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Fulltext A Combination of Tachycardia-Mediated Heart Failure and Coronary Artery Vasospasm-Induced Silent Myocardial Infarction in a Patient with Severe Thyrotoxicosis

Khoo SSK, Chu CM, Fung YK

Case Rep Cardiol, 2018;2018:4827907.
PMID: 29713551 DOI: 10.1155/2018/4827907

Severe thyrotoxicosis can present with a myriad of cardiovascular complications. It may be mild features such as palpitations, tachycardia, and exertional dyspnea or may progress to life-threatening consequences such as atrial fibrillation, tachyarrhythmias, heart failure, myocardial infarction, and shock. In rare cases, they may present with myocardial ischemia secondary to coronary artery vasospasm. We report a case of a 59-year-old Malay gentleman who presented with fast atrial fibrillation and tachycardia-mediated heart failure that evolved to a silent myocardial infarction secondary to severe coronary artery vasospasm with undiagnosed severe thyrotoxicosis. He had complete resolution of heart failure and no further recurrence of coronary artery vasospasm once treatment for thyrotoxicosis was initiated and euthyroidism achieved. This life-threatening consequence has an excellent prognosis if recognised early and treated promptly.
Mitigation of 3-monochloropropane 1,2 diol ester and glycidyl ester in refined oil - A review

Yung YL, Lakshmanan S, Kumaresan S, Chu CM, Tham HJ

Food Chem, 2023 Dec 15;429:136913.
PMID: 37506659 DOI: 10.1016/j.foodchem.2023.136913

The 3-Monochloropropane-1, 2-diol ester (3-MCPDE) and glycidyl ester (GE) are formed at high processing temperatures with the presence of respective precursors. Both are potentially harmful to humans, causing adverse health impacts including kidney damage, reproductive problems, and increased risk of cancer. The presence of 3-MCPDE and GE in palm oil is of particular concern because of its widespread use by the food industry. There are a variety of methods for reducing 3-MCPDE and GE. For example, water washing eliminates mostly inorganic chlorides that, in turn, reduce the formation of 3-MCPDE. 3-MCPDE has also been reduced by up to 99% using combinations of methods and replacing stripping steam with alcohol-based media. Activated carbon, clay, antioxidants, potassium-based salts, and other post-refining steps have positively lowered GE, ranging from 10 to 99%. Several approaches have been successful in reducing these process contaminants without affecting other quality metrics.
Simultaneous mitigation of 3-monochloropropane 1,2 diol ester and glycidyl ester in edible oils: a review

Yung YL, Lakshmanan S, Chu CM, Kumaresan S, Tham HJ

Food Addit Contam Part A Chem Anal Control Expo Risk Assess, 2023 Sep;40(9):1164-1182.
PMID: 37549246 DOI: 10.1080/19440049.2023.2235608

The rising concern about the presence of 3-monochloropropane 1,2 diol ester (3-MCPDE) and glycidyl ester (GE) in food has prompted much research to be conducted. Some process modifications and the use of specific chemicals have been employed to mitigate both 3-MCPDE and GE. Alkalisation using NaOH, KOH, alkali metals or alkaline earth metals and post sparging with steam or ethanol and short path distillation have shown simultaneous mitigation of 51-91% in 3-MCPDE and of 13-99% in GE, both contaminants achieved below 1000 µg/kg. Some of the mitigation methods have resulted in undesirable deterioration in other parameters of the refined oil. When the processed oil is used in food processing, it results in changes to 3-MCPDE and GE. Repeated deep frying above 170 °C in the presence of NaCl and baking at 200 °C with flavouring (dried garlic and onion), resulted in increased 3-MCPDE. Repeated frying in the presence of antioxidants (TBHQ, rosemary and phenolics) decreased 3-MCPDE in processed food. The GE content in foods tends to decline with time, indicating instability of GE's epoxide ring.
Optimization of water washing for mitigation of 3-monochloropropane 1,2 diol ester in palm oil physical refining process

Yung YL, Lakshmanan S, Chu CM, Tham HJ, Kumaresan S

Food Addit Contam Part A Chem Anal Control Expo Risk Assess, 2023 Nov 27.
PMID: 38011619 DOI: 10.1080/19440049.2023.2283873

The presence of 3-monochloropropane-1,2 diol ester (3-MCPDE) and glycidyl ester (GE) in processed palm oils is of concern, as these oils are widely used for edible purposes. The mitigation method studied here optimizes the removal of chloride through water washing of crude palm oil (CPO), to limit the formation of 3-MCPDE. The contaminant removal obtained via washing CPO supports the quantitative findings. By utilizing 5% water in the washing step, water-soluble chlorides in CPO are removed by up to 76%, resulting in a 71% reduction of 3-MCPDE to within statutory limits. In this study, a linear correlation was developed between the chloride and the corresponding 3-MCPDE with a correlation coefficient (R2) of 0.99. Using the correlations, 1.0 mg/kg of 3-MCPDE in refined, bleached and deodorized palm oil (RBDPO) will be obtained from CPO with 1.2 mg/kg chloride with 7% wash water usage. The study also showed minor GE reduction between 7 and 11% was attained after water washing.
Fulltext Coronary artery aneurysm formation after paclitaxel-coated balloon-only intervention for de novo coronary chronic total occlusion

Jun EJ, Shin ES, Kim B, Teoh EV, Chu CM, Kim S, et al.

Front Cardiovasc Med, 2022;9:1039316.
PMID: 36684581 DOI: 10.3389/fcvm.2022.1039316

BACKGROUND: Although coronary artery aneurysm (CAA) is an uncommon complication of drug-coated balloon (DCB) treatment, the incidence and mechanisms CAA formation after DCB intervention for chronic total occlusion (CTO) remains to be clarified. The aim of this study was to investigate the incidence of CAA after DCB intervention for the treatment of CTO of coronary arteries.
MATERIALS AND METHODS: This was a retrospective analysis of 82 patients, contributing 88 vessels, who underwent successful DCB-only treatment for de novo CTO lesions. Follow-up angiography was performed in all cases, at a mean 208.5 (interquartile range [IQR]: 174.8 to 337.5) days after the index procedure.
RESULTS: CAA was identified in seven vessels, in seven patients, at the site of previous successful DCB-only treatment. Of these, six were fusiform in shape and one saccular, with a mean diameter of 4.2 ± 1.0 mm and length of 6.7 ± 2.6 mm. Six CAAs developed at the CTO inlet site, and all CAAs occurred at the lesions following dissection immediately after DCB treatment. CAAs were not associated with an increased risk of major clinical events over the median follow-up of 676.5 (IQR: 393.8 to 1,304.8) days.
CONCLUSION: The incidence of CAA after DCB-only treatment for CTO lesions was 8.0% in this study. Further research is warranted, using intravascular imaging, to clarify the mechanism of DCB-related CAA formation and prognosis.