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.…

Routine ECG in T2D – is it necessary?

!2th March 2021, Dr Chee L Khoo

Routine ECG

A substantial number of myocardial infarctions (MIs) are asymptomatic (silent MI (SMI)) or associated with minor and atypical symptoms and are found accidentally during routine electrocardiogram (ECG) examinations that reveal the existence of abnormal Q waves. The risk factors for occurrence of SMI are increasing age, hypertension, existing coronary artery disease and diabetes.…

Auto-immune arthropathy – understanding the IL-23/IL-17 pathway

26th February 2021, Dr Chee L Khoo


Back in medical school, we were taught that we have B-cells and T-cells. B-cells are responsible for humoral immunity and T-cells are responsible for cell-mediated immunity. T-cells could be killer cells or helper cells although we also have regulatory T-cells which tells the naïve T-cells how to behave. Of course, over the last 2-3 decades, we know more about what makes the regulatory T-cells decide what to tell these naïve cells.…

Carotid artery stenosis – should I have diagnosed it earlier?

11th February 2021, Dr Chee L Khoo


We all have come across this awful scenario. Patient was admitted to hospital with a TIA or a stroke due to significant carotid stenosis. As good caring GPs, we looked back and wonder whether we should have known about the stenosis. After all, these patients often have other hallmarks of atherosclerosis, coronary artery disease or peripheral arterial disease and the usual cardiovascular risk factors and we should have suspected carotid stenosis.…

Sex hormones and eye abnormalities – how are they related?

11th January 2021, Dr Chee L Khoo

Sex hormones are not just responsible for the function of the reproductive system. They are also responsible for bone and cardiovascular health. Interestingly, they are produced, not only by the gonads, but also by other organs (1,2) including the central nervous system (CNS). Well, the eye is a neural structure and there is increasing evidence that oestrogens exert a neuro-protective role (3,4).…

Angiopoeitin-like 3 inhibitors – new therapy for hypercholesterolaemia

27th December 2020, Dr Chee L Khoo

Every time we come across some rare genetic disorder, we learn more about the intricacies of metabolism. Nothing is more true when it comes to lipid and lipoprotein metabolism. Familial combined hypolipidemia (FCHL) is a relatively recently recognised autosomal recessive disorder characterised by globally reduced levels of LDL and HDL cholesterol and triglyceride, with no apparent adverse effects.…

PCSK9 inhibitors on PBS – who can be on it?

24th December 2020, Dr Chee L Khoo

PBS Authority

It’s been a couple of years since we first previewed the PCSK9 inhibitors (PCSK9i) on the PBS for patients with dyslipidaemia despite maximal statins and ezetimibe. Since then PCSK9i have been demonstrated in many trials of its efficacy in patients with high cardiovascular risk with dyslipidaemia despite maximally tolerated statins. The qualifying criteria  under the PBS has significantly loosened and suddenly we all have a number of patients who will meet those PBS criteria.…

Stroke prevention – are two agents better than one?

13th December 2020, Dr Chee L Khoo

Stroke prevention

If you have been following GPVoice over the years, you would have realised that I am easily confused. I am confused again. Why are some patients who has had a TIA or minor stroke on aspirin and some on dual antiplatelet therapy (DAPT)? With supplies of some of these agents interrupted during the pandemic, can we swab one anti-platelet agent for another?…

Aortic aneurysm and fluoroquinolones don’t mix well – do they?

13th October 2020, Dr Chee L Khoo

Aortic aneurysm (AA) and aortic dissection (AD) are potentially fatal conditions. Without treatment, ruptured AA/AD carries a mortality rate of up to 90%. Population-based studies estimated the annual incidence to be 2.4 to 14.8 per 100 000 persons for AA (1-4) and 3.8 to 8.8 per 100 000 persons for AD (3,5-7). Although the incidence varied across countries, the number has universally increased over time (1-5,7).…

Temporal arteritis – which features help with the diagnosis?

11th October 2020, Dr Chee L Khoo

There are a few “rare” medical diagnoses that are stuck in our minds since medical school days. They may be rare but it’s important not to miss them. Temporal arteritis, also known as giant cell arteritis (GCA) is one of those not so common conditions. It is actually not that rare. It is the most frequent primary systemic vasculitis with an annual incidence rate of 15–25 per 100,000 in Caucasians ≥50 years of age and it primarily affects medium- and large-sized vessels (1,2).  When do you suspect GCA?…

Hypoglycaemia in non-diabetics – is it a problem?


27th September 2020, Dr Chee L Khoo

We know that hyperglycaemia is associated with increased cardiovascular mortality. We also know that in patients with diabetes, hypoglycaemia is also associated with increased cardiovascular morbidity and mortality. What about patients who don’t have diabetes and have low blood glucose (<4.0 mmol/L)? I am sure we all have patients who do not have diabetes but on screening blood tests, have BSL lower than 4.0 mmol/L.…