Non-calcified plaque in asymptomatic patients with zero coronary artery calcium score: A systematic review and meta-analysis.

BACKGROUND: There is growing interest in understanding the coronary atherosclerotic burden in asymptomatic patients with zero coronary artery calcium score (CACS). In this population, we aimed to investigate the prevalence and severity of non-calcified coronary plaques (NCP) as detected by coronary CT angiography (CCTA), and to analyze the associated clinical predictors. METHODS: This was a systematic review with meta-analysis of studies indexed in PubMed/Medline and Web of Science from inception of the database to March 31st, 2023. Using the random-effects model, separate Forest and Galbraith plots were generated for each effect size assessed. Heterogeneity was assessed using the I2 statistics whilst Funnel plots and Egger's test were used to assess for publication bias. RESULTS: From a total of 14 studies comprising 37808 patients, we approximated the pooled summary estimates for the overall prevalence of NCP to be 10% (95%CI: 6%-13%). Similarly, the pooled prevalence of obstructive NCP was estimated at 1.1% (95%CI: 0.7%-1.5%) from a total of 10 studies involving 21531 patients. Hypertension [OR: 1.46 (95%CI:1.31-1.62)] and diabetes mellitus [OR: 1.69 (95%CI: 1.41-1.97)] were significantly associated with developing any NCP, with male gender being the strongest predictor [OR: 3.22 (95%CI: 2.17-4.27)]. CONCLUSION: There is a low burden of NCP among asymptomatic subjects with zero CACS. In a subset of this population who have clinical predictors of NCP, the addition of CCTA has a potential to provide a better insight about occult coronary atherosclerosis, however, a risk-benefit approach must be factored in prior to CCTA use given the low prevalence of NCP.

Late Pregnancy Outcomes among Women who Attended and Women who did not Attend First Trimester Antenatal Care Visits in a Suburban Regional Hospital in Cameroon.

BACKGROUND: Despite relatively high number of women who attend antenatal care (ANC) in Cameroon, there is an ever-increasing maternal mortality ratio, and pregnancy outcomes remain inadequate. A new suggested Optimal ANC Package includes attending ANC in the first trimester. This study assesses the overall ANC coverage, the percentage, and pregnancy outcomes among women who attended and did not attend ANC in the first trimester in the Buea Regional Hospital (BRH) in Cameroon. METHODS: A cross-sectional study was carried out among 200 consenting pregnant women presenting for delivery at the BRH. A bivariate analysis was used to compare the frequencies of various pregnancy outcomes within the the two categories of women who attended and who did not attend first trimester ANC. RESULTS: Ninety-six percent of the women attended at least 1 ANC visit with 20.5% of these women attending ANC in the first trimester and 60.2% attending at least 4 visits. Sociodemographic and obstetric factors were not found to be associated with attending ANC in the first trimester. Also, there was no statistically significant association between all the late pregnancy outcomes assessed and attending ANC in the first trimester. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Trends in most sub-Saharan countries seem to suggest that most women do not attend first trimester ANC. This could have negative consequences on overall perinatal outcome. More user-friendly educational programs for women of childbearing age is required in such regions to address this situation.

Foreign body in the appendix presenting as acute appendicitis: a case report.

BACKGROUND: Foreign bodies are a rare cause of appendicitis. In most instances, ingested foreign bodies pass through the alimentary tract asymptomatically. However, those that enter the lumen of the vermiform appendix may not be able to re-enter the colon and may initiate an inflammatory process. We report a case of acute appendicitis induced by an unusual foreign body. CASE PRESENTATION: A 26-year-old Sub-Saharan woman presented with right iliac fossa pain and tenderness. She underwent an open appendectomy which revealed a condom fragment within the appendiceal lumen. A detailed retrospective history confirmed accidental ingestion of the condom 2 weeks prior to onset of symptoms. CONCLUSIONS: Although a rare finding, a variety of foreign bodies can be lodged in the appendix and may instigate an inflammatory process. There is a need to increase awareness of the potential dangers of ingested foreign bodies.