27th October 2024, A/Prof Chee L Khoo
Patients with heart failure have high mortality and morbidity. Each time they are admitted into hospital with an exacerbation, their cardiac function deteriorate and usually do not return to pre hospital level when they are better. Many of these patients have other co-morbidities which can mask their symptoms or they are in and out of hospital with the other co-morbidities that the HF is overlooked.…
13th October 2024, A/Prof Chee L Khoo
We dissected the latest consensus statement from GESA in the last issue of GPVoice when we looked at metabolic dysfunction related fatty liver disease (MAFLD). We highlighted the risk groups that are very likely to have MAFLD. Essentially, these are patients with metabolic syndrome (type 2 diabetes, obesity, hypertriglyceridaemia and hypertension). We looked at the recommendations of using ultrasonography as the first line investigation to diagnose MAFLD and not to rely on abnormal liver function tests (LFTs) to rule in or rule out MAFLD.…
28th September 2024, A/Prof Chee L Khoo
Patients are often given tacit recommendations about lifestyle changes for MAFLD because it’s “just a little fat in the liver”. For those of us who have that few patients with those liver as well as non-liver complications, we will remember how horrible these patients fare moving forward. Yet, we can’t refer all our patients with fatty liver to the hepatologist.…
12th September 2024, A/Prof Chee L Khoo
Inadequate protein intake in older adults may cause impairments of muscle mass and muscle function as well as impairment in immune function. Higher protein intake has been associated with increased muscle mass and strength, slower rate of bone loss, higher bone mineral density, lower risk of frailty, and improved cardiovascular function and recovery from illness (including wound healing) (1,2).…
24th August 2024, A/Prof Chee L Khoo
Last fortnight we looked at the effects of hypertriglyceridaemia (HTG) on atherosclerosis. We explored the source and metabolism of triglycerides (TG). We saw how important lipoprotein lipase was in regulating plasma TG. Triglyceride levels are closely related to plasma triglycerides rich lipoprotein (TRL) and TRL remnants. All three components penetrate through the endothelium into the subendothelial space where atherosclerotic inflammation occur.…
24th August 2024, A/Prof Chee L Khoo
Plasma glucose levels is such a simple test that we take for granted its reliability. The glucose level is absolutely critical in many of our clinical management. It governs whether we diagnose someone with diabetes or not and that have many regulatory implications. We have discussed the diagnosis and management of gestational diabetes mellitus (GDM) and how it affects maternal and offspring outcomes and future risks to both.…
11th August 2024, A/Prof Chee L Khoo
Treating the CV risk factors like hypertension, diabetes mellitus, hypercholesterolemia and smoking have led to significant reductions in cardiovascular disease and mortality. However, up to 25% of first-time patients with myocardial infarction are SMuRF-less. We explored the issue last fortnight. Essentially, SMuRF-less patients are patients who do not have the usual standard modifiable risk factors (SMuRF).…
High salt intake is said to independently contribute to high blood pressure and ultimately, increase cardiovascular disease (CVD). There are also many other diseases that are similarly associated with high salt intake. How robust is the evidence though? As we ponder about the associations, we may or may not push the message of salt reduction as strongly as we should.…
25th July 2024, A/Prof Chee L Khoo
The current gold standard for screening for gestational diabetes mellitus (GDM) for women with no risk factors for hyperglycaemia is an oral glucose tolerance test (OGTT) at 24-28 weeks’ gestation. Women with risk factors are recommended to have an OGTT in the first trimester. Unfortunately, many women are nauseous during the first trimester and performing an OGTT during that time can be very unpalatable.…
21st July 2024, A/Prof Chee L Khoo
I know this what we were all led to believe – high salt intake independently contributes to high blood pressure and ultimately, increases cardiovascular disease (CVD). Further, reducing salt intake will reduce blood pressure and thence, cardiovascular disease. We may sometimes wonder how strong the evidence for both statements is. As we ponder about the associations, we may or may not push the message of salt reduction as strongly as we should.…
13th July 2024, A/Prof Chee L Khoo
Iron deficiency can occur in a number of scenarios. It can arise from blood loss (gastrointestinal, gynaecological), inadequate dietary sources or limited absorption in inflammatory conditions (e.g CKD, heart failure or diabetes). Oral iron supplements not only can have annoying GI side effects but absorption is poor under the best of conditions.…
12th July 2024, A/Prof Chee L Khoo
We are always on the look out for the traditional cardiovascular risk factors – hypertension, diabetes, lipids and smoking to reduce the risk of adverse cardiovascular events. These are termed standard modifiable cardiovascular risk factors (SMuRFs). Unfortunately, there are a significant number of patients that present with acute coronary syndrome (ACS) who has none of the SMuRFs.…