Case and research letter
Varicella Complicated by Rhabdomyolysis
Varicela complicada con rabdomiólisis
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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." 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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" ]
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| 2024 Enero | 56 | 43 | 99 |
| 2023 Diciembre | 48 | 27 | 75 |
| 2023 Noviembre | 47 | 44 | 91 |
| 2023 Octubre | 58 | 30 | 88 |
| 2023 Septiembre | 49 | 39 | 88 |
| 2023 Agosto | 58 | 25 | 83 |
| 2023 Julio | 37 | 45 | 82 |
| 2023 Junio | 54 | 25 | 79 |
| 2023 Mayo | 44 | 27 | 71 |
| 2023 Abril | 29 | 20 | 49 |
| 2023 Marzo | 28 | 28 | 56 |
| 2023 Febrero | 51 | 20 | 71 |
| 2023 Enero | 26 | 40 | 66 |
| 2022 Diciembre | 39 | 44 | 83 |
| 2022 Noviembre | 21 | 31 | 52 |
| 2022 Octubre | 27 | 24 | 51 |
| 2022 Septiembre | 24 | 42 | 66 |
| 2022 Agosto | 21 | 33 | 54 |
| 2022 Julio | 18 | 36 | 54 |
| 2022 Junio | 16 | 19 | 35 |
| 2022 Mayo | 35 | 45 | 80 |
| 2022 Abril | 46 | 46 | 92 |
| 2022 Marzo | 45 | 48 | 93 |
| 2022 Febrero | 28 | 28 | 56 |
| 2022 Enero | 40 | 31 | 71 |
| 2021 Diciembre | 34 | 44 | 78 |
| 2021 Noviembre | 32 | 46 | 78 |
| 2021 Octubre | 42 | 39 | 81 |
| 2021 Septiembre | 31 | 43 | 74 |
| 2021 Agosto | 18 | 31 | 49 |
| 2021 Julio | 25 | 33 | 58 |
| 2021 Junio | 31 | 36 | 67 |
| 2021 Mayo | 23 | 31 | 54 |
| 2021 Abril | 55 | 46 | 101 |
| 2021 Marzo | 54 | 33 | 87 |
| 2021 Febrero | 65 | 38 | 103 |
| 2021 Enero | 33 | 13 | 46 |
| 2020 Diciembre | 30 | 15 | 45 |
| 2020 Noviembre | 18 | 19 | 37 |
| 2020 Octubre | 19 | 8 | 27 |
| 2020 Septiembre | 32 | 12 | 44 |
| 2020 Agosto | 17 | 22 | 39 |
| 2020 Julio | 19 | 16 | 35 |
| 2020 Junio | 36 | 26 | 62 |
| 2020 Mayo | 16 | 18 | 34 |
| 2020 Abril | 22 | 15 | 37 |
| 2020 Marzo | 22 | 22 | 44 |
| 2020 Febrero | 7 | 3 | 10 |
| 2020 Enero | 0 | 7 | 7 |
| 2019 Diciembre | 4 | 4 | 8 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 5 | 3 | 8 |
| 2019 Agosto | 0 | 2 | 2 |
| 2019 Julio | 0 | 3 | 3 |
| 2019 Junio | 2 | 13 | 15 |
| 2019 Mayo | 1 | 46 | 47 |
| 2019 Abril | 0 | 16 | 16 |
| 2019 Marzo | 2 | 12 | 14 |
| 2019 Febrero | 0 | 2 | 2 |
| 2019 Enero | 2 | 1 | 3 |
| 2018 Diciembre | 1 | 7 | 8 |
| 2018 Noviembre | 1 | 3 | 4 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 3 | 1 | 4 |
| 2018 Agosto | 0 | 6 | 6 |
| 2018 Julio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 1 | 1 | 2 |
| 2018 Febrero | 32 | 7 | 39 |
| 2018 Enero | 31 | 5 | 36 |
| 2017 Diciembre | 26 | 8 | 34 |
| 2017 Noviembre | 20 | 8 | 28 |
| 2017 Octubre | 30 | 4 | 34 |
| 2017 Septiembre | 31 | 7 | 38 |
| 2017 Agosto | 46 | 17 | 63 |
| 2017 Julio | 59 | 10 | 69 |
| 2017 Junio | 53 | 25 | 78 |
| 2017 Mayo | 53 | 7 | 60 |
| 2017 Abril | 65 | 11 | 76 |
| 2017 Marzo | 45 | 28 | 73 |
| 2017 Febrero | 36 | 10 | 46 |
| 2017 Enero | 23 | 2 | 25 |
| 2016 Diciembre | 55 | 8 | 63 |
| 2016 Noviembre | 58 | 7 | 65 |
| 2016 Octubre | 53 | 14 | 67 |
| 2016 Septiembre | 45 | 14 | 59 |
| 2016 Agosto | 37 | 13 | 50 |
| 2016 Julio | 28 | 4 | 32 |
| 2016 Junio | 14 | 12 | 26 |
| 2016 Mayo | 12 | 0 | 12 |
| 2016 Abril | 6 | 8 | 14 |
| 2016 Marzo | 7 | 2 | 9 |
| 2016 Febrero | 8 | 1 | 9 |
| 2016 Enero | 10 | 1 | 11 |
| 2015 Diciembre | 7 | 1 | 8 |
| 2015 Noviembre | 12 | 5 | 17 |
| 2015 Octubre | 6 | 1 | 7 |
| 2015 Septiembre | 10 | 2 | 12 |
| 2015 Agosto | 11 | 6 | 17 |
| 2015 Julio | 39 | 10 | 49 |
| 2015 Junio | 31 | 13 | 44 |
| 2015 Mayo | 12 | 7 | 19 |
| 2015 Abril | 15 | 2 | 17 |
| 2015 Marzo | 17 | 4 | 21 |
| 2015 Febrero | 19 | 5 | 24 |
| 2015 Enero | 12 | 3 | 15 |
| 2014 Diciembre | 12 | 4 | 16 |
| 2014 Noviembre | 8 | 6 | 14 |
| 2014 Octubre | 23 | 7 | 30 |
| 2014 Septiembre | 7 | 7 | 14 |
| 2014 Agosto | 10 | 6 | 16 |
| 2014 Julio | 14 | 8 | 22 |
| 2014 Junio | 29 | 5 | 34 |
| 2014 Mayo | 21 | 9 | 30 |
| 2014 Abril | 16 | 4 | 20 |
| 2014 Marzo | 14 | 9 | 23 |
| 2014 Febrero | 19 | 14 | 33 |
| 2014 Enero | 23 | 2 | 25 |
| 2013 Diciembre | 17 | 7 | 24 |
| 2013 Noviembre | 4 | 2 | 6 |
| 2013 Octubre | 7 | 0 | 7 |
| 2013 Septiembre | 5 | 3 | 8 |
| 2013 Agosto | 5 | 4 | 9 |
| 2013 Julio | 3 | 4 | 7 |
| 2013 Junio | 2 | 2 | 4 |
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