Introduction: Periodic breathing (PB) is considered physiological in the neonatal period but must disappear in the first months of life. Few data regarding PB after the neonatal period are available. The objective of this study was to describe the clinical and polysomnographic characteristics of infants presenting with PB after the age of 1 month. Methods: This French multicenter retrospective case series included infants born at term between 2012 and 2021, without underlying disease, and who presented during a polysomnography (PSG) recording more than 1% of PB after 1 month of life. Results: Overall, 10 infants were included, they underwent a PSG for brief resolved unexplained event, desaturation, pauses in breathing, cyanosis, and/or signs of respiratory distress. The percentage of total sleep time spent with PB was 18.1% before 3 months (n=7), 4.7% between 3 and 6 months (n=10), 7.1% between 7 and 12 months (n=2), and 0% after 12 months (n=2). During the first PSG, ≥ 3% desaturations were observed in 77% to 100% of the PB episodes. At the first PSG, 9/10 infants had an obstructive apnea hypopnea index > 10/h and 5/10 had a central apnea index > 5/h. Gastro-esophageal reflux (GER) was suspected in 8/10 infants. All infants showed improvement in initial symptoms during the first year of life. Conclusion: Although PB is rare after 1 month of age, the present study shows that when present, PB is most frequently associated with obstructive and/or central apnea syndrome in term infants without comorbidities other than GER.

A 5-year-old girl had poor growth and unresolving pneumonia. There was persistent collapse-consolidation of the right middle lobe. CT thorax revealed bilateral bronchial wall thickening and dilatation. Bronchoscopy showed numerous endobronchial mucosal nodules, consisting of dense lymphoid infiltrates. Bacterial culture of the nodule biopsy suggested endobronchial actinomycosis. She had T-cell lymphopenia. Genetic test confirmed the diagnosis of activated phosphatidylinositol 3-kinase delta syndrome (APDS), an immunodeficiency condition.

Background: People with cystic fibrosis (PwCF) have chronic lung disease and may be at increased risk of COVID-19-related morbidity and mortality. This study aimed to determine seroprevalence and clinical characteristics of SARS-CoV-2 infection in children with CF, and to assess antibody responses following SARS-CoV-2 infection or vaccination. Methods: Children and adolescents with CF followed at Seattle Children’s Hospital were enrolled between July 20, 2020 and February 28, 2021. SARS-CoV-2 serostatus was determined on enrollment, at 6 and 11 months (+/-2 months) for nucleocapsid and spike IgG. Participants completed intake and weekly surveys inquiring about SARS-CoV-2 exposures, viral/respiratory illnesses, and symptoms. Results: Of 125 PwCF enrolled, 14 (11%) had positive SARS-CoV-2 antibodies consistent with recent or past infection. Seropositive participants were more likely to identify as Hispanic (29% vs 8%, p=0.04) and have pulmonary exacerbations requiring oral antibiotics in the year prior (71% vs 41%, p = 0.04). Five seropositive individuals (35.7%) were asymptomatic, while six (42.9%) reported mild symptoms, primarily cough and nasal congestion. Anti-spike protein IgG levels were approximately 10-fold higher in participants following vaccination compared with participants who had natural infection alone (p < 0.0001) and resembled levels previously reported in the general population. Conclusions: A majority of PwCF have mild or no symptoms of SARS-CoV-2 making it difficult to distinguish from baseline respiratory symptoms. Hispanic PwCF may be disproportionately impacted, consistent with racial and ethnic COVID-19 disparities among the general US population. Vaccination in PwCF generated antibody responses similar to those previously reported in the general population.

Existing research has found that individuals with higher relationship quality in intimate relationships tend to exhibit higher levels of tacit understanding and better interpersonal coordination in social interactions. However, the cognitive neural mechanisms between intimate relationship quality and interpersonal coordination are unclear. We thus argued that interpersonal neural synchronization during interpersonal interactions is an important mediator of intimacy quality and interpersonal coordination. To test this hypothesis, interpersonal neural synchrony and interpersonal coordination were measured in heterosexual dating couples during the completion of a jigsaw puzzle interaction task using an EEG-based hyperscanning technique. A total of 33 couples’ data were included in the analysis. The results showed that β-band synchronization in the left sensorimotor cortex of both members of a romantic couple fully mediated the relationship between intimacy quality and interpersonal coordination during the jigsaw puzzle task. In addition, we found that intimacy quality significantly predicted interpersonal neural synchrony in a jigsaw puzzle task with interaction but not in a jigsaw puzzle task without interaction. These findings support the idea that intimacy is a result of interindividual interactions and that interpersonal neural synchronization during interactions plays an important role in relationship quality and interpersonal coordination.

With the ever-changing social environment, individual creativity is facing a severe challenge induced by stress. However, little is known about the physiological mechanisms by which acute stress affects creative cognitive processing. The current study explored the effects of neuroendocrine response on creativity under stress and its underlying cognitive flexibility mechanisms. The Enzyme-Linked Immuno Sorbent Assay was used to assess salivary cortisol, which acted as a marker of stress-induced activation of the hypothalamic-pituitary-adrenal (HPA) axis. Eye blink rate (EBR) and pupil diameter were measured as respective indicators of dopamine and noradrenaline released by activation of the sympathetic-adrenal medullary (SAM) axis. The Wisconsin Card Task (WCST) measured cognitive flexibility, while the Alternative Uses Task (AUT) and the Remote Association Task (RAT) measured separately divergent and convergent thinking in creativity. Results showed higher cortisol increments following acute stress induction in the stress group compared to the control group. Ocular results showed that the stress manipulation significantly increased EBR and pupil diameter compared to controls, reflecting increased SAM activity. Further analysis revealed that stress-released cortisol impaired the originality component of the AUT by increasing perspective errors of the WCST. Serial mediation analyses showed that both EBR and pupil diameter were also associated with increased perspective errors leading to poor originality on the AUT. These findings confirm that physiological arousal under stress can impair divergent thinking through the regulation of different neuroendocrine pathways, in which the deterioration of flexible switching plays an important mediating role.

Background Rising costs of medical service and the need to better utilize limited resources makes the pursuit of hospital efficiency a key objective for healthcare systems. There is inconsistent evidence regarding the comparison of hospital efficiency. In China, limited research has been conducted in comparing the efficiency of Chinese public and private hospitals at the county-level, especially in western China where national GDP falls in the lowest quartile. Method We selected county-level hospitals from one western province by convenience sampling and conducted questionnaire survey in 2018. We first measured efficiency for the hospitals by bootstrap data envelopment analysis (DEA) with the following input variables: hospital bed, expensive equipment, medical staff and operating expenditure, and output variables revenue from outpatient and inpatient services; the efficiency scores were compared statistically between public and private hospitals by normality and non-parametric tests. Then we conducted bootstrap truncated regression on the estimated efficiency scores against environmental and institutional factors. Results Sixty-four county hospitals from 30 counties across the province were included in the study: 52 public hospitals, and 12 private hospitals. Relative efficiency was estimated to be 0.83 for public hospitals, and 0.96 for private hospitals, with statistically significant difference (p=0.001). Approximately 25.0% and 83.3% of public and private hospitals, respectively, were efficient. The truncated regression showed that being a private hospital (p<0.001), higher physician-nurse ratio (p=0.007), and higher revenue from outpatient services (p=0.041) were able to increase the efficiency by 0.158 (0.116, 0.199), 0.305 (0.190, 0.420), and 0.253 (0.129, 0.378), respectively. Conclusion The overall efficiency of the county level hospitals in a western province of China in 2018 was low. Private county hospitals were significantly more efficient than their public counterparts. Outpatient service revenue and physician nurse ratio were determinants of county hospital efficiency and may serve as future policy intervention targets.

Objective. To analyze the performance of intra-operative neurophysiological monitoring (IONM) including somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) in patients with pre-operative neurological deficit and to identify the high-risk factors for failed IONM. Methods. Patients with pre-operative neurological deficit undergoing spinal surgery between October 2010 and August 2019 were retrospectively reviewed. The presence or absence of SEP and MEP of target muscles were separately recorded and the high-risk factors for failed IONM results were investigated. Results. A total of 136 patients (86 males, 50 females) with an average age of 43.0±17.7 years were included. The muscle strength of recorded muscles in 272 lower extremities included grade 1 in 25 muscles, grade 2 in 15, grade 3 in 41, grade 4 in 134 and grade 5 in 57. The SEP records were available in 177 (65.1%) lower extremities while MEP records were available in 199 (73.2%) lower extremities. Significantly higher success rates of SEP and MEP were obtained in lower extremities with muscle strength of grade 4-5 than those of grade 1-3 (P<0.001). Patients with spinal trauma and cervical spinal stenosis were associated with more prevalent failed IONM results. Conclusions. The overall success rates of SEP and MEP were 65.1% and 73.2%, respectively. The high-risk indicators for failed IONM results included muscle strength lower than grade 4, spinal trauma and cervical spinal stenosis.

C. Abstract AIM: Sevoflurane is an ether-based inhalational anesthetic that induces and maintains general anesthesia. Our study aimed to detect sevoflurane-induced nephrogenic diabetes insipidus using Data Mining Algorithms (DMAs) and molecular docking. The FAERS database was analyzed using OpenVigil 2.1 for disproportionality analysis. Methods: We analyzed FAERS data from 2004 to 2022 to determine the incidence of nephrogenic diabetes insipidus associated with sevoflurane. Reporting Odds Ratios (RORs) and Proportional Odds Ratios (PRRs) with 95% confidence intervals were calculated. We also used molecular docking with AutoDock Vina to examine sevoflurane’s binding affinity to relevant receptors. Results: A total of 554 nephrogenic diabetes insipidus cases were reported in FAERS, of which 2.5% (14 cases) were associated with sevoflurane. Positive signals were observed for sevoflurane with reporting odds ratios (ROR) of 76.012 (95% CI: 44.67-129.35) and proportional odds ratios (PRR) of 75.72 (Chi-sq: 934.688). Of the 14 cases, 50% required hospitalization, 14% resulted in death, and the remaining cases were categorized as other outcomes. Molecular docking analysis showed that sevoflurane exhibited high binding affinity towards AQP2 (4NEF) and AVRP2 (6U1N) with docking scores of -4.9 and -5.3, respectively. Conclusion: Sevoflurane use is significantly associated with the incidence of nephrogenic diabetes insipidus. Healthcare professionals should be cautious when using this medication and report any adverse events to regulatory agencies. Further research is needed to validate these findings and identify risk factors while performing statistical adjustments to prevent false-positives. Clinical monitoring is crucial to validate potential adverse effects of Sevoflurane.

Microhabitat selection in patchy environments supports the co-existence of closely related species competing for resources. We examined niche partitioning in three sympatric species of pikas, Ochotona macrotis, Ochotona nubrica, and Ochotona ladacensis from Ladakh, India, that display contrasting lifestyles, social behavior and co-occur at small spatial scales. We used a classical paired quadrat approach to document biologically relevant vegetation and landscape features (niches) likely to support the presence of different species. We used a Bayesian framework to describe niche spaces , estimate niche widths and overlaps between species pairs. In addition, we used a GLM framework to identify factors that promote the presence of different species in the landscape. The rock-dwelling Ochotona macrotis was a specialist, exclusively associated with microhabitats offering a good cover of large-sized rocks and no shrubs. The social, Ochotona nubrica, was a specialist found across elevations but associated exclusively with mature stands of scrub vegetation (Caragana sp in the South-East and Hippophae sp in the North-West) occupying a unique niche. The social Ochotona ladacensis, although an elevational specialist, was likely to be found in microhabitats of other species characterised by moderate rock cover and low-lying Caragana scrublands, in addition to being found in alpine grasslands and meadows.

This letter proposes a Ku-band voltage-controlled oscillator (VCO) equipped with low-dropout (LDO) based amplitude control, fabricated in the 0.18μm CMOS process. The LDO regulator combines with the voltage distribution network to generate a stable supply of 1.8V and an internal bias voltage range of 0.64−0.72V to the VCO core. The VCO demonstrates an 11.6% tuning range from 15.69GHz to 17.62GHz. The measured phase noise of 17.62GHz carrier frequency is −111.2 dBc/Hz at 1MHz offset frequency while dissipating 3.5mA from 1.8V voltage regulator output, yielding a Figure-of-Merit of 189.4. The whole chip size is 0.6 mm2, including testing pads.

A low-power wideband self-biased phase-locked loop (SPLL) is proposed for multi-protocol SerDes applications in this letter. With the proposed adaptive fast-locking current circuit (AFLCC), the settling time is reduced significantly, and no extra power and jitter contribution. In addition, a start-up module is adopted to reset the system to an optimal initial operating frequency quickly. The proposed 1-3-GHz SPLL, fabricated in TSMC 28-nm CMOS process and occupies a compact 0.028mm2 area. It achieves a roughly constant settling time of 5 μs over all frequencies and division ratios range. Only 0.96 mW is consumed from a 0.9 V supply at 1 GHz frequency.

Photosynthetically carbon (C) allocation largely determines yield and C sequestration of agroecosystem. However, how C allocation of crops responses to climate change at the long-time scale is poorly defined. Combining thirteen years of eddy covariance and inventory measurements, we comprehensively investigated C allocation mechanism in a winter-wheat and summer-maize double cropping field. Significantly increased gross primary production (GPP) was benefited from CO2 fertilization, and 35% of increased GPP transferred to strengthening C sequestration. However, elevated temperature and drying surface soil moisture stimulated the partitioning of GPP to autotrophic respiration, resulted in conservative net primary production and grain yield. Maize faced a greater risk of C loss and yield reduction than wheat to warming and drying. By synthesizing published long-term data of agroecosystems, we further highlight that the GPP partitioning cannot be simply predicted by allometric theory, particularly for grains, which should be considered in predicting C budget and crop yield.

Background Yellow fever is a viral illness caused by an RNA virus from the Flavivirus genus, which is transmitted between humans and Aedes aegypti mosquitoes. Although the virus often spreads through a specific transmission method (Sylvatic Cycle), it can also cause a generally brief illness in infected individuals. Methodology The study was designed as a cross-sectional investigation that analyzed stored Lassa fever PCR negative febrile samples. Randomly, 40 samples were selected and enrolled in the study. The RT-PCR technique was employed to convert the RNA virus to a complementary RNA and subsequently amplify it. The Quagen Analysis was used to analyze the results of the FAM (yellow fever-specific RNA) and the JOE (internal control). Results After analyzing the samples, the results revealed that none of the studied samples were positive for the Yellow Fever virus. Conclusion The study concluded that there was no evidence of yellow fever transmission among the population in Owo, Nigeria. The findings suggest that the virus’s spread has been significantly controlled through vaccination programs in the community.

Drug-resistance mutations (DRM) of HBV in HIV coinfected patients undergoing HAART are complex and incompletely understood. We aim to determine the prevalence of HBV, HBV genotypes, and DRM in a cohort of HIV-infected patients in the northeast region of Colombia. This was a cross-sectional study in HIV patients between January 2010 and July 2011. Virological, immunological and HAART were collected from clinical records. An in-house nested PCR of HBV pol gene was used to identify coinfections, genotypes, DRM and HBV s antigen (HBsAg) escape mutants. Out of 275 subjects, 11.6% were identified as HIV-HBV coinfections from which 3.3% were HBsAg positive. All HBV sequences (n=23) belonged to genotype F3. Among HIV/HBV coinfections, 71.9% had CD4+ T cell counts above 200 cells/mm 3 and 37.5% undetectable HIV viral loads. DRM rtL80I, rtL180M, and rtM204V, which confer resistance to Lamivudine, were found in all HBV isolates. Also, a rt236Y unknown mutation to Tenofovir was identified and HBsAg escape mutations were not observed. Most patients received first-generation HBV antiviral therapy with a low genetic barrier to resistance. In Summary, these findings highlight the importance of molecular HBV screening and new guidelines to overcome DRM and prevent HBV-related liver diseases.

Maintaining aircraft airworthiness to ensure the fleet's safe operation and maintain its readiness is critically dependent on accurate modelling and reliable predictions of fatigue crack growth. In this process a knowledge of the representative initial discontinuity sizes that cause fatigue crack nucleation and early growth in aircraft is essential. Here the effective pre-crack size of aluminium alloy 2024, from samples of aircraft production material and tested under aircraft spectra, are considered.

Asthma is the most common chronic disease in the respiratory system of children caused by abnormal immunity that responses to common antigens. Lonicerin exerts anti-inflammatory activity in other inflammatory models through targeting enhancer of zeste homolog 2 (EZH2) that is related to asthma. We sought to explore the role and mechanism of lonicerin in regulating allergic airway inflammation. Mice were intraperitoneally injected 10 μg ovalbumin (OVA) on postnatal day 5 (P5) and P10, and then inhaled 3% aerosolized OVA for 10 min every day on P18-20, to establish asthmatic mice model. Lonicerin (10 or 30 mg/kg) was given to mice by intragastric administration on P16-P20. Notably, the administration of lonicerin amended infiltration of inflammatory cells and mucus hypersecretion. OVA-specific IgE level, inflammatory cell count and inflammatory cytokines in asthmatic mice were reduced after lonicerin treatment. Moreover, it suppressed the activity of EZH2 and activation of nuclear factor-kappa B (NF-ĸB) as evidenced by decreasing tri-methylation of histone H3 at lysine 27 (H3K27me3) and reducing nuclear translocation of NF-κB p65. In a word, Lonicerin may attenuate asthma by inhibiting EZH2/NF-κB signaling pathway.

Problem: Human papillomavirus infection is integral to developing invasive cervical cancer in the majority of patients. It is unclear how genetic susceptibility to HPV infection directs cervical disease development by affecting host immune response. In a recent genome-wide association study, rs9357152 and rs4243652 have been associated with seropositivity for HPV16 or HPV18, respectively. Methods: We investigate whether the two HPV susceptibility variants show association with subtype-specific cervical cancer in a genetic case-control study (rs9357152: N controls=560, N HPV16+cases= 334; rs4243652: N controls= 544, N HPV18+cases= 115). We further tested whether rs9357152 modulates gene expression of any of 36 genes at the human leukocyte antigen locus in 257 cervical tissues. Results: rs9357152 was associated with invasive HPV16+ve cancer (OR 1.30, 95% CI 1.01-1.66, P= 0.04) whereas rs4243652 was associated with HPV18+ve adenocarcinomas (OR=2.71, 95% CI=1.09-6.75, P= 0.03). rs9357152 was found to be an eQTL for HLA-DRB1 in HPV positive tissues (p ANOVA=0.0009), with the risk allele lowering mRNA levels. Conclusions: HPV seropositivity variants at chromosome 6 and 14 modulate subtype-specific cervical cancer risk. rs9357152 may exert its effect through regulating HLA-DRB1 in the presence of HPV.

We survey the diversity of antimicrobial resistance profiles of Escherichia coli ( E. coli) isolates and molecular genotypes by means of phylogenetic groups circulating in the environment, in sewage and receiving waters bodies as well as clinical isolates both from Boeotia regional district of Greece. The predominant resistant profile among all environmental isolates was to penicillins - ampicillin (AMP) and piperacillin (PIP). ESBLs resistance related profiles were observed both in environmental and clinical isolates. Phylogenetic group B2 was the predominant in clinical isolates, whilst group A was dominant in environmental isolates. We report that reclaimed river water and wastewater are reservoirs of R and MDR E. coli to commonly used antibiotics in clinical practice posing putative threats for human and animal health.

Mapping fluvial hydromorphology is an important part of defining river habitat. Mapping via field sampling or hydraulic modelling is however time consuming, and mapping hydromorphology directly from remote sensing data may offer an efficient solution. Here we present a system for automated classification of fluvial hydromorphology based on a deep learning classification scheme applied to aerial orthophotos. Using selected rivers in Norway, we show how surface flow patterns (smooth or rippled surfaces versus standing waves) can be classified in imagery using a trained convolutional neural network. We show how integration of these classified surface flow patterns with information on channel gradient, obtained from airborne topographic LiDAR data, can be used to compartmentalize the rivers into hydromorphological units that represent the dominant flow features. Automated classifications were consistent with those produced manually. They were found to be discharge-dependent, showing the temporally dynamic aspect of hydromorphology. The proposed system is quick, flexible, generalizable, and free from researcher-subjectivity. The deep learning approach used here can be customized to provide more detailed information on flow features, such as delineating between standing waves and advective diffusion of air bubbles/foam, to provide a more refined classification of surface flow patterns, and the classification approach can be further advanced by inclusion of additional remote sensing methods that provide further information on hydromorphological features.

Background Local allergic rhinitis (LAR) is a condition involving a localized nasal allergic response in absence of systemic atopy. We aimed to describe clinical characteristics of LAR and non-allergic rhinitis (NAR) pediatric patients, their clinical evolution over a 7-year follow-up period and to study the role of basophil activation test (BAT), for the diagnosis of LAR. Methods Forty-four children with non-allergic rhinitis (NAR) were included (24 males, 20 females, aged under 15 years). Nasal allergen provocation test (NAPT) and BAT were performed with Dermatophagoides pteronyssinus and Phleum pratense. Results Seven patients (16%) were diagnosed of LAR. Seven reacted to D pteronyssinus and one also to P pratense. All LAR and 86% of NAR patients presented perennial symptoms. Fifty-seven percent of NAR and LAR patients referred persistent symptoms. Three LAR patients associated conjunctival symptoms. BAT was positive after stimulation with D pteronyssinus only in one LAR patient. On follow-up, 3 LAR patients and 10 of the 25 NAR patients who agreed to be retested, presented systemic sensitization. Conclusions LAR should be considered in children with NAR. Almost half of children with LAR and one fourth of NAR children will develop systemic sensitization over time. BAT shows low sensitivity for the diagnosis of LAR in children. Key message: Since sixteen percent of initially diagnosed as non-allergic rhinitis children present local allergic rhinitis, we suggest performance of nasal provocation test in those cases to achieve a correct diagnosis. Basophil activation test seems to be less sensitive for the diagnosis of local allergic rhinitis in children than in adults. Follow up over would be interesting since a significant number local allergic rhinitis children and non-allergic rhinitis children will eventually develop systemic sensitization to aeroallergens.

Undesired oscillation components appear in active and reactive powers, electromagnetic torque and DC-link voltage of doubly fed induction generators (DFIGs) connected to unbalanced grid voltage. These components oscillate at double source frequency as a result of negative sequence components in voltage and current. Different direct power control (DPC) techniques were studied in literatures to damp these oscillations. However, these techniques require sequence decomposition process, axes transformation of stator voltage/current and estimation of different power components which complicate the overall control system. This paper presents a simplified DPC of DFIGs in stationary reference frame under normal and unbalanced grid voltage. Decomposition process, axes transformation and compensation power terms are totally eliminated. Vector proportional- integral (VPI) controllers are designed to regulate stator active and reactive powers. The performance of the proposed DPC scheme using VPI and proportional-integral-resonant (PIR) controllers is analyzed and compared under different operating conditions. Bode diagram of open loop and closed loop control using VPI and PIR are studied to illustrate stability, steady state and transient response of the two controllers. Also, the performance of proposed technique and previous DPCs designed in synchronous reference frame is compared to prove the validity of proposed one. The results show that proposed DPC using VPI has superior performance in steady state and transient conditions with simple implementation.

A knowledge of the morphology of seeds and diaspores is an invaluable resource that has prompted the compilation of descriptions and/or images in a variety of media, including databases with standardized protocols for trait measurement. The pressing need for new solutions to solve environmental crises, together with advances in the application of machine learning and image analysis to solve ecological problems, call for an upgrade of the diaspore morphological datasets. Here, we present DiasMorph, a dataset of morphological traits and images of diaspores from 1,437 taxa in 513 genera, and 96 families from Central Europe, totalling 94,214 records. Moreover, DiasMorph compiles information on quantitative morphological traits extracted from the images following a standardized and reproducible image analysis method, and include not only traditional morphometric measurements, but also colour, and shape features made available for the first time in a large dataset. The quantitative traits records correspond to measurements of individual diaspores, an input currently unavailable in traits databases that will allow for several approaches to be used for a complete exploration of the morphological traits of these species. We also included information on the presence and absence of appendages and structures in the diaspores of the evaluated taxa. By making these data available, we aim to encourage initiatives to advance on new tools for diaspore identification, further our understanding of morphological traits functions, and provide means for the continuous development of image analyses applications. Keywords: diaspore appendages, dispersal unit, image dataset, plant traits dataset, seed colour, seed morphology, seed shape, seed size, seed traits.

Article Reviewed: Title: "Sleep paralysis and trauma, psychiatric symptoms and disorders in an adult African American population attending primary medical care." Authors: Johnson EO, Roth T, Breslau N. Journal: Sleep, 2006 Jun;29(6):671-8. This research paper investigates the prevalence of sleep paralysis and its relationship to trauma, psychiatric symptoms, and disorders in an adult African American population attending primary medical care. The study involved a cross-sectional survey of 1,007 participants who completed a structured interview and questionnaires about their sleep habits, trauma history, and psychiatric symptoms. Strengths: Large sample size: The study included a large sample of 1,007 participants, which increases the statistical power of the results and enhances the generalizability of the findings to the African American population. Comprehensive assessment: The research paper includes a comprehensive survey that gathered data on sleep habits, trauma history, and psychiatric symptoms from 1,007 participants. The study used a structured interview and questionnaires to comprehensively assess sleep paralysis, trauma history, and psychiatric symptoms and disorders, which provides a comprehensive understanding of the relationships between these variables. Statistical analysis: The study employed appropriate statistical analyses to assess the associations between sleep paralysis, trauma, and psychiatric symptoms and disorders, which enhances the validity of the findings. Well-structured methodology: The research paper's methodology was well-structured, with clear inclusion and exclusion criteria, and a comprehensive data collection process that included multiple measures to ensure the validity and reliability of the data. Novel findings: The research paper's findings that sleep paralysis is associated with trauma and PTSD are novel, and add to the current understanding of the relationship between sleep disturbances and psychiatric symptoms. Weaknesses: Cross-sectional design: The study has a cross-sectional design, which limits the ability to determine the causality between sleep paralysis, trauma, and psychiatric symptoms and disorders. Self-report measures: The study relied on self-report measures to assess sleep paralysis, trauma history, and psychiatric symptoms and disorders, which may be subject to reporting bias and may not accurately reflect the true prevalence or severity of these variables. Limited generalizability: The study was conducted on an African American population attending primary medical care, which may limit the generalizability of the findings to other populations or settings. Potential for bias: The research paper's reliance on self-reported measures may be subject to bias and may not accurately reflect the true prevalence of sleep paralysis or other variables measured. Conclusion: Overall, "Sleep paralysis and trauma, psychiatric symptoms and disorders in an adult African American population attending primary medical care" is a well-designed study that provides valuable insights into the relationships between sleep paralysis, trauma, and psychiatric symptoms and disorders in an African American population attending primary medical care. However, the study's cross-sectional design, self-report measures, and limited generalizability are potential limitations that should be considered in interpreting the findings\cite{pubmeda} \cite{denis2018}\cite{Denis_2018}\cite{Denis_2018a}\cite{Mainieri_2021}\cite{Wr_bel_Knybel_2022}\cite{SZKLO_COXE_2007}\cite{SZKLO_COXE_2007}\cite{Wr_bel_Knybel_2022}

Introduction:Malaria infects humans through the bite of the Anopheles mosquito that transmits the Plasmodium parasite. There are five species of plasmodium: falciparum, vivax, ovale , Malariae and Knowlesi[1]. Some Authors have suggested that Malarial splenic complications are associated with plasmodium vivax infection[2] Malaria infection alone has the greatest impact on global health, affecting more than 500 million individuals with more than 2.5 million deaths every year. It can manifest as an acute febrile illness, but it can lead to severe complications such as shock, respiratory distress, severe anemia, convulsions, intra-abdominal organ inflammation, and bleeding caused by spontaneous splenic rupture [3] According to the WHO, malaria is endemic in Sudan, and over 1.8 million cases have been reported in 2019, representing 12.4% of all diseases surveyed by the health sector with a mortality rate of 13 per 10,000. [4]. Malarial infection incidence in Sudan was estimated to be 9 million cases per year in 2007 with 44,000 deaths related to malaria complications[5]. The spleen plays an important role in immunity against malaria by producing antibodies against malaria parasites, this can lead to splenic enlargement making it more susceptible to complications such as hematoma formation and rupture [6].