One of the indicators on health development in a country is maternal and neonatal mortality rate. Efforts in decreasing mortality rate is by ensuring that every mother had access to high quality health care. Several programs issued by central and local government, also midwives, played an important role in providing comprehensive, thorough, and continuous care by simple follow-up and counseling, such as pregnancy, delivery, postpartum, neonates, and family planning care. We reported a comprehensive representation of midwifery care based on midwifery standards in pregnancy, delivery, postpartum, neonates, and family planning in Mrs. M. at Midwife J, Bandung.

Background: Wristwatches are worn to know the time. lt is commonly used by the young, adult and aged individuals who are male or female respectively. As good as wristwatch is, it can harbour bacterial pathogen that predispose wearers to infection. Notable ornaments worn are bangles, finger rings, chain e.t.c. ln the light of this, the study aim to examine the various types of wristwatches that are harbinger to contamination and infection among the students and staff of the Federal university of Technology Akure. Nigeria. Method and Materials: A cross-sectional study was conducted .120 samples of students and staff of the university, aged 15 to 50 years.68(56.7%) were male and 52(43.3%) were female. The type of wristwatches worn were analysed. 50 were chain watch, 40 were leather watch, 24 were rubber watch and 6 were gold watch. The samples were collected by sterile swabs as duplicates from each of the different watches and transferred immediately to the Microbiology laboratory for processing, isolation and identification, using standard microbiological techniques. Result: Five (5) different bacteria were isolated. Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Streptococcus species and Pseudomonasaeruginosa. Staphylococcus epidermidis (15%) and Streptocococcus species (11%) were the most frequent bacteria isolated from the wristwatches. The chain wristwatch attracted more contamination than others followed by rubber wristwatch then leather while gold wristwatch is the least contaminated. Conclusion: Evidence has shown from this study that wristwatches are potential source of contamination based on bacteria isolated from them. To stem the tide of infection the need to intensify and practice hand hygiene and remove wristwatch early when student/ staff report for duty and put it on at close of work expecially those that work in critical places like laboratories. Science/ engineering workshops. Adhering to this will reduce drastically the level of contamination and infection.

We read with interest the article by Mudabbir et al. about a 41 years old male who was diagnosed with “acute cerebellar ataxia (ACA)” starting two weeks after complete resolution of a COVID-19 infection [1]. The patient profited from steroids and recovered completely within 10 days after starting the therapy [1]. The study is appealing but raises concerns that need to be discussed. We do not agree with the notion that the patient had SARS-CoV-2 associated cerebellitis [1]. The patient had pre-existing cerebellar atrophy on imaging [1]. Therefore, it is more likely that previously asymptomatic cerebellar atrophy became symptomatic from the viral infection.

There is a discrepancy between the three-day history of “walking difficulty” and the normal gait on clinical neurologic exam [1]. This discrepancy should be solved. 

We do not agree with the statement that the most common manifestations of neuro-COVID are stroke, cerebral hypoxia, epilepsy, and critical ill neuropathy/myopathy [1]. The most common manifestations of neuro-COVID are headache, ageusia, anosmia, and Guillain-Barre syndrome (GBS) [2]. Hypoxic encephalopathy is extremely rare as patients with respiratory insufficiency are usually well monitored for their oxygen saturation and immediately supplied with oxygen or even mechanically ventilated in case of desaturations.

Missing is an explanation of the cause of cerebellar atrophy. It is not conceivable that it developed during the SARS-CoV-2 infection but was rather pre-existing. We therefore should be told if the family history was positive for ataxia or a genetic disorder manifesting with ataxia.

Missing is the determination of the cytokine and chemokine profile in the CSF. Particularly, interleukine 6 (IL-6), IL-8, IL-1b, and TNF-alpha have been shown upregulated in the CSF of patients with neuro-COVID [3]. 

Missing is the MR venography to rule out venous sinus thrombosis.

Overall, the interesting study has some limitations and inconsistencies that call the results and their interpretation into question. Clarifying these weaknesses would strengthen the conclusions and could improve the status of the study. Affection of the cerebellum in COVID-19 is rather immune-mediated than infectious.

We read with interest the article by Murawska-Baptista et al. about a 71 years old male who developed respiratory distress due to severe COVID-19 requiring a high-flow nasal canula (HFNC) [1]. His past medical history was positive for arterial hypertension, hyperlipidemia, atrial fibrillation, ablation therapy, obstructive sleep apnea, and Guillain-Barre Syndrome (GBS) following an influenza vaccination, from which he recovered completely [1]. The patient recovered from COVID-19 under remdesivir and steroids [1]. The study is appealing but raises concerns that require discussion. Whether patients with a previous history of GBS are prone to experience a relapse of GBS during a SARS-CoV-2 infection is unknown but there are indications that patients with a previous history of demyelinating neuropathy have an increased risk to experience neuro-immunologic complications. The risk of experiencing a SARS-CoV-2 infection associated GBS may be particularly increased among those with clinical recovery but electrophysioloic evidence of persisting neuropathy. 

The patient presented with progressing respiratory failure despite treatment with remdesivir and steroids but it is unclear if worsening of respiratory insufficiency was due to COVID-19 pneumonia or due to exacerbation of GBS predominantly affecting the respiratory muscles. We should be told if the patient was seen by a neurologist and if there were any indications for relapse of the GBS. GBS is a well-known neurological complication of SARS-CoV-2 infection and has been reported in >400 patients as per the end of June 2021 [2, Finsterer, submitted]. 

We disagree with the statement that GBS following a SARS-CoV-2 vaccination is a rare complication of SARS-CoV-2 vaccinations [1]. Looking at table 1 of the index study it clearly indicated that >500 patients with post-SARS-CoV-2 vaccination GBS have been reported as per the end of December 2021 [1]. Assuming that most cases of SARS-CoV-2 vaccination associated GBS are never published or reported to a database, it is conceivable that the real-world prevalence of SARS-CoV-2 vaccination associated GBS is much higher than anticipated. 

We do not agree with the classification of the vaccine in the patient with SARS-CoV-2 vaccination associated GBS reported by Finsterer as “unknown” [3]. The patient developed GBS eight days after the first dose of a vector-based vaccine (Astra-Zeneca vaccine (AZV)) [1]. 

Overall, the interesting study has some limitations which challenge the results and their interpretation. Addressing these limitations may upvalue the conclusions. Patients with a previous history of GBS should not undergo vaccination for SARS-CoV-2 if there was only clinical but not electrophysiological recovery.

We eagerly read the article by Poisson et al. about a SARS-CoV-2 positive 8yo female, who was diagnosed with cerebral vasculitis upon two brain biopsies [1]. Since IgM antibodies against SARS-CoV-2 were positive in the cerebro-spinal fluid (CSF), vasculitis was attributed to COVID-19 [1]. The study is appealing but raises concerns which require discussion. The condition presented in the case report could be also interpreted as acute, haemorrhagic, necrotising encephalitis (AHNE). This condition has been recently described in an adult patient with tuberculosis and COVID-19 [2]. Thus, it is crucial that cerebral tuberculosis had been excluded by culture, immune-histology, and PCR in the CSF and the brain tissue at autopsy. Cerebral tuberculosis is accompanied by cerebral vasculitis in a quarter of the cases [3]. Unfortunately, only serum antibodies against mycobacterium tuberculosis had been determined in the index patient. Missing are the results of conventional digital subtraction angiography (DSA), computed tomography angiography (CTA), or magnetic resonance angiography (MRA) to confirm the histological diagnosis. Vascular imaging may not only help to confirm the histological diagnosis but also to delineate between vasculitis of large, medium-sized, or small arteries. 

We do not agree with the notion that neuro-COVID only includes stroke, venous sinus thrombosis (VST), seizures, meningitis, encephalitis, ADEM, acute fulminant cerebral edema, posterior reversible encephalopathy syndrome (PRES), headache, myelitis, Guillain-Barre syndrome (GBS), cranial neuropathies, and myositis. The spectrum of neuro-COVID is much broader and additionally includes reversible cerebral vasoconstriction syndrome (RCVS), acute, haemorrhagic, necrotising encephalitis (AHNE), hypophysitis, cerebellitis, myoclonus syndrome, immune encephalitis, multiple sclerosis, neuromyelitis optica spectrum disorder, ventriculitis, pontine myelinolysis, subarachnoid bleeding, Wernicke encephalopathy, insomnia, psychosis, myasthenia, and myasthenic syndrome.

Overall, the elegant study has limitations which challenge the results and their interpretation. Cerebral tuberculosis should be excluded by appropriate means. 

We read with interest the review by Gabis et al. about the association between SARS-CoV-2 vaccines and autism-spectrum disorders(ASD) in children.[1] It was concluded that SARS-CoV-2 vaccines are safe in children, that SARS-CoV-2 vaccines do not cause ASD, and that the myth that SARS-CoV-2 vaccines cause ASD still persists and affects parental attitudes towards vaccination and increases vaccination refusal rates.[1] The study is appealing but raises concerns.

We do not agree that fear from autism is the reason for parents’ hesitancy to immunise their children. According to a search in PubMed not a single pediatric patient with autism triggered by a SARS-CoV-2 vaccination has been reported. More likely than fear from autism, is fear from severe adverse events (SAE) that is responsible for the parent’s hesitancy. SAE of SARS-CoV-2 vaccinations that have been described in children include MIS-C,[2], myocarditis,[3] peri-myocarditis,[4], Guillain-Barre syndrome (GBS), [Finsterer, submitted] thrombocytopenia,[5] facial palsy,[6], vulvar aphthous ulcer,[7], and hypersensitivity reactions.[8],

Parents’ fear from vaccinating their children may be supported by the complications of SARS-CoV-2 infections in children, which include stroke, intracerebral bleeding, subarachnoid bleeding, micro-hemorrhages, venous sinus thrombosis, immune encephalitis, reversible splenial lesions, ADEM, MIS-C, transverse myelitis, GBS, cranial nerve lesions, meningo-encephalitis, encephalopathy, benign intracranial hypertension, and myositis.[9]

A further reason for concerns of parents about SARS-CoV-2 vaccinations in their children is the limited knowledge about the safety profile of SARS-CoV-2 vaccinations in children, which results from the fact that only few children were vaccinated so far compared to adults.

Following the preliminary results available about side effects of SARS-CoV-2 vaccines in children, it is comprehensible why parents have reservations against immunising their children. In addition to medical reasons hesitancy may originate from disinformation through social media. Health care authorities, scientists, and media are obliged to provide valid and reliable data about the pros/cons of SARS-CoV-2 vaccinations in children.   

Health care workers (HCW) with burnout result in poor efficiency and jeopardize optimal patient care. Jawahar Lal Nehru Medical College Hospital (JNMCH) is a busy 1300 bedded tertiary care center. Till date no study has been done to find out the incidence of burnout amongst its HCW. We undertook an observational, cross-sectional study at JNMCH, wherein the burnout data was collected from consenting doctors and staff nurses. Methodology: A 22-item questionnaire based on Maslach Burnout Inventory for HCW was randomly distributed to 60 doctors and nurses to assess the three domains of burnout: Emotional Exhaustion (EE), Depersonalization (DP), Sense of Low Personal achievement (LPA). For this project, Likert scale was used to assess the burnout response of doctors and nurses: 0: Never, 1: A few times a year or less, 2: Once a month or less, 3: A few times a month, 4: Once a week, 5: A few times a week, 6: Every day. With 8 dropouts, data could be collected from 52 HCW (30 doctors and 22 nurses) and analyzed using independent sample t-test. Results: Two important findings of this survey were: 1. Burnout issues were more common amongst doctors as compared to nurses. EE was of high category amongst doctors (30%) as compared to only 4.5 % amongst nurses. Similarly, the incidence of DP of moderate intensity was 23% amongst doctors as compared to none in nursing staff. LPA was of low intensity in both the groups. 2. Female doctors face a significantly higher incidence of EE & DP. as compared to male doctors. Conclusion: Burnout issue at JNMCH is 100 % of varying severity and is more prevalent amongst doctors as compared to staff nurses.