Letter - Clinical
Generalized nodular tinea profunda in an immunosuppressed patient caused by Trichophyton rubrum
Lido
3612
Vezesque se leu este artigo
1388
Total PDF
2224
Total HTML
Compartilhar estatÃsticas
array:22 [ "pii" => "S0365059623000600" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.08.018" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "741" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "pt" => array:17 [ "pii" => "S2666275223000875" "issn" => "26662752" "doi" => "10.1016/j.abdp.2023.03.019" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "741" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cartas ‐ Caso clínico</span>" "titulo" => "Tinea profunda nodular generalizada causada por <span class="elsevierStyleItalic">Trichophyton rubrum</span> em paciente imunossuprimido" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "544" "paginaFinal" => "546" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => 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" => 1929 "Ancho" => 3175 "Tamanyo" => 730128 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Quadro clínico. (A‐C) Múltiplas pápulas e nódulos subcutâneos disseminados e onicomicose.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Wei Li, Kun‐E Lu, Sui‐Qing Cai, Li‐Min Lao" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Wei" "apellidos" => "Li" ] 1 => array:2 [ "nombre" => "Kun‐E" "apellidos" => "Lu" ] 2 => array:2 [ "nombre" => "Sui‐Qing" "apellidos" => "Cai" ] 3 => array:2 [ "nombre" => "Li‐Min" "apellidos" => "Lao" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059623000600" "doi" => "10.1016/j.abd.2021.08.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000600?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000875?idApp=UINPBA00008Z" "url" => "/26662752/0000009800000004/v2_202307101646/S2666275223000875/v2_202307101646/pt/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S0365059623000697" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.11.014" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "750" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Hidradenoma papilliferum of the vulva: a dermoscopic challenging diagnosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "546" "paginaFinal" => "548" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1247 "Ancho" => 3341 "Tamanyo" => 243077 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">50-year-old woman, right interlabial fold of the vulva. (A) Clinically, single, firm, well-circumscribed, smooth surfaced focally ulcerated nodule (4 × 4 mm) with no pigment. (B) Dermoscopy showed a central reddish ulceration with undermined edges due to the detachment of the mucosal surface from the lower layers surrounded by a whitish halo in the absence of other dermoscopically-relevant parameters.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vincenzo De Giorgi, Biancamaria Zuccaro, Flavia Silvestri, Federico Venturi" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Vincenzo" "apellidos" => "De Giorgi" ] 1 => array:2 [ "nombre" => "Biancamaria" "apellidos" => "Zuccaro" ] 2 => array:2 [ "nombre" => "Flavia" "apellidos" => "Silvestri" ] 3 => array:2 [ "nombre" => "Federico" "apellidos" => "Venturi" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000966" "doi" => "10.1016/j.abdp.2023.03.027" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000966?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000697?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000004/v1_202307031010/S0365059623000697/v1_202307031010/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0365059623000612" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.07.012" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "742" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Diagnosis of pseudoxanthoma elasticum in a patient with discrete skin lesions" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "542" "paginaFinal" => "544" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1491 "Ancho" => 3175 "Tamanyo" => 372491 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fundus photograph of the right eye. Note the “peau d’orange” appearance of the fundus temporal to the macula (arrow) and barely visible angioid streaks radiate outwards from the optic disc giving the appearance of a “spider web” (arrowhead). Fluorescein angiography of the left eye demonstrated the angioid streaks with hyperfluorescent edges radiating from the optic nerve up to the midperiphery (arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Catalina Jahr, Valentina Vera, Roberto Bustos, José Contreras" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Catalina" "apellidos" => "Jahr" ] 1 => array:2 [ "nombre" => "Valentina" "apellidos" => "Vera" ] 2 => array:2 [ "nombre" => "Roberto" "apellidos" => "Bustos" ] 3 => array:2 [ "nombre" => "José" "apellidos" => "Contreras" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000887" "doi" => "10.1016/j.abdp.2023.03.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000887?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000612?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000004/v1_202307031010/S0365059623000612/v1_202307031010/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Generalized nodular tinea profunda in an immunosuppressed patient caused by <span class="elsevierStyleItalic">Trichophyton rubrum</span>" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "544" "paginaFinal" => "546" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Wei Li, Kun-E Lu, Sui-Qing Cai, Li-Min Lao" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Wei" "apellidos" => "Li" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 1 => array:3 [ "nombre" => "Kun-E" "apellidos" => "Lu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 2 => array:2 [ "nombre" => "Sui-Qing" "apellidos" => "Cai" ] 3 => array:4 [ "nombre" => "Li-Min" "apellidos" => "Lao" "email" => array:1 [ 0 => "laolimin163@163.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1929 "Ancho" => 3175 "Tamanyo" => 730128 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect: (A‒C) Multiple papules and subcutaneous nodules and onychomycosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 65-year-old man with generalized subcutaneous nodules with intense pruritus for 1 year (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). He had a history of diabetes mellitus for 7 years, hypertension and chronic kidney disease for 5 years, and Bullous Pemphigoid (BP) for 2 years. Systemic glucocorticoid (oral prednisone 25 mg twice a day) was prescribed to treat his BP for more than 1 year.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">After admission, blood test for fungal glucan was 213 pg/mL (the normal is lower than 60 pg/mL), which indicated a deep fungal infection. Blood culture for fungi was negative, and no lymphadenopathy was detected by ultrasonography. The light microscopy showed epidermal hyperplasia, dermal abscess, and infiltration of neutrophils, lymphocytes, epithelioid cells, and scattered multinucleated giant cells (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Intracellular hyphae were observed in multinucleated cells in the granuloma (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). The skin sample was also sent for Next Generation Sequencing (NGS) to identify the pathogen. The NGS reported <span class="elsevierStyleItalic">Trichophyton rubrum</span> nucleotide sequences (Cover rate: 0.0199%) in DNA extracted from the skin specimen. Considering the patient’s clinical and histological manifestations, and the notable high sequencing reads compared to a negative control, we established the diagnosis of generalized nodular tinea profunda caused by <span class="elsevierStyleItalic">Trichophyton rubrum</span>. Oral therapy with 250 mg terbinafine per day was initiated and the nodules regressed completely after 3 months.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Trichophyton rubrum</span> often causes superficial dermatomycosis, such as tinea manus, tinea pedis and tinea corporis. But in very few cases, <span class="elsevierStyleItalic">T. rubrum</span> penetrate into the dermis and subcutaneous tissue, causing tinea profunda, also called deep dermatophytosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Tinea profunda is characterized by the extension of dermatophyte infection beyond the perifollicular area, sometimes spreading to lymph nodes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Most tinea profunda patients have innate or acquired immunodeficiency, including malnutrition, diabetes, leukemia, lymphoma, Acquired Immunodeficiency Syndrome, solid organ transplantation, and chronic kidney disease.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the present case, diabetes mellitus, chronic kidney disease and systemic glucocorticoid treatment for Bullous Pemphigoid (BP) inhibited the patient’s innate and acquired immune system. Although the patient’s blood test was positive to fungal glucan, suggesting a deep fungal infection, the blood fungal culture was negative, and no lymphadenopathy was found by ultrasonography. The patient had onychomycosis for many years and did not received any treatment (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). As BP causes pruritus, the superficial dermatophyte may have been inoculated through the patient’s scratching, leading to generalized nodular tinea profunda.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial Support</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study was funded by a grant from the <span class="elsevierStyleGrantSponsor" id="gs0005">National Natural Science Foundation of China</span> (NFSC) (<span class="elsevierStyleGrantNumber" refid="gs0005">81874248</span>).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Wei Li: Critical review of the literature; critical review of the manuscript.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Kun-E Lu: Drafting and editing of the manuscript.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Sui-Qing Cai: Design and planning of the study.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Li-Min Lao: Approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial Support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:2 [ "identificador" => "xack673914" "titulo" => "Acknowledgments" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-07-27" "fechaAceptado" => "2021-08-10" "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Joint first authors.</p>" "identificador" => "fn0005" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1929 "Ancho" => 3175 "Tamanyo" => 730128 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect: (A‒C) Multiple papules and subcutaneous nodules and onychomycosis.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1243 "Ancho" => 3175 "Tamanyo" => 746228 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Light microscopy: (A) dermal abscess (periodic acid-Schiff, ×20); (B) Intracellular hyphae (arrow heads) in multinucleated cells in granuloma (periodic acid-Schiff, ×400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Rouzaud" 1 => "R. Hay" 2 => "O. Chosidow" 3 => "N. Dupin" 4 => "A. Puel" 5 => "O. Lortholary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/jof2010004" "Revista" => array:6 [ "tituloSerie" => "J Fungi (Basel)" "fecha" => "2015" "volumen" => "2" "paginaInicial" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29376922" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0012369221006863" "estado" => "S300" "issn" => "00123692" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Deep dermatophytosis and inherited CARD9 deficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Lanternier" 1 => "S. Pathan" 2 => "Q. Vincent" 3 => "L. Liu" 4 => "S. Cypowyj" 5 => "C. Prando" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1208487" "Revista" => array:6 [ "tituloSerie" => "N. Engl. J. Med." "fecha" => "2013" "volumen" => "369" "paginaInicial" => "1704" "paginaFinal" => "1714" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24131138" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack673914" "titulo" => "Acknowledgments" "texto" => "<p id="par0055" class="elsevierStylePara elsevierViewall">We thank the patient for granting permission to publish this information.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009800000004/v1_202307031010/S0365059623000600/v1_202307031010/en/main.assets" "Apartado" => array:4 [ "identificador" => "95691" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter – Clinical" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009800000004/v1_202307031010/S0365059623000600/v1_202307031010/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000600?idApp=UINPBA00008Z" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 19 | 7 | 26 |
| 2024 Outubro | 160 | 60 | 220 |
| 2024 Setembro | 191 | 119 | 310 |
| 2024 Agosto | 196 | 131 | 327 |
| 2024 Julho | 212 | 105 | 317 |
| 2024 Junho | 136 | 89 | 225 |
| 2024 Maio | 160 | 53 | 213 |
| 2024 Abril | 139 | 91 | 230 |
| 2024 Março | 141 | 67 | 208 |
| 2024 Fevereiro | 98 | 94 | 192 |
| 2024 Janeiro | 79 | 53 | 132 |
| 2023 Dezembro | 71 | 61 | 132 |
| 2023 Novembro | 69 | 95 | 164 |
| 2023 Outubro | 75 | 74 | 149 |
| 2023 Setembro | 89 | 85 | 174 |
| 2023 Agosto | 92 | 32 | 124 |
| 2023 Julho | 181 | 72 | 253 |
| 2023 Junho | 53 | 34 | 87 |
| 2023 Maio | 54 | 50 | 104 |
| 2023 Abril | 9 | 16 | 25 |
Mostrar tudo
