Background Dermatophytes may cause various and severe types of fungal infections in several communities. Herbal plant extracts may be inhibitory against cutaneous fungi related to Epidermophyton, Microsporum, and Trichophyton. The extract may be more efficient by its mixing with a low concentration of the antifungal agent. Purpose This study demonstrates the antidermatophytic activities of seed methanol extract of Citrullus colocynthis from different habitats in Egypt, namely Sinai desert, El-Wadi El-Gadid, and Wadi Qena. Methods A broth microdilution assay was used to determine the MIC and MFC of the extracts against the investigated fungal strains according to the Clinical and Laboratory Standards Institute (CLSI) M38-Ed3 guidelines. GC/MS was employed for the identification of the active constituents. Keratinase, lipase, phospholipase, and protease were measured spectrophotometrically or by determining the diameter of the reaction zone according to standard methods using a specific medium. Results C.colocynthis seed methanol extract from Sinai desert combined with 0.5 μg/ml of the antifungal drug fluconazole (FLU) was more effective than the extract or FLU, each on its own, in decreasing spore viability and reduction of fungal enzyme activities. The phytochemical analyses of the methanolic seed extract of the three cultivars show the presence of three common main compounds, namely, (9Z,12Z)-methyl octadeca-9,12-dienoate, (9Z,12E)-methyl octadeca-9,12-dienoate, and (9E,12E)-methyl octdeca-9,12-dienoate. The in-silico docking activity of the main compounds toward fungal enzymes showed a high binding affinity between the first compound and lipase enzymes of Microsporum canis and Trichophyton mentagrophytes. Conclusions The variation in the bioactivity of the plant extracts of a certain species may be varied due to the difference of the active constituents that are formed under specific conditions or stress. The inhibitory action of the extract to a certain pathogen could be improved when combined with lower drug concentration. Longer chain carbon compounds were frequently detected in the cultivar of Sinai compared to the compounds identified from the other localities suggesting that there was a variation in the active constituents according to the surveyed habitat although the main core of the constituents is maintained.

Introduction: Facial asymmetry during crying in neonates is an important entity which might be due to an underlying true paralysis of the facial nerve or due to the benign overlooked diagnosis of congenital absence of the depressor angularis oris muscle (DAOM).

Case Report: We report a full-term newborn delivered by normal spontaneous vertex delivery with uneventful pregnancy and Apgar score of 9 and 10 at 1 and 5 minutes respectively. His parents are first-degree cousins with 4 living normal siblings. His birth weight was appropriate for his gestational age. His initial neonatal assessment was normal apart from facial asymmetry during crying in the form of deviation of the angle of the mouth to the left with an otherwise normal facial appearance. The facial asymmetry disappears at rest (without crying). This condition usually poses a diagnostic dilemma. Developmental and traumatic facial paralysis and being part of some syndromes like Mobius and CHARGE syndromes are among the most important differential diagnosis but the disappearance of the facial asymmetry at rest is diagnostic of absent DAOM which is a relatively common but missed diagnosis.

Conclusions: Pediatricians should be aware about the diagnosis of DAOM in neonates with asymmetric crying face if the face was completely normal at rest with deviation of the angle of the mouth on crying which disappears on rest.

INTRODUCTION: Facial asymmetry during crying in neonates is an important entity which might be due to an underlying true paralysis of the facial nerve or due to the benign overlooked diagnosis of congenital absence of the depressor angularis oris muscle (DAOM).

CASE REPORT: We report a full-term newborn delivered by normal spontaneous vertex delivery with uneventful pregnancy and Apgar score of 9 and 10 at 1 and 5 minutes respectively. His parents are first-degree cousins with 4 living normal siblings. His birth weight was appropriate for his gestational age. His initial neonatal assessment was normal apart from facial asymmetry during crying in the form of deviation of the angle of the mouth to the left with an otherwise normal facial appearance. The facial asymmetry disappears at rest (without crying). This condition usually poses a diagnostic dilemma. Developmental and traumatic facial paralysis and being part of some syndromes like Mobius and CHARGE syndromes are among the most important differential diagnosis but the disappearance of the facial asymmetry at rest is diagnostic of absent DAOM which is a relatively common but missed diagnosis.

CONCLUSIONS: Pediatricians should be aware about the diagnosis of DAOM in neonates with asymmetric crying face if the face was completely normal at rest with deviation of the angle of the mouth on crying which disappears on rest.