The Biochemical and Pathophysiological Effects of Alcohol Consumption

While the stance of some conservative Christian (and other) groups advocating abstinence from alcohol intake may not be popular, contemporary research into alcohol and its effects on the body may lend weight to such a position. The consumption of alcohol, coupled with its addictive properties, can lead to a wide not only costly in medical terms but also in terms of domestic violence, accidents and antisocial behaviour. Alcohol is metabolised by the liver and this organ may be consequently damaged resulting in serious impairment of normal hepatic structure and function. Nearly all the physiological systems of the body are adversely affected by alcohol to varying degrees and the behavioural effects observed with intoxication are associated with compromised neurotransmitter functions in the brain and altered brain structure in the long term. Adverse consequences of alcohol intake may be evident in other systems including the cardiovascular, gastrointestinal, reproductive and immunological systems. There is an increased risk of atherosclerosis, cancers of the oral cavity, pancreatitis and immune system disturbances associated with prolonged alcohol intake. In pregnant women alcohol metabolism is reduced and as the developing foetus has lowered ability to metabolise blood alcohol compared to an adult there is an elevated risk of serious consequences associated with foetal alcohol syndrome. Despite the nearly overwhelming negative consequences of alcohol intake, the beneficial effects of drinking red wine linked to lowered heart disease despite a high fat diet (the ‘French Paradox’) may be associated with the antioxidants and other polyphenols also found in non-alcoholic red grape juice. Serious consideration of the effects of alcohol on the body should inform decisions on the intake of alcohol

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication