1
|
Protano C, Vitali M, De Giorgi A, Marotta D, Crucianelli S, Fontana M. Balneotherapy using thermal mineral water baths and dermatological diseases: a systematic review. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024; 68:1005-1013. [PMID: 38530467 PMCID: PMC11108950 DOI: 10.1007/s00484-024-02649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/28/2024]
Abstract
Balneotherapy includes practices and methods using medically and legally recognized mineral-medicinal waters, muds and natural gases from natural springs for therapeutic purposes. One of the most widely used method in balneotherapy is bathing with thermal mineral water. In the course of the years, scientific community has produced an increasing number of evidences that this practice is an effective method for treating signs and symptoms of several pathologies such as rheumatic, cardiovascular and dermatological diseases. This systematic review is aimed at evaluating the effect of balneotherapy with thermal water baths as a treatment to manage signs and symptoms of patients affected by all types of dermatological diseases. The systematic review was conducted according to the PRISMA Statement, and its protocol was registered on PROSPERO platform (CRD42022295913). The research was performed on the databases Pubmed, Scopus, Web of Science and Cochrane. We included clinical trials evaluating the effects of balneotherapy using thermal mineral water baths for managing dermatological diseases in humans, published in English and Italian language. Eight studies were included, seven of them enrolled adults affected by psoriasis and one studied atopic dermatitis patients. The common result of all the articles included was a clear improvement of signs and symptoms of psoriasis and eczematous diseases after use of thermal mineral water baths. These effects seem to be strictly related to physical and chemical properties of thermal water used for balneotherapy. However, studies in this field are still limited to support robust evidence of the effectiveness of balneotherapy using thermal mineral water baths and often their quality is low. Thus, new clinical studies need to be carried out, using more correct methods for conducting the studies and for processing statistical data.
Collapse
Affiliation(s)
- Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.Le Aldo Moro 5, 00185, Rome, Italy.
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.Le Aldo Moro 5, 00185, Rome, Italy
| | - Andrea De Giorgi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.Le Aldo Moro 5, 00185, Rome, Italy
| | - Daniela Marotta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.Le Aldo Moro 5, 00185, Rome, Italy
| | - Serena Crucianelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, P.Le Aldo Moro 5, 00185, Rome, Italy
| | - Mario Fontana
- Department of Biochemical Sciences, Sapienza University of Rome, P.Le Aldo Moro 5, 00185, Rome, Italy
| |
Collapse
|
2
|
von Martial S, Tsianakas A. [Medical rehabilitation in dermatology : Goals, program content, and application process]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:366-376. [PMID: 38649555 DOI: 10.1007/s00105-024-05337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Medical rehabilitation plays an important role in the management of patients with chronic dermatoses and dermato-oncological diseases. OBJECTIVES Which dermatological indications qualify for a medical rehabilitation? What forms need to be completed for a successful application? Which treatments are provided and what are goals to be accomplished during dermatological rehabilitation? MATERIALS AND METHODS Evaluation of current guidelines, directives, and recommendations as well as exemplary reviews. RESULTS Dermato-oncological diseases and every chronic dermatological disease that is associated with a limitation of body functions and structures, activity and participation is eligible for medical rehabilitation. They include need, ability to absolve a rehabilitation, and a favorable prognosis. Treatments range from therapy of the underlying dermatological condition to interdisciplinary treatment of comorbidities with the aim of restoring functional health. CONCLUSIONS Medical rehabilitation follows a holistic approach and represents a significant addition to outpatient and acute inpatient care, often leading to a long-term improvement in clinical outcome, participation, and activity.
Collapse
Affiliation(s)
| | - A Tsianakas
- Klinik für Dermatologie und Allergologie, Fachklinik Bad Bentheim, Am Bade 1, 48455, Bad Bentheim, Deutschland.
| |
Collapse
|
3
|
Chakraborty A. Bathing Practices in Dermatology: Uses and Implications for Patient Management. Indian Dermatol Online J 2023; 14:686-691. [PMID: 37727546 PMCID: PMC10506818 DOI: 10.4103/idoj.idoj_40_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Atreyo Chakraborty
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
4
|
Kulisch Á, Mándó Z, Sándor E, Lengyel Z, Illés A, Kósa J, Árvai K, Lakatos P, Tóbiás B, Papp M, Bender T. Evaluation of the effects of Lake Hévíz sulfur thermal water on skin microbiome in plaque psoriasis: An open label, pilot study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:661-673. [PMID: 36864227 DOI: 10.1007/s00484-023-02443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 06/19/2023]
Abstract
Psoriasis is a chronic inflammatory skin disease. It is associated with changes in skin microbiome. The aim of this study was to evaluate how Lake Hévíz sulfur thermal water influences the composition of microbial communities that colonizes skin in patients with psoriasis. Our secondary objective was to investigate the effects of balneotherapy on disease activity. In this open label study, participants with plaque psoriasis underwent 30-min therapy sessions in Lake Hévíz, at a temperature of 36 °C, five times a week for 3 weeks. The skin microbiome samples were collected by swabbing method from two different areas (lesional skin-psoriatic plaque and non-lesional skin). From 16 patients, 64 samples were processed for a 16S rRNA sequence-based microbiome analysis. Outcome measures were alpha-diversity (Shannon, Simpson, and Chao1 indexes), beta-diversity (Bray-Curtis metric), differences in genus level abundances, and Psoriasis Area and Severity Index (PASI). Skin microbiome samples were collected at baseline, and immediately after treatment. Based on the visual examination of the employed alpha- and beta-diversity measures, no systematic difference based on sampling timepoint or sample location could be revealed in these regards. Balneotherapy in the unaffected area significantly increased the level of Leptolyngbya genus, and significantly decreased the level of Flavobacterium genus. A similar trend was revealed by the results of the psoriasis samples, but the differences were not statistically significant. In patients with mild psoriasis, a significant improvement was observed in PASI scores.
Collapse
Affiliation(s)
- Ágota Kulisch
- St. Andrew Hospital for Rheumatic Diseases, Schulhof Vilmos sétány 1., Hévíz, 8380, Hungary
| | - Zsuzsanna Mándó
- St. Andrew Hospital for Rheumatic Diseases, Schulhof Vilmos sétány 1., Hévíz, 8380, Hungary
| | - Enikő Sándor
- St. Andrew Hospital for Rheumatic Diseases, Schulhof Vilmos sétány 1., Hévíz, 8380, Hungary
| | - Zsuzsanna Lengyel
- Department of Dermatology, Venerology and Oncodermatology, Medical School, Clinical Center, University of Pécs, Akác utca 1., Pécs, 7632, Hungary
| | - Anett Illés
- Department of Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
| | - János Kósa
- Department of Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
- Endocrine Molecular Pathology Research Group, Eötvös Lóránd Research Network, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
- Vascular Diagnostics Kft., Lechner Ödön fasor 3. C. Lház. 3. Em. 1., Budapest, 1095, Hungary
| | - Kristóf Árvai
- Vascular Diagnostics Kft., Lechner Ödön fasor 3. C. Lház. 3. Em. 1., Budapest, 1095, Hungary
| | - Péter Lakatos
- Department of Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
- Endocrine Molecular Pathology Research Group, Eötvös Lóránd Research Network, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
- Vascular Diagnostics Kft., Lechner Ödön fasor 3. C. Lház. 3. Em. 1., Budapest, 1095, Hungary
| | - Bálint Tóbiás
- Endocrine Molecular Pathology Research Group, Eötvös Lóránd Research Network, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
- Vascular Diagnostics Kft., Lechner Ödön fasor 3. C. Lház. 3. Em. 1., Budapest, 1095, Hungary
| | - Márton Papp
- Centre for Bioinformatics, University of Veterinary Medicine Budapest, István utca 2., Budapest, 1078, Hungary
| | - Tamás Bender
- Polyclinic of the Hospitaller Brothers of St John of God, Árpád fejedelem útja 7., Budapest, 1023, Hungary.
| |
Collapse
|
5
|
Szenczi A, Peter I, Nusser N, Ajtay Z, Szendi K, Berenyi K, Horvath-Szalai Z, Szirmay B, Sumegi A, Hanzel A, Nemeth B. Is Balneotherapy Protective Against Oxidative Stress? A Pilot Study. In Vivo 2023; 37:858-861. [PMID: 36881082 PMCID: PMC10026676 DOI: 10.21873/invivo.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM This study aimed to research the effects of Harkány healing water on oxidative stress. The study was performed in a randomized, placebo-controlled, double-blind setup. PATIENTS AND METHODS Twenty patients with psoriasis who underwent a 3-week-long inward balneotherapy-based rehabilitation were enrolled. Psoriasis Area and Severity Index (PASI) score and Malondialdehyde (MDA) - a marker of oxidative stress - were determined, on admission and before discharge. Patients were treated with dithranol. RESULTS The mean PASI score - determined on admission and before discharge - decreased significantly after the 3-week-long rehabilitation 8.17 vs. 3.51 (p<0.001). The baseline MDA value of patients with psoriasis was significantly higher compared to controls (3.0±3.5 vs. 8.4±7.4) (p=0.018). MDA levels of patients receiving placebo water increased significantly compared to MDA levels of patients receiving healing water (p=0.049). CONCLUSION The effectiveness of dithranol resides in the formation of reactive oxygen species. No increased oxidative stress was found in the patients treated with healing water, thus healing water seems to be protective against oxidative stress. However, further research is needed to confirm these preliminary results.
Collapse
Affiliation(s)
- Agnes Szenczi
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | | | | | | | - Katalin Szendi
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary;
| | - Karoly Berenyi
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltan Horvath-Szalai
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Balazs Szirmay
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Andras Sumegi
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Adrienn Hanzel
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Balazs Nemeth
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
- Harkány Spa Hospital, Harkány, Hungary
| |
Collapse
|
6
|
Mind-Body Interventions as Alternative and Complementary Therapies for Psoriasis: A Systematic Review of the English Literature. ACTA ACUST UNITED AC 2021; 57:medicina57050410. [PMID: 33922733 PMCID: PMC8146919 DOI: 10.3390/medicina57050410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022]
Abstract
Objective: Conventional therapeutic methods for psoriasis include topical and systemic drugs, phototherapy, and biologic agents. Despite the fact that these treatment methods, and especially biologic agents, are met with a considerable reduction in disease activity, they can sometimes be costly and are nonetheless accompanied by high risks of adverse events, ranging from mild to debilitating. Therefore, complementary and alternative medicine (CAM), especially mind-and-body interventions, such as acupuncture, psychotherapy, climatotherapy, and cupping may provide a cheaper and potentially beneficial outcome for these patients. Methods: We performed a systematic review of articles pertaining to acupuncture, cupping, psychotherapy and meditation, as well climatotherapy and balneotherapy in the management of psoriasis, by using the PubMED, Medline and Google Academic research databases and reference cross-checking. Results: 12 articles on acupuncture, 9 on dry or wet cupping, 27 concerning meditation, hypnosis or psychotherapy, and 34 regarding climate therapy or balneotherapy were found. Discussion and Conclusions: Currently, there is a lack of evidence in the English literature to support acupuncture as an effective alternative therapy for psoriasis, whereas cupping has been described in the majority of instances to result in Koebner phenomenon and clinical worsening. Stress management therapies such as psychotherapy, hypnosis, and meditation have shown promising results as complementary treatment methods. Climatotherapy and balneotherapy have already been proven as effective means of achieving clinical improvement in psoriasis. Further research is still needed to verify the usefulness of the lesser studied treatment methods.
Collapse
|
7
|
Melandri D, Albano VM, Venturi M, Flamigni A, Vairetti M. Efficacy of combined liman peloid baths and heliotherapy in the treatment of psoriasis at Cervia spa, Emilia, Italy. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:1145-1152. [PMID: 32133542 DOI: 10.1007/s00484-020-01888-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/28/2020] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
This study assessed the effects of liman peloid, followed by bath and heliotherapy in psoriatic patients at Cervia, Emilia, Italy. The psoriatic patients were randomized into two groups: group 1 with 56 patients, treated with liman applications, bath, and heliotherapy, and group 2 with 35 subjects, treated with mud-bath therapy using a clay peloid mixed with tap water and heliotherapy. Data was collected for the following: psoriasis area and severity index (PASI); delta-PASI (difference between post- and pre-treatment PASI); delta-PASI3 and delta-PASI6, 3 and 6 months after the end of treatment, respectively; psoriasis recurrences; and the use of both topical and systemic drugs. Although not significant, a decrease in PASI was recorded in group 1 at the end of treatment and after 3 and 6 months. Compared with group 2, there was a significant change in delta-PASI, delta-PASI3, and psoriasis recurrences in group 1 as well as a significant reduction in the topical use of drugs, both cortisone and nonsteroid drugs. This is the first and preliminary study which documented the efficacy of a specific protocol of liman bath heliotherapy in psoriatic patients as documented by a reduction in delta-PASI and delta-PASI3, a decrease in psoriasis recurrences, and use of topical drugs.
Collapse
Affiliation(s)
- Davide Melandri
- Dermatology Units and Burn Center Ausl Romagna, Bufalini Hospital, Viale Ghirotti, 286,, 47521, Cesena, Italy
| | - Vincenzo Maria Albano
- Dermatology Unit Ausl Romagna, Infermi Hospital, Viale Stradone, 9, 48018, Faenza, Italy
| | - Michela Venturi
- Dermatology Units and Burn Center Ausl Romagna, Bufalini Hospital, Viale Ghirotti, 286,, 47521, Cesena, Italy
| | | | - Mariapia Vairetti
- Department Internal Medicine and Therapeutics, University of Pavia, Via Ferrata, 9a, 27100, Pavia, Italy.
| |
Collapse
|
8
|
Cheleschi S, Gallo I, Tenti S. A comprehensive analysis to understand the mechanism of action of balneotherapy: why, how, and where they can be used? Evidence from in vitro studies performed on human and animal samples. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:1247-1261. [PMID: 32200439 PMCID: PMC7223834 DOI: 10.1007/s00484-020-01890-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 05/19/2023]
Abstract
Balneotherapy (BT) is one of the most commonly used complementary therapies for many pathological conditions. Its beneficial effects are related to physical and chemical factors, but the exact mechanism of action is not fully understood. Recently, there has been an increased interest in the use of preclinical models to investigate the influence of BT on inflammation, immunity, and cartilage and bone metabolism. The objective of this comprehensive analysis was to summarize the current knowledge about the in vitro studies in BT and to revise the obtained results on the biological effects of mineral waters. Special attention has been paid to the main rheumatological and dermatological conditions, and to the regulation of the immune response. The objective of this review was to summarize the in vitro studies, on human and animal samples, investigating the biological effects of BT. In particular, we analyzed the properties of a thermal water, as a whole, of an inorganic molecule, such as hydrogen sulfide in different cell cultures (keratinocytes, synoviocytes, chondrocytes, and peripheral blood cells), or of the organic component. The results corroborated the scientific value of in vitro studies in demonstrating the anti-inflammatory, antioxidant, chondroprotective, and immunosuppressive role of BT at the cellular level. However, the validity of the cell culture model is limited by several sources of bias, as the differences in experimental procedures, the high heterogeneity among the available researches, and the difficulties in considering all the chemical and physical factors of BT. We would like to stimulate the scientific community to standardize the experimental procedures and enhance in vitro research in the field of BT.
Collapse
Affiliation(s)
- Sara Cheleschi
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, 53100, Siena, Italy.
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy.
| | - Ines Gallo
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, 53100, Siena, Italy
| | - Sara Tenti
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, 53100, Siena, Italy
| |
Collapse
|
9
|
Szabó I, Varga C. Finding possible pharmacological effects of identified organic compounds in medicinal waters (BTEX and phenolic compounds). INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:989-995. [PMID: 31673767 PMCID: PMC7266787 DOI: 10.1007/s00484-019-01808-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/15/2019] [Accepted: 08/17/2019] [Indexed: 05/09/2023]
Abstract
Medicinal thermal waters consist of a mixture of different organic and inorganic compounds. Traditionally, these waters are only characterized and classified by their inorganic composition; however, the bioavailability of the majority of these inorganic compounds is limited. Many authors investigate the organic fractions of thermal waters. These authors propose that these compounds have a potential effect on health. To elucidate the underlying mechanisms, it is crucial to know the composition of the organic fractions. The absorption of these compounds on intact skin or mucosa is notable. Some of them have local anaesthetic effect or affect receptors in the central nervous system. In the knowledge of the chemical composition, we are able to estimate the possible pharmacological effect or might be able to assess possible toxicity risks. In the present article, we aim to review possible health effects of two of the identified organic fractions: benzene and alkylbenzenes and phenolic compounds that might correlate with the therapeutic effect on rheumatological or other diseases.
Collapse
Affiliation(s)
- István Szabó
- Department of Environmental Health, Institute of Public Health Medicie, Medical School, University of Pécs, 12. Szigeti St., Pécs, H7624, Hungary.
| | - Csaba Varga
- Department of Environmental Health, Institute of Public Health Medicie, Medical School, University of Pécs, 12. Szigeti St., Pécs, H7624, Hungary
| |
Collapse
|
10
|
Hanzel A, Berényi K, Horváth K, Szendi K, Németh B, Varga C. Evidence for the therapeutic effect of the organic content in Szigetvár thermal water on osteoarthritis: a double-blind, randomized, controlled clinical trial. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:449-458. [PMID: 30734126 DOI: 10.1007/s00484-019-01676-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 05/19/2023]
Abstract
The therapeutic effects of mineral waters have been attributed to the inorganic components alone; however, biologically active organic components are also present. We aimed to investigate whether the healing effect of Szigetvár thermal mineral water could relate to the organic matter in patients suffering from osteoarthritis of the hips and the knees. XAD macroreticular resins were used to prepare the organic fraction. Patients received a 30-min thermal water (34 °C) treatment in a bath tub, five times a week for 3 weeks. After randomization, patients were divided into three groups: tap water, mineral water, and organic fraction group. Primary outcomes were range of movement (ROM), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and visual analog scale (VAS) for pain severity, and the Short Form 36 (SF-36) questionnaire was used. These scores and indices were measured at baseline, after the last treatment, and at the end of the 3-month follow-up period. Seventy-four patients (age 67.3 ± 4.48 years) were enrolled: tap water n = 24, mineral water n = 26, and organic fraction n = 24. Treatment with the redissolved organic fraction significantly improved ROM, WOMAC, and SF-36 scores compared to the tap water. Our clinical trial provided evidence for the beneficial health effects of the organic fraction of Szigetvár medicinal water.
Collapse
Affiliation(s)
- Adrienn Hanzel
- Department of Environmental Health, Institute of Public Health Medicine, Medical School, University of Pécs, 12 Szigeti str., Pécs, 7624, Hungary
| | - Károly Berényi
- Department of Environmental Health, Institute of Public Health Medicine, Medical School, University of Pécs, 12 Szigeti str., Pécs, 7624, Hungary
| | | | - Katalin Szendi
- Department of Environmental Health, Institute of Public Health Medicine, Medical School, University of Pécs, 12 Szigeti str., Pécs, 7624, Hungary.
| | - Balázs Németh
- Department of Environmental Health, Institute of Public Health Medicine, Medical School, University of Pécs, 12 Szigeti str., Pécs, 7624, Hungary
| | - Csaba Varga
- Department of Environmental Health, Institute of Public Health Medicine, Medical School, University of Pécs, 12 Szigeti str., Pécs, 7624, Hungary
| |
Collapse
|