Publications by authors named "Rita Filipe"

15 Publications

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Benzodiazepine Use in Opioid Maintenance Treatment Programme: Risks and Clinical Outcomes.

Acta Med Port 2021 Mar 1;34(3):209-216. Epub 2021 Mar 1.

Drug Addiction Treatment Centre. Agualva-Cacém. Cacém. Portugal.

Introduction: The co-association of benzodiazepines and opioids is associated with an increased risk of overdose, death, and poorer psychosocial prognosis. The aim of this study is to characterize the prevalence, pattern of use, and primary clinical outcomes in benzodiazepines users in a public opioid maintenance treatment unit.

Material And Methods: We conducted a cross-sectional study involving 236 patients treated with opioid substitutes (methadone and buprenorphine). We conducted a descriptive, bivariable, and multivariable analysis to determine clinical differences between benzodiazepines users and non-users.

Results: The prevalence of consumption of benzodiazepines was 25.4% (60). The benzodiazepines were obtained with a medical prescription (49.8%) or on the black market (42.6%). The most prescribed benzodiazepine was diazepam (29.1%), and the main reasons were to relieve insomnia (27.7%) or anxiety (26.9%) and to enhance the psychoactive effects of other drugs (19.7%). Regarding the clinical outcomes, we highlight: a very high prevalence of hepatitis C (51.7%); severe ongoing consumption of psychoactive drugs (73.7%); and a high rate of depression and anxiety (> 60%), significantly higher in the benzodiazepines-user group. In the multivariable analysis of benzodiazepine use, we found alcohol consumption (OR 0.482; IC 95% 0.247, 0.238) had a negative association and having hepatitis C (OR 2.544, IC 95% 1.273, 5.084) or anxiety symptoms (OR 5.591; IC 95% 2.345, 13.326) had positive associations.

Discussion: Our results suggest the BZD users had a complex drug addiction problem and underline the importance of adequately addressing BZD use, contemplating psychological and psychiatric approach in this particular population.

Conclusion: Past or current use of benzodiazepines is associated with poor clinical and psychiatric outcomes. A multidisciplinary approach with a focus on infectious diseases and mental health is critical in order to enhance the treatment effectiveness and overall prognosis.
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http://dx.doi.org/10.20344/amp.13181DOI Listing
March 2021

Dynamics of a Dual SARS-CoV-2 Lineage Co-Infection on a Prolonged Viral Shedding COVID-19 Case: Insights into Clinical Severity and Disease Duration.

Microorganisms 2021 Feb 2;9(2). Epub 2021 Feb 2.

CHUSJ-Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal.

A few molecularly proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases of symptomatic reinfection are currently known worldwide, with a resolved first infection followed by a second infection after a 48 to 142-day intervening period. We report a multiple-component study of a clinically severe and prolonged viral shedding coronavirus disease 2019 (COVID-19) case in a 17-year-old Portuguese female. She had two hospitalizations, a total of 19 RT-PCR tests, mostly positive, and criteria for releasing from home isolation at the end of 97 days. The viral genome was sequenced in seven serial samples and in the diagnostic sample from her infected mother. A human genome-wide array (>900 K) was screened on the seven samples, and in vitro culture was conducted on isolates from three late samples. The patient had co-infection by two SARS-CoV-2 lineages, which were affiliated in distinct clades and diverging by six variants. The 20A lineage was absolute at the diagnosis (shared with the patient's mother), but nine days later, the 20B lineage had 3% frequency, and two months later, the 20B lineage had 100% frequency. The 900 K profiles confirmed the identity of the patient in the serial samples, and they allowed us to infer that she had polygenic risk scores for hospitalization and severe respiratory disease within the normal distributions for a Portuguese population cohort. The early-on dynamic co-infection may have contributed to the severity of COVID-19 in this otherwise healthy young patient, and to her prolonged SARS-CoV-2 shedding profile.
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http://dx.doi.org/10.3390/microorganisms9020300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912897PMC
February 2021

Aortic Prosthesis-Associated MDR Infections as a Diagnostic and Therapeutic Challenge.

Infect Dis Rep 2020 Nov 2;12(3):46-50. Epub 2020 Nov 2.

Infectious Diseases Department, São João University Hospital Center, 4000-319 Porto, Portugal.

Endovascular prostheses are used to treat life-threatening conditions such as ruptured aortic aneurysms. Prosthetic infection cause significant morbidity and mortality, posing important diagnostic and therapeutic challenges. It is particularly difficult to diagnose and, in the era of multidrug resistance (MDR), these type of infections may become even more difficult to treat. Herein, we reported a case of a secondary prosthetic endovascular infection following repeated bacteremia episodes from a urinary source. This case illustrates an MDR aortic infection that was difficult to diagnose with no oral antibiotic treatment options.
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http://dx.doi.org/10.3390/idr12030012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768536PMC
November 2020

Botulism disguised as parotitis.

IDCases 2020 25;21:e00839. Epub 2020 May 25.

Infectious Diseases Department, Centro Hospitalar Universitário de São João, Portugal.

Botulism is an acute toxin-mediated neuroparalytic syndrome caused by some species. It typically presents itself as an acute symmetric descending paralysis of cranial and peripheral nerves, which can potentially evolve to respiratory failure and death. We report a case of botulism diagnosed in a patient presenting with a parotitis probably due to xerostomia, even though he had already sought medical assistance for blurred vision and dysphagia. The neurological symptoms resolved without administration of antitoxin and botulism diagnosis was confirmed with identification of both toxins B and F in patient's serum. We aim to illustrate the need for a high clinical suspicion for the diagnosis of botulism and to report an atypical case of botulism with the production of toxins B and F, the latter being of rare occurrence.
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http://dx.doi.org/10.1016/j.idcr.2020.e00839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264047PMC
May 2020

Change in the Prevalence and Social Patterning of First-and Second-Hand Smoking in PORTUGAL: A Repeated Cross-Sectional Study (2005 and 2014).

Int J Environ Res Public Health 2020 05 20;17(10). Epub 2020 May 20.

NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal.

Between 2005 and 2007, important reinforcements of the tobacco legislation have been implemented in Portugal, which may have affected smoking patterns. The aim of this study was to measure the change in prevalence of first- and second-hand smoking (SHS) among adults, and its socio-demographic patterning in Portugal from 2005 to 2014. Data from the last two Portuguese National Health Interview Surveys (2005 and 2014) were used. The changes in daily smoking and SHS were measured using Poisson regressions, stratifying by sex and survey year. The inequalities were measured using relative inequality indexes (RII). From 2005 to 2014, there was a reduction in SHS (75%-54% among men, and 52%-38% among women), and a reduction in smoking among men (27%-26%), and an increase among women (9%-12%). SHS reduction was more marked among less privileged people. Among Portuguese men, inequalities in daily smoking have increased slightly, while among women the gap favoring low-educated reduced. Between 2005 and 2014, SHS decreased, but not daily smoking, particularly among women. Additionally, socioeconomic inequalities in smoking increased. Future policies should simultaneously tackle smoking and SHS prevalence, and their socioeconomic patterning. More comprehensive policies such as comprehensive national (non-partial) bans, combined with price increases could be more effective.
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http://dx.doi.org/10.3390/ijerph17103594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277527PMC
May 2020

sphenoidal sinusitis as presentation of a non-Hodgkin Lymphoma.

Med Mycol Case Rep 2020 Jun 6;28:26-28. Epub 2020 Apr 6.

Infectious Diseases Department, Centro Hospitalar Universitário São João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.

is a basidiomycetes worldwide distributed that has emerged as cause of invasive infections in immunosuppressed patients. We present a case of a man who was simultaneously diagnosed with a small cell non-Hodgkin lymphoma and a sphenoid sinusitis by . Intraoperative observation and histology description were crucial to consider an alternative diagnosis to mucormycosis suggested by the MRI. The diagnosis was made based on PCR identification and sequencing.
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http://dx.doi.org/10.1016/j.mmcr.2020.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162964PMC
June 2020

Basal cell carcinoma: multimodal treatment and the role of neoadjuvant vismodegib.

Autops Case Rep 2019 Oct-Dec;9(4):e2019116. Epub 2019 Sep 27.

Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal.

Basal cell carcinoma (BCC) is the most common skin cancer. It generally has an indolent course with low rates of metastasis and mortality. However, BCC is locally invasive and can cause significant morbidity due to destructive local spread. We report our experience with a patient who was referred to our skin cancer unit due to a previously neglected lesion on the parietal region of the scalp, which had developed for 7 years. The patient was prescribed vismodegib on the basis that surgery could cause excessive functional and aesthetic damage. The patient had an objective partial response after 20 months of treatment. He was then submitted to radical skin excision, leaving a large defect that was reconstructed using a free latissimus dorsi muscle flap. The patient recovered well, and at the 1-year follow-up there were no signs of local recurrence. Our case demonstrates the value of vismodegib treatment prior to surgery in a locally advanced, high-risk scalp BCC and highlights the importance of an individualized and specialized approach with these patients, within a multidisciplinary team.
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http://dx.doi.org/10.4322/acr.2019.116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771444PMC
September 2019

Central nervous system varicella zoster vasculopathy in an immunocompromised patient.

IDCases 2019 29;15:e00483. Epub 2018 Dec 29.

Infectious Diseases Department, Centro Hospitalar Universitário São João, Oporto, Portugal.

Central nervous system (CNS) vasculopathy associated with Varicella Zoster Virus (VZV) infection, usually manifesting as stroke due to ischemic lesions by involvement of small arteries, is frequently misdiagnosed. Immunocompromised patients have a particularly higher risk of severe disease and also CNS involvement during or following VZV presentations. We report a case of an 84-year-old man, with myelodysplastic syndrome, who presented with herpes zoster ophthalmicus complicated with left periocular cellulitis and an abnormal neurological exam. Intravenous treatment with acyclovir and amoxicillin/clavulanic acid was began. VZV DNA was detected in the cerebrospinal fluid (CSF) and brain magnetic resonance imaging revealed three acute ischemic lesions in the left frontal and both cerebellar lobes. A VZV CNS multifocal vasculopathy was diagnosed and treatment with intravenous acyclovir continued for 21 days. Immunocompromised patients with VZV infection can have a more severe course of disease with disseminated involvement and multifocal vasculopathy. In these patients the CSF detection of anti-VZV IgG as well as VZV DNA can be helpful in the diagnosis of CNS VZV vasculopathy. The antiviral treatment can improve the outcome and should be adjusted taking in consideration the degree of immunosuppression. This clinical case and review of the literature highlights the challenges in the diagnosis and management of VZV CNS vasculopathy in immunocompromised patients.
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http://dx.doi.org/10.1016/j.idcr.2018.e00483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348231PMC
December 2018

[Reply to the Letter Regarding the Article: "Oral Health - Factors of Non-Adherence to Dental Vouchers: A Case- Control Study" by Rita Filipe and Pedro Aguiar].

Acta Med Port 2018 Sep 28;31(9):518-519. Epub 2018 Sep 28.

Escola Nacional de Saúde Pública. Universidade Nova de Lisboa. Lisboa. Portugal.

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http://dx.doi.org/10.20344/amp.11241DOI Listing
September 2018

[Oral Health - Factors of Non-Adherence to Dental Vouchers: A Case-Control Study].

Acta Med Port 2018 Jun 29;31(6):303-311. Epub 2018 Jun 29.

Escola Nacional de Saúde Pública. Universidade Nova de Lisboa. Lisboa. Portugal.

Introduction: A dental voucher was created to facilitate the access to oral health care, however the use of these vouchers, by students aged 7, 10 and 13 with dental caries from state schools within the geodemographic area covered by the Community Health Center Group of Western Lisbon and Oeiras, had a low uptake (23%, school year 2014/2015) The aim of this study was to examine the factors associated with this non-use.

Material And Methods: A case-control study was carried out involving 270 students (135 cases and 135 controls) from 35 state schools who agreed to participate in the study. A descriptive analysis of the reasons for non-adhesion to the voucher, and a study associating the variables and the use/non-use of the dental vouchers using bivariate and multivariate statistical analysis was made adopting a significance of 0.05.

Results: The main reasons for non-use (n = 135) were the use of private dentists outside the dental voucher scheme (23.7%) and forgetting to use the vouchers or exceeding the expiry date (21.5%). The main factor associated with the non-use was students having a private dentist (OR adjusted 2.004, p = 0.012; IC 95%: 1.176 - 3.413) and the main factor associated with the use was having information of dentists accepting dental vouchers (OR adjusted 0.096, p = < 0.001; IC 95%: 0.047 - 0.198).

Discussion: Our findings highlight the need to improve the accessibility to dental vouchers.

Conclusion: It is hoped that the identification of these factors will contribute in the planning of strategies and activities to improve the use of dental vouchers.
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http://dx.doi.org/10.20344/amp.9640DOI Listing
June 2018

Impact of stroke education on middle school students and their parents: A cluster randomized trial.

Int J Stroke 2017 06 1;12(4):401-411. Epub 2016 Jan 1.

1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.

Background School students are an attractive target for stroke education due to the potential impact on stroke prevention and recognition. Additionally, these students can drive behavioral changes in their families. Aim To evaluate the impact of stroke education on school students, in terms of students' and parents' acquired stroke knowledge. Methods A structured questionnaire on knowledge of stroke was filled out by eighth-grade students and one of their parents in seven public schools. In four of these schools, students attended a stroke lecture; educational flyers and magnetic posters were distributed and parent education was encouraged. Students and parents of the other three schools were included in a control group. Students and parents, of both intervention and control groups, were resubmitted to the initial structured questionnaire within one week of the stroke lecture and three months later. Results We included 764 students and 344 parents, 383 (50.1%) and 210 (61.0%) in the intervention group. Correct test scores for students before, within one week, and three months after the intervention were 54.49% versus 55.03% (p = 0.418), 98.69% versus 60.89% (p < 0.001), and 95.58% versus 75.7% (p < 0.001) in the intervention and control groups, respectively. Correct test scores for parents at the same time points were 68.78% versus 64.47% (p = 0.107), 96.89% versus 71.42% (p < 0.001), and 94.58% versus 76.54% (p < 0.001) in the intervention and control groups, respectively. Conclusions School-based interventions may improve stroke knowledge in middle school students and their parents.
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http://dx.doi.org/10.1177/1747493016677980DOI Listing
June 2017

Ear replantation after human bite avulsion injury.

J Craniofac Surg 2011 Jul;22(4):1457-9

Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unit, Hospital de São João, Porto, Medical School, Porto, Portugal.

Traumatic auricular amputation due to human bite is not a common event, but it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but replantation of a severed ear without microsurgery can be a safe alternative. We present a case of a 44-year-old male individual who was involved in a fight and sustained a human bite, resulting in almost a complete amputation of his right ear. The Baudet technique has been used successfully. It is a simple technique and very reliable because it allows a great surface of contact between the graft and the vascular bed, substantially increasing its odds of survival in cases presenting with high risk of infection such as human bite injury. It also produces excellent aesthetic results.
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http://dx.doi.org/10.1097/SCS.0b013e31821d1879DOI Listing
July 2011

Vertical rectus abdominis musculocutaneous flap: a good option for reconstruction of large inguinofemoral defects with exposure of the femoral vessels: brief report focusing on management of advanced vulvar carcinoma.

Int J Gynecol Cancer 2011 Apr;21(3):565-7

Department of Plastic Surgery, Aesthetic, Reconstructive, Maxillofacial and Burns Unit, Hospital de São João, Porto Medical School, Porto, Portugal.

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http://dx.doi.org/10.1097/IGC.0b013e31820d3e1cDOI Listing
April 2011