Internal Medicine

Aspirin – which cancers will it benefit?

The US Preventive Services Task Force (USPSTF) recommends low-dose aspirin use for the prevention of cardiovascular disease among average-risk individuals aged 50 to 59 years with a 10% or greater 10-year risk of cardiovascular disease (1). Long-term regular aspirin use is also associated with reduced risk of obesity- and inflammation-associated cancers, particularly colorectal cancer (CRC) […]

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Coronary artery calcification among endurance athletes – do we need to worry?

5th January 2020, Dr Chee L Khoo Athletes and highly active people are not immune to coronary artery disease. There are some studies which suggest that despite the high levels of physical activity, these individuals have a higher prevalence of coronary artery calcification (CAC) compared with controls with low atherosclerotic risks (1,2). Is this increased […]

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Ubrogepant – the first of the gepants is out now

5th January 2020, Dr Chee L Khoo Last week, we explore the updated pathophysiology of migraine and foreshadow the arrivals of the gepants and the “mabs”  As the article went to press, the FDA approved the first of the gepants, ubrogepant for the acute (immediate) treatment of migraine with or without aura (in adults. It […]

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Pet ownership and cardiovascular mortality – is it the ownership or the walking?

4th January 2020, Dr Chee L Khoo Anecdotal evidence suggests that having a pet reduces cardiovascular mortality. Does it? You can imagine that trying to conduct a randomised control trial can be difficult. One has to consider the pre-existing risks profile of the pet owner, physical activity pre and post pet ownership, marital status of […]

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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 […]

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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 […]

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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 […]

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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, […]

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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 […]

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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 […]

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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 […]

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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 […]

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