Neoplasms of the facial nerve presenting as a parotid mass are uncommon. In the absence of a facial palsy their origin from the nerve is usually diagnosed intraoperatively. The majority of these neurogenic neoplasms are schwannomas, with neurofibromas occurring rarely. Although the Schwann cell is the key element in both, they have distinct histopathological characteristics, and their clinical course and management often differs. The first reported case of an intraparotid facial nerve schwannoma in a child in the English literature is presented.
Ivabradine is a newly approved medication which reduces the heart rate by antagonizing the I f channel. We report a case of intentional overdose on ivabradine. A 26-yearold female presented after taking 250 mg ivabradine. On arrival, her vital signs and neurologic exam were unremarkable. Within 30 min, her heart rate decreased to 31 bpm, but she remained normotensive with no change in mentation. Her bradycardia resolved after treatment with atropine. She experienced two further bradycardic episodes responsive to atropine; the second episode was associated with hypotension, responsive to a fluid bolus. For the remainder of her hospitalization, she remained hemodynamically stable without further interventions. She was dispositioned to the psychiatry service approximately 36 h post-ingestion with a heart rate of 67 bpm. Laboratory analysis confirmed a serum ivabradine concentration of 525 ng/mL, greater than 50 times the mean level in therapeutic trials. Proposed treatments for ivabradine include activated charcoal, atropine, isoproterenol, and intravenous pacing. Further study is needed to identify ideal treatment modalities.
There were a high number of ticks that died in both groups but the data do not support our hypothesis that ivermectin can kill I scapularis. The study was not designed to determine whether it could prevent the transmission of tick-borne illness.
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