25th September 2021, Dr Chee L Khoo
SGLT2 inhibitors (SGLT2i) have been shown to improve outcomes in patients with type 2 diabetes (T2D) and high cardiovascular risks as well as in patients with chronic kidney disease and heart failure regardless of diabetes status and independently of blood glucose levels or HbA1c. There is a little bit of a “catch” though, the eGFR.…
23rd September 2021, Dr Chee L Khoo
You have to agree that the covid-19 vaccines have been pretty effective in reducing the case numbers of covid-19 worldwide. However, over the last few months, with the emergence of the delta variant, there have been resurgence of the virus. Is it because delta variant is more contagious? Perhaps, the efficacy of the vaccines has waned as it’s coming up to 6 months for those who had their vaccines earlier in the year.…
13th September 2021, Dr Chee L Khoo
Phase 3 trials have inherent limitations in assessing vaccine safety because of the small number of participants and the sample population is generally reasonably young and healthy. They are often underpowered to identify less common adverse events. For example, the AZ interventional arm had about 11,000 participants and the interventional arm of the Pfizer Comirnaty vaccine had about 23,000 participants.…
11th September 2021, Dr Chee L Khoo
You may recall when direct acting oral anti-coagulants (DOAC) first came out for treatment of atrial fibrillation (AF). Upon diagnosis of new AF, some GPs were hesitant to initiate a DOAC for the AF but instead refer patients to a cardiologist. There is a danger while waiting to see the cardiologist that the patient may incur a cerebrovascular accident (CVA).…
9th September 2021, Dr Chee L Khoo
You already know that SGLT2 inhibitors, as a class, have been shown to reduce the development and progression of heart failure in patients with diabetes (1-3). Incidentally, it has also been shown to do the same in patients with heart failure but without diabetes. Life used to be simple.…
26th August 2021, Dr Chee L Khoo
The Delta variant, first identified in India in December 2020, spread rapidly throughout a mostly unvaccinated country and caused massive numbers of cases, hospitalisations, and deaths. It’s now responsible for the outbreaks spreading across the world. This includes countries that have high vaccination rates. In the UK, the Delta variant has spread rapidly.…
21st August 2021, Dr Chee L Khoo
Nothing scares patients with diabetes more than blindness. Although we have many treatment options available for proliferative diabetic retinopathy and macular oedema, diabetes remains the leading cause of severe visual impairment in working-aged adults. Diabetic retinopathy affects one in three people with diabetes. Risk factor control and screening are the cornerstones for retinopathy prevention.…
18th August 2021, Spectrum Medical Imaging
We were all taught that we should always see it for ourselves and trust no one when it comes to history and examination. We cannot rely on third party information but sometimes, we have to. When we have to refer patient for imaging, we need to ensure that we can trust the provider and have faith in their experience and quality of reporting.…
14th August 2021, Dr Chee L Khoo
Shoulder pain has to be one of the most common musculoskeletal complaints in general practice. Rotator cuff pathology makes up at least 70% of those cases (1). It is commonly very debilitating, causing pain the whole night, causing significant reduction in function and often last for years. Apart from rest, analgesia, non-steroidal anti-inflammatory drugs, treatment options include physiotherapy, corticosteroid injections and surgical repair.…
8th August 2021, Dr Chee L Khoo
We know that the incidence of thrombocytopaenic thrombosis syndrome (TTS) can occur with the AstraZeneca (AZ) Covid-19 vaccines although it is pretty uncommon. What do you do with patients who had TTS with the first jab and it’s now ready for the next jab? Obviously, they can’t have the second jab with AZ.…
7th August 2021, Dr Chee L Khoo
It is always difficult for pregnant women to decide whether to have the Covid-19 vaccine during pregnancy. Understandably, they are concerned about the safety of the vaccine administered during pregnancy. When the pandemic started last year, there were some studies which suggest that Covid-19 during pregnancy is associated with “significantly” poor maternal and offspring outcomes.…
28th July 2021, Dr Chee L Khoo
Muscular strains especially those around the spine (low back or neck pain) are very common presentations in general practice. Apart from analgesics, muscle relaxants are commonly prescribed. Recommendations for the use of muscle relaxants have, however, conflicted between international clinical practice guidelines for low back pain (1,2). The US guideline recommends non-benzodiazepine antispasmodics as the drug of choice for acute low back pain (3) the Belgian guideline discourages such use (4) and the UK guideline does not make a recommendation (5).…