[Brain check-up: a structured approach diagnosing mild cognitive impairment in the primary care setting]. / Gehirn-Check-up: strukturiertes Vorgehen zur Diagnostik von kognitiven Störungen im hausärztlichen Setting.

BACKGROUND: The reason-related identification of mild cognitive impairment (MCI) in primary care is helpful to treat reversible causes or decelerate progression to dementia by optimal management of existing risk factors. In this process general practitioners are in a key position. The present feasibility study investigated the practicability of a diagnostic algorithm (brain check-up), comprising neuropsychological examinations, differential diagnoses and follow-up measures. METHOD: By means of a standardized questionnaire, the utilization and practicability of the brain check-up was surveyed in n = 37 medical practices of general practitioners and internists in Germany. RESULTS: The brain check-up was performed by n = 37 physicians in 389 patients (66%). The main barriers to implementation included patients' fear of facing the results, the professionals' lack of time, and costs. Overall, 73% of the participants agreed that the brain check-up was practical in everyday treatment. Long waiting times for an appointment with a neurological/psychiatric specialist were perceived as a barrier for optimal care. CONCLUSION: The structured algorithm is convenient in physician's everyday practice and can contribute to identify patients with MCI more easily. Therefore, it appears to be a helpful tool in primary care. To achieve sustainability in everyday use, identified barriers need to be addressed during the implementation phase.

Atypical myopathy in Père David's deer (Elaphurus davidianus) associated with ingestion of hypoglycin A.

From 2004 until 2016, 21 Père David's deer (Elaphurus davidianus) have died for unknown reason at Zoo Duisburg. These deer, also known as milu, have succumbed from a myopathy that occurred seasonally in autumn and in spring. The clinical signs shown by the animals closely resembles those of a disease called equine atypical myopathy (EAM), which is formerly known in horses. The cause for EAM in Europe was found in the ingestion of hypoglycin A, contained in samaras and seedlings of the sycamore maple tree (Acer pseudoplatanus). To test the hypothesis that the mortality of milus was caused by ingestion of hypoglycin A, 79 sera from all zoos and wildlife parks that have kept milus in Germany and Austria, including 19 diseased and 60 healthy animals, were used. Selected biochemical values and additionally hypoglycin A, methylenecyclopropyl acetic acid-carnitine (MCPA-carnitine), and acylcarnitines, which have been found in horses suffering from EAM, were determined. The results showed greater values of serum activities of creatine kinase (P < 0.001) and aspartate aminotransferase (P < 0.001) in diseased milus comparing to healthy ones confirming a myopathy in affected animals. Moreover, hypoglycin A and MCPA-carnitine were found in the blood of Père David's deer and thus, hypoglycin A intoxication was considered to be a potential cause for the myopathies by ingestion of sycamore maple samaras that were present in the enclosure of the affected animals. Hypoglycin A values were greater in diseased animals (P < 0.01) as well as MCPA-carnitine levels (P < 0.05). Additionally, affected milus showed greater C5-OH-carnitine (P < 0.01) and C6-carnitine (P < 0.001) values. Until now hypoglycin A intoxication was only known in the family of Equidae, in humans, and in laboratory rats, and it has not been previously described in other zoological families. Comparing to horses, ruminants do have a different digestive tract and it will need further investigation to find out if several factors are involved to trigger an outbreak in ruminants.

ORAL SQUAMOUS CELL CARCINOMA IN AN AGED CAPTIVE WHITE RHINOCEROS (CERATOTHERIUM SIMUM).

A 48-yr-old captive white rhinoceros ( Ceratotherium simum ) was euthanized due to old age, pododermatitis, and progressive laminitis of the middle toe of the left fore- and hindlimbs. Severe chronic necrotizing periodontitis and dental loss was diagnosed, although food intake prior to death had not decreased. In addition, extensive ulceration of the tongue was noted. Histologically, squamous cell carcinoma of the tongue was diagnosed with chronic severe ulcerative glossitis. Metastatic lesions were not detected. Clinicians should monitor the oral health of aging rhinoceros due to the occult nature of these lesions.

Occurrence of Babesia species in captive reindeer (Rangifer tarandus) in Germany.

Two cases of acute babesiosis in captive reindeer (Rangifer tarandus) in two German zoos in 2009 and 2012 triggered this study to investigate the occurrence and species diversity of Babesia parasites infecting reindeer in different zoos and deer parks in Germany. Between June and December 2013, blood samples were taken from 123 clinically inapparent reindeer from 16 different facilities. Samples were tested for the presence of Babesia species DNA by conventional PCR and sequence analysis of part of the 18S rRNA gene. Also, Giemsa-stained smears of reindeer blood samples were examined for parasitaemia by light microscopy. The overall PCR-prevalence in blood samples was 23.6% (n=29). Comparison of sequenced amplicons with GenBank entries possibly revealed up to five different Babesia species: B. venatorum (n=19), B. capreoli (n=2) and B. capreoli-like (n=4), B. odocoilei-like (n=2) and B. divergens (n=1), while one sample turned out to be a Theileria sp. Out of the 16 facilities in the study, 12 housed at least one positive animal. In Giemsa-stained blood smears, intra-erythrocytic Babesia parasites were detected in samples of three reindeer from three locations. The high prevalence of Babesia infections implicates babesiosis to be a relevant infectious disease threat for captive reindeer in Germany. Consequently, reindeer with clinical signs compatible to those of acute babesiosis should either be tested for the presence of Babesia spp. DNA or blood smears should be examined for parasitaemia.

The first case of intersexuality in an African dwarf crocodile (Osteolaemus tetraspis).

To the authors knowledge this is the first case of intersexuality in an African dwarf crocodile (Osteolaemus tetraspis). An adult African dwarf crocodile with a male-typical phenotype lived at Zoo Duisburg in Germany for 10 years. It died in October 2012 despite intensive treatment as a result of terminal septicemia. After a detailed pathological examination the gonads were histologically confirmed as ovotestes. Half of the 22 extant species of crocodilians have been examined for occurrence of temperature dependent sex determination (TSD). In TSD reptiles, masculinizing temperatures yield 100% or a majority of males, whereas feminizing temperatures yield 100% or a majority of females. In the transition range of temperature (TRT), a mix of males, females and sometimes intersexes are obtained. However, the molecular mechanisms behind TSD and an explanation for the occurrence of intersexuality remain elusive.

Selected hematologic and biochemical values in subadult and adult captive fossas (Cryptoprocta ferox).

Hematologic and serum biochemical values were determined for 26 (16 males and 10 females) clinically healthy captive fossas (Cryptoprocta ferox) living at Zoo Duisburg, Germany. The animals were net-restrained and anesthetized with ketamine and medetomidine for a general examination. A total of 11 animals were classified as subadult (1-3 yr of age) and 15 as adult (aged between 4 and 13 yr). The results include reference intervals and analysis of sex and age differences. Levels of inorganic phosphorus, alkaline phosphatase, glutamate dehydrogenase, creatine kinase, lactate dehydrogenase, and calcium were significantly higher in the subadult group. The white blood cell count and red blood cell count were significantly lower in the adult group than among the subadult group.

Impact of transcutaneous aortic valve implantation on myocardial deformation.

AIMS: To define the impact of transcutaneous aortic valve implantation (TAVI) using the CoreValve prosthesis on myocardial deformation in a serial echocardiographic study with analysis of strain and strain rate. METHODS: In 36 patients (83 ± 6 years; EuroScore: 26 ± 13%) with severe aortic stenosis scheduled for CoreValve implantation serial echocardiographic studies pre- and postintervention (within 1 month) were performed. Midparasternal short-axis and three apical views were acquired. Using customized computer software which allows automatic frame-by-frame tracking of acoustic markers during the heart cycle circumferential, radial, and longitudinal strain (CS, RS, and LS) and strain rate (CSR, RSR, and LSR) were calculated for each segment in a 16 segment model of the left ventricle. RESULTS: Longitudinal strain, systolic, and early diastolic longitudinal strain rate increased significantly within 1 month after TAVI (LS from -15.8 ± 3.6% to -17.6 ± 3.1%; P < 0.001; LSR(S) from -1.03 ± 0.21 s(-1) to -1.21 ± 0.19 s(-1); P < 0.001 and LSR (E) from -1.15 ± 0.42 s(-1) to 1.51 ± 0.44 s(-1); P < 0.001). Circumferential strain and strain rate values remained unchanged after CoreValve implantation. RS (29.1 ± 17.1 to 34.0 ± 15.8%; ns), RSR (S) (1.56 ± 0.69 to 1.91 ± 0.87 s(-1); ns) and RSR(E) (-1.56 ± 0.78 to -1.81 ± 0.82 s(-1); ns) increased only nonsignificantly after TAVI. Analysis of covariance showed only chronic kidney disease to have a relevant impact on early diastolic LSR (P = 0.01). CONCLUSIONS: Mainly longitudinal mechanics respond to unloading of the left ventricle after TAVI for severe aortic stenosis while radial and circumferential deformation is substantially unchanged. Pacemaker implantation or onset of left bundle brunch block after TAVI do not influence early myocardial deformation parameters.