Harefuah
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Practice Guideline
[Guidelines for the diagnosis and treatment of the fibromyalgia syndrome].
Over the past years, considerable progress has been made in understanding the pathogenesis of the fibromyatgia syndrome and the evidence based approach to the diagnosis and management has been significantty extended. The purpose of the current project is to develop practicat and evidence based guidetine recommendations for the Israeli health care system. ⋯ Using an interactive discussion procedure, recommendations were reached and expert opinion was introduced where evidence was considered incomplete. The panel recommendations underline the importance of concomitant and integrated medical therapy, such as serotonin and noradrenaline reuptake inhibitor (SNRI) anti-depressants or gamma-aminobutyric acid (GABA) related anti-epileptics, with regular aerobic physical exercise.
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Marijuana is considered the most commonly used drug in the world, with estimated millions of users. There is dissent in the medical world about the positive and negative effects of marijuana, and recently, a large research effort has been directed to that domain. The main influencing drug ingredient is THC, which acts on the cannabinoid system and binds to the CB1 receptor. ⋯ Furthermore, patients with schizophrenia who used cannabis showed a selective neuro-psychological disruption, and similar cognitive deficiencies and brain morphological changes were found among healthy cannabis users and schizophrenia patients. In contrast to the negative effects of marijuana including addiction, there are the medical uses: reducing pain, anxiety and nausea, increasing appetite and an anti-inflammatory activity. Medicalization of marijuana encourages frequent use, which may elevate depression.
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The newly reLeased guidelines of infectious disease societies suggest abstaining from performing routine chest radiographs in the diagnosis of community acquired pneumonia in clinically stable children, based upon studies where the measured outcome is time to resolution of the disease not antibiotic use. However, the impact of possible over-treatment with antibiotics that might result from this clinical approach is not discussed. ⋯ Reliance on physical examination alone in the diagnosis of community-acquired pneumonia (CAP) in children may over-diagnose cases of pneumonia in a clinically significant manner. Further consideration of this possibility is needed before widely disseminating guidelines that advocate antibiotic treatment based on clinical diagnosis alone.