Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab.

Background: Prolonged shedding of SARS-CoV-2 in immunocompromised patients has been described. Furthermore, an accumulation of mutations of the SARS-CoV-2 genome in these patients has been observed.

Methods: We describe the viral evolution, immunologic response and clinical course of a patient with a lymphoma in complete remission who had received therapy with rituximab and remained SARS-CoV-2 RT-qPCR positive for 161 days.

A rare case of hemodialysis-related portosystemic encephalopathy and review of the literature.

Hemodialysis-related portosystemic encephalopathy (HRPSE) is a clinical phenomenon where portosystemic encephalopathy (PSE) develops without liver dysfunction, usually caused by changes in the portosystemic blood flow related to hemodialysis. We describe the case of a 22-year old patient with a transjugular intrahepatic portosystemic shunt (TIPS) who developed HRPSE several months after initiation of hemodialysis. Despite initial therapy with laxatives and neomycin symptoms recurred.

Electrolytes disturbances after kidney transplantation.

: Water and electrolytes disturbances often occur in renal transplant recipients. The objective is to describe the pathophysiology and the treatment of the most prevalent abnormalities. : We screened PubMed for the following words in various combination: kidney transplantation and (disturbances or abnormalities) of (electrolytes or sodium or potassium or phosphate or calcium or acid-base).

Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy.

In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition.