Several substantial differences were observed, each of which represented more severe medical and psychiatric illness among veterans with dually diagnosed PTSD and substance use disorder compared to those with PTSD alone. However, effective treatments are available for these disorders and special efforts should be made to ensure that veterans with dual diagnoses receive them.

No abstract

Melatonin was injected into intact and eyestalk-ablated fiddler crabs (Uca pugilator), and its effects on hemolymph glucose and lactate levels were studied. In intact crabs, glucose and lactate levels cycled simultaneously, with peaks occurring during early and late photophase. Melatonin caused a shift in the glucose and lactate cycles, with only one peak occurring closer to mid-photophase. In eyestalk-ablated animals, the glucose rhythmicity was lost; lactate cycled, but levels were significantly lower than in intact animals. Melatonin caused a delayed hyperglycemia in eyestalk-ablated animals, with concurrent but much lower increases in lactate. Overall, melatonin demonstrated delayed hyperglycemic effects that do not appear to be mediated solely via eyestalk factors such as crustacean hyperglycemic hormone (CHH), though involvement of the eyestalks cannot be ruled out. An influence on extra-eyestalk CHH secretion is a potential mechanism of melatonin activity.

Avoidant-restrictive food intake disorder (ARFID) is a feeding/eating disorder characterized by malnourishment due to highly restrictive eating patterns. Behaviors may be directly related to lack of interest in food, sensory/textural preferences, or fears of the aversive consequences of eating. The following is a case report of a 68-year-old woman who presented more than 30 times to a family medicine clinic within a 3.5 year time span for chronic nausea, abdominal pain, and weight loss. An extensive medical evaluation was unremarkable. Due to severely low body mass index and non-adherence with nutritional recommendations, the patient was referred to a specialty outpatient clinic that cared for individuals with disordered eating and was diagnosed with ARFID. In order to raise awareness about RFID, the diagnostic criteria and screening/assessment information are provided. Special emphasis is placed on screening and early detection by primary care clinicians to ensure individuals with RFID receive appropriate treatment in a timely manner.