Pulmonary toxicity associated with sirolimus following kidney transplantation: computed tomography findings
a Department of Radiology, Fluminence Federal University. Rio de Janeiro Federal University, Niterói, Rio de Janeiro, Brazil,
b Department of Radiology, Fluminence Federal University, Niterói, Rio de Janeiro, Brazil,
c Department of Nephrology, Fluminence Federal University, Niterói, Rio de Janeiro, Brazil,
d Department of Radiology, Federal University, Rio de Janeiro, Brazil,
Read
9638
Timeswas read the article
2240
Total PDF
7398
Total HTML
Share statistics
array:21 [ "pii" => "X2013251410036042" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2010.Mar.10339" "estado" => "S300" "fechaPublicacion" => "2010-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2010;30:259-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3700 "formatos" => array:3 [ "EPUB" => 291 "HTML" => 2874 "PDF" => 535 ] ] "Traduccion" => array:1 [ "en" => array:17 [ "pii" => "X0211699510036045" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2010.Mar.10339" "estado" => "S300" "fechaPublicacion" => "2010-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2010;30:259-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3620 "formatos" => array:3 [ "EPUB" => 290 "HTML" => 2783 "PDF" => 547 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Pulmonary toxicity associated with sirolimus following kidney transplantation: computed tomography findings" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "259" "paginaFinal" => "260" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pulmonary toxicity associated with sirolimus following kidney transplantation: computed tomography findings" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "T. Davaus Gasparetto, Edson Marchiori, P. Menezes, G. Zanetti" "autores" => array:4 [ 0 => array:2 [ "Iniciales" => "T." "apellidos" => "Davaus Gasparetto" ] 1 => array:2 [ "nombre" => "Edson" "apellidos" => "Marchiori" ] 2 => array:2 [ "Iniciales" => "P." "apellidos" => "Menezes" ] 3 => array:2 [ "Iniciales" => "G." "apellidos" => "Zanetti" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251410036042" "doi" => "10.3265/Nefrologia.pre2010.Mar.10339" "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/X2013251410036042?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699510036045?idApp=UINPBA000064" "url" => "/02116995/0000003000000002/v0_201502091329/X0211699510036045/v0_201502091332/en/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251410036034" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2010.Mar.10340" "estado" => "S300" "fechaPublicacion" => "2010-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2010;30:260-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5018 "formatos" => array:3 [ "EPUB" => 300 "HTML" => 4138 "PDF" => 580 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Guillain-Barré syndrome in kidney transplant" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "260" "paginaFinal" => "261" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Guillain-Barré en trasplante renal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Teresa García Álvarez, A. García Herrera, A. Mazuecos Blanca, C. Lancho Novillo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Teresa" "apellidos" => "García Álvarez" ] 1 => array:2 [ "Iniciales" => "A." "apellidos" => "García Herrera" ] 2 => array:2 [ "Iniciales" => "A." "apellidos" => "Mazuecos Blanca" ] 3 => array:2 [ "Iniciales" => "C." "apellidos" => "Lancho Novillo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699510036037" "doi" => "10.3265/Nefrologia.pre2010.Mar.10340" "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/X0211699510036037?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410036034?idApp=UINPBA000064" "url" => "/20132514/0000003000000002/v0_201502091606/X2013251410036034/v0_201502091606/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251410036050" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2010.Mar.10338" "estado" => "S300" "fechaPublicacion" => "2010-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2010;30:258-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3971 "formatos" => array:3 [ "EPUB" => 264 "HTML" => 3190 "PDF" => 517 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "There are no differences between non-diabetics and diabetics with respect to the effect of anaemia correction in chronic kidney disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "258" "paginaFinal" => "259" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "No hay indicios de diferencias entre no diabéticos y diabéticos en el efecto de la corrección de la anemia en la enfermedad renal crónica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10338108_a18_f1.jpg" "Alto" => 604 "Ancho" => 715 "Tamanyo" => 59305 ] ] "descripcion" => array:1 [ "en" => "Meta-analyses of the effect of high haemoglobin targets on mortality in chronic kidney disease." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Javier García López" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "García López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699510036053" "doi" => "10.3265/Nefrologia.pre2010.Mar.10338" "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/X0211699510036053?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410036050?idApp=UINPBA000064" "url" => "/20132514/0000003000000002/v0_201502091606/X2013251410036050/v0_201502091606/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Pulmonary toxicity associated with sirolimus following kidney transplantation: computed tomography findings" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "259" "paginaFinal" => "260" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "T. Davaus Gasparetto, Edson Marchiori, P. Menezes, G. Zanetti" "autores" => array:4 [ 0 => array:3 [ "Iniciales" => "T." "apellidos" => "Davaus Gasparetto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:4 [ "nombre" => "Edson" "apellidos" => "Marchiori" "email" => array:1 [ 0 => "edmarchiori@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "P." "apellidos" => "Menezes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 3 => array:3 [ "Iniciales" => "G." "apellidos" => "Zanetti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Department of Radiology, Fluminence Federal University. Rio de Janeiro Federal University, Niterói, Rio de Janeiro, Brazil, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Department of Radiology, Fluminence Federal University, Niterói, Rio de Janeiro, Brazil, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Department of Nephrology, Fluminence Federal University, Niterói, Rio de Janeiro, Brazil, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Department of Radiology, Federal University, Rio de Janeiro, Brazil, " "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10339_18030_2321_es_figure1a.jpg" "Alto" => 451 "Ancho" => 314 "Tamanyo" => 69128 ] ] "descripcion" => array:1 [ "en" => "High-resolution CT at the level of the lower lobes (A) (obtained at the time of clinical presentation when respiratory symptoms were evident) demonstrates areas of non-homogeneous air space consolidation in the lower lobes, and mild ground-glass opacities" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor: </span>We read with great interest the letter by Calle et al.<span class="elsevierStyleSup">1</span> describing the case of a patient who underwent a kidney transplant and developed a pneumonitis caused by sirolimus. They related that there are, until now, only seven cases reported of recovery from pneumonitis caused by sirolimus.</p><p class="elsevierStylePara">We would like to describe the case of a 27-year-old woman with a two-year history of haemodialysis for endstage renal disease underwent a haplo-identical, living kidney, donor transplantation. Following the procedure, she began immunosuppressive therapy with tacrolymus, mycophenolate mofetil, and steroid. Her renal function was stable and she was discharged with normal serum creatinine levels.</p><p class="elsevierStylePara">Two months after beginning immunosuppressive therapy she presented with diarrhoea of unknown aetiology. After recovery from the diarrhea, the patient was discharged while using mycophenolate sodium and metronidasol. Six months later, she was admitted with another episode of diarrhea and the tacrolymus was switched to sirolimus.</p><p class="elsevierStylePara">Ten months after initiation of the sirolimus treatment, the patient was admitted with fever, shortness of breath, and dehydration. Chest X-rays and high-resolution CT of the chest demonstrated bilateral areas of nonhomogeneous air space consolidation, mainly in the left upper lobe and lower lobes (figure 1A). Bronchoalveolar lavage revealed hypercellularity with lymphocytosis, and the microbiological evaluation was negative for bacteria, fungi, and viruses. Serological tests for cytomegalovirus were negative. The patient began an empirical, antiinfection treatment with intravenous azithromycin and ciprofloxacin, with no response. The fever persisted with antibiotic treatment and sirolimus was thought to be the cause of the symptoms. When sirolimus was switched to azathioprime symptoms improved within 10 days, and were resolved in 30 days. On the follow-up chest X-ray and high-resolution CT, 30 days after sirolimus discontinuation, the parenchymal abnormalities had improved, with accentuated reduction of the air-space consolidation pattern. There were persisting residual areas of bilateral ground-glass opacities on the high-resolution CT (figure 1B).</p><p class="elsevierStylePara">Sirolimus (rapamycin) is a potent immunosuppressive drug that has been successfully used in solid organ transplant recipients as an alternative to calcineurin inhibitor therapy<span class="elsevierStyleSup">2-4</span>. The most common side effects associated with this drug are dose-dependent hyperlipidemia, and thrombocytopenia. Unlike calcineurin inhibitors, sirolimus does not induce acute or chronic nephrotoxicity. However, in very rare cases, patients treated with sirolimus may exhibit severe pulmonary toxicity<span class="elsevierStyleSup">2,3</span>.</p><p class="elsevierStylePara">The symptoms of pulmonary toxicity related to sirolimus are generally nonspecific, and may include a dry cough, dyspnea, fatigue, and fever, frequently leading to the initial diagnosis of pulmonary infection<span class="elsevierStyleSup">5</span>. Some reports have described histopathological patterns as a result of sirolimus pulmonary toxicity, but these findings are usually nonspecific, consisting of bronchiolitis obliterans with organizing pneumonia, interstitial pneumonitis, and nonnecrotizing granulomas<span class="elsevierStyleSup">2,4</span>. For this reason, a lung biopsy is not essential, and the diagnosis of this condition must fulfil the following criteria: presence of lung disease on imaging tests, exclusion of pulmonary infection or other lung disease, and clinical improvement after drug withdrawal, independent of the pulmonary biopsy<span class="elsevierStyleSup">4,5</span>. All these criteria were fulfilled in the patient presented here, who showed significant imaging and clinical improvement after withdrawal of sirolimus.</p><p class="elsevierStylePara">Due to the increased use of sirolimus, radiologists interpreting imaging studies of transplant patients using this drug should be aware of the imaging features associated with this potentially treatable complication. Although some previous authors reported the use of CT<span class="elsevierStyleSup">2,3,5</span>, to our knowledge, there are no reports illustrating and discussing the highresolution CT findings of pulmonary toxicity due to sirolimus.</p><p class="elsevierStylePara"><a href="grande/10339_18030_2321_es_figure1a.jpg" class="elsevierStyleCrossRefs"><img src="10339_18030_2321_es_figure1a.jpg" alt="High-resolution CT at the level of the lower lobes (A) (obtained at the time of clinical presentation when respiratory symptoms were evident) demonstrates areas of non-homogeneous air space consolidation in the lower lobes, and mild ground-glass opacities"></img></a></p><p class="elsevierStylePara">Figure 1. High-resolution CT at the level of the lower lobes (A) (obtained at the time of clinical presentation when respiratory symptoms were evident) demonstrates areas of non-homogeneous air space consolidation in the lower lobes, and mild ground-glass opacities</p>" "pdfFichero" => "P1-E47-S1884-A10339-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10339_18030_2321_es_figure1a.jpg" "Alto" => 451 "Ancho" => 314 "Tamanyo" => 69128 ] ] "descripcion" => array:1 [ "en" => "High-resolution CT at the level of the lower lobes (A) (obtained at the time of clinical presentation when respiratory symptoms were evident) demonstrates areas of non-homogeneous air space consolidation in the lower lobes, and mild ground-glass opacities" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Calle L, Tejada C, Lancho C, Mazuecos A. Pneumonitis caused by sirolimus: improvement after switching to everolimus. Nefrologia 2009;29(5):490-1. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19820768" 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" => "Adibelli Z, Dilek M, Kocak B, Tulek N, Uzun O, Akpolat T. An unusual presentation of sirolimus associated cough in a renal transplant recipient. Transplant Proc 2007;39(10):3463-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18089408" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Champion L, Stern M, Israel-Biet D, et al. Brief communication: sirolimus-associated pneumonitis: 24 cases in renal transplant recipients. Ann Intern Med 2006;144(7):505- 9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16585664" 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" => "Chhajed PN, Dickenmann M, Bubendorf L, Mayr M, Steiger J, Tamm M. Patterns of pulmonary complications associated with sirolimus. Respiration 2006;73(3):367-74. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16127266" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Haydar AA, Denton M, West A, Rees J, Goldsmith DJ. Sirolimus-induced pneumonitis: three cases and a review of the literature. Am J Transplant 2004;4(1):137-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14678046" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003000000002/v0_201502091606/X2013251410036042/v0_201502091606/en/main.assets" "Apartado" => array:4 [ "identificador" => "35439" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Comments on published articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003000000002/v0_201502091606/X2013251410036042/v0_201502091606/en/P1-E47-S1884-A10339-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410036042?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 3 | 18 |
| 2024 October | 98 | 44 | 142 |
| 2024 September | 206 | 23 | 229 |
| 2024 August | 352 | 44 | 396 |
| 2024 July | 84 | 29 | 113 |
| 2024 June | 88 | 45 | 133 |
| 2024 May | 97 | 33 | 130 |
| 2024 April | 89 | 30 | 119 |
| 2024 March | 95 | 30 | 125 |
| 2024 February | 57 | 41 | 98 |
| 2024 January | 85 | 21 | 106 |
| 2023 December | 77 | 28 | 105 |
| 2023 November | 131 | 38 | 169 |
| 2023 October | 157 | 24 | 181 |
| 2023 September | 87 | 30 | 117 |
| 2023 August | 105 | 25 | 130 |
| 2023 July | 84 | 25 | 109 |
| 2023 June | 69 | 15 | 84 |
| 2023 May | 75 | 27 | 102 |
| 2023 April | 68 | 11 | 79 |
| 2023 March | 49 | 20 | 69 |
| 2023 February | 61 | 16 | 77 |
| 2023 January | 62 | 22 | 84 |
| 2022 December | 68 | 30 | 98 |
| 2022 November | 105 | 35 | 140 |
| 2022 October | 64 | 46 | 110 |
| 2022 September | 53 | 34 | 87 |
| 2022 August | 85 | 50 | 135 |
| 2022 July | 57 | 55 | 112 |
| 2022 June | 74 | 38 | 112 |
| 2022 May | 73 | 27 | 100 |
| 2022 April | 53 | 70 | 123 |
| 2022 March | 96 | 47 | 143 |
| 2022 February | 55 | 48 | 103 |
| 2022 January | 64 | 32 | 96 |
| 2021 December | 67 | 52 | 119 |
| 2021 November | 82 | 41 | 123 |
| 2021 October | 90 | 41 | 131 |
| 2021 September | 59 | 31 | 90 |
| 2021 August | 65 | 29 | 94 |
| 2021 July | 56 | 27 | 83 |
| 2021 June | 48 | 29 | 77 |
| 2021 May | 59 | 22 | 81 |
| 2021 April | 151 | 72 | 223 |
| 2021 March | 61 | 46 | 107 |
| 2021 February | 58 | 37 | 95 |
| 2021 January | 64 | 24 | 88 |
| 2020 December | 38 | 16 | 54 |
| 2020 November | 43 | 7 | 50 |
| 2020 October | 36 | 15 | 51 |
| 2020 September | 30 | 7 | 37 |
| 2020 August | 52 | 7 | 59 |
| 2020 July | 55 | 10 | 65 |
| 2020 June | 86 | 6 | 92 |
| 2020 May | 55 | 9 | 64 |
| 2020 April | 45 | 22 | 67 |
| 2020 March | 63 | 9 | 72 |
| 2020 February | 44 | 19 | 63 |
| 2020 January | 56 | 18 | 74 |
| 2019 December | 64 | 23 | 87 |
| 2019 November | 44 | 21 | 65 |
| 2019 October | 29 | 8 | 37 |
| 2019 September | 30 | 16 | 46 |
| 2019 August | 25 | 10 | 35 |
| 2019 July | 18 | 20 | 38 |
| 2019 June | 21 | 16 | 37 |
| 2019 May | 20 | 14 | 34 |
| 2019 April | 35 | 30 | 65 |
| 2019 March | 19 | 24 | 43 |
| 2019 February | 25 | 20 | 45 |
| 2019 January | 21 | 17 | 38 |
| 2018 December | 78 | 38 | 116 |
| 2018 November | 76 | 13 | 89 |
| 2018 October | 85 | 10 | 95 |
| 2018 September | 74 | 17 | 91 |
| 2018 August | 46 | 17 | 63 |
| 2018 July | 38 | 14 | 52 |
| 2018 June | 46 | 14 | 60 |
| 2018 May | 47 | 18 | 65 |
| 2018 April | 70 | 5 | 75 |
| 2018 March | 58 | 10 | 68 |
| 2018 February | 32 | 5 | 37 |
| 2018 January | 49 | 6 | 55 |
| 2017 December | 48 | 8 | 56 |
| 2017 November | 35 | 10 | 45 |
| 2017 October | 31 | 6 | 37 |
| 2017 September | 31 | 8 | 39 |
| 2017 August | 25 | 13 | 38 |
| 2017 July | 20 | 6 | 26 |
| 2017 June | 24 | 6 | 30 |
| 2017 May | 28 | 6 | 34 |
| 2017 April | 21 | 10 | 31 |
| 2017 March | 11 | 5 | 16 |
| 2017 February | 23 | 5 | 28 |
| 2017 January | 12 | 7 | 19 |
| 2016 December | 52 | 6 | 58 |
| 2016 November | 58 | 9 | 67 |
| 2016 October | 77 | 5 | 82 |
| 2016 September | 105 | 3 | 108 |
| 2016 August | 126 | 6 | 132 |
| 2016 July | 107 | 3 | 110 |
| 2016 June | 107 | 0 | 107 |
| 2016 May | 111 | 0 | 111 |
| 2016 April | 70 | 0 | 70 |
| 2016 March | 83 | 0 | 83 |
| 2016 February | 56 | 0 | 56 |
| 2016 January | 75 | 0 | 75 |
| 2015 December | 90 | 0 | 90 |
| 2015 November | 48 | 0 | 48 |
| 2015 October | 60 | 0 | 60 |
| 2015 September | 49 | 0 | 49 |
| 2015 August | 55 | 0 | 55 |
| 2015 July | 45 | 0 | 45 |
| 2015 June | 25 | 0 | 25 |
| 2015 May | 34 | 0 | 34 |
| 2015 April | 5 | 0 | 5 |
Show all
