Indian Journal of Rheumatology 2011 December Volume 6, Number 4; p. 165
Editorial
Innovations in rheumatology: Order of the day Subramanian Shankar1, Yanamandra Uday2
Scientific advances and new technologies progressively help in the understanding of a disease. “Screening” tools, which help physicians sort through diseases in a short period, have reduced the time and cost associated with detailed interrogation. Nailfold video capillaroscopy is one such screening tool providing insight into capillary bed dynamics involved in pathophysiology of diseases like scleroderma. Behind every new medicine/technology is a story of a researcher’s persistence. Their stories of discovery combine cutting edge science, curiosity, plain hard work and sometimes, plain luck. We in this edition bring forward an innovation in field of rheumatology which was the brainchild of a young Indian rheumatologist.1 This innovation was made plausible due to presence of mind and lateral thinking vis-ávis high technology laboratory-room research. The technique involves utilisation of a digital microscope and modifying it for usage as a video capillaroscope. The rheumatologist, while in a jewellers shop, noticed an electronic gadget with which the merchant was assessing the quality of diamonds. On an enquiry, he discovered that it was merely a magnifier (digital microscope) which would magnify any object by 200 times. An attempt to view nail fold capillaries yielded positive results with reasonable clarity. Enquiry revealed that the same instrument was also being used by hardware engineers to look at electronic circuits. After working through several variations and after assessing over 2000 nail folds, he was able to identify a good working model at a reasonable cost. The high end video capillaroscope in West are priced anywhere between USD 5000 and USD 40,000 ( 2.5 lakhs to 20 lakhs). Owing to financial constraints, almost none of the Indian centres is presently equipped with this instrument. The modified digital microscopes can
be procured at a fraction of the cost, i.e. 5000 or so. In this world of increasing cost of medicines and technology, an innovation to cut the cost of investigations with equivalent results are a welcome addition. The digital microscope provides images almost 20 times bigger and better than the existing techniques and the same can be visualised on computer screens. Images can also be enhanced or edited utilising any picture manager software. Videos can be recorded and printouts given to patients. Unlike the conventional video capillaroscope that is quite bulky in nature, the digital microscope can be installed anywhere with a laptop/computer and can be used to interpret images. It is a good supplement to the rheumatologist’s office even in field conditions and needs no major infrastructural support. This innovation provides easy accessibility into new areas of research as the capillaries can be easily visualised and measured in various situations. Complementary software is under development and once integrated with the microscope, promises to be an excellent alternative to the video capillaroscope at a fraction of the cost. A clarion call to all rheumatologists! In this era of high cost medicine, innovations in various aspects of diagnosis and therapy can be the biggest contribution.
REFERENCE 1.
Vasdev V, Bhakuni DS, Bhayana A, Kamboj P. Nailfold capillaroscopy: a cost effective practical technique using digital microscope. Indian J Rheumatol 2011; 6: 185–91.
1 Professor of Medicine, Rheumatologist and Clinical Immunologist, 2Assistant Professor in Medicine, Department of Internal Medicine, Armed Forces Medical College, Pune – 411040, India. Correspondence: Gp Capt Subramanian Shankar, email:
[email protected]
doi: 10.1016/S0973-3698(11)60200-8
