10th July 2021, Dr Chee L Khoo
In medical school, we were taught that the cerebral spinal fluid (CSF) provides the brain with nutrients, transports catabolites and the blood brain barrier (BBB) keeps nasties out and maintains a stable environment (homeostasis). Now, keeping nasties out is great but how does the brain get rid of the waste it generates?In the last fortnight, we explored how the brain cleans itself of toxic and waste products.…
27th June 2021, Dr Chee L Khoo
We all do it. Either we arrange for patients to come in once a year to have a “general check-up” or patients come in requesting one. There are no set rules what we check for and what blood tests to order. Somehow, patients feel better that they have been given a clean bill of health and at times, we feel that we have check them out properly and all is good.…
25th June 2021, Dr Chee L Khoo
The human circulatory system processes about 20 litres of blood per day through capillary filtration. About 17 litres of the filtered plasma is reabsorbed directly into the blood vessels while the remaining three litres are left in the interstitial fluid. One of the main functions of the lymphatic system is to provide an accessory return route to the blood for that surplus three litres as well as clearance of waste products.…
12th June 2021, Dr Chee L Khoo
More than 50 years ago, there were reports of association between anti-epileptic drugs (AEDs) and birth defects (1). We now have newer AEDs including carbamazepine, lamotrigine, phenytoin and levetiracetam. In 2016, the UK banned valproate use in women who are not in a pregnancy prevention programme. Despite that, sodium valproate is still widely prescribed in many countries to women of childbearing age.…
9th June 2021, Dr Chee L Khoo
We all know that detailed information relating to Covid-19 is both fluid and rapidly changing. It’s only a mere 3 months since the first reports of thrombosis with thrombocytopaenia (TTS) relating to the administration of the AstraZeneca (AZ) vaccine emerged from Austria. The recommendations as to who should not have the AZ vaccine is constantly being revised as more information comes in from the case reports.…
5th June 2021, Dr Chee L Khoo
Cardiovascular disease (CVD) and chronic kidney disease (CKD) are common complications in patients with type 2 diabetes (T2D). 70% of patients with T2D are likely to develop a CV disease while 40% of them will develop CKD. A significant proportion of patients with CKD will progress to kidney failure requiring renal dialysis or renal transplant.…
30th May 2021, Dr Chee L Khoo
Obesity and GDM are the most common clinical risks in obstetric practice increasing the probability of a variety of pregnancy related complications compared to women with a normal BMI and normal glucose tolerance. These complications include pregnancy induced hypertension (PIH), emergency caesarean sections (EMCS), pre-eclampsia (PE), post-partum haemorrhage (PPH), large-for-gestational age infants (LGA) and macrosomia.…
22nd May 2021, Dr Chee L Khoo
Clinical inertia in heart failure (HF) treatment means deferred initiation of additional proven beneficial therapy, which ultimately leads to preventable adverse HF events. Hospitalisation for worsening HF is a prognostically significant event in the clinical course of a patient with chronic HF (1,2). Hospitalisation for HF (hHF) identifies patients who are at high risk for subsequent disease progression, requirement for advanced therapies, and cardiovascular death.…
13th May 2021, Dr Chee L Khoo
Thrombosis with thrombocytopaenia syndrome (TTS) has been reported following vaccination with AstraZeneca (AZ) and Johnson and Johnson (JJ) covid-19 vaccines. It is also called VITT (vaccine-induced immune thrombotic syndrome) and VIPIT (vaccine-induced prothrombotic immune thrombocytopenia). It is rare and primarily occurs in those under 50 years old. Although the government recommend that people under 50 years have the Pfizer vaccine, there are people who are in Phase 1A and 1B who can’t and should not wait for the Pfizer vaccine where supplies are limited.…
13th May 2021, Dr Chee L Khoo
The radical mastectomy introduced by Halsted was the treatment of choice for breast cancer of any size or type, regardless of the patient’s age, for 80 years. Any attempt in surgery less than a radical mastectomy was not widely considered during those years. Subsequent randomised controlled trials designed in 1969 and published in 1973 (1) and 1981 (2) showed that survival rates were equal after radical or breast-conserving surgery (BCS).…
9th May 2021, Dr Chee L Kho
When we think of diabetes-related complications, we usually think about microvascular and macrovascular complications. We don’t usually think about dementia. Type 2 diabetes (T2D) represents an increasing health burden world-wide and its prevalence in particularly higher in elderly population. While epidemiological evidence suggests an increased risk of vascular and Alzheimer’s dementia associated with T2D, the mechanisms underlying the association, however, remain unclear.…
25th April 2021, Dr Chee L Khoo
Chronic rhinosinusitis is a very common problem in general practice. Despite the “-itis”, infection is not actually the core problem. That is why antibiotic scripts after antibiotics script isn’t always the solution. There is often a significant inflammatory/allergic component in the pathogenesis. Current standard of care consists of intranasal steroids, nasal saline irrigation and short courses of systemic corticosteroids.…