Images in Clinical Rheumatology
Ultrasound and Radiographic Abnormalities in a Patient With Chronic Severe Acromegaly
Los hallazgos ecográficos y radiográficos en una paciente con acromegalia crónica severa
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Imágenes compatibles con patrón reticulonodular bilateral, predominantemente basal, con tamaño pulmonar conservado. B) TACAR de tórax con imágenes en anillo de sello en ambos pulmones, nódulos centrilobulillares y patrón en árbol en gemación. C) Bronquio del lóbulo inferior derecho con edema y disminución concéntrica de los orificios de la pirámide basal. D) Biopsia de glándula salival. Infiltrado inflamatorio de predominio linfocítico, con formación de 2 agregados linfoides de más de 50 células/mm<span class="elsevierStyleSup">2</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lourdes Medina-Paz, José Luis Che-Morales, Hirian Alonso Moshe Barrera-Pérez, Arturo Cortes-Telles" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Lourdes" "apellidos" => "Medina-Paz" ] 1 => array:2 [ "nombre" => "José Luis" "apellidos" => "Che-Morales" ] 2 => array:2 [ "nombre" => "Hirian" "apellidos" => "Alonso Moshe Barrera-Pérez" ] 3 => array:2 [ "nombre" => "Arturo" "apellidos" => "Cortes-Telles" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574318300510" "doi" => "10.1016/j.reumae.2016.11.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318300510?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16301668?idApp=UINPBA00004M" "url" => "/1699258X/0000001400000004/v2_201808030430/S1699258X16301668/v2_201808030430/es/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Ultrasound and Radiographic Abnormalities in a Patient With Chronic Severe Acromegaly" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "236" "paginaFinal" => "238" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rita Fonseca, Alberto Fernández-Martínez, Roberto Miguélez, Jacqueline Uson" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Rita" "apellidos" => "Fonseca" "email" => array:1 [ 0 => "anaritapfonseca@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Alberto" "apellidos" => "Fernández-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Roberto" "apellidos" => "Miguélez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Jacqueline" "apellidos" => "Uson" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Rheumatology Department, São João Hospital, Oporto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Endocrinology Department, Hospital Universitario de Móstoles, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Rheumatology Department, Hospital Universitario de Móstoles, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Los hallazgos ecográficos y radiográficos en una paciente con acromegalia crónica severa" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 581 "Ancho" => 1979 "Tamanyo" => 116789 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Lateral right foot X-ray showing increased heel fat pad. (B) Longitudinal ultrasound image showing homogeneous Aquiles tendon and enthesis. (C) Longitudinal ultrasound image of plantar fascia insertion that shows homogeneous non thickened fascia and increased fat pad: 1.4<span class="elsevierStyleHsp" style=""></span>cm (normal <0.39<span class="elsevierStyleHsp" style=""></span>mm).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> F, Kager's fat; C, calcaneous; At, aquilles tendon; Sc, subcutaneous tissue; Fp, heel fat pad; F, plantar fascia; m, muscle.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acromegaly is a rare endocrinopathy caused by hypersecretion of growth hormone (GH). Acromegalic arthropathy, is a common complication, responsible for important morbility.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> At the beginning, GH and IGF-1 levels induce cartilage and soft tissue hypertrophy (ligaments, tendons, nerves, sub-cutaneous fat) that is documented with conventional radiographs as joint space widening. Later on, as the disease evolves, distal tufting of the phalanges, narrowing of joint spaces and osteophytosis develop.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Common peri-articular regional disorders are carpal tunnel syndrome, enthesopathy and trigger fingers. In addition, rheumatoid arthritis is more prevalent then in general population.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Ultrasound (US) can identify sub-clinical synovitis, enthesopathy, tendon lesions and osteophytes but its role in this rare syndrome has not been sufficiently studied. Herein we report the radiographic and US images (using a General Electric Logiq9 ultrasound machine and multifrequency linear array transducers 9–18<span class="elsevierStyleHsp" style=""></span>MHz) of a 41-year-old woman with longstanding acromegaly complaining of mechanical symmetric metacarpophalangeal (MCP), knee, and heel pain as well as bilateral paraesthesia in 1–3 fingers. Musculoskeletal examination revealed diffuse thickening of soft tissue, acral enlargement (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), knee crepitus, positive Phalen and tinel signs and pain in right heel footpad. US examination detected cartilage thickening, median nerve enlargement, osteophytes and foot-pad thickness but not synovitis (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2–5</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion, conventional X-rays lack sensitivity in cartilage and soft tissue evaluation. US helped in evaluation of this patient as it showed cartilage thickening, median nerve enlargement, osteophytes, foot-pad thickness and excluded tendon lesion, enthesitis and synovitis. Although more studies are needed, ultrasound seems to be useful in the clinical setting of the acromegalic patients identifying articular and periarticular abnormalities.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">No funding was received in this work.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">No conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interests" ] 3 => array:2 [ "identificador" => "xack361379" "titulo" => "Acknowledgements" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-08-01" "fechaAceptado" => "2017-01-09" "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 556 "Ancho" => 1605 "Tamanyo" => 210038 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Diffuse thickening of soft tissue and acral enlargement of both hands and feet.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 563 "Ancho" => 1912 "Tamanyo" => 130049 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) PA conventional X-ray of hands showing diffuse soft tissue hypertrophy, acral enlargement and joint space widening. (B and C) Ultrasound longitudinal image of the second and fourth MCP joints in maximal flexion shows increased anechogenic cartilage thickness (normal 0.02–0.05<span class="elsevierStyleHsp" style=""></span>cm).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Mcp, metacarpophalangeal joints; mc, metacarpal head; P, proximal phalanx base; T, extensor tendon; * cartilage.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 563 "Ancho" => 1302 "Tamanyo" => 91422 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ultrasound transverse (A) and longitudinal (B) image of the enlarged fascicular pattern of median nerve of right hand, area: 22<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (normal less than 12<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Power Doppler signal was absent. C, capitate; FT, flexor tendons; M, median nerve; R, flexor retinaculum; L, lunate.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 498 "Ancho" => 1979 "Tamanyo" => 116721 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) PA conventional standing knees X-ray showing joint space widening. (B) Transverse ultrasound image of the knee cartilage in maximal flexion illustrates increased anechogenic cartilage (normal 0.25–0.3<span class="elsevierStyleHsp" style=""></span>cm).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> (C) Longitudinal ultrasound image of medial compartment of the right knee depicts small hyperechogenic articular femoral and tibial bony margins set-ups that represents osteophytes, poorly visualized in the X-ray. C, cartilage; LC, lateral condyle; MC, medial condyle; F, suprapatellar fat pad; Fe, femur; T, tibia; Mm, medial meniscus; L, Medial collateral ligament; * osteophytes.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 581 "Ancho" => 1979 "Tamanyo" => 116789 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Lateral right foot X-ray showing increased heel fat pad. (B) Longitudinal ultrasound image showing homogeneous Aquiles tendon and enthesis. (C) Longitudinal ultrasound image of plantar fascia insertion that shows homogeneous non thickened fascia and increased fat pad: 1.4<span class="elsevierStyleHsp" style=""></span>cm (normal <0.39<span class="elsevierStyleHsp" style=""></span>mm).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> F, Kager's fat; C, calcaneous; At, aquilles tendon; Sc, subcutaneous tissue; Fp, heel fat pad; F, plantar fascia; m, muscle.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arthropathy in acromegaly" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Killinger" 1 => "J. Payer" 2 => "I. Lazúrová" 3 => "R. Imrich" 4 => "Z. Homérová" 5 => "M. Kuzma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheum Dis Clin N Am" "fecha" => "2010" "volumen" => "36" "paginaInicial" => "713" "paginaFinal" => "720" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Musculoskeletal ultrasound including definitions for ultrasonographic pathology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.J. Wakefield" 1 => "P.V. Balint" 2 => "M. Szudlarek" 3 => "E. Filippucci" 4 => "M. Backhaus" 5 => "M.A. D’Agostino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2005" "volumen" => "32" "paginaInicial" => "2485" "paginaFinal" => "2487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16331793" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.S. Klauser" 1 => "E.J. Halpern" 2 => "T. de Zordo" 3 => "G.M. Feuchtner" 4 => "R. Arora" 5 => "J. Gruber" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2501080397" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2009" "volumen" => "250" "paginaInicial" => "171" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19037017" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonographic evaluation of femoral condylar cartilage in osteoarthritis and rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Iagnocco" 1 => "G. Coari" 2 => "A. Zoppini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Rheumatol" "fecha" => "1992" "volumen" => "21" "paginaInicial" => "201" "paginaFinal" => "203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1529288" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of ultrasonography and radiography in assessment of the heel pad compressibility index of patients with plantar heel pain syndrome. Measurement of the fat pad in plantar heel pain syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Uzel" 1 => "E. Cetinus" 2 => "E. Bilgic" 3 => "H. Ekerbicer" 4 => "A. Karaoguz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jbspin.2005.05.008" "Revista" => array:6 [ "tituloSerie" => "Joint Bone Spine" "fecha" => "2006" "volumen" => "73" "paginaInicial" => "196" "paginaFinal" => "199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16513397" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack361379" "titulo" => "Acknowledgements" "texto" => "<p id="par0045" class="elsevierStylePara elsevierViewall">Rheumatology Department of Hospital Universitario de Móstoles.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/1699258X/0000001400000004/v2_201808030430/S1699258X17300013/v2_201808030430/en/main.assets" "Apartado" => array:4 [ "identificador" => "42683" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Reumatología clínica en imágenes" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001400000004/v2_201808030430/S1699258X17300013/v2_201808030430/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17300013?idApp=UINPBA00004M" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 2 | 3 | 5 |
| 2024 Octubre | 47 | 34 | 81 |
| 2024 Septiembre | 54 | 21 | 75 |
| 2024 Agosto | 57 | 37 | 94 |
| 2024 Julio | 58 | 39 | 97 |
| 2024 Junio | 64 | 35 | 99 |
| 2024 Mayo | 62 | 36 | 98 |
| 2024 Abril | 74 | 24 | 98 |
| 2024 Marzo | 76 | 35 | 111 |
| 2024 Febrero | 60 | 25 | 85 |
| 2024 Enero | 78 | 28 | 106 |
| 2023 Diciembre | 67 | 23 | 90 |
| 2023 Noviembre | 57 | 21 | 78 |
| 2023 Octubre | 94 | 32 | 126 |
| 2023 Septiembre | 94 | 37 | 131 |
| 2023 Agosto | 58 | 15 | 73 |
| 2023 Julio | 71 | 26 | 97 |
| 2023 Junio | 62 | 21 | 83 |
| 2023 Mayo | 74 | 20 | 94 |
| 2023 Abril | 52 | 10 | 62 |
| 2023 Marzo | 107 | 28 | 135 |
| 2023 Febrero | 79 | 34 | 113 |
| 2023 Enero | 72 | 13 | 85 |
| 2022 Diciembre | 101 | 40 | 141 |
| 2022 Noviembre | 103 | 37 | 140 |
| 2022 Octubre | 97 | 30 | 127 |
| 2022 Septiembre | 69 | 43 | 112 |
| 2022 Agosto | 107 | 42 | 149 |
| 2022 Julio | 102 | 46 | 148 |
| 2022 Junio | 82 | 37 | 119 |
| 2022 Mayo | 92 | 36 | 128 |
| 2022 Abril | 75 | 45 | 120 |
| 2022 Marzo | 87 | 61 | 148 |
| 2022 Febrero | 92 | 28 | 120 |
| 2022 Enero | 137 | 66 | 203 |
| 2021 Diciembre | 81 | 48 | 129 |
| 2021 Noviembre | 81 | 38 | 119 |
| 2021 Octubre | 75 | 67 | 142 |
| 2021 Septiembre | 54 | 37 | 91 |
| 2021 Agosto | 53 | 45 | 98 |
| 2021 Julio | 51 | 30 | 81 |
| 2021 Junio | 55 | 38 | 93 |
| 2021 Mayo | 94 | 44 | 138 |
| 2021 Abril | 230 | 64 | 294 |
| 2021 Marzo | 134 | 27 | 161 |
| 2021 Febrero | 87 | 36 | 123 |
| 2021 Enero | 88 | 31 | 119 |
| 2020 Diciembre | 120 | 39 | 159 |
| 2020 Noviembre | 82 | 27 | 109 |
| 2020 Octubre | 85 | 16 | 101 |
| 2020 Septiembre | 72 | 31 | 103 |
| 2020 Agosto | 71 | 27 | 98 |
| 2020 Julio | 45 | 22 | 67 |
| 2020 Junio | 54 | 24 | 78 |
| 2020 Mayo | 59 | 19 | 78 |
| 2020 Abril | 85 | 25 | 110 |
| 2020 Marzo | 58 | 27 | 85 |
| 2020 Febrero | 54 | 30 | 84 |
| 2020 Enero | 64 | 28 | 92 |
| 2019 Diciembre | 61 | 28 | 89 |
| 2019 Noviembre | 43 | 20 | 63 |
| 2019 Octubre | 57 | 15 | 72 |
| 2019 Septiembre | 27 | 24 | 51 |
| 2019 Agosto | 66 | 19 | 85 |
| 2019 Julio | 33 | 15 | 48 |
| 2019 Junio | 47 | 19 | 66 |
| 2019 Mayo | 59 | 44 | 103 |
| 2019 Abril | 34 | 16 | 50 |
| 2019 Marzo | 34 | 24 | 58 |
| 2019 Febrero | 19 | 7 | 26 |
| 2019 Enero | 24 | 22 | 46 |
| 2018 Diciembre | 1 | 2 | 3 |
| 2018 Agosto | 3 | 0 | 3 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Abril | 0 | 12 | 12 |
| 2018 Marzo | 0 | 10 | 10 |
| 2018 Febrero | 0 | 10 | 10 |
| 2018 Enero | 0 | 9 | 9 |
| 2017 Diciembre | 0 | 13 | 13 |
| 2017 Noviembre | 0 | 11 | 11 |
| 2017 Octubre | 0 | 11 | 11 |
| 2017 Septiembre | 0 | 10 | 10 |
| 2017 Agosto | 0 | 7 | 7 |
| 2017 Julio | 0 | 12 | 12 |
| 2017 Junio | 0 | 12 | 12 |
| 2017 Mayo | 0 | 12 | 12 |
| 2017 Abril | 0 | 15 | 15 |
| 2017 Marzo | 0 | 27 | 27 |
| 2017 Febrero | 0 | 15 | 15 |
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