Aims:To compare the vitamin D status of 34 children, 9-24 months old, living in an area of Delhi renowned for high levels of atmospheric pollution (Mori Gate), with a comparable age matched group of children from a less polluted (Gurgaon) area of the city. Methods: Serum concentrations of calcium, alkaline phosphatase (ALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25(OH)D), and 1,25-dihydroxyvitamin D (1,25(OH) 2 D) were measured. Haze scores, regarded as a surrogate marker of solar UVB radiation reaching ground level, were measured in both areas. Results: Mean 25(OH)D of children in the Mori Gate area was 12.4 (7) ng/ml, compared with 27.1 (7) ng/ml in children living in the Gurgaon area (p < 0.001). The median ALP (p < 0.05) and mean PTH (p < 0.001) concentrations were higher in children living in the Mori Gate area than in the Gurgaon area. The mean haze score in the Mori Gate area (2.1 (0.5)) was significantly lower (p < 0.05) than in the Gurgaon area (2.7 (0.4)), indicating less solar UVB reaching the ground in Mori Gate. Conclusion: We suggest that children living in areas of high atmospheric pollution are at risk of developing vitamin D deficiency rickets and should be offered vitamin D supplements.I n humans the main source of vitamin D is that formed in the skin by conversion of 7-dehydrocholesterol to cholecalciferol (vitamin D 3 ) on exposure to the sun's ultraviolet B (UVB) radiation. The importance of sunlight in the prevention and cure of rickets was observed over a century ago, by Palm, 1 who found rickets to be most prevalent in cities where people were exposed to low levels of sunlight. Vitamin D is essential for skeletal health and its deficiency results in development of rickets in growing children and osteomalacia in adults. There is concern that increasing atmospheric pollution related haze from industrial and vehicular sources might lead to absorption of UVB photons, thereby reducing the cutaneous vitamin D synthesis. 2-4Delhi (latitude 28.35°N) is one of the most polluted cities in the world; the vehicle population, a major contributor to the atmospheric pollution burden, has grown by over 12% annually for the past two decades. 5 In this cross sectional study we assessed the vitamin D status of infants and toddlers living in a downtown area of Delhi, renowned for high levels of atmospheric pollution, with a comparable group of children from a relatively less polluted area on the outskirts of the metropolitan boundary of the city. We hypothesised that serum total 25-hydroxycholecalciferol (25(OH)D), a reliable measure of an individual's vitamin D status, of children living in the area with high levels of atmospheric pollution would be lower than in those living in the less polluted area of the city.

We find that children living in the permanent houses had a significantly better IQ than those in shanty houses. A review of the literature did not reveal a comparable study.

The present study lends support to the pragmatic approach of the Government to vaccinate babies born at home starting at 6 wk.

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Acute hepatitis A infection is an uncommon cause of pancreatitis in children. To date, only four cases have been reported in the paediatric literature. We report a 7-year-old girl with acute pancreatitis associated with hepatitis A infection who made a satisfactory recovery. The report highlights the CT findings including focal necrosis not previously reported. Because of the extreme rarity of the complication, the four previous reports have also been single case reports. This paper reviews all these cases with a view to elucidating the aetiopathogenesis of the pancreatitis.

The sensitivity and specificity of a new clinical sign of hypocalcaemia were evaluated. The Swan-neck sign, wherein infants with symptomatic hypocalcaemia keep their big toe hyperextended at the metatarsophalangeal joint and flexed at the interphalangeal joint, was looked for in 25 infants presenting with non-febrile seizures, alongside their serum calcium levels. The study showed that the sign had a sensitivity of 63.6% and specificity of 66.6%. (Predictive values of positive and negative tests were 93.3% and 20%, respectively.) This is compared with the standard Trousseau and Chvostek signs.

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