Two killed, two injured at Aramco's Shaybah field

 Two people were killed and two others injured after Saudi air defenses intercepted a drone targeting a facility at Saudi Aramco's Shaybah oil field on Wednesday, the Saudi Press Agency reported, citing officials from the Ministry of Energy.

The victims were foreign nationals from the Philippines and Nepal, while the injured were citizens of Pakistan and India.

The incident sparked a fire in a contractor's vehicle outside the facility's perimeter, but oil field operations were unaffected.

https://breakingthenews.net/Article/Two-killed-two-injured-at-Aramco's-Shaybah-field/67368959

US orders embassy staff to leave Saudi Arabia

 The United States State Department ordered all non-emergency government employees and their families to leave Saudi Arabia on Wednesday, spokesperson Tommy Pigott confirmed on Wednesday.

"Iranian-supported Houthis have increasingly engaged in hostilities against Saudi Arabia, including attacks on civilian airports and other critical infrastructure resulting in civilian casualties and severe travel disruptions," Pigott said in the statement shared on X.

The spokesperson, however, denied media reports suggesting that Washington had ordered all US embassy staff to leave other Gulf countries.

https://breakingthenews.net/Article/US-orders-embassy-staff-to-leave-Saudi-Arabia/67368977

'US said to change stance, favor preemptive Iran strike: Haaretz'

 The United States has shifted its position in the past few hours and now favors a preemptive attack on Iran, Israeli Haaretz newspaper reported on Wednesday, citing unnamed White House sources. Meanwhile, unconfirmed reports emerged that the US may have already carried out an air strike on Sirik in southern Iran.

According to the report, Washington changed its stance after US Defense Secretary Pete Hegseth presented new intelligence to President Donald Trump after his trip to Israel and meeting with that country's Prime Minister Benjamin Netanyahu.

https://breakingthenews.net/Article/US-said-to-change-stance-favor-preemptive-Iran-strike/67369672

'KFF: Dems Demand Tougher Standards for Companies Running States' Medicaid Systems'

 A group of Democratic senators is demanding that the federal agency overseeing Medicaid institute tougher standards for government contractors running complex computer systems that millions of people rely on to get benefits.

Three Democratic senators issued recommendations a year after launching an inquiry into companies -- Deloitte, General Dynamics Information Technology (GDIT), Gainwell Technologies, and Conduent -- that are paid billions in taxpayer dollars to build or run eligibility systems for safety net health coverage. Those benefits, provided to the poorest Americans, can mean the difference between having medical care or going without.

A handful of states directly operate their Medicaid eligibility systems, but most rely on contractors to build and run them. KFF Health News found that Deloitte dominates this slice of government business. Deloitte-run systems have been plagued by errors that can result in eligible people losing their health coverage, previous KFF Health News investigations have shown. Malfunctions can cost millions of taxpayer dollars and take years to fix.

"Administrative errors in this line of work are not like errors in other fields," the senators wrote in a new report. "There are life-and-death consequences for sick Americans who seek care only to find that their Medicaid coverage has been terminated."

President Donald Trump's signature tax and domestic policy law has mandated Medicaid changes that are forcing states to adapt their computer systems on a compressed timeline. Medicaid policies under the One Big Beautiful Bill Act add red tape and restrictions that make it harder for people to stay enrolled.

Those include the first federally mandated work requirements in Medicaid's history. Next year, to keep benefits, millions of adult Medicaid enrollees in more than 40 states must prove they're working or doing a similar activity for at least 80 hours a month, unless they qualify for an exemption.

Democratic senators Ron Wyden of Oregon, Elizabeth Warren of Massachusetts, and Raphael Warnock of Georgia say the new restrictions -- layered atop computer systems with histories of problems -- will result in large numbers of people improperly losing health coverage.

State eligibility systems "have been built up, patched, and frankensteined for decades," the senators said.

The senators sit on the powerful Senate Finance Committee, which oversees government health programs such as Medicare and Medicaid. Many of their recommendations target the Centers for Medicare & Medicaid Services (CMS). Their ideas face long odds at the moment. Republicans control executive branch agencies, and any potential legislation would need to advance in a Republican-controlled Congress.

That balance of power could shift if Democrats win a majority of Senate seats in November's midterm elections. The three lawmakers called on CMS to establish mandatory standards in state contracts with companies so states can receive federal funds.

These companies sign contracts with state governments, but the federal government approves them and pays the bulk of the cost. The federal government covers 90% of state costs to develop and implement state Medicaid eligibility systems and 75% of ongoing maintenance and operations expenses, according to federal regulations.

The lawmakers also said CMS should publicize the contracts and contract amendments. Currently, those documents can be obtained from state governments, but accessibility varies significantly.

The senators also said CMS should publicly disclose companies' performance data and change orders. Change orders are used to adjust computer systems, and states set aside millions of dollars for them. But systems may require fixes beyond the agreed-upon work.

"The millions of Medicaid enrollees who will be required to prove their eligibility every 6 months, to document every hour of work on a glitchy portal, to find a doctor willing to certify that their cancer or their chronic condition is bad enough to qualify for an exemption -- deserve contractors who are accountable for what happens when the system fails them," they wrote.

In October 2025, the three Democratic senators, as well as Sen. Bernie Sanders (I-Vt.), sent letters to several companies that CMS identified as eligibility system contractors. At the time, they wrote that it is each company's responsibility to build functioning eligibility systems, "rather than to prioritize their bottom line."

As of June, 66 million people were enrolled in Medicaid, according to CMS.

The lawmakers had asked the companies about their contracts, lobbying expenditures, and protocols for making changes in light of system errors, among other issues. The companies provided the lawmakers with some details but often did not answer their questions.

The companies said states are responsible for making the final call on whether a person receives benefits. State workers approve or deny eligibility, Deloitte said in its response letter, "not a private contractor or an automated system acting alone."

The companies did not provide the senators with specific details about documents or processes they use to help states make eligibility determinations.

The companies also denied they have any financial incentives to remove people from Medicaid. Conduent said it gets paid less if enrollment drops.

The companies did not say whether states are on the hook for paying to fix the companies' errors.

Deloitte, Gainwell, GDIT, and Conduent said it's common for states to require that they meet certain performance metrics.

Gainwell told lawmakers, "We take seriously the issues raised." GDIT said it would answer additional questions from lawmakers.

Deloitte said in its response to the lawmakers: "We are proud of our work serving individuals and families across the U.S."

CMS did not respond to a request for comment.

CMS takes steps to check whether Medicaid eligibility systems are working properly. As part of the process for certifying states' systems, federal officials check certain metrics. They include whether states are correctly calculating people's incomes, whether individuals are given timely eligibility decisions, and whether eligibility categories are accurate. However, it is rare for the federal government to withdraw federal money from states for falling short.

In August, CMS announced it intends to develop standards for Medicaid systems. The ultimate goal is to improve enrollees' access to care and their experiences with these systems, CMS said. The agency also has said the standards will hold companies accountable to deliver systems that are "continuously improving" and have a "stronger capacity to implement critical policy changes."

https://www.medpagetoday.com/publichealthpolicy/medicaid/123478

Testosterone Screening Thresholds in Active-Duty US Male Service Members

 

1. Stephen R. Hennigar, PhD¹; Steven B. Heymsfield, MD¹; Asma S. Bukhari, PhD, RD¹
2. et al
   
   doi: 10.1001/jama.2026.19794
   
   

   Serum testosterone level is measured to evaluate suspected hypogonadism. A recent US government memorandum1 requires annual testosterone screening for all active-duty and reserve military personnel aged 30 years and older. Consequently, population estimates of prevalence of low testosterone at screening are needed. Clinical guidelines recommend against screening asymptomatic men because testosterone concentrations vary with age, time of day, obesity, illness, and physical stress.² The American Urological Association recommends a total testosterone concentration less than 300 ng/dL as a reasonable cutoff for low testosterone,³ whereas a harmonized Centers for Disease Control and Prevention reference study identified 264 ng/dL as the lower limit of normal in healthy, nonobese men aged 19 to 39 years.⁴ We estimated US Army–wide prevalence of active-duty men with testosterone concentrations below these thresholds.

   Methods

   This cross-sectional analysis used data from the Military Health and Nutrition Examination Study, a multisite survey conducted at 5 US Army installations from August 2024 through January 2026.⁵ Participants with fasting morning serum total testosterone measurements were included; 3 men receiving testosterone replacement therapy were excluded. Total testosterone and sex hormone–binding globulin levels were measured by automated immunoassay (IMMULITE 2000; Siemens) and albumin level on a Beckman UniCel DxC 600 Pro. Free testosterone level was determined by calculation.⁶ Data from women were not included because 73 of 160 (45.6%) had testosterone concentrations below the assay limit of detection (<20 ng/dL). Prevalence using a screening testosterone concentration less than 300 ng/dL and less than 264 ng/dL was estimated with 95% CIs. Poststratification calibration weights aligned estimates with the active-duty US Army population, and survey-weighted logistic regression examined associations of age and body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) with testosterone level. To convert testosterone to nmol/L, multiply values by 0.0347. Participants provided written informed consent, and the study was approved by the Pennington Biomedical Research Center institutional review board and registered on ClinicalTrials.gov (NCT06380322). Additional methods are provided in the eMethods in Supplement 1.

   Results

   Men (n = 479; 1.7% were American Indian or Alaska Native, 6.3% Asian or Pacific Islander, 17.1% Hispanic, 20.5% non-Hispanic Black, and 54.4% non-Hispanic White) had a weighted mean (SE) age of 29.9 (0.6) years and BMI of 28.4 (0.2). The weighted mean morning total testosterone, sex hormone–binding globulin, and free testosterone concentrations were 405 ng/dL (95% CI, 368-442 ng/dL), 3.24 μg/mL (95% CI, 2.73-3.75 μg/mL), and 8.74 ng/dL (95% CI, 7.70-9.81 ng/dL), respectively. According to total testosterone concentrations, an estimated 100 691 active-duty US Army personnel would have a morning screening testosterone concentration less than 300 ng/dL, corresponding to a weighted prevalence of 25.7% (95% CI, 16.8%-34.5%) (Table). Using a threshold of less than 264 ng/dL, approximately 57 788 men would have a screening concentration below the threshold (weighted prevalence, 14.7%; 95% CI, 9.7%-19.7%), including 23 115 nonobese men aged 19 to 39 years (9.7%; 95% CI, 4.6%-14.8%).
   https://jamanetwork.com/journals/jama/fullarticle/2855385

   Table.  Prevalence of Total Testosterone Categories in Male Active-Duty Army Personnel^a,1

   
   

   

Rampant Inflammation in Heart Failure: Can Anything Be Done About It?

 Cardiovascular inflammation was highly prevalent among U.S. heart failure (HF) patients, a registry study found, illustrating the unmet need for good inflammation-targeting pharmacotherapy.

In a subanalysis of POSEIDON -- the largest global registry of inflammation in patients with atherosclerotic cardiovascular disease (ASCVD) or HF -- elevated high-sensitivity C-reactive protein (hsCRP; ≥2 mg/L) was detected in about half the American participants -- 50.8% in those with heart failure with preserved ejection fraction (HFpEF), 44.7% with mildly reduced ejection fraction (HFmrEF), and 50.3% with reduced ejection fraction (HFrEF).

That makes the U.S. cohort at disproportionately high cardiovascular inflammatory risk compared with the global POSEIDON study as a whole, where elevated hsCRP in HFpEF came out to 38.8%, in HFmrEF 38.1%, and in HFrEF 38.2% across 18 countries, reported Marat Fudim, MD, MHS, of Duke University Medical Center in Durham, North Carolina, at the Heart Failure Society of America annual conference.

"Now, what does that mean? I don't know how to address it, but all I can tell you is that we are very inflamed as a nation of HF patients ... Of course, comorbidities are the key drivers ... obesity, diabetes, and CKD [chronic kidney disease] being key drivers," he said.

In Fudim's presentation, residual inflammatory risk persisted despite use of guideline-directed medical therapy. He stressed that hsCRP is a "practical" biomarker to identify HF patients with persistent residual inflammatory risk. "Of course, it starts with lifestyle and exercise that we know can reduce inflammatory risk, weight loss therapy, and you know, addressing key risk factors of CKD. So I use [hsCRP] as a jumping board to motivate my patients and inform me of the risk category," he said.

"Of course, we don't have actually a dedicated treatment," said Fudim, alluding to the "disappointing story" of anti-inflammatory drug development that has left his enthusiasm "a little bit stifled."

In September, Novo Nordisk announced that it had two trials of the interleukin (IL)-6 inhibitor ziltivekimab stopped early for futility. The two placebo-controlled trials, HERMES and ATHENA, had been designed to assess a range of hard and soft endpoints in HF patients with high hsCRP. Prior to the premature stop of these studies, ziltivekimab already showed it was unable to reduce major adverse cardiovascular events in the ZEUS trial of people with ASCVD, CKD, and inflammation.

"A bit of a tricky field to navigate at the moment," commented session discussant Amanda Vest, MBBS, MPH, of Cleveland Clinic, who recalled the long history of neutral, if not outright negative studies that had tried to establish HF drugs that target specific inflammatory pathways.

"How do you put it together? This discrepancy between the demonstration of high inflammatory burden, what we know from other cohorts about its mortality implications, and yet these disappointing interventional trials over the recent years?" Vest posed.

Fudim's answer was to go forward with a broader approach that eradicates multiple inflammatory pathways at once.

He cited GLP-1 drugs as an example. "GLPs reduce inflammation, but they do it differently, right? ... It's going to be a whole array of inflammatory environments, not just IL-6 ... I would probably not put my money right on IL-6 again. I think that door has closed in this moment."

"If you have an agent that can target multiple pathways, you might be OK. But at the same time, be careful how much you suppress or interfere with the immune system. It was given to us for a reason," he cautioned.

Fudim's report was a cross-sectional analysis of the POSEIDON study that prospectively enrolled 18,904 adults with ASCVD and/or HF undergoing routine care. Individuals were recruited in 18 countries from 2023 to 2025.

The U.S. HF subset was further spit into HFpEF (n=315), HFmrEF (n=94), and HFrEF (n=392) cohorts.

Besides the typical characteristics associated with these populations, Fudim noted that there were few distinctive features that made some people more likely to have high inflammation; of note, there did appear to be higher insulin and diuretic use in those with high hsCRP across HF phenotypes.

Elevated hsCRP ≥2 mg/L was linked to higher IL-6 and NT-proBNP across all HF phenotypes.

Disclosures

POSEIDON was sponsored by Novo Nordisk.

Fudim disclosed ties to Alleviant, Axon Therapies, Bayer, Bodyport, Boston Scientific, CVRx, Daxor, Endotronix, Novo Nordisk, Pharmacosmos, ScPharmaceuticals, and Zoll, among other groups.

Vest had no disclosures.

Primary Source

Heart Failure Society of America

Source Reference: Fudim M, et al "Prevalence of cardiovascular inflammation and associated patient characteristics and biomarker profiles across the heart failure spectrum in the United States: results from the POSEIDON study" HFSA 2026.

https://www.medpagetoday.com/meetingcoverage/hfsa/123415

Most flu shots are still non-mRNA

 For those who want to try the new mRNA flu shot (mFlusiva) this season, tracking it down might take some work, observers said.

Moderna's shot was only approved in August, for all adults ages 50 and older, long after national retail pharmacy chains had placed orders for their supply of this year's flu shots. Questions about demand also linger.

So it's not surprising that the mRNA shot will be available in limited quantities this year, Amesh Adalja, MD, of the Johns Hopkins Center for Health Security in Baltimore, told MedPage Today.

A Moderna spokesperson confirmed that the company planned a "limited launch in year one," but noted that the shot is available "at more than 13,000 locations," and provided MedPage Today with a link to the company's vaccine finder.

"If someone wants to get mFlusiva, they're going to have to use that website or call around," Adalja said.

He compared it to the early days of Flublok -- his preferred vaccine -- when he would have to call around different pharmacies to track it down.

"It used to be harder to find Flublok and Flucelvax, which are more novel flu vaccines, because drugstores order the standard one and they don't differentiate the products, which is a problem," Adalja noted.

There are a lot of options when it comes to flu shots. There are a handful of standard-dose products, and they're made by growing the influenza virus in eggs. Brand names include Fluzone, Fluarix, FluLaval, and Afluria.

There's also FluMist, which is an egg-based, live-attenuated nasal spray vaccine.

Then there are "enhanced" products, including the recombinant shot Flublok, which contains three times the antigen of standard-dose vaccines, and the cell-based shot Flucelvax. Both of these are egg-free.

Other enhanced flu shots include Fluzone High-Dose and the adjuvanted shot Fluad, both of which are made in eggs and approved for people ages 65 and up. And now, there's the mRNA shot.

Notably, all flu shots in the U.S. are now trivalent, since the CDC said that the B/Yamagata lineage stopped circulating after March 2020.

Choosing among these vaccines is partly patient preference, and Adalja has his own favorites: "When someone asks me which flu vaccine to get, I basically say Flublok or mFlusiva are the two best flu vaccines to get right now."

That's based on his read of the data, and he acknowledges there aren't good head-to-head studies of the mRNA shot versus other enhanced vaccines in terms of clinical outcomes. Indeed, one of the key complaints about Moderna's pivotal phase III study was that it compared mFlusiva with a standard-dose vaccine.

When the FDA approved the mRNA flu shot this summer, it gave traditional approval in adults ages 50 to 64, but accelerated approval for those 65 and older, with a postmarketing effectiveness study -- ideally against an enhanced vaccine -- planned for that population.

That compromise was reached after the FDA, under former vaccine director Vinay Prasad, MD, MPH, initially refused to review Moderna's application for the vaccine over concerns about the lack of a better comparator. A week later, the agency reversed its decision.

A separate phase III study did show that the mRNA shot led to greater immunogenicity than Fluzone High-Dose in those ages 65 and up, but it did not examine clinical outcomes.

"The immune response elicited by the mRNA vaccine seems to be superior in some respects ... but it remains to be seen whether that translates into better protection," said William Schaffner, MD, of Vanderbilt University in Nashville, Tennessee, who is also a spokesperson for the Infectious Diseases Society of America.

He noted that the mRNA shot has greater reactogenicity than standard flu shots, "and I would anticipate that would also be true for the enhanced vaccines." This includes higher rates of injection-site pain, fatigue, headache, and myalgia, according to data from the phase III trial.

"That is something people have to weigh," Adalja said. "When you look at the comparative efficacy, you've got to say, is it worth the extra reactions that you get for the added protection?"

That may be especially off-putting for healthcare workers who don't want to miss a shift because of a vaccine reaction. On the other hand, Schaffner said, the adaptability of the mRNA platform may be a boon to healthcare workers, as it could theoretically deliver a vaccine that's more closely matched to the circulating strain.

FDA finalizes strain selection in March, but with newer technologies -- including the cell-based and recombinant vaccines, as well as the mRNA vaccine -- that timeline could potentially be shortened, Schaffner said.

That would be a heavier lift from a policy perspective, he added. "FDA and maybe even the WHO [World Health Organization] would have to adapt their recommendation framework."

Regardless of what the future holds, Schaffner emphasized that now is the time to get vaccinated -- and that patients shouldn't wait for "flu before boo" this year.

"Influenza has started early in many parts of the country," he noted. "If you have not been vaccinated, run, do not walk ... and get the vaccine that's available to you."

https://www.medpagetoday.com/infectiousdisease/uritheflu/123431