Publications by authors named "Nitin D Mokashi"

2 Publications

  • Page 1 of 1

Tuberculosis Pathways to Care and Transmission of Multidrug-Resistance in India.

Am J Respir Crit Care Med 2021 Oct 27. Epub 2021 Oct 27.

Harvard Medical School Department of Biomedical Informatics, 168461, Boston, Massachusetts, United States.

Rationale: India is experiencing a regional increase in cases of multidrug-resistant tuberculosis (MDR-TB). Given the complexity of MDR-TB diagnosis and care, we sought to address key knowledge gaps in MDR risk factors, care delays, and drivers of delay to help guide disease control.

Methods: From 1/2018-9/2019, we conducted interviews with adults registered with the National TB Elimination Program (NTEP) for MDR (n=128) and non-MDR-TB (n=269) treatment to quantitatively and qualitatively study care pathways. We collected treatment records and GeneXpert-TB/RIF diagnostic reports.

Measurement And Main Results: MDR-TB was associated with young age, and crowded residence. GeneXpert rifampicin resistance diversity was measured at 72.5% Probe E. Median time from symptom onset to diagnosis of MDR was 90 days vs. 60 days for non-MDR, Wilcoxon-P<0.01. Delay decreased by a median of 30 days among non-MDR patients with wider access to GeneXpert, Wilcoxon P=0.02. Pathways to care were complex with a median of 4 (3-5) and 3 (2-4) encounters for MDR and non-MDR respectively. Of MDR-TB patients, 68% had their first encounter in the private sector and this was associated with a larger number of subsequent healthcare encounters and catastrophic expenditure.

Conclusions: The association of MDR with young age, crowding and low genotypic diversity raise concerns of ongoing MDR transmission fueled by long delays in care. Delays are decreasing with GeneXpert use, suggesting the need for routine use in presumptive TB. Qualitatively, we identify the need to improve patient retention in the NTEP and highlight patients' trust relationship with private providers. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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http://dx.doi.org/10.1164/rccm.202012-4333OCDOI Listing
October 2021

Pro-inflammatory CXCL-10, TNF-α, IL-1β, and IL-6: biomarkers of SARS-CoV-2 infection.

Arch Virol 2021 Dec 23;166(12):3301-3310. Epub 2021 Sep 23.

ICMR-National Institute of Virology, Pune, 411001, Maharashtra, India.

Currently, the world is witnessing the pandemic of COVID-19, a disease caused by the novel coronavirus SARS-CoV-2. Reported differences in clinical manifestations and outcomes in SARS-CoV-2 infection could be attributed to factors such as virus replication, infiltration of inflammatory cells, and altered cytokine production. Virus-induced aberrant and excessive cytokine production has been linked to the morbidity and mortality of several viral infections. Using a Luminex platform, we investigated plasma cytokine and chemokine levels of 27 analytes from hospitalized asymptomatic (n = 39) and mildly symptomatic (n = 35) SARS-CoV-2-infected patients (in the early phase of infection), recovered individuals (45-60 days postinfection) (n = 40), and uninfected controls (n = 36) from the city of Pune located in the state of Maharashtra in India. Levels of the pro-inflammatory cytokines IL-1β, IL-6, and TNF-α and the chemokine CXCL-10 were significantly higher, while those of the antiviral cytokines IFN-γ and IL-12 p70 were significantly lower in both asymptomatic and mildly symptomatic patients than in controls. Comparison among the patient categories revealed no difference in the levels of the cytokines/chemokines except for CXCL-10 being significantly higher and IL-17, IL-4, and VEGF being significantly lower in the mildly symptomatic patients. Interestingly, levels of all key analytes were significantly lower in recovered individuals than in those in both patient categories. Nevertheless, the level of CXCL10 was significantly higher in the recovered patients than in the controls, indicating that the immune system of SARS-CoV-2 patients may take a longer time to normalize. Our data suggest that IL-6, IL-1β, TNF-α, CXCL-10, and reduced antiviral cytokines could be used as biomarkers of SARS-CoV-2 infection.
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http://dx.doi.org/10.1007/s00705-021-05247-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8459145PMC
December 2021
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