We Hold These Distruths to be Self-Evident: How Legal History Could Save America from Itself

This paper explores the threat of disinformation to American society. Focusing on social and cable news media as the primary disseminators of disinformation, it examines how the very design and nature of these two mediums promote and stimulate the intentional and viral spread of wholly inaccurate information as well as the significant and tangible negative consequences experienced across American society as a result. The paper subsequently proposes a legal solution to this dilemma in the form of a repeal of Section 230 paired with a reinstatement of the Fairness Doctrine. The background, history, and effect of each are thoroughly discussed, and the prevailing legal and policy arguments against their respective repeal and reinstatement are considered and countered in concluding that the proposed solution would, to some degree, likely promote a more civil and informed American society better equipped to confront modern challenges.

1456 Back-To-Back Surgeries: A Clinic Case Report Regarding Multiple Complex Spinal Surgeries for Treatment of Multiple Osteochondroma With Histological Conversion to Chondrosarcoma

Background Multiple Hereditary Osteochondromas [MHO], previously known as multiple hereditary exostoses, is a rare disorder of bone growth, whereby osseous transformation of the cartilage caps within the diaphyses of long bones or flat bones within the skeleton occurs. A significant complication of MHO is the conversion of any present osteochondroma into a malignant chondrosarcoma. Chondrosarcomas are mesenchymal, non-meningothelial tumours and most commonly present with insidious pain, associated neurological deficit by means of impingement of underlying nerves. Case presentation We present a clinical case of a 29-year-old female medical student with a background history of multiple hereditary osteochondromas. A previously competitive cross-fitter, she developed the conversion of MHO into a malignant chondrosarcoma. Presenting to outpatient clinic in late 2017, this lady had a 2-year history of lower back pain and an associated palpable lump. An MRI of the thoracolumbar spine demonstrated a large mass arising from the posterior elements of T11 to L2. A biopsy at the time was found to be of benign pathology, most likely in keeping with this patient’s diagnosis of MHO. The patient returned for review in early 2018, where a repeat MRI showed extension of the previously described lesion into the spinal canal at the level of L1 vertebra. This was concerning that this previously identified osteochondroma lesion could be undergoing malignant transformation. The patient went on to have a series of complex spinal surgeries which we will discuss below.

Maculopathy Masquerading as Migraine

We describe a case of a 23-year-old Caucasian woman with a background history of migraines who presented with bilateral paracentral scotomata. The ophthalmoscopy and MRI head were originally thought to be normal, and the scotomata were attributed to be of migrainous origin: a persistent negative aura. However, persistence of her symptoms prompted further specialist review 10 months later, at which time subtle bilateral perifoveal changes were noted, which had been apparent but overlooked at the initial assessment. Near-infrared reflectance imaging enabled better visualization of the lesions, which were apparent prior to any abnormalities on clinical examination. Spectral-domain optical coherence tomography revealed the early findings of hyperreflectivity in the outer nuclear and outer plexiform layers characteristic of acute macular neuroretinopathy. Our case aims to emphasize the importance of scrutinising ancillary tests of the macula in patients presenting with scotomata or atypical migraine symptoms, and to caution clinicians against diagnosing migraine with persistent negative aura without these investigations.

THEMATIC ANALYSIS OF THE CONFLICT IN UNMARRIAGEABLE BY SONIAH KAMAL: A FORMALISTIC STUDY

This study deals with the analysis of the novel Unmarriageable with reference to the (social) conflict by Soniah Kamal. The novel discusses important themes like materialism, feminism, marriages and fight against a conservative mindset etc. Thematically, the novel is very important because it deals with the conflictual aspect of present situation of Pakistani society regarding these important social issues. This is the time of advancement and liberty but the stereotypical families still force their children, especially girls to forced and unwanted marriages. This is one of the main problems that our young generation is facing. This research has been carried out using the qualitative paradigm and analysis of the text of the novel Unmarriageable. The study is limited to the analysis of themes with the help of theory of Formalism. This researcher has analyzed the novel and its main themes without going into the background, history or any personal information of the novelist because in Formalism it is all about the form, text, figures of speech, themes, cohesion, coherence and characters etc. The researcher analyzed and concluded that the writer used language, settings, characters and diction in a way that the novel disclosed and explicated these issues in influential and effective ways. Keywords: Formalism, Snobbery, Stereotypes, Retrospection

Clinical Study on Ocular Manifestations in Patients with Psoriasis, in Chennai, India

BACKGROUND We wanted to determine the prevalence of ocular manifestations assess the frequency and distribution of potential sight threatening complications in patients with psoriasis. METHODS This is a non interventional, observational hospital based study conducted at a tertiary health care centre which included 105 patients with psoriasis. A background history was taken regarding the duration of psoriasis and treatment taken. The prevalence of ocular manifestations were assessed by detailed ocular examination which involved the best corrected visual acuity using Snellen’s chart, examination of the anterior chamber using slit lamp, examination of the fundus, intraocular pressure measurement, dry eye evaluation including Schirmer’s test, tear film break up time test, and Rose Bengal stain test. RESULTS In total 105 patients with psoriasis were enrolled in this study. Among the 105 patients whose 210 eyes were examined, 77 % had psoriasis vulgaris, 14 % had scalp psoriasis, and 9 % had palmoplantar psoriasis. Among the 105 patients, 38 patients had symptomatic ocular manifestations. Out of the 38 % patients with symptomatic ocular manifestations, we found that 28 %, 25 %, 17 %, 2 % of the patients manifested with evaporative dry eye, blepharoconjunctivitis, redness and episcleritis respectively. CONCLUSIONS In our study, ocular manifestations were even seen among the asymptomatic patients. Hence a multi-disciplinary approach including effective screening and early detection of ocular manifestations followed by prompt treatment is essential to reduce the morbidity in patients with psoriasis. KEY WORDS Psoriasis, Dry Eye, Uveitis

Treatment-resistant hypertension in a post-transplant patient with cystic fibrosis: a rare case of phaeochromocytoma

Summary Phaeochromocytoma is a rare catecholamine-producing tumour. We present the case of phaeochromocytoma in a young man with a background history of a double-lung transplant for cystic fibrosis (CF). Clinical case: A 25-year-old man, with a background history of CF, CF-related diabetes (CFRD) and a double-lung transplant in 2012 was presented to the emergency department with crampy abdominal pain, nausea and vomiting. He was diagnosed with distal intestinal obstructions syndrome (DIOS). Contrast-enhanced CT imaging of the abdomen and pelvis showed a 3.4 cm right adrenal lesion. This was confirmed by a subsequent MRI of adrenal glands that demonstrated moderate FDG uptake, suggestive of a diagnosis of phaeochromocytoma. The patient was noted to be hypertensive with a blood pressure averaging 170/90 mm/Hg despite treatment with three different anti-hypertensive medications – amlodipine, telmisartan and doxazosin. He had hypertension for the last 3 years and had noted increasingly frequent sweating episodes recently, without palpitations or headache. Laboratory analysis showed elevated plasma normetanephrines (NMN) of 3167 pmol/L (182–867) as well as elevated metanephrines (MN) of 793 pmol/L (61–377) and a high 3-MT of 257 pmol/L (<185). Once cathecholamine excess was identified biochemically, we proceeded to functional imaging to further investigate. MIBG scan showed a mild increase in the uptake of tracer to the right adrenal gland compared to the left. The case was discussed at a multidisciplinary (MDT) meeting at which the diagnosis of phaeochromocytoma was made. Following a challenging period of 4 weeks to control the patient’s blood pressure with an alpha-blocker and beta-blocker, the patient had an elective right adrenalectomy, with normalisation of his blood pressure post-surgery. The histopathology of the excised adrenal gland was consistent with a 3 cm phaeochromocytoma with no adverse features associated with malignant potential. Learning points Five to ten per cent of patients have a secondary cause for hypertension. Phaeochromocytomas are rare tumours, originating in chromaffin cells and they represent 0.1–1.0% of all secondary hypertension cases. Secondary causes should be investigated in cases where: Patient is presenting <20 years of age or >50 years of age, There is refractory hypertension, or There is serious end-organ damage present. Patients may present with the triad of headache, sweating and palpitations or more vague, non-specific symptoms. Patients with suspected phaeochromocytoma should have 24-h urinary catecholamines measured and if available, plasma metanephrines measured. Those with abnormal biochemical tests should be further investigated with imaging to locate the tumour. Medical treatment involves alpha- and beta-blockade for at least 2 to 3 weeks before surgery as well as rehydration. There is a possibility of relapse so high-risk patients require life-long follow-up.

Teaching the political discourse in russian universities

Nowadays there are great quantities of academic courses in which political discourse is being studied. The present paper analyzes the teaching of American political discourse in Russian academic areas as an actualization of the most important aspects of both the cultural features and the historical background of the USA influencing not only vocabulary but semantics as well. We have selected 5 speeches of the former and current presidents of the USA to analyze their way of speaking from the linguistic point of view. We confirmed the hypothesis that language cannot be learnt without country’ background, history and culture. Hence, we have implemented some exercises developing oral, writing, listening and reading skills. We have reckoned the individual features of our students as well as the field of their interests using a communicative approach. The following exercises are integrated in courses of English for political purposes in RUDN University.

262 Analysis of the Factors Contributing to Unplanned Admissions of Surgical Day Cases

Introduction Day surgery has many benefits including a reduction in waiting lists, cancellations, hospital acquired infections and need for inpatient beds. It is also highly cost effective. The aim of this study is to identify which factors lead to the unanticipated admission of day cases, in order to adjust future patient selection, and retain efficiency Method A list of day cases that took place in 2017 was obtained from the HIPE department in St. Luke’s General Hospital. Day case patients who required admission were retrospectively analysed with the use of patient charts. Patient factors such as age, gender and co morbidities were recorded. The root cause of admission was identified, and the data collated. Results 457-day cases took place during 2017. 35/457 patients were admitted postoperatively (admission rate of 7.8%). The majority of patients were admitted post cholecystectomy (22) and incisional hernia repair (8). Surgical factors were responsible for almost all admissions. Conclusions Surgical factors/complications are not always predictable, but a thorough review of a patient’s background history and imaging can lead to the identification of patients, who should be directed away from day surgery, minimising the need for unexpected admissions, and maximising the efficiency of the unit.

590 False Positives Bladder Scan in Anuric Patient with Ascites: A Case Report

Introduction Urinary retention is one of the common presentations. Sometimes the clinical examination is unreliable, especially in patients with high BMI, ascites or anasarca. This makes the diagnosis uncertain and the bladder scan readings should be interpreted with caution. Thus, radiological imaging might be required before planning further intervention. Case presentation An 83-year-old woman was admitted under the medical team for sepsis secondary to soft tissue infection. She had multiple comorbidities and morbid obesity with a BMI of 58. Lab results showed an AKI. Initial Bladder scan showed 900 cc. Five uneventful attempts of urinary catheter insertion by the medical team, but still, no urine output and the bladder scan showing positive readings. Supra public catheter was considered. On review, the urinary catheter was in place, no evidence of blood per urethra and the bladder scan showed a reading of around 900 cc. Based on patient’s significantly high BMI, background history, uneventful catheterization and persistent reading on bladder scan. False reading on bladder scan was suspected. Out of hours CTKUB showed significant amount of ascites. Discussion: Bladder scan is sensitive for detecting any fluid in the abdomen not specifically urine in the bladder.Formal imaging should always be considered to confirm diagnosis.

158 Oral Submucous Fibrosis in A 2-Year-Old Girl Due to Chewing BIDI Stubs

A 2-year-old girl, complaining of a gradual increase in the restriction of the mouth opening for 3 months, was referred to the Otolaryngologists based on background history of recurrent oral ulcers. The local examination showed the presence of oral ulcers on the cheek in addition to abnormal oral mucosa which appeared blanched, opaque and fibrotic. This was clinically diagnosed as Oral Submucous Fibrosis, owing to classical presentation and the lack of systemic features. A detailed social and family history revealed that the father of the child used to smoke BIDI, a traditional form of nonfiltered cigarette. The child used to play with the burnt stubs and keep them in her mouth, chewing them for long durations. This was assumed to be the aetiological factor behind the development of the pathology, in absence of any other contributing factors. The patient was treated conservatively, and symptomatic improvement was noted on follow-up. This is the youngest reported patient with OSMF, and this case history brought an unusual aetiological factor to the fore.