INTRODUCTION

The existence of a coronary artery aneurysm (CAA) can pose significant risk for death. It can cause thrombosis, dissection, rupture or myocardial infarction. An exceedingly rare involvement of the left main coronary artery (LMCA), particularly giant-sized is even more catastrophic, a finding seen in only 0.1% of patients. Furthermore, co-existence with significant stenotic coronary artery disease (CAD) portends grim survival. Owing to the rarity of this combination, no data is available locally and only limited case reports are documented internationally. Hence, no consensus guidelines have been published yet. This paper aims to contribute to the sparse medical knowledge on the treatment approach and management of LMCA aneurysm with concomitant CAD.

A 62-year-old male, Filipino, hypertensive and hyperlipidemic sought consult due to one-year exertional chest pain. Coronary angiogram revealed the LMCA to be a diffusely aneurysmal, large-sized vessel measuring 9.7 mm x 7.9 mm with a significant two-vessel CAD affecting the proximal left anterior descending (LAD) and right coronary artery (RCA). As per multidisciplinary decision, the patient underwent surgical revascularization via cardiopulmonary bypass graft (CABG) addressing the CAD and LMCA aneurysm managed conservatively through guideline-directed medical therapy. The patient’s course of treatment was uneventful. He returned for follow-ups for three months post-surgery and remained symptom-free.

Giant coronary artery aneurysms (GCAA) are vessel dilatations that exceed 4x the diameter of a normal adjacent artery. The patient had a unique case of GCAA involving the LMCA combined with two-vessel CAD. Few studies have documented a medical or surgical approach and long-term outcomes are unknown. Without sufficient evidence-based guidelines, the multidisciplinary decision was to perform CABG and manage the LMCA aneurysm conservatively.

Due to extremely limited information available on the giant LMCA aneurysm natural history, definitive management remains controversial. A multidisciplinary team approach is highly recommended for patient-specific needs to achieve favorable outcome and ensure survival.

Objective: To evaluate the in vitro anti-diabetic effects of Bryonia dioica roots extracts, including water-acetone extracts and their ethyl acetate and butanol fractions, and chloroform-methanol extracts. Methods: The total phenolic, flavonoid, flavonol, and saponin contents in the Bryonia dioica root extracts (chloroform-methanol extracts, water-acetone extracts and their ethyl acetate and butanol fractions) were determined using colorimetric methods with Folin-Ciocalteu, aluminum trichloride, and vanillin reagents, respectively. The in vitro anti-diabetic activity was evaluated by measuring the half-maximal inhibitory concentration (IC50) values of these root extracts against α-amylase and α-glucosidase activities, evaluating their effects on α-amylase kinetics, quantifying the inhibition of bovine serum albumin (BSA) glycation using fluorometry to assess advanced glycation end products (AGE) production, and determining glucose uptake by isolated rat hemidiaphragm. Additionally, molecular docking analysis was conducted to investigate the binding affinity and interaction types between Bryonia dioica ligands (cucurbitacin B, bryogénin, vitexin, and isovitexin) and target enzymes, and a phytochemical-targets interaction network was constructed. Results: For α-amylase inhibition, ethyl acetate fraction demonstrated the most potent activity (IC50 = 145.95 µg/mL), followed by chloroform-methanol extract (IC50 = 300.86 µg/mL). Water-acetone root extracts and their ethyl acetate and butanol fractions inhibited the α-glucosidase activity with IC50 values ranging from 562.88 to 583.90 µg/mL. Both ethyl acetate and butanol fractions strongly inhibited non-enzymatic BSA glycation (IC50 = 318.26 and 323.12 µg/mL, respectively). The incubation of isolated rat hemidiaphragms with the ethyl acetate fraction (5 mg/mL) significantly increased glucose uptake (35.16%; P < 0.0001), exceeding the effects of insulin (29.27%), chloroform-methanol extract (24.07%), and catechin (15.27%). Molecular docking revealed that cucurbitacin B exhibited the strongest docking scores against α-amylase (– 16.4 kcal/mol), and α-glucosidase (– 14.2 kcal/mol). Compared with other ligands, isovitexin formed the maximum number of hydrogen bonds with the α-amylase active site residues (Asp300, Asp197, and Glu233), α-glucosidase residues (Ser13, Arg44, Met86, Gly10, Asp39, and Tyr131) and other residues (Arg195, Trp59, His299, and Tyr62). Network analysis identified 36 overlapping targets between Bryonia dioica phytochemicals and type 2 diabetes mellitus-associated genes, with cucurbitacins and polyphenols interacting with α-amylase, α-glucosidase, and Glut4 translocation pathway targets. Conclusion Bryonia dioica root extracts demonstrated promising in vitro anti-diabetic activity through multiple mechanisms, including the inhibitory effect on digestive enzymes, protein antiglycation potential, and enhancement of glucose uptake, suggesting their potential as a source for anti-diabetic drugs development.

Objective: One key factor found to be related to creativity is creative self-efficacy. Creative self efficacy (CSE) refers to one’s own conviction in their own ability to produce creative work effectively. The study aims to explore on the predictive values of time management and reading habit on CSE, as well as on the significant difference between gender and CSE. Method: This study (n = 313) is a cross-sectional survey design. The inclusion criteria for the participants are full-time university students studying in Malaysia and aged between 18-25 years old. Data collected was analysed by linear regression, multiple linear regression and independent sample t-Test. Results: Reading habit is a significant positive predictor of CSE. Both daily planning and confidence in long-range planning in time management are significant positive predictors of CSE. However, there is no significant difference between gender in terms of male and female and CSE. Conclusion This study provided evidence on the role of reading habits and time management on creative self-efficacy amongst undergraduate student in Malaysia.
Gender Identity ; Time Management

This review aimed to assess the usefulness of various magnetic resonance imaging (MRI) techniques for the quantification of neonatal white matter myelination. The Scopus, PubMed, and Web of Science databases were searched to identify studies following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement using quantitative MRI techniques to examine samples collected from neonates to quantify myelin. Twelve studies were ultimately included. The results demonstrated that in validation studies, relaxometry is the most frequently explored approach (83.33%), followed by magnetization transfer imaging (8.33%) and a new automatic segmentation technique (8.33%). Synthetic MRI is recommended for quantifying myelin in neonates because of several advantages that outweigh a few negligible limitations.

This review aimed to assess the usefulness of various magnetic resonance imaging (MRI) techniques for the quantification of neonatal white matter myelination. The Scopus, PubMed, and Web of Science databases were searched to identify studies following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement using quantitative MRI techniques to examine samples collected from neonates to quantify myelin. Twelve studies were ultimately included. The results demonstrated that in validation studies, relaxometry is the most frequently explored approach (83.33%), followed by magnetization transfer imaging (8.33%) and a new automatic segmentation technique (8.33%). Synthetic MRI is recommended for quantifying myelin in neonates because of several advantages that outweigh a few negligible limitations.

This review aimed to assess the usefulness of various magnetic resonance imaging (MRI) techniques for the quantification of neonatal white matter myelination. The Scopus, PubMed, and Web of Science databases were searched to identify studies following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement using quantitative MRI techniques to examine samples collected from neonates to quantify myelin. Twelve studies were ultimately included. The results demonstrated that in validation studies, relaxometry is the most frequently explored approach (83.33%), followed by magnetization transfer imaging (8.33%) and a new automatic segmentation technique (8.33%). Synthetic MRI is recommended for quantifying myelin in neonates because of several advantages that outweigh a few negligible limitations.

This review aimed to assess the usefulness of various magnetic resonance imaging (MRI) techniques for the quantification of neonatal white matter myelination. The Scopus, PubMed, and Web of Science databases were searched to identify studies following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement using quantitative MRI techniques to examine samples collected from neonates to quantify myelin. Twelve studies were ultimately included. The results demonstrated that in validation studies, relaxometry is the most frequently explored approach (83.33%), followed by magnetization transfer imaging (8.33%) and a new automatic segmentation technique (8.33%). Synthetic MRI is recommended for quantifying myelin in neonates because of several advantages that outweigh a few negligible limitations.

Purpose: Allgrove syndrome, also known as “triple A” syndrome, is characterized by adrenal insufficiency, achalasia, and alacrimia. When neurological signs are also present, the condition is referred to as “4 A” syndrome. Methods: We conducted a retrospective analysis of three patients with 4 A syndrome confirmed genetically. A complete neurological exam was carried out by an experimented neurologist. Results: Herein, we describe the neurological characteristics often associated with this condition, through the clinical and electrophysiological analysis of three patients. All patients exhibited a mutation in AAAS, the gene coding for ALADIN. While these individuals presented with the classic features of triple-A syndrome, neurological symptoms were not prominent. Conclusion The neurological manifestations of Allgrove syndrome have historically been overlooked and inadequately explored. Due to the condition’s rarity and substantial phenotypic heterogeneity, only recently have a variety of symptoms been recognized and described.

The breast is an unusual site for metastases, accounting for less than 2% of malignant breast lesions but include those from malignant melanomas, carcinomas, sarcomas, and lymphomas from various organs. We diagnosed a very rare case of metastatic choroidal melanoma for a 67-year-old female who presented with a right breast lump and who had been previously diagnosed with choroidal melanoma-monosomy 3 in 2017. To the best of our knowledge, only five such cases have been published so far, with one in a male patient.