Protocol for dental treatment before bone marrow transplantation [BMT] in paediatric patients

Bone marrow transplant [BMT] provides a chance to life for the patients with end-stage diseases like leukaemia, aplastic anaemia etc. The success of the transplantation procedure depends on the immune reactivity of the recipient patient, which may trigger the rejection. The aim of the present study was, to find out dental treatment needs in patients before BMT in Children's Hospital, Pakistan Institute of Medical Sciences [PIMS, Shaheed Zulfiqar Ali Bhutto Medical University] Islamabad, and also to make the dentists aware of the special needs of BMT patients, the specific medication and the necessity of an effective dental treatment. It was retrospective study done on 44 children who required BMT and were referred from oncology department of Children's hospital. Data of patients were taken from the hospital records. The age of patients ranged from 01-12 years with mean of 4.69 +/- 2.5 years. Out of total 44 patients, 12 were females and 32 were males. The difference in ratio between male and female patients is statistically significant [P<0.01]. Patients were divided into 2 groups of 1-5 years and 6-12 years. The difference in ratio of males to females in age group of 1-5 years is also significant [P<0.01]. Patients who required dental treatment before Bone Marrow Transplant were 29 [65.5%], while 15[34%] patients did not require any dental treatment. This difference is highly significant [P<0.05]. More dental treatment was required in age group of 1-5 years old children as compared to group of 6-12 years old. Total 101 teeth were restored, 13 teeth were extracted and 19 fissure sealants were placed. None of the patient showed dental infection after bone marrow transplant, therefore the protocol of the pre-BMT dental treatment was helpful in minimizing infection during immune-suppression period of post bone marrow transplantation

Maternal mortality in an obstetric unit

Maternal deaths amongst 4641 deliveries over 5 years were analysed. The overall maternal mortality was 27.4/1000 total births and 24.4/1000 when abortion deaths were excluded. Complications of pregnancy, labour and puerperium accounted for 72.4%, and indirect causes for 27.6% of deaths. Heamorrhage from all causes [29.9%] and sepsis including septic abortion [29.1%] were the commonest causes of maternal mortality. Majority of the patients [50.3%] were between 20 - 30 years of age and in the post partum period [62.2%]. Mortality was high in those admitted in precarious condition. Of 127 deaths 109 were admitted in critical condition and 120 deaths were considered preventable. The commonest avoidable factor was patient's attitude