Novelties in Dermatology
Multiplatform Application to Determine Presence of Metabolic Syndrome and Cardiovascular Risk in Patients With Psoriasis
Calculadora multiplataforma para síndrome metabólico y riesgo cardiovascular en pacientes con psoriasis
R. Taberner
Hospital Son Llàtzer, Servicio de Dermatología, Palma de Mallorca (Illes Balears), Spain
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See text for a description of the functions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis affects between 1.5% and 3% of the world population. When there is no joint involvement, it has traditionally been considered as a chronic inflammatory disease of the skin that affects otherwise healthy individuals, with a negative impact on their quality of life.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, recent studies have suggested that psoriasis is not an isolated phenomenon but occurs in association with other conditions, such as cardiovascular diseases, and that mortality is higher in patients with severe forms of psoriasis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The link between psoriasis and arteriosclerosis seems to arise as a result of both the increased prevalence of various cardiovascular risk factors and chronic inflammatory phenomena in these patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is not uncommon for dermatologists to be the only health care professional to see an apparently healthy individual with psoriasis. Dermatologists can therefore play an important role in identifying patients who, in addition to psoriasis, may have an elevated risk of cardiovascular disease and early death. Thus, we can detect potential modifiable and avoidable risk factors, recommend lifestyle changes, and refer individuals at risk to their family physician in the event that pharmacological treatment or a closer follow-up is needed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the progress in our understanding of psoriasis and our realization that it is a chronic inflammatory disease not limited to the skin, large barriers remain when incorporating this knowledge into clinical practice. As physicians, dermatologists should provide the patients with advice and counseling about their disease. If we manage to get the patients to better understand the relationship between psoriasis and other diseases, we can encourage greater determination on their part to change their lifestyle, give up deleterious habits, and adhere to therapy.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Psoriasis and Metabolic Syndrome</span><p id="par0025" class="elsevierStylePara elsevierViewall">Obesity, especially abdominal obesity (also known as central obesity), is associated with resistance to the effects of insulin on peripheral glucose and fatty acid utilization. This can lead to type 2 diabetes. Insulin resistance, with the resulting hyperinsulinemia and hyperglycemia, as well as adipokines (cytokines secreted by adipocytes), can lead to endothelial vascular dysfunction, an abnormal lipid profile, hypertension, and vascular inflammation, all of which favor the development of arteriosclerotic cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The term <span class="elsevierStyleItalic">metabolic syndrome</span> was proposed to indicate a situation where certain metabolic risk factors for the development of type 2 diabetes and cardiovascular disease (abdominal obesity, hyperglycemia, dyslipidemia, and hypertension) are present at the same time.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Definitions of metabolic syndrome vary, although the most widely used are those proposed by the National Cholesterol Education Program/Adult Treatment Panel (NCEP/ATP III) and the International Diabetes Federation (IDF).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The 2001 definition of metabolic syndrome by the NCEP/ATP III (updated in 2005) established diagnosis of metabolic syndrome when 3 or more of the 5 criteria listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> are present.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The IDF proposed its criteria for metabolic syndrome in 2004. In this case, central obesity is an essential criterion (with variation according to race/ethnic origin of the patient—in the case of Europeans, a waist circumference >94<span class="elsevierStyleHsp" style=""></span>cm for men and >80<span class="elsevierStyleHsp" style=""></span>cm for women).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Two of the other 4 criteria, which coincide with those of the ATP-III, also need to be met.</p><p id="par8045" class="elsevierStylePara elsevierViewall">According to different meta-analyses, meeting the definition of metabolic syndrome is associated with a relative risk of type 2 diabetes of 5.12 (95% CI, 3.26–8.05), although the difference seems minimal when only fasting glucose levels are considered.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Other studies estimate the relative risk of cardiovascular death to be 1.74 (95% CI, 1.29–2.35).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12–14</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Although metabolic syndrome has been proposed as a simple clinical tool for predicting type 2 diabetes and cardiovascular disease, many authors have questioned the concept of this syndrome in recent years. Criticisms include the lack of agreement in the diagnostic criteria, the lack of a unique pathophysiological mechanism, the omission of important known risk factors (age, tobacco use, sex, low-density lipoprotein [LDL] cholesterol, etc.), the inclusion of patients already diagnosed with diabetes and cardiovascular disease, and the fact that treatment is no different to when the components are taken separately. Thus, some authors propose that metabolic syndrome be considered a premorbid condition rather than a clinical diagnosis, although the concept is clearly useful for health education.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15–18</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Several studies have found an association between psoriasis and metabolic syndrome. According to Gisondi et al.,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> in a case–control study, 30.1% of patients aged over 40 years with psoriasis met the criteria for metabolic syndrome, with an odds ratio (OR) of 1.65 (95% CI, 1.16–2.35), regardless of tobacco use. The association was stronger in patients with longer-standing disease.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Other studies have found a higher prevalence, up to 44%, for metabolic syndrome in psoriasis patients over 40 years.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Psoriasis and Obesity</span><p id="par0060" class="elsevierStylePara elsevierViewall">Obesity has reached epidemic proportions in Europe, where the prevalence has tripled in the past 20 years. It is estimated that 150 million adults (20% of the population) and 15 million children and adolescents (10%) are obese. According to data from the Spanish Health Survey (2003), 13.3% of the Spanish population is obese. The predominance of obesity is slightly higher in women (13.5%) than men (13%).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Diagnosis of obesity is established according to body mass index (BMI) which is calculated by dividing weight in kilograms by the square of height in meters. According to the value, patients can be classified as normal weight (18.5–24.9<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>), overweight (25–29.9<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>), or obese (>30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">For years, psoriasis has been known to be associated with obesity,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> although it has been debated whether obesity causes or is a consequence of psoriasis.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In an Italian case–control study of 560 patients, for a BMI of 26–29<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> and >30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, the OR of having psoriasis was 1.6 and 1.9, respectively, compared to absence of obesity.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> A British study of 127<span class="elsevierStyleHsp" style=""></span>706 patients with mild psoriasis and 3854 patients with severe psoriasis showed that for severe psoriasis and mild psoriasis, the OR for obesity was 1.8 and 1.3, respectively, compared to absence of psoriasis.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Several hypotheses have been put forward to explain the association between psoriasis and obesity, such as social isolation, poor dietary habits, depression, alcohol consumption, and sedentary lifestyle (in particular in patients with psoriatic arthritis). In fact, only 43% of obese patients with psoriasis in the study of Herron et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> exercised for 30<span class="elsevierStyleHsp" style=""></span>minutes or more 2 or 3 times a week, compared to 59% of nonobese patients with psoriasis.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Given that obesity is now considered as a proinflammatory state and that fatty tissue is thought of as an organ with immune and endocrine functions, it is easier to understand why obese patients might be predisposed to the development of psoriasis. Tumor necrosis factor (TNF) α expression is increased in adipocytes of obese rats, and this finding has also been demonstrated in humans. Some authors maintain that the proadipogenic effects of TNF-α are caused by direct autocrine or paracrine effects in the adipose tissue. Furthermore, TNF-α is thought to contribute to insulin resistance.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Finally, we should remember that body weight can have an effect on the efficacy of psoriasis drugs. It has even been suggested that systemic treatment of psoriasis in obese patients could protect against cardiovascular disease, as shown in a study with methotrexate.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Finally, it is necessary to consider the increase in the risk of adverse reactions when these patients are treated with certain drugs (acitretin, methotrexate, ciclosporin, etc.).<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,27,28</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Psoriasis and Cardiovascular Risk</span><p id="par0095" class="elsevierStylePara elsevierViewall">Arteriosclerosis is responsible for most cases of coronary artery disease. A wide range of factors, often acting in combination, are associated with an increased risk of developing atheromatous plaques in the coronary arteries and other arteries.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The importance of detecting these risk factors lies in the fact that, for the most part, they can be modified by applying specific preventive measures. In the INTERHEART study, which included patients from 52 countries, 90% of the population risk of a first myocardial infarction was accounted for by 9 factors: tobacco use, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, daily fruit and vegetable consumption, regular consumption of small amounts of alcohol, and regular physical activity (the last 3 being protective factors).<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">During the last few years, different multivariate models have been developed to estimate 10-year cardiovascular risk in asymptomatic and apparently healthy individuals. A common feature of all these models is that most of the risk factors are not dichotomic, but rather provide a graduated risk according to their value. This is not the case with metabolic syndrome.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The Framingham<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and REGICOR (<span class="elsevierStyleItalic">Registre Gironí del Cor</span>)<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31,32</span></a> tables estimate the 10-year risk of developing coronary artery disease (regardless of whether the outcome is death), whereas the SCORE (Systematic Coronary Risk Evaluation) tables estimate the 10-year risk of death from any cardiovascular cause (including cerebrovascular accident).<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> The SCORE tables are recommended by the Spanish Interdisciplinary Committee for Cardiovascular Prevention (CEIPC). Different tables are available for low- and high-risk populations. In contrast, the REGICOR tables have been chosen as the reference tables by the health services of several Spanish autonomous communities, as they have been validated in the Spanish population.</p><p id="par0115" class="elsevierStylePara elsevierViewall">In most of the studies performed (of a case–control design), psoriasis patients had a statistically significant increase in total cholesterol, LDL cholesterol, and triglycerides compared to controls without psoriasis. In addition, a decrease in serum high-density lipoprotein (HDL) cholesterol has been observed in patients with psoriasis. HDL is a fundamental factor in inverse cholesterol transport, and exerts an anti-inflammatory, antithrombotic, antioxidant, and fibrinolytic effect.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34,35</span></a> There is therefore an inverse relationship between HDL levels and the development of arteriosclerosis.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In addition, it should be remembered that certain drugs (such as ciclosporin and acitretin) used in the treatment of psoriasis could be partly responsible for changes in the lipid profile. TNF-α inhibitors can induce triglyceride elevations, but they would have beneficial effects on HDL levels.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Different studies have shown that tobacco use is an independent risk factor for developing psoriasis, and that there is an association with more severe forms of psoriasis and poorer response to treatment.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> The association is particularly strong in the case of pustular psoriasis.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In contrast, the association between psoriasis and hypertension is debatable, as the studies have offered contradictory results albeit with a majority pointing to such an association,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,38,39</span></a> and even an association with more severe hypertension.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Application for Calculating the BMI, Metabolic Syndrome, and Cardiovascular Risk</span><p id="par0135" class="elsevierStylePara elsevierViewall">In view of the results presented above, the role of dermatologists in screening for metabolic syndrome and cardiovascular risk in patients with psoriasis is decisive.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> But in practice, few dermatologists spend any time during a visit on determining these indicators of cardiovascular health. Calculation of the BMI is a tedious process, the cutoff levels for metabolic syndrome depend on the sex of the individual, and the REGICOR tables are somewhat complicated for someone not accustomed to using them regularly.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Therefore, at the dermatology department at the Hospital Son Llàtzer, Spain, we have automated the diagnosis of metabolic syndrome by integrating its assessment into the electronic medical records and obtaining the data through smart forms. These can retrieve the clinical and laboratory data of the patients so that we only have to enter waist circumference and blood pressure. The results can subsequently be exported to a spreadsheet.</p><p id="par0145" class="elsevierStylePara elsevierViewall">However, this tool only represents a local solution. In order to help other dermatologists to detect patients with greater cardiovascular risk, we developed a multiplatform application that allows all these calculations to be done simply and intuitively. The project had the backing of the Psoriasis Group of the Spanish Academy for Dermatology and Venereology (AEDV) and funding from Laboratorios Janssen. Our development partner was the company EC-Europe. Versions were produced for the iOS operating system (for iPhone, iPd Touch and iPAD terminals) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and Android, and an integrated web tool was made available on the webpage of the Psoriasis Group of the AEDV. The applications for all these platforms can be downloaded for free. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the web addresses for accessing the different versions of the tool, which is divided into 3 parts:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0150" class="elsevierStylePara elsevierViewall">BMI calculator (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). On entering the patient's weight and height, BMI is calculated in kg/m<span class="elsevierStyleSup">2</span> and classified into normal weight, overweight (grades I and II), or obese (grades I-IV).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0155" class="elsevierStylePara elsevierViewall">Metabolic syndrome calculator (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). According to the definition of the ATP-III. Sex, waist circumference, HDL cholesterol, blood pressure, and fasting glucose are entered. The screen displays abnormal parameters in red, and metabolic syndrome is diagnosed when 3 or more positive criteria are present.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0160" class="elsevierStylePara elsevierViewall">Cardiovascular risk calculator (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The application uses the REGICOR tables (validated in the Spanish population), which calculate the 10-year risk of experiencing a coronary event (whether or not the outcome is death). The parameters of sex, blood pressure, and HDL cholesterol are preloaded from previous entries for calculating metabolic syndrome. We therefore only have to enter age, diabetes, tobacco use, total cholesterol, LDL cholesterol, and family history of premature cardiovascular death. In addition to the corresponding risks, we can access a list of therapeutic goals for each case.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">The results can be sent by e-mail, either to the patients themselves or to ourselves for printing or incorporation into the electronic medical records if available.</p><p id="par0170" class="elsevierStylePara elsevierViewall">The aim of this tool is not to label patients as ill when they are not, but rather to identify those with a high cardiovascular risk who would not otherwise visit their physician. It can also act as a stimulus for fundamental lifestyle changes related to changes in smoking habit, improving diet, and doing more physical exercise.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">The project was developed in partnership with EC-Europe, with funding from Laboratorios Janssen. The author did not receive any fees for the design of the application.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The author declares no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres95725" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec82885" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres95724" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec82886" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Psoriasis and Metabolic Syndrome" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Psoriasis and Obesity" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Psoriasis and Cardiovascular Risk" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Application for Calculating the BMI, Metabolic Syndrome, and Cardiovascular Risk" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-09-14" "fechaAceptado" => "2011-11-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82885" "palabras" => array:5 [ 0 => "Psoriasis" 1 => "Metabolic syndrome" 2 => "Cardiovascular risk" 3 => "Obesity" 4 => "Mobile phone" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82886" "palabras" => array:5 [ 0 => "Psoriasis" 1 => "Síndrome metabólico" 2 => "Riesgo cardiovascular" 3 => "Obesidad" 4 => "Teléfono móvil" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Traditionally, psoriasis was considered to be a purely cutaneous disease affecting otherwise healthy patients (except for joint involvement). Recent studies have, however, shown a relationship between psoriasis and cardiovascular disease, with increased mortality in patients who have severe forms of psoriasis.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermatologists are thus in a position to play an important role in identifying patients at greater risk of cardiovascular disease and detecting potential risk factors that are, for the most part, manageable and avoidable.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To this end, we designed a multiplatform application that provides a simple and intuitive tool to determine body mass index, whether or not metabolic syndrome is present, and cardiovascular risk. The application runs on iOS, Android, and the webpage of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (AEDV).</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La psoriasis se ha considerado tradicionalmente (en ausencia de artropatía) como una enfermedad puramente cutánea que afecta por lo general a individuos sanos. Pero estudios recientes han demostrado una relación entre psoriasis y enfermedad cardiovascular, con un incremento de la mortalidad de aquellos pacientes con psoriasis graves.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En este sentido, los dermatólogos podemos desempeñar un importante papel en la identificación de aquellos pacientes con un mayor riesgo de enfermedad cardiovascular detectando potenciales factores de riesgo en su mayoría tratables y evitables.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Por este motivo hemos diseñado una aplicación multiplataforma que permite calcular de una manera sencilla e intuitiva el índice de masa corporal, la presencia o no de síndrome metabólico y el riesgo cardiovascular de nuestros pacientes, disponible para dispositivos móviles iOS, Android y en la página web del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología (AEDV).</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Taberner R. Calculadora multiplataforma para síndrome metabólico y riesgo cardiovascular en pacientes con psoriasis. Actas Dermosifiliogr. 2012;103:111–9.</p>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2875 "Ancho" => 2158 "Tamanyo" => 251553 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Screenshot of the application for iPad (iOS). See text for a description of the functions.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3340 "Ancho" => 2502 "Tamanyo" => 286920 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Body mass index calculator. See text for a description of the functions.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3335 "Ancho" => 2502 "Tamanyo" => 475490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Metabolic syndrome calculator. Pathologic items are highlighted in red. See text for a description of the functions.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3340 "Ancho" => 2502 "Tamanyo" => 469669 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cardiovascular risk calculator (according to REGICOR tables). See text for a description of the functions.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: HDL, high-density lipoprotein.</p>" "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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Women \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Waist circumference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>102<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>88<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum triglycerides \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥150<span class="elsevierStyleHsp" style=""></span>mg/dL or lipid-lowering treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum HDL cholesterol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><40<span class="elsevierStyleHsp" style=""></span>mg/dL or lipid-lowering treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><50<span class="elsevierStyleHsp" style=""></span>mg/dL or lipid-lowering treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥130/85<span class="elsevierStyleHsp" style=""></span>mm Hg or antihypertensive treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fasting glucose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥100<span class="elsevierStyleHsp" style=""></span>mg/dL or treatment for hyperglycemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182036.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara">Metabolic syndrome is diagnosed with ≥3 positive criteria.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Definition of Metabolic Syndrome<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> According to the National Cholesterol Education Program/Adult Treatment Panel (NCEP/ATP-III) 2005.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">BMI, kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Definition \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.5–24.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal weight \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0–26.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade I overweight \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.0–29.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade II overweight (preobesity) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.0–34.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade I obesity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.0–39.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade II obesity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.0–49.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade III obesity (morbid obesity) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade IV obesity (super-obesity) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182038.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Definition of Obesity According to Body Mass Index (BMI).</p>" ] ] 6 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">System \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Version \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Internet Address \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n 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align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" href="https://market.android.com/details%3Fid=com.ec_europe.calculadoramedica%26feature=search_result">https://market.android.com/details?id=com.ec_europe.calculadoramedica&feature=search_result</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx3"></elsevierMultimedia></span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AEDV Psoriasis Group Website \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" href="http://www.aedv.es/grupo_psoriasis/">http://www.aedv.es/grupo_psoriasis/</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182037.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Links to the Different Versions of the Application.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:41 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis causes as much disability as other major medical diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.R. 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| 2024 April | 81 | 29 | 110 |
| 2024 March | 69 | 28 | 97 |
| 2024 February | 67 | 32 | 99 |
| 2024 January | 60 | 36 | 96 |
| 2023 December | 58 | 14 | 72 |
| 2023 November | 77 | 24 | 101 |
| 2023 October | 56 | 26 | 82 |
| 2023 September | 70 | 25 | 95 |
| 2023 August | 43 | 12 | 55 |
| 2023 July | 44 | 42 | 86 |
| 2023 June | 42 | 21 | 63 |
| 2023 May | 54 | 26 | 80 |
| 2023 April | 40 | 14 | 54 |
| 2023 March | 57 | 17 | 74 |
| 2023 February | 46 | 25 | 71 |
| 2023 January | 30 | 36 | 66 |
| 2022 December | 73 | 44 | 117 |
| 2022 November | 34 | 31 | 65 |
| 2022 October | 29 | 26 | 55 |
| 2022 September | 30 | 27 | 57 |
| 2022 August | 23 | 32 | 55 |
| 2022 July | 27 | 26 | 53 |
| 2022 June | 44 | 21 | 65 |
| 2022 May | 34 | 30 | 64 |
| 2022 April | 47 | 37 | 84 |
| 2022 March | 54 | 62 | 116 |
| 2022 February | 42 | 25 | 67 |
| 2022 January | 54 | 33 | 87 |
| 2021 December | 59 | 40 | 99 |
| 2021 November | 39 | 35 | 74 |
| 2021 October | 47 | 49 | 96 |
| 2021 September | 25 | 32 | 57 |
| 2021 August | 44 | 40 | 84 |
| 2021 July | 37 | 22 | 59 |
| 2021 June | 23 | 28 | 51 |
| 2021 May | 30 | 43 | 73 |
| 2021 April | 46 | 33 | 79 |
| 2021 March | 59 | 38 | 97 |
| 2021 February | 34 | 22 | 56 |
| 2021 January | 26 | 14 | 40 |
| 2020 December | 20 | 16 | 36 |
| 2020 November | 31 | 23 | 54 |
| 2020 October | 31 | 12 | 43 |
| 2020 September | 26 | 11 | 37 |
| 2020 August | 22 | 14 | 36 |
| 2020 July | 32 | 18 | 50 |
| 2020 June | 52 | 28 | 80 |
| 2020 May | 29 | 15 | 44 |
| 2020 April | 45 | 16 | 61 |
| 2020 March | 37 | 15 | 52 |
| 2020 February | 7 | 0 | 7 |
| 2019 December | 4 | 2 | 6 |
| 2019 November | 0 | 1 | 1 |
| 2019 September | 4 | 1 | 5 |
| 2019 July | 0 | 1 | 1 |
| 2019 June | 2 | 4 | 6 |
| 2019 May | 1 | 20 | 21 |
| 2019 April | 0 | 1 | 1 |
| 2019 March | 2 | 6 | 8 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 1 | 0 | 1 |
| 2018 February | 13 | 4 | 17 |
| 2018 January | 42 | 6 | 48 |
| 2017 December | 40 | 9 | 49 |
| 2017 November | 41 | 6 | 47 |
| 2017 October | 37 | 4 | 41 |
| 2017 September | 24 | 6 | 30 |
| 2017 August | 36 | 8 | 44 |
| 2017 July | 32 | 12 | 44 |
| 2017 June | 39 | 12 | 51 |
| 2017 May | 34 | 8 | 42 |
| 2017 April | 40 | 11 | 51 |
| 2017 March | 17 | 0 | 17 |
| 2017 February | 27 | 8 | 35 |
| 2017 January | 22 | 11 | 33 |
| 2016 December | 39 | 4 | 43 |
| 2016 November | 51 | 7 | 58 |
| 2016 October | 44 | 6 | 50 |
| 2016 September | 35 | 2 | 37 |
| 2016 August | 31 | 10 | 41 |
| 2016 July | 28 | 4 | 32 |
| 2016 June | 7 | 4 | 11 |
| 2016 May | 6 | 7 | 13 |
| 2016 April | 5 | 6 | 11 |
| 2016 March | 6 | 7 | 13 |
| 2016 February | 8 | 10 | 18 |
| 2016 January | 16 | 8 | 24 |
| 2015 December | 11 | 8 | 19 |
| 2015 November | 22 | 9 | 31 |
| 2015 October | 11 | 9 | 20 |
| 2015 September | 12 | 2 | 14 |
| 2015 August | 12 | 1 | 13 |
| 2015 July | 45 | 5 | 50 |
| 2015 June | 58 | 8 | 66 |
| 2015 May | 93 | 12 | 105 |
| 2015 April | 53 | 7 | 60 |
| 2015 March | 47 | 10 | 57 |
| 2015 February | 48 | 15 | 63 |
| 2015 January | 38 | 7 | 45 |
| 2014 December | 47 | 9 | 56 |
| 2014 November | 31 | 7 | 38 |
| 2014 October | 39 | 26 | 65 |
| 2014 September | 55 | 9 | 64 |
| 2014 August | 51 | 15 | 66 |
| 2014 July | 57 | 24 | 81 |
| 2014 June | 70 | 8 | 78 |
| 2014 May | 77 | 20 | 97 |
| 2014 April | 63 | 8 | 71 |
| 2014 March | 67 | 16 | 83 |
| 2014 February | 18 | 11 | 29 |
| 2014 January | 25 | 6 | 31 |
| 2013 December | 30 | 15 | 45 |
| 2013 November | 20 | 8 | 28 |
| 2013 October | 17 | 3 | 20 |
| 2013 September | 13 | 2 | 15 |
| 2013 August | 10 | 8 | 18 |
| 2013 July | 7 | 13 | 20 |
| 2013 June | 15 | 20 | 35 |
| 2013 May | 13 | 9 | 22 |
| 2013 April | 11 | 18 | 29 |
| 2013 March | 13 | 12 | 25 |
| 2013 February | 31 | 5 | 36 |
| 2013 January | 29 | 7 | 36 |
| 2012 December | 16 | 5 | 21 |
| 2012 November | 1 | 4 | 5 |
| 2012 October | 3 | 4 | 7 |
| 2012 August | 0 | 1 | 1 |
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