Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Vitamin D in Patients with Cardiac Syndrome X and its Relationship with Inflamatuar and Oxidative Stress Markers: A Case Control Study
Kardiyak Sendrom X Hastalarında D Vitamini ve Bunun İnflamatuar ve Oksidatif Stres Belirteçleri ile İlişkisi: Vaka-Kontrol Çalışması
Yasemin ÜSTÜNDAĞa , Dursun TOPALb , Fahri ERc , Kağan HUYSALc
aUniversity of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Department of Clinical Biochemistry, Bursa, Türkiye
bUniversity of Health Sciences Bursa City Hospital, Department of Cardiology, Bursa, Türkiye
cAğrı Training and Research Hospital, Clinic of Cardiology, Ağrı, Türkiye
Turkiye Klinikleri J Cardiovasc Sci. 2024;36(1):21-6
doi: 10.5336/cardiosci.2023-98838
Article Language: EN
Full Text
ABSTRACT
 Objective: Cardiac syndrome X (CSX) is used to define patients with ischemic chest pain and normal coronary arteries, as revealed by angiography. The etiology of CSX may be associated with extensive coronary microvascular endothelial dysfunction, inflammation, and oxidative stress. We aimed to simultaneously investigate the relationships of serum vitamin D levels with oxidative stress, atherogenic index of plasma (AIP) and systemic inflammation marker C-reactive protein (CRP) to albumin ratio in CSX patients. Material and Methods: The present study group included 52 consecutive symptomatic patients diagnosed with CSX and 42 healthy controls. Serum total cholesterol, high-density lipoprotein (HDL), triglyceride, vitamin D, CRP, serum advanced oxidation protein product, and Ferric reducing ability of plasma levels were measured. The CRP/albumin ratio was determined. The AIP was calculated as log (triglyceride/HDL-C). Results: Patients with CSX had decreased vitamin D levels [11.2 (IQR: 6.3) ng/mL vs. 14.8 (IQR: 6.4) ng/mL; p=0.05] and higher CRP/albumin ratios [1.42 (0.84) vs. 1.01 (0.36); p=0.01] and similar AIP (0.11±0.30 vs. 0.14±0.29; p=0.76) compared to the control group. There was a weak negative correlation between vitamin D and CRP/albumin ratio (r=-0.23, p=0.03) levels. Conclusion: The reduction of vitamin D levels and systemic inflammation may play a role in the development of CSX.

Keywords: Cardiovascular disease; inflammation; microvascular angina; oxidative stress; Vitamin D
ÖZET
 Amaç: Kardiyak sendrom X (KSX), anjiyografi ile ortaya konulan normal koroner arterleri olan ve iskemik göğüs ağrısı yaşayan hastaları tanımlamak için kullanılmaktadır. KSX'in etiyolojisi, yaygın koroner mikrovasküler endotel disfonksiyonu, inflamasyon ve oksidatif stres ile ilişkili olabilir. Bu çalışmada, KSX hastalarında serum D vitamini düzeylerinin oksidatif stres, plazmanın aterojenik indeksi [atherogenic index of plasma (AIP)] ve sistemik inflamasyon belirteci olan C-reaktif protein (CRP) ile albumin oranı arasındaki ilişkileri aynı anda araştırmayı amaçladık. Gereç ve Yöntemler: Bu çalışma grubunda, ardışık olarak KSX teşhisi konulan 52 semptomatik hasta ve 42 sağlıklı kontrol bulunmaktadır. Serum total kolesterol, yüksek yoğunluklu lipoprotein [high-density lipoprotein (HDL-K)], trigliserid, D vitamini, CRP, serum ileri oksidasyon protein ürünü ve plazmanın ferrik indirgeme gücü düzeyleri ölçüldü. CRP/albumin oranı belirlendi. Plazma AIP değeri log (trigliserid/HDL-K) ile hesaplandı. Bulgular: KSX hastalarında kontrol grubuna kıyasla düşük D vitamini düzeyleri [11,2 (IQR: 6,3) ng/mL vs. 14,8 (IQR: 6,4) ng/mL; p=0,05] ve daha yüksek CRP/albumin oranları [1,42 (0,84) vs. 1,01 (0,36); p=0,01] ve benzer AIP (0,11±0,30 vs. 0,14±0,29; p=0,76) tespit edildi. D vitamini ile CRP/albumin oranı arasında zayıf bir negatif korelasyon bulundu (r=-0,23, p=0,03). Sonuç: D vitamini düzeylerindeki azalma ve sistemik inflamasyonun, KSX gelişiminde rol oynayabileceği düşünülmektedir.

Anahtar Kelimeler: Kardiyovasküler hastalık; inflamasyon; mikrovasküler anjina; oksidatif stres; Vitamin D
REFERENCES:
  1. Jarczewski J, Jarczewska A, Boryczko A, Poniatowski A, Furgała A, Surdacki A, et al. Microvascular angina (Cardiac Syndrome X) from a historical overview, epidemiology, pathophysiology to treatment recommendations - a minireview. Folia Med Cracov. 2021;61(3):95-114. [PubMed] 
  2. Cao GY, Li JC, Wang WJ, Wu HB. The relationship between the neutrophil to lymphocyte ratio, the platelet to lymphocyte ratio, and cardiac syndrome X. Risk Manag Healthc Policy. 2022;15:427-33. [Crossref]  [PubMed]  [PMC] 
  3. Seydi-Shirvani S, Rasmib Y, Seyyed-Mohammadzad MH, Khosravifar F. Oxidative stress status in patients with cardiac syndrome X. Science Asia. 2012;38(2):136-40. [Crossref] 
  4. Yaşar E, Bayramoğlu A. Systemic Immune-Inflammation Index as a predictor of microvascular dysfunction in patients with cardiac syndrome X. Angiology. 2022;73(7):615-21. [Crossref]  [PubMed] 
  5. Petrucci G, Rizzi A, Hatem D, Tosti G, Rocca B, Pitocco D. Role of oxidative stress in the pathogenesis of atherothrombotic diseases. Antioxidants (Basel). 2022;11(7):1408. [Crossref]  [PubMed]  [PMC] 
  6. Ustundag Y, Huysal K, Kahvecioglu S, Demirci H, Yavuz S, Sambel M, et al. Establishing reference values and evaluation of an in-house ferric reducing antioxidant power (FRAP) Colorimetric Assay in Microplates. Eur Res J. 2016;2(2):126-31. [Link] 
  7. Wiseman H. Vitamin D is a membrane antioxidant. Ability to inhibit iron-dependent lipid peroxidation in liposomes compared to cholesterol, ergosterol and tamoxifen and relevance to anticancer action. FEBS Lett. 1993;326(1-3):285-8. [Crossref]  [PubMed] 
  8. de la Guía-Galipienso F, Martínez-Ferran M, Vallecillo N, Lavie CJ, Sanchis-Gomar F, Pareja-Galeano H. Vitamin D and cardiovascular health. Clin Nutr. 2021;40(5):2946-57. [Crossref]  [PubMed]  [PMC] 
  9. Turhan Caglar FN, Ungan I, Ksanski V, Opan S, Çiftçi S, Kural A, et al. Evaluation of serum vitamin D levels in patients with X syndrome. Eur Rev Med Pharmacol Sci. 2016;20(6):1155-60. [PubMed] 
  10. Makhlouf AMA, Mahmoud AM, Ibrahim RG, Abdel Aziz YS. Effects of vitamin D and simvastatin on inflammatory and oxidative stress markers of high-fat diet-induced obese rats. J Sci Res Med Biol Sci. 2021;2(3):39-50. [Crossref] 
  11. Farhangi MA, Nameni G, Hajiluian G, Mesgari-Abbasi M. Cardiac tissue oxidative stress and inflammation after vitamin D administrations in high fat- diet induced obese rats. BMC Cardiovasc Disord. 2017;17(1):161. [Crossref]  [PubMed]  [PMC] 
  12. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. [Crossref]  [PubMed] 
  13. Li Y, Feng Y, Li S, Ma Y, Lin J, Wan J, et al. The atherogenic index of plasma (AIP) is a predictor for the severity of coronary artery disease. Front Cardiovasc Med. 2023;10:1140215. [Crossref]  [PubMed]  [PMC] 
  14. Witko-Sarsat V, Friedlander M, Nguyen Khoa T, Capeillère-Blandin C, Nguyen AT, Canteloup S, et al. Advanced oxidation protein products as novel mediators of inflammation and monocyte activation in chronic renal failure. J Immunol. 1998;161(5):2524-32. [Crossref]  [PubMed] 
  15. Budak YU, Akdogan M, Huysal K. Relationship of PON1 Activity and hsCRP concentration with disease status in patients with Type 2 diabetes mellitus with and without retinopathy. Int J Diabetes Dev Ctries. 2013;33(1):40-5. [Crossref] 
  16. Dollard J, Kearney P, Clarke G, Moloney G, Cryan JF, Dinan TG. A prospective study of C-reactive protein as a state marker in Cardiac Syndrome X. Brain Behav Immun. 2015;43:27-32. [Crossref]  [PubMed] 
  17. Bozcali E, Polat V, Aciksari G, Opan S, Bayrak IH, Paker N, et al. Serum concentrations of galectin-3 in patients with cardiac syndrome X. Atherosclerosis. 2014;237(1):259-63. [Crossref]  [PubMed] 
  18. Tenekecioglu E, Yilmaz M, Demir S, Bekler A, Ozluk OA, Aydin U, etal. HDL-cholesterol is associated with systemic inflammation in cardiac syndrome X. Minerva Med. 2015;106(3):133-41. [PubMed] 
  19. Sestito A, Lanza GA, Di Monaco A, Lamendola P, Careri G, Tarzia P, et al. Relation between cardiovascular risk factors and coronary microvascular dysfunction in cardiac syndrome X. J Cardiovasc Med (Hagerstown). 2011;12(5):322-7. [Crossref]  [PubMed] 
  20. Boyraz B, Mutluer FO, Topal D, Demir M, Peker T, Yılmaz M, et al. assessment of inflammatory parameters in obstructive coronary artery disease and cardiac syndrome X: an evolving value of neutrophil-lymphocyte ratio. Eur Res J. 2020;6(1):53-61. [Crossref] 
  21. Cosín-Sales J, Pizzi C, Brown S, Kaski JC. C-reactive protein, clinical presentation, and ischemic activity in patients with chest pain and normal coronary angiograms. J Am Coll Cardiol. 2003;41(9):1468-74. [Crossref]  [PubMed] 
  22. Zittermann A, Trummer C, Theiler-Schwetz V, Lerchbaum E, März W, Pilz S. Vitamin D and cardiovascular disease: an updated narrative review. Int J Mol Sci. 2021;22(6):2896. [Crossref]  [PubMed]  [PMC] 
  23. Babür Güler G, Güler E, Hatipoğlu S, Güneş HM, Geçmen Ç, Demir GG, et al. Assessment of 25-OH vitamin D levels and abnormal blood pressure response in female patients with cardiac syndrome X. Anatol J Cardiol. 2016;16(12):961-6. [Crossref]  [PubMed]  [PMC] 
  24. Tarcin O, Yavuz DG, Ozben B, Telli A, Ogunc AV, Yuksel M, et al. Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects. J Clin Endocrinol Metab. 2009;94(10):4023-30. [Crossref]  [PubMed] 
  25. Karabağ Y, Çağdaş M, Rencuzogullari I, Karakoyun S, Artaç İ, İliş D, et al. Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. J Clin Lab Anal. 2018;32(7):e22457. [Crossref]  [PubMed]  [PMC] 
  26. Çağdaş M, Rencüzoğullari I, Karakoyun S, Karabağ Y, Yesin M, Artaç I, et al. Assessment of relationship between C-reactive protein to albumin ratio and coronary artery disease severity in patients with acute coronary syndrome. Angiology. 2019;70(4):361-8. [Crossref]  [PubMed] 
  27. Wang W, Ren D, Wang CS, Li T, Yao HC, Ma SJ. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019;13(10):811-20. [Crossref]  [PubMed] 
  28. Sabanoglu C, Inanc IH. C-reactive protein to albumin ratio predicts for severity of coronary artery disease and ischemia. Eur Rev Med Pharmacol Sci. 2022;26(20):7623-31. [PubMed] 
  29. Soleymani M, Masoudkabir F, Shabani M, Vasheghani-Farahani A, Behnoush AH, Khalaji A. Updates on pharmacologic management of microvascular angina. Cardiovasc Ther. 2022;2022:6080258. [Crossref]  [PubMed]  [PMC] 
  30. Demir B, Ozyazgan S, Korkmaz GG, Karakaya O, Aciksari G, Uygun T, et al. The relationship between ischemia modified albumin and oxidative stress parameters in patients with cardiac syndrome X. Clin Lab. 2013;59(11-12):1319-29. [Crossref]  [PubMed] 
  31. Kilic A, Yarlioglues M, Ercan EA, Duran M, Ugurlu M, Oksuz F, et al. Association of total serum antioxidant capacity with the Tei index in echocardiography in patients with microvascular angina. Coron Artery Dis. 2015;26(7):620-5. [Crossref]  [PubMed] 
  32. Kayikcioglu M, Saygi S, Azarsiz E, Can LH, Kultursay H, Sözmen EY. Serum paraoxonase 1 activity and oxidative markers of LDL in patients with cardiac syndrome X. Acta Cardiol. 2007;62(3):245-9. [Crossref]  [PubMed] 
  33. Silvestrini A, Meucci E, Ricerca BM, Mancini A. Total antioxidant capacity: biochemical aspects and clinical significance. Int J Mol Sci. 2023;24(13):10978. [Crossref]  [PubMed]  [PMC] 
  34. Gawron-Skarbek A, Chrzczanowicz J, Kostka J, Nowak D, Drygas W, Jegier A, et al. Cardiovascular risk factors and total serum antioxidant capacity in healthy men and in men with coronary heart disease. Biomed Res Int. 2014;2014:216964. [Crossref]  [PubMed]  [PMC] 
  35. Aciksari G, Demir B, Uygun T, Gedikbasi A, Kutlu O, Atici A, et al. Serum prolidase activity in patients with cardiac syndrome X. North Clin Istanb. 2020;7(5):471-7. [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