Hasil untuk "Gynecology and obstetrics"

Ersianti YL, Susanah S, Winarno GNA et al.

Yuninda Loviana Ersianti,1,* Susi Susanah,2,* Gatot Nyarumenteng Adhipurnawan Winarno,3,* Hadi Susiarno,3 Herry Herman,4 Sofie Rifayani Krisnadi3 1Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 2Department of Child Health, Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 3Department of Obstetrics and Gynecology, Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 4Department of Orthopaedic and Traumatology, Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia*These authors contributed equally to this workCorrespondence: Yuninda Loviana Ersianti, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, Email yuninda23001@mail.unpad.ac.idAbstract: Anemia affects more than 1.9 billion people globally, with pregnant women being among the most vulnerable. Pallor, a visible sign of reduced hemoglobin levels, is frequently used as a low-cost screening tool, particularly in resource-limited settings. This study aimed to assess the validity of clinical pallor signs for detecting anemia among pregnant women. A scoping review was conducted utilizing multiple databases, including PubMed, ScienceDirect, and Google Scholar. The review followed the PRISMA-ScR reporting guidelines and was systematically structured according to the PEO framework. Out of 812 articles identified, seven selected studies published between 2010 and 2025 were included in the review. The selected studies involved 1,847 participants from countries including India, Indonesia, Pakistan, Ethiopia, and Sri Lanka. This review found a significant association between physical pallor examination of the conjunctiva, buccal mucosa or tongue, and palms with anemia in both pregnant women and women of reproductive age (p< 0.001). This review reported that conjunctival, nailbed, tongue/buccal mucosa, palm pallor, and pallor at any site demonstrated a broad range sensitivity and specificity values ranging from above 0% to 100%. However, the combined pallor examination of the conjunctiva, buccal mucosa or tongue, nail beds, and palms tends to demonstrate high sensitivity and specificity (≥ 70%) in detecting anemia. Therefore, combined pallor assessment is recommended for future research. Nonetheless, further studies are needed to standardize examiner skills, lighting conditions, skin pigmentation considerations, pallor grading systems, and inter-rater reliability analysis. Pallor examination remains a useful initial screening method for detecting moderate to severe anemia in pregnant women in resource-limited settings.Keywords: anemia, pallor examination, diagnostic, validity, pregnant women

Fábio Köpp, César H. Lenzi, César V. Flores et al.

In this work, we explore how astronomical observations (specifically measurements of masses, radii, and tidal deformabilities) can constrain the presence of quark matter inside neutron stars, namely the phase transition from nuclear matter to deconfined quark matter. Our approach employs Bayesian analysis to study this phenomenon. Hadronic matter is modeled using the relativistic mean-field (RMF) approximation, for which we have selected two parameter sets: \(NL3^{*}ωρ\), representing hadronic matter with nucleons only, and $EL3ωρ$ with nucleons only and $EL3ωρY$, which includes hyperons. On the other hand deconfined quark matter is modeled using the vector-MIT bag model. For our purpose, the phase transition is implemented using the Maxwell construction. Bayesian inference is performed by tuning three parameters: the bag constant (i.e. $B^{1/4}$), the vector coupling constant \(\left(G_{v}\right)\), and the Dirac sea contribution ($b_{4}$). We found that a phase transition could exist at densities below \(2.0\,n_{0}\) for both the $EL3ωρ- EL3ωρY $ and $NL3^{*}ωρ$ parametrizations. As a consequence, our results also indicate that a hybrid neutron star could have a large quark core that comprises more than \(80\%\) of its size.

Pakwan Chanprakhon, Michael F. Reid, and Jon-Paul R. Wells

We report on the synthesis and spectroscopic characterization of Sm$^{3+}$-doped K$_2$YF$_5$ microparticles. The particles were synthesized via the hydrothermal technique, yielding a particle size of approximately 20 $μ$m in length. Scanning electron microscopy (SEM) and X-ray diffraction (XRD) analyses confirmed their orthorhombic crystal structure. A combination of absorption and laser excited fluorescence performed on samples cooled to 10~K, allow for the determination of {56} experimental crystal-field levels. A parametrised crystal-field analysis for Sm$^{3+}$ in the C$_{\rm s}$ point group symmetry centres of K$_2$YF$_5$ yields good approximation to the data.

Markus Huemer, Clemens Stilianu, Nick Scholand et al.

Purpose: This work proposes a method for the simultaneous estimation of the exchange-dependent relaxation rate Rex and the longitudinal relaxation time T1 from a single acquisition. Methods: A novel acquisition scheme was developed that combines CEST saturation with an inversion pulse and a Look-Locker readout to capture the magnetization evolution starting from the inverse transient Z-spectrum. The corresponding signal model, derived from the Bloch-McConnell equations, describes both the transient Z-spectrum and the Look-Locker dynamics. A model-based reconstruction approach is employed to jointly estimate Rex and T1. The proposed method was validated using a numerical phantom and benchmarked against conventional CEST and Look-Locker T1 mapping in phantom and in vivo on a clinical 3T scanner. Results: The joint estimation approach demonstrated strong agreement with ground truth and conventional methods across a wide range of T1 and CEST parameters. The acquisition time was reduced by 20-30% compared to standard CEST protocols, while providing higher signal-to-noise ratio (SNR) in parameter maps. Conclusion: The proposed technique enables robust and efficient simultaneous quantification of CEST Rex and T1 in a single acquisition. It improves parameter map quality and reduces scan time, making it suitable for both phantom and in vivo imaging across a wide range of physiological conditions.

Diane Kim, Minh Nguyen Nhat To, Sherif Abdalla et al.

Coronary angiography remains the gold standard for diagnosing Acute Coronary Syndrome (ACS). However, its resource-intensive and invasive nature can expose patients to procedural risks and diagnostic delays, leading to postponed treatment initiation. In this work, we introduce TREAT-Net, a multimodal deep learning framework for ACS treatment prediction that leverages non-invasive modalities, including echocardiography videos and structured clinical records. TREAT-Net integrates tabular-guided cross-attention to enhance video interpretation, along with a late fusion mechanism to align predictions across modalities. Trained on a dataset of over 9000 ACS cases, the model outperforms unimodal and non-fused baselines, achieving a balanced accuracy of 67.6% and an AUROC of 71.1%. Cross-modality agreement analysis demonstrates 88.6% accuracy for intervention prediction. These findings highlight the potential of TREAT-Net as a non-invasive tool for timely and accurate patient triage, particularly in underserved populations with limited access to coronary angiography.

Abdullah Dahir H. Aweis, Abdullah Dahir H. Aweis, Abdullah Dahir H. Aweis et al.

BackgroundAntibiotic resistance poses a significant threat to healthcare services and Methicillin-Resistant Staphylococcus aureus (MRSA) is common among hospital workers. Currently, there is no research on MRSA and its prevalence in Somalia. This study sought to determine the prevalence of nasal Staphylococcus aureus carriage and the susceptibility pattern of healthcare workers’ MRSA isolates.MethodsThis cross-sectional, descriptive study involved nasal swab collection from healthcare workers at Banadir Teaching Hospital. Cefoxitin discs were used to identify methicillin-resistant strains, and their antimicrobial susceptibility was evaluated using the Kirby–Bauer (disc diffusion) method. Based on specialty, e.g., pediatrics, obstetrics, gynecology, laboratory, and intensive care unit (ICU), participants were recruited from different wards. Nasal swabs from 215 participants were inoculated on mannitol salt agar, and yellow colonies were aseptically transferred into blood agar, inoculated on DNase agar, and subjected to catalase, coagulase, and gram staining tests. Next, bacterial suspensions were prepared and aseptically inoculated on Mueller–Hinton agar plates, followed by cefoxitin antibiotic (30 μg) disc testing. Staphylococcus aureus was categorized/interpreted based on the zone diameter (nearest whole millimeter) of the cefoxitin discs. Samples with diameters of ≤21 mm were considered to be MRSA) while those with diameters of ≥22 mm were regarded as methicillin-sensitive Staphylococcus aureus.ResultsSome locations had higher MRSA isolation rates. Ward 16 (postnatal care and neonatal ICU) had the highest MRSA prevalence (n=9, 26.5%), followed by pediatric isolation (n=6, 33.3%), emergency (n=5, 17.9%), and pediatric malnutrition (n=4, 44.4%) wards. A total of 27 (23.70%) MRSA cases were isolated and were susceptible to vancomycin and linezolid.ConclusionSome hospital locations had higher MRSA prevalence, with the postnatal care, neonatal ICU, and isolation wards having the highest isolation rates.

Smit B. Solanki

Chih-Ping Chen

Frank Adusei-Mensah, Olubunmi Olubamwo, Sunday Olaleye et al.

Being a new vaccine platform, continuous monitoring of the mRNA COVID-19 vaccines in pregnant women is of critical importance. This systematic review and meta-analysis evaluate the maternal and neonatal outcomes associated with mRNA COVID-19 vaccination during pregnancy. We conducted a systematic search of PubMed, Embase, Cochrane Library, and clinical trial registries for studies published between December 2020 and July 2024. Studies were included if they assessed obstetric and neonatal outcomes following mRNA COVID-19 vaccination in pregnant women. Data were extracted and analyzed using a random-effects model to calculate pooled odds ratios (ORs) and 95 % confidence intervals (CIs). Fifteen studies met the inclusion criteria, encompassing 42,944 vaccinated and 183,733 unvaccinated pregnant women. mRNA vaccination was associated with a significant reduction in preterm delivery (OR 0.743, 95 % CI 0.607–0.911), fetal distress (OR 0.699, 95 % CI 0.546–0.893), neonatal congenital abnormalities (OR 0.712, 95 % CI 0.570–0.889), and NICU admissions (OR 0.718, 95 % CI 0.617–0.836). However, a slight increase in gestational diabetes risk was observed (OR 1.107, 95 % CI 1.054–1.162). mRNA COVID-19 vaccines are safe during pregnancy and associated with reduced risks of adverse obstetric and neonatal outcomes. An observed marginal increase in gestational diabetes risk underscores the need for continuous monitoring. These findings support the inclusion of pregnant women in vaccination campaigns and inform public health policies and clinical practices to improve maternal and neonatal health outcomes.

Shaomin Chen, Yang Wang, Zhaoyu Wang et al.

Abstract This study investigated the relationship between dyslipidemia prior to conception and the risk of preeclampsia (PE) in women pregnant by in vitro fertilization and embryo transfer (IVF-ET). The retrospective cohort study consisted of 2994 women who conceived by IVF-ET and delivered live neonates. The study population was divided into two components: a training set for the prediction model development (2288 women) and a test set for validation (706 women). Multivariable logistic regression was used for the development and validation of predictive model for the risk of PE. Among the 2288 women in the training set, 266 women (11.6%) developed PE. Multiple logistic regression analysis identified independent predictors for PE: triglyceride (TG) [adjusted odds ratio (aOR) 1.284; 95% confidence interval (CI) 1.113–1.489, P < 0.001]; pre-pregnancy BMI; pre- chronic hypertension; twin pregnancy; embryo transfer protocol. These independent predictors for PE were used to form a risk prediction model, and the area under the receiver-operator characteristic (ROC) curve (AUC) in the training and the test set was 0.77 (95% CI 0.73–0.80)and 0.71 AUC (95% CI 0.65–0.77), respectively. In conclusion, higher TG levels before pregnancy were independently associated with the risk for PE in women pregnant by IVF-ET.

Ping Wang, Chong Chen, Hao Liao et al.

Test of {macroscopic realism} (MR) is key to understanding the foundation of quantum mechanics. Due to the existence of the {non-invasive measurability} loophole and other interpretation loopholes, however, such test remains an open question. Here we propose a general inequality based on high-order correlations of measurements for a loophole-free test of MR at the weak signal limit. Importantly, the inequality is established using the statistics of \textit{raw data} recorded by classical devices, without requiring a specific model for the measurement process, so its violation would falsify MR without the interpretation loophole. The non-invasive measurability loophole is also closed, since the weak signal limit can be verified solely by measurement data (using the relative scaling behaviors of different orders of correlations). We demonstrate that the inequality can be broken by a quantum spin model. The inequality proposed here provides an unambiguous test of the MR principle and is also useful to characterizing {quantum coherence}.

Yan-Lei Zhang, Ming Li, Xin-Biao Xu et al.

Quantum frequency converters that enable the interface between the itinerant photons and qubits are indispensable for realizing long-distance quantum network. However, the cascaded connection between converters and qubits usually brings additional insertion loss and intermediate noises. Here, we propose a cooperative quantum interface (CQI) that integrates the converter and qubit coupling into a single device for efficient long-distance entanglement generation. Compared to traditional cascaded systems, our scheme offers several advantages, including compactness, reduced insertion loss, and suppression of noise from intermediate modes. We prove the excellent performance over the separated devices by about two orders of magnitude for the entangled infidelity of two remote nodes. Moreover, we discuss an extended scheme for multiple remote nodes, revealing an exponential advantage in performance as the number of nodes increases. The cooperative effect is universal that can be further applied to multifunctional integrated quantum devices. This work opens up novel prospects for quantum networks, distributed quantum computing, and sensing.

Raymond Surya, Ekarini Aryasatiani

Introduction: Imperforate hymen (IH), an uncommon congenital anomaly, is a failure to completely canalize the hymen. This report aims to describe a sleeve hymen in a newly married woman and the surgical approach to the patient. Case Illustration: A 24-year-old newly married woman came to the gynecology polyclinic complaining of difficulty in sexual intercourse in the last 6 months. She felt painful and hard penile penetration since the first time of sexual intercourse. Inspection of external genitalia showed there was a hymen covering all vaginal introitus without an erythematous surface. The diagnosis indicated that the patient had a sleeve hymen. The patient underwent a U-shaped incision far away from the urethra as a hymenectomy. Discussion: Most of the IH patients are asymptomatic until menarche. Excess of estrogen status can cause the thickening of the hymen, called the sleeve hymen or “redundant” hymen. Meanwhile, epithelial cells’ failure in the center of the hymen to degenerate or excess cell proliferation may cause a microperforate hymen. There are several choices of treatment for IH, including hymenectomy (cruciate incision or hymen excision), hymen-preserving surgeries (simple vertical incision and annular hymenotomy), carbon dioxide laser, or insertion of a Foley catheter. Conclusion: Good anamnesis and physical examination can lead to the correct diagnosis of sleeve hymen. Hymenectomy is one of the alternative treatments for married women who have less concern about hymen-preserving surgery.

Michail Panagiotopoulos, Maria Tsiriva, Lito Vogiatzi-Vokotopoulou et al.

Hypermobile Ehlers-Danlos syndrome (hEDS) is the most common type of EDS, characterized by joint hypermobility, frequent dislocations, and chronic pain. Genetic markers are not typically used in diagnosis.A 17-year-old clinically diagnosed with hEDS presented with recurrent lower abdominal pain, later attributed to intermittent partial adnexal torsion. Whole-genome sequencing revealed a missense mutation c.1691G > A (p.Arg564His) in the COL1A1 gene. She had undergone two exploratory laparotomies at ages 8 and 10 due to acute pain, resulting in a left adnexectomy and right detorsion with hydrosalpinx drainage. It was suspected that the recurrent adnexal torsion was linked to hEDS-related tissue elasticity, and so a laparoscopic right oophoropexy by shortening the utero-ovarian ligament was performed. At one-year follow-up, she was asymptomatic.This case highlights the potential connection between hEDS and adnexal torsion, which may contribute to chronic abdominal pain, often misattributed to other conditions, such as irritable bowel syndrome.

Lingbin Qi, Yumei Li, Lina Zhang et al.

IntroductionOvulation dysfunction is now a widespread cause of infertility around the world. Although the impact of immune cells in human reproduction has been widely investigated, systematic understanding of the changes of the immune atlas under female ovulation remain less understood.MethodsHere, we generated single cell transcriptomic profiles of 80,689 PBMCs in three representative statuses of ovulation dysfunction, i.e., polycystic ovary syndrome (PCOS), primary ovarian insufficiency (POI) and menopause (MENO), and identified totally 7 major cell types and 25 subsets of cells.ResultsOur study revealed distinct cluster distributions of immune cells among individuals of ovulation disorders and health. In patients with ovulation dysfunction, we observed a significant reduction in populations of naïve CD8 T cells and effector memory CD4 T cells, whereas circulating NK cells and regulatory NK cells increased.DiscussionOur results highlight the significant contribution of cDC-mediated signaling pathways to the overall inflammatory response within ovulation disorders. Furthermore, our data demonstrated a significant upregulation of oxidative stress in patients with ovulation disorder. Overall, our study gave a deeper insight into the mechanism of PCOS, POI, and menopause, which may contribute to the better diagnosis and treatments of these ovulatory disorder.

Ulla-Britt Wennerholm, Ulla-Britt Wennerholm, Lina Bergman et al.

BackgroundPreterm birth is the leading cause of childhood mortality and morbidity. We aimed to provide a comprehensive systematic review on randomized controlled trials (RCTs) on progesterone, cerclage, pessary, and acetylsalicylic acid (ASA) to prevent preterm birth in asymptomatic women with singleton pregnancies defined as risk of preterm birth and multifetal pregnancies.MethodsSix databases (including PubMed, Embase, Medline, the Cochrane Library) were searched up to February 2022. RCTs published in English or Scandinavian languages were included through a consensus process. Abstracts and duplicates were excluded. The trials were critically appraised by pairs of reviewers. The Cochrane risk-of-bias tool was used for risk of bias assessment. Predefined outcomes including preterm birth, perinatal/neonatal/maternal mortality and morbidity, were pooled in meta-analyses using RevMan 5.4, stratified for high and low risk of bias trials. The certainty of evidence was assessed using the GRADE approach. The systematic review followed the PRISMA guideline.ResultsThe search identified 2,309 articles, of which 87 were included in the assessment: 71 original RCTs and 16 secondary publications with 23,886 women and 32,893 offspring. Conclusions were based solely on trials with low risk of bias (n = 50). Singleton pregnancies: Progesterone compared with placebo, reduced the risk of preterm birth &lt;37 weeks 26.7% vs. 30.3% [risk ratio (RR) 0.82 (95% confidence interval [CI] 0.71–0.96)] (high certainty of evidence, 13 trials) thereby reducing neonatal mortality and respiratory distress syndrome. Cerclage probably reduced the risk of preterm birth &lt;37 gestational weeks: 29.0% vs. 37.6% (RR 0.78 [95% CI 0.69 to 0.88]) (moderate certainty of evidence, four open trials). In addition, perinatal mortality may be reduced by cerclage. Pessary did not demonstrate any overall effect. ASA did not affect any outcome, but evidence was based on one underpowered study. Multifetal pregnancies: The effect of progesterone, cerclage, or pessary was minimal, if any. No study supported improved long-term outcome of the children.ConclusionProgesterone and probably also cerclage have a protective effect against preterm birth in asymptomatic women with a singleton pregnancy at risk of preterm birth. Further trials of ASA are needed. Prevention of preterm birth requires screening programs to identify women at risk of preterm birth.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021234946].

Jonathan C Balloch, Julia Kim, and Jessica L Inman et al.

The exploration--exploitation trade-off in reinforcement learning (RL) is a well-known and much-studied problem that balances greedy action selection with novel experience, and the study of exploration methods is usually only considered in the context of learning the optimal policy for a single learning task. However, in the context of online task transfer, where there is a change to the task during online operation, we hypothesize that exploration strategies that anticipate the need to adapt to future tasks can have a pronounced impact on the efficiency of transfer. As such, we re-examine the exploration--exploitation trade-off in the context of transfer learning. In this work, we review reinforcement learning exploration methods, define a taxonomy with which to organize them, analyze these methods' differences in the context of task transfer, and suggest avenues for future investigation.

Kyriakos Stylianopoulos, George Alexandropoulos, Chongwen Huang et al.

The emergent technology of Reconfigurable Intelligent Surfaces (RISs) has the potential to transform wireless environments into controllable systems, through programmable propagation of information-bearing signals. Techniques stemming from the field of Deep Reinforcement Learning (DRL) have recently gained popularity in maximizing the sum-rate performance in multi-user communication systems empowered by RISs. Such approaches are commonly based on Markov Decision Processes (MDPs). In this paper, we instead investigate the sum-rate design problem under the scope of the Multi-Armed Bandits (MAB) setting, which is a relaxation of the MDP framework. Nevertheless, in many cases, the MAB formulation is more appropriate to the channel and system models under the assumptions typically made in the RIS literature. To this end, we propose a simpler DRL approach for orchestrating multiple metasurfaces in RIS-empowered multi-user Multiple-Input Single-Output (MISO) systems, which we numerically show to perform equally well with a state-of-the-art MDP-based approach, while being less demanding computationally.

Emily Eisner, Shôn Lewis, Charlotte Stockton-Powdrell et al.

Abstract Background Depression during the postnatal year is prevalent in mothers (17%) and fathers (9%), and suicide is the leading cause of maternal death in this period. Lifelong costs and consequences of untreated postnatal depression (PND) are high due to impacts on infants as well as parents. We aimed to improve access to PND treatment using digital screening. We developed a smartphone app (ClinTouch DAWN-P) that allows parents to monitor their mood daily with the Edinburgh Postnatal Depression Scale (EPDS), uploading responses in real-time to a secure server. We evaluated the app’s feasibility, acceptability, validity and safety in a proof-of-concept study. Methods Pregnant women (≥ 36 weeks gestation) and partners were recruited from antenatal services and invited to complete daily EPDS assessments via the ClinTouch DAWN-P app until 6 weeks postpartum. Participants completed standard paper-based EPDS at two time points for validity comparisons. We examined app acceptability and usability at 6 weeks postpartum with qualitative interviews, examined using framework analysis, and the abridged Mobile App Rating Scale (convergent mixed methods design). Results Most (96%) eligible pregnant women approached were keen to try the app. Participating mothers (n = 15) and partners/fathers (n = 8) found the app easy to use, and 91% continued to use it for the full study period. Overall, 67% of daily app-based assessments were completed, with a history of depression predicting lower app usage. Participants suggested modifications to the app and its deployment to improve usability (e.g., extending the response window and including feedback and parenting advice). The validity of app-based responses was confirmed by high agreement with standard EPDS. App-based and paper-based ratings showed perfect agreement in identifying cases of likely PND. There were no serious adverse events relating to app use. Conclusions Digital PND screening appears feasible, acceptable, valid and safe. It also benefits from being remotely delivered: we enrolled all participants remotely during the first COVID-19 lockdown. Use of digital screening could address known shortcomings of conventional health visitor-delivered screening such as limited staff time, parental unwillingness to disclose difficulties to a professional, lack of partner/father screening, and language barriers. Trial registration The study was prospectively registered (Clinicaltrials.gov: NCT04279093 ).

Tip Pongsuvareeyakul, Sara Maleki, Bradley D. DeNardo et al.