Articles

Nodal marginal zone lymphomas are indolent and rare non-Hodgkin lymphomas, most often diagnosed at an advanced stage. Their clinical presentations are typically insidious, which can lead to delayed diagnosis. The concomitant secretion of IgM and IgG immunoglobulins with kappa light chains constitutes an exceptional feature in this type of lymphoma, as illustrated by our case. We report the case of a 62-year-old man with a history of treated syphilis and inferior vena cava thrombosis managed with rivaroxaban, who presented with a left inguinal mass evolving over three months, accompanied by fever, night sweats, and weight loss. Clinical examination revealed non-inflammatory left inguinal lymphadenopathy without other abnormalities. Laboratory tests showed non-regenerative anemia, leukopenia, and elevated LDH levels. Protein electrophoresis revealed a monoclonal peak in the gamma region, confirmed by serum immunofixation showing two monoclonal bands of IgG kappa and IgM kappa types. Biopsy of the inguinal lymph node revealed histological and immunohistochemical features consistent with a small B-cell marginal zone lymphoma, staged as IV based on the extension workup. A chemotherapy regimen consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was initiated, resulting in a partial response after four cycles. The coexpression of IgM and IgG kappa light chains in nodal marginal zone lymphomas, which are already rare, is an unusual finding. This particularity warrants multicenter studies to better assess its diagnostic, prognostic, and therapeutic implications.

An unhealthy dietary habit leads to excess calorie consumption (overnutrition) or inadequate supply of one or more essential micronutrients (undernutrition).This nutritional imbalance is assessed by Anthropometric measurements, Biochemical estimations, Clinical examination and assessment of Dietary intakes. Anthropometry is an inexpensive, rapid and non-invasive method that provides details on different components of body structure and is highly sensitive to the broad spectrum of nutritional status. Hence, it has always been an important tool for screening and early diagnosis of malnutrition. Undernutrition in below 5 year children is life-threatening epidemic contributing to about 45% of under 5 child deaths. Children with Severe Acute Malnutrition (SAM) are nine times more likely to die, compared to their healthy counterparts. Therefore, early and accurate diagnosis of children with SAM is crucial for its management and prevention of morbidity and mortality from the same. SAM is defined as weight-for-height Z scores (WHZ) below -3SD of the median or a mid upper arm circumference (MUAC) of <115mm in children of 6-59 months age. The cut-offs for MUAC and WHZ are scientifically approximated to each other and both are used to diagnose children with SAM (Severe Wasting). However, the research findings from various countries revealed that the agreement between WHZ and MUAC is poor as both indices classify the children with SAM differently, with a small overlap, which varies greatly among countries. These discrepancies have an implication when using either one alone for measuring the prevalence of acute malnutrition. Therefore, it is pertinent to adopt both WHZ and MUAC indices to assess the burden of severe acute malnutrition (SAM) in the community.

<b>Background and aim:</b> Developing clinical skills and its assessment is one of the most important components in nursing education which prepares the student for the reality of practice. Objective structured clinical examination (OSCE) is extensively used and widely accepted by nurse educators across the globe to assess the competency skills of nursing students. The present study aimed at identifying the attitude and perceptions of faculty, and exploring their feedback and experience in conducting OSCE as an assessment tool. <b>Methods:</b> A triangulation research approach was used with convenience sampling. Data collection was carried out using questionnaires and semi-structured interviews. Participants were ten faculty members who were involved in conducting OSCE for students. <b>Results and conclusion</b>: Most of the faculty felt that OSCE reflected the skills of delivery of safe patient care, and the structure reflected mastery of knowledge and skills, which are related to course objectives. OSCE was regarded by the faculty as a consistent, reliable, valid, and objective measure to assess students’ performance and to improve students’ confidence in clinical skills. Concerns were raised about a high level of stress in students, the time required for the proper performance of tasks, OSCE scenarios lacking real-life situations in assessment, and the need for repeated practice and intensive mock training sessions. The applicability of OSCE in terms of limitations in human and material resources with a large number of students would necessitate rethinking in developing other assessment strategies to improve the overall process.