Scientific Letter
Poisoning by illegal drugs in young children in Spanish paediatric emergency departments
Intoxicaciones por droga ilegal en niños de corta edad en los servicios de urgencias pediátricos españoles
Beatriz Azkunagaa,
, Esther Crespob, Silvia Olivac, Javier Humayord, Liliana Mangionee
Corresponding author
a Servicio de Pediatría, Hospital Universitario Cruces, Universidad del País Vasco, Bilbao, Vizcaya, Spain
b Servicio de Pediatría, Hospital Virgen de la Salud, Toledo, Spain
c Servicio de Pediatría, Hospital Regional de Málaga, Málaga, Spain
d Servicio de Pediatría, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
e Servicio de Pediatría, Hospital Materno-Infantil, Las Palmas de Gran Canaria, Las Palmas, Spain
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del País Vasco, Bilbao, Vizcaya, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Virgen de la Salud, Toledo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Regional de Málaga, Málaga, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Materno-Infantil, Las Palmas de Gran Canaria, Las Palmas, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intoxicaciones por droga ilegal en niños de corta edad en los servicios de urgencias pediátricos españoles" ] ] "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" => 1168 "Ancho" => 1640 "Tamanyo" => 68097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of poisonings by illegal drugs by age, reason for exposure and number of involved substances.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Poisonings by illegal drugs are rarely seen in paediatric emergency departments (PEDs) and constitute approximately 1.5% of the total cases of poisoning.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> They usually occur in older patients that are exposed to these drugs in a recreational context, and cannabis is the substance most frequently involved.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However, on rare occasions, PEDs manage young children that have been exposed to illegal drugs. These cases usually involve unintentional drug exposure resulting from the drive to explore characteristic of this age group.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although it has been described that the use of psychoactive substances in society at large carries the risk of minors being exposed to them, there are few published studies on the subject.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> It is likely that contact with health care services occurs in cases in which the minor exhibits significant symptoms,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> but the actual number of poisonings may exceed the documented number, as in some cases the symptoms may be minimal or short-lived.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study analyses the prevalence of this type of poisonings in the PEDs, as well as their characteristics and the way in which they are managed in these settings, based on the data of a prospective register of poisoning cases made by the Toxicology Surveillance System of the Spanish Society of Paediatric Emergency Care (Observatorio Toxicológico de la Sociedad Española de Urgencias de Pediatría) between October 2008 and June 2015. The study was approved by the Committee on Ethics and Clinical Research of the Basque Country. <a class="elsevierStyleCrossRef" href="#sec0005">Appendix A</a> lists the participating hospitals.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The data collection protocol applied to each patient included the following variables: age and sex; toxic substance; poisoning setting; family history of substance abuse; potential for exposure to the substance; previous outpatient assessment and/or treatment; circumstances leading to transfer to the PED; signs and symptoms; diagnostic testing and/or treatments in the PED; patient destination after discharge and outcome.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the period under study, 413<span class="elsevierStyleHsp" style=""></span>461 emergency visits were managed in the participating PEDs, of which 1139 corresponded to poisonings (0.27%). Of the latter, 32 cases (2.8%) corresponded to poisonings by illegal substances: 23 involving a single substance and 9 involving a combination of substances. Of the poisonings involving a single substance, 10 (43.5%) corresponded to unintentional exposures in children aged less than 3 years.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the distribution of poisonings by illegal drugs by reason for exposure and patient age. There is a gap in this distribution between ages 3 and 11 years, probably due to an overall decline in the frequency of unintentional exposures at these ages, which at the same time are below the usual age band at which intoxications are due to recreational drug use.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the characteristics of unintentional poisonings. The ten cases of unintentional poisoning in minors involved cannabis and cocaine, and the clinically significant manifestations consisted of central nervous system symptoms, as reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> There are studies in the literature that report that accompanying individuals fail to provide information regarding the exposure to the substance.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> However, in our case series this information was provided by a significant number, which facilitated the management of the child's presenting problem and prevented the performance of unnecessary tests. In three cases, ancillary tests other than those used for detecting the toxic substance were performed due to the severity of the clinical manifestations and/or to assess for potential complications. Management in the PEDs mainly consisted of supportive measures and/or gastrointestinal decontamination, in adherence with clinical practice guidelines.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> All of these patients were admitted to the hospital, and while the final outcome was good in all, 40% were initially admitted to critical care units. In addition, with the exception of one case in which this datum was not documented, local social services and legal authorities were notified in all cases.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Based on this case series, nearly half of poisoning cases in Spanish PEDs involving illegal drugs as the only detected substances corresponded to young children, and usually involved cannabis. Although outcomes are generally good, these children are generally unstable on arrival at the PED and at times require treatment and follow-up care in critical care units.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Azkunaga B, Crespo E, Oliva S, Humayor J, Mangione L. Intoxicaciones por droga ilegal en niños de corta edad en los servicios de urgencias pediátricos españoles. An Pediatr (Barc). 2017;86:47–49.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<p id="par0055" class="elsevierStylePara elsevierViewall">Hospital (H.) Alto Deba: Agustín Rodríguez; H. del Tajo, Aranjuez: Carlos García-Vao; H.U. Arnau de Vilanova, Lleida: Neus Pociello; H.U. Basurto: Javier Humayor; H. Cabueñes: Ramón Fernández; H. Regional de Málaga: Silvia Oliva Rodríguez-Pastor; Complejo (C.) Hospitalario de Jaén: Tomás del Campo; C. Asistencial Universitario de Léon: Ana Gloria Andrés; Corporación Sanitaria Parc Taulí, Sabadell: Mireia Pérez; Hospital Universitario (H.U.) Cruces: Santiago Mintegi, Paula Santiago, Nerea Bilbao; H.U. Doce de Octubre: Sofía Mesa; H.U. Donostia: José Angel Muñoz Bernal; H.U. Dr. Peset. Valencia: J. Rafael Bretón Martínez; H.U. Fuenlabrada: Rocío Rodríguez; H. Francesc de Borja de Gandía: Carlos Miguel Angelats; Fundació Sant Hospital de la Seu d’Urgell: Pablo Javier Ercoli; H. Universitario Fundación Alcorcón: Alberto Barasoain; H. General Universitario de Alicante: Olga Gómez Pérez; H.U. Gregorio Marañón: Paula Vázquez; H. Infanta Cristina, Parla, Madrid: Begoña de Miguel; H. Infanta Elena, Valdemoro: Carmen Gómez; H. de Terrassa: Judit Barrena; H. Laredo: Ana Jorda; H.U. Lucus Augusti: Sandra Yáñez; H. Mendaro: Laura Herrero; H.U. Mutua Terrassa: Elena May Llanas; H.U. Niño Jesús: Juan Carlos Molina; H. Materno-Infantil de Las Palmas de Gran Canaria: Lily Mangione; H. Materno-Infantil de Badajoz: Paz Hurtado; H. Ntra. Sra. de Sonsoles, Ávila: Helvia Benito; H. Montepríncipe, H. Sanchinarro, H. Torrelodones, Madrid: Silvina Natalini; H. Príncipe de Asturias, Alcalá de Henares: M. Ángeles García Herrero; H.U. Puerta de Hierro-Majadahonda: Consuelo Benito Caldés; H. Rey Juan Carlos: Pablo Bello Gutiérrez; H.U. San Agustín: Juan Cózar Olmo; H.U. Río Hortega, Valladolid: Roberto Velasco; H. Sant Joan de Déu, Xarxa Hospitalaria i Universitaria de Manresa, Fundació Althaia: Eva Botifoll García; H.U. Sant Joan de Déu: Lidia Martínez Sánchez; H. San Pedro: Laura Martínez; H. Miguel Servet: Carmen Campos Calleja; H.U. Son Espases, Palma de Mallorca: Victoria López Corominas; H. Son Llàtzer: Carmen Vidal Palacios; H.U. Central de Asturias, Oviedo: Julián Rodríguez; H. Universitario de Salamanca: Javier López Ávila; H.U. Virgen de la Arrixaca: Carlos Pérez; H. Virgen de la Salud, Toledo: Esther Crespo Rupérez; Complejo Hospitalario de Navarra: Miriam Palacios; H. Zumarraga: Amalia Pérez; H. Quirón, Bizkaia: Itziar Iturralde; H. Clínico U. Lozano Blesa: Gonzalo González García; H.U. Puerta del Mar, Cádiz: Arturo Hernández; H. Clínico U. de Valladolid: Elena Urbaneja Rodríguez; Complejo Asistencial de Segovia: H. General: Rebeca Garrote; H.U. y Politécnico La Fe de Valencia: Rafael Señer; Hospital de Mataró: Joaquim Martorell Aymerich; H.U. Marqués de Valdecilla: José Lorenzo Guerra; H. Sierrallana: José Lorenzo Guerra; H. Gernika-Lumo: Alicia Gutiérrez and Complexo Hospitalario Universitario de A Coruña: Alicia Herrera.</p>" "etiqueta" => "Appendix A. Working Group on Poisonings of the Spanish Society of Paediatric Emergency Medicine" "identificador" => "sec0005" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1168 "Ancho" => 1640 "Tamanyo" => 68097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of poisonings by illegal drugs by age, reason for exposure and number of involved substances.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">AC, activated charcoal; CCU, critical care unit; CT, axial computed tomography scan; EKG, electrocardiograph; GL, gastric lavage; PC, primary care; Rx, radiograph.</p>" "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient \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><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">6 \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">7 \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">8 \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">9 \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">10 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Substance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cannabis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cannabis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cannabis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cannabis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cocaine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cannabis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cannabis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cocaine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cannabis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cannabis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (months) \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">15 \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><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">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \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">20 \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">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \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">Female \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">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \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">Female \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Setting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Outside home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Outside home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Outside home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Outside home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Home \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do they report exposure? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family history of substance use? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, parental substance use \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, maternal substance use \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, father in recovery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, parental substance use \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No use, but presence of cocaine in the home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Accompanying individuals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grandmother \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aunt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grandmother \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transport \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Car \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Car \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Car \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ambulance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Car \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Car \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ambulance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ambulance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Car \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Car \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous health care contact \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, PC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, PC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, PC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, IV midazolam and diazepam \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sleepiness, dry mucous membranes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Irritability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sleepiness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sleepiness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Irritability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sleepiness, instability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sleepiness, hypotonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Agitation, visual hallucinations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sleepiness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sleepiness, conjunctival hyperaemia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Findings \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ level of consciousness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ level of consciousness, mydriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ level of consciousness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Agitation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Frequent smiling, ataxia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypertonia, reduced responsiveness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Agitation, mydriasis, tachycardia, hypertonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ level of consciousness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conjunctival hyperaemia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Substance levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Substance levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Substance levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Substance levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Substance levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Substance levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Substance levels, cranial CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Substance levels, EKG, chest Rx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Substance levels, cranial CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Substance levels \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inpatient treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AC<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>GL, midazolam, propofol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AC<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>GL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Destination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CCU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CCU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CCU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CCU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Social/legal services \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1300518.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Characteristics and management of patients with unintentional illegal drug poisoning.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Toxicology surveillance system of the Spanish Society of Pediatric Emergencies: first-year analysis" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "The Intoxications Working Group of the Spanish Society of Pediatric Emergencies" "etal" => false "autores" => array:4 [ 0 => "B. Azkunaga" 1 => "S. Mintegi" 2 => "I. Bizkarra" 3 => "J. Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MEJ.0b013e3283462504" "Revista" => array:6 [ "tituloSerie" => "Eur J Emerg Med" "fecha" => "2011" "volumen" => "18" "paginaInicial" => "285" "paginaFinal" => "287" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21817912" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cambios epidemiológicos en las intoxicaciones atendidas en los servicios de urgencias pediátricos españoles entre 2001 y 2010: incremento de las intoxicaciones etílicas" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "grupo de trabajo de intoxicaciones sociedad española de urgencias de pediatría" "etal" => false "autores" => array:4 [ 0 => "B. Azkunaga" 1 => "S. Mintegi" 2 => "L. Del arco" 3 => "I. Bizkarra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2012" "volumen" => "24" "paginaInicial" => "376" "paginaFinal" => "379" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parenteral cannabis abuse and accidental intoxications in children. Prevention by detecting neglectful situations and at-risk families" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Pélissier" 1 => "I. Claudet" 2 => "A.L. Pélissier-Alicot" 3 => "N. Franchitto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PEC.0000000000000288" "Revista" => array:6 [ "tituloSerie" => "Pediatr Emerg Care" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "862" "paginaFinal" => "866" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25407034" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prolonged coma in a child due to hashish ingestion with quantitation of THC metabolites in urine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.D. Carstairs" 1 => "M.K. Fujinaka" 2 => "G.E. Keeney" 3 => "B.T. Ly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jemermed.2010.05.032" "Revista" => array:7 [ "tituloSerie" => "J Emerg Med" "fecha" => "2011" "volumen" => "41" "paginaInicial" => "e69" "paginaFinal" => "e71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20634020" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S221326001370081X" "estado" => "S300" "issn" => "22132600" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intoxicación accidental por <span class="elsevierStyleItalic">cannabis</span>: presentación de cuatro casos pediátricos en un hospital terciario del sur de España" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Croche" 1 => "M.T. Alonso" 2 => "M. Loscertales" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Argent Pediatr Arch" "fecha" => "2011" "volumen" => "109" "paginaInicial" => "e4" "paginaFinal" => "e7" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intoxicaciones por drogas ilegales II" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Míguez" 1 => "A. Rivas" 2 => "P. Vázquez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Manual de intoxicaciones en pediatría" "paginaInicial" => "266" "paginaFinal" => "270" "serieFecha" => "2012" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgments" "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">We want to thank the Working Group on Poisonings of the Spanish Society of Paediatric Emergency Medicine (Sociedad Española de Urgencias de Pediatría) (<a class="elsevierStyleCrossRef" href="#sec0005">Appendix A</a>).</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008600000001/v1_201612270102/S2341287916301375/v1_201612270102/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008600000001/v1_201612270102/S2341287916301375/v1_201612270102/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916301375?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 14 | 23 |
| 2024 October | 45 | 41 | 86 |
| 2024 September | 53 | 25 | 78 |
| 2024 August | 69 | 59 | 128 |
| 2024 July | 46 | 31 | 77 |
| 2024 June | 66 | 40 | 106 |
| 2024 May | 36 | 35 | 71 |
| 2024 April | 50 | 32 | 82 |
| 2024 March | 46 | 27 | 73 |
| 2024 February | 49 | 33 | 82 |
| 2024 January | 35 | 26 | 61 |
| 2023 December | 33 | 13 | 46 |
| 2023 November | 34 | 23 | 57 |
| 2023 October | 33 | 29 | 62 |
| 2023 September | 29 | 23 | 52 |
| 2023 August | 33 | 19 | 52 |
| 2023 July | 38 | 30 | 68 |
| 2023 June | 29 | 23 | 52 |
| 2023 May | 48 | 24 | 72 |
| 2023 April | 31 | 25 | 56 |
| 2023 March | 53 | 28 | 81 |
| 2023 February | 39 | 17 | 56 |
| 2023 January | 25 | 25 | 50 |
| 2022 December | 55 | 39 | 94 |
| 2022 November | 50 | 33 | 83 |
| 2022 October | 44 | 43 | 87 |
| 2022 September | 27 | 40 | 67 |
| 2022 August | 39 | 33 | 72 |
| 2022 July | 29 | 45 | 74 |
| 2022 June | 39 | 41 | 80 |
| 2022 May | 64 | 37 | 101 |
| 2022 April | 46 | 48 | 94 |
| 2022 March | 57 | 52 | 109 |
| 2022 February | 24 | 35 | 59 |
| 2022 January | 34 | 41 | 75 |
| 2021 December | 30 | 42 | 72 |
| 2021 November | 32 | 44 | 76 |
| 2021 October | 58 | 77 | 135 |
| 2021 September | 27 | 47 | 74 |
| 2021 August | 22 | 41 | 63 |
| 2021 July | 22 | 40 | 62 |
| 2021 June | 43 | 46 | 89 |
| 2021 May | 42 | 47 | 89 |
| 2021 April | 80 | 62 | 142 |
| 2021 March | 68 | 55 | 123 |
| 2021 February | 34 | 30 | 64 |
| 2021 January | 29 | 35 | 64 |
| 2020 December | 42 | 31 | 73 |
| 2020 November | 21 | 26 | 47 |
| 2020 October | 24 | 30 | 54 |
| 2020 September | 27 | 24 | 51 |
| 2020 August | 11 | 6 | 17 |
| 2020 July | 23 | 17 | 40 |
| 2020 June | 29 | 12 | 41 |
| 2020 May | 29 | 16 | 45 |
| 2020 April | 23 | 21 | 44 |
| 2020 March | 36 | 19 | 55 |
| 2020 February | 34 | 12 | 46 |
| 2020 January | 28 | 12 | 40 |
| 2019 December | 43 | 23 | 66 |
| 2019 November | 24 | 8 | 32 |
| 2019 October | 28 | 15 | 43 |
| 2019 September | 32 | 16 | 48 |
| 2019 August | 44 | 17 | 61 |
| 2019 July | 32 | 35 | 67 |
| 2019 June | 26 | 23 | 49 |
| 2019 May | 53 | 19 | 72 |
| 2019 April | 97 | 20 | 117 |
| 2019 March | 30 | 23 | 53 |
| 2019 February | 36 | 19 | 55 |
| 2019 January | 43 | 18 | 61 |
| 2018 December | 48 | 41 | 89 |
| 2018 November | 81 | 31 | 112 |
| 2018 October | 108 | 26 | 134 |
| 2018 September | 48 | 20 | 68 |
| 2018 August | 4 | 0 | 4 |
| 2018 July | 3 | 0 | 3 |
| 2018 June | 2 | 0 | 2 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 24 | 0 | 24 |
| 2018 March | 32 | 0 | 32 |
| 2018 February | 14 | 0 | 14 |
| 2018 January | 15 | 0 | 15 |
| 2017 December | 18 | 0 | 18 |
| 2017 November | 14 | 0 | 14 |
| 2017 October | 14 | 0 | 14 |
| 2017 September | 16 | 0 | 16 |
| 2017 August | 8 | 0 | 8 |
| 2017 July | 24 | 0 | 24 |
| 2017 June | 19 | 9 | 28 |
| 2017 May | 18 | 13 | 31 |
| 2017 April | 84 | 77 | 161 |
| 2017 March | 14 | 11 | 25 |
| 2017 February | 10 | 5 | 15 |
| 2017 January | 29 | 20 | 49 |
| 2016 December | 2 | 9 | 11 |
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