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Background: Tuberculosis (TB) treatment initiation is a critical transition in the care cascade, yet subnational geographic and temporal patterns may be obscured by aggregated estimates. This study characterized patterns of documented TB treatment initiation in Lampung Province, Indonesia.
Methods: We conducted a retrospective observational study using routine TB surveillance data from January to December 2025. All patients residing in Lampung Province with documented treatment initiation were included. Demographic characteristics and monthly and district/city distributions were described. Geographic and temporal variation in treatment initiation counts across 15 districts/cities was assessed using negative binomial regression, with adjusted count ratios (CRs) and 95% confidence intervals (CIs).
Results: Among 20,314 patients, the median age was 46 years (IQR 26–60), 60.5% were male, and 33.7% were aged 45–64 years. Treatment initiations varied substantially geographically, with the highest proportion recorded in Bandar Lampung (15.9%), followed by Lampung Selatan (13.5%) and Lampung Tengah (11.6%). Geographic variation remained significant after adjustment for calendar month (p<0.001). Compared with Bandar Lampung, adjusted treatment initiation counts were lowest in Pesisir Barat (CR 0.11; 95% CI 0.09–0.13), Metro (0.12; 0.10–0.14), and Mesuji (0.13; 0.11–0.16). Temporal variation was also significant (p<0.001), with December showing the largest reduction relative to January (CR 0.68; 95% CI 0.58–0.78).
Conclusions: TB treatment initiation in Lampung showed marked geographic and temporal heterogeneity. These findings represent variation in recorded treatment volumes rather than treatment coverage. Linking surveillance records with diagnostic denominators, population data, and multi-year observations could strengthen subnational monitoring and guide locally targeted TB control strategies.
This study identifies the malaria prevalence and estimate its association with climatic situations, including temperature, rainfall, and humidity, in the three-year post-flood period (2023-2025) in District Sohbatpur. The study was done using a retrospective observational cohort study based on secondary data (DHIS-2 system of District Headquarter Hospital Sohbatpur) and primary data (structured questionnaire). Meteorological information was available in online climatic databases. To assess patterns and correlations between the malaria incidence and climatic variables, descriptive statistics and regression analysis were used. A total of 242,799 people were tested with 66,893 confirmed cases. Test Positivity Rate (TPR) fell in 2023 to 40.55% in 2025 which shows a decrease in the total malaria burden. Nevertheless, the rate of Plasmodium falciparum rose to 63.9% as compared to 47.2% with a decline in Plasmodium vivax and mixed infections. The male percentage was 50.40% indicating occupational exposure. There was a high seasonality in malaria incidence, which was highest during the times of increased temperature and rainfall. The highest increase in transmission occurred at temperatures above 20-25°C with moderate humidity contributing to the survival of the vectors. Regression analysis showed that the temperature, rainfall, and malaria incidence were meaningfully associated.The prevalence of malaria decreased overall, but the proportion of the more serious P. falciparum is increasing, reflecting a changing epidemiological trend. Climatic conditions, and especially temperature and rainfall are very critical in transmission. The concept of climate-informed surveillance and intervention strategies is key to effective malaria control in susceptible post-disaster environments such as Sohbatpur.
An examination of 104 patients with migraine aged 16 to 45 years was carried out duplex scanning (DS) and magnetic resonance methods tomography (MRI). The composition was evaluated substances of the brain and cerebral hemodynamics in patients with migraine without aura (59 patients) and with migraine with aura (45 patients).Structural changes white substances of the brain in the form of hyperintense on T2VI and predominantly isointense on T1VI focus there were 3 to 12 mm revealed in 28.8% of patients with migraine without aura and 53.3% of patients with migraine with aura. The foci were localized mainly in the white matter of the superior lobes (35.2% of patients with migraine without aura and 41.6% of patients with migraine with aura). According to Doppler studies in patients with migraine without aura prevailed vasospastic reactions in the middle brain arteries With migraine with aura more often was noted difficult perfusion in the middle cerebral and vertebral artery.
The findings highlight significant barriers to effective management, including limited diagnostic infrastructure, inconsistent availability and use of magnesium sulfate, delayed patient presentation, and severe healthcare workforce shortages. These systemic challenges contribute to high case fatality rates and poor maternal outcomes. Additionally, sociocultural factors, inadequate health literacy, and weak health systems further exacerbate delays in diagnosis and treatment.
The study emphasizes the need for context-specific interventions, including community-based surveillance, task-sharing, mHealth innovations, and the implementation of standardized care protocols. Strengthening healthcare systems and improving access to timely, evidence-based interventions are critical to reducing preventable deaths associated with eclampsia in resource-constrained environments.
Taif is situated at approximately 1,800 m above sea level, below the conventional threshold for high altitude but sufficiently elevated to justify investigation of oxygen-sensitive phenotypes. Its community-genetics profile is also shaped by consanguinity, family-specific founder variants, and a substantial burden of autosomal-recessive disease. This critical narrative review separates three related questions: the hereditary-disorder spectrum relevant to Saudi and Arab populations, the molecular biology of adaptation to severe high-altitude hypoxia, and the currently untested possibility that moderate-altitude residence modifies disease expression in Taif. Evidence from Saudi genomic programs supports family-based exome or genome sequencing, homozygosity mapping, segregation analysis, and population-specific variant interpretation. Priority clinical groups include neurodevelopmental disorders, inherited retinal disease, hemoglobinopathies, inborn errors of metabolism, mitochondrial disease, and congenital anomalies. Studies of Tibetan, Andean, and Ethiopian populations establish the importance of hypoxia-inducible factor signaling, particularly EPAS1 and EGLN1, but these findings cannot be transferred directly to Taif. Direct local human genomic evidence remains sparse, and the available Taif study of oxidative stress used an animal model rather than a resident population. We propose a staged community genomics program integrating a regional registry, standardized phenotyping, family-centered sequencing, ancestry-aware analyses, a lower-altitude Saudi comparison group, and clinically governed return of results. This approach could improve diagnosis, carrier screening, counseling, and precision prevention while testing whether moderate altitude modifies hematologic, cardiopulmonary, or metabolic phenotypes.