The COVID-19 pandemic has brought more widespread attention to the basic reproductive number (Ro), an epidemiologic measurement. A lesser-known measure of virologic infectivity is the particle-to-plaque ratio (P:PFU). We suggest that comparison between the two parameters may assist in better understanding viral transmission dynamics.

Telemedicine, which is likely to become an enduring legacy of the COVID-19 pandemic, invariably is in conflict with the interstate physician licensing process. This obstacle is being progressively overcome by the Interstate Medical Licensure Compact (IMLC), which has been rapidly gaining ground since its operational inception in 2017. 1 Intent on streamlining physician licensure across state lines, this little-known national construct has facilitated the issuance of more than 11 000 out-of-state medical licenses, with many more likely to follow. 1 According to the IMLC, approximately "80% of U.S. physicians meet the criteria for licensure through the Compact." 1 The benefits of this much-needed overhaul of the interstate licensure process are apt to be considerable. First, the IMLC stands to advance the application of telemedicine across state lines, as well as streamline out-of-state locum tenens arrangements in support of underserved rural communities. 2 Second, the IMLC stands to enhance patient protection by requiring criminal background checks on prospective licensees, as well as cross-jurisdictional sharing of disciplinary records. 1 This Viewpoint reviews the inception of the IMLC, traces its progression, discusses its missions,

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Elevated serum ferritin is a marker of macrophage activation and is associated with increased mortality. The hyperferritinemic syndromes which include hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS), catastrophic antiphospholipid syndrome (CAPS), septic shock, adult-onset Still’s Disease (AOSD), and multi-inflammatory syndrome related to COVID-19 (MIS-C/A) are characterized by intense inflammation and its sequalae. Prompt recognition and management of these heterogenous disorders is required to improve patient outcomes. We perform a scoping review of the existing literature on the key features of these rare syndromes.

Background/Aims: Newborn screening protocols for congenital hypothyroidism (CH) vary as to whether a TSH or T4 algorithm or some combination is performed. We aimed to determine the 3-year clinical outcome of infants diagnosed with CH and screen-positive for CH using a 2-screen protocol that measures both T4 and TSH on all specimens. Methods: Retrospective analysis of patients with CH who were detected by first (NBS1) or second (NBS2) newborn screen in Alabama (2009–2016) and followed at our university-based practice. Clinical follow-up established the final diagnoses in 146 patients, including a subset of 72 patients with eutopic glands. Results: 168 patients were studied: 139 (83%) were detected by NBS1 and 29 (17%) by NBS2. Screening T4 concentrations were 45% reduced in NBS2 compared to NBS1 (p= 0.0002). Thyroid dysgenesis was present in 55% of NBS1 patients while all in NBS2 were eutopic. Follow-up of 146 patients confirmed permanent CH in 92 patients in NBS1 (75%) and 5 in NBS2 (20%). Hispanic infants were only detected by NBS1, and 93% had permanent CH. Transient CH was associated with congenital heart disease. In patients with eutopic, permanent CH, dyshormonogenesis was confirmed in 23% of NBS1 patients and 40% of NBS2. One case of central CH was detected by each screen. Conclusions: This 8-year, retrospective study buttresses the importance of a 2-screen approach for CH by identifying 5 infants with clinically significant permanent thyroid dysfunction including dyshormonogenesis and central hypothyroidism. It is the first 2-screen study to incorporate thyroid ultrasound. Disconcertingly, 4 of 5 second-screen infants with permanent CH had no risk factors for CH, and these infants would otherwise not have been detected.

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A diagnosis of multisystem inflammatory syndrome in children should be made in the appropriate context and after ruling out other infectious causes. At the same time, clinicians should be diligent as the initial presentation can be unusual and the clinical picture can evolve over time. We report a case that was initially diagnosed as a retropharyngeal infection that did not improve on appropriate antimicrobial coverage. However, as the clinical picture evolved, the patient was found to have multisystem inflammatory syndrome in children and appropriately responded to immunomodulatory treatment. Pediatric infectious diseases practice has been significantly affected by the COVID-19 virus and multisystem inflammatory syndrome in children; data are still emerging as the pandemic evolves. We report this case and conduct literature review to expand the body of evidence about the association between multisystem inflammatory syndrome in children and retropharyngeal involvement.