Pneumonitis caused by sirolimus: improvement after switching to everolimus
Neumonitis por sirolimus: resolución tras conversión a everolimus
Read
6491
Timeswas read the article
1991
Total PDF
4500
Total HTML
Share statistics
array:21 [ "pii" => "X2013251409003828" "issn" => "20132514" "doi" => "10.3265/Nefrologia.2009.29.5.5240.en.full" "estado" => "S300" "fechaPublicacion" => "2009-10-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2009;29:490-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3384 "formatos" => array:3 [ "EPUB" => 262 "HTML" => 2613 "PDF" => 509 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699509003820" "issn" => "02116995" "doi" => "10.3265/Nefrologia.2009.29.5.5240.en.full" "estado" => "S300" "fechaPublicacion" => "2009-10-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2009;29:490-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4941 "formatos" => array:3 [ "EPUB" => 223 "HTML" => 4196 "PDF" => 522 ] ] "es" => array:9 [ "idiomaDefecto" => true "titulo" => "Neumonitis por sirolimus: resolución tras conversión a everolimus" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "490" "paginaFinal" => "491" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pneumonitis caused by sirolimus: improvement after switching to everolimus" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Auxiliadora Mazuecos Blanca, L. Calle, C. Tejada, C. Lancho" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Auxiliadora" "apellidos" => "Mazuecos Blanca" ] 1 => array:2 [ "Iniciales" => "L." "apellidos" => "Calle" ] 2 => array:2 [ "Iniciales" => "C." "apellidos" => "Tejada" ] 3 => array:2 [ "Iniciales" => "C." "apellidos" => "Lancho" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251409003828" "doi" => "10.3265/Nefrologia.2009.29.5.5240.en.full" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003828?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003820?idApp=UINPBA000064" "url" => "/02116995/0000002900000005/v0_201502091404/X0211699509003820/v0_201502091405/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X201325140900381X" "issn" => "20132514" "doi" => "10.3265/Nefrologia.2009.29.5.5227.en.full" "estado" => "S300" "fechaPublicacion" => "2009-10-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2009;29:491-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3829 "formatos" => array:3 [ "EPUB" => 273 "HTML" => 3094 "PDF" => 462 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Fanconi syndrome following an accident at work" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "491" "paginaFinal" => "492" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Fanconi tras accidente laboral" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Arantxa Vello Román, M. Samprón Rodríguez, B. Pazos Arias" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Arantxa" "apellidos" => "Vello Román" ] 1 => array:2 [ "Iniciales" => "M." "apellidos" => "Samprón Rodríguez" ] 2 => array:2 [ "Iniciales" => "B." "apellidos" => "Pazos Arias" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699509003812" "doi" => "10.3265/Nefrologia.2009.29.5.5227.en.full" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003812?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325140900381X?idApp=UINPBA000064" "url" => "/20132514/0000002900000005/v0_201502091625/X201325140900381X/v0_201502091626/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251409003770" "issn" => "20132514" "doi" => "10.3265/Nefrologia.2009.29.5.5387.en.full" "estado" => "S300" "fechaPublicacion" => "2009-10-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2009;29:489-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3961 "formatos" => array:3 [ "EPUB" => 265 "HTML" => 3207 "PDF" => 489 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Proximal calciphylaxis in a liver and kidney transplant patient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "489" "paginaFinal" => "490" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calcifilaxis proximal en una paciente con trasplante hepático y renal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "43018078_f1_pag489.jpg" "Alto" => 176 "Ancho" => 260 "Tamanyo" => 7119 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Montserrat Picazo Sánchez, M. Cuxart Pérez, R. Sans Lorman, C. Sardà Borroy" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Montserrat" "apellidos" => "Picazo Sánchez" ] 1 => array:2 [ "Iniciales" => "M." "apellidos" => "Cuxart Pérez" ] 2 => array:2 [ "Iniciales" => "R." "apellidos" => "Sans Lorman" ] 3 => array:2 [ "Iniciales" => "C." "apellidos" => "Sardà Borroy" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699509003773" "doi" => "10.3265/Nefrologia.2009.29.5.5387.en.full" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003773?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003770?idApp=UINPBA000064" "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003770/v0_201502091626/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Pneumonitis caused by sirolimus: improvement after switching to everolimus" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "490" "paginaFinal" => "491" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Auxiliadora Mazuecos Blanca, L. Calle, C. Tejada, C. Lancho" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Auxiliadora" "apellidos" => "Mazuecos Blanca" "email" => array:1 [ 0 => "27541jcg@comb.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "L." "apellidos" => "Calle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "C." "apellidos" => "Tejada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "C." "apellidos" => "Lancho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Puerta del Mar, Cádiz, Cádiz, España, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neumonitis por sirolimus: resolución tras conversión a everolimus" ] ] "textoCompleto" => "<p class="elsevierStylePara">Dear Editor,</p><p class="elsevierStylePara">Sirolimus is the foremost proliferation signal inhibitor (PSI) used in medicine to prevent acute rejection in solid organ transplants. Among the main advantages of this drug is its very low nephrotoxicity and above all, its antitumour action, especially in transplanted patients that develop Kaposi¿s sarcoma.<span class="elsevierStyleSup">1</span> However, one of its most serious side effects is interstitial pneumonitis, which in most cases leads to the suspension of treatment with this drug.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">We would like to describe the case of a 64-year-old woman who underwent a transplant for the first time in September 1992 and experienced early graft loss because of acute vascular rejection. She received a second kidney transplant in December 2000 and was treated with daclizumab, steroids, mycophenolate and tacrolimus. In the third month following the transplant, mycophenolate treatment was suspended definitively because of leukopenia. In June 2003 she developed Kaposi¿s sarcoma which did not respond to a reduction in the tacrolimus dose. Therefore, in November 2003 tacrolimus was substituted by sirolimus and excellent progress was made before the patient fully recovered in a short period of time. With regard to the patient¿s recovery from Kaposi¿s sarcoma, this is something that had been described previously in a study on a series of patients from different hospitals in Spain.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">She remained asymptomatic and with stable kidney function (CRP 1.2-1.3mg/dl) until July 2008. From that moment onwards she made several visits to the Emergency Departments complaining of dyspnoea. The chest x-ray repeatedly showed parenchymatous infiltrates in the middle and lower lobes on both sides of the chest. Although there were no significant findings in the echocardiogram (mild LVH and preserved ejection fraction), a diagnosis of heart failure was made and diuretic treatment was indicated. In September 2008, when she was checked in a transplant clinic and no clinical or radiological improvements were observed, interstitial pneumonitis was suspected and further tests were carried out: 1) full blood count and biochemistry did not indicate any relevant abnormalities; 2) sirolimus levels: 7ng/ml; 3) arterial gases at baseline: pH: 7, 44, pCO2: 35, pO2: 73, SatO2: 95%; 4) Chest CAT scan: bilateral peripheral pulmonary infiltrates, with ground glass opacity in some areas and a reticular pattern in others, no adenopathies; 5) respiratory function tests: mild restrictive ventilatory pattern and moderately affected difussion capacity; 6) immunological study (ANA, ANCA, CRP, rheumatoid factor, complement, immunoglobulins): normal; 7) angiotensin-converting enzyme: 32U/L (normal); 8) testing for common and atypical infections, including pneumocystis, using the induced sputum technique: negative. In light of these findings, once we had ruled out infectious and autoimmune causes, we made the diagnosis of interstitial pneumonitis caused by sirolimus. Given the seriousness of the symptoms that prompted the change to sirolimus (Kaposi¿s sarcoma), we decided to switch to a different PSI, everolimus. The response to the new treatment was fast and very positive, the patient made a full recovery and the chest x-ray and respiratory function tests were normal within a period of a few weeks. The patient remained asymptomatic with everolimus levels at around 7ng/ml.</p><p class="elsevierStylePara">Interstitial pneumonitis caused by sirolimus is characterised by allergy-like symptoms and its incidence is relatively significant (4-14% according to some series).<span class="elsevierStyleSup">2</span> This has also been observed with the use of everolimus although it seems to be less common.<span class="elsevierStyleSup">3</span> Until now, seven cases of recovery from pneumonitis caused by sirolimus after switching to everolimus have been reported.<span class="elsevierStyleSup">4,5</span> The progress made in all cases has been satisfactory, except for in one case where symptoms recurred. The lower pulmonary toxicity seems to be due to the fact that everolimus is more hydrophilic because it differs from sirolimus by one hydroxyl group. Therefore, although the mechanism of action is the same, sirolimus and everolimus may have slightly different side effects. Therefore, the switch from sirolimus to everolimus may lead to recovery in cases of interstitial pneumonitis, especially for those patients who still require PSI treatment like the one described. <br></br></p>" "pdfFichero" => "P-E-S-A425-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gutiérrez-Dalmau A, Sánchez-Fructuoso A, Sanz-Guajardo A, Mazuecos A, Franco A, Rial MC, et al. Efficacy of conversion to sirolimus in posttransplantation Kaposi¿s sarcoma. Transplant Proc 2005;37:3836-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16386556" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Weiner SM, Sellin L, Vonend O, Schenker P, Buchner NJ, Flecken M, et al. Pneumonitis associated with sirolimus: clinical characteristics, risk factors and" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "outcome ¿ a single center experience and review of the literature. Nephrol Dial Transplant 2007;22:3631-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17611248" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Alexandru S, Ortiz A, Baldovi S, Milicua JM, Ruíz-Escribano E, Egido J, et al. Severe everolimus-associated pneumonitis in a renal transplant recipient. Nephrol Dial" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Transplante 2008;23:3353-5." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rehm B, Keller F, Mayer J, Stracke S. Resolution af sirolimus-induced pneumonitis after conversion to everolimus. Transplant Proc 2006;38:711-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16647451" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "De Simone P, Petruccelli S, Precisi A, Carrai P, Doria R, Menichetti F, et al. Switch to evrolimus for sirolimus-induced pneumonitis in a liver transplant recipient ¿ Not all proliferation signal inhibitors are the same: a case report. Transplant Proc 2007;39:3500-1. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18089420" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003828/v0_201502091626/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000005/v0_201502091625/X2013251409003828/v0_201502091626/en/P-E-S-A425-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003828?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 12 | 20 |
| 2024 October | 55 | 40 | 95 |
| 2024 September | 47 | 26 | 73 |
| 2024 August | 52 | 66 | 118 |
| 2024 July | 34 | 32 | 66 |
| 2024 June | 50 | 32 | 82 |
| 2024 May | 55 | 34 | 89 |
| 2024 April | 37 | 31 | 68 |
| 2024 March | 37 | 22 | 59 |
| 2024 February | 30 | 34 | 64 |
| 2024 January | 19 | 32 | 51 |
| 2023 December | 28 | 25 | 53 |
| 2023 November | 30 | 30 | 60 |
| 2023 October | 52 | 21 | 73 |
| 2023 September | 26 | 40 | 66 |
| 2023 August | 29 | 25 | 54 |
| 2023 July | 26 | 30 | 56 |
| 2023 June | 62 | 24 | 86 |
| 2023 May | 59 | 36 | 95 |
| 2023 April | 35 | 19 | 54 |
| 2023 March | 32 | 16 | 48 |
| 2023 February | 34 | 21 | 55 |
| 2023 January | 33 | 31 | 64 |
| 2022 December | 31 | 23 | 54 |
| 2022 November | 32 | 24 | 56 |
| 2022 October | 39 | 37 | 76 |
| 2022 September | 40 | 27 | 67 |
| 2022 August | 37 | 44 | 81 |
| 2022 July | 26 | 40 | 66 |
| 2022 June | 27 | 34 | 61 |
| 2022 May | 24 | 36 | 60 |
| 2022 April | 27 | 47 | 74 |
| 2022 March | 23 | 37 | 60 |
| 2022 February | 35 | 34 | 69 |
| 2022 January | 18 | 26 | 44 |
| 2021 December | 29 | 33 | 62 |
| 2021 November | 32 | 33 | 65 |
| 2021 October | 31 | 47 | 78 |
| 2021 September | 20 | 25 | 45 |
| 2021 August | 31 | 31 | 62 |
| 2021 July | 19 | 27 | 46 |
| 2021 June | 13 | 13 | 26 |
| 2021 May | 39 | 17 | 56 |
| 2021 April | 57 | 33 | 90 |
| 2021 March | 69 | 23 | 92 |
| 2021 February | 49 | 17 | 66 |
| 2021 January | 29 | 11 | 40 |
| 2020 December | 15 | 7 | 22 |
| 2020 November | 28 | 10 | 38 |
| 2020 October | 23 | 8 | 31 |
| 2020 September | 13 | 5 | 18 |
| 2020 August | 28 | 5 | 33 |
| 2020 July | 24 | 5 | 29 |
| 2020 June | 16 | 4 | 20 |
| 2020 May | 21 | 10 | 31 |
| 2020 April | 30 | 14 | 44 |
| 2020 March | 27 | 10 | 37 |
| 2020 February | 27 | 14 | 41 |
| 2020 January | 33 | 15 | 48 |
| 2019 December | 25 | 14 | 39 |
| 2019 November | 16 | 14 | 30 |
| 2019 October | 8 | 4 | 12 |
| 2019 September | 24 | 18 | 42 |
| 2019 August | 12 | 8 | 20 |
| 2019 July | 15 | 18 | 33 |
| 2019 June | 19 | 10 | 29 |
| 2019 May | 12 | 7 | 19 |
| 2019 April | 36 | 27 | 63 |
| 2019 March | 18 | 14 | 32 |
| 2019 February | 8 | 14 | 22 |
| 2019 January | 21 | 14 | 35 |
| 2018 December | 54 | 29 | 83 |
| 2018 November | 76 | 11 | 87 |
| 2018 October | 53 | 16 | 69 |
| 2018 September | 54 | 8 | 62 |
| 2018 August | 35 | 12 | 47 |
| 2018 July | 32 | 6 | 38 |
| 2018 June | 33 | 8 | 41 |
| 2018 May | 18 | 12 | 30 |
| 2018 April | 27 | 6 | 33 |
| 2018 March | 21 | 8 | 29 |
| 2018 February | 23 | 3 | 26 |
| 2018 January | 24 | 7 | 31 |
| 2017 December | 34 | 9 | 43 |
| 2017 November | 14 | 7 | 21 |
| 2017 October | 25 | 6 | 31 |
| 2017 September | 22 | 12 | 34 |
| 2017 August | 23 | 14 | 37 |
| 2017 July | 11 | 5 | 16 |
| 2017 June | 23 | 9 | 32 |
| 2017 May | 29 | 14 | 43 |
| 2017 April | 20 | 7 | 27 |
| 2017 March | 16 | 52 | 68 |
| 2017 February | 14 | 8 | 22 |
| 2017 January | 22 | 7 | 29 |
| 2016 December | 49 | 9 | 58 |
| 2016 November | 53 | 8 | 61 |
| 2016 October | 106 | 8 | 114 |
| 2016 September | 121 | 11 | 132 |
| 2016 August | 151 | 7 | 158 |
| 2016 July | 112 | 5 | 117 |
| 2016 June | 118 | 0 | 118 |
| 2016 May | 119 | 0 | 119 |
| 2016 April | 75 | 0 | 75 |
| 2016 March | 78 | 0 | 78 |
| 2016 February | 88 | 0 | 88 |
| 2016 January | 80 | 0 | 80 |
| 2015 December | 86 | 0 | 86 |
| 2015 November | 74 | 0 | 74 |
| 2015 October | 73 | 0 | 73 |
| 2015 September | 60 | 0 | 60 |
| 2015 August | 76 | 0 | 76 |
| 2015 July | 51 | 0 | 51 |
| 2015 June | 30 | 0 | 30 |
| 2015 May | 45 | 0 | 45 |
| 2015 April | 6 | 0 | 6 |
Show all
