Deep-level dissimilarity and leader–member exchange (LMX) quality: the role of status

Purpose This study explores how status, demographic and positional, moderates the negative effect of deep-level dissimilarity on leader–member exchange (LMX) quality.Design/methodology/approach Data from three samples were analyzed using hierarchical linear regression and linear mixed-effects methods.Findings Results suggest that the negative effect of deep-level dissimilarity (perceived work-related attitude and perspective differences) on LMX quality is stronger when the LMX partner has low demographic status (e.g. the LMX partner is an African-American woman). This moderating effect was not significant when deep-level dissimilarity was extended to include differences in personality, interests and values. Results were mixed on whether low positional status (i.e. when the LMX partner is a member rather than a leader) strengthens the negative effect of deep-level dissimilarity on LMX quality.Practical implications This study may help leaders, organizational members and diversity managers better manage attitude and perspective dissimilarity in leader–member dyads.Originality/value This study expands research exploring interactive effects of dissimilarity and status on work-related outcomes. It is novel in that it explores status not in relative terms but at the societal level. It is also the first study to analyze the moderating effects of two types of status: demographic and positional.

A-63 Non-Alcoholic Wernicke-Korsakoff Syndrome in a Bariatric Surgery Patient

Objective Wernicke-Korsakoff’s Syndrome (WKS), caused by thiamine deficiency and characterized by altered mental status, amnestic memory loss, confabulation, and lack of awareness, has a global prevalence rate up to 3% and is most commonly observed in alcoholics. Cases of non-alcoholic WKS are exceptionally rare and often go undiagnosed until after the critical treatment period, resulting in permanent brain damage. Despite the paucity of research in this group, there is some evidence that there may be differences in demographic factors, neuroanatomic changes, and cognitive functioning between alcoholic and non-alcoholic WKS patients. Thus, case studies are necessary to understand how non-alcoholic WKS may present and determine whether regular testing in individuals diagnosed with disorders or undergoing medical interventions that can cause thiamine deficiency should be encouraged. Methods Patient is a 65-year-old African American woman with a history of hypothyroidism, obesity, and sleep apnea. She complained of gastrointestinal problems one-month into a pre-bariatric surgery diet. Subsequent medical workups were negative, but she was hospitalized 2–3 months post-symptom onset for thiamine deficiency. Acute neuroimaging was reportedly negative. Results Results from a neuropsychological evaluation indicated temporal disorientation, delusions, and hallucinations. Psychometric testing revealed severe impairments in learning and memory. Some variability was noted in other cognitive domains, but attention, processing speed, executive functioning, language, and visuospatial and motor skills were generally intact. Symptoms of minimal depression and moderate anxiety were endorsed. Conclusion Thiamine deficiency is easily treatable, but different presentations between alcoholic and non-alcoholic cases may complicate diagnosis, delay treatment, and result in WKS. Increased awareness of these differences can inform clinical recommendations.

Spontaneous Coronary Artery Dissection in Multiple Gestation Peripartum Period

Background: Non-atherosclerotic spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic and non-iatrogenic separation of the coronary arterial wall. SCAD is a highly uncommon cause of myocardial infarction (0.1 to 0.4 %). Case presentation: 40-year-old African American woman, G1T1P0A0L2, with a past medical history of tobacco abuse and obesity who had uncomplicated cesarean section delivery for healthy twins two weeks prior presented with substernal, sudden onset chest pain. The pain radiated to left arm and back, pressure-like, and is associated with nausea, vomiting, and dyspnea. On examination she was within normal limits except for a well-healed C-section wound. An electrocardiogram showed normal sinus rhythm with Nonspecific ST Abnormality. The first set of troponins less than 0.03, the second set shows troponins 0.18 and D-dimer 2340. The chest x-ray was unremarkable. An echocardiogram showed only mild to moderate mitral valve regurgitation. CT angiography of the chest showed no evidence of pulmonary embolism. She was started on a heparin drip and catheterization the next day showed no atherosclerotic coronary artery disease, but SCAD of inferior diagonal first branch noted. No intervention was done, heparin was stopped. The patient was started on aspirin, statin, Clopidogrel, Metoprolol, and Lisinopril per cardiology recommendation. Conclusions: As an internist and primary care provider, we should keep Non-atherosclerotic SCAD in mind when a young female patient presents with acute chest pain. More studies are needed to find out the optimal management. Current recommended conservative medical management includes long-term aspirin, beta blocker, and one year of clopidogrel, with the addition of a statin in patients with dyslipidemia.

Risperidone-Induced Neutropenia in a Schizophrenic Patient: A Case Report and Literature Review

Neutropenia is an adverse effect of various pharmacological therapies, including antipsychotics. Among the second-generation antipsychotic (SGA) medications, clozapine is most notable for neutropenic adverse effect. Risperidone, another SGA drug, is linked mainly with metabolic adverse effects, but rarely, blood dyscrasia adverse reactions have been reported. Hence, we report the case of a 56-year-old African American woman who developed severe neutropenia following two weeks of oral risperidone treatment. Her neutrophil levels returned to normal limits following discontinuation of risperidone and switching to haloperidol.

Acute pulmonary embolism due to right basilic vein thrombosis

A 40-year-old African-American woman presented to the emergency room (ER) with right upper extremity pain for 3 hours after sleeping overnight on that side. She was diagnosed with basilic vein thrombosis; in the ER, she was tachycardic with minimal ambulation, prompting CT pulmonary angiogram, which confirmed right-sided pulmonary embolism. Bilateral upper and lower extremity venous Dopplers did not show any acute deep venous thrombosis. She received appropriate anticoagulation. Risk factors are a smoker and recently started contraceptive pills.

Fibroid expulsion: a unique presentation of mechanical small bowel obstruction 11 years after uterine artery embolization: a case report

Background Uterine artery embolization in the treatment of uterine leiomyoma has been rarely associated with dislodgement and expulsion of infarcted uterine fibroids through the vagina, peritoneum, or bowel wall, predominantly occurring within 6 months of uterine artery embolization. Case presentation We present the case of a 54-year-old African American woman who underwent uterine artery embolization 11 years prior and developed mechanical small bowel obstruction from the migration of fibroid through a uteroenteric fistula with ultimate impaction within the distal small bowel lumen. Small bowel resection and hysterectomy were curative. Conclusions Uteroenteric fistula with small bowel obstruction due to fibroid expulsion may present as a delayed finding after uterine artery embolization and requires heightened awareness.

Plummer-Vinson Syndrome in an African-American Woman

Plummer-Vinson syndrome (PVS) presents with the classic triad of iron-deficiency anemia, dysphagia, and esophageal webs. The mainstay treatment of PVS is iron supplementation and the dysphagia usually responds to iron supplementation before the hematologic abnormalities are corrected. This syndrome classically affects middle-aged Caucasian women and very few cases have been reported in African Americans. We present a rare case of PVS in an African-American woman. A 63-year-old woman presented with shortness of breath, dysphagia, and lightheadedness for several weeks. Chest X-ray was negative for any acute abnormalities. Initial hemoglobin was 7.0 g/dL, which improved to 7.5 g/dL after 1 unit of packed red blood cells. She had a mean corpuscular volume of 62 fL, a ferritin level of 6 ng/mL, and an iron level of 12 μg/dL. Fecal occult blood test was negative and barium swallow revealed a proximal esophageal web. Her dysphagia did not significantly improve despite intravenous iron supplementation and esophageal web dilation. Video-fluoroscopic swallow study revealed esophageal and pharyngeal phase dysphagia with food entrapment. She was discharged with plans to follow up with a primary care physician and repeat esophagogastroduodenoscopy in 1 year. This case report highlights a rare case of PVS in an African-American woman and emphasizes the importance of maintaining a comprehensive and broad differential diagnosis.