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Preconcentration and speciation of arsenic by using a graphene oxide nanoconstruct functionalized with a hyperbranched polyethyleneimine

Ahmad H, Umar K, Ali SG, Singh P, Islam SS, Khan HM

Mikrochim Acta, 2018 05 10;185(6):290.
PMID: 29748777 DOI: 10.1007/s00604-018-2829-z

A column sorbent for arsenic was obtained through immobilization of highly branched polyethylenimine (PEI) on graphene oxide (GO). The composite material enables speciation of arsenic by tuning the pH of the sample solution which governs the surface charge of the sorbent, depending on whether amino groups (-NH2) are present (at high pH) or ammonium groups (-NH3+; at low pH). The composite can be applied to improved speciation of arsenic (compared to unmodified GO). There is no need for oxidation or reduction of arsenic. A column procedure was applied for the sequestered extraction and speciation of As(III) and As(V) from environmental water samples before their determination by hydride generation-microwave induced plasma-atomic emission spectrometry. The method has a preconcentration factor of 440 for As(III) and of 400 for As(V). The limits of detection (at 3 S/N) are extremely low, being 1.8 ± 0.2 ngL-1 for As(III) and 1.3 ± 0.08 ngL-1 for As(V). This is much lower than the arsenic guideline value of 10 μgL-1 as given by the WHO. Graphical abstract Graphene oxide interconnected with polyethyleneimine has been employed for the speciation and determination of arsenic. Quantitation by atomic emission spectroscopy reveals a high preconcentration factor (440 and 400) and low LODs of 1.8 ± 0.2 and 1.3 ± 0.08 ngL-1for As(III) and As(V), respectively.
PATIENTS SATISFACTION WITH PAIN MEDICATION: A STUDY OF LABORATORY MEDICINE

Akula S, Singh P, Murad M, Hameed W

Georgian Med News, 2022 Oct.
PMID: 36539132

Patients in pain have different levels of satisfaction. The experience of patients regarding medication is based on their past treatment. The mental satisfaction of the patients for laboratory medication is necessary for their health recovery. The satisfaction of patients is a challenge for healthcare institutes to provide better facilities to patients. The goal of this research is to investigate the impact of taking patch pain medication, taking oral pain medication, and taking intravenous medication on patients' satisfaction with laboratory pain medication. The model of this research is based on the gap in the literature. 645 responses were considered for data analysis with Smart PLS 3.0 for study findings. The findings disclosed the impact of taking patch pain medication, taking an oral medication, and taking intravenous medication is significant on patients' satisfaction with laboratory pain medication. The study has theoretically enriched the literature with a unique contribution to the study model. Practically, the study has discovered the ways the healthcare sector can improve the satisfaction of patients for their better health and satisfaction. The future directions highlighted by this study are useful for future studies to contribute to patients' satisfaction with laboratory medication.
Association between painful physical symptoms and clinical outcomes in East Asian patients with major depressive disorder: a 3-month prospective observational study

Ang QQ, Wing YK, He Y, Sulaiman AH, Chiu NY, Shen YC, et al.

Int J Clin Pract, 2009 Jul;63(7):1041-9.
PMID: 19570122 DOI: 10.1111/j.1742-1241.2009.02107.x

Reports from non-Asian populations indicate that painful physical symptoms (PPS) are associated with poorer clinical and functional outcomes in major depressive disorder (MDD). The purpose of this study is to report comparative changes in disease severity, treatment patterns and quality of life observed in East Asian patients with MDD, with and without PPS, as assessed prospectively over a 3-month observation period.
Fulltext The impact of satisfaction, and autonomous learning strategies use on scholastic achievement during Covid-19 confinement in Malaysia

Anthonysamy L, Singh P

Heliyon, 2023 Feb;9(2):e12198.
PMID: 36755584 DOI: 10.1016/j.heliyon.2022.e12198

The purpose of this study is twofold. Firstly, this study seeks to better understand students' learning experience, through scholastic achievement and secondly, this study analyses students' use of autonomous learning strategies, namely satisfaction, self-efficacy, social interactive engagement and study engagement in digital learning amidst the Covid-19 lockdown. While Malaysia grapples with a growing number of Covid-19 cases, the underlying toll of the pandemic has hit the youth hard with many mental health concerns and this has affected their learning. The nurturing of autonomous learning strategies especially during the Covid-19 confinement is critically needed to assist this vulnerable group. Although there is a plethora of studies given students' use of autonomous learning strategies towards scholastic achievement during the Covid-19 lockdown internationally, studies in the Asia region are still rudimentary. This study investigated 316 university students from targeted universities in Malaysia. Responses were gathered from an online survey. Data were analysed using Partial Least Squares-Structural Equation Modelling (PLS-SEM), a second-generation multivariate statistical approach to assess the outer model and inner model that displays the relationships between the constructs. The results of this case study reported that student interactive engagement (β = 0.348, t = 5.45) and study environment (β = 0.314, t = 4.81) have a significant impact on students' scholastic achievement during the lockdown. Remarkably, new insights are uncovered in this paper revealing no relationship between self-efficacy and satisfaction with students' scholastic achievement. Possible explanations surrounding why satisfaction and self-efficacy were suppressed by the lockdown are discussed. The outcomes of this study provide key insights that may assist students to condition their minds to use autonomous learning strategies in digital learning to enhance their scholastic achievement.
Ethnic influence on uterine activity in spontaneous normal labour

Arulkumaran S, Gibb DM, Chua S, Singh P, Ratnam SS

Br J Obstet Gynaecol, 1989 Oct;96(10):1203-6.
PMID: 2590656

Uterine activity in spontaneous normal labour was studied in Singaporean Malay women at term with a singleton vertex presentation. Nulliparae had significantly higher uterine activity compared with their multiparous counterparts. Uterine activity in the Malay population was compared with that of a similar Chinese population. When controlled for parity, maternal height and birthweight of babies, there was no difference in uterine activity between the two groups.
Fulltext The effect of piroxicam in preventing surgically induced miosis

Au MK, Singh P

Med J Malaysia, 1991 Dec;46(4):329-32.
PMID: 1840440

The effect of an antiprostaglandin, piroxicam, in preventing surgically induced miosis is studied. Patients undergoing extracapsular cataract surgery were randomly divided into the piroxicam and placebo groups. Intra-operative measurements of the pupillary diameters were performed. The stages of procedure at which they were measured were at the beginning of operation (Stage 1), after anterior capsulotomy (Stage 2), after lens nucleus delivery (Stage 3) and at the end of irrigation and aspiration (Stage 4). It is noted in this Study that the pupillary diameters were larger at stages 2,3 and 4 in the piroxicam group. The increase in the mean pupillary areas of the piroxicam group were statistically significant for Stages 3 and 4.
Fulltext Preradiation peplomycin for advanced squamous cell carcinomas

Azhar T, Singh P

Med J Malaysia, 1988 Mar;43(1):40-3.
PMID: 2468988
Using tracers to link health services to training through evaluation

Bandaranayake RC, Singh PJ

Med Educ, 1993 Nov;27(6):509-17.
PMID: 8208159

The tracer concept was applied to evaluate the delivery of family health care and the training of family health workers. A retrospective evaluation permitted linking the products of care to process, input and context, by isolating and analysing potential factors contributing to a limited number of representative concerns. Contributory learning deficiencies identified in health workers, one input to health care as well as a product of training, enabled the evaluation of training programmes to be focused on related segments of the courses. The latter were evaluated through a pathway analysis which followed the same deficiency model as the evaluation of health care. Links were thus established between the traditionally compartmentalized training and service sectors in health.
Fulltext Discordance between medication adherence and blood pressure control in primary care clinics in Negeri Sembilan, Malaysia: The problem of therapeutic inertia

Chan CW, Wang J, Bouniu JJ, Singh P, Teng CL

International e-Journal of Science, Medicine & Education, 2015;9(3):27-32.
MyJurnal

Poor adherence to anti-hypertensive agents may be a major contributor for suboptimal blood pressure control among patients with hypertension. This study was conducted to assess the adherence to antihypertensive agents using Morisky Medication Adherence Scale (MMAS-8) among primary care patients, and to determine whether the blood pressure control is associated with the level of adherence.
Performance evaluation of external compound parabolic concentrator integrated with thermal storage tank for domestic solar refrigeration system

Christopher SS, Thakur AK, Hazra SK, Sharshir SW, Pandey AK, Rahman S, et al.

Environ Sci Pollut Res Int, 2023 Mar 20.
PMID: 36940023 DOI: 10.1007/s11356-023-26399-2

The aim of this research was to develop a model for a solar refrigeration system (SRS) that utilizes an External Compound Parabolic Collector and a thermal energy storage system (TESS) for solar water heating in Chennai, India. The system parameters were optimized using TRNSYS software by varying factors such as collector area, mass flow rate of heat transfer fluid, and storage system volume and height. The resulting optimized system was found to meet 80% of hot water requirements for the application on an annual basis, with an annual collector energy efficiency of 58% and an annual TESS exergy efficiency of 64% for a discharge period of 6 h per day. In addition, the thermal performance of 3.5 kW SRS was studied by connecting it to an optimized solar water heating system (SWHS). The system was found to generate an average cooling energy of 12.26 MJ/h annually, with a coefficient of performance of 0.59. By demonstrating the ability to efficiently generate both hot water and cooling energy, the results of this study indicate the potential for utilizing a SWHS in combination with STST and SRS. The optimization of system parameters and the use of exergy analysis provide valuable insights into the thermal behavior and performance of the system, which can inform future designs and improve the overall efficiency of similar systems.
Fulltext Antimicrobial, antioxidant and anti-inflammatory activities of seeds from emblica officinalis (Gaertn.)

G Singh P, S Jain A, B Sridhara Setty P, Bv S, S Patil S, P A, et al.

Bioinformation, 2022;18(8):683-691.
PMID: 37323557 DOI: 10.6026/97320630018683

There is a shred of evidence to suggest that Emblica officinalis Gaertn, the botanical name for amla seeds, has greater medicinal potential than amla fruit. We conducted this work to assess the anti-inflammatory, antibacterial, and antioxidant capacities of E. officinalis seed extracts. The bioactive components from the seeds were fractionated using chloroform, hexane, methanol, and diethyl ether, according to the polarity of the solvents. The total amount of phenolic and flavonoid was estimated. Both the reducing power and antioxidant capacities of the extracts were evaluated using the DPPH (1,1-diphenyl-2-picryl-hydrazyl) technique. 15-lipoxygenase (LOX) was inhibited by seed extracts at doses ranging from 5 to 25 micrograms. In silico docking was employed to assess the results. Some human pathogenic microorganisms were tested for their antibacterial activity using the agar disc diffusion method. Escherichia coli, Proteus vulgaris, and Klebsiella pneumonia were inhibited by a methanolic extract with an IC50 value of 58g, making it the most common organic solvent extract. Methanolic extracts also showed good antioxidant and antibacterial activity. Our investigation led us to discover that amla seeds have anti-inflammatory, antioxidant, and antibacterial effects.
Fulltext The Global, Regional, and National Burden of Adult Lip, Oral, and Pharyngeal Cancer in 204 Countries and Territories: A Systematic Analysis for the Global Burden of Disease Study 2019

GBD 2019 Lip, Oral, and Pharyngeal Cancer Collaborators, Cunha ARD, Compton K, Xu R, Mishra R, Drangsholt MT, et al.

JAMA Oncol, 2023 Oct 01;9(10):1401-1416.
PMID: 37676656 DOI: 10.1001/jamaoncol.2023.2960

IMPORTANCE: Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.
OBJECTIVE: To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.
EVIDENCE REVIEW: The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.
FINDINGS: In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.
CONCLUSIONS AND RELEVANCE: In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.
Description of novel species of Aliinostoc, Desikacharya and Desmonostoc using a polyphasic approach

Kabirnataj S, Nematzadeh GA, Talebi AF, Saraf A, Suradkar A, Tabatabaei M, et al.

Int J Syst Evol Microbiol, 2020 May;70(5):3413-3426.
PMID: 32375955 DOI: 10.1099/ijsem.0.004188

Five cyanobacterial strains with Nostoc-like morphology from different localities of the Mazandaran province of Iran were characterized using a polyphasic approach. Three strains clustered within the Aliinostoc clade whereas one each of the remaining two strains clustered within the genera Desmonostoc and Desikacharya. The phylogenetic positioning of all the strains by the bayesian inference, neighbour joining and maximum parsimony methods inferred using 16S rRNA gene indicated them to represent novel species of the genera Aliinostoc, Desmonostoc and Desikacharya. The 16S-23S ITS secondary structure analysis revealed that all five strains under study represented novel species unknown to science. In accordance with the International Code of Nomenclature for algae, fungi and plants we describe three novel species of the genus Aliinostoc and one species each of the genera Desmonostoc and Desikacharya.
Fulltext Expression and DNA methylation of SERK, BBM, LEC2 and WUS genes in in vitro cultures of Boesenbergia rotunda (L.) Mansf

Karim R, Tan YS, Singh P, Khalid N, Harikrishna JA

Physiol Mol Biol Plants, 2018 Sep;24(5):741-751.
PMID: 30150851 DOI: 10.1007/s12298-018-0566-8

The process of somatic embryogenesis and plant regeneration involve changes in gene expression and have been associated with changes in DNA methylation. Here, we report the expression and DNA methylation patterns of SOMATIC EMBRYOGENESIS RECEPTOR-LIKE KINASE (SERK), BABY BOOM (BBM), LEAFY COTYLEDON 2 (LEC2) and WUSCHEL (WUS) in meristematic block of newly emerged shoots from rhizome, embryogenic and non-embryogenic calli, prolonged cell suspension culture, ex vitro leaf, and in vitro leaf of regenerated plants of Boesenbergia rotunda. Among all seven samples, based on qRT-PCR, the highest level of expression of SERK, BBM and LEC2 was in embryogenic callus, while WUS was most highly expressed in meristematic block tissue followed by embryogenic callus. Relatively lower expression was observed in cell suspension culture and watery callus for SERK, LEC2 and WUS and in in vitro leaf for BBM. For gene specific methylation determined by bisulfite sequencing data, embryogenic callus samples had the lowest levels of DNA methylation at CG, CHG and CHH contexts of SERK, LEC2 and WUS. We observed negative correlation between DNA methylation at the CG and CHG contexts and the expression levels of SERK, BBM, LEC2 and WUS. Based on our results, we suggest that relatively higher expression and lower level of DNA methylation of SERK, BBM, LEC2 and WUS are associated with somatic embryogenesis and plant regeneration in B. rotunda.
Fulltext Multifaceted Pharmacological Potentials of Curcumin, Genistein, and Tanshinone IIA through Proteomic Approaches: An In-Depth Review

Khan FB, Singh P, Jamous YF, Ali SA, Abdullah, Uddin S, et al.

Cancers (Basel), 2022 Dec 30;15(1).
PMID: 36612248 DOI: 10.3390/cancers15010249

Phytochemicals possess various intriguing pharmacological properties against diverse pathological conditions. Extensive studies are on-going to understand the structural/functional properties of phytochemicals as well as the molecular mechanisms of their therapeutic function against various disease conditions. Phytochemicals such as curcumin (Cur), genistein (Gen), and tanshinone-IIA (Tan IIA) have multifaceted therapeutic potentials and various efforts are in progress to understand the molecular dynamics of their function with different tools and technologies. Cur is an active lipophilic polyphenol with pleiotropic function, and it has been shown to possess various intriguing properties including antioxidant, anti-inflammatory, anti-microbial, anticancer, and anti-genotoxic properties besides others beneficial properties. Similarly, Gen (an isoflavone) exhibits a wide range of vital functions including antioxidant, anti-inflammatory, pro-apoptotic, anti-proliferative, anti-angiogenic activities etc. In addition, Tan IIA, a lipophilic compound, possesses antioxidant, anti-angiogenic, anti-inflammatory, anticancer activities, and so on. Over the last few decades, the field of proteomics has garnered great momentum mainly attributed to the recent advancement in mass spectrometry (MS) techniques. It is envisaged that the proteomics technology has considerably contributed to the biomedical research endeavors lately. Interestingly, they have also been explored as a reliable approach to understand the molecular intricacies related to phytochemical-based therapeutic interventions. The present review provides an overview of the proteomics studies performed to unravel the underlying molecular intricacies of various phytochemicals such as Cur, Gen, and Tan IIA. This in-depth study will help the researchers in better understanding of the pharmacological potential of the phytochemicals at the proteomics level. Certainly, this review will be highly instrumental in catalyzing the translational shift from phytochemical-based biomedical research to clinical practice in the near future.
Biotransformation of Raw Mango Seed Waste into Bacterial Hydrolytic Enzymes Enhancement Via Solid State Fermentation Strategy

Khan PA, Mohammad A, Bansal SL, Lal B, Singh P, Singh R, et al.

Mol Biotechnol, 2024 Jan 09.
PMID: 38195817 DOI: 10.1007/s12033-023-01022-4

Solid waste generation is a huge contributor to environmental pollution issues, and food wastes are prominent in this category due to their large generation on a day-to-day basis. Thus, the settlement of daily food waste is one of the major constraints and needs innovative manufacturing sheme to valorize solid waste in sustainable manner. Moreover, these food wastes are rich in organic content, which has promising scope for their value-added products. In the present study, raw mango seed waste has been biotransformed to produce bacterial hydrolytic enzymes as feedstock. On investigating the impact of substrate, the highest bacterial cellulase production was recorded to be 18 IU/gds FP (filter paper) in 24 h of microbial incubation at 5 g of substrate in solid-state fermentation (SSF). Furthermore, at 40 °C and pH 6.0, 23 IU/gds FP enzyme could be produced in 24 h of SSF. Beside this, on comparing the influence of inorganic and organic nitrogen sources, urea has been found to provide better cellulase production, which yielded 28 IU/gds FP in 24 h of incubation, along with 77 IU/gds BG (β-glucosidase) and 89 IU/gds EG (endoglucanase). On the other hand, Tween-40 and Tween-80, two different surfactants, were employed at a 1.0% concentration for 24 h of incubation. It was noticed that Tween-80 showed complete enzyme activity at 24 h, which was found to be relatively superior to that of Tween-40. This study may have potential utility in enzyme production using mango seed as a food waste for various industrial applications.
Fulltext Integrated genomic view of SARS-CoV-2 in India

Kumar P, Pandey R, Sharma P, Dhar MS, A V, Uppili B, et al.

Wellcome Open Res, 2020;5:184.
PMID: 32995557 DOI: 10.12688/wellcomeopenres.16119.1

Background: India first detected SARS-CoV-2, causal agent of COVID-19 in late January 2020, imported from Wuhan, China. From March 2020 onwards, the importation of cases from countries in the rest of the world followed by seeding of local transmission triggered further outbreaks in India. Methods: We used ARTIC protocol-based tiling amplicon sequencing of SARS-CoV-2 (n=104) from different states of India using a combination of MinION and MinIT sequencing from Oxford Nanopore Technology to understand how introduction and local transmission occurred. Results: The analyses revealed multiple introductions of SARS-CoV-2 genomes, including the A2a cluster from Europe and the USA, A3 cluster from Middle East and A4 cluster (haplotype redefined) from Southeast Asia (Indonesia, Thailand and Malaysia) and Central Asia (Kyrgyzstan). The local transmission and persistence of genomes A4, A2a and A3 was also observed in the studied locations. The most prevalent genomes with patterns of variance (confined in a cluster) remain unclassified, and are here proposed as A4-clade based on its divergence within the A cluster. Conclusions: The viral haplotypes may link their persistence to geo-climatic conditions and host response. Multipronged strategies including molecular surveillance based on real-time viral genomic data is of paramount importance for a timely management of the pandemic.
Fulltext Prevalence of oral tori and exostosis in Malaysian population - A cross-sectional study

Kumar Singh A, Sulugodu Ramachandra S, Arora S, Dicksit DD, Kalyan CG, Singh P

J Oral Biol Craniofac Res, 2017 Sep-Dec;7(3):158-160.
PMID: 29123992 DOI: 10.1016/j.jobcr.2017.08.008

Introduction: Oral tori and exostosis are non-pathological bony protuberances seen on the alveolar surfaces of the jaw bones. These are commonly seen on the palatal surfaces of the maxilla [torus palatinus (TP)] and around the premolars in the lingual surface of the mandible [torus mandibularis (TM)]. The aim of this cross-sectional study was to determine the prevalence of tori/exostosis in the Malaysian population.

Methodology: A total of 2666 patients were examined for the presence of tori and exostosis in the maxilla and mandible and were categorized into TP, TM, and exostosis (facial/labial). Collected data was analysed for obtaining descriptive statistics.

Results: 882 subjects were noticed with oral tori/exostosis among the population studied with a prevalence rate of 33%. TP was seen more in females (35%), compared to males (20%), and this difference was statistically significant (p value p value
Treatment of childhood acute lymphoblastic leukemia in Malaysia, 1976-1982

Lin HP, Sinnah D, Menaka N, Cherian R, Singh P

Med. Pediatr. Oncol., 1983;11(5):327-32.
PMID: 6579342

One hundred four children with acute lymphoblastic leukaemia were diagnosed at the University Hospital, Kuala Lumpur, Malaysia, between 1976 and 1982; 87 were evaluable with respect to treatment. They were divided into good prognosis (GP) and bad prognosis (BP) groups based on their initial total white cell count, their treatment differing only during the maintenance phase. Remission was achieved in 82 patients (94%) of whom ten (12%) subsequently died in remission from infection. Twenty-eight (34%) relapsed while on treatment and three while off therapy. Eleven patients ceased treatment after 3 yr of continuous complete remission (CCR). Three of these later relapsed, two within the first year. Survival in CCR was significantly better in the GP group up to 30 months, after which the difference diminished. There was no difference in survival between boys and girls. The overall disease-free survival at 3 yr and 5 yr was 40% and 25%, respectively, with a median follow-up period of 20 months (range 4-69 months). The reasons for the relatively low survival rates as compared with those in developed countries are discussed.
Testicular relapse in childhood acute lymphoblastic leukaemia in Malaysia, 1967-82

Lin HP, Taib NM, Singh P, Sinniah D, Lam KL

Aust Paediatr J, 1984 Mar;20(1):53-6.
PMID: 6590027

From 1967-82, 9 children with testicular relapse (TR) of acute lymphoblastic leukaemia (ALL) were diagnosed out of 99 boys treated, an incidence of 9.1%. The median time from the onset of ALL until diagnosis was 28 months (range 3-41 months). All were asymptomatic; six were detected on routine examination while three were diagnosed only on biopsy. Routine biopsy prior to stopping chemotherapy is useful in detecting occult TR. Biopsies should be done on both the testes regardless of the clinical findings. The age, leucocyte count and hepatosplenomegaly at diagnosis of ALL were not found to be significant factors in influencing relapse. Eight children were in bone marrow remission at the time of TR, but three had preceding or concurrent meningeal leukaemia while in the other five the testis was the first and only site of relapse. Radiotherapy was effective in local disease control but failed to prevent bone marrow relapse in all except two patients despite continuation of chemotherapy. The median time from onset of TR until bone marrow relapse was 7 months (range 3-13 months) and the median time until death, was 11 months (range 6-18 months). The frequency of testicular relapse may be related to the intensity of either the initial induction therapy or the consolidation chemotherapy. Further studies are required to determine whether the incidence of testicular relapse will decline with more intensive early treatment.

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