Alt ekstremite iskemisi olan hastalarda iskemi modifiye albümin düzeylerinin araştırılması

Senay Balcı; Gamze Gezgin Ulas; Aysegul Gorur; Havva Didem Çelikcan; Ayşe Gül Bayazıt; Nehir Sucu; Lülüfer Tamer

doi:10.26559/mersinsbd.837594

Research Article

Investigation of ischemia modified albumin levels in patients with lower limb ischemia

Year 2021, Volume: 14 Issue: 2, 274 - 281, 25.08.2021

Senay Balcı Gamze Gezgin Ulas Aysegul Gorur Havva Didem Çelikcan Ayşe Gül Bayazıt Nehir Sucu Lülüfer Tamer

https://doi.org/10.26559/mersinsbd.837594

Abstract

Aim: Acute limb ischemia occurs after the embolism or thrombosis and if it is not treated it may result in limb loss and even death. In addition, late diagnosis eliminates the chance of immediate intervention. Therefore, early diagnosis is crucial. It has been reported that ischemic modified albumin levels are known to be increased in acute ischemic conditions such as myocardial, cerebral and pulmonary infarctions. The aims of this study were to determine the levels of ischemic modified albumin in lower limb ischemia and to investigate its usability as an auxiliary parameter for early diagnosis. Materials and Methods: 24 patients (5 females, 19 males) with lower limb ischemia (patient group: 23-89 years old), 34 healthy individuals composed of 19 females and 15 males (control group; 20-75 years old) who were totally 58 cases were included in the study. The ischemic modified albumin levels in the serum samples obtained from individuals in the patient and control groups who met the inclusion criteria, were analyzed with the ELISA kit (Organo Teknika, Austria) in line with the manufacturer's instructions. Mann Whitney U test was used to compare ischemic modified albumin levels between groups. Results: It was found that patients with limb ischemia had a significantly increased ischemic modified albumin level compared to the control group (p <0.001). It was detected that the sensitivity value was 91.7 and the specificity value was 82.4 in the ROC curve analysis. Conclusion: We think that the significant increase in serum ischemic modified albumin levels in lower limb ischemia may be useful in the diagnosis of limb ischemia.

Keywords

Ischemia, limb ischemia, ischemia modified albumin, early diagnosis

References

1. Lippi G, Montagnan M, Guidi GC. Albumin cobalt binding and ischemia modified albumin generation: an endogenous response to ischemia? International journal of cardiology. 2006; 108:410-411. doi: 10.1016/j.ijcard.2005.03.040
2. Marcus F, Claude EV, Josephine M, et al. An Exceptional Cause of Acute Limb Ischemia: Nicolau Syndrome—Single-Center Experience with 4 Cases. Annals of vascular surgery. 2019; 58: 383.e7-383.e11. doi: 10.1016/j.avsg.2018.11.022
3. Bar–OrD, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia—a preliminary report. The Journal of emergency medicine. 2000; 19:311-315. doi: 10.1016/s0736-4679(00)00255-9
4. Uzel M, Oray NC, Bayram B, et al. Novel biochemical marker for differential diagnosis of seizure: ischemia-modified albumin. The American journal of emergency medicine. 2014; 32(9), 962-965. doi: 10.1016/j.ajem.2014.05.003
5. Bar‐Or D, Curtis G, Rao N, et al. Characterization of the Co2+ and Ni2+ binding amino‐acid residues of the N‐terminus of human albumin: An insight into the mechanism of a new assay for myocardial ischemia. European Journal of Biochemistry. 2001; 268(1), 42-48. doi: 10.1046/j.1432-1327.2001.01846.x
6. Cho D K, Choi J H, Kim S H, et al. Ischemia-modified albumin is a highly sensitive serum marker of transient myocardial ischemia induced by coronary vasospasm. Coronary artery disease. 2007; 18(2), 83-87. doi: 10.1097/MCA.0b013e328010a49f
7. Mentese A, Mentese U, Turedi S, et al. Effect of deep vein thrombosis on ischaemia-modified albumin levels. Emergency Medicine Journal. 2008; 25(12), 811-814. 10.1136/emj.2007.056614
8. Troxler M, Thompson D, Homer-Vanniasinkam S. Ischaemic skeletal muscle increases serum ischaemia modified albumin. European journal of vascular and endovascular surgery. 2006; 31(2), 164-169. doi:10.1016/j.ejvs.2005.06.019
9. Gunduz A, Mentese A, Turedi S, et al. Serum ischaemia-modified albumin increases in critical lower limb ischaemia. Emergency Medicine Journal. 2008; 25(6), 351-353.
10. Sbarouni E, Georgiadou P, Theodorakis GN, et al. Ischemia-modified albumin in relation to exercise stress testing. Journal of the American College of Cardiology. 2006; 48(12), 2482-2484. doi: 10.1016/j.jacc.2006.06.007
11. Keating L, Benger J R, Beetham R, et al. The PRIMA study: presentation ischaemia-modified albumin in the emergency department. Emergency Medicine Journal. 2006; 23(10), 764-768. doi: 10.1136/emj.2006.036269
12. Refaai MA, Wright RW, Parvin CA, et al. Ischemia-modified albumin increases after skeletal muscle ischemia during arthroscopic knee surgery. Clinica Chimica Acta. 2006; 366(1-2), 264-268. doi: 10.1016/j.cca.2005.10.020
13. Turedi S, Gunduz A, Mentese A, et al. Value of ischemia-modified albumin in the diagnosis of pulmonary embolism. The American journal of emergency medicine. 2007; 25(7), 770-773.
14. Abboud H, Labreuche J, Meseguer E, et al. Ischemia-modified albumin in acute stroke. Cerebrovascular Diseases. 2007; 23(2-3), 216-220. doi: 10.1159/000097644
15. Coverdale JP, Katundu KG, Sobczak AI, et al. Ischemia-modified albumin: Crosstalk between fatty acid and cobalt binding. Prostaglandins, Leukotrienes and Essential Fatty Acids. 2018; 135, 147-157. doi: 10.1016/j.plefa.2018.07.014
16. Yosunkaya Ş, Can U. İskemide Yeni Bir Marker: İskemi Modifiye Albumin. Koşuyolu Kalp Dergisi. 2017; 20(2), 148-152.
17. Yang G, Zhou Y, He H, et al. Ischemia-modified albumin, a novel predictive marker of in-hospital mortality in acute aortic dissection patients. Frontiers in physiology. 2019; 10, 1253. https://doi.org/10.3389/fphys.2019.01253.
18. Maneewong K, Mekrungruangwong T, Luangaram S, et al. Combinatorial determination of ischemia modified albumin and protein carbonyl in the diagnosis of nonST-elevation myocardial infarction. Indian Journal of Clinical Biochemistry. 2011; 26(4), 389-395. doi: 10.1007/s12291-011-0118-2
19. Dursun A, Okumus N, Zenciroglu A. Ischemia-modified albumin (IMA): could it be useful to predict perinatal asphyxia?. The Journal of Maternal-Fetal & Neonatal Medicine. 2012; 25(11), 2401-2405. doi: 10.3109/14767058.2012.697943
20. Hogg K, Hinchliffe E, Halsam S, et al. Is ischaemia-modified albumin a test for venous thromboembolism?. Emergency Medicine Journal. 2012; 29(6), 455-459. doi:10.4236/ojrd.2014.41004.
21. Gunduz A, Turedi S, Mentese A, et al. Ischemia-modified albumin in the diagnosis of acute mesenteric ischemia: a preliminary study. The American journal of emergency medicine. 2008; 26(2), 202-205. doi: 10.1016/j.ajem.2007.04.030
22. Mitsudo S, Brandt LJ. Pathology of intestinal ischemia. The Surgical clinics of North America. 1992; 72(1), 43-63. 10.1016/S0039-6109(16)45627-6
23. Apple FS, Quist HE, Otto AP, et al. Release characteristics of cardiac biomarkers and ischemia-modified albumin as measured by the albumin cobalt-binding test after a marathon race. Clinical Chemistry. 2002; 48(7), 1097-1100.
24. Apple FS, Wu AH, Mair J, et al. Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome. Clinical chemistry. 2005; 51(5), 810-824. doi: 10.1373/clinchem.2004.046292
25. Erdem SS, Yerlikaya FH, Çiçekler H ve ark. Association between ischemia-modified albumin, homocysteine, vitamin B12 and folic acid in patients with severe sepsis. Clinical Chemistry and Laboratory Medicine (CCLM). 2012; 50(8), 1417-1421. doi: 10.1515/cclm-2011-0794
26. Fidan E, Mentese A, Kavgaci H ve ark. Increased ischemia-modified albumin levels in patients with gastric cancer. Neoplasma. 2012; 59(4), 393. doi: 10.4149/neo_2012_051
27. Stachowicz‐Stencel T, Synakiewicz A, Owczarzak A, et al. Ischemia‐modified albumin as a biochemical marker in children with neuroblastoma and soft tissue sarcomas. Journal of clinical laboratory analysis. 2011; 25(4), 255-258. doi: 10.1002/jcla.20469
28. Dominguez-Rodriguez A, Abreu-Gonzalez P. Current role of ischemia-modified albumin in routine clinical practice. Biomarkers. 2010; 15(8), 655-662. doi: 10.3109/1354750X.2010.513449
29. Roy D, Quiles J, Aldama G, et al. Ischemia modified albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiograms and negative cardiac troponin T. International journal of cardiology. 2004; 97(2), 297-301. doi:10.1016/j.ijcard.2004.05.042
30. Zapico-Muñiz E, Santaló-Bel M, Mercé-Muntañola J, et al. Ischemia-modified albumin during skeletal muscle ischemia. Clinical Chemistry. 2004; 50(6), 1063-1065. Doi: 10.1373/clinchem.2003.027789

Alt ekstremite iskemisi olan hastalarda iskemi modifiye albümin düzeylerinin araştırılması

Year 2021, Volume: 14 Issue: 2, 274 - 281, 25.08.2021

Senay Balcı Gamze Gezgin Ulas Aysegul Gorur Havva Didem Çelikcan Ayşe Gül Bayazıt Nehir Sucu Lülüfer Tamer

https://doi.org/10.26559/mersinsbd.837594

Abstract

Amaç: Akut ekstremite iskemisi, emboli ya da tromboz akabinde ortaya çıkmakta ve tedavi edilmezse ekstremite kaybı ve hatta ölümle sonuçlanabilmektedir. Ayrıca, tanının gecikmesi acil girişim şansını ortadan kaldırmaktadır. Bu nedenle, erken tanı büyük önem taşımaktadır. Miyokard enfarktüsü, serebral infarkt ve pulmoner infarkt gibi akut iskemik durumlarda düzeylerinin yükseldiği bildirilen iskemi modifiye albüminin, iskemik durumlarda tanı belirteci olabileceği bildirilmektedir. Bu çalışmanın amacı da alt ekstremite iskemisinde iskemi modifiye albüm düzeyini belirlemek ve erken tanıya yardımcı bir parametre olarak kullanılabilirliğini araştırmaktır. Yöntem: Bu çalışmaya alt ekstremite iskemisi olan 5’i kadın, 19’u erkekten oluşan 24 hasta (hasta grubu; 23-89 yaş) ve kontrol amaçlı gelen 19’u kadın, 15’i erkekten oluşan 34 sağlıklı gönüllü (kontrol gurubu; 20-75 yaş) olmak üzere 58 kişi dahil edildi. Dahil edilme kriterlerine uygun hasta ve kontrol gruplarındaki bireylerden elde edilen serum örneklerindeki iskemi modifiye albüm düzeyleri, ELİSA kiti (Organo Teknika, Avusturya) ile analiz edildi. Gruplar arası iskemi modifiye albüm düzeylerinin karşılaştırılmasında Mann Whitney U testi kullanıldı. Bulgular: Akut ekstremite iskemisi olan hastalarda, kontrol grubundakiler ile karşılaştırıldığında önemli ölçüde artmış iskemi modifiye albüm düzeyi olduğu tespit edildi (p <0.001). ROC eğrisi analizinde sensitivite değeri 91.7 ve spesifite değeri 82.4 olarak tespit edildi. Sonuç: Alt ekstremite iskemisinde serum iskemi modifiye albüm düzeylerinde görülen önemli artışın, ekstremite iskemisinin tanısında yararlı olabileceğini düşünmekteyiz.

Keywords

İskemi, Ekstremite iskemisi, İskemi modifiye albumin, Erken tanı

References

1. Lippi G, Montagnan M, Guidi GC. Albumin cobalt binding and ischemia modified albumin generation: an endogenous response to ischemia? International journal of cardiology. 2006; 108:410-411. doi: 10.1016/j.ijcard.2005.03.040
2. Marcus F, Claude EV, Josephine M, et al. An Exceptional Cause of Acute Limb Ischemia: Nicolau Syndrome—Single-Center Experience with 4 Cases. Annals of vascular surgery. 2019; 58: 383.e7-383.e11. doi: 10.1016/j.avsg.2018.11.022
3. Bar–OrD, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia—a preliminary report. The Journal of emergency medicine. 2000; 19:311-315. doi: 10.1016/s0736-4679(00)00255-9
4. Uzel M, Oray NC, Bayram B, et al. Novel biochemical marker for differential diagnosis of seizure: ischemia-modified albumin. The American journal of emergency medicine. 2014; 32(9), 962-965. doi: 10.1016/j.ajem.2014.05.003
5. Bar‐Or D, Curtis G, Rao N, et al. Characterization of the Co2+ and Ni2+ binding amino‐acid residues of the N‐terminus of human albumin: An insight into the mechanism of a new assay for myocardial ischemia. European Journal of Biochemistry. 2001; 268(1), 42-48. doi: 10.1046/j.1432-1327.2001.01846.x
6. Cho D K, Choi J H, Kim S H, et al. Ischemia-modified albumin is a highly sensitive serum marker of transient myocardial ischemia induced by coronary vasospasm. Coronary artery disease. 2007; 18(2), 83-87. doi: 10.1097/MCA.0b013e328010a49f
7. Mentese A, Mentese U, Turedi S, et al. Effect of deep vein thrombosis on ischaemia-modified albumin levels. Emergency Medicine Journal. 2008; 25(12), 811-814. 10.1136/emj.2007.056614
8. Troxler M, Thompson D, Homer-Vanniasinkam S. Ischaemic skeletal muscle increases serum ischaemia modified albumin. European journal of vascular and endovascular surgery. 2006; 31(2), 164-169. doi:10.1016/j.ejvs.2005.06.019
9. Gunduz A, Mentese A, Turedi S, et al. Serum ischaemia-modified albumin increases in critical lower limb ischaemia. Emergency Medicine Journal. 2008; 25(6), 351-353.
10. Sbarouni E, Georgiadou P, Theodorakis GN, et al. Ischemia-modified albumin in relation to exercise stress testing. Journal of the American College of Cardiology. 2006; 48(12), 2482-2484. doi: 10.1016/j.jacc.2006.06.007
11. Keating L, Benger J R, Beetham R, et al. The PRIMA study: presentation ischaemia-modified albumin in the emergency department. Emergency Medicine Journal. 2006; 23(10), 764-768. doi: 10.1136/emj.2006.036269
12. Refaai MA, Wright RW, Parvin CA, et al. Ischemia-modified albumin increases after skeletal muscle ischemia during arthroscopic knee surgery. Clinica Chimica Acta. 2006; 366(1-2), 264-268. doi: 10.1016/j.cca.2005.10.020
13. Turedi S, Gunduz A, Mentese A, et al. Value of ischemia-modified albumin in the diagnosis of pulmonary embolism. The American journal of emergency medicine. 2007; 25(7), 770-773.
14. Abboud H, Labreuche J, Meseguer E, et al. Ischemia-modified albumin in acute stroke. Cerebrovascular Diseases. 2007; 23(2-3), 216-220. doi: 10.1159/000097644
15. Coverdale JP, Katundu KG, Sobczak AI, et al. Ischemia-modified albumin: Crosstalk between fatty acid and cobalt binding. Prostaglandins, Leukotrienes and Essential Fatty Acids. 2018; 135, 147-157. doi: 10.1016/j.plefa.2018.07.014
16. Yosunkaya Ş, Can U. İskemide Yeni Bir Marker: İskemi Modifiye Albumin. Koşuyolu Kalp Dergisi. 2017; 20(2), 148-152.
17. Yang G, Zhou Y, He H, et al. Ischemia-modified albumin, a novel predictive marker of in-hospital mortality in acute aortic dissection patients. Frontiers in physiology. 2019; 10, 1253. https://doi.org/10.3389/fphys.2019.01253.
18. Maneewong K, Mekrungruangwong T, Luangaram S, et al. Combinatorial determination of ischemia modified albumin and protein carbonyl in the diagnosis of nonST-elevation myocardial infarction. Indian Journal of Clinical Biochemistry. 2011; 26(4), 389-395. doi: 10.1007/s12291-011-0118-2
19. Dursun A, Okumus N, Zenciroglu A. Ischemia-modified albumin (IMA): could it be useful to predict perinatal asphyxia?. The Journal of Maternal-Fetal & Neonatal Medicine. 2012; 25(11), 2401-2405. doi: 10.3109/14767058.2012.697943
20. Hogg K, Hinchliffe E, Halsam S, et al. Is ischaemia-modified albumin a test for venous thromboembolism?. Emergency Medicine Journal. 2012; 29(6), 455-459. doi:10.4236/ojrd.2014.41004.
21. Gunduz A, Turedi S, Mentese A, et al. Ischemia-modified albumin in the diagnosis of acute mesenteric ischemia: a preliminary study. The American journal of emergency medicine. 2008; 26(2), 202-205. doi: 10.1016/j.ajem.2007.04.030
22. Mitsudo S, Brandt LJ. Pathology of intestinal ischemia. The Surgical clinics of North America. 1992; 72(1), 43-63. 10.1016/S0039-6109(16)45627-6
23. Apple FS, Quist HE, Otto AP, et al. Release characteristics of cardiac biomarkers and ischemia-modified albumin as measured by the albumin cobalt-binding test after a marathon race. Clinical Chemistry. 2002; 48(7), 1097-1100.
24. Apple FS, Wu AH, Mair J, et al. Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome. Clinical chemistry. 2005; 51(5), 810-824. doi: 10.1373/clinchem.2004.046292
25. Erdem SS, Yerlikaya FH, Çiçekler H ve ark. Association between ischemia-modified albumin, homocysteine, vitamin B12 and folic acid in patients with severe sepsis. Clinical Chemistry and Laboratory Medicine (CCLM). 2012; 50(8), 1417-1421. doi: 10.1515/cclm-2011-0794
26. Fidan E, Mentese A, Kavgaci H ve ark. Increased ischemia-modified albumin levels in patients with gastric cancer. Neoplasma. 2012; 59(4), 393. doi: 10.4149/neo_2012_051
27. Stachowicz‐Stencel T, Synakiewicz A, Owczarzak A, et al. Ischemia‐modified albumin as a biochemical marker in children with neuroblastoma and soft tissue sarcomas. Journal of clinical laboratory analysis. 2011; 25(4), 255-258. doi: 10.1002/jcla.20469
28. Dominguez-Rodriguez A, Abreu-Gonzalez P. Current role of ischemia-modified albumin in routine clinical practice. Biomarkers. 2010; 15(8), 655-662. doi: 10.3109/1354750X.2010.513449
29. Roy D, Quiles J, Aldama G, et al. Ischemia modified albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiograms and negative cardiac troponin T. International journal of cardiology. 2004; 97(2), 297-301. doi:10.1016/j.ijcard.2004.05.042
30. Zapico-Muñiz E, Santaló-Bel M, Mercé-Muntañola J, et al. Ischemia-modified albumin during skeletal muscle ischemia. Clinical Chemistry. 2004; 50(6), 1063-1065. Doi: 10.1373/clinchem.2003.027789

There are 30 citations in total.

Details

Primary Language	Turkish
Subjects	Health Care Administration
Journal Section	Articles
Authors	Senay Balcı 0000-0002-7498-604X Gamze Gezgin Ulas 0000-0002-6618-9112 Aysegul Gorur 0000-0002-8463-8663 Havva Didem Çelikcan 0000-0003-4868-861X Ayşe Gül Bayazıt 0000-0002-2157-2986 Nehir Sucu 0000-0002-7469-5883 Lülüfer Tamer 0000-0002-0997-0260
Publication Date	August 25, 2021
Submission Date	December 8, 2020
Acceptance Date	February 8, 2021
Published in Issue	Year 2021 Volume: 14 Issue: 2

Cite

APA	Balcı, S., Gezgin Ulas, G., Gorur, A., Çelikcan, H. D., et al. (2021). Alt ekstremite iskemisi olan hastalarda iskemi modifiye albümin düzeylerinin araştırılması. Mersin Üniversitesi Sağlık Bilimleri Dergisi, 14(2), 274-281. https://doi.org/10.26559/mersinsbd.837594
AMA	Balcı S, Gezgin Ulas G, Gorur A, Çelikcan HD, Bayazıt AG, Sucu N, Tamer L. Alt ekstremite iskemisi olan hastalarda iskemi modifiye albümin düzeylerinin araştırılması. Mersin Univ Saglık Bilim derg. August 2021;14(2):274-281. doi:10.26559/mersinsbd.837594
Chicago	Balcı, Senay, Gamze Gezgin Ulas, Aysegul Gorur, Havva Didem Çelikcan, Ayşe Gül Bayazıt, Nehir Sucu, and Lülüfer Tamer. “Alt Ekstremite Iskemisi Olan Hastalarda Iskemi Modifiye albümin düzeylerinin araştırılması”. Mersin Üniversitesi Sağlık Bilimleri Dergisi 14, no. 2 (August 2021): 274-81. https://doi.org/10.26559/mersinsbd.837594.
EndNote	Balcı S, Gezgin Ulas G, Gorur A, Çelikcan HD, Bayazıt AG, Sucu N, Tamer L (August 1, 2021) Alt ekstremite iskemisi olan hastalarda iskemi modifiye albümin düzeylerinin araştırılması. Mersin Üniversitesi Sağlık Bilimleri Dergisi 14 2 274–281.
IEEE	S. Balcı, “Alt ekstremite iskemisi olan hastalarda iskemi modifiye albümin düzeylerinin araştırılması”, Mersin Univ Saglık Bilim derg, vol. 14, no. 2, pp. 274–281, 2021, doi: 10.26559/mersinsbd.837594.
ISNAD	Balcı, Senay et al. “Alt Ekstremite Iskemisi Olan Hastalarda Iskemi Modifiye albümin düzeylerinin araştırılması”. Mersin Üniversitesi Sağlık Bilimleri Dergisi 14/2 (August 2021), 274-281. https://doi.org/10.26559/mersinsbd.837594.
JAMA	Balcı S, Gezgin Ulas G, Gorur A, Çelikcan HD, Bayazıt AG, Sucu N, Tamer L. Alt ekstremite iskemisi olan hastalarda iskemi modifiye albümin düzeylerinin araştırılması. Mersin Univ Saglık Bilim derg. 2021;14:274–281.
MLA	Balcı, Senay et al. “Alt Ekstremite Iskemisi Olan Hastalarda Iskemi Modifiye albümin düzeylerinin araştırılması”. Mersin Üniversitesi Sağlık Bilimleri Dergisi, vol. 14, no. 2, 2021, pp. 274-81, doi:10.26559/mersinsbd.837594.
Vancouver	Balcı S, Gezgin Ulas G, Gorur A, Çelikcan HD, Bayazıt AG, Sucu N, Tamer L. Alt ekstremite iskemisi olan hastalarda iskemi modifiye albümin düzeylerinin araştırılması. Mersin Univ Saglık Bilim derg. 2021;14(2):274-81.

Article Files

Full Text

MEU Journal of Health Sciences Assoc was began to the publishing process in 2008 under the supervision of Assoc. Prof. Gönül Aslan, Editor-in-Chief, and affiliated to Mersin University Institute of Health Sciences. In March 2015, Prof. Dr. Caferi Tayyar Şaşmaz undertook the Editor-in Chief position and since then he has been in charge.

Publishing in three issues per year (April - August - December), it is a multisectoral refereed scientific journal. In addition to research articles, scientific articles such as reviews, case reports and letters to the editor are published in the journal. Our journal, which has been published via e-mail since its inception, has been published both online and in print. Following the Participation Agreement signed with TÜBİTAK-ULAKBİM Dergi Park in April 2015, it has started to accept and evaluate online publications.

Mersin University Journal of Health Sciences have been indexed by Turkey Citation Index since November 16, 2011.

Mersin University Journal of Health Sciences have been indexed by ULAKBIM Medical Database from the first issue of 2016.

Mersin University Journal of Health Sciences have been indexed by DOAJ since October 02, 2019.

Article Publishing Charge Policy: Our journal has adopted an open access policy and there is no fee for article application, evaluation, and publication in our journal. All the articles published in our journal can be accessed from the Archive free of charge.

15456 15458 15459

This work is licensed with Attribution-NonCommercial 4.0 International.