Objectives Chronic heart failure is a major public health problem in which supervised exercise programs are recommended as part of non-pharmacological management. There are various reports of the success of high-intensity aerobic interval training (HI-AIT) and inspiratory muscle training (IMT) in the management of chronic heart failure patients. This study tested the hypothesis that the combination of HI-AIT and IMT could result in additional benefits over the IMT and the HI-AIT alone in terms of inspiratory muscle function, exercise capacity, and quality of life in patients with chronic heart failure and inspiratory muscle weakness. Methods Forty patients with ejection fraction ≤45% and inspiratory muscle weakness described by maximal inspiratory pressure <70% predicted, underwent three exercise training sessions per week for 12 weeks. Patients were randomly allocated to one of four groups: the HI-AIT group, the IMT group, the combined (HI-AIT & IMT) group, and the control group. Before and after completing their training period, all patients underwent different tests that are mentioned above. Results No changes were detected in the control group. However, the combined group, when compared to HI-AIT and IMT groups, respectively, resulted in additional significant improvement in maximal inspiratory training (62%, 24%, 25%), exercise time (62%, 29%, 12%), the 6-minute walk test (23%, 15%, 18%), and the Minnesota Living with Heart Failure Questionnaire (56%, 47%, 36%). Conclusion In patients with chronic heart failure and inspiratory muscle weakness, the combination of the HI-AIT and the IMT resulted in additional benefits in respiratory muscle function, exercise performance, and quality of life compared to that of HI-AIT or IMT alone. Trial Registration number: NCT03538249
Background EnSite Precision technology (Abbott, Chicago, Illinois) is a novel mapping and navigation system facilitating the visualization and manipulation of intracardiac catheters during arrhythmia ablation procedures. When using Sensor Enabled (SE) catheters (Abbott, Chicago, Illinois), the mapping system uses both electrical impedance and magnetic data to facilitate more accurate mapping and navigation. Whether this translates into better clinical outcomes is unknown. Methods This retrospective study will examine whether SE catheters improve the success rate or decrease the risks compared to Biosense Thermocool catheters (Biosense Webster Inc., Irvine, California) not employing sensor-enabled technology utilizing NavX EnSite Precision algorithms. Charts of 146 patients who underwent radiofrequency ablations for supraventricular and ventricular arrhythmias between 2016 and 2019 in the Beirut Cardiac Institute were reviewed and analyzed. It was concluded that SE catheters have the same success rate as electrical impedance catheters. Results A total of 70% of the ablations carried using the impedance-based catheter were successful compared to 74% using the SE catheter. However, the difference was statistically non-significant (p-value: 0.7). As for complications, the ventricular fibrillation rate was increased in the SE catheter group. Three procedures were complicated by pericardial effusion, three patients had reversible heart block, and one death was recorded, all reported while using the standard catheter (p-value: 0.01). Conclusion SE catheters have the same success rates compared to standard catheters using the EnSite Precision mapping system.
BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disorder that can damage a wide variety of body systems. Ear, nose and throat (ENT) involvement is frequent but not often reported. The purposes of our work are to determine the prevalence of ENT involvement during RA and to evaluate its correlation with RA disease activity.ObjectivesThe purposes of our work are to determine the prevalence of ENT involvement during RA and to evaluate its correlation with RA disease activity.MethodsThis is a cross-sectional study of 90 consecutive RA, followed at the Rheumatology department of Monastir Teaching Hospital in Tunisia, during 06 months (November 2016 to April 2017) and 46 matched volunteers. ENT clinical examination with tonal audiometry and thyroid tests (TSH, T4, anti-Thyroperoxidase Ab (Anti TPO Ab) and Anti-Thyroglobulin Ab (Ab anti Tg) were performed.ResultsENT involvement prevalence was 78%. The most frequent functional signs were intermittent dysphonia in 50% and dysphagia in 42% of cases. The neck examination revealed painful larynx mobilisation in 58% cases and cervical lymph nodes in 7% of cases. Indirect laryngoscopy, performed in the 67% of symptomatic patients, noted inflammatory mucosa in 38% of cases and decrease in vocal cord mobility in 8% of cases. Seventy percent patients had temporomandibular Joint (TMJ) involvement. Tonal audiometry revealed 42% of cases of deafness: 27% sensorineural deafness, 13% conductive deafness and 2% cases mixed hearing loss. The ENT manifestations significantly associated to RA compared to the witness group (p<0.01) were intermittent dysphonia, dysphagia, painful larynx mobilisation, inflammatory nasal mucosa, painful TMJ and deafness. Active disease (DAS 28>3.2)is statistically associated with deafness (p≤0.048) and TMJ involvement (p≤0.009). Logistic regression study shows that RA duration over 10 years was associated to laryngeal dyspnea (OR=4.4, p≤0.012, IC (95%) [1.377, 14.134]) and deafness (OR=3.8, p≤0.03, IC(95%) [1.142, 12.882]). In the other hand, RA moderate functional handicap is a protective factor (OR=0.123, p≤0.016, IC (95%) [0.076, 0.772]) of ENT involvement and biotherapy use was associated to thyroid involvement (OR=7.8, p≤0.017, IC(95%) [1.431, 43.175]).ConclusionsENT involvement is a very common, usually asymptomatic extra-articular manifestation during RA. It is, mainly, TMJ involvement, deafness and dysphonia. The main relevant determinants are RA disease activity and duration.References[1] Minichiello, Émeline, Luca Semerano, et Marie-Christophe Boissier. Évolution dans le temps de la polyarthrite rhumatoïde: incidence, prévalence, gravité. Revue systématique de la littérature. Revue du Rhumatisme2017janvier 1;84(1):9–16.[2] Iguelouane N, Skandour D, Rochdi Y, Nouri H, Aderdour L, et A. Raji. Les manifestations ORL dans les maladies systémiques: à propos d’une série de 200 cas. 121e Congrès2014, 11–13octobre;131(4). Paris – Palais des Congrès.Disclosure of InterestNone declared
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