Displaying all 16 publications

  1. Sivalingam S, Krishnasamy S, Yakub MA
    Asian Cardiovasc Thorac Ann, 2015 Jun;23(5):612-4.
    PMID: 24962807 DOI: 10.1177/0218492314540667
    A 9-year-old boy was referred with a perimembranous ventricular septal defect. At birth, he had undergone a right thoracotomy with ligation of a tracheoesophageal fistula, cervical esophagostomy, and feeding gastrostomy. At 2 years of age, he had gastric tube reconstruction with a pull-through retrosternally, anterior to the heart, and an end-to-end esophagogastric anastomosis. Via a right anterolateral thoracotomy through the previous scar, the entire gastric tube was mobilized away from the sternum to facilitate a median sternotomy. With the patient supine, a median sternotomy was performed without difficulty, and the ventricular septal defect was closed under cardiopulmonary bypass.
  2. Krishnasamy S, Kew EP, Bishay E
    J Thorac Dis, 2019 Mar;11(Suppl 3):S478-S479.
    PMID: 30997252 DOI: 10.21037/jtd.2019.01.67
  3. Krishnasamy S, Krishna Nair A, Hashim SA, Raja Mokhtar RA
    Interact Cardiovasc Thorac Surg, 2019 12 01;29(6):976-977.
    PMID: 31363757 DOI: 10.1093/icvts/ivz191
    Liposarcoma is the second most common type of soft tissue malignancy in adults. They are malignant tumours with a mesenchymal origin. Mediastinal liposarcoma accounts for <1% of mediastinal tumours and 2% of liposarcoma. We report a patient with mediastinal liposarcoma who presented with cardiac tamponade, 25 years after the initial liposarcoma in the popliteal fossa.
  4. Ng SH, Kelly B, Se CH, Chinna K, Sameeha MJ, Krishnasamy S, et al.
    Glob Health Action, 2014 Dec;7(1):25169.
    PMID: 28672562 DOI: 10.3402/gha.v7.25169
    Background Food advertising on television (TV) is well known to influence children's purchasing requests and models negative food habits in Western countries. Advertising of unhealthy foods is a contributor to the obesogenic environment that is a key driver of rising rates of childhood obesity. Children in developing countries are more at risk of being targeted by such advertising, as there is a huge potential for market growth of unhealthy foods concomitant with poor regulatory infrastructure. Further, in developing countries with multi-ethnic societies, information is scarce on the nature of TV advertising targeting children. Objectives To measure exposure and power of TV food marketing to children on popular multi-ethnic TV stations in Malaysia. Design Ethnic-specific popular TV channels were identified using industry data. TV transmissions were recorded for each channel from November 2012 to August 2013 (16 hr/day) for randomly selected weekdays and weekend days during normal days and repeated during school holidays (n=88 days). Coded food/beverage advertisements were grouped into core (healthy), non-core (non-healthy), or miscellaneous (unclassified) food categories. Peak viewing time (PVT) and persuasive marketing techniques were identified. Results Non-core foods were predominant in TV food advertising, and rates were greater during school holidays compared to normal days (3.51 vs 1.93 food ads/hr/channel, p<0.001). During normal days' PVT, the ratio of non-core to core food advertising was higher (3.25 food ads/hr/channel), and this more than trebled during school holidays to 10.25 food ads/hr/channel. Popular channels for Indian children had the lowest rate of food advertising relative to other ethnic groups. However, sugary drinks remained a popular non-core product advertised across all broadcast periods and channels. Notably, promotional characters doubled for non-core foods during school holidays compared to normal days (1.91 vs 0.93 food ads/hr/channel, p<0.001). Conclusions This study highlights non-core food advertising, and predominantly sugary drinks are commonly screened on Malaysian TV channels. The majority of these sugary drinks were advertised by multinational companies, and this observation warrants regulatory attention.
  5. Johari B, Abdul Aziz YF, Krishnasamy S, Looi LM, Hashim SA, Raja Mokhtar RA
    Iran J Radiol, 2015 Apr;12(2):e11197.
    PMID: 26060549 DOI: 10.5812/iranjradiol.11197
    The presence of tumor thrombus in the right atrium is frequently the result of direct intraluminal extension of infra-diaphragmatic malignancy into the inferior vena cava (IVC) or supradiaphragmatic carcinoma into the superior vena cava (SVC). Right atrial tumor thrombus with extension into both SVC and IVC has not been reported in the literature. We present a patient who presented with symptoms of right atrial and SVC obstruction. Imaging revealed presence of a thrombus in the right atrium, extending to the SVC and IVC, with the additional findings of a left adrenal mass and multiple liver lesions. The histopathological examination of the right atrial mass revealed metastatic adenocarcinoma cells. The patient was given a presumptive diagnosis of metastatic adenocarcinoma, most likely adrenal in origin, with multiple hepatic lesions suspicious for metastasis. The clinical outcome of the patient was not favorable; the patient succumbed before the adrenal mass could be confirmed to be the primary tumor. This case highlights that in patients manifesting with extensive cavoatrial thrombus as, the existence of primary carcinoma should be considered especially in the adrenal cortex or in the lung.
  6. Hashim S, Chin LY, Krishnasamy S, Sthaneswar P, Raja Mokhtar RA
    J Cardiothorac Surg, 2015;10:32.
    PMID: 25890367 DOI: 10.1186/s13019-015-0230-0
    Recently a biocompatible bone adhesive was introduced in addition to the sternal wires to expedite sternal union and improve patient recovery. In this study we aim to objectively assess the biomarker of pain in patient who received the biocompatible bone adhesive.
  7. Thiagamani SMK, Krishnasamy S, Muthukumar C, Tengsuthiwat J, Nagarajan R, Siengchin S, et al.
    Int J Biol Macromol, 2019 Nov 01;140:637-646.
    PMID: 31437507 DOI: 10.1016/j.ijbiomac.2019.08.166
    This work focuses on the fabrication of hybrid bio-composites using green epoxy as the matrix material, hemp (H) and sisal (S) fibre mats as the reinforcements. The hybrid composite with sisal/hemp fibres were fabricated by cost effective hand lay-up technique, followed by hot press with different stacking sequences. Static properties of the composites such as tensile, compressive, inter-laminar shear strengths (ILSS) and hardness were examined. The physical properties such as density, void content, water absorption and thickness swelling were also analyzed. The experimental results indicate that hybrid composites exhibited minor variation in tensile strength when the stacking sequence was altered. The hybrid composite with the intercalated arrangement (HSHS) exhibited the highest tensile modulus when compared with the other hybrid counterparts. Hybrid composites (SHHS and HSSH) offered 40% higher values of compressive strength than the other layering arrangements. HHHH sample exhibited the highest ILSS value of 4.08 MPa. Typical failure characteristics of the short beam test such as inter-laminar shear cracks in the transverse direction, micro-buckling and fibre rupture were also observed.
  8. Krishnasamy S, Sivalingam S, Dillon J, Mokhtar RAR, Yakub A, Singh R
    PMID: 33577258 DOI: 10.21470/1678-9741-2020-0207
    INTRODUCTION: The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge.

    METHODS: This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR).

    RESULTS: A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse.

    CONCLUSION: We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.

  9. Hashim SA, Amin MA, Nair A, Raja Mokhtar RA, Krishnasamy S, Cheng K
    Heart Lung Circ, 2018 May;27(5):e59-e63.
    PMID: 29246681 DOI: 10.1016/j.hlc.2017.11.011
    The revision of an internal mammary artery graft anastomosis because of a technical error can be time-consuming and complicated and may lead to complications. Here, we describe the technical details and our early experience of using a standard transit-time flowmeter to exclude technical errors and facilitate rapid decision making for anastomosis revision in an arrested heart during aortic cross-clamping in the absence of ultrasound guidance.
  10. Krishnasamy S, Sahid SM, Hashim SA, Singh S, Chung F, Mokhtar RAR, et al.
    J Thorac Dis, 2019 Dec;11(12):5453-5462.
    PMID: 32030264 DOI: 10.21037/jtd.2019.11.44
    Background: Obstructive sleep apnea (OSA) is a serious health disorder which contributes to cardiovascular complications, decreased work productivity, automobile accidents, and death. This condition is characterized by a temporary cessation of breathing resulting due to upper airway closure during a person's sleep. Strain to the heart caused by this repetitive hypoxic insult can lead to postoperative complications for patients undergoing heart surgery. Recognizing cardiac surgical patients with OSA is important. Early recognition and intervention such as use of BiPAP device can reduce the postoperative complications due to OSA.

    Methods: The aim of this study is to identify the incidence of unrecognized OSA in cardiac surgical patients. This is a retrospective analysis of a prospective data of the study which was done between July 2012 and July 2013 in University Malaya Medical Center. All patients undergoing elective cardiac surgery were recruited and the demographic data, questionnaire and the portable sleep study results were obtained. Patients were followed up till 30 days to record any complications. Data were entered in SPSS version 17 and analysis was done.

    Results: The incidence of OSA was 61.4% and 43.5% were moderate to severe OSA. There was male predominance of OSA (79%) with a mean age of 60 years. OSA subjects had shorter inter-incisor distance (4.18±0.6 cm) and larger waistline (94.1±12.1 cm). The STOP-Bang questionnaire has a sensitivity of 75.8% in predicting apnoa-hypopnea index (AHI) ≥5/hour.

    Conclusions: OSA can be diagnosed with a simple screening questionnaire and a bedside portable sleep study. Cardiac patients diagnosed with OSA can be pre-emptively given extra attention in managing their postoperative care.

  11. Krishnasamy S, Mokhtar RAR, Singh R, Sivallingam S, Aziz YFA, Mathaneswaran V
    Braz J Cardiovasc Surg, 2021 Oct 17;36(5):707-716.
    PMID: 33438849 DOI: 10.21470/1678-9741-2020-0433
    INTRODUCTION: Rapid prototyping is a process by which three-dimensional (3D) computerized surface models are converted into physical models. In this study, a 3D heart bio model was created using the rapid prototyping method and the accuracy of this heart model was assessed by clinicians.

    METHODS: The two-dimensional images of normal heart from gated computed tomography scan datasets were used to create a 3D model of the heart. The slices were then processed using the software BioModroid and printed with the 3D printer. The evaluation of the model was performed by a questionnaire answered by four cardiothoracic surgeons, 12 cardiologists, five radiologists, and nine surgical registrars.

    RESULTS: Eighty-six percent of the anatomy structures showed in this model scored 100% accuracy. Structures such as circumflex branch of left coronary artery, great cardiac vein, papillary muscle, and coronary sinus were each rated 77%, 70%, 70%, and 57% accurate. Among 30 clinicians, a total of 93% rated the model accuracy as good and above; 64% of the clinicians evaluated this model as an excellent teaching tool for anatomy class. As a visual aid for surgery or interventional procedures, the model was rated excellent (40%), good (50%), average (23%), and poor (3%); 70% of the clinicians scored the model as above average for training purpose. Overall, this 3D rapid prototyping cardiac model was rated as excellent (33%), good (50%), and average (17%).

    CONCLUSION: This 3D rapid prototyping heart model will be a valuable source of anatomical education and cardiac interventional management.

  12. Hossain MA, Ganesan PB, Sandaran SC, Rozali SB, Krishnasamy S
    Environ Sci Pollut Res Int, 2017 Dec;24(34):26521-26533.
    PMID: 28948458 DOI: 10.1007/s11356-017-0241-6
    Microwave pyrolysis of oil palm fiber (OPF) with three types of Na-based catalysts was experimentally investigated to produce biochar. Sodium hydroxide (NaOH), sodium chloride (NaCl), and sodium carbonate (Na2CO3) with purity 99.9% were selected for this investigation. Microwave muffle reactor (Model: HAMiab-C1500) with a microwave power controller including a microwave generator was used to perform the microwave pyrolysis. OPF particles were used after removing foreign materials, impurities, and dust. Microwave power ranges from 400 to 900 W, temperature ranges from 450 to 700 °C, and N2 flow rates ranges from 200 to -1200 cm3/min were used along with all three Na-based catalysts for this investigation. Lower microwave power, temperature, and N2 flow rate have been found favorable for higher yield of biochar. NaOH is to be found as the more suitable catalyst than NaCl and Na2CO3 to produce biochar. A maximum biochar yield (51.42 wt%) has been found by using the catalysts NaOH at N2 flow rate of 200 cm3/min. One sample of the biochar (maximum yield without catalysts) was selected for further characterization via thermo gravimetric analysis (TGA), scanning electron microscopy (SEM), BET surface area, Fourier transform infrared spectroscopy (FTIR), and ultimate and proximate analysis. SEM and BET surface area analysis showed the presence of some pores in the biochar. High percentage of carbon (60.24 wt%) was also recorded in the sample biochar. The pores and high percentage of carbon of biochar have significant impact on soil fertilization by increasing the carbon sequestration in the soil. It assists to slow down the decomposition rate of nutrients from soil and therefore enhances the soil quality.
  13. Abu Bakar N, Abdul Aziz YF, Singh Sandhu R, Fadzli F, Yaakub NA, Krishnasamy S, et al.
    Heart Lung Circ, 2013 Apr;22(4):305-8.
    PMID: 22921797 DOI: 10.1016/j.hlc.2012.07.016
    Pericardial cysts are uncommon mediastinal lesions that are usually congenital in origin. Patients are usually asymptomatic and the cysts are generally discovered on routine radiography for unrelated purposes. This case illustrates a symptomatic presentation of a haemorrhagic pericardial cyst in which radiographic, echocardiographic and multislice (MRI and CT) imaging were performed. The imaging findings were not typical of pericardial cysts leading to a diagnostic quandary despite the varied imaging techniques. In conclusion, it is important to appreciate that the imaging findings of pericardial cysts can be varied. Radiologists and clinicians alike should be aware of this variability.
  14. Krishnasamy S, Thiagamani SMK, Muthu Kumar C, Nagarajan R, R M S, Siengchin S, et al.
    Int J Biol Macromol, 2019 Dec 01;141:1-13.
    PMID: 31472211 DOI: 10.1016/j.ijbiomac.2019.08.231
    Bio-composites are easy to manufacture and environmentally friendly, could reduce the overall cost and provide lightweight due to the low density of the natural fibers. In a bid to compete with the synthetic fiber reinforced composites, a single natural fiber composite may not be a good choice to obtain optimal properties. Hence, hybrid composites are produced by adding two or more natural fibers together to obtain improved properties, such as mechanical, physical, thermal, water absorption, acoustic and dynamic, among others. Regarding thermal stability, the composites showed a significant change by varying the individual fiber compositions, fiber surface treatments, addition of fillers and coupling agents. The glass transition temperature and melting point obtained from the thermomechanical analysis and differential scanning calorimetry are not the same values for several hybrid composites, since the volume variation was not always parallel with the enthalpy change. However, the difference between the temperature calculated from the thermomechanical analysis and differential scanning calorimetry was lower. Significantly, this critical reviewed study has a potential of guiding all composite designers, manufacturers and users on right selection of composite materials for thermal applications, such as engine components (covers), heat shields and brake ducts, among others.
  15. Krishnasamy S, Lomer MCE, Marciani L, Hoad CL, Pritchard SE, Paul J, et al.
    J Nutr, 2020 Nov 19;150(11):2890-2899.
    PMID: 32805050 DOI: 10.1093/jn/nxaa191
    BACKGROUND: Whole apples produce greater satiety than processed apples, but the underlying mechanisms remain unclear.

    OBJECTIVE: Our aim was to assess the intragastric processing of apple preparations and the associated small and large bowel contents using MRI.

    METHODS: An open label, 3-way crossover, randomized, controlled trial. Eighteen healthy adults (mean ± SD age, 25 ± 4 y; BMI, 22.7 ± 3.5 kg/m2) underwent serial MRI scans on 3 occasions separated by 7 d, after consumption of isocaloric (178 kcal) portions of either whole apples, apple puree, or apple juice. Gastric emptying, small bowel water content (SBWC; primary endpoint), were measured at baseline and at 45 min intervals (0-270 min) postmeal ingestion. Fullness and satiety were also assessed at each time point. Treatment effects between groups were analyzed using ANOVA.

    RESULTS: Gastric emptying half-time (GE t50) was greater (P < 0.0001) after participants consumed whole apple (mean ± SEM), 65 (3.3) min compared with when they consumed apple puree (41 [2.8] min) or apple juice (38 [2.9] min), times that did not differ. Postprandial area under the curve (AUC) (135-270 min) SBWC was also greater for whole apples than puree (P = 0.025) and juice (P = 0.0004) but juice and puree did not differ. AUC for fullness and satiety (0-270 min) postingestion was also greater (P = 0.002 and 0.004, respectively) for whole apple compared with juice but juice and puree did not differ.

    CONCLUSIONS: Gastric emptying is slower after whole apple consumption causing a greater sensation of fullness and satiety than puree or juice in healthy adults. Whole apples increased small bowel and colonic contents during the later phase of the study which may be relevant for subsequent food consumption.This study was registered at clinicaltrials.gov as NCT03714464.

  16. Jalanka J, Gunn D, Singh G, Krishnasamy S, Lingaya M, Crispie F, et al.
    Gut, 2023 Mar;72(3):451-459.
    PMID: 36171082 DOI: 10.1136/gutjnl-2021-326828
    OBJECTIVES: Persistent bowel dysfunction following gastroenteritis (postinfectious (PI)-BD) is well recognised, but the associated changes in microbiota remain unclear. Our aim was to define these changes after gastroenteritis caused by a single organism, Campylobacter jejuni, examining the dynamic changes in the microbiota and the impact of antibiotics.

    DESIGN: A single-centre cohort study of 155 patients infected with Campylobacter jejuni. Features of the initial illness as well as current bowel symptoms and the intestinal microbiota composition were recorded soon after infection (visit 1, <40 days) as well as 40-60 days and >80 days later (visits 2 and 3). Microbiota were assessed using 16S rRNA sequencing.

    RESULTS: PI-BD was found in 22 of the 99 patients who completed the trial. The cases reported significantly looser stools, with more somatic and gastrointestinal symptoms. Microbiota were assessed in 22 cases who had significantly lower diversity and altered microbiota composition compared with the 44 age-matched and sex-matched controls. Moreover 60 days after infection, cases showed a significantly lower abundance of 23 taxa including phylum Firmicutes, particularly in the order Clostridiales and the family Ruminoccocaceae, increased Proteobacteria abundance and increased levels of Fusobacteria and Gammaproteobacteria. The microbiota changes were linked with diet; higher fibre consumption being associated with lower levels of Gammaproteobacteria.

    CONCLUSION: The microbiota of PI-BD patients appeared more disturbed by the initial infection compared with the microbiota of those who recovered. The prebiotic effect of high fibre diets may inhibit some of the disturbances seen in PI-BD.


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