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\title{Reverse Slanting of Split Eyebrows and Palpebral Fissures: A New Dysmorphic Syndrome}
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             \author[1]{Aamir Jalal Al  Mosawi}

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\date{\small \em Received: 16 December 2019 Accepted: 3 January 2020 Published: 15 January 2020}

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\begin{abstract}
        


A dysmorphic syndrome is suspected in the presence of more than three minor anomalies which are variations of normal morphological features that are considered of little or no known medical, surgical, or cosmetic significance; more than one major anomaly which is an abnormality that has major medical, surgical or cosmetic significance; and one major anomaly with two or more minor anomalies are also suggestive of congenital syndrome.Many congenital syndromes are associated with different combinations of hypertelorism (with or without flat mid-face), epicanthic folds, convergent squint, low set ears, upward and downward slanting of the palpebral fissures, and eyebrows abnormalities occurring in association with hypotonia and developmental delay.The aim of this paper is to describe the occurrence of a new congenital syndrome with the novel association of unique eyebrows abnormalities (splitting with a relatively thick upward slanting medial parts and thin non-slanting lateral parts) with downward slanting palpebral fissures, bilateral convergent squint, hypertelorism with flat mid-face, epicanthic folds, large ears, developmental delay, and infantile hypotonia mostly attributed to congenital myopathy.

\end{abstract}


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\let\tabcellsep& 	 	 		 
\section[{Reverse Slanting of Split Eyebrows and}]{Reverse Slanting of Split Eyebrows and}\par
Palpebral Fissures: A New Dysmorphic Syndrome\par
Aamir Jalal Al Mosawi Abstract-A dysmorphic syndrome is suspected in the presence of more than three minor anomalies which are variations of normal morphological features that are considered of little or no known medical, surgical, or cosmetic significance; more than one major anomaly which is an abnormality that has major medical, surgical or cosmetic significance; and one major anomaly with two or more minor anomalies are also suggestive of congenital syndrome. Many congenital syndromes are associated with different combinations of hypertelorism (with or without flat mid-face), epicanthic folds, convergent squint, low set ears, upward and downward slanting of the palpebral fissures, and eyebrows abnormalities occurring in association with hypotonia and developmental delay.\par
The aim of this paper is to describe the occurrence of a new congenital syndrome with the novel association of unique eyebrows abnormalities (splitting with a relatively thick upward slanting medial parts and thin non-slanting lateral parts) with downward slanting palpebral fissures, bilateral convergent squint, hypertelorism with flat mid-face, epicanthic folds, large ears, developmental delay, and infantile hypotonia mostly attributed to congenital myopathy. 
\section[{I. Introduction}]{I. Introduction}\par
dysmorphic syndrome is suspected in the presence of more than three minor anomalies which are variations of normal morphological features that are considered of little or no known medical, surgical, or cosmetic significance; more than one major anomaly which is an abnormality that has major medical, surgical or cosmetic significance; and one major anomaly with two or more minor anomalies are also suggestive of congenital syndrome. Many congenital syndromes are associated with different combinations of hypertelorism (with or without flat midface), epicanthic folds, convergent squint, low set ears, upward and downward slanting of the palpebral fissures, and eyebrows abnormalities occurring in association with hypotonia and developmental delay \hyperref[b0]{[1,}\hyperref[b1]{2,}\hyperref[b2]{3,} {\ref 4]}.\par
The aim of this paper is to describe the occurrence of a new congenital syndrome with the novel association of unique eyebrows abnormalities (splitting with a relatively thick upward slanting medial parts and   
\section[{EMG and nerve conduction studies were performed at the age of seven months (Table-1).}]{EMG and nerve conduction studies were performed at the age of seven months (Table-1).}\par
Nerve conduction study (Table  {\ref -}  
\section[{Needle electromyography (EMG) stud showed:}]{Needle electromyography (EMG) stud showed:}\par
No spontaneous activity.\par
No myotonic discharges. 
\section[{The average duration of 20 motor units:}]{The average duration of 20 motor units:}\par
Right deltoid= 5.1 msec (n=8.3 msec). Right biceps = 4.8 msec (n=8.1 msec). Right vastus medialis = 4.1 msec (n=8.3 msec). Right tibialis anterior = 5.3 msec (n= 10.2 msec). Left tibialis anterior = 5.2 msec (n= 12.5 msec). 30-40\% polyphasia of short duration low amplitude was observed.\par
EMG and nerve conduction studies suggested chronic diffuse non dystrophic myopathic of moderate severity mostly resulting from congenital myopathy.\par
The proximal lower limb muscles were more severely involved.  
\section[{Summarizes the clinical features of the new syndrome}]{Summarizes the clinical features of the new syndrome}\begin{figure}[htbp]
\noindent\textbf{1}\includegraphics[]{image-2.png}
\caption{\label{fig_0}FFigure 1 :}\end{figure}
  \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.85\textwidth}}
thin non-slanting lateral parts) with downward slanting\\
palpebral fissures, bilateral convergent squint,\\
hypertelorism with flat mid-face, epicanthic folds, large\\
ears, developmental delay, and infantile hypotonia\\
mostly attributed to congenital myopathy.\\
II. Case Report\\
1. Highly specific unique eyebrows abnormalities\\
consisting of splitting with a relatively thick upward\\
slanting medial parts and thin non-slanting lateral\\
parts.\\
2. Downward slanting palpebral fissures.\\
3. Epicanthic folds.\\
4. Hypertelorism.\\
5. Depressed nasal bridge.\\
6. Large ears.\\
7. Convergent squints of both eyes.\\
Brain MRI was performed at the age of one\\
month showed normal findings.\\
Screening for several inborn errors of\\
metabolisms has already revealed no abnormality.\end{longtable} \par
  {\small\itshape [Note: Author: 1. Advisor in Pediatrics and Pediatric Psychiatry Children Teaching Hospital of Baghdad Medical City. 2. Head, Iraq Headquarter of Copernicus Scientists International Panel, Baghdad, Ira. e-mail: almosawiAJ@yahoo.com A]} 
\caption{\label{tab_0}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.85\textwidth}}
Sporadic occurrence\\
Non consanguineous parents\\
Splitting of eyebrows with a relatively thick upward slanting medial parts and thin non-slanting\\
lateral parts\\
Downward slanting palpebral fissures\\
Epicanthic folds\\
Hypertelorism\\
Depressed nasal bridge\\
Large ears\\
Convergent squints of both eyes.\\
Infantile hypotonia attributed to congenital myopathy\end{longtable} \par
 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.10986394557823129\textwidth}P{0.18214285714285713\textwidth}P{0.08962585034013605\textwidth}P{0.06360544217687075\textwidth}P{0.13299319727891157\textwidth}P{0.08673469387755102\textwidth}P{0.09829931972789116\textwidth}P{0.08673469387755102\textwidth}}
\tabcellsep \tabcellsep Sensory\tabcellsep \tabcellsep \tabcellsep \tabcellsep Motor\tabcellsep \\
Nerve\tabcellsep Latency msec/cm\tabcellsep Amplitude ?V\tabcellsep SNCV m/sec\tabcellsep Muscle\tabcellsep DML Msec /cm\tabcellsep MNCV msec /cm\tabcellsep F-wave Latency\\
Right median\tabcellsep 2.1\tabcellsep 26.6\tabcellsep 56.2\tabcellsep ABP\tabcellsep 3.1\tabcellsep 50.2\tabcellsep 16.5\\
Right ulnar\tabcellsep 1.9\tabcellsep 27.3\tabcellsep 56.6\tabcellsep ADM\tabcellsep 2.9\tabcellsep 51.2\tabcellsep 17.2\\
\tabcellsep \multicolumn{2}{l}{Right common peroneal}\tabcellsep \tabcellsep Tibialis Ant. EDB\tabcellsep 3.3 4.2\tabcellsep 40.2\tabcellsep 35.3\\
\tabcellsep \multicolumn{2}{l}{Left common peroneal}\tabcellsep \tabcellsep Tibialis Ant. EDB\tabcellsep 3 4.1\tabcellsep 40.3\tabcellsep 36.3\\
Left sural\tabcellsep 2\tabcellsep 15.3\tabcellsep 44.6\tabcellsep \tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_2}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_3}Table 4 .}\end{figure}
 		 		\backmatter   			 
\subsection[{Acknowledgement}]{Acknowledgement}\par
The author would to express his gratitude for the parents of the patients who accepted publishing his photos. 			  			  				\begin{bibitemlist}{1}
\bibitem[Al-Mosawi]{b1}\label{b1} 	 		\textit{Rare genetic disorders in Iraq},  		 			A J Al-Mosawi 		.  		Saarbrücken: LAP Lambert Academic Publishing. 1 p. 2011.  	 	 (st ed.) 
\bibitem[David ()]{b0}\label{b0} 	 		\textit{Recognizable patterns of human malformation: genetic, embryologic, and clinical aspects". Major problems in clinical pediatrics},  		 			S W David 		.  		1970. 7 p. 368.  	 
\bibitem[Al-Mosawi]{b2}\label{b2} 	 		\textit{The uncommon and rare genetic disorders in Iraq},  		 			A J Al-Mosawi 		.  		Saarbrücken: LAP Lambert Academic Publishing. p. 2019.  	 	 (st ed.) 
\end{bibitemlist}
 			 		 	 
\end{document}
