Sant'Anna School of Advanced Studies

This systematic review aims to evaluate the impact of multimedia education compared to standard approaches for people with central venous access devices for long-term use. We systematically searched PubMed, Embase, and CINAHL Complete until January 2025. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment. Ten studies were identified (832 patients), including six randomized controlled trials and four quasi-experimental studies. Seven multimedia educational programs used asynchronous methods (e.g. pre-recorded videos or presentations), while three employed synchronous approaches (e.g. tele-visits or virtual communities). Five studies assessed short-term knowledge, with two showing significant improvements and three reporting no differences. Skill acquisition improved in two studies. Cumulative catheter complications decreased in two studies, though findings on specific issues were mixed. These findings suggest potential benefits of multimedia education in patient care, but methodological limitations and study variability render the evidence inconclusive, underscoring the need for high-quality research.

This study aimed to assess prevalence, distribution, severity and clinical correlates of white matter abnormalities (WMAs) at brain magnetic resonance imaging (bMRI) in Behçet's syndrome patients without active Neuro-Behçet's syndrome (NBS). We retrospectively analysed the bMRI scans of a real-world BS cohort without active neurological involvement. The WMAs in the deep and periventricular white matter were assessed using the Fazekas scale, and WMAs were mapped across predefined cerebral regions. Associations with demographic and clinical data, disease activity (Behçet's disease current activity form [BDCAF]), history of chronic headache and active headache at scan time were analysed. Ninety-five patients (F 72%, M 28%) were evaluated. Periventricular WMAs were nearly absent, while DWM-Fazekas scores ranged from 0 to 1. Lesions predominantly involved the sub-cortical region. No significant differences in the severity and distribution of WMAs were observed according to gender or headache history/status. A positive correlation between Fazekas scores and age was observed, whereas deep WMAs negatively correlated with BDCAF. In BS patients without overt neurological involvement, WMAs are infrequent, mild and predominantly age-related rather than disease-related. These findings suggest that incidental WMAs should not automatically be attributed to subclinical NBS. Advanced imaging and controlled studies are needed to further clarify their clinical significance.

Abstract Background Nonischaemic cardiomyopathy (NICM) comprises patients with very different left ventricular (LV) structure and function, different genetic background and different prognosis. Purpose to study genotype-phenotype relationship in NICM and its prognostic significance. Methods All patients with a comprehensive clinical, genetic and CMR assessment and with LV ejection fraction (LVEF) <55% were retrospectively included. Patients with coronary artery disease, valvular, congenital, hypertrophic, inflammatory or infiltrative disease were excluded. The primary endpoint was a composite of cardiovascular death, sustained ventricular arrhythmias or appropriate defibrillator intervention. The secondary endpoint included also heart failure hospitalizations. Results The cohort included 249 patients (age 53±14 years, 166 males) with median LVEF 45% (IQ range 33-51%), divided in 143 dilated (DCM) and 106 non-dilated (NDLVD) patients. A pathogenic/likely pathogenic (P/LP) mutation was present in 67 (27%), and was not associated with LV dilation, dysfunction or tissue characteristics at CMR . During a 72 (35-119) month follow-up, 54 patients (22%) experienced the composite event (36 sustained ventricular arrhythmias, 18 cardiovascular deaths), 67 patients the secondary endpoint (27%). At multivariate analysis, male sex, disease duration, NT-proBNP, non-sustained ventricular arrhythmias at 24-hour Holter monitoring, LVEF, left atrial volume and CMR-derived LV filling pressure were all predictors of the primary endpoint (p<0.05). Moreover, disease duration, NT-proBNP, non-sustained ventricular arrhythmias at 24-hour Holter monitoring, RVEF and CMR-derived LV filling pressure were all predictors of the secondary endpoint (p<0.05). The presence of P/LP mutations did not predict prognosis. Conclusions In patients with non ischaemic cardiomyopathy, LV and RV systolic dysfunction, left atrial volume and CMR-derived LV filling pressure were predictors of major cardiovascular events independently from established clinical factors, while gene mutations were not.

ABSTRACT Both Sri Lanka and Israel entered the Westphalian epoch in 1948, but the relationship between the two states remained fragile from the beginning. The father of the nation and the first premier of Ceylon, D. S. Senanayake, was among the first world leaders to recognise the independent State of Israel, but the subsequent political upheavals that took place in Sri Lanka weakened the budding stage of Israeli–Sri Lanka relations. In particular, Sirimavo Bandaranaike’s relations with the Arab world and promoting the non-aligned movement deteriorated Israeli–Sri Lankan relations. Anti-colonial and anti-capitalist slogans were gleefully welcomed in the non-aligned platform with a special emphasis on the national liberation movements in which the Palestinian cause was highlighted. This paper examines the many ups and downs that shaped Sri Lanka–Israel relations while assessing how Sri Lanka’s internal politics and security dilemmas hampered Israel–Sri Lanka relations. This paper also evaluates the security partnership between the two states.

Abstract As part of the Journal of Management and Organization’s 30th birthday celebration it is important to reflect and consider what is valuable advice. This perspective article is coauthored by a number of academics and brings together their thoughts about value in management practice. An international array of management teachers and researchers provide their advice in the hope of inspiring future generations of management researchers.

This case report describes the successful treatment of a 15-year-old male with severe hidradenitis suppurativa (HS) using bimekizumab. The patient, previously unresponsive to adalimumab, showed significant clinical and psychological improvement after 6 months of treatment, highlighting the potential of bimekizumab as a therapeutic option for paediatric HS.

Transcatheter aortic valve replacement (TAVR) is the standard treatment for severe aortic stenosis (AS) in select patients. While membranous septum length and pre-TAVR conduction disturbances are known predictors of permanent pacemaker implantation (PPI), the impact of muscular interventricular septal (IVS) thickness, assessed via pre-procedural computed tomography (CT), remains unclear. The aim of the study was to evaluate the role of septal thickness with cardiac CT in predicting the need for PPI after TAVR. This retrospective cohort study analyzed patients undergoing TAVR between January 2019 and December 2022. IVS thickness was measured in end-systole at various levels below the membranous septum on pre-procedural CT scans. Multivariable logistic regression models assessed predictors of PPI, including IVS thickness. Among the 338 patients (median age: 81years; 42.6% women), 20.1% required PPI post-TAVR. Patients needing PPI had significantly lower IVS thickness 2mm (3.9±0.8mm vs. 4.5±1.3mm, p<0.001), 5mm (5.9±1.1mm vs. 6.8±1.8mm, p<0.001), and 10mm (9.3±1.1mm vs. 10.6±2.3mm, p<0.001) below the membranous septum. Multivariable analysis identified IVS thickness at 10mm (HR: 0.73, 95% CI: 0.56-0.96, p=0.023), membranous septum length (HR: 0.79, 95% CI: 0.67-0.94, p=0.007), and right bundle branch block (HR: 7.70, 95% CI: 3.70-15.90, p<0.001) as independent predictors of PPI. IVS thickness on pre-procedural CT independently predicts PPI post-TAVR and improves risk stratification.

Virtual reality (VR) technologies have emerged as valuable tools for medical and emergency training, providing safe, immersive, and repeatable environments where complex procedures can be practiced effectively. This article presents an immersive VR system designed to train workplace first-aid responders, with a particular focus on cardiopulmonary resuscitation (CPR). The platform integrates a physical CPR manikin with virtual patient overlays through mixed-reality calibration, incorporates realistic emergency scenarios with environmental hazards, and enables synchronous multiuser interaction between trainees and instructors. To assess its potential, we provide a detailed description of the system's architecture and functionalities, introducing the results of an extensive user study employing validated questionnaires on usability, performance, and user experience. The proposed framework contributes to the advancement of VR-based medical education, highlighting its benefits, current limitations, and future research opportunities.

Fasting hyperinsulinaemia is a key feature of obesity and is implicated in diabetes progression. However, the following aspects of insulin secretion remain unclear: (1) which index of obesity is most important; (2) what is the shape of the dose-response curve between obesity and insulin secretion; (3) what physiological mechanisms sustain insulin hypersecretion; (4) what are the underlying causes; and (5) whether sex-related differences exist. We analysed data from 1250 healthy participants (547 men, 703 women) of the EGIR-RISC cohort followed up for 3.5 years, with age 30-60 years and BMI 18.5-40.0 kg/m2. Assessments included body composition, insulin secretion, beta cell function modelling from an OGTT and clamp-derived insulin sensitivity. Endogenous glucose production (EGP)was measured in a subset of 368 participants. Multivariable regression models and stratifications for BMI, body fat per cent, WHR and fat mass were applied to evaluate the effect of obesity on insulin secretion and beta cell function. The impact of obesity on fasting insulin secretion (FIS) was continuous across the full spectrum of BMI and WHR valuesand was greater in men than women. Among adiposity indices, fat mass (standardised β coefficient [Stβ] 0.27, p<0.0001) and waist circumference (Stβ 0.21, p<0.0001) were the strongest predictors of FIS. Insulin secretion increased 2.4-fold across BMI deciles, and adiposity-associated insulin hypersecretion appeared to be driven by the combination of hyperglycaemia and an increase in a specific beta cell functionvariable (insulin secretion rate at 5 mmol/l glucose [ISR@5]). In the follow-up cohort, weight gain (mean ± SD ∆ weight=+5.1±3.8 kg) was associated with an increase in FIS and fasting glucose (+0.20±0.63 mmol/l, p<0.03), whereas weight loss (-4.7±2.8 kg) led to a reduction in FIS and fasting glucose (+0.06±0.55 mmol/l, p<0.006). ISR@5 declined in both weight losers and those with stable weight (-0.17±1.9 and -0.16±1.0 U/h, respectively; p<0.002 for both) but not in weight gainers (-0.06±1.1 U/h). Peripheral insulin resistance, plasma NEFA and leptin accounted for only part of obesity's effect on insulin secretion. Subset analysis of fasting and clamp EGP data suggested a rightwards shift in the dose-response curve across fat mass quintiles, indicating progressive hepatic glucose overproduction despite a preserved hepatic insulin response. The effect of body mass on insulin secretion is continuous, more pronounced in men, driven by fat mass and waist, sustained by hyperglycaemia and by an upregulation of beta cell insulin secretion and is only partially explained by typical hormonal and metabolic consequences of obesity. We suggest that hepatic glucose overproduction contributes to the fasting hyperinsulinaemia observed in individuals with obesity.