14th November 2020, Dr Chee L Khoo
It’s been at least 12 weeks since we started to wear facemasks at the practice full time with all face to face consultations. I must admit that during the first week, I did feel a bit suffocating with the mask on. I remember having to stop mid-sentence to catch my breath. I could sympathise with many patients, particularly patients who has COPD, asthma or heart failure.…
14th November 2020, Dr Chee L Khoo
We all know how difficult it is to treat iron deficiency anaemia (IDA) with oral iron supplements. Oral iron supplements not only cause constipation in many patients but they take forever to reverse the iron deficiency anaemia. Gastrointestinal absorption is a problem no matter how many iron tablets you take a day.…
27th October 2020, Dr Chee L Khoo
Some of you would have read about the use of the multi-use lancet devices for testing different individuals that was in mandatory quarantine in Victoria between March and August this year. The lancets were disposable but the device holding the lancets were not. I thought everyone knew. I was wrong. Judging by the comments online after the publication of that issue in the Medical Republic, I suspect many of you don’t actually know the infection risk these devices pose and I felt the imperative to write this urgent article.…
25th October 2020, Dr Chee L Khoo
Although our numbers of new Covid-19 infections and community transmission is pretty good in comparison with most other countries in the world, it isn’t zero. This is as good as it gets for at least the next 12 months. One of the scariest things is transmission of the virus to the newborn if the pregnant mother has the Covid-19 infection.…
13th October 2020, Dr Chee L Khoo
Aortic aneurysm (AA) and aortic dissection (AD) are potentially fatal conditions. Without treatment, ruptured AA/AD carries a mortality rate of up to 90%. Population-based studies estimated the annual incidence to be 2.4 to 14.8 per 100 000 persons for AA (1-4) and 3.8 to 8.8 per 100 000 persons for AD (3,5-7). Although the incidence varied across countries, the number has universally increased over time (1-5,7).…
12th October 2020, Dr Chee L Khoo
We know from various diabetes prevention programs that intensive lifestyle interventions can be successful in reducing progression to diabetes. As GDM is more common in women with higher BMI and in the many high- risk groups and it is logical to ask the question “can we prevent GDM in these women?” If we could reduce progression of patients who has prediabetes to diabetes, we should, in theory, reduce prevalence of GDM in women who are at high risk of GDM.…
11th October 2020, Dr Chee L Khoo
There are a few “rare” medical diagnoses that are stuck in our minds since medical school days. They may be rare but it’s important not to miss them. Temporal arteritis, also known as giant cell arteritis (GCA) is one of those not so common conditions. It is actually not that rare. It is the most frequent primary systemic vasculitis with an annual incidence rate of 15–25 per 100,000 in Caucasians ≥50 years of age and it primarily affects medium- and large-sized vessels (1,2). When do you suspect GCA?…
27th September 2020, Dr Chee L Khoo
We know that hyperglycaemia is associated with increased cardiovascular mortality. We also know that in patients with diabetes, hypoglycaemia is also associated with increased cardiovascular morbidity and mortality. What about patients who don’t have diabetes and have low blood glucose (<4.0 mmol/L)? I am sure we all have patients who do not have diabetes but on screening blood tests, have BSL lower than 4.0 mmol/L.…
24th September 2020, Dr Chee L Khoo
Since Covid-19 pandemic started 6-7 months ago, there have been a deluge of reports coming out in the medical and lay press and sometimes it is hard to keep track of what is real and what is just logical. Because Covid-19 is primarily a respiratory pathogen, infection begins in the nasal and nasopharyngeal mucosa with high viral load especially at the beginning of the infection.…
14th September 2020, Dr Chee L Khoo
We have many patients who have borderline high fasting glucose in their routine check-up. In non-pregnant adults, we have been able to use HbA1c as a generic screening test for type 2 diabetes (T2D) for some time. Unfortunately, neither non-diabetic fasting glucose readings nor HbA1c totally exclude the presence of diabetes. I am sure you have come across patients with non-diabetic fasting glucose and HbA1c but yet fail their oral glucose tolerance test (OGTT).…
14th September 2020, Dr Chee L Khoo
Over the last decade, there has been a push for a less glucocentric management of diabetes. For some, less glucocentric means accepting poorer glycaemic control in our patients with diabetes. It was meant to direct us to not be fixated on managing glucose control without looking at other aspects of the diabetes complications.…
14th September 2020, Dr Chee L Khoo
Tell me this is not, broadly, what you have in mind when you think about gestational diabetes mellitus (GDM). We know that hyperglycaemia and pregnancy does not mix well. GDM is not quite full-blown diabetes in pregnancy but is nonetheless, associated with risks for the mother and infant and with long-term metabolic consequences in both mother and child.…