Mortalité maternelle chez les adolescentes au service de Gynécologie-Obstétrique de l'Hôpital National Ignace Deen / Maternal mortality among adolescents in the Gynecology-Obstetrics department of Ignace Deen National Hospital

Introduction. L'objectif de cette étude était de contribuer à l'étude de la mortalité maternelle chez les adolescentes. Méthodes. Il s'agissait d'une étude retro-prospective descriptive et analytique cas témoin, d'une durée de trois ans. La collecte rétrospective avait porté sur deux (2) ans allant du 1er Janvier 2018 au 31 Décembre 2019 et celle prospective sur un (1) an allant du 1er Janvier 2020 au 31 Décembre 2020. Résultats. Durant la période d'étude nous avons enregistré 38 cas de décès maternels sur 16175 naissances vivantes soit un ratio de 235 décès pour 100000 naissances vivantes. Le décès concerne l'adolescente de 18-19 ans (65,8%), mariée (63,2%), non scolarisé (42,1%), et nullipare (65,8%). La majorité des adolescentes avait effectué 1-3 CPN (44,7%), et provenait d'une maternité périphérique (84,2%) et avait accouché par voie basse (78,4%). Le moyen de transport le plus utilisé était le transport en commun (63,2%). La cause de décès était dominée par l'hémorragie (44,7%). Le post-partum a été la période la plus pourvoyeuse de décès (52,6%). Conclusion. La mortalité maternelle constitue un problème de santé majeure dans notre pays, sa réduction nécessite la mobilisation de tous les acteurs de la société et implique une bonne éducation pour la santé, l'amélioration de la qualité du suivi prénatal et celle des soins obstétricaux d'urgence.

Introduction. The objective of this study was to contribute to the study of adolescent maternal mortality. Methods. This was a retrospective descriptive and analytical case-control study, lasting three years. The retrospective data collection covered two (2) years from January 1, 2018 to December 31, 2019 and the prospective one over one (1) year from January 1, 2020 to December 31, 2020. Results. During the study period we recorded 38 cases of maternal deaths out of 16,175 live births, ie a ratio of 235 deaths per 100,000 live births. The death concerns an adolescent girl aged 18-19 (65.8%), married (63.2%), out of school (42.1%), and nulliparous (65.8%). The majority of adolescent girls had performed 1-3 ANC (44.7%), and had come from a peripheral maternity hospital (84.2%) and had given birth vaginally (78.4%). The most used mode of transportation was public transit (63.2%) The cause of death was dominated by hemorrhage (44.7%). The postpartum period was the most significant period of death (52.6%). Conclusion: Maternal mortality is a major health problem in our country, its reduction requires the mobilization of all actors in society and involves good health education, improving the quality of prenatal care and that of obstetric care emergency

Prévalence et facteurs de risque des infections associées aux soins dans trois hôpitaux nationaux de la ville de Conakry. Guinée / Prevalence and risk factors of healthcare-associated infections in three national hospitals in the city of Conakry. Guinea

Objectif. Cette étude avait pour objectif de déterminer la prévalence et les facteurs liés aux infections associées aux soins dans les hôpitaux nationaux de Conakry. Méthodes. la collecte des données et des prélèvements a été réalisée pendant trois jours du dans les hôpitaux nationaux. Vingt-deux services ont été choisies pour le sondage ; les patients dont la durée d'hospitalisation était supérieure ou égale à 48 heures ayant donné leur consentement ont été prélevé. Les analyses microbiologiques étaient effectuées à l'unité de bactériologie à l'Institut National de la Santé Publique Résultats. Au total251 patients ont été enquêtés parmi lesquels 120 patients ont été prélevés. Les infections associées aux soins ont été observés chez 65 patients soit 54,17%. Les infections urinaires 53 cas(60,2%) ont été signifi cativement plus fréquentes que les autres types d'infections (bactériémies, infection du site opératoire, avec respectivement 23.8% et15,8%). De tous les facteurs identifi és, l'âge était le seul associé (P<0,00) au seuil de signifi cativité de 5%. Escherichia coli a été le germe le plus identifi é avec une fréquence de 13,63% suivi de Klebsiella pneumonie avec 7,95%. Des bactéries comme les Staphylococcus aureus résistaient a la méticilline alors que certaines entérobactéries et des Pseudomonas aériginosa ont été résistants aux céphalosporines de troisième génération et aux carbapénèmes. Conclusion. Ces résultats préliminaires mettent en évidence le besoin d'augmenter la sensibilisation du personnel de l'hôpital concernant les infections associées et de revoir un programme opérationnel rigoureux en hygiène hospitalière. L

Violences sexuelles à l'hôpital Donka (Guinée)

Introduction. L'objectif de ce travail était de déterminer la prévalence, le profi l épidémiologique et clinique des victimes de violences sexuelles prises en charge au Centre Hospitalo-universitaire de Donka. Méthodes. Il s'agissait d'une étude rétrospective de type descriptif qui s'est déroulée du 01 Janvier2015 au 31 Décembre 2017à l'unité de médecine légale. Résultats. Sur un total de 1937 cas constituant l'ensemble des consultations en victimologie, 16% étaient descas de violence sexuelle.L'âge moyen des victimes était de 8 ansavec des extrêmes de 5 et 56ans et un écart type de 10,79.Dans la majorité des cas, l'agresseur était connu de la victime mais ne faisait pas partie de l'entourage familial direct (52,6%). Les victimes ont consulté majoritairement au cours des 5 premiers jours (55,8%) avec des extrêmes de 8heures et 30jours.Il s'agissait dans la majorité des cas des défl orations anciennes (54,2%). Conclusion : Nos résultats ne sauraient refl éter exactement l'ampleur du phénomène car la majorité des victimes préfère pour une raison ou une autre taire leur drame

Prophylactic and emergency cesareans: a comparative study on 718 observations at the maternity ward of Ignace Deen National hospital

Background: The objective of the study is to compare the frequency, the socio-demographic characteristics, the indications, the fetal maternal prognosis and the Robson classification of prophylactic and emergency caesarean sections.Methods: This was a comparative study of prophylactic and emergency caesarean sections at the maternity of Ignace Deen national hospital. It was a 12 month (July 1, 2016 to June 30, 2017) descriptive and analytical study.Results: Prophylactic caesarean sections accounted for 12, 51% of caesarean sections and 3.96% of deliveries at the ward. Prophylactic caesarean sections involved pregnant women aged from 20 to 29, holder of higher education degrees (51.54%), married (92.76%) employed (56.83%) and whose prenatal visit was provided by the obstetrician (73.54%). While the emergency caesarean section concerned parturient aged between 20 and 34, mostly non-schooled (36.49%), transferred patients (80.22%) and nulliparous (58.5%). Surgical indications were mainly scarred uterus (32.32%) and maternal pathologies (18.11%) prophylaxis; bleeding in the last quarter (25.90%) acute fetal distress (20.33%) in emergency. Groups 6 and 5 of the Robson classification were the most represented with a 2.23% morbidity and a zero maternal lethality in prophylaxis versus groups 5 and 6 with a 10.03% morbidity and a 1.67% maternal lethality in emergency.Conclusions: Improving this prognosis would be achieved through an increase in the frequency of prophylactic caesarean sections.

Surgical intervention on uterine fibromyoma in a country with limited resources: case of the gynaecology-obstetrics department of the Communal Medical Centre of Ratoma Conakry - Guinea

Background: In developing countries, treatment of uterine fibromyoma is confronted with numerous problems, namely: financial inaccessibility to the proposed treatments, fear of surgery and the weakness of the technical platform. The objectives of the study were to calculate the frequency of uterine fibromyomas, describe the socio-demographic characteristics of patients, identify the main clinical data and to describe the modalities of surgical management.Methods: It was a mixed descriptive study, cumulative over a period of 5 years (60 months) with data collection in two phases: a 4-year retrospective study from January 1, 2015 to December 31, 2018 and a 1-year prospective study from January 1, 2019 to December 31, 2019.Results: Authors collected 135 cases of uterine fibromyomas operated on out of a total of 260 cases of gynaecological pathologies, i.e. a frequency of 51.92%. Nulliparous women were the most concerned (45.18%), and women who attended school (60%) and those who did not attend school (40%). Women at home and housewives accounted for 42.20% and 54.07% respectively. Clinically, the circumstances of discovery were dominated by menometrorrhagia and menorrhagia respectively 77.77% and 68.14%. The large uterus was the most frequent physical sign found in 96.29% of cases. Uterine fibromyomas were recorded in 86.6% of cases in women with genital activity. The operative indications were dominated by the large polymyomatous uterus (64.44%), followed by hemorrhagic fibroma (18.52%) The surgical treatment was conservative in 92.60%. The total hysterectomy was performed in 7.40. Lethality was 1.4%.Conclusions: The surgical management of fibroids contrasts conservative treatment (myomectomy) with radical treatment (hysterectomy) with multiple possible approaches (hysteroscopy, vaginal surgery, laparoscopy or laparotomy). In this context, only laparotomy was possible due to lack of equipment. Laparoscopy and hysteroscopy equipment are necessary for less invasive surgery.

Obstetrical complications among adolescent girls at the maternity ward of Ignace Deen National Hospital

Background: The objective of this study was to highlight obstetrical complications that occurred among adolescent girls who delivered at the ward and to identify factors associated with the occurrence of such complications.Methods: This was a prospective study of descriptive and analytical type extending over a period of one year from September 1, 2016 to August 31, 2017 carried out at the maternity ward of Ignace Deen National Hospital at Conakry Teaching Hospital (CHU). It covered a continuous series of 1034 deliveries among adolescent girls.Results: The frequency of childbirth among adolescent girls was 16.7%. The main complications identified were dystocia, severe preeclampsia, eclampsia, retroplacental hematoma, placenta previa, uterine rupture, severe anemia, postpartum hemorrhage and puerperal endometritis. These complications occurred among adolescent girls aged 18 to 19, christian, skin and pelvic bones secondary school or university students. Factors associated with such complications were the marital status (p=0.010), the gestational age (p=0.012), the number of prenatal consultations (p=0.001), the place of prenatal consultation (p=0.001), the reason for admission (p=0.000) and the mode of admission (p=0.000).Conclusions: Childbirth among adolescent girls is frequent in this context; complications are numerous but they are preventable in the vast majority of cases.

Diagnosis and management of benign ovarian tumors at the Ignace Deen Maternity Hospital of Conakry University Hospital in Guinea

Background: Benign ovarian tumors are a common reason for consultation and intervention in gynecology. The objective of this was to describe the clinical, ultrasonographic, histological and therapeutic aspects of benign ovarian tumors in the department.Methods: This is a retrospective and descriptive study of three years and six months from January 1, 2016, to June 30, 2019, which focused on the records of women-operated during this period of benign ovarian tumors.Results: The incidence of benign ovarian tumors was 12.58%. The circumstances of discovery were dominated by disorders of the menstrual cycle (35.05%) followed by infertility (20.78%), the sensation of a pelvic mass (19.48%), and pelvic pain. (15.58%). The ultrasound report was in favor of a serous cyst in 74% of cases, a mucoid cyst in 14% of cases, a dermoid cyst in 9% and an endometriotic cyst in 3%. Histology revealed a serous cystadenoma in 70.13% of the cases, a mucinous cystadenoma in 16.88% of the cases, a mature poly tissue teratoma in 9.09% of the cases and an endometrial cyst in 3.90 % of the cases. Cystectomy was the most performed surgical procedure (71%).Conclusions: Benign ovarian tumors are common in our practice. The most common histological forms were serous and mucinous cystadenomas. Conservative treatment has been practiced in the majority of cases.

Cerebrovascular accidents indicative of COVID-19 infection: about 4 observations in Guinea

Introduction: coronavirus is a virus with potential to target the nervous and respiratory systems. The aim of this work is to establish the prevalence of strokes in COVID19 positive patients in Guinea. Methods: all patients with stroke confirmed by brain imaging and COVID-positive PCR were included in this study. Retrospective patient data were obtained from medical records. Informed consent was obtained. Results: the RT-PCR confirmed the initial diagnosis and the chest CT scan provided a good diagnostic orientation. Brain imaging identified ischemic brain lesions. We report the case of four patients with stroke and a COVID-19 incidental finding in Guinea.Conclusion: this work shows that the onset of ischemic stroke associated with COVID-19 is generally delayed, but can occur both early and late in the course of the disease. More attention is needed because the early symptoms of viral attack are not just pulmonary

Factores asociados a las complicaciones de la cirugía electiva de las hernias inguinales / Factors associated with the complications of elective surgery of inguinal hernias

Introducción: La hernia inguinal es una de las enfermedades que más comúnmente requiere tratamiento operatorio y representa entre el 10- 15 por ciento de todas las intervenciones programadas. El porcentaje de complicaciones posoperatorias es de 5- 10 por ciento y aunque no son totalmente evitables, deben conocerse sus posibles causas para lograr reducir su incidencia. Objetivo: Identificar los factores asociados a las complicaciones de la cirugía electiva de las hernias inguinales. Métodos: Se realizó un estudio observacional y descriptivo, de una serie de 246 pacientes operados de hernias inguinales mediante cirugía electiva en el servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba durante el bienio 2016-2017. Resultados: Se constataron 18 complicaciones (7,3 por ciento). Predominó el grupo etario de 51 a 70 años (47,8 por ciento) y el sexo masculino sobre las féminas con razón de 15,4:1. El estado físico preoperatorio fue clasificado ASA 1 en 183 pacientes (74,4 por ciento) y ASA 2 en 62 (25,2 por ciento). El 72,2 por ciento de los complicados tenían al menos una enfermedad asociada. El tipo 2 según clasificación de Nyhus prevaleció con 73 (29,7 por ciento) y 8 (44,4 por ciento) de los complicados. Conclusiones: Los factores referentes a la edad mayor de 50 años, sexo masculino, antecedentes de hipertensión arterial y diabetes mellitus, y hernias tipo II según la clasificación de Nyhus se asocian a la presentación de complicaciones agudas (edema del cordón espermático e infección del sitio operatorio) y crónicas (recidiva y granuloma) de la cirugía electiva de las hernias inguinales(AU)

Introduction: Inguinal hernia is a common surgical treatment illness and represents 10-15 percent of the programmed surgery. The postoperative complications records are 5-10 percent, although they are not avoidable, it is mandatory to know the possible causes to decrease the incidence rate. Objective: To identify the associated factors on the complications of elective inguinal hernia surgery. Methods: An observational and descriptive study of a series of 246 patients operated on elective inguinal hernia surgery in the General Surgery Service of "Saturnino Lora" Hospital of Santiago de Cuba during the years 2016-2017. Results: There were 18 complications (7,3 percent) of the sample. The age group of 51 to 70 years (47,8 percent) predominated and the male sex over females with a ratio of 15,4:1. Preoperative physical state was classified ASA 1 in 183 patients (74,4 percent) and ASA 2 in 62 (25,2 percent). 72,2 percent of the complicated patients had at least one associated disease. Type 2 according to Nyhus classification prevailed with 73 (29,7 percent) patients of the sample, and eight (44,4 percent) of complicated patients. Conclusions: Associated factors on acute and chronic complications of elective inguinal hernia surgery related to age, sex, associated illness, preoperative physical state and type of hernia according to Nyhus classification do not differ from that reported by the national and foreign literature(AU)

Fundamentos históricos del diagnóstico y tratamiento de las hernias inguinales / Historical Foundations of Diagnosis and Treatment of Inguinal Hernias

RESUMEN Introducción: Es necesario conocer la historia de la cirugía, en general, y de la herniología, en particular, para poder comprender mejor los enormes avances experimentados en esas disciplinas. Muchas de las técnicas quirúrgicas modernas están basadas en los conocimientos y experiencias aportados por los primeros cirujanos, pero no fue hasta la divulgación de la obra del francés Eduardo Bassini, en 1889, que comenzó el impetuoso desarrollo de la cirugía de la hernia inguinal a escala mundial. Entre las más notables reparaciones de hernia inguinal, además de la de Bassini, se citan las de McVay, Halsted, Shouldice y la hernioplastia libre de tensión, popularizada por Lichtenstein. Objetivo: Profundizar en los aspectos cognoscitivos relacionados con los fundamentos históricos del diagnóstico y tratamiento de la hernia inguinal, su evolución y aplicación en la cirugía actual. Método: Revisión bibliográfica digital de publicaciones actualizadas en las bases de datos SciELO, Latindex, Elsevier, PubMed, Medline y Web of Science y Google Académico. Conclusiones: La cirugía de las hernias en general, y de las inguinales, en particular, nunca es rutina; debe ser individualizada a las características de cada enfermo y a los recursos disponibles. El futuro de la cirugía herniaria solo puede entenderse ligado al conocimiento de sus fundamentos históricos, del profundo dominio de la anatomía topográfica y de una esmerada técnica quirúrgica(AU)

ABSTRACT Introduction: It is necessary to know the history of surgery, in general, and herniology, in particular, in order to understand better the enormous advances experienced in these disciplines. Many of the modern surgical techniques are based on the knowledge and experiences contributed by the first surgeons, but it was not until the disclosure of the work of the French Eduardo Bassini, in 1889, that the impetuous development of inguinal hernia surgery began to scale worldwide. Among the most notable inguinal hernia repairs, in addition to that of Bassini, are those of McVay, Halsted, Shouldice and tension-free hernioplasty, popularized by Lichtenstein. Objective: To deepen the cognitive aspects related to the historical foundations of the diagnosis and treatment of inguinal hernia, its evolution and application in current surgery. Method: Digital bibliographic review of publications updated in the databases SciELO, Latindex, Elsevier, PubMed, Medline and Web of Science and Google Scholar. Conclusions: Surgery for hernias in general, and particularly for inguinal hernias is never routine. They must be individualized to the characteristics of each patient and the resources available. The future of hernia surgery can only be understood if it is associated with the knowledge of its historical foundations, the deep mastery of topographic anatomy and a careful surgical technique(AU)

Complicaciones posquirúrgicas de las hernias inguinales / Post-surgical complications of inguinal hernias

RESUMEN Introducción: La hernia inguinal es una de las enfermedades más frecuentes y que con mayor número de modificaciones técnicas opera el cirujano general. El porcentaje de complicaciones internacionalmente aceptado oscila entre 5 y 10 por ciento. Objetivo: Identificar las complicaciones en la cirugía electiva de las hernias inguinales. Métodos: Se realizó un estudio observacional y descriptivo, de una serie de 246 pacientes, operados mediante cirugía electiva de las hernias inguinales en el Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba durante los años 2016-2017. Resultados: Se constataron 18 complicaciones (7,3 por ciento) de la muestra. El tipo 2 según la clasificación de Nyhus prevaleció con 73 (29,7 por ciento) enfermos para el total, y ocho (44,4 por ciento) de los complicados. Las operaciones efectuadas fueron abiertas, entre las cuales primaron las tisulares de sobrecapas fasciales (Goderich) con 111 (45,1 por ciento) y las protésicas (Lichtenstein) con 85 (34,5 por ciento). Se presentaron complicaciones en 7 (38,8 por ciento) y 3 (16,6 por ciento) pacientes, respectivamente. El método anestésico más utilizado fue local con sedación en 171 (69,5 por ciento) y en 13 de ellos (72,3 por ciento) se produjeron complicaciones. El tiempo quirúrgico predominante fue de 30 minutos a una hora en 156 enfermos (63,4 por ciento), donde se registraron 10 complicados (55,5 por ciento). Del total de operaciones, el 96,7 por ciento fueron ambulatorias (238 pacientes). El 85,7 por ciento de los casos fueron intervenidos por residentes, grupo que aportó el 94,5 por ciento de las complicaciones diagnosticadas. Conclusiones: Las características de la población de enfermos aquejados de complicaciones posquirúrgicas de las hernias inguinales, referentes a tipo 2 de hernia según Nyhus y presencia de recidiva a largo plazo no difieren de lo reportado por la bibliografía nacional y extranjera(AU)

ABSTRACT Introduction: Inguinal hernia is one of the most frequent illness and with a great number of technical modifications that were operated by the general surgeon. The complications percentage internationally accepted oscillated between 5 and 10 percent. Objective: To identify the complications in the elective surgery of inguinal hernias. Methods: an observational and descriptive study of a series of 246 patients was performed on the complications of elective inguinal hernia surgery in the General Surgery Service of the Provincial Teaching Hospital Saturnino Lora of Santiago de Cuba during the years 2016 -2017. Results: There were 18 complications (7.3 percent) of the sample. Type 2 according to Nyhus classification prevailed with 73 (29.7 percent) patients of the sample, and eight (44.4 percent) of complicated patients; the operations carried out were open, among which the fascial overlayer tissue prevailed (Goderich) with 111 (45.1 percent) and the prosthetic (Lichtenstein) with 85 (34.5 percent). Complications occurred in 7 (38.8 percent) and 3 (16.6 percent) patients, respectively. The most used anaesthetic method was local with sedation in 171 (69.5 percent) and in 13 of them (72.3 percent) there were complications. The predominant surgical time was 30 minutes to one hour in 156 patients (63.4 percent), where 10 complications were recorded (55.5 percent). Of the total operations, 96.7 percent were ambulatory (238 patients). There were operated on 85.7 percent of the cases by residents, a group that contributed 94.5 percent of the complications diagnosed. Conclusions: The characteristics of patients suffering from acute and chronic complications of elective inguinal hernia surgery, related to Type 2 according to Nyhus classification, the open operations carried out, the anaesthetic method employed, surgical time, ambulatory surgery and surgeon level, do not differ from that reported by the national and foreign literature(AU)

State of equity: childhood immunization in the World Health Organization African region

Introduction: in 2010, the Global Vaccine Action Plan called on all countries to reach and sustain 90% national coverage and 80% coverage in all districts for the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) by 2015 and for all vaccines in national immunization schedules by 2020. The aims of this study are to analyze recent trends in national vaccination coverage in the World Health Organization African Region and to assess how these trends differ by country income category.Methods: we compared national vaccination coverage estimates for DTP3 and the first dose of measles-containing vaccine (MCV) obtained from the World Health Organization (WHO)/United Nations Children's Fund (UNICEF) joint estimates of national immunization coverage for all African Region countries. Using United Nations (UN) population estimates of surviving infants and country income category for the corresponding year, we calculated population-weighted average vaccination coverage by country income category (i.e., low, lower middle, and upper middle-income) for the years 2000, 2005, 2010 and 2015.Results: DTP3 coverage in the African Region increased from 52% in 2000 to 76% in 2015,and MCV1 coverage increased from 53% to 74% during the same period, but with considerable differences among countries. Thirty-six African Region countries were low income in 2000 with an average DTP3 coverage of 50% while 26 were low income in 2015 with an average coverage of 80%. Five countries were lower middle-income in 2000 with an average DTP3 coverage of 84% while 12 were lower middle-income in 2015 with an average coverage of 69%. Five countries were upper middle-income in 2000 with an average DTP3 coverage of 73% and eight were upper middle-income in 2015 with an average coverage of 76%.Conclusion: disparities in vaccination coverage by country persist in the African Region, with countries that were lower middle-income having the lowest coverage on average in 2015. Monitoring and addressing these disparities is essential for meeting global immunization targets

Dynamic changes of cellular HIV-1 DNA quantification during highly active antiretroviral therapy in Chinese HIV infected individuals / 中南大学学报(医学版)

OBJECTIVE@#To observe the dynamic changes of 3 types of viral reservoir cells (NK cells, T lymphocytes and monocytes), and its relationship with treatment effect in Chinese HIV-1 infected patients receiving highly active antiretroviral treatment (HAART) for 2 years.@*METHODS@#A total of 40 chronic HIV-1-infected adults who initiated HAART were enrolled in this study and followed up for 2 years. Peripheral whole blood was obtained from each patient at baseline (0 month), 6, 12, 18 and 24 months. Real-time fluorescent quantitative PCR was used to detect the HIV-1 RNA in the plasma and HIV-1 DNA in NK cells, T lymphocytes and monocytes. All the data were statistically analyzed.@*RESULTS@#CD4 count increased with the decrease of the viral load during HAART. After HAART initiation, HIV-1 DNA showed a significant decrease in NK cells, T lymphocytes and monocytes. The HIV-1 DNA from T lymphocytes, NK cells and monocytes correlated positively with the HIV- 1 RNA (P<0.05) while NK cells and T lymphocytes correlated negatively with CD4+ T cell count. However we did not find significant correlation between CD4+ T cell count and HIV-1 DNA in monocytes at the baseline of HAART.@*CONCLUSION@#This study found that NK cell was an important HIV cellular reservoir besides T lymphocytes and monocytes. T lymphocytes may be the main long lasting HIV reservoir. HIV-1 proviral DNA may play an important role in the efficacy of treatment and monitoring the disease progression.