Machine learning approach to predict postpartum haemorrhage: a systematic review protocol.

INTRODUCTION: Postpartum haemorrhage (PPH) is the most serious clinical problem of childbirth that contributes significantly to maternal mortality worldwide. This systematic review aims to identify predictors of PPH based on a machine learning (ML) approach. METHODS AND ANALYSIS: This review adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. The review is scheduled to begin on 10 January 2023 and end on 20 March 2023. The main objective is to identify and summarise the predictive factors associated with PPH and propose an ML-based predictive algorithm. From inception to December 2022, a systematic search of the following electronic databases of peer-reviewed journal articles and online search records will be conducted: Cochrane Central Register, PubMed, EMBASE (via Ovid), Scopus, WOS, IEEE Xplore and the Google Scholar search engine. All studies that meet the following criteria will be considered: (1) they include the general population with a clear definition of the diagnosis of PPH; (2) they include ML models for predicting PPH with a clear description of the ML models; and (3) they demonstrate the performance of the ML models with metrics, including area under the receiver operating characteristic curve, accuracy, precision, sensitivity and specificity. Non-English language papers will be excluded. Data extraction will be performed independently by two investigators. The PROBAST, which includes a total of 20 signallings, will be used as a tool to assess the risk of bias and applicability of each included study. ETHICS AND DISSEMINATION: Ethical approval is not required, as our review will include published and publicly accessible data. Findings from this review will be disseminated via publication in a peer-review journal. PROSPERO REGISTRATION NUMBER: The protocol for this review was submitted at PROSPERO with ID number CRD42022354896.

Maternal and Neonatal Outcomes of Iron Deficiency Anemia: A Retrospective Cohort Study.

INTRODUCTION: Understanding the outcomes of anemia in pregnancy is critical. Since no study has been conducted regarding the maternal and neonatal outcomes of iron-deficiency anemia in Hormozgan province of Iran, this study aims to assess the maternal and neonatal outcomes of iron-deficiency anemia in women who gave birth in Hormozgan province from January 2020 to January 2022. METHODS:  We retrospectively assessed all singleton pregnant women who gave birth at a tertiary hospital in Bandar Abbas, Hormozgan province, Iran, for two years. We divided all women into iron-deficiency anemic and non-iron-deficiency anemic women. Iron-deficiency anemia was defined as hemoglobin less than 10.5 mg/dl at the time of admission without any other hemoglobinopathy, such as sickle cell anemia or thalassemia. Using electronic patient records, data were extracted from the Iranian Maternal and Neonatal Network (IMaN Net), a valid national system. Since the information of birth under 24 weeks of gestation is not recorded in this system, we excluded all deliveries under 24 weeks of gestation. The outcome measures of the study were demographic factors (age, education, residency place, access to prenatal care, smoking), obstetrical factors (parity, labor induction, fetal presentation, mode of delivery), and maternal and neonatal outcomes (the incidence of preeclampsia, gestational diabetes, placenta abruption, postpartum hemorrhage, maternal need for blood transfusion, maternal need for intensive care unit, preterm birth, low birth weight, intrauterine growth retardation, birth asphyxia, stillbirth, and neonatal intensive care admission). Chi-square tests were used to compare differences between iron-deficiency anemic and non-iron-deficiency anemic women. Logistic regression models were used to assess the effect of iron-deficiency anemia on maternal and neonatal outcomes. The result was presented as odds ratio (OR) or adjusted odds ratio (aOR) after adjusting for covariates and a 95% confidence interval (CI).  Results: The incidence of iron-deficiency anemia was 2.97%. Education and residency were among the demographic factors that differed significantly between groups. Iron-deficiency anemia was more frequent in those with higher education and women who lived in rural areas. In terms of obstetrical factors, method of delivery was the only significantly different factor between groups. Iron-deficiency anemic mothers had substantially more instrumental deliveries than non-iron-deficiency anemic mothers (4.3% vs. 0.8%), while the incidence of cesarean section was lower. Based on logistic regression in terms of maternal and neonatal outcomes, iron-deficiency anemic women had a substantially higher risk of the need for maternal blood transfusion (aOR: 6.54, 95%CI: 4.72-8.15), postpartum hemorrhage (aOR: 1.54, 95%CI: 0.71-2.11), preterm birth (aOR: 0.98, 95%CI: 0.45-1.13), low birth weight (aOR: 1.04, 95%CI: 0.78-2.01), intrauterine growth retardation (aOR: 1.30, 95%CI: 0.99-2.10), and neonatal intensive care admission (aOR: 1.06, 95%CI: p.52-2.72), after adjusting for educational level, residency place, and method of delivery. CONCLUSIONS: Despite the higher incidence of postpartum hemorrhage and maternal blood transfusion, we found no increase in maternal intensive care unit admission risk. Regarding neonatal outcomes, iron-deficiency anemia was linked to preterm birth, low birth weight, intrauterine growth retardation, and neonatal intensive care admission.

Transdermal hormone replacement therapy with nanostructured medicines.

OBJECTIVES: Due to hormonal changes during the menopause, women experience a variety of perimenopause and postmenopause symptoms. This review examines the various aspects of nanostructured hormone therapy and its application in the treatments of menopausal symptoms. MATERIAL AND METHODS: Excerpta Medica DataBase, Medical Literature Analysis and Retrieval System Online, Web of Science, and Google Scholar were searched basing on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven eligible studies out of 51 related papers, which satisfied the initial search criteria, were extracted and carefully reviewed to clarify the role of nanomedicine in maintaining postmenopausal women's health. RESULTS: Review of the seven eligible studies confirmed nanostructured hormone therapy as a safe and effective method for the alleviation of menopausal symptoms. According to the existing studies, nanostructured hormone therapy decreased the mean daily frequency and severity of menopausal symptoms. CONCLUSION: The use of transdermal nanoformulations in hormone therapy can relieve climacteric symptoms and prevent other postmenopausal symptoms.

A combined exercise model for improving muscle strength, balance, walking distance, and motor agility in multiple sclerosis patients: A randomized clinical trial.

BACKGROUND: Multiple sclerosis (MS) is a neurological disease with a variety of signs and symptoms. Exercise therapy has been shown to improve physical functions in MS. However, questions about an optimal exercise therapy remain. In this regard, we suggest a combined exercise therapy including aerobic and resistance exercises for MS patients. The study is designed to observe, test and compare the effects of proposed combined exercises on strength, balance, agility, fatigue, speed, and walking distance in people with mild to moderate MS [0 < expanded disability status scale (EDSS) < 5]. METHODS: A total of 40 people with relapse-remitting MS (16 male, 0 < EDSS < 5) were randomized into one of the four groups (3 intervention and one control). The intervention consisted of various combinations of aerobic and resistance exercises with different repetition rates. Pre- and post-intervention scores of fatigue severity scale (FSS), timed up and go (TUG) test, 6-minute walk test (6MWT), 10- and 20-MWT, Berg balance scale (BBS), and one repetition maximum (1RM) test were recorded and analyzed. RESULTS: For most tests, post-intervention values of the group 1, with 3-aerobic and 1-resistance exercises, were significantly higher compared to control group (P < 0.050). However, no significant progression was observed in the other two intervention groups. CONCLUSION: A combination of three aerobic exercises with one resistance exercise may result in improved balance, locomotion, and endurance in MS patients.