MyMedR

Fulltext Parental preferences with regards to disclosure following adverse events occurring in relation to medication use or diagnosis in the care of their children - perspectives from Malaysia

Wong CH, Tan TR, Heng HY, Ramesh T, Ting PW, Lee WS, et al.

Med J Malaysia, 2016 Aug;71(4):186-192.

PMID: 27770117

Open disclosure is poorly understood in Malaysia but is an ethical and professional responsibility. The objectives of this study were to determine: (1) the perception of parents regarding the severity of medical error in relation to medication use or diagnosis; (2) the preference of parents for information following the medical error and its relation to severity; and (3) the preference of parents with regards to disciplinary action, reporting, and legal action.

Internal iliac and ovarian artery ligation in the control of pelvic haemorrhage

Thavarasah AS, Sivalingam N, Almohdzar SA

Aust N Z J Obstet Gynaecol, 1989 Feb;29(1):22-5.

PMID: 2562595

Bilateral ligation of the internal iliac artery with or without ligation of the ovarian arteries was carried out in 17 patients who had life-threatening pelvic haemorrhage; 14 were due to obstetric haemorrhage, 2 followed abdominal hysterectomy and 1 intractable haemorrhage associated with carcinoma of the cervix. The procedure was successful in arresting the haemorrhage in 13 patients but 4 needed hysterectomy in spite of the ligation; 1 patient died from disseminated intravascular coagulation following surgery and 1 had cardiac arrest due to extensive blood loss during surgery and died 12 hours later. A review of the literature, a brief description of the procedure and its indications are discussed.

Fulltext Medical paternalism and patient autonomy; the dualism doctors contend with.

Sivalingam N

Med J Malaysia, 2011 Dec;66(5):421-2.

PMID: 22390093 MyJurnal

Fulltext Concepts in the management of the overactive bladder in women

Sivalingam N, Loh KY

Med J Malaysia, 2012 Feb;67(1):137-41; quiz 142.

PMID: 22582572

The 'overactive bladder' is a common problem affecting the elderly female population especially after the menopause. Urgency with or without urge incontinence accompanied by frequency of micturition and nocturia are presenting symptoms. The diagnosis is established after excluding other diseases of the lower urinary tract which have similar presenting features. The aetiology is multifactorial and this problem often causes physical, psychological and emotional distress to the patient. Management can be provided by primary care physicians initiating behavioral changes which include life style interventions and bladder drills with or without antimuscarinic drugs. The recalcitrant patient not responding to conventional therapy should be referred for specialist care. Non-conventional treatment using acupressure, neuromodulation and surgical methods are only instituted in indicated cases.

Fulltext Managing pelvic inflammatory disease

Sivalingam N, Vanitha NS, Loh KY

Med J Malaysia, 2007 Dec;62(5):425-7; quiz 428.

PMID: 18705484 MyJurnal

Pelvic inflammatory disease (PID) describes the clinical features of sexually transmitted pelvic infection ranging from acute salpingitis to salpingo-oophoritis and ultimately pelvic abscess. Intra-tubal adhesions and pelvic adhesive disease are the long-term sequelae of PID which may lead to both sub-fertility and tubal ectopic pregnancy. Laparoscopy is the definitive diagnostic modality, but is invasive and not suitable for routine clinical practice especially in the primary care setting. Ascending infection by Neiserria gonorrhoea, Chlamydia trachomatis and less commonly bacterial vaginosis and mycoplasma have been traditionally associated as causative pathogens in PID. As polymicrobial infections are being implicated in PID before culture and sensitivity results are available empirical treatment based on clinical guidelines is justified initially. Pre-emptive testing and treatment for woman at increased risk of chlamydia has been shown to reduce the risk of PID by up to two-thirds. It is imperative that medical practitioners have low thresholds for testing and treatment of both sexually active young women and men.

Teaching and learning of professionalism in medical schools

Sivalingam N

Ann Acad Med Singap, 2004 Nov;33(6):706-10.

PMID: 15608822

Concerns about professionalism in medicine have made necessary the explicit teaching and learning of ethics, professionalism and personal development. The noble profession of medicine, taken up as a "calling" by those who are expected to put the needs of the patient above their own, appears to have become a fees-for-service business model and trade. Parental expectations, the diminishing sense of responsibility in teachers, lack of role models, technological advancements, sub-specialisation and third-party involvement in the healthcare delivery system have been identified as reasons for these concerns. The General Medical Council in the United Kingdom, and other professional bodies in both Europe and the Americas, have emphasised the need to enhance the teaching and learning of professionalism in medical schools, particularly the development of good attitudes, appropriate and competent skills, and the inculcation of a value system that reflects the tenets of professionalism in medicine. The medical curriculum will need to be scrutinised so as to introduce the subject of professionalism at all levels of training and education. Barriers to learning professionalism have been identified and students need to be equipped to resolve conflicts and to put the needs of others above their own.

Fulltext Strategic interventions in the management of gestational diabetes to reduce type 2 diabetes mellitus in women in Malaysia

Sivalingam N

Med J Malaysia, 2015 Aug;70(4):211-3.

PMID: 26358015 MyJurnal

No abstract available.

Fulltext Maternal health care at the crossroads

Sivalingam N

Med J Malaysia, 2003 Mar;58(1):1-4.

PMID: 14556320

Fulltext Is there a place for intra-umbilical oxytocin for the management of retained placenta?

Sivalingam N, Surinder S

Med J Malaysia, 2001 Dec;56(4):451-9.

PMID: 12014765

Intra-umbilical injection of oxytocin has been used to hasten placental separation in retained placenta. A randomised controlled trial was done on 35 consequent women who fulfilled the criteria for retained placenta at the Department of Obstetrics & Gynaecology Ipoh Hospital. Nineteen patients who were recruited into the study group received intraumbilical injection of 301U oxytocin in 27mls saline. Another 16 patients who were in the control group received 30mls of 0.9% sodium chloride (placebo). The primary outcome measured was the need for manual removal of placenta (MRP). Nine out of the 19 patients in the oxytocin group required MRP while 10/16 in the control group required MRP. There was a 24% reduction (95% C.I. 0.41 to 1.39) in the need for MRP in the study group compared to the saline group. our results indicate that intra-umbilical vein injection of oxytocin is not clinically useful for the removal of a retained placenta.

Fulltext Clinical experience with management of "near-miss" cases in obstetrics

Sivalingam N, Looi KW

Med J Malaysia, 1999 Dec;54(4):496-503.

PMID: 11072469

Near-miss cases in life-threatening obstetric patients occurring over a one year period are analysed retrospectively with regards to morbidity measured in terms of hospital stay, utilisation of high dependency ward and intensive care beds and adequacy of clinical management. One-hundred and twenty two cases occurred among 9932 deliveries. Massive obstetric haemorrhage (54.2%) and hypertensive disorders of pregnancy (36.9%) were the two main diagnostic groups. Seventy one (58.2%) cases were referred from peripheral centres for obstetric management and 77 (63.1%) were not booked at this hospital for antenatal care. A majority were not ill-looking (92 cases) at the time of admission but turned for the worse in the course of labour. Interventional measures taken in clinical management were considered appropriate in all cases. Delay in instituting treatment was present in 6 cases. Remediable measures were recognised in 15 (12.3%). This study, apart from supplementing mortality audits, demonstrates that high risk obstetric patients can be triaged at the time of admission to labour wards by trained midwives and junior doctors in busy obstetric units without compromising standards of care.

Study site: Obstetric and Gynaecologic Unit in Ipoh Hospital.

Fulltext Tubal ectopic pregnancy

Sivalingam N

Med J Malaysia, 1981 Dec;36(4):254-8.

PMID: 7334965

Forty patients with tubal ectopic pregnancies seen over an 18 month period are studied. Epidemiological parameters in the three major groups are compared. The diagnostic problems, signs and symptoms are discussed. Aetiological factors in this area are compared with changing trends in other centres. Pelvic inflammatory disease remains an important cause. The role of conservative approach in surgical treatment of ectopic pregnancy Z5 discussed. The crude incidence rate of ectopic pregnancy in Johore Baru Hospital between January 1978 and June 1979 is 1:358 deliveries.

Writing Articles on Continuing Medical Education for Medical Journals

Sivalingam N, Rampal L

Med J Malaysia, 2021 03;76(2):119-124.

PMID: 33742616

Sharing of knowledge through Continuing Medical Education (CME) contribute immensely to professional development of skills in clinical medical practice. Thus, the writing of CME articles should adopt an approach that addresses the needs of the readers by attempting to fill gaps in their knowledge, skills, and ethics about clinical care. As such CME articles should be comprehensive and focused on specific areas. The specific learning outcomes should be well defined. In designing and development of such articles, pedagogic principles are to be borne in mind. In this article we outline a guide to writing a CME article, incorporating both the principles of instructional design and directed selflearning. The ideal CME articles will transit through multimedia-enhanced interactive online learning, with greater use of connectivity through the internet. Synchronous and asynchronous learning is in greater need, as distance and online learning are increasingly popular. Authors of CME articles will need to eventually design CME articles to be interactive, enriched with multimedia to engage their readers. Lesson plans employing instructional design principles should aim to promote both instructions for learning and formative assessment ensuring learning have taken place, and outcomes have been achieved. This article describes on how to write effective CME articles for medical journals.

Palliative care in Malaysia: the need to do much more

Sivalingam N, Lim RBL, Rampal L

Med J Malaysia, 2021 05;76(3):279-283.

PMID: 34031323

No abstract provided.

Incidence of vaginal erosion with different synthetic materials for suburethral sling in the treatment of Stress Urinary Incontinence: A systematic review

Sivalingam N, Teng YH, Chong XY, Low CH, Manocha SK, Intan Sabreena MS

Med J Malaysia, 2018 06;73(3):147-153.

PMID: 29962498 MyJurnal

INTRODUCTION: The aim of this systematic review is to compare the vaginal erosion rates in different synthetic materials used in suburethral slings in Tension Free Vaginal Tape (TVT-O /TOT) procedures in management of female stress urinary incontinence.

METHODS: PRISMA 2009 framework was adopted for study design. Scholarly literature search was done using MEDLINE, EMBASE, the Cochrane Library and Clinical Trials.gov using selected keywords. Five articles fulfilled the inclusion and exclusion criteria. Our main outcome of interest is to review the ideal properties of the suburethral sling, procedure of insertion and post-surgical complication following the sling insertion primarily vaginal erosion. Results were compared using one way-ANOVA test and independent T- test.

RESULTS: Total of 1725 subjects were available for analysis in the five studies. Monofilament polypropylene constituted 92.5% of the total sample size from one study alone. Polyester (n= 16/51) causes higher incidence rate of vaginal erosion compared to monofilament polypropylene (31.4 vs., 4.7; p = 0.01). There was no difference in the vaginal erosion rate between monofilament polypropylene and multifilament polypropylene (4.7 vs, 14.1; p=0.055) as well as between multifilament polypropylene and polyester (14.1 vs, 31.4; p=0.068). Although there was a marginally lower rate of vaginal erosion in TVT-O over TVT, the difference was not significant. (5.6 vs., 6.4, p=0.468). Common presentations of vaginal erosion were vaginal discharge, perineal pain and dyspareunia.

CONCLUSION: Given the limited sample size, polyester sling material appears to cause higher rates of vaginal erosion. No difference in erosion rate was seen between TVT and TVT-O.

Fulltext Peripartal cardiomyopathy: problems in diagnosis and management

Sivalingam N, Anwar K, Chandran K

Singapore Med J, 2001 Mar;42(3):122-3.

PMID: 11405564

Peripartal cardiomyopathy is a rare form of heart disease in pregnancy with an unpredictable outcome. We describe one patient who presented in a decompensated state who was successfully managed with medical antifailure treatment. The etiology, management and future obstetric outcome are discussed.

Fulltext Delayed diagnosis of cervical pregnancy: management options

Sivalingam N, Mak FK

Singapore Med J, 2000 Dec;41(12):599-601.

PMID: 11296786

Cervical pregnancy is an uncommon variety of ectopic gestation. The aetiology is obscure. Diagnosis can be missed unless early evaluation is done by experienced personnel utilising pelvic ultrasonography. Three cases of cervical pregnancy managed at this hospital are described illustrating difficulties in early diagnosis and possible association with previous uterine scar and prior curettage of the uterus for retained products of conception. Treatment options vary according to the clinical state of the patient at the time of diagnosis. Non-surgical methods including systemic methotrexate administration in one and surgical evacuation of products of conception with subsequent cervical cerclage in another are discussed. Surgical interventions like total abdominal hysterectomy with internal iliac artery ligation to arrest life-threatening pelvic haemorrhage is also described. Other treatment options include potassium chloride (KCl) alone or in combination with methotrexate.

Fulltext The role of endovaginal ultrasonography and the value of endometrial biopsy in breast cancer patients on tamoxifen therapy

Sivalingam N, Pathmalingam A

Singapore Med J, 1999 Jun;40(6):402-4.

PMID: 10489508

Endometrial changes have been observed when tamoxifen is used as an adjuvant therapy for carcinoma of the breast in postmenopausal women with positive estrogen receptors status.

Fulltext Coital injury requiring internal iliac artery ligation

Sivalingam N, Rajesvaran D

Singapore Med J, 1996 Oct;37(5):547-8.

PMID: 9046215

Profuse bleeding after voluntary sexual intercourse is an uncommon reason for admission to the gynaecological wards. Out of 12 such patients admitted to the Ipoh Hospital over a three-year period, one patient had life-threatening upper vaginal injury after coitus. Blood replacement and conventional suturing failed to arrest the bleeding. Bilateral internal iliac artery ligation promptly arrested further haemorrhage. Vigorous intercourse increases intra-abdominal pressure in women causing tensing of the cul-de-sac, decreasing the elasticity of the posterior fornix, resulting in vaginal laceration. Bilateral internal iliac artery ligation produces a 'pelvic compartment hypotension' converting a high arterial flow system to that of a low one resembling venous flow. The useful role of this procedure to contain pelvic haemorrhage is discussed.

Fulltext The role of prophylactic antibiotics in caesarean section--a randomised trial

Ng NK, Sivalingam N

Med J Malaysia, 1992 Dec;47(4):273-9.

PMID: 1303479

A prospective randomised controlled study was conducted over a 6 month period on the value of administering prophylactic antibiotics in patients undergoing emergency caesarean section at the Ipoh General Hospital. A total of 222 patients were randomised to receive 24 hours of ampicillin (500 mg per dose), cefoperazone (1 gm per dose) or no antibiotics. In all parameters of patient morbidity, the group receiving cefoperazone showed significantly better results as compared to the group not receiving antibiotics. The ampicillin group also had favourable results but generally not achieving statistical significance. Prophylactic antibiotics appear to be beneficial and consideration should be given to make it a routine in all emergency caesarean sections.

Fulltext Propofol and methohexitone for elective caesarean--a comparative study

Miranda AF, Kyi W, Sivalingam N

Med J Malaysia, 1992 Dec;47(4):280-6.

PMID: 1303480

Two identical groups of females underwent caesarean operations. One group was induced with propofol 2.04 (SD 0.023) mg per kilogram and the other group induced with methohexitone 1.05 (SD 0.15) mg per kilogram body weight. Maintenance of anaesthesia was identical in both groups. Post-intubation blood pressure in the methohexitone group was significantly raised whereas with propofol the changes were not significant. There were no significant differences in the Apgar scores, uterine contractility and umbilical venous or arterial blood gases. There was a significant difference in the analgesic requirement in the first hour of the post-operative period; in the propofol group, patients needed less analgesia compared to the methohexitone group. There was no maternal awareness in both groups.

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