Acute compartment syndrome (ACS) is a rare but potentially fatal sequela of myxedema coma. This article reports the second documented case of the presentation and management of a patient who developed ACS in all four extremities from severe hypothyroidism. This case represents an exceptional presentation of myxedema coma and highlights the potentially life-threatening complications from hypothyroidism and its improper treatment.

Epistaxis is a common concern in the pediatric population. Although the underlying cause is often benign, epistaxis may also be a symptom of more concerning pathology. Despite the frequency with which epistaxis arises in these patients, a standardized approach to assessment and management has not been established, leading to potential gaps in care. This article outlines a systematic approach to evaluating and managing pediatric epistaxis with the aim of improving prompt recognition and ensuring timely intervention. To inform this approach, the article provides an overview of the broad differential diagnosis of epistaxis, ranging from the benign and often self-limiting to critical red-flag signs and symptoms of possible serious underlying pathology. Namely, recurrent or severe epistaxis may indicate systemic conditions, bleeding dyscrasia, tumors, or structural anomalies that require specialty consultation. Clinicians should be aware of the indications for advanced diagnostic evaluation as well as criteria for timely specialty referral in cases of recurrent, severe, or suspicious epistaxis. By implementing this systematic approach, clinicians can reduce delays in appropriate referrals, ultimately enhancing comprehensive pediatric epistaxis care.

The prevalence of obesity-and the number of patients seeking treatment for this chronic, progressive disease-continues to rise. Bariatric surgery has long been an effective management option. The population of patients who undergo metabolic weight loss procedures consists predominantly of women and demonstrates a decreasing mean age, and as a result, more patients are undergoing surgery during their reproductive years and subsequently pursuing pregnancy. Although pregnancy following bariatric surgery is associated with improved outcomes compared with pregnancies complicated by uncontrolled obesity, it carries unique risks and potential complications, requiring more frequent and involved monitoring that may not be widely recognized among health care providers. This article reviews current guidelines for the management of patients after bariatric surgery, focusing in particular on those who conceive following these procedures.

Degenerative cervical myelopathy (DCM) is a progressive, age-related condition caused by degenerative changes in the cervical spine that result in spinal cord compression and neurologic dysfunction. Though it is the leading cause of spinal cord impairment among adults, it is underrecognized in clinical practice due to its variable and often subtle presentation, resulting in delays in intervention and preventable morbidity and mortality. Timely diagnosis and intervention are critical, as shorter symptom duration is associated with superior outcomes. Heightened clinical vigilance and updated practice patterns are therefore essential among health care providers who are likely to encounter these patients in primary care, emergency medicine, urgent care, orthopedic, rheumatology, neurology, and neurosurgery settings. Emerging evidence favors early surgical intervention in progressive or moderate to severe disease among all patients, including older adults, to optimize outcomes and limit irreversible deficits.

The physician associate (PA) profession was introduced in Switzerland through an informal hospital-based training program in 2014. In 2016, a formal education process was instituted at Zurich University of Applied Sciences (ZHAW) Institute of Public Health. ZHAW remains the only university with a PA curriculum in Switzerland. Presently, PAs are trained through a multi-tiered certification program with an option to complete a master's degree. Approximately 300 PAs practice in Switzerland as of 2025. As the number of PAs steadily increases, professional organizations, academic institutions, medical leaders, and Swiss authorities are working to develop policies for governance of the PA profession and to establish consistent expectations for PA education, training, and scope of practice.

Diabetic myonecrosis, also referred to as diabetic muscle infarction, is an uncommon complication of uncontrolled diabetes mellitus. This diagnosis typically occurs in patients who have chronic, poorly controlled diabetes; patients often experience additional diabetic complications. The presentation of diabetic myonecrosis involves an acute onset of swelling and pain in the affected area, typically involving a unilateral lower extremity. Diagnosis is often delayed due to the rarity of the condition, along with the need for advanced diagnostic testing such as MRI or muscle biopsy for confirmation. This case report describes a patient with a history of poorly controlled type 2 diabetes who experienced persistent left thigh pain and swelling that was ultimately diagnosed as diabetic myonecrosis, highlighting the importance of recognizing these symptoms.

Now withdrawn from the US market, andexanet alfa was initially approved by the FDA in 2018 to reverse life-threatening bleeds associated with factor Xa (FXa) inhibitors, specifically apixaban and rivaroxaban. Observed effects of andexanet alfa include a reduction in anti-FXa activity resulting in hemostatic efficacy. However, thrombotic events including myocardial infarction and deep venous thrombosis, typically occurring 6 to 30 days after infusion, have also been observed. This case presents the first known patient to develop an ST-segment elevation myocardial infarction while actively receiving infusion of andexanet alfa, which was an approved therapy at the time of the patient's treatment.

Implementation science bridges the gap between research and practice by using structured strategies to integrate evidence-based interventions into clinical care. Physician associates, with their unique roles in team-based care, are well suited to address gaps in delivery of evidence-based interventions and to lead change initiatives. The purpose of this article is to introduce key principles of implementation science and identify opportunities for PA-driven practice change. Clinical vignettes illustrate both practical application of implementation science and the deimplementation of low-value care. By understanding implementation science principles, physician associates can enhance patient outcomes and drive system-level improvements.