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The etiology of this disease is still unknown, and various factors such as hormonal, immunological alterations, genetic aberrations and Borrelia burgdorferi , hepatitis C virus and human papilloma virus (HPV) infection have been implicated.[] However, in all our cases, there was no significant family history or history of any autoimmune disease

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The proportions of widowed respondents were 15.5%, 8.2% and 36.0% in the overall sample, among young and old adults, respectively

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