13th April 2024, A/Prof Chee L Khoo
We are all used to metformin being the first line glucose lowering agent when type 2 diabetes (T2D) is diagnosed. (Well, I know some you also use metformin before diabetes is diagnosed but that’s a different story). Glucose lowering efficacy of metformin is not that terrific as we now have much stronger glucose lowering agents available.…
24th February 2024, A/Prof Chee L Khoo
We all know how important it is for BP control in prevention cardiovascular, cerebrovascular and renal complications. We are also aware of the difficulty is improving medication adherence. We have a broad range of effective BP lowering medications covering diverse classes of medications. Anti-hypertensives work only if our patients take them regularly.…
10th December 2023, A/Prof Chee L Khoo
We don’t get old and weak. Actually, if we get weak, we become old. We all see that in practice. It doesn’t matter how old our patient is. When they become weak, they slow down. They can’t walk very far and they don’t. They become weaker and weaker. They have difficulty get off a chair.…
9th December 2023, A/Prof Chee L Khoo
We know how effective statins are in lowering cholesterol levels. Lowering of cholesterol levels, especially LDL-C, have been shown to incrementally reduce adverse cardiovascular events in patients with atherosclerotic disease. We have data to show that for every 1 mmol/L of LDL-C reduction there is a 23% reduction in cardiovascular events, which means, the lower the better (1).…
27th November 2023, A/Prof Chee L Khoo
Although moderate to severe acne is pretty common in primary care, our management tends to be haphazard. We have our favourite topical and oral therapy but I am not sure that that is evidence-based nor pathophysiological in our approach. When all else fails, we refer on to our friendly dermatologist. I recently attended a brilliant lecture at the Melbourne GPCE presented by Dr Ryan de Cruz, a Melbournian dermatologist.…
25th November 2023, A/Prof Chee L Khoo
Reproductive genetic carrier screening for cystic fibrosis (CF), spinal muscular atrophy (SMA) and fragile X syndrome (FXS) has become available on the Medicare Benefits Scheme (MBS). Screening for those three conditions is recommended for all couples prior to, or in the early stages of pregnancy. Great but what is this genetic screening all about?…
30th October 2023, Dr Chee L Khoo
When we think about precision medicine, we usually think about some fancy, expensive genetic tests that can help us determine ahead of time who is at risk of some serious diseases. This may allow us to target these patients early and reduce morbidity and mortality. There is connotation that only the rich in rich countries can afford these tests and once again, patients in low and middle income countries (LMIC) will miss out on these state of the art expensive tests.…
10th September 2023, Dr Chee L Khoo
We looked at the new understanding of the pathophysiology of COPD last fortnight. Armed with that information, we may be able to make sense of which puffer to use for which patient and what to escalate during their exacerbations. We already do that but, I must admit, rather haphazardly. It, kind of, depends on what samples I have in the drug cupboard or when the last pharma rep came to sell their ware.…
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].…
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.…
29th April 2023, Dr Chee L Khoo
We have a increasing number of patients who has undergone a percutaneous coronary intervention (PCI). This could be in the acute setting of an acute coronary syndrome (ACS) or electively during an exploratory angiogram. Stents used to be bare metal. Then came the first-generation drug eluting stents. The latest generation drug eluting stents are better at reducing subsequent thrombosis of the stented and unstented coronary segments.…
25th April 2023, Dr Chee L Khoo
We may not have many patients with neuropathic pain but patients with neuropathic pain can be heartsinks. Most of the time, nothing seems to work. It can be quite frustrating when anti-depressants after anti-depressants don’t work. The old tricyclics often don’t work either. What about pregabalin? Nope. What about gabapentin? Nope. What about long-acting opioids or tramadol?…