Early experience with customized, meal-triggered gastric electrical stimulation in obese patients.

BACKGROUND: We report our initial gastric electrical stimulation experience using the abiliti® system for the treatment of obese patients followed for 1 year. METHOD: Between March 2011 and June 2013, 27 obese patients (BMI 30 to 46 kg/m(2)) were enrolled in a prospective open label study and implanted with a gastric stimulator. The patients were provided with nutritional support, and sensor-based behavioral feedback. RESULTS: At 12 months, percent excess weight loss (%EWL) obtained was 49.3 ± 19.2 % with no significant differences between gender or age sub-groups. The %EWL data were segmented into two groups according to BMI 30-40 kg/m(2) patients (obesity grade I and II) and BMI >40 kg/m(2), with the results of weight loss being significantly higher for the lower BMI group (59.1 ± 19.5 vs. 46.7 ± 13.4, respectively, p < 0.01). One subject requested to have his device explanted, and the minor postoperative adverse events were resolved without hospital admission. All patients experienced early satiety and reduced their intake. CONCLUSIONS: After 12 months of follow-up, gastric electrical stimulation treatment appears to be a safe and effective option for weight loss in obese subjects. Long-term follow-up and further studies are warranted.

Minimally invasive parathyroidectomy under local anesthesia.

BACKGROUND: More than 85% of primary hyperparathyroidism (PHPT) cases are due to solitary, benign parathyroid adenomas. Recently, the success rate of Tc99m sestamibi scintigraphy in localization has made minimally invasive parathyroidectomy (MIP) more prominent. MIP is as effective as conventional bilateral neck exploration. Moreover, it offers lower morbidity, cost effectiveness, and better cosmetics effects. AIM: We aimed to evaluate the success of MIP, which happens only under local anesthesia, in this study. MATERIALS AND METHODS: Total of 63 patients were operated for PHPT, of which 54 had solitary adenoma. Five patients underwent bilateral neck exploration under general anesthesia for thyroid nodules or unlocalizated adenomas. A total of 49 patients underwent MIP under local anesthesia without any sedation. During MIP, gamma probe was used for all patients. The patients were followed for parathyroid functions. RESULTS: The mean age of 49 patients with MIP (5 male, 44 female) was 59 years. The mean follow-up time was 16.4 (±10.1) months (range: 2-36 months). Of the 49 patients, 47 (96%) were totally cured. In 2 patients, the procedure was switched to conventional bilateral neck exploration. Temporary hypocalcaemia was noted in 4 patients. CONCLUSIONS: If the adenoma is localizated, MIP under only local anesthesia can be performed with a high success rate. Gamma probe-guided MIP under local anesthesia is an effective and safe method. It has the advantage of being minimally invasive and, therefore, it should be preferred over the conventional method.

Cinacalcet treatment for stable kidney transplantation patients with hypercalcemia due to persistent secondary hyperparathyroidism: a long-term follow-up.

BACKGROUND: Cinacalcet is an effective treatment for hypercalcemia due to persistent hyperparathyroidism (HPT) in patients who have undergone kidney transplantation (KT). Few data are available about their long-term follow-up. OBJECTIVE: We aimed to evaluate the long-term efficacy of cinacalcet in functioning stable KT subjects with hypercalcemia secondary to persistent HPT. MATERIAL AND METHODS: Twenty-three patients (6 men) with a stable KT showed persistent hypercalcemia (>12 months) secondary to HPT (parathyroid hormone by radioimmunoassay [iPTH] > 150 pg/mL). The mean age was 54 ± 13 years. Time after KT to beginning cinacalcet treatment was 36.5 ± 37.9 (range 12 to 172) months. Initial cinacalcet doses were 30 mg/d. Median follow-up was 53 ± 7.4 months (range 42 to 60 months). We determined serum calcium, phosphorus, alkaline phosphatase, iPTH, creatinine, and immunosuppressant concentrations at baseline as well as 3, 6, and 12 months and after every 6 months thereafter. RESULTS: Initial serum calcium was 11 ± 0.65 mg/dL and mean calcium during treatment, 10.25 ± 0.81 mg/dL (P < .001). Initial serum phosphorus was 2.8 ± 0.58 mg/dL and mean value serum phosphorus during the treatment period, 3.13 ± 0.6 mg/dL (P = 0.015). Initial iPTH was 260 ± 132 pg/mL and during the treatment period; 237 ± 131 pg/mL (P = ns). There was no change in renal function nor in immunosuppressant blood levels. Doses of cinacalcet at the end of the follow-up were 40.4 ± 18.9 mg/d. CONCLUSION: Cinacalcet was effective for long-term control of hypercalcemia related to persistent HPT for patients with stable KT.

Cinacalcet de novo in persistent hypercalcemia after kidney transplantation secondary to hyperparathyroidism: long-term follow-up and effect of withdrawal.

BACKGROUND: Secondary hyperparathyroidism that persists after kidney transplantation (KT), is the main cause of hypercalcemia. Cinacalcet has been used to control hypercalcemia in KT patients. OBJECTIVE: The aim of this study was to evaluate the effect of de novo cinacalcet in KT patients with hypercalcemia and the evolution after its withdrawal. METHODS: This observational study included 41 KT patients (17 men) with persistent hypercalcemia (>6 months), defined as serum calcium (sCa) ≥10.5 mg/dL, and a mean age of 51.1 ± 13.3 years with a functional allograft for >12 months. The time after surgery to begin cinacalcet was 33 months (range, 12.5-81.3). The initial dose of cinacalcet was 30 mg/d. In a subgroup of 14 patients cinacalcet was stopped after 1 year. We studied the evolution of serum levels of calcium, phosphorus, intact pathyroid hormone (iPTH), and serum creatinine. RESULTS: Calcemia normalized in all patients (sCa <10.2 mg/dL). iPTH decreased (basal 267 ± 212 pg/mL vs final: 219 ± 160 pg/mL; P = ns) Serum phosphorus increased (basal 2.85 ± 0.48 mg/dL vs final 3.16 ± 0.50 mg/dL; P = ns). Renal function remained stable (basal creatinine 1.49 ± 0.48 vs final 1.47 ± 0.32 mg/dL; P = ns). After stopping cinacalcet, in group 1 calcemia persisted at normal levels in 50% (n = 7), but the drug had to be reintroduced in the other 50% after 10 ± 7.9 months. No adverse events were documented. CONCLUSIONS: Cinacalcet is an effective alternative for the treatment of hypercalcemia in patients with persistent hyperparathyroidism after KT. Once the treatment is started, there is presently no invice to disclose to who tolerate its withdrawal or the time to do so.

The investigation of the efficacy of insulin glargine on glycemic control when combined with either repaglinide or acarbose in obese Type 2 diabetic patients.

Combinations of insulin and oral antidiabetic drugs (OAD) are often prescribed instead of insulin alone. In this study, the effects of insulin glargine (IG) in combination with repaglinide or acarbose on glycemic parameters were investigated. Obese Type 2 diabetic patients with fasting blood glucose (FBG) levels >or= 7.7 mmol/l [corrected] and hemoglobin glycated (A1C) >or=9% under maximal OAD combination therapy were enrolled. Previous therapies were discontinued, and patients were randomized into 2 groups. The combinations of IG and repaglinide were administered to group 1, and of IG and acarbose to group 2 for 13 weeks. Twenty patients in group 1 and 18 patients in group 2 completed the study. A1C levels were significantly decreased from 10.9+/-1.4% to 7.7+/-1.1% in group 1 and 11.0+/-1.4% to 8.1+/-1.4% in group 2. FBG levels were significantly decreased from 11.9+/-2.7 to 7.1+/-2.3 mmol/l in group 1 and 11.1+/-2.5 to 6.8+/-1.4 mmol/l in group 2. Post-prandial glucose levels were significantly decreased from 15.3+/-3.8 to 10.3+/-3.0 mmol/l in group 1 and 14.0+/-3.1 to 8.9+/-2.2 mmol/l in group 2. Intergroup comparisons indicated no significant differences. More weight gain was detected in group 1, compared to the baseline. Symptomatic hypoglycemia incidence was similar in both groups. Severe hypoglycemic attacks were seen in two patients in group 1. Flatulence incidence was higher in acarbose group. Conclusively, repaglinide and acarbose were equally effective when combined with IG for obese Type 2 diabetic patients controlled inadequately with OAD alone. Furthermore, acarbose seems to have advantages over repaglinide concerning weight gain and severe hypoglycemic attacks.

Antimicrobial resistance in swine production.

Large amounts of antimicrobial agents are still being used in modern swine production in many countries around the world. This facilitates the emergence and development of antimicrobial resistance. Bacteria causing infections in swine have in several cases acquired resistance to a number of the agents most commonly used for treatment, making it difficult to predict the efficacy of different antimicrobial agents without prior susceptibility testing. This review gives an overview of recent susceptibility data from different parts of the world and discusses the importance of the development of resistance not only in the treatment of infections in swine but also taking into account the human health implications of antimicrobial resistance.

Quistes retro-aeeolares en adolescentes: aspectos clínicos y ultrasonograficos / Retro-areolar cysts in adolescents: clinical and ultrasonographic aspects

Retroareolar cysts are common in pre and postmenarchic girls. Boys are rarely diagnosed with this condition. They correspond to cystic dilatations of the accessory mammary glands that open along with a sebaceous gland at the areola and can be single or multiple, uni or bilateral, palpable or incidental findings on ultrasound. They have variable morphology, thin walls, anechogenic content, sometimes calcic sediment can be observed in their lumen. Infected cysts present enlarged, hypervascularized walls; their content is echogenic, avascular and the adjacent tissue is hyperechogenic, with increased vascularization at color Doppler. If not treated, may become retroareolar abscesses. Inflamatory complications are treated with anti-inflamatory drugs and/or antibiotics. No diagnostic biopsy or puncture aspiration is required, since they are spontaneously drained at the areola. In order to appropriately advise patients and families, it is necessary to have knowledge of both the medical and the ultrasonographic aspects of them and their complications.

Los quistes retroareolares son frecuentes en niñas pre y postmenárquicas. Raramente se diagnostican en el varón. Corresponden a dilataciones quísticas de glándulas mamarias accesorias que se abren junto con una glándula sebácea en la areola, pueden ser únicos o múltiples, uni o bilaterales, palpables o hallazgos incidentales en ecografía. Los no complicados tienen morfología variable, paredes delgadas y contenido anecogénico, pudiendo observarse sedimento calcico en su lumen. Los complicados presentan paredes engrosadas, hipervascularizadas, con contenido ecogénico, avascular, tejidos adyacentes hiperecogénicos y aumento de la vascularización al Doppler color. Sin tratamiento, pueden transformarse en abscesos retroareolares. La complicación inflamatoria se trata con antiinflamatorios y/o antibióticos. No requieren biopsia diagnóstica ni punción evacuadora, puesto que se drenan espontáneamente a la areola. El conocimiento del cuadro clínico y su aspecto ul-trasonográfico permitirá orientar adecuadamente a los pacientes y sus familias.

Identification of Cucumisin (Cuc m 1), a subtilisin-like endopeptidase, as the major allergen of melon fruit.

BACKGROUND: Allergenic components in melon extracts have not been described in spite of the fact that melon (Cucumis melo) is a frequent allergy-eliciting fruit. The aim of this study was to evaluate allergenic components in melon extract and to report the identification of cucumisin as a major melon allergen. MATERIALS AND METHODS: Sera from 35 patients allergic to melon were selected on the basis of clinical symptoms, skin prick tests and oral challenge test. Allergenic components were detected by sodium dodecyl sulphate polyacrylamide gel electrophoresis and immunoblotting. Molecular characterization of IgE-binding bands was performed by N-terminal amino acid sequencing. RESULTS: More than 10 IgE-binding bands, between 10 and 80 kDa, were identified in melon extract. Out of them, four IgE-binding bands were major allergens: 14 kDa, 36 kDa, 54 kDa and 67 kDa. These major allergens, except 14 kDa band, showed the same N-terminal sequence: T-T-R-S-W-D-F-L. Research conducted with protein databases identified this N-terminal sequence as cucumisin, an alkaline serine protease, which shares structural homology with microbial subtilisin. The molecular mass of the identified bands corresponds with different molecular forms of cucumisin produced during the processing or degradation of the enzyme: 67 kDa native cucumisin, 54 kDa mature cucumisin and 36 kDa NH2-terminal cucumisin fragment. CONCLUSION: Cucumisin (Cuc m 1) and several N-terminal cucumisin fragments are the major allergens of melon. The ubiquitous distribution of this protein family (cucumisin-like proteases) in many plant species and its high structural similarity suggest its potential role as a new panallergen in plant foods.

Effect of zinc supplementation on development and growth of Chilean infants.

OBJECTIVE: To evaluate the effect of zinc supplementation on growth and development during infancy. DESIGN: We randomized 150 term neonates of low socioeconomic status to receive supplemental zinc 5 mg/d (SG) or a lactose placebo (PG); 112 completed a 1-year follow-up. All were breast-fed and given cow milk formula after weaning; solid foods and iron were added at 5 months. Anthropometry measured monthly, psychomotor development (PDI), mental development (MDI), and behavior including motor quality factor were assessed by Bayley Scales at 6 and 12 months. The groups were comparable in maternal characteristics, birth weight, home environment, and mother-infant interaction. RESULTS: No effects of zinc on weight, length, and weight for length at 12 months were found controlling for sex and breast-feeding. The mean PDI (SG: 84.5 +/- 11.5 vs PG: 87.6 +/- 9.9) and MDI (90.9 +/- 10.5 vs 88.9 +/- 9.1) were similar; however, 46 of 52 infants in the PG scored <100 in MDI vs 42 of 57 in the SG (P <.05). A smaller proportion of the SG, 2 of 57, scored low in motor quality factor at 6 months compared with the PG, 8 of 52 (P =.02). The mean at 12 months for the SG was 31.9 +/- 2.8 and for the PG 30.8 +/- 2.9 (P <.05); zinc supplementation entered the multiple regression at 12 months (P =.037). CONCLUSIONS: Zinc supplementation may have a beneficial effect on mental development and motor quality behavior of healthy term infants.

A 14-mo zinc-supplementation trial in apparently healthy Chilean preschool children.

Apparently healthy preschool children (46 boys, 52 girls) aged 27-50 mo from low socioeconomic conditions who attended daycare centers in Santiago participated in a 14-mo long double-blind zinc supplementation trial. Unlike most previous studies, no additional inclusion criteria such as short stature or slow growth rate were considered. Subjects were pair matched according to sex and age and randomly assigned to two experimental groups: the supplemented group, which received 10 mg Zn/d, and the placebo group. Selected anthropometric, clinical, dietary, biochemical, and functional indexes were determined at the beginning of the study and after 6 and 14 mo of intervention. Actual dietary zinc intake was 66% of the recommended dietary allowance. Height gain after 14 mo was on average 0.5 cm higher in the supplemented group (P = 0.10). The response, however, was different between sexes. Boys from the supplemented group gained 0.9 cm more than those in the placebo group (P = 0.045). No effect was seen in girls. Although no significant differences were observed in the rest of the variables studied, trends (0.05 < P < 0.10) in the supplemented group compared with the placebo group for increased midarm muscle area in boys, improved response to tuberculin, and reduced rates of parasite reinfestation were noted. We conclude that in preschool children of low socioeconomic status, zinc is a limiting factor in the expression of growth potential.

Zinc supplementation and growth of infants born small for gestational age.

To analyze the effect of zinc supplementation on postnatal growth of infants born small for gestational age, we selected 68 infants at birth and followed them monthly for 6 months. They were randomly assigned to a supplemented group (group S, n = 35) receiving 3 mg of Zn (acetate) per day, or to a placebo (group P, n = 33), in a double-blind study. Weight increments in group S were significantly higher than those in group P at 2 months (p < 0.003); z scores showed catch-up growth only in group S. Length increments were also greater in group S than in group P, ending at 6 months were 64.9 +/- 1.8 versus 63.4 +/- 3.5 cm (mean +/- SD; p < 0.01); changes in z scores for 6 months were -1.28 to -0.66 in group S and -1.43 to -1.47 in group P (p < 0.001). Weight-for-length improved similarly in both groups (z score, -2.2 to +0.2). The increase in weight-for-age was higher in group S girls (p < 0.034), ending at 6 months with -0.13 +/- 0.59, versus -0.52 +/- 0.62 in group S boys, -1.15 +/- 0.49 in group P girls, and -1.05 +/- 0.80 in group P boys (+/- SD). More infants in group P received cow milk-based formula before 4 months because of inadequate weight increments. An additive effect on weight increase was observed between Zn supplementation (p < 0.02), exclusive breast-feeding after 4 months of age (p < 0.001), and gender (p < 0.02). Plasma and hair Zn values showed a downward trend, less marked in group S than in group P. We conclude that Chilean infants born small for gestational age have better weight and linear growth during the first 6 months of life if they receive Zn supplementation.

Zinc supplementation increases growth velocity of male children and adolescents with short stature.

We assessed the effect of zinc supplementation on growth velocity in 79 children and adolescents (48 males, 38 females) with idiopathic short stature. Their height-for-age was < 5th percentile (NCHS standards) and their weight-for-age was normal. Patients were assigned randomly to a supplemented group (S) to receive Zn 10 mg/day or to a placebo (P) group, according to gender and age, and were followed-up for 12 months using a double-blind design. Weight, height, armspan, length of lower segment and plasma and hair concentrations of Zn were measured at 0, 3, 6 and 12 months. On admission and at 6 months, energy, protein, dietary fiber and zinc intakes were similar for groups S and P; mean zinc intake was < 6.5 mg/day. No differences were found in plasma zinc, hair zinc, weight, armspan or lower segment increments. Pre-adolescent males in group S had a significantly greater increase in stature compared with group P (6.2 +/- 2.1 versus 4.5 +/- 1.2 cm/year p < 0.025); z score improved from -2.42 to -2.24 in group S and from -2.63 to -2.61 in group P. For adolescent males, the difference was also significant (8.3 +/- 1.5 versus 6.2 +/- 2.1 cm/year; p < 0.025). No differences were noted in females. In Chilean male schoolchildren and adolescents with idiopathic short stature, zinc supplementation increases growth velocity over a 12-month period.

Decrease in pulmonary artery pressure with slow release nifedipine in Saudi patients with primary pulmonary hypertension.

We studied the acute and short-term hemodynamic effects of vasodilators in three Saudi patients with primary pulmonary hypertension. The study protocol included the measurement of pulmonary artery pressure, resistance and cardiac output at baseline and at 15, 30, 45 and 60 minutes after 10 mg sublingual nifedipine. These hemodynamic studies repeated at 3 and 6 months follow-up. A 24 hour profile of pulmonary artery and aortic pressures were recorded to evaluate the effect of 20 mg of slow release nifedipine, after 25 mg of captopril and 5 mg of sublingual isordil. After nifedipine there was a marked reduction in systolic pulmonary artery pressure from 85 +/- 18 to 55 +/- 8 mmHg and the pulmonary resistance decreased from 1422 +/- 367 to 954 +/- 69 dynes-sec/cm-5. The cardiac output increased from 2.9 +/- 0.2 to 0.2 to 4.0 +/- 0.4 l/min after nifedipine. The patients were discharged on nifedipine 10 mg qid, except for patient #3 who was a non-responder. At follow-up there was a symptomatic improvement and a favourable hemodynamic response was maintained, though patient #2 required a higher dose of nifedipine. The pulmonary artery 24 hour pressure profile revealed that 20 mg slow release adalat reduced pulmonary artery pressure for a 6 hour period. Whereas, regular nifedipine decreased pulmonary artery pressure for a period of less than 90 minutes. There was no favourable hemodynamic response to either captopril 25 mg oral of isordil 5 mg administered sublingually. We conclude that slow release nifedipine decreases the pulmonary artery pressure for longer periods compared to regular nifedipine in patients with primary pulmonary hypertension.

Oral copper supplementation: effect on copper and zinc balance during acute gastroenteritis in infants.

To evaluate the effect of copper supplementation during recovery from acute diarrhea, we randomly assigned 14 hospitalized infants to receive either 80 micrograms copper sulfate.kg body wt-1.d-1 or a placebo. Metabolic balance and plasma copper and zinc concentrations were measured before randomization (period 1) and 6 d after admission (period 2). Fifteen control subjects were studied after respiratory illness. Fecal copper was not affected by supplementation; fecal zinc during period 2 rose significantly only in the copper-supplemented group. Copper retention was significantly higher in the supplemented infants; plasma concentrations increased for period 2 but were similar to those in the placebo group. Zinc concentrations improved over time in both groups but zinc retention was higher in the placebo group for period 2. A significant interference by copper supplementation on zinc absorption was noted. Copper supplementation during the early phase of recovery from diarrhea is not recommended.

Copper deficiency impairs growth of infants recovering from malnutrition.

To evaluate the effect of copper deficiency on growth in humans we performed a prospective case-control study in 11 infants identified as Cu deficient based on low plasma Cu (less than 70 micrograms/dL [11.0 mumol/L]) and low ceruloplasmin (less than 200 mg/L). Growth was evaluated with anthropometric indices 1 mo before and 1 mo after onset of Cu supplementation of 80 micrograms.kg-1.d-1. Plasma Cu and ceruloplasmin rose significantly after 1 mo of supplementation. Weight-for-age and weight-for-length indices increased significantly after supplementation only in the Cu-deficient group. Daily energy intake was significantly higher in the Cu-deficient group after supplementation than it was in the control group. Daily weight gain after supplementation increased significantly in the Cu-deficient group and the value for daily weight gain after supplementation was significantly higher than that of the control group for the equivalent amount of time. Cu supplementation improves the growth of Cu-deficient infants recovering from malnutrition.

PIP: To evaluate the effect of copper deficiency on growth in humans a prospective case-control study was performed in Chile on a group of 11 infants identified as Cu deficient based on low plasma Cu (70 mcg/dL (11.0 mcmol/L) and low ceruloplasmin (200 mg/L). Growth was evaluated with anthropometric indices 1 month before and 1 month after onset of Cu supplementation of 80 mcg x 1/kg x 1/d. Plasma Cu and ceruloplasmin rose significantly after 1 month of supplementation. Weight-for-age and weight-for-length indices increased significantly after supplementation only in the Cu-deficient group. Daily energy intake was significantly higher in the Cu-deficient group after supplementation than it was in the control group. Daily weight gain after supplementation increased significantly in the Cu-deficient group and the value for daily weight gain after supplementation was significantly higher than that of the control group for the equivalent amount of time. Cu supplementation improves the growth of Cu-deficient infants recovering from malnutrition.

Controlled trial of zinc supplementation during recovery from malnutrition: effects on growth and immune function.

To evaluate the effect of zinc on growth and immune function, 32 marasmic infants were selected on admission to the nutrition recovery center; 16 received 2 mg/kg daily of elemental zinc supplement as acetate and the remaining received a placebo. Immunity was assessed by skin-test response, T-cell blastic proliferation immunoglobulins, and infectious morbidity. Weight-for-length gain for initial 60 days in Zn-supplemented group was 9% of standard vs 3% for placebo (p less than 0.05). Energy intake was similar in both groups. Incidence of infections, especially pyoderma, was significantly higher in placebo group: 10 of 16 vs 3 of 16 in the supplemented group (p less than 0.025). Plasma Zn was correlated with number of febrile days in the prospective month (r = -0.66, p less than 0.05). The percent anergic infants decreased and serum IgA increased significantly only in Zn-supplemented group. Zinc supplementation has significant effects on weight gain and host defense mechanisms despite normal plasma levels. Zinc supplementation is recommended for optimal recovery from marasmus.

Red cell superoxide dismutase activity as an index of human copper nutrition.

Red cell superoxide dismutase (SOD) activity was evaluated as a biochemical index of copper nutrition in a double-blind study of 17 infants recovering from malnutrition and receiving marginal copper intakes. Children were paired on admission by sex, birth weight, nutritional status and antecedents of diarrhea and breast feeding. Nine served as controls receiving a copper sulfate supplement (80 micrograms/kg daily for 120 d; eight received a placebo and were supplemented only if plasma copper levels dropped below 90 micrograms/dl or on d 90 for at least 30 d. After copper supplementation there was a significant rise (paired t-test; P less than 0.05) in plasma copper (96 vs. 165 micrograms/dl); ceruloplasmin (33 vs. 50 mg/dl) and SOD (1073 vs. 1371 U/g Hb). After supplementation these values were similar to those of the controls. SOD was correlated with plasma copper (r = 0.78; P less than 0.001) and not with weight-for-age or weight-for-length. Addition of copper in vitro did not modify the SOD activity. Red cell SOD is a good marker of copper nutrition in humans and correlates well with plasma copper.

Controlled trial of copper supplementation during the recovery from marasmus.

To evaluate copper nutritional status and the effect of a Cu supplement during recuperation, 27 marasmic infants were selected on admission to the nutrition recovery center at the Instituto de Nutrición y Tecnología de los Alimentos. Thirteen infants received 80 micrograms/kg/day of copper supplement as sulphate and the remaining a placebo. They were paired by birth weight, age, and sex. Anthropometric indices, complete blood count, ceruloplasmin, and Cu were measured on admission and at monthly intervals. Superoxide dismutase activity was measured in hypocupremic infants and was found to be low. The mean +/- SE Cu levels on admission were 127 +/- 10 micrograms/dl for the supplemented group and 137 +/- 10 micrograms/dl for the control. We found an increase in plasma Cu to 159 and 162 micrograms/dl on days 30 and 60 in the supplement group, and a significant decrease after day 30 in the placebo group. The ceruloplasmin levels followed this trend. Hypocupremia was found in 30% of the placebo group and none in the supplement group. The placebo group had a significantly higher prevalence of severe lower respiratory infections. It is concluded that a significant proportion of marasmic infants fed a milk-based diet present, during recovery, biochemical evidence of Cu deficiency. Supplementation with Cu is suggested.