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Nanopharmacology
and
Nanomedicine
Dr. Basavaraj K. Nanjwade M. Pharm., Ph. D.
Director and Professor
KLE College of Pharmacy,
NIPANI-591 237, Karnataka, India.
E-mail: nanjwadebk@gmail.com
Cell No: 0091 9742431000
1Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanotechnology map
2Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanoscience
• Nanoscale has different definitions in different
scientific fields such as 1-100 nanometers in
physics and chemistry, 0.1-100 nm in some early
monograghs and 1-1000 nm in biomedicine
literatures.
• The bottom up assemble with atoms one by one
• 100 nm (or below) particles at bone marrow,
• 100-200 nm particles at reticular epithelial
systems.
3Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanopharmacology
• Nanopharmacology, a new branch of
pharmacology is gradually emerging with the
application of nanoscience and nanotechnology
in the field of nanomedicine.
• The interactions between traditional drugs and
physiological systems at nanoscle level.
4Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanopharmacology
Drug design and drug delivery to
selected targets to improve
pharmacodynamics and kinetic profiles
toward safer and effective treatment is
known as nanopharmacology.
5Suvarna JNMC National Seminar, Belgaum.15 February 2013
Categorized Nanopharmacology
• Defining targets
• Development of drugs and carrier systems
• Studying target–drug interactions
• Monitoring the target–drug interaction
outcomes
6Suvarna JNMC National Seminar, Belgaum.15 February 2013
Defining targets
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 7
Development of drugs and carrier
systems
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 8
Studying target–drug
interactions
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 9
• Pharmacokinetic interactions
– Absorption
– Distribution
– Biotransformation
– Excretion
• Pharmacodynamic interactions
– Receptor interaction
– Receptor sensitivity
– Neurotransmitter release/Drug transportation
– Electrolyte balance
• Pharmaceutical interactions
Studying target–drug
interactions
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 10
Usually, the binding sites of macromolecules are more
hydrophobic in nature than the surface, and so this enhances the
effect of an ionic interaction.
The drop off in ionic bonding strength with separation is less than
in other intermolecular interactions, so if an ionic interaction is
possible, it is likely to be the most important initial interaction as
the drug enters the binding site.
Quantitative systems
pharmacology
11Suvarna JNMC National Seminar, Belgaum.15 February 2013
Monitoring the target–drug
interaction outcomes
1) Loss of therapeutic effect
2) Toxicity
3) Unexpected increase in pharmacological
activity
4) Beneficial effects e.g additive & potentiating
(intended) or antagonism (unintended).
5) Chemical or physical interaction
e.g I.V incompatibility in fluid or syringes
mixture
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 12
Nanopharmacology features
1. Using nanoscale tools, such as scanning probe
microscopy.
2. Studying particulate drugs, especially the
nanoparticulate drugs.
3. Studying the influences of the nanoparticulate
properties of nano drug carriers on the therapeutic
effects of drugs that they carry.
4. Nanopharmacology theories will provide instructions
for the bottom up assemble of nanodrugs with atoms
one by one.
13Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanopharmacology Target
• Slow release nanopharmacology
• Controlled release nanopharmacology
• Bio barrier penetration nanopharmacology
14Suvarna JNMC National Seminar, Belgaum.15 February 2013
Slow release nanopharmacology
• The slow-release nanopharmacology studies
the question on how to realize the slow release
and the influences of slow release on the drug
metabolisms and the therapeutic effects.
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 15
Slow release nanopharmacology
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 16
Controlled release
nanopharmacology
• The controlled-release nanopharmacology
studies how to realize the smart release of the
drugs according to the therapeutic needs in
the cellular and tissue microenvironments.
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 17
Bio barrier penetration
nanopharmacology
• Bio-barrier-penetration nanopharmacology
studies the capabilities of nanodrugs to passing
through bio-barriers.
• Blood-brain barrier
• Air-blood barrier
• To realize the treatment of some focal diseases
where the traditional drugs can’t arrive because
their incapability of penetrate biobarriers.
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 18
Transport of molecules across the BBB
19Suvarna JNMC National Seminar, Belgaum.15 February 2013
Air-blood barrier
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 20
The perfect drug!
Reality
• All drugs have side effects but new drugs aim to
provide beneficial effects with minimal side effects
How is this achieved?
1. Identify new molecules
2. Modify structure of know molecules
• Test in biological tissue or whole body
21Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanotechnology – based drug
delivery Systems
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 22
Nanomedicine
23Suvarna JNMC National Seminar, Belgaum.15 February 2013
Definition of Nanomedicine
• Nanomedicine is the one of the most valuable medical
application of nanotechnology as the name specifies
naomedicine involves the use of nano particles in the
surgical and medical treatement of pateints.
OR
• We can say nanomedicine is the nanotechnology
application which is used for engineering or binding
molecular or atomic machines for the treatment of
diseases in living organisms.
24Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanomedicine
– Nanomedicine is nanotechnology used for
the treatment, diagnosis, monitoring and
control of biological systems
– Nanomedicine includes the delivery and
targeting of pharmaceutical, therapeutic,
and diagnostic agents using nanoparticles
to cancer and other cells
– Nanomedicine includes nanomaterial for
bone, cartilage, vascular, bladder and
neural applications
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 25
Background
• Nanomedicine is the monitoring, repair,
construction, and control of human biological
systems at the molecular level using
engineered nanodevices and nanostructures.
• Nanomedicine, including nanodiagnostics,
nanotherapeutics, and the development of
nanomedical devices.
26Suvarna JNMC National Seminar, Belgaum.15 February 2013
How nanomedicine works?
• Nanomedicine works at a molecular or
atomic scale.
• The most advanced form of nanomedicine uses
the nanorobots and nanoinstruments as
surgeons.
• Nanomedicine repair damaged cells or get into
the cells and replace or assist damaged
intracellular structures at individual stage.
27Suvarna JNMC National Seminar, Belgaum.15 February 2013
Goals of Nanomedicine
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 28
• End goal of nanomedicine is improved diagnostics, treatment and
prevention of disease
Goals of Nanomedicine
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 29
• Ultimate goal is to integrate detection, diagnostics, treatment and
prevention of disease into a personalized single platform
Recent and future
breakthroughs in medicine
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 30
• Nanotechnology holds key to a number of recent and future
breakthroughs in medicine
Cancer Treatments
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 31
• Because of their small size,
nanoparticles can pass through
interstitial spaces between necrotic
and quiescent cells.
• Tumor cells typically have larger
interstitial spaces than healthy cells
• Particles collect in center bringing
therapeutics to kill the tumor from
inside out.
Nanoparticles as Sensors and
Therapeutics
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 32
• Glutathione (GSH) provides a selective and tunable release
mechanism
• Once inside cells, fluorophores and drugs selectively dissociate
Nanoparticle Success
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 33
• Both cationic and anionic particles penetrate and accumulate
in tumors.
• However, only cationic particles diffuse fully throughout the
tumor.
Types of contrast agents used
for MRI
34Suvarna JNMC National Seminar, Belgaum.15 February 2013
Contrast agents used for MRI
35Suvarna JNMC National Seminar, Belgaum.15 February 2013
Advantages and applications
• Diagnosis using nanomedicine
• Nervous system tracking
• Drugs dispersion
• Artificial antibodies.
• One of the biggest advantage of
naonoemdicne is that it can transform
common medical procedures into faster
one with 90 percent accuracy rate.
36Suvarna JNMC National Seminar, Belgaum.15 February 2013
Diagnosis using nanomedicine
• Diagnostic nano-apparatus could be attached
to keep check of the internal chemistry of the
body.
• Mobile nanorobots, with wireless transmitters,
could easily circulate in the blood and lymph
systems and send out alerts when chemical
imbalances appear within the blood.
37Suvarna JNMC National Seminar, Belgaum.15 February 2013
Drugs and contrast agents
38Suvarna JNMC National Seminar, Belgaum.15 February 2013
Detection of Cancer
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 39
Breast Cancer Cells Healthy Cells
• On the left, cancer cells fluorescence.
• On the right, healthy cells show minimal fluorescence.
Nervous system tracking
• Nanomedicine has also helped doctors to
better understand the phenomenal changes in
the human nervous systems.
• Fixed nanomachines could be inserted in the
nervous system of the human body to monitor
pulse rate, brain activity, and other important
functions.
40Suvarna JNMC National Seminar, Belgaum.15 February 2013
Drugs dispersion
• Live saving drugs are one of the important
ingredients in the latest medicines but its
unusual and excess usage could cause death.
• Nanomedicine also has successful applications for
the reduction of extra drugs from human body.
• Implantation of nanomedicine devices could
disperse drugs or hormones as required in people
with chronic imbalance or deficiency states.
41Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanomedicine platform for
targeted drug delivery
42Suvarna JNMC National Seminar, Belgaum.15 February 2013
Artificial antibodies
• Nanomedicine was the first to conceptualize the
artificial red and white blood cells and later on it
successfully showed the positive results.
• Cancer patients are now treated by injecting
artificial red blood cells to balance the human
body blood level.
• Artificial antibodies, white & red blood cells and
antiviral nanorobots could be considered as
successful applications of nanomedicine.
43Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanorobots
• Imagine going to the doctor to get treatment for
a persistent fever.
• Instead of giving a pill or a shot, the doctor
refers you to a special medical team which
implants a tiny robot into your bloodstream.
• The robot detects the cause of your fever, travels
to the appropriate system and provides a dose of
medication directly to the infected area.
• To treat everything from hemophilia to cancer.
44Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanorobots
• A viable nanorobot has to be small enough to
navigate through the human circulatory
system, an incredibly complex network of
veins and arteries.
• The nanorobot must also have the capacity to
carry medication or miniature tools.
45Suvarna JNMC National Seminar, Belgaum.15 February 2013
Nanorobot
46Suvarna JNMC National Seminar, Belgaum.15 February 2013
Advantages of Nanoscale
devices in Medicine
• Devices smaller than 50 nm can easily
enter most cells
• Devices smaller than 20 nm can transit
out of blood vessels
• Devices are capable of holding
thousands of small molecules
• Contrast Agents
• Drugs
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 47
Major Areas of Development
of Nanomedicine
• Prevention and control
• Early detection
• Imaging diagnostics
• Multifunctional Therapeutics
15 February 2013 Suvarna JNMC National Seminar, Belgaum. 48
Medicines research
49Suvarna JNMC National Seminar, Belgaum.15 February 2013
Thank Youe-mail: nanjwadebk@gmail.com
Cell No: 0091 9742431000
50Suvarna JNMC National Seminar, Belgaum.15 February 2013

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Nanopharmacology and nanomedicine

  • 1. Nanopharmacology and Nanomedicine Dr. Basavaraj K. Nanjwade M. Pharm., Ph. D. Director and Professor KLE College of Pharmacy, NIPANI-591 237, Karnataka, India. E-mail: nanjwadebk@gmail.com Cell No: 0091 9742431000 1Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 2. Nanotechnology map 2Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 3. Nanoscience • Nanoscale has different definitions in different scientific fields such as 1-100 nanometers in physics and chemistry, 0.1-100 nm in some early monograghs and 1-1000 nm in biomedicine literatures. • The bottom up assemble with atoms one by one • 100 nm (or below) particles at bone marrow, • 100-200 nm particles at reticular epithelial systems. 3Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 4. Nanopharmacology • Nanopharmacology, a new branch of pharmacology is gradually emerging with the application of nanoscience and nanotechnology in the field of nanomedicine. • The interactions between traditional drugs and physiological systems at nanoscle level. 4Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 5. Nanopharmacology Drug design and drug delivery to selected targets to improve pharmacodynamics and kinetic profiles toward safer and effective treatment is known as nanopharmacology. 5Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 6. Categorized Nanopharmacology • Defining targets • Development of drugs and carrier systems • Studying target–drug interactions • Monitoring the target–drug interaction outcomes 6Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 7. Defining targets 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 7
  • 8. Development of drugs and carrier systems 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 8
  • 9. Studying target–drug interactions 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 9 • Pharmacokinetic interactions – Absorption – Distribution – Biotransformation – Excretion • Pharmacodynamic interactions – Receptor interaction – Receptor sensitivity – Neurotransmitter release/Drug transportation – Electrolyte balance • Pharmaceutical interactions
  • 10. Studying target–drug interactions 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 10 Usually, the binding sites of macromolecules are more hydrophobic in nature than the surface, and so this enhances the effect of an ionic interaction. The drop off in ionic bonding strength with separation is less than in other intermolecular interactions, so if an ionic interaction is possible, it is likely to be the most important initial interaction as the drug enters the binding site.
  • 11. Quantitative systems pharmacology 11Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 12. Monitoring the target–drug interaction outcomes 1) Loss of therapeutic effect 2) Toxicity 3) Unexpected increase in pharmacological activity 4) Beneficial effects e.g additive & potentiating (intended) or antagonism (unintended). 5) Chemical or physical interaction e.g I.V incompatibility in fluid or syringes mixture 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 12
  • 13. Nanopharmacology features 1. Using nanoscale tools, such as scanning probe microscopy. 2. Studying particulate drugs, especially the nanoparticulate drugs. 3. Studying the influences of the nanoparticulate properties of nano drug carriers on the therapeutic effects of drugs that they carry. 4. Nanopharmacology theories will provide instructions for the bottom up assemble of nanodrugs with atoms one by one. 13Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 14. Nanopharmacology Target • Slow release nanopharmacology • Controlled release nanopharmacology • Bio barrier penetration nanopharmacology 14Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 15. Slow release nanopharmacology • The slow-release nanopharmacology studies the question on how to realize the slow release and the influences of slow release on the drug metabolisms and the therapeutic effects. 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 15
  • 16. Slow release nanopharmacology 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 16
  • 17. Controlled release nanopharmacology • The controlled-release nanopharmacology studies how to realize the smart release of the drugs according to the therapeutic needs in the cellular and tissue microenvironments. 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 17
  • 18. Bio barrier penetration nanopharmacology • Bio-barrier-penetration nanopharmacology studies the capabilities of nanodrugs to passing through bio-barriers. • Blood-brain barrier • Air-blood barrier • To realize the treatment of some focal diseases where the traditional drugs can’t arrive because their incapability of penetrate biobarriers. 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 18
  • 19. Transport of molecules across the BBB 19Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 20. Air-blood barrier 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 20
  • 21. The perfect drug! Reality • All drugs have side effects but new drugs aim to provide beneficial effects with minimal side effects How is this achieved? 1. Identify new molecules 2. Modify structure of know molecules • Test in biological tissue or whole body 21Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 22. Nanotechnology – based drug delivery Systems 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 22
  • 23. Nanomedicine 23Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 24. Definition of Nanomedicine • Nanomedicine is the one of the most valuable medical application of nanotechnology as the name specifies naomedicine involves the use of nano particles in the surgical and medical treatement of pateints. OR • We can say nanomedicine is the nanotechnology application which is used for engineering or binding molecular or atomic machines for the treatment of diseases in living organisms. 24Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 25. Nanomedicine – Nanomedicine is nanotechnology used for the treatment, diagnosis, monitoring and control of biological systems – Nanomedicine includes the delivery and targeting of pharmaceutical, therapeutic, and diagnostic agents using nanoparticles to cancer and other cells – Nanomedicine includes nanomaterial for bone, cartilage, vascular, bladder and neural applications 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 25
  • 26. Background • Nanomedicine is the monitoring, repair, construction, and control of human biological systems at the molecular level using engineered nanodevices and nanostructures. • Nanomedicine, including nanodiagnostics, nanotherapeutics, and the development of nanomedical devices. 26Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 27. How nanomedicine works? • Nanomedicine works at a molecular or atomic scale. • The most advanced form of nanomedicine uses the nanorobots and nanoinstruments as surgeons. • Nanomedicine repair damaged cells or get into the cells and replace or assist damaged intracellular structures at individual stage. 27Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 28. Goals of Nanomedicine 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 28 • End goal of nanomedicine is improved diagnostics, treatment and prevention of disease
  • 29. Goals of Nanomedicine 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 29 • Ultimate goal is to integrate detection, diagnostics, treatment and prevention of disease into a personalized single platform
  • 30. Recent and future breakthroughs in medicine 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 30 • Nanotechnology holds key to a number of recent and future breakthroughs in medicine
  • 31. Cancer Treatments 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 31 • Because of their small size, nanoparticles can pass through interstitial spaces between necrotic and quiescent cells. • Tumor cells typically have larger interstitial spaces than healthy cells • Particles collect in center bringing therapeutics to kill the tumor from inside out.
  • 32. Nanoparticles as Sensors and Therapeutics 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 32 • Glutathione (GSH) provides a selective and tunable release mechanism • Once inside cells, fluorophores and drugs selectively dissociate
  • 33. Nanoparticle Success 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 33 • Both cationic and anionic particles penetrate and accumulate in tumors. • However, only cationic particles diffuse fully throughout the tumor.
  • 34. Types of contrast agents used for MRI 34Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 35. Contrast agents used for MRI 35Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 36. Advantages and applications • Diagnosis using nanomedicine • Nervous system tracking • Drugs dispersion • Artificial antibodies. • One of the biggest advantage of naonoemdicne is that it can transform common medical procedures into faster one with 90 percent accuracy rate. 36Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 37. Diagnosis using nanomedicine • Diagnostic nano-apparatus could be attached to keep check of the internal chemistry of the body. • Mobile nanorobots, with wireless transmitters, could easily circulate in the blood and lymph systems and send out alerts when chemical imbalances appear within the blood. 37Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 38. Drugs and contrast agents 38Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 39. Detection of Cancer 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 39 Breast Cancer Cells Healthy Cells • On the left, cancer cells fluorescence. • On the right, healthy cells show minimal fluorescence.
  • 40. Nervous system tracking • Nanomedicine has also helped doctors to better understand the phenomenal changes in the human nervous systems. • Fixed nanomachines could be inserted in the nervous system of the human body to monitor pulse rate, brain activity, and other important functions. 40Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 41. Drugs dispersion • Live saving drugs are one of the important ingredients in the latest medicines but its unusual and excess usage could cause death. • Nanomedicine also has successful applications for the reduction of extra drugs from human body. • Implantation of nanomedicine devices could disperse drugs or hormones as required in people with chronic imbalance or deficiency states. 41Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 42. Nanomedicine platform for targeted drug delivery 42Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 43. Artificial antibodies • Nanomedicine was the first to conceptualize the artificial red and white blood cells and later on it successfully showed the positive results. • Cancer patients are now treated by injecting artificial red blood cells to balance the human body blood level. • Artificial antibodies, white & red blood cells and antiviral nanorobots could be considered as successful applications of nanomedicine. 43Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 44. Nanorobots • Imagine going to the doctor to get treatment for a persistent fever. • Instead of giving a pill or a shot, the doctor refers you to a special medical team which implants a tiny robot into your bloodstream. • The robot detects the cause of your fever, travels to the appropriate system and provides a dose of medication directly to the infected area. • To treat everything from hemophilia to cancer. 44Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 45. Nanorobots • A viable nanorobot has to be small enough to navigate through the human circulatory system, an incredibly complex network of veins and arteries. • The nanorobot must also have the capacity to carry medication or miniature tools. 45Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 46. Nanorobot 46Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 47. Advantages of Nanoscale devices in Medicine • Devices smaller than 50 nm can easily enter most cells • Devices smaller than 20 nm can transit out of blood vessels • Devices are capable of holding thousands of small molecules • Contrast Agents • Drugs 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 47
  • 48. Major Areas of Development of Nanomedicine • Prevention and control • Early detection • Imaging diagnostics • Multifunctional Therapeutics 15 February 2013 Suvarna JNMC National Seminar, Belgaum. 48
  • 49. Medicines research 49Suvarna JNMC National Seminar, Belgaum.15 February 2013
  • 50. Thank Youe-mail: nanjwadebk@gmail.com Cell No: 0091 9742431000 50Suvarna JNMC National Seminar, Belgaum.15 February 2013