Tập 1 Số 5 (2025): Thong Nhat Hospital’s 50-Year Journey - Comprehensive Healthcare and Healthy Aging

As Vietnam’s population ages rapidly, the health system faces increasing demands for long-term, integrated, and person-centered care for older adults. To meet these challenges, the “Treatment Triangle” model has been proposed, comprising three interconnected pillars: (1) home and community-based care, (2) hospitalbased specialized treatment, and (3) rehabilitative and nursing care at dedicated centers. Together, these pillars form a continuum of care that emphasizes prevention, early detection, comprehensive management of chronic diseases, and recovery of physical and psychological function. This paper describes the structure, roles, and interconnections of each component and discusses how this model could serve as a sustainable and humane framework for geriatric care in Vietnam.

Osteoporosis is a skeletal disorder characterized by compromised bone strength and increased fracture risk. In Vietnam, the disease affects ~30% in postmenopausal women and ~10% in men over 50, highlighting a growing public health challenge as the population ages. Bisphosphonates remain the standard firstline treatment. Recent advances in bone biology highlight the critical role of the RANK/RANKL/OPG pathway in bone remodeling. Osteoporosis arises when the RANKL/OPG ratio becomes imbalanced. Denosumab, a monoclonal antibody that targets RANKL, replicates OPG’s ability to suppress osteoclast activity, increasing bone mineral density and reducing fracture risk by 20–68% across various skeletal sites. Unlike bisphosphonates, Denosumab is reversible, metabolized by the reticuloendothelial system, and appropriate for patients with advanced kidney disease, though it necessitates monitoring for hypocalcemia. This advancement offers clinicians a valuable tool for managing osteoporosis in Vietnam.

Surgical treatment has been the standard of care in selected cases with solid tumors or uterine benign diseases. However, a majority of patients are unable to undergo surgical resection because of the tumor locations, advanced stages, or poor general condition. For patients who are not suitable for surgery or unwilling to undergo surgical treatment, high-intensity focused ultrasound (HIFU) ablation surgery is a new option. HIFU is a novel non-invasive technique that can generate coagulative necrosis at a precise focal point within the body, without damaging to the surrounding structures of the target lesions, even within the path of the beam. Ultrasound guided HIFU (USgHIFU) was first used in the treatment of bone tumors in the 1990s. Over the last two decades, this technology has made significant progress and is now widely used in the treatment of various solid tumors and benign diseases of certain organs. Currently, both magnetic resonance imaging guidance focused ultrasound surgery (MRgFUS) and USgHIFU are commercially available. Each of these two types of HIFU systems has its own advantages in guidance. USgHIFU has higher treatment efficiency, with shorter treatment time, and can treat a wider range of diseases than that of MRgFUS. Recently, HIFU has been proven to be beneficial as an adjunct in the treatment of cardiovascular diseases. In addition, MRgFUS allows for non-invasive treatment of intracranial lesions is another significant advancement in the field of therapeutic ultrasound. Histotripsy was recently approved by the U.S. Food and Drug Administration (FDA) for hepatic targets. Last year, the Focused Ultrasound Foundation announced that focused ultrasound has been used for the treatment of over 170 diseases. As advances in engineering technology, including guidance techniques for the fusion of ultrasound and MRI, as well as optimization of transducer, are making HIFU treatments easier, safer, and more efficacious. This technique may play a key role in future clinical practice.

Aspirin là liệu pháp nền tảng trong điều trị bệnh động mạch vành, tuy nhiên tình trạng quá mẫn làm phức tạp việc sử dụng thuốc trong thực hành lâm sàng. Bài tổng quan tường thuật này tổng hợp các bằng chứng hiện nay từ các nghiên cứu và hướng dẫn, nhằm cung cấp khuyến nghị thực tiễn dựa trên chứng cứ về dịch tễ học, cơ chế, phân loại và quản lý quá mẫn với aspirin. Tỷ lệ hiện mắc được ước tính là 0,5–1,9% trong dân số chung và 2,6% ở bệnh nhân được chụp mạch vành. Trong cơ sở dữ liệu ADAPTED, một phác đồ giải mẫn cảm nhanh đạt tỷ lệ thành công 95,4%, với 80,3% bệnh nhân vẫn duy trì được aspirin sau 12 tháng. Khuyến cáo 2025 của Hội Tim mạch Hoa Kỳ đề xuất giải mẫn cảm aspirin là chiến lược ưu tiên ở bệnh cảnh hội chứng vành cấp. Ngược lại, khuyến cáo 2024 của Hội Tim mạch châu Âu khuyến nghị sử dụng clopidogrel trong bệnh cảnh hội chứng vành mạn khi bệnh nhân không dung nạp aspirin. Giải mẫn cảm chống chỉ định ở những bệnh nhân có tiền sử sốc phản vệ nặng. Do đó, giải mẫn cảm nên được ưu tiên thực hiện bất cứ khi nào có thể. Khi không khả thi hoặc thất bại, các lựa chọn thay thế — như cilostazol, indobufen, hoặc các phác đồ dựa trên thuốc ức chế P2Y12 có hoặc không phối hợp thuốc kháng đông đường uống — có thể được cân nhắc dựa trên nguy cơ thiếu máu cục bộ và nguy cơ chảy máu. Cần có các thử nghiệm ngẫu nhiên có đối chứng với độ tin cậy cao để xác nhận hiệu quả của những chiến lược này.

Dysphagia is increasingly recognized due to higher survival rates after central nervous system injuries, head and neck cancer treatment, and in some cases in healthy elderly individuals. It leads to severe consequences including prolonged hospitalization, delayed recovery, recurrent pneumonia, and even mortality. Bedside clinical tests alone are insufficient for diagnosis. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is one of the gold standards in dysphagia assessment, proven to be safe, effective, and feasible worldwide. However, FEES has not been widely adopted in Vietnam. This paper reports the implementation and clinical experience of FEES at the National Rehabilitation Hospital between 2019 and 2025. Literature review and clinical experience were combined. More than 700 FEES procedures were performed between April 2019 and July 2025. FEES allowed direct visualization of swallowing physiology, identification of penetration/aspiration, and guided compensatory strategies. No serious complications were reported, apart from mild discomfort. FEES is an effective and safe diagnostic tool for dysphagia, supporting individualized management strategies and should be expanded in Vietnam.

The rapid aging of the global population has led to a substantial rise in the demand for orthopedic surgery among elderly patients, particularly for hip, knee, and shoulder arthroplasty. However, age-related physiological decline, comorbidities, and frailty increase the risk of complications and present unique clinical challenges. This review aims to summarize current evidence regarding indications, risks, and evolving strategies in orthopedic surgery for patients aged ≥65 years; We conducted a focused narrative review of the literature published between 2015 and 2025 using PubMed, Scopus, and Google Scholar. Search terms included “orthopedic surgery,” “geriatric patients,” “frailty,” “osteoporosis,” “arthroplasty,” “comprehensive geriatric assessment,” and “enhanced recovery after surgery (ERAS)”. Priority was given to original studies, systematic reviews, meta-analyses, and international guidelines relevant to orthogeriatric care; Evidence synthesis indicates that while elderly patients face higher rates of perioperative complications, successful orthopedic surgery can substantially improve functional recovery and quality of life. Key risk factors include osteoporosis, malnutrition, and frailty, which correlate with delayed healing and increased morbidity. Strategies such as prehabilitation, Comprehensive geriatric assessment, and ERAS protocols have demonstrated effectiveness in reducing hospital stays, lowering complication rates, and enhancing postoperative outcomes; Orthopedic surgery in the aging population offers both opportunities and challenges. Optimal outcomes require a multidisciplinary approach, preoperative optimization, and the integration of evidence-based perioperative strategies. Wider adoption of orthogeriatric care models may improve both safety and sustainability of orthopedic interventions in elderly patients.

Medication management in patients with acute kidney injury (AKI) poses numerous challenges due to the rapid fluctuations in renal function over a short period. This necessitates frequent reassessment of drug indications and dosages to ensure both treatment efficacy and patient safety. This study aimed to investigate the drug use characteristics and evaluate the effectiveness of clinical pharmacist interventions in prescribing medications for patients with AKI; A before-and-after study was conducted on inpatients diagnosed with AKI at Thong Nhat Hospital, Vietnam, during the pre-intervention period (from February 2022 to August 2022) and the intervention period (from September 2022 to March 2023). Clinical pharmacist interventions included reviewing prescriptions and providing guidance on dose adjustments for patients with AKI. Prescriptions were considered appropriate if the indications and dosages complied with drug usage guidelines and the Vietnamese National Drug Formulary. The effectiveness of the intervention was evaluated by comparing the appropriateness of prescribing between the two study periods; A total of 97 patients in the pre-intervention period and 94 patients in the intervention period were included. The proportion of patients receiving at least one drug potentially impairing kidney function in both periods was 33.5%, while 90.6% of patients were prescribed at least one drug that required dose adjustment or discontinuation in cases of renal impairment. The proportion of appropriately dosed prescriptions was higher in the intervention period compared to the pre-intervention period (94.7% vs. 84.5%, p = 0.022). However, the overall rate of appropriate prescribing did not differ significantly between the two periods (79.8% vs. 71.1%, p = 0.165); The rate of appropriate prescribing for AKI patients was relatively high. Clinical pharmacist interventions contributed to improving the appropriateness of drug dosing.

To evaluate the relationship between age, sex, and multimorbidity with hospital length of stay among elderly inpatients. A retrospective cross-sectional study was conducted on 507 medical records of patients aged ≥60 years admitted to the Senior Officer Department, 103 Military Hospital, between December 2022 and October 2024. Data were analyzed using SPSS version 26.0. One-way and two-way ANOVA were performed to examine the effects of age, sex, and comorbidity burden on hospital stay. Male patients had longer hospital stays (10.68 ± 6.24 vs. 9.40 ± 4.95 days) and a higher mean number of comorbidities (3.57 ± 1.70 vs. 3.26 ± 1.69; both p < 0.05) compared with females. Hospital stay increased with advancing age, from 9.27 ± 5.78 days in the 60–69 age group to 11.07 ± 5.54 days in the 80–89 age group (p < 0.001). Similarly, the number of comorbidities rose with age, from 2.84 ± 1.48 to 4.24 ± 1.93 (p < 0.001). Two-way ANOVA confirmed significant effects of both age (p < 0.001) and sex (p = 0.033) on comorbidity burden, whereas the interaction effect was not significant (p = 0.091). For hospital stay, comorbidity burden was the main determinant (p < 0.001), with no significant sex effect (p = 0.09). Patients with ≥6 comorbidities had markedly prolonged hospital stays, irrespective of sex. Age and multimorbidity are the principal determinants of hospital stay duration in elderly patients. While males showed a higher comorbidity burden, the effect of sex on hospital stay was largely explained by multimorbidity. These findings underscore the importance of comprehensive comorbidity management to reduce hospital stay and optimize care for older adults.

This study aim to investigate and characterize the imaging features of knee osteoarthritis (OA) using high-field 3.0 Tesla Magnetic Resonance Imaging (MRI) in a cohort of patients at Thong Nhat Hospital. A cross-sectional descriptive study was conducted on 156 patients with radiographically confirmed knee OA who underwent 3.0T MRI between November 2024 and May 2025. Pathologies of the menisci, cruciate ligaments, collateral ligaments, subchondral bone and joint space were systematically evaluated. Univariable and multivariable logistic regression analysis was employed to identify imaging features associated with OA. The study included 156 patients (mean age 55.8±10.6 years; 73 males). The majority of patients were classified radiographically as Kellgren-Lawrence (KL) grade I (n=99, 63.46%). Despite the prevalence of early-stage radiographic disease, 3.0T MRI revealed a high burden of soft-tissue pathology. The most common ligamentous injury was a partial tear of the anterior cruciate ligament (ACL) in 42 patients (27%), while medial meniscal tears were identified in 56 patients (35.9%). Mild joint effusion was a frequent finding, present in 107 patients (68.6%). In the multivariable model, age (Odds Ratio 1.03, 95% Confidence Interval [CI] 1.02–1.04), ACL injury (OR 1.14, 95% CI 1.02–1.28), posterior cruciate ligament (PCL) injury (OR 1.24, 95% CI 1.02–1.50), collateral ligament injury (OR 1.23, 95% CI 1.02–1.49) and lateral meniscal injury (OR 1.14, 95% CI 1.00–1.29) were identified as significant independent predictors of OA. High-field 3.0T MRI is a pivotal tool for the comprehensive assessment of knee OA, detecting a wide spectrum of radiographically occult soft tissue and bone marrow pathologies. These findings, particularly those related to ligamentous and meniscal integrity, are critical to understanding the disease's biomechanical underpinnings and may be present despite minimal radiographic changes.

This study was conducted to evaluate the therapeutic efficacy and safety of electro-auricular acupuncture in the treatment of functional gastrointestinal disorders, as classified by Traditional Medicine. Thirty patients with digestive disorders were enrolled and received daily electro-auricular acupuncture for 14 consecutive days. Symptom severity was assessed at baseline D0, D7, and D14 using a standardized questionnaire. In the excess pattern group, a statistically significant improvement was observed in certain symptoms by day 7 (abdominal pain, p=0,04; borborygmus/bloating, p=0,008), with most symptoms showing marked reduction by day 14 (p<0,05). For the deficiency pattern group, most symptoms demonstrated significant improvement primarily at D14 (p<0,05); however, specific symptoms such as “sallow complexion/cold limbs” and “fatigue/poor appetite” showed improvement only at this later time point. The treatment was well-tolerated, and no serious adverse events were reported. Minor, self-limited side effects included pain at insertion (10%), mild bleeding (6,7%), and needle faint (3,3%). The findings suggest that electro-auricular acupuncture is an effective intervention for improving the symptoms of digestive disorders in both excess and deficiency patterns and possesses a favorable safety profile.

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.

Older patients (≥65 years old) with non-ST-segment elevation myocardial infarction (NSTEMI) have a high risk of in-hospital complications. This study aimed to evaluate the predictive value of the ACTION ICU score for the need for ICU admission in this patient population. This was a retrospective, descriptive, cross-sectional study of 122 patients ≥65 years old diagnosed with NSTEMI and hemodynamically stable upon admission at Nhan dan Gia Dinh Hospital from January 2022 to December 2023. The primary endpoint was a composite outcome including cardiac arrest, shock, respiratory failure requiring mechanical ventilation, high-degree atrioventricular block requiring a pacemaker, stroke, or in-hospital death. The predictive value of the ACTION ICU score was assessed using receiver operating characteristic (ROC) curve analysis. The mean ACTION ICU score in the group with complications was significantly higher than in the group without complications (11.6 ± 3.5 vs. 7.5 ± 3.3; p < 0.001). The ACTION ICU score showed good predictive ability with an area under the ROC curve (AUROC) of 0.792 (95% CI: 0.688–0.896). The optimal cutoff score was ≥11 points, with a sensitivity of 63.6%, a specificity of 82.0%, a positive predictive value of 43.8%, and a negative predictive value of 91.1%; The ACTION ICU score is a simple and clinically useful tool for risk stratification, helping to predict the need for ICU admission in older NSTEMI patients in Vietnam. The use of this score can support clinical decisions, contributing to a more effective use of ICU resources.

To assess the clinical effectiveness of 3D-printed models in minimally invasive plate osteosynthesis (MIPO) for ankle fractures, compared with conventional surgical planning. Methods: A quasi-experimental study was conducted at Thong Nhat Hospital from January 2024 to January 2025. Twenty-eight patients with ankle fractures were enrolled and divided equally into two groups (n = 14 each): one managed with 3D-assisted preoperative planning and the other with conventional methods. Results: The 3D-assisted group demonstrated significantly better intraoperative and postoperative outcomes. Mean operative time was shorter (55.3 ± 6.6 vs. 68.1 ± 5.3 minutes, p = 0.001), blood loss was lower (75.5 ± 10.2 vs. 110.3 ± 15.7 ml, p < 0.001), and C-arm exposure was reduced (10.8 ± 1.1 vs. 17.2 ± 1.5 shots, p = 0.003). Functional recovery was superior, with higher Rasmussen scores at 3 months (26.7 ± 1.3 vs. 23.4 ± 2.1, p = 0.002). Postoperative complications were also less frequent in the 3D group. Conclusion: Preoperative 3D printing significantly enhanced surgical accuracy and clinical outcomes in ankle fracture management. Patients treated with 3D assistance experienced shorter operations, reduced intraoperative blood loss, fewer fluoroscopic exposures, improved functional recovery, and a lower complication rate.

Hepatitis B virus (HBV) infection is a prevalent and serious infectious disease. Severe acute exacerbation of chronic hepatitis B occurs in 40-50% of patients with chronic hepatitis B, which can progress to acute-on-chronic liver failure (ACLF) when their liver damage worsens. Early diagnosis and treatment play an important role in the survival of patients with ACLF. To investigate risk factors associated with the progression of ACLF in severe acute exacerbation of chronic hepatitis B. A retrospective, cross-sectional study with longitudinal follow-up was conducted on 69 patients with severe acute exacerbation of chronic hepatitis B, conducted at the Department of Gastroenterology, The University of Medicine Center of Ho Chi Minh City from January 2022 to December 2023. Of the 69 patients, 30 (43.5%) progressed to ACLF. Univariate analysis identified a history of compensated cirrhosis (OR = 9.04; 95% CI: 3.0–27.2), spider angiomas (OR = 4.43; 95% CI: 1.54–12.75), palmar erythema (OR = 5.07; 95% CI: 1.75–14.64), lower serum sodium (OR = 1.18; 95% CI: 1.02–1.37), higher total bilirubin (OR = 1.06; 95% CI: 1.01–1.12), and lower serum albumin (OR = 1.29; 95% CI: 1.13–1.47) as significant risk factors for ACLF progression in severe acute exacerbation of chronic HBV. Risk factors associated with the progression of ACLF in severe acute exacerbation of chronic hepatitis B are a history of compensated cirrhosis, spider angiomas, palmar erythema, serum sodium, total bilirubin, and serum albumin. Serum albumin is an independent risk factor.

The Six Sigma approach enables laboratories to objectively evaluate analytical performance, refine IQC protocols, and establish suitable IQC frequencies. This study aimed to evaluate the quality and optimize the IQC procedure for selected hematology tests on the Advia 2120i automated hematology analyzer. A cross-sectional descriptive study was conducted using internal quality control and external quality assessment data from April 2024 to December 2024 at Phuong Chau International Hospital. The results showed that WBC and PLT achieved sigma values >4 at all three IQC levels. HGB had sigma values ranging from 3 to <6, while RBC had sigma values between 2 and <4 across all three IQC levels. Most tests in this study reached “acceptable” sigma performance or higher. These findings demonstrate that the Six Sigma approach is effective in monitoring and improving test quality by enabling the selection of appropriate IQC strategies for each parameter.

To assess patients’ average level of knowledge regarding coronary artery disease and its associated factors at Tra Vinh Provincial General Hospital in the year 2024. A descriptive cross-sectional study was conducted on 128 patients diagnosed with coronary artery disease who came for examination and surgical treatment at the Cardiology Clinic at Tra Vinh Provincial General Hospital from May 2024 to July 2024 using the CADE-Q SV questionnaire. Our research results showed that 76.6% of patients had average knowledge and 23.7% of patients had poor knowledge; no patients had good knowledge; the rate of patients answering correctly for all questions was 45.04%; there was no correlation found between the knowledge of patients with coronary artery disease at Tra Vinh General Hospital and the factors surveyed at the time of the survey. Our research results showed that the knowledge of patients with coronary artery disease at Tra Vinh General Hospital in this study was still low, and there was no factors related to the rate of patients’ knowledge about coronary artery disease have been found.

Cervical cancer is one of the most common cancers in women and can be prevented through HPV vaccination. However, HPV vaccination coverage in Vietnam remains low, especially among healthcare students. This study aimed to assess the status and barriers to HPV vaccination among female nursing students at Tra Vinh University. A descriptive cross-sectional study was conducted among 233 female nursing students from May to July 2024. Data were collected using a self-administered questionnaire and analyzed with SPSS 22.0, employing descriptive statistics, Chi-square tests, and logistic regression. Only 15.5% of students had received at least one dose of HPV vaccine, with 9.4% completing the full three-dose schedule. The main barriers included high cost (73.4%), concerns about side effects (28.8%), perception of unnecessary vaccination without prior sexual activity (22.3%), and lack of accurate information (21.5%). Most students had good knowledge and positive attitudes: 91.4% knew HPV vaccine prevents cervical cancer, 91.8% trusted its effectiveness, and 92.3% were willing to recommend it to peers. HPV vaccination coverage among female nursing students remains low, largely due to financial constraints and insufficient information. Strengthened health education and financial support policies are essential to improve vaccination uptake in this population.

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.

Melanin overproduction can lead to hyperpigmentation issues such as freckles and melasma, impacting aesthetics and health. This study investigates the inhibitory effects of C-Phycocyanin (C-PC) extracted from Spirulina on melanin synthesis using a zebrafish (Danio rerio) model. C-PC demonstrated significant tyrosinase inhibition and reduced melanin content in zebrafish embryos in a dosedependent manner. The IC50 value of C PC for tyrosinase inhibition was determined to be 38.36 ± 19 µg/mL. At the highest tested concentration (10 µg/mL), C-PC reduced melanin content in zebrafish embryos by approximately 48.57%, compared to 71.08% inhibition observed with kojic acid. Importantly, C-PC exhibited low toxicity, with treated embryos maintaining normal morphology and viability. The findings suggest the potential application of C-PC as a natural depigmenting agent in cosmetic formulations.

Left ventricular noncompaction cardiomyopathy (LVNC) can lead to ventricular arrhythmias and may be misdiagnosed as arrhythmia-induced cardiomyopathy (AiCM). While LVNC is associated with genetic abnormalities, AiCM is triggered by arrhythmias and is typically reversible once the arrhythmia is eliminated. We report the case of a 59-year-old woman with LVNC carrying three TTN gene variants: c.100804A>T (p.Met33602Leu, exon 358), c.59200C>G (p.Pro19734Ala, exon 300), and c.52052T>C (p.Val17351Ala, exon 273). The patient was initially diagnosed with AiCM but showed no recovery of left ventricular function after successful catheter ablation of ventricular arrhythmias. Echocardiography and cardiac magnetic resonance imaging confirmed the LVNC phenotype. This case highlights the importance of distinguishing between these two entities in clinical practice.

Drowning is a leading cause of unintentional injury-related mortality worldwide, particularly in two vulnerable populations: children and the elderly. In addition to respiratory compromise, drowning may lead to serious complications such as hypothermia, prolonged neurological injury, and cardiovascular sequelae — including myocardial damage. Myocardial infarction following drowning is rare and frequently overlooked in the acute setting, as elevated cardiac biomarkers are often attributed to resuscitation efforts. Nevertheless, in patients with pre-existing cardiovascular risk factors, systemic hypoxia combined with acute physiological stress induced by drowning may serve as a trigger for true myocardial infarction. This report describes an incidental finding of underlying coronary artery disease following a drowning event, underscoring the critical importance of comprehensive cardiovascular assessment in drowning survivors for early recognition of life-threatening cardiac events and timely, individualized management

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.