Tập 2 Số 7 (2026): Multimodal approaches in geriatrics

To summarize current evidence on the interaction between endocrine factors and skin aging, with a focus on the role of hormones and endocrine pathways. This review was conducted through a literature search in PubMed using the keywords “hormone,” “skin aging,” and “cutaneous aging.” Studies addressing the role of hormones in age-related changes of skin physiology were reviewed and synthesized. Skin aging is closely associated with hormonal changes. In women, the sharp decline in estrogen during menopause is a central factor driving aging, leading to reduced collagen and elastin synthesis, dermal thinning, loss of hydration, and increased sensitivity to environmental stressors. In men, the gradual decrease in testosterone also contributes to skin aging, though typically less prominently. Overall, the evidence highlights hormones as key regulators of skin health and resilience. The changes of some hormones play an important role in the process of skin aging. These findings underscore the potential of future skin rejuvenation strategies targeting endocrine pathways.

The rapidly aging population creates new demands for comprehensive healthcare, including aesthetic dermatology. Physical appearance directly influences psychological well-being, self-confidence, and quality of life in older adults. This review aims to analyze the role of aesthetic skin care in geriatrics, identify the boundaries between appropriate needs and excessive interventions, and highlight the risks of complications as well as physicians’ responsibilities in ensuring safety. We systematically synthesized and analyzed medical literature published between 2015 and 2025 related to skin aesthetics, geriatrics, and elderly healthcare. PubMed, Scopus, and Google Scholar were searched using the following keywords: “geriatrics dermatology”, “skin aesthetics”, “aesthetic skin care”, “elderly dermatology”, “cosmetic dermatology,” “aesthetic interventions complications elderly”, “quality of life”, “skin care elderly”, “complications”, “physician counseling”. Evidence indicates that aesthetic skin care significantly improves psychological health, quality of life, and social connectedness in older adults. However, complication risks are heightened due to multimorbidity, long-term medication use, and age-related physiological changes of the skin. Ethical considerations and the distinction between appropriate and excessive interventions must be carefully addressed in clinical practice. Aesthetic skin care in geriatrics represents an inevitable trend but requires cautious implementation. Physicians play a pivotal role in counseling, preventing complications, and selecting appropriate interventions to optimize both medical benefits and humanistic values in the comprehensive care of older adults.

Lung cancer remains the leading cause of cancer-related death. In central airway lesions, flexible bronchoscopy (FB) is the diagnostic backbone, as it allows direct visualization, lesion localization, and sampling, while integrating new technologies such as autofluorescence bronchoscopy (AFB), narrow-band imaging (NBI), endobronchial ultrasound (EBUS), optical coherence tomography (OCT), electromagnetic/CBCT-guided navigation bronchoscopy (ENB, CBCT), robotic bronchoscopy, and “real-time pathology” techniques such as confocal laser endomicroscopy (CLE). Over the past 5–7 years, evidence shows these technologies significantly enhance sensitivity/early detection, increase diagnostic yield for small peripheral nodules, reduce complications compared with transthoracic biopsy, and open the era of artificial intelligence (AI) for lesion recognition and procedural training. This article summarizes key advances, clinical impact, limitations, and implementation prospects in Vietnam.

Chronic heart failure is one of the leading causes of hospitalizations, impaired quality of life, and increased socioeconomic burden. Adequate disease awareness and effective self-care are key factors in improving prognosis and reducing hospital readmissions. A crosssectional descriptive study was conducted from January 1 to May 31, 2025, involving 200 patients. The tools used included the Dutch Heart Failure Knowledge Scale (DHFKS), a qualityof-life questionnaire, and a self-care assessment. Results: 66% of patients were aged ≥60 years, 94.5% had health insurance, and 78.5% resided in urban areas. Heart failure with reduced ejection fraction (HFrEF) accounted for 73.5%, significantly higher among patients aged ≥60 years (78.8%, p = 0.026). Hypertension (91%) and dyslipidemia (77%) were the most common comorbidities. A total of 78% of patients demonstrated good knowledge of heart failure. Regarding self-care behaviors, most adhered to a low-salt diet and regular weight monitoring, though physical activity remained suboptimal. Dyspnea and lower limb edema significantly impacted quality of life. When symptoms occurred, patients commonly contacted healthcare providers. Conclusions: The majority of outpatients with chronic heart failure demonstrated good disease awareness; however, improvements in self-care practices and multidimensional support are needed to enhance quality of life and reduce disease burden.

Stroke is the leading cause of severe disability among adults worldwide. In Vietnam, the burden is rising rapidly. The increasing incidence drives higher healthcare costs, reduced work capacity, and greater social pressures. Accordingly, post-stroke motor rehabilitation is a priority to reduce mortality and complications and limit disability. At Thống Nhất Hospital, physiotherapy combined with electroacupuncture has been used for years under the guidance of the Ministry of Health, with observed functional benefits. Still, its effectiveness has not been formally evaluated. This study aimed to generate evidence to guide regimen selection and optimise patient outcomes. Materials and Methods: A clinical interventional study without a control group was conducted, employing a pre- and post-treatment comparison. Eighty-six patients newly diagnosed with stroke within the preceding three months, receiving inpatient or outpatient care at the Departments of Rehabilitation, Emergency Interventional Cardiology, Neurology, and Traditional Medicine at Thống Nhất Hospital from January to October 2025, were included. Motor function recovery was assessed through manual muscle testing and the Barthel Index after 30 days of treatment. Results: The proportion with muscle strength grades 0–2 fell from 53.49% to 17.44%, whereas grades 4–5 rose from 29.07% to 59.30%. The mean Barthel Index increased from 44.24 ± 18.16 to 69.07 ± 17.90. Post-intervention classifications were completely independent, 12.79%; partially dependent, 76.74%; entirely dependent, 10.47%. Conclusion: Physiotherapy plus electroacupuncture appears safe and effective for post-stroke rehabilitation, improving muscle strength and independence in activities of daily living. Benefits extend beyond statistical significance to practical gains in quality of life and community reintegration.

Malnutrition and the associated phenotype of sarcopenia significantly compromise treatment tolerance, increase toxicity risk, and worsen overall survival in cancer patients. Given that the majority of oncological care occurs in the ambulatory setting, systematic nutritional assessment is a critical, mandated component of supportive care. This review synthesizes current evidence to evaluate the optimal screening and assessment tools suitable for routine use in outpatient oncology practice. A comprehensive narrative review was conducted, focusing on recent clinical guidelines and peer-reviewed literature concerning the validation and clinical utility of nutritional assessment instruments. Tools were analyzed across two tiers: Tier 1 (Screening) for feasibility and sensitivity; and Tier 2 (Comprehensive Assessment) for diagnostic accuracy regarding muscle loss and inflammation. The Malnutrition Screening Tool (MST) and Mini Nutritional Assessment Short Form (MNA-SF) emerged as the most practical and sensitive Tier 1 tools for general and geriatric oncology, respectively. For Tier 2, the Patient-Generated Subjective Global Assessment (PG-SGA) remains the gold standard. Crucially, the integration of objective measures—specifically Handgrip Strength and AI-assisted analysis of CT-derived Skeletal Muscle Index (SMI)—is essential for accurately diagnosing sarcopenia. Furthermore, the C-Reactive Protein/Albumin Ratio (CAR) is a powerful biomarker confirming the inflammatory drive of cachexia. Effective nutritional assessment mandates a structured, tiered approach. The reliance on advanced tools for objective body composition analysis is paramount for personalized care. Future efforts must focus on digitalizing this pathway, utilizing AI for automated sarcopenia detection, and ensuring robust resource allocation to oncology dietitians.

Ung thư là gánh nặng sức khỏe ngày càng gia tăng, đặc biệt ở người cao tuổi [14]. Chăm sóc giảm nhẹ (CSGN) có vai trò quan trọng trong nâng cao chất lượng sống cho người bệnh [17,18]. Nghiên cứu này nhằm xác định nhu cầu và các yếu tố liên quan đến CSGN ở người bệnh ung thư tại Bệnh viện Đa khoa vùng Tây Nguyên năm 2024. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang trên 434 người bệnh ung thư ≥18 tuổi điều trị nội trú từ 01–09/2024. Dữ liệu được thu thập qua phỏng vấn trực tiếp bằng bộ câu hỏi cấu trúc. Phân tích thống kê sử dụng SPSS 20.0 với hồi quy logistic đa biến. Kết quả: Có 88,2% người bệnh có nhu cầu CSGN. Các nhu cầu cao nhất gồm giao tiếp & quan hệ cộng đồng (83,9%), hỗ trợ thể chất (81,8%), hỗ trợ tinh thần (73,5%). Các yếu tố liên quan đến nhu cầu cao gồm: nữ (OR=3,21; p=0,001), sống nông thôn (OR=2,61; p=0,004), nghỉ việc/hưu trí (OR=3,07; p=0,001), ung thư có di căn (OR=2,87; p=0,004) và có biến chứng (OR=2,45; p=0,012). Kết luận: Phần lớn người bệnh ung thư, đặc biệt nhóm cao tuổi, có nhu cầu CSGN đa dạng. Cần tích hợp yếu tố lão khoa vào CSGN để đáp ứng toàn diện các nhu cầu thể chất, tinh thần và xã hội, qua đó nâng cao chất lượng sống và giảm gánh nặng y tế.

To evaluate the appropriateness of antimicrobial therapy in treating healthcare-associated infections and identify factors associated with patient outcomes at a national hospital in Vietnam. A cross-sectional study was conducted on 122 medical records of patients who were diagnosed with healthcare-associated infection at Thong Nhat Hospital from January 2023 to December 2023, using data from the Infection Control Department. Appropriateness of antimicrobial therapy was defined as physician adherence to Thong Nhat Hospital guidelines for antibiotic use. The factors associated with the treatment outcome were identified using multiple logistic regression analysis. The median age of the patients was 75.5 (65-85). Hospital-acquired pneumonia was identified in 51.6% of patients. The most prevalent pathogens were Klebsiella pneumoniae and Escherichia coli. The overall appropriate rate of empiric antimicrobial therapy was 76.2%. The successful treatment outcome rate was 71.3%. Lower respiratory tract infection, sepsis/sepsis shock, cancer, and comatose state were factors associated with treatment failure. Active management and treatment are essential for patients with lower respiratory infection, sepsis or septic shock, cancer, and comatose states to improve treatment outcomes.

The early diagnosis of pulmonary tuberculosis remains a critical priority in clinical practice. Although the GeneXpert MTB/RIF assay has been recommended for tuberculosis diagnosis, its implementation has not been widely adopted in many regions of Vietnam. This study aimed to evaluate the diagnostic value of the GeneXpert MTB/RIF assay on sputum samples for detecting pulmonary tuberculosis and to compare its results with those from direct sputum smear microscopy (AFB). A cross-sectional descriptive study was conducted on 270 patients with suspected pulmonary tuberculosis who were examined and treated at the Internal Medicine Department, Thong Nhat Hospital, between January 2024 and July 2025. Among the participants, 72.2% were male and 27.8% were female. The mean age was 79.5 ± 15.1 years, and the mean body mass index (BMI) was 21.1 ± 3.4 kg/m². The detection rate of tuberculosis was 14.1% using the GeneXpert MTB/RIF assay, compared to 4.8% by AFB smear microscopy.Compared to AFB smear microscopy, the GeneXpert MTB/RIF assay demonstrated a sensitivity of 84.6%, a specificity of 89.5%, a positive predictive value (PPV) of 28.9%, and a negative predictive value (NPV) of 99.1%. The rate of rifampicin resistance among detected cases was 7.9%. Patients with suspected pulmonary tuberculosis presented with diverse clinical manifestations and comorbidities. The GeneXpert MTB/RIF assay on sputum samples showed high sensitivity and specificity for diagnosing pulmonary tuberculosis, with a rifampicin resistance rate of 7.9%.

Colonic diverticulitis is increasing in Asia, yet data on clinical patterns in Vietnam remain limited. This study aimed to evaluate the clinical, laboratory, imaging characteristics, and treatment outcomes at Thong Nhat Hospital. A retrospective descriptive study was conducted on 105 patients from January 1 to September 1, 2025. Data on demographics, clinical features, laboratory tests, CT findings, WSES classification, treatment strategies, and outcomes were collected and analyzed using SPSS 26.0, with p < 0.05 considered statistically significant. The mean age was 53.9 ± 20.0 years, with 31.4% aged ≥65. Males accounted for 67.6%. The most common symptom was right lower quadrant pain (55.2%). CT revealed diverticula mainly in the sigmoid colon (40.0%), cecum (37.1%), and right colon (19.0%). WSES stages were: 1a (57.1%), 1b (19.0%), 2a (11.4%), 2b (7.6%), 3 (3.8%), and 4 (1.0%). Medical treatment was applied in 89.5% of cases, percutaneous drainage in 1.0%, and surgery in 9.5%. The mean hospital stay was 7.6 ± 4.4 days, significantly longer in complicated cases and those requiring invasive interventions (p < 0.05). Colonic diverticulitis in Vietnam often affects middle-aged males, with location varying by age: cecum/right colon in younger patients and sigmoid colon in the elderly. CT-scan plays a crucial role in diagnosis, staging, and guiding treatment.

Bisphosphonate (BP) is a group of drugs used to treat osteoporosis, multiple myeloma, skeletal metastasis cancer. BP’s mechanism of action is to reduce bone resorption by inhibiting the osteoclasts activity. Therefore, the indication of BP is increasingly widespread and becomes the first class of drugs in the treatment of osteoporosis. At Frienship Hospital, over the past five years, we have encountered 12 cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) at various stages. The key message we wish to convey in this report is to kindly encourage close collaboration between internal medicine specialists and oral maxillofacial surgeons during bisphosphonate therapy, in order to minimize the risk of BRONJ complications for patients.

Ureteral calculi account for approximately 20–40% of urinary tract stone diseases, second only to renal calculi. Retrograde ureteroscopic laser lithotripsy is a widely used minimally invasive procedure, offering rapid recovery and low complication rates. However, postoperative anxiety remains a clinical concern. A descriptive cross-sectional study was conducted on 165 patients undergoing retrograde ureteroscopic laser lithotripsy at Thong Nhat Hospital between March and September 2023. The prevalence and severity of postoperative anxiety were assessed using standardized measures. Postoperative anxiety was identified in 95.15% of patients, predominantly at a mild level. Mild and moderate anxiety were observed in 83.64% and 11.51% of cases, respectively, with a mean score of 4.53 ± 2.58. The most common concerns included fear of complications (84.8%), postoperative pain (66.1%), and indwelling JJ stent placement (43.6%). Postoperative anxiety was highly prevalent among patients undergoing retrograde ureteroscopic laser lithotripsy, although generally mild in severity. These findings underscore the importance of comprehensive perioperative counseling and psychological support to reduce patient anxiety and enhance recovery outcomes.

The triangular fibrocartilage complex (TFCC) plays a crucial role in stabilizing the distal radioulnar joint; TFCC injuries commonly cause ulnar-sided wrist pain and functional impairment of the hand. Arthroscopic wrist surgery is an effective and minimally invasive treatment option; however, domestic reports remain limited. Therefore, we conducted the study entitled “Preliminary outcomes of arthroscopic wrist surgery for the repair of traumatic triangular fibrocartilage complex injuries” with the aims of describing the clinical and paraclinical characteristics of TFCC injuries and evaluating treatment outcomes following arthroscopic wrist surgery. Subject and Methods: A total of 15 patients aged 18 years and older with triangular fibrocartilage complex (TFCC) injuries were included in this study. The diagnosis was confirmed through clinical examination, wrist X-ray, and MRI. Patients underwent arthroscopic TFCC repair at Thong Nhat Hospital from June 2021 to June 2024. Results:The study cohort consisted predominantly of female patients, with a mean age of 36.8 ± 9.14 years, the right wrist was the most commonly affected side, with household accidents being the primary cause of injury, palmer type IB TFCC injury was the most frequently observed type, the mean surgical time was 62 ± 15 minutes, the mean hospital stay was 4.4 ± 1.24 days, the VAS pain score significantly improved from 6.01 ± 0.88 preoperatively to 0.36 ± 0.63 at 6 months postoperatively (p<0.05), the MMWS score improved from 45.33 ± 3.52 to 91 ± 5.07 at 6 months postoperatively (p<0.05). Conclusion: arthroscopic TFCC repair is a minimally invasive, effective, and safe surgical approach that alleviates pain and restores wrist function.

Finger contractures, resulting from burns, trauma, or congenital anomalies, often lead to significant functional impairment. Z-plasty is a versatile reconstructive technique used to release scar contractures while preserving local tissue characteristics. This study aimed to evaluate the functional outcomes of different Z-plasty techniques in the surgical release of contracted fingers. We conducted a prospective descriptive case series involving 31 patients (38 fingers) undergoing Z-plasty for digital contractures. Depending on the location and severity of the contracture, three Z-plasty techniques were used: five-flap, double-opposing, and single 60° Z-plasty. Patients were followed for a mean of 5.6 months. Primary outcomes included range of motion (ROM), web space angle, and DASH scores. Complications and patient satisfaction (VAS) were also assessed. All techniques demonstrated significant improvements in finger extension and flexion. Mean extension deficit improved from −35.4° to −8.1°, and flexion increased from 62.3° to 81.7° (P < .001). The five-flap Z-plasty achieved the greatest gain in web space angle (from 24.2° to 46.8°). DASH scores decreased significantly from 47.6 to 21.8 (P < .001), with patient satisfaction increasing from 4.2 to 8.1 on VAS. Minor complications occurred in 5 patients (16.1%), with no cases of flap necrosis or wound infection. Z-plasty is an effective and low-risk technique for releasing digital contractures and restoring hand function. Five-flap and doubleopposing Z-plasty provide greater functional improvement in web space contractures, while single Z-plasty remains effective for linear joint contractures. These techniques offer reliable outcomes without the need for skin grafting, supporting their continued use in reconstructive hand surgery.

Syndactyly is among the most common congenital limb malformations and is characterized by substantial genetic and clinical heterogeneity. Although its global incidence is well recognized, accumulating evidence indicates that Asian populations exhibit distinct mutational spectra and variable prognostic profiles. This review systematically summarizes recent molecular and clinical findings from Asian cohorts, with emphasis on pathogenic variants, modifier effects, surgical outcomes, and advances in prenatal diagnostics. Literature published between 2008 and 2023 was retrieved from major biomedical databases following PRISMA-guided principles. Studies from Chinese, Mongolian, and Vietnamese families have repeatedly identified pathogenic variants in key developmental genes, including HOXD13, GLI3, GJA1, and FGFR2, highlighting the central role of convergent signaling pathways such as Hedgehog, WNT/BMP, and FGF in digit morphogenesis and interdigital apoptosis. Asian cohort data further demonstrate incomplete penetrance and intrafamilial variability, suggesting contributions from modifier gene networks and epigenetic influences. Clinically, the integration of next-generation sequencing into surgical planning and prenatal counseling has improved diagnostic precision and prognostic stratification, although molecular evidence remains uneven across Southeast Asia. Asian-specific syndactyly research provides critical insights into population-adapted genetic counseling and emerging precision medicine strategies. Future multi-center genomic studies with standardized clinical reporting will be essential to refine genotype–phenotype correlations and advance individualized management across diverse Asian populations.

Decellularized vascular grafts hold potential for small-diameter vascular reconstruction owing to the ECM integrity maintained and appropriate dimensions. However, the thrombogenicity of tissue-derived grafts represents a notable limitation for clinical application. This study focuses on assessing the effectiveness of heparin immobilization on cross-linked decellularized vascular grafts prepared from porcine carotid arteries. The Layer-by-Layer (LbL) assembly technique was applied to immobilize heparin on the graft surface to improve hemocompatibility. Following LbL treatment, the grafts were examined for heparin content and surface morphology using scanning electron microscopy (SEM). To assess their potential for vascular implantation, the biomechanical properties and hemocompatibility were further evaluated. SEM observations and heparin quantification confirmed successful heparin immobilization. Biomechanical testing was measured and found to be suitable for graft applications. In terms of hemocompatibility, in vitro anticoagulant activity assessment revealed a thromboresistant surface on the luminal surface of the grafts. In addition, hemolysis rates remained within the non-hemolytic threshold as defined by ISO 10993-4. In summary, the Layer-by-Layer heparin immobilization method effectively immobilized heparin onto reinforced decellularized vascular grafts, enhanced hemocompatibility, and represents a promising approach for the development of xenogeneic vascular graft materials.

Amyloid cardiomyopathy is an infiltrative disease caused by extracellular deposition of amyloid fibrils within the myocardium, most commonly from immunoglobulin light-chain (AL) or transthyretin (ATTR) sources, leading to progressive heart failure, arrhythmias, and conduction disturbances. We present the case of an 80-year-old man with heart failure with preserved ejection fraction (HFpEF) and comorbidities who was admitted for acute onset dyspnea accompanied by profound hypotension at home. Together with a non-clonal free light-chain profile, these findings supported a diagnosis of transthyretin (ATTR) cardiac amyloidosis. This case highlights the value of integrating electrocardiogram, echocardiography, cardiac magnetic resonance, and bone-avid tracer scintigraphy to establish the diagnosis of ATTR cardiomyopathy and guide management in settings where disease-modifying therapy remains limited.Keywords: supraclavicular brachial plexus nerve block, adductor canal block, popliteal sciatic block, heart failure, limb amputation.

Kidney transplantation is one of the most effective treatment options for patients with end-stage renal disease. However, a considerable number of patients die while waiting for transplantation. We conducted a descriptive case series of six kidney transplantations from brain-dead donors in Thong Nhat hospital. All six procedures were completed successfully following a standardized Enhanced Recovery After Surgery (ERAS) anaesthetic protocol. No patients experienced postoperative nausea or delayed graft function, and early urine output exceeded 2 mL.kg⁻¹.h⁻¹ in all recipients. The prevalence of end-stage renal disease is steadily increasing, while the disparity between available organ supply and transplantation demand continues to widen. Organs from brain-dead donors represent an effective strategy to address this shortage. Kidney transplantation is a highly complex surgical procedure that necessitates meticulous anesthetic planning to ensure patient safety and optimize graft function. ERAS‑based protocols offer safe and effective perioperative management, resulting in reduced complications, shorter hospital stays and improved patient satisfaction.

Heart failure with reduced ejection fraction (HFrEF) presents significant anesthetic risks during limb amputation, especially in patients with multiple comorbidities. This report describes two cases of male patients with HFrEF (EF 27% and 45%) undergoing emergency limb amputation under ultrasound-guided peripheral nerve block (PNB). The first patient, with stage V chronic kidney disease, received a supraclavicular brachial plexus block using 20 mL of 0.35% ropivacaine. Sensory onset occurred at 5 minutes, motor onset at 25 minutes, and analgesia lasted 13 hours. The second patient received adductor canal and popliteal sciatic nerve blocks using 35 mL ropivacaine and IV dexamethasone. Sensory onset was 20 minutes, motor onset 25 minutes, and analgesia lasted 21 hours. Both patients remained awake and hemodynamically stable throughout surgery, with no complications. These cases highlight the safety and efficacy of PNB in high-risk cardiovascular patients. Adjusted dosing strategies, especially in renal impairment, allowed prolonged analgesia without toxicity. Compared to general or spinal anesthesia, PNB avoids airway manipulation and minimizes hemodynamic fluctuations.