Older HIV-infected adults: complex patients- geriatric syndromes (II).

With the widespread adoption of highly active antiretroviral therapy (HAART), HIV infection starts to be considered one of the many chronic illnesses of advanced age. A growing proportion of the affected patients is presently older than 50. It has been suggested that HIV infection may today represent a model of accelerated and accentuated ageing. The need for a closer collaboration between geriatricians and HIV physicians is being growingly recognised to better address the priorities and needs of HIV patients. The final aim behind the generation of such synergies resides in the design of personalised plans of interventions. These plans should stem from the results of a comprehensive assessment of the individual spanning clinical, environmental, and psychosocial domains. Through the early identification of stressors and risk factors potentially disrupting the homeostatic balance of frail patients (including those living with HIV), it might be possible to protect the "biologically old" (but not necessarily "chronologically old") HIV-infected people from developing detrimental geriatric syndromes. In this article, specific features making the ageing HIV population of special interest for geriatric medicine, and the importance of a multidisciplinary model of care are described. The final objective is to stress how the only way for adequately tackling the multifaceted frailty condition of people with HIV is to implement novel models of care based on the comprehensive geriatric assessment.

Automatic speech analysis to early detect functional cognitive decline in elderly population.

This study aimed at evaluating whether people with a normal cognitive function can be discriminated from subjects with a mild impairment of cognitive function based on a set of acoustic features derived from spontaneous speech. Voice recordings from 90 Italian subjects (age >65 years; group 1: 47 subjects with MMSE>26; group 2: 43 subjects with 20≤ MMSE ≤26) were collected. Voice samples were processed using a MATLAB-based custom software to derive a broad set of known acoustic features. Linear mixed model analyses were performed to select the features able to significantly distinguish between groups. The selected features (% of unvoiced segments, duration of unvoiced segments, % of voice breaks, speech rate, and duration of syllables), alone or in addition to age and years of education, were used to build a learning-based classifier. The leave-one-out cross validation was used for testing and the classifier accuracy was computed. When the voice features were used alone, an overall classification accuracy of 0.73 was achieved. When age and years of education were additionally used, the overall accuracy increased up to 0.80. These performances were lower than the accuracy of 0.86 found in a recent study. However, in that study the classification was based on several tasks, including more cognitive demanding tasks. Our results are encouraging because acoustic features, derived for the first time only from an ecologic continuous speech task, were able to discriminate people with a normal cognitive function from people with a mild cognitive decline. This study poses the basis for the development of a mobile application performing automatic voice analysis on-the-fly during phone calls, which might potentially support the detection of early signs of functional cognitive decline.

[Are echographic and radioisotopic studies substitutive or complementary to radiology in renal pathology in childhood?]. / Le indagini ecografiche e radioisotopiche sono sostitutive o complementari alla radiologia nella patologia renale in età pediatrica?

The role of ultrasound on paediatric renal tract investigation has become established over the last 15 years, showing only with nuclear magnetic imaging the merit of being truly, non invasive and almost certainly free from biological hazards. The information obtained remains mainly static rather than dynamic, anatomical rather than functional. Conversely radioisotopic methods allow functional studies, mainly in cases in which separate functional are requested. Recently some Authors claimed that these two techniques could replace conventional x-ray investigations. Aim of this paper is to report the results of these techniques separately applied in urinary tract abnormalities in pediatric age. Reliability and utility in terms of diagnostic and therapeutic approach are discussed.

[Prenatal diagnosis of fetal malformations in women at specific genetic risk: retrospective analysis of 32 cases]. / Diagnostic prénatal de malformations foetales chez des femmes à risque génétique spécifique: analyse rétrospective de 32 cas.

A retrospective analysis of 33 pregnancies with specific risk of an hereditary malformative pathology is presented. In these cases we have made an echographic diagnosis with careful chronology consequent the data from personal and familial anamnesis. The echographic and clinical diagnoses and the results of pregnancies are presented.

Quantitative characterization of the growth of the fetal kidney.

The time-dependent changes in the antero-posterior (A-P) diamter and length (L) of fetal kidneys has been evaluated by means of statistical analysis of measurements made during the third trimester in a normal population. Two hundred eighty pregnant women were examined between 22 and 40 weeks of gestation. Differences between operator-scanner combinations were evaluated. The relationships of the A-P diameter and length to menstrual age were determined in cross-sectional and longitudinal studies of kidney growth. The results obtained confirmed that measurements of fetal kidney can be used as an additional parameter in the routine assessment of fetal well being and to rule out kidney malformations characterized by changes in kidney size.

[Prenatal diagnosis of a case of familial recurrence of unilateral diaphragmatic agenesis]. / Diagnostic prénatal d'un cas de répétition familiale d'agénésie unilatérale du diaphragme.

Prenatal diagnosis of different fetal malformations have been performed by echography. The authors report a case of recurrence of monolateral diaphragmatic agenesy in sibs. The diagnosis was achieved at the 23 degrees week of gestation. Some methodological details are also proposed to improve the possibility of early diagnosis. Embryological and epidemiological data have been evaluated.

Prune-belly syndrome: report of three siblings.

The "Prune-Belly" syndrome is rare and sporadic. The authors describe three siblings of both sexes with the syndrome. Good results in two of the patients arouse new interest in surgery for this syndrome. The possibility of prenatal diagnosis is discussed.