Overview

Objective: The aim of this study was to detect the impact of low intensity laser therapy on immune system response among DS children with pneumonia. Material and Methods: Forty DS children with bronchopneumonia, were included into ; group (A) received low intensity laser therapy, inspiratory muscle training in addition to medical treatment at a frequency of 3 sessions per week for one month, where the second group (B) received inspiratory muscle training in addition to medical treatment. Measurements of WBCs, IgG, IgA, IgM, RR and SaO2 were obtained for both groups before treatment and after one month at the end of the treatment program.

Eligibility

Inclusion Criteria:

• Hospitalisation for heart failure or debilitating dyspnoea (NYHA II-IV) and a diagnosis of HFpEF.
• Left ventricular ejection fraction (LVEF) \>40% in the preceding 12 months or during a period of hospitalisation as determined by either cardiac ultrasound, MRI, left ventricular echocardiography, or isotope imaging.
• NTproBNP \> 300 pg/ml (or BNP \> 100 pg/ml) during hospitalisation or NTproBNP \> 125 pg/ml in outpatients.
• Impaired myocardial relaxation (diastolic dysfunction) as determined by tissue doppler imaging (TDI: lateral mitral annulus velocity, lat E\' \<9cm/s or septal annulus velocity, sept E\' \<8 cm/s)
• Both previously undiagnosed, de-novo heart failure patients and patients admitted to hospital for acute exacerbation of known heart failure will be included in the study.

Exclusion Criteria:

• Age \>85 years
• Significant aortic valve stenosis (AVA ≤1.0 cm2)
• Primary (structural) mitral valve disease with grade III-IV insufficiency or significant stenosis (MVA\<1.5 cm2)
• Other severe valvular defect (e.g. secondary severe mitral or severe tricuspid insufficiency)
• Previous LVEF \< 40% (HFrEF or HF with improved EF)
• Recent acute coronary syndrome (\< 3 months) or myocardial infarction with ST elevations (STEMI) within 12 months
• Previous open heart surgery (CABG/valvular) or percutaneous valvular interventio
• Previously known specific myocardial disease (hypertrophic cardiomyopathy, non-compaction cardiomyopathy (LVNC), right ventricular arrhythmogenic cardiomyopathy (ARVC), cardiac amyloidosis, cardiac sarcoidosis, haemochromatosis)
• End-stage renal disease (eGFR \<15 ml/min or dialysis treatment, previous kidney transplantation)
• Significant physical disability, mobility limitation, or dependence on another person for assistance (patient is not self-sufficient) limits participation in the study