Cotinine Levels Influence the Risk of Rupture of Brain Aneurysms

The relationship between nicotine levels in smokers and brain aneurysm has never been determined. To assess the levels of cotinine in smoker patients with ruptured and unruptured brain aneurysm and the risk of aneurysm rupture we quantified cotinine levels in smoker patients with ruptured or unruptured brain aneurysms. We identified a control group of smokers and nonsmokers without brain aneurysm. Out of 182 participants cerebral aneurysms were statistically significantly associated with smoking (P<0.001) and female sex (P=0.006). Cotinine levels were significantly correlated with both the presence (P=0.009) and the rupture (P=0.002) of brain aneurysms. Compared with nonsmokers, smokers had a 5-fold higher risk of having a brain aneurysm (OR, 5.72; 95% CI, 2.96–11.07; P<0.001). The risk of rupture of brain aneurysms increased by 50% with each cotinine unit and was 4-fold higher with cotinine levels between 4 and 6 (OR, 3.75; 95% CI, 1.48–9.53; P=0.005). With increasing age, the cotinine level decreased (P <0.001, rho= –0.28), declining by 2% with each year of age. In the whole population, the probability of a ruptured aneurysm in patients with cotinine levels between 4 and 6 was higher than in those with levels between 0 and 3 (OR, 5.55; 95% CI, 1.08–28.5; P=0.040). Our results suggest that high cotinine levels in smokers with brain aneurysm, rather than size, are significantly associated with high rupture risk. Cotinine levels decrease with age, possibly reducing the risk of formation and rupture of a brain aneurysm.

The impact of secondhand smoke exposure on the pregnancy outcome: a prospective cohort study among Egyptian community

Background Secondhand smoke (SHS) exposure gained lesser interest than active smoking. There is evidence from previous studies that SHS exposure had negative effects on fetal growth. This study aimed to examine the effect of smoke exposure on pregnancy outcome and to evaluate the level of nicotine urinary end-product cotinine in pregnant women in the late trimester. We included 36 women with a history of SHS exposure and 48 women without a history of exposure; all were in last trimester of pregnancy. We measured cotinine level in urine and followed the two groups until delivery and recorded fetal outcomes. Fetal biophysical parameters and blood flow waveforms were measured using B-mode and Doppler ultrasonography, respectively. Results The total range of the urinary cotinine creatinine ratio (CCR) concentration in the SHS exposed pregnant women was 0.01–0.2, IQR = 0.18 ng/mg.cr, versus 0.01–0.1, and IQR = 0.03 ng/mg.cr in the non-exposed group. The mean value as well as the mean rank of CCR was significantly higher (0.1 ± 0.08 ng/mg.cr., 40.3 respectively) in the exposed pregnant women as compared to the non-exposed pregnant women ((0.04 ± 0.02), 29.3 respectively, p value < 0.05). Newborn of the exposed women had significantly low birth weight which negatively correlated with cotinine level and had a dose-response relationship. Conclusions SHS exposure had negative effects on fetal outcomes. Efforts should be utilized to increase awareness of the consequences of secondhand smoke on the fetus and strict follow-up of exposed women for early detection.

Evaluation of Effectiveness of Chronic Care Model on Smokeless Tobacco Cessation by Measuring Urinary Cotinine Level among the Patient Attended in the Selected Dental College & Hospital, India -An Experimental Study

Background: Smokeless tobacco is one of the most common causes of preventable death. It is a big social and health issue. Smokeless tobacco utilization is a significant cause of morbidity and mortality in India, with more than 20% of the world's tobacco-related mortality occurring in India. The Chronic Care Model is a guide for the principal care management of higher-quality chronic diseases. The Chronic Care Model gives a structure that redirects health care resources to better meet the demands and issues of individual with chronic illness. Objectives: To explore the effectiveness of chronic care model for smokeless tobacco cessation in patients reporting to Sharad Pawar Dental College and Hospital. Methodology: The study will be conducted among patients reporting to Out Patient Department of Sharad Pawar Dental College and Hospital who are chronic smokeless tobacco users. This study will be conducted between two groups, in one of the groups chronic Care Model will be used and behavioural counselling will be given and in other group only behavioural counselling will be given. Urinary cotinine level test will be performed on both groups of patients consuming smokeless tobacco. Results: The chronic care model would be advantageous for the smokeless tobacco cessation. In India, there appears to be an immediate need for the promotion of awareness and informing people about the health problems associated with the use of smokeless tobacco through the model of chronic care. Conclusion: The utilization of Chronic Care Model (CCM) helps patient realize that not only it is a habit to use smokeless tobacco, but a chronic condition that requires long-term treatment to cure it.

Progressive nicotine poisoning by multiple transdermal nicotine patches

The pharmacokinetic properties of transdermal nicotine patches (TNPs) are different from those of other routes of nicotine administration; further, acute nicotine poisoning by TNPs may present with different clinical features. In the present report, we describe the case of a 23-year-old woman who was admitted to emergency department (ED) at Jeju National University Hospital with loss of consciousness. Five hours before the ED visit, she used multiple TNPs to attempt suicide. Initially, nausea and vomiting occurred, and the symptoms worsened over time. We immediately removed the TNPs, and the application sites were gently washed with sterile water. The patient’s level of consciousness gradually improved, and she fully recovered an altered mental status 5 hours later. Her initial urinary cotinine level was 324 ng/mL. Physicians should be aware that acute nicotine poisoning by TNPs can cause various toxic symptoms.

Effect of parental smoking on their children’s urine cotinine level in Korea: A population-based study

Background Children may be exposed to tobacco products in multiple ways if their parents smoke. The risks of exposure to secondhand smoke (SHS) are well known. This study aimed to investigate the association between parental smoking and the children’s cotinine level in relation to restricting home smoking, in Korea. Methods Using the Korea National Health and Nutrition Health Examination Survey data from 2014 to 2017, we analyzed urine cotinine data of parents and their non-smoking children (n = 1,403), in whose homes parents prohibited smoking. We performed linear regression analysis by adjusting age, sex, house type, and household income to determine if parent smoking was related to the urine cotinine concentration of their children. In addition, analysis of covariance and Tukey’s post-hoc tests were performed according to parent smoking pattern. Finding Children’s urine cotinine concentrations were positively associated with those of their parents. Children of smoking parents had a significantly higher urine cotinine concentration than that in the group where both parents are non-smokers (diff = 0.933, P < .0001); mothers-only smoker group (diff = 0.511, P = 0.042); and fathers-only smoker group (diff = 0.712, P < .0001). In the fathers-only smoker group, the urine cotinine concentration was significantly higher than that in the group where both parents were non-smoker (diff = 0.221, P < .0001), but not significantly different compared to the mothers-only smoker group (diff = - -0.201, P = 0.388). Children living in apartments were more likely to be exposed to smoking substances. Conclusion This study showed a correlation between parents’ and children’s urine cotinine concentrations, supporting the occurrence of home smoking exposure due to the parents’ smoking habit in Korea. Although avoiding indoor home smoking can decrease the children’s exposure to tobacco, there is a need to identify other ways of smoking exposure and ensure appropriate monitoring and enforcement of banning smoking in the home.