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array:19 [ "pii" => "X1665579614283656" "issn" => "16655796" "estado" => "S300" "fechaPublicacion" => "2014-01-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Medicina Universitaria. 2014;16:12-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1690 "formatos" => array:3 [ "EPUB" => 32 "HTML" => 1233 "PDF" => 425 ] ] "itemSiguiente" => array:15 [ "pii" => "X1665579614283664" "issn" => "16655796" "estado" => "S300" "fechaPublicacion" => "2014-01-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Medicina Universitaria. 2014;16:15-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1839 "formatos" => array:3 [ "EPUB" => 42 "HTML" => 1412 "PDF" => 385 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Infiltration vs. instillation of ropivacaine 7.5% in radical mastectomies for postoperative analgesia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "15" "paginaFinal" => "18" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "304v16n62-90328366fig3.jpg" "Alto" => 900 "Ancho" => 945 "Tamanyo" => 74225 ] ] "descripcion" => array:1 [ "en" => "Visual analog scale." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. I. Yolanda-Prieto, A. L. Millán-Corrales, D. Palacios-Ríos, B. I. Garduño-Chávez, N. G. López-Cabrera, G. A. Millán-Cornejo, B. T. González-Rocha" "autores" => array:7 [ 0 => array:2 [ "Iniciales" => "B. I." "apellidos" => "Yolanda-Prieto" ] 1 => array:2 [ "Iniciales" => "A. L." "apellidos" => "Millán-Corrales" ] 2 => array:2 [ "Iniciales" => "D." "apellidos" => "Palacios-Ríos" ] 3 => array:2 [ "Iniciales" => "B. I." "apellidos" => "Garduño-Chávez" ] 4 => array:2 [ "Iniciales" => "N. G." "apellidos" => "López-Cabrera" ] 5 => array:2 [ "Iniciales" => "G. A." "apellidos" => "Millán-Cornejo" ] 6 => array:2 [ "Iniciales" => "B. T." "apellidos" => "González-Rocha" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X1665579614283664?idApp=UINPBA00004N" "url" => "/16655796/0000001600000062/v0_201607061506/X1665579614283664/v0_201607061507/en/main.assets" ] "itemAnterior" => array:15 [ "pii" => "X1665579614283648" "issn" => "16655796" "estado" => "S300" "fechaPublicacion" => "2014-01-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Medicina Universitaria. 2014;16:9-11" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1110 "formatos" => array:3 [ "EPUB" => 40 "HTML" => 763 "PDF" => 307 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Frequency of metabolic syndrome in women treated at the Menopause Clinic of the "Dr. José Eleuterio González" University Hospital of the UANL in Northeastern Mexico" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "9" "paginaFinal" => "11" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Cervantes-Flores, J. Vázquez-Méndez, D. Saldívar-Rodríguez, O. Vidal-Gutiérrez, I. Y. González-Carrillo, G. Guerrero-González" "autores" => array:6 [ 0 => array:2 [ "Iniciales" => "M." "apellidos" => "Cervantes-Flores" ] 1 => array:2 [ "Iniciales" => "J." "apellidos" => "Vázquez-Méndez" ] 2 => array:2 [ "Iniciales" => "D." "apellidos" => "Saldívar-Rodríguez" ] 3 => array:2 [ "Iniciales" => "O." "apellidos" => "Vidal-Gutiérrez" ] 4 => array:2 [ "Iniciales" => "I. Y." "apellidos" => "González-Carrillo" ] 5 => array:2 [ "Iniciales" => "G." "apellidos" => "Guerrero-González" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X1665579614283648?idApp=UINPBA00004N" "url" => "/16655796/0000001600000062/v0_201607061506/X1665579614283648/v0_201607061507/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "Correlation between BMI and climateric symptoms in menopausal women" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "12" "paginaFinal" => "14" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "I. Y. González-Carrillo, J. Vázquez-Méndez, G. Guerrero-González, O. Vidal-Gutiérrez, M. Cervantes-Flores" "autores" => array:5 [ 0 => array:3 [ "Iniciales" => "I. Y." "apellidos" => "González-Carrillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "J." "apellidos" => "Vázquez-Méndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "G." "apellidos" => "Guerrero-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 3 => array:3 [ "Iniciales" => "O." "apellidos" => "Vidal-Gutiérrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] 4 => array:3 [ "Iniciales" => "M." "apellidos" => "Cervantes-Flores" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "affe" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Department of Gynecology and Obstetrics, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Department of Gynecology and Obstetrics, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Department of Gynecology and Obstetrics, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Department of Gynecology and Obstetrics, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico " "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] 4 => array:3 [ "entidad" => "Department of Gynecology and Obstetrics, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico " "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "affe" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "304v16n62-90328365fig1.jpg" "Alto" => 779 "Ancho" => 895 "Tamanyo" => 94626 ] ] "descripcion" => array:1 [ "en" => "Dispersion chart between BMI and the Blatt-Kupperman index." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction </span></p><p class="elsevierStylePara"> Menopause is the natural biological process in which a woman's menstrual period stops permanently. During climaterium, the progressive disappearance of the ovarian function occurs leading to a gradual decline in estrogen secretions and several associated hormonal alterations giving rise to a series of organic and psychological changes. In healthy women, menopause occurs between the fifth and the sixth decades of life (from ages 47 to 52).<span class="elsevierStyleSup">1</span> Climateric symptoms worsen in relation to social determinants linked to race, social and cultural entitlements which fall upon their gender.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara"> The manifestations produced as a consequence of the ovarian function ceasing and the subsequent hormonal deficit, are expressed with very unique symptoms known as climateric.<span class="elsevierStyleSup">1-3</span> In order to evaluate climateric symptoms, different scales have been developed, for instance the Kupperman index,<span class="elsevierStyleSup">4</span> the Utian Quality of Life (UQOL) Scale,5 the Greene scale,<span class="elsevierStyleSup">6</span> and the SUMEVA scale.7 Some assess the impact of climateric symptoms in the quality of life, especially the influence on perimenopausal patients, this information being useful in the follow-up of patients who receive hormone replacement treatment (HRT).<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara"> Hypoestrogenism has been related to physiological changes which are, in part, responsible for the weight gain during that period.<span class="elsevierStyleSup">9</span> In Mexico, an overweight prevalence of 72% in adult women has been reported.<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara"> Obesity in connection with vasomotor symptoms is controversial. Previous studies suggest that body fat protects women from vasomotor symptoms due to the aromatization of androgens to estrogens in the adipose tissue; however, other evidence suggests that a greater body mass index (BMI), and increased body fat in particular, are associated with reports of greater climateric manifestations.<span class="elsevierStyleSup">11,12</span> In this study we assess the hypothesis that there is a correlation between BMI and the severity of climateric symptoms, studying overweight (according to BMI) connection with climaterium, through the Blatt-Kupperman index,<span class="elsevierStyleSup">4</span> with the purpose of determining whether or not obese or overweight patients suffer from more severe climateric symptoms.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Materials and methods </span></p><p class="elsevierStylePara"> An observational, retrospective, descriptive, cross-cohort study was described. We included 431 patients who attended the Menopause Clinic of the "<span class="elsevierStyleItalic">Dr. José Eleuterio González" </span>University Hospital of the <span class="elsevierStyleItalic">Universidad Autónoma de Nuevo León</span>, in Monterrey, N. L., Mexico, from November 2008 to December 2011. Patients who had received HRT during the previous 3 months and those who did not comply with the required data were excluded.</p><p class="elsevierStylePara"> We performed a full clinical history check in order to obtain personal data and background information, a physical examination including measurement of height and weight to obtain BMI and a questionnaire on climateric symptoms through the Blatt-Kupperman modified index.<span class="elsevierStyleSup">5</span> The Blatt-Kupperman index is a scale used to determine the severity of climateric symptoms; it assesses 15 symptoms, which are rated by the patients as follows: 0 = none, 1 = mild, 2 = moderate, 3 = severe.</p><p class="elsevierStylePara"> Subsequently, a score was obtained which was categorized as mild (0-20), moderate (21-35), or severe (> 35).<span class="elsevierStyleSup">13</span> The variables included were: age, marital status, occupation, BMI, number of years of menopause, and modified Blatt-Kupperman index.</p><p class="elsevierStylePara"> With the data obtained we created a database in Microsoft Excel<span class="elsevierStyleSup">®</span>, for subsequent analysis using SPSS<span class="elsevierStyleSup">®</span> v. 14. All the variables were analyzed with traditional descriptive statistics such as statistical average and dispersion measures (standard deviation). Pearson's correlation test was used to assess the correlation between BMI and Blatt-Kupperman, as well as a dispersion graph. Using Pearson's correlation, a value of -1 to 1 was obtained (a value closer to 1 indicates a positive correlation while a value closer to -1 indicates a negative correlation; if the value is close to 0, it implies that there is no lineal relation). We assessed the correlation between marital status and occupation with the Blatt-Kupperman index through Pearson's R test.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results </span></p><p class="elsevierStylePara"> A total of 403 patients with an average age of 50.01 (± 7.70) years, with an average of 5.69 (± 5.97) years of menopause were included in the study. The average BMI was 28.98 (± 5.71) kg/m<span class="elsevierStyleSup">2</span>. The average value of the Blatt-Kupperman index was 25.78 ± 13.48. Regarding marital status, 334 (83%) of the patients were married, 52 (13%) were single, and 17 (4%) were widows. Three hundred forty-nine patients (87%) were housewives, 42 (10%) were employed outside their homes and 12 patients (3%) were retired.</p><p class="elsevierStylePara"> We found that the symptoms in 113 patients (28%) were rated as severe, in 140 (35%) as moderate, and in 150 (37%) as mild, according to the Blatt-Kupperman index.</p><p class="elsevierStylePara"> Concerning BMI and degree of obesity, 0.3% of the patients were thin, only 20.1% had what is considered to be a normal BMI, 41.0% were overweight, and 37.7% were obese. We evaluated the correlation between BMI and the Blatt-Kupperman index through Pearson's R test, obtaining a value of 0.053; consequently, we did not find a relationship between these 2 variables.</p><p class="elsevierStylePara"> In order to show a correlation between BMI and the Blatt-Kupperman index, a dispersion graph was created; no correlation was found since we were not able to see an increasing or decreasing tendency of the Blatt-Kupperman index regarding BMI (Fig. 1).</p><p class="elsevierStylePara"><img alt="Figure 1 Dispersion chart between BMI and the Blatt-Kupperman index." src="304v16n62-90328365fig1.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 1 </span>Dispersion chart between BMI and the Blatt-Kupperman index.</p><p class="elsevierStylePara"> We evaluated the relationship between marital status and occupation with the Blatt-Kupperman index, through Pearson's R test, with a value of -0.074 and 0.017 respectively; therefore, no relationship was found between these variables.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion </span></p><p class="elsevierStylePara"> The information regarding the association between BMI and climateric symptoms is controversial. In this study we assessed the correlation between the degree of obesity and the Blatt-Kupperman index, since some authors concur that estrogen production in adipose tissue in overweight and obese patients protects them from suffering climateric symptoms,<span class="elsevierStyleSup">9</span> in contrast with other authors who conclude that a greater BMI and weight gain are associated with reports of greater climateric manifestations, mainly hot flashes, during transition to menopause. These findings concur with a thermoregulatory model of vasomotor symptoms in which body fat acts as an insulator, preventing heat dissipation.<span class="elsevierStyleSup">14</span></p><p class="elsevierStylePara"> Riley et al. found that 30% of 468 perimenopausal and 287 postmenopausal females reported hot flashes. Perimenopausal patients with a BMI > 25 kg/m<span class="elsevierStyleSup">2</span> reported more hot flashes with a relative risk (RR) of 2.00 (RI 95% = 1.28 -3.12). We did not find an association with hot flashes in postmenopausal patients.<span class="elsevierStyleSup">15</span></p><p class="elsevierStylePara"> Martínez Pérez et al. carried out a study with 10,514 women with an average age of 57.9 (± 7.1) years, finding that smoking, use of alcohol, BMI > 25 kg/m<span class="elsevierStyleSup">2</span>, marital status, educational level, and social level were associated with more severe menopausal symptoms for BMI (RR = 3.64; RI 95% = 2.96 - 4.32).<span class="elsevierStyleSup">16 </span></p><p class="elsevierStylePara"> Thurston et al. Assessed the connection of the adiposity with vasomotor symptoms in the study of Women's Health across the nation, which included 1,776 women aged 47 to 59 years with an intact uterus and at least 1 ovary, in whom vasomotor symptoms and hormonal serum levels were evaluated. They concluded that a greater percentage of body fat was associated with vasomotor symptoms (RR = 1.27; RI 95% = 1.14 - 1.42).<span class="elsevierStyleSup">17</span></p><p class="elsevierStylePara"> In this study, no connection between BMI and Blatt-Kupperman index was found; a probable reason for this is the fact that estrogens of peripheral origin do not have the biological action that ovarian estrogen has.</p><p class="elsevierStylePara"> The reason for the inconsistent findings regarding a connection between BMI and climateric symptoms is unknown. Some studies suggest that the inconsistencies may be related to the different endogenous estrogen and other hormones levels in women with different body sizes. Hormonal changes are customary during the transition into menopause. Furthermore, for the formation of estrogens from circulating androgen precursors, the adipose tissue produces hormones such as leptin and tumor necrosis factor, which suppress ovarian production of steroids and have an influence on thermoregulation.<span class="elsevierStyleSup">18 </span></p><p class="elsevierStylePara"> Pérez-Pérez found that women who work in public spaces adapt more easily to hormonal changes in climaterium and menopause, in contrast to those who are housewives who feel misunderstood, rejected, and have a low self-esteem.<span class="elsevierStyleSup">19</span></p><p class="elsevierStylePara"> However, no connection was established between the Blatt-Kupperman index and occupation or marital status in our study. Further studies assessing all risk factors, like health problems, use of alcohol, smoking, role at work, family dynamics, presence of depression, as well as their connection with weight gain or loss in the female in transition to menopause are required.</p><p class="elsevierStylePara"> While the results of this study report that the degree of obesity does not have an impact on climateric symptoms severity, most patients showed some degree of overweight or obesity; hence obese patients should undergo more complete tests, including sociological, physical, and personal history, in order to identify those with a higher risk of presenting symptoms and to develop appropriate preventative strategies, including lifestyle modifications and the establishment of better treatment.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest </span></p><p class="elsevierStylePara"> The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Funding </span></p><p class="elsevierStylePara"> No financial support was provided.</p><hr></hr><p class="elsevierStylePara"> Received: February 2013; <br></br> accepted: november 2013</p><p class="elsevierStylePara"> * Corresponding author: <br></br> Laguna de Catemaco 1359, Las Quintas, Z.P. <br></br> 80060, Culiacán, Sin., Mexico. <br></br> Telephone: (667) 715 8045. <span class="elsevierStyleItalic"><br></br> E-mail address</span>: <a href="mailto:isabelyunuen@hotmail.com" class="elsevierStyleCrossRefs">isabelyunuen@hotmail.com</a> (I. Y. González-Carrillo).</p>" "pdfFichero" => "304v16n62a90328365pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec686974" "palabras" => array:1 [ 0 => "Climateric symptoms; Body mass index; Blatt-Kupperman index; Obesity; Mexico" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"> <span class="elsevierStyleItalic">Objectives</span>: To determine the association between climateric symptoms and body mass index (BMI). In addition, to define the age of onset of climateric symptoms and to associate a patient's occupation and marital status with climateric symptom severity.</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Materials and methods</span>: Observational, retrospective and cross-cohort study including 403 patients attending the Menopause Clinic of the University Hospital of the <span class="elsevierStyleItalic">Universidad Autónoma de Nuevo León</span> from November 2008 to December 2011. Clinical history, physical examination, weight and height, and BMI were evaluated. Climateric symptoms were assessed through the Blatt-Kupperman modified index. Marital status and occupation were also analyzed.</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Results</span>: No relation was found between BMI and climateric severity, nor was there any relation between climateric symptoms and marital status or occupation.</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Conclusions</span>: Additional research is needed to assess the influence of climateric risk factors.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "304v16n62-90328365fig1.jpg" "Alto" => 779 "Ancho" => 895 "Tamanyo" => 94626 ] ] "descripcion" => array:1 [ "en" => "Dispersion chart between BMI and the Blatt-Kupperman index." ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Dispersion chart between BMI and the Blatt-Kupperman index." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "http://www.consultorsalud.com/biblioteca/Guias/Menopausia.pdf. 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Original language: English
Year/Month | Html | Total | |
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2024 November | 12 | 3 | 15 |
2024 October | 40 | 4 | 44 |
2024 September | 51 | 13 | 64 |
2024 August | 52 | 17 | 69 |
2024 July | 57 | 10 | 67 |
2024 June | 50 | 11 | 61 |
2024 May | 26 | 2 | 28 |
2024 April | 45 | 3 | 48 |
2024 March | 63 | 16 | 79 |
2024 February | 65 | 6 | 71 |
2024 January | 90 | 5 | 95 |
2023 December | 62 | 13 | 75 |
2023 November | 76 | 14 | 90 |
2023 October | 106 | 11 | 117 |
2023 September | 57 | 8 | 65 |
2023 August | 62 | 18 | 80 |
2023 July | 54 | 6 | 60 |
2023 June | 55 | 10 | 65 |
2023 May | 75 | 8 | 83 |
2023 April | 49 | 7 | 56 |
2023 March | 67 | 3 | 70 |
2023 February | 42 | 6 | 48 |
2023 January | 35 | 9 | 44 |
2022 December | 42 | 8 | 50 |
2022 November | 40 | 15 | 55 |
2022 October | 52 | 10 | 62 |
2022 September | 47 | 14 | 61 |
2022 August | 48 | 27 | 75 |
2022 July | 32 | 16 | 48 |
2022 June | 37 | 12 | 49 |
2022 May | 31 | 10 | 41 |
2022 April | 52 | 18 | 70 |
2022 March | 66 | 13 | 79 |
2022 February | 70 | 4 | 74 |
2022 January | 99 | 18 | 117 |
2021 December | 51 | 12 | 63 |
2021 November | 52 | 15 | 67 |
2021 October | 70 | 14 | 84 |
2021 September | 65 | 17 | 82 |
2021 August | 69 | 18 | 87 |
2021 July | 41 | 10 | 51 |
2021 June | 37 | 21 | 58 |
2021 May | 55 | 14 | 69 |
2021 April | 296 | 18 | 314 |
2021 March | 115 | 23 | 138 |
2021 February | 53 | 26 | 79 |
2021 January | 58 | 16 | 74 |
2020 December | 60 | 16 | 76 |
2020 November | 53 | 6 | 59 |
2020 October | 50 | 11 | 61 |
2020 September | 46 | 6 | 52 |
2020 August | 52 | 9 | 61 |
2020 July | 45 | 14 | 59 |
2020 June | 39 | 14 | 53 |
2020 May | 68 | 13 | 81 |
2020 April | 40 | 5 | 45 |
2020 March | 59 | 4 | 63 |
2020 February | 62 | 5 | 67 |
2020 January | 44 | 7 | 51 |
2019 December | 40 | 16 | 56 |
2019 November | 38 | 7 | 45 |
2019 October | 43 | 4 | 47 |
2019 September | 24 | 5 | 29 |
2019 August | 18 | 10 | 28 |
2019 July | 21 | 5 | 26 |
2019 June | 33 | 26 | 59 |
2019 May | 54 | 53 | 107 |
2019 April | 45 | 14 | 59 |
2019 March | 10 | 0 | 10 |
2019 February | 10 | 5 | 15 |
2019 January | 8 | 5 | 13 |
2018 December | 8 | 6 | 14 |
2018 November | 7 | 1 | 8 |
2018 October | 16 | 11 | 27 |
2018 September | 14 | 6 | 20 |
2018 August | 6 | 1 | 7 |
2018 July | 3 | 0 | 3 |
2018 June | 5 | 1 | 6 |
2018 May | 7 | 0 | 7 |
2018 April | 8 | 2 | 10 |
2018 March | 2 | 0 | 2 |
2018 February | 1 | 2 | 3 |
2018 January | 7 | 0 | 7 |
2017 December | 5 | 0 | 5 |
2017 November | 10 | 2 | 12 |
2017 October | 3 | 0 | 3 |
2017 September | 9 | 0 | 9 |
2017 August | 4 | 1 | 5 |
2017 July | 3 | 0 | 3 |
2017 June | 11 | 9 | 20 |
2017 May | 14 | 4 | 18 |
2017 April | 31 | 1 | 32 |
2017 March | 27 | 31 | 58 |
2017 February | 11 | 2 | 13 |
2017 January | 9 | 0 | 9 |
2016 December | 17 | 2 | 19 |
2016 November | 8 | 1 | 9 |
2016 October | 8 | 4 | 12 |
2016 September | 5 | 1 | 6 |
2016 August | 10 | 1 | 11 |
2016 July | 10 | 1 | 11 |
2016 June | 20 | 13 | 33 |
2016 May | 11 | 7 | 18 |
2016 April | 17 | 9 | 26 |
2016 March | 15 | 8 | 23 |
2016 February | 17 | 7 | 24 |
2016 January | 15 | 7 | 22 |
2015 December | 10 | 5 | 15 |
2015 November | 15 | 6 | 21 |
2015 October | 22 | 11 | 33 |
2015 September | 26 | 7 | 33 |
2015 August | 36 | 9 | 45 |
2015 July | 34 | 6 | 40 |
2015 June | 17 | 5 | 22 |
2015 May | 27 | 2 | 29 |
2015 April | 27 | 6 | 33 |
2015 March | 22 | 4 | 26 |
2015 February | 14 | 1 | 15 |
2015 January | 14 | 0 | 14 |
2014 December | 31 | 9 | 40 |
2014 November | 15 | 9 | 24 |
2014 October | 22 | 8 | 30 |
2014 September | 20 | 10 | 30 |
2014 August | 30 | 9 | 39 |
2014 July | 35 | 11 | 46 |
2014 June | 16 | 7 | 23 |