Late pneumolabyrinth after stapedectomy.

INTRODUCTION: Pneumolabyrinth is defined as the presence of air within the inner ear causing cochleovestibular signs and symptoms. Twenty-seven cases of pneumolabyrinth are published in the literature of which only two were described as delayed pneumolabyrinth as a complication of stapes surgery. CASE REPORT: A 45-year-old male patient presented with vertigo after Valsalva maneuver 12 years after stapedectomy. He was diagnosed with delayed pneumolabyrinth on high resolution computed tomography and underwent an exploratory tympanotomy with surgical repair. DISCUSSION: Delayed pneumolabyrinth is a rare complication of stapes surgery and should be considered in patients presenting with vestibulocochlear symptoms even many years later. An exploratory tympanotomy is recommended for patients diagnosed with pneumolabyrinth and having a sensorineural hearing loss and/or persistent vertigo.

The Kuwait-Scotland eHealth Innovation Network (KSeHIN): a sustainable approach to quality improvement in healthcare.

BACKGROUND: The rising prevalence of obesity and diabetes in Kuwait represents a significant challenge for the country's healthcare system. Diabetes care in Scotland has improved by adopting a system of managed clinical networks supported by a national informatics platform. In 2010, a Kuwait-Dundee collaboration was established with a view to transforming diabetes care in Kuwait. This paper describes the significant progress that has been made to date. METHODS: The Kuwait-Scotland eHealth Innovation Network (KSeHIN) is a partnership among health, education, industry and government. KSeHIN aims to deliver a package of clinical service development, education (including a formal postgraduate programme and continuing professional development) and research underpinned by a comprehensive informatics system. RESULTS: The informatics system includes a disease registry for children and adults with diabetes. At the patient level, the system provides an overview of clinical and operational data. At the population level, users view key performance indicators based on national standards of diabetes care established by KSeHIN. The national childhood registry (CODeR) accumulates approximately 300 children a year. The adult registry (KHN), implemented in four primary healthcare centres in 2013, has approximately 4000 registered patients, most of whom are not yet meeting national clinical targets. A credit-bearing postgraduate educational programme provides module-based teaching and workplace-based projects. In addition, a new clinical skills centre provides simulator-based training. Over 150 masters students from throughout Kuwait are enrolled and over 400 work-based projects have been completed to date. CONCLUSION: KSeHIN represents a successful collaboration between multiple stakeholders working across traditional boundaries. It is targeting patient outcomes, system performance and professional development to provide a sustainable transformation in the quality of diabetes healthcare for the growing population of Kuwaitis with diabetes in Kuwait.