Predictors of asymptomatic cardiac events and prognostic value of cardiac biomarkers in chronic kidney disease patients

Patients with chronic kidney disease [CKD] are at increased risk of cardiovascular events; cardiovascular disease is a leading cause of death in patients with chronic kidney disease; Circulating biomarkers play a major role in the early detection of cardiovascular disease in those patients. To clarify the prevalence of asymptomatic different cardiac events in CKD and to explore the degree of elevation of N- terminal-pro-B-type Natriuretic Peptide [NT-pro-BNP] in asymptomatic cardiac patients with varying degree of CKD and the relationship between the elevation of this biomarker and the occurrence of these cardiac complications. This case-control study included 40 CKD patients and 40 controls; patients were recruited from nephrology unit of internal medicine department; Assiut university hospital; known to have chronic kidney disease in different grades [grade I- grade V]. Resting transthoracic echocardiography [TTE] and plasma NT-pro-BNP concentrations were measured in patients who were asymptomatic for clinical evidence of any cardiac events, [n=40; mean age 47.63 +/- 17.93 years; 52.5%were males] as well as healthy volunteers n=40; mean age 42.00 +/- 13.25; 62% were males]. In addition, the correlation between plasma NT-pro-BNP concentration and parameters of echocardiography was examined. Increased prevalence of left ventricular hypertrophy [LVH] [70%]; left ventricular diastolic dysfunction [77.5%], left ventricular systolic dysfunction [17.5%] and coronary artery disease [27.5%] in CKD patients as well as serum NT-pro-BNP levels in the patients were significantly higher [6703.75 +/- 2947.68 pg/ml] than those in healthy volunteers [124.83 +/- 140.40 pg/ml] [p=0.000]. NT-pro-BNP level was higher also in patients who had hypertension [p=0.002]; anemia [p-0.004]; hypoalbuminamia [p=0.000];left ventricular hypertrophy [LVH] [7873. 57 +/- 2719. 31 pg/ml] [p = 0.000], diastolic dysfunction [7524. 52 +/- 2824.74 pg/ml] [p= 0.000]; systolic dysfunction [10371.43 +/- 2771.71] [p=0.000] and patients who had segmental wall motion abnormality [SWMA] [8709.0.9 +/- 3512.3.9] [p=0.000] and correlate Positively with C reactive protein [CRP] level [r-0.751 p=0.000]; left ventricular mass [LVM] [r=0.772 p=0.000] and left ventricular mass index [LVMI] [r=0.715 p=0.000] and negatively with ejection fraction [EF] by echocardiography [r=-0.483 p=0.000]. NT-pro-BNP level elevation in asymptomatic patients with CKD reflects underlying cardiac dysfunction, ischemic heart disease and hypertrophy independent of renal function

Microbiological assessment of sludge treatment at the 6[th] October wastewater treatment plant, Giza, Egypt

This study was carried out to assess the sludge treatment processes applied at the 6[th] October wastewater treatment plant [WWTP], Giza, Egypt. The applied processes included aerobic digestion followed by gravity thickening, filter-pressing and drying beds [in emergency cases]. Bacteriological, virological and parasitological evaluation was carried out. Results showed that aerobic digestion removed two log units of total and faecal coliforms and one log unit of Escherichia coli [E. coli] and feacal streptococci. The removal percentages of coliphage and enteroviruses after aerobic digestion were 97.0 and 58.3%, resectively. The salmonellae disappeared from sludge after aerobic digestion. Qualitative and quantitative decrease in helminth ova [Ascaris, Trichuris, Trichostrongylus, Taenia and Hymenoleois] was observed after aerobic digestion and thickening stages. An average decreae of 4 log units for total and faecal coliforms, 3 log units for each of faecal streptococci and coliphage and 2 log units for E. coli through sludge treatment process was observed. Enteroviruses, helminth ova and enteric protozoa were completely eliminated from sludge after 6 months in drying beds. The loads of faecal coliform, E coli, faecal streptococci and coliphage in the dried sludge were 6.5 x 10[2], 1.6 x10[2], 4.5 x 10[2], 4.56 x 10[2] cfu and 8.5 x 10[1] pfu/g, respectively. Microbiological quality of the final treated sludge complied with the regulations of Untied States Environmental Protection Agency