Valley Health System

Introduction: Guidance exists for initiating vasopressors in shock, but little supports their weaning. Midodrine has been investigated as an adjunct to facilitate vasopressor weaning; however, current studies do not explore the comparative effectiveness of different dosing regimens. This study aims to evaluate whether a higher or lower dose of midodrine is more effective in reducing norepinephrine requirements during the weaning process. Methods: A single-center, retrospective chart review was conducted. The primary outcome was time to discontinue norepinephrine after the addition of either a high-dose (greater than 30 mg) or low-dose (30 mg or less) of midodrine. Secondary outcomes were ICU length of stay, percent decrease in norepinephrine rate after 24 hours of midodrine, the proportion of patients discharged on midodrine, and development of bradycardia. A subgroup analysis was performed comparing patients whose midodrine was titrated vs no titration. Results: Of 203 patients reviewed, 42 met inclusion criteria: 6 in the high-dose group and 36 in the low-dose group. Median time to wean norepinephrine was 95.7 hours (IQR 19.2–259.7) in the high-dose group versus 30.8 hours (IQR 16.1–46.2) in the low-dose group (p=0.659), showing no significant difference. In the subgroup analysis, the non-titration group had a shorter weaning time (22.8 hours, IQR 12.1–35.9) compared to the titration group (70.2 hours, IQR 34.2–107.8; p=0.022). Overall, 19 patients (45.2%) were discharged on midodrine, and 11 (26.2%) developed bradycardia. Titration did not significantly impact norepinephrine weaning. Conclusions: This is the first study to compare dosing strategies of midodrine for norepinephrine weaning. The primary endpoint showed no statistically significant difference between high-and low-dose groups. A notable proportion of patients were discharged on midodrine, and bradycardia was a common adverse event.

Abstract Background: Sexual health symptoms are common and distressing in breast cancer survivors. There is limited data regarding the experience with sexual health among patients with metastatic breast cancer (MBC). Given the chronic nature of MBC and ongoing treatments, sexual health concerns may be especially complex and underrecognized in this population. We previously reported data from the WISH-BREAST study evaluating sexual health in breast cancer survivors. Here, we present findings from the WISH-BREAST MBC cohort. Methods: An anonymous online survey on sexual health in breast cancer survivors was distributed through a social media platform (Instagram) and e-mail. Questions included demographics, breast cancer history and treatment, sexual health symptoms and experience with medical care for sexual health symptoms. Results: There were a total of 1775 responses to the survey. 42 reported having MBC and 1420 reported Stage 0-III; these respondents were included in this analysis. The median age of MBC respondents was 44 years (range 39-53 years). Median age at diagnosis was 39 years (range 33-45 years) - younger than the non-MBC respondents. MBC respondents were more likely to report early menopause (57.1% vs 28.2%). 100% of respondents with MBC reported changes to sexual health. 95.2% reported a moderate to great deal of distress related to sexual health changes. The sexual health concerns reported are summarized in Table 1. Respondents with MBC were more likely to report painful sex (78.6% vs 58.8%), no sexual pleasure (52.4% vs 33.4%), and that sexual health concerns impacted relationships (85.7% vs 71.4%) than non-MBC respondents. The majority of respondents with MBC obtained information about sexual health from social media, although a lower percentage compared to those with non-MBC (66.7% vs 80.5%). While 95.2% of respondents with MBC reported vaginal dryness, 64.3% reported that treatment with vaginal hormones was not discussed. A similar proportion of respondents with MBC reported being prescribed vaginal estrogen compared to respondents with non-MBC (23.8% vs 22.7%). Conclusions: In this online survey, respondents with MBC reported high rates of sexual health concerns and distress. Despite the prevalence of symptoms such as vaginal dryness, painful sex and loss of sexual pleasure, conversations around management options, including vaginal hormones, remain limited. These findings underscore critical gaps in clinical care and patient-provider communication regarding sexual health in the metastatic setting and highlight the potential role of social media an information source. Integrating sexual health discussions into routine MBC care, improving access to evidence-based treatments and sexual health programs, and including patients with MBC in clinical trials focused on sexual health are essential steps toward enhancing quality of life for this population. Citation Format: L. S. Agrawal, T. Kluthe, C. Menn, E. Teplinsky. Women's Insights on Sexual Health After Breast Cancer (WISH-BREAST) Online Survey: Metastatic Breast Cancer Cohort [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-03-10.

Abstract Introduction: Estrogen plays a critical role in regulating metabolism, body composition and glucose homeostasis. Its decline after menopause increases the risk of metabolic disorders, including type 2 diabetes & obesity. Endocrine therapies (ET), including tamoxifen and aromatase inhibitors (AI), effectively reduce recurrence & improve survival in women with hormone receptor-positive (HR+) breast cancer (BC), but may disrupt metabolic health, contributing to increased insulin resistance & weight gain. The use of pharmacologic weight loss agents, particularly GLP-1 receptor agonists (GLP-1 RAs) is steadily increasing. Data on their efficacy in patients with BC on ET remains limited. This retrospective study evaluated total body weight loss in patients with stage 0-IV HR+ BC receiving both ET and weight loss medications. Methods: A retrospective chart review was conducted of approximately 110 patients (pts) with HR+ BC diagnosis evaluated at our institution’s weight management center. Of these, 24 pts met inclusion criteria: stage 0-IV HR+ BC, initiation of ET ≥ three months prior to starting weight loss medications, and ≥ 2 follow-up visits for weight management. Data collected included demographics, BC history, comorbidities, and weight loss medication use and body weights. The primary objective was to evaluate the mean total body weight loss at 3 months (mo), 6 mo, 9 mo and 12 mo, when available. Categorical variables were summarized using percentages. Changes in weight from baseline to each follow-up were analyzed using paired t-tests. A repeated measures analysis was performed for patients with data across all timepoints. Results: Median age was 61.5 years (range 43-73); BC stage 0 (n=1); stage 1 (n =18); stage 2 (n =3); stage 3 (n =1); stage 4 (n =1). One pt had HR+/HER2+ BC; remainder were HER2-negative. All were postmenopausal: 2 were on a GNRH agonist and 5 had prior surgical menopause. ET at weight loss medication initiation: anastrozole (n=17); exemestane (n=3), letrozole (n=2), fulvestrant (n=1); tamoxifen (n=1). Median time on endocrine therapy when starting weight loss medications: 41.5 mo (range 5-107). Common comorbidities: pre-diabetes (29.2%), type II diabetes (16.7%), and hyperlipidemia (70.8%). 8.3% had prior bariatric surgery. Most pts (83.3%,n=20) were prescribed GLP-1 RAs and 16.7% (n=4) phentermine. The GLP-1s used were Zepbound (n=10); Mounjaro (n=5); Wegovy (n=4); Ozempic (n=2); Saxenda (n=2); Victoza (n=1); some pts switched agents during treatment. Median initial weight at time of starting weight loss medications was 192.7 lbs (range 153.9-273). All patients had a baseline and 3 mo follow-up visit, with a mean weight loss of 18.8 lbs between timepoints (p<0.001). At 6 mo, 23 patients had available data, showing a mean reduction of 30.9 lbs (p<0.001) from baseline. At nine and twelve mo, follow-up data were available for 50% of patients (n=12), with mean weight losses of 39.6 lbs (p=0.033) and 37.9 lbs (p=0.004), respectively. Among the 8 patients with complete data, repeated measures analysis demonstrated a significant weight reduction from an average of 211.7 lbs to 178.9 lbs (p<0.001). No new safety concerns were identified. Conclusion: The use of GLP-1 RAs or phentermine in this cohort of patients with HR+ BC on ET was associated with meaningful weight loss, most notably within the first nine months, with weight plateauing thereafter. The degree of weight loss observed was comparable to outcomes reported in the general population using these medications. Limitations include a small sample size and grouping of all weight loss agents together. Updated data with a larger sample size and body composition analysis, will be presented. Prospective studies are warranted to further assess long-term efficacy in this pt population. Citation Format: T. Adamson, N. E. Gharaibeh, R. Shaw, C. D. Morrissey, S. Kapoor, A. Podolski, E. Teplinsky. Evaluating weight loss outcomes in patients with hormone receptor-positive breast cancer on endocrine therapy receiving concurrent weight loss medications [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PD8-02.

Objective Disease-modifying antirheumatic drugs (DMARDs) are widely used to treat autoimmune diseases. However, little is known regarding whether they influence in-hospital outcomes in patients admitted with COVID-19. Methods A retrospective cohort study was conducted in two Las Vegas, Nevada, tertiary referral hospitals to evaluate whether the use of DMARD in patients with COVID-19 influences in-hospital outcomes. Data were retrieved from electronic health records of adult patients with COVID-19 who were admitted over six months. Patients were divided into two groups: those who were actively receiving DMARD therapy when they developed COVID-19 (n = 14) and those who were not (n = 553). Primary (mortality rates) and secondary endpoints (type of visit (emergency department versus inpatient admission), need for mechanical ventilation, ICU upgrades, and length of hospital stay) were compared among the two groups. Results The two groups had similar baseline characteristics such as age, sex, race, body mass index, and ethnicity. Although differences existed between the groups' outcomes, these differences were not statistically significant. Mortality rates (p = 0.36), emergency room visit rates ( p = 0.14), ICU admission rate (p = 0.8), total length of hospital stay (8 days vs. 2.8 days, p = 0.2), and ventilator use (p = 0.5) were not statistically significant when comparing the DMARD and non-DMARD groups. Conclusion Our study indicates that both non-DMARD and DMARD groups had similar outcomes after contracting COVID-19 without any statistically significant differences.Although not statistically significant, the observation of reduced mortality, admissions, and ventilator use in the DMARD group compared to the non-DMARD group is hypothesis-generating and should be explored in future studies.

This case describes a 53-year-old male patient presenting with right-sided abdominal pain and acute kidney injury (AKI) who retained intravenous (IV) contrast within the ureter from a previous image 24 hours prior at a different hospitalthat was initially mistaken for a calcified ureteral stent after presenting to a different hospital without the patient initially disclosing his previous hospital stay.This created diagnostic uncertainty and prompted subspecialty consultations for a device the patient had never received. The patient subsequently passed a ureteral calculus with resolution of symptoms and improvement in renal function. This case highlights the importance of recognizing residual IV contrast as a potential mimic of foreign bodies on computed tomography (CT), particularly in patients with recent contrast-enhanced studies.