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Abstract Background Emotional Intelligence is a noteworthy concept in the academic environment due to its theoretical significance and practical implications. The objectives of this research were to investigate (1) the correlation between academic stress, attitudes toward seeking professional psychological help and emotional intelligence, and (2) the mediating role of emotional intelligence. Methods An online questionnaire was administered to a convenience sample of 908 Vietnamese secondary school students. Three scales were employed to gather demographic variables and self-reported data, including The Wong and Law Emotional Intelligence Scale, The Educational Stress Scale for Adolescents, and Attitudes Toward Seeking Professional Psychological Help. Results The findings indicated substantial differences across many variables, such as gender, grade, and academic performance ranking. The investigation identified significant relationships, including the emotional intelligence of others’ emotion appraisal positively affects self-expectation, while self-emotion appraisal negatively influences self-expectation. The use of emotion was positively associated with the openness to seeking professional help. Moderation analyses revealed age moderating others’ emotion appraisal and despondency, self-emotion appraisal, and openness to seeking professional help. Conclusion Emotional intelligence exerts a substantial influence on both academic stress levels and attitudes toward seeking professional psychological assistance. The results are analysed using the guidelines for conducting mixed-methods research. Workshops and awareness sessions for educators and students on emotional intelligence can be conducted with the cooperation of all parties concerned because of the endorsement of all stakeholders.

Abstract The pathophysiology of amnestic Mild Cognitive Impairment (aMCI) is largely unknown, although some papers found signs of immune activation. To assess the cytokine network in aMCI after excluding patients with major depression (MDD) and to examine the immune profiles of quantitative aMCI (qMCI) and distress symptoms of old age (DSOA) scores. A case-control study was conducted on 61 Thai aMCI participants and 60 healthy old adults (both without MDD). The Bio-Plex Pro human cytokine 27-plex test kit was used to assay cytokines/chemokines/growth factors in fasting plasma samples. aMCI is characterized by a significant immunosuppression, and reductions in T helper 1 (Th)1 and T cell growth profiles, the immune-inflammatory responses system, interleukin (IL)1β, IL6, IL7, IL12p70, IL13, GM-CSF, and MCP-1. These 7 cytokines/chemokines exhibit neuroprotective effects at physiologic concentrations. In multivariate analyses, three neurotoxic chemokines, CCL11, CCL5, and CXCL8, emerged as significant predictors of aMCI. Logistic regression showed that aMCI was best predicted by combining IL7, IL1β, MCP-1, years of education (all inversely associated) and CCL5 (positively associated). We found that 38.2% of the variance in the qMCI score was explained by IL7, IL1β, MCP-1, IL13, years of education (inversely associated) and CCL5 (positively associated). The DSOA was not associated with any immune data. An imbalance between lowered levels of neuroprotective cytokines and chemokines, and relative increases in neurotoxic chemokines are key factors in aMCI. Future MCI research should always control for the confounding effects of affective symptoms.

Gallayaporn Nantachai,1– 3,* Michael Maes,1,2,4– 10,* Vinh-Long Tran-Chi,2,4 Solaphat Hemrungrojn,2,7 Chavit Tunvirachaisakul1,2,4,8 1Ph.D. Programme in Mental Health, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 2Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 3Somdet Phra Sungharaj Nyanasumvara Geriatric Hospital, Department of Medical Services, Ministry of Public Health, Chon Buri Province, Thailand; 4Ph.D. Programme in Clinical Sciences, School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 5Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China; 6Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, People’s Republic of China; 7Cognitive Fitness and Biopsychiatry Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 8Center of Excellence in Cognitive Impairment and Dementia, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 9Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria; 10Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria*These authors contributed equally to this workCorrespondence: Michael Maes; Chavit Tunvirachaisakul, Email dr.michaelmaes@hotmail.com; Chavit.T@chula.ac.thBackground: Two distinct symptom dimensions were identified in older adults who did not have major depressive disorder (MDD): a) a dimension associated with mild cognitive dysfunction, and b) a dimension related to distress symptoms of old age (DSOA). It is uncertain whether previous findings regarding the features of amnestic mild cognitive impairment (aMCI) remain valid when patients with MDD are excluded.Methods: To examine the neurocognitive features of aMCI (n = 61) versus controls (n=59) and the objective cognitive characteristics of DSOA in participants without MDD. Neurocognition was evaluated utilizing the Cambridge Neurological Test Automated Battery (CANTAB) and memory tests.Results: This research demonstrated that CANTAB tests may differentiate between aMCI and controls. The One Touch Stockings of Cambridge, probability solved on first choice (OTS_PSFC), Rapid Visual Information Processing, A prime (RVP_ A´), and the Motor Screening Task, mean latency, were identified as the significant discriminatory CANTAB tests. 37.6% of the variance in the severity of aMCI was predicted by OTS_PSFC, RVP_ A´, word list recognition scores, and education years. Psychosocial stressors (adverse childhood experiences, negative life events), subjective feelings of cognitive impairment, and RVP, the probability of false alarm, account for 40.0% of the DSOA score.Discussion: When MDD is ruled out, aMCI is linked to deficits in attention, executive functions, and memory. Psychosocial stressors did not have a statistically significant impact on aMCI or its severity. Enhanced false alarm response bias coupled with heightened psychological stress (including subjective perceptions of cognitive decline) may contribute to an increase in DSOA among older adults.Keyswords: depression, mild cognitive impairment, adverse childhood experiences, stress, anxiety

Ehretia asperula Zoll. & Moritzi was a common medicinal herb found in several Asian nations. This herb was found in many provinces in northern Vietnam, especially Hoa Binh province. Leaves of E. asperula cultivated in Tay Ninh Province were used to isolate compounds and evaluate their potential as antioxidants by five methods, including TAC, RP, FRAP, DPPH, and ABTS•+. Seven compounds were isolated and elucidated from the ethyl acetate fraction, including kaempferol (1), astragalin (2), nicotiflorin (3), rutin (4), caffeic acid (5), (-)-loliolide (6), and daucosterol (7), where compounds 1, 4, 6, and 7 were found from this species for the first time. All isolated compounds from E. asperula leaves exhibited antioxidant activity, consisting of 5.70 ± 0.01 to 299.13 ± 10.19 μg/mL for EC50 values. Especially compound 5 had a very strong antioxidant effect based on five methods TAC (EC50 = 8.43 ± 0.15 μg/mL), RP (EC50 = 6.79 ± 003 μg/mL), FRAP (EC50 = 12.72 ± 006 μg/mL), DPPH (EC50 = 5.57 ± 0.02 µg/mL), and ABTS•+ (EC50 = 5.70 ± 0.01 μg/mL). From our results, Tay Ninh Province's E. asperula leaves are abundant in naturally occurring antioxidants, indicating their potential use as therapeutic materials.

Van-Son Huynh,1,&ast; Gia-Phuoc Tran-Thien,1 Tri-Bao Nguyen,1,&ast; Xuan Thanh Kieu Nguyen,2 Vu Hoang Anh Nguyen,3 Vinh-Long Tran-Chi1 1Faculty of Psychology, Ho Chi Minh City University of Education, Ho Chi Minh City, 700000, Vietnam; 2Faculty of Social Sciences and Public Relations, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, 700000, Vietnam; 3Department of Psychosomatic Medicine, Thu Duc City Hospital, Ho Chi Minh City, 700000, Vietnam&ast;These authors contributed equally to this workCorrespondence: Tri-Bao Nguyen; Gia-Phuoc Tran-Thien, Faculty of Psychology, Ho Chi Minh City University of Education, Ho Chi Minh City, 700000, Vietnam, Email tribao061102@gmail.com; tranthiengiaphuoc@gmail.comIntroduction: The recognition of religion’s significance in mental health has led to several scientific advances in diagnosis or treatment. In contrast, Vietnam is a multi-religious Southeast Asian country with a large number of believers, but there is almost no research addressing the impact of religiosity among Vietnamese believers on mental health concerns such as depression, happiness, and gratitude.Participants and Methods: Our cross-sectional study was focused on Vietnamese believers (N = 374), surveyed directly at different religious facilities in Vietnam. The present study was evaluated utilizing the partial least squares-structural equation modeling (PLS-SEM) methodology.Results: The primary findings of the study indicate that (i) age was found to positively moderate the association between intrinsic religiosity and gratitude (β = 0.191, 95% CI [0.116, 0.277], p < 0.001); (ii) Intrinsic religiosity has a positive influence on depression-happiness scale (β = 0.276, 95% CI [0.168, 0.373], p < 0.001) and gratitude (β = 0.337, 95% CI [0.205, 0.466], p < 0.001); Moreover, (iii) gratitude has a positive influence on depression-happiness scale (β = 0.381, 95% CI [0.280, 0.491], p < 0.001); Finally, (iv) the study revealed that gratitude mediates the relationship between intrinsic religiosity and depression-happiness scale (β = 0.128, 95% CI [0.071, 0.197], p < 0.001).Discussion: The findings of this study suggest that gratitude could potentially play a significant role in comprehending the association between religiosity and the levels of depression and happiness experienced by religious individuals in Vietnam.Keywords: religiosity, intrinsic religiosity, depression, happiness, gratitude, Vietnam

Nghiên cứu được thực hiện để xác định hóa thực vật và hoạt tính sinh học của các cao thân lá, thân và lá rau dệu. Hoạt tính kháng oxy hóa được xác định dựa vào hoạt động trung hòa hoặc ức chế các gốc tự do phi sinh học. Hoạt tính kháng viêm được xác định dựa trên khả năng bảo vệ màng tế bào hồng cầu và ức chế sự biến tính protein. Hoạt tính kháng khuẩn được xác định dựa vào đường kính vòng kháng khuẩn, nồng độ ức chế tối thiểu, nồng độ diệt khuẩn tối thiểu. Các cao rau dệu có hoạt tính kháng oxy hóa, kháng viêm với giá trị EC50 dao động từ 50,60±0,29 đến 125,58±7,12 µg/mL. Các cao rau dệu ức chế vi khuẩn Gram dương hiệu quả hơn Gram âm, nồng độ diệt khuẩn tối thiểu dao động từ 250 đến 2.000 µg/mL. Hoạt động kháng oxy hóa, kháng viêm và kháng khuẩn của rau dệu có liên quan đến hàm lượng polyphenol, flavonoid và alkaloid. Kết quả này cho thấy tiềm năng sử dụng cao rau dệu như chất kháng oxy hóa, kháng viêm, kháng khuẩn tự nhiên.

The study aimed to compare an innovative method, namely liquid CO2 extraction without high-pressure pump (LCE-WHP), with hydro-distillation (HD), microwave-assisted hydro-distillation (MA-HD) and steam distillation (SD) on yield, physical and biological properties of essential oils (EOs) from fruit peels of three green and one yellow orange cultivars. LCE-WHP oils retained the fragrance of the original fruit peels with yellow color and low content of waxes. For green cultivars, oil yields of LCE-WHP (4.8–5.9%) were significantly higher than those of SD (3.6–5.2%), but lower than those of HD (10.5–12.4%) and MA-HD (11–11.9%). Green cultivars had higher oil yield than yellow cultivar regardless of extraction method. Volatile components of EOs were similar for all methods and cultivars. Limonene was main volatile compound of all EOs with concentrations of 95.3–96.9%. Total polyphenol and carotenoid content of LCE-WHP oils were 2.3–19.1 and 5.9–113.6 folds higher than those of oils extracted by other methods, respectively. EOs extracted by LCE-WHP showed the strongest activities against Bacillus cereus, Staphylococcus aureus, Pseudomonas aeruginosa, S. enteritidis, Escherichia coli and Candida albicans as compared to EOs extracted by other methods. Similarly, the antioxidant activities of LCE-WHP oils determined by DPPH and ABTS assay were also the strongest. This is the first report on using LCE-WHP for extracting orange EOs with high quality and biological activities. LCE-WHP has lower capital cost and safer operation than conventional CO2 extraction methods. Such findings promote the application of LCE-WHP for commercial extraction of orange EOs.

Purpose: The current study aimed to figure out the types and dosages of biocomposts supplied with cellulose-degrading Trichoderma strains for ameliorating soil properties, and the growth and yield of pineapple. Method: The experiment with two factors followed a completely randomized block design, including 20 treatments (4 replications). The first factor (A) was the types of biocomposts inoculated with different Trichoderma spp., which were (i) the biocompost supplied with the commercial Trichoderma (the Trichoderma of Can Tho University) as the positive control treatment, and the biocompost supplied with Trichoderma strains of (ii) TC1 (TC1 biocompost), (iii) TC2 (TC2 biocompost), (iv) TC3 (TC3 biocompost), and (v) TC1, TC2, and TC3 (TC123 biocompost). The second factor (B) was rates of bio-compost used (t ha-1) as follows: (i) 1, (ii) 2, (iii) 3, and (iv) 4. Results: The application of TC123 bio-compost at 4 t ha-1 contributed to the greatest available N, soluble P, concentrations, and N, P, and K uptake values. The treatments with the TC123 biocompost correspondingly increased plant height, leaf number, D-leaf length, peduncle height, fruit length, and fruit width by 1.9, 31.8, 16.7, 5.4, 7.8, and 12.1%, in comparison with the treatments with the positive control. The TC123 biocompost fertilization increased fruit size, resulting in enhanced pineapple yield by 9.80% in comparison with the commercial biocompost fertilization. Conclusion: The TC123 biocompost surpassed the commercial one in enhancing the characteristics of pineapples (Ananas comosus (L.) Merr). At 4 t.ha-1, this biocompost performed the greatest.

Background: Depression in high school students is a common mental health problem and requires evaluation for early intervention. The study was carried out to determine the prevalence of depression symptoms and associated characteristics among high school students in Ho Chi Minh City, Vietnam. Methods: This cross-sectional study enrolled participants between February 2022 and June 2022. The instrument utilized was a questionnaire of socioeconomic-demographic variables, educational characteristics, and the self-reported depression scale obtained from the Centre for Epidemiological Studies-Depression (CES-D). Results: 384 high school students (165 males and 219 females) were questioned. The CES-D had a mean score of 17.3, with 57.6% of participants reporting depressed symptoms. The frequency was 63.3% among male students (OR = 1.84, 95% CI = 1.19-2.83, p = .005). Multiple logistic regression revealed that adolescents with poor health, weak friendships, limited participation in school activities, family problems, financial worries, and negative educational environments were significantly more likely to experience depressive symptoms (odds ratios ranging from 1.60 to 9.97, confidence intervals spanning 1.03 to 78.05, and p-values from

Resulting from the Industrial Revolution 4.0, English is evolving into a global language and is detected from multi-aspects consisting of technological, scientific, and business aspects, and completely, English language learning quality must be enhanced. Thus, this paper focuses on constructing a conceptual framework in which competition is presenting as a moderator on the influence on the English language learning quality of students in the context of higher education in Vietnam. To achieve this objective, the paper employs a qualitative approach through tools of the meta-analysis, systematic review, from 86 publications as research papers, theses/ dissertations, books, and other relevant publications in the focused subject from prominent and reliable databases, including Google Scholar, Research Gate, Scopus, Web of Science, EBSCO, Cengage and Springer, etc. and direct observation with 55 English language classes, 5 interviews are conducted by using a semi-structured questionnaire with 135 students and 55 lecturers and 5 educational/ English teaching experts. The paper hopes to contribute to English learning quality enhancement and extends its contribution to the educational quality in higher education.

Vinh-Long Tran-Chi,1,2,&ast; Michael Maes,3– 9,&ast; Gallayaporn Nantachai,2,10 Solaphat Hemrungrojn,2,9 Marco Solmi,11– 14 Chavit Tunvirachaisakul2,8 1Ph.D. Program in Clinical Sciences, School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 2Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 3Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China; 4Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, People’s Republic of China; 5Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria; 6Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; 7Kyung Hee University, Dongdaemun-gu, Seoul, South Korea; 8Cognitive Impairment and Dementia Research Unit, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 9Cognitive Fitness and Biopsychiatry Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 10Somdet Phra Sungharaj Nyanasumvara Geriatric Hospital, Department of Medical Services, Ministry of Public Health, Chon Buri Province, Thailand; 11Department of Psychiatry, University of Ottawa, Ontario, Canada; 12Regional Centre for the Treatment of Eating Disorders and on Track, The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ontario, Canada; 13Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada; 14Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany&ast;These authors contributed equally to this workCorrespondence: Michael Maes, Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, People’s Republic of China, Email dr.michaelmaes@hotmail.com Chavit Tunvirachaisakul, Cognitive Impairment and Dementia Research Unit, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand, Email chavit.t@chula.ac.thBackground: Studies in old adults showed bidirectional interconnections between amnestic mild cognitive impairment (aMCI) and affective symptoms and that adverse childhood experiences (ACE) may affect both factors. Nevertheless, these associations may be confined to older adults with clinical depression.Aim: To delineate the relationship between clinical symptoms of aMCI and affective symptoms in older adults without major depression (MDD) or dysfunctions in activities of daily living (ADL).Methods: This case-control study recruited 61 participants with aMCI (diagnosed using Petersen’s criteria) and 59 older adults without aMCI and excluded subjects with MDD and ADL dysfunctions.Results: We uncovered 2 distinct dimensions, namely distress symptoms of old age (DSOA), comprising affective symptoms, perceived stress and neuroticism, and mild cognitive dysfunctions, comprising episodic memory test scores, the total Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. A large part of the variance (37.9%) in DSOA scores was explained by ACE, negative life events (health and financial problems), a subjective feeling of cognitive decline, and education (all positively). ACE and NLE have a highly significant impact on the DSOA score and are not associated with aMCI or its severity. Cluster analysis showed that the diagnosis of aMCI is overinclusive because some subjects with DSOA symptoms may be incorrectly classified as aMCI.Conclusion: The clinical impact is that clinicians should carefully screen older adults for DSOA after excluding MDD. DSOA might be misinterpreted as aMCI.Keywords: depression, adverse childhood experiences, mild cognitive impairments, affective disorders, negative life events, neurocognitive deficits

BackgroundPrior epidemiologic studies on the association between diabetes and gastric cancer risk provided inconclusive findings, while traditional, aggregate data meta-analyses were characterized by high between-study heterogeneity.ObjectiveTo investigate the association between type 2 diabetes and gastric cancer using data from the 'Stomach Cancer Pooling (StoP) Project', an international consortium of more than 30 case-control and nested case-control studies, which is large and provides harmonized definition of participants' characteristics across individual studies. The data have the potential to minimize between-study heterogeneity and provide greater statistical power for subgroup analysis.MethodsWe included 5592 gastric cancer cases and 12 477 controls from 14 studies from Europe, Asia, North America, and South America in a two-stage individual-participant data meta-analysis. Random-effect models were used to estimate summary odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) by pooling study-specific ORs.ResultsWe did not find an overall association between diabetes and gastric cancer (pooled OR = 1.01, 95% CI, 0.94-1.07). However, the risk of cardia gastric cancer was significantly higher among individuals with type 2 diabetes (OR = 1.16, 95% CI, 1.02-1.33). There was no association between diabetes and gastric cancer risk in strata of Helicobacter pylori infection serostatus, age, sex, BMI, smoking status, alcohol consumption, fruit/vegetable intake, gastric cancer histologic type, and source of controls.ConclusionThis study provides additional evidence that diabetes is unrelated to gastric cancer overall but may be associated with excess cardia gastric cancer risk.

Humans are living in damaged landscapes within a new geographical epoch known as the Anthropocene. The COVID-19 outbreak fuels uncertainty, instability, and ambiguity for humans. This viral disaster has been blamed for losing and further exacerbating ecological imbalance, and prompts a need to re-examine multispecies relations and, in particular, human exceptionalism. The authors, by applying a new theoretical assemblage that brings the new materialist turn entangled with Buddhist philosophies into our stories and diffractions of child-virus bodies, have been prompted to raise two questions about how multispecies justice could disrupt environmental sustainability education. The questions we will engage with in the paper include: Can we explore these new theoretical assemblages (east-west) with child-virus relations as a means for raising multispecies justice that critiques the universalisation of human forces in the Anthropocene? What possibilities does the pandemic offer to rethink multispecies relations as an entangled ecological crisis by exploring what a 'new normal' in post-COVID-19 sustainability education could emerge?

Introduction: The COVID-19 pandemic has also caused significant damage in Vietnam, necessitating medical personnel to work tirelessly at different medical establishments to combat the epidemic. Healthcare professionals in Vietnam may experience stress and burnout, leading to adverse effects on their resilience, job performance, health, and overall quality of life. Methodology: We carried out a cross-sectional investigation involving 147 healthcare professionals from various medical establishments in Ho Chi Minh City, Vietnam. The purpose was to evaluate the levels of stress, burnout, and resilience among these individuals. Results: The study discovered that resilience acts as a mediator in the association between stress and burnout. Additionally, it revealed that gender traits have an impact on the interplay between stress and mental resilience. The study additionally discovered inequalities in stress, burnout, resilience, and social support based on demographic and professional factors. Conclusion: Our study has enhanced our comprehension of mental health concerns among healthcare workers and facilitated the identification of a complex pattern that takes into account detrimental factors, protective factors, and existing support systems in mental healthcare, thus offering comprehensive and insightful perspectives for future research.

Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); it has recently been associated with several hematologic disorders. A 4-year-old boy who had SARS-CoV-2 10 months prior was admitted to the emergency department of our hospital with seizures. His SARS-CoV-2 IgG II level was 885.7 AU/mL. Neuroimaging with cranial computed tomography after admission showed abnormal images of the venous sinus, but this was not sufficient to diagnose cerebral venous sinus thrombosis. Therefore, magnetic resonance imaging and digital subtraction angiography were conducted, which confirmed the diagnosis. He was treated with thrombectomy and anticoagulation drugs, and the clinical outcomes were satisfactory. Because our patient had a medical history of SARS-CoV-2 and exhibited no other risk factors, we present this case as evidence of a potential association between cerebral venous sinus thrombosis and SARS-CoV-2.

Coronary artery fistulas (CAFs) are abnormal connections of coronary arteries where venous circuits bypass the normal capillaries in the myocardium. CAFs are rare, and most patients are asymptomatic. However, CAFs are the most common coronary artery anomalies affecting coronary hemodynamics. While most CAFs are asymptomatic in young patients, symptoms and complications become more frequent with increasing age. CAFs are characterized by variable clinical manifestations based on their size, origin, and drainage site. We describe a 35-year-old woman presenting with the shortness of breath after walking. Despite attempting medical treatment, the patient continued to experience dyspnea, fatigue, fainting the and chest pain episodes. After admission, cardiac imaging was immediately performed and recorded symptomatic CAFs. Percutaneous transcatheter closure treatment was indicated. The patient was discharged with clinical recovery. The treatment of symptomatic CAFs often requires the clear cardiac imaging and endovascular approach to achieve the best clinical results.

Top-of-the-basilar artery occlusion frequently causes infarction of the midbrain, thalamus, and portions of the temporal and occipital lobes as the vascular supply of these regions comes from the posterior communicating and posterior cerebral arterial tributaries of the basilar artery. Clinical signs include an array of visual, oculomotor, and behavioral abnormalities, usually without prominent motor dysfunction, which makes diagnosis challenging for those inexperienced with these sign. We describe a 59-year-old male presenting with acute ischemic stroke due to top-of-the-basilar artery occlusion. Despite attempting several paraclinical examinations relating the sudden coma with Glasgow Coma Scale of 6 points, the neuroimaging detected the large vessel occlusion that was difficult to recognize. After confirming top-of-the-basilar artery occlusion, the recanalization was realized immediately. The patient was discharged with good clinical recovery.