UTHealth collaborates with Rice University to save lives of CVD patients in Fiji

A device born out of a collaboration between The University of Texas Health Science Center at Houston (UTHealth) and Rice University could save lives in Fiji where cardiovascular disease has been called a pandemic.

The device, the AutoSyP, was designed for patients in developing nations who need quick access to medications such as clot busters, which must be given a drop at a time for hours.

"In a lot of the developing world, there's a tremendous burden of cardiac disease," said Rohith Malya, M.D., assistant professor and director of the Division of Global Health in the Department of Emergency Medicine at the UTHealth Medical School. "Fiji is the epicenter of it all. They have a death rate from heart attacks about five to eight times that of the United States."

In the Western world, Malya said, hospitals often treat clots in a catheterization lab where they can receive angioplasty balloons or stents. "But these machines are expensive, and few organizations apart from high-level Western hospitals are able to build and staff them. We're interested in putting older medications to new uses to get Western-level outcomes - bypassing the need for angioplasty in resource-limited settings. There's research out there that suggests this is possible," Malya said.

He approached Rebecca Richards-Kortum, Ph.D., director of the Rice 360˚ Institute for Global Health Technologies, and Maria Oden, Ph.D., director of the Oshman Engineering Design Kitchen, for help.

They in turn brought together a team of students to tackle the problem. The Rice engineering seniors who call themselves Chemomatic have won honors for their box, which costs less than $400. They placed third in the 2013 University of Minnesota Design of Medical Devices student competition earlier this month. But the real payoff will come when UTHealth physicians and residents take the device to Fiji for evaluation with heart-attack and stroke patients.

Malya said heart attacks tend to strike Fijians in their 30s and 40s, much younger than in the Western world. "We think there's a genetic predisposition to the Western diet being exceptionally harmful to them," he said. "The Western diet and tobacco came to them about 30 years ago, at a time when they were a nation of fishermen and everyone was rather healthy."

Fiji was among the South Pacific nations that declared a pandemic for heart disease at the United Nations in 2011. "It was the first time a non-communicable disease was declared a pandemic for any region," Malya said. "This was a wake-up call - as nations started to live like us in the West, they began to die like us at rates much faster than anyone anticipated."

Rice students Glenn Fiedler, Peter Jung, Lemuel Soh and Kevin Jackson designed their device to run for 24 hours using very little battery power as it delivers a measured dose of drugs or saline to a patient more accurately than an IV drip would. Though it can help treat patients with many needs, the first are likely to be cardiac and stroke patients like those under the care of Malya and Amy Noland, M.D., an assistant professor of emergency medicine at UTHealth who also works with the team. Malya and Noland were the clinical mentors for the team.

"Myocardial infarctions are ischemic events, clots that develop in the heart, so you use thrombolytic drugs like tPA and streptokinase to break up the clot," said Jackson, who plans to attend medical school after graduating from Rice. "Both can be used for cardiovascular events. Some strokes are ischemic events, a clot in the brain, and you can use tPA."

The AutoSyP delivers force to syringes of various sizes through a spring-driven ratchet-and-pawlescapement system, like those found in timepieces. "The idea is to regulate something that wants to unwind quickly," said Jung, also a future medical student, explaining why the team used a battery-driven stepper motor to disengage the two pawls from the ratchet in turn.

"The spring wants to unwind the ratchet, but it's opposed by the pawls," Jung said. "So to knock these pawls up one at a time and allow the release in spring tension, we need to input some energy."

Every step pushes the syringe plunger a tiny bit forward. A few simple adjustments allow a clinician to adapt the device for various syringe sizes.

They want the AutoSyP to be portable enough to be used in ambulances. "As they like to say, time is tissue," Jackson said. "The longer you wait (to deliver treatment), the more of it is dying."

Malya hopes to have one or more AutoSyP prototypes in Fiji for evaluation by health officials within the next six months.

"If this works in Fiji, it's very expandable to relieve noncommunicable disease burdens in much of Africa and Southeast Asia," Malya said. "If you start at Bangkok and draw a 1,000-mile radius, you cover 30 percent of the world's population growth. This is a region that is astoundingly susceptible to heart disease, diabetes and stroke."