Disc Displacement without Reduction (DDwoR) is a temporomandibular joint (TMJ) disorder typically associated with limited mouth opening due to obstruction from a non-reducing anteriorly displaced disc. However, in rare instances, patients may maintain normal or increased mandibular mobility due to adaptive changes in the retrodiscal tissues. Minimally invasive treatment approach is extremely helpful in such cases when all conservative protocol fails. KYAMC Journal Vol. 16, No. 04, January 2026: 228-231.
Background: Acute promyelocytic leukaemia (APL) is one of the most curable forms of acute myeloid leukaemia following treatment with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). Risk-adapted ATRA-ATO regimens with reduced chemotherapy exposure are increasingly used to minimize toxicity and treatment burden. However, experience with reduced-dose ATRA in children remains limited in Bangladesh.Objective: To describe the treatment, toxicity, and molecular outcomes of children with APL treated with risk-adapted ATRA-ATO-based regimens.Case Presentation: Five children with newly diagnosed APL, aged 3.8–12 years, were treated at Khwaja Yunus Ali Medical College & Hospital, Bangladesh, during 2025. Diagnosis was confirmed by bone marrow morphology, immunophenotyping, and PML-RARA RT-PCR. Patients were risk-stratified according to presenting white blood cell count. One standard-risk patient received the Lo-Coco regimen with ATRA 45 mg/m²/day and ATO 0.15 mg/kg/day. Four patients received the COG AAML1331-based regimen with reduced-dose ATRA 25 mg/m²/day and ATO 0.15 mg/kg/day; two high-risk patients also received limited-dose idarubicin.Results: All five patients achieved morphological remission after induction and complete molecular remission after the second consolidation, confirmed by negative PML-RARA RT-PCR. Toxicities were manageable. Differentiation syndrome and leucocytosis responded to dexamethasone and hydroxyurea, respectively. Severe pseudotumor cerebri occurred in the patient receiving ATRA 45 mg/m²/day but was not observed among those receiving 25 mg/m²/day.Conclusion: Risk-adapted ATRA-ATO therapy, including reduced-dose ATRA, appears feasible and effective for childhood APL in a resource-constrained setting. These encouraging findings warrant larger studies with longer follow-up. KYAMC Journal Vol. 16, No. 04, January 2026: 232-235.
Background: Intradialytic complications such as hypotension, muscle cramps, nausea, headache, itching, and fever adversely affect patients’ well-being and treatment outcomes. Intradialytic hypotension (IDH) is the most common complication among haemodialysis patients. Previous studies suggest a relationship between serum magnesium levels and IDH in maintenance haemodialysis patients.Objectives: To assess the relation of serum magnesium with intradialytic hypotension in maintenance haemodialysis patients.Materials and Methods: This cross-sectional study included 100 patients receiving maintenance haemodialysis for more than 90 days, selected by purposive sampling. Blood pressure was measured before, during, and after haemodialysis. Serum magnesium and other relevant investigations were performed before and after dialysis. Data were analyzed using SPSS version 25 with paired t-test, Fisher’s exact test, and Chi-square test.Results: Among the participants, 62% were male and 38% female. Diabetic nephropathy was the commonest primary disease (55%). IDH occurred in 42% of patients. In hypotensive patients, mean serum magnesium significantly decreased from 2.27±0.46 mg/dL before dialysis to 2.0±0.44 mg/dL after dialysis (p=0.002). No significant change was observed among non-hypotensive patients. Serum potassium, calcium, and phosphate levels significantly decreased after dialysis in both groups (p<0.001). No significant association was found between IDH and age, dialysis frequency, diabetes mellitus, ischemic heart disease, or interdialytic weight gain.Conclusion: Significant reduction of serum magnesium during haemodialysis was associated with intradialytic hypotension. Maintaining adequate magnesium levels may help improve haemodynamic stability during dialysis. KYAMC Journal Vol. 16, No. 04, January 2026: 162-168.
Background: Asthma is a major global health problem and one of the leading causes of childhood emergency visits. Management is often challenging because of comorbidities, poor adherence, improper inhaler technique, environmental factors, and severe therapy-resistant asthma.Objective: To determine the effects of vitamin D supplementation on asthma control and severity.Materials and Methods: This randomized clinical trial was conducted in the Department of Pediatric Respiratory Medicine at Bangladesh Shishu Hospital and Institute from January 2019 to December 2020 among children aged 6–15 years diagnosed with asthma. Eligible participants were randomly assigned into Group A and Group B with blinding. Group A received oral vitamin D3 (cholecalciferol) 400 IU daily for 4 months along with standard treatment, while Group B received standard treatment only. After 4 months, asthma severity, level of control, peak expiratory flow rate (PEFR), acute exacerbations, and emergency visits were assessed. A p-value <0.05 was considered significant.Results: Asthma control improved significantly in Group A; 33 patients achieved well-controlled asthma compared to 21 in Group B (P=0.029). Moderate persistent asthma decreased from 42 to 20 patients in Group A versus 35 to 31 in Group B (P=0.033). PEFR <80% decreased significantly in Group A (P=0.014). Acute exacerbations and emergency visits were also significantly lower in Group A (P=0.031 and P=0.001, respectively).Conclusion: Low-dose short-course vitamin D supplementation alongside standard therapy improved asthma control, reduced severity, decreased exacerbations, and lowered emergency hospital visits in children with asthma. KYAMC Journal Vol. 16, No. 04, January 2026: 169-176.
