Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
6-18 Yaş Arası Çocuklarda Nütrisyonel Vitamin B12 Eksikliğinde Oral Kobalamin Tedavisinin Etkinliğinin Retrospektif Değerlendirilmesi
A Retrospective Evaluation of the Effectiveness of Oral Cobalamine Treatment in Children Aged 6-18 Years with Nutritional Vitamin B12 Deficiency
Ali PEHLİVANa, Erol ERDURANb, Ayşenur BAHADIRb, Gökçe Pınar REİSb
aAkçaabat Haçkalı Baba Devlet Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, Trabzon, Türkiye
bKaradeniz Teknik Üniversitesi Tıp Fakültesi, Çocuk Hematolojisi ve Onkolojisi BD, Trabzon, Türkiye
Turkiye Klinikleri J Pediatr. 2023;32(1):8-17
doi: 10.5336/pediatr.2022-91251
Article Language: TR
Full Text
ÖZET
 Amaç: Oral yol ile verilen B12 vitamini tedavisi çocukların tedaviye uyumu için daha uygun bir seçenektir. Çalışmamızda, nütrisyonel B12 vitamini eksikliği olan, 6-18 yaş arası çocuklara uygulanan oral B12 vitamini tedavisinin [siyanokobalamin (Dodex ampul)® 1.000 μg/amp, oral yol ile aç karnına, ilk 1 hafta her gün 1.000 μg, daha sonraki hafta günaşırı 1.000 μg, ardından 2 hafta süresince haftada 2 gün 1.000 μg, takiben 4 ay süresince haftada bir gün 1.000 μg oral B12 idame tedavisi verilmiştir] 4 ay süresince haftada bir gün 1.000 μg olarak verilmesinin etkinliğinin retrospektif değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Karadeniz Teknik Üniversitesi Tıp Fakültesi, Pediatri ABD, Çocuk Hematoloji ve Onkoloji Bilim Dalında, Ocak 2010-Ocak 2018 tarihleri arasında B12 vitamini eksikliği tanısıyla takip ve tedavi edilen 6-18 yaş grubu hastaların dosyaları retrospektif olarak incelendi. Bulgular: En sık saptanan başvuru şikâyeti baş ağrısı (%28,8) idi. Hastaların %24,1'inde eritrosit dağılım genişliği yüksekliği, %18,8'inde anemi, %7,5'inde lenfopeni, %3,1'inde makrositoz, %2,8'inde nötropeni, %2,7'sinde trombositopeni ve %30,1'nde homosistein yüksekliği, %15,6'sında idrar metilmalonik asit yüksekliği bulunmuştur. Tedavi sonrası vitamin B12 seviyesi ve hemoglobin değerleri tedavi öncesine göre anlamlı derecede yüksek (p<0,05) saptanmakla beraber ortalama serum B12 seviyeleri 191,4 pg/mL (<200 pg/mL) olarak sonuçlandı. İdame tedavide, 4 ay süre ile verilen haftalık 1.000 mcg siyanokobalamin tedavisinin başarı oranı %27,7 idi. Sonuç: Oral yol ile verilen tedavinin etkili olmakla beraber, 6-18 yaş grubu hastalarda 4 aylık, haftada bir gün verilen idame tedavinin yeterli olmadığı kanaatine varılmıştır, bu nedenle oral yoldan verilecek B12 vitamini idame tedavisinin haftada bir günden daha sık verilmesinin uygun olacağı kanaatindeyiz.

Anahtar Kelimeler: B12 vitamini eksikliği; çocuk; oral tedavi
ABSTRACT
 Objective: Orally administered vitamin B12 treatment is a more suitable option for children to adapt to the treatment. In this study, it was aimed to retrospectively evaluate the effectiveness of oral vitamin B12 treatment [cyanocobalamin (Dodex ampoule)® 1,000 μg/amp, orally on an empty stomach, 1,000 μg every day for the first week, 1,000 μg every other day for the next week, then 1,000 μg twice a week for two weeks, then 1,000 μg once a week for 4 months oral B12 maintenance therapy] conducted on children aged 6-18 years with nutritional vitamin B12 deficiency. Material and Methods: The files of 6-18 age group patients who were followed up and treated with the diagnosis of vitamin B12 deficiency at Karadeniz Technical University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology between January 2010 and January 2018 were analyzed retrospectively. Results: The most common complaint was: headache (28.8%). Patients were diagnosed with high red cell distribution width in 24.1%, anemia in 18.8%, lymphopenia in 7.5%, macrocytosis in 3.1%, neutropenia in 2.8% and thrombocytopenia in 2.7%. Homocysteine elevation was found in 30.1% and urinary methylmalonic acid elevation in 15.6% of the patients. Serum vitamin B12 levels which are evaluated after treatment and hemoglobin values increased. Although these values were found to be significantly higher (p<0.05) compared to the values before the treatment, the mean serum B12 levels were 191.4 pg/mL (<200 pg/mL). In maintenance treatment, the success rate of 1,000 mcg cyanocobalamin treatment given for 4 months, once-a-week was 27.7%. Conclusion: Although oral treatment is effective, it has been concluded that a 4-month, once-a-week maintenance treatment is not sufficient in 6-18 age group patients. Therefore, we believe that it will be more appropriate to offer an oral vitamin B12 maintenance treatment more frequently than once a week.

Keywords: Vitamin B12 deficiency; child; oral treatment
REFERENCES:
  1. Hall CA. Function of vitamin B12 in the central nervous system as revealed by congenital defects. Am J Hematol. 1990;34(2):121-7. [Crossref]  [PubMed] 
  2. Hartmann H, Das AM, Lücke T. Re: Honzik T, Adamovicova A, Smolka V, Magner M, Hruba E, Zeman J. Clinical presentation and metabolic consequences in 40 breastfed infants with nutritional vitamin B12 deficiency--what have we learned? Eur Jour Ped Neurol 14 (2010) 488-95. Eur J Paediatr Neurol. 2011;15(4):377; author reply 378. [Crossref]  [PubMed] 
  3. World Health Organization, Food and Agriculture Organization of the United Nations. Vitamin and Mineral Requirements in Human Nutrition. 2nd ed. Geneva: World Health Organization; 1998. 2005. p.284. Erişim tarihi: 27.07.2020 Erişim linki: [Link] 
  4. Graham SM, Arvela OM, Wise GA. Long-term neurologic consequences of nutritional vitamin B12 deficiency in infants. J Pediatr. 1992;121(5 Pt 1):710-4. [Crossref]  [PubMed] 
  5. Bahadir A, Reis PG, Erduran E. Oral vitamin B12 treatment is effective for children with nutritional vitamin B12 deficiency. J Paediatr Child Health. 2014;50(9):721-5. [Crossref]  [PubMed] 
  6. World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Geneva, Switz: World Health Organization; 2011. [Link] 
  7. Lo SF. Reference intervals for laboratory tests and procedures. In: Kliegman RM, Stanton BF, St. Geme III JV, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA,; Elsevier Inc.; 2011. p.2466. [Crossref] 
  8. Brugnara C. Reference values in infancy and childhood. In: Orkin SH, Nathan DG, Ginsburg D, Look AT, Fisher DE, Lux IV S, eds. Nathan & Oski's Hematology of Infancy and Childhood. 8th ed. Philadelphia, PA,; Elsevier Inc.; 2009. p.1769-96.
  9. Rasmussen K, Nathan E. The clinical evaluation of cobalamin deficiency by determination of methylmalonic acid in serum or urine is not invalidated by the presence of heterozygous methylmalonic-acidaemia. J Clin Chem Clin Biochem. 1990;28(6):419-21. [Crossref]  [PubMed] 
  10. Rasmussen SA, Fernhoff PM, Scanlon KS. Vitamin B12 deficiency in children and adolescents. J Pediatr. 2001;138(1):10-7. [Crossref]  [PubMed] 
  11. Demir N, Koc A, Üstyol L, Peker E, Abuhandan M. Clinical and neurological findings of severe vitamin B12 deficiency in infancy and importance of early diagnosis and treatment. J Paediatr Child Health. 2013;49(10):820-4. [Crossref]  [PubMed] 
  12. Şahin A. Doğu Karadeniz Bölgesi ortaokul çocuklarında nutrisyonel anemi prevalansı [Uzmanlık tezi]. Trabzon: Karadeniz Teknik Üniversitesi; 2016. Erişim tarihi: 27.07.2020 Erişim linki: [Link] 
  13. Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299-326. [Crossref]  [PubMed] 
  14. Serin HM, Arslan EA. Neurological symptoms of vitamin B12 deficiency: analysis of pediatric patients. Acta Clin Croat. 2019;58(2):295-302. [PubMed]  [PMC] 
  15. Sezgin Evim M, Erdöl Ş, Özdemir Ö, Baytan B, Güneş AM. Long-term outcome in children with nutritional vitamin B12 deficiency. Turk J Haematol. 2011;28(4):286-93. [Crossref]  [PubMed] 
  16. Calik M, Aktas MS, Cecen E, Piskin IE, Ayaydın H, Ornek Z, et al. The association between serum vitamin B12 deficiency and tension-type headache in Turkish children. Neurol Sci. 2018;39(6):1009-14. [Crossref]  [PubMed] 
  17. Aydoğdu Çolak A, Anıl M, Toprak B, Köse E, Üstüner F. Çocuklarda B12 vitamin düzeyi ve periferik tam kan sayımı değerleri ile ilişkisi [B12 vitamin level in children and its relationship with complete blood count parameters]. J Dr Behcet Us Child Hosp. 2012;2(2):75-9. [Crossref] 
  18. Bhatia P, Kulkarni JD, Pai SA. Vitamin B12 deficiency in India: mean corpuscular volume is an unreliable screening parameter. Natl Med J India. 2012;25(6):336-8. [PubMed] 
  19. Aktas G, Alcelik A, Tekce BK, Sit M, Savli H, Tekce H. Could mean platelet volume and red cell distribution width predict vitamin b12 deficiency ? British Journal of Medicine & Medical Research. 2014;4(31):4965-71. [Crossref] 
  20. Kartal Ö. Çocuklarda Vitamin B12 düzeyleri ile tam kan parametreleri arasındaki ilişkinin değerlendirilmesi [Evaluation of the relationship between vitamin B12 levels and whole blood parameters in children]. J Contemp Med. 2020;10(1):82-5. [Crossref] 
  21. Vogiatzoglou A, Smith AD, Nurk E, Berstad P, Drevon CA, Ueland PM, et al. Dietary sources of vitamin B-12 and their association with plasma vitamin B-12 concentrations in the general population: the Hordaland Homocysteine Study. Am J Clin Nutr. 2009;89(4):1078-87. [Crossref]  [PubMed] 
  22. Savage DG, Lindenbaum J, Stabler SP, Allen RH. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med. 1994;96(3):239-46. [Crossref]  [PubMed] 
  23. Asma S, Erdoğan F, Ünsal A, Boğa C, Özdoğdu H, Gereklioğlu Ç, et al. Detection of vitamin B12 levels with the aid of some hematological and biochemical parameters that are more sensitive. Marmara Pharmaceutical Journal. 2010;14:125-9. [Link] 
  24. Eikelboom JW, Lonn E, Genest J Jr, Hankey G, Yusuf S. Homocyst(e)ine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Intern Med. 1999;131(5):363-75. [Crossref]  [PubMed] 
  25. Diaz-Arrastia R. Homocysteine and neurologic disease. Arch Neurol. 2000;57(10):1422-7. [Crossref]  [PubMed] 
  26. Norman EJ. Urinary methylmalonic acid to detect vitamin B12 deficiency. JAMA. 1995;273(18):1420. [Crossref]  [PubMed] 
  27. Matchar DB, McCrory DC, Millington DS, Feussner JR. Performance of the serum cobalamin assay for diagnosis of cobalamin deficiency. Am J Med Sci. 1994;308(5):276-83. [Crossref]  [PubMed] 
  28. Moelby L, Rasmussen K, Jensen MK, Pedersen KO. The relationship between clinically confirmed cobalamin deficiency and serum methylmalonic acid. J Intern Med. 1990;228(4):373-8. [Crossref]  [PubMed] 
  29. Lindenbaum J, Savage DG, Stabler SP, Allen RH. Diagnosis of cobalamin deficiency: II. Relative sensitivities of serum cobalamin, methylmalonic acid, and total homocysteine concentrations. Am J Hematol. 1990;34(2):99-107. [Crossref]  [PubMed] 
  30. Lin J, Kelsberg G, Safranek S. Clinical inquiry: Is high-dose oral B12 a safe and effective alternative to a B12 injection? J Fam Pract. 2012;61(3):162-3. [PubMed] 
  31. Altay C, Cetin M. Vitamin B12 absorption test and oral treatment in 14 children with selective vitamin B12 malabsorption. Pediatr Hematol Oncol. 1999;16(2):159-63. [Crossref]  [PubMed] 
  32. Verma D, Chandra J, Kumar P, Shukla S, Sengupta S. Efficacy of oral methylcobalamin in treatment of vitamin B12 deficiency anemia in children. Pediatr Blood Cancer. 2017;64(12). [Crossref]  [PubMed] 
  33. Estourgie-van Burk GF, van der Kuy PHM, de Meij TG, Benninga MA, Kneepkens CMF. Intranasal treatment of vitamin B12 deficiency in children. Eur J Pediatr. 2020;179(2):349-52. [Crossref]  [PubMed] 
  34. van Walraven C, Austin P, Naylor CD. Vitamin B12 injections versus oral supplements. How much money could be saved by switching from injections to pills? Can Fam Physician. 2001;47:79-86. [PubMed]  [PMC] 
  35. Schürmann S, Kersting M, Alexy U. Vegetarian diets in children: a systematic review. Eur J Nutr. 2017;56(5):1797-817. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com