Sudden adult death syndrome

What is sudden adult death syndrome?

Cardiac arrhythmias are a common cause, one in particular, Long QT syndrome, may be genetic in origin.
Sometimes there are no warning signs, but in other cases people can experience dizziness or fainting spells. Sudden loss of consciousness or death often occurs during physical exercise or emotional upset.
The frequency of the condition isn't fully known as many sudden deaths are put down to accidents. But research has indicated that about 500 deaths a year in the UK are because of sudden arrhythmic death syndrome.

Causes and risk factors

Inheritance may be a factor, depending on the underlying syndrome but some conditions are genetic disorders and some are acquired, due to medication.
As more people become aware of the syndromes that may be responsible, more families and individuals are being diagnosed as being at risk.
In some situations, the use of beta blocker medications are effective in 90 per cent of cases. In other cases, surgery might be appropriate.
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Testicular torsion

What is testicular torsion?Each testicle hangs down from a cord called the spermatic cord. Within this cord are the blood vessels that supply the testicle and a tube that carries sperm away from the testicle. If the testicle twists on the cord, the blood supply to the testicle is cut off. This usually happens in the teenage years, but can affect men of any age (although it’s uncommon after the age of 25).

Symptoms

• Sudden and excruciating pain, much worse than being kicked in the testicles. It can be so bad a man may vomit or faint.
• Sometimes the pain is felt deep within the abdomen because the nerves to the testicle originate here.

Causes and risk factors

The twisting may follow strenuous activity. Often, however, it happens spontaneously for no apparent reason and can even happen during sleep. It may be that in some men the spermatic cord is looser and allows the testicle to twist around more easily.

Treatment and recovery

Urgent medical treatment is necessary to untwist the cord and save the testicle (with its blood supply cut off, the cells of the testicle will soon die). This involves a simple operation during which both testes are stitched to tissues in the scrotum to fix them in place so neither can twist and cause problems in the future.
Prompt treatment within six hours of the pain starting usually prevents permanent damage. If the testicle is damaged, however, it will be removed.
Sometimes the cord spontaneously untwists before treatment is provided. However, because there's a high risk of it twisting again, arrangements will usually be made to perform the operation to fix the testes at an appropriate time.
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Tooth decay

What is tooth decay?
Tooth decay, known technically as dental caries, is one of the most common health complaints in the world. The incidence is declining in societies where water is fluorinated or where toothpaste containing fluoride is used.
It is particularly common in children and young adults, and rates have been fuelled by an increase in sugars in the diet, and poor dental hygiene.

Causes and risk factors

The problem is caused by sticky deposits called plaque that collect, in particular, around the gum line, the edges of fillings and the grooved surfaces of the teeth.
Plaque is made up of food debris, saliva and the bacteria that are normally present in the mouth, and convert food into acids.
If plaque is allowed to collect over time it will harden into a substance called tartar. Both tartar and plaque contain acids which, over time, can dissolve away the protective, hard enamel coating of the tooth, and create holes, or cavities.
Most cavities form over a period of months, or even years.
They are usually painless, but they can grow very large, and damage the much softer internal structures of the tooth such as the dentin and the pulp, which is found at the core.
If they remain untreated, they can kill the nerve and blood vessels of the tooth, and ultimately the tooth itself.
Eating a diet rich in sugar and starch increases the risk of tooth decay, and sticky foods can be a particular problem because they are more likely to remain on the surface of the teeth.
Frequent snacking also increases the amount of time that acids are in contact with the teeth.
In the absence of good oral hygiene, it doesn't take long for damage to begin. The acids generated by the breakdown of food stuff in the mouth can begin to attack the tooth enamel within 20 minutes of a meal.
It is thought that tooth decay only became a widespread problem with the establishment of sugar plantations in the 18th century, and worsened with the subsequent widespread cultivation of sugar beet in Europe.

Symptoms

The most obvious sign of tooth decay is toothache, particularly after hot or cold foods or drinks. However, pain may not be present until decay has reached an advanced stage.
Pits or holes may also be visible in the teeth.
Most tooth decay is discovered at an early stage during a routine check up.
A serious complication can be the development of a tooth abscess - the build up of pus resulting from a bacterial infection of the centre of the tooth.
Infection may spread out from the root of the tooth and to the bones supporting the tooth.
Plaque and tartar also irritate the gums, and lead to a gum disease called gingivitis which often leads to dental loss even if the tooth itself is healthy.

Treatment and recovery

The best way to keep your teeth in health condition is to ensure that you have a healthy diet without large amounts of sugars and that you clean your teethregularly to get rid of any plaque build up.
Most dentists recommend that you clean your teeth at least twice a day. Using a toothpaste containing fluoride is probably a good idea as this provides the teeth with added protection from the effects of acid.
Flossing between the teeth is also a good idea, as is rinsing out your mouth after eating sticky foods or sugary drinks.
It is also important to have a regular check up at the dentist - most suggest once every six months to a year.
Unfortunately, even good oral hygiene does not prevent decay as the bacteria congregate in areas inaccessible to brushes and floss.
Once the structure of a tooth has been damaged by decay, there is no way to repair it. However, if decay is picked up at an early stage its progression can be blocked. Decayed material can be removed, and replaced with a restorative material such as silver alloy, or plastic. This is known as a filling.
If the decay is more extensive, then another option is a crown. The decayed or weakened area is removed and repaired and a covering jacket - the crown - is fitted over the remainder of the tooth.
If the nerve in a tooth has died, either from decay or a blow, then a dentist will consider root canal work.
This involves removing the centre of the tooth, including the nerve and blood vessel tissue.
The root is then filled with a sealing material, and the process is completed with either filling or possibly a crown.
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Teenage drinking

What is the impact on society?The British Medical Association (BMA) published a report in September 2009 highlighting concerns about teenage alcohol abuse, following on from a previous report in 2008. 'Under the Influence' advised that not only was there a general rise in the proportion of 11 to 15-year-olds who drink alcohol regularly, but also that there is an increase in the amount they are drinking on each occasion. Alcohol Concern suggested that a third more 11 to 15-year-olds are drinking regularly.

What are the health risks?

It is far easier to work out the health effects of drinking on adults - it is known that heavy drinking over the years is a risk factor for certain cancers, particularly oral and liver, and raised blood pressure which can contribute to heart disease.
'Binge' drinking every now and then tends to be far more harmful to health than drinking a moderate amount occasionally. It has also been suggested that teenagers are more likely to have casual sex if they are regular drinkers.
Doctors think that this effect could be far more pronounced in the young, as alcohol will tend to have more effect on their developing bodies. The increase in the availability of 'designer drinks', the so-called "alcopops" has been accused of making alcohol far more attractive to younger people. Research has shown that it is particularly the 13 to 16 age group that is attracted to the idea of alcopops.
Doctors are worried about an apparent increase in the number of young teenagers who are drinking heavily. While many of the more serious health effects of drinking affect those who have been drinking for many years, it is feared that alcohol abuse during the formative years sets a pattern for later life.

What are the recommendations?

A spokesman for the BMA said: "There is a need for government action to address the problems of underage and teenage drinking. "This must involve changes to legislation, responsible marketing, effective monitoring of the drinks industry and health education."  

What is being done about it?

In Scotland, it is an offence for anyone under 18 to buy alcohol for a person under 18 years old - the BMA would like to see that legislation introduced in England and Wales. In its 2009 report, it also called for the UK government to:

• Ban all alcohol marketing communications Enforce a minimum price for alcoholic products
• Increase excise duty, and adjust so that it more accurately reflected the strength of the alcoholic product
• Regulate availability of products through reduction in licensing hours for on- and off-licensed premises
• Undertake a full audit of the market and consider ways to prohibit products that either appeal to young people more than adults, or are associated with problematic drinking.

The use of words such as 'revitalising' in connection with drinks which contain a stimulant such as caffeine as well as alcohol are now banned.
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