Browse publications by year: 2021

  1. Myo T, Hong SA, Thepthien BO, Hongkrailert N
    Malays J Med Sci, 2021 Aug;28(4):71-86.
    PMID: 34512132 DOI: 10.21315/mjms2021.28.4.8
    Background: Postpartum depression (PPD) can have serious consequences on both the mother and infant. Despite the higher prevalence, there are limited numbers of studies on PPD in low-and middle-income countries, like Myanmar. This study aimed to explore the prevalence and associated factors of PPD in primary healthcare settings in Myanmar.

    Methods: This cross-sectional online study was conducted with 220 mothers under 6 months postpartum in April-May 2020 and who registered in public health centres in Kungyangone Township, Yangon, Myanmar. The postpartum depression was measured with the Edinburgh postpartum depression scale (EPDS, ≥ 13 scores). Independent variables included sociodemographic factors, obstetric and infant factors, psychosocial factors (social support and social media usage), health services utilisation and accessibility factors. Chi-square tests and multiple logistic regression were performed.

    Results: Overall prevalence of depressive symptoms in 220 women under 6 months postpartum was 31.8% (95% confidence interval [CI]: 25.9, 37.3). In multiple logistic regression, unplanned pregnancy (adjusted odds ratio [AOR]: 2.946), less than four times antenatal care (ANC) visits (AOR: 2.518), travel time more than 1 h to reach health centres (AOR: 3.068) and birth interval more than 5 years (AOR: 4.594) were more likely to be associated with PPD, while preterm delivery (AOR: 0.091) was inversely associated.

    Conclusion: This study showed the relatively high prevalence of PPD and the strong association with preterm delivery, pregnancy intention, breastfeeding status, birth interval as well as frequency of ANC received and travel time to health centre. It may suggest that maternal mental health services should be integrated with existing maternal and child health (MCH) services for early detection and prevention of depression symptoms with promotion of MCH services utilisation and improved accessibility among mothers in primary healthcare setting.

  2. Udompanich N, Thanasootr KO, Chanavirut R, Chatchawan U, Hunsawong T
    Malays J Med Sci, 2021 Aug;28(4):87-96.
    PMID: 34512133 DOI: 10.21315/mjms2021.28.4.9
    Background: Balance impairment is a common consequence of chronic ankle instability (CAI). This study aimed to assess the discriminative validity of four clinical tests for quantifying balance impairment in individuals with CAI.

    Methods: Participants were screened for their balance using the single-leg balance test (SLBT) and were assigned to either the positive or the negative SLBT groups. Fifty-four individuals with CAI (N = 27 per group) were recruited and completed four clinical tests including the foot-lift test (FLT), the time-in-balance test (TIBT), the modified star excursion balance test in the posteromedial (mSEBT-PM) direction and the side-hop test (SHT). The receiver operating characteristics (ROC) curve coupled with Youden index were calculated to determine the optimal cut-off scores of each test.

    Results: We found significant differences in balance between groups for all tests, with good to excellent values for the area under the ROC curve (AUC). All four tests reached good to excellent sensitivity and specificity values and had significant cut-off scores to discriminate balance performance among CAI participants.

    Conclusion: All four clinical tests can be conducted with their respective cut-off scores to quantify balance impairment in individuals with CAI.

  3. Cheraghali R, Farshidmehr P
    Malays J Med Sci, 2021 Aug;28(4):97-102.
    PMID: 34512134 DOI: 10.21315/mjms2021.28.4.10
    Background: This prospective cohort study aims to evaluate the primary and exchanged femoral catheter patency rates, as well as mortality rates and determine the probable risk factors affecting femoral catheter survival.

    Methods: All 79 tunneled femoral catheters created in our hospital from 2017 to 2020 were included in this study. Patients having no other means for dialysis access other than the femoral catheter was recruited in this study. Data collected included patient age, sex, comorbidities (diabetes and hypertension), transplant history, dialysis duration, catheter complications, femoral access history, and primary and exchanged femoral patency rates. Patients were followed for 4-36 months.

    Results: The median catheter primary patency was 7 months (95% confidence interval [CI]: 5.77, 8.22) and the primary patency rates at 2, 4 and 6 months were 79%, 68% and 48%, respectively. The median exchanged catheter survival was 8 months (95% CI: 0.83, 15.17) and the exchanged patency rates at 1, 3 and 8 months were 72%, 64% and 32%, respectively. Of the patients (n = 62), 8% (5 patients) died because they had no other option for dialysis access.

    Conclusion: Tunneled femoral catheters have a low patency rate and should be the last option for haemodialysis patients when other probable accesses are not available.

  4. Teo CH, Hing HL, Hamzah NH, Hamzah SPAA
    Malays J Med Sci, 2021 Aug;28(4):103-112.
    PMID: 34512135 DOI: 10.21315/mjms2021.28.4.11
    Background: Examination of post-mortem changes is one of the ways to assess decomposition process on buried bodies. Nonetheless, studies on such assessment are still lacking, especially on the effects of body coverings by different materials in burial conditions. The aim of this research is to study the effect of different types of covering towards decomposition on buried rabbit carcasses by using Total Body Score (TBS) system.

    Methods: Twenty-seven rabbit carcasses were divided into: (i) No Clothing; (ii) Thick Clothing and (iii) Plastic Wrapping groups, and buried into individual shallow graves. One subject was exhumed from first to ninth post-burial week and assessed by using TBS system.

    Results and Discussion: There are significant differences among TBS between different coverings while controlling the time factor, F (2, 23) = 4.80, P < 0.05, partial η 2 = 0.294. TBS score for Plastic Wrapping group is significantly lower than No Clothing group over times at α = 0.05, P < 0.05. The slightly delaying effect of thick clothing is caused by design of jacket, which allows arthropods access and microbial activity. Relatively strong delaying effect by plastic covering could be caused by impermeable property that caused accumulation of decompositional products and slow down the degradation.

    Conclusion: In conclusion, TBS system is a potential tool in describing rate of decomposition for buried cases in Malaysia.

  5. Jahangeer SMA, Hasnain N, Tariq MT, Jamil A, Zia SY, Amir W
    Malays J Med Sci, 2021 Aug;28(4):113-122.
    PMID: 34512136 DOI: 10.21315/mjms2021.28.4.12
    Introduction: This study aimed at determining the frequency and association of stress levels with modes of transportation and was likely to reveal the contributing transportation-related factors for stress in medical students.

    Methods: This was a questionnaire-based, cross-sectional study that included undergraduate medical students of a public sector medical university in Karachi, Pakistan. A total of 573 students participated voluntarily, of which 300 were provided a manual questionnaire and 273 filled it online. The reliability of the questionnaire was assessed using Cronbach's alpha at 0.791. The collected data were analysed using IBM SPSS Statistics for Windows, version 21.0.

    Results: Out of 573 participants, 99.3% (n = 298) of students filled the questionnaire manually, whereas 100% of students filled the questionnaire online. Almost two-thirds of students used university transport; more than 90% lived more than 5 km from the university and 56% had a traveling time of more than an hour. Approximately 15.4% of students reported physical trauma and some form of harassment. Sheldon Cohen's stress scale surprisingly revealed 90% of students to be within the moderate-to-high stress category. Risk factors were associated with stress levels and significant associations were observed with noise exposure (P = 0.023) and sleep quality (P = 0.001). The most common reported stressors associated with commuting included overcrowding, long travel, and air and noise pollution. Noise pollution was the main predictor of stress among commuters.

    Conclusion: Poor transportation has adverse effects on health and academic performance. Administration in their respective jurisdictions is needed to investigate this matter to make commuting a routine rather than a hassle.

  6. Chime OH, Orji CJ, Aneke TJ, Nwoke IN
    Malays J Med Sci, 2021 Aug;28(4):123-137.
    PMID: 34512137 DOI: 10.21315/mjms2021.28.4.13
    Objective: Child sexual abuse (CSA) is a growing public health concern with health, academic and psychosocial implications. The aim of this study was to determine the prevalence, pattern and predictors of CSA among secondary school students.

    Methods: This was a cross-sectional study carried out among adolescents in four secondary schools in Enugu Metropolis, Nigeria. A pretested self-administered questionnaire was used to collect information from 325 adolescents and data was analysed with a significance level set at P ≤ 0.05.

    Results: The prevalence of CSA in this study was 116 (35.7%). While the majority 20 (40%) of the victims were forced to watch pornography, most of the perpetrators were neighbours 34 (29.3%). A higher proportion of the victims were abused once, 79 (68.1%); when they were between 12 and 18 years old, 62 (53.4%); and at home, 39 (33.6%). Grouped ages, whom the child lived with, father's and mother's education, and father's occupation were statistically significant on bivariate analysis. Predictors of CSA were students in senior secondary school Class 2 (SSS2) and those whose fathers were employed.

    Conclusion: Our study revealed a high prevalence of CSA. Comprehensive sexuality education and legislative policies should be implemented to educate adolescents and deter perpetrators.

  7. Mat Din H, Raja Adnan RNE, Nor Akahbar SA, Ahmad SA
    Malays J Med Sci, 2021 Aug;28(4):138-145.
    PMID: 34512138 DOI: 10.21315/mjms2021.28.4.14
    In response to the rising number of COVID-19-related deaths among older adults in Malaysia, observation concerning COVID-19-related mortality among older adults is of urgent public health importance. This study presents a review of the COVID-19-related death cases among older adults in Malaysia. Clinical and social demographic data of death cases officially released by the Ministry of Health Malaysia were reviewed. As of 12 June 2020, 81 older adult death cases were identified and included in this study. The mean age of the death cases was 71.88 years old. Even though 79% of these cases were male, gender was not likely to be associated with mortality. A substantial difference between the prevalence of diabetes among death cases and the nationwide population indicated that diabetes was more likely to be associated with mortality. Most of the studied deaths were individuals with pre-existing medical conditions, predominantly diabetes and hypertension, and those aged 70 years old or above. The mean time from hospitalisation to death was 11.83 days. Extra focus should be given to older adults in the prevention and control of COVID-19.
  8. Rajah R, Lim KY, Ng BH, Soo CI
    Malays J Med Sci, 2021 Aug;28(4):146-152.
    PMID: 34512139 DOI: 10.21315/mjms2021.28.4.15
    Acute dyspnea is one of the prevalent reasons for admission to the emergency department. The use of N-terminal pro-B-type natriuretic peptide (NT-proBNP) as an adjunct for assessing acute dyspnea is not a common practice in many public hospitals in Malaysia. This retrospective review is part of our clinical audit to determine the utility of NT-proBNP as an adjunct to non-standardised clinical evaluation in identifying acute heart failure (HF) in patients with persistent dyspnea (24 h) post-admission. In this cohort of 30 patients with acute dyspnea, NT-proBNP was positive in 20 patients (87%) with acute HF. Three patients (13%) who were treated for septic shock recorded a NT-proBNP false-positive. NT-proBNP demonstrated an overall sensitivity of 90%, a specificity of 70%, a positive predictive value of 85.7% and a negative predictive value of 77.8% in identifying acute HF. These results reinforce that age-stratified NT-proBNP cut-off values are useful for ruling-in or -out acute HF. Thus, NT-proBNP should be considered a crucial point of care, testing to decifer the conundrum of acute dyspneic patients.
  9. Mushi V, Mushi L
    Malays J Med Sci, 2021 Aug;28(4):153-155.
    PMID: 34512140 DOI: 10.21315/mjms2021.28.4.16
    Social and behavioural change strategies are crucial to facilitating the adoption of preventive behaviours during the COVID-19 pandemic. For the success of such social and behavioural changes, the community should be aware of the interventions and willing to adhere to health advice. This letter details the strategies employed in Tanzania to accelerate the adoption of preventive behaviour and contain the spread of COVID-19.
  10. Ashraf MU, Raza S, Ashraf A, Mehmood W, Patwary AK
    J Public Aff, 2021 Jul 04.
    PMID: 34512182 DOI: 10.1002/pa.2716
    The present study aimed to investigate the effects of fear of COVID-19 and situational depression on the quality of life (QOL) of Pakistani citizens. An online cross-sectional survey was conducted on Pakistani citizens via the snowball sampling technique. A total of 377 respondents (256 males and 121 females) participated in this study from August to October 2020. Adapted scales were validated using confirmatory factor analysis, and partial least squares structural equation modelling (PLS-SEM) was applied to the data to test the hypothesised model. The study's findings showed a negative relationship between fear of COVID-19 and QOL. Likewise, a reciprocal relationship was found between situational depression and quality of life. The results indicate that fear of COVID-19 and situational depression during the pandemic have affected the lives of Pakistani citizens. The findings are particularly relevant for improving the QOL by limiting the information received from media and social networks. There is a need to control these mediums and promote community-based interventions to provide accurate knowledge regarding COVID-19. Fear of COVID-19 and situational depression may be reduced in this way. Based on the current findings, psychotherapy and counselling programmes must be planned to minimise the adverse effects of fear of COVID-19 and depression on the QOL of citizens due to the ongoing progression of the pandemic.
  11. Choi JJ, Robb CA, Mifli M, Zainuddin Z
    J Hosp Leis Sport Tour Educ, 2021 Nov;29:100336.
    PMID: 34512193 DOI: 10.1016/j.jhlste.2021.100336
    The general process of learning in educational institutions around the globe has changed since the advent of the COVID-19 virus. Educational sectors in all nations are forced to adapt and rearrange their compositions and systems as the virus spreads. The current study considers the characteristics and issues related to universities moving towards online and blended learning during this period of universal isolation. Through focus group interviews conducted in South Korea and Malaysia, the study provides recommendation for the improvement of online classes and blended learning. The use of student focus groups gives the research an alternative perspective with which to assess the satisfaction level, success, and quality of online learning programs during the COVID-19 pandemic. Results from the focus groups show that for the success of online learning to become a reality, blended education should be considered to bolster learning. Further, results show that communication between lecturers and students remains a fundamental factor for success, regardless of the class category incorporated. Consequently, the results of the study provide further insight into matters experienced by students during the pandemic, and how educators may heed the opinions of students when improving future related blended learning programs.
  12. Sundara Rajoo K, Singh Karam D, Abdu A, Rosli Z, James Gerusu G
    Urban For Urban Green, 2021 Nov;65:127340.
    PMID: 34512230 DOI: 10.1016/j.ufug.2021.127340
    The Coronavirus disease-2019 (COVID-19) pandemic has affected over 200 countries, forcing governments to impose lockdowns to contain the spread of the disease. Although effective in reducing infection rates, the lockdowns have also resulted in a severe negative impact on mental health throughout the world; Setting the foundation for mental illnesses to become the next "silent" pandemic. This study attempts to determine a self-care method of ensuring mental health during the COVID-19 pandemic, especially for those living under lockdown. We evaluated the potential of physical exercise (in a nature setting) and nature therapy in improving mental wellbeing, among young adults with either stress, anxiety or depression symptoms. The study involved thirty subjects, who were equally divided into a nature-exercise group and a nature therapy group. The participants were briefed on the activities that they were to perform on a daily basis, and both groups performed their assigned activities concurrently for one week (27th April 2020 to 3rd May 2020) at urban greeneries accessible to them (rooftop parks, neighbourhood parks, home gardens). We used the depression, anxiety and stress scale - 21 items (DASS-21) to evaluate the mental health status of participants, once before beginning the study (baseline readings) and once at the end of the study (after a week of nature-exercise/nature therapy). There was a statistically significant reduction in stress, anxiety and depression symptoms for both the nature-exercise and nature therapy groups. However, when evaluating the effectiveness of exercise and nature therapy in treating stress, anxiety and depression symptoms on a case-by-case basis, it was discovered that nature therapy was more effective in treating mental health issues. Hence, nature therapy has the potential to be a form of preventive medicine, namely in preserving mental health during the COVID-19 crisis.
  13. Long F, Zhao S, Wei X, Ng SC, Ni X, Chi A, et al.
    Front Behav Neurosci, 2021;15:720451.
    PMID: 34512288 DOI: 10.3389/fnbeh.2021.720451
    The EEG features of different emotions were extracted based on multi-channel and forehead channels in this study. The EEG signals of 26 subjects were collected by the emotional video evoked method. The results show that the energy ratio and differential entropy of the frequency band can be used to classify positive and negative emotions effectively, and the best effect can be achieved by using an SVM classifier. When only the forehead and forehead signals are used, the highest classification accuracy can reach 66%. When the data of all channels are used, the highest accuracy of the model can reach 82%. After channel selection, the best model of this study can be obtained. The accuracy is more than 86%.
  14. Miraj M, Chuntian L, Mohd Said R, Osei-Bonsu R, Rehman RU
    Front Psychol, 2021;12:651550.
    PMID: 34512432 DOI: 10.3389/fpsyg.2021.651550
    This study explores how the scholarly accomplishments of students might increment due to specific fundamental causes. The academic performance of the student was prioritized as a dependent variable, and the independent indicators chosen were "information seeking, IT ability, reading/writing capacity, and resilience." At the same time, age, gender, marital status, and family income were included in the control variables. The research subject samples were limited to (N = 288) postgraduate students from three mega universities in Islamabad, Pakistan. Forward regression analysis was performed in this research to decide the impact of the indicators. The results indicate that information seeking affects academic performance positively and significantly. Essentially, the study revealed that information technology (IT) skills make a fundamentally positive and significant impact on academic performance. Reading and writing influenced academic performance considerably. In addition, resilience affected academic performance emphatically and essentially. Further, this research also noted the relationships between information-seeking behaviors, IT ability, reading/writing capacities, and resilience capabilities and the academic performance of students. These variables have a positive impact on the academic performance of students.
  15. Liu Y, Zheng K, Liu B, Liang Y, You S, Zhang W, et al.
    Front Microbiol, 2021;12:726074.
    PMID: 34512604 DOI: 10.3389/fmicb.2021.726074
    Marinobacter is the abundant and important algal-associated and hydrocarbon biodegradation bacteria in the ocean. However, little knowledge about their phages has been reported. Here, a novel siphovirus, vB_MalS-PS3, infecting Marinobacter algicola DG893(T), was isolated from the surface waters of the western Pacific Ocean. Transmission electron microscopy (TEM) indicated that vB_MalS-PS3 has the morphology of siphoviruses. VB_MalS-PS3 was stable from -20 to 55°C, and with the latent and rise periods of about 80 and 10 min, respectively. The genome sequence of VB_MalS-PS3 contains a linear, double-strand 42,168-bp DNA molecule with a G + C content of 56.23% and 54 putative open reading frames (ORFs). Nineteen conserved domains were predicted by BLASTp in NCBI. We found that vB_MalS-PS3 represent an understudied viral group with only one known isolate. The phylogenetic tree based on the amino acid sequences of whole genomes revealed that vB_MalS-PS3 has a distant evolutionary relationship with other siphoviruses, and can be grouped into a novel viral genus cluster with six uncultured assembled viral genomes from metagenomics, named here as Marinovirus. This study of the Marinobacter phage vB_MalS-PS3 genome enriched the genetic database of marine bacteriophages, in addition, will provide useful information for further research on the interaction between Marinobacter phages and their hosts, and their relationship with algal blooms and hydrocarbon biodegradation in the ocean.
  16. Allahou LW, Madani SY, Seifalian A
    Int J Biomater, 2021;2021:3041969.
    PMID: 34512761 DOI: 10.1155/2021/3041969
    Chemotherapy is the routine treatment for cancer despite the poor efficacy and associated off-target toxicity. Furthermore, therapeutic doses of chemotherapeutic agents are limited due to their lack of tissue specificity. Various developments in nanotechnology have been applied to medicine with the aim of enhancing the drug delivery of chemotherapeutic agents. One of the successful developments includes nanoparticles which are particles that range between 1 and 100 nm that may be utilized as drug delivery systems for the treatment and diagnosis of cancer as they overcome the issues associated with chemotherapy; they are highly efficacious and cause fewer side effects on healthy tissues. Other nanotechnological developments include organic nanocarriers such as liposomes which are a type of nanoparticle, although they can deviate from the standard size range of nanoparticles as they may be several hundred nanometres in size. Liposomes are small artificial spherical vesicles ranging between 30 nm and several micrometres and contain one or more concentric lipid bilayers encapsulating an aqueous core that can entrap both hydrophilic and hydrophobic drugs. Liposomes are biocompatible and low in toxicity and can be utilized to encapsulate and facilitate the intracellular delivery of chemotherapeutic agents as they are biodegradable and have reduced systemic toxicity compared with free drugs. Liposomes may be modified with PEG chains to prolong blood circulation and enable passive targeting. Grafting of targeting ligands on liposomes enables active targeting of anticancer drugs to tumour sites. In this review, we shall explore the properties of liposomes as drug delivery systems for the treatment and diagnosis of cancer. Moreover, we shall discuss the various synthesis and functionalization techniques associated with liposomes including their drug delivery, current clinical applications, and toxicology.
  17. Jamaluddin R
    Case Rep Psychiatry, 2021;2021:7463272.
    PMID: 34513106 DOI: 10.1155/2021/7463272
    Erotomania is a rare subtype of delusional disorder, whereby the affected person believes that another individual, usually someone with higher socio-economic status, is in love with them despite having little or no contact. To the best of our knowledge, this is the first published case of same gender erotomania, involving a 28-year-old single lady and a 42-year-old divorcee towards a female psychiatrist. We aimed to share the challenges experienced by the managing psychiatrist as she inopportunely became the theme of her patients' delusion. We also reviewed and discussed recent literature on erotomania to create awareness among psychiatrists towards this rare psychiatric condition.
  18. Love DC, Allison EH, Asche F, Belton B, Cottrell RS, Froehlich HE, et al.
    Glob Food Sec, 2021 Mar;28:100494.
    PMID: 34513582 DOI: 10.1016/j.gfs.2021.100494
    The COVID-19 pandemic and subsequent lockdowns are creating health and economic crises that threaten food and nutrition security. The seafood sector provides important sources of nutrition and employment, especially in low-income countries, and is highly globalized allowing shocks to propagate. We studied COVID-19-related disruptions, impacts, and responses to the seafood sector from January through May 2020, using a food system resilience 'action cycle' framework as a guide. We find that some supply chains, market segments, companies, small-scale actors and civil society have shown initial signs of greater resilience than others. COVID-19 has also highlighted the vulnerability of certain groups working in- or dependent on the seafood sector. We discuss early coping and adaptive responses combined with lessons from past shocks that could be considered when building resilience in the sector. We end with strategic research needs to support learning from COVID-19 impacts and responses.
  19. Chaudhry GE, Akim A, Naveed Zafar M, Safdar N, Sung YY, Muhammad TST
    Adv Pharm Bull, 2021 May;11(3):426-438.
    PMID: 34513617 DOI: 10.34172/apb.2021.050
    Cancer is a complex mechanism involving a series of cellular events. The glycoproteins such as hyaluronan (HA) are a significant element of extracellular matrix (ECM), involve in the onset of cancer developmental process. The pivotal roles of HA in cancer progression depend on dysregulated expression in various cancer. HA, also gain attention due to consideration as a primary ligand of CD44 receptor. The CD44, complex transmembrane receptor protein, due to alternative splicing in the transcription process, various CD44 isoforms predominantly exist. The overexpression of distinct CD44 isoforms (CD44v) standard (CD44s) depends on the tumour type and stage. The receptor proteins, CD44 engage in a variety of biological processes, including cell growth, apoptosis, migration, and angiogenesis. HA-CD44 interaction trigger survival pathways that result in cell proliferation, invasion ultimately complex metastasis. The interaction and binding of ligand-receptor HA-CD44 regulate the downstream cytoskeleton pathways involve in cell survival or cell death. Thus, targeting HA, CD44 (variant and standard) isoform, and HA-CD44 binding consider as an attractive and useful approach towards cancer therapeutics. The use of various inhibitors of HA, hyaluronidases (HYALs), and utilizing targeted Nano-delivery of anticancer agents and antibodies against CD44, peptides gives promising results in vitro and in vivo. However, they are in clinical trials with favourable and unfavourable outcomes, which reflects the need for various modifications in targeting agents and a better understanding of potential targets in tumour progression pathways.
  20. Liew AKC, Yeh YC, Abdullah D, Tu YK
    Restor Dent Endod, 2021 Aug;46(3):e41.
    PMID: 34513647 DOI: 10.5395/rde.2021.46.e41
    Objectives: This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth.

    Materials and Methods: Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application.

    Results: The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14-3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates.

    Conclusions: Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

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