13th July 2024, A/Prof Chee L Khoo
Iron deficiency can occur in a number of scenarios. It can arise from blood loss (gastrointestinal, gynaecological), inadequate dietary sources or limited absorption in inflammatory conditions (e.g CKD, heart failure or diabetes). Oral iron supplements not only can have annoying GI side effects but absorption is poor under the best of conditions.…
12th July 2024, A/Prof Chee L Khoo
We are always on the look out for the traditional cardiovascular risk factors – hypertension, diabetes, lipids and smoking to reduce the risk of adverse cardiovascular events. These are termed standard modifiable cardiovascular risk factors (SMuRFs). Unfortunately, there are a significant number of patients that present with acute coronary syndrome (ACS) who has none of the SMuRFs.…
30th June 2024, A/Prof Chee L Khoo
We are all aware of the exacerbations in patients with chronic obstructive pulmonary disease (COPD) especially when they are discharged from hospital back to primary care. We tend to forget that each time a patient with COPD have flare up or chest infection, that represent an exacerbation of COPD. Now, you may think it’s just a matter of semantics and coding but it’s more than that.…
31st May 2024, A/Prof Chee L Khoo
It’s coming to almost 10 years now when suddenly, we were not able to prescribe testosterone replacement therapy (TRT) to men with hypogonadism or low testosterone levels under the PBS. This came on the back of a decision by the US FDA in March 2015 to restrict the prescription of TRT (1).…
31st May 2024, A/Prof Chee L Khoo
Renin-angiotensin system (RAS) inhibitors and SGLT2 inhibitors have been the cornerstone treatment of chronic kidney disease (CKD) for many years now. They have been shown to protect kidneys and at the same time reduce adverse cardiovascular outcomes. Finerenone was recently shown to do the same. These three agents are now the guideline-directed three pillars in the treatment of CKD.…
12th May 2024, A/Prof Chee L Khoo
We are used to using colchicine for acute treatment of gout but colchicine has also proven itself a key pharmacotherapy in the treatment of cardiovascular conditions such as pericardial disease (1), post-operative atrial fibrillation (2) and coronary artery disease (3). Colchicine disrupts the inflammatory response in acute gout but the inflammatory pathways that colchicine acts on are also found in other inflammatory diseases including coronary artery disease.…
11th May 2024, A/Prof Chee L Khoo
I recall reading somewhere that increasing fish intake during pregnancy results in leaner offsprings. It all makes sense as we know that ω-3 fatty acid (ω-3 FA) is beneficial for adults (also read somewhere). It must be good for babies then. Is there data on those claims? Well, sort of. We shall look into them.…
27th April 2024, A/Prof Chee L Khoo
We know that suboptimal HbA1c increases the risk of micro and macrovascular complications in people with diabetes. We also know that suboptimal HbA1c increases infection risks in these people. There is increasing evidence that glucose variability is a potent predictor of complications. There are two ways to look at glucose variability – day to day variation as seen on continuous glucose monitoring and variability in HbA1c measured over years.…
27th April 2024, A/Prof Chee L Khoo
Metformin has microvascular (and perhaps, macrovascular) benefits in people with type 2 diabetes (T2D). It crosses the placenta and as with all medications used in pregnancy, we always worry about its potential effects on the offspring in utero. We worry about the metabolic effects of reduced nutrients to the growing baby in there. Current recommendations (RACGP handbook) says that the pros and cons of metformin in pregnancy for women with diabetes (not GDM) are unclear (1).…
28th March 2024, A/Prof Chee L Khoo
We all know that high LDL-C is absolutely and adversely associated with cardiovascular mortality and morbidity. It’s been “proven” again and again in large clinical trials and meta-analyses after meta-analyses. Reducing lipids levels have also been shown to reduce cardiovascular (CV) events in secondary as well as in primary prevention. This is particularly the case in those with intermediate to high CV risks.…
28th March 2024, A/Prof Chee L Khoo
We all know that when type 2 diabetes (T2D) presents at a younger age, they tend to be more aggressive in its progression as well as in the complications it causes. The complications also emerge earlier as well more aggressive. There are more cardiovascular events, more renal events and now, increasingly recognised, more liver complications.…
7th March 2024, A/Prof Chee L Khoo
There was some kerfuffle recently in the lay press about muscle loss with semaglutide. Great horror? Well, it doesn’t matter how you lose the weight. Any significant body weight loss will incur lean body mass loss (LBM). It’s not unique to GLP1-RA injections. Weight loss from bariatric surgery, dietary restrictions or just healthier eating will do the same.…