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Introduction The renoprotective effects of dihydropyridine calcium channel blockers (CCBs) have been established as non-inferior to other classes of antihypertensive drugs. Studying their effect on renal outcome parameters, specifically for amlodipine as monotherapy, in real-world settings can further help in expanding its usage among Indian patients. This study was performed to assess the effects of amlodipine and other dihydropyridine CCBs (cilnidipine, benidipine and azelnidipine) on renal parameters and effectiveness in blood pressure reduction in Indian patients. Methods The retrospective data of adult patients (> 18 years) with essential hypertensive who were prescribed amlodipine (n = 92), cilnidipine (n = 91), benidipine (n = 70) or azelnidipine (n = 71) as monotherapy were analyzed. The renal outcomes, serum creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), microalbumin, urine albumin-to-creatinine ratio (UACR), sodium and potassium levels, and mean changes in BP were analyzed from baseline to 12 months. Appropriate statistical methods were used to determine the significance (p value 0.05). No significant changes were observed in BUN, sodium or potassium levels. Overall, for all CCBs, the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were reduced from baseline to the end of the study (p = 0.002). At the end of the study, the average dose of amlodipine was 7.25 mg, and the average reduction in SBP and DBP per mg dose was 1.54 and 0.57 mmHg. The corresponding numbers for the other CCBs were as follows: cilnidipine, 14.28 mg, 0.26 and 0.01; benidipine, 5.71 mg, 0.41 and 0.11; azelnidipine, 15.88 mg, 0.13 and 0.06. Conclusion Amlodipine and other CCBs demonstrated good efficacy and similar effects on renal parameters from baseline to end of study. Amlodipine also showed higher potency by demonstrating greater BP reduction at a lower dose. Thus, amlodipine can remain a preferred choice among CCBs, even with the advent of the newer CCBs. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-021-00224-8.

Carbon Monoxide is one of the most common causes of inhalation poisoning worldwide and can result in significant morbidity due to persistent neuropathology and cognitive sequelae. The manifestation of carbon monoxide poisoning are non specific and severity of symptoms range from mild such as headache, confusion, lack of energy to severe, such as coma, respiratory depression, cardiac dysfunction and even death. Hyperbaric oxygen therapy has been used for decades in the treatment of acute and delayed effects of carbon monoxide poisoning. Hyperbaric Oxygen is the only treatment for acute CO poisoning where it competes with CarboxyHemoglobin preventing the resultant damage and in delayed neuropsychological sequelae. This case report is of a young lady from rural Haryana presented after 48 hours of CO Poisoning with acute confusion, partial retrograde and complete anterograde memory loss. Following 15 days of hyperbaric oxygen she showed near complete recovery and her Mini Mental Scale Examination (MMSE) score which was 12/30 on the first day went up to 29/30. This case demonstrates that HBO therapy is efficacious in recovery of delayed neuropsychiatric sequelae of Carbon Monoxide poisoning.

With the increasing prevalence of diabetes in the community, morbidity and mortality as a result of diabetic feet has been increasing. Foot complications are one of the most serious and yet preventable complications of diabetes mellitus having an economic impact to the individual and adding the burden to the already inadequate healthcare resources. There are more than 170 million diabetics worldwide of which about 30 million are in India and this number is expected to double by year 2030. Of these about 15% will develop an open foot ulcer. Twnty percent of these ulcers may eventually lead to an amputation. More than 80% of these lesions can be easily prevented or managed with timely and optimum intervention with a combined team approach including Hyperbaric Oxygen (HBO) therapy. Recent research in the role of Hyperbaric Oxygen Therapy (HBOT) in diabetic wounds has confirmed its role in promoting oxygenation, enhance immune mechanisms, neovascular formation, fibroblast proliferation and other beneficial actions. It is now accepted as a useful adjunctive treatment in a select group of diabetic patients with severe or limb threatening wounds. This article discusses the physiological basis, role and place of HBOT in the modern multidisciplinary approach to the treatment of diabetic foot wounds.

The basis of treatment with Hyperbaric Oxygen in neurology cases is the presence of an ischemic penumbra having hibernating neurons that can be revived. This area can be delineated with the help of SPECT and perfusion MRIs. The Hyperbaric Unit at the Apollo Hospital has treated 165 patients with various neurological illnesses over the years from its inception in May 2000 till May 2005. The unpredictable correlation between the structural model of neurology and the functional responses in patients is leading to a belief that there is more to the plasticity of the brain than was earlier believed. The treatment was prescribed with the intent of gaining first hand experience on response to Hyperbaric Oxygen in neurological illnesses and did not follow a predefined protocol. On the basis of our preliminary experience we are of the opinion that there appears evidence of a physiological basis for a possible role of Hyperbaric Oxygen in management of well-defined ischemic and anoxic neurological illnesses. There is however a need for definition of specific indications, patient selection, therapeutic window period, dosage, frequency, and periodicity.

Cancer treatment has improved significantly over the past decade and there is an ongoing focus on not only finding more and better ways to treat cancers but also to improve quality of life of the cancer survivor. One-half of the estimated 1.2 million new cases of invasive cancer will receive radiation therapy as a part of their cancer treatment and despite best efforts, 5% of patients will develop severe reactions to radiation therapy. The goal of radiation therapy is to eradicate tumors with minimal, if any, adverse effects. However despite preventive measures permanent damage may occur. This leads often, to painful and disabling conditions. Conventional treatment of these lesions often has frustrating results. Hyperbaric Oxygenation (HBO) has been proposed asa part of the overall treatment since the mid 1960s and several studies have reported beneficial effects. Hyperbaric oxygen helps reduce morbidity, disfiguring sequelae and further need for corrective surgery. It is also being evaluated for its role in enhancing radiosenstivity in selected head and neck tumors. This article reviews the role of Hyperbaric oxygen in the management of cancers and the sequalae of side effects due to radiation.

The present investigation is designed to work out the isolated and in-combination effects of Zn2+, Cr6+ and Ni2+ to a fish Mystus vittatus. From all the 12 combinations, 6 are antagonistic and 6 are synergistic. The combination Cr/Ni is highly synergistic while combination (Cr + Ni)/Zn is highly antagonistic in nature. The possible mechanisms responsible for antagonistic and synergistic combinations have been discussed and indicated as the occupation of critical receptor sites by less toxic metal (antagonism) or intrinsic affinity of the individual metal for the critical site or relative concentration and distribution of the metals within the target organ site (synergism). The results drawn can be indicated in terms of the effective concentration required to reach a particular level for a particular biological end point and can be expressed as follows.