26th July 2023, Dr Chee L Khoo
First it was aducanumab then lecanemab. Now it’s donanemab. All of them purportedly showed statistically significant improvement in clinical outcomes although the “significance” is hotly debated. Although aducanumab was the first to be approved by FDA (June 2021), the limited clinical improvement together with the increased risk of severe adverse effects meant that aducanumab is no longer used these days.…
12th July 2023, Dr Chee L Khoo
The WHO define biological markers or biomarkers as “any substance, structure or process that can be measured in the body or its products and influence or predict the incidence of outcome or disease”. In heart failure, many biomarkers have been studied but B-type natriuretic peptide (BNP) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) come close to the characteristics of “ideal” heart failure (HF) biomarkers.…
12th July 2023, Dr Chee L Khoo
It’s almost a year since we foreshadowed the arrival of finerenone and it’s finally on the PBS, albeit with the usual and expected very restricted criteria. We discussed finerenone’s impressive cardiovascular and renal outcomes in patients with heart failure and chronic kidney disease. We further discussed why finerenone is a better mineralo-corticosteroid receptor antagonist (MRA) than what we have at the moment, spironolactone and eplenerone.…
25th June 2023, Dr Chee L Khoo
Consensus cardiology recommendations previously supported the ’blanket’ disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. Clinically, it is almost impossible to exclude HCM from physical examination. Thus, sudden cardiac death (SCD) is always on our minds when we are asked to sign off on a clearance to participate in sporting activities.…
25th June 2023, Dr Chee L Khoo
A few weeks ago we explored familial hypercholesterolaemia (FH) primarily in adults. The issues we touched on were how not so rare FH really is and further, how aggressive we should target the LDL-Cholesterol (LDL-C). As we know, commencing lipid lowering agents is only the first step. The next step is to agree on what the LDL-C target should be in this patient based on the cardiovascular risk of the patient.…
11th June 2023, Dr Chee L Khoo
First, we have short acting GLP1-RA (exenatide) which requires twice a day injections. Then, we have once daily GLP1-RA injections (e.g. Exenatide ER, liraglutide, lixisenatide) which makes it more convenient for most patients. Of course, once daily injection is still too many. Once a week would be better, wouldn’t it? Of course, we now have weekly dulaglutide and semaglutide and patients love them.…
10th June 2023, Dr Chee L Khoo
It’s all very confusing, isn’t it? Low fat, low carbohydrate, Mediterranean diet, Paleo diet, Nordic diet or DASH diet. There are many other diets which we haven’t even heard of. Are they any good? Do they cause harm? How can we advise our patients if we don’t know what those diets are?…
30th May, 2023, Spectrum Medical Imaging
Knee injuries are one of the most common injuries we see in general practice. We always start with history to determine the mechanism of injury. Examination is not always straight forward especially, if there is severe pain and restriction of movement. MRI is an excellent tool for demonstrating injuries of the internal soft tissue structures in the joints.…
28th May 2023, Dr Chee L Khoo
Hypertriglyceridaemia has always played second fiddle to hypercholesterolaemia for a long time. Studies after studies have demonstrated the cardiovascular benefits of cholesterol lowering therapy. You might know that most of these clinical trials excluded patients with hypertriglyceridaemia. Does that mean that hypertriglyceridaemia doesn’t matter? We know hypertriglyceridaemia inflict oxidative damage to vital metabolic systems and organs.…
27th May 2023, Dr Chee L Khoo
The first GLP1- RA, exenatide was first isolated by John Eng in 1992 while working at the Veterans Administration Medical Center in the Bronx, New York.[1] It was made by Amylin Pharmaceuticals and commercialised by AstraZeneca. Exenatide was approved by the FDA on April 28, 2005, for people whose diabetes is not well controlled on other oral medications.…
14th May 2023, Dr Chee L Khoo
TOBOGM is the very first study to see if immediate treatment of early gestational diabetes mellitus (GDM) increases or reduces pregnancy complications among women with GDM diagnosed with OGTT before 20 weeks’ gestation. TOBOGM study results will significantly contribute to the management decisions of pregnant women with early GDM. Campbelltown Hospital was the lead recruiting centre with Professor David Simmons being the chief investigator of this international study.…
14th May 2023, Dr Chee L Khoo
When we think about diabetic complications, we usually think about microvascular and macrovascular complications. We don’t often think about dementia as a diabetic complication. Diabetes has consistently been associated with an increased risk of dementia and its subtypes (Alzheimer’s disease and vascular dementia (1). As many with diabetes, especially T2D, are being diagnosed at a younger age, dementia relating to diabetes will increasingly be diagnosed and diagnosed at a younger age.…