Background The aetiology of idiopathic nephrotic syndrome (INS) remains partially unknown. Viral infections have been associated with INS onset. Since we observed fewer first onset INS cases during the Covid-19 pandemic, we hypothesised that lower INS incidence was the result of lockdown measures. Therefore, the aim of this study was to evaluate the incidence of childhood INS before and during the COVID-19 pandemic in two independent European INS cohorts. Methods Children with new INS in the Netherlands (2018–2021) and Paris area (2018–2021) were included. We estimated incidences using census data for each region. Incidences were compared using two proportion Z-tests. Results A total of 128 and 324 cases of first onset INS were reported in the Netherlands and Paris area, respectively, corresponding to an annual incidence of 1.21 and 2.58 per 100,000 children/year. Boys and young children (< 7 years) were more frequently affected. Incidence before and during the pandemic did not differ. When schools were closed, incidence was lower in both regions: 0.53 vs. 1.31 (p = 0.017) in the Netherlands and 0.94 vs. 2.63 (p = 0.049) in the Paris area. During peaks of hospital admissions for Covid-19, no cases were reported in the Netherlands or Paris area. Conclusions Incidence of INS before and during the Covid-19 pandemic was not different, but when schools were closed during lockdown, incidence was significantly lower. Interestingly, incidences of other respiratory viral infections were also reduced as was air pollution. Together, these results argue for a link between INS onset and viral infections and/or environmental factors. Graphical abstract

Leadership strategies of principals in educational institutes is considered an important factor in order to increase support and rewards. Universities in Pakistan suffer from the problems of low support and rewards, due to which most of the teachers and management staff members remain dissatisfied with their principals. This study investigated whether transformational or transactional leadership is better for providing support and rewards to teachers and management staff, along with evaluation of principles&rsquo; leadership qualities. For that, 5-point Likert scale questionnaire was utilised to assess the performance of principals by investigating 75 management and 75 teachers of 3 universities of Pakistan. Critical review approach was used for comparison between Pakistan and Australia. It was found that transformational leadership is much better as compared to transactional leadership, because it improves interaction and support, as observed in Australia. However, teachers and management staff members in Pakistan reported dissatisfaction, when asked about leadership role of their principals. They said that their principals never motivate them, support them nor reward them in contrast to leadership approaches in Australia.

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected most countries, afflicting severe damage. Mitigation measures to control the pandemic rely heavily on existing health capacity and vulnerability of each country. The health capacity and vulnerability with respect to COVID-19 outbreak for 185 countries was assessed in this study to identify those where capacity-building needs to be prioritized. Material and methods: The State Parties Annual Reporting data based on WHO International Health Regulations monitoring and evaluation framework was used to extract an indicator for national health capacity. Another indicator for vulnerability was extracted from INFORM epidemic risk index. These metrics were selected after evaluating their complementarity and availability. Results: Among 185 countries, 111 (60%) had health capacities at level 4 and 5 with most of them having vulnerability at level 3 and 4. Twenty-two (11.89%) countries had level 2 health capacity in place coupled with moderate to high vulnerability. Among continents, Europe had best while Africa had worst mean functional capacity and vulnerability scores. Conclusions: The results showed that most countries had sufficient response and reaction capacities to handle the pandemic. However, resources, intensified surveillance, and capacity building should be prioritized in vulnerable countries with ill-equipped national health capacities.

The availability of accurate data is of vital importance in the COVID-19 pandemic which has presented itself as a formidable challenge. The objective of our paper was to identify the flaws in simple estimates of case-fatality rate (CFR), the epidemiological indicator currently in use, and compare it to another more effective indicator, the adjusted case-fatality rate (aCFR). aCFR is defined as the number of COVID-19-associated fatalities*100/ total cases that reached outcome, i.e. death or recovery, according to the methodology of Ghani and colleagues. The results showed varying CFRs and aCFRs for several countries, signifying the problem with using CFR. Belgium is a prime example of such a case as it had a CFR of 15.82% while an aCFR of 36.38% and the number of cases in Belgium is high enough to make the discrepancy in these results significant. The deaths caused by COVID-19 are being underrepresented by CFR. It can lead to misleading results, especially when comparing countries and regions on their mortalities. Keywords: COVID-19, COVID-19 pandemic, SARS-CoV-2, 2019-nCoV, Epidemiology, Epidemiologic measurements, Case-fatality rate.

Objectives: To assess the risk factors for intensive care unit admission and inpatient all-cause mortality among adult meningitis patients. Method: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data between July 2010 and June 2019 of patients of either gender aged 18 years diagnosed with bacterial, viral or tuberculous meningitis. Multivariable logistic regression analyses were used to explore independent predictors of inpatient mortality and intensive care unit admission. Data was analysed using SPSS 24. Results: Of the 929 patients with suspected meningitis, 506(54.5%) had confirmatory diagnosis. Of them, 303(59.9%) were males. The overall median age of the sample was 47.0 years (interquartile range: 33.0 years). The most common aetiology was bacterial meningitis 324(64%), followed by viral meningitis 141(27.9%). Incidence of inpatient mortality was 53(10.5%), while 75(14.8%) patients required intensive care unit admission. Tuberculous aetiology, intensive care unit admission, concurrent encephalitis, hydrocephalus, inpatient neurosurgery, and longer length of hospital stay were predictors of mortality (p<0.05). Non-indication of blood culture was found to be associated with reduced risk of mortality (p<0.05). For intensive care unit admission, diabetes mellitus, presentation with seizure, imaging suggestive of meningitis, and inpatient neurosurgery were associated with higher risk of admission, while hypertension, presentation with headache, viral aetiology and non-indication of blood culture reduced the risk (p<0.05). Conclusion: Adult meningitis patients tend to have poor expected outcomes, and their management strategies should be planned accordingly. Key Words: Meningitis, Mortality, Intensive care units, Critical care, Risk factors.