Clinical Study on the Retention Enema with Modified Dahuang Mudan Decoction in Treating Lower-Jiao Obstruction Syndrome Caused by Severe Pneumonia Complicated with Heart Failure

[Objectives]To treat patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure using the retention enema with Modified Dahuang Mudan Decoction,and to observe the effect and safety of this treatment on inflammatory indicators,cardiac function,gastrointestinal function and multiple organ failure in patients with Lower-Jiao(lower energizer)Obstruction Syndrome caused by severe pneumonia complicated with heart failure.[Methods]54 patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure diagnosed in Nanchong Chinese Medicine Hospital from January 2020 to December 2021 were randomly divided into experimental group(n=27)and control group(n=27).The control group was given conventional treatment combined with 0.9%sodium chloride injection(100 mL)+glycerine enema(40 mL).The treatment group was treated with Modified Dahuang Mudan Decoction on the basis of conventional treatment for 7 d.The efficacy indicators and adverse events such as white blood count(WBC),C-reactive protein(CRP),procalcitonin(PCT),N-terminal pro-brain natriuretic peptide(NT-proBNP),Lausanne Intestinal Failure Estimation(LIFE)and multiple organ dysfunction score(MODS)were observed.[Results](i)There was no significant difference in WBC,PCT,CRP and NT-proBNP between the two groups before treatment.All indicators after treatment were significantly lower than those before treatment in both groups(P<0.05).The levels of WBC,PCT and CRP in the treatment group were lower than those in the control group after treatment(P<0.05),and there was no significant difference in NT-proBNP between the two groups after treatment(P>0.05),but the difference in NT-proBNP before and after treatment in the treatment group was higher than that in the control group.(ii)The LIFE of the two groups decreased significantly after treatment,and the improvement of LIFE of the treatment group was better than that of the control group(P<0.05).(iii)The MODS of the two groups decreased significantly after treatment(P<0.05),and the degree of decrease after treatment in the treatment group was higher than that in the control group(P<0.05).(iv)There was no significant difference in all-cause mortality between the two groups(P>0.05).(v)No serious adverse events were found in both groups during the treatment period.[Conclusions]The conventional treatment,combined with the retention enema with Modified Dahuang Mudan Decoction could further reduce the inflammatory indicators,improve cardiac function,improve intestinal function and organ function,and the safety was good.

Prevalence of and risk factors for severe malaria caused by Plasmodium and dengue virus co-infection: a systematic review and meta-analysis

Background:Co-infection with both Plasmodium and dengue virus(DENV)infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment.The present study aimed to determine the pooled prevalence estimate of severe malaria among patients with co-infection,the risk of severe diseases due to co-infection,and to describe the complications of severe malaria and severe dengue among patients with coinfection.Methods:Relevant studies published between databases between 12 September 1970 and 22 May 2020 were identified and retrieved through a search of the ISI Web of Science,Scopus,and MEDLINE.The pooled prevalence and 95%confidence interval(CI)of severe malaria among patients with Plasmodium and DENV co-infection was estimated with a random-effects model to take into account the between-study heterogeneity of the included studies.The risks of severe malaria and severe diseases due to co-infection were estimated with the pooled odds ratio(OR)and 95%CI with a random-effects model.Results:Of the 5653 articles screened,13 studies were included in the systematic review and meta-analysis.The results demonstrated that the pooled prevalence estimate of severe malaria among patients with co-infection was 32%(95%CI:18-47%,I 2=92.3%).Patients with co-infection had a higher risk of severe diseases than those with DENV mono-infection(odds ratio[OR]=3.94,95%CI:1.96-7.95,I 2=72%).Patients with co-infection had a higher risk of severe dengue than those with DENV mono-infection(OR=1.98,95%CI:1.08-3.63,I 2=69%).The most severe complications found in severe dengue were bleeding(39.6%),jaundice(19.8%),and shock/hypotension(17.9%),while the most severe complications found in severe malaria were severe bleeding/bleeding(47.9%),jaundice(32.2%),and impaired consciousness(7.43%).Conclusions:The present study found that there was a high prevalence of severe malaria among patients with Plasmodium and DENV co-infection.Physicians in endemic areas where these two diseases overlap should recognize that patients with this co-infection can develop either severe malaria or severe dengue with bleeding complications,but a greater risk of developing severe dengue than severe malaria was noted in patients with this co-infection.Trial registration:The protocol of this study was registered at PROSPERO:CRD42020196792.