Background:Liver transplantation remains the definitive treatment for end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC). While hepatitis C virus (HCV) was historically the leading indication for liver transplant, the introduction of direct-acting antivirals (DAAs) has drastically reduced HCV-related ESLD. In contrast, metabolic dysfunction-associated steatohepatitis (MASH) and alcohol-associated liver disease (ALD) have emerged as predominant causes of liver transplantation. This study evaluates racial and ethnic disparities in liver transplantation indications from 2004 to 2023 and projects future trends through to 2040. Methods:De-identified data from the Standard Transplant Analysis and Research (STAR) files of the United Network for Organ Sharing (UNOS) database were analyzed to assess temporal trends in the proportion of ALD, HCV, and MASH as etiologies of liver transplant indications using Joinpoint regression. The annual percentage change (APC) in the proportion of etiologies of liver transplantation were reported with a significance level at a p-value of 0.5. Future projections were estimated using the Box-Jenkins methodology of Autoregressive Integrated Moving Average (ARIMA) modelling. Trends were stratified by race/ethnicity to evaluate disparities. Results:The proportion of liver transplantation attributed to ALD has risen significantly across all racial groups, with American Indian/Alaska Native (AIAN) individuals experiencing the steepest increase. By 2040, ALD is projected to account for 80% of liver transplantation in AIAN populations. MASH-related liver transplantation is also increasing, particularly among Hispanic and White individuals, with projections reaching approximately 40% by 2040. In contrast, HCV-related liver transplantation has sharply declined across all racial groups likely due to the impact of DAAs, however, the Black population continues to experience disproportionately higher rates of HCV-related ESLD. Conclusion:The shifting landscape of liver transplantation etiologies highlights the growing burden of ALD and MASH, emphasizing the need for targeted prevention strategies. Persistent racial disparities in liver transplant access and outcomes underscore systemic healthcare inequities. Addressing these disparities through equitable healthcare policies, early intervention programs, and improved transplant access is crucial to ensuring fair distribution of transplant resources and improved outcomes for all populations.

Necrotizing Fasciitis (NF) is a severe, potentially fatal soft tissue infection leading to death of muscles, fascia, and surrounding tissue. Perforated colon cancer (CC) is an exceedingly uncommon cause of NF. Here, we present a case of NF secondary to perforated colon cancer. This case emphasizes the significance of prompt identification, aggressive surgical excision of affected tissue, and consideration of rare, yet potentially fatal underlying etiologies in the management of NF as well as underscores the importance of CC screening to prevent devastating complications and mortality.

Strongyloidiasis presents a spectrum of manifestations, ranging from asymptomatic infection to disseminated or potentially fatal hyperinfection. Immunosuppression, particularly induced by corticosteroids or HIV infection, is the most common trigger for life-threatening dissemination of larvae, resulting in mortality rates as high as 85%. We present a case of ANCA vasculitis that initially presented with skin rash, diarrhea, and abdominal pain. Initially evaluated for a potential flare of vasculitis, the patient was ultimately diagnosed with strongyloidiasis.

Introduction:Primary peritoneal clear cell carcinoma (PPCCC) is a rare abdominal tumor, affecting 7 out of every million people. Its vague presenting signs and symptoms often lead to delayed diagnosis and poor prognosis. We present a case involving a young woman with anemia and abdominal discomfort who on further investigation had a 26-cm abdominal tumor identified to be PPCCC. Multimodal therapy with tumor debulking and chemotherapy was pursued. Given the aggressive nature of PPCCC, any clinical suspicion of peritoneal carcinoma should prompt thorough diagnostic evaluation. Case Presentation:A 39-year-old woman with menorrhagia and peptic ulcer disease presented with abdominal discomfort of 2 days duration. She initially had headaches managed with ibuprofen. Following this, she had generalized abdominal pain with bloating that worsened with food and had no relief with use of stool softeners. She had associated dizziness with palpitations, chest pressure, and exertional dyspnea. In the emergency department, the patient was mildly tachycardic but otherwise stable. On exam, she had a distended abdomen with generalized tenderness and normoactive bowel sounds. Labs showed normocytic anemia with a hemoglobin of 5.2 mg/dL. Electrocardiogram and abdominal and chest X-rays were normal. A non-contrast computed tomography of the abdomen and pelvis showed a fibroid uterus and posterior displacement of multiple bowel loops by a large septate cystic mass (13.5 × 26.0 × 26.7 cm) occupying the entire abdominal cavity. Elevated CA 125 and CA 19-9 were also noted. She underwent exploratory laparotomy with mass resection, partial omentectomy, left colectomy (given extension into transverse colon), appendectomy, and total abdominal hysterectomy with bilateral salpingectomy. Biopsy and immunohistochemical staining (positive for PAX-8, ER, P53, P16, Napsin A and negative for PR and WT-1) confirmed mass as stage IIIB PPCCC. There was no evidence of malignancy in other tissue samples. The patient was discharged with a plan for outpatient chemotherapy and genetic counseling. Conclusion:Given the rarity of PPCCC, our case highlights how increased clinical vigilance and prompt multidisciplinary efforts are essential for an accurate diagnosis, especially in younger patients to not delay management. Currently, there are no established management guidelines; however, initial treatment with surgical debulking followed by chemotherapy is often practiced.

Pancreatic carcinoma has remained one of the leading causes of cancer-related mortality worldwide. Cancer originating in the head of pancreas is often detected early in the disease due to biliary obstruction resulting in jaundice. In contrast, cancer of the pancreatic body and tail remains indolent, presenting late with significantly increased tumor burden and distant metastasis. Unfortunately, a single laboratory screening study is neither sensitive nor specific for early detection of pancreatic cancer. In this report, we present a patient with longstanding diabetes incidentally detected to have pancreatic tail carcinoma while presenting with pulmonary embolism, emphasizing the need for pancreatic cancer screening studies in population with longstanding diabetes.

Epstein-Barr virus (EBV)–associated lymphoproliferative disorders (LPDs) are rare conditions. Immunomodulatory therapies impair T-cell–mediated immune responses to latent EBV-infected memory B cells, promoting their reactivation and leading to the excessive division of infected cells, which can result in the development of EBV-associated lymphocyte proliferations. Lymphoproliferative disorders related to immunomodulatory agents are recognized as potential life-threatening complications of prolonged immunomodulator administration. Methotrexate-associated LPDs in rheumatoid arthritis and azathioprine-associated LPDs in inflammatory bowel disease have been reported previously. To our knowledge, we report a unique and possibly the first documented case of a B-cell LPD, specifically an EBV-associated polymorphic LPD, involving the adrenal gland in a patient with granulomatosis with polyangiitis treated with azathioprine.

Proton Pump Inhibitor (PPI)-induced hypomagnesemia, fi rst described in 2006, has gained increasing recognition in recent years as a potentially life-threatening adverse event. In comparison to histamine-2 receptor antagonists (H2RA), PPIs exhibit a higher frequency of electrolyte abnormalities, including hypomagnesemia, hypocalcemia, hypokalemia, and hyponatremia; hypomagnesemia is the most common. We report a case of an 80-year-old woman who presented with generalized weakness and diarrhea. She was found to have multiple electrolyte abnormalities that failed to resolve even after the resolution of diarrhea and resumption of feeding. However, her condition improved within one week of discontinuing PPI medication. Her hospital course was complicated by a seizure, attributed to alterations in ionic gradients across cellular membranes affecting neuronal discharge and facilitating epileptiform activities. Additionally, she experienced Takotsubo cardiomyopathy due to decreased myocardial contractility, both in the context of electrolyte imbalance induced by prolonged PPI use.

Background : The in fl ammatory reaction of foreign body granulomas (FBG) may be so vast that it leads to severe systemic effects. Case report : A 42-year-old woman was referred to the ED with severe recurrent symptomatic hypercalcemia associated with worsening kidney function. She had presented multiple times with similar complaints. Severe hypercalcemia (13.8 mg/dL) was noted, with appropriately low PTH, elevated PTHrP, low 25-hydroxyvitamin D, and normal 1,25dihydroxyvitamin D levels. She admitted having signi fi cant subcutaneous silicone fi ller injections in the hips six years prior. Admission workup revealed a normal 25-hydroxyvitamin D, but a marked elevation of 1,25-dihydroxyvitamin D (138 pg/mL). Whole-body PET-CT demonstrated moderate 2-18F- fl uoro-2-deoxy- D -glucose (FDG) uptake within the subcutaneous adipose tissue of the lateral aspects of the gluteal regions. She was diagnosed with silicone fi ller injectioninduced hypercalcemia, secondary to granulomatous in fl ammation. Her calcium level normalized a month after the initiation of prednisone. Discussion : FBG may occur years after fi ller injection. In rare cases, a signi fi cant granulomatous immune response leads to uncontrolled production of calcitriol. Pro-in fl ammatory cytokines can also upregulate PTHrP expression in macrophages, further contributing to hypercalcemia. Treatment focuses on general hypercalcemia management and FBG remission, most effectively achieved with anti-in fl ammatory corticosteroid doses. Nevertheless, further studies are needed to evaluate its long-term treatment ef fi cacy. Conclusion : Granulomatous in fl ammation from silicone fi ller injection can cause hypercalcemia by uncontrolled production of calcitriol and increased PTHrP production by macrophages and giant cells.

73 Background: The COVID-19 pandemic disrupted several aspects of routine healthcare delivery, many of which have yet to return to pre-pandemic levels of operation. In this study, we compared the adherence rates to cervical cancer screening guidelines in a nationally representative sample of American adults before and following the COVID-19 pandemic. Methods: We included female adults aged 21-65 who participated in the Health Information National Trends Survey (HINTS) 2019 and 2022. Adherence to cervical cancer screening was assessed based on the timing of their last Pap smear test. Participants were classified as non-adherent to cervical cancer guidelines if their last Pap smear test was more than three years ago. Survey-weighted Poisson regression models [adjusted for age, race, and education] were used to explore adherence ratios before and following the COVID-19 pandemic. Results: In 2019, among 1,944 female adults, representing a population of 93,477,003 adults, the mean age (standard deviation [SD]) was 44.5(12.6) years, 61.1% were non-Hispanic White, and 35.2% had a college education or higher. The prevalence of non-adherence to cervical cancer screening was 19.2% [95% CI: 16.3, 22.5]. In adjusted models, being non-Hispanic Black was associated with a lower risk of non-adherence (0.49 [95% CI: 0.30, 0.77] vs. non-Hispanic White), having lower education (less than high school vs. college graduate or higher) was associated with 2.28 [95% CI: 1.21, 4.31] higher likelihood of non-adherence to cervical cancer screening guidelines, while age was not (p>0.05). In 2022, the prevalence of non-adherence to cervical cancer screening was 25.8% [95% CI: 22.9, 29.1]. In adjusted models, having lower education was associated with 1.90 [95% CI: 1.22, 2.97] higher likelihood of non-adherence to cervical cancer screening guidelines, while age and race were not (p>0.05). Compared to 2019, non-adherence rates increased by 6.6% in 2022. When stratified by race, non-Hispanic White adults showed an increase of 5.6% [95% CI: 5.4, 5.6] in non-adherence rates, while non-Hispanic Black adults showed an increase of 13.9% [95% CI: 12.0, 15.2]. Conclusions: There was a decline in adherence to cervical cancer screening guidelines among adult females in the US by about 7% following the COVID-19 pandemic. Additionally, non-Hispanic Black adults and those with lower education showed a disproportionately greater increase in non-adherence rates. These findings are relevant in advancing cervical cancer surveillance in the United States. Further studies are needed to elucidate barriers associated with greater non-adherence rates in minority groups following the pandemic and identify methods to provide more equitable access to healthcare services.

Hepatocellular carcinoma ranks as the third leading cause of cancer-related mortality globally. We present a case of a rapidly progressive hepatocellular carcinoma in an 81-year-old female with metabolic abnormalities. The patient initially presented with non-specific signs and symptoms and was managed for sepsis of suspected urinary source. Unresolving laboratory markers led to repeat abdominal imaging demonstrating new hepatic lesions within six days. Biopsy confirmed moderately differentiated hepatocellular carcinoma. The patient received conservative inpatient treatment with recommendation for nutritional and performance status optimization prior to oncologic therapies, however continued to decline and passed away three months later.

Over the past year, studies have shown potential in the applicability of ChatGPT in various medical specialties including cardiology and oncology. However, the application of ChatGPT and other online chat-based AI models to patient education and patient-physician communication on colorectal cancer screening has not been critically evaluated which is what we aimed to do in this study. We posed 15 questions on important colorectal cancer screening concepts and 5 common questions asked by patients to the 3 most commonly used freely available artificial intelligence (AI) models. The responses provided by the AI models were graded for appropriateness and reliability using American College of Gastroenterology guidelines. The responses to each question provided by an AI model were graded as reliably appropriate (RA), reliably inappropriate (RI) and unreliable. Grader assessments were validated by the joint probability of agreement for two raters. ChatGPT and YouChat™ provided RA responses to the questions posed more often than BingChat. There were two questions that > 1 AI model provided unreliable responses to. ChatGPT did not provide references. BingChat misinterpreted some of the information it referenced. The age of CRC screening provided by YouChat™ was not consistently up-to-date. Inter-rater reliability for 2 raters was 89.2

IgG4-related disease (IgG4-RD) is a fi bro-in fl ammatory condition that can affect various organs. Localized sinonasal IgG4-RD is a rare condition characterized by bone and soft-tissue invasion. In this report, we present a case of a patient initially diagnosed with chronic rhinosinusitis, who underwent endoscopic sinus surgery and was later found to have biopsy proven IgG4-related sinonasal disease despite having normal serum levels of IgG4, resulting in erosion of the right lamina papyracea.

Myroides odoratus is a relatively little-known pathogen despite its ubiquitous presence in the environment. It is an opportunistic gram-negative bacillus commonly found in soil and water. Infection by Myroides species is rare, but the spectrum of illness varies from skin and soft tissue infections, urinary tract infections, pneumonia, and, in severe cases, bacteremia and septic shock. Though infection with Myroides species is uncommon and typically limited to immunocompromised individuals, the wide range of antimicrobial resistance it exhibits makes treatment challenging. In this report, we present the case of a 76-year-old male with compensated cirrhosis who presented with cellulitis complicated by bacteremia secondary to M. odoratus and was managed successfully with levofloxacin.

Gastric Linitis plastica is characterized by extensive infiltration of gastric wall by poorly differentiated tumor cells, creating a "leather-bottle stomach" appearance. We describe a case involving a 71-year-old male presenting with globus sensation, early satiety and weight loss. Recent EGD had revealed chronic gastritis with polypoid mucosa at the GE junction, and subsequent FDG-PET indicated asymmetric FDG localization. On admission, repeat EGD with deep biopsies confirmed invasive poorly differentiated gastric adenocarcinoma with signet ring features. Despite palliative radiation, the patient died within a month, highlighting the disease's aggressiveness and importance of advanced diagnostic techniques in suspected cases of Linitis plastica.

Neurosyphilis is a condition characterized by insidious onset of encephalopathy and delirium. The infrequency with which it is encountered makes neurosyphilis a formidable diagnostic challenge. We present a rare case of a 71-year-old male with ischemic cardiomyopathy, chronic obstructive pulmonary disease (COPD), undifferentiated arthritis and alcohol use disorder who was brought to the emergency department after he was found altered, confused, and paranoid. His hospital stay was eventful for multiple episodes of agitation that were difficult to control despite benzodiazepines and high doses of antipsychotics. After an extensive workup, he was found to have neurosyphilis and his delirium resolved following a brief period of treatment. This case illustrates the importance of early suspicion for neurosyphilis as a cause of delirium, especially in endemic areas and in patients with focal neurologic findings.

Non-compaction cardiomyopathy (NCCM) is a complex, exceedingly rare form of cardiomyopathy. Transient ischemic attack/stroke in NCCM may be cardioembolic or atherosclerotic in origin. While the connection between NCCM and neuromuscular conditions has been documented before, its association with neurological conditions, such as multiple sclerosis has not been established. Here, we present a case of a 45-year-old female with multiple sclerosis (MS) who presented in the context of a transient ischemic attack (TIA) and was found to have non-compaction cardiomyopathy complicated by thromboembolism. To our knowledge, this is the third reported case of NCCM with MS.

416 Background: Genetic testing plays a critical role in identifying individuals at high risk for certain cancers. Despite its significance, recent studies have demonstrated a lack of genetic testing awareness in the general population. This study aimed to illuminate potential avenues for improving the understanding of cancer genetic testing,specifically the association between health information technology (HIT) use and genetic testing awareness. Methods: In this cross-sectional study, we analyzeddata from the 2020 Health Information National Trends Survey (HINTS). Respondents ≥18 years with a family history of cancer were eligible. We excluded respondents without an electronic device or with a prior cancer diagnosis. HIT use (yes vs. no) was defined as having used electronic devices to look up health information, fill prescriptions, schedule medical appointments, or communicate with a health provider. The outcome measure was awareness of cancer genetic testing (yes vs. no). Descriptive statistics was used to compare baseline characteristics by HIT use. Multivariable logistic regression models were fit to calculate adjusted odds ratios (AOR) with 95% CIs. Results: Among a total of 2,075 respondents, 1,772 (85.4%) used one form of HIT and only 830 (40.0%) were aware of cancer genetic testing. The median age of the study population was 47 years. Patients who used HIT were younger, female, insured, married, had a relatively higher level of education and better access to a primary care provider. On multivariable analysis, overall HIT use was associated with increased awareness of cancer genetic testing, though not statistically significant (AOR 1.76; 95% CI: 0.82, 3.75). Stratifying by subgroups, having used HIT to communicate with doctors (AOR 0.83; 95% CI: 0.66, 1.05), check test results (AOR 0.91; 95% CI: 0.77, 1.08), look up health information online (AOR 0.78; 95% CI: 0.51, 1.22), or make health appointments (AOR 0.90; 95% CI: 0.77, 1.05) was not significantly associated with increased awareness of cancer genetic testing. Conclusions: Our study demonstrates a high prevalence of HIT use, with no statistically significant associations with awareness of genetic testing among individuals with a family history of cancer. Findings prompt a reevaluation of other targeted health educational strategies to close the knowledge gap of cancer genetic testing for this high-risk population.