Filipe Froes

Hospital Pulido Valente - Centro Hospitalar Lisboa Norte · Chest Department

The Covid-19 pandemic has caused major damage and disruption to social, economic, and health systems (among others). In addition, it has posed unprecedented challenges to public health and policy/decision-makers who have been responsible for designing and implementing measures to mitigate its strong negative impact. The Portuguese health authoritie...

Background Influenza can have a domino effect, triggering severe conditions and leading to hospitalization or even death. Since influenza testing is not routinely performed, statistical modeling techniques are increasingly being used to estimate annual hospitalizations and deaths associated with influenza, to overcome the known underestimation from...

Objective To evaluate the influence of patient characteristics on hyperlactatemia in an infected population admitted to intensive care units and the influence of hyperlactatemia severity on hospital mortality. Methods A post hoc analysis of hyperlactatemia in the INFAUCI study, a national prospective, observational, multicenter study, was conducte...

Annual vaccination is fundamental for individual and group protection against seasonal influenza infection. International and Portuguese healthcare organizations have established influenza vaccination coverage rate (VCR) targets for risk groups, namely 75% in people ≥ 65 years old. The Vacinómetro® initiative has been monitoring influenza VCR among...

Introduction: The Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group have previously issued health service and management recommendations for critically ill patients with COVID-19. Due to the evolution of knowledge, the panel of experts was again convened to review the current evidence and issue updated recommendations....

Objective: To evaluate the influence of patient characteristics on hyperlactatemia in an infected population admitted to intensive care units and the influence of hyperlactatemia severity on hospital mortality. Methods: A post hoc analysis of hyperlactatemia in the INFAUCI study, a national prospective, observational, multicenter study, was conduct...

Objective: To evaluate the influence of patient characteristics on hyperlactatemia in an infected population admitted to intensive care units and the influence of hyperlactatemia severity on hospital mortality. Methods: A post hoc analysis of hyperlactatemia in the INFAUCI study, a national prospective, observational, multicenter study, was cond...

We report a higher incidence of hospital-acquired pneumonia (HAP) in patients admitted with stroke (odds ratio, 5.6; 95% CI, 5.4–5.8). Patients with HAP and stroke had an elevated risk of death (odds ratio, 1.2; 95% CI, 1.1–1.3). The incidence and mortality of HAP in stroke patients increased across all age groups.

The Covid-19 pandemic has caused impressive damages and disruptions in social, economic, and health systems (among others), and posed unprecedented challenges to public health and policy/decision-makers concerning the design and implementation of measures to mitigate its strong negative impacts. The Portuguese health authorities are currently using...

In 2019, a new virus, SARS-CoV-2, responsible for the COVID-19 disease, was discovered. Asymptomatic and mildly symptomatic patients were forced to quarantine and closely monitor their symptoms and vital signs, most of the time at home. This paper describes e-CoVig, a novel mHealth application, developed as an alternative to the current monitoring...

Purpose Older patients are the fastest expanding subgroup of intensive care units (ICU) and are particularly susceptible to bacterial infections and sepsis. The aim of this study was to address the epidemiology and the main determinants of outcome of infection in old and very old patients admitted to ICU. Methods We performed a post hoc analysis o...

We present the incidence of hospital-acquired pneumonia (HAP) in Portugal during a 4-year period (2014-2017). Data were retrieved from the 100 Portuguese Hospital diagnosis discharge database for adult patients and included gender, age, chronic comorbidities, mortality and hospital length of stay. We found 28,632 episodes of HAP, an incidence of 0....

Background Community-acquired pneumonia (CAP) guidelines have improved the management and outcomes of patients with CAP, primarily by standardization of initial empiric therapy. But current society-published guidelines exclude immunocompromised patients. Research Question There is no concensus regarding the initial management of immunocompromised...

Introduction Hospitalizations due to community-acquired pneumonia (CAP) in mainland Portugal from 2000 to 2009 accounted for 3.7% of all hospital admissions in population with 18 or more years of age. There is no direct-cost data regarding these admissions. Methods In this observational descriptive study all adult hospitalizations associated with...

Current COVID-19 epidemics was declared on December 31, 2019 at the Wuhan city seafood market, rapidly spreading throughout China, and later reaching several countries (mainly South Korea, Japan, Italy and Iran) and, since March 1, reaching Portugal. Most of the infected patients present with mild symptoms, not requiring hospitalization. Among thos...

Admission lactate is a marker of severity, not of infection, on ICU admission C. Mendes Silva1, J.P. Baptista1,6, P. Mergulhão2,6, F. Froes3,6, J. Gonçalves-Pereira4,6, J. Pereira2,6, C. Dias5, J. A. Paiva2,6 1Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 2Centro Hospitalar São João, Porto, Portugal, 3Hospital Pulido Valente, Ce...

Hyperlactatemia in infected patients at admission in intensive care units C. Mendes Silva1, J.P. Baptista1,6, P. Mergulhão2,6, F. Froes3,6, J. Gonçalves-Pereira4,6, J. Pereira2,6, C. Dias5, J. A. Paiva2,6 1Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 2Centro Hospitalar São João, Porto, Portugal, 3Hospital Pulido Valente, Centr...

Introduction: Skin and skin structure infections are an increasing cause of hospitalization. Although mortality is relatively low, skin and skin structure infections are associated with prolonged hospital length of stay and high costs. Oxazolidinones have been suggested as a tool to treat infected patients in the ambulatory setting in order to dec...

Background Pneumonia is one of the leading causes of mortality and has a high burden in morbidity. In Portugal, 7-valent pneumococcal conjugated vaccine (PCV) was used since 2001 and PCV10/13 since 2009, being the last introduced into the National Immunization Program in 2015. Methods We conducted an ecological study to evaluate the impact of PCV7...

All-cause hospitalization rate per 10,000 inhabitants stratified by sex and age group, between 1998/99 and 2015/16, Portugal mainland. (DOCX)

Trends of all-cause hospitalizations by sex and age group, before and after PCV13 introduction. (TIF)

Trends in PP combined with sepsis and PP hospitalizations by sex and age group before and afterPCV13 introduction. (TIF)

Other specific bacterial pneumonias hospitalization rate per 10,000 inhabitants stratified by sex and age group between 1998/99 and 2015/16, Portugal mainland. (DOCX)

Annual trends of other specific bacterial pneumonias hospitalization rate by sex and age group before and after PCV7 and PCV13 use, Portugal mainland. (DOCX)

Annual trends of PP combined with sepsis and PP hospitalization rate by sex and age group, before and after PCV7 and PCV13 introduction, Portugal mainland. (DOCX)

Annual trends of all-cause hospitalization rate by sex and age group, before and after PCV7 and PCV13 use, Portugal mainland. (DOCX)

Trends in bacterial pneumonia hospitalizations by sex and age group before and after PCV13 introduction. (TIF)

Trends in PP (in first seven diagnoses) hospitalizations by sex and age group, before and after PCV7 introduction. (TIF)

Hospitalization rate per 10,000 inhabitants of PP in primary diagnosis combined with sepsis/bacteremia in first diagnosis and PP in secondary diagnosis between 1998/99 and 2015/16, Portugal mainland. (DOCX)

Hospitalization rate per 10,000 inhabitants of PP in first seven diagnoses between 1998/99 and 2015/16, Portugal mainland. (DOCX)

Annual trends of PP in first seven diagnoses hospitalization rate by sex and age group, before and after PCV7 and PCV13 introduction, Portugal mainland. (DOCX)

Trends in bacterial pneumonia hospitalizations by sex and age group before and after PCV7 introduction. (TIF)

Trends of all-cause hospitalizations by sex and age group, before and after PCV7 introduction. (TIF)

Trends in PP combined with sepsis and PP hospitalizations by sex and age group, before and after PCV7 introduction. (TIF)

Trends in PP (in first seven diagnoses) hospitalizations by sex and age group, before and after PCV13 introduction. (TIF)

Chronic obstructive pulmonary disease is a chronic condition that requires the engagement of our patients in lifestyle changes and pharmacological treatment. Although there are guidelines on many aspects of chronic obstructive pulmonary disease management, the challenge of engaging our patients persists. We propose a simple mnemonic that we hope wi...

Purpose of review: Although most patients with community-acquired pneumonia (CAP) are treated as outpatients, the majority of data regarding CAP management is provided by hospitals, either from emergency department or inpatients. This was already noted in the first CAP guidelines, published in 1993, and the challenges regarding the outpatient mana...

Background The incidence of pneumonia and pneumonia related hospitalizations still increasing in different European and American Countries. However, in western countries this increase is driven by secondary diagnoses, recurrent pneumonia episodes in elderly and among those with comorbidities. Given the high frequency of Streptococcus pneumoniae amo...

Introduction: Community-acquired pneumonia (CAP) remains a common and serious infection with wide variability in intra-hospital mortality. Methods: We performed a retrospective analysis of adult patients admitted with CAP in mainland Portugal between the years 2000 and 2009. Results: The intra-hospital mortality rate was 20.4% with deaths in a...

Purpose of review: The first guidelines on community-acquired pneumonia (CAP) were published in 1993, but since then many of the challenges regarding the outpatient management of CAP persist. These include the difficulty in establishing the initial clinical diagnosis, its risk stratification, which will dictate the place of treatment, the empirica...

Patients with COPD and other chronic respiratory diseases are especially vulnerable to viral and bacterial pulmonary infections, which are major causes of exacerbations, hospitalization, disease progression, and mortality in COPD patients. Effective vaccines could reduce the burden of respiratory infections and acute exacerbations in COPD patients,...

The clinical course of intensive care unit (ICU) patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by specific epidemiological, clinical and microbiological aspects. A European network for ICU-related respiratory infections (ENIRRIs), supported by the European Respiratory Society, has been recentl...

Antibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established. To evaluate the impact of different aspects of AT on the outcome of critically ill patients with CAP, we performed a post-hoc analysis of all CAP patients enrolled in a prosp...

Background: Acute bacterial skin and skin structure infections are frequent in-hospital infections. Vancomycin and linezolid are antibacterial agents commonly used in serious acute bacterial skin and skin structure infections but have been associated to prolonged length of stay. Dalbavancin is a new lipoglycopeptide antibacterial, active against Gr...

Background: An outbreak of Legionella pneumophila serogroup 1, with 403 cases was identified on the 7th November 2014 in Vila Franca de Xira, Portugal. Outbreak source was the wet cooling system of a local factory. Hospital Pulido Valente was one of the hospitals receiving patients with Legionnaires' disease (LD). Methods: We describe the clinic...

Objectives This study aimed to estimate the prevalence of diabetes mellitus (DM) in hospitalized patients with community-acquired pneumonia (CAP) and its impact on hospital length of stay and in-hospital mortality. Research design and methods We carried out a retrospective, nationwide register analysis of CAP in adult patients admitted to Portugues...

Background: An outbreak of Legionnaires' disease with 334 confirmed cases was identified in November 2014 in Northern suburban Lisbon, Vila Franca de Xira, Portugal. As part of the team working in the Hospitals that cared for these patients, the authors decided to apply the Legionella Score proposed by Fiumefreddo et al in 2009. This clinical predi...

Introduction: Respiratory infections are frequently associated with DM with general measures as well as flu and pneumococcal vaccination being recommended for people with DM. Portugal presents one of the highest prevalence rates of DM within Europe. Objectives: We have carried out a retrospective, nation-wide register analysis of hospitalized pati...

Abstract Background: An outbreak of Legionnaires' disease with 334 confirmed cases was identified in the 7th of November 2014 in Vila Franca de Xira, Portugal. Although not specific, a combination of clinical findings can be suggestive of Legionnaires' disease. Objective: To describe and compare the clinical and laboratory findings among the conf...

Background: A large outbreak of Legionnaires' disease with 334 confirmed cases was identified on November 2014 in Northern suburban Lisbon, Vila Franca de Xira. As part of the team working in the Hospitals that cared for these patients, the authors decided to assess the social and economic impact of this outbreak by evaluating time to return to wor...

Em Portugal, durante a pandemia de gripe A(H1N1) 2009 foram reportados 124 óbitos. A taxa de mortalidade estimada foi de 1,17/100 000 habitantes. 60% dos falecidos eram do sexo masculino, a média das idades foi de 47,6 anos e em 66,1% havia pelo menos um factor de risco. As doenças crónicas respiratórias e cardíacas foram os factores de risco mais...

A prospective, cohort, clinical, observational study was performed in 14 Intensive Care Units (ICU) to evaluate the contemporary epidemiology, morbi-mortality and determinants of outcome of the population with an infection on admission. All 3766 patients admitted during a consecutive 12-month period were screened. Their median age was 63 [26-83], 6...

Infectious diseases are one of the principle causes of morbidity, mortality and drain on health resources worldwide. In recent years there has been an increase in the impact of respiratory infections, particularly in the Portuguese population. It is for this reason that the Portuguese Respiratory Society has presented a series of recommendations fo...

We analyzed the 124 deaths reported in Portugal form flu pandemic. The estimated mortality rate was 1.17/100 000 population. 60% were males, the average age was 47.6 and 66.1% had at least one risk factor. Chronic lung and heart diseases were the most common risk factors. Viral pneumonia was the major cause of death. 11% of the deceased had no trea...

Introduction and objectives: Herpes zoster and post-herpetic neuralgia increasing incidence is related to ageing. These conditions can be very debilitating and have an important impact in patients' quality of life. In an ageing population like the Portuguese, is expected that the burden of herpes zoster and post-herpetic neuralgia rises, neverthel...

In conclusion, these scores are useful tools but they cannot nor should they substitute medical evaluation and clinical reasoning. Ideally, the best strategic approach to CAP will always depend on experienced doctors (SMARTDOCTORS) who can apply their knowledge to the complexity and specific characteristics of the individual patients and can use th...

Several comorbidities have been independently associated with both predisposition to community-acquired pneumonia and a worse outcome. The goal of this study was to evaluate the impact of comorbidities on the outcome of patients with severe community-acquired pneumonia (SCAP).

Recent studies in the USA and northern Europe have shown an increase in community-acquired pneumonia (CAP). In southern Europe, this increase has not yet been documented. We carried out a retrospective analysis from encoded information from the Portuguese database for hospital admissions that included all individuals aged o18 years, with a primary...