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Cholera continues to represent a major public health concern in Ethiopia. The country has developed a Multi-sectoral National Cholera Elimination Plan in 2022, which targets prevention and control interventions in cholera hotspots. Multiple methods to classify cholera hotspots have been used in several countries. Since 2014, a classification method developed by United Nations Children's Fund has been applied to guide water, sanitation and hygiene interventions throughout Sub-Saharan Africa based on three outbreak parameters: frequency, duration and standardized attack rate. In 2019, the Global Task Force on Cholera Control (GTFCC) proposed a method based on two parameters: average annual cholera incidence and persistence. In 2023, an updated GTFCC method for multisectoral interventions considers three epidemiological indicators (cumulative incidence, cumulative mortality and persistence,) and a cholera-case confirmation indicator. The current study aimed to classify cholera hotspots in Ethiopia at the woreda level (equivalent to district level) applying the three methods and comparing the results to optimize the hotspot targeting strategy. From 2015 to 2021, cholera hotspots were located along major routes between Addis Ababa and woredas adjacent to the Kenya and Somalia borders, throughout Tigray Region, around Lake Tana, and in Afar Region. The multi-method comparison enables decision makers to prioritize interventions according to a sub-classification of the highest-priority areas., (© 2024. The Author(s).)

Since the onset of the seventh cholera pandemic, Ethiopia has been affected by recurrent epidemics. However, the epidemiology of cholera in this country remains poorly understood. This study aimed to describe cholera outbreak characteristics in Ethiopia from 2015 to 2021. During this period, Ethiopia experienced four epidemic waves. The first wave involved nationwide outbreaks during the second half of 2016 followed by outbreaks predominantly affecting Somali Region in 2017. The second wave primarily affected Tigray and Afar Regions. During the third wave, multiple smaller-scale outbreaks occurred during 2019. The fourth wave was limited to Bale Zone (Oromia Region) in 2021. Overall, a north to south shift was observed over the course of the study period. Major cholera transmission factors included limited access to safe water and sanitation facilities. Severe weather events (drought and flooding) appear to aggravate cholera diffusion. Cholera transmission between Ethiopia and nearby countries (Kenya and Somalia), likely plays a major role in regional cholera dynamics. Overall, this study provides the first understanding of recent spatiotemporal cholera dynamics in Ethiopia to inform cholera control and elimination strategies., (© 2024. The Author(s).)

Background: Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions., Methods: We combined information on cholera incidence in sub-Saharan Africa (excluding Djibouti and Eritrea) from 2010 to 2016 from datasets from WHO, Médecins Sans Frontières, ProMED, ReliefWeb, ministries of health, and the scientific literature. We divided the study region into 20 km × 20 km grid cells and modelled annual cholera incidence in each grid cell assuming a Poisson process adjusted for covariates and spatially correlated random effects. We combined these findings with data on population distribution to estimate the number of people living in areas of high cholera incidence (>1 case per 1000 people per year). We further estimated the reduction in cholera incidence that could be achieved by targeting cholera prevention and control interventions at areas of high cholera incidence., Findings: We included 279 datasets covering 2283 locations in our analyses. In sub-Saharan Africa (excluding Djibouti and Eritrea), a mean of 141 918 cholera cases (95% credible interval [CrI] 141 538-146 505) were reported per year. 4·0% (95% CrI 1·7-16·8) of districts, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), have high cholera incidence. By focusing on the highest incidence districts first, effective targeted interventions could eliminate 50% of the region's cholera by covering 35·3 million people (95% CrI 26·3 million to 62·0 million), which is less than 4% of the total population., Interpretation: Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes., Funding: The Bill & Melinda Gates Foundation., (Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The countries of West Africa are largely portrayed as cholera endemic, although the dynamics of outbreaks in this region of Africa remain largely unclear., Methodology/principal Findings: To understand the dynamics of cholera in a major portion of West Africa, we analyzed cholera epidemics from 2009 to 2015 from Benin to Mauritania. We conducted a series of field visits as well as multilocus variable tandem repeat analysis and whole-genome sequencing analysis of V. cholerae isolates throughout the study region. During this period, Ghana accounted for 52% of the reported cases in the entire study region (coastal countries from Benin to Mauritania). From 2009 to 2015, we found that one major wave of cholera outbreaks spread from Accra in 2011 northwestward to Sierra Leone and Guinea in 2012. Molecular epidemiology analysis confirmed that the 2011 Ghanaian isolates were related to those that seeded the 2012 epidemics in Guinea and Sierra Leone. Interestingly, we found that many countries deemed "cholera endemic" actually suffered very few outbreaks, with multi-year lulls., Conclusions/significance: This study provides the first cohesive vision of the dynamics of cholera epidemics in a major portion of West Africa. This epidemiological overview shows that from 2009 to 2015, at least 54% of reported cases concerned populations living in the three urban areas of Accra, Freetown, and Conakry. These findings may serve as a guide to better target cholera prevention and control efforts in the identified cholera hotspots in West Africa.

The authors report the case of an extradural spinal cyst in a patient whose only complaint was lumbar pain and review the literature. Among the 186 cases found, only 21 presented with isolated back pain. Indeed, neurologic signs such as paresthesias and radicular pain are most frequently encountered. Standard radiographic X-rays suggest the diagnosis by demonstrating widening of the interpedicular distance on the anteroposterior view, and bone erosion or scalloping of the posterior surface of the vertebral bodies on lateral view. Myelography most often confirms the diagnosis with opacification of the cyst. However, the least invasive and most accurate examination is undoubtedly magnetic resonance imaging, which demonstrates the cyst and its location even if the communicating orifice is obstructed. These cysts are very probably of congenital origin and are caused by a herniation of the arachnoid through an aplastic area of the dura mater. Treatment is always surgical with, if possible, ligature at the base and cyst removal. Following surgery, the pain disappears and the neurologic signs very often regress.

With regard to a case report and the review of literature the authors point out that this uncommon but severe infection due to an aero-anaerobia bacteria, existing preferentially in stagnant or running water. This seriousness leads to the use of appropriate antibiotics instead of those usually prescribed in compound fractures, and most of the time, to the use of irrigation-stucking drainage of the wounds.

The authors analyse the results of 10 amputations and 10 conservatives treatments for complex isolated trauma of the second ray. The localisation of this finger in the hand require an utilisation in "all or nothing" function. The comparison of the two series show that the amputated one's gives the best results as much for the function that for the cosmetic level. So, the non conservative treatment seems the better solution for the problems of complex trauma of the index finger.

As the incidence of the carpal tunnel syndrome among family members of patients is not precisely defined in the literature, we described here two new cases. Few authors reporting on patients with the carpal tunnel syndrome refer to the familial occurrence of the disorder. Median nerves were constricted under thickened carpal ligaments. In one case, we looked for amyloidosis in the transverse carpal ligament under electron microscope but we could not find any.

The indications for treatment of idiopathic necrosis of the hip depend on the stage of development of the lesion, its extent and the site of the necrotic area. Digital computerised tomography with horizontal sections at five millimetre intervals from the upper to the lower pole of the femoral head is of value in the determination of these three features. For this purpose, fifteen femoral heads removed in the course of total hip arthroplasty were subjected to histological sections in parallel to those of the CT scan. This study showed that digital computerised tomography indicates the extent and topography of the necrosis and provides true histo-radiological sections.

The authors report a case of arterio-venous fistula of the posterior tibial artery after a gunshot wound. They emphasise the value of digital arteriography in such cases. Repair of the artery two months after injury was followed by healing.

35 cases of infantile scoliosis were studied most of whom were followed for more than 10 years. In 11 instances, the scoliosis was present in the new born. The results are compared with those obtained by other authors. The authors consider that the signs found at the first examination as described by Mehta are not reliable enough and that the subsequent evolution of the curve is important. They have observed totally regressive and partially regressive cases. They are also found that right thoraco-lumbar curves in girls were common. Criteria for a more reliable prognosis are put forward.

The authors report a case of myositis ossificans localised in the abductor digiti minimi of the hand. This type of fast growing tumor can be confused with malignant tumors. The diagnosis between these different tumors is discussed. Surgical removal seems the best treatment.

A series of 80 cases of recent isolated fracture of tibia in adults demonstrated the specific problems raised by this type of fracture, related for the most part to the integrity of the fibular splint. A resulting therapeutic attitude is based on a biomechanical study, the place of osteotomy of the fibula being discussed: orthopaedic treatment is suggested for fractures without displacement, under strict radiologic surveillance, and surgical treatment for fractures with primary or secondary displacement. The indications for fibular osteotomy are reviewed.

The authors report eight cases of human ORF disease localized to the hand and transmitted to man by contact with the sheep. This disease is characterized by typical lesions on exposed cutaneous zones. Those lesions must be distinguished from milker's nodules, botryomycosis and above all felon because ORF disease never require surgery.