ABSTRACT
BACKGROUND: Renal transplantation is the most effective treatment for children with end-stage renal disease. Recent work suggests that induction with alemtuzumab in the pediatric population permits the use of lower doses of maintenance immunosuppressive therapy. In addition, it has a low cost compared with other induction therapies. OBJECTIVE: To conduct a clinical description of pediatric renal transplant patients comparing induction protocols to evaluate graft and patient survival, infections complications, and lymphoproliferative diseases. MATERIALS AND METHODS: This descriptive and retrospective study, of evaluated pediatric renal transplant patients between 2006 and 2010. RESULTS: The agents for induction therapy were: alemtuzumab (61.5%), daclizumab (19.25%), and thymoglobulin (19.25%). Graft survival was better among the alemtuzumab group (87.5%) compared with the other two induction therapies (80%). The frequency of acute rejection episodes during the first year posttransplantation as well as chronic rejection was lower among the alemtuzumab group. Cytomegalovirus infection was noted in 30% of patients with greater frequency among those induced with alemtuzumab. CONCLUSION: Induction therapy with alemtuzumab was safe in a pediatric population not predisposing to a greater risk of acute or chronic rejection. Except for a greater incidence of Cytomegalovirus, there was no difference in other complications.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Kidney Transplantation/methods , Renal Insufficiency/therapy , Adolescent , Alemtuzumab , Antibodies, Monoclonal, Humanized/pharmacology , Antilymphocyte Serum/pharmacology , Antineoplastic Agents/pharmacology , Child , Child, Preschool , Cytomegalovirus Infections/complications , Daclizumab , Female , Graft Survival , Humans , Immunoglobulin G/pharmacology , Immunosuppressive Agents/therapeutic use , Lymphoproliferative Disorders/etiology , Male , Pediatrics/methods , Renal Insufficiency/mortality , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Epidemics can be represented mathematically using a variety of models. One of these, the Kermack-McKendrick model, has been used to support health policy decisions concerning vaccination requirements. An unrelated body of literature suggests that some behaviours, including some types of violence, may spread in ways analogous to the contagious spread of infectious diseases, a process that has been characterized as "behavioural contagion". METHOD: Various parameter values reflecting the characteristics of crowds were substituted into the Kermack-McKendrick model. Computer simulations were used to evaluate the impact of these parameter values. RESULTS: The simulations reproduced several features of crowd violence: the tendency for riots to occur in large groups, the importance of rapid removal of violent individuals from crowds, and the roles of alcohol consumption and social identification processes. CONCLUSIONS: Epidemic models may be of relevance to the prevention and control of violent behaviour as they can assist with the identification of high-risk situations and prevention strategies. Theoretical constructs related to epidemic theory may have broad applicability for modelling the unstable course of some mental disorders.
