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Drug-induced photosensitivity refers to the development of cutaneous disease as a result of combined effects of a chemical and light. Photosensitivity reactions may result from systemic medications and topically applied compounds. Pirfenidone is known to cause photosensitivity reactions, rash, pruritus and dry skin at high doses. However, similar adverse reactions with low doses of Pirfenidone have not been reported. We report a case of photosensitivity reaction induced by low-dose Pirfenidone in a patient with idiopathic pulmonary fibrosis (IPF).

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Context:In this era of targeted therapy, it is important to distinguish the various subtypes of nonsmall cell lung carcinoma (NSCC). Diagnosis based on morphology alone is challenging in poorly differentiated carcinomas and core biopsies. Immunohistochemistry (IHC) helps in specifying the lineage for the subtype of NSCC. Till date, p63 is the most frequently used and sensitive marker for squamous cell carcinoma (SQCC). However, it is not specific and stains a subset of adenocarcinoma (ADC). Thus, a more reliable and specific marker is required for the diagnosis of SQCC. Objective: The objective of the study was to validate the diagnostic utility of p40 over p63 in differentiating pulmonary SQCC from ADC and NSCC-not otherwise specified (NOS). Materials and Methods: A total of 123 cases of NSCC were initially reviewed and subtyped blinded to the results of IHC. This was followed by a review of IHC slides which included p63, p40, thyroid transcription factor 1, Napsin-A, cytokeratin (CK) 5/6, and CK7. Results: There were 64 ADC, 19 SQCC, and 40 NSCC-NOS. IHC helped to confirm the morphological diagnosis in 62/64 ADCs and19/19 SQCCs. IHC classified the cases of NSCC-NOS into NSCC favoring ADC -12 cases, NSCC favoring SQCC -10 cases, and NSCC favoring AD-SQCC -4 cases. Both p63 and p40 showed near equal sensitivity for SQCC (100% and 97%, respectively), whereas p63 showed far lower specificity when compared to p40 (51.3% vs. 100%). Conclusion: The present study confirms and validates that p40 is equally sensitive but highly specific than p63 in detecting SQCC. Hence, we recommend the routine use of p40 instead of p63 for the definite categorization of NSCC of the lung.

Background: Vitamin D deficiency is common all over the Indian subcontinent, with a prevalence of 70-100% in the general population. Vitamin D deficiency has a role in several diseases of the respiratory system including chronic obstructive pulmonary disease (COPD). Studies have shown that vitamin D deficient COPD patients have lower lung function measured by FEV1. We conducted a study to see prevalence of Vitamin D deficiency in COPD patients and it’s correlation with Forced Expiratory Volume in 1 second.Methods: A cross sectional observational study was performed in a tertiary care hospital in Hyderabad, Telangana during the period of one and half year. This included 104 COPD cases attending outpatient department of pulmonary medicine. Serum vitamin D levels were measured, and spirometry was done in all patients and data was analyzed accordingly.Results: Among 104 patients, 87 were males and 17 were females. Most of the study population (44.2%) was aged between 60-70 years. Mean BMI was 26.40 (±5.77) kg/m2. Majority of study populations (66.34%) were in GOLD stage 1 and 2. The mean Vitamin D value of the study population was 20.77±11.74ng/ml. Majority of the COPD patients were vitamin D deficient (69.2%). 25.0 % was severely deficient of vitamin D. The mean FEV1 volume (%) was 83.15±11.53, 60.97±17.47, 30.71±7.96 in sufficient, deficient and severe deficient patients.Conclusions: Vitamin D deficiency is common in COPD patients. Serum vitamin D deficiency increases with increased severity of COPD. There is positive correlation between serum vitamin D levels and post bronchodilator FEV1 (%).