Alternative Agent In Patients Research Articles

Investigation of Cajuput and Lemongrass Essential Oils Supplemented in Alcohol-Free Mouthwash: Anti-Inflammation on Human Gingival Fibroblast Cells In Vitro

Alcohol-free mouthwash containing essential oils is a helpful adjunct to self-performed oral hygiene of patients with periodontal disease due to its antimicrobial and anti-inflammatory properties. This study aimed to investigate the anti-inflammatory activity of cajuput and lemongrass essential oils supplemented in alcohol-free mouthwash on human gingival fibroblast cells and RAW 264.7 macrophages, which were incubated in a complete medium. In the current in vitro study, 3 types of mouthwash, including 12 % (v/v) alcohol-free mouthwash, 0.8 % (v/v) cajuput essential oil and 0.4 % (v/v) lemongrass essential oil supplemented in alcohol-free mouthwash, and 0.12 % chlorhexidine mouthwash, were evaluated. All 3 types were determined for cytotoxicity by MTT assay. The sub-IC50 concentration of each mouthwash was calculated to investigate anti-inflammatory activities via the inhibition of lipopolysaccharide-activated nitric oxide production, cyclooxygenases-2, interleukin-1β and interleukin-6 gene expression. The wound healing rate was determined by scratch assay. The results demonstrated that the sub-IC50 concentrations of essential oils in 0.8 % (v/v) cajuput essential oil and 0.4 % (v/v) lemongrass essential oil supplemented in alcohol-free mouthwash significantly inhibited nitric oxide production in lipopolysaccharide-activated RAW 264.7 macrophages and reduced the gene expression of cyclooxygenases-2, interleukin-1β and interleukin-6 in lipopolysaccharide-activated human gingival fibroblast cells, while stimulating the migration of human gingival fibroblast cells, similar to the sub-IC50 concentration of 0.12 % chlorhexidine mouthwash. These findings suggested that essential oils contained in this mouthwash formula exhibited an anti-inflammatory effect and promoted oral wound healing, which might be used as an alternative agent for patients with periodontal disease. HIGHLIGHTS Cajuput and lemongrass essential oils supplemented in alcohol-free mouthwash expressed anti-inflammatory activity by inhibiting nitric oxide production in LPS-activated RAW 264.7 macrophages and reducing COX-2, IL-6 and IL-1β expression in LPS-activated HGFs, as well as by promoting oral wound healing, similar to chlorhexidine mouthwash, which is a common, well-known agent in dental treatment Our findings suggested that this novel mouthwash may be an alternative agent in preventing oral inflammatory diseases, especially periodontal disease GRAPHICAL ABSTRACT

Type 2 diabetes in youth: Rationale for use of off-label antidiabetic agents.

Dr. Kelsey has been a site PI for clinical trials related to youth-onset type 2 diabetes sponsored by Janssen, Boehringer-Ingelheim, Merck, and Daiichi-Sankyo; Dr. Zeitler has been site PI for clinical trials related to youth-onset type 2 diabetes sponsored by Janssen and is a consultant on research design and oversight for clinical trials related to youth-onset type 2 diabetes sponsored by Janssen, Merck, Daiichi-Sankyo, Boehringer-Ingelheim, Novo-Nordisk, and Eli Lilly. Dr. Shah has been a site PI for clinical trials related to youth-onset type 2 diabetes sponsored by Takeda, Daiichi-Sankyo, and Eli Lilly; Dr. Nadeau does not have any conflicts of interest to disclose. The peer review history for this article is available at https://publons.com/publon/10.1111/pedi.13350. Data sharing is not applicable to this article as no new data were created or analyzed in this study. FIGURE S1: The supplementary figure provides a more detailed suggested algorithm for medication adjustment, based on the ST2OMP treatment algorithms, with each panel representing a different in-clinic scenario at the time of HbA1c measurement: (a) Patient has been on metformin monotherapy for at least 2 months. Of note, the threshold for starting insulin is higher in these patients due to a greater opportunity to achieve glycemic control by adding multiple non-insulin agents; (b) Patient is prescribed metformin and one additional non-insulin agent; (c) Patient is prescribed metformin and 2 other non-insulin agents; (d) Patient is prescribed metformin, 2 or more non-insulin agents, and insulin; (e) Patient is being treated for presumed type 1 diabetes based on presentation and has a revised diagnosis of type 2 diabetes. Of note, it is critical to assess adherence and reinvigorate current treatment if suspicion that doses are being missed prior to adding new agents, with the exception that insulin needs to be added regardless of adherence if evidence of metabolic decompensation. Also, we recommend to schedule for a nurse certified diabetes educator visit for patients with HbA1c ≥ 11% 1 month after insulin is added. Second tier agent considerations: GLP-1 agonist (liraglutide, exenatide, exenatide XR, dulaglutide, semaglutide): Consider if patient is overweight and/or needs appetite suppression. Caution if history of pancreatitis or family history of medullary thyroid carcinoma. Thiazolidinedione (pioglitazone): TODAY study outcomes suggest better glycemic outcomes in girls than boys when thiazolidinediones are used as add-on to metformin. There is evidence for improvement of NAFLD with pioglitazone. Discuss risks for edema, especially if on insulin. SGLT2 inhibitor (canagliflozin, empagliflozin, dapagliflozin, ertugliflozin): Consider if daytime/post-prandial hyperglycemia. Caution in patients with low reliability or metabolic decompensation due to risk for euglycemic diabetic ketoacidosis.2 If well-tolerate and insurance allows, consider switching to SGLT2i-metformin combination medication. Caution in patients with history of chronic/recurrent UTI. DPP-4 inhibitor (sitagliptin, saxagliptin, linagliptin): Little utility unless required as 2nd line by insurance. Long-acting insulins: Detemir, glargine, degludac, NPH, if insurance does not cover others. Rapid-acting insulins: Aspart, lispro, regular if insurance does not cover others. aPioglitazone can be used as alternative agent for patients not tolerating metformin; bIn absence of significant adverse effects, new agent should be titrated up each visit to maximal dose; cThese agents would typically be added sequentially, 3 months apart; d Patients with HbA1c ≥11% will also be scheduled for a CDE visit 1 month after insulin is added. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

In vitro activity of ceftazidime-avibactam against Gram-negative isolates collected in 18 European countries, 2015–2017

BackgroundBetween 2015–2017, 21 850 Enterobacterales isolates and 6156 Pseudomonas aeruginosa (P. aeruginosa) isolates were collected by 77 centers in 18 European countries as part of the International Network for Optimal Resistance Monitoring (INFORM) study (which was included into the Antimicrobial Testing Leadership and Surveillance [ATLAS] study in 2018). MethodsA central reference laboratory performed antimicrobial susceptibility testing using broth microdilution panels according to Clinical and Laboratory Standards Institute guidelines. The presence of β-lactamases was confirmed using multiplex PCR assays. ResultsAmong Enterobacterales isolates, the highest rates of susceptibility were to ceftazidime-avibactam (99.0%; MIC90 0.5 mg/L), meropenem (96.3%), amikacin (95.2%), and imipenem (92.8%). All Enterobacterales organisms were highly susceptible to colistin (≥ 94.6%), apart from Proteus mirabilis, which is intrinsically resistant to colistin. Susceptibility rates among ceftazidime-resistant isolates were 95.7% for ceftazidime-avibactam and 87.9% for colistin, and 78.5% and 71.1%, respectively, among carbapenemase-positive isolates. Colistin was the only agent with activity against metallo-β-lactamases (100% susceptibility) among Enterobacterales and P. aeruginosa isolates. Overall susceptibility rates among P. aeruginosa were highest to colistin (99.5%) and ceftazidime-avibactam (92.3%), and were similar to ceftazidime-resistant isolates for colistin (98.9%) and reduced to 66.2% for ceftazidime-avibactam. Susceptibility rates among multidrug-resistant P. aeruginosa isolates were 98.9% to colistin and 71.7% to ceftazidime-avibactam. ConclusionsClinical isolates of Enterobacterales and P. aeruginosa collected from Europe, between 2015–2017, were highly susceptible to ceftazidime-avibactam, suggesting it is a useful alternative agent for patients whose treatment options may be limited. Persistent antimicrobial resistance requires continued surveillance and monitoring.

Genotyping and resistance genes of Enterococcus faecalis isolated from different food sources in Egypt

Enterococcus species are considered as a major etiological agent of nosocomial infections, they are commonly isolated from different sources of food. So, this study was conducted for detection of Enterococcus spp., from (10 fish samples, 30 herbs samples, 20 drinking water samples, 30 dairy products samples, and 20 meat products samples) from Cairo Governorate, Egypt. The results revealed that from 110 food samples analyzed 11.8% were positive for Enterococci, E. faecalis was detected by percentage 53.8%. All E. faecalis isolates were resistant to vancomycin (100%), erythromycin (57.1%), ciprofloxacin (14.3%), chloramphenicol (42.9%), tetracycline (57.1%), while none of the E. faecalis isolates were resistant to ampicillin, penicillin or norfloxacin. PCR was done for detection of some antibiotic resistant genes (mphC, norA, tetK, floR, vanA). Genotypic characterization revealed that tetK and floR genes were present in the all 7 E. faecalis isolates. While, vanA gene was detected in 3 isolates, and mphC gene was detected only in 2 isolates. The results of our investigation indicated high levels of contamination with multi resistant E. faecalis strains of serious concern with the isolation of strains resistant to vancomycin, considering that vancomycin is the alternative agent for patients who are intolerant to penicillin or who have Enterococci infections with high level resistance to penicillin.

Potential Molecular Targets and Drugs for Treatment of Hepatocellular Carcinoma

Hepatocellular Carcinoma (HCC) is a common type of primary liver cancer. According to the recent world cancer report, the disease ranked as the sixth most common cancer worldwide and the third largest cause of cancer-related death. Deregulation of numerous signaling pathways have been implicate in pathogenesis of HCC, including IGF, EGF/TGF, HGF/cMet, WNT, Hedgehog, notch, hippo, VEGF, PDGF, and FGF. Besides, intracellular mediators such as MAPK and PI3K/AKT/mTOR play a role in HCC development and progression. Currently sorafenib is the only molecularly targeted drug available to treat advanced HCC. It only extends survival by a matter of months. Moreover, there is no alternative agent for patients progressing under treatment with sorafenib. Thus, there remains a critical need for both continued molecular characterization and aggressive drug development. This review provided and updated appraisal of the deregulated signaling and epigenetic pathways, targeted therapeutics that is being investigated and possible challenges in drug development for HCC.

The role of Aflibercept in the management of age-related macular degeneration

ABSTRACTIntroduction: During the past decade, significant advances have occurred in the management of neovascular age-related macular degeneration (NV-AMD). The advent of anti-vascular endothelial growth factor (anti-VEGF) therapy has shifted the treatment goal of NV-AMD from merely salvaging vision to improving visual acuity and maintaining a good quality of life. Aflibercept (AFL) is a significant addition to the arsenal of anti-VEGF therapies against the NV-AMD. In the index review, pharmacology and efficacy of AFL has been reviewed.Areas Covered: An extensive literature search was performed to identify preclinical and clinical studies performed to illustrate the role of AFL in NV-AMD. Randomized clinical trials evaluating other anti-VEGF agents were also included for comparison. Additionally, studies where AFL was employed to treat anti-VEGF-resistant cases agents have been reviewed.Expert Opinion: AFL is an effective agent in the management of NV-AMD and its efficacy has been found to be comparable to ranibizumab (RBZ). Additionally, AFL is a good alternative agent in patients with NV-AMD resistant to RBZ and bevacizumab (BVZ), and can potentially lessen the treatment burden. As more research is conducted, the role of AFL in varying dosing regimens, as monotherapy and in combination with other agents, will become further defined.

Melphalan: A Promising Agent in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become an option for peritoneal carcinomatosis (PC). Frequently, these patients have failed systemic chemotherapies and surgeries, including CRS/HIPEC with traditional regimens (mitomycin-C or platinum based). An alternative agent for failed or repeated CRS/HIPEC is unknown. We hypothesize that melphalan is an alternative agent in patients with PC from aggressive primaries, including recurrences following failed regional therapies. A retrospective review of a prospective database of 247 patients revealed 25 patients (9 male and 16 female) who received intraperitoneal melphalan (50 mg/m(2)) in 31 CRS/HIPEC procedures, of which 19 were repeated. Primary malignancies included 17 appendiceal, one colorectal, two ovarian, two uterine sarcomas, two primary peritoneal and one mesentery sarcoma. PC index (PCI) was ≥20 in 76 % of patients (19/25). 88 % of patients (22/25) had complete cytoreduction. Seventeen patients were alive, with mean survival of 63.6 months, and eight patients are deceased. Overall survival (OS) for the entire group since diagnosis was 95.8, 84.5, 50.9, and 38.2 % at 1, 3, 5, and 10 years, respectively; OS since melphalan HIPEC was 89.4, 45, and 30 % at 1, 3, and 5 years, respectively; and OS in patients with appendiceal malignancies was 91.7, 48.1 and 32.1 % at 1, 3 and 5 years, respectively. There was no postoperative mortality. Grade III-IV morbidity was 23 % (7/31). Nine patents had neutropenia, controlled with filgrastim. Melphalan is an efficacious alternative agent in patients undergoing CRS/HIPEC for aggressive and recurrent peritoneal surface malignancies. Its postoperative significant myelosuppression effect should be addressed.

243 Potential cross-reactivity between prasugrel and other antiplatelet agents

BackgroundPrasugrel is a third-generation thienopyridine antiplatelet agent with efficacy in the management of acute coronary syndrome in planned percutaneous coronary intervention (PCI). It became available to Canadian patients in June 2010. It is attractive as an alternative agent in patients who have experienced adverse reactions to clopidogrel. However, cross-reactivity between prasugrel and clopidogrel is unknown. We report our experience with five patients receiving prasugrel with previous documented rash and/or urticaria with clopidogrel.MethodsFive consecutive patients prescribed prasugrel 10mg daily post PCI and stent insertion were followed up post discharge.ResultsTabled 1ConclusionOur experience with five patients with previous skin reactions to clopidogrel suggests that there still may be a risk of cross-reactivity between clopidogrel and prasugrel. Further clinical information is needed. In addition, the importance of determining patients' financial coverage for prasugrel as well as facilitating its availability in community pharmacies post-discharge is essential to ensuring that doses are not unintentionally missed. In these patients, this continuity of care was provided by the clinical pharmacist liaising with the patients' community pharmacist. BackgroundPrasugrel is a third-generation thienopyridine antiplatelet agent with efficacy in the management of acute coronary syndrome in planned percutaneous coronary intervention (PCI). It became available to Canadian patients in June 2010. It is attractive as an alternative agent in patients who have experienced adverse reactions to clopidogrel. However, cross-reactivity between prasugrel and clopidogrel is unknown. We report our experience with five patients receiving prasugrel with previous documented rash and/or urticaria with clopidogrel. Prasugrel is a third-generation thienopyridine antiplatelet agent with efficacy in the management of acute coronary syndrome in planned percutaneous coronary intervention (PCI). It became available to Canadian patients in June 2010. It is attractive as an alternative agent in patients who have experienced adverse reactions to clopidogrel. However, cross-reactivity between prasugrel and clopidogrel is unknown. We report our experience with five patients receiving prasugrel with previous documented rash and/or urticaria with clopidogrel. MethodsFive consecutive patients prescribed prasugrel 10mg daily post PCI and stent insertion were followed up post discharge. Five consecutive patients prescribed prasugrel 10mg daily post PCI and stent insertion were followed up post discharge. ResultsTabled 1 ConclusionOur experience with five patients with previous skin reactions to clopidogrel suggests that there still may be a risk of cross-reactivity between clopidogrel and prasugrel. Further clinical information is needed. In addition, the importance of determining patients' financial coverage for prasugrel as well as facilitating its availability in community pharmacies post-discharge is essential to ensuring that doses are not unintentionally missed. In these patients, this continuity of care was provided by the clinical pharmacist liaising with the patients' community pharmacist. Our experience with five patients with previous skin reactions to clopidogrel suggests that there still may be a risk of cross-reactivity between clopidogrel and prasugrel. Further clinical information is needed. In addition, the importance of determining patients' financial coverage for prasugrel as well as facilitating its availability in community pharmacies post-discharge is essential to ensuring that doses are not unintentionally missed. In these patients, this continuity of care was provided by the clinical pharmacist liaising with the patients' community pharmacist.

ACCF/ACG/AHA 2010 Expert Consensus Document on the Concomitant Use of Proton Pump Inhibitors and Thienopyridines: A Focused Update of the ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

This expert consensus document was developed by the American College of Cardiology Foundation (ACCF), the American College of Gastroenterology (ACG), and the American Heart Association (AHA). Expert consensus documents inform practitioners, payers, and other interested parties of the opinion of ACCF and document cosponsors concerning evolving areas of clinical practice or medical technologies. Expert consensus documents cover topics for which the evidence base, experience with technology, or clinical practice is not considered sufficiently well developed to be evaluated by the formal ACCF/AHA Practice Guidelines process. Often, the topic is the subject of considerable ongoing investigation. Thus, the reader should view the expert consensus document as the best attempt of the ACCF and document cosponsors to inform clinical practice in areas where rigorous evidence may not yet be available. To avoid actual, potential, or perceived conflicts of interest that may arise as a result of industry relationships or personal interests among the writing committee, all members of the writing committee, as well as peer reviewers of the document, are asked to disclose all current healthcare-related relationships and those existing 12 months before initiation of the writing effort. The ACCF Task Force on Clinical Expert Consensus Documents (CECD) reviews these disclosures to determine which companies make products (on market or in development) that pertain to the document under development. Based on this information, a writing committee is formed to include a majority of members with no relevant relationships with industry (RWI), led by a chair with no relevant RWI. Authors with relevant RWI are not permitted to draft or vote on text or recommendations pertaining to their RWI. RWI are reviewed on all conference calls and updated as changes occur. Author and peer reviewer RWI pertinent to this document are disclosed in Appendixes 1 and 2, respectively. Additionally, to ensure complete transparency, …

Benzofuran derivatives and the thyroid

Amiodarone and dronedarone are two clinically important benzofuran derivatives. Amiodarone has been used widely for treating resistant tachyarrhythmias in the past three decades. However amiodarone and its main metabolically active metabolite desethylamiodarone can adversely affect many organs, including the thyroid gland. Amiodarone-induced thyroid disorders are common and often present as a management challenge for endocrinologists. The pathogenesis of amiodarone-induced thyroid dysfunction is complex but the inherent effects of the drug itself as well as its high iodine content appear to play a central role. The non-iodinated dronedarone also exhibits anti-arrhythmic properties but appears to be less toxic to the thyroid. This review describes the biochemistry of benzofuran derivatives, including their pharmacology and the physiology necessary for understanding the cellular mechanisms involved in their actions. The known effects of these compounds on thyroid action are described. Recommendations for management of amiodarone-induced hypothyroidism and thyrotoxicosis are suggested. Dronedarone appears to be an alternative but less-effective anti-arrhythmic agent and it does not have adverse effects on thyroid function. It may have a future role as an alternative agent in patients being considered for amiodarone therapy especially those at high risk of developing thyroid dysfunction but not in severe heart failure.

Rapamycin: Brain Excitability Studied in vitro

Neurological complications are common in transplant recipients treated with immunosuppressant calcineurin inhibitors. Rapamycin, a macrolide antibiotic, was suggested as an alternative agent in patients who develop calcineurin inhibitor associated neurotoxicity, including seizure attacks. The aim of the present study was to test the effect of rapamycin on the bioelectrical activity and evoked field excitatory postsynaptic potentials (fEPSP) in CA1 area of hippocampal tissues and compare its effect with FK506, a calcineurin inhibitor agent. Application of rapamycin at different concentrations neither affected the bioelectrical activity nor changed fEPSP magnitude. In contrast, FK506 elicited epileptiform burst discharges and significantly enhanced fEPSP magnitude. This study supports the suggestion that rapamycin could be used as an alternative to calcineurin inhibitors in the event of neurotoxicity.

Update on the use of the macrolides for community-acquired respiratory tract infections

The use of macrolides dates back more than 50 years, when erythromycin was the first of this class to be introduced into clinical practice. In the early 1990s, the so-called ‘newer’ or extended-spectrum macrolides were approved for clinical use in patients with a variety of infectious diseases. While clinically efficacious, the pharmacokinetic (frequent daily dosing) and adverse-events profile (specifically gastrointestinal) of erythromycin initially limited its use as an alternative agent for patients with allergy to β-lactam agents. Erythromycin could be characterized as being active against Gram-positive and atypical pathogens but has limited in vitro activity against Gram-negative organisms (particularly Haemophilus influenzae). The newer macrolide compounds, azithromycin and clarithromycin, were characterized has having in vitro antibacterial activity that was similar to that of erythromycin but with enhanced in vitro activity against Gram-negative respiratory tract pathogens, most notably, H. influenzae. These ‘newer’ macrolides also offered better pharmacokinetic/pharacodynamic properties with less frequent daily dosing and reduced gastrointestinal side effects. The role of atypical and/or new pathogens combined with the global escalation of acquired antimicrobial resistance continues to redefine and impact on the selection of empiric versus organism-directed therapy for respiratory infectious diseases. Macrolide compounds continue to be a valuable class of antimicrobial compounds, as evidenced by their continued prominent place in various guidelines. The key to the long-term viability of the macrolide class appears to be centered around understanding the factors that lead to the selection of macrolide resistance and the role that different macrolide compounds may have in this process.

Telithromycin: The first ketolide antimicrobial

Telithromycin is the first of the ketolide antibacterials to receive US Food and Drug Administration (FDA) approval for clinical use. It is approved for the treatment of community-acquired pneumonia (CAP), acute exacerbations of chronic bronchitis (AECB), and acute maxillary sinusitis (AMS) in adults. This article reviews the mechanism of action, in vitro antimicrobial activity, pharmacokinetics and pharmacodynamics, clinical efficacy, safety, and drug-interaction profile of telithromycin. Relevant studies were identified through a search of the English-language literature indexed on MEDLINE (1990-March 2005) using the terms telithromycin and HMR 3647, a review of the reference lists of identified articles, and a review of the briefing document prepared by the manufacturer of telithromycin for presentation to the FDA Anti-infective Drugs Advisory Committee. A search of abstracts from the Interscience Conference on Antimicrobial Agents and Chemotherapy (2001-2004) also was performed. The results of in vitro susceptibility studies suggest that telithromycin provides coverage against the key respiratory pathogens, both typical and atypical. In addition, telithromycin may be useful against multidrug-resistant strains of Streptococcus pneumoniae and against Haemophilus influenzae, irrespective of beta-lactamase production. In randomized, double-blind, comparative trials (against amoxicillin, amoxicillin/clavulanate, cefuroxime axetil, clarithromycin, moxifloxacin, or trovafloxacin), telithromycin had comparable efficacy to its comparators in the empiric treatment of CAP (4 studies), AECB (3 studies), and AMS (3 studies). Telithromycin is dosed at 800 mg (two 400-mg tablets) QD in community-acquired respiratory tract infections (RTIs). No dose adjustment is required in the elderly, patients with mild to moderate renal insufficiency, or patients with hepatic insufficiency. The majority of adverse events associated with telithromycin were mild to moderate, with gastrointestinal effects (diarrhea, nausea, vomiting) being the most commonly reported, followed by headache and dizziness. Telithromycin has been associated with elevations in hepatic transaminases and prolongation of the electrocardiographic QTc interval, although the significance of these findings is not known. Telithromycin is also a strong inhibitor of and substrate for the cytochrome P450 (CYP) 3A4 isozyme. Therefore, it is important to monitor for potential drug interactions with medications that prolong the QTc interval or are metabolized by the CYP system. Telithromycin appears to be a useful option for the empiric treatment of community-acquired RTIs in adults. It may be particularly useful in the outpatient setting in areas with high rates of penicillin- and macrolide-resistant S pneumoniae; it may also be an alternative agent for patients who are allergic to beta-lactams and live in areas with a high prevalence of multidrug-resistant S pneumoniae or for those who have failed to respond to beta-lactam- or macrolide-based therapy.

Gadolinium Dimeglumine as a Contrast Agent for Digital Subtraction Angiography:in VitroHounsfield Unit Measurement and Clinical Efficacy

The purpose of this study was to evaluate the feasibility and safety of using gadolinium-chelates for digital subtraction angiography (DSA) in patients with contraindications to iodinated contrast material, and to assess the clinically effective concentration of gadolinium (Gd). Gadopentetate dimeglumine and iopromide were used in density measurements. Using 20 mL disposable syringes, serial dilutions of Gd and iopromide with saline were performed. Computed tomography scanning was done and the attenuation of each was recorded as mean Hounsfield units using region of interest analysis. Clinical trials were done in twelve patients with the following types of angiogram or intervention: hemodialysis access, percutaneous biliary drainage, percutaneous nephrostomy, cerebral angiography and transarterial chemoembolization (TACE) in hepatocellular carcinoma. The density of 1 : 1 diluted Gd was nearly equal to that of 1 : 4 dilution of iopromide, and that of pure Gd was similar to or less than that of 1 : 1 dilution of iopromide. Serum creatinine level was not elevated in any of the patients. Gd is a safe alternative agent in patients with contraindications to iodinated contrast materials. Pure Gd without dilution is the most clinically useful concentration.