Antiproliferative Effects in Colorectal Cancer and Stabilisation in Cyclodextrins of the Phytoalexin Isorhapontigenin.

Isorhapontigenin has been proposed as a better alternative for oral administration than the famous resveratrol, as it shares many biological activities, but with a structure that could make its delivery easier. Although this hydrophobic structure could enhance bioavailability, it could also be a disadvantage in the development of products. In this research, we study the antiproliferative activity of this stilbene against colorectal cancer and overcome its limitations through molecular encapsulation in cyclodextrins. The cytotoxic activity against human colorectal cancer cells of isorhapontigenin was similar to that of resveratrol or piceatannol, supporting its use as a bioactive alternative. The study of the encapsulation through fluorescence spectroscopy and molecular docking revealed that the complexation satisfies a 1:1 stoichiometry and that HP-ß-CD is the most suitable CD to encapsulate this stilbene. Through a spectrophotometric assay, it was observed that this CD could double the basal water solubility, exceeding the solubility of other hydroxylated stilbenes. The stability of these inclusion complexes was higher at a pH below 9 and refrigeration temperatures. Moreover, the use of CDs retained more than 78% of isorhapontigenin after storage for 12 weeks, compared to 15% in free form. Overall, these findings could help design novel formulations to better deliver isorhapontigenin.

Improvement of the Physicochemical Limitations of Rhapontigenin, a Cytotoxic Analogue of Resveratrol against Colon Cancer.

It has been argued that methoxylated stilbenes are better candidates for oral administration than hydroxylated stilbenes, including resveratrol, as they share many biological activities but have better bioavailability. By contrast, they have a disadvantage to consider, i.e., their lower hydrophilic character that leads to precipitation issues in the final product. In this work, we analysed and compared the growth inhibition of colorectal cancer cells of the methoxylated stilbene rhapontigenin and some analogues and overcame potential problems in the development of fortified products by designing inclusion complexes. Among several cyclodextrins, we found the one that best fit the molecule by physicochemical and bioinformatics assays. The stoichiometry and the encapsulation constants with natural and modified cyclodextrins were determined by fluorescence spectroscopy. The most promising complexes were analysed at different temperature and pH conditions, determining the thermodynamic parameters, to discover the optimal conditions for the preparation and storage of the products. The results showed that rhapontigenin solubility and stability were significantly improved, achieving a sevenfold increase in water solubility and maintaining more than 73% of the stilbene after three months. These findings could be of great interest for industries that aim to deliver novel bioactive compounds with higher solubility and lower degradation.

Stilbenes: Characterization, bioactivity, encapsulation and structural modifications. A review of their current limitations and promising approaches.

Stilbenes are phenolic compounds naturally synthesized as secondary metabolites by the shikimate pathway in plants. Research on them has increased in recent years due to their therapeutic potential as antioxidant, antimicrobial, anti-inflammatory, anticancer, cardioprotective and anti-obesity agents. Amongst them, resveratrol has attracted the most attention, although there are other natural and synthesized stilbenes with enhanced properties. However, stilbenes have some physicochemical and pharmacokinetic problems that need to be overcome before considering their applications. Human clinical evidence of their bioactivity is still controversial due to this fact and hence, exhaustive basis science on stilbenes is needed before applied science. This review gathers the main physicochemical and biological properties of natural stilbenes, establishes structure-activity relationships among them, emphasizing the current problems that limit their applications and presenting some promising approaches to overcome these issues: the encapsulation in different agents and the structural modification to obtain novel stilbenes with better features. The bioactivity of stilbenes should move from promising to evident.

Foville syndrome: a neurological emergency of clinical relevance. case report

Introduction: Foville syndrome (inferior medial pontine syndrome) is a clinical entity that makes part of a subclassification of a broader category of posterior circulation stroke. It is characterized by a blockage of the basilar artery caused by lesions in the pontine tegmentum. This syndrome has a very low incidence worldwide, but its clinical relevance is considerable. Case report: A 41-year-old patient without any medical history was admitted to the emergency department due to signs of focal neurologic deficits. Imaging findings were compatible with an ischemic lesion in the brainstem, and cerebral angiography showed involvement of the basilar artery territory. The patient was diagnosed and followed up in the intensive care unit (ICU) until his recovery. Conclusion: Foville syndrome is a rare disease with high morbidity and mortality. Early recognition and a multidisciplinary approach are decisive to improve the patient's prognosis.

Introducción. El síndrome de Foville (síndrome pontino medial inferior) es una entidad clínica que hace parte de una subclasificación de la categoría más amplia de eventos cerebrovasculares de la circulación posterior, se presenta como resultado de la oclusión de la arteria basilar debido a lesiones en el tegmento pontino. Este síndrome tiene una muy baja incidencia a nivel mundial, pero es de gran relevancia clínica. Presentación del caso. Hombre de 41 años sin antecedentes patológicos, que ingresó al servicio de urgencias por signos de focalización neurológica. Sus hallazgos imagenológicos fueron compatibles con una lesión isquémica en el tronco encefálico y la angiografía cerebral evidenció un compromiso en el territorio de la arteria basilar. El paciente fue diagnosticado y se le dio seguimiento en la unidad de cuidados intensivos (UCI) hasta su rehabilitación. Conclusión. El síndrome de Foville es una enfermedad infrecuente y de alta mortalidad. El reconocimiento temprano de esta afección y un abordaje multidisciplinario son determinantes para mejorar el pronóstico del paciente.

Development if healthy milk and yogurt products for reducing metabolic diseases using cyclodextrin and omega-3 fatty acids from fish oil.

The food industry is constantly attempting to develop better products that will have a positive effect on health. Feiraco® and Clesa®, expressed their intention to create novel products using UNICLA® milk as a matrix to develop functional foods. In this respect, ß-cyclodextrin (ß-CD) at 1% was able to reduce the cholesterol concentration in Feiraco-UNICLA® milk products by around 87-85%. Products were fortified with omega-3 from fish oil with α- and ß-CD acting as carriers. It was possible to add around 50% of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) Recommended Dietary Allowances (RDA), with a high diet proportion of fibre and similar organoleptic properties to commercial omega-3 products. 80% of a sensory panel found our formulations satisfactory. The final product was stable, and the bioaccessibilty of the fatty acids added to the milk was around 74%. These results as a whole satisfy the aid of Feiraco® and Clesa® to develop improved products.

Expectations and Experiences of Spanish Primiparous Women Who Decide to Breastfeed Their Infants and Strategies for Change in 2020-A Qualitative Study.

To describe the experiences and expectations of Spanish women regarding breastfeeding and the support they receive from healthcare professionals, family, and friends during the breastfeeding journey, A qualitative study using an empirical-phenomenological approach was conducted. Primiparous women that had already given birth were interviewed using a purposive and snowball sampling. In-depth interviews were conducted between 1 January and 30 April 2020. The interviews were transcribed verbatim and analysed using Haase's adaptation of Colaizzi's phenomenological method. We recruited 14 women who had recently become mothers. Three major themes describing experiences of infant feeding by maternal lactation were identified-institutional influences, establishing breastfeeding, and cessation of breastfeeding-as well as the following 10 categories: hospital routines, lactation concerns (amount and infant nutrition), antenatal breastfeeding decision, embarrassment to breastfeed, and normalisation of breastfeeding. Prior education and support were identified as key elements in possible breastfeeding support strategies.

Estudio transversal sobre factores relacionados con el dolor crónico y su atención, según sexo / Cross-sectional study on factors related to chronic pain and its care, according to sex

Objetivo: Describir las características sociodemográficas, clínicas y terapéuticas de las personas con dolor crónico no oncológico, según sexo.Pacientes y método: Estudio transversal en la Unidad del Dolor del Complejo Asistencial Universitario de Salamanca entre marzo y septiembre de 2020. Se realizó un muestreo consecutivo, obteniendo 105 pacientes. Los datos se extrajeron de las historias clínicas (HHCC) para las variables clínicas y un cuestionario realizado ad hoc para las variables demográficas y socioeconómicas. Se realizó un análisis descriptivo de las variables, según sexo.Resultados: La mayoría de los pacientes con dolor crónico son mujeres (61,9 %) de 56 años, españolas, con residencia en Salamanca y con pareja. Su nivel de estudios es medio/bajo y están en situación de desempleo (p = 0,007). No son las principales proveedoras económicas del núcleo familiar (p < 0,00) y sus ingresos son inferiores a 950 euros al mes (p = 0,001). Poseen vivienda y conviven con otras personas. Su principal actividad son labores domésticas o de cuidados (p = 0,008). Padecen dolor musculoesquelético secundario crónico asociado a alteraciones estructurales, con lumbalgia crónica inespecífica como el diagnóstico más frecuente. Tienen más patologías concomitantes que los hombres, siendo la HTA la más frecuente, y los trastornos psiquiátricos más prevalentes en ellas. Están tratadas con analgésicos y bloqueos de nervios periféricos, respondiendo favorablemente.Conclusión: Identificar la mayor frecuencia de mujeres, con su contexto sociodemográfico y clínico específico, refleja la necesidad de abordar el sexo y los roles de género, y así tenerlos en cuenta a la hora de evaluar cómo influyen ambos en la vivencia del dolor crónico y de cómo llevar a cabo la asistencia y el manejo de nuestros pacientes.(AU)

Objective: To describe the sociodemographic, clinical and therapeutic characteristics of people with chronic non-oncologic pain, according to sex.Patients and method: Cross-sectional study in the Pain Unit of the Complejo Asistencial Universitario de Salamanca between March and September 2020. Consecutive sampling was performed, obtaining 105 patients. Data were extracted from the medical records (HHCC) for clinical variables and an ad hoc questionnaire for demographic and socioeconomic variables. A descriptive analysis of the variables was performed according to sex.Results: Most of the patients with chronic pain were women (61.9 %) aged 56 years, Spanish, living in Salamanca and with a partner. Their level of education is medium/low and they are unemployed (p = 0.007). They are not the main economic providers of the family nucleus (p < 0.00) and their income is less than 950 euros per month (p = 0.001). They own a house and live with other people. Their main activity is domestic or care work (p = 0.008). They suffer from chronic secondary musculoskeletal pain associated with structural alterations, with non-specific chronic low back pain as the most frequent diagnosis. They have more concomitant pathologies than men, with HT being the most frequent, and psychiatric disorders more prevalent in them. They are treated with analgesics and peripheral nerve blocks, responding favorably.Conclusion: Identifying the higher frequency of women, with their specific sociodemographic and clinical context, reflects the need to address sex and gender roles and thus take them into account when assessing how both influence the experience of chronic pain and how to carry out the care and management of our patients.(AU)

Experiences and Perceptions of Nursing Students during the COVID-19 Crisis in Spain.

In the early stages of the 2019 coronavirus pandemic in Spain, the Spanish health system was overwhelmed, mainly due to a lack of personnel, and many hospital centers collapsed by following avalanche of patients with COVID-19; this meant that the National System of Health called for fourth-year nursing students to come to the hospital as health care personnel. Our aim was to describe the perceptions and experiences of a sample of nursing students during the early stages of the outbreak. We conducted a qualitative study with an empirical-phenomenological approach. Twenty nursing students in their final year of study in Spain were recruited using purposive and snowball sampling. They participated in in-depth interviews between 20 April and 10 May 2020. The interviews were transcribed and then analyzed using Haase's adaptation of Colaizzi's phenomenological method. Four main themes emerged from data analysis: "social responsibility and pride as a health worker", "pressure caused by working with COVID-19 patients", "feeling defenseless and let down", and "personal growth as a health worker". These main themes were further divided into 11 theme categories. Due to an intense work day for several days in a row, the students were tired and mentally exhausted. Even so, they managed to overcome any difficulties, demonstrating their professional dedication and resilience. Greater preparatory support should be provided to safeguard the well-being of these future healthcare providers. More intensive preparatory training is necessary for health sciences students to facilitate crisis preparedness and effective crisis management. It is necessary to implement support from healthcare systems, including sufficient personal protective equipment, as well as contracts that accurately reflect the work they do. It is necessary for nursing supervisors to have effective communication in the performance of their functions with nursing students; this dialogue helps to clearly explain which are the functions that students must perform when they are carrying out their internships. There is also a need for preparatory training in managing infectious diseases such as COVID-19.

Máscara laríngea I-Gel® versus bolsa-válvula-mascarilla en la reanimación cardiopulmonar instrumental bajo monitorización capnográfica: ensayo clínico piloto aleatorizado por grupos / I-Gel® laryngeal mask versus bag-valve-mask in instrumental cardiopulmonary resuscitation under capnographic monitoring: Cluster-randomized pilot clinical trial

Objetivo: Comparar la vía aérea básica y la vía aérea avanzada con el dispositivo supraglótico I-Gel®, por medio de la capnografía durante la RCP intermedia. Diseño: Estudio piloto experimental aleatorizado por grupos. Emplazamiento: Asistencia extrahospitalaria en unidades de soporte vital básico en la isla de Mallorca. Participantes: Adultos atendidos tras parada cardiorrespiratoria de origen no traumático. Intervenciones: Manejo de la vía aérea avanzado durante la RCP instrumental con I-Gel® o básica con bolsa-válvula-mascarilla, bajo monitorización capnográfica. Mediciones principales: Niveles capnométricos obtenidos según dispositivo empleado, número de inserciones de la I-Gel®, casos sin conseguir una correcta inserción/ventilación por ramas, consecución de ROSC en la RCP y número de ingresos vivos hospitalarios. Resultados: Se reclutaron 23 casos para su análisis. La tasa de éxito de inserción de la I-Gel® fue 92,9% al primer intento, los valores capnométricos medios fueron de 16,3mmHg en grupo control y de 27,4% en el grupo intervención. El 34,8% (n=8) de los pacientes alcanzó recuperación, circulación espontánea en algún momento y el 26,1% (n=6) ingresaron vivos en el hospital. El análisis de supervivencia, atendiendo a la llegada de la unidad y el primer minuto de ventilaciones registrados junto a la variable ingreso vivo hospitalario sugiere una cierta tendencia hacia una mayor supervivencia en la rama intervención (P=0,066). Conclusiones: El uso de la I-Gel® suscita una mejora en la ventilación de los pacientes en PCR, evidenciado por los valores capnométricos medios en el grupo intervención, no encontrándose correlación con variables de resultado de la RCP.(AU)

Objective: To compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR. Design: Randomized experimental pilot study by groups. Setting: Out-hospital care basic life support units on the Island of Mallorca. Participants: Adults attended after cardiorespiratory arrest of non-traumatic origin. Interventions: Advanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring. Main measurements: Capnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions. Results: Twenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3mmHg in the control group and 27.4% in the intervention group. 34.8% (n=8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n=6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P=.066). Conclusions: The use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.(AU)

[I-Gel® laryngeal mask versus bag-valve-mask in instrumental cardiopulmonary resuscitation under capnographic monitoring: Cluster-randomized pilot clinical trial]. / Máscara laríngea I-Gel® versus bolsa-válvula-mascarilla en la reanimación cardiopulmonar instrumental bajo monitorización capnográfica: ensayo clínico piloto aleatorizado por grupos.

OBJECTIVE: To compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR. DESIGN: Randomized experimental pilot study by groups. SETTING: Out-hospital care basic life support units on the Island of Mallorca. PARTICIPANTS: Adults attended after cardiorespiratory arrest of non-traumatic origin. INTERVENTIONS: Advanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring. MAIN MEASUREMENTS: Capnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions. RESULTS: Twenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3mmHg in the control group and 27.4% in the intervention group. 34.8% (n=8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n=6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P=.066). CONCLUSIONS: The use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.

Fracturas de columna posterior de acetábulo tratadas mediante tornillo ilioisquiático retrógrado percutáneo. Serie de casos / Posterior spine acetabulum fractures treated with percutaneous retrograde ilioischial screw. Number of cases

Introducción: Las fracturas de acetábulo suponen un reto para los traumatólogos. Tradicionalmente el tratamiento de estas fracturas ha sido la reducción abierta y fijación interna, sin embargo, recientemente se han popularizado técnicas percutáneas para el tratamiento de fracturas no desplazadas o mínimamente desplazadas. En este estudio exponemos nuestros resultados en pacientes tratados mediante fijación percutánea con un tornillo ilioisquiático retrógrado de fracturas no desplazadas de columna posterior. Material y Métodos: Desde 2016 a 2020, Ocho varones con una edad media de 59,75 años (27-79), fueron intervenidos en nuestro centro de fracturas simples o combinadas de columna posterior no desplazadas mediante tornillo ilioisquiático retrógrado percutáneo. Realizamos una evaluación postoperatoria mediante el WOMAC Score y el Oxford Hip Score. Registramos complicaciones. Resultados: Los resultados postoperatorios del cuestionario WOMAC fueron 81,24 de media (50-100) y los resultados del Oxford Hip Score 36,42 de media (22-45). Un paciente desarrolló una coxartrosis secundaria a infección del material de osteosíntesis que requirió de artroplastia total de cadera. Un paciente falleció por motivos no relacionados con la fractura. Conclusiones: El tratamiento percutáneo constituye una de las herramientas terapéuticas para el manejo de estas fracturas, con bajas tasas de lesiones neurovasculares, calcificaciones heterotópicas, infecciones, y escaso sangrado quirúrgico.(AU)

Introduction: Acetabulum fractures present a challenge for orthopedic surgeons. Traditionally the usual treatment of these fractures has been open reduction and internal fixation. However, percutanous techniques have recently become popular for the treatment of minimally displaced fractures. In the present paper the results in a group of patients treated by percutaneous fixation with a retrograde ilioischial screw are reported. Material and methods: From 2016 to 2020, Eight men with a mean age of 59.75 years (27-79) were operated on in our center for undisplaced simple or combined posterior column fractures using a percutaneous retrograde ilioischial screw. We performed a postoperative evaluation using the WOMAC Score and the Oxford Hip Score. The number and kind of complications are analyzed. Results: The postoperative results of the WOMAC questionnaire were 81.24 on average (50- 100) and the results of the Oxford Hip Score were 36.42 on average (22-45). One patient developed coxarthrosis secondary to infection of the osteosynthesis material that required total hip arthroplasty. One patient died for reasons unrelated to the fracture. Conclusions: Percutaneous treatment constitutes one of the therapeutic tools for the management of these fractures, with low rates of neurovascular injuries, heterotopic calcifications, infections, and little surgical bleeding.(AU)

Mutación p. RQ92 asociada a amiloidosis / p. RQ92 mutation associated with amyloidosis

La amiloidosis secundaria puede encontrarse en algunas enfermedades autoinflamatorias monogénicas. Presentamos el caso de un varón de 83 años sin antecedentes patológicos de interés. Tras detectarse una anemia ferropénica, se realizó una gastroscopia y la biopsia duodenal evidenció amiloidosis secundaria de tipo AA. El estudio de enfermedades autoinflamatorias reveló la variante heterocigota p.R92Q en el gen TNFRSF1A, siendo negativas las pruebas complementarias para otras causas de amiloidosis. En el síndrome TRAPS la amiloidosis secundaria puede asociarse a mutaciones que afectan a residuos cisteína, no habiéndose evidenciado su asociación con la variante p.R92Q. La amiloidosis secundaria puede estar presente en individuos portadores de la variante p.RQ92, por lo que es importante su diagnóstico para intentar prevenir posibles complicaciones.(AU)

Secondary amyloidosis can be found in some monogenic autoinflammatory diseases. In this study we present an 83-year-old man with no relevant medical history who presented with iron deficiency anaemia. In the study, a gastroscopy was performed with duodenum biopsy showing secondary AA-type amyloidosis. Genetic analyses of monogenic autoinflammatory diseases revealed the heterozygous p.R92Q variant in the TNFRSF1A gene, with negative results in the complementary tests for other causes of amyloidosis. In TRAPS, secondary amyloidosis has usually been associated with mutations affecting cysteine residues, but until now no association has been demonstrated with the p.RQ92 variant. Secondary amyloidosis may be present in carriers of the p.RQ92 variant, therefore it is important to diagnose it to prevent possible complications.(AU)

p.RQ92 mutation associated with amyloidosis. / Mutación p.RQ92 asociada a amiloidosis.

Secondary amyloidosis can be found in some monogenic autoinflammatory diseases. In this study we present an 83-year-old man with no relevant medical history who presented with iron deficiency anaemia. In the study, a gastroscopy was performed with duodenum biopsy showing secondary AA-type amyloidosis. Genetic analyses of monogenic autoinflammatory diseases revealed the heterozygous p.R92Q variant in the TNFRSF1A gene, with negative results in the complementary tests for other causes of amyloidosis. In TRAPS, secondary amyloidosis has usually been associated with mutations affecting cysteine residues, but until now no association has been demonstrated with the p.RQ92 variant. Secondary amyloidosis may be present in carriers of the p.RQ92 variant, therefore it is important to diagnose it to prevent possible complications.

Use of supraglottic airway devices under capnography monitoring during cardiopulmonary resuscitation: A systematic review.

BACKGROUND: Bag-valve-mask ventilation is the most commonly applied method during cardiopulmonary resuscitation. Globally, advanced airway management with blind insertion devices such as supraglottic airway devices has been implemented for years by different emergency services. The efficiency of ventilation via such devices could be measured by capnography. OBJECTIVE: The objective of this study was to determine whether capnography is useful in patients undergoing cardiopulmonary resuscitation and to assess the effectiveness of ventilation via supraglottic airway devices. REVIEW METHODS USED: This is a systematic review written following the steps of Preferred Reporting Items for Systematic Review and Meta-analyses protocols. DATA SOURCES: A bibliographic search was carried out from the following databases: EBSCOhost, Scopus, EMBASE, Virtual Health Library, PubMed, Cochrane Library, Spanish Medical Index, Spanish Bibliographic Index in Health Sciences, and Latin American and Caribbean Health Sciences Literature, from inception until September 2019. REVIEW METHODS: Studies describing the use of capnography with supraglottic airway devices during cardiopulmonary resuscitation manoeuvres were selected and evaluated using the Critical Appraisal Skills Programme. RESULTS: Twenty-four articles were identified by title and abstract: six were randomised clinical trials, 11 were nonrandomised clinical trials, six were descriptive prospective studies, and one was a descriptive retrospective study. Nine primary research articles were selected for synthesis. Only one provided objective values of capnography obtained with ventilation with these devices, correlating them with the results of resuscitation. CONCLUSIONS: The evidence published so far is scarce, mostly from observational studies with high risk of bias in general. Although a degree of recommendation cannot be established, some results indicate that capnography has the potential to facilitate advanced clinical practice of ventilation with supraglottic airway devices during cardiopulmonary resuscitation.

Congestive Hepatopathy.

Liver disease resulting from heart failure (HF) has generally been referred as "cardiac hepatopathy". One of its main forms is congestive hepatopathy (CH), which results from passive venous congestion in the setting of chronic right-sided HF. The current spectrum of CH differs from earlier reports with HF, due to ischemic cardiomyopathy and congenital heart disease having surpassed rheumatic valvular disease. The chronic passive congestion leads to sinusoidal hypertension, centrilobular fibrosis, and ultimately, cirrhosis ("cardiac cirrhosis") and hepatocellular carcinoma after several decades of ongoing injury. Contrary to primary liver diseases, in CH, inflammation seems to play no role in the progression of liver fibrosis, bridging fibrosis occurs between central veins to produce a "reversed lobulation" pattern and the performance of non-invasive diagnostic tests of liver fibrosis is poor. Although the clinical picture and prognosis is usually dominated by the underlying heart condition, the improved long-term survival of cardiac patients due to advances in medical and surgical treatments are responsible for the increased number of liver complications in this setting. Eventually, liver disease could become as clinically relevant as cardiac disease and further complicate its management.

Anxiety, perceived stress and coping strategies in nursing students: a cross-sectional, correlational, descriptive study.

BACKGROUND: For many nursing students, clinical training represents a stressful experience. The levels of stress and anxiety may vary during students' educational training, depending on their ability to adopt behavioral strategies for coping with stress, and other factors. This study aimed to investigate the relationship between anxiety, perceived stress, and the coping strategies used by nursing students during their clinical training. METHODS: A cross-sectional correlational descriptive study. The sample consisted of 190 nursing students enrolled in the Nursing Faculty of Ciudad Real University in Spain. Participants provided data on background characteristics and completed the following instruments: the Perceived Stress Scale; the State-Trait Anxiety Inventory and the Coping Behavior Inventory. Relationships between scores were examined using Spearman's rho. RESULTS: The mean age of participants was 20.71 ± 3.89 years (range 18-46 years). Approximately half of the students (47.92%) indicated a moderate level of stress with a mean Perceived Stress Scale score of 22.78 (±8.54). Senior nursing students perceived higher levels of stress than novice students. The results showed a significant correlation for perceived stress and state anxiety (r = 0.463, p < .000) and also for trait anxiety (r = 0.718, p < .000). There was also a significant relationship between the total amount of perceived stress and the following domains of the coping behavior inventory: problem solving (r = -.452, p < .01), self-criticism (r = .408 p < .01), wishful thinking (r = .459, p < .01), social support(r = -.220, p < .01), cognitive restructuring (r = -.375, p < .01), and social withdrawal (r = .388, p < .01). In the current study, the coping strategy most frequently used by students was problem-solving, followed by social support and cognitive restructuring. CONCLUSIONS: Nursing students in our study presented a moderate level of stress, in addition there was a significant correlation with anxiety. Nursing teachers and clinical preceptors/mentors should be encouraged to develop programs to help prepare nursing students to cope with the challenges they are about to face during their clinical placements.