Alexithymia and perception of illness in patients with cancer.

This study aimed to determine how alexithymia affects the perception of illness in patients with cancer. This was a descriptive study conducted at the Atatürk University Health, Research and Practice Hospital and the Erzurum Regional Training and Research Hospital's Medical Oncology Clinic and Chemotherapy Unit. The study data were collected between July 2013 and January 2014. In total, data were collected from 283 patients with cancer. The data were collected using questionnaires enquiring about demographic and medical information: the IPQ and TAS-20. The study concluded that 50.5% of the participating patients had alexithymia. It was found that the alexithymic patients with cancer perceived the negative outcomes of their illness more strongly, and their negative feelings about the illness were more intense. This study suggests that further research should be carried out on alexithymia in patients with cancer and that their positive beliefs about the illness could be enhanced using psychosocial interventions.

Quality of life after thyroid surgery.

PURPOSE: The purpose of this study was to inquire how patients' quality of life is affected after thyroid surgery and the factors involved. METHODS: A semi-structured questionnaire and the World Health Organization Quality of Life Scale (WHOQOL-BREF) were applied to 101 patients prior to surgery. Thereafter data was collected in the early and again in the late post-operative period. RESULTS: Mean general health score for pre-operative quality of life was 6.72 ± 1.53 (3-10), mean physical field score was 22.81 ± 2.77 (17-31), mean psychological field score was 21.69 ± 2.78 (15-28), mean social field score was 11.10 ± 1.94 (5-15) and mean environmental field score was 27.86 ± 4.30 (18-39). In the early post-operative period, mean general health score was 7.05 ± 1.45 (4-10), mean physical field score was 22.84 ± 2.83 (14-29), mean psychological field score was 21.67 ± 2.32 (16-27), mean social field score was 10.89 ± 1.96 (5-15) and mean environmental field score was 28.56 ± 4.18 (18-40). In the late post-operative period, the general health score for quality of life was 7.43 ± 1.34 (4-10), mean physical field score was 23.59 ± 2.70 (17-35), mean psychological field score was 21.75 ± 2.34 (14-29), mean social field score was 11.23 ± 1.94 (6-15) and mean on-field environment score was 29.30 ± 3.96 (16-40). The pre-operative levels of symptoms were found to be higher than early and late post-operative periods. CONCLUSIONS: Quality of life increased after total thyroidectomy and statistically significant improvement was observed in late post-operative stage.

Efficiency of some soil bacteria for chemical oxygen demand reduction of synthetic chlorsulfuron solutions under agiated culture conditions.

This study searches the efficiency of certain soil bacteria on chemical oxygen demand (COD) reduction of synthetic chlorsulfuron solutions under agitated culture conditions. It also aims to determine the turbidity of liquid culture medium with chlorsulfuron during bacterial incubation for 120 hours. As a result the highest and lowest COD removal efficiency of bacteria was determined for Bacillus simplex as 94% and for Micrococcus luteus as 70%, respectively at the end of the 96th hour. It was found that COD removal efficiency showed certain differences depend on the bacterial species. It was also observed that B. simplex had the highest COD removal efficiency and it was a suitable bacterium species for bioremediation of a chlorsulfuron contaminated soils.

Capacity of a newly isolated fungus Pleurotus eryngii from Tunceli, Ovacik for chemical oxygen demand reduction and biodecolorization of Azo-Dye Congo Red.

Biodecolorization of Congo red dye in both agar—plate and agitated liquid culture mediums by newly isolated white rot fungus Pleurotus eryngii has been studied. This fungus isolated from Tunceli—Ovacik province of Turkey. We have also examined the chemical oxygen demand reduction after decolorization under agitated liquid culture medium. For agar plate screening the decolorization capacity of P. eryngii, growth and decolorization halos were determined on saboroud dextrose agar (SDA) plates containing 0.05, 0.1, 0.5, 1 and 2 g/l of Congo red. P. eryngii showed certain decolorization capacities and was able to decolorize all studied concentrations of Congo red, but not to the same extent. Our results indicated that the new isolate P. eryngii had maximum decolorization (87% at 100 mg/l initial dye concentration) and chemical oxygen demand reduction (82% at 25 mg/l initial dye concentration) activities after 7 days under agitated submerged culture conditions. This new isolate could be an effective bioremediation tool for treatment of Congo red containing textile wastewater.

Essential oil composition, antioxidant and antifungal activities of Salvia sclarea L. from Munzur Valley in Tunceli, Turkey.

The essential oil composition and in vitro antioxidant and antifungal activity of the Salvia sclarea L. from Munzur Valley in Tunceli, Turkey were evaluated in this research. The in vitro antifungal activity of ethanol, hexane and aqueous extracts of S. sclarea against pathogen fungi Epicoccum nigrum and Colletotrichum coccodes were investigated. The essential oil of aerial parts of S. sclarea was obtained by hydrodistillation and was analysed by GC and GC­MS. Total antioxidant status was determined by using Rel assay diagnostics TAS assay kit (Lot.RL024) by Multiscan FC (Thermo). 33 compounds were identified representing the 85.0% of the total oil. The most abundant components (>5%) of the S. sclarea essential oils were caryophyllene oxide (24.1%), sclareol (11.5%), spathulenol (11.4%), 1H-naphtho (2,1,6) pyran (8.6%) and b­caryophyllene (5.1%). The best antifungal and antioxidant effect was seen in ethanolic S. sclarea extract. It can be said that Salvia sclerae could be used as natural antioxidant.

Pomegranate seed extract attenuates chemotherapy-induced liver damage in an experimental model of rabbits.

The aim of this study was to determine whether antioxidant pomegranate seed extract (PSE) has a preventive effect on cisplatin-induced hepatotoxicity. Rabbits were divided into 3 groups (n=6):1­Control group (0.9 % saline. i.p) 2­Cisplatin group (a single dose of cisplatin (5 mg/kg, i.p) 3­ A single dose of cisplatin (5 mg/kg, i.p) + PSE (250 mg/kg/day, i.p) for 6 consecutive days before and 6 consecutive days after a single intraperitoneal dose of 5 mg/kg body weight cisplatin. Liver function enzymes and malondialdehyde (MDA) levels were found significantly higher in cisplatin group compared to control. Liver catalase (CAT) and glutathione peroxidase (GSH-PX) activities decreased with cisplatin treatment but glutathione (GSH) level was increased. In cisplatin + PSE group, liver function enzyme activities and tissue MDA levels were found lower than cisplatin group. PSE ameliorated cisplatin-induced pathological changes. As a result it was demonstrated that PSE has protective effects against cisplatin hepatotoxicity in rabbit.

Evaluation of antioxidant properties, elemental and phenolic contents composition of wild nettle (Urtica dioica L.) from Tunceli in Turkey.

Wild nettle (Urtica dioica L.) types were sampled from different geographical regions in Tunceli (Turkey) to determine their mineral, vitamin, phenolic contents and their antioxidant properties. The total phenol varied from 37.419 ± 0.380 to 19.182 ± 1.00 mg of GAEs g(-1) of dry nettle. The highest radical scavenging effect was observed in Mazgirt parting of the ways 7.5 km with 33.70 ± 0.849 mg mL(-1). The highest reducing power was observed in the nettles from Mazgirt parting of the ways 7.5 km. Among the various macronutrients estimated in the plant samples, potassium was present in the highest quantity followed by calcium and phosphate. Kaempferol and resveratrol were not determined in some nettle samples but rutin levels were determined in all samples. Vitamin A concentrations were ranged between 13.64 ± 1.90 and 5.74 ± 1.00 (mg kg(-1) dry weight). These results show that Urtica dioica L. collected from Tunceli in Turkey could be considered as a natural alternative source for food, pharmacology and medicine sectors.

Comparison of kinesiophobia in patients with rheumatoid arthritis and systemic lupus erythematosus.

OBJECTIVE: Patients with rheumatic disease often experience arthritis and chronic joint pain, which can lead them to avoid movement, known as kinesiophobia. This may result in decreased mobility and endurance, as well as social isolation and depression. This study aimed to assess and compare the prevalence of kinesiophobia among patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), and its association with disease activity, functional status, fear of falling, and fatigue. PATIENTS AND METHODS: A cross-sectional study was conducted with 124 RA, 76 SLE patients, and 87 healthy controls. The tampa kinesiophobia scale (TKS) was used to assess kinesiophobia. The disease activity was assessed using Disease Activity Score 28 (DAS28) in RA, and systemic lupus erythematosus Disease Activity Index 2000 (SLEDAI-2K) in SLE patients. The Health Assessment Questionnaire (HAQ) was used to assess functional status, the Falls Efficacy Scale International (FES-I) was used to assess fear of falling, and the Fatigue Severity Scale (FSS) was used to assess fatigue levels. RESULTS: Kinesiophobia was significantly more prevalent in RA patients compared to SLE patients [77.4% vs. 63.2%, odds ratio (OR): 2, 95% CI: 1.07-3.75; p<0.05]. The mean TKS score was 41.42±6.95 in RA patients, and 37.84±8.85 in SLE (p=0.005). TKS scores were positively correlated with DAS28 in RA patients; however, no correlation was found between SLEDAI-2K in SLE patients. A positive correlation was observed between TKS scores and the HAQ, FSS, and FES-I, both in RA and SLE patients. CONCLUSIONS: RA patients exhibited significantly higher kinesiophobia scores compared to SLE patients. The higher rate of kinesiophobia levels in RA patients compared to SLE patients suggests an association between kinesiophobia and the more destructive course of RA, indicating that tight control of the disease is important. Kinesiophobia was associated with functional impairment, fear of falling, and fatigue. Timely identification and intervention for patients with kinesiophobia are essential to prevent progression, mitigate long-term consequences, and maintain functional capacity.

The effect of climatic and seasonal factors on the microbial keratitis profile.

PURPOSE: To compare retrospective data on microbial keratitis (MK) from two different climatic regions in Turkey over 11 years. STUDY DESIGN: Retrospective cohort. METHODS: This retrospective cohort study included patients diagnosed with presumed MK at two referral centers. Center A was located in the subtropical region of Turkey, whereas Center B was located in a continental temperate climate zone. Clinical and laboratory data were also recorded. The results were evaluated for seasonal variations. RESULTS: This study included data from 665 patients with presumed MK (351 and 314 patients from centers A and B, respectively). The most common predisposing factors were ocular trauma in Center A, prior ocular surgery, and systemic disease in Center B. Severe keratitis was related to prior ocular surgery, presence of systemic disease, and fungal infection at presentation. The culture positivity rate was higher in spring and lower in summer at both centers. Gram-positive bacteria were the most commonly isolated bacteria in both centers in all seasons. The fungal and mixed keratitis ratios were higher in Center A than in Center B. In Center A, filamentous fungi were common pathogens that were found year-round, and peaks were observed in July and October. CONCLUSION: The results of this study show that climatic and seasonal factors may affect the microbial profile of keratitis. Fungal keratitis appears to be a climatic disease. Understanding the regional profile of MK can aid clinicians in their disease management.

Single high dose atorvastatin does not ameliorate endothelial function and large arterial stiffness in dyslipidemic patients without atherosclerosis.

BACKGROUND: Many studies show that statins have beneficial effects on atherosclerotic risk factors and markers such as flow mediated dilatation (FMD). However, studies on early effects of statins on endothelial function of non atherosclerotic humans are limited. AIM: The purpose of this study was to determine whether a single high dose of atorvastatin could improve endothelial function and large arterial stiffness in statin naive dyslipidemic non-atherosclerotic patients. MATERIALS AND METHODS: Thirty statin naïve dyslipidemic non-atherosclerotic patients from Cardiology Outpatient Clinic were enrolled. Arterial stiffness and endothelial function of patients were evaluated by assessing the finger photoplethysmography and the flow-mediated dilatation (FMD) of the brachial artery before and 24 hour after oral administration of 80 mg atorvastatin. RESULTS: Stiffness indices and FMD 24 hours after administration of 80mg atorvastatin did not differ from baseline measurements (6.89 +/- 1.90 vs. 7.06 +/- 2.37 p : NS and 9.13 +/- 6.07 vs. 9.80 +/- 6.34 p : NS). CONCLUSIONS: Although it is widely accepted that statins improve endothelial function, evidences of early effect might largely be associated with endothelial injury. Our study suggests that beneficial early effects of statins might not be applicable to patients without atherosclerosis.

Genetic and biochemical differentiation in Vitis vinifera (Kabarcik) populations grown at different altitudes in Coruh Valley.

We examined genetic differences of four Vitis vinifera populations (A, B, C, D) including local Kabarcik cultivar grown along an altitude gradient of 800, 900, 1000, and 1150 m above sea level in the Coruh Valley (800 m: A population; 900 m: B population; 1000 m: C population; 1150 m: D population). Leaf samples were used for both RAPD and fatty acid analysis. A total of 60 individuals with 15 individuals per population were included in this study. RAPD analyses showed various band sizes, which ranged from 250 to 3000 bp. Mean polymorphic locus ratios were determined as 96.29% considering four populations. The highest percentage of polymorphic loci (97.8%) was produced by the highest altitude. Thirty-two different fatty acids were found; linoleic acid was the most common in all four populations. According to the dendograms obtained from statistical analyses of RAPD and fatty acid profiles the populations that were close to each other in terms of geographical distance also were similar genetically.

Assessment of left ventricular systolic and diastolic dyssynchrony with tissue Doppler echocardiography in patients with heart failure and narrow QRS complex.

AIM: Cardiac dyssynchrony is a well known entity in patients with wide QRS complex (>120 ms). Dyssynchrony may also cause ventricular dysfunction in heart failure patients with narrow QRS complexes. In the study, the presence and extent of cardiac dyssynchrony were investigated in patients with heart failure both with narrow and wide QRS complexes using tissue Doppler echocardiography (TDE). METHODS: Forty-nine patients with heart failure, were included to the study. The first group of 30 patients with a QRS duration of <120 ms (23M; mean age, 64±10.1 years) and the second group consisted of 19 patients with a QRS duration of >120 ms (12M; mean age, 65±11.6 years). In order to examine cardiac synchronization, TDE was performed. Systolic and diastolic intraventricular dyssynchrony and interventricular dyssynchrony were calculated. In order to define systolic and diastolic dyssynchrony, intraventricular delay was accepted as >60 ms, and interventricular delay was accepted as >40 ms. RESULTS: Left ventricular systolic dyssynchrony was detected in 18 patients (60%) within the narrow QRS group and in 18 patients (94%) within the wide QRS group. Interventricular dyssynchrony was detected in 17 patients (56%) within the narrow QRS group and in 18 patients (94%) within the wide QRS group. For systolic dyssynchrony, correlations existed between intraventricular delay and QRS duration (r=0.48), left ventricular end diastolic diameter (r=0.62), left ventricular end systolic diameter (r=0.61), and EF (r=-0.63). Similarly, correlations existed between interventricular delay and QRS duration (r=0.58), left ventricular end diastolic diameter (r=0.65), left ventricle end systolic diameter (r=0.64), and EF (r=-0.64). CONCLUSION: The present study suggested that systolic or diastolic dyssynchrony exists despite normal levels of QRS duration.

Genetic relationships among wild pomegranate (Punica granatum) genotypes from Coruh Valley in Turkey.

The pomegranate has been used traditionally in Coruh Valley in Turkey for a long time; fruits are harvested from wild, semi-domesticated and cultivated trees. In the valley, it occurs in general along with olive trees. We sampled 23 wild-grown pomegranate genotypes sampled from different parts of Coruh Valley and compared them using RAPD primers to determine genetic variability. Eighty-six RAPD primers were used for molecular characterizations, among which 12 gave reliable polymorphic patterns. These primers generated 145 RAPD bands of which 91% were polymorphic. The highest polymorphism ratio was observed with primers OPY06, OPY13, OPBA03, OPBB03, OPBB07, and OPBB09 (100%), while the lowest was with OPBB09 and OPBB10 (75%). The band size was between 250 and 2400 bp. There were five main clusters in the dendrogram; the highest genetic similarity was 0.24 and the lowest was 0.08.

Genetic diversity in wild sweet cherries (Prunus avium) in Turkey revealed by SSR markers.

Wild sweet cherry (Prunus avium) trees are abundant in the northern part of Turkey, including the Coruh Valley. We analyzed 18 wild sweet cherry genotypes collected from diverse environments in the upper Coruh Valley in Turkey to determine genetic variation, using 10 SSR primers. These SSR primers generated 46 alleles; the number of alleles per primer ranged from 3 to 7, with a mean of 4.6. The primer PS12A02 gave the highest number of polymorphic bands (N = 7), while CPSCT010, UDAp-401 and UDAp-404 gave the lowest number (N = 3). Seven groups were separated in the dendrogram, although most of the genotypes did not cluster according to phenological and morphological traits. This level of genetic diversity in these wild sweet cherry genotypes is very high and therefore these trees would be useful as breeders for crosses between cultivated sweet cherry and wild genotypes.

Temozolomide-related infections: review of the literature.

Temozolomide (TMZ) is an alkylating, antineoplastic agent which is being used to treat cases of refractory anaplastic astrocytoma, newly-diagnosed glioblastoma multiforme and metastatic melanoma. TMZ causes lymphopenia and T-cell dysfunction in most of the patients. Related to this toxicity several opportunistic infections have been reported in the literature, but were not well characterized. To further investigate this topic, relevant English language studies were identified through Medline. There were 36 previously reported cases of infection related to TMZ. The median age of the cases was 55 years (range 33-73). The most frequently experienced infections were mucocutaneous candidiasis (n=11; 28.2%), herpes zoster (n=5; 12.8%), herpes simplex virus (n=4; 10.2%), cytomegalovirus (CMV) (n=5; 12.8%), pneumocystis carinii pneumonia (PCP) (n=3; 7.6%), hepatitis B virus (HBV) (n=2; 5.1%) and others (n=9; 23%). Mortality rates were 28.5% (n=4/14) in patients with reported outcome. In this survey, about one third of the TMZ-related severe infections resulted in death. Patients treated with TMZ are at increased risk for opportunistic viral and bacterial infection. Therefore, close monitoring of patients receiving TMZ for opportunistic infections should be carried out.

Favorable outcome with sentinel lymph node biopsy alone after neoadjuvant chemotherapy in clinically node positive breast cancer at diagnosis: Turkish Multicentric NEOSENTI-TURK MF-18-02-study.

PURPOSE: Factors affecting local outcome were evaluated in patients with clinically node-positive (cN+) breast cancer at diagnosis, who underwent sentinel lymph node biopsy (SLNB) alone after neoadjuvant chemotherapy (NAC). METHODS: Between 2004 and 2018, 303 cytopathology-proven cN (+) patients in a multicentric registry, who received NAC and underwent SLNB alone were analysed. All patients had regional nodal irradiation. RESULTS: Median age was 46 (23-70). Of those, 211 patients had ypN0 disease (69.6%), whereas 92 patients had ypN (+) disease including 19 (20.6%) isolated tumor cells (ITC), 33 micrometastases (35.9%) and 40 macrometastases (43.5%). At a median follow-up of 36 months (24-172), one patient (0.3%) with macrometastatic SLN was found to have locoregional recurrence as chest wall and supraclavicular LN metastases at the 60th month. Five-year disease-free survival (DFS) and disease specific survival (DSS) rates were 87% and 95%, respectively. Patients with cT3/4 (HR = 2.41, 95% CI; 1.14-5.07), non-luminal molecular pathology (HR = 2.60, 95% CI, 1.16-5.82), and non-pCR in the breast (HR = 2.11, 95% CI, 0.89-5.01) were found to have an increased HR compared to others in 5-year DFS. However, no difference could be found between ypN0 and ypN ITC and micrometastasis (HR = 1.23, 95% CI, 0.44-3.47), whereas there was a slight increase in HR of patients with ypN macrometastasis versus ypN0 (HR = 1.91, 95% CI, 0.63-5.79). CONCLUSION: ALND could be avoided in meticulously selected cN (+) patients who underwent SLNB after NAC having breast and/or nodal pCR, cT1-2, or low volume residual nodal disease with luminal pathology, as long as axillary radiotherapy is provided.

The effect of adrenomedullin and cold stress on interleukin-6 levels in some rat tissues.

Stress known to stimulate sympathetic activity, as well as the hypothalamic-pituitary-adrenal axis (HPA), produces a significant increase in adrenomedullin (AdM) levels, suggesting a regulatory or protective role for AdM in countering HPA activation that follows a variety of stressors. Stressors can modulate the secretion of proinflammatory cytokines. Interleukin (IL)-6 is a potent activator of the HPA and appears to play a pathogenic role in conditions related to stress. In the present study, we investigated the administration of AdM on IL-6 levels in cold exposed rats. Male Wistar rats were divided into four groups as control, adrenomedullin treatment, cold stress and cold stress+adrenomedullin-treated groups. In the adrenomedullin-treated group, animals received intraperitoneal (i.p.) injection of adrenomedullin (2000 ng/kg body weight) once a day for a week. For the cold stress exposure the rats were kept in separate cages at 10 degrees C for a week. Control group rats were kept in laboratory conditions. The concentration of IL-6 was determined using an enzyme-linked immunosorbent assay (ELISA) kit. When compared to control, IL-6 levels increased significantly in the cold stress- and adrenomedullin-treated groups (P<0.05). Administration of AdM in addition to cold stress decreased IL-6 levels in lung and liver, but increased in brain and heart when compared to control (P<0.05). The results suggest that cold stress may induce increase of rat proinflammatory cytokine IL-6 and adrenomedullin may play a regulatory or protective role for cold stress.

Genetic variation among date plum (Diospyros lotus) genotypes in Turkey.

Turkey is one of the most important genetic resources of the date plum, Diospyros lotus, especially in the northeastern part of the country. Authenticating the identity of germplasm resources of D. lotus would be of great value for breeding. We examined the genetic variability of 11 D. lotus genotypes sampled from Coruh Valley in Turkey. One hundred and twenty-eight DNA markers were generated by 12 random primers. The highest polymorphism ratio was observed with the primer OPA-01 (71%) while the lowest was with OPY-01 (36%). The band size was between 350 and 2500 bp for these primers. The percentage of polymorphic bands was 58%, which demonstrated the efficiency of these primers. The similarity between genotypes ranged from 0.48 to 0.76. The RAPD markers permitted us to distinguish all the genotypes.

Genetic relationships among turnip (Brassica rapa var. rapa) genotypes.

Turnip (Brassica rapa var. rapa) is one of the main vegetables consumed by people living in Eastern Anatolia in Turkey. In this region, farmers obtain their own seeds for production, which results in considerable morphological variability. We examined the genetic variation and relationships among 11 turnip genotypes sampled from diverse environments of the Erzurum region located in Eastern Anatolia in Turkey. Thirty-two Operon RAPD primers were screened; among them, 20 gave reproducible and clear DNA fragments after amplification. The average polymorphism ratio was 90.4%. The genetic distance between turnip genotypes were found to range from 0.302 to 0.733, indicating high genetic variability. Eleven genotypes were divided into three main clusters in a dendrogram; ETS2 and ETS8 genotypes were the most distant. We conclude that RAPD analysis would be useful for genotyping turnip genotypes.

Serum vitamin D status and bone mineral density in fibromyalgia.

OBJECTIVES: To compare serum vitamin D levels and bone mineral density (BMD) values in patients with fibromyalgia and healthy controls. BACKGROUND: The so far available reports of low levels of vitamin D and low BMD values in patients with fibromyalgia are inconsistent. METHODS: Serum 25-hydroxyvitamin D (25-OHD) levels and BMD values were measured in thirty women with fibromyalgia and compared with thirty age-matched healthy women. Serum calcium, phosphorus, alkaline phosphatase and parathyroid hormone (PTH) levels were also measured. All participants completed the Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Score (HADS). Pain severity was assessed with visual analog scale (VAS). RESULTS: Mean serum 25-OHD levels did not differ between the groups (fibromyalgia 10.57 +/- 10.46, controls 10.87 +/- 5.52 ng/l; p=0.89); nor did the frequency of vitamin D deficiency (25-OHD < or = 20 ng/l) in each group (fibromyalgia 86.7%, controls 96.7%; p=0.353). Although, mean serum PTH level was found significantly higher in fibromyalgic patients than in controls (p=0.014), only one patient and two of controls had barely elevated PTH levels. There was no relationship between vitamin D level and FIQ score (p=0.707) or HADS (p=0.824) or pain VAS (p=0.414). BMD values in the patients with fibromyalgia were comparable to those in controls at both, the lumbar spine (p=0.866) and femur neck (p=0.61). CONCLUSION: Neither vitamin D levels nor BMD values are different between women with and without fibromyalgia. In this cross-sectional study, mean serum PTH level was found higher in the fibromyalgic patients than in controls. Nevertheless, in order to confirm the findings of this preliminary study it is still necessary to perform a controlled longitudinal study (Tab. 2, Fig. 2, Ref. 35). Full Text in free PDF www.bmj.sk.