Bikini textile contact dermatitis: A Sherlockian approach revealing 2,4-dichlorophenol as a potential textile contact allergen.

BACKGROUND: Different textile constituents may act as allergens and/or irritants and provoke textile contact dermatitis (TCD). OBJECTIVES: To report a case of TCD caused by ethylene glycol monododecyl ether and 2,4-dichlorophenol, present in a bikini. METHODS: A woman presented with an eczematous, pruritic rash in the area of the bikini straps and back. Patch testing was performed with the European baseline, textile, sunscreen, and photo-patch series, the bikini "as is", and ethanol and acetone extracts of the bikini. Thin-layer chromatography (TLC) of the extracts and gas chromatography-mass spectrometry (GC-MS) analysis were used to elucidate the culprit agents. RESULTS: Positive reactions were found to the bikini "as is" and to the ethanol and acetone extracts. Patch testing with TLC strips showed a strong reaction to spots-fractions 3 and 4. GC-MS was performed to identify substances in each fraction and those suspected to be skin sensitisers were patch tested. On day (D) 4 positive reactions to ethylene glycol monododecyl ether (irritant reaction) and 2,4-dichlorophenol (++) were observed. CONCLUSION: A myriad of chemical compounds can be found in clothing. Ethylene glycol monododecyl ether and 2,4-dichlorophenol were identified as the potential culprits of this bikini TCD.

Time to First Onset of Chest Binding-Related Symptoms in Transgender Youth.

BACKGROUND AND OBJECTIVES: Most transgender individuals assigned female at birth use chest binding (ie, wearing a tight garment to flatten chest tissue for the purpose of gender expression), often beginning in adolescence, to explore their gender identity. Although binding is often critical for mental health, negative physical side effects, ranging from chronic pain to rib fractures, are common. Time to first onset of symptoms is unknown. METHODS: A community-engaged, online, cross-sectional survey ("The Binding Health Project") enrolled 1800 assigned female at birth or intersex individuals who had ever used chest binding. Lifetime prevalence of 27 pain, musculoskeletal, neurologic, gastrointestinal, generalized, respiratory, and skin or soft tissue symptoms related to binding was assessed. Nonparametric likelihood estimation methods were used to estimate survival curves. RESULTS: More than one-half (56%) of participants had begun binding by age 21, and 30% had begun by age 18. In 18 of 27 symptoms, the majority of people who go on to experience the event will do so within the first binding-year, but several skin-related and rare but serious outcomes (eg, rib fracture) took longer to occur. Pain presents rapidly but continues to rise in intensity over time, peaking at >5 years of binding. CONCLUSIONS: Although many symptoms emerge quickly, others can take years to develop. Individuals and their clinicians can use this information to make informed decisions on how to structure binding practices and top surgery timing while meeting goals related to gender expression and mental health. Access to puberty blockers may delay initiation of binding, preventing binding-related symptoms in youth.

Cloth Lanyards as a Source of Intermittent Transmission of Candida auris on an ICU.

OBJECTIVES: Candida auris has been implicated in ICU outbreaks worldwide and is notable for being difficult to identify and treat, its resilience in the environment, and significant patient mortality associated with invasive disease. Here, we describe a small C. auris outbreak and how it was terminated. DESIGN: Single-center, observational. SETTING: Two general adult ICUs at an urban U.K. teaching hospital. PATIENTS: All patients positive for C. auris during the 5-month outbreak were included (n = 7). INTERVENTIONS: Stepwise implementation of enhanced infection prevention and control precautions was introduced including twice-weekly screening, contact tracing, isolation precautions, and environmental decontamination. A detailed environmental screen was performed to identify potential reservoirs. This included the patient bed space and clinical equipment and a frequently handled cloth lanyard attached to a key used to access controlled drugs. Personal possessions such as mobile phones, lanyards, and identification badges were also screened. MEASUREMENTS AND MAIN RESULTS: The index case and six linked acquisitions were identified. Four of six (67%) patients were identified after discharge of all known previous C. auris cases from ICU, highlighting potential for an environmental reservoir. Environmental screening identified C. auris from a patient bed space following deep cleaning, prompting review and enhancement of cleaning procedures. The controlled drug cloth lanyard was positive for C. auris, which prompted removal and culture of all staff lanyards. C. auris was identified on 1/100 staff lanyards (1%). No mobile phones or identification badges were positive for C. auris. The outbreak terminated following withdrawal of lanyards from ICU. CONCLUSIONS: This outbreak further implicates environmental reservoirs as sustaining C. auris ICU outbreaks. Identification of C. auris on cloth lanyards highlights the need to identify commonly handled moveable objects during an outbreak. We suggest that ICUs with a C. auris outbreak should investigate similar infrequently cleaned items as potential reservoirs and review their policies on lanyard use.

Fabric Selection in Atopic Dermatitis: An Evidence-Based Review.

BACKGROUND: Clothing fabrics interact closely with the skin to shape our cutaneous microenvironment. Cotton and silk have been traditionally recommended for patients with atopic dermatitis because of reported patient comfort. New synthetic fabrics combine anti-microbial, anti-inflammatory, moisture-wicking, and soothing properties that may augment conventional management strategies in atopic patients. OBJECTIVE: We review existing and emerging evidence for fabric selection in patients with atopic dermatitis including cotton, wool, lyocell, silk, anionic, cellulosic/cellulose based, zinc oxide coated, citric acid coated, chitosan coated, silver coated, borage seed oil coated, ethylene vinyl, and polyurethane and offer practical suggestions for clothing and bedding choices. METHODS: A systematic search was conducted on PubMed and EMBASE electronic databases for articles from 1 January, 1994 to 1 January, 2020. Studies were included based on the following inclusion criteria: clinical trial, published in English, and fabric as the main agent being evaluated. Case reports, case series, conference abstracts, reviews, animal studies, and duplicates were excluded. Studies were then manually screened by title, abstract, and full-text articles and selected to specifically describe the effects of fabrics in patients with atopic dermatitis. Both adult and pediatric patient studies were included. RESULTS: There appears to be an advantage to modern fabric manufacturing and processing techniques that have created smaller diameter, smoother fibers such as super- and ultrafine merino wool and anti-microbial finishes. Traditional cotton and silk fabrics have mixed evidence in improving atopic dermatitis symptoms and severity but have shown to be generally safe. Large-diameter wool has been shown to induce itching and irritation; ultra- or superfine merino wool is non-pruritic and may be recommended as an alternative. Emerging fabrics with potential efficacy in reducing atopic dermatitis severity and Staphylococcus aureus burden include silver-coated, chitosan-coated, and cellulose-based fabrics. Zinc oxide-coated, acid-coated, polyurethane-coated, borage seed oil-coated, anionic, lyocell, and ethylene vinyl fabrics have sparse evidence and require further study before conclusions can be made. CONCLUSIONS: Appropriate fabric selection can reduce the symptom severity and exacerbations of atopic dermatitis.

An analysis of children's clothing-related injuries cases reported by the media in mainland of China from 2003 to 2017.

BACKGROUND: Numerous reports in the media have suggested that children could be hurt due to their clothing, yet there are few medical reports that discussed children's clothing-related injuries. This study therefore, aimed to describe the epidemiological characteristics of media-reported injury cases related to children's clothing in Mainland of China. METHODS: This study systematically collected a total of 192 cases of children's clothing-related injuries reported in the news reports and medical literatures published by the Chinese media before December 2017. A content analysis of these cases was conducted to obtain information on the characteristics of these injuries. RESULTS: Cases of clothing-related injuries were most common in children aged 3 to 6 years (54.7%); the ratio of the number of boys to the number of girls in the 192 cases was 1.5: 1. In addition, approximately 51% of the cases occurred in the region of East China. The most common location of the incidents was in the home (35%). Furthermore, the zippers are the most common cause of injuries (15.1%), and the most common injured body part was the genital organs (29.2%). Besides, there were 24 cases reported death related to clothing injuries (13%). Moreover, the locations where the injuries occurred, the reasons for the occurrence of the injuries and the injured body parts differed significantly by gender and age (P < .05). CONCLUSIONS: Our findings suggest that future unintentional injuries could be prevented by implementing 2 major initiatives: improving the promotion of the safety of children clothing design in China and educating consumers on the potential risk associated with children's clothing.

Evidence for Infections by the Same Strain of Beta 2-toxigenic Clostridium perfringens Type A Acquired in One Hospital Ward.

This study conducts a comparative phenotypic and genetic analysis of C. perfringens strains isolated from two patients hospitalized at the same time in 2017 in the surgical ward of the Provincial Specialist Hospital in Wloclawek (Kujawsko-Pomorskie Province) who developed necrotizing soft tissue infections (NSTI). To explain the recurring cases of this infection, a comparative analysis was performed for these strains and the ones originating from infections recorded at the same hospital in three patients with gas gangrene in 2015. The two C. perfringens isolates studied in 2017 (8554/M/17 from patient No. 1 and 8567/M/17 from patient No. 2) had identical biochemical profiles. A comparison of research results using multiplex PCR from 2017 with a genetic analysis of strains from 2015 enabled us to demonstrate that the strains currently studied have the genes encoding the same toxins (α and ß2) as the two strains analyzed in 2015: no. 7143 (patient No. 3) and no. 7149 (patient No. 2). A comparative analysis of the strain profiles obtained with pulsed-field gel electrophoresis (PFGE) in 2017 with the results from 2015 has found one identical and genetically unique restriction profile, corresponding to one clone of C. perfringens comprising of two strains: no. 8567/M/17 (patient No. 2 in 2017) and no. 7143 (patient No. 3 in 2015). The epidemiological data and detailed analysis of the course of both events suggest that this clone of C. perfringens possibly survived in adverse conditions of the external environment in the operating block of this hospital for many months.This study conducts a comparative phenotypic and genetic analysis of C. perfringens strains isolated from two patients hospitalized at the same time in 2017 in the surgical ward of the Provincial Specialist Hospital in Wloclawek (Kujawsko-Pomorskie Province) who developed necrotizing soft tissue infections (NSTI). To explain the recurring cases of this infection, a comparative analysis was performed for these strains and the ones originating from infections recorded at the same hospital in three patients with gas gangrene in 2015. The two C. perfringens isolates studied in 2017 (8554/M/17 from patient No. 1 and 8567/M/17 from patient No. 2) had identical biochemical profiles. A comparison of research results using multiplex PCR from 2017 with a genetic analysis of strains from 2015 enabled us to demonstrate that the strains currently studied have the genes encoding the same toxins (α and ß2) as the two strains analyzed in 2015: no. 7143 (patient No. 3) and no. 7149 (patient No. 2). A comparative analysis of the strain profiles obtained with pulsed-field gel electrophoresis (PFGE) in 2017 with the results from 2015 has found one identical and genetically unique restriction profile, corresponding to one clone of C. perfringens comprising of two strains: no. 8567/M/17 (patient No. 2 in 2017) and no. 7143 (patient No. 3 in 2015). The epidemiological data and detailed analysis of the course of both events suggest that this clone of C. perfringens possibly survived in adverse conditions of the external environment in the operating block of this hospital for many months.

Round-knit or flat-knit compression garments for maintenance therapy of lymphedema of the leg? - Review of the literature and technical data.

To date, there have been no studies comparing flat-knit and round-knit compression garments for maintenance therapy of lymphedema of the leg. According to expert opinion, flat-knit fabrics are generally recommended for this purpose. Given the differences in the clinical presentation of lymphedema in terms of disease stage and location as well as patient adherence, and, last but not least, for economic reasons, it seems questionable whether all patients with lymphedema of the leg actually do require flat-knit compression garments. Considering technical aspects, published data and our own clinical experience, it seems reasonable that the choice of compression stockings be based on clinical findings and not on the diagnosis. Typical indications for flat-knit garments include significant differences in leg circumference as well as deep skin folds and edema of the toes/forefoot. However, there are also patients with lymphedema who benefit from round-knit fabrics with a high degree of stiffness. In any case, prior to maintenance therapy, it is essential to adequately decongest the legs using compression bandages and/or adaptive compression systems.

Brief versus Thong Hygiene in Obstetrics and Gynecology (B-THONG): A survey study.

AIM: The aim of this study was to evaluate if thong use is associated with a higher report of urogenital infections, including urinary tract infections, yeast vaginitis and bacterial vaginosis. METHODS: A cross-sectional survey regarding underwear preferences and infectious history was designed and distributed to women via a crowdsourcing service. All survey questions related to the last 12 months. Parametric and nonparametric statistical methods were used to compare responses between thong wearers and nonthong wearers. Thong wearers were defined as women who wore a thong equal to or more than 50 % of the time. RESULTS: Nine hundred and eighty-six respondents met inclusion criteria and completed the survey; 186 (18.9%) were defined as thong wearers and 800 (81.1%) were defined as nonthong wearers in the last 12 months. Reported rates of urogenital infections in the last 12 months were not significantly different for thong wearers versus nonthong wearers. Thong use was not an independent predictor of any urogenital infection in this study. CONCLUSION: In this large cross-sectional study we found that oral sex was the only independent predictor of urinary tract infection and bacterial vaginosis, and that wearing noncotton crotch underwear was associated with yeast vaginitis. Wearing thong underwear was not associated with any urogenital infections. Medical providers should discuss sexual practices and underwear fabric, rather than style, with their patients when there is concern for urogenital infection.

Sewing shirts with injured fingers and tears: exploring the experience of female garment workers health problems in Bangladesh.

BACKGROUND: The ready-made garment industry in Bangladesh not only contributes to the nation's economic development, but has created income opportunities for women, benefiting their whole family. However, these benefits come at considerable cost to the women. This research examines how the work environment and gendered family role in this conservative society affect the health of the female industrial workers. METHODS: A qualitative study employed in-depth interviews (n-20) and focus group discussions with female garment workers (n-4) in two cities of Dhaka district. Further, key informant interviews (n = 4) with factory doctors, along with eight workplace observations were conducted to explore the lived experience of female workers' health issues. Interview transcripts were coded in Atlas-ti, 5.2. The data were analysed using thematic analysis approach. The themes are illustrated with case narratives. RESULTS: The female workers reported that their work has led to back and joint pain, continuous headache, eye pain and difficulty in breathing associated with inhaling fabric dust. Inadequate lighting, constantly sitting in one position without back rest and continuous noise from hundreds of machines makes them feel permanently tired. Further, the female workers reported that working in the factory and meeting the expectations of the families at home has doubled their workload. The doctors indicated that the physical work environment, their low job status and the nature of the job affect the health of female workers. CONCLUSION: This study found that female workers in the ready-made garment industry face a high risk of health problems. Both government and non-government organizations need to be better involved in designing interventions targeting these women, to protect them from such health risks. In addition, recognition by the whole society of the important role the women play in the economy is needed, so that support by both family and society can be improved.

Evaluation of antimicrobial textiles for atopic dermatitis.

BACKGROUND: Functional textiles have been proposed as safe adjunct treatment for atopic dermatitis (AD). Some data have been published regarding their antimicrobial properties and their clinical efficacy. OBJECTIVE: This study examined the physical and functional properties of 11 commercially available functional textiles, including their antimicrobial activity in vitro, as a function of multiple laundering cycles. METHODS: All materials were weighed and examined under scanning electron microscopy (SEM) before and after laundering for fibre morphology and silver coating. Bioburden of newly purchased textiles was assessed by measuring bacterial colony forming units (CFU). Deliverable antimicrobial efficacy was evaluated in vitro for each specimen, before and after 30, 70, 100, 150 and 200 laundering cycles. RESULTS: Textile weight showed high variability. Damaged silver coating of variable degree was observed under SEM in most materials after laundering. Products made of silk showed smoother and tighter fibre morphology compared to cotton. The bacterial load of unwashed material ranged from <1 CFU to 35 CFU per 50 × 50 mm specimen. Most silver-containing products lost their antimicrobial activity rapidly after laundering. Silk and cotton retrieved products had no deliverable antimicrobial effect even in their original state. CONCLUSION: Elastic, lightweight textiles with smooth fibres are comfortable for daily use. Functional textiles rapidly losing their deliverable antimicrobial activity in vitro are not advisable for AD patients. Recommendations for functional textiles should be based on a combination of in vitro analysis of products in their original state and after laundering, together with real-life data obtained from controlled clinical trials.