Tuberculosis (TB) is a major global public health threat. The World Health Organization’s 2020-2024 Global TB Reports cover the TB situation from 2019 to 2023. In 2023, TB re-emerged as the world’s leading infectious killer, with an estimated 10.8 million new cases. The growth in the incidence rate has slowed, and the number of deaths decreased to 1.25 million. The COVID-19 pandemic significantly disrupted TB control efforts in 2020-2021; as control measures are gradually restored, TB control is showing a positive trend. However, significant regional disparities in incidence persist, with eight high-burden countries, including India and China, accounting for over two-thirds of the global total. In 2023, the global treatment coverage for drug-resistant TB was 44% with a treatment success rate of 68%, but with 400 000 new drug-resistant cases, the control situation remains severe. China has made remarkable progress in TB control: new cases fell to 741 000 in 2023 (an incidence of 52 per 100 000); mortality decreased significantly; the proportion of drug-resistant cases dropped from 14% to 7.3%; and the TB/HIV co-infection rate fell from 1.68% to 0.66%, outperforming the global average. Globally, control measures continue to improve: global treatment coverage increased from 70% in 2019 to 75% in 2023, the number of people receiving preventive therapy grew to 4.7 million, and rapid diagnostic coverage reached 48%. In China, the number of patients treated recovered to 564 900 in 2023, and the rapid diagnostic coverage rate rose to 74%. While technological innovations have enhanced the efficiency of prevention, screening, diagnosis, treatment, and management, achieving the 2030 end TB goals will require strengthening TB management, building primary healthcare capacity, and targeting interventions for high-risk populations, while balancing resource allocation with technological innovation to address the challenges of a heterogeneous global epidemic.
ObjectiveTo investigate the effect of surgical treatment on chest wall tuberculosis.MethodsA total of 407 patients with chest wall tuberculosis who met the inclusion and exclusion criteria from April 2008 to December 2017 in Chengdu Public Health Clinical Medical Center were enrolled. They were divided into two groups according to the time of admission: a control group (203 patients admitted from April 2008 to December 2012) treated with traditional focus debridement, including 135 males and 68 females, with an average age of 40.65±4.68 years, and an observation group (204 patients admitted from 2013 to 2017) undergoing complete focus debridement, including 139 males and 65 females, with an average age of 40.73±4.72 years. The general clinical data, perioperative related indexes, incision healing, incidence of complications and recurrence between the two groups were compared.ResultsThere was no significant difference in general clinical data, operation time, postoperative pain time, extubation time, hospital stay or recurrence rate between the two groups (P>0.05), but compared with the control group the grade A healing rate in the observation group was significantly higher and incidence of complications was significantly lower (P<0.05).ConclusionThorough debridement can achieve a better effect in the treatment of chest wall tuberculosis, and help to reduce complications and promote wound healing. It is suitable for clinical application.
ObjectiveTo overview the systematic reviews on the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients.MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were searched for systematic reviews about the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients from inception to December, 2018. Two reviewers independently screened literature, extracted data, evaluated the reporting and methodological qualities using the PRISMA checklist and the AMSTAR tool. After re-extraction of individual RCT data from included systematic reviews, meta-analysis was performed by Stata10.0 software.ResultsA total of 11 systematic reviews were included. The average methodological quality score was 8.13 in AMSTAR , the reporting quality score was from 19.5 to 25 in PRISMA. Re-performed meta-analysis showed that, the total success rate of operation was 93.3% (95%CI 92.9 to 93.8), the failure rate was 3.7% (95%CI 3.3 to 4.0), the mortality rate was 2.0% (95%CI 1.8 to 2.2), and the loss rate was 1.0% (95%CI 0.8 to 1.2). The cure rates of different surgical methods were all over 80%, among which single lobectomy (98.47%) and compound lobectomy (98.94%) had the higher cure rates than others. For the time of different surgical interventions, cure rate could be improved obviously in patients receiving surgery treatment after 1 months (OR=1.58, 95%CI 1.29 to 1.94, P=0.000 12), 1-8months (OR=1.66, 95%CI 1.30 to 2.12, P=0.000 05) and 9-24 months (OR=1.48, 95%CI 1.15 to 1.90, P=0.002) of anti-tuberculosis therapy compared with 0 month.There were significant differences between two groups.ConclusionCurrent evidence shows that operation is an effective way for severe multidrug-resistant pulmonary tuberculosis. Operative opportunity should be selected after 1-24 months of anti-tuberculosis drug treatment when the operation time depending on whether the tuberculosis has turned negative or not. Operative mode should be decided by the location and the scope of the lesion, which ensures the maximum excision of lesions and retention of lung function.
ObjectiveTo analyze the incidence of complications, duration of chest tube indwelling, and nutritional status in tuberculosis (TB) patients undergoing pulmonary surgery, and to explore perioperative nutritional management strategies and rehabilitation measures by identifying nutritional factors influencing postoperative chest tube duration. MethodsA retrospective analysis was conducted on clinical data of TB patients who underwent lobectomy at the Department of Thoracic Surgery, Chengdu Public Health Clinical Medical Center from 2022 to 2023. Patients were grouped based on chest tube duration (≤7 days vs. >7 days) and propensity score matching (PSM) was performed. Complications, drainage volume, and nutritional status were compared between groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with prolonged chest tube duration. ResultsAmong 276 enrolled patients, 163 had chest tube duration ≤7 days [pre-PSM: 91 males, 72 females, mean age of (34.88±14.10) years] and 113 had duration >7 days [pre-PSM: 69 males, 44 females, mean age of (39.04±13.28) years]. After PSM (45 patients per group), no significant differences were observed in pleural or pulmonary infection rates between groups (P>0.05). Univariate analysis revealed statistical differences in preoperative albumin-to-globulin ratio (A/G), 24-hour postoperative A/G, 24-hour postoperative prognostic nutritional index (PNI), pre-discharge A/G, and pre-discharge hemoglobin (P<0.05). Multivariate logistic regression identified the following independent risk factors for prolonged chest tube duration: preoperative A/G, 24-hour postoperative A/G, 24-hour postoperative PNI, pre-discharge A/G, and pre-discharge hemoglobin. ConclusionPreoperative A/G, 24-hour postoperative A/G and PNI, and pre-discharge A/G and hemoglobin significantly influence chest tube duration in TB patients. Preoperative nutritional-immunological indicators independently predict prolonged drainage, while dynamic postoperative monitoring provides comprehensive recovery assessment. Integrating these parameters enables early identification of high-risk patients, facilitates personalized drainage management, and may reduce hospitalization duration while improving prognosis.