Changing of Trace Element, Homocysteine, Oxidative Stress Parameters and Physical Activity Levels in Covid-19

Since December 2019, the new severe acute respiratory syndrome coronavirus 2, called
SARS-CoV-2, has spread rapidly to almost every country that causes coronavirus disease-19
(COVID-19) pneumonia. Currently, there is no specific treatment for COVID-19 with proven
safety and effectiveness. In order to find an effective treatment for this disease, more than
100 randomized controlled trials are currently being conducted with many drugs, some of them
are expected to be announced in the coming months. It is known that the use of treatment
options within the framework of randomized controlled studies and based on information
obtained from other scientific studies is more rational. However, due to the urgency of the
current situation and the limited scientific data, treatment options with limited data on
their effectiveness are widely used for these patients all over the world. As in general of
viral infections, the data obtained from SARS and influenza suggest that early initiation of
antiviral treatment is more beneficial, and antiviral drugs should be started as early as
possible. The combined use of possible treatment options in COVID-19 patients should be
considered on a patient-specific basis and by evaluating all the relevant literature, and
attention should be paid to the interactions and adverse effects of the drugs used.

Since it will take a long time to find a treatment specific to COVID-19, during the current
pandemic, drugs such as hydroxychloroquine, favipiravir, remdesivir, lopinavir-ritonavir,
which have been previously licensed for the treatment of other diseases in humans, have been
widely used in these indications, have been shown to be safe and are effective in SARS CoV-2
in vitro, have been recommended and used. Numerous studies are still ongoing on the efficacy
and safety of these drugs in COVID-19.

The clinical picture of COVID-19 can be heterogeneous, ranging from asymptomatic to severe
disease, which can be associated with a cytokine storm. The pathogenesis of COVID-19 is not
fully understood, but is likely multifactorial and, in severe cases, with a systemic
hyperinflammatory response and associated thromboembolic complications.

It may be beneficial for patients infected with COVID-19 due to the anti-inflammatory and
antioxidant properties of certain vitamins and nutrients. Vitamins such as A, B, C, D, E and
folate and trace elements such as iron, zinc, magnesium, selenium and copper play important
roles in supporting both innate and adaptive immune systems.

High plasma homocysteine levels significantly increase the incidence of vascular damage in
both small and large vessels. Concentrations above the 90th percentile are associated with an
increased risk of degenerative and atherosclerotic processes in the coronary, cerebral and
peripheral circulatory systems. Although homocysteine is an effective cardiovascular risk
biomarker and is critical for cardiovascular complications in hospitalized COVID-19 patients,
studies on this parameter have not focused much on laboratory markers useful for clinical
evaluation of COVID-19.

Free radicals are continuously formed at the active site of enzymes as intermediates in
enzymatic reactions occurring during cell metabolism. Reactive oxygen species and reactive
nitrogen, known as intermediates, sometimes leach from the active site of enzymes and
accidentally interact with molecular oxygen and form free oxygen radicals. Lipids, proteins,
enzymes, carbohydrates, and DNA can be damaged due to oxidative stress, random breaks and
bonds in DNA chains may occur as a result of damage to membranes, damage to enzymes and
structural proteins may result in cell death, and these phenomena constitute the molecular
basis in the development of cancer, neurodegenerative and cardiovascular diseases, diabetes
and autoimmune disorders.

The general recommendation for thinking that an adult is physically active is to achieve at
least 150 minutes of moderate or 75 minutes of vigorous vigorous activity per week, or an
equivalent combination of both, and involving sedentary behavior, energy expenditure ≤ 1.5
metabolic equivalent (MET), while lying down, leaning, It is defined as any waking behavior
practiced while sitting or standing. As the disease spreads all over the world, healthy
people are asked to stay at home for a long time. As a result, COVID-19 has radically changed
the determinants of both behaviors (individual, interpersonal, environmental, regional or
national policies and global). Accordingly, it can be said that regular and joint activities
decrease due to isolation and limitations, especially in the first weeks when the population
has limited chances to find alternatives to keep active even at home, and reducing sedentary
behavior during closure poses a significant challenge. Because of this situation, physical
activity in the home environment is strongly encouraged by public health advocates to prevent
the potential harmful effects of protective lifestyle regulations due to COVID-19 and to
prevent the restrictions from causing physical inactivity.

The purpose of this study is to compare the trace element, homocysteine, oxidative stress
parameters and physical activity levels before and after COVID-19 treatment according to the
COVID-19 treatment guide published by Ministry of Health, Republic of Turkey.