AZ vaccine related thrombosis – when do you suspect?

13th May 2021, Dr Chee L Khoo

Thrombosis with thrombocytopaenia syndrome (TTS)

Thrombosis with thrombocytopaenia syndrome (TTS) has been reported following vaccination with AstraZeneca (AZ) and Johnson and Johnson (JJ) covid-19 vaccines. It is also called VITT (vaccine-induced immune thrombotic syndrome) and VIPIT (vaccine-induced prothrombotic immune thrombocytopenia). It is rare and primarily occurs in those under 50 years old. Although the government recommend that people under 50 years have the Pfizer vaccine, there are people who are in Phase 1A and 1B who can’t and should not wait for the Pfizer vaccine where supplies are limited.…

Breast cancer surgery – is more necessarily better?

13th May 2021, Dr Chee L Khoo

The radical mastectomy introduced by Halsted was the treatment of choice for breast cancer of any size or type, regardless of the patient’s age, for 80 years. Any attempt in surgery less than a radical mastectomy was not widely considered during those years. Subsequent randomised controlled trials designed in 1969 and published in 1973 (1) and 1981 (2) showed that survival rates were equal after radical or breast-conserving surgery (BCS).…

Diabetes and dementia – who is at higher risk?


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.…

Knee MRI – how reliable is it?

27th April, Spectrum Medical Imaging

Acute knee pain is a pretty common presentation in general practice. In experienced hands, a thorough physical examination can narrow the differential diagnosis to a few common injuries. Often we have to resort to an MRI to confirm our suspicion. How reliable is the MRI diagnosis?

In a novel study to evaluate the reproducibility, repeatability, and agreement of MRI evaluation with the gross pathology examination at operation, in 23 patients undergoing total knee arthroplasty, MRIs were performed just before the surgery (1).…

Monoclonal Ab for rhinosinusitis? – what will they think of next

25th April 2021, Dr Chee L Khoo

chronic rhinosinusitis

Chronic rhinosinusitis is a very common problem in general practice. Despite the “-itis”, infection is not actually the core problem. That is why antibiotic scripts after antibiotics script isn’t always the solution. There is often a significant inflammatory/allergic component in the pathogenesis. Current standard of care consists of intranasal steroids, nasal saline irrigation and short courses of systemic corticosteroids.…

Migraine prophylaxis – finally, something that works

22nd April 2021, Dr Chee L Khoo


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].…

AZ vaccine and clots – number crunching time

13th April 2021, Dr Chee L Khoo

Every time the government overpromise and underdeliver, we are the ones that have to deal with the public whose expectations have been led unnecessarily high for political reasons. With the issue of clots relating to the AZ vaccine on the front page over the last week or so, patients are now utterly confused and look to their GP for advice as to where and when to proceed.…

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).…

Image guided injections – who gets what where and how?

30th March 2021, Spectrum Medical Imaging

image guided injections

We know that interventional radiologist can inject into practically anyway these days but sometimes it’s helpful to know what injections are for what conditions. Some injections are targeted at joints or near joints while others are injected into soft tissues like tendons or bursas. Sometimes we need ultrasound to guide the injections to the right place while other times, a CT scan required because we have bones in the way.…

White rice & T2D – both cause and effect?

29th March 2021, Dr Chee L Khoo

white rice and T2D

463 million adults  are living with diabetes globally, and this number is estimated to rise to 700 million by 2045. Interestingly, 60% of them live in Asia. By 2030, without intervention, both China and India combined will have almost half a billion of people with diabetics. While lifestyle issues and epigenetics play significant roles in the ever increasing prevalence of type 2 diabetes (T2D), white rice feature prominently in the Asian diet.…

AZ vaccine and clots – media hype?

27th March 2021, Dr Chee L Khoo

cerebral venous sinus thrombosis (CVST)

It all started when the Austrian regulatory authority suspended the use of a batch of AstraZeneca (AZ) vaccine on March 9th after a patient was diagnosed with multiple thrombosis and died 10 days after vaccination, and another was hospitalised with pulmonary embolism after being vaccinated. At least 16 other countries follow suit and suspended the use of AZ vaccine.…