[NEOADJUVANT TREATMENT OF LOCALLY ADVANCED ESTROGEN/PROGESTERONE POSITIVE, HER2NEU NEGATIVE BREAST CANCER].

INTRODUCTION: Women who present with locally advanced breast cancer that would require a mastectomy are often recommended to undergo chemotherapy prior to surgery in hopes of down-staging the tumor and allowing for breast-conserving surgery. This approach is very effective in women with triple negative and Her2neu positive locally advanced breast cancer, yet the results in ER/PR positive (luminal) breast cancers have been less effective. In post-menopausal women, neoadjuvant hormonal treatment in such cases can cause tumor regression and allow for breast-conserving therapy, in some patients. In premenopausal women with locally advanced luminal type breast cancer, neoadjuvant hormonal therapy can also be effective and is a valid option according to the NCCN guidelines. Yet, there remains a sense that perhaps treatment of this group of patients with chemotherapy results in better outcomes. For the past fifteen years various molecular profiles of luminal breast cancers have been studied and have been used to help guide decisions as to the benefit of adjuvant treatment - whether chemotherapy is necessary or hormonal therapy alone would be adequate. In the neo-adjuvant setting, these profiles can also help predict which tumors are likely to respond to chemotherapy and which are less likely to respond. The only hormonal drugs available until very recently for use in the neoadjuvant setting were either Tamoxifen or an aromatase inhibitor. In the past few years a new class of drugs, CDK4/6 inhibitors have been developed and approved and have significantly improved response rates and time to progression in patients with metastatic hormone responsive breast cancer, and they have also been studied in small trials in the neoadjuvant setting. In this article we will review the data that is available to help guide the optimal choice of treatment in women who present with locally advanced luminal breast cancers including the use of molecular profiles and the potential role of anti-CDK 4/6 drugs.

[The association between pertussis during infancy and childhood asthma].

BACKGROUND: The prevalence of pertussis and asthma in Israel increased during the last decade. OBJECTIVE: To examine the association between pertussis during infancy (<6 months of age) and childhood asthma (3-9 years). METHODS: We compared two groups of children >6 months of age who presented to the emergency room with a cough. Pertussis was diagnosed in the study group (SG) and ruled-out in the control group (CG) by Polymerase Chain Reaction. Asthma was diagnosed by a questionnaire. RESULTS: Out of 393 children, presented to the emergency-room, 44 in the SG and 52 in the CG were detected and completed the questionnaire. There was no significant difference between the groups in their demographic data (time of presentation [median and range] 2.2 [1-6] months vs. 3 [1-6] months, gender and place of residence). There were more Arab children in the SG (38% vs. 15%, p<0.05). More children were hospitalized at presentation in the SG (75% vs. 46%, p<0.01). There was no significant difference between the groups in the rate of pertussis vaccination or in genetic or environmental variables that could affect asthma prevalence. There was no significant difference between the study and control groups in the prevalence of asthma (18% vs. 9.6%, p=0.24) or atopic diseases or in childhood asthma in children hospitalized at presentation (18.2% vs. 8.3%, respectively, p=0.44). However, the rate of the combination of asthma and/or atopy in hospitalized infants was significantly higher in the SG (33% vs. 8.3%. p=0.03). CONCLUSIONS: Our study did not show that pertussis during infancy significantly increases the prevalence of childhood asthma.

[Tuberculosis in a pair of twins--the use of molecular biology methods for the detection of the source of infection].

Tuberculosis is still one of the most prevalent infectious diseases worldwide with a high annual morbidity and mortality rate. Its mode of spread necessitates prompt investigation to identify those with active disease, possible carriers and as many contacts as possible. This article describes a pair of twins with endobronchial tuberculosis following close contact with a family relative who had active disease. Mycobacterium tuberculosis was isolated from the family relative and the two children. Laboratory diagnosis of the mycobacterial strain and epidemiologic follow-up were performed using a molecular biology tool, the restriction fragment length polymorphism method. Treatment was successful due to the close cooperation between the medical staff of the hospitals, the community clinics and the Center for Diagnosis and Treatment of Tuberculosis. Treatment was administered by the directly observed therapy (DOT) method recommended by the World Health Organization. This article describes the clinical course and treatment of the patients and reviews the new molecular biology methods currently being used for the diagnosis of tuberculosis and their important clinical applications.

[Bacteriophages as antibacterial agents].

Bacteriophages are viruses that only infect bacteria. They have played an important role in the development of molecular biology and have been used as anti-bacterial agents. Since their independent discovery by Twort and d'Herelle, they have been extensively used to prevent and treat bacterial infections, mainly in Eastern Europe and the former Soviet Union. In western countries this method has been sporadically employed on humans and domesticated animals. However, the discovery and widespread use of antibiotics, coupled with doubts about the efficacy of phage therapy, led to an eclipse in the use of phage in medicine. The emergence of antibiotic resistant bacteria, especially strains that are multiply resistant, has resulted in a renewed interest in alternatives to conventional drugs. One of the possible replacements for antibiotics is the use of bacteriophages as antimicrobial agents. This brief review aims to describe the history of bacteriophage and early clinical studies on their use in bacterial disease prophylaxis and therapy, and discuss the advantages and disadvantages of bacteriophage in this regard.