Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Nöropatisi Olan Tip 2 Diyabetiklerde Farklı Adım Sayılarıyla Yürüyüş Sonrası Plantar Sıcaklık Değişiminin İncelenmesi
Investigation of Plantar Temperature Changes After Walking with Different Step Counts in Type 2 Diabetics with Neuropathy
Yasin YURTa, Mehtap MERCANa, Cansu KOLTAKa
aDoğu Akdeniz Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Gazimağusa, KKTC
Turkiye Klinikleri J Health Sci. 2021;6(4):854-60
doi: 10.5336/healthsci.2020-80841
Article Language: TR
Full Text
ÖZET
 Amaç: Tip 2 diyabetin (T2D) tedavisi ve komplikasyonların önlenmesi için tempolu yürüyüş, önerilen orta şiddet egzersizlerden birisidir. Ayak ülseri riski olan T2D'li bireylerde ise bu egzersizin ayak sağlığı açısından güvenliği tartışmalıdır. Amacımız, nöropatisi olan T2D'li bireylerde farklı adım sayılarıyla yürüyüş sonrası plantar sıcaklık değişimlerini incelemekti. Gereç ve Yöntemler: Çalışmaya, en az 1 yıldır T2D tanısı olan, bağımsız yürüyebilen ve Michigan Nöropati Tarama Testi fiziksel değerlendirmesinden 2 ve üstü puan alan, 44 birey dâhil edildi. Katılımcıların cinsiyet, yaş, vücut ağırlığı, boy uzunluğu, beden kitle indeksi, HbA1c değerleri ve hastalık yılları sorgulandı. Bireylerin ayrı günlerde, 3 farklı adım sayısı (2.000, 4.000 ve 6.000 adım) ile koşu bandı üzerinde yürüyüşleri öncesi ve sonrasında plantar sıcaklıkları kızılötesi termometre ile değerlendirildi. Bulgular: İki bin adımla yürüyüş sonrasında sol ayak başparmak altı ve 1. metatars distali, her 2 ayak laterali ve sağ ayak topuk sıcaklık değerleri anlamlı olarak artış gösterdi (p<0,05). Dört bin ve 6.000 adım yürüyüşleri sonrasında ise her 2 ayağın ölçülen tüm bölgelerinde sıcaklık anlamlı olarak yükseldi (p<0,05). Farklı adım sayılarıyla yürüyüş sonrası sıcaklık artış değerleri karşılaştırıldığında, her 2 ayakta da 4.000 adım sonrası artışın 2.000 adımdan fazla, 6.000 adım sonrası artışın ise en fazla olduğu görüldü (p<0,05). Sonuç: Nöropatisi olan T2D'li bireylerde plantar sıcaklık, yürüyüş adım sayısının artmasıyla birlikte artış göstermektedir. Özellikle 2.000 adım üzerinde belirgin olan sıcaklık artışı, ülser riskini artırabileceği için tempolu yürüyüşe başlayan nöropatili bireylerin, tek seferde 2.000 adımdan fazla atmaması daha güvenli olabilir.

Anahtar Kelimeler: Diyabetik ayak; egzersiz; deri sıcaklığı
ABSTRACT
 Objective: Brisk walking is one of the moderate exercises which are advised in the type 2 diabetes (T2D) treatment and preventing complications. Safety of this exercise for T2D subjects with foot ulcer risk is controversial. Our aim was to investigate plantar temperature changes after walking with different step counts in T2D subjects with neuropathy. Material and Methods: Forty-four individuals with; T2D diagnoses for at least one year, ability to walk independently and more than two points from Michigan Neuropathy Screening Tool physical assessment participated in the study. Gender, age, body mass index, body length, HbA1c value and disease year of participants were questioned. Plantar temperatures of the subjects were measured before and after walking on treadmill, with three different step counts (2,000, 4,000 and 6,000 steps), on different days. Results: Temperature values increased significantly after 2000 steps under hallux, distal first metatarsal, lateral of both feet and right heel (p<0.05). After 4,000 and 6,000 steps of walking, temperature increased significantly at all measured cites of both feet (p<0.05). When temperature changes were compared, increase after 4,000 steps was higher than 2,000 and it was the highest after 6,000 steps (p<0.05). Conclusion: Plantar temperature shows an increase with increasing step count in T2D subjects. It could be safer to take no more than 2,000 steps when the neuropathic subjects start to do brisk walking. Because, the temperature increase which was prominent above 2,000 steps, might increase the ulcer risk.

Keywords: Diabetic foot; exercise; skin temperature
REFERENCES:
  1. Williams R, Karuranga S, Malanda B, Saeedi P, Basit A, Besançon S, et al. Global and regional estimates and projections of diabetes-related health expenditure: results from the International Diabetes Federation Diabetes Atlas, 9th ed. Diabetes Res Clin Pract. 2020;162:108072. [Crossref] [PubMed] 
  2. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al; IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. [Crossref] [PubMed] 
  3. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366(9498):1719-24. [Crossref] [PubMed] 
  4. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28. [Crossref] [PubMed] 
  5. Raghav A, Khan ZA, Labala RK, Ahmad J, Noor S, Mishra BK. Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always. Ther Adv Endocrinol Metab. 2018;9(1):29-31. [Crossref] [PubMed] [PMC] 
  6. Vinik AI, Nevoret ML, Casellini C, Parson H. Diabetic neuropathy. Endocrinol Metab Clin North Am. 2013;42(4):747-87. [Crossref] [PubMed] 
  7. Crisp AJ, Heathcote JG. Connective tissue abnormalities in diabetes mellitus. J R Coll Physicians Lond. 1984;18(2):132-41. [PubMed] [PMC] 
  8. Zimny S, Schatz H, Pfohl M. The role of limited joint mobility in diabetic patients with an at-risk foot. Diabetes Care. 2004;27(4):942-6. [Crossref] [PubMed] 
  9. Lavery LA, Armstrong DG, Boulton AJ; Diabetex Research Group. Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus. J Am Podiatr Med Assoc. 2002;92(9):479-82. [Crossref] [PubMed] 
  10. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clinical Diabetes. 2008;26(2):77-82. [Crossref] 
  11. Ortegon MM, Redekop WK, Niessen LW. Cost-effectiveness of prevention and treatment of the diabetic foot: a Markov analysis. Diabetes Care. 2004;27(4):901-7. [Crossref] [PubMed] 
  12. Dixit S, Maiya AG, Shastry BA. Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, parallel group randomized controlled trial. J Diabetes Complications. 2014;28(3):332-9. [Crossref] [PubMed] 
  13. Balducci S, Iacobellis G, Parisi L, Di Biase N, Calandriello E, Leonetti F, et al. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications. 2006;20(4):216-23. [Crossref] [PubMed] 
  14. Qiu S, Cai X, Yin H, Sun Z, Zügel M, Steinacker JM, et al. Exercise training and endothelial function in patients with type 2 diabetes: a meta-analysis. Cardiovasc Diabetol. 2018;2;17(1):64. [Crossref] [PubMed] [PMC] 
  15. Zanuso S, Jimenez A, Pugliese G, Corigliano G, Balducci S. Exercise for the management of type 2 diabetes: a review of the evidence. Acta Diabetol. 2010;47(1):15-22. [Crossref] [PubMed] 
  16. Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003. Diabetes Care. 2007;30(2):203-9. [Crossref] [PubMed] 
  17. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2003;26 Suppl 1:S33-50. Erratum in: Diabetes Care. 2003;26(3):972. [Crossref] [PubMed] 
  18. Shenoy S, Guglani R, Sandhu JS. Effectiveness of an aerobic walking program using heart rate monitor and pedometer on the parameters of diabetes control in Asian Indians with type 2 diabetes. Prim Care Diabetes. 2010;4(1):41-5. [Crossref] [PubMed] 
  19. Wilde BE, Sidman CL, Corbin CB. A 10,000-step count as a physical activity target for sedentary women. Res Q Exerc Sport. 2001;72(4):411-4. [Crossref] [PubMed] 
  20. Fayehun AF, Olowookere OO, Ogunbode AM, Adetunji AA, Esan A. Walking prescription of 10 000 steps per day in patients with type 2 diabetes mellitus: a randomised trial in Nigerian general practice. Br J Gen Pract. 2018;68(667):e139-e45. [Crossref] [PubMed] [PMC] 
  21. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29(6):1433-8. [Crossref] [PubMed] 
  22. Kluding PM, Bareiss SK, Hastings M, Marcus RL, Sinacore DR, Mueller MJ. Physical training and activity in people with diabetic peripheral neuropathy: paradigm shift. Phys Ther. 2017;97(1):31-43. [PubMed] [PMC] 
  23. Mueller MJ, Tuttle LJ, Lemaster JW, Strube MJ, McGill JB, Hastings MK, et al. Weight-bearing versus nonweight-bearing exercise for persons with diabetes and peripheral neuropathy: a randomized controlled trial. Arch Phys Med Rehabil. 2013;94(5):829-38. [Crossref] [PubMed] [PMC] 
  24. Welk GJ, Differding JA, Thompson RW, Blair SN, Dziura J, Hart P. The utility of the Digi-walker step counter to assess daily physical activity patterns. Med Sci Sports Exerc. 2000;32(9 Suppl):S481-8. [Crossref] [PubMed] 
  25. Yavuz M, Brem RW, Davis BL, Patel J, Osbourne A, Matassini MR, et al. Temperature as a predictive tool for plantar triaxial loading. J Biomech. 2014;47(15):3767-70. [Crossref] [PubMed] 
  26. Najafi B, Wrobel JS, Grewal G, Menzies RA, Talal TK, Zirie M, et al. Plantar temperature response to walking in diabetes with and without acute Charcot: the Charcot activity response test. J Aging Res. 2012;2012:140968. [Crossref] [PubMed] [PMC] 
  27. Kaymaz S, Alkan H, Karasu U, Çobankara V. Turkish version of the Michigan Neuropathy Screening Instrument in the assessment of diabetic peripheral neuropathy: a validity and reliability study. Diabetol Int. 2020;11(3):283-92. [Crossref] [PubMed] [PMC] 
  28. Romero SA, Minson CT, Halliwill JR. The cardiovascular system after exercise. J Appl Physiol (1985). 2017;122(4):925-32. [Crossref] [PubMed] [PMC] 
  29. Kokate JY, Leland KJ, Held AM, Hansen GL, Kveen GL, Johnson BA, et al. Temperature-modulated pressure ulcers: a porcine model. Arch Phys Med Rehabil. 1995;76(7):666-73. [Crossref] [PubMed] 
  30. Armstrong DG, Holtz-Neiderer K, Wendel C, Mohler MJ, Kimbriel HR, Lavery LA. Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. Am J Med. 2007;120(12):1042-6. Erratum in: Am J Med. 2008;121(12). [Crossref] [PubMed] 
  31. Lavery LA, Higgins KR, Lanctot DR, Constantinides GP, Zamorano RG, Armstrong DG, et al. Home monitoring of foot skin temperatures to prevent ulceration. Diabetes Care. 2004;27(11):2642-7. [Crossref] [PubMed] 
  32. Wijlens AM, Holloway S, Bus SA, van Netten JJ. An explorative study on the validity of various definitions of a 2?2°C temperature threshold as warning signal for impending diabetic foot ulceration. Int Wound J. 2017;14(6):1346-51. [Crossref] [PubMed] [PMC] 
  33. Skafjeld A, Iversen MM, Holme I, Ribu L, Hvaal K, Kilhovd BK. A pilot study testing the feasibility of skin temperature monitoring to reduce recurrent foot ulcers in patients with diabetes--a randomized controlled trial. BMC Endocr Disord. 2015;15:55. [Crossref] [PubMed] [PMC] 
  34. Yavuz M, Ersen A, Hartos J, Lavery LA, Wukich DK, Hirschman GB, et al. Temperature as a causative factor in diabetic foot ulcers: a call to revisit ulceration pathomechanics. J Am Podiatr Med Assoc. 2019;109(5):345-50. [Crossref] [PubMed] 
  35. Sohn MW, Lee TA, Stuck RM, Frykberg RG, Budiman-Mak E. Mortality risk of Charcot arthropathy compared with that of diabetic foot ulcer and diabetes alone. Diabetes Care. 2009;32(5):816-21. [Crossref] [PubMed] [PMC] 

.: Up To Date

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