Impact of Covid 19 Pandemic on Elective Rectal Cancer Surgery - Single Institution Experience

Introduction: Surgical treatment of rectal cancer depends on clinical stage, size and location of primary tumor. A sphincter preserving technique such as low anterior resection (LAR) is the preferred method if negative distal margin can be achieved. If an adequate distal margin cannot be obtained, an abdominoperineal resection (APR) is required. A proctosigmoidectomy (Hartmann's procedure) is performed in patients with potentially curable obstructing rectal cancer after neoadjuvant chemoradiotherapy, or as a palliative treatment for locally advanced rectal cancer. Aim(s): The aim of this retrospective study was to investigate the impact of COVID 19 pandemic on the number and type of surgeries performed for the treatment of rectal cancer in UHC Zagreb, Department of Surgery. Material(s) and Method(s): Collected data were extracted from medical records of the patients who underwent surgery at the Department of Surgery from 1st of January 2016 to 31st of December 2022 with prior Ethics Committee approval. Total of 688 patients were included. Retrospective analysis of number and type of surgery was done consecutively by years for the period of interest. Result(s): In 2016 total of 75 patients underwent elective surgery for rectal cancer. LAR was performed in 64% (N=48) of patients, Hartmann's procedure in 20% (N=15), and APR in 16% (N=12). In 2017, 94 surgeries were performed. LAR accounted for 64% (N=60), Hartmann's procedure 17% (N=16), and APR 19% (N=18). In 2018, 115 surgeries were performed. LAR accounted for 69% (N=79), Hartmann's procedure 10% (N=12), and APR 21% (N=24). In 2019, 80 surgeries were performed. LAR accounted for 67% (N=54), Hartmann's procedure 9% (N=80), and APR 24%. In 2020, 78 surgeries were performed. LAR accounted for 59% (N=46), Hartmann's procedure 14% (N=11), and APR 27% (N=21). In 2021, 124 surgeries were performed. LAR accounted for 66% (N=82), Hartmann's procedure 14% (N=17), and APR 20% (N=25). In 2022, 122 surgeries were performed. LAR accounted for 64% (N=78), Hartmann's procedure 15% (N=18), and APR 21% (N=26). Conclusion(s): Our results show steady growth in numbers of performed surgeries in the years prior to the pandemic, with exception of the year 2019 when our department underwent organizational changes. In 2020, significant decrease in number of surgeries was observed as a result of restrictive epidemiological measures established to reduce the spread of COVID 19 infection. COVID 19 pandemic measures also resulted in delayed diagnosis and treatment of rectal cancer which is indirectly shown through the increasing share of Hartmann's procedure. In the years following the relaxation of measures, significant increase in number of performed surgeries that exceeded all the pre-pandemic years was recorded. Constant elevated share of Hartmann's procedure was noted as possible consequence of post COVID delay in diagnosis and confirmation of rectal cancer in more advanced stages of disease.

Disseminated tuberculosis and diagnosis delay during the COVID-19 era in a Western European country: a case series analysis.

Background: Disseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis. Objectives: To describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period. Methodology: We consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings. Results: We included all 30 patients reported during the study period-5, 9, and 16 in 2019, 2020, and 2021 respectively-20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8-30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p < 0.001). Conclusion: There was a substantial delay in the diagnosis of disseminated TB in our study region, which might impacted the prognosis with women affected more negatively. Our results suggest that an increase in the occurrence of disseminated TB set in motion by diagnosis delay may have been a secondary effect of the COVID-19 pandemic.

Cognitive bias in the context of epidemic

In connection with the scope and duration of the COVID-19 pandemic, the clinical judgement of clinicians and medical practitioners could be influenced such that diagnostic errors (delays and inaccuracies) may ensue. We hereby recall through two clinical scenarios the constant need for practitioners to take a step back in reflecting of the diagnostic process to avoid the <<tunnel effect>> which may result in delaying common and frequent infectious diseases. The flu-like symptoms presented by these patients (fever, myalgia and asthenia...) quickly prompted our emergency room colleagues to suspect SARS-CoV-2 infection. However, further investigations including imagery and blood cultures revealed completely different but common infectious disease conditions, which are potentially fatal.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

Improving Detection of Alpha-1 Antitrypsin Deficiency: Role of the Allergist.

Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder that manifests as lung and/or liver disease. Because symptoms of AATD overlap with those of common pulmonary and hepatic conditions, AATD is often misdiagnosed, which has resulted in substantial underdiagnosis of AATD worldwide. Although screening patients for AATD is recommended, the lack of procedures to facilitate testing remains a barrier to accurate diagnosis of AATD. Delays in AATD diagnosis can worsen outcomes for patients by postponing appropriate disease-modifying treatments. Patients with AATD-related lung disease experience symptoms similar to other obstructive lung disorders and are often misdiagnosed for years. In addition to existing screening guidelines, we recommend that screening for AATD become a standard part of allergists' workups of patients with asthma and fixed obstructive disease, chronic obstructive pulmonary disease, bronchiectasis without known origin, and patients under consideration for treatment with biologics. This Rostrum article reviews screening and diagnostic tests available in the United States and emphasizes evidence-based strategies to increase testing frequency and improve AATD detection rates. We underscore the pivotal role of allergists in managing care for patients with AATD. Finally, we urge health care providers to be aware of potentially poor clinical outcomes among patients with AATD during the coronavirus disease 2019 pandemic.

Using Tree-Based Gradient Boosting to Distinguish Between Lymphoma and COVID-19

Over 600,000 new lymphoma cases and around 280,000 lymphoma-related deaths were reported in 2020. The delayed diagnosis of lymphoma has long been a problem. However, the advent of the COVID-19 pandemic, which disrupted healthcare services worldwide, may have caused more significant delays in lymphoma diagnoses. Since lymphomas can sometimes present with symptoms like COVID-19 and can affect the lungs, there is also a risk of misdiagnosis. We collected 505 lymphoma and 180 COVID-19 case reports from ScienceDirect and applied boosting methods to classify each patient as having COVID-19 or lymphoma based on the patient's age, gender and reported symptoms. LightGBM had the highest ROC AUC (0.89), meaning it best differentiates between the two diseases. Therefore, this model can be used as a screening tool to reduce the delay in lymphoma diagnosis and improve the patients' chances of survival. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

A cross-sectional study of unlocking childhood cancer services during COVID-19 pandemic: a pediatric oncology tertiary care center's experience from a developing country

Introduction: The global coronavirus disease 2019 (COVID-19) pandemic has made the provision of cancer care services a challenging task all over the world, even in developed countries. Multiple studies have already reported increased rate of diagnostic delays, interruptions in radiotherapy and chemotherapy administration, and shortage of health care personnel to deliver these services. Background: The aim of this study was to analyze the impact of strategies used to deliver uninterrupted childhood cancer services at our center during the COVID-19 pandemic. Materials and Methods: This is a cross-sectional study of the children less than 18 years of age admitted at our center between March 2020 and September 2021 to assess the effect of strategies adopted to provide uninterrupted cancer services during the COVID-19 pandemic. All the children with cancer who were managed during the study period were included in the study. The children who had treatment interruptions/lost to follow-up prior to onset of COVID-19 were excluded from the study. The primary outcome was to measure the effect of COVID-19 on delivery of cancer care services. The secondary outcome was to assess whether the strategies followed at our center helped to reduce diagnostic delays or loss to follow-up during the COVID-19 pandemic. Results: Out of total 1,490 admissions, 199 children were managed during the study period. Among the 199 children managed, 124 of them were newly diagnosed, 75 had ongoing treatment, 16 children relapsed, 13 children received palliative care, and 6 families were lost to follow-up. Out of 1,471 tests done, only 16 children and 6 caregivers tested COVID-19 positive during routine screening. Thirty-five underwent surgery and 23 received radiotherapy during this period. Among 199 children, 143 (71.8%) received financial support for hospital expenses, 23 (11.5%) received travel support, 20 (10%) were provided free accommodation, and 15 (7.5%) received home delivery of oral chemotherapy and pain medications. A total of $86,989.05 was supported for diagnostic investigations, COVID-19 testing, chemotherapy, and supportive care;$1,144.90 for travel support;and $17,010.94 was waived off by hospital administration to support the poor families. Conclusion: The shared care model, support from nongovernmental organizations and hospital administration, and utilization of local resources productively and effectively helped to avoid diagnostic delays and treatment interruptions, and provide uninterrupted pediatric cancer care services at our center.

Invasive fungal infections in COVID-19 patients from Pakistan

Objective: The objective of this study is to report the frequency and clinical characteristic of IFI in COVID-19 patients. Method(s): This observational study was conducted in Karachi, Pakistan from March 2020-April 2021. Patients with COVID-19 associated aspergillosis (CAPA) were diagnosed using ECMM/ISHAM criteria modified to include tracheal aspirate culture and/or Galactomannan Index (GMI) >4.5 in the possible CAPA category. COVID-19 associated candidemia (CAC) was defined by isolation of Candida species from blood cultures. COVID-19 associated mucormycosis (CAM) was defined as updated EORTC/MSG criteria with inclusion of COVID-19 as host factor. Pneumocystis jirovecii pneumonia (PJP) was defined by consistent clinical and radiological features and PCR positivity. Result(s): During the study period a total of 123 (3.3%) IFI in 3506 hospitalized COVID-19 patients were identified. This included 78 (2.2%) CAPA patients (42 probable;36 possible), 29 (0.8%) CAC (5 C. auris;24 non-C. auris), 10 (0.3%) CAM (7 pulmonary;3 rhinocerebral), 3 (0.08%) PJP and three (0.08%) cases of rare invasive fungal infections (2 C. neoformans;1 Trichosporon asahii). Outcome data was available on 117/123 patients. Of these 117 patients, 78 expired (66.7%). These include 52/74 (70%) CAPA patients, 17/27 (63%) CAC patients, 7/10 (70%) CAM patients and 2/3 (67%) PJP patients. Conclusion(s): We report a rate of 3.3% IFI amongst hospitalized COVID-19 patients at our center. We consider this rate to be an underestimate due to less bronchoscopic procedures and inclusion of only candidemia cases. We also report higher mortality rate with IFI in our patients than global data probably due to delayed diagnosis, co-infections and limited therapeutic options.

THE IMPACT OF COVID-19 PANDEMIC ON DIAGNOSIS AND TREATMENT IN OTORHINOLARYNGOLOGY PATIENTS IN CROATIA.

COVID-19 pandemic resulted in a decrease in the number of diagnostic and therapeutic procedures in most ENT departments. We performed a survey among ENT specialists in Croatia aiming to assess how the pandemic influenced their practice, and consequently the patient diagnosis and treatment. The majority of the 123 participants who completed the survey stated that there was a delay in diagnosis and treatment of ENT diseases, which they expected to have negative effects on patient outcomes. Since the pandemic is still ongoing, there is the need for improvement at different levels of the healthcare system to minimize the consequences of the pandemic in non-COVID patients.

Pulmonary embolism or COVID-19 pneumonia? A case report.

Pulmonary embolism (PE) is the most severe clinical presentation of venous thromboembolism (VTE), which can be challenging to diagnose due to its non-specific symptoms. The overlapping clinical symptoms of Coronavirus disease 2019 (COVID-19) and PE may make distinguishing between the two difficult. Thus, the diagnosis of PE may be delayed or missed, with grave consequences for the patient's outcome and safety. We herein present the case of a 63-year-old Iranian female admitted to our hospital showing symptoms of delirium superimposed on dementia. Soon after her admission, she developed a fever and respiratory symptoms. However, overestimating the likelihood of COVID-19 pneumonia and attributing the patient's symptoms to this disease led to a delayed diagnosis and treatment of pulmonary embolism, resulting in the patient's death. During the COVID-19 pandemic, a high index of suspicion is required for the timely diagnosis of PE, especially in patients with identifiable risk factors. This is specifically true for older patients who cannot express their symptoms due to neurocognitive disorders.

Abstracts of the 2022 Pediatric Endocrine Society (PES) Annual Meeting

The proceedings contain 228 papers. The topics discussed include: congenital adrenal hyperplasia is associated with increased risk of poor cardiometabolic health;adrenal insufficiency in peroxisomal disorders;patient and parent perspectives on testicular adrenal rest tumors in congenital adrenal hyperplasia;never say never! delayed diagnosis of a rare form of congenital adrenal hyperplasia;prevalence of adrenal insufficiency in pediatric patients with acute recurrent and chronic pancreatitis who undergo a total pancreatectomy with islet auto transplantation (TPIAT);the utility of a random cortisol level in determining neonatal central adrenal insufficiency;neural correlates of obesity and inflammation in youth with congenital adrenal hyperplasia due to 21-hydroxylase deficiency;glucocorticoid dosage and dexamethasone treatment are associated with increased markers of depression in youth with classical congenital adrenal hyperplasia;and new onset primary adrenal insufficiency and autoimmune hypothyroidism in a pediatric patient presenting with MIS-C due to COVID- 19 infection.

Revisiting strategies for maternal health care in the face of covid-19 pandemic

Novel coronavirus (SARS-CoV-2) is a new strain of coronavirus causing COVID-19, first identified in Wuhan City, China towards the end of 2019. At present, there is no evidence that pregnant women are more likely to be severely ill, need ICU care, or die from the illness in comparison to non-pregnant adults. Evidences suggest that vertical transmission, might be possible. We searched and retrieved the published literature from PubMed and Google Scholar using various keywords. We further searched the official webpages of various organizations for the updated information. Pregnant individuals in particular are encouraged to take all available precautions to optimize health and avoid exposure to COVID-19. Adequate Testing should be prioritized in pregnant women admitted with suspected COVID-19. When a pregnancy is complicated by critical illness, the pregnant patient should ideally be cared for at a Level III or IV hospital. In the face of COVID-19, antenatal fetal surveillance and ultrasonography should continue as medically indicated when possible and elective ultrasound examinations should not be performed. Maternal immunizations continue to be an essential component of prenatal care and Ob-gyns should screen all pregnant individuals for mental health issues. Although the most commonly reported sign in COVID-19 is fever, nevertheless, other causes of intrapartum fever should not be overlooked. Cesarean delivery should be based on obstetric indications and not COVID-19 status alone. Infants born to patients with known COVID-19 should be considered infants with suspected COVID-19. The suspected or confirmed COVID-19 mother and infant can be allowed to remain together with enhanced precautions and suspected or confirmed maternal COVID-19 is not a contraindication to breastfeeding. If both the mother and the infant are healthy, it may be prudent to expedite discharge, so as to limit the risk of inadvertent exposure and infection. The Ob-gyns should commit to providing necessary care, although modifications to health care delivery approaches may be necessary. Copyright © 2020, Kathmandu University. All rights reserved.

Abstracts of the 2022 Pediatric Endocrine Society (PES) Annual Meeting

The proceedings contain 228 papers. The topics discussed include: congenital adrenal hyperplasia is associated with increased risk of poor cardiometabolic health;adrenal insufficiency in peroxisomal disorders;patient and parent perspectives on testicular adrenal rest tumors in congenital adrenal hyperplasia;never say never! delayed diagnosis of a rare form of congenital adrenal hyperplasia;prevalence of adrenal insufficiency in pediatric patients with acute recurrent and chronic pancreatitis who undergo a total pancreatectomy with islet auto transplantation (TPIAT);the utility of a random cortisol level in determining neonatal central adrenal insufficiency;neural correlates of obesity and inflammation in youth with congenital adrenal hyperplasia due to 21-hydroxylase deficiency;glucocorticoid dosage and dexamethasone treatment are associated with increased markers of depression in youth with classical congenital adrenal hyperplasia;and new onset primary adrenal insufficiency and autoimmune hypothyroidism in a pediatric patient presenting with MIS-C due to COVID- 19 infection.

Ewing's Sarcoma in a 58-Year-Old Man: Oncological Diagnosis in the Time of COVID-19

Ewing's sarcoma is a rare and extremely aggressive neoplasm with a tendency to recur even after radical surgery and a tendency to early metastasis. This cancer is characteristic of the pediatric population because the peak incidence of this type of cancer occurs in patients between 10 and 20 years of age, but about 30% of cases occur in older patients. We present a case of Ewing's sarcoma in a 58-year-old man with a foot tumor manifestation with a history of back and left leg pain. Due to a lung tumor in the chest X-ray, the patient was referred to the Pulmonology Department, however, the diagnosis was postponed for many months, which in the case of an aggressive tumor, such as Ewing's sarcoma, significantly worsened the initially unfavorable prognosis. The COVID-19 pandemic is having a strong impact on the healthcare systems of countries around the world. Reorganizing medical care and focusing on the pandemic has an impact on the diagnosis and treatment of other diseases. In the current situation, we observe an increase in the number of patients presenting at an advanced stage of the disease, which excludes the possibility of radical treatment. Fear of infection causes both patients to avoid diagnosing disease by focusing on acute symptomatic treatment. The discussed case shows the possible impact of the epidemiological situation of the COVID19 pandemic on the diagnosis and treatment of oncology.

Diagnostic delay due to COVID-19 pandemic: a case of uncontrolled growth of peripheral giant cell granuloma

COVID-19 pandemic had several consequences including reduced access to public health care service that led to significant delays in screenings, diagnosis, and treatments. Peripheral giant cell granuloma (PGCG) is a benign exophytic lesion of reactive nature, affecting gingiva and alveolar ridge. Recent studies report its highest prevalence in 5th-6th decade of age, occurring mainly in mandible with an average size of 1.3-1.7 cm. We aimed to show the impact of pandemic on diagnosis delay in a patient with peripheral giant cell granuloma that reached unusual dimensions. ACaucasian 61-year-old male referred to our observation for the presence of an exophytic lesion on edentulous alveolar crest of the mandible. He was an edentulous patient, that developed a lesion of unusual dimensions of 7x4.5x3.5 cm. The soft consistency, slow exophytic growth and bluish-red color suggested an inflammatory hyperplastic nature of the lesion. An excisional biopsy was performed in association with curettage of underlying periosteum. Histological examination revealed presence of spindle-shaped mononuclear cells and multiple multinucleated giant cells in a well vascularized stromal tissue. No calcifications were found. Clinical and histological features suggested the diagnosis of PGCG. This case is clinical evidence of the delays induced by the COVID-19 emergency, which negatively affected all health care and suggests that the PGCG, albeit benign in nature, may have an uncontrolled and non-self-limiting growth, making its surgical removing and healing process more complicated. Copyright © 2022 Edizioni Minerva Medica. All rights reserved.

The Effect of COVID-19 on the Management of Upper Gastro-intestinal Cancers at a London NHS Trust

Background: The advent of the COVID-19 pandemic in 2020 led to staff redeployment and prioritization of urgent care services. Cancer services were impacted by staff and resource diversion. Cancer diagnoses fell by 33% due to reduction in surveillance, diagnosis, and screening. Upper gastro-intestinal cancers (UGI) include cancers of the esophagus, stomach, small intestine, pancreas, liver, and gall bladder. These cancers progress insidiously, present at late stages and are challenging to treat. Delayed diagnosis significantly reduces the scope of treatment options available and therefore impacts the prognosis of the patient. A Public Health England Report in 2021 showed a reduction in tumor resection surgeries in UGI cancers between March to May 2020 and December to February 2021. The backlog of surgical cancer management is ongoing as the pandemic evolves and NHS service provisions adapt. It is important to understand the effects of COVID-19 on diagnosis, staging and treatment of UGI cancers in order to improve service provision in the ensuing years. Method(s): This was a cross-sectional study conducted at Barking, Havering and Redbridge NHS Trust from January to June 2019, 2020 and 2021. Data for 316 study participants was sourced from the Somerset Cancer Database and supplemented with data from electronic patient care records. Six months of data was compared in 2019 (pre-pandemic), 2020 (mid-pandemic including the first lockdown) and 2021. The data was analysed as raw proportions and percentages. Result(s): The number of UGI cancers diagnosed was lowest in 2020 during the height of the pandemic compared to 2019 and 2021. The most common cancer in all three years was pancreatic. Pancreatic cancer was also the most common emergency cancer presentation. The highest proportion of stage IV cancers presented in 2021 (67%). The proportion of cases that resulted in palliative care management increased from 2019 to 2021 (67% and 70% respectively). 53% of all patients came from neighbourhoods that fell within 50% of the most deprived areas nationally. Conclusion(s): The COVID-19 pandemic has had variable impacts on the presentation and management of UGI cancers at the BHRUT NHS Trust. This study exhibits local trends and percentages following suit from Public Health England's National Cancer Registration and Analysis Service data for trend-based discussion. Further research within London NHS Trusts is encouraged to understand the full impact of COVID-19 on surgical cancer services in the NHS.

A study of factors influencing delayed diagnosis in pediatric cancers: A step towards better outcomes A cross-sectional study

Background: Annually, India contributes to one fifth of newly diagnosed pediatric cancer cases worldwide. The poor outcome of pediatric malignancies in India as compared to developed nations can be attributed to various factors. Early diagnosis and prompt treatment are necessary to achieve higher cure rates. Hence, the study of factors influencing delay in diagnosis holds prime importance in formulating strategies and counter-measures to improve overall survival. Owing to a prominent lack of such studies from India, we, at our center, attempted to determine the factors that lead to delayed diagnosis of pediatric cancers. Method(s): This cross-sectional study enrolled 185 children diagnosed with malignancy at our center over a duration of 4 years. Data were collected from questionnaires and medical records. Diagnosis delay was defined and further divided into patient delay and physician delay. Various patient related factors and socioeconomic factors that could potentially affect diagnosis were studied. Statistical analysis included descriptive analysis, Man-Whitney U- test, Kruskal-Wallis test, and multivariate linear regression.we also studied the impact of COVID 19 on diagnosis dealy in this study. Result(s): Of the 185 patients enrolled over 4years, male: female ratio was 1.37.Median diagnosis delay, patient delay, and physician delays were 59, 30, and 7 days respectively. Median diagnosis delay was significantly higher in younger children, children of illiterate parents, and low monthly family income. Median diagnosis delay in children presenting to general practitioner [9(4-29) days] was higher than those presenting to pediatrician [5.5 (2-18) days]. Gender, occupation of parents and distance from oncology center did not affect time for diagnosis. Conclusion(s): Augmentation of parents attitude, increased awareness, higher suspicion, advocation of lymph node biopsies, and decentralization of specialized pediatric care to rural areas can accelerate the diagnosis of cancers and significantly reduce mortality from otherwise curable malignancies. Copyright © 2022

A Cluster of Paragonimiasis with Delayed Diagnosis Due to Difficulty Distinguishing Symptoms from Post-COVID-19 Respiratory Symptoms: A Report of Five Cases.

Paragonimiasis caused by trematodes belonging to the genus Paragonimus is often accompanied by chronic respiratory symptoms such as cough, the accumulation of sputum, hemoptysis, and chest pain. Prolonged symptoms, including respiratory symptoms, after coronavirus disease 2019 infection (COVID-19) are collectively called post-COVID-19 conditions. Paragonimiasis and COVID-19 may cause similar respiratory symptoms. We encountered five cases of paragonimiasis in patients in Japan for whom diagnoses were delayed due to the initial characterization of the respiratory symptoms as a post-COVID-19 condition. The patients had consumed homemade drunken freshwater crabs together. One to three weeks after consuming the crabs, four of the five patients were diagnosed with probable COVID-19. The major symptoms reported included cough, dyspnea, and chest pain. The major imaging findings were pleural effusion, pneumothorax, and nodular lesions of the lung. All the patients were diagnosed with paragonimiasis based on a serum antibody test and peripheral blood eosinophilia (560-15,610 cells/µL) and were treated successfully with 75 mg/kg/day praziquantel for 3 days. Before diagnosing a post-COVID-19 condition, it is necessary to consider whether other diseases, including paragonimiasis, may explain the symptoms. Further, chest radiographic or blood tests should be performed in patients with persistent respiratory symptoms after being infected with COVID-19 to avoid overlooking the possibility of infection.

[Diagnostic delay in rare diseases: between fear and resilience]. / Demora diagnóstica en enfermedades raras: entre el miedo y la resiliencia.

OBJECTIVE: To describe the impact of diagnosis delay in rare diseases and analyze psychosocial needs related to this delay in patients. METHOD: The qualitative approach has been used by conducting online group interviews with patients and family members in the Valencian Region (Spain) and a content analysis has been carried out. Two categories were differentiated: with diagnostic delay of 1 year or more and without diagnostic delay. Five interviews were conducted with a total of 25 participants. RESULTS: The content analysis showed unequal aspects vs. common aspects, in persons with or without diagnostic delay. People with delay expressed the need to feel supported in order to live with continuous uncertainty. People without delay verbalized the importance of adequate communication between patients and professionals. The problems by the COVID-19 were common in both groups; the participants expressed that they did not feel unattended in their disease by the health services. CONCLUSIONS: High resilience and coping capacity has been identified in people with rare disease, regardless of whether they have suffered diagnostic delay or not. The professional psychosocial support during the diagnostic process of these rare diseases is essential.

A quality improvement (QI) innovation during the COVID-19 pandemic: Improving early diagnosis of type 1 diabetes (T1D) in children and young people (CYP) in Cardiff & Vale University Health Board

Introduction: Most CYP present with symptoms of T1D for the first time to primary care. Delayed diagnosis is common and associated with risk of life threatening diabetic ketoacidosis (DKA). In Cardiff, we had a pre-pandemic QI project to improve early diagnosis. As the pandemic changed delivery of healthcare, we introduced systems to facilitate early diagnosis of T1D. Objective(s): To facilitate early diagnosis of T1D via effective pathways during the pandemic. The primary objective is to reduce the incidence of DKA at diagnosis. Method(s): We worked with partners in primary care to identify barriers and develop initiatives at the start of the pandemic. This included an updated referral pathway, training for triage staff, revising online algorithms, and raising public awareness. Retrospective case note analysis of all newly diagnosed CYP covering prepandemic (1/4/2018-31/3/2020) and pandemic (1/4/2020- 31/3/2022). Key points included delayed diagnosis, presentation, appropriate testing, and prompt referral. Result(s): Pre-pandemic, 6/7 with delayed diagnosis had delayed triage and 1 had fasting blood glucose (BG). 25/28 had POC BG testing and 2 had a urine test. During the pandemic, 2/4 with delayed diagnosis had delayed triage. 46/49 had POC BG test and 3 a urine test. The 4 in severe DKA had delayed presentation but promptly diagnosed, of which 2 were presumed to have COVID. During the pandemic 91% had POC testing and prompt referral to secondary care compared with 75% pre pandemic. There was no increase in the DKA rates during the pandemic despite a significant increase in the number newly diagnosed. Conclusion(s): During the pandemic, we demonstrated an improvement in prompt diagnosis following the QI initiatives between primary and secondary care. Delayed presentation has resulted in severe DKA despite public awareness campaigns. Data analysis, feedback, training and public awareness campaigns across other health boards is planned.