Electronic health records (EHRs) in clinical research and platform trials: Application of the innovative EHR-based methods developed by EU-PEARL.

OBJECTIVE: Electronic Health Record (EHR) systems are digital platforms in clinical practice used to collect patients' clinical information related to their health status and represents a useful storage of real-world data. EHRs have a potential role in research studies, in particular, in platform trials. Platform trials are innovative trial designs including multiple trial arms (conducted simultaneously and/or sequentially) on different treatments under a single master protocol. However, the use of EHRs in research comes with important challenges such as incompleteness of records and the need to translate trial eligibility criteria into interoperable queries. In this paper, we aim to review and to describe our proposed innovative methods to tackle some of the most important challenges identified. This work is part of the Innovative Medicines Initiative (IMI) EU Patient-cEntric clinicAl tRial pLatforms (EU-PEARL) project's work package 3 (WP3), whose objective is to deliver tools and guidance for EHR-based protocol feasibility assessment, clinical site selection, and patient pre-screening in platform trials, investing in the building of a data-driven clinical network framework that can execute these complex innovative designs for which feasibility assessments are critically important. METHODS: ISO standards and relevant references informed a readiness survey, producing 354 criteria with corresponding questions selected and harmonised through a 7-round scoring process (0-1) in stakeholder meetings, with 85% of consensus being the threshold of acceptance for a criterium/question. ATLAS cohort definition and Cohort Diagnostics were mainly used to create the trial feasibility eligibility (I/E) criteria as executable interoperable queries. RESULTS: The WP3/EU-PEARL group developed a readiness survey (eSurvey) for an efficient selection of clinical sites with suitable EHRs, consisting of yes-or-no questions, and a set-up of interoperable proxy queries using physicians' defined trial criteria. Both actions facilitate recruiting trial participants and alignment between study costs/timelines and data-driven recruitment potential. CONCLUSION: The eSurvey will help create an archive of clinical sites with mature EHR systems suitable to participate in clinical trials/platform trials, and the interoperable proxy queries of trial eligibility criteria will help identify the number of potential participants. Ultimately, these tools will contribute to the production of EHR-based protocol design.

TransFAIR study: a European multicentre experimental comparison of EHR2EDC technology to the usual manual method for eCRF data collection.

PURPOSE: Regulatory authorities including the Food and Drug Administration and the European Medicines Agency are encouraging to conduct clinical trials using routinely collected data. The aim of the TransFAIR experimental comparison was to evaluate, within real-life conditions, the ability of the Electronic Health Records to Electronic Data Capture (EHR2EDC) module to accurately transfer from EHRs to EDC systems patients' data of clinical studies in various therapeutic areas. METHODS: A prospective study including six clinical trials from three different sponsors running in three hospitals across Europe has been conducted. The same data from the six studies were collected using both traditional manual data entry and the EHR2EDC module. The outcome variable was the percentage of data accurately transferred using the EHR2EDC technology. This percentage was calculated considering all collected data and the data in four domains: demographics (DM), vital signs (VS), laboratories (LB) and concomitant medications (CM). RESULTS: Overall, 6143 data points (39.6% of the data in the scope of the TransFAIR study and 16.9% when considering all data) were accurately transferred using the platform. LB data represented 65.4% of the data transferred; VS data, 30.8%; DM data, 0.7% and CM data, 3.1%. CONCLUSIONS: The objective of accurately transferring at least 15% of the manually entered trial datapoints using the EHR2EDC module was achieved. Collaboration and codesign by hospitals, industry, technology company, supported by the Institute of Innovation through Health Data was a success factor in accomplishing these results. Further work should focus on the harmonisation of data standards and improved interoperability to extend the scope of transferable EHR data.

Evolutionary dynamics of Usutu virus: Worldwide dispersal patterns and transmission dynamics in Europe.

Background: Usutu virus (USUV) is an emerging mosquito-borne Flavivirus, with birds as the main zoonotic reservoir. Humans are accidental hosts and mostly develop mild or even asymptomatic infections, although severe complications such as encephalitis can also arise. Detailed characterization of the pathogen's phylogenetics may offer valuable insights into the prediction and prevention of potential epidemics; however, lack of uniformity and the number of available USUV sequences worldwide hamper comprehensive investigation. Aim: The study aimed to investigate USUV spatio-temporal dispersal inter- and intracontinentally and to estimate the dynamics of viral spread within Europe. Methods: Phylogeographic and phylodynamic analyses were done using advanced phylogenetic methods implemented in Beast 1.10.4 and Beast 2.6.4 software packages. Results: Herein, we report on a new USUV isolate from Culex pipiens collected in 2019 from Serbia. The results of this research revealed two newly described intercontinental migration events of USUV from Africa to Germany in the 1970s and from Africa to the Middle East (Israel) in the late 90s. Finally, phylodynamic analysis substantiated the ongoing active expansion of USUV in Europe. Conclusion: The data would imply a high potential for further USUV expansion in Europe. Detailed phylogenetic characterization of the pathogen may offer valuable insights into prediction and prevention of potential epidemics; however, lack of uniformity and number of available USUV sequences worldwide hampers comprehensive investigation. This study draws attention to the need for upscaling USUV surveillance.

Detection of the Xanthi Chryso-like Virus in New Geographical Area and a Novel Arthropod Carrier.

Here, we report on a serendipitous finding of a chryso-like virus associated with Culex pipiens mosquitos in the course of study aimed to detect and characterize West Nile virus (WNV) circulating in mosquitos in Serbia, Southern Europe. Upon initial detection of unexpected product in a PCR protocol for partial WNV NS5 gene amplification, further confirmation and identification was obtained through additional PCR and Sanger sequencing experiments. Bioinformatic and phylogenetic analysis identified the obtained sequences as Xanthi chryso-like virus (XCLV). The finding is particular for the fact that it associates XCLV with a new potential vector species and documents a novel geographical area of its distribution.

Bilateral aplasia of the anterior cerebral artery in the presence of its vascular source: a case report.

PURPOSE: Our goal was to investigate the cases of bilateral aplasia of the anterior cerebral artery (ACA). METHODS: The macro- and microdissection of the target human brain arteries of 388 cadaveric cases was applied under the magnifying glass. Each case was photographed and diagrammatically represented in the workbook. The length and the outer diameter of the corresponding arteries on the photos were measured using a computer software program. RESULTS: There was only one case (1/388 or 0.25%) of bilateral ACA aplasia that belonged to a male adult cadaver. Except for the variations of the posterior communicating artery on one side and the basilar artery, the instance of cerebral pathology was not recorded in this case. We compared the recent case with available literature cases. CONCLUSION: Summarizing small number of literature cases, the recent case of bilateral ACA aplasia as the fifth case discovered so far, represents a true morphological rarity.

Improvement of Germination and Early Growth of Radish (Raphanus sativus L.) through Modulation of Seed Metabolic Processes.

Radish (Raphanus sativus L.) is a vegetable cultivated worldwide because of its large succulent hypocotyls. The priming method initiates metabolic processes at early stages and regulates the metabolic events in seed necessary for germination. This research was conducted to examine the influence of various priming treatments on physiological performance (germination, growth, lipid peroxidation, primary and secondary metabolism) and antioxidant activity of radish seedlings. On the basis of germination and growth characteristics, vigor index, and relative water content in leaves, it was confirmed that priming treatments with 0.01% ascorbic acid (AA) and 1% KNO3 improves the initial stages of radish development. Furthermore, the efficiency of AA as a priming agent was confirmed through the reduction of malondialdehyde (MDA) level compared to unprimed seedlings. On the other hand, hormopriming with indole-3-acetic acid (IAA) significantly increased the concentration of photosynthetic pigments and total soluble leaf proteins compared to non-primed seedlings. The highest content of total phenolic compounds, including flavonoids, were obtained after hormopriming with 1 mM IAA and halopriming with 1% MgSO4. On the basis of the percentage of inhibition of DPPH radicals, it was confirmed that treatments with IAA and AA can improve the antioxidant activity of radish seedlings. This study provides useful information regarding the possibilities of pregerminative metabolic modulation through the seed priming for the biochemical and physiological improvement of radish, and this topic should be further investigated in order to determine the potential use of AA and IAA as suitable priming agents in radish commercial production.

Vortioxetine as an analgesic in preclinical inflammatory pain models: Mechanism of action.

Vortioxetine is a novel atypical antidepressant with multimodal activity that has recently demonstrated efficacy against neuropathic pain. There is no published data about its analgesic properties in models characterized by peripheral inflammation and consequent pain pathway sensitization, nor data on its mechanism of antinociceptive action. This study aimed to investigate vortioxetine's antinociceptive/antihyperalgesic effects in trigeminal, visceral, and somatic inflammatory pain models, and provide evidence on its mechanism of action in the modulation of trigeminal nociception. Vortioxetine's effects on the nociceptive behavior in orofacial formalin test (OFT) and acetic acid-writhing test in mice and on mechanical hyperalgesia in carrageenan-induced paw inflammation in rats were examined following peroral single administration. The involvement of serotonergic/adrenergic/cholinergic/cannabinoid/adenosine receptors was evaluated in OFT by intraperitoneally treating mice with an appropriate antagonist immediately after vortioxetine application. We used antagonists of 5-HT1B/1D serotonergic (GR 127935), α1 -adrenergic (prazosin), α2 -adrenergic (yohimbine), ß1 -adrenergic (metoprolol), muscarinic (atropine), α7 nicotinic (methyllycaconitine), CB1 /CB2 cannabinoid (AM251 and AM630), and adenosine A1 (DPCPX) receptors. Vortioxetine dose-dependently reduced pain behavior in OFT and acetic acid writhing test, as well as inflammatory hyperalgesia in paw pressure test. All examined antagonists except prazosin dose-dependently inhibited vortioxetine's antinociceptive effects. In conclusion, vortioxetine exerted analgesic efficacy in trigeminal, visceral, and somatic inflammatory pain. The effect is at least in part mediated by 5-HT1B/1D serotonergic, α2 /ß1 -adrenergic, muscarinic and nicotinic cholinergic, CB1 /CB2 cannabinoid, and adenosine A1 receptors. These findings contribute to better understanding of the analgesic effect of vortioxetine and suggest its potential usefulness for inflammatory pain treatment.

Characterization of PM2.5 sources in a Belgrade suburban area: a multi-scale receptor-oriented approach.

Designated as the most harmful for health, PM2.5 aerosol fraction was a subject of our study. It was collected for all four seasons during 2014/15 in the suburban area of Belgrade (Serbia) and analysed for Al, Si, P, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Br, As, Ba and Pb elements and for NH4+, NO3- and SO42- ions by particle-induced X-ray emission and ion chromatography techniques, respectively. Obtained concentrations have been treated by a combination of several receptor-oriented models to reveal source contributions to the suburban PM2.5 at different spatial scales. Applied positive matrix factorization analysis indicated five main groups of emission sources: biomass burning (14.5%), traffic (3.9%), regional combustion/secondary sulphates (28.8%), local combustion/secondary nitrates (29.7%) and soil (5.4%). Local heating units had been pointed out as dominant contributors by long-range transport and ground-wind circulation analyses. Air masses circulating over the Balkan Peninsula denoted regional emissions as responsible for the high concentrations of secondary sulphates. Local and long-range transport analyses combined suggested that the BB and the LC/NO3 originated from the wider urban area. Several Saharan dust episodes were detected as well. Presented results might be a basis for the development of air pollution mitigation strategies in the continental Balkan area, considered one of the most polluted and under-investigated European regions.

Performances of a Solution to Semi-Automatically Fill eCRF with Data from the Electronic Health Record: Protocol for a Prospective Individual Participant Data Meta-Analysis.

Clinical trial data collection still relies on a manual entry from information available in the medical record. This process introduces delay and error risk. Automating data transfer from Electronic Health Record (EHR) to Electronic Data Capture (EDC) system, under investigators' supervision, would gracefully solve these issues. The present paper describes the design of the evaluation of a technology allowing EHR to act as eSource for clinical trials. As part of the EHR2EDC project, for 6 ongoing clinical trials, running at 3 hospitals, a parallel semi-automated data collection using such technology will be conducted focusing on a limited scope of data (demographic data, local laboratory results, concomitant medication and vital signs). The evaluation protocol consists in an individual participant data prospective meta-analysis comparing regular clinical trial data collection to the semi-automated one. The main outcome is the proportion of data correctly entered. Data quality and associated workload for hospital staff will be compared as secondary outcomes. Results should be available in 2020.

Vortioxetine reduces pain hypersensitivity and associated depression-like behavior in mice with oxaliplatin-induced neuropathy.

Chronic pain and depression commonly occur together so dual-acting agents might be particularly useful. The population of patients with chemotherapy-induced neuropathy is increasing in parallel with the increase of population of cancer survivors and there is a compelling need for satisfactory treatment of symptoms of neuropathy and concomitant depression. We examined the effects of vortioxetine, a novel antidepressant with unique mechanism of action, on pain hypersensitivity and depression-like behavior in oxaliplatin-induced neuropathy model in mice (OIPN). Vortioxetine (1-10 mg/kg, p.o.) significantly and dose-dependently reduced mechanical allodynia in von Frey test and cold allodynia in acetone test in OIPN mice, in both repeated prophylactic and acute therapeutic treatment regimens. It also reduced depression-like behavior in the forced swimming test in OIPN mice, in both treatment paradigms. Its antiallodynic and antidepressive-like effects were comparable to those exerted by duloxetine (1-15 mg/kg, p.o.). The antiallodynic and antidepressive-like effects of repeatedly administered vortioxetine might be related to the increased content of 5-hydroxytryptamine (5-HT) and noradrenaline (NA), detected in the brainstem of treated OIPN mice. These results indicate that vortioxetine could be potentially useful in prevention and treatment of chemotherapy-induced neuropathy, for the relief of pain and concomitant depressive symptoms. It should be further tested to this regard in clinical settings.

Exploring Evolutionary and Transmission Dynamics of HIV Epidemic in Serbia: Bridging Socio-Demographic With Phylogenetic Approach.

Previous molecular studies of Serbian HIV epidemic identified the dominance of subtype B and presence of clusters related HIV-1 transmission, in particular among men who have sex with men (MSM). In order to get a deeper understanding of the complexities of HIV sub-epidemics in Serbia, epidemic trends, temporal origin and phylodynamic characteristics in general population and subpopulations were analyzed by means of mathematical modeling, phylogenetic analysis and latent class analysis (LCA). Fitting of the logistic curve of trends for a cumulative annual number of new HIV cases in 1984-2016, in general population and MSM transmission group, was performed. Both datasets fitted the logistic growth model, showing the early exponential phase of the growth curve. According to the suggested model, in the year 2030, the number of newly diagnosed HIV cases in Serbia will continue to grow, in particular in the MSM transmission group. Further, a detailed phylogenetic analysis was performed on 385 sequences from the period 1997-2015. Identification of transmission clusters, estimation of population growth (Ne), of the effective reproductive number (Re) and time of the most recent common ancestor (tMRCA) were estimated employing Bayesian and maximum likelihood methods. A substantial proportion of 53% of subtype B sequences was found within transmission clusters/network. Phylodynamic analysis revealed Re over one during the whole period investigated, with the steepest slopes and a recent tMRCA for MSM transmission group subtype B clades, in line with a growing trend in the number of transmissions in years approaching the end of the study period. Contrary, heterosexual clades in both studied subtypes - B and C - showed modest growth and stagnation. LCA analysis identified five latent classes, with transmission clusters dominantly present in 2/5 classes, linked to MSM transmission living in the capital city and with the high prevalence of co-infection with HBV and/or other STIs.Presented findings imply that HIV epidemic in Serbia is still in the exponential growth phase, in particular, related to the MSM transmission, with estimated steep growth curve until 2030. The obtained results imply that an average new HIV patient in Serbia is a young man with concomitant sexually transmitted infection.

High Frequency of Human Leukocyte Antigen-B*57:01 Allele Carriers among HIV-Infected Patients in Serbia.

Abacavir is an effective antiretroviral drug and one of the most commonly used nucleoside reverse transcriptase inhibitors in Serbia. А percentage of the treated patients experience a potentially life-threatening hypersensitivity reaction, which was shown to be associated with the presence of the class I MHC allele, HLA-B*57:01; hence genotyping for HLA-B*57:01 prior to starting abacavir is nowadays recommended in international HIV treatment guidelines. In Serbia, this testing became available in 2013. This study was designed to estimate the prevalence of the HLA-B*57:01 allele in Serbian HIV-1-infected patients. The presence of the HLA-B*57:01 allele was analyzed in 273 HIV-1-infected patients aged 18 years or more, who were abacavir naïve. Buccal swab samples were obtained from all participants and assayed for the presence of HLA-B*57:01 using a commercially available HLA-B*57:01 real-time PCR kit. The presence of the HLA-B*57:01 allele was found in 22 of 273 tested individuals (8%; 95% CI 5.4-11.9%). This is the first study that estimated the HLA-B*57:01 prevalence among HIV-infected patients in Serbia. The very high prevalence of HLA-B*57:01 found in our study strongly supports HLA-B*57:01 genotyping, which should be implemented prior to the initiation of an abacavir-containing therapy to reduce the risk of potentially life-threatening hypersensitivity reactions.

Forensic application of phylogenetic analyses - Exploration of suspected HIV-1 transmission case.

Transmission of human immunodeficiency virus (HIV) between individuals may have important legal implications and therefore may come to require forensic investigation based upon phylogenetic analysis. In criminal trials results of phylogenetic analyses have been used as evidence of responsibility for HIV transmission. In Serbia, as in many countries worldwide, exposure and deliberate transmission of HIV are criminalized. We present the results of applying state of the art phylogenetic analyses, based on pol and env genetic sequences, in exploration of suspected HIV transmission among three subjects: a man and two women, with presumed assumption of transmission direction from one woman to a man. Phylogenetic methods included relevant neighbor-joining (NJ), maximum likelihood (ML) and Bayesian methods of phylogenetic trees reconstruction and hypothesis testing, that has been shown to be the most sensitive for the reconstruction of epidemiological links mostly from sexually infected individuals. End-point limiting-dilution PCR (EPLD-PCR) assay, generating the minimum of 10 sequences per genetic region per subject, was performed to assess HIV quasispecies distribution and to explore the direction of HIV transmission between three subjects. Phylogenetic analysis revealed that the viral sequences from the three subjects were more genetically related to each other than to other strains circulating in the same area with the similar epidemiological profile, forming strongly supported transmission chain, which could be in favour of a priori hypothesis of one of the women infecting the man. However, in the EPLD based phylogenetic trees for both pol and env genetic region, viral sequences of one subject (man) were paraphyletic to those of two other subjects (women), implying the direction of transmission opposite to the a priori assumption. The dated tree in our analysis confirmed the clustering pattern of query sequences. Still, in the context of unsampled sequences and inherent limitations of the applied methods, we cannot unambiguously prove that HIV-1 transmission occurred directly between two individuals. Further exploration of the known and suspected transmission cases is needed in order to define methodologies and establish their reliability.

Can we do better? Economic analysis of human resource investment to improve home care service for the elderly in Serbia.

BACKGROUND: Social services aimed at the elderly are facing great challenges caused by progressive aging of the global population but also by the constant pressure to spend funds in a rational manner. PURPOSE: This paper focuses on analyzing the investments into human resources aimed at enhancing home care for the elderly since many countries have recorded progress in the area over the past years. The goal of this paper is to stress the significance of performing an economic analysis of the investment. METHODS: This paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method. RESULTS: The economic analysis of investing in human resources for home care service in Serbia showed that the both scenarios of investing in either additional home care hours or more beneficiaries are cost-efficient. However, the optimal solution with the positive (and the highest) value of economic net present value criterion is to invest in human resources to boost the number of home care hours from 6 to 8 hours per week and increase the number of the beneficiaries to 33%. CONCLUSION: This paper shows how the statistical and economic analysis results can be used to evaluate different scenarios and enable quality decision-making based on exact data in order to improve health and quality of life of the elderly and spend funds in a rational manner.

Assessment of PM10 pollution level and required source emission reduction in Belgrade area.

The aim of this study was to assess PM10 pollution level and estimate required source emission reduction in Belgrade area, the second largest urban center in the Balkans. Daily mass concentrations and trace metal content (As, Cd, Cr, Mn, Ni, Pb) of PM10 were evaluated for three air quality monitoring sites of different types: urban-traffic (Slavija), suburban (Lazarevac) and rural (Grabovac) under the industrial influence, during the period of 2012-13. Noncompliance with current Air Quality Standards (AQS) was noticeable: annual means were higher than AQS at Slavija and Lazarevac, and daily frequency threshold was exceeded at all three locations. Annual means of As at Lazarevac were about four times higher than the target concentration, which could be attributed to the proximity of coal-fired power plants, and dust resuspension from coal basin and nearby ash landfills. Additionally, levels of Ni and Cr were significantly higher than in other European cities. Carcinogenic health risk of inhabitants' exposure to trace metals was assessed as well. Cumulative cancer risk exceeded the upper limit of acceptable US EPA range at two sites, with Cr and As as the major contributors. To estimate source emission reduction, required to meet AQS, lognormal, Weibull and Pearson 5 probability distribution, functions (PDF) were used to fit daily PM10 concentrations. Based on the rollback equation and best fitting PDF, estimated reduction was within the range of 28-98%. Finally, the required reduction obtained using two-parameter exponential distribution suggested that risks associated to accidental releases of pollutants should be of greater concern.

Economic analysis of social services for the elderly in Serbia: two sides of the same coin.

According to demographic trends, the ratio of senior citizens in the overall population of the Republic of Serbia is rising. This generates the need to create socially acceptable and economically sustainable models for the protection of the elderly. The goal of this paper is to stress the necessity of analyzing and evaluating the efficiency of social protection services aimed at senior citizens. The first part of the paper underlines the need for economic analysis of these services; while the second part features the analysis of the two most frequently provided services for the elderly in Serbia: admission to social protection institutions and home care for senior citizens. Based on the research results, the paper also provides a comparative overview of the efficiency of the services mentioned. This overview clearly confirms that both services prove to be economically justifiable from a social perspective; nevertheless, it also indicates that the cost of home care per user is considerably lower than the cost of putting a senior citizen into a nursing home. After presenting and discussing the results of the studies, the paper also offers recommendations aimed at enhancing the development and sustainability of the social protection system for the elderly in Serbia.

Kinetic method for the determination of traces of thyroxine by its catalytic effect on the Mn(III) metaphosphate-As(III) reaction.

A new, highly sensitive and simple kinetic method for the determination of thyroxine was proposed. The method was based on the catalytic effect of thyroxine on the oxidation of As(III) by Mn(III) metaphosphate. The kinetics of the reaction was studied in the presence of orthophosphoric acid. The reaction rate was followed spectrophotometrically at 516 nm. It was established that orthophosphoric acid increased the reaction rate and that the extent of the non-catalytic reaction was extremely small. A kinetic equation was postulated and the apparent rate constant was calculated. The dependence of the reaction rate on temperature was investigated and the energy of activation and other kinetic parameters were determined. Thyroxine was determined under the optimal experimental conditions in the range 7.0 x 10(-9) to 3.0 x 10(-8) mol L(-1) with a relative standard deviation up to 6.7% and a detection limit of 2.7 x 10(-9) molL(-1). In the presence of 0.08 mol L(-1) chloride, the detection limit decreased to 6.6 x 10(-10) mol L(-1). The proposed method was applied for the determination of thyroxine in tablets. The accuracy of the method was evaluated by comparison with the HPLC method.

Electrochemical behavior and antioxidant and prooxidant activity of natural phenolics.

We have investigated the electrochemical oxidation of a number natural phenolics (salicylic acid, m-hydroxybenzoic acid, p-hydroxybenzoic acid, protocatechuic acid, o-coumaric acid, m-coumaric acid, p-coumaric acid, caffeic acid, quercetin and rutin) using cyclic voltammetry. The antioxidant properties of these compounds were also studied. A structural analysis of the tested phenolics suggests that multiple OH substitution and conjugation are important determinants of the free radical scavenging activity and electrochemical behavior. Compounds with low oxidation potentials (Epa lower than 0.45) showed antioxidant activity, whereas compounds with high Epa values (>0.45) act as prooxidants.

Compounds of Mo, V and W in biochemistry and their biomedical activity.

Molybdenum, vanadium and tungsten compounds are widely applied as analytical reagents for determination of numerous pharmacologically active substances and different biochemical parameters. Recent data from the available literature pointed to a very potent biomedical activity of compounds containing these trace elements. The present paper represents a survey on the structure and chemical properties of these compounds, as well as on their biological activity, mostly based on their interaction with cations of biomolecules, such as phospholipids and proteins. Besides, their potent inhibitory effects on cellular targets, bacterial and viral DNA and RNA polymerases will be discussed, as well. Numerous authors clearly demonstrated the antiviral (especially anti-HIV), anticoagulant and antineoplastic properties of the compounds containing the above trace elements. It has been also shown that these compounds act on some cellular enzymatic systems leading to the normalisation of blood pressure, blood glucose and serum lipid levels. Also, compounds of these trace elements represent potent antiobesity agents and express hepatoprotective and antioxidative stress activity.