|Year : 2019 | Volume
| Issue : 3 | Page : 180-183
Effectiveness of teaching orientation on polymerase chain reaction in leprosy among medical interns posted in central leprosy institute
Pugazhenthan Thangaraju1, Sajitha Venkatesan2, K Arunagiri2, T Tamilselvan3, Elavarasan Sivashanmugam2, M K Showkath Ali4
1 Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
2 Department of Clinical and Laboratory Division, Central Leprosy Teaching and Research Institute, Chengalpattu, Tamil Nadu, India
3 Department of Information Technology, SRM University, Gangtok, Sikkim, India
4 Advisor, National Center for Disease Control, Calicut, India
|Date of Submission||31-Jul-2018|
|Date of Decision||26-Sep-2018|
|Date of Acceptance||14-Oct-2018|
|Date of Web Publication||24-Dec-2019|
Dr. Pugazhenthan Thangaraju
Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Context: There is no study evaluating the teaching orientation regarding polymerase chain reaction (PCR) in leprosy.
Aims: The aim of the study is to assess the level of teaching orientation and knowledge of medical interns regarding PCR in leprosy.
Settings and Design: It is a cross-sectional study done in Central Leprosy Teaching and Research Institute (CLTRI), Chengalpattu, during October to December 2017.
Subjects and Methods: A pretested and well-structured questionnaire consisting of 13 questions (11 – option question, 1 – wrongly introduced accessing question, and 1 – the intern's attitude question) was administered to interns posted in CLTRI on day 2 and the same day after orientation. The questions were grouped under different headings and covered various aspects of PCR.
Statistical Analysis Used: Paired t-test was used to determine significance at P < 0.05.
Results: A total of 42 interns were surveyed. The male and female were 16 (38%) and 26 (62%), respectively. The posttest analysis after teaching orientation was statistically significant and also helps in exploring the molecular aspect of leprosy for the junior medical interns in academic settings.
Conclusion: This is the first study done in this rare area of molecular aspect of leprosy teaching and this also helped us to know the medical interns' inclination toward working in molecular laboratory.
The following core competencies are addressed in this article: Practice-based learning and improvement, Systems-based practice.
Keywords: Knowledge, leprosy, medical interns, polymerase chain reaction, teaching
|How to cite this article:|
Thangaraju P, Venkatesan S, Arunagiri K, Tamilselvan T, Sivashanmugam E, Ali M K. Effectiveness of teaching orientation on polymerase chain reaction in leprosy among medical interns posted in central leprosy institute. Int J Acad Med 2019;5:180-3
|How to cite this URL:|
Thangaraju P, Venkatesan S, Arunagiri K, Tamilselvan T, Sivashanmugam E, Ali M K. Effectiveness of teaching orientation on polymerase chain reaction in leprosy among medical interns posted in central leprosy institute. Int J Acad Med [serial online] 2019 [cited 2020 Sep 21];5:180-3. Available from: http://www.ijam-web.org/text.asp?2019/5/3/180/273931
| Introduction|| |
Leprosy is a chronic granulomatous infectious disease that affects the skin, mucosa, and peripheral nerve. It is caused by an acid-fast bacillus, Mycobacterium leprae, which is a droplet infection. If untreated, it will lead to disability, deformity that will lead to the social stigma for the patients' in rest of their life. Hence, insist was made on early detection and treatment of M. leprae.
Diagnosis of leprosy has been based mainly on clinical examinations of skin and peripheral nerves and slit skin smears. The microscopy has an advantage in peripheral and referral centers with its detection limit of 104 bacilli/ml but with an expertise in reporting, and also, it suffers from low sensitivity. This drawback can be overcome with DNA-based polymerase chain reaction (PCR) and that has shown superior to detect bacilli in all clinical samples such as blood, urine, lymph, tissues, and skin.,,,, However, their application is not wide in resource-poor countries.
The importance of PCR in leprosy is stressed in several situations among the researchers and in academics. The Central Leprosy Teaching and Research Institute (CLTRI) is a 124-bedded hospital in South India, which caters various services in the field of leprosy like diagnosis (clinical/laboratory), medical, surgical management with physiotherapy intervention. A full-blown molecular biology department is functional with special emphasis on PCR techniques in diagnosis of difficult to diagnose leprosy cases. The techniques have been used for drug resistance study also. A scheduled training of all health professionals in molecular leprosy is a part of functional academics.
The aim of the study has been to evaluate the orientation teaching to the medical interns posted for 5 days in the institute with a day posting in laboratory inclusive of molecular teaching.
| Subjects and Methods|| |
This is an analysis done to evaluate the effectiveness of the orientation teaching for interns in PCR in leprosy in CLTRI, Chengalpattu, Tamil Nadu, after due approval. The interns were from nearby government and private medical colleges. The time duration of the study is 2 months between October 2017 and December 2017. The questionnaire was composed of three parts with 13 questions: question number 1–11 is about PCR, question number 12 is a preplanned introduction of a wrong question for assessment by interns, and question number 13 is regarding the interest of the interns in the field of molecular medicine. A score of 1 is given for right answer.
The collected data consisted only of numerical variables. The completed questionnaires data were entered in Excel 2010 and it was applied to manage data. The Statistical Package for the Social Sciences version 20.0 (SPSS 20, IBM, Armonk, NY, United States of America) was used for data analysis. The results were summarized using frequencies and percentages for correct responses. The alpha level was set at 0.05 to determine statistical significance. The paired t-test is used for knowing the significance between the pretest and posttest scoring.
| Results|| |
A total of 42 interns were completed posting in 2 months. About 16 (38%) and 26 (62%) were male and female, respectively [Figure 1].
From [Figure 2], it is seen that in pretest, only 9 (21.43%) interns gave correct response for causative organism for leprosy, 27 (64.29%) for leprosy diagnosed in laboratory by smear, histopathology, and PCR, all 42 (100%) gave correct response for expansion of PCR, 26 (61.90%) gave correct response to limitation of conventional laboratory diagnosis, 19 (45.24%) for PCR assay, 25 (59.52%) for different types of specimens and application of PCR in laboratory diagnosis, 19 (45.24%) for application of PCR in drug resistance, 26 (61.90%) for problem in screening of drug resistance in animals, 20 (47.62%) for the base pair for M. leprae commonly used in our setup, and 11 (26.19%) for the base pair for rifampicin gene commonly used in CLTRI. In posttest analysis except for question number 5, 10, and 11, namely PCR assay, the base pair for M. leprae commonly used in CLTRI, and the base pair for rifampicin gene commonly used in CLTRI question, 41 have answered it right and rest all other questions were answered correctly by all the respondents.
|Figure 2: Total number of respondent given a correct response in pre- and posttest|
Click here to view
From [Table 1], it was seen that around 35.12% were above 7 marks in the pretest that was converted into 100% after orientation in molecular laboratory.
From [Table 2], it was seen that there was a good increase in mean score from pretest to posttest showing good teaching and orientation provided to the interns.
From [Table 3], it is clearly shown that there is a higher significance of the effect of orientation to all interns regarding PCR in leprosy.
A wrong question was introduced for assessing the specific orientation in base pair sequence. About 34 (80.95%) have attended the question in pretest. After class on PCR in leprosy, only 14 (33.34%) interns have identified the question as wrong and given the answer by the side. In the rest of the 28 interns, 26 (61.90%) not attended the question and 2 (4.76%) again gave the wrong responses that were later revealed to the interns.
Regarding interest in molecular work from [Figure 3], there was a strong impact of the teaching orientation that made 30 (71.43%) medical interns to develop interest in molecular field.
| Discussion|| |
The main advantage of PCR in leprosy is useful in detecting leprae DNA in difficult to make diagnoses cases and helps in correct diagnosis and the early identification and treatment. As it is mentioned in published literature, the molecular tests for leprosy diagnosis have revealed that clinical manifestations in pure neural leprosy are much more common.,, Furthermore, PCR has been utilized for surveillance of household contacts of leprosy patients and helps in early diagnosis of the disease and managing accordingly. Even though it has been used in many advantageous ways, still it is not available in most of the teaching medical colleges and the government hospital setup. Hence, getting exposed by MBBS students in molecular areas specific to PCR in leprosy is difficult in their early academic career.
Hence, this study was planned in exposing the junior medical interns in molecular area of leprosy in the central leprosy institute. This is the first study done in a molecular teaching in leprosy for medical interns in the postelimination era of leprosy. The medical interns were posted in our institute as per defined scheduled timetable in clinical, surgical, laboratory, and epidemiology division.
In laboratory, the medical interns were focused to cover the informations available in sterile animal house premises and facilities in the molecular laboratory. We consider these two areas are of great importance for researches in leprosy and we provided a junior medical intern an opportunity to get access during their early educational career.
A pre- and posttest survey was done after giving a minimum of 1–2 h of teaching orientation.
From the analysis, it is shown that there was a greater improvement in the knowledge of PCR among the medical interns that was depicted by the posttest analysis. This shows the impact of our training in molecular PCR toward the junior medical graduates. This encouraged us to teach the future medical and health-care professionals in the molecular domain of leprosy. This will also encourage them to plan PCR for any difficult to diagnose cases and for the treatment and diagnosis of relapse cases due to drug resistance.
Furthermore, after teaching it is also found that 30 (71.43%) interns have shown their inclination toward the molecular field in future. This also shows their understanding in molecular aspect of any diseases, and in future, all these molecular methods will support the health-care professionals for better diagnosis, treatment, and follow-up.
There are few limitations for this survey. The design of the study has limited participation of medical interns as the period is of short duration. Furthermore, there were a limited number of respondents for few questions and more could be learned from assessing large volumes of participants. Thus, application of these findings in general needs to be correlated with caution.
| Conclusion|| |
This study helped us to penetrate the molecular knowledge into the medical interns' mind. Through our orientation, our medical interns became increasingly knowledgeable about the diagnosis of leprosy through molecular medicine. Our hope is that we can take our findings and apply it toward better teaching and development of our orientation program in various aspects of molecular medicine.
The authors would like to sincerely thank Mr. Robert, for his support in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Ethical conduct of research
The study has been well discussed and got permitted from the competent authority of the institution. Since no human/animals involved as a trial, the study has been approved locally in the institute. The authors followed applicable EQUATOR Network (http://www.equator-network.org) research reporting guidelines.
| References|| |
Lastória JC, Abreu MA. Leprosy: Review of the epidemiological, clinical, and etiopathogenic aspects – Part 1. An Bras Dermatol 2014;89:205-18.
Diagnosis and classification of leprosy. In: Report of the International Leprosy Association Technical Forum 2002. Lepr Rev 2002;73:S17-26.
Shepard CC, McRae DH. A method for counting acid-fast bacteria. Int J Lepr Other Mycobact Dis 1968;36:78-82.
Woods SA, Cole ST. A rapid method for the detection of potentially viable Mycobacterium leprae
in human biopsies: A novel application of PCR. FEMS Microbiol Lett 1989;53:305-9.
Hartskeerl RA, de Wit MY, Klatser PR. Polymerase chain reaction for the detection of Mycobacterium leprae
. J Gen Microbiol 1989;135:2357-64.
Plikaytis BB, Gelber RH, Shinnick TM. Rapid and sensitive detection of Mycobacterium leprae
using a nested-primer gene amplification assay. J Clin Microbiol 1990;28:1913-7.
Williams DL, Gillis TP, Booth RJ, Looker D, Watson JD. The use of a specific DNA probe and polymerase chain reaction for the detection of Mycobacterium leprae
. J Infect Dis 1990;162:193-200.
Wichitwechkarn J, Karnjan S, Shuntawuttisettee S, Sornprasit C, Kampirapap K, Peerapakorn S, et al.
Detection of Mycobacterium leprae
infection by PCR. J Clin Microbiol 1995;33:45-9.
Antunes SL, Chimelli L, Jardim MR, Vital RT, Nery JA, Corte-Real S, et al.
Histopathological examination of nerve samples from pure neural leprosy patients: Obtaining maximum information to improve diagnostic efficiency. Mem Inst Oswaldo Cruz 2012;107:246-53.
Jardim MR, Antunes SL, Santos AR, Nascimento OJ, Nery JA, Sales AM, et al.
Criteria for diagnosis of pure neural leprosy. J Neurol 2003;250:806-9.
Jardim MR, Antunes SL, Simons B, Wildenbeest JG, Nery JA, Illarramendi X, et al.
Role of PGL-I antibody detection in the diagnosis of pure neural leprosy. Lepr Rev 2005;76:232-40.
Martinez AN, Talhari C, Moraes MO, Talhari S. PCR-based techniques for leprosy diagnosis: From the laboratory to the clinic. PLoS Negl Trop Dis 2014;8:e2655.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]