Diagnostic dilemma in diagnosing rare cause of protein losing enteropathy: Waldmann's disease.

Waldmann's disease, or primary intestinal lymphangiectasia, is an unusual cause of protein-losing enteropathy primarily characterized by lymphopenia, hypoalbuminemia, and hypogammaglobulinemia. However, variable clinical presentations result dilemmas in diagnosis and effective management. We present a toddler diagnosed with Waldmann's disease managed with a high-protein diet and medium-chain triglyceride supplementation.

How depression influences the receipt of primary care services among women: a propensity score analysis.

BACKGROUND AND OBJECTIVES: Many patients with psychiatric disorders do not receive appropriate medical services, whereas others receive unnecessary medical services. This study investigated whether female primary care patients with depression were more or less likely to receive preventive/diagnostic tests. METHODS: Preventive/diagnostic tests for females with depression or hypertension or both over a 5-year period were extracted from an electronic medical record (EMR) used at a university-based family practice clinic. Tests extracted included cholesterol screening, mammogram, Pap smear, and colonoscopy. RESULTS: Of 860 included in the analysis, 270 were diagnosed with depression, 380 with hypertension, and 210 with both conditions. Women with depression were significantly more likely to receive colonoscopies and Pap smears than women with hypertension. Hypertensive patients were significantly more likely to have their cholesterol checked. CONCLUSIONS: Somatization associated with depression may lead to more preventive and diagnostic testing among female primary care patients.

Curriculum planning: a needs assessment for complementary and alternative medicine education in residency.

BACKGROUND AND OBJECTIVES: The curricular needs in complementary and alternative medicine (CAM) of family medicine residents are unknown. Our objective was to assess perceptions of knowledge, attitudes, practice behaviors, and interest toward CAM by family medicine residents. METHODS: A questionnaire was administered to family medicine residents (n=153) throughout one state. RESULTS: The response rate was 77% (118/153), with an equal distribution of first-, second-, and third-year residents. Respondents reported minimal knowledge of CAM and low awareness of CAM resources. Many do not routinely ask patients about their CAM usage. Most respondents reported discomfort advising their patients of the risks and benefits of CAM therapies, and most were interested in learning about CAM. While prior training made a difference in responses, gender and training level did not. Whites were more likely to have had prior training in CAM than non-whites. CONCLUSIONS: Family medicine residents in Arkansas may not have enough training in CAM. Given the growing popularity of these modalities among the general public, residents might benefit from training and education in CAM.

The triple threat for chronic disease: obesity, race, and depression.

The authors investigated the interrelationships between race, obesity, depression, and chronic disease by abstracting data from all primary-care patients seen at a family-medicine clinic over a 3-year period. A total of 8,197 patients were included in the analysis. Sixty-three percent of patients were either overweight (26%) or obese (37%). African-American race, obesity, and having a diagnosis of depression each independently and significantly increased the likelihood of having a chronic disease. Also, these risk factors interacted to create an increased likelihood of disease prevalence. Thus, obesity, race, and depression interacted to create a "triple threat" of developing certain chronic diseases.