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Objectives This study aimed to assess medication use in pregnant women in Malaysia by measuring use, knowledge, awareness, and beliefs about medications. Methods This was an observational, cross-sectional study involving a total of 447 pregnant women who attended the Obstetrics and Gynecology Clinic, Hospital Kuala Lumpur (HKL), Malaysia. A validated, self-administered questionnaire was used to collect participant data. Results Most of pregnant women had taken medication during pregnancy and more than half of them (52.8%) showed a poor level of knowledge about the medication use during pregnancy. Eighty-three percent had a poor level of awareness and 56.5% had negative beliefs. Age and education level were significantly associated with the level of knowledge regarding medication use during pregnancy. Multiparous pregnant women, and pregnant women from rural areas were observed to have a higher level of awareness compared with those who lived in urban areas. Use of medication during pregnancy was determined to be significantly associated with education level, and race. Conclusion Although there was prevalent use of medication among pregnant women, many had negative beliefs, and insufficient knowledge and awareness about the risks of taking medication during pregnancy. Several sociodemographic characteristics were significantly associated with the use (race and education level), level of knowledge (age and education level), awareness (parity and place of residence), and beliefs (race, education level, and occupation status) towards medication use during pregnancy.

This paper presents an overview of the various components of an emergency pipeline repair system which should be in place in order to act effectively and efficiently during an emergency pipeline repair scenario. The condition of pipelines during operation is typically monitored by means of external and internal inspections. These inspections allow for planned intervention when a pipeline is found to be deteriorating. A failure to inspect adequately for time dependent threats, or randomly occurring events such as third party interaction, could result in a pipeline failure, leading to a requirement to rapidly return to operation and thus the need for an emergency repair. An Emergency Pipeline Repair System (EPRS) is therefore an essential part of a pipeline integrity management system. The primary purpose of the EPRS is to ensure that pipeline operators have the necessary level of readiness to allow an emergency repair to be carried out, thus minimising the economic consequences of having a pipeline out of service, whilst optimising the cost of purchasing and maintaining equipment and spares. In general, pipeline operators will have some emergency repair procedures to cater for unplanned or unexpected incidents. However, to complete an emergency repair efficiently and effectively, the availability of adequate spare materials and timely access to the damage location is required. For a large pipeline network, satisfying these requirements can be challenging. This paper discusses some basic elements of an EPRS and describes a case study of the development of a risk based EPRS strategy for an offshore pipeline operator. This approach involves the identification of credible hazards that can lead to damage requiring an emergency repair, and identification of repair options. The relative importance of the individual pipelines, in terms of their availability requirement, and the expected time required to complete an emergency repair are then taken into account. This enables the pipelines to be ranked based on the consequence of failure. Pipelines with consequence rankings that are considered unacceptable are therefore highlighted, and EPRS readiness related to those pipelines can subsequently be optimised. Recommendations for the development of an EPRS for an onshore or offshore pipeline network are also made.

The aim of this article was to analyse the results of the transanal haemorrhoidal dearteralization (THD) technique in the treatment of haemorrhoidal disease. A case series of 42 patients (36 men and six women) with grade II and III haemorrhoids who underwent THD between September 2011 and October 2012 was carried out. Patients were subjected to three to six ligations and those with prolapse had mucopexy. Following surgery, patients were evaluated after 1 week, 3 months and 1 year. Forty-one patients presented with bleeding per rectum as the main complaint and one had only discharge. All cases were carried out as day-case surgeries. Twenty-six patients had six ligations, and 16 had between three and five. The mucopexy was carried out in 34 patients. The mean operative time was 46.8±9.4 minutes. Twenty-six patients (62%) had post-operative pain, four of whom had severe pain (score >7) which required analgesia. Thirty-three patients (79%) did not have any complications and nine (21%) had an immediate post-operative complication which was not severe. After 1 year, seven patients (17%) had recurrence of bleeding. The THD technique has shown that it is effective in terms of less pain and fewer complications in the population we studied. It can be carried out safely as a day-case surgery.

A 41-year-old homosexual man presented with a 10-week history of headache without pressure features commencing 10 weeks after a new sexual contact. Three days after the headache onset he noticed intermittent, bilateral visual blurring, worse in the right eye. The visual disturbance persisted intermittently and led to his referral to a local ophthalmology department where he was found to have bilateral papilloedema. There were no other abnormal signs on full examination of other systems and no other abnormal ocular findings. Cerebral imaging studies were normal. A lumbar puncture revealed a raised opening pressure of 35 mm cerebrospinal fluid (CSF) with a white cell count of 58 cells/mcl (mainly lymphocytes). Venereal disease research laboratory (VDRL), Treponema pallidum haemagglutination (TPHA) and Inno-LIA tests confirmed the presence of neurosyphilis. HIV testing was negative. He was treated with CSF pressure reduction via repeat lumbar puncture and acetozolamide and procaine penicillin intramuscularly. He recovered and remains symptom free at 1 year.