Lokesh Tiwari | All India Institute of Medical Sciences, Patna (original) (raw)
Papers by Lokesh Tiwari
Indian pediatrics, 2009
We report nasopharyngeal teratoma in a term female neonate, that presented within first week of l... more We report nasopharyngeal teratoma in a term female neonate, that presented within first week of life with episodic stridor, apnea and cyanosis. Laryngoscopy revealed a mass which was confirmed by MRI. The mass was surgically excised and diagnosed as nasopharyngeal teratoma on histopathology. The child is doing well on follow-up.
Haemolytic uremic syndrome (HUS) is characterised by the triad of non immune haemolytic anaemia, ... more Haemolytic uremic syndrome (HUS) is characterised by the triad of non immune haemolytic anaemia, thrombocytopenia and renal failure. It is rare in newborns. Only 5 cases of neonatal HUS have been reported to-date. We describe a series of 2 cases of neonatal HUS where one had definite history of birth asphyxia and another was an abandoned baby without clinical details about perinatal period. The known modalities of treatment include transfusion of plasma and plasmapheresis. In first baby haematological and renal parameters improved after double volume exchange transfusion while second baby responded to transfusion of fresh whole blood (packed red cells + plasma). Exchange transfusion essentially provides plasma exchange besides augmenting the haemoglobin levels. Arguably this is the first report of neonatal HUS treated with exchange transfusion.
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2015
Archives of Disease in Childhood
Re: Clinical significance of blood pressure ratios in hypertensive crisis in children. Wu, et al.... more Re: Clinical significance of blood pressure ratios in hypertensive crisis in children. Wu, et al. 97:3 200-205 doi:10.1136/archdischild-2011-300373 We commend Wu et al f or their work on blood-pressure-ratios. Up until now hy pertension was def ined using statistically deriv ed limits based on gender, age and height specif ic norms. The f ormulation of Wu et al permits assessments of adv erse ef f ects at dif f erent blood-pressure-ratios across age, gender and height percentile groups. (1) Howev er giv en that multiple readings in an indiv idual f luctuate quite wildly , identif ication of the 'real BP' f or calculation of blood pressure ratio is still a problem. The statistically deriv ed limits of normal BP are relativ ely tight bands. Conv entionally , blood pressure (BP) abov e the 95th centile is classif ied as hy pertension. That below the 90th centile is considered normal and BP between the 90th and 95th percentile is labeled 'pre-hy pertension'. The dif f er...
India is emerging as huge labour market and medical profession is not exception to it. In current... more India is emerging as huge labour market and medical profession is not exception to it. In current crisis of middle grade staff many deaneries from UK are heading towards this market with short-term lucrative offers hiring qualified doctors at reasonable rate in much cost effective way. MTI is a strategically planned initiative to hire overseas doctors to meet the crisis without increasing economic burden of permanent migrants on British Government as doctors coming under this scheme cannot stay in UK for more than two years. However it is not immune of ethical controversies and seems to be a trick rather than a plan raising a big question mark on its survival. To ensure it will work we need to see it from "their" point of view, standing in the midst of the "market" . In India there is 3 tier system medical training and education. In first tier doctors have to complete 3 year training in a particular specialty with rotations in its different sub-specialties as â j...
Management of cardiopulmonary arrest in children is one of the most important aspects of post gra... more Management of cardiopulmonary arrest in children is one of the most important aspects of post graduate training in Pediatrics that needs understanding of current guidelines and expertise on skills of performing CPR. Team leader and every team member should know his/her role and limitations. New guidelines of performing CPR advocate compression-airway-breathing (C-A-B) rather than airway-breathing-compression (A-B-C) sequence practiced before. Here we discuss current CPR guidelines and use of common drugs during or immediately after performing CPR.
Indian pediatrics, 2009
We report nasopharyngeal teratoma in a term female neonate, that presented within first week of l... more We report nasopharyngeal teratoma in a term female neonate, that presented within first week of life with episodic stridor, apnea and cyanosis. Laryngoscopy revealed a mass which was confirmed by MRI. The mass was surgically excised and diagnosed as nasopharyngeal teratoma on histopathology. The child is doing well on follow-up.
Indian pediatrics, 2008
IMSEAR Digital Repository, ...
Pediatric Critical Care Medicine, 2012
To study the clinical profile and risk factors of cerebral edema in children with diabetic ketoac... more To study the clinical profile and risk factors of cerebral edema in children with diabetic ketoacidosis with specific reference to fluid refractory shock. Retrospective review of medical records. Twelve-bed pediatric intensive care unit of a teaching hospital. Seventy-seven patients admitted to pediatric intensive care unit with a diagnosis of diabetic ketoacidosis over 5 yrs. Medical records were reviewed, and data with respect to patients' age, clinical features, biochemical profile (blood glucose, osmolality, electrolytes, urea, creatinine, arterial pH, PaCO(2), and HCO(3) at admission, 6-12 hrs, 24 hrs, and beyond 24 hrs), cerebral edema, presence of sepsis and shock, treatment details, and primary outcome in terms of survival or death were retrieved. Patients with and without cerebral edema were compared. Variables that were significant on univariate analysis were entered in a multiple logistic regression analysis to determine the predictors for cerebral edema. Odds ratio and 95% confidence interval were calculated using SPSS version 15. Mean age of the patients was 5.6 (standard deviation, 3.8) years. Fifty-five (71.4%) patients had new-onset diabetes mellitus. Cerebral edema was seen in 20 patients (26%). Blood glucose, serum osmolality, and CO(2) values at admission and rate of decline in glucose and osmolality during the first 12 hrs were similar in the cerebral edema and noncerebral edema groups. On multiple logistic regression analysis, fluid refractory shock (odds ratio, 7.3; 95% confidence interval, 1.3-41; p = .025) and presence of azotemia (odds ratio, 4.3; 95% confidence interval, 1.1-16; p = .034) at admission were predictors for development of cerebral edema. Mortality in cerebral edema group was 25% as compared to 3% in the noncerebral edema group. Patients with fluid refractory shock and azotemia at admission had higher odds for development of cerebral edema. Initial blood glucose, effective osmolality, or decline in glucose and osmolality had no association with cerebral edema.
Medical Veritas: The …, 2006
Indian Journal of Critical Care Medicine, 2014
There is a paucity of data evaluating serum albumin levels and outcome of critically ill-children... more There is a paucity of data evaluating serum albumin levels and outcome of critically ill-children admitted to intensive care unit (ICU). The aim was to study frequency of hypoalbuminemia and examine association between hypoalbuminemia and outcome in critically ill-children. Retrospective review of medical records of 435 patients admitted to 12 bedded pediatric ICU (PICU). Patients with hypoalbuminemia on admission or any time during PICU stay were compared with normoalbuminemic patients for demographic and clinical profile. Effect of albumin infusion was also examined. Odds ratio and 95% confidence interval were calculated using SPSS 16. Hypoalbuminemia was present on admission in 21% (92 of 435) patients that increased to 34% at the end of 1(st) week and to 37% (164 of 435) during rest of the stay in PICU. Hypoalbuminemic patients had higher Pediatric Risk of Mortality scores (12.9 vs. 7.5, P < 0.001) and prolonged PICU stay (13.8 vs. 6.7 days, P < 0.001); higher likelihood of respiratory failure requiring mechanical ventilaton (84.8% vs. 28.8%, P < 0.001), prolonged ventilatory support, progression to multiorgan dysfunction syndrome (87.8% vs. 16.2%) and risk of mortality (25.6% vs. 17.7%). Though, the survivors among recipients of albumin infusion had significantly higher increase in serum albumin level (0.76 g/dL, standard deviation [SD] 0.54) compared with nonsurvivors (0.46 g/dL, SD 0.44; P = 0.016), albumin infusion did not reduce the risk of mortality. Hypoalbuminemia is a significant indicator of mortality and morbidity in critically sick children. More studies are needed to define role of albumin infusion in treatment of such patients.
British Medical Journal, 2004
Lancet, 2004
... However, a more absolute measure of affordability comes from looking at the intervention agai... more ... However, a more absolute measure of affordability comes from looking at the intervention against the per-capita gross national product of the country.4 Under-five mortality in India is 98 per 1000 livebirths, and neonatal death is responsible for 49 deaths. ...
Tropical Doctor, 2007
The sensitivity and specificity of a new clinical sign of hypocalcaemia were evaluated. The Swan-... more The sensitivity and specificity of a new clinical sign of hypocalcaemia were evaluated. The Swan-neck sign, wherein infants with symptomatic hypocalcaemia keep their big toe hyperextended at the metatarsophalangeal joint and flexed at the interphalangeal joint, was looked for in 25 infants presenting with non-febrile seizures, alongside their serum calcium levels. The study showed that the sign had a sensitivity of 63.6% and specificity of 66.6%. (Predictive values of positive and negative tests were 93.3% and 20%, respectively.) This is compared with the standard Trousseau and Chvostek signs.
Journal of Hepatology, 2003
1. J Hepatol. 2003 Jul;39(1):133; author reply 134-5. Computerised-hepatitis B-model is subject t... more 1. J Hepatol. 2003 Jul;39(1):133; author reply 134-5. Computerised-hepatitis B-model is subject to processing axiom: garbage in, garbage out. Tiwari L, Varghese RM, Puliyel JM. Comment on: J Hepatol. 2003 Feb;38(2):215-22. ...
Indian pediatrics, 2009
We report nasopharyngeal teratoma in a term female neonate, that presented within first week of l... more We report nasopharyngeal teratoma in a term female neonate, that presented within first week of life with episodic stridor, apnea and cyanosis. Laryngoscopy revealed a mass which was confirmed by MRI. The mass was surgically excised and diagnosed as nasopharyngeal teratoma on histopathology. The child is doing well on follow-up.
Haemolytic uremic syndrome (HUS) is characterised by the triad of non immune haemolytic anaemia, ... more Haemolytic uremic syndrome (HUS) is characterised by the triad of non immune haemolytic anaemia, thrombocytopenia and renal failure. It is rare in newborns. Only 5 cases of neonatal HUS have been reported to-date. We describe a series of 2 cases of neonatal HUS where one had definite history of birth asphyxia and another was an abandoned baby without clinical details about perinatal period. The known modalities of treatment include transfusion of plasma and plasmapheresis. In first baby haematological and renal parameters improved after double volume exchange transfusion while second baby responded to transfusion of fresh whole blood (packed red cells + plasma). Exchange transfusion essentially provides plasma exchange besides augmenting the haemoglobin levels. Arguably this is the first report of neonatal HUS treated with exchange transfusion.
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2015
Archives of Disease in Childhood
Re: Clinical significance of blood pressure ratios in hypertensive crisis in children. Wu, et al.... more Re: Clinical significance of blood pressure ratios in hypertensive crisis in children. Wu, et al. 97:3 200-205 doi:10.1136/archdischild-2011-300373 We commend Wu et al f or their work on blood-pressure-ratios. Up until now hy pertension was def ined using statistically deriv ed limits based on gender, age and height specif ic norms. The f ormulation of Wu et al permits assessments of adv erse ef f ects at dif f erent blood-pressure-ratios across age, gender and height percentile groups. (1) Howev er giv en that multiple readings in an indiv idual f luctuate quite wildly , identif ication of the 'real BP' f or calculation of blood pressure ratio is still a problem. The statistically deriv ed limits of normal BP are relativ ely tight bands. Conv entionally , blood pressure (BP) abov e the 95th centile is classif ied as hy pertension. That below the 90th centile is considered normal and BP between the 90th and 95th percentile is labeled 'pre-hy pertension'. The dif f er...
India is emerging as huge labour market and medical profession is not exception to it. In current... more India is emerging as huge labour market and medical profession is not exception to it. In current crisis of middle grade staff many deaneries from UK are heading towards this market with short-term lucrative offers hiring qualified doctors at reasonable rate in much cost effective way. MTI is a strategically planned initiative to hire overseas doctors to meet the crisis without increasing economic burden of permanent migrants on British Government as doctors coming under this scheme cannot stay in UK for more than two years. However it is not immune of ethical controversies and seems to be a trick rather than a plan raising a big question mark on its survival. To ensure it will work we need to see it from "their" point of view, standing in the midst of the "market" . In India there is 3 tier system medical training and education. In first tier doctors have to complete 3 year training in a particular specialty with rotations in its different sub-specialties as â j...
Management of cardiopulmonary arrest in children is one of the most important aspects of post gra... more Management of cardiopulmonary arrest in children is one of the most important aspects of post graduate training in Pediatrics that needs understanding of current guidelines and expertise on skills of performing CPR. Team leader and every team member should know his/her role and limitations. New guidelines of performing CPR advocate compression-airway-breathing (C-A-B) rather than airway-breathing-compression (A-B-C) sequence practiced before. Here we discuss current CPR guidelines and use of common drugs during or immediately after performing CPR.
Indian pediatrics, 2009
We report nasopharyngeal teratoma in a term female neonate, that presented within first week of l... more We report nasopharyngeal teratoma in a term female neonate, that presented within first week of life with episodic stridor, apnea and cyanosis. Laryngoscopy revealed a mass which was confirmed by MRI. The mass was surgically excised and diagnosed as nasopharyngeal teratoma on histopathology. The child is doing well on follow-up.
Indian pediatrics, 2008
IMSEAR Digital Repository, ...
Pediatric Critical Care Medicine, 2012
To study the clinical profile and risk factors of cerebral edema in children with diabetic ketoac... more To study the clinical profile and risk factors of cerebral edema in children with diabetic ketoacidosis with specific reference to fluid refractory shock. Retrospective review of medical records. Twelve-bed pediatric intensive care unit of a teaching hospital. Seventy-seven patients admitted to pediatric intensive care unit with a diagnosis of diabetic ketoacidosis over 5 yrs. Medical records were reviewed, and data with respect to patients' age, clinical features, biochemical profile (blood glucose, osmolality, electrolytes, urea, creatinine, arterial pH, PaCO(2), and HCO(3) at admission, 6-12 hrs, 24 hrs, and beyond 24 hrs), cerebral edema, presence of sepsis and shock, treatment details, and primary outcome in terms of survival or death were retrieved. Patients with and without cerebral edema were compared. Variables that were significant on univariate analysis were entered in a multiple logistic regression analysis to determine the predictors for cerebral edema. Odds ratio and 95% confidence interval were calculated using SPSS version 15. Mean age of the patients was 5.6 (standard deviation, 3.8) years. Fifty-five (71.4%) patients had new-onset diabetes mellitus. Cerebral edema was seen in 20 patients (26%). Blood glucose, serum osmolality, and CO(2) values at admission and rate of decline in glucose and osmolality during the first 12 hrs were similar in the cerebral edema and noncerebral edema groups. On multiple logistic regression analysis, fluid refractory shock (odds ratio, 7.3; 95% confidence interval, 1.3-41; p = .025) and presence of azotemia (odds ratio, 4.3; 95% confidence interval, 1.1-16; p = .034) at admission were predictors for development of cerebral edema. Mortality in cerebral edema group was 25% as compared to 3% in the noncerebral edema group. Patients with fluid refractory shock and azotemia at admission had higher odds for development of cerebral edema. Initial blood glucose, effective osmolality, or decline in glucose and osmolality had no association with cerebral edema.
Medical Veritas: The …, 2006
Indian Journal of Critical Care Medicine, 2014
There is a paucity of data evaluating serum albumin levels and outcome of critically ill-children... more There is a paucity of data evaluating serum albumin levels and outcome of critically ill-children admitted to intensive care unit (ICU). The aim was to study frequency of hypoalbuminemia and examine association between hypoalbuminemia and outcome in critically ill-children. Retrospective review of medical records of 435 patients admitted to 12 bedded pediatric ICU (PICU). Patients with hypoalbuminemia on admission or any time during PICU stay were compared with normoalbuminemic patients for demographic and clinical profile. Effect of albumin infusion was also examined. Odds ratio and 95% confidence interval were calculated using SPSS 16. Hypoalbuminemia was present on admission in 21% (92 of 435) patients that increased to 34% at the end of 1(st) week and to 37% (164 of 435) during rest of the stay in PICU. Hypoalbuminemic patients had higher Pediatric Risk of Mortality scores (12.9 vs. 7.5, P < 0.001) and prolonged PICU stay (13.8 vs. 6.7 days, P < 0.001); higher likelihood of respiratory failure requiring mechanical ventilaton (84.8% vs. 28.8%, P < 0.001), prolonged ventilatory support, progression to multiorgan dysfunction syndrome (87.8% vs. 16.2%) and risk of mortality (25.6% vs. 17.7%). Though, the survivors among recipients of albumin infusion had significantly higher increase in serum albumin level (0.76 g/dL, standard deviation [SD] 0.54) compared with nonsurvivors (0.46 g/dL, SD 0.44; P = 0.016), albumin infusion did not reduce the risk of mortality. Hypoalbuminemia is a significant indicator of mortality and morbidity in critically sick children. More studies are needed to define role of albumin infusion in treatment of such patients.
British Medical Journal, 2004
Lancet, 2004
... However, a more absolute measure of affordability comes from looking at the intervention agai... more ... However, a more absolute measure of affordability comes from looking at the intervention against the per-capita gross national product of the country.4 Under-five mortality in India is 98 per 1000 livebirths, and neonatal death is responsible for 49 deaths. ...
Tropical Doctor, 2007
The sensitivity and specificity of a new clinical sign of hypocalcaemia were evaluated. The Swan-... more The sensitivity and specificity of a new clinical sign of hypocalcaemia were evaluated. The Swan-neck sign, wherein infants with symptomatic hypocalcaemia keep their big toe hyperextended at the metatarsophalangeal joint and flexed at the interphalangeal joint, was looked for in 25 infants presenting with non-febrile seizures, alongside their serum calcium levels. The study showed that the sign had a sensitivity of 63.6% and specificity of 66.6%. (Predictive values of positive and negative tests were 93.3% and 20%, respectively.) This is compared with the standard Trousseau and Chvostek signs.
Journal of Hepatology, 2003
1. J Hepatol. 2003 Jul;39(1):133; author reply 134-5. Computerised-hepatitis B-model is subject t... more 1. J Hepatol. 2003 Jul;39(1):133; author reply 134-5. Computerised-hepatitis B-model is subject to processing axiom: garbage in, garbage out. Tiwari L, Varghese RM, Puliyel JM. Comment on: J Hepatol. 2003 Feb;38(2):215-22. ...