ABSTRACT:

BACKGROUND: The Millennium Development Goal (MDG) for 2015 has a target MMR of 52/100,000 live births but this goal been difficult to achieve. In the Philippines, 11 mothers die everyday from pregnancy related complications, a bulk contributed by Hypertension. Public health midwives sometimes attend to these obsterical emergencies often in the absence of a physician. this led to the BEmONC program, which addresses the rising morbidities from far-flung areas where resources are scarce, and helps train midwives in essential obsterical emergency care. The midwives are our allies in providing the best standard of care every mother and child rightfully deserves. Only thru periodic evaluation can we help strengthen BEmONC program, making it crucial to evaluate the midwives' knowledge and management practices in hypertension to help identify the setbacks that have impeded our progress in achieving the MDG.

GENERAL OBJECTIVE: To access the knowledge and management practices of midwives in the management of hypertension in pregnancy in accourdance to the BEmONC protocol.

STUDY DESIGN: Descriptive Study

STUDY SETTING: The 69 public health centers of Cebu City

STUDY POPULATION: Public Health Midwives

METHODOLOGY:This is descriptive study where a survey questionnaire was used and convenience sampling was done. Chi square and Fischer exact tests were employed to compare proportions. Descriptive statistics was used to summarize the data in proportion.

RESULT: More than 70% of the midwives were knowledgeable regarding expected competencies, where BEmONC-trained midwives were 5-14x more likely to identity appropriate function. However, Only a dismal 22-36% will actually administer Magnesium Sulfate, which shows that knowledge is not translated into practice. Also, more than 70% were knowledgeable on the risk factors and danger signs of hypertension in pregnancy. It also showed that the midwives agreed to give antihypertensive medications- where Methyldopa was commonly given. Among those who agreed too give Methyldopa, majority were BEmONC-trained. A number also agreed to give hydralazine and diazepam in the setting of sever preeclampsia and eclampsia, where more non-BEmONC midwives agreed. Alarmlingly, only less than 50% will refer to a physician in the management og gestational hypertension and mild preeclampsia, and only 50%-60% agreed to facilitate hospital transport in the setting of severe preeclampsia and eclampsia.

CONCLUSION: The BEmONC manual must be updated to keep up with current guidelines and ensure the conversation of knowledge into practice. The BEmONCcoverage of training must also be expanded so that all practicing midwives know the protocol. However, the DOH must further strengthen their role in the active surveillance of public health midwives and review the retention of their skills and regular practice of knowledge. Midwives must also be certified proficient, not merely trained. The must also be consulted to explore their problems in the implementation of current guidelines so we can better understand their situation as to why knowledge is not put into practice. By identifying deficiencies, we can improve and address setbacks that have impeded our progress towards achieving the Millennium Development Goal.

Human ; Knowledge ; Methyldopa ; Antihypertensive Agents ; Eclampsia ; Hypertension, Pregnancy-induced ; Magnesium Sulfate ; Midwifery ; Pre-eclampsia ; Live Birth ; Diazepam ; Hydralazine ; Obstetrics

OBJECTIVETo investigate the correlation between methylation status and gene expression of APC (adenomatous polyposis coli) gene in HeLa, CaSki and SiHa cell lines of cervical carcinoma, and explore the effect of hydralazine on the transcription regulation of the 5'CpG island demethylation of APC gene and the proliferation and apoptosis of the cell lines.

METHODSMethylation status and the expression of APC gene were analyzed using methylated specific PCR, RT-PCR and FQ-PCR methods. The expression of beta-catenin protein which correlates closely with APC was detected by SP method after treatment with Hydralazine. MTT and FCM assays were used to observe the changes of proliferation activity and apoptosis of the cells after Hydralazine treatment.

RESULTS(1) APC gene was methylated or hemimethylated respectively in HeLa and CaSki cell lines, at the same time, APC gene was not methylated in SiHa cell. (2) After having been treated by 40 micromol/L Hydralazine for 72 hours, growth inhibitory ratios of HeLa, CaSki and SiHa cell lines were (52.12 +/- 3.78)%, (44.31 +/- 2.59)% and (47.73 +/- 4.73)% respectively, on the contrary, normal cell HECV's growth inhibitory ratio was only (27.18 +/- 0.79)%. APC gene in HeLa and CaSki cell lines which were treated by 40 micromol/L Hydralazine for 72 hours was demethylated and expressed positively, the expression of APC mRNA in HeLa, CaSki and SiHa cell lines increased to 10.35, 11.40 and 0.73 times respectively. (3) Hydralazine, when used at the concentration of 40 micromol/L for 72 hours, induced S phase and G2/M phase arrest and apoptosis in HeLa and CaSki cells. beta-catenin protein can be expressed in cell membrane after treatment with Hydralazine.

CONCLUSIONAPC gene methylation plays an important role in the carcinogenesis of cervical cells and can re-express after the treatment with Hydralazine which also could inhibit the growth of the cervical cancer cells.

Adenomatous Polyposis Coli Protein ; genetics ; metabolism ; Antineoplastic Agents ; pharmacology ; Apoptosis ; drug effects ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; CpG Islands ; genetics ; DNA Methylation ; Female ; Gene Expression Regulation, Neoplastic ; Genes, APC ; HeLa Cells ; Humans ; Hydralazine ; pharmacology ; RNA, Messenger ; metabolism ; Uterine Cervical Neoplasms ; metabolism ; pathology ; beta Catenin ; metabolism

BACKGROUND: Controlled hypotension improves surgical field and decreases transfusion requirement in surgical patients and can be induced with various kinds of drugs including esmolol and hydralazine. METHODS: This study examined the effect of a combination of esmolol and hydralazine as hypotensive agents in spine surgery. In the esmolol group (n = 15), after boluses of esmolol (0.5 mg/kg) injection, esmolol was infused to maintain the mean arterial pressure of 55-65 mmHg. In the hydralazine-esmolol group (n = 15), hydralazine (0.3 mg/kg) was administered 15 minutes before esmolol injection which was done in the same way as that of the esmolol group. RESULTS: The mean arterial pressure decreased to the target range more rapidly in the hydralazine-esmolol group. The heart rate was increased by hydralazine, but reduced by esmolol. The cardiac output remained elevated after hydralazine injection in the hydralazine-esmolol group, and decreased significantly by esmolol in the esmolol group. The administered dose of esmolol was much less in the hydralazine-esmolol group than in the esmolol group. CONCLUSIONS: Our data suggest that hydralazine can enhance the efficacy of esmolol-induced controlled hypotension. It can reduce the requirement of esmolol and maintain a higher cardiac output during hypotension.
Arterial Pressure ; Cardiac Output ; Heart Rate ; Humans ; Hydralazine* ; Hypotension ; Hypotension, Controlled* ; Spine*

OBJECTIVETo detect the 5'CpG island methylation of estrogen receptor (ER) alpha gene promotor region in ER alpha-negative human breast cancer cell lines (MDA-MB-231 and MDA-MB-435) and breast cancer tissues; and to investigate the possibility of hydralazine in restoring the expression of ER alpha gene through demethylation.

METHODSThe CpG island methylation status of ER alpha gene promotor region-A, B and C in ER alpha-negative human breast cancer cell lines (MDA-MB-231 and MDA-MB-435) and 20 cases of breast cancer tissues were analyzed using methylation-specific polymerase chain reaction (MSP). The mRNA expression profile of ER alpha isoforms (ERalpha-A, ERalpha-B and ERalpha-C) and coding region in ER alpha gene were analyzed by using RT-PCR, after hydralazine treatment.

RESULTSIn the two cell lines studied, CpG island was methylated in ERalpha-A and ERalpha-B but not ERalpha-C. Among them, methylation of CpG island in ERalpha-A was obtained in 13 breast tumor cases; methylation of ERalpha-B seen in 10 tumor cases; methylation of both ERalpha-A and ERalpha-B seen in 9 cases; and methylation of ERalpha-C was obtained in only 1 case. The positivity rates were 65%, 50%, 45% and 5% respectively.

CONCLUSIONSThe ER alpha gene non-expression in breast cancer is probably associated with CpG island methylation in ER alpha gene promotor region A and B, and the level of methylation is enhanced as advance of tumors in clinical stage. Hydralazine, served as a demethylating agent enables to restore the expression of ER alpha gene.

Adult ; Aged ; Breast Neoplasms ; genetics ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; genetics ; metabolism ; pathology ; Cell Line, Tumor ; CpG Islands ; DNA Methylation ; Estrogen Receptor alpha ; biosynthesis ; genetics ; Female ; Gene Expression Regulation, Neoplastic ; Gene Silencing ; Humans ; Hydralazine ; pharmacology ; Middle Aged ; Promoter Regions, Genetic ; RNA, Messenger ; biosynthesis ; genetics

Hypertension and anemia may be causes of left ventricular hypertrophy (LVH) in uremia but the molecular mechanism is not known. Uremia was induced in male Spraugue Dawley rats by 5/6 nephrectomy. The following groups of rats were studied for 6 weeks; uremic rats (U) fed ad. lib., control rats (C) pair-fed with U, U rats given hydralazine (100 mg/kg/day) (UH), U rats given erythropoietin (48U/kg/week, i.p.) (UE). Both diastolic and mean arterial pressures are higher (P<0.01) in U and UE compared with C whereas both pressures in UH were normalized. Hemoglobin in U was lower than in C, and was normalized in UE. U, UH and UE had higher heart weight/body weight ratios (HW/BW) as well as left ventricular weight/body weight ratios (LV/BW) compared with C (P<0.01). Compared with U, UH has lower HW/BW and LV/BW (P <0.05) and UE has normal HW/BW but lower LV/BW than U (P<0.05). To see if the gene expression in uremic LVH is similar to that described in pressure overload LVH in which mRNA levels of angiotensin converting enzyme (ACE), transforming growth factor-beta1 (TGF-beta1), atrial natriuretic factors (ANF) and skeletal alpha-actin were increased, we measured these mRNA levels by Northern analysis. TGF-beta, ACE and alpha-actin mRNA levels were not changed in all 4 groups. ANF mRNA in U and UE was increased 3 fold over C, and normalized in UH. Treatment of anemia with erythropoietin improved uremic LVH but did not change ANF mRNA; whereas treatment of hypertension with hydralazine normalized ANF mRNA but did not completely correct uremic LVH. Thus, gene expression in uremic LVH is distinct from that in pressure- overload LVH, suggesting that other unidentified factor(s) might be involved in uremic LVH.
Actins/genetics/metabolism ; Anemia/*complications/drug therapy/metabolism ; Animals ; Atrial Natriuretic Factor/genetics/metabolism ; Erythropoietin/pharmacology/therapeutic use ; *Gene Expression ; Heart Ventricles/chemistry/drug effects/pathology ; Hydralazine/pharmacology/therapeutic use ; Hypertension/*complications/drug therapy/metabolism ; Hypertrophy, Left Ventricular/etiology/*genetics/metabolism ; Male ; Peptidyl-Dipeptidase A/genetics/metabolism ; RNA, Messenger/analysis/metabolism ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta/genetics/metabolism ; Uremia/etiology/*genetics/metabolism

BACKGROUND: Hydralazine produces cerebral vasodilation, which could appear differently according to which kind of anesthetics was used. SjO2, CBF and AJDO2 have been studied during general anesthesia with enflurane, isoflurane or propofol in 42 patients undergoing spinal surgery. METHODS: Forty-two healthy adult patients were divided into Group P (Propofol-N2O, n = 15), Group E (Enflurane-N2O, n = 15) and Group I (Isoflurane-N2O, n = 12). During the course of the study, the anesthetic concentration was constant. Induced hypotension was provided with hydralazine 20 mg in combination with a continuous infusion of esmolol within 50 - 100ng/kg/min. Arterial blood and jugular bulb blood were obtained and analyzed at normotensive and hypotensive period, respectively. SjO2, was compared within and between groups. RESULTS: SjO2 values of Group P were 66.2 +/- 7.7%, and 81.5 +/- 6.1%, those of Group E were 79.5 +/- 5.6%, and 78.9 +/- 4.9% and those of Group I were 82.0 +/- 6.2%, and 84.4 +/- 3.7% at normotension and hypotension, respectively (P < 0.05 between Group P and Group E, P < 0.05 between Group P and Group I, P < 0.05 within Group P). CONCLUSIONS: When the changes of CBF is assumed with that of SjO2, it may be concluded that CBF increased with hydralazine-induced hypotension in propofol-N2O anesthesia. It may be suggested that hydralazine reverses propofol induced cerebral vasoconstriction.
Adult ; Anesthesia* ; Anesthesia, General ; Anesthetics ; Enflurane* ; Humans ; Hydralazine ; Hypotension* ; Isoflurane* ; Oxygen* ; Propofol* ; Vasoconstriction ; Vasodilation

BACKGROUND: This study was performed to evaluate whether the degree of hypotension influences blood loss during spinal surgery. METHOD: Fifty patients undergoing only one level spinal fusion were assigned to one of three groups. In group 1 (n = 14), the systolic blood pressure (SBP) was maintained at 100 120 mmHg with enflurane. In groups 2 (n = 18) and 3 (n = 18), the SBP were maintained at 80 100 and 60 80 mmHg, respectively. Hydralazine and esmolol were used in the hypotensive groups. RESULTS: Blood losses during operation in groups 2 (554 +/- 287 ml) and 3 (456 +/- 162 ml) were significantly lower than in group 1 (1141 +/- 690 ml) (P < 0.05), although there was no significant difference between groups 2 and 3. The percentage of patients receiving transfusions during the operation in groups 1 and 2 were 57.1 and 5.6%, respectively. CONCLUSIONS: The results show that a moderate reduction in SBP (80 - 100 mmHg) reduces blood loss by more than half in comparison to a mild reduction in SBP (100 - 120 mmHg). However, a severe reduction in SBP (60 - 80 mmHg) does not increase the reduction in blood loss in comparison to moderate hypotension.
Blood Pressure ; Enflurane ; Humans ; Hydralazine ; Hypotension* ; Spinal Fusion

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provides better visibility, but may produce ischemic damage to the liver. The purpose of this study is to compare liver function after induced hypotension between general anesthesia with enflurane and isoflurane in spinal surgery. METHODS: Forty patients were randomly allocated to enflurane (group 1, n = 20) and isoflurane (group 2, n = 20) group. During operation, hypotension was induced with hydralazine to maintain systolic blood pressure between 60 to 80 mmHg in both groups. Preoperative and postoperative 1, 3, 5 and 7 days' serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT) and alkaline phosphatase (ALP) were evaluated. RESULTS: In group 1, SGOT levels increased significantly at postoperative 1, 3 days, and SGPT levels increased significantly at postoperative 3, 5, 7 days. In group 2, SGOT levels increased significantly at postoperative 1, 3, 5, 7 days, and SGPT levels increased significantly at postoperative 3, 5, 7 days, but there was no significant difference between the groups in SGOT and SGPT levels. ALP levels decreased at postoperative 1, 3, 5 days in group 1, and at postoperative 1, 3 days in group 2; however, there was no significant difference between the groups in ALP levels except in preoperative values. CONCLUSIONS: These results suggest that there is no difference in postoperative liver function between general anesthesia with enflurane and isoflurane in spinal surgery after induced hypotension.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Anesthesia, General ; Aspartate Aminotransferases ; Blood Pressure ; Enflurane* ; Humans ; Hydralazine ; Hypotension* ; Isoflurane* ; Liver* ; Pyruvic Acid

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provides better visibility, but may produce an ischemic damage on liver. The purpose of this study is to evaluate postoperative liver function according to the degree of induced hypotension in spine surgery. METHODS: Sixty patients were classified into three groups. In group 1 (n=20) undergoing simple laminectomy, the systolic blood pressure (SBP) was maintained at 120 to 100 mmHg with controlling the concentration of enflurane. Hydralazine and/or esmolol were given to maintain the SBP at 100 to 80 mmHg in group 2 (n=20) and 80 to 60 mmHg in group 3 (n=20) as needed. Preoperative and postoperative 1, 3, 5, 7 day's serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT) and alkaline phosphatase (ALP) were evaluated. RESULTS: In group 1, postoperative SGOT levels were increased significantly on postoperative 1, 3, 5, 7 day and postoperative SGPT levels were increased significantly on postoperative 7 day only. In group 2, postoperative SGOT levels were increased significantly on postoperative 1, 3, 5, 7 day and there was no significant difference between preoperative and postoperative SGPT levels. In group 3, postoperative SGOT levels were increased significantly on postoperative 1, 3 day and postoperative SGPT levels were increased significantly on postoperative 3, 5, 7 day. There was no significant difference among three groups in SGOT and SGPT levels. Postoperative ALP levels were decreased on postoperative 1, 3, 5, 7 day in all groups and there was no significant difference among three groups except a significant difference between group 1 and 3 on postoperative 1, 3 day in ALP levels. CONCLUSIONS: These results suggest that severe reduction in SBP at 80 to 60 mmHg by hydralazine and/or esmolol under general anestheia with enflurane can not exclude the possibility of liver damage.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Aspartate Aminotransferases ; Blood Pressure ; Enflurane ; Humans ; Hydralazine ; Hypotension ; Laminectomy ; Liver* ; Pyruvic Acid ; Spine*

BACKGROUND: The induced hypotensive anesthesia may produce serious complications related to central nervous system, heart, liver, kidney and eyes. In this study, the blood loss during and after operation were compared to evaluate the delayed effect of hypotension on postoperative bleeding and also, the urine output was measured in control group and furosemide treated group, to investigate the effect of furosemide on the protection of kidney function. METHODS: Forty patients undergoing spinal surgery were evaluated and the hypotension was induced by the combination of hydralazine, esmolol and propranolol under enflurane anesthesia. During hypotensive anesthesia, the systolic arterial blood pressure was maintained between 65 to 75 mmHg. I compared the arterial blood gas analysis, plasma protein, albumin and calcium level, blood urea nitrogen (BUN), creatinine and complete blood count (CBC) before, durng and after hypotensive anesthesia. And also, the volume of blood loss and the units of transfused blood were measured intraoperatively and postoperatively. To investigate the effect of furosemide on the protection of kidney function, patients were randomly divided to contol group (n=20) and furosemide group (n=20). In furosemide goup, 0.1 mg/kg was administered intravenously and the urine output was measured during and after hypotensive anesthesia in both groups. RESULTS: The systolic arterial blood pressure during hypotensive anesthesia was maintained between 65 to 75 mmHg as planned in all forty patients. The average blood loss during and after operation were 769+/-541 and 786+/-397 ml, respectively and the average total blood loss was 1555+/-784 ml. The average units of transfused packed red cell during and after operation were 2.6+/-0.8 and 1.9+/-0.4 units, respectively, and the average total transfused units were 2.3+/-0.8 units. In both control and furosemide treated groups, all forty patients showed oliguria during first two hours after starting hypotensive anesthesia but urine outputs were recovered after the end of hypotensive anesthesia in both groups. During and after hypotensive anesthesia, pH was slightly but significantly decreased. Plasma protein, albumin, calcium and BUN were decreased during and after hypotensive anesthesia compared with before hypotensive anesthesia values. During and after hypotensive anesthesia, platelet count was decreased significantly but white cell count was increased. Severe oliguria was noted during hypotensive anesthesia in both groups and no serious complication related to hypotensive anesthesia was found. CONCLUSIONS: In this study, the volume of blood loss after anesthesia was almost same as that during anesthesia. And the administration of furosemide 0.1 mg/kg did not prevent oliguria during hypotensive anesthesia.
Anesthesia* ; Arterial Pressure ; Blood Cell Count ; Blood Gas Analysis ; Blood Urea Nitrogen ; Calcium ; Cell Count ; Central Nervous System ; Creatinine ; Enflurane ; Furosemide* ; Heart ; Hemorrhage ; Humans ; Hydralazine ; Hydrogen-Ion Concentration ; Hypotension ; Kidney ; Liver ; Oliguria ; Plasma ; Platelet Count ; Propranolol