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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



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



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



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,



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



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



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.



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.



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 )



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)



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.



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,



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



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



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)



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



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



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.



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.



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



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.



• 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



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



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.



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.



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



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



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.

patola research defense 2-1-13

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