Immune check point inhibitors, microbiome and antibiotics
13th September, 2019. Dr Chee L Khoo Checkpoint molecules are key regulators of the immune system. These checkpoint molecules are expressed by T cells and are essential for maintenance of immunological tolerance by preventing the unimpeded activation of T cells. Tumour cells capitalise on these checkpoint molecules to protect themselves from attacks by the immune […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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. […]
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 […]