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Introduction: Diagnostic challenge is seen in Systemic Lupus Erythematosus (SLE) due to insidious onset, unpredictable course, broad spectrum of clinical presentation that mimic other diseases manifestation and possibility not fulfilling the classification criteria at the earlier course of the disease. Case report: We highlighted a case of a man, lived with diagnosis of Schizophrenia for almost 15 years subsequently revealed him suffered from neuropsychiatric lupus as he fulfilled the SLE classification criteria. His initial presentation was altered sensorium treated as acute psychosis-the tip of an iceberg to the underlying disease. His multiple admissions to psychiatric ward were believed contributed by episode of lupus flare. Necessary investigation is important to exclude another medical condition before make a diagnosis of Schizophrenia using DSM-V criteria. The misdiagnosis has significantly impaired his social life and untreated disease had leads to morbidity and severe organ damage. This case emphasizes on the crucial aspect of assessing patient as a whole, follow-up the progression and re-evaluates patient’s condition for a new hint. Even though there is no cure yet for SLE, correct and early diagnosis is able to guide for individualized treatment and thus helping in good disease control that warrant better outcome.

Introduction: Premature ejaculation (PE) reduces sexual satisfaction and quality of life. Both SSRI Fluoxetine and Dapoxetine have been used in the treatment of PE. Fluoxetine is used as off-label treatment meanwhile Dapoxetine is the first SSRI specifically designed for PE with short half-life and few side effects. Objectives: To compare the PE symptoms and marital satisfaction score between Fluoxetine and Dapoxetine groups. Materials and method: In this clinical trial, 44 participants aged between 18 and 64 with PEDT score of ≥9 from the Primary Care clinic of Hospital USM, Kelantan were recruited and randomized into two groups; Fluoxetine Group(FG) and Dapoxetine Group(DG). They were prescribed with either daily oral Fluoxetine 20mg or Dapoxetine 30mg on demand twice weekly for 8 weeks. PE symptoms were measured using the Premature Ejaculation Diagnostics Tool(PEDT) score and marital satisfaction score were measured using the Dyadic Satisfaction-Dyadic Adjustment Scale(DS-DAS) score. Measurements were made at baseline and at the 8thweek(post intervention). Results: In FG and DG, 22 and 21 participants completed the study, respectively. PEDT scores reduced significantly within both groups[from 11.41 to 5.45(P