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Low bone mass may manifest early in MS: this finding calls for an active approach to optimize bone health.

Low Bone Mass in Early-Stage Multiple Sclerosis

A 13 y/o boy is seen for a pruritic rash that been spreading x1 week; lesions are widespread over chest and back w axilla involvement. Recent hx of viral illness now resolved. PMH: noncontributory.

VIDEO: The lesions appear oval with trailing edge scale. Note the the pattern and distribution in the video interview; what's your diagnosis? 

Clinical Topics

Teen Boy with a Progressive Pruritic Rash 

A 68-year-old man presented with two growths on his chest, which he said had been slowly expanding over the past 2 years. They were occasionally tender and had bled with minimal trauma.

Can you identify the 2 slowly expanding growths on the chest of this 68-year-old man?

Pearly Pink Chest Lesions 

No labs, no biopsies . . .  you can make this Doorway Diagnosis just by looking.

Pictured is the posterior right knee of a 69-year-old woman showing a rounded protuberance at the popliteal fossa.

No labs, no biopsies, no imaging -- only your seasoned clinical judgement is required to make a diagnosis in this case. 

Bulge Behind the Knee 

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier. The boy is otherwise healthy.

White Knuckles

For 2 months, a 29-year-old man had pain and circular, soft swelling (7 x 7 cm in diameter) over the anterior left knee, superficial to the patellar ligament. Pain was minimal and associated with extension and flexion.

Medial collateral and lateral collateral ligament injury

For 2 months, a 29-year-old man had pain and circular, soft swelling (7 x 7 cm in diameter) over the anterior left knee, superficial to the patellar ligament. Your dx?

Swelling Over Left Anterior Knee

Lifestyle Interventions for Treatment and Remission of Prediabetes and T2D: There's a Guideline for That? 

Yes, there is a clinical practice guideline for that, recently published by the American College of Lifestyle Medicine (ACLM). 

Lifestyle interventions for the treatment and remission of type two diabetes and prediabetes in adults

according to authors, that  places lifestyle modification at the center of care for adults with 

In an interview with Patient Care, guideline lead author Richard Rosenfeld, MD, MPH, MBA, talked about the timing of the publication of the ACLM recommendations. Although the release in the A

¹ was the next step in an iterative development process, the publication is in ideal synch with the state of American's health, Rosenfeld stressed. "Over half the US population has either prediabetes, about 38%, or type 2 diabetes, about 14.5%" and there is a proportion who "don't even know they have it." Add the obesity epidemic into the equation, and "the timing really just seemed right to do this." 

Rosenfeld adds that the evidence based to support the essential role of durable lifestyle change in reducing the risk for type 2 diabetes (T2D) and even in reversing the disease, is growing rapidly. He discusses the development of the ACLM guideline in the short video above and the goal of remission of T2D. 

For an at-a-glance preview of the 14 lifestyle interventions recommended in the guideline, see 

Guideline Topline: 14 Key Lifestyle Interventions to Treat, Prevent Type 2 Diabetes

Richard Rosenfeld, MD, MPH, MBA, is the distinguished professor of otolaryngology, SUNY Downstate Health Sciences University and senior advisor for quality and guidelines for the American Academy of Otolaryngology – Head and Neck Surgery. Rosenfeld is board certified in otolaryngology – head and neck surgery and in lifestyle medicine. 

The American College of Lifestyle Medicine recently published "that guideline," and lead author Richard Rosenfeld, MD, MPH, MBA, says the timing was right. 

Stine Marit Moen, MD

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