DOAC for valvular AF – is that allowed?

11th September 2021, Dr Chee L Khoo

stroke prevention in AF

You may recall when direct acting oral anti-coagulants (DOAC) first came out for treatment of atrial fibrillation (AF). Upon diagnosis of new AF, some GPs were hesitant to initiate a DOAC for the AF but instead refer patients to a cardiologist. There is a danger while waiting to see the cardiologist that the patient may incur a cerebrovascular accident (CVA).…

Neurodegenerative diseases – the role of glymphatics

10th July 2021, Dr Chee L Khoo

neurodegenerative disorders

In medical school, we were taught that the cerebral spinal fluid (CSF) provides the brain with nutrients, transports catabolites and the blood brain barrier (BBB) keeps nasties out and maintains a stable environment (homeostasis). Now, keeping nasties out is great but how does the brain get rid of the waste it generates?In the last fortnight, we explored how the brain cleans itself of toxic and waste products.…

Glymphatic system – the brain’s lymphatic system

25th June 2021, Dr Chee L Khoo

Where are the lymphatics?

The human circulatory system processes about 20 litres of blood per day through capillary filtration. About 17 litres of the filtered plasma is reabsorbed directly into the blood vessels while the remaining three litres are left in the interstitial fluid. One of the main functions of the lymphatic system is to provide an accessory return route to the blood for that surplus three litres as well as clearance of waste products.…

Newer anti-epileptic drugs in pregnancy – how safe are they?

12th June 2021, Dr Chee L Khoo

More than 50 years ago, there were reports of association between anti-epileptic drugs (AEDs) and birth defects (1). We now have newer AEDs including carbamazepine, lamotrigine, phenytoin and levetiracetam. In 2016, the UK banned valproate use in women who are not in a pregnancy prevention programme.  Despite that, sodium valproate is still widely prescribed in many countries to women of childbearing age.…

SGLT2 inhibitors in heart failure – it’s almost an emergency!

22nd May 2021, Dr Chee L Khoo

Emergency

Clinical inertia in heart failure (HF) treatment means deferred initiation of additional proven beneficial therapy, which ultimately leads to preventable adverse HF events. Hospitalisation for worsening HF is a prognostically significant event in the clinical course of a patient with chronic HF (1,2). Hospitalisation for HF (hHF) identifies patients who are at high risk for subsequent disease progression, requirement for advanced therapies, and cardiovascular death.…

Diabetes and dementia – who is at higher risk?

Dementia

9th May 2021, Dr Chee L Kho

When we think of diabetes-related complications, we usually think about microvascular and macrovascular complications. We don’t usually think about dementia. Type 2 diabetes (T2D) represents an increasing health burden world-wide and its prevalence in particularly higher in elderly population. While epidemiological evidence suggests an increased risk of vascular and Alzheimer’s dementia associated with T2D, the mechanisms underlying the association, however, remain unclear.…

Migraine prophylaxis – finally, something that works

22nd April 2021, Dr Chee L Khoo

migraines

We know migraines as recurrent episodes of headache, associated with symptoms such as nausea, photophobia and phonophobia. While we have agents that can treat acute migraine pretty effectively, many patients with migraines have frequent episodes. These patients with frequent migraines should be offered migraine prophylaxis. Unfortunately, amongst patients with frequent migraines, only 3–13% receive migraine preventive treatment [1,2].…

Quadruple therapy for heart failure – why is there treatment inertia?

9th April 2021, Dr Chee L Khoo

Quadruple therapy

We are all aware of the treatment inertia in the management of patients with diabetes. In patients with heart failure, several drug classes have demonstrated significant but independent survival benefit. Quadruple therapy with an angiotensin receptor–neprilsyin inhibitor (ARNI), evidence-based β-blocker, mineralo-corticoid receptor antagonist (MRA) and sodium glucose cotransporter 2 inhibitor (SGLT2i) can cumulatively reduce the risk of death by 73% over 2 years (1).…

Medicinal Cannabis – is it the wonder drug?

12th March 2021, Dr Chee L Khoo

Medicinal cannabis

I don’t about you but I seem to be bombarded by emails championing the wonderful things that cannabis oil can do. I even had a pharmaceutical rep swinging by to ask why I wasn’t prescribing cannabis oil for my patients. I even have a specialist (of sorts) that recommended that my patient come and discuss cannabis oil for his condition with me.…