Letter to the Editor
Thrombotic microangiopathy and accelerated hypertension after treatment with interferon beta
Microangiopatía trombótica e hipertensión acelerada tras tratamiento con interferón beta
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"apellidos" => "Ortega" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251418301147" "doi" => "10.1016/j.nefroe.2018.02.012" "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/S2013251418301147?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699518300365?idApp=UINPBA000064" "url" => "/02116995/0000003800000005/v1_201810110611/S0211699518300365/v1_201810110611/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Thrombotic microangiopathy and accelerated hypertension after treatment with interferon beta" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "564" "paginaFinal" => "565" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elisa Pereira Pérez, María Dolores Sánchez de la Nieta García, Lucía González López, Francisco Rivera Hernández" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Elisa Pereira" "apellidos" => "Pérez" "email" => array:1 [ 0 => "elisapereirap@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" => "María Dolores" "apellidos" => "Sánchez de la Nieta García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Lucía González" "apellidos" => "López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Francisco Rivera" "apellidos" => "Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología del Hospital Universitario General de Ciudad Real, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica del Hospital Universitario General de Ciudad Real, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Microangiopatía trombótica e hipertensión acelerada tras tratamiento con interferón beta" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 737 "Ancho" => 975 "Tamanyo" => 118247 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fibrin thrombi occluding the glomerular capillary lumen. (A and B) Red Masson staining. X63. (C) Eosinophil with HE. X63. (D) Not stained with silver methenamine. X63.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report a case of a 48-year-old patient with multiple sclerosis (MS) since she was 18, receiving treatment with beta-interferon 1-a three times a week for the past 9 years and with no other medical treatment or relevant family history.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient referred symptoms of upper respiratory infection for the last 15 days for which she had been receiving symptomatic treatment. She presented high blood pressure, decreased urine output (with no macroscopic changes), and impaired renal function. Significant findings of the physical examination included blood pressure values of 190/93<span class="elsevierStyleHsp" style=""></span>mmHg and edema of the lower limbs up to the knees. In addition, crossings and cotton wool spots were observed in the ocular fundus.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Blood tests showed hemoglobin levels of 9.8<span class="elsevierStyleHsp" style=""></span>g/dL with an MCV of 93.5<span class="elsevierStyleHsp" style=""></span>fl, platelet values of 142<span class="elsevierStyleHsp" style=""></span>mil/uL, and LDH of 588<span class="elsevierStyleHsp" style=""></span>IU/L, total bilirubin of 1.2<span class="elsevierStyleHsp" style=""></span>mg/dL, creatinine of 1.9<span class="elsevierStyleHsp" style=""></span>mg/dL, and proteinuria of 0.8<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h; in the urine sediment: cell counts were 4–6 RBCs/field, 25–30 leukocytes/field, and common bacteria. A peripheral blood smear was performed, with 2% of schistocytes. The renal Doppler ultrasound and echocardiogram were normal as was the immunological study, HCV, HBV and HIV serology values. Haptoglobin was undectectable, and creatinine was increased to 2.5<span class="elsevierStyleHsp" style=""></span>mg/dL. In the absence of gastrointestinal symptoms, shigatoxin was not tested for. The ADAMTS 13 test was normal and the direct Coombs test was negative. A renal biopsy was performed, which was compatible with thrombotic microangiopathy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Suspecting that beta interferon could have been the cause of thrombotic microangiopathy and/or accelerated hypertension, the drug was discontinued. After five months, the patient presented improved renal function with creatinine levels of 1.6<span class="elsevierStyleHsp" style=""></span>mg/dL and with a urine protein/creatinine ratio of 0.13, along with acceptable good blood pressure in the absence of antihypertensive medication (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Ubara et al. described one case of haemolytic uremic syndrome (HUS) in a patient undergoing treatment with INFB for 44 days for chronic hepatitis C.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Subsequently, Herrera et al. presented two cases of patients with thrombotic thrombocytopenic purpura (TTP), both of whom were being treated with INFB for periods of 2 and 4 weeks.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In our case, TTP was ruled out due to the absence of current neurological symptoms and to the fact that the ADAMTS13 activity and platelets were normal and thrombotic microangiopathy within accelerated hypertension.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Broughton et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and Olea et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> reported cases of TMA in patients undergoing treatment with INFB for MS, both of which were similar to the case reported here. Interferon treatment was discontinued and treatment with renin angiotensin system inhibitors was initiated.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The onset of hypertension or poorly controlled blood pressure has been previously described in patients undergoing INFB treatment, with the FDA describing 19 cases of hypertension out of 12,700 patients treated with INFB.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Modrego et al. reported a patient who had been treated for MS with INFB for many years and who was referred with poorly controlled hypertension and a renal biopsy compatible with kidney damage secondary to high blood pressure. The patient continued with treatment for hypertension after discontinuing INFB.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">It is clear that there are many questions in relation to these associations, presently unresolved with the current literature. The pathogenesis of thrombotic microangiopathy in accelerated hypertension is not exactly known but is considered to play an important role in activating the renin–angiotensin–aldosterone system. In the case of our patient, is seems like arterial hypertension, kidney damage and thrombotic microangiopathy might be justified by treatment with interferon. However we cannot exclude that thrombotic microangiopathy is the cause by accelerated hypertension or the result of this one. Being difficult to assess which is the cause and which is the effect.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 737 "Ancho" => 975 "Tamanyo" => 118247 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fibrin thrombi occluding the glomerular capillary lumen. (A and B) Red Masson staining. X63. (C) Eosinophil with HE. X63. (D) Not stained with silver methenamine. X63.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Date \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hemoglobin (g/dL) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Platelet (mmiles/uL) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Creatinine (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LDH (IU/L) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Proteinuria (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">March 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">157 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">588 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">April 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">254 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">236 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">July 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">230 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">September 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">347 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">123 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1869769.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Blood test evolution.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemolytic uremic syndrome associated with beta-interferon therapy for chronic hepatitis C" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Ubara" 1 => "S. Hara" 2 => "H. Takedatu" 3 => "H. Katori" 4 => "K. Yamada" 5 => "K. Yoshihara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000045147" "Revista" => array:6 [ "tituloSerie" => "Nephron" "fecha" => "1998" "volumen" => "80" "paginaInicial" => "107" "paginaFinal" => "108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9730725" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occurrence of a TTP-like syndrome in two women receiving beta interferon therapy for relapsing multiple sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.G. Herrera" 1 => "L.B. Balizet" 2 => "S.W. Harberts" 3 => "S.T. Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Neurology" "fecha" => "1999" "volumen" => "52" "paginaInicial" => "153" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombotic microangiopathy induced by long-term interferon-B therapy for multiple sclerosis: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Broughton" 1 => "J. Cosyns" 2 => "M. Jadoul" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Nephrol" "fecha" => "2011" "volumen" => "76" "paginaInicial" => "396" "paginaFinal" => "400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22000560" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombotic microangiopathy associated with use of interferon-beta" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Olea" 1 => "R. Díaz-Mancebo" 2 => "M. Picazo" 3 => "J. Martínez" 4 => "A. Robles" 5 => "R. Selgas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/IJNRD.S30194" "Revista" => array:6 [ "tituloSerie" => "Int J Nephrol Renovasc Dis" "fecha" => "2012" "volumen" => "5" "paginaInicial" => "97" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22815645" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arterial hypertension induced by interferon beta Ib in a patient with multiple sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Modrego" 1 => "J. Gazulla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Mult Scler J" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "1655" "paginaFinal" => "1656" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02116995/0000003800000005/v1_201810110611/S0211699518300043/v1_201810110611/en/main.assets" "Apartado" => array:4 [ "identificador" => "48186" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/02116995/0000003800000005/v1_201810110611/S0211699518300043/v1_201810110611/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699518300043?idApp=UINPBA000064" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 13 | 22 |
| 2024 Octubre | 47 | 44 | 91 |
| 2024 Septiembre | 50 | 30 | 80 |
| 2024 Agosto | 68 | 66 | 134 |
| 2024 Julio | 43 | 33 | 76 |
| 2024 Junio | 78 | 41 | 119 |
| 2024 Mayo | 91 | 36 | 127 |
| 2024 Abril | 71 | 37 | 108 |
| 2024 Marzo | 85 | 27 | 112 |
| 2024 Febrero | 52 | 36 | 88 |
| 2024 Enero | 49 | 28 | 77 |
| 2023 Diciembre | 32 | 35 | 67 |
| 2023 Noviembre | 41 | 32 | 73 |
| 2023 Octubre | 49 | 34 | 83 |
| 2023 Septiembre | 28 | 31 | 59 |
| 2023 Agosto | 42 | 27 | 69 |
| 2023 Julio | 41 | 28 | 69 |
| 2023 Junio | 39 | 26 | 65 |
| 2023 Mayo | 63 | 35 | 98 |
| 2023 Abril | 37 | 20 | 57 |
| 2023 Marzo | 49 | 37 | 86 |
| 2023 Febrero | 54 | 24 | 78 |
| 2023 Enero | 52 | 33 | 85 |
| 2022 Diciembre | 57 | 48 | 105 |
| 2022 Noviembre | 58 | 40 | 98 |
| 2022 Octubre | 66 | 50 | 116 |
| 2022 Septiembre | 52 | 43 | 95 |
| 2022 Agosto | 52 | 53 | 105 |
| 2022 Julio | 46 | 60 | 106 |
| 2022 Junio | 44 | 44 | 88 |
| 2022 Mayo | 38 | 51 | 89 |
| 2022 Abril | 52 | 67 | 119 |
| 2022 Marzo | 65 | 56 | 121 |
| 2022 Febrero | 58 | 48 | 106 |
| 2022 Enero | 41 | 39 | 80 |
| 2021 Diciembre | 69 | 57 | 126 |
| 2021 Noviembre | 46 | 39 | 85 |
| 2021 Octubre | 112 | 60 | 172 |
| 2021 Septiembre | 49 | 52 | 101 |
| 2021 Agosto | 69 | 46 | 115 |
| 2021 Julio | 78 | 37 | 115 |
| 2021 Junio | 38 | 30 | 68 |
| 2021 Mayo | 73 | 51 | 124 |
| 2021 Abril | 210 | 88 | 298 |
| 2021 Marzo | 87 | 32 | 119 |
| 2021 Febrero | 79 | 27 | 106 |
| 2021 Enero | 61 | 29 | 90 |
| 2020 Diciembre | 71 | 30 | 101 |
| 2020 Noviembre | 50 | 18 | 68 |
| 2020 Octubre | 34 | 31 | 65 |
| 2020 Septiembre | 48 | 27 | 75 |
| 2020 Agosto | 55 | 30 | 85 |
| 2020 Julio | 46 | 24 | 70 |
| 2020 Junio | 38 | 19 | 57 |
| 2020 Mayo | 59 | 15 | 74 |
| 2020 Abril | 45 | 37 | 82 |
| 2020 Marzo | 54 | 24 | 78 |
| 2020 Febrero | 57 | 27 | 84 |
| 2020 Enero | 48 | 27 | 75 |
| 2019 Diciembre | 42 | 26 | 68 |
| 2019 Noviembre | 52 | 43 | 95 |
| 2019 Octubre | 37 | 24 | 61 |
| 2019 Septiembre | 48 | 18 | 66 |
| 2019 Agosto | 49 | 35 | 84 |
| 2019 Julio | 45 | 27 | 72 |
| 2019 Junio | 47 | 33 | 80 |
| 2019 Mayo | 49 | 45 | 94 |
| 2019 Abril | 82 | 59 | 141 |
| 2019 Marzo | 57 | 17 | 74 |
| 2019 Febrero | 41 | 27 | 68 |
| 2019 Enero | 36 | 31 | 67 |
| 2018 Diciembre | 111 | 58 | 169 |
| 2018 Noviembre | 148 | 35 | 183 |
| 2018 Octubre | 113 | 20 | 133 |
| 2018 Septiembre | 62 | 17 | 79 |
| 2018 Agosto | 71 | 24 | 95 |
| 2018 Julio | 83 | 15 | 98 |
| 2018 Junio | 79 | 27 | 106 |
| 2018 Mayo | 66 | 20 | 86 |
| 2018 Abril | 107 | 22 | 129 |
| 2018 Marzo | 116 | 10 | 126 |
| 2018 Febrero | 79 | 10 | 89 |
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