Depression is the primary cause of psychological distress, particularly in a crisis like the SARS-CoV-2 pandemic. Primary healthcare structures don't seem to be able to identify and treat a sizable percentage of depressed individuals. This study aimed to examine the prevalence of undiagnosed depression in primary healthcare settings during the post-COVID-19 pandemic and its correlation with demographics and alcoholism. This cross-sectional study used the PHQ-9 (Patient Health Questionnaire-9) to measure depression levels and the FAST (Fast Alcohol Screening Test) to assess alcoholism. A total of 212 individuals (86 males, aged 51.22 ± 6.11, and 126 females, aged 49.75 ± 6.22) who visited a Primary Health Center in Western Greece between May 2022 and September 2022 were included in the study. Findings revealed the occurrence of undetected depression in a percentage of 63.2% of cases. More specifically, 36.8% of the sample showed no depressive symptoms at all, 28.3% had mild depression, 18.4% had moderate depression, and 16.5% had severe depression. However, gender and alcoholism did not seem to influence the occurrence of depressive symptoms somehow. The results offer significant evidence regarding the prevalence of depression and its inadequate diagnosis in primary healthcare settings throughout the post-COVID-19 era. Based on the findings, general practitioners, mental health professionals, and the personnel of a Primary Health structure can use these questionnaires as screening tools for depression and alcoholism problems during patients’ visits. Future longitudinal studies might be conducted to examine the enduring psychological impacts of the pandemic and develop a depression awareness campaign within the context of primary healthcare.

Mobile vaccination units administered COVID-19 vaccines to homebound populations in Greece. This study explores the perspectives of public healthcare providers involved in the COVID-19 home vaccination program, aiming to identify challenges and propose improvements in the delivery of healthcare services at home. This study employed a cross-sectional mixed-methods design and was conducted within public Primary Health Care (PHC) facilities. It utilized a questionnaire consisting of both closed- and open-ended questions. The study population included healthcare professionals and administrative staff involved in vaccination units. Data were collected from April to July 2022 and analyzed using descriptive statistics for quantitative data and thematic analysis for qualitative data. The integration of both data types enhanced the depth and reliability of the findings. Ethical approval for the study was granted by the Bioethics Committee of the Aristotle University of Thessaloniki. Twelve hundred participants from 168 facilities across six Health Districts responded. The majority were nurses (34.1%) and general practitioners (24.7%). Participants overwhelmingly praised the concept of home-based care, aligning it with PHC, and expressed readiness for future involvement, despite time constraints. Four main themes emerged from the thematic analysis of 1,072 text responses. Challenges in providing such services included difficulties in balancing home care with existing workload, addressing understaffing, and achieving effective time management to prevent staff burnout and service disruptions. Participants’ experiences in the national COVID-19 home vaccination project highlight their positive attitudes toward home care while also underscoring several potential challenges in organizing similar home-based services.

This century has seen a revolution the management of beta-thalassemia major. Over a 12-year period to 2016, we aimed to analyze the benefits of such advances. In 209 patients, independent of the chelation regimen, ferritin, cardiac T2* and liver iron concentration changes were evaluated. We defined chelation success (ChS) as no iron load in the heart and acceptable levels in the liver. Over 3 early magnetic resonance imagings, the same parameters were assessed in 2 subgroups, the only 2 that had sufficient patients continuing on 1 regimen and for a significant period of time, 1 on deferrioxamine (low iron load patients n = 41, Group A) and 1 on deferoxamine-deferiprone (iron overloaded n = 60, Group B). Finally, 28 deaths and causes were compared to those of an earlier period. The 209 patients significantly optimized those indices, while the number of patients with chelation success, increased from 6% to 51% (P < .0001). In group A, ChS after about 8 years increased from 21 to 46% (P = .006), while in Group B, from 0% to 60% (P < .001) after about 7 years. Deaths over the 2 periods showed significant reduction. Combined clearance of cardiac and liver iron (ChS) is feasible and should become the new target for all patients. This requires, serial magnetic resonance imagings and often prolonged intensified chelation for patients.

Background The coronavirus outbreak (COVID-19) tested health care systems worldwide. This qualitative study aimed to explore and understand the experiences, beliefs and concerns of Primary Care Professionals (PCPs) regarding the preparedness and response of primary care to the first wave of the pandemic in Greece, a country where a public structured primary care system has been developing. Methods We conducted semi-structured telephone interviews with 33 PCPs (General Practitioners, community General Internal Medicine Specialists, community Paediatricians and nurses) recruited from all regions of Greece after the first wave of the pandemic (June 2020). Interviews were transcribed verbatim, data were anonymised and analysed. Thematic analysis was applied developing a conceptual framework. Results Four main themes were identified: a) Primary care unit adaptation and issues faced during the pandemic; b) Management of suspected COVID-19 cases; c) Management of non-suspected cases; d) Consequences of the pandemic. In the first phase of the pandemic, remote management of suspected cases and their referral to the hospital were preferred as a result of a shortage of personal protective equipment and inaccessibility to coronavirus testing in primary care. Due to the discontinuation of regular medical services and the limited in-person contact between doctors and patients, chronic disease management and prevention programmes were left behind. Social and emotional consequences of the pandemic, such as workplace stigma, isolation and social seclusion, deriving from fear of viral transmission, as well as burnout symptoms and exhaustion were commonly experienced among PCPs. Positive consequences of the pandemic were considered to be the recognition of the importance of an empowered public healthcare system by citizens and the valuable insight, knowledge and experience professionals gained in times of crisis. Conclusions Primary care has a key role to play during and after the pandemic by using its information infrastructure to identify at-risk groups, detect new cases of COVID-19, provide care according to needs, and carry out vaccination programmes. Central coordination and empowerment of primary care will increase its effectiveness, via public awareness, holistic patient management, and unburdening of hospitals.

Objectives Many patients with haemoglobinopathies, including thalassaemia and sickle cell disease, are at increased risk of developing severe complications from the coronavirus disease 2019 (COVID-19). Although epidemiologic evidence concerning the novel coronavirus (SARS-CoV-2) infection in these patients is currently lacking, the COVID-19 pandemic represents a significant challenge for haemoglobinopathy patients, their families and their attending physicians. Methods The present statement summarizes the key challenges concerning the management of haemoglobinopathies, with particular focus on patients with either transfusion-dependent or non-transfusion-dependent thalassaemia, identifies the gaps in knowledge and suggests measures and strategies to deal with the pandemic, based on available evidence and expert opinions. Key areas covered include patients' risk level, adaptation of haemoglobinopathy care, safety of blood transfusions, blood supply challenges, and lifestyle and nutritional considerations. Conclusions The proposed measures and strategies may be useful as a blueprint for other disorders which require regular hospital visits, as well as for the timely adaptation of patient care during similar future pandemics.

Therapeutic advances in β-thalassaemia have gradually lead to a significant improvement in prognosis over the past few decades. As a result, patients living in areas where disease-specific programmes offering access to modern therapy are in place experience a new era of prolonged survival that tends to reach that of the normal population. This ageing thalassaemia population, however, faces a new spectrum of comorbidities resulting from increasing age that may jeopardise the advances in prognosis provided by current therapy and thus poses new challenges in diagnosis, monitoring and treatment. In this position paper of the Thalassaemia International Federation, we review the changing epidemiology and clinical spectrum of patients with β-thalassaemia and propose actions to be undertaken in order to address the emerging spectrum of comorbidities resulting from ageing.

Background Being fairly frequent in systemic autoimmune disease (SAD), haematological manifestations may sometimes indicate clinical exacerbation. As inflammation occurs in systemic context, haemocytopenias may occur due to bone marrow (BM) failure or excessive peripheral blood cells9 (PBCs) destruction, both of which may be immune-mediated, without ignoring the drug-induced toxicity. In SAD setting, complement system overactivation can be proved detrimental to autologous tissues. Though, the role of complement regulatory proteins, such as CD55 (DAF) and CD59 (MIRL), has been poorly clarified. Their deficiency was initially described in paroxysmal nocturnal haemoglobinuria (PNH), a rare acquired non-malignant clonal haematopoietic stem cell disorder characterized by a somatic mutation of X-linked gene PIG-A, essential for glycosyl-phosphatidyl inositol anchor biosynthesis. According to the “dual pathogenesis” model, an immunoregulatory selection in favor of PNH clones to dominate over normal haemopoiesis, on a hypoplastic BM microenvironment, is equally fundamental to the pathophysiology of the disease. Its cardinal triad of chronic haemolytic anaemia, thromboembolic tendency and BM failure makes PNH a truly unique clinical syndrome. Besides, the presence of PNH clones in other haematological disorders, like aplastic anaemia or some types of myelodysplastic syndromes, has been associated with good response to immunosuppressive treatment. Objectives The aim of this study was to assess the CD55 and/or CD59 red-cell deficiency in SAD patients and investigate their possible correlation with clinical features, laboratory parameters and undergoing treatment. Methods CD55 and CD59 red-cell deficiency was evaluated in 86 SAD patients, 50 healthy individuals (HIN) and 7 PNH patients, using the sephacryl gel microtyping system. In all samples with “PNH-like” red blood cells (RBCs), Ham and sucrose tests were also performed. Results Although the great majority of SAD patients (80/86, 93%) demonstrated CD55 and/or CD59 red-cell deficiency, no clinical or laboratory sign of haemolysis was observed. Interestingly, “PNH-like” RBCs never surpassed 25% of the total red-cell population in these patients. Moreover, a significant difference (δ) was revealed between the occurrence of CD55 (75/86, 87%) and CD59 (40/86, 47%) deficient red-cell populations (δ=40%, p<0.0001). Only 3 (6%) HIN had “PNH-like” RBCs, which never exceeded 10% of the total population. All PNH patients (7/7, 100%) exhibited concomitant CD55/CD59 red-cell deficiency. Ham and sucrose tests were positive only in the latter. Conclusions While the presence of CD55- and/or CD59- deficient RBCs was not associated with any cytopenia or specific treatment, CD55 red-cell expression was proved as a significant influence factor of haemoglobin (Hb) levels in SAD patients (F=10.615, p=0.002). Indeed, CD55 red-cell deficiency was associated with a mean Hb reduction of 2.25 g/dl compared to its normal expression (95% CI: 0.88 g/dl to 3.63 g/dl, p=0.0016), reflecting the contribution of autoimmunity on impaired erythropoiesis in SAD patients, through immune-mediated BM failure. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1298

Background: Complement has the potential to provoke severe impairment to host tissues, as shown in autoimmune diseases where complement activation has been associated with diminished CD55 and/or CD59 expression on peripheral blood cell membranes. The aim of this study was to evaluate the presence of CD55-and/or CD59-deficient erythrocytic populations in patients with different rheumatic diseases and to investigate possible correlations with clinical or laboratory parameters.Material/Methods: CD55 and CD59 expression was evaluated in erythrocytes of 113 patients with rheumatic diseases, 121 normal individuals, and 10 patients with paroxysmal nocturnal hemoglobinuria (PNH) using the Sephacryl gel microtyping system. Ham and sucrose tests were also performed.Results: Interestingly, the majority of patients (104/113, 92%) demonstrated CD55-and/or CD59-deficient erythrocytes: 47 (41.6%) with concomitant deficiency of CD55 and CD59, 50 (44.2%) with isolated deficiency of CD55, and 6 (6.2%) with isolated deficiency of CD59. In normal individuals, only 2 (1%) had concomitant CD55/CD59 negativity and 3 (2%) had isolated CD55 or CD59 deficiency. All PNH patients exhibited simultaneous CD55/CD59 deficiency. Positive Ham and sucrose tests were found only in PNH patients. There was no association between the CD55-and/or CD59-deficient erythrocytes and hemocytopenias or undergoing treatment. However, CD55 expression significantly influenced hemoglobin values (F=6.092, p=0.015).Conclusions: This study provides evidence supporting the presence of erythrocytes with CD55 and/or CD59 deficiency in patients with rheumatic diseases. Moreover, CD55 deficiency on red cells influences hemoglobin concentration. Further studies using molecular techniques will clarify the exact pathophysiological mechanisms of this deficiency.

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematopoietic stem cell disorder characterized by the somatic mutation of X-linked gene PIG-A, required for glycosylphosphatidylinositol (GPI)-anchor biosynthesis. This results in absent or decreased expression of all membrane proteins normally anchored by GPI - including CD55 and CD59 - in all circulating cells, leading to an unusual sensitivity of red blood cells (RBCs) to complement lysis and subsequently intravascular hemolysis and hemoglobinuria. According to the “dual pathogenesis” model, there is an immunoregulatory selection in favor of PNH clones to proliferate preferentially over normal hemopoiesis on a microenvironment of bone marrow failure. The incidence of “PNH-like” defect has been also demonstrated in many hematological diseases and on peripheral blood cells (PBC) of normal individuals.

OBJECTIVE To evaluate the presence of CD55 and/or CD59 in the erythrocytes of patients with autoimmune disorders and their possible correlation with the demographic characteristics, clinical features, complete blood count (CBC) and treatment administered. METHOD CD55 and CD59 expression was evaluated in the erythrocytes of 113 patients with autoimmune connective tissue disorders using the sephacryl-gel microtyping system. Control groups consisting of 121 healthy blood donors of similar age and gender, and 10 patients with paroxysmal nocturnal hemoglobinuria (PNH) were also studied. In all samples with CD55- and/or CD59-negative erythrocytes Ham and sucrose tests were also performed. RESULTS Of the 113 patients, 104 (92%) demonstrated "PNH-like" erythrocyte populations: 47 (41.6%) with concomitant deficiency of CD55 and CD59, 50 (44.2%) with isolated deficiency of CD55 and 6 (6.2%) with isolated deficiency of CD59. In healthy donors, only 2 (1.6%) had red cells with concomitant CD55/CD59 negativity and 3 (2.4%) with isolated CD55 or CD59 deficiency. All patients with PNH exhibited simultaneous CD55/CD59 deficiency. There was no clinical or laboratory evidence of hemolysis in any patient. Positive Ham and sucrose tests were found only in patients with PNH. No association was found between the presence of "PNH-like" red cell populations and cytopenia or any specific treatment. CONCLUSIONS This study provides evidence supporting the presence of "PNH-like" erythrocytes in patients with autoimmune connective tissue disorders. It was demonstrated that the presence of "PNH-like" population may affect the hematological profile, in these patients. Further studies will be required to clarify the pathophysiological mechanisms of this phenomenon.

Recent advances in magnetic resonance imaging (MRI) techniques allow the assessment of iron overload in tissues 1 especially the heart, 2 in transfusion-dependent thalassemia patients. The R2* value (1/T2*) recorded in the intraventricular septum of the heart indirectly measures the degree of cardiac iron load. Applying this new technology we looked at a number of historical and biochemical parameters in order to determine their relationship to cardiac iron overload and the effect of cardiac iron on functional and structural changes of the heart in transfusion-dependent thalassemics.

An 80-year-old man was complaining of pain in the left shoulder and arm for the last 2 months. He did not report any recent traumatism or repeated mechanical strain of the shoulder joint, while he did not have any similar complaints in the past. His past medical history included mild arterial hypertension, diabetes mellitus treated with insulin, coronary artery disease and chronic obstructive pulmonary disease, both of them adequately controlled with medication. He was a former smoker, with 50 pack/years. He did not have any fever or arthralgias in any other