Turkiye Klinikleri Journal of Forensic Medicine and Forensic Sciences

.: ORIGINAL RESEARCH
Comparison of Two Extraction Set-ups for the Determination of Illicit Drugs fromWastewater
Atık Suda Yasadışı Madde Tayini İçin İki Farklı Çekitleme Düzeneğinin Karşılaştırılması
Selda MERCANa, Tuğba TEKİNa, Merve KULOĞLUa, Zeynep TÜRKMENa, Ahmet Özgür DOĞRUc, Ayşe Nur SAFRANc,d, Münevver AÇIKKOLa, Faruk AŞICIOĞLUb
Departments of
aScience,
bMedicine, İstanbul University Cerrahpasa, Institute of Forensic Sciences,
cDepartment of Geomatics, İstanbul Technical University, Faculty of Civil Engineering,
dİstanbul Water and Sewerage Administration, İstanbul, TURKEY
Turkiye Klinikleri J Foren Sci Leg Med. 2019;16(1):28-36
doi: 10.5336/forensic.2018-62466
Article Language: EN
Full Text
ABSTRACT
 Objective: Wastewater-based epidemiology is becoming a widespread technique with the ability to fill the gaps of conventional methods such as general population surveys, drug related deaths, seizure data. Studies on analytical techniques to identify consumption rates are more of a focus of interest than extraction methods even though sample extraction techniques have a noteworthy contribution to analysis results as well. The aim of this study was to compare two vacuum pressure manifold (negative and positive) systems in off-line solid-phase extraction (SPE) method in terms of extraction efficiency in wastewater for morphine (MOR), 6-monoacetylmorphine (6-MAM), amphetamine (AMP), methamphetamine (METH), 3,4-methylenedioxymethamphetamine (MDMA), benzoylecgonine (BE), cocaine (COC), 11-nor-Δ9-THC carboxylic acid (THC-COOH). Material and Methods: In this study, two different extraction set-ups were used to determine illicit drugs from wastewater and analysis were carried out by using Liquid Chromatography-Mass Spectrometry. Results: Correlation coefficients for all substances were found as r>0.999, LOD values were between 0.01-0.2 ng mL-1. Linear ranges of 6-MAM, METH, BE and COC were found between 0.2-100 ng mL-1, where the others' lowest calibration points were varying from 0.5 to 2 ng mL-1. Optimized SPE procedure was applied to both negative pressure manifold (NPM-SPE) and positive pressure manifold (PPM-SPE) by spiking tap water and wastewater samples separately. Conclusion: Efficiency differences were tested in terms of recovery, sample loading, time consumption, pressure control ability, and contamination sources. Overall recovery results revealed that there was no significant difference between PPM and NPM-SPE processes for both tap water and wastewater. Although set-ups have different superiorities to one another, it has been determined that the selection of the system should be made according to the type of targeted analytes and matrices.

Keywords: Sewage; forensic toxicology; solid phase extraction; waste water
ÖZET
 Amaç: Atık su-tabanlı epidemiyolojik çalışmalar; anket araştırmaları, yasadışı madde kullanımına bağlı ölümler, ele geçirme verileri gibi geleneksel yöntemlere destek olan bir araçtır. Çekitleme tekniklerinin analiz sonuçlarına önemli katkı sağladığı bilinse de, tüketim oranlarını tayin etmek için kullanılan analitik teknikler çekitleme yöntemlerine göre daha çok ilgi odağı olmaktadır. Bu çalışmanın amacı, morfin (MOR), 6-monoasetilmorfin (6-MAM), amfetamin (AMP), metamfetamin (METH), 3,4-metilendioksimetamfetamin (MDMA), benzoilekgonin (BE), kokain (COC) ve 11-nor-Δ9-THC-karboksilik asit (THC-COOH) maddelerinin atık suda çekitleme verimi açısından, negatif ve pozitif basınçlı vakum sistemlerinin kullanıldığı manuel katı faz çekitleme (SPE) yöntemlerinin karşılaştırılmasıdır. Gereç ve Yöntemler: Bu çalışmada atık suda yasadışı madde tespiti için iki farklı çekitleme düzeneği kullanılmış ve tüm analizler Sıvı Kromatografi-Ardışık Kütle Spektrometresi sistemi kullanılarak yapılmıştır. Bulgular: Tüm maddeler için korelasyon katsayıları r>0,999, LOD değerleri 0,01-0,2 ng mL-1 arasında bulunmuştur. 6-MAM, METH, BE ve COC'nin doğrusal aralıkları 0,2-100 ng mL-1 arasında bulunurken, diğer kalibrasyon noktalarının en düşükleri ise 0,5-2 ng mL-1 arasında değişmektedir. Belirlenen SPE prosedürü, musluk suyu ve atık su numuneleri kirletilerek hem negatif basınç (NPM-SPE) hem de pozitif basınç (PPM-SPE) kullanılan düzeneklerde uygulanmıştır. Sonuç: Düzenekler arasındaki verim farklılıkları, geri kazanım, numune yükleme, zaman tüketimi, basınç kontrol yeteneği ve kontaminasyon kaynakları bakımından değerlendirilmiştir. Tüm geri-kazanım sonuçlarına bakıldığında, hem musluk suyu hem de atık su için, PPM ve NPM-SPE arasında anlamlı bir fark olmadığı bulunmuştur. Her ne kadar basınç düzeneklerinin birbirine göre üstünlükleri olsa da, sistemin seçiminin, hedeflenen analiz ve matrikslerin türüne göre yapılması gerektiği düşünülmektedir.

Anahtar Kelimeler: Lağım; sıvı atık; adli toksikoloji; solid faz çıkartımı; atık su
REFERENCES:
  1. Löve ASC, Baz-Lomba JA, Reid MJ, Kankaanpää A, Gunnar T, Dam M, et al. Analysis of stimulant drugs in the wastewater of five Nordic capitals. Sci Total Environ. 2018;627:1039-47. [Crossref] [PubMed]
  2. Mastroianni N, López-García E, Postigo C, Barceló D, López de Alda M. Five-year monitoring of 19 illicit and legal substances of abuse at the inlet of a wastewater treatment plant in Barcelona (NE Spain) and estimation of drug consumption patterns and trends. Sci Total Environ. 2017;609:916-26. [Crossref] [PubMed]
  3. Rico M, Andrés-Costa MJ, Picó Y. Estimating population size in wastewater-based epidemiology. Valencia metropolitan area as a case study. J Hazard Mater. 2017;323(Pt A):156-65.
  4. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Country Drug Report 2017. ISBN: 978-92-9497-030-5. Turkey, Lisbon: 2017. p.18.
  5. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Country Drug Report 2018. Turkey, Lisbon: 2018. [Crossref]
  6. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Key Indicators; 2015. (accessed date: 12.07.2018). [Link]
  7. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Insights Series No 9. Assessing illicit drugs in wastewater Potential and limitations of a new monitoring approach. Luxemburg: 2008. ISBN 978-929168-317-8.
  8. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Assessing illicit drugs in wastewater: advances in wastewaterbased drug epidemiology. Insights 22. Publications Office of the European Union, Luxembourg: 2016. p.77. doi: 10.2810/017397.
  9. González-Mariño I, Quintana JB, Rodríguez I, González-Díez M, Cela R. Screening and selective quantification of illicit drugs in wastewater by mixed-mode solid-phase extraction and quadrupole-time-of-flight liquid chromatography-mass spectrometry. Anal Chem. 2012;84(3):1708-17. [Crossref] [PubMed]
  10. Hogenboom AC, van Leerdam JA, de Voogt P. Accurate mass screening and identification of emerging contaminants in environmental samples by liquid chromatography-hybrid linear ion trap orbitrap mass spectrometry. J Chromatogr A. 2009;1216(3):510-9. [Crossref] [PubMed]
  11. Wilson JF, Smith BL, Toseland PA, Watson ID, Williams J, Thomson AH, et al. A survey of extraction techniques for drugs of abuse in urine. Forensic Sci Int. 2001;119(1):23-7. [Crossref]
  12. Drummer OH. Chromatographic screening techniques in systematic toxicological analysis. J Chromatogr B Biomed Sci Appl. 1999;733(1-2):27-45. [Crossref]
  13. van Wel JH, Kinyua J, van Nuijs AL, Salvatore S, Bramness JG, Covaci A, et al. A comparison between wastewater-based drug data and an illicit drug use survey in a selected community. Int J Drug Policy. 2016;34:20-6. [Crossref] [PubMed]
  14. van Nuijs AL, Castiglioni S, Tarcomnicu I, Postigo C, Lopez de Alda M, Neels H, et al. Illicit drug consumption estimations derived from wastewater analysis: a critical review. Sci Total Environ. 2011;409(19):3564-77. [Cross - ref] [PubMed]
  15. Bijlsma L, Botero-Coy AM, Rincón RJ, Peñuela GA, Hernández F. Estimation of illicit drug use in the main cities of Colombia by means of urban wastewater analysis. Sci Total Environ. 2016;565:984-93. [Crossref] [PubMed]
  16. Bijlsma L, Beltrán E, Boix C, Sancho JV, Hernández F. Improvements in analytical methodology for the determination of frequently consumed illicit drugs in urban wastewater. Anal Bioanal Chem. 2014;406(17): 4261-72. [Crossref] [PubMed]
  17. Irvine RJ, Kostakis C, Felgate PD, Jaehne EJ, Chen C, White JM. Population drug use in Australia: a wastewater analysis. Forensic Sci Int. 2011;210(1-3):69-73. [Crossref] [PubMed]
  18. Tscharke BJ, Chen C, Gerber JP, White JM. Temporal trends in drug use in Adelaide, South Australia by wastewater analysis. Sci Total Environ. 2016;565:384-91. [Crossref] [PubMed]
  19. Löve ASC, Baz-Lomba JA, Reid MJ, Kankaanpää A, Gunnar T, Dam M, et al. Analysis of stimulant drugs in the wastewater of five Nordic capitals. Sci Total Environ. 2018;627:1039-47. [Crossref] [PubMed]
  20. Baker DR, Kasprzyk-Hordern B. Critical evaluation of methodology commonly used in sample collection, storage and preparation for the analysis of pharmaceuticals and illicit drugs in surface water and wastewater by solid phase extraction and liquid chromatography-mass spectrometry. J Chromatogr A. 2011;1218(44):8036-59. [Crossref] [PubMed]
  21. Vazquez-Roig P, Blasco C, Picó Y. Advances in the analysis of legal and illegal drugs in the aquatic environment. Trends Anal Chem. 2013;50:65-77. [Crossref]
  22. Castiglioni S, Thomas KV, Kasprzyk-Hordern B, Vandam L, Griffiths P. Testing wastewater to detect illicit drugs: state of the art, potential and research needs. Sci Total Environ. 2014;487:613-20. [Crossref] [PubMed]
  23. van Nuijs AL, Tarcomnicu I, Bervoets L, Blust R, Jorens PG, Neels H, et al. Analysis of drugs of abuse in wastewater by hydrophilic interaction liquid chromatography-tandem mass spectrometry. Anal Bioanal Chem. 2009; 395(3):819-28. [Crossref] [PubMed]
  24. Postigo C, de Alda MJ, Barceló D. Fully automated determination in the low nanogram per liter level of different classes of drugs of abuse in sewage water by on-line solid-phase extraction-liquid chromatography-electrospraytandem mass spectrometry. Anal Chem. 2008;80(9):3123-34. [Crossref] [PubMed]
  25. Postigo C, de Alda ML, Barceló D. Evaluation of drugs of abuse use and trends in a prison through wastewater analysis. Environ Int. 2011;37(1):49-55. [Crossref] [PubMed]
  26. Kim EM, Lee JS, Choi SK, Lim MA, Chung HS. Analysis of ketamine and norketamine in urine by automatic solid-phase extraction (SPE) and positive ion chemical ionizationgas chromatography-mass spectrometry (PCIGC-MS). Forensic Sci Int. 2008;174(2-3): 197-202. [Crossref] [PubMed]
  27. Baker DR, Kasprzyk-Hordern B. Multiresidue analysis of drugs of abuse in wastewater and surface water by solid-phase extraction and liquid chromatography-positive electrospray ionisation tandem mass spectrometry. J Chromatogr A. 2011; 1218(12):1620-31. [Crossref] [PubMed]
  28. Castiglioni S, Bijlsma L, Covaci A, Emke E, Hernández F, Reid M, et al. Evaluation of uncertainties associated with the determination of community drug use through the measurement of sewage drug biomarkers. Environ Sci Technol. 2013;47(3):145-60. [Crossref] [PubMed]
  29. Jacox A, Wetzel J, Cheng SY, Concheiro M. Quantitative analysis of opioids and cannabinoids in wastewater samples. Forensic Sci Res. 2017;2(1):18-25. [Crossref] [PubMed] [PMC]
  30. Causanilles A, Baz-Lomba JA, Burgard DA, Emke E, González-Mariño I, Krizman-Matasic I, et al. Improving wastewater-based epidemiology to estimate cannabis use: focus on the initial aspects of the analytical procedure. Anal Chim Acta. 2017;988:27-33. [Crossref] [PubMed]
  31. González-Mariño I, Quintana JB, Rodríguez I, Rodil R, González-Peñas J, Cela R. Comparison of molecularly imprinted, mixed-mode and hydrophilic balance sorbents performance in the solid-phase extraction of amphetamine drugs from wastewater samples for liquid chromatography-tandem mass spectrometry determination. J Chromatogr A. 2009; 1216(48):8435-41. [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