Effects of a Combined Geothermal and Solar Heating System as a Renewable Energy Source in a Pig House and Estimation of Energy Consumption Using Artificial Intelligence-Based Prediction Model.

This experiment evaluated the performance of a combined geothermal heat pump and solar system (GHPS). A GHPS heating system was installed at a pig house and a comparative study was carried out between the environmentally friendly renewable energy source (GHPS) and the traditional heating method using fossil fuels. The impact of both heating systems on production performance, housing environment, noxious gas emission, and energy efficiency were evaluated along with the GHPS system performance parameters such as the coefficient of performance (COP), inlet and outlet water temperature and efficiency of solar collector. The average temperature inside the pig house was significantly higher (p < 0.05) in the GHPS heating system. Similarly, the outflow temperature was increased significantly (p < 0.05) than the inflow temperature. The results of COP and efficiency of the solar system also indicated that the GHPS is an efficient heating system. The electricity consumption and carbon dioxide gas concentration were also reduced (p < 0.05) in the GHPS system. This study also predicts electricity consumption using an artificial intelligence (AI)-based model. The results showed that the proposed model justifies all the acceptance criteria in terms of the correlation coefficient, root mean square value and mean absolute error. The results of our experiment show that the GHPS system can be installed at a pig house for sustainable swine production as a renewable energy source.

Potential Role of Protocatechuic Acid as Natural Feed Additives in Farm Animal Production.

Restriction on using antibiotics in animal feed that generates demand for antibiotics alternatives in animal breeding. Providing safe food to humans free from the residual effects of antibiotics is a great challenge to animal producers and food-producing industry owners. Medicinal plants and their extracts as feed supplements have been used to promote the growth and health of farm animals for centuries. Protocatechuic acid (PCA) is a phenolic compound that originated from natural plants. For years, the health-promoting role of PCA has been becoming an attraction of research in nutrition and pharmacy. Thus, it can be used as an active natural feed additive while synthetic antibiotics are illegal to use in animal breeding. However, the practical application of PCA in view of dosages in animal nutrition, together with its mode of action on animal health, is not well known. In this regard, this review study has explored the mode of action of PCA and the feasibility of using those compounds in animal nutrition. This review study concludes that phenolic-rich protocatechuic acid as a natural feed additive may be useful in enhancing antioxidant status, immune function, antimicrobial, intestinal health and growth performance of farm animals.

Carcass Characteristics, Proximate Composition, Fatty Acid Profile, and Oxidative Stability of Pectoralis major and Flexor cruris medialis Muscle of Broiler Chicken Subjected to with or without Level of Electrical Stunning, Slaughter, and Subsequent Bleeding.

With an emphasis on the global meat market and considering the ritual requirements and quality aspects, four types of slaughtering treatments were compared: (1) NSHS (without electrical stunning, halal neck cut, and subsequent bleeding for 180 s), (2) LSHS (electrically stunned at 250 mA for five seconds, halal neck cut, and subsequent bleeding for 180 s), (3) MSHS (electrically stunned at 500 mA for 10 s, halal neck cut, and subsequent bleeding for 180 s), and (4) HSHS (electrically stunned at 1000 mA for 20 s, halal neck cut, and subsequent bleeding for 180 s). Four hundred 36 day-old Ross 308 broiler chickens (body weights of 1.4 to 1.8 kg) were divided into four random groups of 100 birds each (ten replicated pens of ten birds). This study examined the livability, bleeding out, Pectoralis major and Flexor cruris medialis proximate composition, cholesterol content, fatty acid profile and post-mortem pH, microbial loads, and oxidative stability. The livability and bleeding out were higher in NSHS and LSHS than MSHS and HSHS (p < 0.05). The Pectoralis major and Flexor cruris medialis proximate composition, cholesterol content and fatty acid profile, post-mortem pH, and microbial loads were unaffected by the slaughter treatments (p > 0.05), but the oxidative stability of Pectoralis major differed during the eight-day post-mortem period (p < 0.05). The results suggest that for capturing the global meat market, the meat industry can consider NSHS and LSHS because the ritual requirements are fulfilled, and there is no negative impact on the nutritional aspects.

Time for a Paradigm Shift in Animal Nutrition Metabolic Pathway: Dietary Inclusion of Organic Acids on the Production Parameters, Nutrient Digestibility, and Meat Quality Traits of Swine and Broilers.

Because the application of antibiotic growth promoters (AGP) causes accelerated adverse effects on the animal diet, the scientific community has taken progressive steps to enhance sustainable animal productivity without using AGP in animal nutrition. Organic acids (OAs) are non-antibiotic feed additives and a promising feeding strategy in the swine and broiler industry. Mechanistically, OAs improve productivity through multiple and diverse pathways in: (a) reduction of pathogenic bacteria in the gastro-intestinal tract (GIT) by reducing the gut pH; (b) boosting the digestibility of nutrients by facilitating digestive enzyme secretion and increasing feed retention time in the gut system; and (c) having a positive impact and preventing meat quality deterioration without leaving any chemical residues. Recent studies have reported the effectiveness of using encapsulated OAs and synergistic mechanisms of OAs combinations in swine and broiler productivity. On the other hand, the synergistic mechanisms of OAs and the optimal combination of OAs in the animal diet are not completely understood, and further intensive scientific explorations are needed. Moreover, the ultimate production parameters are not similar owing to the type of OAs, concentration level, growth phase, health status of animals, hygienic standards, and environmental factors. Thus, those factors need to be considered before implementing OAs in feeding practices. In conclusion, the current review evaluates the basics of OAs, mode of action, novel strategies to enhance utilization, influence on growth performances, nutrient digestibility, and meat quality traits of swine and broilers and their potential concerns regarding utilization.

Egg Quality Parameters, Production Performance and Immunity of Laying Hens Supplemented with Plant Extracts.

This study examined the effects of Mentha arvensis (MA) and Geranium thunbergii (GT) extracts in drinking water on the production performance, egg quality, cholesterol content of egg yolk, proximate composition, and sensory qualities of egg and immunity parameters in laying hens. Ninety-six 28-week-old Hy-Line Brown layers were randomly divided into four dietary treatments for 16 weeks. The dietary treatments were (1) control, (2) T1 (0.01% 1 MA:1 GT), (3) T2 (0.05% 1 MA:1 GT), and (4) T3 (0.1% 1 MA:1 GT). Egg production increased significantly with increasing levels of MA and GT. The egg weight was increased in T2, and the feed intake was highest in T2 and T3 (p < 0.05). The Haugh unit and egg shape index were significantly better in T3 and the control than with other treatments (p < 0.05). The content of yolk cholesterol was significantly lower (p < 0.05) in T2 and T3. On the other hand, there were no significant differences in the egg proximate composition. A significant increase in the serum interleukin 6 (IL-6), tumor necrosis factor (TNFα) and immunoglobulins (IgG and IgA) concentration was observed in the birds fed plant extracts when compared to the control. On average, T2 and T3 showed significantly lower (p < 0.05) concentrations of NH3 gas from the feces as compared to the control. This study suggests that MA and GT supplementation could improve the laying performance, egg quality, and immunity, and decrease the egg yolk cholesterol content in a dose-dependent manner.

Sensory Attributes, Microbial Activity, Fatty Acid Composition and Meat Quality Traits of Hanwoo Cattle Fed a Diet Supplemented with Stevioside and Organic Selenium.

This study examined the effects of stevioside (S) and organic selenium (O-Se) supplementation on the sensory attributes, microbial activity, fatty acid composition, and meat quality traits of Hanwoo cattle (Korean native cattle). Twenty-four Hanwoo cattle (663 ± 22 kg body weight) were assigned to two dietary treatments for 8 months: control diet and 1% stevioside with 0.08% organic selenium supplemented diet. S and O-Se inclusion in the diet enhanced the final body weight, weight gain, and carcass crude protein (p < 0.05). Moreover, supplementation with S and O-Se had a significant effect on lowering the drip loss and shear force and enhanced the a* (redness) of the longissimus dorsi muscle (p < 0.05). The inclusion of dietary S and O-Se improved the sum of the polyunsaturated fatty acid (ΣPUFAs) content of the meat, and the oxidative status (TBARS) values during second week of storage decreased by 42% (p < 0.05). On the other hand, the microbial count tended to decrease (7.62 vs. 7.41 log10 CFU), but it was not significant (p > 0.05), and all sensory attributes were enhanced in the S and O-Se supplemented diet. Overall, these results suggest that supplementation of the ruminant diet with stevioside and organic selenium improves the growth performance, carcass traits, and meat quality with enriched PUFAs profile and retards the lipid oxidation during the storage period in beef.

Effect of a Heating System Using a Ground Source Geothermal Heat Pump on Production Performance, Energy-Saving and Housing Environment of Pigs.

This study examined the effects of a heating system using a ground source geothermal heat pump (GHP). A GHP was installed in a pig house, and a comparative analysis was performed between the GHP and the control (conventional heating system) in terms of the production performance, housing environment, noxious gas emissions, electricity consumption, and economics. The geothermal system performance index, such as the coefficient of performance (COP), inlet, and outlet temperature, were also evaluated. The outflow temperature during each period (weaning, growing, and finishing) was significantly higher than the inflow temperature in all three components of the GHP system. Similarly, the average internal temperature of the GHP-connected pig house was increased (p < 0.05) during each period. The carbon dioxide (CO2) concentration, electricity usage, and cost of electricity during the 16-week experimental period were reduced significantly in the GHP system relative to the control. The concentrations of ammonia (NH3) during the growing and finishing period and the concentrations of formaldehyde during the weaning phase were also lower in the GHP-installed pig house (p < 0.05). These results indicate that the GHP system can be used as an environmentally friendly renewable energy source in pig houses for sustainable pig production without harming the growth performance.

Physico-chemical attributes, sensory evaluation and oxidative stability of leg meat from broilers supplemented with plant extracts.

This feeding trial was conducted to investigate the effects of Mentha arvensis (MA) and Geranium thunbergii (GT) in drinking water on physicochemical attributes, sensory qualities, proximate analysis and oxidative stability of broiler leg meat. One hundred and twenty broiler chicks were assigned to 1 of 4 dietary treatments for 5 weeks. The dietary treatments were 1) control, 2) T1 (0.1% 1 MA:1 GT), 3) T2 (0.1% 1 MA:4 GT), 4) T3 (0.1% 4 MA: 1 GT). The water holding capacity and cooking loss were improved (p < 0.05) in T2 and T3. The flavor, texture and acceptability of leg meat by consumers were significantly increased in T2 relative to the control (p < 0.05). The crude protein content was increased in T3 while the crude fat decreased in T2 (p < 0.05). Moreover, broilers supplemented with plant extracts had the lowest leg meat TBARS (thiobarbituric acid reactive substances) values after 2 weeks of storage as compared with the control. Total phenolic contents and 1-1-diphenyl 2 picrylhydrazyl (DPPH) activity were also better in the T2 group (p < 0.05) compared with the control, whereas 2,2-Azinobis-3 ethytlbenzothiazoline-6-sulfonic acid (ABTS+) remained unaffected. Overall, these results demonstrate that broiler drinking water with the inclusion of plant extract combination can be used to enhance the oxidative stability, shelf life and quality characteristics of broiler leg meat without compromising the growth performance.

Meat Composition, Fatty Acid Profile and Sensory Attributes of Meat from Goats Fed Diet Supplemented with Fermented Saccharina japonica and Dendropanax morbifera.

A 90-day feeding trial was conducted to evaluate the effects of diets supplemented with three concentrations (control or 0%, 0.5% and 1.0%) of fermented Saccharina japonica and Dendropanax morbifera (FSJ-DM) on the meat composition, growth performance, oxidative stability and fatty acid profile of Korean native black goat (KNBG) meat. The feed conversion ratio and body weight gain (1st to 2nd month) were improved significantly (p < 0.05) in response to feed supplemented with 1.0% FSJ-DM. Moisture content was increased, whereas ether extract and cholesterol contents were decreased in meat obtained from goats supplemented with 1.0% FSJ-DM dietary feeds (p < 0.05). In the same diet group, the total saturated fatty acids (ΣSFA) were lower, whereas the sum of polyunsaturated fatty acids (ΣPUFA) was higher, along with higher PUFA/SFA ratio and lower n-6/n-3 ratio (p < 0.05). On an average, the dietary supplementation of 1.0% FSJ-DM reduced the thiobarbituric acid reactive substance (TBARS) and pH values of goat meat. Overall, the results of this study suggest that diet supplemented with 1.0% FSJ-DM improves the meat composition, growth performance and fatty acid profile and reduces lipid oxidation of goat meat.

Medium to long-term echo follow-up after ventricular septal defect device closure.

OBJECTIVE: We aimed to assess the medium to long-term results of echocardiographic follow-up of perimembranous and muscular ventricular septal defect closure with various Amplatzer devices. METHODS: We successfully closed ventricular septal defects percutaneously in 45/49 patients. There were 35 perimembranous and 10 muscular ventricular septal defects. The median age and weight was 8.50 years (range 2-36.70 years) and 24 kg (range 10-106 kg), respectively. The median size of the ventricular septal defect was 7 mm (range 3-14 mm) on transthoracic echocardiography, 6 mm (range 4-15 mm) on transesophageal echocardiography, and 6 mm (range 3-14 mm) on left ventricular angiography. The median pulmonary-to-systemic blood flow ratio was 1.40 (range 1.0-3.0). RESULTS: In the 49 attempted cases, the procedure was successful in 45, with a success rate of 91.84%. At a mean follow-up of 54.50 months, echocardiography showed complete closure in 41 (91%) patients and 4 (9%) had a tiny (1-2 mm) residual defect. New-onset aortic regurgitation was seen in 6 (13.3%) patients at 54.50 months, but it was mild in nature. Tricuspid valve regurgitation was observed in 13 (29%) patients at 54.50 follow-up, of whom 10 (22%) had mild and 3 (7%) had moderate regurgitation. CONCLUSION: Transcatheter closure of perimembranous and muscular ventricular septal defects is effective, however, these patients need to be followed up regularly to detect device-related problems, specifically, aortic and tricuspid valve regurgitation.

Noninvasive evaluation of single-ventricle patients before Fontan operation.

OBJECTIVE: To determine whether patients with single-ventricle physiology who are free from known risk factors could skip routine pre-Fontan hemodynamic evaluation, without affecting the postoperative outcome. METHODS: A diagnostic algorithm including echocardiographic, clinical, and angiographic risk factors was used retrospectively to evaluate all 44 patients who underwent Fontan completion at Hamad General Hospital between January 2000 and December 2012. We evaluated the efficacy of this algorithm as a screening tool to identify inoperable and high-risk patients in whom pre-Fontan cardiac catheterization should be performed. RESULTS: Mean age at Fontan completion was 5.9 years (range 1.08-24.5 years), and mean weight was 18 kg (range 7.4-60 kg). Three patients were found to be inoperable based on hemodynamic cardiac catheterization results. The algorithm was highly sensitive in detecting all 3 inoperable patients who were classified as high-risk subjects. Of the other 41 patients, 17 (41%) had no risk factors and 24 (59%) had one or more risk factors. This noninvasive algorithm showed a sensitivity of 83% and specificity of 76% in detecting adverse postoperative outcomes. The sensitivity did not change after adding hemodynamic data obtained by cardiac catheterization as additional risk factors. CONCLUSION: This noninvasive diagnostic algorithm could be used as an effective screening tool to detect patients in whom pre-Fontan cardiac catheterization could be avoided; magnetic resonance imaging and computed tomography can be a good substitute.

High incidence of abdominal venovenous collaterals after Kawashima operation.

INTRODUCTION: Systemic venous collaterals have been found at different stages of single-ventricle palliation, specifically after Kawashima operation. In this study, we present the incidence, clinical features, associated risk factors, and management of such venovenous collaterals (VVCs) after Kawashima procedure. MATERIALS AND METHODS: A retrospective review of all the patients who underwent Kawashima procedure prior to December 2011 at Hamad General Hospital, Qatar, was performed. Data were collected and reviewed from medical records. RESULTS: The study group involved a total of six patients with Kawashima procedure. The median age of patients was 112.7 months (range 46-336 months), and median age at the time of Kawashima operation was 31.7 months (range 15-187 months). Mean systemic arterial oxygen saturation (Spo 2) after Kawashima operation was 94.5% ± 1.5%. In five patients, during a median follow-up of 53.4 months (range 16.9-147.9 months), the Spo 2 declined to a mean of 78.8% ± 8.2%. A total of 16 venous collaterals were observed in the study group, and majority (70%) of these collaterals were subdiaphragmatic. CONCLUSION: In our study, abdominal VVCs were observed in 100% of the patients who were followed after Kawashima operation. We therefore recommend that thorough evaluation for such VVCs should be part of the ongoing evaluation of patients after Kawashima operation, especially in those with low Spo 2. We also recommend early surgical rerouting of hepatic veins to pulmonary arteries in all post-Kawashima patients.

Role of serum-ascites albumin gradient in differential diagnosis of ascites.

BACKGROUND: The classification of ascites as 'exudative' and 'transudative' based on ascitic fluid total protein (AFTP) has been challenged in many clinical conditions like cardiac ascites, patients on prolonged diuretic therapy and malignant ascites because it had poor diagnostic efficacy. These drawbacks have led to the development of another approach to classify ascites, which is based on Serum-Ascites Albumin Gradient (SAAG) to differentiate ascitic fluid into two categories: SAAG > or = 11 g/L in ascites due to portal hypertension and SAAG < 11 g/L in ascites unrelated to portal hypertension. Objective of this study was to compare the diagnostic efficacy of serum/ascites fluid albumin gradient and ascitic fluid total protein in patients having ascites. METHODS: This Cross-sectional comparative study was conducted in the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from 1st Jun 2007 to 30th May 2008. Ninety-three patients were included in the study by non probability convenience sampling. The patient grouped as: (Group I) 73 cases of liver cirrhosis, (Group II) 14 cases of hepatoma and 6 cases of tuberculous ascites. Ascitic fluid specimen and 3 ml blood were obtained for ascitic fluid estimation of ascitic fluid albumin, total proteins and serum albumin. Diagnostic efficacy of SAAG and AFTP was calculated by comparing the results with clinical, ultrasonographic, histopathological findings, ascitic fluid cell count/acid fast bacilli culture and other relevant investigations. RESULTS: Seventy-three cases had liver cirrhosis (group I), 14 cases had hepatoma and 6 cases had tubercular ascites (group II). Age ranged 25-80 years with mean age 56 years. Diagnostic accuracy, Sensitivity, Specificity, Positive predictive value (PPV) and Negative predictive value (NPV) of SAAG were 96%, 97%, 95%, 98.6%, and 90% respectively, whereas those of AFTP were 56%, 53%,70%, 86%, and 29% respectively. CONCLUSION: Differential diagnosis of ascites should be based on SAAG because diagnostic efficacy of SAAG was significantly higher than AFTP in work-up of ascites.

Serum inhibin B as a diagnostic marker of male infertility.

BACKGROUND: Infertility affects about 15% of all couples in the world. Approximately 40% of all infertility cases could be attributed entirely to male factors. Serum inhibin B has emerged as a sensitive marker of male fertility. Analysis of serum inhibin B reflects the relationship between inhibin B, Sertoli cell function and spermatogenesis. METHODS: This validation study was conducted to calculate the sensitivity, specificity, positive and negative predictive value of serum inhibin B in diagnosis of male infertility, using semen analysis as the gold standard. One hundred and sixty men were included in the study, they reported for semen analysis for evaluation of male infertility. Sperm count was done per standard procedure. Serum inhibin B level was determined by ELISA. RESULTS: Serum inhibin B level > or = 80 pg/ml was regarded as a normal response. The serum inhibin B test had 75% sensitivity, 93.1% specificity, 80.5% PPV and 90.7% NPV. CONCLUSION: Serum inhibin B has a positive correlation with sperm counts and could be used for evaluation of male infertility as a non-invasive predictor of spermatogenesis. The sensitivity, specificity and PPV are appropriate for clinical decision making and to avoid unnecessary testicular biopsies.

Safety and efficacy of low-profile balloons in native coarctation and recoarctation balloon angioplasty for infants.

Background Traditionally, high-profile/high-pressure balloons have been used for angioplasties, whereas low-profile/low-pressure balloons have been used for valvuloplasties. High-profile balloons require larger introducing sheaths, which can be a limiting factor for percutaneous catheter interventions in infants. This report aims to report the author's experience with the efficacy of low-profile balloons using smaller introducing sheaths for coarctation balloon angioplasty in infants. Methods From April 2004 to April 2008, 15 infants, representing both native coarctation and recoarctation indications, underwent coarctation balloon angioplasty and were retrospectively reviewed. The arterial access was achieved using 4-Fr (Cook) introducing sheaths and Tyshak (NuMED, Hallenweg-Netherlands) balloons 5 to 8 mm in diameter for coarctation angioplasty in the study group. Results In this study, 15 infants (7 with native coarctation and 8 with postoperative recoarctation) underwent balloon angioplasty. These infants ranged in age from 2 to 9 months (median, 4 months) and in weight from 3.5 to 10.8 kg (median, 5.7 kg). The peak-to-peak coarctation gradient was reduced from 46.2 +/- 28 mmHg before angioplasty to 10 +/- 8 mmHg afterward (p = 0.001). The angiographic diameter of the coarctation segment was increased from 2.4 +/- 1.0 mm before angioplasty to 5 +/- 0.8 mm afterward (p = 0.001). There were no immediate major or minor complications. During a follow-up period up to 48 months, only one patient from the native coarctation group experienced recoarctation and underwent successful reballooning, and none of the patients experienced aneurysms. Conclusion This study shows that the use of low-profile/low-pressure balloons is an effective treatment for infants. Furthermore, low-profile balloons required smaller introducing sheaths, which provides a clear advantage of minimizing vascular complications with coarctation ballooning in younger infants.

Percutaneous closure of ventricular septal defect associated with tunnel-shaped aneurysm using the Amplatzer duct occluder.

Different devices have been used for percutaneous closure of ventricular septal defects (VSDs). Over the past 6 months, we have used the Amplatzer duct occluder for VSDs associated with tunnel-shaped aneurysm in three patients here at our institution. Due to the anatomic resemblance between such VSDs and the duct occluder, we selected this device for percutaneous closure. There was trivial residual shunt in one patient. All three patients tolerated the procedure well and there were no untoward complications.

Impact of new diagnostic criteria of diabetes mellitus.

OBJECTIVE: To compare the frequency of diabetic individuals diagnosed by fasting plasma glucose (FPG) > or = 7.0 mmol/L with previous value i.e. > or = 7.8 mmol/L and to determine the diagnostic accuracy of FPG > or = 7.0 mmol/L. DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: The Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from April to July 2003. PATIENTS AND METHODS: FPG of 5250 subjects was checked to compare the frequency of diabetic subjects diagnosed by FPG > or = 7.0 mmol/L with > or = 7.8 mmol/L. Of them, 301 symptom-free subjects were subjected to 75 g Oral Glucose Tolerance Test (OGTT) and their 2 hours post glucose (2-h PG) challenge level was taken as "gold standard" to determine the diagnostic accuracy of FPG at > or = 7.0 mmol/L. RESULTS: By lowering the cut off point of FPG from 7.8 mmol/L to 7.0 mmol/L, the percentage of diagnosed diabetic subjects increased from 35% to 42%. Statistical analysis revealed a significant increase (p < 0.0001). FPG > or = 7.0 mmol/L had a diagnostic sensitivity of 70%, specificity 91%, the predictive value of positive and negative diagnosis was 84% and 80% respectively. CONCLUSION: FPG at cut off point of >7.0 mmol/L, will greatly facilitate the early diagnosis of diabetes mellitus (DM). An early diagnosis can be further facilitated by a combination of FPG and 2-h PG estimation.

Serum hyaluronic acid as a marker of hepatic fibrosis.

OBJECTIVES: To determine the serum hyaluronic acid (HA) levels as biochemical marker of hepatic fibrosis and cirrhosis and correlate it with the degree of hepatic fibrosis and cirrhosis. DESIGN: Comparative cross-sectional study. PLACE AND DURATION OF STUDY: The Armed Forces Institute of Pathology, Rawalpindi from September 2003 to August 2004. PATIENTS AND METHODS: This study was performed on 100 patients of chronic liver disease whose liver biopsies had been carried out. Fifty healthy controls were also included in the study. Routine liver function tests, hepatitis serology and serum hyaluronic acid levels were carried out on patients and controls. RESULTS: Liver biopsy of 100 patients revealed that 21 were in stage 0 fibrosis, 38 in stage 1 fibrosis, 26 in stage 3 fibrosis and 15 in stage 4 fibrosis. Mean Serum HA (mean+/-SD) concentration in patients were 189+/-98 mg/L vs. 21+/-10 mg/L of healthy controls. The difference observed was statistically significant (p < 0.001). Patients in stage 4 fibrosis had significantly higher (p < 0.001) mean serum HA concentration as compared to other stages of liver fibrosis. Diagnostic accuracy of serum HA at marginally elevated level of 60 mg/L determined the sensitivity 78.4 %, specificity 80.9%, positive predicted value 93.9% and negative predicted value of 50%. CONCLUSION: Serum HA is a useful non-invasive marker of liver fibrosis. There is a strong positive correlation between serum HA levels and degree of liver fibrosis. The concentration of serum HA rises according to progression of liver fibrosis and levels are highest in patients with liver cirrhosis.

Insulin resistance in human subjects having impaired glucose regulation.

OBJECTIVE: To determine insulin resistance in human subjects having impaired glucose regulation (IGR) by Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). DESIGN: Comparative cross-sectional study. DURATION OF THE STUDY: This study was carried out between September 2004 to September 2005, at the Department of Chemical Pathology and Clinical Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi. PATIENTS AND METHODS: A total of 100 subjects with impaired glucose regulation were selected for evaluation of metabolic syndrome as per the criteria of National Cholesterol Education Program, Adult Treatment Panel III (NCEP, ATP III), along with 47 healthy age and gender-matched controls. Physical examination to determine blood pressure and waist circumference was carried out and so was sampling for plasma glucose, serum triglycerides, HDL-cholesterol and insulin. Insulin resistance was calculated by the HOMA-IR. Finally, subjects with and without metabolic syndrome were compared with controls (n=47), using one-way ANOVA for studying insulin resistance between groups, with Tukey's post-hoc comparison. RESULTS: The frequency of finding metabolic syndrome in cases of IGR remained 47%. The insulin resistance demonstrated stepwise worsening from control population (mean=1.54, 95 % CI: 1.77-2.37) to subjects suffering from only IGR (mean=2.07, 95 % CI: 1.77-2.37) to metabolic syndrome (mean= 2.67, 95 %, CI: 2.34 - 3.00) [p<0.001]. CONCLUSION: Patients with impaired glucose regulation may have significant insulin resistance. It is, thus, recommended that a vigorous search be made to measure insulin resistance in all cases diagnosed to have impaired glucose regulation.