Chronic kidney disease (CKD) alters the pharmacokinetic and pharmacodynamic response of various drugs and increases the risk of toxicity. The data regarding the pattern and predictors of medication dosing errors is scare from the developing countries. Therefore, the present study was conducted to assess the pattern and predictors of medication dosing errors in CKD patients in a tertiary care setting in Pakistan. A retrospective study design was employed and medical charts of all those CKD patients who had an eGFR ≤60ml/min/1.73m², hospitalization ≥24 hours, and admitted in the nephrology unit during January 2013 to December 2014 were assessed. Descriptive statistics and the logistic regression analysis were done using IBM SPSS version 20. In total, 205 medical charts were assessed. The mean age of patients was 38.64 (±16.82) years. Overall, 1534 drugs were prescribed to CKD patients, of which, nearly 34.0% drugs required dose adjustment. Among those drugs, only 41.8% were properly adjusted, and the remaining 58.2% were unadjusted. The logistic regression analysis revealed that the medication dosing errors were significantly associated with the CKD stages, i.e. stage 4 (OR 0.054; 95% CI [0.017–0.177]; p <0.001) and stage 5 (OR 0.098; 95% CI [0.040–0.241]; p <0.001), the number of prescribed medicines ≥ 5 (OR 0.306; 95% CI [0.133–0.704]; p 0.005), and the presence of a comorbidity (OR 0.455; 95% CI [0.226–0.916]; p 0.027) such as the hypertension (OR 0.453; 95% CI [0.231–0.887]; p 0.021). It is concluded that more than half drugs prescribed to CKD patients requiring dose adjustment were unadjusted. The predictors of medication dosing errors were the severe-to-end stages of chronic kidney disease, the presence of a comorbidity such as hypertension, and a higher number of prescribed medicines. Therefore, attention should be paid to these risk factors.

The history of cancer chemotherapy is as old as cancer itself. With the increase in the complexities of cancer and the development of resistance towards existing anticancer agents, increased attention is now being paid to the advancement of chemotherapy. Some chemotherapeutic agents were discovered by accident or trial-and-error methods while others were found to be useful for neoplasia when they were being evaluated for some other purpose. Broadly, these agents have been classified as alkylating agents, antimetabolites, platinum compounds, antitumor antibiotics and natural products. Hormones and compounds interfering with hormone metabolism are widely used in cancer treatment, besides monoclonal antibodies and small molecules targeting angiogenesis. In this review an attempt is made to discuss the major breakthroughs that have shaped the course of cancer chemotherapy, helping to decrease the mortality as well as lessen the suffering of patients.

Inadequate infection control in healthcare settings can increase healthcare-associated infections and worsen morbidity and mortality rates. Standard precautions, applicable to all patients with suspected or confirmed infections, safeguard both healthcare personnel and patients. This study aimed to evaluate knowledge, attitudes and practices regarding standard precautions among healthcare personnel in tertiary care hospitals across Punjab, Pakistan. This multi-centre cross-sectional study, conducted from May to July 2019, included 600 healthcare personnel recruited via convenience sampling from tertiary care hospitals in six cities selected at random. Out of 533 healthcare personnel, the response rate was 88.8%. Most respondents were female (N=341, 64.2%), mean ± standard deviation (SD) age was 28.85 ±7.08 years, and mean ± SD length of service was 5.58 ± 5.78 years. Knowledge, attitudes and practices regarding standard precautions were poor, and only 37.5%, 46.7% and 46.3% of respondents had good knowledge, positive attitudes and safe practices, respectively. Healthcare personnel with >10 years of experience [adjusted odds ratio (AOR) 2.98, 95% confidence interval (CI) 1.60–5.55], previous infection control training (AOR 1.96, 95% CI 1.30–2.94), professional degrees (AOR 2.04, 95% CI 1.16–3.60), and availability of infection control guidelines in their work department were more likely to have good knowledge regarding standard precautions. The availability of infection control guidelines in the work department was also significantly associated with positive attitudes (AOR 2.83, 95% CI 1.76–4.56) and safe practices (AOR 3.46, 95% CI 1.94–6.14). Knowledge, attitudes and practices of healthcare personnel regarding standard precautions were inadequate. Continuous education and certified training for healthcare personnel can improve infection control measures substantially in public healthcare settings.