The role of school psychologists and pedagogical counselors in counteracting aggressive behavior at school

According to the conducted studies, the interventions of the aggressive pupils in the Bulgarian schools are entrusted mainly to the school psychologists and, in the case of the more severe offenses - to the children's pedagogical rooms. Systemic work with pupils, both individual and group, is lacking.The purpose of this review is to examine the practical possibility of implementing preventive and corrective actions, to characterize the current situation and difficulties and to offer options for optimizing the role and function of these specialists.In the present work of school psychologists, three distinct trends are emerging: psycho-diagnostics, crisis response, or ambiguous mediator functions between teachers and parents.In conversations with school psychologists, it became clear that virtual harassment is increasing, there is a lack of systematic work with pupils and their parents. The need for serious preventive programs and the introduction of a subject in health and social education, in which the topics include both acquaintance with the main diseases and conditions that are significant for the school age, as well as with psychological methods and techniques for responding to aggression is realized.It is necessary to impose the state educational standard for psychological services in education, in which to include also emotional and social education of children. School psychologists should have a leading role in the realization of these activities

Treatment of tetanus in childhood with MgSO4 - benefits and risks

Тетанус е остра инфекциозна болест, характеризираща се с клиничната триада мускулна ригидност, мускулен спазъм и дисфункция на автономната нервна система. Овладяването на болезнения, протрахиран мускулен спазъм и ригидност е основен момент в лечението. В кли-ничната практика са използвани редица медикаменти като бензодиазепини, опиати, пропофол, дантролен, баклофен, мускулни релаксанти. Алтернативно средство за контрол е MgSO4.Представяме клиничен случай на 12-год. Дете с тетанус, при който за първи път в нашето от-деление бе използвана продължителна интравенозна инфузия на MgSO4. Медикаментът бе при-ложен за контрол на мускулните спазми в комбинация с Dormicum, Tilidine и Baclofen. С добавянето към терапията на MgSO4 успяхме да овладеем мускулния спазъм и да намалим ригидността, избягвайки повишаване на дозите на седативи и опиати, както и провеждането на ендотрахеална интубация с последваща трахеостомия, изкуствена белодробна вентилация (ИБВ) и мускулна релаксация.Решението да представим нашия опит за управление на тетанус с прилагане на непрекъсната i.v. Инфузия с MgSO4 бе продиктувано от факта, че в литературата се откриха само единични клинични случаи. Посочените дози бяха твърде вариабилни, може би защото децата бяха с различна степен на тежест на заболяването, със или без подкрепяща ИБВ. Тези факти ни мотивираха да опишем подробно нашия клиничен случай с оглед подкрепа на бъдещата кли-нична практика у нас.Tetanus is an acute infectious disease characterized by clinical triad muscle rigidity, muscle spasm and dysfunction of the autonomic nervous system. The management of the painful, protracted muscle spasm and rigidity is a basic element in the treatment of tetanus. Numerous medications such as benzodiazepines, opiates, propofol, dantrolene, baclofen, muscle relaxants have been used in clinical practice. An alternative agent is MgSO4.We present a clinical case of tetanus in a 12-year-old child, in which a prolonged intravenous infusion of MgSO4 was used for the first time at our intensive care unit. The drug was used to control muscle spasms in combination with Dormicum, Tilidine and Baclofen. With the addition of MgSO4 to the therapy, we managed to control muscle spasms and to reduce rigidity, avoiding increase in the doses of the sedative and opiate, as well as endotracheal intubation followed by tracheostomy, mechanical ventilation and muscle relaxation.The decision to present our experience of managing tetanus by application of continuous i.v. infusion with MgSO4 was due to the fact that only single clinical cases were described in the literature. Furthermore, the indicated doses were too variable, perhaps because the children were with varying severity of tetanus, with or without supportive artificial lung ventilation. These facts motivated us to describe our clinical case in detail in order to support future local clinical practice

Diagnosis and treatment of a child with propionic acidemia - an issue both near and distant

      Propionic acidemia (PA) is a genetic heterogeneous hereditary disease, that is due to deficiency of the mitochondrial enzyme propionyl-CoA carboxylase. As a result of the inherited genetic error of metabolism, propionic acid and propionyl-CoA-related metabolites accumulate in the body. The clinical manifestation of PA is caused by the toxic effect of the formed substances. PA presents with acute encephalopathy, progressive eating disorders, vomiting, dehydration and hypotension, running against the background of severe metabolic ketoacidosis, an increased anion gap (AnGap) ≥15 and hyperammonemia. The clinical condition is defined as an acute metabolic crisis of PA. The early diagnosis and the timely treatment are crucial for the outcome of the disease.      We present a clinical case of PA in a two-month-old infant who was admitted to the Pediatric Intensive Care Unit in St. Marina University Hospital, Varna with seizures and disturbance of consciousness. The current clinical case is presented with the aim of focusing on the problems of hereditary diseases of the metabolism, in particular organic acidemias and the critical importance of the initial stabilization and adequate management of the lives of the affected patients.Propionic acidemia (PA) is a genetic heterogeneous hereditary disease, that is due to deficiency of the mitochondrial enzyme propionyl-CoA carboxylase. As a result of the inherited genetic error of metabolism, propionic acid and propionyl-CoA-related metabolites accumulate in the body. The clinical manifestation of PA is caused by the toxic effect of the formed substances. PA presents with acute encephalopathy, progressive eating disorders, vomiting, dehydration and hypotension, running against the background of severe metabolic ketoacidosis, an increased anion gap (AnGap) ≥15 and hyperammonemia. The clinical condition is defined as an acute metabolic crisis of PA. The early diagnosis and the timely treatment are crucial for the outcome of the disease.We present a clinical case of PA in a two-month-old infant who was admitted to the Pediatric Intensive Care Unit in St. Marina University Hospital, Varna with seizures and disturbance of consciousness. The current clinical case is presented with the aim of focusing on the problems of hereditary diseases of the metabolism, in particular organic acidemias and the critical importance of the initial stabilization and adequate management of the lives of the affected patients

Design and specific features of the Programme for Early Detection and Follow-Up of Full-Term and Preterm Children, Born Small for Their Gestational Age

In 2007 the International Consensus for Management of Children Born Small for Their Gestational Age (SGA) was published. SGA birth is connected to many complications in different periods of life. Often in practice children born with small sizes are underestimated and not always referred timely to а pediatric endocrinologist. Thеse children represent а significant part of children with growth problems. In our country there is not enough information for the condition and algorithm for its follow-up. Having all this in mind, Varna Pediаtric Endocrine Society (VAPES) and Bulgarian Neonatology Association (BNА) created the Programme for Early Detection and Follow-Up of Full-Term and Pre-Term Children, Born SGA. The current publication presents the design of the study. The Programme is scientifically applied investigation for early detection of full-term and preterm SGA children, aiming to facilitate timely diagnosis of syndromes and conditions connected to SGA births and, if needed, to recommend additional testing, including genetic. Through the Programme we expect to update the data for the prevalence of SGA births and SGA children without postnatal catch-up in our country. At the end of the Programme, we will evaluate its cost-effectiveness and will create an algorithm for detection and treatment of these children

Initial results from the treatment with growth hormone of short, small for gestational age children

Introduction: Growth is important indicator of a child`s health. According to the literature, every year between 3 and 7% children are born with birth length and/or weight less than the 10th percentile for the corresponding gestational age. From those born short for gestational age (SGA), one in every ten children cannot catch up in growth. Recently, these children are defined in the literature as “short, SGA children”. Namely, in those children, especially in those untreated, metabolic and cardiovascular changes can be seen with age. In Bulgaria there is still no reimbursement for growth hormone (GH) treatment of this indication, and treatment is supported by a nation-wide charity (The Bulgarian Christmas).Aim: The aim of this article is to assess patients born SGA, without catch-up growth, regarding the age at start of the treatment, duration and effect of growth hormone treatment.Patients and Methods: Patients’ data was collected retrospectively from the maintained VECRED record. Statistical analysis was conducted by means of the SPSS programme. The most important factors regarding growth hormone treatment efficacy were assessed.Results: Currently at the center there are 43 SGA patients with short stature at an average age of 10.3 ± 7.1 y (1.7–40.1), 26 (60.5%) at an average age of 10.3 ± 4.2 y (3.7–17.3) are treated with growth hormone and 17 (39.5%) are just followed. The average age when the GH treatment was initially started is 6.5 ± 3.7 y (1.4–12.1). The gender distribution of the group is nearly 1:1 (22 boys:21 girls). The most common specific diagnosis is Silver-Russell Syndrome (22, 51.2%), followed by Noonan syndrome (3, 6.9%), Di George Syndrome (2, 4.7%), Lowe syndrome, etc. On the average the treatment duration is 39.3 ± 30.2 months (4–120). From the start of the treatment until the current survey, the height of the patients has increased with 1.23 ± 1.8 SDS.Conclusion: Growth hormone treatment in short SGA children leads to good results and that is why it is currently an accepted standard worldwide. This is also confirmed by the current results