Case and Research Letters
Classic Ehlers-Danlos Syndrome: Clinical and Ultrasound Findings
Síndrome de Ehlers-Danlos clásico: hallazgos clínicos y ecográficos
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Obsérvense también 2 cicatrices de aspecto atrófico en el tercio distal de la pierna derecha y la rodilla izquierda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Herrero-Moyano, L. Noguera-Morel, A. Torrelo, A. Hernández-Martín" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Herrero-Moyano" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Noguera-Morel" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Torrelo" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Hernández-Martín" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219019303543" "doi" => "10.1016/j.adengl.2019.12.004" "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/S1578219019303543?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018304435?idApp=UINPBA000044" "url" => "/00017310/0000011100000001/v3_202009190630/S0001731018304435/v3_202009190630/es/main.assets" ] ] "itemAnterior" => array:20 [ "pii" => "S1578219019303567" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.06.031" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "2251" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2020;111:81-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Marjolin Ulcer: A Report of 2 Cases of Squamous Cell Carcinoma Arising From Posttraumatic Soft-Tissue Scarring" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "81" "paginaFinal" => "83" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlcera de majorlin: 2 casos de carcinoma escamoso sobre cicatriz por trauma en tejidos blandos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1374 "Ancho" => 1505 "Tamanyo" => 422151 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Ulcerated verrucous tumor on the right forearm. B, Well-differentiated infiltrating squamous cell carcinoma (hematoxylin-eosin, original magnification ×10). C, Mitosis, nuclear pleomorphism (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V.L. Dávila Osorio, L. Méndez Gaviria, J.R. Amador Patarroyo, M.I. González" "autores" => array:4 [ 0 => array:2 [ "nombre" => "V.L." "apellidos" => "Dávila Osorio" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Méndez Gaviria" ] 2 => array:2 [ "nombre" => "J.R." "apellidos" => "Amador Patarroyo" ] 3 => array:2 [ "nombre" => "M.I." "apellidos" => "González" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731019303011" "doi" => "10.1016/j.ad.2018.06.025" "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/S0001731019303011?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019303567?idApp=UINPBA000044" "url" => "/15782190/0000011100000001/v2_202004200619/S1578219019303567/v2_202004200619/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Classic Ehlers-Danlos Syndrome: Clinical and Ultrasound Findings" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "83" "paginaFinal" => "85" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Herrero-Moyano, L. Noguera-Morel, A. Torrelo, A. Hernández-Martín" "autores" => array:4 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Herrero-Moyano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Noguera-Morel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Torrelo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "A." "apellidos" => "Hernández-Martín" "email" => array:1 [ 0 => "ahernandez@aedv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario del Niño Jesús, Madrid, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Ehlers-Danlos clásico: hallazgos clínicos y ecográficos" ] ] "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" => 1112 "Ancho" => 1505 "Tamanyo" => 172216 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Characteristic clinical signs of classic Ehlers-Danlos syndrome. A, Joint hypermobility with hyperextension of the fingers. B, Atrophic scars with a cigarette-paper-like appearance. C, Skin hyperlaxity. D, Hyperextension of the tongue (Gorlin sign).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ehlers-Danlos syndrome (EDS) is a heterogeneous group of congenital connective tissue diseases caused by mutations in genes involved in the synthesis or processing of collagen fibers.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The phenotypic manifestations of EDS vary greatly, and mild cases can go unnoticed until late in life. We present the case of a girl who was diagnosed with classic EDS in our hospital based on clinical and ultrasound findings.</p><p id="par0010" class="elsevierStylePara elsevierViewall">An 8-year-old girl was referred from the emergency department for evaluation of a painful lesion on the left leg that had appeared several weeks earlier after a fall from a ladder. Physical examination revealed a subcutaneous bulge of about 4<span class="elsevierStyleHsp" style=""></span>cm in diameter in the left pretibial region with yellowish-purpuric overlying skin and a strikingly gummy consistency. The patient had reticulated erythematous-violaceous lesions on the right leg and dehiscent and atrophic scars on the right leg and left knee (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). High-frequency ultrasound (18 MHz) of the left pretibial lesion revealed an anechogenic collection delimited by a thin pseudocapsule, compatible with an organized hematoma (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Septal edema compatible with traumatic panniculitis was evident in the surrounding hyperechogenic subcutaneous tissue. Doppler signal was absent. In the directed anamnesis the patient's mother reported that the girl had been born preterm due to premature rupture of membranes and had muscular hypotonia during the neonatal period. The patient was undergoing tests in the endocrinology department of another hospital for short stature and disproportion between the trunk and limbs. The family history provided by the mother included joint hyperlaxity, abnormal scarring, and early osteoarthritis. The patient also presented with skin hyperextensibility, joint hypermobility, and Gorlin sign (ability to reach the nose with the tip of the tongue) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Based on these data a suspected diagnosis of classic EDS was established. A cardiological examination, including electrocardiogram and echocardiography, revealed no findings of interest, and the results of a laboratory workup, including a complete blood count and coagulation tests, were normal apart from slightly elevated D-dimer levels. A second ultrasound examination performed 1 month later revealed a reduction in the hematoma of approximately 50% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Classic EDS is inherited in an autosomal dominant manner and is caused by mutations in <span class="elsevierStyleItalic">COL5A1</span> or <span class="elsevierStyleItalic">COL5A2</span>, which encode the alpha-1 and alpha-2 chains, respectively, of collagen type V.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The disease is characterized by skin hyperextensibility, joint hypermobility and associated complications (luxations, pain, early osteoarthritis), and other clinical characteristics that are reviewed in a recent international consensus paper.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Dermatologic manifestations of classic EDS include skin hyperextensibility and abnormal scarring, which results the formation of atrophic scars with a cigarette-paper-like appearance. Patients have thin, velvety skin that bruises in response to minimal trauma. Other potential lesions include nodular molluscoid pseudotumors secondary to calcification and fibrosis of hematomas; spheroids (hard spherical nodules on the forearms and pretibial areas); and piezogenic pedal papules.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> Our patient fulfilled the diagnostic criteria (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). No genetic study was performed as this was not essential for confirmation of the diagnosis. Classic EDS is usually diagnosed when affected individuals begin to stand and walk, as this period coincides with the appearance of lacerations and bruising that tend to alarm parents. The main clinical differential diagnosis in childhood is bruising caused by child abuse, potentially distinguishing features of which include lesions located in areas not exposed to accidental trauma (e.g., backs of the legs or abdomen), peculiar morphology (e.g., imprints caused by fingers, the dental arch, belts, etc.), and the time course of lesion appearance.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a> In rarer cases extensive bruising may constitute the initial manifestation of coagulopathies that can be detected by laboratory analyses.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">High-resolution ultrasound is a useful tool for diagnostic confirmation of bruising and differentiation from other causes of subcutaneous lesions on the legs, including erythema nodosum, abscesses, and benign (lipoma) or malignant (rhabdomyosarcoma, fibrosarcoma) soft-tissue tumors.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> Hematomas present as anechoic collections that may become hypoechoic or heterogeneous over days or weeks, without peripheral hypervascularization. These lesions can be compressed with the ultrasound probe only in early stages, after which the fluid within is replaced with fibrous tissue. Another feature, which is less well characterized in the literature, is the presence of a thin pseudocapsule that corresponds to the fibrin and peripheral granulation tissue produced as the hematoma organizes. In contrast to hematomas, the aforementioned subcutaneous lesions tend to have more irregular borders and usually differ in terms of the degree of vascularization. Ultrasound also allows measurement of the depth of the hematoma and confirmation of its regression, allowing distinction from hemorrhagic soft-tissue tumors.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, classic EDS should be suspected in children with joint and skin hyperlaxity and easy bruising. High-resolution ultrasound is very useful for the diagnosis and follow-up of hematomas associated with EDS.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" 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: Herrero-Moyano M, Noguera-Morel L, Torrelo A, Hernández-Martín A. Síndrome de Ehlers-Danlos clásico: hallazgos clínicos y ecográficos. Actas Dermosifiliogr. 2020;111:83–85.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 679 "Ancho" => 905 "Tamanyo" => 67017 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Extensive purpuric lesion on the anterior aspect of the middle and distal third of the left leg, and reticulated erythematous-violaceous lesions on the contralateral leg. Note the presence of 2 atrophic scars on the distal third of the right leg and on the left knee.</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" => 617 "Ancho" => 1255 "Tamanyo" => 87581 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ultrasound images of the left pretibial lesion (B-mode, 13-MHz probe). A, At the level of the ecchymotic area is an anechoic subcutaneous mass delimited by a thin pseudocapsule. B, Follow-up ultrasound 1 month later reveals a marked reduction in lesion thickness.</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" => 1112 "Ancho" => 1505 "Tamanyo" => 172216 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Characteristic clinical signs of classic Ehlers-Danlos syndrome. A, Joint hypermobility with hyperextension of the fingers. B, Atrophic scars with a cigarette-paper-like appearance. C, Skin hyperlaxity. D, Hyperextension of the tongue (Gorlin sign).</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">For diagnosis it is necessary to fulfil major criterion 1<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>major criterion 2, or major criterion 1<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3 of the minor criteria. Source: Malfait et al., 2017.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">7</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Major Criteria \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Minor Criteria \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Marked skin hyperextensibility and atrophic scarring2. Generalized joint hypermobility \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Easy bruising2. Soft, velvety skin3. Skin fragility4. Molluscoid pseudotumors5. Subcutaneous spheroids6. Hernia (or history thereof)7. Epicanthic folds8. Complications associated with joint hypermobility (e.g., sprains, subluxation/dislocation, pain, flat feet)9. First-degree relative who fulfils the clinical criteria \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2275679.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Diagnostic Criteria for Classic Ehlers-Danlos Syndrome</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ehlers-Danlos syndrome, classical type" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Bowen" 1 => "G.J. Sobey" 2 => "N.P. Burrows" 3 => "M. Colombi" 4 => "M.E. Lavallee" 5 => "F. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 53 | 5 | 58 |
| 2024 Octubre | 885 | 86 | 971 |
| 2024 Septiembre | 724 | 58 | 782 |
| 2024 Agosto | 876 | 87 | 963 |
| 2024 Julio | 516 | 69 | 585 |
| 2024 Junio | 448 | 77 | 525 |
| 2024 Mayo | 229 | 103 | 332 |
| 2024 Abril | 215 | 41 | 256 |
| 2024 Marzo | 478 | 33 | 511 |
| 2024 Febrero | 645 | 38 | 683 |
| 2024 Enero | 580 | 33 | 613 |
| 2023 Diciembre | 748 | 33 | 781 |
| 2023 Noviembre | 1175 | 41 | 1216 |
| 2023 Octubre | 1259 | 68 | 1327 |
| 2023 Septiembre | 1083 | 55 | 1138 |
| 2023 Agosto | 1031 | 51 | 1082 |
| 2023 Julio | 1111 | 83 | 1194 |
| 2023 Junio | 1056 | 37 | 1093 |
| 2023 Mayo | 1036 | 72 | 1108 |
| 2023 Abril | 642 | 39 | 681 |
| 2023 Marzo | 1138 | 49 | 1187 |
| 2023 Febrero | 917 | 45 | 962 |
| 2023 Enero | 868 | 33 | 901 |
| 2022 Diciembre | 628 | 55 | 683 |
| 2022 Noviembre | 432 | 33 | 465 |
| 2022 Octubre | 454 | 34 | 488 |
| 2022 Septiembre | 512 | 52 | 564 |
| 2022 Agosto | 496 | 62 | 558 |
| 2022 Julio | 317 | 52 | 369 |
| 2022 Junio | 254 | 38 | 292 |
| 2022 Mayo | 798 | 47 | 845 |
| 2022 Abril | 910 | 41 | 951 |
| 2022 Marzo | 1111 | 76 | 1187 |
| 2022 Febrero | 1018 | 41 | 1059 |
| 2022 Enero | 844 | 57 | 901 |
| 2021 Diciembre | 729 | 53 | 782 |
| 2021 Noviembre | 596 | 59 | 655 |
| 2021 Octubre | 666 | 50 | 716 |
| 2021 Septiembre | 488 | 41 | 529 |
| 2021 Agosto | 584 | 68 | 652 |
| 2021 Julio | 627 | 37 | 664 |
| 2021 Junio | 613 | 51 | 664 |
| 2021 Mayo | 764 | 45 | 809 |
| 2021 Abril | 1500 | 144 | 1644 |
| 2021 Marzo | 751 | 64 | 815 |
| 2021 Febrero | 663 | 52 | 715 |
| 2021 Enero | 669 | 35 | 704 |
| 2020 Diciembre | 651 | 42 | 693 |
| 2020 Noviembre | 522 | 28 | 550 |
| 2020 Octubre | 325 | 23 | 348 |
| 2020 Septiembre | 408 | 28 | 436 |
| 2020 Agosto | 172 | 20 | 192 |
| 2020 Julio | 35 | 13 | 48 |
| 2020 Junio | 38 | 12 | 50 |
| 2020 Mayo | 37 | 17 | 54 |
| 2020 Abril | 43 | 16 | 59 |
| 2020 Marzo | 20 | 8 | 28 |
| 2020 Febrero | 4 | 2 | 6 |
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