27th October 2019. Dr Chee L Khoo
Imagine you are the interventional cardiologist. You are asked to perform a percutaneous coronary intervention for a symptomatic coronary artery stenosis with a view of inserting a stent for the tight stenotic lesion. As the coronary angiogram is being performed, you discover that there are more than one stenotic lesion. Do you stent the symptomatic lesion alone as was originally intended or do you stent all the other incidentally found stenotic lesions?…
27th October 2019. Dr Chee L Khoo
We often hear about cardiovascular outcomes trials (COVT) involving the new anti-diabetic agents – the SGLT2 inhibitors, the DPP4 inhibitors and the GLP1-RAs. The CVOTs were meant to ensure that the agents do not have significant major adverse cardiovascular outcomes (MACE) when we prescribed them for patients with type 2 diabetes (T2D). All make sense as we need to make sure that post Phase 2 trials when these agents are used in hundreds of thousands of patients, they don’t cause more harm that good.…
11th October 2019. Dr Chee L Khoo
We all know that weight management is not as simple as a calories in calories out equation. Increasing nut consumption in particular, in theory, can cause weight gain because of nuts’ energy density but it doesn’t always translate to weight gain. In fact, a recent study showed the opposite – increased nut consumption actually is associated with reduced long term weight gain.…
22nd June 2019, Dr Chee L Khoo
Screening mammography has been shown in many prospective, randomised, clinical trials to reduce breast cancer deaths by between 25-40% (1-4). Unfortunately, small but high-grade cancers can be masked by the presence of dense breast tissues or may be confused as benign breast disease in mammograms. In fact, in countries that have national breast screening mammography programs, advanced breast cancers have not decreased (5,6).…
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. Thus, in addition to hyperglycaemia, other factors could be involved in the development of DPN such as obesity, hypertension, dyslipidaemia and renal impairment. …
2nd August, 2018, Dr Chee L Khoo
I first met Jack 14 years ago when he was diagnosed with T2D from an OGTT in 2005. He was a 47 years old then. He was a busy businessman with no time for exercise and eating out fairly regularly. His BMI back then was 34.7. He was already on treatment for hypertension and dyslipidaemia.…
June 1, 2018, Dr Chee L Khoo
Imagine if your vaccine fridge sends you a message if the fridge temperature veered outside its set range of 2-8 degrees Celsius. You would say “now that’s technology”. And imagine you could do all that for a little more than A$100. Well, that’s exactly how my vaccine fridge at the practice is “wired” up to do.…
June 1, 2018, Dr Chee L Khoo
Source: SENSIMED
We are all familiar with 24-hour BP monitor. We are also familiar with 24-hour Holter monitor and continuous glucose monitoring. We now have 24-hour intraocular pressure monitor. It doesn’t actually monitor intraocular pressure but the effects of it (a bit later). A recent study has now confirmed the association between the intraocular pressure monitoring and progression of glaucoma in older adults.…
June 1, 2018, Dr Chee L Khoo
Yikes, I must have torn my ACL!
For patients with anterior cruciate ligament (ACL) tears, it used to be that conservative treatment is tried first and if the knee joint is symptomatic and/or unstable, then surgery can be considered. But have you noticed that patients are now routinely heading for surgery without a trial of conservative treatment and irrespective of what future demands on their joints may be?…
June 1, 2018, Dr Chee L Khoo
What? So many different types of T2D!
Have you noticed that your patients with type 2 diabetes (T2D) are a heterogeneous group? Some T2D patients are more insulin resistant than others. Some T2D patients are more insulin deficient than others. These tend to be the younger T2D. Some patients are obese and some are not.…