Regunath Kandasamy - Academia.edu (original) (raw)

Papers by Regunath Kandasamy

PubMed, Sep 1, 2022

Introduction: The elderly is at risk for traumatic brain injury (TBI), but local data on their mo... more Introduction: The elderly is at risk for traumatic brain injury (TBI), but local data on their morbidity and mortality outcomes was lacking. This study aims to assess the outcome in mortality and functional outcome, Glasgow Outcome Scale (GOS) and factors associated with poor outcomes in patients with TBI more than 60 years old. Materials and methods: This single centre retrospective cohort study was carried out involving patients age 60 years old and above with TBI between June 2018 to May 2021. The mortality and GOS at hospital discharge, 30th day, and 90th day of trauma were analysed. The simple logistic regression (SLR) and multiple logistic regression (MLR) were performed to determine factors associated with poor outcomes and mortality. Results: A total of 248 patients were analysed. The mean age was 67.5 ± 6.31 years. 156 (62.9%), 26 (10.5%), and 66 (26.6%) had mild, moderate, and severe TBI, respectively. The overall mortality rate was 9.7% and the median(IQR) GOS score were 4(2); p<0.001 at hospital discharge, 30th day and 90th day. There was significant difference in GOS outcomes after 90 days χ2(2) = 136.76 p<0.001. Upon MLR, there was a significant association of polytrauma, Adj. OR 11.04 (2.503-48.711); p < 0.002 and TBI severity: moderate TBI, Adj. OR 71.44(13.028-391.782); p < 0.001 and severe TBI, Adj OR 2533.51 (213.050-30127.644); p<0.001 towards poor outcome. However, only severity of TBI: moderate TBI, Adj. OR 19.48 (1.899-199.094); p=0.012 and severe TBI, Adj OR 26.42 (2.864-243.722); p=0.004 is associated with mortality. Conclusion: Polytrauma and moderate-severe head injury are associated with poor outcomes and moderate-severe head injury is associated with high mortality.

Surgical neurology international, Jun 28, 2024

is is an open-access article distributed under the terms of the Creative Commons Attribution-Non... more is is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Purpose:To study the optic neural sheath diameter in non-traumatic intracranial hemorrhage patien... more Purpose:To study the optic neural sheath diameter in non-traumatic intracranial hemorrhage patient in order to identify if this bedside non-invasive ultrasonographic investigation may provide some guidance to subsequent clinical decisions. We evaluated the correlation between Optic neural sheath Diameter (ONSD), haemorrhage volume, Glasgow Coma Scale, and Intracerebral haemorrhage Score (ICH score).Materials and Method:This was a prospective single center, single operator, observational study carried out for 6 months from September 2017 till February 2018. Total of 50 patients were approached, out of which 5 were excluded due to ineligibility. ONSD was measured using standard technique as described in literature. The data was analysed using SPSS 24. Correlation between ONSD-haemorrhage volume, ONSD-GCS and ONSD-ICH Score were assessed using Pearson correlation.Results:The study included 45 patients (mean age: 59.9 +/- 13.4 years old, 26(57.8%) Male), with the mean ONSD value 0.5919 +/- 0.046 cm. The statistical assessment yielded positive correlation value of 0.303 (p-value = 0.043) between ONSD-Haemorrhage volume and correlation between ONSD-ICH was 0.372 (p-value = 0.012). Moreover, a negative correlation value of - 0.351 (p-value = 0.018) were shown between ONSD-GCS.Conclusion:Our study, indicate that as haemorrhage volume increases the ONSD increases as well. This correlation is similarly seen with increases in ICH score suggesting increase in mortality risk. ONSD is a non-invasive method to evaluate severity and mortality risk in patients with non traumatic intracranial haemorrhage.

The underlying mechanisms of secondary neuronal damage following intracerebellar hemorrhage are n... more The underlying mechanisms of secondary neuronal damage following intracerebellar hemorrhage are not yet clear. We aimed to study the possible mechanisms in the mediation of secondary neuronal damage following intracerebellar hemorrhage. ICbH was induced by collagenase type VII-S into mice in 2 phases (n=24/phase): 12 in control group, 12 in day 1 group, 12 in day 3 group and another 12 in day 7 group. All mice underwent locomotor assessment and subsequently sacrificed on day 1, day 3 and day 7 respectively. Cerebellum from phase one and phase two were taken to study morphological, immunohistochemistry and oxidative stress respectively. Mice behavior disturbed following ICbH at day 3 and y 7 as compared with control. Besides, NO increased-on day 1 post induction and suppressed on day 3 and 7. Expressions of SOD, CAT, nNOS, GPX1 and COX-2 were significantly raised on day 3. Morphological studies of the perihaematoma region and tissue showed neuronal damage occurred from day 1 onwards,...

Journal of Korean Neurosurgical Society, Jul 1, 2021

Objective : Hemorrhagic stroke (HS) and hypertensive retinopathy are known end organ damage of th... more Objective : Hemorrhagic stroke (HS) and hypertensive retinopathy are known end organ damage of the brain and eye respectively, with HS having deleterious consequence to the patients. This study is to correlate between hypertensive retinopathy and HS in hypertensive disease. Methods : A control group of hypertensive patients only, and an investigated group of hypertensive HS patients. Fundoscopic examination to determine the grade of retinopathy was performed and then divided into low or high severity hypertensive retinopathy. Clinical and radiological parameter included are demography, vital signs, Glasgow coma scale (GCS) on admission, clot volume, site of clot, Intracerebral hemorrhage (ICH) score and Glasgow outcome scale (GOS). Data were correlated with the severity of hypertensive retinopathy. Results : Fifty patient in the control group and 51 patients in the investigated group were recruited. In the hypertensive HS group, 21 had low severity retinopathy (no or mild retinopathy) accounting for 41.2% and 30 patients had high severity (moderate or severe retinopathy). In the hypertensive patients 49 had low severity and one had high severity (p-value of 0.001). In HS group low severity showed better GCS score of 9-15 on admission (p-value of 0.003), clot volume less than 30 mL (p-value 0.001), and also a better 30 days mortality rate by using the ICH score (p-value 0.006), GOS score of 4 and 5 the low severity retinopathy fair better than the high severity retinopathy (p-value of 0.001), and the relative risk to develop HS in low severity and high severity retinopathy was 0.42 and 29.4, respectively. Conclusion : Hypertensive retinopathy screening could be used as an indicator in hypertensive patient, to evaluate the risk of developing hypertensive HS in the future.

World Neurosurgery, Dec 1, 2021

Gülhane tıp dergisi, 2019

Here, we have performed DNA sequencing and PCR-RFLP methods for IDH1 mutation analysis in 47 glio... more Here, we have performed DNA sequencing and PCR-RFLP methods for IDH1 mutation analysis in 47 glioma samples con-versiti Sains Malaysia, Malaysia.

Journal of neurological surgery, Mar 11, 2016

Symptomatic intracranial arachnoid cysts are commonly treated using neuroendoscopy. Cysts located... more Symptomatic intracranial arachnoid cysts are commonly treated using neuroendoscopy. Cysts located within the posterior fossa may present a greater surgical challenge to the neurosurgeon due to the numerous vital neurovascular structures located within this confined space. Adding neuronavigation during endoscopy helps a neurosurgeon to visualize and utilize both anterior and posterior corridors safely to access and manage these lesions. We present three symptomatic posterior fossa arachnoid cysts that were treated successfully using minimally invasive neuronavigation-guided endoscopic neurosurgery utilizing the anterior transfrontal transaqueductal, anterior transfrontal transtrigonal, and posterior suboccipital infratentorial supracerebellar approaches.

The Malaysian Journal of Medical Science, Feb 23, 2022

Background: Stroke is the third leading cause of death in Malaysia. This study aims to evaluate t... more Background: Stroke is the third leading cause of death in Malaysia. This study aims to evaluate the mortality risk factors of spontaneous intracerebral haemorrhage (ICH) in Hospital Kuala Lumpur, Malaysia. Methods: A single centre prospective cohort study was performed between 1 May 2017 and 30 April 2018 for patients above 18 years old with spontaneous ICH. Patients exhibiting haemorrhage due to tumours and ruptured arteriovenous malformations were excluded. The demographics, clinical parameters, radiology findings, surgical intervention, mortality at 30 days and outcome based on modified Rankin score (MRS) grading were recorded. Selected variables were incorporated into a binary logistic regression to determine the outcome predictors of mortality. Results: A total of 292 patients were recruited into the study. The findings showed that the mean age of ICH patients was 48.9 years old. Most of the lesions were located in the putamen (45.9%). More than half (61.0%) of the patients presented with a good outcome whereas 39.0% of the patients presented with a poor outcome. The mortality rate at 30 days was 29.1%. The important predictors for mortality were male (odds ratio [OR] = 0.343; P = 0.043), concomitant use of warfarin and aspirin (OR = 14.696; P = 0.007), ischaemic heart disease [IHD] (OR = 0.007; P = 0.003), brainstem bleed (OR = 0.001; P = 0.001), the presence of intraventricular haemorrhage [IVH] (OR = 0.198; P = 0.049) and surgery. Conclusion: Most diagnosed ICH patients in Malaysia were at a younger age (mean of 48.9 years old) with the significant mortality predictors were IVH, IHD, surgery and brainstem bleed.

Injury to the spinal cord may result in devastating neurological deficits which reciprocally affe... more Injury to the spinal cord may result in devastating neurological deficits which reciprocally affect other major systems in the body. Outcome is significantly influenced by management strategies and outlooks. Ideally such patients are best managed in a facility specializing in treating spinal cord injury (SCI). However it has been noted that up to 50 % of patients with acute SCI are admitted to non-specialized intensive care units pending transfer to specialized units. This occurs either due to logistic factors or because patient’s condition is not safe for transfer. The care of patients may sometimes fall on the shoulders of practitioners with limited experience. This common scenario necessitates practitioners to have an appropriate awareness of the critical care requirements of SCI patients. When handling a SCI patient with multiple organ systems facing overt or impending dysfunction, a clear idea of therapeutic objectives in a prioritized manner can help ensure patient safety. Vigilant monitoring of specific parameters for each major system will provide an avenue to ensure problems are prevented or treated as early as possible. This chapter entails the safety risks encountered in the critical care management of acute spinal cord and guidelines to circumvent these problems.

The Malaysian Journal of Medical Science, Oct 26, 2021

Background: To study the clinical outcome of tuberculous meningitis with hydrocephalus (TBMH) and... more Background: To study the clinical outcome of tuberculous meningitis with hydrocephalus (TBMH) and the factors contributing to its poor clinical outcome. Methods: Clinical data of 143 adult patients diagnosed with TBM over a 6-year period in two tertiary hospitals in Malaysia were retrospectively reviewed. Relevant clinical and radiological data were studied. Patients with TBMH were further analysed based on their clinical grade and rendered treatment to identify associated factors and outcome of this subgroup of patients. The functional outcome of patients was assessed at 12 months from treatment. Results: The mean age of patients was 35.6 (12.4) years old, with a male gender predominance of 67.1%. Forty-four percent had TBMH, of which 42.9% had surgical intervention. In the good modified Vellore grade, 76.5% was managed medically with concurrent antituberculosis treatment (ATT), steroids and osmotic agents. Four patients had surgery early in the disease as they did not respond to medical therapy and reported a good outcome subsequently. Poor outcome (65.2%) was seen in the poor modified Vellore grade despite medical and surgical intervention. Multivariate model multiple Cox regression showed significant results for seizure (adjusted hazard ratio [aHR]: 15.05; 95% CI: 3.73, 60.78), Glasgow coma scale (GCS) (aHR: 0.79; 95% CI: 0.70, 0.89) and cerebrospinal fluid (CSF) cell count (aHR: 1.11; 95% CI: 1.05, 1.17). Conclusion: Hydrocephalus was seen in 44% of patients in this study. GCS score, seizure and high CSF cell count were factors associated with a poor prognosis in TBM. Patients with TBMH treated medically (TBMHM) had better survival function compared to TBMH patients undergoing surgical intervention (TBMHS) (P-value < 0.001). This retrospective study emphasises that TBMH is still a serious illness as 47.6% of the patients had poor outcome despite adequate treatment.

World Neurosurgery, Jul 1, 2016

Cervical kyphotic deformity can be a debilitating condition with symptoms ranging from mechanical... more Cervical kyphotic deformity can be a debilitating condition with symptoms ranging from mechanical neck pain, radiculopathy, and myelopathy to impaired swallowing and horizontal gaze. Surgical correction of cervical kyphosis has the potential to halt progression of neurological and clinical deterioration and even restore function. There are various operative approaches and deformity correction techniques. Choosing the optimal strategy is predicated on a fundamental understanding of spine biomechanics. Preoperative characterization of cervical malalignment, assessment of deformity rigidity, and defining postoperative clinical and radiographic objectives are paramount to formulating a surgical plan that balances clinical benefit with morbidity. This review of cervical deformity treatment provides an overview of the biomechanics of cervical kyphosis, radiographic classification, algorithm-based management, surgical techniques, and current surgical outcome studies.

International Journal of Neuroscience, Feb 6, 2013

Nitric oxide has a definitive role in the complex pathophysiology of traumatc brain injury (TBI).... more Nitric oxide has a definitive role in the complex pathophysiology of traumatc brain injury (TBI). This prospective cohort study investigated the changes in nitric oxide metabolite (NOx) levels in cerebrospinal fluid (CSF) and their correlation with factors associated with severity and prognosis after severe TBI. NOx levels were measured in CSF obtained via ventriculostomy in 44 adult patients admitted after severe TBI (Glasgow Coma Scale ≤ 8/15). The overall mean level of CSF NOx in the study population was 7.40 ± 1.59 μmol/L. Levels of CSF NOx were found to be significantly higher in subgroups of patients with poorer outcome measured by Glasgow Outcome Scale score (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.042), in patients with high intracranial pressure (ICP) readings (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.027) and in those with higher Marshall computed tomography (CT) grading scores (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.026). Simple logistic regression demonstrated that CSF NOx levels were a significant predictor of ICP (b = 0.493, 95%CI: 1.03, 2.58, p = 0.033). A patient with 1 μmol/L increase in NOx level had 1.6 times the odds to have an ICP ≥ 20 mmHg when other confounders were not adjusted. NOx level is also a significant predictor of Marshall CT grading (b = 0.473, 95%CI: 1.02, 2.50, p = 0.037). A patient with 1 μmol/L increase in NOx level had 1.6 times the odds to have a high Marshall grade when other confounders were not adjusted. It can be concluded that CSF NOx levels may serve as a potentially useful biomarker in severe TBI given its significant association with ICP readings as well as Marshall CT grading.

Journal of critical reviews, 2020

The brain tumors arise inside the cranial cavity from brain tissue and surrounding meninges. The ... more The brain tumors arise inside the cranial cavity from brain tissue and surrounding meninges. The tumors are responsible for increase mortality in general population building a pressure in the health care system of many countries. This study is performed to enlighten the prevalence of brain tumor with headache as their presenting symptom. This is a retrospective study of patients with brain tumour. The data is collected from the patients case file of Hospital University Sains Malaysia, Kelantan, Malaysia available from 2013 to 2018. A total of 138 patients were selected for the study. Out of them 77 patients with brain tumour headache were included in the study. The age group was considered from 5th year of life to 65 years and above. The analysis is performed by SPSS version 23. The tumours are categorized as intra-axial and extra-axial. Under intra-axial tumour, 10 patients of glioblastoma and metastatic brain tumour encountered headache which is highest among intra-axial tumours. Meningiomas are the top most extra-axial tumour precipitated headache. About 25 patients of this tumour are detected encountering headache. The headache associated with tumour temporal lobe accounts 16 patients. The frontal lobe tumour (14 patients) is second commonest producing headache. The Kruskal Wallis H test shows a significant difference between brain tumour, gender and location. A correct diagnosis is very important for treatment of brain tumor. One of the tools for accurate treatment is their presenting symptoms.

The Malaysian Journal of Medical Science, Dec 29, 2017

Epilepsy surgery has been performed by a few centres in Malaysia, including Hospital Universiti S... more Epilepsy surgery has been performed by a few centres in Malaysia, including Hospital Universiti Sains Malaysia (HUSM). To date, a total of 15 patients have undergone epilepsy surgery in HUSM. The epilepsy surgery included anterior temporal lobectomy (ATL) with amygdalohippocampectomy (AH) and Vagal nerve stimulation (VNS). The surgical outcomes of the patients were assessed using the International League Against Epilepsy (ILAE) outcome scale. The ILAE scores for patients who underwent ATL with AH were comparatively better than those who underwent VNS. One of the patient who underwent ATL with AH and frontal lesionectomy was found to have psychosis during follow up. Epilepsy surgery has proven to be an important treatment for medically resistant epilepsy. Thus it is important to raise public awareness regarding epilepsy and its treatment.

$Research paper thumbnail of Intracranial bleeding following induction of anesthesia in a patient undergoing elective surgery for refractory epilepsy$

Surgical Neurology International, 2013

Background: A patient with refractory epilepsy due to underlying mesial temporal sclerosis underw... more Background: A patient with refractory epilepsy due to underlying mesial temporal sclerosis underwent general anesthesia for an elective anterior temporal lobectomy and amgydalo-hippocampectomy. He was a known hypertensive and his blood pressure was well controlled on medication. Case Description: Following induction of general anesthesia and subsequent opening of the craniotomy flap it was noted that the patient had a very swollen brain that herniated out of the dural defect. There was an underlying spontaneous intraparenchymal bleed encountered in the region of the left temporal lobe with associated subarachnoid hemorrhage within the sylvian fissure. The clot was evacuated and subsequently brain swelling reduced allowing us to proceed with the intended surgery. Despite the intracranial findings there was no overt abnormality in the hemodynamic status from the time of induction of anesthesia to the craniotomy opening excepting a mild nonsustained elevation of blood pressure at the outset. Conclusion: This case is of interest due to the fact that spontaneous intraparenchymal bleeding after induction of anesthesia has not been reported before in literature and should be considered in any patient in which brain swelling occurs in a setting of elective neurosurgery in which the primary lesion does not cause elevated intracranial pressure.

Surgical Neurology International, 2014

Background: Malignant middle cerebral artery (MCA) infarction is a devastating clinical entity af... more Background: Malignant middle cerebral artery (MCA) infarction is a devastating clinical entity affecting about 10% of stroke patients. Decompressive craniectomy has been found to reduce mortality rates and improve outcome in patients. Methods: A retrospective case review study was conducted to compare patients treated with medical therapy and decompressive surgery for malignant MCA infarction in Hospital Kuala Lumpur over a period of 5 years (from January 2007 to December 2012). A total of 125 patients were included in this study; 90 (72%) patients were treated with surgery, while 35 (28%) patients were treated with medical therapy. Outcome was assessed in terms of mortality rate at 30 days, Glasgow Outcome Score (GOS) on discharge, and modified Rankin scale (mRS) at 3 and 6 months. Results: Decompressive craniectomy resulted in a significant reduction in mortality rate at 30 days (P < 0.05) and favorable GOS outcome at discharge (P < 0.05). Good functional outcome based on mRS was seen in 48.9% of patients at 3 months and in 64.4% of patients at 6 months (P < 0.05). Factors associated with good outcome include infarct volume of less than 250 ml, midline shift of less than 10 mm, absence of additional vascular territory involvement, good preoperative Glasgow Coma Scale (GCS) score, and early surgical intervention (within 24 h) (P < 0.05). Age and dominant hemisphere infarction had no significant association with functional outcome. Conclusion: Decompressive craniectomy achieves good functional outcome in, young patients with good preoperative GCS score and favorable radiological findings treated with surgery within 24 h of ictus.

The Medical journal of Malaysia, Nov 1, 2020

Introduction: Chiari malformation (CM) is a disorder of mesodermal origin and is commonly associa... more Introduction: Chiari malformation (CM) is a disorder of mesodermal origin and is commonly associated with syringomyelia. Foramen magnum decompression is the first-line of standard treatment in symptomatic patients with a confirmed radiographic diagnosis. Magnetic resonance (MR) cine allows accurate evaluation of cerebrospinal fluid (CSF) physiology at the craniovertebral junction but often this is under-utilised in Malaysia. Methods: In this series, we looked into nine cases of CM with syringomyelia from clinical and radiological perspective before and after surgery. The radiological parameters were herniated tonsillar length, syrinx: cord ratio, syrinx length and diameter. Flow velocity and morphologic changes in Chiari were illustrated. Results: Seven patients showed either reduction in syrinx length, syrinx: cord ratio or both postoperatively. Clinical recovery somewhat varied in motor and sensory symptoms. Four patients gained better functional grade in modified Rankin scale (MRS) while the rest remained similar. The study highlighted the advantage of CSF flow dynamics information over MR anatomical radiographic improvement in addressing the neurologic and functional recovery. We also discussed the practicality of cine sequence in preoperative patient selection, syrinx analysis and postoperative flow evaluation in anticipation of clinical outcome. Conclusion: Phase-contrast cine MRI is a useful tool dictated by resource availability. We recommend its routine use in preoperative analysis and subsequent observational follow-up after surgery.