62 years old man with non small cell adenocarcinoma and biomarker evaluation for targeted therapy

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here after collecting informed patient consent (form downloadable Click Here) by BMJ Elective Student.

The 62 year old man appears to have a non-small-cell lung (NSCLC) adenocarcinoma lung with cerebral metastasis and the doctors are looking to further test for bio-markers that may predict response to targeted precision Medicine.

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WhatsApp Discussion:
SC:should prophylactic cranial irradiation be performed in bronchial adenocarcinoma/NSCLC as is advocated for SCLC? Because this patient had a brain met

RB: Yes "traditionally, whole-brain radiation therapy (WBRT) has been the standard treatment for brain metastases with multiple intracranial lesions although studies have shown no overall survival benefit and no improvement in quality of life.
It's one of the reasons why oncologists currently have shifted to what are termed as precision Medicine approaches and one sees case reports where "small-molecule inhibitor of EGFR-TKI is used in lung adenocarcinoma with brain metastases showing EGFR mutation-positive with reasonable quality of life outcomes. This is perhaps what has also been planned for our patient in Tata memorial. Shreyas do you have his current update?

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55 years Old male with Bipolar affected disorder moving from depression to Manic to depression phase

Disclaimer:- This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here December 2017 after collecting informed patient consent (form downloadable Click Here) This is a case of a 55 years old, diabetic, hypertensive patient who was diagnosed with Bipolar affected disorder since 1995. In 1995 due to financial loss he was attacked by this condition. He was seen by Dr. D. K Agarwala and diagnosed as BPAD-Depression phase and treated with lithium, sodium valporate, propranolol, Zeptol cr, Nitrosum - S. With the treatment he was reasonably well but every 6 months of interval he appeared to have some disturbance like didn't want to talk to anybody, forgot to smile etc. They went to the doctor and treated accordingly and was continuing the treatment. In the year of 2013, August he was diagnosed with BPAD-severe depression phase but, he was not responding well to the medications and then they went to NIMHANS for

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drugs to avoid or use in terms of their pregnancy category

The optimal AEDs therapy of women with epilepsy who are of childbearing age is unclear because of a lack of conclusive data on the comparative teratogenicity of different antiseizure drugs and no antiepileptic drug has proven safe in pregnancy in terms of teratogenesis. Data on the comparative efficacy of various antiseizure drugs for controlling seizures during pregnancy are also quite limited, and there are no randomized trials in this setting. Treatment must be individualized for all patients. Women with epilepsy are classified as high risk during pregnancy and as there are no clear data indicating that any drug is without risk in pregnancy therefore, the antiseizure drug regimen should be optimized six months prior to planned conception. Choice of antiepileptic drugs in women of childbearing age and pregnant women with epilepsy: 1. T he antiseizure drug that stops seizures in a given patient is the one that should be used with an exception of valproate. 2.

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