Search

Background: Coronavirus disease 2019 (COVID-19) vaccination has proved its importance and effectiveness in the fight against COVID-19. India began the world’s largest vaccination campaign against COVID-19 on 16th January 2021 with two vaccines, namely, Covishield and Covaxin. Aims: The present study was conducted to understand the trend of COVID-19 vaccination during the 1st year of the vaccination drive at a COVID Vaccination Centre in a tertiary care hospital of Uttarakhand. Patients and Methods: It was a retrospective record-based study conducted at a COVID-19 Vaccination Centre in a tertiary care hospital of Uttarakhand. Vaccination-related data of 1-year period (16th January 2021–16th January 2022) had been collected from the CoWIN app and COVID-19 vaccination register and analysed. Results: The total dose administered was 63,015 over a time period of 1 year during 299 vaccination sessions that were conducted. Analysis of total doses administered in relation to vaccination sessions held during different months of 1-year study period shows that on average, 199 individuals per session were vaccinated. There was an overall declining trend in the COVID-19 vaccine wastage rate for 1-year period of COVID-19 vaccination. Conclusion: This study will help us to understand how this experience of the past 1 year can be utilised for further planning and policy making.

Purpose: The purpose of the study was to measure the mental well-being of patients suffering from low vision using the Depression, Anxiety, and Stress Scale (DASS). Methods: Low-vision patients who visited the low-vision clinic of CL Gupta Eye Institute were studied using the DASS. Patients were excluded if they were

Purpose: Tibial stress fracture associated with knee osteoarthritis is an unusual and difficult clinical scenario. There is no clear existing treatment guideline for this uncommon clinical disease. The aim of this study is to review the impact of various treatment options for patients with advanced knee osteoarthritis associated with proximal tibial stress fracture. Methods: The study was performed using the databases of PubMed and Scopus. Methodological index for non-randomized studies score was used to evaluate the included studies’ bias. The concluded data included the treatment approach, reported outcome measure, and time to fracture union. The literature search was started in December 2021 and accomplished in January 2022. A narrative description of the different methods and comparison of their results were done. Results: Out of total assessed 69 studies, 9 studies were included in our review. The commonest treatment approach used was total knee arthroplasty by long tibial stem extension. The mean preoperative knee society score and knee functional score were 30.62 and 23.17, respectively. The mean postoperative knee society knee score was 86.87, while the functional score was 83.52. The average reported time to achieve fracture union was 4 months (a range of 2.07 – 5.50 months). Conclusion: The optimal clinical outcome for treating either acute or mobile tibial stress fracture in patients with advanced knee osteoarthritis can be achieved with long stem total knee arthroplasty. However, due to heterogeneity of data, comparison of different treatment options for chronic proximal tibial stress fracture mal-union/non-union coexisting with knee osteoarthritic and such inferences need to be judged cautiously.

Background: Many legislatures allow for written or in-person questions to be directed to members of the administration, which is a common feature of legislatures. The parliamentary probes usually generate a lot of media attention and public interest. The types of questions that are asked in parliament and the outcomes are still unknown, despite their significance and interest. Aim and Objectives: The study aimed to assess the interest of Indian parliamentarians (Lok Sabha) in health issues by screening the questions raised in the Lok Sabha related to health. Methodology: A cross-sectional study using records from the 17th Lok Sabha from 2014 to 2022 was done to identify “health-related” inquiries made by parliamentarians between 2014 and 2022. Results: The Ministry of Health and Family Welfare explicitly responded to questions in the Lok Sabha from 2014 to 2022, making up 5.41% of all questions (starred and unstarred) raised during that time. Of the total 117,967 questions raised in the Lok Sabha from 2014 to 2022, these 6389 questions were related to “health.” Conclusion: In India, the COVID-19 pandemic has sparked worries about several issues, including the quality of health care, institutional and governmental responses, and challenges with law and order. The constitutional and statutory framework ought to be useful in answering these problems.

Coleus aromaticus Benth. (Family: Lamiaceae) is a huge perennial, aromatic and succulent herb native to the Indian subcontinent. The dried leaves have an oregano-like texture making them a perfect culinary food supplement to be used as herbal seasoning for meat and other food products. The present study aimed to identify the bioactive components in the essential oil collected from the fresh aerial parts of Coleus aromaticus Benth. Using GC/MS analysis, 12 terpenoid components were identified, accounting for 97.5% of the overall oil content. Thymol (69.6%), p-cymene (3.9%), (E)-caryophyllene (3.7%), carvacrol (3.2%), α-thujene (3.2%), γ-terpinene (2.9%), and carvacrol methyl ether (2.3%) were identified to be the primary constituents in the oil, which was determined to be dominated by oxygenated monoterpenes (72.8%). Additionally, at the highest dose, CAEO showed significant pesticidal activity, inhibiting the egg hatchability of Meloidogyne incognita by 96.9%, immobilizing it by 52.3%, insecticidal activity on Spodoptera litura by 71.13%, and phytotoxic activity on Raphanus raphanistrum seeds by 97.75%. For speculating the potential method of action of CAEO components, the proteins/enzymes namely acetylcholinesterase (PDB ID: 6XYS), carboxylesterase (PDB ID: 5IVH), and acetohydroxyacid synthase (PBD ID: 1YHZ) were employed. The novel aspect of this study was that the herbal spice material was collected during its vegetative stage from the Tarai region of Pantnagar (India) in order to bio-evaluate its nematicidal, herbicidal, and insecticidal effectiveness. It was found that CAEO is an effective alternative source of natural pesticides and opens the way for additional research on its mechanistic techniques and field tests to determine its pesticidal studies.

In India, the incidence of mucormycosis reached high levels during 2021–2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March–July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease’s clinical progression and help frame standard treatment guidelines.

Background The most crucial step in the management of type 2 diabetes is identifying its pathogenesis and progression. Fat accumulation in the pancreas and decreased parenchymal volume can influence pancreatic function due to insulin resistance or β-cell dysfunction. This study aims to find out the difference in pancreatic volume and fat content by using contrast-enhanced computed tomography (CECT) between normal subjects and patients with different durations of type 2 diabetes mellitus (T2DM).

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

Nutrition constitutes a vital element of health and development. In India, there is an alarming rise in the food industry and this has led to an increased uptake of foods high in fats, salt, and sugar (HFSS) and ultra-processed foods. Food labelling is a procedure where a label, containing printed, written, or graphic materials, is provided with the food thereby facilitating communication between the consumer and the manufacturers. In 2022, FSSAI has exempted specific food products from the stringent requirements of detailed nutritional labelling. Exemptions are applied to commodities such as raw agricultural products, liquid products in reusable bottles, alcoholic beverages, self-serve condiments, and modified meals as per the customer's request, single unit packaging, and packets under 100 sq. cm. In conclusion, these exemptions strike a balance between reducing the regulatory burden for smaller packaging and ensuring consumers' right to essential information.

Either the editor or someone else who has been invited by the editor may write an editorial. On top of that, it serves a multitude of other purposes, such as providing critiques of original articles that were published in the same issue of the journal, providing brief reviews of subjects that do not warrant a fulllength invited review, and providing other topics on very recent developments that the editor believes are important to the readers of the journal and the community. Because the editorial often has a limited amount of space in which to present its contents, the message that is contained within it needs to be carefully thought out and given in a concise manner. A clear conclusion should be included at the end of the section, and it should have the correct sequencing of the elements of critical argument. Ideally, it should be supported by evidence.

Abstract Background and Study Design Role of 18F‐fluoro‐2‐deoxy‐2‐d‐glucose positron emission tomography‐computed tomography (FDG PET‐CT) in evaluation of renal cell cancers (RCC) and urinary bladder cancers is not standardized, and the COPPER‐T trial, which is a single centre prospective randomized study, was designed to compare it with conventional imaging for staging of clinically localized high risk RCC and urinary bladder carcinoma (Stage T2 and above). Patients and Methods There will be two subgroups of patients: RCC and urinary bladder carcinoma. In each of these, the patients will be randomized to either Arm A or Arm B. In each of the arms, each patient will be subjected to diagnostic imaging by FDG PET‐CT. The CT scan will be a contrast‐enhanced scan like that in conventional staging. A radiologist and nuclear medicine specialist will report the scan independently. The radiologist will not have access to the PET scan sequences and will only review the contrast‐enhanced computed tomography (CECT) images. In Arm A, the report of the conventional imaging modality, that is, CECT and bone scan if done, will be reviewed first by the clinician, and based on this report, a management plan will be made. Then, the PET‐CT report will be reviewed, and change in the management plan will be noted. New findings or equivocal findings if any in the PET‐CT report would be noted. In Arm B, the report of the PET‐CT report will be reviewed first by the clinicians, and a management plan will be made. Then, the CECT and/or bone scan reports will be reviewed, and any change in the management plan will be noted. Outcome and Significance Final analysis of the data after completion of the trial will help in clarifying the role of FDG PET‐CT in high risk RCC and transitional cell carcinoma (TCC) of the bladder, its diagnostic accuracy compared with conventional imaging and the impact of using it on patient management.

The main research question addressed in this work is how energy clusters can be evaluated and what general conclusions can be drawn out of their activities. Traditional innovation cluster analysis approaches chiefly rely on surveys, interviews, open publications, and patents—lack of using updated activities of innovation clusters. Therefore, preceding cluster analysis methodologies always lack of providing up-to-date information. In this sense, analyzing energy cluster activities is an obvious interest for policymakers, investors, companies, etc. Moreover, such assessment help to track the development of new technologies, participation of different actors in an innovation ecosystem, and emerging topics in the energy sector. This work presents the research outcomes on the leading energy-innovation clusters in Germany. To this end, this paper exploits the publicly available website data from the clusters and member’s web-pages to investigate their geographical distribution, key focus areas, cluster, and member activities. In the course of the project, a web-scraping tool has been developed to crawl the clusters and member’s websites and scrape their text data. The tool performs systematic and guided web-scraping for searching a keyword presence on a particular web-page. In addition to this, data from commercially available company databases are used to complement the missing information from the website data. A total of 44 energy clusters along with 4524 members are taken into account in this study. The proposed methodology has shown that unstructured web-data is a valuable source for analyzing the clusters and their member’s innovation activities. Results have also indicated that there is a strong correlation (r=0.85) between Research and Development (R&D) expenditure and cluster count in individual federal states. The overall results have indicated that the majority of energy clusters are very specialized in certain topics, nevertheless, topics such as hydrogen, carbon, and bioenergy are getting notable attention from various stakeholders. Simultaneously, various cross-sectoral topics are also emerging due to the coupling between different sectors. Findings could help policymakers and federal innovation agencies to understand the ongoing progress in cleantech innovation activities. From the methodological point of the view, it provides an underlying ground to access the impact of cluster policies.

Areas like aerospace, solar, medical, electronics, optics widely use nano-finished or high precision aluminium alloys. These nano-finished aluminium alloys are being used as metal mirrors, micro-electronics devices, diaphragm in optical sensors etc. In general, aluminium alloys are finished by conventional processes such as grinding, lapping. However, to achieve nano-level finish on soft material like aluminium alloys which possess high malleability and ductility is difficult for traditional processes without producing high residual stresses, subsurface damage etc. In this work, the surface finish of aluminium 7075 alloy workpiece was improved using a novel finishing technique viz. chemical assisted ball end magnetorheological finishing (CA-BEMRF). To validate the results a comparison of % decrease in surface roughness obtained after ball end magnetorheological finishing (BEMRF) as well as achieved after CA-BEMRF process is carried out. Results showed a 1.84 % improvement in % decrease in surface roughness after CA-BEMRF process as compared to BEMRF without chemical assistance. The statistical and graphical effects of various changing process parameters on % decrease in surface roughness are addressed. Using analysis of variance (ANOVA) and the F-test, significant process factors impacting surface roughness during workpiece finishing are identified. Optimum value of % decrease in surface roughness has been found as 55.316 at magnetizing current 3.43amp, tool rotational speed 326.97 rpm and working gap of 0.74 mm. Confirmatory experimental tests have been conducted and results obtained were found very close to the predicted outcome. Scanning electron microscopy (SEM) of the workpiece finished using BEMRF process and CA-BEMRF technique are compared to assess the effects of magnetizing current, tool rotation and working gap on surface topography of machined surface.

The tobacco crisis, which claims more than 8 million lives yearly and adds 1.2 million more from secondhand smoke inhalation, is a serious concern for world health. The detrimental impact of tobacco usage on health is projected to have an annual economic cost of 1.4 trillion US dollars (health costs plus lost productivity) or 1.8% of the world's GDP. Both smokers and users of smokeless tobacco can profit greatly from quitting. Quitting smoking lowers the likelihood of developing respiratory problems, delays their beginning, and slows the progression of chronic lung diseases. Therefore, the "World Health Organisation (WHO)" and the "Ministry of Health & Family Welfare", Government of India, worked together to open official tobacco cessation clinics throughout India. The goal of tobacco cessation centers was to offer to counsel people trying to stop smoking. This includes monitoring the patient's progress and providing counseling, either by itself or in conjunction with medication.

Introduction: Coronavirus disease 2019 (COVID-19), is an infectious illness caused by the coronavirus strain known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We set out to monitor the evolution of lung changes in individuals who survived COVID-19 infection, investigate prospectively in the Indian population, and determine their predictive factors. None of the studies was conducted on the Indian people for long-term follow-up prospectively. Materials and methods: We enrolled patients who had been treated for COVID-19 at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India. At the time of admission and 3-monthly follow-up visits, high-resolution computed tomography (HRCT) chest was done to look at the evolution of lung changes. Results: At the 3-month follow-up CT, 28 of the 50 participants (56%) (group I) showed fibrotic changes with or without residual consolidation/ground-glass opacity (GGO). In contrast, the remaining 22 people (44%) (group II) did not show fibrotic changes and had either complete radiologic resolution or only residual GGO consolidation. Conclusion: Common findings noted on admission were predominant consolidation and predominant GGO. Post-COVID-19 lung fibrosis was observed in about half of the survivors. Consolidation in the initial chest CT scan was linked to a higher risk of developing post-COVID-19 lung fibrosis. These fibrotic changes were linked to an older age, male patient, and acute respiratory distress syndrome at admission.

Charcot Spine Arthropathy (CSA) is a form of degenerative disease affecting vertebra of lumbar and thoraco-lumbar region. It is commonly seen after injury to the spinal cord or in patients with traumatic paraplegia. It was first described by Kronig in 1884. Case Report- A 35year old male patient presented to our outpatient clinic with complaint of difficulty in changing his position while sitting, lying down, and sitting on a wheel chair. In 2014, he had sustained injury to his spinal cord with bowel and bladder involvement with ASIA-A grade neurology for which long segment fixation was performed from D7-D10 level and the patient was wheel chair bound after surgery. In the present case scenario, the patient was managed conservatively with bed rest, immobilization and medications for pain relief as stated in the existing literature. Conclusion- CSA is a disease of surgical origin commonly seen in patients with spinal cord injury in the past. Although surgery in the form of circumferential arthrodesis is the treatment of choice in most of cases, it is reserved for cases with instability, as it is associated with complications like infections and hardware failure.

IntroductionTumour Mutation Burden (TMB) is a potential biomarker for immune cancer therapies. Here we investigated parameters that might affect TMB using duplicate cytology smears obtained from endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA)-sampled malignant lymph nodes.MethodsIndividual Diff-Quik cytology smears were prepared for each needle pass. DNA extracted from each smear underwent sequencing using large gene panel (TruSight Oncology 500 (TSO500 - Illumina)). TMB was estimated using the TSO500 Local App v. 2.0 (Illumina).ResultsTwenty patients had two or more Diff-Quik smears (total 45 smears) which passed sequencing quality control. Average smear TMB was 8.7 ± 5.0 mutations per megabase (Mb). Sixteen of the 20 patients had paired samples with minimal differences in TMB score (average difference 1.3 ± 0.85). Paired samples from 13 patients had concordant TMB (scores below or above a threshold of 10 mutations/Mb). Markedly discrepant TMB was observed in four cases, with an average difference of 11.3 ± 2.7 mutations/Mb. Factors affecting TMB calling included sample tumour content, the amount of DNA used in sequencing, and bone fide heterogeneity of node tumour between paired samples.ConclusionTMB assessment is feasible from EBUS-TBNA smears from a single needle pass. Repeated samples of a lymph node station have minimal variation in TMB in most cases. However, this novel data shows how tumour content and minor change in site of node sampling can impact TMB. Further study is needed on whether all node aspirates should be combined in 1 sample, or whether testing independent nodes using smears is needed.

Objective Chronic ‘displaced’ displaced type II fractures, though uncommon, are difficult to manage. They usually require a transoral procedure followed by a posterior instrumented fusion. We describe here, a new method to reduce the fractured displaced odontoid using a posterior cervical approach only. Methods Prospective and observational, n=14 had a ‘displaced and irreducible’ old fracture dens causing cord compression (type I, 1; type II, 13). They underwent a novel technique to reduce the fracture. The C1 arch was first drilled and removed. The C1 lateral masses on both sides were then drilled completely and a spacer was placed between the occiput and C2 facet. Following this, an intraoperative reducing maneuver was performed, utilizing the spacer as a fulcrum, and then achieving complete reduction and realignment. Results All patients improved clinically (mean Nurick preoperative score: 4.07±0.8; the postoperative score was 1.3±0.4). The mean correction in effective canal diameter was 74.3%±9.5% and the mean correction in actual canal diameter was 77%±8.7%. Solid bone fusion was demonstrated in 12 patients with at least 1-year follow-up (follow-up range, 12–35 months; mean, 21.8±9.8 months). Conclusion The new described modification of distraction, compression extension, and reduction seems to be effective for ‘displaced’ chronic fracture dens with cord compression. It avoids additional transoral surgery in these patients.

Backgrounds: The Universal Immunization Program of India is one of the most cost-effective interventions in public health. Missing or delaying vaccination may elicit an uncertain immune response in the body, making the population susceptible to vaccine-preventable diseases. The objectives of this study were to determine the coverage of newborn immunization for birth doses under the National Immunization Schedule and its epidemiological determinants in the rural areas of the Dehradun district, Uttarakhand. Materials and Methods: A community-based cross-sectional study was conducted for a period of one year with a sample size of 570. World Health Organization (WHO) 30 Cluster sampling technique was used with 19 children in each cluster. The data on determinants were collected using a semi-structured, pre-designed schedule through a house-to-house survey. Multivariate analysis was conducted to identify factors associated with immunization coverage, taking the significance level as P < 0.05. Results: The coverage of the Bacillus Calmette–Guérin vaccine, oral polio vaccine zero dose and hepatitis B birth dose were 100%, 91.9%, and 58.8%, respectively in the study area with an overall prevalence of incomplete coverage of newborn immunization as 42.5%. The most cited reason for children being unimmunized with birth doses was the unavailability of vaccines at the birthplace center (29.6%). Conclusions: The prevalence of incomplete coverage of newborn immunization was quite high, which was undermining the holistic approach of the National Immunization Program. Vaccine availability and accessibility at the birthplace with capacity building and training of the healthcare workers may be considered to ensure coverage of birth doses.

Introduction: Noncommunicable diseases (NCDs) have emerged as a pandemic globally and the situation is worse for developing nations. The four major NCDs that are responsible for a major proportion of mortality across the globe are cardiovascular diseases, cancer, respiratory diseases, and diabetes. For a country with limited resources, an integrated approach toward the management of NCDs is of particular importance. Complementary and alternative medicines (CAMs) are those health-care and medical practices that are not currently an integral part of conventional medicine system. This study was undertaken to estimate the prevalence, pattern, and predictors of CAM use among patients with NCDs (diabetes, hypertension, or both). Materials and Methods: A health-facility-based cross-sectional study was conducted at different levels of government health-care facilities in Rishikesh, Uttarakhand. CAM categories included alternative medical systems, mind–body intervention, biologically based therapies, manipulative and body-based methods, and energy therapies. Additionally, jhaad phook/local healers were also included in our study. Results: The study showed that 41% of all the study participants were ever users of CAM. While most of the users were practicing more than one type of CAM, the most common type of CAM practiced was alternative medicine system (83.3%) followed by mind–body medicine (40.2%). Except religion and place of residence of the study participant, no other factor showed a significant association with ever usage of CAM. Conclusion: CAM use was popular among study participants as almost half of them were using/consuming it and alternative medicine system was the most common type of CAM practiced.

Background: India initiated Expanded Programme on Immunization (EPI) in 1978 and was renamed to Universal Immunization Programme (UIP) in 1985 and subsequently integrated with National Rural Health Mission (NRHM) in 2005. Many studies have shown that health workers involved in immunization are more concerned towards coverage than the quality of immunization services provided. Aims and Objectives: This study aimed to assess the quality of routine immunization services in rural areas of Doiwala Block of Dehradun, Uttarakhand. Material and Methods: It was a cross-sectional study conducted for a duration of one year. Study participants included Auxillary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs) and parents/caregivers of children aged 12–23 months residing in that area who had received immunization services on the day of the survey. Institutional ethics committee clearance was obtained before the start of the study. A P value of 0.05). The most common vaccine not available was the Bacillus Calmette–Guérin (BCG) vaccine. The majority of clients at both high (92%) and low-performing centres (96%) said that they never waited for at least 30 min post-vaccination at the vaccination site for observation. Conclusion: The study highlights that most of the ANMs at the immunization centre were having good knowledge and were adequately trained for maintaining cold chains at session sites.

Background: Ensuring high immunisation coverage and its acceptance among the beneficiaries are crucial for a healthy society. Hence, this study aimed to estimate vaccine coverage and barriers of immunisation among children of age 12–23 months in urban areas of Rishikesh, Uttarakhand. Aims: To estimate the immunization coverage rate among children of age 12-23 months in urban area of Rishikesh. Objectives: To identify the barriers towards immunization in children of age 12-23 months in urban area of Rishikesh. Materials and Methods: A community-based cross-sectional study was done in urban areas of Rishikesh for 1 year, including 210 children, using the WHO's 30 × 7 cluster sampling technique to collect data on immunisation status. Results: About 92% of the children were fully immunised. Bacillus Calmette–Guérin has the highest coverage rate (99.5%), whereas the coverage was the lowest for the measles vaccine (93.8%). Full immunisation coverage was found to be statistically significant with the education of the respondent, socio-economic status (SES) of the family and birth order of the child. Additional vaccines uptake showed a significant association between SES of the family and the place of vaccination. Conclusion: There were significant variations in childhood immunisation coverage across socio-economic and demographic factors. These findings emphasize on the need for regular monitoring and evaluation of immunisation coverage to achieve the benefits of vaccination in all strata of society.

Introduction: Continuous ambulatory peritoneal dialysis (CAPD) catheter placement is a part of renal replacement therapy. We describe our 20-year experience in using the open technique and assess its safety, efficacy, and outcome in the treatment of end-stage renal disease patients. Methods: In a retrospective study, we analyzed data of all patients who had a CAPD catheter placed using our open dissection technique using local anesthesia over the previous 20 years, with minimum 1 year of follow-up. Intraoperative data, postoperative data, and complications were noted. Results: A total of 1410 cases were included in the study. The mean duration of follow-up was 72 ± 18 months (range 12–120 months). The mean operative time was 19 ± 7.5 min and mean hospital stay was 3 ± 1 days. No major intraoperative complications were noted. We observed a peritonitis rate of 0.49 episodes/patient/year. The most common reason for permanent catheter removal was refractory peritonitis in 21%, followed by flow failure in 7%, and ultrafiltration failure in 6.5%. The death-censored technical survival rate was 94.3%, 83.2%, 75.9%, 69.2%, and 60.6% patients at 1 year, 2 years, 3 years, 4 years, and 5 years, respectively. Conclusions: The open dissection method of peritoneal dialysis catheter insertion using local anesthesia at well-experienced center is a simple, painless, and uncomplicated procedure with excellent outcomes. Optimal exposure, judicious use of energy source, and using appropriate technique provide good technical success rate with lesser complications.

IntroductionExposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities.MethodologyMulticentric case–control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA).ResultsA total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29–4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43–3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home.DiscussionThe results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed.

Natural coloring agents obtained from plants, insects, animals, and minerals are used to color faces, hairs, textiles, and food preparations for centuries. This current review explained the role of traditional natural coloring agents in ancient times. It encompasses the advantages of natural dyes over synthetic dyes, their classification, and medicinal properties. The objective of review is to provide a retrospective study of natural colors for fibers based on their therapeutic potential. For the preparation of this manuscript, all the relevant information was gathered from accessible and inaccessible resources (Web, Books, Thesis, etc.). The information included in the article was downloaded from scientific engines and databases (Google Scholar, Web of Science, Scifinder, Science Direct, Publons, Wiley Online Library, PubMed, Taylor & Francis online and Scopus indexed journals) using different keywords. Natural coloring agents like Carica papaya, curcumin, betalain, quercetin, lycopene, lawsone, crocin, juglone, anthocyanin, and several others are reported to have medicinal values. The present review summarizes the application of natural dyes for coloring fibers and pharmaceutical preparations is beneficial over synthetic dyes based on their additional therapeutic effects. The use of synthetic dyes for fibers can cause toxic effects as it contain heavy metals and causes pollution and damage the environment.

Abstract A provisional diagnosis of urticaria pigmentosa was revised to lichen planus pigmentosus with dermatographism, after histopathologic examination of specimen from hyperpigmented patch. It is important to keep differential diagnosis of inducible wheals while making a diagnosis.

Enoxaparin is a low-molecular-weight heparin (LMWH), i.e., widely used for prophylaxis and therapy of venous thromboembolism. Skin necrosis after subcutaneous injection is an uncommon and possibly underreported complication of LMWH. We report a case of enoxaparin-induced localized skin necrosis. Prompt diagnosis, discontinuation of LMWH, and work-up to rule out heparin-induced thrombocytopenia, a potentially life-threatening condition goes a long way in improving the outcome.

Extrarenal calyces (ERC) is a rare renal anomaly. First described in 1925, and till now, >60 cases have been reported worldwide. The association of ERC in ectopic kidneys with ureteropelvic junction obstruction (UPJO) is a very rare presentation. We encountered a case of an adult male with ERC in a pelvic kidney with UPJO, in which the dilated ERC mimicked the ureter and created intraoperative confusion.

In India, there is a mandate to increase institutional delivery, which has led to an overwhelming response in health-care delivery. The maternal mortality rate has been an essential yardstick, used by health-care planners to assess the quality of obstetric services. As of late, there has been a shift in focus to maternal near-misses (MNMs) as a more valuable indicator of maternal health than the maternal mortality rate. The aim of this research article was to compare various standardized tools to address MNM, namely, the World Health Organization MNM tool, The Government of India's facility-based MNM review tool, etc.

Objectives Urinary tract infection (UTI) is one of the most common diagnoses in patients visiting urology clinics. Rampant use of empiric and inadequate doses of antibiotics leads to an increase in resistance and poses a huge financial burden. We evaluated UTI in relation to antibiotics used, frequency, susceptibility, and resistance pattern of different pathogens at a tertiary care center and made some important observations. Methods Prospectively 729 patients diagnosed with UTI attending a urology outpatient department from July 2018 to January 2020 were managed accordingly. Antibiotics were started on the basis of urine culture and sensitivity (c/s) or empirically and changed according to subsequent urine c/s. Repeat urine c/s was performed after 5 to 7 days of starting therapy and 10 days after completion of therapy. Results Out of 729 subjects, 417 (57.2%) were males and 312 (42.8%) were females. The most common symptom at diagnosis was dysuria 512 (70.2%), whereas 221 (30.3%) patients presented with fever. Escherichia coli was the most common organism isolated, 453 (62.1%). Among 729 patients, 239 took antibiotics without c/s report, whereas in 490 patients antibiotics were prescribed after the report. A total of 431 (59.1%) patients required one antibiotic session for clearance of pathogen, whereas 135 (18.5%) required two sessions, and three sessions were required in 66 (9%) cases. Among 239 patients whose culture came out to be positive, 145 (60.6%) were found to be resistant to the previously given antibiotic and the common pathogens isolated were E. coli (61 [42%]), Pseudomonas (28 [19.3%]), Enterococcus (22 [15.1%]), Klebsiella (14 [9.6%]), and others. Conclusion Unchecked, rampant, and inadequate use of antibiotics leads to complicated UTI with the increasing share of Pseudomonas, Klebsiella, or other dangerous microbes, which are difficult to treat as well as pose threat in the future.

Objectives: Possessing accurate knowledge and utilization of reliable information sources may play a vital role in adoption of positive health behaviours, including acceptance of vaccine. The present study was conducted with an objective to assess the awareness and attitude of undergraduate nursing students regarding COVID-19 vaccine. Methods: A cross-sectional survey was conducted in Mid May 2021 using Google Forms through Google platform on-line. A total of 354 nursing students participated in the survey. A validated and pre-tested structured knowledge and Attitude, questionnaire was used to collect data from undergraduate nursing students regarding COVID-19 vaccine. Chi-square test, followed by binary logistic, was applied to determine factors associated with knowledge scores. Results: The mean knowledge score was 11.31 (SD ± 2.31, range: 2–15), with a correct response rate of 75.4%. However, the mean attitude score was 40.56 (SD ± 5.10, range: 28–55) with an unfavourable response towards COVID-19 vaccination (54.8%). The knowledge level was found to be significantly associated with student's professional qualifications and Vaccination status (P

Abstract Blockade of N-methyl-D-aspartate receptors (NMDAR) is known to augment cortical serotonin 2A receptors (5-HT2ARs), which is implicated in psychosis. However, the pathways from NMDAR hypofunction to 5-HT2AR up-regulation are unclear. Here we addressed in mice whether genetic deletion of the indispensable NMDAR-subunit Grin1 principally in corticolimbic parvalbumin-positive fast-spiking interneurons, could up-regulate 5-HT2ARs leading to cortical hyper-excitability. First, in vivo local-field potential recording revealed that auditory cortex in Grin1 mutant mice became hyper-excitable upon exposure to acoustic click-train stimuli that release 5-HT in the cortex. This excitability increase was reproduced ex vivo where it consisted of an increased frequency of action potential (AP) firing in layer 2/3 pyramidal neurons of mutant auditory cortex. Application of the 5-HT2AR agonist TCB-2 produced similar results. The effect of click-trains was reversed by the 5-HT2AR antagonist M100907 both in vivo and ex vivo. Increase in AP frequency of pyramidal neurons was also reversed by application of Gαq protein inhibitor BIM-46187 and G protein-gated inwardly-rectifying K+ (GIRK) channel activator ML297. In fast-spiking interneurons, 5-HT2AR activation normally promotes GABA release, contributing to decreased excitability of postsynaptic pyramidal neurons, which was missing in the mutants. Moreover, unlike the controls, the GABAA receptor antagonist (+)-bicuculline had little effect on AP frequency of mutant pyramidal neurons, indicating a disinhibition state. These results suggest that the auditory-induced hyper-excitable state is conferred via GABA release deficits from Grin1-lacking interneurons leading to 5-HT2AR dysregulation and GIRK channel suppression in cortical pyramidal neurons, which could be involved in auditory psychosis.

The automobile sector is rising rapidly at a global level. In the current scenario, emphasis is given on electric vehicles (EVs) to reduce conventional energy demand and minimize greenhouse gasses. Most work has been done on solar-powered vehicles used for the transportation of people rather than agricultural transport such as labor, tools, and farm production. Therefore solar-powered farm rickshaw were tailored to Indian farm conditions. A three-wheel rear-driven 450-watt capacity solar-powered farm rickshaw was designed, developed, and evaluated in Indian climatic conditions. The developed rickshaw were comprised of three 150-watt polycrystalline solar modules. The produced electricity is stored in a 48-volt 30 Ah lithium-ion battery. A maximum power point tracking (MPPT) system was also incorporated to access the maximum power from solar panels. Statistical analysis was made with ANOVA tool and FCRD-test. The results were tested at the 5% significant level. The developed rickshaw has a cargo capacity of 300 kg and can be used to transport labor and farm produce. It reduces annual fossil fuel demand by approximately 350 liters and annual CO2 emissions by approximately 837 kg. The developed solar-powered farm rickshaw not only reduces fossil fuel demand but also reduces the emission of greenhouse gasses at large. The main goal behind the design and development of a solar-powered farm rickshaw is to do farm work at low-cost and pollution-free.

The food industry is diversifying and adapting to shifting consumer tastes and environmental issues. Consumers value the quality and uniformity of the fundamental ingredients used to make packaged goods, as well as the longevity, originality, logistics, lifespan, and recyclability of packaging. For the global distribution of food, the safety of agricultural products is critical. In order to enhance efficiency and maximize product manufacturing and distribution, data and information technologies are becoming increasingly vital in the global food and agriculture industry. In the "food and agriculture" (FAI) industry, blockchain is a well-known technical innovation. It facilitates the timely sharing of information such as origin, batch number, and production date, as well as the openness and transparency of the manufacturing environment, food safety certification, and organic products, all of which contribute to food safety and customer trust.

Background: The reproductive, maternal, newborn, child + adolescent health (RMNCH+A) strategy was launched by the Indian government in the year 2013 to remain in the lead of the global war against child and maternal mortality and morbidity. Under RMNCH+A program in Uttarakhand state, according to the State public health policy, various provisions are needed to be done for maintenance of downtrend in infant mortality rate (IMR). There are various thrust areas under the child health program. The purpose of our study is to monitor the program implementation in terms of Input and Process indicators and to identify if there are any gaps in the child health services provided by RMNCH+A in the PHCs and subcentres of Doiwala block of Dehradun district, Uttarakhand. Aim: To evaluate Input and the process indicators of child health services under RMNCH+A strategy at Primary health care level in Doiwala block of Dehradun district, Uttarakhand. Methods: This Cross-sectional study was carried out in Doiwala Block of Dehradun district, Uttarakhand in 3 randomly selected Primary health centres (PHCs) and their 6 subcentres using a validated standard checklist for PHCs and subcentres. Results: In PHCs, mean obtained score for Input indicators was 56% and for Process indicators was 35%. The mean obtained score in subcentres for Input indicators and Process indicators was 53% and 51%, respectively. Conclusions: Both the input and the process indicators for child health services in PHCs and subcentres of Dehradun district were inadequate. Most indicators scored less than 50% at both the PHCs and subcentres.

Context: The novel coronavirus disease 2019 (COVID-19) that has emerged as a pandemic now has put health care workers (HCWs) at great risk as they are the warriors in frontlines screening and treating the infected patients. When a COVID-19-positive HCW is identified, its contacts need to be traced to check the spread of the infection among patients and other HCWs. Aims: This study was aimed to study epidemiology and risk factors associated with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection among HCWs and to quantify the risk of infection among HCWs in a tertiary level health care setting. Settings and Design: This cross-sectional study enrolled all the HCWs who were exposed to a patient with COVID-19 in a tertiary level health care center, Rishikesh, Uttarakhand from 1st May to 30th July, 2020. Methods and Material: All the exposed HCWs were followed up for 14 days after the last exposure to a patient with confirmed COVID-19 infection. Epidemiological data were obtained using structured interviews. Statistical Analysis Used: The data were analyzed using SPSS 23.0. Frequencies and proportions were calculated for descriptive variables, and risk ratios were calculated for risk factors affecting the transmission of disease. Results: We observed that 1,141 HCWs of the tertiary level health care hospital were exposed to COVID-19 patients during the study period. A total of 22 HCWs were tested COVID-19 positive among these exposed HCWs. Univariate analysis revealed a high risk of exposure to be significantly associated with a higher secondary attack rate of SARS CoV-2. Conclusions: The study demonstrates the risk of COVID-19 transmission through asymptomatic carriers. Therefore, periodic testing of all health care workers is necessary to ensure early mitigation of the shortage of health care providers.

Background: Discoid eczema, defined by well-demarcated round or oval plaques, is a form of endogenous eczema in which the role of contact allergens is not clearly established. Objectives: This study aims to assess the role of contact allergens in discoid eczema by patch testing, determine clinical relevance and correlate patch test reactivity with the severity of disease and atopy. Materials and Methods: Sample characteristics including occupation, atopic diathesis and clinical details were recorded. Disease severity was assessed by the Eczema and Area Severity Index (EASI) and patch testing carried out with the Indian Standard Battery. Relevance of patch tests was determined by a history of exposure and patch testing with patients' own materials. Results: Fifty-one patients having a median age of 38 years were enrolled out of which 31 (60.8%) were male. Patch tests were reactive in 25 (49%) patients, common sensitizers being fragrance mix in 9 (31.0%), potassium dichromate in 4 (13.8%), paraphenylenediamine in 4 (13.8%), and nickel in 3 (10.3%) cases. Clinical relevance was established in 11 (37.9%) cases. In patch test reactive patients the mean EASI score was 3.4 as compared with 4.5 in nonreactors. Patch tests were positive in 3 (25%) atopic as compared with 22 (56.4%) nonatopic patients. Conclusion: Contact sensitization to common allergens may not contribute to disease severity in discoid eczema. Patch test reactivity is low in atopic as compared with nonatopic patients with discoid eczema.

Background: Coronavirus disease 19 (COVID-19) pandemic is a recent outbreak of a viral infection caused by severe acute respiratory syndrome coronavirus 2. Increase in the use of personal protective equipment (PPE) among doctors has resulted in increase in adverse effects such as contact dermatitis, urticaria, acne, and infections. Objectives: To identify the prevalence of common dermatosis developing in doctors using PPE. To compare if dermatosis is more common in doctors working in COVID-19 dedicated setup. To assess if the development of dermatosis use was related to the duration of PPE use. Materials and Methods: A cross-sectional type of observational study was conducted. A questionnaire was circulated on social media to the doctors. The response was collected in Microsoft Excel and analyzed. Results: Two hundred and sixty-nine (71.35%) doctors reported the development of dermatosis due to personal protective equipment (PPE) use. Eczema of the face (30%) and acne (26.25%) were the commonly reported dermatosis in our study. The development of dermatosis was significantly related to the duration of PPE use. Our study revealed a high prevalence of dermatosis among doctors using PPE, which was related to the duration of work. Conclusion: Hence, there is a need to make the doctors aware about such dermatosis, suggest prevention measures, provide them with effective dermatological treatment, and establish guidelines for prevention for occupational skin disorders at a national level.

Aim: The aim of this study was to estimate the percentage and sources of secondhand smoke (SHS) exposure among non-smoking pregnant women. It was a cross-sectional study conducted among the non-smoking pregnant women registered at the primary health center (PHC) under the All India Institute of Medical Science (AIIMS), Rishikesh. Materials and Methods: All registered pregnant women at sub-center in the field practice area (Raiwala) of the Department of Community and Family Medicine, AIIMS Rishikesh were recruited in the study. In this study, a questionnaire was used for measuring the exposure of SHS. Mean and standard deviation (SD), median, minimum, and maximum were used for continuous variables. A Chi-square test was used to compare the association of categorical variables. Results: Out of the total participants, 62% were exposed to SHS. 33% of participants were exposed to SHS at home only, 24% at public places only, and 5% were the ones exposed both at home and public places. More than half (69%) of the participants were having inadequate knowledge about the harms caused by SHS. Conclusions: More than half of the participants were exposed to SHS. Inadequate knowledge among the participants about adverse effects of SHS exposure and insufficient practices and action were observed.

The outbreak of coronavirus disease (COVID-19) has triggered changes and reforms in the health sector in India. As the pandemic points to a gap in the industry, it has led to the creation of new opportunities to solve problems. To help the country repair the damage caused by the virus pandemic, the Government of India announced that in the health budget 2021, promotion of health and well-being will be one of the six pillars. Investment in health infrastructure in the 2021 budget has increased significantly to welcome the much-needed increase in budget allocations of Rs. 2.3 lakh crore. Three areas will also be strengthened, including preventive health care and therapeutic health care. Special emphasis is placed on prevention, treatment, and health care. To promote primary health care, the country will establish 17,000 rural and 11,000 urban health care centers. Provision of affordable quality medical insurance will be provided by the government. The integrated and collaborative model of the public and private sectors in the provision of health services has led to a rapid expansion of work. This is an attempt to demonstrate the planned reforms in the health budget, especially during the COVID-19 pandemic. The budget of 2022-23 is about to be announced soon. It is to be seen how the financial allocation for the health sector impacts the health of the Indian people.

Background: National Health Mission intended to achieve decentralization and community participation through creating and supporting Village Health Sanitation and Nutrition Committees (VHSNCs). The services offered through VHSNC include maternal and child health, family planning, sanitation, communicable diseases and health promotion, and nutrition. The study was carried out to assess awareness on the implementation of the functioning of VHSNC implementation among village-level functionaries in the Dehradun district. Methods: A community-based cross-sectional study was conducted in the doiwala and Raipur blocks of Dehradun district from June 2019 to July 2019. Members of VHSNC with at least 3 months of membership were included in the study. A pretested semi-structured questionnaire was used to collect sociodemographic variables and questions about their awareness and responsibilities in implementing VHSNC. Data were collected by personal interviews using Epi-Collect and analyzed by SPSS 23. Result: Out of 69 members, 64 (92.4%) had formal education until high school. Only around 50% of members knew about the essential documents related to the VHSNC. Sixty-five members (98.48%) believed that the committee had the primary role in health-related services in the village, 54 (81.82%) members also marked providing safe drinking water as a function, 48 (72.73%) were in favor of access to clean public toilet and sanitation facilities while some others added role in Public Distribution System. Conclusion: Around half of the members were partially or completely aware of the functioning of VHSNCs. Providing them with further awareness is required.

Aim: Present study was conducted to evaluate the impact of nutritional status on oral health related quality of life using Geriatric Oral Health Assessment Index (GOHAI) among geriatric population attending outpatient department (OPD) of tertiary health care centre in Rishikesh. Settings and Design: Present cross-sectional study was conducted on geriatric male & female participants attending Outpatients Department (OPD) of tertiary care centre, RISHIKESH. Methods and Material: Nutritional assessment was recorded by using Mini Nutritional Assessment (MNA) tool. Oral health related quality of life was assessed using pre-validated Hindi version of Geriatric Oral Health Assessment Index (GOHAI) questionnaire. Statistical analysis: Kruskal-Wallis and Mann-Whitney U test were applied using SPSS 22.0 Software. Logistic regression analysis was done to find out risk factors. Results: A total of 281 participants completed the questionnaire with mean age of 66.89 ± 6.43 years. About three fourth (73%) of total participants were at risk of malnourishment. A statistically significant difference (P=0.005) was observed when the median GOHAI scores were compared with nutritional status (MNA scores). Conclusions: A statistically significant difference was found between nutritional status and geriatric oral health related quality of life (GOHAI). Nutritional status affects oral health related quality of life among elderly population.

In vitro callus induction and shoot emergence protocols for Maytenus emarginata (Willd) Ding Hou. have been established using young leaves and stem explants of in vivo growing, one and half year-old plants. Plants were growing in the month of August 2016 at department of Botany, Ch. Charan Singh University, Meerut. However, explants were collected in the month of August, 2019. MS (Murashige and Skoog) medium and WPM (Woody Plant Medium), supplemented with different concentrations and combinations of plant growth regulators (PGRs) such as 0.5-2.0 mg/l Naphthalene acetic acid (NAA), 0.5-1.0 mg/l Benzyl Amino Purine (BAP), 2, 4-D (1.0-2.0 mg/l) and 1.0-1.5 mg/l Gibberellic acid (GA3) and temperature regimes were used for callus induction and shoot emergence. The presence of GA3 was found necessary for callus induction and shoot emergence from both explants (leaf and stem). The best response of callus formation from leaf explants was obtained at 24°C on WPM supplemented with 0.5 mg/l NAA+1.0mg/l BAP+1.5mg/l GA3 and MS medium supplemented with 2.0 mg/l NAA+ 0.5 mg/l BAP+ 1.0mg/l GA3. Stem explants exhibited best degree of callus induction only on MS medium supplemented with 0.5mg/l NAA+ 1.0 mg/l BAP+1.5 mg/l GA3. Light and temperature play very crucial role in shoot emergence because exposure of callus or nodal section of stem, to 12 hours dark period followed by 12 hours PAR (photosynthetically active radiation) at 27±2 °C induced shoot emergence on MS medium supplemented with 0.5mg/l NAA+1.0mg/l BAP+1.5 mg/l GA3 after 42 days. This is the first optimization report on tissue culture and medicinal use of callus of Maytenus emarginata.

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) is an important means of obtaining a tissue for advanced lung cancer. Optimizing the EBUS TBNA needling technique is important to maintain procedural simplicity and maximize sample quality for emerging molecular diagnostics. Methods: We prospectively explored three versus 10 agitations of the needle in sequential passes into the lymph node using separate needles. Resulting Diff-Quik cytology smears were quantitatively assessed using microscopic (tumor cell cellularity, abundance scores, erythrocyte contamination) and DNA yields. Microscopy was reported by two cytopathologists, and an inter-rater assessment was made by four additional cytopathologists. Results: In 86 patients confirmed as having malignant disease by EBUS TBNA (45 males, 41 females), a mean of 5.3 smears were made per patient with a total of 459 smears scored by pathologists and 168 paired smears extracted for DNA. There was no significant difference between three versus 10 agitations for smear cellularity (p = 0.44), DNA yield (p = 0.84), or DNA integrity (p = 0.20), but there was significantly less contamination by erythrocytes from three agitations (chi-square p = 0.008). There was significantly more DNA in the first pass into the node using three agitations than with other passes and with 10 agitations (pass × agitations interaction, p = 0.031). Reviewing pathologists correctly classified smears as more than or equal to 25% cellularity 86.3% of the time (κ = 0.63 [95% confidence interval: 0.55–0.71]). Conclusions: Three agitations are noninferior to 10 agitations for overall abundance of malignant cells and DNA content on smears. A smear with adequate DNA for panel sequencing could almost always be made with the first needle pass using three agitations.