Dedicated orthopaedic elective unit: our experience from a district general hospital.

INTRODUCTION: The significance of ring-fencing orthopaedic beds and protected elective sites has recently been highlighted by the British Orthopaedic Association and the Royal College of Surgeons. During the pandemic, many such elective setups were established. This study aimed to compare the functioning and efficiency of an orthopaedic protected elective surgical unit (PESU) instituted during the pandemic with the pre-pandemic elective service at our hospital. METHODS: We retrospectively collected data of all patients who underwent elective orthopaedic procedures in PESU during the pandemic and a similar cohort of patients operated on via the routine elective service immediately prior to the pandemic. To minimise the effect of confounding factors, a secondary analysis was undertaken comparing total hip replacements by a single surgeon via PESU and pre-pandemic ward (PPW) over 5 months. RESULTS: A total of 192 cases were listed on PESU during the studied period whereas this number was 339 for PPW. However, more than half of those listed for a surgery on PPW were cancelled and only 162 cases were performed. PESU had a significantly better conversion rate with only 12.5% being cancelled. Forty-nine percent (87 out of 177) of the cases cancelled on PPW were due to a 'bed unavailability'. A further 17% (30/177) and 16% (28/177) were cancelled due to 'emergency case prioritisation' and 'patient deemed unfit', respectively. In contrast, only 3 out of the 24 patients cancelled on PESU were due to bed unavailability. Single-surgeon total hip replacement showed similar demographic features for the 25 patients on PESU and 37 patients on PPW. The patients on PESU also demonstrated a decrease in length of hospital stay with an average of 3 days.

Antiviral potential of garlic (Allium sativum) and its organosulfur compounds: A systematic update of pre-clinical and clinical data.

BACKGROUND: Garlic (Allium sativum L.) is a common herb consumed worldwide as functional food and traditional remedy for the prevention of infectious diseases since ancient time. Garlic and its active organosulfur compounds (OSCs) have been reported to alleviate a number of viral infections in pre-clinical and clinical investigations. However, so far no systematic review on its antiviral effects and the underlying molecular mechanisms exists. SCOPE AND APPROACH: The aim of this review is to systematically summarize pre-clinical and clinical investigations on antiviral effects of garlic and its OSCs as well as to further analyse recent findings on the mechanisms that underpin these antiviral actions. PubMed, Cochrane library, Google Scholar and Science Direct databases were searched and articles up to June 2020 were included in this review. KEY FINDINGS AND CONCLUSIONS: Pre-clinical data demonstrated that garlic and its OSCs have potential antiviral activity against different human, animal and plant pathogenic viruses through blocking viral entry into host cells, inhibiting viral RNA polymerase, reverse transcriptase, DNA synthesis and immediate-early gene 1(IEG1) transcription, as well as through downregulating the extracellular-signal-regulated kinase (ERK)/mitogen activated protein kinase (MAPK) signaling pathway. The alleviation of viral infection was also shown to link with immunomodulatory effects of garlic and its OSCs. Clinical studies further demonstrated a prophylactic effect of garlic in the prevention of widespread viral infections in humans through enhancing the immune response. This review highlights that garlic possesses significant antiviral activity and can be used prophylactically in the prevention of viral infections.

Spironolactone may provide protection from SARS-CoV-2: Targeting androgens, angiotensin converting enzyme 2 (ACE2), and renin-angiotensin-aldosterone system (RAAS).

In coronavirus disease-19 (COVID-19), four major factors have been correlated with worse prognosis: aging, hypertension, obesity, and exposure to androgen hormones. Angiotensin-converting enzyme-2 (ACE2) receptor, regulation of the renin-angiotensin-aldosterone system (RAAS), and transmembrane serine protease 2 (TMPRSS2) action are critical for the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) cell entry and infectivity. ACE2 expression and RAAS are abnormal in hypertension and obesity, while TMPRSS2 is overexpressed when exposed to androgens, which may justify why these factors are overrepresented in COVID-19. Among therapeutic targets for SARS-CoV-2, we hypothesized that spironolactone, a long used and safe mineralocorticoid and androgen receptors antagonist, with effective anti-hypertensive, cardioprotective, nephroprotective, and anti-androgenic properties may offer pleiotropic actions in different sites to protect from COVID-19. Current data shows that spironolactone may concurrently mitigate abnormal ACE2 expression, correct the balances membrane-attached and free circulating ACE2 and between angiotensin II and Angiotensin-(1-7) (Ang-(1-7)), suppress androgen-mediated TMPRSS2 activity, and inhibit obesity-related RAAS dysfunctions, with consequent decrease of viral priming. Hence, spironolactone may provide protection from SARS-CoV-2, and has sufficient plausibility to be clinically tested, particularly in the early stages of COVID-19.