Source and risk factors of a cutaneous anthrax outbreak, Jiangsu, Eastern China, 2012

Anthrax is still a severe public health problem and threat to human health. A cutaneous anthrax outbreak occurred in Jiangsu Province, a non-endemic anthrax region of eastern China, from July to August 2012. Epidemiological and laboratory investigation were initiated to trace the source of infection and identify the risk factors of the outbreak. On 25 July 2012, 17 persons were exposed to a sick cow, which had been imported from northeast China a few days previously. Of the 17 exposed, eight developed symptoms between 1 and 8 days and were diagnosed as cutaneous anthrax cases. Three main genes of Bacillus anthracis were detected from both human and cow meat samples, indicating that the outbreak was associated with this infected cow. A retrospective cohort study showed that contact with blood and presence of skin damage contributed to the case infection with B. anthracis. The outbreak highlights the need to enhance quarantine for imported livestock, which should have been vaccinated prior to importation, the significance of education for high-risk individuals, and training for primary healthcare workers even in anthrax-free areas.

A smaller endotracheal tube combined with intravenous lidocaine decreases post-operative sore throat - a randomized controlled trial

BACKGROUND

Post-operative sore throat (POST) has increasingly been a common clinical complication particularly in thyroid surgery. We conducted a trial to evaluate the effect of non-pharmacological [smaller-sized endotracheal tube (ETT)] combined with pharmacological intervention [lidocaine intravenous (i.v.)] on POST in women undergoing thyroid surgery.

METHODS

Two hundred and forty patients scheduled for thyroid surgery were randomly divided into four groups: Group A, ETT size 7.0 with saline; Group B, ETT size 6.0 with saline; Group C, ETT size 7.0 with lidocaine; Group D, ETT size 6.0 with lidocaine. Patients in Groups C and D received i.v. 1.5 mg/kg lidocaine that was filled in syringe up to 10 ml 5 min before induction of anaesthesia; whereas patients in Groups A and B received an equal volume of saline. The incidence and severity of POST were evaluated at 1, 6 and 24 h after tracheal extubation.

RESULTS

The highest incidence of POST occurred at 6 h after extubation in all groups. The incidence of POST was significantly lower in Group D compared with Groups A (23% vs. 62%, P < 0.01), B (23% vs. 42%, P = 0.03) and C (23% vs. 43%, P = 0.02) at 6 h after extubation. Group D had significantly decreased severity of POST compared with Groups A, B and C 6 and 24 h after extubation (P < 0.05).

CONCLUSION

Use of smaller-sized ETT combined with i.v. lidocaine decreases the incidence and severity of POST in women undergoing thyroid surgery.