15th August 2018, Dr Chee L Khoo
Following an acute coronary event we know that two anti-platelets are better than aspirin alone in preventing further coronary events. What about a cerebro-vascular events? Following a mild CVA or a TIA, we would normally commenced aspirin to prevent another stroke especially in the first 90 days. Would adding another agent to aspirin be better in preventing further strokes?…
1st August, 2018, Dr Chee L Khoo
Ben
ign prostatic hyperplasia (BPH) is increasingly more common when men gets older. Transurethral resection of prostate (TURP) is still the gold standard treatment for most patients. Since alpha-adrenergic antagonists (also called alpha blockers) came to market, TURP is performed a lot less often. 5-alpha reductase convert testosterone into 5-alpha-di-hydrotestosterone (DHT), which is responsible for prostate hypertrophy and blocking this enzyme prevents further prostate growth.…
1st August, 2018, Dr Chee L Khoo
Although one third of patients with colorectal cancer (CRC) have a family history of cancer, only 5% of all patients with CRC have an identifiable cause to their cancer predisposition. Most of these identifiable predispositions are inherited mutations in genes that regulate growth processes in colonic stem cells and/or genome caretakers which ensure the only good clean DNA is passed on to the next generation. …
1st August, 2018, Dr Chee L Khoo
After metformin and sulphonylurea, under the PBS we can choose between a DPP4 inhibitor, an SGLT2 inhibitor, a thiazolidinedione or a GLP1-RA injectable. Because of the potential adverse effects of cardiac failure with thiazolidinedione, realistically, it’s a three horse race. The cost effectiveness of each of the class of agents has not been explored thus far.…
1st August, 2018, Dr Chee L Khoo
We all know that unhealthy lifestyles are major risk factors for many chronic diseases and premature deaths. Many studies previously have reported that reduction in these unhealthy lifestyles can lead to increase in life expectancy of between 7.4 to 17.9 years in Japan, UK, Canada, Denmark, Norway and Germany 1-4. It would really be helpful during a consultation with our patients if we can quantify the benefit of these measures on the various chronic diseases and life expectancy.…
July 15, 2018, Dr Chee L Khoo
I must declare my personal interest in this discussion. I have been taking omega-3 fish oil supplements for years to reduce my triglycerides. I am also on a statin for my hypercholesterolaemia and the fish oil is to treat the residual hypertriglyceridaemia. A recent study confirm the efficacy of this approach1. However, does the addition of fish oil and reduction of triglycerides translate to improvement in cardiovascular (CV) outcomes?…
July 15, 2018, Dr Chee L Khoo
Diabetes can be diagnosed if fasting glucose is >7.0 mmol/L, 2 hour post prandial > 11.0 mmol/L and/or HbA1c >6.5. However, clinical guidelines recommend that we repeat testing within a “short period of time” to reduce the possibility of a false positive result. Sometimes, repeat testing may not be possible or not uncommonly, patients may be lost to follow up.…
July 15, 2018, Dr Chee L Khoo
It’s always sad to lose a patient due to complications of a disease. It’s even harder if the patient is another doctor especially if the disease has well recognised complications. Many of you may have read about the sad story of Dr Rana, known to have cystic fibrosis, who died of complications resulting from an unrecognised bowel obstruction.…
July 15th 2018, Dr Chee L Khoo
Have you noticed that an increasing n
umber of patients with renal stones discharged from emergency department are prescribed tamsulosin. It makes perfect sense, doesn’t it? Tamsulosin is an alpha blocker and by inhibiting the smooth muscles in the ureter, it facilitates the passage of stone into the bladder. Does it really? It’s logical but is there evidence that it works?…
July 1st, 2018, Dr Chee L Khoo
We all know Prazosin (Minipress) as an alpha 1 blocker used to treat hypertension. Prazosin is also useful in treating urinary hesitancy associated with prostatic hyperplasia by blocking the alpha-1 receptors which control constriction of both the prostate and urethra. Obviously, we now have better and newer agents for hypertension and bladder problems. As such, Prazosin is a long-forgotten agent.…
July 1st, 2018, Dr Chee L Khoo
With early diagnosis and improved treatment, many of our cancer patients have increased survival. You may already have noticed that many of our patients being managed in the multi-disciplinary oncology units are routinely promoting healthy lifestyles. Chronic co-morbidities including diabetes and cardiovascular diseases not only affect quality of life in these survivors but are the major cause of non-cancerous mortality in cancer patients.…
July 1st, 2018, Dr Chee L Khoo
I am sure you have been asked by parents of young patients about to undergo tonsillectomy +/- adenoidectomy whether the removal of the tonsils will affect future immunity since the tonsils and adenoids are integral to the body’s immune response. I have had those questions asked of me and the answer used to be “Of course not.…