Injury of the nail bed is commonly encountered in the emergency department. Despite the importance of initial management, difficulties such as long duration of operation and need of skill hinder the practice. Tissue repair with tissue adhesives, like 2-N-butylcyanoacrylate (Histoacryl(TM)), is a common replacement for suture repair. Here we describe a case of nail bed injury, which was repaired with Histoacryl(TM), and the method of repair.
Emergencies ; Nails ; Sutures ; Tissue Adhesives

Purpose: We aimed to identify the factors associated with the repeated febrile seizures (RFS), defined as recurrent seizures during the same febrile illness. Methods: We reviewed the medical records of children with febrile seizure who visited 4 academic emergency departments from October 2016 through September 2018. Differences were identified in variables regarding clinical and laboratory characteristics between the children with and without RFS. The RFS was the primary outcome. Logistic regression was conducted to identify factors associated with the occurrence of RFS. Results: Among 1,551 children, 922 were included in the study, of whom, 198 (21.5%) underwent RFS. Of the children with RFS, 188 (94.9%) underwent the recurrences within the initial 24 hours. Logistic regression showed focal seizure (adjusted odds ratio, 6.67; 95% confidence interval, 2.37-18.82), venous pH < 7.31 (5.89; 3.13-11.08), and postictal drowsiness > 30 minutes (1.90; 1.30-2.78) as the factors for RFS. Conclusion In children with febrile seizure, focal seizure, acidosis, and prolonged postictal state may be independent risk factors for RFS. These findings may be informed to healthcare professionals and parents caring for children with febrile seizure.

Inappropriate shocks from an implantable cardioverter defibrillator (ICD) can cause potentially dangerous ventricular arrhythmias and impaired quality of life. We describe a case in which a dislodged lead caused inappropriate ICD shocks through simultaneous sensing of atrial and ventricular signals. Interestingly, repeated short-long R-R sequences were recorded, but ICD interrogation parameters were usually unchanged.
Arrhythmias, Cardiac ; Defibrillators ; Quality of Life ; Shock

Purpose: We aimed to identify the factors associated with the repeated febrile seizures (RFS), defined as recurrent seizures during the same febrile illness. Methods: We reviewed the medical records of children with febrile seizure who visited 4 academic emergency departments from October 2016 through September 2018. Differences were identified in variables regarding clinical and laboratory characteristics between the children with and without RFS. The RFS was the primary outcome. Logistic regression was conducted to identify factors associated with the occurrence of RFS. Results: Among 1,551 children, 922 were included in the study, of whom, 198 (21.5%) underwent RFS. Of the children with RFS, 188 (94.9%) underwent the recurrences within the initial 24 hours. Logistic regression showed focal seizure (adjusted odds ratio, 6.67; 95% confidence interval, 2.37-18.82), venous pH < 7.31 (5.89; 3.13-11.08), and postictal drowsiness > 30 minutes (1.90; 1.30-2.78) as the factors for RFS. Conclusion In children with febrile seizure, focal seizure, acidosis, and prolonged postictal state may be independent risk factors for RFS. These findings may be informed to healthcare professionals and parents caring for children with febrile seizure.

Tenofovir is the representative treatment for human immunodeficiency virus and hepatitis B virus infection. This study was conducted to assess the pharmacokinetics (PKs) and safety characteristics after a single administration of tenofovir disoproxil phosphate compared to tenofovir disoproxil fumarate in healthy male subjects. An open-label, randomized, single administration, two-treatment, two-sequence crossover study was conducted in 37 healthy volunteers. Serial blood samples were collected up to 72 hours. Non-compartmental analysis was used to calculate the PK parameters. The 90% confidence intervals (90% CIs) of the geometric mean ratio (GMR) were calculated for comparing tenofovir disoproxil phosphate to tenofovir disoproxil fumarate. Safety assessments were performed including clinical laboratory tests, adverse events, etc. during the study. The GMR and 90% CIs were 1.0514 (0.9527–1.1603) for C max and 1.0375 (0.9516–1.1311) for AUC last , respectively, and both fell within the conventional bioequivalence range of 0.8–1.25. Both tenofovir salt forms were tolerable. This study demonstrated that tenofovir disoproxil phosphate (292 mg) was bioequivalent to tenofovir disoproxil fumarate (300 mg).

Background: Unlike the Mycoplasma IST2 kit (bioMérieux), the Mycoplasma IST3 kit has been updated to comply with the standardized antimicrobial susceptibility test (AST) method for Ureaplasma spp. (Up) and Mycoplasma hominis (Mh). We aimed to verify the use of the Mycoplasma IST3 kit for genital mycoplasma cultures. Methods: From September 2023 to January 2024, the R1 medium remaining after inoculation with IST2 was refrigerated until the next day. For IST2-positive samples, 300 μL of residual R1 medium was inoculated into the IST3. Species identification, enumeration, and AST results obtained using IST3 were compared with those obtained using IST2. Results: A total of 48 IST2-positive samples were inoculated into IST3, including 35, 1, and 12 Up-only, Mh-only, and both Up- and Mh-positive samples, respectively. Among Up-only samples, 2.8%, 91.4%, and 100.0% were susceptible to ciprofloxacin, tetracycline, and erythromycin, respectively. With IST3, 45 (93.8%) samples grew genital mycoplasmas; 42 (89.4%) of the 47 Up-positive samples and 6 (46.2%) of the 13 Mh-positive samples showed growth of the same organisms. All seven samples that failed to grow Mh were from mixed cultures, of which four Mh concentrations of < 104 /mL. Up was susceptible to levofloxacin, tetracycline, and erythromycin at the rates of 64.3 %, 88.1 %, and 95.2 %, respectively. Conclusion IST3 showed good performance in detecting genital Mycoplasma except for its tendency to not detect Mh of low concentrations in mixed cultures. IST3 is preferable to IST2 because it can accurately screen for erythromycin resistance in Up and reduce falseresistances for fluoroquinolone.

Simvastatin is used to reduce plasma cholesterol by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase and is primarily used to treat hypercholesterolemia. This study was conducted to assess the bioequivalence between the generic formulation of simvastatin 20 mg and the branded formulation of simvastatin 20 mg. A generic formulation of simvastatin 20 mg tablet was developed and the pharmacokinetics of the generic formulation were compared with those of the branded formulation of simvastatin 20 mg tablet in 33 healthy male volunteers after a single oral dose in a randomized, open-label, two-period, two-sequence, crossover study. The reference (Zocor®, MSD Korea LTD.) and test (Simvarotin®, Korea Arlico Pharm Co., Ltd.) formulations, two 20 mg tablets each, were administered to all subjects in fasting status. The serial blood samples for pharmacokinetic analysis were collected before dosing and up to 24 hours post-dose, and plasma concentrations of simvastatin were determined by liquid chromatography-tandem mass spectrometry. The pharmacokinetic parameters including T(max), C(max), AUC(last), AUC(inf) and t½ were calculated for both formulations by non-compartmental method, and the log-transformed C(max) and AUC(last) were compared statistically. Geometric mean ratios (90% confidence intervals) of the test to the reference formulation in C(max) and AUC(last) were 0.9652 (0.8302–1.1223) and 0.9891 (0.8541–1.1455), respectively. No significant differences in tolerability profiles were noted between the two formulations. The two formulations of simvastatin 20 mg tablets exhibited comparable pharmacokinetic profiles and 90% confidence intervals were within the acceptable range of bioequivalence criteria.
Cholesterol ; Coenzyme A ; Cross-Over Studies ; Fasting ; Humans ; Hypercholesterolemia ; Korea ; Male* ; Mass Spectrometry ; Methods ; Oxidoreductases ; Pharmacokinetics ; Plasma ; Simvastatin* ; Tablets ; Therapeutic Equivalency ; Volunteers*

Alpha-lipoic acid, a physiological form of thioctic acid, is a strong antioxidant that relieves diabetic neuropathic symptoms. R(+)-α-lipoic acid shows superior antioxidative effects to its racemate. We compared the pharmacokinetics (PKs) and tolerability of R(+)- and S(-)-α-lipoic acid after a single oral dose of R(+)-α-lipoic acid, Dexid®, and its racemate, thioctic acid in healthy male subjects. We used an open-label, randomized, single-dose, three-treatment, parallel study design to compare the PK exposure of the active form, R(+)-α-lipoic acid. Thirty subjects completed the study with no clinically relevant safety issues. The peak concentrations (C(max), mean±SD) of R(+)-α-lipoic acid after doses of R(+)-α-lipoic acid 200 mg, 300 mg and thioctic acid 600 mg were 4186.8±1956.7, 6985.6±3775.8 and 6498.4±3575.6 µg/L, respectively, and the areas under the plasma concentration-time curve from 0 to the last measurable concentration (AUC(last)) were 1893.6±759.4, 3575.2±1149.2 and 3790.0±1623.0 µg·h⁻¹·L⁻¹, respectively. The geometric mean ratio and 90% confidence intervals of R(+)-α-lipoic acid 200 mg to thioctic acid 600 mg for the C(max) and AUC(last) were 0.71 (0.43–1.15) and 0.51 (0.37–0.70), respectively. The corresponding R(+)-α-lipoic acid 300 mg to thioctic acid 600 mg values were 1.11 (0.68-1.80) and 0.97 (0.71-1.34), respectively. In conclusion, R(+)-α-lipoic acid 300 mg showed PK characteristics similar to those of thioctic acid 600 mg and both formulations were well tolerated.
Humans ; Male* ; Pharmacokinetics ; Plasma ; Thioctic Acid*

OBJECTIVE: This paper reports the possibility of using of a locking horizontal mattress suture technique in repairing lacerations that are difficult to suture with staples. METHODS: Data were collected retrospectively over a 6-month period regarding the routine repair of scalp lacerations: those in areas injured by a high energy blunt mechanism, continued to bleed after pressure, nonlinear or damaged skin repaired with a locking horizontal mattress technique, and simple interrupted technique. The effects of the two techniques used to repair scalp lacerations on wound healing, complication rate, and patient satisfaction were examined. The categorical variables are expressed as the number and percent. A Mann-Whitney-Wilcoxon test was used for statistical analysis. A P-value less than 0.05 was considered significant. RESULTS: Thirty-seven consecutive patients with scalp lacerations presented for care. Wound closure was accomplished with the locking horizontal mattress sutures in 40.5% (n=15) (median length, 5.0 cm; interquartile range [IQR], 4.0–7.0 cm). Simple interrupted sutures (median length, 4 cm; IQR, 3.0–5.0 cm) were used in 59.5% (n=22) (P=0.015). The frequency of additional bandage compression (P=0.008), frequency of exudative hemorrhage (P=0.018), and suture mark frequency at suture removal (P=0.047) were significantly lower in the locking horizontal mattress group. CONCLUSION: The locking horizontal mattress suture, which has the advantage of a horizontal mattress suture, may be one of the ways that can be used alternatively to treat scalp lacerations that difficult to suture with staples.
Bandages ; Hemorrhage ; Humans ; Lacerations* ; Methods* ; Patient Satisfaction ; Retrospective Studies ; Scalp* ; Skin ; Suture Techniques ; Sutures* ; Wound Healing ; Wounds and Injuries

Objective: Emergency cricothyroidotomy is an infrequently performed procedure and post-procedural complications may result from attempting to pass a device with a large external diameter through the cricothyroid membrane. This study aimed to determine the maximum height of the cricothyroid membrane according to the patient’ s sex and age based on cervical-spine computed tomography (C-spine CT) in the emergency department (ED) and determine the appropriate endotracheal tube (ETT) size. Methods: A retrospective analysis of patients was conducted from May 2014 to April 2020 in the ED. The data were obtained from medical records. Electronic calipers were used to measure the maximum height of the cricothyroid membrane in C-spine CT by an emergency physician and an emergency medicine resident. Results: Six hundred and sixty-four patients were included in the study. The mean height of the cricothyroid membrane was 10.11±2.24 mm in males (n=351) and 8.90±1.84 mm in females (n=313) (P<0.001). In males, the cricothyroid membrane height showed significant variance between the ≥75-year-old and the 25-34-year-old groups (9.26±2.40 mm vs. 11.80±2.36 mm) (P<0.001). The tube size of the cricothyroidotomy equipment was suitable for more than 72.1% of patients when applied with an ETT (internal diameter ≤6.0 mm). Conclusion This study showed that the height of the cricothyroid membrane differed according to sex and also age in males. It may thus be necessary to consider anatomical differences according to sex and age when selecting the appropriate tube size to reduce complications during emergency cricothyroidotomy.