Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Relationship Between C-Reactive Protein, Uric Acid and Fibrinogen Levels and Insulin Resistance in Different Body Mass Indexes: Descriptive Research
Farklı Beden Kitle İndekslerinde C-Reaktif Protein, Ürik Asit ve Fibrinojen Düzeyleri ile İnsülin Direnci Arasındaki İlişki: Tanımlayıcı Araştırma
Murat AKŞİTa , Merve ZEYTİNLİ AKŞİTb
aDepartment of Medical Biochemistry, İzmir Tepecik Training and Research Hospital, İzmir, Türkiye
bDepartment of Medical Biochemistry, Bakırçay University Çiğli Training and Research Hospital, İzmir, Türkiye
Turkiye Klinikleri J Cardiovasc Sci. 2023;35(1):21-6
doi: 10.5336/cardiosci.2022-94122
Article Language: EN
Full Text
ABSTRACT
 Objective: Chronic inflammation in obesity is the main factor that increases insulin resistance by causing changes in insulin sensitivity. Our study aimed to investigate the relationship between insulin resistance and C-reactive protein (CRP), uric acid, and fibrinogen levels in different body mass indexes (BMI). Material and Methods: In our study, patients who applied to our hospital with the complaint of overweight in 2021-2022 were retrospectively analyzed, and 149 women aged 20 and over were included in the study. Glucose, uric acid, total cholesterol, high-density lipoprotein cholesterol, lowdensity lipoprotein cholesterol, triglyceride (TG), CRP, insulin, fibrinogen results, which were measured simultaneously with the height and weight measurements of the patients, were obtained from the laboratory information system. Results: The patients included in the study were 25 normal weight, 56 overweight, 53 obese and 15 morbidly obese according to BMI. The uric acid and TG levels of the overweight group were found to be significantly higher than the normal group (respectively; p=0.012, p=0.031), the CRP level of the morbidly obese group was found to be significantly higher than the normal, overweight, and obese groups (respectively; p<0.001, p<0.001, p=0.006). A significant positive correlation was found between Homeostatic Model Assessment for Insulin Resistance and CRP and uric acid (respectively; r=0.219, p=0.009; r=0.353, p<0,001). Conclusion: We think that uric acid levels in the early stage of obesity and CRP levels in the advanced stage may be a guide for insulin resistance and obesity-related diseases.

Keywords: Fibrinogen; uric acid; C-reaktive protein; obesity; insulin resistance
ÖZET
 Amaç: Obezitede görülen kronik inflamasyon, insülin duyarlılığında değişikliğe neden olarak insülin direncini artıran temel faktördür. Çalışmamızda, farklı beden kitle indekslerinde (BKİ) insülin direnci ile C-reaktif protein (CRP), ürik asit ve fibrinojen düzeyleri arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmamızda, 2021-2022 yıllarında fazla kilo şikâyeti ile hastanemize başvuran hastalar retrospektif olarak incelendi ve 20 yaş ve üzeri 149 kadın çalışmaya dâhil edildi. Hastaların boy ve kilo ölçümleri ile eş zamanlı olarak ölçülen glukoz, ürik asit, total kolesterol, yüksek dansiteli lipoprotein kolesterol, düşük dansiteli lipoprotein kolesterol, trigliserid (TG), CRP, insülin ve fibrinojen sonuçları laboratuvar bilgi sisteminden alındı. Bulgular: Çalışmaya dâhil edilen hastalar BKİ'ye göre 25 normal kilolu, 56 kilolu, 53 obez ve 15 morbid obezdi. Aşırı kilolu grubun ürik asit ve TG düzeyleri normal kilolu gruba göre anlamlı olarak yüksek (sırasıyla; p=0,012, p=0,031), morbid obez grubun CRP düzeyi normal, fazla kilolu ve obez gruplara göre anlamlı yüksek bulundu (sırasıyla p<0,001, p<0,001, p=0,006). İnsülin Direncinin Homeostatik Modeli Değerlendirmesi ile CRP ve ürik asit arasında anlamlı pozitif korelasyon saptandı (sırasıyla; r=0,219, p=0,009; r=0,353, p<0,001). Sonuç: Obezitenin erken evresinde ürik asit, ileri evresinde ise CRP düzeylerinin, insülin direnci ve obezite ile ilişkili hastalıklar için yol gösterici olabileceğini düşünüyoruz.

Anahtar Kelimeler: Fibrinojen; ürik asit; C-reaktif protein; obezite; insülin direnci
REFERENCES:
  1. Raza Q, Doak CM, Khan A, Nicolaou M, Seidell JC. Obesity and cardiovascular disease risk factors among the indigenous and immigrant Pakistani population: a systematic review. Obes Facts. 2013;6(6):523-35. [Crossref]  [PubMed]  [PMC] 
  2. Timmis A, Townsend N, Gale C, Grobbee R, Maniadakis N, Flather M, et al; ESC Scientific Document Group. European Society of Cardiology: Cardiovascular Disease Statistics 2017. Eur Heart J. 2018;39(7):508-79. [PubMed] 
  3. Nomiyama T, Perez-Tilve D, Ogawa D, Gizard F, Zhao Y, Heywood EB, et al. Osteopontin mediates obesity-induced adipose tissue macrophage infiltration and insulin resistance in mice. J Clin Invest. 2007;117(10):2877-88. [Crossref]  [PubMed]  [PMC] 
  4. Patel PS, Buras ED, Balasubramanyam A. The role of the immune system in obesity and insulin resistance. J Obes. 2013;2013:616193. [Crossref]  [PubMed]  [PMC] 
  5. Kim J, Lee J. Role of obesity-induced inflammation in the development of insulin resistance and type 2 diabetes: history of the research and remaining questions. Ann Pediatr Endocrinol Metab. 2021;26(1):1-13. [Crossref]  [PubMed]  [PMC] 
  6. Hortin GL. Amino acids, peptides, and proteins. In: Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. St. Louis, USA: Elsevier Saunders; 2012. p.509-62. [Crossref] 
  7. Stanimirovic J, Radovanovic J, Banjac K, Obradovic M, Essack M, Zafirovic S, et al. role of C-reactive protein in diabetic inflammation. Mediators Inflamm. 2022;2022:3706508. [Crossref]  [PubMed]  [PMC] 
  8. Gherghina ME, Peride I, Tiglis M, Neagu TP, Niculae A, Checherita IA. Uric acid and oxidative stress-relationship with cardiovascular, metabolic, and renal impairment. Int J Mol Sci. 2022;23(6):3188. [Crossref]  [PubMed]  [PMC] 
  9. Varesi A, Chirumbolo S, Campagnoli LIM, Pierella E, Piccini GB, Carrara A, et al. The role of antioxidants in the interplay between oxidative stress and senescence. Antioxidants (Basel). 2022;11(7):1224. [Crossref]  [PubMed]  [PMC] 
  10. Kang DH, Ha SK. Uric acid puzzle: dual role as anti-oxidantand pro-oxidant. Electrolyte Blood Press. 2014;12(1):1-6. [Crossref]  [PubMed]  [PMC] 
  11. Kim HK, Lee M, Lee YH, Lee BW, Cha BS, Kang ES. Uric acid variability as a predictive marker of newly developed cardiovascular events in type 2 diabetes. Front Cardiovasc Med. 2021;8:775753. [Crossref]  [PubMed]  [PMC] 
  12. Ciarla S, Struglia M, Giorgini P, Striuli R, Necozione S, Properzi G, et al. Serum uric acid levels and metabolic syndrome. Arch Physiol Biochem. 2014;120(3):119-22. [Crossref]  [PubMed] 
  13. Liu SL, Wu NQ, Shi HW, Dong Q, Dong QT, Gao Y, et al. Fibrinogen is associated with glucose metabolism and cardiovascular outcomes in patients with coronary artery disease. Cardiovasc Diabetol. 2020;19(1):36. [Crossref]  [PubMed]  [PMC] 
  14. Mahjabeen S, Selim S, Mustari M, Rajib MH, Rahman AK, Fariduddin M, et al. Association of plasma fibrinogen and insulin resistance in women with gestational diabetes mellitus. Archives of Clinical and Biomedical Research. 2022;6(3):492-502. [Crossref] 
  15. Türkiye Endokrinoloji ve Metabolizma Derneği. Obezite Tanı ve Tedavi Kılavuzu. 3. Baskı. Ankara: Miki Matbaacılık San ve Tic Ltd Şti; 2016. p.12-24.
  16. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-9. [Crossref]  [PubMed] 
  17. Rocha VZ, Libby P. Obesity, inflammation, and atherosclerosis. Nat Rev Cardiol. 2009;6(6):399-409. [Crossref]  [PubMed] 
  18. Gregor MF, Hotamisligil GS. Inflammatory mechanisms in obesity. Annu Rev Immunol. 2011;29:415-45. [Crossref]  [PubMed] 
  19. Abbasi F, Brown BW Jr, Lamendola C, McLaughlin T, Reaven GM. Relationship between obesity, insulin resistance, and coronary heart disease risk. J Am Coll Cardiol. 2002;40(5):937-43. [Crossref]  [PubMed] 
  20. Baskın Y, Yiğitbaşı T, Afacan G, Bağbozan Ş. İnsülin direnci olan erişkin kilolu ve obezlerde lipoprotein (a) ile lipid parametreleri [Lipoprotein (a) and lipid parameters in overweight and obese adults with insulin resistance]. Türk Klinik Biyokimya Derg. 2008;6(2):65-71. [Link] 
  21. Hancı T, Türkön H, Çolak Aydoğdu A, Yıldız Ö, Karademirci İ, Çoker I. Yüksek duyarlıklı C-reaktif protein (HSCRP) ve obezite ilişkisi [Association of high sensitivity C-reactive protein (HSCRP) and obesity]. Türk Klinik Biyokimya Derg. 2012;10(1):1-7. [Link] 
  22. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282(22):2131-5. [Crossref]  [PubMed] 
  23. Bastard JP, Jardel C, Bruckert E, Blondy P, Capeau J, Laville M, et al. Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of obese women after weight loss. J Clin Endocrinol Metab. 2000;85(9):3338-42. [Crossref]  [PubMed] 
  24. Missel AL, Saslow LR, Griauzde DH, Marvicsin D, Sen A, Richardson CR, et al. Association between fasting insulin and C-reactive protein among adults without diabetes using a two-part model: NHANES 2005-2010. Diabetol Metab Syndr. 2021;13(1):29. [Crossref]  [PubMed]  [PMC] 
  25. Çarlıoğlu A, Karakurt F, Maral S, Kasapoğlu B, Darcın T. Serum uric acid levels in obese women. The New Journal of Medicine. 2011;28:34-7. [Link] 
  26. de Carvalho Vidigal F, de Lima Rosado LE, Paixão Rosado G, Lanes Ribeiro Rde C, Castro Franceschini Sdo C. Serum uric acid can predict higher C-reactive protein levels in apparently healthy men. Nutr Hosp. 2014;29(4):935-40. [PubMed] 
  27. Lippi G, Montagnana M, Luca Salvagno G, Targher G, Cesare Guidi G. Epidemiological association between uric acid concentration in plasma, lipoprotein(a), and the traditional lipid profile. Clin Cardiol. 2010;33(2):E76-80. [Crossref]  [PubMed]  [PMC] 
  28. Yu P, Huang L, Wang Z, Meng X, Yu X. The association of serum uric acid with beta-cell function and insulin resistance in nondiabetic individuals: a cross-sectional study. Diabetes Metab Syndr Obes. 2021;14:2673-82. [Crossref]  [PubMed]  [PMC] 
  29. Li F, Chen S, Qiu X, Wu J, Tan M, Wang M. Serum uric acid levels and metabolic ındices in an obese population: a cross-sectional study. Diabetes Metab Syndr Obes. 2021;14:627-35. [Crossref]  [PubMed]  [PMC] 
  30. Adnan E, Rahman IA, Faridin HP. Relationship between insulin resistance, metabolic syndrome components and serum uric acid. Diabetes Metab Syndr. 2019;13(3):2158-62. [Crossref]  [PubMed] 
  31. Koçak A, Kutlu R, Çivi S, Kılınç İ. Obezitede insülin direnci ile leptin, interlökin-6, hs-CRP ve fibrinojen ilişkisi [Relationship between insulin resistance and leptin, interleukin-6, hs-CRP and fibrinogen in obesity]. Turk J Biochem. 2014;39(3):373-82. [Link] 
  32. Keskin S, Sayalı E, Temeloglu E, Ekizoglu E. Obezite ve inflamasyon [Obesity and inflammation]. Turkiye Klinikleri J Med Sci. 2005;25(2):636-41.
  33. Gómez-Ambrosi J, Salvador J, Silva C, Pastor C, Rotellar F, Gil MJ, et al. Increased cardiovascular risk markers in obesity are associated with body adiposity: role of leptin. Thromb Haemost. 2006;95(6):991-6. [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