{"id":3998,"date":"2025-07-22T14:53:54","date_gmt":"2025-07-22T11:53:54","guid":{"rendered":"https:\/\/tatd.org.tr\/toksikoloji\/?p=3998"},"modified":"2025-10-01T21:52:27","modified_gmt":"2025-10-01T18:52:27","slug":"gorunmeyen-tehlike-hava-kirliligi-ve-toksikolojik-etkileri","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2025\/07\/22\/gorunmeyen-tehlike-hava-kirliligi-ve-toksikolojik-etkileri\/","title":{"rendered":"G\u00f6r\u00fcnmeyen Tehlike: Hava Kirlili\u011fi ve Toksikolojik Etkileri"},"content":{"rendered":"\n

Sabah i\u015fe yeti\u015fmek i\u00e7in evden \u00e7\u0131k\u0131yorsunuz. D\u0131\u015far\u0131da g\u00f6zle g\u00f6r\u00fcl\u00fcr bir sis yok, ama havada yo\u011fun bir egzoz kokusu var. Bu, sadece rahats\u0131z edici bir koku de\u011fil; i\u00e7inde onlarca toksik bile\u015feni bar\u0131nd\u0131ran g\u00f6r\u00fcnmez bir kimyasal bulut. \u0130\u015fte bu g\u00f6r\u00fcnmeyen tehdit, her g\u00fcn maruz kald\u0131\u011f\u0131m\u0131z ama \u00e7o\u011fu zaman fark etmedi\u011fimiz hava kirlili\u011fi. Akut etkileri kadar kronik toksik birikimi de olan bu maruziyet, h\u00fccresel d\u00fczeyden organ sistemlerine kadar geni\u015f bir spektrumda hasara yol a\u00e7abiliyor.<\/p>\n\n\n\n

Hava kirlili\u011fi, atmosferin do\u011fal yap\u0131s\u0131n\u0131 bozan kimyasal, fiziksel ya da biyolojik etkenlerin i\u00e7 veya d\u0131\u015f ortam havas\u0131n\u0131 kirletmesiyle olu\u015fur. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc\u2019ne (DS\u00d6) g\u00f6re hava kirlili\u011fine neden olan ba\u015fl\u0131ca kirleticiler; k\u00fck\u00fcrt dioksit (SO\u2082), azot dioksit (NO\u2082), karbonmonoksit (CO), ozon (O\u2083) ve partik\u00fcl maddelerdir (PM2.5<\/sub>, PM10<\/sub>). Bu kirleticilerin atmosferdeki konsantrasyon d\u00fczeyleri, hava kalitesi indeksleriyle (Air Quality Index \u2013 AQI) izlenir (Tablo 1). Hem DS\u00d6 hem de Amerikan \u00c7evre Koruma Ajans\u0131 (EPA) taraf\u0131ndan belirlenen e\u015fik de\u011ferler do\u011frultusunda, hava kalitesi s\u0131n\u0131fland\u0131r\u0131l\u0131r ve buna g\u00f6re halk sa\u011fl\u0131\u011f\u0131na y\u00f6nelik uyar\u0131lar yap\u0131l\u0131r.<\/p>\n\n\n\n

DS\u00d6 verilerine g\u00f6re, k\u00fcresel n\u00fcfusun %99\u2019u, \u00f6nerilen s\u0131n\u0131rlar\u0131n \u00fczerinde kirleticiler i\u00e7eren havay\u0131 solumakta; en y\u00fcksek maruziyet ise d\u00fc\u015f\u00fck ve orta gelirli \u00fclkelerde g\u00f6r\u00fclmektedir. 2019 y\u0131l\u0131nda d\u00fcnya genelinde yakla\u015f\u0131k 6,7 milyon \u00f6l\u00fcm\u00fcn i\u00e7 (indoor pollution) ve d\u0131\u015f (outdoor pollution) ortam hava kirlili\u011fiyle ili\u015fkili oldu\u011fu bildirilmi\u015ftir. T\u00fcrkiye\u2019de de \u00c7evre, \u015eehircilik ve \u0130klim De\u011fi\u015fikli\u011fi Bakanl\u0131\u011f\u0131, Ulusal Hava Kalitesi \u0130zleme A\u011f\u0131-S\u00fcrekli \u0130zlem Merkezi (S\u0130M) arac\u0131l\u0131\u011f\u0131yla hava kalitesine ili\u015fkin verilere kamu eri\u015fimini sa\u011flamaktad\u0131r. Sabit ve gezici istasyonlardan elde edilen bu veriler, AQI\u2019 ye g\u00f6re iyi, orta, hassas, sa\u011fl\u0131ks\u0131z, k\u00f6t\u00fc ve tehlikeli<\/em><\/strong> \u015feklinde s\u0131n\u0131fland\u0131r\u0131larak payla\u015f\u0131lmakta ve saatlik olarak g\u00fcncellenmektedir. Baz\u0131 istasyonlar, SO\u2082, NO\u2082, CO, O\u2083, PM2.5<\/sub> ve PM10 <\/sub>gibi kirleticilerin d\u00fczeylerini de ayr\u0131ca raporlamaktad\u0131r.<\/p>\n\n\n\n

Modern toplumlarda hava kirlili\u011fi, sessiz ama \u0131srarl\u0131 bir halk sa\u011fl\u0131\u011f\u0131 tehdidi olmaya devam etmektedir. Genellikle \u00e7evre sa\u011fl\u0131\u011f\u0131 veya pulmonoloji ba\u015fl\u0131\u011f\u0131 alt\u0131nda ele al\u0131nsa da, hava kirlili\u011fi asl\u0131nda toksikolojinin do\u011frudan ilgi alan\u0131d\u0131r. Soludu\u011fumuz havadaki partik\u00fcller ve gaz formundaki kirleticiler, biyolojik sistemler \u00fczerinde hem akut hem de kronik toksik etkilere yol a\u00e7maktad\u0131r. \u00d6zellikle acil servislerde s\u0131k kar\u015f\u0131la\u015f\u0131lan klinik tablolar\u0131n (\u00f6rne\u011fin KOAH ataklar\u0131, akut miyokard infarkt\u00fcs\u00fc, inme, CO zehirlenmeleri) atmosferik kirleticilerle ili\u015fkili olabilece\u011fi g\u00fcn ge\u00e7tik\u00e7e daha fazla kabul g\u00f6rmektedir.<\/p>\n\n\n\n

Bu yaz\u0131da, hava kirlili\u011fini toksikolojik bir ajan olarak ele alarak, ba\u015fl\u0131ca kirleticilerin insan sa\u011fl\u0131\u011f\u0131 \u00fczerindeki etkilerini; sistemik yans\u0131malar\u0131n\u0131 ve \u00f6zellikle acil sa\u011fl\u0131k hizmetleri a\u00e7\u0131s\u0131ndan neden kritik \u00f6neme sahip olduklar\u0131n\u0131 inceleyece\u011fiz. Ayr\u0131ca hava kirlili\u011fini azaltmaya y\u00f6nelik politikalar\u0131n halk sa\u011fl\u0131\u011f\u0131na etkilerini de tart\u0131\u015faca\u011f\u0131z. Hava kirlili\u011fini azaltmaya y\u00f6nelik politikalar hem iklim hem de sa\u011fl\u0131k a\u00e7\u0131s\u0131ndan kazan-kazan stratejisi sunar. Hava kirlili\u011fine ba\u011fl\u0131 hastal\u0131k y\u00fck\u00fcn\u00fc azalt\u0131r ve iklim de\u011fi\u015fikli\u011finin k\u0131sa ve uzun vadede hafifletilmesine katk\u0131da bulunur.<\/p>\n\n\n\n

HAVA K\u0130RLET\u0130C\u0130LER\u0130<\/strong><\/p>\n\n\n\n

Hava Kalitesi \u0130ndeksi (Air Quality Index-AQI): Soludu\u011funuz Havaya Puan\u0131n\u0131z Ka\u00e7?<\/strong><\/h3>\n\n\n\n

Soludu\u011fumuz havan\u0131n ne kadar temiz ya da kirli oldu\u011funu sadece g\u00f6zlemleyerek anlamak \u00e7o\u011fu zaman m\u00fcmk\u00fcn de\u011fildir. \u0130\u015fte bu noktada, bilimsel verileri herkesin anlayabilece\u011fi tek bir say\u0131ya d\u00f6n\u00fc\u015ft\u00fcren Hava Kalitesi \u0130ndeksi (Air Quality Index \u2013 AQI)<\/strong> devreye giriyor. AQI, havadaki kirleticilerin insan sa\u011fl\u0131\u011f\u0131 \u00fczerindeki potansiyel etkilerini yans\u0131tan standart bir \u00f6l\u00e7\u00fcm sistemidir. Adeta havan\u0131n \u201ckarnesi\u201d gibidir.<\/p>\n\n\n\n

Amerikan \u00c7evre Koruma Ajans\u0131 (EPA) taraf\u0131ndan geli\u015ftirilen bu indeks, alt\u0131 temel kirletici maddenin (CO, SO2, O3, NO2, PM10<\/sub> ve PM 2.5<\/sub>) <\/strong>atmosferik konsantrasyonlar\u0131n\u0131n belirli algoritmalarla hesaplanmas\u0131yla elde edilir.  AQI ve di\u011fer hava kirleticilerin d\u00fczeylerine g\u00f6re hava kalitesi s\u0131n\u0131fland\u0131r\u0131lmas\u0131 Tablo 1\u2019 de g\u00f6sterilmi\u015ftir. AQI skoruna g\u00f6re hava kalitesi \u015fu \u015fekilde s\u0131n\u0131fland\u0131r\u0131labilir: iyi (0\u201350), orta (51\u2013100), hassas (101\u2013150), sa\u011fl\u0131ks\u0131z (151\u2013200), \u00e7ok k\u00f6t\u00fc (201\u2013300) ve tehlikeli (301\u2013500) HK\u0130 i\u015fte bu 5 zararl\u0131 gaz\u0131n havadaki oranlar\u0131na g\u00f6re hesaplanmaktad\u0131r.<\/p>\n\n\n\n

Her bir kirletici i\u00e7in ayr\u0131 ayr\u0131 hesaplanan skorlar aras\u0131nda en y\u00fcksek olan\u0131 o g\u00fcnk\u00fc genel AQI de\u011feri olarak kabul edilir. Bu y\u00f6ntem, \u00f6zellikle duyarl\u0131 gruplar i\u00e7in (ya\u015fl\u0131lar, \u00e7ocuklar, kalp veya akci\u011fer hastal\u0131\u011f\u0131 olan bireyler) maruziyet riskini en iyi yans\u0131tan yakla\u015f\u0131m\u0131 sunar.<\/p>\n\n\n\n

G\u00fcn\u00fcm\u00fczde bir\u00e7ok \u00fclkede ve \u015fehirde AQI verileri saatlik olarak g\u00fcncellenmekte ve mobil uygulamalar ya da dijital platformlar \u00fczerinden halkla payla\u015f\u0131lmaktad\u0131r. T\u00fcrkiye’de de Ulusal Hava Kalitesi \u0130zleme A\u011f\u0131<\/strong> bu verileri \u015feffaf bi\u00e7imde kamuya sunmaktad\u0131r (Web-sitesi birka\u00e7 ayd\u0131r g\u00fcncellemede).<\/p>\n\n\n\n

\u00d6zellikle PM 2.5<\/sub>, PM 10<\/sub> ve Ozon d\u00fczeylerinin artt\u0131\u011f\u0131 d\u00f6nemlerde AQI h\u0131zl\u0131 \u015fekilde y\u00fckselebilir. Bu nedenle, hava kalitesi sadece \u00e7evre sa\u011fl\u0131\u011f\u0131 de\u011fil, bireysel sa\u011fl\u0131k kararlar\u0131 a\u00e7\u0131s\u0131ndan da \u00f6nemli bir g\u00f6stergedir<\/strong>. AQI’nin \u201corta\u201ddan \u201csa\u011fl\u0131ks\u0131z\u201da kayd\u0131\u011f\u0131 g\u00fcnlerde, egzersiz saatlerini planlamak, d\u0131\u015f ortam aktivitelerini s\u0131n\u0131rlamak veya solunum yolu hastal\u0131\u011f\u0131 olan bireyleri uyarmak hayati \u00f6nem ta\u015f\u0131yabilir.<\/p>\n\n\n\n

Partik\u00fcl Madde (PM): Toksikolojik Y\u00fck\u00fc En A\u011f\u0131r Kirletici<\/strong><\/p>\n\n\n\n

Partik\u00fcl madde (PM), atmosferde ask\u0131da bulunan kat\u0131 par\u00e7ac\u0131klar ve s\u0131v\u0131 damlac\u0131klar\u0131n\u0131n genel ad\u0131d\u0131r. \u00c7aplar\u0131 0.001\u2013100 \u00b5m aras\u0131nda de\u011fi\u015fen bu partik\u00fcller, kaynaklar\u0131na ve boyutlar\u0131na g\u00f6re farkl\u0131 sa\u011fl\u0131k etkileri olu\u015fturabilir. Toz, is, duman gibi baz\u0131 partik\u00fcller \u00e7\u0131plak g\u00f6zle g\u00f6r\u00fclebilirken, PM2.5<\/sub> gibi ince partik\u00fcller yaln\u0131zca elektron mikroskobu ile tespit edilebilecek kadar k\u00fc\u00e7\u00fckt\u00fcr. Bu boyut k\u00fc\u00e7\u00fckl\u00fc\u011f\u00fc, partik\u00fcllerin derin solunum yollar\u0131na ve hatta dola\u015f\u0131m sistemine ula\u015fmalar\u0131n\u0131 m\u00fcmk\u00fcn k\u0131lar. PM, insan sa\u011fl\u0131\u011f\u0131 \u00fczerindeki etkileri ve ekosistemler ve altyap\u0131lar gibi \u00e7evresel sorunlara katk\u0131lar\u0131 nedeniyle en \u00f6nemli atmosferik kirleticilerden biri olarak kabul edilir.2021 y\u0131l\u0131 verilerine g\u00f6re, PM kaynakl\u0131 hava kirlili\u011fi, d\u00fcnya genelindeki engellili\u011fe g\u00f6re ayarlanm\u0131\u015f ya\u015fam y\u0131l\u0131 (DALY) kay\u0131plar\u0131n\u0131n %8\u2019inden sorumludur.<\/p>\n\n\n\n

Partik\u00fcllerin penetrasyon kapasitesi b\u00fcy\u00fck \u00f6l\u00e7\u00fcde \u00e7aplar\u0131na ba\u011fl\u0131d\u0131r: PM10<\/sub>, \u00fcst solunum yollar\u0131 ve akci\u011ferlerde birikirken; PM2.5 <\/sub>alveolleri ge\u00e7erek dola\u015f\u0131ma ula\u015fabilir ve sistemik toksisiteye neden olabilir. \u0130nce partik\u00fcller (\u00f6zellikle PM2.5<\/sub>), k\u0131sa vadede nazofarenjit, bron\u015fit ve ast\u0131m ataklar\u0131n\u0131 tetiklerken; uzun vadede kardiyovask\u00fcler hastal\u0131klar, inme, diyabet, premat\u00fcr mortalite ve hatta perinatal \u00f6l\u00fcmlerle ili\u015fkilendirilmi\u015ftir. Baz\u0131 \u00e7al\u0131\u015fmalar, PM2.5<\/sub> d\u00fczeyindeki her 10 \u00b5g\/m\u00b3 art\u0131\u015f\u0131n kardiyovask\u00fcler mortaliteyi yakla\u015f\u0131k %1 oran\u0131nda art\u0131rd\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir. Kronik hastal\u0131\u011f\u0131 olan bireyler \u2013\u00f6rne\u011fin KOAH, diyabet, hipertansiyon veya koroner arter hastal\u0131\u011f\u0131 olanlar\u2013 bu toksik etkilere kar\u015f\u0131 daha duyarl\u0131 kabul edilmektedir.<\/p>\n\n\n\n

Toksikolojik d\u00fczeyde, solunumla al\u0131nd\u0131\u011f\u0131nda partik\u00fcl maddeler \u00f6ncelikle lokal inflamatuvar yan\u0131t\u0131 tetikler. Solunum epiteline temas eden partik\u00fcller, okside olmu\u015f d\u00fc\u015f\u00fck yo\u011funluklu lipoprotein (ox-LDL) ve interl\u00f6kin-6 gibi proinflamatuvar mediat\u00f6rlerin sal\u0131n\u0131m\u0131na neden olur. Bu mediat\u00f6rler, dola\u015f\u0131ma ge\u00e7erek sistemik inflamasyona ve vask\u00fcler endotelde disfonksiyona yol a\u00e7abilir. Ayn\u0131 zamanda partik\u00fcl maddeler serbest radikal \u00fcretimini art\u0131rarak oksidatif stres d\u00fczeyini y\u00fckseltir; bu da h\u00fccresel hasar, aterosklerotik plak destabilizasyonu, vazokonstr\u00fcksiyon, hipertansiyon ve tromboz gibi olaylar\u0131 tetikleyebilir.<\/p>\n\n\n\n

Literat\u00fcrde, komorbiditelerin hava kirlili\u011fine kar\u015f\u0131 bireyleri daha duyarl\u0131 hale getirdi\u011fine dair \u00e7al\u0131\u015fmalar bulunmaktad\u0131r. Hipertansiyon, hiperlipidemi, diyabet veya koroner kalp hastal\u0131\u011f\u0131 olan AMI hastalar\u0131n\u0131n PM2.5′<\/sub> ten daha fazla etkilenme e\u011filiminde oldu\u011fu \u00f6ne s\u00fcr\u00fclm\u00fc\u015ft\u00fcr [24, 25]. Bu konuda klini\u011fimizde (Sa\u011fl\u0131k Bilimleri \u00dcniversitesi, Adana \u015eehir E\u011fitim ve Ara\u015ft\u0131rma Hastanesi) y\u00fcr\u00fctt\u00fc\u011f\u00fcm\u00fcz prospektif bir \u00e7al\u0131\u015fma da dikkat \u00e7ekici sonu\u00e7lar ortaya koymu\u015ftur. ST elevasyonlu miyokard infarkt\u00fcs\u00fc (STEMI) tan\u0131s\u0131yla acil servise ba\u015fvuran 1413 hastan\u0131n de\u011ferlendirildi\u011fi bu \u00e7al\u0131\u015fmada, hastalar\u0131n ba\u015fvuru an\u0131ndaki hava kalitesi parametreleri ile klinik \u00f6zellikleri aras\u0131ndaki ili\u015fki incelendi.<\/p>\n\n\n\n

Elde etti\u011fimiz bulgular \u00e7arp\u0131c\u0131yd\u0131: Hastalar\u0131n tamam\u0131nda ba\u015fvuru an\u0131ndaki hava kalitesi indeksi (AQI) de\u011ferleri (Medyan: 53, IQR: 37\u201355) ve PM2.5 d\u00fczeyleri (Medyan: 18 \u00b5g\/m\u00b3, IQR: 11\u201327) Amerikan \u00c7evre Koruma Ajans\u0131 (EPA) taraf\u0131ndan tan\u0131mlanan s\u0131n\u0131r de\u011ferlerin \u00fczerindeydi. Bir ba\u015fka dikkat \u00e7ekici bulgu ise, koroner arter hastal\u0131\u011f\u0131 (KAH) \u00f6yk\u00fcs\u00fc olan bireylerin ve kad\u0131n hastalar\u0131n STEMI geli\u015ftirdi\u011fi g\u00fcnlerde maruz kald\u0131klar\u0131 PM10 d\u00fczeylerinin, di\u011fer hastalara k\u0131yasla istatistiksel olarak anlaml\u0131 bi\u00e7imde daha d\u00fc\u015f\u00fck olmas\u0131yd\u0131. Bu, altta yatan kalp hastal\u0131\u011f\u0131 olan ki\u015filerin ve kad\u0131nlar\u0131n daha d\u00fc\u015f\u00fck seviyelerdeki partik\u00fcl maddeye dahi duyarl\u0131 olabilece\u011fine i\u015faret ediyor.<\/p>\n\n\n\n

Ya\u015fl\u0131 bireylerde g\u00f6zlenen etkiler de dikkat \u00e7ekiciydi. Yetmi\u015f be\u015f ya\u015f \u00fczeri hastalarda ba\u015fvuru an\u0131ndaki PM2.5 d\u00fczeyleri (Medyan: 20.5 \u00b5g\/m\u00b3, IQR: 13\u201329), 75 ya\u015f alt\u0131 gruba g\u00f6re anlaml\u0131 \u015fekilde daha y\u00fcksekti (p=0.022). Bu bulgu, ya\u015fl\u0131lar\u0131n solunan kirli havaya kar\u015f\u0131 fizyolojik olarak daha savunmas\u0131z olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcr\u00fcyor.<\/p>\n\n\n\n

Bu \u00e7al\u0131\u015fman\u0131n sonu\u00e7lar\u0131, hava kirlili\u011fi ile kardiyovask\u00fcler olaylar aras\u0131ndaki ili\u015fkiye dair klinik d\u00fczeyde g\u00fc\u00e7l\u00fc kan\u0131tlar sunarken; ya\u015fl\u0131lar, kad\u0131nlar ve KAH \u00f6yk\u00fcs\u00fc olan bireylerin daha d\u00fc\u015f\u00fck d\u00fczeydeki kirletici maruziyetlerinde dahi daha y\u00fcksek risk alt\u0131nda olabilece\u011fini g\u00f6steriyor. Bu nedenle, hava kalitesi k\u00f6t\u00fc oldu\u011funda bu riskli gruplar i\u00e7in erken uyar\u0131 sistemlerinin geli\u015ftirilmesi ve fark\u0131ndal\u0131k \u00e7al\u0131\u015fmalar\u0131n\u0131n art\u0131r\u0131lmas\u0131, kardiyovask\u00fcler olaylar\u0131n \u00f6nlenmesi a\u00e7\u0131s\u0131ndan kritik \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n\n\n\n

Ozon (O\u2083): G\u00fcne\u015fli G\u00fcnlerin G\u00f6r\u00fcnmez Tehdidi<\/strong><\/p>\n\n\n\n

Ozon, y\u00fcksek voltajl\u0131 elektrik de\u015farj\u0131 s\u0131ras\u0131nda oksijen molek\u00fcllerinin par\u00e7alanmas\u0131yla olu\u015fan reaktif bir gazd\u0131r. Atmosferin \u00fcst tabakalar\u0131nda ultraviyole \u0131\u015f\u0131n\u0131m\u0131n\u0131 engelleyen koruyucu bir rol\u00fc varken, yer seviyesindeki ozon insan sa\u011fl\u0131\u011f\u0131 i\u00e7in toksiktir. Solunum yoluyla al\u0131nan ozon, cildin \u00fcst tabakalar\u0131, g\u00f6zya\u015f\u0131 kanallar\u0131 ve \u00f6zellikle akci\u011fer dokusunda hasara yol a\u00e7ar. Ara\u015ft\u0131rmalar, ozonun epidermal keratinositlerde DNA hasar\u0131n\u0131 art\u0131rd\u0131\u011f\u0131n\u0131 ve bu yolla hem morfolojik hem de fonksiyonel bozulmalara neden olabilece\u011fini g\u00f6stermektedir. Y\u00fcksek s\u0131cakl\u0131k ve g\u00fcne\u015fli havalarda ozon seviyesi artt\u0131\u011f\u0131ndan, \u00f6zellikle ast\u0131m ve KOAH gibi solunum hastal\u0131klar\u0131 olan bireyler i\u00e7in risk daha da b\u00fcy\u00fcr.<\/p>\n\n\n\n

Azot Dioksit (NO\u2082): Trafikten Gelen Toksik Y\u00fck<\/strong><\/p>\n\n\n\n

Azot dioksit, ba\u015fta otomobil egzozlar\u0131 olmak \u00fczere fosil yak\u0131tlar\u0131n yanmas\u0131yla a\u00e7\u0131\u011fa \u00e7\u0131kan \u00f6nemli bir trafik kaynakl\u0131 kirleticidir. Solundu\u011funda bron\u015flarda irritasyona, \u00f6ks\u00fcr\u00fck, wheezing, dispne ve ciddi olgularda pulmoner \u00f6deme yol a\u00e7abilir. \u00d6zellikle 0.2 ppm’nin \u00fczerindeki yo\u011funluklar, bronkospazm riskini art\u0131rmaktad\u0131r. NO\u2082 maruziyeti ayn\u0131 zamanda ba\u011f\u0131\u015f\u0131kl\u0131k sistemini de etkiler; CD8+ T h\u00fccreleri ve do\u011fal \u00f6ld\u00fcr\u00fcc\u00fc (Natural Killer-NK) h\u00fccreleri gibi imm\u00fcn sistemin \u00f6nemli bile\u015fenlerinde fonksiyon bozukluklar\u0131na yol a\u00e7abilir. Kronik maruziyet, \u00e7ocuklarda ast\u0131m geli\u015fimiyle, eri\u015fkinlerde ise kronik akci\u011fer hastal\u0131\u011f\u0131n\u0131n ilerlemesiyle ili\u015fkilendirilmi\u015ftir.<\/p>\n\n\n\n

S\u00fclf\u00fcr Dioksit (SO\u2082): Sanayile\u015fmenin Yak\u0131c\u0131 Solu\u011fu<\/strong><\/p>\n\n\n\n

S\u00fclf\u00fcr dioksit, \u00e7o\u011funlukla fosil yak\u0131tlar\u0131n yak\u0131lmas\u0131yla ya da end\u00fcstriyel \u00fcretim s\u00fcre\u00e7lerinde ortaya \u00e7\u0131kan keskin kokulu bir gazd\u0131r. Y\u0131ll\u0131k maruziyet i\u00e7in belirlenen s\u0131n\u0131r de\u011feri 0.03 ppm\u2019dir. SO\u2082, \u00f6zellikle solunum yollar\u0131 mukozas\u0131nda tahri\u015fe neden olur; nefes darl\u0131\u011f\u0131, bron\u015fit, mukus \u00fcretiminde art\u0131\u015f ve wheezinge yol a\u00e7abilir. Ayr\u0131ca lakrimasyon, \u00fcrtiker, korneal opasite gibi oftalmolojik etkiler ve \u00f6nceden mevcut kardiyovask\u00fcler hastal\u0131klarda k\u00f6t\u00fcle\u015fmeye neden olabilir. Hassas bireylerde bu etkiler \u00e7ok daha d\u00fc\u015f\u00fck seviyelerde bile ortaya \u00e7\u0131kabilir.<\/p>\n\n\n\n

Karbon Monoksit (CO): Sessiz Katil<\/strong><\/p>\n\n\n\n

Karbon monoksit (CO), renksiz, kokusuz ve tats\u0131z bir gazd\u0131r; bu nedenle \u201csessiz katil\u201d olarak an\u0131lmas\u0131 tesad\u00fcf de\u011fildir. Kirlenmemi\u015f a\u00e7\u0131k hava ortamlar\u0131nda CO d\u00fczeyi genellikle 0.02\u20131.0 ppm aral\u0131\u011f\u0131ndad\u0131r. Ancak b\u00fcy\u00fck \u015fehirlerde, \u00f6zellikle k\u0131\u015f aylar\u0131nda s\u0131cakl\u0131k inversiyonlar\u0131<\/strong> ya da yaz\u0131n dura\u011fan hava k\u00fctleleri gibi atmosferik durgunluk d\u00f6nemlerinde bu seviyeler on kat\u0131na kadar \u00e7\u0131kabilir<\/strong>.<\/strong> Bu art\u0131\u015flar \u00e7o\u011fu zaman \u00e7\u0131plak g\u00f6zle ya da burunla alg\u0131lanamaz; ama sonu\u00e7lar\u0131 ciddi olabilir.<\/p>\n\n\n\n

Son y\u0131llarda yap\u0131lan \u00e7al\u0131\u015fmalar, sadece meteorolojik (s\u0131cakl\u0131k, nem, r\u00fczgar h\u0131z\u0131) fakt\u00f6rlerin de\u011fil; ayn\u0131 zamanda hava kirleticilerinin (PM2.5, <\/sub>PM10<\/sub>, CO, SO2,<\/sub> NO2,<\/sub> ve O3<\/sub>)de hastane-d\u0131\u015f\u0131 kariyak arrest vakalar\u0131 veya CO zehirlenme vakalar\u0131 ile ili\u015fkili oldu\u011funu g\u00f6stermektedir. Bu veriler do\u011frultusunda, hava kirlili\u011fi ve meteoroloji verilerini entegre eden tahmin modelleri<\/strong> geli\u015ftirilmi\u015ftir. Bu modeller, CO zehirlenmesi riskinin hangi ko\u015fullarda artt\u0131\u011f\u0131n\u0131 \u00f6ng\u00f6rerek olas\u0131 vakalar\u0131 \u00f6nceden belirleyebilme potansiyeline sahiptir. \u00d6zellikle y\u00fcksek riskli g\u00fcnlerde halk\u0131 uyarmak a\u00e7\u0131s\u0131ndan bu modellerin etkinli\u011fi giderek artmaktad\u0131r.<\/p>\n\n\n\n

Bu konuda Gaziantep \u00dcniversitesi ve klini\u011fimizin (SB\u00dc Adana \u015eehir E\u011fitim ve Ara\u015ft\u0131rma Hastanesi) ortakla\u015fa y\u00fcr\u00fctt\u00fc\u011f\u00fc \u00e7ok merkezli prospektif bir \u00e7al\u0131\u015fma<\/strong>,<\/strong> \u00f6nemli bulgular ortaya koymu\u015ftur. \u0130ki farkl\u0131 \u015fehirdeki acil servislere ba\u015fvuran karbon monoksit zehirlenmesi vakalar\u0131 analiz edilerek, d\u0131\u015f ortam hava kirlili\u011fi ile klinik sonu\u00e7lar aras\u0131ndaki ili\u015fki incelendi. Literat\u00fcrden farkl\u0131 olarak bu \u00e7al\u0131\u015fmada hava kalitesi indeksinin (AQI)<\/strong>,<\/strong> yaln\u0131zca zehirlenme olas\u0131l\u0131\u011f\u0131n\u0131 de\u011fil; ayn\u0131 zamanda hastane yat\u0131\u015f\u0131 ve miyokardiyal etkilenme gibi klinik sonu\u00e7lar\u0131 \u00f6ng\u00f6rmede de ba\u011f\u0131ms\u0131z bir belirte\u00e7<\/strong> oldu\u011fu g\u00f6sterildi.<\/p>\n\n\n\n

Bu bulgu, karbon monoksit maruziyetine ba\u011fl\u0131 geli\u015fen ciddi tablolar\u0131n erken d\u00f6nemde tespit edilmesine yard\u0131mc\u0131 olabilir. \u00d6rne\u011fin, hava durumu yay\u0131nlar\u0131nda AQI de\u011ferlerinin halka a\u00e7\u0131k \u015fekilde sunulmas\u0131, halk\u0131n CO zehirlenmesine kar\u015f\u0131 daha bilin\u00e7li olmas\u0131n\u0131 sa\u011flayabilir<\/strong>.<\/strong> Yine benzer \u015fekilde, f\u0131rt\u0131na \u00f6ncesi ya da hava inversiyonu d\u00f6nemlerinde toplu ta\u015f\u0131ma ara\u00e7lar\u0131, haber b\u00fcltenleri ve dijital platformlar arac\u0131l\u0131\u011f\u0131yla yap\u0131lacak \u00f6nleyici uyar\u0131lar<\/strong>,<\/strong> olas\u0131 zehirlenmelerin \u00f6n\u00fcne ge\u00e7ebilir. Elbette \u00f6nleme kadar, zehirlenme ger\u00e7ekle\u015ftikten sonraki s\u00fcre\u00e7te de zamanla yar\u0131\u015f s\u00f6z konusudur. Bu nedenle toplum genelinde CO \u00fcretimini azaltma yollar\u0131na dair e\u011fitimlerin<\/strong> \u00f6zellikle okullarda verilmesi, hem hava kirlili\u011fiyle m\u00fccadelede hem de bu sessiz tehlikenin uzun vadeli kontrol\u00fcnde etkili bir ad\u0131m olacakt\u0131r. Zehirlenme meydana geldi\u011finde ise h\u0131zl\u0131 tan\u0131, do\u011fru de\u011ferlendirme ve uygun tedavi ile mortalite riski belirgin \u015fekilde azalt\u0131labilir.<\/p>\n\n\n\n

Deprem ve Hava Kirlili\u011fi: Sessiz Tehlike Deprem Sonras\u0131nda da S\u00fcr\u00fcyor<\/strong><\/h3>\n\n\n\n

6 \u015eubat 2023\u2019te ger\u00e7ekle\u015fen ve \u201cAsr\u0131n Felaketi\u201d olarak adland\u0131r\u0131lan Kahramanmara\u015f merkezli deprem, T\u00fcrkiye tarihinin en b\u00fcy\u00fck ve en y\u0131k\u0131c\u0131 sars\u0131nt\u0131lar\u0131ndan biri oldu. Depremler sadece anl\u0131k can kayb\u0131 ve fiziksel y\u0131k\u0131mla de\u011fil; sonras\u0131nda ortaya \u00e7\u0131kan \u00e7evresel ve halk sa\u011fl\u0131\u011f\u0131 sorunlar\u0131yla da derin izler b\u0131rak\u0131r. Bu ba\u011flamda, deprem sonras\u0131 ortaya \u00e7\u0131kan hava kirlili\u011fi, g\u00f6z ard\u0131 edilmemesi gereken \u00f6nemli bir halk sa\u011fl\u0131\u011f\u0131 tehdididir.<\/p>\n\n\n\n

Deprem an\u0131nda y\u0131k\u0131lan binalardan serbest kalan asbest, kur\u015fun gibi tehlikeli maddeler, hava, toprak ve su kaynaklar\u0131n\u0131 h\u0131zla kirletir. Ard\u0131ndan enkaz kald\u0131rma ve ta\u015f\u0131nma s\u00fcre\u00e7lerinde a\u00e7\u0131\u011fa \u00e7\u0131kan toz ve duman, a\u011f\u0131r makinelerden yay\u0131lan egzoz gazlar\u0131, hava kalitesini daha da d\u00fc\u015f\u00fcr\u00fcr. Uygun olmayan at\u0131k y\u00f6netimi ve yasad\u0131\u015f\u0131 d\u00f6k\u00fcmler de \u00e7evresel kirlili\u011fi art\u0131ran di\u011fer fakt\u00f6rler aras\u0131nda yer al\u0131r.<\/p>\n\n\n\n

SB\u00dc Adana \u015eehir E\u011fitim ve Ara\u015ft\u0131rma Hastanesi\u2019nin ana merkez oldu\u011fu, Kahramanmara\u015f ve \u00e7evresindeki 8 ilde (Kahramanmara\u015f, Hatay, Adana, Ad\u0131yaman, Kilis, Gaziantep, Malatya, Osmaniye) y\u00fcr\u00fct\u00fclen \u00e7ok merkezli retrospektif \u00e7al\u0131\u015fmam\u0131zda, depremin birinci y\u0131l\u0131nda bu illerde acil servislere ba\u015fvuran karbon monoksit zehirlenmesi vakalar\u0131 ile hava kirlili\u011fi aras\u0131ndaki ili\u015fkiyi inceledik. Sonu\u00e7lar, deprem sonras\u0131 hava kirlili\u011finde anlaml\u0131 bir art\u0131\u015f oldu\u011funu g\u00f6sterdi. Deprem merkez \u00fcss\u00fc Kahramanmara\u015f ve en \u00e7ok etkilenen illerden Hatay\u2019da, y\u0131ll\u0131k ortalama Hava Kalitesi \u0130ndeksi (AQI) ve PM2.5<\/sub> de\u011ferleri, ABD \u00c7evre Koruma Ajans\u0131\u2019n\u0131n (EPA) belirledi\u011fi s\u0131n\u0131rlar\u0131n \u00fcst\u00fcndeydi. Bir \u00f6nceki y\u0131l ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, hem Kahramanmara\u015f\u2019ta hem de Hatay\u2019da AQI\u2019 nin istatistiksel olarak anlaml\u0131 d\u00fczeyde y\u00fckseldi\u011fi saptand\u0131. \u00d6zellikle Kahramanmara\u015f\u2019ta AQI ve PM10<\/sub> de\u011ferleri kritik e\u015fiklerin \u00fczerine \u00e7\u0131kt\u0131; Hatay ise en y\u00fcksek CO seviyeleri ve y\u00fcksek PM10<\/sub> konsantrasyonlar\u0131 ile dikkat \u00e7ekti.<\/p>\n\n\n\n

Deprem gibi b\u00fcy\u00fck afetler, sadece anl\u0131k y\u0131k\u0131m de\u011fil, ayn\u0131 zamanda uzun vadeli \u00e7evresel sa\u011fl\u0131k krizlerini de tetikler. Uzun s\u00fcreli hava kirlili\u011fine maruz kalmak, \u00f6zellikle kardiyovask\u00fcler hastal\u0131klar i\u00e7in risk fakt\u00f6rlerini art\u0131rabilir. Bu nedenle, afet sonras\u0131 hava kalitesi izleme sistemlerinin geli\u015ftirilmesi ve \u00e7evresel etkilerin s\u00fcrekli de\u011ferlendirilmesi<\/strong>,<\/strong> halk sa\u011fl\u0131\u011f\u0131n\u0131 korumak a\u00e7\u0131s\u0131ndan kritik \u00f6neme sahiptir.<\/p>\n\n\n\n

Sonu\u00e7 olarak; her g\u00fcn fark\u0131nda olmadan ci\u011ferlerimize \u00e7ekti\u011fimiz hava, asl\u0131nda karma\u015f\u0131k bir kimyasal kokteyl olabilir. Bazen g\u00f6rmedi\u011fimiz \u015feyler daha tehlikeli olabilir. Hava kirlili\u011fi, sessizce ve yava\u015f yava\u015f bedenimize i\u015fleyen toksik bir risk. Bu yaz\u0131da, bu g\u00f6r\u00fcnmeyen tehdidin molek\u00fcler d\u00fczeyde nas\u0131l zarar verdi\u011fini ve hangi hasta gruplar\u0131n\u0131 daha \u00e7ok etkiledi\u011fini konu\u015ftuk. Ama bu sadece bir bilimsel ger\u00e7eklik de\u011fil; ayn\u0131 zamanda ki\u015fisel ve toplumsal bir sorumluluk. Toksikoloji, sadece zehirleri tan\u0131mak de\u011fil; zarar\u0131 \u00f6nceden g\u00f6rmek, uyar\u0131 sistemlerini geli\u015ftirmek ve insan sa\u011fl\u0131\u011f\u0131n\u0131 koruyacak \u00e7\u00f6z\u00fcmler \u00fcretmekle ilgilidir. Belki de en etkili \u00e7\u00f6z\u00fcm, fark\u0131nda olmakla ba\u015flar. \u00c7\u00fcnk\u00fc hava kirlili\u011fini azaltmak, sadece bacalardan \u00e7\u0131kan duman\u0131 azaltmakla de\u011fil, bilgiyle, bilin\u00e7le ve birlikte hareket etmekle<\/strong> m\u00fcmk\u00fcnd\u00fcr.<\/p>\n\n\n\n

Tablo 1. Hava kalitesi parametrelerinin EPA\u2019 ya g\u00f6re cut-off de\u011ferleri<\/strong><\/p>\n\n\n\n

AQI<\/strong><\/td>SO2 <\/sub>(\u00b5g\/m3<\/sup>)<\/strong><\/sub><\/strong><\/td>NO2 <\/sub>(\u00b5g\/m3<\/sup>)<\/strong><\/strong><\/td>CO (\u00b5g\/m3<\/sup>)<\/strong><\/strong><\/td>O3 <\/sub>(\u00b5g\/m3<\/sup>)<\/strong><\/strong><\/td>PM10 <\/sub>(\u00b5g\/m3<\/sup>)<\/strong><\/strong><\/td>PM2.5 <\/sub>(\u00b5g\/m3<\/sup>)<\/strong><\/strong><\/td> <\/td><\/tr>
1h average<\/td>24h average<\/td>1h average<\/td>8h average<\/td>8h average<\/td>1h average<\/td>24h average<\/td>24h average<\/td><\/tr>
0-50<\/td>0-93<\/td> <\/td>0-102<\/td>0-5,2<\/td>0-108<\/td> <\/td>0-54<\/td>0,0-12,0<\/td>Good<\/td><\/tr>
51-100<\/td>94-200<\/td> <\/td>103-192<\/td>5,3-11<\/td>109-248<\/td> <\/td>55-154<\/td>12,1-35,4<\/td>Moderate<\/td><\/tr>
101-150<\/td>201-493<\/td> <\/td>193-689<\/td>11,1-14,5<\/td> <\/td>249-328<\/td>155-254<\/td>35,5-55,4<\/td>Unhealthy for Sensitive Groups  <\/td><\/tr>
151-200<\/td>494-810<\/td> <\/td>690-1242<\/td>14,6-18<\/td> <\/td>329-408<\/td>255-354<\/td>55,5-150,4<\/td>Unhealthy<\/td><\/tr>
201-300<\/td> <\/td>811-1609<\/td>1243-2380<\/td>18,1-35,5<\/td> <\/td>409-808<\/td>355-424<\/td>150,5-250,4<\/td>Very Unhealthy<\/td><\/tr>
301-400<\/td> <\/td>1610-2141<\/td>2381-3145<\/td>35,6-47,1<\/td> <\/td>809-1008<\/td>425-504<\/td>250,5-350,4<\/td>Hazardous<\/td><\/tr>
401-500<\/td> <\/td>2142-2674<\/td>3146-3910<\/td>47,2-58,8<\/td> <\/td>1009-1208<\/td>505-604<\/td>350,5-500,4<\/td>Hazardous<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n

KAYNAKLAR<\/strong><\/p>\n\n\n\n

    \n
  1. WHO. Air Pollution. WHO. https:\/\/www.who.int\/data\/gho\/data\/themes\/air-pollution<\/a><\/li>\n\n\n\n
  2. T\u00fcrkiye Cumhuriyeti \u00c7evre, \u015eehircilik ve \u0130klim De\u011fi\u015fikli\u011fi Bakanl\u0131\u011f\u0131, Ulusal Hava Kalitesi \u0130zleme A\u011f\u0131, S\u00fcrekli \u0130zleme Merkezi. https:\/\/sim.csb.gov.tr\/<\/a> https:\/\/www.mgm.gov.tr\/tahmin\/il-ve-ilceler.aspx?il=Adana<\/a>.<\/li>\n\n\n\n
  3. EPA hava kirlili\u011fi kriterleri. https:\/\/www.epa.gov\/criteria-air-pollutants\/naaqs-table<\/a><\/li>\n\n\n\n
  4. Sabak M, Gulen M, Satar S, Yildirim C, Yildiz AF, Zengin S. The Prognostic Effect of Air Pollution in Patients Presenting to the Emergency Department with Carbon Monoxide Poisoning. Disaster Med Public Health Prep. 2024 Sep 18;18:e126. doi: 10.1017\/dmp.2024.135.<\/li>\n\n\n\n
  5. Demirel I, Gulen M, Satar S, Acehan S, Balta A, Oguz P. STEMI\u00a0and Air Pollution: Relationship Between Hourly Air Pollution and Cardiovascular Risk Factors. Journal of Cardiovascular Medicine (2025-Ahead of Print)<\/li>\n\n\n\n
  6. Farrow, A., Miller, K. A., & Myllyvirta, L. (2020). Toxic air: The price of fossil fuels. <\/em>Greenpeace Southeast Asia. Retrieved March 19, 2023, from https:\/\/www. green peace. org\/ south easta sia\/ publi cation\/ 3603\/toxic- air- the- price- of- fossil- fuels- full- report\/<\/li>\n\n\n\n
  7. EPA. (2022). Particulate matter (PM) pollution<\/em>. EPA. https:\/\/ www. epa. gov\/ pm- pollu tion\/ parti culate- matterpm-basics. Accessed 29 Mar 2023.<\/li>\n\n\n\n
  8. Kara Y, \u015eevik SEY, Toros H. Comprehensive analysis of air pollution and the influence of meteorological factors: a case study of adiyaman province. Environ Monit Assess. 2024 May 9;196(6):525. doi: 10.1007\/s10661-024-12649-4.<\/li>\n\n\n\n
  9. GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 18;403(10440):2162-2203. doi: 10.1016\/S0140-6736(24)00933-4. Erratum in: Lancet. 2024 Jul 20;404(10449):244. doi: 10.1016\/S0140-6736(24)01458-2.<\/li>\n\n\n\n
  10. Claeys MJ, Rajagopalan S, Nawrot TS, Brook RD (2016) Climate and environmental triggers of acute myocardial infarction. Eur Heart J 38(13):955\u2013960<\/li>\n\n\n\n
  11. Bind MA, Baccarelli A, Zanobetti A, Tarantini L, Suh H, et al. Air pollution and markers of coagulation, inflammation, and endothelial function: associations and epigene-environment interactions in an elderly cohort. Epidemiology. 2012 Mar;23(2):332-40. doi: 10.1097\/EDE.0b013e31824523f0.<\/li>\n\n\n\n
  12. Li J, Liu C, Cheng Y, Guo S, Sun Q, et al. \u00a0Association between ambient particulate matter air pollution and ST-elevation myocardial infarction: A case-crossover study in a Chinese city. Chemosphere. 2019 Mar;219:724-729. doi: 10.1016\/j.chemosphere.2018.12.094.<\/li>\n\n\n\n
  13. Bhaskaran K, Armstrong B, Hajat S, Haines A, Wilkinson P, Smeeth L. Heat and risk of myocardial infarction: hourly level case-crossover analysis of MINAP database. BMJ. 2012 Dec 13;345:e8050. doi: 10.1136\/bmj.e8050.<\/li>\n\n\n\n
  14. Bezirtzoglou E, Alexopoulos A. Ozone history and ecosystems: a goliath from impacts to advance industrial benefits and interests, to environmental and therapeutical strategies. In: Ozone Depletion, Chemistry and Impacts. (2009). p. 135\u201345.<\/li>\n\n\n\n
  15. WHO. Health Risks of Ozone From Long-Range Transboundary Air Pollution. http:\/\/www.euro.who.int\/data\/assets\/pdf_file\/0005\/78647\/E91843.pdf<\/li>\n\n\n\n
  16. Hatch GE, Slade R, Harris LP, McDonnell WF, Devlin RB, Koren HS, et al. Ozone dose and effect in humans and rats. A comparison using oxygen- 18 labeling and bronchoalveolar lavage. Am J Respir Crit Care Med. (1994) 150:676\u201383. doi: 10.1164\/ajrccm.150.3.8087337.<\/li>\n\n\n\n
  17. McCarthy JT, Pelle E, Dong K, Brahmbhatt K, Yarosh D, Pernodet N. Effects of ozone in normal human epidermal keratinocytes. Exp Dermatol. (2013) 22:360\u20131. doi: 10.1111\/exd.12125 ) (24 Lippmann M. Health effects of ozone. A critical review. JAPCA. (1989) 39:672\u201395. doi: 10.1080\/08940630.1989.10466554.<\/li>\n\n\n\n
  18. Richmont-Bryant J, Owen RC, Graham S, Snyder M, McDow S, Oakes M, et al. Estimation of on-road NO2 concentrations, NO2\/NOX ratios, and related roadway gradients from near-road monitoring data. Air Qual Atm Health. (2017) 10:611\u201325. doi: 10.1007\/s11869-016-0455-7.<\/li>\n\n\n\n
  19. Hesterberg TW, Bunn WB, McClellan RO, Hamade AK, Long CM, Valberg PA. Critical review of the human data on short-term nitrogen dioxide (NO2) exposures: evidence for NO2 no-effect levels. Crit Rev Toxicol. (2009) 39:743\u201381. doi: 10.3109\/10408440903294945.<\/li>\n\n\n\n
  20. Chen T-M, Gokhale J, Shofer S, Kuschner WG. Outdoor air pollution: nitrogen dioxide, sulfur dioxide, and carbon monoxide health effects. Am J Med Sci. (2007) 333:249\u201356. doi: 10.1097\/MAJ.0b013e31803b900f.<\/li>\n\n\n\n
  21. US EPA. Table of Historical SO2 NAAQS, Sulfur US EPA. Available online at: https:\/\/www3.epa.gov\/ttn\/naaqs\/standards\/so2\/s_so2_history.html (accessed on October 5, 2019)).<\/li>\n\n\n\n
  22. National ambient air quality objectives for carbon monoxide: desirable, acceptable and tolerable levels. Ottawa: Environment Canada and Health Canada. 1994. Available: http:\/\/publications.gc.ca\/Collection\/En42-17-8-1994 E.pdf.<\/li>\n\n\n\n
  23. Campbell ME, Benson BA, Muir MA. Urban air quality and human health: a Toronto perspective. Can J Public Health. 1995;86:351\u20137.<\/li>\n\n\n\n
  24. Lin CM, Liao CM. Temperature-dependent association between mortality rate and carbon monoxide level in a subtropical city: Kaohsiung, Taiwan. Int J Environ Health Res. 2009;19(3):163-174. doi:10.1080\/09603120802460384.<\/li>\n\n\n\n
  25. Dennekamp M, Akram M, Abramson MJ, et al. Outdoor air pollution as a trigger for out-of-hospital cardiac arrests. Epidemiology. 2010;21(4):494-500. doi:10.1097\/EDE.0b013e3181e093db.<\/li>\n\n\n\n
  26. Ruan HL, Deng WS, Wang Y, et al. Carbon monoxide poisoning: a prediction model using meteorological factors and air pollutant. BMC Proc. 2021;15(Suppl 1):1. Published 2021 Mar 2. doi:10.1186\/s12919-021-00206-7.<\/li>\n\n\n\n
  27. Gijsenbergh FP, Vispoel M, Poppe H, Delooz HH. Weather influence on the prevalence of carbon monoxide intoxications. Acta Clin Belg Suppl. 1990;13: 96\u20137.<\/li>\n\n\n\n
  28. Hampson NB, Piantadosi CA, Thom SR, Weaver LK. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med. 2012;186:1095\u2013101.).\u00a0<\/li>\n\n\n\n
  29. Onbas\u0131 D. (2024) Earthquake and air pollution. Health in Extraordinary Situations: Earthquake. Editor: Ogenler O, Yapici G, Okuyaz S, Bola\u00e7 F. Afyonkarahisar, Yaz Publications, E_ISBN 978-625-6642-22-5.<\/li>\n\n\n\n
  30. Zanoletti A, Bontempi E. The impacts of earthquakes on air pollution and strategies for mitigation: a case study of Turkey. Environ Sci Pollut Res Int. 2024,Apr;31(16):24662-24672. doi: 10.1007\/s11356-024-32592-8.<\/li>\n\n\n\n
  31. Gulen M, Satar S, Sabak M, Acehan S, Yavuz E, Bozkurt M, Gurbuz M, Polat M, Gedik MS, Akba\u015f I, Aytekin T, Koca AN, Nogay S, Esen CI.\u00a0 Karbon Monoksit Zehirlenmesi ile Hava Kirlili\u011fi Aras\u0131ndaki \u0130li\u015fki: 6 \u015eubat Depreminden Etkilenen \u0130llerde \u0130lk Y\u0131l\u0131n Sonunda Yap\u0131lan \u00c7ok Merkezli \u00c7al\u0131\u015fma. 20.T\u00fcrkiye Acil T\u0131p Kongresi (TATKON), S\u00f6zl\u00fc Bildiri, 14-17 Kas\u0131m 2024-Antalya.<\/li>\n\n\n\n
  32. Hsu SC, Huang YT, Huang JC, Tu JY, Engling G, Lin CY, Lin FJ, Huang CH. Evaluating real-time air-quality data as earthquake indicator. Sci Total Environ. 2010,May 1;408(11):2299-304. doi: 10.1016\/j.scitotenv.2010.02.023.<\/li>\n\n\n\n
  33. Bayram H, Rastgeldi Dogan T, \u015eahin \u00dcA, Akdis CA. Environmental and health hazards by massive earthquakes. Allergy. 2023,Aug;78(8):2081-2084. doi: 10.1111\/all.15736.<\/li>\n\n\n\n
  34. Uprety A, Ozaki A, Higuchi A, Leppold C, Tanimoto T. The 2015 Nepal earthquake and worsening air pollution in Kathmandu. Lancet Planet Health. 2019,Jan;3(1):e8-e9. doi: 10.1016\/S2542-5196(18)30247-X.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Sabah i\u015fe yeti\u015fmek i\u00e7in evden \u00e7\u0131k\u0131yorsunuz. D\u0131\u015far\u0131da g\u00f6zle g\u00f6r\u00fcl\u00fcr bir sis yok, ama havada yo\u011fun bir egzoz kokusu var. Bu, sadece rahats\u0131z…<\/p>\n","protected":false},"author":3242,"featured_media":3999,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10019,8],"tags":[27,202,10022,406,413,449],"class_list":["post-3998","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-tft","category-toxipaper","tag-acil-tip","tag-intoksikasyon","tag-tft","tag-toksikoloji","tag-toksisite","tag-zehirlenme"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3998","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/3242"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=3998"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3998\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/3999"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=3998"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=3998"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=3998"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}