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Health

Tips for managing insomnia in children with autism spectrum disorder (ASD)

Highlights

  • Up to 80% of children with ASD have sleep difficulties
  • This could last into adulthood if left untreated, says Cleveland Clinic Children’s researcher.
  • Certain behavioural-based approaches suggested alongside short-term use of medications, including melatonin and iron supplements, recommended.

Dubai: Behavioural therapy and certain short-term medication could help alleviate insomnia in children with autism spectrum disorder (ASD), according to an expert.

Cynthia Johnson, PhD, Director of Cleveland Clinic Children’s Center for Autism and Professor of Paediatrics, said insomina affects 8 out of 10 children ASD. She explained that behavioural-based approaches and short-term use of medications, such as melatonin supplements, may be helpful.

Behavioural approaches

Behavioural-based approaches, she said, involve the following:

·  Environmental modification,

·  Establishment of stimulus control,

·  Skill building, and

·  Leveraging principles of reinforcement.

The good news, said Dr. Johnson, is that several research projects where she has been involved in show behavioural strategies can make a significant difference in reducing insomnia.

“Short-term use of medications such as melatonin supplements might also be considered,” she added.

Sleep problems in individuals with ASD have been associated with poor social interaction, problems in communication, and overall autistic behaviour.

Family involvement

Many of the strategies can be successfully delivered by the child’s family, said Dr Johnson, who made the remarks on the occasion of World Autism Day (April 2).

The specialist says insomnia in kids with ASD can have a negative impact on both the wellbeing of sufferers and the wellbeing of their families.

What is autism spectrum disorder (ASD)?

ASD is a chronic nervous system condition brought on by genetic, metabolic, or other biological causes. The World Health Organisation (WHO) estimates that one in 160 kids worldwide has ASD. As a developmental disability, autism can cause significant emotional, social and behavioural dysfunction. Sleep disorders co-occur in a huge portion of the patients with ASD.

Insomnia: Common in children with ASD

“Insomnia is significantly more common in children with ASD compared with the general paediatric population, and also persists for a longer period, carrying through to adolescence and adulthood, if left untreated,” says Dr Johnson.

She lists a number of behavioural traits of children with ASD, which may raise the risk of sleeplessness, including:

·  Rigidity and insistence on sameness,

·  Inadequate communication,

·  Anxiety, and

·  Hyperactivity.

Biological risk factors

Biological risk factors can also lead to certain effects — such as variations in brain development, changed melatonin secretion, or mutations in genes that control circadian rhythms.

In addition, clinical variables including untreated gastrointestinal issues and negative pharmaceutical side effects might also worsen sleep disorders.

Commenting on the impact of insomnia on a child, Dr. Johnson says, “Sleep plays an important role in the growth, development and wellbeing of children.”

Studies have shown a lack of adequate, quality sleep can have negative effects on attention, daytime behaviour and the regulation of emotions, and could even impact children’s cardiovascular, metabolic and immune systems.

In addition to the child, the family will be impacted, Dr. Johnson adds.

“The child’s insomnia can affect other family members’ ability to function because, if the child is not sleeping, everyone’s sleep can be disturbed. This adds to parental stress in the long term, with parents dedicating a great deal of time to strategizing on how to get the child to sleep.”

Varying presentation

Insomnia presents in children with ASD varies from child to child, she said, adding: “Sleep problems may be irregular, cyclical or constant and they can take many forms.

For example, the child might resist bedtimes, or insist on elaborate bedtime routines, or might have difficulty falling asleep or staying asleep, or the child might wake up too early.”

Low ferritin levels is also a factor seen behind insomnia in children with ASD.

What can be done?

Interventions are not “one size fits all” solutions, she said.

“As each child responds differently to treatment strategies, parents should work together with an expert in ASD sleep disorders and behavioural interventions.

“The aim is to approach the problem collaboratively and systematically, exploring the day and nighttime routines of the child and family, and testing various preventative and skill-building strategies until the best solution is found.”

Dr. Johnson points out that treatment approaches are continuing to evolve, and new therapies have been found over the past decade and a half.

Behavioural-based approaches, supplements

Behavioural-based approaches involve environmental modification, establishment of stimulus control, skill building and leveraging principles of reinforcement.

Short-term use of medications such as melatonin supplements might also be considered, she says.

Studies also show that low ferritin levels can also be a factor in sleep disorders.

In 2013, a retrospective chart review of data involving 9,791 children with ASD conducted by researchers led by Julie Youssef, of the Department of Neurology, Boston Children’s Hospital, Harvard Medical School, found that significantly low serum ferritin levels were associated with several sleep disorders — including:

·  Periodic limb movements during sleep,

·  Sleep fragmentations, and

·  Poor sleep efficiency.

Ferritin is a storage form of iron. The sudy found that iron supplementation was be effective in the treatment of low ferritin with sleep disorders.

Also, in a 2012 study led by Lynn M. Trotti, of the Department of Neurology, Emory University School of Medicine in Atlanta recommends  iron therapy for low ferritin level below 50 ng/mL for children with ASD facing sleep disorders.

Further research

A study, published in 2007 in Paediatric Neurology, conducted an open-label trial of oral iron supplement (6 mg elemental iron/kg/day) for 8 weeks in children with autism and showed improvement in sleep, with an increase in serum ferritin level.

However, potential side effects were cited, including “metallic” taste, vomiting, nausea, constipation, diarrhoea, and black/green stools.

Antipsychotics, antidepressants, and alpha (α) agonists have also generally been used alongside melatonin.

Experts, however, said that given the limited evidence for psycho-pharmacological treatments in autism, behavioural interventions are considered a primary mode of treatment.

Still, further research and information are needed to guide and individualise treatment for this population group.

 Gulf News

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Health

The rise of ‘Ozempic neck’

he advent of weight loss drugs on the mass market have offered a lifeline for many of us unhappy with our waistlines – but there’s a new physical side-effect that’s very hard to run from, say doctors.

When the fat melts away – as drugs such as Ozempic and Mounjaro work their magic by suppressing appetite, those who take them exalt that the benefits are as plentiful as the food they once devoured.

There’s the raft of health pros – slimmed down souls rave about better sleep, improved mental wellness and the decreased risk of developing serious conditions such as heart disease and diabetes.

However, others will readily admit that the motivation for spending up to £250-a-month on weight loss jabs is purely vacuous – fired by the quest to look better and feel sexier.

And that’s where the latest Ozempic side-effect to emerge is particularly hard to swallow.

‘Ozempic neck’ – a twist on the traditional ‘turkey neck’, which has long been associated with the ageing process and takes its name from the crepe-like red wattle on real-life turkeys – is firmly on the rise, say experts.

It’s a weight loss jab side-effect that no moisturiser in the land can remedy, with surgery or more intense aesthetic treatments often the only option.

Former X Factor judge Sharon Osbourne, 73, admitted that taking Ozempic left her looking physically ‘too gaunt‘.

In November 2024, the wife of late rocker Ozzy, told Howie Mandel’s podcast, she was ‘frustrated’ by what the drugs had done to her physique.

The 73-year-old said: ‘I can’t put on weight now, and I don’t know what it’s done to my metabolism, but I just can’t seem to put any on, because I think I went too far.’

‘Ozempic neck’ finds itself added to a growing list of terms that describe the often irreversible – if you remain slim – consequences of being half the person you once were. 

There’s already ‘Ozempic feet’, referring to sagging or aging skin on the feet due to rapid fat loss – ‘Ozempic face’ and ‘Ozempic butt’, both caused by dramatic reductions in body fat. 

Ozempic and other alternatives like Mounjaro and Wegovy are all different brand names for the drug semaglutide that mimics the the actions of GLP-1 – a hormone in the brain that regulates appetite and feelings of fullness

Weekly doses of these blockbuster weight loss medicines can help people shed 15 to 20 per cent of their body weight on average.

While the physical side effects while taking such drugs have been well documented – ranging from nausea to bloating and constipation, there’s an increasing school of thought that such rapid weight-loss will definitely take off the pounds – but it can also pile on the years. 

Like the face, the neck is one of the most visible parts of the human body, and is amongst the first place that ageing is obvious.

Why is the nape and under the jaw so vulnerable to being negatively transformed by weight-loss? 

Aesthetic doctor, Dr Emma Goulding, who runs her own clinic in Cheshire, explains, telling the Daily Mail: ‘The neck has much thinner skin, less oil production and less underlying support than the face, so when fat is lost quickly, especially in midlife and beyond, the skin often can’t bounce back as smoothly.  

‘Ozempic neck is really the skin reacting to rapid weight loss combined with age, which causes reduced elasticity. 

‘That’s when fine lines, creasing and laxity start to show.’

Which other celebrities have struggled with the cosmetic downsides? 

Robbie Williams revealed he lost 25lbs – nearly 2 stone – using weight-loss drugs but some fans were left concerned by the Take That star’s ‘skinny’ appearance in his 2023 Netflix series.

While Ozempic neck is much more likely in older patients, some cosmetic doctors say they’re also seeing requests to remedy sagging neck skin in much younger patients.  

Consultant plastic surgeon Mr Paul Tulley says a ‘growing number of patients in their 20s Many now view early treatment as a preventative approach rather than waiting until signs become more pronounced. The openness of celebrities and influencers discussing their own treatments has helped remove a lot of the previous stigma.’

For some, if it’s been a major amount of weight lost, their neck is likely to look different to the way it has for their entire adult life. 

Says Dr Victoria Manning, Cosmetic Doctor at The Cosmetic Skin Clinic: ‘What’s particularly interesting is that many people are discovering they actually have necks – not just “fnecks” where the face morphs directly into the neck. 

‘When you lose significant weight, suddenly there’s definition where there wasn’t before, but along with that comes loose, crepey skin that people weren’t prepared for. 

and 30s are becoming increasingly concerned about the appearance of their neck.’

The neck has become one of the most challenging areas to treat because the skin there is so delicate and prone to laxity.’ 

So, if surgery or cosmetic ‘tweakments’ are the only way to rid yourself of ‘Ozempic neck’, where should you begin? 

Dr Emma Goulding says: ‘The good news is that treatments which stimulate collagen, such as radiofrequency, ultrasound skin tightening and injectable bio stimulators, can significantly improve firmness and texture. 

‘The best results tend to come from starting early and taking a gradual, medically guided approach.’

Is prevention better than cure? 

It’s not quite as straightforward as that, explains Dr Ed Robinson, who runs a Harley Street aesthetic clinic, but he advises there are definitely steps you can take while your weight-loss journey is happening. 

He tells the Daily Mail: ‘Aim for slower, steadier change where appropriate. If weight loss is very rapid, skin contraction often lags behind. A slower trajectory can sometimes be kinder to the neck.’

Dr Robinson says having a conversation with whoever’s prescribing your weight loss drugs about how often you take the drugs could help. 

‘And consider your lifestyle factors, prioritising dietary proteins as this supports lean mass and skin building blocks. 

‘Resistance training also helps to preserve muscle mass, which reduces the “deflated” look overall. Make sure to apply daily SPF 50 on the neck – most people miss this area!’

Daily Mail

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Health

Saudi Arabia approve Anktiva for advanced lung cancer

Saudi Arabia became the first country in the world to grant conditional regulatory approval for Anktiva as a treatment for advanced non-small cell lung cancer, according to the Saudi Food and Drug Authority.

The Saudi Food and Drug Authority has granted conditional approval for Anktiva (nogapendekin alfa inbakicept) to be used alongside immunotherapy in adults with metastatic non-small cell lung cancer whose disease has progressed despite prior treatment. It is the first regulatory authority worldwide to approve the drug for this indication.

In a parallel decision, the authority also approved Anktiva in combination with Bacillus Calmette-Guérin (BCG) for adults with high-risk, BCG-unresponsive non-muscle-invasive bladder cancer with carcinoma in situ, a group of patients with limited remaining options.

Anktiva works through a novel mechanism that targets the interleukin-15 (IL-15) receptor, stimulating the body’s immune defences by activating natural killer cells and key T-cell populations involved in fighting cancer, while avoiding the expansion of immune-suppressive regulatory T cells.

For lung cancer patients, the drug is administered by subcutaneous injection. In bladder cancer, it is delivered directly into the bladder, allowing treatment to be concentrated at the disease site.

The conditional approval for lung cancer was based on results from a single-arm clinical study involving patients who had failed one or more previous treatments, including immune checkpoint inhibitors.

The trial suggested a potential survival benefit, prompting regulators to allow the drug’s use while requiring a confirmatory study to verify long-term clinical benefit.

In bladder cancer, clinical trials showed a complete response rate of 62 per cent, with approval granted on the basis of this primary endpoint. Regulators said the results supported Anktiva as a meaningful new option for patients facing disease progression or radical surgery.

According to the SFDA, the most common side effects in bladder cancer studies included painful or difficult urination, blood in the urine, urinary urgency, elevated creatinine levels and urinary tract infections. Other reported effects included fever, chills, muscle and bone pain, and increased potassium levels.

In lung cancer trials, patients most frequently experienced injection-site reactions, fatigue, fever, nausea, chills, flu-like symptoms and reduced appetite.

GN

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Health

Cervical Cancer: Why Vaccination and Screening Can Save Lives

Cervical cancer is a malignant disease that develops in the cervix, the lower portion of the uterus that connects to the vagina. It occurs when abnormal cells in the lining of the cervix begin to grow uncontrollably. Unlike many other cancers, cervical cancer develops slowly, often over many years, progressing from precancerous cellular changes to invasive disease. This long development period makes cervical cancer one of the most preventable and treatable cancers when appropriate screening and preventive measures are in place.

Globally, cervical cancer remains a significant public health concern. It is the fourth most common cancer among women worldwide,after breast, colorectal, and lung cancers. Each year, hundreds of thousands of new cases are diagnosed, and the disease causes a substantial number of cancer-related deaths. The global burden is disproportionately higher in low- and middle-income countries, where limited access to healthcare services, screening programs, and vaccination contributes to late diagnosis and poor outcomes. 

The primary cause of cervical cancer is persistent infection with high-risk types of the Human Papillomavirus (HPV), a very common sexually transmitted infection. HPV is a DNA virus which is spread by skin to skin contact. There are over 100 subtypes, most of which do not cause significant disease in humans. Nearly all cases of cervical cancer are linked to HPV, with the majority of diagnoses being linked to HPV types 16 and 18 – to name a few .  While most HPV infections resolve on their own without causing harm, long term infection with high risk strains can lead to abnormal cellular changes in the cervix that may progress to cancer if left untreated.

Several factors increase the risk of developing cervical cancer. These include smoking, which weakens the immune system’s ability to clear HPV infections; a weakened immune system due to conditions such as HIV; long-term use of oral contraceptives; early onset of sexual activity; multiple pregnancies; and limited access to regular screening. Socioeconomic factors and lack of awareness also play a role in delayed diagnosis.

In its early stages, cervical cancer often causes no noticeable symptoms, which is why regular screening is crucial. As the disease progresses, symptoms may include abnormal vaginal bleeding (such as bleeding between periods, after sexual intercourse, or after menopause), unusual vaginal discharge, pelvic pain, or pain during intercourse. These symptoms are not exclusive to cervical cancer but should always prompt medical evaluation.

Cervical cancer is highly preventable through a combination of HPV vaccination and regular screening. The HPV vaccine is most effective when administered before exposure to the virus, typically between the ages of 9 and 14. Usually only 2 doses of the vaccine are required at this age, but if over the age of 15, 3 doses are needed. It provides strong protection against the HPV types most likely to cause cervical cancer. Many countries have incorporated the vaccine into their national immunisation programs as a key cancer prevention strategy. 

Screening methods such as the Pap smear and HPV testing can detect precancerous changes long before cancer develops. Regular screening allows healthcare providers to treat abnormal cells early, preventing progression to invasive cancer. When cervical cancer is detected at an early stage, treatment success rates are very high. Regular cervical screening decreases the risk of death from cervical cancer by 75%.

Compared to global figures, the incidence of cervical cancer in the United Arab Emirates is relatively low, reflecting the country’s strong healthcare infrastructure and growing emphasis on preventive medicine. However, cervical cancer remains a notable health issue. It is among the top five most common cancers affecting women in the UAE.

Despite the availability of advanced healthcare services, studies and health reports indicate that screening uptake among women in the UAE remains suboptimal. Cultural factors, lack of awareness, fear, and misconceptions about screening procedures can discourage women from undergoing routine Pap smears. As a result, some cases are diagnosed at later stages, when treatment becomes more complex.

The UAE has taken significant steps to reduce the burden of cervical cancer. HPV vaccination was introduced into the national immunisation program in 2018, initially targeting adolescent girls and later expanding to include boys. This reflects a long-term commitment to reducing HPV transmission and protecting future generations.

In addition, national and emirate level health authorities regularly conduct awareness campaigns, particularly during Cervical Cancer Awareness Month, to educate women about risk factors, symptoms, and the importance of screening. Public and private healthcare facilities across the country offer Pap smear and HPV testing services, often at subsidised rates or as part of routine health check-ups.

Conclusion

Cervical cancer is a largely preventable disease with well established methods for early detection and effective treatment. While the global burden remains high, especially in developing regions, countries like the UAE have made notable progress through vaccination, screening programs, and public health initiatives. Continued efforts to increase awareness, improve screening participation, and promote HPV vaccination are essential to further reduce incidence and mortality. With sustained commitment, cervical cancer has the potential to become a rare disease in the UAE, safeguarding the health and well being of women across the nation.

By Dr Dalia Aziz, Consultant Obstetrics & Gynaecologist at NMC Royal Hospital, DIP & NMC Royal Medical Centre, The Palm

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