Usefulness of Michigan Neuropathy Screening Instrument (MNSI) in diagnosis of diabetic neuropathy in a Sri Lankan diabetic clinic

Objectives: Diabetic sensory neuropathy is a common complication of diabetes mellitus causing considerable morbidity and disability. The objectives were to determine the proportion of diabetic neuropathy among the patients attending the diabetic clinic of the Colombo South Teaching Hospital and the use of Michigan Neuropathy Screening Instrument (MNSI) in screening for diabetic neuropathy.Methods: A descriptive cross sectional study was done on 384 subjects diagnosed with having Type 2 diabetes mellitus (T2DM) attending the diabetic clinic of the Colombo South Teaching Hospital. An interviewer administered questionnaire assessed socio demographic data. MNSI, Diabetic Neuropathy Index (DNI) and Monofilament tests were used in the assessment of neuropathy. Diabetic neuropathy was confirmed by a positive score of two of the above three tests. Data analysis was done by using the SPSS 16 version software.Results: 175(45.6%) of the subjects had diabetic neuropathy according to the diagnostic criteria. On study of clinic records only 16% of patients had been previously diagnosed with neuropathy. 165(43%) subjects of the neuropathy group were diagnosed positive for both MNSI and DNI. The MNSI score was positively correlated with the PPBS level of the diabetic subjects (correlation coefficient 0.235, p=0.011).Conclusions: The data reveals a high frequency of diabetic neuropathy in this study. All diabetic patients should be screened for neuropathy annually in Sri Lanka as recommended by the American Diabetes Association. MNSI was confirmed as a useful, easily implementable tool to screen for neuropathy in diabetic clinics in Sri Lanka.

Does training improve the pulmonary function amongst Sri Lankan national level athletes

Objectives: To determine the status of pulmonary functions amongst Sri Lankan national level athletes in comparison to matched controlsMethods: National level athletes (n = 63) engaged in resistance and endurance sports were studied. Baseline data were collected by a questionnaire and clinical examination. Pulmonary functions were assessed by a Vitallograph spirometer. Results were compared with age, height, weight and gender matched controls (n= 63). Data were analyzed using SPSS version 16 statistical package.Results: Inspiratory function as indicated by the Forced Inspiratory Vital Capacity (FIVC), Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1st second (FEV1) were significantly higher amongst the athletes (p< 0.05). The small air way function as determined by mid stream Forced Expiratory Flow (FEF25%-75%) of the athletes was similar to the controls (p>0.05). The expiratory muscle efficiency as indicated by Peak Expiratory Flow Rate (PEFR) and FEV1/ FVC ratio was not significantly different between the athletes and the controls (p> 0.05).Conclusions: The study concludes that training programmes for the athletes must consist of exercise schedules to optimize the strength of respiratory muscles. This will achieve optimal pulmonary function amongst athletes. Improvement of pulmonary function may in turn promote better performance of athletes at competition

Protocol for the cultural adaptation of pulmonary rehabilitation and subsequent testing in a randomised controlled feasibility trial for adults with chronic obstructive pulmonary disease in Sri Lanka

Introduction: International guidelines recommend pulmonary rehabilitation (PR) should be offered to adults living with chronic obstructive pulmonary disease (COPD), but PR availability is limited in Sri Lanka. Culturally appropriate PR needs to be designed and implemented in Sri Lanka. The study aims to adapt PR to the Sri Lankan context and determine the feasibility of conducting a future trial of the adapted PR in Sri Lanka. Methods and analysis: Eligible participants will be identified and will be invited to take part in the randomised controlled feasibility trial, which will be conducted in Central Chest Clinic, Colombo, Sri Lanka. A total of 50 participants will be recruited (anticipated from April 2021) to the trial and randomised (1:1) into one of two groups; control group receiving usual care or the intervention group receiving adapted PR. The trial intervention is a Sri Lankan-specific PR programme, which will consist of 12 sessions of exercise and health education, delivered over 6 weeks. Focus groups with adults living with COPD, caregivers and nurses and in-depth interviews with doctors and physiotherapist will be conducted to inform the Sri Lankan specific PR adaptations. After completion of PR, routine measures in both groups will be assessed by a blinded assessor. The primary outcome measure is feasibility, including assessing eligibility, uptake and completion. Qualitative evaluation of the trial using focus groups with participants and in-depth interviews with PR deliverers will be conducted to further determine feasibility and acceptability of PR, as well as the ability to run a larger future trial. Ethics and dissemination: Ethical approval was obtained from the ethics review committee of Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka and University of Leicester, UK. The results of the trial will be disseminated through patient and public involvement events, local and international conference proceedings, and peer-reviewed journals. Trial registration number ISRCTN1336773

Effect of stress on cognitive functions in Sri Lankan adolescents

Psychosocial stress may affect cognitive (CF) and executive functions (EF). The objective ofthis study was to determine the association between stress and CF during adolescence. In thiscross-sectional study on adolescents (n = 162; mean age 11.82 years ± 0.40 SD; 73.5% males), psychosocial adversity was measured by the Adolescent Psychosocial Adversity Questionnaire (APAQ). CF and EF were assessed by the Test of Non Verbal Intelligence (TONI-3), Wechsler Intelligence Scale for Children (WISC-IV), visuospatial working memory and stroop inhibitory tasks. Stress was observed in 85% of adolescents. The Perceptual Reasoning Index (b1 -0.180, b2 -0.052, p = 0.091), Processing Speed Index (b2 -0.042, p 0.022) and Estimated Full Scale Intelligence Quotient (b1 -0.072, b2 -0.140, p 0.028) were non-linearly related with stress and reflected an inverted U-shape curve. The results indicate the necessity of a base line level of stress for cognition. Both high and low levels of stress are detrimental to cognition inadolescents.Keywords: Adolescent, stress, cognitive functions, Sri Lank