Introduction
  Sales of prescription-only drugs are not well regulated in developing countries. Self-medication with antibiotics is a major concern in global public health from the perspective of increased drug resistance. In addition to common self-medication with prescription-only drugs, distribution of dangerous counterfeit drugs is a social problem in Indonesia. This study aims to examine the factors relevant to self-medication with antibiotics by clarifying customers’ behavior requesting antibiotics at pharmacies and pharmacists’ response in the capital region of Indonesia.
Method
  Two hundreds customers who requested antibiotics were exit-interviewed at 6 community pharmacies in the Ciputat district of South Tangeran City. Structured questionnaire was used on general attribute including health insurance coverage and having/not-having prescription and instructions by pharmacists, etc. Eight informants of pharmacists and an owner from a pharmacy were interviewed by using semi-structured questionnaire. They were questioned on number of customers requesting antibiotics with/without prescriptions, pharmacists’ responses and experience of health damages. The investigation was conducted between late May and early July of 2012.
Results
  Of the customers requesting antibiotics, 48.5% (97/200) had no prescriptions. Neither consultation with doctor nor self-medication is statistically associated with health insurance coverage. Among customers without prescriptions, 51.9% (54/104) purchased antibiotics by showing drug samples they did not take. This was significantly more frequent than those following advice by family/friends or pharmacists. Pharmacists are cautious of dispensing antibiotics without prescriptions. They assess patients, being mindful of allergy and drug resistance. Pharmacists recognize the importance of patient education and intervention in the community.
Conclusion
  The results of exit-interview suggested that economic reason is not a dominant factor to promote self-medication. From the observations among self-medicated customers who are on over-confidence, purchase antibiotics using drug samples they left over, and having preference of advice by family/friends to advice by pharmacist, self-medication is considered based on heuristic selection as well as risk-management within their limited scope of options. The efficacy of antibiotics is manifested in a short duration so that it gives efficient feedback as well as successful experience to patients. The successful experience is considered to strengthen patients’ behavior of self-medication. Pharmacists are expected to challenge their new role to develop patient education to alter patient behaviors.

Introduction : We evaluated the efficacy of keishito and maobushisaishinto with reference to keikyososooshinbuto, for patients feeling cold, by means of multiple regression analysis.
Case reports : We reported a patient with an upset stomach whose severe coldness was improved as the stomach condition was cured by adding keishito to maobushisaishinto. Moreover, the combination of keishito and maobushisaishinto was effective for a patient feeling cold, with appetite loss, general fatigue and stiffness of the joints (case 1), a patient feeling cold, with chill, general fatigue, heavy feeling in the stomach, and prone to catch colds (case 2), and a patient feeling extremely cold, with general fatigue and menstrual pain (case 3).
Subjects and Methods : In this study, the subjects were 43 patients who reported feeling cold. They were treated with keishito and maobushisaishinto according to their Sho for more than one month. The relationships between the improvement of cold sensation and 52 other factors, such as symptoms noted at their first medical examination, were evaluated by means of multi-dimensional cross-sectional analysis.
Results : The factors of chilly or unpleasant wind and coldness of the whole body were significant.
Discussion : The factors of coldness in the whole body with chill, and headache without diarrhea were important for improvement of cold feeling with keishito and maobushisaishinto.

Introduction : We evaluated the efficacy of daisaikoto for patients with generalized fatigability or easy fatigability by multiple regression analysis.Subject and Methods : The subjects were fifty-three patients with generalized fatigability or easy fatigability, consisting of 6 males and 47 females, mean age 38 y/o (range 23-72), who were treated with daisaikoto according to Sho for more than one month. The relationships between the improvement of generalized fatigability or easy fatigability and 46 factors, including age, sex, height, body weight, hypertension and other symptoms noted at the first medical examination, were examined by multi-dimensional cross-sectional analysis.Results : The factors of sweating, hot flushes, sensation of something stuck in the throat, and feeling of fullness in the chest were significant. Improvement of objective tenderness on the sides of the abdomen and sweating formed the best subset of explanatory variables.Discussions : The sensation of something stuck in the throat and feeling of fullness of the chest often occur under Ki stagnation. The improvement rather than the existence of objective tenderness on the sides of the abdomen is assumed to be more important factor.

A 40-year old man with chest pain was admitted to our hospital. A three-dimensional CT revealed an unruptured left coronary sinus of Valsalva aneurysm and mild stenosis of the left main trunk. An echocardiogram revealed severe aortic regurgitation. He was operated on with an aortic root replacement procedure. Though the procedure was itself uneventful, he could not be weaned from cardiopulmonary bypass because of unexpected coronary events ; relative stenosis of the RCA and stretched LMT due to a huge aneurysm of the sinus of Valsalva. Additional CABG with LITA to LAD and SVG to RCA led to weaning from cardiopulmonary bypass. Left coronary sinus of Valsalva aneurysm is rare, and it requires early surgical intervention for an increase in the diameter of the aneurysm together with myocardial ischemia due to compression of the coronary artery.

We evaluated the efficacy of yokukansan-based prescriptions for patients with headache. Forty-five patients with headache (34 migraine, 6 tension-type, and 5 combined headaches), or 6 males and 39 females, mean age 38 (25 to 68) years were treated with yokukansan-based prescriptions according to their Sho diagnosis, for 1 to 24 months. Relationships between headache improvement, and 31 factors including age, sex, height, body weight and other symptoms at first examination, were qualified with multi-dimensional analysis. Factors such as painful eye sensation, back stiffness, eyestrain and irritability were significant indicators of headache improvement. Three of these factors (painful eye sensation, back stiffness and irritability) were the best subset of explanatory variables. Yokukansan-based prescriptions seemed to be effective for “liver-related” headache, and were thought to be useful to relieve a triggering or worsening of headache factors. And to our knowledge, this is the first paper to propose the importance of examinations of the back, when considering yokukansan-based prescriptions.
Headache ; Back ; Therapeutic procedure ; Esthesia ; Prescriptions

We evaluated the efficacy of chotosan for headache patients via multiple regression analysis. The subjects were 46 patients with headache (31 migraine, 14 tension-type, and1combination headache), consisting of 1 3males and 33 females, mean age 48 years (range 19-77 years), who were treated with chotosan according to their Sho (symptoms) for more than1month. The relationships between the improvement of headache and 38 factors, including age, sex, height, body weight, hypertension and other symptoms noted upon first medical examination, were examined through multi-dimensional cross-sectional analysis. Morning headache, dizziness, insomnia, body weight, tinnitus and vasodilatation of sublingual veins were significant factors. Morning headache is traditionally an indication for the use of chotosan, and our results support its efficacy for this purpose. Three factors, i.e. morning headache, vasodilatation of sublingual veins and stiff shoulder, were the best subset of explanatory variables. Stiff shoulder is a key symptom for the application of chotosan, while stiffness in the back is a key symptom for the application of yokukansan.
Headache ; symptoms <1> ; multiple regression ; Analysis ; Pulmonary evaluation

PURPOSE: Nasal polyposis is a chronic inflammatory disease of the upper airways often associated with asthma and characterized by markedly increased numbers of eosinophils, Th2 type lymphocytes, fibroblasts, goblet cells and mast cells. Previous studies have shown elevated levels of thymic stromal lymphopoietin (TSLP) in atopic diseases like asthma, atopic dermatitis and mainly in animal models of allergic rhinitis (AR). Here, we investigated the expression of TSLP in nasal polyps from atopics and non-atopics in comparison with the nasal mucosa and its potential role in nasal polyposis. METHODS: Messenger RNA expression for TSLP, thymus and activation-regulated chemokine (TARC) and macrophage derived chemokine (MDC) in nasal polyps and nasal mucosa of atopics and non-atopics was analyzed by real time PCR. Immunoreactivity for TSLP in nasal polyps and in the nasal mucosa of patients with AR and non-allergic rhinitis (NAR) was analyzed by immunohistochemistry. Eosinophil counts was analyzed by Wright-Giemsa staining and nasal polyp tissue IgE, by ELISA. RESULTS: Messenger RNA expression for TSLP,TARC and MDC was markedly higher in nasal polyps as compared to the allergic nasal mucosa. Immunoreactivity for TSLP was detected in epithelial cells, endothelial cells, fibroblasts and inflammatory cells of the nasal mucosa and nasal polyps. The number of TSLP+ cells was significantly greater in the nasal mucosa of AR than NAR patients. The number of TSLP+ cells in nasal polyps from atopics was significantly greater than that of non-atopics and that in the allergic nasal mucosa. The number of TSLP+ cells correlated well with the number of eosinophils and the levels of IgE in nasal polyps. CONCLUSIONS: The high expression of TSLP in nasal polyps and its strong correlation to eosinophils and IgE suggest a potential role for TSLP in the pathogenesis of nasal polyps by regulating the Th2 type and eosinophilic inflammation.
Asthma ; Chemokine CCL17 ; Chemokine CCL22 ; Cytokines ; Dermatitis, Atopic ; Endothelial Cells ; Eosinophils ; Epithelial Cells ; Fibroblasts ; Goblet Cells ; Humans ; Immunoglobulin E ; Immunohistochemistry ; Inflammation ; Lymphocytes ; Mast Cells ; Models, Animal ; Nasal Mucosa ; Nasal Polyps ; Real-Time Polymerase Chain Reaction ; Rhinitis ; Rhinitis, Allergic, Perennial ; RNA, Messenger

A19-year-old man was admitted to the hospital because of severe congestive heart failure on 7 April 2000. In the previous year his case had been diagnosed as Churg-Strauss syndrome (allergic granulomatous angiitis, AGA) with bronchial asthma and mononeuritis multiplex. Echocardiography revealed the dilatation of the left ventricle (LVDd 74 mm) and impaired left ventricular systolic function (LVEF 20%). On the 21st hospital day, the irregularity of peripheral branches of left and right coronary arteries was detected by coronary arteriography. Right ventricular endomyocardial biopsy yielded little fibrosis and no infiltration of eosinophil. Although all the laboratory tests showed lower activity of AGA, steroid pulse therapy was tried and the use of steroids was tapered at intervals of two weeks. Left ventricular function was slowly improved (LVDd 60 mm, LVEF 36%). He was discharged on foot on the 71st hospital day.

Objective: In the treatment of patients with schizophrenia, pro re nata (PRN) drugs are commonly prescribed for medical indications such as agitation, acute psychiatric symptoms, insomnia, and anxiety. However, high-quality evidence supporting the use of PRN medications is lacking, and these drugs are administered on the basis of clinical experience and habits. Therefore, the actual use of psychotropic PRN drugs and its influence on the patients’ outcomes need to be investigated. Methods: This study included 205 patients who underwent inpatient treatment for schizophrenia. We investigated the prescription of psychotropic drugs before admission and at discharge, as well as the dosing frequency of PRN drugs during hospitalization. We also examined the influence of psychotropic PRN drug use on hospitalization days, antipsychotic polypharmacy, and readmission rates. Results: Patients who used psychotropic PRN drugs during hospitalization had significantly longer hospitalization days (p = 7.5 × 10−4 ) and significantly higher rates of antipsychotic polypharmacy (p = 2.4 × 10−4 ) at discharge than those who did not use psychotropic PRN drugs. Moreover, a higher number of psychotropic PRN drugs used per day was associated with higher readmission rates within 3 months of discharge (p = 4.4 × 10−3 ). Conclusion Psychotropic PRN drug use is associated with prolonged hospitalization, antipsychotic polypharmacy, and increased readmission rates in inpatients with schizophrenia. Therefore, psychiatric symptoms should be stabilized with regularly prescribed medications without the extensive use of psychotropic PRN drugs. Moreover, a system for monitoring and reexamining PRN drug use needs to be established.