Perivascular Fibrosis Is Mediated by a KLF10-IL-9 Signaling Axis in CD4+ T Cells.

BACKGROUND: Perivascular fibrosis, characterized by increased amount of connective tissue around vessels, is a hallmark for vascular disease. Ang II (angiotensin II) contributes to vascular disease and end-organ damage via promoting T-cell activation. Despite recent data suggesting the role of T cells in the progression of perivascular fibrosis, the underlying mechanisms are poorly understood. METHODS: TF (transcription factor) profiling was performed in peripheral blood mononuclear cells of hypertensive patients. CD4-targeted KLF10 (Kruppel like factor 10)-deficient (Klf10fl/flCD4Cre+; [TKO]) and CD4-Cre (Klf10+/+CD4Cre+; [Cre]) control mice were subjected to Ang II infusion. End point characterization included cardiac echocardiography, aortic imaging, multiorgan histology, flow cytometry, cytokine analysis, aorta and fibroblast transcriptomic analysis, and aortic single-cell RNA-sequencing. RESULTS: TF profiling identified increased KLF10 expression in hypertensive human subjects and in CD4+ T cells in Ang II-treated mice. TKO mice showed enhanced perivascular fibrosis, but not interstitial fibrosis, in aorta, heart, and kidney in response to Ang II, accompanied by alterations in global longitudinal strain, arterial stiffness, and kidney function compared with Cre control mice. However, blood pressure was unchanged between the 2 groups. Mechanistically, KLF10 bound to the IL (interleukin)-9 promoter and interacted with HDAC1 (histone deacetylase 1) inhibit IL-9 transcription. Increased IL-9 in TKO mice induced fibroblast intracellular calcium mobilization, fibroblast activation, and differentiation and increased production of collagen and extracellular matrix, thereby promoting the progression of perivascular fibrosis and impairing target organ function. Remarkably, injection of anti-IL9 antibodies reversed perivascular fibrosis in Ang II-infused TKO mice and C57BL/6 mice. Single-cell RNA-sequencing revealed fibroblast heterogeneity with activated signatures associated with robust ECM (extracellular matrix) and perivascular fibrosis in Ang II-treated TKO mice. CONCLUSIONS: CD4+ T cell deficiency of Klf10 exacerbated perivascular fibrosis and multi-organ dysfunction in response to Ang II via upregulation of IL-9. Klf10 or IL-9 in T cells might represent novel therapeutic targets for treatment of vascular or fibrotic diseases.

Exploring climate shifts in the Ganga-Brahmaputra basin based on rainfall and temperature variability.

Climate change has a significant impact on the Ganga-Brahmaputra (GB) basin, the major food belt of India, which frequently experiences flooding and varied incidences of drought. The current study examines the changing trend of rainfall and temperature in the GB basin over a period of 30 years to identify areas at risk with an emphasis on the Paris Agreement's mandate to keep increasing temperatures below 2 °C. The maximum temperature anomaly in the middle Ganga plains recorded an increase of more than 1.5 °C year-1 in 1999, 2005, and 2009. Some extreme events were observed in the Brahmaputra basin during 1999, 2009, and 2010, where a prominent temperature increase of 1.5 °C year-1 was observed. The minimum temperature revealed an increasing trend for the G-B basin with an anomalous increase of 0.04 to 0.06 °C year-1. The rainfall variability across the Ganga basin shows a rising tendency over the lower Ganga region while the Brahmaputra basin showed a downward trend. To identify the statistical relation between the Global climatic oscillations and regional climate, Standardized Precipitation Index (SPI) and Niño 3.4 were used. The wet and dry period estimation shows a rise in flood conditions in the Ganga basin whereas, in the Brahmaputra basin, an increase in drought frequency was observed. The correlation based on Niño 3.4 and SPI3 presents a negative relation for the monsoon season in the G-B basin revealing a situation of drought occurrence (SPI3 below 0) with increased Nino 3.4 values (El Niño above + 0.4C).

Immunometabolic Endothelial Phenotypes: Integrating Inflammation and Glucose Metabolism.

[Figure: see text].

Expression of CD70 Modulates Nitric Oxide and Redox Status in Endothelial Cells.

BACKGROUND: Endothelial dysfunction is a critical component in the pathogenesis of cardiovascular diseases and is closely associated with nitric oxide (NO) levels and oxidative stress. Here, we report on novel findings linking endothelial expression of CD70 (also known as CD27 ligand) with alterations in NO and reactive oxygen species. METHODS: CD70 expression was genetically manipulated in human aortic and pulmonary artery endothelial cells. Intracellular NO and hydrogen peroxide (H2O2) were measured using genetically encoded biosensors, and cellular phenotypes were assessed. RESULTS: An unbiased phenome-wide association study demonstrated that polymorphisms in CD70 associate with vascular phenotypes. Endothelial cells treated with CD70-directed short-interfering RNA demonstrated impaired wound closure, decreased agonist-stimulated NO levels, and reduced eNOS (endothelial nitric oxide synthase) protein. These changes were accompanied by reduced NO bioactivity, increased 3-nitrotyrosine levels, and a decrease in the eNOS binding partner heat shock protein 90. Following treatment with the thioredoxin inhibitor auranofin or with agonist histamine, intracellular H2O2 levels increased up to 80% in the cytosol, plasmalemmal caveolae, and mitochondria. There was increased expression of NADPH oxidase 1 complex and gp91phox; expression of copper/zinc and manganese superoxide dismutases was also elevated. CD70 knockdown reduced levels of the H2O2 scavenger catalase; by contrast, glutathione peroxidase 1 expression and activity were increased. CD70 overexpression enhanced endothelial wound closure, increased NO levels, and attenuated the reduction in eNOS mRNA induced by TNFα. CONCLUSIONS: Taken together, these data establish CD70 as a novel regulatory protein in endothelial NO and reactive oxygen species homeostasis, with implications for human vascular disease.

Challenges faced by frontline health managers during the implementation of COVID-19 related policies in India: A qualitative analysis.

Background & objectives: The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district. Methods: A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed. Results: Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement. Interpretation & conclusions: The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.

Use of machine learning-based classification algorithms in the monitoring of Land Use and Land Cover practices in a hilly terrain.

The current high rate of urbanization in developing countries and its consequences, like traffic congestion, slum development, scarcity of resources, and urban heat islands, raise a need for better Land Use Land Cover (LULC) classification mapping for improved planning. This study mainly deals with two objectives: 1) to explore the applicability of machine learning-based techniques, especially the Random forest (RF) algorithm and Support Vector Machine (SVM) algorithm as the potential classifiers for LULC mapping under different scenarios, and 2) to prepare a better LULC classification model for mountain terrain by using different indices with combination of spectral bands. Due to differences in topography, shadows, spectral confusion from overlapping spectral signatures of different land cover types, and a lack of access for ground verification, classification in mountainous terrain is difficult task compared to plain terrain classification. An enhanced LULC classification model has been designed using two popular machine learning (ML) classifier algorithms, SVM and RF, explicitly for mountainous terrains by taking into consideration of a study area of Gopeshwer town in the Chamoli district of Uttarakhand state, India. Online-based cloud platform Google Earth Engine (GEE) was used for overall processing. Four classification models were built using Sentinel 2B satellite imagery with 20m and 10m resolutions. Two of these models (Model 'i' based on RF algorithm and Model 'ii' based on SVM algorithm) were designed using spectral bands of visible and infrared wavelengths, and the other two (Model 'iii' based on RF algorithm and Model 'iv' based on SVM algorithm) with the addition of indices with spectral bands. The accuracy assessment was done using the confusion matrix based on the output results. Obtained result highlights that the overall accuracy for model 'i' and model 'ii' were 82% and 86% respectively, whereas these were 87.17% and 87.2% for model 'iii' and model 'iv' respectively. Finally, the study compared the performance of each model based on different accuracy metrics for better LULC mapping. It proposes an improved LULC classification model for mountainous terrains, which can contribute to better land management and planning in the study area.

Mitochondrial Deacetylase Sirt3 Reduces Vascular Dysfunction and Hypertension While Sirt3 Depletion in Essential Hypertension Is Linked to Vascular Inflammation and Oxidative Stress.

RATIONALE: Hypertension represents a major risk factor for stroke, myocardial infarction, and heart failure and affects 30% of the adult population. Mitochondrial dysfunction contributes to hypertension, but specific mechanisms are unclear. The mitochondrial deacetylase Sirt3 (Sirtuin 3) is critical in the regulation of metabolic and antioxidant functions which are associated with hypertension, and cardiovascular disease risk factors diminish Sirt3 level. OBJECTIVE: We hypothesized that reduced Sirt3 expression contributes to vascular dysfunction in hypertension, but increased Sirt3 protects vascular function and decreases hypertension. METHODS AND RESULTS: To test the therapeutic potential of targeting Sirt3 expression, we developed new transgenic mice with global Sirt3OX (Sirt3 overexpression), which protects from endothelial dysfunction, vascular oxidative stress, and hypertrophy and attenuates Ang II (angiotensin II) and deoxycorticosterone acetate-salt induced hypertension. Global Sirt3 depletion in Sirt3-/- mice results in oxidative stress due to hyperacetylation of mitochondrial superoxide dismutase (SOD2), increases HIF1α (hypoxia-inducible factor-1), reduces endothelial cadherin, stimulates vascular hypertrophy, increases vascular permeability and vascular inflammation (p65, caspase 1, VCAM [vascular cell adhesion molecule-1], ICAM [intercellular adhesion molecule-1], and MCP1 [monocyte chemoattractant protein 1]), increases inflammatory cell infiltration in the kidney, reduces telomerase expression, and accelerates vascular senescence and age-dependent hypertension; conversely, increased Sirt3 expression in Sirt3OX mice prevents these deleterious effects. The clinical relevance of Sirt3 depletion was confirmed in arterioles from human mediastinal fat in patients with essential hypertension showing a 40% decrease in vascular Sirt3, coupled with Sirt3-dependent 3-fold increases in SOD2 acetylation, NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) activity, VCAM, ICAM, and MCP1 levels in hypertensive subjects compared with normotensive subjects. CONCLUSIONS: We suggest that Sirt3 depletion in hypertension promotes endothelial dysfunction, vascular hypertrophy, vascular inflammation, and end-organ damage. Our data support a therapeutic potential of targeting Sirt3 expression in vascular dysfunction and hypertension.

A study on initiation of postpartum family planning in India based on NFHS-4: does urban poor differ significantly from rural?

OBJECTIVE: To explore the differentials of postpartum contraceptive adoption between rural and urban poor after adjusting for utilization of MCH services and other selected socioeconomic and demographic covariates. METHODS: The data for this study is taken from the 4th round of NFHS survey conducted in India during 2015-16. The analysis is limited to 125,340 currently married women whose menses had returned at the time of survey. Discrete time complementary log-log multilevel model was applied.  RESULTS: The results clearly indicate that women from rural areas had a lower chance of early initiation of modern spacing methods after having recent birth as compare to that of Urban Poor and Urban non-poor areas. The contributions of several socioeconomic and demographic characteristics that were important for family planning practice were also highlighted in this study. CONCLUSION: There is an urgent need of designing an intervention that will result in effective delivery of services to achieve the greatest impact. Policy planners must focus on targeted interventions for family planning use in the postpartum period than simply focusing on family planning.

Motor neuron disease-associated loss of nuclear TDP-43 is linked to DNA double-strand break repair defects.

Genome damage and their defective repair have been etiologically linked to degenerating neurons in many subtypes of amyotrophic lateral sclerosis (ALS) patients; however, the specific mechanisms remain enigmatic. The majority of sporadic ALS patients feature abnormalities in the transactivation response DNA-binding protein of 43 kDa (TDP-43), whose nucleo-cytoplasmic mislocalization is characteristically observed in spinal motor neurons. While emerging evidence suggests involvement of other RNA/DNA binding proteins, like FUS in DNA damage response (DDR), the role of TDP-43 in DDR has not been investigated. Here, we report that TDP-43 is a critical component of the nonhomologous end joining (NHEJ)-mediated DNA double-strand break (DSB) repair pathway. TDP-43 is rapidly recruited at DSB sites to stably interact with DDR and NHEJ factors, specifically acting as a scaffold for the recruitment of break-sealing XRCC4-DNA ligase 4 complex at DSB sites in induced pluripotent stem cell-derived motor neurons. shRNA or CRISPR/Cas9-mediated conditional depletion of TDP-43 markedly increases accumulation of genomic DSBs by impairing NHEJ repair, and thereby, sensitizing neurons to DSB stress. Finally, TDP-43 pathology strongly correlates with DSB repair defects, and damage accumulation in the neuronal genomes of sporadic ALS patients and in Caenorhabditis elegans mutant with TDP-1 loss-of-function. Our findings thus link TDP-43 pathology to impaired DSB repair and persistent DDR signaling in motor neuron disease, and suggest that DSB repair-targeted therapies may ameliorate TDP-43 toxicity-induced genome instability in motor neuron disease.

Extreme rainfall-induced urban flood monitoring and damage assessment in Wuhan (China) and Kumamoto (Japan) cities using Google Earth Engine.

Floods in urban areas result in a detrimental impact on the natural environment and human health and pose major risks to assets and communication systems. In cities with high population density, the magnitude of flood damage largely depends upon flood inundation as well as floodwater depths. The present study compared recent flood inundation extent, damages caused, and possible floodwater depth in two highly developed metropolises of China and Japan, i.e., Wuhan and Kumamoto cities, for the year 2020. Sentinel-1 satellite data-driven change detection algorithm in Google Earth Engine (GEE) was applied to identify potentially flooded regions. Major land use land cover classes such as urban areas and croplands affected by the flood were mapped in conjunction with the exposed population. ALOS PALSAR digital elevation model (DEM) was used to study the inundation depth. The study revealed that 322 km2 of the area has been inundated by floodwater in Wuhan city with 230 km2 and 140 km2 areas under damaged croplands and urban regions. Around 817,095 people were exposed to this natural catastrophe in Wuhan. The city Kumamoto has witnessed an inundation area of about 505 km2 with damaged cropland of 350 km2 and an urban area of 83 km2.

Assessment of snout analysis of Himalayan glaciers: impact studies on Pindari, Kafni, Sundardhunga, and Baljuri base camp glaciers.

There are several causes for the increasing rate of deglaciation, such as global warming, increase in the concentration of black carbon, and extensive use of fossil fuels which causes the change in the overall climate system and shifting glacier ecosystem. This study was conducted on Pindari valley glaciers part of lesser Himalaya in Uttarakhand. This study investigates to (1) monitor and map change in the frontal length or the snout region of a glacier that can be studied with the help of remote sensing techniques and (2) evaluate the decadal and annual retreat rate of the glacier from 1972 to 2018. The study applies both the maximum likelihood classifier and NDSI spectral indices based classification for extracting the glacier region for different periods. This study reveals a significant amount of retreats taking place in the selected glaciers, Pindari, Sundardhunga, Kafni, and Baljuri base camp glaciers, from 1972 to 2018 as 1719.95 m, 1751.21 m, 1057.01 m, and 810.78 m, respectively. The highest amount of change is noticed in Pindari and Sundardhunga glaciers, higher than ~ 1700 m. The study analyses temporal variation of the annual and decadal retreat rate in the Pindari valley glaciers, which would be helpful for the further study of the other glaciers.

Improvement in air quality and its impact on land surface temperature in major urban areas across India during the first lockdown of the pandemic.

The SARS CoV-2 (COVID-19) pandemic and the enforced lockdown have reduced the use of surface and air transportation. This study investigates the impact of the lockdown restrictions in India on atmospheric composition, using Sentinel-5Ps retrievals of tropospheric NO2 concentration and ground-station measurements of NO2 and PM2.5 between March-May in 2019 and 2020. Detailed analysis of the changes to atmospheric composition are carried out over six major urban areas (i.e. Delhi, Mumbai, Kolkata, Chennai, Bangalore, and Hyderabad) by comparing Moderate Resolution Imaging Spectroradiometer (MODIS) Aerosol Optical Depth (AOD) and land surface temperature (LST) measurements in the lockdown year 2020 and pre-lockdown (2015-2019). Satellite-based data showed that NO2 concentration reduced by 18% (Kolkata), 29% (Hyderabad), 32-34% (Chennai, Mumbai, and Bangalore), and 43% (Delhi). Surface-based concentrations of NO2, PM2.5, and AOD also substantially dropped by 32-74%, 10-42%, and 8-34%, respectively over these major cities during the lockdown period and co-located with the intensity of anthropogenic activity. Only a smaller fraction of the reduction of pollutants was associated with meteorological variability. A substantial negative anomaly was found for LST both in the day (-0.16 °C to -1 °C) and night (-0.63 °C to -2.1 °C) across select all cities, which was also consistent with air temperature measurements. The decreases in LST could be associated with a reduction in pollutants, greenhouse gases and water vapor content. Improvement in air quality with lower urban temperatures due to lockdown may be a temporary effect, but it provides a crucial connection among human activities, air pollution, aerosols, radiative flux, and temperature. The lockdown for a shorter-period showed a significant improvement in environmental quality and provides a strong evidence base for larger scale policy implementation to improve air quality.

Global Hunger Index does not really measure hunger - An Indian perspective.

The Global Hunger Index (GHI) is calculated and disseminated annually. India, which is the 5th largest economy in the world and has a good ranking in many other indicators, has a poor ranking based on this index. After a critical review of the appropriateness of the indicators used in GHI, the Indian Council of Medical Research has the viewpoint that the indicators of undernourishment, stunting, wasting and child mortality do not measure hunger per se. Referring to this index as a Hunger Index, and thereby ranking countries is not appropriate, since many of the measures that are used to evolve an index that measures hunger are probably contextual. Countries should therefore evolve their own measures that are suitable for their own context.

Application of remote sensing in alpine grasslands cover mapping of western Himalaya, Uttarakhand, India.

Grasslands are the world's most extensive terrestrial ecosystem, which provides a variety of services for humans, such as carbon storage, food production, crop pollination, pest regulation, and are a major feed source for livestock. However, grasslands are today one of the most endangered ecosystems due to land-use change, agricultural intensification, land abandonment, as well as climate change. Grasslands are an integral part of human societies across the globe, which are broadly known as tropical savannah and temperate grasslands. In the Himalayan region, grasslands are found in more than 55% of the area and different climatic conditions lead to different varieties of grasslands like Danthonia grasslands, kobresia sedge meadow, etc. Grasslands deal with the spatial and temporal distribution of heterogeneous landscapes, which support a high diversity of various species. Owing to very rugged terrain and inaccessibility, the information on the extent of alpine grassland and percent grass cover (%) across the meadows is limited. Therefore, the present attempt was made to assess the current status of grassland in the alpine region of Uttarakhand above 3000 m asl. LANDSAT-8 (OLI and TIRS sensors) satellite data were used to delineate the grasslands using normalized difference vegetation indices (NDVIs) of the alpine region with the help of over 179 ground truth points out of which 50 points are testing points and 129 points are training points. Grass covers (%) were also assessed in the whole alpine region of Western Himalaya of Uttarakhand which nearly consists of over 75 meadows by using random plots (1 × 1 m, total 10 per site) in each meadow. Overall, 89.52% accuracy was achieved based on 50 randomly selected testing points. A total of 4949.25 sq. km area is under the different percentage of grass cover in the alpine region of Uttarakhand, Western Himalaya. Danthonia grasslands below 4000 m and Kobresia sedge meadows above 4000 m elevation are dominant in the state. In the alpine region, over 1056 sq. km grassland area have less than 10% grass cover indicating higher degraded and cold desert areas and only 565.69 sq. km area have more than 60% grass cover, which is highly favorable for rich biodiversity and grazing.

Impacts of partial to complete COVID-19 lockdown on NO2 and PM2.5 levels in major urban cities of Europe and USA.

SARS CoV-2 (COVID-19) coronavirus has been causing enormous suffering, death, and economic losses worldwide. There are rigorous containment measures on industries, non-essential business, transportation, and citizen mobility to check the spread. The lockdowns may have an advantageous impact on reducing the atmospheric pollutants. This study has analyzed the change in atmospheric pollutants, based on the Sentinel-5Ps and ground-station observed data during partial to complete lockdown period in 2020. Results revealed that the mean tropospheric NO2 concentration substantially dropped in 2020 due to lockdown against the same period in 2019 by 18-40% over the major urban areas located in Europe (i.e. Madrid, Milan, Paris) and the USA (i.e. New York, Boston, and Springfield). Conversely, urban areas with partial to no lockdown measures (i.e. Warsaw, Pierre, Bismarck, and Lincoln) exhibited a relatively lower dropdown in mean NO2 concentration (3 to 7.5%). The role of meteorological variability was found to be negligible. Nevertheless, the reduced levels of atmospheric pollutants were primarily attributed to the shutdown of vehicles, power plants, and industrial emissions. Improvement in air quality during COVID-19 may be temporary, but regulatory bodies should learn to reduce air pollution on a long-term basis concerning the trade-offs between the environment, society, and economic growth. The intersection of urban design, health, and environment should be addressed by policy-makers to protect public health and sustainable urban policies could be adopted to build urban resilience against any future emergencies.

Impact of social media on the academic performance of undergraduate medical students.

BACKGROUND: Social media has become an integral part in the life of every individual in the 21st century. Social media addiction in the younger age group is a major problem. The objective of this study was to find a correlation between academic performance and social media use. METHODS: This was a cross-sectional questionnaire-based study conducted in a medical school over a period of 3 months (Nov 2018-Jan 2019), where 400 medical undergraduates who use social media participated in the study. Data collected from the questionnaire included the academic performance in terms of university examination marks, the duration of social media use per day and the social media addiction score. Data correlation was done using the Pearson's correlation factor. RESULTS: 41.5% of students used social media for upto 3 h per day. Whatsapp (98.25%) and Youtube (91.75%) were the most commonly used social media applications. 73.5% used social media to read health-related news, 71.5% used it to complete assignments and more than 50% used it for seminar preparation, test preparation and research-related purposes. Academic performance of female students was better than male students. There was a significantly higher use of social media among academically low-performing medical students compared with high-performing medical students. There was a weak negative correlation between academic performance and social media usage and a strong positive correlation between social media usage and the social media addiction score. CONCLUSIONS: Social media has a negative impact on the academic performance of 21st-century undergraduate medical students.

One-month long foundation course for newly joined Indian medical undergraduates: Faculty and students' perspective.

BACKGROUND: A one-month long foundation course has been introduced at the entry-level for first-year MBBS (Bachelor of Medicine and Bachelor of Surgery) students in the medical institutions across India from 2019. Therefore, the present study is aimed at describing the experience of implementing a one-month long foundation course conducted for the Competency-based Undergraduate Medical Curriculum (CBUC) of Indian Medical Graduate as per the guidelines from the National Medical Commission (NMC) (erstwhile Medical Council of India, MCI). We have evaluated the student and faculty perceptions towards the effectiveness of the program. METHODS: The foundation course had six modules Orientation, Skills, Field visit to Community Health Centre, Professional Development including Ethics, Sports and Extracurricular activities, Computer Skills, and Language enhancement program. Regular feedback wascollected from students (N = 250) and teachers (N = 26) involved in the Foundation course using a semi-structured questionnaire. The program's overall feedback was also obtained at the end of the course, using a validated questionnaire. The quantitative findings were expressed in frequency and percentage. The qualitative observations (reflections of students and faculty) were subjected to thematic. RESULTS: The students and faculty appreciated the one-month long foundation course. The course's defined objectives were met as indicated by most students (98.4%) and faculty (75%). The course seemed to be useful for students to embark on a formal MBBS curriculum. It also exposed them to new knowledge and practices, as indicated by the feedback. Thematic analysis of the students' and faculty's reflections was carried out and two themes were identified, i.e., 'strengths' and 'challenges.' The Foundation Course Committee will work out appropriate remedial measures to overcome the challenges in the future sessions for subsequent batches. CONCLUSIONS: The one-month-long foundation course was found to be beneficial for newly joined students to get introduced and adjusted to higher education systems' demands. Also, the challenges faced during the program needs to be addressed with suitable remedial measures while implementing for subsequent batches. This effort will ensure a smooth conduct of the foundation course for the future batches of medical undergraduates and make the program more effective.

Surveillance based estimation of burden of malaria in India, 2015-2016.

BACKGROUND: India has launched the malaria elimination initiative in February 2016. Studies suggest that estimates of malaria are useful to rationalize interventions and track their impact. Hence, a national study was launched to estimate burden of malaria in India in 2015. METHODS: For sampling, all 624 districts of India were grouped in three Annual Parasite Incidence (cases per thousand population) categories, < two (low); two-five (moderate) and > five (high) API. Using probability proportional to size (PPS) method, two districts from each stratum were selected covering randomly 200,000 persons per district. Active surveillance was strengthened with 40 trained workers per study district. Data on malaria cases and deaths was collated from all health care providers i.e. pathological laboratories, private practitioners and hospitals in private and public health sectors and was used for analysis and burden estimation. RESULTS: Out of 1215,114 population under surveillance, 198,612 (16.3%) tests were performed and 19,386 (9.7%) malaria cases were detected. The malaria cases estimated in India were 3875,078 (95% confidence interval 3792,018-3958,137) with API of 3.05 (2.99-3.12) including 2789,483 (2740,577-2838,389) Plasmodium falciparum with Annual Falciparum Incidence of 2.2 (2.16-2.24). Out of 8025 deaths investigated, 102 (1.27%) were attributed to malaria. The estimated deaths in India were 29,341 (23,354-35,327) including 19,067 (13,665-24,470) confirmed and 10,274 (7694-12,853) suspected deaths in 2015-2016. CONCLUSIONS: Estimated malaria incidence was about four folds greater than one million reported by the national programme, but three folds lesser than thirteen million estimated by the World Health Organization (WHO). However, the estimated deaths were 93 folds more than average 313 deaths reported by the national malaria programme in 2015-2016. The 29,341 deaths were comparable with 24,000 deaths in 2015 and 22,786 deaths in 2016 estimated by the WHO for India. These malaria estimates can serve as a benchmark for tracking the success of malaria elimination campaign in India.

Findings from the 2017 HIV estimation round & trend analysis of key indicators 2010-2017: Evidence for prioritising HIV/AIDS programme in India.

Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels. Methods: Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015. Results: The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed. Interpretation & conclusions: With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.