Advanced non-small cell lung cancer treated with palliative systemic therapy complicated by calvarial metastasis: a case report.

Background: Bony metastases are often seen in advanced cancers and lead to deterioration in patient quality of life with common complications of pain, bone fractures, and hypercalcemia. While most sites of metastasis to bone are observed in the axial skeleton from patients with a primary lung, breast or prostate cancer, metastases to the calvarium from lung cancer are less common, and thus less likely to be identified and managed. Case Description: A 69-year-old Caucasian female with advanced non-small cell lung cancer (NSCLC) presented with worsening symptoms of widespread body pain, fatigue, and weight loss. Physical examination was remarkable for a palpable protrusion on the patient's head. Imaging revealed a parieto-occipital calvarial lesion, a likely metastasis from her lung cancer. A previously performed CT-guided lung biopsy was evaluated for actionable tumor markers to allow for more specific and efficacious line of treatments; the patient's tumor had lacked any notable gene mutations. The treatment plan included radiotherapy, combined immunotherapy and chemotherapy consisting of pembrolizumab, pemetrexed, and carboplatin. Despite the treatment, the patient's skull lesion had continued to grow, and her overall condition deteriorated to the point where she required hospice. Conclusions: Given the unique location of calvarial metastases, early detection appears to correlate with improving patient outcomes and quality of life. A multimodal approach with a high index of suspicion is essential for diagnosing and managing rare presentations of metastatic disease.

Low-dose ketamine as an adjuvant for pain control in a cancer patient: a case report.

Cancer patients often suffer from pain related problems such as under-treatment of pain, ineffective and persistent opioid administration as well as adverse opioid use outcomes. There is a growing need for non-opioid analgesic alternatives for patients undergoing treatment for obstinate pain. Ketamine is a fast-acting N-methyl-D-aspartate (NMDA) receptor antagonist that has been emerging as an effective medication for pain alleviation. While protocols have been established for the use of Low-Dose Ketamine (LDK) for post-operative pain, there is growing evidence for using LDK as a clinical alternative to opioids in a palliative care setting. This case study involves monitoring the efficacy of LDK treatment in combination with opioid analgesics in a cancer patient in a hospital setting. This is a very selected case of a patient with Metastatic Prostate Cancer (Gleason 9 Adenocarcinoma) where LDK was shown to be efficacious at reducing pain when opioids and standard pain medications were not satisfactory. While the study involved using a relatively novel pharmacological protocol and close patient monitoring, the patient reported a sustained reduction in pain level based on the Numerical Rating Scale for months after the termination of LDK infusions. Moreover, the treatment also resulted in a reduction of total opioid usage after the addition of LDK. Although additional research is needed to ascertain optimal dosing schedules and route of Ketamine, given these promising findings, Ketamine may be a useful option for improving the treatment of refractory pain in patients with cancer and a good tool in palliative medicine for treating neoplastic pain.

Current approaches in regenerative medicine for the treatment of diabetes: introducing CRISPR/CAS9 technology and the case for non-embryonic stem cell therapy.

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder in which the body destroys its pancreatic ß cells. Since these cells are responsible for insulin production, dysfunction or destruction of these cells necessitates blood glucose control through exogenous insulin shots. Curative treatment involves pancreas transplantation, but due to the incidence of transplant rejection and complications associated with immunosuppression, alternatives are being explored. Despite facing clinical challenges and issues with public perception, the field of regenerative stem cell therapy shows great promise for the treatment of diabetes. The idea of harnessing pluripotency to derive cells and tissues with characteristics of choice is astounding but feasible, and this review seeks to determine which method of stem cell derivation is preferable for diabetes treatment. In this report, we outline the methods for deriving human embryonic stem cells (hESCs), induced pluripotent stem cells (iPSCs), and adult stem cells or progenitor cells to generate functional islet cells and related tissues. We discuss the specific uses and advantages of each method, and we comment on the ethics and public perceptions surrounding these methods and how they may affect the future of stem cell research. For the reasons outlined in this paper, we believe that non-embryonic stem cell lines, including iPSCs, somatic cell nuclear transfer lines, and adult tissue derived stem cells, offer the highest therapeutic potential for treating diabetes.