Gradual on top-of-acute correction of neglected adolescent tibia vara by percutaneous tibial osteotomy and two-ring Ilizarov frame.

OBJECTIVES: This study aims to assess the effect of gradual correction after acute translation of the tibia in tibia vara using a two-ring Ilizarov frame on the correction of mechanical axis deviation (MAD), union time, and the rate of complications. PATIENTS AND METHODS: Between September 2018 and January 2021, a total of 30 patients (25 males, 5 females; mean age: 20±5 years; range, 15 to 25 years) with adolescent tibia vara were included. The patients had a transverse fibular ostectomy and percutaneous tibial osteotomy below the level of the tibial tuberosity. Acute correction of the rotation deformity combined with acute translation was done. A two-ring Ilizarov frame with a medial distractor and two lateral hinges were used to fix the osteotomy and the coronal plane deformity was gradually corrected. RESULTS: The mean follow-up was 24±4 months. All patients had improvement in the mechanical medial proximal tibial angle (mMPTA) and MAD postoperatively. There was an improvement in the Hospital for Special Surgery knee score at one year postoperatively. No neurovascular complications or union complications were observed. CONCLUSION: Acute translation followed by gradual angulation of the proximal tibia in cases with adolescent tibia vara yields better correction of the mechanical axis with good functional and radiological outcomes.

COVID-19 hot-spot strategy: a special innovation in pandemic response, Oyo State Nigeria.

BACKGROUND: COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into a pandemic. Oyo state, Nigeria with a population of 9,233,010, recorded the first case of COVID-19 on the 12th of March 2020 and it is among the highest contributing States to the nation's burden of the disease with 3267 confirmed cases, including 40 deaths as of date, with an overall test positivity rate of 18.1%, far higher compared to the National average within a limited period from recorded index case. A 'Hotspot strategy' was designed by the Presidential Task Force on COVID-19 and Oyo State was selected to implement the strategy through upscaling case detection, isolation and treatment, quarantine of contacts and strengthening public health and social measures. METHODS: We used a descriptive cross-sectional survey of 3 identified hotspot Local Government Areas (LGAs) in Oyo State using mobile phones under Surveillance, Outbreak Response Management and Analysis System (SORMAS) platform to collect data from October to December 2020. Interventions comprised of enhanced active case search, contact line listing, contact investigation, and contact follow-up as well as to facilitate data collection and entry, community sensitization and management of alert/rumors. Baseline information and that after the 3-month period was then analyzed with the descriptive statistics presented. RESULTS: The implementation of the hotspot strategy was shown to have had a major impact in Irepo LGA, where more than a 100% increase in samples tested, confirmed cases, contacts listed and contacts followed were recorded, while there were no significance changes noticed in Ibadan North and Lagelu LGAs. However, test positivity rates among contacts were found to be quite high in Ibadan North LGA (48%), compared to the other two, even though Lagelu LGA (5.7%) tested more contacts than Ibadan North. CONCLUSION: The observed increase in number of samples tested, cases confirmed, contact listed and investigated as well as test positivity rate in the 3 LGAs after the intervention implies that the hotspot strategy can be said to have contributed positively to the sensitivity of COVID-19 surveillance in Oyo State, Nigeria. This implies that strengthening this 'hotspot strategy' may be a key area of focus to improve COVID-19 surveillance sensitivity and response and in turn may help in breaking the transmission and bringing the pandemic to a halt.