Association Between Sex Hormone Levels and Clinical Outcomes in Patients With COVID-19 Admitted to Hospital: An Observational, Retrospective, Cohort Study

Understanding the cause of sex disparities in COVID-19 outcomes is a major challenge. We investigate sex hormone levels and their association with outcomes in COVID-19 patients, stratified by sex and age. This observational, retrospective, cohort study included 138 patients aged 18 years or older with COVID-19, hospitalized in Italy between February 1 and May 30, 2020. The association between sex hormones (testosterone, estradiol, progesterone, dehydroepiandrosterone) and outcomes (ARDS, severe COVID-19, in-hospital mortality) was explored in 120 patients aged 50 years and over. STROBE checklist was followed. The median age was 73.5 years [IQR 61, 82]; 55.8% were male. In older males, testosterone was lower if ARDS and severe COVID-19 were reported than if not (3.6 vs. 5.3 nmol/L, p =0.0378 and 3.7 vs. 8.5 nmol/L, p =0.0011, respectively). Deceased males had lower testosterone (2.4 vs. 4.8 nmol/L, p =0.0536) and higher estradiol than survivors (40 vs. 24 pg/mL, p = 0.0006). Testosterone was negatively associated with ARDS (OR 0.849 [95% CI 0.734, 0.982]), severe COVID-19 (OR 0.691 [95% CI 0.546, 0.874]), and in-hospital mortality (OR 0.742 [95% CI 0.566, 0.972]), regardless of potential confounders, though confirmed only in the regression model on males. Higher estradiol was associated with a higher probability of death (OR 1.051 [95% CI 1.018, 1.084]), confirmed in both sex models. In males, higher testosterone seems to be protective against any considered outcome. Higher estradiol was associated with a higher probability of death in both sexes.The research was funded by Italian Ministry of Health “Fondi Ricerca Corrente, Project L1P5” for IRCCS Sacro Cuore Don Calabria Hospital. The funding source had no role in the collection, analysis, or interpretation of data, the study design, or the writing of the paper.Peer reviewe

Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Collateral, mutual guarantees and the entrepreneurial orientation of SMEs

Purpose: The purpose of this paper is to investigate whether guarantees characterised by different degrees of relationship lending (particularly referring to collateral and guarantees provided by Mutual Loan Guarantee Institutions) are able to convey some entrepreneurial orientation (EO) dimensions from firms to banks. Design/methodology/approach: Exploiting data from a survey of Austrian and Italian SMEs, the empirical analysis is based on a sample of 328 small business firms. To test the signalling hypothesis, the authors used logistic regressions to assess the explanatory power of EO dimensions on the presence of several types of guarantees. Findings: The analyses suggest that collateral cannot signal any EO dimension, even when controlling for the strength of the bank – firm relationship. Furthermore, SMEs are able to mitigate their financial risk through collateral only in a multiple bank – firm relationship. Lastly, innovativeness, competitive energy and aggressiveness allow SMEs to obtain external guarantees (mutual guarantees, bank guarantees and public guarantees, respectively), helpful in order to promote credit access. Research limitations/implications: The mediation role of collateral and external guarantees on EO – credit access relation should be analysed in future research. Since the role of guarantees can change among different bank lending technologies, further studies should carefully consider lender’s characteristics. Lastly, the use of loan data in respect of the firm data can help to better separate the effect of loan and firm attributes on the collateral. Practical implications: The study suggests how managers and entrepreneurs should manage the financial risk through collateral in different situations (one–to–one and multiple bank – firm relationship). Furthermore, depending on the level of innovativeness, competitive energy and aggressiveness, a firm should request a specific type of external guarantees in order to increment the credit availability, to maximise the possibility of success and to improve its performance. Originality/value: To the authors’ knowledge, this paper is the first attempt to analyse whether EO affects the request for guarantees instead of credit access. This can be helpful especially when the banks involved in the relation apply a transaction lending technology

Strumenti finanziari a supporto dello sviluppo delle PMI

Il presente libro giunge a compendio del Progetto di ricerca Interreg IV Italia- Austria intitolato "Strumenti Finanziari a Supporto dello sviluppo delle P.M.I." che ha visto il Dipartimento di Scienze Economiche e Statistiche dell'Università di Udine quale Lead Partner. Lo studio si inserisce in un contesto nel quale per ragioni tanto strutturali quanto congiunturali le piccole e medie imprese soffrono rilevanti vincoli finanziari che ne comprimono le potenzialità competitive con particolare riferimento ai processi di innovazione ed internazionalizzazione. Il lavoro si articola come segue. Dapprima si fornisce il quadro concettuale di riferimento entro il quale calare le criticità connesse alla gestione finanziaria e manageriale delle PMI. Saranno, pertanto, trattate sotto un profilo teorico le problematiche connesse ai vincoli finanziari per la piccola e media impresa e le relative determinanti. Successivamente, saranno presentati e discussi gli archetipi di riferimento della teoria dell'entrepreneurship. Il volume, poi, presenta i risultati dell'indagine condotta mediante somministrazione di un questionario ad un campione di PMI. In particolare, saranno indagate una serie di relazioni rilevanti tra variabili espressive dei comportamenti manageriali e variabili rappresentative dei rapporti col sistema finanziario. L'obiettivo di fondo è individuare i fabbisogni finanziari rilevanti delle PMI nelle aree di programma ed i profili di soddisfazione verso il sistema finanziario. Sulla scorta dei risultati ottenuti, si provvederà a tratteggiare i profili e gli elementi economici di modelli di finanziamento coerenti con le specificità delle PMI

Growth Plate Lesions of 62 Fattening Bulls From An Abattoir In The North-East of Italy

Introduction: Lameness caused by growth plate lesions is a problem in beef cattle; however, there are no recent reports on this topic. This paper describes the macroscopic and microscopic lesions of the distal metatarsal physis of bulls from farms in North-Eastern Italy. Materials and Methods: The distal metatarsal physes from 62 bulls of 16.44 1.72 months of age were examined; 12 bulls were slaughtered due to severe lameness (group A) and 50 were slaughtered with no signs of lameness (group B). Animals were from the same area and shared similar intensive husbandry practices and diet. Grossly, 124 metatarsi were examined. Four distal metatarsal bones from grossly normal bulls, 24 from group A and 18 from group B with macroscopic lesions, were examined microscopically. Results: Macroscopic lesions present in group A bulls included one example of bilateral purulent chronic physitis (PCP), seven of unilateral PCP, three of bilateral physeal osteochondrosis (OCD), six of unilateral OCD and three of unilateral purulent tenosynovitis. Nineteen bulls (38%) from group B also had macroscopic OCD lesions (13 bilateral and six unilateral), confirmed by histology in six cases. On microscopic examination, severe segmental thickening of the hypertrophic zone was present, consistent with physeal OCD. In animals with PCP, the physis was necrotic with eosinophilic cartilage matrix, extensive neutrophilic infiltrate, haemorrhage and fibrin deposition. Conclusions: A high incidence of OCD was found in lame and nonlame fattening bulls. Haematogenous bacterial implantation in the metaphysis led to a purulent physitis that resulted in severe lameness and necessitated emergency slaughter of affected animals