Impact of Collared Peccaries Dycotiles tajacu (Artiodactyla: Tayassuidae) on understory vegetation in the tropical rainforest of the Nogal-La Selva Biological Corridor, Costa Rica / Impacto del pecarí de collar, Dycotiles tajacu (Artiodactyla: Tayassuidae) en la vegetación del sotobosque del bosque tropical húmedo del Corredor Biológico Local Nogal-La Selva, Costa Rica

Abstract Introduction: Evidence suggests that herbivores, such as peccaries, shape vegetation structure and diversity through predation, trampling, dispersal, and rooting behavior. Objective: To evaluate the impact of peccaries (Dycotiles tajacu) on the understory vegetation of the tropical rainforest in the Nogal-La Selva Local Biological Corridor, Costa Rica, comparing a site with the absence of peccaries to another with the presence of these animals. Methodology: From June to November 2021, 20 experimental exclusions and 20 free access plots, each measuring 2 m2 were used to quantify herbivory, the number of leaf blades, damaged leaves, healthy leaves, sapling height, and fallen biomass at both sites. Results: A higher sapling density was found in the Nogal Reserve, but a lower sapling diversity, while in La Selva there was a higher sapling diversity, but a lower density of seedlings. Herbivory and sapling height in La Selva exceeded those in Nogal. The exclusion of peccaries reduced seedling damage but did not affect the dynamics of fallen biomass. Conclusion: For the design, implementation, and evaluation of the effectiveness of biological corridors, it is crucial to consider plant-animal interactions to enhance the flow of ecological processes through functional and structural connectivity, analyzed from interactions such as those presented in this paper.

Resumen Introducción: Existe evidencia que herbívoros, como los saínos, dan forma a la estructura y diversidad de la vegetación a través del comportamiento de depredación, pisoteo, dispersión y enraizamiento. Objetivo: Evaluar el impacto de los saínos (Dycotiles tajacu) en la vegetación del sotobosque del bosque tropical húmedo en el Corredor Biológico Local Nogal-La Selva, Costa Rica, en un sitio con ausencia y en otro con presencia de saínos. Métodos: De junio a noviembre de 2021 se utilizaron 20 exclusiones experimentales y 20 parcelas de acceso libre de 2 m2, se cuantifico la herbivoría, número de láminas foliares, hojas dañadas, hojas sanas, altura de brinzales y biomasa caída en ambos sitios. Resultados: Se encontró una mayor densidad de brinzales en Reserva Nogal pero una menor diversidad, contrario en La Selva donde se encontró una mayor diversidad de brinzales, pero una menor densidad de plántulas. La herbivoría y la altura de brinzales en La Selva fue mayor que en Nogal. La exclusión de los saínos disminuyó el daño a las plántulas, pero no afectó la dinámica de la biomasa caída. Conclusión: Es necesario contemplar para el diseño, implementación y evaluación de la efectividad de corredores biológicos, las interacciones planta-animal, para potencializar el flujo de procesos ecológicos mediante la conectividad funcional y estructural, analizada a partir de interacciones como las presentadas en este trabajo.

Assessment of antimicrobial activity of Meliponula ferrugica in pathogenic wound samples

Background: Honey is a naturally occurring sweet material that bees make from nectar from flowers, secretions from plant parts, or excretions from plants that suck insects from plant parts. Honey’s antibacterial and antifungal qualities are widely known, and it has been used to heal burns, surgical wounds, and decubitus ulcers. Honey instantly sterilizes wounds affected by Staphylococcus aureus. The honey’s ability to fight bacteria can be ascertained by the nectar’s origin. Many antibiotic resistances among the bacteria that cause infections in humans have directly evolved as a result of the use of antibiotics in clinical practice. Methods: This study found that Bergey’s manual of determinative bacteriology can be used to identify Pseudomonas aeruginosa and Staphylococcus aureus. According to the study’s findings, honey has a capacity to neutralise Pseudomonas aeruginosa and Staphylococcus aureus that have been isolated from infected wounds. Honey’s antibacterial characteristics account for a significant portion of its antibacterial activity. Results: Staphylococcus aureus and Pseudomonas aeruginosa were both susceptible to the antibacterial activity of the honey sample. Pseudomonas aeruginosa exhibited lower activity compared to Staphylococcus aureus. Conclusions: The results of this investigation show that Bergey’s handbook of determinative bacteriology can be used to identify Staphylococcus aureus and Pseudomonas aeruginosa. According to the study’s findings, honey has the ability to neutralise Pseudomonas aeruginosa and Staphylococcus aureus that have been isolated from infected wounds.

Cost analysis study of price variation among the various brands of proton pump inhibitors available in Benghazi-Libya

Background: A large proportion of patients in developing countries have to pay out of pocket for their medications. The prices of different brands of the same medications vary considerably and may vary from one community pharmacy to another. This study was undertaken to evaluate the variation in costs of proton pump inhibitors (PPI) and histamine H2-receptor antagonists available in Libya. Methods: Prices of various brands of PPI and various formulations were collected from four community pharmacies in the city of Benghazi. Both cost ratio and percentage variation were calculated and compared for various brands of the same strength and number of tablets, capsules, injections, or syrups. Results: The highest cost ratio and percentage price variation were found with omeprazole 20 mg, followed by omeprazole 40 mg. Other significant cost variations (>100%) were seen with pantoprazole 40 mg, Downoprazol (omeprazole + sodium bicarbonate) 40 mg, and esomeprazole 40 mg. Ampoules of omeprazole, cimetidine, and ranitidine had cost ratios of 1:1.7, 1:1.7, and 1:1.8, and cost variation ratios of 71.4, 66.7, and 75, respectively. Variations in prices of PPI and histamine H2 antagonists from the same manufacturer between different community pharmacies were common. The highest percentage cost variation (100) was seen with omeprazole 20 mg. Conclusions: Due to political instability, the prices of all drugs are controlled by importing private companies and the owners of community pharmacies instead of governmental authorities, that leads to cost variations. Therefore, the health authorities exert strict control on pricing of medications.

Role of vildagliptin and its combination in type 2 diabetes mellitus management: a knowledge, attitude, and practice survey among Indian healthcare professionals

Background: Type 2 diabetes mellitus (T2DM) is a prevalent condition, with a significant burden in India, affecting approximately 74.2 million individuals. Vildagliptin, a selective dipeptidyl peptidase 4 (DPP-4) inhibitor, is approved globally for monotherapy and combination therapy. Recently, it became available as a generic product, which increased its accessibility to patients. This study aimed to assess the knowledge, attitude, and practice (KAP) regarding vildagliptin and its combination in T2DM management. Methods: A pan-India cross-sectional KAP survey was conducted from February 2022 to March 2023. The survey utilized a specially designed questionnaire focusing on various aspects of vildagliptin treatment. A total of 1,440 healthcare professionals (HCPs) with recognized qualifications and experience in diabetes management participated. Descriptive statistics were employed for data analysis. Results: HCPs reported initiating Vildagliptin monotherapy at an HbA1c 6.5-7.5%, while combination therapy with vildagliptin and metformin at HbA1c 7-8%. Vildagliptin was primarily preferred as an add-on to metformin. Inadequate HbA1c control with existing therapy emerged as the primary trigger for switching to vildagliptin and metformin combination. Treatment-na飗e T2DM patients with HbA1c 1.5% above target and those uncontrolled on metformin monotherapy or dual therapy were reported to benefit most from combination therapy. Combination therapy was reported to result in a glycemic reduction of 1.0-1.5%. HCPs perceived vildagliptin better than other DPP4 inhibitors due to its efficacy in reducing HbA1c and a lower risk of hypoglycemia. Conclusions: The KAP survey highlights the value Indian HCPs place on the effectiveness and tolerability of vildagliptin and their attitudes and practices in its use, highlighting its clinical utility in routine practice.

Non obstructive versus obstructive coronary artery disease documented by coronary angiography: prevalence, diagnostic features in a single center experience

Background: Coronary angiography often detects NOCAD. Stable angina or MI patients may have NOCAD, defined as less than 50% luminal diameter decrease by visual assessment on coronary angiography. The study was to determine the frequency of non-obstructive coronary artery disease in Al Hussain cardiac centre patients who underwent CAG and the differences in clinical presentation and associated morbidity between the two groups. Methods: Cross-sectional research was done at Karbala's al-Hussaini cardiac centre. CAG data from 167 IHD-like patients between January and May 2021. NOCAD 42 individuals (stenosis <50%) were compared to 125 obstructive CAD patients (?50% stenosis). Results: Between January and May 2021, 167 individuals received CAG for diagnostic, therapeutic, elective, or emergency purposes. The study included 113 (67.7%) men and 54 (32.3%) women. Patients had an average age of 56.52�.09 years, with a median of 58 years. Overall, 25.1% (n=42) of research participants had NOCAD. The frequency of INOCA was 29.4% and MINOCA 19.1%. Patients with NOCAD were younger than those with obstructive CAD (p<0.05). no significant gender, co morbidity, or clinical differences across groups. Conclusions: We believe this is the first report of prevalence, risk factors, and clinical aspects in karbalai patients' cardiac care centre in Iraq. NOCAD patients are younger and their medical history, clinical features, ECG, and serum troponin are difficult to distinguish from OCAD.

The effect of guided imagery on pain levels in post-caesarean section patients

Background: Cesarean section is one form of surgical procedure involving incision of the abdominal and uterine walls, which poses a risk of postoperative pain. Pain is a common issue experienced by women after cesarean section, particularly within the first 48 hours. Uncontrolled pain can lead to physical and psychological complications such as postpartum depression and difficulties in infant care. Pain management may involve pharmacological therapy, but non-pharmacological alternatives such as relaxation therapy like guided imagery need to be explored, which can help reduce post-cesarean section pain. Methods: This study is experimental, utilizing a randomized controlled trial pre-test and post-test control group double-blind design. The research was conducted from July to September 2022. A simple randomized sampling technique was employed, with a sample size of 32 post-cesarean section patients divided into two groups: the treatment group (guided imagery and standard therapy) consisting of 16 patients, and the control group (standard therapy) consisting of 16 patients. Results: The study revealed a decrease in visual analogue score (VAS) scores by -2.875�619 with an effect size of 0.641 in the treatment group. The study had a significant impact with a p value of 0.000 (p<0.05). Conclusions: Guided imagery is effective in reducing the pain level of post-cesarean section patients.

Reverse dorsal metacarpal artery flap: a review

Deep soft tissue injuries around the thumb can significantly impair hand function if not managed appropriately. Various surgical options exist for treating these complex lesions, including microsurgical flaps, local flaps, and distant pedicled flaps. The dorsal metacarpal artery (DMCA) family of flaps belongs to the latter category. These versatile flaps can be designed as racquet-shaped, island, or bilobed flaps, utilizing the first DMCA alone or in combination with the second DMCA. In this review, we explore the surgical anatomy, techniques, and clinical applications of reversal DMCA flap (RDMA).

Brain abscess in a 12-year-old child with congenital heart disease: lessons learnt

Brain abscess is a rare and often life-threatening sequelae, observed in 5-20% of the patients with cyanotic congenital heart diseases (CHD). Cyanotic heart diseases involve a right-to-left shunt by-passing the pulmonary vascular bed, culminating in tissue hypoxia. We present a case of an uncorrected atrioventricular canal defect (AVCD) with a double outlet right ventricle (DORV) complicated by a brain abscess in a 12-year-old girl. This patient was a known case of CHD diagnosed at 2 years of age and presented to the neurology out-patient department with a holocranial headache, vomiting, and low-grade fever for 5 days. General examination was suggestive of cyanosis and low-set ears. Systemic examination revealed a pansystolic murmur with bilateral extensor plantar reflexes. MRI brain with contrast revealed an abscess in the right temporoparietal lobe with perilesional edema. The patient was managed conservatively. Nine days post-discharge, the patient presented with generalized tonic-clonic seizures and was readmitted and managed accordingly. Subsequently, she was referred to the cardiothoracic surgery department for correction of the CHD. However, the family gave negative consent for the same. The relatives of the case described here were counseled to get a surgical correction done for the cardiac defect at the time of diagnosis but with no success. The aim of publishing this case is to emphasize the need for timely diagnosis and correction of such anomalies to curb serious complications causing profound morbidity and mortality.

Congenital multiseptate gall bladder in a child: a rare case report

Congenital multiseptate gallbladder (CMGB), is a rare congenital anomaly of gall bladder and it may be associated with other abnormalities. The gallbladder has one or many septa that divides the cavity into multiple distinct sections. It is considered as a pseudo-duplication of the gallbladder. Septate gall-bladder has not been a well-documented entity as most of the patients are asymptomatic, and this is usually an incidental finding which is discovered accidentally during the evaluation of abdominal pain. Some patients may present to the clinician with the complaints of pain in the right hypochondrium and epigastrium or colicky abdominal pain. Rarely, there may be stone formation due to septations, which may lead to recurrent abdominal pain. The most accurate way to diagnose septate gall-bladder is to combine ultrasonography and magnetic resonance cholangiography (MRCP). Here we present a four-year-old female child with a multiseptate gall bladder who underwent laparoscopic cholecystectomy, and her abdominal pain resolved entirely.

The application of mindfulness-based cognitive therapy as an adjunctive therapy to alleviate depressive symptoms in post-stroke patients: a case report

This case report explores the application of mindfulness-based cognitive therapy (MBCT) as an adjunctive therapy to alleviate depressive symptoms in post-stroke patients. Stroke is a major global health issue, leading to significant mortality and long-term disability. Post-stroke depression (PSD) is a common complication that negatively impacts recovery and quality of life. This study aims to understand the effectiveness of MBCT in managing PSD in a patient at RSUD Dr. Moewardi. Ny. SH, a 54-year-old housewife, experienced severe depression following a stroke. Her depressive symptoms were compounded by personal challenges, including a tumultuous relationship with her husband. Over eight MBCT sessions, the patient engaged in various mindfulness exercises designed to enhance present-moment awareness and develop healthier coping mechanisms. The sessions focused on building rapport, linking thoughts and emotions, confronting negative experiences, and integrating learned techniques into daily life. The patient reported significant improvements in mood, reduced depressive symptoms, and better coping strategies. Her Hamilton depression rating scale (HDRS) score decreased, indicating a reduction in the severity of her depression. The findings suggest that MBCT can be an effective adjunctive therapy for managing depression in post-stroke patients, improving mental health through structured mindfulness and cognitive therapy techniques. This case underscores the potential benefits of MBCT in enhancing recovery and quality of life for stroke survivors. Further research is needed to standardize MBCT procedures and explore its broader application in clinical settings.

Multiple hamartomatosis of the biliary tract: case report

Von Meyenburg complex or multiple biliary hamartomatosis is a rare clinical diagnosis, with a reported prevalence of up to 5.6% in large autopsy series. Since this type of pathology often lacks clinical symptoms, it is usually an incidental finding. We present the case of an 85-year-old female referred to our unit for persistent jaundice, abdominal pain and weight loss. The diagnosis and management of this pathology is often a challenge, the natural history of these cases remains unknown, and neither follow-up nor treatment protocols have been developed in patients with multiple biliary hamartomatosis. Multiple biliary hamartomatosis is a rare pathology which has no specific treatment, however, knowing about it allows a good differential diagnosis with obstructive and parenchymal hepatic pathology.

Tinea nigra: rare and almost never remembered superficial mycosis

Tinea nigra is a chronic fungal infection of the stratum corneum caused by the fungus Hortaea werneckii, clinically manifested by asymptomatic and hyperchromic macules ranging in color from light brown to black and affecting mainly the palmar and plantar areas. must be differentiated mainly from acral melanoma. It occurs mainly in South America (Brazil, Colombia, Venezuela), Central America and the Caribbean (Panama, Cuba), Asia (India, Japan, Sri Lanka) and the coastal regions of Africa and is uncommon in Europe, correlated with travel and immigration intercontinental. In relation to Brazil in the period 1916-2020, 203 cases were reported. We present a case of palmar tinea nigra in an adult patient with 3 months of evolution, diagnosed through clinical examination, direct mycological examination, Sabouraud agar culture, and dermatoscopy of the lesion was also performed. who fully responded to topical therapy with miconazole.

Delayed splenic rupture following abdominal trauma: a case report

We present the case of a 20-year-old male who presents multiple traumas of the abdomen 26 days prior to his return to the emergency room. Going again to evaluation with frank data of peritoneal irritation, since there is no hemodynamic commitment, a contrasted abdomen computed tomography (CT) scan is requested, finding a grade III splenic lesion, which is why he is admitted for emergency splenectomy. This case reports a splenic injury with the need for delayed splenectomy.

Pyloric hypertrophy in adults: case report

Pyloric hypertrophy is a benign condition characterized by narrowing of the pyloric canal, which may be associated with other pathologies. It is believed to manifest as a mild form of hypertrophy from childhood into adulthood. Symptoms can be nonspecific, such as nausea, vomiting, oral intolerance, and weight loss. Diagnosis can be challenging for physicians, and accurate reporting of cases is difficult due to some patients remaining asymptomatic.

Prevalence of hypertension among fisherman community in Chennai, Tamil Nadu, South India: a descriptive cross-sectional study

Background: Hypertension, often referred to as the "silent killer," usually presents no symptoms, making many people unaware of their condition. Fishing, as a profession, poses unique health risks due to harsh environmental conditions, irregular work patterns, and strenuous physical demands. Fishermen are particularly vulnerable due to unhealthy diets, sleep disturbances, physical inactivity, tobacco and alcohol use, and obesity. Estimating the prevalence of hypertension among fishermen is crucial for understanding the extent of this hidden health issue within this high-risk group and for implementing targeted interventions to improve their health outcomes. Methods: A cross-sectional study was conducted among Chennai's fishermen using systematic random sampling. Data were collected using a semi-structured questionnaire, and blood pressure was recorded following JNC criteria. Results: The study included 180 fishermen with a mean (SD) age of 49 (12). The prevalence of hypertension was 38.9%. Significant associations were found between hypertension, age, and years of fishing experience. Notably, 77.2% of fishermen lacked knowledge about hypertension, and 86.1% were unaware of its risk factors. Isolated systolic hypertension was found in 16% of participants, while 36% had isolated diastolic hypertension. Conclusions: In Chennai, hypertension is highly prevalent among fishermen and is significantly associated with age, years of fishing experience and smoking. There was no significant association with family history of hypertension, stress, or fried fish consumption. Awareness and knowledge about hypertension were very low among the fishermen. Although isolated systolic and diastolic hypertension were relatively minimal, regular hypertension screening for this community is essential.

A ruptured cornual pregnancy with previous history of salpingectomy: rare case of 3rd ectopic pregnancy

A cornual pregnancy is the most dangerous type of ectopic pregnancy since it can be misdiagnosed easily and has high mortality rate. It is diagnosed when the implantation site is at the junction between the fallopian tube and the uterus. It accounts for 2� of ectopic pregnancies. In a ruptured case, patient usually presents with hypovolemia and shock. For a successful outcome, early diagnosis and management are critical. A 29 years old woman, G3P0A2L0 with 8 weeks 5 days of amenorrhea conceived by IVF-ET with a history of left salpingectomy and right cornual cauterization, presented in emergency with complaints of lower abdominal pain, vomiting, burning micturition and giddiness. Per abdominal examination- soft with mild tenderness. Resuscitation started. All necessary investigations were done. Treatment started considering provisional diagnosis as septic shock following urinary tract infection (UTI). Ultrasound report showed uterus with thickened endometrium with hyperechoic irregular small gestational sac like structure in uterine cavity with hemoperitoneum in pelvis. Emergency laparotomy done considering a diagnosis of hypovolemic shock due to ruptured cornual ectopic pregnancy. Intra-operatively she was found to have hemoperitoneum with left sided ruptured cornual ectopic pregnancy. Early diagnosis is the cornerstone of cornual pregnancy before its rupture and to reduce the chances of maternal mortality. Combination of clinical features, increased serum ?-hCG, high resolution trans-vaginal ultrasonography gives the correct diagnosis in most of the cases. While doing antenatal ultrasonography in the first trimester, high index of suspicion is needed to diagnose cornual ectopic pregnancy. Conservative medical and surgical management is decided on clinical condition of the patient. Our case represents that a history of salpingectomy does not eliminate the potential of ipsilateral ectopic pregnancy.

Judicialización de medicamentos de alto precio en Argentina: estudio cuali-cuantitativo / Judicialization of high priced medications in Argentina: quali-quantitative study

Resumen Introducción : Las consecuencias económicas de la cobertura obligatoria, vía judicial, de medicamentos de alto precio constituye un problema creciente, que amerita conocer sus características locales para aportar posibles soluciones. Objetivo : Identificar medicamentos, enfermedades, impacto económico y factores contextuales de la ju dicialización de medicamentos de alto precio (MEP) Argentina. Métodos : Estudio descriptivo cuali-cuantitativo que analizó retrospectivamente recursos de amparos legales por MEP de tres bases de datos nacionales y provinciales durante 4 años, evaluando relación existente entre am paros con aprobación regulatoria, inclusión de los MEP al paquete de beneficios y relación con notas periodísticas. Resultados : Se incluyeron 405 amparos provenientes principalmente del Ministerio de Salud Nacional. Los tres medicamentos más judicializados fueron nusiner sen (21.7%), palbociclib (5.9%) y agalsidasa-alfa (4.7%). Solo el 69.4% de los medicamentos se encontraban aprobados para la comercialización en Argentina al momento del amparo; el 45.7% se encontraban incorpo rados al Sistema Único de Reintegros y el 16.8% contaban con informe de la Comisión Nacional de Evaluación de Tecnologías Sanitarias y Excelencia Clínica (CONETEC), negativa en el 87.1% de casos. El tiempo promedio des de la solicitud hasta la provisión del medicamento fue de 150 días. Se observó una correlación temporal entre la aparición del MEP en la prensa nacional gráfica y la presentación de amparos de dicho MEP. Conclusiones : La judicialización se concentró en medicamentos de altísimo precio para enfermedades poco frecuentes u oncológicas. Los fallos fueron mayo ritariamente a favor del demandante, siendo los tiempos de acceso al medicamento prolongados. Los medios de comunicación anticiparon los procesos judiciales.

Abstract Introduction : The economic consequences of manda tory coverage, through judicial means, of high-priced medications constitutes a growing problem, which mer its knowing its local characteristics to provide possible solutions. Objective : To identify medications, diseases involved, economic impact and contextual factors of the judi cialization of high-priced medications in the Argentine Health System(MEP). Methods : Quali-quantitative descriptive study that retrospectively analyzed legal protection resources by MEP from three national and provincial databases from January 2017 to December 2020, evaluating the exist ing relationship between lawsuits with regulatory ap proval, inclusion in benefit packages and relationship with journalistic articles for the three most frequently prosecuted drugs. Results : 405 lawsuits were included, mainly from the Ministry of National Health. The three most prosecuted medications were nusinersen (21.7%), palbociclib (5.9%) and agalsidase-alfa (4.7%). Only 69.4% of medications were approved for marketing in Argentina at the time of the protection; 45.7% were incorporated into the Single Reimbursement System, and 16.8% had a report from the National Commission for the Evaluation of Health Technologies and Clinical Excellence (CONETEC), which was negative in 87.1% of cases. The average time from request to provision of the medication was 150 days. A temporal correlation was observed between the appear ance of the MEP in the national graphic press and the appeals occurrence. Conclusions : Judicialization focused on very high-priced medications for rare or oncological diseases. The rulings were mostly in favor of the plaintiff, and access times to the medication took a long time. The mass media anticipated the judicial processes.

Neumatosis intestinal y neumoperitoneo: no siempre una indicación quirúrgica / Intestinal pneumatosis and pneumoperitonum: not al ways a surgical indication

Resumen La neumatosis intestinal y el neumoperitoneo no son entidades patológicas en sí mismas, son signos radio lógicos que resultan de alguna condición subyacente. En general, estos se asocian con procesos graves intra-abdominales que resultan en cirugías de urgencias con resecciones de intestino. A continuación, presentamos el caso de una mujer de 80 años, con diagnóstico de cáncer de mama estadio IV en tratamiento con ful vestrant y ribociclib, que ingresó a nuestro centro por dolor abdominal y vómitos. Se diagnosticó neumatosis intestinal y neumoperitoneo por lo que se procedió a laparotomía exploradora por sospecha de isquemia intestinal. No hubo evidencia de necrosis o perforación intestinal por lo que no se realizó resección. Evolucionó durante la internación de forma satisfactoria y en el control tomográfico al mes del egreso hubo resolución completa del cuadro. Si bien está descrito esta afectación en relación a los episodios de aumento de presión intraabdominal, como en la emesis, también se describió en pacientes con neoplasias, principalmente del tubo digestivo, ya sea por daño local o por toxicidad asociada a la quimioterapia. No encontramos reportes en la literatura de neumatosis intestinal vinculada a esta medicación antineoplásica en humanos. Probablemente en nuestro caso la etiolo gía haya sido multifactorial. Es posible que el ribociclib haya jugado un rol, ya sea por un mecanismo indirecto asociado a los vómitos y la inmunosupresión o directo sobre el enterocito debido a su mecanismo de acción celular no específico.

Abstract Pneumatosis intestinalis and pneumoperitoneum are not pathological entities in themselves, they are radiological signs that result from some underlying condition. In general, these are associated with serious intra-abdominal processes that result in emergency surgeries with bowel resections. Below, we present the case of an 80-year-old woman, diagnosed with stage IV breast cancer under treatment with fulvestrant and ribociclib, who was admitted to our center due to abdominal pain and vomiting. She was diagnosed with intestinal pneumatosis and pneumoperitoneum, so she underwent exploratory laparotomy for sus pected intestinal ischemia. There was no evidence of intestinal necrosis or perforation, so resection was not performed. She progressed satisfactorily during hospitalization and in the tomographic control one month after discharge there was complete resolution of the condition. Although this condition has been described in relation to episodes of increased intra-abdominal pressure, such as emesis, it has also been described in patients with neoplasms, mainly of the digestive tract, either due to lo cal damage or toxicity associated with chemotherapy. We found no reports in the literature of pneumatosis intesti nalis linked to this antineoplastic medication in humans. Probably in our case the etiology was multifactorial. It is possible that ribociclib played a role, either through an indirect mechanism associated with vomiting and im munosuppression or directly on the enterocyte due to its non-specific cellular mechanism of action.