“Effects of Tawa-tawa(Euphorbia Hirta) to the Platelet Count of Dengue Patients” free essay sample

Dengue fever also known as breakbone fever is an infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs. Dengue is transmitted by several species of mosquito within the genus Aedes, principally A. aegypti. The virus has five different types; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. As there is no commercially available vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites. Treatment of acute dengue is supportive, using either oral or intravenous rehydration for mild or moderate disease, and intravenous fluids and blood transfusion for more severe cases. We will write a custom essay sample on â€Å"Effects of Tawa-tawa(Euphorbia Hirta) to the Platelet Count of Dengue Patients† or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The incidence of dengue fever has increased dramatically since the 1960s, with around 50–100 million people infected yearly. Early descriptions of the condition date from 1779, and its viral cause and the transmission were elucidated in the early 20th century. Dengue has become a global problem since the Second World War and is endemic in more than 110 countries. Apart from eliminating the mosquitoes, work is ongoing on a vaccine, as well as medication targeted directly at the virus. Dengue virus is primarily transmitted by Aedes mosquitoes, particularly A. aegypti. These mosquitoes usually live between the latitudes of 35 ° North and 35 ° South below an elevation of 1,000 metres (3,300 ft). They typically bite during the day, particularly in the early morning and in the evening, but they are able to bite and thus spread infection at any time of day all during the year. Other Aedes species that transmit the disease include A. albopictus, A. polynesiensis and A. scutellaris. Humans are the primary host of the virus, but it also circulates in nonhuman primates. An infection can be acquired via a single bite. A female mosquito that takes a blood meal from a person infected with dengue fever, during the initial 2–10 day febrile period, becomes itself infected with the virus in the cells lining its gut. About 8–10 days later, the virus spreads to other tissues including the mosquitos salivary glands and is subsequently released into its saliva. The virus seems to have no detrimental effect on the mosquito, which remains infected for life. Aedes aegypti prefers to lay its eggs in artificial water containers, to live in close proximity to humans, and to feed on people rather than other vertebrates. Dengue can also be transmitted via infected blood products and through organ donation. In countries such as Singapore, where dengue is endemic, the risk is estimated to be between 1. 6 and 6 per 10,000 transfusions. Vertical transmission (from mother to child) during pregnancy or at birth has been reported. Other person-to-person modes of transmission have also been reported, but are very unusual. The genetic variation in dengue viruses is region specific, suggestive that establishment into new territories is relatively infrequent, despite dengue emerging in new regions in recent decades. Predisposition Severe disease is more common in babies and young children, and in contrast to many other infections it is more common in children that are relatively well nourished. Other risk factors for severe disease include female sex, high body mass index, and viral load. While each serotype can cause the full spectrum of disease, virus strain is a risk factor. Infection with one serotype is thought to produce lifelong immunity to that type, but only short term protection against the other three. The risk of severe disease from secondary infection increases if someone previously exposed to serotype DENV-1 contracts serotype DENV-2 or DENV-3, or if someone previously exposed to DENV-3 acquires DENV-2. Dengue can be life-threatening in people with chronic diseases such as diabetes and asthma. There are no specific antiviral drugs for dengue, however maintaining proper fluid balance is important. Treatment depends on the symptoms, varying from oral rehydration therapy at home with close follow-up, to hospital admission with administration of intravenous fluids and/or blood transfusion. A decision for hospital admission is typically based on the presence of the warning signs listed in the table above, especially in those with preexisting health conditions. Intravenous hydration is usually only needed for one or two days. The rate of fluid administration is titrated to a urinary output of 0. 5–1 mL/kg/h, stable vital signs and normalization of hematocrit. Invasive medical procedures such as nasogastric intubation, intramuscular injections and arterial punctures are avoided, in view of the bleeding risk. Paracetamol (acetaminophen) is used for fever and discomfort while NSAIDs such as ibuprofen and aspirin are avoided as they might aggravate the risk of bleeding. Blood transfusion is initiated early in patients presenting with unstable vital signs in the face of a decreasing hematocrit, rather than waiting for the hemoglobin concentration to decrease to some predetermined transfusion trigger level. Packed red blood cells or whole blood are recommended, while platelets and fresh frozen plasma are usually not. During the recovery phase intravenous fluids are discontinued to prevent a state of fluid overload. If fluid overload occurs and vital signs are stable, stopping further fluid may be all that is needed. If a person is outside of the critical phase, a loop diuretic such as furosemide may be used to eliminate excess fluid from the circulation. Introduction Euphorbia hirta, more commonly known as tawa-tawa, gatas-gatas, or botobotonis in the Philippines, is a small, erect or ascending, slender-stemmed, annual herb, spreading up to 45 cm tall, though sometimes can be seen lying down. The plant has a hairy stem with many branches from the base to the top. The stem and leaves of E. hirta produce a white or milky juice when cut. This plant commonly grows in tropical countries, especially in roadsides and on wasteland. It is widely abundant in the Philippines. E. hirta is also known as E. pulifera, E. capitata, Chamaesyce hirta, snakeweed, pill-bearing spurge, hairy spurge, asthma weed, and asthma plant. Whole plant or leaf extracts of Euphorbia hirta is known to have a multitude of actions in the biological system. In Asia and Australia, the herb is widely used in traditional medicine to treat a variety of medical conditions including asthma, coughs, diarrhea, and dysentery. In east, central, and west Africa, a decoction of the herb is used to treat asthma, oral thrush, boils, sores, and skin and wound infections, in addition to its use as an antispasmodic, antipruritic, carminative, depurative, diuretic, febrifuge, galactagogue, purgative and vermifuge. In Mauritius, a decoction of the plant is used to treat respiratory tract infections, vomiting, fever, bronchitis, and pulmonary disorders. In Nigeria, exudates of the stem is used to treat eye and ear infections, while a decoction of the plant is used to treat enteric infections including diarrhea and dysentery, constipation and other stomach problems, asthma, bronchitis, eczema, athletes foot and scorpion bite pains. It is usually taken in dosages of 0. 1 to 0. 3 g of dried powdered herb 3 times daily or 0. 12 to 2 mL of liquid extract 3 times daily, and repeated over 2 to 3 weeks. E. hirta is registered in Mali as a remedy against diarrhea and dysentery. The powder of aerial parts is used for the production of medicinal preparation marketed under the name Dysenteral ®. This product is included in the National List of Essential Drugs in Mali. In animal studies, E. hirta had been reported to exhibit antibacterial, antiamoebic, antifungal, antiviral, spasmolytic, antidiarrheal, sedative, anxiolytic, analgesic, antipyretic, anti-inflammatory, antimalarial, and antihypertensive properties. E. hirta was reported to contain coumarins, flavonoids, tannins, sugars, mucilage, reduced compounds, sterols and triterpenes including phytosterols, cardiac glycosides, diterpenes (phorbol esters), aromatic acids (shikimic and related acids), alkaloids, and anthocyanins. A number of compounds have been isolated from E. hirta and were chemically characterized. These include cycloarternol, 24-methylene-cycloarternol, ? -sitosterol, euphorbol, hexacozonate, ? -amyrin, ? -amyrin, 1-hexacosanol, ingeno-triacetate, tinyaloxin, p-coumaric acid, campesterol, stigmasterol, and quercitin. However, despite the array of chemical compounds characterized from E. hirta, and the diverse local medicinal uses of the plant, very little clinical pharmacological evaluations have been carried out to ascertain the rationale behind most of the folkloric claims of its efficacy. More recently, concerns from local authorities have been raised in the reported rampant indiscriminate use of E. hirta in the management of dengue patients. Despite, warnings from health authorities that there is not enough efficacy and safety data to support its clinical use, patients and health professional continued to use E. hirta. The confidence of the general public in the effectiveness of E. hirta in treating dengue cases was solely based on the results of animal studies showing that it exerts a platelet count-increasing activity, and testimonials from patients or health professionals who claimed to experience clinical benefits from its use. To safeguard the public, more detailed information should be provided to let both the patients and the health professionals fully understand the potential dangers of using E. hirta in dengue patients or in any other medical conditions. II. Significance of the Study At least 42,207 dengue cases, 193 of them fatal, had been recorded from January to the first week of June this year, even as the Department of Health pushed for the basics of early prevention and community action. The DOHs National Epidemiology Center said the total figure represents a one-percent decline, or 456 fewer cases, compared to the same period in 2012. A breakdown of data showed that most of the dengue cases from Jan. 1 to June 8 were recorded in: Central Visayas (6,023 cases, 51-percent increase) Calabarzon (4,742, 17-percent decrease) Davao Region (4,364, 30-percent increase) Western Visayas (4,444, 102-percent increase) SOCCKSARGEN (3,963, 126-percent increase). Euphorbia hirta has been claimed to have a curative effects on dengue patients, based on personal testimonies, particularly in the Philippines. Despite its widespread use, there is no evidence to support this claim. The Philippine Council for Health Research and Development (PCHRD), the health research arm of the Department of Science and Technology (DOST) spearheads studies to assess the curative component of Euphorbia hirta for dengue. This study would provide information to dengue patients and their families about the advantages of the tawa-tawa plant. The information that will be gathered would help them on how to administer the proper dosage of the tawa-tawa plant extract to dengue patients. This study would also provide data on how the taw-tawa plant help in increasing the platelet count on the patient’s blood. Statement of the Problem This study aims to answer one important question; does the tawa tawa plant help in curing dengue? This research’s main goal is to verify indeed if the tawa tawa plant helps in increasing the platelet count of dengue patients. This will not include scientific experiments to verify the findings. We the researchers will conduct interview to dengue patients who are drinking the plant decoction and will solely base their conclusion on their statements and personal experience. Review of Related Literature Clinical studies An exhaustive search for literature was conducted, but no published local or international reports of clinical trials conducted on E. hirta use in the treatment of dengue fever or dengue hemorrhagic fever were found. An observational clinical study was conducted in Davao Medical Center in 2003 to test the efficacy of E. hirta decoction on male and female pediatric patients (aged 2 to 10 years) with acute dengue fever (n=137). The patients were assigned to open-labeled treatment with either E. hirta decoction plus standard therapy or with standard therapy alone. No details can be provided on the number of patients assigned to each treatment group. The dosing regimen of E. hirta decoction was not standardized. Both the preparation and the administration of the E. hirta decoction were done by the guardians of the patients. The amount administered to each patient was uncontrolled (also under the discretion of the guardian). The patients were treated for 3 to 5 days, depending on the length of hospital stay. Results of this study showed that patients who received the E. hirta decoction in addition to standard therapy experienced significantly greater increases in platelet counts compared to the patients who received standard therapy alone. No treatment-emergent adverse events were reported in both treatment groups. Animal studies In a study conducted in the University of Santo Tomas, E. hirta was found to exert significant platelet-increasing activity. The effect of E. hirta, prepared either as a decoction or an ethanolic extract, on platelet, RBC, and WBC counts was investigated using Sprague-Dawley rats (6 to 8 weeks old) as test animals. The test animals were divided into two major groups: decoction and ethanolic extract groups. Each group was further subdivided into two subgroups (consisted of 2 male and 4 female Sprague-Dawley rats) which were assigned to receive either 60. 4 mg/kg or 483. 0 mg/kg of the decoction or the ethanolic extract. The two doses used in this study were the lowest and highest doses tested for hematologic toxicity in a study conducted in Nigeria. Results of the study showed that both the decoction and the ethanolic extract of E. hirta, at doses of 60. 4 mg/kg and 483. 0 mg/kg have a significant effect on the platelet counts of Sprague-Dawley rats. The RBC and WBC counts were not significantly affected, demonstrating that E. hirta does not affect the circulating RBC or the erythropoietic centers of the experimental animals, and it does not induce production or destruction of the WBC. The mean increases in platelet count in the decoction and ethanolic extract groups did not significantly differ, suggesting that both preparations can be used for further studies. The difference in the mean platelet counts of subgroups who received the 60. 4 mg/kg and 483. 0 mg/kg doses was not significant as shown in Dunnet’s test. This finding indicated that the platelet-increasing activity of E. hirta was not dose-dependent. The platelet-increasing activity of E. hirta was further evaluated by determining the effect of the plant material on stimulating platelet production in the bone marrow. In this evaluation, the dose and preparation (483. 0 mg/kg of the ethanolic extract) that produced the greatest numerical increase in platelet count during the initial evaluation was used. Anagrelide, a drug which inhibits the maturation of megakaryocytes into platelets, was administered to decrease the platelet counts of the test animals. After exposure to anagrelide, 483. 0 mg/kg of ethanolic extract was administered to 50% of the test population. Results of this further evaluation showed that the mean platelet count did not differ significantly in the group which received both anagrelide (125  µg/day) and ethanolic extract of E. hirta (483. 0 mg/kg) and in the group who were only exposed to anagrelide (control). This suggested that the platelet-increasing activity of E. hirta was not due to stimulation of the platelet production in the bone marrow. ?In another study conducted by the students of St. Mary’s School in Davao, E. hirta was also found to increase the platelet counts of white mice (Mus musculus). E. hirta was prepared in a teabag form. The results of this study were not published, and therefore, no further information was obtained. In Nigeria, the effects of aqueous and methanolic extracts of E. hirta on platelet count, bleeding time, and clotting time were also investigated. The extracts of E. hirta were administered orally to albino Wistar rats. Platelet count, bleeding time, and clotting time were determined before, and at different time intervals after administration of the extracts. At 60 minutes, the aqueous extract reduced bleeding time by 54% compared to 49. 5% for methanolic extract, and the difference was significant (p