Search

Abstract Breast cancer (BC) has emerged as the most common malignancy among females. The genomic profile of BC is diverse in nature and complex due to heterogeneity among various geographically different ethnic groups. The primary objective of this study was to carry out a comprehensive mutational analysis of Indian BC cases by performing whole exome sequencing. The cohort included patients with a median age of 48 years. TTN, TP53, MUC16, SYNE1, and OBSCN were the frequently altered genes found in our cohort. The PIK3CA and KLC3 genes are driver genes implicated in various cellular functions and cargo transportation through microtubules, respectively. Except for CCDC168 and PIK3CA, several gene pairings were found to be significantly linked with co-occurrence. Irrespective of their hormonal receptor status, RTK/RAS was observed with frequently altered signaling pathways. Further analysis of the mutational signature revealed that SBS13, SBS6, and SBS29 were mainly observed in our cohort. This study supplements the discovery of diagnostic biomarkers and provides new therapeutic options for the improved management of BC.

The progression of gallbladder inflammatory lesions to invasive cancer remains poorly understood, necessitating research on biomarkers involved in this transition. This study aims to identify and validate proteins associated with this progression, offering insights into potential diagnostic biomarkers for gallbladder cancer (GBC). Label-free liquid chromatography assisted tandem mass spectrometry (LC-MS/MS) proteomics was performed on samples from 10 cases each of GBC and inflammatory lesions, with technical duplicates. Validation was conducted through the enzyme-linked immunosorbent assay (ELISA) using 80 samples (40 GBC and 40 inflammatory lesions). Bioinformatics tools analyzed protein-protein interaction (PPI) networks and pathways. Statistical correlations with clinicopathological variables were assessed. Prognostic evaluation utilized Kaplan–Meier survival analysis and Cox regression analyses. mRNA expressions were studied using real time-polymerase chain reaction (RT-PCR). Out of 5,714 proteins analyzed, 621 were differentially expressed. Three upregulated (the S100 calcium-binding protein P [S100P], polymeric immunoglobulin receptor [PIGR], and complement C1q-binding protein [C1QBP]) and two downregulated (transgelin [TAGLN] and calponin 1 [CNN1]) proteins showed significant expression. Pathway analysis implicated involvement of proteoglycans in cancer and glycosaminoglycan metabolism. Significant correlations were observed between protein concentrations and clinicopathological variables. Prognostic factors such as tumor size, lymph node metastasis, and preoperative bilirubin levels were associated with overall survival. Protein-based assays demonstrated higher resolution compared to mRNA analysis, suggesting their utility in GBC risk stratification. S100P, PIGR, C1QBP, TAGLN, and CNN1 emerge as potential protein-based biomarkers involved in the progression from gallbladder inflammatory lesions to invasive cancer. These findings hold promise for improved diagnostic and prognostic strategies in GBC management.

Over recent years, the scientific community has acknowledged the crucial role of certain microbial strains inhabiting the intestinal ecosystem in promoting human health, and participating in various beneficial functions for the host. These microorganisms are now referred to as next-generation probiotics and are currently considered as biotherapeutic products and food or nutraceutical supplements. However, the majority of next-generation probiotic candidates pose nutritional demands and exhibit high sensitivity towards aerobic conditions, leading to numerous technological hurdles in large-scale production. This underscores the need for the development of suitable delivery systems capable of enhancing the viability and functionality of these probiotic strains. Currently, potential candidates for next generation probiotics (NGP) are being sought among gut bacteria linked to health, which include strains from the genera Bacteroids, Faecalibacterium, Akkermansia and Clostridium. In contrast to Lactobacillus spp. and Bifidobacterium spp., NGP, particularly Bacteroids spp. and Clostridium spp., appear to exhibit greater ambiguity regarding their potential to induce infectious diseases. The present review provides a comprehensive overview of NGPs in terms of their health beneficial effects, regulation framework and risk assessment targeting relevant criteria for commercialization in food and pharmaceutical markets.

Microbes are a worthwhile organism of the earth that could be formulated as consortium which can be utilized as biofertilizers. Consortium-based bioinoculants or biofertilizers are superior to single strain-based inoculants for sustainable agricultural productivity and increased micronutrient content in yield. The aim of present study was to evaluate the effect of different combinations of beneficial bacteria that are more effective than single-based bioinoculants. The current work focuses on the isolation of rhizospheric microorganisms from various cereals and pseudocereal crops and the development of a single inoculum as well as a bacterial consortium which were evaluated on wheat crop. A total 214 rhizospheric bacteria were sorted out and, screened for mineral solubilizing attributes i.e., phosphorus, potassium, zinc and selenium solubilization. Among all the bacterial isolates, four potential strains exhibiting P, K, Zn and Se-solubilizing attributes were identified with the help of 16S rRNA gene sequencing as Rahnella aquatilis EU-A3Rb1, Erwinia aphidicola EU-A2RNL1, Brevibacillus brevis EU-C3SK2, and Bacillus mycoides EU-WRSe4, respectively. The identified strains formulated as a consortium which were found to improve the plant growth and physiological parameters in comparison to single culture inoculants and control. To the best of our knowledge, the present investigation is the first report that has developed the consortium from bacterial strains Rahnella aquatilis EU-A3Rb1, Erwinia aphidicola EU-A2RNL1, Brevibacillus brevis EU-C3SK2, and Bacillus mycoides EU-WRSe4. A combination of bacterial strains could be used as liquid inoculants for cereal crops growing in mountainous regions.

Biotic stress affects economically important crop species and leads to quality and yield losses. Plants exhibit the ability of responding to the pathogen attack by synthesizing compounds which leads to either the inhibition or reduction of disease incidence. Plants live in close association with microbial communities. Microbes and their metabolites impact the health of the plants by supplying mineral nutrients, hormonal modulation and protection from the pathogenic organisms. Induced systemic response is one of the major mechanisms employed by the microbes in biocontrol. Beneficial microbes release certain compounds as elicitors in the rhizospheric region which are perceived by the plant roots as signals that increase the defense and resistance of the plants against the phytopathogens. The phytohormones such as ethylene, jasmonic acid, and salicylic acid are involved in regulation of the induced defense responses. The present review highlights the negative impact of the biotic stress on the plants and how induced systemic response is induced in the plants further discussing the role of the microbial elicitors in induced systemic response, their molecular mechanisms and hormonal regulation and draws the attention of the scientific community to explore new microbial elicitors as disease control alternatives.

Abstract Agriculture is the backbone of developing countries, which plays an essential role in primary drivers of economy. The increasing use of chemical fertilizers and toxic insecticides endangers the health of human, plant soils, and the environment. Microbial insecticides have been implemented in current scenario for crop protection. Biological agents for pest control have gained more attention in recent year as substitutes for management of pests and pathogens. It provides a sustainable approach to plant health management and assists to minimize the excessive applications of toxic substances. The antagonistic microbes belong to six different phyla including Bacillota, Actinomycetota, Pseudomonadota, Bacteroidota and Mucoromycota. Microbial pesticides have been developed through a number of processes, including extraction of pure culture and screening using effectiveness bioassays under controlled and natural conditions. Biological control agents (BCAs) are recognized to be the most sophisticated technology for environmentally friendly agriculture. The various beneficial BCAs have been reported for the management of plant health, but they required effective acceptance together with the standardization of bioformulation. The present review deals with the recent development of microbial control agents, mechanisms of actions, development of microbial pesticides and their potential applications for agricultural productivity.

CONTEXT: Structured Feedback is a learning and assessment tool designed to provide feedback to students and educators to adjust learning and teaching during the training. Lack of provision of structured feedback to postgraduate (PG) medical students prompted us to plan a study to introduce a structured feedback module into the existing monthly assessment schedules in the Department of Transfusion Medicine. AIM: This study aims to introduce a structured feedback module and evaluate its efficacy after incorporation into the existing monthly assessment schedules for the PG students in the Department of Transfusion Medicine. DESIGN AND SETTING: A quasi-experimental study was commenced after obtaining clearance from the Institutional Ethics Committee in the Department of Transfusion Medicine for the students pursuing postgraduation in Transfusion Medicine. METHODOLOGY: A peer-validated feedback module was designed and implemented for MD students by the core team faculty. The students underwent the structured feedback sessions after each monthly assessment for of 3 months. One on one, verbal feedback was conducted using Pendleton's method, for monthly online assessment for the learning that happened during study period. DATA COLLECTION AND STATISTICAL ANALYSIS: The data were collected from the open-ended and closed-ended questions using Google form-based Student/Faculty perception and students' pre-post self-efficacy questionnaires on 5-point Likert Scale and the quantitative data analysis was done using percentage of Likert scores, median values for each item for pre-and post-responses and comparison using nonparametric test – Wilcoxon signed-rank test. The qualitative data analysis was done using thematic analysis from the open ended questions. RESULTS: All (n = 9; 100%) the PG students strongly agreed and agreed (median score of 5 and 4) that the feedback they received made them aware of their learning gaps, enabled them in bridging those gaps and provided ample opportunity to interact with faculty. Both students and faculty agreed that the feedback session should be an ongoing and continuous process in the department. CONCLUSION: Both the students as well as faculty were satisfied with the implementation of the feedback module in the department. Students reported awareness about the learning gaps, identification of appropriate study resources, and ample opportunity to interact with faculty, after taking the feedback sessions. The faculty felt satisfied on the acquisition of new skill for delivering structured feedback to students.

Lantana weed (Lantana camara L.) is among the most noxious weeds in the world. Keeping in mind its invasive behavior and great ecological tolerance, it becomes imperative to analyze the structure and function of associated microbiome. In this perspective, Illumina-based metagenome sequencing was performed to gain a better understanding of prokaryotic diversity and community structure in the rhizosphere soil of L. camara L. The organic carbon, nitrogen, phosphorus, and potassium contents in the rhizosphere soil were 0.91% (± 0.21%); 280 Kg ha-1 (± 4.02 Kg ha-1), 54.5 Kg ha-1 (± 3.12 Kg ha-1), and 189 Kg ha-1 (± 6.11 Kg ha-1), respectively. The metagenome analysis revealed the existence of 41 bacterial and 2 archaeal phyla, with only 12 showing ≥1% abundances. Pseudomonadota was the dominant phylum with 31.3% abundance, followed by Actinomycetota (20.9%). Further, 54 different genera were identified with the highest abundance of Devosia (2.8%). The PICRUSt analysis predicted various functional traits in the soil metagenome, with general cellular functions dominating, followed by stress tolerance. Moreover, 10% of the functions were associated with nitrogen fixation, phosphate solubilization, and potassium mobilization. In conclusion, the present study revealed the existence of diverse prokaryotic communities in the rhizosphere of the L. camara L. which was primarily associated with stress response and plant growth promotion. To the best of our knowledge, this study documents for the first time the L. camara L. microbiome. Furthermore, the identified genera can be explored for agricultural needs in future.

Microbes play crucial functions in maintaining the health and growth of the plants directly or indirectly by supplying nutrients. These microbes could be used as biofertilizers for the enhancement of soil health and growth of crops. In preset investigation, potential microbes from endophytic and rhizospheric region of Aegilops kotschyi growing in green slopes of Shivaliks, Himachal Pradesh were sorted out and screened for plant growth promoting attributes including phosphorus and potassium solubilization. The potential bacterial strains were identified through 16S rRNA gene sequencing and developed as microbial consortium for the plant growth of wheat and wild wheat relative Aegilops kotschyi. A total 125 isolates of bacteria were sorted out and among them 36 were found as P-solubilizers and 19 showed K-solubilization attribute and two highly potential bacterial strain were identified as Bacillus tropicus EU-ARP-44 (P-solubilizer; 270.5 ± 0.00 mg L−1) and B. megaterium EU-ARK-23 (K-Solubilizer; 51.3 ± 1.7 mg mL−1). The microbial consortium of Rahnella sp. strain EU-A3SNfb (N-fixer; MN294545), B. tropicus EU-ARP-44 (P-solubilizer) and B. megaterium EU-ARK-23 (K-solubilizer) evaluation in Aegilops kotschyi and wheat crop resulted in the enhancement of growth as well as physiological parameter including shoot/root length, fresh/dry weight and chlorophyll, carotenoid, total soluble sugar content, phenolic and flavonoid content as compared to un-inoculated control. Microbial consortium consisting of potential plant growth promoting (PGP) bacterial strains could be used as biofertilizer and bioinoculants in cereals crop growing in hilly region.

Drought stress is among the most destructive stresses for agricultural productivity. It interferes with normal metabolic activities of the plants resulting, a negative impact on physiology and morphology of the plants. The management of drought stress requires various adaptive and alleviation strategies in which stress adaptive microbiomes are exquisite bioresources for plant growth and alleviation of drought stress. Diverse drought adaptive microbes belonging to genera Achromobacter, Arthrobacter, Aspergillus, Bacillus, Pseudomonas, Penicillium and Streptomyces have been reported worldwide. These bioresources exhibit a wide range of mechanisms such as helping plant in nutrient acquisition, producing growth regulators, lowering the levels of stress ethylene, increasing the concentration of osmolytes, and preventing oxidative damage under water deficit environmental conditions. Horticulture is one of the potential agricultural sectors to speed up the economy, poverty and generation of employment for livelihood. The applications of drought adaptive plant growth promoting (PGP) microbes as biofertilizers and biopesticides for horticulture is a potential strategy to improve the productivity and protection of horticultural crops from abiotic and biotic stresses for agricultural sustainability.

Bioinoculants provide better opportunity for ecological farming practices to improve the plant growth and enhanced crop productivity. Different types of bioinoculants containing single microbial culture and multiple microbial strains in single formulation could be used for agricultural sustainability. The different efficient microbial strain in single formulation as a consortium is an emerging trend in the present era. The present study deals with the isolation of nitrogen fixing, phosphorus and potassium solubilizing microbes from rhizospheric soil and root's internal tissues of different cereal/pseudocereal crops and their application as a microbial consortium for the growth of cereal crops. A total of 152 rhizospheric and endophytic bacteria were isolated and screened for the plant growth promoting (PGP) traits of nitrogen fixation, solubilization of phosphorus, and potassium. Among all the isolates, nine were found to fix nitrogen, fifteen and eleven exhibited phosphorus and potassium solubilization activity, respectively. Three selected efficient bacterial strains were identified using 16S rRNA gene sequencing as Erwinia sp. EU-B2SNL1 (N-fixer), Chryseobacterium arthrosphaerae EU-LWNA-37 (P-solubilizer), and Pseudomonas gessardii EU-MRK-19 (K-solubilizer). The inoculation of these three bacterial strains on barley crop as single inoculum and as microbial consortium enhanced the growth and physiological parameters including root/shoot length and biomass, chlorophyll, carotenoids, phenolics, flavonoids and soluble sugar content in comparison with untreated control. The microbial consortium was found to be more effective as compared to single inoculum. The microbial consortium of nitrogen fixing and mineral solubilizing microbes could be used as biofertilizer for plant growth and soil health.

Microbes are ubiquitous in nature, and plant-microbe interactions are a key strategy for colonizing diverse habitats. Fungi are producing a wide range of secondary metabolites and bioactive compounds, which are probable alternative sources of drugs and/or antibiotics. Fungi are associated with the crops and plays an important role in plant growth promotion and enhanced soil fertility using different PGP mechanism such as solubilization of phosphorus, zinc, potassium; production of plant growth regulator (auxins, cytokinin, gibberellins, ethylene and abscisic acid); hydrolytic enzymes (xylanases, laccase, pectinases, cellulases); and siderophores. Besides eliciting plant defence reaction against pathogens; PGP fungi also help in plant growth promotion and alleviation of different abiotic stresses under harsh environments. The PGP fungi have reported from different genera of phyla Chytridiomycota, Zygomycota, Glomeromycota, Ascomycota, and Basidiomycota. Fungi also have significant potential applications in various industries like medical, and food. In the medical applications, fungi and fungal products are used to control disease in human and animals. In the fermentation industries fungi used to make alcoholic beverages, cheeses, bread, kefir, yogurt and various other food preparations and the agricultural sectors used to make plant healthy and protects to pathogens. The present review, deals with the biodiversity of beneficial fungi from different habitats and their biotechnological applications in plant growth promotion and soil health.

Summary: Background: The association of air pollution with multiple adverse health outcomes is becoming well established, but its negative economic impact is less well appreciated. It is important to elucidate this impact for the states of India. Methods: We estimated exposure to ambient particulate matter pollution, household air pollution, and ambient ozone pollution, and their attributable deaths and disability-adjusted life-years in every state of India as part of the Global Burden of Disease Study (GBD) 2019. We estimated the economic impact of air pollution as the cost of lost output due to premature deaths and morbidity attributable to air pollution for every state of India, using the cost-of-illness method. Findings: 1·67 million (95% uncertainty interval 1·42–1·92) deaths were attributable to air pollution in India in 2019, accounting for 17·8% (15·8–19·5) of the total deaths in the country. The majority of these deaths were from ambient particulate matter pollution (0·98 million [0·77–1·19]) and household air pollution (0·61 million [0·39–0·86]). The death rate due to household air pollution decreased by 64·2% (52·2–74·2) from 1990 to 2019, while that due to ambient particulate matter pollution increased by 115·3% (28·3–344·4) and that due to ambient ozone pollution increased by 139·2% (96·5–195·8). Lost output from premature deaths and morbidity attributable to air pollution accounted for economic losses of US$28·8 billion (21·4–37·4) and $8·0 billion (5·9–10·3), respectively, in India in 2019. This total loss of $36·8 billion (27·4–47·7) was 1·36% of India's gross domestic product (GDP). The economic loss as a proportion of the state GDP varied 3·2 times between the states, ranging from 0·67% (0·47–0·91) to 2·15% (1·60–2·77), and was highest in the low per-capita GDP states of Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, and Chhattisgarh. Delhi had the highest per-capita economic loss due to air pollution, followed by Haryana in 2019, with 5·4 times variation across all states. Interpretation: The high burden of death and disease due to air pollution and its associated substantial adverse economic impact from loss of output could impede India's aspiration to be a $5 trillion economy by 2024. Successful reduction of air pollution in India through state-specific strategies would lead to substantial benefits for both the health of the population and the economy. Funding: UN Environment Programme; Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Summary: Background: Air pollution is a major planetary health risk, with India estimated to have some of the worst levels globally. To inform action at subnational levels in India, we estimated the exposure to air pollution and its impact on deaths, disease burden, and life expectancy in every state of India in 2017. Methods: We estimated exposure to air pollution, including ambient particulate matter pollution, defined as the annual average gridded concentration of PM2.5, and household air pollution, defined as percentage of households using solid cooking fuels and the corresponding exposure to PM2.5, across the states of India using accessible data from multiple sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three Socio-demographic Index (SDI) levels as calculated by GBD 2017 on the basis of lag-distributed per-capita income, mean education in people aged 15 years or older, and total fertility rate in people younger than 25 years. We estimated deaths and disability-adjusted life-years (DALYs) attributable to air pollution exposure, on the basis of exposure–response relationships from the published literature, as assessed in GBD 2017; the proportion of total global air pollution DALYs in India; and what the life expectancy would have been in each state of India if air pollution levels had been less than the minimum level causing health loss. Findings: The annual population-weighted mean exposure to ambient particulate matter PM2·5 in India was 89·9 μg/m3 (95% uncertainty interval [UI] 67·0–112·0) in 2017. Most states, and 76·8% of the population of India, were exposed to annual population-weighted mean PM2·5 greater than 40 μg/m3, which is the limit recommended by the National Ambient Air Quality Standards in India. Delhi had the highest annual population-weighted mean PM2·5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India, all with mean values greater than 125 μg/m3. The proportion of population using solid fuels in India was 55·5% (54·8–56·2) in 2017, which exceeded 75% in the low SDI states of Bihar, Jharkhand, and Odisha. 1·24 million (1·09–1·39) deaths in India in 2017, which were 12·5% of the total deaths, were attributable to air pollution, including 0·67 million (0·55–0·79) from ambient particulate matter pollution and 0·48 million (0·39–0·58) from household air pollution. Of these deaths attributable to air pollution, 51·4% were in people younger than 70 years. India contributed 18·1% of the global population but had 26·2% of the global air pollution DALYs in 2017. The ambient particulate matter pollution DALY rate was highest in the north Indian states of Uttar Pradesh, Haryana, Delhi, Punjab, and Rajasthan, spread across the three SDI state groups, and the household air pollution DALY rate was highest in the low SDI states of Chhattisgarh, Rajasthan, Madhya Pradesh, and Assam in north and northeast India. We estimated that if the air pollution level in India were less than the minimum causing health loss, the average life expectancy in 2017 would have been higher by 1·7 years (1·6–1·9), with this increase exceeding 2 years in the north Indian states of Rajasthan, Uttar Pradesh, and Haryana. Interpretation: India has disproportionately high mortality and disease burden due to air pollution. This burden is generally highest in the low SDI states of north India. Reducing the substantial avoidable deaths and disease burden from this major environmental risk is dependent on rapid deployment of effective multisectoral policies throughout India that are commensurate with the magnitude of air pollution in each state. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Summary: Background: The burden of diabetes is increasing rapidly in India but a systematic understanding of its distribution and time trends is not available for every state of India. We present a comprehensive analysis of the time trends and heterogeneity in the distribution of diabetes burden across all states of India between 1990 and 2016. Methods: We analysed the prevalence and disability-adjusted life-years (DALYs) of diabetes in the states of India from 1990 to 2016 using all available data sources that could be accessed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, and assessed heterogeneity across the states. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed the contribution of risk factors to diabetes DALYs and the relation of overweight (body-mass index 25 kg/m2 or more) with diabetes prevalence. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings: The number of people with diabetes in India increased from 26·0 million (95% UI 23·4–28·6) in 1990 to 65·0 million (58·7–71·1) in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5·5% (4·9–6·1) in 1990 to 7·7% (6·9–8·4) in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala (high ETL) and Delhi (higher-middle ETL), followed by Punjab and Goa (high ETL) and Karnataka (higher-middle ETL). The age-standardised DALY rate for diabetes increased in India by 39·6% (32·1–46·7) from 1990 to 2016, which was the highest increase among major non-communicable diseases. The age-standardised diabetes prevalence and DALYs increased in every state, with the percentage increase among the highest in several states in the low and lower-middle ETL state groups. The most important risk factor for diabetes in India was overweight to which 36·0% (22·6–49·2) of the diabetes DALYs in 2016 could be attributed. The prevalence of overweight in adults in India increased from 9·0% (8·7–9·3) in 1990 to 20·4% (19·9–20·8) in 2016; this prevalence increased in every state of the country. For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34–42) with diabetes, compared with the global average of 19 adults (17–21) in 2016. Interpretation: The increase in health loss from diabetes since 1990 in India is the highest among major non-communicable diseases. With this increase observed in every state of the country, and the relative rate of increase highest in several less developed low ETL states, policy action that takes these state-level differences into account is needed urgently to control this potentially explosive public health situation. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Summary: Background: The burden of cardiovascular diseases is increasing in India, but a systematic understanding of its distribution and time trends across all the states is not readily available. In this report, we present a detailed analysis of how the patterns of cardiovascular diseases and major risk factors have changed across the states of India between 1990 and 2016. Methods: We analysed the prevalence and disability-adjusted life-years (DALYs) due to cardiovascular diseases and the major component causes in the states of India from 1990 to 2016, using all accessible data sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016. We placed states into four groups based on epidemiological transition level (ETL), defined using the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed heterogeneity in the burden of major cardiovascular diseases across the states of India, and the contribution of risk factors to cardiovascular diseases. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings: Overall, cardiovascular diseases contributed 28·1% (95% UI 26·5–29·1) of the total deaths and 14·1% (12·9–15·3) of the total DALYs in India in 2016, compared with 15·2% (13·7–16·2) and 6·9% (6·3–7·4), respectively, in 1990. In 2016, there was a nine times difference between states in the DALY rate for ischaemic heart disease, a six times difference for stroke, and a four times difference for rheumatic heart disease. 23·8 million (95% UI 22·6–25·0) prevalent cases of ischaemic heart disease were estimated in India in 2016, and 6·5 million (6·3–6·8) prevalent cases of stroke, a 2·3 times increase in both disorders from 1990. The age-standardised prevalence of both ischaemic heart disease and stroke increased in all ETL state groups between 1990 and 2016, whereas that of rheumatic heart disease decreased; the increase for ischaemic heart disease was highest in the low ETL state group. 53·4% (95% UI 52·6–54·6) of crude deaths due to cardiovascular diseases in India in 2016 were among people younger than 70 years, with a higher proportion in the low ETL state group. The leading overlapping risk factors for cardiovascular diseases in 2016 included dietary risks (56·4% [95% CI 48·5–63·9] of cardiovascular disease DALYs), high systolic blood pressure (54·6% [49·0–59·8]), air pollution (31·1% [29·0–33·4]), high total cholesterol (29·4% [24·3–34·8]), tobacco use (18·9% [16·6–21·3]), high fasting plasma glucose (16·7% [11·4–23·5]), and high body-mass index (14·7% [8·3–22·0]). The prevalence of high systolic blood pressure, high total cholesterol, and high fasting plasma glucose increased generally across all ETL state groups from 1990 to 2016, but this increase was variable across the states; the prevalence of smoking decreased during this period in all ETL state groups. Interpretation: The burden from the leading cardiovascular diseases in India—ischaemic heart disease and stroke—varies widely between the states. Their increasing prevalence and that of several major risk factors in every part of India, especially the highest increase in the prevalence of ischaemic heart disease in the less developed low ETL states, indicates the need for urgent policy and health system response appropriate for the situation in each state. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

AIM: To study the pattern and prevalence of dyslipidemia in a large representative sample of four selected regions in India. METHODS: Phase I of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study was conducted in a representative population of three states of India [Tamil Nadu, Maharashtra and Jharkhand] and one Union Territory [Chandigarh], and covered a population of 213 million people using stratified multistage sampling design to recruit individuals ≥20 years of age. All the study subjects (n = 16,607) underwent anthropometric measurements and oral glucose tolerance tests were done using capillary blood (except in self-reported diabetes). In addition, in every 5th subject (n = 2042), a fasting venous sample was collected and assayed for lipids. Dyslipidemia was diagnosed using National Cholesterol Education Programme (NCEP) guidelines. RESULTS: Of the subjects studied, 13.9% had hypercholesterolemia, 29.5% had hypertriglyceridemia, 72.3% had low HDL-C, 11.8% had high LDL-C levels and 79% had abnormalities in one of the lipid parameters. Regional disparity exists with the highest rates of hypercholesterolemia observed in Tamilnadu (18.3%), highest rates of hypertriglyceridemia in Chandigarh (38.6%), highest rates of low HDL-C in Jharkhand (76.8%) and highest rates of high LDL-C in Tamilnadu (15.8%). Except for low HDL-C and in the state of Maharashtra, in all other states, urban residents had the highest prevalence of lipid abnormalities compared to rural residents. Low HDL-C was the most common lipid abnormality (72.3%) in all the four regions studied; in 44.9% of subjects, it was present as an isolated abnormality. Common significant risk factors for dyslipidemia included obesity, diabetes, and dysglycemia. CONCLUSION: The prevalence of dyslipidemia is very high in India, which calls for urgent lifestyle intervention strategies to prevent and manage this important cardiovascular risk factor.

Background. Evidence-based research aids in decisionmaking in the health sector for developing health policies for prevention, diagnosis and treatment of diseases. Medical research is not taught in the undergraduate curriculum. Studies show that attributes of research knowledge, awareness and practical involvement in research are low among undergraduate students. We developed and validated a module and trained undergraduate students in research skills through an inter-ventional workshop using the structured module. Methods. We did this participatory action research with a mixed-methods approach in the Department of Community Medicine at Adesh Institute of Medical Sciences and Research, Bathinda, Punjab. A structured module was developed by the core committee and validated internally and externally. Pilot testing of the module was done by delivering it in the form of a workshop to 46 students. For statistical analysis, percentage agreements, validity indices, median (interquartile range), satisfaction percentages and Wilcoxon sign test were used. Results. The structured and validated module was established to have high face validity (>90%) and content validity (CVI=0.975). The module was successfully pilot tested for delivery through both onsite and online modes. The satisfaction percentage with the workshop was 91% and 100% and overall rating of the module was 74% and 91% by interns and MBBS students, and 100% by faculty. The scores of knowledge and skills were found to be significantly higher on all variables post workshop with p<0.001. All students scored satisfactory grades for research skills. Conclusions. Teaching research using a structured validated module improved the knowledge and skills related to research among students. Both students and faculty were satisfied with the use of the structured module. [ABSTRACT FROM AUTHOR]