Causality assessment of adverse drug reaction: A narrative review to find the most exhaustive and easy-to-use tool in post-authorization settings.

BACKGROUND: The core motive of pharmacovigilance is the detection and prevention of adverse drug reactions (ADRs), to improve the risk-benefit balance of the drug. However, the causality assessment of ADRs remains a major challenge among clinicians, and none of the available tools of causality assessment used for assessing ADRs have been universally accepted. OBJECTIVE: To provide an up-to-date overview of the different causality assessment tools. METHODS: We conducted electronic searches in MEDLINE, EMBASE, and the Cochrane database. The eligibility of each tool was screened by three reviewers. Each eligible tool was then scrutinized for its domains (the reported specific set of questions/areas used for calculating the likelihood of cause-and-effect relation of an ADR) to discover the most comprehensive tool. Finally, we subjectively assessed the tool's ease-of-use in a Canadian, Indian, Hungarian, and Brazilian clinical context. RESULTS: Twenty-one eligible causality assessment tools were retrieved. Naranjo's tool and De Boer's tool appeared the most comprehensive among all the tools, covering 10 domains each. Regarding "ease-of-use" in a clinical setting, we judged that many tools were hard to implement in a clinical context because of their complexity and/or lengthiness. Naranjo's tool, Jones's tool, Danan and Benichou's tool, and Hsu and Stoll's tool appeared to be the easiest to implement into various clinical contexts. CONCLUSION: Among the many tools identified, 1981 Naranjo's scale remains the most comprehensive and easy to use for performing causality assessment of ADRs. Upcoming analysis should compare the performance of each ADR tool in clinical settings.

Label free and high specific detection of mercury ions based on silver nano-liposome.

Herein, we report an eco-friendly, mild and one-pot approach for synthesis of silver nanoparticles via a lipopeptide biosurfactant - CHBS. The biosurfactant forms liposome vesicles when dispersed in an aqueous medium. The amino acid groups of the biosurfactant assists in the reduction of Ag(+) ions leading to the production of homogeneous silver nanoparticles, encapsulated within the liposome vesicle, as confirmed from TEM analysis. Rate of synthesis and size of particle were greatly dependent on pH and reaction temperature. Kinetic analysis suggests the involvement of an autocatalytic reaction and the observed rate constant (kobs) was found to decrease with temperature, suggesting faster reaction with increasing temperature. Furthermore, the silver nanoparticles served as excellent probes for highly selective and sensitive recognition of Hg(2+) ions. Interaction with Hg(2+) ions results in an immediate change in colour of nanoparticle solution form brownish red to milky white. With increasing Hg(2+) ions concentration, a gradual disappearance of SPR peak was observed. A linear relationship (A420/660) with an R(2) value of 0.97 was observed in the range of 20 to 100ppm Hg(2+) concentration. Hg(2+) ions are reduced to their elemental forms which thereby interact with the vesicles, leading to aggregation and precipitation of particles. The detection method avoids the need of functionalizing ligands and favours Hg(2+) detection in aqueous samples by visible range spectrophotometry and hence can be used for simple and rapid analysis.