Cases for Diagnosis
Hyperpigmented Plaque on the Foot of a Kenyan Patient
Placa hiperpigmentada en el pie de un paciente keniata
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Sendagorta, C. Vidaurrázaga, R. Mulekyo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Sendagorta" "email" => array:1 [ 0 => "elenasendagorta@hotmail.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" => "C." "apellidos" => "Vidaurrázaga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Mulekyo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Pediátrico Pablo Horstmann de Anidan, Lamu, Kenia" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placa hiperpigmentada en el pie de un paciente keniata" ] ] "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" => 767 "Ancho" => 700 "Tamanyo" => 84719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy shows a brown ring around a central pore, surrounded by a whitish halo.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a black male, 38 years old, who was seen for a lesion that had been developing for 15 days on the external aspect of the ankle of the left foot. The lesion was painful and made walking difficult. Of interest, the patient lives in Kenya, in an area of extreme poverty where going barefoot is common.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination showed a hyperpigmented plaque, 4×4 cm, with poorly defined borders. The plaque consisted of several confluent papules, each of which had a dark brown spot at its centre, surrounded by a white halo with a hyperkeratotic surface (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopy (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) showed that this spot was in fact a brown pigmented ring around a central pore (white arrow), surrounded by a whitish area bounded by a faint pigmented peripheral ring (black arrow).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical and dermoscopic characteristics of the lesion allowed us to establish a diagnosis of tungiasis. Once extracted, the dermoscopic image of the flea showed the presence of eggs in the abdominal cavity, as well as the posterior opening of the exoskeleton (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course</span><p id="par0030" class="elsevierStylePara elsevierViewall">Surgery was used to completely extract the parasites, which were 5 in number. Antibiotic prophylaxis and a tetanus booster dose were administered. The patient's subsequent clinical course was satisfactory.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Tungiasis is an ectoparasitic infestation by the pregnant sand flea <span class="elsevierStyleItalic">Tunga penetrans</span>. The flea is endemic to Sub-Saharan Africa, South America, the Caribbean, and parts of Asia, where it is a serious health problem.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The flea is transmitted by direct contact of the skin with soil contaminated by pig or cow feces. It is typically a result of walking barefoot and lesions therefore often appear in the skin of the feet, particularly in the periungal area, although they can be seen in any region of the body.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The clinical manifestations are highly variable, with isolated or multiple hyperpigmented papules being typical. It may present with pruritus or mild pain, but intense pain may also develop and walking may become impossible. Bacterial superinfection is the most common complication.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Diagnosis is based on the clinical characteristics of the lesion, although histological study is sometimes needed.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In 2004, Bauer et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> used dermoscopy as an effective diagnostic aid for tungiasis. The dermoscopic characteristics they described included the presence of a brown ring around a central pore, which is the pigmented chitin surrounding the posterior opening of the sand flea's exoskeleton (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, white arrow). Subsequently, a peripheral pigmented ring or halo was described, which is the posterior part of the abdomen of the parasite.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Dermoscopy has also led to the description of additional tungiasis characteristics that are more variable and are not present in all patients, such as blue-gray spots, whitish chainlike structures, and the recently described radial crown sign.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> It should be noted that some of these signs have been described in white patients and that they are difficult to observe in black patients, as in the case we present.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The differential diagnosis of tungiasis includes myiasis, cutaneous larva migrans, scabies, bacterial infections, tumors, warts, and foreign-body reactions.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The most effective treatment involves surgical extraction of the flea, the administration of antibiotics, and tetanus vaccination; the role of other treatments, such as the use of ivermectin or thiabendazole, remains unclear. The use of adequate footwear is recommended as a preventative measure.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Immigration has produced a significant increase in the incidence of tungiasis outside of areas where it is endemic, leading inevitably to diagnostic difficulties.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> As occurs in other parasitic infestations,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> dermoscopy can be helpful in patients in whom the diagnosis cannot easily be established on the basis of clinical findings.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Sendagorta E, Vidaurrázaga C, Raphael Mulekyo. Placa hiperpigmentada en el pie de un paciente keniata. Actas Dermosifiliogr.2012;103:633-634.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 599 "Ancho" => 800 "Tamanyo" => 101547 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hyperkeratotic plaque consisting of confluent papules that have a central brown spot.</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" => 767 "Ancho" => 700 "Tamanyo" => 84719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy shows a brown ring around a central pore, surrounded by a whitish halo.</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" => 641 "Ancho" => 800 "Tamanyo" => 69145 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Image of the flea following extraction. Dermoscopy shows a large number of eggs in the abdominal cavity of the flea.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tunga penetrans: a stowaway from around the world" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.M. Sachse" 1 => "K.K. Guldbakke" 2 => "A. Khachemoune" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2006.01888.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2007" "volumen" => "21" "paginaInicial" => "11" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17207161" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tungiasis. Presentación de dos nuevos casos y revisión de 20 casos de la literatura española" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Casals Andreu" 1 => "A. Campo Voegeli" 2 => "F. García Hernández" 3 => "F. Aspiolea Ferrero" 4 => "A. Camps Fresneda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "1999" "volumen" => "90" "paginaInicial" => "311" "paginaFinal" => "314" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy of tungiasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Bauer" 1 => "A. Forschner" 2 => "C. Garbe" 3 => "M. Röcken" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.140.6.761" "Revista" => array:7 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2004" "volumen" => "140" "paginaInicial" => "761" "paginaFinal" => "763" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15210479" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673602117673" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An additional dermoscopic feature of tungiasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Di Stefani" 1 => "C.M. Rudolph" 2 => "R. Hoffmann-Wellenhof" 3 => "R.R. Müllegger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.141.8.1045" "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2005" "volumen" => "141" "paginaInicial" => "1045" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16103343" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Entodermoscopy: a new tool for diagnosing skin infections and infestations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Zalaudek" 1 => "J. Giacomel" 2 => "H. Cabo" 3 => "A. Di Stefani" 4 => "G. Ferrara" 5 => "R. Hofmann-Wellenhof" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000109353" "Revista" => array:7 [ "tituloSerie" => "Dermatology" "fecha" => "2008" "volumen" => "216" "paginaInicial" => "14" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18032894" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028209036929" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tunga penetrans: description of a new dermoscopic sign-the radial crown" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Marazza" 1 => "A. Campanelli" 2 => "G. Kaya" 3 => "R.P. Braun" 4 => "J.H. Saurat" 5 => "V. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 8 | 16 |
| 2024 Octubre | 57 | 30 | 87 |
| 2024 Septiembre | 75 | 26 | 101 |
| 2024 Agosto | 88 | 60 | 148 |
| 2024 Julio | 77 | 26 | 103 |
| 2024 Junio | 80 | 31 | 111 |
| 2024 Mayo | 91 | 28 | 119 |
| 2024 Abril | 67 | 31 | 98 |
| 2024 Marzo | 73 | 28 | 101 |
| 2024 Febrero | 66 | 36 | 102 |
| 2024 Enero | 44 | 33 | 77 |
| 2023 Diciembre | 48 | 16 | 64 |
| 2023 Noviembre | 61 | 23 | 84 |
| 2023 Octubre | 84 | 21 | 105 |
| 2023 Septiembre | 105 | 26 | 131 |
| 2023 Agosto | 46 | 22 | 68 |
| 2023 Julio | 62 | 31 | 93 |
| 2023 Junio | 66 | 25 | 91 |
| 2023 Mayo | 66 | 26 | 92 |
| 2023 Abril | 58 | 17 | 75 |
| 2023 Marzo | 44 | 27 | 71 |
| 2023 Febrero | 77 | 27 | 104 |
| 2023 Enero | 56 | 36 | 92 |
| 2022 Diciembre | 74 | 33 | 107 |
| 2022 Noviembre | 45 | 28 | 73 |
| 2022 Octubre | 34 | 29 | 63 |
| 2022 Septiembre | 32 | 39 | 71 |
| 2022 Agosto | 33 | 38 | 71 |
| 2022 Julio | 24 | 29 | 53 |
| 2022 Junio | 20 | 23 | 43 |
| 2022 Mayo | 45 | 41 | 86 |
| 2022 Abril | 55 | 31 | 86 |
| 2022 Marzo | 60 | 62 | 122 |
| 2022 Febrero | 63 | 30 | 93 |
| 2022 Enero | 45 | 39 | 84 |
| 2021 Diciembre | 46 | 46 | 92 |
| 2021 Noviembre | 50 | 42 | 92 |
| 2021 Octubre | 42 | 51 | 93 |
| 2021 Septiembre | 48 | 47 | 95 |
| 2021 Agosto | 48 | 26 | 74 |
| 2021 Julio | 44 | 27 | 71 |
| 2021 Junio | 52 | 28 | 80 |
| 2021 Mayo | 42 | 29 | 71 |
| 2021 Abril | 78 | 33 | 111 |
| 2021 Marzo | 96 | 42 | 138 |
| 2021 Febrero | 54 | 30 | 84 |
| 2021 Enero | 39 | 13 | 52 |
| 2020 Diciembre | 68 | 17 | 85 |
| 2020 Noviembre | 43 | 14 | 57 |
| 2020 Octubre | 39 | 7 | 46 |
| 2020 Septiembre | 61 | 8 | 69 |
| 2020 Agosto | 40 | 26 | 66 |
| 2020 Julio | 39 | 11 | 50 |
| 2020 Junio | 36 | 31 | 67 |
| 2020 Mayo | 28 | 15 | 43 |
| 2020 Abril | 35 | 16 | 51 |
| 2020 Marzo | 35 | 27 | 62 |
| 2020 Febrero | 1 | 5 | 6 |
| 2020 Enero | 4 | 2 | 6 |
| 2019 Diciembre | 8 | 1 | 9 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Septiembre | 0 | 1 | 1 |
| 2019 Agosto | 3 | 5 | 8 |
| 2019 Julio | 8 | 6 | 14 |
| 2019 Junio | 4 | 15 | 19 |
| 2019 Mayo | 6 | 38 | 44 |
| 2019 Abril | 4 | 15 | 19 |
| 2019 Marzo | 2 | 9 | 11 |
| 2019 Febrero | 2 | 5 | 7 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Noviembre | 5 | 0 | 5 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 7 | 0 | 7 |
| 2018 Marzo | 4 | 0 | 4 |
| 2018 Febrero | 34 | 5 | 39 |
| 2018 Enero | 43 | 6 | 49 |
| 2017 Diciembre | 49 | 11 | 60 |
| 2017 Noviembre | 44 | 1 | 45 |
| 2017 Octubre | 38 | 5 | 43 |
| 2017 Septiembre | 66 | 15 | 81 |
| 2017 Agosto | 109 | 4 | 113 |
| 2017 Julio | 80 | 14 | 94 |
| 2017 Junio | 115 | 11 | 126 |
| 2017 Mayo | 71 | 7 | 78 |
| 2017 Abril | 84 | 7 | 91 |
| 2017 Marzo | 66 | 13 | 79 |
| 2017 Febrero | 47 | 10 | 57 |
| 2017 Enero | 38 | 16 | 54 |
| 2016 Diciembre | 96 | 17 | 113 |
| 2016 Noviembre | 79 | 13 | 92 |
| 2016 Octubre | 91 | 9 | 100 |
| 2016 Septiembre | 78 | 20 | 98 |
| 2016 Agosto | 67 | 33 | 100 |
| 2016 Julio | 53 | 8 | 61 |
| 2016 Junio | 13 | 13 | 26 |
| 2016 Mayo | 5 | 10 | 15 |
| 2016 Abril | 3 | 4 | 7 |
| 2016 Marzo | 10 | 7 | 17 |
| 2016 Febrero | 6 | 3 | 9 |
| 2016 Enero | 5 | 1 | 6 |
| 2015 Diciembre | 8 | 1 | 9 |
| 2015 Noviembre | 15 | 5 | 20 |
| 2015 Octubre | 13 | 10 | 23 |
| 2015 Septiembre | 6 | 1 | 7 |
| 2015 Agosto | 9 | 7 | 16 |
| 2015 Julio | 114 | 22 | 136 |
| 2015 Junio | 53 | 6 | 59 |
| 2015 Mayo | 79 | 5 | 84 |
| 2015 Abril | 88 | 15 | 103 |
| 2015 Marzo | 61 | 15 | 76 |
| 2015 Febrero | 63 | 14 | 77 |
| 2015 Enero | 101 | 21 | 122 |
| 2014 Diciembre | 61 | 8 | 69 |
| 2014 Noviembre | 63 | 12 | 75 |
| 2014 Octubre | 112 | 23 | 135 |
| 2014 Septiembre | 90 | 15 | 105 |
| 2014 Agosto | 29 | 7 | 36 |
| 2014 Julio | 23 | 5 | 28 |
| 2014 Junio | 49 | 9 | 58 |
| 2014 Mayo | 45 | 5 | 50 |
| 2014 Abril | 34 | 3 | 37 |
| 2014 Marzo | 32 | 12 | 44 |
| 2014 Febrero | 28 | 8 | 36 |
| 2014 Enero | 37 | 5 | 42 |
| 2013 Diciembre | 44 | 12 | 56 |
| 2013 Noviembre | 31 | 7 | 38 |
| 2013 Octubre | 25 | 7 | 32 |
| 2013 Septiembre | 23 | 5 | 28 |
| 2013 Agosto | 16 | 13 | 29 |
| 2013 Julio | 17 | 16 | 33 |
| 2013 Junio | 9 | 15 | 24 |
| 2013 Mayo | 13 | 12 | 25 |
| 2013 Abril | 19 | 10 | 29 |
| 2013 Marzo | 18 | 11 | 29 |
| 2013 Febrero | 32 | 4 | 36 |
| 2013 Enero | 27 | 6 | 33 |
| 2012 Diciembre | 16 | 4 | 20 |
| 2012 Octubre | 0 | 2 | 2 |
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