Paediatric endocrinology - prospectives and near future

It is my greatest pleasure to introduce the papers devoted to Paediatric Endocrinology, coming in the current issue of Scripta Scientifica Medica!Paediatric Endocrinology is a relatively new but quickly and steadily developing paediatric subspecialty. While it is still unrecognized in some European countries, Paediatric Endocrinology was officially introduced in Bulgaria 20 years ago (in 1995). Even before that, many renowned paediatricians developed both endocrinology and diabetology and put the foundation for further development (professors Zhelev, Damyanova, Stanchev and others). In the 80s Prof. Lilia Peneva was the first Bulgarian paediatrician who officially joined the European Society of Paediatric Endocrinology (ESPE) and paved the way for efficient participation in the life of the biggest professional paediatric endocrine society nowadays. Since then many colleagues joined efforts in improving care for children with short stature, diabetes, rare endocrine and metabolic diseases and scientific potential grew in parallel. In 2010 the Varna Paediatric Endocrine Society (VAPES) was registered, and a year later - the Bulgarian National Society of Paediatric Endocrinology (BNSDE). Many causes have been raised and many problems solved, especially in day care. Both BNSPE and VAPES endorse the ESPE Training Syllabus (https://www.eurospe.org/education/education_training.html), and the quality and knowledge of trainees is improving constantly. This brings new successful researchers in the field, and gradually increases the number of publications in respected international journals. A good appraisal of the merit of the discipline`s development is the attraction of World renowned speakers to the annual meetings of both VAPES (www.vapesbg.org) and BNSPE (www.bnsde.org)

Growth hormone deficiency and multiple Enchondromatosis (Ollier disease) in a boy with short stature

We present a boy diagnosed and treated with growth hormone (GH) for isolated GH deficiency. During 2 year follow up he did not catch up in both height and weight. Although there was no skeletal disproportionality, nor any other complaints, his walk began changing and lower limbs deformity appeared (genua vara). Extensive skeletal radiological survey found multiple enchondromatosis (knees, iliac bones) and Ollier disease was diagnosed. There is no specific treatment for this condition, but its presence questions future GH therapy. The poor response to growth hormone treatment and the risk of developing malignant transformation in the future raises the important questions of the real benefits and the possible harms of its maintenance

Preschool children - obesity and risk behaviours. Trends from 2009 to 2013

In the beginning of 2011, according to WHO more than 40 million children under 5 years are overweight, and over 30 million of them live in developing countries. In Bulgaria Iotova et. al. (2009) reported an increased incidence of obesity in 9-year old girls from 4.3% to 10.4% over a period of 5 years (2002-2007).Aim: To determine the incidence of overweight and general and abdominal obesity in preschool children, and also some risk behaviors and their trend over 2009.Participants and methods: height, weight and WC were measured of a total of 117 children aged 4,53±0.29 years that were attending kindergartens in Varna. BMI (kg/m2) was calculated and compared with the IOTF references for the corresponding age and sex. The comparison was made with a group of 189 children from Varna, of the same age (mean age 4,58±0,31 years), measured by the same methods in 2009. Res ults : When comparing the two groups there was a significant reduction in WC (p=0.022). In 2009 OW/ obese were 12.7% of the children and significantly increased to 19.7% in 2013 (p=0.01). There is a decrease in the proportion of obese children (from 4.2% to 0.9%) and an increase in those who were overweight (from 8.5% to 18.8%).Conclusion: Reducing the percentage of obese children in this young age most likely reflects a positive trend in the attitude towards obesity. Increasing percentage of overweight children who are potential pool of increasing obesity with age, requires serious attention in the prevention of obesity

The ESPE e-learning webportal: A global tool for instruction and formative assessment of pediatric endocrinology

The ESPE e-learning portal (http://www.espe-elearning.org) aims at supporting the learning of cognitive objectives, competencies and skills at two levels: core (medical students) and advanced (fellow/postdoc). It provides a rich source of up-to-date information on various Pediatric Endocrinology topics. The ESPE elearning webportal offers a set of functionalities consisting of a general learning content (chapters, problem solving cases, self-tests, glossary, community) and the option to construct specific courses for an event (ESPE school) or organization: a client, university or institution. Moreover, a set of question types has been developed allowing scoring and assessment of competencies. The content is being expanded and includes chapters and/or cases on the topics of growth, puberty, DSD, calcium and bone, diabetes, hyperinsulinism, thyroidal disorders, adrenal disorders, dis-electrolytemia. Since the portal has been moved to its definite address the global use of the portal has increased: during the period September - December 2013 there were 1264 visits; during the period January-April 2014 there were 2393 visits. The availability of the portal for members and non-members of ESPE needs to be emphasized and needs to be made public widely. Moreover, relevant feedback from users should be translated by the editorial board to make practical improvements. As demonstrated during two courses held in Varna, Bulgaria the portal facilitates the combination of online learning and face-to-face instruction: blended learning. Finally, the next step in extending the impact of the e-learning portal is the further development of learning and competency assessment tools. Furthermore, in demonstrating its applicability at a global level, regional and cultural aspects should be fully recognized

Association between vitamin D status and obesity in Bulgarian pre-pubertal children: a pilot study

Background: It is considered that obesity and metabolic syndrome are accompanied with vitamin D deficiency. We aimed to examine the interrelations between vitamin D status and biomarkers for metabolic syndrome in Bulgarian pre-pubertal children.Methods: The study enrolled 51 pre-pubertal children (29 boys, 22 girls) examined for serum 25-xydroxyvitamin D, and routine parameters for metabolic syndrome. Obesity was evaluated by body mass index and waist circumference.Results: More than half (57.1%) of the studied children were vitamin D deficient, prevalent in girls than in boys (65.0% vs. 51.7% respectively). A tendency for worse metabolic status in the vitamin D-deficient group, expressed by higher fasting insulin, total cholesterol, total cholesterol/HDL-ratio and Homeostasis Model Assessment (HOMA)-index was observed. A trend for negative correlation was established between 25-xydroxyvitamin D and waist circumference, HOMA-index, and fasting insulin.Conclusions: Vitamin D deficiency and inverse relationships between 25-xydroxyvitamin D and waist circumference, HOMA-index, and insulin were found amongst studied children

Adiponectin, some markers of metabolic risk and abdominal obesity in preschool age

Всички проучвания на Балканския полуостров през последното десетилетие откриват нарастваща честота на затлъстяването. Абдоминалното затлъстяване се смята за по-морбидно поради по-високата метаболитна активност на абдоминалната мастна маса, характеризираща се с нискостепенно хронично възпаление.ЦЕЛ: Да се установи връзка между мастната маса (ММ) и някои метаболитни маркери в предучилищна възраст.УЧАСТНИЦИ И МЕТОДИ: Измерени са ръст, тегло и коремна обиколка (KO) на 40 здрави деца от област Варна на средна възраст 5,31 години (4-7 год.), разпределени като нормални, с наднормено тегло и със затлъстяване чрез ИТМ и CDC референтни стойности в зависимост от пола и възрастта. Биохимичните изследвания са взети след 12 ч. нощен глад. Поставени са педометри за определяне нивото на физическа активност (ФА). С цел валидизиране на абдоминалното затлъстяване се проведе DXA изследване заколичество MM.РЕЗУЛТАТИ: Със затлъстяване са 17,5% от участниците, като само 9,7% от всички покриват минималните препоръки за двигателна активност през седмицата и 16,1% през почивните дни. ММ (ср. кг) корелира сигнификантно с ИТМ и KO (р<0,001), a от метаболитните маркери корелира с hsCRP (r=0,533; p=0,04), както и с повишените нива на общ холестерол (r=0,458; р=0,016). Открива се значима връзка между серумния лептин и ИТМ, KO, ММ (р<0,001), както и с общия холестерол (r=0,482; р=0,008) и ниските нива на LDL-холестерол (r=0,434; р=0,019). Нивата на серумен адипонектин корелират обратнопропорционално с теглото (r=-0,415, p=0,025), при контролиране за ФА и с КО (r=-0,437; p=0,042).ЗАКЛЮЧЕНИЕ: Настоящото проучване открива значима връзка между коремната обиколка, мастната маса и утвърдени маркери за метаболитен риск при здрави деца дори в тази ранна възраст.All the studies in the Balkan countries, over the last decade, found an increasing incidence of obesity. Abdominal obesity is considered with higher morbidity,due to the higher metabolic activity of the abdominal fat mass, which is characterized by low-level chronic inflammation.OBJECTIVE: to establish a link between (abdominal) fat mass and some metabolic markers in preschool age.PARTICIPANTS AND METHODS: height, weight and waist circumference (WC) of 40 healthy children living in Varna district were measured, mean age 5.31 years (4-7 yr.). Normal weight, overweight and (abdominal) obesity was defined by BMI and CDC reference values according to sex and age. Biochemical tests were taken after 12 hours of overnight fasting. Children wore pedometers to measure physical activity. In order to determine and validate the abdominal obesity a DXA study was performed.RESULTS: With obesity were 17.5% of respondents, and only 9.7% of all meet the minimum recommendations for physical activity during the week and 16.1% at weekends. Fat mass correlated significantly with BMI and WC (p <0.001), and of metabolic markers it correlated with hsCRP (r=0,533, p=0,04), as well as with elevated cholesterol levels (r=0,458, р=0,016). A significant correlation between serum leptin and BMI, WC, fat mass (p<0.001), as well as total cholesterol (r=0,482, р=0,008) and lower levels of LDL-cholesterol (r=0,434, р=0,019) was found. Levels of serum adiponectin correlated inversely with weight (r=-0,415, p=0,025), when controlling for the level of physical activity with WC too (r=-0,437, p=0,042).CONCLUSION: This study found a significant association between waist circumference, fat mass and established metabolic risk markers in healthy children even at this early age

Advantages from “do-it-yourself” loops among children and adolescents in Varna’s Diabetes Center

Introduction: In the last 5 years, the use of automatic insulin delivery systems has been increasing among patients with type 1 diabetes mellitus (T1DM). It has been shown that they improve metabolic control, decrease the time spent in hypoglycemia and the number of episodes of nocturnal hypoglycemia; increase the time spent in target and are feasible and safe.Aim: Our aim is to evaluate the glycemic control in children/adolescents using do-it-yourself (DIY) regulatory unapproved insulin-delivery loops vs sensor-augmented pump therapy (SAP).Materials and Methods: A total of 43 families with child/children with T1DM on pump treatment and continuous use of continuous glucose monitoring (CGM) were invited to participate in the study; 31 (72.1%) of the families accepted. The children were followed for 6 months, a total of 196 patient months.Results: The study group consisted of 31 children with T1DM, 24 (77.4%) of them were on SAP, and 7 (22.6%) used DIY loops. No differences were observed in regard to age, duration of diabetes, and daily insulin dose between groups. Patients on DIY loops spent significantly more time in range (83.0 vs 68.8%, p=0.02), less time in hyperglycemia above 14 mmol/L (2.1 vs 8.6%, p=0.02). They had significantly better HbA1c at the 6th month (6.5 vs 7.2%, p=0.006) vs SAP patients for the follow-up period. No severe hypoglycemia and diabetic ketoacidosis (DKA) occurred. There were no gender differences between and within both groups.Conclusion: DIY unregistered loop systems showed promising results for better metabolic control at least in terms of mean blood glucose levels (BGLs) and without increasing the risk of severe hypoglycemia and DKA. Further impact e. g. mean insulin dose, long-term efficacy, consumed fat/protein in the daily diets, etc., remains to be studied in future larger and longer studies

Adiponectin, some markers of metabolic risk and abdominal obesity in preschool age

Всички проучвания на Балканския полуостров през последното десетилетие откриват нарастваща честота на затлъстяването. Абдоминалното затлъстяване се смята за по-морбидно поради по-високата метаболитна активност на абдоминалната мастна маса, характеризираща се с нискостепенно хронично възпаление. Цел: Да се установи връзка между мастната маса (ММ) и някои метаболитни маркери в предучилищна възраст.Участници и методи: Измерени са ръст, тегло и коремна обиколка (KO) на 40 здрави деца от област Варна на средна възраст 5,31 години (4-7 год.), разпределени като нормални, с наднормено тегло и със затлъстяване чрез ИТМ и CDC референтни стойности в зависимост от пола и възрастта. Биохимичните изследвания са взети след 12 ч. нощен глад. Поставени са педометри за определяне нивото на физическа активност (ФА). С цел валидизиране на абдоминалното затлъстяване се проведе DXA изследване за количество MM.Резултати: Със затлъстяване са 17,5% от участниците, като само 9,7% от всички покриват минималните препоръки за двигателна активност през седмицата и 16,1% през почивните дни. ММ (ср. кг) корелира сигнификантно с ИТМ и KO (р<0,001), a от метаболитните маркери корелира с hsCRP (r=0,533; p=0,04), както и с повишените нива на общ холестерол (r=0,458; p=0,016). Открива се значима връзка между серумния лептин и ИТМ, KO, ММ (р<0,001), както и с общия холестерол (r=0,482; p=0,008) и ниските нива на LDL-холестерол (r=0,434; p=0,019). Нивата на серумен адипонектин корелират обратнопропорционално с теглото (r=-0,415, p=0,025), при контролиране за ФА и с КО (r=0,437; p=0,042).Заключение: Настоящото проучване открива значима връзка между коремната обиколка, мастната маса и утвърдени маркери за метаболитен риск при здрави деца дори в тази ранна възраст.All the studies in the Balkan countries, over the last decade, found an increasing incidence of obesity. Abdominal obesity is considered with higher morbidity, due to the higher metabolic activity of the abdominal fat mass, which is characterized by low-level chronic inflammation.Objective: to establish a link between (abdominal) fat mass and some metabolic markers in preschool age. Participants and methods: height, weight and waist circumference (WC) of 40 healthy children living in Varna district were measured, mean age 5.31 years (4-7 yr.). Normal weight, overweight and (abdominal) obesity was defined by BMI and CDC reference values according to sex and age. Biochemical tests were taken after 12 hours of overnight fasting. Children wore pedometers to measure physical activity. In order to determine and validate the abdominal obesity a DXA study was performed. Results: With obesity were 17.5% of respondents, and only 9.7% of all meet the minimum recommendations for physical activity during the week and 16.1% at weekends. Fat mass correlated significantly with BMI and WC (p <0.001), and of metabolic markers it correlated with hsCRP (r=0,533, p=0,04), as well as with elevated cholesterol levels (r=0,458, p=0,016). A significant correlation between serum leptin and BMI, WC, fat mass (p<0.001), as well as total cholesterol (r=0,482, p=0,008) and lower levels of LDL-cholester ol (r=0,434, p=0,019) was found. Levels of serum adiponectin correlated inversely with weight (r=-0,415, p=0,025), when controlling for the level of physical activity with WC too (r=-0,437, p=0,042).Conclusion: This study found a significant association between waist circumference, fat mass and established metabolic risk markers in healthy children even at this early age. Keywords: metabolic risk, adiponectin, abdominal obesity, preschoolers