Shot of senior residents building a puzzle in a retirement home
A new study has found a molecule that could serve as a biomarker to identify those at greater risk of developing dementia in later life. It could also help scientists develop preventive treatments.
Dementia is a debilitating condition that involves the progressive decline of memory, communication, and thinking.
Globally, the number of people with this condition has more than doubled, rising from 20.2 million in 1990 to 43.8 million in 2016.
The most common form of dementia is Alzheimer’s disease, which accounts for 60-70% of all cases. As populations age, the prevalence of Alzheimer’s and other forms of dementia is expected to continue rising.
Currently, once symptoms occur, they cannot be reversed. With this in mind, researchers are exploring ways to diagnose the condition years or even decades before it develops, and find drugs to prevent its progress.
One promising biomarker of Alzheimer’s is a molecule that circulates in the blood, known as asymmetric dimethylarginine (ADMA).
By inhibiting an enzyme called nitric oxide synthase, ADMA reduces the amount of nitric oxide synthesized by the endothelial cells that line blood vessels.
The role of nitric oxide is to dilate blood vessels, increasing blood flow. When levels are abnormally low, it restricts blood flow to tissues, starving them of oxygen and triggering inflammation.
The importance of childhood intelligence
Low levels of nitric oxide are linked to the development of atherosclerosis, cardiovascular disease, and Alzheimer’s. A few small studies have also found a link between high concentrations of ADMA and cognitive decline in older people.
However, none of these studies have adjusted for the effect of low intelligence in childhood, which accounts for up to 50% of cognitive decline in old age.
Now, researchers at the University of Aberdeen and the University of Oxford in the United Kingdom, and Flinders University in Melbourne, Australia, have found a breakthrough.
They analyzed data from 63-year-olds, who had all taken the same mental ability test at Scottish schools in 1947 when they were 11 years of age.
Two decades ago, the 1936 Aberdeen Birth Cohort was established by medical researchers to follow this unique set of people.
Between 2000 and 2004, 93 of them took part in a research project to study cognitive aging and health. Blood samples were taken in 2000, and the participants underwent a series of cognitive tests at regular intervals over the next 4 years.
After adjusting for their childhood intelligence testscores, the authors of the new study found a link between raised ADMA concentrations in their blood and a decline in cognitive performance four years later.
Poor cognitive performance late in middle age is an established risk factor for the development of dementia.
“Therefore the results of this study suggest that ADMA, an easily measurable marker of atherosclerosis and cardiovascular risk, could be an early indicator of cognitive decline in old age — and possibly dementia,” says study authorProf. Arduino Mangoni, head of clinical pharmacology at Flinders University.
However, the study accounts for too few participants to draw definitive conclusions.
“We should be cautious about emphasizing the results with the 93 participants’ results here,” says lead author Dr. Deborah Malden, from the Nuffield Department of Population Health at the University of Oxford.
“We would know much more after repeating this study in a large-scale cohort, potentially tens of thousands of individuals.”
Future research could include genetic information about participants and involve repeated measurements of ADMA at regular intervals, rather than the single analysis used in this study.
Ideally, there would also be follow-up with participants for longer than 4 years.
In addition, the present study could not rule out the possibility of reverse causality. In other words, individuals with early dementia may have changed their resulting behavior, which in turn could have affected their ADMA levels.
Shared pathway
If future research confirms the results of this preliminary study, however, existing drugs could be deployed as preventive treatments.
The investigators write:
“Importantly, ADMA concentrations can be modulated by pharmacological interventions, and therefore ADMA may prove valuable as a future prevention strategy for dementia and [Alzheimer’s disease].”
Intriguingly, previous studies suggest that high levels of ADMA in the bloodstream are a common factor in the development of a wide range of diseases, say the researchers.
High concentrations are linked to type 2 diabetes, chronic obstructive pulmonary disease (COPD), and depression, as well as cardiovascular disease and dementia.
This suggests that a single drug could help address the wide range of medical conditions that develop from this shared metabolic pathway.
A review suggests smoking and vaping could increase the severity of COVID-19 due to blood vessel damage and a higher risk of stroke.
“There is a growing body of evidence to suggest that, as well as the respiratory symptoms of COVID-19, the disease can also cause, among others, neurological effects.”
A recent report from a neurological hospital in the United Kingdom identifies cases of delirium, brain inflammation, nerve damage, and stroke in COVID-19 patients.
Reports of stroke in COVID-19 are particularly prevalent. Some reports estimate that 30% of critically ill COVID-19 patients experience blood clots. And if they occur in the brain, they may trigger a stroke.
Researchers from Texas Tech University Health Sciences Center previously found that smoking and vaping increases the risk of viral infection. They have now published a review on how these activities might affect the risk of neurological dysfunction in COVID-19, particularly from damage to blood vessels in the brain.
They found that both smoking and vaping could increase the risk of stroke in COVID-19 due to damage to the blood-brain barrier and a higher risk of blood clots.
Smoking causes well-known damage to the lungs and respiratory system. Previous research has shown that it also makes a person more vulnerable to influenza.
Smoking can also affect the vascular system in the brain, prompting the researchers to review the evidence on how this activity might influence the neurological symptoms of people who contract COVID-19.
They first looked at the evidence on SARS-CoV-2 and neurological disorders, including stroke. They found one study which showed that 36.4% of COVID-19 patients had neurological symptoms. Another paper found five cases of sudden stroke in COVID-19 patients aged 30–40 years due to abnormal blood clotting in their large arteries.
But how does this relate to smoking? The researchers explain that when the body is deprived of oxygen, which occurs with smoking, the amount of clotting factors in the blood increase.
In combination with COVID-19, which also increases blood-clotting proteins, the risk of stroke rises.
“COVID-19 seems to have this ability to increase the risk for blood coagulation, as does smoke. This may ultimately translate in higher risk for stroke.” – Luca Cucullo, Ph.D., Center for Blood-Brain Barrier Research, Texas Tech University Health Sciences Center
What about vaping?
Although there is less evidence around vaping, the authors found studies that show vape aerosol components can harm blood vessels in the brain.
Vaping also appears to affect the blood-brain barrier, the defensive structure which protects the brain from toxins and pathogens in the blood.
The researchers also found specific evidence that long-term vaping may increase the risk of stroke.
Vaping may also make a person more vulnerable to COVID-19 by increasing the number of ACE2 receptors expressed in the body, which are used by the novel coronavirus to infect cells. Smoking can also increase expression of the ACE2 receptor, and damages the blood-brain barrier.
More research needed
The authors conclude that smoking and vaping may increase the severity of COVID-19 by increasing expression of the ACE2 receptor, which allows the virus to infect more cells. They were also found to damage the blood-brain barrier, which increases the risk of neurological complications.
There is an elevated risk of stroke in COVID-19 patients who smoke due to increased blood clotting factors in the blood.
However, the authors say more research is needed, including comparisons of autopsy samples from COVID-19 patients who did or did not smoke, and further animal studies.
A new study shows that a compound in pickled capers activates channels that are important for the activity of the heart and brain. The findings could potentially lead to the design of new drugs for epilepsy and arrhythmia.
People have practiced traditional or folk medicine — which the Western world generally considers alternative medicine — for centuries, and it remains the mainstay of healthcare in many countries.
Much traditional medicine relies on the use of plants, which have been the basis of medical treatments for thousands of years. Sometimes, researchers examine this traditional knowledge, interpret it in modern scientific terms, and then translate it into Western medicine.
Aspirin, for example, comes from willow plants and has played a role in medicine since ancient Egyptian times, long before people understood its mechanism of action.
A new study from the University of California, Irvine School of Medicine shows a similar story for capers, which people around the world consume and also use in traditional medicine.
The study, which appears in Communications Biology, finds that a compound in pickled capers activates potassium channels that regulate the activity of the heart and brain.
The researchers say that their findings could aid the design of new drugs for epilepsy and arrhythmia (abnormal heart rhythms).
A food with ancient origins
The authors of the study note that humans have been eating capers for more than 10,000 years. Findings in soil deposits in Syria and late Stone Age cave dwellings in modern day Greece and Israel have shown this to be true.
The ancient Roman cookbook “Apicius” also mentions capers. People continue to use them in traditional medicine for their antihelminthic, anticancer, antidiabetic, and anti-inflammatory properties and their possible circulatory and gastrointestinal benefits.
The research team behind the current study has now shown how capers act on the body, which includes activating a potassium channel important for heart and brain activity.
The researchers started looking at capers based on the results from a screen of plant extracts. They screened a range of extracts for activity on a family of potassium channels called KCNQ channels.
The KCNQ family of potassium channels plays several important roles in the body, including regulating the heartbeat, the contraction of muscles, and the function of the gastrointestinal tract. Their dysfunction is associated with certain diseases, including diabetes, arrhythmia, and epilepsy.
The importance of pickling
The researchers used an extract from pickled capers, the most common form in the United States, and found that a 1% extract was able to activate the channels.
The pickling process causes the formation of quercetin, which is the compound that activates KCNQ channels.
Further experiments with quercetin found that it binds to a part of the channels responsible for sensing electrical activity. This binding causes the channels to open when they would otherwise be closed, which may underlie the medicinal properties of capers.
Although capers are the richest natural source of quercetin, the authors note that other plant-derived compounds, such as E-2-dodecenal (present in cilantro), are more potent activators of KCNQ channels.
However, the authors also found that these compounds can work together. So, while eating capers alone may not have a significant effect, eating them together with other specific foods, such as cilantro, could increase their benefits.
Quercetin is also very common in food, being present in apples, berries, celery, chili peppers, and onions, as well as green tea and red wine. The compound may, therefore, accumulate in the body over time to provide benefits. Research has also shown that adding quercetin to food is safe, although this practice does not currently exist in the U.S.
Drugs to treat epilepsy and arrhythmia
Outside of food, the researchers say that their findings could help medicinal chemists design new drugs.
“Increasing the activity of KCNQ channels in different parts of the body is potentially highly beneficial. Synthetic drugs that do this have been used to treat epilepsy and show promise in preventing abnormal heart rhythms.” – corresponding author Geoffrey Abbott, Ph.D.
Researchers are also investigating capers for their potential benefits against cancer, diabetes, and various inflammatory, circulatory, and gastrointestinal diseases. Understanding how capers act on the body on a molecular level could, therefore, lead to a wide range of new treatments.
A new study has found that cannabis may improve the mood of people who experience chronic pain from sickle cell disease.
New research suggests that cannabis may help improve the mood of people with chronic pain from sickle cell disease. This proof of principle study also found that cannabis was a relatively safe intervention.
The research, published in the journal JAMA Network Open, paves the way for future studies to verify the initial findings and expand the investigation on cannabis-based interventions on chronic pain.
According to the Centers for Disease Control and Prevention (CDC), sickle cell disease is a type of red blood cell disorder that causes the cells to become misshapen and look similar to the crescent shape of a sickle.
Sickle red blood cells die sooner than normal cells, which means less oxygen is transported throughout a person’s body. Furthermore, sickle cells tend to clog smaller blood vessels, resulting in acute or chronic pain, infection, and other serious cardiovascular issues.
According to the CDC, treatments for mild pain from sickle cell disease include over-the-counter analgesics, such as ibuprofen and aspirin.
For people in more severe pain from this condition, doctors can often prescribe daily opioid medications, such as morphine. However, opioids come with various side effects and risks, including addiction and overdose.
Consequently, it is important to find other ways of managing the pain associated with sickle cell disease.
Addressing a research gap
In the United States, cannabis is increasingly popular as an analgesic. It is legal for medicinal use in 33 states, as well as the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.
Cannabis use as an analgesic has been found to have the best evidence base compared with its use for other interventions. However, the authors of this study note that there are relatively few human studies that explore the use of cannabis as a treatment for pain from chronic health conditions.
To address this issue, the authors developed a double-blind, placebo-controlled, randomized proof of principle study. Their aim was to test the hypothesis that cannabis can effectively relieve chronic pain in adults with sickle cell disease, compared with placebo.
The study enrolled participants who had sickle cell disease and were receiving an opioid analgesic to manage their pain.
Participants were also required to have prior experience of smoking cannabis to ensure that they would be able to inhale the medication and would recognize its effects. However, people currently using cannabis were asked to discontinue their use 1 week before the trial began.
However, the team excluded those who declared themselves to have serious health issues or substance use disorders.
This resulted in a study group of 27 participants, of whom 23 completed the full trial. The researchers included these individuals in the analysis of the results.
During the trial, participants made two 5-day trips to an inpatient research center that were at least 30 days apart. They inhaled either vaporized cannabis or a vaporized placebo three times a day.
During this period, the researchers assessed participants’ pain levels and the interference of pain in a range of daily activities and mood. They also monitored the side effects.
Reducing the effect of pain on mood
The researchers found that inhaled, vaporized cannabis did not significantly improve the intensity of participants’ experience of pain compared with a placebo.
However, they observed that when participants inhaled vaporized cannabis, the pain interfered less with the participants’ mood.
Finally, cannabis use did not have any significant adverse side effects compared with the placebo.
According to Dr. Kalpna Gupta, Professor of Medicine at the University of California Irvine’s Center for the Study of Cannabis and co-lead author of the study:
“These trial results show that vaporized cannabis appears to be generally safe. They also suggest that sickle cell patients may be able to mitigate their pain with cannabis — and that cannabis might help society address the public health crisis related to opioids. Of course, we still need larger studies with more participants to give us a better picture of how cannabis could benefit people with chronic pain.”
This research does have limitations. As a proof of principle study, it only had a small number of participants, meaning that larger studies are necessary to verify its findings.
Furthermore, aside from the short treatment duration, the participants took the vaporized cannabis three times a day during the study. This might not reflect how people typically use medical cannabis to manage their pain.
However, the research findings show promise for the development of new treatments to manage chronic pain.
Medical experts have warned that non-communicable diseases (NCDs) such as hypertension, diabetes, cancer, cardiovascular diseases are responsible for the majority of Coronavirus disease (COVID-19) deaths in the country.
President, NCD Alliance Nigeria, Olorogun Dr. Sonny F. Kuku, in his opening remarks during a webinar on, “Non-communicable Diseases and COVID-19 in Nigeria – The response”, held Tuesday, July 21, 2020, said: “… We are only seeing the tip of the iceberg and unfortunately, people with NCDs are at greater risk. It is impacting the poorest people and most vulnerable. People with hypertension, diabetes and heart disease are the most vulnerable. We are now seeing stroke as symptom. This means COVID-19, which is an infectious disease is manifesting as an NCD in the form of stroke…”
Vice President, Scientific Affairs, NCDs Alliance Nigeria, Dr. Kingsley Akinroye, has said blamed the situation on the nation’s years of lack of commitment to the course of NCDs. The cardiologist said NCDs account for 29 per cent of deaths in Nigeria.
Akinroye, at the launch of the New Civil Society Solidarity Fund on NCDs in response to COVID-19, harped on the need to strengthen the healthcare system, intensify awareness, increase access to care and treatment, and vote more money for NCDs care and management.
However, the NCD Alliance Nigeria and 19 other global and national NCD Alliances have been awarded $300,000.
Akinroye added that regional and national NCD Alliance including NCD Alliance Nigeria would get $15,000 to address the critical needs of people living with NCDs during the pandemic through advocacy and communication activities that would support stronger organisational stability and resilience
According to the cardiologist, COVID-19 shows many connections between it and NCDs stating that people living with NCDs are more vulnerable to COVID-19 with a substantially higher risk o becoming severely ill or dying from the virus.
The expert said that actions taken to control NCDs in Nigeria include the launch o the First Multi-Sectoral Action Plan or Prevention and Control o NCDs by the Federal Ministry of Health (FMoH) and the NCD Alliance Nigeria Publication of the Handbook on Civil Society Organisation in NCDs.
“Activities in Nigeria will include the development of a database of people living with NCDs in Lagos, Osun, and Federal Capital Territory and by NCD area of focus. Also, establishment and support for people living with NCDs with skills and knowledge, and connect them to NCD Alliance Nigeria, federal Ministry o Health, World Health Organisation and State Ministry of Health in the four states,” he added.
Akinroye further stated that they would build capacity for people living with NCDs on advocacy for their rights to health, prevention, access to treatment and care; provision of support and empowerment
He explained that NCD Alliance Nigeria would develop a directory and a database in the states by area of focus cardiovascular disease, diabetes, cancer, sickle cell disease, respiratory diseases and mental health and also develop advocacy communication materials targeting Lawmakers, Policymakers and opinion leaders that are persuasive and effective to improve prevention, care and access to treatment for people living with NCDs.
The expert, however, tasked the Presidential Taskforce on COVID-19 to mobilise for more testing and awareness amongst the grassroots and also provide free hypertensive and diabetic drugs or the vulnerable population.
Executive Director, NCD Alliance Nigeria, Prof. Akin Osibogun, also presented a paper on “NCDs in Nigeria and COVID-19: The Nigerian experience.”
Osibogun is a consultant public health physician/epidemiologist, a member of Lagos State COVID-19 Response Team and former Chief Medical Director (CMD), Lagos University Teaching Hospital (LUTH) Idi Araba.
Member, Nutrition Committee, Nigerian Heart Foundation (NHF) and Food Scientist, Prof. Isaac Adebayo Adeyemi, spoke on “COVID-19 and Nutrition: Gathering evidence.”
Akinroye delivered a paper on “People Living with NCDs in Nigeria and COVID-19.”
Adeyemi, who is Vice chancellor of Bells University of Technology Ota, Ogun State, and the pioneer Deputy Vice-Chancellor, Ladoke Akintola University of Technology (LAUTECH), Ogbomoso, Oyo State, said functional foods are important to boost the immune system.
Adeyemi said that a well functioning immune system is key to providing robust defence against pathogenic organisms. Adeyemi noted that mortality in people living with NCDs is likely the result of immune decline or impaired immune response.
The expert said that energy is required to fight the virus likewise, protein to produce essential antibodies.
He encouraged intake of Phytochemicals like quercetin from onions, phloretin and also Epigallocatechin gallate (EGCG) as well as conventional foods containing bioactive food compounds like vegetables, fruits, grains, dairy, fish and meat.
“Eat fresh and unprocessed food every day like fruits and vegetables, legumes and whole grains and animal products. Eat a moderate amount o fats and oils. Eat at home to reduce your rate of contact with other people,” he added.
Adeyemi urged the consumption of plant food such as grains, legumes and oilseeds, fruits and vegetables containing vitamins, minerals, fibre and phytochemicals.
He, however, stressed on the need to avoid the intake of caffeine, trans fat while also limiting the intake of salt because they are predisposing factors that contribute to morbidity o patients with COVID-19.
According to a study published in Scholars Journal of Applied Medical Sciences and titled “COVID-19 and Nutrition: Review of Available Evidence”, nutritional support is indicated for depleted patients with respiratory diseases because it provides not only supportive care, but direct intervention through improvement in respiratory and peripheral skeletal muscle function and in exercise performance.
The researchers noted: “A combination of oral nutritional supplements and exercise or anabolic stimulus appears to be the best approach to obtaining significant functional improvement. Patients responding to this treatment even demonstrated a decreased mortality. Furthermore, weight loss and malnutrition opens the door of infection reoccurrence. Poor response was related to the effects of systemic inflammation on dietary intake and catabolism.
“Dietary management of pre-existing diseases has been suggested as a strategy to minimise the potential risk of COVID-19 infection in conditions such as irritable bowel syndrome, Crohn’s and Colitis. WHO, dietetic associations and dietitians have been calling for patients with pre-existing conditions to continue abiding by their dietary advice and nutritional therapy steps received from their dietician if tested positive for COVID-19.”
Meanwhile, according to a World Health Organisation (WHO) survey, prevention and treatment services for NCDs have been severely disrupted since the COVID-19 pandemic began. The survey, which was completed by 155 countries during a three-week period in May, confirmed that the impact is global, but that low-income countries are most affected.
This situation is of significant concern because people living with NCDs are at higher risk of severe COVID-19-related illness and death.
Director-General of the WHO, Dr. Tedros Adhanom Ghebreyesus, said: “The results of this survey confirm what we have been hearing from countries for a number of weeks now.
“Many people who need treatment for diseases like cancer, cardiovascular disease and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”
The main finding is that health services have been partially or completely disrupted in many countries. More than half (53 per cent) of the countries surveyed have partially or completely disrupted services for hypertension treatment; 49 per cent for treatment for diabetes and diabetes-related complications; 42 per cent for cancer treatment, and 31 per cent for cardiovascular emergencies.
Rehabilitation services have been disrupted in almost two-thirds (63 per cent) of countries, even though rehabilitation is key to a healthy recovery following a severe illness from COVID-19.
In the majority (94 per cent) of countries responding, ministries of health staff working in the area of NCDs were partially or fully reassigned to support COVID-19.
The postponement of public screening programmes (for example for breast and cervical cancer) was also widespread, reported by more than 50 per cent of countries. This was consistent with initial WHO recommendations to minimize non-urgent facility-based care whilst tackling the pandemic.
But the most common reasons for discontinuing or reducing services were cancellations of planned treatments, a decrease in public transport available and a lack of staff because health workers had been reassigned to support COVID19 services. In one in five countries (20 per cent) reporting disruptions, one of the main reasons for discontinuing services was a shortage of medicines, diagnostics and other technologies.
Unsurprisingly, there appears to be a correlation between levels of disruption to services for treating NCDs and the evolution of the COVID-19 outbreak in a country. Services become increasingly disrupted as a country moves from sporadic cases to community transmission of the coronavirus.
Globally, two-thirds of countries reported that they had included NCD services in their national COVID-19 preparedness and response plans; 72 per cent of high-income countries reported inclusion compared to 42 per cent of low-income countries. Services to address cardiovascular disease, cancer, diabetes and chronic respiratory disease were the most frequently included. Dental services, rehabilitation and tobacco cessation activities were not as widely included in response plans according to country reports.
Seventeen percent of countries reporting have started to allocate additional funding from the government budget to include the provision of NCD services in their national COVID-19 plan.
Encouraging findings of the survey were that alternative strategies have been established in most countries to support the people at the highest risk to continue receiving treatment for NCDs. Among the countries reporting service disruptions, globally 58 per cent of countries are now using telemedicine (advice by telephone or online means) to replace in-person consultations; in low-income countries, this figure is 42 per cent. Triaging to determine priorities has also been widely used, in two-thirds of countries reporting.
Also encouraging is that more than 70 per cent of countries reported collecting data on the number of COVID-19 patients who also have an NCD.
Director of the Department of NCDs at WHO, Dr. Bente Mikkelsen, said: “It will be some time before we know the full extent of the impact of disruptions to health care during COVID-19 on people with NCDs.
“What we know now, however, is that not only are people with NCDs more vulnerable to becoming seriously ill with the virus, but many are unable to access the treatment they need to manage their illnesses. It is very important not only that care for people living with NCDs is included in national response and preparedness plans for COVID-19 – but that innovative ways are found to implement those plans. We must be ready to ‘build back better’- strengthening health services so that they are better equipped to prevent, diagnose and provide care for NCDs in the future, in any circumstances.”
According to the WHO, NCDs kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, 15 million people die from an NCD between the ages of 30 and 69 years; more than 85 per cent of these “premature” deaths occur in low- and middle-income countries.
Scientists have discovered and evaluated more herbal remedies for the prevention and treatment of Coronavirus disease (COVID-19).
Researchers have in recent studies demonstrated how cannabidiol (CBD), a cannabis compound, could help avert lung destruction in coronavirus patients as well as mitigate sickle cell disease pain.
They also found that nutritional supplements made of turmeric compound, curcumin, and artemisinin from Artemisia annua plant, ginger with vitamin C, zinc, soybean among other natural products could help protect against viral infections including COVID-19.
Also researchers at Imo States University, Owerri, have identified potential plants for treatment and management of COVID-19 in Nigeria.
The study focused on some plants containing bioactive compounds that showed promising results against previous coronaviruses. Potential plants identified include Zingiber officinale (ginger), Allium cepa (onions), Allium sativum (garlic), echinacea, Euphorbia hirta (asthma herb), Garcinia kola (bitter kola), Curcuma longa (turmeric), Aloe vera and Olea europaea.
The study was published in Academic Journal Chemistry.
The researchers wrote: “Although inhibition of viral replication is seen as the possible mechanism for antiviral activity of most of the natural compounds, recent research has shown that some natural compounds can interact with major viral proteins associated with virulence. Thereby, showing they could be a valuable tool for possible inhibition, management and treatment of SARS-CoV-2. However, further research is required to investigate and validate their potential use as anti-SARS-CoV-2.”
Also, researchers have developed a protocol for the prevention and treatment of COVID-19 called Covalyse.
The study published by Jean-Noël Mputu Kanyinda of the University of Kinshasa, Democratic Republic of Congo noted: “… Based on our current knowledge of this virus and in the absence of a vaccine, this article is an attempt to propose ways to prevent, treat and control the COVID-19 virus, using medicinal plants such as Eucalyptus globulus (eucalyptus), Cymbopogon citratus (lemongrass), Mentha, citrus lemon/medica (lemon/lime), Zingiber officinale (ginger), Syzygium aromaticum (cloves), which have been shown to be effective.”
Also, MGC Pharmaceuticals will be testing the efficacy of treating COVID-19 patients using an oral spray made of curcumin and artemisinin – a bioactive derived from the Artemisia annua plant, in clinical trials.
Known as ArtemiC, the new product is jointly developed by MGC and Switzerland firm Micelle Technology based on a product originally developed by the latter. New adaptations have been made to the product in response to COVID-19.
The supplement, which also contains vitamin C and Boswellia serrata, will be tested on COVID-19 patients in Israel’s Nazareth Hospital EMMS.
Meanwhile, researchers found CBD reduced the cytokine storm and excessive lung inflammation that is killing many patients with COVID-19.
The study was published in the journal Cannabis and Cannabinoid Research.
While more work, including clinical trials to determine optimal dosage and timing, is needed before CBD becomes part of the treatment for COVID-19, researchers at the Dental College of Georgia and Medical College of Georgia (MCG), United States, have early evidence it could help patients showing signs of acute respiratory distress syndrome (ARDS) avoid extreme interventions like mechanical ventilation as well as death.
Immunologist and interim associate dean for research at MCG and corresponding author of the study in the journal Cannabis and Cannabinoid Research, Dr. Babak Baban, said: “ARDS is a major killer in severe cases of some respiratory viral infections, including severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and we have an urgent need for better intervention and treatment strategies.”
CBD is a compound from Cannabis, also known as marijuana among other names. It is a psychoactive drug from the Cannabis plant used primarily for medical or recreational purposes. The main psychoactive component of cannabis is tetrahydrocannabinol (THC), which is one of the 483 known compounds in the plant, including at least 65 other cannabinoids, including CBD.
CBD is available without a prescription and is used to treat problems like seizures as well as Parkinson’s, Crohn’s and other conditions where pain and/or inflammation are a major factor. It is derived from the hemp and cannabis plant, which are essentially the same although hemp has a much lower concentration of the “high” producing THC. Other investigators have shown the calming effect of CBD, for example, can block IL-6 in other models of inflammatory disease.
ARDS is a rapid, severe infection of the lungs that results in widespread inflammation, shortness of breath, rapid breathing and the inability to sustain adequate oxygen levels to the body and brain. Shortness of breath and difficulty breathing are some of the early signs of COVID-19. ARDS is a major cause of death in patients who are critically ill for a variety of reasons, including common sepsis.
Co-author, physician-scientist and chief of pediatric plastic surgery at MCG, Dr. Jack Yu, said: “Our laboratory studies indicate pure CBD can help the lungs recover from the overwhelming inflammation, or cytokine storm, caused by the COVID-19 virus, and restore healthier oxygen levels in the body.”
Also, cannabis could be a safe and potentially effective treatment for the chronic pain that afflicts people with sickle cell disease, according to a new clinical trial co-led by the University of California, Irvine researcher Kalpna Gupta and Dr. Donald Abrams of UC San Francisco, United States (U.S.). The findings published in JAMA Network Open.
“These trial results show that vaporized cannabis appears to be generally safe,” said Gupta, a professor of medicine on the faculty of UCI’s Center for the Study of Cannabis. “They also suggest that sickle cell patients may be able to mitigate their pain with cannabis — and that cannabis might help society address the public health crisis related to opioids. Of course, we still need larger studies with more participants to give us a better picture of how cannabis could benefit people with chronic pain.”
Also, research published in the journal Phytotherapy Research has demonstrated the potential effects of curcumin in the treatment of COVID-19 infection.
Until now, curcumin and its analogues are the main phytonutrients of turmeric (Curcuma longa) and other Curcuma species, which are widely used around the world as culinary spices, traditional medicine as well as a popular dietary supplement ingredient due to its wide range of health benefits including anti-inflammation, anti-cancer, cardiovascular regulation, respiratory and immune system benefits.
The researchers concluded: “To sum up, this review shows that curcumin as an antiviral and anti‐inflammatory agent can be helpful for both prevention and treatment of new emerging coronavirus. However, well-designed clinical trials are needed to demonstrate the potential efficacy of curcumin against SARS-CoV2 infection and its ensuing complications.”
Another study published in the Indian Journal of Clinical Biochemistry concluded that curcumin is a wonder drug as a preventive measure for COVID-19 management.
The researchers said nutritional supplements of curcumin with vitamin C and zinc have shown promising results in boosting the natural immunity and protective defense against the coronavirus infections have been noted in many hospitalised patients in Indian setting. It is also noted that the pharmacological formulation of curcumin in the nano-emulsion system proved increased solubility and bioavailability and with enhanced antihypertensive effect.
The researchers noted: “Henceforth, it is clear that the biological properties including advance mode of drug delivery system of curcumin could be considered while formulating the pharmaceutical products and its application as a preventive measure in the inhibition of transmission of SARS-COV2 infection among humans. However, further large-scale clinical trials are warranted to understand the usefulness of curcumin for the pharmacological application in the nano-emulsion system. In conclusion, we propose that curcumin could be used as supportive therapy in the treatment of COVID19 disease in any clinical settings to circumvent the lethal effects of SARS-CoV-2.”
Researchers have also demonstrated how a novel combination of vitamin C, curcumin and glycyrrhizic acid potentially regulates immune and inflammatory response associated with coronavirus infections.
The researcher noted: “Based on recent advances in nutrients and phytonutrients research, a novel combination of vitamin C, curcumin and glycyrrhizic acid (VCG Plus) was developed that has potential against coronavirus infection….
“Therefore, our findings suggest that VCG Plus may be helpful in regulating immune response to combat coronavirus infections and inhibit excessive inflammatory responses to prevent the onset of cytokine storm. However, further in vitro and in vivo experiments are warranted to validate the current findings with system biology tools. Our current approach provides a new strategy in predicting formulation rationale when developing new dietary supplements.”
Glycyrrhizic acid (GA) is a major phytonutrient found in licorice root (Glycyrrhiza uralensis, G. inflata, G. glabra), which is considered an ingredient for both food and medicinal use in China.
Also, a study published in the Journal of General Virology showed that curcumin could prevent Transmissible gastroenteritis virus (TGEV)- an alpha-group coronavirus that infects pigs- from infecting cells. At higher doses, the compound was also found to kill virus particles.
Infection with TGEV causes a disease called transmissible gastroenteritis in piglets, which is characterised by diarrhea, severe dehydration and death. TGEV is highly infectious and is invariably fatal in piglets younger than two weeks, thus posing a major threat to the global swine industry. There are currently no approved treatments for alpha-coronaviruses and although there is a vaccine for TGEV, it is not effective in preventing the spread of the virus.
To determine the potential antiviral properties of curcumin, the research team treated experimental cells with various concentrations of the compound, before attempting to infect them with TGEV. They found that higher concentrations of curcumin reduced the number of virus particles in the cell culture.
Curcumin has been shown to inhibit the replication of some types of virus, including dengue virus, hepatitis B and Zika virus. The compound has also been found to have a number of significant biological effects, including antitumor, anti-inflammatory and antibacterial activities.
Meanwhile, pigs that eat soybean, as a regular part of their diet may be better protected against viral pathogens, a new study from the University of Illinois showed. The researchers attributed the effect to isoflavones, a natural compound in soybeans.
Porcine reproductive and respiratory syndrome virus (PRRSV) is a widespread disease that costs U.S. swine producers around $650 million every year. There is evidence that feeding soy helps protect pigs against the disease, but it’s not clear why or how it works, says Ryan Dilger, a co-author on the study and associate professor in the Department of Animal Sciences, Division of Nutritional Sciences, and Neuroscience Program at U of I.
Dilger and his collaborators previously pointed to dietary soy isoflavones as the active ingredient, and they wanted to explore that hypothesis further.
“In this study, we’re looking specifically at isoflavones and whether they have a beneficial effect on the immune response,” Dilger said. “We wanted to understand how we can take a primary protein source in a diet that’s already used for pigs and provide a practical way for producers to combat the endemic PRRSV.”
Isoflavones are a flavonoid compound that occurs naturally in plants, with a particularly high concentration in soybeans. It has well-known health benefits and is used as a dietary supplement for humans, explained Brooke Smith, lead author of the study and graduate researcher in the Veterinary Medical Scholars Program at U of I.
“When they are included in the diet of infected pigs, these isoflavones seem to be supportive by either helping the pigs clear secondary infections or setting them up for a more successful immune response so they clear the infection and don’t succumb to it,” Smith said.
The first study, “Dietary soy isoflavones reduce pathogen-related mortality in growing pigs under porcine reproductive and respiratory syndrome viral challenge,” is published in the Journal of Animal Science.
The second study, “Alterations of fecal microbiome characteristics by dietary soy isoflavone ingestion in growing pigs infected with porcine reproductive and respiratory syndrome virus,” is also published in the Journal of Animal Science.
The federal government has received $890 million as grants from the Global Fund to fight HIV/AIDS, tuberculosis and malaria.
The Minister of Health, Dr. Osagie Ehanire, said yesterday that the fund would be used to implement programmes aimed at eradicating the diseases over a three year period, from 2021 to 2023.
Ehanire said that the Global Fund also approved a grant of US$21.9 million to support Nigeria’s COVID-19 response.
He said: “The purpose of this press briefing today is to announce the receipt of a grant, made to the Federal Republic of Nigeria by The Global Fund to fight HIV/AIDS, tuberculosis and malaria, amounting to $890 million, over an implementation period of three years, beginning from 2021 to 2023.”
The minister noted that the grant, which is the largest given to any country in this funding cycle, is sequel to a successful funding request made by the Nigeria Country Coordination Mechanism (CCM).
The Global Fund for the fight against HIV/AIDS, Tuberculosis and Malaria (GF) is an innovative international financing mechanism that was established by the United Nations in 2002, with its headquarters in Geneva, Switzerland.
The fund is made up of global partnership of governments, civil societies and private donors and established for the purpose of attracting, leveraging and investing resources to fund public health interventions that would accelerate the eradication of HIV, tuberculosis and malaria in affected high burden countries to further goals of Sustainable Development Goals (SDGs).
The Global Fund has committed the sum of USD$2.586 billion since 2002 to operations in Nigeria, which are split into four program areas: HIV/AIDS, tuberculosis, malaria and the Resilient Systems Strengthening for Health, (RSSH).
Nigeria has accessed $2.436 billion, which represented 94 percent of the committed amount.
The minister said the grant would complement the investment of the government of Nigeria and of other Development Partners in HIV/AIDS, tuberculosis and malaria programmes, including the Resilient and Sustainable System for Health, over the period 2021-2023.
He said the approval of the grant came following the review of the proposal that the CCM Nigeria submitted on March 23, 2020, which was adjudged to be technically sound and strategically focused by the independent Technical Review Panel of the Global Fund.
Ehanire said: “This grant will support access to malaria prevention, diagnostic and treatment services in 13 states. The States include Adamawa, Delta, Gombe, Jigawa, Kaduna, Kano, Katsina, Kwara, Niger, Ogun, Osun, Taraba and Yobe States.
“Access to HIV/AIDS and tuberculosis services across all the 36 states and the FCT; Improvements in our health system, particularly, provision of infrastructure for warehousing and distribution of health commodities, laboratory services, data management and capacity building for our healthcare providers, including support to community system.”
The minister said the implementation of the grant would specially target the poor, the most vulnerable and disadvantaged, and those at higher risk of the target diseases, to promote equity in access to health care services.
He further said: “With regard to Nigeria’s COVID-19 response effort, The Global Fund gave approval to repurpose the sum of US$6.2 million out of our on-going grants for HIV, tuberculosis and malaria to support the implementation of our initial Incident Action Plan (IAP) for COVID-19.
When children indulge in sugary foods, they turn feral and bounce off every available surface. This is, as most parents can attest, a fact. In this Special Feature, we ask whether this common knowledge holds up to scientific scrutiny.
You are at a party, and there are around 20 children, aged 3–6. The noise is deafening and the candy bowls are empty. Screams of joy fill the air as parents marvel at their offspring’s sugar-induced bedlam.
But what does the science say? Does sugar increase the risk of hyperactivity in children? Perhaps surprisingly, the data says “probably not.”
This will come as a surprise to anyone who has attended a gathering of children where sweet treats are available, so let’s dive into the evidence, or lack thereof.
Sugar and hyperactivity in children
The question of whether sugar influences children’s behavior started to generate interest in the 1990s, and a flurry of studies ensued. In 1995, JAMA published a meta-analysis that combed through the findings of 23 experiments across 16 scientific papers.
The authors only included studies that had used a placebo and were blinded, which means that the children, parents, and teachers involved did not know who had received the sugar and who had been given the placebo.
After analyzing the data, the authors concluded: “This meta-analysis of the reported studies to date found that sugar (mainly sucrose) does not affect the behavior or cognitive performance of children.”
However, the authors note that they cannot eliminate the possibility of a “small effect.” As ever, they explain that more studies on a large scale are needed.
There is also the possibility that a certain subsection of children might respond differently to sugar. Overall, though, the scientists demonstrate that there certainly isn’t an effect as large as many parents report.
Are some children more sensitive to sugar?
Some parents believe that their child is particularly sensitive to sugar. To test whether this might be the case, one group of researchers compared two groups of children:
25 “normal” children aged 3–5
23 children, aged 6–10, whose parents described them as being sensitive to sugar
Each family followed three experimental diets in turn and each for 3 weeks. The diets were:
high in sucrose, with no artificial sweeteners
low in sucrose, but with aspartame as a sweetener
low in sucrose, but with saccharin — a placebo — as a sweetener
The study included aspartame, as the authors explain, because it, too, has been “considered a possible cause of hyperactivity and other behavior problems in children.”
All three diets were free from artificial food colorings, additives, and preservatives. Each week, the scientists assessed the children’s behavior and cognitive performance. After analysis, the authors concluded:
“For the children described as sugar-sensitive, there were no significant differences among the three diets in any of 39 behavioral and cognitive variables. For the preschool children, only 4 of the 31 measures differed significantly among the three diets, and there was no consistent pattern in the differences that were observed.”
In 2017, a related study appeared in the International Journal of Food Sciences and Nutrition. The researchers investigated the impact of sugar consumption on the sleep and behavior of 287 children aged 8–12.
The scientists collected information from food frequency questionnaires and demographic, sleep, and behavior questionnaires. A surprising 81% of the children consumed more than the recommended daily sugar intake.
Still, the researchers concluded that “Total sugar consumption was not related to behavioral or sleep problems, nor affected the relationship between these variables.”
Taking the findings together, it seems clear that if sugar does impact hyperactivity, the effect is not huge and does not extend to the majority of children.
Why does the idea persist?
At this point, some readers might be asking, “If there is no scientific evidence that sugar induces hyperactivity in children, why does it induce hyperactivity in my children?” Some of the blame, it is sad to say, may fall on parental expectations.
A study that underlines this point appeared in the Journal of Abnormal Child Psychology in 1994. The researchers recruited 35 boys aged 5–7 whose mothers described them as being behaviorally “sugar sensitive.”
The children were split into two groups. They all received a placebo, which was aspartame. Half of the mothers were told that their children had each received a placebo, and the others were told that theirs had each received a large dose of sugar.
The scientists filmed the mothers and sons as they interacted and were asked questions about the interaction. The authors explain what they saw:
“Mothers in the sugar expectancy condition rated their children as significantly more hyperactive. Behavioral observations revealed these mothers exercised more control by maintaining physical closeness, as well as showing trends to criticize, look at, and talk to their sons more than did control mothers.”
Also, the media plays a part in perpetuating the myth. From cartoons to movies, the term “sugar rush” has entered common parlance.
Another factor is the setting in which a child might be given excess sugar. The classic scenario is a room full of children at a birthday party. In this environment, they are having fun and are likely to be excitable, regardless of the candy consumed.
Similarly, if candy is a special treat, the simple fact of receiving a delicious reward might be enough to generate a boisterous outburst of high-octane activity.
Where did this idea begin?
The health effects of sugar have been discussed widely over the last century. Even today, much research is dedicated to understanding the full details of this sweet chemical’s power over human health.
In 1947, Dr. Theron G. Randolph published a paper discussing the role of food allergies in fatigue, irritability, and behavioral problems in children. Among other factors, he described sensitivity to corn sugars, or corn syrup, as the cause of “tension-fatigue syndrome” in children, symptoms of which include tiredness and irritability.
In the 1970s, sugar was blamed for reactive or functional hypoglycemia — in other words, a dip in blood sugar following a meal — which can cause symptoms such as anxiety, confusion, and irritability.
These were the two prominent theories that underpinned the belief that children’s behavior is negatively impacted by consuming sugar: It is either an allergic reaction or a response to hypoglycemia. However, neither theory is now backed by the data.
Another lay explanation is that sugary snacks cause a brief spike in blood glucose, an effect called hyperglycemia. However, the symptoms of hyperglycemia include thirst, frequent urination, fatigue, irritability, and nausea. They do not include hyperactivity.
In the late 1970s and early 1980s, there was a fresh surge of interest in the sugar–hyperactivity theory. A number of studies appeared to show that children who were the most hyperactive consumed more sugar.
However, these studies were cross-sectional, meaning that they studied one population of children at one point in time. As the authors of the meta-analysis cited above explain, from these findings, it is impossible to know whether sugar causes hyperactivity or whether hyperactivity drives increased sugar intake.
Ongoing research
Since the 1990s, studies looking at hyperactivity and sugar have trailed off, with most experts considering the case closed. In one domain, however, studies have continued.
For the vast majority of children, sugar will not cause hyperactivity, but the jury is still out for one group of youngsters: those with attention deficit hyperactivity disorder (ADHD).
Scientists have approached this topic from two angles; some studies ask whether a high-sugar diet could increase the risk of developing ADHD, while others investigate whether sugar could exacerbate symptoms of ADHD in kids with the condition.
From the first camp of research, a study published in 2011 followed 107 fifth-graders and found “no significant association […] between total volume of simple sugar intake from snacks and ADHD development.”
Looking for longer-term effects, a systematic review and meta-analysis published in the Journal of Affective Disorders in 2019 assessed “evidence of the association between dietary patterns and ADHD.” The authors concluded that “a diet high in refined sugar and saturated fat can increase the risk” of ADHD and that a diet heavy in fruit and vegetables is protective.
However, they acknowledge that the evidence was generally weak. For instance, of the 14 studies that found a relationship between diet and ADHD, 10 used a cross-sectional or case-control design, both of which are observational and can have methodological problems.
Cross-sectional studies cannot tease apart which came first, the cause or the effect, because they determine the prevalence of both at the same point in time.
Case-control studies provide stronger evidence, as they look back into potential causes, or risk factors, after working out who has the health issue in question. The researchers then explore the occurrence of the risk factors in a similar group of people who do not have the health problem.
However, information about potential causes can be affected by memory bias — for example, people with ADHD may be more likely to report that they had a sugary diet because the association is expected.
The authors of the meta-analysis make another important point; there is some evidence that people with ADHD are more likely to binge eat than people without it. This might mean that increased consumption of foods that activate reward networks in the brain, such as sugary snacks, might be the result of ADHD, rather than a factor that increases the risk of ADHD.
An important final word
Sugar, it seems, does not cause hyperactivity in the vast majority of children. In the future, larger, longer studies might detect a small effect, but current evidence suggests that the association is a myth.
This, however, does not discount the fact that a diet high in sugar increases the risk of diabetes, weight gain, tooth cavities, and heart disease. Monitoring children’s, and our own, sugar intake is still important for maintaining good health.
A safe and effective COVID-19 vaccine could be ready by December, according to the promising results of an Oxford University’s experimental jab published yesterday in the medical journal, The Lancet.
The outcomes indicated that the proposed treatment provoked an immune reaction that lasted for at least two months.
The highly anticipated clinical trial revealed that 100 per cent of the volunteers injected produced an immune response against the novel coronavirus.
Pharmaceutical giant, AstraZeneca, is already manufacturing the vaccine, AZD1222, and the United Kingdom government had ordered 100 million doses ahead of time.
According to the study, all participants, who were tested, retained a “neutralising” response – meaning their bodies may be able to prevent COVID-19 – after a month. Immune responses remained strong for a minimum of 56 days.
This means that there were strong signs in their blood that they could fight off the virus if they were to catch it.
Though the therapy had not be licensed for human use, the investigators, however, said it is “possible” that the vaccine could be ready by December if tests keep going according to plan.
Remarkably, nobody suffered any negative side effects, as it stimulated the immune system as hoped.
Some people though developed headaches, tiredness and pain in their arms after given the jab, but scientists claimed that none of them was severe.
The researchers stated: “The early results hold promise, but more is still needed.”
Prof. Sarah Gilbert, one of the scientists leading the project, said: “There is still much work to be done before we can confirm if our vaccine will help manage the COVID-19 pandemic, but these early results hold promise.”
Infectious disease experts warned: “There is still a long way to go before any vaccine is rolled out.”
In a related development, Nigeria, Ethiopia, Democratic Republic of Congo and Tanzania have accounted for over 33 per cent of vaccine-preventable deaths in Africa, but ongoing immunisation could save 702,000 children.
A survey in The Lancet Global Health journal said the benefits of routine childhood vaccination far outweigh potential risks of coronavirus transmission to older family members from clinics.
A new study by a team of scientists at Oxford University’s Jenner Institute and Oxford Vaccine Group said it has taken the next step towards the discovery of a safe, effective and accessible vaccine against coronavirus.
Oxford and AstraZeneca are collaborating with clinical partners around the world as part of a global clinical programme to get a vaccine.
The global programme is made up of a Phase III trial in the U.S. enrolling 30,000 patients, a paediatric study, as well as Phase III trials in low-to-middle income countries including Brazil and South Africa which are already underway.
According to a statement published on Oxford University webiste on Monday, the results of the Phase I/II trial publishedm in the scientific journal, The Lancet, indicate no early safety concerns and induces strong immune responses in both parts of the immune system.
The vaccine provoked a T cell response within 14 days of vaccination (white blood cells that can attack cells infected with the SARS-CoV-2 virus), and an antibody response within 28 days (antibodies are able to neutralise the virus so that it cannot infect cells when initially contracted).
Study
During the study, participants who received the vaccine had detectable neutralising antibodies, which have been suggested by researchers as important for protection, and these responses were strongest after a booster dose, with 100 per cent of participants’ blood having neutralising activity against the coronavirus.
The next step in studying the vaccine is to confirm that it can effectively protect against SARS-CoV-2 infection.
A professor, Andrew Pollard said, “We saw the strongest immune response in the 10 participants who received two doses of the vaccine, indicating that this might be a good strategy for vaccination”.
A UK Phase I/II trial began in April testing the Oxford coronavirus vaccine ChAdOx1 nCoV-19. The team started working to develop a vaccine against the global threat in January 2020 and have been working with unprecedented urgency in a race against the coronavirus.
During the Phase I/II trial the vaccine has been evaluated in more than 1,000 healthy adult volunteers aged between 18 and 55 years in a randomised controlled trial.
A subset of these volunteers (10 people) received two doses of the vaccine. Between April 23, 2020 and May 21, 2020, 1077 volunteers, received the vaccine ChAdOx1 nCoV-19 or a placebo MenACWY vaccine. There were no serious adverse health events related to ChAdOx1 nCoV-19.
The University of Oxford is working with the UK-based global biopharmaceutical company AstraZeneca for the further development, large-scale manufacture and potential distribution of the vaccine, with plans for clinical development and production of the Oxford vaccine progressing globally.
The project has been further spurred by £84 million of Government funding to help accelerate the vaccine’s development.
Mene Pangalos, Executive Vice President of BioPharmaceuticals Research and Development at AstraZeneca said, “We are encouraged by the Phase I/II interim data showing AZD1222 was capable of generating a rapid antibody and T-cell response against SARS-CoV-2. While there is more work to be done, today’s data increases our confidence that the vaccine will work and allows us to continue our plans to manufacture the vaccine at scale for broad and equitable access around the world.”
Business Secretary Alok Sharma said: “Today’s results are extremely encouraging, taking us one step closer to finding a successful vaccine to protect millions in the UK and across the world. Backed by £84 million Government investment for the vaccine’s development and manufacture, the agility and speed with which the University of Oxford have been working is outstanding. I am very proud of what they have achieved so far.”
Kate Bingham, Chair of the UK’s Vaccine Taskforce said: “The UK is fortunate to have such outstanding academic innovators working alongside the highly experienced global team at AstraZeneca. This partnership is working at exceptional speed to demonstrate the safety and clinical effectiveness of the chadox vaccine in protecting people against COVID-19 infection.”
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