Turkiye Klinikleri Archives of Lung

.: REVIEW
COVID-19 Pandemisinde Astım, Kronik Obstrüktif Akciğer Hastalığı ve Eşlik Eden Komorbiditelerin Yönetimi: Sistematik Derleme
The Management of Asthma, Chronic Obstructive Pulmonary Diseases and Other Comorbidities in the COVID-19 Pandemic: Systematic Review
Muzaffer Onur TURANa, Ege Güleç BALBAYb, Kurtuluş AKSUc, Esra UZASLANd
aİzmir Kâtip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları ABD, İzmir, Türkiye
bDüzce Üniversitesi Sağlık Uygulama ve Araştırma Merkezi, Göğüs Hastalıkları ABD, Düzce, Türkiye
cAnkara Keçiören Sanatoryum Atatürk Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları ABD, İmmünoloji ve Alerji Hastalıkları BD, Ankara, Türkiye
dBursa Uludağ Üniversitesi Sağlık Uygulama ve Araştırma Merkezi, Göğüs Hastalıkları ABD, Bursa, Türkiye
Turkiye Klinikleri Arch Lung. 2022;21(1):29-38
doi: 10.5336/archlung.2021-86355
Article Language: TR
Full Text
ÖZET
 Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID19)] pandemisinde, astım ve kronik obstrüktif akciğer hastalığı (KOAH) hastaları için COVID-19 gelişme riskinde belirgin bir artış tanımlanmadığı gibi COVID-19 hastalarında da havayolu hastalıklarının sıklığı artmamıştır. Yine ilginç bir şekilde, astım ve KOAH'lı hastalar SARSCoV-2 enfeksiyonuna bağlı alevlenmeler nedeniyle hastaneye daha az sıklıkta başvurmaktadırlar. Bu hasta gruplarının çoğunlukla evlerinde izole olması ve tedavilerinde yer alan inhale kortikosteroid kullanımının COVID-19 hastalığındaki potansiyel koruyucu etkisi gibi sebepler, beklendiğinden az oranda CoV ile enfekte olunmasına yol açmış olabilir. Biyolojik ajan kullanan ağır astımı olan hastalarda COVID-19'un ağırlığına ilişkin bilgiler sınırlıdır. Şimdiye kadar yayımlanan çalışmaların ışığında, havayolu hastalığı mevcut hastaların COVID-19'u şiddetli geçirmelerinin; ileri yaş ve eşlik eden komorbiditelerle ilişkili olduğu görünmektedir; bu nedenle obezite, diyabet, uyku apnesi ve kardiyovasküler hastalıkların ön planda yer aldığı bu komorbiditelerin yönetimi de önemlidir. Genel olarak astımlı hastalarda COVID-19 ile ilişkili ölüm riski artmazken, şiddetli akut solunum sendromu-koronavirüs-2 ile enfekte KOAH hasta grubunda hastaneye yatış ihtimali, ağır pnömoni ve mortalite riskinde artış olduğu belirtilmektedir. Uluslararası kılavuzlar, astım ve KOAH hastalarının mevcut tedavilerine aynı şekilde devam etmelerini ve tüm bireyler için geçerli olan korunma önlemlerine uymalarını önermektedir. Hastalıklar ve komorbiditelerin optimal kontrolünün sağlanması ve günlük fiziksel aktivitenin artırılması olası bir enfeksiyon durumunda riskin kontrolüne destek olacaktır.

Anahtar Kelimeler: COVID-19; pandemi; astım; kronik obstrüktif akciğer hastalığı; morbidite
ABSTRACT
 An increase in the risk of developing coronavirus disease-2019 (COVID-19) for patients with asthma and chronic obstructive pulmonary disease (COPD) has not been identified so far, and the frequency of airway diseases has not increased in patients with COVID-19. Interestingly, patients with asthma and COPD are not admitted to hospital because of exacerbations due to SARS-CoV2 infection. Reasons such as the fact that these patient groups are mostly isolated at home and the potential protective effect of inhaled corticosteroid use in the treatment of COVID-19 disease may have led to a lower rate of being infected with CoV than expected. Information on the severity of COVID-19 in patients with severe asthma using biologic agents is limited. In light of the studies published so far, it seems that severe illness for COVID-19 in patients with airway diseases is associated with advanced age and co-existing comorbidities such as obesity, diabetes, sleep apnea and cardiovascular diseases. That's why, management of comorbidities is also an important issue. In general, while the risk of death associated with COVID-19 does not increase in asthmatic patients, it is stated that the risk of hospitalization, severe pneumonia and mortality are increased in the severe acute respiratory syndrome-coronavirus-2 infected COPD patient group. International guidelines recommend that patients with asthma and COPD may continue their current therapy and follow prevention measures that apply to all individuals. Ensuring optimal control of diseases and comorbidities and increasing daily physical activity will support the control of the risk in case of a possible infection.

Keywords: COVID-19; pandemic; asthma; chronic obstructive lung disease; morbidity
REFERENCES:
  1. T.C. Sağlık Bakanlığı [İnternet]. Copyright © 2022 T.C. Sağlık Bakanlığı [Erişim tarihi: 28 Mayıs 2021]. COVID-19 (SARS-CoV-2 Enfeksiyonu) Genel Bilgiler Epidemiyoloji ve Tanı. Bilimsel Danışma Kurulu Çalışması. Erişim linki: [Link] 
  2. Liu S, Zhi Y, Ying S. COVID-19 and asthma: reflection during the pandemic. Clin Rev Allergy Immunol. 2020;59(1):78-88. [Crossref]  [PubMed]  [PMC] 
  3. Türkiye Cumhuriyeti Adalet Bakanlığı Personel Genel Müdürlüğü [İnternet]. [Erişim tarihi: 28 Mayıs 2021]. Duyurular. Erişim linki: [Link] 
  4. Özel Hastaneler ve Sağlık Kuruluşları Derneği [İnternet]. OHSAD © 2015 [Erişim tarihi: 28 Mayıs 2021]. Duyurular. Erişim linki: [Link] 
  5. Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-41. [Crossref]  [PubMed] 
  6. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110-8. [Crossref]  [PubMed]  [PMC] 
  7. Italian Ministry of Health-COVID-19 pandemic update. Erişim tarihi: 30 Nisan 2020. Erişim linki: [Link] 
  8. Naziroğlu T, Aksu K. Rare atopy in COVID-19 patients or COVID-19 famine in atopic patients? Dermatol Ther. 2021;34(1):e14581. [Crossref]  [PubMed]  [PMC] 
  9. Jackson DJ, Busse WW, Bacharier LB, Kattan M, O'Connor GT, Wood RA, et al. Association of respiratory allergy, asthma, and expression of the SARS-CoV-2 receptor ACE2. J Allergy Clin Immunol. 2020;146(1):203-6.e3. [Crossref]  [PubMed]  [PMC] 
  10. Aksu K, Yesilkaya S, Topel M, Turkyilmaz S, Ercelebi DC, Oncul A, et al. COVID-19 in a patient with severe asthma using mepolizumab. Allergy Asthma Proc. 2021;42(2):e55-e7. [Crossref]  [PubMed]  [PMC] 
  11. Global Initiative for Asthma [İnternet]. Copyright © 2022 [Erişim tarihi: Accessed May 28, 2021]. Interim Guidance about COVID-19 and Asthma. Erişim linki: [Link] 
  12. Yamaya M, Nishimura H, Deng X, Sugawara M, Watanabe O, Nomura K, et al. Inhibitory effects of glycopyrronium, formoterol, and budesonide on coronavirus HCoV-229E replication and cytokine production by primary cultures of human nasal and tracheal epithelial cells. Respir Investig. 2020;58(3):155-68. [Crossref]  [PubMed]  [PMC] 
  13. Peters MC, Sajuthi S, Deford P, Christenson S, Rios CL, Montgomery MT, et al. COVID-19-related genes in sputum cells in asthma. Relationship to demographic features and corticosteroids. Am J Respir Crit Care Med. 2020;202(1):83-90. Erratum in: Am J Respir Crit Care Med. 2020;202(12):1744-6. [Crossref]  [PubMed]  [PMC] 
  14. Ramakrishnan S, Nicolau DV Jr, Langford B, Mahdi M, Jeffers H, Mwasuku C, et al. Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial. Lancet Respir Med. 2021;9(7):763-72. Erratum in: Lancet Respir Med. 2021;9(6):e55. [PubMed]  [PMC] 
  15. Chang C, Zhang L, Dong F, Liang Y, Chen Y, Shang Y, et al. Asthma control, self-management, and healthcare access during the COVID-19 epidemic in Beijing. Allergy. 2021;76(2):586-8. [Crossref]  [PubMed]  [PMC] 
  16. Broadhurst R, Peterson R, Wisnivesky JP, Federman A, Zimmer SM, Sharma S, et al. Asthma in COVID-19 hospitalizations: an overestimated risk factor? Ann Am Thorac Soc. 2020;17(12):1645-8. [Crossref]  [PubMed]  [PMC] 
  17. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430-6. [Crossref]  [PubMed]  [PMC] 
  18. Liu S, Cao Y, Du T, Zhi Y. Prevalence of comorbid asthma and related outcomes in COVID-19: a systematic review and meta-analysis. J Allergy Clin Immunol Pract. 2021;9(2):693-701. [Crossref]  [PubMed]  [PMC] 
  19. Global Initiative for Asthma [İnternet]. Copyright © 2022 All Rights Reserved Global Initiative for Asthma-GINA [Erişim tarihi: 21 Mayıs 2021]. Global strategy for asthma management and prevention (Update 2021). Erişim linki: [Link] 
  20. Assaf SM, Tarasevych SP, Diamant Z, Hanania NA. Asthma and severe acute respiratory syndrome coronavirus 2019: current evidence and knowledge gaps. Curr Opin Pulm Med. 2021;27(1):45-53. [Crossref]  [PubMed] 
  21. Jesenak M, Banovcin P, Diamant Z. COVID-19, chronic inflammatory respiratory diseases and eosinophils-Observations from reported clinical case series. Allergy. 2020;75(7):1819-22. [Crossref]  [PubMed] 
  22. Eger K, Hashimoto S, Braunstahl GJ, Brinke AT, Patberg KW, Beukert A, et al. Poor outcome of SARS-CoV-2 infection in patients with severe asthma on biologic therapy. Respir Med. 2020;177:106287. [Crossref]  [PubMed]  [PMC] 
  23. Murphy TF, Sethi S. Bacterial infection in chronic obstructive pulmonary disease. Am Rev Respir Dis. 1992;146(4):1067-83. [Crossref]  [PubMed] 
  24. Riou M, Marcot C, Canuet M, Renaud-Picard B, Chatron E, Porzio M, et al; COVID-19 pneumonia group. Clinical characteristics of and outcomes for patients with COVID-19 and comorbid lung diseases primarily hospitalized in a conventional pulmonology unit: A retrospective study. Respir Med Res. 2021;79:100801. [Crossref]  [PubMed]  [PMC] 
  25. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al; China Medical Treatment Expert Group for COVID-19. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5):2000547. [Crossref]  [PubMed]  [PMC] 
  26. Signes-Costa J, Nú-ez-Gil IJ, Soriano JB, Arroyo-Espliguero R, Eid CM, Romero R, et al; HOPE COVID-19 investigators. Prevalence and 30-day mortality in hospitalized patients with Covid-19 and prior lung diseases. Arch Bronconeumol. 2021;57:13-20. [Crossref]  [PubMed]  [PMC] 
  27. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323(18):1775-6. Erratum in: JAMA. 2020;323(16):1619. [Crossref]  [PubMed] 
  28. Turan O, Arpınar Yigitbas B, Turan PA, Mirici A. Clinical characteristics and outcomes of hospitalized COVID-19 patients with COPD. Expert Rev Respir Med. 2021;15(8):1069-76. [Crossref]  [PubMed]  [PMC] 
  29. Alqahtani JS, Oyelade T, Aldhahir AM, Alghamdi SM, Almehmadi M, Alqahtani AS, et al. Prevalence, severity and mortality associated with COPD and smoking in patients with COVID-19: a rapid systematic review and meta-analysis. PLoS One. 2020;15(5):e0233147. [Crossref]  [PubMed]  [PMC] 
  30. He Y, Xie M, Zhao J, Liu X. Clinical characteristics and outcomes of patients with severe COVID-19 and chronic obstructive pulmonary disease (COPD). Med Sci Monit. 2020;26:e927212. [Crossref]  [PubMed]  [PMC] 
  31. Wu F, Zhou Y, Wang Z, Xie M, Shi Z, Tang Z, et al; Medical Treatment Expert Group for COPD and COVID-19. Clinical characteristics of COVID-19 infection in chronic obstructive pulmonary disease: a multicenter, retrospective, observational study. J Thorac Dis. 2020;12(5):1811-23. [Crossref]  [PubMed]  [PMC] 
  32. Lee SC, Son KJ, Han CH, Park SC, Jung JY. Impact of COPD on COVID-19 prognosis: a nationwide population-based study in South Korea. Sci Rep. 2021;11(1):3735. [Crossref]  [PubMed]  [PMC] 
  33. Tal-Singer R, Crapo JD. COPD at the time of COVID-19: a COPD foundation perspective. Chronic Obstr Pulm Dis. 2020;7(2):73-5. [Crossref]  [PubMed]  [PMC] 
  34. Higham A, Mathioudakis A, Vestbo J, Singh D. COVID-19 and COPD: a narrative review of the basic science and clinical outcomes. Eur Respir Rev. 2020;29(158):200199. [Crossref]  [PubMed]  [PMC] 
  35. Graziani D, Soriano JB, Del Rio-Bermudez C, Morena D, Díaz T, Castillo M, et al. Characteristics and prognosis of COVID-19 in patients with COPD. J Clin Med. 2020;9(10):3259. [Crossref]  [PubMed]  [PMC] 
  36. Halpin DMG, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, et al. Global initiative for the diagnosis, management, and prevention of chronic obstructive lung disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2021;203(1):24-36. [Crossref]  [PubMed]  [PMC] 
  37. Kyung SY, Kim Y, Hwang H, Park JW, Jeong SH. Risks of N95 face mask use in subjects with COPD. Respir Care. 2020;65(5):658-64. [Crossref]  [PubMed] 
  38. COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community. London: National Institute for Health and Care Excellence (NICE); 2020. [PubMed] 
  39. Elbeddini A, Tayefehchamani Y. Amid COVID-19 pandemic: challenges with access to care for COPD patients. Res Social Adm Pharm. 2021;17(1):1934-7. [Crossref]  [PubMed]  [PMC] 
  40. Ferguson NM, Cummings DA, Fraser C, Cajka JC, Cooley PC, Burke DS. Strategies for mitigating an influenza pandemic. Nature. 2006;442(7101):448-52. [Crossref]  [PubMed]  [PMC] 
  41. Finney LJ, Glanville N, Farne H, Aniscenko J, Fenwick P, Kemp SV, et al. Inhaled corticosteroids downregulate the SARS-CoV-2 receptor ACE2 in COPD through suppression of type I interferon. J Allergy Clin Immunol. 2021;147(2):510-9.e5. [Crossref]  [PubMed]  [PMC] 
  42. Liang Y, Chang C, Chen Y, Dong F, Zhang L, Sun Y. Symptoms, management and healthcare utilization of COPD patients during the COVID-19 epidemic in Beijing. Int J Chron Obstruct Pulmon Dis. 2020;15:2487-94. [Crossref]  [PubMed]  [PMC] 
  43. Amirav I, Newhouse MT. Transmission of coronavirus by nebulizer: a serious, underappreciated risk. CMAJ. 2020;192(13):E346. [Crossref]  [PubMed]  [PMC] 
  44. Cazzola M, Ora J, Bianco A, Rogliani P, Matera MG. Guidance on nebulization during the current COVID-19 pandemic. Respir Med. 2021;176:106236. [Crossref]  [PubMed]  [PMC] 
  45. Joseph T, Ashkan M. Clinical features of COVID‑19 infection. International Pulmonologist's Consensus on COVID‑19. 1st ed. Kochi, Kerala, India: Amrita Institute of Medical Sciences; 2020. p. 9-11.
  46. Çelebi Sözener Z, Çiftci F, Aydın Ö, Mungan D. Astımda sistemik komorbiditeler: kontrol, ağırlık ve fenotip ile ilişkisi [Relation of systemic comorbidities in asthma with disease: control, severity and phenotype]. Tuberk Toraks. 2018;66(4):288-96. [Crossref]  [PubMed] 
  47. Yildiz F, Mungan D, Gemicioglu B, Yorgancioglu A, Dursun B, Oner Erkekol F, et al. Asthma phenotypes in Turkey: a multicenter cross-sectional study in adult asthmatics; PHENOTURK study. Clin Respir J. 2017;11(2):210-23. [Crossref]  [PubMed] 
  48. Uzaslan E. Mortaliteyi etkileyen faktörler. Ursavaş A, Akalın H, editörler. COVID-19. Bursa: Medyay Kitapevi; 2021. p.183-9. ISBN no: 978-605-80859-7-8
  49. Holman N, Knighton P, Kar P, O'Keefe J, Curley M, Weaver A, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol. 2020;8(10):823-83. [Crossref]  [PubMed]  [PMC] 
  50. Wu J, Mamas MA, Mohamed MO, Kwok CS, Roebuck C, Humberstone B, et al. Place and causes of acute cardiovascular mortality during the COVID-19 pandemic. Heart. 2021;107(2):113-9. [Crossref]  [PubMed]  [PMC] 
  51. De Smet D, De Smet K, Herroelen P, Gryspeerdt S, Martens GA. Serum 25(OH)D level on hospital admission associated with COVID-19 stage and mortality. Am J Clin Pathol. 2021;155(3):381-8. [Crossref]  [PubMed]  [PMC] 
  52. Kerget B, Kerget F, Kızıltunç A, Koçak AO, Araz Ö, Yılmazel Uçar E, et al. Evaluation of the relationship of serum vitamin D levels in COVID-19 patients with clinical course and prognosis. Tuberk Toraks. 2020;68(3):227-35. [Crossref]  [PubMed] 
  53. Nemani K, Li C, Olfson M, Blessing EM, Razavian N, Chen J, et al. Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry. 2021;78(4):380-6. [Crossref]  [PubMed]  [PMC] 
  54. Salgado-Aranda R, Pérez-Castellano N, Nú-ez-Gil I, Orozco AJ, Torres-Esquivel N, Flores-Soler J, et al. Influence of baseline physical activity as a modifying factor on COVID-19 mortality: a single-center, retrospective study. Infect Dis Ther. 2021;10(2):801-14. [Crossref]  [PubMed]  [PMC] 

.: 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