Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Infective Endocarditis Cases in İstanbul-Turkey: Evaluation of Bacteriological, Serological andMolecular Methods on the Microbiological Diagnosis of Infective Endocarditis
İstanbul, Türkiye?de Enfektif Endokardit Olguları: Enfektif Endokarditin Mikrobiyolojik TanısındaBakteriyolojik, Serolojik ve Moleküler Yöntemlerin Değerlendirilmesi
Sinem ÖZDEMİRa, Serap ŞİMŞEK YAVUZb, Müzeyyen MAMAL TORUNc
aİstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, İstanbul, TURKEY
bİstanbul University İstanbul Medical of Faculty, Department of Clinical Microbiology and Infectious Diseases, İstanbul, TURKEY
cBahçeşehir University Faculty of Medicine, Department of Medical Microbiology, İstanbul, TURKEY
Turkiye Klinikleri J Cardiovasc Sci. 2020;32(1):29-36
doi: 10.5336/cardiosci.2019-72146
Article Language: EN
Full Text
ABSTRACT
 Objective: In spite of being an infectious disease with low incidence, infective endocarditis (IE) has a high mortality risk. In this study, we aimed to evaluate the added values of bacteriological, serological, and molecular methods for the diagnosis of infective endocarditis in Istanbul, Turkey. Material and Methods: The study has a multicentre prospective design. Fifty adult patients (age > 14 years), who were hospitalized at the Department of Cardiology of Cerrahpasa Faculty of Medicine in Istanbul University, at Haseki Cardiology Institute in Istanbul University, and at Siyami Ersek Cardiovascular Surgery Hospital with the diagnosis of IE, were included in this study. Results: We have gathered 50 IE cases for the study. The mean age of the patients was 47 years. Causative microorganisms were detected in 37 patients (74%), and undefined causative agents were found in 13 (26%) patients. Causative microorganisms were staphylococci (28%), streptococci (12%), enterococci (8%), and Brucella melitensis (4%), Pseudomonas aeruginosa (2%), Aggregatibacter actinomycetemcomitans (2%), Peptostreptococcus anaerobius (2%), Candida parapsilosis (4%), Bartonella henselae (8%) and Chlamydophila pneumoniae (4%). Conclusion: In this study, among the cases in which the etiological agents were detected, 31 (62%) were culture-positive and 19 (38%) were culture-negative. To reduce the rate of culture-negative cases, samples for blood culture should be collected carefully, and new diagnostic techniques should be used.

Keywords: Endocarditis; infection; diagnosis
ÖZET
 Amaç:Düşük insidanslı enfeksiyöz bir hastalık olmasına rağmen, enfektif endokardit (IE) yüksek mortalite riskine sahiptir. Bu çalışmada, Türkiye'de enfektif endokardit tanısı için bakteriyolojik, serolojik ve moleküler yöntemlerin tanıdaki yerini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Çok merkezli ve prospektif olarak tasarlanmış olan çalışmaya Ocak 2012 ? Aralık 2016 tarihleri arasında, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Kardiyoloji Anabilim Dalı, İstanbul Üniversitesi Haseki Kardiyoloji Enstitüsü ve Siyami Ersek Kalp Damar Cerrahisi Hastanesi'ne yatırılan ve kesin enfektif endokardit tanısı alan 50 (14 yaş üstü) hasta dahil edildi. Enfektif endokarditin mikrobiyolojik tanısı için bakteriyolojik, serolojik ve moleküler yöntemler kullandı. Bulgular: Çalışmaya dahil edilen 50 IE olgusunun yaş ortalaması47 idi. Otuz yedi hastada (%74) olağan mikroorganizmalar saptanrken, 13 (%26) hastada tanımlanamayan nedensel ajanlar tespit edildi. Etken olarak tanımlanan mikroorganizmalar, stafilokoklar (%28), streptokoklar (%12), enterokoklar (%8), Brucella melitensis (%4), Pseudomonas aeruginosa (%2), Aggregatibacter actinomycetemcomitans(%2), Peptostreptococcus anaerobius (%2), Candida parapsilosis (%4), Bartonella henselae (%8) and Chlamydophila pneumoniae (%4) olarak tespit edildi. Sonuç: Bu çalışmada,tespit edilen etiyolojik ajanların, 31?i (% 62) kültür-pozitif, 6?sı(% 12) kültür-negatif idi. Kültür-negatif vakaların oranını azaltmak için, kan kültürü örnekleri dikkatle toplanmalı ve yeni tanı teknikleri kullanılmalıdır.

Anahtar Kelimeler: Endokarditler; bakteri enfeksiyonları; tanı
REFERENCES:
  1. Chirouze C, Alla F, Fowler VG Jr, Sexton DJ, Corey GR, Chu VH, et al. Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study. Clin Infect Dis. 2015;60(5):741-9.
  2. Simsek-Yavuz S, Sensoy A, Kasikcioglu H, Çeken S, Deniz D, Yavuz A, et al. Infective endocarditis in Turkey: aetiology, clinical features, and analysis of risk factors for mortality in 325 cases. Int J Infect Dis. 2015;30:106-14. [Crossref]  [PubMed] 
  3. Gupta K, Jagadeesan N, Agrawal N, Bhat P, Nanjappa MC. Clinical, echocardiographic and microbiological study, and analysis of outcomes of infective endocarditis in tropical countries: a prospective analysis from India. J Heart Valve Dis. 2014;23(5):624-32.
  4. Chirio D, Le Marechal M, Moceri P, de la Chapelle A, Chaillou-Optiz S, Mothes A, et al. Factors associated with unfavorable outcome in a multicenter audit of 100 infective endocarditis. Eur J Clin Microbiol Infect Dis. 2019;38(1):109-15. [Crossref]  [PubMed] 
  5. Vogkou CT, Vlachogiannis NI, Palaiodimos L, Kousoulis AA. The causative agents in infective endocarditis: a systematic review comprising 33,214 cases. Eur J Clin Microbiol Infect Dis. 2016;35(8):1227-45. [Crossref]  [PubMed] 
  6. Tattevin P, Watt G, Revest M, Arvieux C, Fournier PE. Update on blood culture-negative endocarditis. Med Mal Infect. 2015;45(1-2):1-8. [Crossref]  [PubMed] 
  7. Siciliano RF, Randi BA, Gualandro DM, Sampario RO, Bittencounrt MS, da Silva Pelaes CE, et al. Early-onset prosthetic valve endocarditis definition revisited: Prospective study and literature review. Int J Infect Dis. 2018;67:3-6. [Crossref]  [PubMed] 
  8. Ambrosioni J, Hernandez-Meneses M, Téllez A, Pericàs J, Falces C, Tolosana JM, et al. The changing epidemiology of ınfective endocarditis in the twenty-first century. Curr Infect Dis Rep. 2017;19(5):21. [Crossref]  [PubMed] 
  9. Topan A, Carstina D, Slavcovici A, Rancea R, Capalneanu R, Lupse M. Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases. Clujul Med. 2015;88(3):321-6. [Crossref]  [PubMed]  [PMC] 
  10. Fowler VG, Scheld WM, Bayer AS. Endocarditis and intravascular infections. In: Bennett JE, Dolın R, Martın J. Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Updated Edition. 8th ed. Philadelphia: Elseiver Health Sciences; 2015. p.990-1028.
  11. Arnold CJ, Johnson M, Bayer AS, Bradley S, Giannitsioti E, Miró JM, et al. Candida infective endocarditis: an observational cohort study with a focus on therapy. Antimicrob Agents Chemother. 2015;59(4):2365-73. [Crossref]  [PubMed]  [PMC] 
  12. Mu-oz P, Bouza E, Marín M, Alcalá L, Créixems MR, Valerio M, et al. Heart valves should not be routinely cultured. J Clin Microbiol. 2008;46(9):2897-901. [Crossref]  [PubMed]  [PMC] 
  13. Cui J, Yan W, Xie H, Xu H, Wang Q, Zhang W, et al. A retrospective seroepidemiologic survey of Chlamydia pneumoniae infection in patients in Beijing between 2008 and 2017. PLoS One. 2018;13(11):e0206995. [Crossref]  [PubMed]  [PMC] 
  14. El-Kholy AA, El-Rachidi NG, El-Enany MG, AbdulRahman EM, Mohamed RM, Rizk HH. Impact of serology and molecular methods on improving the microbiologic diagnosis of infective endocarditis in Egypt. Infection. 2015;43(5):523-9. [Crossref]  [PubMed] 
  15. Pradeep J, Stephen S, Ambroise S, Gunasekaran D. Diagnosis of acute Q fever by detection of Coxiella burnetii DNA using real-time PCR, employing a commercial genesig easy kit. J Clin Diagn Res. 2017;11(9):DC10-3. [Crossref]  [PubMed]  [PMC] 
  16. Okaro U, Addisu A, Casanas B, Anderson B. Bartonella species, an emerging cause of blood-culture-negative endocarditis. Clin Microbiol Rev. 2017;30(3):709-46. [Crossref]  [PubMed]  [PMC] 
  17. Norman AF, Regnery R, Jameson P, Greene C, Krause DC. Differentiation of bartonella-like isolates at the species level by PCR-restriction fragment length polymorphism in the citrate synthase gene. J Clin Microbiol. 1995;33(7):1797-803. [Crossref]  [PubMed]  [PMC] 
  18. Selton-Suty C, Célard M, Le Moing V, Doco-Lecompte T, Chirouze C, Iung B, et al. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis. 2012;54(9):1230-9. [Crossref]  [PubMed] 
  19. Agca FV, Demircan N, Peker T, Ari H, Karaagac K, Ozluk OA, et al. Infective endocarditis: a tertiary referral centre experience from Turkey. Int J Clin Exp Med. 2015;8(8):13962-8.
  20. Cetinkaya Y, Akova M, Akalın HE, Aşçioglu S, Hayran M, Uzun O, et al. A retrospective review of 228 episodes of infective endocarditis where rheumatic valvular disease is still common. Int J Antimicrob Agents. 2001;18(1):1-7. [Crossref] 
  21. Elbey MA, Akdağ A, Kalkan MA, Kaya MG, Sayın MR, Karapınar H, et al. A multicenter study on experience of 13 tertiary hospitals in Turkey in patients with infective endocarditis. Anadolu Kardiyol Derg. 2013;13(6):523-7. [Crossref]  [PubMed] 
  22. Kestler M, Mu-oz P, Marín M, Goenaga MA, Viedma PI, de Alarcón A, et al. Endocarditis caused by anaerobic bacteria. Anaerobe. 2017;47:33-8. [Crossref]  [PubMed] 
  23. Non LR, Santos CA. The occurrence of infective endocarditis with Staphylococcus lugdunensis bacteremia: a retrospective cohort study and systematic review. J Infect. 2017;74(2):179-86. [Crossref]  [PubMed] 
  24. Van Vlasselaer A, Rasmussen M, Nilsson J, Olaison L, Ragnarsson S. Native aortic versus mitral valve infective endocarditis: a nationwide registry study. Open Heart. 2019;6(1):e000926. [Crossref]  [PubMed]  [PMC] 
  25. Marmolin ES, Hartmeyer GN, Christensen JJ, Nielsen XC, Dargis R, Skov MN, et al. Bacteremia with the bovis group streptococci: species identification and association with infective endocarditis and with gastrointestinal disease. Diagn Microbiol Infect Dis. 2016;85(2):239-42. [Crossref]  [PubMed] 
  26. Subedi S, Jennings Z, Chen A. Laboratory approach to the diagnosis of culture- negative infective endocarditis. Heart Lung Circ. 2017;26(8):763-71. [Crossref]  [PubMed] 
  27. Padmaja K, Lakshmi V, Subramanian S, Neeraja M, Krishna SR, Satish OS. Infective endocarditis due to Granulicatella adiacens: a case report and review. J Infect Dev Ctries. 2014;8(4):548-50. [Crossref]  [PubMed] 
  28. Raja K, Antony M, Harikrishnan S. Infective endocarditis due to Streptococci and Enterococci: a 3-year retrospective study. Indian J Pathol Microbiol. 2018;61(4):545-8. [Crossref]  [PubMed] 
  29. Reguera JM, Alarcón A, Miralles F, Pachón J, Juárez C, Colmenero JD. Brucella endocarditis: clinical, diagnostic, and therapeutic approach. Eur J Clin Microbiol Infect Dis. 2003;22(11):647-50. [Crossref]  [PubMed] 
  30. Liesman RM, Pritt BS, Maleszewski JJ, Patel R. Laboratory Diagnosis of Infective Endocarditis. J Clin Microbiol. 2017;55(9):2599-608. [Crossref]  [PubMed]  [PMC] 
  31. Siciliano RF, Castelli JB, Mansur AJ, dos Santos FP, Colombo S, do Nascimento EM, et al. Bartonella spp. and Coxiella burnetii Associated with community-acquired, culture-negative endocarditis, Brazil. Emerg Infect Dis. 2015;21(8):1429-32. [Crossref]  [PubMed]  [PMC] 
  32. 2. Edouard S, Nabet C, Lepidi H, Fournier PE, Raoult D. Bartonella, a common cause of endocarditis: a report on 106 cases and review. J Clin Microbiol. 2015;53(3):824-9. [Crossref]  [PubMed]  [PMC] 
  33. Jang YR, Song JS, Jin CE, Ryu BH, Park SY, Lee SO, et al. Molecular detection of Coxiella burnetii in heart valve tissue from patients with culture-negative infective endocarditis. Medicine (Baltimore). 2018;97(34):e11881. [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