The Effect of Inhaled Corticosteroids on the Urinary Calcium to Creatinine Ratio in Childhood Asthma

Background: The use of inhaled corticosteroids (ICS) via spacers in childhood asthma is increasing. However, concern has been raised about its long-term impact. Hypercalciuria is a known adverse effect of treatment with systemic corticosteroids. The urinary calcium to creatinine ratio (UCa : Cr) is a simple, reliable and non-invasive tool for evaluation of hypercalciuria. Aim: To determine whether ICS can induce hypercalciuria in children with asthma. Setting: Outpatient clinic in a referral hospital. Methods: The UCa : Cr was determined in 25 children aged 3–6 years with mild-to-moderate persistent asthma before and after a 2-month course of inhaled budesonide 400 μg/day via an aerochamber. Children who had received oral corticosteroids, diuretics, antibiotics or theophylline were excluded. Statistics: Paired Student's t-test and Fisher's exact test. Results: The mean UCa : Cr was similar in the children with asthma before and after 2 months' administration of budesonide (0.10 ± 0.10 and 0.11 ± 0.08, respectively; p = 0.601). The numbers of hypercalciuric children were two and five, respectively (p = 0.417). In 68% of patients, the UCa : Cr increased and in 16% the increase indicated hypercalciuria (UCa : Cr > 0.2). Conclusions: Although the treatment of childhood asthma with budesonide 400 μg/day via an aerochamber does not appear to be associated with hypercalciuria, the existence of a subgroup of patients in whom ICS may induce hypercalciuria is plausible. This needs to be further evaluated in a larger study

“Doctor, will that x-ray harm my unborn child?”

Abstract: Exposure to ionizing radiation can be a source of anxiety for many pregnant women and their health care providers. An awareness of the radiation doses delivered by different techniques and the acceptable exposure thresholds can help both patients and practitioners. We describe exposure to radiodiagnostic procedures during pregnancy and suggest an approach to assess the potential risk

Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry.

INTRODUCTION: An increasing number of jurisdictions have legalized recreational cannabis for adult use. The subsequent availability and marketing of recreational cannabis has led to a parallel increase in rates and severity of pediatric cannabis intoxications. We explored predictors of severe outcomes in pediatric patients who presented to the emergency department with cannabis intoxication. METHODS: In this prospective cohort study, we collected data on all pediatric patients (\u3c18 \u3eyears) who presented with cannabis intoxication from August 2017 through June 2020 to participating sites in the Toxicology Investigators Consortium. In cases that involved polysubstance exposure, patients were included if cannabis was a significant contributing agent. The primary outcome was a composite severe outcome endpoint, defined as an intensive care unit admission or in-hospital death. Covariates included relevant sociodemographic and exposure characteristics. RESULTS: One hundred and thirty-eight pediatric patients (54% males, median age 14.0 years, interquartile range 3.7-16.0) presented to a participating emergency department with cannabis intoxication. Fifty-two patients (38%) were admitted to an intensive care unit, including one patient who died. In the multivariable logistic regression analysis, polysubstance ingestion (adjusted odds ratio = 16.3; 95% confidence interval: 4.6-58.3; CONCLUSIONS: Severe outcomes occurred for different reasons and were largely associated with the patient\u27s age. Young children, all of whom were exposed to edibles, were at higher risk of severe outcomes. Teenagers with severe outcomes were frequently involved in polysubstance exposure, while psychosocial factors may have played a role