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Article ; Online: Targeted HIV screening in the emergency department.

Spagnolello, Ornella / Reed, Matthew J

2021 Volume 16, Issue 5, Page(s) 1273–1287

Abstract: Despite considerable improvement in human immunodeficiency virus (HIV) knowledge and treatment in the last 3 decades, the overall number of people living with HIV (PLHIV) is still rising with up to one quarter being unaware of their HIV status. Early HIV ...

Abstract	Despite considerable improvement in human immunodeficiency virus (HIV) knowledge and treatment in the last 3 decades, the overall number of people living with HIV (PLHIV) is still rising with up to one quarter being unaware of their HIV status. Early HIV diagnosis and treatment prolongs life, reduces transmission, improves quality of life, and is a cost-effective public health intervention. The emergency department (ED) sees a large number of patients from marginalized and traditionally underserved populations in whom HIV is known to be more prevalent and who may not attend traditional services because of either cultural reasons or because of a chaotic lifestyle. This article discusses the two main approaches to screening; 'Opt-out' screening offers testing routinely in all clinical settings, and 'Targeted' screening offers testing to individuals presenting with indicator conditions. There are many studies of 'Opt-out' ED HIV screening in urban areas of high-HIV prevalence. However, little is known about the effectiveness of 'targeted' HIV screening, especially in areas of low prevalence. This review discusses the background to HIV screening in the ED and reviews the evidence around 'targeted' HIV screening in adult EDs in different HIV prevalence settings, concluding that targeted HIV screening at the ED can be impactful, cost-effective, and well accepted in the ED population, but its long-term implementation requires extra funding and increased staffing resource limiting its application in low resource setting. Despite most evidence being from areas of high-HIV prevalence, targeted screening might also be appropriate in low-HIV prevalence areas.
MeSH term(s)	Emergency Service, Hospital/organization & administration ; Emergency Service, Hospital/statistics & numerical data ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; Humans ; Mass Screening/methods ; Mass Screening/standards ; Mass Screening/statistics & numerical data ; Prevalence ; Public Opinion
Language	English
Publishing date	2021-02-07
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	2454173-4
ISSN	1970-9366 ; 1828-0447
ISSN (online)	1970-9366
ISSN	1828-0447
DOI	10.1007/s11739-021-02648-5
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Article ; Online: Impact and Feasibility of Mechanical Ventilation at a Surgical Center in Sierra Leone: Experience From EMERGENCY's Hospital in Goderich.

Spagnolello, Ornella / Cole, Richmond Dixon / Unisa, Jalloh / Vandi, Hawa / Macarthy, Marian / Gatti, Sofia / Cormio, Manuela / Portella, Gina / Baiardo Redaelli, Martina

Critical care medicine

2024

Abstract: Objectives: Despite the large burden of critically ill patients in developing countries, mechanical ventilation (MV) is scarce in these low-resource settings. In the absence of data, issues like costs and lack of training are often felt to outweigh the ... ...

Abstract	Objectives: Despite the large burden of critically ill patients in developing countries, mechanical ventilation (MV) is scarce in these low-resource settings. In the absence of data, issues like costs and lack of training are often felt to outweigh the benefits of potential MV implementation in such places. We aimed to investigate the impact and feasibility of MV in a surgical ICU in West Africa. Design: This is a 7-month retrospective observational study (from October 25, 2022, to May 25, 2023), covering all patients consecutively admitted to ICU. Setting: The NGO EMERGENCY's hospital in Goderich, Freetown, Sierra Leone. The hospital is a referral center for acute care surgery. Patients: Critical patients admitted to the hospital's ICU. Interventions: Following brief, practical training of the nursing staff, one basic mechanical ventilator was installed at the hospital's ICU, under the supervision of two intensivists. Only patients with a body weight of over 15 kg and who met the "extreme criteria" for MV received this life-saving therapy. Measurements and main results: Of the 195 files of patients admitted to ICU during the study period, 162 were analyzed. The median age was 16 (interquartile range 7-27) and 48.1% of the population were under 14 years. The most common cause of admission was trauma (58.6%), followed by acute abdomen (33.3%), caustic soda ingestion (6.2%), and burns (1.9%). Of the overall population, 26 patients (16%) underwent MV (88.5% trauma cases vs. 11.5% acute abdomen). Median time on MV was 24 hours (12-64). The mortality rate in the MV group was 30.8% (8/26), while in the overall study population, it was 11.7% (19/162). One potentially life-threatening event of tube obstruction was handled appropriately. Conclusions: This study strongly supports the implementation of MV in low-resource settings. In our experience, the consistent benefit of reduced mortality among critical patients largely outweighs the associated challenges.
Language	English
Publishing date	2024-04-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000006304
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Article ; Online: Kabul airport suicide attack: report of a mass casualty.

Spagnolello, Ornella / Gatti, Sofia / Esmati, Shekiba / Shahir, Mir Abdul Azim / Portella, Gina

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2022 Volume 48, Issue 4, Page(s) 2687–2688

MeSH term(s)	Airports ; Bombs ; Disaster Planning ; Humans ; Mass Casualty Incidents ; Suicide ; Terrorism
Language	English
Publishing date	2022-02-17
Publishing country	Germany
Document type	Letter
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-022-01898-y
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Article: Lesson learned from the 2017 measles outbreak in Italy: report from an emergency department.

Spagnolello, Ornella / Russo, Alessandro / Borrazzo, Cristian / d'Ettorre, Gabriella / Ceccarelli, Giancarlo

Le infezioni in medicina

2021 Volume 29, Issue 2, Page(s) 252–258

Abstract: Measles is a preventable disease still responsible for a number of outbreaks worldwide. Although most adults with measles recover uneventfully, measles-related complications may occur. However, as to whether every complicated case requires hospital ... ...

Abstract	Measles is a preventable disease still responsible for a number of outbreaks worldwide. Although most adults with measles recover uneventfully, measles-related complications may occur. However, as to whether every complicated case requires hospital management is still a point of debate. In this study we described the rate, clinical features and severity of measles complications in patients admitted to the ED of a tertiary-care teaching hospital during the outbreak that took place in 2017. Some insights into the impact on the health care system are reported as well. A retrospective cohort study was performed. Medical records of adults discharged from January to December 2017 with diagnosis of "measles" were collected and analyzed. Out of 58,579 of ED admissions, 162 measles cases were enrolled. Acute measles infection was laboratory confirmed in 71.6% and deemed as possible/probable in 24.0% of cases. Three percent of patients were immunocompromised while 1.2% of cases occurred in pregnant women. Of all complications reported (37%), hepatitis was the most frequent (29%) followed by pneumonia (10.4%), keratitis (3.8%), thrombocytopenia (3.8%) and otitis media (0.6%). No significant clinical and laboratory difference emerged between complicated and non-complicated cases besides antibiotic prescription (80.0% vs 66.3%; p=0.039). The course of the disease was mild, and no life-threatening measles-related complications or critical care support were reported. One out of three measles cases may experience at least one measles-related complication. However, the course of the disease seems to be rather benign in young adults, and the widespread use of the ED and hospitalization observed seem an inappropriate approach to the issue.
MeSH term(s)	Disease Outbreaks ; Emergency Service, Hospital ; Hospitalization ; Humans ; Italy/epidemiology ; Measles/epidemiology ; Measles/prevention & control ; Vaccination
Language	English
Publishing date	2021-06-01
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2041081-5
ISSN	1124-9390
ISSN	1124-9390
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Article ; Online: Civilian war victims in Afghanistan: five-year report from the Kabul EMERGENCY NGO hospital.

Spagnolello, Ornella / Gatti, Sofia / Shahir, Mir Abdul Azim / Afzali, Mohammod Fahim / Portella, Gina / Baiardo Redaelli, Martina

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2022 Volume 49, Issue 3, Page(s) 1401–1405

Abstract: Background: Afghanistan has been plagued by war for more than 30 years, but little is known about the civilian cost of such a long-lasting conflict. In particular, the incidence of war injuries among civilians has largely been under-reported. EMERGENCY ... ...

Abstract	Background: Afghanistan has been plagued by war for more than 30 years, but little is known about the civilian cost of such a long-lasting conflict. In particular, the incidence of war injuries among civilians has largely been under-reported. EMERGENCY NGO's Surgical Centre for War Victims has been operating in Kabul since 2001, providing care free of charge to anyone injured in war. The primary aim of our study is to describe the population of patients admitted to our hospital in Kabul. Methods: This is a 5-year retrospective analysis of all recorded hospital admissions at EMERGENCY NGO's hospital in Kabul, Afghanistan, from 1 January 2017 to 31 December 2021. Results: During the study period, 16,053 patients were admitted. Of these, 85.7% were male and 17.5% were under 14 years old. The proportion of male patients increased progressively with the age ranges (from 63.4 to 89.0%). Bullet wounds were the most frequent kind of injury (55.6%), followed by shell, stab and mine wounds (32.2%, 8.3% and 3.9% respectively). Only 5.8% of patients arrived at our hospital within the "golden hour" following injury. No significant reduction in the hospitalization trend was observed over the study period. The overall in-hospital mortality rate was 4.41%, which bore no correlation to the number of admissions. Conclusions: This study provides for the first time epidemiology of war-related injuries in a hospital located in a place of long-standing conflict.
MeSH term(s)	Humans ; Male ; Adolescent ; Female ; Afghanistan/epidemiology ; Retrospective Studies ; Hospitalization ; Hospitals ; War-Related Injuries/epidemiology ; War-Related Injuries/therapy
Language	English
Publishing date	2022-11-30
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-022-02137-0
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Article ; Online: Kabul airport suicide bombing attack: Mass casualty management at the EMERGENCY NGO Hospital.

Spagnolello, Ornella / Esmati, Shekiba / Amiri, Abdul Fahim / Shahir, Mir Abdul Azim / Gatti, Sofia / Portella, Gina / Langer, Martin

The journal of trauma and acute care surgery

2022 Volume 93, Issue 4, Page(s) 552–557

Abstract: Background: Terrorist attacks with large numbers of civilian victims are not uncommon in war-torn countries, and present a unique challenge for health care facilities with limited resources. However, these events are largely underreported and little is ... ...

Abstract	Background: Terrorist attacks with large numbers of civilian victims are not uncommon in war-torn countries, and present a unique challenge for health care facilities with limited resources. However, these events are largely underreported and little is known about how the mass casualty events (MCEs) are handled outside of a military setting. Methods: This study is a retrospective analysis of the MCE which ensued the Kabul Airport suicide attack (August 26, 2021) at the Kabul EMERGENCY NGO Hospital (Afghanistan). Results: Within 6 hours, 93 causalities presented at our hospital. Of them, 36 severe injured were admitted. Mean age was 30.8 years (SD, 10.1 years). The most common injury mechanism was shell fragments. The most common injury site was head (63%; 23/36), followed by limbs (55.5%; 20/36) and thoracoabdominal region (30.5%; 11/36). Combined injuries occurred in 38.9% of cases. Patients receiving surgery presented more combined injuries in comparison with patients receiving only medical treatment (47.1% vs. 31.6%). Thoracoabdomen (25.0% vs. 15.4%) and/or extremity injury (42.9% vs. 28.6%) were more prevalent in the surgical group. Thirty major surgical procedures were carried out on 17 patients in the 9 hours following the first arrival. The rate of intensive care unit/high dependency unit admission was 36.1% and the 30-day in-hospital mortality was 16.6% (6/36). All deaths were recorded in the first 24 hours, and none of them received surgery. Conclusion: A large number of wounded patients must be anticipated after suicide bombing attacks. The authors report the challenges faced and key aspects of their management of MCEs. Level of evidence: Prognostic/Epidemiological; Level IV.
MeSH term(s)	Adult ; Airports ; Blast Injuries ; Hospitals ; Humans ; Mass Casualty Incidents ; Retrospective Studies ; Suicide ; Terrorism
Language	English
Publishing date	2022-06-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003724
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Article ; Online: The Role of Targeted HIV Screening in the Emergency Department: A Scoping Review.

Spagnolello, Ornella / Gallagher, Bernadette / Lone, Nazir / Ceccarelli, Giancarlo / D'Ettorre, Gabriella / Reed, Matthew J

Current HIV research

2020 Volume 19, Issue 2, Page(s) 106–120

Abstract: Background: Human immunodeficiency virus (HIV) infection continues to expand worldwide, and a significant proportion of infection is still undiagnosed. Recent studies have addressed the impact and feasibility of 'opt-out' HIV screening in Emergency ... ...

Abstract	Background: Human immunodeficiency virus (HIV) infection continues to expand worldwide, and a significant proportion of infection is still undiagnosed. Recent studies have addressed the impact and feasibility of 'opt-out' HIV screening in Emergency Departments (EDs) in urban settings at high HIV prevalence, whereas little is known about the yield of implementing 'targeted' HIV testing, especially in low-prevalence areas. Objective: The present study undertakes a scoping review of research carried out on the implementation of targeted HIV screening of adult in EDs to determine the impact, feasibility and acceptability of HIV testing in different HIV prevalence settings. Design: Online databases (EMBASE, MEDLINE) were used to identify papers published between 2000 to 2020. A three-concept search was employed with HIV (HIV, Human immunodeficiency virus infection, HIV infections), targeted testing (Target, screening or testing) and emergency medicine (Emergency Service, emergency ward, A&E, accident and emergency or Emergency Department) (28 Results: The search provided 416 articles. Of these, 12 met inclusion criteria and were included in the final review. Most of the included studies were carried out in the United States ( Conclusions: Targeted HIV screening at the ED can be impactful, feasible and well accepted, but often requires extra funding and staff. Most previous work has focused on areas of high disease prevalence.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Emergency Service, Hospital/standards ; Emergency Service, Hospital/statistics & numerical data ; Female ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; HIV Testing/standards ; HIV Testing/statistics & numerical data ; Humans ; Male ; Mass Screening/standards ; Mass Screening/statistics & numerical data ; Middle Aged ; Practice Guidelines as Topic/standards ; Prevalence ; United States
Language	English
Publishing date	2020-11-23
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2192348-6
ISSN	1873-4251 ; 1570-162X
ISSN (online)	1873-4251
ISSN	1570-162X
DOI	10.2174/1570162X18666201123113905
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Article ; Online: Providing a simple and easily accessible diagnostic tool for HIV diagnosis does not always match success in screening campaigns addressed to migrant populations.

Ceccarelli, Giancarlo / Angeletti, Silvia / Vita, Serena / Crialesi, Antonio / Ciotti, Marco / Spagnolello, Ornella / Pacifici, Laura Elena / Fabris, Sivia / Ciccozzi, Massimo / d'Ettorre, Gabriella

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

2022 Volume 122, Page(s) 373–374

MeSH term(s)	HIV Infections/diagnosis ; HIV Infections/prevention & control ; Humans ; Mass Screening ; Transients and Migrants
Language	English
Publishing date	2022-06-16
Publishing country	Canada
Document type	Letter ; Comment
ZDB-ID	1331197-9
ISSN	1878-3511 ; 1201-9712
ISSN (online)	1878-3511
ISSN	1201-9712
DOI	10.1016/j.ijid.2022.06.015
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Article: Rates and Determinants of Hospital-Acquired Infection among ICU Patients Undergoing Cardiac Surgery in Developing Countries: Results from EMERGENCY'NGO's Hospital in Sudan.

Spagnolello, Ornella / Fabris, Silvia / Portella, Gina / Raafat Shafig Saber, Dimiana / Giovanella, Elena / Badr Saad, Manahel / Langer, Martin / Ciccozzi, Massimo / d'Ettorre, Gabriella / Ceccarelli, Giancarlo

Antibiotics (Basel, Switzerland)

2022 Volume 11, Issue 9

Abstract: Introduction. Knowledge of local and regional antimicrobial resistance (AMR) is crucial in clinical decision-making, especially with critically ill patients. The aim of this study was to investigate the rate and pattern of infections in valvular heart ... ...

Abstract	Introduction. Knowledge of local and regional antimicrobial resistance (AMR) is crucial in clinical decision-making, especially with critically ill patients. The aim of this study was to investigate the rate and pattern of infections in valvular heart disease patients admitted to the intensive care unit (ICU) at the Salam Centre for Cardiac Surgery in Khartoum, Sudan (run by EMERGENCY NGO). Methods. This is a retrospective, observational study from a single, large international referral centre (part of a Regional Programme), which enrolled patients admitted to the ICU between 1 January and 31 December 2019. Data collected for each patient included demographic data, operating theatre/ICU data and microbiological cultures. Results. Over the study period, 611 patients were enrolled (elective surgery n = 491, urgent surgery n = 34 and urgent medical care n = 86). The infection rate was 14.2% and turned out to be higher in medical than in surgical patients (25.6% vs. 12.4%; p = 0.002; OR = 2.43) and higher in those undergoing urgent surgery than those undergoing elective (29.4% vs. 11.2%; p = 0.004; OR = 3.3). Infection was related to (a) SOFA score (p < 0.001), (b) ICU length of stay (p < 0.001) and (c) days from ICU admission to OT (p = 0.003). A significant relationship between the type of admission (elective, urgent surgery or medical) and the presence of infections was found (p < 0.001). The mortality rate was higher among infected patients (infected vs. infection-free: 10.3% vs. 2.1%; p < 0.001; OR = 5.38; 95% CI: 2.16−13.4; p < 0.001). Conclusions. Hospital-acquired infections remain a relevant preventable cause of mortality in our particular population.
Language	English
Publishing date	2022-09-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2681345-2
ISSN	2079-6382
ISSN	2079-6382
DOI	10.3390/antibiotics11091227
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Article ; Online: Bergamo Field Hospital Confronting COVID-19: Operating Instructions.

Spagnolello, Ornella / Rota, Silvia / Francesco Valoti, Oliviero / Cozzini, Claudio / Parrino, Pietro / Portella, Gina / Langer, Martin

Disaster medicine and public health preparedness

2020 Volume 16, Issue 3, Page(s) 875–877

Abstract: The coronavirus disease (COVID-19) pandemic represented an unprecedented challenge for health care facilities, and innovative solutions were urgently required to overcome the high volume of critically ill infectious patients, limit in-hospital outbreaks, ...

Abstract	The coronavirus disease (COVID-19) pandemic represented an unprecedented challenge for health care facilities, and innovative solutions were urgently required to overcome the high volume of critically ill infectious patients, limit in-hospital outbreaks, and limit the risk of occupational infection for health care workers (HCWs). Bergamo was the hardest-hit Italian province by COVID-19, and the local health care system had to undergo a profound and prompt reorganization. A COVID-19-only field hospital was rapidly set up meeting the standards for severe acute respiratory infection (SARI) treatment centers (https://apps.who.int/iris/handle/10665/331603). A zones partition, dedicated in-hospital pathways for HCWs, strict infection prevention and control (IPC) measures, and constant staff supervision were key components of our strategy to limit the risk of occupational infection for HCWs. Herein, we present the Bergamo field hospital layout enlightening fundamental IPC measures adopted as a valuable example of a SARI treatment center confronting COVID-19.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Mobile Health Units ; SARS-CoV-2 ; Pandemics/prevention & control ; Health Personnel
Keywords	covid19
Language	English
Publishing date	2020-11-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2020.447
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