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Acute Pisa syndrome secondary to betahistine treatment in a patient with mild cognitive impairment
Síndrome de Pisa agudo tras tratamiento con betahistina en un paciente con deterioro cognitivo leve
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López-Blanco, M.P. Guerrero-Molina, J. González-de la Aleja, J. Ruiz-Morales" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "López-Blanco" "email" => array:1 [ 0 => "robretolb@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" => "M.P." "apellidos" => "Guerrero-Molina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "González-de la Aleja" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Ruiz-Morales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Electroencefalografía, Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain" "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 Pisa agudo tras tratamiento con betahistina en un paciente con deterioro cognitivo leve" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Betahistine is an oral histamine analogue which, due to its vasodilatory properties, is used habitually to treat episodic vertigo and other inner ear disorders.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> Adverse effects include headache, confusion, nausea, dyspepsia, and hypotension. The literature describes only one case of acute dystonia<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> and one of delayed-onset dystonia<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> associated with the drug; no paper published to date describes Pisa syndrome (PS).</p><p id="par0010" class="elsevierStylePara elsevierViewall">PS is characterised by an abnormal, dystonic posture of the trunk, causing a lateral inclination with some degree of axial rotation. The condition was originally described in 1972 by Ekbom et al.,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> in patients receiving antipsychotic drugs. Since then, researchers have pointed to other drugs, including antiemetics, antidepressants, benzodiazepines, cholinesterase inhibitors, and almost all dopaminergic drugs, as potential causes of PS.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">5,6</span></a> The condition has been described in patients with various neurodegenerative diseases and with normal pressure hydrocephalus (NPH); other cases are idiopathic.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">5,7,8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 76-year-old woman, with a history of episodes of vertigo and a one-year history of mild cognitive impairment, for which she was under follow-up at another hospital. Neuroimaging findings were suggestive of NPH. The patient attended the emergency department due to acute-onset lateral deviation of the trunk following a single 16<span class="elsevierStyleHsp" style=""></span>mg dose of betahistine to treat a vertigo episode similar to those she had previously experienced. She had no further symptoms and was taking no other drugs. The general physical examination revealed no other abnormalities. In the neurological examination, we observed a leftward inclination of the trunk and normal vestibular manoeuvres. A cranial CT scan displayed mild cortical atrophy and increased ventricular volume, with no signs of trasudate. Within 24<span class="elsevierStyleHsp" style=""></span>hours of betahistine withdrawal, the patient's posture returned to normal and she remained completely asymptomatic. The patient was lost to follow-up following discharge.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Past drug exposure is a highly valuable criterion for demonstrating the cause of potential adverse drug reactions; however, we must also consider biological plausibility, consistency, and the statistical strength of the association.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> The reproduction of symptoms supports a proposed association; however, given the paramount importance of ethics in the field of medicine, this was not considered in the present case. Clinical suspicion and communication are therefore crucial in these cases, despite the evidential limitations of reporting isolated clinical cases. It is also necessary to verify causality.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This is the first published case of PS occurring subsequently to a single 16<span class="elsevierStyleHsp" style=""></span>mg dose of betahistine, in a patient with several noteworthy characteristics. Firstly, the patient was under follow-up for mild cognitive impairment at another centre; this may be related to Alzheimer disease or to NPH, given the clinical and neuroimaging findings. Both Alzheimer disease and NPH have been described as potential causes of PS; there is also a possibility of patients being affected by both conditions.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">8,10</span></a> Secondly, the acute onset and subsequent complete recovery following withdrawal of the drug is suggestive of a connection. Thirdly, the patient reported several previous episodes of vertigo with similar characteristics; these were treated with betahistine, with no trunk deviation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The pathophysiology of PS is not fully understood. It has been suggested that the acute or subacute onset of PS following ingestion of specific drugs may be similar to the case of dystonia, given the good response to anticholinergics or reducing the dosage of the drug involved. This may point to an imbalance between dopamine and choline levels.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> Drugs acting on such neurotransmitters as norepinephrine and serotonin may also have a role; however, the mechanism involved is unknown.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> Chronic forms of PS have been described in patients with such neurodegenerative conditions as Parkinson's disease. The suggested mechanisms include alteration of proprioceptive sensory feedback, peripheral vestibular hypofunction, impaired subjective visual vertical, and even musculoskeletal disorders.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In patients with Alzheimer disease, only one case of PS has been confirmed by an anatomical pathology study in a patient who had not been exposed to any drug; the underlying mechanisms are unknown.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> It has been suggested that in patients with NPH, PS symptoms may be related to compromised periventricular blood flow, decreased dopamine levels in the substantia nigra, or damage to the striatal GABAergic neurons.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> This mechanism may be involved in the present case; however, the acute onset of the condition after the dose of betahistine and the complete recovery following withdrawal would appear to suggest the involvement of multiple mechanisms. The histaminergic system could, therefore, be an additional factor, with betahistine being the trigger for PS in this patient. We should also note that in the previous episodes of vertigo, the patient took betahistine and did not experience PS.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We would therefore suggest that the onset of mild cognitive impairment may affect the action of betahistine by causing imbalances in the neurotransmission systems involved in postural control, triggering PS.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In animal models, betahistine acts as a partial histamine H<span class="elsevierStyleInf">1</span> receptor agonist, increasing vestibular blood flow and histamine turnover, and as an H<span class="elsevierStyleInf">3</span> receptor antagonist, promoting histamine release in the central nervous system.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> The rat striatum contains a high concentration of H<span class="elsevierStyleInf">3</span> receptors, and reactions have been described between H<span class="elsevierStyleInf">3</span> receptors and the D<span class="elsevierStyleInf">1</span> and D<span class="elsevierStyleInf">2</span> dopamine receptors. Some studies have described betahistine acting as a postsynaptic antagonist, with H<span class="elsevierStyleInf">3</span> agonism resulting in motor inhibition and H<span class="elsevierStyleInf">3</span> antagonism increasing motor activity through coactivation of the D<span class="elsevierStyleInf">1</span> and D<span class="elsevierStyleInf">2</span> receptors.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> In the context of these observations, the antidystonic effects of such H<span class="elsevierStyleInf">1</span> receptor antagonists as diphenhydramine suggest that histamine may be involved in dystonia. However, the literature includes very few reports of dystonia secondary to betahistine use, despite the frequent use of the drug to treat vertigo in our setting.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, we suspect that in this patient with amnesiac mild cognitive impairment, betahistamine may have caused an imbalance in the vestibular pathways, the striatal circuitry, or both, causing a deviation of the trunk and triggering PS.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The study was presented in poster format at the SEN's Annual Meeting, November 2015.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: López-Blanco R, Guerrero-Molina MP, González-de la Aleja J, Ruiz-Morales J. Síndrome de Pisa agudo tras tratamiento con betahistina en un paciente con deterioro cognitivo leve. Neurología. 2018;33:204–205.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histamine in the treatment of vertigo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.J. Fischer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Otolaryngol Suppl" "fecha" => "1991" "volumen" => "479" "paginaInicial" => "24" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2068937" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0070" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute dystonia secondary to treatment with betahistine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Mascías" 1 => "O.S. Pérez" 2 => "D. Chaverri" 3 => "J.S. Mora" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurologia" "fecha" => "2000" "volumen" => "15" "paginaInicial" => "417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11195153" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0075" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An elderly female patient with tardive oromandibular dystonia after prolonged use of the histamine analog betahistine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. De Riu" 1 => "M.P. Sanna" 2 => "P.L. de Riu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jocn.2010.01.034" "Revista" => array:6 [ "tituloSerie" => "J Clin Neurosci" "fecha" => "2010" "volumen" => "17" "paginaInicial" => "1330" "paginaFinal" => "1331" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20594853" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0080" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New dystonic syndrome associated with butyrophenone therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Ekbom" 1 => "H. Lindholm" 2 => "L. Ljungberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Z Neurol" "fecha" => "1972" "volumen" => "202" "paginaInicial" => "94" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4115928" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0085" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pisa syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.F. Michel" 1 => "A.C. Oscar" 2 => "T.E.S. Correa" 3 => "P.L. Alejandro" 4 => "F. Micheli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/WNF.0000000000000092" "Revista" => array:7 [ "tituloSerie" => "Clin Neuropharmacol" "fecha" => "2015" "volumen" => "38" "paginaInicial" => "135" "paginaFinal" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26166239" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1575092212003282" "estado" => "S300" "issn" => "15750922" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0090" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute Pisa syndrome after administration of a single dose of mirtazapine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.M. Guerrero" 1 => "S. Llamas" 2 => "F.J. Murcia" 3 => "J. Ruíz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Neuropharm" "fecha" => "2013" "volumen" => "36" "paginaInicial" => "133" "paginaFinal" => "134" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0095" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary and reversible Pisa syndrome in juvenile normal pressure hydrocephalus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.E. Leon-Sarmiento" 1 => "G. Pradilla" 2 => "M. del Rosario Zambrano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1601-5215.2012.00657.x" "Revista" => array:6 [ "tituloSerie" => "Acta Neuropsychiatr" "fecha" => "2013" "volumen" => "25" "paginaInicial" => "57" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23794788" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0100" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pisa syndrome without neuroleptic exposure in a patient with dementia of the Alzheimer type: a follow-up report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.N. Tariot" 1 => "W. Pendlebury" 2 => "R. Hamill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/089198879701000308" "Revista" => array:5 [ "tituloSerie" => "J Geriatr Psychiatry Neurol" "fecha" => "1997" "volumen" => "10" "paginaInicial" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9322137" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0105" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The environment and disease: association or causation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.B. Hill" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Proc R Soc Med" "fecha" => "1965" "volumen" => "58" "paginaInicial" => "295" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14283879" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0110" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alzheimer's disease comorbidity in normal pressure hydrocephalus: prevalence and shunt response" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Golomb" 1 => "J. Wisoff" 2 => "D.C. Miller" 3 => "I. Boksay" 4 => "A. Kluger" 5 => "H. Weiner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neurol Neurosurg Psychiatry" "fecha" => "2000" "volumen" => "68" "paginaInicial" => "778" "paginaFinal" => "781" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10811706" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0115" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actions of betahistine at histamine receptors in the brain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.M. Arrang" 1 => "M. Garbarg" 2 => "T.T. Quach" 3 => "M. Dam Trung Tuong" 4 => "E. Yeramian" 5 => "J.C. Schwartz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Pharmacol" "fecha" => "1985" "volumen" => "111" "paginaInicial" => "73" "paginaFinal" => "84" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2990946" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0120" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interactions between histamine H3 and dopamine D2 receptors and the implications for striatal function" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Ferrada" 1 => "S. Ferré" 2 => "V. Casadó" 3 => "A. Cortés" 4 => "Z. Justinova" 5 => "C. Barnes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.neuropharm.2008.05.008" "Revista" => array:6 [ "tituloSerie" => "Neuropharmacology" "fecha" => "2008" "volumen" => "55" "paginaInicial" => "190" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18547596" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003300000003/v1_201804060407/S217358081830018X/v1_201804060407/en/main.assets" "Apartado" => array:4 [ "identificador" => "9409" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003300000003/v1_201804060407/S217358081830018X/v1_201804060407/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217358081830018X?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 2 | 21 |
| 2024 October | 135 | 17 | 152 |
| 2024 September | 170 | 17 | 187 |
| 2024 August | 157 | 10 | 167 |
| 2024 July | 168 | 15 | 183 |
| 2024 June | 125 | 14 | 139 |
| 2024 May | 127 | 12 | 139 |
| 2024 April | 160 | 70 | 230 |
| 2024 March | 203 | 10 | 213 |
| 2024 February | 186 | 5 | 191 |
| 2024 January | 212 | 10 | 222 |
| 2023 December | 199 | 7 | 206 |
| 2023 November | 290 | 10 | 300 |
| 2023 October | 312 | 27 | 339 |
| 2023 September | 217 | 26 | 243 |
| 2023 August | 181 | 14 | 195 |
| 2023 July | 141 | 18 | 159 |
| 2023 June | 163 | 17 | 180 |
| 2023 May | 184 | 10 | 194 |
| 2023 April | 173 | 3 | 176 |
| 2023 March | 163 | 3 | 166 |
| 2023 February | 190 | 6 | 196 |
| 2023 January | 188 | 8 | 196 |
| 2022 December | 176 | 7 | 183 |
| 2022 November | 242 | 11 | 253 |
| 2022 October | 238 | 8 | 246 |
| 2022 September | 182 | 11 | 193 |
| 2022 August | 286 | 17 | 303 |
| 2022 July | 275 | 11 | 286 |
| 2022 June | 202 | 8 | 210 |
| 2022 May | 175 | 10 | 185 |
| 2022 April | 166 | 14 | 180 |
| 2022 March | 141 | 17 | 158 |
| 2022 February | 134 | 5 | 139 |
| 2022 January | 147 | 10 | 157 |
| 2021 December | 123 | 12 | 135 |
| 2021 November | 99 | 10 | 109 |
| 2021 October | 107 | 24 | 131 |
| 2021 September | 122 | 12 | 134 |
| 2021 August | 100 | 9 | 109 |
| 2021 July | 92 | 6 | 98 |
| 2021 June | 107 | 7 | 114 |
| 2021 May | 99 | 7 | 106 |
| 2021 April | 276 | 11 | 287 |
| 2021 March | 156 | 11 | 167 |
| 2021 February | 129 | 16 | 145 |
| 2021 January | 132 | 6 | 138 |
| 2020 December | 116 | 12 | 128 |
| 2020 November | 119 | 7 | 126 |
| 2020 October | 77 | 5 | 82 |
| 2020 September | 98 | 7 | 105 |
| 2020 August | 89 | 12 | 101 |
| 2020 July | 62 | 5 | 67 |
| 2020 June | 51 | 14 | 65 |
| 2020 May | 53 | 11 | 64 |
| 2020 April | 49 | 2 | 51 |
| 2020 March | 92 | 5 | 97 |
| 2020 February | 79 | 7 | 86 |
| 2020 January | 90 | 5 | 95 |
| 2019 December | 87 | 2 | 89 |
| 2019 November | 58 | 9 | 67 |
| 2019 October | 74 | 10 | 84 |
| 2019 September | 104 | 14 | 118 |
| 2019 August | 75 | 14 | 89 |
| 2019 July | 99 | 36 | 135 |
| 2019 June | 138 | 22 | 160 |
| 2019 May | 264 | 46 | 310 |
| 2019 April | 105 | 35 | 140 |
| 2019 March | 32 | 13 | 45 |
| 2019 February | 43 | 8 | 51 |
| 2019 January | 18 | 6 | 24 |
| 2018 December | 16 | 9 | 25 |
| 2018 November | 17 | 8 | 25 |
| 2018 October | 18 | 20 | 38 |
| 2018 September | 16 | 4 | 20 |
| 2018 August | 5 | 0 | 5 |
| 2018 July | 12 | 1 | 13 |
| 2018 June | 22 | 6 | 28 |
| 2018 May | 15 | 2 | 17 |
| 2018 April | 8 | 6 | 14 |
| 2018 March | 1 | 4 | 5 |
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