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Natural history museums are vital repositories of specimens, samples and data that inform about the natural world; this Formal Comment revisits a Perspective that advocated for the adoption of compassionate collection practices, querying whether it will ever be possible to completely do away with whole animal specimen collection.

Objective  Neonates perceive pain which also has adverse long-term consequences. Newborns experience several painful procedures a day. Various methods of analgesia may be used but are underutilized. The SMART aim of this project was to increase the use of procedural analgesia from 11.5 to 75% in 6 months by using quality improvement principles. Study Design  After a baseline audit, a root cause analysis was done. Based on this, a series of interventions were done as Plan-Do-Study-Act (PDSA) cycles. These included posters on analgesia, display of the pain protocol, orders for analgesia, a written test, small power point presentations on the importance of analgesia, and reminders on the trays used for procedures. At the end of each PDSA cycle, an audit was done to determine the proportion of times analgesia was used. Process indicators were also used when possible. Analysis was done by using the Chi-square test and the paired t -test. Results  At baseline 11% of procedures were done after giving analgesia. This significantly improved to 40% at the end of the first PDSA, and 81% after third PDSA. This was sustained at 75% over the next 2 months. Conclusion  Procedural analgesia can improve and be sustained by using simple interventions. Key Points Procedural pain in neonates can be decreased by the use of analgesia. However, most units do not utilize analgesia appropriately. This QI showed that simple interventions can optimize use of procedural analgesia. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is the principal cause of morbidity and mortality in adults with congenital heart disease (ACHD). Robust evidence-based treatment options are lacking. This study aims to evaluate the safety, tolerability, and short-term HF-related effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in a real-world ACHD population. All patients with ACHD treated with SGLT2i in 4 European ACHD centers were included in this retrospective study. Data were collected from 1 year before starting SGLT2i to the most recent follow-up. Data on side effects, discontinuation, mortality, and hospitalizations were collected. In total, 174 patients with ACHD were treated with SGLT2i from April 2016 to July 2023. The mean age was 48.7 ± 15.3 years, 72 (41.4%) were female, and 29 (16.7%) had type 2 diabetes mellitus. Ten (5.7%) patients had mild, 75 (43.1%) moderate, and 89 (51.1%) severe congenital heart disease. HF was the most frequent starting indication (n = 162, 93.1%), followed by type 2 diabetes (n = 11, 6.3%) and chronic kidney disease (n = 1, 0.6%). At median follow-up of 7.7 months (Q1-Q3: 3.9–13.2 months), 18 patients (10.3%) reported side effects, 12 (6.9%) permanently discontinued SGLT2i, and 4 (2.3%) died of SGLT2i-unrelated causes. A significant reduction in the HF hospitalization rate was observed from 6 months before to 6 months after starting SGLT2i (relative rate = 0.30; 95% CI: 0.14-0.62; P = 0.001). SGLT2i generally seem safe, well-tolerated, and potentially beneficial in patients with ACHD. SGLT2i was associated with a 3-fold reduction in the 6-month HF hospitalization rate. These results warrant prospective randomized investigation of the potential benefits of SGLT2i for patients with ACHD. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Pathogenic concepts of right ventricular (RV) failure in pulmonary arterial hypertension focus on a critical loss of microvasculature. However, the methods underpinning prior studies did not take into account the 3-dimensional (3D) aspects of cardiac tissue, making accurate quantification difficult. We applied deep-tissue imaging to the pressure-overloaded RV to uncover the 3D properties of the microvascular network and determine whether deficient microvascular adaptation contributes to RV failure., Methods: Heart sections measuring 250-µm-thick were obtained from mice after pulmonary artery banding (PAB) or debanding PAB surgery and properties of the RV microvascular network were assessed using 3D imaging and quantification. Human heart tissues harvested at the time of transplantation from pulmonary arterial hypertension cases were compared with tissues from control cases with normal RV function., Results: Longitudinal 3D assessment of PAB mouse hearts uncovered complex microvascular remodeling characterized by tortuous, shorter, thicker, highly branched vessels, and overall preserved microvascular density. This remodeling process was reversible in debanding PAB mice in which the RV function recovers over time. The remodeled microvasculature tightly wrapped around the hypertrophied cardiomyocytes to maintain a stable contact surface to cardiomyocytes as an adaptation to RV pressure overload, even in end-stage RV failure. However, microvasculature-cardiomyocyte contact was impaired in areas with interstitial fibrosis where cardiomyocytes displayed signs of hypoxia. Similar to PAB animals, microvascular density in the RV was preserved in patients with end-stage pulmonary arterial hypertension, and microvascular architectural changes appeared to vary by etiology, with patients with pulmonary veno-occlusive disease displaying a lack of microvascular complexity with uniformly short segments., Conclusions: 3D deep tissue imaging of the failing RV in PAB mice, pulmonary hypertension rats, and patients with pulmonary arterial hypertension reveals complex microvascular changes to preserve the microvascular density and maintain a stable microvascular-cardiomyocyte contact. Our studies provide a novel framework to understand microvascular adaptation in the pressure-overloaded RV that focuses on cell-cell interaction and goes beyond the concept of capillary rarefaction., Competing Interests: Disclosures None.

Background: Primary precautionary approaches for oral health is an essential tool concerning public health, as dental caries is one of the eminently prevailing chronic diseases among children across the globe. As pediatricians and pediatric healthcare professionals are more likely to encounter children when compared to general dentists, it is crucial for them to be acquainted with possible risk factors and diseases occurring in early childhood. Therefore, it is highly advocated to take necessary steps at an initial stage to help promote pragmatic results during childhood and succeeding adulthood phases., Objectives: The pediatrician's attitude toward dental health and his dental screening, counseling, and referral practices., Material and Methods: This was a cross-sectional study in the Hyderabad district, following area sampling on a sample of 200 child healthcare professionals, as calculated based on a pilot study. A definitive and validated questionnaire was used for the collection of data, and pediatric health professionals were approached in their workplaces., Results: About 44.5% of pediatricians usually check teeth during routine tongue and throat examinations. Around 59.5% of them suspect cavities when the child looks undernourished. A total of >80% of them voted that oral health cannot be neglected, as it is an integral part of a child's general health and dental screening, and referral at regular intervals of time is their responsibility. Only 8.5% advised fluoridated toothpaste, whereas only 62.5% counseled parents on the dental ill effects of nighttime bottle-feeding and digit sucking., Conclusion: Although all the pediatricians had appropriate attitudes toward oral health, they were not put into action by many., Dental Public Health Significance: Pediatricians play a vital role as potential partners in the oral health promotion of children and their families. A pediatric primary care provider's regular screening, counseling, and referral would help his/her patients in getting the right treatment done at the right time., How to Cite This Article: Reddy SM, Shaik N, Pudi S, et al. Assessing the Pediatricians' Role in Improving Young Children's Oral Health in Telangana State: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(5):591-595., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2022; The Author(s).)