Tobacco Stained Fingers and Its Association with Death and Hospital Admission: A Retrospective Cohort Study

Clinical signs of nitrous oxide use: case report and review of the literature

Nitrous oxide is used medically as an anesthetic agent; in the food industry as a propellant for condiments; and recreationally for its euphoric and dissociative effects. We report three cases of nitrous oxide misuse causing severe, symptomatic cobalamin (vitamin B12) deficiency in which signs of nitrous oxide use per se, as well as signs of toxicity, were observed, including characteristic palmar calluses over the metacarpal heads, and frostbite. These signs may assist clinicians in the recognition of nitrous oxide use and the timely diagnosis of nitrous oxide toxicity.

High-risk smoking in the United States: Nicotine staining predicts increased colonic adenomas and advanced adenomas on colonoscopy

BACKGROUND

Smoking is linked with numerous adverse health effects. Nicotine staining on fingers or teeth is thought to suggest active or heavy smoking. The significance of nicotine staining within gastroenterology remains unclear.

AIM

We set out to establish the predictive value of nicotine staining for adenomas and advanced adenomas.

METHODS

This was a cross-section study of patients who underwent colonoscopy at the Oklahoma City Veterans Affairs Medical Center from November 2019 to November 2020. Pre-procedure patient survey ascertained current smoking status. Endoscopist performed a nicotine staining survey upon completion of the respective colonoscopy. Chart review allowed determination of patient demographics, comorbidities, and colonoscopy findings. Patients without smoking history were assigned to a control cohort. We applied one-way analysis of variance when comparing the mean of continuous variables and the Chi-square test when comparing categorical variables. Lastly, we used stepwise logistic regression to estimate adjusted odds ratio. A p-value <0.05 was considered statistically significant.

RESULTS

Compared to those without smoking history or evidence of nicotine staining, patients with positive nicotine staining were older (P = 0.03), leaner (P < 0.0001), and more likely to have chronic obstructive pulmonary disease (P < 0.0001) or history of alcohol abuse (P < 0.0001). Furthermore, presence of nicotine staining independently predicted increased likelihood of multiple adenomas (OR 1.5, 95% CI [1.2-1.9]) and advanced adenomas (OR 1.6, 95% CI [1.2-2.2]).

CONCLUSION

This marks the first investigation of nicotine staining within gastroenterology. We have demonstrated that the presence of nicotine staining independently predicts numerous adenomas and advanced adenomas.