Timing of corticosteroids in non-severe non-hospitalized COVID-19 patients: open-label, two-center, randomized controlled study (TICS-COV19 study)

Background/Aims@#Corticosteroids (CSs) are frequently used in coronavirus disease 2019 (COVID-19); however, their utility remains controversial in mild to moderate cases. The timing of CSs initiation during the disease course remains unaddressed. The study aims to evaluate the impact of early CSs in non-severe COVID-19. @*Methods@#A randomized controlled, open-label study was conducted on 754 COVID-19 patients randomized into a study group (n = 377) in which patients received CSs with COVID-19 protocol and a control group (n = 377) in which patients received COVID-19 protocol only. @*Results@#Both groups were comparable regarding baseline characteristics, presenting symptoms, and inflammatory markers. The composite endpoint (need for O2, need for hospitalization or 28-day mortality) was significantly (p = 0.004) lower in the CS group 42 (11.14%) versus the control group 70 (18.67%) with odds ratio 0.55 (95% confidence interval [CI], 0.36 to 0.83), absolute risk reduction 7.53% (95% CI, 2.46% to 12.59%) and number needed to treat of 13.29 (95% CI, 7.94 to 40.61). Regarding severity at day 10, only (11.1%) of the study group patients were severe versus (18.7%) of the control group patients (p < 0.001). The median time-to-return to daily activity in the CS group was 8.0 days, while in the control group, it was 22.0 days (p < 0.001). @*Conclusions@#In non-severe COVID-19, CS may decrease hospitalization, severity, and mortality.

Comparative Study between the Effect of Perineural versus Intravascular Dexmedetomidine in Ultrasound-Guided Supraclavicular Brachial Plexus Block

Background:Augmentation of postoperative analgesia with various adjuvants has become a standard in regional anesthesia. There are no studies about dexmedetomidine multiple approaches in supraclavicular brachial plexus block (BPB) was contrasted. We compare perineural dexmedetomidine and intravenous dexmedetomidine Bupivacaine as adjuvant in supraclavicular brachial plexus block.Materials and Methods: This prospective randomized controlled double-blind study was conducted on 120 patients with age between 20 and 60 years, both sexes, scheduled for elective upper limb surgery. Patients were randomly allocated into 3 groups, 40 patients in each received plain bupivacaine 0.5% (20ml) in supraclavicular BPB; group I (Control group): add 1mL normal saline perineural, group II: Bupivacaine with perineural dexmedetomidine (BDP) add 1 μg.kg 1dexmedetomidine perineurally. group III: Bupivacaine with intravenous dexmedetomidine (BDV) add 0.5 μg.kg-1 dexmedetomidine in 50 mL of normal saline administered as infusion over 10 min.Onset and duration of sensory and motor blocks, hemodynamic variables, adverse effects, and duration of analgesia were assessed.Results:Heart rate and mean arterial pressure was significantly decrease in group III &group II compared to group I were compared by ANOVA (F) test. onset of sensory &motor block was statistically significant shorter in group II compared to group I & III. Duration of sensory &motor block was statistically significant longer in group II compared to group I & III. there was statistically significant decrease VAS in group II were analysed using Kruskal-Wallis test between three groups. There was statistically significant increase RSS in group II & III. The first time of analgesic request was statistically significant prolonged in duration in group II.Conclusion:Perineural dexmedetomidine (1 μg/ kg) as an adjuvant to bupivacaine is significantly high thanIV dexmedetomidine (0.5 μg/ kg) and bupivacaine alone in supraclavicular BPB as regards to the onset and the duration of sensory block, so Increasingpostoperative analgesia

Therapeutic effect of al-Quran murattal on anxiety, sFlt-1, PIGF and sFlt-1/PIGF ratio in pregnant women with risk of preeclampsia

Background: Pregnancy was a critical period. This study aimed to examine the effect of murattal al-Quran therapy on the level of anxiety, sFlt-1, and PIGF level in pregnant women with preeclampsia risk.Methods: A quasi-experimental study was conducted in February, 2018. Ten participants received routine midwifery care were combined with murattal of the Qur'an therapy, the rests as control group. Variables were measured at pre and post 12 interventions. Interviews were conducted after the intervention.Results: There was a mean difference of anxiety of 5.250 (SD of 11.021, 95% CI: 0.092-10,408, p-0.046), sFlt-1 p=0.411, PIGF p=0.002, sFlt-1/PIGF ratio p=0.001.Conclusions: This study found a decrease in the level of anxiety, increase score of PIGF and decrease of sFlt-1/PIGF ratio among pregnant women with the risk of preeclampsia who received routine midwifery care plus al-Quran Murattal therapy.

Radionuclide concentrations and excess lifetime cancer risk due to gamma radioactivity in tailing enriched soil around Maiganga coal mine, Northeast Nigeria

Background: Human activities such as mining enhance the radioactivity levels above normal background which can lead to an incremental increase in the radiation risk to the population

Materials and Methods: 20 tailing enriched soil samples collected around Maiganga coal mine, Gombe, Northeast Nigeria were assessed for their[226]Ra,[232]Th and [40]K contents using HPGe gamma-ray detector

Results: The mean activity values of 11.9013.0, 17.72+/-3.6 and 70.44+/-20.4 Bq kg[-1] were obtained for [226]Ra, [232]Th and [40]K respectively. These values were below the world average values documented by UNSCEAR. The ratio of [232]Th:[226]Ra obtained was 1.5, which showed that [232]Th activity was higher than the activity of [226]Ra while [40]K recorded the highest activity concentration in the studied samples. Statistical analysis identified strong positive relationships among all radiological parameters and confirmed that [225]Ra,[232]Th and [40]K were the major contributors to radiation dose. Radium equivalent activity [Ra[eg]], absorbed gamma dose rate [D[r]], annual effective dose [AEDE], activity utilization index [AUI], external and internal hazard indices [H[ex]] and H[in], gamma representative index [l[vr]], annual gonadal dose [AGDE] and excess lifetime cancer risk [ELCR] were calculated to quantify the radiation risk to the public from exposure to[226]Ra, [232]Th and [40]K in the studied samples. The mean values of these hazard parameters were within the acceptable limits provided for human safety and environmental protection

Concfusfon: The use of the raffing enrfcnecf soff sampfes of Maiganga coaf mine for any purpose whatsoever does not therefore pose any immediate radiological risk to the coaf workers or the general pubfic

Parasitological studies on some intestinal parasites in primary school children in Aswan Governorate, Egypt

This cross sectional study in Aswan Governorate determined the prevalence of intestinal parasites and to identify the risk factors for infection in primary school children in this geographical area. The results would facilitate evaluation of the endemic level of different intestinal parasites and the determination of whether widespread or focal measures of parasite control are required. After obtaining official permission from the school administration, information and consent forms were given to the parents of all the schoolchildren. They were three-hundreds children aged between 6-12 year were enrolled; a detailed questionnaire, complete clinical assessment complete as well as stool analysis was done The study showed that the over-all infection was 31%, single parasitic infection was 26% and mixed one was 5%.The commonest helminthic infection was E. vermicularis 6.6% followed by H. nana 3% Ascaris lumbricoides 1%, The commonest protozoa infection was E. histolytica 8.3% followed by Giardia lamblia 3.7% and Cryptosporidium parvum 1.7%. Mixed infection was E. vermicularis plus E. histolytica [23.4%], E vermicularis plus G. lamblia [17.6%], E. vermicularis plus C. parvum [11.8%], E. histolytica plus H. nana [11.85%], A. lumbricoides plus E. histolytica [17.6%] and G. lamblia plus E. histolytica. in [11.8%]. Parasitic infection was more prevalent in boys [53.8%] than girls [46.2%] and more prevalent in rural children [39.73%] than urban ones [20.13%] among age ranged from to 12 years [8.97+/-1.72]

Influenza virus positivity and circulating subtypes among cases of influenza-like illness and severe acute respiratory infection, Egypt, 2012-2015

Information on the prevalence of influenza, circulating virus subtypes and seasonality is essential for selecting strains for annual vaccines and for planning immunization programmes. Data were obtained from the 13 sentinel surveillance sites throughout Egypt during 2012-2015. Laboratory-confirmed influenza was found in 13% of cases of influenza-like illness [ILI] and 18% of cases of severe acute respiratory infection [SARI]; positivity for influenza was similar in cases of ILI and SARI in patients up to 15 years of age but increased for SARI and decreased for ILI in people aged >/- 15 years . The most commonly observed influenza virus subtypes were B followed by A/H3 in ILI cases, and A/H1N1 followed by B in SARI cases. The seasonality of influenza in ILI cases was November-February, and that in SARI cases was November-March, peaking in January

Effect of Tyrosine Phosphorylation Sites of Oncogenic Protein NPM-ALK on Cell Cycle and Its Related Mechanisms / 中国实验血液学杂志

<p><b>UNLABELLED</b>Objective：To explore the effect of tyrosine phosphorylation sites Tyr644 and Tyr664 in oncogenic protein NPM-ALK on cell cycle and its related mechanisms.</p><p><b>METHODS</b>Transiently transfected 293T cells and stably transfected Jurkat cells were used for analysis of cell cycle and protein after the transfection with the constructed recombinant plasmid pEGFP-N1, pEGFP-N1-NPM-ALK and pEGFP-N1-NPM-ALK(644, 664); soft agar assay for colony formation was performed to examine the different carcinogenicity of stable cell lines; cell viability of stable cell lines was examined by CCK-8 after the treatment with PPP.</p><p><b>RESULTS</b>The S arrest occurred in both NPM-ALK(644,664) transfected 293T and Jurkat cells; the susceptibility of NPM-ALK transfected Jurkat cells to PPP was highest among the 3 stable cell lines; the phosphorylated levels of AKT, ERK and STAT3 were decreased in NPM-ALK(644,664) cells compared with the NPM-ALK ones. Additionally, the double mutation induced the increase of CDK2 and the decrease of P27 (P<0.05).</p><p><b>CONCLUSION</b>The mutation of Tyr644 and 664 sites in NPM-ALK can induce cell cycle arrest in S phase and lower susceptibility to PPP that may be related with the phosphorylation change of cell growth related molecules in the downstream of NPM-ALK.</p>

Study of cases of children with mesangioproliferative glomerulonephritis attending Alexandria university children's hospital

Objective: the present study was conducted to study files of pediatric mesangioproliferative glomerulonephritis [MesPGN] cases attending Alexandria university children's hospital [AUCH] nephrology clinic during the period from [2001-2012] to identify their clinical presentations, course, complications, management and outcome

Methods: this was a retrospective study of children with MesPGN over the mentioned period. It included 37 patients. Data were collected from the files of all children diagnosed as having MesPGN and included personal characteristics, initial clinical presentation, investigations, renal biopsy reports, complications and treatment

Results: the mean age of disease onset in the studied cases was 4.51 years +/- 3.16. There was no significant difference in gender distribution. The most common presentation of primary MesPGN was nephrotic syndrome, while the secondary MesPGN mainly presented with lupus nephritis. Almost all patients had proteinuria. Hematuria was present in nearly half of the patients. Immunofluorescence studies were done only for 17 renal biopsies, 10 of them revealed deposits for immunoglobulins and 32.4% underwent remission while 10.8% died. Different treatment modalities were used according to the presentation

Conclusion: MesPGN is a heterogeneous disease with a wide range of presentations and its outcome varies accordingly, so it can't be considered a special entity like FSGS

Interleukin-10 level in occult hepatitis C virus infection in hemodialysis patient

Interleukin 10 is a critical immunoregulatory molecule, produced mainly by macrophage, Th2 and regulatory T cells, is a potent immunosuppressive cytokine with anti-inflammatory activity. Detection of the serum level of IL-10 in OCI in HD patients. 75 HD patients from HD units in Assiut university Hospital, were enrolled in this study, and IL-10 were measured in 8 patients with OCI, 68 HD without OCI and 10 normal subjects as a control. The level of IL-10 was highly significantly increased in HD patient with OCI than in HD patients without OCI [P< 0.001], and in HD patients than normal subject [P<0.001] There is significant increase as regarding ALT [P<0.001], AST [P< 0.001], in occult HCV infection in HD patients. Our data revealed a high serum level of IL-10 in occult HCV infection in HD patients with persistently abnormal elevated levels of liver enzymes than HD patients without OCI

Analytical evaluation of hepatitis c virus core antigen detection as a diagnostic test in diagnosis of HCV infection

The aim of the present study was to evaluate the efficacy of hepatitis C virus [HCV] core Ag assay by comparing it with anti-HCV antibodies and PCR-based technology for measuring viral load in diagnosis of HCV. HCV core Ag by ELISA in serum, in the presence or absence of anti-HCV antibodies was compared to HCV- RNA by PCR on total number of 100 subjects, divided into 3 groups; including 80 patients and 20 volunteers. The sensitivity of the test was [72.5%]] and the specificity was [86.6%]. Also positive predictive value of the test was [78.3%] and negative predictive value was [82.5%]. Core antigen detection by ELISA can be used as a reliable test for detection of vireamia in HCV infection

Viral causes of acute respiratory infection among Egyptian children hospitalized with severe acute asthma exacerbation

Background: Viral respiratory infections are associated with nearly 80% of asthma exacerbation episodes. These can have severe adverse outcomes in patients with established asthma

Aim: The aim of the study was to identify the viral causes of acute respiratory infection that precipitate acute asthma exacerbation in Egyptian asthmatic children

Patients and methods: The current prospective study was conducted in Cairo University Children's Hospitals from December 2010 to December 2011. All asthmatic children [n=130] aged 2-12 years admitted with asthma exacerbation due to severe lower respiratory tract infection were included. All cases were subjected to nasopharyngeal or throat swabs that were analyzed for common respiratory viruses, including respiratory syncytial virus [RSV], human metapneumovirus [hMPV], influenza B [Flu B], human parainfluenza virus [hPIV], influenza A [H1N1], and adenovirus [ADV] using the real-time PCR technique. All patients were followed up to record the outcome

Results: PCR analysis was positive for one respiratory virus in 54 asthmatic patients [41.5%] and was negative in 76 patients [58.5%], with a high predominance of RSV [51.9%] and hMPV [25.9%] especially in winter and early spring months. Hypoxia was detected in all patients with RSV infection; of these patients, 21.4% were admitted to the ICU, 14.3% required mechanical ventilation, and 14.3% died. In contrast, among those with hMPV infection, hypoxia was detected in 71.4%; none required ICU admission or mechanical ventilation

Conclusion and recommendations: Viral etiology of lower respiratory tract infections constitutes an important cause of acute asthma exacerbation in asthmatic children admitted to children's hospitals in Cairo, supporting the need for large-scale multicentric studies on asthmatic patients over multiple years using a wider-panel PCR for detection of respiratory viruses

[ effect of glass ionomer containing various levels of titanium dioxide nanoparticles against Streptococcus mutans]

The use of nanoparticles in improvement antibacterial property of dental resins is one of the most important issues in recent studies. Studies which added these particles to resin materials have reported desirable results in decreasing bacteria's growth. Titanium dioxide nanoparticles have been proposed for reinforcing fillers in dental resin composites and epoxy. The aim of this study was to evaluate the effect of adding titanium dioxide nanoparticles into a light cure glass ionomer on antibacterial properties of this resin against streptococcus mutans. In this in-vitro study, samples were divided into 5 light cure glass ionomergroups which contain respectively of 0 [as control group], 0.5, 1, 3, 5 weight percentage of nano-titanium dioxide. 15 discs [3 from each experimental group] were cured in plastic frames with 2mm thickness and 8mm diameter, for disc diffusion test. Then antibacterial properties against streptococcus mutans were studied in chocolate agar culture. For Direct Contact Test, 15 micro-tubes containing resin groups [3 discs from each experimental group] were prepared and their antibacterial effect were evaluated after 3, 6 and 24 hours. The data was analyzed by Kruskal-Wallis Test and Mann-Whitney Test. In Disc Diffusion Test the amount of antibacterial effect around discs, containing 0.5 nanoparticles was similar to halo around the other discs containing nanoparticles, and it was little more than control group. In Direct Contact Test, glass ionomers containing nanoparticles, number of bacteria was diminished on surface of resin groups that contain more percentages of nanoparticles at 3, 6, 24 hours,. Four experimental groups did not reveal any significant difference, but it was diminished in compare to control group. However the growth of bacteria in both tests in comparison with control group was decreased, antibacterial property of samples that contain nanoparticles doesn't show any significant difference. This property was more significant in direct contact with bacteria

[ effect of reflexology massage on disability in patients with chronic low back pain returnee to physical therapy unit in Baghiathallah hospital]

Introduction: Low back pain is a complaint in communities. Low back pain has negative effects on different aspects of the patient, s lives. Different methods used for reduction effects. Foot reflexology causes pain and disability reduction. This study conducted to examines effects of foot reflexology on disability in patients with low back pain

Methods: This study was clinical trial study and 3 groups. This study conducted 150 men with low back pain returnee to Baghiatallah hospital in Tehran. First men patients were selected by purposive sampling and then they with random allocation method had been divided into three groups: Experimental [foot reflexology was applied in real points once a week for three week], placebo [sham foot reflexology was applied low pressure in all points once a week for three weeks] and control [without any intervention]. Dates were collected by demographic questionnaire and Roland-Morris Disability Questionnaire. For analyze of data used SPSS v.18 and variance q squre

Results: The results indicated that disability before intervention in 3 groups not differences significant [P>0.05] but after intervention Variance showed mean of disability reduced in three groups [P<0.05]

Conclusion: In conclusion, the study showed foot reflexology effects of reduction of disability. So proposes for nurses to use foot reflexology for reduction of disability in patients with low back pain

Study the relationship of erythropoietin and chronic obstructive pulomonary disease

It has long been known that COPD causes polycythemia secondary to erythrocytosis caused by hypoxia present in advanced cases of COPD. However, it was shown in several studies that some COPD patients had anemia rather than erythrocytosis. Revealing the changes which occur in erythropoiesis in response to COPD was the aim of the current study. 41 COPD patients of different groups according to the inclusion and exclusion criteria and ten healthy control subjects age and sex matched were enrolled in the study. For all, history taking and full Clinical exam were performed, also ABGs, PFT [spirometry], routine labs [CBC, liver and renal function] and determination of EPO should be performed on human serum by ELISA. Showed that the erythropoietin level was 15.24 +/- 2.6 in stage 1, 22.61 +/- 5.68 in stage 2, 33.59 +/- 4, in stage 3, then 17.9 +/- 3.3 in stage 4. Also the total percentage of anemia in COPD patients was 46.3% [19/41], in comparison to 51.3% [21/41] non anemic and 2.4% [1/41] polycythemic. And that the percentage of anemia was 27.3% in stage 1, followed by 38.0% in stage 2, 100% in stage 3 then dropped to 58.33% in stage 4 with emergence of polycythemia in 8.33% of cases. Although COPD was thought to cause polycythemia, the current study showed that almost half of patients have anemia, and polycythemia occurred only in the advanced stages. It also appeared that response to erythropoietin in COPD is probably blunted especially with increased severity of the condition. This might be considered as a contributing factor in the development of anemia in COPD which is considered as anemia of chronic disease

[Evaluating the performance of Anaerobic Migrating Blanket Reactor [AMBR] in biodegradation of perchloroethylene [PCE]]

PCE is a chlorinated aliphatic hydrocarbon which has been widely used in some industries. The aim of this study was to determine the PCE biodegradation potential in anaerobic migrating blanket reactor [AMBR].In this study the concentration of PCE was more than that of other studies. So far AMBR has not been used for bioremediation of this compound. This study was an Experimental - laboratory study. A laboratory scale anaerobic migrating blanket reactor [AMBR] with a capacity of 10 L and with four compartments was used for biological degradation of PCE in synthetic substrate. Performance of the reactor was evaluated during 4 stages with PCE loading rate of 3.75 to 75 mgPCE/L.d. Excel software was used for data analysis. Optimum COD removal with 98% efficiency was obtained with COD loading of 3.1gCOD/L.d. For PCE removal, the optimum efficiency rate was 99.8% which was achieved with PCE loading rate of 37.5 mgPCE/L.d. The mean values for COD and PCE removal during the whole activity period of reactor were 91.4 and 99.5%, respectively. The results indicated that use of AMBR in full-scale studies using real industrial wastewater contaminated with PCE is a simple, efficient and reliable method for removal of PCE from industrial waste water

Abnormal temporomandibular joint radiographic findings in patients referred to department of oral and maxillofacial radiology, dental school, Shahid Beheshti University of Medical Sciences

Temporomandibular Joint disorders are relatively frequent in different societies. The purpose of the present study was to determine abnormal Temporomandibular Joint radiographic findings in patients referred to Dental School, Shahid Beheshti University. This descriptive cross-sectional study was done on 400 patients with no marked symptoms of temporomandibular joint disorders who met criteria of the study. Mean age of patient was 38.38. The data was collected by taking patients history, clinical evaluation while the panoramic radiographies were taken in standard conditions viewing by means of black-colored sheets .for statistical evaluation data was analyzed by chi- square and exact fisher tests. Flattening was the most observed abnormal finding with 16.3% incidence. Erosion, condylar hyperplasia, concavity, Bifid condyle,condylar hypoplasia and sclerosis respected were the most common abnormal findings in this study. There were no significant differences in the incidence of abnormal findings regarding the patient's gender, dental status and occlusion, but the prevalence of abnormal radiographic findings was significantly uprising as the age of the patients increased [P< 0.002]. The results demonstrated the incidence of abnormal radiographic findings in 34.4% of the patients referring to the studied center which shows a relatively high prevalence

Effects of preoperative beta-blocker on blood loss and blood transfusion during spinal surgeries with sodium nitroprusside-controlled hypotension

The present study sought to determine whether premedication with oral beta-blocker before hypotensive anesthesia with sodium nitroprusside could improve the quality of surgical field, decrease the blood loss, and decrease the need for homologous blood transfusion and duration of surgery. Eighty patients scheduled for spinal fixation surgery were included in a prospective, randomized, double-blinded study. Patients were classified into two groups: Group I received oral atenolol 50 mg twice one day before surgery; and Group II received placebo tablets identical in appearance to atenolol tablets for the same period and interval. All patients in both the groups received intraoperative sodium nitroprusside [SNP] as a hypotensive agent. Hemodynamic variables, amount of sodium nitroprusside used, quality of surgical field, and the amount of homologous blood transfusion and blood loss were compared between groups. Heart rate and amount of SNP used were significantly less [P < 0.0001] in the atenolol group, but no significant difference was found in intraoperative mean arterial blood pressure [MABP] between the two groups. The time of surgeries was significantly shorter in Group I than in Group II [185 +/- 15.21 vs 225 +/- 12.61 min], P < 0.0001. The quality of surgical field was better in Group I than in Group II in all times of measurements, P < 0.0001. The amount of blood loss and the amount of packed red blood cells transfused were significantly less in Group I than in Group II, P < 0.0001. No clinically significant complications were observed in either group. Premedication with oral atenolol 50 mg twice/day for one day before hypotensive anesthesia with SNP during spinal surgeries seems to be clinically safe and effective to reduce heart rate, amount of SNP used, amount of blood loss, and amount of blood transfused with better quality of surgical field

Synthesis of magnetite nanoparticles and evaluation of its efficiency for arsenic removal from simulated industrial waste water

In this study the efficiency of magnetic nanoparticles for removal of trivalent arsenic from synthetic industrial wastewater was evaluated. The nanoparticles was prepared by sol-gel method and characterized by X-ray methods including XRD, XRF, and SEM, and vibrating sample magnetometer [VSM]. The results showed that synthesized nanoparticles were in the size range of 40-300 nm, purity of about 90%, and magnetization of nanoparticles was 36.5emu/g. In initial conditions including: pH=7, As[III] concentration of 10 mg/L, nanomagnetite concentration of Ig/L, shaking speed of 250 rpm and 20 minute retention time, 82% of As [III] was removed. Competition from common coexisting ions such as Na[+], Ni[2+], Cu[2+], SO[4][2-], and Cl[-] was ignorable but for NO[3-] was significant. The adsorption data of magnetite nanoparticles fit well with Freundlich isotherm equations. The adsorption capacity of the Fe[3]O[4] for As [III] at pH=7 was obtained as 23.8 mg/g. It was concluded that magnetite nanoparticles have considerable potential in removal of As [III] from synthetic industrial wastewaters

Integrated Management of Childhood Illness in Lahej, Yemen: a qualitative analysis from the perspective of health providers

Health providers' perceptions about the Integrated Management of Childhood Illness [IMCI] in Lahej governorate, Yemen, were explored in a qualitative analysis of 12 in-depth interviews in 2007. The following themes emerged: appreciation of clinical aspects of IMCI but unclear about community IMCI; IMCI working better in peripheral than central health facilities; inflexible rules; lack of integration of services; poor supervision; multiple roles for one person; success of immunization; basic equipment and drug supplies deficient; conflicting views about health committees and community participation; and solutions for community health problems. After 4 years of IMCI experience in Yemen, the gaps identified would endanger the positive influence of IMCI unless action is undertaken at different levels