We conducted a study of 47 pati ents with various voice disorders to determin e the prevalence of concomitant psychopathology. The prevalence of psychiatric symptoms varied considerably among patients with the three most common voice disorders: 63.6 % among patients with vocal f old paralysis, 29.4% am ong those with fun ctiona I dysphonia , and 7.1 % among those with spasmodic dysphonia. Levels of anxiety and depression correlated moderately with the seve rity ofvoice symptoms in patients with vocalfo ld paralysis, but not in those with functional or spasmodic dysphonia. Certain abnormal personality traits-including interpersonal sensitivity and distrust of others-were more common among pat ients with fun ctional dysphonia. The low rate ofp sychopathology among pat ients with spasmodic dysphonia is consi stent with rates reported in previous investigatio ns. Our fi ndings suggest that the p revalence of psychopathology in patients with voice disorders varies acco rding to the specific voice diagnosis, as does the relationship between specific psychiatric and voice symptoms.

Background Observational studies suggest that asthma control improves after adenotonsillectomy, but longitudinal studies that correlate the effect of the procedure on the levels of biomarkers associated with airway inflammation are limited. Methods We conducted a longitudinal, observational study on pediatric patients, both with and without asthma, undergoing adenotonsillectomy. Asthma Control Test (ACT) scores and chitinase activity in the circulation were measured at time of surgery and at 6-month follow-up. Results 66 children with asthma and 64 control subjects were enrolled. Mean ACT scores improved by 3 points (p< 0.001) after 6 months. 85% of children with poorly-controlled asthma demonstrated an increase in ACT score of at least 3 points or a decrease in Emergency Department/Urgent Care visits, oral corticosteroid courses, or rescue short acting bronchodilator usage. Chitinase activity decreased significantly in asthmatics who improved (p< 0.01). Higher chitinase activity levels at baseline were associated with improved asthma control following surgery (p< 0.01). Conclusions In children with high pre-operative circulating chitinase activity levels, asthma control and healthcare utilization were significantly improved after adenotonsillecotmy. Chitinase activity decreased after surgery in children with improved control. This suggests that adenotonsillectomy modulates chitinase activity, affecting airway inflammation and improving airway disease.

Due to the potentially unforgiving nature of epiglottitis and supraglottitis, the clinician should have a firm understanding of the presentation, work up, and management of a patient presenting with worrisome symptoms.

Follicular helper T (Tfh) cells are necessary for germinal center B cell maturation during primary immune responses; however, the T cells that promote humoral recall responses via memory B cells are less well defined. In this article, we characterize a human tonsillar CD4 T cell subset with this function. These cells are similar to Tfh cells in terms of expression of the chemokine receptor CXCR5 and the inhibitory receptor PD-1, IL-21 secretion, and expression of the transcription factor BCL6; however, unlike Tfh cells that are located within the B cell follicle and germinal center, they reside at the border of the T cell zone and the B cell follicle in proximity to memory B cells, a position dictated by their unique chemokine receptor expression. They promote memory B cells to produce Abs via CD40L, IL-10, and IL-21. Our results reveal a unique extrafollicular CD4 T cell subset in human tonsils, which specialize in promoting T cell-dependent humoral recall responses.

No abstract

No abstract

Background Caring for an adult with chronic critical illness is a difficult undertaking. Family surrogates are tasked with decision-making on behalf of their loved one, particularly during acute-on-chronic illness episodes. Critical care nurses are well positioned and well qualified to facilitate this process. Objective To explore family surrogate decision-making for people with chronic critical illness. Methods In this qualitative study, interviews were conducted with family surrogates (n = 7) as part of a larger descriptive, longitudinal study (N = 264). Content analyses were guided by Miles and colleagues' methods of data analysis. Results Family surrogates serving as decision makers for a spouse or another adult loved one were mostly female. Although decision-making was often described as "frustrating," most surrogates reported that they were "comfortable" with this role. Major decision-making themes were "communication as key in decision-making," "impact of past experiences," and "difficulties and coping." Advice from family and friends, health care providers (such as nurses), and faith or spirituality were significant resources for coping with decision-making challenges. Conclusions Results support recent recommendations of the National Academy of Medicine that endorsed shared decision-making. Data also support development of more effective team communication and decision support strategies, particularly addressing consistency and continuity. Critical care nurses can use their expertise to positively influence these outcomes. (Critical Care Nurse. 2019;39[3]:e18-e26)

we report 2 cases ofpediatric hypopharyngeal perforation that occurred during endoscopy and 1 case of esophageal perforation that developed duringnasogastric tube insertion at a tertiary care academic medical center. These cases were identified during a retrospective chart review. All 3 patients were treated with intravenous antibiotics and nasogastric tubefeedings, and noneexperienced'[urthersequelae. Perforations ofthe hypopharynx and esophagus in children during endoscopy or insertion ofendotracheal and nasogastric tubes are not uncommon. Many affected children can bemanaged conservatively without surgical drainage, depending on the cause and specific location ofthepetforation and the timing ofthe diagnosis. we discuss the clinical criteriafOr various managementoptions, and weofferan algorithm that outlines important clinicalconsiderat ionsin thedecision-makingprocess. Ouraim in presenting these cases isto increaseawareness ofthemanagement optionsfO r children with hypopharyngeal and esophagealperforat ionsand todemonstrate theeffectiveness ofnonsurgical management in selected cases.From the D ivision of Otolaryngology, Child ren's Ho spital of Philadelphia, and the D epartm ent