Introduction: Herpes zoster (HZ) or shingles occurs as a result of reactivation after a primary infection with varicella zoster virus (chickenpox). The burden of HZ in older adults in China is not well understood. We conducted a systematic literature review to understand the burden of disease related to HZ, its complications, and associated costs in China. Areas covered: Using publications retrieved from Chinese and English literature databases, we described incidence and prevalence of HZ, occurrence of HZ-related complications, and costs associated with HZ in mainland China, Taiwan, and Hong Kong. Expert opinion: The data, although limited, indicate that the burden of disease due to HZ is substantial in China, with incidence rates that are comparable to the rest of the world. Recently, an adjuvanted recombinant HZ vaccine was approved for use in China. Disease prevention is likely to reduce the burden of disease, with potentially significant economic benefits. However, understanding the public health impact of vaccination in China will require extensive baseline information about incidence, complication rates, and associated costs. This review gives an overview of available research, but also reveals existing gaps. Well-designed observational studies are needed to quantify the total burden of disease and potential impact of prevention through vaccination.
MRI is an excellent diagnostic tool in the imaging of sports-related musculoskeletal pathology; however, standard slice thickness acquisitions can lack the spatial resolution to accurately define and characterise osseous abnormalities. Standard MRI sequences may be supplemented with CT to reduce diagnostic uncertainty. We provide a clinical perspective, in the form of pictorial review, on the potential applications of 3D MRI sequences, specifically using volumetric interpolated breath-hold examination in the characterisation of various musculoskeletal osseous pathologies. The potential to negate the requirement for CT in a young radiation sensitive cohort is a clinically significant concept and suggests the requirement for further studies comparing the performance of volumetric MRI to CT.
THE clinical examination of sheep was among the many practical problems encountered during the 2001 pan-Asiatic type O foot-and-mouth disease (FMD) outbreak in the UK and was a cause for concern for many veterinary surgeons. The difficulty in diagnosing FMD arises from the fact that, often, only mild disease is seen in sheep and also because lesions associated with some of the common endemic diseases of sheep, such as interdigital dermatitis and orf (parapoxvirus infection), are similar in appearance. Oral lesions due to FMD are most likely to develop at sites vulnerable to trauma (eg, the dental pad, upper and lower gums, and the tongue). However, it became apparent during the 2001 outbreak that the differential diagnosis of FMD was further complicated by the presence of oral lesions of unknown cause (colloquially known as OMAGOD). These lesions can be quite common and subsequent studies have confirmed that trauma alone is the primary cause. This article discusses the causes of oral ulceration and how these lesions might be differentiated from those due to FMD. The differential diagnosis of endemic foot diseases, which can appear very similar to FMD, is not covered. Other oral abnormalities, such as dental disease or neoplasia, are not relevant to the differential diagnosis of FMD and, hence, are also not considered here.
A total of 214 sheep with lesions of the oral mucosa were recorded at the Veterinary Laboratories Agency regional laboratories between March 15, 2002 and February 28, 2003. Using denominator data from the scrapie abattoir survey a prevalence of 0.95 per cent (95 per cent CI 0.82 to 1.10 per cent) was recorded, and using the fallen stock survey a prevalence of 1.15 per cent (95 per cent CI 0.64 to 1.91 per cent) was recorded. The lesions varied widely and included dental pad lesions in 20 per cent of cases. In total, 248 sites were affected, the commonest being the lower gum below the incisors, which was affected in 100 sheep. Most of the lesions were 1 cm or less in diameter. Ninety per cent of the 251 lesions examined histologically were erosions, ulcers, healed ulcers, focal epithelial necrosis or haemorrhages, and the changes observed indicated that trauma was the most likely primary cause.
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