Continuity of Care for Persons With Serious Mental Illness in a Rural Rehabilitation Program During the COVID-19 Pandemic in India.

The COVID-19 pandemic has posed challenges to community-based rehabilitation (CBR) for persons with mental illness, especially in resource-constrained settings. This column discusses the pandemic-related challenges faced by a rural CBR program in Jagaluru taluk (a subdistrict) in Karnataka, India. Thanks to stakeholder collaboration, task shifting with lay health workers, and implementation of telepsychiatry, the authors' clinical team could ensure uninterrupted medical care for persons with serious mental illness. Other CBR components were reduced because of pandemic-imposed resource and logistic constraints.

Anaplastic lymphoma kinase-positive pulmonary inflammatory myofibroblastic tumor with sarcomatous morphology and distant metastases: An unusual histomorphology and behavior.

Inflammatory myofibroblastic tumor (IMT), an intermediate-grade neoplasm of myofibroblastic/fibroblastic differentiation, occurs commonly in children and young adults. It is characterized by anaplastic lymphoma kinase (ALK) gene rearrangement and overexpression of ALK-protein. However, aggressive behavior is more commonly associated with ALK-negativity rather than ALK-positivity. Pulmonary involvement is most common visceral location and carries minimal potential for distant metastasis. We present a case of 49-year-old female with pulmonary IMT of spindle cell sarcomatous histomorphology. Frequent mitoses and necrosis with characteristic cytoplasmic immunoreactivity for ALK-1 protein and ALK-gene rearrangement on fluorescence in-situ hybridization were noted. This case is unusual for occurrence in higher age-group of fifth decade, sarcomatous histomorphology at presentation (rather than transformation) and metastases to distant sites despite ALK-protein overexpression and gene rearrangement.