Choledochal cysts are a rare congenital anomaly, the malignant degeneration is the most dreadful complication of this pathology with a very unfavorable prognosis, and we report an observation illustrating this complication and its prognostic in a young woman taken in charge in our unit.

Purpose: The research was conducted to determine the knowledge level, awareness status, delay level in treatment and causes of delay of the cases of cutaneous leishmaniasis in Sanliurfa province. Method: The research is a cross-sectional study. It was conducted between November-December 2018. The patients who applied to Sanliurfa Cutaneous Leishmaniasis Diagnosis and Treatment Center (SCLDTC) constitute the study population. 375 people participated in the study. Findings: The median age of the participants was 17 years (mean 22.1 ± 17.9) and 50.9% were under 18 years of age. 53.3% of the patients were female and 46.7% were male. The education level of 51.7% of adult participants and the mothers of participants under the age of 18 was below the primary school. 54.9% of the participants or their families did not work in any job. 45.3% of the patients had facial lesions. A delay was found in 41.4 % of patients although they directly applied to SCLDTC and 58.6% of them who applied to SCLDTC after referral. 344 of CL patients experienced a total of 570 delays in different stages of access to treatment. 32.8% of those who had access to CLDTC after direct application or referral had patient delay. The most common patient delay causes are assuming that it is acne with 16.5% and neglecting with 14.6%. Delays due to health care centers are mostly in public hospitals at 13.2%. 91.6% of delays are due to dermatology clinics. The reason for the delay is that misdiagnosis and the wrong treatment in dermatology clinics. 49.6% of the delay cases were caused by the CLDTC and the most common reason for the delay was the absence of medication with 48.4%. In the logistic regression model, where independent variables affecting the patient delay are evaluated together, that the lesion is on the face increases early treatment application 2.4 times and that having only one lesion increases it 1.8 times. Result: Patients' level of basic education and knowledge of the disease is low. Although the patients knew that they should apply directly to the CLDTC, patient delay levels are high. The presence of lesions in regions other than the face decreases patients' behavior of seeking early treatment. Therefore, the information and awareness of the patients and the society about CL should be increased, the patients applying to CLDTC and their relatives should be informed, these training should be pursued and supported by posters and brochures in women's support centers, schools, etc. Compliance training should be performed with appropriate time intervals in CLDTC, with dermatologist physicians, who will work in Sanliurfa in order to reduce system delays. Pentavalent antimony required for the CLDTC and other centers should be provided on time.

A high incidence of lymphopenia has been reported in Covid-19 patients. The initial neutrophil-to-lymphocyte ratio (NLR) of ≥ 3.13 in Covid-19 patients predicts a high propensity of these patients to progress to critical illness. However, it has not yet been established if NLR would start to lower towards a normal ratio of 1-3 during patient’s road to recovery. This study hypothesized that NLR would start to return towards normal as patients recovered from this illness. This study included 43 patients with Covid-19 infection treated in the ICU at Khoula Hospital, Muscat from 10th May to 5th August 2020. Seven readings of NLR (NLR1 to NLR7) from the time of going on ventilator (NLR1) to discharge of patient (NLR7) from the ICU were statistically analyzed using paired ‘t’ test for patients who recovered or those who died. NLR values demonstrated a progressive fall in patients who recovered when comparison was made between NLR1 with other readings (NLR2 to NLR7). On the contrary, insignificant changes in NLR values were observed when comparison was made between NLR1 with subsequent day’s readings in patients who died while in ICU. In conclusion, this study suggests that the NLR of patients who survived showed a downward trend from its initial high values. In contrast, patients who died while in the ICU, NLR values showed little change from their basal value.