Vol. 1 No. 3 (2025): Adapting to the trend of population aging and an aged population

Population aging is a global trend driven by rising life expectancy and declining birth rates, creating profound socio-economic impacts. Vietnam officially entered this stage in 2011 and is now facing one of the world’s fastest aging rates, projected to become an “aged society” by 2036. The country’s primary challenge is the risk of “getting old before getting rich,” as its demographic transition outpaces its national financial accumulation, placing immense pressure on multiple sectors. The healthcare system is unprepared for the surging demand from the elderly, who often suffer from multiple chronic diseases and have treatment costs 7-8 times higher than younger individuals. Vietnam currently lacks sufficient geriatric hospitals, nursing homes, and integrated healthcare models. In terms of social security, a staggering 73% of the elderly do not have a pension and must continue to work or rely on their children, while the pay-as-you-go (PAYG) social insurance system is threatened by demographic shifts. The labor market, despite being in its “golden population” period, is constrained by a low rate of trained labor and low productivity, which affects future financial accumulation capabilities. Simultaneously, traditional family support systems are weakening due to smaller family sizes and geographic dispersion. To adapt effectively, Vietnam needs a comprehensive reform strategy, including promoting sustainable economic growth , improving the labor market , and restructuring the healthcare system towards integrated care, geriatric network development, and long-term care models. Concurrently, developing a multi-pillar social security system is critical to expand coverage and ensure the well-being of the elderly.

Periprosthetic fractures around the knee are serious complications following total knee arthroplasty, commonly occurring in elderly patients with poor bone quality. The most frequent fracture site is the supracondylar region of the femur, followed by the tibia and patella. Causes may include low-energy trauma, suboptimal surgical technique, or implant loosening. Diagnosis and treatment of periprosthetic fractures around the knee are challenging due to interference from the implant and compromised bone quality. Treatment may be conservative in non-displaced fractures or surgical in cases of displacement, implant loosening, or comminuted fractures. Surgical options include locked plating, retrograde intramedullary nailing, or revision arthroplasty using long-stem components. Fracture classifications by Lewis-Rorabeck and Su are helpful in guiding management. Tibial and patellar periprosthetic fractures may also occur and require careful preoperative planning to avoid complications. Postoperative complications such as non-union, infection, or soft tissue injury are common when not properly managed. Prevention through patient screening, improved surgical technique, and close postoperative monitoring plays a critical role in reducing fracture incidence. Successful treatment requires a multidisciplinary approach involving orthopedic surgery, rehabilitation, and management of comorbidities.

The global population is aging rapidly, leading to an increase in the number of elderly individuals who are more vulnerable and require comprehensive healthcare services, including long-term care and skilled nursing facilities. In this context, aspiration pneumonia has become a significant concern due to its high incidence, mortality rate, and substantial financial burden, particularly among elderly patients requiring intensive care unit admission. Aspiration pneumonia is defined as a pulmonary infection resulting from the inhalation of food, liquid, saliva, or stomach contents into the lungs, often due to impaired swallowing or consciousness. Symptoms may include cough, fever, shortness of breath, chest pain, and fatigue . Risk factors include neurological disorders, impaired consciousness, advanced age, and conditions affecting swallowing. Diagnosis is based on clinical presentation, imaging studies such as chest X-rays or CT scans, and, if necessary, swallowing assessments. Treatment typically involves antibiotics, and in severe cases, may include oxygen therapy or mechanical ventilation . Preventive measures focus on managing risk factors, improving swallowing function, and maintaining oral hygiene. This article aims to provide information on aspiration pneumonia in the elderly, including its causes, symptoms, diagnosis, and treatment, to raise awareness and help reduce the incidence and mortality associated with this condition.

Objective: To evaluate the result of arthroscopic anterior cruciate ligament reconstruction with all inside technique in Orthopaedic department - Thong Nhat hospital. Subjects and research Methods: 186 patients with ACL ruptured have arthroscopic surgery in Thong Nhat hospital from 02/2021 to 06/2024, the prospective study. Results: All patients were monitored 1 month, 3 months, 6 months after surgery, evaluated on a Lyshome score, good and very good, reaching 17.75% after 1 month, 87.64% after 3 months. Conclusion: Arthroscopic ACL reconstruction with all inside technique is a new promising method with the advantage of small skin incision, no cavity fracture into bone, large size graft, and tension force.

Osteoporosis is a common complication in elderly patients with chronic kidney disease (CKD), particularly at fracture-prone sites such as the femoral neck. However, osteoporosis screening in this population remains insufficient in routine clinical practice, especially in Vietnam. This study aimed to determine the prevalence of osteoporosis and its associated factors in patients aged ≥70 years with CKD. A cross-sectional study was conducted on 76 patients aged ≥70 years with stage 3–5 CKD (including 47 predialysis and 29 maintenance hemodialysis patients) at Thong Nhat Hospital from September 2022 to June 2024. Clinical and laboratory data were collected, and bone mineral density (BMD) was measured using DXA at three sites: lumbar spine (LS), total hip (TH), and femoral neck (FN). Logistic regression was used to identify predictors of osteoporosis, with model accuracy evaluated by AUC. The overall prevalence of osteoporosis was 43.4%, highest at the femoral neck (40.8%). Mean BMD at the femoral neck (0.559 ± 0.147 g/cm²) was significantly lower than at the total hip (0.713 ± 0.168) and lumbar spine (0.901 ± 0.209; p < 0.001). Independent protective factors included male sex (OR = 0.082; p < 0.001) and higher BMI (OR = 0.670; p = 0.004). Maintenance hemodialysis was identified as an independent risk factor (OR = 4.368; p = 0.027). The predictive model incorporating these three variables achieved good accuracy (AUC = 0.89). Patients aged ≥70 years with CKD—particularly women, those with low BMI, and those on maintenance hemodialysis—are at high risk of osteoporosis, especially at the femoral neck. Routine BMD screening should be implemented for early detection and timely intervention.

To evaluate the clinical features, paraclinical findings, and treatment outcomes of giant cell tumor (GCT) of bone. Fifteen patients aged 20 to 40 years with bone lesions underwent surgery and histopathological examination and were diagnosed with “giant cell tumor of bone” between January 2011 and December 2024. There were 6 males and 9 females. The most common tumor location was the tibia (53.3%). The most frequent histological pattern was fibrosis, present in 11 cases (73.3%). The average follow-up duration was 55 months. Local recurrence occurred in 3 out of 15 cases, with no cases of metastasis. The GCT cases in our study shared pathological characteristics with classic GCT populations. No specific histological feature was associated with adverse outcomes. Curettage combined with bone cement filling proved to be an effective treatment option.

 Laparoscopic restoration of intestinal continuity after Hartmann’s procedure offers significant benefits but remains a considerable challenge for gastrointestinal surgeons. To evaluate the feasibility, safety, and efficacy of laparoscopic colostomy closure after Hartmann’s procedure at Thong Nhat Hospital. A retrospective descriptive analysis was conducted on 35 cases from February 2017 to May 2025. Patients who had undergone Hartmann’s procedure with an end colostomy and received laparoscopic intestinal continuity restoration were included. The laparoscopic success rate was 85.71%. Major complications included surgical site infection (30%), anastomotic leakage, and intestinal obstruction (3% each). The average operative time was 162 minutes, and the mean hospital stay was 9.3 days. There were no mortality cases. Laparoscopic reversal of Hartmann’s procedure is a feasible, safe, and effective method with a high success rate and low complication rate.

Cardiac surgery patients with elevated serum procalcitonin (PCT) levels are associated with postoperative complications. The use of extracorporeal circulation is linked to an increase in PCT levels within the first 24 hours after cardiac surgery. We conducted this study with the aim of investigating serum procalcitonin levels in patients after cardiac surgery. A cross-sectional, 52 cardiac surgery patients meeting the inclusion criteria for the study. The median serum PCT level was 3.2 pg/ml. The highest value was 175 pg/ml, and the lowest was 0.03 pg/ml. Serum procalcitonin levels between the group of cardiac surgery patients with and without the use of extracorporeal circulation were 20.7 (95% CI: 9.5-31.8) and 2.8 (0.03-5.7), respectively, p=0.15. The area under the ROC curve (AUC) of 0.42 indicates poor significance when relying on serum PCT to diagnose infection. Serum procalcitonin levels are elevated in patients after cardiac surgery. An elevated PCT value alone is not sufficient evidence to diagnose infection for clinical decision-making.

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.

Colorectal cancer is one of the most common malignancies with high incidence and mortality rates. KRAS and BRAF mutations play a crucial role in its pathogenesis and prognosis, but their association with clinical characteristics in Vietnam requires further investigation. To investigate the prevalence of KRAS and BRAF mutations in colorectal cancer patients and analyze their relationship with clinical, epidemiological, and disease-stage features. A retrospective descriptive study was conducted on 92 colorectal cancer patients diagnosed and treated at Thong Nhat Hospital from February 2020 to December 2024. Data included demographic characteristics, clinical symptoms, tumor location, disease stage, and genetic mutation test results. The median age of patients was 66, with a male/female ratio of 2.1. Common symptoms included abdominal pain (71.7%) and bloody stools (38%). The mutation rates were 35.9% for KRAS (predominantly G12D and G12V), 6.5% for BRAF, and no NRAS mutations were detected. KRAS and BRAF mutations showed no significant association with age, gender, clinical symptoms, or disease stage (p>0.05), but were linked to peripheral lymphadenopathy (p=0.035). KRAS and BRAF mutations are relatively common in colorectal cancer patients but are not strongly associated with clinical features or disease stage. Genetic testing remains essential for personalized diagnosis and treatment.

46 patients (patients) with proximal humerus fractures were operated on at Thong Nhat Hospital from January 2019 to April 2024. They were divided into 2 groups, group 1: 22 patients with the support of 3D printing models and group 2: 24 patients without 3D models. All patients were open reduction and internal fixation with a locking plate on the proximal humerus. The patients were evaluated for bone healing and deformity on X-ray, and shoulder function was assessed according to the Constant scale. Surgical time of group 1 (90.68 ± 13.029) was shorter than group 2 (105.25 ± 12.037). Mean blood loss of group 1 (164.55 ± 50.042) was less than group 2 (218.75 ± 28.789). Shoulder function were very good and good, accounting for a high rate of 82.6%, and there was no difference between the 2 groups. Postoperative complications had a low rate and there was no difference between the 2 groups in wound surface infection and subacromial conflict. Complications of screw perforation, osteomyelitis, and bone nonunion have not been observed.

Early vascular recanalization in acute ischemic stroke is an effective therapeutic strategy for neurological recovery; however, the outcome is influenced by various patient-related and baseline factors. To evaluate the effectiveness of recanalization therapy and investigate factors associated with neurological improvement in patients with acute ischemic stroke. A retrospective descriptive study was conducted on 186 acute ischemic stroke patients treated at Thong Nhat Hospital from January 2024 to March 2025. Clinical assessments (NIHSS, mRS), degree of recanalization (TICI), and associated factors were analyzed. The proportion of patients with NIHSS improvement ≥4 points was high in the thrombectomy-only and bridging therapy groups, at 80,7% and 90,3%, respectively. The highest rate of complete recanalization (TICI 3) was observed in the bridging therapy group (64,5%). The highest proportion of favorable functional outcome at discharge (mRS 0–2) was seen in the IV thrombolysis-only group (80,6%). Factors significantly associated with neurological improvement included: baseline mRS 0–2 (p=0,016), pre-intervention blood pressure (p<0,05), initial NIHSS score (p=0,004), pre-intervention blood glucose level (p=0,003), degree of recanalization (p=0,048), and hemorrhagic transformation (p=0,001). Combined intravenous thrombolysis and mechanical thrombectomy yielded the greatest neurological improvement. Multiple baseline factors are predictive of prognosis and should be thoroughly assessed prior to intervention.

To survey the characteristics of inguinal hernia and compare between the open and laparoscopic inguinal hernia surgery at Thong Nhat Hospital from April 2023 to April 2024. A restrospective study of 139 patients with laparoscopic and open inguinal hernia surgery in Thong Nhat hospital during the study period. Of 139 included patients, 97.8% were men, and the median (IQR) age was 60 (20-88) years. Compared between open and laparoscopic repair was associated with a nonsignificant duration of hospitalization. Most of patient lived in Ho Chi Minh City. We performed 72.66% open surgery. The majority of patients with unilateral inguinal hernias were treated with open surgery (80.34%) and bilateral inguinal hernias were treated with laparoscopic surgery (68.18%). The average duration of hospitalization for patients undergoing inguinal hernia surgery was 7.99±3.6 days. Most of patients has lived in Ho Chi Minh city. Duration of hospitalization was similar for the laparoscopic and open general anesthesia groups. Individualisation treatment with laparoscopic or open repair for patients and the decision should be made considering both patient and surgeon factors.

Evaluate the clinical efficacy of silver-containing antimicrobial dressings on superficial burn wounds. A prospective study involving 32 patients treated for thermal burns at the Trauma and Orthopedic Surgery Department of Thong Nhat Hospital. The patients were dressed with silver-containing antimicrobial bandages, and clinical efficacy was assessed based on the local wound progression. The dressing adhered well to the wound, was easy to change, and caused minimal pain and bleeding during dressing changes. The average treatment duration was 11.2 ± 5.8 days. Only 9.4% of patients experienced wound infection. Silver-containing antimicrobial dressings are effective in the clinical management of superficial thermal burn wounds.

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.

This study was conducted to analyze drug expenditure in treatment at Thống Nhất Hospital in 2024. A retrospective cross-sectional descriptive study analyzing drug usage costs in treatment at Thống Nhất Hospital in 2024. In 2024, Thống Nhất Hospital provided medical examination and treatment services to 650,000 health insurance patients, with over 595,000 outpatient visits, accounting for 90.63%. The total drug expenditure was VND 490.89 billion, representing 36.98% of the total health insurance medical examination and treatment costs. Western medicines accounted for 97.32% of the drug costs, while herbal and traditional medicines made up 2.86%. Imported drugs constituted 76.2% of the total drug expenditure. Original brand-name drugs, Group 1, and Group 2 drugs were the highest-cost categories, accounting for 38.63%, 25.59%, and 13.11% respectively. Cardiovascular drugs and those affecting the endocrine system and hormones were the most utilized, comprising 35.61% and 22.0% respectively. According to the ABC/VEN analysis, essential drugs classified as ‘E’ were the most used in terms of both quantity and cost, accounting for 58.55% and 75.51% respectively. Drug groups such as AV, AE, AN, BV, and CV represented 84.72% of the total drug expenditure. The CN group accounted for only 0.87% of the total drug expenditure in 2024. The study results indicate that the drug formulary used at Thống Nhất Hospital in 2024 aligns with the hospital’s disease patterns. The diverse and comprehensive drug list meets the treatment needs of patients.

The survey aimed to evaluate and improve the performance of testing methods of 10 biochemistry assays on AU5800 (Beckman Coulter) and cobas c503 (Roche Diagnostics) by Sigma metrics. Cross-sectional study. Ten biochemistry assays: glucose, urea, creatinine (Jaffe), cholesterol, triglycerides, AST, GGT, uric acid, HDL-Cho, total bilirubin. Collect internal and external inspection data on 2 devices under the same laboratory conditions, same test materials, at the same time from January to March 2024, calculate Sigma value. Evaluate performance and take improvement action on low-performing tests. On the AU5800 analyzer, 5 out of 10 tests (urea, creatinine, cholesterol, HDL-cholesterol, and total bilirubin) had Sigma values less than 3; 2 out of 10 tests (glucose and AST) had Sigma values between 3 and 6; and 3 out of 10 tests (triglycerides, GGT, and uric acid) had Sigma values greater than 6. On the Cobas c503 analyzer, 1 out of 10 tests (creatinine) had a Sigma value less than 3; 4 out of 10 tests (urea, cholesterol, AST, and total bilirubin) had Sigma values between 3 and 6; and 5 out of 10 tests (glucose, triglycerides, GGT, uric acid, and HDL-cholesterol) had Sigma values greater than 6. The tests with “acceptable to excellent” performance accounted for 50% on the AU5800 analyzer and 90% on the Cobas c503. The creatinine test (Jaffe method) showed “not good” performance on both systems. After improvement by switching to the enzymatic method on the c503 system, its performance changed from “not good” to “excellent.” On the AU5800 system, the performance of the creatinine (Jaffe) test improved from “not good” to “good".

Appendiceal cancer is a rare condition, often diagnosed late due to nonspecific symptoms. We report a case of appendiceal cancer invading the abdominal wall to evaluate the effectiveness of laparoscopic surgery and a multimodal treatment strategy. A 60-year-old male patient was admitted with persistent right iliac fossa pain for 2 months and a 3kg weight loss. Imaging confirmed an 6x8cm appendiceal tumor invading the abdominal wall and cecum, causing partial bowel obstruction. The patient underwent laparoscopic right hemicolectomy with D2 lymphadenectomy. Pathology confirmed moderately differentiated adenocarcinoma with metastases to 12/17 lymph nodes and peritoneal fluid (stage IVB). Postoperative recovery was uneventful, and the patient was discharged on day 7 with adjuvant chemotherapy scheduled. After 3 weeks of follow-up, the patient remained stable. This case highlights the importance of early diagnosis and radical surgery, combined with adjuvant therapy, in improving outcomes for patients with advanced-stage appendiceal cancer.

Retroperitoneal liposarcoma is a rare condition, accounting for approximately 15% of adult soft tissue tumors and has a high recurrence rate. We report a case of recurrent retroperitoneal tumor to evaluate and review treatment approaches. We report a case of a 45-year-old female with a history of surgical resection of a large pelvic retroperitoneal liposarcoma (23x12cm) in 2020, which was well-differentiated (Grade I) but had tumor cells in an ovarian cyst (Stage IIIB). After 3 years of follow-up, the patient was found to have a tumor recurrence at the lower pole of the right kidney measuring 37x38mm on CT scan. The patient underwent complete surgical resection of the recurrent tumor with negative margins (R0), and pathology confirmed well-differentiated liposarcoma (Grade I). After 9 months of followup, no recurrence has been detected. This case emphasizes the importance of regular postoperative follow-up, which helps detect early recurrence when tumors are still small, increases the possibility of complete treatment, and improves patient prognosis.

Abdominal wall aggressive fibromatosis (Desmoid tumor) is a rare, locally invasive tumor with a high recurrence rate. This study reports a case of surgical resection of a large tumor and multi-material abdominal wall reconstruction, evaluating functional and aesthetic outcomes. A 29-year-old male presented with a 10x15cm abdominal wall mass, diagnosed as Desmoid tumor via biopsy. The patient underwent complete tumor resection, resulting in a significant abdominal defect. Reconstruction was performed using a combination of intraperitoneal onlay mesh (IPOM), rectus abdominis muscle flap, and fascia flap. Pathology confirmed R0 resection. The patient was discharged on day 7 without major complications. At 1-year follow-up, results showed excellent aesthetic and functional recovery with no recurrence. Surgical resection of Desmoid tumors combined with multi-material abdominal wall reconstruction is a feasible approach, ensuring long-term functional and aesthetic success. This case highlights the importance of selecting appropriate reconstruction techniques for large post-resection defects.

Pheochromocytoma is a rare endocrine cause of secondary hypertension. The definitive diagnosis requires a combination of biochemical testing and imaging studies. Management of pheochromocytoma-induced hypertension involves appropriate pharmacologic therapy followed by surgical resection of the adrenal tumor. In this report, we present the case of an elderly patient who was admitted with chest pain and initially diagnosed with acute coronary syndrome. However, invasive coronary angiography revealed no significant stenosis. Subsequent investigations confirmed the diagnosis of pheochromocytoma. The patient underwent successful medical stabilization and surgical removal of the tumor. This case highlights the importance of multidisciplinary collaboration in the diagnosis and treatment of pheochromocytoma at Thong Nhat Hospital.

Femoral hernia is a rare type of hernia with a high risk of complications, commonly seen in elderly women and often mistaken for other groin pathologies. Imaging, particularly computed tomography (CT), plays a crucial role in detecting and differentiating femoral hernias from inguinal hernias and other groin conditions. Key CT imaging findings distinguishing femoral hernias from inguinal hernia are the location of the hernia sac lateral to the pubic tubercle and associated compression of the ipsilateral femoral vein. Additionally, CT can help detect complications of femoral hernias such as incarceration, bowel obstruction, or bowel ischemia, thereby guiding timely and effective management. The presented clinical case clearly illustrates the important role of CT in diagnosing this uncommon type of abdominal wall hernia.