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Pediatric Update

 
Spring 2006

Research Highlights

DOCTOR-PARENT INTERACTION

A new UCLA study shows how communication techniques between a doctor and parents can increase parents’ satisfaction with the treatment plan for their child’s upper respiratory illness and avoid unnecessary antibiotic prescriptions.The findings, presented May 2004 at the Pediatric Academic Society’s annual meeting in San Francisco, California, concluded that focusing positively on what can be done to make a child feel better, rather than on what is not needed (antibiotics), can increase parents’ acceptance of non-antibiotic treatment and satisfaction with care.

“Oftentimes, the dynamics of a doctor-parent interaction leads the pediatrician to perceive that parents expect a prescription for antibiotics, and this can lead to unnecessary prescribing,” says Rita Mangione-Smith, M.D., lead investigator of the study and a pediatrician at Mattel Children’s Hospital at UCLA.

According to Dr. Mangione-Smith, studies show that patients with respiratory illnesses receive antibiotics 30 percent of the time. However, 55 percent of antibiotic prescriptions for these illnesses are not needed—and inappropriate use can lead to antibiotic-resistant infections.

WHY DO WE FEEL MALE OR FEMALE?

Refuting 30 years of scientific theory that solely credits hormones for brain development, UCLA scientists have identified 54 genes that may explain the different organization of male and female brains. Published in the October 2004 edition of the journal Molecular Brain Research, the UCLA discovery suggests that sexual identity is hard-wired into the brain before birth and may offer physicians a tool for gender assignment of babies born with ambiguous genitalia.

“Our findings may help answer an important question—why do we feel male or female?” explains Eric Vilain, M.D., assistant professor of human genetics and urology at the David Geffen School of Medicine at UCLA and a pediatrician at Mattel Children’s Hospital at UCLA. “Sexual identity is rooted in every person’s biology before birth and springs from a variation in our individual genome.”

Since the 1970s, scientists have believed that estrogen and testosterone were wholly responsible for sexually organizing the brain. In other words, a fetal brain simply needed to produce more testosterone to become male.

To their surprise, the researchers found 54 genes produced in different amounts in male and female mouse brains, prior to hormonal influence.“We didn’t expect to find genetic differences between the sexes’ brains,” admits Dr.Vilain.“But we discovered that the male and female brains differed in many measurable ways, including anatomy and function.”

TEACHING THE IMMUNE SYSTEM NEW TRICKS

A recent collaboration facilitated by the Jonsson Cancer Center at UCLA between the Department of Neurosurgery and Ted Moore, M.D., clinical director of pediatric hematology-oncology at Mattel Children’s Hospital at UCLA, has resulted in a new dendritic cell vaccine protocol for children with the usually fatal anaplastic astrocytoma and glioblastoma multiform brain tumors. The Food and Drug Administration approved the therapy in Fall 2004. This new therapy takes stem cells from a patient’s blood and develops them into dendritic cells that are specific antigen processing cells.The dendritic cells are incubated with lysates of tumor from the patient, so that they can process the tumor antigens and, when innoculated into the patient, can each the patient’s immune system to attack the cancer. This therapy is an important method of utilizing a person’s own immune system to fight cancer.

ONE DISEASE MAY PREVENT ANOTHER

 The knowledge that one disease may prevent the onset of another is not new. For example, the discovery that cowpox vaccines can prevent smallpox dates back to 1798. E. Richard Stiehm, M.D., a professor of pediatrics at the Mattel Children’s Hospital at UCLA, researched examples throughout medical history of ways that one disease prevents another.

His findings suggest that genetic, infectious and metabolic influences should be considered when looking for treatments, particularly in regard to HIV/AIDS. “Clinical observations of disease-versus-disease interactions have led to an understanding of the mechanisms of several diseases,” Dr. Stiehm says. “In turn, these observations have led to the development of vaccines, therapeutic antibodies, medications and special diets.”

Detailed in the January 2006 issue of Pediatrics, Dr. Stiehm’s research illustrated 12 disease pairs, reviewed their therapeutic implications and suggested additional applications.

Overall, Dr. Stiehm proposed that new evidence can be found for using certain viruses to treat diseases such as HIV, which do not respond to other medications.“There have been several studies indicating that HIV patients co-infected with a virus related to Hepatitis C, called GB virus C, have less severe HIV disease and improved survival,” Dr. Stiehm says.





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