Turkiye Klinikleri Journal of Veterinary Sciences

.: ORIGINAL RESEARCH
Natural Thermal Water Consumption Could be Capable of Improving Gut Mycobiome in Dogs with Inflammatory Bowel Disease and Dermatological Manifestations: Randomized Clinical Study
Yangısal Bağırsak Hastalığı ve Dermatolojik Bulguları Olan Köpeklerde Doğal Termal Su Tüketimi Bağırsak Mikobiyomunu Geliştirebilir: Randomize Klinik Çalışma
Kerem URALa , Hasan ERDOĞANa , Songül ERDOĞANa , Serdar PAŞAa
aDepatment of Internal Medicine, Aydın Adnan Menderes University Faculty of Veterinary, Aydın, Türkiye
Turkiye Klinikleri J Vet Sci. 2023;14(1):1-10
doi: 10.5336/vetsci.2022-91433
Article Language: EN
Full Text
ABSTRACT
Objective: Given the gut microbiome is a supreme immunological and metabolic organ, much data is recognized within the intestinal bacteria whereas the prevalence along with phylogenetic interpretation of fungal organisms participating within intestinal ecosystem have not explored convincingly among dogs with inflammatory bowel disease (IBD). In the present study, the present authors' for the first time a) described the fungal gut mycobiome, b) analyzed disbiosis network for fungal kigdom, c) detected the efficacy of natural thermal water (nTW) on gut mycobiome. Material and Methods: For these purpose, MIDOG All-in One Microbial Test targetting Next-Generation DNA Sequencing was used to determining of fungal microbiome prior to and thereafter nTW in a total of 13 dogs with IBD. Results: Aspergillus sp. (n=5), Acremonium hyalinulum (n=4), Acremonium fusidoides-hansfordii (n=4) were frequently isolated as fungal pathogens whereas case VII exhibited 5 different species (at most) and 4 other dogs presented solely 1 species. Interestingly a 6 week course of nTW consumption resulted with disapperance of fungal pathogens in 12 out of 13 cases. On behalf of repeated Next-Generation DNA Sequencing at 6th week analysis of all 12 cases wered deemed more diverse gut mycobiome. Conclusion: Obtained data preserved protective/restorative roles of nTW on gut mycobiome in dogs with IBD and dermatological manifestations ivolved at the present study.

Keywords: Alkaline water; dog; inflamatory bowel disease; gut microbiome
ÖZET
Amaç: Bağırsak mikrobiyomunun üstün bir immünolojik ve metabolik organ olduğu göz önüne alındığında, intestinal bakteriler için çok fazla veri tanımlanırken, yangısal bağırsak hastalığı olan köpeklerde intestinal ekosisteme katılan mantar organizmalarının filogenetik değerlendirmesi ile birlikte prevalansı ikna edici bir şekilde araştırılmamıştır. Bu çalışma ile araştırmacılar ilk defa a) fungal bağırsak mikrobiyomunun tanımlamış, b) fungal faunadaki disbiyozis ağını tanımlamış, c) doğal termal suyun bağırsak mikrobiyatası üzerine etkisini belirlemiştir. Gereç ve Yöntemler: Bu amaçlar doğrultusunda yangısal bağırsak hastalığı olan 13 köpekte doğal termal su tüketimi öncesi ve sonrası fungal mikrobiyatanın belirlenmesi için DNA sekansının belirlenmesine dayanan MIDOG ALL-in One Mikrobiyal Test kullanılmıştır. Bulgular: Fungal patojen olarak sıklıkla Aspergillus sp. (n=5), Acremonium hyalinulum (n=4), Acremonium fusidoides-hansfordii (n=4) izole edilmişken, olgu VII 5 farklı tür (en fazla) ve diğer 4 köpekte sadece 1 tür tespit edilmiştir. İlginç olarak 6 haftalık termal su kullanımı sonrası 13 vakanın 12'sinde fungal patojenler kaybolmuştur. Sonuç: Yangısal bağırsak hastalığı ve dermatolojik bulguları olan köpeklerde doğal termal suyun bağırsak mikrobiyomu üzerindeki koruyucu/yenileyici rolü bu çalışmadan elde edilen verilerle ortaya konulmuştur.

Anahtar Kelimeler: Alkali su; köpek; yangısal bağırsak hastalığı; bağırsak mikrobiyomu
REFERENCES:
  1. Suchodolski JS. Analysis of the gut microbiome in dogs and cats. Veterinary Clinical Pathology. 2022;50(S1):6-17. [Crossref]  [PubMed]  [PMC] 
  2. Barry KA, Middelbos IS, Vester Boler BM, Dowd SE, Suchodolski JS, Henrissat B, et al. Effects of dietary fiber on the feline gastrointestinal metagenome. J Proteome Res. 2012;11(12):5924-33. [Crossref]  [PubMed] 
  3. Foster ML, Dowd SE, Stephenson C, Steiner JM, Suchodolski JS. Characterization of the fungal microbiome (mycobiome) in fecal samples from dogs. Vet Med Int. 2013;2013:658373. [Crossref]  [PubMed]  [PMC] 
  4. German AJ, Hall EJ, Day MJ. Chronic intestinal inflammation and intestinal disease in dogs. J Vet Intern Med. 2003;17(1):8-20. [Crossref]  [PubMed] 
  5. Washabau RJ, Day MJ, Willard MD, Hall EJ, Jergens AE, Mansell J, et al; WSAVA International Gastrointestinal Standardization Group. Endoscopic, biopsy, and histopathologic guidelines for the evaluation of gastrointestinal inflammation in companion animals. J Vet Intern Med. 2010;24(1):10-26. Erratum in: J Vet Intern Med. 2010;24(3):796. [Crossref]  [PubMed] 
  6. Minamoto Y, Otoni CC, Steelman SM, Büyükleblebici O, Steiner JM, Jergens AE, et al. Alteration of the fecal microbiota and serum metabolite profiles in dogs with idiopathic inflammatory bowel disease. Gut Microbes. 2015;6(1):33-47. [Crossref]  [PubMed]  [PMC] 
  7. Wikipedia [Internet]. [Cited: 5 May, 2022]. Hot spring. Available from: [Link] 
  8. Ghannoum M. Cooperative evolutionary strategy between the bacteriome and mycobiome. mBio. 2016;7(6):e01951-16. [Crossref]  [PubMed]  [PMC] 
  9. Xu J, Verbrugghe A, Lourenço M, Janssens GP, Liu DJ, Van de Wiele T, et al. Does canine inflammatory bowel disease influence gut microbial profile and host metabolism? BMC Vet Res. 2016;12(1):114. [Crossref]  [PubMed]  [PMC] 
  10. Allenspach K, House A, Smith K, McNeill FM, Hendricks A, Elson-Riggins J, et al. Evaluation of mucosal bacteria and histopathology, clinical disease activity and expression of Toll-like receptors in German shepherd dogs with chronic enteropathies. Vet Microbiol. 2010;146(3-4):326-35. [Crossref]  [PubMed] 
  11. Frank DN, St Amand AL, Feldman RA, Boedeker EC, Harpaz N, Pace NR. Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases. Proc Natl Acad Sci U S A. 2007;104(34):13780-5. [Crossref]  [PubMed]  [PMC] 
  12. Packey CD, Sartor RB. Commensal bacteria, traditional and opportunistic pathogens, dysbiosis and bacterial killing in inflammatory bowel diseases. Curr Opin Infect Dis. 2009;22(3):292-301. [Crossref]  [PubMed]  [PMC] 
  13. Craven M, Egan CE, Dowd SE, McDonough SP, Dogan B, Denkers EY, et al. Inflammation drives dysbiosis and bacterial invasion in murine models of ileal Crohn's disease. PLoS One. 2012;7(7):e41594. [Crossref]  [PubMed]  [PMC] 
  14. Mulder DJ, Noble AJ, Justinich CJ, Duffin JM. A tale of two diseases: the history of inflammatory bowel disease. J Crohns Colitis. 2014;8(5):341-8. [Crossref]  [PubMed] 
  15. Turnbaugh PJ, Ley RE, Hamady M, Fraser-Liggett CM, Knight R, Gordon JI. The human microbiome project. Nature. 2007;449(7164):804-10. [Crossref]  [PubMed]  [PMC] 
  16. Honda K, Littman DR. The microbiome in infectious disease and inflammation. Annu Rev Immunol. 2012;30:759-95. [Crossref]  [PubMed]  [PMC] 
  17. Beheshti-Maal A, Shahrokh S, Ansari S, Mirsamadi ES, Yadegar A, Mirjalali H, et al. Gut mycobiome: The probable determinative role of fungi in IBD patients. Mycoses. 2021;64(5):468-76. [Crossref]  [PubMed] 
  18. Stewart DB Sr, Wright JR, Fowler M, McLimans CJ, Tokarev V, Amaniera I, et al. Integrated meta-omics reveals a fungus-associated bacteriome and distinct functional pathways in clostridioides difficile infection. mSphere. 2019;4(4):e00454-19. [Crossref]  [PubMed]  [PMC] 
  19. Niemiec BA, Gawor J, Tang S, Prem A, Krumbeck JA. The mycobiome of the oral cavity in healthy dogs and dogs with periodontal disease. Am J Vet Res. 2021;83(1):42-9. [Crossref]  [PubMed] 
  20. Iliev ID, Leonardi I. Fungal dysbiosis: immunity and interactions at mucosal barriers. Nat Rev Immunol. 2017;17(10):635-46. [Crossref]  [PubMed]  [PMC] 
  21. Qiu X, Ma J, Jiao C, Mao X, Zhao X, Lu M, et al. Alterations in the mucosa-associated fungal microbiota in patients with ulcerative colitis. Oncotarget. 2017;8(64):107577-107588. [Crossref]  [PubMed]  [PMC] 
  22. Li Q, Wang C, Tang C, He Q, Li N, Li J. Dysbiosis of gut fungal microbiota is associated with mucosal inflammation in Crohn's disease. J Clin Gastroenterol. 2014;48(6):513-23. [Crossref]  [PubMed]  [PMC] 
  23. Sokol H, Leducq V, Aschard H, Pham HP, Jegou S, Landman C, et al. Fungal microbiota dysbiosis in IBD. Gut. 2017;66(6):1039-48. [Crossref]  [PubMed]  [PMC] 
  24. Lee D, Hong JH. The fundamental role of bicarbonate transporters and associated carbonic anhydrase enzymes in maintaining Ion and pH homeostasis in non-secretory organs. Int J Mol Sci. 2020;21(1):339. [Crossref]  [PubMed]  [PMC] 
  25. Palileo C, Kaunitz JD. Gastrointestinal defense mechanisms. Curr Opin Gastroenterol. 2011;27(6):543-8. [Crossref]  [PubMed] 
  26. Seidler UE. Gastrointestinal HCO3- transport and epithelial protection in the gut: new techniques, transport pathways and regulatory pathways. Curr Opin Pharmacol. 2013;13(6):900-8. [Crossref]  [PubMed] 
  27. Tarnawski AS, Ahluwalia A, Jones MK. Increased susceptibility of aging gastric mucosa to injury: the mechanisms and clinical implications. World J Gastroenterol. 2014;20(16):4467-82. [Crossref]  [PubMed]  [PMC] 
  28. Said H, Kaunitz JD. Gastrointestinal defense mechanisms. Curr Opin Gastroenterol. 2016;32(6):461-6. [Crossref]  [PubMed]  [PMC] 
  29. Barnich N, Rodrigues M, Sauvanet P, Chevarin C, Denis S, Le Goff O, et al. Beneficial effects of natural mineral waters on intestinal inflammation and the mucosa-associated microbiota. Int J Mol Sci. 2021;22(9):4336. [Crossref]  [PubMed]  [PMC] 
  30. Fukudome I, Kobayashi M, Dabanaka K, Maeda H, Okamoto K, Okabayashi T, et al. Diamine oxidase as a marker of intestinal mucosal injury and the effect of soluble dietary fiber on gastrointestinal tract toxicity after intravenous 5-fluorouracil treatment in rats. Med Mol Morphol. 2014;47(2):100-7. [Crossref]  [PubMed] 
  31. Honzawa Y, Nakase H, Matsuura M, Chiba T. Clinical significance of serum diamine oxidase activity in inflammatory bowel disease: Importance of evaluation of small intestinal permeability. Inflamm Bowel Dis. 2011;17(2):E23-5. [Crossref]  [PubMed] 
  32. Letscher-Bru V, Obszynski CM, Samsoen M, Sabou M, Waller J, Candolfi E. Antifungal activity of sodium bicarbonate against fungal agents causing superficial infections. Mycopathologia. 2013;175(1-2):153-8. [Crossref]  [PubMed] 
  33. Sousa FA, Paradella TC, Koga-Ito CY, Jorge AO. Effect of sodium bicarbonate on Candida albicans adherence to thermally activated acrylic resin. Braz Oral Res. 2009;23(4):381-5. [Crossref]  [PubMed] 
  34. Zeichner J, Seite S. From probiotic to prebiotic using thermal spring water. J Drugs Dermatol. 2018;17(6):657-62. [PubMed] 
  35. Murakami S, Goto Y, Ito K, Hayasaka S, Kurihara S, Soga T, et al. The consumption of bicarbonate-rich mineral water improves glycemic control. Evid Based Complement Alternat Med. 2015;2015:824395. [Crossref]  [PubMed]  [PMC] 

.: Up To Date

Login



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