Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the country faced a new outbreak-between 14 February and 19 June 2021-near the epicentre of the previous epidemic 1,2 . Here we use next-generation sequencing to generate complete or near-complete genomes of Zaire ebolavirus from samples obtained from 12 different patients. These genomes form a well-supported phylogenetic cluster with genomes from the previous outbreak, which indicates that the new outbreak was not the result of a new spillover event from an animal reservoir. The 2021 lineage shows considerably lower divergence than would be expected during sustained human-to-human transmission, which suggests a persistent infection with reduced replication or a period of latency. The resurgence of Zaire ebolavirus from humans five years after the end of the previous outbreak of Ebola virus disease reinforces the need for long-term medical and social care for patients who survive the disease, to reduce the risk of re-emergence and to prevent further stigmatization.At least 30 outbreaks of Ebola virus disease (EVD) have been identified since the late 1970s, the most severe of which affected Guinea, Sierra Leone and Liberia from December 2013 to June 2016 1,2 . Guinea experienced a new outbreak of EVD in 2021, which started in Gouéké-a town about 200 km away from the epicentre of the 2013-2016 outbreak. The probable index case was a 51-year-old nurse, an assistant of the hospital midwife in Gouéké. On 21 January 2021, she was admitted to hospital in Gouéké suffering from headache, asthenia, nausea, anorexia, vertigo and abdominal pain. She was diagnosed with malaria and salmonellosis and was released two days later. Feeling ill again once at home, she attended a private clinic in Nzérékoré (40 km away) and visited a traditional healer, but died three days later. In the week after her death, her husband-as well as other family members who attended her funeral-fell ill, and four of them died. They were reported as the first suspect cases by the national epidemic alert system on 11 February. On 12 February, blood was taken from two suspect cases admitted to

Repair of hernia is a very common procedure performed by a general surgeon. Laparoscopic approach has demonstrated advantages over direct approach: less complications, faster recovery and less postoperative pain. In Spiegel hernias, if the ring is less than 2 cm, a simple laparoscopic suture can be performed; however, laparoscopic transabdominal preperitoneal (TAPP) hernioplasty has lower risk of recurrence. We report the case of a woman with and strangulated Spiegel hernia which was attempted by TAPP hernioplastly. 63 year old woman consulted in emergency for a swelling of the left flank an occlusive syndrome. Physical examination found a distended abdomen with presence of a painful mass in the left flank, irreducible. Radiological findings were inconclusive, so an ultrasound was performed which showed an abdominal wall defect of 15×15 mm with an ischemic small bowel loop herniation: strangulated Spiegel hernia. A exploratory laparoscopy was attempted emergently. It found a 2 cm hole at the abdominal wall with 15 cm of ischemic small bowel. Ischemia was confirmed with indocyanine green (ICG). Afterwards, TAPP herniopplasty was performed: peritoneal incision to create a peritoneal flap. The peritoneal sac was reduced and then, we closed the defect. After this, we placed a prosthesis covering the area of weakness in the pre-peritoneal space and fixed with biological glue. At least, we covered the mesh with the peritoneal closure. Finally, we performed a resection of ischemic bowel and isoperistaltic mechanical laterolateral extracorporeally anastomosis. She had an unremarkable post-operative course, and she was discharge on the 4th postoperative day.

No abstract