Genetic diversity of the banana Fusarium wilt pathogen in Cuba and across Latin America and the Caribbean.

Fusarium wilt of bananas (FWB) is a severe plant disease that leads to substantial losses in banana production worldwide. It remains a major concern for Cuban banana cultivation. The disease is caused by members of the soil-borne Fusarium oxysporum species complex. However, the genetic diversity among Fusarium species infecting bananas in Cuba has remained largely unexplored. In our comprehensive survey, we examined symptomatic banana plants across all production zones in the country, collecting 170 Fusarium isolates. Leveraging genotyping-by-sequencing and whole-genome comparisons, we investigated the genetic diversity within these isolates and compared it with a global Fusarium panel. Notably, typical FWB symptoms were observed in Bluggoe cooking bananas and Pisang Awak subgroups across 14 provinces. Our phylogenetic analysis revealed that F. purpurascens, F. phialophorum, and F. tardichlamydosporum are responsible for FWB in Cuba, with F. tardichlamydosporum dominating the population. Furthermore, we identified between five and seven distinct genetic clusters, with F. tardichlamydosporum isolates forming at least two subgroups. This finding underscores the high genetic diversity of Fusarium spp. contributing to FWB in the Americas. Our study sheds light on the population genetic structure and diversity of the FWB pathogen in Cuba and the broader Latin American and Caribbean regions.

The Vulnerability of Cuban Banana Production to Fusarium Wilt Caused by Tropical Race 4.

Bananas are major agricultural commodities in Cuba. One of the main constraints of banana production worldwide is Fusarium wilt of banana. Recent outbreaks in Colombia, Perú, and Venezuela have raised widespread concern in Latin America due to the potential devastating impact on the sustainability of banana production, food security, and livelihoods of millions of people in the region. Here, we phenotyped 18 important Cuban banana and plantain varieties with two Fusarium strains-Tropical Race 4 (TR4) and Race 1-under greenhouse conditions. These varieties represent 72.8% of the national banana acreage in Cuba and are also widely distributed in Latin America and the Caribbean region. A broad range of disease responses from resistant to very susceptible was observed against Race 1. On the contrary, not a single banana variety was resistant to TR4. These results underscore that TR4 potentially threatens nearly 56% of the contemporary Cuban banana production area, which is planted with susceptible and very susceptible varieties, and call for a preemptive evaluation of new varieties obtained in the national breeding program and the strengthening of quarantine measures to prevent the introduction of TR4 into the country.

Complex adaptive architecture underlies adaptation to quantitative host resistance in a fungal plant pathogen.

Plant pathogens often adapt to plant genetic resistance so characterization of the architecture underlying such an adaptation is required to understand the adaptive potential of pathogen populations. Erosion of banana quantitative resistance to a major leaf disease caused by polygenic adaptation of the causal agent, the fungus Pseudocercospora fijiensis, was recently identified in the northern Caribbean region. Genome scan and quantitative genetics approaches were combined to investigate the adaptive architecture underlying this adaptation. Thirty-two genomic regions showing host selection footprints were identified by pool sequencing of isolates collected from seven plantation pairs of two cultivars with different levels of quantitative resistance. Individual sequencing and phenotyping of isolates from one pair revealed significant and variable levels of correlation between haplotypes in 17 of these regions with a quantitative trait of pathogenicity (the diseased leaf area). The multilocus pattern of haplotypes detected in the 17 regions was found to be highly variable across all the population pairs studied. These results suggest complex adaptive architecture underlying plant pathogen adaptation to quantitative resistance with a polygenic basis, redundancy, and a low level of parallel evolution between pathogen populations. Candidate genes involved in quantitative pathogenicity and host adaptation of P. fijiensis were identified in genomic regions by combining annotation analysis with available biological data.

Convergent Adaptation to Quantitative Host Resistance in a Major Plant Pathogen.

Plant pathogens can adapt to quantitative resistance, eroding its effectiveness. The aim of this work was to reveal the genomic basis of adaptation to such a resistance in populations of the fungus Pseudocercospora fijiensis, a major devastating pathogen of banana, by studying convergent adaptation on different cultivars. Samples from P. fijiensis populations showing a local adaptation pattern on new banana hybrids with quantitative resistance were compared, based on a genome scan approach, with samples from traditional and more susceptible cultivars in Cuba and the Dominican Republic. Whole-genome sequencing of pools of P. fijiensis isolates (pool-seq) sampled from three locations per country was conducted according to a paired population design. The findings of different combined analyses highly supported the existence of convergent adaptation on the study cultivars between locations within but not between countries. Five to six genomic regions involved in this adaptation were detected in each country. An annotation analysis and available biological data supported the hypothesis that some genes within the detected genomic regions may play a role in quantitative pathogenicity, including gene regulation. The results suggested that the genetic basis of fungal adaptation to quantitative plant resistance is at least oligogenic, while highlighting the existence of specific host-pathogen interactions for this kind of resistance.IMPORTANCE Understanding the genetic basis of pathogen adaptation to quantitative resistance in plants has a key role to play in establishing durable strategies for resistance deployment. In this context, a population genomic approach was developed for a major plant pathogen (the fungus Pseudocercospora fijiensis causing black leaf streak disease of banana) whereby samples from new resistant banana hybrids were compared with samples from more susceptible conventional cultivars in two countries. A total of 11 genomic regions for which there was strong evidence of selection by quantitative resistance were detected. An annotation analysis and available biological data supported the hypothesis that some of the genes within these regions may play a role in quantitative pathogenicity. These results suggested a polygenic basis of quantitative pathogenicity in this fungal pathogen and complex molecular plant-pathogen interactions in quantitative disease development involving several genes on both sides.

Ex Ante Assessment of Returns on Research Investments to Address the Impact of Fusarium Wilt Tropical Race 4 on Global Banana Production.

The spread of Fusarium oxysporum f. sp. cubense tropical race 4 (Foc TR4), causal agent of Fusarium wilt of banana (FWB), has been projected to reach 17% of the global banana-growing area by 2040 equaling 36 million tons of production worth over US$10 billion. This potential loss has fueled (inter)national discussions about the best responses to protect production and small-scale growers' livelihoods. As part of a multi-crop ex ante assessment of returns on research investments conducted by the CGIAR Research Program on Roots, Tubers, and Bananas (RTB) from 2012 to 2016, four FWB research options were assessed: (i) improved exclusion, surveillance, eradication, and containment (ESEC) measures to reduce Foc TR4 spread, (ii) integrated crop and disease management (ICDM) to facilitate production of partially FWB resistant cultivars on Foc-infested soils, (iii) conventional breeding of FWB-resistant cultivars (CBRC), and (iv) genetically modified (GM) FWB-resistant cultivars (GMRC). Building on a risk index (Foc scale) predicting the initial occurrence and internal spread of Foc TR4 in 29 countries, an economic surplus (ES) model, cost-benefit analysis, and poverty impact simulations were used to assess impact under two adoption scenarios. All options yield positive net present values (NPVs) and internal rates of return (IRRs) above the standard 10% rate. For the conservative scenario with 50% reduced adoption, IRRs were still 30% for ICDM, 20% for CBRC, and 28% for GMRC. ESEC has IRRs between 11 and 14%, due to higher costs of capacity strengthening, on-going surveillance, farmer awareness campaigns, and implementation of farm biosecurity practices, which could be effective for other diseases and benefit multiple crops. The research investments would reach between 2.7 million (GMRC) and 14 million (ESEC) small-scale beneficiaries across Asia/Pacific, Sub-Saharan Africa, and Latin America/Caribbean. The options varied in their potential to reduce poverty, with the largest poverty reduction resulting from CBRC with 850,000 and ESEC with 807,000 persons lifted out of poverty (higher adoption scenario). In the discussion, we address the data needs for more fine-grained calculations to better guide research investment decisions. Our results show the potential of public investments in concerted research addressing the spread of Foc TR4 to yield high returns and substantially slow down disease spread.

Pattern of local adaptation to quantitative host resistance in a major pathogen of a perennial crop.

Understanding the mechanisms involved in pathogen adaptation to quantitative resistance in plants has a key role to play in establishing durable strategies for resistance deployment, especially in perennial crops. The erosion of quantitative resistance has been recently suspected in Cuba and the Dominican Republic for a major fungal pathogen of such a crop: Pseudocercospora fijiensis, causing black leaf streak disease on banana. This study set out to test whether such erosion has resulted from an adaptation of P. fijiensis populations, and to determine whether or not the adaptation is local. Almost 600 P. fijiensis isolates from Cuba and the Dominican Republic were sampled using a paired-population sampling design on resistant and susceptible banana varieties. A low genetic structure of the P. fijiensis populations was detected in each country using 16 microsatellite markers. Cross-inoculation experiments using isolates from susceptible and resistant cultivars were carried out, measuring a quantitative trait (the diseased leaf area) related to pathogen fitness on three varieties. A further analysis based on those data suggested the existence of a local pattern of adaptation to resistant cultivars in both of the study countries, due to the existence of specific (or genotype by genotype) host-pathogen interactions. However, neither cost nor benefit effects for adapted populations were found on the widely used "Cavendish" banana group. These results highlight the need to study specific host-pathogen interactions and pathogen adaptation on a wide range of quantitative resistance phenotypes in banana, in order to develop durable strategies for resistance deployment.

Bacterial Diseases of Bananas and Enset: Current State of Knowledge and Integrated Approaches Toward Sustainable Management.

Bacterial diseases of bananas and enset have not received, until recently, an equal amount of attention compared to other major threats to banana production such as the fungal diseases black leaf streak (Mycosphaerella fijiensis) and Fusarium wilt (Fusarium oxysporum f. sp. cubense). However, bacteria cause significant impacts on bananas globally and management practices are not always well known or adopted by farmers. Bacterial diseases in bananas and enset can be divided into three groups: (1) Ralstonia-associated diseases (Moko/Bugtok disease caused by Ralstonia solanacearum and banana blood disease caused by R. syzygii subsp. celebesensis); (2) Xanthomonas wilt of banana and enset, caused by Xanthomonas campestris pv. musacearum and (3) Erwinia-associated diseases (bacterial head rot or tip-over disease Erwinia carotovora ssp. carotovora and E. chrysanthemi), bacterial rhizome and pseudostem wet rot (Dickeya paradisiaca formerly E. chrysanthemi pv. paradisiaca). Other bacterial diseases of less widespread importance include: bacterial wilt of abaca, Javanese vascular wilt and bacterial fingertip rot (probably caused by Ralstonia spp., unconfirmed). This review describes global distribution, symptoms, pathogenic diversity, epidemiology and the state of the art for sustainable disease management of the major bacterial wilts currently affecting banana and enset.

Epidural Neurostimulation of Posterior Funiculi for the Treatment of Buerger's Disease.

Background. Buerger disease is a nonatherosclerotic, segmental, occlusive and recurrent inflammatory vascular disorder that affects small and medium-sized arteries and veins of the upper and lower extremities. Case reports. We report two cases of Buerger disease. Medical History. Smoking habit. No autoimmune diseases. No diabetes mellitus. Intermittent vascular claudication at 100-150 m. Several hospital admissions for amputations. Prior Medical Treatment. Antiplatelet agents, vasodilators, nonsteroidal anti-inflammatory drugs, third-step analgesics, fibrinolytic treatment and lumbar sympathectomies. Following all of the above treatments, Synergy(®) spinal cord (ECP) stimulator with two electrodes (Quad PISCES(©) ) placed at the level of T9-T10. Results. There has been a reduction in pain of about 80% and an improvement of intermittent claudication (one of the patients no longer claudicates, whereas the other patient claudicates at 400 m). Conclusion. Neurostimulation of the posterior funiculi could be considered not only as palliative care but also as a therapeutic option.

Bilateral infusion pump implants as therapy for refractory corneal ulcers in a patient with CREST syndrome: an interdisciplinary approach.

Internal infusion pumps are implantable and programmable systems that have been widely used for years in the management of chronic pain. During the past few years, these devices have had an increasingly prominent role given the possibility of insulin infusions in patients with diabetes mellitus because they provide patients with higher autonomy in the management of their disease, despite the fact that they are expensive systems and require surgery for implantation. These features make internal infusion pumps a suitable therapeutic option for those patients who need to use artificial tears continuously because of severe dry eyes. We report a case of severe eye pain due to xerophthalmia in a patient with CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome who was treated with an implanted pump reservoir.

Tratamiento farmacológico del trastorno del sueño en la fibromialgia / No disponible

La fibromialgia es una patología crónica y compleja que provoca dolor muscular generalizado que puede llegar a ser invalidante, asociado a mal descanso nocturno y fatigabilidad, y que afecta a las esferas biológica, psicológica y social de los pacientes. Además su elevada prevalencia hace de ella un problema sanitario de primera magnitud. Dificultad añadida supone el que sus criterios diagnósticos únicamente sean clínicos y que su etiopatogenia todavía no haya sido aclarada, lo que dificulta aún más su estudio y por supuesto su abordaje terapéutico. Los múltiples síntomas que acompañan a esta enfermedad, su elevada incidencia y el desconocimiento de su etiología y tratamiento adecuados enfatizan la necesidad de un abordaje multidisciplinar, donde el equipo asistencial, incluido el farmacéutico, promoverá el uso racional de las medidas farmacológicas y fomentará aquellas medidas no farmacológicas que mejoren la calidad de vida del enfermo de fibromialgia (AU)

Fibromyalgia is a chronic and complex pathology that provokes muscular pain which may become invalidant, associated to a badly night rest and fatigue that affects the biological, psychological and social environment of the patients. Its high prevalence makes fibromyalgia a first magnitude sanitary problem. The fact that its diagnostic criteria be only clinical, and that its aetiopathogenesis has not yet been clarified, makes it difficult its study and therapeutical approach. A multidisciplinary approach is necessary because of the multiple symptoms, the high number of cases and the low knowledge of the etiology and the satisfactory treatment. The care team, including pharmacist, will promote the rational use of the pharmacological and the not pharmacological measures that improve de quality of life (AU)

Dolor irruptivo. Avances en su tratamiento: citrato de fentanilo oral transmucosa / Breakthrough pain. Advances in treatment: oral transmucosal fentanyl citrate

El dolor irruptivo o incidental es el síntoma más esperado y temido en pacientes con cáncer. El escaso tratamiento preventivo para el síntoma convierte las consultas a las unidades de urgencias en un hecho frecuente. El objetivo de este trabajo consiste en ampliar los conocimientos de enfermería sobre este tipo de tratamiento. Aprender a manejar opioides potentes (como el citrato de fentanilo) permite realizar una adecuada educación sanitaria sobre recomendaciones concretas para su uso. Actualmente el único fármaco diseñado específicamente para tratar el dolor irruptivo es el fentanilo oral transmucosa, de fácil y sencilla administración, importante rapidez de acción y con un buen perfil de seguridad. Como característica adicional, en las encuestas de satisfacción realizadas es el preferido por los pacientes como rescate habitual para las crisis álgidas. Su forma de administración sencilla e indolora, sumada a la rápida absorción, lo convierte en la analgesia con mayor efectividad en el control del dolor

Breakthrough or incidental pain is the most widely feared symptom in cancer patients. Because there is little preventive treatment for this symptom, it is a frequent cause of visits to emergency departments. The aim of this study was to increase nurses' knowledge of this type of treatment. Learning to manage potent opioids (such as fentanyl citrate) would allow nurses to provide health education to patients and their families on specific recommendations for their use. Currently, the only drug specifically design to treat breakthrough pain is oral transmucosal fentanyl, which is easily and simply administered, with fast onset of action and a good safety profile. As an additional characteristics, satisfaction surveys have demonstrated that oral transmucosal fentanyl is preferred by patients as routine rescue therapy for pain exacerbations. Because of its simple and painless administration and rapid absorption, this drug is the most effective analgesic in controlling pain