Correlation Between Daily PM10, Nitrogen Dioxide, and Ozone Measurements with the Stringency Index in 15 Different Districts of a Big Metropolis.

OBJECTIVE: Studies have investigated the effects of lockdowns on air quality around the world and found that fine particulate matter and nitrogen dioxide concentrations decreased due to reduced human activity, while ozone concentrations increased. In this study, we aimed to evaluate the correlation between daily stringency index values of our country and daily PM10, nitrogen dioxide, and ozone measurements in different districts of Istanbul between March 1, 2020, and February 28, 2022. MATERIAL AND METHODS: Ministry of Environment and Urbanization and National Air Quality Monitoring Network data on Istanbul air quality monitoring stations were used. The analysis included 15 stations that can monitor at least 75% of the days in a year. PM10, nitrogen dioxide, and ozone were the main pollutants analyzed. RESULTS: There was negative correlation between daily PM10 measurements and daily stringency index values in 3 stations; there was positive correlation in 6 stations. Between daily stringency index values and daily nitrogen dioxide measurements, there was a negative correlation in 3 stations and a positive correlation in 1 station. The daily measurements of 1 station showed a negative correlation with the daily values of stringency index for both PM10 and nitrogen dioxide. In 1 station, while PM10 measures were negatively correlated with stringency index, nitrogen dioxide measurements were positively correlated. CONCLUSION: This study showed that pandemic limitations could not improve Istanbul's air quality everywhere. For adequate evaluation of impact of the limitations on air quality, it may be more relevant to study the socioeconomic infrastructure of each living area, the sociospatial inequality, industrial employment, the number of households, the density of employee class, and so on with all influencing factors that could have contributed to these various changes.

COVID-19 Outbreak in Istanbul.

OBJECTIVE: The COVID-19 pandemic has demonstrated that the social determinants of health play a fundamental role in the course of the pandemic. This article aims to reveal the class dynamics of the COVID-19 epidemic in Istanbul, Turkey. MATERIAL AND METHODS: Spatial analysis and geographic information system data provided by Istanbul Metropolitan Municipality for March and April 2020 were used. Public transport mobility and turnstile data were analyzed. The data obtained were collated into thematic maps. RESULTS: Between March 16 and 24, 2020, the use of public transportation declined with the tightening of movement restrictions. However, despite the restrictions, an increase in transportation density was observed between 6 and 9 am and between 5 and 7 pm. Although the overall mobility toward outside the city has fallen due to travel restrictions, it has been observed that exit mobility continued between Gebze and Kocaeli, both industrial centers where blue-collar jobs dominate. Most of the mobility in the city is observed in Avcilar, Bahçelievler, Esenyurt, and Küçükçekmece, which are mostly blue-collar residential districts. On the Asian side, activity was observed in Kurtköy, Pendik, Samandira, Ümraniye, and Tuzla, areas where blue-collar workers predominantly reside. From March 25 to April 7, 2020, it was determined that the most intense activity areas of the blue-collar workers were Avcilar, Bahçelievler, Bagcilar, Çekmeköy, Esenyurt, Küçükçekmece, Ümraniye, and D-100 highway line. CONCLUSION: The density in the use of public transportation rose during the hours corresponding to the working hours of the workers who had to continue working despite the pandemic. In addition, the physical movement of blue-collar workers continued despite the travel restrictions imposed along the city borders where they worked and resided. Our data point to the importance of social protection measures for workers in general, and blue-collar workers in particular, for the management of the pandemic.

COVID-19 mortality in Istanbul in association with air pollution and socioeconomic status: an ecological study.

This study aims to reveal the relationship between the COVID-19 mortality indicators and socioeconomic status (SES) and air pollution. In this ecological study, the focus was put on the relationship between COVID-19 mortality and both air quality and socioeconomic status at the district level in Istanbul. The mortality variables of the study are the excess deaths due to the pandemic, the proportion of deaths due to the pandemic among all deaths, COVID-19 mortality rate (per 100,000), and the proportion of COVID-19 deaths among older people (above the age of 65). The daily air quality measurements of PM10, SO2, NO2, and NOx of the pre-pandemic term were included in the research to avoid bias due to decreasing traffic burden during the pandemic. Partial correlation was applied to analyze the relationship between air quality and mortality measures by controlling socioeconomic status, the percentage of the older population, and household size. Every 20% deterioration in the SES stratum has contributed to a 4% increase in excess mortality at the district level. The elderly population ratio of over 10% in the districts was found to increase the COVID-19 deaths in the total population by 35% and the deaths in the population over 65 years old by 3%. Average household size was correlated with COVID-19 deaths in the population over 65. A moderate correlation was found between the COVID-19 mortality rate per 100,000 population and PM10, SO2, and NO2 (r = 0.413, 0.421, and 0.431, respectively). Mortality during the COVID-19 pandemic in Istanbul is related to an interaction of socioeconomic characteristics and air pollution as an environmental issue.

Premature deaths attributable to long-term exposure to PM2.5 in Turkey.

This research aims to reveal the premature deaths caused by long-term exposure to PM2.5 in 2018 in Turkey utilizing the AirQ+ program developed by the World Health Organization. Calculation of yearly average PM2.5 concentration in provinces, acreage of provinces, and the mortality rate of the at-risk population was the data required for the operation of the AirQ+ program. With the help of the AirQ+ program, the results revealed that a total of 44,617 people (95% CI 29.882-57.709) died prematurely due to sustained exposure to PM2.5 in Turkey in 2018. The highest estimated mortality proportion attributable to PM2.5 pollution was in the provinces of Igdir and Kahramanmaras. The highest estimated number of mortality cases per 100,000 population attributable to PM2.5 pollution was in the provinces of Manisa and Afyonkarahisar. This research points out that reaching the PM2.5 limits specified by the WHO could have prevented 44,617 premature deaths in the year 2018 in Turkey.

Perceptions of Students of a Medical School on Combined Health Warnings in Plain Packs.

OBJECTIVE: Turkey has recently adopted the regulation of plain and standard packaging for tobacco products and introduced newly designed combined health warnings. In this study, we aimed to reveal how the new combined health warnings are perceived among medical students. MATERIAL AND METHODS: The study was descriptive and the data were collected by a 3-part questionnaire. The first part covered demographic characteristics, the second part was designed to measure the saliency of the combined health warnings, and the third part evaluated their effect on the motivation to quit. RESULTS: Out of 484 students of medicine, 287 (59%) were included in the study; 54.4% of the participants were female and 45.6% were male; and the average age was 21.18 ± 1.94 years. There were 79 (27.5%) smokers and the mean duration of smoking was 39.07 ± 24.07 months. The combined health warning that reads "Smoking causes laryngeal cancer" had the highest score both in terms of saliency and motivation to quit smoking. The one that reads "Protect children: don't let them inhale your smoke" had the lowest score in both categories. Non-smokers found the stimuli more effective than smokers and quitters (P > .05). CONCLUSION: The findings point out that smoking rate is unexpectedly high among participants, and medical students perceived the warnings emphasizing the physical deformities caused by tobacco products on individuals as more effective than combined health warnings aimed at protecting "others." This study suggests that the combined health warnings should be selected in a more nuanced way for different target groups.

Persistent Ambient Air Pollution in Turkey: A 4-Year Analysis.

OBJECTIVE: Ambient air pollution is an important cause of morbidity and mortality for both individual and public health. The major contaminant that creates air pollution in Turkey is particulate matter. This study aims to demonstrate Turkey's air quality in terms of particulatematter in the last 4 years. MATERIAL AND METHODS: In this descriptive study, the public data of the National Air Quality Monitoring Network between the years 2016 and 2019 were analyzed for particulate matter (PM10). Stations with less than 75% data throughout the year were excluded from the evaluation while calculating the annual average values. The averages of the years were compared statistically with each other. RESULTS: For 111 stations that made sufficient measurements for 4 years, the annual median value of particulate matter remained constant in 12 stations (10.8%), increased in 26 stations (23.4%), and decreased in 73 stations (65.7%). The level of air pollution at 18 stations has been sustained for 4 years. It has been observed that there is no significant improvement in the criterion that the daily average PM10 level should not be higher than 50 µg/m3 for more than 35 days, and pollution is detected above the limit value permitted by the World Health Organization in all provinces and stations except a few provinces every year. Finally, during the 4-year observation, the number of stations that did not make sufficient measurements throughout the year has been found to increase over the years. CONCLUSION: Our data reveal that the air pollution attributable to particulate matter in Turkey between the years 2016 and 2019 did not regress prominently. On the contrary, air pollution has been found to gain permanency in certain provinces, and air quality monitoring has been inadequate due to insufficient measurement activities of some of the stations.

COVID-19 Pandemic and the Global Perspective of Turkish Thoracic Society.

It has been more than 3 months now since the first case of COVID-19 was reported in Turkey. Globally, the number of confirmed cases and deaths reached 9,653,048 and 491,128 respectively, as reported by 216 countries by June 27, 2020. Turkey had 1,396 new cases, 194,511 total cases, and 5,065 deaths by the same date. From the first case until today, the Turkish Thoracic Society (TTS) has been very proactive in educating doctors, increasing public awareness, undertaking academic studies, and assisting with public health policies. In the present report, social, academic, and management perspectives of the pandemic are presented under appropriate subtitles. During this critical public health crisis, TTS has once again demonstrated its readiness and constructive stance by supporting public health, healthcare workers, and the environment. This review summarizes the perspective of TTS on each aspect of the COVID-19 pandemic and casts light on its contributions.

Imatinib Treatment for Bleomycin-Induced Pulmonary Toxicity.

The basic treatment for bleomycin-induced pulmonary toxicity is corticosteroids. However, unresponsiveness to corticosteroid treatment can be observed in some cases. We present a case of a 51-year-old man, diagnosed with seminoma, who was receiving a combination treatment of bleomycin, etoposide, and cisplatin when admitted to the hospital with progressive cough and exercise-induced dyspnea. The patient's computed thorax tomography imaging showed bilateral consolidation of lungs, bronchoalveolar lavage (BAL) showed neutrophilia, and transbronchial biopsy showed fibroblastic proliferation. The sputum and BAL cultures were all sterile, and the patient was treated with methylprednisolone for the diagnosis of acute interstitial pneumonia. However, despite the corticosteroid treatment, patient suffered a respiratory failure. On the sixteenth day, imatinib 300 mg/day was added to the corticosteroid treatment. The result of the combination therapy was successful; therefore, corticosteroid and imatinib were stopped at the fifth and ninth month of the combination treatment, respectively. The patient, who is still under follow-up without any therapy until now, demonstrated that in cases of bleomycin-induced pulmonary toxicity that is unresponsive to corticosteroids, addition of imatinib to the treatment can be an alternative option.