Correction to: An in vitro and clinical dose-finding study of antifoaming effects of simethicone during colonoscopy (Indian Journal of Gastroenterology, (2019), 38, 3, (268-272), 10.1007/s12664-019-00966-3)

In the above article, due to probable typo error with the picture and legend, the correct Fig. 1 and the Legend to the Fig. 1 are printed here: (Figure presented.)

An evidence-based approach towards targeted patient education to improve bowel preparation for colonoscopy

Goals and Background: Quality of bowel preparation is an important factor influencing adenoma detection. Patient education is believed to improve the quality of bowel preparation but might be resource-intensive. We aimed to (a) identify risk factors for failed bowel preparations and (b) develop and test the efficacy of a screening tool that allows to prospectively identify and target patients at increased risk. Study: Part 1: 76 consecutive outpatients with poor bowel preparation were compared with 76 age-matched and gender-matched outpatients with good preparation from the same procedure lists. Sociodemographic and clinical data were obtained from centralized databases. Univariate analysis and multivariate logistic regression was used to identify risk factors for poor bowel preparation. Part 2: on the basis of results of part 1, a screening tool for prospectively identifying patients at high risk was developed, and targeted education tested. Results: We identified the use of opioids or other constipating agents and low socioeconomic status as risk factors for poor bowel preparation [odds ratio (OR)=2.88; 95% confidence interval (CI): 1.22-6.80 and OR=2.43; 95% CI: 1.25-4.72]. Diabetes, hypothyroidism, age, and gender were found to have no effect on quality. When education was provided only to patients at increased risk, the targeted approach did not negatively affect the proportion of poor preparation (OR=6.12%; 95% CI: 4.79%-7.78% vs. OR=5.73%; 95% CI: 4.61%-7.10%). Conclusions: Poor bowel preparation is associated with specific risk factors. Identifying and specifically targeting education at patients with these risk factors appears to facilitate more efficient use of education resources in endoscopy

An in vitro and clinical dose-finding study of antifoaming effects of simethicone during colonoscopy

Simethicone is an antifoaming agent frequently added to endoscopic rinse solutions but has recently been implicated as a risk factor for transmission of infections due to the formation of simethicone deposits within scope channels. Since the build-up of residue is likely dose-related, the smallest effective dose of simethicone should be used but there are no data available on the effective dose. Thus, we conducted a dose-finding study in an “in vitro bubble model” to determine the appropriate simethicone dose. Six 100-mL test tubes were filled with a 1% (v/v) solution of kitchen detergent (Fairy®, Procter & Gamble,\ua0London, England) in water for irrigation (Baxter®, Sydney, Australia). One test tube served as the control, while different doses of simethicone (Infacol®, Nice Pak, Melbourne, Australia) were added to the other five tubes (0.02, 0.2, 2.0, 20, and 200\ua0mg/100\ua0mL). Oxygen was streamed for 30\ua0s into the test tubes at a rate of 2\ua0L/min. After 10\ua0s, photographs were taken and the visible\ua0bubbles were semi-quantitatively rated by independent assessors blinded to the dosing of simethicone. Simethicone at doses of 2\ua0mg/100\ua0mL had no appreciable antifoaming effect, whereas concentrations ≥ 20\ua0mg/100\ua0mL were sufficient to suppress bubble formation. This is substantially lower compared with frequently used doses of up to 200\ua0mg/100\ua0mL. Subsequently, we tested the lower simethicone dose with previously used higher doses, in 1475 and 1340 patients, respectively. We found it to have no impact on polyp detection with a rate of 56.7% (54.2–59.3% [95% CI]) at the lower dose and 56.5% (53.8–59.1% [95% CI]) at the higher dose. [Figure not available: see fulltext.]

Cyclodextrin-crosslinked poly(acrylic acid): synthesis, physicochemical characterization and controlled release of diflunisal and fluconazole from hydrogels

The aim of this work was to develop mucoadhesive hydrogels with variable drug delivery properties by crosslinking poly(acrylic acid) (PAA) with cyclodextrins (CDs). CD-PAA polymers with high CD content and good inter-batch reproducibility were synthesized by activating PAA with SOCl2, then reacting PAA chloride with CD in the presence of 4-dimethylaminopyridine at 50 degrees C. Manipulation of the synthesis conditions affected the physicochemical character of the CD-PAA polymers and hydrogels in terms of CD content, the average number of ester bonds to an individual CD, viscosity, and the association and release of model drugs. Inclusion complexation of diflunisal (DIF) and fluconazole (FLZ) with CD-PAA hydrogels was assessed by F-19 NMR spectroscopy and association constants (K(a)s) for DIF were in the range 220-486 M-1 with beta CD-PAA and 1327-6055 M-1 with hydroxypropyl-beta CD-PAA. For FLZ the K-a range was 34-171 M-1 with hydroxypropyl-beta CD-PAA. The hydrogels were found to release both drugs by means of Fickian diffusion as the predominant mechanism. A slight trend toward negative correlation was found between the K-a and Higuchi k(H) values for DIF. These results highlight the potential of CD-PAA hydrogels to control the release of model drugs through inclusion complexation. (C) 2013 Elsevier B. V. All rights reserved

Influence of simethicone added to the rinse water during colonoscopies on polyp detection rates: results of an unintended cohort study

Simethicone is a common antifoaming agent that is added to endoscopic rinse solutions, but data regarding its effect on polyp detection rates is lacking. In this study, we report the effect of discontinuation of this practice on polyp detection rates.Procedure data of 4,254 consecutive colonoscopies were used. Patients underwent standard bowel preparation with polyethyleneglycol (Glycoprep®). Colonoscopies were performed utilising Olympus EVIS EXERA III, CV-190 equipment, while quality data (withdraw times, polyp detection rates, quality of bowel preparation) was assessed utilising an endoscopy reporting system (Provation®). Following an educational event that highlighted that simethicone may form deposits in the channels of endoscopes, the practice to add simethicone (InfacolR, Nice Pak) to the auxiliary channel water pump was abandoned, but endoscopists were not notified about this change. After 5 days and performing 75 colonoscopies, the change of practice was identified and addition of simethicone recommenced.The discontinuation of simethicone use reduced the polyp detection rate from 55% (95% CI 53-56) to 45% (95% CI 34-56, 1-sided, p = 0.028); the polyp detection rate returned to the pre-intervention levels of 55% (95% CI 52-58) upon resumption of normal practice.The addition of simethicone to the auxiliary water pump during colonoscopy results in a 10% increase in polyp detection rates