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SID and SAD

Death is the end of life, when all brain activity ceases permanently. We all expect to die. But in Nature, the old die before the young, parents before their children. A disruption of this normal sequence results in distress, depression and an inability to cope.

CLICK & SEE....>…...SIDS………..SAD

SAD victims who simply drop dead in the middle of action may have unrecognized underlying risk factors

The unexpected death of a healthy child can be the result of SIDS (Sudden Infant Death Syndrome), also known as  cot death or  crib death  It occurs in a seemingly normal child, usually a male, under the age of one year, who goes to sleep in the night and fails to wake up in the morning.

The immature brains of children do not regulate the heart rate or breathing very efficiently, especially at night. This may be further compromised by exposure to cigarette smoke. Also, the child may be accidentally smothered when parents roll over in their sleep, or it could be that its nose and mouth get blocked by soft, fluffy sheets or pillows.

Parents are, therefore, advised to avoid sleeping in the same bed as the child and to always place the child on the back instead of the stomach. These measures appear to significantly reduce the number of SIDs.

Death in healthy young adults between the ages of 16 and 60 years may be due to accidents or violence. Some like the SIDS infants just  drop dead  or die during their sleep. Their death is sudden, unexpected, tragic and inexplicable.

These unexplained deaths have been grouped together and given the expressive acronym SAD (Sudden Adult Death). More men than women die this way. Some families are even considered cursed, with many economically productive young men in the family dying in the prime of their life.

Autopsies on SAD victims have shown that some of them actually did have unrecognized underlying risk factors. This is particularly true in India where we have many young undiagnosed diabetics and others with metabolic abnormalities of syndrome X (insulin resistance, hypertension, lipid abnormalities). Despite their youth, some had coronary arteries partially blocked with fatty deposits and plaques. In others, the vessels supplying the muscles of the heart arose from abnormal locations. The congenital heart diseases may have been mild enough to remain unrecognized and undiagnosed until it was too late. The efficient functioning of the heart may have been affected by a group of diseases called cardiomyopathies. Infection of the heart muscle (myocardium) with viruses and bacteria may have caused myocarditis. The infection can trigger arrhythmia and death. Some prescription drugs like terfenadine can also set off similar fatal reactions. Unfortunately, as such people appeared healthy and had no symptoms, they were never investigated for risk factors prior to the sudden death.

SAD has been in the news recently because of the discovery that many affected individuals had a  long QT  in their ECG (electrocardiograph). Even if the initial resting ECG is normal, the abnormality shows up on an ECG taken after exercise. These ECG changes are caused by disturbances in the electrical conduction currents of the heart and are inherited. The genetic defects causing this are of various types. The percentage of genetic carriers in the population is probably around 5 to 10 for 100,000 persons. This has lead to speculation that SID and SAD are two spectrums of the same disease.

The defects are commoner in Southeast Asia than in the western countries. The syndrome even has local names bangungutin the Philippines,  pokkuri in Japan and  lai tai in Thailand. It has been known for many centuries, although the precise defect was identified only recently.

About 60 per cent of people with hereditary long QT syndrome has non-specific symptoms like fainting spells or seizures during childhood and adolescence. Around 40 per cent has no symptoms at all and the condition may just present itself with sudden death. Many die in front of family and friends. Unfortunately, from the time the heart stops beating, irreversible brain damage occurs in three to six minutes, followed by coma and death. Cardio-pulmonary resuscitation (CPR) may have saved the lives of a few of these people. However, most people do not learn CPR, and others are too stunned by the occurrences to initiate it in time.

Once the long QT is picked up on an ECG, measures can be taken to prevent sudden death. Medications belonging to the beta-blocker group can be started. Certain prescription drugs that prolong the QT can be avoided. Potassium levels in blood need to be monitored as low levels can precipitate death. Some patients may need pacemakers.

Symptoms in persons with a long QT syndrome can be precipitated by physical exertion. The long QT has been implicated in the sudden death of trained Olympic-level athletes. Competitive sports, therefore, are risky and better avoided.

Exercise is good for health, well being, diabetic control and lipid abnormalities, but vigorous action should be undertaken only after medical advice in those with risk factors.

Source: The Telegraph (Kolkata, India)

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Hearing Loss Is Common, but Often Untreated

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Americans who suffer from hearing loss. They include a third of Americans over 60 and up to half of those over 75, most of whom have age-related hearing loss, a condition known medically as presbycusis. Hearing loss is the third most common chronic condition among older Americans, after hypertension and arthritis. Hearing difficulties in older people can have serious consequences, including social isolation, functional decline and depression. Hearing loss can also impair memory and cognitive function, according to a study by neuroscientists at Brandeis University.

A survey of 2,000 hearing-impaired adults conducted in 1999 by the National Council on Aging found that those using aids had better feelings about themselves, greater independence, improved mental health and better relationships with their families. Yet only one person in five with hearing loss wears a hearing aid — partly because of their cost, which is not covered by Medicare and rarely by private insurance.

Acknowledging the Problem
Some people do not know — or they deny — that they have a hearing problem, complaining instead that everyone seems to mumble or talk too fast. Even those who get a yearly physical rarely have their hearing checked. Others are embarrassed to wear a hearing aid. About 30 percent of people who have hearing aids don’t wear them daily.

Hearing aids have improved vastly in the past decade, in both design and selection. Even so, some people, having once had a bad experience, refuse to explore the many new options.

As with the eye and vision, there are many steps between the ear and hearing, a process that takes but a tiny fraction of a second. Sound entering the ear canal causes the eardrum to vibrate. These vibrations are picked up by three tiny bones in the middle ear that connect the drum to the cochlea, a snail-shell-like structure with three tubes filled with fluid. The resulting waves in the fluid signal hair cells in the cochlea that transmit electrical signals to the auditory nerve that connects to the brain stem. These signals then travel to the brain’s auditory center, where the message is processed.

Disruption or damage at any stage in this chain can result in hearing loss. Among factors that can damage hearing are trauma, chronic infection, wax buildup, fusion of ear bones, diseases like diabetes and medications like the antibiotics vancomycin and gentamicin. Some anticancer drugs are also toxic to the ear. Heredity, too, plays a role; some people carry gene mutations that make them more susceptible to hearing loss.

The most common environmental factor is loud noise, either a sudden very loud noise like an explosion or gunshot next to the ear or, more commonly, repeated exposure to loud noises like those produced by rock bands or earbuds and headphones. Some rockers and countless rock fans have developed hearing problems.

Hearing loss associated with aging most often results from cumulative damage to the hair cells in the cochlea, which, like other body parts, suffer the wear and tear of age. The first to decline are those in the outer part of the cochlea that are sensitive to high-frequency sounds, including those produced by the consonants f, sh, ch, p, s and t, which are crucial to clarity in perceiving speech. The low-frequency vowel sounds are the last to go.

Finding a Solution
Detection of a hearing problem is the first step. Hearing specialists have long urged family physicians to check the hearing of patients over 60 at every annual visit by doing a whisper test in each ear or administering a short written quiz.

Anyone with a suspected hearing problem should be referred to an audiologist for detailed testing, or to an otolaryngologist if the cause is medical. Anyone experiencing sudden loss of hearing in one or both ears should consult an otolaryngologist without delay. That could be a reversible problem if treated quickly.

Audiologists are certified clinicians trained to analyze a hearing problem, prescribe hearing aids and help people adjust to their use. In areas where there is no audiologist, look for a licensed hearing aid specialist who is trained to fit and dispense hearing aids.

Choosing a Hearing Aid

Four styles of aids are now available, ranging in price from about $400 to $3,000:

*  A behind-the-ear model fits over the ear and directs sound into the ear canal through a tube and custom-fitted ear mold. This model offers the most circuit and feature options and is easiest to handle for people with limited dexterity.

*An in-the-ear model fits into the outer ear and projects slightly into the ear canal. It is relatively easy to handle and also supports many features.

* An in-the-canal model protrudes only slightly into the outer ear but can accommodate fewer features and is more difficult to handle.

* A completely-in-the-canal model, the smallest and most difficult to handle, is not noticeable in the outer ear but has the fewest features.

Audiologists can help patients select the most appropriate model based on their hearing and living needs and dexterity. When circumstances change, audiologists can also reprogram hearing aids. New designs help patients distinguish speech in noisy environments; some adjust automatically while others require the user to make adjustments. For people with severe hearing loss who need a lot of amplification, new devices have been designed to suppress the high-pitched whistle that can be produced by a hearing aid turned to high volume amplification.

Most important for anyone getting a hearing aid is to take the time needed to adjust to its use. No hearing aid can replace normal hearing, but when properly fitted and adjusted, an aid can greatly improve quality of life.

For more information on hearing aids and preventing hearing loss: “Save Your Hearing Now  by Michael D. Seidman and Marie Moneysmith.

Source:  The New York Times

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