Understanding Differential Cyanosis Causes
Understanding Differential Cyanosis Causes In this section, we will explore the causes of differential cyanosis, a condition characterized by the distinct blue discoloration of certain body parts. Understanding the underlying factors that contribute to this condition is crucial for proper diagnosis and effective treatment.
When the skin takes on a blue color, it can be a sign of cyanosis. Cyanosis can be classified as peripheral cyanosis or central cyanosis, both of which result in a bluish tint of the skin. However, differential cyanosis is a specific type of cyanosis that presents with blue discoloration in certain regions of the body.
Differential cyanosis often occurs in infants, making it essential to understand its unique features. By recognizing the signs and symptoms, healthcare professionals can accurately diagnose and identify the underlying conditions causing the blue discoloration.
Get Free Consultation
ACIBADEM Health Point: The Future of Healthcare
We believe that everyone deserves access to quality healthcare, which is why we have established multiple branches in strategic locations. Whether you're in need of routine check-ups, specialized treatments, or emergency care, ACIBADEM Health Point is here for you.Some common causes of differential cyanosis include cardiac, pulmonary, and vascular abnormalities. Cardiac conditions, for example, can affect blood oxygenation and contribute to the development of differential cyanosis. Similarly, certain pulmonary conditions and vascular abnormalities can have an impact on blood circulation and skin color.
Aside from these causes, there are other underlying factors that can lead to differential cyanosis. Identifying these less common causes is important in the differential diagnosis of blue skin.
Proper diagnosis of differential cyanosis involves a comprehensive approach, ruling out potential underlying causes, and utilizing diagnostic tools and methods. Once the underlying condition is identified, appropriate treatment options can be explored.
ACIBADEM Health Point: Your Health is Our Priority!
ACIBADEM Health Point, we are dedicated to providing exceptional healthcare services to our patients. With a team of highly skilled medical professionals and state-of-the-art facilities, we strive to deliver the highest standard of care to improve the health and well-being of our patients. What sets ACIBADEM Health Point apart is our patient-centered approach. We prioritize your comfort, safety, and satisfaction throughout your healthcare journey. Our compassionate staff ensures that you receive personalized care tailored to your unique needs, making your experience with us as seamless and comfortable as possible.The long-term prognosis and outlook for individuals with differential cyanosis vary depending on the specific condition causing the blue discoloration. Understanding the expected outcomes and potential complications associated with this condition is important for patient care.
In conclusion, differential cyanosis is a complex condition with various causes. By understanding these causes and recognizing the signs, healthcare professionals can provide accurate diagnosis and appropriate treatment. If you or your loved ones exhibit signs of differential cyanosis, it is important to consult with a trusted medical professional for comprehensive evaluation and treatment.
What is Cyanosis?
Cyanosis is a visible manifestation of low oxygen levels in the bloodstream, resulting in a bluish tint of the skin. It is important to understand the categorization of cyanosis into two types: peripheral cyanosis and central cyanosis. Each type presents distinct symptoms and affects different areas of the body.
Peripheral Cyanosis:
In peripheral cyanosis, the bluish discoloration is primarily visible in the extremities, such as the fingertips, toes, and lips. This occurs when there is reduced blood flow or increased extraction of oxygen from the blood at the peripheral tissues. Peripheral cyanosis can be caused by various factors, including cold temperatures, Raynaud’s disease, and certain medications.
Central Cyanosis:
Central cyanosis, on the other hand, affects the core areas of the body, including the lips, tongue, and mucous membranes. It is typically indicative of a more serious underlying condition, such as respiratory or cardiac disorders, that impairs the oxygenation of blood. In central cyanosis, the reduced oxygen levels are more systemic and affect the entire body.
The presence of cyanosis is an important clinical indicator that should not be ignored. It is a visible sign that there may be an underlying health issue that requires further investigation and medical attention.
Common symptoms associated with cyanosis include:
- Blue or gray discoloration of the skin, especially in the affected areas
- Shortness of breath or difficulty breathing
- Rapid heart rate
- Dizziness or lightheadedness
- Fatigue or weakness
Differentiating Differential Cyanosis
Differential cyanosis is a specific type of cyanosis that manifests as blue discoloration in specific regions of the body. Unlike generalized cyanosis that affects the entire body, the distinct feature of differential cyanosis is the asymmetrical distribution of blue discoloration. This condition is particularly observed in infants, making it essential to understand its unique features and occurrence in this specific age group.
When infants experience cyanosis, it is crucial to differentiate between central and peripheral cyanosis to determine the underlying cause. Central cyanosis, often associated with cardiovascular or respiratory issues, presents as bluish discoloration of the lips, tongue, and mucous membranes. Peripheral cyanosis, on the other hand, primarily affects the extremities and is usually caused by reduced blood flow or exposure to cold temperatures.
In the case of differential cyanosis in infants, the dominant feature is the contrasting coloration of the upper and lower extremities. While the upper extremities may appear pink or normal in color, the lower extremities exhibit a bluish hue, indicating a potential underlying cardiovascular abnormality. This distinct presentation can aid healthcare professionals in diagnosing and addressing the specific cause of differential cyanosis.
Differential cyanosis is commonly associated with coarctation of the aorta, a congenital heart defect where the aorta is narrowed, restricting blood flow to the lower body. Other cardiac conditions, such as transposition of the great arteries and truncus arteriosus, may also contribute to differential cyanosis in infants.
Early identification and intervention are crucial in addressing the underlying cause of differential cyanosis and ensuring optimal outcomes for affected infants. Healthcare providers will conduct a comprehensive evaluation, which may include a physical examination, diagnostic imaging, and various cardiac tests to determine the specific cardiovascular abnormality causing differential cyanosis.
Common Causes of Differential Cyanosis
In differential cyanosis, there are several common underlying conditions that can lead to blue discoloration of specific body parts. Understanding these causes is essential for accurate diagnosis and effective treatment. Let’s explore some of the primary contributors to differential cyanosis:
Cardiac Causes
Cardiac conditions can significantly impact blood oxygenation, leading to differential cyanosis. Some common cardiac causes include:
- Tetralogy of Fallot
- Transposition of the Great Arteries
- Tricuspid Atresia
Pulmonary Causes
Pulmonary conditions affecting oxygen saturation can also result in differential cyanosis. The following are some notable pulmonary causes:
- Pulmonary Atresia
- Pulmonary Hypertension
- Chronic Obstructive Pulmonary Disease (COPD)
Other Underlying Causes
In addition to cardiac and pulmonary causes, there are other less common conditions that can contribute to differential cyanosis. These may include:
- Sickle Cell Disease
- Methemoglobinemia
- Polycythemia
It is important to note that this is not an exhaustive list, and there may be other causes specific to an individual case. A comprehensive evaluation by a healthcare professional is necessary to determine the precise cause of differential cyanosis.
| Common Cardiac Causes | Common Pulmonary Causes | Other Underlying Causes |
|---|---|---|
| Tetralogy of Fallot | Pulmonary Atresia | Sickle Cell Disease |
| Transposition of the Great Arteries | Pulmonary Hypertension | Methemoglobinemia |
| Tricuspid Atresia | Chronic Obstructive Pulmonary Disease (COPD) | Polycythemia |
Cardiac Causes of Differential Cyanosis
Differential cyanosis, characterized by the distinct blue discoloration of certain body parts, can often be attributed to various cardiac conditions. Understanding these specific cardiac causes is crucial for diagnosing and treating differential cyanosis effectively.
Cardiac Defects
In some cases, congenital heart defects can lead to differential cyanosis. These defects may affect the structure and function of the heart, resulting in inadequate oxygenation of the blood. Common cardiac defects associated with differential cyanosis include:
| Anomalous Pulmonary Venous Connection | Tetralogy of Fallot | Transposition of the Great Arteries | Tricuspid Atresia |
|---|---|---|---|
| Abnormal connection of one or more pulmonary veins to the right atrium or other systemic veins, leading to oxygen-rich and oxygen-poor blood mixing. | A combination of four heart abnormalities, including a ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. | The switching of the positions of the pulmonary artery and the aorta, leading to a lack of oxygen-rich blood reaching the body. | A missing tricuspid valve, preventing blood flow from the right atrium to the right ventricle. |
Congestive Heart Failure
Congestive heart failure (CHF) can also manifest as differential cyanosis. CHF occurs when the heart is unable to pump blood effectively, causing fluid accumulation in the body. The decreased blood flow can result in inadequate oxygenation and subsequent blue discoloration of specific body parts.
Cardiac Arrhythmias
Cardiac arrhythmias, such as atrial fibrillation or ventricular tachycardia, can contribute to differential cyanosis. These irregular heart rhythms disrupt the normal pumping action of the heart, affecting proper blood oxygenation.
Valvular Heart Disease
Valvular heart disease, particularly severe stenosis (narrowing) or regurgitation (leakage) of the valves, can lead to differential cyanosis. These conditions impede blood flow within the heart, hindering proper oxygenation and resulting in blue discoloration.
By exploring the specific cardiac causes of differential cyanosis, healthcare professionals can identify the underlying conditions and provide appropriate treatment. It is crucial to consult with a trusted medical professional for comprehensive evaluation, diagnosis, and management of differential cyanosis related to cardiac causes.
Pulmonary Causes of Differential Cyanosis
When it comes to the development of differential cyanosis, certain pulmonary conditions play a significant role. These conditions can directly impact oxygenation and lead to the distinct blue discoloration of specific body parts. Identifying these specific causes and understanding their effects on oxygen saturation is essential for an accurate diagnosis and subsequent management.
Here are some common pulmonary causes of differential cyanosis:
| Cause | Description |
|---|---|
| Pulmonary Embolism | A blood clot that blocks a blood vessel in the lungs, impeding proper blood flow and oxygenation. |
| Chronic Obstructive Pulmonary Disease (COPD) | A group of progressive lung diseases, including chronic bronchitis and emphysema, that impair airflow and oxygen transfer. |
| Pulmonary Arterial Hypertension | A condition characterized by high blood pressure in the arteries of the lungs, leading to reduced oxygenation. |
| Pulmonary Hypertension due to Congenital Heart Disease | A type of pulmonary hypertension caused by structural abnormalities of the heart and its blood vessels, resulting in inadequate oxygen delivery. |
These are just a few examples of the pulmonary causes of differential cyanosis. It’s important to note that each individual case is unique, and a thorough evaluation by a healthcare professional is necessary to determine the underlying cause for accurate diagnosis and appropriate treatment.
In the next section, we will explore the vascular causes of differential cyanosis and their impact on blood circulation.
Vascular Causes of Differential Cyanosis
In some cases, differential cyanosis can be attributed to vascular abnormalities. These abnormalities affect blood circulation and can result in a distinct blue discoloration of specific body parts. Understanding the vascular causes of differential cyanosis is essential for accurate diagnosis and appropriate treatment.
Arterial Vascular Causes
- Peripheral arterial disease
- Arteriovenous malformations
- Embolism
Arterial vascular causes of differential cyanosis involve issues with the arteries and their ability to deliver oxygenated blood to the affected areas. Conditions such as peripheral arterial disease, arteriovenous malformations, and embolism can lead to impaired blood flow and subsequent cyanosis.
Venous Vascular Causes
- Deep vein thrombosis
- Chronic venous insufficiency
- Vascular tumors
Venous vascular causes of differential cyanosis involve issues with the veins and their ability to return deoxygenated blood effectively. Conditions such as deep vein thrombosis, chronic venous insufficiency, and vascular tumors can impede venous blood flow, resulting in cyanosis in specific body parts.
Anatomic Vascular Abnormalities
- Coarctation of the aorta
- Congenital heart defects
- Patent ductus arteriosus
Anatomic vascular abnormalities can also contribute to differential cyanosis. Conditions such as coarctation of the aorta, congenital heart defects, and patent ductus arteriosus can cause disturbances in blood circulation and oxygenation, resulting in cyanosis in certain areas of the body.
Identifying the specific vascular causes of differential cyanosis is crucial for determining the appropriate treatment approach. A comprehensive evaluation, which may include imaging tests and specialized consultations, can aid in diagnosing the underlying vascular abnormalities and guiding further management.
Other Underlying Causes of Differential Cyanosis
While cardiac, pulmonary, and vascular causes are the most commonly associated with differential cyanosis, there are other lesser-known factors that can contribute to this condition. It is important to consider these alternative causes when evaluating patients with blue discoloration of the skin.
Metabolic Disorders
Metabolic disorders, such as methemoglobinemia, polycythemia, and sulfhemoglobinemia, can disrupt normal blood oxygenation and lead to cyanosis. These conditions affect the oxygen-carrying capacity of the blood, resulting in the characteristic blue discoloration of the skin.
Environmental Factors
Exposure to certain environmental toxins, such as carbon monoxide or industrial chemicals, can interfere with oxygen transport in the body and cause cyanosis. Individuals who work in high-risk environments or live in areas with poor air quality may be more susceptible to this type of cyanosis.
Genetic Disorders
Some genetic disorders, like Fanconi anemia or Alagille syndrome, can present with cyanosis as a symptom. These conditions often affect multiple body systems, including the heart, lungs, and blood vessels, leading to differential cyanosis.
Medication Side Effects
Certain medications, particularly those that affect blood circulation or oxygenation, can induce cyanosis as a side effect. These medications may alter the normal functioning of the cardiovascular or respiratory system, leading to differential cyanosis.
Other Rare Causes
In addition to the previously mentioned causes, there are other rare and uncommon factors that can contribute to differential cyanosis. These may include blood disorders, connective tissue diseases, or even blood vessel abnormalities that are not related to the common vascular causes previously discussed.
Other Underlying Causes of Differential Cyanosis
| Cause | Description |
|---|---|
| Metabolic Disorders | Conditions that disrupt normal blood oxygenation, including methemoglobinemia, polycythemia, and sulfhemoglobinemia |
| Environmental Factors | Exposure to toxins or poor air quality that interferes with oxygen transport |
| Genetic Disorders | Inherited conditions that affect multiple body systems, including the heart, lungs, and blood vessels |
| Medication Side Effects | Certain medications that impair cardiovascular or respiratory function, resulting in cyanosis |
| Other Rare Causes | Less common factors such as blood disorders, connective tissue diseases, or non-vascular abnormalities |
It is important for healthcare professionals to consider these other underlying causes of differential cyanosis in order to provide accurate diagnosis and appropriate treatment. By evaluating all possible factors, a comprehensive approach can be taken to address the specific condition causing the blue discoloration of the skin.
Diagnostic Approach for Differential Cyanosis
Proper diagnosis of differential cyanosis requires a systematic approach to identify and rule out potential underlying causes. Healthcare professionals employ various diagnostic tools and methods to determine the specific etiology of this condition.
1. Patient History and Physical Examination
The diagnostic process starts with a comprehensive patient history and a thorough physical examination. The healthcare provider will inquire about the duration, frequency, and intensity of cyanosis, as well as any associated symptoms. They will also assess vital signs and examine the affected areas to look for localized signs of discoloration and possible abnormalities.
2. Oxygen Saturation Measurement
A crucial diagnostic tool used in assessing differential cyanosis is pulse oximetry. This non-invasive procedure measures the oxygen saturation levels in the blood, helping to evaluate the efficiency of oxygen transport. A lower oxygen saturation level suggests underlying oxygenation issues.
3. Imaging Studies
Imaging studies such as echocardiography, chest X-rays, and angiography may be used to visualize the heart, lungs, and blood vessels. These diagnostic tools help identify any structural abnormalities, such as heart defects or pulmonary diseases, which could contribute to differential cyanosis.
4. Laboratory Tests
Laboratory tests, including blood tests, arterial blood gas analysis, and coagulation profiles, can provide valuable insights into potential underlying causes. These tests help evaluate blood oxygen levels, identify metabolic abnormalities, and assess coagulation factors that may influence oxygenation and blood circulation.
5. Genetic Testing
In certain cases, genetic testing may be warranted to identify any underlying genetic disorders associated with differential cyanosis. This approach can help determine if a specific genetic mutation or abnormality is contributing to the condition.
6. Consultations with Specialists
Depending on the initial findings, further consultations with specialists such as cardiologists, pulmonologists, or hematologists may be necessary. These experts bring specialized knowledge and expertise to the diagnostic process, aiding in the accurate identification of the underlying cause of the differential cyanosis.
Overall, a multidisciplinary approach, combining patient history, physical examinations, diagnostic tests, and specialist consultations, is crucial in diagnosing differential cyanosis and identifying the root cause. By implementing this comprehensive diagnostic approach, healthcare professionals can establish an accurate differential diagnosis and develop an appropriate treatment plan.
| Diagnostic Approach for Differential Cyanosis | Diagnostic Tools and Methods |
|---|---|
| Patient History and Physical Examination | – In-depth assessment of symptoms and physical signs of cyanosis – Evaluation of vital signs and localized abnormalities |
| Oxygen Saturation Measurement | – Pulse oximetry to measure blood oxygen saturation levels |
| Imaging Studies | – Echocardiography, chest X-rays, and angiography to visualize heart, lungs, and blood vessels |
| Laboratory Tests | – Blood tests, arterial blood gas analysis, and coagulation profiles to evaluate oxygen levels, metabolic abnormalities, and coagulation factors |
| Genetic Testing | – Identifying genetic mutations or abnormalities associated with differential cyanosis |
| Consultations with Specialists | – Collaboration with cardiologists, pulmonologists, or hematologists for specialized expertise and evaluation |
Treatment Options for Differential Cyanosis
Effective management of differential cyanosis involves treating the underlying cause. The specific treatment options for differential cyanosis vary depending on the contributing conditions. In this section, we will explore the available treatment approaches for addressing differential cyanosis.
1. Cardiac Interventions
When differential cyanosis is caused by a cardiac condition, interventions may be necessary to correct the underlying issue. These interventions can include:
- Cardiac catheterization
- Open-heart surgery
- Valve repair or replacement
2. Surgical Procedures
In cases where structural abnormalities contribute to differential cyanosis, surgical procedures may be recommended. These procedures aim to correct the anatomical defects and improve blood circulation. Examples of surgical interventions include:
- Repair of aortic coarctation
- Correction of congenital heart defects
- Removal of obstructive lesions
3. Medications
In certain instances, medications can be prescribed to manage the underlying causes of differential cyanosis. The specific medications will depend on the diagnosed conditions contributing to the cyanosis. Common medications used include:
- Diuretics to reduce fluid buildup
- Blood thinners to prevent clot formation
- Antibiotics to treat infections
4. Oxygen Therapy
Oxygen therapy is a common treatment approach for individuals with impaired oxygenation. It can be administered in various forms, including:
- Supplemental oxygen through nasal cannula or face mask
- Oxygen saturation monitoring
5. Lifestyle Modifications
In some cases, making certain lifestyle modifications can help manage differential cyanosis. These modifications may include:
- Dietary changes to reduce sodium intake
- Regular physical activity to improve cardiovascular health
- Avoidance of triggers that exacerbate symptoms
It is important to note that the treatment options for differential cyanosis should be determined and guided by medical professionals. Each case is unique and requires a personalized approach to ensure the best outcome for the individual.
Prognosis and Outlook for Differential Cyanosis
Understanding the long-term prognosis and outlook for individuals with differential cyanosis is essential for effective patient care. The prognosis for cyanosis depends on various factors including the underlying cause, timely diagnosis, and appropriate treatment.
In cases where differential cyanosis is caused by a treatable condition, such as certain cardiac or pulmonary abnormalities, early intervention and proper management can significantly improve the prognosis. Timely diagnosis and targeted treatment can help restore normal blood oxygenation and mitigate the risk of complications.
However, the prognosis may be less favorable in cases where differential cyanosis is associated with severe or irreversible underlying conditions. In such instances, management focuses on providing symptomatic relief, maximizing quality of life, and preventing further complications.
It is important to note that differential cyanosis can be a challenging condition to diagnose accurately, as it may involve multiple underlying causes. Therefore, the prognosis may vary depending on the specific etiology and any associated comorbidities.
Potential complications associated with differential cyanosis may include:
- Reduced exercise tolerance
- Developmental delays
- Pulmonary hypertension
- Heart failure
- Respiratory distress
Close monitoring and regular follow-up with healthcare professionals specializing in cardiac and respiratory care are crucial for ongoing management and early detection of any potential complications.
In conclusion, while the prognosis for individuals with differential cyanosis depends on various factors, including the underlying cause and timely intervention, early diagnosis and appropriate treatment can significantly improve long-term outcomes. Regular medical supervision and proactive management are essential to optimize the patient’s quality of life and minimize the risk of complications.
Conclusion
In conclusion, a thorough understanding of the causes of differential cyanosis is essential for accurate diagnosis and effective treatment. By recognizing the signs and symptoms, healthcare professionals can identify the underlying conditions that contribute to this condition and provide the necessary care and support.
If you or your loved ones exhibit signs of differential cyanosis, it is crucial to consult with a trusted medical professional. Acibadem Healthcare Group is renowned for its expertise in diagnosing and treating complex medical conditions, including differential cyanosis. Their experienced team of healthcare providers is dedicated to delivering comprehensive evaluation and personalized treatment plans.Understanding Differential Cyanosis Causes
Remember, early detection and intervention can significantly improve outcomes for individuals with differential cyanosis. Seeking medical attention at a reputable institution like Acibadem Healthcare Group ensures that you receive the highest quality care and access to the latest advancements in medical technology.
FAQ
What is differential cyanosis?
Differential cyanosis is a condition characterized by the distinct blue discoloration of certain body parts. It occurs when there is a variation in blood oxygenation levels between the upper and lower body.
What are the causes of cyanosis?
Cyanosis can be caused by various factors, including cardiac, pulmonary, vascular, and other underlying conditions. These factors can affect the oxygenation of blood and result in the bluish discoloration of the skin.
How is differential cyanosis different from other types of cyanosis?
Differential cyanosis is a specific type of cyanosis that presents with blue discoloration in specific regions of the body. It is often seen in infants and occurs due to certain cardiac defects or abnormalities.
What are the common causes of differential cyanosis?
The common causes of differential cyanosis include various cardiac conditions, pulmonary diseases, vascular abnormalities, and other underlying factors. Identifying the specific underlying cause is essential for proper diagnosis and treatment.
What are the cardiac causes of differential cyanosis?
Cardiac causes of differential cyanosis include congenital heart defects, such as Tetralogy of Fallot, Transposition of the Great Arteries, and Hypoplastic Left Heart Syndrome. These conditions affect blood flow and oxygenation, leading to differential cyanosis.
What are the pulmonary causes of differential cyanosis?
Pulmonary causes of differential cyanosis include conditions such as chronic lung disease, pulmonary hypertension, and pulmonary embolism. These conditions affect the oxygenation of blood in the lungs and can contribute to differential cyanosis.
What are the vascular causes of differential cyanosis?
Vascular causes of differential cyanosis include conditions such as coarctation of the aorta, peripheral artery disease, and venous thrombosis. These conditions can affect blood circulation and contribute to the development of differential cyanosis.
What are the other underlying causes of differential cyanosis?
In addition to cardiac, pulmonary, and vascular causes, other underlying factors that can lead to differential cyanosis include certain hematological disorders, peripheral nerve damage, and Raynaud's disease. These less common causes should be considered during the differential diagnosis of blue skin.
How is differential cyanosis diagnosed?
Diagnosis of differential cyanosis involves a thorough evaluation of medical history, physical examination, and diagnostic tests. These may include imaging studies, blood tests, and cardiac evaluations. A systematic approach is used to identify the specific underlying cause of the differential cyanosis.
What are the treatment options for differential cyanosis?
Treatment options for differential cyanosis depend on the underlying cause. In some cases, medical management, such as medication or oxygen therapy, may be recommended. Surgical interventions, such as corrective heart surgeries or vascular procedures, may be necessary in certain cases. Early intervention is crucial to improve outcomes and prevent complications.
What is the prognosis for differential cyanosis?
The prognosis for individuals with differential cyanosis depends on the underlying cause, severity, and timely management. With proper diagnosis and treatment, the outlook can be favorable for many patients. However, the prognosis can vary, and some underlying conditions may have long-term implications or require ongoing medical care.
ACIBADEM Healthcare Group Hospitals and Clinics
With a network of hospitals and clinics across 5 countries, including 40 hospitals, ACIBADEM Healthcare Group has a global presence that allows us to provide comprehensive healthcare services to patients from around the world. With over 25,000 dedicated employees, we have the expertise and resources to deliver unparalleled healthcare experiences. Our mission is to ensure that each patient receives the best possible care, supported by our commitment to healthcare excellence and international healthcare standards. Ready to take the first step towards a healthier future? Contact us now to schedule your Free Consultation Health session. Our friendly team is eager to assist you and provide the guidance you need to make informed decisions about your well-being. Click To Call Now !*The information on our website is not intended to direct people to diagnosis and treatment. Do not carry out all your diagnosis and treatment procedures without consulting your doctor. The contents do not contain information about the therapeutic health services of ACIBADEM Health Group.