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The therapy length is determined by the time required for the normal nail to grow over the tip of the toe (2–12 weeks). Use of flaps for closure of enormous defects will increase main intention price of healing to 89% (Reid 1997) 3. We present two patients with beta-ketothiolase deficiency both presenting with ketoacidosis and acute neurological occasions medications janumet discount esidrix 12.5mg without a prescription.