sensory impairment and dementia may have important implications for individual and global public health, particularly if interventions to improve sensory function reduce dementia risk (3).…

Breast cancer surgery – is more necessarily better?

13th May 2021, Dr Chee L Khoo

The radical mastectomy introduced by Halsted was the treatment of choice for breast cancer of any size or type, regardless of the patient’s age, for 80 years. Any attempt in surgery less than a radical mastectomy was not widely considered during those years. Subsequent randomised controlled trials designed in 1969 and published in 1973 (1) and 1981 (2) showed that survival rates were equal after radical or breast-conserving surgery (BCS).…

Knee MRI – how reliable is it?

27th April, Spectrum Medical Imaging

Acute knee pain is a pretty common presentation in general practice. In experienced hands, a thorough physical examination can narrow the differential diagnosis to a few common injuries. Often we have to resort to an MRI to confirm our suspicion. How reliable is the MRI diagnosis?

In a novel study to evaluate the reproducibility, repeatability, and agreement of MRI evaluation with the gross pathology examination at operation, in 23 patients undergoing total knee arthroplasty, MRIs were performed just before the surgery (1).…

Monoclonal Ab for rhinosinusitis? – what will they think of next

25th April 2021, Dr Chee L Khoo

chronic rhinosinusitis

Chronic rhinosinusitis is a very common problem in general practice. Despite the “-itis”, infection is not actually the core problem. That is why antibiotic scripts after antibiotics script isn’t always the solution. There is often a significant inflammatory/allergic component in the pathogenesis. Current standard of care consists of intranasal steroids, nasal saline irrigation and short courses of systemic corticosteroids.…

Aspirin for colorectal cancer prevention – who will benefit?

13th February 2021, Dr Chee L Khoo

colorectal cancer

Aspirin as a chemoprotective agent against colorectal cancer (CRC) has gone through quite exhaustive reviews over the last 20 years. After initially recommended against using aspirin for CRC prevention in 2007, the US Preventative Services Task Force (USPSTF) in 2015 recommended initiating low-dose aspirin use for the primary prevention of CVD and CRC in “adults aged 50 to 59 years who have a >10% 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years and are willing to take low-dose aspirin daily for at least 10 years” (1).…

Sex hormones and eye abnormalities – how are they related?

11th January 2021, Dr Chee L Khoo

Sex hormones are not just responsible for the function of the reproductive system. They are also responsible for bone and cardiovascular health. Interestingly, they are produced, not only by the gonads, but also by other organs (1,2) including the central nervous system (CNS). Well, the eye is a neural structure and there is increasing evidence that oestrogens exert a neuro-protective role (3,4).…

Does wearing a facemask cause hypoxia?

14th November 2020, Dr Chee L Khoo


It’s been at least 12 weeks since we started to wear facemasks at the practice full time with all face to face consultations. I must admit that during the first week, I did feel a bit suffocating with the mask on. I remember having to stop mid-sentence to catch my breath. I could sympathise with many patients, particularly patients who has COPD, asthma or heart failure.…

Aortic aneurysm and fluoroquinolones don’t mix well – do they?

13th October 2020, Dr Chee L Khoo

Aortic aneurysm (AA) and aortic dissection (AD) are potentially fatal conditions. Without treatment, ruptured AA/AD carries a mortality rate of up to 90%. Population-based studies estimated the annual incidence to be 2.4 to 14.8 per 100 000 persons for AA (1-4) and 3.8 to 8.8 per 100 000 persons for AD (3,5-7). Although the incidence varied across countries, the number has universally increased over time (1-5,7).…