Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Kromozom 22q11.2 Delesyon Sendromu Tanılı Hastaların Klinik ve Laboratuvar Özellikleri
Evaluation of the Clinical and Laboratory Findings of Patients with Chromosome 22q11.2 Deletion Syndrome
Filiz HAZANa, Özlem NALBANTOĞLUb, Semra GÜRSOYc, Selime ÖZENd, Murat Muhtar YILMAZERe, Ferah GENELd, Timur MEŞEe, Behzat ÖZKANb
aDr. Behçet Uz Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi, Tıbbi Genetik Kliniği, İzmir, TÜRKİYE
bDr. Behçet Uz Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Endokrinoloji Kliniği, İzmir, TÜRKİYE
cDr. Behçet Uz Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Genetik Kliniği, İzmir, TÜRKİYE
dDr. Behçet Uz Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk İmmünoloji ve Alerji Kliniği, İzmir, TÜRKİYE
eDr. Behçet Uz Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Kardiyoloji Kliniği, İzmir, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2021;30(2):117-26
doi: 10.5336/pediatr.2021-81283
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmada; kromozom 22q11.2 Delesyon Sendromu (22q11.2DS) tanısı konulan hastaların, genetik polikliniğine başvuru nedenleri ile birlikte, klinik ve laboratuvar bulgularının ayrıntılı olarak değerlendirilmesi amaçlandı. Ayrıca bu sendroma özgü fizik muayene bulgularına dikkat çekilerek, erken tanı ve izlemdeki önemleri vurgulandı. Gereç ve Yöntemler: Ocak 2014 ve Nisan 2018 tarihleri arasında 'Floresan in Situ Hibridizasyon Analizi' ile 22q11.2DS tanısı konulan 13 hasta çalışma kapsamına alındı. Hastaların başvuru yakınmaları, fizik ve dismorfik muayene bulguları, tanı alma yaşları, laboratuvar ve görüntüleme sonuçları, dosyalarından geriye dönük olarak incelenerek değerlendirildi. Bulgular: Hastaların, genetik polikliniğine en sık başvuru nedenleri; atipik yüz görünümü ve kardiyak anomali olarak saptandı. Hastalar, klinik bulgularına göre değerlendirildiğinde en sık bulgular; öğrenme geriliği (13 hasta; %100), doğumsal kalp anomalileri (12 hasta; %92,3) dismorfik yüz bulguları (11 hasta; %84,6) ve hipernazal konuşma (10 hasta; %76,9) idi. Dört (%30,9) hastada, yarık damak tespit edildi. Boy kısalığı 3 hastada görülürken, büyüme hormon eksikliği hiçbir hastada saptanmadı. Üç (%23) hastaya hipoparatiroidizm, 5 (%38,4) hastaya hipokalsemi ve 4 (%30,7) hastaya hipotiroidi tanısı konuldu. İki (%15,4) hastada ise timus hipoplazisi vardı. İskelet sistemi değerlendirilmesinde; 2 (%15,4) hastada skolyoz, 1 (%7,6) hastada platibazi ve 1 (%7,6) hastada pes ekinovarus deformitesi saptandı. Bağ dokusu problemi olarak; 3 (%23,1) hastada umblikal herni ve 1 (%7,6) hastada ise inguinal herni tespit edildi. Sonuç: 22q11.2DS'li hastalarda, majör klinik bulguların yanında, diğer sistemik bulguların varlığı da mutlaka araştırılmalıdır. Hastaları değerlendirirken özellikle; skolyoz, platibazi, umblikal ve inguinal herni gibi iskelet sistemi ve bağ dokusu anomalileri açısından da dikkatli olunmalıdır.

Anahtar Kelimeler: 22q11.2 Delesyon Sendromu; iskelet sistemi; skolyoz; platibazi; herni
ABSTRACT
 Objective: It was aimed to evaluate in detail the clinical and laboratory findings of the patients diagnosed with chromosome 22q11.2 Deletion syndrome (22q11.2DS), together with the reasons for their application to the genetic clinic. In addition, by drawing attention to the physical examination findings specific to this syndrome, their importance in early diagnosis and follow-up was emphasized. Material and Methods: A total of 13 patients diagnosed with 22q11.2DS by Fluorescence in Situ Hybridization Analysis between January 2014 and April 2018 were included in this study. The causes of admission, physical and dysmorphic features, age of diagnosis, laboratory and imaging results of the patients were retrospectively evaluated from their medical records. Results: Atypical facial appearance and cardiac anomalies were the most common reasons for admission to genetic clinic. The most common features of the patients were learning disability (13 patients; 100%), congenital heart anomalies (12 patients; 92.3%), dysmorphic facial findings (11 patients; 84.6%), and hypernasal speech (10 patients; 76.9%). Cleft palate was seen in 4 patients (30.9%). While short stature was found in 3 patients, growth hormone deficiency was not detected in any of them. Hypoparathyroidism, hypocalcemia and hypothyroidism were seen in 3 patients (23%), 5 patients (%38.4), and 4 patients (30.7%), respectively. Two patients (15.4%) had thymus hypoplasia. During evaluation of skeletal system scoliosis, platybasia and pes equinovarus were observed in 2 patients (15.4%), 1 patient (7.6%), and 1 patient (7.6%) respectively. Connective tissue problems including, umbilical hernia (3 patients; 23.1%), and inguinal hernia (1 patient; 7.6%) were also noted. Conclusion: In addition to major clinical findings, the presence of other systemic findings should definitely be investigated in the evaluation of patients with 22q11.2DS. Care should be taken when evaluating patients with 22q11.2DS in terms of possible anomalies such as skeletal system and connective tissue pathologies including especially scoliosis, platibasia, umbilical and inguinal hernia.

Keywords: 22q11.2 Deletion Syndrome; skeletal system; scoliosis; platybasia; hernia
REFERENCES:
  1. Kirkpatrick JA Jr, DiGeorge AM. Congenital absence of the thymus. Am J Roentgenol Radium Ther Nucl Med. 1968;103(1):32-7. [Crossref] [PubMed] 
  2. McDonald-McGinn DM, Hain HS, Emanuel BS, Zackai EH. 22q11.2 Deletion Syndrome. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Stephens K, Amemiya A, eds. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2020. [Link] 
  3. Du Q, de la Morena MT, van Oers NSC. The genetics and epigenetics of 22q11.2 deletion syndrome. Front Genet. 2020;10:1365. [Crossref] [PubMed] [PMC] 
  4. Palmer LD, Butcher NJ, Boot E, Hodgkinson KA, Heung T, Chow EWC, et al. Elucidating the diagnostic odyssey of 22q11.2 deletion syndrome. Am J Med Genet A. 2018;176(4):936-44. [Crossref] [PubMed] [PMC] 
  5. Driscoll DA, Salvin J, Sellinger B, Budarf ML, McDonald-McGinn DM, Zackai EH, et al. Prevalence of 22q11 microdeletions in DiGeorge and velocardiofacial syndromes: implications for genetic counselling and prenatal diagnosis. J Med Genet. 1993;30(10):813-7. [Crossref] [PubMed] [PMC] 
  6. Farrera A, Villanueva M, Vizcaíno A, Medina-Bravo P, Balderrábano-Saucedo N, Rives M, Cruz D, et al. Ontogeny of the facial phenotypic variability in Mexican patients with 22q11.2 deletion syndrome. Head Face Med. 2019;15(1):29. [Crossref] [PubMed] [PMC] 
  7. Brown JJ, Datta V, Browning MJ, Swift PG. Graves' disease in DiGeorge syndrome: patient report with a review of endocrine autoimmunity associated with 22q11.2 deletion. J Pediatr Endocrinol Metab. 2004;17(11):1575-9. [Crossref] [PubMed] 
  8. Göktürk B, Reisli İ. DiGeorge Sendromu [DiGeorge Syndrome]. Asthma Allergy Immunol.2016;14:129-42. [Crossref] 
  9. Nepesov S, Aygün FD, Küçüksezer U, Taşdemir E, Çokuğraş H, Camcıoğlu Y. Clinical and immunophenotypic characteristics of patients with chromosome 22q11.2 deletion syndrome: a single institution's experience. Turk Pediatri Ars. 2019;54(1):28-34. [PubMed] [PMC] 
  10. Jiramongkolchai P, Kumar MS, Sowder D, Chinnadurai S, Wootten CT, Goudy SL. Speech outcomes in children with 22q11.2 deletion syndrome following surgery for velopharyngeal insufficiency. Int J Pediatr Otorhinolaryngol. 2016;88:34-7. [Crossref] [PubMed] 
  11. Goldmuntz E. 22q11.2 deletion syndrome and congenital heart disease. Am J Med Genet C Semin Med Genet. 2020;184(1):64-72. [Crossref] [PubMed] 
  12. McDonald-McGinn DM, LaRossa D, Goldmuntz E, Sullivan K, Eicher P, Gerdes M, et al. The 22q11.2 deletion: screening, diagnostic workup, and outcome of results; report on 181 patients. Genet Test. 1997;1(2):99-108. [Crossref] [PubMed] 
  13. Momma K. Cardiovascular anomalies associated with chromosome 22q11.2 deletion syndrome. Am J Cardiol. 2010;105(11):1617-24. [Crossref] [PubMed] 
  14. Oskarsdóttir S, Persson C, Eriksson BO, Fasth A. Presenting phenotype in 100 children with the 22q11 deletion syndrome. Eur J Pediatr. 2005;164(3):146-53. [Crossref] [PubMed] 
  15. Park IS, Ko JK, Kim YH, Yoo HW, Seo EJ, Choi JY, et al. Cardiovascular anomalies in patients with chromosome 22q11.2 deletion: a Korean multicenter study. Int J Cardiol. 2007;114(2):230-5. [Crossref] [PubMed] 
  16. Derbent M, Yilmaz Z, Baltaci V, Saygili A, Varan B, Tokel K. Chromosome 22q11.2 deletion and phenotypic features in 30 patients with conotruncal heart defects. Am J Med Genet A. 2003;116A(2):129-35. [Crossref] [PubMed] 
  17. Bousfiha A, Jeddane L, Picard C, Al-Herz W, Ailal F, Chatila T, et al. Human inborn errors of immunity: 2019 update of the IUIS phenotypical classification. J Clin Immunol. 2020;40(1):66-81. [Crossref] [PubMed] [PMC] 
  18. Legitimo A, Bertini V, Costagliola G, Baroncelli GI, Morganti R, Valetto A, et al. Vitamin D status and the immune assessment in 22q11.2 deletion syndrome. Clin Exp Immunol. 2020;200(3):272-86. [Crossref] [PubMed] [PMC] 
  19. Morsheimer M, Brown Whitehorn TF, Heimall J, Sullivan KE. The immune deficiency of chromosome 22q11.2 deletion syndrome. Am J Med Genet A. 2017;173(9):2366-72. [Crossref] [PubMed] 
  20. Jawad AF, McDonald-Mcginn DM, Zackai E, Sullivan KE. Immunologic features of chromosome 22q11.2 deletion syndrome (DiGeorge syndrome/velocardiofacial syndrome). J Pediatr. 2001;139(5):715-23. [Crossref] [PubMed] 
  21. Gennery AR, Barge D, O'Sullivan JJ, Flood TJ, Abinun M, Cant AJ. Antibody deficiency and autoimmunity in 22q11.2 deletion syndrome. Arch Dis Child. 2002;86(6):422-5. [Crossref] [PubMed] [PMC] 
  22. Suksawat Y, Sathienkijkanchai A, Veskitkul J, Jirapongsananuruk O, Visitsunthorn N, Vichyanond P, et al. Resolution of Primary Immune Defect in 22q11.2 Deletion Syndrome. J Clin Immunol. 2017;37(4):375-82. [Crossref] [PubMed] 
  23. Patel K, Akhter J, Kobrynski L, Benjamin Gathmann MA, Davis O, Sullivan KE; International DiGeorge Syndrome Immunodeficiency Consortium. Immunoglobulin deficiencies: the B-lymphocyte side of DiGeorge Syndrome. J Pediatr. 2012;161(5):950-3. Erratum in: J Pediatr. 2013;162(3):658. [Crossref] [PubMed] 
  24. Cancrini C, Puliafito P, Digilio MC, Soresina A, Martino S, Rondelli R, et al; Italian Network for Primary Immunodeficiencies. Clinical features and follow-up in patients with 22q11.2 deletion syndrome. J Pediatr. 2014;164(6):1475-80.e2. [Crossref] [PubMed] 
  25. Weinzimer SA. Endocrine aspects of the 22q11.2 deletion syndrome. Genet Med. 2001;3(1):19-22. [Crossref] [PubMed] 
  26. Young D, Shprintzen RJ, Goldberg RB. Cardiac malformations in the velocardiofacial syndrome. Am J Cardiol. 1980;46(4):643-8. [Crossref] [PubMed] 
  27. Goldberg R, Motzkin B, Marion R, Scambler PJ, Shprintzen RJ. Velo-cardio-facial syndrome: a review of 120 patients. Am J Med Genet. 1993;45(3):313-9. [Crossref] [PubMed] 
  28. Weinzimer SA, McDonald-McGinn DM, Driscoll DA, Emanuel BS, Zackai EH, Moshang T Jr. Growth hormone deficiency in patients with 22q11.2 deletion: expanding the phenotype. Pediatrics. 1998;101(5):929-32. [Crossref] [PubMed] 
  29. Ryan AK, Goodship JA, Wilson DI, Philip N, Levy A, Seidel H, et al. Spectrum of clinical features associated with interstitial chromosome 22q11 deletions: a European collaborative study. J Med Genet. 1997;34(10):798-804. [Crossref] [PubMed] [PMC] 
  30. Shugar AL, Shapiro JM, Cytrynbaum C, Hedges S, Weksberg R, Fishman L. An increased prevalence of thyroid disease in children with 22q11.2 deletion syndrome. Am J Med Genet A. 2015;167(7):1560-4. [Crossref] [PubMed] 
  31. Verheij E, Derks LSM, Stegeman I, Thomeer HGXM. Prevalence of hearing loss and clinical otologic manifestations in patients with 22q11.2 deletion syndrome: A literature review. Clin Otolaryngol. 2017;42(6):1319-28. [Crossref] [PubMed] 
  32. Homans JF, Baldew VGM, Brink RC, Kruyt MC, Schlösser TPC, Houben ML, et al. Scoliosis in association with the 22q11.2 deletion syndrome: an observational study. Arch Dis Child. 2019;104(1):19-24. [Crossref] [PubMed] 
  33. Glander K 2nd, Cisneros GJ. Comparison of the craniofacial characteristics of two syndromes associated with the Pierre Robin sequence. Cleft Palate Craniofac J. 1992;29(3):210-9. [Crossref] [PubMed] 
  34. Gokturk B, Guner SN, Kara R, Kirac M, Keles S, Artac H, et al. Would mean platelet volume/platelet count ratio be used as a novel formula to predict 22q11.2 deletion syndrome? Asian Pac J Allergy Immunol. 2016;34(2):166-73. [PubMed] 
  35. Barnett C, Langer JC, Hinek A, Bradley TJ, Chitayat D. Looking past the lump: genetic aspects of inguinal hernia in children. J Pediatr Surg. 2009;44(7):1423-31. [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