Fibromyalgia – which drug for which symptom?

23rd May 2022, Dr Chee L Khoo


We all know that the term fibromyalgia is a wishy-washy term used to cover something rather imprecise. Don’t get me wrong. I am not doubting the syndrome but just the name used to refer to the constellation of symptoms of widespread chronic pain, easy physical exhaustion, cognitive difficulties, depressed mood, sleep problems and digestive problems.…

CV disease and inflammation – where do the cells come from?

22nd May 2022, Dr Chee L Khoo

The close association of inflammation and cardiovascular disease is well known for some time. Inflammation is an essential mediator of all stages of atherosclerosis, from initiation to progression and the development of thrombotic complications (1,2). Circulating immune cells play a critical role in the build-up of atherosclerotic plaques by adhering to activated endothelium and infiltrating the arterial wall to become lesional cells (3).…

PPIs and diabetes – is there a link?


13th May 2022, Dr Chee L Khoo

Another month, another commonly used class of drugs are implicated in either aggravating glucose control in patients with type 2 diabetes (T2D) or actually, increase the risk of developing T2D. This month, we a report suggesting the use of proton pump inhibitors (PPIs), as a class of agent, is associated with increased risk of developing T2D.…

Dasiglucagon – finally here?

12th May 2022, Dr Chee L Khoo

severe hypoglycaemia

It’s been more than 4 years since we herald the arrival of the stable formulation of the new glucagon, dasiglucagon in a ready-to-use delivery device for the management of hypoglycaemia. If you think about how much time is wasted in the emergency treatment of hypoglycaemia. The existing glucagon emergency kits we currently have need reconstitution before administration.…

Acute Achilles tendon rupture – is non-surgical treatment just as good?

11th May 2022, Dr Chee L Khoo

I was fortunate to have received ample orthopaedic experience in my training days. I was all destined to be an orthopaedic surgeon but changed my mind. I have seen a few complete Achilles tendon rupture and assisted in many successful surgical repair. Conceptually, you can’t imagine how anyone can plantar flex again if the tendon ends are not reattached surgically.…

Nuchal translucency or Non-invasive prenatal screening

30th April 2022, Spectrum Medical Imaging

Women who are in their first trimester of pregnancy have two options for screening for structural abnormalities and chromosomal abnormalities such as Down’s, Edwards or Patau syndrome. While it not necessary to perform both, we need to know which test exclude what abnormalities. Spectrum offers both and we need to understand both tests for that we can discuss them with our patients.…

Type 2 diabetes and cancers – what and why?

24th April 2022, Dr Chee L Khoo

There have many observational studies that have shown increased risks of a variety of cancers in patients with both type 1 and type 2 diabetes independent of body mass index (BMI). Cancer is also the second most common cause of death in patients with diabetes. Up to 18% of patients with cancers have diabetes.…

The glucose pattern that predates pancreatic cancer

21st April 2022, Dr Chee L Khoo

We have discussed the two-way relationship between pancreatic cancer and diabetes. Patients with type 2 diabetes are at 1.5-2.0 times higher risk of developing pancreatic ductal adenocarcinoma (PDAC). In patients with T2D, the development of PDAC destabilises glucose homeostasis pretty much in all patients with T2D. In patients that do not have T2D, the development of PDAC pushes them across the threshold of T2D up to 6-12 months before the diagnosis.…

GLP1-RAs and gallbladder diseases – is there a connection?

biliary system

12th April 2022, Dr Chee L Khoo

It’s almost close to a wonder drug. It is widely used in type 2 diabetes (T2D) for management of hyperglycaemia when the HbA1c is >7.0%. For that indication, it is pretty potent and in clinical trials, can reduce the HbA1c by 1-1.5%. It also assists in weight reduction and thence, reduce the core problem of insulin resistance in these patients.…

Perioperative antibiotics – is less actually more?

12th April 2022, Dr Chee L Khoo

Antibiotic cover?

We continue to see “routine” antibiotic cover for many surgical procedures. It is not uncommon to see antibiotic prophylaxis used in major surgery like open heart surgery, joint replacement surgery and bowel surgery but the list extends to sinus surgery, routine orthopaedic surgery and not that uncommonly, plastic reconstructive surgery. This is despite international guidelines stating that for clean and clean-contaminated procedures (explicitly including any prosthetic joint arthroplasty with or without a drain, additional prophylactic antimicrobial doses should not be administered after the surgical incision is closed in the operating room.…

Cardiovascular risk predictors – are they any good?

8th April 2022, Dr Chee L Khoo

CV Risk Calculator

CVD is the major cause of mortality and morbidity in patients with type 2 diabetes (T2D). There are many hundreds of cardiovascular risk prediction tools around. Well, whenever you have many versions of a particular tool, it usually tells us that none of them are particularly good in what they are meant to do – that is to predict the risk of a cardiovascular event.…

Image guided injections – what goes where?

28th March 2022, Spectrum Medical Imaging

I have to admit that even I get confused as to what imaging modality is needed to assist in image guided injections. Is it ultrasound guided or is it CT guided. The table below makes the whole choice easy to follow. Image guided injections is a very effective treatment modality in patients with spinal joint related pain whether it involves facet joints in the lumbosacral or cervical spine or the root canal of the spine.…