Role Portrayed by Serum NGAL and Vitamin D in Patients with Bone Tumors.

BACKGROUND: Bone tumors are responsible for considerable morbidity and mortality at an early age. Malignant bone tumors are quite aggressive in nature. Thus, an accurate and timely diagnosis is essential for bone tumors. Neutrophil gelatinase associated lipocalin (NGAL) and vitamin D have been found to be associated with cancer and may have potential to act as biomarkers for bone tumors also. METHODS: Serum levels of NGAL and 25-OH vitamin D were estimated in 14 patients with benign and 14 with malignant bone tumors and compared with 14 apparently healthy controls. The data collected was compared among different groups using appropriate statistical analysis. NGAL was estimated by enzyme linked immunosorbent as-say (ELISA) and 25-OH vitamin D by radioimmunoassay (RIA) in the serum samples. RESULTS: Serum NGAL levels were found to be increased significantly and 25-OH vitamin D levels decreased significantly in patients with malignant bone tumors as compared to healthy controls (p < 0.001) while this difference was not statistically significant in patients with benign bone tumors (p = 0.05). The difference in serum levels of NGAL and 25-OH vitamin D in patients with malignant bone tumors was found to be statistically significant as compared to patients with benign bone tumors (p < 0.05). The correlation was not statistically significant between the levels of 25-OH vitamin D and NGAL in group I (r = 0.067, p = 0.819), group II (r = 0.204, p = 0.483), and group III (r = -0.086, p = 0.772). CONCLUSIONS: Serum NGAL and 25-OH vitamin D may be used as important serological biomarkers in patients with bone tumors along with other standard investigative modalities.

Comparative evaluation of hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate and high risk prostate cancer.

Background: The purpose of this study was to comparatively evaluate an efficacy and toxicity profile of hypofractionated radiotherapy (67.5 Gy in 25 fractions) to conventionally fractionated radiotherapy (78 Gy in 39 fractions) in prostate cancer patients with intermediate and high-risk disease. Materials and methods: From January 2015 to December 2018, 168 patients were randomized to hypofractionated radiation treatment and conventional fractionated radiation treatment schedules of volumetric modulated arc therapy (VMAT) to the prostate and seminal vesicles. All the patients also received androgen deprivation therapy (ADT) and radiation therapy started after ADT. Results: The median (range) follow-up was 51 (31-63) and 53 (33-64) months in the hypofractionated and conventionally fractionated regimes, respectively. The 3-year biochemical no evidence of disease (bNED) rates were 86.9% and 73.8% in the hypofractionated and conventionally fractionated groups, respectively (p = 0.032, significant). The 3-year bNED rates in patients at a high risk [i.e., pretreatment prostate-specific antigen (PSA) > 20 ng/mL, Gleason score ≥ 8, or T ≥ 2 c], were 87.9% and 73.5% (p = 0.007, significant) in the hypofractionated and conventionally fractionated radiotherapy groups, respectively. No statistically significant difference was found for late toxicity between the two groups, with 3-year grade 2 gastrointestinal toxicity rates of 19% and 16.7% and 3-year grade 2 genitourinary toxicity rates of 15.5% and 11.9% in the hypofractionated and conventionally fractionated radiotherapy groups, respectively. Conclusion: Hypofractionated schedule is superior to the conventional fractionation schedule of radiation treatment in terms of bNED in intermediate and high grade prostate cancer patients. Also, the late toxicity is found to be equivalent between the two treatment groups.

Alteration of ischemia modified albumin and nitric oxide levels in hypothyroidism.

BACKGROUND: Thyroid disorders especially hypothyroidism is associated with increased generation of oxidants. Nitric oxide and ischemia modified albumin are considered markers for oxidative stress. In addition, nitric oxide is involved in regulation of thyroid function and coagulation profile alteration in thyroid disorders may produce ischemia like conditions. METHODS: Nitric oxide and ischemia modified albumin were estimated in fifty patients of newly diagnosed hypothyroidism using standard photocolorimetric techniques. Results were compared with fifty healthy euthyroid controls and subjected to appropriate statistical analysis. RESULTS: Nitric oxide and ischemia modified albumin were found to be significantly raised (p < 0.05) in hypothyroid patients as compared to controls. A positive, but statistically insignificant correlation was observed between nitric oxide and ischemia modified albumin. CONCLUSIONS: Estmation of nitric oxide and ischemia modified albumin in hypothyroidism may help to throw light on its pathogenesis and assessing the severity of the disease, though further research is needed to establish their role as biomarkers in hypothyroidism.

A Qualitative Study on the Policy Process and Development of the National Action Plan on Antimicrobial Resistance in Singapore.

The global public health threat of antimicrobial resistance (AMR) has been accelerated by many interrelated factors spanning across One Health-human health, animal health, and the environment. Singapore launched its own National Strategic Action Plan (NSAP) on AMR in November 2017 with the aim of tackling the growing threat of AMR in Singapore through coordinated approaches. However, little is known about the policy process and development of the NSAP in Singapore. In this study, we analysed these aspects using an AMR governance framework. In-depth interviews were conducted with 20 participants across the One Health spectrum. The interviews were transcribed verbatim and analysed thematically. Areas that were well executed included (1) good coordination across various agencies, (2) a dedicated office to coordinate the work on the NSAP, and (3) a high level of governmental support. Areas that were lacking included (1) a lack of participation from certain sectors, (2) insufficient awareness around the AMR issue, (3) constraints in information sharing, and (4) a lack of ideal indicators to track the progress in addressing AMR. Improvements in these areas will provide a more holistic One Health engagement in support of the effective planning and implementation of the NSAP.

A Qualitative Study on the Implementation of the National Action Plan on Antimicrobial Resistance in Singapore.

Antimicrobial resistance (AMR) is a global public health threat that affects humans, animals, and the environment across the One Health spectrum. Singapore launched its own National Strategic Action Plan (NSAP) on AMR in 2017 with the aim of tackling the growing threat of AMR in Singapore through coordinated approaches. However, little is known about the implementation of the NSAP. In this study, we analysed the implementation of the NSAP with guidance from an AMR governance framework. We conducted in-depth interviews with 20 participants across the One Health spectrum. The interviews were transcribed verbatim and analysed thematically. Overall, the implementation of activities against AMR was more advanced with respect to human health compared to other sectors such as (1) AMR and antimicrobial use (AMU) surveillance systems in hospitals; (2) the hospital antimicrobial stewardship (AMS) service and legislation to optimise AMU; (3) the national children and adults vaccination programme for IPC; (4) multiple avenues for education and awareness for both professionals and public; and (5) extensive research and collaboration networks with many sources of funding. Areas that were lacking presented problems including (1) an incomplete surveillance system for AMR and AMU across all sectors; (2) the need for better AMS and legislation in some sectors; (3) insufficient innovation in education for sustained behavioural modification; and (4) the need for more open research collaborations and the translation of research into policy outcomes. Improvements in these areas will enhance the overall implementation of the NSAP through a more holistic One Health approach.

Mitigating the impacts of the COVID-19 pandemic on vulnerable populations: Lessons for improving health and social equity.

The COVID-19 pandemic had an inequitable and disproportionate impact on vulnerable populations, reversing decades of progress toward healthy populations and poverty alleviation. This study examines various programmatic tools and policy measures used by governments to support vulnerable populations during the pandemic. A comparative case study of 15 countries representing all World Health Organization's regions offers a comprehensive picture of countries with varying income statuses, health system arrangements and COVID-19 public health measures. Through a systematic desk review and key informant interviews, we report a spectrum of mitigation strategies deployed in these countries to address five major types of vulnerabilities (health, economic, social, institutional and communicative). We found a multitude of strategies that supported vulnerable populations such as migrant workers, sex workers, prisoners, older persons and school-going children. Prioritising vulnerable populations during the early phase of COVID-19 vaccination campaigns, direct financial subsidies and food assistance programmes were the most common measures reported. Additionally, framing public health information and implementing culturally sensitive health promotion interventions helped bridge the communication barriers in certain instances. However, these measures remain insufficient to protect vulnerable populations comprehensively. Our findings point to the need to expand fiscal space for health, enlarge healthcare coverage, incorporate equity principles in all policies, leverage technology, multi-stakeholder co-production of policies and tailored community engagement mechanisms.

Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries.

BACKGROUND: The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develop a framework for resilient health financing, and use this pandemic to argue a case to move towards universal health coverage (UHC). METHODS: In this case study, we examined the national health financing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing. FINDINGS: Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. We observed that five key financing policies were implemented across the countries-namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. INTERPRETATION: Our findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC. FUNDING: Bill & Melinda Gates Foundation.

Oxidative Stress in Primary Bone Tumors: A Comparative Analysis.

Background Bone tumors account for 1% of all cancers and have considerable morbidity and mortality. There is a proposed theory of increased oxidative stress characterized by an increased level of reactive oxygen species (ROS) that disrupts the intracellular reduction-oxidation (redox) balance which has been implicated in various diseases including cancer. The aim of the present study was to measure the levels of oxidant stress and antioxidant mechanism in bone tumors (benign as well as malignant).  Methods The study cohort consisted of 42 subjects: 14 malignant bone tumors, 14 benign bone tumors, and 14 healthy controls. Serum Malondialdehyde (MDA) levels were determined to assess oxidative stress while antioxidant status was evaluated using superoxide dismutase (SOD). Results Patients with malignant bone tumors showed a significant increase in plasma MDA levels (p<0.05) while SOD levels were significantly decreased (p<0.05). No significant difference in oxidative damage was noted between both the sarcomas (p>0.05). Conclusions In conclusion, an increase in oxidative stress and a decrease in antioxidant status are observed in bone tumors. Further studies on the manipulation of redox balance in patients with bone tumors can act as a useful approach in early diagnosis or designing management strategies for bone tumors.

COVID-19 public health and social measures: a comprehensive picture of six Asian countries.

The COVID-19 pandemic will not be the last of its kind. As the world charts a way towards an equitable and resilient recovery, Public Health and Social Measures (PHSMs) that were implemented since the beginning of the pandemic need to be made a permanent feature of health systems that can be activated and readily deployed to tackle sudden surges in infections going forward. Although PHSMs aim to blunt the spread of the virus, and in turn protect lives and preserve health system capacity, there are also unintended consequences attributed to them. Importantly, the interactions between PHSMs and their accompanying key indicators that influence the strength and duration of PHSMs are elements that require in-depth exploration. This research employs case studies from six Asian countries, namely Indonesia, Singapore, South Korea, Thailand, the Philippines and Vietnam, to paint a comprehensive picture of PHSMs that protect the lives and livelihoods of populations. Nine typologies of PHSMs that emerged are as follows: (1) physical distancing, (2) border controls, (3) personal protective equipment requirements, (4) transmission monitoring, (5) surge health infrastructure capacity, (6) surge medical supplies, (7) surge human resources, (8) vaccine availability and roll-out and (9) social and economic support measures. The key indicators that influence the strength and duration of PHSMs are as follows: (1) size of community transmission, (2) number of severe cases and mortality, (3) health system capacity, (4) vaccine coverage, (5) fiscal space and (6) technology. Interactions between PHSMs can be synergistic or inhibiting, depending on various contextual factors. Fundamentally, PHSMs do not operate in silos, and a suite of PHSMs that are complementary is required to ensure that lives and livelihoods are safeguarded with an equity lens. For that to be achieved, strong governance structures and community engagement are also required at all levels of the health system.

An analysis of national action plans on antimicrobial resistance in Southeast Asia using a governance framework approach.

The complex problem of antimicrobial resistance (AMR) is spread across human health, animal health, and the environment. The Global Action Plan (GAP) on AMR and context-specific national action plans (NAPs) were developed to combat this problem. To date, there is no systematic content analysis of NAPs from countries of the Association of Southeast Asia Nations (ASEAN). As the validity periods of most NAPs are ending, an analysis now will provide an opportunity to improve subsequent iterations of these NAPs. We analysed the current NAPs of ten ASEAN countries. We explored their objective alignment with GAP and performed content analysis using an AMR governance framework. Themes were broadly classified under five governance areas: policy design, implementation tools, monitoring and evaluation, sustainability, and One Health engagement. We identified policy priorities, useful features of NAPs, and specific areas that should be strengthened, including accountability, sustained engagement, equity, behavioural economics, sustainability plans and transparency, international collaboration, as well as integration of the environmental sector. Enhancement of these areas and adoption of best practices will drive improved policy formulation and its translation into effective implementation.

Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries.

Health systems resilience is key to learning lessons from country responses to crises such as coronavirus disease 2019 (COVID-19). In this perspective, we review COVID-19 responses in 28 countries using a new health systems resilience framework. Through a combination of literature review, national government submissions and interviews with experts, we conducted a comparative analysis of national responses. We report on domains addressing governance and financing, health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. We then synthesize four salient elements that underlie highly effective national responses and offer recommendations toward strengthening health systems resilience globally.

Health system resilience in managing the COVID-19 pandemic: lessons from Singapore.

Singapore, one of the first countries affected by COVID-19, adopted a national strategy for the pandemic which emphasised preparedness through a whole-of-nation approach. The pandemic was well contained initially until early April 2020, when there was a surge in cases, attributed to Singapore residents returning from hotspots overseas, and more significantly, rapid transmission locally within migrant worker dormitories. In this paper, we present the response of Singapore to the COVID-19 pandemic based on core dimensions of health system resilience during outbreaks. We also discussed on the surge in cases in April 2020, highlighting efforts to mitigate it. There was: (1) clear leadership and governance which adopted flexible plans appropriate to the situation; (2) timely, accurate and transparent communication from the government; (3) public health measures to reduce imported cases, and detect as well as isolate cases early; (4) maintenance of health service delivery; (5) access to crisis financing; and (6) legal foundation to complement policy measures. Areas for improvement include understanding reasons for poor uptake of government initiatives, such as the mobile application for contact tracing and adopting a more inclusive response that protects all individuals, including at-risk populations. The experience in Singapore and lessons learnt will contribute to pandemic preparedness and mitigation in the future.

Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.

BACKGROUND: A regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma. We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer. METHODS: We randomly assigned patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or lower esophagus to either perioperative chemotherapy and surgery (250 patients) or surgery alone (253 patients). Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin (50 mg per square meter of body-surface area) and cisplatin (60 mg per square meter) on day 1, and a continuous intravenous infusion of fluorouracil (200 mg per square meter per day) for 21 days. The primary end point was overall survival. RESULTS: ECF-related adverse effects were similar to those previously reported among patients with advanced gastric cancer. Rates of postoperative complications were similar in the perioperative-chemotherapy group and the surgery group (46 percent and 45 percent, respectively), as were the numbers of deaths within 30 days after surgery. The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group. With a median follow-up of four years, 149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died. As compared with the surgery group, the perioperative-chemotherapy group had a higher likelihood of overall survival (hazard ratio for death, 0.75; 95 percent confidence interval, 0.60 to 0.93; P=0.009; five-year survival rate, 36 percent vs. 23 percent) and of progression-free survival (hazard ratio for progression, 0.66; 95 percent confidence interval, 0.53 to 0.81; P<0.001). CONCLUSIONS: In patients with operable gastric or lower esophageal adenocarcinomas, a perioperative regimen of ECF decreased tumor size and stage and significantly improved progression-free and overall survival. (Current Controlled Trials number, ISRCTN93793971 [controlled-trials.com].).

Assessment of quality control system by sigma metrics and quality goal index ratio: A roadmap towards preparation for NABL.

AIM: To study sigma metrics and quality goal index ratio (QGI). METHODS: The retrospective study was conducted at the Clinical Biochemistry Laboratory, PGIMS, Rohtak, which recently became a National Accreditation Board for Testing and Calibration of Laboratories accredited lab as per the International Organization for Standardization 15189:2012 and provides service to a > 1700-bed tertiary care hospital. Data of 16 analytes was extracted over a period of one year from January 2017 to December 2017 for calculation of precision, accuracy, sigma metrics, total error, and QGI. RESULTS: The average coefficient of variation ranged from 2.12% (albumin) to 5.42% (creatinine) for level 2 internal quality control and 2% (albumin) to 3.62% (high density lipoprotein-cholesterol) for level 3 internal quality control. Average coefficient of variation of all the parameters was below 5%, reflecting very good precision. The sigma metrics for level 2 indicated that 11 (68.5%) of the 16 parameters fall short of meeting Six Sigma quality performance. Of these, five failed to meet minimum sigma quality performance with metrics less than 3, and another six just met minimal acceptable performance with sigma metrics between 3 and 6. For level 3, the data collected indicated eight (50%) of the parameters did not achieve Six Sigma quality performance, out of which three had metrics less than 3, and five had metrics between 3 and 6. QGI ratio indicated that the main problem was inaccuracy in the case of total cholesterol, aspartate transaminase, and alanine transaminase (QGI > 1.2), imprecision in the case of urea (QGI < 0.8), and both imprecision and inaccuracy for glucose. CONCLUSION: On the basis of sigma metrics and QGI, it may be concluded that the Clinical Biochemistry Laboratory, PGIMS, Rohtak was able to achieve satisfactory results with world class performance for many analytes one year preceding the accreditation by the National Accreditation Board for Testing and Calibration of Laboratories. Aspartate transaminase and alanine transaminase required strict external quality assurance scheme monitoring and modification in quality control procedure as their QGI ratio showed inaccuracy.

Comparative Evaluation of Three Palliative Radiotherapy Schedules in Locally Advanced Head and Neck Cancer.

BACKGROUND: The aim of the study was to evaluate and compare the efficacy, tolerability and toxicity of three palliative radiotherapy (RT) schedules in locally advanced head and neck carcinoma (LAHNC), i.e. Quad Shot schedule, Christie schedule and conventional palliative schedule. METHODS: The patients were randomly divided into three groups of 30 each. Group I patients were planned for 14.8 Gy in 4 fractions over 2 days, repeated three weekly for two more cycles. Group II patients were planned for 50 Gy in 16 fractions over 3.1 weeks. Group III patients were planned for 20 Gy in 5 fractions over 5 days, repeated after an interval of 3 weeks. The quality of life was assessed before and after RT using University of Washington Quality of Life questionnaire version 4. RESULTS: Local control rates were 84%, 76%, and 76% for groups I, II and III, respectively. Disease status at 6-month follow-up was no evidence of disease (20%, 28%, and 16%), residual disease (72%, 48%, and 76%), and recurrent disease (8%, 24%, and 8%) in groups I, II and III, respectively. Grade III acute skin reactions were 28%, 44%, and 16% in groups I, II and III, respectively. Grade III acute mucosal reactions were 36%, 56%, and 24% in group I, II and III, respectively. Quality of life improved in all groups after RT. CONCLUSION: Quad Shot schedule may be used in LAHNC with better local control and acceptable toxicity as compared to conventional palliative RT schedule in Indian setting.

Levels of neutrophil gelatinase-assosciated lipocalin in patients with head and neck squamous cell carcinoma in Indian population from Haryana state.

AIM: To study the levels of neutrophil gelatinase associated lipocalin (NGAL) in head and neck squamous cell carcinoma (HNSCC). METHODS: This was a non randomized case control study conducted at Department of Biochemistry, in collaboration with Regional Cancer Center over a period of one year. The study population included 50 adult newly diagnosed HNSCC patients reporting in outpatient department at Regional Cancer Center and compared with 50 healthy controls. NGAL was estimated by ELISA technique. Student t test and χ2 test were applied for comparison of means of study groups. Correlations between groups were analyzed using Pearson correlation coefficient (r) formula. RESULTS: Patients with HNSCC exhibited significantly increased levels of NGAL (P < 0.05) as compared to healthy controls (978.88 ± 261.39 ng/mL vs 34.83 ± 7.59 ng/mL). Out of 50, 26 patients (52%) were in stage IV, 21 (42%) in stage III, 1 (2%) patient in stage II and 2 (4%) patients were in stage I. Metastasis was absent in 98% patients and mean NGAL levels were highest in these patients but P value was not significant. Mean NGAL levels were highest in stage IV [1041.54 ± 222.15 ng/mL (stage IV) vs 1040 ± 0.00 ng/mL (stage I); 900 ± 0.00 ng/mL (stage II) and 1031.90 ± 202.55 ng/mL (stage III)] and χ2 test was highly significant (P < 0.001). Thirty-six patients (72%) were having moderately differentiated HNSCC and mean NGAL levels were maximum in patients with well differentiated HNSCC (1164 ± 315.64 ng/mL vs 1013.33 ± 161.19 ng/mL in moderately differentiated and 890 ± 11.55 ng/mL in poorly differentiated) and the results were also highly significant (P < 0.001, χ2 test). CONCLUSION: The present work demonstrates a potential role of NGAL as cancer biomarker and its use in monitoring the HNSCC progression.

Allelopathic effect of four weed species extracts on germination, growth and protein in different varieties of Glycine max (L.) Merrill.

Allelopathic effect of Ageratum conyzoides L., Cynodon dactylon (L.) Pers., Parthenium hysterophorus L., and Solanum nigrum L. were examined on seed germination, seedling growth, total protein content and protein profile on Ankur, Bhatt, Bragg, PK -416, PS-1042 and Shilajeet varieties of soybean (Glycine max (L) Merill). Aqueous extracts of weeds (10% w/v) showed both inhibitory and stimulatory influence on percent seed germination and seedling growth in different varieties of soybean. On the basis of per cent reduction in different parameters, the variety Bragg and PS-1042, and Shilajeet were resistant and susceptible respectively to different weed extracts, and among weed extracts, S. nigrum was most effective followed by P. hysterophorus compared to others. The total protein content (mg/g f wt.) in different varieties was increased with all the weed extracts except Bragg with C. dactylon and P. hysterophorus, PS-1042 with A. conyzoides and Shilajeet with C. dactylon, in which it was decreased. The protein banding pattern in different varieties not only differ between control and treatments but also among treatments. The order of susceptibility of different varieties with different weed extracts followed the order: Ankur > PK-416 > Bhatt > Shilajeet > Bragg and > PS-1042.

Homocysteine as Predictive Marker for Pregnancy-Induced Hypertension-A Comparative Study of Homocysteine Levels in Normal Versus Patients of PIH and Its Complications.

OBJECTIVE: To find the correlation between serum homocysteine levels, relevant laboratory investigations and complications associated with PIH. METHODS: This was a prospective study conducted over 2 years. Two hundred and fourteen cases were studied. They were divided into mild preeclampsia (64), severe preeclampsia (50), eclampsia (32) and control groups (68). Parameters evaluated for statistical analysis were blood pressure, platelet counts, SGOT, SGPT and serum homocysteine levels. RESULTS: A definite statistical correlation was found between the homocysteine levels and severity of hypertension (8 mmol/l, p = .759). A higher level of homocysteine was also associated with many maternal complications like abruption, retinopathy, MODS, maternal mortality and eclampsia. Sixty-nine out of 87 patients with elevated homocysteine levels were complicated with some or the other condition, making a high percentage of 79.31 %. Patients with normal level of homocysteine delivered healthy babies (88.1 %). There were 6 maternal mortalities and 20 stillbirths in the hyperhomocysteinemia group. CONCLUSION: Homocysteine levels have a direct statistical correlation with the severity of hypertension and complication with preeclampsia and eclampsia. It can be considered as a reliable predictive marker for PIH and its wide syndrome.