Does clinical research account for diversity in deploying digital health technologies?

Digital health technologies (DHTs) should expand access to clinical research to represent the social determinants of health (SDoH) across the population. The frequency of reporting participant SDoH data in clinical publications is low and is not known for studies that utilize DHTs. We evaluated representation of 11 SDoH domains in 126 DHT-enabled clinical research publications and proposed a framework under which these domains could be captured and subsequently reported in future studies. Sex, Race, and Education were most frequently reported (in 94.4%, 27.8%, and 20.6% of publications, respectively). The remaining 8 domains were reported in fewer than 10% of publications. Medical codes were identified that map to each of the proposed SDoH domains and the resulting resource is suggested to highlight that existing infrastructure could be used to capture SDoH data. An opportunity exists to increase reporting on the representation of SDoH among participants to encourage equitable and inclusive research progress through DHT-enabled clinical studies.

Transcranial Color-Coded Doppler Cerebral Hemodynamics Following Aerobic Exercise Training: Outcomes From a Pilot Randomized Clinical Trial.

Introduction: An active lifestyle with regular exercise is thought to decrease or delay the onset of Alzheimer dementia through increasing blood flow to the brain. We examined the mean flow velocity (MFV) and pulsatility index (PI) in the middle cerebral arteries of individuals randomized into two groups-a Usual Physical Activity (UPA) group and an Enhanced Physical Activity (EPA) exercise intervention group-to determine if exercise training is related to changes in cerebral blood flow. Methods: We examined 23 participants, randomized into a UPA group (n=12) and an EPA group (n=11), with transcranial color-coded Doppler (TCCD) and cardiorespiratory fitness (VO2peak, mL/kg/min) testing at baseline and following a 26-week intervention. TCCD was used to measure MFV and PI. Participants in the EPA group completed supervised aerobic exercise training for 26 weeks. Kendall's tau b correlation was used to examine relationships between variables. The Wilcoxon Rank Sum tests were used to examine changes between the UPA and EPA groups. Results: There was no significant change in MFV or PI in the UPA group or the EPA group (p-values >0.05) between baseline and 26 weeks; the change between the UPA and EPA groups was also not significant (p=0.603). There was no evidence of an association between change in VO2peak and change in MFV or PI (all p-values >0.05). Participants in the EPA group significantly increased their VO2peak compared to the UPA group (p=0.027). Conclusion: This study did not demonstrate evidence of a significant change in the MFV in the middle cerebral arteries or evidence of a significant change in the PI between UPA and EPA groups. Future studies should be performed in larger cohorts and should consider use of personalized exercise programs to maximize understanding of how cerebrovascular hemodynamics change in structure and function with exercise for adults at risk for Alzheimer dementia.

Bioelectronic organ-based sensor for microfluidic real-time analysis of the demand in insulin.

On-line and real-time analysis of micro-organ activity permits to use the endogenous analytical power of cellular signal transduction algorithms as biosensors. We have developed here such a sensor using only a few pancreatic endocrine islets and the avoidance of transgenes or chemical probes reduces bias and procures general usage. Nutrient and hormone-induced changes in islet ion fluxes through channels provide the first integrative read-out of micro-organ activity. Using extracellular electrodes we captured this read-out non-invasively as slow potentials which reflect glucose concentration-dependent (3-15 mM) micro-organ activation and coupling. Custom-made PDMS-based microfluidics with platinum black micro-electrode arrays required only some tens of islets and functioned at flow rates of 1-10 µl/min which are compatible with microdialysis. We developed hardware solutions for on-line real-time analysis on a reconfigurable Field-Programmable Gate Array (FPGA) that offered resource-efficient architecture and storage of intermediary processing stages. Moreover, real-time adaptive and reconfigurable algorithms accounted for signal disparities and noise distribution. Based on islet slow potentials, this integrated set-up allowed within less than 40 µs the discrimination and precise automatic ranking of small increases (2 mM steps) of glucose concentrations in real time and within the physiological glucose range. This approach shall permit further development in continuous monitoring of the demand for insulin in type 1 diabetes as well as monitoring of organs-on-chip or maturation of stem-cell derived islets.

Emissions of volatile sulfur compounds (VSCs) throughout wastewater biosolids processing.

Volatile sulfur compounds (VSCs) are important contributors to nuisance odours from the processing of wastewater sludge and biosolids. However, emission characteristics are difficult to predict as they vary between sites and are likely to be affected by biosolids processing configuration and operation. VSC emissions from biosolids throughout 6 wastewater treatment plants (WWTPs) in Sydney, Australia were examined in this study. H2S was the VSC found at the highest concentrations throughout the WWTPs, with concentrations ranging from 7 to 39,000µg/m3. Based on odour activity values (OAVs), H2S was typically also the most dominant odorant. However, methyl mercaptan (MeSH) was also found to be sensorially important in the biosolids storage areas given its low odour detection threshold (ODT). High concentrations of VOSCs such as MeSH in the storage areas were shown to potentially interfere with H2S measurements using the Jerome 631-X H2S sensor and these interferences should be investigated in more detail. The VSC composition of emissions varied throughout biosolids processing as well as between the different WWTPs. The primary sludge and biosolids after dewatering and during storage, were key stages producing nuisance odours as judged by the determination of OAVs. Cluster analysis was used to group sampling locations according to VSC emissions. These groups were typically the dewatered and stored biosolids, primary and thickened primary sludge, and waste activated sludge (WAS), thickened WAS, digested sludge and centrate. Effects of biosolids composition and process operation on VSC emissions were evaluated using best subset regression. Emissions from the primary sludge were dominated by H2S and appeared to be affected by the presence of organic matter, pH and Fe content. While volatile organic sulfur compounds (VOSCs) emitted from the produced biosolids were shown to be correlated with upstream factors such as Fe and Al salt dosing, anaerobic digestion and dewatering parameters.

Sulfur flows and biosolids processing: Using Material Flux Analysis (MFA) principles at wastewater treatment plants.

High flows of sulfur through wastewater treatment plants (WWTPs) may cause noxious gaseous emissions, corrosion of infrastructure, inhibit wastewater microbial communities, or contribute to acid rain if the biosolids or biogas is combusted. Yet, sulfur is an important agricultural nutrient and the direct application of biosolids to soils enables its beneficial re-use. Flows of sulfur throughout the biosolids processing of six WWTPs were investigated to identify how they were affected by biosolids processing configurations. The process of tracking sulfur flows through the sites also identified limitations in data availability and quality, highlighting future requirements for tracking substance flows. One site was investigated in more detail showing sulfur speciation throughout the plant and tracking sulfur flows in odour control systems in order to quantify outflows to air, land and ocean sinks. While the majority of sulfur from WWTPs is removed as sulfate in the secondary effluent, the sulfur content of biosolids is valuable as it can be directly returned to soils to combat the potential sulfur deficiencies. Biosolids processing configurations, which focus on maximising solids recovery, through high efficiency separation techniques in primary sedimentation tanks, thickeners and dewatering centrifuges retain more sulfur in the biosolids. However, variations in sulfur loads and concentrations entering the WWTPs affect sulfur recovery in the biosolids, suggesting industrial emitters, and chemical dosing of iron salts are responsible for differences in recovery between sites.

Distribution and sensorial relevance of volatile organic compounds emitted throughout wastewater biosolids processing.

A diverse range of volatile organic compounds (VOCs) are emitted from wastewater biosolids processing. Odorous emissions are predominately made up of volatile sulfur compounds (VSCs) which are typically the only odorants measured. However, a range of VOCs are known to contribute to malodours yet previous studies often overlook the contribution of VOCs in comparison with VSCs. This study aims to evaluate how emissions are affected by different biosolids processing configurations, and if any non-sulfur VOCs should be included in odour measurement and management. Non-sulfur VOCs emitted from biosolids throughout six wastewater treatment plants in the Sydney, Australia region were measured at six locations on average twice each week over 2-3weeks at each site. Variations in types of VOCs emitted throughout and between the sites were assigned to differences in WWTP processing configurations, plant operation and variations in industrial and municipal flows to the sewer network, referred to as sewer catchments. The presence of VOCs is likely due to biotic generation as well as industrial or residential additions to the sewer network. The dewatered and stored biosolids samples had the highest levels of VOC emissions. Sensorially important odorants were p-cresol and butanoic acid, based on the frequency of detection and odour activity values. Other compounds with a high risk of nuisance impacts were trimethylamine, indole and phenol emitted from the dewatered and stored biosolids, and volatile fatty acids from the anaerobic digester inlet and outlet at one particular site. The findings show that non-sulfur VOCs should be added to odorant monitoring campaigns at WWTPs. Identification of VOCs as sensorially important odorants opens opportunities for the more efficient management of nuisance odours, through targeted odour control or process improvement.

Odorous volatile organic compound (VOC) emissions from ageing anaerobically stabilised biosolids.

Opportunities for the beneficial re-use of biosolids are limited by nuisance odour emissions. Volatile organic compounds (VOCs) from anaerobically stabilised biosolids were measured to identify compounds that could contribute to the overall odour character of nuisance emissions. Flux hood sampling and chemical analysis were used to identify VOCs emitted from biosolids as they were stored in ambient conditions. Compounds emitted varied as the biosolid cakes were stored for a period of 50 days. VOCs detected in the biosolids are likely to occur from catchment sources as well as abiotic and biotic generation in the wastewater processing and the biosolids as they are stored. Odour activity values (OAVs) were used to compare odorants. Trimethylamine was the only VOC detected that exceeded the sulfur compounds in terms of OAVs. Other compounds such as limonene, ethyl methyl benzene and acetic acid were detected at concentrations exceeding their olfactory detection limits, however at lower OAVs than sulfur compounds.

[About microbiological methods for detection of oxacillin resistance in coagulase-negative staphylococci]. / Sobre los métodos microbiológicos para la detección de la resistencia a oxacilina en Staphylococcus coagulasa negativos.

OBJECTIVE: Coagulase-negative staphylococci (CoNS) take part of the human skin and mucous membranes, but they are also involving in infections with the increasing use of prosthetic, indwelling devices or intravascular catheter-related bacteraemia. They are more resistance than Staphylococcus aureus against a wide range of antimicrobial agents, and it have been observed an increase in morbidity and mortality of patients with incorrect treatment. METHODS: To analyze the results obtained by different commercial techniques: two automatic microdilution systems (MicroScan and Vitek2 Compact), PBP2a agglutiation test, with and without 1 µg oxacillin disk induction, and detection of mecA gene by nucleic acids amplification techniques, for the diagnosis of methicillin resistance staphylococci in 170 strains of CoNS isolated from blood cultures. RESULTS: One hundred and seventy methicillin resistance staphylococci were detected by MicroScan, 167 strains by Vitek 2 Compact, 115 strains were PBP2a positive without oxacillin induction and 168 after oxacillin induction. Finally, 167 strains were mecA gene positive detected by nucleic acids amplification techniques. CONCLUSIONS: It is necessary to do oxacillin induction before PBP2a test to avoid false negatives. There are a great variability in the phenotypic expression of methicillin resistance in CoNS.

Towards a comprehensive greenhouse gas emissions inventory for biosolids.

Effective handling and treatment of the solids fraction from advanced wastewater treatment operations carries a substantial burden for water utilities relative to the total economic and environmental impacts from modern day wastewater treatment. While good process-level data for a range of wastewater treatment operations are becoming more readily available, there remains a dearth of high quality operational data for solids line processes in particular. This study seeks to address this data gap by presenting a suite of high quality, process-level life cycle inventory data covering a range of solids line wastewater treatment processes, extending from primary treatment through to biosolids reuse in agriculture. Within the study, the impacts of secondary treatment technology and key parameters such as sludge retention time, activated sludge age and primary-to-waste activated sludge ratio (PS:WAS) on the life cycle inventory data of solids processing trains for five model wastewater treatment plant configurations are presented. BioWin(®) models are calibrated with real operational plant data and estimated electricity consumption values were reconciled against overall plant energy consumption. The concept of "representative crop" is also introduced in order to reduce the uncertainty associated with nitrous oxide emissions and soil carbon sequestration offsets under biosolids land application scenarios. Results indicate that both the treatment plant biogas electricity offset and the soil carbon sequestration offset from land-applied biosolids, represent the main greenhouse gas mitigation opportunities. In contrast, fertiliser offsets are of relatively minor importance in terms of the overall life cycle emissions impacts. Results also show that fugitive methane emissions at the plant, as well as nitrous oxide emissions both at the plant and following agricultural application of biosolids, are significant contributors to the overall greenhouse gas balance and combined are higher than emissions associated with transportation. Sensitivity analyses for key parameters including digester PS:WAS and sludge retention time, and assumed biosolids nitrogen content and agricultural availability also provide additional robustness and comprehensiveness to our inventory data and will facilitate more customised user analyses.

Técnica neuromuscular de la vaina rectal abdominal / No disponible

La Técnica Neuromuscular (TNM) permite simultanear exploración, diagnóstico y tratamiento, y tiene como objetivo normalizar el tejido muscular y conjuntivo. La técnica permite localizar las induraciones y/o dificultades del deslizamiento dentro de tejido conjuntivo, que se interpretan como una disminución de las propiedades viscoelásticas de dicho tejido, lo que limita la doble función de filtro iónico y difusión de nutrientes. Consta de una serie de trazos realizados con el pulgar, de forma lenta, que permiten centrar la atención tanto en la sensación palpatoria como en la respuesta del paciente. La técnica abdominal básica trata las zonas abdominales y consta de varias partes. Debe prestarse especial atención a la línea alba y la vaina rectal abdominal, por su gran variedad de factores funcionales y estructurales, y su repercusión tanto a nivel local como sobre la salud en su conjunto (AU)

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Repercusiones de la técnica neuromuscular abdominal sobre el ángulo craneocervical en pacientes con cervicalgia mecánica crónica / Effects of the neuromuscular abdominal technique on the craniocervical angle in patients with chronic mechanical cervicalgia

Introducción: Los músculos abdominales juegan un papel importante en el mantenimiento de la postura. Existen evidencias de que las disfunciones de la pared abdominal tienen gran influencia con los dolores de espalda y en particular con las cervicalgias mecánicas crónicas (CMC). Objetivos: Evaluar la influencia inmediata de la Técnica Neuromuscular (TNM) a nivel de la vaina rectal abdominal, en los trabajadores con posición mantenida más de 4 horas delante del ordenador, en el dolor percibido durante el movimiento cervical, en la movilidad cervical y en la posición de la cabeza. Material y Métodos: Se realizó un ensayo clínico aleatorizado, paralelo de tratamiento experimental frente a tratamiento control, en 34 pacientes (n=34), Grupo Control (GC:n=17) y Grupo Experimental (GE:n=17) . El GC recibió como placebo una técnica de simulación de equilibración funcional a nivel del epigastrio, y en el GE aplicamos la Técnica Neuromuscular a nivel de la vaina rectal abdominal. Resultados: Se encontraron diferencias estadísticamente significativas en el ángulo cráneo-cervical en sedestación (p=0,033) con un 4,93 ± 5,7 % de cambio en el grupo experimental y un 0,6 ± 3,77% en el grupo control. No se encontraron diferencias en el ángulo cráneo-cervical en bipedestación, en el dolor percibido durante el movimiento cervical ni en la amplitud de movilidad del cuello (p>0,05). Conclusiones: La TNM a nivel de la vaina rectal abdominal mejora la posición de la cabeza en sedestación , pero no es útil para equilibrar la posición cefálica en bipedestación, aumentar la movilidad cervical, ni modificar el dolor percibido durante el movimiento cervical (AU)

Introduction: The abdominal muscles play an important role in maintaining the posture. There is evidence that dysfunctions in the abdominal wall have a profound effect on back pain and, in particular, on chronic mechanical cervicalgia (CMC). Objectives: To assess the immediate effect of the Neuromuscular Technique (NMT) at the level of the rectus abdominis sheath in workers maintaining their position for more than 4 hours in front of a computer, for pain noticed during a cervical movement, in cervical mobility and in the head's position. Material and methods: A randomised clinical trial was carried out, in parallel with an experimental treatment compared to a control treatment, in 34 patients (n=34), Control Group (CG:n=17) and Experimental Group (EG:n=17). The control group received a technique simulating a functional balance at the epigastric level, and on the experimental group we applied the Neuromuscular Technique at the level of the rectus abdominis sheath. Results: No statistically significant differences were found in the craniocervical angle in a sitting position (p=0.033) with a 4.3±5.7% change in the experimental group and 0.6±3.77% in the control group. No differences were found in the craniocervical angle in a standing position, in the pain noticed during cervical movement or in the range of neck mobility (p>0.05). Conclusions: NMT at the level of the rectus abdominis sheath improves the head’s position sitting down, but it is not useful to balance the cephalic position when standing, increase the cervical mobility or modify the pain noticed during a cervical movement (AU)

Hyperinfection strongyloidiasis in a liver transplant recipient treated with parenteral ivermectin.

Severe strongyloidiasis, including hyperinfection and dissemination, is a recognized complication of solid organ transplantation. However, the development of strongyloidiasis in a liver transplant recipient has not been previously described. We present a case of severe strongyloidiasis occurring in a patient 4 months after liver transplantation and 1 month after receiving treatment for acute rejection. We assess the management challenges in this patient who remained symptomatic despite oral treatment with ivermectin and albendazole and eventual successful treatment with parenteral ivermectin. We review the published experience with alternative methods of ivermectin administration. We also investigate the possible source of infection, as the patient was not from an endemic area.

Necesidad de una clínica multidisciplinar de pie diabético: reflexiones sobre nuestra experiencia / The need for a multidisciplinary clinical picture of diabetic foot: reflections on our experience

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Consumo de SPA, reflexiones académicas sobre estudios epidemiológicos realizados en Colombia / SPA consumption, academic reflections regarding epidemiological studies made in Colombia

El propósito del siguiente artículo es presentar 10 estudios epidemiológicos sobre consumo de sustancias psicoactivas realizadas en Colombia desde 1992 hasta 2001, identificando sus aportes en el control de consumo y las dificultades que puedan llegar a alterar la validez y generalización de los resultados, para ello se tuvieron en cuenta los siguientes aspectos: objetivo del estudio, diseño metodológico y resultados. Se busca que a partir de esta reflexión se diseñen y ejecuten otros estudios con miras a brindar respuestas eficaces y concretas ante esta problemática que cobra cada vez más víctimas especialmente en la población más joven. El propósito del siguiente artículo es presentar 10 estudios epidemiológicos sobre consumo de sustancias psicoactivas realizadas en Colombia desde 1992 hasta 2001, identificando sus aportes en el control de consumo y las dificultades que puedan llegar a alterar la validez y generalización de los resultados, para ello se tuvieron en cuenta los siguientes aspectos: objetivo del estudio, diseño metodológico y resultados. Se busca que a partir de esta reflexión se diseñen y ejecuten otros estudios con miras a brindar respuestas eficaces y concretas ante esta problemática que cobra cada vez más víctimas especialmente en la población más joven.

The purpose of this paper is to discuss our review of ten (10) epidemiological studies on the consumption of Psychoctives Subtances caried out in Colombia from 1992 to 2001. We identified their contribution to the control of consumption as well some methodological problems which could have affected their validity and the generalization of their results. We focused on the following characteristics of the studies: objectives, methodological desing and results. We hope, based on our review, to desing and to excuse more powerful studies and programs aimed to help in the solution to this problem.

[Radical hysterectomy in stage 1-B-1 cervical cancer]. / Histerectomía radical en cáncer de cérvix estadio 1-B-1.

From 1980 to 1991 were received 6,295 patients diagnosed as invasive cervical cancer at the Instituto Nacional de Cancerología of México; from this group, 884 cases were considered as stage IB (12.76%) and 133 cases, adenocarcinoma in 10, adenosquamous carcinoma in 6 and minimal deviation adenocarcinoma (malignant adenoma) in one case. Eighty percent of cases had a less than 2 cm tumor size. Thirteen cases had metastatic pelvic lymph nodes. Mean age 46 years (range 28-64 years), mean operatory time 4:50 hours (range 3-15 hours), average of hemorrhage 1,500 ml (range 300 to 5,000 ml). One patient died from no related cause. Bladder malfunction was observed in 8.4% and uro-vaginal fistula in 6.9% of the cases. Thirteen patients experimented tumor relapsing after 8 to 22 months of follow up. Only 3 out of 7 from that with tumor relapsing were saved with whole pelvic radiotherapy. One hundred-fifteen patients are alive and well after 63 months mean follow-up. Radical hysterectomy plus bilateral lymphadenectomy is an optimal surgical procedure in managing early invasive carcinoma of the cervix uteri.

Menstrual patterns and progesterone circulating levels following different procedures of tubal occlusion.

This study was undertaken to assess the effects of different tubal occlusion procedures on ovarian function. Three groups of subjects randomized to tubal occlusion by laparoscopy and Yoon ring (24 subjects), minilaparotomy and Yoon ring (19 subjects) and minilaparotomy and Pomeroy (22 subjects), and one separate control group of 26 healthy subjects not using any form of contraception were studied in a prospective design. The characteristics of the menstrual patterns were studied for one year after sterilization. Determination of the circulating progesterone levels were made on days 15, 20 and 25 of menstrual cycles initiated 1, 3, 6 and 12 months following the tubal ligation. In the analysis of the bleeding pattern there was a statistically significant difference in the mean segment length and in the longest bleeding-free interval in the subjects who had been sterilized by minilaparotomy with Yoon ring, when compared to the other two study groups and to the control group. However, the magnitude of this difference in number of days was not considered clinically significant. There was no statistically significant difference in the percentage of ovulatory cycles within the study and the control groups, or when the results of the study groups were compared with each other or to the control group.

PIP: This study was undertake to assess the effects of different tubal occlusion procedures on ovarian function. 3 groups of subjects randomized to tubal occlusion by laparoscopy and Yoon ring (24 subjects), minilaparotomy and Yoon ring (19 subjects) and minilaparotomy and Pomeroy (22 subjects), and 1 separate control group of 26 healthy subjects not using any form of contraception were studied in a prospective design. The characteristics of the menstrual patterns were studied for 1 year after sterilization. Determination of the circulating progesterone levels were made on days 15, 20, and 25 of menstrual cycles initiated 1,3,6 and 12 months following the tubal ligation. In the analysis of the bleeding pattern there was a statistically significant difference in the mean segment length and in the longest bleeding-free interval in the subjects who had been sterilized by minilaparotomy with Yoon ring, when compared to the other 2 study groups and to the control group. However, the magnitude of this difference in number of days was not considered clinically significant. There was no statistically significant difference in the % of ovulatory cycles within the study and the control groups, or when the results of the study groups were compared with each other or to the control group. (Author's).

The use of biodegradable norethisterone implants as a 6-month contraceptive system.

The effects of a 6-month contraceptive system of biodegradable norethisterone (NET) implants on the menstrual cycle, estradiol and progesterone levels, the presence of side effects, its contraceptive effectiveness, and the NET levels achieved were studied in a group of nine women. There was practically no disruption of the menstrual cycle and no important side effects. Ovulation was inhibited in four subjects, and another four subjects remained ovulatory. In all the subjects a cyclic secretion of estradiol was maintained. No pregnancies occurred. The circulatory levels of NET were very stable throughout the 6-month period of implant use.

Defective thyroidal iodine concentration in protein-calorie malnutrition.

Although protein-calorie malnutrition (PCM) is known to result in various abnormalities of thyroid function, the exact relationship between the two is not clearly understood. Therefore, the thyroid function of 10 men, 13-55 yr of age, with severe PCM was studied in a clinical research ward before and 3-4 months after protein-calorie repletion. Before repletion, all subjects had low serum T4 (mean +/- SEM, 5.1 +/- 0.5 micrograms/dl) and T3 (74 +/- 6 ng/dl) concentrations. Eight subjects were chemically euthyroid, and their free T4 (1.5 +/- 0.1 ng/dl) and serum TSH (2.9 +/- 1.4 microU/ml) values were normal. Two subjects were chemically hypothyroid, with low free T4 values and high serum TSH values. After repletion, the 8 euthyroid subjects had significant increases in serum T4 (P less than 0.01) and T3 (P less than 0.005), but TSH did not change. Serum T4 and T3 were still lower (P less than 0.05-0.001) and TSH higher (P less than 0.01) than in 28 normal men of comparable age coming from the same area. After repletion, values remained unchanged in the 2 hypothyroid subjects, except for moderate increases in serum T3 and slight decreases in TSH. In all PCM subjects, values of thyroidal exchangeable iodine (23.1 +/- 7 vs. 42.9 +/- 8 mg; P less than 0.02), estimated thyroidal I per g wet wt (1.05 +/- 0.3 vs. 1.99 +/- 0.36 mg; P less than 0.02), and thyroidal iodide clearance (13.8 +/- 1.6 vs. 19.4 +/- 1.3 ml/min; P less than 0.002) were lower before repletion than after; the protein-bound 131I level (72 h; 0.27% vs. 0.08 dose/liter; P less than 0.05) was higher, but thyroid hormone secretion rates (200 +/- 49 vs. 153 +/- 25 micrograms/day) were not significantly different. Thyroid iodide clearance was lower even though plasma inorganic iodine (6.3 +/- vs. 12.5 +/- 3 micrograms/liter; P less than 0.05) and daily urinary iodine excretion (158 +/- 43 vs. 395 +/- 62 micrograms; P less than 0.01) were lower before than after repletion. In 2 PCM euthyroid subjects, baseline thyroid 131I uptake was lower before than after repletion, and the magnitude of the increase after TSH (10 U, im) stimulation was greater when the malnourished state improved. TSH increased concentrations of serum T4 and T3 both before and after protein repletion. After repletion, one hypothyroid patient failed to respond to TSH; the other had a small increase in 131I uptake but not in serum T4 or T3. The results indicate defective thyroid iodine concentration in human PCM, but adequate hormone secretion. This situation leads to depletion of thyroid iodine stores. This alteration, if extreme, might result in hypothyroidism. Adequate protein-calorie intake tends to reverse these abnormalities.