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7/29/2019 Patola REsearch Defense 2-1-13
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Effectiveness of Patola in Decreasing the Blood Pressure of Hypertensive
Middle-aged Adults, 30-65 years old of Selected Barangays in Manila
A Research Proposal Submitted to the Nursing Faculty Committee on
Proposal Defense
In Partial Fulfillment of the Requirements in the course
Nursing Research I
Submitted by:
Anas Ann Pauline Basada, Reazan Ann
De Vera, Gazzel Del Rosario, Pamela Janine
Fuentes, Mary Dominica Guballa Guianne Mishael
Jahiron Nashraifar Imperio Aryanne Fay
Month and Year
February 1, 2013
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Chapter I
The Problem and its Background
Introduction
Initially the knowledge about plants as source of medicine was confined to the
dwellers of high mountains, tribes and village folks. Several of the medicinal plants used
by traditional folk healers have long been proved to be a great biological significance.
Several herbal medicines has been proven and tested by researchers that the
Department of Health has approved for treating and managing illnesses. However, there
are still plants present in our environment which have medicinal properties that can beutilized as an alternative for synthetic and laboratory made medications. The use of
these plants will be cost effective and available for community areas. Most health care
providers would recommend these for treatment compared to the traditional use of
medicines because they are both likely to have the same effect but then largely differs
in price.
Hypertension is one of the many diseases in which most Filipinos are suffering
from nowadays. This illness entails prolonged treatment which requires money for
availing everyday maintenance medication. Evidently, it adds up to their daily expenses.
Therefore, the researchers decided to conduct an experimental study about the possible
property of patola in decreasing blood pressure.
“Almost every Asian country, have a vast indigenous knowledge on the use of medicinal
plants and although modern medicine is established in Asia, traditional medicine also
plays a big role in people‟s healthcare – and is gaining in popularity in other countries
too.”( de Ubaldo,2008)
In the Philippines, patola is a common vegetable sold in the markets and when it
matures and dries up, it becomes a well-known sponge for one‟s beauty regimen. In
recent years, many studies have been conducted about what more the patola plant can
give aside from having it served on Filipino tables and being more than just a bath
sponge. Most researches directed to prove its value to be effective in treating various
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conditions such as jaundice, bacterial and parasitic infections, and as well as of its anti-
oxidant properties. However, patola has been traditionally used in managing excess
body fluid, but no scientific studies are currently known that proves its diuretic value in
humans, like much more of patola‟s folkloric uses that still bides for confirmation of its
capability to provide other medicinal values.
“The Philippines have been struggling with many healthcare issues. The
Philippine health system is now at the throes of major reforms as it tries to confront old
and emerging health challenges. (Duque III,2008)
Due to the rising healthcare costs, approaches in making the health care efficient
and cost effective for patients suffering from their illnesses through the natural way
which is accessible, safe and readily available has been strengthened, giving way for
the Primary Healthcare program of DOH that includes the use of medicinal plants in
managing and providing help to patients with common problems or conditions.
The need for awareness of the public about this accessibility should be stressed
and emphasized by the government so that this program can be well known and be
utilized by the community, not only in rural areas but to those urban areas as well,
combined with the approach of encouraging the patients to be more involved in the
management of their health, thus improving their quality of life and healthcare system.
Background of the Study
According to Healthcare journal (2011), patola had been found to be popular in
the International market being used as an adjunct and even primary treatment for
various diseases as well as to alleviate signs and symptoms that is associated with
certain illnesses, not just the fruit itself being used but as well as the plant‟s other botanical parts namely the roots, leaves, and seeds.
Several studies had been conducted throughout the world as to the different
medicinal and therapeutic properties of patola plant and some studies had been proved
to be effective for its specific action and preparation, for instance in Java, Indonesia, the
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leaves of the patola plant is prepared as decoction to be used for treatment of uremia
(blood in the urine) and amenorrhea (absence of menses), and in China, the patola is
used as a pesticide.
Patola, not only for its use as bath sponge has been known to be used all
throughout the world. According to Dr. Eduardo Quisimbing, “the root is used as a purge
in Russia while in India, the root is used as a laxative”.
Current scientific works specifically proved patola‟s effectivity as an antimicrobial,
antihelmintic, immunomodulatory, oxytocic, antitumor, antioxidant, antihyperglycemic,
and hepatoprotective, which all directed to prove its value to be potent in treating
various conditions. Thus far, a great deal of its unsaid uses still awaits for confirmations
of its potential to offer further therapeutic values.
Several research studies had been done about the potentiality of different
botanical parts of patola in treating and assisting in the curative process of various
conditions, yet, there is no scientific study done to test its potential in decreasing the
elevated blood pressure.
Are the substances present in the patola plant limited only to the given medicinal
properties cited? Is there a property in the patola plant that would allow lowering of
systemic blood pressure? It is in this context that the researchers decided to conduct
the study.
Statement of the Problem
The main objective of this study is to determine the effect of patola in decreasing
blood pressure of hypertensive middle aged adults, 30-65 years old.
This study aims to seek answers to the following questions:
1. What is the blood pressure of the study participants before the treatment
1.1. Experimental group 1,
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1.2. Controlled group 1?
2. What is the blood pressure study participants‟ after the treatment
2.1 Experimental 1: after taking antihypertensive drug and patola extract,
2.2 Control 1: after taking antihypertensive drug and water only?
3. Is there any significant difference in the blood pressure between the two groups
before and after the treatment.
Hypothesis
The researchers have postulated the hypothesis:
1. Null hypothesis: There is no significant difference in the blood pressure of the
experimental group and the control group before the treatment.
2. Research hypothesis: There is a significant difference in the blood pressure of
the experimental group and the control group after the treatment.
Significance of the Study
This study aims to determine the effect of Patola in decreasing blood pressure on
hypertensive Middle-aged adults, 30-65 years old. The result of this study will be
significant to the following groups:
Hypertensive patients. The study can help hypertensive middle-aged adults to make
an active effort in managing their condition through an approach that is natural,
accessible, and cost-efficient.
Nursing education. This study will contribute knowledge regarding care of
hypertensive patients with the use of patola extract as one way in lowering blood
pressure.
Nursing Profession. This research will give another milestone for the Nursing
Profession because it is an alternative way to lower blood pressure and giving
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opportunities to conduct further research about other alternative treatment that can be
utilized by the public.
Community. This study will help the community health workers and community
members with hypertension to become aware of the therapeutic benefits of patola fruit
extract which can be a natural substitute of antihypertensive drugs currently sold in the
markets, thus, enhancing to them the principle of “self -reliance” as this study may have
contribute valuable results they can adopt to actively manage their health.
Department of Health. This study may provide information that they can use in coming
up with other herbal medications.
Conceptual Framework
The conceptual framework of this study is best shown by figure 1, which
illustrates the independent and the dependent variables.
The independent variable in this case is the patola extract. It is the one
responsible for that anticipated change in the blood pressure of the experimental group.
The patola extract is the one to be administered on hypertensive study participants in
order to observe if it will produce a decreasing effect on their blood pressure. While the
dependent variable is the blood pressure of the hypertensive study participants which
may change as a result of intake of the patola extract.
Independent variable:
Patola extract
Experimental group 1
Control group 1
Patolaextract antihypertensive
Waterantihypertensive
Dependent variable:
Blood pressure of study
participants
with hypertension
FIGURE 1. conceptual paradigm of the study
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Scope and Delimitations
The study aims to determine the effect of patola in study participants with
elevated blood pressure.
This study will be chiefly concerned on the patola extract‟s antihypertensive
effects on hypertensive study participants of selected barangays in Manila. The
research will only cover the collection, extraction of patola fruit, and determination of
Patola extract‟s antihypertensive effects through extract intake of the study participants.
Aside from determining if the patola extract has antihypertensive effects, the
researchers will also involve its implications to health and to the nursing profession.
The researchers will conduct the experiment in selected barangays in Manila.
The patola extract will be tested for its capability in decreasing the blood pressure of
hypertensive study participants. The study will cover sixty (60) participants, thirty (30)
for the experimental group and thirty (30) for the controlled group. Individuals who have
elevated blood pressure and are prescribed to take antihypertensive drugs, ages 30-65
years old, male and female will be included as participants of the study.
The study is limited only to blood pressure lowering effect of the patola extract on
hypertensive study participants through measurement of their blood pressure. The studywill be conducted during the1st semester of school year 2013-2014.
Definition of Terms:
Patola. A sponge gourd, any of several tropical annual climbers having large yellow
flowers and edible young fruits, grown
commercially for the mature fruit's dried fibrous interior that is used as a sponge. In this
study, the fruit extract of this plant will be used to determine its effect in decreasing the
blood pressure of hypertensive study participant.
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Folkloric. The traditional customs, tales, sayings, dances, or art forms preserved
among groups of people. In this study, it is the traditional uses of patola as a natural
curative medicine.
Medical values. Being able to incorporate all other paradigms of medicine, including
scientific and evidence-based medicine, within it, because it can include anything that
contributes to human security and flourishing. In this study, it is the various effects of
patola extract which are proved therapeutic or has beneficial content.
Hypertension. An abnormally high arterial blood pressure that is usually indicated by
an adult systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure
of 90 mm Hg or greater, is chiefly of unknown cause but may be attributable to a
preexisting condition (as a renal or endocrine disorder), that typically results in a
thickening and inelasticity of arterial walls and hypertrophy of the left heart ventricle, and
that is a risk factor for various pathological conditions or events (as heart attack, heart
failure, stroke, end-stage renal disease, or retinal hemorrhage). In this study, this
connotes having blood pressure above normal level, which is systolic blood pressure
above 120 millimeters of mercury (mmHg) and diastolic pressure above 80 millimeters
of mercury (mmHg).
Blood pressure. The pressure that is exerted by the blood upon the walls of the blood
vessels and especially arteries and that varies with the muscular efficiency of the heart,
the blood volume and viscosity, the age and health of the individual, and the state of the
vascular wall. In this study, it is the force of blood exerted to the blood vessels in every
heart beat.
Alternative Approach. A possibility of choice, especially between two things, courses
of action, or either of such choices. In this study, this term refers to a safe substitute for
management of a certain condition, specifically, hypertension.
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Chapter II
Review of Related Literature and Studies
This chapter presents the local and international literatures that will be used by
the researchers in the conduct of the study.
The utilization of plant life intended for medication or for maintaining wellbeing is
as old as the human race. Impelled by the natural intuition for continued existence near
the beginning, man experimented diverse plants for food, consequently gaining
immediate familiarity of their effects on the body or on ailment. The mounted
understanding with patola plant like any other plants was then passed on generation
upon generation, ensuing in the body of indigenous information on therapeutic plants
that continue living in the present day.
Patola is commonly cultivated here for its edible fruit, but is not established. It is a
common vegetable sold in the markets. It is eaten cooked with other vegetables or
alone with shrimps and pork. The fibrous network of the mature fruit, devoid of the pulp
and cleaned, is used as a bath or sponge. Analyses of the ripe fruit show it is a good
source of calcium and iron, an excellent source of phosphorus, and fair source of
vitamin B. the fruit also contains an amorphous bitter principle, luffeine. The seeds
contain a fixed oil which consists of the glycerides of palmitic, stearic, and myristic
acids. The root is used as a purge in Russia and in India, it is used as a laxative and in
dropsy. The decoction of leaves is used in Java for uremia and amenorrhea. The juice,
heated, is good in the adrenal variety of diabetes. (Quisimbing,2009 )
Patolang bilog is commonly cultivated throughout the Philippines for its edible
fruit. It is pantropic in cultivation. Luffa, the spongy fiber contains cellulose,
xylan,mannan, galactan, and lignin chemical study of the Philippine luffa cylindrical
confirmed presence of a saponium, which is crystalline, white and bitter. Its action
comprises increased urination, dilatation of the pupils, and a slight decreases of rectal
temperature. The hemolytic index was 1:27,000, using dog‟s blood at 28 degree celcius;
the foam index, 1:7000; and the fish foam index, 1:33000. (Quisimbing, 2009 )
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Patola is popular in the international market. In other countries, patola is used
traditionally to treat many ailments. In Russia, the roots are used for cleansing by
purging. Whereas in india, it is used as a laxative and for edema, even using the leaves
as jaundice treatment.( Tolentino 2011 )
Traditional system of medicine consists of large number of plant with various
medicinal and pharmacological importances and hence represents a priceless tank of
new bioactive molecules. Luffa cylindrical is found all over the world. It is commonly
known as 'tori' and has been recognized in different traditional system of medicines for
the treatment of varied diseases of human being. The phytoconstituents present in it
mainly belong to the category of flavonoids. Different part of this plant are traditionally
claimed to be used for the treatment of broad spectrum of ailment including snake bites,
convulsions, cramps, tetanus, emetic, cathartic, dropsy, nephritis, chronic bronchitis,
asthma, sinusitis and fever to be list a few. ( Partap, 2012 )
The WHO estimates that high blood pressure causes one out of every eight
deaths worldwide, making hypertension the 3rd
leading cause of death in the world.
Uncontrolled high blood pressure can lead to stroke, heart attack, or kidney failure by
pressing stress on a number of target organ. Hypertension affects the heart, brain,
kidneys, eyes, sexual function, and pregnancy outcomes. (Arlene Spark, 2008)
In the study of Garcia of UPLB, “Antioxidant Potential and Compounds of
Philippine Vegetables and Fruits” was prompted by the need to determine antioxidant
activity in fruits and vegetables traditionally grown all over the country. Antioxidants are
known to play a significant role in the prevention of oxidative damage in the body that
leads to Cardiovascular diseases, diminished immune function, and certain types of
Cancer. Garcia stressed that people must consume dietary form of antioxidant if they
want to obviate the possibility of major diseases even if its known to humans and other
organisms have their own forms of exogenous enzymatic antioxidants as defense
mechanisms. The 15 fruits and vegetables subjected to Gracia‟s studies were
Malunggay, spinach, bignay, eggplant, patola, tiesa, durian, kalumpit, alugbati,
ampalaya, saluyot, bago, sayote, sitao, at ubi.(Garcia,2009)
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In India and the Philippines luffa plant is commonly cultivated. The roasted seeds
are edible and contain edible oil. The oil has been used in the United States in soap
manufacture. The bitter and toxic seedcake is unsuitable as feed for cattle, but can be
used as fertilizer given that it is rich in N and P. The fruits and leaves are browsed by
goats. Bees feed on the flowers.
In traditional African medicine, pulp of the whole plant is used as a suppository
against constipation, Root are taken for the treatment of constipation and as a diuretic.
In Gabon a root preparation is used as remedy of nose cancer. In DR Congo a
decoction of the roots and leaves is recorded to be drunk or used in an enema as an
abortifacient, but in Tanzania a root decoction and leaf sap are recorded to be drunk to
reduce the danger of abortion. The leaves are used to promote wound healing and to
maturate abscesses. In Togo leaf preparations are applied on edemas and taken for the
treatment of malaria.
In the Central African Republic ground leaves are introduced rectally for the
treatment of enterobiasis. In Congo the leaf juice is considered to be effective against
filaria, and an aqueous maceration of fresh leaves is taken for the treatment of
whooping cough. In Rwanda the leaves are pounded with water and the sap is taken for
the treatment of stomach-ache. In Uganda leaf preparations are used to facilitate
childbirth. Zulu people in South Africa take a leaf decoction to treat stomach-ache. The
fruit is used in Guinea on tumours and swellings, and the fruit pulp is used in Guinea
and Nigeria as an emollient. The fruit sap is taken as a strong purgative. The seeds are
credited with emollient and anthelminthic properties. They are also emetic and cathartic.
The seed oil is used for the treatment of skin problems. ( Achigan-Dako & N‟danikou,
and Vodouhê, 2011 )
Patola (luffa) commonly called sponge gourd, loofa, vegetable sponge, bath
sponge or dish cloth gourd, is a member of cucurbitaceous family. Plant is widely
distributed throughout India. Its fruit is used in the traditional medicine as an
anthelmentic, carminative, laxative, depurative, emollient, expectorant, and diuretic and
lactagogue and are useful in fever, syphilis, tumours, bronchitis, splenopathy and
leprosy.
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Patola is used as a vegetable either prepared like squash or eaten raw like
cucumbers. Its seeds have been used in the treatment of asthma, sinusitis and fever.
The seed oil is reported to be used for skin infections in the form of tincture. The fruit
used in the treatment of ascites, jaundice and billiary and intestinal colitis and also in
enlarged spleen and liver. The plant is reputed to have anti tubercular and antiseptic
properties. The extract of leaves has been used in snake- bites. Keeping in mind such
astounding properties exhibited by the plant, the present study was intended to
investigate anthelmintic activity of methanolic and aqueous extract of L.cylindrica
leaves in Indian earthworm. ( Jha, 2009 )
The plant material consisting of fresh stems were air-dried, cut into small pieces
and grounded in a grinding machine. The grounded stem was extracted by percolation
using 95%, 75% and 60% alcohol consecutively. The alcoholic extracts were
concentrated in a vacuo dissolved in 95% alcohol, poured in cold distilled water and
filtered. The filtrate was extracted c butanol saturated c water and TLC was done on the
butanol and aqueous layers and residue. Sugar crystals were obtained during the
course of the thesis work due to the hydrolysis of the concentrated 60% alcoholic
extract. Different samples of the sugar were obtained after recrystallization c alcohol.
The definite melting point was undetermined due to decomposition at higher
temperatures. It may be concluded that sugar crystals obtained contained inorganic
substances. Results of the different TLC‟s also indicated that glycoside present may
contain series of sugars. It was unfortunate however, that no saponin was isolated but
instead sugar was obtained due to the hydrolysis of the glycoside.(Maranan, 1982)
Luffa plant is bitter tonic, emetic, diuretic and purgative and useful in asthma,
skin diseases and splenic enlargement. It is used internally for rheumatism, backache,
internal hemorrhage, chest pains as well as hemorrhoids. Young fruit can be eaten rawlike cucumber or cooked like squash, while the young leaves, shoots, flower buds, as
well as the flowers can be eaten after being lightly steamed. The seeds can be roasted
as a snack, or pressed to produce oil. Externally, it is used for shingles and boils. The
dried fruit fibers are used as abrasive sponges in skin care, to remove dead skin and to
stimulate the circulation. The fruits are antihelmintic, carminative, laxative, depurative,
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emollient, expectorant, tonic and galactagogue and are useful in fever, syphilis,
tumours, bronchitis, splenopathy and leprosy. The vine is most commonly grown for the
fibrous interior of the fruits. Kernel of seed is expectorant, demulcent and used in
dysentery. Seed oil is used in leprosy and skin diseases. Fruit is intensely bitter and
fibrous. It has purgative property and is used for dropsy, nephritis, chronic bronchitis
and lung complaints. It is also applied to the body in putrid fevers and jaundice.
( Kumar, 2012 )
Traditional system of medicine consists of large number of plant with various
medicinal and pharmacological importances and hence represents a priceless tank of
new bioactive molecules. Luffa cylindrica found all over the world. It is commonly known
as „tori‟ and has been recognized in different traditional system of medicines for the
treatment of varied diseases of human being. The phytoconstituents present in it mainly
belong to the category of flavonoids. Different part of this plant are traditionally claimed
to be used for the treatment of broad spectrum of ailment including snake bites,
convulsions, cramps, tetanus, emetic, cathartic, dropsy, nephritis, chronic bronchitis,
asthma, sinusitis and fever to be list a few. Results from the study conducted proved its
acclaimed therapeutic use, added by the miscellaneous values as anti-acute hepatic
injury, cardiac stimulation, S180 sarcoma inhibitory, and antihuman immunodeficiency
virus actions. Oral administration of proteins isolated from the seeds exhibited anti-
reproductive property in mice. Luffin P1 inhibited trypsin. Luffin S had
ribosomeinactivating protein-like activity . Intracerebroventricular administration of 3-O-
β-D-glucopyranosyl-maslinic acid promoted the recovery from cerebral ischemia-
induced behavioral disorders in rats. (Sharma, 2012)
Luffa cylindrica., also known as Sigua or Loofah, is a plant of the Cucurbitaceae
family, the dried vascular bundles of the ripe fruit are used as a medicine. Its Chinese
medicinal name is Sigualuo. There are about 8 species of plants in the Luffa genus in
the world which are distributed in the tropical and sub-tropical areas in the Eastern
Hemisphere. Among them, 2 species are usually cultivated in China, and both are used
as herbal medicines. This species is cultivated throughout China, and is also widely
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cultivated in the temperate and tropical areas in the world. “Sigualuo” was first
described as a medicine in Compendium of Materia Medica. It is recorded in most of the
ancient herbal medicine literatures. This species is stated in Chinese Pharmacopoeia as
the official botanical origin of the Chinese medicine Sigualuo.
It is produced throughout China, with the best quality from Cixi in Zhejiang
Province, and good quality from Nantong of Jiangsu and Suzhou. The major chemical
components of Luffa cylindrica are triterpenoid saponins, as well as flavonoids. Chinese
Pharmacopoeia uses the macroscopic characteristics to control the quality of the
medicinal materials. Pharmacological studies indicate that Luffa cylindrica has the
effects of anti-inflammation, anti-bacteria, relieving pain, sedating, stopping coughing,
eliminating phlegm and relieving wheezing, etc. In traditional Chinese medicine theory,
Sigualuo unblocks collaterals, promotes blood circulation, and dispels wind, etc.
Luffa cylindrica plant has been used in ayurvedic medicine since ancient times,
with various biological applications. Although some work has been done on the possible
medicinal applications, no studies for drug-development have been carried out as yet.
Although the crude extract has numerous medicinal applications, clinical applications
can be made only after extensive research on its bioactivity, mechanism of action and
toxicity studies. However, recent years have seen an increased enthusiasm in treating
various diseases with natural products. Luffa cylindrical is a non-toxic, highly promising
natural antimicrobial, antioxidant compound having a wide spectrum of biological
functions. It is expected that Luffa cylindrica may find application as a novel drug in the
near future to control various diseases, including inflammatory disorders,
carcinogenesis and oxidative stress induced pathogenesis. ( Saxena, 2011 )
According to Stuart, Luffa cylindrica are prescribed in skin diseases and orchitis;
vine and root, in the decayed teeth; ozoena, and parasitic affections. Patola also
reputed to be carminative, pectoral, colling to the blood, antiseptic, antihelmintic,
emmenagogue,, quickening to the circulation and galactogogue and is also in the
treatment of hemorrhage from bowels or bladder, hemorhroids, toothache, small pox
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postule. The fresh fruit is considered to be cooling and beneficial to the intestine,
warning to the stomach and tonic to the genital organ. Seeds are said to be emethic and
cathartic. Infusion of the seeds or their aqueous or alcohol emulsion is a drastic
purgative and is useful as antihelmintic. (Detablan,Dy, Oliveros, October 2003)
Kobert (1978) says that the root of Luffa is used as a purge in Russia while
Nadkarni says that in India the root is laxative and is used in dropsy. According to
Burkill, the decoction of the leaves is used in Java for Uraemia and amenorrhea.
Nadkarni reports that the leaves are applied locally in splenitis, hemorrhoids and
leprosy. The juice of the fresh leaves is dropped into the eyes of children in granular
conjunctivitis and also to prevent the lids from adhering atnight on account of excessive
meibomian secretion. The juice heated is good in the adrenal variety of diabetes.
Dymock, Warden and Hooper says that the juice of the leaves is used as an external
application to sores and the bites of venomous animals. Nadkarni adds that the infusion
of the ripe fruit is used in doses of one to two ounces, or 20-30 g of the dried kernel.
The oil of the seeds is used in skin complaints. Hooper record that the pulp of the fruit is
administered internally to cause vomiting and purging. The dried fruit is powdered and
made into a snuff for those suffering from jaundice. (Batongbakal, Cateno, Noay,
Poquinzasel, March 2001)
The antibacterial activity of luffa acutangula against pathogens in bacterial
conjunctivitis was evaluated using the paper disc diffusion assay. fresh leaves of the
plant were osterized and freeze dried extract was shown to be inactive against
haemiphillus influenza, streptococcus pneumonia, staphylococcus aureous, e. coli, and
pseudomonas aeroginosa but active against klebsilla pneumoniae proteuos vulgaris
and bacillus subtillis with a minimum inhibitory concentration of 500 ug, 250 ug, and 50
ug respectively. The extract retained its antibacterial properties after sterilization, ocular
irritancy in 3 rabbits eyes.it is isotonic and has pH 6.64. phytochemical screening the
extract revealed the presence of tannins, saponin, reducing subtances and flavones.
( Dela Cruz, 2000)
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A study was conducted to proved the determination of antiseptic property of
Saponin glycosides from the pulp of Patolang Bilog (Luffa cylindrical Linn, Family
Cuccurbitaceae) Saponin Glycosides, an active constituent of the pulp were extracted
using reflux method of extraction and 80% of ethyl alcohol as a solvent. In the
preliminary tests, lead acetate test, Fehling‟s test and froth test yielded a positive result,
while traces of alkaloids and fixed oils and fats have been found reflux method of
extraction was used to obtain a high percentage yield of the extract. It gave a
percentage yield of 2.2%. Physical test were determined using lead acetate test,
Fehling‟s test and Froth test. Microbiological test yielded an negative result in all
microorganisms such as E.coli, S. aureus, C. albicans and t. rubrum. The researchers
recommend to have further analysis and study about the plant and it is constituent.
They perform other microbiological method of analysis to identify the antiseptic property
of patolang bilog and the use of higher concentration of the purified extract to determine
the effectivity of the Saponin.( Cudac, Evangelista, Gamboa, Reyes, October 2001)
Patola grows abundantly in the Philippines and popularly known because of its
edible fruit and for its numerous medicinal value. The plant sample was purchased from
Central Market of Manila due to the availability and abundance, The seeds were
collected by hand picking and was air dried. Extraction of fixed oil from the dried seeds
of Luffa Acutangula (Patola) by continuous extraction using petroleum ether as the
solvent. The percentage yield of the fixed oil extract was 20%. The preliminary test were
conducted as well as physical test for the fixed oil showing positive result of spd test
with the used of filter paper and bond paper. Also miscibility test wherein fixed oil is
miscible with petroleum ether, chloroform, ethyl alcohol and immiscible in distilled water.
The appearance of fixed oil obtained was Iodine value 43.43. Finally the fixed oil dealth
with the preparation emulsion used as a laxative. (Dela Cruz, Crantoza, September
1995)
The extracted tannins, as an active constituents is responsible for its antifungal
property from the leaves of patola. The freshly gathered leaves were cut into small
pieces, dried and grind the subjected in to the process of decoction to extract the pure
tannins. The final product was brown in color, faint odor and has a bitter taste. Upon
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obtaining the pure tannin they do the physical and chemical tests and the proximate
chemical analysis. Then formulate an ointment product. The data obtained indicate that
the ointment product was effective against skin disease Tinea pedis. Therefore Tannins
from patola leaves can be used in the treatment of athletes foot which is fungus known
as Tinea pedis. ( Bernabe, Villanueva, October 1996)
Proximate chemical analysis of patola leaves and physical properties of fixed oil
extracted were also undertaken. Microbial test was also conducted using
staphylococcus aureus, Escherichia coli, and yeast cell as sample bacteria. It was found
that those bacteria were all susceptible to the fixed oil extract from patola leaves. The
products were formulated an ointment and cream. And through this formulation, the
author hope that this will serves as a great help in local pharmaceutical. (Punzalan,
Refraccion, October 1991)
An estimated 500,000 people in the United States experience a hypertensive
crisis annually. Hypertensive emergency is associated with significant morbidity in the
form of end-organ damage. Rapid controlled reduction of blood pressure (BP) may be
necessary to prevent or minimize end-organ damaged. IV antihypertensive agents
available for the treatment of hypertensive emergencies are, in general, characterized
by a short onset and offset of action and predictable responses during dosage
adjustments or extreme fluctuations in BP. Nicardipine, nitropruside, feneldopam,
nitroglycerin, enalaprilat, hydralazine, labetalol, esmolol and phenotalamine are IV
antihypertensive agents recommend for use in hypertensive emergency by the seventh
report of the Joint National Committee on prevention, detection, evaluation, and
treatment of high blood pressure. Since the publication of these recommendations,
another IV antihypertensive agent, clevidipine, became commercially available. The
selection of specific agent should be based on the agent‟s pharmacology and patient
specific factors, such as comorbidity and the presence of end-organ damaged. The
rapid recognition and initiation of therapy are key to minimizing end-organ damage in
patients with hypertensive emergency. Tailoring drug selection according to individual
patient characteristics can optimize the management and potential outcomes of patients
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with hypertensive emergency. (Asian Journal of Health System Pharmacy, Rhoney and
Peacock, August 2009)
Synthesis
In our country, there is a need to pay more attention about structuring on what
Filipinos had experienced and what natural wealth we have, for the reason that these
God-given gifts are what accessible and blessed to be ready for our reaping. Our plants,
our herbs, our folk knowledge and putting together what the community and the
community people have, guided by scientific rationales connected to nature‟s healing,
such as our very own patola and its potent capability, as an effective approach to the
present modernized western way of healing, could create an impact to every individual‟s
precious life.
The researchers would like to further inculcate and encourage the use of
alternative medicine for both treatment and complementary approach in managing
certain illnesses. Through this study adequate knowledge and information will be
imparted in the public as to the importance of alternative medicine and how the use of
plants with medicinal properties can be determined. Also, this study would like to open
the eyes not just to the public but also health care providers from other allied health
groups to participate and engage in the promotion of alternative medicine and help
others realize and discover the health benefits of this among community members and
be partners with them in the care of their health.
The related studies that are used in this study will serve as guide for the
researchers in preparing and organizing their study. The related literature and studies
give the researchers Ideas on how to carry on with the study, It encourages them to dowell with honesty, patience, perseverance and determination in their hearts to be able to
produce a good and beneficial research study. It gives them information that would
supply and provide them with the information that the researchers need. The related
literature and studies would help in validation and support the content of this study as to
the possible effect and properties of patola in decreasing blood pressure.
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Each Related literature and studies cited by the researchers will be very much
acknowledged. Through this study, every information in their works will be further
disseminated and possibly be known by others who are oblivious about it, revealing
each author‟s great works and contribution in the field of research.
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Chapter III
Methodology
Research Design
The research design that will be used is experimental research utilizing the
pretest-posttest design. It is a type of experimental design in which data are collected
from study participants before and after introducing an intervention. This type of design
would help the researchers associate the differences between the controlled group and
experimental group after the administration of the intervening variable.
This design would allow the researchers to obtain a concrete basis for comparison whether the intake of patola extract with antihypertensive drug can
potentiate its antihypertensive effect and whether intake of antihypertensive agent alone
will possibly show difference in terms of blood pressure levels when compared to
participants taking both antihypertensive and patola extract.
Instrumentation
Physiologic measures
The blood pressure cuff and the stethoscope will be the primary tools in
gathering the blood pressure data of each participant. The same devices will be used by
the researchers in monitoring the blood pressure of all the study participants during the
four-week course administration of the patola extract.
A day-to-day recording tool will be developed using the physical assessment
books of Kozier and Bate‟s as guide and will be subjected to validity tests of various
experts in the academe to ensure that information regarding assessment will be
gathered, recorded and graphed accordingly. The self constructed tool will include the
name, age, address of the study participants and the study participants‟ history of
hypertension. It will also include the blood pressure monitoring chart in which day to day
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blood pressure will be recorded and graphed. Subjective and objective physical
assessments of the hypertensive study participants will also be included in the recording
tool. The day to day recording tool will be used for four consecutive weeks, before and
after rendering the intervention.
Fruit material
Collection and preparation of fruit material
Fresh fruits of patola will be collected in Diliman, Norzagaray, Bulacan where
patola are mostly cultivated. Fruit will be washed in running water, dried, and weighed.
Preparation of the extract
The weighted patola fruit will be peeled and cut into two pieces. The seeds will
be removed then the fruit will be chopped into cubes and then blended. Cheesecloth will
be used to filter the solute of the blended patola fruit twice. The collected extract will be
placed in calibrated containers in order to show its volume.
Screening of study participants
Day 1
• The researchers will go to their respective health centers to collect the lists of
hypertensive patients, including their names, age, and address.
• The researchers will perform blood pressure screening for regular patients in the
health center and perform house to house screening for non-compliant patients
of the health center.
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• Informing of prospective study participants about health teaching regarding
hypertension and encouraging the use of alternative medicine in managing their
condition.
Proposal of the study to community members
Day 2
• Health teaching about hypertension and currently used alternative medicine in
managing hypertensive condition.
• Informing the patients about the proposed research study about the effectiveness
of patola in decreasing blood pressure.
• Presentation of informed consent and explanation of its content to prospective
study participants.
Obtaining the population for the study
Day 3
• Retrieval of consent among prospective study participants.
• Randomization of the names through fishbowl sampling technique.
• Assignation of study participants according to experimental and controlled groups
and orienting them about the procedure to be done.
Pretreatment assessment of study participants
Day 4 to Day 10
• Administration of day-to-day recording tool
• Monitoring of blood pressure of both the experimental and the control group as
they regularly take only their prescribed antihypertensive medications
Testing patola extract's blood pressure lowering effect
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Day 11 to Day 31
• Administration of day-to-day recording tool
• Monitoring of blood pressure of the experimental group as they take patola
extract and their prescribed antihypertensive medications
• Monitoring of blood pressure of the control group as they take only their
prescribed antihypertensive medications
Day 32
• Organizing and tabulation of pretreatment and post treatment results
Day 33
• Application of statistical treatments on the pretreatment and post treatment data
Day 34
• Analysis and interpretation of results
Research Locale
The study will be conducted of selected barangays in Manila, which are under
the care of Dapitan, Maria Clara, San Diego, and Belmonte Health Centers.
The barangay 483, Zone 48 is located within the vicinity of Maria Clara health
center, its boundaries are half of Miguelin St., to Algeciras St., beside their barangay is
a satellite fire station, and across their location is the railroad of the PNR train.
Community members are composed mostly of economically depressed families. Most
identified job of the people residing within the community is tricycle driving. Presence of
„rolling stores‟ as the barangay‟s project for their community is readily seen within the
area.
The barangay 510, Zone 50 which is governed by Chairman Abel Sarmiento is
one of the barangays being catered by Dapitan health center. Its boundaries are from
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half of Maceda St, Kundiman St., Laong Laan St., and Maria Clara St. Landmark that is
easily seen within the place is a big warehouse of steel and secondhand lumbers. It is
the 5th street after PNR railroad when one would be riding a jeep from Quiapo. The
community is classified as an upper class, as mostly, big concrete houses are observed
within the place. The community has a rough estimate population count of 800
residents, and the registered voters in the place are 426. Majority of people living in this
community are employees and have businesses of their own as their source of income.
Current projects that can be readily seen at this community are motorcycle patrol and
maintenance in beautification of their barangay.
The barangay 499, Zone 49 is governed by Chairman Eduardo Frayco, and is
under the care of San Diego health center. The boundary of the place is from Simoun
St., to Maria Clara St, and half of the Kundiman St., and Algeciras St. The landmarks of
this community are the arc statue of „Muling Pagkabuhay ni Hesus‟ and the „Balumpare‟,
which is an old well that was used by the priests during the Spanish era. There is a
newly-built day care center that is located just across their barangay hall. Most of the
residents are not currently employed. Source of income of the people residing within
this community are tricycle driving and working in a construction. Livelihood programs
that can be observed is the DSWD loan program which they lend money to community
members for them to be able to start a small business they intended to have.
The barangay 478, Zone 47 is governed by Atty. Ruben Pena and is under the
care of Belmonte health center. The boundary of this community is from Ma. Cristina St.
to Don Quijote St. Landmarks of the barangay are the BDO bank along Maria Cristina
St. and JJ‟s eatery. Rough estimate of their population are 2000 residents which
composed mostly of the students and the working population. Office jobs are the
people‟s source of income in this community. The barangay can be classified as middle
class as the roads within the place are within good condition and concrete houses are
readily observed within the community.
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The screening of the community members will be done at Dr. Demetrio Belmonte
Health Center, Ma.Clara Health Center, Dapitan Health Center, and San Diego Health
Center. Hypertensive individuals, including both male and female, ages 30-65 years old,
which are currently taking or was prescribed to take but is not able to consistently
comply with their antihypertensive drugs as their medication in managing their
hypertension from the communities cited will be the study participants of our research. A
total of sixty (60) study participants will divided into two sets of group that will consist of
fifteen (15) members and be assigned for the two experimental groups and another two
sets of fifteen (15) members will be assigned for the two controlled groups.
Sampling Technique
Sampling technique that will be utilized is the purposive sampling technique. The
researchers will perform screening of community members and will get the list of
qualified participants that will meet the inclusion criteria, then, random assignation of
controlled and experimental groups will be made through fishbowl random sampling.
The study participants will be composed of sixty (60) individuals who are
hypertensive and are prescribed to take their antihypertensive medication. They willbe divided into two groups and there will be thirty (30) study participants for each
group (group 1 and group 2). The thirty (30) study participants that will be assigned
for group 1 will be further divided into two subsets of study participants, each
consisting of 15 members each group and will be assigned as experimental group 1
and control group 1. The remaining thirty study participants will be assigned for group
2, which will also be further divided into two subsets of study participants, each will
also consist of 15 members each group and will be assigned as experimental group 2
and control group 2. The group 1 will be the study participants who regularly take
their prescribed antihypertensive medication and the group 2 will be the participants
who don‟t take any prescribed antihypertensive medication.
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Data Gathering Procedure
Upon the approval of the study, the researchers will ask the permission of the
City health officer of Manila, Dr. Benjamin Yson, through personal appearance and
communication letter which encompasses the researchers‟ study and prospective
communities where we will be conducting our research. The researchers will attend
a courtesy call at Dr. Demetrio Belmonte Health Center and proceed to Ma.Clara
Health Center, Dapitan Health Center, and San Diego Health Center and to their
respective barangays. A letter of approval from the City health office about the
research to be conducted together with a communication letter about the research
study will be presented to the chairman of the respective barangays and the
Physician-in-charge in community health centers stated. After proper channeling of the research study through community officials, the researchers will then start to
conduct the study about the effectiveness of patola in decreasing blood pressure in
middle aged adults, 30-65 years old of selected barangays in Manila. Primary
approach of the researchers will be the initial screening of participants and the
requisition of cooperation of the prospective study participants through the use of an
informed consent to be able to obtain appropriate community members‟ approval
needed.
Sixty (60) individuals from the community that will meet the researchers‟ inclusion
criteria will be included in the study. The prospective study participants who will
agree to be a participant of the research study will be divided into two groups, 30
study participants will be assigned as experimental group and the another 30 study
participants will be assigned as control group. The group 1 (experimental group) will
be the study participants who regularly take their prescribed antihypertensive
medication and takes a patola extract. The group 2 (control group) will be the
participants who regularly take their prescribed antihypertensive medication and
having limited fluid intake.
The research study will be done for four consecutive weeks. It will be conducted
by utilizing the patola extract which the patient will take and the physiologic measures
as the data gathering tool which includes taking the study participants‟ blood pressure
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using only the same apparatus and the same person who will take measurements of
blood pressure for each study participants. Continuous monitoring of the study
participant‟s blood pressure will be performed throughout the whole course of the study
using the same equipment and same person assigned on measuring physiologic
parameters of the study participants, so as to maintain accuracy of the results.
Statistical Treatment
The data that will be gathered from each study participant will be carefully
recorded and tabulated. The statistical formula will be used to ensure comprehensive
interpretation of data:
Paired t- test will be used as it provide measures when the two sets of scores
are not independent, thus, the reason the researchers use a paired t-test is that it is a
test for dependent groups which is both the control group and the experimental group in
this study. A t-statistics then would be computed from pre-treatment and post-treatment
data with the given formula:
To apply the test, let
Then we get the t by:
where t represents the paired t statistics result which can be computed by
multiplying the mean difference over the square root of the population multiplied by
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degrees of freedom over the summation of study participants‟ blood pressure results,
multiplied by the squared difference of the pre-treatment and post-treatment results.