Vasculitis crioglobulinémica por hiperviscosidad y formación de criogel como debut de mieloma múltiple. Caso clínico / Cryoglobulinemic vasculitis due to hyperviscosity and cryogel formation as the onset of multiple myeloma. Report of one case

Multiple Myeloma (MM) is characterized by a clonal expansion of plasma cells in the bone marrow. These cells typically produce a monoclonal immunoglobulin, and its symptoms arise either from plasma cell infiltration in several organs, or secondary to the presence of a monoclonal protein peak. Symptoms can be summarized by the acronym CRAB (hypercalcemia, renal failure, anemia and bone lesions). Sometimes, in the setting of a protein secreting monoclonal gammopathy, formation of cryoglobulins develops. Cryoglobulins are plasma proteins that precipitate at low temperatures, forming a cold - induced precipitate at small vessels, causing a wide range of clinical manifestations. We report a female consulting for ulcers lasting 2 months in the left foot associated with purpuric lesions in both lower limbs. Protein electrophoresis showed a monoclonal peak in the gamma region. Bone marrow aspirate showed 27% of plasma cells with kappa chain restriction by cytometry. The presence of cryoglobulins was confirmed. The patient was treated with dexamethasone and bortezomib, with a progressive healing of lower limb lesions and disappearance of cryoglobulins. She was discharged in good conditions.

[Cryoglobulinemic vasculitis due to hyperviscosity and cryogel formation as the onset of multiple myeloma. Report of one case]. / Vasculitis crioglobulinémica por hiperviscosidad y formación de criogel como debut de mieloma múltiple. Caso clínico.

Multiple Myeloma (MM) is characterized by a clonal expansion of plasma cells in the bone marrow. These cells typically produce a monoclonal immunoglobulin, and its symptoms arise either from plasma cell infiltration in several organs, or secondary to the presence of a monoclonal protein peak. Symptoms can be summarized by the acronym CRAB (hypercalcemia, renal failure, anemia and bone lesions). Sometimes, in the setting of a protein secreting monoclonal gammopathy, formation of cryoglobulins develops. Cryoglobulins are plasma proteins that precipitate at low temperatures, forming a cold - induced precipitate at small vessels, causing a wide range of clinical manifestations. We report a female consulting for ulcers lasting 2 months in the left foot associated with purpuric lesions in both lower limbs. Protein electrophoresis showed a monoclonal peak in the gamma region. Bone marrow aspirate showed 27% of plasma cells with kappa chain restriction by cytometry. The presence of cryoglobulins was confirmed. The patient was treated with dexamethasone and bortezomib, with a progressive healing of lower limb lesions and disappearance of cryoglobulins. She was discharged in good conditions.

Nivel de Fatiga Aguda estimada a través de la aplicación «Access Point» en conductores de la Gran Minería Chilena / Acute fatigue level estimated by the «Access Point» application divers Great Chilean Mining

Este estudio tiene como objetivo la estimación del nivel de fatiga aguda de un grupo de 8.920 conductores de una empresa de la Gran Minería Chilena, localizada hacia el sur de la Región Metropolitana, en el periodo comprendido entre enero y diciembre del año 2014. Para estimar su nivel de fatiga aguda antes de entrar a faena y definir la intervención dirigida a mitigar sus efectos según los resultados, se utilizó la aplicación Access Point. El instrumento se aplicó diariamente a una muestra aleatoria de conductores. Esto dio por resultado un total de 19.828 observaciones. Los conductores que presentan mayores niveles de fatiga son los que tienen mayor edad, conducen vehículos de transporte de pasajeros y tienen una jornada de ocho o doce horas rotativas. Es importante la evaluación y mitigación de la fatiga, dado que estudios recientes indican la importante relación que existe entre fatiga y accidentabilidad, sobre todo en el ámbito laboral, en el cual esta condición contribuye en forma significativa a la ocurrencia de muertes y lesiones serias (AU)

This study aims to estimate the acute fatigue level of a group of 8,920 drivers a big mining company of Chile, located to the south of the metropolitan area, in the period between January and December 2014. To estimate their acute fatigue level before entering task and define the intervention aimed at mitigating their effects according to the results, the Access Point application was used. The instrument was applied daily to a random sample of drivers. This resulted in a total of 19,828 observations. Drivers who have higher levels of fatigue are those who are older, leading passenger vehicles and have an eight or twelve hours rotating. It is important to the assessment and mitigation of fatigue, since recent studies indicate the important relationship between fatigue and accidents, especially in the workplace, in which this condition contributes significantly to the occurrence of deaths and serious injuries (AU)