Introduction: Opioid dependence is recorded as the most common drug of abuse in Malaysia. Currently, the preferred substitution therapy for most Government treatment centres is methadone used as substitution therapy for opioid dependence. There are, however patients who may benefit from being on the combined buprenorphine-naloxone formulation as substitution therapy instead. We discuss six cases of opioid dependence of varied backgrounds that were treated with buprenorphinenaloxone therapy and their outcomes. Discussion: All of the reported patients improved after the induction of buprenorphine- naloxone. Two of the cases highlighted the transfer of patients on methadone to buprenorphine-naloxone due to the adverse effect and interactions of methadone with other medications. During the transfer there were no major adverse reactions noted, and patients were safely able to continue with the maintenance therapy of buprenorphine- naloxone. Conclusion: Buprenorphine-naloxone is a safe and effective drug substitution therapy for opioid dependence. It has fewer interactions with other medications, and has similar efficacy to methadone. Being a partial agonist, it has a less sedating effect making patients more functional.
Buprenorphine, Naloxone Drug Combination

Objective:Breast cancer is the most common cancer in women,causing significant mortality in the world,which contributed 11.7％ to the overall cancer-related mortality in Afghanistan.In 2018,3062 new breast cancer cases were reported accounting for 29.7％ of all cancers in women in the country.However,a comprehensive diagnostic and therapeutic system is lacking in Afghanistan.In this paper,we reported the implementation of a project aiming to establish a comprehensive breast cancer center in Herat province of Afghanistan.Methods:From July 2017,a two-year-program initiated at Kimia Hospital in Herat.This first free diagnostic and therapeutic breast cancer project planned by the Afghanistan Surgeons Society-West and the Verein für Afghanistan-F(o)rderung e.V.,as well supported by three international foundations.The target populations of this project were women presenting with breast problems at Kimia Hospital in Herat and healthcare staff involved in breast cancer diagnosis and management.Results:A group of six medical personnel chosen to represent the breast cancer core team for breast cancer diagnosis and management were trained in India.These caregivers established the breast cancer service and tumor board.During a period of 20 months,a total of 632 women with breast problems presented to Kimia Hospital of whom 44 (7.0％) were diagnosed with breast cancer.Diagnosis was established by a physical exam-ination,ultrasonography,mammography,biopsy and histopathology.Treatment included surgery,radiotherapy and chemotherapy.Twelve seminars for 512 healthcare workers,1000 brochures and a movie were prepared for awareness-raising actions.For continuation of this project,potential resource providers were identified.A database was developed to record project findings.Conclusion:Implementation of this comprehensive breast cancer project resulted in significant achievements in healthcare staff capacity building,diagnosis and management of breast cancer patients in Herat province.Data obtained in this project offer Afghan govemment,public health authorities,and the community the opportunity of improving diagnosis and treatment of breast cancer in Afghanistan.

COVID-19 pandemic aggravated the global public health system, which is already overwhelmed by the increasing statistics of comorbidities and burden due to obesity. The number of individuals with obesity and obesity-associated diseases are rising in many regions that could attribute to the growing obesogenic environment and the lockdown implemented to curb COVID-19. This review focuses on the aspects of the obesity epidemic, chronic inflammatory effects of obesity, positive outcomes of obesity interventions and the worsening effects observed in obese COVID-19 patients. The chronic inflammatory effects of obesity are apparent by the increase of pro-inflammatory signals by immune cells in the adipose tissue and reactive species populations. The reduction of antioxidants exacerbates the effects of oxidative stress on genomic and tissue levels. The public must be made aware of the importance of practising a healthier lifestyle, even more now as we are fighting the COVID-19 pandemic.