Three Devices in Development Now Could Improve Health in India

by Rob Goodler

BENGALURU (Reuters Health) - Two prototypes in development in India target medical conditions common to developing
countries: a skin-infection-diagnosing dermoscope and a hypothermia-monitoring bracelet for newborns.

The devices took two of the top three places at the hardware exposition iShow, held here by the American Society of Mechanical Engineers on April 28.

The dermoscope, now in early development, is an ultraviolet lamp and detector designed to identify bacterial and fungal infections on the skin. In principle, the device would bathe the skin in varying wavelengths of ultraviolet light to cause any pathogens that might be present to fluoresce.

The fluorescence and the precise UV wavelength that causes it would pinpoint the species, said Geethanjali Radhakrishnan, founder at Adiuvo Diagnostics in Chennai, who heads the dermoscope development.

Thus far the device has been tested on fluorescent ink on paper. Following further refinement, Radhakrishnan told Reuters
Health that her team plans to begin trials in a dermatology clinic later this year.

"Skin and soft-tissue infections are the biggest burden that we face right now, especially in" intensive care units, says Dr. Aayush Gupta, a dermatologist at Dr. D.Y. Patel Medical College in Pune, who is advising the dermoscope development.

Dr. Gupta likes two things about the device, he said. 

First, it could make a diagnosis instantly and forego the normal procedure of sending samples off to a lab for a culture.
Rather than waiting for results that can take one to four weeks, doctors commonly send the sample and immediately prescribe broad-spectrum antibiotics. If this device prevents those kinds of blanket prescriptions, it could slow the progression of antibiotic resistance, Dr. Gupta said.

Second, the dermoscope may be able to detect pathogens on clothes, equipment, and other surfaces in the hospital.

"The way I see the dermoscope fitting in here is 'import substitution' of expensive equipment," says Arun Venkatesan, a
senior advisor for Villgro, a social enterprise incubator, and an advisor to iShow, who specializes in the development of
low-cost products with "social impact" like the dermoscope.

"In India, device cost is not only part of the overall cost, a lot of times it's an enabler. Having a device that's affordable changes the treatment paradigm," Venkatesan says.

Radhakrishnan does not know what the retail cost might be, but she guesses that it could be affordable enough for
widespread use.

The dermoscope has similarities to Wood's lamp, a UV lamp that has been in use since its invention in 1903. One of the
dermoscope's advantages over that instrument is that it emits light in varying wavelengths rather than just one, giving it the potential to identify specific pathogens.

The hypothermia monitor, called Bempu, is a bracelet that tracks a newborn's temperature and the duration at which it
drops below a certain threshold. The bracelet beeps if the baby is cold for too long.

The exact amount of time and the temperature threshold are proprietary secrets plugged into an algorithm that governs the alarm.

Bempu is in a late stage of development. The bracelet has been used in neonatal intensive care units, including in
surgery, and consumer sales have begun, priced at 2,000 Indian rupees (US $30).

"Since we launched in November, we've already caught three babies with sepsis at least 24 hours before standard care would have, and saved those babies' lives," says Gini Morgan, a public health specialist on Bempu's development team.

Independent analysis of the device's accuracy is under way in a cohort of 480 babies at Jawaharlal Institute of
Postgraduate Medical Education and Research in Puducherry. Preliminary results suggest that the device can accurately
predict mild hypothermia. Thus far it has had a sensitivity of 98% and specificity of 92%, with a positive predictive value of
78% and a negative predictive value of 99%.

"Neonatal mortality is quite high in India and one of the unexpected causes is hypothermia. Baby is swaddled and people
think it's a hot climate so it won't happen. But it does happen," Venkatesan says.

The third winner was Inc, a soot scrubber for the large diesel generators attached to cellphone towers in Delhi and
other major Indian cities. The devices prepare the soot they collect for conversion into ink, which is used to print clean-air-themed t-shirts and to paint murals. Each of the three winners took home $15,000 grants, 20 hours of consultation from
the U.S. firm Catapult Design and Autodesk software and advice.