Celiac disease is a major public health problem worldwide. Although initially it was reported from countries with predominant Caucasian populations, it now has been reported from other parts of the world. The exact global prevalence of celiac disease is not known. We conducted a systematic review and meta-analysis to estimate the global prevalence of celiac disease.We searched Medline, PubMed, and EMBASE for the keywords celiac disease, celiac, celiac disease, tissue transglutaminase antibody, anti-endomysium antibody, endomysial antibody, and prevalence for studies published from January 1991 through March 2016. Each article was cross-referenced with the words Asia, Europe, Africa, South America, North America, and Australia. The diagnosis of celiac disease was based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. Of 3843 articles, 96 articles were included in the final analysis.The pooled global prevalence of celiac disease was 1.4% (95% confidence interval, 1.1%–1.7%) in 275,818 individuals, based on positive results from tests for anti–tissue transglutaminase and/or anti-endomysial antibodies (called seroprevalence). The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% (95% confidence interval, 0.5%–0.9%) in 138,792 individuals. The prevalence values for celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was higher in female vs male individuals (0.6% vs 0.4%; P < .001). The prevalence of celiac disease was significantly greater in children than adults (0.9% vs 0.5%; P < .001).In a systematic review and meta-analysis, we found celiac disease to be reported worldwide. The prevalence of celiac disease based on serologic test results is 1.4% and based on biopsy results is 0.7%. The prevalence of celiac disease varies with sex, age, and location. There is a need for population-based prevalence studies in many countries.

Cette observation rapporte l’histoire clinique d’un homme de 58 ans, ayant contracté une infection à chikungunya à La Réunion en mars 2006. S’agissant d’une forme compliquée de méningo-encéphalite et de polyradiculonévrite, il a été décidé un rapatriement dans la région parisienne. Il s’agit d’un cas unique dans notre expérience de médecin Physique et de Réadaptation. À cet égard, nous rapportons son bilan clinique, les principes de sa prise en charge et son évolution à court et moyen termes. À l’issue de cette observation, nous élucidons les quelques données de la littérature qui s’adressent à cette pathologie.

La survenue d’un ou plusieurs épisodes d’anémies au cours de la vie d’un individu est quasiment une constante. Parfois inaperçus, parfois symptomatiques ils sont rarement sévères. Des mécanismes très divers peuvent être impliqués. Souvent la cause de l’anémie est évidente, parfois des explorations sont nécessaires pour en déceler la cause. Lors de la prise de médicaments cette cause peut être suspectée. L’étude de l’hémogramme et surtout l’évolution des constantes érythrocytaires au fil du temps permet en général d’identifier le mécanisme en cause et surtout d’en dater l’évolution. Chez les patients polymédicamentés, donc souvent porteurs de plusieurs pathologies intriquées, il peut parfois s’avérer extrêmement difficile d’identifier la cause de l’anémie. Connaître les causes médicamenteuses d’anémie et leur mécanisme permet dans certains cas d’éviter des explorations inutiles. L’auteur envisage de façon exhaustive les anémies d’origine médicamenteuse : anémie aiguë hémorragique, anémie par dilution ou par expansion plasmatique, spoliation chronique, anémie par carence, anémie par blocage de la multiplication cellulaire, anémie par inhibition de l’érythropoïétine, anémie par atteinte immuno-allergique de la cellule souche hématopoïétique, anémie hémolytique immuno-allergique, anémie hémolytique corpusculaire, anémie mécanique.The onset of one or several episodes of anemia during the course of an individual's lifetime is highly common. At times undetected, at other times symptomatic, these episodes are rarely severe. Highly diverse mechanisms can be involved. Often the cause of anemia is obvious; sometimes explorations are needed to detect the cause. When a patient is taking medications, this cause should be suspected. The hemogram, particularly the changes in erythrocyte constants over time, can generally identify the causal mechanism and identify when these changes began. In patients taking several medications, who often have several interconnected pathologies, it can sometimes be extremely difficult to identify the cause of anemia. Knowing these causes related to medications and their mechanism can in some cases rule out unnecessary tests. The article provides an exhaustive review of anemia caused by medications: acute hemorrhagic anemia, anemia caused by plasma volume dilution or expansion, chronic depletion, deficiency anemia, anemia resulting from blockage of cell multiplication, anemia caused by inhibition of erythropoietin, anemia caused by hemapoietic stem cell immunoallergic reaction, hemolytic anemia of the hemapoietic stem cell, immune hemolytic anemia, corpuscular hemolytic anemia, mechanical anemia.

Gastrointestinal tuberculosis is a rare form of extrapulmonary tuberculosis and its diagnosis can be difficult.Aims - To analyze the diagnostic and therapeutic characteristics of gastrointestinal tuberculosisMethods - Retrospective study from 17 cases collected in 4 hospitals in Seine Saint-Denis between 1987 and 2002.Results - Seventeen cases and 19 localizations were collected: small intestine (N = 7), ileocecum (N = 6), colon (N = 4) and gastroduodenum (N = 2). Two patients had two localizations. Mean age was 43.9 years. Subjects from immigrant populations (76.5%) were preferentially affected. Twenty-three percent of patients (13 tested) were infected by human immunodeficiency virus. Weight-loss and general weakness (88%), abdominal pain (88%), fever (59%), nausea/vomiting (53%) were the predominant symptoms. The delay in diagnosis was 82 days (range: 7-180) and time before specific treatment 31.6 days (range: 7-90). Histological evidence of caseating granuloma was found in six patients. Mycobacterium tuberculosis Was detected in six. Digestive imaging was abnormal in 15 patients. Mesenteric lymph nodes were the most common associated site of tuberculosis (N = 8, 47%). Mean duration of treatment was 8.2 months (range: 6-12). Thirteen patients were cured, three died and one was lost to follow up.Conclusion - Gastrointestinal tuberculosis is not an uncommon diagnosis in the north-eastern Parisian area, especially among immigrant populations and immunodeficient patients. The most frequent localizations are the small intestine and ileocecum. Diagnosis can be made by pathology and/or bacteriology on endoscopic and/or surgical biopsy samples.

The breast cancer screening program has continued in Taiwan during the COVID-19 pandemic. Our nationwide data showed that the total number of screenings decreased by 22.2%, which was more pronounced for in-hospital examinations (−37.2%), while outreach showed a 12.9% decrease. This decline in screening participation happened at all levels of hospitals, more significantly at the highest level. Our report revealed that outreach services could maintain relatively stable breast cancer screening under this kind of public health crisis. Building a flexible, outreach system into the community might need to be considered when policymakers are preparing for future possible pandemics.

SUBJECTAnalyze characteristics of neuromeningeal tuberculosis in the northeastern suburbs of Paris.MATERIAL AND METHODRetrospective study of 19 observations between 1988 and 1999.RESULTSThirteen cases of meningitis, 3 cases of meningitis associated with a tuberculoma and 3 cases with isolated tuberculoma were described. Young subjects (average age 46.4), foreign born (73.7%) were preferentially affected. Three patients were infected by the human immunodeficiency virus. Weight-loss and weakness (84%), fever (79%), headache (63%) dominate the clinical manifestations. The diagnosis delay was 56.6 days, and the therapeutic time, 8.6 days. The search for acid fast bacilli was positive only in one case on direct examination of the cerebrospinal fluid, whereas the culture was positive in 68.7% of the cases. Cerebral imagery was abnormal in13 patients. Average duration of antituberculous treatment was 13,4 months (range: 9-24). Corticosteroids were associated in 12 patients. Thirteen patients were cured, 3 died and 3 were lost to follow up.CONCLUSIONThe characteristics of neuromeningeal tuberculosis are not modified, but the diagnosis delay of the neuromeningeal tuberculosis, which conditions the prognosis, remains significant. The optimal duration of the antituberculous treatment and the conditions of the steroid therapy have to be specified.

A 49-year-old diabetic patient with abdominal pain was found at ultrasonography and computed tomography to have a cystic mass in the head of the pancreas with dilatation of the main pancreatic duct. The head of the pancreas and the duodenum were removed surgically. Examination of the operative specimen showed chronic pancreatitis, dilatation of the main pancreatic duct, and impacted mucus in the secondary ducts with villous proliferation of the ductal epithelium, thus allowing a diagnosis of intraductal adenomatosis. There was no evidence of malignancy. The resection margin was involved, and consequently the remainder of the pancreas was removed six months after the initial surgical procedure. A review of the literature showed that intraductal adenomatosis tends to spread and carries a high risk of malignant transformation. Surgery is required because of the risk of pancreatic duct obstruction and pancreatic cancer. Intraductal papillary tumour of the pancreas shares many characteristic with other adenomatous proliferation of the gastrointestinal tract (colorectal villous adenoma, bile duct adenomatosis) including the presence of villous structures with increased mucus production, a tendency to spread massively, and a high risk of malignant transformation.

Background: Big cities were particularly affected by tuberculosis in the 1990s. Methods: We studied 141 cases of extrapulmonary tuberculosis in patients not infected by HIV in the northeastern suburbs of Paris. Results: A total of 84 men and 57 women were included in the study. Their average age at diagnosis was 42.2 years. Some 73.6% of the patients were foreign-born. A total of 182 sites were identified in 141 patients. There was an association with pulmonary tuberculosis in 38 cases. The sites were: lymph node (48.9%), pleural (25.5%), skeletal (22.7%), genitourinary (5.7%), and meninges (5%). Unfavorable social conditions were frequently observed. The average duration of treatment was 10 months. Twenty-four adverse drug effects were noted. Sixty-eight strains of Mycobacterium tuberculosis were isolated. Five cases of primary resistance to at least one antituberculous drug and only one case of multidrug resistance were observed. Some 95.7% of the 93 patients who were not lost to follow up were cured. Conclusion: Independently of HIV infection, extrapulmonary tuberculosis is still present, particularly in the suburbs of big cities, where social conditions are poor. The significant number of patients lost to follow-up demands that measures be adapted for the therapeutic management of these patients.

We report 59 cases of lymph node tuberculosis in adults not infected by the human immunodeficiency virus (HIV), observed over a period of 5 years in the North Eastern suburbs of Paris. There were 31 women and 28 men; 84.7% were aged under 44 years; 69.5% were not French, and 78% had exclusive lymph node tuberculosis. A superficial distribution was found in 52 cases and a deep pattern in 17 cases. Cervical and supraclavicular lymphadenopathies were the most common (64.4%). General symptoms were present in 63% of cases. The diagnosis was established by fine needle aspiration in 10 cases and by biopsy in 36 cases. Three cases of primary resistance to anti-tuberculosis therapy were described. Lymph node tuberculosis is still present in the Paris region, independently of HIV infection, probably due to poor social conditions.

Compare the efficacy and the tolerance of two treatments associating two NRTI and one NNRTI (Nevirapine). in naive patients HIV infected, with a follow up of one year.Twenty patients, two homogeneous groups, AZT+3TC+Nevirapine versus D4T+DDI+Nevirapine 70% undetectable patients at W52, in each group, with Chiron test 500 copys/ml. The CD4 mean increment is more important in the group D4T+DDI+Nevirapine. The long term use of 2 NRTI+1 NNRTI in naive patients positive for the future.