The Hindu Business Line : An ANSwer to diabetes

You don't often see a house complete with conference hall, huge glass-top conference tables, custom-built acoustics and central air-conditioning, a hall that can be converted in minutes into an auditorium for a mini kutcheri.

You don't often see a house where an automated plumbing system waters the terrace garden twice a day at 4 a.m. and 10 p.m.

If Srini Nageshwar can pay so much attention to just his house, then surely his work must command even more passion. He has managed to bring together mathematics and medicine, resulting in a product called the ANSiScope.

But let's talk about you, the average medical patient, before we delve into this novelty of a product.

Have there been times when you wished medicines could treat the cause of a problem rather than the symptoms?

Haven't you ever once wished you could have spotted an affliction earlier than you did, just so you could have been spared the pain of a highly aggravated condition?

If those two wishes are to be granted, your doctor should know two things: one, know what the problem is, instead of just the symptoms; and two, the ability to spot a problem in an organ before the symptoms show up.

Nageshwar, with his team of researchers and scientists, has come up with this piece of equipment that can help doctors achieve those two aims above, at least in the area of treating diabetes.

He says, "The ECG is a huge repository of knowledge of the body. For now, we are only able to measure the rhythms of the heart. But it contains information on how other important body organs are functioning at the moment."

If all pieces of information from the ECG can be deciphered, it will give us more insight into the body's functioning than it does now.

But, the problem lies in the actual deciphering. Nageshwar gives a real world example. When a film sequence is captured on camera, it is converted into signals and transmitted from the TV station. Your TV is able to reconvert it and helps you view the film in the sequence it was transmitted.

He says, "This is possible only because man knew how the signals were produced from the original and hence it is easy to reconvert signals to generate the original sequence of the film."

In the case of the body, if a kidney or the liver malfunctions, it sends signals through the ECG. "Currently, since we don't know how those signals came to be in the first place, we are at a loss to use them to infer problems with other organs."

Nageshwar's team of scientists has used chaos theory and fractal geometry to do this - that is, use the information from the ECG to show what else is right or wrong with the body.

The device generates a couple of graphs that represent the parasympathetic and sympathetic signals from the body. These two signals play a huge role in determining whether the body is under pain or stress.

If either of these signals moves erratically from their normal paths, it is an indication that the body is undergoing some pain or stress. These two signals form what is called the autonomic nervous system. Hence the name for the product.

Who can use this?

Every general physician who uses equipment such as the stethoscope and the blood pressure machine in his clinic would have use for the ANSiscope, feels Nageshwar.

"Diabetes is a big killer, especially in India. One possible effect of diabetes is sensory neuropathy - the impairment of the nervous system - that has evident symptoms that the doctor could treat. But autonomic neuropathy has no outward symptoms. The ANSiscope helps spot this problem very early on."

In other words, if, in the normal course of events, a person is diagnosed with diabetes, it is possible that use of the ANSiscope could have detected some trouble very early - possibly months before the diagnosis actually happened.

"Doctors can then begin advising patients on lifestyle changes. At that early stage, it is possible to slow down the progress of the disease."

The second area where the device comes in handy is anaesthesiology. Since the signals that the device generates indicate the levels of stress or pain that the body undergoes, anaesthetists can act accordingly to help reduce pain.

But asks one anaesthetist, "If the device only works on signals from the ECG, we already have the ECG, among other sophisticated equipment in the operating room, to help us take decisions."

Nageshwar replies, "Our device is not a substitute for the ECG but a complement. It makes use of information in the ECG signals that are not presented to the naked eye by the ECG machine itself."

Dyansys, the company that makes the ANSiscope, conducted an experiment in Spain. A surgery was conducted without the aid of the ANSiscope while the Dyansys folks stood by with the device. Even after becoming unconscious, the patient was undergoing intense pain due to the incision.

The effect later showed up on the blood pressure machine. It took nine minutes longer than it need have to help reduce the pain.

"We believe that the ANSiscope could have helped the anaesthetist act faster," says Nageshwar. "And, in complex surgeries, minutes can make a difference to a life."

Echoing the above feeling, Dr Murali Chakravarthy, an anaesthetist who has been using the ANSiscope in his work for several months, says, "This has great scope for quicker and better diagnosis of killer diseases."

Interestingly, Nageshwar's team is as widely flung out, as the inspirations that went into designing his house are eclectic. He is based out of the US, while the research team is in Geneva and the engineering team is in Bangalore. He hopes to start production of the ANSiscope in Chennai.

Ask him about the market for his hand-held ANSiscope and he reels off statistics of the number of physicians graduating from Indian medical schools.

"Only a portion of that number registers with the all India medical association. Even a fraction of that number is a good enough market for me."

Thinking about it, the beauty of the device is not doing something wholly new, but using the information available in existing devices and applying complex theories to make them useful. Just like the floor-level planks placed next to the Western-style dining table... planks that he got from his ancestral home and which he has refurbished for visitors to have meals from plantain leaves on the floor while seated cross-legged.

Math in medicine

Nageshwar says his team uses sophisticated mathematics from the field of chaos theory and fractal geometry to make the ANSiscope work.

The net result of all this is a complex number. The real part of the complex number is the response of the sympathetic system and the imaginary part of the complex number is the response of the parasympathetic system.

The result is a 3D wave equation for the sympathetic system response and another 3D wave equation for the parasympathetic response. "These two waves are the three dimensional diagrams that are shown on our ANSiscope screen. We then play these waves against each other to yield the sympathovagal balance. This is like the trajectory of a free body under the attraction of two opposite poles (the sympathetic being one and the parasympathetic being the other).

This entire calculation is done at every R peak of the ECG signal. Hence the real-time signal display. From here, we derive two indices (to help doctors analyse the 3D waves). These are the sympathetic and the parasympathetic indices that are displayed on the screen of the ANSiscope."

bharatk@thehindu.co.in

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