Background: Inappropriate medication dosing in patients with chronic kidney disease can cause toxicity or ineffective therapy. Patients are at a high risk of developing related adverse events caused by the altered effect of drugs in conjunction with the use of polypharmacy to treat comorbid conditions. Aim: The aim of this work was to highlight the awareness among patients and doctors regarding dose adjustment in chronic kidney disease. Methods: This is cross-sectional study was carried out in Benha University hospitals in Internal Medicine, Cardiology, Hepatology, Pulmonology, and Neuropsychiatry Departments on different doctors and patients in the wards using questionnaire. The questionnaire included the following items: Demographic data, Occupational history, Education history, and Personal/family history of kidney disease. Results: Regarding questions asked to patients, 55% knew that patients with CKD need dose adjustment, 14% knew drugs need to be adjusted and 9% knew percentage of drugs need to be adjusted. Conclusions: Regarding questions asked to doctors, 97% knew that patients with CKD need dose adjustment, 91% knew drugs need to be adjusted, 84% knew Percentage of drugs adjusted and 66% knew level of GFR a given medication needs to be adjusted. Patients across all levels of training demonstrated poor awareness and knowledge of individualizing therapy based on patient"s renal function. Poor knowledge of renal dosing rules and lack of medication information have been identified as major causes of prescribing errors.

Catheter related blood stream infection (CRBSI) is a common complication with the use of central venous catheters (CVC) in hemodialysis patients. The study was designed to evaluate the effect of implementation of surveillance cultures (SCs) on the rate of CRBSIs. Method: This prospective cohort study was done over a period of 6 months on hemodialysis patients with internal jugular vein catheters. Catheter related blood stream infection rates (BSI) were measured and compared in the 2 included groups, the study group (15 patients) and the control group (15 patients). In both groups, conventional infection prevention and control measures were applied. Patients in the study group were checked for intraluminal microbial colonization every 2 weeks by SCs. According to SCs results, patients were classified into 4 groups, then according to the group they were managed with antibiotic lock therapy (ALT) with or without systemic antibiotics. Results: Of the collected 140 SCs from the study group, 108 (77%) were negative and 32 (23%) were positive. Eighteen cases in groups 2 & 3 received ALT and 6 patients in group 4 received ALT and systemic antibiotic. SCs succeed to eliminate intraluminal microbial colonization in all positive cases except for 1 case in group 2 and 3 cases in group 4. The CRBSI rate was 2.14 per 1,000 catheter days in the study group compared to 5.57 per 1,000 catheter days in the control group (P=0.037). Conclusion: This study shows that the implementation of periodic SCs is associated with a significant reduction in the CRBSI rates in hemodialysis patients.

Paediatric patients undergoing surgical procedures commonly require some volume of blood or blood component replacement in the perioperative period. Paediatric patients undergoing major surgery associated with substantial blood loss should be evaluated pre-operatively. Pre-operative correction of anaemia may be done considering the age, plasma volume status, clinical status and comorbidities. Maximum allowable blood loss (MABL) for surgery must be calculated, and appropriate quantity of blood and blood components should be arranged. Intraoperative monitoring of blood loss should be done, and volume of transfusion should be calculated in a protocol based manner considering the volemia and the trigger threshold for transfusion for the patient and the MABL. Early haemostasis should be achieved by judicious administration of red blood cells, blood components and pharmacological agents.