Vol. 1 No. 2 (2025): Aging Population and Healthcare Challenges

Population aging is an inevitable global trend, driven by increased life expectancy and a prolonged decline in the total fertility rate (TFR) below replacement level. This article analyzes the current situation and underlying causes of persistently low fertility in high-income countries and in Vietnam. It points out that once the TFR drops below 2.1 for several decades, almost no country has succeeded in restoring replacement-level fertility, despite implementing numerous supportive policies at great cost. Through the analysis of demographic, economic, and social data from over 40 countries, combined with typical surveys conducted in Ho Chi Minh City and Japan, the author identifies five root causes of fertility decline. Based on these insights, a comprehensive system of solutions is proposed to shift from unsustainable to sustainable aging. Key measures include: ensuring a living wage for a family of four; reforming the social insurance system; expanding public housing and preschool education; promoting gender equality; preserving Vietnamese cultural traditions that value family life; educating citizens on knowledge and skills for building happy families; raising awareness of civic responsibility; and creating a social environment that is friendly to women and children.The article emphasizes that without decisive policy changes during the 2025–2050 period, Vietnam’s population could shrink from a peak of 107 million in 2050 to just 88 million by 2100, with further severe decline thereafter. Conversely, if strategic solutions are comprehensively implemented, Vietnam can fully achieve the goal: happy elderly, a prosperous nation, and a thriving people.

Periprosthetic fractures of the hip are serious complications following total hip arthroplasty, particularly affecting elderly patients, those with osteoporosis, or individuals with a history of revision surgeries. These fractures may occur intraoperatively or postoperatively, involving the femoral shaft (classified as Vancouver A, B, or C) or the acetabulum (Paprosky classification). Acetabular fractures are less common than femoral fractures. The mechanisms of fracture involve both biological factors (such as stress risers, implant loosening, and poor bone quality) and external forces (such as falls, torsional, and bending loads). Identified risk factors include advanced age, female gender, osteoporosis, implant loosening, use of cementless femoral stems, rheumatoid arthritis, and multiple revision surgeries. Studies have reported the incidence of periprosthetic fractures after primary hip replacement ranging from 0.8% to 4.5%, with higher rates observed following revision procedures. Diagnosis relies on both clinical and paraclinical assessments, with plain radiographs and computed tomography (CT) being the primary tools to evaluate implant stability, bone loss, and to guide treatment planning. Treatment depends on the type of fracture and the stability of the prosthesis. Stable Vancouver A fractures may be managed conservatively; Vancouver B1 fractures often require internal fixation with plates and screws; B2 and B3 fractures typically necessitate revision with a long-stem prosthesis and bone grafting if needed. Nondisplaced acetabular fissure fractures may be treated conservatively, but displaced or unstable fractures require surgical reconstruction using plates, screws, bone grafts, or specialized acetabular components. Prognosis is influenced by patient age, the severity of osteoporosis, prosthesis stability, and the number of prior surgeries. The mortality rate following periprosthetic hip fractures ranges from 7% to 18% within the first year postoperatively. Prevention, thorough risk assessment, and appropriate treatment strategies play crucial roles in improving clinical outcomes.

Non Small Cell Lung Cancer (NSCLC) is the second most common cancer in both sex but it is still the leading cause of cancer death. Most of NSCLN appear in the late stage so the prognosis is very poor. Although, the patient in early stage NSCLC who underwent standard lobectomy but the recurrent rate is still so high. Adjuvant therapy after standard surgical therapy gives the patient better overall survival (OS) and disease Free Survival (DFS). Recent advances in diagnosis and treatment for NSCLC show the benefit of adjuvant therapy with TKI or Immunotherapy for selected NSCLC patients.

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.

We conducted this study to investigate the etiology and histopathological characteristics of kidney diseases in elderly patients undergoing kidney biopsy at Thong Nhat Hospital. This cross-sectional, retrospective study included all patients who underwent kidney biopsy at Thong Nhat Hospital from the period between May 2012 and May 2022, excluding cases with (1) inadequate samples for pathological analysis, (2) repeated biopsies and (3) incomplete medical records. The results showed that steroid-resistant nephrotic syndrome was the leading indication for kidney biopsy in the elderly (64%). Primary glomerular diseases were the leading cause of kidney diseases, with focal segmental glomerulosclerosis and membranous nephropathy being the commonest types, accounting for 32,5% and 19,4%, respectively. In contrast, minimal change disease and IgA nephropathy were less common than in younger patients. Additionally, diabetic nephropathy and tubulointerstitial lesions appeared more frequently in the elderly group. Our study revealed that the histopathological features of kidney diseases in elderly patients differ significantly from those in younger patients, with a higher prevalence of focal segmental glomerulosclerosis and membranous nephropathy. Therefore, early and accurate recognition of these features is crucial for precise diagnosis, prognosis, and appropriate treatment of kidney diseases in the elderly.

Open tibial shaft fractures are common injuries, accounting for the highest proportion of open long bone fractures. External fixation, particularly the FESSA frame, is highly valued for its safety, ease of application, and convenience in soft tissue wound care. To evaluate the outcomes of treating open tibial shaft fractures using the FESSA external fixation system at Thong Nhat Hospital. A retrospective cross-sectional study was conducted on 53 patients with open tibial shaft fractures treated with the FESSA frame. Bone healing was assessed using the RUST scoring system, and functional recovery was evaluated using the Karlström-Olerud criteria. The bone union rate was 92.3%, with an average healing time of 6.75 ± 3.44 months. Good and excellent functional recovery outcomes accounted for 87.5%. The FESSA external fixation system is an effective method for managing open tibial shaft fractures.

Laparoscopic surgery (LS) is increasingly applied in the placement and salvage of Tenckhoff catheters for peritoneal dialysis in end-stage chronic kidney disease (ESKD). This study aims to evaluate the preliminary efficacy and safety of this technique. A retrospective descriptive study was conducted on 27 patients who underwent laparoscopic Tenckhoff catheter placement or salvage at Thong Nhat Hospital from January 2022 to October 2024. There were 17 new catheter placements (60.71%) and 11 salvages (39.29%). The mean age was 56 ± 17 years, and the average operative time was 60.59 ± 17.09 minutes. In the placement group, 29.41% underwent omentectomy, 17.64% received omentopexy, and 58.82% had catheter fixation to the abdominal wall. Reported complications included poor outflow and abdominal wall hernia (11.76%), and infection (5.88%). In the salvage group, 81.82% had catheter migration due to the omentum, with 54.55% requiring omentectomy and 18.18% undergoing omentopexy; all patients had catheter fixation. Complications included poor outflow and hernia (9.09%), with no infections or catheter removals observed within 3 months. Catheter function was well maintained postoperatively. Laparoscopic surgery is a safe and effective method for Tenckhoff catheter placement and salvage, supporting longterm catheter function and reducing risks of infection and obstruction. It is a viable option for renal replacement therapy with peritoneal dialysis in ESKD patients.

Diabetes mellitus remains a major risk for lower extremity artery disease. The ankle-brachial index (ABI) is a noninvasive technique for assessing the lower extremity artery disease. To estimate the ABI in older patients with diabetes mellitus. This case series study was conducted on the older patients with diabetes mellitus from 01/12/2021 to 31/05/2022 at Department of Cardiology in Thong Nhat Hospital. This study included 100 patients aged ≥ 60 years (mean age 72.5 ± 8,1years; male 54.0%). 71.0% of patients had diabetes mellitus with duration of diagnosis more than 5 years and 21,0% of patients has been being treated with insulin. The rates of comorbidities: hypertension (94,0%), dyslipidemia (62,0%), coronary artery disease (21,0%), history of ischemic stroke (3,0%), and heart failure (18,0%). There was 22 patients having claudication. The rates of ABI: ≤ 0.9: 27.0% and 1-1.4: 73.0%. No patient in our study had ABI higher than 1.4. In our study, 27.0% of diabetic patients had ABI of  ≤ 0.9 and 22.0% of patients had claudication.

Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency requiring early risk stratification to improve prognosis. This study aimed to evaluate the value of the Glasgow-Blatchford Score (GBS) in prognosticating patients with NVUGIB. This prospective, descriptive study included patients diagnosed with NVUGIB admitted to the Emergency Department of Thong Nhat Hospital from January 2020 to July 2020. Among 122 patients (73.0% male, mean age 63 years), 45.9% required medical intervention (MI), 5.7% experienced re-bleeding, and 2.5% died. The mean GBS was 9. The GBS (AUC=0.828) showed better prognostic value for MI than the clinical Rockall score (AUC=0.650). With a cut-off score of ≥10, the GBS had a sensitivity of 0.68 and a specificity of 0.88 in predicting the need for MI. Most patients with NVUGIB were elderly. The GBS is a valuable tool for prognosticating the need for medical intervention in this patient group.

Bowel obstruction due to colorectal cancer is a common emergency complication, especially in elderly patients with multiple comorbidities, requiring optimal surgical treatment decisions to improve clinical outcomes.To evaluate the effectiveness of one-stage right hemicolectomy with primary anastomosis in the management of bowel obstruction due to colon cancer at Thong Nhat Hospital. A retrospective and prospective descriptive case series study was conducted on 48 patients with bowel obstruction due to right-sided colon cancer who underwent one-stage right hemicolectomy with primary anastomosis at Thong Nhat Hospital from January 2019 to December 2024. Evaluation parameters included clinical characteristics, surgical methods, complications, and early treatment outcomes. The mean age of patients was 62.3 ± 13.2 years, with males accounting for 58.7%. Laparoscopic surgery was performed in 17 cases (35.4%) and open surgery in 31 cases (64.6%). The overall early complication rate was 16.7%, with the laparoscopic group showing a lower rate than the open surgery group (5.9% vs 22.6%). Mean hospital stay in the laparoscopic group was significantly shorter than the open surgery group (7.8 ± 2.4 vs 10.2 ± 3.5 days). The anastomotic leak rate was 2.1% and mortality rate was 2.1%. One-stage right hemicolectomy with primary anastomosis is a safe and effective method for treating bowel obstruction due to colon cancer. Laparoscopic surgery showed better outcomes regarding recovery time and reduced complications compared to open surgery.

Evaluation of the analgesic effect of low-power intravascular laser combined with electroacupuncture compared to electroacupuncture alone in patients with chronic low back pain treated at the Traditional Medicine Department of Thong Nhat Hospital. 60 patients with confirmed diagnosis of chronic back pain at the Department of Traditional Medicine, Thong Nhat Hospital. Patients were randomly divided into 2 groups. The control group (n=30) was treated with electroacupuncture; the intervention group (n=30) was treated with low-power intravascular laser combined with electroacupuncture similar to the control group. The treatment course was continuous for 10 days, once a day. Treatment effectiveness was assessed based on the VAS pain scale assessed after 5 and 10 days of treatment. After 10 days of treatment, the VAS pain score was 2,42 ± 1,67 in the control group and 1,57 ± 1,48 in the intervention group. Both groups experienced a reduction in pain to the levels of no pain (0–2 points) or mild pain (2–4 points). The intervention group demonstrated superior pain relief starting from day 5, reaching statistical significance by day 10 (p = 0.03 < 0.05). Combining electroacupuncture with intravascular low-level laser therapy  enhance effeciency in relive pain due to lumbago. No significant side effects were noted.

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 evaluate arterial blood gas test results in patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD). Cross-sectional descriptive study, evaluating blood gas results on 150 patients diagnosed with AECOPD, inpatient treatment at the Respiratory Department in Thong Nhat Hospital from January 2023 - March 2024.  The majority of patients (80%) have decreased PaO2 and 60% of patients have increased PaCO2. The average value of some blood gas indicators: pH 7.37 ± 0.08, PaO2 61.2 ± 10.5, PaCO2 48.3 ± 8.2, HCO3- 27.1 ± 3.4. There were 126 patients with COPD exacerbated hospitalization (84%) with respiratory failure manifested in arterial blood gas Respiratory failure characteristics according to arterial blood test in the study were mainly increased PaCO2 accounting for 30%, in patients with mixed respiratory failure had 26% and reduced respiratory depression PaO2 had 32%.  Arterial blood gas is a significant test for diagnosis the respiratory failure and discovered acid- base disorders.

Hospital-acquired infections (HAIs) are a major challenge, especially in intensive care units (ICUs), where they lead to increased morbidity, mortality, prolonged stays, and higher healthcare costs. This study aimed to determine HAI rates, identify causative microorganisms, and assess associated risk factors among inpatients at Thong Nhat Hospital's ICU in 2024. A cross-sectional analysis was conducted from January to June 2024, including all eligible ICU inpatients. Data collection utilized medical records. The prevalence of HAIs was 4.9%, with the most common types being hospital-acquired pneumonia, bloodstream infections, and urinary tract infections. The primary causative agents were Gram-negative bacteria such as Acinetobacter baumannii and Pseudomonas aeruginosa. Factors associated with HAIs included age, underlying medical conditions, duration of endotracheal intubation, tracheostomy, duration of tracheostomy, urinary catheterization, duration of urinary catheter use, duration of central venous catheter use, duration of nasogastric tube placement, and length of stay in the. The HAI rate was 4.9%. Factors associated with HAIs included age, comorbidities, invasive procedures, and length of ICU-PCU stay. Strengthening infection control measures is essential to reduce HAIs and improve patient outcomes.

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.

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.

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.

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.

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality and disability worldwide. Among elderly patients, COPD not only reduces quality of life but also places a significant burden on healthcare systems. Chronic inflammation plays a key role in the pathogenesis of COPD. In recent years, peripheral blood inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) have gained attention as useful tools for assessing inflammation and predicting disease prognosis. However, in Vietnam, especially among elderly patients- research on the role of NLR in monitoring and managing COPD remains limited. Therefore, we conducted the study titled: “Investigation of Neutrophil-to-Lymphocyte Ratio in Elderly Patients with Chronic Obstructive Pulmonary Disease at Thong Nhat Hospital”. To determine the NLR levels in elderly patients with COPD and evaluate the relationship between NLR and disease severity. Additionally, to compare NLR values across different patient subgroups based on factors such as age, gender, BMI, medication usage, comorbidities, and to investigate the correlation between NLR and the inflammatory marker               CRP. Sectional descriptive study conducted on elderly COPD patients visiting the respiratory outpatient clinic at Thong Nhat Hospital. From January 2025 to May 2025, we collected data from 221 elderly COPD patients. The mean age was 71 (65-77) years, Males accounted for a higher proportion than females. The mean NLR was 3,3 (2,2 – 6,2), CRP (mg/L)  4,3 (2,6 - 9,5), NLR showed a weak but statistically significant negative correlation with FEV1 (r = -0.147, p < 0,029) and a statistically significant positive correlation with CRP (r = 0,5012, p < 0,0001). Our study demonstrates that NLR is weakly but significantly inversely correlated with pulmonary function (FEV1), and positively correlated with CRP levels, indicating its potential role in assessing disease severity and inflammatory status.

This study investigates the distribution of pathogenic microorganisms and their antibiotic resistance status in bloodstream infections at Thong Nhat Hospital from April 30, 2024, to May 1, 2025. Retrospective, cross-sectional descriptive study conducted on 770 microbial isolates obtained from blood samples from April 30, 2024, to May 1, 2025, at Thong Nhat Hospital. Among the total 770 isolated strains, bacteria accounted for 97.27%, and fungi accounted for 2.73%. The common pathogens included Coagulase-negative Staphylococci (30.44%), Escherichia coli (21.23%), Staphylococcus aureus (8.54%), Klebsiella pneumoniae (7.34%), and Pseudomonas aeruginosa (2.94%). E. coli showed >80% susceptibility to amikacin and piperacillin/tazobactam and >97% susceptibility to carbapenems. K. pneumoniae demonstrated resistance rates of 30.2% to imipenem, 31,3% to meropenem, and 25.5% to ertapenem. P. aeruginosa resistance rates were 50% to imipenem and 40.9% to meropenem. S. aureus exhibited high resistance to benzylpenicillin (96.6%), erythromycin (75.9%), and clindamycin (67.2%) but remained 100% susceptible to vancomycin, linezolid, teicoplanin, and tigecycline. The MRSA rate was 62.5%. Candida spp. remained susceptible to commonly used antifungal agents. Bacteria are the primary cause of bloodstream infections. Multidrug-resistant strains such as P. aeruginosa, K. pneumoniae, and MRSA account for a significant proportion. Continuous monitoring of resistance patterns supports clinicians in selecting appropriate antibiotics, thereby reducing mortality and treatment costs.