An overview of the long-established methods of diagnosing onychomycosis (potassium hydroxide testing, fungal culture, and histopathological examination) is provided followed by an outline of other diagnostic methods currently in use or under development. These methods generally use one of two diagnostic techniques: visual identification of infection (fungal elements or onychomycosis signs) or organism identification (typing of fungal genus/species). Visual diagnosis (dermoscopy, optical coherence tomography, confocal microscopy, UV fluorescence excitation) provides clinical evidence of infection, but may be limited by lack of organism information when treatment decisions are needed. The organism identification methods (lateral flow techniques, polymerase chain reaction, MALDI-TOF mass spectroscopy and Raman spectroscopy) seek to provide faster and more reliable identification than standard fungal culture methods. Additionally, artificial intelligence methods are being applied to assist with visual identification, with good success. Despite being considered the ‘gold standard’ for diagnosis, clinicians are generally well aware that the established methods have many limitations for diagnosis. The new techniques seek to augment established methods, but also have advantages and disadvantages relative to their diagnostic use. It remains to be seen which of the newer methods will become more widely used for diagnosis of onychomycosis. Clinicians need to be aware of the limitations of diagnostic utility calculations as well, and look beyond the numbers to assess which techniques will provide the best options for patient assessment and management.

Background: Recently, low-dose oral minoxidil (LDOM) has entered the landscape of therapies for androgenetic alopecia (AGA). We determined whether using LDOM is associated with improving AGA in a dose-dependent manner; secondarily, we examined whether a dose-dependent association also exists for safety. Methods: Systematic searches were conducted in PubMed and Scopus to identify studies that would be eligible for our quantitative analyses; the logistics of our analyses was determined by the data we gathered. Results: Six studies were eligible for quantitative analyses; we conducted meta-regressions. We found that, for persons with AGA, increasing the dosage of LDOM by 1 mg/day was – after six months – significantly associated with an expected sex-adjusted increase in hair diameter (mean difference = 1.4 μm, p = 0.01), total hair density (mean difference = 47.1 hairs/cm2, p = 0.007), terminal hair density (mean difference = 9.1 hairs/cm2, p = 0.001), risk of hypertrichosis (mean difference = 17.9%, p = 0.006), and cardiovascular adverse events (mean difference = 4.8%, p = 0.004). Conclusions: Our study produced new evidence as our work is the first to show a positive dose-dependent association between the use of LDOM and change in hair diameter, hair density, risk of hypertrichosis, and cardiovascular adverse events for persons with AGA. Future randomized trials could produce causal evidence that would corroborate these dose-dependent associations.

This research examined the interpretation of the pragmatic markers literally and figuratively when they followed familiar and unfamiliar proverbs (e.g., "Birds of a feather will flock together, literally"). Event-related brain potential methodology was used to measure costs associated with interpreting the markers during online comprehension. and an offline task provided additional insight into how sensible the markers were in the proverbial contexts. N400 potentials revealed that literally was less semantically congruent than figuratively with familiar and unfamiliar proverbial contexts, and differences in late positive potentials showed that resolving the interpretation of markers inconsistent with the salient meaning of the proverbs was more difficult following unfamiliar than familiar proverbs. Sensibility ratings showed that literally was less sensible than figuratively following both types of proverbs, and that both markers were more sensible following familiar proverbs. These results have implications for understanding how people interpret the pragmatic intent of these markers when they appear after the figurative statements they modify. and highlight the sensitivity of the markers to context.