AR Advanced Respiratory HUBDr. Ranjit Singh is a Pulmonologist with specialized expertise in Sleep Apnea, NIV and ILD procedures and has an experience of 18 years in this field. Having laid the foundation of his career in 2001, Dr. Singh has come a long way in terms of professional experience. His present centres of consultation are RTIICS (Kolkata) and Advanced Respiratory Centre (Jharkhand) where one may visit with a prior appointment.. He completed MBBS from Ranchi University in 1996, DM - Pulmonary Medicine from SMS Medical College, Jaipur in 2001 and MRCP from Royal Colleges of Physicians, Uk in 2008. Faculty at CMC Vellore. Trained in interventional Bronchology from France Marsille. MRCP examiner since 2012. Some of the services provided by the doctor are Video Bronchoscopy, Endobronchial Ultrasound (EBUS) and Thoracoscopy, Cryo biopsy in ILD, Debulking of the Tumor, Management of central airways Tumor, Ultrasound chest etc. Diseases like Interstitial lung diseases, Lung cancer, severe COPD, Severe Uncontrolled Asthma.
Personalised Medicine for Asthma and Chronic Obstructive Pulmonary Disease
Asthma and chronic obstructive pulmonary disease (COPD)
are prevalent condition sboth significant heterogeneity
within each of these conditions and additionally significant
overlap in many of the clinical and inflammatory features useful clinical and immunological biomarkers which
inform about prognosis and response to therapy have
emerged in both asthma and COPD.
These biomarkers will allow both better targeting of existing treatments and the identification of those patients who will respond to novel therapies which are now becoming available Delivery of precision medicine
in airways disease is now feasible and is a core component
of a personalised healthcare delivery in asthma and COPD
COPD (Chronic obstructive pulmonary diseases or chronic bronchitis)
Assessment of the risk of death in this patients depend on their BODE Index B stand for BMI, O- Obstruction depending on FEV1, D - Shortness of breath OR dyspnea using MMRC scale , E - Exercise capacity, measured by 6 minutes walk test 6MWT.This index calculated using a scale of 0 to 3 for each parameter, depending on severity. except BMI scale different < 21 is 0 and more than >21 is 1. BODE score of 7 to 10 falls in the higher chance of mortality.
Other factors have also been associated with increased moribidity and mortality in COPD , For example : acute exacerbation of COPD, Hospitalization, cardiac comorbidities
Survival benefit are smoking cessation and lung volume reduction surgery in selected patients .Oxygen is beneficial who are hypoxemic on room air. None of the medications consistently demonstrated to prolong life.
Blood Eosinophils and Response to Maintenance Chronic Obstructive Pulmonary Disease Treatment. Data from the FLAME Trial.
indacaterol/glycopyrronium provides superior or similar benefits over salmeterol/fluticasone regardless of blood eosinophil levels in patients with COPD
The incidence of pneumonia was higher in patients receiving salmeterol/fluticasone than indacaterol/glycopyrronium in both the <2% and ≥2% subgroups
Indacaterol/glycopyrronium was significantly superior to salmeterol/fluticasone for the prevention of exacerbations
COPD patients significant effects on survival have been shown for several interventions , including. high-frequency neuromuscular electrical stimulation should initiated as the main training modality during his Pulmonary rehabilitation programme, weight gain in underweight patients , non-invasive positive pressure ventilation in chronic hypercapnic patients and lung volume reduction surgery or endobronchial valve treatment in patients with upper-lobe predominant emphysema and poor exercise capacity
2000 classification of idiopathic interstitial lung diseases
The 2000 classification consists of seven entities of idiopathic interstitial diseases which are defined on clinical, radiological and pathological criteria: idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, respiratory bronchiolitis associated interstitial lung disease, desquamative interstitial pneumonia and lymphoid interstitial pneumonia. The most frequent is Idiopathic Pulmonary Fibrosis, which has a poor prognosis.
Postoperative Pulmonary Complications
Br J Anaesth. 2017;118(3):317-334.
Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, and atelectasis develops in > 75% of patients receiving a neuromuscular blocking drug..The respiratory system may take 6 weeks to return to its preoperative state after general anaesthesia for major surgery.
clinicians should be aware of non-modifiable and modifiable factors in order to recognize those at risk and optimize their care.Preventative measures include preoperative optimization of co-morbidities, smoking cessation, and correction of anaemia, in addition to intraoperative protective ventilation strategies and appropriate management of neuromuscular blocking drugs. Protective ventilation includes low tidal volumes, which must be calculated according to the patient's ideal body weight.
the most beneficial level of PEEP is required,
Bronchoscopic Lung Cryobiopsy Increases Diagnostic Confidence in
the Multidisciplinary Diagnosis of Idiopathic Pulmonary Fibrosis
American Journal of Respiratory and Critical Care Medicine Volume 193 Number 7 | April 1 2016
BLC is a new biopsy method that has a meaningful
impact on diagnostic confidence in the multidisciplinary
diagnosis of interstitial lung disease and may prove useful in the
diagnosis of IPF.