Displaying publications 41 - 60 of 106 in total

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  1. Fulltext Effects of ischemic preconditioning of different intraoperative ischemic times of vascularized bone graft rabbit models
    Halim AS, Wan Ahmad Kamal WS, Noor NM, Abdullah S
    Arch Plast Surg, 2013 Nov;40(6):687-96.
    PMID: 24286040 DOI: 10.5999/aps.2013.40.6.687
    Ischemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published.
  2. Fulltext Primary dapsone resistant Mycobacterium leprae in a non endemic country
    Jamil A, Noor NM, Osman AS, Baseri MM, Muthupalaniappen L
    Indian J Dermatol Venereol Leprol, 2013 Jul-Aug;79(4):527-9.
    PMID: 23760326 DOI: 10.4103/0378-6323.113096
  3. A novel shape representation of the dental arch and its applications in some dentistry problems
    Rijal OM, Abdullah NA, Isa ZM, Davaei FA, Noor NM, Tawfiq OF
    Annu Int Conf IEEE Eng Med Biol Soc, 2011;2011:5092-5.
    PMID: 22255484 DOI: 10.1109/IEMBS.2011.6091261
    Standardized digital images of maxillary dental casts of 47 subjects were analyzed using MATLAB software whereby the two hamular notches and the incisive papilla defines the Cartesian vertical and horizontal axes, as well as the origin. The angle and length of the midpoints of the anterior teeth, mesiobuccal and distobuccal cusp of the posterior teeth were measured from the origin and denoted as θ(1), …, θ(18) and l(1), …, l(18) respectively. These values were collectively used to represent the shape of each dental cast. Clustering and principal component analyses were employed to find possible groups of dental arches using the above measure of shape. The main result of this study is that the 3 groups of dental arch shape may be represented by the novel feature vector v(k) = (θ(k)(1), l(k)(1), θ(k)(3), l(k)(3), θ(k)(5), l(k)(5), θ(k)(13), l(k)(13)), k = 1, 2, 3. Knowledge of v(k) implies three impression trays should be sufficient in a particular prosthetic dentistry application for Malaysian patients. Further, given that v(k) are accurately measured they may be potential candidates as evidence in specific application of forensic dentistry.
  4. Fulltext Molecular systematics of Polygonum minus Huds. based on ITS sequences
    Bunawan H, Choong CY, Md-Zain BM, Baharum SN, Noor NM
    Int J Mol Sci, 2011;12(11):7626-34.
    PMID: 22174621 DOI: 10.3390/ijms12117626
    Plastid trnL-trnF and nuclear ribosomal ITS sequences were obtained from selected wild-type individuals of Polygonum minus Huds. in Peninsular Malaysia. The 380 bp trnL-trnF sequences of the Polygonum minus accessions were identical. Therefore, the trnL-trnF failed to distinguish between the Polygonum minus accessions. However, the divergence of ITS sequences (650 bp) among the Polygonum minus accessions was 1%, indicating that these accessions could be distinguished by the ITS sequences. A phylogenetic relationship based on the ITS sequences was inferred using neighbor-joining, maximum parsimony and Bayesian inference. All of the tree topologies indicated that Polygonum minus from Peninsular Malaysia is unique and different from the synonymous Persicaria minor (Huds.) Opiz and Polygonum kawagoeanum Makino.
  5. Applying a statistical PTB detection procedure to complement the gold standard
    Noor NM, Yunus A, Bakar SA, Hussin A, Rijal OM
    Comput Med Imaging Graph, 2011 Apr;35(3):186-94.
    PMID: 21036539 DOI: 10.1016/j.compmedimag.2010.10.002
    This paper investigates a novel statistical discrimination procedure to detect PTB when the gold standard requirement is taken into consideration. Archived data were used to establish two groups of patients which are the control and test group. The control group was used to develop the statistical discrimination procedure using four vectors of wavelet coefficients as feature vectors for the detection of pulmonary tuberculosis (PTB), lung cancer (LC), and normal lung (NL). This discrimination procedure was investigated using the test group where the number of sputum positive and sputum negative cases that were correctly classified as PTB cases were noted. The proposed statistical discrimination method is able to detect PTB patients and LC with high true positive fraction. The method is also able to detect PTB patients that are sputum negative and therefore may be used as a complement to the gold standard.
  6. Screening of tetrodotoxin in puffers using gas chromatography-mass spectrometry
    Man CN, Noor NM, Harn GL, Lajis R, Mohamad S
    J Chromatogr A, 2010 Nov 19;1217(47):7455-9.
    PMID: 20950812 DOI: 10.1016/j.chroma.2010.09.064
    Tetrodotoxin (TTX), a toxic compound found in some puffers can cause death to humans through consumption. We have developed a simplified method for the screening of TTX in puffers using GC-MS. A puffer tissue of 0.5g was treated with 5mL of 0.1% acetic acid, followed by alkaline hydrolysis, LLE or liquid-liquid extraction and N-methyl-N-TMS-trifluoroacetamide derivatization. The developed method used only a small sample and solvent, simplified LLE and derivatization procedures and short chromatographic analysis (8.2min). All of these contribute to cost-saving, enhanced sample throughput and high sensitivity of the screening assay. The developed method was validated and proved to be within the acceptable range.
  7. Regression methods to investigate the relationship between facial measurements and widths of the maxillary anterior teeth
    Isa ZM, Tawfiq OF, Noor NM, Shamsudheen MI, Rijal OM
    J Prosthet Dent, 2010 Mar;103(3):182-8.
    PMID: 20188241 DOI: 10.1016/S0022-3913(10)60028-5
    In rehabilitating edentulous patients, selecting appropriately sized teeth in the absence of preextraction records is problematic.
  8. A probability distribution of shape for the dental maxillary arch using digital images
    Rijal OM, Abdullah NA, Isa ZM, Noor NM, Tawfiq OF
    Annu Int Conf IEEE Eng Med Biol Soc, 2012;2012:5420-3.
    PMID: 23367155 DOI: 10.1109/EMBC.2012.6347220
    Selected landmarks from each of 47 maxillary dental casts were used to define a Cartesian-coordinate system from which the positions of selected teeth were determined on standardized digital images. The position of the i-th tooth was defined by a line of length (l(i)) joining the tooth to the origin, and the angle (θ(i)) of this line to the horizontal Cartesian axis. Four teeth, the central incisor, lateral incisor, canine and first molar were selected and their position were collectively used to represent the shape of the dental arch. A pilot study using clustering and principal component analysis strongly suggest the existence of 3 groups of arch shape. In this study, the homogeneity of the 3 groups was further investigated and confirmed by the Dunn and Davies-Bouldein validity indices. This is followed by an investigation of the probability distribution of these 3 groups. The main result of this study suggests 3 groups of multivariate (MV) normal distribution. The MV normal probability distribution of these groups may be used in further studies to investigate the issues of variation of arch shape, which is fundamental to the practice of prosthodontics and orthodontics.
  9. Cryopreservation of Citrus aurantifolia seeds and embryonic axes using a desiccation protocol
    Cho EG, Noor NM, Kim HH, Rao VR, Engelmann F
    Cryo Letters, 2002 Sep-Oct;23(5):309-16.
    PMID: 12447490
    The desiccation and freezing tolerance of seeds, with and without testas, and embryonic axes of Citrus aurantifolia were investigated. Seeds were desiccated with silica gel, under the laminar air flow cabinet or by placing them on a laboratory bench. Whatever the desiccation method employed, survival before and after cryopreservation was higher for seeds without testas. When freezing intact seeds, the highest survival percentage (41.3 %) was achieved after desiccation to 7.3 % moisture content (fresh weight basis) on the laboratory bench. Survival of seeds cryopreserved without testas could reach up to 85 % after desiccation under the laminar air flow cabinet or on the laboratory bench, corresponding to moisture contents of 7.1 and 4.5 %, respectively. After desiccation with silica gel, survival reached a maximum of 60.0 %, for a seed moisture content of 3.3 %. Survival of control embryonic axes was high (80-100 %) whatever the sucrose concentration in the preculture medium and the duration of the desiccation period. After cryopreservation, no survival was noted with embryonic axes, which had not been precultured nor desiccated. Survival of non-desiccated embryonic axes after cryopreservation increased progressively in line with increasing sucrose concentrations in the preculture medium, from 7.5 % with 0.1 M sucrose to 77.5 % with 0.7 M sucrose. Survival of desiccated and cryopreserved embryos was always high, whatever the preculture treatment and desiccation period, ranging from 55.8 % to 92.5 %.
  10. Fulltext Prospective role of mitochondrial apoptotic pathway in mediating GMG-ITC to reduce cytotoxicity in H2O2-induced oxidative stress in differentiated SH-SY5Y cells
    Jaafaru MS, Nordin N, Rosli R, Shaari K, Bako HY, Noor NM, et al.
    Biomed Pharmacother, 2019 Nov;119:109445.
    PMID: 31541852 DOI: 10.1016/j.biopha.2019.109445
    The antioxidant and neuroprotective activity of Glucomoringin isothiocyanate (GMG-ITC) have been reported in in vivo and in vitro models of neurodegenerative diseases. However, its neuroprotective role via mitochondrial-dependent pathway in a noxious environment remains unknown. The main objective of the present study was to unveil the mitochondrial apoptotic genes' profile and prospectively link with neuroprotective activity of GMG-ITC through its ROS scavenging. The results showed that pre-treatment of differentiated SH-SY5Y cells with 1.25 μg/mL purified isolated GMG-ITC, significantly reduced reactive oxygen species (ROS) production level, compared to H2O2 control group, as evidenced by flow cytometry-based evaluation of ROS generation. Presence of GMG-ITC prior to development of oxidative stress condition, downregulated the expression of cyt-c, p53, Apaf-1, Bax, CASP3, CASP8 and CASP9 genes with concurrent upregulation of Bcl-2 gene in mitochondrial apoptotic signalling pathway. Protein Multiplex revealed significant decreased in cyt-c, p53, Apaf-1, Bax, CASP8 and CASP9 due to GMG-ITC pre-treatment in oxidative stress condition. The present findings speculated that pre-treatment with GMG-ITC may alleviate oxidative stress condition in neuronal cells by reducing ROS production level and protect the cells against apoptosis via neurodegenerative disease potential pathways.
  11. Fulltext LC-MS data for metabolomics analysis of Garcinia mangostana L. seed germination
    Mazlan O, Aizat WM, Aziz Zuddin NS, Baharum SN, Noor NM
    Data Brief, 2018 Dec;21:2221-2223.
    PMID: 30555858 DOI: 10.1016/j.dib.2018.11.072
    Metabolic regulation is important during seed germination for the establishment of seedling. The germination strategy of mangosteen (Garcinia mangostana L.) seed is thought to be unique due to its recalcitrant characteristic (sensitive to coldness and drying). To investigate the metabolic changes during seed germination, we performed metabolomics analysis on germinating mangosteen seed sown after zero, one, three, five, seven and nine days. Sampled mangosteen seeds were subjected to methanol extraction prior analysis using Liquid Chromatography-Time of Flight-Mass Spectrometry (LC-TOF-MS). MS data were further analyzed using ProfileAnalysis (version 2.1). This is one of the earliest reports in metabolite identification and profiling of mangosteen seed at different germination stages. This data article refers to the article entitled "Metabolite profiling of mangosteen seed germination highlights metabolic changes related to carbon utilization and seed protection" (Mazlan et al., 2019) [1].
  12. Fabricated germanium-doped fibres for computed tomography dosimetry
    Rais NNM, Bradley DA, Hashim A, Osman ND, Noor NM
    Appl Radiat Isot, 2019 Nov;153:108810.
    PMID: 31351374 DOI: 10.1016/j.apradiso.2019.108810
    For a range of doses familiarly incurred in computed tomography (CT), study is made of the performance of Germanium (Ge)-doped fibre dosimeters formed into cylindrical and flat shapes. Indigenously fabricated 2.3 mol% and 6 mol% Ge-dopant concentration preforms have been used to produce flat- and cylindrical-fibres (FF and CF) of various size and diameters; an additional 4 mol% Ge-doped commercial fibre with a core diameter of 50 μm has also been used. The key characteristics examined include the linearity index f(d), dose sensitivity and minimum detectable dose (MDD), the performance of the fibres being compared against that of lithium-fluoride based TLD-100 thermoluminescence (TL) dosimeters. For doses in the range 2-40 milligray (mGy), delivered at constant potential of 120 kilovoltage (kV), both the fabricated and commercial fibres demonstrate supralinear behaviours at doses  4 mGy. In terms of dose sensitivity, all of the fibres show superior TL sensitivity when compared against TLD-100, the 2.3 mol% and 6 mol% Ge-doped FF demonstrating the greatest TL sensitivity at 84 and 87 times that of TLD-100. The TL yields for the novel Ge-doped silica glass render them appealing for use within the present medical imaging dose range, offering linearity at high sensitivity down to less than 2 mGy.
  13. Fulltext Regulation of terpenoid biosynthesis by miRNA in Persicaria minor induced by Fusarium oxysporum
    Samad AFA, Rahnamaie-Tajadod R, Sajad M, Jani J, Murad AMA, Noor NM, et al.
    BMC Genomics, 2019 07 16;20(1):586.
    PMID: 31311515 DOI: 10.1186/s12864-019-5954-0
    BACKGROUND: Persicaria minor (kesum) is an herbaceous plant with a high level of secondary metabolite compounds, particularly terpenoids. These terpenoid compounds have well-established roles in the pharmaceutical and food industries. Although the terpenoids of P. minor have been studied thoroughly, the involvement of microRNA (miRNA) in terpenoid regulation remains poorly understood and needs to be explored. In this study, P. minor plants were inoculated with the pathogenic fungus Fusarium oxysporum for terpenoid induction.

    RESULT: SPME GC-MS analysis showed the highest terpenoid accumulation on the 6th day post-inoculation (dpi) compared to the other treatment time points (0 dpi, 3 dpi, and 9 dpi). Among the increased terpenoid compounds, α-cedrene, valencene and β-bisabolene were prominent. P. minor inoculated for 6 days was selected for miRNA library construction using next generation sequencing. Differential gene expression analysis showed that 58 miRNAs belonging to 30 families had significantly altered regulation.
    Among these 58 differentially expressed genes (DEGs), 27 [corrected] miRNAs were upregulated, whereas 31 [corrected] miRNAs were downregulated. Two putative novel pre-miRNAs were identified and validated through reverse transcriptase PCR. Prediction of target transcripts potentially involved in the mevalonate pathway (MVA) was carried out by psRobot software, resulting in four miRNAs: pmi-miR530, pmi-miR6173, pmi-miR6300 and a novel miRNA, pmi-Nov_13. In addition, two miRNAs, miR396a and miR398f/g, were predicted to have their target transcripts in the non-mevalonate pathway (MEP). In addition, a novel miRNA, pmi-Nov_12, was identified to have a target gene involved in green leaf volatile (GLV) biosynthesis. RT-qPCR analysis showed that pmi-miR6173, pmi-miR6300 and pmi-nov_13 were downregulated, while miR396a and miR398f/g were upregulated. Pmi-miR530 showed upregulation at 9 dpi, and dynamic expression was observed for pmi-nov_12. Pmi-6300 and pmi-miR396a cleavage sites were detected through degradome sequence analysis. Furthermore, the relationship between miRNA metabolites and mRNA metabolites was validated using correlation analysis.

    CONCLUSION: Our findings suggest that six studied miRNAs post-transcriptionally regulate terpenoid biosynthesis in P. minor. This regulatory behaviour of miRNAs has potential as a genetic tool to regulate terpenoid biosynthesis in P. minor.

  14. Fulltext Correction to: Regulation of terpenoid biosynthesis by miRNA in Persicaria minor induced by Fusarium oxysporum
    Samad AFA, Rahnamaie-Tajadod R, Sajad M, Jani J, Murad AMA, Noor NM, et al.
    BMC Genomics, 2019 08 01;20(1):627.
    PMID: 31370802 DOI: 10.1186/s12864-019-5994-5
    Following publication of the original article [1], the authors reported a number of errors, which are listed in this Correction article. The corrections are marked in bold.
  15. Fulltext A Case Report of Steroid Withdrawal Syndrome
    Wahab F, Rahman RA, Yaacob LH, Noor NM, Draman N
    Korean J Fam Med, 2020 Sep;41(5):359-362.
    PMID: 32961047 DOI: 10.4082/kjfm.18.0181
    We report a case of steroid withdrawal syndrome in a 74-year-old woman who was suspected of having an occult exogenous Cushing's syndrome secondary to prolonged traditional complementary medicine use. She presented with non-specific symptoms of lethargy, malaise, and poor oral intake with weight loss for 1 month, and investigations showed suboptimal 9 AM cortisol level. She has responded well to steroid replacement.
  16. Fulltext In Vitro Performance of Dutasteride-Nanostructured Lipid Carriers Coated with Lauric Acid-Chitosan Oligomer for Dermal Delivery
    Noor NM, Abdul-Aziz A, Sheikh K, Somavarapu S, Taylor KMG
    Pharmaceutics, 2020 Oct 20;12(10).
    PMID: 33092119 DOI: 10.3390/pharmaceutics12100994
    Dutasteride, licensed as an oral medicine for the treatment of benign prostatic hypoplasia, has been investigated as a treatment for androgenic alopecia. In this study, the potential for dustasteride to be delivered topically in order to reduce systemic exposure, irritation of the skin, and also cytotoxicity was explored. Chitosan oligomer (CSO) was successfully synthesised with lauric acid as a coating for a dutasteride-loaded nanostructured lipid carriers (DST-NLCs) system. DST-NLCs were prepared using a combination of melt-dispersion and ultrasonication. These negatively charged NLCs (-18.0 mV) had a mean particle size of ~184 nm, which was not significantly increased (p > 0.05) when coated with lauric acid-chitosan oligomer (CSO-LA), whilst the surface charge changed to positive (+24.8 mV). The entrapment efficiency of DST-NLCs was 97%, and coated and uncoated preparations were physically stable for up to 180 days at 4-8 °C. The drug release was slower from DST-NLCs coated with CSO-LA than from uncoated NLCs, with no detectable drug permeation through full-thickness pig ear skin from either preparation. Considering the cytotoxicity, the IC50 values for the DST-NLCs, coated and uncoated with CSO-LA were greater than for dutasteride alone (p < 0.05). DST-NLCs and empty NLCs coated with CSO-LA at 25 µM increased the cell proliferation compared to the control, and no skin irritation was observed when the DST-NLC formulations were tested using EpiDerm™. The cell and skin uptake studies of coated and uncoated NLCs incorporating the fluorescent marker Coumarin-6 showed the time-dependent uptake of Coumarin-6. Overall, the findings suggest that DST-NLCs coated with CSO-LA represent a promising formulation strategy for dutasteride delivery for the treatment of androgenic alopecia, with a reduced cytotoxicity compared to that of the drug alone and lower irritancy than an ethanolic solution of dutasteride.
  17. Dosimetric response of fabricated Ge-doped optical fibres in computed tomography RQT beam quality x-ray beams
    Rais NNM, Bradley DA, Hashim A, Isa NM, Osman ND, Ismail I, et al.
    J Radiol Prot, 2019 Sep;39(3):N8-N18.
    PMID: 31018196 DOI: 10.1088/1361-6498/ab1c16
    Novel germanium (Ge)-doped silica glass fibres tailor-made in Malaysia are fast gaining recognition as potential media for thermoluminescence (TL) dosimetry, with active research ongoing into exploitation of their various beneficial characteristics. Investigation is made herein of the capability of these media for use in diagnostic imaging dosimetry, specifically at the radiation dose levels typically obtained in conduct of Computed Tomography (CT). As a first step within such efforts, there is need to investigate the performance of the fibres using tightly defined spectra, use being made of a Philips constant potential industrial x-ray facility, Model MG165, located at the Malaysian Nuclear Agency Secondary Standards Dosimetry Lab (SSDL). Standard radiation beam qualities (termed RQT) have been established for CT, in accord with IEC 61267: 2003 and IAEA Technical Reports Series No. 457: 2007. A calibrated ionisation chamber has also been utilised, forming a component part of the SSDL equipment. The fabricated fibres used in this study are 2.3 mol% flat fibre (FF) of dimensions 643 × 356 μm2 and 2.3 mol% cylindrical fibre (CF) of 481 μm diameter, while the commercial fibre used is 4 mol% with core diameter of 50 μm. The dopant concentrations are nominal preform values. The fibres have been irradiated to doses of 20, 30 and 40 milligray (mGy) for each of the beam qualities RQT 8, RQT 9 and RQT 10. For x-rays generated at constant potential values from 100 to 150 kV, a discernible energy-dependent response is seen, comparisons being made with that of lithium fluoride (LiF) thermoluminescence dosimeters (TLD-100). TL yield versus dose has also been investigated for x-ray doses from 2 to 40 mGy, all exhibiting linearity. Compared to TLD-100, greater sensitivity is observed for the fibres.
  18. Fulltext Simple Orthodontic Correction of Rotated Malpositioned Teeth Using Sectional Wire and 2 × 4 Orthodontic Appliances in Mixed-Dentition: A Report of Two Cases
    Sockalingam SNMP, Zakaria ASI, Khan KAM, Azmi FM, Noor NM
    Case Rep Dent, 2020;2020:6972196.
    PMID: 32695527 DOI: 10.1155/2020/6972196
    The correction of rotated malpositioned tooth/teeth into the dental arch alignment in the mixed-dentition is often a challenging task for paediatric dentists. Failure in addressing this issue can bring about detrimental effect to the developing dentition and increases the probability of a complex orthodontic treatment in later years. Factors such as severity of the malpositioned teeth, patient's treatment compliance, limitation in specific functions of the selected appliance, availability of bone and space may dictate the success of the treatment. The combined use of a simple sectional orthodontic wire appliance and a 2 × 4 orthodontic appliance has been shown to produce a positive effect. The appliances resulted in derotation of the rotated malpositioned teeth and bringing them into arch alignment in two cases. This treatment option had eliminated the detrimental effects to the developing dentition and helped patients to enhance their smile and dental aesthetics.
  19. Monoterpene alcohol metabolism: identification, purification, and characterization of two geraniol dehydrogenase isoenzymes from Polygonum minus leaves
    Hassan M, Maarof ND, Ali ZM, Noor NM, Othman R, Mori N
    Biosci Biotechnol Biochem, 2012;76(8):1463-70.
    PMID: 22878188
    NADP(+)-dependent geraniol dehydrogenase (EC 1.1.1.183) is an enzyme that catalyzes the oxidation of geraniol to geranial. Stable, highly active cell-free extract was obtained from Polygonum minus leaves using polyvinylpolypyrrolidone, Amberlite XAD-4, glycerol, 2-mercaptoethanol, thiourea, and phenylmethylsulfonylfluoride in tricine-NaOH buffer (pH 7.5). The enzyme preparation was separated into two activity peaks, geraniol-DH I and II, by DEAE-Toyopearl 650M column chromatography at pH 7.5. Both isoenzymes were purified to homogeneity in three chromatographic steps. The geraniol-DH isoenzymes were similar in molecular mass, optimal temperature, and pH, but the isoelectric point, substrate specificity, and kinetic parameters were different. The K(m) values for geraniol of geraniol-DH I and II appeared to be 0.4 mM and 0.185 mM respectively. P. minus geraniol-DHs are unusual among geraniol-DHs in view of their thermal stability and optimal temperatures, and also their high specificity for allylic alcohols and NADP(+).
  20. Fulltext Norepinephrine in Septic Shock: A Systematic Review and Meta-analysis
    Ruslan MA, Baharuddin KA, Noor NM, Yazid MB, Noh AYM, Rahman A
    West J Emerg Med, 2021 Feb 16;22(2):196-203.
    PMID: 33856300 DOI: 10.5811/westjem.2020.10.47825
    INTRODUCTION: Most experts recommend norepinephrine as the first-line agent in septic shock. Our objective was to determine the effectiveness and safety of norepinephrine in patients with septic shock.

    METHODS: We searched the Cochrane Central Register of Controlled Trials and Epistemonikos, as well as MEDLINE from 1966 till August 2019. Screening of full texts, evaluation for eligibility, and data extraction were done by four independent reviewers. We estimated risk ratios (RR) and mean differences (MD) using a random-effects model with 95% confidence intervals (CI). The primary outcomes included the number of participants who achieved the target mean arterial pressure (MAP), time to achieve the target MAP, and number of participants with all-cause 28-day mortality. The secondary outcomes included the length of stay in the intensive care unit, length of hospital stay, incidence of arrhythmia and myocardial infarction, vasopressor-free days, and number of participants with all-cause 90-day mortality.

    RESULTS: We identified 11 randomized controlled trials with a total of 4,803 participants. There was no difference in the number of participants who achieved the target MAP between those patients receiving norepinephrine and other vasopressors (RR 1.44; 95% CI, 0.32 to 6.54; P = 0.640; I2 = 94%; two trials, 116 participants). There was no significant difference in time to achieve the target MAP (MD -0.05; 95%, CI, -0.32 to 0.21; P = 0.690; I2 = 26%; two trials, 1763 participants) and all-cause 28-day mortality (RR 0.95; 95% CI, 0.89 to 1.02; P = 0.160; I2 = 0%; seven trials, 4,139 participants). Regarding the secondary outcome, norepinephrine may significantly reduce the incidence of arrhythmia as compared to other vasopressors (RR 0.64; 95% CI, 0.42 to 0.97; P = 0.030; I2 = 64%; six trials, 3974 participants). There was no difference in the incidence of myocardial infarction (RR 1.28; 95% CI, 0.79 to 2.09), vasopressor-free day (RR 0.46; 95% CI, -1.82 to 2.74) and all-cause 90-day mortality (RR 1.08; 95% CI, 0.96 to 1.21) between norepinephrine and vasopressors.

    CONCLUSION: In minimizing the occurrence of an arrhythmia, norepinephrine is superior to other vasopressors, making it safe to be used in septic shock. However, there was insufficient evidence concerning mortality and achievement of the target MAP outcomes.

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