Background:Serum amyloid A (SAA) protein is a major acute phase protein. Increased concentrations have been reported in many inflammatory diseases. In bacterial infections, high levels correlate with those of C-reactive protein (CRP). In viral infections, where CRP changes are weaker, SAA is of value for establishing early diagnosis, monitoring the severity, and the evolution of the disease.Objective:Evaluation of SAA as a marker for diagnosis of infectious mononucleosis, including severe forms.Material and methods:A total of 31 patients with non-complicated and severe, complicated infectious mononucleosis were examined. SAA and CRP were measured by immuniturbidimetric assays at the day of admission and 4.97 ± 1.35 days later.Results:SAA increases significantly than those in a control group, without correlation with the etiologic agent. It decreases when full recovery appears. In the subgroup of subjects with complications, we observed significant increased SAA when Epstein-Barr virus /EBV/ was the etiologic agent, in the course of bacterial and viral secondary infection. SAA is higher than CRP in non-complicated group. In cases of bacterial superinfections, both increase simultaneously and treatment have to be adapted. Second, serum sample for CRP is normal in patients without full recovery where SAA stay increased.Conclusion:In viral infections, high SAA concentrations are indicative for early diagnosis, severe course of the diseases, effect of the treatment, early recovery, and disease outcome. When SAA and CRP increase simultaneously, bacterial co-infection is suspected, and relevant antibiotic treatments have to be initiated.

Background: Medical nutrition therapy is essential for all people with diabetes, of any type or severity. Compliance with the recommended nutrition is an integral part of the treatment of type 1 diabetes (T1D). It remains unclear to what extent the dietary intake of patients with type 1 diabetes adheres to the recommendations for healthy eating.Objective: The primary aim of our study is to collect and analyze published articles on the nutrition of T1D patients in comparison with the general population and recommendations.Research Strategy and Methods: A literature search for articles, published between January 2006 and July 2021 was conducted, using electronic databases (PubMed and Google Scholar) for all available publications in English and Bulgarian. The process of study selection, identification, screening, eligibility and inclusion followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations for a flowchart. Based on the keywords search, 425 titles were retrieved, of which 27 were selected based on title and abstract. All papers were crosschecked and reviewed for selection by 3 independent reviewers. As a result, 19 titles were eligible and met inclusion criteria for a full review.Results: Energy intake tends to be lower in T1D patients or comparable to controls and in most cases within the general recommendations. The percentage of calories from protein is within the recommendations for children, adolescents and adults. Only two studies showed that T1D patients consume significantly less than the recommendation for total fat intake (<35E%). The median intake of carbohydrates is in the lower end of the recommended 45 to 60E%. The median intake of dietary fiber adjusted for total energy is too low for T1D patients and the general population.Conclusion: Study findings suggested a lack of knowledge or misunderstanding of diabetes dietary management. Patients with T1D, who are being consulted with a dietician as a part of their treatment plan may have better compliance to their recommended diet and as a result, are likely to have better health outcomes. Nutritional therapy should focus not only on glycemic control and pure carbohydrate counting but also on healthy eating and complication prevention.

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: Type 1 diabetes mellitus (T1DM) is a chronic disease which starts early in life and often leads to micro- and macrovascular complications. The incidence of the disease is lower than that of type 2 DM and varies in different countries and ethnical groups, and the etiological and pathogenetic factors are different from T2DM. The aim of this overview is to investigate the effect of T1DM on all-cause mortality and CVD morbidity and mortality. During the last decades the treatment of T1DM has improved the prognosis of the patients. Still, the mortality rates are higher than those of the age- and sex-matched general population. With the prolonged survival, the macrovascular complications and the cardiovascular diseases (CVD) appear as major health problems in the management of patients with T1DM. The studies on the CVD morbidity and mortality in this disease group are sparse but they reveal that T1DM is associated with at least 30% higher mortality. In comparison to healthy people, CVD are more common in T1DM patients and they occur earlier in life. Furthermore, they are a major cause for death and impaired quality of life in T1DM patients. The correlation with the diabetic control and the duration of T1DM is not always present or is insignificant. Nevertheless, the early detection of the preclinical stages of the diseases and the risk factors for their development is important and the efforts to improve the glycemic and metabolic control are of paramount importance.

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

INTRODUCTION: Acute phase response represents an increase in hepatic production of the so-called acute phase proteins (APP). Until now, C-reactive protein (CRP) has routinely been measured as an indication of bacterial infections. Serum amyloid A (SAA) is a novel marker. It is a more conservative protein for viral etiology of the disease. We analyzed the dynamic changes of SAA and CRP during influenza infection and evaluated the role of SAA as a significant marker for viral infections. MATERIALS AND METHODS: We studied 31 patients with clinically suspected and serologically proved influenza, hospitalized in the Department of Infectious Diseases at St. Marina University Hospital, Varna. Serum levels of SAA and CRP were measured on admission and 4.23±1.03 days later by immunoturbidimetric assays, adapted on Olympus AU 400. RESULTS: The mean serum concentrations of SAA during the acute stage were 168.92 mg/L and those of CRP were 48.08 mg/L. In the group of bacterial complications, such as bronchitis, sinusitis and otitis media, the SAA levels were 5-to 9-fold greater than CRP. Analyses of the second measurement showed a tendency of serum SAA to disappear more quickly than CRP-52.11 mg/L vs. 16.71 mg/L. CONCLUSION: SAA is more sensitive APP than CRP in viral infection settings. In cases of bacterial superinfections, serum SAA is more predominant than CRP, indicating the necessity of an antibiotic therapy. Prompt downgrading of SAA in sera correlates with auspicious prognosis could be used as an effective treatment monitoring.

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INTRODUCTION:Evidence associates obesity with glomerular hyperfiltration. Concurrent inflammation, hypertension, dyslipidemia, and insulin resistance represent further established risks to renal health in both children and adults. Our aim was to investigate the relationship between childhood obesity and the risk of renal impairment.