Frequency and etiological distribution of genital infections in children with Type 1 Diabetes

Purpose: To determine the frequency and etiological distribution of genital infections among children and adolescents with T1D in the Pleven region. Material: The study was performed at the Department of Pediatrics, University Hospital -Pleven. It involved 78 patients (33 boys and 45 girls) with T1D at the age of 11.9±0.8 years, admitted from March 2013 to March 2014. They were on an intensive insulin therapy with recombinant human insulin or analog insulins.Methods:An inspection of the external genitalia for signs of inflammation.Microbiological testing of genital discharge.Glycosylated hemoglobin (HbA1c) for assessment of metabolic control.Results: Out of the 78 studied children, 34 (43.5%) had clinical signs of genital infection (GI). The mean level of their HbA1c was 11.25±0.65%. Positive cultures were found in 28/78 (36%). Most GI were caused by fungi - in 15/28 cases, followed by bacteria - 9/28 and mixed fungal-bacterial flora in 4/28 cases. The main fungal pathogens cultured was Candida albicans in 10/15 cases, followed by Candida tropicalis - in 3/15. Bacteria were presented by Streptococcus agalactiae in 3/9 cases, Enterococcus faecalis - 3/9, Staphylococcus aureus - 2/9 and Escherichia coli in only 1 child.Conclusions: Our data confirm badly controlled T1D as a predisposing factor for genital infections in children, predominantly with Candida albicans, which can sometimes be associated with bacterial pathogens. This requires external genitalia inspection and microbiological testing for early diagnosis, and adequate treatment to prevent further complications

Comparative analysis of the practices of diagnostics and treatment of short stature, established in the outpatient clinics of general practitioners from Pleven and Varna

Introduction: Normal growth of the child is an index of good health, but it is a limited in time process, and for this reason, timely diagnosis and start of treatment of children with short stature (SS) are crucial for achieving adequate adult height and good quality of life.Aim: The aim of the present interview is to study the knowledge of general practitioners (GPs) about growth disorders and to increase the informational level in the process of creating national referral criteria and algorithms for the management of children with SS.Materials and Methods: GPs from Pleven and Varna (n=40, mean age 54.5 ± 8.85 yrs, work experience 25.9 ± 8.8 yrs, working in urban settings – 75%, children in their practices 0-18 - 23 079) have completed a questionnaire with 20 questions. All interviewed GPs defined SS as a problem for children. Almost all of them (80%) indicated use of standards for growth evaluation. They claimed that they provided screening for early detection of SS and they knew where to send a child with growth deviation. The main cause of SS, according to GPs, is genetic predisposition (35%), and that both - GPs and parents, are active in diagnosis of SS (82.5%). However, GPs shared that they were faced with some difficulties in the diagnosis of SS because of the “unclear” path of the patient after directing him to a specialist and that was the reason some of the children with SS to remain undiagnosed.Conclusion: SS is a problem that GPs are conscious of, but there is a strong need of measurements for building the “route” of the patient with SS, starting from the first step – the general practitioner

Glycemic control in type 1 diabetes mellitus among Bulgarian children and adolescents: the results from the first and the second national examination of HbA1c

The standardized hemoglobin A1c (HbA1c) test is an essential tool to evaluate the glycaemic control and the diabetes care. The aim of our study was to evaluate and compare the actual HbA1c level in a cohort of Bulgarian patients with type 1 diabetes aged 0–19 years in two consecutive national studies, in 2012 and 2014. We used a standardized method for HbA1c high performance liquid chromatography (HPLC). Тhe survey was conducted in 11 paediatric endocrinology practices in Bulgaria. Overall 829 patients with type 1 diabetes participated in the first study, 422 boys and 407 girls, aged 11.9 ± 4.2 years. The second study included 498 patients: 261 boys and 237 girls, aged 11.6 ± 4.1 years. The mean HbA1c level for the patients studied in 2014 (8.42 ± 1.69%) was significantly lower compared to that in the patients studied in 2012 (8.93 ± 1.98%, p < 0.001). Significantly more patients in the second study (36%) showed optimal control with HbA1c < 7.5% (p < 0.05) compared to those from the first one (24.9%). Teenagers in both studies had higher HbA1c levels compared to the other age groups: 9.19 ± 2.11% in 2012 and 8.8 ± 1.87% in 2014. We found significant differences in the HbA1c levels between the different centres in Bulgaria (from 7.92% to 9.95% in 2012 and from 7.42% to 9.13% in 2014). All age groups, except the teenagers showed improvement in the glycemic control in the second study as a result of continuous and structured education of the patients and their families