Bee Honey Consumption Among the Population of Varna

Honey bees produce unique products that provide health and promote human longevity. Honey is the best known and most widely consumed substance produced by bees. The purpose of this study is to assess the role of bee honey for the nutrition of Varna citizens and the level of their awareness about the benefits of honey and bee products. A total of 438 individuals from the town of Varna at an average age of 42,90±10,90 years (range, 27 to 83 years) were recruited. They filled-in a questionnaire about their nutritive habits in regard to honey. Respondents were divided into two age groups - aged up to 40 and above 40 years old. The study shows that people aged over 40 years consume more often honey every day compared to those aged up to 40 years (p<0,05). Besides 20,55% of all the respondents consume honey every day, 13,47% do only in winter and 14,84% - only when they are ill. Only 5,94% of the respondents do not consume honey at all. Over half of the respondents (60,50%) share that they would consume honey more often. In 46,35% of the respondents honey has been used as a sweetener. A total of 32,65% respondents replace sugar with honey always when possible, 50,68% of them do it occasionally only, and 15,30% never do it. People under the age of 40 years hardly replace sugar with honey when possible. Only 33,79% of the respondents consume honey as food. This is more common among subjects aged up to 40 years (p<0,05). In 24,20% of the cases honey is a means for treatment of diseases. The majority of respondents (92,69%) believe that bee products are useful because they are natural, contain essential ingredients for the human body and strengthen the immune system

Nutritional status, macro- and micronutrient deficiency in children with neurodevelopmental disorders

The nutritional status of children with neurodevelopmental disorders (NDDs) has a significant impact on their overall health and quality of life. Most of the scientific research, exploring NDD children`s nutrition, has been dedicated to cerebral palsy (CP) patients who are reported to suffer from malnutrition in 46% - 90% of the cases. The etiology of malnutrition in children with NDD involves many underlying factors and can be contributed to both nutritional and non-nutritional factors. Obesity typically associated with mentally retarded children and children with genetic syndromes (e.g. Down syndrome) is nowadays less frequently observed. The energy needs of children with severe cases of central nervous system disorder differ from the energy requirements of normally developing children. The difference can be largely attributed to the interplay of several factors affecting the basal metabolic rate. The prevalence of malnutrition can induce or worsen respiratory failure as well as secondary immune deficiency, which in turn affects the prognosis of the underlying disease. Macronutrient deficiency in NDD children is commonly accompanied by micronutrient losses of folate, iron, magnesium, vitamin D, essential fatty acids, etc., which are crucial for a number of metabolic pathways. The lacking in any or all macro- and micronutrients may produce symptoms that are difficult to distinguish from the already present neurological disorder. This situation calls for a comprehensive evaluation and nutritional support for NDD children for an improved prognosis and quality of life, considering the current data and knowledge on the problem

Influence of the oral mucosa condition on the nutritional status of children with neurological impairment in Varna

Introduction: The assessment of the causes for malnutrition in children with neurological impairment (NI) in Bulgaria is  challenging due to the heterogeneity of the leading diagnosis. In the case of soreness of the oral mucosa due to inflammatory processes or mechanical irritation, children experience discomfort and this disrupts the normal course of chewing. So far, no association between undernutrition in children with NI and the condition of the oral mucosa has been examined in Bulgaria.Aim: The aim of this article is to evaluate the condition of the oral mucosa and its relationship to the nutritional status of children with NI.Materials and Methods: About 54 patients with NI were recruited for the study, which took place between April and October 2017. Twenty-five of them lived in family settings and 29 in residential care (RC) in Varna, Bulgaria. After briefing all participants (family members and caretakers) about the nature and meaning of the study, they took an informed participation in an intraoral examination of the oral cavity of their children. The nutritional status was assessed by anthropometric measurements. The study was approved by the Medical Ethical Committee of the Medical University of Varna.Results: The examination of the condition of the oral mucosa of children with NI revealed various signs of inflammatory changes of the mucous membranes, showing that among 66% of the recruited patients redness and swelling, lining on the back of the tongue, etc. were observed. There were various inflammatory changes observed in the oral mucosa in 89.28% of the cases who are raised in the RC and 40% in those living in family settings. The differences in the prevalence of inflammatory changes of the oral mucosa between the two groups of patients was statistically significant (X2 = 16.13, p = 0.001). Statistically significant was also the relationship between the oral mucosal status and the status of malnutrition, as estimated by anthropometric indicators such as weight-for-age, height-for-age and subscapular skin fold thickness following the World Health Organization criteria and standards (2006, 2007).Discussion: Many factors affect malnutrition in children with NI. One of the factors is the condition of the oral mucosa. Its improvement would most probably increase the ability of this vulnerable group of children to eat foods of varying composition and consistency, which would have a positive effect on their nutritional status.Conclusion: Our study shows a direct link between inflamed and painful oral mucosa and malnutrition in children with NI.Introduction: The assessment of the causes for malnutrition in children with neurological impairment (NI) in Bulgaria is  challenging due to the heterogeneity of the leading diagnosis. In the case of soreness of the oral mucosa due to inflammatory processes or mechanical irritation, children experience discomfort and this disrupts the normal course of chewing. So far, no association between undernutrition in children with NI and the condition of the oral mucosa has been examined in Bulgaria.Aim: The aim of this article is to evaluate the condition of the oral mucosa and its relationship to the nutritional status of children with NI.Materials and Methods: About 54 patients with NI were recruited for the study, which took place between April and October 2017. Twenty-five of them lived in family settings and 29 in residential care (RC) in Varna, Bulgaria. After briefing all participants (family members and caretakers) about the nature and meaning of the study, they took an informed participation in an intraoral examination of the oral cavity of their children. The nutritional status was assessed by anthropometric measurements. The study was approved by the Medical Ethical Committee of the Medical University of Varna.Results: The examination of the condition of the oral mucosa of children with NI revealed various signs of inflammatory changes of the mucous membranes, showing that among 66% of the recruited patients redness and swelling, lining on the back of the tongue, etc. were observed. There were various inflammatory changes observed in the oral mucosa in 89.28% of the cases who are raised in the RC and 40% in those living in family settings. The differences in the prevalence of inflammatory changes of the oral mucosa between the two groups of patients was statistically significant (X2 = 16.13, p = 0.001). Statistically significant was also the relationship between the oral mucosal status and the status of malnutrition, as estimated by anthropometric indicators such as weight-for-age, height-for-age and subscapular skin fold thickness following the World Health Organization criteria and standards (2006, 2007).Discussion: Many factors affect malnutrition in children with NI. One of the factors is the condition of the oral mucosa. Its improvement would most probably increase the ability of this vulnerable group of children to eat foods of varying composition and consistency, which would have a positive effect on their nutritional status.Conclusion: Our study shows a direct link between inflamed and painful oral mucosa and malnutrition in children with NI.

Study of breastfeeding practices in Varna region

Правилното хранене на детето в неонаталния и кърмаческия период е предпоставка за нормално физическо и нервно-психическо развитие с възможни дълготрайни здравни ефекти. Цел: Целта на проведеното проучване е да се оценят практиките на кърмене във Варненска област. Материали и методи: През месеците май-септември 2013 г. е проведено транзверзално проучване за честотата и практиките на кърмене във Варненска област. Анкетирани на случаен принцип са 286 жени на средна възраст 33 год. ( 3,3) (от 18 до 42 год.) за начина на хранене на децата им от раждането до края на третата година. Данните са обработени статистически чрез вариационен и алтернативен анализ и сравнени с критерия на Стюдънт-Фишер при ниво на значимост p< 0,05. Резултати: Резултатите от нашето проучване показват, че бебетата са поставени на гърда средно на 17,7 ми час след раждането (от 1ви до 192 ри час). Родилите със секцио жени са започнали да кърмят средно на 26 ти час (1 ви - 192 ри) след раждането, докато родилите по нормален път - средно на 10 ти час (от 1ви до 72 ри час) (p< 0,05) . Жените с висше образование кърмят по-продължително в сравнение с тези със средно образование (9,19% vs 6,04%) (p< 0,05). Едва 4,5% от децата (n=4) са кърмени до 24 месеца. Обсъждане: Участниците в нашата анкета започват да кърмят късно след раждането. Продължителността на кърмене на децата е малка и не отговаря на съвременните препоръки на СЗО, но се наблюдават положителни тенденции в сравнение с предишни проучвания.Optimal nutrition of the child in the neonatal period and infancy is a prerequisite for normal physical and neuro-psychological development and for possible long-term health effects. Our study was aimed at revealing breastfeeding practices in the first couple of years of children`s life. Aim of the study: The aim of this study is to assess the breastfeeding practices in Varna region. Materials and Methods: A transverse study of breastfeeding practices is conducted over a period of 5 months- May - September 2013 in Varna region. A total of 286 questionnaires are administered for the study period. Women (mean age of the respondents was 33 years 3.3) who have born their children with cesaerian section or had vaginal delivery are radomly recruited after obtaining informed consent for inclusion in the study. Questionnaires include questions regarding the nutrition of children from birth until the end of the third year. The data is processed statistically by means of variation and alternative analysis and compared with the criterion Student-Fisher at significance level

Mortality in childhood-onset type 1 diabetes

It is well-recognized that diabetes-related complications are the leading cause of the still increased morbidity and mortality from diabetes and exert a heavy economic burden on society. The discovery of insulin led to a dramatic change in life expectancy of patients with type 1 diabetes (T1D). Furthermore, it caused a major shift in the distribution of causes of death - from diabetic coma in the pre-insulin era, to long-term complications being the predominant causes of death nowadays. The aim of the present review is to assess the trends in the absolute and the relative mortality rates as well as the leading causes of death among patients with childhood-onset (< 18 years) T1D in populations from different latitudes. It is also observed how disease duration, age at diagnosis, and year of diagnosis affect these mortality trends. Eight population-based studies published in English in the last 14 years, as well as another one, published in 2001, with different duration of follow-up, are included in the review. However, it is hard to compare different populations due to the dissimilarities in the study methods and the characteristics of the examined cohorts

Bone mineral density and its determinants in long-term childhood Hodgkin's lymphoma survivors - a pilot study

Aim: The purpose of this study is to evaluate bone mineral density (BMD) and its determinants in long-term survivors of childhood Hodgkin`s lymphoma (HL), treated and followed up in a single center.Methods: We compared 18 long-term survivors between 18 and 34 years of age (mean age 26.2 ± 3.9 yrs), to 25 age- and sex-matched controls and assessed their anthropometric features and biochemical and hormonal parameters. The participants` BMD, BMD Z-scores and young-adult T-scores, bone mineral content (BMC), fat mass (FM), lean mass (LM) and appendicular lean mass (ALM) were measured by whole body Dual-energy X-ray absorptiometry (DEXA). Their physical activity (PA) was assessed through the means of questionnaires and semi-structured interviews.Results: An average of 12.3 ± 3.2 yrs after treatment completion, HL survivors had lower BMD Z-scores and BMD young-adult T-scores (-0.03 ± 1.07 vs 0.69 ± 1.19, р = 0.04 and -0.20 ± 0.92 vs 0.48 ± 1.27, р = 0.07, respectively). Hypergonadotropic hypogonadism was found in 54.5% of male survivors, and 3 out of 7 female survivors presented with thyroid dysfunction. No participant had SDSBMD lower than -2. The frequency rate of BMD Z-scores < -1 among survivors was 16.7% (3/18). All HL survivors with a BMD Z-score < -1 were males. They were treated with more intensive therapy (n=3) and 2 of them presented with treatment-induced hypogonadism. Compared to controls, survivors, especially women, exhibited lower physical sports activity frequency and duration (1.6 ± 2.1 vs 3.7 ± 3.4/week, p = 0.02 and 90 ± 127 vs 279 ± 419 min/week, p = 0.06). BMD positively correlated with LM, ALM and physical activity parameters. Lean mass, older age at diagnosis and the dose of the radiotherapy delivered during treatment were all independent predictors of BMD in HL survivors.Conclusion: Compared to controls, long-term childhood HL survivors have lower BMD Z-scores and BMD T-scores at an age close to their individual bone mass peak. Males treated with intensive therapy present with deteriorated bone health in the context of therapy-induced hypogonadism and low physical activity. The timely detection of low BMD, treating hormonal dysfunctions and increasing PA are effective means to preventing and delaying late morbidity

USE OF THE PROBIOTIC Lactobacillus reuteri DSM 17938 IN THE PREVENTION OF ANTIBIOTIC-ASSOCIATED INFECTIONS IN HOSPITALIZED BULGARIAN CHILDREN: A RANDOMIZED, CONTROLLED TRIAL

Objective: To evaluate the effectiveness of Lactobacillus reuteri DSM 17938 for the prevention of antibiotic-associated diarrhoea and Clostridium difficile-related infections in hospitalized children in a Bulgarian hospital. Study design: Children (n=100, aged 3 to 12 years) admitted to the hospital for acute infections were enrolled in a randomized, double- blind, placebo-controlled trial. They were assigned to receive either a probiotic supplement containing 1 x 108 CFU Lactobacillus reuteri DSM 17938 in the form of one chewable tablet once per day (n=49) (BioGaia AB, Stockholm, Sweden) or placebo (n=48). The probiotic or placebo was taken 2 hours after lunch each day, during the entire period of antibiotic treatment at the hospital and for additional 7 days. Results: Data from 97 children were included in the final analysis. The incidence of diarrhoea (defined as at least 3 loose or watery stools per day in a 48-hour period that occurred during or up to 21 days after cessation of antibiotic treatment) was unexpectedly low in both groups - L. reuteri (n=1) versus placebo (n=1): 2,04 vs. 2,1 per 100 (p>0,05, risk ratio 1,02, 95% CI 0,7-1,4). L reuteri DSM 17938 did not significantly affect the incidence or severity of AAD diarrhoea and Clostridium difficile infection. We found unusually high colonisation rate of non-symptomatic C. difficile measured by toxin-specific ELISA. There was no difference between the probiotic and placebo groups for any of the other secondary outcomes (i.e., incidence of mild diarrhoea, frequency of stool samples positive for C. difficile toxin A and B at the beginning and at the end of study period, frequencies of other gastrointestinal symptoms in the same study period) (p<0,05). No adverse events were reported. Conclusion: Due to the low incidence of antibiotic-associated diarrhoea in both groups, no conclusion can be made on the efficacy of L. reuteri DSM 17938 on AAD in hospitalized Bulgarian children. The probiotic did not affect the non-symptomatic high rate of C. difficile colonisation (33.3% in the placebo and 38.8% in the L. reuteri group at baseline) in this population. There was also no difference between groups regarding different gastrointestinal side effects

Wilson disease - clinical findings and diagnosis in children and adolescents

Wilson disease (WD) is an uncommon autosomal recessive condition of impared hepatic copper excretion, resulting in excessive amounts of body copper. Study's aim was to reveal the clinical findings, diagnosis and treatment of WD in children. In 1987-06 the diagnosis was proved in 21 pts. (3-17y.) (10 M. and 11 F.) by clinical, laboratory (+specific), neurologic, ultrasonographic, and/or genetic and MRI investigation. Eighteen of these children were with hepatic dysfunction: fatigue (17/18), abdominal pain (16/18), jaudice (12/18), oedema (6/18), ascites (17/18), hepatomegaly (18/18); elevated aminotrasnferases (18/18), decreased prothrombin time (16/186) & serum albumin (14/18) & cholesterol (5/18). Neurologic manifestations were presented in 3 adolescents: asterixis (3/3), dysarthria (2/3), dysphagia (1/3), rigidity (1/3), choreic movement (1/3) with minimal changes in hepatic function (increased aminotransferases). Twenty of pts. had Kayser-Flaisher corneal ring. Specific examinations showed: decreased ceruloplasmin (19/21), decreased serum copper (16/21), increased urinary excretion of copper for 24h. (21/21). Test with 1.0 D penicillamine provocated the elevation of urinary excretion of copper from 10-20 times. In 15/18 pts. themutation in ATP 7B gene is proved. Ultrasound imaged portal hypertensia in 15/21 pts., ascites in 3/8, hepatomegaly in 19/21. MRI showed changes in the basal ganglia in 1 of the pts. with neurologic symptoms. In conclusion the diagnosis of WD is difficult because of the variable clinical manifestation and laboratory tests. In children and adolescents with unclear hepatic and/or neurologic symptoms copper metabolism and molecular genetic analysis should be examined.Scripta Scientifica Medica 2009; 41(2): 141-145

ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis

BACKGROUND: Malnutrition is both a frequent feature and a comorbidity of cystic fibrosis (CF), with nutritional status strongly associated with pulmonary function and survival. Nutritional management is therefore standard of care in CF patients. ESPEN, ESPGHAN and ECFS recommended guidelines to cover nutritional management of patients with CF. METHODS: The guidelines were developed by an international multidisciplinary working group in accordance with officially accepted standards. The GRADE system was used for determining grades of evidence and strength of recommendation. Statements were discussed, submitted to Delphi rounds, reviewed by ESPGHAN and ECFS and accepted in an online survey among ESPEN members. RESULTS: The Working Group recommends that initiation of nutritional management should begin as early as possible after diagnosis, with subsequent regular follow up and patient/family education. Exclusive breast feeding is recommended but if not possible a regular formula is to be used. Energy intake should be adapted to achieve normal weight and height for age. When indicated, pancreatic enzyme and fat soluble vitamin treatment should be introduced early and monitored regularly. Pancreatic sufficient patients should have an annual assessment including fecal pancreatic elastase measurement. Sodium supplementation is recommended and a urinary sodium:creatinine ratio should be measured, corresponding to the fractional excretion of sodium. If iron deficiency is suspected, the underlying inflammation should be addressed. Glucose tolerance testing should be introduced at 10 years of age. Bone mineral density examination should be performed from age 8-10 years. Oral nutritional supplements followed by polymeric enteral tube feeding are recommended when growth or nutritional status is impaired. Zinc supplementation may be considered according to the clinical situation. Further studies are required before essential fatty acids, anti-osteoporotic agents, growth hormone, appetite stimulants and probiotics can be recommended. CONCLUSION: Nutritional care and support should be an integral part of management of CF. Obtaining a normal growth pattern in children and maintaining an adequate nutritional status in adults are major goals of multidisciplinary cystic fibrosis centers