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As the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection spreads globally, physicians and physician-scientists are confronted with an enlarging body of literature about the nature of this pandemic. Understanding the current epidemiological models for disease spread, mortality, and recovery is more important than ever before. One of the most relevant mathematical models relating to the spread of a pandemic is the susceptible-infectious-removed (SIR) model. Other models worth exploring are the susceptible-exposed-infectious-removed (SEIR) and the susceptible-unquarantined-quarantined-confirmed (SUQC) model.

Kidney transplant recipients require meticulous clinical and laboratory surveillance to monitor allograft health. Conventional biomarkers, including serum creatinine and proteinuria, are lagging indicators of allograft injury, often rising only after significant and potentially irreversible damage has occurred. Immunosuppressive medication levels can be followed, but their utility is largely limited to guiding dosing changes or assessing adherence. Kidney biopsy, the criterion standard for the diagnosis and characterization of injury, is invasive and thus poorly suited for frequent surveillance. Donor-derived cell-free DNA (dd-cfDNA) is a sensitive, noninvasive, leading indicator of allograft injury, which offers the opportunity for expedited intervention and can improve long-term allograft outcomes. This article describes the clinical rationale for a routine testing schedule utilizing dd-cfDNA surveillance at months 1, 2, 3, 4, 6, 9, and 12 during the first year following kidney transplantation and quarterly thereafter. These time points coincide with major immunologic transition points after transplantation and provide clinicians with molecular information to help inform decision making.

Patient reporting of symptom events during ambulatory reflux monitoring is commonly performed with little data regarding its accuracy. We employed a novel time-synchronized ambulatory audio recording of symptom events simultaneously with prolonged pH/impedance monitoring to assess temporal accuracy of patient-reported symptoms.An acoustic monitoring system was employed to detect cough events via tracheal and chest wall sounds and it was temporally synchronized with an ambulatory impedance/pH monitoring system. Patients were instructed to record their symptoms in the usual manner. Six separate observers independently listened to the 24-h audio recordings and logged the exact timing of each cough event. Patients were blinded to study design and the audio reviewers were blinded to their own reports and those of patients and other reviewers. Concurrence of audio recordings and patient-reported symptoms were tested for three separate time thresholds: 1, 2, and 5 min.The median (interquartile range (IQR)) number of cough events by audio detection was significantly (P0.001) higher than those reported by patients: 216 (90-275) and 34 (22-60), respectively. There was significantly (P0.001) higher agreement among the audio recording listeners (substantial to almost perfect agreement; kappa=0.77-0.82) than between the audio recording and patient-reported symptoms (slight to fair agreement; kappa=0.13-0.27). Patients did not report 91, 82, and 71% of audible cough events based on 1-, 2-, and 5-min concordance time windows, respectively.We found that patients do not report the majority of their symptoms during ambulatory reflux monitoring even within a 5-min time window of the true event and advise caution in clinical decision-making based solely on symptom indices.

Laryngopharyngeal reflux (LPR) is associated with symptoms of laryngeal irritation such as throat pain, cough, and voice change. Currently, the two main diagnostic tools are laryngoscopy and reflux monitoring. On laryngoscopy, the signs most commonly used to diagnose LPR are erythema and edema of the larynx; however, these signs are not specific for LPR, may be associated with other causes, and may even be found in healthy individuals. In addition, pH testing has low sensitivity in diagnosing gastroesophageal reflux disease-related laryngeal findings. Proton pump inhibitor (PPI) therapy remains the cornerstone of treatment. The current management recommendation for this group of patients is empiric therapy with twice-daily PPIs for 1 to 2 months. In the majority of those who are unresponsive to such therapy, other causes of laryngeal irritation are considered. Surgical fundoplication is most effective in those who are responsive to acid-suppressive therapy.

Introduction: Gastroesophageal reflux (GER) causes esophageal and extra-esophageal symptoms. Frequent extra-esophageal symptoms are cough, laryngospasm, laryngitis and asthma. Microand macro-aspiration are hypothesized pathophysiologic mechanisms. Aim: to compare the results obtained with two techniques that can measure reflux in the hypo-pharynx. Methods: The "Restech technique" evaluate the pH at the level of the hypo-pharynx through a probe with a pH-antimony sensor which is placed behind the soft palate. Mutichannel intraluminal impedance/pH-monitoring (MII/pH) records the passage gas and liquid reflux, and the pH of the latter, through a probe with 6 impedance sensors and 2 pH antimony sensors (the lower at 3 cm above the LES and the high at the level of hypo-pharynx). Ten adults patients (age 46.33 ± 9.86yrs; range 33.9-66.11) presenting with chronic coughing underwent simultaneous a Restech and MII/pH recording. A time-interval of 2 minutes was allowed between Restech and MII/pH to be considered simultaneous episodes. The results were statistically tested with the Chi-square test; a p value