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Lynch ME. Antidepressants as analgesics: a review of randomized controlled trials. J Psychiatry Neurosci 2001; 26:30-6. [PMID: 11212591 PMCID: PMC1408040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
This review provides an overview of 59 randomized placebo-controlled trials that examined the analgesic effect of antidepressants. To summarize, there is significant evidence that the tricyclic group of antidepressants is analgesic and that trazodone is not; the data regarding selective serotonin reuptake inhibitors are conflicting. To date, there are no randomized controlled trials examining the potential analgesic action of nefazodone or venlafaxine, but on the basis of initial clinical reports and its structural similarity to other analgesics, venlafaxine shows promise as an analgesic.
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Oleson KC, Poehlmann KM, Yost JH, Lynch ME, Arkin RM. Subjective overachievement: individual differences in self-doubt and concern with performance. J Pers 2000; 68:491-524. [PMID: 10831310 DOI: 10.1111/1467-6494.00104] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We discuss the construct of doubt about one's competence and suggest that doubt can have myriad consequences (e.g., self-handicapping, defensive pessimism). We focus on the effect of self-doubt when it is combined with a concern with performance and assert that this combination leads to the phenomenon of subjective overachievement. In two studies, we present a new 17-item Subjective Overachievement Scale (SOS), which includes two independent subscales measuring individual differences in self-doubt and concern with performance. The first study, consisting of two large samples (Ns = 2,311 and 1,703), provides evidence that the scale has high internal consistency and a clear two-factor structure. Additionally, the subscales have adequate test-retest reliability (Ns = 67 and 115). A second study reveals that the SOS has good convergent and discriminant validity. Both subscales are unrelated to social desirability but exhibit the predicted patterns of associations with other related constructs. The Concern with Performance Subscale is correlated with achievement motivation, whereas the Self-Doubt Subscale is correlated with scales assessing negative affectivity (e.g., self-esteem, social anxiety) and other self-related strategies associated with concerns about one's competence (e.g., self-handicapping, defensive pessimism, impostor phenomenon). The SOS, which combines the two subscales, appears to tap a unique strategy that individuals may use to deal with doubts about their own competence.
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Bard KA, Coles CD, Platzman KA, Lynch ME. The effects of prenatal drug exposure, term status, and caregiving on arousal and arousal modulation in 8-week-old infants. Dev Psychobiol 2000; 36:194-212. [PMID: 10737865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Prenatal exposure to cocaine, as well as other drugs, has been linked with "dysregulation," usually defined as problems in arousal and/or behavioral regulation. This study was designed to describe the physiological basis of dysregulation as a function of prenatal cocaine/polydrug exposure and term status. Eight-week-old infants were selected because they are just developing the ability to modulate arousal. One hundred-eighteen infants (23 preterm control, 27 preterm drug-exposed, 29 full-term control, and 39 full-term drug-exposed) completed a protocol during which heart rate (HR) and respiratory rate (RR) were measured. Drug group differences were found in baseline, arousal (response to stress), and arousal modulation (recovery from stress). A hierarchical multiple regression analysis was conducted to determine the portion of variance attributable to postnatal caregiving environment, term status, and specific drug exposure. Term status accounted for significant variance in arousal (both RR and HR), and in arousal modulation (only RR). Prenatal exposure to cocaine contributed a significant amount of unique variance in HR arousal whereas tobacco contributed significantly to HR arousal modulation. Prenatal drug exposure and preterm status contributed differently to dysregulation as measured by physiological responses.
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Coles CD, Bard KA, Platzman KA, Lynch ME. Attentional response at eight weeks in prenatally drug-exposed and preterm infants. Neurotoxicol Teratol 1999; 21:527-37. [PMID: 10492387 DOI: 10.1016/s0892-0362(99)00023-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To evaluate the effect of prenatal polydrug exposure on infant attention, 105 8-week-old African-American infants were presented a series of stimuli and their heart rates (HRs) were recorded. Infants were identified postnatally based on mothers' substance use. Four groups were tested: 1) preterm drug-exposed infants (n = 25); 2) full-term, drug-exposed (n = 32); 3) preterm nonexposed (n = 22); and 4) full-term, nonexposed (n = 26). Preterm infants' ages were corrected. Infant's baseline HRs were recorded and then stimuli presented in the following order: auditory (rattle), visual (red ring), and social (examiner's face and voice). There were no HR differences at baseline or in auditory or visual conditions. However, significant differences (F(2, 103) = 6.54, p < 0.01) were seen in response to social stimuli. Drug-exposed infants showed an acceleratory HR indicating distress or arousal and control infants showed a deceleratory response indicating focused attention and there was an interaction due to greater HR response in preterms. Hierarchical regression indicated cocaine (R2 = 0.034, p < 0.05) but not other drug use and instability in parenting (R2 = 0.137, p < 0.001) accounted for the observed differences.
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Wat LI, Brimacombe JR, White PF, Templin PA, Lynch ME, Hammamura RK. Use of the laryngeal mask airway in the ambulatory setting. J Clin Anesth 1998; 10:386-8. [PMID: 9702618 DOI: 10.1016/s0952-8180(98)00050-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE To determine the utility of the laryngeal mask airway (LMA) in an ambulatory surgery practice. DESIGN Prospective, longitudinal device (survival) study. SETTING University-based ambulatory surgery center. PATIENTS 1,831 ASA physical status I, II, and III outpatients undergoing superficial ambulatory surgery procedures. INTERVENTIONS Twenty LMA devices were entered into service over a 2-year period and the number of uses, as well as the structural integrity, were assessed at the end of this study period. The serial number on each LMA device was used to track the number of times it was autoclaved, as well as the date that the device failed any of the standardized pre-use tests or was lost. MEASUREMENTS AND MAIN RESULTS During the 2-year survey, 6,430 general anesthetics were administered at the ambulatory surgery center, with 1,831 (28%) using an LMA device for airway management. At the end of the study period, nine devices were still in use, three had been withdrawn for structural analysis by the manufacturer (after > 100 uses), three failed the pre-use test (after 38-82 uses), and five devices were lost (after 21-162 uses). The structural examination revealed that the tubes were 50% weaker; however, the cuffs, pilot balloons, and values were functioning normally. The median (range) number of uses was 92 (21-195). Thus, the 20 LMA devices evaluated tolerated an average of 92 autoclave cycles each over the 2-year observation period. CONCLUSIONS To optimize the use of the LMA device in the ambulatory setting, it is necessary to increase awareness that it is a nondisposable piece of equipment and to adhere to the manufacturer's instructions for cleaning, sterilization, and insertion.
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Lynch ME, Sobel JD, Fidel PL. Role of antifungal drug resistance in the pathogenesis of recurrent vulvovaginal candidiasis. JOURNAL OF MEDICAL AND VETERINARY MYCOLOGY : BI-MONTHLY PUBLICATION OF THE INTERNATIONAL SOCIETY FOR HUMAN AND ANIMAL MYCOLOGY 1996; 34:337-9. [PMID: 8912167 DOI: 10.1080/02681219680000571] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aetiology of recurrent vulvovaginal candidiasis (RVVC) caused by Candida albicans remains unclear. To adequately address the role of antifungal resistance as a potential mechanism for RVVC, a longitudinal susceptibility analysis of 177 C. albicans isolates collected from 50 C. albicans RVVC patients over a period of 3 months to 7 years was performed. Antifungals tested included clotrimazole, ketoconazole, miconazole, itraconazole and fluconazole. Results showed that all vaginal isolates were uniformly susceptible to all drugs tested and that successive isolates from individual patients did not show increased resistance to any drug despite long-term exposure to azoles. These results suggest that episodes of RVVC caused by C. albicans are rarely of ever attributable to azole antifungal resistance.
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Katz DA, Lynch ME, Littenberg B. Clinical prediction rules to optimize cytotoxin testing for Clostridium difficile in hospitalized patients with diarrhea. Am J Med 1996; 100:487-95. [PMID: 8644759 DOI: 10.1016/s0002-9343(95)00016-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although routine testing of hospitalized patients with diarrhea for Clostridium difficile cytotoxin has been advocated as a high-yield procedure, the rationale for this practice has been questioned. To target a low-yield subgroup for whom routine testing could be deferred, we derived a clinical decision rule for predicting results of the C difficile cytotoxin assay in hospitalized adults with diarrhea. METHODS We hypothesized a priori that two variables, antibiotic use (within 30 days prior to testing) and history of significant diarrhea (new onset of > 3 partially formed or watery stools per 24 hour period), would be highly predictive of cytotoxin results, and obtained these data on 480 consecutive patients who underwent diagnostic testing for C difficile at a university hospital and affiliated Veterans Affairs medical center. For more detailed modelling, we recorded symptoms, signs, comorbidity, and other potential causes of diarrhea for 68 test positive patients (cases) and 265 randomly selected test negative patients (controls) within the study cohort. RESULTS The overall prevalence of positive cytotoxin assays was 14%. Prior antibiotic therapy (OR = 9.0, 95% CI 2.1-38.4), significant diarrhea (OR = 2.2, 95% CI 1.1-4.7), and abdominal pain (OR = 1.9, 95% CI 0.96-3.7) were independent predictors of cytotoxin assay results. The model discriminated patients with positive and negative assays with a receiver operating characteristic (ROC) area of 0.68; observed and predicted probabilities of a positive cytotoxin assay were well correlated over the entire range of observed probabilities (r2 = 0.86). A decision rule (defined as positive if prior antibiotic use and either significant diarrhea or abdominal pain are present) demonstrated sensitivity and specificity of 86 and 45%. When applied to the entire dataset (N = 480), a simplified a priori rule, defined as positive if both prior antibiotic use and history of significant diarrhea are present, demonstrated sensitivity, specificity, positive and negative predictive value of 80, 45, 18 and 94%, respectively (6% of those predicted to be cytotoxin-negative actually tested positive). Use of this rule would have averted 39% of cytotoxin assays in our study population. CONCLUSIONS Patients without prior antibiotic use and either significant diarrhea or abdominal pain are unlikely to have positive C difficile cytotoxin assay results, and may not routinely require cytotoxin testing.
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Lynch ME, Elgeneidy AK. The role of sympathetic activity in neuropathic orofacial pain. JOURNAL OF OROFACIAL PAIN 1996; 10:297-305. [PMID: 9161234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Seventeen patients with neuropathic orofacial pain are presented with reference to precipitating events, pain descriptions, response to treatment, and other aspects of their histories and clinical presentation. Stellate ganglion blocks were done on 14 patients. Ten of 14 patients reported temporary relief of pain with stellate ganglion blocks. Five of these patients noted more prolonged improvement in pain, two reported no change, and two experienced a temporary increase in pain. It is argued that sympathetically maintained pain involving orofacial locations does occur and that stellate ganglion blocks may benefit a subgroup of these patients. It is noted that current diagnostic categories are inadequate to describe a subgroup of these patients. New categories are suggested, and further study is recommended.
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Abstract
Advanced practice neonatal nurses (APNNs) have participated as crucial care providers during the past two decades in supporting the development and implementation of safe, therapeutic interventions for critically ill infants in the neonatal intensive care unit (NICU). This role has been limited primarily to the NICU environment, however, and there has been minimal opportunity for APNNs to participate in caregiving that extends beyond this boundary. This boundary-based practice may no longer be practical as a result of significant changes in health care financing and health care reform. It is important for all neonatal health care providers to consider an expanded scope of practice for the APNN that extends beyond the NICU into the community and home and encompasses caregiving for the neonate and infant within the first year of life.
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Fidel PL, Lynch ME, Sobel JD. Circulating CD4 and CD8 T cells have little impact on host defense against experimental vaginal candidiasis. Infect Immun 1995; 63:2403-8. [PMID: 7790050 PMCID: PMC173321 DOI: 10.1128/iai.63.7.2403-2408.1995] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The etiology of recurrent vulvovaginal candidiasis in otherwise healthy women of child-bearing age remains an enigma. To date, results from both clinical studies and a murine model of vaginal candidiasis indicate that Candida vaginitis can occur in the presence of Candida-specific Th1-type cell-mediated immunity expressed in the peripheral circulation. The present study was designed to determine the role of circulating CD4 and CD8 cells in primary and secondary vaginal infections with Candida albicans. Vaginal fungal burden, Candida-specific delayed-type hypersensitivity (DTH), and lymph node cell Th1/Th2 cytokine production were monitored in CD4 and/or CD8 cell-depleted mice during persistent primary vaginal infections and secondary vaginal infections against which partial protection was observed. Treatment of mice with anti-CD4 or anti-CD8 antibodies resulted in 90% or greater depletion of the respective cell populations. Mice depleted of CD4 cells had significantly reduced Candida-specific DTH and lymph node cell Th1-type cytokine production during a primary vaginal infection, as well as reduced anamnestic DTH during a secondary vaginal infection. In contrast, mice depleted of CD8 cells showed only reduced gamma interferon production during a primary infection; no alterations in DTH were observed. Despite reductions in DTH and cytokine production, however, CD4 and/or CD8 cell depletion had no effect on vaginal C. albicans burden in mice after a primary or secondary vaginal inoculation. Taken together, these results suggest that while circulating CD4 and CD8 cells contribute to systemic Candida-specific cell-mediated immunity in vaginally infected mice, neither CD4 nor CD8 circulating T cells appear to provide significant host defenses against C. albicans at the vaginal mucosa.
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Fidel PL, Lynch ME, Conaway DH, Tait L, Sobel JD. Mice immunized by primary vaginal Candida albicans infection develop acquired vaginal mucosal immunity. Infect Immun 1995; 63:547-53. [PMID: 7822020 PMCID: PMC173030 DOI: 10.1128/iai.63.2.547-553.1995] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
It has been postulated that systemic cell-mediated immunity (CMI) is an important host defense mechanism against Candida infections of the vagina. However, in an estrogen-dependent murine model of experimental vaginal candidiasis, we recently showed that systemic Candida-specific Th1-type CMI induced by immunization with Candida culture filtrate antigen had no effect on vaginal Candida population levels during the course of a vaginal infection. In the present study, mice given a second vaginal inoculation in the presence of peripheral Candida-specific Th1-type CMI induced by prior vaginal infection had anamnestic-type increased delayed-type hypersensitivity (DTH) responses, concomitant with significantly fewer Candida organisms in the vagina than in primary-infected mice. In addition, organisms in secondary-infected mice were fragmented and superficial penetration into the epithelium was reduced. The systemic presence of Candida-specific T suppressor (Ts) cells that significantly suppressed the infection-derived anamnestic DTH reactivity did not abrogate the protective effect in the vagina. Additional experiments showed that vaginally immunized mice were not protected from gastrointestinal or systemic candidiasis and, in contrast to mice with a second vaginal infection, did not demonstrate anamnestic DTH reactivity. These results suggest that a moderate level of local protection against a Candida vaginal infection can be achieved by vaginal immunization but that the protective role of acquired peripheral Candida-specific Th1-type reactivity at the vaginal mucosa appears to be limited.
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Carter WJ, Lynch ME. Comparison of the effects of salbutamol and clenbuterol on skeletal muscle mass and carcass composition in senescent rats. Metabolism 1994; 43:1119-25. [PMID: 7916118 DOI: 10.1016/0026-0495(94)90054-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Aging decreases skeletal muscle mass and strength, making elderly subjects particularly vulnerable to catabolic effects of age-related diseases. Clenbuterol, a muscle anabolic beta 2-adrenergic agonist, has reduced or restored skeletal muscle losses in experimental catabolic states. However, the doses of clenbuterol used to prevent or reverse muscle wasting in most animal models have exceeded the estimated safe dose in man. Recently, another beta 2-adrenergic agonist, salbuamol (albuterol), has been shown to increase muscle weight and protein content in young rats at a dose similar to that used clinically. In contrast to clenbuterol, salbutamol is currently approved for human use as a bronchodilator in the United States. This study has compared the muscle and protein anabolic effects of salbutamol at a clinically relevant dose with those of clenbuterol at a dose typically used in animal models of muscle wasting. Salbutamol and clenbuterol were administered by implanted osmotic minipumps to Fisher-344 rats aged 3 and 24 months at doses of 1.03 mg and 600 micrograms per kilogram per 24 hours for 3 weeks. The weights of five hindlimb muscles, as well as carcass protein and fat content, were determined. Salbutamol and clenbuterol increased combined hindlimb muscle weight 19% and 28% in young rats, with 19% and 25% increases in old rats. Similarly, these drugs increased gastrocnemius weight and protein content 19% and 24% in young rats, with 19% and 23% increases in old rats. Salbutamol and clenbuterol increased carcass protein content 20% and 30% in young rats, with 12% and 21% increases in old rats.(ABSTRACT TRUNCATED AT 250 WORDS)
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Carter WJ, Lynch ME. Effect of clenbuterol on recovery of muscle mass and carcass protein content following dietary protein depletion in young and old rats. JOURNAL OF GERONTOLOGY 1994; 49:B162-8. [PMID: 8014387 DOI: 10.1093/geronj/49.4.b162] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There is a need for new therapeutic agents designed to prevent or restore skeletal muscle loss in frail, elderly subjects resulting from injury or disease and associated catabolic stresses such as malnutrition. Since the beta 2-adrenergic agonist clenbuterol increases skeletal muscle mass in rats, the effect of this agent on recovery of muscle mass and carcass protein content following protein malnutrition was studied in young and old rats. The 3-week period of severe dietary protein restriction reduced body weight 21%, hind-limb muscle weight 24 and 15%, and carcass protein content 31 and 19%, respectively, in 3- and 24-month-old rats. During the 3-week recovery period induced by feeding a complete diet, 10 mg clenbuterol per kg diet increased hind-limb muscle weight 34 and 30% and carcass protein content 27 and 25%, respectively, in 3- and 24-month-old rats. Restoration was complete in animals of both ages fed clenbuterol and incomplete in animals fed the control diet. These observations suggest that clenbuterol or similar beta 2-adrenergic agonists may be useful in hastening the recovery of muscle mass and body protein stores lost because of malnutrition in frail, elderly humans.
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Carter WJ, Lynch ME. Effect of clenbuterol on recovery of muscle mass and carcass protein content following experimental hyperthyroidism in old rats. COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY. COMPARATIVE PHYSIOLOGY 1994; 108:387-94. [PMID: 7914859 DOI: 10.1016/0300-9629(94)90110-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The beta 2-adrenoceptor agonist, clenbuterol, has hastened the recovery of skeletal muscle and carcass weights and carcass protein stores lost during experimental hyperthyroidism in 24-month-old rats. Daily injection of 6.5 micrograms T3 per 100 g body weight for 2 weeks and 4.0 micrograms for the third week caused a 17-22% reduction in total body, carcass and combined hindlimb muscle weights, and a 16-21% reduction in carcass protein stores. Feeding diet containing 10 mg clenbuterol per kg during a 3-week recovery period caused complete restoration of these parameters to euthyroid control levels while the feeding control diet did not.
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Fidel PL, Lynch ME, Sobel JD. Effects of preinduced Candida-specific systemic cell-mediated immunity on experimental vaginal candidiasis. Infect Immun 1994; 62:1032-8. [PMID: 8112837 PMCID: PMC186220 DOI: 10.1128/iai.62.3.1032-1038.1994] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
It has been postulated that systemic cell-mediated immunity (CMI) is an important host defense factor against recurrent vaginal infections caused by Candida albicans. Using an estrogen-dependent murine model of vaginal candidiasis, we have previously shown that mice inoculated vaginally with C. albicans acquire a persistent vaginal infection and develop Candida-specific Th1-type systemic CMI. In the present study, experimental vaginitis was monitored in the presence of preinduced systemic Candida-specific CMI. Mice immunized systemically with C. albicans culture filtrate antigens (CaCF) in complete Freund's adjuvant (CFA) had Th1-type reactivity similar to that of vaginally infected mice. CaCF given to mice intravenously induced Candida-specific suppressor T (Ts) cells. Mice preimmunized with CaCF-CFA and given a vaginal inoculum of C. albicans had positive delayed-type hypersensitivity (DTH) reactivity from the time of vaginal inoculation through 4 weeks. Conversely, mice infected in the presence of Ts cells had significantly reduced DTH responses throughout the 4-week period in comparison with naive infected mice. However, the presence of Th1-type Candida-specific DTH cells or Ts cells, either induced in mice prior to vaginal inoculation or adoptively transferred at the time of inoculation, had no effect on the vaginal Candida burden through 4 weeks of infection. A similar lack of effects was obtained in animals with lower Candida population levels resulting from a reduction in or absence of exogenous estrogen. These results suggest that systemic Th1-type CMI demonstrable with CaCF is unrelated to protective events at the level of the vaginal mucosa.
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Lynch ME, Sobel JD. Comparative in vitro activity of antimycotic agents against pathogenic vaginal yeast isolates. JOURNAL OF MEDICAL AND VETERINARY MYCOLOGY : BI-MONTHLY PUBLICATION OF THE INTERNATIONAL SOCIETY FOR HUMAN AND ANIMAL MYCOLOGY 1994; 32:267-274. [PMID: 7983571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Although numerous antimycotic agents are available for the treatment of yeast vaginitis there is little comparative data on the in vitro activity of these drugs. In the present two-part study, in vitro macro-broth dilution sensitivity tests were performed on a total of 377 clinical vaginal yeast isolates of nine different species. Antimycotics surveyed included amphotericin B, 5-fluorocytosine and eight azole derivatives. Results show that all vaginal Candida albicans isolates were uniformly sensitive at low concentration to all 10 antimycotics tested. However, non-albicans species, especially Candida glabrata and Saccharomyces cerevisiae, manifested several-fold increases in minimal inhibitory concentrations to all azoles tested except butoconazole. In particular, the in vitro potency of fluconazole and terconazole against species other than C. albicans was relatively poor, whereas the drugs demonstrating the best activity were itraconazole, butoconazole and saperconazole. Susceptibility testing of vaginal C. albicans isolates is not routinely indicated, even in patients with recurrent vaginitis and should be reserved for selected organisms, especially non-albicans species, in patients with clinical failure only.
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Fidel PL, Lynch ME, Redondo-Lopez V, Sobel JD, Robinson R. Systemic cell-mediated immune reactivity in women with recurrent vulvovaginal candidiasis. J Infect Dis 1993; 168:1458-65. [PMID: 8245529 DOI: 10.1093/infdis/168.6.1458] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
It has been suggested that impaired cell-mediated immunity (CMI) against Candida antigens is responsible for susceptibility to recurrent vulvovaginal candidiasis (RVVC) in adult women. To address this, we conducted a comprehensive longitudinal study examining in vivo and in vitro systemic CMI reactivity in RVVC patients. Results showed that RVVC patients frequently demonstrated a transient loss of Candida-specific delayed cutaneous skin test reactivity during episodes of symptomatic vaginitis. In contrast, in vitro peripheral blood lymphoproliferation and Th1-type lymphokine production by RVVC patients in response to a T cell mitogen and multiple Candida and bacterial antigens were similar to controls both during acute episodes of vaginitis and during periods of infection-free remission. These results suggest that women with RVVC have no detectable impairment of systemic CMI in peripheral blood and that transient reductions in skin test reactivity appear to be a result of vaginal Candida infection and not a predisposing factor to RVVC.
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Fidel PL, Lynch ME, Sobel JD. Candida-specific Th1-type responsiveness in mice with experimental vaginal candidiasis. Infect Immun 1993; 61:4202-7. [PMID: 8406809 PMCID: PMC281145 DOI: 10.1128/iai.61.10.4202-4207.1993] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The role of systemic cell-mediated immunity (CMI) as a host defense mechanism in the vagina is poorly understood. Using a murine pseudoestrus model of experimental vaginal candidiasis, we previously found that animals given a vaginal inoculum of viable Candida albicans blastoconidia acquired a persistent vaginal infection and developed Candida-specific delayed-type hypersensitivity (DTH) responses. The present study was designed to characterize the peripheral CMI reactivity generated from the vaginal infection in mice and to determine whether pseudoestrus is a prerequisite for the induction of peripheral CMI reactivity. Mice treated or not treated with estrogen and given a vaginal inoculum of C. albicans blastoconidia were examined for 4 weeks for their vaginal Candida burden and peripheral CMI reactivity, including DTH responsiveness and in vitro Th1 (interleukin-2 [IL-2], gamma interferon [IFN-gamma]/Th2 (IL-4, IL-10)-type lymphokine production in response to Candida antigens. Results showed that although mice not treated with estrogen before being given a vaginal inoculum of C. albicans blastoconidia developed only a short-lived vaginal infection and harbored significantly fewer Candida CFU in the vagina compared with those given estrogen and then infected; DTH reactivity was equivalent in both groups. In vitro measurement of CMI reactivity further showed that lymph node cells from both estrogen- and non-estrogen-treated infected mice produced elevated levels of IL-2 and IFN-gamma in response to Candida antigens during the 4 weeks after vaginal inoculation. In contrast, lymph node cells from the same vaginally infected mice showed no IL-10 production and only small elevations of IL-4 during week 4 of infection. These results suggest that mice with experimental vaginal candidiasis develop predominantly Th1-type Candida-specific peripheral CMI reactivity and that similar patterns of Th1-type reactivity occur in mice regardless of the persistence of infection and the estrogen status of the infected mice.
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Lynch ME. Male and female circumcision in Canada. CMAJ 1993; 149:16. [PMID: 8018120 PMCID: PMC1485263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Lynch ME. What to do when ... the patient does not speak english! THE JOURNAL OF PRACTICAL NURSING 1993; 43:38-40. [PMID: 8510038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Fidel PL, Lynch ME, Sobel JD. Candida-specific cell-mediated immunity is demonstrable in mice with experimental vaginal candidiasis. Infect Immun 1993; 61:1990-5. [PMID: 8097493 PMCID: PMC280793 DOI: 10.1128/iai.61.5.1990-1995.1993] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Women with recurrent vulvovaginal candidiasis often demonstrate a down-regulation of cell-mediated immunity (CMI) to Candida albicans detected by a lack of cutaneous delayed-type hypersensitivity (DTH) to Candida antigens. However, the role of systemic CMI as a host defense mechanism against recurrent vulvovaginal candidiasis is not well understood, in part because of the lack of a well-defined murine model of vaginal candidiasis. The present study was undertaken to determine: (i) whether soluble Candida culture filtrate antigens (CaCF) could be used to induce and detect Candida-specific CMI in mice and (ii) whether these antigens would be useful in detecting systemic CMI in mice given an experimental Candida vaginal infection. To this end, mice were immunized subcutaneously with CaCF in complete Freund's adjuvant, and within 7 days they developed Candida-specific DTH reactivity detected by footpad swelling (increase in footpad thickness, 0.36 mm) 24 h after footpad challenge with CaCF. Adoptive transfer studies showed that the DTH responsiveness was elicited by CD4+ DTH T cells. In mice given a vaginal inoculum of C. albicans blastoconidia (5 x 10(5)), footpad challenge with CaCF resulted in positive DTH responses (0.24 mm) as early as 1 week, responses similar to immunization in 2 to 3 weeks (0.33 mm), and sustained low levels of DTH reactivity (0.15 mm) through 10 weeks of vaginal infection. Vaginal lavage cultures revealed that peak vaginal Candida burden occurred 1 week post-vaginal inoculation (10(5) CFU) and declined 16-fold by week 10. These results provide evidence that Candida-specific systemic CMI is generated and can be detected longitudinally in mice with Candida vaginitis by a multiantigen preparation of Candida organisms which both initiates and detects Candida-specific CMI.
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72
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Abstract
The relation between maternal unipolar major depression and children's self-concept, self-control, and peer relationships were studied in a middle-class, predominantly white sample of 96 families. Each family included a target child between the ages of 5 and 10. Depressed mothers varied on whether or not the child's father also had a psychiatric disorder. Well mothers all had spouses with no psychiatric disorders. Analyses controlled for marital status, age, and sex of child. Children completed measures of self-concept and peer relations skills; teachers completed measures of self-control and a rating of popularity with peers. Results supported the multiple risk factor model in that fathers' psychiatric status and parents' marital status explained much of the variability in children's social and emotional competence. Maternal depression alone, in the context of a well husband/father, was only related to children having been rated by their teachers as less popular. Results are discussed in terms of possible mechanisms by which maternal depression may interact with paternal psychopathology and divorce in relation to children's social and emotional competence. The findings may further indicate that older children are more vulnerable to these multiple risk factors than younger children.
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73
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Affonso DD, Hurst I, Mayberry LJ, Haller L, Yost K, Lynch ME. Stressors reported by mothers of hospitalized premature infants. Neonatal Netw 1992; 11:63-70. [PMID: 1448032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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74
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Lynch ME. Psychological aspects of reflex sympathetic dystrophy: a review of the adult and paediatric literature. Pain 1992; 49:337-347. [PMID: 1408300 DOI: 10.1016/0304-3959(92)90241-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In 1864, W. Mitchell and colleagues first described the clinical syndrome which came to be known as 'causalgia'. Since that time, the concept of sympathetically related pain has evolved. There is general agreement that profound emotional and behavioural changes can follow these types of pain. Opinions have varied widely on the issue of a psychological etiology. It has often been suggested that certain personality traits predispose one to develop sympathetically related pain syndromes. A review of the literature reveals no valid evidence to substantiate this claim.
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75
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Rushton CH, Lynch ME. Dealing with advance directives for critically ill adolescents. Crit Care Nurse 1992; 12:31-7. [PMID: 1597062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Respecting the values and preferences of adolescents regarding treatment is an essential dimension of nursing practice. As public policy and societal thinking about the role of minors in healthcare decisions evolves, critical care nurses are in a pivotal position to provide leadership and guidance. Critical care nurses who care for adolescents should embrace the opportunity created by the PSDA to implement creative strategies for involving minors in decision making, seek improved methods of assessing decision-making capacity, and document the values and preferences of minors.
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