1. How to really implement a control quality ? Virtut Velmishi « Mother Teresa Hospital » Tirana-Albania 1 SERVICE OF PEDIATRIC GASTROHEPATOLOGY

2. What are people thinkıng ? 2 Brain tumor or leukemia are « true » disease What kind of disease is CD whose treatement is only diet

3. Money or idea ??? 3

4. Different countries, different economies GDP ( per capita) (nominal) France 42793 $ Italy 36267 $ Spain 32360 $ Turkey10522 $ Montenegro 7316 $ Tunisia4351 $ Albania3992 $ 4

5. How much cost the diagnostic of CD in Albania? Public health care Private (clinics and hospitals) Ig A t TG - Free20 euros IgA totale - Free13 euros IgA anti EMA- not performed 40euros HLA DQ2/DQ8-not performed 50 euros Intestinal biopsy- free ( children > 3 y) 90 euros Biopsy interpretation –free 30 euros 5 243 euros

6. What can we do? 1. Collaboration with specialised centers abroad Sending blood samples or saliva for HLA Sending images of intestinal biopsy Training for biopsy by capsule (for children< 3 y) 6

7. First collaboration with Naples 7 The biopsy is within the normal limit. The ratio villi/criptae is difficult to measure, because of orientation problem of the sample, but in the observed villi it appears normal, The number of Intra-Epithelial Lymphocytes if around 20% : quite normal. The mitosis in the crypts are rare (slow proliferation). This is a biopsy of a child who is suspected for coeliac disease.Biopsy is performed in Albania and the images are interpreted in Naples

8. 8 Naples Tirana Collaboration is necessary for small centers

9. Great news from Albania! In March 2012 we have created the first Albanian Coeliac Association (ACA) 9

10. Thank you! THANK YOU! 10