Lokesh Tiwari - Academia.edu (original) (raw)
Papers by Lokesh Tiwari
Clinical Pediatrics, 1995
tures. Septicemia, urinary tract infection, and bacterial meningitis due to E. coliwere diagnosed... more tures. Septicemia, urinary tract infection, and bacterial meningitis due to E. coliwere diagnosed. Later, macroscopic hematuria with blood clots appeared. Renal Doppler ultrasound showed right urinary tract dilatation and a hyperechoic image at the urinary bladder level compatible with a blood clot, without renal vascular pathology. In a later renal ultrasound, hyperechoic kidneys, increased in size,
Journal of pediatric critical care, 2022
PubMed, May 30, 2023
Children between 8-12 years of age attending the institution between May and September, 2022 were... more Children between 8-12 years of age attending the institution between May and September, 2022 were enrolled, and their knowledge and perception of COVID-19 evaluated by asking them to draw a diagram of SARS-CoV-2, and by getting their responses on a multiple-choice written questionnaire. Majority had correct knowledge regarding the mode of spread of virus (n=91), safe practices (n=91) and prevention by vaccine (n=69).
Journal of pediatric critical care, 2018
Snake bite is a common but under-reported medical emergency accounting for 0.5% of all deaths wit... more Snake bite is a common but under-reported medical emergency accounting for 0.5% of all deaths with greater risk of fatal envenomation in children. In India, four species of venomous snake are most common but better classification of medically significant species is warranted. Snake venom is a mixture of peptides with enzymatic & toxic properties which mediate activation of cytokine cascades along with organ specific toxicities, manifesting into local and systemic symptoms. The syndromic approach of attributing a constellation of signs & symptoms to a particular family of venomous snake has clinical acceptance but overlaps exist. Management of snake bite victim starts with a first aid measures of reassurance, immobilization and quick transfer to hospital. Measures such as application of tourniquet, incision and suction are harmful & should not be done. On arrival at hospital, triage and stabilization of Airway, Breathing & Circulation (ABC) is done followed by a focused assessment to ascertain the severity of envenomation. Antivenom treatment is the mainstay of snake bite management. ASV should be started only when specific indications such as signs of neurotoxicity, coagulopathy, hypotension, hematuria are present. Indiscriminate use of ASV is strongly condemned. Currently 8-10 vials of ASV as initial dose with a maximum of 25 vials is recommended. There is no role of test dose of ASV. Measures to treat any ASV induced anaphylaxis should be ready prior to start of ASV treatment. Supportive treatment is as important in determining the final outcome of envenomation as ASV.
Case Reports, Mar 1, 2021
Asymptomatic individuals positive for SARS-CoV-2 RNA constitute a significant proportion of the i... more Asymptomatic individuals positive for SARS-CoV-2 RNA constitute a significant proportion of the infected population and play a role in the transmission of the virus. We describe a healthcare worker who presented with fever and malaise and was diagnosed with mild COVID-19. The symptoms resolved within 4 days but there was persistent positivity of viral RNA in the upper respiratory tract for more than 58 days, which is the longest reported duration of persistence of SARS-CoV-2 in a healthcare worker. In this case report, we discuss clinical and administrative issues such as the role of asymptomatic cases in the transmission of the virus to patients and coworkers as an occupational hazard, interpretation of persistent positivity of nucleic acid test, duration of isolation and return-to-work guidelines pertinent to researchers and global health policymakers.
Case Reports, Feb 1, 2022
Wilson’s disease in childhood could present with features ranging from asymptomatic liver disease... more Wilson’s disease in childhood could present with features ranging from asymptomatic liver disease to acute liver failure and cirrhosis. Neurological manifestations and psychiatric illness occur more commonly in adults and older children. Skin manifestation with Wilson’s disease is not frequently reported in literature but could be an early diagnostic clincher. We present a child with hepatic Wilson’s disease and skin hyperpigmentation. We aim to highlight the possible importance of skin lesions as an early marker of Wilson’s disease.
Indian Pediatrics, 2004
Sharma and Virmani have looked at X-ray and blood biochemistry (serum calcium phosphorus and Alka... more Sharma and Virmani have looked at X-ray and blood biochemistry (serum calcium phosphorus and Alkaline phos-phatase levels) in 100 infants and children with clinical rickets in Delhi and found that 35% children had low calcium and 35.5% children had raised alkaline phosphatase. However to diagnose vitamin D deficiency with rickets it is best that vitamin D metabolites are measured. 25 Hydroxy-cholecalciferol (25 (OH) D) is the most reliable measure of an individual’s vitamin D status. We have recently conducted a study looking at the 25 (OH) D levels in slum children from three areas in Delhi and found evidence of widespread vitamin D deficiency. This study was funded by Department of Science and Technology of the Government of India. (excerpt)
Journal of pediatric critical care, 2022
Paediatric Critical Care Society
Sri Lanka Journal of Child Health, 2021
Introduction: Data on COVID-19 transmission, manifestations and outcome for the neonatal populati... more Introduction: Data on COVID-19 transmission, manifestations and outcome for the neonatal population is scarce, particularly from developing country settings. Objectives: To assess the transmission risk of SARS-CoV-2 in the mother-infant dyad and to describe the clinical profile of neonates born to COVID-19 positive mothers in a tertiary care centre in Northern India. Method: An observational cohort study was conducted in the neonatal COVID-19 unit of All India Institute of Medical Sciences Patna, India. All neonates delivered by COVID-19 positive mothers at this hospital were admitted. During the pandemic, admissions were also allowed for out-born neonates positive for SARS-CoV-2. COVID-19 RT-PCR on nasopharyngeal swab of neonate at 24 and 48-72 hours was the primary outcome variable. Clinicolaboratory variables were collected during the hospital stay and follow up. An inferential analysis was done using SPSS version 22.0. Results: Fifty-one out of 145 (142 delivered at our institut...
Indian Journal of Pediatrics, 2020
Corona virus disease 2019 (COVID-19) pandemic has posed significant risk for health care workers.... more Corona virus disease 2019 (COVID-19) pandemic has posed significant risk for health care workers. Various steps of cardiopulmonary resuscitation involve aerosol-generating procedures and have significant risk of spread of corona virus. Indian Academy of Pediatrics Advanced Life Support Basic Life Support (IAP ALS BLS) group had constituted a guideline update team to suggest modifications in existing resuscitation guidelines in view of COVID-19 pandemic. The GRADE approach was used to develop recommendations on shortlisted clinical practice questions on resuscitation during COVID pandemic as modifications.
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...
Archives of Disease in Childhood, 2012
baby responded to transfusion of fresh whole blood (packed red cells + plasma). Exchange transfus... more 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.
Medical Veritas: The …, 2006
... 3 (2006) 11471149 1147 An initial inquiry into cost-effectiveness of surfactant in India: a ... more ... 3 (2006) 11471149 1147 An initial inquiry into cost-effectiveness of surfactant in India: a pilot randomized control trial Lokesh Tiwari1, DNB ... Indian J Ophthalmol 2001; 49: 1878 [7] Narang A, Kumar P, Dutta S, Kumar R. Surfactant ther-apy for hyaline membrane disease: the ...
Lungs and Breathing, 2017
Congenital tuberculosis (CTB) is a rare disease with a high mortality rate, requiring high index ... more Congenital tuberculosis (CTB) is a rare disease with a high mortality rate, requiring high index of suspicion to diagnose because of non-specific presentation. This report describes a case of 6 month male child with congenital tuberculosis with possible placental transmission. Infant had fever, fast breathing and cough since 20 days of life. Ultrasonography (USG) abdomen showed granulomatous lesions in liver. Although mother was diagnosed to be having tuberculosis during 3 rd week after delivery and started on anti-tuberculosis treatment (ATT), child remained undiagnosed for 6 months and didn't get appropriate treatment. Fever, respiratory distress and cough initially improved after starting ATT but patient worsened after 2 weeks of ATT which could not be attributed to cause other than tuberculosis paradoxical reaction (TB-PR). Patient was given steroid following which he gradually improved. This case highlights the importance of keeping high index of suspicion for congenital TB in infants, especially in developing nations, and need for early diagnosis and treatment for the survival of theses infants. PR should be considered even in infancy if patient shows worsening of symptoms after initial improvement that couldn't be explained otherwise.
International Journal of Contemporary Pediatrics, Sep 21, 2020
Accidental strangulation is an uncommon injury in children, however it may lead to neurological d... more Accidental strangulation is an uncommon injury in children, however it may lead to neurological disability or death. Various modes of injuries have been reported in such accidents. Children might get strangulated while playing if they are wrapping any cord or cloth like material around their neck. Caregivers of the children should be aware of the potential sources around and mechanisms of such injuries to avoid such accidents.
Resuscitation plus, Jun 1, 2023
Cureus, Jun 19, 2023
Background and aims: The N95 filtering facepiece respirator (FR) is the most commonly recommended... more Background and aims: The N95 filtering facepiece respirator (FR) is the most commonly recommended respiratory protection used in healthcare settings. However, concerns have been raised about its use because it can increase respiratory resistance and dead space. The primary objective of this study was to determine the effect of wearing N95 masks on the vital signs, i.e., oxygen saturation, pulse rate, and respiratory rate, of the participant health workers. Our secondary objective was to assess the subjective feeling of discomfort when wearing N95 masks. Methods: The study participants were healthy healthcare workers taking care of coronavirus disease 2019 (COVID-19)-infected pediatric cases who did at least six hours of continuous shift duty in the pediatric COVID-19 ward at a tertiary care hospital in the eastern part of India. They were evaluated for vital signs at various time intervals while wearing N95 masks. Subjective discomfort at any point in time was also noted. Results: We found a significant variation in the mean oxygen saturation (SpO 2) and heart rate (HR) reduction across the four different points. The pair-wise comparison showed a small but significant decrease in the mean SpO 2 of 98.3% (1.1) at six hours as compared with a mean SpO 2 of 98.7% (0.9) at three hours. Similarly, a significant increase was noted for a mean HR of 84.7 bpm (11.2) at six hours compared with a baseline of 82.3 bpm (9.2) and 83.2 bpm (8.8) at three hours. Conclusion: The continuous use of an N95 mask leads to a mild increase in respiratory rate. However, heart rate and oxygen saturation vary significantly at different points in time after N95 mask use.
Қазақстанның клиникалық медицинасы, Jan 21, 2021
Rickets is a disease of growing bone, before fusion of epiphyses. There is defective mineralizati... more Rickets is a disease of growing bone, before fusion of epiphyses. There is defective mineralization of cartilage matrix in the zone of provisional calcification caused either by nutritional vitamin D deficiency and/or low calcium intake or by non-nutritional causes, like hypophosphatemic rickets and rickets due to renal tubular acidosis. In addition, some varieties are due to inherited defects in vitamin D metabolism and are called vitamin D dependent rickets. The diagnosis is made on the basis of history, physical examination, and biochemical testing, and is confirmed by radiographs. Treatment consists of vitamin D supplementation as Stoss therapy or daily or weekly oral regimens, all with equal efficacy and safety, combined with calcium supplements. For renal rickets, the active form of Vit D, 1,25(OH)2 also called Calcitriol is used, treatment is tailored to another type of renal rickets. Routine supplementation starting from the newborn period is being increasingly endorsed by various international organizations. Adequate sunlight exposure, food fortification, and routine supplementation are the currently available options for tackling this nutritional deficiency. In this review article, we discuss the pathophysiology, diagnosis, and management of rickets in detail.
Clinical Pediatrics, 1995
tures. Septicemia, urinary tract infection, and bacterial meningitis due to E. coliwere diagnosed... more tures. Septicemia, urinary tract infection, and bacterial meningitis due to E. coliwere diagnosed. Later, macroscopic hematuria with blood clots appeared. Renal Doppler ultrasound showed right urinary tract dilatation and a hyperechoic image at the urinary bladder level compatible with a blood clot, without renal vascular pathology. In a later renal ultrasound, hyperechoic kidneys, increased in size,
Journal of pediatric critical care, 2022
PubMed, May 30, 2023
Children between 8-12 years of age attending the institution between May and September, 2022 were... more Children between 8-12 years of age attending the institution between May and September, 2022 were enrolled, and their knowledge and perception of COVID-19 evaluated by asking them to draw a diagram of SARS-CoV-2, and by getting their responses on a multiple-choice written questionnaire. Majority had correct knowledge regarding the mode of spread of virus (n=91), safe practices (n=91) and prevention by vaccine (n=69).
Journal of pediatric critical care, 2018
Snake bite is a common but under-reported medical emergency accounting for 0.5% of all deaths wit... more Snake bite is a common but under-reported medical emergency accounting for 0.5% of all deaths with greater risk of fatal envenomation in children. In India, four species of venomous snake are most common but better classification of medically significant species is warranted. Snake venom is a mixture of peptides with enzymatic & toxic properties which mediate activation of cytokine cascades along with organ specific toxicities, manifesting into local and systemic symptoms. The syndromic approach of attributing a constellation of signs & symptoms to a particular family of venomous snake has clinical acceptance but overlaps exist. Management of snake bite victim starts with a first aid measures of reassurance, immobilization and quick transfer to hospital. Measures such as application of tourniquet, incision and suction are harmful & should not be done. On arrival at hospital, triage and stabilization of Airway, Breathing & Circulation (ABC) is done followed by a focused assessment to ascertain the severity of envenomation. Antivenom treatment is the mainstay of snake bite management. ASV should be started only when specific indications such as signs of neurotoxicity, coagulopathy, hypotension, hematuria are present. Indiscriminate use of ASV is strongly condemned. Currently 8-10 vials of ASV as initial dose with a maximum of 25 vials is recommended. There is no role of test dose of ASV. Measures to treat any ASV induced anaphylaxis should be ready prior to start of ASV treatment. Supportive treatment is as important in determining the final outcome of envenomation as ASV.
Case Reports, Mar 1, 2021
Asymptomatic individuals positive for SARS-CoV-2 RNA constitute a significant proportion of the i... more Asymptomatic individuals positive for SARS-CoV-2 RNA constitute a significant proportion of the infected population and play a role in the transmission of the virus. We describe a healthcare worker who presented with fever and malaise and was diagnosed with mild COVID-19. The symptoms resolved within 4 days but there was persistent positivity of viral RNA in the upper respiratory tract for more than 58 days, which is the longest reported duration of persistence of SARS-CoV-2 in a healthcare worker. In this case report, we discuss clinical and administrative issues such as the role of asymptomatic cases in the transmission of the virus to patients and coworkers as an occupational hazard, interpretation of persistent positivity of nucleic acid test, duration of isolation and return-to-work guidelines pertinent to researchers and global health policymakers.
Case Reports, Feb 1, 2022
Wilson’s disease in childhood could present with features ranging from asymptomatic liver disease... more Wilson’s disease in childhood could present with features ranging from asymptomatic liver disease to acute liver failure and cirrhosis. Neurological manifestations and psychiatric illness occur more commonly in adults and older children. Skin manifestation with Wilson’s disease is not frequently reported in literature but could be an early diagnostic clincher. We present a child with hepatic Wilson’s disease and skin hyperpigmentation. We aim to highlight the possible importance of skin lesions as an early marker of Wilson’s disease.
Indian Pediatrics, 2004
Sharma and Virmani have looked at X-ray and blood biochemistry (serum calcium phosphorus and Alka... more Sharma and Virmani have looked at X-ray and blood biochemistry (serum calcium phosphorus and Alkaline phos-phatase levels) in 100 infants and children with clinical rickets in Delhi and found that 35% children had low calcium and 35.5% children had raised alkaline phosphatase. However to diagnose vitamin D deficiency with rickets it is best that vitamin D metabolites are measured. 25 Hydroxy-cholecalciferol (25 (OH) D) is the most reliable measure of an individual’s vitamin D status. We have recently conducted a study looking at the 25 (OH) D levels in slum children from three areas in Delhi and found evidence of widespread vitamin D deficiency. This study was funded by Department of Science and Technology of the Government of India. (excerpt)
Journal of pediatric critical care, 2022
Paediatric Critical Care Society
Sri Lanka Journal of Child Health, 2021
Introduction: Data on COVID-19 transmission, manifestations and outcome for the neonatal populati... more Introduction: Data on COVID-19 transmission, manifestations and outcome for the neonatal population is scarce, particularly from developing country settings. Objectives: To assess the transmission risk of SARS-CoV-2 in the mother-infant dyad and to describe the clinical profile of neonates born to COVID-19 positive mothers in a tertiary care centre in Northern India. Method: An observational cohort study was conducted in the neonatal COVID-19 unit of All India Institute of Medical Sciences Patna, India. All neonates delivered by COVID-19 positive mothers at this hospital were admitted. During the pandemic, admissions were also allowed for out-born neonates positive for SARS-CoV-2. COVID-19 RT-PCR on nasopharyngeal swab of neonate at 24 and 48-72 hours was the primary outcome variable. Clinicolaboratory variables were collected during the hospital stay and follow up. An inferential analysis was done using SPSS version 22.0. Results: Fifty-one out of 145 (142 delivered at our institut...
Indian Journal of Pediatrics, 2020
Corona virus disease 2019 (COVID-19) pandemic has posed significant risk for health care workers.... more Corona virus disease 2019 (COVID-19) pandemic has posed significant risk for health care workers. Various steps of cardiopulmonary resuscitation involve aerosol-generating procedures and have significant risk of spread of corona virus. Indian Academy of Pediatrics Advanced Life Support Basic Life Support (IAP ALS BLS) group had constituted a guideline update team to suggest modifications in existing resuscitation guidelines in view of COVID-19 pandemic. The GRADE approach was used to develop recommendations on shortlisted clinical practice questions on resuscitation during COVID pandemic as modifications.
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...
Archives of Disease in Childhood, 2012
baby responded to transfusion of fresh whole blood (packed red cells + plasma). Exchange transfus... more 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.
Medical Veritas: The …, 2006
... 3 (2006) 11471149 1147 An initial inquiry into cost-effectiveness of surfactant in India: a ... more ... 3 (2006) 11471149 1147 An initial inquiry into cost-effectiveness of surfactant in India: a pilot randomized control trial Lokesh Tiwari1, DNB ... Indian J Ophthalmol 2001; 49: 1878 [7] Narang A, Kumar P, Dutta S, Kumar R. Surfactant ther-apy for hyaline membrane disease: the ...
Lungs and Breathing, 2017
Congenital tuberculosis (CTB) is a rare disease with a high mortality rate, requiring high index ... more Congenital tuberculosis (CTB) is a rare disease with a high mortality rate, requiring high index of suspicion to diagnose because of non-specific presentation. This report describes a case of 6 month male child with congenital tuberculosis with possible placental transmission. Infant had fever, fast breathing and cough since 20 days of life. Ultrasonography (USG) abdomen showed granulomatous lesions in liver. Although mother was diagnosed to be having tuberculosis during 3 rd week after delivery and started on anti-tuberculosis treatment (ATT), child remained undiagnosed for 6 months and didn't get appropriate treatment. Fever, respiratory distress and cough initially improved after starting ATT but patient worsened after 2 weeks of ATT which could not be attributed to cause other than tuberculosis paradoxical reaction (TB-PR). Patient was given steroid following which he gradually improved. This case highlights the importance of keeping high index of suspicion for congenital TB in infants, especially in developing nations, and need for early diagnosis and treatment for the survival of theses infants. PR should be considered even in infancy if patient shows worsening of symptoms after initial improvement that couldn't be explained otherwise.
International Journal of Contemporary Pediatrics, Sep 21, 2020
Accidental strangulation is an uncommon injury in children, however it may lead to neurological d... more Accidental strangulation is an uncommon injury in children, however it may lead to neurological disability or death. Various modes of injuries have been reported in such accidents. Children might get strangulated while playing if they are wrapping any cord or cloth like material around their neck. Caregivers of the children should be aware of the potential sources around and mechanisms of such injuries to avoid such accidents.
Resuscitation plus, Jun 1, 2023
Cureus, Jun 19, 2023
Background and aims: The N95 filtering facepiece respirator (FR) is the most commonly recommended... more Background and aims: The N95 filtering facepiece respirator (FR) is the most commonly recommended respiratory protection used in healthcare settings. However, concerns have been raised about its use because it can increase respiratory resistance and dead space. The primary objective of this study was to determine the effect of wearing N95 masks on the vital signs, i.e., oxygen saturation, pulse rate, and respiratory rate, of the participant health workers. Our secondary objective was to assess the subjective feeling of discomfort when wearing N95 masks. Methods: The study participants were healthy healthcare workers taking care of coronavirus disease 2019 (COVID-19)-infected pediatric cases who did at least six hours of continuous shift duty in the pediatric COVID-19 ward at a tertiary care hospital in the eastern part of India. They were evaluated for vital signs at various time intervals while wearing N95 masks. Subjective discomfort at any point in time was also noted. Results: We found a significant variation in the mean oxygen saturation (SpO 2) and heart rate (HR) reduction across the four different points. The pair-wise comparison showed a small but significant decrease in the mean SpO 2 of 98.3% (1.1) at six hours as compared with a mean SpO 2 of 98.7% (0.9) at three hours. Similarly, a significant increase was noted for a mean HR of 84.7 bpm (11.2) at six hours compared with a baseline of 82.3 bpm (9.2) and 83.2 bpm (8.8) at three hours. Conclusion: The continuous use of an N95 mask leads to a mild increase in respiratory rate. However, heart rate and oxygen saturation vary significantly at different points in time after N95 mask use.
Қазақстанның клиникалық медицинасы, Jan 21, 2021
Rickets is a disease of growing bone, before fusion of epiphyses. There is defective mineralizati... more Rickets is a disease of growing bone, before fusion of epiphyses. There is defective mineralization of cartilage matrix in the zone of provisional calcification caused either by nutritional vitamin D deficiency and/or low calcium intake or by non-nutritional causes, like hypophosphatemic rickets and rickets due to renal tubular acidosis. In addition, some varieties are due to inherited defects in vitamin D metabolism and are called vitamin D dependent rickets. The diagnosis is made on the basis of history, physical examination, and biochemical testing, and is confirmed by radiographs. Treatment consists of vitamin D supplementation as Stoss therapy or daily or weekly oral regimens, all with equal efficacy and safety, combined with calcium supplements. For renal rickets, the active form of Vit D, 1,25(OH)2 also called Calcitriol is used, treatment is tailored to another type of renal rickets. Routine supplementation starting from the newborn period is being increasingly endorsed by various international organizations. Adequate sunlight exposure, food fortification, and routine supplementation are the currently available options for tackling this nutritional deficiency. In this review article, we discuss the pathophysiology, diagnosis, and management of rickets in detail.