In the near future, the burden of CD will increase tremendously. Few Mediterranean countries are able to face this expanding epidemic alone.

BackgroundThe World Gastroenterology Organization recommends developing national guidelines for the diagnosis of Celiac Disease (CD): hence a profile of the diagnosis of CD in each country is required. We aim to describe a cross-sectional picture of the clinical features and diagnostic facilities in 16 countries of the Mediterranean basin. Since a new ESPGHAN diagnostic protocol was recently published, our secondary aim is to estimate how many cases in the same area could be identified without a small intestinal biopsy.MethodsBy a stratified cross-sectional retrospective study design, we examined clinical, histological and laboratory data from 749 consecutive unselected CD children diagnosed by national referral centers.ResultsThe vast majority of cases were diagnosed before the age of 10 (median: 5 years), affected by diarrhea, weight loss and food refusal, as expected. Only 59 cases (7.8%) did not suffer of major complaints. Tissue transglutaminase (tTG) assay was available, but one-third of centers reported financial constraints in the regular purchase of the assay kits. 252 cases (33.6%) showed tTG values over 10 times the local normal limit. Endomysial antibodies and HLA typing were routinely available in only half of the centers. CD was mainly diagnosed from small intestinal biopsy, available in all centers. Based on these data, only 154/749 cases (20.5%) would have qualified for a diagnosis of CD without a small intestinal biopsy, according to the new ESPGHAN protocol.ConclusionsThis cross-sectional study of CD in the Mediterranean referral centers offers a puzzling picture of the capacities to deal with the emerging epidemic of CD in the area, giving a substantive support to the World Gastroenterology Organization guidelines.

oal: The research was undertaken with the aim to determine the frequency of positive findings of serological tests for celiac disease of the first relatives of children with celiac disease. Materials and methods: The study included 175 first relatives of 68 children suffering from celiac disease. Of that number, 75 (40 mothers and 26 fathers), 4 sisters and five brothers agreed to be tested for the presence of antibodies to celiac disease. For each subject were done tests on presence of anti-gliadin IgA, IgG antigliadin antibodies and IgA antibodies on tissue transglutaminase in the Poly

<p><strong>Aim</strong> <br />To examine and quantify patients’ satisfaction and correlate with the objective clinical presentation after the treatment and to present a comprehensive literature review on tarsoconjunctival/ Hughes flap technique.<br /><strong>Methods</strong> <br />A review of more than 159 peer-review articles and a combined retrospective-prospective two-centres case series of 17<br />patients who underwent a two-stage modified Hughes flap procedure (2019-2021) to repair a lower eyelid defect caused by epithelial cancer was conducted. All patients were followed up for a minimum of six months. Patient macroscopic evaluation of redness, lid position, retraction, trichiasis, conjunctival overgrowth, tissue inflammation/infection and hypertrophic scarring were obtained, and findings were graded on a scale of 1 to 5 or binary YES/NO scale. Patients’ satisfaction using a Likert-type scale and correlation with the clinical presentation were analysed.<br /><strong>Results</strong> <br />Pearson correlation coefficient between patients’ satisfaction and clinical presentation was 0.534. Out of 510 (the highest<br />summed score for patients’ satisfaction), the total score was 479 (93.9%); out of 187 (the highest summed score for clinical presentation), the total score was 162 (86.6%). Although both scores were high, a lower correlation coefficient and the higher satisfaction score can be explained by more realistic expectations in oncological patients compared to cosmetic ones.<br /><strong>Conclusion</strong> <br />Hughes flaps provide multiple benefits in the reconstruction of selected patients with large defects, especially when<br />poor wound healing is expected, or when local advancement flaps do not provide tension-free reconstruction. The rate of complications is low and manageable, whereas additional therapy is usually observational or symptomatic. </p>

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