Letter to the Editor
Tuberculosis in infants less than 3 months of age of Risaralda, Colombia
Tuberculosis en lactantes menores de 3 meses de Risaralda, Colombia
Angela Zapata-Marína, Diva Gamboa-Santacruza, Carmen Luisa Betancur-Pulgarina,b, Alfonso J. Rodriguez-Moralesa,c,
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a Epidemiología, Fundación Universitaria del Área Andina, Seccional Pereira, Pereira, Risaralda, Colombia
b Grupo de Investigación ZIPA, Zona de Investigaciones Posgrados Andina, Facultad de Ciencias de la Salud, Fundación Universitaria del Área Andina, Seccional Pereira, Pereira, Risaralda, Colombia
c Grupo y Semillero de Investigación Salud Pública e Infección, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
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Rodriguez-Morales" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Angela" "apellidos" => "Zapata-Marín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Diva" "apellidos" => "Gamboa-Santacruz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Carmen Luisa" "apellidos" => "Betancur-Pulgarin" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "Alfonso J." 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We agree with the interesting and important aspects of the study, and we would like to take advantage of the opportunity to present what is occurring in a department (greater territorial unit) of Colombia, specifically Risaralda, with respect to TB in infants under 3 months of age.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Risaralda is a department in western Colombia with 946,626 inhabitants as of 2014, 1.62% (15,290) of whom are under one year of age. TB is a significant public health problem in this department, with an overall incidence of approximately 25 cases per 100,000 inhabitants (2010).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> When the registry of cases of TB in infants under 3 months of age diagnosed with TB in the department of Risaralda between 1 January 2008 and 31 December 2013 was reviewed, it was found that 209 cases of TB had been diagnosed in children under 14 years of age. Among them, 7 were infants under 3 months of age. These accounted for 3.34% of paediatric cases of TB (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The mean age at the time of diagnosis was 58 days (interquartile range: 29–58 days); 4 were male and one was just one day old (potentially congenital TB). Two were indigenous children, and 4 were from Pueblo Rico, the city with the highest indigenous population in the department. Just one patient was asymptomatic. The time from the onset of symptoms to diagnosis in these cases ranged from 0 to 28 days. Two patients had meningeal TB, and the rest had pulmonary TB (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0020" class="elsevierStylePara elsevierViewall">In Colombia, in this population, the tuberculin test has little diagnostic value, as the BCG vaccine is administered at birth. In this series, only 2 of the patients did not have a BCG scar. In 3 cases, culture (gastric aspirate) was performed and found to be positive. In 3 of them, radiographic findings consistent with TB (lymphadenopathy and infiltrates) were found (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). All of them received standard treatment, according to the Colombian national TB management programme<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>—isoniazid, rifampicin and pyrazinamide (6 months overall, with an initial intensive phase with these 3 drugs daily and then a second biweekly phase with H [isoniazid] and R [rifampicin])—with good tolerance.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> All patients progressed favourably and none died.</p><p id="par0025" class="elsevierStylePara elsevierViewall">As Rosal Rabes et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> affirmed, TB is uncommon in infants under 3 months of age, but potentially very serious, and in many cases, not considered or suspected in newborns. We would like to thank the authors for publishing the study which inspired us to review the subject in question and to think about future more in-depth and prospective studies in this regard, since despite its seriousness, there are few series on TB in newborns and young infants in the literature and in Colombia, and previously no such series in Risaralda.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they did not receive any funding to complete this study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-05-03" "fechaAceptado" => "2015-05-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Zapata-Marín A, Gamboa-Santacruz D, Betancur-Pulgarin CL, Rodriguez-Morales AJ. Tuberculosis en lactantes menores de 3 meses de Risaralda, Colombia. Enferm Infecc Microbiol Clin. 2017;35:327–328.</p>" ] ] "multimedia" => array:1 [ 0 => 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 [ "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" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age (days) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ethnicity \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time to seek care (days)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TB type \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BCG scar \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Symptoms<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Culture \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Radiographic diagnosis<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Index case \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Indigenous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Meningeal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unknown \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unknown \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Family/home \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Meningeal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unknown \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mother \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Community \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Indigenous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Family/home \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414638.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Time elapsed between the date on which symptoms started and the date on which care was sought.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Symptoms suggestive of TB (fever, cough and respiratory difficulty).</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Changes suggestive of TB, chest X-ray.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the infants under 3 months of age with tuberculosis in Risaralda, Colombia, from 2008 to 2013.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tuberculosis en lactantes menores de 3 meses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Rosal Rabes" 1 => "F. Baquero-Artigao" 2 => "A.M. Méndez-Echevarría" 3 => "M.J. Mellado Peña" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2015.03.011" "Revista" => array:2 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2015" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Castañeda-Hernández DM, Rodriguez-Morales AJ. Epidemiological burden of tuberculosis in developing countries. In: Rodriguez-Morales AJ (editor). Current topics in public health, Chapter 15. Croatia; InTech; 2013. p. 317–340." ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Ministerio de Salud de Colombia. Guía de atención de la tuberculosis pulmonar y extrapulmonar" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2010" "editorial" => "Ministerio de Salud" "editorialLocalizacion" => "Bogotá" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tuberculosis congénita asociada con tuberculosis materna miliar diseminada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.M. Sosa" 1 => "L.L. Cala" 2 => "J.C. Mantilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Biomedica" "fecha" => "2007" "volumen" => "27" "paginaInicial" => "475" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18320114" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of children exposed to adult pulmonary tuberculosis in Cali, Colombia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.L. Villegas" 1 => "B.E. Ferro" 2 => "C.M. Rojas" 3 => "C.M. Perez-Velez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1179/2046905514Y.0000000128" "Revista" => array:6 [ "tituloSerie" => "Paediatr Int Child Health" "fecha" => "2014" "volumen" => "34" "paginaInicial" => "170" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24939365" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17301375/v1_201705111055/en/main.assets" "Apartado" => array:4 [ "identificador" => "66012" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000005/v1_201705111055/S2529993X17301375/v1_201705111055/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301375?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 31 | 6 | 37 |
| 2024 September | 28 | 4 | 32 |
| 2024 August | 19 | 4 | 23 |
| 2024 July | 27 | 4 | 31 |
| 2024 June | 32 | 4 | 36 |
| 2024 May | 14 | 1 | 15 |
| 2024 April | 33 | 1 | 34 |
| 2024 March | 41 | 12 | 53 |
| 2024 February | 24 | 1 | 25 |
| 2024 January | 30 | 3 | 33 |
| 2023 December | 28 | 8 | 36 |
| 2023 November | 13 | 12 | 25 |
| 2023 October | 15 | 2 | 17 |
| 2023 September | 9 | 1 | 10 |
| 2023 August | 10 | 4 | 14 |
| 2023 July | 8 | 6 | 14 |
| 2023 June | 8 | 3 | 11 |
| 2023 May | 28 | 1 | 29 |
| 2023 April | 46 | 3 | 49 |
| 2023 March | 23 | 3 | 26 |
| 2023 February | 25 | 5 | 30 |
| 2023 January | 75 | 2 | 77 |
| 2022 December | 36 | 3 | 39 |
| 2022 November | 37 | 21 | 58 |
| 2022 October | 27 | 8 | 35 |
| 2022 September | 19 | 4 | 23 |
| 2022 August | 19 | 9 | 28 |
| 2022 July | 9 | 5 | 14 |
| 2022 June | 10 | 8 | 18 |
| 2022 May | 34 | 10 | 44 |
| 2022 April | 23 | 12 | 35 |
| 2022 March | 17 | 10 | 27 |
| 2022 February | 48 | 5 | 53 |
| 2022 January | 24 | 6 | 30 |
| 2021 December | 31 | 11 | 42 |
| 2021 November | 37 | 6 | 43 |
| 2021 October | 32 | 15 | 47 |
| 2021 September | 28 | 11 | 39 |
| 2021 August | 23 | 9 | 32 |
| 2021 July | 11 | 5 | 16 |
| 2021 June | 17 | 6 | 23 |
| 2021 May | 19 | 8 | 27 |
| 2021 April | 33 | 17 | 50 |
| 2021 March | 9 | 22 | 31 |
| 2021 February | 19 | 23 | 42 |
| 2021 January | 15 | 9 | 24 |
| 2020 December | 10 | 11 | 21 |
| 2020 November | 12 | 8 | 20 |
| 2020 October | 7 | 6 | 13 |
| 2020 September | 8 | 13 | 21 |
| 2020 August | 7 | 5 | 12 |
| 2020 July | 7 | 6 | 13 |
| 2020 June | 7 | 10 | 17 |
| 2020 May | 17 | 6 | 23 |
| 2020 April | 4 | 3 | 7 |
| 2020 March | 15 | 2 | 17 |
| 2020 February | 10 | 3 | 13 |
| 2020 January | 15 | 5 | 20 |
| 2019 December | 13 | 5 | 18 |
| 2019 November | 12 | 4 | 16 |
| 2019 October | 10 | 6 | 16 |
| 2019 September | 10 | 2 | 12 |
| 2019 August | 11 | 11 | 22 |
| 2019 July | 7 | 9 | 16 |
| 2019 June | 21 | 27 | 48 |
| 2019 May | 76 | 29 | 105 |
| 2019 April | 26 | 14 | 40 |
| 2019 March | 7 | 4 | 11 |
| 2019 February | 4 | 9 | 13 |
| 2019 January | 6 | 2 | 8 |
| 2018 December | 4 | 4 | 8 |
| 2018 November | 4 | 5 | 9 |
| 2018 October | 5 | 9 | 14 |
| 2018 September | 3 | 1 | 4 |
| 2018 August | 11 | 1 | 12 |
| 2018 July | 9 | 0 | 9 |
| 2018 June | 4 | 4 | 8 |
| 2018 May | 2 | 6 | 8 |
| 2018 April | 5 | 1 | 6 |
| 2018 March | 48 | 1 | 49 |
| 2018 February | 6 | 2 | 8 |
| 2018 January | 7 | 0 | 7 |
| 2017 December | 10 | 1 | 11 |
| 2017 November | 8 | 1 | 9 |
| 2017 October | 5 | 5 | 10 |
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