Linking Leader's Behavioral Integrity With Workplace Ostracism: A Mediated-Moderated Model.

Drawing on the social exchange theory (SET) and research on leadership influences, we developed and inspected a multilevel model to test the conditions and mechanisms through which a leader's behavioral integrity (LBI) deters workplace ostracism (WO). We used trust as a mediator and the narcissistic personality of a leader as a boundary condition in the connection between a LBI and WO. Data were collected from 249 employees working in different five- and four-star hotels in Pakistan over three time lags. The statistical results revealed that a LBI reduces WO. Additionally, a LBI has an indirect effect on WO through interpersonal trust. We did not find statistical support for the moderating role of the narcissistic personality of a leader in the relationship between a LBI and WO. Implications, along with limitations and future research directions, are also discussed.

Microscopic polyangiitis complicated by intracerebral hemorrhage and pulmonary hemorrhage in a pediatric patient.

PATIENT: Female, 10 FINAL DIAGNOSIS: Polyangiitis Symptoms: Intracranial hemorrhage • swelling • oliguria MEDICATION: Cyclophosphamide • prednisolone Clinical Procedure: Plasmapheresis Specialty: Paediatric nephrology • nephrology • paediatrics. OBJECTIVE: Rare disease. BACKGROUND: MPO ANCA-associated vasculitis is very rare in children. Renal disease is almost universally present but lung and central nervous system involvement are not commonly reported. CASE REPORT: We present a pediatric case of microscopic polyangiitis with the unusual presentation of pauci-immune glomerulonephritis, intracerebral hemorrhage and pulmonary hemorrhage. The neurological and pulmonary symptoms settled after treatment with cyclophosphamide and plasmapheresis. However, there was no renal recovery and the patient was rendered dialysis-dependent. CONCLUSIONS: We believe that this is the first reported case of pediatric microscopic polyangiitis with central nervous system involvement. The disease may have a subclinical presentation resulting in chronic damage to different organs. Prompt treatment of acute disease with immunosuppression and plasmapheresis can halt disease progression in these patients.

Clinical efficacy of sevelamer hydrochloride in patients with end-stage renal disease: a retrospective study.

INTRODUCTION: Sevelamer hydrochloride (Renagel) is frequently used as a second-line phosphate binder in patients on renal replacement therapy. Many studies have shown that sevelamer can improve vascular calcification, serum uric acid and low-density lipoprotein (LDL) cholesterol levels. The main objectives of this study were to assess the efficacy of sevelamer against calcium-based phosphate binders, as well as its tolerability and side-effect profile. METHODS: This was a retrospective study that included all patients on renal replacement therapy (between 2008 and 2011) who had previously received calcium-based binders for ≥ 6 months and were subsequently switched to sevelamer. Data collected from the patients' medical records included demographics, as well as renal parameters three months prior to sevelamer treatment, and at three and six months post treatment. The study excluded patients on multiple, concomitant phosphate binders or with functioning renal transplants, and those who were noncompliant or had inadequate follow-up blood investigations. RESULTS: A total of 39 patients were included in the study. No major side effects were reported by any of the patients. There were improvements in calcium, phosphate, uric acid and LDL cholesterol levels at three and six months post-sevelamer treatment. CONCLUSION: We found sevelamer to be superior to calcium-based phosphate binders in reducing serum calcium, phosphate, uric acid and LDL cholesterol levels in our patient population with advanced renal bone disease. Sevelamer also appears to be well tolerated with no significant side effects.

Impact of local circumstances on outcome of renal casualties in major disasters.

BACKGROUND: In the aftermath of earthquakes, the cumulative incidence of crush-induced acute kidney injury (AKI) is difficult to predict. Insight into factors determining this risk is indispensable to allow adequate logistical planning, which is a prerogative for success in disaster management. METHODS: Data of 88 crush-related AKI patients in the aftermath of the Kashmir earthquake were collected and outcome measures were analysed. Then the findings were compared with the data of 596 crush-related AKI patients of the Marmara earthquake. RESULTS: The earthquake in Kashmir occurred in a rural area with lack of medical facilities and difficult transportation conditions while the earthquake in Marmara occurred in an urban area with more efficient transport possibilities. In Kashmir we reported fewer patients with treated AKI (1.2 AKI per 1000 deaths, 1.3 AKI per 1000 victims) than in Marmara (34.1 AKI per 1000 deaths; P < 0.001, 13.6 AKI per 1000 victims; P < 0.001). Time lag between earthquake and admission to hospitals was longer in Kashmir (5.8 +/- 5.8 days) than in Marmara (3.5 +/- 3.7 days; P < 0.001). The frequencies of fasciotomies (P < 0.001), amputations (P < 0.001) and dialysis (P = 0.005) were lower in Kashmir, than in Marmara AKI patients. CONCLUSIONS: The cumulative incidence of treated AKI related to number of deaths or victims might differ substantially among earthquakes. Many factors may affect the frequency of AKI: hampered rescue and transport possibilities; destroyed medical facilities on the spot; availability or not of sophisticated therapeutic possibilities and structure of the buildings might all have impacted on different cumulative incidence between Kashmir and Marmara.