12th July 2023, Dr Chee L Khoo
It’s almost a year since we foreshadowed the arrival of finerenone and it’s finally on the PBS, albeit with the usual and expected very restricted criteria. We discussed finerenone’s impressive cardiovascular and renal outcomes in patients with heart failure and chronic kidney disease. We further discussed why finerenone is a better mineralo-corticosteroid receptor antagonist (MRA) than what we have at the moment, spironolactone and eplenerone.…
25th June 2023, Dr Chee L Khoo
A few weeks ago we explored familial hypercholesterolaemia (FH) primarily in adults. The issues we touched on were how not so rare FH really is and further, how aggressive we should target the LDL-Cholesterol (LDL-C). As we know, commencing lipid lowering agents is only the first step. The next step is to agree on what the LDL-C target should be in this patient based on the cardiovascular risk of the patient.…
28th May 2023, Dr Chee L Khoo
Hypertriglyceridaemia has always played second fiddle to hypercholesterolaemia for a long time. Studies after studies have demonstrated the cardiovascular benefits of cholesterol lowering therapy. You might know that most of these clinical trials excluded patients with hypertriglyceridaemia. Does that mean that hypertriglyceridaemia doesn’t matter? We know hypertriglyceridaemia inflict oxidative damage to vital metabolic systems and organs.…
NIA Diagnostic Imaging, 14th May 2023
Colorectal cancer (also known as bowel cancer) is the third most prevalent type of newly diagnosed cancer and the second deadliest type of cancer in Australia. CRC generally arises from the inner lining of the colon and is often characterised by polyps, which, if left undetected, can transform into aggressive malignancies. Despite the fact that optic colonoscopy is the golden standard for the detection of colorectal cancer, CT colonography (CTC) is regarded as a non-inferior alternative.…
14th May 2023, Dr Chee L Khoo
When we think about diabetic complications, we usually think about microvascular and macrovascular complications. We don’t often think about dementia as a diabetic complication. Diabetes has consistently been associated with an increased risk of dementia and its subtypes (Alzheimer’s disease and vascular dementia (1). As many with diabetes, especially T2D, are being diagnosed at a younger age, dementia relating to diabetes will increasingly be diagnosed and diagnosed at a younger age.…
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?…
1st April 2023, Dr Chee L Khoo
Two months ago, we explored heart failure in cancer survivors exposed to anthracyclines in a dose dependent manner. Anthracyclines are a common agents used in chemotherapy against breast cancer and lymphomas. Heart failure may appear as early as within 12 months of receiving anthracyclines and the incidence continues to grow over time. There have been a lot of work done on the possible molecular pathways in the development of the cardiotoxicity, the prevention strategies explored and the development of “safer” anthracycline derivatives.…
30th March 2023, Spectrum Medical Imaging
We are used to ordering chest CT when we suspect an inflammatory or infective condition in the lungs. Sometimes, we need more information than that. A HRCT CHEST is a CT technique in which thin-slice images of the chest are obtained and post-processed in a high-spatial-frequency reconstruction algorithm. When do you order a HRCT of the chest and when do you order an ordinary CT of the chest?…
27th February 2023, Dr Chee L Khoo
We might see one case every 5 years in primary care. It might not be common but a missed diagnosis can be devastating. Patients rarely present to emergency department or the vascular surgeon without presenting to primary care first. Giant cell arteritis (GCA) is now thought of as a systemic inflammatory disease. Although glucocorticoids remain the mainstay of treatment , in the last few decades, new knowledge have dramatically changed the way we diagnose and treat GCA.…
13th February 2023, Dr Chee L Khoo
Now that I know how common metabolic-dysfunction associated fatty liver disease (MAFLD) is especially amongst those patients with elements of metabolic syndrome, it’s hard not to assume that every second patient have MAFLD. We also know that not all MAFLD has abnormal liver function tests (LFTs). So, if you only suspect or screen only those with abnormal LFts, then you are going to miss many MAFLD.…
4th January 2023, Dr Chee L Khoo
The term non-alcoholic fatty liver disease (NAFLD) was first coined by Ludwig in 1980. It was rather an exclusive diagnostic term to exclude the other liver disease from being included in the definition. If your liver disease relates to excessive alcohol intake, drugs or autoimmune conditions, it cannot be included in the diagnosis.…