DELHI PULMONOLOGIST

Charmswood Village, Faridabad, Haryana

This is a life saving procedure performed during bronchoscopy to rapidly control the bleeding from the airways or lungs. It is a simple procedure but requires high end expertise. After identifying the site of bleeding, an endobronchial balloon is threaded over a guide wire and inflated at the opening of the bleeding segment to produce tamponade. Once bleeding comes under control the balloon can be easily pulled out. The procedure has >90% success rate.

In patients with bronchogenic carcinoma, when the tumour is occupying and obstructing the passage of air resulting in breathlessness, after debulking the tumour with LASER a stent is placed to keep the passage patent. This is a self expandable metallic stent which is placed under local anaesthesia during flexible bronchoscopy and provides instant relief to the patient.

This a specialized diagnostic procedure carried out to access the lymph glands which are lying outside the airways but inside the chest (area is called mediastinum). It is usually done for diseases like Sarcoidosis, Tuberculosis, Lymphoma, Multiple myeloma etc. A very fine needle is used to go beyond the confines of the tracheobronchial tree during the bronchoscopy. It can also be used for the diagnosis of growths or tumours present within the airways but carrying a high risk of bleeding with biopsy. It carries a diagnostic accuracy of 65 to 75% approximately.

Bronchoscopy is a technique of visualizing the human airways using an endoscope called bronchoscope. It is a thin tubular instrument that can be flexible or rigid (metallic) fixed with a video camera at one end and viewer at the other. Flexible bronchoscope is more common than rigid type as there is no need to give anesthesia and can be performed easily as an outdoor or daycare procedure in the Bronchoscopy suite or even bedside of the patient. videobronchoscope is an advanced equipment which replaces the flexible bronchoscope. It has a charged couple device at its tip which captures images and relays to a video-processor unit which then displays the images on a monitor. The images, thus produced are magnified and much sharper. Multiple images can be examined together, video recordings performed and shared with the patients.

Medical thoracoscopy.

Pulmonary Function Test is also called as PFT. It is an objective test which helps in measuring the functional capacity of the lungs. It is conducted for evaluation of cough and breathlessness. Not only does it help in reaching a diagnosis but also helps in measuring the severity of the problem and the likelihood of response to treatment. The analysis is based on a computer generated report. A specialized test, called Diffusion Capacity is conducted in selected patients.

Infectious diseases, also known as communicable or transmissible diseases are those diseases which have been caused by a pathogenic microbe like virus, bacteria, fungi and protozoa. These include diseases like flu, h1n1, dengue, chikungunya, typhoid, malaria, tuberculosis, pneumonia, gastroentritis, hiv, urinary tract infection, meningitis, antibiotic resistant community acquired and hospital acquired infections and many more in india, the range and burden of such diseases is enormous. Infection, not heart disease, diabetes, or cancer, is the leading cause of death in india. The greatest challenge being faced by healthcare workers, today, is the resistance acquired by the microbes to the commonly used antibiotics resulting in multi-drug resistant pathogens or superbugs as they are commonly referred to. Thus it is imperativ to consult an infectious diseases specialist for proper treatment of such diseases. However, in india, while other specialists like internist, intensivist, cardiologist, nephrologist are all easy to find, but there are very few qualified infectious diseases specialists (i d specialists) available.

Critical care or Intensive care medicine is that branch of medicine which deals with the diagnosis and management of life threatening conditions like Respiratory Failure, Acute Respiratory Distress Syndrome (ARDS), Sepsis, Shock, Multi-Organ Failure, Coma, Electrolyte Imbalance and many more. Such patients can be very challenging & require immediate care. They are managed in the Intensive Care Unit (ICU) of a hospital. Dr. Nangia, is one of the few in the city, with over 20 years of experience of working in this field. He has been a visiting fellow to the Pulmonary & Critical Care Units of Cleveland Clinics, USA. He is, currently, the Director of Medical ICU at Fortis Hospital, Vasant Kunj and commonly gets transfers of very sick patients from various hospitals. He has also been involved in the care of patients on ventilators and BiPAPs at home.

Insufficient SleepSleep FragmentationNarcolepsyRecurrent Hypersomnias Non-Pharmacologic StrategiesPharmacologic TreatmentSleep DisorderSummaryAlthough the importance of sleep and well-being has been known for centuries, only recently has the medical profession begun to focus on sleep disorders and their effects. According to a research, 40 million Americans were chronically ill with various sleep disorders, with an additional 20 to 30 million experiencing intermittent sleep-related problems. Besides excessive daytime sleepiness and loss of productivity, many studies have suggested that sleep disorders cause important cardiovascular morbidity and possibly mortality.Most patients studied in sleep laboratories for clinical examination do so because of complaints related to excessive daytime sleepiness, nonrefreshing sleep, and chronic fatigue that cannot be ameliorated by sleep. In 80% to 90% of these patients, laboratory examination uncovers breathing disorders during sleep. Sleepiness is the increased likelihood of falling asleep, often during monotonous or sedentary activities, whereas fatigue is difficulty sustaining a high level of performance. There are three commonly available tools to aid in measuring the degree of sleepiness: the Epworth Sleepiness Scale (ESS), the Multiple Sleep Latency Test (MSLT), and the Maintenance Of Wakefulness Test (MWT). The ESS is a self-administered questionnaire that has patients rate on a scale of 0 to 3 their likelihood of falling asleep during eight common situations and provides a simple subjective measure of sleepiness (Table 1). The questionnaire reflects the level of the patient's daytime somnolence; the higher the score, the sleepier the patient. The MSLT and MWT are objective tests of daytime sleepiness, testing length of time to achieving sleep onset and REM sleep during daytime naps. During the MSLT, the subject is instructed to try to sleep, whereas in the MWT the patient is instructed to try to stay awake.