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Objective The aim of this article was to study the impact of early versus late tracheostomy on clinical outcomes of moderate-to-severe traumatic brain injury (TBI). Materials and Methods A retrospective cross-sectional study was conducted in the Neurosurgery Department, Mayo Hospital, Lahore, in which a sample size of 50 cases was calculated over a period of 6 months from January 1, 2022, to June 30, 2022. The included cases were patients who suffered from moderate-to-severe TBI, isolated TBI, needed elective ventilation, required intensive care unit (ICU) admission during their hospital stay, and were between the ages of 18 and 65 years. All the rest were excluded. A structured proforma was used by the physician to collect data after the informed consent of the patient. The results were computed and analyzed statistically using Statistical Package for Social Sciences , version 26. Results The median age of patients was 40 (interquartile [IQ] range 34) years and were predominantly male (72%). The most common mode of injury was road traffic accidents (58%). The median Glasgow Coma Scale (GCS) score at arrival was 8 (IQ range 6) and the most common pupillary light reflex at presentation was bilaterally equally responsive to light (68%). Neurologic deficits were mostly absent or cannot be assessed on presentation (86%) and in 38% of the cases multiple findings were noted on computed tomography (CT) scan while among single findings seen on CT scan, subdural hematoma was the most common (22%). Multiple regression analysis was done through two separate models using age, gender, mode of injury, presenting GCS score, number of CT-scan findings, number of days after endotracheal intubation after which tracheostomy was done, and the timing of tracheostomy (early vs. late) as predictors, and a significant relationship was noted between the timing of tracheostomy (early vs. late) and GCS at discharge (p = 0.001) as well as extended Glasgow Outcome Score (GOS) at discharge (p = 0.013). Conclusion This study suggests that moderate-to-severe TBIs are most common in middle-aged males and mostly involve road traffic accidents. In most cases, multiple CT-scan findings are seen as compared with a single predominant finding. In such patients, early tracheostomy is superior to late tracheostomy as it results in significantly better GCS and GOS scores at discharge as well as a decreased duration of mechanical ventilation and ICU stay. [ABSTRACT FROM AUTHOR]

Context.--: Nuclear protein in testis (NUT) carcinoma is an aggressive carcinoma defined by NUTM1 gene rearrangement. Diagnostic challenges include morphologic overlap with poorly differentiated squamous cell carcinoma, small cell carcinoma, thoracic SMARCA4-deficient undifferentiated tumor, and other small round blue cell tumors. Objective.--: To comprehensively study the immunohistochemistry (IHC) features of a large cohort of NUT carcinomas. Design.--: Fifty-seven NUT carcinoma cases were identified from 2012-2022, including 38 thoracic/mediastinal, 13 head and neck/sinonasal, and 6 from other sites. Pathology reports and available slides were reviewed. Comprehensive IHC studies were performed on available cases. Results.--: Keratin stains showed variable positivity and were entirely negative in 15% (8 of 55) of cases. p40 was only positive in 65% (24 of 37) of cases, implying inferior sensitivity when compared to p63 (87% sensitivity, 20 of 23 cases) and other squamous cell markers. Neuroendocrine markers were focally/weakly positive in few cases; however, INSM1 was positive in 54% (7 of 13) of cases, indicating a possible diagnostic pitfall. TTF-1 was mostly negative with focal positivity in 26% (10 of 38) of cases. Occasional CD34 (15%, 3 of 20 cases) and CD99 (21%, 3 of 14 cases) positivity could also cause potential diagnostic confusion. S100, desmin, CD45, and SALL4 were rarely positive. BRG1 and INI1 were retained in all cases. Ki-67 proliferative index was high (median, 60%). PD-L1 was negative in all tested cases. Conclusions.--: This comprehensive IHC study demonstrates the immunohistochemical spectrum of NUT carcinoma. The findings can help narrow the differential diagnosis and recognize potential pitfalls. [ABSTRACT FROM AUTHOR]

The present research was carried out to explore the relationship between academic procrastination and academic performance among virtual and conventional university students. The role of the demographic characteristics of the participants was also explored. Nonprobability convenience sampling technique was used to select a sample of 200 students. Academic procrastination scale (McCloskey, 2011) and students’ CGPA were used to measure variables. Pearson product-moment correlation, multiple linear regression, and independent sample t-test were used to test study hypotheses. Among the demographic characteristics, level of education, living status, and mode of education were positively related to academic procrastination. Gender negatively predicted academic procrastination. Living status, mode of education, and job status positively predicted academic procrastination. Level of education and mode of education positively predicted academic performance. Academic procrastination negatively predicted academic performance. Men showed more academic procrastination than women. Graduate-level students had higher academic performance than undergraduate students. Students belonging to rural areas had significantly higher academic procrastination than urban students. Conventional university students showed less academic procrastination than virtual students. Working students had higher academic procrastination than nonworking students. The findings of the study can be used to provide pertinent recommendations to institutes and parents to overcome academic procrastination and enhance academic performance. [ABSTRACT FROM AUTHOR]

India announced its first National Telecom Policy in 1994 and since then its telecommunications Industry has witnessed tremendous growth. At a teledensity of 89.92% (TRAI 2019), it is the second largest telecom market in the world. The policy maker, Department of Telecommunication (DoT) and the regulator, Telecom Regulatory Authority of India (TRAI) have taken several initiatives to ensure affordable services to telecom users. TRAI also drives initiatives to increase the level of awareness about telecom industry among users. To analyse impact of these initiatives by TRAI and DoT, this study presents an objective assessment of user's awareness and their assessment of affordability of telecom services. A structured questionnaire is used to collect data by surveying a sample of 408 telecom users. It was found that half of the respondents were aware of DoT; more than half were aware of the regulator TRAI and Indian governments vision for telecommunications and 85% of survey respondents found telecom services affordable. The level of affordability varied across gender, age group and education levels. Through regression analysis, the study found that awareness about telecom industry influences users' assessment of service affordability. Hence, TRAI and DoT should take actions to increase the level of awareness, which will improve users' perception of affordability and may lead to increased adoption of telecom services. In addition, it is suggested that affordability of female users can be addressed through customized tariff plan and schemes.

Context.--With widespread screening for colorectal cancer, the number of early-stage colorectal cancers is increasing. Local excision of pT1 tumors is associated with considerably less morbidity and mortality, but this must be weighed against risk of lymph node metastases. Objective.--To understand histologic prognostic factors associated with adverse outcome in malignant polyps. Data Sources.--Pertinent literature regarding histologic features of prognostic significance in malignant polyps and low-stage colorectal carcinomas is summarized and our institute's cases are used to highlight these histologic features. Conclusions.--Poor prognostic factors for malignant polyps include high tumor grade, presence of lymphovascular invasion, tumor less than 1 mm from resection margin, submucosal invasion deeper than 1 mm, and high tumor budding. These features should be assessed by the pathologist and communicated to the clinical team in order to allow proper management. doi: 10.5858/arpa.2019-0291-RA, With widespread screening for colorectal cancer (CRC), the number of early-stage CRCs is increasing. Stage I CRCs represent approximately 25% of all CRC cases. Endoscopic excision of adenocarcinomas with submucosal [...]