23rd August 2019, Dr Chee L Khoo
Remember we used to have lipid targets for patients with diabetes and patients with cardiovascular disease. Life was simple then. Just follow those numbers. Then the 2013 ACC/AHA guidelines told us to throw away those targets and put everyone with cardiovascular (CV) risk above a certain figure on maximally tolerated statins. It’s kind of set and forget strategy.…
13th August 2019, Dr Chee L Khoo
Although persons 75 years or older account for 6% of the population, they account for more than 65%of all deaths due to cardiovascular disease (CVD) (1). We know from numerous trials that intensive treatment to reduce lipid levels reduces CV events in patients after they have an ACS (2). What about elderly patients (>75 years old)?…
12th August 2019, Dr Chee L Khoo
We are often reminded to review statins prescriptions for primary prevention in the “elderly” because the evidence of benefit of statins in this group of patients is often “lacking”. Lacking doesn’t mean it there is no benefit. It may mean there are no or limited studies done in that age group.…
28th July 2019, Dr Chee L Khoo
It’s not often that we cure anyone of any disease. Hepatitis C is one of those exceptions to the rule. The World Health Organization (WHO) set the ambitious target of eliminating hepatitis C as a public health threat by 2030 [1]. Australia is one of the very first countries in the world to have made the direct acting anti-viral (DAA) agents available on the PBS.…
26th July 2019, Dr Chee L Khoo
All of us remember the association of QT prolongation with the dramatic Torsale de Pointes (TdP) and sudden cardiac death (SCD) from medical school. Fortunately, both are relatively rare in general practice and we really don’t need to know much about QT prolongation in general practice as it belongs to the hospital people and the cardiologists, right?…
13th July 2019, Dr Chee L Khoo
First, it’s not good, then it’s Ok and now we are not sure. Maybe it is, maybe it isn’t. We are talking about eggs and the association with cardiovascular disease and mortality. It’s stuck in many of our and our patients’ minds that eggs are no good. It doesn’t help when the 2015-2020 Dietary Guidelines for Americans came out with somewhat contradictory recommendations: “ (1) Cholesterol is not a nutrient of concern for overconsumption” and (2) “Individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern” (1).…
12th July 2019, Dr Chee L Khoo 
When we think about Alzheimer disease (AD) we think about the two classes of abnormal structures, extracellular amyloid plaques and intraneuronal neurofibrillary tangles. The soluble building blocks of these structures are amyloid-β (Aβ) peptides for plaques and tau for tangles. We have known about the association between Aβ and tau and AD for some time yet the only therapies available for patients with AD are the cholinesterase inhibitors and memantine which only target the symptoms of the disease.…
22nd June 2019, Dr Chee L Khoo
It is standard to measure blood lipids after an 8-12 hour fast. Pretty much all our guidelines for management of cardiometabolic conditions are based on these fasting blood levels. The actual reading is important because it guides us to determine whether a patient is commenced on a statin or not. Do meals affect lipid levels?…
22nd June 2019, Dr Chee L Khoo
Distal polyneuropathy (DPN) is one of the more severe complications of diabetes. The exact pathologic metabolic process of DPN is still uncertain but it is more common in patients with type 2 diabetes (T2DM) than in patients with type 1 diabetes (T1DM) even after adjusting for glucose levels. Thus, in addition to hyperglycaemia, other factors could be involved in the development of DPN such as obesity, hypertension, dyslipidaemia and renal impairment. …
10th June 2019, Dr Chee L Khoo
Children with moderate to severe asthma often needs more than the usual bronchodilators. Even the newer long acting beta agonists (LABA) or long acting muscarinic antagonists (LAMA) may not be enough to control the symptoms and reduce exacerbations and inhaled corticosteroids (ICS) are often needed. But we are careful to keep the total daily dose of corticosteroids to a minimum.…
8th June 2019, Dr Chee L Khoo
Checkpoint inhibitors are monoclonal antibodies that block checkpoint molecules, cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed death-1 (PD-1) and PD-1 ligand 1 (PD – L1). They have revolutionised cancer treatment because of their ability to improve survival in a growing number of cancers. Some of the cancers that have been successfully treated include melanoma, lung cancer, kidney cancer, bladder cancer, head and neck cancer, and Hodgkin’s lymphoma.…
26th May 2019, Dr Chee L Khoo
Sometimes when a drug is contraindicated for patients with low eGFR, it may mean that usage of the drug may further damage the kidneys or increase the risk of certain adverse events. For example, the use of metformin in patients with eGFR <30 significantly increase the risk of lactic acidosis. Usage of lithium in patients with impaired renal function (low eGFR) may further damage the kidneys.…