Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organ systems. Musculoskeletal (MS) involvement occurs in either during the disease course in 70-95% of SLE patients or as an initial finding in nearly 50% of the cases. 1,2 MS involvement may vary from myalgia, arthralgia, non-erosive arthritis, myositis, tenosynovitis to contractures and avascular necrosis. 2 However, coexistence of sacroiliitis 3,4 or spondyloarthropathy (SpA) is really scarce. 5 In this article, we reported a patient presenting with juvenile SLE and SpA and discussed the clinical and laboratory findings by the literature review. To the best of our knowledge, this is the first pediatric case with coexistence of juvenile SLE and SpA. CASE REPORT A 16-year-old Syrian female patient was admitted to our hospital with low-back pain present for two months. She was born by vaginal delivery at 39 weeks as the second child of consanguineous parents (first cousins). She had initially presented to a local medical center with fever, rash, fatigue, oral ulcers and pancytopenia a year before. She was diagnosed with SLE. Prednisolone (1 mg/kg) and hydroxychloroquine therapy was administered. One year later, she was referred to our hospital due to complaints of low-back pain worsening in the morning and after a long resting period during the last two months. She also suffered from morning stiffness lasting two-three hours and heel pain. On physical

BACKGROUND: The aim of this study is to compare the efficacy and complication rates of percutaneous gallbladder aspiration (PA) and percutaneous cholecystostomy (PC) in the management of AC and present the experiences of a single third-line center. METHODS: The results of 159 patients with AC who admitted to our hospital between 2015 and 2020, that underwent PA and PC procedures, because they did not respond to conservative treatment and LC could not be performed, were retrospectively analyzed. Clinical and laboratory data before and 3 days after PC and PA procedure, technical success, complications, response to treatment, duration of hospital stay, and reverse transcriptase-polymerase chain reaction (RT-PCR) test results were recorded. RESULTS: Out of 159 patients, 22 (8 men 14 women) underwent PA procedure and 137 (57 men 80 women) underwent PC. No significant difference was detected between the PA and PC groups in terms of clinical recovery (P:0.532) and duration of hospital stay (P:0.138) in 72 h. The technical success of both procedures was 100%. While 20 out of 22 patients with PA were having a noticable recovery, only one was treated with twice PA procedures and a complete recovery was observed (4.5%). Complication rates were low in both groups and were statistically insignificant (P:1.00). CONCLUSION: In this pandemic period, PA and PC procedures are effective, reliable, and successful treatment method that can be applied at the bedside for critical patients with AC who are not compatible with surgery, which are safe for health workers and low-risk minimal invasive procedures for patients. In uncomplicated AC patients, PA should be performed, and if there is no response to treatment, PC should be reserved as a salvage procedure. The PC procedure should be performed in patients with AC who have developed complications and are not suitable for surgery.

Background: The clinical significance of gastrointestinal wall thickening (GWT) on abdominal computed tomography (CT) is not certain, yet. Despite the need for clinical guidelines describing the importance and evaluation of GWT on a CT scan, there have been few studies evaluating these incidental imaging abnormalities. The aim of this study is to endoscopically evaluate certain etiologies that cause incidental GWT found on CT. Methods: This retrospective cohort study was carried out with patients who had incidentally detected GWT on a CT scan at the Kanuni Sultan Süleyman Training and Research Hospital between February 2016 and December 2018. Results: A total of 129 patients (62 males and 67 females; mean age 57.5 years, range: 26-87 years) were included in the study. Abnormalities observed during endoscopy at the exact site of the GWT noted on a CT image were found in 114 patients (99%): upper endoscopy revealed malignancy in 33 (29%), gastritis in 63 (52%), hiatal hernia in 19 (16%), a gastric ulcer in 7 (6%), and alkaline gastritis in 3 (2%). Colonoscopy revealed malignancy in 4 (33%), benign polyps in 5 (35%), colonic ulcer in 2 (16%), and 2 patients (16%) had normal findings. Malignancy was detected more frequently in the cardioesophageal region compared with the antrum (P = 0.020). Conclusion:In this study, detection of GWT on CT often indicated pathologies which were subsequently confirmed endoscopically. Pathological findings were detected in 83% of these patients, with approximately 30% determined to be malignant. Endoscopic evaluation is recommended when GWT is reported on a CT scan.

Purposes: The purpose of the present paper was to prove the efficacy of Percutaneous Cholecystostomy (PC) in the treatment of patients with Acute Cholecystitis (AC) before the COVID-19 pandemic and especially during the pandemic, and to show that it is a safe procedure for patients and healthcare professionals.Materials and Methods: The demographic data of the patients with AC who applied to our hospital, who underwent PC procedure in the 24-month and 12-month period before and during the pandemic, clinical and laboratory data, technical success of PC, clinical response to treatment, length of hospital stay, one-month postprocedural observation, and complications were compared.Results: PC was applied to a total of 124 patients in the pre-pandemic period (52) and pandemic period (72) examined in the study. The median age was 73.5 (25–93) in the pre-pandemic period, and 64 (23–90) in the pandemic period, and the difference between these was found to be significant (p = 0.004). Clinical improvement due to PC was detected in 43 (86%) patients in the pre-pandemic period, and in 61 (84.7%) patients in the pandemic period, no significant differences were detected between the two groups (p = 1.000). The day of hospitalization median value was 3 (1–18) days in pandemic period, and 3 (1–30) days in the pandemic period, and no significant differences were detected between the groups (p = 0.794).ConclusionPC treatment in patients with AC during the pandemic andpre-pandemicc period is effective and safe for both the patient and the healthcare professionals who perform the procedure.The efficacy of percutaneous cholecystostomy in patients with acute cholecystitis before and during the COVID-19 pandemic. Is the percutaneous cholecystostomy procedure safe for patients and healthcare professionals in pandemic conditions?