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Fulltext Overcoming a difficult nasogastric tube insertion procedure with a video laryngoscope (C-Mac(®))

Dharmalingam TK, Gunasekaran V

Indian J Crit Care Med, 2016 Dec;20(12):751-752.
PMID: 28149039 DOI: 10.4103/0972-5229.195756
Doctors' knowledge and attitudes on pain assessment and management in Queen Elizabeth Hospital, Kota Kinabalu, Sabah

Dharmalingam TK, Muniandy RK

Med J Malaysia, 2020 01;75(1):68-73.
PMID: 32008024

INTRODUCTION: Doctors play an important role to assess and manage pain. Failing to do so properly, pain will affect the quality of life and increase the length of hospital stay for patients. In Queen Elizabeth Hospital (QEH), Kota Kinabalu, Sabah, pain assessment and management programs have been conducted on a regular basis. However, there has been no studies to assess the effectiveness of these programs.
METHODOLOGY: This is a cross-sectional study to assess the knowledge and attitude on pain assessment and management among medical officers at QEH. A universal sampling technique was used, to represent medical officers from major clinical departments. The Knowledge and Attitudes Survey Regarding Pain (KASRP) questionnaire was used for this study.
RESULTS: A total of 278 questionnaires were distributed to medical officers. The study sample consisted of 125 females (44.9%), and 153 males (55.1%). The age group of the participants ranged from 25 to 41 years old. A 116 respondents scored less than 60% on the knowledge of pain (41.7%). These findings show there was a deficit in their knowledge and attitude about pain. There was also a difference of scores between genders, where the male doctors performed better than the female doctors. There was a difference between scores among doctors from different departments. The highest mean score was from the department of Anaesthesia (80.2%). There was also a difference regarding pain knowledge based on the years of working as a doctor, where the highest passing rate was from doctors working for more than five years.
CONCLUSION: This study demonstrated that there is a lack of knowledge and attitude on pain assessment and management among QEH medical officers who responded to this study. This will support the plan on a more aggressive and continuous education programme to improve pain assessment and management among doctors in QEH.
Telemedicine therapy among chronic pain patients during the COVID-19 pandemic

Dharmalingam TK, Rajah U, Muniandy RK

Med J Malaysia, 2023 Jul;78(4):472-475.
PMID: 37518914

INTRODUCTION: Patients with chronic pain have been one of the most difficult patients to manage during the COVID-19 pandemic. As pain physicians navigate through this pandemic in order to maintain contact with their patients, telemedicine emerged as a very useful tool. It helped patients to access care despite being in distant areas, or during the lockdown period. The objective of this research is to assess the perception of chronic pain patients who received telemedicine therapy. Self-efficacy and coping level of pain among these chronic pain patients were also assessed.
MATERIALS AND METHODS: This is a cross-sectional study involving patients who are under follow-up at the Chronic Pain Clinic, Hospital Pulau Pinang for more than a year and received telemedicine during this pandemic. Participants had to fill out a self-administered questionnaire. Once respondents completed the questionnaires, the answered questionnaires were collected for analysis.
RESULTS: A total of 154 patients between 22 and 88 years old were included in this study. Most of the participants had a history of pain for more than 3 years (44.2%). The majority of our patients are still working (55.8%). From the patients who were working, 7.8% of them lost their jobs during the pandemic. 31.2% of patients reported that the pain condition had worsened while the rest did not experience any difference in their pain condition. More than half (59%) of the patients' reported telemedicine was beneficial for their pain management, while only 41% felt that their telemedicine was helpless for their pain management during the pandemic.
CONCLUSION: Telemedicine is beneficial for patients with chronic pain. Telemedicine can be used poste-pandemic and may produce a good outcome with patients.
Fulltext Survey on maternal satisfaction in receiving spinal anaesthesia for caesarean section

Dharmalingam TK, Ahmad Zainuddin NA

Malays J Med Sci, 2013 May;20(3):51-4.
PMID: 23966825 MyJurnal

This study was undertaken to evaluate patient satisfaction after spinal anaesthesia, which is the most frequently administered anaesthesia in obstetric patients.
Fulltext Left Bundle Branch Block Under General Anaesthesia in an Athlete's Heart

Dharmalingam TK, Nor Azian AZ, Thiruselvi S, Abdul Aziz J

Med J Malaysia, 2013 Apr;68(2):177-8.
PMID: 23629572

Left bundle branch block (LBBB) during anaesthesia is uncommon. During general anaesthesia, LBBB may be related to hypertension or tachycardia and its acute onset makes the diagnosis of acute myocardial ischemia or infarction difficult. We would like to present a case report of a healthy patient who developed LBBB intra operatively. Acute LBBB should lead to suspicion of acute coronary syndrome until proven otherwise. Inability to exclude an acute cardiac event resulted in postponement of surgery twice after general anaesthesia was administered. Cardiological investigation of our patient showed physiological left ventricular hypertrophy (LVH), "athlete's heart" which was the most likely cause of the LBBB under anaesthesia.
Fulltext Prolonged paralysis with atracurium use in a patient with Rubinstein-Taybi syndrome

Dharmalingam TK, Liew Sat Lin C, Muniandy RK

BMJ Case Rep, 2018 Feb 22;2018.
PMID: 29472422 DOI: 10.1136/bcr-2017-222692

Rubinstein-Taybi syndrome (RTS) is a rare autosomal dominant disorder that occurs due to a microdeletion of chromosome 16p13. The craniofacial abnormalities in these patients may pose a challenge for anaesthetist performing tracheal intubation. However, there are no known reported cases of drug interaction with non-depolarising muscle relaxant in patients with RTS. This young patient with RTS presented with an unexpected prolonged atracurium effect during the course of anaesthesia. After ruling out other possible causes, we have come to a conclusion that RTS itself could have played a role in the prolonged effect of atracurium. However, further studies will be needed to confirm this hypothesis. In the meantime, care should be used when using muscle relaxants in patients with RTS.