How Do Banking Characteristics Influence Companies' Debt Features and Performance during COVID-19? A Study of Portuguese Firms

This paper investigates how bank characteristics (market share, principal shareholders, profitability, and size), and the gender of the company's board members, along with their supervisory abilities, influence the firm's performance, cost of debt, and leverage. We extracted relevant data from a sample of nearly 18,300 Portuguese companies in 2020 (the pandemic year) to build our model with all the main explanatory variables;then, through the least absolute shrinkage and selection operator estimation, we reduced the variables. The robust ordinary least-squares standard-errors approach was applied by company size. Our findings allowed us to observe the crucial negative role of multiple bank relations, but only on the returns of small companies. A decrease in bank relations led to an increase in debt cost and reduced leverage across larger companies. Profitable banks generate higher company returns, mainly for small companies. Furthermore, the better-informed bank shareholders (management, institutional, or government) persuaded the banks to charge higher interest rates, resulting in a higher leverage ratio for companies of average size. Female board members tended to vote for lower debt ratios due to greater risk aversion, while the opposite was true of male board members. The supervisory capacity of the board in the area of bank relations showed a more substantial link with the increased financing costs of small companies. In brief, bank characteristics and board gender were strongly associated with the financial aggregates of companies relative to their size. This work contributes to the literature by using new bank characteristics and an original variable representing board ability to cope with bank relations. To the best of our knowledge, this is the first study to determine the association of the above characteristics in the Portuguese market relative to company size, and their impact on profitability, cost of debt, and leverage. The company board and banking systems should evaluate the impact of their decisions on corporate activity and make necessary adjustments.

Did the COVID-19 Pandemic Affect Contrast Media-Induced Adverse Drug Reaction's Reporting? A Pharmacovigilance Study in Southern Italy.

Medical imaging is required for a complete clinical evaluation to identify lung involvement or pulmonary embolism during SARS-CoV-2 infection or pulmonary and cardiovascular sequelae. Contrast media (CM) have undoubtedly been useful in clinical practice due to their ability to improve medical imaging in COVID-19 patients. Considering their important use, especially in hospitalized COVID-19 patients, and that increased use of a medical tool could also be associated with its deeper knowledge, we chose to explore if new information emerged regarding CM safety profiles. We analyzed all Individual Case Safety Reports (ICSRs) validated by Campania Pharmacovigilance Regional Centre from 1 January 2018 to 31 December 2021 and reported a CM (ATC code V08) as a suspected drug. We compared CM-related reporting between 2 years before (period 1) and 2 years during (period 2) the COVID-19 pandemic. From our analysis, it emerged that, during the COVID-19 pandemic, CM-related ADR reporting decreased, but a significant increase in reporting of serious cases emerged. Serious ADRs were mainly related to iodinated CM (V08A ATC) compared to magnetic resonance imaging CM (V08C ATC). Cutaneous and respiratory disorders were the most frequently reported in both periods. No new or unknown ADRs were reported in the overall study period.

Post-exposure prophylaxis with sotrovimab for Omicron (B.1.1.529) SARS-CoV-2 variant during the aplastic phase of autologous stem cell transplantation.

BACKGROUND: To date, there is no information on the safety and efficacy of the novel anti-sarbecoviruses monoclonal antibody sotrovimab administered, as a post-exposure prophylactic measure, during the aplastic phase of autologous stem cell transplantation (ASCT). METHODS: We describe the outcomes of a Multiple Myeloma (MM) patient, who was threateningly exposed to the Omicron (B.1.1.529) SARS-CoV-2 variant, two days after having received a myeloablative regimen of high-dose melphalan. The patient fulfilled all CDC criteria for prolonged close contacts with an index patient who tested positive for a molecular nasopharyngeal swab (Omicron; B.1.1.529) soon after admission to the ward. Given the high risks of morbidity and mortality in the case of COVID-19 developing during the aplastic phase of transplantation, we adopted a post-exposure prophylaxis intervention based on intravenous (i.v.) sotrovimab. RESULTS: Sotrovimab (500 mg i.v.) was administered at day + 2 from stem cells reinfusion, i.e. 4 days after myeloablative chemotherapy, and at day + 5 from the last close contact with the Omicron-positive index case. The patient was fully protected from SARS-CoV-2 infection throughout his clinical course and remained molecularly negative at the day + 30 from the transplant. We compared times to engraftment and transplant-related toxicities of the sotrovimab-treated patient with the last 15 MM patients transplanted at our Centre, evidencing no unexpected safety signals, infusion-related reactions, or alarming effects on engraftment kinetics. CONCLUSIONS: We have shown here for the first time that administration of sotrovimab during the pre-engraftment phase of ASCT is effective, safe, and not associated with delays in hemopoietic recovery. As compared to MM patients who received the same myeloablative conditioning regimen, the patient given sotrovimab during the aplastic phase did not show any significant differences in engraftment kinetics and toxicity outcomes. Post-exposure prophylaxis with sotrovimab may represent a valuable approach in the stem cell transplantation setting for patients with high-risk exposure to a confirmed COVID-19 case sustained by highly infectious SARS-CoV-2 variants escaping the vaccine-derived immunity due to antigenic shifts in the spike proteins.

Fatal Outcome of COVID-19 Relapse in a Fully Vaccinated Patient with Non-Hodgkin Lymphoma Receiving Maintenance Therapy with the Anti-CD20 Monoclonal Antibody Obinutuzumab: A Case Report.

Few data are available regarding the effectiveness of anti-SARS-CoV-2 vaccine in immunocompromised patients. Vaccination may have a suboptimal efficacy in this population, in particular if patients are exposed to anti-B-cell therapy. We report the virological and clinical characteristics of a patient with follicle center lymphoma under bimonthly maintenance therapy with obinutuzumab, an anti-CD20 monoclonal antibody. Despite three doses of BNT162b2 vaccine, the patient was infected by the SARS-CoV-2 Omicron variant. After an initial period of clinical and molecular remission due to early therapy with sotrovimab, the patient experienced a fatal relapse sustained by the same viral strain.

COVID-19 elicits an impaired antibody response against SARS-CoV-2 in patients with haematological malignancies.

COVID-19 is associated with high mortality in patients with haematological malignancies (HM) and rate of seroconversion is unknown. The ITA-HEMA-COV project (NCT04352556) investigated patterns of seroconversion for SARS-CoV-2 IgG in patients with HMs. A total of 237 patients, SARS-CoV-2 PCR-positive with at least one SARS-CoV-2 IgG test performed during their care, entered the analysis. Among these, 62 (26·2%) had myeloid, 121 (51·1%) lymphoid and 54 (22·8%) plasma cell neoplasms. Overall, 69% of patients (164 of 237) had detectable IgG SARS-CoV-2 serum antibodies. Serologically negative patients (31%, 73 of 237) were evenly distributed across patients with myeloid, lymphoid and plasma cell neoplasms. In the multivariable logistic regression, chemoimmunotherapy [odds ratio (OR), 3·42; 95% confidence interval (CI), 1·04-11·21; P = 0·04] was associated with a lower rate of seroconversion. This effect did not decline after 180 days from treatment withdrawal (OR, 0·35; 95% CI: 0·11-1·13; P = 0·08). This study demonstrates a low rate of seroconversion in HM patients and indicates that treatment-mediated immune dysfunction is the main driver. As a consequence, we expect a low rate of seroconversion after vaccination and thus we suggest testing the efficacy of seroconversion in HM patients.

Atypical COVID-19 dynamics in a patient with mantle cell lymphoma exposed to rituximab.

Patients with non-hodgkin lymphomas (NHL) represent a population of special interest during the current Coronavirus disease-19 (COVID-19) pandemics. NHLs are associated with disease- and treatment-related immunodeficiencies which may generate unusual COVID-19 dynamics and pose unique management challenges. We report the unusual clinical course of COVID-19 in a patient with mantle cell lymphoma (MCL) exposed to nine doses of Rituximab shortly before infection with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). He had a prolonged asymptomatic phase, with negative molecular and antibody testing for SARS-CoV-2, followed by a rapidly progressive evolution to severe COVID-19. Despite detection of viral RNA overlapped with first symptoms occurrence, anti-SARS-CoV-2 antibodies displayed an asynchronous pattern, with IgG first appearing 2 days after RNA positivity and IgM never being detected throughout the entire clinical course. While disease-associated immune derangements and/or previous treatments involving anti-CD20 antibodies might have contributed to COVID-19 dynamics in our patient, data suggests that antibody testings, without concurrent molecular assessment for SARS-CoV-2, may turn inadequate for monitoring of MCL patients, and in general NHL patients heavily exposed to anti-CD20 antibodies, during the current pandemics. We suggest that repeated molecular testing of nasopharyngeal swab should be implemented in these subjects despite a negative serology and absence of symptoms of SARS-CoV-2 infection. For the same reasons, a customized strategy needs to be developed for patients exposed to anti-CD20 antibodies, based on different features and mechanism of action of available SARS-CoV-2 vaccines and novel vaccinomics developments.

Fall in organ donations and transplants in Ceará in the COVID-19 pandemic: a descriptive study, April - June 2020. / Declínio nas doações e transplantes de órgãos no Ceará durante a pandemia da COVID-19: estudo descritivo, abril a junho de 2020.

OBJECTIVE: To describe organ donations and transplants in Ceará state, Brazil, following the declaration of the COVID-19 pandemic. METHODS: This was a descriptive study using data from the Brazilian Organ Transplantation Association. The number of donors and transplants from April to June 2020 was compared to the same period in 2019 and to the first quarter of 2020. RESULTS: In the first half of 2020, the state registered 72 effective donors, just 17 (23.6%) of whom related to the second quarter. Of the 352 transplants in the first half of 2020, 37 (10.7%) were performed in the second quarter. Compared with the period from April to June 2019, there was a reduction of 67.9% and 89.3% in the number of donors and transplants, respectively, in the same period of 2020. CONCLUSION: The number of donors and transplants in Ceará showed an important fall in the three months following the declaration of the COVID-19 pandemic, especially for kidney, heart and cornea transplants.

Lesson by SARS-CoV-2 disease (COVID-19): whole-body CT angiography detection of "relevant" and "other/incidental" systemic vascular findings.

OBJECTIVES: Increasing evidence suggests that SARS-CoV-2 infection may lead to severe and multi-site vascular involvement. Our study aimed at assessing the frequency of vascular and extravascular events' distribution in a retrospective cohort of 42 COVID-19 patients. METHODS: Patients were evaluated by whole-body CT angiography between March 16 and April 30, 2020. Twenty-three out of the 42 patients evaluated were admitted to the intensive care unit (ICU). Vascular and extravascular findings were categorized into "relevant" or "other/incidental," first referring to the need for immediate patient care and management. Student T-test, Mann-Whitney U test, or Fisher exact test was used to compare study groups, where appropriate. RESULTS: Relevant vascular events were recorded in 71.4% of cases (n = 30). Pulmonary embolism was the most frequent in both ICU and non-ICU cases (56.5% vs. 10.5%, p = 0.002). Ischemic infarctions at several sites such as the gut, spleen, liver, brain, and kidney were detected (n = 20), with multi-site involvement in some cases. Systemic venous thrombosis occurred in 30.9% of cases compared to 7.1% of systemic arterial events, the first being significantly higher in ICU patients (p = 0.002). Among incidental findings, small-sized splanchnic arterial aneurysms were reported in 21.4% of the study population, with no significant differences in ICU and non-ICU patients. CONCLUSIONS: Vascular involvement is not negligible in COVID-19 and should be carefully investigated as it may significantly affect disease behavior and prognosis. KEY POINTS: • Relevant vascular events were recorded in 71.4% of the study population, with pulmonary embolism being the most frequent event in ICU and non-ICU cases. • Apart from the lung, other organs such as the gut, spleen, liver, brain, and kidneys were involved with episodes of ischemic infarction. Systemic venous and arterial thrombosis occurred in 30.9% and 7.1% of cases, respectively, with venous events being significantly higher in ICU patients (p = 0.002). • Among incidental findings, small-sized splanchnic arterial aneurysms were reported in 21.4% of the whole population.

Disminución de donaciones y trasplantes de órganos en Ceará durante la pandemia COVID-19: un estudio descriptivo, abril - junio de 2020 Fall in organ donations and transplants in Ceará in the COVID-19 pandemic: a descriptive study, April - June 2020

Resumo Objetivo Descrever as doações e os transplantes de órgãos no Ceará, Brasil, após a declaração da pandemia da COVID-19. Métodos Estudo descritivo, com dados da Associação Brasileira de Transplantes de Órgãos. O número de doadores e transplantes do período de abril a junho de 2020 foi comparado ao mesmo período de 2019 e ao primeiro trimestre de 2020. Resultados No primeiro semestre de 2020, o estado registrou 72 doadores efetivos. Destes, 17 (23,6%) no segundo trimestre. Dos 352 transplantes do primeiro semestre de 2020, 37 (10,7%) foram realizados no segundo trimestre. Em comparação ao período de abril a junho de 2019, houve redução de 67,9% e 89,3% no número de doadores e transplantes, respectivamente, no mesmo período de 2020. Conclusão Os números de doadores e transplantes do Ceará apresentaram importante declínio nos três meses seguintes ao decreto da pandemia da COVID-19, especialmente os das modalidades de rim, coração e córneas. Resumen Objetivo Describir las donaciones y trasplantes de órganos en Ceará, Brasil, después de la declaración de la pandemia COVID-19. Métodos estudio descriptivo con datos de la Asociación Brasileña de Trasplantes de Órganos. Se comparó el número de donantes y trasplantes de abril a junio de 2020 con el mismo período de 2019 y el primer trimestre de 2020. Resultados El primer semestre de 2020, Ceará registró 72 donantes efectivos. De estos, 17 (23,6%) en el segundo trimestre. De 352 trasplantes realizados en el primer semestre de 2020, 37 (10.7%) fueron realizados en el segundo trimestre. En comparación al período de abril a junio de 2019, hubo reducción de 67,9% y 89,3% en el número de donantes y trasplantes, respectivamente, en el mismo período de 2020. Conclusión El número de donantes y trasplantes en Ceará mostró importante disminución en los tres meses siguientes al decreto pandémico COVID-19, especialmente las modalidades renal, cardíaca y córneas. Objective To describe organ donations and transplants in Ceará state, Brazil, following the declaration of the COVID-19 pandemic. Methods This was a descriptive study using data from the Brazilian Organ Transplantation Association. The number of donors and transplants from April to June 2020 was compared to the same period in 2019 and to the first quarter of 2020. Results In the first half of 2020, the state registered 72 effective donors, just 17 (23.6%) of whom related to the second quarter. Of the 352 transplants in the first half of 2020, 37 (10.7%) were performed in the second quarter. Compared with the period from April to June 2019, there was a reduction of 67.9% and 89.3% in the number of donors and transplants, respectively, in the same period of 2020. Conclusion The number of donors and transplants in Ceará showed an important fall in the three months following the declaration of the COVID-19 pandemic, especially for kidney, heart and cornea transplants.

Disminución de donaciones y trasplantes de órganos en Ceará durante la pandemia COVID-19: un estudio descriptivo, abril - junio de 2020 Fall in organ donations and transplants in Ceará in the COVID-19 pandemic: a descriptive study, April - June 2020

Resumo Objetivo Descrever as doações e os transplantes de órgãos no Ceará, Brasil, após a declaração da pandemia da COVID-19. Métodos Estudo descritivo, com dados da Associação Brasileira de Transplantes de Órgãos. O número de doadores e transplantes do período de abril a junho de 2020 foi comparado ao mesmo período de 2019 e ao primeiro trimestre de 2020. Resultados No primeiro semestre de 2020, o estado registrou 72 doadores efetivos. Destes, 17 (23,6%) no segundo trimestre. Dos 352 transplantes do primeiro semestre de 2020, 37 (10,7%) foram realizados no segundo trimestre. Em comparação ao período de abril a junho de 2019, houve redução de 67,9% e 89,3% no número de doadores e transplantes, respectivamente, no mesmo período de 2020. Conclusão Os números de doadores e transplantes do Ceará apresentaram importante declínio nos três meses seguintes ao decreto da pandemia da COVID-19, especialmente os das modalidades de rim, coração e córneas. Resumen Objetivo Describir las donaciones y trasplantes de órganos en Ceará, Brasil, después de la declaración de la pandemia COVID-19. Métodos estudio descriptivo con datos de la Asociación Brasileña de Trasplantes de Órganos. Se comparó el número de donantes y trasplantes de abril a junio de 2020 con el mismo período de 2019 y el primer trimestre de 2020. Resultados El primer semestre de 2020, Ceará registró 72 donantes efectivos. De estos, 17 (23,6%) en el segundo trimestre. De 352 trasplantes realizados en el primer semestre de 2020, 37 (10.7%) fueron realizados en el segundo trimestre. En comparación al período de abril a junio de 2019, hubo reducción de 67,9% y 89,3% en el número de donantes y trasplantes, respectivamente, en el mismo período de 2020. Conclusión El número de donantes y trasplantes en Ceará mostró importante disminución en los tres meses siguientes al decreto pandémico COVID-19, especialmente las modalidades renal, cardíaca y córneas. Objective To describe organ donations and transplants in Ceará state, Brazil, following the declaration of the COVID-19 pandemic. Methods This was a descriptive study using data from the Brazilian Organ Transplantation Association. The number of donors and transplants from April to June 2020 was compared to the same period in 2019 and to the first quarter of 2020. Results In the first half of 2020, the state registered 72 effective donors, just 17 (23.6%) of whom related to the second quarter. Of the 352 transplants in the first half of 2020, 37 (10.7%) were performed in the second quarter. Compared with the period from April to June 2019, there was a reduction of 67.9% and 89.3% in the number of donors and transplants, respectively, in the same period of 2020. Conclusion The number of donors and transplants in Ceará showed an important fall in the three months following the declaration of the COVID-19 pandemic, especially for kidney, heart and cornea transplants.

Preparation of a radiology department in an Italian hospital dedicated to COVID-19 patients.

Preparedness for the ongoing coronavirus disease 2019 (COVID-19) and its spread in Italy called for setting up of adequately equipped and dedicated health facilities to manage sick patients while protecting healthcare workers, uninfected patients, and the community. In our country, in a short time span, the demand for critical care beds exceeded supply. A new sequestered hospital completely dedicated to intensive care (IC) for isolated COVID-19 patients needed to be designed, constructed, and deployed. Along with this new initiative, the new concept of "Pandemic Radiology Unit" was implemented as a practical solution to the emerging crisis, born out of a critical and urgent acute need. The present article describes logistics, planning, and practical design issues for such a pandemic radiology and critical care unit (e.g., space, infection control, safety of healthcare workers, etc.) adopted in the IC Hospital Unit for the care and management of COVID-19 patients.