Judged 3-Minute Oral Presentation Session I

Background/Significance:

A woman’s reproductive lifespan (age at menopause-age at menarche) is anchored within two significant physiological shifts. On average, women spend half their life in this phase and are susceptible to gynecological diseases.

Purpose:

The aim of the menopause (M2M) study is to examine the shift in reproductive lifespan.

Methods:

The M2M study included women (10-90 years) with a documented age at menarche and 1> annual encounter between 2014-2024 within a large Midwestern Health System (n=340,220). Demographics, gynecological conditions, and comorbidities were extracted from electronic health records. Descriptive statistics for continuous variables are presented as means and standard deviations and counts and percentages are used to describe categorical and dichotomous variables. Ages were stratified in quartiles by birth year: Q1(1924-1959), Q2 (1960-1972), Q3 (1973-1985), and Q4 (1986-2013). Linear regression (means, 95% confidence intervals [CI]) adjusting for race/ethnicity and earliest available BMI was used to determine association between birth year quartile and age at menarche. Survival analysis (Hazard ratio [HR], 95% CI) adjusting for age at menarche, parity, hysterectomy, body mass index, smoking, alcohol, hormone replacement therapy, hypertension, diabetes, depression, race/ethnicity, and marital status was used to examine association between birth year quartile and time to menopause.

Results:

Women were mostly non-Hispanic White (72%), never smokers (53%), with an average age of 45 years. Average age at menarche was 13 years, 55 years for menopause, while the average reproductive lifespan was 43 years. Model-adjusted age at menarche means were: Q1 (oldest) 12.63 (95% CI:12.63,12.67), Q2 12.72 (95% CI:12.71,12.74), Q3 12.50 (95% CI:12.49,12.52), and Q4 (youngest)12.30 (95% CI:12.29,12.32). Compared to Q1, Q2 had an adjusted difference of 0.08 years (0.06,0.09; p<.0001) while Q3 and Q4 had adjusted differences of -0.14 years (-0.16,-0.12; p<.0001) and -0.35 years (-0.37,-0.33; <.0001), respectively. Compared to Q1, Q2 (HR=1.03, 95% CI: 1.00-1.04), Q3 (HR=2.49, 95% CI: 2.39-2.59), and Q4 (HR=13.77, 95% CI: 10.67-17.78) had a shorter time to menopause.

Conclusion:

Age at menarche and menopause have decreased significantly over time, with women in the younger cohort experiencing menarche and reaching menopause at an earlier age. Further modeling is warranted to understand the impact of this shift on reproductive lifespan on women’s health.

Background/Significance:

The American College of Obstetricians and Gynecologists issued its first recommendation for universal prenatal depression screening (PDS) in 2015 and reinforced this opinion in 2018. In 2019, the National Committee for Quality Assurance added Prenatal Depression Screening and Follow-up as a quality measure. Language can be a barrier to receipt of recommended screenings.

Purpose:

To evaluate how language preference was associated with uptake of PDS following updated recommendations.

Methods:

This retrospective cohort included people who received prenatal care (PNC) for delivery at an Advocate Midwest facility between 2019 and 2024. We identified PDS through the presence of a depression screening instrument in the electronic health record during the PNC period. We used logistic regression with robust clustered standard errors to account for patients contributing multiple deliveries and calculated marginal probabilities of receiving PDS. An interaction term between language and year was used to assess whether the relationship between preferred language and PDS differed by year of delivery, controlling for maternal age, race/ethnicity, insurance, parity, gestational age, singleton versus multiple gestation, and state of PNC.

Results:

Of 99,526 deliveries, 37% received most prenatal care in Illinois and 63% in Wisconsin. Patients reported 76 preferred languages, reported as English (94%), Spanish (3%), and Another Language (3%) The interaction between language and year was statistically significant (p<0.001). In 2019, marginal probabilities of PDS were similar across groups: English 0.50 (95% CI, 0.49–0.51), Spanish 0.48 (95% CI, 0.41–0.56), and Another Language 0.50 (95% CI, 0.42–0.58). These probabilities diverged over time. By 2024, the probability of screening increased to 0.81 (95% CI, 0.80–0.81) for English-language preference patients, 0.66 (95% CI, 0.63–0.70) for Spanish-language preference patients, and 0.71 (95% CI, 0.68–0.74) for patients with another preferred language.

Conclusion:

PDS increased from 2019 to 2024, but improvements were not uniform across language groups, resulting in larger screening gaps by 2024 for patients with non-English language preference. Potential contributors include availability of validated instruments in preferred language, interpreter integration at screening, and documentation workflows.

Background/Significance:

Tumor necrosis factor-α (TNF-α) inhibitors are widely used in the management of inflammatory bowel disease (IBD), often combined with Methotrexate (MTX) to reduce immunogenicity. Agents such as Infliximab and Adalimumab are effective for moderate to severe ulcerative colitis and Crohn's disease. Although generally well tolerated, both have been linked to dermatologic adverse effects. Alopecia is a visible and distressing side effect that may affect quality of life and adherence. The magnitude of this risk in IBD patients receiving combination therapy remains unclear. Post-marketing databases allow detection of rare adverse drug reactions and potential interactions.

Purpose:

We used OpenVigil, a validated interface for the FDA Adverse Event Reporting System (FAERS), to evaluate alopecia reporting with infliximab or adalimumab plus MTX and determine whether signals persist within IBD.

Methods:

We performed a retrospective pharmacovigilance analysis using OpenVigil 2.1, extracting FAERS reports from inception through the most recent quarter. Disproportionality analyses identified signals for alopecia associated with infliximab or adalimumab, alone and with MTX. Reporter odds ratios (RORs) with 95% confidence intervals (CIs) were calculated for all indications and IBD-restricted reports. Signal persistence after stratification by diagnosis and the impact of MTX were assessed. Duplicate and incomplete reports were excluded.

Results:

There were 186,551 alopecia reports without indication of restriction, 944 for UC, and 468 for Crohn’s disease. Without restriction, significant signals were observed for infliximab (ROR 5.83, CI 5.72–5.94), MTX (ROR 4.15, CI 4.09–4.22), infliximab + MTX (ROR 20.94, CI 20.48–21.42), adalimumab (ROR 2.67, CI 2.63–2.72), and adalimumab + MTX (ROR 11.58, CI 11.50–11.82). In ulcerative colitis, significant signals were seen with adalimumab (ROR 1.16, CI 1.02–1.32) and adalimumab + MTX (ROR 2.39, CI 1.53–3.75). In Crohn’s disease, significant findings included infliximab (ROR 0.63, CI 0.51–0.79) and adalimumab (ROR 1.66, CI 1.37–2.00).

Conclusion:

A strong disproportional signal for alopecia was observed with infliximab–MTX, with a smaller signal for adalimumab–MTX. When restricted to IBD reports, the signal diminished or disappeared, suggesting a possible indication-dependent effect. Although reporting bias cannot be excluded, further study is warranted. Recognizing adverse effect profiles in IBD populations is important for counseling and long-term adherence.

Background/Significance:

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) reduce cardiovascular and renal events but carry a recognized risk of diabetic ketoacidosis (DKA), including euglycemic presentations. Whether combining SGLT2i with glucagon-like peptide-1 receptor agonists (GLP-1RA) modifies DKA risk compared with monotherapy remains unclear. We evaluated 1-year DKA risk among adults with type 2 diabetes treated with combination therapy versus either agent alone.

Purpose:

To compare the 1-year incidence and hazard of DKA across three treatment strategies: (1) SGLT2i + GLP-1RA vs GLP-1RA alone; (2) SGLT2i + GLP-1RA vs SGLT2i alone; and (3) SGLT2i alone vs GLP- 1RA alone.

Methods:

We conducted a retrospective multicenter cohort study using the TriNetX Global Collaborative Network (17 healthcare organizations). Adults ≥18 years with type 2 diabetes (ICD-10 E11) initiating study medications were included. Exclusions were type 1 diabetes, pregnancy, total pancreatectomy, or prior to DKA. The primary outcome was DKA within 365 days (ICD-10 E11.1/E13.1). Propensity-score matching (1:1) adjusted for age, sex, HbA1c, BMI, diabetes duration, insulin use, eGFR, hypertension, ASCVD, heart failure, and CKD. Effect measures included risk difference (RD), risk ratio (RR), and hazard ratio (HR) using Kaplan–Meier and Cox proportional hazards analyses.

Results:

Combination vs GLP-1RA alone (matched n=16,673 vs 16,660): DKA risk 0.5% vs 0.4% (RR 1.35, 95% CI 0.98–1.85; HR 1.53, 95% CI 1.11–2.11). Combination vs SGLT2i alone (n=16,673 vs 16,711): DKA risk 0.5% vs 0.6% (RR 0.92, 95% CI 0.69–1.22; HR 1.02, 95% CI 0.76–1.35). SGLT2i alone vs GLP-1RA alone (n=213,160 vs 212,923): DKA risk 0.5% vs 0.4% (RR 1.41, 95% CI 1.29– 1.55). Absolute risks were low (approximately 0.5–0.6% at 1 year).

Conclusion:

Combination therapy did not reduce 1-year DKA risk versus SGLT2i monotherapy by either risk-based or time-to-event analyses. Compared with GLP-1RA alone, combination therapy was associated with a higher DKA hazard. SGLT2i monotherapy carried significantly higher DKA risk than GLP-1RA monotherapy. Although absolute risks were low (~0.5–0.6% over 1 year), the relative differences are clinically meaningful in high-risk populations. GLP-1RA monotherapy demonstrated the lowest 1-year risk of DKA. Adding GLP-1RA to SGLT2i did not lower risk below SGLT2i alone, challenging the assumption that GLP-1RA mitigates SGLT2i-associated DKA. These findings should inform drug sequencing, shared decision-making, and risk counseling for patients who are predisposed to ketosis.

Background/Significance:

Inhaled β-agonists are central to the management of COPD exacerbations, and high-dose albuterol is often administered via jet nebulizer (JN) to ensure adequate bronchodilation. Vibrating mesh nebulizers (VMNs) may enhance aerosol delivery efficiency and substantially reduce treatment time compared to JNs, but evidence comparing these devices for high-dose therapy in COPD exacerbations remains limited.

Purpose:

This quasi-experimental, before-and-after non-inferiority study evaluated clinical outcomes associated with transitioning from continuous JN to VMN delivery of high-dose albuterol in the emergency department (ED).

Methods:

This institutional review board–approved study was conducted in the ED of a tertiary care hospital. Historically, high-dose albuterol (>5 mg) was delivered continuously by JN over approximately 60 minutes at doses of 10–15 mg. In December 2024, a protocol change standardized the use of a VMN (Aerogen Solo Ultra or inline) for all high-dose treatments, with dosing modified to 5 mg or, in cases of severe respiratory distress, 10 mg, delivered over approximately 10 minutes. Patients with COPD exacerbations who received high-dose albuterol during December 2023–January 2024 (JN arm) and December 2024–January 2025 (VMN arm) were included. Analyses were intent-to-treat. The primary outcome was needed for repeat albuterol treatment in the ED, with a non-inferiority margin of 5%.

Results:

A total of 132 subjects were included (JN n=83; VMN n=49). One patient in the VMN arm crossed over to JN delivery. Repeat albuterol treatment was required in 16% of VMN patients versus 29% of JN patients (p=0.01 for non-inferiority). Secondary clinical outcomes, including hospital admission, need for ventilatory support, and ED length of stay, were similar between groups.

Conclusion:

In adults presenting to the ED with COPD exacerbation requiring high-dose nebulized albuterol, rapid VMN treatment is non-inferior to continuous JN delivery in preventing the need for repeat bronchodilator therapy. VMN delivery may allow faster treatment without compromising clinical effectiveness.

Background/Significance:

Clinical practice guidelines for the acute management of migraines recommend antiemetics such as prochlorperazine as first-line therapy. Although intravenous (IV) magnesium sulfate (Mg) has demonstrated benefit as a standalone treatment for acute migraines, whether it can provide additive analgesic benefit when combined with prochlorperazine is unknown.

Purpose:

Determine whether IV Mg combined with prochlorperazine provides greater reduction than prochlorperazine monotherapy in emergency department (ED) patients with acute migraine.

Methods:

This prospective, double-blind, randomized controlled trial compares IV prochlorperazine and Mg with prochlorperazine and placebo in patients presenting the ED with symptoms of acute migraine. All participants received IV diphenhydramine 25 mg and prochlorperazine 10 mg, with randomization to Mg 2 g or placebo. The primary endpoint was mean change in pain 30 minutes after the initiation of the study drug using an 11-point Numeric Rating Scale. Secondary endpoints included pain reduction at 45 and 60 minutes, time to discharge, and adverse effects. Analysis employed descriptive statistics with Shapiro-Wilk, Chi-square tests, ANOVA, and logistic regression. A power analysis indicated 100 patients, 50 per group, were required to detect a 15% difference in pain reduction between groups at p<0.05 significance.

Results:

As of February 8, 2026, 26 patients were enrolled (n=11 Mg, n=15 placebo). All patients in the Mg group were female versus 11 of 15 in the placebo group. Mean ages were 37 and 49 years, respectively. Migraine history was present in 7 Mg and 6 placebo patients; aura occurred in 3 and 2 patients, respectively. Baseline pain scores averaged 7.2 for Mg and 6.4 for placebo, with 30-minute reductions of 4.6 points (64%) versus 1.3 points (20%); at 45 minutes, 6.0 points (83%) versus 3.3 points (52%); and at 60 minutes, 6.3 points (88%) versus 4.0 points (63%), respectively. Adverse events occurred in 3 Mg patients (flushing, akathisias) and 4 placebo patients (akathisias, dizziness, drowsiness). Rescue medication use was lower in the Mg group (2 vs. 4 patients), and mean ED discharge times were 409 minutes for Mg and 879 minutes for placebo.

Conclusion:

Preliminary findings signal Mg combined with prochlorperazine provides greater efficacy in reducing migraine pain compared to prochlorperazine alone. Full enrollment and analysis are needed to confirm the role of Mg in acute migraine management and its potential to improve outcomes for ED patients.