RESUMO
BACKGROUND: Endovascular treatment of large vessel occlusion in acute ischemic stroke patients is difficult to establish in remote areas, and time dependency of treatment effect increases the urge to develop health care concepts for this population. SUMMARY: Current strategies include direct transportation of patients to a comprehensive stroke center (CSC) ("mothership model") or transportation to the nearest primary stroke center (PSC) and secondary transfer to the CSC ("drip-and-ship model"). Both have disadvantages. We propose the model "flying intervention team." Patients will be transported to the nearest PSC; if telemedically identified as eligible for thrombectomy, an intervention team will be acutely transported via helicopter to the PSC and endovascular treatment will be performed on site. Patients stay at the PSC for further stroke unit care. This model was implemented at a telestroke network in Germany. Fifteen remote hospitals participated in the project, covering 14,000 km2 and a population of 2 million. All have well established telemedically supported stroke units, an angiography suite, and a helicopter pad. Processes were defined individually for each hospital and training sessions were implemented for all stroke teams. An exclusive project helicopter was installed to be available from 8 a.m. to 10 p.m. during 26 weeks per year. Key Messages: The model of the flying intervention team is likely to reduce time delays since processes will be performed in parallel, rather than consecutively, and since it is quicker to move a medical team rather than a patient. This project is currently under evaluation (clinicaltrials NCT04270513).
Assuntos
Resgate Aéreo/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Procedimentos Endovasculares , AVC Isquêmico/terapia , Serviços de Saúde Rural/organização & administração , Telemedicina/organização & administração , Trombectomia , Terapia Trombolítica , Área Programática de Saúde , Procedimentos Endovasculares/efeitos adversos , Humanos , AVC Isquêmico/diagnóstico , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Resultado do TratamentoAssuntos
Doença de Borna/virologia , Vírus da Doença de Borna/genética , Encéfalo/virologia , Encefalite Viral/virologia , Transplantes/virologia , Idoso , Animais , Vírus da Doença de Borna/isolamento & purificação , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Evolução Fatal , Feminino , Humanos , Transplante de Rim , Transplante de Fígado , Imageamento por Ressonância Magnética , Masculino , Filogenia , RNA Viral/isolamento & purificação , Zoonoses/virologiaRESUMO
BACKGROUND: Adult and pediatric patients suffering from MuSK (muscle-specific kinase) -antibody positive myasthenia gravis exhibit similar features to individuals with acetylcholine receptor (AChR) antibodies, but they differ in several characteristics such as a predominant bulbar, respiratory and neck weakness, a generally worse disease severity and a tendency to develop muscle atrophy. Muscle atrophy is a rare phenomenon that is usually restricted to the facial muscles. RESULTS: We describe a girl with MuSK-antibody positive myasthenia gravis who developed a myopathy with severe generalized muscular weakness, muscle atrophy, and myopathic changes on electromyography. CONCLUSION: This is the first published example of a generalized myopathic syndrome in myasthenia gravis. We review the relevant literature and discuss the hypothesis of a mitochondrial myopathy as a pathogenic mechanism in MuSK-antibody positive myasthenia gravis.