Risk factors for hepatitis C infection among adult patients in Kedah state, Malaysia: A case-control study.

Hepatitis C infection is a global public health problem. This study was designed to identify the risk factors associated with hepatitis C infection among adult patients in Kedah state, Malaysia. A matched, hospital-based, case-control study was conducted at a tertiary hospital. Cases were adult (aged ≥ 18 years) patients with positive serology test results for hepatitis C virus antibody and detectable hepatitis C virus RNA from January 2015 to December 2018, and controls were age-, sex- and ethnicity-matched patients who were not infected with hepatitis C virus. Self-administered questionnaires were used to collect data on demographic characteristics and previous exposure to selected risk factors among the study participants. Associations between hepatitis C and demographic and risk factors were assessed using univariable and multivariable logistic regression analyses. A total of 255 case-control patient pairs were enrolled. The multivariable analysis indicated that having a history of blood or blood product transfusion before 1992 (adjusted odds ratio [AOR] = 6.99, 95% confidence interval [CI]: 3.73-13.81), injection drug use (AOR = 6.60, 95% CI: 3.66-12.43), imprisonment (AOR = 4.58, 95% CI: 1.62-16.40), tattooing (AOR = 3.73, 95% CI: 1.37-12.00), having more than one sexual partner (AOR = 2.06, 95% CI: 1.16-3.69), piercing (AOR = 1.71, 95% CI: 1.04-2.80), and having only secondary education (AOR = 1.92, 95% CI: 1.06-3.57) were independently associated with hepatitis C. No associations were found between health care occupation, needle-prick injury, surgical procedures, haemodialysis, acupuncture, cupping, or contact sports and hepatitis C infection. These findings demonstrate that hepatitis C risk is multifactorial. Having a history of blood or blood product transfusion before 1992, injection drug use, imprisonment, tattooing, having more than one sexual partner, piercing, and having only secondary education were associated with increased odds of hepatitis C.

No increased risk of transfusion-transmissible infections after tattooing, body piercing, or acupuncture among blood donors in the Netherlands.

BACKGROUND: In the Netherlands, needle-related events (NREs) including tattoos, piercings, and acupuncture are a reason for temporary blood donor deferral. This study aims to evaluate whether donors with recent NREs had a higher risk of transfusion-transmissible infections (TTIs) compared to donors without recent NREs. STUDY DESIGN AND METHODS: Data from 2006 through 2015 on all blood donation attempts in the Netherlands were collected. Multivariate regression models (for repeated measurements) were used to assess the associations between recent NREs and the acquisition of TTIs. Posttest counseling data were used to determine the most likely risk factor in TTI-positive new and repeat donors. RESULTS: Recent NREs were documented in 97,518 out of 9,266,036 (1.1%) donation attempts; 14,097 (14.5%) NREs resulted in NRE-based donor deferral. Recent NREs reported pre-donation were not associated with an increased risk for TTIs. A total of 29 out of 287 TTI-positive donors (11 repeat donors, 18 new donors) reported a recent NRE pre- and/or post-donation. Recent NREs, all needle-stick injuries, were the likely route of transmission in 12 out of 287 (4.2%) of TTI-positive donors. The donor health questionnaire (DHQ) identified only 1 out of 12 TTI-linked NREs. Non-return after NRE deferral, any deferral, or no deferral was 24, 15, and 5%, respectively. DISCUSSION: Recent tattoos, body piercings, or acupuncture were not associated with an increased risk for TTIs in Dutch donors. Given the lower return rates of donors following a temporary NRE-based deferral, we advocate ending blood donor deferral policies for acupuncture, tattooing, and body piercings, but not needle-stick injuries, in countries where these practices can be considered safe.

Is there a risk of transfusion-transmissible infections after percutaneous needle treatments in blood donors? A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: The donor medical questionnaire identifies a blood donor's history of known blood safety risks. Current Australian, Canadian, European and USA legislation temporarily defers blood donors who received different percutaneous needle treatments (i.e. tattooing, acupuncture and piercing) from blood donation. This systematic review aimed to scientifically underpin these deferrals by identifying the best available evidence on the association between percutaneous needle treatments and the risk of transfusion-transmissible infections (TTIs). MATERIALS AND METHODS: Studies from three databases investigating the link between percutaneous needle treatments and TTIs (HBV, HCV and HIV infection) in blood donors were retained and assessed on eligibility by two reviewers independently. The association between percutaneous needle treatments and TTIs was expressed by conducting meta-analyses and calculating pooled effect measures (odds ratios (ORs) and 95% CIs). The GRADE methodology (Grades of Recommendation, Assessment, Development and Evaluation) was used to assess the quality of evidence. RESULTS: We identified 1242 references and finally included 21 observational studies. Twenty studies assessed the link between percutaneous needle treatments and HCV infection and found that blood donors receiving these treatments had an increased risk of HCV infection (tattooing: pooled OR 5·28, 95% CI [4·33, 6·44], P < 0·00001 (low-quality evidence); acupuncture: pooled OR 1·56, 95% CI [1·17, 2·08], P = 0·03 (very low-quality evidence); and piercing: pooled OR 3·25, 95% CI [1·68, 6·30], P = 0·0005 (low-quality evidence)). CONCLUSION: Percutaneous needle treatments may be associated with an increased HCV infection risk. Further high-quality studies are required to formulate stronger evidence-based recommendations on percutaneous needle treatments as a blood donor deferral criterion.

Oral exfoliative cytology and corrosion of metal piercings. Tissue implications.

OBJECTIVES: A group of adolescents with oral piercings was studied to determine the presence of metallic particles in cells exfoliated from the mucosa surrounding their metal oral piercings and the association between such particles and the metal jewelry, and to evaluate subsequent tissue implications. MATERIALS AND METHODS: Sixteen teenage patients who had tongue and/or lip piercings were included. The clinical features of the oral mucosa and lip skin were evaluated. Exfoliative cytology was performed in the area surrounding the piercing. The surface of used and unused jewelry was studied by scanning electron microscopy and energy dispersive X-ray analysis. RESULTS: Hyperplastic, leukoedematous, and lichenoid lesions were observed in the mucosa, as well as lesions associated with metallosis of the lip skin. Cytological smears showed the presence of particles inside the epithelial cells; the particles were found to contain aluminum, tungsten, and molybdenum. In one case requiring surgical removal of the piercing, histological examination of the tissue associated with the piece of jewelry showed the presence particles containing aluminum, iron, and tin inside multinucleated giant cells. Although surface finish defects were observed on both unused and used piercing jewelry, they were more evident on the used pieces. CONCLUSIONS: Ion particles are released from the metal piercings and could have been adjuvant factors in the development of the observed lesions. Cells exfoliated from the oral mucosa surrounding metal piercings may serve as bioindicators of corrosion processes. CLINICAL RELEVANCE: We propose the use of exfoliative cytology to monitor corrosion processes and for routine clinical follow up.

Risk Factors for Hepatitis C Virus (HCV) Infection in Areas with a High Prevalence of HCV in the Republic of Korea in 2013.

BACKGROUND/AIMS: The prevalence of hepatitis C virus (HCV) infection in Busan, Gyeongnam, and Jeonnam Provinces in Korea is more than twice the national average. This study aimed to examine whether demographic and lifestyle characteristics are associated with HCV infection in these areas. METHODS: A case control study was performed at three study hospitals. HCV cases were matched with two controls for sex and age. Patient controls were selected from non-HCV patients at the same hospital. Healthy controls were subjects participating in medical checkups. Conditional logistic regression models were used. RESULTS: A total of 234 matched-case and patient- and healthy-control pairs were analyzed. The significant risk factors for both controls were sharing razors (adjusted odds ratio [aOR], 2.39 and 3.29, respectively) and having more than four lifetime sexual partners (aOR, 2.15 and 6.89, respectively). Contact dockworkers (aOR, 1.91) and tattoos (aOR, 2.20) were significant risk factors for the patient controls. Transfusion (aOR, 5.38), a bloody operation (aOR, 5.02), acupuncture (aOR, 2.08), and piercing (aOR, 5.95) were significant risk factors for the healthy controls. Needle stick injuries and intravenous drug abuse were significant in the univariate analysis. CONCLUSIONS: More education concerning the dangers of sharing razors, tattoos and piercings is required to prevent HCV infection. More attention should be paid to needle stick injuries in hospitals and the community.

Risk Factors for Hepatitis C Virus (HCV) Infection in Areas with a High Prevalence of HCV in the Republic of Korea in 2013

BACKGROUND/AIMS: The prevalence of hepatitis C virus (HCV) infection in Busan, Gyeongnam, and Jeonnam Provinces in Korea is more than twice the national average. This study aimed to examine whether demographic and lifestyle characteristics are associated with HCV infection in these areas. METHODS: A case control study was performed at three study hospitals. HCV cases were matched with two controls for sex and age. Patient controls were selected from non-HCV patients at the same hospital. Healthy controls were subjects participating in medical checkups. Conditional logistic regression models were used. RESULTS: A total of 234 matched-case and patient- and healthy-control pairs were analyzed. The significant risk factors for both controls were sharing razors (adjusted odds ratio [aOR], 2.39 and 3.29, respectively) and having more than four lifetime sexual partners (aOR, 2.15 and 6.89, respectively). Contact dockworkers (aOR, 1.91) and tattoos (aOR, 2.20) were significant risk factors for the patient controls. Transfusion (aOR, 5.38), a bloody operation (aOR, 5.02), acupuncture (aOR, 2.08), and piercing (aOR, 5.95) were significant risk factors for the healthy controls. Needle stick injuries and intravenous drug abuse were significant in the univariate analysis. CONCLUSIONS: More education concerning the dangers of sharing razors, tattoos and piercings is required to prevent HCV infection. More attention should be paid to needle stick injuries in hospitals and the community.

Successful treatment of chronic nausea and vomiting related to body piercing and tattooing with integrative medicine interventions.

Chronic nausea and vomiting of uncertain etiology can be debilitating and uncomfortable for patients while frustrating for clinicians. This article presents the case of a young woman with chronic nausea and vomiting of unknown etiology resulting from body piercing and tattoo scars on body areas that Chinese Medicine asserts are related to the gastrointestinal system. The patient had long-term total resolution after 1 treatment session consisting of neural therapy for scars resulting from a tongue ring, belly ring, and tattoo near her left wrist along with acupuncture treatment. The research community is called to further evaluate the possible association of body piercing and tattooing with nausea and vomiting along with the possible treatment options of neural therapy and acupuncture.

Tongue piercing and chronic abdominal pain with nausea and vomiting--two cases.

Chronic upper gastrointestinal (GI) symptoms of unclear etiology are frustrating to patients and physicians alike. The integrative medicine procedures of acupuncture and neural therapy may provide treatment options. Tongue piercing, which is prevalent in 5.6% of the adolescent population, may be a contributing factor in upper gastrointestinal symptoms. The objectives of the study were as follows: (1) To demonstrate the usefulness of an integrative medicine treatment approach in two cases of patients with chronic abdominal pain, nausea, and vomiting of unclear etiology who had failed standard medical management. (2) To identify scars from tongue piercings as a possible contributing factor in chronic upper GI symptoms of unclear etiology. Two retrospective case studies are presented of young adult females who were seen in a private multi-physician integrative medicine practice in the US. The patients were treated with neural therapy and acupuncture. The desired outcome was the cessation or reduction of the frequency of abdominal pain, nausea, and vomiting. Both patients had resolution of their symptoms. From this study, we have concluded the following: (1) Tongue scars from tongue rings may be causes of chronic upper gastrointestinal symptoms. (2) Neural therapy and acupuncture may be helpful in the treatment of chronic upper GI symptoms related to tongue scars.

A rare complication of ear piercing: a case of subcutaneous phaeohyphomycosis caused by Veronaea botryosa in China.

We present the third case of phaeohyphomycosis caused by Veronaea botryosa in China and the tenth case worldwide. A 16-year-old Chinese girl developed crusted, verrucous lesions, initially on the left ear and later on the left buttock, within 2-5 months of receiving an ear piercing. Histopathological examination of biopsy specimens confirmed diagnosis of subcutaneous phaeohyphomycosis. Microscopic examination of the colonies recovered in culture from a portion of the biopsy specimen resulted in the identification of Veronaea botryosa based primarily on the presence of two-celled, brownish pigmented, cylindrical conidia produced sympodially from erect conidiogenous cells. The lesions significantly improved with daily oral treatment with itraconazole 400 mg and adjuvant thermotherapy for 6 months. A maintenance therapy with low dose itraconazole was prescribed in order to achieve clinical and mycological cure. A two-year follow-up didn't reveal any recurrence of infection. Our case is the first report of V. botryosa infection associated with a cosmetic procedure, which suggests that skin piercing could precipitate V. botryosa or other dematiaceous, as well as opportunistic fungal infections.

Impact of donor high-risk social behaviors on recipient survival in cardiac transplantation.

OBJECTIVE: To investigate the impact of cardiac donor participation in high-risk social behaviors (HRSBs) on recipient survival. METHODS: Retrospective chart review queried cardiac transplantations performed at our institution from August 1994 to November 2007 involving donors known to have engaged in HRSBs. Kaplan-Meier methodology was used to analyze survival rates, and a Cox proportional hazards regression was performed to determine the impact of donor HRSBs on survival. RESULTS: We identified 143 donors with social histories containing the following HRSBs: incarceration (n=69), unprofessional tattoos or piercings (n=44), alternative lifestyle practice (n=11), cocaine use (n=60), heroin smoking (n=6), marijuana use (n=79), oral narcotic abuse (n=20), and intravenous drug use (n=21). At the time of donation, viral screens detected 10 donors who were hepatitis B virus (HBV) positive, 11 donors who were hepatitis C virus (HCV) positive, and no donors who were positive for the HIV. One-year and 5-year survival were 92.2% and 84.4%, respectively. Cox regression analysis found only donor HCV infection to be associated with poorer recipient survival (P=0.14). CONCLUSION: Using cardiac allografts from high-risk donors who are serologically negative for viruses does not seem to impact recipient survival. There is a considerable risk for transmission of HBV and HCV when these are detected by pretransplant screens. However, if pretransplant screening does not discover donor HBV, HCV, or HIV infection, it is unlikely that subclinical disease transmission will occur.

A Case of Chronic Hepatitis C Acquired throughEar Piercing and Acupuncture / 대한소아소화기영양학회지

Although transfusion of blood and plasma products are accepted as the principle means of transmission of HCV, other parenteral methods, such as acupuncture, tattooing needles, piercing, and surgery are possible methods of transmission of HCV. We managed a case of chronic hepatitis C acquired through ear piercing and acupuncture. A 10-year old girl presented with nausea, abdominal pain, and anorexia for 1 month. Her laboratory finding showed the following: AST/ALT, 865/1,290 IU/L; positive anti-HCV Ab; and HCV RNA. One year previously, she was treated with acupuncture for an ankle sprain and 2 years previously, she had her ears pierced. Laboratory findings of family members showed AST/ALT in the normal ranges, and negative anti-HCV Ab and HCV RNA. The pathologic findings of a liver biopsy revealed chronic hepatitis with mild lobular activity, moderate porto-periportal activity, and portal fibrosis. She was treated with pegylated interferon alpha-2a and oral ribavirin for 6 months, after which the clinical symptoms and laboratory findings improved.

A Case of Pseudolymphoma which Developed after Gold Acupuncture / 대한피부과학회지

Cutaneous pseudolymphoma refers to a heterogeneous group of benign reactive T- or B-cell lymphoproliferative diseases of the skin that resembles cutaneous lymphoma both clinically and histologically. Although most pseudolymphomas develop from unknown causes, various stimuli can induce pseudolymphomas. Pseudolymphomas have developed followed medications, infections, insect bites, ear piercing, and gold. To date, no case of pseudolymphoma developing after gold acupuncture has been reported in the Korean dermatologic literature. We report a case of a 49-year-old female who presented with multiple skin-colored papules on the left lower eyelid that showed features of a pseudolymphoma based on histopathologic assessment.

Laying down the knife may decrease risk of HIV transmission: cultural practices in Cameroon with implications for public health and policy.

The risk of HIV transmission may be increased by certain cultural practices. In Cameroon, these practices include group circumcision of boys using unsterile knives during rites of passage, skin cutting or tribal markings, group breast feeding practices and nose shaving rituals. Since traditional healers and circumcisers have a vital role in these practices at the village level, their collaboration is needed by government and biomedical communities to engage in health education and prevention efforts to stem HIV incidence and prevalence. Such efforts should include comprehensive education on HIV counseling, testing, condom use and male circumcision in health centers, clinics and hospitals. As more people emigrate to the U.S. from sub-Saharan countries where such cultural practices (including female circumcision) are endemic, health care providers need to identify and follow up potential health problems of these immigrants.

["My body belongs to me"--cultural history and psychology of piercings and tattoos]. / "Mein Körper gehört mir" - Kulturgeschichte und Psychologie des Piercing und Tattoo.

At present tattoos and piercings can no longer be regarded as destructive acts of self mutilation practized by fringe groups. Body modifications (BMs) are found in virtually all preindustrial cultures and have their roots in ancient myths and magical rituals. The prevalence of tattoos and piercings in the German population is 8.5% and 6.8%, respectively. Unemployed young men and young women who do not live in a firm partnership show particularly high prevalences. The incidence of BMs correlates positively with the personality trait "sensation seeking", particularly in young women. BMs often serve to express individuality and identity, and they also reflect changed attitude towards the human body and body art as well as following fashion trends. However, BMs can also provide valuable diagnostic indications for identity search and risk taking behaviour.

Treatment of Various Auricular Diseases Using Magnetic Disks

PURPOSE: The earlobe is one of the areas which are most vulnerable to trauma. Various auricular diseases need compression treatment. We report a new compression method using magnetic disks. METHODS: Seventeen patients with auricular diseases were treated from October 2002 to September 2006. The mean age was 29.1 years. The diseases details were osteochondroma in 2 patients; cauliflower's ears in 2 patients; acute otohematoma in 1 patient; and hypertrophic scars in 11 patients. The most common cause of their disease was ear piercing. The mean follow-up period was 8.9 months. All surgical procedures were performed under local anesthesia. To compress immediately, a pair of magnetic disks was applied to the anterior and posterior surface of the earlobe. RESULTS: The results were generally good. Major complications, such as recurrence, necrosis, dehiscence, or infection, did not occur. CONCLUSION: A pair of magnetic disks are useful compression tool in various auricular diseases.