Vol. 2 No. 6 (2026): Thách thức trong lão khoa 2026: Những giải pháp điều trị và chăm sóc toàn diện

Most epidemiological and observational clinical studies in Vietnam are conducted on hospitalized patients, frequently lacking a control group. Despite their practicality and data accessibility, these studies are often utilized to address questions that exceed the inferential capacity of their design. In this article, I analyze the methodological limitations of hospital-based epidemiological research, particularly in the absence of a control group, within the context of medical research in Vietnam. Drawing on conceptual analysis and epidemiological principles, the article discusses common sources of bias in hospital-based studies, including selection bias, collider bias, the lack of control groups, and the regression toward the mean phenomenon. Inpatients represent a highly selected population, influenced not only by disease severity but also by healthcare accessibility, referral pathways, and socio-economic factors. Conditioning the analysis on a hospitalized group can distort the association between exposure and disease, creating spurious correlations or masking true causal relationships. Without a control group, observed associations are easily misinterpreted as population-level risk factors. Furthermore, before-after studies in hospitals are susceptible to regression toward the mean, leading to inaccurate evaluations of intervention efficacy. Prognostic models developed from inpatient data may perform well in training environments but often fail to generalize to broader settings. While hospital-based research remains vital for describing severe illness, inpatient prognosis, and evaluating care processes, its inferential scope is inherently limited. Clearly identifying these methodological boundaries and anchoring interpretations to sampling conditions is essential to avoid biased conclusions and to enhance the quality of medical research in Vietnam.

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.

Impaired balance in older adults can directly lead to falls, leading to injuries, reduced quality of life, and increased dependence in daily activities. To diversify neuromotor exercises, evidence on the effectiveness of Taekwondo has been reviewed. Searches using relevant keywords reported that Taekwondo significantly improves both static and dynamic balance measures in individuals over 65 years old. Additionally, the findings suggest that Taekwondo may enhance exercise adherence among participants. These results support the potential of Taekwondo as a exercise to improve balance for older adults, although further high-quality evidence is needed.

Osteoporotic vertebral compression fractures are a major cause of back pain and reduced spinal function in elderly patients. To evaluate the pain-relieving effectiveness of vertebroplasty in patients with osteoporotic vertebral compression fractures. A prospective study was conducted on 26 patients, assessing VAS, Macnab, and ODI scores before and after cement vertebroplasty, analyzed according to the number of fractured vertebrae. VAS scores significantly decreased from 4.85 ± 0.61 to 1.81 ± 0.49 after the procedure (p < 0.001). Macnab and ODI scores also improved markedly, with pain relief observed even in patients with multiple fractured vertebrae. Vertebroplasty is a minimally invasive procedure that effectively reduces pain and improves spinal function in patients with one or multiple osteoporotic vertebral fractures.

Autologous Platelet-Rich Plasma (PRP) is an increasingly popular biological therapy in sports medicine and rehabilitation, particularly for periarticular soft tissue pathologies of the shoulder. To evaluate the clinical efficacy of autologous PRP in treating simple shoulder periarthritis over a 4-month follow-up period and to analyze factors associated with treatment outcomes. Methods: A longitudinal clinical intervention study was conducted on 30 patients diagnosed with simple shoulder periarthritis. After 4 months, the mean Visual Analogue Scale (VAS) score significantly decreased from 5.6 to 2.6, accompanied by improvements in ultrasonographic findings. Greater pain reduction was observed in younger patients. Adverse effects were primarily limited to mild, self-limiting injection-site pain resolving within 3 days. Autologous PRP is a safe and effective treatment for shoulder periarthritis, especially in younger populations.

To evaluate the safety and mid-term outcomes of laparoscopic right hemicolectomy in elderly patients (≥65 years old). A retrospective descriptive study was conducted on 52 patients aged ≥65 years who underwent laparoscopic radical right hemicolectomy with lymph node dissection at Thong Nhat Hospital from 01/2020 to 01/2025. Data analysis was performed using SPSS software version 25.0. The early complication rate was 15.4%, and the 30-day mortality rate was 1.9%. The median number of harvested lymph nodes was 13.2 (92.3% of patients had ≥12 nodes). The 36-month disease-free survival (DFS) and overall survival (OS) rates were 62.5% and 68.9%, respectively. Only 55.6% of indicated patients completed the adjuvant chemotherapy regimen. Laparoscopic right hemicolectomy is a safe, feasible, and oncologically sound procedure for elderly patients. The mid-term survival outcomes were impacted by a low adjuvant chemotherapy completion rate.

Chronic subdural hematoma (CSDH) is a common condition in the elderly, often associated with a prior history of trauma and progressively worsening symptoms if not diagnosed and treated promptly. This study aims to describe the clinical characteristics, imaging findings, and surgical outcomes of patients with CSDH treated at Long Khanh Regional General Hospital from 2021 to 2024; A total of 34 patients diagnosed with CSDH underwent single-burr-hole surgical drainage between January 2021 and September 2024. The mean patient age was 68.4 ± 16.9 years, with males accounting for 88.2%. Trauma was the primary cause (52.9%), including falls in 29.4% of cases. Motor weakness was the most common symptom (64.7%), followed by headache (55.8%), altered consciousness (23.5%), and aphasia (20.6%). Most patients presented with mild traumatic brain injury (GCS 13–15, 76.5%), while coma was recorded in 8.8%. CT imaging showed a mean hematoma thickness of 21.1 ± 6.3 mm and a mean midline shift of 9.4 ± 4.8 mm; unilateral CSDH was observed in 70.6% of cases. All patients underwent single-burr-hole surgery. Postoperatively, 88.2% achieved a GCS of 15. There were no cases of infection or intraoperative bleeding. Recurrence occurred in four patients, including one requiring reoperation after three weeks; the mortality rate was 2.9%. The average hospital stay was 10.7 ± 5.4 days. At discharge, 73.5% of patients had good outcomes, and 73.5% returned to normal life within one month. In conclusion, single-burr-hole drainage for chronic subdural hematoma is effective, safe, and associated with favorable outcomes, low complication rates, and good functional recovery in most patients.

To evaluate the effectiveness of early mobilization on patients after gastrointestinal surgery. This is a cross-sectional study observed on 78 patients who underwent gastrointestinal tumor surgery at the Department of Gastrointestinal Surgery, Thong Nhat Hospital, from October 2024 to June 2025. We collected and analyzed data on age, sex, time to first flatus, Visual Analog Scale (VAS) pain scores, Timed Up and Go test performance, postoperative complications, and time to discharge. Physiotherapy was typically initiated two days postoperatively and combined respiratory with mobility training. Patients who achieved early mobilisation demonstrated earlier return of bowel function, shorter hospital stay, lower VAS pain scores, and better functional mobility as indicated by shorter Timed Up and Go test durations at postoperative days 1, 3, and 7 compared with those without early mobilization. The study demonstrated that the early mobilization group had an earlier time to first flatus, shorter length of hospital stay, lower pain levels, and better functional mobility compared with the non-early mobilization group.

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.

The treatment of community-acquired pneumonia (CAP) has become increasingly challenging due to the growing antimicrobial resistance among bacterial pathogens. Rational antibiotic use is a key determinant of treatment effectiveness in patients with CAP. To investigate antimicrobial resistance patterns and antibiotic utilization in the treatment of communityacquired pneumonia at Hoc Mon Regional General Hospital. A descriptive cross-sectional study was conducted using 270 medical records of hospitalized patients diagnosed with communityacquired pneumonia at Hoc Mon Regional General Hospital from July 2024 to September 2024. The median age of patients was 69 years (interquartile range, 59–77), with 65.2% aged over 65 years. Gram-negative bacteria accounted for 93.2% of isolated pathogens, predominantly Klebsiella pneumoniae (24.1%) and Pseudomonas aeruginosa (15.5%). Klebsiella pneumoniae demonstrated susceptibility rates ranging from 70% to 100% to beta-lactam/beta-lactamase inhibitor combinations. Pseudomonas aeruginosa showed high susceptibility rates (89–100%). The most commonly prescribed empirical antibiotics were ceftriaxone (51.9%) and levofloxacin (40.4%). Overall appropriateness of empirical antibiotic therapy was 41.5%. Older patients, higher Charlson score, higher CURB-65 score, and ICU admission were factors associated with treatment failure. The antibiotics recommended for the treatment of community-acquired pneumonia remain largely effective against common causative pathogens at the hospital. However, adherence to treatment guidelines for empirical antibiotic selection was suboptimal, underscoring the need for targeted interventions to promote rational antibiotic use and improve the quality of infection management.

Osteoarthritis is a chronic musculoskeletal disorder characterized by pain, functional impairment, and diminished quality of life, with knee, hip, and hand osteoarthritis representing the most prevalent clinical manifestations. This study aimed to analyze patient characteristics and patterns of medication utilization in the outpatient management of osteoarthritis at Thong Nhat Hospital during the period from 2016 to 2024. A retrospective cross-sectional study was conducted involving 40,916 patients diagnosed with osteoarthritis based on ICD-10 codes M16, M17, and M18. The results indicated that knee osteoarthritis accounted for most cases (97.28%). The mean age of patients was 59 years, with most patients belonging to the 30–65 and ≥65 age groups. A high prevalence of comorbid conditions was observed, particularly cardiovascular diseases and metabolic disorders. Oral NSAIDs were the most frequently prescribed medications (66.2%), followed by analgesics and topical NSAIDs. Co-prescription network analysis demonstrated that oral NSAIDs occupied a central position in most medication combination patterns, especially among patients with knee osteoarthritis, who exhibited a higher degree of polypharmacy compared with patients with osteoarthritis affecting other joint sites. These findings provide evidence to support individualized treatment strategies and to improve the effectiveness of osteoarthritis management in the Vietnamese clinical context.

Dyslipidemia (DLP) is a major risk factor for cardiovascular disease, and statins are the first-line treatment. The level of adherence to statin treatment has a significant impact on treatment outcomes in patients. This study aims to evaluate the medication utilization patterns and statin adherence levels at Thong Nhat Hospital during the 2016-2023 period. A retrospective cross-sectional study was conducted on 23,373 outpatients with dyslipidemia (ICD-10: E78) who had a continuous treatment duration of ≥1 year. Demographic characteristics, comorbidities (CCI), and prescription information were analyzed; statin adherence levels were assessed using MPR and PDC, with the threshold for good adherence being MPR >80% và PDC ≥80%. The mean age was 66,1 ± 12,2 with 72% of patients aged ≥ 60 years and a high multimorbidity burden (mean CCI of 5.91). Among 461,435 examination visits with prescribed treatment, statins accounted for 96.4%, primarily rosuvastatin and atorvastatin at moderate doses. The utilization rate of fixed-dose combinations (FDC) increased from 10.1% (2016) to 25.5% (2023). Adherence levels were low, with a mean MPR of 0.33 and PDC of 0.30; only 5.64% of patients achieved MPR > 80% and 3.53% achieved PDC ≥80%. The study indicates that statins are primarily used in dyslipidemia treatment with a growing trend toward FDC usage; however, the level of treatment adherence remains low.

This study aimed to describe the characteristics of common hematological disorders through immunophenotypic analysis using flow cytometry (FCM). A retrospective descriptive study was conducted on all patients aged 16 years and older who were analyzed by FCM testing at the Hematology Department, Thong Nhat Hospital from January 2023 to March 2025. Convenience sampling was applied. Data analysis was performed using Microsoft Excel 2021. A total of 104 patients were tested by flow cytometry. The median age at diagnosis was 68 years [55.8–77]. Baseline hematologic findings showed anemia (Hb 9.3 ± 2.6 g/dL) and wide variations in white blood cell (20.1 ± 42.4 K/uL) and platelet counts (197 ± 172.3 K/uL), reflecting the diversity of underlying hematologic conditions. FCM demonstrated high diagnostic value in identifying and classifying various hematologic disorders: distinguishing acute leukemia lineages (myeloid/B-lymphoid/T-lymphoid), detecting monoclonal lymphoid populations in lymphomas, and differentiating benign from malignant plasma cells in multiple myeloma. Correlation with bone marrow morphology was high, especially in diagnostically challenging cases. However, FCM could not fully replace bone marrow examination in assessing cellular morphology and tissue architecture. In conclusion, Flow cytometry is a powerful complementary tool in the diagnosis of hematologic disorders. The combination of FCM and bone marrow studies provides optimal diagnostic accuracy and supports effective patient management.

Ankylosing spondylitis (AS) is a chronic inflammatory disease strongly associated with the genetic marker HLA-B27. HLA-B27 testing plays an important role in supporting early diagnosis. Flow cytometry is a novel method with high potential for detection of HLA-B27. To determine the prevalence of HLA-B27 positivity and negativity among AS patients and to evaluate its association with biological characteristics within the study population. A retrospective descriptive study was conducted at Thong Nhat Hospital from January to July 2025 on patients diagnosed with AS based on ICD code M45. HLA-B27 testing was performed using the flow cytometry technique. Data were analyzed using descriptive statistics and correlation analysis via Microsoft Excel 2021. Among 248 patients diagnosed with AS (ICD M45), females were predominant (male:female ratio = 1:1.5). The average age of the cohort was 44.6 ± 14.9 years. The rate of HLA-B27 positivity was 12% (30/248), significantly lower than in previous studies. Patients with HLA-B27 positivity had a younger mean age at disease onset compared to the negative group (40.9 ± 15.4 vs. 45.1 ± 14.8 years; p = 0.048). No statistically significant difference in gender distribution was observed between the two groups (p > 0.05), although a higher proportion of females was noted in the HLA-B27 negative group. In Conclusions, The low HLA-B27 positivity rate in this study may reflect population characteristics and broader screening criteria. HLA-B27 positivity was associated with younger age at disease onset, suggesting its role not only in diagnosis but also in clinical presentation. Flow cytometry proved effective in detecting HLA-B27 and shows potential for broader clinical application.

Cardiovascular disease remains one of the leading causes of mortality worldwide, and LDL-C is a critical risk factor. Although direct measurement of LDL-C using homogeneous enzymatic assays provides high accuracy, it remains costly and time-consuming. The Friedewald equation, while widely applied, reduces accuracy in patients with elevated triglyceride, whereas the extended Martin-Hopkins (eMH) equation has been proposed to overcome this limitation. This cross-sectional study was conducted on 626 patients at Thong Nhat Hospital with TG levels ranging from 400-800 mg/dL. LDL-C concentrations were determined using a homogeneous enzymatic method and estimated using both the Friedewald and eMH equations. Accuracy was assessed by Pearson’s/Spearman’s correlation coefficient, mean absolute error (MAE), root mean square error (RMSE), and concordance rate for risk reclassification. The eMH equation demonstrated a higher correlation with direct measurement compared to Friedewald (0,74 > 0,70), lower MAE and RMSE values (20,6 mg/dL and 27,8 mg/dL vs 42,3 mg/dL and 52,2 mg/ dL), and a higher concordance rate (39% vs 29%). In conclusion, the eMH equation showed superior accuracy and concordance within the TG range of 400-800 mg/dL compared with the Friedewald equation. Nevertheless, further multicenter studies and comparisons with reference β-quantification methods are warranted before broad public implementation.

Iron deficiency anemia (IDA) constitutes a significant global health issue. Recent studies indicate that 8-15% of iron deficiency anemia cases are attributable to gastrointestinal malignancies.  This study presents a series of cases to elucidate the clinical and paraclinical characteristics, etiologies of iron deficiency anemia (IDA), and to assess the correlation among certain variables in patients.  The study results included 119 patients aged 16 years and older diagnosed with iron deficiency anemia (IDA) from June 2024 to May 2025 indicated a median age of 60 ± 17.4 years, with 59.7% being female.  Prevalent symptoms of anemia include dizziness, vertigo (96.6%), and pallor of the skin and mucous membranes (82.4%).  The majority of individuals with severe anemia (87.4%) exhibited inadequate bone marrow response (RPI = 0.3 ± 0.1).  The median ferritin level was 10.3 ± 7.5 ng/mL, exhibiting a strong correlation with red blood cell shape (MCV, MCH, MCHC) and transferrin levels.  The primary cause was chronic iron deficiency, with 9.2% attributed to gastrointestinal neoplasms, predominantly affecting men at a rate of 72.7%.  Studies indicate that TMTS is a prevalent condition, particularly among women and the elderly.  It is crucial to screen for the etiology of iron deficiency, particularly gastrointestinal neoplasms, in elderly males.

Antibiotic resistance is a major global health challenge. This study aimed to investigate the prevalence and antibiotic resistance patterns of pathogenic bacteria at Cai Nuoc General Hospital during 2023–2024. A cross-sectional descriptive study was conducted using clinical specimens identified and tested for antibiotic susceptibility according to CLSI 2023 standards. The predominant isolates were Escherichia coli 9,9%, Klebsiella pneumoniae 8.1%, Staphylococcus epidermidis 13,5% and Staphylococcus aureus 46,8%. High resistance rates were observed for beta-lactam and quinolone groups. ESBL-producing Gram-negative bacilli accounted for 21,2%, and MRSA for 89,7%. Conclusion: Antibiotic resistance at the hospital remains high, emphasizing the need for antimicrobial stewardship and regular surveillance.

The COVID-19 pandemic had a widespread impact on all aspects of human life globally, and specifically on Phu Yen Province (now part of eastern Dak Lak Province) in Vietnam. Numerous studies reported significant declines in outpatient visits, hospital admissions, and healthcare service utilization during this period. Evaluating the changes in disease patterns and healthcare service delivery at Phu Yen Traditional Medicine Hospital from 2020 to 2023 is essential for guiding service quality improvements and strengthening preparedness for future public health emergencies. To assess the variation in inpatient disease patterns and describe healthcare service activities at Phu Yen Traditional Medicine Hospital between 2020 and 2023. Study subjects included all inpatient medical records with primary ICD-10 diagnosis codes at Phu Yen Traditional Medicine Hospital from January 1, 2020 to December 31, 2023. Research design: retrospective cross-sectional descriptive study. From 2020 to 2023, musculoskeletal and neurological diseases were the most common. In 2021, COVID-19 cases appeared, with a notable rise in infectious diseases among patients under 15 (94.6%). Clinical staffing remained stable; bed numbers increased from 2022. During the pandemic, patient visits declined but clearly recovered by 2023. Bed occupancy was lowest in 2021 (69.7%) and peaked in 2023 (113.8%). The inpatient disease pattern and hospital service activity at Phu Yen Traditional Medicine Hospital were notably affected by COVID-19, with a sharp decline in 2021 followed by recovery starting in 2022.

To describe the current status of treatment adherence among outpatients with chronic diseases and to analyze factors associated with treatment adherence in Thu Duc City during 2024–2025. Cross-sectional descriptive study. The study included 253 patients with hypertension, 150 patients with diabetes mellitus, and 130 patients with chronic obstructive pulmonary disease (COPD) treated at Le Van Viet Hospital and Thu Duc City Medical Center (Facilities 1, 2, and 3) from July 2024 to March 2025. The mean age was 65.7 ± 10.9 years; 52.2% were male and 47.8% were female. The duration of illness was 6.8 ± 6.5 years. Hypertension and diabetes were mostly discovered incidentally; 74.6% of COPD patients were diagnosed when symptoms appeared. 10% of hypertensive patients, 17.3% of diabetic patients, and 6.2% of COPD patients had at least one comorbidity. 67.7% of hypertensive patients had blood pressure <140/90 mmHg. Blood glucose levels were 137.7 ± 50.4 mg/dL (96%). 24.6% of COPD patients were in GOLD stage 3 or 4. The overall treatment adherence rate was 23.8% good, 48.6% fair, and 27.6% poor. Better treatment adherence was observed among patients who lived with family, were diagnosed through regular check-ups, had a disease duration of less than 5 years, and had no comorbidities (p < 0.05). Treatment adherence was significantly associated with achieving treatment goals, particularly among patients with hypertension, and to a lesser extent among those with COPD and diabetes. Conclusion: Treatment adherence plays an essential role in the management of chronic diseases.

Acromegalic cardiomyopathy is classified as an endocrine cardiomyopathy. Acromegaly is characterized by the hypersecretion of Growth Hormone (GH) and its peripheral mediator, Insulin-like Growth Factor 1 (IGF-1). The etiology in the majority of cases is a pituitary adenoma. Chronic elevation of circulating GH and IGF-1 levels affects cardiomyocyte growth, myocardial contractility, and triggers various indirect mechanisms culminating in cardiomyopathy. The clinical phenotype typically presents as hypertrophic cardiomyopathy; however, without hormonal control, it may progress to a dilated cardiomyopathy phenotype with reduced ejection fraction. In this article, we report a clinical case in an older patient presenting with dyspnea. Based on clinical and diagnostic findings, the patient was diagnosed with acromegaly secondary to a pituitary adenoma, complicated by heart failure with reduced ejection fraction (HFrEF). Management included diuretics for decongestion and optimization of Guideline-Directed Medical Therapy (GDMT), with planned pituitary tumor resection upon stabilization of heart failure. However, the patient declined surgical intervention.

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.