Although the conclusion is controversial, there has long been an appealing notion that catecholamines may be involved in some way in the pathogenesis of primary hypertension and almost invariably most of hypotensive drugs involve at various sites of the neuron and produce their effect by depletion of norepinephrine in the sympathetic nerve ending. The authors undertook the comparative study on catecholamine depleting action of 3 most effective drugs available for the treatment of hypertension, reserpine, guanethidine and alpha-methyldopa, measuring the plasma catecholamine levels and urinary exceretion of caecholamine by the modified fluorometric method of Weil-Malherbe and Bone during the treatment of hypertension. The results are as follows: 1) Before the administration of hypotensive drugs, mean blood pressure was 180/110mmH, mean psalma epinephrine level was 0.36+/-0.23gamma%, mean plasma norepinephrine level was 0.48+/-0.35gamma%, 24 hours urinary excretion of epinephrine was 3.6+/-0.12gamma/day and 24 hours urinary excretion of norepinephrine was 68.9+/-0.34gamma/day. 2) In group 1 (reserpin administered group), the mean blood pressure was 190/110mmHg before the treatment and which was declined to 155/89mmHg on the last day of 4th week, in group 2 (guanethidine administered group), the mean blood pressure measured before the treatment was 185/110mmHg and which was declined to 150/85mmHg on the last day of 4th week, and in group 3 (alpha-methylodpa administered group), the mean blood measured pressure measured before the treatment was 182/110mmHg and which was declined to 153/88mmHg on the last day of 4th week. 3) After the treatment for 4 weeks with reserpin guanethidine and alpha-methyldopa, the mean plasma epinephrine levels were declined from 0.37+/-0.12gamma% to 0.11+/-0.08gamma% in group 1, from 0.38+/-0.16gamma% to 0.14+/-0.10gamma% in group 2 and from 0.33+/-0.23gamma% to 0.10+/-0.09gamma% in group 3. 4) The mean plasma norepinephrine levels were declined from 0.05+/-0.21gamma% to 0.22+/-0.12gamma% in group 1, from 0.51+/-0.25gamma% to 0.20+/-0.10gamma% in group 2 and from 0.51+/-0.21gamma% to 0.20+/-0.11gamma% in group 3 after the treatment of 4 weeks respectively. 5) Urinary exceretion of epinephine was declined from 32.3+/-0.16gamma/day to 10.4+/-0.10gamma/day in group 1, from 34.5+/-0.34gamma/day to 17.2+/-0.16gamma/day in group 2, and from 28.2+/-0.14gamma/day to 10.3+/-0.11gamma/day in group in group 3 after the treatment of 4weeks duration. 6) The mean value of 24 hours urinary excretion of norepinephrine was declined to from 72.2+/-0.35gamma/day to 28.5+/-0.14gamma/day in group1, from 69.2+/-0.34gamma/day to 22.6+/-0.21gamma/day in group 2 and from 68.6+/-0.34gamma/day to 18.2+/-0.10gamma/day in group 3 after the treatment of 4 weeks duration. 7) From the above result we can summarized as follows: Antihypertensive effect of each drugs was; guanethidine>alpha-methylodopa>reserpin in order but depressing action plasma norepinephrine levels was; alpha-methyldopa>guanethidine>reserpin and depressing effect of urinary norepinephrine excretion was; alpha-methyldopa>guanethidine>reserpin, in order.
Antihypertensive Agents* ; Blood Pressure ; Catecholamines ; Epinephrine ; Guanethidine ; Humans ; Hypertension ; Methyldopa ; Nerve Endings ; Neurons ; Norepinephrine ; Plasma* ; Reserpine

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

Hypertension is a well known causative factor of congestive heart failure and other cardiovascular disease, and usually induce myocardial hypertrophy. Recent study shows that some antihypertensive drugs may reduce the hypertrophied cardiac mass reversibly. And over the past some decades, increasing attention was focused on these drugs. These drugs include methyldopa, angiotensin converting enzyme inhibitor, calcium channel inhibitor, beta-adrenergic blocker, but diuretics and vasodilators were known not to reduce the hypertrophied ventricular mass. In this study, 46 hypertensive patients were managed by captopril, atenolol, or hydrochlorothiazide monotherapy. And wer estimated and follow up LV mass by echocardiography during 3 months. Captopril and atenolol group showed LV mass reduced, but hydrochlorothiazide group did not. LV mass was reduced more in captopril group than in atenolo group. In conclusion, we have been impressed by this study that diuretics monotherapy for hypertension shoud be reconsidered. And we concluded that drugs which can reduce myocardial mass shoud be chosen to control hypertension as a monotherapeutic drug or a additive drug.
Antihypertensive Agents ; Atenolol ; Calcium Channels ; Captopril ; Cardiovascular Diseases ; Diuretics ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Hydrochlorothiazide ; Hypertension* ; Hypertrophy ; Methyldopa ; Peptidyl-Dipeptidase A ; Vasodilator Agents

The effects of antihypertensive drugs on the choroidal blood flow in rabbits were studied by an apparatus based on the principle of internal calorimetry of Grayson. Thermistors, as the sensing elements, were fastened on the scleral surface of the eye, and determinations were performed up to 60 minutes after intravenous administrations of drugs. The drugs studied were: ganglion blocking agents (pentholinium tartarate, 4 mg; hexamethonium bromide, 1 mg; and mecamylamine chloride, 0.15mg), alpha-methyldopa, 4 mg; guanethidine, 0.5 mg; reserpine, 0.2 mg; hydralazine, 5 mg; and diuretics (dichlorothiazide, 2.5 mg; frusemide, 2.5 mg). Except the diuretics, all the drugs employed produced considerable increase in the choroidal blood flow. The relationships between blood pressure, intraocular pressure and the choroidal blood flow were discussed and the clinical applications were suggested.
Administration, Intravenous ; Antihypertensive Agents* ; Blood Pressure ; Calorimetry ; Choroid* ; Dental Calculus ; Diuretics ; Furosemide ; Ganglion Cysts ; Guanethidine ; Hexamethonium ; Hydralazine ; Intraocular Pressure ; Mecamylamine ; Methyldopa ; Rabbits* ; Reserpine

Drug-induced toxic hepatitis is a relatively common hepatic disease in children, and it is usually self-limiting upon cessation of the offending drugs. Antituberculous drugs are well known for inducing hepatitis. Some cases of drug-induced hepatitis with autoimmune features have been reported; in these cases, the offending drugs were usually methyldopa, nitrofurantoin, minocycline, and interferon. The authors report the first case in Korea of drug-induced autoimmune hepatitis associated with thyroiditis and multiple autoantibodies that was induced by the antituberculous drugs isoniazid and rifampin.
Autoantibodies ; Child ; Drug-Induced Liver Injury ; Hepatitis ; Hepatitis, Autoimmune ; Humans ; Interferons ; Isoniazid ; Korea ; Methyldopa ; Minocycline ; Nitrofurantoin ; Rifampin ; Thyroid Gland ; Thyroiditis ; Thyroiditis, Autoimmune

No abstract available.
Carbidopa ; Levodopa ; Memory Disorders ; Chromatography, High Pressure Liquid

OBJECTIVE: X-linked dystonia parkinsonism (XDP) is an adult-onset, progressive and debilitating movement disorder described among Filipino males from Panay Island. The available oral medications have been ineffective. While chemodenervation with botulinum toxin A works and deep brain stimulation surgery is promising, these are not affordable for the vast majority of patients. Thus, we decided to look into the efficacy, safety and tolerability of levodopa+carbidopa (levodopa) versus placebo among patients with XDP.

METHODS: This was a double blind, randomized, placebo-controlled clinical trial. Patients were randomized to receive levodopa or placebo for 6 months. The dose was increased gradually until 1000 mg levodopa/day is reached or until side effects appear.

RESULTS: A total of 86 out of 94 randomized patients (91.5%) were included in the intention-to-treat cohort for the primary efficacy analysis. Nineteen patients (9 in levodopa, 10 in placebo) dropped out or were lost to follow up. There was no significant difference in the baseline and last visit Burke Fahn Marsden Dystonia Rating Scale and the part III of the Unified Parkinson's Disease Rating Scale scores between levodopa and placebo. The most common adverse events in the levodopa group were increased movements, pain and nausea/ vomiting.

CONCLUSION: While levodopa is safe and well-tolerated, it does not have any effect in alleviating the dystonia or parkinsonism in XDP.

Human ; Dystonia ; Parkinsonian Disorders ; Levodopa ; Carbidopa ; Parkinson Disease

BACKGROUND: XDP is an X-linked recessive disorder characterized by parkinsonism and dystonia described among Filipinos. Oral medications are frequently ineffective. Lately, DBS have been promising. However these are not generally available or affordable for the vast majority of patients. We then decided to evaluate the effectiveness of levodopa-carbidopa for XDP.
OBJECTIVE: To compare the efficacy, safety and tolerability of levodopa-carbidopa vs. placebo in XDP patients.
METHODS: After informed consent and randomization, the BFM and the UPDRS parts III and IV were performed at baseline and monthly up to 6 months. Patients were randomized to receive either levodopa-carbidopa at a starting dose of 125 mg levodopa/ day in 2 divided doses or corresponding placebo. Gradual uptitration was done to a maximum of 1000 mg levodopa/ day or until side effects appeared.
Homogeneity of the characteristics of patients in the 2 groups was determined using Independent t-test and Chi-square test. To determine the significance of changes in the efficacy parameters within each group, Wilcoxon Matched Pairs Signed Ranks Test was used. To compare the scores of the different efficacy parameters of the 2 groups, Mann Whitney U Test was applied to the data. A p?0.050 was considered significant.
RESULTS: A total of 107 patients were recruited. There were 13 screen failures, and 94 were subsequently enrolled. The baseline characteristics (age, duration of illness, baseline BFM and UPDRS (motor) scores were not significant between levodopa and placebo (age in years: 47 + 9.35 vs. 50 + 9.51; duration of illness in years 6.3 + 7 vs. 6.2 + 5.2; BFM score: 32.8 + 24.5 vs. 28.4 + 26.5; UPDRS score 29.9 + 20.7 vs. 34.8 + 26.8).
There was a decrease in BFM scores from baseline to all follow-up periods in patients given levodopa but were statistically significant only on visit 2 and visit 9. In the placebo group, decrease in scores was also observed in some observation periods but no statistical significance was shown. A comparison of the 2 groups showed that the magnitude of decrease in the levodopa group was statistically greater than the placebo group on the second visit. There were no significant differences observed in all other follow-up periods. Both groups showed a decrease in UPDRS scores but significant decrease was observed in visits 2, 5, 6, 7, 9 of the levodopa group. While in the placebo group, a significant decrease was observed only on visit 2. Comparison of the 2 groups did not show any significant differences.
There were 17 patients from the levodopa group who reported adverse events (most common: increased involuntary movements, nausea/ vomiting/ dizziness, headache, and generalized weakness. In the placebo group, there were 11 patients (most common: increased involuntary movements, abdominal pain). There were 9 patients who dropped out (levodopa: 4, placebo: 5).
CONCLUSION: There was a significant decrease in the BFM and UPDRS scores in XDP patients given levodopa compared to placebo. Levodopa is a safe and effective drug that may be considered in patients with XDP.
NOTE: This study was supported by an unrestricted grant by Torrent Pharma Philippines, Inc.

Human ; Abdominal Pain ; Carbidopa ; Dyskinesias ; Dystonia ; Dystonic Disorders ; Headache ; Levodopa ; Nausea ; Parkinsonian Disorders ; Statistics, Nonparametric ; Vomiting

BACKGROUND: Cognitive impairments are common in patients with Parkinson's disease (PD). However little is known about the cognitive effects of dopaminergic therapy. METHODS: The study was a single-blind prospective study of 21 patients with PD. Each patient had received either levodopa (Sinemet(R), n=8) or dopamine agonist (Requip(R), n=13) during 24 consecutive weeks. Neuropsychological battery, including Korean version of Alzheimer's Disease Assessment Scale(R) cognitive subscale (ADAS-Cog) and frontal-executive function part of SNSB (Seoul Neuropsychological Screening Battery), were performed two times, before and after the 24 weeks of management. Patients also received quantitative ratings of motor symptom severity and functional status using Unified Parkinson's Disease Rating Scale (UPDRS) before and after the dopaminergic therapy. RESULTS: After six months of treatment, motor scale improved in both groups (p<0.05) without difference between the groups (p>0.05). In ADAS-Cog testing, Requip(R) group improved at more categories than Sinemet(R) group but without statistical difference (p>0.05). The results of frontal-executive function test did not differ between the groups, either. CONCLUSIONS: Our study does not provide an evidence that dopaminergic treatment improves cognitive functions in Parkinson's disease. Furthermore, we found no significant difference in the effect on cognition between the two tested drugs and no difference in the results of the above-listed neuropsychological tests between the first and the last visits.
Alzheimer Disease ; Carbidopa ; Cognition ; Dopamine ; Dopamine Agonists ; Humans ; Levodopa ; Mass Screening ; Neuropsychological Tests ; Parkinson Disease ; Prospective Studies

Akinetic mutism is a clinical syndrome in which the patient is unable to speak (mutism) or move (akinesia). Various brain lesions can induce akinetic mutism. We attended a 71-year-old woman who presented with akinetic mutism caused by bilateral anterior cerebral artery infarction. The patient improved after the administration of levodopa com-bined with carbidopa, in response to visual and verbal stimuli. Increased verbal output and spontaneous motor activities were also noted. Levodopa may be helpful to the treatment of akinetic mutism.
Aged ; Akinetic Mutism* ; Anterior Cerebral Artery* ; Brain ; Carbidopa ; Female ; Humans ; Infarction, Anterior Cerebral Artery* ; Levodopa* ; Motor Activity