Case and research letter
Varicella Complicated by Rhabdomyolysis
Varicela complicada con rabdomiólisis
Read
6008
Timeswas read the article
2356
Total PDF
3652
Total HTML
Share statistics
array:23 [ "pii" => "S1578219013001042" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.06.029" "estado" => "S300" "fechaPublicacion" => "2013-06-01" "aid" => "711" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2012" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:448-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1915 "formatos" => array:3 [ "EPUB" => 44 "HTML" => 1337 "PDF" => 534 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731012004097" "issn" => "00017310" "doi" => "10.1016/j.ad.2012.06.015" "estado" => "S300" "fechaPublicacion" => "2013-06-01" "aid" => "711" "copyright" => "Elsevier España, S.L. y AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:448-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2305 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 1766 "PDF" => 538 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Varicela complicada con rabdomiólisis" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "448" "paginaFinal" => "449" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Varicella Complicated by Rhabdomyolysis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.L. Martínez-Martínez, J.G. Córdoba-Soriano, J. Calbo-Mayo, M. Melero Bascones" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.L." "apellidos" => "Martínez-Martínez" ] 1 => array:2 [ "nombre" => "J.G." "apellidos" => "Córdoba-Soriano" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Calbo-Mayo" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Melero Bascones" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219013001042" "doi" => "10.1016/j.adengl.2012.06.029" "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/S1578219013001042?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012004097?idApp=UINPBA000044" "url" => "/00017310/0000010400000005/v1_201307050850/S0001731012004097/v1_201307050850/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S1578219013001030" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.04.011" "estado" => "S300" "fechaPublicacion" => "2013-06-01" "aid" => "710" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:446-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4470 "formatos" => array:3 [ "EPUB" => 38 "HTML" => 3497 "PDF" => 935 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and research letter</span>" "titulo" => "Congenital Subungual and Periungual Melanocytic Nevus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "446" "paginaFinal" => "448" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nevus melanocítico congénito subungueal y periungueal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 499 "Ancho" => 1400 "Tamanyo" => 86324 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, The initial dermoscopy revealed the presence of pigmented globules in the nail plate and in the proximal periungual skin. B, Two months later, pigmented globules were visible on a brown background, with narrow and regular longitudinal lines in the nail plate. C, At 6 months the dermoscopic pattern was unchanged.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Agusti-Mejias, F. Messeguer, I. Febrer, V. Alegre" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Agusti-Mejias" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Messeguer" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Febrer" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Alegre" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012004085" "doi" => "10.1016/j.ad.2012.04.021" "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/S0001731012004085?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001030?idApp=UINPBA000044" "url" => "/15782190/0000010400000005/v1_201307051101/S1578219013001030/v1_201307051101/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and research letter</span>" "titulo" => "Varicella Complicated by Rhabdomyolysis" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "448" "paginaFinal" => "449" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.L. Martínez-Martínez, J.G. Córdoba-Soriano, J. Calbo-Mayo, M. Melero Bascones" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.L." "apellidos" => "Martínez-Martínez" "email" => array:1 [ 0 => "mlmartinezm@sescam.jccm.es" ] "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" => "J.G." "apellidos" => "Córdoba-Soriano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Calbo-Mayo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Melero Bascones" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cardiología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Complejo Hospitalario Universitario de Albacete, Albacete, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Varicela complicada con rabdomiólisis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary varicella-zoster virus (VZV) infection usually occurs in childhood and in the majority of cases runs a self-limiting course. In infants, adults, and immunocompromised individuals, however, the infection can be serious if certain complications develop.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of an immunocompetent adult patient with VZV infection complicated by rhabdomyolysis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 29-year-old man, with no relevant past medical history, who presented at the emergency department with pruritic skin lesions. He said that the lesions, which were not initially filled with fluid, had erupted in successive crops over the previous 24<span class="elsevierStyleHsp" style=""></span>hours, causing intense itching. He also reported fever of 39<span class="elsevierStyleHsp" style=""></span>°C, a lack of strength and energy, and loss of appetite. He had experienced general malaise for a week and had also had low-grade fever and muscle pain. Physical examination revealed a rash, mainly affecting the trunk, consisting of fluid-filled vesicles at different stages of development on a red base; there were no vesicles on the mucous membranes or on the palms or soles. Blood tests revealed elevated values for creatine phosphokinase (11<span class="elsevierStyleHsp" style=""></span>480 U/L), aspartate aminotransferase (165 U/L), alanine transaminase (63 U/L), lactate dehydrogenase (820 U/L), and myoglobin (200.1<span class="elsevierStyleHsp" style=""></span>ng/mL). The other values were within normal ranges and included pH, 7.38; bicarbonate, 24 mEq/L; creatinine, 0.98<span class="elsevierStyleHsp" style=""></span>mg/dL; urea, 29<span class="elsevierStyleHsp" style=""></span>mg/dL; sodium, 139<span class="elsevierStyleHsp" style=""></span>mmol/L; potassium, 4.1<span class="elsevierStyleHsp" style=""></span>mmol/L; and chloride, 100<span class="elsevierStyleHsp" style=""></span>mmol/L. No abnormalities were observed on the chest radiograph. A Tzanck smear revealed the presence of multinucleated giant cells and acantholytic keratinocytes. A diagnosis of varicella complicated by rhabdomyolysis was established and the patient was admitted for treatment with acyclovir and intravenous fluid therapy with normal saline. Additional measures, such as the administration of mannitol, furosemide, or bicarbonate, were not required. During the patient's stay in hospital, human immunodeficiency virus (HIV) infection was ruled out and there was no impairment of renal function. The skin lesions and blood results improved gradually, and the patient was discharged after a week, having developed no other complications.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The most common complications of VZV infection are bacterial superinfection, laryngitis, and pneumonia. Nervous system complications include encephalitis and cerebellitis and, very rarely, polyneuritis, myelitis, radiculitis, and optic neuritis. Hepatitis and myocarditis have also been described. Rhabdomyolysis is a rare complication of primary VZV infection, with only few cases reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–8</span></a> In otherwise healthy patients with varicella, morbidity and mortality due to rhabdomyolysis are 10 to 20 times higher in adults than in children.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Rhabdomyolysis is characterized by massive tissue breakdown leading to the passage of toxic intracellular metabolites into the circulatory system. This can cause acute kidney failure, hyperkalemia, metabolic acidosis, and disseminated intravascular coagulation. Possible causes of rhabdomyolysis include epileptic seizures, drugs such as statins, alcohol intake, trauma, strenuous physical exercise, and, more rarely, infections. The only risk factor in our patient was VZV infection. The most common viral causes of rhabdomyolysis are influenza, HIV, and enterovirus infection.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Influenza appears to be the viral infection most commonly associated with renal impairment in patients with rhabdomyolysis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The risk of renal impairment in patients with rhabdomyolysis secondary to VZV infection does not appear to be related to creatine phosphokinase levels.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Although rhabdomyolysis due to primary VZV infection is believed to be rare, it might be underdiagnosed. Because creatine phosphokinase levels are not routinely measured in patients with varicella, mild to moderate cases of rhabdomyolysis could go unnoticed<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in the absence of suggestive signs or symptoms such as abnormal urine color, weakness, or intense muscle pain, as was the case with our patient.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, rhabdomyolysis should be considered as a possible complication in patients with primary VZV infection as this will help to ensure prompt initiation of appropriate treatment to prevent potentially serious complications.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez-Martínez ML, et al. Varicela complicada con rabdomiólisis. Actas Dermosifiliogr. 2013;104:448-9.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unusual onset of varicella zoster reactivation with meningoencephalitis, followed by rhabdomyolysis and renal failure in a young, immunocompetent patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Pirounaki" 1 => "G. Liatsos" 2 => "I. Elefsiniotis" 3 => "M. Skounakis" 4 => "A. Moulakakis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00365540600798809" "Revista" => array:6 [ "tituloSerie" => "Scand J Infect Dis" "fecha" => "2007" "volumen" => "39" "paginaInicial" => "90" "paginaFinal" => "93" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17366023" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fulminant varicella infection complicated with acute respiratory distress syndrome, and disseminated intravascular coagulation in an immunocompetent young adult" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Lee" 1 => "N. Ito" 2 => "T. Inagaki" 3 => "T. Okajima" 4 => "A. Muramatsu" 5 => "Y. Ito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intern Med" "fecha" => "2004" "volumen" => "43" "paginaInicial" => "1205" "paginaFinal" => "1209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15645661" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Varicella zoster infection associated rhabdomyolysis demonstrated by Tc-99m MDP imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Bhargava" 1 => "C. Bhutani" 2 => "Q. Feng" 3 => "A. Alavi" 4 => "H. Zhuang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.RLU.0000073605.79931.EF" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2003" "volumen" => "28" "paginaInicial" => "594" "paginaFinal" => "595" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12819419" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rhabdomyolysis associated with varicella infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Al-Langawi" 1 => "M.R. al-Marri" 2 => "H. al Soub" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Clin Pract" "fecha" => "2001" "volumen" => "55" "paginaInicial" => "484" "paginaFinal" => "485" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11594261" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Varicella induced rhabdomyolysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Rodríguez Ferrán" 1 => "A. Vernet Bori" 2 => "P. Poo Argüelles" 3 => "E. Fernández Alvarez" 4 => "J. García Calatayud" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Esp Pediatr" "fecha" => "2001" "volumen" => "55" "paginaInicial" => "374" "paginaFinal" => "377" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11578548" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disseminated intravascular coagulation (DIC) and rhabdomyolysis in fulminant varicella infection–case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "U. Hollenstein" 1 => "F. Thalhammer" 2 => "H. Burgmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Infection" "fecha" => "1998" "volumen" => "26" "paginaInicial" => "306" "paginaFinal" => "308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9795791" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rhabdomyolysis associated with acute varicella infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.D. Pratt" 1 => "J.S. Bradley" 2 => "C. Loubert" 3 => "A. LaRocco Jr." 4 => "R.M. McNeal" 5 => "R.O. Newbury" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "1995" "volumen" => "20" "paginaInicial" => "450" "paginaFinal" => "453" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7742454" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Varicella zoster infection, massive rhabdomyolysis, myoglobinuria, and renal failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.E. Roberts" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Board Fam Pract" "fecha" => "1995" "volumen" => "8" "paginaInicial" => "52" "paginaFinal" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7701961" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infectious etiologies of rhabdomyolysis: three case reports and review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "U. Singh" 1 => "W.M. Scheld" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "1996" "volumen" => "22" "paginaInicial" => "642" "paginaFinal" => "649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8729203" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute renal failure due to rhabdomyolysis associated with echovirus 9 infection: a case report and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Tanaka" 1 => "T. Takada" 2 => "D. Takagi" 3 => "N. Takeyama" 4 => "Y. Kitazawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Jpn J Med" "fecha" => "1989" "volumen" => "28" "paginaInicial" => "237" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2659856" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000005/v1_201307051101/S1578219013001042/v1_201307051101/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000005/v1_201307051101/S1578219013001042/v1_201307051101/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001042?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 10 | 20 |
| 2024 October | 76 | 35 | 111 |
| 2024 September | 64 | 19 | 83 |
| 2024 August | 99 | 77 | 176 |
| 2024 July | 79 | 35 | 114 |
| 2024 June | 100 | 38 | 138 |
| 2024 May | 60 | 47 | 107 |
| 2024 April | 82 | 42 | 124 |
| 2024 March | 59 | 41 | 100 |
| 2024 February | 60 | 30 | 90 |
| 2024 January | 56 | 43 | 99 |
| 2023 December | 48 | 27 | 75 |
| 2023 November | 47 | 44 | 91 |
| 2023 October | 58 | 30 | 88 |
| 2023 September | 49 | 39 | 88 |
| 2023 August | 58 | 25 | 83 |
| 2023 July | 37 | 45 | 82 |
| 2023 June | 54 | 25 | 79 |
| 2023 May | 44 | 27 | 71 |
| 2023 April | 29 | 20 | 49 |
| 2023 March | 28 | 28 | 56 |
| 2023 February | 51 | 20 | 71 |
| 2023 January | 26 | 40 | 66 |
| 2022 December | 39 | 44 | 83 |
| 2022 November | 21 | 31 | 52 |
| 2022 October | 27 | 24 | 51 |
| 2022 September | 24 | 42 | 66 |
| 2022 August | 21 | 33 | 54 |
| 2022 July | 18 | 36 | 54 |
| 2022 June | 16 | 19 | 35 |
| 2022 May | 35 | 45 | 80 |
| 2022 April | 46 | 46 | 92 |
| 2022 March | 45 | 48 | 93 |
| 2022 February | 28 | 28 | 56 |
| 2022 January | 40 | 31 | 71 |
| 2021 December | 34 | 44 | 78 |
| 2021 November | 32 | 46 | 78 |
| 2021 October | 42 | 39 | 81 |
| 2021 September | 31 | 43 | 74 |
| 2021 August | 18 | 31 | 49 |
| 2021 July | 25 | 33 | 58 |
| 2021 June | 31 | 36 | 67 |
| 2021 May | 23 | 31 | 54 |
| 2021 April | 55 | 46 | 101 |
| 2021 March | 54 | 33 | 87 |
| 2021 February | 65 | 38 | 103 |
| 2021 January | 33 | 13 | 46 |
| 2020 December | 30 | 15 | 45 |
| 2020 November | 18 | 19 | 37 |
| 2020 October | 19 | 8 | 27 |
| 2020 September | 32 | 12 | 44 |
| 2020 August | 17 | 22 | 39 |
| 2020 July | 19 | 16 | 35 |
| 2020 June | 36 | 26 | 62 |
| 2020 May | 16 | 18 | 34 |
| 2020 April | 22 | 15 | 37 |
| 2020 March | 22 | 22 | 44 |
| 2020 February | 7 | 3 | 10 |
| 2020 January | 0 | 7 | 7 |
| 2019 December | 4 | 4 | 8 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 5 | 3 | 8 |
| 2019 August | 0 | 2 | 2 |
| 2019 July | 0 | 3 | 3 |
| 2019 June | 2 | 13 | 15 |
| 2019 May | 1 | 46 | 47 |
| 2019 April | 0 | 16 | 16 |
| 2019 March | 2 | 12 | 14 |
| 2019 February | 0 | 2 | 2 |
| 2019 January | 2 | 1 | 3 |
| 2018 December | 1 | 7 | 8 |
| 2018 November | 1 | 3 | 4 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 3 | 1 | 4 |
| 2018 August | 0 | 6 | 6 |
| 2018 July | 0 | 4 | 4 |
| 2018 May | 0 | 4 | 4 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 1 | 1 | 2 |
| 2018 February | 32 | 7 | 39 |
| 2018 January | 31 | 5 | 36 |
| 2017 December | 26 | 8 | 34 |
| 2017 November | 20 | 8 | 28 |
| 2017 October | 30 | 4 | 34 |
| 2017 September | 31 | 7 | 38 |
| 2017 August | 46 | 17 | 63 |
| 2017 July | 59 | 10 | 69 |
| 2017 June | 53 | 25 | 78 |
| 2017 May | 53 | 7 | 60 |
| 2017 April | 65 | 11 | 76 |
| 2017 March | 45 | 28 | 73 |
| 2017 February | 36 | 10 | 46 |
| 2017 January | 23 | 2 | 25 |
| 2016 December | 55 | 8 | 63 |
| 2016 November | 58 | 7 | 65 |
| 2016 October | 53 | 14 | 67 |
| 2016 September | 45 | 14 | 59 |
| 2016 August | 37 | 13 | 50 |
| 2016 July | 28 | 4 | 32 |
| 2016 June | 14 | 12 | 26 |
| 2016 May | 12 | 0 | 12 |
| 2016 April | 6 | 8 | 14 |
| 2016 March | 7 | 2 | 9 |
| 2016 February | 8 | 1 | 9 |
| 2016 January | 10 | 1 | 11 |
| 2015 December | 7 | 1 | 8 |
| 2015 November | 12 | 5 | 17 |
| 2015 October | 6 | 1 | 7 |
| 2015 September | 10 | 2 | 12 |
| 2015 August | 11 | 6 | 17 |
| 2015 July | 39 | 10 | 49 |
| 2015 June | 31 | 13 | 44 |
| 2015 May | 12 | 7 | 19 |
| 2015 April | 15 | 2 | 17 |
| 2015 March | 17 | 4 | 21 |
| 2015 February | 19 | 5 | 24 |
| 2015 January | 12 | 3 | 15 |
| 2014 December | 12 | 4 | 16 |
| 2014 November | 8 | 6 | 14 |
| 2014 October | 23 | 7 | 30 |
| 2014 September | 7 | 7 | 14 |
| 2014 August | 10 | 6 | 16 |
| 2014 July | 14 | 8 | 22 |
| 2014 June | 29 | 5 | 34 |
| 2014 May | 21 | 9 | 30 |
| 2014 April | 16 | 4 | 20 |
| 2014 March | 14 | 9 | 23 |
| 2014 February | 19 | 14 | 33 |
| 2014 January | 23 | 2 | 25 |
| 2013 December | 17 | 7 | 24 |
| 2013 November | 4 | 2 | 6 |
| 2013 October | 7 | 0 | 7 |
| 2013 September | 5 | 3 | 8 |
| 2013 August | 5 | 4 | 9 |
| 2013 July | 3 | 4 | 7 |
| 2013 June | 2 | 2 | 4 |
Show all
