New England Journal of Medicine - Clinical Medicine

1. Polymyalgia Rheumatica

   This review summarizes the diagnosis and management of polymyalgia rheumatica in adults older than 50 years of age, emphasizing clinical diagnosis, glucocorticoids as first-line therapy, relapses, and glucocorticoid-sparing options.

2. Health Consequences of Immigration Enforcement in U.S. Communities

   U.S. clinicians, health systems, and policymakers should recognize immigration enforcement as a social determinant of health currently implicated in a public health crisis and act accordingly.

3. Massive Intravascular Hemolysis from Clostridium perfringens Bacteremia

   A 73-year-old woman presented in shock with a 1-day history of malaise, dyspnea, and confusion. Serum samples could not be processed owing to gross hemolysis. Dehemoglobinized red cells and bacilli were seen on a peripheral-blood smear.

4. Good Compressions

   Faced with a young woman whose seizures, of untraceable cause, can’t be stopped by the medical team, a medical student viscerally learns the limits to what can be accomplished by pushing harder.

5. Soft Tick Relapsing Fever

   A 74-year-old man was admitted to the hospital with a 3-week history of intermittent fevers, muscle aches, and vomiting. Thin blood smears showed spirochetes.

6. Not Otherwise Specified — Season 3: The Forever Crisis of Primary Care: Dream Team — NOS Episode 3.11

   If the future of primary care lies in teams, what makes a team and how should it function? NOS host Lisa Rosenbaum and her guests consider the possibilities of team-based care.

7. A Feverish Pace

   This interactive feature describes a 52-year-old man who presented to his primary care clinic with a 3-week history of fevers, drenching night sweats, fatigue, myalgias, and dyspnea on exertion. Test your diagnostic and therapeutic skills at NEJM.org.

8. Vulvar Melanoma with Vaginal Extension

   A 49-year-old woman presented with a 6-month history of an itchy lump on her vulva. Examination showed a painless purple mass originating in the labia minora on the left side.

9. Case 8-2026: A 57-Year-Old Woman with Chest Pain, Dyspnea, and Syncope

   A 57-year-old woman was evaluated because of 2 days of chest pain and dyspnea. Ultrasonography showed a pericardial effusion with diastolic inversion of the right ventricle. A diagnosis was made.

10. Valuing Care Provided by Residents and Fellows — Toward Competency-Based Billing

    CMS billing rules create a wide gap between the services trainees provide and the revenue hospitals can capture for those services. Competency-based billing could help close this gap.

11. Inhaled Treprostinil for Idiopathic Pulmonary Fibrosis

    In a phase 3 trial involving patients with idiopathic pulmonary fibrosis, inhaled treprostinil was associated with a smaller decline in forced vital capacity and a lower risk of clinical worsening than placebo over 52 weeks.

12. Effects of Pervasive Immigration Enforcement on Children’s Health

    The types of immigration-enforcement actions being taken in the United States can activate children’s stress-response systems, disrupting neurodevelopment, immune function, and emotional regulation.

13. Efficacy and Safety of Obinutuzumab in Active Systemic Lupus Erythematosus

    In patients with SLE without advanced lupus nephritis, obinutuzumab plus standard therapy was superior to placebo plus standard therapy in conferring and sustaining a clinically meaningful reduction in disease activity over 52 weeks.

14. Finerenone in Type 1 Diabetes and Chronic Kidney Disease

    In adults with type 1 diabetes and chronic kidney disease with albuminuria, the decrease in the urinary albumin-to-creatinine ratio was significantly greater with finerenone than with placebo.

15. Blood-Pressure Targets in Hypertension Management

    This feature about blood-pressure targets to manage hypertension offers a case vignette accompanied by two essays, one recommending a systolic blood-pressure target of less than 120 mm Hg and the other supporting a target of less than 140 mm Hg.

16. The Corporatization of U.S. Health Care: Private Equity’s Transformation of American Medicine — Implications for Health Equity

    Private equity firms have gained increasing control of U.S. health care infrastructure. Along with other potential consequences, this growth threatens to undermine progress in health equity.

17. The Eyes Have It

    A 47-year-old man was brought to the ED by EMS after being found dyspneic in his car. He reported having been drinking for 6 hours before presentation. He noted a sensation of tongue swelling and difficulty breathing.

18. Expiratory Central Airway Collapse

    A woman with asthma and obstructive sleep apnea presented with a 1-month history of worsening dyspnea and dry cough. CT of the chest showed anterior bowing of the posterior wall of the intrathoracic trachea during expiration.

19. Finerenone for Diabetic Kidney Disease in Type 1 Diabetes — A Fine Answer?

    Type 1 diabetes is characterized by an absolute insulin deficiency and immune dysregulation. Nearly one in three persons with type 1 diabetes will go on to have diabetic kidney disease,1 an independent risk factor for cardiovascular events and premature death.2 Glomerular hyperfiltration and other changes precede...

20. From Equity to Efficiency — Navigating Changes to the AHEAD Model

    The AHEAD model was intended to slow health care cost growth, improve population health, and advance health equity. But under the new administration, its focus has shifted from equity to efficiency.