Novel outbreak with coronavirus 2019 began since 31 December 2019. Coronaviruses can cause multiple systemic infections that respiratory complications are the most obvious symptoms. In this report, we describe the symptoms of Guillain Barre syndrome (GBS) in one infected patient with COVID-19, for the first time. We reported a 65-years- old male patient with complaints of acute progressive symmetric ascending quadriparesis. Two weeks prior to hospitalization, the patient suffered from cough, fever, and RT-PCR was reported positive for COVID-19 infection. The electrodiagnostic test showed that the patient is an AMSAN variant of GBS. COVID-19 stimulates inflammatory cells and produces various inflammatory cytokines and as a result, it creates immune-mediated processes. GBS is an immune-mediated disorder and molecular mimicry as a mechanism of autoimmune disorder plays an important role in creating it. It is unclear whether COVID-19 induces the production of antibodies against specific gangliosides. Further investigations should be conducted about the mechanism of GBS in patients with COVID-19, in the future.

Access to hospitals has been dramatically restricted during the COVID 19 pandemic. As a result, the patients were unable to communicate with their families other than through virtual communication channels. A still significant number of patients, which do not have access to modern videoconference tools, were completely isolated. As a result, the University Hospitals of Geneva decided to implement a Visio conference system inside their patient app ecosystem to allow every patient to remain connected. This article presents the iterative development of the solution in order to respond to the specific timely constraint of the situations as well as its evaluation by the patients and caregivers. Two iterations of the tool have been developed. The first relied on an existing commercial platform whereas the second is a fully integrated solution in our patient app ecosystem. The very positive evaluation at the first stage by more than 300 patients, relatives and caregivers convinced us to invest additional effort to provide a fully integrated solution. The second version, evaluated by 16 patients, confirmed that the Visio reaches its objective of reducing isolation during hospitalization. This initiative is completely in line with the objective of the hospital of providing human centered care.

Coeliac disease (CeD) has been associated with psychological disorders and reduced quality of life. Our prospective study evaluated the changes in the quality of life, anxiety and depression in CeD patients up to two years after diagnosis. We recruited adult patients residing in the Veneto region with a new diagnosis of CeD. Several validated questionnaires were administered to measure quality of life, psychological symptoms and adherence to a gluten-free diet (GFD) at the time of diagnosis and after 1 and 2 years. Ninety-three patients reached the 1-year follow-up (81.7% were females with a median age at diagnosis of 35 years), and 55 patients reached the 2-year follow-up. We observed a significant improvement in quality of life, anxiety and depression scores at 1 year after diagnosis, particularly in patients who complied with a GFD. The improvements among classical CeD patients were similar to those observed in nonclassical patients except for anxiety, which improved only in patients with a classical presentation at diagnosis. Age, sex and other disease factors did not affect the change in quality of life (QoL) or other mood disorders. Most of the improvements measured 1 year after diagnosis and 2 years after diagnosis were not significant. In conclusion, QoL and mood disorders must be considered, and psychological counselling should be used when needed.

Hypercalcemia is one of the most commonly encountered laboratory abnormalities in clinical medicine. Various causes have been well established. However, it is likely that the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may be a newly found cause of this frequent finding, especially amongst those with a history of cosmetic surgery, specifically by means of silicone injection. In this case series, we describe 2 patients presenting with symptomatic hypercalcemia likely from their prior silicone injections. Interestingly, each patient only developed symptoms of hypercalcemia following infection with SARS-CoV-2.

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. Background/Introduction The COVID-19 pandemic has had far-reaching effects on everyday life leading to stress and anxiety, which may be heightened in those undergoing cardiac surgery. Health impacts following a traumatic event may be apparent at one month but can also present after many months. PURPOSE: The aim of the CardiacCovid study was to explore the effect of the pandemic on recovery from cardiac surgery. We report the preliminary results from a single centre study in the UK during the early phase of the COVID-19 pandemic. METHODS: Patients >18 years old undergoing any form of cardiac surgery between 23rd March 2020 (UK lockdown) to 4th July 2020 (lifting of most restrictions) were recruited to this prospective observational study. Those too unwell or unable to give consent/complete study questionnaires were excluded. Participants completed a Quality of Life (QoL) (EQ-5D), impact of event (IES-R), depression (CES-D) and health service use questionnaire at baseline, 1 week after hospital discharge, and 6 weeks after surgery. Questionnaires were completed electronically on the Amplitude platform or via post. Ethics approval (20/YH/0132) was obtained and the study was registered (Clinicaltrials.gov:NCT04366167). RESULTS: A total of 395 patients had surgery of which 298 (91.7%) were screened and 203 (68.1%) were enrolled to the study. Participants were mostly male (74.6%), with a mean age of 63 years, undergoing urgent/emergency (57.9%) CABG +/-valve (70.1%). Mean inpatient stay was 8.6 days and in-hospital mortality was 0.5%. No patients had Covid-19. The initial findings suggest a deterioration of QoL at 1 week post discharge with near restoration to baseline level at 6 weeks post-surgery. Mean scores for CES-D and IES-R remained within subclinical levels at all available time points. However, at 6 weeks, a proportion of patients reached levels for depression on the CES-D and had high IES-R scores indicating possible post-traumatic stress. CONCLUSION: We believe that this is the largest/only study exploring the impact of the pandemic on cardiac surgery recovery, including QoL, spanning the immediate recovery phase but will continue until 1 year. The findings so far show that recovery from cardiac surgery during the Covid-19 pandemic is similar to that reported prior to the pandemic (Cromhout et al 2018) and reinforces the need for psychosocial assessments to identify patients who may require additional support during the immediate recovery phase.

Introduction La dcouverte dun cluster autour dun cas dinfection coronavirus Covid-19 dans une commune fran?aise a dclench la cration dune cellule de crise Une quipe dintervention a d? tre constitue 24h aprs cette dcouverte pour dpister les contacts dun enfant infect appartenant ce cluster Celle ci tait compose dune quipe mdicale et paramdicale dinfectiologie, dun mdecin et dambulanciers du SAMU Lobjet de ce travail est de dcrire le r?le des paramdicaux lors de la prparation et de la ralisation du dpistage autour des cas Matriels et mthodes Il est dcrit laction du cadre infirmier et de lquipe infirmire lors de la cration dune quipe de dpistage en urgence autour dun cluster de coronavirus et la gestion de laccueil des cas possibles en hospitalisation Rsultats Lintervention ncessitait la mobilisation, en moins de 24h, dune quipe afin de dpister 100 enfants des coles frquentes par lenfant infect Une premire quipe comprenant mdecins, infirmiers, cadres infirmiers et ambulanciers tait charge du dpistage dans la commune du cas La ractivit de lquipe paramdicale a t permise par limplication ds la dcouverte du cluster du cadre soignant du service Celui-ci a t impliqu dans la cellule de crise, puis sest dplac sur la commune concerne pour lorganisation et la ralisation des premiers prlvements du cluster Fort de cette exprience, le cadre a pu, 24h aprs, coordonner la prparation du matriel, le circuit des cas contacts et le protocole des rgles dhygine et de prlvements Sur la base du volontariat, 5 infirmires de lquipe dinfectiologie, un cadre et 2 infirmiers du SAMU ont particip laction de terrain en plus du cadre dinfectiologie Ceci a permis la cration de 6 postes de prlvements en coopration avec les mdecins infectiologues Dans lhypothse dhospitalisation des cas possibles, il a t ncessaire dorganiser en parallle un cohorting ddi au coronavirus dans le service de maladies Infectieuses du centre hospitalier de rfrence Celui-ci a t coordonn par le cadre soignant avec les mdecins infectiologues rests en lien avec la cellule de crise Le transfert de la moiti des patients alors hospitaliss dans le service a t ralis Un protocole de libration de la totalit des lits du service a t rdig par anticipation Conclusion Cette exprience montre la capacit de mobilisation trs rapide dune quipe paramdicale pour mettre en place une intervention de dpistage dlocalise face un risque pidmique La bonne gestion de la crise a t permise par lanticipation, la ractivit, lexprience et la comptence en hygine des acteurs paramdicaux

BACKGROUND: Coronavirus (SARS-CoV-2), the cause of COVID-19, a fatal disease emerged from Wuhan, a large city in the Chinese province of Hubei in December 2019. MAIN BODY OF ABSTRACT: The World Health Organization declared COVID-19 as a pandemic due to its spread to other countries inside and outside Asia. Initial confirmation of the pandemic shows patient exposure to the Huanan seafood market. Bats might be a significant host for the spread of coronaviruses via an unknown intermediate host. The human-to-human transfer has become a significant concern due to one of the significant reasons that is asymptomatic carriers or silent spreaders. No data is obtained regarding prophylactic treatment for COVID-19, although many clinical trials are underway. CONCLUSION: The most effective weapon is prevention and precaution to avoid the spread of the pandemic. In this current review, we outline pathogenesis, diagnosis, treatment, ongoing clinical trials, prevention, and precautions. We have also highlighted the impact of pandemic worldwide and challenges that can help to overcome the fatal disease in the future.

Background: P.1 lineage (Gamma) was first described in the State of Amazonas, northern Brazil, in the end of 2020, and has emerged as a very important variant of concern (VOC) of SARS-CoV-2 worldwide. P.1 has been linked to increased infectivity, higher mortality and immune evasion, leading to reinfections and potentially reduced efficacy of vaccines and neutralizing antibodies. Methods: The samples of 276 patients from the State of Amazonas were sent to a central referral laboratory for sequencing by gold standard techniques, through Illumina MiSeq platform. Both global and regional phylogenetic analyses of the successfully sequenced genomes were conducted through maximum likelihood method. Multiple alignments were obtained including previously obtained unique human SARS-CoV-2 sequences. The evolutionary histories of spike and non-structural proteins from ORF1a of northern genomes were described and their molecular evolution was analyzed for detection of positive (FUBAR, FEL, and MEME) and negative (FEL and SLAC) selective pressures. To further evaluate the possible pathways of evolution leading to the emergence of P.1, we performed specific analysis for copy-choice recombination events. A global phylogenomic analysis with subsampled P.1 and B.1.1.28 genomes was applied to evaluate the relationship among samples. Results: Forty-four samples from the State of Amazonas were successfully sequenced and confirmed as P.1 (Gamma) lineage. In addition to previously described P.1 characteristic mutations, we find evidence of continuous diversification of SARS-CoV-2, as rare and previously unseen P.1 mutations were detected in spike and non-structural protein from ORF1a. No evidence of recombination was found. Several sites were demonstrated to be under positive and negative selection, with various mutations identified mostly in P.1 lineage. According to the Pango assignment, phylogenomic analyses indicate all samples as belonging to the P.1 lineage. Conclusion: P.1 has shown continuous evolution after its emergence. The lack of clear evidence for recombination and the positive selection demonstrated for several sites suggest that this lineage emergence resulted mainly from strong evolutionary forces and progressive accumulation of a favorable signature set of mutations.

During epidemics and pandemics healthcare personnel (HCP) are on the front line of disease containment and mitigation. Personal protective equipment (PPE), such as NIOSH-approved N95 filtering facepiece respirators (FFRs), serve an important role in minimizing HCP risks and are in high demand during public health emergencies. Because PPE demand can exceed supply, various public health strategies have been developed to reduce the rate of PPE consumption as supply dwindles. Extended use and limited reuse of N95 FFRs are strategies advocated by many governmental agencies used to increase the number of times a device can be used. Increased use of respirators designed for reuse-such as powered air-purifying respirators (PAPRs) and elastomeric half-mask and full facepiece air-purifying respirators- is another option designed to reduce the continuous need for new devices as the daily need for respirator use increases. Together, these strategies are designed to reduce the number of PPE units that must be discarded daily and, therefore, extend the longevity of available supply. The purpose of this paper is to theoretically estimate the impact of extended use and limited reuse strategies for N95 FFRs and the increased use of reusable respirator options on PPE consumed. The results suggest that a considerable reduction in PPE consumption would result from extended use and limited reuse of N95 FFRs and the increased use of respirators designed for reuse; however, the practical benefits must be balanced with the risks and economic costs. In addition, extended use and reuse strategies must be accompanied by proper procedures to reduce risk. The study is designed to support epidemic and pandemic PPE supply and demand planning efforts.

Recent studies using data accrued from global SARS-CoV-2 vaccination efforts have demonstrated that breakthrough infections are correlated with levels of neutralizing antibodies. The decrease in neutralizing antibody titers of vaccinated individuals over time, combined with the emergence of more infectious variants of concern has resulted in waning vaccine efficacy against infection and a rise in breakthrough infections. Here we use a combination of neutralizing antibody measurements determined by a high throughput surrogate viral neutralization test (sVNT) together with published data from vaccine clinical trials and comparative plaque reduction neutralization test (PRNT) between SARS-CoV-2 variants to develop a model for vaccine efficacy (VE) against symptomatic infection. Vaccine efficacy estimates using this model show good concordance with real world data from the US and Israel. Our work demonstrates that appropriately calibrated neutralizing antibody measurements determined by high throughput sVNT can be used to provide a semi-quantitative estimate of protection against infection. Given the highly variable antibody levels among the vaccinated population, this model may be of use in identification of individuals with an elevated risk of breakthrough infections.

BACKGROUND: To contribute to the understanding of the coronavirus disease (COVID-19) pandemic, this study evaluated the correlations of the frequencies of COVID-19 cases, hospitalisations due to COVID-19, and deaths due to COVID-19 with social isolation indices and outpatient prescriptions of hydroxychloroquine and chloroquine in the state of Santa Catarina, southern Brazil. METHODS: This was an analytical, observational, retrospective study based on secondary data that were obtained from public Brazilian databases and covered the period from March 1, 2020 to October 31, 2020 (epidemiological weeks 10-44). Data on weekly COVID-19 cases, hospitalisations and deaths due COVID-19, sales of chloroquine and hydroxychloroquine, and social isolation indices were obtained. Associations between the variables were tested using multiple linear regression analysis. RESULTS: In all regions of Santa Catarina, there were almost simultaneous peaks of COVID-19 pandemic in weeks 28-31, followed by a sudden decrease. Social isolation indices were not associated with the outcomes; sales of chloroquine and hydroxychloroquine were significant predictors of all outcomes (p < 0.001). COVID-19 prevalence was significantly different across the state regions when COVID-19 cases started to decline (p < 0.001). DISCUSSION: Collective immunity and social isolation may not have been the only causes for the reduction of the COVID-19 pandemic observed in Santa Catarina. The results of this study were compatible with the hypothesis that early treatment of COVID-19 cases with chloroquine or hydroxychloroquine may contribute to reducing the transmissibility of COVID-19 in the population. This hypothesis needs to be further tested in future studies.

In the field of science and technology, the graph theory has offered several approaches to articulate any situation or concept. The use of graph theory enables the users to understand and visualize the situations like COVID-19. Looking at this pandemic disease, its impact and the preventing measures, the graph theory would be the most appropriate way to exercise the graph models with theoretical as well as practical aspects to control this epidemic. In the context of COVID-19, this chapter defines the variable set, variable graphs, and their types considering the variations in the vertex sets and edge sets. The virus graph and their type are discussed in this chapter that states that the Virus graph type I and III are not so perilous for all living beings, but virus graph type III and IV are extremely hazardous for the harmony of the world. Initially, the COVID-19 was in Virus graph-I type, but presently it is in Virus graph-II type. Given different aspects for expansion of pandemic, this chapter presents growth types of virus graphs and their variation as 1-1, 1-P, and 1-all growth types. This chapter provide the number of infected people after n number of days concerning different values of P and growth rates with I0 = 100. At the end of this chapter, the country-wise starting dates of stages of the virus graph-I and II are specified. The concept of cut sets is applicable for the prevention of COVID-19 and the whole world is using the same analogy.

Background Surgical site infection (SSI) is common in colorectal surgery patients and associated with morbidity and mortality. Guidelines recommend preoperative intravenous antimicrobial prophylaxis with aerobic and anaerobic coverage to reduce SSI risk. Cephalosporin based prophylaxis (CBP) regimens are recommended as first-line prophylaxis, and non-cephalosporin based are recommended as alternative prophylaxis (AP). We evaluate the efficacy of CBP versus AP in preventing surgical site infections in colorectal surgery patients. Methods A systematic review and meta-analysis was conducted of studies published between 2005 and 2020 in MEDLINE and Web of Science. Studies were excluded if intravenous antimicrobial prophylaxis was not administered, or if oral and intravenous prophylaxis were routinely co-administered. Heterogeneity was reported using the Q-statistic and I2-statistic. Publication bias was evaluated using a funnel plot and Egger test for small study effects. Statistical significance was defined as a two-sided p < 0.05. Results 11 studies met inclusion criteria. AP was not associated with increased SSI risk at 30 days compared to CBP (OR 1.01, 95% CI 0.91, 1.13; OR < 1 favors AP). There was no effect size variability in subgroup analysis comparing higher-to lower-quality studies (I2 = 99%, P = 0.17). Subgroup analysis by publication year approached a significant difference in effect size between studies published prior to 2014 and later than 2014 (I2 = 99%, P = 0.06). Conclusions Meta-analysis of 11 studies of SSI risk in adult colorectal surgery patients suggest that SSI risk is similar for patients receiving CBP or AP, subgroup analysis of studies published since 2014 suggest increased SSI risk with AP compared to CBP.

OBJECTIVES: To explore the perspective of urological patients on the possibility to defer elective surgery due to the fear of contracting COVID-19. METHODS: All patients scheduled for elective urological procedures for malignant or benign diseases at two high-volume Centres were administered a questionnaire, through structured telephone interviews, between 24(th) and 27(th) April 2020. The questionnaire included three questions: 1) In light of the COVID-19 pandemic, would you defer the planned surgical intervention? 2) If yes, when would you be willing to undergo surgery? 3) What do you consider potentially more harmful for your health: the risk of contracting COVID-19 during hospitalization or the potential consequences of delaying surgical treatment? RESULTS: Overall, 332 patients were included (51.5% and 48.5% in the oncology and benign groups, respectively). Of these, 47.9% patients would have deferred the planned intervention (33.3% vs 63.4%; p<0.001), while the proportion of patients who would have preferred to delay surgery for more than six months was comparable between the groups (87% vs 80%). These answers were influenced by patient age and ASA score (in the Oncology group) and by the underlying urological condition (in the benign group). Finally, 182 (54.8%) patients considered the risk of COVID-19 potentially more harmful than the risk of delaying surgery (37% vs 73%; p<0.001). This answer was driven by patient age and the underlying disease in both groups. CONCLUSIONS: Our findings reinforce the importance of shared decision-making before urological surgery, leveraging patients values and expectations to refine the paradigm of evidence-based medicine during the COVID-19 pandemic and beyond.

Objectives: Several parameters aid in deciphering between viral and bacterial infections;however, new tools should be investigated in order to reduce the time to results and proceed with an early target-therapy Validation of a biomarker study, including CD64 and CD169 expression, was conducted Material and Methods: Patients with active SARS-CoV-2 infection (ACov-2), bacterial infection (ABI), healthy controls, and antiretroviral-controlled chronic HIV infection were assessed Whole blood was stained and, after lysing no-wash protocol, acquired by flow cytometry The median fluorescence intensity (MFI) of CD64 and CD169 was measured in granulocytes, monocytes, and lymphocytes The CD64 MFI ratio granulocytes to lymphocytes (CD64N) and CD169 MFI ratio monocytes to lymphocytes (CD169Mo) were evaluated as biomarkers of acute bacterial and viral infection, respectively Results: A CD64N ratio higher than 3 3 identified patients with ABI with 83 3 and 85 9% sensitivity and specificity, with an area under the curve (AUC) of 83 5% In contrast, other analytic or hematological parameters used in the clinic had lower AUC compared with the CD64N ratio Moreover, a CD169Mo ratio higher than 3 3 was able to identify ACov-2 with 91 7 and 89 8 sensitivity and specificity, with the highest AUC (92 0%) Conclusion: This work confirms the previous data of CD64N and CD169Mo ratios in an independent cohort, including controlled chronic viral HIV infection patients as biomarkers of acute bacterial and viral infections, respectively Such an approach would benefit from quick pathogen identification for a direct-therapy with a clear application in different Health Care Units, especially during this COVID pandemic ? Copyright ? 2021 Comins-Boo, Gutirrez-Larra?aga, Roa-Bautista, Guiral Foz, Renuncio Garca, Gonzlez Lpez, Irure Ventura, Fari?as-lvarez, San Segundo and Lpez Hoyos

OBJECTIVE: The COVID-19 pandemic has had various effects on the social life and daily activities of people in most countries in the world, including Iran. Hygienic precautions have been recommended, such as wearing masks and maintaining social distancing, to reduce the spread of the COVID-19. However, some people in society have not considered and ignored these health issues. This study aims to identify the sociological perceptions of people who ignore the COVID-19 warning. A qualitative study was carried out from May to July 2020. The interviewees were purposefully selected from people in Isfahan who avoided paying attention to the COVID-19 warnings. The saturation point was reached in 20 semi-structured interviews. The thematic analysis approach was used to analyze the transcribed documents using MAXQDA software (version 12). RESULTS: The results show 2 themes and 4 sub-themes related to the sociological perception of people who ignore the COVID-19 warning. The themes and sub-themes include: feelings of social anomie (disruption and social unrest, social distrust), unmet social relationship needs (intention to maintain social participation, Feeling of reduced social support). In order to tackle social perceptions contrary to health observance during the coronavirus pandemic, educational resources such as mass media, cyberspace and social programs on the necessity and importance of health observance need to be used. Policies should also be implemented in the social, cultural and legislative contexts to enhance the degree of individuals' social responsibility. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13104-021-05797-0.

The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety.

BACKGROUND: Curcumin has attracted much attention due to its wide range of therapeutic effects. In this study, we used serum collected from patients undergoing one-lung ventilation (OLV) to establish an in vitro acute lung injury (ALI) model to explore the potential protective mechanism of curcumin on ALI. Our study provides a new reference for the prevention and treatment of ALI induced by OLV. METHODS: A549 cells were treated with 20% serum from patients undergoing OLV to establish an in vitro ALI model. Curcumin, at a dose of 40 g/ml, was administered two hours prior to this model. The levels of inflammation and oxidative stress markers were observed by Western blot, qRTCPCR, ELISA and reactive oxygen species assay. Additionally, the expression of peroxiredoxin 6 (Prdx6) and proteins involved in the NF-B signaling pathway was evaluated. RESULTS: Twenty percent of serum collected from patients undergoing OLV downregulated the expression of Prdx6, leading to the activation of the NF-B signaling pathway, which was associated with the subsequent overproduction of inflammatory cytokines and reactive oxygen species. Pretreatment with curcumin restored Prdx6 downregulation and inhibited NF-B pathway activation by suppressing the nuclear translocation of P65, eventually reducing inflammation and oxidative stress damage in A549 cells. CONCLUSIONS: Prdx6 mediated the protective function of curcumin by inhibiting the activation of the NF-B pathway in ALI in vitro.

Background: Healthcare workers are under such a tremendous amount of pressure during the COVID-19 pandemic that many have become concerned about their jobs and even intend to leave them. It is paramount for healthcare workers to feel satisfied with their jobs and lives during a pandemic. Methods: Between 10 to 30 April, 2020, 240 healthcare workers in Bolivia completed a cross-sectional online survey, which assessed their job satisfaction, life satisfaction, and turnover intention in the ongoing COVID-19 pandemic. Results: The results revealed that their number of office days predicted job satisfaction, life satisfaction, and turnover intention, but the relationships varied by their age. For example, office days of healthcare workers negatively predicted job satisfaction for the young (e.g. at 25 years old: b=-0.21; 95% CI: -0.36 to -0.60) but positively predicted job satisfaction for the old (e.g. at 65 years old: b=0.25; 95% CI: 0.06 to 0.44). Conclusions: These findings provide evidence to enable healthcare organizations to identify staff concerned about job satisfaction, life satisfaction, and turnover intention to enable early actions so that these staff can remain motivated to fight the prolonged COVID-19 pandemic. Keywords: healthcare staff; office days; Latin America; occupational well-being; risk factors; COVID-19

AIMS: Faecal Immunochemical Tests (FIT) are increasingly used for stratification of colorectal cancer risk in symptomatic patients. FIT is not currently recommended for use in patients with rectal bleeding, but recent studies have reported its safe use. We report our experiences of FIT in patients presenting with rectal bleeding during the COVID-19 pandemic. METHODS: Patients referred to NUH NHS Trust with rectal bleeding from 15/04/20-15/08/20 were invited to complete a postal-based FIT (OC-Sensor). Demographics, symptoms, investigations and results were recorded. Outcomes were retrospectively reviewed using an electronic hospital system. RESULT: 344 patients were invited to participate, with 301 (87.5%) returning FITs in accordance with testing protocol. 36 patients declined to be seen, 4 were considered not fit for investigation, and 4 had incomplete records. 257 patients were included in the final analysis with 10 CRC detected (3.9%). Rectal bleeding (257, 100%) was the most common presenting symptom followed by change in bowel habit (133, 51.8%). 10 CRC were diagnosed (3.9%). 2 CRC were detected with FIT <4 g Hb / g faeces (2/137, 1.5%) and 8 were detected >100 g Hb / g faeces (8/45, 17.8%). FIT result was significantly associated with CRC diagnosis (p < 0.0001). 4 with CRC had anaemia (4/53, 7.5%), 1 had thrombocytosis (1/12, 8.3%). CONCLUSIONS: FIT missed 20% of CRC in this patient group with the application of a very low threshold (<4 g Hb / g faeces). Both cancers missed by FIT were detectable on digital rectal examination, emphasising the importance of this examination in primary care.