5th January, 2019, Dr Chee L Khoo
The incidence of ischaemic strokes in young adults is on the increase. Worldwide, it has risen up to 40% over the past decades. This contrasts with the decreasing incidence of stroke in older adults. It’s never a good time to have a stroke whatever the age of onset is but the socioeconomic costs are much higher in the younger.…
4th January 2019, Dr Chee L Khoo
When you treat a medical condition with an agent with known intended effects, it is not uncommon that we come across some of the unintended effects of the agent. Glucagon-like peptide 1 receptor antagonists (GLP1-RAs) are very useful agents which not only improve glucose control via its known effects on insulin and glucagon but it is associated with modest weight loss.…
4th January 2019, Dr Chee L Khoo
Huntington Disease (HD) was first described in 1872 by George Huntington, MD, in his paper “On Chorea”. HD is an autosomal-dominant, neurodegenerative disorder that is caused by expansion of a cytosine-adenine-guanine (CAG) triplet repeat in the huntingtin gene which is located on the short arm of chromosome 4 (1). The gene codes for the huntingtin protein.…
25th December 2018, Dr Chee L Khoo
After the acute management of an ischaemic stroke, what follows is the diagnostic process to find the underlying cause and secondary prevention of further strokes. In younger patients and in patients whose atherosclerotic burden is low, the search for a cause can be challenging. Some of the rarer causes of stroke and cardioembolic causes (including atrial fibrillation) needs to be excluded.…
24th December 2018, Dr Chee L Khoo
Losing weight is the second hardest thing to do. The hardest is keeping that weight off. With weight loss, hunger increases and energy expenditure decreases as the body adapts physiologically to the weight loss. The kilogram loss is not all fat loss. Some of the losses are muscles and with less muscle bulk, basal metabolic rate also decreases adding further to the decrease in energy expenditure. …
22nd December 2018, Dr Chee L Khoo
Patients with active cancers are at an increased risk of DVTs and pulmonary embolism. Some patients are at higher risk than others. Thromboembolic prophylaxis could reduce that risk but is not routinely recommended in practice guidelines because the absolute risk is modest and of course, there are potential major bleeding risk. With the introduction of the new oral anti-coagulants (NOACs), the equation might be different.…
13th December 2018, Dr Chee L Khoo
Three weeks ago, 25 of our GP and allied health professional (AHP) colleagues sacrificed their valuable Saturday and became engaged in a highly interactive session exploring the use of injectables in the management of our patients with type 2 diabetes. Evaluation, comments and suggestions from the participants have just been collated and here at the Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU) we are just absolutely delighted about the results.…
13th December 2018, Dr Chee L Khoo
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the latest therapeutic strategy in the treatment of type 2 diabetes mellitus (T2DM). They feature prominently in the latest international diabetes management guidelines. They not only improve glycaemic control but recent clinical trials demonstrated cardiovascular protection, combined with a reduction in body weight and blood pressure. There used to be three SGLT2 inhibitors, dapagliflozin, empagliflozin and canagliflozin until canagliflozin withdrew from the Australian market.…
10th December, 2018, Dr Chee L Khoo
Elevated triglyceride (TG) level serves as an independent marker for an increased risk of ischaemic events, as shown in epidemiologic and mendelian randomisation studies (1-5). However, in most of the statin trials, patients with high TG are generally excluded. There is confusion out there as to whether fish oils is useful or not for cardiovascular protection.…
10th December 2018, Dr Chee L Khoo
Treatment resistant depression is not that uncommon in general practice. We have quite a few patients that don’t respond to maximal dose of our usual SSRI or SNRIs. Naturally, we need to check adherence to medications and alcohol intake. A review of the history is important as there may be hidden skeletons unresolved (including sexual abuse).…
27th November, 2018, Dr Chee L Khoo
Of the patients with type 2 diabetes (T2D) who die from cardiovascular (CV) disease, 40% die from IHD, 15% die from heart failure and 15% die from strokes. Patients with T2D have greater atherosclerotic plaque burden, higher atheroma volume, and smaller coronary artery lumen diameter than persons without diabetes. Numerous processes contribute to atherosclerotic cardiovascular disease (ASCVD) in diabetes including (but not limited to) hyperglycaemia, insulin resistance and/or hyperinsulinemia, dyslipidaemia, inflammation, reactive oxygen species, endothelial dysfunction, hypercoagulability, and vascular calcification.…
27th November 2018, Dr Chee L Khoo
I recently saw a young lady whose mother had anti-phospholipid syndrome (APL) . She is now worried whether she has the same problem and request some blood tests. She is otherwise fit and healthy. Sure, among other things, I ordered APL antibodies hoping that the pathologist will know what I was looking for. Pretty straight forward so far until the results of her tests came back.…