Increasing incidence of tuberculosis diagnosed by surgery: a single centre analysis in low-incidence country.

OBJECTIVE: The aim of this study was to assess the incidence of thoracic tuberculosis (TB) in patients who underwent surgery for indeterminate lung nodules, mass and pleural effusions. METHODS: A monocentric retrospective study was carried out from 2012 to 2018 in a high-volume thoracic surgery centre. All patients with finding of thoracic TB within surgery and/or confirmed post-surgery were studied. Demography, origin, TB related symptoms, immunosuppression, type of surgery, and complication of surgery were analyzed. RESULTS: During the seven-year period TB was diagnosed in 71 cases, 58% were men. The mean age was 50 years. 21% of the cases had family history of TB or were successfully treated for TB in the past. 14% of patients had prior history of treatment for malignancy. Five patients (7%) received immunosuppressive therapy. The indication for surgery was indeterminate lung nodules and mass in 55 patients (77.5%) and indeterminate recurrent or persistent pleural effusions in 21 patients (22.5%). In five patients (7%) a lung carcinoma and a concomitant TB infection was detected. 63 of the cases (88.7%) had positive real-time PCR TBC test. Direct microscopic detection of Mycobacterium tuberculosis detected TB in five cases (7%). The microbiological diagnosis by culture was achieved in 19 patients (26.8%). Two patients (2.8%) were diagnosed with multidrug-resistant TB. Surgical procedure complications occurred in nine cases (12.7%). CONCLUSIONS: Although the overall incidence of TB in the Czech Republic is low and constantly continues to decrease, the number of TB detected by surgical procedures is increasing. Surgery still remains an important tool in diagnostics of nonobvious cases of TB, especially in patients with a potential risk of malignancy.

Breastfeeding During Military Service: Different Countries, Different Possibilities.

INTRODUCTION: Breastfeeding is a human biological norm that is widely acknowledged as the ideal form of nutrition for all infants. Human milk saves lives, improves long-term health for the both mother and infant, and significantly reduces health care-related costs. The American Academy of Pediatrics recommends exclusive breastfeeding for at least 6 months and thereafter to continue with breastfeeding, in addition to complimentary foods for at least 1 year or longer. The World Health Organization extends this recommendation to at least 2 years or beyond this age. MATERIALS AND METHODS: Multiple complex policies and directives would not be necessary if a federal law would entitle all new mothers to an adequate length of paid maternity leave and would protect parents during the time they personally care for their infants. Although a nationally mandated maternity leave is not available, the DoD should create a coherent global policy applicable to all active duty personnel across all branches of the U.S. Military. A global policy would govern positive change across all military branches and create consistent work conditions conducive for mothers to achieve their personal breastfeeding goals. In addition, a global policy would improve the military employees' health as well as maintain retention of military personnel. RESULTS: A comparison of the U.S. Armed Forces to the Czech Armed Forces shows that the individual breastfeeding policies and directives of the U.S. Military branches are certainly steps in the right direction to support breastfeeding military members. CONCLUSION: The well-documented evidence of long-term breastfeeding health benefits in addition to the economic benefits justifies such global military policy and would be a foundation to a national maternity leave policy, given that the USA is the only developed country without nationally mandated statutory entitlement to paid maternity leave.