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Swati Mahajan ; John Durfee ; Pushpa Nussair

Fiji Medical Journal.2006;25(2):24-27.

A 48 year old Indo-Fijian female presented with irregular vaginal bleeding for 3 years. On office examination she was diagnosed with carcinoma of vagina stage I and this was confirmed on histology. She underwent radical hysterectomy, upper vaginectomy and pelvic lymphadenectomy.

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Swati Mahajan ; John Durfee ; Pushpa Nussair

Fiji Medical Journal.2006;25(1):32-34.

A 28-year-old Fijian female presented with a two-month history of a vulvar growth. Office biopsy showed severe dysplasia but clinically the lesion was invasive, consistent with a stage II vulvar carcinoma. She underwent radical wide excision with bilateral inguinofemoral lymphadenectomy and final pathology confirmed invasive disease.

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Medical Education: An Area of Constant Change

Alan H. Penington

Fiji Medical Journal.1981;9(10):153-158.

"There is no subject which has given rise to more rational and irrational discussion than Medicine".

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Adrenal Insufficiency

Bhagat Ram ; Parshu Ram

Fiji Medical Journal.1982;10(3):62-64.

Adrenal insufficiency is a relatively rare disorder. It results when the level of adrenal steroids fall below the level required for the maintenance of normal health, both under basal and stress conditions. Five cases of adrenal insufficiency, seen in the last five years, are described.

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The CWM Hospital Covid-19 Response

Ravi Naidu ; Nigel McCarley ; Luke Nasedra

Fiji Medical Journal.2024;24(4):123-127.

Summary This paper is intended to provide an overview of the Colonial War Memorial Hospital’s response to the Covid-19 pandemic in Fiji. It presents the management and organizational systems and processes developed to ensure effective and timely management of potential COVID-19 cases presenting within CWM. It presents the theoretical model developed to support the Outbreak Management Team in determination of appropriate responses that required to be modified in the light of new knowledge and experience. The paper describes actions taken to ensure the preparedness of CWM; the development of process algorithms required to ensure consistency across the organization; the establishment of an Emergency Management Centre that provides 24 hour oversight of the CWM Covid-19 response; arrangements for quarantine of staff etc. It will also present the Covid-19 Preparedness Assessment Tool that was developed in CWM and subsequently used to assess the state of preparedness at other facilities nationally.

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Back to the Future: Putting ‘Primary’Back Into The Kiribati Health System

Gabrielle Appleford ; Mohamed Abdallah ; Wendy Erasmus ; Helen Murdoch ; Eretii Timeon

Fiji Medical Journal.2024;24(4):133-137.

Abstract This paper explores the introduction of a quality improvement initiative in Kiribati’s primary health care (PHC) system.

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Gestational Diabetes in Melanesia and Appropriateness of Current Screening and Diagnostic Tests

Tope Adepoyibi ; Heather Gidding ; Richard Taylor ; Ben Coghlan

Fiji Medical Journal.2024;24(4):138-142.

Abstract In low-resource settings such as Melanesia, gestational diabetes often goes undiagnosed due to many factors, including the unsuitability of current tests. Ideally a gestational diabetes test for low-resource settings should meet criteria related to acceptability, test performance and operational characteristics, with minimal impositions on individual patients or the wider health system. None of the six tests recommended in country-specific gestational diabetes guidelines in Melanesia (2-hour oral glucose tolerance test, glucose challenge test, fasting plasma glucose, random plasma glucose, 2-hour postprandial glucose and glycated haemoglobin) meet criteria related to these attributes. Additionally, each Melanesian country has different, complex algorithms that use multiple tests in different combinations. With a high and increasing burden of diabetes mellitus (and therefore assumed gestational diabetes), Melanesian health practitioners and policymakers should be aware of the limitations of recommended tests for gestational diabetes and be open to alternative technologies that may be more appropriate.

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Prevention of Diabetic Nephropathy Through RAAS Blockade in a Resource Poor Setting – A review of Evidence

Shitanjni Shila Wati ; Abdul Mushib Ibrahim

Fiji Medical Journal.2024;24(4):143-150.

Background: In Fiji, 1 in every 3 Fijian is being diagnosed with diabetes. The contribution of chronic kidney disease (CKD) to mortality in Fiji has increased to become the fourth leading cause of death in the country. Fiji Ministry of Health and Medical Services data show that admissions to hospitals for CKD are increasing and treatment of end‐stage kidney disease (ESKD) is a growing burden. Since renal replacement therapy is not readily available or affordable in Fiji, it is advisable to prevent or slow the progression of renal disease to ESKD. Early deduction of renal impairment in diabetic patient is paramount and foremost is to identify proteinuria in the earliest stage. Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) offer reno-protection. These agents reduce proteinuria, a risk marker for renal disease progression. Aim: To evaluate and provide evidence for use ACE-I and ARB in prevention of diabetic nephropathy in our clinical setting. Method: An online search using MESH terms that best answered our research question was conducted on the Medline database. Four seminal papers were identified after shifting through abstracts of 210 studies. These papers were evaluated and conclusions discussed. Results ACE-I and ARBs are equally reno-protective agents when used individually; it slows the progression of diabetic renal impairment to ESKD and reduces proteinuria to almost normal levels. ARBs are likely to be used as first line agent in patients who have already developed significant diabetic proteinuria since additional blood pressure lowering capabilities of this class of drug may have accentuated benefits. Additionally, ARB’s should be used in patients who cannot tolerate ACE-I induced side effects. For prevention and conversion of diabetic nephropathy to normo-proteinuria; moderate to maximum doses of ACE-I or ARB should be used in clinical practice. Combination of ACE-I plus ARB in management is not recommended. ACE-I still remains the most cost-effective drug for a low resourced clinical setting such as ours.

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A Prospective Study of Acute Spinal Blockade Complications Occurring in 24 hours at Labasa Divisional Hospital – from November 2019 to November 2020

Sitiveni Weleilakeba

Fiji Medical Journal.2024;24(4):160-166.

Objective: To determine the incidence of acute spinal blockade complications and the association of frequent spinal blockade complications and acute spinal blockade complications. Methodology: A prospective, qualitative survey of 685 adults at Labasa Hospital was done from November 2019 to November 2020 to determine the incidence of having spinal blockade complications in 24 hours. Cross tabulation was used to determine the strength of association between frequent spinal blockade complications and the incidence of acute post spinal blockade complications. Results: The incidence of acute post spinal complications was 18%. 685 participants were entered into analysis. 17% of patients thereby had frequent spinals during the study period. The Odds Ratio of frequent spinal blockade complications to acute post spinal complications was found to be 2.56 (Confidence Interval: 1.62-4.02). Conclusion The study describes the cohort getting spinal blockades in Labasa Hospital. In addition, this audit highlights the incidence of acute post spinal blockade complications. The strong association of acute post spinal blockade complications and frequent spinal blockades is confirmed. The author believes that this lays groundwork for studies showing the validity of doing post anaesthesia visits and increasing research into the dangers of having frequent spinal blockades.

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Assessing the Adequacy of Perioperative Pain Management on Immediate Post-Operative Analgesia for Patients Anesthetised Under General Anesthesia who had Elective Intraabdominal Surgeries in Lautoka Hospital – A Retrospective Audit

Eunice Murtle Onisimo ; Luke Nasedra ; Lisepa Daulako

Fiji Medical Journal.2024;24(4):167-175.

Introduction: Perioperative pain is a major problem for patients undergoing surgery. Inadequate pain relief can lead to complications like pneumonia, extended hospital stay, re-admissions and patient dissatisfaction. The aim of this research was to determine adequacy of perioperative pain management on immediate post-operative analgesia for elective Intra-abdominal procedures done under general anaesthesia. Method: This is a retrospective study which involved auditing inpatient folders from the 1st of January to 31st of December, 2015.The inclusion criteria were those between the ages of 18 to 60years who had Elective Intra-abdominalprocedure done under general anesthesia.Each folder was audited for perioperative pain management from surgical and anaesthetic charts and data were entered into a proforma list. EpiInfo 3.1 software and Microsoft Excel Spreadsheetwere used for analysis of the extracted data. Results: 159 records met the inclusion criteria but only 127 folders were recovered. 28% of patients recorded pain in the immediate postoperative period. There were more females than males and Total Abdominal Hysterectomies was the most common procedure. The age between 31 to 40 years, reported the most pain. Open cholecystectomy’s procedures recorded the most pain complaints and hernia repairs had the least. Verbal response was the highest pain indicator used and 11% of patients who indicated having some pain went from PARU untreated. There were no records of usage of pain scales in any folder retrieved. Discussion: Pain recording in the recovery unit was heavily dependent on the recovery nurse and the patient. The incidence of immediate postoperative pain from this study group was lower when compared to other studies. This could be due to a lack of documentation or a reflection on how well perioperative pain treatment has been done in Lautoka. Conclusion Overall management of perioperative pain still needs improvement. The anaesthetic team should seriously look at this problem as Anaesthetists are still unaware of their patients pain. It is highly recommend that the formulation of an Acute Pain Management Protocol for Fiji to ensure that Pain be included as the 5th vital sign.

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