13th February 2023, Dr Chee L Khoo
Survival rates amongst our cancer patients have improved dramatically over the years with the advent of better chemotherapy regimen. This is particularly the case in breast cancer and the different lymphomas. One of the adverse effects is cardiotoxicity in patients exposed to anthracyclines which can be life-threatening and can occur immediately or in the longer term.…
13th February 2023, Dr Chee L Khoo
Now that I know how common metabolic-dysfunction associated fatty liver disease (MAFLD) is especially amongst those patients with elements of metabolic syndrome, it’s hard not to assume that every second patient have MAFLD. We also know that not all MAFLD has abnormal liver function tests (LFTs). So, if you only suspect or screen only those with abnormal LFts, then you are going to miss many MAFLD.…
29th January 2023, Dr Chee L Khoo
We have always regarded HDL-Cholesterol (HDL-C) as the good guys. In the 1970s, the Framingham Heart Study showed that HDL-C was negatively associated with the development of cardiovascular disease (CVD) (1). Thus, we have regarded HDL as anti-atherogenic lipoprotein and expected HDL-C-raising therapy to reduce CVD events. However, there have been recent reports of the associations of high HDL-C and osteoporosis and fractures in healthy older adults.…
29th January 2023, Dr Chee L Khoo
We looked at the difference in definitions between non-alcoholic and metabolic-dysfunction associated fatty liver disease (so-called NAFLD vs MAFLD) in the last issue of GPVoice. There are many similarities and overlap between the two entities. At the end of the day, does it really matter we call the diseases. Since writing the article, I have diagnosed quite a few MAFLD and taken the appropriate next steps in the management.…
4th January 2023, Dr Chee L Khoo
The term non-alcoholic fatty liver disease (NAFLD) was first coined by Ludwig in 1980. It was rather an exclusive diagnostic term to exclude the other liver disease from being included in the definition. If your liver disease relates to excessive alcohol intake, drugs or autoimmune conditions, it cannot be included in the diagnosis.…
4th January 2023, Dr Chee L Khoo
The most recent US Prevention Services Task Force (USPSTF) recommendations pour cold water onto its use in primary prevention of CVD in April 2022 (1). We explored the details and rationale behind that turnaround recently. The recommendation for use of aspirin for prevention of colorectal cancer is lumped in together with the recommendation for CVD prevention.…
29th December 2022, Spectrum Medical Imaging
Last week we explored coronary artery calcium score and looked at how the score is really more than a score. There is a lot more details than just a number in the report. Spectrum also has a team of subspecialist Cardiac Radiologists and Cardiologists who are trained in cardiovascular imaging interpretation. The report has details that allows us to proceed to the next stage of the cardiovascular risk assessment.…
24th December 2022, Dr Chee L Khoo
There have been a number of contentious safety concerns regarding the prolonged used of denosumab. The original FREEDOM trial demonstrated efficacy in reducing vertebral, hip and femoral fractures over 3 years of denosumab therapy. There was a further 7 years extension to the original trial and the report was published last year. There were some suggestions a few years ago that patients might, perhaps, need a drug holiday after 5-10 years on denosumab but there is increasing evidence of rapid reduction in bone densitometry (BDM) after denosumab is stopped.…
18th December 2022, Dr Chee L Khoo
Making a decision whether to treat patients with lipid lowering agents is relatively easy in patients who either have symptomatic cardiovascular (CV) disease or have a very low risk according to our CV risk assessment. It is a bit more difficult in the intermediate CV risk group. We have to consider the cost and adverse effects of initiating lifelong preventive therapy versus the potential benefit to the patient.…
12th December 2022, Dr Chee L Khoo
We explored lipoprotein a (Lp(a)) as a significant residual risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis in August this year. We looked at the strong and log-linear association between elevated Lp(a) and cardiovascular (CV) events. While the new PCSK9 inhibitors, notably alirocumab, has been shown to modestly reduce Lp(a) levels (and is associated with a small reduction in CV events) in the ODYSSEY trials, we do not have any agents that specifically lower Lp(a) approved yet (1).…
11th December 2022, Dr Chee L Khoo
You would have heard the exciting hype about lecanemab in the treatment of early Alzheimer’s disease. It’s all over the news and it is getting many patients excited. The Alzheimer’s disease community has become accustomed to false hope, disappointment, and controversy. Existing “treatments” of AD can hardly be called treatment as they can only slow down the progression of the disease (if it indeed work at all).…
1/12/2022, Spectrum Medical Imaging
We all see lots of knee problems in general practice. History and examination obviously is important but it will be nice to have confirmation in cases where there may be dual pathology. MRI of knee is an excellent tool which can confirm and exclude various soft tissue injuries which makes a significant difference in their prognosis and management.…