Diseases In Arab Countries Research Articles

Knowledge and Attitudes Toward Premarital Screening Programs Among Students at the University of Tripoli, Libya.

Despite the increase in hereditary disease in Arab countries due to the high rates of consanguineous marriages, research on community awareness of premarital screening (PMS) for disease carriers is still scarce. To investigate knowledge and attitudes towardgenetic PMS programs among university students in Libya. A cross-sectional study was conducted using a self-administered questionnaire distributed to 421 Libyan students aged 18-25 years at the University of Tripoli. Most of the participants (79%, n=316) agreed that a PMS program is important and expressed willingness to have PMS programs if they were advised to do so. Two-thirds of participants (67%, n=268)had heard of PMS programs, of whom (27.2%, n=73) heard of them from social media. Most of the university students had good knowledge of PMS but poor knowledge of the hereditary disease targeted by PMS. Most of them had a positive attitude toward PMS.

Prevalence of hypertension and hypertensive chronic kidney disease in Arab Countries

Prevalence of hypertension and hypertensive chronic kidney disease in Arab Countries

Evaluating knowledge, attitudes, and practices toward breast cancer and breast cancer screening among females in Arab countries of the Middle East: A systematic literature review.

e18761 Background: Among all types of cancer, breast cancer (BC) is the most diagnosed cancer in women and is the leading cause of cancer-related deaths in females globally. Developing countries possess approximately 60% to 70% of all worldwide breast cancer deaths. Despite the increasing efforts to expand awareness and encourage screening, breast cancer is still the most frequently diagnosed form of the disease in Arab countries. In this study, we aim to systematically review the knowledge, attitudes, and practices of middle-eastern Arab women toward the recognition of early breast cancer symptoms, risk factors, and screening. Methods: A literature search was conducted on PubMed and Scopus to identify relevant literature. Search terms included “Knowledge” OR “attitude” OR “practice” AND “breast cancer” AND “Arab region” OR “middle east region”, and other relevant and equivalent terms. All English language studies which achieved the inclusion criteria were included. Each article was independently screened by two researchers in two levels (title/abstract and full-text screening). Data extracted included, but was not limited to, country, study design, study population, sample size, level of knowledge, attitudes, practices, conclusions, and limitations for each study. Results: Out of the 1182 publications identified, 14 cross-sectional studies were included with respondents aged 15 and above. Study populations varied from females attending healthcare centers, to country residents and students. Five studies reported the level of overall BC knowledge, where respondents with low levels of knowledge ranged from 19.7% to 67%. The most chosen risk factors for BC were personal or family history (n = 5), and prior radiation (n = 2). A breast lump or mass was the most chosen warning sign (n = 5), followed by an armpit lump (n = 2). Regarding screening, women who had ever performed breast self-examination (BSE) ranged from 30.3% in Yemen to 57.5% in Oman, while those who consistently performed BSE ranged from 17.4% to 27.9%. Women who had ever undergone mammography ranged from 1.6% to 40%. Barriers to screening included system-related barriers (n = 2), feeling healthy (n = 2), fear of the results (n = 2), and others. Better screening practices were mostly associated with a higher level of education (n = 5), and personal or family history (n = 4). Conclusions: The majority of Arab women in the middle east had heard about breast cancer, but had a low level of knowledge, attitudes, and practices toward breast cancer and its screening methods, which was also variable among different counties. Multiple barriers to screening were found. Such findings can raise the need for programs that elevate knowledge, and provide accessible screening programs that solve for the barriers to screening in the Arab region.

The Impact of Date Syrup on the Physicochemical, Microbiological, and Sensory Properties, and Antioxidant Activity of Bio-Fermented Camel Milk

Fermented camel milk is rich in nutrients and vitamins necessary for the health of humans and has therapeutic properties. Date palm camel milk has been reported to be beneficial for preventing and treating various diseases in Arab countries. This study targeted the production of probiotic fermented camel milk fortified with date syrup. In addition, the effect of adding date syrup as a prebiotic and flavoring agent to probiotic fermented camel milk on the physicochemical, phytochemical, microbiological, and sensory properties of probiotic fermented camel milk during storage was investigated. Probiotic fermented camel milk without adding date syrup served as a control, and the other two treatments were supplemented with date syrup at ratios of 6.0% and 8.0%. Probiotic fermented camel milk was analyzed after 1 day and 15 days from storage at 5 ± 1 °C. Interestingly, the present study revealed that the addition of date syrup significantly (p ≥ 0.05) increased total solids (TS), ash, Na, K, Fe, acetaldehyde, total phenolic contents, and titratable acidity, viscosity, and antioxidant values of resultant synbiotic fermented camel milk, and this increase was proportional to the level of date syrup fortification. In addition, non-significant changes in these components were observed during the storage period. However, total protein and fat content did not show significant changes. Furthermore, the addition of date syrup significantly increased (p ≥ 0.05) the total bacterial and Bifidobacteria counts, and this increase was associated with the level of the addition of date syrup. The addition of date syrup also significantly (p ≥ 0.05) improved the sensory scores for flavor, consistency, appearance, and total scores of resultant products. Moreover, the addition of date syrup at a level of 8% showed the highest sensory scores. In conclusion, probiotic fermented camel milk could be produced using a probiotic strain and flavored with date syrup at a level of 8%.

The participation of Arab women in randomised clinical trials for cardiovascular diseases.

Women's enrolment in randomised clinical trials (RCTs) raises the attention of medical personnel and evidence-based medicine researchers to achieve the highest possible quality and transparency of conducted studies. This study aims to demonstrate various patterns and relationships of women's enrolment in cardiovascular RCTs conducted in Arab countries. Three databases (PubMed, Web of Science and Scopus) were accessed and searched for randomised clinical trials investigating cardiovascular diseases in Arab countries. Studies were screened, data were extracted and risk of bias of included studies was assessed independently by two sets of authors. The female to male ratio and the participation prevalence ratio (PPR) were calculated for each trial and the association of them with different variables were analysed. Of the 9071 patients enrolled in the 71 included RCTs, 38.02% were women. Various factors such as age of participants, publication year, therapeutic class, clinical indication, prevention type, and location of trial showed a significant association with the level of women enrolment in cardiovascular randomised clinical trials in Arab countries (P-value <.05). The median female to male ratio of all the trials was 0.55. The median female: male ratio varied by clinical indications (2.33 for valvular heart diseases vs 0.5 for stroke), intervention type (0.46 for surgical procedures vs 0.52 for drugs), prevention type (0.79 for secondary prevention, 0.74 for primary prevention and 0.52 for tertiary prevention), sample size (0.48 for Q1 vs 0.85 for Q2) and by age groups (0.98 for ages ≤50years old vs 0.47 for 56-60years old). Women were overrepresented in valvular heart disease trials (PPR = 1.37), and underrepresented in coronary artery disease, stroke and atrial fibrillation trials (PPR = 0.6, 0.63, and 0.71, respectively). As a result of the huge importance of RCTs in the medical field, and to reduce biases arising from inaccurate representation of different study populations, women's enrolment in Arab cardiovascular trials should be pre-planned and based on the percentage of women among the studied disease population.

Significant variants of type 2 diabetes in the Arabian Region through an Integration of exome databases.

Type 2 diabetes (T2D) is a major global health issue, and it has also become one of the major diseases in Arab countries. In addition to the exome databases that have already been established, whole exome sequencing data for the Greater Middle East are now available. To elucidate the genetic features of T2D in the Arabian Peninsula, we integrated two exome databases (gnomAD exome and the Greater Middle East Variome Project) with clinical information from the ClinVar. After the integration, we obtained 18 single nucleotide polymorphisms and found two statistically and clinically significant variants in two genes, SLC30A8 rs13266634 and KCNJ11 rs5219. Interestingly, the two genes are linked to the uptake of the metals, Zn and K respectively, which indicating the regional features of the genetic variants. The frequency of the risk allele of rs13266634 among individuals in the Arabian Peninsula was higher than among individuals in other regions. On the other hand, the frequency of the risk allele of rs5219 in the Arabian Peninsula was lower than that in other regions. We identified and characterized T2D-related variants that show unique tendencies in the Arabian Peninsula. Our analyses contribute to and provide guidance for the clinical research of T2D in the Arabian Peninsula.

Study Properties of Fermented Camels’ and Goats’ Milk Beverages Fortified with Date Palm (&amp;lt;i&amp;gt;Phoenix dactylifera L&amp;lt;/i&amp;gt;.)

Camels’ milk (CM) and goats’ milk (GM) are rich in nutrients and vitamins necessary for the health of humans and have therapeutic properties as they are rich in antioxidants and have a protective role against free radicals that have harmful effects on human health. Date palm (DP), camels’ milk and goats’ milk have been reported to be used for the prevention and treatment of various diseases in Arab countries. This study was designed to mix date palm with camels’ milk and goats’. Eight formulations of both camels’ milk and goats’ were made from different percentages of date palm. These formulations were added at ratios of 0 (control), 10%, 20% and 30% (w/v) to camels’ milk and goats’ and the effect of this date palm on the composition and texture properties of the fermented obtained products were followed. It has been found that pH, protein, fat decreased and total solid, carbohydrate, ash, viscosity, vitamins, minerals and antioxidants increased with the increase of the added percentage of date palm compared to control. Microbial counts of the fermented camels’ milk (FCM) and goats’ milk (FGM) increased significantly (P improved the composition, viscosity, microbiological quality of fermented camels’ and goats’ milk with nutritional functional values and acceptable sensory attributes.

The Epidemiology of Celiac Disease in the General Population and High-Risk Groups in Arab Countries: A Systematic Review.

Background and Aims Celiac disease (CD) is possibly the most common autoimmune disorder, which may lead to dietary problems in the Arab region. This paper is aimed at exploring the epidemiology of the celiac disease in Arab countries, including its prevalence, associated risk factors, and clinical patterns. Methods An extensive search of the literature was conducted from electronic databases such as PubMed, Embase, and Google Scholar. In total, 134 research papers were retrieved. We extracted studies published from January 1996 to December 2019. Our search was limited to studies published in English. Findings. The review included 35 studies with 22,340 participants from 12 countries and demonstrated a wide variation in the prevalence of CD. The highest prevalence among the general population (3.2%) was reported in Saudi Arabia, and the lowest (0.1%) was reported in Tunisia. Women demonstrated a higher prevalence of celiac disease relative to men. The peak age at diagnosis fell between 1 and 3 years and 9-10 years. Most studies focused on type 1 diabetes. Children with type 1 diabetes have a higher prevalence of CD (range from 5.5% to 20%), while the prevalence of CD in Down's syndrome patients was 1.1% and 10.7% in UAE and Saudi Arabia, respectively. Other autoimmune diseases associated with CD are thyroid disease and irritable bowel disease. The most widely recognized clinical presentation was an inability to flourish and poor weight gain, followed by short stature, abdominal pain, abdominal distension, bloating, and chronic diarrhea. Conclusion The prevalence of the celiac disease in Arab countries varies with sex and age. However, we found that celiac disease presented similar clinical characteristics independent of the geographic region. Longitudinal population-based studies are needed to better identify the true burden and determinants of celiac disease.

Incidence of pediatric glomerular diseases in Arab world: A systematic review

Despite the high number of Arab children, there are a scanty available data about different types of pediatric glomerular diseases in all Arab countries. Very few Arab countries have a national renal biopsy registry. In this review, we performed a systematic review analyzing the incidence of pediatric glomerular disease in all Arab countries. Relevant manuscripts in all 22 Arab countries found through searches of Medline, Science Direct, Embase and Google Scholar were evaluated. The period was from January 1990 to March 2018. A total of 17 manuscripts containing 3083 renal biopsies from seven countries were analyzed. Male-to-female ratio was 1.3:1. Saudi Arabia revealed the most published studies with seven papers. The average period of the study was 8.63 years. Retrospective studies represent 94.12%. Minimal change disease (MCD) (29.25%), focal and segmental glomerulosclerosis (FSGS) (22.34%), mesangioproliferative glomerulonephritis (14.78%), membranoproliferative glomerulonephritis (6.9%), IgA nephropathy (3.98%), and membranous glomerulopathy (2.65%) were the top types of primary glomerular diseases. The most common types of secondary glomerular diseases were lupus nephritis (36.1%), postinfectious glomerulonephritis (17.62%), congenital nephrotic syndrome (6.08%), Alport syndrome (4.71%), Henoch-Schönlein purpura (1.49%), and amyloidosis (1.36%). In conclusion, MCD and lupus nephritis are, respectively, the most common types of primary and secondary glomerular diseases in children of all evaluated Arab countries. FSGS is the predominant pattern of primary glomerular diseases in Asian Arab countries. The trend of all types of glomerular diseases has not changed in the past 28 years except a noted significant reduction in FSGS. Arab countries are strongly recommended to establish a renal biopsy registry.

Precision medicine of monogenic disorders: Lessons learned from the Saudi human genome.

Congenital and genetic disorders cause many diseases in Arab countries due to large family sizes and high levels of inbreeding. Saudi Arabia (SA) has the highest consanguinity rates among Middle Eastern countries (~60% of all marriages) and is burdened by the highest number of genetic diseases. Genetic diseases can be life-threatening, often manifesting early in life. Approximately 8% of births in SA are affected, and more common genetic diseases, such as metabolic disease and cancer, manifest later in life in up to 20% of the population. This represents a massive healthcare burden to SA hospitals. The number of genetic disorders in the human population ranges from 7000 to 8000, over 3000 of which are caused by unknown mutations. In 2013, SA initiated the Saudi Human Genome Program (SHGP), which aims to sequence over 100,000 human genomes, with the goal of identifying strategies to discover, prevent, diagnose and treat genetic disorders through precision therapy. High-technology genomics and informatic-based centers that exploit next-generation sequencing (NGS) have now identified mutations underlying many unexplained diseases.

A comparison between health research output and burden of disease in Arab countries: evidence from Palestine

BackgroundResearch conducted on conditions responsible for the greatest disease burden should be given the highest priority, particularly in resource-limited settings. The present study aimed to assess the research output in relation to disease burden in Palestine and to identify the conditions which are under- or over-investigated, if any.MethodsWe searched PubMed and Scopus for reports of original research relevant to human health or healthcare authored by researchers affiliated with Palestinian institutions and published between January 2000 and December 2015. We categorised the condition studied in included articles using the Global Burden of Disease (GBD) taxonomy. Data regarding burden of disease (percentage of deaths and disability-adjusted life years (DALYs)) was obtained from the Palestine profile in the GBD study. We examined the degree of discordance between the observed number of published articles for each disease/condition with the expected number based on the proportion of disease burden of that disease/condition.ResultsOur search identified 2469 potentially relevant records, from which 1650 were excluded following the screening of titles and abstracts. Of the remaining 819 full-text articles, we included 511 in our review. Communicable (infectious) diseases (n = 103; 20%) was the condition with the highest number of published studies. However, cancer (n = 15; 3%) and chronic respiratory diseases (n = 15; 3%) were the conditions with the lowest number of published studies. Research output was poorly associated with disease burden, irrespective of whether it was measured in terms of DALYs (rho = −0.116, P = 0.7) or death (rho = 0.217, P = 0.5). Cardiovascular disease, cancer, and maternal and neonatal deaths accounted for more than two-thirds of the total deaths in Palestine (67%), but were infrequently addressed (23%) in published articles.ConclusionsThere is evidence of research waste measured by a mismatch between the health burden of certain diseases/conditions and the number of published research reports on those diseases/conditions in Palestine. A national research priority-setting agenda should be developed to meet the local community’s need for quality evidence to implement independent and informed health policies.

Spectrum of glomerular diseases in Arab countries: A systematic review.

According to the best of our knowledge, there is no review compiling incidence of glomerular disease in all Arab countries. Most of the Arab countries do not have a national renal biopsy registry. In addition, there is scanty data available on the epidemiology of glomerular diseases in Arab countries. In this review, we performed a systematic review analyzing the incidence of glomerular disease in all Arab countries. Relevant manuscripts in all 22 Arab countries found through searches of Medline, Science Direct, Embase, and Google Scholar were evaluated. The time was from January 1990 to March 2018. A total of 36 manuscripts containing 10,727 biopsies from 11 countries were analyzed. The male-to-female ratio was 1.2:1. Saudi Arabia had the largest number of published studies with 14 papers followed equally by Iraq, Jordan, and Sudan with three papers each. The average period of study was 8.17 years. Retrospective studies represented 86.11%. Focal and segmental glomerulosclerosis (FSGS) (27%), minimal change disease (14%), membranoproliferative glomerulonephritis (13%), mesangioproliferative glomerulonephritis (13%), and membranous glomerulopathy (11%) were the main types of primary glomerular diseases. The most common types of secondary glomerular diseases were lupus nephritis (LN) (58%), amyloidosis (10.19%), diabetic nephropathy (9.89%), hypertension (4.84%) and poststreptococcal glomerulonephritis (2.72%). In conclusion, FSGS and LN are the most common types of primary and secondary glomerular diseases, respectively, in all evaluated Arab countries. The trend of all types of glomerular diseases has not changed in the last three decades. We strongly recommend that each Arab country should have its own renal biopsy registry.

Who's been left behind? Why sustainable development goals fail the Arab world

1–5 Evidence of persistent infectious disease in low-income and middle-income Arab countries exists, alongside increased prevalence of non-communicable diseases in all Arab countries, 6,7 high out-of-pocket health expenditure, 8 poor access to safe water, as well as violent confl ict, persistent foreign interventions, and high levels of social and political fragmentation that result in weak health systems and diminished rights to health. 9 Two sets of indicators, with important implications for health and development, are strikingly extreme in the Arab region (appendix). First, the Arab world has ten times the per person world average number of refugees and, in the Gulf Cooperation Council (GCC) countries, the highest number of international migrant workers as a percentage of the population at more than ten times the world average. Second, the Arab world has high levels of militarisation, with weapons imports per person at more than four times the world average. Additionally, the Arab world has the lowest ratios of health to military expenditures at less than one-fi fth of the world average.

Cardiac rehabilitation in Canada and Arab countries: comparing availability and program characteristics.

BackgroundDespite the high burden of cardiovascular diseases in Arab countries, little is known about cardiac rehabilitation (CR) delivery. This study assessed availability, and CR program characteristics in the Arab World, compared to Canada.MethodsA questionnaire incorporating items from 4 national / regional published CR program surveys was created for this cross-sectional study. The survey was emailed to all Arab CR program contacts that were identified through published studies, conference abstracts, a snowball sampling strategy, and other key informants from the 22 Arab countries. An online survey link was also emailed to all contacts in the Canadian Association of Cardiovascular Prevention and Rehabilitation directory. Descriptive statistics were used to describe all closed-ended items in the survey. All open-ended responses were coded using an interpretive-descriptive approach.ResultsEight programs were identified in Arab countries, of which 5 (62.5 %) participated; 128 programs were identified in Canada, of which 39 (30.5 %) participated. There was consistency in core components delivered in Arab countries and Canada; however, Arab programs more often delivered women-only classes. Lack of human resources was perceived as the greatest barrier to CR provision in all settings, with space also a barrier in Arab settings, and financial resources in Canada. The median number of patients served per program was 300 for Canada vs. 200 for Arab countries.ConclusionAvailability of CR programs in Arab countries is incredibly limited, despite the fact that most responses stemmed from high-income countries. Where available, CR programs in Arab countries appear to be delivered in a manner consistent with Canada.

Assessment of research productivity of Arab countries in the field of infectious diseases using Web of Science database.

BackgroundTo meet the future challenges of infectious diseases and limit the spread of multidrug resistant microorganisms, a better understanding of published studies in the field of infectious diseases is needed. The objective of this study was to analyze the quantity and quality of research activity in the field of infectious diseases in Arab countries and compare it with that in non-Arab countries.MethodsDocuments published in Arab countries within the research category of “infectious diseases” were extracted and analyzed using the Web of Science database. The data analyzed represent research productivity during the time interval between 1900 – 2012.ResultsWorldwide, the total number of documents published in the field of infectious diseases up to 2012 was 227,188. A total of 2,408 documents in the field of infectious diseases were published in Arab countries, which represents 1.06% of worldwide research output. Research output from Arab countries in the field of infectious diseases was low for decades. However, approximately a five-fold increase was observed in the past decade. Arab countries ranked 56th to 218th on the standard competition ranking (SCR) in worldwide publications in the field of infectious diseases. Egypt, with a total publication of 464 (19.27%) documents ranked first among Arab countries, while Kuwait University was the most productive institution with a total of 158 (6.56%) documents. Average citation per document published in Arab countries was 13.25 and the h-index was 64. Tuberculosis (230; 9.55%), malaria (223; 9.26%), and hepatitis (189; 7.8%) were the top three infectious diseases studied as according to the retrieved documents.ConclusionThe present data reveals that some Arab countries contribute significantly to the field of infectious diseases. However, Arab countries need to work harder to bridge the gap in this field. Compared with non-Arab countries in the Middle East, research output from Arab countries was high, but more efforts are needed to enhance the quality of this output. Future research in the field should be encouraged and correctly directed.Electronic supplementary materialThe online version of this article (doi:10.1186/2049-9957-4-2) contains supplementary material, which is available to authorized users.

Behcet's disease: demographic and genetic aspects (a literature review)

A review of literature focused on Behcet's disease (BD) is presented. BD is systemic vasculitis of unknown etiology affecting multiple organs. BD is endemic in the countries along the Eastern Mediterranean coast and the areas of Central and East Asia. We report the data on BD prevalence in different regions and the effect of population migration on BD incidence rate. Patients were found to be younger at the onset of the disease in Arab countries, Turkey, and Israel (19.9; 25.6; and 26 years, respectively) than those in East Asia countries (31.7 years). We summarized the data attesting to the genetic susceptibility in BD patients: HLA B51-positive individuals, family aggregation observed when studying twins, etc. The clinical polymorphism in BD patients was shown to depend on their region of residence and ethnicity. The data of a series of large cohort studies are reported; the frequencies of the international criteria of BD in the US and Japanese patients are compared in these studies. The question regarding the need for cross-sectional population-based and case-control studies using the standard criteria and clear definition of ethnicity is brought up in some publications.

Nutritive Value and Characterization Properties of Fermented Camel Milk Fortified with some Date Palm Products Chemical, Bacteriological and Sensory Properties

Camel milk and dates have been reported to be used for prevention and treatment of various diseases in Arab countries. A total of 40 milk samples after parturition were collected from different zones of Al-Ahsa area, KSA. The analyses of chemical and nutritional values of camel milk were performed. The samples were analysed for total solids, fat, total protein, sugears, ash, minerals as well as vitamins. Results showed 11.90± 0.11% total solids, 2.69± 0.28% protein,3.26± 0.14 % fat, 1.13.22± 0.54 (g/100g), lactose 3.22±0.04%, glucose 3.22±0.07 %.sucrose 1.93. ±0.03% and ±0.04 %0.14 % acidity. The levels of ash, Ca, Mg, Na, vitamin C and B12 were higher. however concentration of Fe, vitamin A was relatively lower. Antimicrobial agents, lactoferrin (LF) were determined and the concentarion was 1.61 ±0.19 mg/ml. Generally, camel milk presented high nutritive and therapeutic applications. Yoghurt made from camel milk was prepared by adding date palm syrup (Depis) to cultured milk. The main objective from this part was to investigate the influence of Depis on chemical characteristics (titrable acidity, total solids, fat, and protein content), microbiological and sensory properties and acceptability of the resultant yoghurt during storage for 21 days at 4° C. Addition of 1, 2.5 and 5 % of Depis did not affect yoghurt pH or protein and fat content, but decreased moisture and increased the total solids significantly. Moreover, addition of Depis improved the viablity and stabilty of satrter cultuer during storage and the total viable counts were 0.67, 7.4, 7.7 and 7.8 ×10-7for control, 1, 2.5 and 5 % of Depis, respectively.Finally, addition of 5% Depis provided yoghurt with desired sensory properties.

Patterns of renal disease in Arab countries

Patterns of renal disease in Arab countries

Paediatric Infectious Diseases in Arab Countries

Paediatric Infectious Diseases in Arab Countries

Childhood idiopathic thrombocytopenic purpura in Egypt and the neighboring Arab countries: a regional form with three different patterns of clinical expression.

Childhood idiopathic thrombocytopenic purpura in the western world is essentially an acute self-limited disorder. In contrast, the clinical expression of the disease in Arab countries, as revealed by a study of 160 patients from Egypt, Saudi Arabia, Oatar and North Sudan, is heterogenous forming a spectrum that includes three distinct clinical forms: (a) the acute self-limited form, (b) the intermediate form, and (c) the chronic adulthood-like form. The relative proportions of these forms were 40. 15 and 45%, respectively. The chronic form shows limited response to steroids, and runs a platelet count less than 100,000 microliters for more than 1 year, with a tendency for later spontaneous elevation in platelet counts during the first few years of a long follow-up. The intermediate form shows a transient steroid-induced complete remission giving place to widely fluctuating platelet counts above and below 100,000 microliters once the steroid dosage is reduced to maintenance levels. Platelet counts in excess of 100,000 microliters were achieved in this group by extending steroid maintenance therapy fo 6--9 months. In spite of a tendency to chronicity and partial resistance to steroids i the intermediate and chronic forms, the overall response to steroids was enough both to reduce the number of cases requiring splenectomy to 15%, and to prevent the development of major complications in all the children included in the study.