Brain abscess following rituximab infusion in a patient with pemphigus vulgaris.

BackgroundImmunocompromised patients are at increased risk for developing meningitis or, rarely, brain abscess with opportunistic organisms like Listeria monocytogenes.Case reportA 52 year-old Saudi Arabian woman who was diagnosed with pemphigus vulgaris and diabetes and had been on prednisolone and azathioprine for about 4 years. She presented with headache, low-grade fever, and left-sided weakness 2 weeks after receiving the second dose of rituximab infusion. Magnetic resonance imaging revealed an enhanced space-occupying lesion with multiple small cyst-like structures and vasogenic edema in the right temporoparietal area. Her blood culture was positive for Listeria monocytogenes, and a brain biopsy showed necrotic tissues with pus and inflammatory cells. She recovered after a 6-week course of antibiotics with ampicillin and gentamycin.ConclusionsBrain abscess due to Listeria monocytogenes is a risk that should be considered when adding rituximab to the regimen of a patient who is already Immunocompromised

An experimental and theoretical study of the hot-carrier energy distribution in VLSI MOSFETs

MOSFET devices have, recently, been considered the basic building element in any electronic IC circuit or system. The great advances achieved by modem technologies has made it possible to scale-down considerably the MOSFET device (channel length L smaller than 0.5μm and oxide thickness smaller than 400Å) which appreciably influences the device performance and its operating parameters. [Continues.

Intermediate school mathematics teachers' profile in teaching geometry and its relation to the van Hiele Theory

تهدف الدراسة الحالية إلى تحليل تحركات مجموعة من معلمي الرياضيات في المرحلة المتوسطة للتعرف على اتجاهاتهم حول العوامل المرتبطة بتدريس وحدة "مبادئ الهندسة المستوية" بالصف الأول المتوسط و مدى ارتباط أساليب تدريسهم بمستويات فان هيل لتدريس الهندسة، وللتحقق من تأثر اتجاهاتهم وأساليب تدريسهم بمتغيرات: المؤهل؛ سنوات الخبرة في مجال التدريس؛ وعدد الطلاب في الفصل الواحد. و سعت الدراسة إلى رصد الخبرات والسلوكيات المرتبطة بتعليم و تعلم الهندسة وتحليل مدى ارتباط الأساليب التدريسية بمراحل فان هيل باستخدام الاستطلاعات47 معلماً في خمس مجالات رئيسة مقتبسة تتمثل في الفروق الفردية بين المعلمين، طبيعة الأعمال داخل الفصل، رأي المعلمين في الطلاب، رأي المعلمين في المحتوى، وأراء المعلمين حول أساليب التدريس. وكان من أبرز نتائج الدراسة تركيز أكثر المعلمين على استخدام الأسلوب الإلقائي في تدريس الهندسة من استخدام السبورة والحل الجماعي للأنشطة والتدريبات. كما أوضحت الدراسة ضعف خبرات المعلمين بالنظريات الحديثة للتدريس حيث لم تتجاوز نسبة المعلمين الذين سمعوا بنظرية فان هيل 10%. كما أوضحت نتائج الدراسة تأثير حجم الفصل على اتجاهات المعلمين واستراتيجياتهم التدريسية. وفي ضوء نتائج الدراسة أوصى الباحث بضرورة النظر في أساليب إعداد المعلمين وتدريبهم أثناء الخدمة.In this study the researcher used a survey questionnaire, to study 4 7 in-service mathematics teachers to analyze whether the profile of the teachers is related to van Hiele theory. The researcher studied teachers' experiences, attitudes, and strategies regarding the teaching/learning environment of the geometry unit "fundamentals of plane geometry" at the seventh grade. The questionnaire contains five areas: Teachers' individual differences, task nature, teachers opinion of students, teachers opinion of content, and didactic decisions about teaching from Shavelson, R & Stem, P. (1981). The results of the study showed weak experiences and general information about the Hiele theory. Teachers' patterns were traditionally oriented. Class size was a main factor that affected teachers profiles. The study recommended that in order to implement programs effectively it is necessary to set in advance comprehensive teacher training programs. These programs should be related to the implemented program

Paraneoplastic neuromyelitis optica spectrum disorder associated with stomach carcinoid tumor

Neuromyelitis optica (NMO), or Devic’s syndrome, is an autoimmune central nervous system demyelinating disorder primarily affecting the spinal cord and the optic nerves. It is characterized by the presence of NMO antibodies, alongside clinical and radiological findings. NMO and NMO-spectrum disorders (NMO-SD) have been reported in autoimmune disorders, and are infrequently described as a paraneoplastic syndrome with cancers of lung, breast, and carcinoid tumors of the thyroid. We report a patient who presented with severe vomiting, blurring of vision, vertigo, diplopia, left hemiparesis and hemisensory loss and ataxia. She was found to have a longitudinally-extensive demyelinating lesion extending from the medulla to the upper cervical spinal cord on MRI. Her gastric endoscopy revealed carcinoid tumor of the stomach, and classic paraneoplastic antibodies in the serum were negative. She had extremely high serum gastrin level and high titer of NMO IgG autoantibody. The patient made an excellent recovery with tumor resection and immunotherapy, with both clinical and radiological improvement. On rare instances, NMO or NMO-SD may present as a paraneoplastic neurological syndrome associated with carcinoid tumor of the stomach. Keywords: Demyelinating disease (CNS), Devic’s syndrome, Autoimmune diseases, Paraneoplastic syndrome, Carcinoid tumor associated with paraneoplasti

Brain abscess following rituximab infusion in a patient with pemphigus vulgaris.

BackgroundImmunocompromised patients are at increased risk for developing meningitis or, rarely, brain abscess with opportunistic organisms like Listeria monocytogenes.Case reportA 52 year-old Saudi Arabian woman who was diagnosed with pemphigus vulgaris and diabetes and had been on prednisolone and azathioprine for about 4 years. She presented with headache, low-grade fever, and left-sided weakness 2 weeks after receiving the second dose of rituximab infusion. Magnetic resonance imaging revealed an enhanced space-occupying lesion with multiple small cyst-like structures and vasogenic edema in the right temporoparietal area. Her blood culture was positive for Listeria monocytogenes, and a brain biopsy showed necrotic tissues with pus and inflammatory cells. She recovered after a 6-week course of antibiotics with ampicillin and gentamycin.ConclusionsBrain abscess due to Listeria monocytogenes is a risk that should be considered when adding rituximab to the regimen of a patient who is already Immunocompromised

Fulminant Guillain–Barré Syndrome Post Hemorrhagic Stroke: Two Case Reports

Guillain–Barré syndrome (GBS) is an acute, immune-mediated inflammatory peripheral polyneuropathy characterized by ascending paralysis. Most GBS cases follow gastrointestinal or chest infections. Some patients have been reported either following or concomitant with head trauma, neurosurgical procedures, and rarely hemorrhagic stroke. The exact pathogenesis is not entirely understood. However, blood–brain barrier damage may play an essential role in triggering the autoimmune activation that leads to post-stroke GBS. Here, we present two cases of fulminant GBS following hemorrhagic stroke to remind clinicians to be aware of this rare treatable complication if a stroke patient develops unexplainable flaccid paralysis with or without respiratory distress

Clinical characteristics and treatment outcome of childhood acute lymphoblastic leukemia in Saudi Arabia: A multi-institutional retrospective national collaborative study

Background: Treatment of childhood acute lymphoblastic leukemia (ALL) has been available in Saudi Arabia (SA) for over 30 years; however, only limited data have been published from there. This study was conducted to establish processes for collaborative data collection and provide clinical characteristics and outcome of children with ALL in SA.Procedure: Clinical data for patients diagnosed from 2004 to 2008 were retrospectively collected at eight institutions and entered remotely into a custom-built database. Statistics regarding clinical and genetic characteristics and treatment outcome were calculated.Results: The 594 evaluable patients had a median age of 4.37 years and 56.4% were boys. Majority of patients had B-precursor ALL while 10.7% had T-ALL. CNS leukemia was present in 5.2% of patients. The distribution of common genetic abnormalities was similar to that reported from western populations, with 24.6% hyperdiploidy, 21% RUNX1-ETV6 positivity, 4.2% BCR-ABL1 positivity, and 2.5% with MLL gene rearrangement. Patients received risk-adapted therapy according to various protocols, although treatment strategies for the majority were similar. Five-year OS, RFS and EFS were 86.9%, 79.1%, and 73.3%, respectively. The OS for patients with pre-B ALL was significantly higher than for T-ALL (88.0% vs. 71.8%; P = 0.019, Log-Rank test). Patients with pre-B ALL categorized as low-risk by NCI/Rome criteria and those with hyperdiploidy had OS of 93.4% and 95.8%, respectively.Conclusions: The characteristics of childhood ALL in SA are similar to those observed in developed countries. Future prospective studies utilizing unified national protocols are needed to further improve the outcome of our patients