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l, although the sequelae of disease and treatment is associated with significant morbidity. Symptoms of fistula, percutaneous nephrostomy complications, and chronic pain present unique issues that require extensive supportive care.

Patients with stage IVA cervical cancer may have substantial long term survival, although the sequelae of disease and treatment is associated with significant morbidity. Symptoms of fistula, percutaneous nephrostomy complications, and chronic pain present unique issues that require extensive supportive care.A 70-year-old man with a history of hypertension was evaluated in our dermatology department due to the appearance of a clinical picture compatible with bullous pemphigoid that was confirmed histologically. The lack of response to topical and systemic immunosuppressive treatment resulted in omalizumab being prescribed in a multidisciplinary committee based on the clinical and analytical findings and the patient's refusal to be treated with rituximab. The evaluation at 3 months showed the absence of blisters on the clinical examination. No associated adverse effects were observed. In the following 3 months the patient was administered medication at home in the absence of an anaphylactic reaction and with prior training by the nursing staff of the Hospital Pharmacy Service. After 6 months the medication was suspended with no relapses for 6 months since the last dose. Omalizumab, an anti-IgE monoclonal drug which has a good safety profile with minimum adverse side effects should be considered when there is a contraindication to the use of intravenous therapies (eg, immunoglobulins, rituximab) or prolonged immunosuppressive treatment (eg, methotrexate, azathioprine).

The large number of available medicines and devices makes it almost impossible to have sufficient knowledge of each individual medicine and device, especially for general practitioners. This may lead to suboptimal treatment, more exacerbations, hospitalisations and higher treatment costs. Reducing the number of medicines and devices, based on rational criteria, allows physicians and pharmacists to build experience with a more limited set of medicines and to standardise the inhalation instructions.

In this study inhalers are compared by means of the System of Objectified Judgement Analysis (SOJA) method. The following selection criteria were applied uniformity in device, number of steps per inhalation, risk of errors, hygienic aspects, feedback mechanism, and risk of inhalation with an empty inhaler.

Substantial differences were seen in the overall scores, with the Ellipta device showing the highest score, followed by Diskus/Accuhaler, Genuair and Nexthaler. Several devices require more or less identical techniques, such Ellipta and Diskus/Accuhaler as well as Genuair and Novolizer. When patients use these devices in combination this increases their uniformity, because additional medicines become available for the devices starting therapy with Diskus or Novolizer and follow-up with Ellipta or Genuair. The resistance of Respimat and Breezhaler is lower than that of other devices, which makes these devices suitable for patients who cannot generate sufficient inhalation flow.

A substantial reduction of inhalers, combined with optimal and standardised instructions, should improve the care of patients with chronic obstructive pulmonary disease.

A substantial reduction of inhalers, combined with optimal and standardised instructions, should improve the care of patients with chronic obstructive pulmonary disease.

Low-molecular-weight heparins are widely used in clinical practice for the treatment or prophylaxis of venous thromboembolism (VTE). As these drugs are eliminated mainly by renal means, any renal function impairment may lead to higher plasma concentrations and increase the risk of bleeding. This study aims to evaluate whether in clinical practice there is an increase in the occurrence of bleeding in patients with renal insufficiency (RI) during treatment or prophylaxis with dalteparin, and to analyse the risk factors potentially influencing the appearance of such bleeding events.

Patients were sampled from the Universitary Severo Ochoa Hospital, Leganés, Spain. This was a retrospective cohort study with a 1 year inclusion period, conducted at a Spanish university hospital with 400 beds, on patients undergoing treatment or prophylaxis for VTE with dalteparin for a minimum of 3 days. The main outcome measure was the number of patients who had bleeding events, independently of their severity, during daltepar on dalteparin in RI, which has not been widely studied before.

To evaluate, with spectral-domain optical coherence tomography (SD-OCT), the glaucoma-diagnostic ability of a deep-learning classifier.

A total of 777 Cirrus high-definition SD-OCT image sets of the retinal nerve fibre layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) of 315 normal subjects, 219 patients with early-stage primary open-angle glaucoma (POAG) and 243 patients with moderate-to-severe-stage POAG were aggregated. The image sets were divided into a training data set (252 normal, 174 early POAG and 195 moderate-to-severe POAG) and a test data set (63 normal, 45 early POAG and 48 moderate-to-severe POAG). The visual geometry group (VGG16)-based dual-input convolutional neural network (DICNN) was adopted for the glaucoma diagnoses. Unlike other networks, the DICNN structure takes two images (both RNFL and GCIPL) as inputs. The glaucoma-diagnostic ability was computed according to both accuracy and area under the receiver operating characteristic curve (AUC).

For the test data set, DICNNly from established patients with glaucoma but also from patients with early-stage glaucoma. The deep-learning model with DICNN, as trained by both RNFL and GCIPL thickness map data, showed a high diagnostic ability for discriminatingpatients with early-stage glaucoma from normal subjects.

To study the morphological features of the palpebral lobe of the main lacrimal gland in normal and dry eyes.

This cross-sectional study included 25 healthy subjects and 83 patients with dry eye disease (DED). The aetiological groups of DED were cicatrising conjunctivitis (CC, n=35), evaporative dry eyes (EDE, n=25) and Sjogren's syndrome (SS, n=23). AZD-9574 PARP inhibitor The palpebral lobes in both eyes were evaluated using slit-lamp biomicroscopy and photography for size (exposed area in mm

), shape (convex or flat), presence of cicatrisation (scarring and/or symblepharon) and appearance of the overlying conjunctival vessels.

The palpebral lobes in the normal and EDE group were similar in terms of size (41.5±15.6 mm

vs 39±12.2 mm

, p=0.203), convex shape (100%) and absence of cicatrisation or vascular engorgement (0%). However, as compared to normal controls, the size of the palpebral lobe was markedly reduced in the SS (27.9±12.3, p<0.0001) and CC (18.1±13.7, p<0.0001) groups. The size of the lobes was asymmetric in the CC group (p<0.