Research

Heart failure with reduced ejection fraction (HFrEF) represents a major global health burden, characterized by high rates of morbidity, hospitalization, and mortality, particularly among elderly patients. Low blood pressure is a common condition in this population, associated with worse prognosis and challenges in optimizing guideline-directed medical therapy (GDMT). Evidence from randomized controlled trials and real-world studies demonstrates that the benefits of GDMT persist even in patients with low blood pressure. Among the foundational therapies, sodium–glucose cotransporter-2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists (MRA) have minimal hemodynamic effects and can be initiated early, whereas angiotensin receptor–neprilysin inhibitors (ARNi), angiotensin-converting enzyme inhibitors (ACEi), and beta-blockers (BB) should be started at low doses and carefully up-titrated. In Vietnam, prescription rates of GDMT remain limited; however, current evidence highlights the importance of maintaining GDMT to the maximum tolerated extent, alongside evaluating secondary causes of hypotension and tailoring therapy to individual patients. This review summarizes updated evidence, discusses pharmacodynamic considerations, and proposes clinical strategies for managing elderly patients with HFrEF and low blood pressure, emphasizing the role of comprehensive geriatric assessment in achieving safe and effective therapy

Evaluation of the treatment outcomes of ureteral stones in super-elderly patients using retrograde ureteroscopic lithotripsy (URSL) at Thong Nhat Hospital, Ho Chi Minh City. A retrospective descriptive study was conducted on 68 patients aged 80 years and older who underwent URSL from January 2022 to January 2025. Data on patient characteristics, stone size and location, stone-free rates, operative time, hospital stay, complications, and factors affecting treatment outcomes were collected and analyzed. The mean age of patients was 83.7 ± 3.1 years, with 57.3% being male. The average stone size was 12.3 ± 3.8 mm; 36.8% of patients had stones larger than 1.5 cm, and 30.9% had stones located in the upper third of the ureter. The stone-free rate after the first ureteroscopic lithotripsy was 84.7%, which increased to 93.8% after the second session. However, 7.4% of patients still had residual stones, mainly due to difficult anatomical locations or ureteral edema. The mean operative time was 29.4 ± 9.7 minutes (range 19–48 minutes). Complications occurred in 12.1% of cases, most commonly urinary tract infection (5.8%), mild bleeding (2.9%), and minor ureteral injury (3.4%). The mean hospital stay was 7.2 ± 1.9 days. Retrograde ureteroscopic lithotripsy represents an effective and safe treatment modality in the super-elderly population, demonstrating high stone-free rates with an acceptable complication profile. However, individualized treatment planning is essential, particularly in cases involving large calculi, proximal ureteral stones, or significant underlying comorbidities.

To evaluate the treatment outcomes of lumbar spinal stenosis with instability in osteoporotic patients at Thong Nhat Hospital. A retrospective descriptive case series study on all cases of lumbar spinal stenosis with instability accompanied by osteoporosis (T-score < -2.5 SD) who underwent posterior lumbar interbody fusion (PLIF) combined with pedicle screw fixation using cement augmented cannulated screws at the Neurosurgery Department of Thong Nhat Hospital, Ho Chi Minh City, from June 2015 to June 2021. Among 59 patients meeting the inclusion criteria, all showed postoperative recovery. Nearly 50% had excellent outcomes, with significant reductions in back pain and a mean motor recovery time of 23 days post-surgery. According to the Japanese Orthopaedic Association (JOA) score: 49.1% had excellent improvement, 39% good, 11.9% moderate, and no poor outcomes were observed. Preoperative vs. discharge clinical symptoms showed significant improvement: VAS score for back pain decreased from 7.1 to 3.4 (p < 0.05), radicular leg pain from 6.44 to 3.76 (p < 0.05), and neurogenic claudication reduced from 68.12% to 7.2% (p < 0.05). According to Lee’s fusion assessment criteria: 72.9% achieved definite fusion (Grade A), 25.4% probable fusion (Grade B), and only one case showed pseudoarthrosis. Complications were rare and included cement leakage, surgical site infection, and dural tear. JOA score improvements were more pronounced in patients with 1 or 2 fusion levels and significantly higher in those with 3-level fusions. Posterior lumbar interbody fusion using cement-augmented cannulated screws is an effective surgical treatment for lumbar spinal stenosis with instability in osteoporotic patients, offering good recovery outcomes.

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.

According to the World Health Organization, sexual health constitutes an essential component of overall health. Nevertheless, culturally adapted instruments for assessing sexual health in Vietnamese remain scarce. Therefore, the development of an additional tool that is concise, user-friendly, and applicable in Vietnamese is warranted. This study aimed to translate and culturally adapt the Short Sexual Well-Being Scale (SSWBS) into Vietnamese. The translation process adhered to international guidelines and involved five steps. Two independent translators performed forward translation, followed by synthesis. The back-translated version demonstrated high equivalence with the original questionnaire, with all discrepancies being synonymous. During pilot testing with 40 healthcare professionals, 34 (85%) reported that the questionnaire was clear, comprehensible, and free of ambiguity, while six (15%) raised concerns regarding the wording of item 5. After further semantic clarification, these participants also confirmed the questionnaire’s clarity and comprehensibility. Overall, the translation and cultural adaptation of the SSWBS were conducted using a standardized methodology and were evaluated as simple, clear, and easy to understand.

Thyrotoxic cardiomyopathy is categorized within the spectrum of metabolic cardiomyopathies and typically presents with high-output heart failure accompanied by a supranormal left ventricular ejection fraction. In recent years, heart failure with supranormal ejection fraction (HFsnEF) has been increasingly regarded as a distinct heart failure phenotype, exhibiting worse prognosis and suboptimal treatment response compared with the group with preserved ejection fraction. In this report, we present a clinical case of a patient admitted with fatigue, palpitations, and diarrhea. After comprehensive integration of clinical findings, laboratory test results, and imaging data, the patient was ultimately diagnosed with thyrotoxicosis accompanied by heart failure with supranormal ejection fraction. The patient was treated with a combination of antithyroid medication and a beta-blocker. After seven days of therapy, the patient demonstrated marked improvement in clinical symptoms as well as cardiac function on echocardiographic assessment.

Transesophageal overdrive pacing is an accepted method for the diagnosis and treatment of paroxysmal supraventricular tachycardias, although is not used frequently in clinical practice. We describe four complex cases of paroxysmal supraventricular arrhythmia to review the role of transesophageal overdrive pacing in the interruption of paroxysmal supraventricular tachycardia. In these cases depend on clinical features such as pregnancy, resistance to antiarrhythmic drugs, and comorbid bradycardia that make it difficult to treat. These cases were successfully converted by transesophageal overdrive atrial pacing. Transesophageal overdrive atrial pacing is a low-cost, simple and safe procedure that can be performed at the bedside and can do many times, especially in patients, whose condition makes difficult the usage of medicines.

To evaluate the results of ACL reconstruction with repair of posterior horn of the meniscus. prospective study of 34 patients with ACL rupture with posterior horn of the meniscus tear underwent elective knee arthroscopy at Thong Nhat hospital from March 2020 to March 2023. There are 17 males and 17 females.  Mean age was 36 years (from 18 to 50 years). Body mass index (BMI): average 24 (range 18 to 32). Mechanism of injury: 42.3% sports accidents, 32.7% traffic accidents, 25% daily life accidents. The mean time before surgery was 44 days (4-180 days). Posterior horn medial meniscus tear accounts for 38.2% of patients and lateral horn medial meniscus tear accounts for 61.8% of patients. Chondral lesions according to Outerbrigde: 70% grade 2, 17% grade 1 and 13% grade 3. After 1 year, the mean IKDC score was 78.28 points (from 68 to 83 points), the mean Lysholm score was 88.28 points (from 70 to 94 points). Patients with knee joint stability after 1 year of follow-up have a rate of over 88.2%, patients with good symptoms of a meniscus tear after 1 year of follow-up have a rate of over 73.5%. All patients were satisfied. 83% of patients with grade I and 17% of patients with grade II according to K-L system for classification of osteoarthritis on X-ray of the knee joint after 1 year. No complications of infection, delay healing, nerve or vascular injuries, pulmonary embolism, deep vein thrombosis; 21.2% of patients had synovitis. ACL reconstruction with repair of posterior horn of the meniscus gave satisfactory results

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.

At Thong Nhat Hospital, Ho Chi Minh City, the spectral CT system has brought significant advancements in the diagnosis of coronary artery disease. The post-processing applications of spectral CT that are used include: virtual monoenergetic images (MonoE), effective atomic number (Z-effective), iodine density map, iodine no water, virtual non-contrast images (VNC), and enhanced visualization of contrast-enhancing structures. The diverse types of images obtained from the spectral CT technique bring many benefits such as reducing the contrast media dose for patients and reducing artifacts to improve image quality, thereby helping to more accurately assess the degree of coronary stenosis. Iodine maps also help assess myocardial perfusion status, providing more comprehensive and accurate information about coronary artery disease. The use of VNC to calculate the calcium score as a replacement for true non-contrast (TNC) images is currently in the research phase at Thong Nhat Hospital with promising initial results, holding the promise of replacing TNC in CS assessment, thereby reducing the radiation dose for patients. This article aims to present the applications of spectral CT and actual clinical cases at Thong Nhat Hospital - Ho Chi Minh City to clarify the application of spectral CT in the evaluation of coronary artery disease.

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.

To survey the prevalence of cancer types, disease stages, and treatment methods in Department A1, Thong Nhat Hospital, from 2019 to 2023, and to evaluate initial cancer treatment outcomes. A cross-sectional descriptive study was conducted on 192 cancer patients admitted for inpatient and outpatient treatment in Department A1 from January 2019 to December 2023. Prostate cancer (29.2%) and colorectal cancer (22.4%) were the most common types. In terms of treatment, 68.2% of patients received two or more treatment modalities, with surgery and chemotherapy being the most frequently applied methods. The proportion of patients receiving late treatment (stage III-IV) was low (11.5%), with 52.6% of patients stable after treatment and a mortality rate of 20.8%. The study highlights the highest prevalence in prostate and colorectal cancer. Multimodal treatment plays a crucial role in stabilizing patients, with a low rate of late treatment and positive treatment outcomes.

To investigate the correlation between triglyceride, lipase, C-reactive protein (CRP), and white blood cell (WBC) levels in patients with acute pancreatitis (AP) upon hospital admission. A cross-sectional analytical study was conducted involving 222 patients admitted to Thong Nhat Hospital between January 2023 and March 2025. Data on triglyceride, lipase, CRP, WBC levels were collected at the time of admission. Among AP patients, 68% had elevated triglyceride levels. Specifically, 30% had moderately elevated triglycerides, while 28% had severely or very severely elevated levels. The distribution of study indicators was wide. A weak negative correlation was found between lipase - triglyceride levels, and between lipase and CRP levels (p < 0,001). No significant correlation was observed between lipase and WBC levels, or between WBC and triglyceride levels at the time of admission. At the time of admission, 28% of AP patients had severe or very severe hypertriglyceridemia. Lipase levels showed a weak negative correlation with triglyceride and CRP levels. These findings suggest that triglyceride levels may be a useful marker for assessing the severity of AP.

To determine the prevalence of coagulopathy in sepsis patients, clinical indicators according to the SOFA score, and laboratory indicators based on the SIC score at Thong Nhat Hospital. To investigate the correlation between the SIC score and disseminated intravascular coagulation (DIC). A cross-sectional descriptive study of sepsis patients aged 18 and older at Thong Nhat Hospital based on the Sepsis-3 criteria from November 2023 to July 2024. Among 106 sepsis patients, 69 (65.1%) were male, with an average age of 69.9 ± 17.1 years. The majority had hypertension (41.5%) and diabetes (26.4%), with infection sources primarily from the respiratory system (44.3%) and gastrointestinal tract (21.7%). The median SOFA score and SOFA (SIC score) were 5 (3 – 7) and 3 (2 – 5), respectively. Multiorgan dysfunction syndrome (MODS) was present in 54.7% of patients. The prevalence of coagulopathy in sepsis patients according to the SIC score was 49.1%. There was a statistically significant difference in the rate of coagulopathy between the multiorgan dysfunction syndrome group, those with thrombocytopenia < 150 G/L; INR > 1.2; aPTT > 37s; D-Dimer > 500ng/ml; total bilirubin > 21µmol/L; Hb < 10.5g/dL (p < 0.05). A positive correlation of r = 0.6 was found between the SIC score and the Overt-DIC score, significant with p < 0.05. Most sepsis patients are elderly with comorbidities. The rate of coagulopathy due to sepsis according to the SIC score is high and correlates with laboratory indicators such as thrombocytopenia, INR, aPTT, D-Dimer, total bilirubin, and Hb. There is a strong positive correlation with the DIC score.

Albuminuria is a key marker for early kidney damage and cardiovascular risk in patients with diabetes and hypertension, even when glomerular filtration rate (GFR) is preserved. However, data on the prevalence of albuminuria in Vietnamese populations remains limited. To assess the prevalence of albuminuria and its associated clinical factors in patients with type 2 diabetes and/or hypertension. This cross-sectional study included 209 patients at Thong Nhat Hospital, Ho Chi Minh City. Clinical characteristics, blood pressure control, and laboratory data including urinary albumin-to-creatinine ratio (UACR) were collected. Albuminuria was defined as UACR ≥30 mg/g, including microalbuminuria (30–299 mg/g) and macroalbuminuria (≥300 mg/g). Logistic regression was used to identify factors associated with albuminuria. The mean age was 68.04 ± 13.94 years, and 38.8% had type 2 diabetes. Overall, 27.7% of patients had albuminuria, including 16.7% with microalbuminuria and 11.0% with macroalbuminuria. Blood pressure was controlled in 58.7% of participants. Only 42.5% of diabetic patients achieved glycemic targets. Macroalbuminuria was significantly more common in patients with uncontrolled blood pressure (18.6% vs. 5.7%, p < 0.01). No significant associations were found between albuminuria and age, sex, or ASCVD. Albuminuria is prevalent in patients with diabetes and hypertension, particularly among those with uncontrolled blood pressure. These findings support routine screening for albuminuria and early initiation of renoprotective therapy to prevent renal and cardiovascular complications in high-risk Vietnamese populations.

Blood transfusion plays a crucial role in the treatment of various acute and chronic conditions, especially in elderly patients with comorbidities requiring transfusion interventions. Understanding the correlation between the demand for blood products and the disease patterns can help hospitals proactively develop plans for blood storage and distribution, optimizing treatment and minimizing the risks of shortages or delays.: To determine the correlation between the demand for blood products and the disease patterns in first-time blood transfusion patients at Thong Nhat Hospital in 2023. A retrospective cross-sectional study was conducted, analyzing the types and quantities of blood products from blood transfusion requests for 2,180 patients who underwent their first blood transfusion. The highest proportion of patients were diagnosed with anemia (25.83%), followed by gastrointestinal bleeding (19.68%) and cancer (12.52%). Red blood cell concentrates (RBC) were the most commonly used blood products, particularly for anemia (88.45%), gastrointestinal bleeding (93.24%), and cancer (93.04%) patients. Fresh frozen plasma (FFP) was predominantly used in gastrointestinal bleeding patients (4.90%), with a high average quantity (5.29 units per patient). Platelet concentrates (PC) were mainly used in anemia (9.24%) and cancer (5.86%) patients. All results demonstrated statistically significant differences in the demand for blood products based on disease type (p < 0.001). The demand for blood products is closely correlated with the disease patterns in first-time blood transfusion patients at Thong Nhat Hospital. Red blood cell concentrates are the primary blood product used in anemia, gastrointestinal bleeding, and cancer patients. The distribution of blood product usage reflects the disease characteristics of each group and serves as a critical basis for developing blood inventory and transfusion plans to ensure efficient and appropriate blood use in hospitals.

Survey compliance with the 1-hour sepsis bundle in patients with sepsis and septic shock at Thong Nhat hospital and analyze the relation between compliance with the 1-hour bundle and patient’s outcomes. A retrospective study was conducted on 55 patients admitted to the Emergency Department of Thong Nhat Hospital from January 2024 to July 2024. Patients were selected based on the diagnostic criteria for sepsis in Sepsis-3 definition with no prior treatment. Compliance with the 1-hour sepsis bundle was assessed, including blood culture collection, initiation of antibiotics, fluid resuscitation, lactate measurement, and vasopressor administration when needed. In 55 patients included in the study, male accounted for 50.1%; proportion of female was 49.1% with mean age was 79 ± 18.35. According ro the diagnosis of emergency doctors, there were 43/55 (78.2%) cases of sepsis and 12/55 (21.8%) cases of septic shock. The history of hypertension was the majority (65.5%) with the most common focus of infection being the respiratory tract (54.5%), urinary tract (30.9%), of which 14 cases had 2 or more foci of infection. Regarding compliance with the one-hour bundle in the care of patients with sepsis and septic shock, 35/55 (63.6%) completed the one-hour package and 25.4% did not complete it. Adherence to the one-hour bundle in primary analyses showed improved mortality in patients with sepsis and septic shock with OR = 5.07 (p < 0.05). Our study showed that proportion of one-hour bundle compliance had improved over time, with increasing clinical application. It also demonstrated the effectiveness and importance of adherence to the one-hour bundle in improving sepsis and septic shock patient survival.

Colonoscopy is an important procedure for diagnosing and treating lower gastrointestinal diseases. However, performing colonoscopy in very elderly patients poses many challenges, particularly in the quality of bowel preparation and the risk of complications. Objective: To describe the characteristics of colonoscopy in patients aged ≥ 80. Methods: A cross-sectional study was conducted on 254 patients aged ≥ 80 who underwent colonoscopy at Thong Nhat Hospital. Results: The mean age was 84,7 ± 3,16. No cases of perforation or bleeding related to colonoscopy were reported. 32,7% procedures were performed with sedation. The main reasons for incomplete colonoscopies were poor bowel preparation (52,6%) and intolerable pain (39,5%). Polyps were the most commonly detected lesions (48,6%), with the majority having ≥ 3 polyps and measuring <10mm. Notably, colorectal cancer was found in 6,7% of cases. Most polyps and colorectal cancers were located in the left colon. Conclusion: Colonoscopy in very elderly patients is safe, but the risks and benefits should be carefully weighed before performing the procedure.

Heart failure after acute myocardial infarction (MI) is a common complication and increases mortality. The factors influencing heart failure and the treatment outcomes of acute heart failure following acute MI remain unclear. This study aim to determining the prevalence, associated factors, and treatment outcomes of acute heart failure in patients with ST-elevation MI. A case series descriptive study was conducted on 110 patients with ST-elevation MI undergoing percutaneous coronary intervention at Long Khanh Regional General Hospital from June 2023 to June 2024. Results showed the prevalance of acute heart failure is 35%. Factors associated with acute heart failure after MI included: late hospital admission >12 hours (OR = 13.6; 95% CI: 1.8–100.8); double-vessel coronary artery disease (OR = 8.87; 95% CI: 1.0002–78.65), triple-vessel coronary artery disease (OR = 10.06; 95% CI: 1.11–90.77), and left main coronary artery disease (OR = 37.4; 95% CI: 1.8–763.2). Treatment outcomes included average hospital stay of 7.9 ± 5.2 days; the most frequently intervened coronary branch was the RCA; pre-intervention coronary flow was mostly TIMI 0, and post-intervention normal coronary flow was achieved in 86% of cases. Common complications were access-site hematoma, fever, and infection; in-hospital mortality rate was 7%; procedural success rate was 83.6%. These findings emphasize the importance of early identification of prognostic factors that can easily lead to acute heart failure after myocardial infarction, in order to improve approaches and patient outcomes

This study aims to evaluate the clinical characteristics of elderly patients, with particular attention to common clinical manifestations, comorbid conditions, and the length of hospital stay. In addition, it investigates laboratory parameters and examines the presence and strength of correlations among these variables within the study population. The study included 69 elderly patients presenting with abdominal pain who were admitted to the Geriatrics Department of Ngu Hanh Son Hospital. The groups were compared in terms of gender, history of abdominal pain, use of self-medication at home, clinical manifestations and associated comorbidities. There was 44.9% males and 55.1% females (p < 0.0001). With past history of gastric pain 52.2% (p < 0.0001). Health insurance covers 100%. Used medicament at home 39.1%. Admission <6h: 18.8%, 6–24h: 42.0%, >24h: 39.1% (p < 0.0001). Mean age: 72.38 ± 9.50 years. Mean hospital stay: 8.25 ± 3.38 days. Dull pain 50.7%, intermittent pain 49.3% (p < 0.0001). Most common pain location: Epigastrium: 69.6% (p < 0.0001). Symptoms: Vomiting (34.8%), diarrhea (34.8%). Hospital transfers 5.8%. Coexisting diseases from two to four: 85.5% (p < 0.0001). Leukocytosis (14.5%), anemia (42.9%), ECG abnormalities (69.5%), ECHO abnormalities in GI (23.2%) and urinary system (14.5%) (p < 0.0001). Weak positive correlation between age and length of stay (r = 0.17), and between age and admission time (r = 0.22). Moderate correlation between self-medication and delayed admission (r = 0.47) (p = 0.0001). Increase public health education, discourage unsupervised self-medication, and promote periodic health check-ups for elderly individuals to manage chronic non-communicable diseases.

To assess the level of stress and describe the coping strategies of health students at Tay Nguyen University. A cross-sectional descriptive study was conducted on 424 students of General Medicine, Bachelor of Nursing, and Bachelor of Medical Laboratory Technology at Tay Nguyen University. The stress rate among health students at Tay Nguyen University is 84.0%. Of these, mild stress accounts for 34.9%, moderate stress for 40.1%, and severe stress for 9.0%. Stressed students often use the coping strategy of "cognitive restructuring" with an average score of 2.22 ± 0.63, and "problem-solving" with an average score of 2.37 ± 0.64. The rate of stressed students is relatively high. The majority of students use active coping strategies. However, inappropriate strategies still exist, so it is necessary to provide timely support interventions to improve students' physical and mental health.

This systematic review aimed to identify an effective stationary cycling dosage for pain reduction in adults aged 60 years and older with knee osteoarthritis. The review was conducted according to PRISMA 2020 guidelines, searching PubMed, the Cochrane Library, and PEDro for randomized controlled trials reporting the dosage of stationary cycling interventions. The primary outcome was pain reduction, assessed using standardized scales such as KOOS, WOMAC, and AIMS2. Five studies involving 377 participants were included in the analysis. All 5 studies reported statistically significant pain reduction compared with baseline or control groups. The synthesized intervention dosage comprised a total duration of 8–24 weeks, a frequency of 3–7 sessions per week, a session length of 25–60 minutes, and an intensity ranging from 40–85% of maximum heart rate or 60–110 pedal revolutions per minute. No adverse events relating to the interventions were reported. However, all included studies were judged to be at high risk of bias, primarily due to the inability to blind participants and the use of self-reported scales. Stationary cycling is an effective intervention for pain reduction in older adults with knee osteoarthritis, but the application of training dose should be interpreted cautiously and individualized.

Acute myocardial infarction is a leading cause of mortality in the elderly; however, it may present with atypical clinical contexts that require early recognition for timely intervention. We report a unique case of a 77-year-old male with a history of chronic coronary artery disease (previous stenting) and type 2 diabetes mellitus, who developed grade III anaphylaxis following intravenous administration of cefuroxime. The patient was initially managed according to the anaphylactic shock protocol and subsequently transferred to a tertiary hospital in a hemodynamically stable condition, although persistent cutaneous allergic manifestations and dull chest pain were still present. This case illustrates a typical clinical presentation of Kounis syndrome type II (an allergic acute coronary syndrome in a patient with preexisting coronary artery disease), triggered by drug-induced anaphylaxis, and characterized by a biphasic course. In older adults, the diagnosis of Kounis syndrome is particularly challenging due to the high prevalence of underlying coronary artery disease, age-related immune alterations, and polypharmacy—factors that can themselves act as allergens. Furthermore, the elderly often exhibit atypical symptoms, complicating early recognition. Biphasic anaphylaxis, although rare, is a potentially life-threatening phenomenon, especially when superimposed on preexisting cardiovascular disease, as it may exacerbate myocardial ischemia or cause actual infarction.  Vigilant monitoring during the first 24 to 72 hours following the initial anaphylactic episode is essential to enable timely detection and management of potentially life-threatening cardiovascular complications.

Major adverse cardiovascular events (MACE) encompass serious complications that significantly impact the prognosis and quality of life in patients with acute myocardial infarction (AMI). Despite their clinical relevance, real-world data on short-term MACE in Vietnamese settings—particularly at Thong Nhat Hospital—remain limited. This study aims to determine the incidence of MACE during hospitalization and within 30 days post-admission among patients with AMI treated at Thong Nhat Hospital. A prospective cohort study was conducted on 259 patients diagnosed with AMI and admitted to the Emergency-Intervention Cardiology Department of Thong Nhat Hospital from October 2023 to June 2024. MACE was defined as a composite of all-cause mortality, cardiogenic shock, recurrent myocardial infarction, acute heart failure, and life-threatening ventricular arrhythmias. The in-hospital MACE rate was 26.64% (69/259), with acute heart failure being the most frequent event (16.22%), followed by cardiogenic shock (5.41%), all-cause mortality (4.63%), life-threatening ventricular arrhythmias (3.86%), and recurrent myocardial infarction (1.93%). At 30 days, the cumulative MACE rate increased to 33.59% (87/259), with acute heart failure continuing to predominate (23.17%). The short-term incidence of MACE in patients with AMI at Thong Nhat Hospital remains substantial, particularly due to acute heart failure. These findings underscore the need for early risk stratification, intensive monitoring, and optimized, multimodal management strategies during the acute phase to improve clinical outcomes and reduce cardiovascular complications.

Sheehan syndrome, characterized by pituitary necrosis secondary to postpartum hemorrhage, results in partial or complete hypopituitarism. Diagnosis is often delayed due to its nonspecific clinical manifestations; however, the condition can lead to life-threatening complications such as hyponatremia. We present the case of a 56-year-old woman admitted with symptomatic severe chronic hyponatremia, who was subsequently diagnosed with panhypopituitarism caused by Sheehan syndrome. The patient was successfully managed with hypertonic saline infusion and hormone replacement therapy (levothyroxine and hydrocortisone). This case emphasizes the importance of obtaining a thorough obstetric history and maintaining a high index of suspicion for Sheehan syndrome in middle-aged women presenting with unexplained hyponatremia.