South Asian Population Research Articles

Role of Genetic Testing in the Management of Indeterminate Thyroid Nodules in the Indian Setting.

The increased detection of thyroid nodules in the human population has led to an increase in the number of thyroid surgeries without an improvement in survival outcomes. Though the choice for surgery is straightforward in malignant thyroid nodules, the decision is far more complex in those nodules that get categorized into indeterminate thyroid nodules (ITN) by fine needle aspiration. Therefore, there is a pressing need to develop a tool that will aid in decision-making among the ITN. In this context, the development of various molecular testing (MT) panels has helped to confirm or rule out malignancy, reducing unnecessary surgeries and potentially guiding the extent of surgery as well. Currently, such tests are widely used among the Western population but these MT panels are not used by the South Asian population because of non-availability of validated panels and the high cost involved. There is a need to develop a suitable panel which is population-specific and validate the same. In this review, we would focus on current trends in the management of ITN among the South Asian population and how to develop a novel MT panel which is cost-effective, with high diagnostic accuracy obviating the need for expensive panels that already exist.

Diversity of genes encoding immune-related GTPase B2 protein, an inherited element responsible for resistance against virulent Toxoplasma gondiistrains, among wild Mus musculus in local area of Japan.

The major genetic group of Toxoplasma gondii, known as type I, generally displays high lethality in laboratory Mus musculus (mouse) strains, with few exceptions. However, because rodents are the primary reservoir hosts for T. gondii, if this characteristic manifests in the wild, type I strains would be extinct. Therefore, we hypothesized that populations of wild rodents capable of harboring type I T. gondii asymptomatically exist globally and are not limited to a few localized areas, as previously thought. The strength of mouse resistance to T. gondii is known to depend on the affinity of the mouse-expressed immunity-related GTPases B2 (IRGB2) protein for the T. gondii-expressed rphoptry protein 5B (ROP5B) protein. Therefore, the Irgb2 gene sequences of 12 individuals mice captured at two animal farms in Gifu Prefecture, and on an island in Okinawa Prefecture, Japan were determined, and subjected to a molecular phylogenetic analysis together with those of various mouse strains worldwide. The Irgb2 gene of M. musculus individuals captured on one farm and one island showed diverse sequences. The sequences from two individual mice captured in an animal farm formed a single clade with a wild mouse derived CAST/EiJ strain, known for its exceptional resistance to type I T. gondii lethality. These results suggest that M. musuculus individuals resistant to the Type I T. gondii strain may be present in Japan, in addition to the previously known populations in South Asia, Thailand and India.

Postpartum Pelvic floor disorder in Primiparous women - A prospective observational study

ABSTRACT Purpose: Pelvic floor dysfunction (PFD) describes clinical conditions related to changes in the pelvic floor causing voiding and defecation problems, pelvic organ prolapse (POP), sexual dysfunction, and pelvic pain. The postpartum period being associated with the onset or aggravation of PFD gives us an opportunity for identification and intervention. The evidence implicating vaginal delivery as a cause of PFD is controversial. This study will increase the understanding of the effect of vaginal birth on PFD, especially in the South Asian population. Methodology: A prospective observational study using pelvic floor disability index (PFDI 20) questionnaire (Hindi Version) was conducted. Two hundred primiparous women with term singleton fetuses who were admitted for planned delivery at term were enrolled and PFDI 20 questionnaire was filled. These women were followed till delivery and divided into two groups normal vaginal delivery (NVD) and LSCS. Enrolled women were followed up at 3 months postpartum and assessed using the PFDI 20 questionnaire. Results: Most common PFD symptom was POP in both groups followed by fecal incontinence and urinary incontinence symptoms. The percentage prevalence of any PFD symptoms was more in LSCS 67% as compared to 63% in the NVD group. The women with body mass index >28, prolonged labor >18 h, and instrumental delivery women with birth weight >3 kg had a higher prevalence of any PFD symptoms at 3 months postpartum irrespective of mode of delivery. Conclusion: Vaginal delivery should always remain as the first and best choice for delivery.

Bioinformatics analysis to identify the relationship between human papillomavirus-associated cervical cancer, toll-like receptors and exomes: A genetic epidemiology study.

Genetic variants may influence Toll-like receptor (TLR) signaling in the immune response to human papillomavirus (HPV) infection and lead to cervical cancer. In this study, we investigated the pattern of TLR expression in the transcriptome of HPV-positive and HPV-negative cervical cancer samples and looked for variants potentially related to TLR gene alterations in exomes from different populations. A cervical tissue sample from 28 women, which was obtained from the Gene Expression Omnibus database, was used to examine TLR gene expression. Subsequently, the transcripts related to the TLRs that showed significant gene expression were queried in the Genome Aggregation Database to search for variants in more than 5,728 exomes from different ethnicities. Cancer and HPV were found to be associated (p<0.0001). TLR1(p = 0.001), TLR3(p = 0.004), TLR4(221060_s_at)(p = 0.001), TLR7(p = 0.001;p = 0.047), TLR8(p = 0.002) and TLR10(p = 0.008) were negatively regulated, while TLR4(1552798_at)(p<0.0001) and TLR6(p = 0.019) were positively regulated in HPV-positive patients (p<0.05). The clinical significance of the variants was statistically significant for TLR1, TLR3, TLR6 and TLR8 in association with ethnicity. Genetic variants in different TLRs have been found in various ethnic populations. Variants of the TLR gene were of the following types: TLR1(5_prime_UTR), TLR4(start_lost), TLR8(synonymous;missense) and TLR10(3_prime_UTR). The "missense" variant was found to have a risk of its clinical significance being pathogenic in South Asian populations (OR = 56,820[95%CI:40,206,80,299]). The results of this study suggest that the variants found in the transcriptomes of different populations may lead to impairment of the functional aspect of TLRs that show significant gene expression in cervical cancer samples caused by HPV.

Is fat-to-lean mass ratio a better predictor of heart variability than body mass index?

Body mass index (BMI) may not accurately predict cardiometabolic risk due to confounders like age, gender, relatively high lean mass, and the "thin-fat phenotype" prevalent in south Asian populations. Fat-to-lean mass ratio (FTLM), which assesses the balance between fat and lean body mass, may provide a more complete assessment of cardiometabolic health. This cross-sectional analytical study investigated the relationship between FTLM ratio, BMI, and heart rate variability (HRV) in apparently healthy male adults. 88 participants recruited through convenience sampling underwent anthropometric assessments, bioimpedance body composition analysis, and HRV testing. Pearson's or Spearman's correlation and linear regression analyses were performed where appropriate to assess the relationship between FTLM ratio, BMI, and HRV. Both BMI and FTLM showed significant positive correlation with normalized LF power and LF-HF ratio and a negative correlation with normalized HF power, RMSSD, and pNN50. However, FTLM ratio showed a stronger association with HRV parameters than BMI and could explain a greater percentage of the variability in LF-HF ratio (32% compared to 18.4%, P < 0.001). Assessment of both fat and lean mass, expressed as a ratio, is a better index of quantifying adiposity and predicting the influence of altered body composition on cardiometabolic health.

Phenome-wide association study of population-differentiating genetic variants around gene ACSL1.

Demographic dynamics and natural selection during human evolution shaped the present-day patterns of genetic variations, and geographically varying genetic factors contribute to different disease prevalences across human populations. This study aims to evaluate the presence of positive selection on the gene encoding long-chain fatty acyl-CoA synthetase 1 (ACSL1) and the phenotypic impacts of population-differentiating genetic variants around this gene. Three types of statistical tests for positive selection, based on site frequency spectrum, extended haplotype homozygosity and population differentiation, were applied to the whole-genome sequencing data from the 1000 Genomes Project. A phenome-wide association study of ACSL1 was performed with published genome-wide association studies (GWAS) and transcriptome-wide association studies, including phenome-wide studies in biobanks. Genetic variants associated with ACSL1 expression in various tissues exhibit geographically varying allele frequencies. Three types of statistical tests consistently supported the presence of positive selection on the coding and regulatory regions of ACSL1 in African, European, South Asian and East Asian populations. A phenome-wide association study of ACSL1 revealed associations with type 2 diabetes, blood glucose, age at menopause, mean platelet volume and mean reticulocyte volume. The top allele associated with lower diabetes risk has the highest frequency in European populations, whereas the top allele associated with later menopause has the highest frequency in African populations. Positive selection on ACSL1 resulted in geographically varying genetic variants, which may contribute to differential phenotypes across human populations, including type 2 diabetes and age at menopause.

Chronic diseases and their behavioural risk factors among South Asian immigrants in Australia.

ObjectivesThe prevalence of chronic diseases among immigrants varies across different ethnic groups attributed to the disparities in their risk factors. This study aimed to explore the prevalence and correlates of chronic diseases among the rapidly growing South Asian population in Australia.MethodsAn online survey was administered (2020-2021) among South Asian immigrants in Australia. Diagnosed chronic diseases, smoking habits, physical activity, alcohol consumption, body mass index, and fruit and vegetable intake were assessed. A multivariable logistic regression model was used to examine factors associated with chronic disease.ResultsOverall, 50% of the study participants had one chronic disease and 39% had more than one chronic disease (n=282). Back pain (30%), depression (22%), diabetes (21%), hypertension (19%), and heart disease (12%) were the most reported diseases. Approximately 78% of participants were insufficiently active and 38% regularly consumed alcohol. Approximately three-quarters consumed fruits and vegetables less than once per day. Multivariable analyses showed that those who were aged more than 50years (OR=4.38, 95% CI 1.66-11.56), consumed alcohol more than once/month (OR=3.25, 95% CI 1.17-8.96), and ate less than one serving of vegetables/day (OR=2.94, 95% CI 1.19-7.26) had higher odds of having two or more chronic diseases.ConclusionsFifty percent of study participants presented with preventable diseases, signifying a substantial health burden. Public health interventions should primarily focus on reducing alcohol intake and increasing fruit and vegetable consumption, particularly among individuals of advanced age, to reduce the overall burden on the healthcare system.

Early Diagnosis and Management of Type-2 Diabetes: A Case Study

Metabolic diseases, such as hypertension, obesity, type-2 diabetes, and vascular diseases, have reached epidemic proportions globally, contributing significantly to non-communicable disease (NCD)-related mortality. Non-communicable diseases account for 71% of global deaths annually, with cardiovascular diseases (CVDs) leading the statistics. The South Asian phenotype presents a unique set of clinical characteristics, including, typical visceral obesity, high triglycerides, increased low-density lipoprotein cholesterol (LDL-Cholesterol), insulin resistance, and high propensity for type-2 diabetes. Several clinical studies have demonstrated that risk factors such as unhealthy diets, lack of physical inactivity, tobacco use, and alcohol consumption drive the development and progression of these metabolic disorders. The Framingham Heart Study remains pivotal, identifying robust predictors of CVDs including hypertension, dyslipidemia, smoking, and diabetes. Hypertension, a widespread silent condition, stands as a significant precursor to premature mortality globally. Childhood obesity rates have escalated dramatically, correlating with the rise in unhealthy lifestyles. Type-2 diabetes, increasingly prevalent, underscores the potential reversibility through early detection and management strategies. Complications from poorly managed diabetes, including cardiovascular events and microvascular complications, emphasize the urgency for the development of effective preventive measures. The South Asian population exhibits distinct metabolic traits predisposing to insulin resistance, type-2 diabetes, and cardiovascular diseases, influenced by genetic, dietary, and lifestyle factors. Addressing these unique challenges through targeted lifestyle interventions holds promise for mitigating vascular disease risks among South Asians. This case study advocates for a proactive approach to early diagnosis of cardiometabolic risks and comprehensive management of identified risks, aiming to reduce the burden of heart disease among younger populations. Insights from current research underscore the critical need for integrated strategies encompassing genetics, lifestyle modifications, and community-based interventions to combat the escalating crisis of metabolic diseases worldwide.

Association between the Number of Days/Week of Different Levels of Physical Activity and Chronic Pain in People of Different Races: A Mendelian Randomization Study.

Regular physical activity is beneficial for health, but the effect of the number of days/week of physical activity on chronic pain (CP) remains unclear, so we used a two-sample Mendelian randomization (MR) analysis to explore the relationship between the number of days/weeks of different levels of physical activity and chronic pain in people of different races. We obtained summary data from genome-wide association studies (GWASs) on the number of days/week of physical activity and multisite chronic pain in European, South Asian, East Asian, Middle Eastern, and African American populations. The single-nucleotide polymorphisms (SNPs) of the exposed data were visualized with a Manhattan plot via the R program. MR analysis was performed by the MR-Base platform. The results indicated that a higher number of days/week with ≥10 min of walking protects against CP in African American and Afro-Caribbean populations (inverse-variance weighting, IVW p < 0.05) but has little effect on people of different races (IVW p > 0.05). A higher number of days/week with ≥10 min of moderate physical activity increased the risk of CP in European and South Asia (IVW p < 0.05) but had little effect on people of different races (IVW p > 0.05). The number of days/week of ≥10 min of vigorous physical activity increased the risk of CP in Europeans (IVW p < 0.05) and protected against CP in African Americans and Afro-Caribbeans (IVW p < 0.05). A higher number of days/week of moderate and vigorous physical activity increased the risk of CP in Europeans; however, a higher number of days/week of walking and vigorous physical activity may protect against CP in African American and Afro-Caribbean individuals.

Stroke is Prevalent among South Asians, whether Living in Their home Country or Abroad

Background and Purpose: Every year, 15 million people worldwide suffer from an acute stroke, with one-third dying due to the incident. South Asians have a greater stroke mortality rate than the rest of the world. The causes of South Asians' increased risk of cerebrovascular illness remain unknown. The following study seeks to examine current stroke knowledge comprehensively and systematically in South Asian populations, particularly identifying distinctive aspects of stroke epidemiology in this demography. Summary of Review: Stroke is a common occurrence among South Asians, which may be due to inadequate metabolic and glycemic responses. Furthermore, hyperglycemia and stress, early predictors of long-term stroke mortality, appear to predict stroke-related death. Socioeconomic circumstances additionally serve as contributory factors. Conclusion: Given their greater incidence of heart disease, stress, diabetes, and the need for specific healthcare techniques, this study emphasizes the urgency of more significant stroke research among the South Asian population.

Genetic epidemiology of monogenic dyslipidemia and statin-associated adverse drug phenotypes in Indian population from whole-genomes of 1029 self-declared healthy individuals

BackgroundMonogenic dyslipidemia is a group of inherited genetic disorders characterized by abnormal levels of lipids and lipoproteins in blood, contributing to a significant risk for coronary artery diseases (CAD) and stroke. There is a paucity of prevalence estimates and genetic epidemiology of monogenic dyslipidemia in South Asian populations. The availability of population-scale genome sequencing datasets could potentially enable a better understanding of the genetic epidemiology of the disease. MethodsWe analyzed whole-genome sequence data of 1029 healthy individuals from India to identify pathogenic variants in 24 genes associated with 26 primary monogenic dyslipidemias. The American College of Medical Genetics and Genomics (ACMG) guidelines was used to classify the variants. We also inferred statin-associated adverse drug phenotypes from SLCO1B1, ABCG2, and CYP2C9 genotypes/haplotypes. ResultsOur analysis identified 12 pathogenic (P) and 9 likely pathogenic (LP) variants in 10 different genes. Autosomal dominant monogenic dyslipidemia prevalence ranged from 0.1% to 0.9%, while autosomal recessive disorder ranged from 0.000005% and 0.0005%. An infrequent ε4/ε4 APOE genotype associated with hypercholesterolemia was found in 1% of samples. Our pharmacogenomic analysis revealed that 10% may require reduced dosage for most statins including atorvastatin, and 1.5% may require reduced dosage for rosuvastatin. ConclusionOur study emphasizes the need for population-scale screening to enable early diagnosis and appropriate treatment of monogenic dyslipidemia in India. By identifying variants and estimating prevalence, our findings can inform healthcare providers in developing targeted prevention and management strategies to reduce cardiovascular disease risk.

Diabetes in South Asians: Uncovering Novel Risk Factors With Longitudinal Epidemiologic Data: Kelly West Award Lecture 2023.

South Asian populations have a higher prevalence and earlier age of onset of type 2 diabetes and atherosclerotic cardiovascular diseases than other race and ethnic groups. To better understand the pathophysiology and multilevel risk factors for diabetes and cardiovascular disease, we established the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study in 2010. The original MASALA study cohort (n = 1,164) included 83% Asian Indian immigrants, with an ongoing expansion of the study to include individuals of Bangladeshi and Pakistani origin. We have found that South Asian Americans in the MASALA study had higher type 2 diabetes prevalence, lower insulin secretion, more insulin resistance, and an adverse body composition with higher liver and intermuscular fat and lower lean muscle mass compared with four other U.S. race and ethnic groups. MASALA study participants with diabetes were more likely to have the severe hyperglycemia subtype, characterized by β-cell dysfunction and lower body weight, and this subtype was associated with a higher incidence of subclinical atherosclerosis. We have found several modifiable factors for cardiometabolic disease among South Asians including diet and physical activity that can be influenced using specific social network members and with cultural adaptations to the U.S. context. Longitudinal data with repeat cardiometabolic measures that are supplemented with qualitative and mixed-method approaches enable a deeper understanding of disease risk and resilience factors. Studying and contrasting Asian American subgroups can uncover the causes for cardiometabolic disease heterogeneity and reveal novel methods for prevention and treatment.

A Research Study on Comparison of Prevalence and Outcome of Maxillofacial Odontogenic Space Infection between Diabetic and Non-Diabetic Patients

Background: Orofacial space infections are commonly encountered problems in dental practice. The highest prevalence is seen among South Asian population because of their negligence in seeking dental treatment. Diabetes is one of the most common systemic illnesses suppressing the immunity of individual and increasing their susceptibility to infections. Currently, immunocompromised situation (Diabetes mellitus) and space infection together leads to complexity to evaluate the overall outcome of the patients. Objective: Aim of this study is to compare the prevalence and outcome of maxillofacial odontogenic space infection between diabetic and non-diabetic patients. Materials and Methods: This cross sectional study was conducted in the Department of Oral and Maxillofacial Surgery, BSMMU and DMCH over a period of 15 Months, from June 2020 to August 2021.The selection of the patients was as per the inclusion and exclusion criteria. The study commenced after IRB clearance. All the patients enrolled in this study after proper counseling and informed written consent. A total of 63 patients were taken and divided in to two groups on the basis of presence or absence of diabetes mellitus, Group A (diabetic): N1 number of patients and Group B (non-diabetic): N2 number of patients. Results: Majority of the patients were from BSMMU (58.73%) followed by DMCH (41.26%). Male were more commonly affected than females. Submandibular space was most commonly involved. Streptococcus was the most commonly isolated organism in non-diabetics while Klebsiella in diabetic patients. Meropenem was the most sensitive antibiotic while Amoxicillin was least sensitive antibiotic against the organisms found. This data will be helpful for future research and that will be considered baseline information for public health department. Conclusion: Prevalence of MSI was 4.33 (per thousand) in the study centers of Dhaka. Submandibular space was most common involved space in both diabetic and non-diabetic patients. Streptococcus was the most commonly isolated organism in non-diabetics while Klebsiellain diabetic patients. Meropenam was the most sensitive antibiotic in both group while Amoxicillin was not found sensitive on any patient in group A while least sensitive in group B. Keywords: odontogenic infection, fascial spaces, culture and antibiotic sensitivity

In silico identification and functional prediction of differentially expressed genes in South Asian populations associated with type 2 diabetes

Type 2 diabetes (T2D) is one of the major metabolic disorders in humans caused by hyperglycemia and insulin resistance syndrome. Although significant genetic effects on T2D pathogenesis are experimentally proved, the molecular mechanism of T2D in South Asian Populations (SAPs) is still limited. Hence, the current research analyzed two Gene Expression Omnibus (GEO) and 17 Genome-Wide Association Studies (GWAS) datasets associated with T2D in SAP to identify DEGs (differentially expressed genes). The identified DEGs were further analyzed to explore the molecular mechanism of T2D pathogenesis following a series of bioinformatics approaches. Following PPI (Protein-Protein Interaction), 867 potential DEGs and nine hub genes were identified that might play significant roles in T2D pathogenesis. Interestingly, CTNNB1 and RUNX2 hub genes were found to be unique for T2D pathogenesis in SAPs. Then, the GO (Gene Ontology) showed the potential biological, molecular, and cellular functions of the DEGs. The target genes also interacted with different pathways of T2D pathogenesis. In fact, 118 genes (including HNF1A and TCF7L2 hub genes) were directly associated with T2D pathogenesis. Indeed, eight key miRNAs among 2582 significantly interacted with the target genes. Even 64 genes were downregulated by 367 FDA-approved drugs. Interestingly, 11 genes showed a wide range (9–43) of drug specificity. Hence, the identified DEGs may guide to elucidate the molecular mechanism of T2D pathogenesis in SAPs. Therefore, integrating the research findings of the potential roles of DEGs and candidate drug-mediated downregulation of marker genes, future drugs or treatments could be developed to treat T2D in SAPs.

Tobacco use in people with severe mental illness: Findings from a multi-country survey of mental health institutions in South Asia.

People with severe mental illness (SMI) tend to die early due to cardiovascular and respiratory diseases, which may be linked to tobacco use. There is limited information on tobacco use in people with SMI in low- and middle-income countries where most tobacco users reside. We present novel data on tobacco use in people with SMI and their access to tobacco cessation advice in South Asia. We conducted a multi-country survey of adults with SMI attending mental health facilities in Bangladesh, India, and Pakistan. Using data collected with a standardized WHO STEPS survey tool, we estimated the prevalence and distribution of tobacco use and assessed receipt of tobacco cessation advice. We recruited 3874 participants with SMI; 46.8% and 15.0% of men and women consumed tobacco, respectively. Smoking prevalence in men varied by country (Bangladesh 42.8%, India 20.1% and Pakistan 31.7%); <4% of women reported smoking in each country. Smokeless tobacco use in men also varied by country (Bangladesh 16.2%, India 18.2% and Pakistan 40.8%); for women, it was higher in Bangladesh (19.1%), but similar in India (9.9%) and Pakistan (9.1%). Just over a third of tobacco users (38.4%) had received advice to quit tobacco. Among smokers, 29.1% (n=244) made at least one quit attempt in the past year. There was strong evidence for the association between tobacco use and the severity of depression (OR=1.29; 95% CI: 1.12-1.48) and anxiety (OR=1.29; 95% CI: 1.12-1.49). As observed in high-income countries, we found higher tobacco use in people with SMI, particularly in men compared with rates reported for the general population in South Asia. Tobacco cessation support within mental health services offers an opportunity to close the gap in life expectancy between SMI and the general population. ISRCTN88485933; https://doi.org/10.1186/ISRCTN88485933 39.

Prevalence and determinants of hypertension in South-Asian Urban Communities: findings from Demographic and Health Surveys (DHS) data of South Asian countries.

Hypertension increases risk of stroke and other cardiovascular diseases, however, its prevalence and determinants in South Asian urban communities using country representative community-based datasets is lacking. This study evaluated prevalence of hypertension and it's determinants among urban residents of three South Asian countries. Urban population data from demographic and health surveys in Bangladesh, India, and Nepal were extracted. Hypertension prevalence was defined as systolic/diastolic blood pressure 140/ 90 mmHg. Age, education, wealth, physical activity, alcohol, BMI were considered as risk factors associated with the increased risk of hypertension. We performed binary logistic regression and calculated adjusted Odds Ratios (AOR) with 95% confidence interval (CI) to assess factors related to hypertension. Hypertension prevalence was 37.4% in India, 25.1% in Bangladesh and 18.4% in Nepal. Prevalence increased with age in all settings. Females had reduced odds of hypertension in Bangladesh (AOR 0.75; CI: 0.69, 0.81) and Nepal (AOR 0.62; CI: 0.54, 0.71), but higher risk in India (AOR 2.54; CI: 2.45, 2.63). Low education, caffeine consumption, obesity was associated with higher prevalence of hypertension in all three countries. Smokers had increased odds of hypertension in India (AOR 1.11; CI: 1.06, 1.15) and Nepal (AOR 1.23; 1.02, 1.47). Overall, hypertension prevalence is high in all three countries. Modifiable socioeconomic and lifestyle factors (education, wealth index, smoking status, caffeine consumption and BMI) associated with hypertension. Comprehensive hypertension pacific and sensitive interventions (including behavioral modification treatments and timely screening and access to health care) are urgently needed to prevent and control hypertension among urban populations in South Asia.

Associations of general and central adiposity with hypertension and cardiovascular disease among South Asian populations: a systematic review and meta-analysis

BackgroundThe relevance of measures of general and central adiposity for cardiovascular disease (CVD) risks in populations of European descent is well established. However, it is less well characterised in South...

Future Amplification of Multivariate Risk of Compound Drought and Heatwave Events on South Asian Population

AbstractOver the past few decades, South Asia (SA) has experienced an upsurge in the frequency of severe monsoonal compound drought and heatwave (CDHW) occurrences. Climate models that identify land‐atmosphere coupling as a major contributing factor for this exacerbation and anticipate an increase in the intensity and frequency of CDHW occurrences in future also represent this. For the first time, this study investigated the future evolution of monsoonal CDHW events based on new generations of the CMIP6 and population products by applying a multivariate framework. Specifically, this study explored the impacts of natural climate variability and future land‐atmosphere coupling on the monsoonal CDHW event risks and their bivariate return periods for two future time‐periods and emission scenarios across SA and its subregions. The odds of CDHW occurrences were then examined using a logistic regression model and its association with the natural and anthropogenic drivers was determined. The results indicate that the monsoonal CDHWs occurrence is anticipated to increase substantially during the late twenty‐first century (2056–2090). The 50‐year CDHW events might increase by two‐fold across most of SA by the mid‐21st century under the high emission scenario. We find that the co‐occurring dry and warm conditions rapidly strengthens with soil moisture and temperature coupling and are further exacerbated by land‐atmospheric feedback loops. Our findings show that persistent dry spells contribute significantly to heatwave events, emphasizing regional exposure to changing climates.

Genetic Affinities and Adaptation of the South-West Coast Populations of India.

Evolutionary event has not only altered the genetic structure of human populations but also associated with social and cultural transformation. South Asian populations were the result of migration and admixture of genetically and culturally diverse groups. Most of the genetic studies pointed to large-scale admixture events between Ancestral North Indian (ANI) and Ancestral South Indian (ASI) groups, also additional layers of recent admixture. In the present study, we have analyzed 213 individuals inhabited in South-west coast India with traditional warriors and feudal lord status and historically associated with migratory events from North/North West India and possible admixture with West Eurasian populations, whose genetic links are still missing. Analysis of autosomal Single Nucleotide Polymorphism (SNP) markers suggests that these groups possibly derived their ancestry from some groups of North West India having additional Middle Eastern genetic components. Higher distribution of West Eurasian mitochondrial haplogroups also points to female-mediated admixture. Estimation of Effective Migration Surface (EEMS) analysis indicates Central India and Godavari basin as a crucial transition zone for population migration from North and North West India to South-west coastal India. Selection screen using 3 distinct outlier-based approaches revealed genetic signatures related to Immunity and protection from Viral infections. Thus, our study suggests that the South-west coastal groups with traditional warriors and feudal lords' status are of a distinct lineage compared to Dravidian and Gangetic plain Indo-Europeans and are remnants of very early migrations from North West India following the Godavari basin to Karnataka and Kerala.

ACP Conversations with Chinese and South Asian Patients: Physicians' Perspectives of Barriers and Facilitating Factors.

Advance Care Planning (ACP) discussions are infrequently conducted with physicians, even fewer among minorities. We explored physicians' experiences in engaging Chinese (CH) and South Asian (SA) patients in ACP conversations to understand initiation and participation patterns, topics covered, and barriers and facilitating factors. Twenty-two physicians with 15%+ SA patients aged 55+ and 19 with 15%+ CH patients aged 55+ were interviewed. SA- and CH-serving physicians described similar initiation patterns, cultural context, and need for standardized ACP routines. However, the SA-serving physicians described greater involvement of family members, while CH-serving physicians described more communication barriers and family members' desire to hide the diagnosis from patients. Cultural taboos surrounding discussion around death and dying appear to influence CH older adults and families strongly. Lack of familiarity with ACP amongst the SA population accounts more for their limited engagement in ACP discussions.