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Internal Medicine

Is there a doctor on the plane?

9th January 2019, Dr John Goswell According to a recent article in JAMA, in flight emergencies occur in about 1:600 flights. This comforting statistic should allow doctors to relax and enjoy their holidays. Not so for me. I have answered the call “Is there a…

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Investigating ischaemic stroke in a young patient

5th January, 2019, Dr Chee L Khoo The incidence of ischaemic strokes in young adults is on the increase. Worldwide,  it has risen up to 40% over the past decades.  This contrasts with the decreasing incidence of stroke in older adults. It’s never a good…

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Cholecystokinin (CCK) – more than just a gallbladder hormone

4th January 2019, Dr Chee L Khoo When you treat a medical condition with an agent with known intended effects, it is not uncommon that we come across some of the unintended effects of the agent. Glucagon-like peptide 1 receptor antagonists (GLP1-RAs) are very useful…

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Management of Huntington’s Disease – where are we at?

4th January 2019, Dr Chee L Khoo Huntington Disease (HD) was first described in 1872 by George Huntington, MD, in his paper “On Chorea”. HD is an autosomal-dominant, neurodegenerative disorder that is caused by expansion of a cytosine-adenine-guanine (CAG) triplet repeat in the huntingtin gene…

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Patent foramen ovale – to close or not to close?

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…

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Weight loss – how to keep it off?

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…

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Preventing thrombo-embolism in cancer patients – who should we target?

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…

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High dose fish oil and CV outcomes – another fishy tale?

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…

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The Diabetic Heart – the dawn of the myocardium

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…

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Anti-phospholipid antibodies – how much do you know?

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,…

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Dapagliflozin more than DECLARE its CV benefits

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…

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Floppy Iris Syndrome – is your patient at risk?

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…

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