Knowledge about biosafety measures in clinical setting during the COVID-19 pandemic: a cross-sectional study with Brazilian dental students

Objective: To evaluate the knowledge of Brazilian dental students about biosafety measures that should be adopted in the clinical setting during the coronavirus disease-2019 (COVID-19) pandemic. Methods: A cross-sectional study with 1,050 dental students was conducted. A semi-structured questionnaire was shared with students. Mean knowledge score on biosafety guidelines during the COVID-19 pandemic was the outcome, with a maximum of 8 scores. Explanatory variables included sociodemographic and educational characteristics, aspects related to biosafety education, actions adopted by the dental schools during the pandemic, and sources of biosafety information. Multivariate linear regression analyses were performed. Results: Mean knowledge score was 5.19 (1.28). Female students (β=0.346; 95%CI:0.154–0.539), those enrolled in the intermediate (β=0.525; 95%CI:0.167–0.883) or final (β=0.569; 95%CI:0.200–0.937) stage of course, and those who had already received theoretical-practical training in biosafety (β=0.464; 95%CI:0.063–0.866) presented higher mean knowledge scores. Students who did not receive guidance on aerosol control measures before the pandemic (β=-0.324; 95%CI:-0.519–-0.130) had the lowest score. Conclusion: Students presented a medium level of knowledge about dental biosafety measures in the COVID-19 pandemic. Sociodemographic characteristics and those related to the institutional profile of the participants, and access to orientation and training in biosafety may influence their knowledge.

Approach to hypercalcemia

Hypercalcemia is a presentation commonly encountered in the clinical setting. Due to its vast differential diagnosis, a systematic approach is necessary when approaching patients with hypercalcemia. This article presents a simple, yet thorough approach to help clinicians determine the etiology of their patient's hypercalcemia. The main components of history taking, physical examination, and laboratory investigations for patients with hypercalcemia are highlighted. Emphasis is put on the importance of determining whether the hypercalcemia is associated with elevated or inappropriately normal parathyroid hormone (PTH) or not. The main etiologies of PTH-dependent hypercalcemia and PTH-independent hypercalcemia are explored. Primary hyperparathyroidism and hypercalcemia secondary to malignancy are highlighted as together, they make up 90% of hypercalcemia cases. A presentation of the management principles of hypercalcemia is also provided.

Sunitinib-Induced Adrenal Crisis in a Patient with Pre-Existing Immunotherapy-Related Hypopituitarism

Sunitinib is a tyrosine kinase inhibitor that is frequently used in the treatment of metastatic renal cell carcinoma (mRCC). As a multikinase inhibitor, numerous off-target side effects of this medication are widely recognized. More recently, endocrine side effects, including hypoadrenalism, are becoming more apparent. We report a case in which a 71-year-old female experienced recurrent adrenal crises when managed with sunitinib for mRCC on a background of immune-related hypopituitarism and hypoadrenalism as a result of previous treatment with immunotherapy. Clinicians should be aware of this potential toxicity when using such medications and consider further investigation in the appropriate clinical setting.

Ocular Emergencies in Children

This chapter covers general bedside and chairside examination procedures and instruments used to examine a pediatric patient in an acute care setting. Pediatric patients may present to an emergency room or present emergently in any clinical setting with a wide variety of acute ocular conditions. When working in an emergency room or hospital-based setting, it is unlikely that a clinician will have all of the exam equipment typically used for routine care. The authors review the various ocular imaging techniques used to obtain a view of the internal structures of the eye, orbit, head, and brain when external examination is not sufficient. The procedures described aid the clinician in appropriately and thoroughly evaluating pediatric patients presenting with ocular emergencies.

Testing Accommodation in Children

Accommodation disorders are associated with a host of etiologies. Children with accommodative disorders can present with various symptoms including blur, fluctuating vision, eye pain, burning sensation, tired eyes, asthenopia, headaches, fatigue with near work, and excessive rubbing, blinking, or tearing. This chapter provides an overview of accommodation testing on pediatric patients in the clinical setting. The author describes the indications for accommodation testing and provides clinical pearls for testing accommodative function in children. The chapter covers the specific tests, equipment required, and step-by-step procedures for testing accommodative amplitude, accommodative response, and accommodative facility.