MANAGEMENT OF MEDICALLY COMPROMISED PATIENTS

SAKINAH MOHD SALEH1090041MOHD AZIZUL MOHD ATAN1090042ABDULLAH ZAHID AZHARI1090043NUR AMALINA ZULKEPRE1090044NURMARZURA ABDUL LATIF1090045AHMAD ZULKHAIRI RESALI1090046NURUL ASMAT ABDUL RAHMAN1090048

MANAGEMENT OF MEDICALLY COMPROMISED PATIENTS

GROUP 3: ONCOLOGYDiscuss the aetiologies, clinical presentations, problems related to dental management and general management of patients with this medical problem.IntroductionCancer is a complex illness that requires clinical care by a physician or other health care professional.Among 50 types of childhood cancers, the most common forms include leukemias, lymphomas, central nervous system tumours, primary sarcoma of bone and soft tissues.Chemotherapy, radiotherapy and surgery has resulted in 70% cure rateWhat is cancer?Cancer is an abnormal growth of cells. Cancer cells rapidly reproduce despite restriction of space, nutrients shared by other cells or signals sent from the body to stop reproduction. Cancer cells are often shaped differently than healthy cells, they do not function properly and they can spread to many areas of the body. ONCOLOGYAETIOLOGYThe factors involved may be genetic, environmental or constitutional characteristics of the individual.Lifestyle factors :-smoking, high-fat diet and working with toxic chemicalsGenetics:genetic mutation, exposure to chemicals near a family's residence, a combination of these factors or simply coincidence.genetic disorders)Exposure:-viruses such as the Epstein-Barr virus (EBV) and human immunodeficiency virus (HIV).- environmental such as pesticides, fertilizers, and powerONCOLOGYCLINICAL PRESENTATIONClinical presentations: Incidence150 new cases per I million US children

2nd leading cause of deathClinical presentationsIncidence of childhood cancerCancerIncidenceleukemia30.2Central nervous system21.7lymphoma10.9neuroblastoma8.2Soft tissue sarcoma7.0Renal tumor6.3Bone tumor4.7others11.0Recent trends in childhood cancer incidence and mortality in the United States. J Nati Cancer Inst 1999;91:1051-8Clinical presentationsCancer diagnosis in children is often delayedbecause the presenting symptoms tend to benonspecific and resemble those of benignconditions.LEUKEMIANON-HODGKINS LYMPHOMANEUROBLASTOMACommon disease of childhood cancerLeukemiaDefinition:a heterogenous group of haematological malignancies caused by proliferation of primitive white blood cells

Types:-Acute lymphoblastic leukemia-Acute myeloid leukemia-Chronic myeloid leukemia

i- Acute lymphoblastic leukemiaAccounts for 80-85% of childhood leukemiasDefined by the presence of 30% lymphoblasts in the bone marrow.Therapy is tailored to the risk of relapse and includes combination inductio chemotherapy, central nervous system and maintenance chemotherapy.Approximately 2 years for total therapy.Generally 70% of patients are curedPrognosis depends on age, initial white cell count, cytogenic abnormalities.

ii- Acute myeloid leukemiaiii- Chronic myeloid leukemia15-20% of acute childhood leukemias.Bone marrow infiltrated with primitive myeloid cells, classified by morphological apppearance.Induction therapy may be followed by bone marrow transplantation (autogenous or allogenic)Cure rate is less than acute lymphoblastic leukemia approximately 50%Rare in childhood, accounts for 2,000/mm3: no need for antibiotic prophylaxis1000 to 2000/mm3: Use clinical judgment1based on the patients health status and planned procedures. Some authors1,5 suggest that antibiotic coverage (dosed per AHA recommendations) 75,000/mm: no additional support needed. 40,000 to 75,000/mm3: platelet transfusions may be considered pre- and 24 hours post-operatively. Local-ized procedures to manage prolonged bleeding may include sutures, hemostatic agents, pressure packs, and/or gelatin foams is needed.