Letter to the Editor
Agraphia manifesting during a WhatsApp conversation
Awagrafia
M. Iglesias Espinosa
, J. Fernández Pérez, T. Ramírez García, P.J. Serrano Castro
Corresponding author
Unidad de Neurología, Complejo Hospitalario Torrecárdenas, Almería, Spain
Read
1649
Timeswas read the article
441
Total PDF
1208
Total HTML
Share statistics
array:25 [ "pii" => "S2173580820300365" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2017.08.007" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1123" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:69-70" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485317303006" "issn" => "02134853" "doi" => "10.1016/j.nrl.2017.08.004" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1123" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:69-70" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 471 "formatos" => array:3 [ "EPUB" => 22 "HTML" => 241 "PDF" => 208 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Awagrafia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "69" "paginaFinal" => "70" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Agraphia manifesting during a WhatsApp conversation" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2667 "Ancho" => 1500 "Tamanyo" => 317212 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">«Awagrafia» en captura de pantalla obtenida del <span class="elsevierStyleItalic">smartphone</span> del paciente.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Iglesias Espinosa, J. Fernández Pérez, T. Ramírez García, P.J. Serrano Castro" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Iglesias Espinosa" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Fernández Pérez" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Ramírez García" ] 3 => array:2 [ "nombre" => "P.J." "apellidos" => "Serrano Castro" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580820300365" "doi" => "10.1016/j.nrleng.2017.08.007" "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/S2173580820300365?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485317303006?idApp=UINPBA00004N" "url" => "/02134853/0000003500000001/v1_202003180804/S0213485317303006/v1_202003180804/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2173580819301178" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2017.10.009" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1167" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:70-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 128 "formatos" => array:2 [ "EPUB" => 11 "PDF" => 117 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "<span class="elsevierStyleItalic">Sinus pericranii</span>: early infant diagnosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "70" "paginaFinal" => "72" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Sinus pericranii</span>: diagnóstico precoz en el lactante" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1702 "Ancho" => 1992 "Tamanyo" => 210057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Sagittal T2-weighted MRI sequence. The white arrow (signal voids) points to the varicose vein draining to the sagittal sinus. (B) Coronal slice at the level of the varicose vein (white arrow). Protrusion is observed at the surface. (C) Axial sequence showing the lesion at the midline. (D) External appearance of the <span class="elsevierStyleItalic">Sinus pericranii</span>. A macule is visible on the scalp; its size fluctuated during examination.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Lubián-Gutiérrez, M.I. Sánchez-Códez, E. Peromingo-Matute, A. Zuazo-Ojeda" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Lubián-Gutiérrez" ] 1 => array:2 [ "nombre" => "M.I." "apellidos" => "Sánchez-Códez" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Peromingo-Matute" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Zuazo-Ojeda" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485317303730" "doi" => "10.1016/j.nrl.2017.10.014" "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/S0213485317303730?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580819301178?idApp=UINPBA00004N" "url" => "/21735808/0000003500000001/v1_202004040635/S2173580819301178/v1_202004040635/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2173580820300353" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2020.03.001" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1120" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2020;35:67-8" "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">Letter to the Editor</span>" "titulo" => "Posterior reversible leukoencephalopathy after cyanamide overdose" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "67" "paginaFinal" => "68" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Leucoencefalopatía posterior reversible tras sobredosis de carbimida" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1669 "Ancho" => 2500 "Tamanyo" => 417092 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MRI study showing signs of reversible posterior leukoencephalopathy syndrome. Subcortical white matter hyperintensities are observed in both occipital lobes, with focal extension to the left parietal and frontal areas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Y. Peñasco, A. González-Castro, J.C. Rodríguez-Borregán, R. Sánchez-de la Torre, A. González-Suárez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Y." "apellidos" => "Peñasco" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "González-Castro" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Rodríguez-Borregán" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Sánchez-de la Torre" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "González-Suárez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485317302827" "doi" => "10.1016/j.nrl.2017.07.022" "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/S0213485317302827?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580820300353?idApp=UINPBA00004N" "url" => "/21735808/0000003500000001/v1_202004040635/S2173580820300353/v1_202004040635/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Agraphia manifesting during a WhatsApp conversation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "69" "paginaFinal" => "70" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Iglesias Espinosa, J. Fernández Pérez, T. Ramírez García, P.J. Serrano Castro" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Iglesias Espinosa" "email" => array:1 [ 0 => "mariglesp@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Fernández Pérez" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Ramírez García" ] 3 => array:2 [ "nombre" => "P.J." "apellidos" => "Serrano Castro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Neurología, Complejo Hospitalario Torrecárdenas, Almería, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Awagrafia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2667 "Ancho" => 1500 "Tamanyo" => 317681 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Screen capture from the patient's smartphone showing the “awagraphia.”</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Recent years have seen the emergence of new health problems associated with the development of new technologies. This has led to the creation of the terms “Nintendinitis,” “Wiiitis,” and “Whatsappitis” to refer to tendinitis secondary to the use of Nintendo and Wii consoles and the WhatsApp mobile application.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a> Cases have also been described of diagnostic uncertainty associated with transient monocular blindness following smartphone use.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a> As well as causing new disorders, these technologies may also constitute a new, peculiar form of manifestation of classical disorders.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We propose the term “awagraphia” to describe the presentation of agraphia during use of the WhatsApp instant messaging service in a patient with the syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL).</p><p id="par0015" class="elsevierStylePara elsevierViewall">HaNDL syndrome, also known as pseudomigraine with pleocytosis, is a benign entity whose aetiology is not well understood. Aphasia is a frequent manifestation of this syndrome, in which patients display lymphocytic pleocytosis and self-limited episodes of neurological deficits, which last minutes and usually precede severe headache.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical case</span><p id="par0020" class="elsevierStylePara elsevierViewall">We present the case of a Spanish man of 26 years of age without history of migraine who presented a self-limited episode of language alteration (agraphia) during a WhatsApp conversation with his mother (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), which we colloquially refer to as “awagraphia” to emphasise the unusual form of presentation. It is unclear whether comprehension was preserved, although we do know that oral conversation was not possible, as the patient was taken to the emergency department after speech alterations were noted during a telephone conversation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">By the time of assessment, the neurological deficit had resolved and no abnormalities were detected, although the patient reported intense, pulsatile, holocranial headache accompanied by nausea, which had lasted several hours. The patient's family showed us the WhatsApp conversation, and insisted that several minutes earlier “we couldn’t understand anything he was saying.” Blood analysis and a head CT study yielded normal results.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient reported similar episodes of headache of several hours’ duration in the previous 20 days, for which he had consulted twice and which had been treated symptomatically, without assessment by a neurologist. One previous attack had been preceded by an episode of hemibody sensory disturbance of several minutes’ duration, and another had been accompanied by blurred vision, although no significance had been attributed to these symptoms. Between episodes, the patient was asymptomatic.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Blood tests included a complete blood count; kidney and liver biochemistry; a coagulation test; an autoimmunity study; and serology for HIV, hepatitis B and C viruses, cytomegalovirus, and Epstein-Barr virus. We also performed a brain MRI study with intravenous contrast administration, and an electroencephalography. All test findings were normal. Analysis of the cerebrospinal fluid revealed predominantly mononuclear pleocytosis and elevated protein levels (130<span class="elsevierStyleHsp" style=""></span>leucocytes/mm<span class="elsevierStyleSup">3</span>, 99% mononuclear; 0.59<span class="elsevierStyleHsp" style=""></span>mg/L protein), leading to a diagnosis of pseudomigraine with pleocytosis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This case demonstrates the way in which the everyday use of new technologies can give rise to new forms of presentation of neurological symptoms. According to the information collected from the patient and his family in the clinical history interview, we may infer that he presented jargon aphasia with neologisms, although we were unable to assess speech as symptoms had resolved before he arrived at the emergency department. Similarly, the screen capture of the WhatsApp conversation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) shows jargon agraphia with neologisms. As we do not know what the patient wanted to express during the episode, we cannot conclude that he presented paragraphia. Insufficient data are available to identify the type of aphasia the patient presented during the episode.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In any case, agraphia was the sentinel symptom that triggered the search for specialised medical attention in a clinical context that had previously not been considered relevant. The expression of classical symptoms through new technologies may inform the differential diagnosis of language disorders, which can be difficult when symptoms are described by family members and not observed directly by the neurologist. In this case, we were able to recognise and characterise the disorder, with the added peculiarity of its form of presentation, enabling us to establish a working diagnosis, which was subsequently confirmed.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical case" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Iglesias Espinosa M, Fernández Pérez J, Ramírez García T, Serrano Castro PJ. Awagrafia. Neurología. 2020;35:69–70.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">This case report was presented in poster format at the 39th Annual Meeting of the Andalusian Society of Neurology (October 2016).</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2667 "Ancho" => 1500 "Tamanyo" => 317681 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Screen capture from the patient's smartphone showing the “awagraphia.”</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nintendo related injuries and other problems: review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.B. Jalink" 1 => "E. Heineman" 2 => "J.P.E.N. Pierie" 3 => "H.O. Ten Cate Hoedemaker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.g7267" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2014" "volumen" => "349" "paginaInicial" => "g7267" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25515525" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "«WhatsAppitis»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I.M. Fernández-Guerrero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(14)60519-5" "Revista" => array:5 [ "tituloSerie" => "Lancet" "fecha" => "2014" "volumen" => "383" "paginaInicial" => "1040" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24656201" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transient smartphone «Blindness»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Alim-Marvasti" 1 => "W. Bi" 2 => "O.A. Mahroo" 3 => "J.L. Barbur" 4 => "G.T. Plant" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMc1514294" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2016" "volumen" => "374" "paginaInicial" => "2502" "paginaFinal" => "2504" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27332920" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transient smartphone blindness: relevance to misdiagnosis in neurologic practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Sathiamoorthi" 1 => "D.M. Wingerchuk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/WNL.0000000000003639" "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2017" "volumen" => "88" "paginaInicial" => "809" "paginaFinal" => "810" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28100724" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003500000001/v1_202004040635/S2173580820300365/v1_202004040635/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/21735808/0000003500000001/v1_202004040635/S2173580820300365/v1_202004040635/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580820300365?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 15 | 14 | 29 |
| 2024 September | 34 | 18 | 52 |
| 2024 August | 24 | 11 | 35 |
| 2024 July | 29 | 8 | 37 |
| 2024 June | 31 | 2 | 33 |
| 2024 May | 14 | 6 | 20 |
| 2024 April | 22 | 4 | 26 |
| 2024 March | 22 | 7 | 29 |
| 2024 February | 21 | 3 | 24 |
| 2024 January | 25 | 10 | 35 |
| 2023 December | 22 | 10 | 32 |
| 2023 November | 20 | 10 | 30 |
| 2023 October | 25 | 11 | 36 |
| 2023 September | 13 | 0 | 13 |
| 2023 August | 19 | 7 | 26 |
| 2023 July | 11 | 5 | 16 |
| 2023 June | 17 | 3 | 20 |
| 2023 May | 37 | 7 | 44 |
| 2023 April | 46 | 4 | 50 |
| 2023 March | 13 | 2 | 15 |
| 2023 February | 22 | 3 | 25 |
| 2023 January | 27 | 0 | 27 |
| 2022 December | 27 | 5 | 32 |
| 2022 November | 34 | 8 | 42 |
| 2022 October | 31 | 7 | 38 |
| 2022 September | 21 | 6 | 27 |
| 2022 August | 20 | 15 | 35 |
| 2022 July | 17 | 9 | 26 |
| 2022 June | 16 | 6 | 22 |
| 2022 May | 19 | 7 | 26 |
| 2022 April | 17 | 11 | 28 |
| 2022 March | 35 | 14 | 49 |
| 2022 February | 39 | 9 | 48 |
| 2022 January | 70 | 12 | 82 |
| 2021 December | 30 | 11 | 41 |
| 2021 November | 24 | 8 | 32 |
| 2021 October | 18 | 10 | 28 |
| 2021 September | 18 | 13 | 31 |
| 2021 August | 17 | 6 | 23 |
| 2021 July | 9 | 10 | 19 |
| 2021 June | 10 | 7 | 17 |
| 2021 May | 18 | 13 | 31 |
| 2021 April | 45 | 23 | 68 |
| 2021 March | 24 | 6 | 30 |
| 2021 February | 18 | 5 | 23 |
| 2021 January | 14 | 13 | 27 |
| 2020 December | 13 | 4 | 17 |
| 2020 November | 13 | 6 | 19 |
| 2020 October | 10 | 7 | 17 |
| 2020 September | 15 | 7 | 22 |
| 2020 August | 11 | 7 | 18 |
| 2020 July | 16 | 11 | 27 |
| 2020 June | 7 | 4 | 11 |
| 2020 May | 11 | 5 | 16 |
| 2020 April | 8 | 3 | 11 |
| 2020 March | 0 | 6 | 6 |
Show all
