Cholangiocarcinoma presenting as hemobilia and recurrent iron-deficiency anemia: a case report.

INTRODUCTION: Iron-deficiency anemia is a relatively common presenting feature of several gastrointestinal malignancies. However, cholangiocarcinoma has rarely been reported as an underlying cause. The association of cholangiocarcinoma with the rare clinical finding of hemobilia is also highly unusual. To our knowledge, this is the first case report of cholangiocarcinoma presenting with acute hemobilia and chronic iron-deficiency anemia. CASE PRESENTATION: We report the case of a Caucasian, 84-year-old woman presenting with recurrent, severe iron-deficiency anemia who was eventually diagnosed with intra-hepatic cholangiocarcinoma, following an acute episode of hemobilia. A right hepatectomy was subsequently performed with curative intent, and our patient has now fully recovered. CONCLUSION: This is a rare example of hemobilia and chronic iron-deficiency anemia in association with cholangiocarcinoma. We suggest that a diagnosis of cholangiocarcinoma should be considered in patients who present with iron-deficiency anemia of unknown cause, particularly in the presence of abnormal liver function.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Direct patient reporting of adverse drug reactions: An analysis of spontaneous reports submitted to Malaysian pharmacovigilance centre

Purpose: To evaluate patient adverse drug reaction (ADR) reports in terms of categories by System Organ Class (SOC), suspected products and seriousness.Methods: The national database was retrospectively searched from 2008 to 2015. ADR reports by patients were included but vaccine-related reports and reports by healthcare professionals were excluded. Eligible reports were analysed descriptively and Chi-square test was used to evaluate the association of various categorical variables with serious ADRs.Results: Of the total of 75,391 reports screened in the National ADR database for the study period, only 81 (0.11 %) were reports from patients, of which 32 (40 %) reports involved serious ADRs. The majority of reports was associated with unregistered products or unapproved cosmetics. Half of the reports involved traditional products while cosmetic products constituted another 10 % of the reports. The three main SOCs involved were skin and appendages disorders (26 %), body as a whole (25 %), and central and peripheral nervous system disorders (9 %). A total of 23 out of 47 products tested were adulterated with prescription drugs while 4 cosmetic products exceeded the permitted limit for hydroquinone or mercury. Two factors found to be significantly associated with serious ADRs were product registration status and presence of adulteration.Conclusion: The findings indicate that patient reporting of suspected ADRs has the potential to add valuable information to pharmacovigilance.Keywords: Adulterants, Patient reporting, Complementary and alternative medicines, Cosmetics, Pharmacovigilanc

Effect of discarded smooth and rough glass waste on mechanical properties of cement concrete

The depletion of natural material leads to an alternative material in its place in concrete. If the alternative material is a recycled material, it serves the purpose of reuse and reduces its impact on the environment. One such material is glass waste. In this study, two varied textures of transparent waste glass of size 12.5 mm are used as an alternative material for coarse aggregate with 10, 20, and 30% of replacement. The mechanical properties such as compressive strength, flexural strength and split tensile strength are studied along with water absorption and unit weight characteristics. It is observed that the compressive strength showed a maximum value at 10% replacement for both textured glasses, beyond that it reduces irrespective of curing period. A similar trend is observed in flexural strength also. The split tensile strength increases with percentage replacement due to the contribution of waste glass in interface transmission zone. The water absorption falls well within 3% for all the combinations indicating its good behaviour. The unit weight decreases making it suitable for making lighter material. When comparing cost, there is a reduction in cost by 3 to 7 %; however, it is minimum it addresses the environmental aspects

The role of podcasts in agricultural extension: Enhancing farmer-to-farmer learning

The rise of digital communication tools has opened new avenues for agricultural extension, with podcasts emerging as a powerful medium for farmer-to-farmer learning. This study explores the effectiveness of podcast-based agricultural education in enhancing knowledge dissemination among farmers in the Coimbatore region. Adopting an action research design, podcast interviews were created with 30 farmers, including both pesticide-using and innovative practitioners. These podcasts were then disseminated to another group of 30 purposively selected farmers to evaluate awareness and attitudinal changes. The study employed ranking techniques like Garrettranking and word cloud analysis using NVivo software to interpret the responses. The results revealed that podcasts significantly contributed to creating awareness, improving knowledge, shaping positive attitudes and encouraging symbolic and actual adoption of agricultural innovations. Respondents found the content relatable, easy to understand and accessible, highlighting the value of localized and experience-based communication. Despite these positive outcomes, the study identifies research gaps, such as limited understanding of long-term behavioural changes and the need for scalability across diverse farming communities. The findings suggest that podcasts canbe a cost-effective and impactful tool in agricultural extension when integrated with participatory approaches and supported by ICT infrastructure. Future research should focus on measuring the economic benefits, enhancing content delivery in multiple languages and fostering community-driven content creation to sustain interest and impact

Consumer Adverse Drug Reactions (ADRs) Reporting in Malaysia: A Retrospective Analysis of Spontaneous Reports from the National Pharmacovigilance Database from 2008 to 2015

Many countries are incorporating direct patient reporting of adverse drug reactions (ADRs) into their pharmacovigilance systems as patients provide a different insight into drug safety compared to healthcare professionals. In Malaysia, consumer reporting of ADRs and issues with product qualitiesbegan in 2007. The aim of this study was to examine consumer reports in terms of ADR categoriesby System Organ Class (SOC), suspected products and the seriousness of the ADRs

Natural farming and its global adoption - A bibliometric analysis literature review

Natural farming, introduced by Masanobu Fukuoka, provides a sustainable alternative to traditional farming by tackling issues like soil damage, chemi- cal use, and environmental harm. This study looks at global research on natural farming from 2018 to 2024, focusing on research trends, themes, and factors influencing its adoption. A review of 210 publications was con- ducted using Scopus, following PRISMA guidelines, with analysis done using R Studio and VOS viewer. India is the leader in natural farming research, with 135 publications, driven by government policies that support sustaina- bility. Other key contributors include China, Italy, and the United States. The analysis identified three main themes: environmental sustainability, eco- nomic benefits, and adoption strategies. The citation analysis highlighted important researchers like Bharucha and Venkateshmurthy. The main rea- sons farmers adopt natural farming include better soil health, less chemical use, lower costs, and greater climate resilience. Techniques like Zero- Budget Natural Farming (ZBNF), which includes practices like Jeevamritha and organic mulching, are vital for improving soil fertility and cutting down on input costs. This study shows that natural farming can help balance the environment, improve farmer incomes, and encourage more sustainable practices. Future research should explore the role of digital technologies and cooperation between countries to expand natural farming worldwide

Guardians of giants: a bibliometric analysis of mahout-elephant relationships and management takeaways for the Nilgiris

The study presents a systematic bibliometric review of mahout-elephant relations and management with specific applications for the Nilgiris region. Asian elephants face significant survival threats including habitat loss and captivity-based exploitation, with approximately 15,000 individuals in captivity across their range countries. Effective conservation strategies require a deep understanding of captive elephant management and welfare issues. Through a systematic review of 63 peer-reviewed articles from 2014-2024, spanning disciplines including animal welfare science, conservation biology, and veterinary medicine, this study identifies critical trends and knowledge gaps. Bibliometric analysis revealed two distinct research clusters with minimal overlap: elephant welfare/management studies and computational approaches. Thailand, particularly Chiang Mai University, emerged as a key research hub with strong international collaborations. Research output has increased significantly since 2016, with a notable acceleration around 2020. Thematic analysis identified concerning shifts in mahout demographics, with younger, less experienced individuals replacing traditional mahouts, compromising vital knowledge transmission. Tourism significantly impacts elephant welfare, with 82% of surveyed Thai camps chaining elephants for extended periods. Health concerns include tuberculosis, with seroprevalence reaching 36% in some populations. Research gaps include limited studies on long-term training effects, elephant psychology, rewilding outcomes, and technological applications in welfare assessment. This review highlights the need for interdisciplinary approaches targeting both elephant and human welfare, emphasizing collaborative efforts among mahouts, local communities, researchers, and conservation agencies to ensure sustainable Asian elephant conservation. The findings and recommendations provide a framework for evidence-based management strategies at the Theppakadu Elephant Camp in the Nilgiris and other similar facilities

HLA-DQA1*05 carriage associated with development of anti-drug antibodies to infliximab and adalimumab in patients with Crohn's Disease

Anti-tumor necrosis factor (anti-TNF) therapies are the most widely used biologic drugs for treating immune-mediated diseases, but repeated administration can induce the formation of anti-drug antibodies. The ability to identify patients at increased risk for development of anti-drug antibodies would facilitate selection of therapy and use of preventative strategies.This article is freely available via Open Access. Click on Publisher URL to access the full-text