Also, by using this score, different risk levels could be used to triage patients for a decision regarding the initiation of renal replacement therapy. Furthermore, the score could be used to identify higher-risk patients who could be enrolled in clinical trials and be evaluated for risk-treatment Fingolimod interactions. The strength of this study is in its development of an ADR risk score for hospitalized patients with moderate to severe CKD. The score is practical because all the variables included can be obtained routinely in a hospital setting. However, the limitation of our study is that the ADR risk score was developed based on hospitalized CKD patients. Thus, it may not be confidently applied in the ambulatory care. Hence, we recommend future studies to evaluate its validity and applicability in ambulatory care. In conclusion, the current study has developed a practical and efficient risk score for identifying CKD patients who are at increased risk for experiencing ADRs during hospital stay. The score uses routinely available patient data. Bacterial meningitis is a serious and often fatal infection. Neisseria meningitidis,ICI 182780 Streptococcus pneumoniae, and Haemophilus influenzae type b account for the vast majority of bacterial meningitis cases outside the neonatal period. Understanding the burden of bacterial meningitis is important because of recent advances in vaccines for these infections. Hib conjugate vaccines have led to the near disappearance of invasive Hib disease in Brazil and elsewhere. Pneumococcal conjugate vaccine has had a huge impact on the incidence of invasive pneumococcal disease in the United States and is being incorporated into the routine pediatric immunization schedule in Brazil, as is serogroup C meningococcal conjugate vaccine. In many developing countries, surveillance for bacterial meningitis is hampered by limited use of bacterial culture and a high frequency of negative cultures. Availability of overthe- counter antibiotics, administration of antibiotics before performance of lumbar puncture, lack of microbiology resources for bacterial culture, and variable quality of microbiology services are among the reasons for culture negativity. This problem leads to an underestimate of disease burden and assessments of the potential impact of vaccination.