Balloon valvuloplasty in dysplastic pulmonary valve stenosis: immediate and intermediate outcomes

To determine the immediate and intermediate outcome in dysplastic and doming pulmonary valve stenosis in children and to determine various factors associated with unsuccessful outcome. An interventional study. The Children's Hospital, Lahore, Pakistan, from June 2006 to December 2012. All patients presenting with severe pulmonary valve stenosis were enrolled in the study. Balloon valvuloplasty was performed on all patients. Successful outcome [residual gradient < 36 mmHg] was compared with matched doming pulmonary valve stenosis control group valvuloplasty. Difference in various quantitative variables was calculated using independent t-test and Mann Whitney U test. Categorical variables were compared using Chi square and Kruskal-Wallis test. Multivariate analysis was performed to determine various factors associated with outcome. Kaplan- Meier survival table was used to determine freedom from re-intervention proportions. One hundred and fifty two patients [Dysplastic group A, n=73; Doming group B, n=79] with median age of 24 months [range 3 - 192 months] and M:F; 2:1 were included in the study. Mean gradient decreased from 96 +/- 33 mmHg to 29 +/- 20 mmHg. Group A had significantly higher number of patients with unsuccessful outcome [9.6%, p=0.02]. Preprocedure gradient > 75 mmHg was the most significant factor associated with unsuccessful outcome [p < 0.001]. Median follow-up duration was 3 years [range 1 - 6 years]. Freedom from re-intervention proportion at 1, 3 and 6 years was 91.3%, 86.7% and 78.9% respectively in group A compared to 100%, 96.5% and 96.5% respectively in group B. Immediate postprocedure gradient > 60 mmHg was the only significant factor associated with re-intervention in group A [p=0.001]. The results from balloon valvuloplasty in dysplastic pulmonary valve were suboptimal when compared to doming valves. However, it provides a high freedom from re-intervention rate in intermediate follow-up. Intervention at moderate severity can result in better outcome

Factors leading to the development of chronic obstructive pulmonary disease in adult Pakistani males

The study was conducted to determine the factors associated with development of COPD among adult Pakistani men of 40 to 70 years of age. This case control study was conducted with total sample of 88 males aged 40 to 70 years old, 44 cases and 44 matched controls with 1:1 ratio. Cases were selected from the patients admitted in the Pulmonology Department Jinnah Hospital Lahore and controls from the other departments of the same hospital, during one month period. The data was collected through questionnaire consisting of variables like age, locality, occupation and smoking status. The spirometric cut off points [FEV1<80% of predicted and FEV1/FVC ratio <70% of predicted] were used as diagnostic tool for COPD. Cross tabulation was performed with dependent variables as presence of COPD and independent variables such as smoking, age, occupational exposure, locality etc. Multivariate logistic regression model was used with backward elimination technique for the adjustment of age, locality, income status, occupation, previous history of disease and smoking status. Cigarette smoking and age of more than 55 yrs have shown significant relationship with the development of COPD [p value<0.05]. Adjusted odd's ratio was 9.1065 for smoking and 4.2315 for age. Urban residents have a risk of developing COPD 2.14 times more than that of rural residents. Cigarette smoking is most important risk factor for development of COPD, so efforts should be made to control it