1. PRESENTED BY Dr. N. Gopal Reddy, M.D. Associate Professor Anaesthesia& critical care KIMS-NKP, Nalgonda. Telangana. 1 Nanomedicine –its use in emergency and critical care.

2. Out line 2 Introduction of Nanomedicine Present day challenges Application of nanomedicine: 1.Diagnosis, 2.Treatment, 3. prevention. Use in Emergency and critical care, Conclusion.

3. What is NanoTechnology 3 Smallest Technology to be used at cellular, molecular and atomic level A nanometer is a billionth of a meter Use of nano tech in medicine is called nanomedicine Nano-robots(Nanobots) are used in this technology

4. What is nanomedicine 4 Def: Nanomedicine is the process of diagnosing, treating, preventing disease and traumatic injury, Relieving pain, Preserving and improving human health, Using molecular tools and molecular knowledge of the human body.

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6. Present day challenges 6 Vital organs failure, CVS, CNS, RESP, Renal, Hepatic Early cancer detection and treatment. Deadly Viral infections, drug resistant infections. Congenital defects and deformities. Neural defects, paralysis and control organs Trauma injuries, organ damages, amputations. Gene control, stem cell control, new organ growth Ageing and many others.

7. Nanotechnology-nanobots: 7 Primary technical tools -nanorobots. They programmed -to build other nano-bots. The Nano -boats are atomically build structures atom by atom by nano technology. They can perform multiple cellular level functions, including replacing, repairing DNA that is damaged in the cell as we age and diseased. They are self replicating.

8. NANOBOTS 8 They are very small, tiny robots will have built in power supplies, sensors and on board computers to direct activities. Travel through blood stream, even squeeze narrowest capillaries of the body. They are synthetic with biological function at atomic level and perform programmed task.

9. Shapes Of Nanobots 9

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11. NANOBOTS -USE 11 Repair of damaged tissue and cells Gases exchange-o2 and co2 Carries nutrients and others Drug delivery, Cancer detection and cure Investigation and imaging Gene silencing,. Anaesthesia Critical care, heart and lung repair Pain –palliative care

12. Advantages of nano robots 12 Nano robots are non biological entities– no side effects. Being highly specific and target oriented -reduce morbidity. Since they reach specific sectors, lesser drug required. They bind to terminal receptors. No peaks and troughs in effect. They do not follow first order kinetics as other injectables

13. Cell repair: 13 Damaged cells of the body can be very difficult to repair. But nanotechnology could provide a way to get around this. Small nanobots could be used to manipulate molecules and atoms on an individual cell level, repair them.

14. Nano bots in work in blood stream 14

15. Sickle cell repair 15

16. Different Nanorobot Species 16 Respirocytes. (Artificial red cells) Microbivores (artificial white cells) Clottocytes (artificial platelets) Pharmacytes (ideal drug delivery nanobots) Dentifrobots (dental nanobots) Vasculoid (complete artificial vasculature) Nonobuilders- (reconstructing nanobots)

17. 17 These nanostructures transport o2 in human body similar to erythrocytes 256 times faster. Shape- micron in diameter Also transport co2

18. 18 Artificial platelets -halt bleeding 1000 times faster. Number required is very less for desired activities. Specifically programmed motile clottocytes -detect internal bleeding and spontaneously seal the site. Giving hope for avoiding emergency surgeries. No bleeding diathesis, no DIC-syndrome. Reduces the ICU mortality.

19. CLOTTOCYTES -various stages of clot formation- and bleeding control 19 Image #208 Image #208 Fibot 1 Image #209 Image #209 Fibot 2 Image #210 Image #210 Fibot 3 Image #211 Fibot 4Image #211 Image #212 Image #212 Fibot 5 Image #213 Fibot 6Image #213

20. Microbivores 20 Microbivores would mimic white cells and perform phagocytosis of specific bacteria, viruses or fungi and including cancer cells. Microbivores

21. 21 This artificial white cells uses retractable tentacles, encircling the main body, to convey the idea of pathogen capture, in place of the hundreds of tiny telescoping arms that were employed in Freitas' original technical design. Catch bacteria and virus digest them and release non biological particles outside. Microbivores

22. Vasculoids: 22 A vasculoid is a single, complex, multi-segmented nanotechnological medical robotic system capable of all transport functions of the blood, including circulation of respiratory gases, glucose, hormones, cytokines, waste products and cellular components. This nanorobotic system could substitute the human vascular system.,

23. An ideal nanotechnology- based drug delivery system is a pharmacyte--a self- powered-Drug will de delivered at desired. An ideal nanotechnology- based drug delivery system is a pharmacyte--a self- powered-Drug will de delivered at desired. Drug-carrying nanoparticles may be targeted to specific cell types. 23 Pharmacytes

24. Diagnostics-medical lab 24 Nanotechnology-puts-a-medical-lab-in-your-hand with high-powered chip -performs various lab functions. Rapid testing, potentially in the doctors office - complete diagnosis and start of treatment immediately-stopping disease early possibly with less damage to the patient.

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26. Drug delivery to nerve endings, neuro –muscular junction or at required site -anaesthesia use- for pain control in pain & palliative care 26

27. 27 Vitals maintenance Infection control Antibiotic resistance Ventilator dependence ARDS Cardiac -Respiratory failure

28. RESPIRATORY CARE- CILIA CLEANING 28

29. Repair of ARDS lung 29

30. A single inhaled nanorobot reaches, deeply inspired into the lungs, enters an alveolar duct and attaches to the tissue surface. A pulmonary alveolar macrophage slowly crawls along the duct wall in the background and repair 30

31. Heart disease: 31 There is a possibility that nanobots could perform a number of heart related functions in the body. The repair of damaged heart tissue is only one possibility. Another option is to use nano devices to clean out arteries, helping unclog those that have buildup due to cholesterol and other problems.

32. Chest pain-heart care 32

33. Ischemia- blocked vessel 33

34. A nalysis and drug delivary-5 minutes 34

35. Nanobots injected-clearing plaques 35

36. CLEANING ARTERY 36

37. Nano boats-repairing artery 37

38. A nanomachine swimming through a capillary attacks a fat deposit (such as normally may accompany an arteriosclerotic lesion). 38

39. Final Shape after cleaning 39

40. Nanotechnology vs. Heart Disease 40 The use of nanotechnology to treat heart disease offers some exciting possibilities, including the ability to: 1.Treat defective heart valves 2.Detect and treat arterial plaque 3.Understand at a sub-cellular level how heart tissue functions in both healthy and damaged organs and design better treatments

41. TO NORMAL HEART 41

42. CNS Care-Nanobot in nerve cell repair 42

43. Brain repair 43

44. Brain repair 44

45. Nanotechnology for Regenerating Nerves 45

46. Paralyzed Limb control: 46 NanoProsthetics -paralysis is handled. Nanochips help those who have lost limb control use,their minds to send signals to provide for motion.

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48. Diabetes: 48 No need to draw blood-nano-composite contact lenses actually change color to indicate blood sugar level.

49. Nanodiamonds deliver insulin for wound healing. 49

50. Possibility of Scarless Surgery 50

51. Seizure- control 51 Nanochips -analyze brain signals, and adjust the brain so that epilepsy could be better controlled.

52. Sensory feedback: 52 For those who have lost feeling in their body, it is possible to use nanotechnology to increase sensory feedback. Nanochips provide the opportunity for electrical impulses to be intercepted and interpreted.

53. Medical monitoring- 53 Small nanochips implanted in your body could monitor your health and systems, and then send you feedback to your computer, doctor or other device.

54. Disease prevention 54 Having a nano device in your body could actually help prevent diseases-by programming, you avoid some diseases, repair problems before they become serious issues.

55. Anti-cancer drug delivery 55  D rugs delivery to tumors by using two types of nanoparticles.  The first type of nanoparticle locates the cancer tumor  Second type of nanoparticle (carrying the therapeutic drugs) homes in on a signal generated by the first type and destroy cancer cells.

56. A schematic illustration showing how nanoparticles or other cancer drugs might be used to treat cancer 56

57. Gene -repair 57

58. Stem cells: 58 Nanotechnology can actually help adult stem cells, modify them into the types of cells that are actually needed.

59. New ways in Medicine-DNA construction by nanobots 59

60. Life Extension through Nanotechnology 60  There are two ways -to extend our lives. 1. Eradicate life-threatening diseases such as cancer, 2.By repairing damaged cells  Extending Life by Curing Life Threatening Disease

61. Conclusion: 61 With this technology there is no need of ventilators in critical care units. no drug resistant respiratory infections, ARDS cases will be treated without ventilator and no deaths due to cardio-respiratory failure. Human society can live without fear of AIDS, SARS and Ebola virus infections. No heart attacks, no lung diseases, no strokes, no cancers.

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