• Journal of The Korean Society of Clinical Toxicology
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• v.20 no.2
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• pp.82-85
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• 2022

Traditionally, most cases of nicotine poisoning have been due to ingestion of nicotine pesticides. However, the increasing use of electronic cigarettes (e-cigarettes) has resulted in both intentional and unintentional exposure to concentrated liquid nicotine or "e-liquid" leading to an increase in nicotine poisoning cases. However, fatalities following the ingestion of the e-liquid are extremely rare. We report a rare case of cardiac arrest and severe encephalopathy following the intentional ingestion of e-liquid. We present the case of a 20-year-old woman who intentionally ingested liquid nicotine intended for e-cigarette use. She was found in asystole and experienced a return of spontaneous circulation (ROSC) after undergoing approximately 46 mins of cardiopulmonary resuscitation. Her plasma nicotine levels were >500 ng/ml. Despite aggressive supportive care, she was found to have encephalopathy consistent with severe anoxic brain injury on magnetic resonance imaging. In recent times, there have been some reports of deaths following liquid nicotine ingestion. Our case illustrates the potential for fatal nicotine toxicity from ingestion of e-cigarettes.

• Tuberculosis and Respiratory Diseases
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• v.50 no.6
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• pp.693-703
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• 2001

Background : Smoking is the most important and consistent determinant of the development and progression of COPD(Ed Note : Define COPD). The fact that cigarette smokers develop a different type of COPD, chronic bronchitis and emphysema, with different clinical and pathological aspects, suggests that the development of COPD has a relationship with other smoking-associated factors beyond just a simple smoking history. The aim of this was to analyze the smoking habits and history of patients with COPD and to evaluate the development of different types of COPD according to patient's smoking habits. Method : To evaluate the differences in the smoking patterns of patients with chronic bronchitis and emphysema, a pulmonary function test was conducted, and the smoking history and patterns was obtained through a smoking history questionnaire by a direct personal interview from 333 male cigarette smokers diagnosed with COPD, in the Yeungnam university medical center(190 patients diagnosed with chronic bronchitis, 143 patients diagnosed with emphysema). Result : The patients with emphysema smoked earlier and had a higher smoking history(ie, more packyears, more total amounts of smoked cigarette, and more deep inhalation and longer duration of plain cigarette exposure) than those with chronic bronchitis. The depth of inhalation was also significantly higher in the emphysema patients after taking into account age, cumulative cigarette consumption and the type of cigarette smoked. Conclusion : Emphysema was more associated with the increasing degree of inhalation as assessed by the depth of inhalation. A high alveolar smoke exposure may be a significant risk factor for the development of emphysema.

• Journal of Environmental Health Sciences
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• v.35 no.3
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• pp.153-161
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• 2009

The purpose of this paper is to evaluate 1) blood lead levels of workers at auto repair shops as Biological Exposure Indices (BEI) of toxic substances such as lead and toluene that are produced during automotive painting process, 2) the differences depending on personal characteristics of workers who have been exposed to toluene by using urine hippuric acid concentration as a marker and 3) the correlation between the concentration of hazardous chemicals in each workplace and the BEL. All subjects were male with a mean age of 36.2 years. In terms of age, most were in the 30 to 40 age group (13 persons, 48.1%). In relation to the length of work experience, the highest proportion had experience of 10 years of less (18 persons, 66.7%). Twenty three workers were cigarette smokers (85.2%) while 4 (14.8%) were non-smokers. In addition, more than 80% of the workers drank alcohol. Dust concentration and toluene exposure during automotive painting showed no significant difference with age, length of work experience, smoking and drinking while a significant difference (p<0.05) has been detected between lead concentration and smoking. The geometric mean of dust concentration, lead concentration and toluene concentration were $0.38mg/m^3,\;0.0021mg/m^3$ and 1.08ppm respectively. In addition, the geometric mean of blood lead levels and urine hippuric acid concentration were $1.70{\mu}g/dl$ and 0.25g/g respectively, which were lower than the standard levels suggested by the Ministry of Labor. To determine the influential factors on blood lead and urine hippuric acid concentrations, a correlation analysis has been conducted with variables of air, lead and toluene concentrations, age, length of work experience and amount of cigarette smoking. According to the analysis, a relatively high correlation (p<0.01) has been observed between air lead concentration and biological sample concentration.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.1
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• pp.139-145
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• 2016

Environmental tobacco smoke (ETS) is a major public health problem for all ages. Despite the high prevalence of smoking among the Saudi population, there is limited information about levels of urinary cotinine in Saudi children exposed to SHS. The aim of the study was to assess the exposure of schoolchildren to ETS, and measure their urinary cotinine levels. Multistage cluster sampling was carried out, where schoolchildren from 4 schools were randomly chosen from primary schools in Taif city. A questionnaire including questions on SHS exposure and smoking rules in the residence were sent to students parents/guardians. Urine samples were taken and analyzed for total cotinine using chemiluminescent immunoassay. Of the studied children, 38.4% had a smoking father, 61.8%, 41.2% and 49.3% of them were exposed to ETS indoors, outdoors and both indoors and outdoors respectively. The mean urinary cotinine was significantly higher among children exposed to ETS compared to unexposed children. Urinary cotinine levels in children with both indoor and outdoor exposure was significantly higher compared with its level in children with single exposure. A significant positive correlation was found between urinary cotinine concentrations and the number of cigarette packs smoked by parents, and the number of smokers in the residence. The mean urinary cotinine level was significantly higher in children who reported no smoking rules at the residence.. The study revealed a high exposure of Saudi children to ETS. An antismoking media awareness campaign on the harmful effects of ETS should be carried out, in addition to family counseling programs targeted to parents to protect their children from ETS.

• Journal of Nutrition and Health
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• v.41 no.2
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• pp.135-140
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• 2008

Cigarette smoke (CS) induces oxidative and nitrosative stress to the respiratory tract (RT) via both oxidants contained in CS and by CS-induced activation of RT inflammatory-immune pro-oxidant processes. CS exposure has been associated with reduced levels of plasma micronutrient antioxidants, in part due to an increased utilization and turnover of alpha-tocopherol (AT). It has been suggested that gamma-tocopherol (GT) may have an expanded spectrum of antioxidant activation compared to alpha-tocopherol (AT). In order to investigate effects of high GT supplementation as compared to AT, C57 BL/6 mice were fed control AT (35 mg/kg diet) or high GT (1,000 mg/kg diet) diet for 8-10 weeks and then exposed to 60 $mg/m^3$ CS, 6 hr/day for 3 days. AT and GT levels and their metabolites were measured at endpoints. High GT supplementation significantly reduced AT levels in plasma, liver and lung compared to AT. CS increased levels of AT and GT in plasma and lung of control AT group but decreased GT levels in lung of high GT supplemented group. Moreover, CS significantly decreased GT metabolite, gamma-CEHC. The results suggest that high GT supplementation have selective modulation of concentrations of vitamin E and its metabolite in plasma and lung but not in liver against in vivo CS exposure.

• Tuberculosis and Respiratory Diseases
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• v.50 no.4
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• pp.426-436
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• 2001

Background : Chronic obstructive pulmonary disease(COPD) is one of the major contributors to morbidity and mortality among the adult population. Cigarette smoking(CS) is undoubtedly the single most important factor in the pathogenesis of COPD. However, its mechanism is unclear. The current hypothesis regarding the pathogenesis of COPD postulates that an imbalance between proteases and antiproteases leads to the destructive changes in the lung parenchyma. This study had two aims. First, to evaluate the effect of CS exposure on histologic changes of the lung parenchyme, and second, to evaluate the effect of CS exposure on the expression of the gelatinolytic enzymes in BAL fluid cells in guinea pigs. Methods : Two groups of five guinea pigs were exposed to the whole smoke of 20 commercial cigarettes per day, 5 hours/day, 5 days/week, for 6weeks, and 12 weeks, respectively, using a smoking apparatus. Five age-matched guinea pigs exposed to room air were used as controls. Five or more sections were microscopically extamined(${\times}400$) and the number of cellular infiltration of the alveolar wall was measured in order to evaluate the effect of CS exposure on the histologic changes of lung parenchyme. The statistical significance was analyzed by a linear regression method. To evaluate the expression of the gelatinolytic enzymes in intraalveolar cells, BAL fluid was obtained and the intraalveolar cells were separated by centrifugation (500 g for 10 min at $4^{\circ}C$). Two sets of culture plates were loaded with $1{\times}10^6$ intraalveolar cells. One plate, contained O.1mM EDTA, a inhibitor of matrix metalloproteases(MMPs), and the other plate had no EDTA. Both plates were incubated for 48 hours at $37^{\circ}C$. After incubation, gelatinolytic protease expression in the supernatants was analyzed by gelatin zymography. Results : At the end of CS exposure, the level of blood carboxy Hb had increased significantly(4.1g/dl in control group, 24g/dl immediately after CS exposure, 18g/dl 30 min after CS exposure, 15g/dl 1 hour after CS exposure). Alveolar inflammatory cells were identified in the CS exposed guinea pigs. The number of alveolar cellular cells observed in a microscopic field ($400{\times}$) was $121.4{\pm}7.2$, $158.0{\pm}20.2$, $196.8{\pm}32.8$, in the control, the 6 weeks, and the 12 weeks group, respectively. The increased extent of inflammatory cellular infiltration of the lung parenchema showed a statistically significant linear relationship with the duration of CS exposure(p=0.001, $r^2=0.675$). Several types of gelatinolytic enzymes in the intraalveolar cells of CS exposed guinea pigs were expressed, of which some were inhibited by EDT A. However, the gelatinolytic enzymes were not expressed in the control groups. Conclusion : CS exposure increases inflammatory cellular infiltration of the alveolar wall and the expression of gelatinolytic proteases in guinea pigs. EDTA inhibits some of the gelatinolytic proteases. These findings suggest a possibility that CS exposure may increase MMP expression in the lungs of guinea pigs.

• Safety and Health at Work
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• v.4 no.1
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• pp.71-74
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• 2013

Here, we present a case of lung cancer in a 48-year-old male horse trainer. To the best of our knowledge, this is the first such case report to include an exposure assessment of respirable crystalline silica (RCS) as a quartz. The trainer had no family history of lung cancer. Although he had a 15 pack/year cigarette-smoking history, he had stopped smoking 12 years prior to his diagnosis. For the past 23 years, he had performed longeing, and trained 7-12 horses per day on longeing arena surfaces covered by recycled sands, the same surfaces used in race tracks. We investigated his workplace RCS exposure, and found it to be the likely cause of his lung cancer. The 8-hour time weight average range of RCS was 0.020 to $0.086mg/m^3$ in the longeing arena. Horse trainers are exposed to RCS from the sand in longeing arenas, and the exposure level is high enough to have epidemiological ramifications for the occupational risk of lung cancer.

• Journal of Preventive Medicine and Public Health
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• v.14 no.1
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• pp.23-31
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• 1981

This study was conducted to investigate the effects of passive inhalation of cigarette smoke and the correlation between change of flicker value and active or passive smoking in poorly ventilated room. Forty five male students were tested by divided into four experimental groups composed of active and passive smokers and three control groups. Each four experimental groups were exposed to smoke for Two hours in enclosed room. Vital capacities, flicker values, blood carboxyhemoglobin levels and carbon monoxide concentration in room air were estimated before, during and after the exposure, and amounts of smoking or smoke exposure during two hours were also noted. The results obtained were as follows; 1. Concentration of carbon monoxide in air and increase of blood carboxyhemoglobin level (% COHb) were positively correlated with smoking amount. 2. Increase of blood carboxyhemoglobin in passive smokeres, in average, were about seventy six percent of that in smokers, as 2.2% vs. 2.9%. 3. Comparison with published data showed that Peterson's equation gave most similar result to this study in estimation of increase of blood carboxyhemoglobin level. 4. During the exposure, flicker values fell steadily in both experimental groups and control groups as time passed. Flicker values were, however, elevated again in experimental groups after exposure, despite the fact that values still fell in control groups. 5. Blood carboxyhemoglobin and flicker value were negatively correlated and this correlationship was stronger in passive smoker than in active smoker. 6. Multiple regression equation between flicker value and exposure time and blood carboxyhemoglobin level was expressed as: Flicker value=41.6-0.2 COHb%-0.9Hour, 7. In general, it is suggested that biological criteria would be more preferrable than chemical criteria in establishment of statutory limitation of smoking in enclosed spaces.

• Journal of Korean Society for Atmospheric Environment
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• v.16 no.E
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• pp.1-17
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• 2000

In this study, the concentrations of particulate organic constituents of environmental tobacco smoke(ETS) were determined using an environmental smog chamber, where ETS is the sole source of target compounds. ETS was generated in a 30 ㎥ environmental chamber by a number of different cigarettes, including the Kentucky 1R4F reference cigarette and eight commercial brands. A total of 12 experimental runs was conducted, and target analytes included a group of ETS markers both in vapor and particulate phase and a class of polycylic aromatic hydrocarbos(PAHs) associated with ETS particles. The mass concentrations of PAH in ETS particles were also determined. The average contents of benzo(a) pyrene and benzo(a) anthracene in ETS particles for the commercial brands were 12.8 and 21.5$\mu\textrm{g}$/g, respectively, There values are all somewhat higher than those determined previously by other studies. Results form the chamber study are further used to estimate the average and variability of cigarette yields for target compounds associated with ETS. Finally, ratios of RSP to the surrogate standards of UVPM, FPM and solanesol were calculated for each sample. The average conversion factors factors for the eight commercial brands were 7.3, 38, and 41 for UVPM, EPM, and solanesol, respectively. The UVPM and FPM factors are in good agreement with the recently published values. Whereas there might be a substantial difference in the solanesol content among cigarettes produced in different countries, the variability is somewhat greater than those of UVPM and FPM, Unfortunately, comparison of the PAH yield data from this study with literature values was complicated by a lack of consistency in cigarette smoke generating methodology. Validation of the PAH yields was also difficult due to a lack of information on the ETS related PAH in the literature. From and engineering viewpoint , however, these data on the cigarette yields of ETS components may still provide useful information to studies on the mathematical modeling of indoor air quality management regarding tobacco smoke as a source of interest, or to studies on the assessment of human exposure to ETS.

• Journal of Korean Public Health Nursing
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• v.18 no.2
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• pp.330-341
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• 2004

Parental smoking status and smoking environment do not only affect children's health through exposure to nicotine, but are also related to children's smoking attitude, intention and knowledge of smoking. Since this study was conducted to examine a relationship between family members smoking and smoking attitude, intention and knowledge of their children, little is known about psychosocial factors influencing smoking among Korean preschool children. This study aimed to determine the psychosocial factors (sociodemographic factors, education for smoking cigarette, knowledge about smoke cigarette) influencing smoking attitude and smoking intention, with a purpose of providing directions for future education programs for Korean preschool children. A cross sectional sample of 840 children, ages 4-7 years, living in a rural district were interviewed during August 6 - November 14, 2003. Among them, 834 children whose missing data were less than $10\%$ were included the analysis. The independent variables included sociodemographic characteristics and education for smoking cigarette, while the dependent variables were knowledge about smoking, the children's smoking attitude and their intention of smoking. The data on sociodemographic characteristics were analyzed using descriptive statistics including frequency, percentage, mean, and standard deviation. The correlations between the independent variables and attitude and intention of smoking were analyzed using chi-square test, t-test, and logistic regression. The results of this study were s follows. The factors that were found to be significantly correlated to smoking attitude include mother's smoking $(x^2=4.86,\;p=.03)$, grandmother's smoking $(x^2=5.56,\;p=.02)$, and knowledge of smoking cigarette $(x^2=-5.13 p<.01)$. The factors that were significantly correlated to the intention of smoking include gender $(x^2=.08,\; p=.02)$, education for smoking$(x^2=17.65,\;p<.01)$, mother's smoking $(x^2=19.05,\; p<.01)$, grandmother's smoking $(x^2=17.67,\; p<.01)$, and knowledge$(x^2=-2.17,\;p=.03)$. The children who had non smoking mother were more likely to have negative attitude (OR=2.29). The children who had a higher knowledge about smoking were more likely to have negative attitude (OR=1.58). The findings suggest that a smoking prevention program specific for preschool children is necessary to prevent early onset of smoking. The findings also suggest that the program should involve children's family members who influence their smoking attitude and intention.