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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 210 Documents
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Intensive Care Management of Non-Ischemic Dilated Cardiomyopathy with Morbid Obesity in a Parturient Undergoing Cesarean Section Darmoko, Aris; Kestriani , Nurita Dian
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.v4i11.242

Abstract

Introduction: Dilated cardiomyopathy (DCM) in pregnancy is a rare but life-threatening condition, with reported incidence ranging from 1:4,950 deliveries in Europe to 2.38:1,000 deliveries in Asia. When complicated by morbid obesity, it significantly increases perioperative and critical care challenges, requiring a coordinated multidisciplinary approach to optimize maternal outcomes. Case Description: A 32-year-old primigravida with morbid obesity (BMI 49.5 kg/m²) and non-ischemic dilated cardiomyopathy presented with decompensated heart failure at 29 weeks of gestation. She underwent elective cesarean section under general anesthesia followed by 19 days of intensive care. Management included hemodynamic optimization with dobutamine infusion, restrictive fluid strategy targeting negative balance, stepwise ventilator weaning from mechanical ventilation to nasal cannula, and treatment of complications including electrolyte disturbances and postoperative delirium secondary to obesity hypoventilation syndrome (Pickwickian syndrome). Continuous hemodynamic monitoring using MostCare and invasive arterial pressure enabled precise titration of therapy. Conclusion: Successful maternal outcome in pregnant patients with dilated cardiomyopathy and morbid obesity can be achieved through comprehensive preoperative optimization, carefully selected anesthetic technique, and prolonged multidisciplinary intensive care. This case highlights the importance of integrated hemodynamic, respiratory, and metabolic management in this high-risk population.
Septic Shock Management Using Continuous Renal Replacement Therapy in a Postpartum Patient with Diabetic Ketoacidosis, Acute Kidney Injury, and Ventilator-Associated Pneumonia Putra, Prana Indra; 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.v4i11.248

Abstract

Introduction: Postpartum sepsis in patients with pregestational diabetes mellitus is a life-threatening condition that may precipitate acute kidney injury (AKI) and diabetic ketoacidosis (DKA). Sepsis frequently leads to multiorgan dysfunction, with the kidneys being particularly vulnerable. Severe AKI in septic shock often requires renal replacement therapy. Continuous Renal Replacement Therapy (CRRT), particularly in hemodynamically unstable patients, is the preferred modality due to its gradual solute and fluid removal, cytokine modulation, and ability to manage complex acid-base disturbances. In this setting, secondary ventilator-associated pneumonia (VAP) further complicates management. Case Description: A 35-year-old woman with pregestational type 2 diabetes mellitus developed septic shock with DKA following spontaneous vaginal delivery. She presented with refractory hypotension, severe metabolic acidosis (pH 6.98), hyperglycemia (301 mg/dL), ketonuria (2+), and oliguria (0.3 mL/kg/h). Serum creatinine rose from 0.85 to 3.61 mg/dL, fulfilling KDIGO stage 3 AKI criteria. During ICU stay, the patient developed VAP, necessitating prolonged mechanical ventilation and targeted antimicrobial therapy. Conclusion: Early initiation of Continuous Veno-Venous Hemodiafiltration (CVVHDF) using bicarbonate-buffered replacement fluid and an oXiris filter effectively corrected severe acidosis (pH 7.255 → 7.359 within 76 hours), removed ketones and inflammatory mediators, stabilized hemodynamics, and facilitated renal recovery while reducing vasopressor requirements. Multidisciplinary management, including strict VAP prevention bundle and culture-directed antibiotics, enabled successful extubation. Timely high-volume CRRT combined with comprehensive critical care is crucial in managing complex postpartum septic shock with DKA and AKI.
Management of Refractory Status Epilepticus and Profoundly Impaired Consciousness in Anti-NMDA Receptor Autoimmune Encephalitis Alam, Mohamad Deny Saeful; Indriasari, Indriasari
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.v4i11.249

Abstract

Introduction: Autoimmune encephalitis is a major cause of non-infectious encephalitis and remains challenging to diagnose based solely on clinical presentation. Confirmation is particularly difficult in antibody-negative cases despite strong clinical suspicion, requiring comprehensive diagnostic workup. Case Description: A 25-year-old male presented with progressive altered mental status and seizures preceded by behavioral changes for 10 days. EEG showed no epileptiform activity, cerebrospinal fluid analysis excluded infection, and brain CT was unremarkable. Serum and CSF HSV IgG/IgM were non-reactive. Anti-NMDA receptor antibodies in CSF were strongly positive. The patient developed refractory status epilepticus requiring mechanical ventilation, deep sedation with propofol, and multiple anti-seizure medications including phenytoin. Empirical acyclovir was administered for 10 days without improvement. High-dose methylprednisolone (1 g/day for 5 days) was given as first-line immunotherapy but yielded no neurological recovery. On day 14, plasma exchange was initiated for three sessions, resulting in marked clinical improvement with recovery of consciousness and seizure control. Conclusion: This case highlights the critical importance of considering autoimmune encephalitis even when initial antibody results are pending or imaging is normal. Early escalation to second-line immunotherapy, particularly plasma exchange, can be lifesaving in anti-NMDAR encephalitis presenting with refractory status epilepticus and profound coma.
Association of GWTG-HF Risk Score with Major Adverse Cardiovascular Events in Acute Heart Failure Patients: A Retrospective Study in a Tertiary Hospital in Indonesia Sumbayak, Novra Christy Grace; Hasan, Refli; Raynaldo, Abdul Halim; Haykal, Teuku Bob; Nasution, Ali Nafiah; Sarastri, Yuke
Journal of Society Medicine Vol. 4 No. 12 (2025): December
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i12.250

Abstract

Introduction: Heart failure (HF) affects approximately 64 million people globally, contributing to high mortality, morbidity, reduced quality of life, and substantial healthcare burden. Acute heart failure (AHF) requires urgent intervention and carries elevated risks of mortality and major adverse cardiovascular events (MACE). The Get With The Guidelines-Heart Failure (GWTG-HF) risk score, originally developed for predicting in-hospital mortality in HF patients, has shown potential in forecasting MACE in certain populations. However, its association with MACE in Indonesian AHF patients remains underexplored. Method: This retrospective observational cohort study included 319 AHF patients admitted to Adam Malik General Hospital, Medan, Indonesia, from January 2024 to March 2025. Patient characteristics, GWTG-HF scores, and in-hospital MACE were recorded. Statistical analyses involved receiver operating characteristic (ROC) curves and multivariate regression. Results: Patients had a mean age of 55 years, with 54.5% males. Median hospital stay was 5 days (range 1–47). Predominant features included acute decompensated HF (65.8%), infection as etiology (46.7%), HFrEF (52.0%), coronary heart disease (62.4%), and smoking (50.8%). In-hospital MACE occurred in 20.4% of patients, primarily mortality (18.8%), increasing with GWTG-HF risk categories (low: 8.1%; moderate: 17.4%; high: 36.7%). Age, systolic blood pressure, heart rate, sodium, and blood urea nitrogen significantly influenced MACE (p<0.05). The GWTG-HF score demonstrated good predictive performance for MACE (AUC 0.759, p<0.001; sensitivity 63.2%; specificity 78.1%). Conclusion: The GWTG-HF score is significantly associated with in-hospital MACE in Indonesian AHF patients, supporting its utility as a risk stratification tool to guide clinical decisions and optimize management.
Evaluation and Management of Suspected Sepsis and Septic Shock in Adult Patients Tona, Azwar Iwan
Journal of Society Medicine Vol. 4 No. 12 (2025): December
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i12.251

Abstract

Sepsis is a life-threatening clinical syndrome arising from a dysregulated host response to infection, encompassing a continuum of severity that ranges from sepsis to septic shock. Despite advances in critical care, sepsis remains a leading cause of morbidity and mortality worldwide, with reported mortality rates exceeding 10% in sepsis and rising beyond 40% when septic shock develops. Contemporary management strategies emphasize early recognition, prompt source control, timely administration of antimicrobial therapy, and hemodynamic optimization. Current clinical practice largely aligns with the definitions proposed by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, which focus on organ dysfunction as a central feature of sepsis. However, these definitions are not universally adopted, as alternative frameworks, including earlier systemic inflammatory response–based criteria, continue to influence clinical and regulatory practices in certain settings. The ongoing debate highlights concerns that the broad application of modern definitions may inadvertently promote overtreatment, particularly unnecessary exposure to broad-spectrum antibiotics, in patients with less severe disease. This review summarizes contemporary concepts in the clinical management of sepsis and septic shock, integrating evolving definitions with practical and bedside decision-making. Emphasis is placed on balancing rapid, protocolized care for high-risk patients with judicious therapeutic strategies to minimize harm to patients with milder presentations. By synthesizing guideline-based recommendations and ongoing controversies, this review aimed to provide a pragmatic framework for clinicians managing sepsis in diverse clinical contexts.
Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyposis: Current Evidence and Future Perspectives Setiawan , Gunawan Wijaya
Journal of Society Medicine Vol. 4 No. 12 (2025): December
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i12.252

Abstract

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a common type 2 inflammatory disease affecting approximately 1–4% of the population and is characterized by persistent nasal obstruction, olfactory dysfunction, facial pain, and substantial impairment in quality of life. Although standard therapies such as intranasal corticosteroids and endoscopic sinus surgery remain the mainstay of treatment, a significant proportion of patients experience recurrent or inadequately controlled disease. Improved understanding of the immunopathogenesis of CRSwNP has highlighted the central role of type 2 inflammation, driven by cytokines including interleukin-4, interleukin-5, interleukin-13, and immunoglobulin E, thereby enabling the development of targeted biologic therapies. Biologic agents such as dupilumab, mepolizumab, benralizumab, and omalizumab have demonstrated consistent efficacy in phase III randomized controlled trials and real-world studies, leading to significant reductions in nasal polyp burden, improvements in Sino-Nasal Outcome Test (SNOT-22) scores, restoration of olfactory function, and decreased need for systemic corticosteroids and revision surgery. Patient selection is increasingly guided by clinical phenotype and biomarkers, including blood eosinophil counts, total serum IgE levels, and the presence of comorbid asthma or aspirin-exacerbated respiratory disease. Emerging evidence supports the integration of biologic therapy with surgical management in refractory cases, while ongoing trials targeting upstream mediators such as interleukin-33 and thymic stromal lymphopoietin may further expand therapeutic options. Overall, biologic therapies represent a paradigm shift in the management of severe CRSwNP, paving the way toward precision-based, individualized treatment strategies.
Antidiabetic Effects of Moringa oleifera Leaf Extract on Blood Glucose Levels in Alloxan-Induced Diabetic Rats (Rattus norvegicus): A Systematic Literature Review Harahap , Armansyah Maulana; Ginting, Muhammad Aldi Rivai; Putri, Yulia; Sari, Herviani; Priawan, Indra
Journal of Society Medicine Vol. 4 No. 12 (2025): December
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i12.267

Abstract

Introduction: This systematic literature review, guided by PRISMA guidelines, evaluates the effectiveness of Moringa oleifera leaf extracts in reducing blood glucose levels in alloxan-induced diabetic rats. Method: Literature was searched in PubMed and Google Scholar using keywords including “Moringa oleifera,” “leaf extract,” “alloxan-induced diabetes,” and “blood glucose.” From 472 identified articles, 9 studies met inclusion criteria and were analyzed. Results: Nearly all studies reported significant reductions in blood glucose levels following administration of Moringa oleifera leaf extracts at effective doses ranging from 200–800 mg/kg body weight over 14–28 days. Key mechanisms include protection of pancreatic β-cells from oxidative stress, enhanced insulin secretion, and improved insulin sensitivity. Both aqueous and ethanolic extracts exhibited antihyperglycemic effects, with aqueous extracts demonstrating faster onset and ethanolic extracts providing more sustained outcomes. Conclusion: These findings support the potential of Moringa oleifera leaf extracts as a natural antidiabetic agent in preclinical models. However, further research is required to standardize extraction methods, dosages, and molecular mechanisms to facilitate clinical translation in humans.
Clinical Utility of Procalcitonin for Stratifying Severity in Sepsis Secondary to Pneumonia Saputra , Wachyoe Hadi; Prima, Agus; Wirdah, Wirdah
Journal of Society Medicine Vol. 5 No. 1 (2026): January
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i1.253

Abstract

Introduction: Procalcitonin (PCT) is a biomarker that reflects the systemic inflammatory response to bacterial infections and has been widely studied in the context of sepsis. In patients with pneumonia, early identification of the severity of sepsis is essential for appropriate clinical management and prognostic evaluation. This study aimed to assess the clinical utility of serum procalcitonin levels in stratifying sepsis severity in patients with pneumonia. Methods: This analytical cross-sectional study was conducted between February 2013 and March 2014 in the Emergency Department and Internal Medicine Wards of Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia. Thirty patients diagnosed with pneumonia were enrolled in this study using quota sampling method. Serum procalcitonin levels were measured and categorized according to the severity of sepsis. Statistical analysis was performed using one-way analysis of variance (ANOVA), followed by the least significant difference (LSD) post-hoc test using the SPSS software. Statistical significance was set at P < 0.05. Results: Serum procalcitonin levels progressively increased with increasing severity of sepsis. The lowest PCT level was observed in patients with pneumonia without sepsis (0.091 ng/mL), followed by those with sepsis (0.686 ng/mL), severe sepsis (3.593 ng/mL), and septic shock (21.703 ng/mL). Significant differences in PCT levels were found across the severity groups (P < 0.05), indicating a strong relationship between elevated procalcitonin levels and worsening clinical severity. Conclusion: Serum procalcitonin levels correlate with the severity of sepsis in patients with pneumonia and may serve as a useful biomarker for sepsis severity stratification and clinical risk assessment.
Anesthesia: Principles, Clinical Practice, and Recent Advances George , Steve
Journal of Society Medicine Vol. 4 No. 12 (2025): December
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i12.254

Abstract

Anesthesia is a fundamental component of modern surgical and interventional care, enabling procedures to be performed safely and humanely through the achievement of analgesia, hypnosis, amnesia, and appropriate muscle relaxation, while maintaining physiological homeostasis. Contemporary anesthetic practice extends beyond drug administration to encompass comprehensive perioperative management, including pre-anesthetic risk assessment, intraoperative monitoring, airway management, and postoperative recovery care. Advances in anesthetic pharmacology, monitoring technologies, and equipment design have substantially improved patient safety and expanded the scope of anesthesia across diverse clinical settings, including ambulatory surgery, non-operating room anesthesia, and critical care. The selection of anesthetic techniques, ranging from general, neuraxial, and regional anesthesia to monitored anesthesia care, is increasingly individualized and guided by surgical requirements, patient comorbidities, functional status, and patient preferences. Innovations such as ultrasound-guided regional anesthesia, multimodal analgesia, processed electroencephalographic monitoring, and enhanced recovery pathways have further optimized perioperative outcomes while reducing complications and resource utilization costs. In parallel, the implementation of standardized safety protocols, improved communication strategies, and system-based approaches have contributed to a marked decline in anesthesia-related morbidity and mortality. This review provides an integrated overview of the core principles of anesthesia, current clinical practices, and recent advances that continue to shape the evolution of anesthesiology toward a safer, more precise, and patient-centered perioperative care.
Adjunctive Micronutrient Therapy in Sepsis: Associations with Inflammation and Organ Dysfunction Prima , Agus; Lubis , Bastian
Journal of Society Medicine Vol. 5 No. 1 (2026): January
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i1.256

Abstract

Introduction: Despite advances in supportive care, sepsis remains a major cause of morbidity and mortality among critically ill patients. Adjunctive therapies targeting inflammation and endothelial dysfunction, such as thiamine and ascorbic acid, have gained increasing attention in recent years. Matrix metalloproteinase-9 (MMP-9) and its inhibitor TIMP-1 are key biomarkers involved in inflammatory dysregulation and organ dysfunction in sepsis. Methods: This retrospective cohort study was conducted over 12 months at Haji Adam Malik General Hospital. A total of 147 adult patients with sepsis were initially enrolled and categorized into four groups: normal saline (control), thiamine, ascorbic acid, and thiamine–ascorbic acid combination therapy. Propensity score matching was applied to achieve comparable baseline characteristics, resulting in 25 patients in each group. Serum MMP-9 and TIMP-1 levels were measured at the Integrated Laboratory, Faculty of Medicine, Universitas Sumatera Utara. The clinical outcomes included incidence rates, MMP-9/TIMP-1 ratios, and Sequential Organ Failure Assessment (SOFA) scores. Results: Combination therapy did not significantly reduce the incidence rate (OR 1.19; 95% CI 0.37–3.80) or MMP-9/TIMP-1 ratio (OR 0.34; 95% CI 0.09–1.30) compared to the control. In contrast, a single administration of ascorbic acid and thiamine significantly reduced the incidence rates and improved the MMP-9/TIMP-1 balance. Combination therapy was not associated with improved SOFA scores (OR 2.66; 95% CI 0.85–8.36). Conclusion: Combined thiamine and ascorbic acid therapies did not confer any superior clinical or biomarker benefits. Single-agent thiamine or ascorbic acid therapy demonstrated favorable effects on the incidence rate, MMP-9/TIMP-1 ratio, and organ dysfunction in patients with sepsis.

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