The Pakistan cochlear implant programme was started in Lahore in August 2000. It was initially established with the technical support of the Manchester cochlear implant team. There are no government resources available for cochlear implantation in Pakistan and the cost of cochlear implantation is met by the candidates and their families. Up till December 2005, 52 individuals have been implanted. Forty-four (84.6 per cent) of these patients were children and eight (15.4 per cent) patients were adults. Congenital deafness (94 per cent) is the main aetiological factor in children. Seventy-six per cent of these children were born to blood related parents. All patients received a Med-El Combi 40þ device. The listening progress profile, the meaningful auditory integration scale and the meaningful use of speech scale were used to assess the auditory performance in children. Thirty-nine children achieved an average listening progress profile score of 37.7 after 12 months of implantation. The overall rate of major and minor complications was 11.5 per cent. Failure rate for the device itself has been 3.8 per cent. In addition to considering these preliminary outcomes and funding issues, the problems of setting up a cochlear implant programme in a developing country are discussed.
Objective To determine the cost-effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low- and lower-middle income countries in Asia. Study Design Cost-effectiveness analysis. Setting Bangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, and Sri Lanka participated in the study. Subjects and Methods Costs were obtained from experts in each country with known costs and published data, with estimation when necessary. A disability-adjusted life-years model was applied with 3% discounting and 10-year length of analysis. A sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost-effectiveness was determined with the World Health Organization standard of cost-effectiveness ratio per gross domestic product (CER/GDP) per capita <3. Results Deaf education was cost-effective in all countries except Nepal (CER/GDP, 3.59). CI was cost-effective in all countries except Nepal (CER/GDP, 6.38) and Pakistan (CER/GDP, 3.14)—the latter of which reached borderline cost-effectiveness in the sensitivity analysis (minimum, maximum: 2.94, 3.39). Conclusion Deaf education and CI are largely cost-effective in participating Asian countries. Variation in CI maintenance and education-related costs may contribute to the range of cost-effectiveness ratios observed in this study.
The outcome of otitis media with effusion (OME) in children is generally good. 54 children with symptomatic otitis media with effusion not responding to medical treatment of four weeks were treated with grommet insertion at Jinnah Hospital. On one year follow-up no major complication was noted. However five patients required retympanostomy due to recurrence of disease. Procedure was accompanied by adenoidectomy in 15 patients and tonsillectomy in 8 patients. Adenotonsillectomy was decided on individual basis. The mean duration of stay for ventilation tubes was ???? and they extruded spontaneously in all except one patient, who required removal under general anesthesia. One patient had persistent residual perforation which was treated by cigarette paper method.
Spinal cord infarctions are a form of stroke characterized by ischemia originating within the spinal cord or its supplying arteries. Presentation of spinal cord infarctions vary greatly due to its diverse pathologies, but can include bladder dysfunction, paraplegia, quadriplegia, etc. The average age of people with this disease tends to be older adults, with very few reported cases in the younger demographic. Here, we report a case of spinal infarction in a young 25-year-old adult male with no predisposing risk factors.
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