Turkiye Klinikleri Archives of Lung

.: ORIGINAL RESEARCH
COVID-19 Nedeniyle Hastaneye Yatırılarak Tedavi Edilen Hastaların Demografik ve Klinik Özelliklerinin Prognozla İlişkisi: Kesitsel Çalışma
The Relationship Between Demographic and Clinical Characteristics of Hospitalized COVID-19 Patients with Prognosis: Cross-Sectional Study
Serdanur ÖZDEMİRa, Bilge YILMAZ KARAb, Aziz GÜMÜŞb, Uğur KESİMALc
aSağlık Bilimleri Üniversitesi Ahi Evren Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları ABD, Trabzon, Türkiye
bRecep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları ABD, Rize, Türkiye
cAnkara Eğitim ve Araştırma Hastanesi, Radyoloji ABD, Ankara, Türkiye
Turkiye Klinikleri Arch Lung. 2022;21(2):51-8
doi: 10.5336/archlung.2022-90348
Article Language: TR
Full Text
ÖZET
Amaç: Milyonlarca ölüme neden olan koronavirüs hastalığı-2019'un [coronavirus disease-2019 (COVID-19)] kesin tedavisi henüz bilinmediğinden, mortalite açısından yüksek riskli grupların ve prognoza etki eden faktörlerin belirlenmesi önemlidir. Çalışmamızda, hastaneye yatırılarak izlenen COVID-19 olgularının demografik, klinik ve laboratuvar verilerinin değerlendirilmesi; prognoza ve mortaliteye etkili faktörlerin saptanması amaçlandı. Gereç ve Yöntemler: Pandemi servisi veya yoğun bakım ünitesinde yatarak tedavi almış, polimeraz zincir reaksiyonu testi pozitif hastaların demografik, klinik ve laboratuvar özellikleri retrospektif olarak incelendi. Pnömoni şiddeti, yatış süresi, mortalite verileri incelendi. Mortalite ilişkili faktörler değerlendirildi. Bulgular: Çalışmadaki 165 hastanın yaş ortalaması 59±16 (%58 erkek) yıldı. Hastaların %57'si hiç sigara içmemişken, %43'ü eski veya aktif içiciydi. En sık görülen komorbid hastalıklar hipertansiyon (%50,3) ve diyabetti (%25,5). İleri yaş, erkek cinsiyet, sigara kullanımı, yüksek modifiye Charlson Komorbidite İndeksi, geliş oksijen satürasyon düşüklüğü, yüksek tomografi skoru ve uzun yatış süresinin mortaliteyi öngördüğü belirlendi. Nötrofil, nötrofil lenfosit oranı, üre, laktat dehidrogenaz, C-reaktif protein (CRP), ferritin yüksekliği ve albümin düşüklüğü ile mortalite arasında pozitif korelasyon izlendi. Nötrofil değerleri 4.000/μL ve üzerinde olması, CRP düzeyinin 50 mg/L'nin üzerinde olması ve ferritin değerinin 700 ng/mL'nin üzerinde olması mortalite riskinde sırasıyla 9 kat 5,7 kat ve 3,8 kat artışa neden olmaktadır. Takipte, tedavisine steroid eklenmek zorunda kalınan hastaların mortalitesinin daha fazla olduğu saptanmıştır. Sonuç: Komorbiditesi yüksek, yaşlı, erkek, başlangıçta oksijen satürasyonu düşük, tomografi skoru yüksek ve laboratuvar parametreleri bozulmuş hastalarda mortalite daha fazladır. İlk tedaviye yanıtsızlık, takipte steroid tedavisi gereksinimi, yoğun bakım ihtiyacı ve uzun süreli yatış diğer kötü prognostik faktörlerdir.

Anahtar Kelimeler: COVID-19; modifiye Charlson Komorbidite İndeksi; prognoz; mortalite
ABSTRACT
Objective: It is critical to identify factors affecting prognosis in coronavirus disease-2019 (COVID-19). In this study, we aimed to evaluate the demographic, clinical and laboratory data of hospitalized patients with COVID-19 and to determine the factors affecting the prognosis and survival. Material and Methods: Demographic, clinical and laboratory findings of polymerase chain reaction-positive inpatients were evaluated and recorded retrospectively. Pneumonia severity, length of hospital stay, and mortality data were analyzed. Results: The mean age of the 165 patients was 59±16 (58% male) years. While 57% of the patients were non-smokers, 43% were quitters or smokers. The most common comorbid diseases were hypertension(50,3%) and diabetes (25,5%). Advanced age, male gender, smoking, high modified Charlson Comorbidity Index, low oxygen saturation, high computed tomography (CT) score at admission was related to mortality. There was a positive correlation between mortality and high neutrophil counts, neutrophil lymphocyte ratio, urea, lactate dehydrogenase, C-reactive protein (CRP), ferritin and low albumin levels. When the neutrophil counts are ≥4,000/μL, there is 9-fold increase in the risk of mortality. CRP levels >50 mg/L causes a 5.7-fold, and ferritin values >700 ng/mL causes a 3.8-fold increase in the mortality risk. Mortality was higher in patients who need add-on steroid theraphy during follow-up. Conclusion: The mortality rate is higher in patients with COVID-19 who are elderly, male and who have manycomorbidities, low oxygen saturation, high CT score and impaired laboratory parameters. Other factors associated with poor prognosis are unresponsiveness to first treatment, long-term hospitalization and the need for add-on steroids or intensive care admission.

Keywords: COVID-19; modified Charlson Index; prognosis; mortality
REFERENCES:
  1. Worldometers [Internet]. [Cited: January 8, 2022]. COVID-19 coronavirus pandemic. Available from: [Link] 
  2. Parohan M, Yaghoubi S, Seraji A, Javanbakht MH, Sarraf P, Djalali M. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies. Aging Male. 2020;23(5):1416-24. [Crossref]  [PubMed] 
  3. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42. [Crossref]  [PubMed] 
  4. RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384(8):693-704. [Crossref]  [PubMed]  [PMC] 
  5. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. [Crossref]  [PubMed] 
  6. Extermann M. Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hematol. 2000;35(3):181-200. [Crossref]  [PubMed] 
  7. Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;30(12):6808-17. [Crossref]  [PubMed]  [PMC] 
  8. T.C Sağlık Bakanlığı [İnternet]. © 2022 T.C. Sağlık Bakanlığı. [Erişim tarihi: 09.04.2020]. Erişkin Hasta Tedavi Rehberi. Erişim linki: [Link] 
  9. Qian J, Zhao L, Ye RZ, Li XJ, Liu YL. Age-dependent gender differences in COVID-19 in Mainland China: Comparative Study. Clin Infect Dis. 2020;71(9):2488-94. [Crossref]  [PubMed]  [PMC] 
  10. Pradhan A, Olsson PE. Sex differences in severity and mortality from COVID-19: are males more vulnerable? Biol Sex Differ. 2020;11(1):53. [Crossref]  [PubMed]  [PMC] 
  11. Singh AK, Gupta R, Misra A. Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers. Diabetes Metab Syndr. 2020;14(4):283-7. [Crossref]  [PubMed]  [PMC] 
  12. Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM. Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: a systematic review and meta-analysis. PLoS One. 2020;15(8):e0238215. [Crossref]  [PubMed]  [PMC] 
  13. Wang AL, Zhong X, Hurd YL. Comorbidity and sociodemographic determinants in COVID-19 mortality in an US urban healthcare system. MedRxiv. 2020 Jan 1. [Crossref] 
  14. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38. [Crossref]  [PubMed]  [PMC] 
  15. Shao M, Li X, Liu F, Tian T, Luo J, Yang Y. Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: a systematic review and meta-analysis of 40 studies and 24,527 patients. Pharmacol Res. 2020;161:105107. [Crossref]  [PubMed]  [PMC] 
  16. Singh J, Malik P, Patel N, Pothuru S, Israni A, Chakinala RC, et al. Kidney disease and COVID-19 disease severity-systematic review and meta-analysis. Clin Exp Med. 2022;22(1):125-35. [Crossref]  [PubMed]  [PMC] 
  17. Hu Y, Zhan C, Chen C, Ai T, Xia L. Chest CT findings related to mortality of patients with COVID-19: a retrospective case-series study. PLoS One. 2020;15(8):e0237302. [Crossref]  [PubMed]  [PMC] 
  18. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58(7):1021-8. [Crossref]  [PubMed] 
  19. Henry B, Cheruiyot I, Vikse J, Mutua V, Kipkorir V, Benoit J, et al. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: a meta-analysis. Acta Biomed. 2020;91(3):e2020008. [PubMed]  [PMC] 
  20. Ziadi A, Hachimi A, Admou B, Hazime R, Brahim I, Douirek F, et al. Lymphopenia in critically ill COVID-19 patients: a predictor factor of severity and mortality. Int J Lab Hematol. 2021;43(1):e38-40. [Crossref]  [PubMed]  [PMC] 
  21. Valerio L, Ferrazzi P, Sacco C, Ruf W, Kucher N, Konstantinides SV, et al; Humanitas COVID-19 Task Force. Course of D-dimer and c-reactive protein levels in survivors and nonsurvivors with COVID-19 pneumonia: a retrospective analysis of 577 patients. Thromb Haemost. 2021;121(1):98-101. [Crossref]  [PubMed]  [PMC] 
  22. El-Shabrawy M, Alsadik ME, El-Shafei M, Abdelmoaty AA, Alazzouni AS, Esawy MM, et al. Interleukin-6 and C-reactive protein/albumin ratio as predictors of COVID-19 severity and mortality. Egypt J Bronchol. 2021;15(1):1-7. [Crossref]  [PMC] 
  23. Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020;14:1753466620937175. [Crossref]  [PubMed]  [PMC] 
  24. American College of Cardiology [Internet]. © 2020 American College of Cardiology Foundation. [Cited: March 29, 2020]. Ventricular Arrhythmia Risk Due to HydroxychloroquineAzithromycin Treatment For COVID-19. Available from: [Link] 
  25. RECOVERY [Internet]. © 2020 Nuffield Department of Population Health. [Cited: January 26, 2020]. Randomised Evaluation for COVID-19 Therapy. Available from: [Link] 
  26. Özlüşen B, Kozan Ş, Akcan RE, Kalender M, Yaprak D, Peltek İB, et al. Effectiveness of favipiravir in COVID-19: a live systematic review. Eur J Clin Microbiol Infect Dis. 2021;40(12):2575-83. [Crossref]  [PubMed]  [PMC] 

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