Non-alcoholic steatohepatitis (NASH) is a chronic and progressive form of non-alcoholic fatty liver disease. Its global incidence is increasing and makes NASH an epidemic and a public health threat. Non-alcoholic fatty liver disease is associated with major morbidity and mortality, with a heavy burden on quality of life and liver transplant requirements. Due to repeated insults to the liver, patients are at risk for developing hepatocellular carcinoma. The progression of NASH was initially defined according to a two-hit model involving an initial development of steatosis, followed by a process of lipid peroxidation and inflammation. In contrast, current evidence proposes a “multi-hit” or “multi-parallel hit” model that includes multiple pathways promoting progressive fibrosis and oncogenesis. This model includes multiple cellular, genetic, immunological, metabolic, and endocrine pathways leading to hepatocellular carcinoma development, underscoring the complexity of this disease.

Emphysematous gastritis is a rare life-threatening infection caused by gas trapping within the gastric mucosal wall. It is diagnosed by radiological or operative findings most typically by CT scan of the abdomen. It is caused by gas-producing bacteria. Predisposing factors include but are not limited to alcohol intake, trauma, diabetes and surgery. Clinical presentation will typically include severe abdominal pain, abdominal distension and shock. Here we present the only reported case to our knowledge of Emphysematous gastritis with concomitant portal venous gas and pneumoperitoneum caused by Candida Glabrata.

Marijuana, derived from the Cannabis sativa plant, is the most commonly abused illicit drug in the United States. Now, more than ever, due to changing regulations, marijuana is more readily available and is known to be habitually used by millions. The neuropsychiatric effects of marijuana are well-known which include chronic fatigue syndrome and polyphagia. However, marijuana is also known to exert cardiac effects, such as tachycardia, hypotension, and hypertension. Marijuana has also been described in association with atrial fibrillation, ventricular tachycardia, and cardiac arrest. However, acute coronary syndromes, such as myocardial infarction in the setting of marijuana use, is rare. Herein, we present the case of a non-ST-elevation myocardial infarction (NSTEMI) in the setting of marijuana use in a 42-year-old African American male with no significant past medical history who presented with chest pain at rest one hour after smoking marijuana.

Sapovirus causes acute gastroenteritis (AGE) which manifests as severe diarrhea and vomiting. It is most often seen in, but not limited to, children and toddlers but can occur in people of all ages. It is typically more prevalent in low to middle-income countries but has also been reported in progressive countries such as the United States. Due to the universal use of reverse transcriptase-polymerase chain reaction (RT-PCR) testing, the reported incidence of sapovirus has continued to grow as the culprit agent in both AGE outbreaks and isolated cases. Its symptoms resemble what is seen with rotavirus but with a milder clinical course. This discussion explores the dire implications of a relatively understated pathogen. Here, we present a rare case of a 20-year-old woman who presented with septic shock secondary to severe gastroenteritis as a result of sapovirus infection.

Pancreatitis is caused by a number of different etiologies, most commonly caused by gallstone induced, alcohol, and familial hypertriglyceridemia. Other less common causes include trauma, medications, and autoimmune conditions. Drug-induced pancreatitis (DIP) is only responsible for less than 2% of all cases but is a very important etiology that has been observed with increasing frequency in the acute setting. Here we present a case of recurrent pancreatitis with no other risk factors except for the initiation of quetiapine approximately six months prior to the first episode.

Background Hyperparathyroidism, associated with calcium abnormalities has an increased probability of developing arrhythmias. However, there are very few studies to demonstrate the significance of hyperparathyroidism on Atrial Fibrillation (A-fib). Methods This is a retrospective cohort study using the 2017-2018 National Inpatient Sample. Patients with a primary discharge diagnosis of A-fib were extracted with ICD10. Patients with hyperparathyroidism were extracted as a secondary diagnosis. Demographics, clinical complications were compared, and outcomes were assessed using linear and logistic regression models to adjust for confounders. Results A total of 649,179 patients (Age >18) were identified with A-fib as the primary diagnosis, and amongst them, 6254 had hyperparathyroidism. Notably, the patients with Hyperparathyroidism and A-fib were more likely to be female and blacks (26.8 vs 8). In-hospital mortality was higher in A-fib patients with hyperparathyroidism (2%) compared to A-fib patients without hyperparathyroidism (0.84%), with a crude odds ratio of 2.4 and adjusted odds ratio of 2.65 (p<0.001). Mean length of stay (LOS) was greater in hyperparathyroidism patients (4.5 vs 3.2 days), with an adjusted odds ratio of 1.26, (p<0.001). Similarly, mean total charges were also significantly higher in hyperparathyroidism patients ($53792 vs $39128). Conclusions Among patients with atrial fibrillation, those who have hyperparathyroidism as comorbidity are associated with more in-hospital mortality, LOS, and total charges. Further studies are required to study the causation of this association. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:54 p.m. - 12:59 p.m.

endoluminal stent placement. However, these interventions are only palliative, and the diagnosis confers a poor prognosis. We aim to provide further knowledge and clinical experience regarding duodenal obstruction secondary to TCC for early identification and management.

Discussion: When GI schwannomas arise, they are most commonly found in the upper GI tract, with 60-70% of GI cases found in the stomach and only 3% in the colon. There are no clear risk factors for their development other than advanced age. As in our patient's case, colorectal schwannomas are typically detected incidentally on screening colonoscopies. They can be asymptomatic, or present with rectal bleeding (22.9%), abdominal pain (15.6%) or constipation (7.3%). The mass effect of large schwannomas can lead to colonic obstruction necessitating surgical resection of the tumor, but smaller lesions can typically be resected endoscopically. Schwannomas present as submucosal lesions and are almost always benign, with only atypical versions harboring any malignant potential. Numerous studies have demonstrated that recurrence after complete resection is rare, even after extended follow-up. There is no established guidance regarding follow-up intervals for patients with colorectal schwannomas, owing to their rarity. Based on the lack of malignant potential and the low risk of recurrence, we recommended a repeat colonoscopy in 5 years for our patient.[2002] Figure 1. Cecal schwannoma in macroscopic (left) and microscopic (right) views.