A rare delayed onset of esophageal varices and portal vein thrombosis in a ten-year-old patient following umbilical vein catheterization.

Introduction and significance: Portal vein thrombosis (PVT) is not commonly observed in patients, particularly those who have gone through neonatal intensive care unit (NICU) stays and had umbilical catheters. Although PVT can potentially cause hypertension and gastrointestinal bleeding it is highly unusual for this condition to manifest during childhood. Case presentation: The authors present a case of a 10-year-old child who developed portal hypertension, esophageal varices, and multiple thrombophilia associated mutations. This child was born prematurely. Had to stay in the NICU, where an umbilical venous catheter was used which likely triggered the development of PVT. At the age of 7 he started experiencing distension, anemia and low platelet count, which eventually led to splenectomy. On at the age of 10 he began experiencing episodes of bleeding. Was diagnosed with esophageal varices and portal gastropathy. Through procedures, like Histoacryl glue injection and band ligation bleeding was successfully controlled. Genetic analysis revealed mutations associated with thrombophilia. Clinical discussion: This case highlights how rare it is for older children to develop PVT and emphasizes the possibility of delayed onset symptoms following catheterization. The placement of catheters in NICUs can disrupt blood flow and increase the likelihood of clot formation. The presence of hypertension resulting from PVT can lead to complications such as varices. Effective control, over bleeding was achieved through interventions.Importantly, the presence of ACE I/D, FXIII Val34Leu, and Factor V Leiden mutations introduces an aspect to this scenario. It is worth noting that these mutations are not commonly linked to thrombophilia or clotting disorders. Conclusion: This case highlights pediatric PVT, emphasizing the need for a collaborative approach among gastroenterologists, hematologists, and geneticists. Further research is required to understand PVT mechanisms and long-term implications, aiding in diagnosis and management, especially when it appears in late childhood. Evaluation is crucial in deciphering thrombophilia-related complications in the context of hypertension.

TECPR2-related hereditary sensory and autonomic neuropathy in two siblings from Palestine.

Due to the majority of currently available genome data deriving from individuals of European ancestry, the clinical interpretation of genomic variants in individuals from diverse ethnic backgrounds remains a major diagnostic challenge. Here, we investigated the genetic cause of a complex neurodevelopmental phenotype in two Palestinian siblings. Whole exome sequencing identified a homozygous missense TECPR2 variant (Chr14(GRCh38):g.102425085G>A; NM_014844.5:c.745G>A, p.(Gly249Arg)) absent in gnomAD, segregating appropriately with the inheritance pattern in the family. Variant assessment with in silico pathogenicity prediction and protein modeling tools alongside population database frequencies led to classification as a variant of uncertain significance. As pathogenic TECPR2 variants are associated with hereditary sensory and autonomic neuropathy with intellectual disability, we reviewed previously published candidate TECPR2 missense variants to clarify clinical outcomes and variant classification using current approved guidelines, classifying a number of published variants as of uncertain significance. This work highlights genomic healthcare inequalities and the challenges in interpreting rare genetic variants in populations underrepresented in genomic databases. It also improves understanding of the clinical and genetic spectrum of TECPR2-related neuropathy and contributes to addressing genomic data disparity and inequalities of the genomic architecture in Palestinian populations.

Antimicrobial activity of eugenol and carvacrol against Salmonella enterica and E. coli O157:H7 in falafel paste at different storage temperatures.

The objectives of the current study were: i) to investigate the antimicrobial activity of 0.125, 0.250 and 0.50 % (7.54, 15.08 and 30.17 mmol/Kg of eugenol) and (8.15, 16.31, and 33.61 mmol/Kg of carvacrol) against S. enterica and E. coli O157:H7 in falafel paste (FP) stored at 4, 10 or 25 °C for 10 d; and ii) to study the sensory properties of fried falafel treated with eugenol and carvacrol. S. enterica grew well in untreated falafel (control) samples at 10 and 25 °C, while E. coli O157:H7 grew only at 25 °C. However, numbers of S. enterica and E. coli O157:H7 in FP stored at 4 °C were reduced by 1.4-1.6 log CFU/g after 10 d. The antimicrobial agents were more effective at 25 °C against S. enterica, but were better at 4 and 10 °C against E. coli O157:H7. Addition of 0.125-0.5 % eugenol or carvacrol reduced the S. enterica numbers to undetectable level by direct plating (2 log CFU/g) by 2-10 d at 25 °C. FP samples treated with 0.5 % eugenol or 0.25-0.5 % carvacrol were negative for S. enterica cells by enrichment (1 CFU/5 g) by 10 d at 25 °C. In contrast, viable E. coli O157:H7 were not detected by direct plating when FP was treated with 0.25-0.5 % carvacrol or 0.5 % eugenol and stored at 4 °C by 2 d. Addition of eugenol or carvacrol did not affect the color, texture, and appearance of fried falafel but decreased the flavor and overall acceptability scores compared to untreated falafel. Using eugenol and carvacrol as natural antimicrobials have the potential to enhance the safety of FP by reducing the threat from foodborne pathogens.

Survival and growth behavior of common foodborne pathogens in falafel paste under different storage temperatures.

Falafel is a popular breakfast food in the Middle East that has been recently involved in several outbreaks of foodborne illnesses. The aim of the study was to explore the growth behavior of Salmonella enterica, Escherichia coli O157:H7, Shigella sonnie, Shigella flexneri, Listeria monocytogenes and Staphylococcus aureus in falafel paste (FP) under different storage temperatures (4, 10, or 24 °C) for 14 days. FP (pH = 6.2, aw = 0.96) was inoculated with 5.0 to 6.0 log CFU/g of each of the pathogens separately. Salmonella spp. significantly declined by 1.5 log at 4 °C but grew significantly by ca. 2 and 4 log at 10 and 24 °C, respectively after 14 days. E. coli O157:H7 significantly increased (4.5 log) in FP when stored under 24 °C and survived at a level of ~105 CFU/g at 10 °C. Comparatively, Sh. sonnie and Sh. flexneri showed a better survival pattern in FP stored under 4 °C and grew (˃ 3 log) after 5 days at 10 and 24 °C. L. monocytogenes was capable of growing by 1.9 and 4.3 log after 14 d days and by 3.9 log after 3 days at 4, 10, or 24 °C, respectively. No significant decline in S. aureus counts at 4 and 10 °C occurred, however, it increased significantly to ˃ 7 log CFU/g at 24 °C. Total mesophilic count and yeast and mold count reached to spoilage levels (˃107 CFU/g) in un-inoculated FP after 1 and 3 days of storage at 24 and 10 °C, respectively. FP could support the growth of common foodborne pathogens and hence it is recommended to utilize natural antimicrobials in FP and keep the product under refrigeration (4 °C) to preclude the growth of vegetative foodborne pathogens.

Prevalent MLC1 mutation causing autosomal recessive megalencephalic leukoencephalopathy in consanguineous Palestinian families.

BACKGROUND: Recessive forms of megalencephalic leukoencephalopathy with subcortical cysts (MLC, OMIM 604004) is a rare early-onset leukodystrophy that presents with macrocephaly, seizures, slowly progressive gross motor deterioration, and MRI evidence of diffuse symmetric white matter swelling and subcortical cysts in the anterior temporal and frontoparietal regions. Later in the disease course, significant spasticity and ataxia develop, which may be accompanied by intellectual deterioration. This disease is caused mostly by biallelic pathogenic variants in the MLC1 gene. METHODS: In this study, we analysed the clinical and molecular architecture of 6 individuals, belonging to 4 unrelated consanguineous Palestinian families, presenting with consistent MLC features. We sequenced the entire coding and flanking intronic regions of the MLC1 gene. RESULTS: In all recruited individuals, we detected one recurrent homozygous splice donor mutation NM_015166.4: c.423 + 1G > A. All parents were heterozygous carriers. The mutation abolishes a highly conserved splice site in humans and other species. In silico splice predictors suggested the loss of a canonical splice donor site (CADD score 33.0. SpliceAI: 0.980). The c.423 + 1G > A variant is rare; it was detected in only 4 heterozygous carriers in gnomAD. CONCLUSION: In this study, we identified a recurrent MLC1 variant (c.423 + 1G > A) as the cause of MLC among a group of Palestinian patients originating from a particular region of the country. Cost-effective studies should be performed to evaluate the implementation of carrier screening in adults originating from this region. Our findings have the potential to contribute to improved genetic diagnosis and carrier testing for individuals within this population and the wider community.

Vaccines Attitudes, Concerns, and Information Sources Reported by Parents of Young Children among North Palestinian Parents.

Parental acceptance of routine childhood immunization is critical to protecting children's health, as high vaccination-coverage rates lead to decreased rates of vaccine-preventable diseases. However, to communicate effectively with parents about vaccines and vaccine-preventable diseases, it is necessary to assess their vaccine-related attitudes and concerns continually. Recently the Palestine Ministry of Health has recorded epidemics of measles and mumps. Poor compliance with vaccination has been attributed to multiple factors including physician inadequacy advocating for vaccination and public mistrust of vaccinations. As a result, this study was conducted to describe the vaccine-related attitudes, concerns, and information sources of North Palestinian parents of young children. A cross-sectional survey was conducted involving parents visiting emergency departments and primary health care centers from different North Palestinian hospitals and centers. 480 surveys were eligible and analyzed. The surveys revealed that although parental confidence in vaccine safety is high, several vaccine-related concerns, such as pain from vaccine administration and the number of vaccines given at once, were common among parents of young children. To maintain and improve the success of childhood vaccines in preventing disease, a holistic approach is needed to address parents' concerns in an ongoing manner. Listening and responding in ways and with resources that address specific questions and concerns could help parents make more informed vaccination decisions.