Retrospective cohort study of anti-tumor necrosis factor agent use in a veteran population.

Introduction. Anti-tumor necrosis factor (TNF) agents are effective for several immunologic conditions (rheumatoid arthritis (RA), Crohn's disease (CD), and psoriasis). The purpose of this study was to evaluate the efficacy and safety of anti-TNF agents via chart review. Methods. Single-site, retrospective cohort study that evaluated the efficacy and safety of anti-TNF agents in veterans initiated between 2010 and 2011. Primary aim evaluated response at 12 months post-index date. Secondary aims evaluated initial response prior to 12 months post-index date and infection events. Results. A majority of patients were prescribed anti-TNF agents for CD (27%) and RA (24%). Patients were initiated on etanercept (41%), adalimumab (40%), and infliximab (18%) between 2010 and 2011. No differences in patient demographics were reported. Response rates were high overall. Sixty-five percent of etanercept patients, 82% of adalimumab patients, and 59% of infliximab patients were either partial or full responders, respectively. Approximately 16%, 11%, and 12% of etanercept, adalimumab, and infliximab were non-responders, respectively. Infections between the groups were non-significant. Etanercept and adalimumab patients had higher but non-significant odds of being a responder relative to infliximab. Conclusions. Most patients initiated with anti-TNF agent were responders at 12 months follow-up for all indications in a veteran population

Impact of desflurane versus sevoflurane on coagulation in radical cystectomy patients

Background: Hypercoagulability in patients with cancer is difficult to detect through standard coagulation tests unless the platelet count and fibrinogen concentration is markedly increased. Reaching haemostasis during major surgical procedures is one of the most difficult problems which face anaesthesiologists. Objective: The aim of this study is to investigate the impact of desflurane in comparison to sevoflurane on coagulation detected by ROTEM to find out which of them is more suitable in reducing blood loss and better patient outcome after major surgery in the study population of patients. Patients and Methods: This study was conducted on thirty-six patients of both sexes having cancer bladder were admitted to Theodore Bilharz Research Institute (TBRI). They were randomly allocated into 2 groups (18 patients each). Group (S) received sevoflurane, while group (D) received desflurane as an inhalational anesthetic for Radical Cystectomy surgery. Six venous blood samples were collected for assessment of thromboelastometric parameters with INTEM, EXTEM, FIBTEM analysis which were CT (clotting time), CFT (clot formation time), α angle and MCF (maximum clot firmness)