OBJECTIVE: To protect transfusion recipients from transfusion-transmissible infections, blood donors are deferred from donating after recent tattooing or piercing. To explore to what extent and how this deferral impacts donor availability, we performed an international study to investigate how many donors were deferred for a recent tattoo or piercing and how many of these donors returned to donate.
METHODS: We surveyed blood centre members of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative and the European Blood Alliance Donor Studies Working Group on their numbers of donations, tattoo and piercing deferrals, and return rates in the year 2017.
RESULTS: Eight blood centres participated. Overall, deferral rates were lower for repeat donors compared to new donors. Repeat donors were more likely to return than new donors. Women and young donors were more often deferred than male and older donors. Men were more demotivated by tattoo or piercing deferral, resulting in lower return rates compared to women. Return rates differed greatly between blood centres.
CONCLUSIONS: Tattoo and piercing deferrals lead to missed donations and result in lower return rates. However, the numbers vary largely internationally, probably due to cultural and policy differences. Shortening deferral periods after tattooing or piercing may reduce the impact on donor availability, which should be investigated in single-centre studies.

Tattooing and piercing may lead to health complications. The present multicenter cross-sectional study aimed to assess awareness and knowledge of health risks related to body art and to identify their possible determinants among a large sample of undergraduates in Italy. A web-based questionnaire collecting information on socio-demographic characteristics, awareness, knowledge, and some potential predictors was administered to undergraduates attending twelve Italian universities. The level of knowledge was expressed as the number of correct answers (0-11 for tattooing, 0-14 for piercing). A total of 2985 participants (mean age 23.15 ± 3.99, 73.9% F) participated in the study. Although 95.4% of the respondents were aware of possible health consequences of body art, a low level of specific knowledge was registered for both tattooing (mean number of correct answers 5.38 ± 2.39) and piercing (5.93 ± 3.12) consequences. Lower knowledge was associated with the attendance of non-life science course and with lower duration of academic education for both tattoo and piercing. Lower knowledge of tattooing risks was related with commuter status, while lower knowledge of piercing risks was associated with lower father\'s education. These findings highlight the need to enhance information campaigns targeted to youths to increase their awareness of possible health risk of body art.

Body-art, including tattoos and piercings, is steadily increasing world-wide but with relatively limited reporting of adverse outcomes. The objective of the present study was to identify correlates that would facilitate a preventative strategy to minimize adverse effects of body-art.
We examined patterns of body-art, health risk and perceptions among 921 participants (54% female, mean age of 35; SD = 10.8) through in-person questionnaire.
A significantly lower frequency of those with body-art acknowledged that not all venues (parlors, clinics, etc.) are safe in terms of health and hygiene (84.7%t vs. 96.6%, p < .001) as compared to those without body-art. Similarly, knowledge of the need for a Ministry of Health certification was reported with lower frequency (77.2% vs. 94.5%, p < .001) among those with body-art. Those who experienced medical complications reported higher frequencies of smoking cigarettes and hookah as well as using ecstasy (MDMA). The risk of medical complication after body-art was 4 times higher in those who used ecstasy (OR = 3.97; CI 1.0-14.4; p < 0.05). In addition, it was more than 3 times higher for street or home tattooing as compared to studio or a licensed medical center (OR = 3.59; CI 1.32-9.76; p < .01), as well as almost 3 times higher among those who did not receive information before performing body-art (OR = 2.70; CI 1.05-6.92; p < .05) and who had somebody other than themselves decide on the body-art design (OR = 2.68; CI 1.00-7.19; p < .05).
A targeted informational-preventative program should be developed, informed by the risks highlighted in this study. In addition, it would be necessary to draft policies related to regulation and enforcement in order to more effectively manage body-art service provision. The Ministry of Health should supervise and guide tattooists and practitioners regarding the health risks of body-art and offer training and raise awareness among potential clients.

The aim of the present study is to verify the knowledge of risks and complications of oral piercings, and to observe the main complications associated with piercings, using a sample from central Italy of patients wearing intraoral piercings. Through piercing and tattoo studios selected randomly in Rome, Latina and Campobasso, and a tattoo and piercing convention in Latina, a group of 387 individuals with oral piercings were selected and asked to complete an anonymous questionnaire. After filling in questionnaires, 70 individuals of the 387 selected agreed to be visited to allow the observation of the integrity of their teeth and gums (especially close to the oral piercing), oral hygiene conditions, piercing cleaning, bad habits and gingival recession. Among the respondents, 46.8% said they had not been informed about these risks, 48.5% claimed not to clean the piercing, 70.6% stated that they had not been made aware of gingival problems that can arise, 60.4% subjects stated that they were not informed about the complications of piercings concerning teeth, 52.8% had insufficient oral hygiene conditions, 42% showed signs of generalised gingivitis, 20% had 3-4 mm recessions and 22% had tooth fracture(s) due to piercing. From this study, it emerged that oral piercings can represent a risk to oral health and that there is a widespread lack of awareness of the complications and correct methods of maintaining oral piercings. Periodic checks by both dentists and dental hygienists, for patients with oral piercings, could play a decisive role in preventing, intercepting and treating the complications that they can cause.

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.

Aim of this cross-sectional study was to investigate the prevalence of selected potentially periodontal pathogenic bacteria in different sites of patients with tongue piercing (TP) in comparison to a control group (C). Fifty participants in each group were recruited. Samples from the biofilm originating from the piercing surface (TP group), periodontal pocket, tongue as well as cheek surface were examined regarding presence of 11 selected potentially periodontal pathogenic bacteria based on polymerase-chain reaction (PCR). In the periodontal pocket of the participants, the majority of examined bacteria were more frequently detected in TP compared to C group (pi < 0.05). At tongue and cheek surface, the prevalence of Treponema denticola (P < 0.01) and Prevotella intermedia (P < 0.01) was significantly higher in TP. For the majority of bacteria, a significant correlation between TP surface and periodontal pocket was detected (P < 0.05). In conclusion TP must be considered as potentially important ecological niche and reservoir for periodontal pathogens.

OBJECTIVE: Aim of this cross-sectional case-control study was the comprehensive examination of oral health, oral behaviour and oral health-related quality of life of patients with tongue piercing. Furthermore, different piercing related factors and the presence of habits should be considered regarding their potential association to piercing-related complications.
METHODS: Participants with tongue piercing (n = 50) and a matched control (n = 50) were included. Dental examination included decayed-, missing- and filled-teeth-index (DMF-T) and the presence of non-carious tooth defects. Periodontal examination contained of periodontal probing depth (PPD), bleeding on probing (BOP) and recession. Piercing-related factors, oral behaviour as well as oral health-related quality of life [German short form of oral health impact profile (OHIP G14)] were assessed based on questionnaires.
METHODS: Man-Whitney U test, chi-square and Fisher\'s exact test (significance level p < 0.05).
RESULTS: Participants with tongue piercing suffered from worse DMF-T, PPD, BOP and recession (pi < 0.01). Higher prevalence of enamel cracks and trough-shaped abrasions were found in piercing-group (pi < 0.01). Additionally, participants with tongue piercing showed worse oral behaviour, insufficient cleaning of piercing and in majority of cases (80%) calculus formation at piercing surface as well as comparable OHIP-G14 to control (p = 0.39). While piercing design was associated to both, recession and non-carious tooth defects (pi < 0.05), only infractures of enamel were associated to the presence habits (p = 0.04).
CONCLUSIONS: Patients with tongue piercing show insufficient dental and periodontal health as well as reduced oral behaviour. Thereby, piercing design and wearing period is associated to recessions and non-carious tooth defects.
CONCLUSIONS: Increased attention of patients wearing tongue piercing in dental practice is necessary.

The treatment of keloid and hypertrophic scar is challenging with no universally accepted mode for permanent ablation. Conventional therapies yield unpredictable results, significant complications and require elaborate hardware.
The objective was to establish the safety and efficacy of intralesional 5-fluorouracil (5-FU) for the treatment of keloids and hypertrophic scars.
Randomized controlled trial (RCT).
It was conducted at the Jinnah Burn and Reconstructive Surgery Center/Allama Iqbal Medical College, Lahore, Pakistan from May 2012 to March 2013.
We included 120 patients divided in two groups. The group A patients received intralesional triamcinolone acetonide (TAC) and the group B patients received both 5-FU and TAC. 8 injections at a week interval were given and patients were evaluated at the start of treatment and then at 4th and at 8th week during the treatment and then 4 weeks after the end of treatment. Patents were assessed for mean reduction in scar height, efficacy and complications.
Total of 108 patients completed the study. The mean reduction in the scar height in group B (5-FU+TAC) 1.144+.4717 was markedly better than that of group A (TAC alone) 1.894+1.0751 (t=4.781, p=.000). The efficacy (defined previously as >50% reduction in initial scar height) was superior in group B 44 (77.2%) than that of group A 25 (49.0% (X2=9.260, p=.002). Recurrence was seen in 39.2% (20) of patients of the group A while in only 17.5% (10) of the cases of group B (P=0.012). Mean follow up was of 22 months.
5-FU+TAC is safe, easy to administer and effective treatment for problematic scars and has the lower rate of recurrence on larger follow up.

BACKGROUND: Perceptions regarding body art change over time as societal norms change. Previous research regarding patients\' perceptions of physicians with exposed body art have been hampered by flaws in design methodology that incorporate biases into patient responses. This study was performed to determine whether emergency department (ED) patients perceived a difference in physician competence, professionalism, caring, approachability, trustworthiness and reliability in the setting of exposed body art.
METHODS: Standardised surveys about physician competence, professionalism, caring, approachability, trustworthiness and reliability rating providers on a five point Likert scale were administered to patients in an ED after an encounter with a physician provider who demonstrated no body art modification, non-traditional piercings, tattoos, or both piercings and tattoos. Each provider served as their own control. Patients were blinded to the purpose of the survey.
RESULTS: Patients did not perceive a difference in physician competence, professionalism, caring, approachability, trustworthiness or reliability in the setting of exposed body art. Patients assigned top box performance in all domains >75% of the time, regardless of physician appearance.
CONCLUSIONS: In the clinical setting, having exposed body art does not significantly change patients\' perception of the physician.

BACKGROUND: Studies on sensitization to metals in the general population are scarce.
OBJECTIVE: To determine the prevalence of sensitization to metals in the general population, and factors associated with nickel sensitization.
METHODS: In 5 European countries (The Netherlands, Germany, Italy, Portugal and Sweden), a random sample (N = 3119) from the general population (aged 18-74 years) was patch tested and interviewed by use of a questionnaire on exposure to metals, piercing, and jewellery.
RESULTS: Overall, the age-standardized prevalences of sensitization to nickel, cobalt and chromium were, respectively, 14.5%, 2.1%, and 0.8%. The highest prevalence of nickel sensitization was seen in Portugal (18.5%) and the lowest (8.3%) in Sweden. The prevalence of cobalt sensitization varied between 3.8% (The Netherlands) and 0.9% (Italy), and the prevalence of chromium sensitization varied between 1.3% (Portugal) and 0.2% (Sweden). Significant associations were observed between nickel allergy and female sex (odds ratio [OR] 5.19; 95% confidence interval [95%CI]: 3.99-6.74), past piercing use (OR 3.86; 95%CI: 2.85-5.24), and currently having ≥3 piercings (OR 5.58; 95%CI: 4.02-7.76).
CONCLUSIONS: The prevalence of sensitization to metals in the European general population was high, mostly because of nickel. The lowest prevalence of contact allergy to nickel and chromium observed in Sweden supports the effectiveness of long-standing regulation.