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Internal Medicine

Diabetes inducing drugs – who is next on the list?

13th May 2019, Dr Chee L Khoo The list of drugs that increase the risk of type 2 diabetes (T2D) is increasing. We know statins (1,2), anti-psychotics (3) and many of the anti-retroviral (4) and immunosuppressant agents (5) have been shown to increase the risk…

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Breakfast – how important is it?

23rd April, 2019, Dr Chee L Khoo Somehow, it has been drummed into us, as doctors and consumers, that breakfast is the most important meal of the day. What does that even mean? As discerning scientists, we should seek to clarify what outcome measures they…

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“Ideal” BP in the Elderly – what is the target again?

22nd April 2019, Dr Chee L Khoo “Hardening of the arteries” is pretty much inevitable when one gets older. A majority of our patients >70 years old are on anti-hypertensive treatment. The problem is they keep changing the targets we are meant to be aiming…

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Weight loss with Duromine® – how safe is Duromine®?

14th April 2019, Dr Chee L Khoo It’s difficult, isn’t it? Patients who are overweight or obese often has either significant cardiovascular risks or already have cardiovascular co-morbidities. These are the patients that need some assistance with weight loss but we always hesitate to prescribe…

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Reduction of major CV events by SGLT2 inhibitors – who will benefit from what?

13th April 2019, Dr Chee L Khoo SGLT2 inhibitors, as a class of anti-diabetic drugs, have been shown in multiple cardiovascular outcomes trials (EMPA-REQ, DECLARE-TIMI 58, CANVAS) to “reduce cardiovascular events in patients with type 2 diabetes (T2D)”. These are big headlines but as obsessive…

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Continuous glucose monitoring – how accurate are they?

13th April 2019, Dr Chee L Khoo The monitoring of plasma glucose levels is crucial when we are titrating insulin doses, correlating lifestyle messages with glucose control and in detecting asymptomatic hypoglycaemia. Until now, finger-prick glucose checking is the gold standard for self-monitored blood glucose…

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Cerebral Amyloid Angiopathy – a real case study

We read last fortnight about cerebral amyloid angiopathy (CAA). I am not sure that I can pick up a CAA when I see one. I mean, we are not experts in CT or MRI of the brain. A fairly obvious, bit chunk of an  infarct…

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Fournier’s gangrene & SGLT2i – how rare is it?

23rd March 2019, Dr Chee L Khoo You may remember receiving warnings recently from the Therapeutics Goods Administration (TGA) about a serious “rare” infection, called necrotising fasciitis of the perineum, also referred to as Fournier’s gangrene (FG). FG is reported to be associated with the…

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Haemorrhagic stroke – is that cerebral amyloid angiopathy?

10th March 2019, Dr Chee L Khoo About 10% of all strokes are haemorrhagic strokes. In about 10% of cases of primary intracerebral haemorrhage (ICH), cerebral amyloid angiopathy (CAA) is regarded as a possible cause. The recurrence rate of ICH is significantly higher in patients…

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Can Vitamin C reduce plasma glucose?

22nd February 2019, Dr Chee L Khoo Increased oxidative stress appears to be a significant factor leading to insulin resistance, dyslipidaemia, β-cell dysfunction, impaired glucose tolerance and ultimately leading to type 2 diabetes (T2D). Ascorbic acid (AA) is a water soluble anti-oxidant that reduces oxidative…

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Losing weight: Different diets for different patients – are we there yet?

13th February 2019, Dr Chee L Khoo It’s all too confusing. It used to be low fat diet. It’s now low carbohydrate (carb) diet. Some studies show that low carb diet loses more weight than low fat diet while others show the opposite. Yet, other…

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Case Study – man with increasing neck pain for one month

44-year-old male with 1 month of increasing neck pain was referred for a cervical spine injection. A CT scan of the cervical spine two weeks prior (Figure A), revealed foraminal narrowing at the C5-6 level. There was a significant difference between the new scan and…

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