salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
TRANSCRIPT
![Page 1: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/1.jpg)
ACUTE CORONARY SYNDROMES,
RİSK FACTORS AND PREVENTİON
KOÇ UNIVERSİTY SCHOOL OF NURSING
SERPİL TOPÇU R.N., M.S.N.
![Page 2: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/2.jpg)
ACUTE CORONARY SYNDROMES
• Acute coronary syndrome (ACS) refers to a group of
conditions due to decreased blood flow in the coronary
arteries such that part of the heart muscle is unable to
function properly.
![Page 3: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/3.jpg)
Coronary Artery DiseaseClinical Signs;
• Sudden death
• Heart failure
• Stable angina pectoris,
• Unstable angina pectoris,
• Myocardial infarction (MI)
![Page 4: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/4.jpg)
Global Atlas On Cardiovascular Disease
Prevention And Control- 2011
![Page 5: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/5.jpg)
Global Atlas On Cardiovascular Disease
Prevention And Control- 2011
![Page 6: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/6.jpg)
Cardiovascular DiseaseProfile Around the World
COUNTRIES CVD MORTALITY RATE
European Union members %40
China (1/5 of the world's population)
%36
Latin America %31
Middle East %25-45
India (1/6 of the world population )
%24
Africa %10 (primary stroke)
Türkiye Kalp Ve Damar Hastalıklarını Önleme ve Kontrol Programı 2010-2014
![Page 7: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/7.jpg)
![Page 8: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/8.jpg)
![Page 9: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/9.jpg)
Cardiovascular DiseaseProfile in Turkey
• Primary cause of the disability-adjusted life
year (DALY) in Turkey is cardiovascular diseases -
%19.32
• DALY results on cardiovascular disease;o Males -%20,5
o Females -%18
Türkiye Hastalık Yükü Çalışması- UHY (DALY- 2004)
![Page 10: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/10.jpg)
RISK FACTORS AND
PREVENTION
![Page 11: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/11.jpg)
![Page 12: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/12.jpg)
Türkmen E, Badır A, Ergün A ( 2012). Koroner Arter Hastalıkları Risk Faktörleri: Primer ve Sekonder Korunmada Hemşirelerin Rolü. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. Cilt: 3 • Sayı: 4 • Ekim
![Page 13: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/13.jpg)
1- Tobacco Smoking
![Page 14: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/14.jpg)
![Page 15: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/15.jpg)
![Page 16: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/16.jpg)
- Turkey is 3rd in Europe and 7th around the world about
smoking
- Smoking rate in;
Men % 47,9
Women % 15,2
![Page 17: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/17.jpg)
![Page 18: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/18.jpg)
![Page 19: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/19.jpg)
Prevention of SmokingIn Turkey
• November 25 2004 “Tütün Kontrol Çerçeve
Sözleşmesi-WHO-FCTC Framework Convention on Tobacco
Control” is accepted;
- Raise awareness of the public
- Quit smoking
- Price and taxes
- Passive smoking control
- Advertising and sponsorship
- Product control and consumer education.
![Page 20: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/20.jpg)
2- Overweight and Obesity
![Page 21: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/21.jpg)
• Every year 2.6 million people dies due to overweight and
obesity. It is related to CVD.
• In Turkey according to TURDEP- I (2002)results obesity
rate;
- Men - %25.3
- Women - %46.2
• TURDEP- II (2010)
• Obesity - %44 ↑
- Waist circumference - women 6cm↑,
-men 7cm↑
![Page 22: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/22.jpg)
Definition of Overweight andObesity
Target 1: Waist circumference
Men ≥ 94 cm, w𝒐𝒎𝒆𝒏 ≥ 80 cm (do not gain weight)
Target 2: Waist circumference
Men ≥ 102 cm, women ≥ 88 cm ( advice losing weight)
![Page 23: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/23.jpg)
Prevention of Overweight and Obesity
• Diet, exercise, and behaviour modifications
• Medical therapy with orlistat and/or bariatric surgery for
patients with BMI ≥35 kg/m2 or a BMI ≥35 kg/m2 in the
presence of high-risk comorbid conditions are the only
options.
![Page 24: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/24.jpg)
• Saturated fatty acids to account for <10% of total energy
intake, through replacement by polyunsaturated fatty acids
• Avoid processed food,
• <5 g of salt per day
• 30–45 g of fibre per day, from wholegrain products, fruits
and vegetables
• fruits and vegetables per day 2-3 servings
• Fish at least twice a week, one of which to be oily fish.
![Page 25: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/25.jpg)
![Page 26: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/26.jpg)
3- Physical Inactivity
![Page 27: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/27.jpg)
Physical Inactivity
With 150 minutes of regular exercise per week.
- Reducing ischemic heart diseases %30
- Reducing Diabetes rate %27
![Page 28: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/28.jpg)
Physical InactivityIn Turkey;
According to the results of : “Sağlıklı Beslenelim, Kalbimizi
Koruyalım (2004)” (N:15.468) ;
Only 3,5% of people are doing regular exercise at least 3
times a week 30 minute.
![Page 29: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/29.jpg)
Physical Inactivity and Obesity
Prevention- In Turkey
• Educating children about healthy food by family, teacher
and public health nursing.
• Advertisement control about fast food.
• Regulating menus of branch restaurants which are suitable
for preventing CVD
• Organizing exercise programs.
• The main responsibility belongs to health care providers.
TKD Ulusal Kalp Sağlığı Politikası Raporu
![Page 30: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/30.jpg)
4- Hypertension
![Page 31: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/31.jpg)
Hypertension
• HT is the major risk factor MI, stroke, hearth and kidney
failure, vascular dieseases and blindness
• High blood pressure is responsible of the total deaths of
%13around the world.
![Page 32: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/32.jpg)
![Page 33: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/33.jpg)
![Page 34: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/34.jpg)
• According to Turkish Hypertension Prevalence Study;
• Nearly 15 milion people have hypertension however
%40 of them are aware of high blood pressure
• Only %31of them are taking antihypertensive therapy.
![Page 35: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/35.jpg)
Reduce; Systolic blood pressure 20 mmHg
Diastolic blood pressure 11 mmHg ;
• Decrease Stroke risk % 63
• CVD risk % 46
TKD Ulusal Kalp Sağlığı Politikası Raporu
![Page 36: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/36.jpg)
Prevention of Hypertension
• Weight control, increase pyhsical activity level
• Reduce alcohol intake
• Limiting salt intake
• More Vegetable and fruit
• Prefering saturated dairy products
• It is suggested to all hypertensive and high normal blood
pressure patient ( Class I, Level B).
![Page 37: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/37.jpg)
Prevention of Hypertension1. Social Practice
• Starting prenventive life style changes in childhood.
• Family and school education programs.
• Ministery of Health, Education, Sports, Agriculture and
Religion etc. Should support this cause using media.
• Writing the salt level and calorie in food ingridients.
• Decreasing salt level in all food products.
![Page 38: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/38.jpg)
Prevention of Hypertension
• People should be encourage to exercise and it should be
accessible.
• Necessary prevention should be applied to quit smoking
2- Personal Practice
• Healthy life style
• This is the main responsibiliyt of health care provider.
![Page 39: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/39.jpg)
5- Alcohol
![Page 40: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/40.jpg)
![Page 41: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/41.jpg)
• The relationship between alcohol and CVD is not
clarified yet.
• If moderate alcohol use is peep
- CVD risk factors
- Hard to control blood pressure
- Synergetic effect of cigarates.
- Obesity
![Page 42: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/42.jpg)
Prevention of CVD
• Moderate alcohol use is suggested.
Women 1 cup per day (10 g alcohol),
Men 2 cups per day (20 g alcohol)
![Page 43: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/43.jpg)
6- Diabetes
![Page 44: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/44.jpg)
![Page 45: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/45.jpg)
• Diabetes was accepted by United Nations for the first time a
non-infected diesea is considered as a global health threat
(Dec, 20 2006). They also called the countries in action to
fight againts diabetes.
![Page 46: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/46.jpg)
![Page 47: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/47.jpg)
Prevention of CVD with Diabetes;
Target HbA1c <%7.0
• Statines use
• Prevent gaining execisive weigth and hypoglisemi
• BP <140/80 mmHg
![Page 48: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/48.jpg)
Prevention of DiabetesT.C. Ministry of Health Action Plan (2011-2014)
• Prevention of diabetes, to increase quality of care in
patients with diabetes and decrease complications of
diabetes and deaths.
http://www.saglik.gov.tr/HM/dosya/1-71375/h/turkiye-diyabet-onleme-ve-kontrol-
programi.pdf
![Page 49: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/49.jpg)
7- Hyperlipidemia
![Page 50: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/50.jpg)
![Page 51: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/51.jpg)
![Page 52: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/52.jpg)
![Page 53: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/53.jpg)
Prevention of Hyperlipidemia
• Life style changes.
• Drug treatment.
![Page 54: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/54.jpg)
8- Social Factors
• Poverty, lack of education and unplanned urbanization
have a negative impact on cardiovascular health.
• Unfair distribution of power, money and resources
increases exposure to cardiovascular risk factors.
![Page 55: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/55.jpg)
9-Risk Factors Take Root In The Womb,Childhood And Youth
• Undernutrition in fetal life and infancy increases an
individual’s vulnerability to CVD.
• Low birth weight is related to CVD and DM
• Healthy behaviours are learned in childhood and
continue into adulthood.
• Passive smoking exposure in childhood.
![Page 56: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/56.jpg)
TÜRKİYE HASTALIK YÜKÜ ÇALIŞMASI 2004
RİSK FAKTÖRLERİ ÖNLENEBİLİR ÖLÜM ORANLARI
Hipertansiyon %25,2
Beden Kitle İndeksi ( BKİ) %13,3
Tütün kullanımı %12,7
Hiperlipidemi %11,4
Fiziksel aktivite %10,5
Sebze meyve tüketimi %9
Ilımlı alkol %4,3
![Page 57: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/57.jpg)
![Page 58: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/58.jpg)
Nursing Roles in PreventionPrimary prevention;
Primary prevention in providing of CAD is worse than
secondary;
Because of
• Risk calculators focus on short-term risk
• Prediction difficulties (people who are at risk)
![Page 59: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/59.jpg)
Nursing Roles in Prevention
![Page 60: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/60.jpg)
![Page 61: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/61.jpg)
Results of the study;
• Students were knowledgeable about cardiovascular
disease and associated risk factors,
• There were significant gaps in their knowledge; these
should be addressed through improved nursing curricula.
• While students were generally healthy, they could
improve their practice of health-promoting behaviors.
![Page 62: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/62.jpg)
According to nursing case manager models in secondary
prevention;
• Proper medication use results in improvements in risk
factors, exercise toleration, blood glucose level
• CVD
• Mortality
• Coronary atherosclerosis
• Perception of healht improves
![Page 63: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/63.jpg)
![Page 64: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/64.jpg)
The EUROACTION trial studying patients with
CHD and those at high risk of CVD in 8 countries;
The approach was;
• Family centred and led to healthier lifestyle changes in
terms of diet and physical activity, improvements in
lifestyle e (diet and physical activity)
• More effective control of risk factors such as blood
pressure in both patients and their partners in the
intervention arm compared with usual care
![Page 65: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/65.jpg)
CCNAP: Council on Cardiovascular Nursing and Allied
Professions
and
AHA CVD Nursing Comitte prepare a settelement about
nurses to have an active role in prevention of CVD.
![Page 66: Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing](https://reader034.vdocument.in/reader034/viewer/2022042701/55a718b91a28abbf048b4660/html5/thumbnails/66.jpg)