Scientific Letter
Pneumocystis jirovecii Pneumonia Complicating the Progress of a Patient with Glioblastoma Multiforme Receiving Temozolomide
Neumonía por Pneumocystis jirovecii complicando la evolución de una paciente con glioblastoma multiforme en tratamiento con temozolomida
Read
5479
Timeswas read the article
1934
Total PDF
3545
Total HTML
Share statistics
array:24 [ "pii" => "S1579212916301793" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.07.021" "estado" => "S300" "fechaPublicacion" => "2016-10-01" "aid" => "1349" "copyright" => "SEPAR" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2016;52:534-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2074 "formatos" => array:3 [ "EPUB" => 139 "HTML" => 1390 "PDF" => 545 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289616300060" "issn" => "03002896" "doi" => "10.1016/j.arbres.2016.02.013" "estado" => "S300" "fechaPublicacion" => "2016-10-01" "aid" => "1349" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2016;52:534-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4357 "formatos" => array:3 [ "EPUB" => 115 "HTML" => 3644 "PDF" => 598 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Neumonía por <span class="elsevierStyleItalic">Pneumocystis jirovecii</span> complicando la evolución de una paciente con glioblastoma multiforme en tratamiento con temozolomida" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "534" "paginaFinal" => "535" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Pneumocystis jirovecii</span> pneumonia complicating the progress of a patient with glioblastoma multiforme receiving temozolomide" ] ] "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" => 1424 "Ancho" => 1795 "Tamanyo" => 302914 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Imagen axial de la TC de cráneo, tras la administración de contraste intravenoso, en la que se observan 2 lesiones intraaxiales con realce en anillo (flechas), en hemisferio cerebral izquierdo, con importante efecto de masa y edema perilesional asociado. B) Radiografía anteroposterior de tórax, en la que se identifican opacidades de atenuación en vidrio deslustrado en ambos pulmones. C) Imagen axial de la TC de tórax (ventana de pulmón), en la que se visualiza un llamativo patrón en mosaico del parénquima pulmonar, alternándose áreas de atenuación en vidrio deslustrado con otras de menor densidad, típico de la infección por <span class="elsevierStyleItalic">Pneumocystis jirovecii</span>. D) Imagen axial de la TC de tórax (ventana de mediastino), con contraste intravenoso (obtenida al mismo nivel que la imagen C), en la que se demuestra un defecto de repleción central en la arteria lobar inferior derecha (flecha), en relación con un tromboembolismo pulmonar.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe Sarasúa, Almudena Ureña-Vacas, Jacobo Rodrigo Muñoz del Toro" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] 1 => array:2 [ "nombre" => "Almudena" "apellidos" => "Ureña-Vacas" ] 2 => array:2 [ "nombre" => "Jacobo Rodrigo" "apellidos" => "Muñoz del Toro" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212916301793" "doi" => "10.1016/j.arbr.2016.07.021" "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/S1579212916301793?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616300060?idApp=UINPBA00003Z" "url" => "/03002896/0000005200000010/v3_201609300128/S0300289616300060/v3_201609300128/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S157921291630043X" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.04.004" "estado" => "S300" "fechaPublicacion" => "2016-10-01" "aid" => "1350" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2016;52:535-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1523 "formatos" => array:3 [ "EPUB" => 113 "HTML" => 944 "PDF" => 466 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Autopsy Case of Pulmonary Artery Sarcoma Forming Aneurysm Without FDG Uptake" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "535" "paginaFinal" => "536" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Autopsia de un sarcoma de arteria pulmonar, que formaba un aneurisma sin captación de FDG" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2500 "Ancho" => 2215 "Tamanyo" => 483553 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET/CT showed FDG uptake in multiple lung nodules (A), but not in PA aneurysm (B). The thin arrow indicates PA aneurysm (B). Macroscopic findings from the specimen obtained by autopsy revealed PA leiomyosarcoma with cystic degeneration (C). PA, pulmonary artery; LA, left atrium; RA, right atrium.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Keisuke Watanabe, Masaharu Shinkai, Takeshi Kaneko" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Keisuke" "apellidos" => "Watanabe" ] 1 => array:2 [ "nombre" => "Masaharu" "apellidos" => "Shinkai" ] 2 => array:2 [ "nombre" => "Takeshi" "apellidos" => "Kaneko" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616300072" "doi" => "10.1016/j.arbres.2016.02.014" "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/S0300289616300072?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291630043X?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000010/v2_201609300109/S157921291630043X/v2_201609300109/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212916301781" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.07.020" "estado" => "S300" "fechaPublicacion" => "2016-10-01" "aid" => "1346" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2016;52:533-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1388 "formatos" => array:3 [ "EPUB" => 131 "HTML" => 897 "PDF" => 360 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Pseudochylotorax without Pleural Thickening Associated with Rheumatoid Arthritis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "533" "paginaFinal" => "534" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seudoquilotórax sin engrosamiento pleural asociado a artritis reumatoide" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 601 "Ancho" => 900 "Tamanyo" => 65608 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT image showing pleural effusion with no signs of pleural thickening.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lucía Zamora Molina, Guillermo Moreno Redondo, Alejandro Maestro Borbolla" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Lucía" "apellidos" => "Zamora Molina" ] 1 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Moreno Redondo" ] 2 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Maestro Borbolla" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616300035" "doi" => "10.1016/j.arbres.2016.02.010" "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/S0300289616300035?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301781?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000010/v2_201609300109/S1579212916301781/v2_201609300109/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "<span class="elsevierStyleItalic">Pneumocystis jirovecii</span> Pneumonia Complicating the Progress of a Patient with Glioblastoma Multiforme Receiving Temozolomide" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "534" "paginaFinal" => "535" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luis Gorospe Sarasúa, Almudena Ureña-Vacas, Jacobo Rodrigo Muñoz del Toro" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" "email" => array:1 [ 0 => "luisgorospe@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Almudena" "apellidos" => "Ureña-Vacas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Jacobo Rodrigo" "apellidos" => "Muñoz del Toro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neumonía por <span class="elsevierStyleItalic">Pneumocystis jirovecii</span> complicando la evolución de una paciente con glioblastoma multiforme en tratamiento con temozolomida" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1424 "Ancho" => 1795 "Tamanyo" => 297059 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Axial CT image of the head, after administration of intravenous contrast medium, showing 2 intra-axial ring enhancing lesions (arrows) in the left cerebral hemisphere, with a significant mass effect and associated perilesional edema. (B) Anteroposterior chest radiograph showing ground glass opacities in both lungs. (C) Axial image of chest CT (lung window), showing a noteworthy mosaic pattern in the pulmonary parenchyma, with areas of ground glass attenuation alternating with others of less density, typical of <span class="elsevierStyleItalic">Pneumocystis jirovecii</span> infection. (D) Axial image of chest CT (mediastinum window) with intravenous contrast (obtained at the same level as image C), showing central filling defect in the right lower lobe artery (arrow), associated with pulmonary thromboembolism.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pneumocystis jirovecii</span> pneumonia (PJP) is an opportunistic infection that is particularly common in patients with human immunodeficiency virus (HIV), although it is also encountered in patients receiving corticosteroids, immunosupressants and anticancer drugs. Temozolomide is a relatively new alkylating anticancer agent used as a first-line drug in the treatment of glioblastoma multiforme (GM).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> A rare but serious complication of temozolomide is the appearance of PJP. The pathogenic mechanism is associated with the induction of lymphocytopenia and selective T cell dysfunction.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Few references are available in the literature that describe the development of PJP in patients receiving temozolomide treatment.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 69-year-old woman with a diagnosis of multifocal GM (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), who presented with a clinical picture of fever and rapidly progressing respiratory failure, 4 weeks after starting temozolomide and high-dose corticosteroids. Chest radiograph (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) showed increased ground glass density in both lungs, which was confirmed on chest computed tomography (CT) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). An incidental finding was bilateral pulmonary thromboembolism (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). PJP was suspected, so fiberoptic bronchoscopy was performed which confirmed PJP in bronchoalveolar lavage. The patient responded favorably, both clinically and radiologically, to anticoagulants and antibiotic treatment with trimethoprim–sulfamethoxazole.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">PJP is a serious, opportunistic infection, commonly seen in patients with advanced HIV infection, but it can also affect patients who are immune deficient for other reasons (high corticosteroid doses or immunosuppressants, anticancer treatments, etc.). In recent years, the incidence of PJP has risen in non-HIV patients. Moreover, in patients without HIV, PJP is more aggressive and generally has a higher mortality rate than in patients with HIV infection.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Temozolomide is a relatively new alkylating anticancer drug used in the treatment of high-grade glial tumors. One of its effects is to induce lymphocytopenia and T cell dysfunction, predisposing patients to developing PJP. This complication is particularly common in patients receiving concomitant corticosteroids and radiation therapy (2 standard treatments in patients with central nervous system tumors), so the prophylactic administration of trimethoprim–sulfamethoxazole is usually recommended to prevent its appearance.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Thromboembolic disease is also relatively common in patients with glioblastoma (up to 33% of GM patients develop deep vein thrombosis and/or pulmonary embolism, according to a recent study), particularly in the first month after neurosurgery and during chemotherapy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Few references are available in the literature that describe PJP in patients receiving temozolomide and to our knowledge none has described concomitancy with pulmonary thromboembolism.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We believe that knowledge of this specific infectious respiratory complication in GM patients receiving temozolomide is important for early detection and optimal management.</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: Sarasúa LG, Ureña-Vacas A, Muñoz del Toro JR. Neumonía por <span class="elsevierStyleItalic">Pneumocystis jirovecii</span> complicando la evolución de una paciente con glioblastoma multiforme en tratamiento con temozolomida. Arch Bronconeumol. 2016;52:534–535.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1424 "Ancho" => 1795 "Tamanyo" => 297059 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Axial CT image of the head, after administration of intravenous contrast medium, showing 2 intra-axial ring enhancing lesions (arrows) in the left cerebral hemisphere, with a significant mass effect and associated perilesional edema. (B) Anteroposterior chest radiograph showing ground glass opacities in both lungs. (C) Axial image of chest CT (lung window), showing a noteworthy mosaic pattern in the pulmonary parenchyma, with areas of ground glass attenuation alternating with others of less density, typical of <span class="elsevierStyleItalic">Pneumocystis jirovecii</span> infection. (D) Axial image of chest CT (mediastinum window) with intravenous contrast (obtained at the same level as image C), showing central filling defect in the right lower lobe artery (arrow), associated with pulmonary thromboembolism.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current medical treatment of glioblastoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.A. Venur" 1 => "D.M. Peereboom" 2 => "M.S. Ahluwalia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/978-3-319-12048-5_7" "Revista" => array:6 [ "tituloSerie" => "Cancer Treat Res" "fecha" => "2015" "volumen" => "163" "paginaInicial" => "103" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25468228" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Selective lymphopenia and opportunistic infections in neuroendocrine tumor patients receiving temozolomide" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.B. Schwarzberg" 1 => "E.H. Stover" 2 => "T. Sengupta" 3 => "A. Michelini" 4 => "M. Vincitore" 5 => "L.R. Baden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/07357900701206380" "Revista" => array:7 [ "tituloSerie" => "Cancer Invest" "fecha" => "2007" "volumen" => "25" "paginaInicial" => "249" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17612935" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109704019424" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Temozolomide-related infections: review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.C. Kizilarslanoglu" 1 => "S. Aksoy" 2 => "N.O. Yildirim" 3 => "E. Ararat" 4 => "I. Sahin" 5 => "K. Altundag" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J BUON" "fecha" => "2011" "volumen" => "16" "paginaInicial" => "547" "paginaFinal" => "550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22006764" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Pneumocystis jirovecii</span> pneumonia in non-HIV infected patients in the era of novel immunosuppressive therapies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Tasaka" 1 => "H. Tokuda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10156-012-0453-0" "Revista" => array:6 [ "tituloSerie" => "J Infect Chemother" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "793" "paginaFinal" => "806" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22864454" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent venous thromboembolism in glioblastoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N.C. Edwin" 1 => "M.N. Khoury" 2 => "D. Sohal" 3 => "K.R. McCrae" 4 => "M.S. Ahluwalia" 5 => "A.A. Khorana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.thromres.2015.11.027" "Revista" => array:6 [ "tituloSerie" => "Thromb Res" "fecha" => "2016" "volumen" => "137" "paginaInicial" => "184" "paginaFinal" => "188" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26657302" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000010/v2_201609300109/S1579212916301793/v2_201609300109/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000010/v2_201609300109/S1579212916301793/v2_201609300109/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301793?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 4 | 6 |
| 2024 October | 46 | 22 | 68 |
| 2024 September | 68 | 17 | 85 |
| 2024 August | 80 | 35 | 115 |
| 2024 July | 51 | 29 | 80 |
| 2024 June | 70 | 27 | 97 |
| 2024 May | 83 | 26 | 109 |
| 2024 April | 41 | 27 | 68 |
| 2024 March | 43 | 28 | 71 |
| 2024 February | 47 | 18 | 65 |
| 2023 March | 9 | 2 | 11 |
| 2023 February | 39 | 19 | 58 |
| 2023 January | 33 | 39 | 72 |
| 2022 December | 45 | 36 | 81 |
| 2022 November | 49 | 24 | 73 |
| 2022 October | 40 | 34 | 74 |
| 2022 September | 30 | 25 | 55 |
| 2022 August | 42 | 37 | 79 |
| 2022 July | 25 | 44 | 69 |
| 2022 June | 33 | 30 | 63 |
| 2022 May | 37 | 30 | 67 |
| 2022 April | 41 | 30 | 71 |
| 2022 March | 43 | 47 | 90 |
| 2022 February | 40 | 43 | 83 |
| 2022 January | 45 | 46 | 91 |
| 2021 December | 58 | 43 | 101 |
| 2021 November | 74 | 50 | 124 |
| 2021 October | 57 | 48 | 105 |
| 2021 September | 37 | 52 | 89 |
| 2021 August | 33 | 32 | 65 |
| 2021 July | 41 | 35 | 76 |
| 2021 June | 46 | 36 | 82 |
| 2021 May | 47 | 36 | 83 |
| 2021 April | 117 | 73 | 190 |
| 2021 March | 58 | 26 | 84 |
| 2021 February | 32 | 24 | 56 |
| 2021 January | 39 | 21 | 60 |
| 2020 December | 42 | 28 | 70 |
| 2020 November | 52 | 15 | 67 |
| 2020 October | 30 | 19 | 49 |
| 2020 September | 39 | 16 | 55 |
| 2020 August | 57 | 21 | 78 |
| 2020 July | 52 | 24 | 76 |
| 2020 June | 30 | 11 | 41 |
| 2020 May | 45 | 11 | 56 |
| 2020 April | 37 | 28 | 65 |
| 2020 March | 35 | 14 | 49 |
| 2020 February | 46 | 27 | 73 |
| 2020 January | 39 | 23 | 62 |
| 2019 December | 43 | 28 | 71 |
| 2019 November | 42 | 20 | 62 |
| 2019 October | 33 | 22 | 55 |
| 2019 September | 31 | 16 | 47 |
| 2019 August | 29 | 16 | 45 |
| 2019 July | 38 | 23 | 61 |
| 2019 June | 26 | 8 | 34 |
| 2019 May | 37 | 21 | 58 |
| 2019 April | 43 | 41 | 84 |
| 2019 March | 37 | 31 | 68 |
| 2019 February | 26 | 38 | 64 |
| 2019 January | 27 | 14 | 41 |
| 2018 December | 32 | 18 | 50 |
| 2018 November | 77 | 15 | 92 |
| 2018 October | 66 | 37 | 103 |
| 2018 September | 36 | 18 | 54 |
| 2018 May | 21 | 0 | 21 |
| 2018 April | 53 | 7 | 60 |
| 2018 March | 45 | 4 | 49 |
| 2018 February | 67 | 11 | 78 |
| 2018 January | 148 | 9 | 157 |
| 2017 December | 133 | 4 | 137 |
| 2017 November | 29 | 7 | 36 |
| 2017 October | 19 | 9 | 28 |
| 2017 September | 30 | 4 | 34 |
| 2017 August | 17 | 15 | 32 |
| 2017 July | 14 | 10 | 24 |
| 2017 June | 34 | 14 | 48 |
| 2017 May | 25 | 11 | 36 |
| 2017 April | 18 | 11 | 29 |
| 2017 March | 18 | 6 | 24 |
| 2017 February | 10 | 7 | 17 |
| 2017 January | 15 | 7 | 22 |
| 2016 December | 1 | 0 | 1 |
Show all
