Purpose Tamoxifen is part of endocrine therapy in breast cancer treatment. Studies have indicated the use of endoxifen concentrations, tamoxifen active metabolite, to guide tamoxifen efficacy.... Show morePurpose Tamoxifen is part of endocrine therapy in breast cancer treatment. Studies have indicated the use of endoxifen concentrations, tamoxifen active metabolite, to guide tamoxifen efficacy. Three endoxifen thresholds have been suggested (5.9 ng/ml, 5.2 ng/ml and 3.3 ng/ml) for therapeutic drug monitoring (TDM). Our aim was to validate these thresholds and to examine endoxifen exposure with clinical outcome in early-breast cancer patients using tamoxifen. Methods Data from 667 patients from the CYPTAM study (NTR1509) were available. Patients were stratified (above or below), according to the endoxifen threshold values for tamoxifen efficacy and tested by Cox regression. Logistic regressions to estimate the probability of relapse and tamoxifen discontinuation were performed. Results None of the thresholds showed a statistically significant difference in relapse-free survival: 5.2 ng/ml threshold: hazard ratio (HR): 2.545, 95% confidence interval (CI) 0.912-7.096,pvalue: 0.074; 3.3 ng/ml threshold: HR: 0.728; 95% CI 0.421-1.258,pvalue: 0.255. Logistic regression did not show a statistically significant association between the risk of relapse (odds ratio (OR): 0.971 (95% CI 0.923-1.021,pvalue: 0.248) and the risk for tamoxifen discontinuation (OR: 1.006 95% CI 0.961-1.053,pvalue: 0.798) with endoxifen concentrations. Conclusion Our findings do not confirm the endoxifen threshold values for TDM nor does it allow definition of a novel threshold. These findings indicate a limited value of TDM to guide tamoxifen efficacy. Show less
Conclusions: Respiratory viruses are frequently detected in young children presenting to the hospital emergency department with ARTI and require PCR diagnosis since presenting signs and symptoms... Show moreConclusions: Respiratory viruses are frequently detected in young children presenting to the hospital emergency department with ARTI and require PCR diagnosis since presenting signs and symptoms are not discriminant for a type of virus. RSV and HRV bear a high burden of morbidity in the pediatric clinical setting. Show less
The aims of this thesis were to investigate the efficacy and safety of outpatient treatment of patients with pulmonary embolism (PE) and to identify the best method for selection of PE patients for... Show moreThe aims of this thesis were to investigate the efficacy and safety of outpatient treatment of patients with pulmonary embolism (PE) and to identify the best method for selection of PE patients for outpatient treatment. Therefore, we performed the Hestia study and compared the selection of patients with the Hestia criteria to other methods for risk stratification, for example the simplified Pulmonary Embolism Severity Index and the method described in the European Society of Cardiology guidelines. Show less
