Case and Research Letter
Multimodal Treatment of Calciphylaxis With Sodium Thiosulfate, Alprostadil, and Hyperbaric Oxygen Therapy
Tratamiento multimodal de la calcifilaxis con tiosulfato sódico, alprostadil y oxigenoterapia hiperbárica
L. Ossorio-García
, D. Jiménez-Gallo, C. Arjona-Aguilera, M. Linares-Barrios
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Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Ossorio-García, D. Jiménez-Gallo, C. Arjona-Aguilera, M. Linares-Barrios" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Ossorio-García" "email" => array:1 [ 0 => "lidia.osga@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Jiménez-Gallo" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Arjona-Aguilera" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Linares-Barrios" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento multimodal de la calcifilaxis con tiosulfato sódico, alprostadil y oxigenoterapia hiperbárica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 965 "Ancho" => 1500 "Tamanyo" => 299350 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Calciphylaxis-related skin ulcers on the anterior aspect of the thighs. B, Livedo racemosa and retiform purpura on the abdomen. C, Healing of the ulcers on the anterior aspect of the thighs after combined treatment with intravenous sodium thiosulfate and alprostadil. D, Disappearance of the livedo racemosa and retiform purpura on the abdomen.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Calciphylaxis is characterized by calcification of the media of the small arteries and arterioles of the skin, provoking cutaneous ischemia. It affects patients with end-stage renal disease (ESRD) on hemodialysis and carries a high morbidity and mortality, with death most commonly due to sepsis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> We describe the case of a patient with calciphylaxis treated successfully with multimodal therapy including sodium thiosulfate (ST) and prostaglandins.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 51-year-old woman on hemodialysis for ESRD secondary to polycystic kidney disease. She consulted for ulcers that had appeared on her abdomen and right thigh more than a year earlier; the ulcers produced intense pain refractory to opioid analgesia. Physical examination revealed deep, foul-smelling skin ulcers up to 10<span class="elsevierStyleHsp" style=""></span>cm in diameter on the anterior surface of the thighs and lower abdomen, with areas of superficial necrotic eschar. The ulcers were situated in extensive areas of livedo racemosa and retiform purpura (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, A and B). Important findings in the blood tests were secondary hyperparathyroidism with parathormone levels of 895.8<span class="elsevierStyleHsp" style=""></span>pg/mL (normal range, 15-65<span class="elsevierStyleHsp" style=""></span>mg/mL), calcium 9.4<span class="elsevierStyleHsp" style=""></span>mg/dL (normal range, 8.2-10.3<span class="elsevierStyleHsp" style=""></span>mg/dL), and phosphorus, 5.8<span class="elsevierStyleHsp" style=""></span>mg/dL (normal range, 2.7-4.5<span class="elsevierStyleHsp" style=""></span>mg/dL). Further additional tests to exclude other causes of livedo racemosa, including antinuclear antibodies, antineutrophil cytoplasmic antibodies with antimyeloperoxidase and antiproteinase-3 activity, cryoglobulins, anticardiolipin antibodies, and anticitrullinated peptide antibodies, were normal or negative. Skin biopsy showed calcification of the media of vessels in the subcutaneous cellular tissue with focal calcium deposits in subdermal lobules, confirming the diagnosis of calciphylaxis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was treated with intravenous (IV) ST, 25<span class="elsevierStyleHsp" style=""></span>mg, administered immediately after each hemodialysis session, with no clinical response. She was receiving 3 hemodialysis sessions per week. Nausea was the only adverse effect. After 36 sessions of IV ST with no clinical response, we added treatment with IV alprostadil, 60<span class="elsevierStyleHsp" style=""></span>μg, administered during each hemodialysis session. From the first infusion of alprostadil, the patient reported rapid pain relief that enabled the opioids to be withdrawn. With this combination, the skin ulcers and livedo racemosa improved progressively. In order to accelerate healing of the skin ulcers and to reduce the risk of infection, we added treatment with monthly intralesional infiltrations of 10<span class="elsevierStyleHsp" style=""></span>mL of ST solution, 1/6<span class="elsevierStyleHsp" style=""></span>M, around the borders of the ulcers, without previous anesthesia, and hyperbaric oxygen therapy for 3 months. Hyperbaric oxygen therapy was performed on Monday to Friday each week, with a duration of 60<span class="elsevierStyleHsp" style=""></span>min per session, at an absolute pressure to 2.4 atmospheres, with a total of 70 sessions. After 5 months of treatment, all the skin ulcers and the livedo racemosa had resolved (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, C and D). For more than a year, the patient has continued on maintenance treatment with IV alprostadil during the hemodialysis sessions combined with IV ST after each session and occasional ST infiltrations when small ulcers develop. This multimodal therapy has achieved good overall control of this severe disease more than 2 years after its onset.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The medical treatments most widely used for calciphylaxis are IV ST and the bisphosphonates.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> ST has a vasodilator effect that reduces pain and is a chelator of calcium salts, making them more soluble.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Alprostadil, or prostaglandin E1, is well known for its vasodilator effect and antiplatelet and fibrinolytic activity.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> There are no reports in the scientific literature of any case of calciphylaxis successfully treated with the combination of IV and intralesional ST and IV alprostadil. Miceli et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> described the combination of IV ST and prostaglandin E1 in a patient with calciphylaxis associated with a marked deterioration in the patient's general state of health; despite treatment, the patient showed further deterioration and died. Alikadic et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> reported the use of a prostacyclin analog, iloprost, in combination with hyperbaric chamber treatment and autologous skin cell culture for the treatment of calciphylaxis, achieving a good response. Horishita et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> described the use of alprostadil to prevent a fall in peripheral blood flow to damaged tissues during general anesthesia in a patient with calciphylaxis, but not as a treatment for this disease. Alprostadil has also been effective in other obstructive alterations of the cutaneous microcirculation, such as livedoid vasculopathy.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In our patient, IV ST was ineffective until IV alprostadil was added; this led to a rapid improvement in the pain, skin ulcers, and livedo racemosa. We believe that this is an interesting therapeutic association because of the combined blood-vessel calcium chelating effect of IV ST and the vasodilator and antithrombotic effect of the prostaglandins, which help to dilate vessels made rigid by calcium deposits.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3,4</span></a> Calciphylaxis obliterates blood vessel lumens due to calcification of the wall, fibrosis of the intima, and the development of fibrin thrombi.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Intralesional ST has also been described in the literature as local treatment for ulcers secondary to calciphylaxis.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> Treatment with hyperbaric oxygen acts by improving healing through its beneficial effects on neovascularization and fibroblast proliferation and by reducing the risk of infection through the release of reactive oxygen species. It is now considered a safe and viable option as part of a multidisciplinary approach to the treatment of calciphylaxis.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">8,10,11</span></a> The improvement in the livedo racemosa can be explained by the prostaglandin-related vasodilatation.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Tolerance to maintenance therapy has been good for more than a year, with a low economic cost given the elevated morbidity and severity of this disease. We therefore consider that the adjuvant role of intravenous alprostadil should be evaluated in cases of severe calciphylaxis that do not respond to standard treatment with IV ST.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ossorio-García L, Jiménez-Gallo D, Arjona-Aguilera C, Linares-Barrios M. Tratamiento multimodal de la calcifilaxis con tiosulfato sódico, alprostadil y oxigenoterapia hiperbárica. Actas Dermosifiliogr. 2016;107:695–697.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 965 "Ancho" => 1500 "Tamanyo" => 299350 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Calciphylaxis-related skin ulcers on the anterior aspect of the thighs. B, Livedo racemosa and retiform purpura on the abdomen. C, Healing of the ulcers on the anterior aspect of the thighs after combined treatment with intravenous sodium thiosulfate and alprostadil. D, Disappearance of the livedo racemosa and retiform purpura on the abdomen.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calciphylaxis treated with sodium thiosulfate: Report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.P. Garcia" 1 => "E. Roson" 2 => "G. Peon" 3 => "M.T. Abalde" 4 => "C. de la Torre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "19616" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24050290" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calcific uremic arteriolopathy in end stage renal disease: Pathophysiology and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Yerram" 1 => "K. Chaudhary" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ochsner J" "fecha" => "2014" "volumen" => "14" "paginaInicial" => "380" "paginaFinal" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25249804" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calciphylaxis: A systematic review of existing and emerging therapies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Vedvyas" 1 => "L.S. Winterfield" 2 => "R.A. Vleugels" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2011.06.009" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "e253" "paginaFinal" => "e260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21821309" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of livedoid vasculopathy with alprostadil (PGE-1): Case report and review of published literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Mofarrah" 1 => "W. Aberer" 2 => "E. Aberer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2012.04480.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "e252" "paginaFinal" => "e254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22364635" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sodium thiosulfate not always resolves calciphylaxis: An ambiguous response" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Miceli" 1 => "G. Milio" 2 => "S. la Placa" 3 => "D. di Raimondo" 4 => "A. Tuttolomondo" 5 => "M. li Vecchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/0886022X.2010.536288" "Revista" => array:7 [ "tituloSerie" => "Ren Fail" "fecha" => "2011" "volumen" => "33" "paginaInicial" => "84" "paginaFinal" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21219211" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283812001765" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Review of calciphylaxis and treatment of a severe case after kidney transplantation with iloprost in combination with hyperbaric oxygen and cultured autologous fibrin-based skin substitutes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Alikadic" 1 => "D. Kovac" 2 => "M. Krasna" 3 => "J. Lindic" 4 => "M. Sabovic" 5 => "J. Tomazic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-0012.2009.01062.x" "Revista" => array:6 [ "tituloSerie" => "Clin Transplant" "fecha" => "2009" "volumen" => "23" "paginaInicial" => "968" "paginaFinal" => "974" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19712088" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anesthetic management of patients with severe peripheral ischemia due to calciphylaxis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Horishita" 1 => "K. Minami" 2 => "J. Ogata" 3 => "T. Sata" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/01.ANE.0000121960.22554.D7" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2004" "volumen" => "99" "paginaInicial" => "438" "paginaFinal" => "439" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15271720" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calcinosis cutis and calciphylaxis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Jiménez-Gallo" 1 => "L. Ossorio-García" 2 => "M. Linares-Barrios" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2015.09.001" "Revista" => array:7 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2015" "volumen" => "106" "paginaInicial" => "785" "paginaFinal" => "794" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26394755" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0959804910008786" "estado" => "S300" "issn" => "09598049" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intralesional sodium thiosulfate for the treatment of calciphylaxis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Strazzula" 1 => "S.U. Nigwekar" 2 => "D. Steele" 3 => "W. Tsiaras" 4 => "M. Sise" 5 => "S. Bis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2013.4565" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2013" "volumen" => "149" "paginaInicial" => "946" "paginaFinal" => "949" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23760631" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of oxygen therapy by means of the hyperbaric chamber in oral and maxillofacial surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.I. Iriarte-Ortabe" 1 => "J.M. Batle-Vidal" 2 => "M. Urdiain-Asensio" 3 => "J. Caubet-Biayna" 4 => "M.A. Morey-Mas" 5 => "J. Collado-López" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cir Oral y Maxilofac" "fecha" => "2006" "volumen" => "28" "paginaInicial" => "7" "paginaFinal" => "24" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyperbaric oxygen in the treatment of calciphylaxis: A case series and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. An" 1 => "B. Devaney" 2 => "K.Y. Ooi" 3 => "S. Ford" 4 => "G. Frawley" 5 => "S. Menahem" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nephrology (Carlton)" "fecha" => "2015" "volumen" => "20" "paginaInicial" => "444" "paginaFinal" => "450" "itemHostRev" => array:3 [ "pii" => "S0302283811003198" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000008/v2_201704100057/S1578219016301615/v2_201704100057/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/15782190/0000010700000008/v2_201704100057/S1578219016301615/v2_201704100057/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016301615?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 12 | 20 |
| 2024 Octubre | 79 | 49 | 128 |
| 2024 Septiembre | 114 | 33 | 147 |
| 2024 Agosto | 122 | 42 | 164 |
| 2024 Julio | 93 | 37 | 130 |
| 2024 Junio | 112 | 32 | 144 |
| 2024 Mayo | 97 | 44 | 141 |
| 2024 Abril | 86 | 38 | 124 |
| 2024 Marzo | 80 | 26 | 106 |
| 2024 Febrero | 79 | 34 | 113 |
| 2024 Enero | 59 | 29 | 88 |
| 2023 Diciembre | 65 | 16 | 81 |
| 2023 Noviembre | 116 | 31 | 147 |
| 2023 Octubre | 94 | 16 | 110 |
| 2023 Septiembre | 84 | 29 | 113 |
| 2023 Agosto | 78 | 21 | 99 |
| 2023 Julio | 93 | 37 | 130 |
| 2023 Junio | 73 | 19 | 92 |
| 2023 Mayo | 97 | 29 | 126 |
| 2023 Abril | 77 | 24 | 101 |
| 2023 Marzo | 65 | 30 | 95 |
| 2023 Febrero | 48 | 22 | 70 |
| 2023 Enero | 47 | 30 | 77 |
| 2022 Diciembre | 49 | 47 | 96 |
| 2022 Noviembre | 42 | 33 | 75 |
| 2022 Octubre | 29 | 24 | 53 |
| 2022 Septiembre | 31 | 43 | 74 |
| 2022 Agosto | 27 | 32 | 59 |
| 2022 Julio | 32 | 35 | 67 |
| 2022 Junio | 26 | 25 | 51 |
| 2022 Mayo | 40 | 28 | 68 |
| 2022 Abril | 44 | 32 | 76 |
| 2022 Marzo | 46 | 53 | 99 |
| 2022 Febrero | 68 | 31 | 99 |
| 2022 Enero | 62 | 42 | 104 |
| 2021 Diciembre | 52 | 33 | 85 |
| 2021 Noviembre | 65 | 51 | 116 |
| 2021 Octubre | 63 | 45 | 108 |
| 2021 Septiembre | 84 | 40 | 124 |
| 2021 Agosto | 95 | 33 | 128 |
| 2021 Julio | 67 | 27 | 94 |
| 2021 Junio | 41 | 29 | 70 |
| 2021 Mayo | 45 | 54 | 99 |
| 2021 Abril | 187 | 89 | 276 |
| 2021 Marzo | 78 | 25 | 103 |
| 2021 Febrero | 80 | 37 | 117 |
| 2021 Enero | 62 | 16 | 78 |
| 2020 Diciembre | 49 | 16 | 65 |
| 2020 Noviembre | 50 | 19 | 69 |
| 2020 Octubre | 41 | 28 | 69 |
| 2020 Septiembre | 50 | 22 | 72 |
| 2020 Agosto | 37 | 24 | 61 |
| 2020 Julio | 29 | 22 | 51 |
| 2020 Junio | 29 | 49 | 78 |
| 2020 Mayo | 30 | 23 | 53 |
| 2020 Abril | 18 | 18 | 36 |
| 2020 Marzo | 25 | 21 | 46 |
| 2020 Febrero | 3 | 1 | 4 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 14 | 0 | 14 |
| 2019 Mayo | 7 | 2 | 9 |
| 2019 Abril | 5 | 2 | 7 |
| 2019 Marzo | 3 | 1 | 4 |
| 2019 Febrero | 1 | 0 | 1 |
| 2019 Enero | 5 | 0 | 5 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Febrero | 19 | 4 | 23 |
| 2018 Enero | 47 | 17 | 64 |
| 2017 Diciembre | 39 | 12 | 51 |
| 2017 Noviembre | 41 | 7 | 48 |
| 2017 Octubre | 46 | 17 | 63 |
| 2017 Septiembre | 41 | 12 | 53 |
| 2017 Agosto | 40 | 14 | 54 |
| 2017 Julio | 29 | 3 | 32 |
| 2017 Junio | 58 | 12 | 70 |
| 2017 Mayo | 58 | 15 | 73 |
| 2017 Abril | 44 | 11 | 55 |
| 2017 Marzo | 39 | 21 | 60 |
| 2017 Febrero | 45 | 18 | 63 |
| 2017 Enero | 40 | 21 | 61 |
| 2016 Diciembre | 27 | 36 | 63 |
| 2016 Noviembre | 44 | 23 | 67 |
| 2016 Octubre | 190 | 35 | 225 |
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