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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 218 Documents
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Gut Microbiota–Driven Modulation of Host Immune Responses in Severe Infections: Mechanistic Insights and Translational Implications Bello, Fatima; Okafor, Chinedu
Journal of Society Medicine Vol. 5 No. 3 (2026): March
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i3.268

Abstract

Introduction: Severe infections, particularly sepsis and ICU-acquired infections, remain leading causes of global morbidity and mortality, primarily driven by dysregulated host immune responses. Increasing evidence positions the gut microbiota as a critical regulator of systemic immunity through bidirectional host–microbiome interactions, functioning not merely as a passive microbial reservoir but also as an active determinant of disease progression and clinical outcomes. Methods: A structured narrative synthesis was conducted using literature retrieved from PubMed, Embase, and Cochrane Library. Priority was given to high-quality randomized controlled trials, large observational cohorts, and mechanistic preclinical studies published within the past 10–15 years. Evidence was systematically appraised using standardized risk-of-bias frameworks, including Cochrane tools, and integrated into a translational model linking microbiome alterations with host immune dynamics. Results: Severe infections were consistently associated with rapid-onset gut dysbiosis, characterized by reduced microbial diversity and expansion of opportunistic pathogens. Five principal mechanistic domains were identified: immune system modulation, disruption of epithelial barrier integrity, altered microbial metabolite signaling, systemic microbial translocation, and antibiotic-induced ecological imbalance. Although observational data demonstrate strong associations between dysbiosis and adverse outcomes, interventional studies targeting the microbiome have reported heterogeneous efficacy, reflecting the underlying biological complexity and current therapeutic limitations. Conclusion: Gut microbiotas represent a dynamic and potentially modifiable regulator of host immune responses during severe infections. Future research should emphasize causal inference, precision microbiome-based interventions, and the integration of multi-omics approaches to develop mechanism-based therapeutic strategies and clinically actionable biomarkers to improve outcomes in critically ill patients.
Risk Factor–Weighted Clinical Probability for Predicting Obstructive Coronary Artery Disease in Patients Presenting with Unstable Angina Batubara , Gio Justisia; Hasan , Refli; Nasution , Ali Nafiah; Hasan, Harris; Lubis, Anggia Chairuddin; Andra, Cut Aryfa
Journal of Society Medicine Vol. 5 No. 3 (2026): March
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i3.271

Abstract

Introduction: Determining the optimal invasive strategy for patients with unstable angina remains challenging, often resulting in unnecessary coronary angiography. Existing risk scores, including the GRACE and TIMI scores, were not designed to predict obstructive coronary artery disease. This study evaluated the predictive performance of a risk factor–weighted clinical likelihood model. Methods: This retrospective analytical cohort study included 150 patients with low-to intermediate-risk unstable angina who underwent coronary angiography at a tertiary hospital. Predictive accuracy was assessed using receiver operating characteristic analysis and compared with the Diamond Forrester, Fladseth, guideline-based criteria, GRACE, and TIMI scores. Obstructive disease was defined as significant stenosis or physiologically relevant lesions. Results: The prevalence of obstructive coronary disease was 60%. The model demonstrated superior discrimination, with an area under the curve of 0.885, which exceeded that of the comparator models. At a threshold score, 42.7% of angiographies were safely deferred, with a negative predictive value of 76.6%. Calibration improved after model adjustment. Conclusion: The risk factor–weighted clinical likelihood model provides a robust prediction of obstructive coronary artery disease in patients with unstable angina. This may support objective decision-making and enable a more selective invasive strategy, thereby reducing unnecessary procedures while maintaining diagnostic safety.
Postoperative Pulmonary Hypertension After Complete Tetralogy of Fallot Repair: Mechanistic Determinants and Prognostic Implications for Early Clinical Outcomes Damayanti , Eka; Tavianto, Doddy
Journal of Society Medicine Vol. 5 No. 3 (2026): March
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i3.272

Abstract

Introduction: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, with an incidence of approximately three per 10,000 live births. Postoperative pulmonary hypertension following complete repair is a rare but life-threatening complication that may lead to weaning failure from cardiopulmonary bypass. This condition is driven by acute increases in pulmonary vascular resistance and impaired right ventricular–pulmonary arterial coupling. Recognized risk factors include chronic preoperative hypoxia, younger age at surgery, and severe right ventricular dysfunction. Case Description: A three-year-old child with stunted growth and longstanding cyanosis since infancy underwent evaluation, revealing a large malaligned ventricular septal defect, 50% overriding aorta, and severe pulmonary stenosis with a pressure gradient of 85 mmHg. Intraoperative findings confirmed a double-outlet right ventricle with multiple atrial septal defects. Following total correction, the patient was not weaned from cardiopulmonary bypass because of acute right ventricular failure and severe pulmonary hypertension. Atrial septal defect creation for decompression and maximal inotropic support with dobutamine, adrenaline, and milrinone were performed. Despite aggressive management, the patient progressed to refractory cardiogenic shock with an arterial pressure of 25/19 mmHg and died within 24 hours postoperatively. Conclusion: This case underscores the catastrophic impact of postoperative pulmonary hypertensive crises in patients with complex congenital heart disease. The failure of weaning from cardiopulmonary bypass due to acute right ventricular failure represents a critical inflection point associated with extremely high mortality. Early risk stratification, perioperative optimization, and timely consideration of advanced mechanical circulatory support are essential. The integration of targeted pulmonary vasodilator therapy with vigilant hemodynamic monitoring may improve right ventricular adaptation and clinical outcomes in high-risk patients.
Perioperative Neutrophil-to-Lymphocyte Ratio as an Independent Predictor of Acute Kidney Injury Following Cardiac Surgery: A Multicenter Observational Study Chaiyasit , Anan; Wattanakul, Siriporn; Rattanapong , Kittisak
Journal of Society Medicine Vol. 5 No. 4 (2026): April
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i4.273

Abstract

Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent and severe complication that significantly contributes to postoperative morbidity and mortality. Systemic inflammation plays a central role in the pathophysiology of CSA-AKI, and the neutrophil-to-lymphocyte ratio (NLR), a simple and widely available biomarker, has shown potential as a prognostic tool for CSA-AKI. However, robust multicenter evidence regarding its perioperative role in predicting CSA-AKI remains limited. Methods: We conducted a multicenter observational cohort study involving 1,248 adult patients who underwent cardiac surgery. NLR was measured at three critical time points: preoperatively, upon ICU admission, and on the first postoperative day. The primary outcome was CSA-AKI, as defined by the Kidney Disease: Improving Global Outcomes criteria. Multivariable mixed-effects logistic regression models were used to assess the independent association between perioperative NLR and CSA-AKI, adjusting for relevant confounders and center-level variability. Model performance was evaluated using discrimination and calibration metrics. Results: CSA-AKI occurred in 27.6% of the patients. Elevated perioperative NLR was significantly associated with an increased risk of CSA-AKI. In the adjusted analyses, higher preoperative NLR independently predicted CSA-AKI (adjusted OR 1.82 per unit increase; 95% CI 1.34–2.47). Similar associations were observed between ICU admission and postoperative NLR. Incorporating NLR into the predictive model enhanced its discrimination (AUC 0.78) and demonstrated a strong calibration. Conclusion: Perioperative NLR is an independent and clinically significant predictor of CSA-AKI. Its simplicity, cost-effectiveness, and accessibility make it an invaluable tool for early risk stratification in patients undergoing cardiac surgery. Integrating NLR into perioperative assessment models could facilitate personalized preventive strategies, potentially improving clinical outcomes, and guiding more targeted interventions for CSA-AKI.
Primary Closure Consideration and Local Flap Reconstruction in a Neonate with Giant Occipital Meningoencephalocele: A Case Report and Technical Considerations Anggia, Risa; Hidayat, Imam; Rizal, Syamsul
Journal of Society Medicine Vol. 5 No. 4 (2026): April
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i4.275

Abstract

Introduction: Meningoencephalocele is a rare congenital neural tube defect characterized by herniation of meninges and brain tissue through a cranial defect. Giant occipital lesions in neonates present substantial neurosurgical and reconstructive challenges owing to fragile tissues, limited physiological reserve, and increased risk of cerebrospinal fluid (CSF) leakage, wound complications, and infection. Despite well-established neurosurgical principles, optimal strategies for soft tissue reconstruction in this population remain insufficiently reported. Case Description: An 11-day-old female neonate presented with a large midline occipital mass that had been present since birth. Clinical examination revealed a soft, fluctuant, skin-covered lesion without neurological deficits or signs of infection. Cranial imaging revealed an occipital skull defect with herniation of the meninges and brain tissue, consistent with occipital meningoencephalocele. Following a multidisciplinary evaluation, primary closure was considered but deemed unsafe because of excessive tension. Therefore, staged surgical management was performed. Neurosurgical excision of the non-functional herniated tissue and watertight dural repair was followed by tension-free scalp reconstruction using a local occipital rotation flap. The post-excisional defect measured approximately 8 × 6 cm, and the total operative time was approximately 180 minutes. No intraoperative complications occurred. The postoperative course was uneventful, with stable wound healing, intact flap viability, and no evidence of CSF leakage, wound dehiscence, infection, or neurological deterioration during the early follow-up. Conclusion: A staged multidisciplinary approach integrating precise neurosurgical repair with well-planned local flap reconstruction enables safe closure, preserves neural protection, minimizes complications, and provides favorable functional and aesthetic outcomes in neonatal occipital meningoencephalocele.
Early Vasopressor Initiation as an Independent Determinant of Survival in Septic Shock: A Multicenter Real-World Causal Inference Analysis Hassan , Ahmed; Al-Faisal, Khalid; Al-Harbi, Faisal
Journal of Society Medicine Vol. 5 No. 4 (2026): April
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i4.276

Abstract

Introduction: Septic shock is a life-threatening syndrome characterized by profound circulatory failure and dysregulated host response, with mortality remaining unacceptably high despite advances in critical care. Rapid restoration of perfusion pressure is central to resuscitation, and current guidelines advocate prompt vasopressor initiation to avoid hypotension. However, the survival benefit of early vasopressor administration remains uncertain. Methods: We conducted a multicenter retrospective cohort study of adult patients with septic shock defined according to the Sepsis-3 criteria. The primary exposure was the time from shock recognition to vasopressor initiation, categorized as early (≤X hours) versus delayed (>X hours), with complementary continuous-time analyses. The primary outcome was 28-day all-cause mortality. Secondary outcomes included ICU and hospital length of stay, vasopressor duration, organ support utilization, cumulative fluid balance, and adverse events (AEs). Multivariable adjustment was combined with propensity score–based inverse probability weighting, balance diagnostics, multiple imputation, and prespecified sensitivity analyses. Results: Among 2,184 patients, 1,042 received early vasopressor initiation and 1,142 received delayed initiation of vasopressor therapy. The unadjusted 28-day mortality rates were 27.8% and 34.6%, respectively. After adjustment, early vasopressor initiation was independently associated with lower mortality (adjusted OR 0.74, 95% CI 0.62–0.88; P<0.001). Early initiation was also associated with shorter ICU stay, reduced vasopressor duration, and lower 24-hour cumulative fluid balance without increased arrhythmia or ischemic complications. Conclusion: Early vasopressor initiation following shock recognition was independently associated with improved short-term survival, supporting a pragmatic guideline-aligned strategy that prioritizes timely hemodynamic stabilization while minimizing delays in vasopressor administration.
Independent Determinants of Ventilator-Associated Pneumonia in Critically Ill Mechanically Ventilated Patients: A Prospective Multicenter Cohort Study Ndlovu, Samuel; Mokoena, Thabo; Khumalo , Lerato
Journal of Society Medicine Vol. 5 No. 4 (2026): April
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i4.278

Abstract

Introduction: Procalcitonin (PCT) is increasingly used to support antibiotic stewardship in sepsis, particularly for guiding antimicrobial discontinuation. Although randomized trials suggest that PCT-guided strategies reduce antibiotic exposure without harm, their effectiveness in heterogeneous intensive care unit (ICU) populations remains unclear. Methods: We conducted a prospective multicenter cohort study of adult ICU patients with sepsis managed using either a PCT-guided discontinuation protocol or standard care protocol. The protocol recommended antibiotic discontinuation when PCT decreased by at least 80% from peak values or reached 0.5 ng/mL or lower, provided that stability was achieved. The primary outcome was the duration of antibiotics for the index sepsis episode. Secondary outcomes included 28-day mortality, ICU length of stay, antibiotic consumption measured by days of therapy and defined daily doses, and direct costs of treatment. Mixed-effects regression and propensity score weighting were used to adjust for confounding and center-level variabilities. Results: Among 1,284 patients, 642 received PCT-guided antibiotic stewardship and 642 received standard care. PCT-guided stewardship was associated with shorter antibiotic duration (6.1 vs. 7.5 days; adjusted difference, −1.2 days; 95% CI, −1.6 to −0.8; p<0.001). There was no increase in 28-day mortality (18.9% vs. 20.4%; adjusted OR, 0.92; 95% CI, 0.71–1.18). Antibiotic consumption was lower (612 vs. 742 DOT per 1,000 ICU-days), with reduced direct costs despite PCT testing. Conclusion: PCT-guided antibiotic stewardship reduced antibiotic exposure and costs without compromising survival, supporting its integration as a pragmatic adjunct to clinical judgment in ICU sepsis management.
Early Fluid Resuscitation Volume as an Independent Determinant of Mortality in Sepsis: A Multicenter Real-World ICU Cohort Study El-Sayed, Amina; Hassan, Omar; Khaled, Youssef
Journal of Society Medicine Vol. 5 No. 4 (2026): April
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i4.279

Abstract

Introduction: Early intravenous fluid resuscitation is central to sepsis management; however, the optimal volume during the initial resuscitation window remains uncertain. Although current guidelines recommend at least 30 mL/kg of crystalloids within 3 h, this fixed-volume threshold may not capture the heterogeneity of septic ICU care unit. This study evaluated the association between early fluid resuscitation volume and mortality using multicenter, real-world ICU data. Methods: We conducted a retrospective multicenter cohort study using MIMIC-IV and eICU-CRD. Adult ICU patients who fulfilled the Sepsis-3 criteria were included. The primary exposure was the cumulative crystalloid volume administered within the first 3 h after sepsis onset. Fluid volume was analyzed as categorical mL/kg strata, the conventional ≥30 mL/kg threshold, and a continuous variable using restricted cubic splines. The primary outcome was in-hospital mortality. Multivariable logistic regression, propensity score weighting, and marginal structural models were used to address the baseline severity, treatment intensity, and time-varying confounding. Results: Among 18,742 septic ICU care unit, early fluid volume showed a nonlinear dose–response association with mortality. Patients receiving 20–30 mL/kg had the lowest adjusted mortality, whereas both lower-volume resuscitation (< 10 mL/kg) and liberal resuscitation (≥ 40 mL/kg) were associated with increased mortality. The ≥30 mL/kg threshold was not consistently associated with improved survival after the adjustment. The findings remained robust across sensitivity analyses, alternative exposure windows, and causal inference models. Conclusion: Early fluid resuscitation volume in patients with sepsis is associated with mortality in a non-linear, dose-dependent pattern. These findings challenge the universal applicability of fixed 30 mL/kg resuscitation and support individualized physiology-guided fluid strategies in critically ill patients with sepsis.

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