Oropharyngeal pH monitoring for the detection of liquid and aerosolized supraesophageal gastric reflux

The association between gastroesophageal reflux disease (GERD) and extraesophageal symptoms is poorly understood and difficult to document. pH monitoring in this group of patients has resulted in conflicting data due to lack of diagnostic sensitivity. Recently, a new sensitive pH device for detection of liquid and aerosolized droplets in the oropharynx (The Dx-pH Measurement System [Dx-pH]) has become available. Our hypothesis is that we will be able to improve our ability to identify and understand this group of patients with this device. The aim of this preliminary observation study was to compare the results of this new device to the standard esophageal and pharyngeal pH probes in a small group of patients with extraesophageal symptoms. Patients with suspected extraesophageal GER symptoms underwent traditional 24-hour esophago-pharyngeal pH monitoring (24pH) simultaneous with Dx-pH monitoring in the oropharynx. Tracings were reviewed for comparison and correlation between the two probes, with an event in the Dx-pH Probe being defined as a rapid drop >3 standard deviation from baseline. Fifteen patients (10 females, 5 males) with mean age of 57.5 years (range, 25-75) were studied. The predominant chief complaint included 12/15 chronic cough, 2/15 asthma; and 1/15 throat clearing. All Dx-pH events were preceded and associated with distal esophageal pH drops in a progressive ante grade manner. Ten patients had 1-13 abnormal oropharyngeal pH events as measured by Dx-pH monitoring with a total of 48 events. The median pH of reflux events had a statistically significant increase from 3.1 at the distal esophageal probe to 5.2 at the pharynx and 5.6 at the oropharynx, the latter being 80% higher than the distal esophageal probe (P<0.001). The percentage of acid events decreased in a cephalad manner from 66.7% at distal esophagus to 25% at the pharynx and only 6.25% at the oropharyngeal Dx-pH Probe, with the remaining events being weakly acidic. Dx-pH Probe is a new sensitive oropharyngeal pH device whose values correlate well with the gold-standard 24-hour pH device, and appears to accurately detect pH events that begin at the distal esophagus and travel upward to the oropharynx. This device suggests that supraesophageal events manifest themselves as rapid pH drops (>10%), which are likely not to be identified using the standard criteria of pH <4 due to the gradient of increasing pH from the lower esophagus to the oropharynx.

Seasonal Studies of Body Condition in Platypuses, Ornithorhynchus anatinus, Managed in Captivity at Healesville Sanctuary

Platypuses at Healesville Sanctuary are managed so that the animals are physically examined on a daily basis before being allowed access to the display areas. This enables staff to monitor the health status of each animal by recording its weight and checking for any other physical abnormalities. Weights have been monitored for over ten years and the data presented here depicts seasonal changes and those associated with adaptation to a captive environment. Platypuses are extremely sensitive to changes in their environment and many wild platypuses do not adapt well to a captive environment. When platypuses are brought into the Sanctuary (whether for display purposes or due to injury) they are monitored on a daily basis for any weight changes and other obvious abnormalities. Monitoring of weight changes is continued on a daily basis throughout the captive life of the platypus to assess seasonal changes and any changes associated with reproductive status.

An Overview of Captive Husbandry of The Platypus, Ornithorhynchus anatinus, At Healesville sanctuary

The captive management of platypuses is a specialised field due to the stressful nature of the species and its cryptic habits. Husbandry practices vary from one institution to another with some properties adopting a &apos;hands-off&apos; approach and others, such as Healesville Sanctuary, conditioning their animals to being regularly handled. This paper discusses the husbandry practices at Healesville Sanctuary in the management of captive platypuses and highlights the advantages and disadvantages of various routines.

Setting up a community health house

In 1990 Mid Glamorgan health authority agreed to fund a 'community health house' on a deprived council estate in the Welsh valleys, and for the local health visitor to devote part of her time to supporting the project. Rosamund Bryar and Lyn Fisk describe the challenge to conventional health visiting management and practice in the community development approach to health promotion with vulnerable families.