Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
Evaluation of Hematological and Inflammatory Biomarkers in Patients Receiving Omalizumab Treatment in Chronic Urticaria
Kronik Ürtikerde Omalizumab Tedavisi Alan Hastalarda Hematolojik ve İnflamatuar Biyobelirteçlerin Değerlendirilmesi
Esra İNAN DOĞANa, Akın AKTAŞb
aDepartment of Dermatology, Adıyaman University Faculty of Medicine, Adıyaman, TURKEY
bDepartment of Dermatology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, TURKEY
Turkiye Klinikleri J Dermatol. 2021;31(1):28-35
doi: 10.5336/dermato.2021-81209
Article Language: EN
Full Text
ABSTRACT
 Objective: This study aims to evaluate the effects of omalizumab on hematological parameters and inflammation biomarkers in patients diagnosed with chronic spontaneous urticaria (CSU). Material and Methods: The records of 109 (76 women and 33 men) patients, who were treated with omalizumab with the diagnosis of CSU were retrospectively examined. In addition, the pre-treatment and postomalizumab treatment periods were evaluated in CSU patients by comparing hematological, inflammatory and biochemical parameters. The data of these patients were compared to a healthy control group with similar characteristics such as age and gender. Results: C-reactive protein (CRP), neutrophil (NEU), and monocyte values were significantly higher in patients with CSU, while basophil values in control individuals. The comparison of the measurements of the patients before and after omalizumab treatment revealed a significant reduction in CRP, white blood cell (WBC), NEU, and platelet (PLT) levels. WBC, NEU, and eosinophil levels were found to be significantly reduced in responders compared to non-responders to treatment. Conclusion: The evaluation of CRP, NEU, PLT levels are found to be important to show the activity of the disease in CSU. We think that these inflammatory markers are important in the follow-up of CSU and omalizumab treatment. We think that these inflammatory markers are important in the follow-up of CSU and omalizumab treatment. Our results will contribute to the medical literature to establish both the mechanism of action of omalizumab and the parameters used in the follow-up of omalizumab therapy in patients with CSU.

Keywords: Omalizumab; chronic urticaria; inflammation
ÖZET
 Amaç: Bu çalışmada, kronik spontan ürtiker (KSÜ) tanılı hastalarda omalizumabın hematolojik parametreler ve inflamasyon biyobelirteçleri üzerine olan etkilerinin değerlendirmesi amaçlanmaktadır. Gereç ve Yöntemler: KSÜ tanısıyla omalizumab ile tedavi edilmiş 109 (76 kadın, 33 erkek) hastanın hastane kayıtları retrospektif olarak incelendi. Ayrıca hastalarda tedavi öncesi ve omalizumab tedavisi sonrası dönemde hematolojik, inflamatuar ve biyokimyasal parametreler karşılaştırılarak değerlendirildi. Bu hastaların verileri yaş ve cinsiyet gibi benzer özelliklere sahip sağlıklı kontrol grubu ile karşılaştırıldı. Bulgular: C-reaktif protein (CRP), nötrofil (NEU), monosit değerleri KSÜ'lü hastalarda ve bazofil değeri ise kontrol bireylerinde anlamlı düzeyde daha yüksek olduğu görüldü. Hastalarda omalizumab tedavisi öncesi ve sonrası ölçümleri karşılaştırıldığında CRP, beyaz kan hücresi [white blood cell (WBC)], NEU ve platelet (PLT) düzeylerinde anlamlı azalma tespit edildi. Tedaviye yanıt veren hastalarda WBC, NEU, EOS düzeyleri, yanıt vermeyenlerle karşılaştırıldığında anlamlı düzeyde azaldığı bulundu. Sonuç: KSÜ'de hastalığın aktivitesini göstermek için CRP, NEU, PLT düzeylerinin değerlendirilmesinin önemli olduğu bulundu. KSÜ ve omalizumab tedavisinin takibinde bu inflamatuar belirteçlerinin önemli olduğunu düşünmekteyiz. Sonuçlarımız, KSÜ hastalarında hem omalizumabın etki mekanizmasını hem de omalizumab tedavisinde takipte kullanılan parametreleri oluşturmak için tıbbi literatüre katkıda bulunacaktır.

Anahtar Kelimeler: Omalizumab; kronik ürtiker; inflamasyon
REFERENCES:
  1. Taşkın B, Eriş Eken Z, Alper S. [The diagnosis and treatment approches in chronic spontaneous urticaria]. Turkiye Klinikleri J Dermatol-Special Topics. 2015;8(1):20-5.[Link] 
  2. Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau A, et al; Dermatology Section of the European Academy of Allergology and Clinical Immunology; Global Allergy and Asthma European Network; European Dermatology Forum; World Allergy Organization. EAACI/GA(2) LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64(10):1417-26.[Crossref] [PubMed] 
  3. Młynek A, Maurer M, Zalewska A. Update on chronic urticaria: focusing on mechanisms. Curr Opin Allergy Clin Immunol. 2008;8(5):433-7.[Crossref] [PubMed] 
  4. Asero R, Tedeschi A, Riboldi P, Cugno M. Plasma of patients with chronic urticaria shows signs of thrombin generation, and its intradermal injection causes wheal-and-flare reactions much more frequently than autologous serum. J Allergy Clin Immunol. 2006;117(5):1113-7.[Crossref] [PubMed] 
  5. Zhu H, Liang B, Li R, Li J, Lin L, Ma S, et al. Activation of coagulation, anti-coagulation, fibrinolysis and the complement system in patients with urticaria. Asian Pac J Allergy Immunol. 2013;31(1):43-50.[PubMed] 
  6. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al; European Academy of Allergy and Clinical Immunology; Global Allergy and Asthma European Network; European Dermatology Forum; World Allergy Organization. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69(7):868-87.[PubMed] 
  7. Kaplan AP, Giménez-Arnau AM, Saini SS. Mechanisms of action that contribute to efficacy of omalizumab in chronic spontaneous urticaria. Allergy. 2017;72(4):519-33.[Crossref] [PubMed] [PMC] 
  8. Maurer M, Rosén K, Hsieh HJ, Saini S, Grattan C, Gimenéz-Arnau A, et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013;368(10):924-35. Erratum in: N Engl J Med. 2013;368(24):2340-1.[Crossref] [PubMed] 
  9. Saini SS, Bindslev-Jensen C, Maurer M, Grob JJ, Bülbül Baskan E, Bradley MS, et al. Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on H1 antihistamines: a randomized, placebo-controlled study. J Invest Dermatol. 2015;135(1):67-75. Erratum in: J Invest Dermatol. 2015;135(3):925.[Crossref] [PubMed] [PMC] 
  10. Altrichter S, Hawro T, Hänel K, Czaja K, Lüscher B, Maurer M, Baron J. Successful omalizumab treatment in chronic spontaneous urticaria is associated with lowering of serum IL‐31 levels. Journal of the European Academy of Dermatology and Venereology. 2016;30(3)454-5.[Crossref] [PubMed] 
  11. Kasperska-Zajac A, Sztylc J, Machura E, Jop G. Plasma IL-6 concentration correlates with clinical disease activity and serum C-reactive protein concentration in chronic urticaria patients. Clin Exp Allergy. 2011;41(10):1386-91.[Crossref] [PubMed] 
  12. Kasperska-Zajac A, Grzanka A, Machura E, Misiolek M, Mazur B, Jochem J. Increased serum complement C3 and C4 concentrations and their relation to severity of chronic spontaneous urticaria and CRP concentration. J Inflamm (Lond). 2013;10(1):22.[Crossref] [PubMed] [PMC] 
  13. Deza G, Ricketti PA, Giménez-Arnau AM, Casale TB. Emerging Biomarkers and Therapeutic Pipelines for Chronic Spontaneous Urticaria. J Allergy Clin Immunol Pract. 2018;6(4):1108-17.[Crossref] [PubMed] 
  14. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010;14(1):28-32.[PubMed] [PMC] 
  15. Kasperska-Zając A, Grzanka A, Jarzab J, Misiołek M, Wyszyńska-Chłap M, Kasperski J, et al. The association between platelet count and acute phase response in chronic spontaneous urticaria. Biomed Res Int. 2014;2014:650913.[Crossref] [PubMed] [PMC] 
  16. Göncü EK, Aktan Ş, Atakan N, Başkan EB, Erdem T, Koca R, et al. The Turkish guideline for the diagnosis and management of urticaria-2016. Turkderm. 2016;50;82-98.[Crossref] 
  17. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17(1):47-58.[Crossref] [PubMed] 
  18. Ihara A, Kawamoto T, Matsumoto K, Shouno S, Morimoto T, Noma Y. Relationship between hemostatic factors and the platelet index in patients with ischemic heart disease. Pathophysiol Haemost Thromb. 2006;35(5):388-91.[Crossref] [PubMed] 
  19. Prajapati JH, Sahoo S, Nikam T, Shah KH, Maheriya B, Parmar M. Association of high density lipoprotein with platelet to lymphocyte and neutrophil to lymphocyte ratios in coronary artery disease patients. J Lipids. 2014;2014:686791.[Crossref] [PubMed] [PMC] 
  20. Avci A, Avci D, Erden F, Ragip E, Cetinkaya A, Ozyurt K, et al. Can we use the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume values for the diagnosis of anterior uveitis in patients with Behcet's disease? Ther Clin Risk Manag. 2017;13:881-6.[Crossref] [PubMed] [PMC] 
  21. Magen E, Mishal J, Zeldin Y, Feldman V, Kidon M, Schlesinger M, et al. Increased mean platelet volume and C-reactive protein levels in patients with chronic urticaria with a positive autologous serum skin test. Am J Med Sci. 2010;339(6):504-8.[Crossref] [PubMed] 
  22. Djordjevic D, Rondovic G, Surbatovic M, Stanojevic I, Udovicic I, Andjelic T, et al. Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia? Mediators Inflamm. 2018;2018:3758068.[Crossref] [PubMed] [PMC] 
  23. Chang TW, Chen C, Lin CJ, Metz M, Church MK, Maurer M. The potential pharmacologic mechanisms of omalizumab in patients with chronic spontaneous urticaria. J Allergy Clin Immunol. 2015;135(2):337-42.[Crossref] [PubMed] 
  24. Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al; Endorsed by the following societies: AAAAI, AAD, AAIITO, ACAAI, AEDV, APAAACI, ASBAI, ASCIA, BAD, BSACI, CDA, CMICA, CSACI, DDG, DDS, DGAKI, DSA, DST, EAACI, EIAS, EDF, EMBRN, ESCD, GA²LEN, IAACI, IADVL, JDA, NVvA, MSAI, ÖGDV, PSA, RAACI, SBD, SFD, SGAI, SGDV, SIAAIC, SIDeMaST, SPDV, TSD, UNBB, UNEV and WAO. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7):1393-414.[Crossref] [PubMed] 
  25. Jörg L, Pecaric-Petkovic T, Reichenbach S, Coslovsky M, Stalder O, Pichler W, et al. Double-blind placebo-controlled trial of the effect of omalizumab on basophils in chronic urticaria patients. Clin Exp Allergy. 2018;48(2):196-204.[Crossref] [PubMed] 
  26. Puxeddu I, Pratesi F, Ribatti D, Migliorini P. Mediators of Inflammation and Angiogenesis in Chronic Spontaneous Urticaria: Are They Potential Biomarkers of the Disease? Mediators Inflamm. 2017;2017:4123694.[Crossref] [PubMed] [PMC] 
  27. Kaplan AP, Greaves M. Pathogenesis of chronic urticaria. Clin Exp Allergy. 2009;39(6):777-87.[Crossref] [PubMed] 
  28. Folci M, Heffler E, Canonica GW, Furlan R, Brunetta E. Cutting Edge: Biomarkers for Chronic Spontaneous Urticaria. J Immunol Res. 2018;2018:5615109.[Crossref] [PubMed] [PMC] 
  29. Akdogan N, Demirel Ogut N, Dogan S, Atakan N. Long-term effects of omalizumab on peripheral blood cells and C-reactive protein levels in patients with chronic spontaneous urticaria. Dermatol Ther. 2019;32(4):e12966.[Crossref] [PubMed] 
  30. Acer E, Kaya Erdogan H, Yüksel Çanakçı N, Saracoglu ZN. The effect of omalizumab on hematological and inflammatory parameters in patients with chronic spontaneous urticaria. Cutan Ocul Toxicol. 2019;38(1):5-8.[Crossref] [PubMed] 
  31. Maouia A, Youssef M, Leban N, Ben Chibani J, Helal A. N, Kassab A. CRP relevance in clinical assessment of chronic spontaneous urticaria Tunisian patients. Cutaneous and Ocular Toxicology. 2017;36(4):387-92.[Crossref] [PubMed] 
  32. Kolkhir P, Altrichter S, Hawro T, Maurer M. C-reactive protein is linked to disease activity, impact, and response to treatment in patients with chronic spontaneous urticaria. Allergy. 2018;73(4):940-8.[Crossref] [PubMed] 
  33. Asero R, Cugno M, Tedeschi A. Eosinophils in chronic urticaria: supporting or leading actors? World Allergy Organ J. 2009;2(9):213-7.[Crossref] [PubMed] [PMC] 
  34. Tamer F. Omalizumab does not lead to a distinct alteration in hematological parameters and complete blood count-derived inflammation biomarkers except for basophil count. Cutan Ocul Toxicol. 2020;39(3):229-32.[Crossref] [PubMed] 
  35. Ertaş R, Özyurt K, Karakükçü Ç, Akkuş MR, Özlü E, Avcı A, et al. Evaluation of platelet parameters and neutrophil/lymphocyte ratio during omalizumab treatment in patients with severe chronic spontaneous urticaria. Turk J Med Sci. 2018;48(6):1255-62.[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