was read the article
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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "53" "paginaFinal" => "54" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Ribeiro, A.M. Correia, R. Duarte" "autores" => array:3 [ 0 => array:3 [ "nombre" => "C." "apellidos" => "Ribeiro" "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" => "A.M." "apellidos" => "Correia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Duarte" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Public Health Department, Administração Regional de Saúde do Norte, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Referência Regional para a Tuberculose Multirresistente da Região de Saúde do Norte, Vila Nova de Gaia, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centro de Diagnóstico Pneumológico de Vila Nova de Gaia, Vila Nova de Gaia, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tuberculose e antagonistas do FNTα – onde estamos a falhar?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2012 Portugal had a tuberculosis incidence of 21.6/100,000 inhabitants (2286 new cases, 942 of which were reported in the northern region).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A recent retrospective study in Portugal identified, from 2001 to 2012, 25 cases of tuberculosis out of 765 patients under anti-TNFα (297/100,000 patient-years).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Treatment with tumor necrosis factor antagonists (anti-TNFα) is associated with an elevated risk for development of tuberculosis mostly due to reactivation of latent tuberculosis infection. Since 2006, national guidelines advise tuberculosis screening for all candidates for anti-TNFα therapy including chest X ray, tuberculin skin test (TST) and Interferon-Gamma Release Assay (IGRA) and treatment should be offered to every patient with evidence of LTBI, provided major toxicity is excluded.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Worldwide, the application of tuberculosis screening guidelines in these patients has been related to a decrease of tuberculosis within this group.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In order to understand the pitfalls that can still lead to the development of tuberculosis in these patients, we reviewed all cases of tuberculosis between 03/2010 and 02/2012 in Portugal's northern region, identifying those who developed the disease while on anti-TNF-α therapy. In this region there are both clinical notification of all tuberculosis cases and laboratory notification of confirmed cases (which allowed for the identification of all patients). Demographic, epidemiological and clinical data was obtained by consulting epidemiological research studies and clinical records.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the period studied, 1834 cases of tuberculosis were diagnosed in the region, five of which were receiving anti-TNF-α therapy (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">All these 5 cases had intestinal disease (4 had Crohn's disease) of an average duration of 18.2 years (minimum 7 maximum 30). None of the patients had known exposure to tuberculosis, 3 patients underwent screening with TST but IGRA was never used. One patient was diagnosed with latent infection based on a TST of 8<span class="elsevierStyleHsp" style=""></span>mm induration and started isoniazid but it was suspended 15 days later due to liver toxicity and anti-TNF-α was started. Patients developed tuberculosis between 3 and 24 months on therapy.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In none of the cases was screening performed according to the published guidelines, it was either absent or incomplete. Even though they represent a small fraction of TB diagnosis, the incidence in this group is significantly higher<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and a methodical screening and follow up while on biological therapy should be our goal. This is particularly important in a country like ours which has an intermediate incidence of TB.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The fact that all TB cases occurred in patients being treated for inflammatory bowel disorders may represent a lack of awareness of tuberculosis and of the guidelines by the clinicians treating these patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ulcerative colitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Crohn's disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Crohn's disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Crohn's disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Crohn's disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Disease duration (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Previous TB or previous contact with TB patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Other high risk condition for TB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Other immunossupressors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CorticosteroidsAzathioprine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Azathioprine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CorticosteroidsAzathioprine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TB screeningTSTIGRA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performedNot performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performedNot performed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LTBI treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Isoniazid – suspended for hepatic toxicity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-TNFα therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Infliximab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adalimumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Infliximab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Infliximab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adalimumab \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Time on anti-TNF α (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Site of disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disseminated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary, Lymphatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary, Pleural \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TB treatment duration (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cured \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cured \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cured \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cured \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cured \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab884666.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient data.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 8 | 6 | 14 |
2024 October | 38 | 38 | 76 |
2024 September | 36 | 26 | 62 |
2024 August | 53 | 31 | 84 |
2024 July | 41 | 31 | 72 |
2024 June | 40 | 18 | 58 |
2024 May | 37 | 28 | 65 |
2024 April | 38 | 25 | 63 |
2024 March | 30 | 21 | 51 |
2024 February | 36 | 17 | 53 |
2024 January | 30 | 28 | 58 |
2023 December | 29 | 29 | 58 |
2023 November | 23 | 32 | 55 |
2023 October | 20 | 61 | 81 |
2023 September | 18 | 30 | 48 |
2023 August | 30 | 20 | 50 |
2023 July | 19 | 30 | 49 |
2023 June | 24 | 14 | 38 |
2023 May | 34 | 26 | 60 |
2023 April | 21 | 16 | 37 |
2023 March | 48 | 25 | 73 |
2023 February | 36 | 14 | 50 |
2023 January | 22 | 18 | 40 |
2022 December | 43 | 15 | 58 |
2022 November | 48 | 31 | 79 |
2022 October | 36 | 26 | 62 |
2022 September | 27 | 27 | 54 |
2022 August | 25 | 39 | 64 |
2022 July | 29 | 48 | 77 |
2022 June | 17 | 23 | 40 |
2022 May | 30 | 36 | 66 |
2022 April | 30 | 33 | 63 |
2022 March | 23 | 47 | 70 |
2022 February | 25 | 23 | 48 |
2022 January | 25 | 38 | 63 |
2021 December | 20 | 38 | 58 |
2021 November | 31 | 32 | 63 |
2021 October | 31 | 32 | 63 |
2021 September | 14 | 24 | 38 |
2021 August | 26 | 28 | 54 |
2021 July | 21 | 26 | 47 |
2021 June | 15 | 31 | 46 |
2021 May | 34 | 32 | 66 |
2021 April | 49 | 48 | 97 |
2021 March | 80 | 24 | 104 |
2021 February | 53 | 18 | 71 |
2021 January | 44 | 21 | 65 |
2020 December | 20 | 10 | 30 |
2020 November | 41 | 16 | 57 |
2020 October | 31 | 20 | 51 |
2020 September | 59 | 17 | 76 |
2020 August | 67 | 26 | 93 |
2020 July | 48 | 21 | 69 |
2020 June | 47 | 14 | 61 |
2020 May | 60 | 21 | 81 |
2020 April | 55 | 18 | 73 |
2020 March | 52 | 14 | 66 |
2020 February | 64 | 21 | 85 |
2020 January | 49 | 15 | 64 |
2019 December | 39 | 14 | 53 |
2019 November | 55 | 8 | 63 |
2019 October | 51 | 13 | 64 |
2019 September | 33 | 20 | 53 |
2019 August | 67 | 8 | 75 |
2019 July | 73 | 21 | 94 |
2019 June | 55 | 9 | 64 |
2019 May | 95 | 12 | 107 |
2019 April | 78 | 15 | 93 |
2019 March | 120 | 10 | 130 |
2019 February | 115 | 6 | 121 |
2019 January | 82 | 22 | 104 |
2018 December | 59 | 6 | 65 |
2018 November | 18 | 5 | 23 |
2018 October | 23 | 5 | 28 |
2018 September | 26 | 6 | 32 |
2018 August | 41 | 27 | 68 |
2018 July | 62 | 18 | 80 |
2018 June | 54 | 18 | 72 |
2018 May | 80 | 14 | 94 |
2018 April | 84 | 19 | 103 |
2018 March | 93 | 19 | 112 |
2018 February | 29 | 12 | 41 |
2018 January | 55 | 19 | 74 |
2017 December | 52 | 6 | 58 |
2017 November | 39 | 11 | 50 |
2017 October | 25 | 16 | 41 |
2017 September | 42 | 19 | 61 |
2017 August | 34 | 17 | 51 |
2017 July | 29 | 18 | 47 |
2017 June | 36 | 13 | 49 |
2017 May | 45 | 17 | 62 |
2017 April | 16 | 9 | 25 |
2017 March | 28 | 20 | 48 |
2017 February | 13 | 12 | 25 |
2017 January | 18 | 4 | 22 |
2016 December | 15 | 17 | 32 |
2016 November | 10 | 6 | 16 |
2016 October | 10 | 10 | 20 |
2016 September | 8 | 5 | 13 |
2016 August | 6 | 5 | 11 |
2016 July | 1 | 9 | 10 |
2016 June | 2 | 0 | 2 |
2016 May | 0 | 7 | 7 |
2016 April | 22 | 1 | 23 |
2016 March | 38 | 16 | 54 |
2016 February | 27 | 21 | 48 |
2016 January | 25 | 18 | 43 |
2015 December | 27 | 17 | 44 |
2015 November | 26 | 13 | 39 |
2015 October | 18 | 13 | 31 |
2015 September | 27 | 20 | 47 |
2015 August | 20 | 7 | 27 |
2015 July | 26 | 13 | 39 |
2015 June | 19 | 2 | 21 |
2015 May | 54 | 3 | 57 |
2015 April | 75 | 14 | 89 |
2015 March | 68 | 5 | 73 |
2015 February | 68 | 5 | 73 |
2015 January | 82 | 9 | 91 |
2014 December | 83 | 10 | 93 |
2014 November | 74 | 7 | 81 |
2014 October | 92 | 14 | 106 |
2014 September | 89 | 32 | 121 |
2014 August | 87 | 10 | 97 |
2014 July | 29 | 16 | 45 |
2014 June | 27 | 8 | 35 |
2014 May | 37 | 10 | 47 |
2014 April | 45 | 20 | 65 |
2014 March | 71 | 39 | 110 |
2014 February | 81 | 39 | 120 |
2014 January | 78 | 24 | 102 |