CHAPTER 1 INTRODUCTION

Philippines is known to be an endemic area for malaria, schistomiasis japonicum and intestinal capilliariasis. Some studies have established the high prevalence of intestinal helminthes in the country, one of which is the World Health Organized and a Korean sponsored study. The studies find an alarming rate of 95.5% infection rate among preschool children, and infestation rate of 56% in urban areas and 92.3% in rural areas among children and adolescents. Trichuris trichiura, ascaris lumbricoides, and hookworms were generally found to be most prevalent in the country. Children are most vulnerable to these parasite infestations since they are prone to eating dust during their play activities for lack insight as well on the proper hygiene. If much of the in festive egg s are ingested, it may cause detriment to the childrens health. It can cause intestinal obstruction, verminous pneumonia or obstruction in the bile and/or pancreatic duct. Trichuriasis particularly can cause anemia, or if heavily infected may have rectal prolapse. If left untreated, presence of helminthes may affect nutrition and significantly reduce the childrens weight. In fact, the World Health Organization has identified helminthes as one of the causes of the childrens nutrition. Treatment from helminthes includes pharmaceuticals, where most effective and most used are Pyrantel Pamoate and Levamisole to eliminate ascaris lumbricoides and Mebendazole to eliminate trichuris trichiura. These drugs work either by stunning or by killing these helminthes. However, these clinically prepared drugs are expensive for most of the Filipino families. Thus, natural antihelminthics are resorted to, and some of these alternatives include pineapple, tobacco, garlic and malunggay. This research tries

to find an alternative medicine that would effectively expel helminthes from the human body. This study theorizes ampalaya as an antihelmenthics alternative medicine. Studies have cited that ampalaya has positive effects on malaria, type 2 diabetes, and HIV infection. It is also found to aid in apoptosis on cancer cells, and is also used to induce intestinal and systemic anti-inflammatory responses. Because of ampalayas potency, Philippines have commercially made capsules and tea out of the herbs fruit and/or leaves. Claims have been found to significantly relieve patients of various ailments, including those already cited above. Studies relating ampalaya as antihelminthics was however not yet cited or published. The group is interested in identifying an alternative cure for expelling helminths, since helminthes commonly plague school children especially in the Philippines. Finding an alternative cure that can be readily made available in the childrens diet would be great help to most parents. This is in line with the thrust of the Department of Health in finding alternative medicines for common diseases and ailments pervading greater populace. Thus, this study may help in exploring the possibility of bridging the gap between expulsion of helminthes and availability of antihelminthics to Filipinos. Particularly, it hopes to determine the effectiveness of bitter gourd of ampalaya in expelling intestinal parasites the ascaris lumbricoides and trichuris trichiura. It is of interest to the researchers to support the Department of Healths thrust in fighting off malnutrition among young children, not only by knowing what is best that should be taken to ones bodies but also in knowing what to prevent it from.

Chapter 2 REVIEW OF RELATED LITERATURE AND STUDIES The studies and literatures cited in this chapter are the basis of the theoretical and conceptual framework of this study. This chapter cites literature on ampalaya and medical studies using the herb, and helmenthics and ascaris, as to its nature as well as medical studies pertaining to its eradication. There are yet no known studies or literature that used ampalaya as antihelminthics. Related Literature Ampalaya, Bitter Melon or Bitter Gourd Ampalaya, as commonly known in the Philippines, has an English name of bitter melon or bitter gourd. Its scientific name is Momordica charantia, and taxonomically is under the family Cucurbitaceae of the plant kingdom. It is a tropical and subtropical vine widely grown as edible fruit, however the most bitter of all vegetables. It is widely grown in South and Southeast Asia, China, Africa and the Caribbean. The fruit is oblong in shape and has distinct warty looking exterior. It has hollow in cross-section, where the central seed cavity is filled with large flat seeds and pith. Seeds and pith appear white in unripe fruits. As the fruit ripens, the pith becomes sweet and its color turns red. Red and sweet bitter melon pith is a popular ingredient in some special Southeast Asian style salad. The skin or flesh can be eaten as well, and is crunchy and watery in texture. The fruit is most often eaten green because it becomes bitterer as it ripens (Wikipedia).

Bitter melons have long been used in Asia as a traditional medicine. Due to its bitter taste, bitter melon stimulates digestion, thus helpful with people who have sluggish digestion, dyspepsia, and constipation (Wikipedia, Encarta Dictionary). Bitter gourd can also be used to soothe irritated or inflamed skin or mucous membranes. Panamanians and Colombians use bitter melons in preventing and treating malaria and diabetes. The leaves of the plant are used to make a tea. It is brewed in hot water by allowing the leaves to steep in hot water before being strained thoroughly, so that only the remaining liquid is used for the tea (Wikipedia). Rosales and Fernando (2001) made tea out of bitter gourd by placing 3 grams of dried fruits with seeds in a Flo-thru bag and adding 650 ml boiling water and brewing for additional five minutes. Artificial sweeter, drops lemon (calamansi) and ice may be added to suit to taste. Laboratory studies have confirmed that various species of bitter melon have antimalarial activity, though human studies have not yet been published (Wikipedia). Folk wisdom has it that ampalaya helps to prevent or counteract type-ll diabetes. A laboratory study on diabetic-induced rats showed that there was significant reduction of maltase and renal disaccharides activities with bitter gourd supplement (Shetty, Kumar, Salimath, 2005). Dr. Rayundo (1997) studied effects of ampalaya and aloe vera on Swiss mice and finds that oath has blood glucose-lowering effects comparable to insulin. A book by Frank Murray documents individual testimonies on how ampalaya has positive effects on lowering blood sugar. Bitter Melon contains four bioactive compounds, one of which activate a protein called AMPK, which is well known for regulating fuel metabolism and enabling glucose uptake, processes which are impaired

in diabetics. Bitter melon contains a lectin that has insulin-like activity. The insulin-like bioactivity of this lectin is due to its linking together two insulin receptors. This lectin lowers blood glucose concentrations by acting on peripheral tissues and suppresses the appetite. Lectin binding is non-protein specific, and this is likely why bitter melon has been credited with immunotimulatory activity by linking receptors that modulate the immune system, thereby stimulating said receptors (Wikipedia). Laboratory tests suggest that compounds in bitter melon might be effective for treating HIV infection. A study using Thai bitter gourd protein (MRK29) showed that MRK29 inhibited the HIV-1 reverse transcriptase with 50% IR at the concentration of 18 micrograms/ml. MRK29 was concentrated in the 30-60% salt precipitated fraction, at which the concentration of 0.175 microgram/ml exerted 82% reduction of viral core protein p24 expression in HIV-infected cells. MRK29 might have modulatory role on immune cells, because it increased 3-fold TNF activity (Jiratchriyakul, 2001). As most compounds isolated from bitter melon that impact HIV have either been proteins or glycoproteins lectins, neither of which are well-absorbed. It is thus; unlikely that oral intake of bitter melon will slow HIV in infected people. It is possible oral ingestion of bitter melon could offset negative effects of anti-HIV drugs, if a test tube study can be shown to be applicable to people. In one preliminary clinical trial, an enema form of a bitter melon extract showed some benefits in people infected with HIV (Zhang 1992). Clearly more research is necessary before this could be recommended. Bitter gourd is further found to significantly induce apoptosis on cancer cells. A comparative study by Satome, et. Al (2002) used five vegetables (carrot, Welsh onion (2 varieties), Chinese radish, bitter gourd and cabbage) and 4 varieties of sweet potato to

study apoptosis in cancer cells. The vegetables were extracted with ethanol and the inhibitory effects of the ethanol extracts on the growth of HL60 human leukemia cells were examined. Among the extracts, the bitter gourd extract was the most effective inhibitor of the HL60 cell growth. A study by Manabe, et. al. (2003) assessed the immunomodulatory activity of bitter gourd finds that with the use of the herb there was decrease in the intestinal secretion of IL-7 and an increase in the secretions of TGF-B and IL-10. These effects reflect that the bitter gourd induces changes in systemic immunity by decreasing the number of lymphocytes, increasing in the populations of TH cells and NK cells, and increasing in the LG production of lymphocytes. Dietary bitter gourd may therefore induce both intestinal and also systemic anti-inflammatory responses. In Philippines, ampalaya is sold as a food supplement and elixir. Studies so far demonstrate improvement but not cure in some diabetic parameters. Various cautions are indicated however. Due to its bitter taste, it can sometimes make heartburn and ulcers worse. Their seed, which contains vicine, can trigger susceptible individuals to symptoms of favism, an acute anemia caused by allergic reaction to broad bean or plants pollens. Further, the red arils of the seeds are reported to be toxic to children, and the fruit is contraindicated during pregnancy (Wikipedia; Encarta Dictionary). Administration of bitter gourd by ingesting using ampalaya tea has documented gastrointestinal side effects particularly increased bowel movements (Rosales and Fernando, 2001).