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The Journal of Society Medicine (JSOCMED)
Published by PT. CoinReads Media Prima
ISSN : -     EISSN : 29645565     DOI : https://doi.org/10.47353/jsocmed.v2i1
Core Subject : Health, Science,
Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience
The Journal of Society Medicine (JSOCMED) | ISSN (e): 2964-5565 is a leading voice in the Indonesia and internationally for medicine and healthcare. Published continuously, JSOCMED features scholarly comment and clinical research. JSOCMED is editorially independent from and its The Editor-in-Chief (EIC) is Prof. dr. Aznan Lelo, PhD, SpFK. JSOCMED offers many attractive features for authors, including free online access to all research articles, online publication ahead of print, and online responses to articles published as Quick Comments. In addition, as befitting a publication of the Journal of Society Medicine, JSOCMED implements best practice in scientific publishing with an open peer review process, declarations of competing interests and funding, full requirements for patient consent and ethical review, and statements of guarantorship, contributorship, and provenance.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 193 Documents
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Management of Septic Shock Secondary to Submandibular Phlegmon and Ventilator-Associated Pneumonia in the Intensive Care Unit Hutasuhut, Afrizal F.; Rismawan , Budiana
Journal of Society Medicine Vol. 4 No. 9 (2025): September
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i9.237

Abstract

Introduction: Septic shock secondary to submandibular phlegmon, a severe deep neck infection, is a life-threatening condition requiring urgent intervention in the intensive care unit (ICU). When complicated by ventilator-associated pneumonia (VAP), a common nosocomial infection, it significantly increases morbidity and mortality risks. Effective management necessitates rapid source control, targeted antimicrobial therapy, and comprehensive supportive care to address the complex pathophysiology of septic shock and prevent further complications. This case report elucidates the clinical approach to managing septic shock due to submandibular phlegmon complicated by VAP in the ICU. Case Description: A 62-year-old male presented with septic shock secondary to a submandibular phlegmon, characterized by neck swelling, fever, and hemodynamic instability. Initial management included fluid resuscitation, norepinephrine, and empirical antibiotics (meropenem and vancomycin). Surgical drainage of the phlegmon was performed within six hours of admission, revealing extensive purulent material. On day three of ICU care, the patient developed VAP, confirmed by chest X-ray and endotracheal aspirate cultures positive for Pseudomonas aeruginosa. Antibiotic therapy was adjusted based on susceptibility, and lung-protective ventilation was employed. Multidisciplinary care, including fluid optimization, analgesia, and nutritional support, facilitated recovery, with extubation on day seven and ICU discharge on day ten. Conclusion: Successful management of septic shock due to submandibular phlegmon and VAP hinges on early source control, tailored antimicrobial therapy, and meticulous ICU supportive care. This case underscores the importance of multidisciplinary strategies to mitigate complications and improve outcomes in critically ill patients.
Management of Intra-Abdominal Infection Patients with Septic Shock in the ICU Ariaty, Geeta Maharani; Rismawan, Budiana
Journal of Society Medicine Vol. 4 No. 9 (2025): September
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i9.238

Abstract

Introduction: Intra-abdominal infections (IAIs) complicated by septic shock pose a critical challenge in intensive care units (ICUs) due to high morbidity and mortality. Effective management requires rapid diagnosis, source control, and optimized antimicrobial therapy. This case report describes the multidisciplinary approach to managing IAI with septic shock, highlighting evidence-based strategies. Case Description: A 59-year-old male presented with septic shock secondary to generalized peritonitis caused by an incarcerated hernia. Initial management included fluid resuscitation with 1,500 mL Ringer’s lactate, norepinephrine, and broad-spectrum antibiotics (meropenem and metronidazole). Emergency laparotomy within 4.5 hours achieved source control by evacuating 300 mL of purulent peritoneal fluid. ICU care involved mechanical ventilation, analgesia (fentanyl, paracetamol), sedation (midazolam, transitioned to dexmedetomidine), and enteral nutrition starting on day three. Multidisciplinary collaboration facilitated hemodynamic stabilization, extubation on day five, and transfer to the high-care unit on day six, with significant clinical improvement. Conclusion: Successful management of IAI with septic shock hinges on timely source control, appropriate antimicrobial therapy, and comprehensive ICU care. The absence of microbiological cultures, a key limitation, underscores the need for improved diagnostic access in resource-limited settings. Adherence to evidence-based protocols and multidisciplinary expertise are critical to improving survival. Future efforts should focus on enhancing diagnostics to optimize therapy and reduce antimicrobial resistance.
Prenatal Diagnosis, Neonatal Outcomes, and Management of Pregnancies Complicated by Gastroschisis Rajuddin, Rajuddin; Meutia, Inong Indira
Journal of Society Medicine Vol. 4 No. 9 (2025): September
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i9.244

Abstract

Introduction: Gastroschisis, a congenital abdominal wall defect, causes external protrusion of intestines and organs due to incomplete wall closure near the umbilicus. Accurate prenatal diagnosis through ultrasonography requires skilled operators to detect the defect and guide management. Early identification enables perinatal care planning to minimize complications, such as organ perforation, and optimize neonatal outcomes. This case report examines the prenatal diagnosis and management of gastroschisis in a primigravida, highlighting ultrasonography's role in clinical decision-making. Case Description: A 26-year-old primigravida at 34–35 weeks gestation was referred from Zubir Mahmud Regional Hospital with a prenatal diagnosis of gastroschisis. She reported severe abdominal pain and vaginal spotting for three weeks. Physical examination indicated stable hemodynamics, with obstetric findings including a fundal height of 26 cm, estimated fetal weight of 2015 g, left-sided fetal back, fetal heart rate of 142 beats/min, breech presentation, and no contractions. Speculum examination revealed a closed external cervical os, no dilation, negative fluxus, positive flour, protruding amniotic membranes, and a positive nitrazine test. Vaginal examination showed a posterior, soft cervix with no dilation or palpable fetal parts. The pregnancy was diagnosed with congenital gastroschisis, and a cesarean section was planned to prevent abdominal organ perforation. Conclusion: Gastroschisis, identified at 34–35 weeks gestation, necessitates early prenatal diagnosis to prepare for appropriate perinatal care. Cesarean delivery is a preferred strategy to reduce risks of organ damage, supporting improved neonatal outcomes in affected pregnancies.
Minimally Invasive Correction of Proximal Phalanx Malunion Using Cannulated Headless Screws: A Case Series Sibarani, Jonathan Junius; Satria, Oryza; Aprilya, Dina
Journal of Society Medicine Vol. 4 No. 10 (2025): October
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i10.236

Abstract

Introduction: Malunion of the proximal phalanx can result in significant aesthetic and functional impairments, including malrotation, finger scissoring, and diminished grip strength. Conventional treatment involves open osteotomy with plate and screw fixation, which is associated with drawbacks such as surgical site scarring, prolonged rehabilitation, and tendon or soft tissue adhesions. This case series evaluates a minimally invasive technique using cannulated headless screws as an alternative approach for correcting proximal phalanx malunion. Methods: Three patients with proximal phalanx malunion underwent a minimally invasive procedure. The technique involved two small incisions: one for osteotomy and another for guide wire insertion, followed by fixation with a cannulated headless screw under fluoroscopic guidance. Postoperative outcomes were assessed at three months, focusing on hand function, deformity correction, and complications. Results: At the three-month follow-up, all patients demonstrated significant improvements in hand function, with restored alignment and no reported malrotation or scissoring. Grip strength was enhanced, and no complications, such as infection or hardware failure, were observed. Patients reported minimal scarring and faster recovery compared to traditional open approaches. Conclusion: The minimally invasive approach using cannulated headless screws offers a promising alternative for correcting proximal phalanx malunion. It minimizes soft tissue trauma, reduces scarring, and promotes faster rehabilitation while achieving favorable functional outcomes. Further studies with larger cohorts are warranted to validate the efficacy and long-term outcomes of this technique.
Clinical Hirsutism Secondary to Ovarian Clear Cell Carcinoma: A Rare Case Report Muknisa, Liza; Nainggolan, Sarah Ika Nainggolan; Rusnaidi, Rusnaidi; Septivera, Yusra
Journal of Society Medicine Vol. 4 No. 10 (2025): October
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i10.240

Abstract

Introduction: Hirsutism affects 5–15% of premenopausal women, predominantly due to hyperandrogenemia (80–90% of cases), with the remainder classified as idiopathic or normoandrogenic. While virilizing ovarian tumors are known causes, the association between hirsutism and ovarian clear cell carcinoma (OCCC) has not been previously documented. Case Description: A 51-year-old multiparous woman presented with progressive abdominal distension over one year and new-onset hirsutism (Ferriman–Gallwey score 13) involving the face, axillae, pubic area, and lower limbs. She reported abdominal pain, nausea, vomiting, anorexia, 5-kg weight loss, vaginal discharge, regular menses, and poorly controlled type 2 diabetes. Examination revealed an underweight habitus and a firm, irregular, mobile, tender pelvic-abdominal mass extending above the umbilicus. Laboratory evaluation showed hypoalbuminemia (3.22 g/dL), elevated creatinine (1.64 mg/dL), markedly raised CA-125 (1,480 U/mL), and normal serum testosterone (7.5 ng/dL). Imaging confirmed a 9.5 × 8.3 × 5.5 cm solid-cystic right ovarian mass with ascites and suspected peritoneal metastases. Total abdominal hysterectomy with surgical staging was performed; histopathology confirmed OCCC. Conclusion: This is the first reported case of clinical hirsutism in OCCC with normal testosterone levels, supporting a diagnosis of idiopathic hirsutism. Potential mechanisms include increased peripheral 5α-reductase activity, androgen receptor hypersensitivity, or local androgen production, warranting further molecular investigation.
Association Between Indoxyl Sulfate Levels and Major Cardiovascular Events in Hemodialysis Patients with Chronic Kidney Disease Suhendra, Adi; Ramadani , Sumi; Tarigan , Radar Radius
Journal of Society Medicine Vol. 4 No. 10 (2025): October
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i10.259

Abstract

Introduction: Chronic kidney disease (CKD) markedly reduces quality of life and increases mortality risk, predominantly due to cardiovascular complications. Indoxyl sulfate, a protein-bound uremic toxin, is increasingly recognized for its role in accelerating cardiovascular disease in CKD patients. This study aims to evaluate the association between indoxyl sulfate levels and major cardiovascular events (MCE) in patients with stage 5 CKD undergoing hemodialysis. Methods: This observational case-control study included 50 patients with stage 5 CKD on hemodialysis. Inclusion criteria were informed consent, willingness to undergo laboratory assessments, and a confirmed CKD diagnosis. Patients with a history of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, cardiac arrest, arrhythmias, or incomplete laboratory data were excluded. Serum indoxyl sulfate, creatinine, urea, and estimated glomerular filtration rate (eGFR) were measured. Statistical analyses, including t-tests and logistic regression, were used to compare clinical parameters between patients with and without MCE. Results: Of the 50 patients (mean age: 55.4 ± 8.2 years for MCE group, 47.8 ± 7.9 years for non-MCE group; p=0.015), 29 experienced MCE, and 21 did not. Hemodialysis duration averaged 15.9 ± 4.3 years (MCE) versus 25.9 ± 5.1 years (non-MCE; p=0.005). Significant differences were found in creatinine (p=0.014), creatinine-urea ratio (p=0.007), and eGFR (p<0.001). Elevated indoxyl sulfate levels were strongly associated with MCE (p=0.001). Conclusion: Higher indoxyl sulfate levels are significantly correlated with major cardiovascular events in hemodialysis-dependent CKD patients, underscoring its potential as a predictive biomarker for cardiovascular risk.
Comparative Analysis of Ankle-Brachial Index in Chronic Myeloid Leukemia Patients Treated with Imatinib versus Nilotinib at Adam Malik Hospital Alfajri, Muhammad Jailani Alfajri; Syahrini Lubis, Henni; Gatot, Dairion
Journal of Society Medicine Vol. 4 No. 10 (2025): October
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i10.260

Abstract

Introduction: Chronic myeloid leukemia (CML) is commonly managed with tyrosine kinase inhibitors (TKIs) such as imatinib and nilotinib. However, these therapies are associated with cardiovascular risks, including peripheral arterial disease (PAD). This study compares the Ankle-Brachial Index (ABI), a non-invasive measure of PAD, in CML patients receiving imatinib or nilotinib at Adam Malik Hospital, Medan. Methods: A cross-sectional study was conducted from December 2023 to February 2024 at Adam Malik Hospital. Forty-eight CML patients (34 on imatinib, 14 on nilotinib) were enrolled using consecutive sampling. ABI was measured to assess PAD prevalence, with values <0.9 indicating abnormality. Data were analyzed using independent t-tests and chi-square tests, with significance set at p<0.05. Results: The mean age was 42.9 years (imatinib) and 49.1 years (nilotinib). Abnormal ABI values were observed in 20.6% (7/34) of imatinib-treated patients and 50% (7/14) of nilotinib-treated patients. The mean ABI for the left leg was significantly lower in the nilotinib group (0.91 ± 0.12) compared to the imatinib group (1.06 ± 0.11, p=0.017). A significant difference in ABI values between groups was confirmed (p=0.042, odds ratio 3.857), indicating a higher PAD risk with nilotinib. Conclusion: Nilotinib therapy is associated with a higher incidence of PAD compared to imatinib in CML patients. These findings underscore the need for routine cardiovascular monitoring in TKI-treated patients and further research into the vascular effects of TKIs.
Anesthesia Management for Esophageal Atresia Feryadi, Rahmat; Riswandi, Riswandi
Journal of Society Medicine Vol. 4 No. 10 (2025): October
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i10.261

Abstract

Introduction: Esophageal atresia (EA), a congenital anomaly characterized by esophageal discontinuity, often accompanied by tracheoesophageal fistula (TEF), necessitates urgent surgical intervention. This report outlines the anesthesia management for a 9-day-old male infant with EA treated at Zainoel Abidin General Hospital, Banda Aceh. Case Description: The patient presented with clinical symptoms including swallowing difficulty, excessive salivation, and vomiting during feeding, confirmed by nasogastric tube insertion and radiological examination. Initial management involved emergency gastrostomy and esophagostomy for decompression, followed by thoracotomy and esophageal repair using the Foker technique. General anesthesia combined with caudal regional anesthesia was employed to ensure hemodynamic stability and minimize intraoperative opioid requirements. Key anesthetic challenges included the risk of aspiration, difficult airway management, and maintenance of fluid balance and body temperature in a neonate. Postoperatively, the patient was admitted to the neonatal intensive care unit (NICU) with ventilator support, rigorous hemodynamic monitoring, and antibiotic therapy to prevent complications such as infection and respiratory distress. Conclusion: A multidisciplinary anesthetic approach was critical to the successful surgical correction of EA. Early and comprehensive management resulted in a favorable prognosis, highlighting the importance of tailored anesthesia strategies in neonatal surgery.
Management of Severe Head Injury Patients with Concurrent Metabolic Disorders, Hyperkalemia, Stage III Acute Kidney Injury, and Suspected Alcohol Intoxication Using Renal Replacement Therapy in ICU Irawati, Dian; Pradian, Erwin
Journal of Society Medicine Vol. 4 No. 11 (2025): November
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i11.239

Abstract

Introduction: Severe head injury (SHI) presents complex challenges, particularly when complicated by metabolic disorders, hyperkalemia, acute kidney injury (AKI), and suspected alcohol intoxication. These conditions necessitate comprehensive management in the Intensive Care Unit (ICU), often incorporating renal replacement therapy (RRT) to address life-threatening complications. This case highlights the multidisciplinary approach required to optimize outcomes in such critical scenarios. Case Description: A 45-year-old male presented to the ICU with SHI following a motor vehicle accident, exhibiting a Glasgow Coma Scale score of 6. Clinical evaluation revealed hyperkalemia (potassium 6.8 mmol/L), stage III AKI (serum creatinine 4.2 mg/dL), and metabolic acidosis. Suspected alcohol intoxication was noted based on clinical history and odor of alcohol. Initial management included neuroprotective measures, mechanical ventilation, and fluid resuscitation. Continuous renal replacement therapy (CRRT) was initiated to manage hyperkalemia and AKI, stabilizing electrolyte imbalances within 48 hours. Neuroimaging confirmed diffuse axonal injury, prompting anticonvulsant therapy and intracranial pressure monitoring. Multidisciplinary care involving neurology, nephrology, and critical care teams facilitated tailored interventions, resulting in gradual improvement in renal function and consciousness over two weeks. Conclusion: Effective management of SHI with concurrent metabolic disorders, hyperkalemia, AKI, and suspected alcohol intoxication requires integrated ICU care and RRT. Early intervention, precise monitoring, and multidisciplinary coordination are critical for improving patient outcomes in such complex cases.
Management of Myasthenic Crisis in the Intensive Care Unit Putra, Angga Permana; Zulfariansyah, Ardi
Journal of Society Medicine Vol. 4 No. 11 (2025): November
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i11.241

Abstract

Introduction: Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigability due to impaired neuromuscular transmission. Approximately 15–20% of patients develop myasthenic crisis requiring endotracheal intubation and mechanical ventilation. Management is challenging in the presence of comorbidities, necessitating careful selection of immunomodulatory therapy. Case Description: A 39-year-old woman was admitted to the General Intensive Care Unit of Dr. Hasan Sadikin Hospital with progressive dyspnea and generalized weakness. She was diagnosed with myasthenic crisis complicated by bradyarrhythmia, hypercoagulable state (elevated D-dimer, prolonged PT/INR/APTT), and electrolyte imbalance. Intravenous immunoglobulin (IVIG) was chosen over plasma exchange due to its non-invasive administration, avoidance of large-bore vascular access, more favorable hemodynamic profile, and lower risk of arrhythmia or hypotension. Potential arrhythmogenic effects from fluid shifts and hypotension associated with plasma exchange (reported in ~3% of cases) were considered contraindications in this patient. IVIG was administered at 0.4 g/kg/day for 5 consecutive days. Significant clinical improvement was observed, allowing successful extubation on day 8 and transfer to the High Care Unit on day 9. Conclusion: This case demonstrates the efficacy and safety of IVIG as first-line immunomodulatory therapy in myasthenic crisis with complex comorbidities. A comprehensive multidisciplinary approach combined with appropriate selection of IVIG resulted in rapid clinical recovery and favorable outcome.

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