[Choice of Family and Community Medicine in the MIR 2002-2023: An objective approach shows that it is as highly valued as hospital specialties]. / Elección de Medicina Familiar y Comunitaria en el MIR 2002-2023: un enfoque objetivo muestra que es una especialidad tan valorada como las hospitalarias.

INTRODUCTION: Currently there is a shortage of general practitioners (GP), and this is expected to increase in the coming years. Despite this need, it is a specialty that is supposedly little demanded, leaving specialized training places unfilled in recent years. The purpose of this study is to present new parameters to more objectively measure the demand and the relationship between supply and demand. METHODS: A database was used with the results of the places assigned in the MIR calls from 2002 to 2023. The calculated parameters were quoting index (CI), quote order, the order of top demand and the order of total demand of the GP specialty. The software R version 4.3.02 was used for statistical analysis. RESULTS: The specialty quotation and top demand have remained constant during the study period, while there has been a slight and progressive worsening of the total demand. Nevertheless, the total demand for Family Medicine in the last call for MIR exam was higher than that for specialties such as urology, neurology, ENT, endocrinology, oncology, intensive care medicine or neurosurgery, among others. CONCLUSIONS: In contrast to the subjective perception of the worsening attractiveness Family Medicine in the last MIR calls, using objective parameters, we found that the attractiveness of the specialty, measured as quotation (supply/demand ratio) and demand, has remained stable (with a slight worsening of total demand).

Transdiagnostic inflammatory and oxidative biomarkers with predictive capacity of self-injurious behavior in impulsive and unstable disorders.

INTRODUCTION: Alterations in inflammatory processes have previously been reported in impulsive and unstable disorders, as well as in other psychiatric conditions. In order to investigate transdiagnostic biomarkers associated with various phenotypic features of these disorders, this study is designed to identify biomarkers of inflammatory and oxidative endophenotypes related to autolytic behavior. METHODS: Peripheral blood mononuclear cells were collected from 35 patients with borderline personality disorder (BPD), 29 patients with restrictive eating disorder (rED), 21 patients with purging eating disorder (pED) and 23 control subjects. Plasma levels of different inflammatory and oxidative factors were measured by ELISA and the expression of selected proteins was by Western Blot. Principal component analysis (PCA) was performed to categorize the different inflammatory factors. Additionally, Ancova was performed to observe the differences in the principal components among the different groups and logistic regression analysis was conducted to assess the predictive capacity of these components for autolytic behaviors. RESULTS: We found two inflammatory/oxidative components were associated with BPD, characterized by high levels of JNK and ERK and low levels of GPx, SOD and Keap1; and two other inflammatory/oxidative components were linked to pED, associated with more JNK, TBARS and TNF-α and less GPx and SOD. Two components, with more JNK and ERK and less GPx, SOD and Keap1, predicted non-suicidal self-injury and three components, with higher JNK, TBARS and TNF-α levels and lower GPx, SOD and iNOS levels, predicted suicide attempts. CONCLUSIONS: These results strongly support the endophenotypic characterization of impulsivity and the identification of transdiagnostic inflammatory/oxidative biomarkers relevant to autolytic behavior in impulsive and unstable disorders. These dates lay the groundwork for developing of screening tests for these biomarker components to rapidly detect biological risk factors for specific impulse control disorders and future self-injurious behaviors.

Androgen deprivation therapy in localized prostate cancer. Current status and future trends.

INTRODUCTION: Prostate cancer (PCa) has been recognized as an androgen-sensitive disease since the investigations from Huggins and Hodges in 1941. Thanks to these findings, they received the Nobel Prize in 1966. This was the beginning of the development of androgen deprivation therapy (ADT) as treatment for patients with PCa. OBJECTIVE: To summarize the current indications of ADT in localized PCa. EVIDENCE ACQUISITION: We conducted a comprehensive English and Spanish language literature research, focused on the main indications for ADT in localized PCa. EVIDENCE SYNTHESIS: Nowadays, the indications for ADT as monotherapy in localized PCa have been limited to specific situations, to patients unwilling or unable to receive any form of local treatment if they have a PSA-DT < 12 months, and either a PSA > 50 ng/mL, a poorly differentiated tumor, or troublesome local disease-related symptoms. ADT can be used in combination with local treatment in different scenarios. Although neoadjuvant treatment with ADT prior to surgery with curative intent has no clear oncological impact, as a future sight, PCa is a heterogeneous disease, and there could be a group of patients with high-risk localized disease that could benefit. CONCLUSIONS: We need to optimize the treatment with ADT in localized PCa, selecting the patients accordingly to their disease characteristics. Given that the therapeutic armamentarium evolves day by day, there is a need for the development of new clinical trials, as well as a molecular studies of patients to identify those who might benefit from an early multimodal treatment.

Evaluation of non-exudative tomographic signs in cases of exudative age-related macular degeneration.

OBJECTIVE: To analyse the prevalence of non-exudative tomographic signs (onion sign, pseudoswelling, external retinal tubulation, pseudocysts, subretinal clefts and macular atrophy) in patients with neovascular age-related macular degeneration. MATERIAL AND METHODS: A total of 174 eyes of patients with neovascular age-related macular degeneration who had not received previous treatment were included in the study. Visual acuity, neovascularization activity, and the appearance or not of the different signs under study were assessed at times 0 (initial visit), 4 months, one year, year and a half, and at 2 and 3 years of follow-up. The following were also evaluated: age, sex, affected eye and type of neovascularization (1, 2, 3, polypoid or mixed). The analysis were performed using the statistical software R (version 3.3.2) and the glmmADMB package (version 0.8.3.3). RESULTS: The presence of pseudocysts and external retinal tubulation increases throughout the follow-up. The onion sign begins with an ascending frequency up to 12 months, then decreases at 18 months and increases again at 24 months. Regarding pseudowelling, it maintains an increase until 18 months to finally decrease. Subretinal clefts is the rarest sign, presenting in 1.1% on the first visit. Finally, macular atrophy, present in 12.6% of the eyes initially, is found in 25% after 2 years. CONCLUSION: Pseudocysts, external retinal tubulation and macular atrophy were the most prevalent signs, while subretinal clefts were the most infrequent.

Single nucleotide polymorphisms in ADAM17, IL23R and SLCO1C1 genes protect against infliximab failure in adults with Crohn's disease.

BACKGROUND: To predict primary failure of infliximab (IFX) therapy in Crohn's disease (CD) and to identify patients who maintain long-term effectiveness to IFX is currently not feasible. Some genetic variations are proposed as potential biomarkers. AIM: We assessed a set of single nucleotide polymorphisms (SNPs) in genes related to the IFX mechanism of action and the presence of HLA-DQA1 * 05 allele on the primary response and long-term durability in CD patients. METHODS: A multi-centre cross-sectional study of IFX-exposed adult patients with CD was undertaken. Treatment persistence and time to failure were co-primary endpoints. DNA from the 131 patients was genotyped. Association between SNPs and clinical variables with IFX persistence was assessed. RESULTS: Failure to IFX was documented in 65 (49.6%) out of 131 patients. IFX persistence was associated either with carrying the TT genotype in ADAM17 rs10929587 (ORa=0.2; 95%CI=0.1-0.8; p = 0.021), or the CC genotype in SLCO1C1 rs3794271 (ORa=0.2; 95%CI=0.1-0.7; p = 0.008), according to multivariate logistic regression. In contrast, previous bowel resection increased the risk of IFX failure (ORa=2.8; 95%CI=1.1-7.3; p = 0.025). Cox regression analysis confirmed these findings and also identified IL23R rs10489629-TT (HRa 0.41; 95%CI=0.22-0.75; p = 0.004) and concomitant immunosuppressants (HRa 0.46; 95%CI=0.27-0.77; p = 0.003) as protection from IFX failure. However, no association between HLA-DQA1 * 05 allele and persistence of IFX therapy was found, with similar failure rates among carriers and non-carriers (52.8% vs. 47.4%, respectively; p = 0.544). CONCLUSIONS: SNPs rs10929587-TT in ADAM17, rs10489629-TT in IL23R and rs3794271-CC in SLCO1C1, together with no previous bowel surgery and concomitant immunosuppression, were identified as protection from failure to IFX.

Opsoclonus-myoclonus syndrome: Clinical characteristics, therapeutic considerations, and prognostic factors in a Spanish paediatric cohort.

INTRODUCTION: Opsoclonus-myoclonus-ataxia syndrome is a rare neuroinflammatory disorder with onset during childhood; aetiology may be paraneoplastic, para-infectious, or idiopathic. No biomarkers have yet been identified, and diagnosis is clinical. Better cognitive prognosis appears to be related to early onset of immunomodulatory therapy. METHODS: We describe the epidemiological, clinical, therapeutic, and long-term prognostic characteristics of a cohort of 20 Spanish patients. RESULTS: The mean age of onset was 21 months (range, 2-59). Ataxia and opsoclonus were the most frequent symptoms both at disease onset and throughout disease progression. The mean time from onset to diagnosis was 1.1 months. Neuroblast lineage tumours were detected in 45% of patients; these were treated with surgical resection in 7 cases and chemotherapy in 2. Cerebrospinal fluid analysis revealed pleocytosis in 4 cases (25%) and neither antineuronal antibodies nor oligoclonal bands were detected in any patient. Immunomodulatory drugs were used in all cases. Nine patients started combined immunomodulatory treatment at the time of diagnosis, and 5 patients after a mean of 2.2 months. In the long term, 6 of the 10 patients followed up for more than 5 years presented mild or moderate cognitive sequelae. Four patients presented relapses, generally coinciding with the decrease of corticosteroid doses. CONCLUSIONS: Early initiation of immunotherapy, as well as triple combination therapy, where needed, was associated with a lower frequency of cognitive impairment 2 years after onset.

Loss of p16 expression is a risk factor for recurrence in sinonasal inverted papilloma.

BACKGROUND: The purpose of this study was to evaluate p16, p53, EGFR, pEGFR protein expression and HPV infection as possible markers of tumor progression in a series of sinonasal inverted papilloma (SNIP) and sinonasal squamous cell carcinoma (SNSCC). METHODS: A series of 49 SNIP, 11 SNSCC associated with SNIP (SNIP-SNSCC) and 52 SNSCC not associated with SNIP were analyzed for p16, p53, EGFR, and phosphorylated EGFR (pEGFR) expression by immunohistochemistry. Human papillomavirus (HPV) infection status was evaluated by DNA-PCR. Results were correlated to clinical and follow-up data. RESULTS: Reduced or loss of p16 expression was observed in 18% SNIP, 64% SNIP-SNSCC and 87% of SNSCC. Reduced or loss p16 staining in SNIP correlated with shorter recurrent SNIP-free follow-up. In contrast, p16 expression was not predictive of recurrent SNSCC in cases with SNIP-SNSCC and SNSCC. P53, EGFR, and pEGFR expression did not differ between the tumor groups, nor were they related to recurrent SNIP-free follow-up or recurrent SNSCC. Oncogenic HPV types 16 and 18 were detected in 5% of SNIP and 18% of SNIP-SNSCC, but not in SNSCC. There was no correlation between HPV infection and >70% p16 immunostaining. CONCLUSIONS: HPV infection appears to play a minor role in SNIP and SNSCC and p16 immunostaining does not appear a valid surrogate marker for HPV. However, reduced or loss p16 expression may have prognostic value as a risk marker for recurrent SNIP.

[Joubert syndrome and neurofibromatosis type 1]. / Síndrome de Joubert y neurofibromatosis de tipo 1.

TITLE: Síndrome de Joubert y neurofibromatosis de tipo 1.

Posterior chamber implantation of a Preserflo Microshunt in a patient with a compromised endothelium.

The objective of the present case is to describe a variation in the Preserflo Microshunt surgical technique, placing it in the posterior chamber to minimise the risk of endothelial cell loss in cases with a compromised endothelium. The patient was a 72-year-old pseudophakic woman, with granular dystrophy and a primary diagnosis of open-angle glaucoma presenting with a progressive visual field defect and an IOP of 26 mmHg with maximal medical therapy. The cornea had incipient stromal folds with an endothelial count of 700 cells/mm2. A Preserflo Microshunt was implanted in the posterior chamber to minimise the possibility of further damage to the corneal endothelium. Six months after surgery, the implant remains functional. The IOP is 9 mmHg without medications. As far as we know, this is the first Preserflo implanted in the posterior chamber described in the literature.

Development of a neuropsychological assessment in smoking. / Desarrollo de una batería de evaluación neuropsicológica en fumadores.

INTRODUCTION: Smoking is one of the causes leading to the development of disease and mortality worldwide. One of the focuses of interest in this area is the impact of smoking on neuropsychological health. However, few studies provide instruments to assess executive functioning in smokers. The purpose of this study was to examine the viability of the internal structure of a neuropsychological battery for the assessment of executive function in smokers. SUBJECTS AND METHODS: A total of 171 smokers (Mage= 47.44, SDage= 8.48) were assessed. Executive functions were assessed at baseline with measures of inhibition (go/no go task and five digit test), updating (visual search and attention test and letter-number sequencing) and shifting (delay discounting task and Iowa gambling task). RESULTS: The exploratory factor analysis obtained a three-component solution of 59.6%. Establishing a first factor composed of visual search and attention test and letter-number sequencing, a second factor composed of delay discounting task and go/no go task and a third factor with Iowa gambling task and five digit test. CONCLUSIONS: The analysis of the internal structure reflected three factors which are consistent with the structure proposed by Miyake (2000).

TITLE: Desarrollo de una batería de evaluación neuropsicológica en fumadores.Introducción. El tabaquismo es una de las causas que conducen al desarrollo de enfermedades y a la mortalidad en todo el mundo. Uno de los focos de interés en esta área es el impacto del tabaquismo en la salud neuropsicológica. Sin embargo, son pocos los estudios que proporcionan instrumentos para evaluar el funcionamiento ejecutivo en los fumadores. El propósito de este estudio fue examinar la viabilidad de la estructura interna de una batería neuropsicológica para la evaluación de la función ejecutiva en fumadores. Sujetos y métodos. Se evaluó a un total de 171 fumadores (mediaedad = 47,44; desviación estándaredad = 8,48). Las funciones ejecutivas se evaluaron en la línea de base con medidas de inhibición (tarea go/no go y prueba de los cinco dígitos), actualización (prueba de búsqueda y atención visual, y escala de inteligencia de Wechsler para adultos) y cambio (tarea de descuento por demora y tarea de juego de Iowa). Resultados. El análisis factorial exploratorio obtuvo una solución de tres componentes del 59,6%, y se estableció un primer factor compuesto por la prueba de búsqueda y atención visual y la escala de inteligencia de Wechsler para adultos; un segundo factor, por la tarea de descuento por demora y la tarea go/no go; y un tercer factor, por la tarea de juego de Iowa y la prueba de los cinco dígitos. Conclusiones. El análisis de la estructura interna reflejó tres factores que son consistentes con la estructura propuesta por Miyake (2000).

Consensus of experts from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology for the genotyping of DPYD in cancer patients who are candidates for treatment with fluoropyrimidines.

5-Fluorouracil (5-FU) and oral fluoropyrimidines, such as capecitabine, are widely used in the treatment of cancer, especially gastrointestinal tumors and breast cancer, but their administration can produce serious and even lethal toxicity. This toxicity is often related to the partial or complete deficiency of the dihydropyrimidine dehydrogenase (DPD) enzyme, which causes a reduction in clearance and a longer half-life of 5-FU. It is advisable to determine if a DPD deficiency exists before administering these drugs by genotyping DPYD gene polymorphisms. The objective of this consensus of experts, in which representatives from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology participated, is to establish clear recommendations for the implementation of genotype and/or phenotype testing for DPD deficiency in patients who are candidates to receive fluoropyrimidines. The genotyping of DPYD previous to treatment classifies individuals as normal, intermediate, or poor metabolizers. Normal metabolizers do not require changes in the initial dose, intermediate metabolizers should start treatment with fluoropyrimidines at doses reduced to 50%, and poor metabolizers are contraindicated for fluoropyrimidines.

Functional, Clinical, and Sociodemographic Variables Associated with Risk of In-Hospital Mortality by COVID-19 in People over 80 Years Old.

OBJECTIVES: The objective is to assess the role of functional, clinical, and analytic parameters in predicting mortality in older patients hospitalized due to COVID-19. DESIGN: Cohort study with a mean follow-up of 12.8 days. SETTING: Public university hospital (Madrid, Spain). PARTICIPANTS: 499 patients 80 and above consecutively admitted to a Spanish public university hospital between 4 March 2020 and 16 May 2020. MEASUREMENTS: Mortality was the main outcome. Data of sociodemographic variables (age, sex, living), comorbidities, polypharmacy, functional status, date of hospital admission and length of stay was recorded. Clinical symptoms, laboratory and X-ray findings were collected at time of admission. For multivariant analysis, logistic regressions were performed to identify risk factors for death. RESULTS: Mean age was 86.7±4.4 with 37% of death. Mortality was associated with male gender [odds ratio (OR) 1.50; 95% confidence interval (CI) 1.01-2.24], with a 5-points increase on Barthel Index [OR 1.01 (95%CI 1.00-1.02)], higher Charlson Index score [OR 1.13 (95%CI 1.02-1.26)] and comorbidities [OR 1.28 (95%CI 1.06-1.53)], hyperpolipharmacy [OR 2.00 (95%CI 1.04-3.82)], unilateral pneumonia [OR 1.83 (95%CI 1.01-3.30)], higher levels of C-reactive protein [OR 1.09 (95%CI 1.06-1.12)] and creatine [OR 1.48 (95%CI 1.15-1.89)]. Higher oxygen levels were a protective factor [OR 0.92 (95%CI 0.89-0.95)]. CONCLUSIONS: Functional status, being male, a higher burden of comorbidities, hyperpolipharmacy, unilateral pneumonia and some laboratory parameters predict in-hospital mortality in this older population. The knowledge of these mortality risk factors should be used to improve the survival of older hospitalized patients.

Teoría de los cuidados, aplicada en el cuidado de niños con enfermedades neuropsiquiátricas durante la estimulación cerebral no invasiva / Theory of care, applied in the care of children with neuropsychiatric diseases during non-invasive brain stimulation

Introducción: el cuidado es la razón de ser de la profesión de enfermería y constituye su objeto de estudio, convertirlo en el centro de interés de la investigación en enfermería, es una necesidad, pues permitirá robustecer su cuerpo de conocimientos, con fundamentos y principios científicos, humanistas sustentado en modelos teóricos que orientan la disciplina y práctica profesional. Objetivo: describir la vinculación de la teoría de los cuidados al cuidado de niños con enfermedades neuropsiquiátricas durante la estimulación cerebral no invasiva. Material y métodos: revisión no sistemática de la literatura para desarrollar un análisis crítico reflexivo de documentos como: libros, tesis y artículos científicos. Se utilizaron las bases de datos bibliográficas: PubMed, CUMED, CINAHL, CUIDEN, Lilacs y Google académico. Se siguieron los principios de análisis de contenido, integrando la identificación de significados que se señalaban de forma más repetitiva, la consistencia, explicaciones y relaciones de éstos, a través de todos los estudios incluidos en esta revisión. Conclusiones: se evidencia la importancia de realizar una gestión enfocada estratégicamente en los cuidados donde se consideren valores, actitudes y conocimientos de la disciplina que conlleven a realizar un liderazgo dirigido a la meja continua de los cuidados.

Introduction: care is the raison d'être of the nursing profession and constitutes its object of study, making it the center of interest for nursing research, it is a necessity, which will strengthen its body of knowledge, with foundations and scientific, humanistic principles based on theoretical models that guide discipline and professional practice. Objective: describe the link of theory of care to the care of children with neuropsychiatric diseases during non-invasive brain stimulation. Material and methods: a non-systematic review of the literature was carried out to develop a reflective critical analysis of different documents that included books, theses and scientific articles. Bibliographic databases: PubMed, CUMED, CINAHL, CUIDEN, Lilacs and Google Scholar were used. The principles of content analysis were followed, including the identification of meanings that were indicated more repetitively, their consistency, explanations and relationships, throughout all the studies included in this review. Conclusions: Swanson's theory of care describes the relationships between nursing professionals and clients; It contributes to the nursing professional assuming responsible decisions regarding care that ensure their quality.

Cleavage and activation of LIM kinase 1 as a novel mechanism for calpain 2-mediated regulation of nuclear dynamics.

Calpain-2 (CAPN2) is a processing enzyme ubiquitously expressed in mammalian tissues whose pleiotropic functions depend on the role played by its cleaved-products. Nuclear interaction networks, crucial for a number of molecular processes, could be modified by CAPN2 activity. However, CAPN2 functions in cell nucleus are poorly understood. To unveil CAPN2 functions in this compartment, the result of CAPN2-mediated interactions in cell nuclei was studied in breast cancer cell (BCC) lines. CAPN2 abundance was found to be determinant for its nucleolar localization during interphase. Those CAPN2-dependent components of nucleolar proteome, including the actin-severing protein cofilin-1 (CFL1), were identified by proteomic approaches. CAPN2 binding, cleavage and activation of LIM Kinase-1 (LIMK1), followed by CFL1 phosphorylation was studied. Upon CAPN2-depletion, full-length LIMK1 levels increased and CFL1/LIMK1 binding was inhibited. In addition, LIMK1 accumulated at the cell periphery and perinucleolar region and, the mitosis-specific increase of CFL1 phosphorylation and localization was altered, leading to aberrant mitosis and cell multinucleation. These findings uncover a mechanism for the role of CAPN2 during mitosis, unveil the critical role of CAPN2 in the interactions among nuclear components and, identifying LIMK1 as a new CAPN2-target, provide a novel mechanism for LIMK1 activation. CFL1 is crucial for cytoskeleton remodeling and mitosis, but also for the maintenance of nuclear structure, the movement of chromosomes and the modulation of transcription frequently altered in cancer cells. Consequently, the role of CAPN2 in the nuclear compartment might be extended to other actin-associated biological and pathological processes.

Sticholysin II shows similar immunostimulatory properties to LLO stimulating dendritic cells and MHC-I restricted T cell responses of heterologous antigen.

Induction of CD8+ T cell responses against tumor cells and intracellular pathogens is an important goal of modern vaccinology. One approach of translational interest is the use of liposomes encapsulating pore-forming proteins (PFPs), such as Listeriolysin O (LLO), which has shown efficacy at priming strong and sustained CD8+ T cell responses. Recently, we have demonstrated that Sticholysin II (StII), a PFP from the sea anemone Stichodactyla helianthus, co-encapsulated into liposomes with ovalbumin (OVA) was able to stimulate, antigen presenting cells, antigen-specific CD8+ T cells and anti-tumor activity in mice. In the present study, we aimed to compare StII and LLO in terms of their abilities to stimulate dendritic cells and to induce major histocompatibility complex (MHC) class I restricted T cell responses against OVA. Interestingly, StII exhibited similar abilities to LLO in vitro of inducing dendritic cells maturation, as measured by increased expression of CD40, CD80, CD86 and MHC-class II molecules, and of stimulating OVA cross-presentation to a CD8+ T cell line. Remarkably, using an ex vivo Enzyme-Linked ImmunoSpot Assay (ELISPOT) to monitor gamma interferon (INF-γ) producing effector memory CD8+ T cells, liposomal formulations containing either StII or LLO induced comparable frequencies of OVA-specific INF-γ producing CD8+ T cells in mice that were sustained in time. However, StII-containing liposomes stimulated antigen-specific memory CD8+ T cells with a higher potential to secrete IFN-γ than liposomes encapsulating LLO. This StII immunostimulatory property further supports its use for the rational design of T cell vaccines against cancers and intracellular pathogens. In summary, this study indicates that StII has immunostimulatory properties similar to LLO, despite being evolutionarily distant PFPs.

Management of strabismus related to infantile glaucoma: Case series.

OBJECTIVE: To evaluate the different modalities of treatment of the strabismus related to infantile glaucoma, its complications, and results. METHODS: The clinical history of 7 patients with infantile glaucoma which required strabismus surgical treatment were analyzed. Age at onset of glaucoma, type of glaucoma, glaucoma surgeries, type of strabismus, strabismus surgical treatment and postoperative results were studied. RESULTS: Four patients required strabismus surgery, two were treated with botulinum toxin and one required both. Primary congenital glaucoma was the most common (71,42%), 14,28% had an anterior segment dysgenesis and 14,28% had secondary glaucoma. Regarding strabismus, 4 patients had exotropia and 3 had esotropia. The main difficulty involved the management of the conjunctiva and the filtering blebs. CONCLUSION: Strabismus is a frequent complication in infantile glaucoma. The management of these patients should be individualized. In our case series, treatment of strabismus improved eye alignment. Surgery should be the mainstay of treatment while preserving the conjunctiva and interfere the less with glaucoma surgeries. Botulinum toxin is a reasonable option when conservative treatment is needed.

Propolis extract and oregano essential oil as biofungicides for garlic seed cloves: in vitro assays and synergistic interaction against Penicillium allii.

AIMS: This study aimed to evaluate in vitro individual and combined antifungal activity of propolis extract (PE) and oregano essential oil (OEO) against Penicillium allii, causal agent of blue mould disease. The chemical characterization of both products was also included. METHODS AND RESULTS: Chromatographic analysis of PE and OEO confirmed the presence of bioactive compounds. The antifungal susceptibility assays showed that PE and OEO were highly active against the mycelial growth and conidial germination of P. allii. PE and OEO MICs were 12·5 and 1·5 µl ml-1 , respectively. The MFCs of these products were 50 and 3·1 µl ml-1 , respectively. PE acted mainly through diffusion, while OEO acted by a mixed contribution of vapour and diffusion. Synergism and additive effect between both products were found in some combination ratios. CONCLUSION: PE and OEO, both natural products with different chemical composition, have a strong antifungal activity against P. allii and show a favourable interaction causing synergism. SIGNIFICANCE AND IMPACT OF THE STUDY: The results of this study indicated the potential use of PE combined with OEO as a non-conventional strategy towards the formulation of a biofungicide to control blue mould disease in garlic seed-cloves.