Dr. P Satish

Cyclic vomiting syndrome (CVS) is characterized by periodic bouts of nausea and vomiting that happens at cyclical intervals. It affects all ages, but is more common in children. The condition is quite stereotypical in that there are paroxysms or bouts of vomiting that is recurrent and follows days of normal health.

Causes:

There is no definite reason identified, but it is said to have a strong hereditary correlation. Studies have shown mitochondrial heteroplasmies (abnormal growth of mitochondria, which is a cellular component) to be one of the factors that can lead to CVS. The genetic correlation, however, is very difficult to establish, specifically because vomiting and nausea are common symptoms that occur with most conditions in children. And CVS is most commonly noted with conditions like infections and emotional excitement. Infection could be either tooth decay or sinusitis or anything else. Lack of sleep, anxiety, holidays, allergies, overeating, certain foods, menstruation – a host of factors have been shown to induce CVS. There is also a strong association with migraine and conditions that lead to excessive production of stress hormones.

Symptoms:

The syndrome (a group of symptoms) usually has 4 phases:

1. Symptom-free interval phase: The child is completely normal in this phase, which happens in between bouts.

2. Prodromal phase: Prodrome is an indication that a disease or a condition is about to happen. In CVS, this is usually nausea and abdominal pain that can last from a few minutes to a few hours. Treatment in this phase can curb the disease. However, there could be some children in whom this may not manifest and the child may directly start with vomiting.

3. Vomiting phase: Repeated bouts of paroxysmal vomiting happen associated with nausea, exertion, fatigue, and drowsiness.

4. Recovery phase: As the nausea and vomiting begin to subside, which may take a couple of days, the child returns back to normal slowly. However, the lethargy and energy levels will take a couple of days to return to normal.

Treatment:

Treatment again depends on the severity and the phase at which it is being recognized. If a child has repetitive bouts, then the parent and the doctor would have identified a pattern to it.

1. If the causative agent has been identified, for instance, infection or migraines, then managing that takes care of the CVS also.

2. If identified during the prodromal phase, again it can be managed with suitable anti-emetic medications.

3. If identified after full onset, rest and sleep and medications to control nausea and vomiting are required.

Adequate hydration with electrolyte replenishment and sedatives can provide additional support. However, in most cases of childhood CSV, the pattern will be identified and that helps in better management, both the child/parent and the podiatrist.

Symptoms, causes and treatment for Asthma

Thalassemia is a type of a disease, resulting in the abnormal production of hemoglobin in the blood. Hemoglobin stimulates oxygen circulation all over the body. Therefore, a dip in the hemoglobin count can lead to anemia, a disease inducing weakness as well as fatigue. Acute anemia can take a toll on the organs and ultimately cause death.

Severe thalassemia in children yields symptoms, such as dark urine, abdominal swelling, slow growth, jaundice, a pale appearance and deformed skull bones. Diarrhea, frequent fevers and eating disorders are also common.

Treatment:

1. Blood transfusions: Regular blood transfusion is the only treatment needed for beta thalassemia aiming to keep sufficient Hb level to avoid long-term complications, though bone marrow transplant is radical cure for the disease.
2. Iron chelation therapy: The hemoglobin in the red blood cells is rich in iron-protein that gets deposited in the blood with regular blood transfusion. This condition is known as iron overload as it damages heart, liver and various parts of the body. Iron chelation therapy is used to prevent this damage as it helps to remove the excess iron from the body.  Deferoxamine and Deferasirox are two such medicines used for this therapy.
3. Folic acid supplements: Folic acid being a B vitamin produces healthy red blood cells and is therefore recommended as a substitute for the above procedures.
4. Transplant of blood and marrow stem cell: A blood and a marrow (a substance within the cavities of bones where blood cells are produced) transplant replaces the faulty stem cells with healthy ones contributed by a donor.