Muscle strain – do muscle relaxants work?

28th July 2021, Dr Chee L Khoo

Muscle strain

Muscular strains especially those around the spine (low back or neck pain) are very common presentations in general practice. Apart from analgesics, muscle relaxants are commonly prescribed. Recommendations for the use of muscle relaxants have, however, conflicted between international clinical practice guidelines for low back pain (1,2). The US guideline recommends non-benzodiazepine antispasmodics as the drug of choice for acute low back pain (3) the Belgian guideline discourages such use (4) and the UK guideline does not make a recommendation (5).…

AZ jab 2 at 6 weeks – should we?

23rd July 2021, Dr Chee L Khoo

AZ Jab 2

It’s all too confusing. And annoying. They keep releasing updates in the lay media and says “see your GP to discuss” but did not update us. You will recall that 2 weeks ago the recommendations to have the second AstraZeneca vaccination moved to 6 weeks after the first vaccination in areas with the outbreak which is pretty much all of Sydney.…

Preventing Type 1 Diabetes – are we there yet?

14th July 2021, Dr Chee L Khoo


The risk for people in the general population of developing type 1 diabetes (T1D) is about 1 in 300. For those who have a family member with T1D, the risk is 1 in 20. T1D progresses over 3 stages. In stage 1, two or more autoantibodies are already slowly attacking the β-cells. This can occur years before clinical diagnosis of T1D.…

The twincretins are here

11th July 2021, Dr Chee L Khoo


3 years ago we previewed the highly anticipated drug LY3298176, a novel dual GLP1 and GIP receptor agonist which activate both GLP1 and GIP receptors in islet cells when we look at twincretins. In healthy human subjects, LY3298176 caused weight loss and improved glucose tolerance. In subjects with T2D, LY3298176 reduced fasting glucose, glucose excursions and body weight with increasing doses.…

Neurodegenerative diseases – the role of glymphatics

10th July 2021, Dr Chee L Khoo

neurodegenerative disorders

In medical school, we were taught that the cerebral spinal fluid (CSF) provides the brain with nutrients, transports catabolites and the blood brain barrier (BBB) keeps nasties out and maintains a stable environment (homeostasis). Now, keeping nasties out is great but how does the brain get rid of the waste it generates?In the last fortnight, we explored how the brain cleans itself of toxic and waste products.…

General check up – does it do anything?

27th June 2021, Dr Chee L Khoo

We all do it. Either we arrange for patients to come in once a year to have a “general check-up” or patients come in requesting one. There are no set rules what we check for and what blood tests to order. Somehow, patients feel better that they have been given a clean bill of health and at times, we feel that we have check them out properly and all is good.…

Invasive ductal carcinoma – a case study

27th June 2021, Spectrum Medical Imaging

Invasive ductal carcinoma (IDC), which is also known as infiltrating ductal carcinoma, is the most common type of breast cancer. Although invasive ductal carcinoma can affect women at any age, it is more common as women grow older and can also affect men.

A 29-year-old female presented with a palpable lump in the left breast.…

Glymphatic system – the brain’s lymphatic system

25th June 2021, Dr Chee L Khoo

Where are the lymphatics?

The human circulatory system processes about 20 litres of blood per day through capillary filtration. About 17 litres of the filtered plasma is reabsorbed directly into the blood vessels while the remaining three litres are left in the interstitial fluid. One of the main functions of the lymphatic system is to provide an accessory return route to the blood for that surplus three litres as well as clearance of waste products.…

Newer anti-epileptic drugs in pregnancy – how safe are they?

12th June 2021, Dr Chee L Khoo

More than 50 years ago, there were reports of association between anti-epileptic drugs (AEDs) and birth defects (1). We now have newer AEDs including carbamazepine, lamotrigine, phenytoin and levetiracetam. In 2016, the UK banned valproate use in women who are not in a pregnancy prevention programme.  Despite that, sodium valproate is still widely prescribed in many countries to women of childbearing age.…

AZ Covid-19 vaccine – who shouldn’t have it?

9th June 2021, Dr Chee L Khoo

Covid-19 vaccines

We all know that detailed information relating to Covid-19 is both fluid and rapidly changing. It’s only a mere 3 months since the first reports of thrombosis with thrombocytopaenia (TTS) relating to the administration of the AstraZeneca (AZ) vaccine emerged from Austria. The recommendations as to who should not have the AZ vaccine is constantly being revised as more information comes in from the case reports.…

Chronic kidney disease in diabetes – who looks after these patients?

5th June 2021, Dr Chee L Khoo

Cardiovascular disease (CVD) and chronic kidney disease (CKD) are common complications in patients with type 2 diabetes (T2D). 70% of patients with T2D are likely to develop a CV disease while 40% of them will develop CKD. A significant proportion of patients with CKD will progress to kidney failure requiring renal dialysis or renal transplant.…

Paediatric Radiology – is it that simple?

30th May 2021, Spectrum Medical Imaging

Medical Imaging

Children are not little adults. Paediatric imaging can be challenging in two ways: 1) The whole process can be particularly daunting to the child and requires understanding, support and patience from the staff at the imaging centre 2) The expertise and experience in interpreting the images cannot be taken for granted. It requires the skills of radiographers and radiologists who are both experienced and have special interests in the field.…