The direct cost of modern systemic therapy is a growing obstacle for United States patients who rely on Medicare Part B. Two biologic rich standards dominate early breast cancer care: an immunotherapy containing regimen for triple negative disease and a dual HER2 regimen for tumors that are hormone receptor positive and HER2 positive, often called triple positive. Up to date information on the absolute Medicare and patient out of pocket cost for each regimen is limited. To measure 1 year Medicare drug spending and beneficiary coinsurance for the immunotherapy regimen used in triple negative cancer and the dual HER2 regimen used in triple positive cancer, and to test how those totals change with body size and with 340B acquisition pricing. Average Sales Price files for Medicare Part B quarter 3 2025 supplied unit prices. Doses came from National Comprehensive Cancer Network Breast Guideline version 4 2025. Rules were applied to a reference woman who weighed 70 kg and had a body surface area (BSA) 1.82 m2. For each drug the per dose rule was converted to milligrams, multiplied by cycle count, divided by the billing unit size listed in the Healthcare Common Procedure Coding System, rounded up, and multiplied by Average Sales Price plus 6 percent. Beneficiary liability was 20 percent coinsurance. Sensitivity runs repeated every calculation for 60 kg and 90 kg and for a 40 percent 340B discount. For the 70 kg patient Medicare paid 212,008 USD for the immunotherapy regimen and 205,484 USD for the dual HER2 regimen. Coinsurance liabilities were 42,402 USD and 41,097 USD, respectively. Pembrolizumab accounted for more than 90 percent of triple negative cost, whereas trastuzumab plus pertuzumab accounted for more than 80 percent of triple positive cost. Changing weight from 60 kg to 90 kg moved annual immunotherapy cost by less than 0.2 percent, yet shifted dual HER2 cost from 196,539 USD to 223,302 USD (plus 13.6 percent). Coinsurance moved in parallel, from 39,308 USD to 44,660 USD. A 40 percent 340B discount lowered every total proportionally without changing the rank order. At 2025 quarter 3 prices Medicare pays about 200,000 USD for 1 year of either regimen and the beneficiary faces approximately 42,000 USD in coinsurance. Fixed dose pembrolizumab makes the triple negative regimen cost almost independent of body size, whereas weight based trastuzumab and pertuzumab make the triple positive regimen strongly size dependent. These updated figures quantify present financial burden and provide transparent inputs for future budget impact and cost effectiveness work. P. Jain, V. Majmundar, C. Bhanushali, N. Ganatra, M. Patel, R. Patel, A. Kothari, K. Patel, T. Naqvi. Medicare Part B Drug Cost Burden of Pembrolizumab Based Triple Negative and Dual HER2 Triple Positive Regimens for Early Breast Cancer at 2025 Q3 Payment Rates [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 PS4-11-01.
Background The association between baseline prediabetes and recurrent ischemic stroke in patients with atrial fibrillation (AF) and prior cerebrovascular events remains uncertain. Methods Using the TriNetX United States Collaborative Network (67 healthcare organizations), adults with AF and prior ischemic stroke or transient ischemic attack were classified at baseline as having prediabetes or normoglycemia; diabetes mellitus was excluded. One-to-one propensity score matching balanced demographics and comorbidities. Cumulative risk and time-to-event analyses assessed recurrent ischemic stroke, all-cause mortality, gastrointestinal bleeding, and intracranial hemorrhage. Glycemic status was not updated during follow-up. Results After matching, 80,335 patients per cohort were analyzed (mean age 70 years; 54.7% male; all standardized mean differences <0.02). Cumulative recurrent stroke risk did not differ significantly (60.0% vs 60.4%; risk ratio 0.993, 95% confidence interval [CI] 0.982–1.005; P = 0.264). Time-to-recurrence was longer in the prediabetes cohort (median 1,794 vs 1,695 days; hazard ratio [HR] 0.960, 95% CI 0.943–0.978; P < 0.001). Prediabetes was associated with lower mortality (HR 0.891, 95% CI 0.873–0.910; P < 0.001) and gastrointestinal bleeding (HR 0.918, 95% CI 0.889–0.947; P = 0.003). Intracranial hemorrhage did not differ significantly (HR 0.961, 95% CI 0.917–1.007; P = 0.065). Conclusions Baseline prediabetes was not associated with increased cumulative recurrent stroke risk in this AF population. The observed time-to-event and secondary-outcome associations do not establish a protective effect. Metabolic surveillance remains an untested hypothesis; unmeasured care differences, residual confounding, and unaccounted-for glycemic progression limit interpretation and require prospective evaluation.
Hereditary angioedema is an inherited condition marked by recurrent, non-pitting swelling of subcutaneous tissues, abdominal pain episodes, and occasional airway involvement that may become life-threatening. The majority of affected individuals carry disease-causing alterations in the Serpin Family G Member 1 (SERPING 1) gene. Mutation in other genes contributes to a small number of cases. Because the condition is uncommon, it is frequently overlooked in early stages, and episodes are often treated as allergic angioedema using corticosteroids and antihistamines. Confirmation of diagnosis for appropriate genetic counseling of trigger avoidance and guidance regarding measures to tackle edematous attacks. We report a case of 11-year-old twins presenting with swelling of the face, positive family history, and similar complaints and a heterozygous mutation in the SERPING1 gene successfully managed with systemic tranexamic acid.
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for relapsed or refractory classical Hodgkin lymphoma (cHL); however, a substantial subset of patients ultimately requires allogeneic hematopoietic stem cell transplantation (allo-HCT) to achieve long-lasting disease control. The use of ICIs as a bridge to allo-HCT has therefore gained increasing clinical interest, though concerns persist regarding post-transplant complications and incompletely-defined safety profiles. Accordingly, this systematic review and meta-analysis was conducted to evaluate outcomes of ICIs administered prior to allo-HCT in cHL. Following PRISMA guidelines, a comprehensive literature search was conducted across online databases through January 2026. Eligible studies included observational designs reporting survival and transplant-related outcomes in cHL patients treated with ICIs followed by allo-HCT. Pooled proportions for overall survival, progression-free survival, non-relapse mortality, and graft-versus-host disease (GVHD) incidence were calculated using a random-effects model. Seven studies comprising 739 patients were included. Post-transplant survival outcomes were favorable, with high pooled estimates across timepoints. Transplant-related mortality remained low, with NRM rates consistently within an acceptable range through long-term follow-up. Acute GVHD was observed at a meaningful frequency, including a smaller subset of severe cases, while chronic GVHD occurred in approximately one-quarter of patients at follow-up. Overall, these findings suggest that ICI therapy prior to allo-HCT in cHL is associated with encouraging survival and disease control and does not appear to confer excessive non-relapse mortality, supporting its use as a feasible and effective bridging strategy, while underscoring the need for future prospective studies to clarify optimal timing, risk mitigation strategies, and patient selection.
Abstract Background: Consultation-liaison psychiatry (CLP) is an important branch of psychiatry comprising clinical understanding, teaching, and research activities of mental health professionals in the nonpsychiatric divisions. Materials and Methods: This was an observational cross-sectional study from three institutes, a multicentric study. Data were collected from May 20 to December 30, 2024. A total of 750 patients were referred to the psychiatry department from other branches and diagnosed with interview and Diagnostic and Statistical Manual of Mental Disorder Fifth Edition Criteria. Sociodemographic details and clinical questionnaire were applied including Brief Psychiatric Rating Scale after inquiring patients and relatives. Aims: To estimate the prevalence of psychiatric illness in indoor referrals, to assess the presenting complaints for psychiatric referrals, to estimate the different types of psychiatric diagnoses and its management in indoor referrals, and to associate it with sociodemographic and clinical parameters. Results: Out of the total 750 patients, psychiatric morbidity was high (84.13%), while 15.87% of patients had no psychopathology. Delirium was the most common psychiatric diagnosis (22.4%). Low mood was the most common reason for psychiatric referral (around 29%). Pharmacotherapy was prescribed to 85.7% of patients, and 17.6% of patients were provided psychotherapy with overlap. General medicine was the most common referring department (54.13%). Psychiatric illnesses were significantly higher in Hindu patients compared to Muslims. Conclusion: Liaison Psychiatry(CLP) is an important branch of Psychiatry comprising clinical understanding, teaching and research activities of mental health professionals in the non-psychiatric divisions..
