Efficacy, Safety and Tolerability of Valsartan and Hydrochlorothiazide Compared to Valsartan and Amlodipine in Stage 2 Hypertension

Background: Hypertension is a growing medical and public health issue. The United States and European treatment guidelines have been issued to attain smooth control of hypertension in various categories of patients. It is a need of time to unveil safe combination therapies in various populations. Objectives: (i) To determine the efficacy of valsartan and hydrochlorothiazide versus valsartan and amlodipine (ii) To determine the safety and tolerability of both combinations. Materials & Methods: This experimental study was conducted at Shalamar Hospital Lahore. 126 patients with stage 2 hypertension were recruited from the medical outdoor of Shalamar Hospital Lahore after getting informed consent. In group A, 63 patients were given valsartan and hydrochlorothiazide. In group B, 63 patients were given valsartan and amlodipine. Blood pressure (BP) of both study groups was recorded on day zero, 2nd, 4th, and 8th weeks and the readings were entered on a Proforma. The efficacy of drug combinations was accessed in both groups by recording the change in mean systolic blood pressure (MSBP) and mean diastolic blood pressure (MDBP). The safety and tolerability of the drug combinations were assessed in terms of side effects and laboratory findings. Results: In group A, there was a 39±7mmzHg and 18±1mmHg decrease in MSBP and MDBP, respectively, from baseline BP. In group B, there was a 26.7±4mmHg and 14±2 mmHg decrease in MSBP and MDBP, respectively, from baseline BP. Both combinations were safe, and no significant difference in the efficacy of both combinations was observed after 8-week of treatment. Conclusion: Both combinations are effective for control of BP, but the valsartan and hydrochlorothiazide combination (group A) appears to have better tolerability and greater effect in decreasing BP as compared to the combination of valsartan and amlodipine (group B), although this difference is not statistically significant.  

A Study of the Significant Factors Affecting the Academic Achievement of Government Secondary Schools, Karachi

Karachi is called a “mini Pakistan” due to its unique socio-political chemistry, diversity of cultures, imbalance and blend of huge population from the both rural and urban areas. During the past few decades, demographic variations have greatly changed the lifestyle of the people economic of Karachi in civic facilities including health and education. Education is one of the important elements of social sectors that influences the society at micro and macro level. Quality of education, particularly in government secondary schools has dropped during the last few decades in Karachi. Present study, titled as, “A Study of the Significant Factors Affecting the Academic Achievements of Government Secondary Schools, Karachi” is about mainly this issue. Hypotheses were developed on important question i.e. Are the existing physical, administrative and academic facilities of the government secondary schools in Karachi sufficient to give the expected results? Hence, the study is meant to identify those scholastic and socioeconomic factors that affect the academic achievement of the contextual schools of Karachi. The study is limited to the Govt. Secondary Schools, located within six administrative districts of Karachi and working under the Education and Literacy Department, Government of Sindh, Pakistan. Education Officers, Senior School Heads, teachers, students of 573 schools and related were the population for this study based. A sample of 144 out of 573 schools was taken. During the research, three sets of questionnaires were developed for the respondents (students, teachers and parents) after ensuring validity and reliability. Rating sheet was developed to rate each of the schools in the sample against each of the situational factors by the raters (Education Officers/Senior School Heads). Data of the three years’ result of Secondary Schools Examination (held under Board of Secondary Education Karachi) and School Census Data from Sindh Education Management and Information System was transformed into software module for usage. The research was carried out in two phases. First phase of identification of 18 situation pedagogical factors (variables) was completed by scanning of the views of respondents collected through 345 questionnaires (115 by each group of the respondents). Seven of these 18 factors were found to be relating with external (home and environment) while 11 were found relating with school itself. The second phase of rating of schools against each variable during which each rater rated each of the 18 variables on the scale from 1-11 (best-worst) and scores thus obtained. Similarly, the grading score of each school was also determined through the three years’ annual examination result (held under Board of Secondary Education Karachi). Finally, with the statistical analysis, the values of correlations between “the mean scores of rating” (against each of 18 variables) and “mean score of grading of result (academic achievement)” were calculated. Result thus found was used for making inferences. According to the findings, the 18 variables i.e. were found to be significantly correlating with the academic achievements thus affecting the performance of schools. Hence, scholastic factors e.g. the teachers terms of service, theirs and school head’s competencies, basic, academic facilities in school, maintenance of school building, its location and financial stability, strict admission, examination policies and resort to tuition while domestic factors e.g. parents’ education and their occupations, household income, students’ residence and parents contact are correlate with the academic achievements. The study stressed need to attend the weak areas highlighted above. The leading recommendations were: 1. Establishing Provincial Think Tank for Education replacing the bureaucratic approach, 2. Decentralization of Powers, 3. Education Group of Services in Provincial and National Civil Services of Pakistan, 4. Pilot Programs for Subsidizing and Privatization of Unsuccessful Schools, 5. Programs for Creating Educational Leadership, 6. Declaring Emergency in Education, 7. Effective Monitoring and Inspection System, 8. Whole Campus Development Program for Selected Schools in each District. 9. Skill Development Trainings for Students and Parents, 10. Parents Awareness and Empowerment of School Management Committees Program. The study also suggested to initiate change in the mindset towards education and educationists, through mass mobilization.