Comilla Medical College

Abstract Brexpiprazole 2–4 mg daily is a novel dopamine D2 partial agonist approved for schizophrenia and improves effectiveness and tolerance by balancing D2, 5‐HT1A, and 5‐HT2A effects. This review assesses current evidence on its efficacy and safety within this dose range. PubMed, ScienceDirect, and The Cochrane Library were searched for trials published between 2011 and 2025 using specific keywords. Eligibility criteria included schizophrenia patients diagnosed using DSM‐IV, DSM‐IV‐TR, DSM‐5, or ICD‐10, with intervention being 2–4 mg of brexpiprazole. Positive and Negative Syndrome Scale (PANSS) score and Clinical Global Impression ‐ Severity scale (CGI‐S) were the primary efficacy endpoints, and treatment‐related adverse events were used to assess efficacy. Subgroup analysis was planned between the two dosage groups. The quality of randomized controlled trials (RCTs) was evaluated using the ROB2 tool, and the protocol registration was completed in PROSPERO. Among 464 retrieved articles, five trials with 2182 participants were found to be eligible. Brexpiprazole significantly improved total PANSS scores (mean difference [MD] −5.76; 95% confidence interval [CI] −7.69 to −3.83; p < 0.00001), positive subscale scores, negative subscale scores, and CGI‐S scores (MD −1.35; 95% CI −1.87 to −0.84; p < 0.00001). The treatment‐emergent adverse events were similar to placebo, and the risk of discontinuation was less with brexpiprazole (risk ratio 0.58; 95% CI 0.430.77; p = 0.0002). The most usual extrapyramidal symptom was akathisia. Brexpiprazole 2–4 mg showed significant improvements in PANSS and CGI‐S scores, with a lower risk of treatment discontinuation. These findings support its efficacy and tolerability in managing schizophrenia.

Abstract Introduction The ability to have children is connected with self-image, self-respect, and sexuality. Infertilitycan result in either sexual dysfunction or marital distress or both in male and female. Physicians often ignore the dyadic relation of the couple and their sexual intimacy while treating infertility. Objective The purpose of the present study was to examine the proportion of sexual dysfunction and their marital adjustment issues in individuals sufferring from infertility and compare differrent aspects of adjustment issues. Methods Patients were recruited randomly from the departments of infertility in two tertiary care hospitals named Bangladesh Medical University (BMU) and Bangladesh Institute of Rehabilitation of Diabetic and Endocrine metabolism (BIRDEM) in Dhaka city in Bangladesh. Only diagnosed patients seeking treatment were recruited. The study period was from October 2024 till June 2025. IRB was approved from BMU (IRB number: BSMMU/2024/5584). Either male or female patients with diagnosed infertility were randomly selected from these two institutes. Validated instruments like FSFI-6 was used to see female sexual dysfunction and IIEF-6 to see Erectile Dysfunction (ED) of any form and PEDT to see premature ejaculation (PE). Revised Dyadic Adjustment Scale (R-DAS) was applied to see the marital adjustment and satisfaction. Results Total 658 patients (male=320, female=338) were recruited.The mean age of male and female who came for infertility treatment were 33.77 and 28.57 respectively. In men, (n = 320) ED (Any degree) was found in 108 (33.7%) patients. Among the respondents, Mild ED was found in 77 (24.1%), Mild to moderate ED in 26 (8.1%) and Moderate ED in 05 (1.6%) patients. Premature ejaculation (Any degree) 60 (18.7), Probable PE was found in 18 (5.6%), PE 42 (13.1). Among the women, (n = 338) Sexual dysfunction was found in 47 (13.90%) patients. The prevalence of sexual dysfunction was substantial in this sub fertile cohort, affecting nearly one in four individuals (24.2%) overall. Men were disproportionately affected, with ED and PE is present in 33.7% and 18.7% of male partners respectively. These findings highlight that male sexual health concerns are a predominant comorbidity within the infertile population. R-DAS was used to see the marital adjustment and all three R-DAS constructs-Consensus, Satisfaction, and Cohesion-showed significant associations with sexual functioning outcomes. A score of 47 or less indicates marital dissatisfaction. Marital dissatisfaction was found in 17.2% male and 34% female. Higher Consensus and Satisfaction scores were positively correlated with better erectile (IIEF-6) and female sexual functioning (FSFI-6) and negatively correlated with premature ejaculation (PEDT) scores, indicating that greater marital agreement and satisfaction are linked to healthier sexual functioning. Cohesion showed a weaker but significant positive correlation with FSFI-6. Marital distress was significantly more prevalent among infertile women than men (34.0% vs. 17.2%, <0.001). High prevalence of distress was observed in men with mild-to-moderate ED (34.6%). And PE (p = 0.012). Conclusions Physicians dealing infertility should frequently address marital adjustment and sexual dysfunction among couples. Disclosure No

Gastric trichobezoar, though rare in children under 3 years, should be considered in cases of chronic vomiting, malnutrition, and unexplained gastric masses, particularly with clinical clues of irregular alopecia and history of hair ingestion. Abdominal CT is diagnostic, demonstrating a heterogeneous intragastric mass; surgical removal via gastrotomy is definitive treatment, with recurrence rates approaching 20% if underlying causes are unaddressed. Childhood pica and trichophagia are frequently associated with neglect, psychosocial stress, malnutrition, and micronutrient deficiencies, requiring comprehensive multidisciplinary intervention including surgery, nutritional rehabilitation, family psychological support, and child protection services evaluation. Early recognition and holistic management are essential to prevent life‐threatening complications such as obstruction, perforation, and severe malnutrition.

Background: COPD is now one of the top three causes of death worldwide and 90% of these deaths occur in low and middle income country.Assessment of functional capacity is vital for appropriate therapy, standard rehabilitation program and also a strong predictor of survival in patients of chronic obstructive pulmonary disease. Field walking tests are simpler and cheaper, require less technical expertise and equipment. Incremental shuttle walking test and the widely practiced 6MWT is a good predictor of functional status for patients with COPD. 2MWT is more feasible in some settings as frail elderly patients were unable to complete a single trial of 6MWT but better able to tolerate 2MWT. So to find a cut off value of walking distance 2MWT and validity of the test this study is necessary. We search relation between 2MWT and airflow limitation of COPD patients. We also search relation of the test with 6MWT. Objective: To assess the usefulness of 2MWT as an assessment tool of functional capacity of stable COPD patients. Materials and Methods: This cross sectional study was conducted in the department of Respiratory Medicine of National Institute of Diseases of the Chest and Hospital (NIDCH) from February, 2022 to March, 2023. Eight five (85) stable COPD patients with mild to very severe airflow obstruction were enrolled in this study. Baseline data (FEV1, FEV1/FVC, resting pulse rate, respiratory rate and SpO2) were collected and then all the patients were subjected to perform 2 min walk Test (2MWT) and 6MWT under normal ambient conditions. Then pertinent post-exercise data (walking distance, pulse rate, respiratory rate, SpO2) were collected. The Statistical Package for Social Science (SPSS) v.23 was used for statistical analysisResults: Out of 85 patients, Majority 30(35.3%) patients had severe COPD, 27(31.8%) had very severe, 18(21.2%) had moderate and 10(11.8%) had mild COPD. Mean pulse, SpO2, respiratory rate - at the end of 2 minute walk test and 6 minute walk test were statistically significant (p<0.05) compare with baseline. Mean distance walked was found 96.6±36.2 meter in the end of 2 minute and 250.3±91.8 meter in the end of 6 minute. Significant relationship was found between severity of COPD and 2MWT (p<0.001). Based on the receiver-operator characteristic (ROC) curves 2 minute walk test had area under curve 0.886.. Receiver-operator characteristic (ROC) was constructed by using 2 min walk test, which gave a cut off value d”95.7 meter, with 82.5% sensitivity and 85.7% specificity for prediction of severe FEV1. Based on the receiver-operator characteristic (ROC) curves 6 min walk test had area under curve 0.839. Receiver-operator characteristic (ROC) was constructed by using 6 min walk test, which gave a cut off value d”286.5 meter, with 89.4% sensitivity and 71.4% specificity for prediction of severe FEV1. The validity of 2 minute walk test vs 6 minute walk testevaluation for severity of airflow limitation of COPDwas correlated by calculating sensitivity (84.7%), specificity (96.2%), accuracy (88.2%), positive predictive value (98.0%) and negative predictive value (73.5%). Conclusion: This study concluded that the 2MWT is a reliable, valid, and sensitive test for the assessment of functional status in patients with stable COPD. It is practical, simple, quick, easy to administer, and well-tolerated by patients with stable COPD. Chest Heart J. 2024; 48(2) : 90-99

Background Rhinosporidiosis is a chronic inflammatory disease frequently occurring in Asia. Surgery is the mainstay of treatment. About 48% of postoperative patients experience recurrence. To prevent recurrence, dapsone is now recommended. Our study aims to determine the appropriateness of dapsone therapy to prevent recurrence of rhinosporidiosis. Methods A survey of 101 patients in the two tertiary care hospitals, Cumilla, Bangladesh, from 15 july, 2016 to 30 June, 2022. Diagnostic nasal endoscopy (DNE) was performed at every step for provisional diagnosis of rhinosporidiosis. Here, 60 patients were treated with dapsone, and 41 were not. Results Males (81.2%) suffered more than females (18.8%). The age range was 5–14 years (38; 37.63%), followed by 15–24 years (30; 29.70%). Rural (85.1%) and poor (70.3%) were more affected. Children were 50 (49.5%) (Age < 18 years), and adults were 51 (50.5%) (Age ≥ 18 years). 26.7% (27) were recurrent cases; postoperative treatment with dapsone was 60 (59.4%); and 41 (40.6%) were not receiving dapsone. Recurrence without dapsone was 5; 4.95%, and with dapsone, 1; .99%. The odds ratio between the two groups was evaluated using binary logistic regression: age odds ratio = 1.105 (1.009–1.210), P=.032. sex odds ratio = .260, .045 = 1.485, P=.130, number of operations odds ratio= .038, .001-.989, P=.052. treatment with dapsone odds ratio = 164.246, 11.736 = 2298.629, P = < .001, and follow-up time in months odds ratio = 1.081, 1.035–1.130, P < .001. Conclusion A positive trend in cure was observed across age groups, treatment with dapsone, and follow-up time; a negative trend was observed for sex and the number of operations in postoperative dapsone therapy for rhinosporidiosis.