Case and Research Letters
Coma Blisters After an Overdose of Central Nervous System Depressants
Ampollas del coma tras sobredosis de fármacos depresores del sistema nervioso central
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Vázquez-Osorio, P. Gonzalvo-Rodríguez, E. Rodríguez-Díaz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Vázquez-Osorio" "email" => array:1 [ 0 => "rogivaos@gmail.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" => "P." "apellidos" => "Gonzalvo-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Rodríguez-Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ampollas del coma tras sobredosis de fármacos depresores del sistema nervioso central" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1248 "Ancho" => 850 "Tamanyo" => 296729 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Focal epithelial necrosis in the eccrine coils with neutrophilic periglandular infiltration (hematoxylin-eosin, original magnification ×20). B, Predominantly neutrophilic perivascular and periadnexal infiltrates and foci of fibrinoid necrosis in the walls of dermal capillaries, with neutrophilic infiltration of the walls (hematoxylin-eosin, original magnification ×20).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The term <span class="elsevierStyleItalic">coma blisters</span> refers to a condition that occurs in patients who lose consciousness. It was first described in 1812 by Larrey<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> in soldiers with carbon monoxide poisoning. Since then, it has been mainly associated with overdose of drugs and nervous system depressants, such as barbiturates, tricyclic antidepressants, opiates and alcohol; neurological disorders, such as meningoencephalitis, cerebrovascular disease, and cranioencephalic trauma; and metabolic disorders, such as hyperkalemia, hypoglycemia, and diabetic ketoacidosis.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–4</span></a> Coma blisters, however, have also been described in patients without an altered state of conscience, in particular in cases of long immobilization or Wegener granulomatosis.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 24-year-old woman with a history of a personality disorder and occasional consumption of cocaine and amphetamines who was found unconscious in her home. She had taken multiple pills from her regular medication supply (topiramate, duloxetine, quetiapine, and clorazepate).</p><p id="par0015" class="elsevierStylePara elsevierViewall">On arrival at the emergency department, she had a low level of consciousness (score 6 on the Glasgow Coma Scale), pale skin, and reactive mydriatic pupils. Partial improvement (Glasgow Coma Scale 10) was observed following physical stimulation, and the patient was treated with oxygen, fluid therapy, gastric lavage, and activated charcoal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">There was no evidence of acute intracranial lesions on the computed tomography scan. The laboratory workup showed a serum creatine kinase level of 5590<span class="elsevierStyleHsp" style=""></span>U/L and normal kidney function. The urine drug screening test showed high levels of benzodiazepines.</p><p id="par0025" class="elsevierStylePara elsevierViewall">During her first 24<span class="elsevierStyleHsp" style=""></span>hours in hospital, the patient developed asymptomatic skin lesions located mainly on bony prominences. The physical examination showed tense clear fluid-filled blisters on well-delimited erythematous plaques (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A,B). The lesions had an artifactual morphology and were characteristically located on pressure points (metacarpophalangeal joints on the right hand, right hip, and left knee).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The histopathologic examination showed a subepidermal blister with foci of reepithelialization (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and focal epithelial necrosis of eccrine coils, with periglandular infiltration of neutrophils (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). Additional findings included dermal, perivascular, and periadnexal infiltrates, which were predominantly neutrophilic, together with foci of fibrinoid necrosis in the walls of the small dermal capillaries and neutrophilic infiltration of the walls (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Administration of topical antibiotics led to resolution of the lesions within 3 weeks, and there were no signs of scarring or recurrence.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The clinical presentation and histopathologic findings were consistent with a diagnosis of coma blisters.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinically, coma blisters are characterized by tense clear or hemorrhagic blisters that develop on erythematous-violaceous macules or plaques of varying size. The lesions typically appear within 24<span class="elsevierStyleHsp" style=""></span>hours of the intake of drugs and within 48 to 72<span class="elsevierStyleHsp" style=""></span>hours of the loss of consciousness. They primarily develop on pressure points, such as fingers and toes, elbows, knees, ankles, and heels. They are self-limiting and heal within days or weeks, without causing scarring or atrophy. The only treatment indicated thus is topical treatment to prevent secondary infections.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Multiple factors have been implicated in the etiology and pathogenesis of coma blisters, including local pressure or friction, generalized hypoxia and tissue ischemia, direct toxicity due to drugs excreted in sweat, immune mechanisms, and vasomotor changes in comatose states.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Although a diagnosis can be established on clinical grounds only, a histopathologic study can be of great use. The main histopathologic findings are subepidermal or intraepidermal blisters and eccrine gland necrosis, mainly affecting the secretory portion. The secretory coils and ducts of the eccrine glands show a granular eosinophilic cytoplasm, ghost nuclei, and irregular membranes. However, the absence of necrosis in these glands does not necessarily rule out a diagnosis of coma blisters. Other possible findings are neutrophil exocytosis, necrosis of dermal or subcutaneous tissue or epidermal appendages, predominantly neutrophilic perivascular infiltrates, focal fibrinoid necrosis of the walls of small capillaries and arterioles, and thrombi in the lumen of dermal vascular structures.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The vascular damage observed in drug-induced coma blisters is probably a consequence rather than a cause of the blisters. Furthermore, the absence of an epidermal infiltrate and the presence of thrombi in the dermal vessels are mainly observed in coma blisters not induced by drugs.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Direct immunofluorescence studies performed in certain cases of coma blisters have shown patched intercellular staining for immunoglobulin (Ig) G, IgA, and C3, together with IgG, IgM, and C3 deposits in dermal vessel walls and epidermal keratinocytes. These findings, however, are nonspecific and are not considered to result from an immune-mediated response.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion, coma blisters are a benign, self-limiting condition that should be suspected in patients who develop pressure blisters several hours after an altered state of consciousness. Although the diagnosis is mainly clinical, correlation of clinical and pathologic findings is necessary to rule out other blistering dermatoses.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0075" 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: Vázquez-Osorio I, Gonzalvo-Rodríguez P, Rodríguez-Díaz E. Ampollas del coma tras sobredosis de fármacos depresores del sistema nervioso central. Actas Dermosifiliogr. 2017;108:81–83.</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" => 508 "Ancho" => 1500 "Tamanyo" => 72601 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Tense clear fluid-filled blisters on well-delimited erythematous plaques on the metacarpophalangeal joints. B, Similar lesions on the left knee with an artifactual morphology.</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" => 675 "Ancho" => 900 "Tamanyo" => 162042 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Subepidermal blister without inflammatory cells and with foci of reepithelialization (hematoxylin-eosin, original magnification ×4).</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" => 1248 "Ancho" => 850 "Tamanyo" => 296729 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Focal epithelial necrosis in the eccrine coils with neutrophilic periglandular infiltration (hematoxylin-eosin, original magnification ×20). B, Predominantly neutrophilic perivascular and periadnexal infiltrates and foci of fibrinoid necrosis in the walls of dermal capillaries, with neutrophilic infiltration of the walls (hematoxylin-eosin, original magnification ×20).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "“The French campaign”, seventh part of “Memoires de chirurgie militaire et campagnes.”(last)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.D. Larrey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Hist Filoz Med." "fecha" => "1999" "volumen" => "62" "paginaInicial" => "233" "paginaFinal" => "243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11625711" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma blisters in children: Case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Bosco" 1 => "D. Schena" 2 => "C. Colato" 3 => "P. Biban" 4 => "G. Girolomoni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0883073812464684" "Revista" => array:6 [ "tituloSerie" => "J Child Neurol." "fecha" => "2013" "volumen" => "28" "paginaInicial" => "1677" "paginaFinal" => "1680" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23155203" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma blisters in a patient with diabetic ketoacidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.R. Mehregan" 1 => "M. Daoud" 2 => "R.S. J3rd Rogers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1992" "volumen" => "27" "paginaInicial" => "269" "paginaFinal" => "270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1430372" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma blisters after poisoning caused by central nervous system depressants: Case report including histopathological findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.M. Branco" 1 => "E.M. Capitani" 2 => "M.L. Cintra" 3 => "S. Hyslop" 4 => "A.C. Carvalho" 5 => "F. Bucaretchi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol." "fecha" => "2012" "volumen" => "87" "paginaInicial" => "615" "paginaFinal" => "617" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22892778" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug-induced sweat gland necrosis in a non-comatose patient: A case presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Ferreli" 1 => "V.I. Sulica" 2 => "N. Aste" 3 => "L. Atzori" 4 => "M. Pinna" 5 => "P. Biggio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol." "fecha" => "2003" "volumen" => "17" "paginaInicial" => "443" "paginaFinal" => "445" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12834457" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma bullae: Associations beyond medications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Piede" 1 => "E. Wallace" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4065/mcp.2010.0364" "Revista" => array:5 [ "tituloSerie" => "Mayo Clin Proc." "fecha" => "2011" "volumen" => "86" "paginaInicial" => "e5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21193646" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma blisters sans coma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Heinisch" 1 => "M. Loosemore" 2 => "C.A. Cusack" 3 => "H.B. Allen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cutis." "fecha" => "2012" "volumen" => "90" "paginaInicial" => "137" "paginaFinal" => "139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23094313" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma blisters" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Rocha" 1 => "T. Pereira" 2 => "F. Ventura" 3 => "F. Pardal" 4 => "C. Brito" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000249150" "Revista" => array:6 [ "tituloSerie" => "Case Rep Dermatol." "fecha" => "2009" "volumen" => "1" "paginaInicial" => "66" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20652118" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma blisters in two postoperative patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.H. Chacon" 1 => "U. Farooq" 2 => "S. Choudhary" 3 => "N. Yin" 4 => "B. Nolan" 5 => "M. Shiman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0b013e31827955e7" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol." "fecha" => "2013" "volumen" => "35" "paginaInicial" => "381" "paginaFinal" => "384" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23334516" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopathology of cutaneous changes in drug-induced coma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Sánchez-Yus" 1 => "L. Requena" 2 => "P. Simón" 3 => "M. Hospital" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol." "fecha" => "1993" "volumen" => "15" "paginaInicial" => "208" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8100121" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000001/v1_201612300037/S157821901630302X/v1_201612300037/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/15782190/0000010800000001/v1_201612300037/S157821901630302X/v1_201612300037/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901630302X?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 25 | 9 | 34 |
| 2024 Octubre | 113 | 46 | 159 |
| 2024 Septiembre | 103 | 20 | 123 |
| 2024 Agosto | 139 | 48 | 187 |
| 2024 Julio | 135 | 31 | 166 |
| 2024 Junio | 118 | 31 | 149 |
| 2024 Mayo | 107 | 32 | 139 |
| 2024 Abril | 83 | 25 | 108 |
| 2024 Marzo | 93 | 32 | 125 |
| 2024 Febrero | 81 | 33 | 114 |
| 2024 Enero | 79 | 39 | 118 |
| 2023 Diciembre | 69 | 19 | 88 |
| 2023 Noviembre | 85 | 32 | 117 |
| 2023 Octubre | 96 | 35 | 131 |
| 2023 Septiembre | 87 | 39 | 126 |
| 2023 Agosto | 58 | 20 | 78 |
| 2023 Julio | 79 | 32 | 111 |
| 2023 Junio | 62 | 21 | 83 |
| 2023 Mayo | 104 | 22 | 126 |
| 2023 Abril | 61 | 29 | 90 |
| 2023 Marzo | 57 | 26 | 83 |
| 2023 Febrero | 77 | 25 | 102 |
| 2023 Enero | 61 | 35 | 96 |
| 2022 Diciembre | 40 | 34 | 74 |
| 2022 Noviembre | 34 | 26 | 60 |
| 2022 Octubre | 23 | 33 | 56 |
| 2022 Septiembre | 25 | 40 | 65 |
| 2022 Agosto | 19 | 27 | 46 |
| 2022 Julio | 25 | 31 | 56 |
| 2022 Junio | 18 | 23 | 41 |
| 2022 Mayo | 47 | 32 | 79 |
| 2022 Abril | 69 | 37 | 106 |
| 2022 Marzo | 60 | 37 | 97 |
| 2022 Febrero | 83 | 19 | 102 |
| 2022 Enero | 102 | 32 | 134 |
| 2021 Diciembre | 66 | 33 | 99 |
| 2021 Noviembre | 67 | 35 | 102 |
| 2021 Octubre | 81 | 42 | 123 |
| 2021 Septiembre | 72 | 26 | 98 |
| 2021 Agosto | 99 | 28 | 127 |
| 2021 Julio | 84 | 30 | 114 |
| 2021 Junio | 66 | 30 | 96 |
| 2021 Mayo | 94 | 58 | 152 |
| 2021 Abril | 139 | 75 | 214 |
| 2021 Marzo | 72 | 27 | 99 |
| 2021 Febrero | 73 | 29 | 102 |
| 2021 Enero | 52 | 20 | 72 |
| 2020 Diciembre | 48 | 20 | 68 |
| 2020 Noviembre | 28 | 18 | 46 |
| 2020 Octubre | 35 | 25 | 60 |
| 2020 Septiembre | 44 | 12 | 56 |
| 2020 Agosto | 50 | 20 | 70 |
| 2020 Julio | 47 | 17 | 64 |
| 2020 Junio | 34 | 36 | 70 |
| 2020 Mayo | 30 | 8 | 38 |
| 2020 Abril | 22 | 15 | 37 |
| 2020 Marzo | 17 | 16 | 33 |
| 2020 Febrero | 6 | 0 | 6 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Mayo | 3 | 0 | 3 |
| 2019 Abril | 0 | 5 | 5 |
| 2019 Marzo | 2 | 0 | 2 |
| 2018 Diciembre | 5 | 0 | 5 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 35 | 6 | 41 |
| 2018 Enero | 58 | 9 | 67 |
| 2017 Diciembre | 94 | 33 | 127 |
| 2017 Noviembre | 59 | 6 | 65 |
| 2017 Octubre | 40 | 5 | 45 |
| 2017 Septiembre | 35 | 9 | 44 |
| 2017 Agosto | 37 | 7 | 44 |
| 2017 Julio | 29 | 6 | 35 |
| 2017 Junio | 61 | 26 | 87 |
| 2017 Mayo | 36 | 45 | 81 |
| 2017 Abril | 21 | 53 | 74 |
| 2017 Marzo | 30 | 58 | 88 |
| 2017 Febrero | 44 | 56 | 100 |
| 2017 Enero | 52 | 71 | 123 |
| 2016 Diciembre | 3 | 22 | 25 |
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