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Additional evidence on the frequency of Vitamin D deficiency rickets
March, 1969 T h e Journal o[ P E D I A T R I C S
485
Letterf to the Editor
Additional evidence on the frequency of Vitamin D deficiency rickets
49 females, and in the second study, out of 28 cases, 15 were male and 13 female. The name incidentally is Ghosh and not Grosh. S H A N T I GI-IOS H D E P A R T M E N T OF PEDIATRICS SAFDARJ U N G HOSPITAL
To the Editor:
N E W DELHI, INDIA
I have just read the paper, "Vitamin D deficiency rickets in Greece," by Lapatsanis and associates, in the August, 1968, issue of this JOURNAL, They have quoted me as having given the incidence of rickets at Irwin Hospital, New Delhi, as 35 per cent (J. Indian Paediat. Soc. 1:253, 1962). I am afraid this incidence is due to "printer's devil," the figure really being 0.35 per cent, i.e., 100 out of 28,400 patients. The mistake was reproduced in Advances in Paediatrics (XIII: 250, 1964). I pointed out this error to the Editor at the time. We definitely felt that the incidence of rickets was much higher than 0.35 per cent and that some early cases were missed in a busy outpatient clinic. To remedy that, we studied 1,000 consecutive children up to 5 years of age attending the pediatric outpatient clinic of I r w i n Hospital, clinically and radiologically (Indian Pediat. 3:9, 1966). The wrist only was x-rayed earlier in the study, but in 650 cases, both the wrist and the knee were x-rayed. Twenty-eight patients out of these 1,000 were found to have rickets, an incidence of 2.7 per cent. I agree with Lapatsanis and associates that clinical and radiological changes appear later than the changes in serum alkaline phosphatase levels. If we had done the serum alkaline phosphatase levels in our patients, the incidence would have been higher. Our data on sex incidence does not conform with that of J~apatsanis and associates. In the first study referred to, there were 51 males and
Toxicity with diphenlyl~ydantoin To the Editor: I would like to add another cause of toxicity with diphenylhydantoin in children to those described by Patel and Crichton in the November, 1968, issue of the JOURNAL OF PEDIATRICS. Dilantin suspension is very viscons and requires vigorous shaking to uniformly resuspend it. Simply inverting the bottle once or twice is apt to result in an over concentrated suspension, as the contents of the bottom of the bottle tend to displace the upper layer without adequate mixing. One must consider inadvertent overdose due to this settling whenever toxicity occurs at a normal therapeutic dosage. R U T H ANDREA SELLER, M.D. PEDIATRIC HEMATOLOGIST,
DIVISIONOF PEDIATRICS, COOKCOUNTYHOSPITAL~CHICAGO,ILL.
Reply Appreciation for a practical suggestion which would seem to be important. EDITOR
VoI. 74, No. 3, p. 485
485
Letterf to the Editor
Additional evidence on the frequency of Vitamin D deficiency rickets
49 females, and in the second study, out of 28 cases, 15 were male and 13 female. The name incidentally is Ghosh and not Grosh. S H A N T I GI-IOS H D E P A R T M E N T OF PEDIATRICS SAFDARJ U N G HOSPITAL
To the Editor:
N E W DELHI, INDIA
I have just read the paper, "Vitamin D deficiency rickets in Greece," by Lapatsanis and associates, in the August, 1968, issue of this JOURNAL, They have quoted me as having given the incidence of rickets at Irwin Hospital, New Delhi, as 35 per cent (J. Indian Paediat. Soc. 1:253, 1962). I am afraid this incidence is due to "printer's devil," the figure really being 0.35 per cent, i.e., 100 out of 28,400 patients. The mistake was reproduced in Advances in Paediatrics (XIII: 250, 1964). I pointed out this error to the Editor at the time. We definitely felt that the incidence of rickets was much higher than 0.35 per cent and that some early cases were missed in a busy outpatient clinic. To remedy that, we studied 1,000 consecutive children up to 5 years of age attending the pediatric outpatient clinic of I r w i n Hospital, clinically and radiologically (Indian Pediat. 3:9, 1966). The wrist only was x-rayed earlier in the study, but in 650 cases, both the wrist and the knee were x-rayed. Twenty-eight patients out of these 1,000 were found to have rickets, an incidence of 2.7 per cent. I agree with Lapatsanis and associates that clinical and radiological changes appear later than the changes in serum alkaline phosphatase levels. If we had done the serum alkaline phosphatase levels in our patients, the incidence would have been higher. Our data on sex incidence does not conform with that of J~apatsanis and associates. In the first study referred to, there were 51 males and
Toxicity with diphenlyl~ydantoin To the Editor: I would like to add another cause of toxicity with diphenylhydantoin in children to those described by Patel and Crichton in the November, 1968, issue of the JOURNAL OF PEDIATRICS. Dilantin suspension is very viscons and requires vigorous shaking to uniformly resuspend it. Simply inverting the bottle once or twice is apt to result in an over concentrated suspension, as the contents of the bottom of the bottle tend to displace the upper layer without adequate mixing. One must consider inadvertent overdose due to this settling whenever toxicity occurs at a normal therapeutic dosage. R U T H ANDREA SELLER, M.D. PEDIATRIC HEMATOLOGIST,
DIVISIONOF PEDIATRICS, COOKCOUNTYHOSPITAL~CHICAGO,ILL.
Reply Appreciation for a practical suggestion which would seem to be important. EDITOR
VoI. 74, No. 3, p. 485