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1.
Front Plant Sci ; 15: 1363248, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39055353

RESUMEN

Despite the critical role of balanced nutrition in crop productivity, the use of potash (K) and zinc (Zn) is not much practiced by Pakistani farmers. The reduced nutrient uptake and crop productivity together increase the costs associated with fertilization and revisit farmers' confidence in the efficacy and profitability of fertilizers. To address this problem, a field study was conducted in the research area of the MNS-University of Agriculture, Multan, in collaboration with Engro Fertilizers Limited. The research plan consisted of five treatments, including T1 = control (without N, P, K, and Zn fertilizers), T2 = NP in practice (NP at 32-23-0 kg acre-1), T3 = recommended NP (NP at 48-34.5 kg acre-1), T4 = balanced NPK (NP+K at 48-34.5-30 kg acre-1), and T5 = balanced NPK + Zn (NPK+Zn at 48-34.5-30 + 7.5 kg acre-1). Wheat was used as a test crop, and its growth, yield, and physiological and nutritional parameters were studied. The results indicated that NPK+Zn balanced nutrition increased plant height, spike length, photosynthetic rate, water use efficiency, transpiration rate, stomatal conductance, and grain yield by 13%, 15%, 44%, 60%, 63%, 39%, and 78%, respectively, compared with the control. It was found that the combined application of NP, K, and Zn improved the recovery efficiency of applied nutrients, i.e., nitrogen recovery efficiency (NRE) by 230%, phosphorus recovery efficiency (PRE) by 136%, potassium recovery efficiency (KRE) by 135%, and zinc recovery efficiency (ZnRE) by 136% compared to NP-alone application. Agronomic use efficiency of applied fertilizers, such as potassium agronomic use efficiency (KAUE) by 71%, phosphorus agronomic use efficiency (PAUE) by 72%, nitrogen agronomic use efficiency (NAUE) by 70%, and zinc agronomic use efficiency (ZnAUE) by 72%, was observed compared to NP-alone application. The results showed that NPUE, PPUE, NPUE, and ZnPUE were reduced by 5%, 3%, 3%, and 5%, respectively, compared to NP-alone application. Our findings suggest that K and Zn should be made an essential part of wheat nutrition management for higher yield and better quality of produce.

2.
Global Spine J ; : 21925682241251764, 2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38695328

RESUMEN

STUDY DESIGN: Cross sectional comparative study. OBJECTIVES: The current study aims to explore the calcification potential (BMP2 expression) of intervertebral discs and its association with the presence of vertebral endplate defects visible on MRI. METHODS: Forty-seven herniated lumbar disc samples obtained from patients aged 20-76 (31 M/16F) undergoing surgery. Five-µm thin sections were stained with H&E in order to assign a histological degeneration score (HDS) from 0-15 on the basis of cell density (0-5), structural alterations (0-4), granular changes (0-3) and mucus degeneration (0-3). Sections were immuno-stained with anti BMP-2 antibodies to observe the calcification potential in these discs. In addition, pre-operativeT2-T1 W MRI images of the lumbar spine were analyzed for the presence and type (typical or atypical) of vertebral endplate defects, grade of disc degeneration (Pfirrmann grade I-V), presence of high intensity zones (HIZ), and Modic changes at the operated level. RESULTS: Vertebral endplate defects, Modic changes & HIZ were observed in 81%, 29% and 21% of patients respectively. Mean HDS & BMP-2 expression was 9 ± 2 and mean 71 ± 36 spots/mm2 respectively. Discs with adjacent vertebral endplate defects showed increased cell density (P = .004), mucus degeneration (P = .002), HDS (P = .01) and BMP-2 expression (P = .01). Discs with HIZ also had increased HDS, but significance was seen with increased BMP2 expression (P = .006). HDS showed a positive correlation with BMP 2 expression (r = .30, P = .04). CONCLUSION: These findings suggest that the altered mechanical environment of discs is strongly associated with BMP-2 expression which is an important marker of intervertebral disc calcification.

3.
Artículo en Inglés | MEDLINE | ID: mdl-38696293

RESUMEN

Epilepsy is a neurological disorder characterized by abnormal neuronal discharges that manifest in life-threatening seizures. These are often monitored via EEG signals, a key aspect of biomedical signal processing (BSP). Accurate epileptic seizure (ES) detection significantly depends on the precise identification of key EEG features, which requires a deep understanding of the data's intrinsic domain. Therefore, this study presents an Advanced Multi-View Deep Feature Learning (AMV-DFL) framework based on machine learning (ML) technology to enhance the detection of relevant EEG signal features for ES. Our method initially applies a fast Fourier transform (FFT) to EEG data for traditional frequency domain feature (TFD-F) extraction and directly incorporates time domain (TD) features from the raw EEG signals, establishing a comprehensive traditional multi-view feature (TMV-F). Deep features are subsequently extracted autonomously from optimal layers of one-dimensional convolutional neural networks (1D CNN), resulting in multi-view deep features (MV-DF) integrating both time and frequency domains. A multi-view forest (MV-F) is an interpretable rule-based advanced ML classifier used to construct a robust, generalized classification. Tree-based SHAP explainable artificial intelligence (T-XAI) is incorporated for interpreting and explaining the underlying rules. Experimental results confirm our method's superiority, surpassing models using TMV-FL and single-view deep features (SV-DF) by 4% and outperforming other state-of-the-art methods by an average of 3% in classification accuracy. The AMV-DFL approach aids clinicians in identifying EEG features indicative of ES, potentially discovering novel biomarkers, and improving diagnostic capabilities in epilepsy management.

4.
J Trop Med ; 2024: 6613120, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38784112

RESUMEN

To determine the incidence of antimicrobial-resistant emerging pathogens, Clostridium difficile, and its associated risk factors in tertiary care setups of Pakistan. This cross-sectional prospective study was conducted from January 2019 to December 2020, to determine the prevalence and antimicrobial resistance patterns of C. difficile strains isolated from 450 stool specimens of patients suffering from diarrhea hospitalized in tertiary care hospitals in Peshawar, Pakistan. The stool samples of the patients were processed for culture and detection of toxin A and toxin B by enzyme-linked immunosorbent assay (ELISA) and tpi PCR. The drug sensitivity test was performed for antibiotics including ampicillin, cefixime, cefepime, amoxicillin, nalidixic acid, sulpha/TMP (SXT), chloramphenicol, metronidazole, vancomycin, ciprofloxacin, levofloxacin, and imipenem. Of 450 stool specimens, 108 (24%) were positive for C. difficile by stool culture, whereas 115 (25.5%) were only positive for C. difficile toxins based on ELISA and PCR (128 (28.6%). Of 108, 90.7% (n = 98) isolates were resistant to one antibiotic, and 90 (83.4%) were resistant to three or more antimicrobials. The highest resistance rates were found against penicillin (83.3%) followed by amoxicillin (70%), nalidixic acid (61%), and metronidazole (38%), and the lowest resistance was found against vancomycin (6.4%) and imipenem (3.7%). CDI was statistically significantly correlated with increased age, use of antibiotics, abdominal surgeries, use of proton pump inhibitors and H2a, and presence of comorbidities. The high frequency of C. difficile in Peshawar, Pakistan, indicates that CDI is an important nosocomial infection in different hospitals. The results will be helpful for clinicians to redesign control and therapeutic strategies in hospitals.

5.
J Trop Med ; 2024: 8529788, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38576602

RESUMEN

Introduction: This study determines the incidence of common viral and helminth coinfections with malaria in the tertiary care hospital set up in southern Khyber Pakhtunkhwa, Pakistan. Materials and Methods: The multidimensional research included malaria patients admitted to different hospitals of district Kohat during January and December 2021. Stool samples and blood were assembled from the patients. Giemsa-stained microscopy-positive samples were processed by the immunochromatography technique (ICT) to identify Plasmodium species. Common viral infections such as viral hepatitis (A, B, and C), HIV, and dengue (DENV) were analyzed by ICT kits while SARS-CoV-2 was confirmed through real-time PCR. Furthermore, the intestinal helminths were identified using the Kato-Katz thick smear method. Results: Among 1278 patients, 548 were diagnosed with malaria, 412 (75.2%) were positive for P. vivax infection, 115 (21%) for P. falciparum, and 21 (3.8%) for mixed malaria infection (P. vivax/P. falciparum), with a higher incidence among males (65.2%) than females (34.8%). Coinfection with helminths was positive in 215 (39.3%) malaria patients. The most common infections were caused by the Ascaris lumbricoides species (42.6%) followed by Enterobius vermicularis (31.7%) and hookworm. A total of 24.6% of malaria-positive cases were also coinfected with different viruses with higher frequencies of confection for HAV (8.2%) and DENV (6.2%), respectively. The patients revealed higher incidence of coinfections with P. falciparum (57%) as compared with P. vivax (39.2%) and mixed infections (3.7%). Conclusion: This study demonstrated that the study population exhibited a significant incidence of coinfections with intestinal helminth and viral malaria.

6.
Trop Anim Health Prod ; 56(4): 137, 2024 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-38649642

RESUMEN

This study aimed to explore polymorphisms in the promoter region of the caprine BMPR1B (Bone morphogenetic protein receptor 1 beta) gene and its association with body measurement and litter size traits in Damani does. A total of 53 blood samples were collected to analyze the association between the BMPR1B gene polymorphism and 11 phenotypic traits in Damani female goats. The results revealed that three novel SNPs were identified in the promoter region of the caprine BMPR1B gene, including g.67 A > C (SNP1), g.170 G > A(SNP2), and g.501A > T (SNP3), among which the SNP1 and SNP2 were significantly (p < 0.05) associated with litter size and body measurement traits in Damani goats. In SNP1 the AC genotype could be used as a marker for litter size, and the CC genotype for body weight in Damani goats. In SNP2, the genotype GG was significantly (p < 0.05) associated with ear and head length. Therefore, we can conclude from the present study, that genetic variants AC and CC of the caprine BMPR1B gene could be used as genetic markers for economic traits through marker-assisted selection for the breed improvement program of the Damani goat.


Asunto(s)
Receptores de Proteínas Morfogenéticas Óseas de Tipo 1 , Cabras , Tamaño de la Camada , Polimorfismo de Nucleótido Simple , Regiones Promotoras Genéticas , Animales , Cabras/genética , Cabras/fisiología , Tamaño de la Camada/genética , Femenino , Receptores de Proteínas Morfogenéticas Óseas de Tipo 1/genética , Genotipo , Irán
7.
Trop Med Infect Dis ; 9(3)2024 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-38535887

RESUMEN

INTRODUCTION: Raw milk may contain pathogenic microorganisms harmful to humans, e.g., multidrug-resistant Escherichia coli non-O157:H7, which can cause severe colitis, hemolytic uremia, and meningitis in children. No studies are available on the prevalence of Shiga toxin-producing E. coli (STEC O157:H7) in sick or healthy dairy animals in the Khyber Pakhtunkhwa Province of Pakistan. AIM: This study aimed to isolate, characterize, and detect antibiotic resistance in STEC non-O157:H7 from unpasteurized milk of dairy bovines in this province. MATERIALS AND METHODS: We collected raw milk samples (n = 800) from dairy farms, street vendors, and milk shops from different parts of the Khyber Pakhtunkhwa Province. E. coli was isolated from these samples followed by latex agglutination tests for serotyping. The detection of STEC was conducted phenotypically and confirmed by the detection of virulence genes genotypically. An antibiogram of STEC isolates was performed against 12 antibiotics using the disc diffusion method. RESULTS: A total of 321 (40.12%) samples were found to be positive for E. coli in this study. These samples were processed for the presence of four virulence genes (Stx1, Stx2, ehxA, eae). Forty samples (5.0%) were STEC-positive. Of these, 38%, 25%, 19%, and 18% were positive for Stx1, Stx2, ehxA, and eae, respectively. Genotypically, we found that 1.37% of STEC isolates produced extended-spectrum beta-lactamase (ESBL) and contained the blaCTX M gene. Resistance to various antibiotics ranged from 18% to 77%. CONCLUSION: This study highlights the risk of virulent and multidrug-resistant STEC non-O157:H7 in raw milk and the need for proper quality surveillance and assurance plans to mitigate the potential public health threat.

8.
Int J Mol Sci ; 25(6)2024 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-38542433

RESUMEN

Theiler's murine encephalomyelitis virus (TMEV) infection has been used as a mouse model for two virus-induced organ-specific immune-mediated diseases. TMEV-induced demyelinating disease (TMEV-IDD) in the central nervous system (CNS) is a chronic inflammatory disease with viral persistence and an animal model of multiple sclerosis (MS) in humans. TMEV infection can also cause acute myocarditis with viral replication and immune cell infiltration in the heart, leading to cardiac fibrosis. Since platelets have been reported to modulate immune responses, we aimed to determine the role of platelets in TMEV infection. In transcriptome analyses of platelets, distinct sets of immune-related genes, including major histocompatibility complex (MHC) class I, were up- or downregulated in TMEV-infected mice at different time points. We depleted platelets from TMEV-infected mice by injecting them with platelet-specific antibodies. The platelet-depleted mice had significantly fewer viral antigen-positive cells in the CNS. Platelet depletion reduced the severities of TMEV-IDD and myocarditis, although the pathology scores did not reach statistical significance. Immunologically, the platelet-depleted mice had an increase in interferon (IFN)-γ production with a higher anti-TMEV IgG2a/IgG1 ratio. Thus, platelets may play roles in TMEV infection, such as gene expression, viral clearance, and anti-viral antibody isotype responses.


Asunto(s)
Esclerosis Múltiple , Miocarditis , Humanos , Ratones , Animales , Miocarditis/etiología , Miocarditis/metabolismo , Sistema Nervioso Central/metabolismo , Esclerosis Múltiple/metabolismo , Antígenos de Histocompatibilidad Clase I/metabolismo , Enfermedad Crónica
9.
IEEE J Biomed Health Inform ; 28(6): 3236-3247, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38507373

RESUMEN

The efficient patient-independent and interpretable framework for electroencephalogram (EEG) epileptic seizure detection (ESD) has informative challenges due to the complex pattern of EEG nature. Automated detection of ES is crucial, while Explainable Artificial Intelligence (XAI) is urgently needed to justify the model detection of epileptic seizures in clinical applications. Therefore, this study implements an XAI-based computer-aided ES detection system (XAI-CAESDs), comprising three major modules, including of feature engineering module, a seizure detection module, and an explainable decision-making process module in a smart healthcare system. To ensure the privacy and security of biomedical EEG data, the blockchain is employed. Initially, the Butterworth filter eliminates various artifacts, and the Dual-Tree Complex Wavelet Transform (DTCWT) decomposes EEG signals, extracting real and imaginary eigenvalue features using frequency domain (FD), time domain (TD) linear feature, and Fractal Dimension (FD) of non-linear features. The best features are selected by using Correlation Coefficients (CC) and Distance Correlation (DC). The selected features are fed into the Stacking Ensemble Classifiers (SEC) for EEG ES detection. Further, the Shapley Additive Explanations (SHAP) method of XAI is implemented to facilitate the interpretation of predictions made by the proposed approach, enabling medical experts to make accurate and understandable decisions. The proposed Stacking Ensemble Classifiers (SEC) in XAI-CAESDs have demonstrated 2% best average accuracy, recall, specificity, and F1-score using the University of California, Irvine, Bonn University, and Boston Children's Hospital-MIT EEG data sets. The proposed framework enhances decision-making and the diagnosis process using biomedical EEG signals and ensures data security in smart healthcare systems.


Asunto(s)
Electroencefalografía , Epilepsia , Procesamiento de Señales Asistido por Computador , Humanos , Electroencefalografía/métodos , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Inteligencia Artificial , Niño , Diagnóstico por Computador/métodos , Algoritmos , Adolescente , Preescolar , Masculino , Adulto , Femenino
10.
ACS Omega ; 9(1): 166-177, 2024 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-38222566

RESUMEN

Proper management and control measurements are needed to stop the spread of highly pathogenic E. coli isolates that cause urinary tract infections (UTI) by developing new antibacterial agents to ensure the safety of public health. Therefore, the present investigations were used to achieve the synthesis of iron oxide nanoparticles (IONPs) via a simple coprecipitation method using ferric nitrates Fe (NO3)3 as the precursor and hydrazine solution as the precipitator and to explore the antibacterial activity against eradicating Uropathogenic Escherichia coli (E. coli). The synthesized IONPs were further studied using a UV-vis spectrophotometer, Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), and scanning electron microscopic (SEM) analysis. The maximum surface plasmon resonance peak was observed as absorption at 320 nm in a colloidal solution to validate the synthesis of IONPs. The FT-IR analysis was used to identify different photoactive functional groups that were responsible for the reduction of Fe (NO3)3 to IONPs. The crystalline nature of synthesized IONPs was revealed by XRD patterns with an average particle size ranging as 29 nm. The SEM image was employed to recognize the irregular morphology of synthesized nanoparticles. Moreover, significant antibacterial activity was observed at 1 mg/mL stock solution but after (125, 250, and 500 µg/mL) dilution, the synthesized IONPs showed moderate activity and became inactive at lower concentrations. The morphological and biochemical tests were used to confirm the presence of E. coli in the samples. Furthermore, the minimum inhibitory concentration (MIC) and minimum bacterial concentration (MBC) were carried out to determine the inhibitory concentrations for the isolated bacteria. The isolated E. coli were also subjected to antibiotic sensitivity testing that showed high resistance to antibiotics such as penicillin and amoxicillin. Thus, the findings of this study were to use IONPs against antibiotic resistance that has been developed in an inappropriate way.

11.
ACS Omega ; 9(1): 317-329, 2024 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-38222602

RESUMEN

This research study was designed with the aim to prepare plant extract-mediated iron oxide nanoparticles (IONPs) and different chemically modified carbon adsorbents from the Parthenium hysterophorus plant and then optimize the carbon adsorbents by evaluating their adsorption applications in wastewater for the selected metal ions like arsenic (As3+), lead (Pb2+), and cadmium (Cd2+). The Fourier transform infrared spectroscopy (FTIR) technique was used to highlight functional groups in plant-mediated IONPs and chemically modified carbon adsorbents. A scanning electron microscopy study was conducted to explain the surface morphology of the adsorbents. Energy-dispersive X-rays was used for elemental analysis and X-ray diffraction for particle size and crystallinity of the adsorbents. From the study, it was found that the best optimum conditions were pH = 5-6, initial concentration of adsorbate of 10 mg/L, dose of adsorbent of 0.01 g, contact time of 90-120 min of adsorbent and adsorbate, and temperature of 25 °C. At optimum conditions, the adsorption capacities of IONPs for arsenic (As) 144.7 mg/g, lead (Pb) 128.01 mg/g, and cadmium (Cd) ions 122.1 mg/g were recorded. The activated carbon at optimum conditions showed adsorption capacities of 46.35 mg/g for As, 121.95 mg/g for Pb, and 113.25 mg/g for Cd ion. At equilibrium, Langmuir, Freundlich Temkin, and Dubinin-Radushkevich isotherms were applied on the experimental adsorption data having the best R2 values (0.973-0.999) by the Langmuir isotherm. High-correlation coefficient R2 values (0.996-0.999) were obtained from the pseudo-second-order for all cases, showing that the adsorption process proceeds through pseudo second-order kinetics. The apparent adsorption energy E value was in the range of 0.24-2.36 kJ/mol. The adsorption capacity of regenerated IONPs for As gradually decreased from 144.8 to 45.67 mg/g, for lead 128.15 to 41.65 mg/g, and cadmium from 122.10 to 31.20 mg/g in 5 consecutive cycles. The study showed that the synthesized IONPs and acid-activated carbon adsorbent were successfully used to remove selected metal ions from wastewater.

12.
Anim Biotechnol ; 35(1): 2290528, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-38142270

RESUMEN

The present study was designed with the aim to study morphometric characterization as well as phylogeny and diversity of the local Surguli goat at their breeding tract district Kohat through mitochondrial DNA region, i.e., Cytochrome C Oxidase Subunit One (CO1) gene. Morphometric data and blood samples were collected from thirty (30) pure goats. Morphometric analysis showed that sex had significant effect (p < 0.05) on body weight, body length, hearth girth and horn length while no significant effect (p > 0.05) was observed for other characteristics. The results also indicated that age had significant effect (p < 0.05) on height at rump, ear length, horn length and tail length while no significant effect (p > 0.05) was observed for other characteristics. The phylogenetic analysis through CO1 nucleotide sequences within nucleotide range 1-767 showed nine polymorphic sites segregating into eight haplotypes. The mean intraspecific diversity and mean interspecific diversity were calculated as 0.23 and 2.36%, respectively. Phylogenetic tree revealed that Capra Ibex and native Surguli goat have common ancestors. The morphometric and molecular results obtained from the present study can be exploited as a selection tool for breeding and overall improvement.


Asunto(s)
ADN Mitocondrial , Cabras , Animales , Cabras/genética , Filogenia , Secuencia de Bases , ADN Mitocondrial/genética , Mitocondrias/genética
13.
Vet Sci ; 10(12)2023 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-38133234

RESUMEN

Ticks pose a major threat to cattle health and production in Pakistan because they transmit pathogens of diseases like Babesiosis and Theileriosis. Hyalomma spp., found across Africa, Asia, and Europe, are especially problematic. This study explored biocontrol of Hyalomma spp. using spore-free fungal culture filtrates collected from dairy farm soil in Kohat, Pakistan. Three fungal species of the genera Alternaria, Aspergillus, and Penicillium were isolated, and their filtrates were tested against tick adults and larvae. Filtrate concentrations were prepared at different strengths. Data were taken after the exposure of adults and larvae ticks to various concentrations of the fungal filtrates. Results indicated that at 100% concentration, all fungal filtrates induced 100% mortality in adults and larvae. Decreasing filtrate concentration lowered tick mortality. The lowest concentration caused the least mortality. The effect was time- and dose-dependent. In conclusion, spore-free fungal culture filtrates can provide biocontrol of Hyalomma spp. in a time- and concentration-dependent manner. Further research should explore the active compounds causing mortality and optimal application methods. The process outlined here provides a natural biocontrol alternative to chemical pesticides to reduce tick infestations and associated cattle diseases in Pakistan.

14.
Front Artif Intell ; 6: 1292466, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38274052

RESUMEN

In the last years, several techniques of artificial intelligence have been applied to data from COVID-19. In addition to the symptoms related to COVID-19, many individuals with SARS-CoV-2 infection have described various long-lasting symptoms, now termed Long COVID. In this context, artificial intelligence techniques have been utilized to analyze data from Long COVID patients in order to assist doctors and alleviate the considerable strain on care and rehabilitation facilities. In this paper, we explore the impact of the machine learning methodologies that have been applied to analyze the many aspects of Long COVID syndrome, from clinical presentation through diagnosis. We also include the text mining techniques used to extract insights and trends from large amounts of text data related to Long COVID. Finally, we critically compare the various approaches and outline the work that has to be done to create a robust artificial intelligence approach for efficient diagnosis and treatment of Long COVID.

15.
Int. arch. otorhinolaryngol. (Impr.) ; 24(3): 313-318, July-Sept. 2020. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1134144

RESUMEN

Abstract Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas. The length of stay decreased from a median of 3 days (range 2-9 days; mean 3.32) preprotocol to a median of 2 days (range 2-3 days; mean 2.16) postprotocol (p< 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p= 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.

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