Dr. Rishi Raj is an Clinical Professor of Medicine at Stanford University and directs the Interstitial Lung Disease program at Stanford. He specializes in the diagnosis and treatment of interstitial lung diseases and has practiced pulmonary and critical care medicine for more than 15 years. Dr. Raj's primary clinical interest and primary focus of clinical research is interstitial lung diseases including idiopathic pulmonary fibrosis, other idiopathic interstitial lung diseases, drug induced interstitial lung diseases, interstitial lung disease associated with connective tissue diseases including scleroderma, rheumatoid arthritis, dermatomyositis etc., sarcoidosis, hypersensitivity pneumonitis and other miscellaneous interstitial lung diseases. Dr. Raj is the principal investigator and co-investigator on multiple clinical trials evaluating new therapies for treating idiopathic pulmonary fibrosis and pulmonary fibrosis/interstitial lung disease from other etiologies.
- Idiopathic Pulmonary Fibrosis
- Other Idiopathic Interstitial Lung Diseases
- Connective Tissue Associated Interstitial Lung Disease (RA, Scleroderma, Myosites, others)
- Drug Induced Interstitial Lung Diseases
- Hypersensitivity Pneumonitis
- Other Interstitial Lung Diseases
- Pulmonary Disease
Clinical Professor, Medicine - Pulmonary, Allergy & Critical Care Medicine
Director, Interstitial Lung Disease Program, Stanford (2017 - Present)
Board Certification: American Board of Internal Medicine, Critical Care Medicine (2003)
Board Certification: American Board of Internal Medicine, Pulmonary Disease (2002)
Fellowship: Baylor College of Medicine Registrar (2002) TX
Residency: Texas Tech University Health Sciences Center (1999) TX
Medical Education: Christian Medical College/Vellor (1995)
Sleep Patterns and Health Behaviors in Healthcare Students.
Southern medical journal
2020; 113 (3): 104–10
OBJECTIVES: Personal health behavior can influence the academic development of healthcare students. This study was designed to evaluate the personal health behavior, including sleep time, of healthcare students at a large health sciences center.METHODS: An anonymous online survey based on standardized questionnaires about sleep, insomnia, depression, alcohol use, and exercise was sent to all of the healthcare students (including medical, nursing, pharmacy, graduate biomedical science, and allied health students) in the Texas Tech University Health Sciences Center graduate education programs in Lubbock.RESULTS: In total, 412 students replied to this survey. Their mean sleep duration during the weekday was 7.5 ± 1.2 hours; 16.5% were short sleepers (<7 hours) during weekdays; 33% of the students woke up "feeling tired or worn out" >15 days during the last month. Many students were either moderately or severely bothered by "the lack of energy" because of poor sleep, and 56.6% of students rated their sleep as either fair or poor. Approximately 35% of students had drinking patterns that qualified as hazardous drinking, 6.3% of students smoked, and 23% of students did not do even mild exercise during the week. Eighty-nine percent of students reported stress in their life, including family stress, job stress, financial stress, legal stress, and other stress. Thirty-five percent of students considered their health as either poor or fair. Approximately 50% of students did not expect any change in their situation during the next 3 to 6 months.CONCLUSIONS: Although most healthcare students report adequate sleep times, more than half of them rate their sleep as fair or poor. In addition, some have poor health habits, including excessive alcohol use. Health science centers should introduce programs to promote healthy behaviors and reduce stress in healthcare students.
View details for DOI 10.14423/SMJ.0000000000001077
View details for PubMedID 32123923
Vaping-related Acute Parenchymal Lung Injury: A Systematic Review.
The ongoing U.S. outbreak of vaping-related acute lung injury, recently named EVALI (E-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature reveals 216 patient cases spanning 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, pathologic patterns of lung injury attributable to vaping, as well as provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most common vaped substance and Vitamin E acetate was found in bronchoalveolar lavage specimens from many affected individuals, however no specific component or contaminant has conclusively been identified as the cause for the injury to date. Patients present with cough, dyspnea, constitutional symptoms, and gastrointestinal symptoms. Radiology and histopathology demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the key to an accurate diagnosis. Treatment is supportive, mortality is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease but more rigorous studies are needed to clarify their role in treating vaping related lung injury.
View details for DOI 10.1016/j.chest.2020.03.085
View details for PubMedID 32442559
Peripheral blood proteomic profiling of idiopathic pulmonary fibrosis biomarkers in the multicentre IPF-PRO Registry
2019; 20 (1): 227
Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease for which diagnosis and management remain challenging. Defining the circulating proteome in IPF may identify targets for biomarker development. We sought to quantify the circulating proteome in IPF, determine differential protein expression between subjects with IPF and controls, and examine relationships between protein expression and markers of disease severity.This study involved 300 patients with IPF from the IPF-PRO Registry and 100 participants without known lung disease. Plasma collected at enrolment was analysed using aptamer-based proteomics (1305 proteins). Linear regression was used to determine differential protein expression between participants with IPF and controls and associations between protein expression and disease severity measures (percent predicted values for forced vital capacity [FVC] and diffusion capacity of the lung for carbon monoxide [DLco]; composite physiologic index [CPI]). Multivariable models were fit to select proteins that best distinguished IPF from controls.Five hundred fifty one proteins had significantly different levels between IPF and controls, of which 47 showed a |log2(fold-change)| > 0.585 (i.e. > 1.5-fold difference). Among the proteins with the greatest difference in levels in patients with IPF versus controls were the glycoproteins thrombospondin 1 and von Willebrand factor and immune-related proteins C-C motif chemokine ligand 17 and bactericidal permeability-increasing protein. Multivariable classification modelling identified nine proteins that, when considered together, distinguished IPF versus control status with high accuracy (area under receiver operating curve = 0.99). Among participants with IPF, 14 proteins were significantly associated with FVC % predicted, 23 with DLco % predicted, 14 with CPI. Four proteins (roundabout homolog-2, spondin-1, polymeric immunoglobulin receptor, intercellular adhesion molecule 5) demonstrated the expected relationship across all three disease severity measures. When considered in pathways analyses, proteins associated with the presence or severity of IPF were enriched in pathways involved in platelet and haemostatic responses, vascular or platelet derived growth factor signalling, immune activation, and extracellular matrix organisation.Patients with IPF have a distinct circulating proteome and can be distinguished using a nine-protein profile. Several proteins strongly associate with disease severity. The proteins identified may represent biomarker candidates and implicate pathways for further investigation.ClinicalTrials.gov (NCT01915511).
View details for DOI 10.1186/s12931-019-1190-z
View details for Web of Science ID 000492020100001
View details for PubMedID 31640794
View details for PubMedCentralID PMC6805665
- Survival implications of pulmonary hypertension in end-stage COPD EUROPEAN RESPIRATORY SOC JOURNALS LTD. 2019
- Elevated pulmonary vascular resistance is associated with increased risk of death in IPF EUROPEAN RESPIRATORY SOC JOURNALS LTD. 2019
Predictors of death or lung transplant after a diagnosis of idiopathic pulmonary fibrosis: insights from the IPF-PRO Registry
2019; 20: 105
Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a variable clinical course and high mortality. We used data from a large national US registry of patients with IPF to investigate relationships between patient characteristics, including markers of disease severity, and mortality.The analysis cohort comprised patients enrolled in the IPF-PRO Registry from its inception on 5 June 2014 to 26 October 2017. The primary criterion for inclusion in this registry is that patients must be diagnosed or confirmed with IPF at the enrolling centre within 6 months. Associations between patient characteristics and markers of disease severity at enrolment and mortality outcomes were investigated using univariable, multivariable and adjustment models.Among 662 patients enrolled, 111 patients died or had a lung transplant over a follow-up period of 30 months. The probability of being free of both events at month 30 was 50.6% (95% CI: 40.0, 60.2). When patient characteristics and markers of disease severity were jointly examined in a multivariable analysis, oxygen use at rest (hazard ratio [HR] 2.44 [95% CI: 1.45, 4.10]), lower forced vital capacity (FVC) % predicted (HR 1.28 [95% CI: 1.10, 1.49] per 10% decrease) and diffusion capacity for carbon monoxide (DLco) % predicted (HR 1.25 [95% CI: 1.04, 1.51] per 10% decrease) were significantly associated with increased risk of death or lung transplant. The risk of death or lung transplant increased with increasing age in patients ≥62 years old (HR 1.18 [95% CI: 0.99, 1.40] per 5-year increase), and decreased with increasing age in patients <62 years old (HR 0.60 [95% CI: 0.39, 0.92] per 5-year increase).In an observational US registry of patients with IPF, oxygen use at rest, lower FVC % predicted, and lower DLco % predicted were associated with risk of death or lung transplant. An audio podcast of the lead author discussing these data can be downloaded from: http://www.usscicomms.com/respiratory/snyder/IPF-PROsurvival1/ .ClinicalTrials.gov number: NCT01915511 .
View details for DOI 10.1186/s12931-019-1043-9
View details for Web of Science ID 000469504900001
View details for PubMedID 31142314
View details for PubMedCentralID PMC6542049
- Tissue Continues to Be the Issue Role of Histopathology in the Context of Recent Updates in the Radiologic Classification of Interstitial Lung Diseases ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE 2019; 143 (1): 30–33
Tissue Continues to Be the Issue: Role of Histopathology in the Context of Recent Updates in the Radiologic Classification of Interstitial Lung Diseases.
Archives of pathology & laboratory medicine
2019; 143 (1): 30–33
High-resolution computed tomography (HRCT) imaging has an increasingly important role in clinical decision-making in patients with interstitial lung diseases. The recent Fleischner Society white paper on the diagnostic criteria for idiopathic pulmonary fibrosis highlights the advances in our understanding of HRCT imaging in interstitial lung diseases.To discuss the evidence and recommendations outlined in the white paper as it pertains to the radiologic diagnosis of interstitial lung disease, specifically highlighting the current limitations of HRCT in confidently predicting histopathologic findings.The recent Fleischner Society white paper and other studies pertaining to the role of HRCT in predicting histopathology in interstitial lung diseases are reviewed.High-resolution computed tomography is highly predictive of a usual interstitial pneumonia (UIP) pattern on histopathology when the HRCT shows a typical UIP pattern on a "confident" read by the radiologist. A probable UIP pattern is also very predictive of a UIP pattern on histopathology, and histopathologic confirmation is not needed for most patients demonstrating this pattern in the appropriate clinical setting. A UIP pattern may be seen in a substantial proportion of patients with an "indeterminate UIP" pattern on HRCT and in many patients for whom the HRCT suggests an alternative diagnosis; histopathologic confirmation should be considered in patients demonstrating these patterns whenever feasible.
View details for PubMedID 30785335
Rituximab Versus Mycophenolate Mofetil in Interstitial Lung Disease Secondary to Connective Tissue Disease
View details for Web of Science ID 000447268902402