Primary pituitary abscess with atypical imaging features: A rare case report.

INTRODUCTION AND IMPORTANCE: A pituitary abscess (PA) is an extremely rare disease. It is characterized by the presence of an infected purulent collection within the Sella turcica. PAs are categorized in two categories: primary, when the pituitary is normal before the infection, or secondary, when there is a pre-existing sellar pathology (e.g., pituitary adenoma, Rathke's cleft cysts, or craniopharyngioma), meningitis, paranasal sinusitis, or head surgery, which may be indicative of the source of infection. CASE PRESENTATION: We presented a case of a 52-year-old male with visual disturbances. Both a computerized tomography scan and magnetic resonance imaging revealed a sellar mass lesion, initially suspected to be a pituitary tumor. During transsphenoidal surgery for excision of the pituitary mass, an amount of pus was drained, indicating a pituitary abscess, which was confirmed by positive Staphylococcus aureus colonies in the culture. After surgery, the patient received antibiotic treatment for 12 weeks. After two years of follow-up, the patient remained free of complications and did not require hormone replacement therapy. CLINICAL DISCUSSION: In previous research, there were a total of 488 patients, of those, 318 were primary pituitary abscess. Preoperative diagnosis is still difficult due to a combination of nonspecific symptoms and imaging findings. Endonasal trans-sphenoidal pus evacuation, culture, and individualized antibiotic therapy are available treatment options. CONCLUSION: Pituitary abscess is a rare illness, but it should always be considered when evaluating a patient with a fast visual decline. Following the diagnosis, surgery and antibiotics should be started immediately. Proper therapy usually yields a positive effect.

Estudio transversal multicéntrico sobre la prevalencia de delirium en unidades de ortogeriatría: protocolo de «Estudio DELFRA 24» / Multicenter cross-sectional study on the prevalence of delirium in orthogeriatric units: «DELFRA 24 study» protocol

Introducción El delirium es la complicación perioperatoria más frecuente en el adulto mayor con fractura de cadera (FC) conllevando un impacto catastrófico en su recuperación funcional y su estado cognitivo. Actualmente se desconoce la prevalencia real de este síndrome ya que no está protocolizada su detección y abordaje en la práctica clínica habitual. Métodos Se realizará un estudio observacional multicéntrico de tipo transversal a nivel nacional en el que participarán distintas unidades de ortogeriatría de España. Se evaluará la prevalencia de delirium con la escala 4AT, así como las características de este y su relación con otros síndromes geriátricos, variables sociodemográficas, características de la cirugía y parámetros analíticos. Resultados La recogida de datos se llevará a cabo el próximo día mundial del delirium (miércoles 13 de marzo de 2024), por lo que los resultados se esperan durante el segundo o tercer trimestre del año 2024. Conclusiones Conocer la prevalencia real y las características del delirium en mayores con FC podría contribuir a sensibilizar en la detección sistemática, la prevención y el abordaje protocolizado del delirium en servicios quirúrgicos, disminuyendo el impacto de sus consecuencias. (AU)

Introduction Delirium is the most common perioperative complication in older adults with hip fracture (HF), leading to a catastrophic impact on their functional recovery and cognitive status. Currently, the true prevalence of this syndrome is unknown as its detection and management are not standardized in clinical practice. Methods A multicenter observational cross-sectional study will be conducted nationwide, involving different orthogeriatric units in Spain. The prevalence of delirium will be assessed using the 4AT scale, along with its characteristics and its relationship with other geriatric syndromes, sociodemographic variables, surgical characteristics, and laboratory parameters. Results Data collection is scheduled to take place on World Delirium Day (Wednesday, March 13, 2024), and therefore, the results are expected during the second or third quarter of 2024. Conclusions Understanding the real prevalence and characteristics of delirium in older adults with HF could contribute to the development of strategies for its detection and management, reducing the impact of its consequences. (AU)

Estudio transversal multicéntrico sobre la prevalencia de delirium en unidades de ortogeriatría: protocolo de «Estudio DELFRA 24» / Multicenter cross-sectional study on the prevalence of delirium in orthogeriatric units: «DELFRA 24 study» protocol

Introducción El delirium es la complicación perioperatoria más frecuente en el adulto mayor con fractura de cadera (FC) conllevando un impacto catastrófico en su recuperación funcional y su estado cognitivo. Actualmente se desconoce la prevalencia real de este síndrome ya que no está protocolizada su detección y abordaje en la práctica clínica habitual. Métodos Se realizará un estudio observacional multicéntrico de tipo transversal a nivel nacional en el que participarán distintas unidades de ortogeriatría de España. Se evaluará la prevalencia de delirium con la escala 4AT, así como las características de este y su relación con otros síndromes geriátricos, variables sociodemográficas, características de la cirugía y parámetros analíticos. Resultados La recogida de datos se llevará a cabo el próximo día mundial del delirium (miércoles 13 de marzo de 2024), por lo que los resultados se esperan durante el segundo o tercer trimestre del año 2024. Conclusiones Conocer la prevalencia real y las características del delirium en mayores con FC podría contribuir a sensibilizar en la detección sistemática, la prevención y el abordaje protocolizado del delirium en servicios quirúrgicos, disminuyendo el impacto de sus consecuencias. (AU)

Introduction Delirium is the most common perioperative complication in older adults with hip fracture (HF), leading to a catastrophic impact on their functional recovery and cognitive status. Currently, the true prevalence of this syndrome is unknown as its detection and management are not standardized in clinical practice. Methods A multicenter observational cross-sectional study will be conducted nationwide, involving different orthogeriatric units in Spain. The prevalence of delirium will be assessed using the 4AT scale, along with its characteristics and its relationship with other geriatric syndromes, sociodemographic variables, surgical characteristics, and laboratory parameters. Results Data collection is scheduled to take place on World Delirium Day (Wednesday, March 13, 2024), and therefore, the results are expected during the second or third quarter of 2024. Conclusions Understanding the real prevalence and characteristics of delirium in older adults with HF could contribute to the development of strategies for its detection and management, reducing the impact of its consequences. (AU)

Streptomyces spp. Strains as Potential Biological Control Agents against Verticillium Wilt of Olive.

Verticillium wilt of olive (VWO) caused by Verticillium dahliae is considered a major olive (Olea europaea) disease in Mediterranean-type climate regions. The lack of effective chemical products against VWO makes it necessary to search for alternatives such as biological control. The main goal of this study was to evaluate the effect of six Streptomyces spp. strains as biological control agents (BCAs) against VWO. All of them were molecularly characterized by sequencing 16S or 23S rRNA genes and via phylogenetic analysis. Their effect was evaluated in vitro on the mycelial growth of V. dahliae (isolates V004 and V323) and on microsclerotia (MS) viability using naturally infested soils. Bioassays in olive plants inoculated with V. dahliae were also conducted to evaluate their effect against disease progress. In all the experiments, the reference BCAs Fusarium oxysporum FO12 and Aureobasidium pullulans AP08 were included for comparative purposes. The six strains were identified as Streptomyces spp., and they were considered as potential new species. All the BCAs, including Streptomyces strains, showed a significant effect on mycelial growth inhibition for both V. dahliae isolates compared to the positive control, with FO12 being the most effective, followed by AP08, while the Streptomyces spp. strains showed an intermediate effect. All the BCAs tested also showed a significant effect on the inhibition of germination of V. dahliae MS compared to the untreated control, with FO12 being the most effective treatment. Irrigation treatments with Streptomyces strain CBQ-EBa-21 or FO12 were significantly more effective in reducing disease severity and disease progress in olive plants inoculated with V. dahliae compared to the remaining treatments. This study represents the first approach to elucidating the potential effect of Streptomyces strains against VWO.

[Multicenter cross-sectional study on the prevalence of delirium in orthogeriatric units: «DELFRA 24 study¼ protocol]. / Estudio transversal multicéntrico sobre la prevalencia de delirium en unidades de ortogeriatría: protocolo de «Estudio DELFRA 24¼.

INTRODUCTION: Delirium is the most common perioperative complication in older adults with hip fracture (HF), leading to a catastrophic impact on their functional recovery and cognitive status. Currently, the true prevalence of this syndrome is unknown as its detection and management are not standardized in clinical practice. METHODS: A multicenter observational cross-sectional study will be conducted nationwide, involving different orthogeriatric units in Spain. The prevalence of delirium will be assessed using the 4AT scale, along with its characteristics and its relationship with other geriatric syndromes, sociodemographic variables, surgical characteristics, and laboratory parameters. RESULTS: Data collection is scheduled to take place on World Delirium Day (Wednesday, March 13, 2024), and therefore, the results are expected during the second or third quarter of 2024. CONCLUSIONS: Understanding the real prevalence and characteristics of delirium in older adults with HF could contribute to the development of strategies for its detection and management, reducing the impact of its consequences.

¿Por qué los graduados en medicina no quieren ser médicos de familia? / Why do medical graduates not want to be family doctors?

Objetivo: conocer la prioridad concedida a la elección de Medicina Familiar (MF) en Castilla-La Mancha (CLM) entre los opositores MIR de 2019-2022 que escogieron plaza en esta comunidad, y los factores asociados con esta elección. Métodos: se trata de un análisis de datos secundarios. De la web del Ministerio de Sanidad, se obtuvo información de 1.223 opositores: sexo, nacionalidad, puntuación en el examen y total, número en la oposición, especialidad y provincia elegidas. El análisis estadístico se ha realizado con SPSS 25.0: estadística descriptiva, comparación de proporciones y medianas, y cálculo de la probabilidad de elección de MF relacionada con el número en la oposición (Kaplan-Meier). Resultados: el 67,4% eran mujeres; el 89% eran españoles. Un 29,1% eligieron MF. Las medianas del número para elegirla aumentó a lo largo de los años: 7.106 (rango intercuartiles [RI]: 6.993,1-7.218,9), 7.511 (RI: 7.378,2-7.643,7), 8.159 (RI: 8.036,5-8.281,5), 8.821 (RI: 8.551,2-9.090,8), respectivamente de 2019 a 2022, con diferencias estadísticamente significativas (p < 0,0001). Los valores correspondientes para el resto de especialidades no mostraron diferencias significativas entre los 4 años, pero eran significativamente inferiores (p < 0,0001) a las de MF. No existían diferencias por sexo para la elección de MF. Solo en 2020 fue más precoz la elección de MF en Albacete (p = 0,037), sin diferencias en el global de los 4 años en cuanto a la elección de provincia. Conclusión: la elección de plazas de MF en CLM se hace con números altos de la oposición MIR. En los últimos años se ha venido produciendo un progresivo retraso en dicha elección. (AU)

Aim: to ascertain the priority given to the choice of family medicine (FM) posts in Castilla-La Mancha (CLM) among resident intern competitive examination candidates in 2019 and 2022 who chose this autonomous community and the factors associated with this choice. Method: this is an analysis of secondary data. The following was obtained from the Spanish Ministry of Health website about 1223 candidates: sex, nationality, score in the examination; total, competitive examination position, specialty and province chosen. Statistical analysis was performed with SPSS 25.0: descriptive statistics, comparison of proportions and medians and probability of FM post choice related to candidate order (Kaplan-Meier). Results: a total of 67.4% were women; 89% were Spanish; 29.1% chose FM. The median number selecting FM increased over the years: 7.106 (interquartile range [IR]: 6993.1-7218.9), 7.511 (RI: 7378.2-7643.7), 8159 (RI: 8036, 5-8281.5), 8821 (RI: 8551.2-9090.8), respectively from 2019 to 2022, with statistically significant differences (P<0.0001). The corresponding values for the other specialties did not reveal any statistically significant differences among the four years. However, they were statistically significantly lower (P<0.0001) than those for FM. There were no differences by sex for choosing FM. Only in 2020 FM was chosen earlier in Albacete (P=0.037). There were no differences in the overall four-year period in regard to choice of province. Conclusion: FM posts in Castilla-La Mancha are chosen with high classification numbers from the resident intern entrance examinations. In recent years there has been a gradual delay in this choice. (AU)

Urethral reconstruction using amniotic membrane allograft in hereditary androgen insensitivity syndrome: a case series.

Partial androgen insensitivity syndrome is a rare X-linked disorder. While most cases are sporadic, familial cases are less frequent. The management of this syndrome follows a multidisciplinary approach involving hormone substitution, psychological counseling, and surgical procedures. We present a case series of three young siblings with familial partial androgen insensitivity syndrome who presented with a female phenotype. All of them were managed with hormonal treatment for 6 months followed by surgical reconstruction. The operative procedure involved phalloplasty and urethroplasty using amniotic membrane transplant, which is considered a novel technique in this group of patients. No intraoperative or postoperative complications were observed and good results were achieved within 2 years of follow-up.

Systemic sclerosis sine scleroderma with atypical clinical course: a rare case report.

Introduction and importance: Systemic sclerosis (SSc) is divided into three subtypes: limited cutaneous SSc (lcSSc), diffuse cutaneous SSc (dcSSc), and systemic sclerosis sine scleroderma (ssSSc). ssSSc is a rare subtype of SSc that presents with internal organ manifestations but no cutaneous findings. Case presentation: We report the case of a 58-year-old patient with a history of pulmonary hypertension who presented with symptoms of fatigue, inflammatory polyarthritis, and joint swelling. Following a comprehensive clinical examination and laboratory tests, the patient was diagnosed with ssSSc. Clinical discussion: Due to its atypical clinical course, we present this case report, which commenced with idiopathic pulmonary hypertension. Subsequently, after 7 months, the patient presented complaints of polyarthritis with positive antinuclear antibodies. Raynaud's phenomenon was identified 2 months later during the rheumatology clinic examination. Typically, the clinical course encompasses all three features simultaneously, without any gap between them. Conclusion: Diagnosis of ssSSc remains challenging, and it is essential to consider this disease form in all cases involving unexplained fibrotic involvement of the internal organs.

Fungal Pathogens Associated with Almond Decline Syndrome, an Emerging Disease Complex in Intensive Almond Crops in Southern Spain.

In 2016, an almond (Prunus dulcis) decline syndrome (ADS) emerged in intensive almond plantations in the Andalusia region (southern Spain), showing branch dieback, gummosis, and general tree decline. The aim of this work was to elucidate the etiology of this disease complex. For this purpose, surveys were conducted across the Andalusia region, and a wide collection of fungi was recovered from wood samples showing gum and internal discoloration. Representative isolates were selected and identified by sequencing ITS, TEF1, TUB, ACT, LSU, and/or RPB2 genes. The following fungal species were identified to be associated with the disease: Botryosphaeria dothidea, Diplodia corticola, Di. seriata, Dothiorella iberica, Lasiodiplodia viticola, Macrophomina phaseolina, Neofusicoccum mediterraneum, N. parvum, N. vitifusiforme, Diaporthe neotheicola, Dia. rhusicola, Dia. ambigua, Eutypa lata, E. tetragona, Eutypella citricola, Eu. microtheca, Fusarium oxysporum s.l., Pleurostoma richardsiae, Phaeoacremonium iranianum, Pm. krajdenii, Pm. parasiticum, and Cytospora sp. All isolates were tested for pathogenicity by inoculating detached or attached almond shoots. Di. corticola and N. parvum were the most aggressive species, showing the largest lesions and most gummosis in attached shoots. The results suggest that the species belonging to Botryosphaeriaceae play a key role in disease development, while the remaining identified species may act as secondary pathogens or endophytes. However, further research to determine the interaction between all these fungal species and other biotic and abiotic factors in the ADS progress is needed.

Diversity of Cellulolytic Microorganisms Associated with the Subterranean Termite Reticulitermes grassei.

Reticulitermes grassei is a subterranean termite species that forages on woody structures of the Iberian Peninsula, and is often a building and crops pest. A total of 23 microorganisms associated with the activity of R. grassei were isolated from colonized ecosystems in southern Spain. They were morphologically and molecularly characterized, with fungi being the most prevalent ones. The fungi showed high values of optimum growth temperature, suggesting that they could be able to survive and develop in warm regions. Their cellulolytic activity was tested in carboxymethylcellulose (CMC) agar, concluding that all fungal isolates produce cellulases, and the enzymatic index (EI) was revealed in CMC agar with Gram's iodine solution, with Penicillium citrinum showing the highest EI and Trichoderma longibrachiatum the highest mycelial growth rate on CMC. A preliminary microorganism dispersion assay was carried out with the termites, concluding that these insects may have a positive influence on fungal dispersion and the subsequent colonization of new substrates. Our study suggests that fungi associated with R. grassei may potentially be of interest in biotechnological fields such as biofuel production and the food industry.

Etiology of Septoria Leaf Spot of Pistachio in Southern Spain.

Septoria leaf spot (SLS) is the most prevalent disease of pistachio (Pistacia vera L.) in Spain. To elucidate its etiology, 22 samples of pistachio leaves showing SLS symptoms were collected mainly from 1993 to 2018 across southern Spain. Affected leaves from terebinth (P. terebinthus) were also collected for comparative purposes. Six Septoria-like isolates were recovered from pistachio leaves. They were identified as S. pistaciarum by sequencing internal transcribed spacers, partial RNA polymerase II second largest subunit locus, and 28S ribosomal RNA genes. The phenotypic characteristics of conidia and colonies were evaluated, confirming the identity of S. pistaciarum. Conidia were solitary, hyaline, and straight to curved. Large differences in length were observed between conidia from leaf samples, with those from terebinth being slightly larger than those from pistachio. Colonies showed slow mycelial growth on potato dextrose agar (PDA). The effect of temperature on conidial germination and mycelial growth was evaluated in vitro on PDA. For both characters, the optimum temperature was approximately 19 to 20°C. Eight culture media were tested, with oatmeal agar and Spezieller Nährstoffarmer agar showing the highest mycelial growth and pistachio leaf agar (PLA) showing the highest sporulation. A specific culture medium integrating lyophilized-powdered pistachio leaves into diluted PDA improved sporulation compared with PLA. Pathogenicity tests were conducted by inoculating detached and in planta pistachio and terebinth leaflets with conidial suspensions. Typical symptoms of SLS and cirri of S. pistaciarum developed at 10 and 21 days after inoculation, respectively, in both hosts. To our knowledge, this is the first report of S. pistaciarum causing SLS in pistachio and terebinth in Spain.

Diversity of Colletotrichum Species Associated with Olive Anthracnose Worldwide.

Olive anthracnose caused by Colletotrichum species causes dramatic losses of fruit yield and oil quality worldwide. A total of 185 Colletotrichum isolates obtained from olives and other hosts showing anthracnose symptoms in Spain and other olive-growing countries over the world were characterized. Colony and conidial morphology, benomyl-sensitive, and casein-hydrolysis activity were recorded. Multilocus alignments of ITS, TUB2, ACT, CHS-1, HIS3, and/or GAPDH were conducted for their molecular identification. The pathogenicity of the most representative Colletotrichum species was tested to olive fruits and to other hosts, such as almonds, apples, oleander, sweet oranges, and strawberries. In general, the phenotypic characters recorded were not useful to identify all species, although they allowed the separation of some species or species complexes. ITS and TUB2 were enough to infer Colletotrichum species within C. acutatum and C. boninense complexes, whereas ITS, TUB2, ACT, CHS-1, HIS-3, and GADPH regions were necessary to discriminate within the C. gloesporioides complex. Twelve Colletotrichum species belonging to C. acutatum, C. boninense, and C. gloeosporioides complexes were identified, with C. godetiae being dominant in Spain, Italy, Greece, and Tunisia, C. nymphaeae in Portugal, and C. fioriniae in California. The highest diversity with eight Colletotrichum spp. was found in Australia. Significant differences in virulence to olives were observed between isolates depending on the Colletotrichum species and host origin. When other hosts were inoculated, most of the Colletotrichum isolates tested were pathogenic in all the hosts evaluated, except for C. siamense to apple and sweet orange fruits, and C. godetiae to oleander leaves.

Vascular Fungi Associated with Branch Dieback of Olive in Super-High-Density Systems in Southern Spain.

Symptoms of branch dieback of olive with internal longitudinal dark streaking were observed during routine surveys in super-high-density systems in southern Spain. Nineteen fungal isolates recovered from wood samples showing internal discoloration and necrotic xylem vessels were selected. Multilocus alignments of the internal transcribed spacer, 28S ribosomal RNA, ß-tubulin, or actin were performed, and the following species were identified: Acremonium sclerotigenum, Cadophora luteo-olivacea, Paracremonium sp., Phaeoacremonium italicum, P. minimum, P. scolyti, and Pseudophaeomoniella oleicola. Colony color, mycelial growth, conidial characteristics, and production were defined on potato dextrose agar, malt extract agar (MEA), and oatmeal agar. Phenotypic characteristics and conidial production varied depending on the isolate and culture media. The effect of temperature on mycelial growth was evaluated on MEA. The isolates showed slow mycelial growth (0.5 to 2.0 mm day-1), with the optimum temperature ranging from 23.2 to 33.9°C. Pathogenicity tests were conducted on 9-month-old olive potted plants (Arbequina) inoculated with mycelial plugs. C. luteo-olivacea, Phaeoacremonium minimum, and Phaeomoniella chlamydospora isolates from grapevine were included in the pathogenicity tests for comparative purposes. Prior to inoculation, the effect on the infection by inoculation with conidial suspensions or mycelial plugs was evaluated, with the second method being the most effective. C. luteo-olivacea was the fungus most aggressive to olive, followed by Phaeoacremonium minimum.

Water Stress Enhances the Progression of Branch Dieback and Almond Decline under Field Conditions.

Branch dieback and tree decline have been described as a common complex disease worldwide in woody crops, with Botryosphaeriaceae and Diaporthaceae being considered the most frequent fungi associated with the disease symptoms. Their behaviour is still uncertain, since they are considered endophytes becoming pathogenic in weakened hosts when stress conditions, such as water deficiency occur. Therefore, the main goal of this study was to determine if water stress enhances general decline on weakened almond trees subjected to different irrigation treatments under natural field conditions. In parallel, the occurrence of fungal species associated with almond decline was also determined in relation to disease progression by fungal isolation, and morphological and molecular based-methods. The symptoms of branch dieback and general decline were observed over time, mainly in the experimental plots subjected to high water deficiency. Botryosphaeriaceae were the most consistently isolated fungi, and Botryosphaeria dothidea was the most frequent. Collophorina hispanica was the second most frequent species and Diaporthe and Cytospora species were isolated in a low frequency. Most of them were recovered from both asymptomatic and symptomatic trees, with their consistency of isolation increasing with the disease severity. This work reveals the need to elucidate the role of biotic and abiotic factors which increase the rate of infection of fungal trunk pathogens, in order to generate important knowledge on their life cycle.

First Report of Colletotrichum karstii Causing Fruit Anthracnose of Carissa grandiflora in Spain.

The species Carissa grandiflora A. DC., commonly called Natal plum, is a shrub native to the coastal region of Natal, South Africa. In southern Spain, Natal plum is used as an ornamental plant due to its beautiful flowers and red ripen fruits. In March 2019 and 2020, we surveyed nine public gardens in the cities of Cadiz and Sanlucar de Barrameda (Andalusia, Spain); and Natal plum fruit showing anthracnose symptoms were observed in six (55% prevalence) of them. Affected fruits showed necrotic and circular lesions with acervuli in the center (Fig. 1a) causing the complete mummification of the fruit (Fig. 1b). Affected fruits were collected from four gardens and disinfested according to Moral et al. (2010). Six fungal isolates were recovered from small (3-4 × 1-2 mm) pieces of the affected fruits in Potato Dextrose Agar (PDA), and hyphal tips from them were transferred to fresh PDA to obtain pure cultures. The six isolates were initially identified as Colletotrichum karstii according to their morphology and the sequences of the ITS1-5.8S-ITS2 (ITS) region (Damm et al. 2012). The six Colletotrichum isolates showed similar colony morphology and their ITS sequences were identical. Overall, C. karstii isolates showed cylindrical and straight conidia that were 12.1 to 14.2 µm long and 4.9 to 5.6 µm wide (n = 50). The aerial mycelia of the fungus varied from grayish-white to dark gray. A multilocus approach was conducted for more precise identification of the Colletotrichum species. For that, ITS, beta-tubulin (TUB2), actin (ACT), partial sequences of the chitin synthase 1 (CHS-1), histone 3 (HIS3), and a 200-bp intron fragment of the glyceraldehyde-3-phosphate dehydrogenase (GAPDH) of a representative isolate (FITP19001) were amplified and sequenced according to Damm et al. (2012). GenBank Accession Nos. for ITS, TUB2, ACT, CHS-1, HIS3 and GADPH: MT757643, MT759805, MT759806, MT759807, MT759808 and MT759809, respectively. Sequences showed 100% identity with homologous sequences belonging to C. karstii (GenBank taxid:1095194). To test Koch's postulates, 10 unripen and 10 ripen C. grandiflora fruits, harvested from asymptomatic plants, were inoculated. For each group, five fruits were inoculated using a drop of 10 µl of 5 × 104 conidia per ml suspension of C. karstii (FITP19001) and another five fruits were inoculated using a mycelial plug of the same isolate. Inoculated fruits were incubated in a humid chamber at room temperature (19-24ºC) under light for two weeks. Non-inoculated control fruits were treated with sterile water or a PDA plug and incubated under the same conditions. The pathogenicity test was conducted twice. After 10 days, typical anthracnose symptoms developed on both unripen and ripen inoculated fruits, but not on non-inoculated controls. Overall, the severity of anthracnose lesions was higher on ripen fruits than in the unripen fruits. Likewise, the severity of symptoms was higher on the fruits inoculated using a mycelial plug than on those fruits inoculated with a spore suspension. The species C. karstii was reisolated from lesions of all inoculated fruits as described above but not from non-inoculated fruits. The species C. karstii has been described affecting numerous species worldwide (Damm et al., 2012). Previously, C. gloeosporioides was reported causing fruit anthracnose of Natal plum in Florida (Alfieri et al., 1984). To our knowledge, this is the first report of C. karstii causing anthracnose on the fruit of Natal plum in Spain and worldwide.

Etiology of Branch Dieback and Shoot Blight of English Walnut Caused by Botryosphaeriaceae and Diaporthe Species in Southern Spain.

English walnut (Juglans regia L.) is considered an economically important fruit crop worldwide. In Spain, little attention has been given to walnut diseases owing to the minor economic importance of the walnut crop in the country until recently. In 2017, typical symptoms of branch dieback and shoot blight of English walnut were observed in southern Spain. From 2017 to 2018, 10 commercial walnut orchards showing disease symptoms were surveyed. Botryosphaeriaceae and Diaporthe fungi were consistently isolated from affected shoots. Cytospora isolates were also recovered with minor relevance. Representative isolates of each fungal group were characterized based on colony and conidial morphology, optimum growth temperature, and comparison of DNA sequence data from the internal transcribed spacer, elongation factor 1-α, and ß-tubulin genomic areas. Pathogenicity tests were performed on detached and attached shoots and on detached fruit by inoculating them with mycelial plugs. Botryosphaeriaceae and Diaporthe isolates had higher optimum growth temperatures (≈25 to 27°C) than Cytospora sp. (19.5°C). The following species were identified: Botryosphaeriaceae: Botryosphaeria dothidea, Diplodia seriata, Dothiorella sarmentorum, Dothiorella sp., Neofusicoccum mediterraneum, and N. parvum; Diaporthe: Diaporthe neotheicola, Dia. rhusicola, Diaporthe sp., and Phomopsis amygdali; and Cytospora sp. Botryosphaeriaceae isolates were the most aggressive fungi to walnut in all tissues evaluated, followed by Diaporthe isolates and Cytospora sp. N. parvum was the most virulent among the remaining species tested in any of the tissues evaluated, followed by B. dothidea or N. mediterraneum. This work is the first report to identify the fungal species causing this complex disease of English walnut in Spain and Europe.

At what stage in the undergraduate curriculum is it best to train in family medicine? A study from two medical schools in Spain.

BACKGROUND: A course in family medicine (FM) could dispel the possibility of negative stereotyping about this speciality, and instil in students a greater interest. However, when is it preferable: at the beginning or at the end of undergraduate training? OBJECTIVES: To determine changes in knowledge and attitudes towards FM by medical students completing a course in primary care at the beginning or the end of the undergraduate training and whether those changes anticipate the choice of speciality. METHODS: Students from Albacete and Seville medical schools (primary care course in second and sixth years, respectively) were asked to respond to the 'valuation of attitudes towards and knowledge of family medicine questionnaire' (CAMF). Students from Albacete answered before and after the course, and in Seville second-year students answered at the end of the first trimester. All students were invited to respond again at the end of their undergraduate training. Afterwards, we investigated the score on the speciality exam (order for the election from highest to lowest score) and their choice of speciality. The outcome measures were the MIR exam score, the number in the ranking, the chosen speciality and the result of the CAMF. RESULTS: In Albacete 88 and 64 and in Seville 50 and 98 students responded in their second and sixth years, respectively. In Albacete, mean CAMF scores were 15.4, 22.7 before and after the course, and 21.8 at the end while in Seville, 13.9 in the second year, and 23.5 in the sixth year. Logistic regression analysis showed an association of the choice of FM only with the score on the speciality exam (OR: 0.667; 95%CI: 0.553-0.806). CONCLUSION: There were no significant differences between CAMF scores at the end of undergraduate training. Only the score on the speciality exam predicts FM choice: the higher the score, the lower the probability of choosing FM.