COVID-19 has rapidly become a global challenge. 1 We read with interest the article by Bezzio et al 1 that reported the characteristics and outcomes of COVID-19 patients with pre-existing IBD. Patients with pre-existing cirrhosis, who have immune dysfunction and poorer outcomes from acute respiratory distress syndrome (ARDS) than patients without cirrhosis, are also considered a high-risk population for COVID-19. 2 3 In previous studies, the proportion of COVID-19 patients with pre-existing liver conditions ranged from 2% to 11%. 2 However, the clinical course and risk factors for mortality in these patients has not yet been reported. This retrospective multicentre study (COVID-Cirrhosis-CHESS, ClinicalTrials. gov NCT04329559) included consecutive adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pre-existing cirrhosis from 16 designated hospitals in China between 31 December 2019 and 24 March 2020. Patient characteristics are summarised in table 1. Twenty-one COVID-19 patients with preexisting cirrhosis (Child-Pugh class A, B and C in 16, 3 and 2 patients, respectively) were included in the analysis. The median age was 68 years; 11 (52.4%) were male. Most patients had compensated cirrhosis (81.0%) and chronic HBV infection was the most common aetiology (57.1%). Comorbidities other than cirrhosis were present in most patients (66.7%). In previous studies, older age, male sex and pre-existing comorbidities were associated with higher risk of mortality for COVID-19. 4 5 Here, there were no significant differences between survivors (n=16) and non-survivors (n=5) in age, sex, comorbidities, aetiology of cirrhosis, stage of cirrhosis, Child-Pugh class, Model for End-stage Liver Disease (MELD) score, interval between onset and admission, or onset symptoms of COVID-19. Comorbidities have been associated with adverse outcomes in cirrhosis, 6 but our analysis did not show clear prognostic associations-possibly due to the small size and narrow composition of the study population.

BackgroundThe treatment of patients with MDR- and XDR-TB is usually more complex, toxic and costly and less effective than treatment of other forms of TB. However, there is little information available on risk factors for poor outcomes in patients with MDR- and XDR-TB in China.Methodology/Principal FindingsWe retrospectively analyzed the clinical records of HIV-negative TB Patients with culture-proven MDR- or XDR-TB who were registered from July 2006 to June 2011 at five large-scale Tuberculosis Specialized Hospitals in China. Among 1662 HIV-seronegative TB cases which were culture-positive for M. tuberculosis complex and had positive sputum-smear microscopy results, 965 cases (58.1%) were DR-TB, and 586 cases (35.3%) were classified as having MDR-TB, accounting for 60.7% of DR-TB. 169 cases (10.2%) were XDR-TB, accounting for 17.5% of DR-TB, 28.8% of MDR-TB. The MDR-TB patients were divided into XDR-TB group (n=169) and other MDR-TB group (non-XDR MDR-TB) (n=417). In total, 240 patients (40.95%) had treatment success, and 346 (59.05%) had poor treatment outcomes. The treatment success rate in other MDR-TB group was 52.2%, significantly higher than that in the XDR-TB group (13%, P<0.001). In multivariate logistic regression analysis, poor outcomes were associated with duration of previous anti-TB treatment of more than one year (OR, 0.077; 95% CI, 0.011-0.499, P<0.001), a BMI less than 18.5 kg/m2 (OR, 2.185; 95% CI, 1.372-3.478, P<0.001), XDR (OR, 13.368; 95% CI, 6.745-26.497, P<0.001), retreatment (OR, 0.171; 95% CI, 0.093-0.314, P<0.001), diabetes (OR, 0.305; 95% CI, 0.140-0.663, P=0.003), tumor (OR, 0.095; 95% CI, 0.011-0.795, P=0.03), decreased albumin (OR, 0.181; 95% CI, 0.118-0.295, P<0.001), cavitation (OR, 0.175; 95% CI, 0.108-0.286, P<0.001).Conclusions/SignificanceThe patients with MDR-TB and XDR-TB have poor treatment outcomes in China.The presence of extensive drug resistance, low BMI, hypoalbuminemia, comorbidity, cavitary disease and previous anti-TB treatment are independent prognostic factors for poor outcome in patients with MDR-TB.

Sustained current generation by anodic biofilms is a key element for the longevity and success of bioelectrochemical systems. Over time, however, inactive or dead cells can accumulate within the anode biofilm, which can be particularly detrimental to current generation. Mixed and pure culture (Geobacter anodireducens) biofilms were examined here relative to changes in electrochemical properties over time. An analysis of the three-dimensional metabolic structure of the biofilms over time showed that both types of biofilms developed a live outer-layer that covered a dead inner-core. This two-layer structure appeared to be mostly a result of relatively low anodic current densities compared to other studies. During biofilm development, the live layer reached a constant thickness, whereas dead cells continued to accumulate near the electrode surface. This result indicated that only the live outer-layer of biofilm was responsible for current generation and suggested that the dead inner-layer continued to function as an electrically conductive matrix. Analysis of the electrochemical properties and biofilm thickness revealed that the diffusion resistance measured using electrochemical impedance spectroscopy might not be due to acetate or proton diffusion limitations to the live layer, but rather electron-mediator diffusion.

Using Cfz to treat MDR tuberculosis promotes cavity closure, accelerates sputum culture conversion, and improves treatment success rates.

consultation; and (iii) establish a short-term web-based followup to define drug efficacy and adapt treatment accordingly. Thus, in this particular situation the diagnosis of AIH may be given without histology, if typical biochemical and serological results are followed by a convincing treatment response. Prove of the diagnosis can be undertaken later, either by a relapse upon therapy reduction, or a follow-up liver biopsy when conditions are safer. As already reported in China, 8 advanced liver cirrhosis and decompensated patients can be monitored with a webbased system and all non-urgent medical visits should be postponed until the emergency is over. Urgent procedures (i.e. paracentesis) should be organised using a COVID-19-free path in the hospital, another COVID-19-free facility or home care. Finally, we recommend strict adherence to standard social distancing protocols and social isolation and emphasise, in cirrhotic patients, the importance of vaccination for Streptococcus pneumoniae and seasonal flu and of reinforcing social distancing measures. Further data are needed in order to demonstrate the real impact of COVID-19 infection in immunocompromised patients. Until then, and while vaccination is not available, we suggest continuing a cautious approach during low-level seasonal persistence of COVID-19 in the years to come.Although we cannot currently evaluate the efficacy of our management protocol, we believe this framework might be a useful tool for management of AILD for the time being.