Combining antidepressants – are two agents better than one?


15th March 2022, Dr Chee L Khoo

We are seeing increasing number of patients with depression. This is particularly the case over the last 2 years of the pandemic. Many of our patients were scared in the first year before the vaccines became available and confused in the second year with all sorts of news (good and bad) about the vaccines and their potential side effects.…

SGLT2i/GLP-1RA combo – is two better than one?

22nd March 2022, Dr Chee L Khoo


If you don’t already know that SGLT2 inhibitors (SGLT2i) have significant cardiovascular (and renal) benefits over and above its glucose lowering action, you better catch up with our many, many past issues at GPVoice. You should also be as familiar with the similar benefits of the GLP1 receptor agonists (GLP-1RA), especially the newer weekly injectables.…

Statins in T2D – friend or foe?

12th March 2022, Dr Chee L Khoo

Nox family
friend or foe?

When you look at the management of patients with type 2 diabetes (T2D), almost all the patients are on a statin for both primary and secondary prevention of cardiovascular complications. I suspect that those that are not already on a statin should be on as some doctors are not aware of the tightened lipid targets in the management of patients with T2D.…

Fixed dose combination – what else can we combine with insulin?

7th March 2022, Dr Chee L Khoo


We are all familiar with various fixed dose combination of glucose lowering agents. We have DDP4 inhibitors + metformin, SGLT2 inhibitors + Metformin and SGLT2 inhibitors + DPP4 inhibitors. We also have combination insulins for some time – rapid acting insulin + long acting insulin (so-called pre-mix or co-formulations). Pharmacologically, they make sense as these combined agents either work via different mechanisms or have different pharmacokinetics.…

Covid Heart – long term complications of Covid-19

6th March 2022, Dr Chee L Khoo

The Covid Heart

This is about the potential cardiovascular complications after contracting covid-19 infection. It is coined “the Covid Heart”. A recent analysis of data from 154,000 US veterans one year out from their covid-19 infection have highlighted some scarry statistics. Naturally, you would expect that those who had more severe disease had higher risks of cardiovascular complications but these complications affect patients who are not hospitalised.…

Familial hypercholesterolaemia is rare but what can it teach us?

27th February 2022, Dr Chee L Khoo


Homozygous familial hypercholesterolaemia (HoFH) is one of those conditions that allow us to prescribe the new PCSK9 inhibitors under PBS Authority. It is a pretty rare inherited disorder resulting in extremely elevated low-density lipoprotein cholesterol (LDL) levels and significantly elevated risk of premature atherosclerotic cardiovascular disease (ASCVD). Despite the extreme high risks, HoFH is usually go unrecognised and if recognised are diagnosed late and undertreated.…

Prescribing exercises in T2D – what, how much and how often?

26th February 2022, Dr Chee L Khoo

which exercise?

We all know that, in theory, exercises are always good for our patients with type 2 diabetes (T2D) in more ways than one. There are a few problems though, when putting theory into practice. Most of our patients with T2D not only don’t exercise regularly, they actually don’t know what exercise to do, how they should do it for and how often they are supposed to be doing them.…

The tale of two cysts

24th February 2022, Spectrum Medical Imaging

Case 1

7-year-old girl has 3-week history of headache, lethargy and vomiting.Woke up in the morning with headache and vomiting, presented to hospital casualty. Urgent CT brain showed acute hydrocephalus with raised intracranial pressure requiring urgent operative insertion of ventricular drain to reduce ventricular pressure. What is the cause of the obstruction?

Case 2

6 ½ year old girl.…

Urgent Urgent Urgent – TOBOGM for GDM

14th February 2022, Dr Chee L Khoo

Early GDM – is treatment necessary?

TOBOGM is its final stages of recruitment. TOBOGM is the very first study to see if immediate treatment of early GDM increases or reduces pregnancy complications among women with mildly higher blood glucose diagnosed before 20 weeks’ gestation. The world is waiting on the results of this landmark study.…

Urolithin reduces aging effects – what is it?

13th February, 2021, Dr Chee L Khoo

getting older

One of the signs of getting old is that you are increasingly drawn to articles about efforts to reduce the effects of aging on health and age-related conditions. The positive effects of direct urolithin A (UA) administration in health, aging, and age-related conditions have been identified in several recent studies. UA is a gut microbiome derived natural compound that only 40% of people can naturally convert from dietary precursors at meaningful levels.…

Covid-19 antivirals – how to prescribe them

12the February 2022, Dr Chee L Khoo

covid-19 antivirals

There is quite a bit of things to know about these medications for patients who are infected with covid-19 who are at high risk of severe disease. Whether we like it or not, we have to know them. The number of patients who qualify may not be large but we need to know who needs them and how to prescribe them as they need to be started early in the disease and not when they become sick (severe).…

Pfizer vaccine adverse reaction – is that myocarditis?

28th January, 2022, Spectrum Medical Imaging


Quite a few months ago, we explored the safety of Pfizer’s Comirnaty vaccine especially in young people. In particular, we looked at the increase in the incidence of myocarditis following Pfizer’s Comirnaty vaccines. We publish the list of symptoms that may suggest myocarditis but diagnosis is not always straight forward.

Medicare has now introduced an item number which allows Cardiac MRIs to be bulk billed if you suspect myocarditis.…