Due to its heterogeneous morphology and its rarity, anaplastic lymphoma kinase gene-rearranged renal cell carcinoma (ALK RCC) is a diagnostically challenging entity, often leading to labelling these tumors as RCC, not otherwise classified. This may have clinical and managerial implications, given that patients with ALK oncogene rearrangement may benefit from ALK-inhibitors. Therefore, we attempted to elucidate the clinicopathologic and immunophenotypical characteristics of ALK RCC in a large international cohort. Sixteen multi-institutional tumors were included in the study. Clinical, macroscopic, microscopic, immunohistochemical (IHC), molecular (DNA and RNA sequencing, FISH) and follow-up data were evaluated. There were 9 male and 7 female patients with tumor size ranging from 2 to 12.2 cm (mean=7.1 cm). All tumors had solid, tan-white with focal cystic changes and gelatinous appearance. Cystic changes and necrosis were seen in 7 and 6 tumors, respectively. Microscopically, a heterogeneous growth pattern was observed including solid (12), tubular (7), papillary (5), tubulocystic (2), pleomorphic epithelioid cells (6), sarcomatoid (2), rhabdoid (4), and intranuclear pseudoinclusions. All tumors were ALK-positive, coexpressing PAX8, KRT7, SDH, FH, and variably CD10, Vimentin, and AMACR. Molecular analysis through next-generation sequencing (NGS) was performed on 14/16 tumors. EML4::ALK (n=5) was the most common gene fusion observed; others included TPM1::ALK(n=4), TPM3::ALK(n=2), SLIT1::ALK(n=2)and VCL::ALK(n=1). Despite focal TFE3 immunoreactivity in 4/13 cases, the absence of TFE3 gene rearrangement by molecular analysis excludes TFE3- rearranged RCC as a differential diagnosis. Our study further expands the clinicopathologic, morphologic, and molecular genetic spectrum of ALK-RCC. ALK-RCC can be morphologically heterogeneous and mimic other well-established entities posing a misdiagnosis if appropriate IHC and/or molecular studies are not performed. Accurate diagnosis is of clinical significance as patients with this neoplasm may potentially benefit from ALK-inhibitors, particularly in a metastatic setting. As TFE3 immunoreactivity is not uncommon in ALK-RCC, documentation of ALK gene rearrangement is critical, either by surrogate IHC staining or cytogenetic/molecular analysis is essential.
Leptospirosis is a globally prevalent zoonotic infection caused by Leptospira species. Cardiac involvement is increasingly recognized, yet large-scale studies comprehensively evaluating electrocardiographic and echocardiographic manifestations, including myocarditis, remain limited. This retrospective study included adult patients with clinically suspected leptospirosis and positive IgM ELISA admitted to a tertiary care hospital in South India between January 2016 and September 2020. Clinical features, electrocardiographic (ECG) findings, two-dimensional echocardiographic parameters, and in-hospital outcomes were analyzed. Binomial logistic regression was performed to identify independent predictors of all-cause mortality and myocarditis. A total of 510 patients were analyzed (mean age 48.4 ± 13.7 years; 66.5
Hereditary angioedema (HAE) with C1 inhibitor deficiency is a rare disease characterized by unpredictable episodes of tissue swelling (angioedema), which, in most cases, occur first under the age of 18 years, and entail a significant burden of disease not only for the patients but also for their families. Clinical symptoms of HAE are not specific, which may cause difficulties in differential diagnosis. Additionally, if not appropriately treated, HAE attacks can be life-threatening. The international HAE guidelines published so far have focused mainly on adults. A guideline that refers to the age-specific characteristics of pediatric patients, both in terms of diagnosis and management, was therefore needed. The International Steering Committee and Taskforce developed recommendations and provided evidence-based grading based on expert opinion and strength of evidence. Recommendations were presented to, discussed, and electronically voted by healthcare professionals during the 14th C1 Inhibitor Deficiency and Angioedema Workshop in Budapest, Hungary, 2025. This international guideline will ensure early diagnosis, standardized and up-to-date treatment, and promote the availability of effective therapies for all pediatric patients affected with this rare disease. It also draws attention to the importance of establishing HAE centers and registries, which solicit specialist care and research of the disease.
Background and aim:Length-based tapes are extremely useful in critically sick children to estimate weight, emergency drug dosages, size of the equipment, and dose of defibrillation/cardioversion. The Indian Academy of Pediatrics (IAP), Advanced Life Support (ALS), and Basic Life Support (BLS) group felt the need to develop an indigenous tape for Indian children. A color-coded length-based tape [Indian Children Length-based Tape (InChiTape)] was planned to develop and later validate it. Patients and methods:The population included children admitted to the emergency in the age range of 1 month-12 years and weight range of 2.5-40 kg. A color-coded length-based tape was developed using the World Health Organization (WHO) weight-for-length/height charts for boys (≤5 years) and the IAP weight-for-length/height charts for boys (>5 years). The median weights/lengths, corresponding +2SD and -2SD lengths, were marked on the charts for boys starting from 2.5 kg onward. Results:Fourteen centers from all zones of India pooled the data of 1,595 children. The majority of children were in the age range of 1-3.9 years (30%) and weight range of 5-9.9 and 10-14.9 kg (24.9 and 24.4%, respectively). The actual weight of children corresponded to the correct weight range/band on the InChiTape in 69.1% (n = 1,102) children, ranging from 56.6 to 78.4% in different age-groups and 55.5 to 76.3% in different weight ranges. There was a good correlation between actual weight and the average of respective weight range/band on the InChiTape (Pearson correlation of 0.95, p < 0.001). Conclusion:The InChiTape is a rapid, reliable, and accurate method of estimating the weight of Indian children weighing 2.5-40 kg in an emergency. How to cite this article:Angurana SK, Gupta S, Tiwari L, Shamarao S, Khera D, Sarkar M, et al. Development and Validation of Indian Children Length-based Tape (InChiTape) for Use in Critically Sick Children. Indian J Crit Care Med 2026;30(1):35-39.
Skin aging reflects both intrinsic biological decline and extrinsic influences collectively known as the skin exposome, including ultraviolet (UV) radiation, air pollution, psychosocial stress, fatigue, sleep disruption, and suboptimal lifestyle behaviors. These factors contribute to cumulative molecular and structural damage, positioning the skin as both a visible marker of whole-body aging and a target for longevity strategies. This review examines the validity of an integrative “In and Out” approach, combining topical treatments, such as retinoids, peptides, antioxidants, and exosome-based formulations, with internal nutraceuticals including NAD+ precursors, collagen peptides, polyphenols, and microbiome modulators. By targeting key hallmarks of aging, oxidative stress, inflammation, and epigenetic changes, this dual-modality model has the potential to promote skin regeneration, enhance aesthetic and functional outcomes, and contribute to broader health span optimization. Emerging tools such as skin aging clocks, biomarker-driven personalization, and artificial intelligence (AI)-guided interventions further strengthen this paradigm, establishing a scientifically grounded, preventive, and personalized framework that redefines the role of dermatology in the context of longevity. Personalized strategies that integrate diagnostic tools, lifestyle coaching, and tracking technologies allow for adaptive, dynamic strategies both internally and externally.
