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Bioactivities and green advanced extraction technologies of ginger oleoresin extracts: A review

Kamaruddin MSH, Chong GH, Mohd Daud N, Putra NR, Md Salleh L, Suleiman N

Food Res Int, 2023 Feb;164:112283.
PMID: 36737895 DOI: 10.1016/j.foodres.2022.112283

Zingiber officinale Roscoe is an excellent source of bioactive compounds, mainly gingerols and shogaols compounds, that associated with various bioactivities including antioxidant, anticancer, anti-inflammatory, antimicrobial, and antibiofilm. Zingiber officinale Roscoe found its application in the food, pharmaceutical, and cosmeceutical industries. The demand for a high quality of ginger oleoresin extracts based on the contents of gingerols and shogaols compounds for a health-benefit has dramatically increased. Various extraction techniques, including the conventional and advanced extraction techniques for gingerols and shogaols have been reported based on the literature data from 2012 to 2022. The present review examines the functional composition and bioactivities of Zingiber officinale Roscoe and the advanced green extraction technologies. Some variations in the quantity and quality of gingerols and shogaols compounds are because of the extraction method employed. This review provides a depth discussion of the various green advanced extraction technologies and the influences of process variables on the performance of the extraction process. Lower temperature with a short exposure time such as ultrasound-assisted and enzyme-assisted extraction, will lead to high quality of extracts with high content of 6-gingerol. High thermal processing, such as microwave-assisted and pressurized liquid extraction, will produce higher 6-shogaol. Meanwhile, supercritical fluid extraction promotes high quality and the safety of extracts by using non-toxic CO2. In addition, challenges and future prospects of the extraction of ginger oleoresin have been identified and discussed. The emerging green extraction methods and technologies show promising results with less energy input and higher quality extracts than conventional extraction methods.
Fulltext Comparison of clinical and laboratory characteristics between severe and non-severe dengue in paediatrics

Idrus NL, Md Jamal S, Abu Bakar A, Embong H, Ahmad NS

PLoS Negl Trop Dis, 2023 Dec;17(12):e0011839.
PMID: 38113250 DOI: 10.1371/journal.pntd.0011839

BACKGROUND: The timely identification of severe dengue in peadiatric patients is of utmost importance, as any delay in diagnosis could lead to an irreversible state of shock potentially leading to fatal consequences. The primary aim of our study was to characterize dengue severity in paediatric patients based on initial symptoms, signs, and laboratory investigation of their presentation in the emergency department.
METHODOLOGY: We conducted a retrospective data retrieval from the medical records of 254 paediatric patients who had been diagnosed with confirmed cases of dengue fever. The clinical characteristics were compared between severe and non-severe dengue. Multiple logistic regression analysis was utilised to elucidate the variables that exhibited associations with severe dengue.
RESULTS: A total of 254 paediatric patients were included, among whom 15.4% (n = 39) were diagnosed with severe dengue. Multiple logistic regression analysis identified lethargy, systolic blood pressure (SBP) below 90 mmHg, capillary refilled time (CRT) longer than 2 seconds, ascites, and hepatomegaly were independently associated with severe dengue.
CONCLUSION: In paediatric patients, severe dengue is associated with specific clinical indicators, including lethargy, low systolic blood pressure, prolonged capillary refill time (CRT), and the presence of ascites and hepatomegaly. Identifying these clinical features early is crucial for primary care physicians, as it enables accurate diagnosis and timely intervention to manage severe dengue effectively.
Functional polysaccharides of fucoidan, laminaran and alginate from Malaysian brown seaweeds (Sargassum polycystum, Turbinaria ornata and Padina boryana)

Mohd Fauziee NA, Chang LS, Wan Mustapha WA, Md Nor AR, Lim SJ

Int J Biol Macromol, 2021 Jan 15;167:1135-1145.
PMID: 33188815 DOI: 10.1016/j.ijbiomac.2020.11.067

Brown seaweeds are rich source of functional polysaccharides that exhibit various bioactivities. However, Malaysian seaweeds are under-utilised, leading to low revenue throughout the supply chain of the seaweed industry. The aims of this study were to extract the functional polysaccharides, namely fucoidan (F), laminaran (L) and alginate (A) from Malaysian brown seaweeds (Sargassum polycystum, Turbinaria ornata and Padina boryana) and subsequently evaluate the properties of the extracted polysaccharides. P. boryana recorded the significantly (p ≤ 0.05) highest carbohydrate content (74.78 ± 1.63%) with highest fucoidan yield (Fpad = 1.59 ± 0.16%) while T. ornata contained significantly (p ≤ 0.05) highest alginate yield (Atur = 105.19 ± 3.45%). Water activities of these extracted polysaccharides varied from 0.63-0.71 with average score of browning indexes (~40). Fourier transform infrared (FTIR) spectroscopy analysis demonstrated that the extracted polysaccharides exhibited similar spectral pattern of spectra with the respective standards. Meanwhile, laminaran extracts showed the significantly highest (p ≤ 0.05) total phenolic contents (Lsar = 43.29 ± 0.43 mgGAE/g) and superoxide anion scavenging activity (Lsig = 21.7 ± 3.6%). On the other hand, the significantly highest (p ≤ 0.05) DPPH scavenging activity was recorded in alginate with Asar at 85.3 ± 0.8%. These findings reported the properties and bioactivities of natural polysaccharides from Malaysian brown seaweeds that revealed the potential to develop high-value functional ingredients from Malaysian brown seaweeds.
Anxiety Status and its Relationship with General Health Related Quality of Life among Prostate Cancer Patients in Two University Hospitals in Kuala Lumpur, Malaysia

Isa MR, Moy FM, Abdul Razack AH, Md Zainuddin Z, Zainal NZ

Iran J Public Health, 2013;42(3):240-8.
PMID: 23641401

This study aimed to determine the prevalence of anxiety among prostate cancer patients, and to ascertain the association between stress status, socio-demographic, medical and surgical illness, current urinary problem and cancer status with general health-related quality of life (HRQOL) among these patients.
Association between physiological responses and heat shock protein 70 (HSP70) expressions in the vulnerable populations of Kuala Lumpur

Muhamad SN, Lim FL, Md Akim A, Karuppiah K, Mohd Shabri NSA, How V

Int J Environ Health Res, 2024 Apr 14.
PMID: 38616509 DOI: 10.1080/09603123.2024.2340125

Continued heat exposure can cause physiological and cellular responses. This study investigated the association between physiological responses and heat shock protein 70 (HSP70) expressions in Kuala Lumpur's urban vulnerable population. We conducted a cross-sectional study involving 54 participants from four areas classified as experiencing moderate to strong heat stress. Physiological measurements included core body temperature, heart rate, and diastolic and systolic blood pressure. RT-qPCR and ELISA were also performed on blood samples to assess HSP70 gene and protein expressions. Despite indoor heat stress, participants maintained normal physiological parameters while there were significant indications of HSP70 expression at both the gene and protein levels. However, our study found no significant correlation (p > 0.05) between physiological responses and HSP70 expressions. This study shows no interaction between physiological responses and HSP70 expressions in the study population, revealing the complex mechanisms of indoor heat stress in vulnerable individuals.
Family study of haemoglobin Arya in a Malaysian family

Nahanthiran S, Nik Mustapha NH, Yasin N, Idris FB, Md Noor SB

Malays J Pathol, 2024 Aug;46(2):315-320.
PMID: 39207009

INTRODUCTION: Thalassemia and haemoglobinopathies are relatively common among Malaysians. One of the rare haemoglobinopathies reported is Haemoglobin (Hb) Arya, which occurs due to substitution of aspartic acid at residue 47 of the alpha chain by asparagine. Here, we report the detection of Hb Arya in a Malaysian family, which was detected incidentally during family screening.
CASE REPORT: A 16 years-old girl, clinically asymptomatic was noted to have low mean corpuscular haemoglobin (MCV) with normal Hb level. Hb analysis using capillary electrophoresis (CE) showed reduced Hb A of 76.5%, Hb A2 of 1.6% with presence of small peak at Zone 1 likely A2'. There was also a small peak noted at Hb D zone and Hb S zones which quantified as 1.5% and 20% respectively. Supplementary test by high performance liquid chromatography (HPLC) showed a prominent peak at D-window (19.6%) and a small peak at S-window (0.6%). DNA analysis revealed a heterozygous state of α2 codon 47 Hb Arya mutation. Subsequent family study showed a similar mutation in the father and sister of the index case.
CONCLUSION: Very few reports are available up to date regarding Hb Arya. This report highlights the rare haemoglobinopathy in a Malay family in Malaysia that contributes to the growing literature of this rare haemoglobin variant.
Synergistic effect of Hylocereus polyrhizus (dragon fruit) peel on physicomechanical, thermal, and biodegradation properties of thermoplastic sago starch/agar composites

Taharuddin NH, Jumaidin R, Mansor MR, Hazrati KZ, Hafila KZ, Md Yusof FA

Int J Biol Macromol, 2024 Oct;277(Pt 1):133852.
PMID: 39025171 DOI: 10.1016/j.ijbiomac.2024.133852

The potential of Hylocereus polyrhizus peel (HPP) as a new eco-friendly reinforcement for thermoplastic sago starch/agar composite (TPSS/agar) was investigated. The integration of HPP into TPSS/agar composite aimed to enhance its mechanical and thermal characteristics. The study employed Fourier transform-infrared spectroscopy (FT-IR), Scanning electron microscopy (SEM), Thermogravimetric analysis (TGA), and Differential Scanning Calorimetry (DSC), as well as mechanical, physical properties and soil burial testing to analyse the composites. The results showed a favourable miscibility between the matrix and filler, while at higher concentrations of HPP, the starch granules became more visible. The tensile and impact properties of the composites improved significantly after incorporating HPP at 20 wt%, with values of 12.73 MPa and 1.87 kJ/m2, respectively. The glass transition temperature (Tg) and initial decomposition temperature (Ton) decreased with the addition of HPP. The density of the composites reduced from 1.51 ± 0.01 to 1.26 ± 0.01 g/cm3 as the HPP amount increased. The environmental properties indicated that the composites can be composted, with weight loss accelerating from 35 to 60 % and 61 to 91 % by the addition of HPP in 2- and 4-weeks' time, respectively. The study demonstrates the potential of TPSS/agar/HPP composites as eco-friendly materials for various applications.
Synergistic Effect of Allium-like Ni9S8 & Cu7S4 Electrodeposited on Nickel Foam for Enhanced Water Splitting Activity

Mottakin M, Selvanathan V, Ariful Islam M, Almohamadi H, Alharthi NH, Yoshimura S, et al.

Chem Asian J, 2024 Aug 19;19(16):e202300532.
PMID: 37544903 DOI: 10.1002/asia.202300532

This study explores a water-splitting activity using a biphasic electrodeposited electrode on nickel foam (NF). The *Ni9S8/Cu7S4/NF electrode with citric acid reduction exhibits superior OER (oxygen evolution reaction) and HER (hydrogen evolution reaction) performance with reduced overpotential and a steeper Tafel slope. The *Ni9S8/Cu7S4/NF electrode displays the ultra-low overpotential value of 212 mV for OER and 109 mV for HER at the current density of 10 mA cm-2. The Tafel slope of 25.4 mV dec-1 for OER and 108 mV dec-1 for HER was found from that electrode. The maximum electrochemical surface area (ECSA), lowest series resistance and lowest charge transfer resistance are found in citric acid reduced electrode, showing increased electrical conductivity and quick charge transfer kinetics. Remarkably, the *Ni9S8/Cu7S4/NF electrode demonstrated excellent stability for 80 hours in pure water splitting and 20 hours in seawater splitting. The synergistic effect of using bimetallic (Cu&Ni) sulfide and enhanced electrical conductivity of the electrode are caused by reduction of metal sulfide into metallic species resulting in improved water splitting performance.
Trends in Vaccination Refusal in Children Under 2 Years of Age in Kedah, Malaysia: A 4-Year Review From 2013 to 2016

Chan HK, Soelar SA, Md Ali SM, Ahmad F, Abu Hassan MR

Asia Pac J Public Health, 2018 03;30(2):137-146.
PMID: 29292654 DOI: 10.1177/1010539517751312

The current study examined how the trends in childhood vaccination refusal in Kedah, Malaysia, changed over a 4-year period (2013-2016). Data contributed by 60 public health centers were used to determine the annual incidence rates (per 1000 newborns) of vaccination refusal, and to identify the reasons for refusal among the mothers. The trend analysis revealed a 2.2-times increment in the incidence rates of vaccination refusal from 4.72 in 2013 to 10.51 in 2015, followed by a 52.2% reduction to 5.02 in 2016 ( P = .046). Besides, the proportion of mothers who refused vaccination because of religious belief reduced from 78% between 2013 and 2015 to 67.1% in 2016 ( P = .005). Overall, the finding confirms the positive impact of the educational and religious interventions introduced by the State Health Department of Kedah since January 2016; nonetheless, efforts to strengthen the existing strategies and thereby to maximize the vaccination coverage in Kedah are warranted.
Fulltext Phytol and bilimbi phytocompounds induce thermogenic adipocyte differentiation: An in vitro study on potential anti-obesity effects

Md Fauzi F, Hamzah MF, Mahmud MZ, Amanah A, Mohd Noor MH, Zainuddin Z, et al.

Heliyon, 2024 Dec 15;10(23):e40518.
PMID: 39698098 DOI: 10.1016/j.heliyon.2024.e40518

Obesity is a major health concern associated to diabetes, cardiovascular disease, and cancer. Brown adipocytes, which specialise in thermogenesis, offer a potential therapeutic target for obesity prevention and related conditions. This study builds on previous findings of the browning activity of Averrhoa bilimbi hexane fractions and aims to elucidate the underlying mechanisms in vitro. Squalene and phytol, key phytocompounds from bilimbi leaf extract and fractions, were assessed for their ability to induce thermogenic adipocyte using 3T3-L1 preadipocytes and C2C12 myoblasts in vitro models. The result shows that bilimbi fractions F7, F8, and F9, along with squalene and phytol, effectively induced thermogenic adipocyte differentiation. This was evidenced by the upregulation of key markers, including Ucp1, Prdm16, and Pgc1α, and increased expression of the brown adipocyte-specific protein CIDEA in treated 3T3-L1 preadipocytes. Notably, all treatments promoted thermogenic adipocytes differentiation in C2C12 myoblasts via the upregulation of Pgc1α, Ucp1 genes, and UCP1 protein. These findings suggest that bilimbi fractions and its phytocompounds may hold potential as nutraceutical interventions for obesity management.
Incidental finding of intravascular large B cell lymphoma in a multinodular goiter

Sahmah NAA, Ling KMY, Abdullah Suhaimi SN, Md Pauzi SH, Wong YP, Tan GC

Malays J Pathol, 2024 Dec;46(3):463-464.
PMID: 39731496

No abstract available.
Fulltext Familial adenomatous polyposis-associated papillary thyroid cancer

Abdullah Suhaimi SN, Nazri N, Nani Harlina ML, Md Isa N, Muhammad R

Malays J Med Sci, 2015 Jul-Aug;22(4):69-72.
PMID: 26715910 MyJurnal

Papillary thyroid carcinoma (PTC) associated with familial adenomatous polyposis (FAP) is rare. It is usually associated with the cribriform-morular variant of PTC, with unusual patterns on detailed histology examination. This variant is known to have a good prognosis. Papillary thyroid carcinoma associated with FAP commonly occurs in females in their 30s and rarely in the elderly. We report a case of a 69-year-old female presenting with thyroid swelling and a history of FAP.
Fulltext Correlations between subdural empyema and paraclinical as well as clinical parameters amongst urban malay paediatric patients

Nayan SA, Abdullah MS, Naing NN, Haspani MS, Md Ralib AR

Malays J Med Sci, 2008 Oct;15(4):19-27.
PMID: 22589634 MyJurnal

Paediatric subdural empyema is frequently seen in developing Asean countries secondary to rinosinusogenic origins. A cross-sectional analysis on the surgical treatment of intracranial subdural empyema in Hospital Kuala Lumpur (HKL), a major referral center, was done in 2004. A total number of 44 children who fulfilled the inclusion criteria were included into this study. The methods of first surgery, volume of empyema on contrasted CT brain, improvement of neurological status, re-surgery, mortality and morbidity, as well as the demographic data such as age, gender, sex, duration of illness, clinical presentation, probable origin of empyema, cultures and follow-up were studied. Chi-square test was performed to determine the association between surgical methods and the survival of the patients, neurological improvement, clearance of empyema on CT brain, re-surgery and long morbidity among the survivors. If the 20% or more of the cells were having expected frequency less than five, then Fisher's Exact test was applied. The level of significance was set at 0.05. SPSS version 12.0 was used for data entry and data analysis. There were 44 patients who were less than 18 years. Their mean age was 5.90 ± 6.01 years. There were 30 males (68.2%) and 14 females (31.8%) involved in the study. Malays were majority with 28 (63.6%) followed by Indian 8 (18.2%), Chinese 5 (11.4%) and others 3 (6.8%). The variables which were under interest were gender, race, headache, vomiting, seizures, sign of meningism, cranial nerve palsy, thickness site of abscess, first surgical treatment, improvement in neurological deficit, clearance of CT and whether re-surgery was necessary. All variables were found not to be associated with Henk W Mauser Score for PISDE grading. Comparison between this urban study and a rural setting study by the same corresponding author in the same period on subdural empyema was done. Common parameters were compared and it was found out that seizures were more prevalent in urban study where the patients are more than one year old (p=0.005). Mortality was much higher in urban study than the rural one (p=0.040). The larger proportion of urban group had volume of abscess less than or equal to 50 ml (p=< 0.001).
Fulltext Granulomatosis With Polyangiitis in a Young Lady: Challenges in Achieving Remission

Mohammad NI, Gunaseelan S, Kuganasan S, Mat Saad N, Md Din N

Cureus, 2024 Dec;16(12):e75139.
PMID: 39759718 DOI: 10.7759/cureus.75139

Granulomatosis with polyangiitis (GPA) is a subtype of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) that commonly requires aggressive immunosuppression to achieve remission. We present a case of a young Malay lady with recurrent episodes of ANCA-positive nodular anterior scleritis who responded poorly to topical and systemic corticosteroids and relapsed while on methotrexate. A year later, she had epistaxis, and a sino-nasal biopsy confirmed granulomatous vasculitis. While receiving cyclophosphamide, she developed proptosis with optic neuropathy, which resolved with intravenous methylprednisolone. She eventually required rituximab as she was still having relapses on other immunosuppressants. Adequate and targeted treatment with immunomodulators is crucial to achieving disease remission in GPA.
The Effect of Surgical Intervention of Endometriosis to CA-125 and Pain

Abdul Karim AK, Abd Aziz NH, Md Zin RR, Mohd Mokhtar N, Shafiee MN

Malays J Med Sci, 2020 Dec;27(6):7-14.
PMID: 33447130 DOI: 10.21315/mjms2020.27.6.2

Endometriosis is an inflammatory condition characterised by the presence of endometrial growth beyond the uterine cavity. It is a debilitating disease requiring multiple modalities of treatment. In considering surgery as the option of treatment, the benefits should outweigh the risk. Besides direct surgical risk, intervention may lead to a reduction of ovarian reserve, in addition to premature menopause and low fecundity. To date, there is an inconclusive evidence to support any specific parameters in monitoring disease progression following surgical intervention. Serum cancer antigen (CA)-125 is expressed by coelomic epithelium and has been extensively studied as a biomarker for endometriosis. Elevated expression of CA-125 has been shown in endometrial tissues and the marker increased indirectly from peritoneal irritation that accompanies an extensive form of endometriosis. Additionally, the visual analogue scale (VAS) scores have been used as an objective measurement for measuring pain, especially in a complex disease such as endometriosis. This review aims to consolidate a series of clinical trials that utilised CA-125 level and VAS score as tools for monitoring patients undergoing surgery for endometriosis.
Fulltext Lymphocytic mastitis mimicking breast carcinoma, radiology and pathology correlation: review of two cases

Alhabshi SM, Rahmat K, Westerhout CJ, Md Latar NH, Chandran PA, Aziz S

Malays J Med Sci, 2013 May;20(3):83-7.
PMID: 23966831 MyJurnal

Lymphocytic mastitis, or diabetic mastopathy, is an unusual finding in early-onset and long-standing diabetes. It can presents as a non-tender or tender palpable breast mass. Mammogram and ultrasound frequently demonstrate findings suspicious of malignancy, thus biopsy and histological confirmation is usually required. We reviewed two cases of lymphocytic mastitis with characteristics findings on mammogram, ultrasound, and histopathology. Diagnoses were confirmed with excision biopsy.
Fulltext Navigating Diagnostic Complexities and Treatment Strategies of Moyamoya Syndrome: A Case Report

Kwan LL, Abdul Rashid AM, Md Noh MSF, Hoo FK, Inche Mat LN

Cureus, 2024 Nov;16(11):e73242.
PMID: 39650868 DOI: 10.7759/cureus.73242

Moyamoya syndrome (MMS) is characterized by progressive narrowing of intracranial arteries and the development of collateral vessel networks, often presenting with recurrent ischemic or hemorrhagic strokes. MMS poses significant challenges in diagnosis due to its overlapping symptoms with other cerebrovascular conditions. Treatment aims to improve cerebral blood flow, reduce symptom frequency, and prevent future strokes. Management requires a multidisciplinary approach, including medical optimization and potential surgical intervention. This case report discusses a 37-year-old woman with poorly controlled type 2 diabetes and hyperlipidemia who experienced multiple strokes before being diagnosed with MMS. Initial symptoms included intermittent headaches, hemiparesis, and slurred speech. The presence of underlying metabolic conditions led to an initial assumption of atherosclerosis as the primary cause of her strokes. This case underscores the diagnostic challenge of distinguishing MMS from more common vascular conditions, highlighting the need for careful evaluation when typical risk factors like atherosclerosis do not fully explain recurrent cerebrovascular events.
A pilot study of reference vibrotactile perception thresholds on the fingertip obtained with Malaysian healthy people using ISO 13091-1 equipment

Daud R, Maeda S, Kameel NN, Ripin MY, Bakrun N, Md Zein R, et al.

Ind Health, 2004 Apr;42(2):189-95.
PMID: 15128168

The purpose of this paper is to clarify the reference vibrotactile perception thresholds (VPT) for healthy people in Malaysia. The measurement equipment standard, ISO 13091-1, of the vibrotactile perception thresholds for the assessment of nerve dysfunction and the analysis and interpretation of measurements at the fingertips standard, ISO 13091-2, were published in ISO/TC108/SC4/WG8 on 2001 and 2003 individually. In the ISO 13091-2 standard, the reference VPT data were obtained from few research papers. Malaysian people's VPT data don't include to this standard. In Malaysia, when the VPT is using to diagnose of the hand-arm vibration syndrome, the reference VPT data need to compare with the worker's ones. But, Malaysia does not have the reference VPT data yet. So, in this paper, the VPT was measured by using ISO 13091-1 standard equipment to obtain the reference data for Malaysian people. And these data were compared with the ISO reference data on the ISO 13091-2 standard. From the comparison of these data, it was clear that the Malaysian healthy people's VPT data were consistent with the reference data of the ISO 13091-2 standard.
Mapping the Malaysian Smoking Cessation Clinics: A Geographic Information System-Based Study

Md Bohari NF, Sabri NF, Wan Rasdi WND, Mohd Radzi NA, Bakri NN

Asia Pac J Public Health, 2020 12 24;33(2-3):227-233.
PMID: 33356376 DOI: 10.1177/1010539520982718

Although geographic information system-based studies are particularly increasing in other sectors, few have embraced their full potential in health services allocation in Malaysia. This study aimed to produce a visual map on the distribution of smoking cessation clinics (SCCs) in Malaysia and analyze its pattern against the national population of smokers. SCC addresses were obtained from the government website and mapped using geographic information system tools. A total of 199 and 449 private and public SCCs was mapped throughout the country, respectively. The lowest SCC to smoker population ratio was in the state of Negeri Sembilan with 1:3000. The highest SCC to smoker population ratio was in Sabah with 1 SCC for 15 000 smokers. Almost 70% of SCCs were primary health clinics. Smoking cessation clinics were distributed throughout all the states in Malaysia except the state of Sabah.
Complex Indirect Carotid-Cavernous Fistula With Contralateral Ophthalmic Manifestations

Mohammad Razali A, Sobri MJ, Fuad MKA, Abdul Rashid AM, Md Noh MSF

Cureus, 2024 Nov;16(11):e73670.
PMID: 39677153 DOI: 10.7759/cureus.73670

A carotid-cavernous fistula (CCF) involves an abnormal communication between the carotid artery and the cavernous sinus. For indirect CCF, it usually occurs in post-menopausal women. Contralateral symptoms for indirect CCF are rare. We report a 79-year-old lady with underlying hypertension and dyslipidemia, who had a complex indirect CCF from the right internal and right external carotid artery, draining into the left ophthalmic vein and giving rise to left ocular manifestation. Endovascular embolization was attempted but was unsuccessful. The patient subsequently developed a stroke one day post-procedure, with a favorable recovery of function.

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