Doktorarbeit / Dissertation, 2022
210 Seiten
List of Abbreviations
Acknowledgment
Executive Summary
1. Introduction
1.1. Research Background
1.1.1. How SARS-COV-2 differs from other variants of SARS
1.2 The role of CBD as medicine for lung-based diseases
1.3 Research Aims and Objectives
1.4 Overview
2. Literature Review
2.1. Introduction
2.2. Main assessment
2.2.1. What is SARS-COV-2?
2.2.2. The Spread of the virus in the last three years and long term effects of it
2.2.3. Researches that have been done to cure the SARS-COV-2 and its pathogenesis
2.2.4. The use of CBD to treat lung-related diseases
2.2.5. CBD in the context of SARS-COV-2 and its pathogenesis
2.3. Conclusion
3. Materials and Methods
3.1. Introduction
3.2 Research Philosophy
3.3 Research Approaches
3.3.1 Research methods to be considered
3.3.2 The approaches that are viable for this research
3.4 Data collection methods
3.5 Inclusion and Exclusion Criteria
3.6 Conclusion
4 Case Study
4.1 Introduction
4.2 Overview of the data
4.2.1 Genome structure
4.2.2 Lifecycle
4.2.3 Pathogenesis
4.2.4 Diagnosis, prognosis and outcome
4.3 CBD and SARS-COV-2
4.3.1 Countering COVID-19 With Cannabis And Derivatives
4.3.2. CBD AND APELIN
4.3.3. CBD Reduces Inflammation And Increases Appeal Levels
4.3.4. CBD AND COVID-19: The Role Of Cannabidiol And Apelin In The Covid Pandemic
4.3.5. A Global Pandemic And The Need For A Quick Cure
4.4. STUDIES ON CANNABIS AND DERIVATIVES FOR COVID-19
4.4.1 Cannabis And COVID-19: The Rationale For Using Cannabinoids
4.4.2 CBD AND Exosomes
4.4.3 CBD AND Steroid Drugs
4.4.4 The Anti-Inflammatory Properties Of Cannabis
4.4.5 Terpenes As Antiviral Agents
4.4.6 Cannabis Therapy In Times Of Crisis
4.4.7 Cannabis And Coronavirus Anxiety
4.5. CBD against other medicine for SARS-COV-2
4.5.1 Treatment and prevention
4.5.2 Drugs
4.5.3 Neutralizing antibody
4.5.4 Vaccines
4.6 Conclusion
5. Discussions of findings
5.1. Findings from the data
5.2. Comparison to existing literature
6. Conclusion
6.1. Summary and recap of the Findings
6.2. Limitations
6.3. Future Recommendations
References
To my mentors, family and friends, I could not have done this without you. Thank you for your all your support and encouragement. I dedicate this thesis to Nilmini Wickremanayake, Rajapaksha Shelton Dunuwila, Mallika Dunuwila and Budhadasa Peter Rajapaksha Dunuwila. They have been my pillars of success. It is on their strength and support I stand where I am today.
In December 2019, a new outbreak of pneumonia emerged in China, which was identified as SARS-CoV-2, which has a rapid spread as it is transmitted mainly through coughing, sneezing or contact. It presents various symptoms such as fever, dry cough and myalgia. It can affect any age, being mainly mild and with spontaneous resolution, but in older people and/or with comorbidities, and it can present a severe or fatal course. For its diagnosis, it is important to evaluate the presence of fever, perform an epidemiological history, chest CT and laboratory tests such as RT-PCR or respiratory tract samples. A systematic qualitative review was carried out by searching the Medline and ClinicalKey databases. Seventy-two articles were found, which were read completely; 16 of them met the inclusion and exclusion criteria. Most of the dental actions produce drops or aerosols; for this reason, protection measures must be taken, selection of patients and types of treatments to reduce the possibility of infections in health personnel and patients, evaluate the use of rubber dam and mouthwashes prior to care, avoid aerosol-generating instruments, postpone elective care, treat only dental emergencies, and take extreme measures to disinfect the facilities using biocidal agents that are effective against the coronavirus. Transmission by fomites and aerosols is proven, so we must take extreme precautions. In pandemic situations, it is necessary to consider providing psychological support to patients, especially with psychosomatic oral pathologies which can worsen. The possibility of transmission in the recovery period is neither proven nor ruled out.
Moreover, this can be attributed to its interaction with apelin that is present in the body. Apelin or its receptor agonists have an excellent potential for treating or reducing the spread of the SARS-COV-2 virus. The apelin may represent a novel molecular target that will be able to improve the protective effects of the endocannabinoid signalling in the body. Along with dealing with SARS-COV-2, this may be even able to reduce the amount of lung damage that the virus cause. CBDs regulate apelin and other receptors in the lungs as it helps in improving the lung functions and the reduction of the virus's damage to the body.
CBDs are effective when it comes to acting as an anti-inflammatory agent. It may be due to how well it can do due to its interaction with apelin. CBD has been shown to have a wide range of anti-inflammatory effects inside it. Malinoswska et al. (2021) noted that it could help reduce the negative consequences of hypoxia and ischemia within patients. A small dose of CBD may prove to be beneficial when treating children with neonatal asphyxia due to their mothers suffering from the COVID-19 virus.
Cannabis smoke contains many chemicals known to be toxic and carcinogenic, like tobacco smoke. Cannabis smoking is related to a higher incidence of chronic cough with production of phlegm, branch stenosis and symptoms that also affect the upper airways. In addition, long-term cannabis smoking can worsen respiratory symptoms and exacerbate chronic bronchitis episodes. In countries where cannabis is used legally, such as Canada, the rates of cannabis use have increased in recent months. The elderly have a higher risk of developing respiratory and cardiovascular complications, and the prevalence of cannabis smoking in those with COVID-19 could increase the risk.
There are some limitations of the research, which includes the active compound in patients is probably the metabolite 7-OH-CBD, the same one involved in the treatment of epilepsy. Another mechanism that contributes to the antiviral activity of CBD is the modulation of interferon after activation of the host immune response to the viral pathogen. Although the study was initially conducted in beta, the authors believe that CBD blocks viral replication after cell entry and is, therefore, likely to be effective against mutant viral variants (Osipiuk, 2021). A substantial reduction in the risk of SARS-CoV-2 infection by approximately one order of magnitude in patients taking FDA-approved CBD highlights the potential efficacy of this drug in combating SARS. Another mechanism that contributes to the antiviral activity of CBD is the modulation of interferon after activation of the host immune response to the viral pathogen. The paper concludes with future recommendations.
There are seven different types in the coronavirus group. Most of them only cause mild colds. However, like the Sars pathogen 2002/2003, Sars-CoV-2 uses a particular way to penetrate the cells of the body, particularly effectively. Therefore, the virus is particularly dangerous for the lungs and attacks the vessels in other organs.
The genome of the SARS-CoV-2 virus that caused the new crown epidemic is composed of nearly 30,000 nucleotides. Nucleotides are molecules that contain instructions for the amino acids that make up their protein. But like all viruses, this genetic code is not static. When a virus infects a cell, it produces thousands of copies of itself, and sometimes errors occur in the process. These errors-or mutations are mostly harmless and will not cause a considerable change in the way the virus infects and spreads among people. But sometimes, these genetic changes can help the virus stay one step ahead, making the variant more contagious and spread more quickly.
Mutations may cause changes in any part of the virus, but the subtle adjustment of its spike protein is the change that researchers are most worried about. These spike proteins allow the virus to attach and invade the cells of its host. Variants with significant mutations in the spike protein are listed by the WHO as "variants of concern" because they are related to increased transmission and severity and may have an impact on immunity. According to Professor Mackey, "These mutations can make the spike protein bind more closely to the receptors of human cells, so the success rate of the binding will be higher than if there is no tight binding”. Although spike mutations have gained attention, other modifications may also give SARS-CoV-2 variants an advantage. Other errors in the genetic sequence can help the virus make more copies in human cells.
Coronaviruses have been known for a long time. This pathogen was first discovered in humans in the 1960s. Four types of viruses circulate in the population worldwide: CoV OC43, CoV NL63, CoV 229E, and CoV HKU1. They are responsible for about ten per cent of the common colds, but most of them take a mild course. Two other coronaviruses (Sars-CoV and Mers-CoV) triggered minor epidemics in 2003 and 2012.
Experts can know the known viruses, and the new Sars-CoV-2 can be distinguished from one another by the genetic fingerprint. The spread of these six coronaviruses and other pathogens that cause respiratory infections is monitored daily. The network for respiratory viruses has been collecting laboratory results from patients with symptoms in Germany since 2009. The researchers know that some types of coronaviruses prefer autumn and winter through these regular examinations, while others also remain active in summer. At the end of 2019, scientists in China discovered a novel coronavirus that causes particularly serious respiratory diseases. This virus was named Sars-CoV-2 by the World Health Organization in February 2020. Coronaviruses behave very differently, even though they belong to the same virus family. But the new pathogen has a particularly dangerous property that Wodarg ignored.
All coronaviruses use a protein on their outer shell to penetrate the cells of the body and certain entry ports into human cells. Like the Sars pathogen from the 2002/2003 epidemic, Sars-CoV-2 uses the ACE2 receptor as a gateway. However, according to initial studies, the new virus binds ten to twenty times more strongly to this receptor than the causative agent of the first Sars epidemic.
Usually, one of the jobs of the ACE2 protein is to protect the lungs from damage. This important function of ACE2 seems to be suppressed by the infection with Sars-CoV-2. This receptor is also found on heart muscle cells and cells that form blood vessels. The ACE system is one of the most important regulatory systems in the body and has a very large effect on the cardiovascular system.
Pathologists at the University Hospital Zurich discovered during autopsies that the Covid 19 deceased did not only suffer from inflammation of the lungs. The inflammation affects the entire vascular system (endothelium) of various organs: heart, brain, lung, and kidney vessels, as well as vessels in the intestinal tract. With previous illnesses such as high blood pressure, diabetes, heart failure, or coronary heart disease, the function of the endothelium is already restricted. This explains the high death rates among people with previous illnesses.
The endothelium of younger patients usually copes well with the attack of the virus, report the Zurich researchers. This finding by the pathologist is nothing more than a first clue. Research into whether the mechanism via the ACE2 receptors is one of the reasons for the higher mortality with Sars-CoV-2 compared to the other coronaviruses will take years.
Like all viruses, the SARS-CoV-2 coronavirus also mutates, i.e., the genetic material of the virus changes. Most of such changes, called mutations, are without serious consequences. However, some mutations can change the genome and thus the virus in certain properties in such a way that worrying variants arise. Virus variants are considered "worrying" if, for example, they are more contagious or if the immune system of people who have already recovered or who have been vaccinated is less able to fight off these virus variants.
The following virus variants (Variants of Concern, VOC) of SARS-CoV-2 are currently known:
- The Delta variant (B.1.617.2) is currently the most widespread in Germany. This variant was first discovered in India and has now spread widely in many countries. The delta variant has mutations that increase the transferability of the virus. The Delta variant is significantly more contagious than the Alpha variant. Studies have shown that even infections with the Delta variant provide good protection against symptomatic infection and very good protection against severe disease after full vaccination. However, after only one of two necessary doses of the vaccine, decreased efficacy in relation to mild courses has been demonstrated.
- The South African Ministry of Health first reported on the Omikron variant (B.1.1.529) in November 2021. On November 26, 2021, the World Health Organization (WHO) declared Omikron a worrying virus variant. Omikron is now the predominant variant in South Africa and has already been proven in many other countries around the world. Cases have also become known in Germany. This virus variant was created independently of the currently predominant Delta variant. Omikron has an unusually high number of mutations in the spike protein compared to the original SARS-CoV-2 virus variant from Wuhan. These include mutations that are known to make the virus more transmissible. For many mutations, however, the meaning is still unclear. The protective effect of the corona vaccination against the Omikron variant cannot yet be finally assessed. Intensive investigations are ongoing for omicron.
- The variant Alpha (B.1.1.7) was discovered in Great Britain. At the end of 2020, it was reported that this variant was spreading there for the first time. The alpha variant is easier to transfer than the conventional SARS-CoV-2. People who carry this virus variant infect more people on average. There is also evidence that infections with the virus variant Alpha are associated with increased mortality, regardless of age. After this virus variant was dominant in spring 2021, it is now only rarely detected in Europe. There is no evidence that the effectiveness of the COVID-19 vaccines against this variant is significantly reduced.
- The variant Beta (B.1.351) was identified in South Africa at the end of 2020. A higher transferability is also assumed for this variant. There is also evidence that a previous infection with the original SARS-CoV-2 and the COVID-19 vaccines are less effective in protecting against infection with this virus variant.
The variant Gamma (P.1) was first identified in the Brazilian state of Amazonas. The changes are similar to the beta version. Here, too, increased transferability is assumed. There are indications that those who have recovered or have been vaccinated are less well protected against the variant gamma.
In December 2019, in the city of Wuhan, China, a new outbreak of pneumonia of unknown origin emerged, which has spread rapidly around the world (Ge et al., 2020). According to the report of the World Health Organization (WHO), as of March 25, there are a total of 413,467 confirmed cases and 18,433 deaths in the world, affecting 197 countries, being described as a pandemic and the greatest public health challenge in the world (World Health Organization, 2020).
This new pneumonia managed to be isolated, and its genome was sequenced, receiving the name of SARS-CoV-2 or COVID-19 (Huh et al., 2020), presenting a genetic similarity of 79% with SARS-CoV and 50% with MERS-CoV, all of the β-coronavirus family (Van Doremalen et al.,2020). Most coronaviruses cause mild respiratory illnesses in humans. However, βcoronaviruses cause fatal respiratory illnesses (Peng et al., 2020).
This new virus is characterized by a rapid spread, surpassing MERS-CoV and SARS-CoV. There is direct person-to-person transmission by inhalation of droplets produced when talking loudly or laughing since saliva contains viruses in infected patients. However, the possible vertical transmission between mother and newborn has yet to be corroborated (Xu et al., 2020).
Routes of Transmission COVID-19
Typical symptoms are fever, dry cough, myalgia, fatigue, and dyspnea with an abnormal chest tomography (CT) showing bilateral pneumonia, ground-glass opacity, and/or bilateral irregular shadows. Atypical symptoms are sputum production, headaches, hemoptysis, diarrhoea, dizziness, abdominal pain, nausea, vomiting, confusion, and sore throat (Sohrabi et al., 2020
Epidemiological data indicate that all ages are susceptible. Still, men with a mean age of 56 years, individuals in close contact with symptomatic or asymptomatic infected people, including other patients who are in health centres, as well as other patients who are in health centres, have a higher prevalence than the medical team who make up a significant percentage of infected people. The specific reasons for the failures of personal protective equipment (PPE) in health equipment should be investigated (Sabino-Silva et al., 2020).
Most cases are mild and resolve spontaneously. According to data in China, 15% - 25% of their cases are severe (Meng et al., 2020). Elderly patients and/or with comorbidity such as diabetes mellitus (DM), arterial hypertension (HT), cerebrovascular, cardiac, endocrine, digestive, respiratory, and immunosuppressed diseases are more susceptible to developing a severe infection, and they may present acute kidney damage, acute respiratory distress syndrome, organ failure, progressive respiratory failure, and even death (Meng et al., 2020). The incubation period ranges from 2 to 19 days, with a mean of 5.2 days. Incubating or asymptomatic individuals can transmit the virus. Studies suggest that it should be demonstrated whether patients in the recovery phase are a potential source of virus transmission (SabinoSilva et al., 2020).
The global SARS-CoV-2 mortality rate is 0.39% - 17.9%. An adjustment made to the Wuhan data shows a mortality rate of 20% (Baud et al.,2020). Mortality increases with age. In China, as of March 21, 14.8% was reported in ≥80 years, and 0% in ≤9 years. Other figures are lower than SARS-CoV with 10% and MERS-CoV with 34%, but higher than seasonal influenza with 0.01% - 0.17% (Center for Evidence-Based Medicine, 2020).
Studies have shown that, like SARS-CoV, it binds to the human angiotensin-converting enzyme II (ACE II) receptor but cannot bind to cells that do not express this receptor. ACE II receptors are abundant in the respiratory tract, especially in type II alveolar lung cells, and in various organs such as the heart, kidney, and/or gastrointestinal. Within the oral cavity, we can find them highly present in epithelial cells of the tongue (40.6% of those present in the oral cavity) and to a lesser extent in the duct of the salivary glands and other oral and gingival tissues (Peng et al., 2020). Due to their high genomic similarity, RCT II is an early target for SARS-CoV and probably also for COVID-19, but it has not been reported in investigations. Organs with a high ACE II receptors expression should be considered a potential risk of infection (Xu et al., 2020).
It is estimated that around the world, there are about 200 drugs under investigation to combat SARS-CoV-2, most of which consist of antivirals. However, there are also numerous examples of treatments that combat the ravages caused by the action of our immune system or monoclonal antibody treatments.
There are currently a large number of studies underway, most of them sponsored by the solidarity project of the World Health Organization, in which more than 90 countries around the world collaborate. Another outstanding initiative is the recovery trial, organized by the University of Oxford, in which cases of more than 5,000 patients are analyzed. In Spain, the Carlos III hospital keeps an account of more than a hundred research projects aimed at curbing Covid-19 and the Spanish Agency for Medicines and Health Products (AEMPS). It collects on its website the medical recommendations on the different drugs available and the latest news related to their dosage or possible adverse effects. All efforts are few to find effective new treatments to combat this new disease, but not all drugs are safe, nor are they all used under the same conditions. Here is a list of the most used ones.
Antivirals
They are drugs that directly attack the virus called lopinavir and ritonavir, and interferon beta 1-b could shorten the survival period of the virus in the body of hospital patients with moderate symptoms. This combination of drugs is used for other viruses, such as HIV, and, according to the study authors, is effective because of its potential to inhibit the protease, an enzyme that both HIV and the new Coronavirus use to multiply.
It also belongs to this group., one of the most popular drugs against SARS-CoV-2, belonging to the group of nucleoside analogue drugs, which act against the RNA polymerases of the virus. The pharmaceutical company Gilead designed it as an effective treatment against the Ebola virus, although it was later shown to be effective in treating other viruses, including another coronavirus, the one that causes MERS.
This drug was listed as the "star drug" against SARS-Cov due to the first preliminary studies that were made public. However, its proven efficacy has been the subject of controversy, especially after WHO leaked the results of the first large clinical trial to date. In which it was concluded that the drug has more than discrete effects. Gilead took cover, claiming that those results were not conclusive and that the trend of later reports would prove the potential benefits of the drug, especially in those patients treated early. At the moment, we know that the Administration of Medicines and Drugs of the United States approved on May 1 its use for patients in an advanced stage of the disease. Despite this approval, in Spain, the AEMPS alleges that "it is a drug not well characterized" and warns that its main adverse reaction is infusion hypotension and does not allow its compassionate use, that is, outside of clinical trials.
Immune System Regulators
When the Coronavirus enters our body, it unleashes a coordinated response of the immune system in different phases. Among the complex defensive battery of this will include the phagocytes, in charge of destroying infected cells. In addition to pouncing on their potential victims, these immune cells produce a secondary weapon called a 'Cytokine,' a protein that is responsible for making a' call effect 'to the entire body to put it on alert. However, its excess can be counterproductive. The so-called 'cytokine storm' can unleash inflammations with fatal outcomes, especially in seriously ill patients or in advanced stages of the disease.
One of these cytokines is interferons, a molecule involved in the inflammation process designed to fight the virus. As mentioned in the first point, the interferon-beta 1-b - administered with two other antivirals is one of the drugs evaluated against Covid-19. But, paradoxically, there are clinical studies that indicate that it could be more harmful than effective since it increases the amount of ACE2 receptors, cells offer more doors of entry to the virus. For this reason, for the moment, the AEMPS does not include them among the possible effective treatments. "There is currently no evidence from controlled clinical trials. Furthermore, there is recent evidence from the Ordovas-Cordobés group in vitro showing how interferon is capable of increasing the expression of ACE2 in human epithelial cells, which may favour infection," reads a statement.
Here is another paradox, faced with a 'cytokine storm' caused by the immune system, one might think that the best solution would be to 'stop' or 'turn off' that 'defensive overactivity.' To this end, there are numerous immunosuppressive drugs in the formulary. The problem is that, precisely, the immune system is our main defensive weapon against the virus. The key here is to find a molecule capable of extinguishing that excessive inflammation caused by cytokines without crippling our defences.
In this idea, there are numerous clinical studies in which different drugs are investigated. One of them is omicron, a molecule that neutralizes the biological activity of interleukin-1 (IL1), the cytokine responsible for local inflammations. The AEMPS affirms that it is a drug used for the chronic treatment of a series of inflammatory diseases, for which its use is authorized outside of clinical trials - one of them carried out in Spain -although it states that its efficacy has not been demonstrated.
Other potential drugs with the ability to 'appease' the immune system without harming it are chloroquine and hydroxychloroquine. These are two drugs initially used to treat malaria, which has subsequently been used to treat autoimmune diseases, such as rheumatoid arthritis. The AEM warns that "so far, the information available on its antiviral action comes from in vitro studies and series of patients with limitations in size and methodology" and that "different studies are being carried out to evaluate its efficacy and safety." Of course, he admits that although currently, the data on its efficacy are limited, it is one of the commonly used drugs in the treatment of Covid-19.
However, the organization warns, these two drugs constitute a potential treatment for Covid-19 and are being used extensively in clinical practice in Covid-19 patients, at doses higher than those recommended in their authorized indications and frequently in association with the antibiotic azithromycin. Like redeliver, chloroquine has been one of the star drugs of the pandemic, driven above all by public statements by senior political leaders, such as the president of the United States, Donald Trump, or that of France, Emmanuel Macron. However, successive clinical trials have shown that in certain cases, it can do more harm than good. The National Institute of Allergies and Infectious Diseases of the United States already stated in its day the risk that patients treated with this drug could suffer a cardiac arrest. In addition to this adverse effect, health authorities, including the Spanish Ministry of Health, has warned medical professionals that these drugs could also cause psychiatric disorders, including acute psychosis, something that the AEMPT warns about in their research.
Another drug in the clinical trial phase is tocilizumab (TCZ), an inhibitor of IL-6. A drug also used for the treatment of rheumatoid arthritis and cytokine release syndrome is associated with immunotherapy treatment. The AEMP reports that in March, this drug "was included in the seventh updated diagnosis and treatment plan for SARS-CoV-2 issued by the National Health Commission of China", although "it has not received approval from the health authority for this indication in no country and at present, there is no solid clinical evidence regarding safety and efficacy." This drug is one of the first to be incorporated into treatments against Covid-19, which is why, according to the Spanish health authorities, it is one of the drugs on which there is more clinical experience. It is used primarily to reduce the need for patients to receive mechanical ventilation, and there are studies in China that have proven its efficacy, although with a limited number of patients.
Monoclonal Antibodies
When SARS-COV2 infects our body, it works by producing proteins called antibodies designed to fight the antigen. One of the medical possibilities this immune response offers is to use part of these proteins present in the plasma of infected patients to make drugs that act directly against the pathogen. Another option is to clone these natural antibodies in a laboratory. It is what is known by the name of 'monoclonal antibodies. These treatments, proven with success in other diseases, such as cancer or Ebola, are perhaps one of the most promising, although their development is not easy, nor is it cheap. That is why numerous international organizations, including the European Commission, are joining forces to finance research projects in this area. One of them is the MANCO (Monoclonal Antibodies against 2019-New Coronavirus) project, in collaboration with research groups, biotechnology companies, and medical organizations from different countries, including the National Center for Biotechnology (CNB).
Among the most interesting conclusions is that of a team of researchers from the University of Utrecht, in the Netherlands: in an experiment tested with humanized mice (genetically modified with human cells) to produce antibodies that attack protein S, the spike that the virus used to enter human cells. They discovered that one of the antibodies used could neutralize the new Coronavirus. One of the main benefits of the study of antibodies for the treatment of Covid-19 is its transversality since it allows incorporating some of the advances proven in areas such as cancer research into the fight against the new pathogen. This is the case of Trastuzumbal, a proven breast cancer drug that uses a monoclonal antibody that mimics the immune system. In Barcelona, a group of experts led by Joan Seoane, Director Of Translational Research At The Valld'Hebron Institute Of Oncology, has developed a monoclonal antibody that stops a protein involved in the progression of tumours that could also be used to develop a drug against Coronavirus. The results of research like this could take a definitive step that helps us permanently fight the virus until the world has an effective vaccine.
Cannabis is the Latin term for hemp. People have been using this plant for thousands of years: the fibres are used to make ropes, and the seeds are used to make oil. The intoxicants hashish and marijuana can be extracted from dried flowers and leaves. For some time now, more research has been carried out into the medicinal effects of cannabis. The medicinal effects of hemp are mainly due to the ingredients tetrahydrocannabinol (THC) and cannabidiol (CBD). THC has an intoxicating and relaxing effect, and it can reduce nausea (Devinsky et al., 2014). CBD has an anti-anxiety effect and can reduce inflammation.
Prescription of Cannabis
Since 2017, statutory health insurance companies have been assuming the costs of cannabis medicines in certain cases. There are strict requirements for this:
- There is a serious illness.
- Recognized medical treatment is not available or, according to a doctor's judgment, is not possible.
- There is a not entirely distant prospect that the course of the disease or severe symptoms will noticeably improve.
The doctor will assess whether these requirements are met. Before the first prescription, you must obtain approval from your health insurance company. Then you will receive a so-called narcotics prescription in the doctor's office.
Consideration of CBD as a medicine
Cannabis has been examined for the following diseases or ailments, among others:
- Permanent (chronic) pain
- Muscle spasms in multiple sclerosis or paralysis of the legs
- Nausea and vomiting, for example, as a result of chemotherapy
- unwanted weight loss, for example, as a result of AIDS
Whether cannabis is an option for you for these complaints depends on which other treatments would be possible and whether the risk of side effects appears acceptable. Most of the time, cannabis is not given to you in addition to the medication you are already taking. It has only been studied as an adjunct drug.
Effectiveness of CBD for Lung Diseases
So far, there are not enough good studies that it is not possible to judge with certainty how effective cannabis is. For persistent pain, muscle cramps, nausea, or weight loss, studies suggest that drugs containing THC can relieve symptoms. However, the observed effect was mostly rather minor. Cannabis does not help against sudden ailments. It takes a while for it to work. Cannabis has so far not been able to help with the following diseases: inflammatory bowel disease, Parkinson's disease, movement disorders, tremors, Huntington's disease (a rare hereditary disease) or bladder weakness as a result of multiple sclerosis. There are no good studies on other diseases (Keeberger & Peden, 2005). Cannabidiol is approved for a rare form of epilepsy but is currently advertised as an aid for many ailments. There is currently insufficient evidence that it works against this.
Side effects of using CBD
The most common side effects of cannabis include tiredness and poor concentration. The following symptoms can also occur mood swings, dizziness, dry mouth, dry eyes, muscle weakness, increased appetite, racing heart, sudden drop in blood pressure and heart problems. No life-threatening complications have been reported after the medical use of cannabis. Cannabis increases the risk of getting mentally ill and developing delusions (psychosis). Around one in three people discontinues long-term treatment with cannabis because of side effects.
Anyone who takes cannabis for a long time becomes insensitive to many of its effects. One speaks of tolerance (Voulo et al., 2019). Anyone who suddenly stops cannabis can develop withdrawal symptoms. Do not use cannabis if you are pregnant or have had psychosis or other serious mental illnesses. Caution is advised in the case of severe cardiovascular diseases.
Types of CBDs used for Medical Purposes
The doctor can prescribe different types of cannabis products:
- The active ingredients nabilone and nabiximols are available as ready-made drugs in pharmacies, as capsules or as an oral spray.
- The active ingredient dronabinol is available in Germany as a so-called prescription drug. The remedy is prepared for you personally in the pharmacy, usually as oily drops that you take.
- There is also medicinal hemp in the form of dried flowers or plant extract. Both have to be heated for the ingredients to work. An evaporator is suitable for this.
The leaflets accompanying the cannabis medication list addiction as a possible side effect. The available data do not allow any conclusions to be drawn as to whether cannabis drugs are addictive in the amounts that have been investigated in studies. No such cases are known to date. Another reason for this is that most of the studies didn't last long enough.
Recommendations for using CBD
- If cannabis is an option for you for medical reasons, you should receive finished or prescription drugs. Unlike flowers and extracts, these do not vary in their composition and effectiveness.
- Because of their harmful effects, experts advise against smoking flowers as a joint or mixing cannabis drops in liquids.
- You should not actively participate in road traffic at the beginning of treatment or when the dose is adjusted.
Chronic obstructive pulmonary disease is a progressive, life-threatening lung disease that mainly causes shortness of breath (initially during exertion), fatigue and hypoxia, which can easily lead to serious diseases. Although relatively few people have heard of this disease, on average, one person dies from this disease every ten seconds in the world (Burstein, 2015). Traditionally, such conditions are treated with old-fashioned medical methods, but why not prevent them or relieve symptoms without the adverse effects of antibiotics and hormones? Unfortunately, there is no solid research on cannabis products (especially CBD) in the treatment of chronic obstructive pulmonary disease; however, CBD has shown great promise in relaxing airway muscles, allowing more oxygen to pass through, and reducing anxiety and shortness of breath (Maier, 2002).
Due to the increase in the number of smokers in developing countries, the reduction in mortality from infectious diseases, and the widespread use of biomass fuels (such as firewood, grass or other organic materials), the prevalence of chronic obstructive pulmonary disease is increasing worldwide. Death from chronic obstructive pulmonary disease may also be more serious in developing countries than in developed countries. The chronic obstructive pulmonary disease has been diagnosed in 64 million people. It caused 3.2 million deaths worldwide in 2015 and is expected to become the third leading cause of death in the world by 2030.
As mentioned earlier, mainly due to COPD is tobacco smoke (including passive smoking ). Other risk factors include.
- Indoor air pollution.
Air pollution:
Dust and chemicals (vapors, irritants and fumes) are present in the workplace. Lower respiratory tract infections often occur in childhood. The most harmful substance to the lungs is dust containing cadmium and silicon. Among the occupations of construction workers, workers in the metallurgical, cement, and chemical industries may be riskier.
Genetic factors
The most valuable gene mutation that causes this disease is a α-1-antitrypsin deficiency, which is the main cause of emphysema in non-smokers and greatly increases the susceptibility of smokers to this disease. In addition, there are more than 30 alleles of more than 30 genes found in some populations that are related to the development of COPD or decreased lung function, but the most important of them is an α-1-antitrypsin deficiency.
Symptoms of chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease develops slowly and manifests itself in people over 40-50 years of age. The most common symptoms of chronic obstructive pulmonary disease are.
- Shortness of breath.
- Chronic cough.
- Sputum secretion;
- Respite, other more serious symptoms.
- Blue lips or nails.
- Frequent colds.
- Lose weight unintentionally.
- The chest is stuffy.
- Swelling of the feet and ankles.
- Extremely tired, Life-threatening chronic obstructive pulmonary disease can be complicated by the following conditions.
- Severe weight loss.
- Pneumothorax.
- Acute decompensation with frequent episodes.
- Right ventricular failure or acute or chronic respiratory failure.
As the patient's health deteriorates, performing normal daily activities, such as climbing stairs or carrying bags, may be a challenge. In addition, patients often experience aggravation, from a few days to a few weeks of severe asthma, cough, and severe episodes of sputum secretion. These episodes can lead to a major need for emergency medical care (including hospitalization).
Diagnosis and treatment
People with the above symptoms are usually suspected of having chronic obstructive pulmonary disease (COPD). A breath test to confirm the diagnosis is called spirometry. It measures how much air a person can exhale quickly at one time with the best effort. The medical history, physical examination, and chest X-ray are to make a complete and accurate diagnosis.
The availability of opportunities for diagnosis and treatment of chronic obstructive pulmonary disease depends on the level of resource supply. Unfortunately, the chronic obstructive pulmonary disease is incurable. However, existing drugs and physical therapy can relieve symptoms, increase exercise capacity and quality of life, and reduce the risk of death. Smoking cessation is the most effective and economical treatment for smokers' chronic obstructive pulmonary disease. This will delay the progression of the disease and reduce deaths from causes related to COPD. Some (but not all) patients with chronic obstructive pulmonary disease benefit from inhaled corticosteroids. Treatment also includes
- Bronchodilators (enlarge the lumen of the bronchus).
- Mucolytics (dilute sputum).
- Antibiotics (resistance infection).
- Drugs that reduce the tension of bronchial smooth muscles.
In the later stages of the disease, lung volume reduction surgery or transplantation is used. However, in the absence of medical assistance and treatment, approximately 50% of patients with severe chronic obstructive pulmonary disease die within ten years of diagnosis. Therefore, if the medicine has not found a cure for this lung disease, perhaps an alternative method can be used.
Evidence that CBD is particularly helpful for chronic obstructive pulmonary disease so far, there have not been many studies and conclusive evidence that Cannabidiol is specifically used to treat patients with chronic obstructive pulmonary disease; however, the preliminary results are encouraging.
Reduce inflammation
Inhalation exposure induces airway inflammation and alveoli. , Which leads to the development of diseases in genetically susceptible people. In patients with chronic obstructive pulmonary disease, activated neutrophils and other inflammatory cells release proteases as part of the inflammatory process. Protease activity is better than anti-protease activity, leading to tissue destruction and excessive mucus secretion. Go further. A 2014 study of CBD in mice showed that CBD could help reduce inflammation and improve lung function in mice with damaged lungs (Riberiro et al., 2015).
The activation of neutrophils and macrophages can also lead to the accumulation of free radicals, which can lead to bronchial obstruction, mucosal oedema and mucus accumulation. Six hours after the induction of lung inflammation, the mice were injected with 20 and 80 mg/kg of CBD. Twenty-four hours later, after the inflammation was induced, the lung mechanics and the level of inflammation was evaluated. The results are shown below -CBD total resistance and reduced lung elasticity, decreased the migration of leukocytes to the lungs, and thus anti-inflammatory immune response, and reducing the production of pro-inflammatory cytokines (TNF and IL-6) and chemokines (MCP -1 and MIP-2). In bronchoalveolar lavage fluid.
As with any life-threatening illness, fear and shortness of breath can cause severe anxiety disorders. Inability to cope with daily life and combat constant stress may be one of the important complications of chronic obstructive pulmonary disease. Fortunately, many personal testimonies and early studies have shown that CBD is useful for those experiencing anxiety. A study by Scott Shannon and others in a 2019 study pointed out that the consumption of CBD helped 72 people with anxiety and sleep disorders, making them feel more relaxed and less worried (79% of people reduced anxiety, 66.7% of people improved their sleep).
Respiratory tract infections (prone to patients with chronic obstructive pulmonary disease) can promote the progression of lung destruction. Bacteria, especially Haemophilus influenzae colonization in the respiratory tract of up to 30% of chronic obstructive pulmonary disease patients. Bacterial colonization in Pseudomonas aeruginosa or other gram-negative bacteria colonization in patients with more severe disease is very common (for example, patients who had previously been hospitalized). (Blaskovich et al., 2019) presented the research at the American Society for Microbiology meeting. Mark Center for Biological Sciences of the University of Queensland Institute of Molecular Blaskovich Dr. investigated the CBD for external use in a variety of infectious skin diseases in which cannabidiol in the fight against gram-positive bacteria, including those on antibiotics (vancomycin or daptomycin Vegetarian) highly resistant bacteria. In addition, CBD has been shown to disrupt biofilms, a physical form of bacterial growth that causes infections that are difficult to treat.
Smoking and obstruction of the airway can lead to impaired mucus clearance in the lower respiratory tract, which can easily lead to infection. Repeated infection cases will increase the inflammatory process, leading to the rapid development of the disease. However, there is no evidence that long-term use of antibiotics can slow the progression of COPD.
So far, there has been a lot of controversy surrounding the method of consuming marijuana, but it is believed that smoking marijuana is harmful to patients with lung diseases. Generally speaking, there is no filter on the marijuana "joint". Compared with cigarettes or other tobacco products, people tend to inhale smoke deeper into the lungs. The American Thoracic Association strongly discourages smoking marijuana on the grounds that it may cause the lungs to form obvious bullae, which may burst and cause the lungs to collapse. This situation is more likely to happen to young cannabis users under 45.
However, there are alternatives to smoking. Many people who did not smoke before but want to get the benefits of medical marijuana can choose to ingest the product through edible items (such as biscuits, brownies, capsules, gummies), smoking, or sublingual oil.
In the research paper, we aim to look at the secondary data and research available online in order to discuss the containing COVID-19 pandemic and the emergence of SARS-CoV-2 highlight the need for novel therapies. Cannabidiol (CBD) reduces SARS-CoV-2 infection in cells and mice, according to this study. CBD and its metabolite 7-OH-CBD inhibit SARS-CoV-2 multiplication in lung epithelial cells more effectively than THC or other congeneric cannabinoids examined. CBD works after SARS-CoV-2 has entered the body, blocked viral gene expression and reversed many of the virus's effects on host gene transcription. CBD suppresses SARS-CoV-2 replication by upregulating the IRE1 RNase endoplasmic reticulum (ER) stress response and interferon signalling pathways in the host. CBD (100 mg/ml oral solution per medical records) had a substantial negative correlation with positive SARS-CoV-2 testing in matched groups of human patients from the National COVID Cohort Collaborative.
The research has identified CBD as a possible prophylactic agent for early-stage SARS-CoV-2 infection, and further clinical trials are warranted. At this time, we advise against using non-medical formulations such as edibles, inhalants, or topicals as prophylactic or therapeutic therapy. Coronavirus disease 2019 (COVID-19), a pandemic that has swept the globe in the last year, is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is the eighth coronavirus species to infect humans and is linked to the severe acute respiratory syndrome-associated coronavirus (SARS-CoV). SARS-CoV, 229E, NL63, OC43, HKU1, and MERS-CoV are among the coronaviruses that produce symptoms ranging from the common cold to more serious diseases. Despite the availability of vaccination, SARS-CoV-2 continues to spread fast, emphasising the need for alternate therapies, particularly for communities that do not have access to immunisations.
Just a few medications currently block SARS-CoV-2 replication and viral generation. SARS-CoV-2 is an enveloped virus with a positive-sense single-stranded RNA (+ssRNA) envelope and four structural proteins that promote viral particle production. The virus membrane proteins spike (S), membrane (M), and envelope (E) help to induce virion budding while also attracting the nucleocapsid (N) protein and viral genomic RNA into nascent virions. SARS-CoV-2, like SARS-CoV, enters human cells primarily through binding of the viral S protein to the angiotensin-converting enzyme 2 (ACE2) receptor (3–5), after which the S protein is proteolysed into two non-covalently bound peptides (S1, S2) that facilitate viral entry into the host cell by transmembrane protease, serine 2 (TMPRSS2) or other proteases.
Following proteolytic cleavage by TMRSS2 or other proteases, the N-terminal S1 binds the ACE2 receptor, while the C-terminal S2 causes viral-cell membrane fusion. Depending on the cell type, viral entry can occur after ACE2 binding without the need for proteolytic cleavage. Followed by cell entrance, the SARS-CoV-2 genome is translated into two large polypeptides that are cleaved by two viral proteases, MPro and PLPro, to create proteins, as well as the creation of DNA fragment RNAs that carry additional accessory proteins in addition to the four protein molecules. These enzymes are required for virus assembly, integration, and release. We examined the antibacterial efficacy of a variety of small compounds that target host stress response pathways in an effort to inhibit infection by the SARS-CoV-2 beta-coronavirus and other emerging deadly viruses. Cannabidiol (CBD), a member of the cannabinoid class of natural compounds, is one possible regulator of host stress and antiviral inflammatory responses. Cannabis sativa (Cannabaceae; marijuana/hemp) produces CBD.
Cannabis plants or products generated from them that contain 0.3 per cent or less of the psychoactive tetrahydrocannabinol (THC) and often have a high CBD concentration are referred to as hemp. Marijuana, on the other hand, refers to C. Sativa materials containing greater than 0.3 per cent THC by dry weight. CBD increases the potency of THC's impact by attaching to the cannabinoid receptor. Despite countless research and a slew of often unfounded claims about CBD-containing products, the biology of CBD remains a mystery, and precise targets are mostly unknown. On the other hand, an oral CBD solution is an FDA-approved medicine, primarily for the treatment of epilepsy. As a result, CBD has drug status, is a potential treatment, and cannot be sold in the United States as a dietary supplement. Some studies have found that some cannabinoids have antiviral properties against the hepatitis C virus (HCV) and other viruses, albeit the evidence is limited.
It aims to use methods that provide us with facts and meanings, as compared to other methods that are used in the positivist method that only consists of the data and numbers. For this, we will need to have a clear idea and opinion on how CBD helps with blocking SARS-COV-2 so that we can use this to analyse the data that we will collect ourselves. Having a clear understanding of each aspect of medicinal research is vital. Pallas (2001) has stated that all aspects of any research process are usually informed by the researcher's epistemology. Since we will be examining the effect of CBD on the SARS-COV-2, careful consideration should be made towards looking at how they perform and discussing the aspects that surround it on the whole.
Once we have built the hypotheses and set up the research questions, the next step is to find the right tools or methods to conduct the research. Finding the right kind of tool or approach is vital when collecting the data that will help answer the questions that we aim to solve.
The research also aims to find out that cannabis offers more than a high that has been known for millennia. Hemp is a traditional medicinal plant that contains a colourful mix of terpenes, flavonoids and, most importantly, cannabinoids. About 100 of these cannabinoids have been studied so far, and the most well-known is certainly the intoxicating tetrahydrocannabinol (THC). Cannabidiol, or CBD for short, unfolds its medical effects without any intoxication. It is a potent pain reliever, relieves anxiety, can prevent epileptic seizures and has an anti-inflammatory effect. According to a study by Oregon State University, its herbal precursor CBDA, the acid of cannabidiol and another cannabinoid - cannabigerol acid (CBGA) - even work against SARS-CoV-2. The two acids bind to the spike protein of the virus and thus prevent the virus from docking to the cells. The scientists are convinced that the two natural substances should help prophylactically against the infection and alleviate the symptoms of a disease that has already broken out - albeit only to a limited extent. The researchers emphasise that they cannot replace vaccination.
Sars-CoV-2 uses a special way to penetrate the cells of the body, particularly effectively. Variants with major mutations in the spike protein are listed by the WHO as "variants of concern". Other errors in the genetic sequence can help the virus make more copies in human cells. Coronaviruses were first discovered in humans in the 1960s and are responsible for about ten percent of the common colds. Coronaviruses use a protein on their outer shell to penetrate the cells of the body.
Sars-CoV-2 binds ten to twenty times more strongly to this receptor than the first Sars epidemic. Pathologists at the University Hospital Zurich discovered that the Covid 19 deceased did not only suffer from inflammation of the lungs. The inflammation affects the entire vascular system (endothelium) of various organs. The endothelium of younger patients usually copes well with the attack of the virus, report the Zurich researchers. Research into whether the mechanism via the ACE2 receptors is one of the reasons for the higher mortality with Sars-CoV-2 will take years. Virus variants are considered "worrying" if, for example, they are more contagious or if the immune system of people who have already recovered is less able to fight them.
In December 2019, in the city of Wuhan, China, a new outbreak of pneumonia of unknown origin emerged, which has spread rapidly around the world. This new pneumonia managed to be isolated, and its genome was sequenced, receiving the name of SARS-CoV-2 or COVID-19 (Huh et al., 2020). The new coronaviruses cause mild respiratory illnesses in humans, but can also cause fatal respiratory illnesses. The incubation period ranges from 2 to 19 days, with a mean of 5.2 days. The specific reasons for the failures of personal protective equipment (PPE) in health equipment should be investigated.
Typical symptoms are fever, dry cough, myalgia, fatigue, and dyspnea with an abnormal chest tomography (CT) showing bilateral pneumonia, ground-glass opacity, and/or bilateral irregular shadows. According to data in China, 15% - 25% of their cases are severe. The global SARS-CoV-2 mortality rate is 0.39% - 17.9%. An adjustment made to the Wuhan data shows a mortality rate of 20% (Baud et al., 2020). In China, as of March 21, 14.8% was reported in ≥80 years, and 0% in ≤9 years.
COVID-19 binds to the human angiotensin-converting enzyme II (ACE II) receptor but cannot bind to cells that do not express this receptor. Organs with a high ACE II receptors expression should be considered a potential risk of infection.
It is estimated that around the world, there are about 200 drugs under investigation to combat SARS-CoV-2. Not all drugs are safe, nor are they all used under the same conditions. A large number of studies are underway, most of them sponsored by the World Health Organization. In Spain, the Carlos III hospital keeps an account of more than a hundred research projects aimed at curbing Covid-19. Covid-19 was listed as the "star drug" against SARS-Cov due to the first preliminary studies that were made public.
The Administration of Medicines and Drugs of the United States approved on May 1 its use for patients in an advanced stage of the disease. In Spain, the AEMPS alleges that "it is a drug not well characterized" and warns that its main adverse reaction is infusion hypotension. The immune system is our main defensive weapon against the virus. The key here is to find a molecule capable of extinguishing that excessive inflammation caused by cytokines without crippling our defenses. One of them is omicron, a molecule that neutralizes the biological activity of interleukin-1 (IL1), the cytokine responsible for local inflammations.
Other potential drugs with the ability to 'appease' the immune system without harming it are chloroquine and hydroxychloroquine. Chloroquine has been one of the star drugs of the pandemic, driven above all by public statements by senior political leaders. The AEM warns that "different studies are being carried out to evaluate its efficacy and safety". In addition to this adverse effect, health authorities, including the Spanish Ministry of Health, has warned medical professionals that these drugs could also cause acute psychosis.
The AEMP reports that in March, this drug was included in the seventh updated diagnosis and treatment plan for SARS-CoV-2 issued by the National Health Commission of China. Another drug in the clinical trial phase is tocilizumab (TCZ), an inhibitor of IL-6. This drug is used primarily to reduce the need for patients to receive mechanical ventilation. There are studies in China that have proven its efficacy, although with a limited number of patients. Monoclonal antibodies are treatments proven with success in other diseases, such as cancer or Ebola.
One of the most interesting conclusions is that a team of researchers from the University of Utrecht produced antibodies that could neutralize the new Coronavirus. The results of research like this could take a definitive step that helps us permanently fight the virus until the world has an effective vaccine.
The medicinal effects of hemp are mainly due to the ingredients tetrahydrocannabinol (THC) and cannabidiol (CBD). THC has an intoxicating and relaxing effect, and it can reduce nausea. CBD has an anti-anxiety effect and can reduce inflammation. Cannabis has been examined for the following diseases or ailments, among others. Cannabidiol (CBD) is approved for a rare form of epilepsy but is advertised as an aid for many ailments.
The most common side effects of using CBD include tiredness and poor concentration. Cannabis increases the risk of getting mentally ill and developing delusions (psychosis). One in three people discontinue long-term treatment with cannabis because of side effects. One person dies from chronic obstructive pulmonary disease (COPD) every ten seconds around the world. There is no solid research on cannabis products (especially CBD) in the treatment of COPD.
CBD has shown great promise in relaxing airway muscles, allowing more oxygen to pass through, and reducing anxiety and shortness of breath. It is expected to become the third leading cause of death in the world by 2030.
Tobacco smoke is mainly due to COPD is tobacco smoke (including passive smoking) and indoor air pollution. The most valuable gene mutation that causes this disease is an α-1-antitrypsin deficiency, which is the main cause of emphysema in non-smokers. Chronic obstructive pulmonary disease develops slowly and manifests itself in people over 40-50 years of age. It can be complicated by the following conditions:. Severe weight loss, severe asthma, cough, and episodes of sputum secretion.
Smoking cessation is the most effective and economical treatment for smokers' chronic obstructive pulmonary disease (COPD). Smoking cessation will delay the progression of the disease and reduce deaths from causes related to COPD. Some (but not all) patients benefit from inhaled corticosteroids. A 2014 study in mice showed cannabidiol (CBD) could help reduce inflammation and improve lung function in mice with damaged lungs. A study by Scott Shannon and others found that CBD helped 72 people with anxiety and sleep disorders, making them feel more relaxed and less worried. CBD has been shown to disrupt biofilms, a physical form of bacterial growth that causes infections that are difficult to treat.
SARS-COV-2 is one of many coronavirus that have appeared in recent times. Coronaviruses are defined to be enveloped RNA viruses that can be broadly distributed across various animals and humans alike. Lu et al (2020) state that each of these viruses can cause acute and chronic diseases which can kill individuals if they are fatal. Prior to COVID-19, there were only six recognised human coronavirus. SARS-COV-2 was first transmitted when a man in Wuhan ate one of the bats that contained the virus, which led to the current pandemic.
The genomes of it are able to latch on to the respiratory tracts of the human lungs, similar to SARS and MERS. It has the same cellular receptor as SARS, i.e. ACE2, which suggests that it has a similar route of entry as Sars and the same tropism as well, as stated by Lu et al (2020). Petrosillo et al. (2020) notes that SARS generally has a less severe clinical picture, which can attribute to how it is easily transmissible compared to the likes to MERS and SARS. Covid-19 is considered a systemic disease, which means it can infect any other part of the body, not just the lungs.
Long-term Covid is used to explain cases of complications and sequelae due to Covid. CBD is an active ingredient in marijuana and has no mental effect. It can be used as an anti-inflammatory agent in the prevention and treatment of lung diseases. SARS-COV-2 was able to cause a global outbreak in three months after the first set of cases were reported in Wuhan, China. The majority of infected people only show mild-to-moderate symptoms such as shortness of breath, or in many cases, nothing.Only 5-10% of the infected individuals show the complete respiratory syndrome called COVID-19. This has mostly contributed to how the infected but asymptomatic people have spread within each other.
Research philosophy is considered to be a system of researcher's thoughts that can be used to get the right and reliable knowledge. It acts as the basis for determining the strategy that we will use, how we will understand and evaluate the problem, and then collect and analyze the data. According to Cecez-Kecmanovic, the two major philosophies that we can use consist of the positivist approach and interpretivist approach. The interpretivist approach is concerned with getting a clear understanding of the world based on the viewpoint of the individual conducting the research. Qualitative research deals with data that is in the form of words and texts rather than dealing with any numeric data, unlike quantitative research. As such, conducting qualitative research will be necessary when it comes to examining how CBD helps and also any other facets that can deter against the use of CBD.
After SARS-CoV-2 enters the body, it binds to the ACE2 receptor of respiratory epithelial cells through the S protein. When type II alveolar cells die, they release specific inflammatory mediators, stimulate immune cell activation. Immune cells secrete a large amount of IL-1, IL-6 and tumor necrosis factor (TNF-α) leading to cytokine storm or cytokine release syndrome. In order to alleviate cytokine storms, some studies have proposed to use IL-6 receptor antagonists to treat patients. After SARS-CoV-2 infection, pulmonary macrophage infiltration, extensive activation of complement and platelets, up-regulation of inflammation-related cytokines and interferon gene ISG, as well as vascular endothelial damage and thrombosis were found. (Zhang et al., 2019) performed whole-genome sequencing or whole-exome sequencing in blood samples from 659 severe and 534 mild or asymptomatic COVID-19 patients to detect deletions in TLR3 and IRF7-related genes. The team also found that about 10% of severe patients had self-neutralizing antibodies against type I IFNs. The incubation period of SARS-CoV-2 is 2-14 days, and the median incubation time is 5.7 days (Prather et al., 2020), so the general isolation time is 14 days. In addition to social distancing, prevention strategies should emphasize wearing masks and maintaining indoor ventilation. The elderly over 68 years old and those with underlying diseases are more seriously ill after infection (Oran & Topol, 2020).
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