27th August 2023, Dr Chee L Khoo
I thought I knew how to diagnose COPD when I see one. I thought I knew everything I need to know as a GP in managing COPD. I mean, how hard can it be? LABA, LAMA +/- ICS. If in doubt, put them on a triple puffer. Might be a bit of an overkill but what is the harm?…
27th August 2023, Dr Chee L Khoo
We talked about a number of monoclonal antibody (-mab) treatment for Alzheimer Dementia (AD) that have made headlines recently. We explore how (non) exciting the results of the clinical trials were including adverse effects. We also touched on how similar in efficacy the new wonder drugs are when compared with older existing anti-cholinesterases.…
13th August 2023, NIA Diagnostic Imaging
A 49-year-old lady presented with pain in her right breast. There is a strong family history of breast cancer. Breast examination was difficult because of “lumpiness” of the breasts. She was referred for a breast ultrasound at NIA. Ultrasound showed two lesions in the right breast – one at 3 o’clock, 2cm from the nipple and another at 7 o’clock, 2cm from the nipple.…
13th August 2023, Dr Chee L Khoo
Over the last 2 decades we have seen a number of new classes of glucose-lowering agents in the management of patients with type 2 diabetes (T2D). It was quite a few years after the introduction of the thiazolidinediones (pio- and rosiglitazones) that the DPP4 inhibitors, the GLP1- RA and then SGLT2 inhibitors came along and now changed the way we manage T2D.…
13th August 2023, Dr Chee L Khoo
Many of the male doctors are slowly losing the battle against male pattern alopecia. It’s either thinning or receding. For those who are not there yet, it’s coming. We are also seeing women joining the club. Androgenetic alopecia (AGA) is the most common form of hair loss in humans affecting 80% of Caucasian men and 50% of Caucasian women.[1].…
28th July 2023, Spectrum Medical Imaging
I couldn’t never work out the work flow of electronic referrals (e-referrals) for patients whom I refer for imaging. We are so used to having a piece of paper in our hand to make an appointment. You will be surprised how many patients look at you wondering what to do with that piece of paper.…
26th July 2023, Dr Chee L Khoo
It is coming up to 10 years now when we, as GPs, were suddenly not allowed to prescribe TRT for our patients with low serum testosterone levels. The rationale cited at the time was that testosterone replacement therapy (TRT) was potentially harmful because we were told that TRT is associated with increased cardiovascular risk in men with hypogonadism.…
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.…
13th July 2023, NIA Diagnostic Imaging
Aortic aneurysms are known as silent killers as the majority of patients with the condition are asymptomatic and are usually found incidentally during physical examinations or diagnostic imaging studies performed for other reasons (Faiza & Sharman, 2023). Ruptured aortic aneurysms are associated with high mortality rates of approximately 80-90% for patients with ruptured AAAs (Wise et al., 2016) in which “more than 50% of patients die before they reach the emergency room” (Shaw et al., 2023).…
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.…